When I was a girl, type 2 diabetes was often called the 'mild kind of diabetes'- it's not. It may not cause dramatic symptoms at first - being a bit thirsty, tiredness - but taking it seriously and staying on top of your condition could add years to your life.
Have you ever wondered what all the fuss about diabetes is about? It certainly seems to be everywhere. Try these figures for size and maybe you'll understand why doctors are so worried - the number of people with diabetes has almost quadrupled in 35 years; every three minutes in the UK someone is diagnosed with it; another 9.8 million people are at risk of getting it.
Type 1 diabetes , unlike type 2, has nothing to do with lifestyle. It's an autoimmune condition - your body's immune system attacks your pancreas, which produces insulin. It tends to start in childhood or early adulthood, and symptoms are usually dramatic - extreme thirst and tiredness, rapid weight loss, then collapse if it's not recognised. It needs insulin treatment for life.
There's lots of work done on possible transplants of the pancreas (or the 'islet cells' in the pancreas that produce insulin) but still a long way to go. Insulin pumps which deliver regular doses of insulin through a tiny tube under your skin may improve blood sugar control. However, you still need to check your blood sugar levels very regularly.
About 90% of people with diabetes in the UK have type 2 diabetes - and that's where most of the drug advances have come in recent years. Largely related to lifestyle (and particularly weight), your risk of type 2 diabetes rises with age and family history. Family history also plays a part, as does ethnicity - people of South Asian origin are at much higher risk. Everyone diagnosed with diabetes should be offered a full education programme to help understand and manage their condition
At least once a year you should have a full check of your eyes, feet and kidneys as well as blood pressure, sugar and cholesterol
Treatments for type 2 diabetes
In the early stages, changing your diet and losing weight may be enough to keep your blood sugar under control. But in time, most people will need tablets to keep blood sugar down. Unlike type 1 diabetes, where insulin injections are essential from day 1, many people with type 2 diabetes never reach the stage of needing injection medication. However, keeping your blood sugar controlled is vital for type 2 as well as type 1 diabetes - even though you may feel fine with high blood sugar, it can damage your eyes, your kidneys and your nerves
Metformin has been around for 50 years, but it's still the 'go-to' drug for type 2 diabetes. It can cause side effects (including diarrhoea and feeling sick) in the short term, but this often wears off. If you need medicines on top of this, there are now lots of options.
Until this year, UK national guidelines recommended that for most people, the next option was a group of medicines called SUs (most commonly gliclazide). However, these medicines make you prone to weight gain and potentially serious episodes of low blood sugar called 'hypos'. They may also increase your risk of heart attack and heart failure. Now there are three main groups of medicines as an alternative:
- Gliptins like sitagliptin don't cause weight gain or significant 'hypos'. Most people have few or no side effects and they're just as effective as SUs like gliclazide at lowering blood sugar
- Pioglitazone doesn't cause hypos but can cause weight gain and heart failure
- The SGLT2 inhibitors (they all have names ending in '-flozin') work by stopping your kidneys reabsorbing sugar. You can't take them if you have kidney problems or if you're dehydrated. However, they don't cause hypos and some people lose up to ½ a stone on them. Studies using one SGLT2 inhibitor, Empagliflozin, have shown very impressive reductions in heart complications and progression of kidney disease related to diabetes.
- Injectable treatments called GLP1 agonists are a later option. They don't cause the same hypos and can contribute to weight loss, but involve at least weekly injections and side effect rate (especially feeling sick) is high. Some GLP1 agonist studies have also shown improvements in some heart outcomes.
Controlling blood pressure and cholesterol are also very important - your medical team will advise and offer tablets as needed. But ultimately, good diabetes control is down to you. Regular exercise, low alcohol intake and a healthy diet are the cornerstones of preventing complications in diabetes.
Can you cure diabetes?
Lots of newspaper column inches have been given over to low-calorie diets 'reversing' type 2 diabetes. It's true that early studies have shown striking results, with blood sugar levels back to normal without tablets. But the diet involved ready is very low calorie - 600 calories a day compared to 2,000 for the average woman - and should always be supervised by a specialist. It's also jolly hard to stick to!
Type 1 diabetes hope?
Hot off the press is news of a new trial for people recently diagnosed with type 1 diabetes, which may offer hope for stalling development of the disease. It involves six injections of tiny fragments of proteins which are found in the pancreas cells that produce insulin. The idea is that it will jump-start their immune systems into jump to the defence of the pancreas and protect it. The trial is in its early days but is very exciting.
With thanks to 'My Weekly' magazine where this article was originally published.
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