Diabetes

Introduction

Diabetes mellitus is a chronic disease caused by too much glucose in your blood. Your blood-sugar level can be too high if your body does not make enough of the hormone insulin. Insulin is produced by the pancreas (a gland behind the stomach) and moves glucose out of the blood and into cells, where it is broken down to produce energy.

If diabetes is not treated it can cause long-term health problems because the high glucose levels in the blood damage the blood vessels.

There are two types of diabetes.

Type I or insulin-dependent diabetes

In type I diabetes the body produces little or no insulin. Someone with this type of diabetes needs treatment for the rest of their life. They must check the levels of glucose in their blood regularly and watch out for complications. Type I diabetes is also known as juvenile diabetes or early onset diabetes because it usually develops before the age of 40, often in the teenage years.

Type II or non-insulin dependent diabetes

In type II diabetes the body does not make enough insulin or cannot use insulin properly. This type of diabetes is usually linked with obesity. It used to be referred to as maturity onset diabetes because it occurs mostly in people over the age of 40.

Some pregnant women have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This is known as gestational diabetes or diabetes in pregnancy. It affects less than 1 in 20 pregnant women. Gestational diabetes usually disappears after the baby is born. However, women who develop gestational diabetes are more likely to develop type II diabetes later in life.

Diabetes affects 1.3 million people in the UK and there may be as many as a million more people who have the disease but do not know it yet. Nine out of ten people with diabetes have type II diabetes and over 80% of these people are overweight.

Symptoms

Without treatment, the main symptoms are:

• feeling very thirsty,
• producing excessive amounts of urine (going to the toilet a lot),
• tiredness, and
• weight loss and muscle wasting (loss of muscle bulk).

Other symptoms can include:

• itchiness around the vagina or penis, or getting thrush regularly, due to the excess sugar in your urine encouraging infections,
• blurred vision, caused by the lens of your eye becoming very dry
• and damage to your kidneys, due to excessive urination, potentially leading to kidney failure over time.

Symptoms of type I diabetes can develop quickly, over days or weeks.
 
If your blood glucose levels become too high you can suffer a hyperglycaemic attack. This can happen if you haven’t taken your insulin. The symptoms of a hyperglycaemic attack can include dehydration, drowsiness and a frequent need to urinate. If left untreated, hyperglycaemia can lead to diabetic ketoacidosis, which can eventually cause unconsciousness and even death. Diabetic ketoacidosis occurs when your body begins to break down fats for energy instead of glucose, leading to a build up of ketone acids in your blood.

If your glucose levels become too low you can suffer a hypoglycaemic attack. This can happen if you have taken too much insulin. Symptoms of a ‘hypo’ include feeling shaky and irritable and can be brought under control by eating or drinking something containing fast acting carbohydrates, such as a fizzy drink, sugar cubes or raisins.

Symptoms of type II diabetes usually develop over weeks or months. Some people with type II diabetes have few symptoms or even no symptoms at all. However, they still need to have treatment so that other health problems do not develop later on.

Causes

Diabetes is usually caused by your pancreas (a gland behind the stomach) not producing the hormone insulin, or not producing enough. It can also be caused by your body being unable to use insulin properly. Rarely, diabetes can be caused by a disease of the pancreas called pancreatitis.

Type I diabetes

If you have type I diabetes your body is unable to produce insulin, or is not able to produce enough. This is because your immune system attacks the cells in your pancreas, destroying them or damaging them enough to reduce insulin production. In some cases, a virus infection can trigger type I diabetes.

You are more at risk of developing type I diabetes if it runs in your family.

Type II diabetes

If you have type II diabetes your body does not produce enough insulin, or the cells in your body do not react properly to the insulin. Type II diabetes is closely linked to obesity. If you are overweight then losing weight, eating a healthy diet and taking regular exercise will greatly reduce your risk of developing diabetes.

You are more at risk of developing type II diabetes if:

• you have high blood pressure or high cholesterol,
• type II diabetes runs in your family,
• you are of Asian, Afro-Caribbean or Middle-Eastern background, or
• you are a woman who has given birth to a large baby (over 9 lbs/4 kg).

The risk of developing type II diabetes also rises as you get older

Diagnosis

In order to diagnose diabetes, your GP will ask for a urine sample. They will test this to see if it contains glucose. Sometimes you will also need to have a blood test to make sure that the diagnosis is right.

If your glucose levels are not high enough for your doctor to diagnose diabetes, you may need to have an oral glucose tolerance test. Your doctor will give you a glucose drink and take blood tests every half an hour for two hours to see how your body is dealing with the glucose

Treatment

Although diabetes cannot be cured, you can control the symptoms and help to prevent health problems later on in life.

It is important to diagnose diabetes as early as possible so that you can start treatment. If you experience symptoms you should see your GP as soon you can.

Type I diabetes

If you have type I diabetes you will need to take regular insulin injections for the rest of your life to keep your glucose levels normal. Insulin injections can be taken using a syringe or an injection pen. Most people need either 2 or 4 injections a day and your GP or diabetes nurse will teach you and/or a friend or relative how to inject the insulin properly.

An alternative to injecting insulin is insulin pump therapy. An insulin pump is a small device - about the same size as a pack of cards – that holds the insulin. The pump is attached to you via a long piece of thin tubing with a needle at the end, inserted under your skin. Most people insert the needle into their stomach, but the hips, thighs, buttocks or arms can also be used. The pump allows insulin to flow into your bloodstream at a rate that you can control. This means that you no longer need to give yourself injections.

A new device for delivering insulin without using a needle is now available on the NHS. Known as the insulin jet system, it can be used on the stomach, buttocks and thighs. It works by forcing a very small stream of insulin through a nozzle placed against the skin. The insulin travels at such high speed it goes through the skin.

You will need to keep an eye on your glucose levels. This can be done at home using a simple blood test or a urine test. Your GP will talk to you about your ideal glucose level as it varies between people, and varies throughout the day. The normal level is between 4 and 7 mmol/l before meals, and less than 10 mmol/l two hours after meals. Mmol/l means millimols per litre; it is a way of measuring the different parts of the blood.

You should also make sure you have a healthy diet and take regular exercise because this will help to reduce the level of glucose in your blood.

Type II diabetes

You can usually control type II diabetes by making changes to your diet (see Prevention) and losing weight if you are overweight. Some people with type II diabetes need to take tablets or insulin injections as well as making changes to their diet.

If you have diabetes, you need to keep a regular check on your glucose levels. This can be done with a blood test or a urine test.

Regular check-ups

You will need to see your GP for regular check-ups to see how well you are managing the symptoms of your diabetes. You will have regular blood tests and blood pressure tests. Your GP will also need to check your eyes, feet and nerves regularly as these can be affected by diabetes (see Complications). Your GP may also refer you to a dietician who will be able to give you advice on maintaining a healthy lifestyle.

Complications

If diabetes is not treated it can lead to many different health problems. This is because large amounts of glucose can damage the blood vessels, nerves and organs.

It is important to keep a check on your blood pressure to prevent problems such as heart disease, stroke, angina and poor circulation. You should monitor your blood pressure regularly and try to make sure it stays at the right level by maintaining a healthy lifestyle. This means eating a healthy diet, stopping smoking and avoiding stress.

Blood flow problems can lead to nerve damage in the hands and feet. About 1 in 10 people with diabetes get foot ulcers, which can cause serious infection. As well as keeping your diabetes under control with the treatment your GP has advised, you should also take good care of your feet. Keep your nails short and your feet clean. Wear shoes that fit properly and see a podiatrist or chiropodist regularly so that any problems are found early.

Blood flow problems can also cause blindness, cataracts and retinopathy (damage to the back of the eyes). Your GP should examine your eyes regularly.

Over time, excessive urination and damage to blood vessels can damage the kidneys.

Diabetes can lead to impotence in some men, which may be treated with medication.

Pregnant women with diabetes are at increased risk of miscarriage and stillbirth. If their blood-sugar level is not carefully controlled in the early stages of pregnancy there is also an increased risk of the baby developing a serious birth defect. Pregnant women with diabetes will usually have their antenatal check-ups in hospital or in a diabetic clinic, where doctors can keep a close watch on their blood-sugar levels and control their insulin dosage more easily.

Prevention

You may be at risk of developing type II diabetes if it runs in your family or if you are overweight and don’t get a lot of exercise. The best thing you can do to try and prevent diabetes is to eat a healthy diet and take regular exercise.

A healthy diet is one that is low in saturated fat, salt and sugary snacks and drinks. Try to eat regular meals throughout the day to keep your blood-sugar level constant and eat at least five portions of fruit and vegetables every day. Stop smoking and reduce your alcohol intake. If you have diabetes, you can still eat foods such as chocolate and sweets as long as you keep your overall diet healthy.

Ideally you should take thirty minutes of exercise at least three times a week. However, regular exercise does not have to be a chore; you can make sure you keep active by walking instead of taking the bus and using the stairs instead of the lift.

Healthcentral 2005

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