Diabetes

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Diabetes (diabetes mellitus) is a long-term condition caused by an excess of glucose in the bloodstream.

Over 2 million people in the UK are thought to have diabetes, and 1 million are thought to have it without realising¹. Currently, the number of people suffering from diabetes is rising in tandem with obesity levels, suggesting a strong connection between the two.

Untreated diabetes can lead to serious health problems such as heart disease, stoke, kidney failure, amputation and blindness. 

How diabetes develops

Diabetes occurs either when the production of the glucose-regulating hormone insulin has slowed down or stopped, or when the insulin produced has become less effective.

Insulin works by stimulating cells to absorb just enough glucose (from the blood) for the energy that they require. A lack of insulin results in an overload of glucose, which can cause long-term damage to organs, nerves and blood vessels.

Glucose can either come from sweet food, digested carbohydrates and starch, or naturally from the liver.

There are 2 types of diabetes- type 1 diabetes and type 2 diabetes. Type 1 diabetes is when the pancreas ceases to produce insulin altogether. Type 2 diabetes is when not enough insulin is produced by the pancreas, or when cells do not react naturally to the insulin that is produced.

What is type 1 diabetes?

Type 1, or ‘insulin-dependent’ diabetes is less common than type 2. Only 10% of all diabetics have type 1².

Type 1 diabetes is when the pancreas produces no insulin at all. It tends to emerge in childhood or early adulthood (before the age of 40) and must be regulated by regularly injecting insulin.

Symptoms of type 1 diabetes

Symptoms of type 1 diabetes can develop quickly and suddenly over weeks or sometimes days. The most common symptoms of type 1 diabetes include:

• extreme thirst
• excessive urinating
• feeling of tiredness
• weight loss
• loss of muscle bulk.

Less common symptoms include:

• cramps
• constipation
• skin infection
• itchiness around the genitals, or regular reoccurrence of infections such as thrush
• blurred vision- this happens when the lens of the eye becomes dry.

What causes type 1 diabetes?

Although the exact cause of type 1 diabetes is currently unknown, it is widely believed to be an ‘autoimmune condition’.

An autoimmune condition is a condition that occurs when the body’s immune system mistakenly attacks a naturally occurring and necessary substance in the body.

With type 1 diabetes, the immune system attacks cells in the pancreas. This destroys or damages them enough to stop the production of insulin. A number of experts attribute this occurrence to a viral infection.

Genetics are also thought to play a part in the cause of type 1 diabetes; it has often been seen to run in families.

People who have a close relative (parent or sibling) with type 1 diabetes have a 6% chance of developing type 1 diabetes too³.

In some instances, type 1 diabetes can be caused by a condition of the pancreas known as ‘chronic pancreatitis’. Chronis pancreatitis causes an inflammation of the pancreas and can cause serious damage to the cells that produce insulin.

How is type 1 diabetes diagnosed?

The sooner type 1 diabetes is diagnosed, the sooner it can be treated. If type 1 diabetes is left untreated for long periods of time, it can cause long term damage to organs. 

If you do experience the symptoms related to type 1 diabetes, it is advisable to book an appointment with your GP.

At your appointment, it is likely that your GP will ask for details regarding your symptoms in order to obtain a clearer picture of your condition. Other tests may include:

• Urine sample- your urine will be screened for traces of glucose. Usually it shouldn’t contain any, however in the case of diabetes, glucose can overflow through the kidneys and into the urine.

• Blood test- if the urine does contain glucose, you will be asked to have a blood test to measure glucose levels. A sample of blood will be taken in the morning before you have eaten.

• Oral glucose tolerance test (OGTT)- if your blood glucose levels are not high enough for the GP to diagnose diabetes, you may need to have  an OGTT. You will be given a glucose mix to drink and then your blood will be taken every half hour for 2 hours in order to monitor how your body deals with the glucose.

Treating type 1 diabetes

Type 1 diabetes cannot be completely cured, however there are ways to regulate blood glucose levels and treat symptoms.

If you have been diagnosed with type 1 diabetes then you will be referred to a specialist care team who will then monitor your condition closely in order to identify any resulting health problems.

The Department of Health (DH) has outlined national standards for the care and treatment of diabetics in England in the ‘Diabetes National Service Framework’. The standards state that good diabetes care must involve:

• access to information and support
• a care plan helping diabetics to lead a healthy lifestyle
• information on controlling blood glucose, monitoring blood pressure and minimising risk factors and complications
• access to services that can identify and treat complications
• effective hospital care if necessary.

Living with type 1 diabetes

Diet and nutrition

 A GP will usually recommend that a person with diabetes maintains a healthy, balanced diet that incorporates all of the important nutrients necessary for the functioning of the human body.

Some important tips you may want to remember are:

• Cut down on saturated (animal) fats- fat can build up in arteries, causing blockages which can result in high cholesterol, heart disease, stroke and heart attack. Replace saturated fats with unsaturated fats such as olive or rapeseed oil. 

• Eat oily fish- experts recommend you eat two portions of oily fish a week.

• Eat 5 servings of starchy, carbohydrate foods every day- pasta, bread, potatoes, noodles, cereals and rice (serving equal to 1 cup of pasta)

• Choose low GI carbs and wholegrain foods.

• Eat 2 servings of protein every day- e.g. lean meat, fish, eggs or pulses (serving equal to ¼ of a chicken breast).

• Eat at least 5 portions of fruit and vegetables a day

• Eat 3 servings of low-fat dairy foods every day

Diabetics should follow the same alcohol guidelines as non-diabetics. It is always recommended that you drink in moderation (or not at all), and to only drink a maximum of 2-3 units per day for women (equivalent to 1 small glass of wine), and 3-4 units per day for men (equivalent to 1 pint of beer). 

Regular exercise 

Whereas glucose levels rise after eating, they fall during physical activity. This means that it is very important for diabetics to exercise regularly. Experts recommends that diabetics, like everyone else, should aim to do at least 2 ½ hours of moderate aerobic exercise a week. It is advisable to always consult your GP before starting a new activity because it does affect insulin levels. Your care team may have to adjust your insulin treatment or diet plan in conjunction with your physical habits.

Don’t smoke

With diabetes comes an increased risk of cardiovascular disease (stoke, heart attack etc.). Smoking increases this risk further so giving up is advisable.  A GP, Life Coach, Hypnotherapist or Counsellor could help you to give up smoking.

Type 2 diabetes 

Type 2 diabetes is more common than type 1. 90% of people who have diabetes have type 2⁴.

Type 2 diabetes occurs either when the pancreas can’t produce enough insulin, or when the body’s cells can’t react properly to insulin. People with type 2 diabetes do not need to take insulin injections.  

People of African-Caribbean or South Asian descent are more likely to develop type 2 diabetes. It tends to develop at an early age, usually from about the age of 25. 

Symptoms of type 2 diabetes 

There are no obvious symptoms of type 2 diabetes. Type 2 diabetes is usually discovered during a routine check up with the GP.

Possible symptoms can include:

• excessive urinating
• unexplained weight loss
• extreme tiredness
• constant thirst
• blurred vision
• itchy skin around the genitals, or regular reoccurrence of infections like thrush
• noticeably slow healing of wounds and cuts.

If you notice any of these symptoms and you think you may have type 2 diabetes, it is advisable to see your GP for further tests.

What causes type 2 diabetes?

There are a number of risk factors that increase the likelihood of diabetes. These include:

• Being overweight or obese- especially when there is an excess of fat around the abdomen (this is often described as an ‘apple’ body shape)

• If you are of African-Caribbean or South Asian descent.

• If you have a personal history of serious mental health problems.

• If you are an overweight woman with polycystic ovary syndrome.

• If a close member of your family (parent or sibling) has diabetes.

• If you have high blood pressure or have had a stroke or heart attack.

• If you rarely exercise.

• If you have conditions known as ‘impaired glucose tolerance’ or ‘impaired fasting glycaemia’, then the blood glucose levels will be naturally higher than normal.

How is type 2 diabetes diagnosed?

If for any reason you believe you might have type 2 diabetes, it is advisable to book an appointment with a GP. Your GP will initially ask questions about your medical history and current symptoms in order to get a clearer idea of your possible diagnosis. You may be asked to provide the following samples:

1. Urine- a urine sample will be taken to test for signs of glucose.
   
   
2. Blood- you may be required to offer 2 blood samples for 2 separate tests. The first of these is known as a ‘fasting blood glucose test’. You will be asked to refrain from eating anything before this test (taken in the morning so the fasting can take place overnight) in order to assess your natural glucose levels. The second test is called a ‘glucose tolerance test’. This will be taken if the first test offers borderline results and will require you to drink a glucose mix in order to test how your glucose levels change over time.

Treating type 2 diabetes

There is currently no cure for type 2 diabetes, however glucose levels can be controlled either with lifestyle changes or by taking prescribed medication.

Diet and nutrition

Like type 1 diabetes, doctors simply recommend a healthy, balanced diet with meals eaten at regular times throughout the day. Drink alcohol in moderation and stick to the recommended daily guidelines.

Regular exercise 

Experts recommend a minimum of 2 ½ hours of moderate aerobic exercise per week to stave off excess fat, reduce cholesterol and the risk of high blood pressure and cardiovascular disease. Glucose levels drop during physical activity so it is important for diabetics to exercise regularly.

Don’t smoke

Diabetics already have an increased risk of developing cardiovascular disease or circulatory problems. Smoking will only heighten these risks further.

Medication

Your GP will assess your need for medical treatment during your appointment. There are certain types of oral drugs available on prescription, and some sufferers may require injections to boost the production of insulin.

How can a nutritionist help with type 1 and type 2 diabetes?

Finding the right balance of necessary nutrients is thought to important for regulating diabetes. Nutritionists aim to apply their expert knowledge to a diet plan tailored to your individual needs. This can help alleviate some of the pressure and confusion that comes with conflicting nutritional advice and opinions. Diabetes cannot be completely cured, but it may be more easily regulated and controlled with the right diet. With a nutritionist’s help, you may be able to significantly improve the quality of your life with diabetes. 

References

¹BBC, diet and diabetes

²Bupa, type 1 diabetes

³NHS, type 1 diabetes

⁴Bupa, type 2 diabetes

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