The diabetes explosion

Symptoms
Type 1 diabetes develops acutely and the symptoms tend to be more severe. They include tiredness, weight loss, excessive thirst and hunger, passing large amounts of urine, poor sleep (from getting up to pass urine at night) and blurred vision. In some people the onset is more serious and severe (diabetic ketoacidosis) and they require hospital admission to stabilise the body fluids. Symptoms suggesting this include vomiting, abdominal pain, drowsiness, headache, confusion, deep breathing and the scent of acetone (like pear drops or nail polish remover) on the breath.

Type 2 diabetes has a more insidious onset with similar symptoms as above except that Type 2 diabetics do not develop ketoacidosis. Recurrent infections such as vaginal thrush, boils or cystitis may indicate raised blood sugar levels, since the immune system is impaired under these conditions.

Complications
The complications of diabetes are similar in Types 1 and 2. The longer you have had diabetes the more likely you are to develop complications. They are related to the effect that a persistently high blood glucose level has on the delicate membrane lining of the arteries. Microscopic damage to this membrane (called the vascular endothelium) causes cholesterol and other substances to be deposited, narrowing the calibre of the artery. This reduces the amount of oxygen supplied to the tissues and can causes long term damage to the eyes, kidneys, nerves, and the blood vessels supplying the heart and brain. The blood supply to the feet can also be affected, causing reduced blood flow.

All these changes lead to the vastly increased risk that diabetics have of developing problems with their eyesight, angina and heart attacks, strokes, kidney failure, foot ulcers, gangrene and leg amputations.

All diabetics have an increased risk of high blood pressure and high blood lipids (cholesterol and triglycerides) so these need treating vigorously as well as blood sugar control being optimal.