| The diabetes explosion
Millions of people are at risk from diabetes and we need to examine our lifestyles and those of our children to prevent it becoming an epidemic, says Dr Lesley Hickin. In the UK, 1.4 million people suffer from diabetes and at least another million are estimated to have it without knowing. The cost of treating diabetes and related conditions is soaring and is set to use up a fifth of the entire NHS budget by the year 2010. The reasons for the increase include an ageing population (Type 2 diabetes is more common among older people), growing obesity among all age groups and lack of exercise. There are also worrying signs that overweight children who don't exercise are risking diabetes in later life. Three out of five adults in the UK are considered overweight or obese, and one in four children. What is diabetes? Insulin, a hormone produced by a gland called the pancreas, situated behind the stomach, helps glucose enter cells. Levels are increased in response to a rise in the blood glucose level, and levels of insulin go down when blood glucose levels fall, for example during exercise. In this way the blood glucose level is kept within a narrow range. Insulin also enables carbohydrate stored in muscles and the liver to be converted to glucose when necessary. In diabetes the amount of glucose in the body rises too high because of insufficient insulin or resistance to the action of insulin in the tissues. The cells have to find an alternative source of energy, particularly stored fat, leading to a build-up of toxic waste products in the body. Glucose accumulates in the blood and spills out into the urine, drawing extra water with it. All these processes can lead to the symptoms of diabetes detailed below. Many people think of diabetes simply as a disorder of glucose and insulin, but it would be more realistic to think of it as a complicated metabolic disorder of glucose and blood lipids (fats in the blood including cholesterol), high blood pressure and disease of blood vessels. The two types Type 1 diabetes develops when there is a severe lack of insulin in the body because most or all of the cells in the pancreas that produce insulin are destroyed. This type of diabetes often appears suddenly in childhood, though it can occur up to the late 30s. The cells in the pancreas are destroyed by the body's immune system for an as yet unknown reason. About 350,000 people in the UK have this type of diabetes. Symptoms 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 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. How can complications be prevented? Maintaining a healthy diet and exercising regularly are essential, as are taking care of feet and having regular eye check-ups. Diabetics should all have access to a dietician, chiropodist and retinal screening facility staffed by people with special training and experience in dealing with diabetes. Diabetics more than most people should not smoke because of the increased risk of developing vascular disease. Type 1 diabetics need to monitor their own blood glucose levels to adjust the amount of insulin they require and ensure the blood levels are correct. More and more people with Type 2 diabetes are also self-monitoring to ensure that their treatment is working well. Find out more Diabetes UK |