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Diabetes

A close up of a hand injecting a dose of insulin into a stomach

Please note that all content on this website (including, but not limited to, copy, images, commentary, advice, tips, hints, guides, observations) is provided as an informational resource only. It is not a substitute for correct and accurate diagnosis, or recommendation, or treatment by a medical professional. Please ensure that you obtain proper guidance from your GP, or another medical professional. The information provided on this website does not create any patient-medical expert relationship and must not be used in any way as a substitute for such.

 

Diabetes Mellitus commonly referred to as just – diabetes – is a life-long condition that affects more than 400 million people in the world.

It is estimated that more than 4.7 million people are living with diabetes in the UK (1 in 10 people over the age of 40). Diabetes type 2 is much more prevalent than type 1, accounting for 90% of all reported cases.

Diabetes is known to increase the chances of premature death by 50%.

Almost 50% of people with type 2 diabetes may be living with the condition undiagnosed, and the most common fatal complication arising from diabetes is heart disease.

No cure exists for diabetes, but the condition can be managed with lifestyle modifications, medication, and support.

What is Diabetes Mellitus?

Diabetes mellitus is a chronic metabolic disorder characterised by hyperglycemia (high glucose content in the bloodstream). If left undiagnosed and untreated, diabetes can have serious, and fatal, health consequences.

The word ‘diabetes’ is derived from a Greek word meaning ‘to pass through (in copious amounts)’. ‘Mellitus’ is derived from a Latin word that means ‘sweetened with honey’. This is because patients with diabetes not only have high blood sugar levels, but they also urinate more frequently and pass that sugar in their urine (glucosuria).

The term ‘Diabetes Mellitus’ first appeared in English medicine in the late 1600s, as a result of the way the condition was generally diagnosed. Physicians would taste the urine of patients and make a judgment based on how sweet it was.

In the simplest terms, the biology behind diabetes can be explained in the following way… when we eat, the enzymes in our digestive system work to break down the food into its constituent nutrients, such as carbohydrates, proteins, vitamins and minerals. These nutrients are then absorbed into the bloodstream and transported to various organs in the body for further processing and utilization.

Most carbohydrates like fructose and sucrose, are broken down to glucose in the liver and released back into the bloodstream. So, a little while after eating, the amount of glucose in our blood increases.

The body has two ways of utilizing this glucose – either convert it into energy, or store it for later use.

Glucose and oxygen react in the muscle cells to produce energy, which we then utilize in our normal day-to-day activities. The excess glucose is converted to glycogen in the liver for storage purposes.

It is important to regulate the amount of glucose in the blood because too little glucose (hypoglycemia) is just as detrimental to health as is too much glucose (hyperlycemia). Both can damage vital organs and cause neurological problems, vision loss and kidney failure.

This regulation is accomplished by two pancreatic enzymes known as insulin and glucagon that have opposite effects, but a common goal – to maintain a healthy level of glucose in the blood (glucose homeostasis).

Insulin is a hormone produced by beta cells in the pancreas in response to increasing levels of blood glucose, after a meal, for instance. Insulin is responsible for driving glucose molecules into the cells. It helps the muscle cells to absorb glucose and convert it into energy. If there is still glucose left over, insulin helps liver cells absorb the excess glucose for conversion into glycogen for storage.

Glucagon is a hormone produced by alpha cells in the pancreas in response to decreasing blood glucose levels. This can happen if a person hasn’t eaten in a while, and the body has to rely on stored reserves for energy. Glucagon triggers the conversion of stored glycogen in the liver into glucose and the release of that glucose into the bloodstream. Once in the blood, insulin can then promote the utilization of the released glucose for energy production.

Thus, while insulin works to reduce the level of glucose in the blood, glucagon has the opposite effect – to increase the blood glucose level. It is these two hormones that perform the important function of glucose homeostasis i.e. ensuring that the blood glucose level does not rise too high after one meal, or drop too low before the next.

This glucose homeostasis is what gets disturbed in patients with diabetes.

People with diabetes are either unable to produce enough insulin (type 1, gestational) or the insulin they do produce is ineffective (type 2). This leads to a build-up of glucose in the blood, which damages the blood vessels leading to a lot of other detrimental health outcomes.

an image of flowers with the text "types" on it

Photo by Brand and Palms from Pexels

Diabetes type 1 and type 2 account for 98% of all diabetes cases in the UK. The remaining 2% of diabetes patients have other rarer forms of the condition.

Diabetes Type 1

Around 8% of diabetes patients in the UK have diabetes type 1.

Diabetes type 1 is an autoimmune disorder which means that the body’s own malfunctioning immune system attacks and impairs the necessary insulin-producing beta cells in the pancreas. Consequently, the body cannot produce the insulin it needs to adequately manage the blood glucose levels.

Diabetes type 1 was historically referred to as ‘juvenile diabetes’ since it was commonly diagnosed in young children. However, the condition can develop at any age. Patients need to learn to manage their insulin levels artificially, and they have to be very vigilant in this regard. This is why diabetes type 1 is also called ‘insulin-dependent’ diabetes.

There are no known causes of diabetes type 1 except for genetic factors. A person is more likely to develop diabetes type 1 if there is a family history of the disease. Unlike diabetes type 2, diabetes type 1 is not linked with any lifestyle choices.

Diabetes Type 2

Diabetes type 2, also known as ‘non-insulin-dependent’ diabetes, develops as a result of insulin resistance in the body’s cells. In a nutshell, the pancreas produces insulin. However, the muscle cells in the body do not respond to the insulin in the desired way. They display a certain resistance to the insulin in that they do not take up the increasing glucose molecules circulating in the blood, even though the insulin is there. This leads to hyperglycemia. The pancreas responds by going into over-drive and producing even more insulin and eventually getting damaged.

Insulin resistance is often known as prediabetes, and it develops as a result of several inter-playing lifestyle and genetic factors. Obesity (too much belly fat), smoking, a sedentary lifestyle, little or no exercise, and even not getting enough sleep, combined with a genetic predisposition, all come together to trigger insulin resistance and prediabetes. However, unlike diabetes type 1, insulin resistance may be reversed by adopting a healthy diet, losing weight, and exercising. This has been known to delay and even prevent the onset of diabetes type 2.

Gestational Diabetes

Gestational diabetes is diabetes that develops during pregnancy, but usually disappears shortly after childbirth.

Pregnancy puts extra strain on the body, and the pancreas is sometimes unable to produce the amount of insulin needed by the changing body. Thus, low insulin levels lead to hyperglycemia and diabetes.

Around 16 in 100 pregnant women develop this form of diabetes in the UK. Still, the condition is easily diagnosed by conducting blood tests at 24 to 32 weeks of pregnancy.

Gestational diabetes is generally not a life-threatening condition. However, if left unchecked, it can lead to type 2 diabetes in the mother and even cause stillbirth. There is also evidence that links gestational diabetes in the mother with an increased risk of developing diabetes type 2 later in the life of the child. It is, therefore, imperative to keep a close eye on the symptoms of diabetes during pregnancy and get the support needed at the right time.

Diabetes Insipidus

Diabetes Insipidus (DI) is unrelated to diabetes mellitus, but has similar symptoms i.e. extreme thirst and frequent and lots of urination.

DI has nothing to do with insulin, but is reliant on a different hormone known as anti-diuretic hormone (ADH).

ADH is produced in a part of the brain called the hypothalamus and is stored in the pituitary gland. ADH helps the body retain water during normal kidney function. The kidneys respond to ADH by producing concentrated urine, effectively conserving water in the body. If the hypothalamus, or the pituitary glands, stop functioning correctly, as a result of injury, for instance, they do not produce ADH, which in turn makes the kidneys excrete much more water. This causes dehydration and extreme thirst.

Risk Factors and Preventive Measures

There are some risk factors of diabetes that cannot be helped; these are family history, age and ethnicity. If you have one, or more family members, with diabetes, you have a higher susceptibility towards developing diabetes at some point in your life.

Diabetes type 2 can develop at any age. However, most cases are diagnosed between 40 to 65 years.

In the UK, ethnic minorities, especially people of South Asian descent, are far more likely to be diagnosed with diabetes type 2.

The risk factors that can be somewhat controlled are obesity and a sedentary lifestyle. Basically, the more fatty tissue a person has, the more likely they are to develop insulin resistance, or prediabetes, and that can quickly escalate to diabetes type 2. So, if a person has a genetic predisposition towards the condition, the best way to prevent it is to maintain a healthy weight by eating and drinking healthy foods that are low in carbohydrates and fats, and by exercising regularly. Doctors routinely suggest overweight patients in a prediabetes state lose weight as a means to delay, and even prevent, the onset of diabetes type 2.

Screening and Diagnosis

Diabetes is both screened for and diagnosed by checking the blood sugar levels.

A healthy individual has a fasting blood glucose level of 4.0 to 5.4 mmol/L (72 to 99 mg/dL). This number may increase to 7.8 mmol/L (140 mg/dL) 2 hours after eating. If a person is suspected to be diabetic, or pre-diabetic, they are offered a fasting blood glucose test. They are asked to fast overnight, and then their blood glucose level is tested by taking a small amount of blood, often a prick on the finger. If the levels come out to be in the range of 5.6 to 6.9 mmol/L (100 to 125 mg/dL), the person is considered to be pre-diabetic; if the levels are even one unit higher than that, i.e. 7 mmol/L (126 mg/dL) or higher, the person is classed as diabetic.

Another test that is conducted to assess diabetes is the oral glucose tolerance test. This test checks how well the body tolerates, or responds to, an increase in glucose by comparing the blood glucose levels at fasting to those taken one and/or two hours after drinking a concentrated sugary drink. The normal range for the results of these tests is less than 11.1 mmol/L (200 mg/dL) after one hour and less than 7.8 mmol/L (140 mg/dL) after two hours.

Urine tests for diabetics are conducted to assess the severity of hyperglycemia. In severe cases of hyperglycemia, too much fat is metabolized to release much-needed energy. The metabolic by-product of this fat metabolism is an acid called ketone. These ketones are then excreted with the urine and can be measured.

What are the Symptoms of Diabetes Mellitus?

There are several symptoms associated with diabetes. Some of them are more common than others. These include:

  • Being very thirsty most of the time. The kidneys of diabetes patients have to work over-time to get rid of the excess glucose circulating in the bloodstream. More water is siphoned from the body to keep up with the overworked kidneys. This results in dehydration and the feeling of always being thirsty.
  • Being hungry even though you are eating. When the body is unable to get energy from the food being consumed, the brain does not receive the signal of satiation (being full). Thus, a person with diabetes may be eating, but still feel hungry.
  • Frequent urination, particularly at night. As stated above, with hyperglycemia, the kidneys have to work extra hard to remove the build-up of glucose in the body. This causes patients to urinate more frequently, often keeping them up at night.
  • Unexplained tiredness. The inability of the body to process glucose means that patients are always low on energy. This means that patients always feel tired, even though there may be no increased activity to account for the fatigue. Another reason for the fatigue could be attributed to the frequent urination and accompanying insomnia.
  • Sudden weight loss, or muscle loss. When the body cannot get energy from glucose, it has to fall back on its fat reserves, and even muscle mass, to burn and produce the much-needed energy. This causes the weight of the patient to suddenly drop, often accompanied by loss of muscle mass.
  • Itching around the genitals. Uncontrolled glucosuria can cause a build-up of sugar around the vagina, or penis, allowing yeast infections like thrush to build up. Fungal infections cause soreness and itchiness and are notoriously tough to get rid of.
  • Impaired, or blurry vision. High blood sugar damages blood vessels all over the body. It also damages blood vessels in the eyes and the retina. The retina is responsible for sending signals to the brain. When damaged, it causes vision impairment and ultimately, partial blindness.
  • Cuts and wounds take longer to heal. Healing cuts and wounds require special blood cells called platelets to reach the site of the injury and clot the sliced blood vessels and stop the bleeding. Diabetics have poor blood circulation as a result of a build-up of sugar in the vessels. This means that enough platelets do not reach the site of injury in time to stop the bleeding and clot the wound.
  • Tingling in hands and feet. The high blood glucose damages not only blood vessels, but also nerves. Peripheral neuropathy causes numbness, loss of sensation, or tingling in the extremities, such as hands, feet, arms and legs.

Aside from the primary symptoms of diabetes, many secondary symptoms may arise and need addressing. The most common of these are:

High Blood Pressure and Heart Disease

As a result of hyperglycemia, the damaged blood vessels become hardened and less flexible. So the heart has to work extra hard to pump blood through them. This causes high blood pressure and constant strain on the heart leading to heart disease.

A good way of keeping track of your blood pressure is by using a Upper Arm Classic Blood Pressure Monitor regularly.

Swelling in Ankles and Feet

With reduced circulation and damaged blood vessels, the blood sometimes leaks fluids into the tissues of the extremities. This fluid retention in tissues causes swelling, often referred to as oedema.

Oedema can be checked by pressing the flesh on the ankles for two seconds and then releasing. If the flesh does not spring back instantly and leaves a ‘pit’ for more than a few seconds (this is called ‘pitting’), then this is indicative of oedema.

Ability Superstore stocks a range of oedema socks. These socks feature elastic-free seams and are specifically designed for problematic and sensitive feet, allowing for a comfortable non-binding of the foot and calf. 

A grey armchair next to a small table inside a light grey room. The words – Living with the Condition – can be seen

Photo by JZhuk on iStock

Living with diabetes is a steep learning curve. It requires management of not only the condition itself, but also of the primary and secondary symptoms arising from the condition.

Patients need to be aware of what kind of complications may arise and what those complications are indicative of. This is important because, if left unchecked, the smallest of inconveniences, like tingling feet, could lead to a major surgical intervention, like an amputation.

Treatment and Management

All people with diabetes type 1, and less than half of the people with diabetes type 2, require daily insulin injections.

The regular dose of insulin could be 0.5 to 1.0 units per kg. However, no medicine can reverse, or cure diabetes. The most effective way of controlling its symptoms and adverse effects is maintaining a healthy lifestyle, weight loss, and regular physical activity.

Apart from insulin and lifestyle modifications, patients are required to self-monitor their blood sugar and blood pressure daily.

Hypoglycemia can be fatal if not caught instantly. This is why diabetes patients need to monitor their blood sugar, particularly at nighttime, when they would otherwise not notice a drop in blood sugar.

Monitoring blood glucose can be accomplished by home testing kits, or by modern wearable technology like the Freestyle Libre.

In addition to these, the primary and secondary symptoms of diabetes also require regular supervision and management.

Diabetics have to pay particular attention to their feet and ankles. Doctors recommend inspecting them every day for signs of swelling, or numbness. Poor circulation in the feet cannot only cause fluid retention, but several other foot problems including ulcers, fungal infections, ingrown toenails and bunions.

If these problems go unnoticed for too long, infection, combined with reduced circulation, can cause parts of the tissue to die and ultimately require amputation. A picture of four light bulbs with the filaments replaced by words – help, support, advice and guidance

Photo by EtiAmmos on iStock

There are several organizations operating in the UK that diabetic patients can turn to for support.

The National Health Service

The NHS has a dedicated helpline (0345 123 2399) for people who use insulin. It also has several apps specifically designed to help people manage different aspects of their diabetes. Other information and resources about diabetes can be accessed via the NHS website.

Diabetes UK

Diabetes.org.uk's vision is “a world where diabetes can do no harm”, and to that end, they provide a host of excellent resources and support in addition to funding research into diabetes.

Diabetes.co.uk

Diabetes.co.uk is an extensive online community for diabetics where you can join dedicated forums, get specially designed recipes, manage finances, and get guidance on a range of pertinent aspects of living with diabetes.