What is Diabetes?
Diabetes is a condition defined by an elevated blood glucose level, due to an absolute or relative lack of insulin produced by the pancreas gland. Insulin is a circulating protein in the blood that reduces the blood glucose, among its many actions, and the pancreas can either stop producing insulin completely or not produce quite enough to work, or when the body is resistant to the actions of insulin usually due to obesity.
Diabetes is a common condition and affects about 4% of the population in Norfolk, where there are 42,000 people with known or as yet undiagnosed diabetes.
There are several types of diabetes:
Type 1 diabetes
This type of diabetes develops because the pancreas produces little or no insulin. It is commonly seen in people under the age of 40 years and mot commonly in children, adolescents and young adults. It always requires insulin and about 10% of the diabetes population have Type 1 diabetes.
Type 2 diabetes (previously known as non-insulin dependent diabetes)
Type 2 diabetes is the commonest form of diabetes, and usually occurs in middle age or later. The average age at diagnosis is about 65 years old and whilst most people can be well managed with diet or tablets, many people do need insulin treatment after 5-10 years of diabetes as the tablets become less effective. Starting insulin still means you have Type 2 diabetes (rather than Type 1 diabetes) but just require insulin.
Gestational Diabetes Mellitus (GDM)
This means developing diabetes for the first time during pregnancy, and this often disappears after the baby is born although women who have had this are at increased risk of getting Type 2 diabetes and should have an annual glucose check through their GP practice.
Gestational diabetes usually occurs after the 24th week of pregnancy.
Maturity Onset Diabetes of Young (MODY)
These rare inherited forms of diabetes mellitus in which there is a problem with the secretion of insulin but the insulin action itself is normal or is only slightly faulty. It is caused by a number of genetic disorders that runs in some families and often presents as Type 2 diabetes in people under 25 years of age and often with a strong family history of early onset dibaetes.
Symptoms of Diabetes
The main symptoms of untreated diabetes are:
- increased thirst
- passing water frequently especially at night
- extreme tiredness
- weight loss
- genital itching or frequent episodes of thrush
- blurred vision
These symptoms may come on very gradually and may pass unnoticed for months or even years. Many people have no symptoms at all and are diagnosed during a routine health check, when blood or urine is tested for glucose. Type 2 diabetes typically develops slowly. It is thought that as many as one million people in the UK may have undiagnosed type 2 diabetes. In contrast, type 1 diabetes develops rapidly with weight loss and marked symptoms of thirst.
Diabetes Diagnosis – In most people, the diagnosis is made and confirmed by a GP measuring a glucose level (usually a fasting blood test) or an average glucose levels test (HbA1c) which measures glucose levels over about 10 weeks. The diagnosis should not be made on a single test, but usually on two separate measurements. Sometimes (particularly with Type 1 diabetes) the initial presentation is with very high blood glucose levels indeed and further testing is usually unnecessary.
Aims of Diabetes Management – Type 2 diabetes is very common, and only a very small minority of people with this condition diagnosed in their 60s and 70s will develop the complications of loss of vision, kidney damage, or amputations that many people have read about. However, these complications can occur, and circulatory problems are also much commoner. Getting good blood pressure control, taking a cholesterol tablet (statin), and getting good blood glucose control are all equally important in reducing this risk. The same applies to people with Type 1 diabetes. It can be difficult to achieve these targets without weight gain or increased risk of low blood sugars ('hypos'). The next section summarises some ways you can reduce your risk of diabetes complications and avoiding hypos.