Diabetes

Diabetes is a long-term health condition that affects millions of people worldwide. It's a condition where your body either doesn't produce enough insulin or can't effectively use the insulin it does produce. Insulin is a hormone that helps glucose (sugar) from food get into your cells to be used for energy. When this system doesn't work properly, sugar builds up in your bloodstream, leading to various health problems. Understanding diabetes is the first step towards effectively managing it and living a healthy life. This guide aims to provide a clear and comprehensive overview of diabetes, from its basic understanding to practical tips for daily living.

At its core, diabetes is a metabolic disorder characterised by high blood sugar levels. Our bodies need glucose for energy. We get glucose from the food we eat, particularly carbohydrates. Insulin, produced by the pancreas, acts like a key, unlocking our cells to allow glucose to enter and be used for energy. In people with diabetes, this key either isn't produced in sufficient quantities, or the cells become resistant to it, meaning the key doesn't work effectively. This results in glucose accumulating in the blood, rather than being used by the body's cells. Over time, high blood sugar can damage various organs and systems in the body, including the heart, kidneys, eyes, and nerves.

Diabetes is a significant global health concern, with its prevalence continuing to rise. Globally, the International Diabetes Federation (IDF) reports that 589 million adults aged 20-79 years were living with diabetes in 2024, with this number projected to rise to 853 million by 2050. A concerning statistic is that almost one in two adults with diabetes are unaware they have the condition.

There are several types of diabetes, each with distinct causes and characteristics:

• Type 1 Diabetes: This is an autoimmune condition where the body's immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. This means the body produces little to no insulin. Type 1 diabetes usually develops in children and young adults, though it can occur at any age. People with type 1 diabetes require daily insulin injections or an insulin pump to survive. It cannot be prevented.
• Type 2 Diabetes: This is the most common form of diabetes, accounting for about 90% of all cases. In type 2 diabetes, the body either doesn't produce enough insulin, or the cells don't respond to insulin effectively (insulin resistance). This type often develops gradually over many years and is strongly linked to lifestyle factors like obesity and lack of physical activity, as well as genetics. It typically affects adults, but is increasingly seen in children and adolescents.
• Gestational Diabetes: This type of diabetes develops during pregnancy in women who haven't been diagnosed with diabetes before. It occurs when the body can't produce enough insulin to meet the increased demands of pregnancy. Gestational diabetes usually resolves after childbirth, but it increases the mother's and child's risk of developing type 2 diabetes later in life.
• Other Specific Types of Diabetes: These are less common and can be caused by various factors, including genetic defects, diseases of the pancreas (like pancreatitis or cystic fibrosis), certain medications, or other endocrine disorders. Examples include Monogenic Diabetes (MODY) and Latent Autoimmune Diabetes in Adults (LADA).

The causes of diabetes vary depending on the type:

• Type 1 Diabetes: The exact cause is not fully understood, but it's believed to be a combination of genetic predisposition and environmental triggers, such as viral infections, that prompt the immune system to attack the pancreas.
• Type 2 Diabetes: This type is primarily caused by a combination of genetic and lifestyle factors.
  • Insulin resistance: Cells in the muscles, fat, and liver become less responsive to insulin.
  • Insufficient insulin production: The pancreas can't produce enough insulin to overcome the resistance.
  • Genetics: A family history of type 2 diabetes increases the risk.
  • Obesity and overweight: Excess body fat, particularly around the abdomen, is a major risk factor.
  • Physical inactivity: Lack of regular exercise contributes to insulin resistance.
  • Unhealthy diet: Diets high in refined carbohydrates and sugary drinks can increase the risk.
• Gestational Diabetes: Hormonal changes during pregnancy can make the body's cells more resistant to insulin. If the pancreas cannot produce enough additional insulin to compensate, gestational diabetes develops.
• Other Types: Genetic mutations, pancreatic diseases, certain medications (e.g., steroids), and other endocrine disorders can impair insulin production or function, leading to other specific types of diabetes.

Recognising the symptoms of diabetes is crucial for early diagnosis and treatment. Common symptoms across types include:

• Frequent urination: The body tries to get rid of excess sugar through urine, leading to increased trips to the toilet, especially at night.
• Increased thirst: Due to fluid loss from frequent urination, individuals feel constantly thirsty.
• Unexplained weight loss: Despite eating more, the body cannot utilise glucose for energy, leading to fat and muscle breakdown.
• Extreme hunger: Cells are deprived of energy, leading to persistent feelings of hunger.
• Blurred vision: High blood sugar can affect the lenses of the eyes, causing temporary vision problems.
• Slow-healing sores or frequent infections: High blood sugar can impair the body's ability to heal and fight off infections.
• Fatigue: Lack of energy due to insufficient glucose uptake by cells.
• Tingling or numbness in hands or feet: This can be a sign of nerve damage, a potential complication of prolonged high blood sugar.

Diagnosing diabetes involves a simple blood test to measure blood glucose levels. Common diagnostic tests include:

• Fasting Plasma Glucose (FPG) test: Measures blood sugar after an overnight fast (at least 8 hours). A level of 7.0 mmol/L (126 mg/dL) or higher on two separate occasions typically indicates diabetes.
• Oral Glucose Tolerance Test (OGTT): Measures blood sugar before and 2 hours after drinking a sugary drink. A 2-hour blood sugar level of 11.1 mmol/L (200 mg/dL) or higher indicates diabetes. This test is often used for diagnosing gestational diabetes.
• HbA1c test (Glycated Haemoglobin test): Measures your average blood sugar levels over the past 2 to 3 months. An HbA1c level of 48 mmol/mol (6.5%) or higher indicates diabetes. This test doesn't require fasting and is a convenient diagnostic tool.
• Random Plasma Glucose test: Measures blood sugar at any time. A level of 11.1 mmol/L (200 mg/dL) or higher, along with diabetes symptoms, suggests diabetes.

While there is no cure for diabetes, it can be effectively managed to prevent or delay complications. Treatment plans are individualised and depend on the type of diabetes, its severity, and the individual's overall health.

Type 1 Diabetes: This requires lifelong insulin therapy, either through multiple daily injections or an insulin pump. Careful monitoring of blood sugar levels is essential, along with a balanced diet and regular physical activity.

Type 2 Diabetes: Management typically begins with lifestyle changes, including:

• Healthy eating: Focusing on whole foods, controlling portion sizes, and limiting sugary and processed foods.
• Regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise per week.
• Weight management: Losing even a small amount of weight can significantly improve blood sugar control.
• Medications: If lifestyle changes aren't enough, oral medications containing metformin (Brands: Glycomet, Okamet, Metfor), sulphonylureas, etc., are often prescribed to help the body produce more insulin, improve insulin sensitivity, or reduce glucose absorption. Some individuals with type 2 diabetes may eventually require insulin injections.

Gestational Diabetes: Management often involves dietary changes and regular exercise. If blood sugar levels remain high, insulin injections may be necessary.

All types of diabetes require regular monitoring of blood glucose levels, often multiple times a day, to adjust medication and lifestyle interventions as needed. Regular check-ups with healthcare professionals, including an endocrinologist, dietitian, and eye specialist, are crucial for comprehensive diabetes care.

Although alternative therapies should never take the place of standard medical treatment for diabetes, some people choose to explore them as additional ways to support their health and possibly help with blood sugar management. It's very important to talk to your doctor before starting any alternative therapy, as certain treatments may interact with your medications or cause unwanted side effects. Commonly used alternative therapies include:

• Herbal supplements: Certain herbs, such as fenugreek, bitter melon, and cinnamon, have been studied for their potential blood sugar-lowering effects. However, scientific evidence supporting their widespread use is often limited and more research is needed.
• Chromium supplements: Chromium is a trace mineral that plays a role in carbohydrate and fat metabolism. Some studies suggest it might improve insulin sensitivity, but results are mixed.
• Dietary approaches: Beyond standard healthy eating guidelines, some individuals explore specific diets like low-carbohydrate or ketogenic diets. These require careful planning and monitoring under medical supervision to ensure nutritional adequacy and safety.

• Family history of diabetes.
• Overweight or obesity.
• Physical inactivity.
• Unhealthy diet.
• Age (risk increases with age).
• High blood pressure.
• High cholesterol levels.
• History of gestational diabetes.
• Certain ethnic backgrounds (e.g., South Asian, Black African, Caribbean).
• Polycystic ovary syndrome (PCOS).
• Prediabetes (impaired glucose tolerance or impaired fasting glucose).

• Heart disease and stroke (cardiovascular disease).
• Kidney disease (nephropathy), potentially leading to kidney failure.
• Nerve damage (neuropathy), causing numbness, tingling, or pain.
• Eye damage (retinopathy), potentially leading to blindness.
• Foot problems, including ulcers and infections, potentially leading to amputation.
• Dental problems and gum disease.
• Sexual dysfunction.
• Increased susceptibility to infections.
• Depression and anxiety.

Living with diabetes requires ongoing self-management, but with the right strategies, you can lead a full and healthy life.

• Monitor blood sugar regularly: This is essential for understanding how food, activity, and medication affect your glucose levels.
• Follow a diabetes-friendly eating plan: Work with a dietitian to create a meal plan that helps manage your blood sugar and provides essential nutrients.
• Stay active: Regular physical activity helps improve insulin sensitivity and manage weight.
• Take medications as prescribed: Adhere strictly to your doctor's instructions for insulin or oral medications.
• Manage stress: Stress can impact blood sugar. Find healthy ways to cope, such as meditation or hobbies.

Myth: Diabetes is caused by eating too much sugar. 

While consuming excessive sugar can contribute to weight gain, a risk factor for type 2 diabetes, it's not the sole cause. Diabetes is a complex condition influenced by genetics, lifestyle, and other factors.

Myth: People with diabetes can't eat any sugar or carbohydrates. 

This is incorrect. People with diabetes can enjoy a balanced diet that includes carbohydrates and some sweet treats in moderation, as part of a well-managed meal plan. The key is portion control and choosing nutrient-dense options.

Myth: Diabetes is not a serious condition. 

Diabetes is a serious chronic condition that, if poorly managed, can lead to severe and life-threatening complications affecting various organs.

It's important to seek medical attention if you experience any of the common symptoms of diabetes, such as increased thirst, frequent urination, unexplained weight loss, or fatigue. If you have risk factors for type 2 diabetes, such as a family history or being overweight, discuss regular screening with your doctor. Early detection and management are crucial for preventing serious complications. If you are already diagnosed with diabetes and experience persistent high or low blood sugar, frequent infections, or any new or worsening symptoms, consult your healthcare team immediately.

• What are my specific target blood sugar levels (HbA1c, fasting, and post-meal)?
• What lifestyle changes can I make to improve my blood sugar control?
• What are the potential side effects of my diabetes medication, and what should I do if I experience them?
• How often should I monitor my blood glucose, and how should I interpret the readings?
• What are the signs and symptoms of hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar), and how should I treat them?
• Are there any specific exercises or physical activities I should avoid or be particularly careful with?
• What preventative screenings or specialist referrals (e.g., eye doctor, foot specialist) do I need and how often?

Diabetes is a prevalent and complex health condition, but with proper knowledge and a proactive approach, individuals can effectively manage their condition and lead fulfilling lives. Understanding the different types, causes, symptoms, and treatment options is essential for anyone affected by diabetes. By embracing healthy lifestyle choices, adhering to medical advice, and seeking continuous support, people with diabetes can minimise the risk of complications and maintain their overall well-being. Remember, managing diabetes is a journey, and with consistent effort and the right support system, it is a journey that can be navigated successfully.