Diabetes is a condition where not enough insulin is made. This means that blood sugar levels can go up and down, with various effects on the body.
Risks if you have diabetes, or have it but not been diagnosed.
- You are twice as likely to have a heart attack or stroke than someone without diabetes.
- High levels of glucose damage the eyes, kidneys and nerves.
- Women with breast cancer and diabetes are more likely to have problems with tiredness, sleep disturbance and sexual problems compared to those who don't.
There are two types of diabetes.
Type 1 is an auto-immune disease. Your immune system attacks your pancreas, and stops it producing insulin. It has nothing to do with weight or lifestyle, and you will need insulin administered from day 1.
A small minority of people have rarer forms of diabetes, including maturity onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA).
It can't be cured, but meticulous monitoring and insulin treatment can greatly reduce the risk of complications.
Type 1 - Monogenetic diabetes. People with this condition produce some insulin, but less than healthy people. They often present with similar problems as those with type 1 diabetes, such as constant thirst and subsequent need to urinate, blurred vision and weight loss, which is why the two conditions are often confused. But since they produce some small amounts of insulin, it could be possible to control their condition with 'dietary tweaks' or daily tablets that stimulate the body to produce more insulin. (Type 1 patients can't take these tablets as they are unable to produce insulin.)
Until now doctors have struggled to diagnose this condition, but now increased training and testing is finding more patients. If patients constantly struggle with varying blood sugar levels, it might be due to monogenic diabetes rather than simple type 1.
Monogenic diabetes is caused by a genetic fault that leads to the pancreas producing less insulin. There are numerous sub-types of this condition, linked to problems with different genes and it tends to run in families. The usual HbA1c blood test only shows that someone has the diabetes, not which type. If a parent is diagnosed with type 1 diabetes, it may be worth testing parent and child(ren) for monogenic diabetes.
Type 2 is almost all about lifestyle. It is mostly about your body's ability to process insulin.
Risk of developing diabetes. Obesity is the biggest risk factor, accounting for 80 to 85% of the risk of developing diabetes. Those of South Asian or Afro-Caribbean origin also have an increased risk. Some women develop diabetes during pregnancy; while their blood glucose usually settles after delivery, they remain at higher risk of developing diabetes type 2 in later life.
Until a few years ago it was considered a chronic, progressive disease. Then a 2016 study demonstrated that after eight weeks on a very low calorie diet (VLCD) people lost substantial amounts of weight, and if this was maintained for at least six months, more than two in five had glucose levels in the normal range. It is thought that the weight loss removed excess fat from the pancreas, allowing if to produce insulin more efficiently, thus controlling blood glucose effectively. This needs to be overseen in a medical setting, but while Type 2 diabetes cannot be cured, it now seems possible to stay in remission. NHS England has agreed to start providing access to VLCDs on the NHS.
The basis for the low carb diet is the increased understanding that starchy carbs (e.g. bread, potatoes or breakfast cereals) digest down to a surprisingly large amount of sugar.
Not everyone can achieve remission with diet but there are signs that another treatment can help. The surgical procedure Revita (endoscopic duodenal mucosal resurfacing) has been shown to be beneficial but is not currently available on the NHS.
Sources: Feature Diabetes: the other health crisis by Dr Sarah Jarvis, in Good Housekeeping, July 2020 and article in Daily Mail by Ethan Ennals on 6th Nov. 2021.
