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HOW TO PREVENT OR DELAY THE ONSET OF DIABETES

13 Aug
The number of Britons diagnosed with diabetes hit three million this year for the first time – equivalent to almost one in 20 of the population.
The majority have Type 2 which is strongly linked to being overweight or obese, leading a sedentary lifestyle and an unhealthy diet.
What is diabetes?
Diabetes is an incurable condition in which the body cannot control blood sugar levels, because of problems with the hormone insulin. There are two main types of diabetes. In Type 1 diabetes the cells of the pancreas stop making insulin. In Type 2 diabetes, either the pancreas cells do not make enough insulin, or the body’s cells do not react properly to it. This is known as insulin resistance.
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How does the body control blood sugar levels?
Your body uses blood sugar (glucose) for energy. Glucose is a basic ingredient of sweet foods such as sweets and cakes. It can also be produced by carbohydrates such as potatoes, pasta or bread when they are digested and broken down.
Under normal circumstances, the hormone insulin, which is made by your pancreas, carefully regulates how much glucose is in the blood. Insulin stimulates cells all over your body to absorb enough glucose from the blood to provide the energy, or fuel, that they need.
After a meal, the amount of glucose in your blood rises, which triggers the release of insulin. When blood glucose levels fall, during exercise for example, insulin levels fall too.

Types of diabetes and how they cause health problems.

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Type 1 diabetes is an autoimmune condition, and the immune system attacks the cells of the pancreas. It tends to affect people before the age of 40, and often follows a trigger such as a viral infection.
I have diagnosed several younger diabetics that have presented with abdominal pain and vomiting or with thrush or abscesses  or during pregnancy. On closer questioning they admit to loss of weight( 10lbs/4.5kg unintentional weight loss) excessive thirst and frequency of urination with fatigue.
If people living with Type 1 diabetes don’t receive treatment they can develop very high blood sugar levels – hyperglycaemia – within days. As I remember being taught as a medical student in the days, when we were drilled like army cadets, the consultant Dr Byron-Evans proclaimed in a loud, authoritative, deep Welsh  voice ,” Now, good boys ( female medical students were an unusual presence-and not really recognised in those days!) this is the most important of medical emergencies be aware of it as it is slow to happen, undramatic  but potentially fatal”. How could I forget, I  tremble as I write this!
This occurs because  there is no insulin to drive the sugar from the blood into the cells, the kidneys try to remove the excess glucose. This leads to frequent urination, dehydration and intense thirst.At the same time, the body starts breaking down fat for fuel to counter the low levels of sugar available to the cells. This leads to toxic levels of acids building up in the blood – a life-threatening condition known as ketoacidosis.
 As we screen so readily now, and attempt to improve patient education diabetics presenting with hyperglycaemic ketoacidosis is less common but it still happens.
 About 16 years ago I remember seeing an  18 year old boy who came to the surgery  with his sister in an embarrassed state as he had thrush  and after testing his urine I diagnosed diabetes. He looked at me petrified and said “Am I going to die?” to which I replied ,” I hope not for a long time” . He was started on insulin and the diabetes was brought under control. He moved away from Ealing but recently I bumped into his sister in a local supermarket  and asked how he was. Indeed, he was well,  living a normal life and had never been admitted to hospital.
Those with Type 1 can also suffer a dangerous complication of treatment known as hypoglycaemia, which can cause a coma. This occurs when blood sugar levels fall dangerously low as a result of taking too much insulin, or sometimes by skipping a meal. The brain requires a constant supply of glucose from the blood otherwise it can’t function properly.

If treatment doesn’t effectively control high blood sugar levels, it leaves a person with diabetes more vulnerable to infections. Over time it can also damage the small blood vessels and nerves throughout the body, including the smaller vessels at the back of the eye, which can result in blindness, and the kidneys, leading to kidney failure.

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In Type 2 diabetes, either the pancreas cells do not make enough insulin,  and it has been shown that when someone is diagnosed with Type 2 diabetes up to 50% of their pancreas is damaged  ie the beta cells are not functioning or the body’s cells do not react properly to it and this is known as insulin resistance.
The exact mechanisms that lead to Type 2 diabetes are not fully understood, but an underlying genetic susceptibility is usually present. This could be a family history of the illness, for example. The condition is then triggered by lifestyle factors – such as obesity – and it usually appears in people over the age of 40.
Type 2 diabetes tends to develop more gradually, which is one of the reasons why medical professionals think that so many cases go undiagnosed.
Most Type 2 diabetics are overweight but there  are some elderly patients who present in the same way as Type 1 diabetics by losing weight, excessive thirst and urination.
In the long-term, diabetes raises the risk of many conditions, including peripheral vascular disease (when the arteries to the extremities are damaged by atherosclerosis) and peripheral nerve damage. Together they can result in ulcers, infections, gangrene and amputations. It can also increase the risk of impotence, heart attacks and strokes. Over time it can also damage the small blood vessels and nerves throughout the body, including the smaller vessels at the back of the eye, which can result in blindness, and the kidneys, leading to kidney failure. On a dialysis unit the majority of patients are diabetics.
Cataracts are also common in diabetic patients.
Gestational Diabetes – During pregnancy, some women experience heightened blood sugar levels and can’t produce enough insulin to absorb it all. In most cases it develops between the 14th and 26th week of pregnancy, known as the second trimester, and disappears after the baby is born.
The mother and baby has to be closely monitored  during and immediately after delivery. She may need to take insulin during the pregnancy. A specialist diabetologist usually oversees this alongside the obstetrician . The outcome has improved considerably as I recall in the past  mothers delivered very large babies and in some cases they did not survive.
Neonatal diabetes – This is very rare. It is caused by a change in a gene that affects insulin production.
Maturity onset diabetes of the young (MODY) – Caused by a mutation in a single gene and is also very rare but now mor frequently being diagnosed. There is a specific blood test to make this diagnosis.
For further support and information:-

http://www.diabetes.org.uk/

I trust after reading this you are better informed as to what a serious condition diabetes is and why I feel important to draw attention  to the recent survey which showed the importance of how you travel to work  and how this can potentially reduce your risk of developing diabetes.
Experts at Imperial College London and University College London examined how health is affected by the way people travel to work, using a survey of 20,000 Britons
They found cycling, walking, and using public transport were all associated with a lower risk of being overweight than driving or taking a taxi.
Those who walked to work were far less likely to have Type 1 or Type 2 diabetes than drivers, and had a 17 per cent lower risk of high blood pressure.

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Cyclists were around half as likely to have diabetes as those who drove.
High blood pressure, diabetes, and being overweight are all major risk factors for heart and circulatory disease, the UK’s biggest killer.
In addition, riding to work or to the shops is one of the most time-efficient ways to incorporate regular exercise into everyday routine. You can get your daily exercise done without having to spend extra time or money at the gym. The simple act of riding your bike can burn between 750 – 1000 calories an hour, which helps both your health and fitness.
Several years ago a study was carried out by Diabetes UK whereby one group of people were strongly encouraged to exercise and another group were given no advise. The trial was to last 4 years and it was aimed at establishing  the importance of exercise in Diabetes prevention . After 2 years the trial was abandoned as it was found that it was shown  so strongly that exercise did prevent diabetes it was considered unethical not encourage everyone to exercise.
Recently when I was trying to help some 4th year students,who have to carry out a study looking at health prevention, it did cross my mind to look at those people who use public transport and see how many were overtly obese as the impression is that there noticeably  less obese people traveling on the underground. Hence, I was not surprised by the results.
They found wide variations in the modes of travel used in different parts of the UK. Public transport was used most in London, at 52 per cent, while only 5 per cent used it in Northern Ireland.
Of the working-age adults who used  private transport such as cars, motorbikes and taxis to get to work, 19 per cent were obese, compared to 15 per cent of those who walked and 13 per cent of those who cycled.
The researchers said people could reduce their risks of serious health problems such as heart attacks by avoiding using a car.
Anthony Laverty, from the School of Public Health at Imperial College London, who led the research, said: ‘This study highlights that building physical activity into the daily routine by walking, cycling or using public transport to get to work is good for personal health.
‘It demonstrates associations between active travel to work and a reduced likelihood of being overweight, having diabetes and having hypertension.’
Robin Hewings, of Diabetes UK, said the charity ‘recommends that the best way to reduce your risk of Type 2 diabetes is by combining physical activity with a healthy balanced diet that is low in salt, fat and sugar and rich in fruit and vegetables’.
He added: ‘Walking to work is a great way to improve your overall health and we recommend people walk where possible in place of a car or public transport.’
A study by Leicester University earlier this year found those at high risk of developing diabetes can reduce the likelihood by cutting the time they spend sitting by 90 minutes a day.
“We are recommended to have at least 30 minutes’ moderate exercise a day so only a 15-minute walk at either end and you have done your quota — although the longer the better,” Millett said. “It’s also more convenient than going to the gym because it can be factored in as part of your day without having to set aside any other time.”
All new patients are screened by urine testing but if you are concerned that you have symptoms of weight loss, thirst and frequently passing urine please ask for a  special blood test. If you are noticeably overweight and have a family history of diabetes, heart disease, strokes or kidney disease it would also be reasonable to be screened.
We are also actively assessing all patients with blood pressure as to how much exercise they do and if appropriate issuing them with an exercise prescription .
I trust I will see more of you walking or cycling in the streets of West Ealing!
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Posted by on August 13, 2013 in Training and Advice

 

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