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Diabetes

According to the charity Diabetes UK, more than two million people in the UK have the condition and up to 750,000 more are believed to have it without realising they do.

The full name diabetes mellitus derives from the Greek word diabetes meaning siphon - to pass through - and mellitus, the Latin for honeyed or sweet. This is because not only is excess sugar found in the blood but it may also appear in the urine, hence it being known in the 17th century as the 'pissing evil'.

In Type 1 diabetes, the body is unable to produce any insulin. It usually starts in childhood or young adulthood, and is treated with diet control and insulin injections.

More than three-quarters of people with diabetes have Type 2 diabetes mellitus. This used to be known as non-insulin dependent diabetes mellitus (NIDDM) or maturity-onset diabetes mellitus. The number of people with Type 2 diabetes is rapidly increasing as it commoner in the overweight and obese, which is itself a growing problem. The remainder have Type 1 diabetes mellitus, which used to be known as insulin-dependent diabetes mellitus.

In Type 2 diabetes, not enough insulin is produced or the insulin that is made by the body doesn't work properly. It tends to affect people as they get older and usually appears after the age of 40, but increasingly is seen in younger, overweight.

Type 2 diabetes is a long-term and typically preventable condition that results in too much glucose (a type of sugar) in the blood. Symptoms include:

  • feeling very thirsty
  • going to the toilet a lot, especially at night
  • extreme tiredness
  • weight loss and loss of muscle bulk

There are a wide range of risk factors for Type 2 diabetes, such as obesity and ethnicity and there are several serious complications, including other cardiovascular diseases (such as heart attack and stroke). It can also lead to visual impairment, kidney failure and lower limb amputations due to foot ulcers.

The body converts glucose from food into energy. Glucose comes ready made in sweet foods such as sweets and cakes, or from starchy foods such as potatoes, pasta or bread once they're digested. The liver is also able to manufacture glucose.

Under normal circumstances, the hormone insulin, which is made by the pancreas, carefully regulates how much glucose is in the blood. Insulin stimulates cells to absorb enough glucose from the blood for the energy, or fuel, that they need. Insulin also stimulates the liver to absorb and store any glucose that's left over.

After a meal, the amount of glucose in the blood rises, which triggers the release of insulin. When blood glucose levels fall, during exercise for example, insulin levels fall too. A second hormone manufactured by the pancreas is called glucagon. It stimulates the liver to release glucose when it's needed, and this raises the level of glucose in the blood.

Diabetes that is not controlled can cause many serious long-term problems. Excess glucose in the blood can damage the blood vessels, contributing to heart disease, strokes, kidney disease, impotence and nerve damage.

Uncontrolled diabetes is the most common cause of blindness in people of working age. People with diabetes are also 15 per cent more likely to have an amputation than people without the condition.

In most cases, it is possible to reduce the risk of such complications by following medical advice and keeping diabetes under control. It's vitally important for people with diabetes to check their glucose levels regularly at home and to attend GP, diabetes nurse or hospital check-ups, and so any problems can be detected and treated early.

New guidelines have been published by the National Institute of Health and Clinical Excellence (NICE) and provide recommendations that are designed to:

  • identify people at a potential high risk of developing the  condition
  • assess their individual risk with testing, and, if necessary
  • offer lifestyle advice (such as advice on diet and exercise), to help prevent the condition in people who are at high risk, and advise on such things as dietary changes and increased physical activity

NICE wants major initiatives, nationally and locally, aimed at preventing Type 2 diabetes. It hopes that these initiatives will include a body to oversee effective practice in Type 2 diabetes prevention. Local NHS organisations will be expected to ensure that prevention of diabetes Type 2 is a central part of their work.

Preventing Type 2 diabetes from occurring in the first place would have a significant positive impact in terms of public health and the life of millions of people in this country.

  Difference of Opinion

There appears to be a growing controversy over the health service’s diet advice for diabetics. At the heart of this dispute lies widely differing beliefs about carbohydrates. The NHS commends them — but the American approach says that diabetics should shun carbs whenever possible.

For healthy people with everyday food habits, the difference might sound like diet-faddism. But for people with Type 1 or Type 2 diabetes, it may make the difference between health and disability, even premature death. Finding the right diet may help to contain Britain’s fast-growing diabetes epidemic.

The NHS teaches that carbs are a key part of a balanced diet. But shunning them might help patients reduce insulin injections. In America, however, opinions have already swayed towards low carbs. The American Diabetes Association changed its advice on low-carb diets in 2008. It now considers them to be an effective treatment for short-term weight loss among obese people suffering from Type 2 diabetes.

The effects of low-carb diets have been studied more extensively in Type 2 diabetes. In May, a two-year study at Sweden’s Linköping University showed that low-carb, high-fat diets may have a better effect on blood-sugar levels than high-carb diets. It compared 61 patients on either a low-carb, high-fat diet, or a high-carb, low-fat diet. It found a “clear improvement” in the blood-sugar levels of the low-carb patients within six months of starting the diet. Patients were able, on average, to drop their insulin doses by a third, the study in the journal Diabetologia said. The cholesterol levels of the patients improved, with an increase in their average level of “good” HDL cholesterol. No such improvements were seen in the high-carb, low-fat group.

So why does the NHS persist with recommending high-carb, low-fat diets? The concern is that people with diabetes are known to have an increased risk of heart disease - and the high fats in low-carb diets are feared to worsen this. Instead, the Department of Health recommends that diabetics try to eat low-GI (glycaemic index) carbs such as brown rice and wholemeal grains, which are turned more slowly into sugars by the body, and thus cause fewer “spikes” in blood-glucose.

Last year, Diabetes UK changed its advice for people with Type 2 diabetes to say that a low-carb diet where less than 45 per cent of calories come from carbohydrates “may be suitable for a year”. Other expert organisations are following suit.

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HFCS

High fructose corn syrup (HFCS) is used as a sweetener in a wide range of processed food and drinks, but its use and consumption varies widely between countries.

A recent ecological study looking into whether there is a link between diabetes levels and the availability of HFCS found that countries that produced and sold the most HFCS also had higher levels of diabetes when compared with countries with the lowest levels of HFCS availability. Researchers from the University of Oxford and the University of Southern California report concludes that a growing body of evidence supports the hypothesis that in addition to overall sugar intake, fructose is especially detrimental to health and increases the risk of type 2 diabetes.

It states that the epidemics of obesity and type 2 diabetes we are currently seeing constitute an "alarming public health concern" and that global increases in the use of HFCS in food and beverage production may be contributing to this.

Diabetes Around the World

The small island of Nauru in the South Pacific is believed to have the highest prevalence of diabetes in the world with a massive 31% of adults between 20 and 79 suffering from either type-1 or type-2 diabetes in 2010. The prevalence of diabetes in the United States is estimated to be 10.3% which is relatively high. By comparison, diabetes rates are 3.6% in the United Kingdom, 9.2% in Canada, and 5.7% in Australia. Worldwide, it is estimated that 6.4% of adults are living with diabetes and this figure is predicted to increase to 7.7% by 2030.


 

Diabetes

 
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