Dealing with diabetes – your questions answered
16th November, 2022
Type 2 diabetes, which accounts for 90% of all diabetes cases (in adults and children) and is linked with obesity, has been growing at a particularly high rate and is now one of the world’s most common long-term health conditions. However, it’s also one that it is within our power to do something about. Making simple lifestyle choices can prevent, help manage and even reverse type 2 diabetes, and all forms of diabetes can lead to serious complications if not managed properly. So it’s really important to understand what it’s all about and what you can do to help yourself, or friends and family members who have the condition.
What causes it? How to recognise symptoms, and the important role that diet and lifestyle play in managing the most common form of diabetes – type 2.
Q. What is diabetes?
A. Diabetes occurs when your body doesn’t produce enough insulin or is unable to use the insulin it produces as well as it should (insulin resistance). Produced by the pancreas, the hormone insulin is important because it helps move glucose out of the blood and into our cells, where it’s converted into energy. When you have diabetes, the lack of insulin or resistance to its effects causes a build-up of glucose – a type of sugar – in the blood, which can lead to serious health complications, including blindness, heart disease, kidney failure and stroke if not controlled.
Q. What’s the difference between type 1 and type 2 diabetes and is one more serious than the other?
A. Both type 1 and type 2 diabetes are diagnosed on the basis of your blood sugar being too high, together with the symptoms you are experiencing. Type 1 diabetes tends to start earlier in life (usually in childhood or teenage years) and has to be treated with insulin injections from the outset.
Type 1 diabetes is less common than type 2. Whereas type 1 occurs when the body produces no insulin at all, type 2 occurs when the body doesn’t produce enough insulin or when the cells in the body don’t react to insulin as they should (known as insulin resistance). The hormone insulin is important because it helps control the amount of sugar in the blood. Produced by the pancreas, insulin works by moving glucose out of the blood and into cells, where it’s broken down into energy. If you don’t have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin, so the right amount of glucose can get into your cells. Similarly, if blood glucose levels fall too low a process is triggered that replenishes glucose levels in the blood from reserves in the body. In this way the level of glucose in the blood is kept within the ‘normal’ range. But if you have diabetes, this system doesn’t work as it should.
Type 2 diabetes is more closely linked to being overweight. It tends to run in families, to come on in adulthood and can often be treated with diet, weight control and tablets, at least in the early stages.
There is no mild form of diabetes. Regular treatment and follow-up are crucial for both type 1 and type 2 diabetes and both can cause serious complications if not properly controlled.
Q. What should blood sugar levels be?
A. Type 1 diabetics and type 2 diabetics who are being treated with insulin need to measure their blood sugar levels regularly during the day and before meals to ensure they remain stable.
Blood sugar is measured by millimols per litre (mmol/l). Blood sugar levels for type 2 adult diabetics should be:
• 4 to 7 mmol/l before meals
• Less than 8.5 mmol/l two hours after meals
For type 1 diabetics, ranges are:
• 5 to 6 mmol/l on waking
• 4 to 7 mmol/l before meals
• 5 to 9 mmol/l 90 minutes after meals
Blood sugar levels are tested for diabetes, normally after eight hours of fasting, using the following levels:
• Normal – 70 to 100mg/dl (5.6mmol/l)
• Pre-diabetes or impaired glucose tolerance -101 to 126mg/dl (5.6 to 7mmol/l)
• Diabetes – more than126mg/dl (7mmol/l)
Q. Why are blood sugar levels important?
A. If blood sugar falls too low, hypoglycaemia can occur. A blood sugar level below 3.9 – and definitely below 3mmol/l – is classified as a ‘hypo’ (see below).
Some medicines for diabetes – insulin injections and tablets called sulphonylureas and glinides or prandial glucose regulators) – can drop blood sugar too much, causing a hypoglycaemic event. In people who suffer from diabetes, ‘hypos’ can also be triggered if you skip a meal or wait too long between meals. It can also happen after exercising or if you drink alcohol on an empty stomach.
If blood sugar levels rise too high, hyperglycaemia (hyper) may occur. With very high levels, you can become dehydrated and even comatose, and may need hospital treatment.
Q: What are the most common symptoms of diabetes?
A. In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed by the immune system and therefore cannot produce insulin. Type 1 comes on very quickly, often within days or weeks. The most common symptoms include:
• Increased and constant thirst – termed polydipsia
• Producing excess urine which causes someone to pass urine more frequently – termed polyuria
• Extreme fatigue
• Blurred vision
• Unexplained weight loss.
With type 2, the pancreas either produces inadequate amounts of insulin, or the body is unable to use the insulin that is produced (insulin resistance). Often linked with diet and lifestyle, type 2 is usually slow to develop. The most common symptoms include:
• Producing excess urine which causes someone to pass urine more frequently – termed polyuria – particularly at night
• Increased hunger and/or feeling hungry not long after eating a meal
• Increased thirst
• Blurred vision
• Repeated thrush infections in the vagina (candidiasis)
• Wounds that take a long time to heal
• Itching of the skin, especially around the genitals.
Q. Is there a cure for diabetes?
A. Diabetes is a lifelong condition and at the moment there’s no known cure. However, the disease can be controlled – often very successfully. For people with type 1 diabetes that means taking insulin – either by regular injection or through a pump, which drip feeds the insulin into the body throughout the day.
Type 2 diabetes can be controlled through diet and exercise initially, although tablets are often required as the condition progresses to improve your response to, or increase the level of insulin. Sometimes injections are needed to help maintain healthy blood sugar levels.
Q. What is prediabetes?
A. Prediabetes occurs when your blood glucose levels are higher than they should be, but not high enough to qualify as diabetes. This puts you at increased risk of developing type 2 diabetes. In many cases, changes in diet and being more active can delay or prevent the onset of full-blown diabetes.
Q: Is it true that Glucose Fructose Syrup (HFCS) is a key contributor to the sharp rise in diabetes in younger people?
A. HFCS is not a key contributor to diabetes in children. The vast majority of children and young people (under 19) have type 1 rather than type 2 diabetes and diet does not contribute to type 1 diabetes.
There are a growing number of children being diagnosed with type 2 diabetes, but so far there is no evidence that their condition is linked to consumption of HFCS. Further research is in the pipeline to identify any links between consuming fructose and developing type 2 diabetes.
The body’s inability to produce enough insulin when an individual consumes a high calorie diet does contribute to type 2 diabetes. See the answer below and ongoing links for more on the relationship between diet and diabetes.
Q. I’m following a healthy diet with reduced salt and sugar and exercise regularly and yet nothing in my body changes – BMI, weight and waist size have all stayed the same and I’m still at risk of/borderline type 2 diabetes. Is there anything else that an individual can do to make a difference?
A.If you’re exercising regularly – at least 30 minutes a day – and eating a healthy calorie-reduced diet and you’re not seeing any change in your BMI or waistline, you may need to see your GP to exclude any underlying disorder.
Q. I am trying to limit my consumption of sugar to the Recommended Daily Intake (RDI) of 90 grams. Does the sugar in fruit and honey count towards this amount?
A.Yes – all sugars count, including fruit sugars.
Q. Are there any other life changes that help to prevent diabetes? I already exercise.
A. It’s a good idea to keep your weight down. It is also a good idea to limit the amount of sugary liquids such as fizzy drinks because these give a sudden rush of glucose to the system, which can be difficult for your body to deal with when you’re pre-diabetic or have diabetes. It’s best to stick to a healthy balanced diet and avoid long sedentary periods – sitting at a desk, playing games or watching TV.
Q. How and why does diabetes affect your feet?
A. Foot problems are much more common in people with diabetes because of the damage that raised blood sugars can cause to sensation and circulation. Two specific complications of diabetes can be peripheral arterial disease, a common condition which can cause poor circulation to your feet; and peripheral neuropathy (nerve damage). Signs to look out for include:
• Changes to the general condition of the skin on your feet, e.g. cracks, splits or broken skin, which can increase the likelihood of infection
• Impaired sensation or numbness, meaning you may not feel an injury to your foot, or if a shoe it rubbing, either of which may lead to infection
• Changes to the shape of the feet, including thickened, hard skin forming on areas experiencing pressure or rubbing, which may in turn increase pressure and cause damage to the underlying tissues.
If you have diabetes, you’ll be offered a yearly foot care check as part of your ongoing review. In between times there are things you can do to prevent or minimise the risk of developing foot problems. Our article on diabetes and foot care contains further information on this subject, including what to expect at your yearly foot care check.
Q. My sister is pregnant and has been diagnosed with diabetes. Will this be with her for the rest of her life or will it go when she’s had the baby?
A. For those who are diagnosed with diabetes during pregnancy (gestational diabetes), blood glucose levels usually return to normal once the baby is born and any medication is usually stopped. Blood tests will be taken before your sister is discharged after the birth to make sure this has happened, with a follow up fasting blood test at the six week postnatal check. Those who’ve had gestational diabetes have an increased likelihood of developing gestational diabetes in future pregnancies and also type 2 diabetes.
Q: Is getting diabetes later in life worse than getting it when you are young?
A. Type 1 diabetes generally affects children. Although younger people are getting type 2 diabetes, this happens more commonly later on in life. With type 1 diabetes you have to inject insulin; type 2 can usually be controlled by diet and oral medication, although in some cases, insulin injections may be needed if the condition progresses.
Factors such as your general health and any other medical conditions you may have will determine how you cope with either type of diabetes. Diabetes can be a contributing factor to other medical conditions for example strokes, heart disease, high blood pressure and poor circulation
The older we become, the more likely we are of having other medical conditions which diabetes can exacerbate.