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Diabetes Week 2010: dispelling the myths

Emma Burns
Diabetes UK

Diabetes UK is the largest UK charity for people with diabetes. Diabetes Week is the charity's annual UK-wide awareness and fundraising week, and this year it is being held from 13-19 June 2010. Read on for some startling facts about the condition and ideas as to how you can get involved ...

Diabetes UK is using Diabetes Week 2010 to highlight the importance of a healthy lifestyle for all; that being active is good for everyone, but especially important for people with diabetes.

As nurses working in the primary care setting will know, physical activity, combined with healthy eating and any diabetes medication that the patient is taking, all help to manage the condition and prevent long-term diabetes complications.

What are the differences between the two types of diabetes?
Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. Type 1 diabetes is the least common of the two main types and accounts for between 5-15% of all people with diabetes. Although it is not known exactly how type 1 diabetes develops it is believed to be caused by a combination of genetic and environmental factors.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (insulin resistance). This type of diabetes usually appears in people over the age of 40, though in South Asian and African-Caribbean people it often appears after the age of 25. It is becoming more common in young people and children of all ethnicities. Type 2 diabetes is the more common of the two main types and accounts for between 85-95% of all people with diabetes.

How many people in the UK have diabetes?
There are currently 2.6 million people in the UK already diagnosed with the condition and we estimate that more than 500,000 people also have the condition but are not aware of it. Shockingly, it is estimated that by 2025, there will be more than four million people with diabetes in the UK. Most of these cases will be type 2 diabetes, attributable to an ageing population and rapidly rising numbers of overweight and obese people.

What are the risk factors for diabetes?
Besides the risk factors of age and ethnicity other risk factors include:

  • Being overweight. This is especially important for women who have polycystic ovarian syndrome.
  • Body mass index (BMI) is one indicator with risk increasing if the once the BMI is over 25kg/m2.
  • Waist circumference also shows if someone is at an increased risk of developing diabetes: if the waist is 31.5 inches or over for women; 35 inches or over for Asian men and 37 inches or over for white and black men there is an increased risk of developing diabetes.

There is also a genetic factor to type 2 diabetes as having a close family member with type 2 diabetes (parent, brother or sister) increases the risk of developing the condition.
Hypertension (high blood pressure ) also increases risk.

What can be done to cut down the risk of developing type 2 diabetes?
To reduce the risk of developing type 2 diabetes, it is recommended to follow a healthy balanced diet low in fat, salt and added sugar but high in fruits and vegetables, to lead an active lifestyle and lose weight if necessary.

What are the symptoms of diabetes?
The signs and symptoms of diabetes are:

  • Increased thirst.
  • Passing urine more frequently - especially at night.
  • Tiredness.
  • Unintentional weight loss.
  • Blurred vision.
  • Genital itching or regular episodes of thrush.
  • Slow healing of wounds.

In type 1 diabetes the signs and symptoms will usually be very obvious, developing quickly, usually over a few weeks. In people with type 2 diabetes the signs and symptoms will not be so obvious or even non-existent in people with type 2 diabetes. An older person may put the symptoms down to “getting on a bit”.

In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. Early treatment will also reduce the chances of developing serious health problems.

What are the complications of diabetes?
Diabetes is a serious condition causing microvascular, macrovascular and neuropathic damage. This can lead to a variety of complications including: heart disease and stroke, kidney failure, blindness and leg ulcers and lower limb amputation. Good blood glucose control is crucial to avoid or delay developing the above complications.

Diabetes and pregnancy: what is gestational diabetes?
Gestational diabetes mellitus (GDM) is a type of diabetes that arises during pregnancy (usually during the second or third trimester). In some women, it occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. Figures show that GDM affects around 20,000 women each year in the UK.

If gestational diabetes is suspected an oral glucose tolerance test (OGTT) should be offered. The risk factors for developing GDM are:

  • Obesity (BMI above 30kg/m2.
  • First degree relative with diabetes.
  • Ethnicity - people whose family origin is South Asian, black Caribbean or Middle Eastern.
  • A very large infant in a previous pregnancy (over 4.5 kg).
  • Previous gestational diabetes.

It is essential that women with GDM receive treatment and keep tight controls of their blood glucose levels during pregnancy to avoid harming the baby. Often, blood glucose levels can be controlled by diet and physical activity alone but some women may need insulin injections. Between 10 and 30% of women with GDM take insulin.

GDM usually goes away once the baby is born. In most cases, GDM comes to light during the second trimester of pregnancy and the baby's major organs are fairly well developed at this stage. Therefore, the risk is lower than the risk to babies of women with type 1 or type 2 diabetes.

GDM can lead to macrosomia - a large baby - in women whose blood glucose levels are not well controlled. High blood glucose levels in the mother means that an increased quantity of glucose and other nutrients are passed to the baby.

  • Possible health problems of being a large baby include:
  • Damage to the shoulders during birth (shoulder dystocia).
  • Early delivery which could lead to higher risk of respiratory problems.
  • Hypoglycaemia (low blood sugar).

Women with GDM have a 50% risk of developing type 2 diabetes within 10 years of the pregnancy. Women from ethnic minority groups (African, African-Caribbean and Asian) are especially likely to develop type 2 diabetes if they have had GDM. A small percentage of women with GDM develop type 1 diabetes at some time in their lives. These women have a slowly developing form of type 1 that is “unmasked” during pregnancy. Being the right weight to height will reduce the risk for women who have already had GDM from developing the condition in future pregnancies.

Where can I get more information on diabetes?
Anyone wanting more information on diabetes or anyone needing support can ring the Diabetes UK Careline on 0845 123 2399. The Diabetes UK website, www.diabetes.org.uk, also offers a lot information and advice on diet, keeping active, driving and diabetes
at work.

More information on Diabetes Week
There are many organised activities taking place across the UK during Diabetes Week, including Walk the Extra Mile and other fundraising events. For more information and lots more ideas about what to do during Diabetes Week visit www.diabetes.org.uk/DiabetesWeek; call 0207 424 1000 and ask to speak to someone about the week or email: DiabetesWeek@diabetes.org.uk