Type 2 Diabetes, Diagnosis, Prevention and Treatment

Introduction

Why are we discussing type 2 diabetes? Because the condition is so closely associated with being overweight and obese. And because so many of those who walk into our clinics searching for help on weight loss are also affected in some way by type 2 diabetes (even sometimes when they are unaware they have the condition, that they are in a pre-diabetic state or that some of the their health issues are symptoms of type 2 diabetes).

The number of people with type 2 diabetes has doubled globally over the past 30 years. It’s no coincidence that this has happened at the same time as a dramatic increase in the number of people overweight and obese. A recent study published in The Lancet showed that, over the past 33 years, worldwide overweight and obesity rates among adults have increased by 27.5%, while such rates among children and adolescents have increased by a shocking 47.1%. This does not bode well for our future health

What About Ireland?

At present, nearly a quarter of a million people in Ireland are living with diabetes. Between 10 and 15 per cent of those have type 1 diabetes, which is an autoimmune condition usually diagnosed in early childhood. The remaining 80-90 per cent have type 2 diabetes. The numbers of children who are presenting with type 2 diabetes are also increasing and this is thought to be down to lifestyle factors such as the fact that children are less active than they used to be and that sugar is so readily available and hidden in the foods our children commonly consume. Also, factor in those addtional adults and children that have symptoms of type 2 diabetes but have yet to see a medical professional.

But it’s not just an individual burden; the economic burden of diabetes on the Irish health care system is becoming a major challenge for the government and the HSE. Current figures suggest that as much as 10 per cent of the national health budget is being consumed treating the condition, and this could increase by 2020. The good news is that type 2 diabetes is a reversibe condition for a lot of people. The challenge is trying to make the public aware of this.

What are the Types of Diabetes?

Type 1 diabetes: the pancreas shuts down and you don’t produce any insulin, causing the glucose to rise in your blood. This type is usually diagnosed in young people aged 10-14 years.

Type 2 diabetes: the pancreas may still produce insulin but the amount may be reduced or the insulin it produces doesn’t work properly. This typically presents in people who are overweight, but some people may have the condition without necessarily having a weight problem.

Why is Diabetes so Dangerous?

Symptoms of type 2 diabetes can be easy to ignore, especially in the early stages when you’re feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:

• Heart and blood vessel disease. Diabetes dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
• Nerve damage (neuropathy). Excess sugar can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Eventually, you may lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
• Kidney damage. Diabetes can sometimes lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage. Diabetes increases the risk of serious eye diseases, such as cataracts and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
• Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Sleep apnea. Obstructive sleep apnea is common in people with type 2 diabetes. Obesity may be the main contributing factor to both conditions. Treating sleep apnea may lower your blood pressure and make you feel more rested, but it’s not clear whether it helps improve blood sugar control.
• Alzheimer’s disease. Type 2 diabetes seems to increase the risk of Alzheimer’s disease, though it’s not clear why. The worse your blood sugar control, the greater the risk appears to be.
• Cancer: Diabetes has even been linked to cancer. According to one study, comparing more than 450,000 people with type 2 diabetes with more than two million without the condition (over an average of seven years), individuals with diabetes face a 20 per cent greater risk of developing bowel cancer and a 5 per cent higher risk of breast cancer compared with their diabetes-free counterparts. What’s more, having the condition affects survival rates; people with diabetes already diagnosed with cancer also fare worse, with a 25 per cent and 29 per cent higher chance of dying following a breast and prostate cancer diagnosis (respectively) than their peers without diabetes.

Know the Risk Factors & Symptoms of Type 2 Diabetes

The risk factors for type 2 diabetes include:

• being over 40 years of age;
• having a parent or sibling with diabetes;
• being overweight;
• not getting the recommended 30 minutes of exercise each day;
• having high blood pressure and/or high cholesterol.
• High stress levels and a lack of sleep have also been linked to a higher risk, as has ethnicity (those from South Asian and Afro-Caribbean ethnic groups are more likely to develop the diesase).

Symptoms of type 2 diabetes include:

• blurred vision;
• fatigue, or a lack of energy;
• extreme thirst;
• frequent trips to the bathroom (urination), especially at night;
• rapid and unexplained weight gain or loss;
• brain ‘fog’;
• frequent infections and numbness, pain or tingling in the hands or feet.

Diagnosis & Treatment of Type 2 Diabetes

If you have any of the symptoms above, go to your GP and he/she will arrange a urnine and blood test. Type 2 diabetes is diagnosed by detecting high blood levels of glucose and HbA1c, which reflects blood glucose levels over the three preceeding months. If you have borderline results, you will be deemed ‘pre-diabetic’ (see below) and you should be checked annually.

Once diagnosed, patients require regular checks on their blood pressure, cholesterol, kidneys, feet, eyes and circulation to see if more intensive treatment is need to prevent the serious complications involved with diabetes. Patients learn the symptoms of dangerously low blood sugar (such as sweating, hunger, irritability, confusion and even unconciousness) and are prescribed medicine accordingly.

Am I at Risk of Pre-Diabetes?

Pre-diabetes is where the amount of glucose (sugar) in the blood stream is higher than it should be. The body operates best with blood glucose levels maintained between 4-7 mmols (normal levels). Having a blood glucose level above 8.0 mmols is considered high and, over time, damages blood vessels, especially the smaller blood vessels that deliver blood to the eyes, heart, feet and kidneys. A person may have no symptoms but still even be pre-diabetic. If you carry excess weight around your middle, you may be at risk so do consult your GP to have a blood test. Pre-diabetes is diagnosed on the results of an HbA1c test or an Oral Glucose Tolerance Test. Pre-diabetes does not always lead to type 2 diabetes but if you are pre-diabetic, it is vital to take steps to prevent diabetes (see prevention below).

A VHI Healthcare Screening Projects tested 30,000 people for type 2 diabetes between 2009 and 2013 and produced some interesting findings about pre-diabetes. Abnormal blood sugar levels, pre-diabetes and diabetes were more common in men than in women with men 2-3 times more likely to have abnormal blood sugar levels and undiagnosed diabetes. The study also found that the risk of having undiagnosed diabetes increased by 89 per cent for every 5 KG / m2 increase in body mass index which demonstrates the importance of diet and lifestyle in preventing diabetes (see more under ‘prevention’ below). The study reported the prevalence of pre-diabetes in participants over 45 years to be a shocking 19.8% (that’s nearly 1 in 5 people!) which would imply there are 338,956 people in the over 45 age group at high risk of developing diabetes in Ireland in the coming years. In reality, given rising obesity levels in younger age groups, diabetes experts believe that figure is much more likely to be close to 450,000.

The Main Aspect of Prevention

Thankfully there is great potential to prevent type 2 diabetes in high-risk individuals by lifestyle intervention. There is sufficient evidence based on several clinical trials that dietary modification and weight reduction in high risk individuals can be highly effective and can even reverse the condition.

For women, aiming to have a waist size that is 31.5 inches or below and, for men, 36 inches or below is one of the best ways to help prevent the disease. If you attend a Motivation clinic for weight loss, your weight loss consultant will automatically take these measurements every four weeks, or you can ask to be measured more often.

Visceral fat (i.e. not the fat that sits just under the skin, but the type of fat that is internal and sits around our organs) seems to further increase our risk of diabetes by causing more insulin resistance than fat in other areas. If you have a lot of visceral fat, losing just 10 per cent of your weight can cut your visceral fat by as much as 30 per cent, and may very dramatically reduce your chances of diabetes or heart attack. Visceral fat is relatively easy to lose by following a sensible weight loss programme like the ones at Motivation. This is very encouraging for our clients and prospective clients. For more on visceral fat listen to our podcast.

Diet is key. Reducing your intake of high-sugar, starchy foods – particularly sugary drinks (even fruit juices and smoothies), sweets, chocolate, jellies, cakes and biscuits – has been shown to be very effective. Start with simple changes and swaps. Fibre also seems to play a role; populations with a high prevalence of diabetes tend to eat a diet that is low in fibre. Dietary fibre seems to be protective against diabetes because it slows down the rate at which glucose enters the bloodstream.

Also making sure to get active for 30 minutes on five days of the week is advisable. These recommendations are 100 per cent in line with the guidelines we recommend at Motivation. In this way, doing a programme with Motivation is a sure way to also dramatically prevent your changes of developing this disease, particularly if you are in the high-risk category.

What We Know from the Research

Many studies have confirmed the importance of BMI in determining who develops diabetes. A large study of thousands of nurses in the US showed that the nurses with a BMI of greater than 35 had diabetes almost 100 times more often than nurses with a BMI of less than 22 (check your BMI right now).

The Diabetes Prevention Program Outcomes Study showed in their follow-up of participants at 10 years that type 2 diabetes incidence in the group with lifestyle changes was reduced by 34% compared with the control group (ie. no action).

The Finish Diabetes Study (2003) showed that lifestyle changes can be accomplished and sustained, not only in a research setting like that of the Diabetes Prevention Program (above), but also in a community setting. Their efforts showed a 58 per cent reduction in the onset of diabetes with lifestyle intervention.

In terms of physical activity, the same study of the health of nurses cited above showed that women who were physically active on a regular basis had diabetes only two-thirds as often as ‘couch pototatoes’. And, in one study carried out in Hawaii, the occurrence of diabetes was greatest for the non-exercisers (and none of the peoplein the study was obese, so that was not a factor).

Also, a relatively new study from the UK (The Direct study) has claimed that type 2 diabetes can be ‘reversed’ if sufferers stick to a very low-calorie diet (around 800 calories each day). In the study, which recruited 300 volunteers, 36 per cent of study participants with the condition who spent up to five months on a strict diet were still in remission two years later. The scientists behind the study said their findings prove that type 2 diabetes not “an inevitably progressive disease”. Of note is the fact that each of the dieters in this study was supported by a nurse or dietitian to maintain their weight; which, at Motivation, we strongly believe is the recipe for success, particularly when clients are on a particularly low calorie plan.

All of these studies back up the theory that, in order to reduce the risk of developing type 2 diabetes, it is recommended that we all follow a healthy balanced diet, take regular physical activity and attain a healthy BMI. We can help you to achieve that. Come in for an assessment with us to find out more.

What Role Does Sugar Play?

A high-sugar diet has been linked with an increased incidence of type 2 diabetes due to the links between high sugar intake and obesity. The Scientific Advisory Committee on Nutrition (SACN) also conducted a meta-analysis, which included nine cohort studies in 11 publications that suggest that there is a relationship between sugars-sweetened beverages and the incidence of type 2 diabetes

A sugar tax was introduced in Ireland by the government to try to tackle the problem of obesity and rising diabetes levels in Ireland. The tax applies at a rate of 30 per cent per litre if drinks have over 8 grams of sugar per 100ml (while a 20 cent per litre tax will apply if drinks have between 5g and 8g of sugar per 100ml). Drinks with less than 5g of sugar are not taxed.

It means the price of some popular drinks increased by as much as 60 per cent for a two-litre bottle (affecting high-sugar drinks like Coke and Red Bull). The hope is that higher prices will lead to lower consumption, and not only will people be incentivised to opt for healthier drinks, but the soft drinks industry will reformulate products to reduce the added sugar content and therefore the tax liability. So the question is, is it working?

The jury is out. Supporters say we will see reducing levels of both obesity and diabetes levels over the coming years, while opponents say it only really hits the pockets of the poorest, furthering health inequalities in this country. Whether it will sway you or not in your drink decisions is up to you, but what is in no doubt is that the manufacturers have begun cutting sugars in their products and reformulating their drinks to avoid the tax which is sure to have a positive effect.

For More Information

Take the Diabetes Ireland Risk Test here.

Visit the Diabetes Ireland website.

Download a copy of Type 2 Diabetes – Are You Or A Loved One At Risk?

The Truth about Sugar – download our report here.