Sunday, 24 March 2013

What Is Diabetes?

Run Graffiti
I've already commented on society's collective ambivalence regarding diabetes and alongside our fundraising, it is important to us that we continue Emily's personal mission to educate people about the condition and with this in mind, I wanted to put together a piece which would serve as a beginners guide to diabetes. As the condition itself is complex, there are many factors and details which have been simplified or left out, but hopefully not to the detriment of the science.

Before Emily was diagnosed with Type 1 diabetes, my understanding of the condition was based solely on experiences of my Nana and someone at school. 
From these, I concluded that diabetes could affect old people but bore no major consequence aside from a prescription of tablets, a requirement for diabetic jam and that when it affected young people, it permitted a Marathon bar (now called Snickers) to be eaten in lessons and the occasional skive off PE.
Diabetes really didn't seem to be a big deal and I wrote it off as something quite benign and unimportant. However, the reality of the condition, as this blog's very existence makes brutally clear, is that underlying all the labels, the science and terminology and in the face of society's blithe, sometimes mis-informed, fingers-in-ears indifference towards it, diabetes is a big deal; a really big deal.

It is easy to understand that when your heart stops beating you will die, but in order to beat, the heart muscle must have a source of energy and this is true of all the processes that give us life - every cell and every organ in our body needs energy to survive and function.
Unfortunately, your cells are quite picky regarding their energy, in fact as far as they are concerned, they will only accept one type: glucose, and your body is constantly at work making it by taking what you eat and drink and turning whatever it can that is not already glucose in to glucose and pumping it in to your bloodstream.
Once there however, the amount of glucose in your blood needs to be kept in constant check - too much is toxic and too little means your cells run out of energy and your body ceases to work - and there are several systems in your body which act together to maintain an optimum level. 
If your body senses that there is too much glucose in your blood, it releases a messenger called insulin from special cells found only in your pancreas. The message insulin carries to your liver, skeletal muscles and fat cells, tells them to remove surplus glucose from your blood which would otherwise be harmful and it is this messaging system which becomes compromised in diabetes mellitus:
  • With Type 1 diabetes, the pancreatic cells that make insulin have been completely destroyed and therefore can no longer produce insulin. 
  • With Type 2 diabetes, insulin may still be being produced by the pancreas however, it is not as effective as it should be because its message is either not strong enough, it has become scrambled, or although correct, it is no longer being understood by the cells themselves. 
In either case, the body loses, or at very least becomes limited in, its ability to take glucose from the bloodstream which on its own would be bad enough. However, because cells are no longer absorbing and storing any glucose, your body - unaware of the communication breakdown - mistakenly concludes that you must be starving and that energy is vitally needed. In response to this perceived crisis, it releases another pancreatic messenger called glucagon which tells your body to take the glucose which it has previously stored and pump it right back in to the blood stream which, as we know, is unfortunately already full of the stuff.

Your body only has a limited supply of stored glucose (stored as glycogen) and when this runs out, the body - still convinced you are starving - starts to metabolise fat as a last resort and this causes diabetic ketoacidosis (DKA), which can quickly become a medical emergency. DKA is rare in Type 2, as there is usually some insulin on hand to stop things reaching such an extreme, but someone who develops Type 1 and who does not receive medical intervention will ultimately fall in to a coma and die. 
Although the condition may not be so immediately life-threatening for someone with undiagnosed Type 2, there are several serious long-term complications which are caused by the permanently elevated glucose levels. These include severe eye damagekidney disease, pain and numbness in extremities caused by nerve damage and heart disease and stroke caused by damage to blood vessels. Ultimately, even after diagnosis, the life expectancy of someone with type 2 is likely to be reduced, as a result of the condition, by up to 10 years.
There's clearly much more to diabetes than missing PE and buying special jam.

For Emily - as for everyone with Type 1 - no one really knows why she developed the condition. Current thinking is that a person may develop Type 1 diabetes when a genetic predisposition is triggered by a viral illness, dietary factors, particular drugs or something else yet to be identified which in turn causes the body to suddenly destroy the pancreatic cells that make insulin in a self-immune reaction. At the moment, Type 1 is not currently a preventable condition. 
Although development of Type 2 can be due to elements which are out of our control such as genetics and advancing age, importantly there are also other factors which are in our control such as lifestyle and weight which have been proven to significantly affect the likelihood of you developing the condition. 
Click here for a quick online test to see how you score for risk of developing Type 2.

The main symptoms of undiagnosed diabetes can include:

  • passing urine more often than usual, especially at night
  • increased thirst
  • extreme tiredness
  • unexplained weight loss
  • genital itching or regular episodes of thrush
  • slow healing of cuts and wounds
  • blurred vision

    For those who have developed Type 1 the symptoms will occur very quickly over a couple of weeks and are relieved on treatment with insulin.
    For those at risk of Type 2 it may not be as easy to recognise symptoms as it can develop over a couple of years and is usually diagnosed through a routine health check.

    Managing diabetes for Type 1 is via injections of insulin several times a day in order to maintain a balanced blood sugar level, combined with a healthy and balanced diet. This is easier said than done and I know Emily struggled when she was first diagnosed since even having a cold or getting upset can tip the scales but with time, Emily was acutely aware of how her body would react to certain foods and activities and made compensatory judgements with the injections to keep an even keel. That said, every coat pocket, handbag, nook and cranny of Emily's flat was littered with Dextro tablets for quickly responding to hypo symptoms when the glucose dropped the other way.
    Those with Type 2 will usually be advised to manage the diabetes through lifestyle interventions first such as weight loss (where appropriate) and an increase in regular exercise. If there's no improvement then orally administered drugs and/or injected insulin may be necessary.

    Incredibly, just 28 years ago in 1985, there were an estimated 30 million adults with diabetes worldwide. By 2010 this figure had reached 285 million of which 90% were Type 2, the number is now over 370 million. However, these numbers pale against future forecasts. In the UK, Diabetes UK say that 
    "Most health experts agree that the UK is facing a huge increase in the number of people with diabetes. Since 1996 the number of people diagnosed with diabetes has increased from 1.4 million to 2.9 million. By 2025 it is estimated that five million people will have diabetes. Most of these cases will be Type 2 diabetes, because of our ageing population and rapidly rising numbers of overweight and obese people."
    Diabetes is serious. Do yourself a favour and do what you can to reduce your risk of developing Type 2 diabetes. This prediction need not be a reality.

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