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 damage, kidney 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.

Lessons

Lesson #1

Big hill = shredded thighs

The huge green hump in the chart above was the middle section of my long run on Sunday and is Priest Hill joining Old Windsor and Englefield Green in Surrey. I felt I had no choice as returning the way I'd come meant a cross-country swamp dodge due to the effects of the flooded Thames and that wasn't much fun either. It really is incredible how doing something you're not used to despite all the fitness training, in this case running up steep hills, can have unexpected after-effects and as such I couldn't walk comfortably let alone do my swim yesterday. Lesson learned - hill running remains for loonies (and Iain) and London Marathon long-distance training MUST be flat.

Lesson #2

Artificial fabric running top = room-emptying stench

When Iain started shutting my Nike long-sleeved running top in the bathroom to dry alone I knew I couldn't wait for it to wear out before I replaced it so I am now the owner of two Smartwool Light long-sleeved tops. I wore one out on Sunday and can say that it's certainly warm and absorbent (see soggy post-run picture below), didn't chafe and doesn't smell bad so far. Merino wool has myriad benefits in a garment in addition to being environmentally sustainable so it gets the thumbs up from me.

A final thought and reference to my last post about doing our best to avoid Type 2 diabetes is that most things are ok in moderation so long as there's a balance:

13 Mile Run (approx. 1400 calories burned) = Alison Gets to Eat a Pile of Cake

Yum :) and thanks to everyone who told me on Sunday at the aforementioned cake-eating extravaganza at Great Fosters in celebration of Francesca's (Mark of TEAM!'s partner) imminent child-birthingness they've been reading our blog over the last few months. It's great to feel supported. x

Running For A Reason

Happy New Year Everyone!

At the time of my last post, I was finishing the first 50% of my training plan which culminated in a race-pace Half Marathon on the 23rd December. The following week provided a break which allowed the seasonal consumption of large amounts of protein, sugar and a bit of alcohol - I wasn't expecting this time off and I think I must have miscalculated my weeks somewhere - so that worked out quite well then! Today, stage two has begun with a 10K race in Hyde Park on which Iain will report shortly.


Half our time off over Christmas was spent cooking, eating and washing-up and in the other half we attempted the ambitious challenge of sorting out our spare room once and for all. We really know how to enjoy ourselves!
A chunk of the sorting was through things that came from Emily's flat and amongst them I found something so relevant that it needs to be shared.

In 2005, Emily applied and was given a Golden Bond place for Diabetes UK. Sadly she had to turn it down a few months later as she struggled to keep control of her condition under the demands of the training. 
Members of TEAM! will be familiar with the application form, and what follows is from Emily's own application to run from 7 years ago.

Why do you want to support Diabetes UK?
"Finding out that I had Type 1 Diabetes came as a big shock and my desire to run the London Marathon for Diabetes UK stems from a desire to turn diabetes into something positive for me. I want to prove to myself that having diabetes will not change my outlook on life. I am a positive, motivated and hardworking individual who loves to set challenges."

How will you fundraise?
"My idea of fundraising incorporates both raising money for Diabetes UK and raising awareness of Diabetes among those who choose to sponsor me. Therefore in asking people for sponsorship I want to highlight and educate them on current debates surrounding diabetes. A recent article in The Times suggested that 'one in ten Britons can expect to suffer from diabetes by 2010'. As a diabetic I feel that I have a duty to highlight medical concerns arising from high levels of obesity currently dominating headlines in this country. My aim would be to offer sponsors information compiled around a healthy lifestyle of diet and exercise. I want to highlight the consequences of poor diet and minimal exercise and offer alternative ways of living to ensure the individual strives to stay healthy. Alongside this I want to propel forward the active research into Type 1 diabetes that will have a positive effect on myself in the future. My fundraising message will be one of education and awareness. To do this I will present each sponsor with a fact sheet of information that encourages them to become more informed. This along with my sponsorship information I would send to all my friends and family and encourage them to pass it amongst their peers and colleagues. I would also advertise my marathon mission in the local shops and newspapers and wear a Diabetes UK t-shirt during my training to encourage people to enquire about my challenge thus promoting the cause and mission ahead."

Emily continued to apply through the marathon ballot and finally got a place to run in 2012 which she deferred to 2013. 

Aside from being a terrifically poignant reminder of my loss, here in her own words, Emily is telling us how she felt about diabetes. 
Emily had no choice in developing the condition and she knew very well how serious and impactful being a diabetic was. When she saw so many people taking their good health for granted; making and pursuing highly unhealthy lifestyle choices which dramatically increased their own likelihood of developing the condition, it caused her a great deal of sadness, disbelief and real anger that people could actively choose to increase their own risk of developing it.  
As all of TEAM! are helping to run Emily's marathon for her, here is the essence of her message from 2005 brought to you as I hope she would be pleased with:

Whilst we will all have been consuming a little too much over Christmas, and probably making the same old new year resolutions to lose weight, get fitter and eat more healthily perhaps we all ought to start keeping those promises. 
Diabetes as we have discovered is not a benign condition which can be swept under the carpet and the likelihood of developing Type 2 diabetes is heavily influenced by your lifestyle choices 
It's serious shit: don't bring it on yourself.
Alison (and Emily)