We thought this spring newsletter would feature diabetes, an increasingly common disease with serious long-term consequences.
400 million in the world have diabetes.
43 million people in the UK have diabetes.
35 million are diagnosed.
People nowadays can have a full productive life with Type 1. Shining examples are Steve Redgrave and Theresa May. Globally it has been increasing steadily in proportion to the amount of disease in UK and the world. In 1990 it became the 8th most common cause of morbidity.
Insulin was isolated from the Islets of Langerhan in the pancreas (discovered originally by Paul Langerhan in 1867), extracted and purified and found to be the great medical discovery
Ethnicity and Diabetes
Asian origin:- x9 more likely to have diabetes.
African origin:- x6 more likely to have diabetes.
There is also a higher risk of gestational diabetes.
Essence of Diabetes
The body’s need to keep glucose within a narrow perimeter- too much glucose produces high blood sugar levels and too little will causes organs, especially the brain, to malfunction. The ‘B’ cells within the Islets of Langerhan produce the hormone insulin, in response to high glucose levels. Other cells respond to this, by storing energy in the liver, fat cells and muscle.
Type 1Diabetes (10%of diabetes)
In childhood or early adulthood the ‘B’ cells start to die and stop producing insulin. Without this the body cannot regulate glucose or energy. It is thought that Type 1 may be an autoimmune disease. Genetically if a family member suffers from this then the percentage rises slightly in being passed down to offspring. If the patient has DKA (diabetic ketoacidosis), then as the blood glucose increases so does the ketone level causing the blood to become acidic, which can lead to a coma. If there is a high level of glucose without ketones then infection or illnesses can occur.
This can start in middle age. Here the body responds abnormally to insulin production and does not reduce the glucose levels as much as it should. A combination of genes and behavioural element is the cause. 80-85% is accounted for by people being overweight and this in turn can lead to obesity. Link is causal in many cases.
This can occur in 5% of pregnancies during the 2nd/3rd trimesters, resulting in a heavier baby. Usually it is resolved when the child is born. There is a x7 % risk that the mother can develop Type 2.
UntreatedDiabetes (both Type 1 and 2)
Frequency of passing urine
Skin infections such as Thrush
Delayed wound healing
This is usually given by injection or pump. We try to mimic by using insulin to control the glucose levels in the most natural way throughout the day. If too much insulin is administered, then hypoglycaemia can occur and the patient can lapse into a coma. Carrying a Mars bar or similar at all times is a good idea.
Type2Diabetestreatment and help
Usually diet is paramount and here the Government can help by:-
Taxing fizzy drinks and sugar.
Restrict direct advertising to children.
Restrict fast food outlets near schools.
Engage with industry.
The aim is not to stop enjoyment but reduce unnecessary energy level intake.
Is usually Sulphonylureas, which stimulates the pancreas to produce more insulin, or Metformin, which reduces the glucose production and DPP-4i drugs, which inhibit the breakdown of gut enzymes which reduce the production of glucose.
Bariatric surgery is also used, where replumbing the stomach and upper gut can lead to weight loss and drastic increase in glucose control.