Diabetes

CASE STUDIES:

• Lee: Not going to the doctor nearly killed me
• Olympic gold medallist Steve Redgrave: when I got diabetes I thought my rowing career was over

What is it?

While diabetes is often thought to be no big deal and just "something to do with sugar", the truth is that diabetes is an illness with potentially devastating health effects. It can even be life threatening.

Put simply, diabetes is a condition where the body can no longer use and control glucose (sugar) — as a result diabetics have abnormally high blood glucose levels.

Normally, the body controls blood glucose levels with a hormone called insulin but in diabetics, either:

• the insulin doesn't work as well as it should, or
• not enough insulin is produced, or
• the body stops making insulin altogether.

The body tries to get rid of the dangerously high levels of glucose in the blood by passing it out in the urine, which is why people with untreated diabetes often urinate frequently and, consequently, can feel constantly thirsty. It also explains why the medical term for this condition, "diabetes mellitus", literally means "sugary fountain".

Left untreated, high blood glucose levels can cause major health problems:

• blindness
• kidney failure
• heart disease
• stroke
• and nerve damage (which can, in turn, lead to impotence)

The key to avoiding these complications is early diagnosis, effective treatment and good self-management.

There are two main types of diabetes, commonly called Type 1 and Type 2.

Type 1 diabetes

• Type 1 diabetes is also known as insulin-dependent diabetes. Type 1 diabetics lose the ability to make any insulin of their own. Of the two main types of diabetes, Type 1 is probably the best known, partly because it is most likely to develop in childhood and partly because people with Type 1 diabetes must inject insulin on a daily basis. It most commonly develops in people under the age of 40, often in childhood, but it can present at any age.

Type 2 diabetes

• Type 2 diabetes is also known as non-insulin-dependent diabetes. It develops when the body still produces some insulin, but not enough, or when the insulin no longer works properly. This is the type that affects the vast majority of diabetics (over 75%). Usually this type of diabetes appears in people over the age of 40 — because of this, Type 2 diabetes used to be known as "late" or "mature onset" diabetes.
• Type 2 diabetes develops slowly and the symptoms are less obvious. Consequently it is much harder to diagnose and, as a result, it is estimated that on average people will have Type 2 diabetes for seven years before they are diagnosed.
• Type 2 diabetes is occasionally referred to as "mild" diabetes, even by GPs. This is dangerous nonsense — no form of diabetes is mild. Even though people with Type 2 diabetes don't always need insulin to treat their condition, Type 2 is in fact no less serious than Type 1. 

What are the main symptoms?

If you've developed diabetes and it isn't being treated you are likely to have some of the following symptoms, to a greater or lesser degree:

• General tiredness and lethargy
• Increased thirst
• The need to urinate all the time, especially at night
• Weight loss, especially in Type 1
• Itchiness, especially around the genitals
• Blurred vision

The symptoms are usually very visible in younger diabetics but may not be so obvious in older people. Unfortunately older people, and sometimes their GPs, may put any symptoms down to simply "getting on a bit".

If you have any of the above symptoms go and see your GP, as the earlier diabetes is diagnosed the better the chances of controlling it before it does too much damage. And don't be fobbed off — if you think you've got the symptoms, ask for a test.

Untreated or badly managed diabetes can cause even more serious short-term problems and long-term complications. 

What's the risk?

At least three in every 100 people in the UK will develop diabetes and 1.8 million people in the UK are thought to have had their diabetes diagnosed (an increase of 400,000 in just eight years). However, it is estimated that there is a "missing million" — people who have diabetes but just don't know it.

Nobody really understands what causes diabetes, but we do know that there are some clear risk factors. The main ones are:

• Being male. Men are one-and-a-half times more likely to get diabetes than women.
• Family history. The closer a relative with diabetes, the greater the risk of developing it yourself. At least 30% of Type 2 diabetics have a family history, although that's true of only 10% of Type 1 diabetics.
• Age. Up until about 75 years of age, the older you are, the greater the risk. The average age of diagnosis for Type 2 is 52 in people with no family history, or 51 in those with a family history.
• Ethnic background. People from Afro-Caribbean or Asian cultures living in the UK are four to five times more likely to develop diabetes than Caucasian members of the population.
• Weight and shape. Over 80% of Type 2 diabetics are overweight. The more overweight you are — and the less physical activity you do — the greater your risk of developing diabetes. In particular, central body fat (being "apple shaped" or having what's sometimes called "big belly obesity") is linked to Type 2 diabetes.

What causes it?

The causes of diabetes are still not fully understood, although scientists believe that it's probably down to a combination of inherited genetic factors, alongside some environmental triggers. What is known for certain is that, contrary to some people's medieval beliefs, diabetes cannot be caught off somebody else.

Type 1

Type 1 diabetics cannot produce any insulin of their own. This is because the insulin-producing islets of Langerhans in the pancreas have been destroyed. Nobody knows for sure why this happens in some people and not in others, but it is most likely due to some abnormal reaction in the body, perhaps triggered by a viral infection.

Type 2

The great majority of cases of Type 2 diabetes are caused by a combination of resistance of the body to its own naturally produced insulin (this is known as "insulin resistance") and malfunction of the insulin-producing cells of the pancreas. Insulin resistance occurs very early in the disease process and is associated in particular with obesity and a lack of exercise. If someone can produce sufficient quantities of insulin from the pancreas to overcome the insulin resistance then diabetes does not develop. If the pancreas cannot compensate for the insulin resistance by producing sufficient quantities of insulin then diabetes will develop.

There is also a debate over a cluster of risk factors known as metabolic syndrome which appears to increase the risk of both diabetes and heart disease. The risk factors involved are: high blood pressure, central obesity (ie. being 'apple' rather than 'pear' shaped), high levels of triglycerides, low levels of high density lipoprotein (HDL or 'good' cholesterol). Some researchers believe that insulin resistance is the underlying problem in metabolic syndrome. What's not yet clear is whether tackling metabolic syndrome is a better way of beating diabetes than addressing individual risk factors like obesity. 

How can I prevent it?

You can reduce your risk by:

• Being physically active
• Keeping to a healthy weight for your height
• Eating a healthy and balanced diet, including lots of fruit and vegetables and less fat

It may turn out that low carbohydrate diets are useful intreating diabetes, but the clinical evidence for this is currently a bit limited. However, the high fat/high protein components of some low carb diets are unlikely to be helpful to people with diabetes and extreme versions of these should be avoided. 

Should I see a doctor?

If you think you have the symptoms of diabetes you should see your GP, and if you already have diabetes, you should have a regular check-up at least once a year.

The earlier diabetes is diagnosed and treated properly, the better your chances of avoiding life-threatening and disabling diabetic complications. Diabetes is not a condition to be macho about, because if you don't look after yourself — getting help where and when it's needed — diabetes will clobber you.

The process of diagnosing diabetes is actually very straightforward — your GP or practice nurse will take a tiny drop of your blood or carry out a urine test to check your glucose levels.

What are the main treatments?

Diabetes cannot be cured, but it can be treated very successfully. The main aim of all treatments is to keep blood glucose levels within a normal range.

Diabetes is a progressive condition, which means that it is likely to get worse over time (though this progression can be slowed down with treatment). Studies have also shown that people who begin taking medication as soon as they need it are less likely to suffer diabetic complications.

Treating Type 1 diabetes

• Type 1 diabetics have to rely on daily insulin injections for the rest of their lives. Because insulin is destroyed by the digestive juices in the stomach it cannot be taken by mouth and must be injected. Typically, Type 1 diabetics inject insulin two or four times a day.
• As well as controlling blood glucose levels, there is growing emphasis on keeping blood pressure levels within normal limits, using tablets if necessary.
• In addition to insulin injections and, where needed, blood pressure tablets, Type 1 diabetics must eat a healthy diet  and should stay physically active.

Treating Type 2 diabetes

Type 2 diabetics can manage their diabetes in a number of ways:

• Healthy diet and physical activity alone.
• Healthy diet, physical activity and tablets.
• Healthy diet, physical activity and insulin injections.

If tablets are prescribed, they will either:

• help the pancreas produce more insulin, or
• help the body make better use of the insulin which is produced, or
• reduce the speed at which the body absorbs glucose from the intestine.

Type 2 diabetics also need to make sure their blood pressure is within the normal range. If it does creep above a safe level, it should be treated immediately.

People with both Type 1 and Type 2 diabetes are also more likely to have an increase in their blood fats, and it is particularly important that these are checked; if cholesterol is raised, this may need both dietary and tablet treatment. 

How can I help myself?

Diabetes is not a condition you can ignore. To avoid diabetic complications you've got to look after yourself — good diabetes care is all about self-management. Although you'll probably have to make some changes to your lifestyle, you should be able to continue enjoying a normal, day-to-day life.

Here's what you need to do:

• Follow a healthy diet.
• Quit smoking. You may think that smoking is one of your last pleasures, but smoking is probably the worst thing you can continue with since it further increases an already heightened risk of developing heart disease.
• Get physical. The fitter you are, the easier it is to control your diabetes.
• Follow your treatment plan. Don't be tempted to miss out on your treatment, whether that's diet, medication or physical activity. You should be aiming to keep your blood glucose and blood pressure levels as near to normal as possible.
• Have regular medical check-ups. Everyone with diabetes should have a thorough medical check-up at least once a year. Diabetic complications such as eye disease can be caught early on before any symptoms are obvious, and can be treated very successfully. Your annual check-up should test:
  • Blood glucose
  • Blood pressure
  • Kidney function (including a urine test for protein which may be an early indicator of diabetic kidney disease)
  • Cholesterol levels
  • Weight
  • Legs and feet for skin and circulation problems
  • Eyes
  • Insulin injection sites
  • The blood for glycated haemoglobin (HbA_1c), which gives an indication of overall diabetic control over the previous six weeks 

What's the outlook?

While there's no cure for diabetes, if it's well managed this will reduce the risks of the ill health and complications which are so often associated with diabetes. The key is early diagnosis, early detection of any complications, and taking responsibility for the management of your own health. 

Who else can help?

• Diabetes UK - For information and advice on all aspects of diabetes (Tel: 020 7424 1000)
• Sexual Dysfunction Association - For information and advice on all sexual dysfunction (Tel: 0970 774 3571)
• Royal National Institute for the Blind (RNIB) - Tel: 0845 766 99 99 (open Monday to Friday, 9 am—5 pm)

First drafted by John Isitt, a health journalist specialising in diabetes. Updated by malehealth for 2005.

Have your say about diabetes

Have you been affected by diabetes? If so, we'd like to hear about your experience and to post it on the malehealth.co.uk site. This could be useful to other men who are also affected by this problem. Please note, we cannot answer any queries posted here.