Some 4.5 million people – around one in 16 – in the UK have diabetes, double the number 20 years ago. Six million, meanwhile, have persistently raised blood glucose, increasing their risk of Type 2 diabetes mellitus (T2DM).
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The condition occurs when excess glucose builds up in the bloodstream. It can cause everything from fatigue to serious damage to your eyes, heart, kidneys and more.
Type 1 diabetes usually affects children or young adults. The pancreas cannot produce insulin. Treatment, which is lifelong, involves injecting insulin with a ‘pen’ or via a pump.
Type 2 occurs when the pancreas either doesn’t produce enough insulin or the insulin doesn’t work properly (insulin resistance). It usually starts in later life. Family history, age and ethnic background increase risk, as does being overweight. Treatment involves a healthy diet and increased activity plus (often) tablets and/or insulin injections/pumps.
The good news is there’s mounting evidence that T2DM, until recently considered irreversible and progressive, can be reversed. As Dr Emily Burns of Diabetes UK observes, ‘We’re moving into an era where remission is a real possibility.’
Type 2 diabetes: what you need to know
Surgical solutions for type 2 diabetes
Strong research that suggests gastric bypass (bariatric) surgery, traditionally used to treat obesity, can send T2DM packing. It’s not known exactly how, but mechanisms may include strengthening nerve messenger signals that regulate glucose, changing gut bacteria, boosting bile-acid circulation to restore insulin sensitivity, and changing the action of ‘transport molecules’ that usher glucose from the gut into the bloodstream.
A trial of a knife-free operation recently began at London’s University College Hospital. Called the Revita procedure, it involves inserting a heated balloon, via an endoscope, into the small intestine, to destroy cells that are involved in glucose control. The effect is to ‘reboot’ the cells so they process glucose more effectively, putting diabetes into remission.
Weight loss surgery for diabetes
How hormones may help type 2 diabetes
Another reason for the success of bariatric surgery is thought to be that it triggers a rise in certain gut hormones. Scientists are now trying to harness the potential of these same hormones to put T2DM into remission – without the need for a full-blown gastric bypass. The two frontrunners are GLP-1 and PYY, hormones known to be involved in appetite control.
Researchers think they may improve the function of ‘pancreatic islets’, tiny cell clusters containing the cells that produce insulin. Diabetes UK is currently funding a major study, led by Dr Victoria Salem at London’s Imperial College, to find out whether a combination of gut hormones can mimic the effects of bariatric surgery.
What’s your risk of diabetes?
Can fast-track dieting help type 2 diabetes?
A Mediterranean diet can help regulate blood glucose.
Losing weight is key to T2DM control. ‘Excess visceral fat [found around the pancreas and other organs] makes the pancreas less sensitive to insulin and damages its ability to produce enough of it,’ says Douglas Twenefour, Diabetes UK deputy head of care. His organisation’s flagship Diabetes Remission Clinical Trial is due to report soon.
The aim of the study, led by doctors from Glasgow and Newcastle universities, is to investigate whether a fast-track 800-calorie-a-day soup and highly nutritious shake diet puts T2DM into remission – and whether it’s practical to deliver this on the NHS. Meanwhile, a Mediterranean diet can help regulate blood glucose and reduce heart disease risk.
8 foods that help regulate blood sugar
Keeping the pancreas healthy
Diabetes leads to too much glucose accumulating in the bloodstream but, in T2DM, the underlying culprit behind this surfeit is a group of ailing pancreatic cells, called beta cells, which produce insulin. It has become increasingly clear that these cells aren’t simply ‘sick’, they also start to lose their sense of ‘who’ they are and transform themselves into different kinds of cells.
A great deal of research is now going on into understanding exactly what causes this loss of identity and ways to prevent it from happening. And, says Dr Emily Burns, ‘In the future, this approach could have the potential to slow the progression of Type 2 diabetes, by keeping insulin-producing cells healthy.’
Do I have pre-diabetes?
How keeping fit helps reduce type 2 diabetes
Elizabeth Nevison, 71, from Middlesbrough turned her diabetes around thanks to an NHS exercise referral scheme.
‘I was horrified when the doctor told me I had Type-2 diabetes last March. And even more so when she prescribed a 12-week exercise programme at a nearby Everyone Active gym – never having set foot in such a place.
‘At first, I couldn’t stay on the treadmill for more than three minutes, but I now easily do 30. I’ve lost three stone and no longer have diabetes. I go to the gym three times a week and I’ve also dropped from an 18-20 dress size to a 12.’
Regular exercise can reduce incidence of T2DM by almost 60% in people at risk and improve the outlook for existing diabetics. ‘It’s thought to boost muscle cells’ sensitivity to insulin and improve glucose uptake,’ says Douglas Twenefour.
New research by Dr Jonathan Barlow of the University of Birmingham, meanwhile, aims to discover how biologically active compounds produced by muscles during exercise may ‘talk to’ the pancreas and whether this could be harnessed to maximise exercise benefits for people with diabetes. Although still at the lab stage it’s already proven that exercise can slow progression of T2DM, so it’s well worth getting those 30 active minutes a day.
Need encouragement? Ask your GP if there’s a local NHS exercise referral scheme. Alternatively, try the new free NHS Active 10 walking app.
Visit our fitness section for more ideas and inspiration
Towards more tailored treatment for type 2 diabetes
Scientists recently found that certain alterations in DNA can affect how people with diabetes respond to treatment.
A change in a gene called SLC2A2, which carries instructions for a protein instrumental in letting glucose in and out of cells around the body, disrupted the body’s ability to keep glucose stable in the blood stream. People with this problem responded especially well to the T2DM drug metformin.
Dr Burns is optimistic that a better understanding of the role of genes could lead to tailored treatments. ‘The advent of personalised treatments based on genetics has transformed cancer treatment. The hope is that it can do the same in diabetes,’ she says.
Eat less salt to help prevent type 2 diabetes
New Swedish research suggests that a high-salt diet may up the risk of T2DM.
New Swedish research suggests that a high-salt diet may up the risk of T2DM. The research from the renowned Karolinska Institute found that people with a high salt consumption (more than 7.9g a day) had a 58% higher risk of developing T2DM than those with low salt consumption (less than 6g, around a teaspoon a day).
Why? It’s thought that sodium may affect insulin resistance, where the body makes but can’t use insulin, which is the forerunner of diabetes.
The researchers found that a high-salt diet also increases the risk of another type of diabetes, latent autoimmune diabetes in adults, most often diagnosed in middle-age and later life.
The message? Skip salt in cooking and at the table - and remember a great deal of salt is found in processed foods, so cook meals from scratch.
10 signs that you are eating too much salt