Am I at risk of diabetes? How to spot the signs
Around 1.3 million people in the UK have undiagnosed diabetes and 12.1 million are prediabetic. We explain the warning signs and how to tell if you are at risk.
Around 1.3 million people in the UK have undiagnosed diabetes and 12.1 million are prediabetic. We explain the warning signs and how to tell if you are at risk.
First of all, what is diabetes? Diabetes is a condition where your blood glucose (sugar level) is too high because your body can’t make enough (or any) of the hormone insulin, or the insulin you are producing isn’t working well.
It’s estimated that more than 5.8 million people in the UK have type-1 or type-2 diabetes, including 1.3 million who are undiagnosed for type-2, according to the charity Diabetes UK. Around 1.5 million people living with diabetes in the UK are over the age of 65.
There are also 12.1 million adults living with prediabetes, with blood sugar levels higher than normal, but not high enough to meet the threshold for a type-2 diabetes diagnosis, but who are at risk of developing it.
According to new research from the York Health Economics Consortium, diabetes costs the NHS around £10.7 billion a year – 6% of the UK health budget and is predicted to rise to £18 billion by 2035.
“There are two main types of diabetes, type 1 and type 2,” explains Emma Pike, deputy head of clinical at Diabetes UK. Type 2 makes up 90% of cases, Type 1 about 8% and other rare types 2%.
“Unfortunately, it’s a condition where a lot of stigma persists” says Pike, citing a YouGov poll which found that 86% of people with type 1 and 75% with type 2 say they experience blame and judgement for their condition.
“Type 1 is an auto immune condition where your body’s own immune system attacks the cells that produce insulin in the pancreas, causing blood sugar levels to increase,” says Pike.
Type 1 is most commonly diagnosed in childhood with symptoms appearing within days or weeks, but it can occur at any age, including in your seventies and eighties.
Although type-1 diabetes can run in families, many people develop it without any family history.
Some studies suggest that certain viral infections can accelerate or trigger type 1 in people with a genetic predisposition.
“Type-1 diabetes symptoms have a much more sudden onset than type 2,” says Dr Parijat De, a consultant physician specialising in diabetes at the private HCA The Harborne Hospital and the NHS Midland Metropolitan University Hospital.
“These will usually come on in a matter of days and weeks, due to lack of insulin produced by the body and it can have a dramatic effect.”
Dr De says that the symptoms of diabetes fall under the four Ts:
“A lot of symptoms can be nonspecific including dry mouth and blurred vision, as well as recurrent infections such as thrush, urinary tract and skin infections, and cuts taking longer to heal, and can have other causes,” says Dr De.
Another symptom is breath that smells fruity (similar to pear drops). This can be one of the signs of diabetic ketoacidosis (DKA), when the body breaks down fat for energy instead of glucose. Other symptoms of DKA can include nausea and vomiting and abdominal pain, as well as increased thirst and needing to pee more, confusion and passing out.
DKA is a medical emergency that needs treatment with insulin, IV fluids and electrolytes in hospital.
Because your body is not producing insulin, insulin replacement therapy is necessary with either injections or insulin pumps, small electronic devices that deliver insulin throughout the day.
There are also hybrid closed-loop systems (an artificial pancreas) which link up continuous glucose monitoring (CGM) with insulin pumps, automatically adjusting insulin levels. These are now being rolled out by the NHS in England for specific groups, a world first.
“In type-2 diabetes, blood glucose levels are high due to the body not producing enough insulin, or the insulin does produce not working properly,” says Pike.
Type-2 diabetes is more common in adults but there has been an increase in the number of children being diagnosed with the condition. It can go undiagnosed for years as sometimes there are no symptoms or people don’t notice them.
Dr De says the symptoms of type 2 can be similar to type 1.
“The key thing is that they will have a much slower onset than those of type 1,” explains Dr De. “They can go unnoticed for a long time – you can live with prediabetes for years as prediabetes doesn’t have any symptoms. Part of the problem is that some of the symptoms such as tiredness are very common and may be caused by other medical conditions, or in older people just put down to getting older.”
Dr De adds: “The fact that many people with type-2 diabetes can remain asymptomatic for a long time doesn’t help the situation.”
The most common symptoms of type-2 diabetes include excessive thirst, needing to pee more, extreme tiredness and unintended weight loss (without dieting). People with type 2 are generally (but not always) overweight or obese.
Other symptoms may include dark patches developing in the folds of the skin such as the armpits, itchy skin, candida albicans yeast infections under the breasts and around the groin, recurrent urinary tract infections, as well as fatigue and mood changes and blurred vision.
Risk factors for developing type-2 diabetes include:
Diabetes UK lists other risk factors including smoking; a history of gestational diabetes (a type of diabetes that happens only during pregnancy); a history of heart attack or stroke; some medical conditions such as polycystic ovary syndrome (PCOS), a hormone disorder which affects the ovaries; and some mental illnesses such as bipolar, schizophrenia, or depression.
“One myth is that developing type-2 diabetes is related to eating too much sugar, but this is not the case,” says Dr De.
“It’s all about your overall diet, how active you are, and how you metabolise sugar and whether your body has enough insulin to dispose of that excess sugar adequately, as well as insulin resistance where the insulin your body produces doesn’t work as well.”
Lifestyle changes for managing type-2 diabetes include increasing activity to at least 2.5 hours a week of moderate intensity, eating a healthy diet, limiting alcohol to within safe limits, quitting smoking, and managing weight.
Drugs prescribed for type-2 diabetes include metformin which lowers blood sugar by improving the way your body handles insulin, as well as sulfonylureas (e.g. gliclazide) to stimulate insulin production, and DPP-4 inhibitors (known as gliptins), which promote more insulin production.
Earlier this year the National Institute of Health and Care Excellence (NICE) recommended a group of drugs called sodium glucose co-transporter 2 inhibitors (SGLT-2 inhibitors) which not only lower blood sugar by helping the kidneys reduce excess sugar in the body, but also protect against heart failure and heart attacks. NICE advised that these should be prescribed as a first line treatment for all people with diabetes, not just those with heart disease. Research had shown that older people, women and Black people were less likely to be prescribed these.
Other drugs for type-2 diabetes include GLP-1 injectable drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro) to manage blood sugar but which also aid weight loss. Semaglutide also comes in tablet form (Rybelsus).
“The answer to that is yes, there is evidence from several high-quality trials that losing 10% to 20% of your bodyweight can lower your Hba1c levels and put the disease into remission,” says Dr De.
“This seems to work best in the first six years after diagnosis.”
The DIRECT trial which followed patients who were given a very low calorie meal replacement “soups and shakes” diet for three months, found that 46% were in remission from type-2 diabetes after one year, and 36% after two years. At five years, the original DIRECT intervention group still had an average weight loss of 6kg and 25% of those who were in remission at two years were still in remission at five years. This approach is now available on the NHS Path to Remission Programme.
“These days diabetes can be diagnosed with a straightforward non-fasting blood test called HbA1c,” says Dr De.
“HbA1c is a measure of the percentage of haemoglobin in your red blood cells that have glucose attached to it and can give you an average blood sugar figure over the past two to three months.”
Your blood sugar is normal if your HbA1c result is less than 42 mmol/mol, you are in the prediabetes zone if your reading is between 42 to 47, and have diabetes if your reading is 48 or above on two or more occasions over a two-week period.
Every week diabetes leads to more than 930 strokes, 660 heart attacks and almost 2,990 cases of heart failure.
“Diabetes can damage small and large blood vessels throughout the body, raising the risk of heart attacks, strokes and peripheral vascular disease where the arteries in the legs become clogged, which can lead to amputation,” says Dr De.
“It can also damage small blood vessels behind the eyes leading to diabetic retinopathy, (where the retina at the back of the eyes is damaged), those supplying the kidneys (diabetic nephropathy) and nerves, leading to nerve damage (neuropathy).
“This is why early diagnosis and good control of blood glucose levels with lifestyle changes and medication if needed, is so important.”
(Hero image credit: GettyImages)
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