What is diabetes? 

Diabetes happens when the level of glucose (sugar) in the blood is too high because the body is unable to use it properly. This is because the body’s method of converting glucose into energy is not working, as it should.

There are two types of diabetes

  • People with type 1 diabetes do not produce any insulin.
  • People with type 2 diabetes do not produce enough insulin, or their cells lose the ability to use the insulin.

Diabetes can present with various symptoms such as thirst, passing more urine than usual, particularly at night, tiredness, unexplained weight loss and blurred vision. Sometimes people are not aware of their condition, as they never have tested for it. It is commonly diagnosed when patients have tests for other problems, such as heart disease, kidney disease and stroke. The good news is that you can prevent, delay or reduce these problems by lifestyle changes and managing your diabetes well.


What is diabetes?

Diabetes happens when the level of glucose (sugar) in the blood is too high because the body is unable to use it properly. This is because the body’s method of converting glucose into energy is not working as it should.

Glucose is produced when our body digests starchy foods such as bread, rice, potatoes, and sugar and other sweet foods. The liver also makes glucose. The blood carries glucose to all the cells.

A hormone called insulin helps the glucose to enter the cells, where the body uses it as a fuel. Insulin is made in the pancreas – a large gland that lies behind the stomach. As the insulin lets the cells take glucose out of the blood, the amount of glucose left in the blood goes down.

There are two types of diabetes.

  • People with type 1 diabetes do not produce any insulin.
  • People with type 2 diabetes do not produce enough insulin, or their cells lose the ability to use the insulin.

In people with diabetes, the cells become starved of glucose because they cannot get it from the blood. At the same time, because the glucose cannot get into the cells, the level of glucose in the blood goes up.

Type 1 diabetes

Type 1 diabetes is less common than type 2 diabetes and it usually develops in children and young adults. Type 1 diabetes probably happens because the body’s own immune system (the cells that fight infection) attacks the pancreas and destroys its ability to make insulin. The cause of this is probably viruses or other infections, but nobody is really sure.

Type 2 diabetes

Most people with diabetes – about nine out of every 10 – have type 2 diabetes. This condition tends to develop gradually after the age of 40. many cases obesity is closely linked to type 2 diabetes and this may be an important factor in the increasing number of cases of type 2 diabetes.

It is a worrying trend that, in recent years, type 2 diabetes is being diagnosed more and more in younger people, and even in children. It seems that this is largely due to the fact that children these days lead less active lifestyles.

Both genetic and environmental factors contribute to the development of diabetes. People are more likely to develop type 2 diabetes if they have some or all of the following risk factors:

  • not being physically active enough
  • being overweight
  • a family history of type 2 diabetes
  • previous diabetes in pregnancy (gestational diabetes).

The risk of developing type 2 diabetes can be significantly reduced by lifestyle changes which increase physical activity and reduce body weight.

What are the symptoms of diabetes?

In type 1 diabetes, symptoms develop quickly over a few weeks. However, in type 2 diabetes the symptoms often develop gradually over many years and so you may not think they are abnormal.

Different people develop different combinations of symptoms. The range of symptoms for both types of diabetes are:

  • thirst
  • passing more urine than usual, particularly at night
  • tiredness
  • unexplained weight loss
  • blurred vision
  • itching in the genital area (or regular episodes of thrush).

These symptoms are the direct result of having too much glucose in the blood and not enough in the cells. However, over many years, the high levels of glucose can also damage many different parts of the body:

  • in the heart and blood vessels, causing coronary heart disease, strokes and peripheral arterial disease (disease of the arteries that carry blood to different parts of the body such as the legs).
  • in the eyes, causing reduced vision and sometimes leading to blindness
  • in the kidneys, which gradually work less well
  • in the feet, causing ulcers
  • in the nerves, causing many symptoms such as loss of sensation (especially in the feet and legs), pins and needles, and sexual impotence.

The good news is that you can prevent, delay or reduce these problems by lifestyle changes and managing your diabetes well. Good management includes keeping good control of your blood glucose and blood pressure levels, and going for a review each year.

How is diabetes diagnosed?

If you have some of the risk factors for diabetes, you should ask your doctor for a simple screening test to see whether you have diabetes.

Remember, even if you don’t have any symptoms, you may still have diabetes.

You are likely to have diabetes if you have diabetes symptoms (passing a lot of urine and being very thirsty) and unexplained weight loss.

If you don’t have any symptoms of diabetes, your doctor should not diagnose diabetes on the basis of just one blood glucose measurement, so he or she will ask you to go back for another test on another day.

Why does diabetes affect the heart?

Diabetes seems to act in several ways to damage the heart.

  • High glucose levels in the blood affect the walls of the arteries, making them more likely to develop atheroma.
  • Diabetes increases the damage done by the major coronary heart disease risk factors of smoking, high blood pressure and high blood cholesterol.
  • People with type 2 diabetes often have higher triglyceride levels and lower levels of HDL cholesterol (the ‘protective’ type of cholesterol).
  • People with diabetes are more likely to have high blood pressure.
  • Diabetes can affect the heart muscle itself, making it a less efficient pump.
  • Diabetes can affect the nerves to the heart, so that symptoms of angina may not be felt in the usual way. This leads to delay and difficulties in diagnosing angina and heart attacks.

What can I do to reduce my risk of coronary heart disease?

Your doctor can work out your risk of developing coronary heart disease by using a special chart, and will show you how you can reduce your risk by lifestyle changes and effective treatment.

Your doctor will prescribe medicines to treat some of the risk factors that you may have. For example, he or she may give you medicine to lower your blood cholesterol level. Diabetes alone is considered a significant risk factor for coronary heart disease so, if you have diabetes, you will probably be given medicines to reduce your risk of coronary heart disease – such as aspirin to reduce the risk of blood clotting.

Controlling blood glucose and blood pressure well is essential for preventing the long-term problems of diabetes, such as damage to the eyes, kidneys and feet. However, this is not enough to prevent coronary heart disease. The major risk factors for coronary heart disease need to be controlled by a combination of effective treatment and the following lifestyle changes.

Be more physically active

Physical inactivity is not only a major risk factor for coronary heart disease; it is also a risk factor for developing type 2 diabetes. If you already have diabetes, physical activity may help to reduce the amount of tablets or insulin that you need to take.

The aim is to gradually increase your physical activity until you are doing 30 minutes of moderate intensity activity on at least five days a week. Moderate intensity means activity that makes you feel warm and breathe slightly more heavily than usual. The type of activity that helps both your heart and your diabetes is moderate, rhythmic exercise such as brisk walking, cycling or swimming. Walking is one of the best forms of activity. It’s easy to do, you don’t need to wear any special clothes, and it’s easy to fit into your everyday life. There are many different ways to be more physically active and it’s important to find activities, which are safe and right for you. You may be asked to have an exercise ECG test, either on a treadmill or a stationary bike. This will help your doctor to work out how much activity you can do safely at first.

If your diabetes is treated with insulin or tablets, you may find that your blood glucose level falls quickly during or after exercise. It is important to monitor your blood glucose carefully as you start to build up your level of physical activity because you may need to change the dose of your medication. Your doctor can advise you about this.

You should always have some form of fast-acting carbohydrate with you when you take exercise, such as glucose tablets or a sugary drink, in case your glucose level falls.

  • When you are doing any physical activity or sport, begin slowly for the first few minutes and build up gradually. At the end, spend a couple of minutes slowing down gradually.
  • Stop if you get any pain or feel dizzy, sick or unwell, or very tired.
  • Build up your activity level gradually.
  • Dress warmly when doing any physical activity in very cold or windy weather.

What treatment do people receive for diabetes?

If you have type 1 diabetes, your doctor will need to start treating you with insulin straight away.

If you have type 2 diabetes, the first line of treatment is normally to try and lose weight, become more physically active and eat a more healthy diet. Your doctor or nurse will help you with this.

Some people may need to take medicines for their diabetes. There are different kinds of medicines that work in different ways. Your doctor will explain which medication is best for you. Many people with type 2 diabetes eventually need to have insulin injections to control their diabetes, but this is unlikely to happen when you are first diagnosed.

Keep control of your blood pressure and Cholesterol levels. For more information on how to achieve this, see the relevant pages in this website.





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