Early signs of diabetes to watch out for and how to reduce your risk

Celebrated on November 14 in honour of Sir Fredrick Banting, the co-founder of insulin, World Diabetes Day aims to raise awareness of a disease which is largely preventable.

Although Type 1 diabetes is largely the luck of the draw, Type 2 – a fast-rising form of the disease with strong links to obesity – can be avoided.

Diabetes has been referred to as the "fastest growing health crisis of our time", with the number of people in the UK diagnosed doubling in 20 years.

Nearly 3.7million people in the UK were known to have the condition in figures released in February 2018, with a further million thought to be unaware they are diabetic.

Untreated, diabetes can lead to amputations, blindness, kidney illness, stroke and heart disease, which puts a huge burden on the NHS.

But the good news is it can be reversed with changes to your diet and lifestyle.

Here we explain the differences between Type 1 and Type 2 diabetes, the symptoms and warning signs to look out for, and the treatments that can make a difference…

What is diabetes?

Diabetes occurs when the level of sugar (glucose) in the blood becomes higher than normal. This happens when the body can’t make the hormone insulin, or stops responding to it.

How to test for diabetes

The standard test is first for glucose in urine. If it is found, a special blood test – glycated haemoglobin (HbA1c) – is used to check the level of sugar in your blood. It shows the average level over two to three months, can be done at any time of day and does not need any special preparation, like fasting.

A 2014 study by the University of Manchester and King’s College London claimed Type 2 diabetes could be diagnosed far earlier by examining proteins in the blood – with hopes the new blood test could be developed in five years.

Signs and symptoms to look out for

    Watch out for the four Ts:

    • Toilet: Going to the toilet a lot, or a previously dry child wetting the bed.
    • Thirsty: Being really thirsty and not being able to quench your thirst.
    • Tired: Feeling more tired than usual.
    • Thinner: Unexpected weight loss or looking thinner than usual

    Other warning signs

    • Getting up in the night to go to the toilet
    • Dry mouth
    • Blurred vision
    • Recurrent infections
    • Itching around your genitals, or frequent bouts of thrush
    • Cuts or wounds that are slow to heal

    What is the difference between Type 1 and Type 2 diabetes?

    Type 1 is rarer and something you’re born with. Sufferers can’t make insulin, the hormone which controls blood sugar, as the cells that produce it are destroyed. They need to inject insulin.

    While it typically strikes in teenagers, it can affect anyone, usually up to the age of 40. It is not necessarily hereditary or genetic and it is not always clear why this happens to people later in life. In some cases, it could be caused by the body’s reaction to a virus or other infection. Symptoms tend to come on quickly, with the condition developing over weeks or even days.

    It’s Type 2 diabetes that’s causing the epidemic – representing nine out of 10 cases. It is caused when the body cannot produce enough insulin or the insulin does not work properly.

    It’s generally triggered by lifestyle factors, mainly obesity, but a family history of the condition also makes you more at risk. Many people have the condition for years without realising.

    What is pre-diabetes?

    Pre-diabetes means your blood sugar level is higher than normal. It is not yet high enough to be considered diabetes – but it does mean you are at risk of developing diabetes.

    Simple lifestyle changes can make a massive difference.

    Dr Ralph Abraham, one of the UK’s leading diabetes experts warns: “If you have prediabetes, there are no symptoms, and a shocking number of people are sleep-walking towards developing full diabetes and serious health problems.”

    Diabetes specialist Dr Gill Jenkins says: “This level of denial can be deadly. Ignoring it doesn’t make it go away. Diabetes damages blood vessels, destroys sight and undermines almost every aspect of your health until one day there is a crisis and it becomes impossible to ignore.”

    What happens if you have untreated diabetes?

    Left untreated, diabetes leaves high amounts of glucose in the body, which can damage your blood vessels as well as your nerves and internal organs.

    This can cause heart disease, stroke, vision problems and damaged nerves in extremities, such as the feet, which can lead to gangrene and even amputation.

    How is diabetes treated?

    The aim of treatment is to keep a steady blood sugar level – type 1 needs to be treated with insulin injections for the rest of the patient’s life. It’s also important to eat at regular intervals to maintain a steady blood-sugar level.

    You also need to carry out regular blood tests throughout the day to monitor blood-sugar levels.

    If blood sugar falls too low, there’s a danger of hypoglycaemia, known as a hypo, where you can end up unconscious. On the other hand, if it gets too high, you can develop diabetic ketoacidosis (DKA), which needs emergency hospital treatment and can lead to a coma.

    Type 2 is a progressive condition, but research in 2011 found a low-calorie, healthy lifestyle can reverse the symptoms and keep the condition at bay.

    As a patient loses weight, the body draws upon its own stores of fat to burn, clearing fatty deposits within the pancreas and liver which can otherwise interfere with insulin secretion and normal insulin action.

    Holby City and Hollyoaks director Eddy Marshall was warned he would be diabetic for the rest of his life – but was removed from the register after trialling the Back to Basics diet.

    Whether you have pre-diabetes or the condition is established, making alterations to your routine can still lower the chance of developing some of the nastier complications, such as heart attack, stroke, kidney failure and blindness.

    The main treatment to normalise Type 2 diabetes is to lose weight. But some people may need to take medication, usually the tablet metformin.

    Dr Jenkins says: “The truth is that diabetes can be controlled and when it is managed many of the associated risks are reduced. But if it’s poorly managed or simply not diagnosed, it can have a devastating impact on the quality and length of your life."

    Researchers from Newcastle University have supported the lifestyle approach with a recent study proving established diabetes can be reversed by following a very low-calorie diet.

    Weight loss surgery available on the NHS

    Bariatric surgery – a gastric band or gastric bypass – has been found to cure more than 80% of people with type 2 diabetes and is already offered on the NHS to diabetes patients with a BMI of more than 35.

    People recently diagnosed, particularly with a South Asian background, may be assessed and considered as candidates for bariatric surgery even if their BMI is below 35.

    However lifestyle changes are even more effective if you make them early enough to avoid the need for treatment altogether.

    How to spot a hypo

    Symptoms of a hypo (low blood sugar) include:

    • Shaking
    • Sweating
    • Feeling hungry
    • Feeling tired,
    • Having blurred vision
    • Having pins and needles around the mouth
    • Difficulty concentrating
    • Headaches
    • Feeling tearful or irritable
    • Eventual loss of consciousness.

    If this happens, the sufferer needs to eat and rest until blood sugar stabilises.

    How to spot a hyper

    Symptoms of a hyper (high blood sugar) include:

    • Breath smelling like pear drops
    • Feeling thirsty and needing to wee a lot
    • Headaches
    • Extreme tiredness
    • Stomach pain
    • Nausea and vomiting
    • Deep, rapid breathing
    • Drowsiness
    • Eventual unconsciousness.

    If someone with diabetes vomits, has deep, rapid breathing and is drowsy, they could have developed diabetic ketoacidosis (DKA) and need urgent hospital treatment.

    Supporting children with diabetes

    Dr Miriam Stoppard says:

    Give them plenty of support: They may feel different and isolated so be aware of any signs your child isn’t coping. Make sure their friends – and their parents – know about their condition and what to do in an emergency.

    Make sure the school knows what to do: It’s vital that the school is informed about your child?*s condition and how it affects them – for example, that they may need to eat in class if they feel a hypo coming on. Ideally, a member of your child’s diabetes care team should visit the nursery or school.

    Avoid complications: From the age of 12, make sure your child has a comprehensive health check at least once a year to avoid possible complications such as damage to eyes, feet, kidneys and circulation.

    Help them stay healthy: The healthier their diet, and the more they active they are, the better placed they are to avoid complications later.

    Top tips to lower the risk of developing diabetes

    Obesity is the leading cause of Type 2 diabetes. In February 2018 it was estimated 12.3 million people in the UK were at increased risk of developing it.

    When it comes to reducing your chances of developing diabetes, research shows the following simple self-help methods make a big difference…

    Shed some weight

    Factors such as genetics and ethnicity play a part, but obesity is by far the biggest trigger for diabetes. Losing excess weight means your risk goes right back down. If you can shed just 5-10% of your body weight, you can lower your risk of diabetes by 60%.

    Get moving

    Exercise can lower the high blood sugar levels that cause diabetes. Just five, 40-minute brisk walks a week cuts your risk of the condition by almost a third, provided you walk fast enough to raise your heart rate. High intensity mini workouts can also help.

    Researchers at Heriot Watt University in Edinburgh reported substantial benefits when volunteers did sprint sessions on an exercise bike three times a week. That was a total of just six minutes!

    Change your diet

    A study published in the British Medical Journal found that sticking to the traditional Mediterranean diet, which includes plenty of fruit and vegetables, lean meat and fish, wholegrains, nuts and pulses, with a moderate amount of milk and dairy foods, can reduce your risk of developing the disease by more than 80%.

    Blitz your belly

    Although your overall weight is important, losing inches around the waistline is now thought to be the crucial thing when it comes to preventing diabetes (see The risk factors). This is because excess fat around the middle gathers around the liver and pancreas and damages the body’s regulation of blood sugar.

    Ditch sugary drinks

    Swap fizzy drinks and fruit juices for water or tea and you can save 200-300 calories a day, which is enough to encourage weight loss, before you’ve even thought about changing what you eat.

    Stop smoking

    Smoking increases your risk of diabetes by 40% – the more you smoke, the more likely you’ll get it. Speak to your GP about giving up.

    Are you at risk of developing diabetes?

    • Are you overweight and over 40? Medium risk.
    • Does anyone in your family have diabetes? Medium to high risk.
    • Are you black or South Asian? High risk. These ethnic groups are more prone to diabetes, so problems start at a lower weight threshold – even being just a little overweight can be enough to make the difference.
    • Do you have high blood pressure? Medium – or high if you answered yes to any of the previous questions.
    • Did you have gestational diabetes while pregnant? Medium – or high if you answered yes to any of the previous questions.

    Famous people with diabetes

    Prime Minister Theresa May has Type 1 diabetes and injects insulin five times a day to manage the condition.

    Labour MP Diane Abbott revealed her Type 2 diabetes forced her to take a break from campaigning during the 2017 general election.

    Where to get advice

    • Speak to your GP
    • Contact the Diabetes UK careline on 0345 123 2399 or visit www.diabetes.org.uk
    • Visit the NHS website

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