I feel it’s really time I put together a few blog posts about Type 2 Diabetes as I spend a significant proportion of my working life thinking about it in one way or another.
I’m going to start today with basics – what is Diabetes and who gets it?
Before we start though it’s useful to go through what SHOULD happen when the body works normally. The body is really clever. When you eat starchy foods like potatoes, rice, pasta and breads- also known as carbohydrates- substances in your saliva and in your stomach break the foods down into sugar. The sugar from starches and from the other sugars you eat then passes from your gut into your blood-stream.
The brain, muscles and other cells in the body use sugar for energy. The liver turns sugar back into a special form of starch and stores it, in case you need extra energy but don’t have instant access to a food supply.
It’s at this point insulin comes in to the story. Insulin is produced by the pancreas – a long, thin organ situated in the abdomen behind the stomach. The pancreas releases insulin when sugar enters the blood. The job of insulin is to act as a key to the body’s cells to let the sugar get in.
The whole system is very clever and very precise when working normally. The sugar in the blood always sits between tightly controlled limits. It doesn’t get too low and it doesn’t get too high.
The problem arises when the system isn’t working properly. There are a number of reasons that this can happen.
In Type 1 diabetes – a type of diabetes that occurs more commonly in younger people – the insulin producing cells in the pancreas are destroyed to the extent that no insulin is produced at all. It usually occurs over a period of a few weeks. People develop very high blood sugars. Some of the excess sugar passes into the urine, taking lots of extra body water with it – they end up going to the toilet frequently, feeling extremely thirsty and potentially becoming dangerously dehydrated. The body can’t use sugar for energy as although the levels in the blood are high, without the insulin key, it can’t get it into the cells that need it so the body breaks down protein and fat instead. People can have dramatic weight loss and feel very tired. If it isn’t picked up at this stage they will become increasingly unwell and may end up admitted to hospital. Once insulin injections are started they will quickly feel much better. People diagnosed with type 1 diabetes will need insulin for the rest of their life – they will either give themselves several injections of insulin a day, or receive it through a pump.
Type 1 Diabetes occurs because antibodies in the blood attack the insulin producing cells in the pancreas. It tends to run in families. It is unrelated to the type of diet or lifestyle the person has.
In Type 2 diabetes the situation is a bit different. Initially most people do produce what would, under normal circumstances, be enough insulin. The problem that occurs is that the person’s body doesn’t have a normal response to insulin. They have what is known as insulin resistance. This means they need more insulin than usual for it to have the same effect. The most common cause of insulin resistance is being overweight – particularly what would be described as being “an apple”, ie. being overweight and carrying most of that weight around the abdominal area. There are other causes of insulin resistance, such as stress and certain medications. Someone with insulin resistance may be able to produce extra insulin to keep their sugars within the normal range for a certain length of time, but ultimately, the pancreas may stop working as well so the insulin levels can’t keep up with the high demands. If nothing changes at this point the person will gradually go from having normal blood sugars, to mildly abnormal blood sugars (a situation called prediabetes) and then eventually to developing type 2 Diabetes.
The process is usually a much longer, more gradual situation than it is in Type 1 Diabetes. People may not have any symptoms whatsoever – they may discover they have diabetes from a routine blood test. They may have symptoms like weight loss, passing more urine and increased thirst, but generally speaking the symptoms are not as marked and progress very slowly.
People with Type 2 Diabetes or Prediabetes may be able to get rid of it altogether by losing weight, which will make them less insulin resistant and allow the insulin they are making to work more effectively again. Losing weight also results in fat loss from the pancreas which allows it to work better as well. They may be able to control their diabetes and normalise their blood sugars by reducing the starches and sugars they eat in their diet. There are also a huge variety of medicines that can be used.
Sometimes, in people who have had Type 2 Diabetes for a long time, their insulin production gets lower and lower and they need more medication. Some people eventually end up on insulin injections. This doesn’t mean they have Type 1 Diabetes, they still have Type 2 Diabetes but need insulin to treat it.
Type 2 Diabetes also tends to run in families and is closely associated with overweight and obesity (which also tends to run in families). There are a proportion of people with Type 2 Diabetes who are a normal weight at the time of diagnosis but it’s much less common.
There are other less common causes of diabetes. For instance the pancreas can be damaged due to a medical condition called pancreatitis or it can occur in someone has had surgery to remove a large part of their pancreas. A number of medications can put people at increased risk of developing diabetes such as steroids, or some medications used for severe depression. There are rare genetic forms of diabetes, where many members of one family tend to develop it in the their teens, twenties and thirties. Women can develop diabetes during pregnancy, which then goes away again following the birth of their baby.
To make matters more complicated, Type 2 Diabetes was traditionally diagnosed in people in middle age or the elderly – now, because of the rise in obesity, we’re seeing it more commonly in younger people. Additionally sometimes Type 1 Diabetes develops in much older people and in people with weight problems. In older people sometimes it develops more slowly and the symptoms are less severe. It can be tricky even as an experienced diabetes specialist to know exactly what you are dealing with right from day 1.
I guess the take home messages from this post are-
Know the symptoms of diabetes:
- Passing urine frequently
- Weight Loss
Do your best to keep yourself as healthy as you can in terms of what you eat, being physically active and also in the other less obvious ways that we’ll talk about in further blogs like sleeping well, and stress reduction. This applies ESPECIALLY if you, like me, come from a family with lots of individuals with Type 2 Diabetes or body-weight issues.