I’ve been a hospital doctor now for 20 years, and I began my specialist training in Diabetes and Endocrinology in 2004. There is no doubt that things have changed a great deal over the years. When I started we were really very limited in what we could do for people with Type 2 Diabetes other than a generally healthy diet, a small selection of medications and failing that, insulin injections.
Additionally, the kind of people who develop Type 2 Diabetes has changed. When I started training it tended to be mainly middle aged or elderly people, but over the years, in conjunction with the increasing problem of obesity in wider society the people we are treating have got younger. Now we even have a small number of people with Type 2 Diabetes in our adolescent clinic.
I have several families of people with Type 2 Diabetes. A typical scenario might be something like this:
Granny is overweight and developed her diabetes in her 60’s. Her daughter became overweight at a younger age and developed her diabetes in her 40’s. Subsequently her grandchildren have been overweight since childhood and one of her grandsons has been diagnosed with diabetes in his 20s.
The problem is not just diabetes itself, although it can make you tired, thirsty and miserable. The bigger issue is the damage it can do to you over the decades if it isn’t under adequate control. Imagine our granny, who we mentioned above. Let’s say she didn’t worry too much about her diabetes and her blood sugars were consistently high over the years. She didn’t really run into problems at all until a decade later. She still felt alright however when she went to her clinic appointments, her doctors were beginning to mention things like “small amounts of protein in the urine” and “ some dots on the back of the eyes”. Over the next 10 years she still didn’t worry too much about her diabetes and eventually died in her mid-80’s of something unrelated.
If you can consider her daughter who developed diabetes in her 40’s. She has potentially 40 or 50 years of diabetes in front of her and therefore much more time to develop related problems. The same applies to an even greater degree to her grandchildren who, if their diabetes is uncontrolled may develop complications in their 30’s and 40’s.
You can see just how vital it is that diabetes is managed carefully. You can probably also see why it is easy for people to put it to the back of their minds – they feel alright on a day to day basis, and the problems they may have to deal with are decades in the future.
The last few years have been exciting in terms of approaches to diabetes. We already know we can reduce long-term risk hugely through good control and attention to other related issues like blood pressure and cholesterol levels. We have a variety of new medication. However, most importantly there is increasing recognition generally of the massive positive effect that lifestyle change can make – often more so than any tablet that can be prescribed. Recent studies have even shown that in patients with relatively recently diagnosed Type 2 Diabetes losing around 15 kg in weight (2.5 stones) can reverse diabetes completely, at least in the short term.
