Over the last few years, the diabetes crisis has been at the forefront of Britain’s health warnings, yet not enough people are aware of how serious the condition is and how devastating its complications are. As part of World Diabetes Day 2016, Simon O’Neill, Diabetes UK’s Director of Health Intelligence and Professional Liaison, joins us to talk about the devastating condition and its effects.
A lot of people seem to get confused about how you get diabetes, can you explain exactly what it is?
There are two main types of diabetes. Type 1 diabetes occurs when the body destroys the insulin producing cells in the pancreas. This is an autoimmune disease and we don’t really know why some people get it but we do know it is unrelated to diet or lifestyle. Type 2 diabetes occurs when the body can’t make enough insulin, or when the insulin it does make is unable to work effectively. Although it does run in families, Type 2 diabetes is often related to lifestyle factors, such as being overweight.
Both types of diabetes however lead to blood sugar (also known as blood glucose) levels rising too high. This can cause short and long term complications and keeping blood sugar, blood pressure and cholesterol levels under control are the main aims of treatment to prevent those complications.
“There are an estimated 4.5 million people in the UK walking around with diabetes, and another 12 million are at risk of developing Type 2. Type 1 diabetes accounts for just under 10 per cent of all people with diabetes, but the vast majority, approximately 89 per cent, are Type 2.
“Diabetes presents itself in many different forms. Although Type 1 and Type 2 are the most discussed there are other rarer forms too. The small percentages of people affected may be misdiagnosed, and as a result, are not getting the correct treatment for their condition, and over many years Diabetes UK has funded significant research to help us better understand these conditions and how to treat them.”
What are these other forms of diabetes?
“They are far too complex to go into real detail, but here’s a brief overview.
“Gestational diabetes affects pregnant women, usually during the second or third trimester. These women don’t have diabetes before their pregnancy, and after giving birth it usually goes away. In some women, diabetes may be diagnosed in the first trimester, and in these cases the condition most likely existed before pregnancy.
Maturity onset diabetes of the young (MODY)
“MODY is a rare form of diabetes which runs strongly in families and is caused by a mutation in a single gene. If a parent has this gene mutation, any child they have has a 50 per cent chance of inheriting it from them. If a child does inherit the mutation, they will generally go on to develop MODY before they’re 25 whatever their weight, lifestyle, ethnic group etc.
“Neonatal diabetes is a form that’s diagnosed under the age of six months. It’s a different type of diabetes than Type 1 as it’s not an autoimmune condition (where the body has destroyed its insulin producing cells) but is caused by a change in the gene which affects insulin production.
Wolfram Syndrome and Alström Syndrome are other less common, but more complex types of diabetes.”
Find out more about different types of diabetes.
So, we know Type 1 and Type 2 diabetes are the most common; how do people manage the condition?
“Managing blood sugar levels well will help you keep on top of your diabetes. As people with Type 1 don’t produce any insulin, they will need to take a synthetic version to do this. People with Type 2 may be able to control their diabetes initially with changes to diet and exercise, but the majority will need one or more tablets and many will go on to need insulin. The best way of ensuring that you are on top of your diabetes is by testing your blood sugar throughout the day, particularly before meals.
“It’s important to aim to keep blood sugar levels as near as possible to the normal range. For people with Type 1 diabetes, NICE recommend levels of 4-7mmol before eating. However, blood sugar targets should be based on the individual, their lifestyle and their risk of low blood sugars, so it’s important for the person with diabetes to agree individual target levels with their diabetes team.”
Can you tell us more about testing for those who are insulin treated?
“Self-monitoring can be a great way to help control blood sugar as it allows flexibility in lifestyle and treatment choices, as well as helping to monitor for symptoms of hypo- or hyperglycaemia (very low or very high blood sugar levels). Some people with diabetes (but not all) will test their blood sugar levels at home gaining an accurate picture at the time of the test. There are a few different ways of testing, with new technology constantly being developed.
Traditionally, people generally tested their blood sugar at home by pricking the side of their finger and putting a drop of blood on a testing strip. This could then be read visually to get an indication of the blood sugar level. Nowadays, most people who test use a blood sugar meter to keep on top of diabetes management. These give a faster and more accurate result and many also keep a record of your blood sugar readings. Some manufacturers have even produced software allowing users to look at trends in their sugar levels.
“Choosing a meter can be quite complex as new products are coming on to the market all the time. It's essential that insulin treated people are taught how to carry out tests properly and can operate their equipment as poor technique may lead to incorrect results, which could lead to inaccurate medication dosing. Diabetes UK also recommends that people check with their GP before purchasing a meter, as some GPs will only prescribe test strips for certain meters.
“If you are treated with tablets or insulin for your diabetes, you should be able to get test strips free on prescription, however, Diabetes UK are aware that some people struggle to get enough test strips on prescription, so we put together a guide for information and support for anyone dealing with this issue.”
How exactly do blood glucose meters work?
“A standard blood glucose monitoring system measures the level of sugar in the blood on one particular occasion. Although this may help the user keep their levels under control or adjust their diet or medication, it may not be useful for those who find it more difficult to manage their blood sugars, especially those who have regular hypos. A continuous Glucose monitoring (CGM) system may help in these cases. This system consists of a small disposable sensor inserted into the skin. A transmitter connected to the sensor wirelessly transmits results to a receiver which displays them. The sensor measures the sugar in the interstitial fluid (the fluid between your cells) and the user matches their actual blood sugar values at regular intervals during the CGM wear.
“CGM works 24 hours a day and can be used with any type of insulin dosage or diabetes medication. They also have an alarm feature to indicate when sugar levels are too low or high.
“Flash Glucose Monitoring (flash GM) is a very new method of glucose testing and uses CGM type technology to allow you to replace most finger prick blood tests. The Abbott FreeStyle Libre is currently the only flash glucose monitoring product available and has only been approved in Europe. In flash GM, users have a sensor inserted on their upper arm and a separate touchscreen reader device. When the reader device is swiped close to the sensor, it transmits both an immediate sugar level and an eight-hour trend chart allowing people to get individual blood sugar readings and trend information. However, unlike CGM, flash GM does not have low or high blood sugar alarms.”
What other technology developments are there in blood glucose testing?
“There’s a lot of research on how to make testing easier and less invasive. We’ve seen researchers announce a diabetic tattoo; a flexible patch which applies a mild electrical current to the skin. Google are also developing their smart lens to measure sugar levels from tears, and we’re even very close to clinical trials for using saliva to get readings. Although these methods sound interesting, we’re probably still a few years away from them becoming a real product on the market.”
You said testing is an important part of diabetes management. What happens if you can’t manage your blood sugar levels appropriately?
“Poor diabetes management can lead to a range of devastating complications including blindness, amputations and kidney disease; even an early death.
“This is why it’s so important that people with diabetes take their medication or insulin and keep their blood sugar between their recommended levels as much as possible. These alarming complications can be preventable, not only by managing blood sugar, but also getting regular health checks. Diabetes UK recommends fifteen healthcare essentials for all people with diabetes to help get the checks and support they need, and to lower their risk of developing complications. We also recommend that where possible, people go on education courses to learn how to manage their condition the best way they can.”
Find out more about diabetes education courses.
Managing blood sugar levels seems like a significant part of living with diabetes. What advice would you give to someone who is struggling to do this?
“You are not alone. Many people with diabetes find it difficult to engage with testing. They may find it uncomfortable or embarrassing to do or they may struggle to make sense of the results or to use them to improve their overall treatment. Calling it a blood test can give people a sense of pass or fail. Instead you should think of it as a check-in point to see whether you are on track or need to make some changes. It’s just one more tool that can be used to help you with your own diabetes management. If you are struggling with testing, speak to your local diabetes team.
“Diabetes UK offer a dedicated helpline for anyone dealing with the condition, for family or friends who support people with the condition, or for anyone who thinks they might be at risk of developing the condition and needs information or guidance about living with diabetes.
“Call 0345 123 2399, Monday to Friday, 9am–7pm or email firstname.lastname@example.org to find out more.”