What is it?
Diabetes is a lifelong condition caused by raised glucose (or blood sugar) levels. After we eat a meal any carbohydrates that we eat, like starchy foods or sweet foods, are broken down into glucose by our gut. An organ below the stomach, called the pancreas, secretes a hormone called insulin after meals during digestion. Insulin helps our bodies cells to absorb glucose through their cell walls. Once inside the cells it is used as fuel to power our bodies. In people with diabetes this pathway does not work properly & the blood glucose levels become abnormally raised.
What causes it?
There are 2 main types of diabetes which are both disorders of the glucose metabolism but have slightly different causes & treatments. The most common cause by far is type 2 diabetes which accounts for approximately 90% of cases here in the UK.
- Type 1 diabetes: This is caused when your immune system destroys the cells in your pancreas which make insulin. The reasons why this happens are unclear but it is thought to be triggered by infections in certain people.
- Type 2 diabetes: In this type your body is still making insulin but there is either not enough of it or the cells in the body become more resistant it. Some people are born with a predisposition to diabetes as it is more common in families. There is a very strong association with being overweight & having a sedentary lifestyle.
- Gestational diabetes: You may hear this term which refers to a temporary type of diabetes that can affect pregnant women. They can make very high levels of glucose & do not have enough insulin to help it absorb into the cells. This needs to be carefully managed by a specialist team during the pregnancy & usually resolves after delivery. It is important to remember that women who develop this do have a higher risk of developing diabetes in later life and should have yearly blood tests to screen for diabetes.
Where does prediabetes come into this?
Prediabetes is a pre-cursor to type 2 diabetes. This means that the glucose levels are raised, above normal levels & over time it will go on to develop into type 2 diabetes. The amount of time that it will take for this to happen varies from person to person.
The key thing about prediabetes is that it can be reversible with diet & lifestyle changes. This can avoid it developing into a lifelong condition. We will talk about this later in the article.
What should I be looking out for?
The symptoms for type one diabetes can develop very quickly, even over days. Type 2 diabetes develops over a slower time & can take many years to develop. Because it is of a gradual onset many people do not notice any symptoms at all or very vague generalised symptoms.
You should have a diabetes test if you have any of the following:
- Weight loss
- Needing to pass urine frequently
- Recurrent thrush infections – in women this can present with changes to your discharge or itching around the vulva. In men this can cause balanitis – an itch or redness around the tip of the penis or a stinging when you are passing urine
- Slow healing of wounds
- Recurrent infections
- Blurry vision
Am I at risk of diabetes?
The following are higher risk groups for developing type 2 diabetes:
- Overweight or obese
- Have a first degree relative with diabetes (parents, sibling or child)
- Are over 40 years of age
- Have ever been diagnosed with diabetes in a pregnancy (gestational diabetes)
- Are of South Asian, Chinese, Black African or Black Carribean ethnicity (even if you are raised in the UK).
You can do a free personalised diabetes risk assessment online at Diabetes.org.uk. You will need a tape measure & to put in some basic information like your height, weight and waist circumference. It will indicate if you are at risk of developing diabetes & has lots of healthy lifestyle advice.
How is it diagnosed?
There are two tests used to diagnose diabetes
- HbA1C: This is a blood test that looks for signs of damage done by high blood sugar levels to your red blood cells over the previous 3 months. Therefore – it is not suitable if you have new or recent symptoms as it can take a few months to show. It is also not suitable for certain patients (for example people with inherited abnormal shaped red blood cells or end stage kidney disease).
A persistent HbA1C(I.e: more than one reading) of over 48 mmol/mol (6.5%) is in keeping with diabetes.
- Blood glucose levels: These can vary depending on when we have last eaten so the interpretation depends on when you have last eaten. A random reading over 11mmol/l, or fasting glucose over 7.9 mmol/l are considered in the diabetic range.
If you do not have any symptoms, then your doctor would usually want to repeat the sample before confirming a diagnosis of type 2 diabetes.
How is it treated?
Type 1 diabetes will always need to be treated with injectable insulin.
For the treatment of type 2 diabetes you will need close monitoring with your GP & practice nurse. Your treatment will depend on what your results show and if you have any complications. Treatments range from diet & exercise, medications to injectable insulin.
The cornerstone of good management, particularly for type 2, is good diet & lifestyle. With diet you should be eating 5-7 portions of fruit & vegetables per day. I would advise no more than 2 portions of fruit as they can be high in sugar. You should have a healthy, balanced diet, that is low in processed foods, red meat, fats & sugars.
Exercise is essential in keeping you healthy. You should be aiming to do 30 minutes of moderate exercise (brisk walking, swimming, rowing) 5 times per week. Alternatively, you can do 75 minutes of vigorous exercise split over 2-3 session.
Living with diabetes
Many people live full & heathy lifestyles with diabetes. Your care will include regular check-ups, including blood & urine tests and screening, for possible complications of diabetes. This is usually done in a yearly review but can be more often if needed. You should also be offered the flu jab every year.
How can London Doctors Clinic help?
We are a convenient GP clinic with many central London locations. Our experienced & friendly GPs offer same day and pre-bookable appointments. We also offer video appointments with our GPs so you can see us from anywhere, and on any device.
If you have any concerns about diabetes book an appointment – if you would like to have a diabetes test we can do this in the 15 minute appointment with blood test results available the same day.
Written by Dr Ciara Yeates, General Practitioner
Published: November 2018
Review: November 2021