What is Diabetes?

More than 4.9 million people in the UK are currently living with diabetes. 90% of people with diabetes have a diagnosis of Type 2 diabetes, 8% have a diagnosis of Type 1 diabetes, and 2% have rarer types of diabetes.

However, diabetes is only becoming more prevalent. Diabetes UK reports that 13.6 million people are now at risk of Type 2 diabetes in the UK. The pressure on the NHS is also growing, with 10% of the NHS’s annual budget being spent on diabetes alone, amounting to a huge £10 billion.

Today, we are going to take a look at diabetes in more detail, focusing on the different types of diabetes.

What is Diabetes?

Diabetes is a chronic disease that impacts how your body turns food into energy. Most food we eat is broken down into sugar (or glucose) and released into your bloodstream. When your food is digested, the sugar enters your bloodstream.

When your blood glucose, or blood sugar, levels go up, a signal is sent to your pancreas telling it to release insulin. Insulin is a hormone that is made by your pancreas. It helps glucose get into your cells so it can be used for energy.

Diabetes occurs when your pancreas is no longer able to make insulin, or your body cannot use the insulin as well as it should. The glucose will then stay in your blood and won’t reach your cells. Raised glucose levels in the blood are known as hyperglycaemia. Over time, too much glucose in your blood can cause serious health problems. This includes heart disease, kidney disease, strokes, vision loss, dental disease, nerve damage, and damage to your organs and tissues.

Diabetes currently has no cure. However, steps can be taken that can help you to manage your diabetes.

Some people wonder, ‘Is diabetes a disease?’ and, ‘What kind of disease is diabetes?’ Diabetes is a metabolic disease. Metabolism is the process of your body making energy from the food you eat. A metabolic disease is when abnormal chemical reactions in your body disrupt the process of your body converting food into energy.

There are several different types of diabetes:

• Type 1 Diabetes.
• Types 2 Diabetes.
• Gestational Diabetes.
• Diabetes Insipidus.

What is Type 1 Diabetes?

Type 1 diabetes is a serious condition where a person’s blood glucose levels are too high because their body cannot make insulin. It is caused by an autoimmune reaction, meaning your body attacks the cells in your pancreas so they cannot produce insulin.

Your body will still break down the carbohydrates from food and drink and turn them into glucose; however, once the glucose enters your bloodstream, there is no insulin to enable it to enter your cells, meaning the glucose remains in your bloodstream and continues to build up until your blood sugar levels are too high.

Type 1 diabetics may experience hypoglycaemias (hypos). This is when your blood glucose levels are too low. They can happen if you take too much insulin, don’t eat enough carbohydrates, do too much exercise, or drink alcohol. If you experience a hypo, you will need to eat or drink something sugary to help raise your glucose levels.

You may also experience hyperglycaemias (hypers). This is when your blood glucose levels are too high. This can happen if you are unwell, stressed, less active or do not have enough insulin. Very high blood sugars can be dangerous and even life-threatening.

Type 1 diabetes is usually diagnosed in children, teenagers and young adults. Type 1 diabetes is not preventable. Unlike other types of diabetes, once you have been diagnosed with Type 1 diabetes, it is not curable. This means you will have the disease for life.

Doctors are not completely sure what causes Type 1 diabetes. There is thought to be a genetic aspect, with around 10% of Type 1 diabetics having a close relative that also has the disease. Other causes of Type 1 diabetes include the environment you grow up in, the types of foods you eat, and exposure to viruses.

Signs and Symptoms of Type 1 Diabetes

Symptoms of Type 1 diabetes usually develop very quickly. Some common signs and symptoms include:

• Increased thirst.
• More frequent urination.
• Unintentional weight loss.
• Extreme hunger.
• Unexplained changes in mood.
• Increased irritability.
• Tiredness or weakness.
• Blurred vision.
• Cuts and grazes that do not heal.
• Fruity smelling breath.
• Recurring thrush.
• Unusual bedwetting in children.

Diagnosing Type 1 Diabetes

If you experience any of these symptoms, you should see your GP as soon as possible. Your GP may do a urine test or check your blood glucose levels. If your GP thinks you may have diabetes, you will be advised to go to the hospital immediately for an assessment.

You will most likely stay in hospital until you get your blood test results. If you are diagnosed with Type 1 diabetes, you will remain in hospital until a specialist diabetes nurse can explain your condition and show you how to manage your diabetes.

Treatment for Type 1 Diabetes

Type 1 diabetes is a lifelong condition and cannot currently be cured. Instead, your symptoms can be managed through careful treatment. If you do not follow your treatment plan very carefully, you could cause long-term damage to your health, or even put yourself at risk of death.

Your Type 1 diabetes will be treated with insulin. The insulin helps you to manage your blood glucose levels. Your insulin can be administered by injection or by a pump.

You may be given basal insulin, also known as long-acting or background insulin. This provides your body with insulin whether you eat or not. It should also help to keep your blood glucose levels stable throughout the day and night. Basal insulin is administered once or twice a day.

Alternatively, you may take insulin with food or drink. This is known as bolus insulin, fast-acting insulin, or mealtime insulin. It helps to reduce the rise in your blood glucose levels that occurs when you eat or drink.

You may be given injections, and you will need to inject yourself with insulin. Alternatively, you may be offered a pump. This delivers small amounts of insulin into your blood throughout the day and night. This can improve your blood glucose levels and reduce the number of hypoglycaemias that occur. Every time you eat or drink, you can administer extra insulin through the pump.

Type 1 diabetics will need to check their blood sugar levels throughout the day. This is done by using the finger prick test. This can warn you if your blood sugar levels are too high or too low, tell you how much insulin you need to take and whether you need to eat something. It is important to take a note of all of your readings so that your healthcare team can look at whether your treatment needs to be adjusted.

What is Type 2 Diabetes?

Type 2 diabetes is the most common type of diabetes. It is caused by your body not making or using insulin well. It can occur when your body becomes resistant to insulin and your blood glucose levels start to build up and become too high.

If you have Type 2 diabetes, your body still breaks down carbohydrates and turns them into glucose. Your pancreas will then release insulin. However, as the insulin does not work properly, your pancreas will release more insulin. In some cases, this causes your pancreas to become tired and it begins to make less insulin. Your blood sugar levels can then become so high that you are at risk of hyperglycaemia.

Type 2 diabetes develops over several years. It is most commonly diagnosed in middle-aged and older adults, although more and more young people are being diagnosed. Type 2 diabetes can be prevented or delayed with a healthy lifestyle. This could include losing weight (if you are overweight), eating healthy food and being more active.

Type 2 diabetes does not always cause symptoms. If you are at risk, it may therefore be a good idea to get your blood sugar levels tested.

You may be deemed to be high risk if:

• You are overweight or inactive.
• You have a family history of Type 2 diabetes.
• You are over the age of 40, or over the age of 25 if you are from South Asia.
• You are of Asian, African Caribbean or Black African origin.

Type 2 diabetes is a serious disease, and it can be lifelong. Although it cannot be cured, it is possible to put Type 2 diabetes into remission. This means your blood sugar levels will become lower and you will no longer need to take medication. However, it is not possible for everyone who has Type 2 diabetes to enter remission, and some people will have the disease for the rest of their life.

Signs and symptoms of Type 2 Diabetes

As mentioned earlier, some people with Type 2 diabetes do not realise they have symptoms.

However, some common signs and symptoms of Type 2 diabetes include:

• Increased thirst.
• More frequent urination.
• Feeling more tired than usual.
• Unintentional weight loss.
• Cuts or wounds that take longer to heal.
• Blurred vision.
• Itchiness around your genitals, or recurrent thrush.

Diagnosing Type 2 Diabetes

If you have any symptoms or are worried that you are at high risk, you should visit your GP. Your GP will do a blood test to determine whether you have Type 2 diabetes. Your GP will also likely do a urine test.

You will usually not have to visit a hospital unless your diabetes is already advanced and is causing other health problems.

Treatment for Type 2 Diabetes

If you are diagnosed with Type 2 diabetes, there are several ways your doctor can choose to treat it.

1. You may be prescribed medication to help you manage your blood sugar levels. This is usually in the form of tablets that stimulate the pancreas to produce insulin.

2. You may be asked to make changes to your diet. For example, you may need to keep sugar, fat, and salt to a minimum and make sure you never skip meals.

3. You may be asked to become more physically active.

You will also be asked to go for regular check-ups. This can be check-ups on your diabetes or on parts of your body that are commonly affected by Type 2 diabetes, such as eye tests.

What is Gestational Diabetes?

Gestational diabetes develops in some women when they are pregnant, even though they have never had diabetes. It is characterised by high blood glucose levels and happens when your body cannot produce enough insulin to meet the extra insulin needs you have during pregnancy.

Gestational diabetes results in a higher risk pregnancy and can cause problems for you and your baby, both during the pregnancy and after the birth. However, the earlier gestational diabetes is detected, the lower the risks will be as doctors can work to manage the condition.

You may be at higher risk of developing gestation diabetes if:

• Your body mass index (BMI) is above 30.
• You previously had a baby that weighed more than 10lb at birth.
• You have previously been diagnosed with gestational diabetes.
• You have a parent or sibling with diabetes.
• You are of South Asian, Black, African Caribbean or Middle Eastern origin.

Gestational diabetes usually goes away after your baby is born. However, if you experience gestational diabetes, you may be at higher risk of developing Type 2 diabetes later in life. Your baby may also have a higher risk of developing Type 2 diabetes.

Other risks associated with gestational diabetes include a larger than average baby which can lead to difficulties during birth, premature labour, pre-eclampsia, polyhydramnios, and your baby developing low blood sugar or jaundice. In some cases, gestational diabetes can result in a stillbirth – although this is rare.

For information, support or advice about gestational diabetes, visit Gestational Diabetes UK.

Signs and symptoms of Gestational Diabetes

In many cases, gestational diabetes does not cause any symptoms. It is often discovered that you have the condition during routine blood glucose level testing. You may experience symptoms, however, if your blood glucose levels become so high that you have a hyperglycaemia.

Symptoms of this include:

• Increased thirst.
• More frequent urination.
• A dry mouth.
• Increased tiredness.

Diagnosing Gestational Diabetes

If you are at risk of gestational diabetes, you will be offered a screening, known as an oral glucose tolerance test (OGTT). This is usually done between 24 and 28 weeks of your pregnancy, although it may occur earlier in some cases.

Treatment for Gestational Diabetes

If you receive a diagnosis of gestational diabetes, you will be given a testing kit so that you can check your blood glucose levels.

There are different treatment options available, including:

• Changing your diet.
• Changing your exercise routine.
• Medication.
• Insulin injections.

What is Diabetes Insipidus?

Diabetes insipidus is a rare disorder that results in an imbalance of fluids in the body. This imbalance can cause you to produce excess amounts of urine. It can also make you feel extremely thirsty, regardless of how much you drink. In extreme cases of diabetes insipidus, an individual can urinate up to 20 litres of urine in one day.

Diabetes insipidus is not actually related to diabetes, although it does share some of the same symptoms.

There is currently no cure for diabetes insipidus. However, treatment can help to relieve your thirst and decrease the frequency at which you need to urinate. It can also help to prevent dehydration.

There are four main types of diabetes insipidus:

1. Cranial diabetes insipidus.

2. Nephrogenic diabetes insipidus.

3. Gestational diabetes insipidus.

4. Primary polydipsia.

Signs and symptoms of Diabetes Insipidus

The main symptoms of diabetes insipidus are:

• Extreme thirst.
• Needing to urinate excessively.
• Frequently needing to urinate at night.
• A strong preference for cold drinks.

In young children with diabetes insipidus, the signs and symptoms may be slightly different.

They could include:

• Uncharacteristic bedwetting.
• Difficulties sleeping.
• Vomiting and constipation.
• Fever.
• Delayed growth.
• Unexplained weight loss.

Causes of Diabetes Insipidus

Diabetes insipidus is caused by problems with the hormone vasopressin (AVP), also known as antidiuretic hormone (ADH). This hormone has a key role in regulating the amount of fluid in the body.

AVP is produced by the hypothalamus in the brain and then passed to the pituitary gland where it is stored. The pituitary gland releases AVP if the amount of water in your body is too low. It helps your kidneys to reduce the amount of water that is lost through urine. If you have diabetes insipidus, your kidneys pass too much water from your body.

Treatment for Diabetes Insipidus

In mild cases, diabetes insipidus may not require treatment. Instead, you may be asked to increase the amount of water you drink to compensate for the extra fluid you are losing.

However, your doctor may prescribe you medication to replicate the functions of AVP or to reduce the amount of urine your kidneys produce.

What is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious complication of diabetes. It occurs when a person’s body starts to run out of insulin, and it begins to break down fat to create energy. The body then produces high levels of harmful blood acids called ketones which build up in the bloodstream. If left untreated, this can lead to diabetic ketoacidosis which can be life-threatening.

Diabetic ketoacidosis mainly affects people with Type 1 diabetes. However, it can sometimes affect individuals with Type 2 diabetes.

You are most likely to experience DKA if you have hyperglycaemia.

However, there are some other risk factors that could cause you to develop DKA, including:

• If you have an infection.
• If you have not been following your diabetes treatment plan.
• If you recently got an injury or underwent surgery.
• Taking certain medications.
• Drinking excessive alcohol or taking drugs.
• If you are currently pregnant.
• If you are currently on your period.

Keeping on top of your blood sugar levels and ensuring they do not rise too high is one way of protecting yourself from DKA. If you have a blood sugar level of 11mmol/L or above, this could mean there is a risk your body will start to produce ketones. If you have a ketone testing kit at home, you should test your ketone levels immediately.

If your ketone levels are 0.6-1.5 mmol/L you have a small increased risk of DKA and you should test your levels again in 2 hours. If your ketone levels are 1.6-2.9 mmol/L, this means you have an increased risk of DKA and should contact your doctor as soon as you can. If your ketone levels are 3mmol/L or higher, you should seek medical help immediately.

Signs and symptoms of Diabetic Ketoacidosis

Some of the most common signs and symptoms of DKA include:

• More frequent urination.
• Excessive thirst.
• Vomiting.
• Stomach pain.
• Fruity smelling breath.
• Breathing that is deep or fast.
• Feelings of tiredness or confusion.
• Fainting or losing consciousness.

Treatment of Diabetic Ketoacidosis

As DKA is so serious, it is usually treated in hospitals.

Common treatments include:

• Intravenous insulin.
• Intravenous fluids for rehydration.
• Intravenous nutrients to replace any you have lost.

What is Diabetes Neuropathy?

Diabetes neuropathy is a type of nerve damage caused by diabetes. High blood glucose levels can damage the small blood vessels that supply the nerves in different parts of your body, including your hands, feet, organs and muscles. In most cases, nerve damage occurs in the legs and feet.

It can affect people with any type of diabetes. The nerves carry messages between your brain and other parts of your body. They allow us to see, hear, feel, move and even breathe.

Neuropathy is a serious complication of diabetes. Depending on the nerves that are affected, you may experience pain, tingling or numbness in your legs and feet, muscle weakness and problems with your blood vessels, heart, urinary tract or digestive system. Symptoms can range from mild to extremely painful and debilitating.

There are several different types of neuropathy.

Peripheral Neuropathy

This is the most common type of neuropathy experienced by people with diabetes. It first affects the legs and feet, followed by the arms and hands.

Symptoms of peripheral neuropathy include:

• Numbness.
• Reduced ability to feel changes in temperature or pain.
• Cramps.
• Sharp, burning or shooting pains.
• Increased sensitivity.
• Ulcers or infections.
• Bone and joint pain.
• Loss of coordination.

Autonomic Neuropathy

This affects the nerves that carry information to your organs and glands. It is connected to the autonomic nervous system that controls your heart, bladder, stomach, intestines, sexual organs and eyes. The autonomic nervous system controls some functions without conscious thought.

Symptoms of autonomic neuropathy include:

• Loss of bladder control.
• Loss of bowel control.
• Irregular heartbeat.
• Impotence.
• Problems with sweating.
• Extremely slow digestion (causing nausea, vomiting and loss of appetite).
• Difficulties adjusting from light to dark.

Motor Neuropathy

This involves the nerves that control movement being affected. This can lead to weakness or wasting of the muscles, a loss of muscle tissue and muscle twitching and cramps.

Focal Neuropathy (mononeuropathy)

This is damage to the nerves connected to your eyes. It can be either cranial or peripheral.

Symptoms include:

• Double vision.
• Difficulty focusing your eyes.
• Pains or aches behind one eye.
• Paralysis on one side of the face.
• Numbness or tingling in your hands or fingers that does not include the pinkie finger.
• Weakness in your hand.

It is thought that neuropathy can affect as many as half of all people with diabetes. Once nerve damage has occurred, it is not usually possible to reverse the damage. However, nerve damage can be prevented by consistently managing your blood sugar levels and by following a healthy lifestyle. You should also check your feet every day and attend all eye appointments that are offered as part of your diabetes care.

What is Borderline Diabetes?

Pre-diabetes, also known as borderline diabetes, is not a term recognised by medical professionals or the World Health Organisation (WHO). However, it is a term that is widely used in the media and that many people are aware of. It is used to refer to people who are at high risk of developing Type 2 diabetes.

It usually means your blood sugar levels are higher than normal, but not high enough to be recognised as Type 2 diabetes. You are unlikely to be experiencing any symptoms but higher than normal blood sugars may have been detected in a blood test.

You may hear this described as:

• Impaired Fasting Glucose (IFG).
• Impaired Glucose Tolerance (IGT).
• Impaired Glucose Regulation (IGR).
• Non-Diabetic Hyperglycaemia.

As mentioned earlier, more than 13.6 million people are currently at risk of developing Type 2 diabetes in the UK. However, in up to 50% of people, Type 2 diabetes can be prevented or delayed.

Some of the risk factors associated with pre-diabetes include:

• If you are over the age of 40 (if you are white).
• If you are over the age of 25 (if you are African Caribbean, Black African or South Asian).
• If you have a parent or sibling with diabetes.
• If you have ever had high blood pressure.
• If you are overweight.

If your doctor tells you that you are at an increased risk of developing Type 2 diabetes, there are some things you can do to reduce the risk:

• Lose weight if you are in the overweight or obese categories.
• Eat a healthy, balanced diet.
• Do more exercise or be more physically active.