Around 3 million people have diabetes in the UK but may have not yet developed symptoms. Diabetes is a long-term condition which can occur at any age so it’s important you know how to recognise the symptoms.
Diabetes is linked to insulin, a hormone produced by the beta cells in the pancreas to aid in digestion of carbohydrates, being either absent or working ineffectively. Insulin acts as a 'key' to let glucose into cells for energy, so when insulin is absent or working ineffectively, glucose builds up instead in the bloodstream.
Not everyone has symptoms, particularly if their diabetes has developed very gradually, but key signs to watch out for include tiredness, passing water frequently, thirst, frequent infections particularly urinary or thrush and weight loss.
There are two main types of diabetes which have very different causes:
Type 1 Diabetes
Around 10 – 15% of people in the UK have type 1 diabetes, making it the less common form of the condition.
It is caused by a complete lack of insulin due to the beta cells in the pancreas being destroyed by the body’s own immune system.
Because the destruction process is ongoing, people with diabetes are likely to develop symptoms quickly such as becoming extremely unwell in the space of a few weeks, with dramatic weight loss and an unquenchable thirst.
Type 1 diabetes commonly manifests itself in young people, so can appear during childhood or adolescence and even in very young babies, although it can still occur at any age.
Treatment for Type 1 Diabetes
Treatment is always with insulin via injection or an insulin pump. Treatment aims to try and replace the insulin in a way which closely reflects how the body would naturally in a person without diabetes.
Insulin treatments have become much more sophisticated in the last 20 years. Typically, people have one or two long-acting injections and three or more quick-acting injections a day, in an attempt to mimic what the body would normally do.
Insulin pumps worn externally 24 hours a day are a more sophisticated way of giving insulin. People with Type 1 diabetes use quick-acting insulin pump, as they have a constant supply, and programme their pump to top-up their insulin whenever they need to. At present, pumps are the most sophisticated method of insulin delivery and are mainly used in Type 1.
Type 2 Diabetes
Type 2 accounts for around 90% of people with diabetes in the UK and it is being heralded as a killer disease because it has strong links with heart and circulatory disease.
People with Type 2 diabetes generally are still producing insulin at diagnosis, but are either not producing enough or they have 'insulin resistance', where insulin is present but the body cells are resistant to it.
In either case, to combat this, beta cells produce increasing amounts of insulin so are constantly overworking. This can happens gradually over many years and diabetes may only be diagnosed when blood glucose levels rise after the beta cells can no longer keep up.
Type 2 diabetes is a progressive condition and can often be managed by changes to diet and lifestyle or through medication. However over 50% of people with Type 2 diabetes will need insulin injections within 10 years of diagnosis.
Symptoms of type 2 diabetes often include being overweight, have high blood pressure and high cholesterol or other blood fats. All of these things together are known as the 'metabolic syndrome'.
Type 2 has generally appeared in the older generation but we are beginning to see it in younger people, even children, which is thought to be related to inactivity and obesity.
Treatment for Type 2 Diabetes
There are now a range of non-insulin medications that do various things including encouraging additional insulin production, some inhibit the body's own production of glucose and some try to directly combat insulin resistance.
There are currently 20 brand names listed in 7 different categories, plus some combined formulas, most are tablets but some are still injected.
Complications of Diabetes
In the short term, balancing blood glucose levels can be difficult and low blood glucose, known as hypoglycaemia, can occur if there is too much insulin around. Early symptoms of hypoglycaemia can include:
- Tingling lips
Later symptoms, which occur when the brain is extremely short of glucose, can lead to unconsciousness if not treated quickly and can include:
- Lack of co-operation
High blood glucose levels can also cause difficulties in the short term, causing symptoms similar to those at diagnosis. If someone with Type 1 diabetes becomes acutely short of insulin in their body, they may get diabetic ketoacidosis, where the blood glucose is very high. If this happens, emergency hospital treatment is required.
Long term complications
If a person with diabetes often has high blood glucose levels over many years they are at risk of developing diabetic-specific complications:
Eyes (diabetic retinopathy) - damage to the small blood vessels in the retina.
Annual screening picks up early signs, laser treatment can be used, and it is much rarer nowadays for people to go blind from it
Feet (peripheral neuropathy) - damage to peripheral nerves that causes gradual loss of feeling, resulting potentially in foot ulcers and possible amputation for gangrene.
Annual screening detects people at risk, but all people given 'safe feet' advice.
Kidneys (nephropathy) - gradual reduction in kidney function that can lead to renal failure and will require dialysis or a transplant to treat.
Annual screening can pick up early signs - tiny amounts of protein in the urine - and medication can help at this stage.
Autonomic neuropathy - damage to 'involuntary' nerves like automatic systems, particularly heart rate and digestion.
This is a less common complication, but one of the more difficult ones to live with. Erectile dysfunction (previously referred to as impotence, but now more correctly named from the inability to maintain an erection sufficient to have sex) is part of the spectrum of autonomic neuropathy.