A recent report carried out by Diabetes UK has found that the number of people living with diabetes in the UK has topped 5 million for the first time ever. This includes an estimated of 850,000 people that are as yet undiagnosed based on Association of Public Health Observatories projections.
We spoke to Esther Walden, a senior clinical advisor based at Diabetes UK, about what is behind the increase in numbers, how we might be able to get the numbers down and how to tell if you are at risk.
How does diabetes affect the body?
There are several different types of diabetes, but there are two main types - type 1 and type 2. In type 1 diabetes, an autoimmune attack destroys the cells in the pancreas that make insulin. Insulin is a hormone that is responsible for moving glucose, or sugar, from the blood into the cells where it's then used as energy to fuel the cells. People with type 1 diabetes aren't able to make any insulin anymore.
In type 2 diabetes people either don’t make enough insulin or their bodies don’t respond properly to the insulin that they do make. So what happens is that the sugar they get from their diet builds up in the blood because not enough of it can get into the cells to be used for energy.
What's the current situation in the UK?
We’ve found that for the first time there are over 5 million people living with diabetes in the UK. The split is about roughly 90 per cent type 2 diabetes, 8 per cent type 1 diabetes and 2 per cent other types of diabetes. We’ve seen a rise. We know there are 4.3 million people living with a diagnoses of diabetes in the UK, but we now know that there are about 850,000 people who are living with type 2 diabetes and are yet to be diagnosed.
It’s really important that people know the signs of diabetes so they can get early treatment.
Why is this rise happening?
We think there are several factors at play here. One of the biggest risk factors for type 2 diabetes is living with overweight or obesity. Recently, there has been a rise in general levels of living with overweight and obesity in the United Kingdom. It now comes to about 64 per cent of people in England and that is translating into an increase in the levels of type 2 diabetes that we're seeing as well.
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How is diabetes treated?
The treatment of type 1 and type 2 diabetes is different. Type 1 diabetes requires lifelong insulin injections. But the treatment for type 2 diabetes needs to be a combination of measures to help people to deal with different lifestyle factors. Things like helping people to eat healthier, be more physically active and lose weight or maintain a healthy weight . But there are other treatments such as medication.
If we can support people earlier, before they are diagnosed, to make these modifications, we can make a real difference. There's lots of stigma attached to having type 2 diabetes and to living with overweight and obesity. A lot of people will say that people with diabetes have done it to themselves, which is not the case. It's a complex condition with lots of factors at play.
People need to really feel supported. If weight management, for example, is their goal, then weight management clinics can support them through their journey. We also need to give continued support afterwards, to maintain the changes they make.
I think that as well as general treatment, there's more government and society can do. Things like looking at the food environment that we live in, looking at areas of low economic income etc. Unless all of these factors are tackled, we're probably not going to make a big difference.
How can you tell if you're at risk?
It’s important to look out for the signs and symptoms of diabetes. For type 1, these are:
- Going to the toilet more often to pass urine
- Feeling tired a lot of the time
- Feeling thirsty a lot and having to drink lots
- Losing weight and getting thinner
For people with type 2 diabetes signs to look for, apart from those indicated above, are:
- Cuts and wounds taking longer to heal
- Blurred vision
- Regularly getting up in the middle of the night to go to the toilet
If you think that you've got any of these signs and symptoms go to see your healthcare professional.
Living with overweight or obesity, particularly if you've got excess weight around your middle, is a risk factor. People from ethnic minority populations are more at risk even if they are at lower weights. Black African or South Asian communities have got a 2 to four times higher risk of developing type 2 diabetes.
If you live a particularly sedentary lifestyle that’s also a risk factor. And we know that people who live in areas of socio-economic deprivation are also more likely to get type 2 diabetes.
We’ve got a handy Know Your Risk tool on our website. People can fill it in and see if they are at risk and then contact their healthcare professional if they are. In England we have a diabetes prevention program that people can go on so if they are at risk, they can get help before they get diagnosed with diabetes.
Is it possible to reverse diabetes?
It is possible to put your type 2 diabetes into remission. The Diabetes UK DiRECT trial using a diet of soups and shakes showed that with support you can help people to lose weight. There are other diets – of course, one diet doesn't fit all.
People generally need to lose about 15 kilograms or 10 per cent of their body weight in order to get into remission levels. The original DiRECT trial ran for two years. Previous results showed that almost half (46 per cent) of people with type 2 diabetes who received the weight management programme were in remission one year later, and 36 per cent at two years.
It is really important, from a stigma point of view, to say that not all cases of type 2 diabetes can be put into remission. And not everybody with type 2 diabetes lives with overweight or obesity either. But it is achievable for quite a lot of people.
About our expert, Esther Walden
Esther is a senior clinical advisor based at Diabetes UK. Prior to this she worked as a diabetes specialist nurse.
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