SEX & DRUGS & SAUSAGE ROLLS...
GOOD HEALTH The changes you can make to reduce your risk of diabetes
Most of us know that too many calorie-laden snacks can raise our risk of type 2 diabetes, but far fewer realise how seriously this condition can damage our health. Heart disease, stroke, kidney failure, nerve damage, the risk of amputation, loss of sight and sexual dysfunction are all scary complications that have been linked to it.
Of the 3.8 million people in the UK with diabetes, nearly all (90%) have type 2, which is largely preventable and primarily caused by being overweight – especially carrying fat around the waist. Chris Askew, chief executive of Diabetes UK, describes the disease as ‘the fastest growing health crisis of our time’. And Diabetes UK says that about 7,000 children and young people are now being treated for type 2 diabetes. Yet among the grim figures there is new hope.
It used to be thought that once you were diagnosed, type 2 diabetes was a chronic, lifelong condition, but breakthrough research led by Professor Roy Taylor at Newcastle University and Professor Mike Lean at Glasgow University found that significant weight loss on a low-calorie liquid diet actually put this condition into remission in nearly half of cases.
Research is ongoing, and Diabetes UK is funding the five-year study (called DIRECT, or Diabetes Remission Clinical Trial), but such is the success of the findings that the NHS is to pilot this for up to 5,000 people through GP surgeries in two areas.
Not overweight? There’s more you need to know. Often described as TOFIS – thin outside, fat inside – some people carry too much visceral fat in their abdomen. Or, at least, it’s too much fat for them – as we all have what Professor Taylor describes as a personal fat threshold, or a point at which fat starts being stored in the pancreas, affecting or preventing insulin production. This ties in with the fact that some people are far more susceptible to type 2 diabetes. While obesity is bad for our health in many ways, causing cardiovascular disease and cancer to name but two, not everyone who is obese becomes diabetic.
WHAT HAPPENS IN OUR BODY?
Glucose is one of the body’s main sources of fuel, and the pancreas produces the hormone insulin, which acts like a chemical key, allowing glucose to enter the body’s cells. Without insulin, the level of glucose, our ‘blood sugar’, rises and, over time, can cause complications that damage blood vessels and nerves and affect our heart, eyes, feet and kidneys.
People with type 1 and type 2 diabetes both have too much glucose in their blood, but for quite different reasons. In type 2, fat in the pancreas can stop insulin-producing cells working properly. In addition, the body is more resistant to the action of insulin that is produced (known as insulin resistance).
Type 1 diabetes, though, is an autoimmune disease where the body’s defence system attacks the pancreas, destroying the cells so they can’t produce insulin. Only 10% of people living with diabetes have type 1, which is most commonly diagnosed in childhood but can also occur later. One in five are diagnosed over the age of 40, including Prime Minister Theresa May, who was diagnosed in her 50s. Treatment for type 1 involves daily insulin via a pump or injection, though research funded by Diabetes UK is looking at the development of an artificial pancreas.
COULD YOU HAVE TYPE 2 DIABETES?
Perhaps. Nearly one million of us could have type 2 diabetes and not know it, says Diabetes UK. Not everyone has symptoms, and others may not recognise the signs – like needing to go to the loo a lot, especially at night, excessive thirst, tiredness, unexplained weight loss, thrush, slow healing of cuts and blurred vision.
There’s also a lack of awareness among both men and women about what obese means, says Jane Deville-almond, chair of the British Obesity Society and an independent nurse consultant who runs workshops for healthcare professionals, including GPS, with the title ‘Sex, Drugs and Sausage Rolls’.
‘I may have nurses talk to me about obese patients and they’re obese themselves,’ says Jane. ‘There’s a tendency to see “obesity” as an extreme – the person confined to bed because of their size. People are far more likely to recognise themselves if you say “fat”. They don’t realise it can just mean two stone overweight.’
Men, who are at slightly higher risk of developing type 2 diabetes than women, can be especially unaware. As part of a research study led by Jane, male drivers at a motorway service station were asked their waist measurement. Nearly all gave an incorrect answer and were shocked to discover their true size. The reason? ‘Men tuck their paunch over the waistband so they’re actually buying trousers with a smaller waist size,’ says Jane, who has held clinics in barbers’ shops, Harley Davidson showrooms and army bases in an effort to get the message across to men.
As well as waist size and weight, there are other risk factors, too. Family history and ethnicity play an important role. Incidence is higher in people with African or Afro-caribbean heritage, and people from South Asia are up to six times more likely to develop type 2, possibly due to the way their bodies metabolise fat. (See riskscore.diabetes.org.uk for your personal score.)
The most common blood test is an Hba1c – this gives an average blood glucose level for the last two to three months, the length of time red blood cells survive. An Hba1c of 48mmol/mol or above is used to diagnose diabetes, and a reading between 42-47mmol/mol indicates an increased risk of developing type 2.
DIABETES AND SEX
While excessive thirst or frequent loo trips can be
symptoms, for men, erectile dysfunction as a warning sign of possible type 2 diabetes is far less well-known. ‘If suddenly your partner can’t maintain an erection, make sure they go to the doctor because this is often one of the first clinical signs,’ says Jane. ‘Erectile dysfunction can be devastating for men. It’s important they know it can be a complication of diabetes but is very treatable.’
Women can also have difficulty becoming aroused and suffer from vaginal dryness for the same reason – high sugar levels mean blood doesn’t flow so well, and tiny blood vessels and nerves can become damaged. The risk of thrush and urinary tract infections is also greater. Managing blood sugar makes this less likely, and vaginal moisturisers and lubricants can help dryness.
REVERSING THE CONDITION
If you have type 2 diabetes, weight loss of about two and a half stone or a sixth of your body weight is needed to ‘wake up’ the insulin-producing cells and normalise blood glucose levels by stripping excess fat out of the liver and pancreas, advises Professor Taylor. Taking action as early as possible after diagnosis is very important; after 10 years with type 2 diabetes, there is a much lower chance that the cells will be able to fully recover, although this could still mean you need less medication and have many other benefits.
The amount of weight lost is more important than the time taken, and different approaches suit different people. Either cutting back the amount eaten each day or sticking to a very low-calorie liquid diet will work, but in either case you must seek the advice of your GP. The participants of the DIRECT trial consumed nutritionally balanced shakes providing no more than 853 calories a day for an average of 16 weeks. They found that hunger was less of a problem after the first couple of days than the social aspect of being unable to share meals with friends and family. During the period of weight loss, advice is to not increase normal activity levels simply because you’ll think you can eat more – although, when it comes to keeping the weight off afterwards, activity and exercise are very important. Diabetes Prevention Week (1-7 April) is aimed at helping people find out their risk and take action to reduce it. See preventing-diabetes. co.uk for more details.
IS SURGERY AN OPTION?
Gastric bypass surgery puts type 2 diabetes into remission over and above the effect of weight loss, says Francesco Rubino, professor of metabolic and bariatric surgery at King’s College Hospital and King’s College London. Patients who are obese and not responding to medication are eligible for referral, but Professor Rubino says far too few bariatric operations are being performed and, of those, only a third are as a treatment for type 2 diabetes. He believes that this is partly because obesity is often stigmatised as a moral failure by patients themselves, the public and within the healthcare service – and also because of underfunding and misconceptions about cost. To be referred for surgery as a treatment for type 2 diabetes, you need to fulfil certain criteria (diabetes.org.uk has details) but the first step, as ever, is to talk to your GP.
CAN SLIMMING DRUGS HELP?
Taking slimming pills may make you erroneously think that you don’t need to cut calories, and even though a drug that blocks the absorption of fat is now available from chemists under the brand names Orlistat and Alli, experts advise against taking it without supervision.
Emma Elvin, senior clinical adviser for Diabetes UK, says, ‘Orlistat should only be used on prescription as part of a treatment package and not bought over the counter.’
Don’t be tempted by ‘miracle’ slimming products available on the internet – they may be fake or even dangerous. More than £5m worth of fake diet pills have been seized by the Medicines and Healthcare products Regulatory Agency in the last five years – the majority of which contained the active ingredient sibutramine. This was suspended by the European Medicines Agency because it increased users’ risk of heart attack or stroke. If you buy any medicine online, check sellers are registered at gov.uk/fakemeds.
ARE SAUSAGE ROLLS OFF THE MENU?
Unfair as it seems, some people can enjoy eating occasional high-calorie treats but, for others, they carry a higher risk. It’s all down to the way we metabolise sugar, which is highly individual, explains Alison Barnes, research associate (dietician) for the DIRECT
trial and NHS diabetes specialist dietician.
‘Some people can eat as many carbs as they like yet their blood glucose levels won’t suffer. People susceptible to type 2 diabetes, unfortunately, cannot, and need to be aware of the effects so they can make choices about what, and how much, to eat. Higher fibre varieties can be more filling and release glucose more slowly, but the amount eaten is still the most important factor.
‘There are different dietary strategies for managing type 2 diabetes,’ Alison adds. ‘The important thing is finding the one that suits you and that you can stick with.’ But, Alison cautions, try to avoid or at least limit foods in which both fat and carbs are high. Yes, it’s those tempting sausage rolls again, but also biscuits, cakes and chocolate.
‘The carbohydrate turns to glucose and stimulates insulin, which tells the body to store fat, not burn it. And these foods are particularly powerful at lighting up reward pathways in our brains, making us want more of them.
‘Home cooking is preferable, as you know exactly what’s going into it, and it always tastes more delicious in my experience,’ says Alison. ‘But people can’t always cook from scratch, for a variety of reasons, and then options such as ready meals can be helpful. Always compare labels to make sure it’s a good choice for your preferred eating pattern, and, if you have high blood pressure, choose one with low salt.’