The Origin of Diabetes Mellitus

Diabetes comes from the Greek word meaning siphon. When early doctors found that people with diabetes passed large amounts of urine and the urine was sweet to taste, they realized it was full of sugar. Gradually the Latin word for honey/sweet – ‘mellitus’, was added to form the name Diabetes Mellitus. Understanding that origins helps us understand what is diabetes.

Diabetes is a disorder which develops when a person does not produce enough insulin. Insulin is a hormone which works in all parts of the body and helps the sugar we get from our food move from our bloodstream into our cells, tissues and muscles to give us energy. Insulin is needed to keep us healthy and our body in good working order. Insulin is released from a gland in the body called the pancreas. The pancreas is a jelly like gland, weighs about 60g and is found lying behind your stomach. If the pancreas is not producing enough insulin, the level of sugar in the blood starts to rise. Without enough insulin the body is unable to convert sugar from food eaten into energy. If the body goes without insulin for too long, damage can occur to all the blood vessels in the body and major organs, such as the kidneys and eyes.

Insulin was discovered in 1921-2 and was one of the most important medical discoveries of the modern age. Before this people who had diabetes would experience very difficult times and some would die very young.

Diabetes is not a mild condition. All diabetes should be taken seriously and treated properly. People who have diabetes have a higher chance of developing certain serious health problems, including heart disease, stroke, high blood pressure, circulation problems, nerve damage and damage to the eyes and kidneys. These risks are particularly high for people with diabetes who are overweight, who smoke or who are not very active.

Types of Diabetes

There are two main types of diabetes. Type 1 diabetes also known as insulin dependent diabetes and Type 2 diabetes also known as non-insulin dependent diabetes.

Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 30 and is treated by insulin injections, healthy eating and regular exercise. Type 1 diabetes usually happens very quickly, usually over a few weeks. Insulin injections are vital for people with Type 1 diabetes.

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is being made does not work very well. This type of diabetes usually appears in people over 40 years of age. It is treated by healthy eating, and exercise, tablets and if the tablets do not lower the blood sugar insulin injections will be started. Type 2 diabetes can happen very slowly and may not be obvious, a person may just feel generally unwell.

Tablets taken for diabetes are not insulin, but substances which get a person’s own insulin supply moving when it is needed or makes the cells in the body more sensitive to the insulin being produced by the pancreas. In Type 2 diabetes insulin injections may need to be taken with the tablets if the tablets do not lower the blood sugar enough. This does not mean a person has Type 1 diabetes, they still have Type 2 diabetes but require insulin injections to help control the blood sugar levels.

How Do You Get Diabetes?

Diabetes is very common. About 2.3 million people in the United Kingdom have diabetes, it is estimated that approximately another half a million people have diabetes without even knowing it. Diabetes tends to be more common as people get older. [In 2017, this figure has grown to an estimated 4 million people living with diabetes]

Type 1 diabetes develops when the cells which produce insulin in the pancreas are destroyed. It is not fully understood how or why this happens. The most likely cause is the body attacking its own cells, this is called an auto-immune response. This can be triggered by a viral infection or other types of infections. Type 1 diabetes does not necessarily run in families. Type 1 diabetes accounts for 5-15% of all people with diabetes.

Type 2 diabetes develops usually as people get older. The main cause is that the body is not able to produce enough insulin and/or the insulin which it is producing is not being used properly. People who are overweight are more likely to develop Type 2 diabetes. Type 2 diabetes tends to run in families and is more common in Asian and African-Caribbean communities. Type 2 diabetes accounts for 85-95% of all people with diabetes.

Identify Diabetes Early – Are You At Risk?

Early diagnosis and treatment can reduce the risk of complications. Diabetes causes high levels of sugar in the blood. Untreated diabetes may cause damage to the heart, eyes, kidneys and feet. Some of the signs of diabetes include feeling extremely tired, feeling irritable, feeling thirsty, passing urine excessively and getting lots of infections.

Risk factors for diabetes include:

• Having a close family member who has diabetes, such as father, mother, brother or sister.
• Having a waist measurement of 31.5 inches (80cm) or over for women; 35 inches (90cm) or over for Asian men and 37 inches (94cm) or over for white and black men
• Having high blood pressure or if you have had a heart attack or stroke
• If you are a women with polycystic ovary syndrome and are overweight
• If you are over the age of 40 or if your over the age of 25 and black, Asian or from a minority ethnic group. This risk goes up as you get older, so the older you get the more at risk you become
• If you have been told you have impaired glucose tolerance, which means your body is finding it difficult to use the sugar taken from the food you eat
• If you have had diabetes during pregnancy (gestational diabetes)
• If you have severe mental health problems

Early diagnosis and treatment of diabetes will benefit you in several ways:

• You will receive detailed dietary advice that may help with weight reduction and will help control your blood sugar levels
• You will be encouraged to use exercise and activity to help control diabetes.
• You will have the benefit of regular medical care to ensure that the diabetes is controlled and that complications of diabetes are prevented.

Diagnosis of Diabetes

With Type 2 diabetes it is possible that you may have been feeling unwell for some time before diabetes is diagnosed. Sometimes people have diabetes for over 5 years without knowing. Type 1 diabetes usually happens very quickly, within a few weeks.

Diagnosis of diabetes can be carried out by having a blood test, this will probably be a fasting blood sugar test. If the result of the blood sugar test is higher than normal, diabetes is diagnosed. Diabetes cannot be cured, it is a long term condition.

Myths About Diabetes

There are lots of different stories told about diabetes, many of which are make-believe. These include:

• Type 2 diabetes is mild – All diabetes is serious and should be treated properly
• Diabetes is caused by eating too much sugar – eating sugar does not cause diabetes, however, being overweight and eating too much sugar and fat increases the chances of getting diabetes
• Type 1 diabetes is more serious than Type 2 diabetes – all diabetes is serious regardless of whether a person is taking injections following a healthy diet and exercise programme
• People with Diabetes have to have a special diet – a special diet is not necessary, it is important to follow a healthy diet, low in fat, low in sugar and high in fibre
• People with diabetes cannot eat cakes, chocolate, grapes, bananas or tomatoes – Fruit and vegetables are good for you. Eating five portions of a variety of fruit and vegetables is an important part of healthy eating. Cakes and chocolate are high in fat and sugar, this does not mean they are banned food. It is important to limit the amount of these foods in your diet, especially if you are overweight and trying to lose weight
• People with diabetes should have special ‘diabetic’ food – Food labelled ‘diabetic’ is of no benefit and is often more expensive and can have a laxative effect.
• People with diabetes who take insulin all have Type 1 diabetes – Treatment for Type 1 diabetes is always insulin injections. Treatment for Type 2 diabetes may be a combination of healthy eating, tablets and/or insulin. People with Type 2 diabetes may have insulin injections to help control their sugar levels
• People who have diabetes go blind and have their legs amputated – Uncontrolled diabetes leads to serious complications, such as blindness and poor circulation in the legs. By taking regular exercise, eating a healthy diet and controlling blood sugar levels the risk of developing such complications is greatly reduced.

Treatment For Diabetes

Treatment for diabetes may be different for each individual who has diabetes.

• Treatment for everyone who has diabetes includes 1,2,3 and 4
• Treatment for people with Type 1 diabetes includes 1,2,3,4 and 5
• Treatment for people with Type 2 diabetes includes 1,2,3,4,6 and 5 when tablets no longer control the blood sugar levels.
• Treatment will often include tablets for blood pressure and cholesterol control

1. Healthy Eating
2. Exercise and/or increased activity
3. Managing your weight
4. Education about diabetes
5. Insulin injections
6. Tablets

What Is Healthy Eating?

A Balanced Diet
Food is divided into five main groups and to enjoy a healthy, balanced diet we need to eat food from these groups in the right proportions.

An area which has received a lot of attention is glycaemic index. Glycaemic Index is a measure of how quickly a carbohydrate food is digested and released as sugar into the blood stream. It is generally healthier to eat food which cause a slow release of sugar into the blood. This helps keep the blood sugar levels within the normal range, supplying energy over several hours and reducing the need to overeat or snack. When we talk about the glycaemic index we are talking about carbohydrates, that’s foods such as pasta, rice bread, cereal and potatoes, although carbohydrate is also found in all fruits and vegetables and in other foods. Each food is given a rating on a scale of 1-100, and the lower the rating, the better. The highest ranking food is Glucose at 100. Anything with a rating above 70 is considered high GI, a rating between 55-70 is medium GI and below 55 is a low GI. Higher the fibre content the lower the GI ranking is likely to be. Focusing on foods that that provide slow, steady amounts of energy throughout the day helps control blood sugar levels..

[See the Glycaemic Index of Common Foods for more information and Patrick Holfords article relating to a  low GL diet: Sugar, Caffeine & Carbohydrates Make You Fat

• Have at least five portions of fruit and vegetables every day
• A portion of fruit is: a piece of fruit (e.g. medium apple, small banana or medium pear); a slice of a large fruit (e.g. melon, mango and pineapple); two small fruits (e.g. satsumas or apricots), a cupful of berries or grapes; a small glass of unsweetened fruit juice; three serving spoons of tinned or stewed fruit; half a serving spoon of dried fruit
• A portion of vegetables is 2-3 tablespoons or a bowl of salad
• Fruit juice is rich in vitamin C. However, fruit juice contains natural sugar and can cause blood glucose levels to rise so it is best taken with meals, having up to 150-200 mls per day.

Bread, Cereals, Whole Grains, Pasta and Potatoes

• Choose starchy foods like bread, pasta, rice, chapatis, potatoes or cereals as the main part of all meals and snacks
• Opt for wholewheat pasta and noodles and brown rice instead of white varieties
• Swap crisps, biscuits and cakes for whole grain snacks such as plain popcorn, rye cirspbreads or a bowel of cereal
• Add a handful of pearl barley to stews, casseroles and soups
• Wholegrain bread, wholemeal pitta bread and cereals such as weetabix, porridge, shredded wheat, bran flakes are preferred

Milk and Dairy Foods

• Choose Skimmed or semi-skimmed milk – ½ a pint per day
• Try lower fat varieties of dairy foods like low fat yoghurt, light crème frâiche, lower fat cheese e.g Edam Gouda, half fat cheddar and fromage frais
• Limit high fat dairy foods

Meat, Fish and Alternatives

• Choose lean red meat or poultry without skin
• Eat fish at least twice a week. White fish is lower in fat. Oily fish such as sardines, salmon and mackerel – choose at least once a week
• Pulses such as baked beans, dahls, butter beans and lentils can be added to so ups, salads, casseroles and mince dishes 
• Soya products, such as tofu and Quorn are low in fat and can replace meat in certain recipes
• Limit intake of sausages, pies, burgers

Ready-Prepared Meals and Sauces

• Ready-prepared meals and sauces tend to be high in fat and salt and low in fibre. Choose lower fat or healthy choice options, add extra salad and vegetables to make a meal more balanced
• Sauces (like ketchup), relishes and chutneys can be eaten as usual and choose low fat varieties of ready-made sauces

Foods Containing Fat
Reducing your fat intake doesn’t have to mean not eating any of the foods you enjoy, some fat is essential for the body to function properly.

Snack foods such as crisps, biscuits, cakes, chocolate and other deep fried or baked snacks tend to be high in saturated fat, so these should be limited and only eaten as an occasional treat.

To reduce your fat intake:

• Grill, bake, boil, steam, microwave or dry roast rather than frying
• Avoid fatty cuts of meat or any meat products that have been processed
• Reduce oil or fat in cooking, spread margarine thinly. Choose monounsaturated, polyunsaturated fats such as corn oil, sunflower oil
• Crisps and biscuits are usually high in fat and calories so choose carefully, only have these as a treat
• Eat fewer pastries, pies and cakes

Foods Containing Sugar:

• A healthy diet is low in sugar not sugar free. Use diet, low calorie or no added sugar drinks
• Buy artificial sweeteners such as Sweetex, Hermestas and Canderel to replace sugar
• Look out for reduced sugar, low sugar and sugar free foods where available, e.g. sugar-free jelly
• There is no need to eat diabetic foods – they are unnecessary, offer no benefit over ordinary foods and are more expensive.

Salt Cellar

• Reducing salt (sodium) intake can help reduce blood pressure. High blood pressure is associated with increased risk of coronary heart disease and stroke

Alcohol
Excess alcohol can increase blood pressure and obesity. Recommended healthy lifestyle limits:

For Men Up to 21 units of alcohol per week (3-4 units per day)

For Women Up to 14 units of alcohol per week (2-3 units per day)

1 unit of alcohol is 10ml of pure alcohol = pub optic measure of spirits, or half pint of beer/larger, or 1 standard glass of wine. Be aware home measures tend to be more generous!

Examples
1 pint of ordinary strength larger (Carling Black Label. Fosters) = 2 units
1 pint strong lager (Stella Artois, Kronenbourg 16664) = 3 units
1 pint ordinary bitter (John Smith’s, Boddingtons) = 2 units
1 pint best bitter (Fuller’s ESB, Young’s Special) = 3 units
1 pint ordinary strength (Woodpecker) = 2 units
1 pin of strong cider (Dry Blackthorn, Strongbow) = 3 units
1 x 175 ml glass of red or white wine = 2 units
1 x alcopop (Smirnoff Ice, Bacardi Breezer, WKD, Reef) = 1.5 units

Managing Your Weight and Increasing Your Activity

Over half of all adults in the UK are overweight. The number of people who are overweight is still rising. Diabetes is very closely linked with being overweight.

For people with diabetes there are major benefits in losing weight. Losing weight helps the body’s insulin to work better. Losing weight will help control blood sugar, cholesterol and blood pressure. It will also help reduce tiredness, aches and pains, joint damage and increase your mobility. Many people fail in trying to lose weight because they set unrealistic targets, wanting to lose too much weight too quickly. It is important to start slowly making small changes, over time these small changes will make a big difference.

Top Tips for Losing Weight and Keeping It Off

• Always eat breakfast
• Stick to a meal routine by eating at the same times each day
• Walk it off – join the Green Gym
• Watch portion sizes – Eat lots of vegetables and salads
• Plan what you are going to eat so you are not tempted by fast food fixes
• Enjoy eating, chew your food slowly
• Stop eating when you feel full, you don’t have to clear the plate
• Reduce your alcohol intake, it has lots of sugar in it.

Activity

Being active is good for all of us, but is especially important for people with diabetes. Activity combined with healthy eating will help to manage diabetes and prevent long term diabetes complications.

Activity or exercise does not mean having to go jogging or joining a gym., pick activities you enjoy. If there are difficulties for you doing some activities try doing exercises whilst sitting in a chair, for example, raising your arms in the air or rotating your ankles from left to right. Small movements all add up to extra activity and exercise. Try and do 5-10 minutes each day and slowly build this up each month. If your activities can fit into your everyday life with little disruption to your normal routine you are more likely to stick to it. Make it a habit not an effort.

Activities to try:

• Walking
• Arm and Leg Exercises in a chair
• Swimming
• Cycling
• Tai Chi
• Yoga

The Department of Health recommends adults should exercise for at least 30 minutes a day, five days a week. Small changes make a big difference.

Complementary Therapies

Diabetes is a long term condition. Healthy eating, exercise and in many cases tablets and insulin are essential for correct diabetes management. Most complementary therapies aim to maintain or restore balance by assisting the body to heal itself. There is a wide variation in the quantity and quality of scientific evidence for complementary therapies. In many cases the safety and efficacy of complementary therapies for diabetes management are not established.

It is important to realise that there may be some interactions between complementary therapies and conventional medicines for diabetes. These can include, infections, bruising, low blood sugar and high blood sugar and allergies.

Complementary therapies are widely used and some may have beneficial psychological, quality of life and symptom management. Exercise, nutrition, stress management, counselling and empowering strategies could support current diabetes management. Although the research basis of complementary therapies is increasing, there is still insufficient evidence for many therapies or their application to diabetes.

Diabetes and Smoking

Smoking is a killer. It increases the risk of cancer, heart disease, stroke and other diseases. Smoking and diabetes are a lethal combination. Cigarette smoking should be avoided completely. Smoking and diabetes increases the risk of developing complications of diabetes by 2 or 3 times. The longer a person with diabetes smokes the greater the risk. There is lots of help available to stop smoking. The benefits of stopping start immediately. Many people worry about stopping smoking because they fear weight gain. But the benefits of stopping smoking far outweigh any problems of weight gain.

There area many different ways to quit smoking with a greater range of Nicotine Replacement Therapy options on prescription and to buy over the counter. Support from health care professionals to maintain control whilst attempting to stop smoking may be required. There is a national NHS Smoking Helpline – 0800 169 0 169.

Holidays and Diabetes

People with diabetes, both Type 1 and Type 2 travel all over the world, diabetes is no barrier. Plan your trip in advance and ensure you carry personal identification when travelling. Ensure you have had any necessary vaccinations as required. Ensure that you have comprehensive travel insurance which includes pre-existing medical conditions as well as emergencies. Look for a premium with at least £250,000 of cover. Free or reduced cost emergency treatment is available at some centre in other European Union countries. To take advantage of this service you will need to take with you the European Health Insurance Card (EHIC) and form T1 ‘The Travelers Guide to Health’.

It is advisable to carry double the supplies of insulin/medication normally required and to carry insulin/medication in your hand luggage and not in the hold of the plane. Remember that holidays do not always go as exactly as planned, so always be prepared, for example, carry extra snacks in your hand luggage, such as fruit, cereal bars, crackers, sandwiches and fruit juice.

Diabetes and Foot Care

Diabetes, particularly if it is poorly controlled, can damage the nerves in the feet and the legs. This is called neuropathy. The symptoms of neuropathy include, numbness, burning or tingling in the feet. It is important to check feet on a daily basis. Remove both shoes and socks/stockings to look at both feet together for comparison. Observe general foot care:

• Wash your feet daily, test the temperature of the water with an elbow to avoid scalding
• Dry well especially between toes
• Apply moisturizer (or hand cream) to keep your skin supple and prevent cracking
• Observe for any signs of trauma, ulceration, swelling, reddened areas, or pressure marks
• Observe for any signs of temperature changes, using the back of your hand. Warm areas may indicate inflammation or infection
• Keep toenails healthy, cut them to the shape of the end of the toes; once in every 6 to 8 weeks is usually often enough
• If you are able to cut your own toenails, cut and file straight across
• The right shoes and stockings/tights/socks will help to keep your feet healthy. Choose shoes which are broad fitting, are flat or low heeled and are fastened by a lace or buckle to keep the heel in the back of the shoe.

If you notice any changes with your feet you should alert your Practice nurse/GP/Chiropodist as soon as possible.

Diabetes and Eye Care

All people with diabetes are entitled to a free annual retinal screening test by digital camera from the NHS. Diabetes is the leading cause of blindness in the United Kingdom. This is why it is important to have eye screening every year.

People with diabetes need to have their retinas (the seeing part at the back of the eye) examined as part of their diabetes care. Retinal screening is different to from a general eye examination, which checks that you can see properly, that your glasses, if needed are correct and that your eyes are healthy. To be able to see clearly, light must be able to pass through to the retina – the seeing part at the back of the eye, without anything getting in its way.

Retinopathy is a complication of diabetes. Retinopathy is caused when blood vessels in the retina become blocked, leaky or grow haphazardly which can damage the retina and stop it working properly.

What helps you to take care of your eyes:

• Good blood sugar control
• Good blood pressure control
• Normal cholesterol levels
• Keeping active
• Stopping smoking
• Keeping a healthy weight

Retinopathy can affect you whether your diabetes is treated with diet and exercise alone or together with tablets and/or insulin. Not all people with diabetes will experience retinopathy. However, it is essential that all people with diabetes have regular screening.

How is retinopathy treated?

Special lasers are used for treating retinopathy. Laser treatment can not improve vision that has already been lost, but it can prevent further damage from occurring. Laser light is used to seal leaky blood vessels and prevent them from becoming worse. Laser treatment also destroys abnormal new blood vessels in the retina. For some people surgery is also necessary.

Case Study

Jean is a 60 year old lady who works at a local supermarket. She is married to John. Jean weighs 15 stone and is overweight and smokes up to 15 cigarettes per day. Jean was diagnosed with Type 2 diabetes three years ago. Jean spends a lot of time sitting down during the day and has noticed that she needed to visit the toilet more often and felt very tired all the time.

Jean takes two different types of tablets to help control her blood sugar levels and two tablets to help control her blood pressure and one tablet for cholesterol. Diabetes is not only about control of blood sugar levels, monitoring the levels of blood pressure and cholesterol, and keeping these and blood sugar levels as near to normal as possible is very important as it reduces the risk of diabetes complications occurring.

Jean states:

‘ It’s not just me who’s got diabetes, the family has diabetes, because it is part of everything. The family has had little support since I was diagnosed three years ago. I feel guilty, because my diabetes affects all the family. I also feel guilty if I enjoy food or eat the wrong types of food. I find it difficult to relax because I’m always thinking about what to eat, what is healthy, how tired I feel and how this affects my family’.

Many people with diabetes can become overwhelmed with the difficulties and feelings associated with coping with diabetes every day. Jean contacted her local diabetes service because she was feeling so awful. Jean spoke to one of the diabetes specialist nurses who arranged for Jean to have a blood test, this showed that Jeans diabetes control was not very good. Jean had not had any education about how to manage her diabetes. Jean was invited to attend the local diabetes education programme. The programme covers topics such as, what is diabetes, managing diabetes, monitoring diabetes, diabetes and illness, living with diabetes, food choices, test results and annual reviews, physical activity, emotions and self management. Because diabetes has no cure, people with diabetes have to accept it as part of life; and they are the ultimate managers of the treatment and care, education helps enormously. Jean thoroughly enjoyed the session and arranged an appointment with one of the diabetes specialist nurses.

Jean said:

‘ At the education programme we learned which foods are good for us and what choices we could make. And those of us who smoke – like me, were encouraged to quite. Suggestions included being more active, building up to at least 30 minutes of activity five days a week. I’ve started slowly by walking 10 minutes every other day. Well, it’s a start and my diabetes specialist nurse tells me any extra exercise will make a difference. We were all given a booklet which gave me all the information I needed, which we could keep and refer to at any time. After the session I felt encouraged to start improving my health and felt determined to work on losing weight, being responsible for my own health and diabetes makes me feel in control. I always know the nurses are their for support and help if I need it.’

At Jeans appointment with the diabetes specialist nurse a full history was taken and the diabetes specialist nurse worked with Jean to find out how Jean could improve her diabetes control, fitting this in with her daily life. A diabetes care plan for the next six months was agreed between Jean and the diabetes specialist nurse. The care plan included:

• Jean joining a diet and fitness club to help her lose weight
• Walking for 10 minutes each day
• Contacting the diabetes specialist nurses once a fortnight to check progress and discuss any concerns
• Having a repeat blood test every three months to monitor diabetes control
• Having blood pressure checked once a month for three months
• Having a repeat cholesterol test in three months

After three months Jean lost an astonishing 2 stone in weight. Jean had increased her walking to 20 minutes three times a week and no longer felt tired all the time. Jeans blood sugar levels, blood pressure and cholesterol all improved significantly, so much so, that two of the diabetes tablets were stopped and one of the blood pressure tablets was stopped.

Awareness of the risks of being overweight and the link with Type 2 diabetes is increasing, but management of personal lifestyle involves conscious decision making which will improve quality of life and management of diabetes. People with diabetes need to be given the right information and the right support, and use it effectively in their own lives. Paying attention to preservation of good health, following a healthy balanced diet, not too many calories, regular exercise, together with special education is vital for good diabetes management and wellbeing.

Jean set herself realistic activities together with support rather than instructions. It is important when making changes that manageable targets are set. In relation to diet, exercise and medication, Jeans success was achieved by her own ability to decide what would be helpful for her and to have the option of regular support from her local diabetes specialist nurse. Jeans next step is to quit smoking. Jean has now joined an NHS local stop smoking group and is doing very well.

Many people prefer to keep quite about diabetes because they feel they don’t want to bother anyone or they see it as a ‘mild’ condition. Sometimes people view it as like having a headache, annoying but take a tablet and it will go away. Diabetes is serious, lifestyle adjustments are the best treatment for diabetes, high blood pressure and high cholesterol. Jean took the time and effort to find out how to help herself which resulted in improved quality of life, health and wellbeing.

Apart from managing the condition and potential health risks, diabetes can cause many other knock-on effects such as increasing life insurance premiums. Nonetheless, it is important that full details of the condition are disclosed in any existing or new policies to avoid invalidating the insurance.

Healthy Life With Diabetes
By Alexis Hodgkins RGN/DN/MSc
Alexis is a registered nurse and specialist is diabetes care and management.

Picture Credits
“Overweight african american” © Lucian Coman | Dreamstime.com