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SIR MICHAEL

HIRST TALKS

Type 2 diabetes How lifestyle choices can make all the difference

In your hands Learn the best ways to manage the condition

DIABETES UK

5TIPS

No. 5/May ‘10Mediaplanet takes responsibility for all content in this independent supplement

Distributed within the Daily Telegraph

DIABETES

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Personal account: The President-elect of the International Diabetes Federation shares

his experiences on dealing with diabetes as a family.

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Why the UK is fighting back

Medical and technological advances provide great armour against diabetes, allowing people to live the lives they want to more than ever before. But with the number of people with diabetes climbing daily, more needs to be done - from research and development to increased education.

With 2.6 mil-lion people living with a condition that, on aver-age, reduces life expect-

ancy by between ten and 20 years, dia-betes is undoubtedly one of the biggest health challenges currently facing the UK. This means that even if you do not have the condition, it is likely that you will know either a loved one, a friend or a colleague who does.

Often preventable, type 2 diabetes accounts for the vast majority of these cases and, worryingly, it is an estimat-ed up to half a million people have the condition but don’t know it, putting themselves at unnecessary increased risk of devastating complications such as heart disease, stroke, kidney failure, blindness and amputation.

Diabetes is a condition where the amount of glucose (sugar) in the blood is too high as the body cannot use it properly. Normally a hormone called insulin is released from the pancre-as to take the glucose from the blood

to the cells where it is used for energy. However, in people with diabetes, the pancreas either does not produce any or not enough insulin or the insulin that is produced doesn’t work properly (known as insulin resistance).

There are two main types of diabetes:

1Type 1 diabetes This develops when the body is

unable to produce any insulin. This usu-ally appears before the age of 40, partic-ularly in childhood with peak diagnosis between the ages of 10 and 14. It is treat-ed with insulin either by injection or pump, a healthy diet and regular physi-cal activity.

2 Type 2 diabetes This develops when the body

doesn’t produce enough insulin or the insulin that is produced doesn’t work properly. Type 2 diabetes is treated with a healthy diet and regular physical ac-tivity, but medication and/or insulin is often required.

The risk factors of type 2 diabetes are being overweight or having a large waist, being aged over 40, though in

South Asian and Black people the condi-tion can develop over the age of 25, and having a family history of the condition. The UK’s spiralling obesity crisis is caus-ing a once ‘middle-aged’ condition to be seen in young people and children.

It is vital to raise awareness of type 2 diabetes risk factors because lifestyle changes can reduce the risk or delay onset of its development. It is also es-sential to find the estimated half a mil-lion people who remain undiagnosed with type 2 diabetes. The sooner peo-ple are diagnosed, the sooner they can start managing their condition to re-duce the risk of complications. Type 2 diabetes can go undiagnosed for up to ten years, and at the time of diagnosis, around half already have signs of long term complications.

Diabetes is a lifelong condition and the NHS spends £1 million an hour on diabetes and its complications. It is es-sential to provide access to high qual-ity, specialist care, structured educa-tion, and emotional and psychologi-cal support to all people to help them manage their diabetes to reduce the risk of complications.

“Carrying my comatose child into hospital is something I’ll never forget”

Sir Michael Hirst The former MP talks about the moment he found out his daughter was diabetic

WE RECOMMEND

PAGE 06

Are you diabetic? p. 041. Why good self-management is key to a happier you.

Look who’s talking p. 102. How education and communication can dramatically change lives.

DIABETES, 5TH EDITION, MAY 2010

Country Manager: Willem De GeerEditorial Manager: Danielle StaggSales Manager: Simon Kenneally

Responsible for this issueProject Manager: Danielle CrankPhone: 0207 6654404E-mail: [email protected]

Distributed with: The Sunday Telegraph, May 2010Print: Telegraph Media Group

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We make our readers succeed!Douglas SmallwoodChief Executive, Diabetes UK

1Current research holds promise for the future treatment of dia-

betes, with ongoing work including hopeful development of a vaccine for Type 1 diabetes, along with islet cell transplantation and non-invasive in-sulin delivery.

2Diabetes is a common lifelong condition that has the potential

to have a huge impact – yet when armed with knowledge, it is very man-ageable. Raising awareness for people with diabetes and the population in general is key.

MY BEST TIPS

CHALLENGES


Question: We know there’s no cure to diabetes yet – so what’s the best strategy? Answer: With wise management, good knowledge and the right intervention, diabetes has less impact on lives – and on the quality of lives – than ever before.

Diabetes is a complex chronic condi-tion and as a result there is not one sin-gle factor associated with good diabetes management, says Helen McGuire, diabe-tes education and health systems special-ist at the International Diabetes Founda-tion (IDF).

And good diabetes management re-quires commitment at all levels of the health care system, she points out: policymakers across a range of minis-try departments, such as health, edu-cation, finance, and communities and local government are all vital. But, al-though they have the support of their healthcare providers, people with dia-betes are in charge of the management of their diabetes, says Helen. “The time with their healthcare team is limited and they are faced with decisions eve-ry day that influence their risk of devel-oping complications - people need to be informed and supported to identify their goals for change and to integrate these changes into their life,” she says.

All the evidence we now have clearly supports the fact that diabetes educa-tion and support are an essential part of good diabetes management.

Innovative models of service delivery that maximise the scope of each health care discipline are important, says Helen: timely access to healthcare is essential for nurses, dieticians and doc-tors to achieve best clinical outcomes.

The main aim of managing both Type 1 and Type 2 diabetes is to achieve blood glucose, blood pressure and lipid levels as near to normal as possible.

Self-monitoring of blood glucose (SM-BG), by blood and/or urine testing, com-bined with education, provides infor-mation for people with type 1 and type 2 diabetes to make day-to-day decisions, shifting the balance of power back into their hands and allowing them to re-gain some control. It’s possible, for in-stance, to adjust your glucose moni-toring and intake to the events of your life – both daily events and exceptional events, from taking additional exercise, having sexual activity, eating different

types of food or travelling. While glu-cose monitoring can seem difficult to perfect, a little knowledge goes a long way and the results for those with di-abetes can be life-changing. Insulin pumps are appropriate for some peo-ple and can improve glycaemic control whilst allowing for increased flexibili-ty in lifestyles.

Clinical trials have demonstrated the value of tight glycaemic control to re-duce the risk of costly and life threat-ening complications, point out Dia-betes UK – and prolonged raised blood glucose levels are extremely detrimen-tal to health, as it is associated with in-creased risk of heart disease, strokes, blindness, amputations and kidney dis-ease.

Glucose monitors are a method of ob-taining information about the amount of glucose in your blood at a given time, explains Helen McGuire – and in order for this information to influence diabetes management it must be acted on by the person with diabetes and/or the health care team. “Self-monitor-

ing of blood glucose can increase peo-ple’s understanding of diabetes, add flexibility to food choices and lead to improved glucose control. When peo-ple with diabetes and their health careteam are committed to using glucose monitors correctly, recording the re-sults and using the results to make de-cisions, self-monitoring of blood glu-cose provides important feedback on how blood glucose levels are affected by food, lifestyle and medications.

The IDF’s guidelines on self-mon-itoring of blood glucose (SMBG) are that it “should be considered as part of ongoing diabetes self-management education to assist people with dia-betes to better understand their dis-ease and provide a means to active-ly and effectively participate in itscontrol and treatment in collabora-tion with healthcare professionals”. (SMBG Guidelines, IDF, 2009)

Take control - and live life to the full

EMILY DAVIES

[email protected]

CHANGE

“People need to be informed and supported to identify their goals for change.”Helen McGuire International Diabetes Foundation

INSPIRATION

KNOW YOUR ENEMY

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EASY LIVINGGood management and a positive attitude are key when living with diabetes.PHOTO: ISTOCKPHOTO.COM

TIPS ON GLUCOSE

MONITORING

3

In your own hands

195 per cent of diabetes care is self-care.

Make your own plan

2Decisions about self-moni-toring should be made on a

case-by-case basis.

See the benfits

3Considerable cost savings and improvements in quality of

life can be made from supporting self-care, including improved well-being, prevention of unnecessary hospital admissions, and reduced frequency of support from the NHS.

Evidence has shown that SMBG allows people with diabetes to:

Enable better management of short and longer term metabolic control assisting in the prevention of short and long term complica-tions.

Monitor effectiveness of medi-cation, eating and physical activity on blood glucose levels.

Help to maintain or improve motivation for managing diabetes.

Provide reassurance and reduc-ing anxiety and fear of hypoglycae-mia.

Improve feelings of confidence and control over their own diabetes.

SOURCE: DIABETES UK

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How we triumphed over the agony together

Sir Michael Hirst’s groundbreaking advocacy for diabetes began 25 years ago in a Glasgow hospital – with an or-ange in one hand and a glass syringe in the other. Faced with a gravely ill five-year-old daughter newly diag-nosed with diabetes, Sir Michael and his wife Naomi were to learn how to inject her with insulin at home.

“We were given a large glass sy-ringe that had to be kept in spirit and a needle that had to be sharpened”, Sir Michael, from Kippen in Stirling-shire, remembers. “When I realised even I was struggling to get my hands around the orange and the syringe – I had to ask if there was an easier way.” On learning that disposable syring-es were not available on the NHS and had to be bought, a nerve was struck.

“We were very lucky to have a neighbour who was a pharmaceu-tical wholesaler and who offered

to supply us with as many disposa-ble syringes as we wished,” says Sir Michael. “We bought a far more mod-est amount than he offered but real-ised how lucky we were to be able to. I felt acutely aware that it was an ex-pense that not all could afford – and that there had to be a better way.”

After his energetic campaigning

hit “a brick wall of opposition” from the Treasury and the Department of Health, Sir Michael succeeded in hav-ing disposable syringes added to the drug tariff after then Prime Minister Margaret Thatcher overruled.

Now president-elect of the Inter-national Diabetes Federation, Sir Michael is continuing his campaign-

ing. While Kate has type 1 diabetes, an autoimmune disease, type 2 diabetes is largely preventable and on the in-crease.

“Carrying my comatose child into hospital is something I’ll never for-get. When the consultant told us Kate had diabetes, I instantly asked how long she would have to have insulin injections. He looked at me as if I was the village idiot – and said, “well, for-ever”.”

“I immediately saw it as a life sen-tence – but leaving hospital that day feeling numb I bumped into one of my constituents whose child had died of leukaemia. I explained about the ‘sen-tence’ Kate had been given – to which she replied that a life sentence of insu-lin was far better a blow than a death sentence of leukaemia.” That reply was serendipitous, says Sir Michael – be-stowing a sense of perspective. Today, Sir Michael is adamant that diabetes never be viewed as a disability nor an obstacle. Above all, prevention of this silent killer is key: “Type 2 diabetes can certainly be mitigated and in many cases could be avoidable; type 1 diabe-tes remains a challenge and cannot yet be prevented, but research will be the key to finding a cure and sparing young people and their families the burden of a lifetime chronic disease.”

“Carrying my comatose child into hospital is something I’ll never forget.”Sir Michael HirstInternational Diabetes Federation.

EMILY DAVIES

[email protected]

Question: Why is Sir Michael Hirst, the former Scottish Con-servative and Unionist Party MP so keen to raise awareness of diabetes and drive home the vital message of prevention?

Answer: Sir Michael’s daughter Kate nearly lost her sight through type 1 diabetes – they are both anx-ious no parent or child has to en-dure the experience they did.

HAPPY FAMILIESDealing with Kate’s diabetes has become routine for the Hirst family.PHOTO: PRIVATE

INSPIRATION

DIABETES IN CHILDREN/YOUNG PEOPLE

There are over 22,000 people under the age of 17 with diabetes in Eng-land. 97% have type 1 diabetes, 1.5 % have type 2 and 1.5 diabetes.

Type 1The current estimate of prevalence

of type 1 diabetes in children in the UK

is one per 700–1,000. This gives a total

population of 25,000 under-25s with Type

1 diabetes.

The peak age for diagnosis is be-

tween 10 and 14 years of age.

Type 2Prevalence figures for children are

limited but as many as 1,400 children may

have type 2 diabetes in the UK.

In 2000, the first cases of type 2 dia-

betes in children were diagnosed in over-

weight girls aged nine to 16 of Pakistani,

Indian or Arabic origin. It was first report-

ed in white adolescents in 2002.

In 2004, children of South Asian ori-

gin were more than 13 times more likely to

have type 2 diabetes than white children.SOURCE: DIABETES UK

HOW WE MADE IT

What has been the worst of your experience?

!At 22 I began to notice dete-rioration in my vision, which

was due to retinopathy. My vision soon deteriorated a great deal. I lost the ability to read – just as I’d graduated and was looking for a job. I had to put that on hold and became reliant on people to help me, which was extremely scary. I couldn’t use the computer, read my mail - or even look at my phone.

What happened next?

!I had incredible support from my family but beyond

that there was very little informa-tion available about what was happening to me. What prevailed were the messages I felt surround-ed by - that diabetics lose their sight. I feared I would be blind be-fore I was 23.

I had laser treatment, which can stop retinopathy but in my case didn’t work. I was having haemor-rhages in my eyes - seeing blood in front of my eyes was terrifying.

Fortunately I could have a vitrec-tomy, where the jelly in the eyes is removed and replaced with fluid, which stops the vessels bursting. Luckily that was successful and a few months later my eyesight be-gan to return. I was able to start working again, went into teacher training and have now been work-ing as a teacher for four years.

My eyesight will never be what it was. I need reading glasses and I can’t get upstairs at all if it’s dark. But that I can cope with. It pretty much doesn’t stop me doing any-thing and it’s a small price to pay in relation to what could have hap-pened. Only a few years ago I was facing a pretty bleak future - it’s certainly made me see things dif-ferently. My sight was saved just in time but not everyone is so lucky. Recently I met a woman only a few years older than me who had the same operation I did but for whom it came too late. She is now blind. Everyone with diabetes must have their eyes checked regularly – tim-ing is crucial.

There needs to be more informa-tion – the power of knowledge is huge.

QUESTION & ANSWER

Kate Hirst, 30Sir Michael’s daughter, Kate is a primary school teacher in Edinburgh. She was diagnosed with diabetes when she was 5.

DON’T LET IT GET YOU DOWN

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Question: Why is it so im-portant to maintain foot and leg health?

Answer: Diabetes puts a person at risk of damage to the nerves and the blood sup-ply, which can have dangerous complications. They are easily prevented, however, with good knowledge and professional in-tervention

Diabetes is the single most common cause of lower-limb amputation in the UK – and every 30 seconds a leg is lost due to diabetes somewhere in the world.

The shocking realityIn 2006/07 there were 5015 lower limb amputations in people with di-abetes in England, equivalent to 100 a week, according to Diabetes UK – and more than one in ten foot ul-cers in people with diabetes result in an amputation, meaning people with diabetes are between 15 and 30 times more likely to have an ampu-

tation than those without.One in three people with diabetes do

not realise that having the condition puts them more at risk of having an amputation and yet £600m each year goes on treating foot problems in peo-ple with diabetes in the UK, and at least £252m of this is spent on amputation.

People with type 1 and type 2 diabe-tes are at risk of damage to the nerves (neuropathy) and blood supply (ischae-mia) to their feet. Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputa-tion. However, Diabetes UK estimates that between 49 per cent and 85 per cent of all diabetic amputations can be prevented.

What you can doPeople with diabetes should have their legs and feet examined by a healthcare professional at least once a year. The examination will include neuropathy testing, where the examiner will press a series of instruments on their toes and the balls of their feet to check for

numbness; they will also test the per-son’s reflexes and may check whether they can feel the difference between hot and cold. It will also include circu-lation testing – the examiner will feel the foot and leg pulses and might lis-ten to the blood moving in the arteries of their legs and feet. The person may also have the blood pressure of their legs taken.

It is essential for the diabetes prac-titioner to assess the level of neurop-athy in a person with diabetes. One of the most important tools in the armoury of the foot care team is the monofilament, where a person with diabetes is assessed to be at risk if they cannot feel the pressure against the foot – within which the accurate-ly calibrated 10g monofilament is most key. There have been monofil-aments that purport to be 10g but in fact are less, or more – giving danger-ously misleading results as false pos-itives or false negatives.

KEEP YOUR BEST FOOT FORWARD

EMILY DAVIES

[email protected]

NEWS

SUB NEWS

Since 2000, new hope has been prom-ised by islet cell transplantation - de-stroyed islet cells are replaced us-ing cells harvested from donor pan-creases, reducing or eliminating the amount of insulin needed.

Islets are groups of cells in the pan-creas which contain the beta cells that make insulin as needed to main-tain blood glucose levels. In people with type 1 diabetes the beta cells are destroyed, so they must inject insu-lin. Typically a transplant patient will receive islets from up to three donat-ed pancreases; the transplanted cells produce insulin which stabilises the diabetes and reduces the amount of insulin that needs to be adminis-tered. In some cases the transplant-ed cells may produce enough insulin to allow a person to come off insulin completely.

“At the moment islet cell trans-plantation is limited and we antici-pate that only about 80 people with diabetes every year will benefit from the procedure. These will be peo-ple with poor blood glucose control. However, the benefits to the recipi-

ent are enormous as they massively-increase their quality of life,” says Dr Iain Frame, director of research at Di-abetes UK.

The current work on islet cell trans-plantation will have a huge impact in the future, says Dr Frame – and devel-opments in cell replacement thera-pies or stem cell advances are likely to rely on techniques learnt from is-let cell transplantation work.

“I am always excited to hear about anything that removes the need to take a blood test to check blood glucose levels and develop-ments in non-invasive insulin de-livery - anything along these lines, in the absence of a cure, will be hugely beneficial,” says Dr Frame. “I’m also watching with interest developments on the artificial pan-creas. If successful, this will benefit children, pregnant women and oth-er adults with type 1 diabetes.”

Dr Iain FrameDirector of Research, Diabetes UK

OUT OF YOUR DEPTH?Don’t let diabetes get the best part of you. Early di-agnosis and a healthy life-style can help you avoid the worst.PHOTO: ISTOCKPHOTO.COM

How cells hold the secret

EMILY DAVIES

[email protected]

DON’T LET IT GET YOU DOWN

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NEWS IN BRIEF

DEVELOPMENTS

Research offers diabetics new hope

“It is impossible to predict the future but, we have already come such a long way since the discov-ery of insulin 80 years ago, when a diabetes diagnosis was considered a life sentence - I am confident that research will play a signifi-cant part in developing positive changes in diabetes in the next half a century.

“We know that scientists are trying to develop methods of deliv-ering drugs such as insulin orally and if these methods work it will mean an end to daily injections for people with type 1 diabetes and those injecting drugs for type 2 di-abetes.

“There is a lot of work going on looking at developing a vac-cine for Type 1 diabetes. Whilst this won’t cure someone with di-abetes the prospect of a vaccine to prevent it in those at high risk, and perhaps even delaying the on-set of diabetes is really exciting.”

SOURCE: DR IAIN FRAME, DIRECTOR OF RESEARCH, DIABETES UK


The power of knowledge

IN THE KNOWEducation is key for under-standing the risks and fac-tors affecting diabetesPHOTO: ISTOCKPHOTO.COM

With prevention the most impor-tant and consistent message in di-abetes, education and awareness is more vital than ever – and from tried and tested routes to innova-tive new ways, there are more meth-od than ever before of delivering the message.

One of the most inventive meth-ods is the Diabetes Conversation Map programme, consisting of four unique 3ft by 5 ft tabletop visuals, was developed by Healthy Interac-tions Inc. (Healthyi) in partnership with Diabetes UK.

The programme is designed to help people with diabetes learn how to effectively and efficient-ly self-manage their condition and aims to engage people with Type 2 diabetes in a new way, using inter-active group discussion and work with healthcare professionals. Over 10,000 healthcare professionals have already been trained in the US and Canada where the programme was well-received, after which the UK was the first country to put it in-to place.

“It is a very innovative approach to helping people with diabetes im-

prove how they manage their condi-tion - at least 95 per cent of diabetes care is self-management and edu-cation is a key factor in this,” says Douglas Smallwood, chief executive of Diabetes UK. “The programme aids diabetes learning in many dif-

ferent ways and our hope is that it will become part of structured ed-ucation in the UK. Almost 90 per cent of people with diabetes in this country have never received struc-tured education, so it is vital that we make this area a priority for im-

provement.” The programme comprises a set of

four different ‘maps,’ with each spe-cifically tailored for people with diabe-tes in the UK available: Managing My Diabetes, which provides an overview of diabetes and diabetes self-manage-ment; Diabetes and a Healthy Lifestyle, which focuses on the importance of eating well and keeping active; Start-ing Insulin, for people with diabetes who are considering or have already started insulin injections; and Expe-riencing Life with Diabetes, which fo-cuses on how to cope with and manage diabetes over a lifetime.

Healthcare professionals trained to facilitate the Conversation Map pro-gramme use the tabletop visuals to guide small groups of people with dia-betes through an illustrative ‘journey’ that encompasses images, questions and facts, with the aim of encouraging lively discussion and participation.

“It enables a discussion that goes both ways, instead of a didactic, one-way information flow,” says Joanne Hamilton, a diabetes specialist based in Canada who has used the programme regularly. It is, she points out, motivat-ing and highly constructive: “People walk away from each session feeling so much more empowered about tak-ing control of their diabetes than if they’d simply attended a class.”

“It is a very innovative ap-proach to helping people with diabe-tes improve how they manage their condition”

Douglas SmallwoodChieft Executive Diabetes UK

EMILY DAVIES

[email protected]

Question: Are you struggling with sore eyes after hours in front of the PC-screen?

Answer: If you keep the right distance and take regular breaks from your desk, water might come back to your eyes.

NEWS

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FACTS

The UK is facing a huge increase

in the number of people with diabetes.

Since 1996 the number of people di-

agnosed with diabetes has increased

from 1.4 million to 2.6 million.

By 2025 it is estimated that over

four million people will have diabetes.

Most of these cases will be type 2

diabetes, because of our ageing pop-

ulation and rapidly rising numbers of

overweight and obese people.

The rate of new diagnosis is

around 400 people every day – almost

17 people every hour or three people

every ten minutes.

It is estimated that there are up

to half a million more people in the UK

who have diabetes but have not been

diagnosed.

It is estimated that up to one in 20

people in England has diabetes (diag-

nosed and undiagnosed)

10 per cent of adults with diabe-

tes have type 1 diabetes; 90 per cent of

adults with diabetes have type 2SOURCE: DIABETES UK

Why is awareness so partic-ularly important in issues sur-rounding children and diabe-tes?

!“Children spend up to 40 hours a week in school - this

represents a large part of a child’s life with diabetes. It is therefore imperative that school personnel, parents and the child work to-gether to ensure diabetes is man-aged and that the child is able to take part in any school activities desired without compromising their health. ”

How can awareness and ed-ucation about diabetes in chil-dren be achieved?

!“Parents and teachers should communicate regularly re-

garding the needs of the student. Parents should either teach the school personnel or arrange for a health professional who special-ises in diabetes to do so. School personnel should be aware of dai-ly routines such as regular meals and snacks, testing blood glucose, and the need for insulin as well as being able to recognise diabetes emergencies.

All school personnel should know how to treat hypoglycaemia and who and when to call for help. The goals should be to enhance the health, safety and satisfac-tion with the educational experi-ence for students with diabetes by providing information and direc-tion to all parties regarding diabe-tes management; to limit anxiety for parents and school personnel by encouraging steps to increase communication and cooperation to ensure student safety; and to permit and encourage students to manage their diabetes effectively during school hours.

It is important that regular communication is established be-tween all parties so that an effec-tive response is ready for chang-es in activities, special events or meals at school, or to changes to the child’s diabetes management requirements.

Severe hypoglycaemia is rare but it is an emergency situation and often requires the adminis-tration of glucagon, which school personnel should be trained to ad-minister.”

QUESTION & ANSWER

Anne BeltonDiabetes nurse ed-ucator and author of the International Diabetes Federa-tion international curriculum for dia-betes health profes-sional education.


“The major risk factor for type 2 di-abetes is obesity: if the entire popu-lation stayed below a BMI of around 23, i.e. well within normal range, we could prevent around 90 per cent of cases of type 2 diabetes in the UK,” explains Dr Naveed Sattar, Profes-sor of Metabolic Medicine, Univer-sity of Glasgow.

“The risk of developing type 2 dia-betes rises to about 10-fold at a BMI of 30 (i.e. when obese) but around 50-80 times at a BMI of 35 and above - so obesity is the major risk factor by far for diabetes. We also know that individuals with diabetes who can lose considerable weight, for in-stance more than 15kg, can actually become non-diabetic in many cases - although currently this is not easy without surgery.”

It is not sugar intake that is the problem – it is about whether or not you are overweight and how much fat you have, Prof Sattar points out. “Research in the last decade has shown quite clearly that excess weight gain will lead to excess fat accumulating in organs relevant to the efficient metabolism of sugar, a phenomenon increasingly known as ‘ectopic’ fat accumulation - sus-ceptible organs include the liver, muscles, and potentially the pan-

creas,” says Prof Sattar.The point or BMI at which weight

or excess fat begins to accumulates in these organs is related to genet-

ics and ethnicity, and varies. For example, individuals with a family history of diabetes or those who are South Asian will develop ectopic fat and diabetes at a lower average BMI compared to the general popu-lation in whom the average BMI to develop diabetes is 28.

“The rates of diabetes are rising as obesity levels are rising across all age groups and rising obesity also drives down the average age of diag-nosis so more are getting it young-er, though the fact that life expect-ancy is also rising and the longer we live, the more time there is to devel-op diabetes,” points out Prof Sattar. “The good news is that cholesterol lowering and blood pressure tablets have helped to reduce deaths from diabetes.”

“People at risk of diabetes need to be encouraged to help make sustainable changes to their di-et. At government level the penny has now dropped: it’s realised that obesity needs to be lessened across society, looking at changes in food culture and reducing the availabil-ity of high dense calories (found in refined foods), for instance - the government’s 2007 Foresight Re-port ‘Tackling Obesities: Future Choices’ is an example.

“I think we are moving away from blaming individuals to fo-cus on the real problems at hand but there is a considerable way to go yet.“

Arm yourself, protect yourself

OBESITY AND DIABETES. With a proven link between obesity and diabetes, there has never been more reason to keep fit and active and eat a sensible diet. PHOTO: ISTOCKPHOTO.COM

EMILY DAVIES

[email protected]

Question: How relevant are lifestyle choices in the battle against diabetes?

Answer: Type 2 diabetes is on the rise – and intrinsically linked to weight increase and a lack of healthy diet and exercise.

NEWS

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FACTS ON OBESITY / BMI

Statistics show that over 80 per

cent of people diagnosed with type

2 diabetes are overweight. The more

overweight and the more inactive you

are the greater your risk. If you don’t

know whether you’re overweight, ask

your GP to measure your BMI or try the

following NHS link:

http://www.nhs.uk/Tools/Pages/

Healthyweightcalculator.aspx

Women with a waist measurement

of 31.5in (80cm) or more have an in-

creased risk.

Men who are white or black with a

waist measurement of 37in (94cm) or

more have an increased risk of devel-

oping diabetes; for an Asian man the

figure is 35in (90cm) or more.

A healthy weight has a BMI of

18.5-24.9 (Asian adult 18.5-22.9); over-

weight is classified as 25-29.9 (Asian

adult 23-24.9); obese is classified as

30-39.9 (Asian adult 25-34.9) and mor-

bidly obese a BMI of 40 or more (Asian

adult 35 or more).SOURCE: DIABETES UK

1Make sustainable changes in die-tary habits to eat better quality

foods which are less dense in calories – less refined sugar, fat, processed food and more fruit, vegetables and fibre in the form of low density calories (unrefined, raw and whole foods) is vital.

2Of course reducing sedentary be-havour is important - any activity is

better than none. Stay active as much as you can, using any opportunity for exer-cise or activity.

3Both my parents have Type 2 diabe-tes and I am South Asian so it’s like-

ly my diabetes risk is very high - indeed both my maternal uncles developed dia-betes around about a BMI of 24-25 and in their 30s. I have followed these rules: yes, I still have treats but these are now excep-tions rather than the rule.

4The important point is that it can take a few months to retrain one’s

tastebuds but that supported individuals can “wean” themselves and develop tastes for better quality foods.

5Changes can be small but sustained. It took time for me to adopt the

changes and in essence I have “retrained” my tastebuds - but enjoy my food as much as ever.

TOP TIPS

5Dr Naveed SattarDuis Professor of Metabolic Medicine, University of Glasgow.

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onMobile is a tool that helps you communicate your

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onCard onCard is a sealed card that contains your most

vital health information inside. The outside of the card

clearly identifies you as a diabetic.

Living with diabetes requires that you take personal

responsibility for your health and wellbeing on a daily

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Amongst other precautions, the World Diabetes

Foundation recommends that you always carry a card

identifying your condition and who to contact in an

emergency situation.

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SurgiCare is the UK’s leading weight loss surgery provider.

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and are all members of the British Obesity and Metabolic Surgery Society

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SurgiCare patients lose on average 80% of their excess weight 1 year after a

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Our dedicated team of Dieticians and Specialist Nurses will help you every

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The Journal of Clinical Endocrinology & Metabolism


Know yourself

A hypo can be a frightening event - for a person with diabetes and anyone who witnesses it. The good news is that with a combination of self-knowledge and technology, hypos are now more easily prevented than ever. Libby Dowling, an experienced diabetes nurse and care advisor with Diabetes UK, explains all we need to know.

When the lev-el of glucose in the blood falls too low, h y p o g l y -caemia (or a ‘hypo’) oc-

curs - usually when the level reach-es below 4 (mmol/l). People with di-abetes who take insulin and/or cer-tain diabetes medication are at risk of having a hypo.

This may happen for a number of reasons: a hypo may occur if you have taken too much diabetes med-ication, delayed or missed a meal or snack, not eaten enough carbohy-drate, taken part in unplanned or more strenuous exercise than usu-al, or have been drinking alcohol without food. Sometimes there is no obvious cause at all.

Treatment is usually very sim-ple and requires taking 10-20g of fast acting carbohydrate, followed up with 10-20g of longer acting carbohydrate or the next meal if it is due. If left untreated the person might, eventually, become uncon-scious and would need to be treat-ed with an injection of glucagon (a hormone that raises blood glucose levels).

But in the vast majority of cases

the liver will release its own stores of glucose and raise the blood glu-cose level to normal, though this may take several hours. Many peo-ple have hypos while they are asleep and come to no harm. Parents with children with diabetes will be given a glucagon injection to have ready for use if their child becomes un-conscious, which encourages the liver to release sugar already stored and therefore treat the hypo.

When a hypo happens the person often experiences ‘warning signs’, which occur as the body tries to raise the blood glucose level. These ‘warning signs’ vary from person to person but often include feeling shaky, shivering, sweating, tingling in the lips, going pale, heart pound-ing, confusion and irritability.

For people on insulin it’s difficult to prevent hypos - and the odd hypo now and again is to be expected. Every person with diabetes should be told by doctors and nurses if their medication might cause hy-pos, an explanation of what a hypo is and how it might feel.

The danger is that if you don’t recognise signs or take notice it will only get worse – interim signs include acting irrationally, and if that goes untreated a collapse can

ensue followed by unconsciousness and even a fit – it’s rare that people ignore all the signs but if they do, the first thing they will know about their hypo is when they collapse.

A glucose monitor is advisable to keep track of your blood sugar lev-el. A regular problem we see at Dia-betes UK is people having difficulty getting access to glucose monitor-ing. Glucose monitors are availa-ble to buy or ask your GP, because it should be available to you – it’s a de-cision best made in consultation with your healthcare team.

The most important thing to know about glucose monitoring is that there is little point in sim-ply doing a series of tests. The most helpful method of glucose monitor-ing is to do tests and simultaneously keep a diary of daily events and how you feel, so that you can keep track of hypos and so that you can think about why the hypos are occurring – and how they might be prevented.

Different people have different warning signs – everyone learns what theirs are and it helps to keep others close to you informed too. It’s important to know that warn-ing signs of a hypo can change, in any person – so even if you think it isn’t a hypo, it’s best to be cautious.

“Different people have different warning signs – everyone learns what theirs are and it helps to keep others close to you informed too.”

Libby DowlingDiabetes nurse and care advisor for Diabetes UK

PREPARATION

PROFESSIONAL INSIGHT

1Consider whether a glucose monitor would help – they are available to buy but in

the first instance talk to your GP or diabetes specialist.

2If a hypo feels imminent, take 10 to 20 grams of short-acting carbohydrates such

as Lucozade or Lucozade tablets, sweets such as Jelly Babies or fruit juice.

Avoid chocolate because its fat content means its carbohydrate content is slower to be absorbed, and any confectionery such as boiled sweets which need to be chewed or crunched before they get to the stomach. Always carry such a snack with you and keep in the car, too.

3Follow up with 10 to 20 grams of a long-acting car-bohydrate such as half a

sandwich, a couple of biscuits or a piece of fruit. People with insulin pumps don’t necessarily need to fol-low on and with children with dia-betes some children just have the initial sugar intake without a fol-low-up.

4One thing that can inter-fere with the liver’s natu-ral, eventual self-correct-

ing capacity after a hypo is alcohol – so always eat before drinking alco-hol, while you are drinking and defi-nitely after drinking.

LIBBY DOWLING’S TIPS

ON HYPOS

4

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