Diabetes Mellitus – How to Reduce Your Risk

What is diabetes mellitus?
Diabetes mellitus is more commonly known just as Diabetes. This is a condition in which the body is unable to regulate blood glucose levels within normal limits. It is important to have good blood glucose control because poor control may result in long-term complications, affecting organs such as the eyes, kidneys, heart and nerves. 

There are two common types of diabetes mellitus:

• Type 1 diabetes typically affects very young individuals and results from little or no insulin in the body.  Type 1 diabetes necessitates treatment with insulin and is otherwise life-threatening.  This disorder is usually autoimmune in aetiology. 
• Type 2 diabetes mellitus is a disease that typically affects older patients than type 1 diabetes and is associated with an increased resistance to the effects of insulin.  Although these patients produce excess insulin, it is still insufficient for controlling blood glucose levels adequately.  Patients with type 2 diabetes can be managed with diet, tablets and in some cases injectable treatments.  Type 2 is more common than type 1 and accounts for 80-90% of all patients with diabetes mellitus. 

What causes type 2 diabetes?
This condition usually develops as one gets older and when multiple risk factors combine.  These risk factors include a family history (or genetic predisposition) of type 2 diabetes: weight gain, obesity, a sedentary lifestyle and particular medication.  Type 2 diabetes is also more common in certain ethnic groups, e.g. South Indian Asians. 

What are the symptoms of diabetes mellitus?
The classical symptoms include:

• Weight loss
• Passing excessive amounts of urine
• Feeling thirsty

Patients may also experience an increased frequency of infections including thrush, skin and urine infections.  Some patients may also complain of blurred vision.  In the early stages of the disease however, these symptoms may not be present.  In such individuals, disease may only be detected with blood or urine tests.

How is type 2 diagnosed?
Diabetes is usually diagnosed by measuring blood glucose.  In patients with symptoms, a random glucose greater than 11 mmol/L is sufficient to diagnose diabetes mellitus.  In a patient who has no symptoms, two fasting glucose levels of 7 mmol/L or greater are sufficient to diagnose diabetes.  Whether a patient has type 1 or type 2 diabetes is dependent on the clinical presentation and other blood and urine tests.  Although urine tests can detect glucose in the urine, these are not used to diagnose diabetes, but are rather indicators of a problem.

What are the risks associated with type 2?
Elevated blood glucose levels, over a long period of time, can affect various organs in the body.  These include the eyes, kidneys, feet and nerves.  It is important therefore that patients with type 2 diabetes mellitus are monitored regularly to ensure they have good diabetes, blood pressure and cholesterol control.  It is also important that diabetes related complications are being monitored and appropriate treatment administered at the appropriate time.

How can you lower your risk for developing type 2 diabetes?
It is obviously not possible for us to lower our genetic predisposition to developing type 2 diabetes mellitus.  We can however, use this information to assess our risk for developing this disorder.  The risk of developing type 2 diabetes increases as follows: father affected, mother affected and both parents affected.  We can utilise our family history to determine whether we are at an increased risk of developing type 2 diabetes.  If so, we need to pay greater attention to treatable risk factors in an effort to reduce the overall risk of developing type 2 diabetes mellitus.  Such treatable risk factors include sedentary lifestyle, weight gain, obesity and particular medication.

How does exercise reduce our risk?
Exercise improves the body’s sensitivity to insulin.  Improving insulin sensitivity will reduce the amount of insulin required to regulate blood glucose levels.  The stress or work rate of the pancreas is therefore reduced, and it is assumed that pancreatic function is thereby preserved for longer and the onset of type 2 diabetes mellitus delayed.  It is advised that we take regular exercise two to three times per week. 

How does losing weight help reduce the risk?
Weight gain is also associated with an increased resistance to the effects of insulin.  Obese patients with type 2 diabetes mellitus may require more medication or larger doses of insulin to control diabetes, compared to slim individuals.  This is a reflection of their greater resistance to the effects of insulin.

Losing weight and maintaining a healthy weight therefore improves the body’s sensitivity to insulin and in doing so preserves pancreatic function for longer, delaying the onset of type 2 diabetes mellitus.

What medications increase the risk of developing diabetes mellitus?
Virtually all medications have some side effects.  Before treating any disorder with medication, doctors have to weigh up the pros and cons of using a particular drug.  Although particular medicines can increase the risk of developing diabetes mellitus, there are usually very good clinical reasons for using these drugs.  It is extremely important that patients should not discontinue any medication without consulting their doctor.  Medications that have been associated with an increased risk of developing diabetes mellitus include oral glucocorticoids and certain anti-psychotic medication.

What should I do if I am concerned that I have type 2 diabetes?
It would be reasonable to initially compare your symptoms with those that are associated with diabetes mellitus.  If your symptoms are suggestive, you should consult a doctor for blood tests to be performed.  This will help establish whether you do not have diabetes mellitus.  Those patients with a strong genetic or family history of diabetes mellitus should be particularly aware of this.

Who should undergo regular screening for type 2 diabetes mellitus?
There is no national screening programme to detect diabetes in the UK.  Those patients with a strong family history of diabetes mellitus should be aware of the symptoms of this disorder and if suspicious, should arrange to consult a doctor.

Patients in whom a marginally raised glucose level has previously been detected are often advised to undergo an annual fasting glucose measurement.  Pregnancy can be associated with a temporary form of diabetes mellitus.  This is referred to as gestational diabetes.  Women with a history of gestational diabetes who following delivery, have no evidence of diabetes mellitus are also advised to undergo annual fasting glucose measurements.

Dr Asjid Qureshi is a Consultant Endocrinologist in based in North West London his expertise include the management of patients with hypertension, hyperlipidaemia, electrolyte distances osteoporosis, Type 1 and Type 2 diabetes, hypoglycaemia, insulin pumos, obesity and general internal medical conditions.

If you would like to make an appointment with Dr Qureshi please contact the Wellington Enquiry Helpline on 0207 483 5148.

The Wellington Hospital is currently supporting the Juvenile Diabetes Research Foundation as part of The Wellington £1Million Appeal if you would like more information on Type 1 Diabetes or the work of JDRF please visit the charity website www.JDRF.org.uk or  Diabetes.org.uk