Diabetes: is it too late?

Diabetes mellitus is a devastating metabolic disease that has seen cases in the UK rising 74% from 1997 to 2003 alone. With 4.7% of the UK population suffering with the condition and almost 300 million worldwide, scientists are trying to understand the mechanisms of glucose control and ultimately, what it is that goes wrong. Today brings new challenges as scientists battle with time due to the ever-increasing rate of diagnoses, fuelled by a spiralling obesity epidemic. With World Diabetes Day fast approaching, what better time is there to make a difference?

Diabetes mellitus is a disorder where glucose is not regulated effectively and can be categorised as either type 1 (insulin dependent or early-onset) or type 2 (non-insulin dependent or adult-onset). Type 1 diabetes is caused by insufficient insulin production, whereas type 2 diabetes is caused by insulin resistance, where normal insulin production remains, yet the target organs do not respond to it adequately. Both types lead to dramatic changes in blood glucose levels and other metabolic disturbances, which can eventually lead to blindness, strokes and peripheral vascular disease.

Neither type 1 nor type 2 diabetes has a definitive cause. However, it is thought that type 1 diabetes is an autoimmune condition; the immune system begins to attack the body’s own tissues. Type 2 diabetes is thought to have a genetic cause, with a major breakthrough in the year 2000 leading to the discovery of one of the genes that contributes to the development of the disease.

Obesity and sedentary lifestyles are becoming increasingly common and with harrowing statistics that by 2050 it is predicted that 6 out of 10 of us will be obese (with 3 to 4 out of 10 already there), this is the most likely explanation for the exponential rise of new diagnoses in such a short period of time in recent years.

When the glucose in the blood has been used for respiration, hypoglycaemia may occur. Tiredness and confusion, confounded by irrational behaviour, are key symptoms and ultimately it leads to a coma if left untreated. This is always a medical emergency and can be fatal.

To complicate the lives of diabetics even more, slow-healing sores and repeated skin infections are something they have to become familiar with if their glucose is not well controlled. Excess water excreted in the urine can often leave one dehydrated. This, plus the damage caused to the nervous system by excess glucose in their blood, resulting in reduced perspiration, can lead to extremely dry skin, reducing the defences to outside pathogens. Often, patients may suffer from diseased blood vessels due to impaired circulation, making skin infections harder to treat.

However, there is some hope for those who adjust to this harrowing future. Professor Sir George Alberti, Chair of Diabetes UK and Senior Research Fellow at Imperial College London, told Felix how “new insulins have been developed which are better able to mimic normal insulin secretion… Imperial is at the forefront of efforts to produce… [an] ‘artificial pancreas’.”

Professor Sir Alberti further adds that everyone can do their bit to prevent developing diabetes: “Increased physical activity is crucial - it does not need to be marathon running - 30 minutes brisk walking a day will make a difference. Similarly, eating a sensible diet and not becoming overweight is everybody’s responsibility”.

With all of this taken into account, diabetes can be an extremely scary diagnosis to have to cope with; the worrying, the need to become your own nurse, the pressures of being ‘different’. Many individuals will develop diabetes and reach into denial, refusing to accept that they’re ill, partly due to doctors not being able to pinpoint an exact cause to every patient, but also due to its intangibility. Some will not realise the severity of their condition until it comes to the removal of their gangrenous limb, whereas others will adapt relatively easily. What is important however, is that we realise the potential consequences and costs to society.

Professor Sir Alberti believes that “if numbers increase on the present trajectory then either treatment and care will become severely substandard or the NHS will be bankrupted. This will have a major impact on society as well as on the individuals affected. This is a bleak prospect and a major effort is needed by individuals, by society and by government to change the nation from an obesogenic environment into one where healthy living is the norm”.

Unless action is taken with a big focus on both lifestyle and self-management, incidence will continue to increase over time, predictably faster than the NHS budget. The question is: will we beat the ticking time bomb?