What Causes Diabetes And Types Of Diabetes

Diabetes is a condition which affects the body's ability to take glucose (sugar) from the bloodstream and use it inside cells. Glucose is essential to the body as an energy source. It is a component of carbohydrate foods (sugars and starches). Glucose is helped into the body's cells by the hormone insulin, which is produced by the pancreas. In diabetes, the level of glucose in the blood rises because the body isn't producing enough insulin or the body's cells don't respond to it as well as they should.

There Are Two Types Of Diabetes

• Type I, Insulin Dependent Diabetes (IDDM), accounts for about 15 per cent of people with diabetes and usually occurs in younger age groups. With this type, the body stops producing insulin so that diet and insulin injections are required for treatment.

• Type II, Non-Insulin Dependent Diabetes (NIDDM), makes up 85 per cent of people with diabetes. Although people with this type still produce insulin, their body's cells do not respond to it as well and they cannot keep their blood sugar in the normal range (between 4 and 8 mmol/L). This type occurs later in life and requires diet and possibly tablets or insulin for treatment.

What Causes Diabetes?

Type I diabetes is caused by the body producing antibodies that attack and destroy the insulin-producing cells in the pancreas. It is usually 'triggered' in susceptible people by a viral infection. There are several problems in the body that lead to Type II diabetes but the exact cause remains unknown. It is brought out in susceptible people particularly by being overweight and physically inactive.

Diabetes can also develop in people who have other diseases of the pancreas, it can develop following treatment with some medications (such as high doses of cortisone that may be required to treat asthma or arthritis), and it occasionally develops in association with other rarer inherited conditions. The tendency to develop diabetes can be inherited. Stress and shock do not cause the pancreas to stop working (and hence do not cause diabetes), but stress usually causes the blood sugar level to rise in people with diabetes. This sometimes brings previously undiagnosed diabetes to light.

What Are The Risk Factors?

Having a close relative with Type I diabetes raises the risk of diabetes. In Type II diabetes, the risks include:

• A family history of diabetes

• Being over 50

• Being overweight

• Having had diabetes in pregnancy (gestational diabetes)

• A history of large babies (over 4kg - about 9lb - at birth)

What Are The Symptoms?

Tiredness, thirst, passing water frequently, blurred vision, increased skin or bladder infections and occasionally leg cramps are common symptoms. Any combination of these can occur. Sometimes few or no symptoms occur. However, it is important for people with any of these risk factors to be tested for diabetes.

What Treatment Is Available?

If you have diabetes and it is not treated properly, a number of problems can result. High blood sugar levels increase your risk of infections and poor healing of cuts and wounds. In the long term, there can be other complications including problems with large blood vessels (causing increased risk of heart attack, stroke and foot problems), small blood vessels (in your eyes or kidneys) or with the nerves in your feet (causing numbness or sometimes burning pain). It is important to avoid complications from diabetes by following appropriate treatment that keeps blood sugar levels as close as possible to the normal range.

All people with diabetes need to have a healthy lifestyle with regular meals and some exercise. If you have Type I diabetes you will require daily insulin injections which can be given by needle and syringe, or by an insulin pen device. If you have Type II diabetes you may be able to manage the condition with diet alone, particularly if you lose weight and exercise regularly. Some people with Type II require tablets or perhaps insulin injections in addition to dietary measures.

What Is A 'Hypo'?

If you take insulin or some types of tablets to control diabetes, you may occasionally suffer a 'hypo'. A hypo, or hypoglycaemic reaction (also called an insulin reaction), occurs when the blood sugar falls below danger level (below 4 mmol/L). It is usually accompanied by any combination of the following symptoms: sweating, blurred vision, hunger, light headedness, and/or you may have a change in mood, becoming either quieter, perhaps appearing drunk or even becoming aggressive. If untreated, you may lose consciousness.

A hypo can occur if you delay or miss a meal, exercise more than usual, or take excess tablets or insulin by mistake. If this happens you should eat something sweet immediately, for example glucose tablets, two barley sugars, seven jelly beans, ordinary lemonade or cola (not diet or low calorie drinks) to build your sugar level up. You should then have some starchy food, for example biscuits or a piece of fruit to keep your sugar level up. This treatment is taken in addition to your normal diet. You will need to discuss with your GP whether you need to alter your medication. This will depend on the cause of the hypo.

Lifestyle Tips

¤ Work closely with your GP. He or she may refer you to a dietitian, diabetes educator and/or a chiropodist if necessary

¤ Education is important. Learn as much about diabetes and its management as you can. Diabetes education programmes are run by many hospitals

¤ See your dietitian for advice on your personal eating plan

¤ Monitor your own blood sugar levels regularly (and more frequently when you are unwell)

¤ If you are on tablets or insulin, make sure you always have ready access to hypo treatment

¤ On sick days (when your blood sugars are likely to be elevated), always take your usual medication and consult your doctor if you develop vomiting or diarrhoea

¤ Because diabetes may cause poor circulation and/or numbness in the feet, maintain good foot care and always wear well fitting, comfortable shoes. Seek advice from your doctor or chiropodist for corns, calluses or ulcers as soon as they develop. NEVER treat them yourself

¤ Have your blood pressure, eyes, kidneys and feet checked regularly

¤ It is also important that family, friends and school or work mates know that you have diabetes and know how to react if you develop a hypo. They should give you something sweet, but they should NOT try to give you sugar if you are unconscious.
 By Dr Peter Stott.

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