Diabetes and “pre diabetes”

Diabetes and “pre diabetes”

A recent Healthy Ireland study showed that about 850000 adults over 40 in Ireland are at increased risk of developing (or have) Diabetes. Perhaps more worryingly, there are another 300,000 people in the 30 – 39 year age group that are at increased risk of developing diabetes. This predominantly lifestyle illness currently costs us a whopping 10% of the Irish Healthcare budget; most of which is entirely preventable!

The alarming rise is unfortunately consistent with the trend globally; in the UK for example, the explosion in new cases costs the health budget an estimated 10 billion yearly and has led some to question whether or not diabetes will be the condition to bankrupt and end the NHS.

The reason for the rise in Ireland, like elsewhere, is mostly due to the rise in overweight and obesity. Seventy per cent of men in Ireland are overweight while fifty-two per cent of females unfortunately are too. Being overweight accounts for the majority of case of Type 2 Diabetes which accounts for about 85% of cases of diabetes in general. The remainder of Diabetics have Type 1 Diabetes which is an autoimmune condition and is independent of weight levels.

Possible complications of uncontrolled diabetes include strokes, heart attacks and blindness amongst others. In pregnancy, uncontrolled diabetes slightly increases the risk of pregnancy complications and raises your longterm risk of diabetes outside of pregnancy.

If you develop diabetes, one of the main reasons it is so hard to control, is because it is a very difficult illness to understand psychologically. You generally do not feel unwell with it initially. That biscuit you ate will raise your blood sugars but you do not feel any different. Therefore, there is no immediate motivation to change your diet. However, if left uncontrolled, even at modestly high levels for a prolonged period of time it can and usually does, lead to death or disability.

These terrible outcomes are very preventable. To do this, the main thing you should focus on is becoming a diabetes expert! A good start is to become a member of diabetes Ireland. You should attend as many Diabetes courses as possible to ensure you receive the right advice. The HSE has many free Dietitian led courses like the X-PERT programme or the DESMOND programme. Your Doctor should have referred you to one of these programmes at diagnosis. If you prefer to learn in the comfort of your own home, there is an excellent free course online, entitled “Diabetes Smart” available at www.diabeteseducation.ie. You cannot and should not rely solely on your Doctor. A lot of Doctors are not very skilled in this area!

Weight loss, calorie restriction and exercise are the mainstays of controlling your sugar levels. Your Doctor will not only concentrate on helping you manage your blood sugars; we also focus on controlling your blood pressure and cholesterol levels which are actually more important than controlling your sugars when it comes to reducing heart attacks and strokes. To achieve this most people have to be on a statin cholesterol tablet. Your blood pressure should be consistently lower than 130/80 at least. This is an important target. Do not accept your blood pressure being consistently “a little high”. It is so easily treatable with tablets and not to demand perfection is negligent!

If you don’t have diabetes and are told at your annual health check-up that your sugars are “slightly high” or “borderline” this usually means you have prediabetes. Alarm bells should going off! The risk of developing full blown diabetes is up to 30% over the next 5 years. You can reduce this risk by up to 60% by taking urgent corrective action. This would involve losing weight, typically about 5-10% of your body weight over the space of 6-12 months. Look at your diet. Search online for the Dietary Approaches to Stop Hypertension (DASH) diet or a Mediterranean-style diet and pick the option that appeals to you most. Stop smoking and engage in at least 150 minutes of fast walking per week. Still need help? “Prediabetes for dummies” is a very useful book for motivated patients (this should be everyone!).

In the longterm, to reduce the rise in diabetes we need to focus on our children. Efforts are underway to combat the ongoing increase in childhood overweight and obesity but more needs to be done. Factors which promote unhealthy habits in our children including the ongoing rise of sugary drinks, larger portion sizes, diminished family presence at meals and less structured exercise needs to be confronted at a societal level. A 2 year old in Saudi Arabia in 2013 become the youngest person to have weight loss surgery- God forbid that could happen here!