Diabetes is the fourth most common disease in the Western world, with 425m people affected. That is more than one in 20 (5%) of the world population. Diabetes kills 1,500,000 people per year. That is just short of 3 people a minute, every minute. By the time you have read this article, around 30 people will have died from diabetes.
Globally, deaths from diabetes have increased by a startling 70% in the last two decades. In the Eastern Mediterranean, the number of deaths has doubled.
What is causing such a massive increase? What are the consequences of developing diabetes? What are the early warning signals? What is meant by “pre-diabetes” and what can you do to prevent “pre” from turning into “actual”?
What is diabetes?
Its full name is diabetes mellitus, although it is widely referred to in its shortened form: diabetes. There are two types of diabetes. Type 1 and Type 2.
Type 1 diabetes is a condition where the body, specifically the pancreas, does not produce the hormone insulin. Type 1 appears to be caused by an organ-specific autoimmune reaction leading to the destruction of the beta cells in the pancreas that make insulin. Insulin enables the body to use glucose for energy and helps regulate glucose levels in the blood, also known as blood sugar. Insulin enables the cells of the body to absorb glucose. No insulin means no energy absorption.
Type 2 diabetes seems to be caused by being overweight or inactive or having a genetic history – family members who have Type 2. Unlike cases of Type 1, where the body produces no or very little insulin, in cases of Type 2, the pancreas does produce insulin. However, the cells of the body don’t respond to insulin as they should. That is known as insulin resistance.
When glucose cannot get into cells, as happens with insulin resistance, or insulin absence, the blood sugar level rises. The body has self-regulating systems, and it seems that when sugar levels are high and yet cells are not receiving enough energy, as is the case in Type 2 diabetes, the pancreas then works harder to make even more insulin.
Type 1 diabetes is associated with insulin absence, or near absence, and Type 2 is associated with insulin resistance. Type 2 is much more common than Type 1, with an estimated 5%–10% of cases being Type 1.
Type 1 and Type 2, often written as T1DM and T2DM, (Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus) have similar effects; the body becomes unable to regulate blood sugar levels, causing blood sugar levels to be dangerously high. Prolonged hyperglycaemia can and does cause damage to the eyes, nerves, kidneys and blood vessels.
Diabetic foot ulcers form as a result of poor glycemic control, neuropathy (nerve damage), peripheral vascular disease, or poor foot care.
Unhealed ulcers and subsequent foot infections are the primary reason for diabetes-related amputations. Diabetic foot ulcers were present prior to 80% of amputations.
This next figure is alarming. The compliance rate with the life-saving treatments offered to diabetic patients is low. It is only 30-50%. What does that mean? That at least half of diabetic patients do not comply with their treatment plan and, as a result, experience health problems which were avoidable.
Currently, there is no known prevention for T1DM. Why the immune system starts attacking the beta cells in the pancreas is not understood. There are plausible theories, such as genetic predisposition, environmental causes, viral causes, and immune system error causes… To date, none of the theories has proven to be the cause of Type 1 diabetes. Usually, when a phenomenon cannot be explained by any one theory, it is later shown to have more than one cause, or to have multifactorial causes, or, there are multiple sequences of events that can lead to the same outcome. Whether that proves to be the case with T1DM remains to be seen.
With Type 2 there is a slightly clearer picture of its causes. Being overweight or obese dramatically increases the likelihood of developing T2DM. That is generally accepted as true. How, specifically, does carrying too much body fat cause Type 2 diabetes? That is not so clear.
The human body seems capable of storing fat in just about every conceivable way: under the skin (subcutaneous fat), between the internal organs (visceral fat), in muscles, (intra-muscular fat), and even inside the bones (bone marrow fat).
Higher levels of fat around the body produce more non-esterified fatty acids, glycerol, hormones, and pro-inflammatory cytokines, and make many other biochemical changes. Somehow, those changes can develop insulin resistance.
There is no clear understanding of the process that leads to the insulin resistance of T2DM. The elements of the causal chain are not clear. For instance, is it the breakdown of lipid homeostasis that leads to T2DM, or is lipid imbalance a consequence, or, is it a mediating variable? We don’t know.
What we do know is that being overweight, obese, morbidly obese, or super obese, increases the chances of developing T2DM, massively. The more body fat a person carries, the greater their chance of developing Type 2 diabetes.
What are the early warning signals that someone is on track to develop T2DM?
Elevated blood sugar levels indicate what is known as “pre-diabetes.” Pre-diabetes means that the long-term damage to the heart, blood vessels, nerves and kidneys associated with T2DM may have already started.
Here is the good news for anyone who has been diagnosed with pre-diabetes: losing weight, reducing calorie intake, and increasing the amount of exercise taken, can all return the person to health and prevent pre-diabetes from turning into full-blown diabetes.
Here is the good news for people who have developed T2DM: going on a restricted diet, and losing body fat can reverse T2DM. Yes, really. Even for people unable to regulate their weight by self-control, bariatric surgery, (the name given to gastric bypass and other weight-loss surgeries), can reverse Type 2 diabetes. Yes, reverse it.
In the majority of cases, T2DM can be reversed. Although we don’t fully understand the mechanisms, it seems to be that as body fat is reduced, the biochemical causes of insulin resistance are removed or reduced.
Going slightly too far, for the purposes of making the point, it could be said that T2DM is a function of body fat; remove the excess body fat, and Type 2 diabetes is also removed.
Since pre-diabetes and Type 2 diabetes can be reversed, the logical question is: why is the number of cases increasing so dramatically?
Could it be the cheap and ready availability of food? Could it be that people don’t like to feel hungry? Could it be that people don’t like to feel weak or low in energy? Could it be the increased energy density of our food? Could it be that we think it “won’t happen to me”? Could it be that we have evolved to eat when we can because countless generations before us had to do just that to survive, and now there is such availability of food, what was a survival mechanism is now killing us? Are we killing ourselves one mouthful at a time?
Probably all of the above, and more besides.
Whatever the causes of the rapidly increasing number of T2DM cases (projected to be 629m by 2045), we can prevent the development of pre-diabetes and Type 2 diabetes by keeping our weight (fat levels) within safe limits, eating a healthy balanced diet, exercising regularly, and avoiding heavy alcohol intake, and reducing the amount of sugar in our diet.
Now that you have the information, what are you going to do to give yourself the maximum chance of preventing T2DM? If you have pre-diabetes or Type 2 diabetes already, what are you going to do to maximise your chances of reversing it?
Whatever you decide, seeking medical supervision is wise.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
