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T2DM

Type 2 diabetes mellitus (T2DM) is what we are talking about. Type 1 DM is something else, although it is also a risk factor for all the other diseases which T2DM fosters (mainly heart disease, blindness, kidney failure, nerve damage and susceptibility to infections). T1DM is a condition whose onset is usually in young people whose pancreas fairly suddenly packs in and stops producing insulin. Type 2 diabetes develops later in life and the problem is not an absence but an insufficiency of insulin.

Insulin

Insulin is produced by the pancreas and is essential for the control of glucose in the blood by facilitating the passage of this form of sugar into the cells.  The pancreas in normal people responds to the flood of glucose into the bloodstream after each meal by increasing the output of insulin. The insulin helps the cells to absorb the glucose, keeping blood glucose level constant within fairly narrow limits. Type 1 diabetics can survive only by regularly injecting themselves with insulin for the rest of their days.

Causes of T2DM

T2DM develops later in life and is largely a result of an unhealthy lifestyle. There is a genetic element – the tendency to develop T2DM is inherited, but it rarely manifests in the absence of too much food and too little exercise. 80-85% of the risk of developing T2DM is down to obesity though a small percentage of T2DM sufferers are of normal weight. Exercise is important because it enhances absorption of glucose into muscle cells.

People who carry too much weight, particularly those with central obesity, and take too little exercise develop a state called insulin resistance. In this condition, insulin becomes less effective at keeping blood glucose levels normal and a greater production of insulin is needed to maintain normal blood levels. So the pancreas has to work ever harder to produce enough insulin for normal metabolism and eventually becomes unable to satisfy the body’s ability to keep its sugar level within normal limits. Blood sugar rises, a state called  ‘hyperglycaemia’, the hallmark of diabetes. The problem is aggravated by the laying down of fat where it is not wanted. In the liver this further increases insulin resistance. In the pancreas it further reduces the production of insulin. Physical inactivity increases insulin resistance.

Frequency of T2DM

T2DM is a growing epidemic, with ever-rising rates of diagnosis as the population becomes older and fatter – and less active. In the mid-1990s about 2–3 per cent of the UK population were known to be affected; the figure now is about 6 per cent and growing with about 100,000 newly diagnosed diabetics each year. There are about 4 million diabetic patients in the UK, with more than 21,000 deaths due to diabetes per annum. With the enormous increase in childhood obesity, T2DM in children, which used to be a rarity, is on the rise too. In England and Wales about 7,000 people under the age of 25 are diabetic. The cost to the NHS of managing diabetes is a staggering £11.7 billion, which is more than 12 per cent of the total NHS budget.

Side-effects of diabetes
The complications of diabetes are legion. It is a risk factor for atheroma (‘hardening of the arteries’) of large vessels, which leads to heart attacks and strokes and may also result in gangrene of the legs. Small blood vessels are affected too, leading to kidney disease and impairment of sight and ultimately to blindness. Damage to nerves causes numbness and neuralgic pain. Diabetics are particularly susceptible to infections. Since most type 2 diabetics are obese, they are at increased risk of a number of different cancers, but there is also a link between diabetes and cancer that is independent of their obesity. Untreated diabetes is a risk factor for dementia, which develops more rapidly in diabetic sufferers.  Frailty of old age is an increasing end-stage for many.

T2DM is not a nice disease and in most cases it is preventable. Indeed, too much food and too little exercise are such important causative factors that diabetes can be cured in a large proportion of sufferers simply by doing more and eating less. The fact that this is so seldom achieved is a tribute to the difficulty in changing long established lifestyles.

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