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Love Sunday | Diabetes in w...

Love Sunday Magazine (the weekend supplement in The Sunday People newspaper) recently approached us for help around the topic of diabetes, and particularly its effects in women.

Our very own Consultant Diabetologist and Endocrinologist Dr Aftab Ahmad, answered several 'frequently asked questions' which will appear in the magazine later this month. Have a read here in the meantime;

 

1.     Can you explain the difference between type 1 and type 2 diabetes for someone who knows very little about either?

Diabetes mellitus is a disorder that causes high blood sugars for a prolonged period due to insulin deficiency or resistance. It is classified into various types depending on the underlying pathology. Type-1 diabetes occurs when the pancreas produces very little or no insulin due to destruction of insulin producing cells in the pancreas.

Type-2 diabetes on the other hand is due to resistance of the cells to insulin rendering insulin ineffective usually in individuals who are overweight but in some cases due to relative insulin insufficiency due to partial destruction of the insulin producing cells in the pancreas.

The other difference is in the age and speed of onset of the disease. Type-1 diabetes is mostly diagnosed before the age of 20 but can develop at any age and rapidly leads to symptoms such as increased thirst, increased frequency of urine and rapid weight loss.

Type-2 diabetes usually presents after the age of 30 but can develop at any age, usually in overweight individuals and can remain undiagnosed for months and years as the symptoms develop gradually including increased thirst and frequency of passing urine.

The other key difference is the dependence on insulin. In type-1 diabetes the life of an individual depends on taking insulin regularly as stopping insulin can lead to serious consequences including death in a short period, whereas, in type-2 diabetes insulin can be used to improve blood sugar control.

2.     Is type 1 easier to diagnose than type 2?

The diagnosis of all types of diabetes is based on the presenting symptoms including increased thirst, increased fluid intake, frequency of passing urine and weight loss and the diagnosis is confirmed by a blood test, which is the same for all types.

The difference is the speed of onset of symptoms which allows type-1 diabetes to be diagnosed within days of development, whereas, type-2 diabetes can remain undiagnosed for a long time if the symptoms develop gradually and not noticed by individuals as abnormal due to various reasons.

3. What are the consequences of having type 2 diabetes and it going undiagnosed for a long period of time?

Undiagnosed type-2 diabetes allows high blood sugar to abnormally settle down in the blood vessels of various organs such as eyes, kidneys, nerves over a prolonged period and cause distortion of the blood vessels allowing blood to leak in the surrounding tissue leading to serious complications including blindness, kidney failure and loss of sensations in the limbs.

Unlike type-1 diabetes that is usually diagnosed almost immediately not allowing this settlement of blood sugar, individuals with delayed diagnosis of diabetes may already have diabetes related complications at diagnosis making it difficult to manage.

4. Why do women with type 1 diabetes face a greater risk of dying from a range of diseases, like stroke and kidney disease, as opposed to men? Is the care they receive different? Do they not look after their health in the same way?

It is not clear why women with type-1 diabetes have a higher rate of dying from stroke and kidney disease compared to men, reported recently. There is no evidence that their care is different or they do not look after their health compared to men. One factor that has been highlighted is the hormonal changes women go through during their lives that may be contributing to fluctuating blood sugars with a variable response to insulin treatment. It is also possible their blood vessels suffer more damage from high blood sugars than men but we are not yet sure of the underlying pathology to explain the difference as yet.

5. Can you comment on the Tape measure test? What's the connection between obesity and diabetes?

The Tape measure test refers to the waist circumference and there is enough evidence to suggest that women with a waist circumference more than 88 cm and men with more than 102 cm have a much higher risk of developing diabetes.

Obesity leads to insulin resistance, which means that the insulin being produced in response to the carbohydrate and sugar meals is ineffective at the cellular level and does not lower the blood sugar as the same amount of insulin would do if the individual was not obese. This in turn leads to the development of type-2 diabetes.

Reducing weight and the waist circumference would help prevent the development of diabetes and people who have developed diabetes would find it easier to control by losing weight.

6. What do you think about the recent study that states that taking a daily probiotic pill can rewire the body to help combat diabetes? Any thoughts? Is it worth women trying adding probiotics into their diet to prevent diabetes?

Probiotic pills being studied in animal models suggest they help produce another important hormone in the body called GLP-1, which in turn helps regulate insulin production. However, it is too early to comment on its benefits on humans as no human studies have yet been done and it may be harmful to the human body. Until such evidence is presented everyone with diabetes should stick to the conventional treatment.

7. Any comments on the news about 'Smart' insulins being created for Type 1 suffered. If something like this became available how might it change the life of a type 1 diabetic?

Smart insulins is an exciting area but in the very early stages of research. The idea behind this concept is to produce insulin molecules with special coating that will circulate in the blood inactive until there is an increase in the blood sugar after a meal when these insulins will become active and lower the blood sugar as would the endogenous insulin would have done in people without diabetes.

If human research confirms that it works in the human body and is safe then no doubt it will be a useful addition to the management of diabetes but for now it is way too early to comment. For now stick with the conventional treatment for diabetes.