DIABETES is when the body is unable to correctly process the glucose it takes in from food. There are many forms, but Type 2 Diabetes (T2D) is largely, but not exclusively, linked to increasing age (usually presents over the age of 40), and higher weight (85% of T2D patients are overweight).
Genetics can also play a role, meaning that if a close family member has T2D, then you’re more likely to develop it. Other risk factors include lack of exercise, being a smoker, eating unhealthily, high blood pressure, high cholesterol levels, and cardiovascular disease.
When we eat a meal, the glucose from that meal is absorbed from our guts into the bloodstream. In a normally functioning body, insulin is then triggered to be released by the pancreas, and acts almost like a traffic warden, directing the glucose from the bloodstream to where it needs to go i.e. to cells around body for energy, or to the liver for storage. This prevents a “traffic jam” of glucose, and the levels in our blood going too high, known as “hyperglycaemia.”
In Type 2 Diabetes however, the glucose in the blood begins to ignore what the insulin is telling it to do, known as ‘decreased sensitivity’ or insulin resistance. For a while, the body counteracts this by releasing more and more insulin until the glucose gets the message! But over time, the body loses its ability to produce insulin in sufficient quantities, so the blood glucose levels gradually begin to creep up.
T2D is often without symptoms for a long time, and when they do eventually present, they tend to include frequent urination, high levels of thirst, and sudden unplanned weight loss. It’s important to screen for T2D in a timely manner in order to prevent long term complications arising, such as nerve, kidney, eye and heart damage. The fear is that without screening, this damage is already occurring, without us even realising it.
Established T2D that isn’t adequately managed by lifestyle alterations can eventually require a range of oral and/or injectable medications to keep it under control.
It’s important to be familiar with what normal blood sugar levels should be. First thing in the morning after fasting for eight to nine hours, the body should be after directing most of the glucose out of the bloodstream to where it needs to go.
Therefore, it makes sense that the levels left in the blood should be relatively low; 7mmol/L or less. If you check the levels two hours after eating, it would be expected that there would still be some glucose that hasn’t been directed to its destination yet (because that all takes time!), so the level in this instance is allowed to be a bit higher at 11.1mmol/L. Once diagnosed, the doctor sets specific targets to aim for during your T2D management, which may be even tighter than these.
If you’re being screened for diabetes, you may be asked by your doctor to take part in an Oral Glucose Tolerance Test. This involves your doctor checking your blood sugar level first thing in the morning after fasting, drinking a solution from your pharmacy that contains a precise amount of glucose in it (75g), then waiting two hours in the surgery or in your car without any physical activity before checking the blood sugar levels again. This test allows your doctor to track exactly how your body is handling the glucose, and to determine if an issue is present that needs to be addressed.
The above figures refer to the amount of free glucose in the blood at a particular point in time, a snapshot as it were, and is something that can be checked by your local pharmacy or yourself at home with the appropriate equipment if this has been recommended for you to do.
Another type of test often employed to get a more extended overview of blood glucose control is your HbA1C levels. This has to be conducted by your doctor, as bloods need to be sent to a lab. It looks specifically at red blood cells because they get coated by the glucose floating around in the blood. The higher the percentage of red blood cells that are coated in glucose, the higher the glucose levels in the blood must have been in the previous weeks and months.
Because these red blood cells circulate for approximately a month before dying off, this measurement is a more long-term view of how the blood glucose is being controlled, and should be checked in those with T2D every 3-4 months. Ideally this figure should be less than 48mmol/L, or sometimes slightly higher, depending on the target set for you by your doctor.
Screening for T2D is normally recommended over the age of 45, or sooner if you’re overweight with another risk factor also present. If you’re wondering how you can be proactive about preventing T2D, look at the risk factors above. Age is not something you can reduce unfortunately, but weight is, through diet and exercise.
This figure which takes your weight and maps it to your height should ideally fall between 20 and 25. Higher than this, and you’re increasing your risk of developing T2D. Losing weight improves your body’s sensitivity to insulin. Think back to that traffic jam of glucose in the blood – losing weight makes the glucose more likely to go where the insulin tells it to, lowering the blood sugar levels, and reducing the risk of damage.
Quitting smoking, addressing blood pressure, cholesterol and heart issues are also imperative. Any further concerns, symptoms or questions should be directed to your pharmacist or doctor sooner rather than later.
Time is of the essence with T2D!
Other risk factors include lack of exercise, being a smoker, eating unhealthily, high blood pressure, high cholesterol levels and cardiovascular disease.
Dr Michelle O’Driscoll is a Lecturer of Clinical Pharmacy in UCC, while continuing to work in the community pharmacy setting.
Her research lies in the area of mental health education, and through her company InTuition she delivers health promotion workshops to corporate and academic organisations nationally