Mags Gargan
Increasing numbers of people in Ireland are developing diabetes, which is linked to our more sedentary lifestyle, writes Mags Gargan
Diabetes is “a global pandemic,” according to Dr Aisling O’Leary, Lecturer in Pharmacy Practice at the Royal College of Surgeons in Ireland (RCSI), which recently hosted a public health lecture on the ‘Rise and Rise of Diabetes in Ireland’.
Diabetes is a long-term condition caused by too much glucose, a type of sugar, in the blood and it affects over 200,000 people in Ireland. It occurs in two forms.
Type 1 occurs when the body produces no insulin – the hormone produced by the pancreas which controls the amount of sugar in the blood and ensures it is broken down into energy for the body. It can develop quickly, over weeks or even days, and is typically diagnosed in childhood. Type 2 occurs when not enough insulin is produced by the body for it to function properly. It is often associated with obesity and is on the rise due to the increase in our more sedentary lifestyle, but many people have it for years without knowing it.
The main symptoms of diabetes are feeling very thirsty, going to the toilet a lot, (particularly at night), extreme tiredness and rapid weight loss. A simple finger prick test by a GP can lead to early diagnosis.
Injections
Only about 10% of all people with diabetes have type 1 and they need to take insulinn injections for life and monitor their blood glucose levels. Type 2 diabetes is far more common and symptoms can be controlled by simply eating a healthy diet and monitoring blood glucose level. However, as type 2 diabetes is a progressive condition, it may eventually need medication, usually tablets or injections, to control.
Gestational diabetes can also occur in about 12% of pregnant women, when they have such high levels of glucose in their blood that their body cannot produce enough insulin to absorb it all. This can increase the risk of health problems in an unborn baby and tests for high blood sugar are routinely run throughout pregnancy.
The International Diabetes Federation Diabetes Atlas (2013) estimate that there are 207,490 people with diabetes in Ireland in the 20 – 79 age group (prevalence of 6.5% in the population) which is in line with previous estimates that by 2020 there would be 233,000 people with the condition, and by 2030 that would increase to 278,850 people.
According to Dr Garry Duffy, Senior Lecturer in RCSI, diabetes will be “one of the foremost public health challenges facing the world in the decades ahead, as its incidence increases rapidly”.
“There is a need to develop much greater awareness of diabetes in Ireland, through public education, investment in healthcare and healthcare staff working together to ensure the condition gets the attention it deserves,” he said.
Complications for untreated diabetes can lead to a number of health conditions including heart disease, stroke, kidney failure, nerve damage and blindness.
However the consequences of diabetes are not just physical, but social, psychological and economic. “About 10% of public expenditure on healthcare in Ireland is spent on diabetes,” said Dr O’Leary, “which works out at €1billion per annum.”
She also emphasised the burden of type 1 diabetes on patients. “How many times a day do you have to monitor blood glucose – five, six or more? Then maybe four or five insulin injections. There is also significant interaction with healthcare professionals, not just a GP but a consultant and nutritionist. You have to do these things to make sure your disease is kept under control. The impact is quite significant on patients and it does require a change in your lifestyle.
“Living with diabetes can therefore result in significant psychological stress. People cope very well but there is a low-lying stress – loss of freedom, relentless decision-making and it ultimately affects the quality of life.” She said children and parents of children with diabetes are particularly under psychological stress and “require intensive support”.
Self-management
She said patient self-management and self-care is critical to support patients in making all the behavioural changes needed to control their diabetes. This is particularly important for children and young adults as they develop into their teens and “transition from adolescence into adulthood and want to take control of their own medication”.
Currently, there is no cure for type 1 diabetes, which can only be treated by administering insulin and monitoring diet. However, research in this area is rapidly advancing and Prof. Paul Johnson, Professor of Paediatric Surgery at the University of Oxford, has achieved considerable clinical success through pancreatic islet transplantation (Edmonton Protocol), with up to 85% of patients achieving insulin-independence for at least one year post transplantation.
Islets are clusters of cells in the pancreas that make insulin and these cells can be taken from a donor pancreas and transferred into another person where they will make and release insulin.
Prof. Johnson said we are only “at the tip of the iceberg” with islet treatment for diabetes and this novel treatment would be ideal for children. He said there are a number of challenges still to overcome before islet transplantation can be made more widely available, including rejection of the new islets and access to anti-rejection drugs, but the “future is looking very positive”.
Cornerstone
The “cornerstone of treatment” for type 2 diabetes, according to Dr Diarmuid Smith, Consultant Endocrinologist in Dublin’s Beaumont Hospital, is exercise and a healthy diet.
“We need to think as a society of the messages we are giving to our children and the type of diet we are asking them to eat,” he said. “European data shows that about 20-25% of teenagers and young children are either overweight or obese and they are at a very high risk of developing type 2 diabetes”.
He said there is data to suggest a link between long periods of sitting and diabetes. “If you are working in an office, get up off your chair and stand or walk around for a few minutes every hour.”
Irish data shows that 50% of 7 and 8-year-olds watch over three hours of television every day at the weekend and one third of children in first class have a TV in their bedroom. “And what they are watching on TV are adverts about the wrong types of food that they should be eating.
“We also have a problem with exercise,” Dr Smith said. “As a country we are exercising less and less. We are not walking the stairs, we are pressing a button for the lift. We are not washing the dishes, we are loading the dishwasher. We’re not washing the car, we are going to the carwash. So society is changing in so many ways and it is increasing the risk of developing diabetes.”
So the key take home message from Dr Smith is: “If you have children or grandchildren, get them out and exercise!”
For more information on diabetes see www.diabetes.ie
Types of diabetes
Type 1 diabetes tends to occur in childhood or early adult life, and always requires treatment with insulin injections. It is caused by the body’s own immune system destroying the insulin-making cells (beta-cells) of the pancreas.
Type 2 diabetes usually develops slowly in adulthood. It is progressive and can sometimes be treated with diet and exercise, but more often type 2 diabetes may require medicine or insulin injections.