Once you develop diabetes, dietary changes and exercise may not be enough.

What is it?

Four million people in the UK live with diabetes and nearly a quarter of a million more are being diagnosed each year. Ninety per cent of those with diabetes have type 2 diabetes (T2D) and you’re more prone to it if you’re overweight, it runs in your family or you’re of south Asian or African descent. In T2D, the body doesn’t respond properly to insulin, the hormone produced in the pancreas that dispatches glucose from the food we eat to the cells of the body to be used for energy or stored as fat. T2D is treated by weight loss, lifestyle changes and oral drugs. Type 1 diabetes (T1D), which accounts for 10% of cases, can appear in childhood and is treated with injectable insulin. In T1D, the pancreas gradually stops making insulin for reasons that are still unclear but may be triggered by a viral illness.

High blood-glucose levels damage blood vessels supplying many parts of the body, so there’s an increased risk of kidney failure, blindness, strokes, heart attacks and gangrene. Life expectancy is reduced by 20 years for people with T1D and up to 10 years for T2D. The good news is that careful control hugely reduces these risks and that new developments are coming on stream at a rapid rate.

Prevention is best

T1D can’t be prevented, but T2D can. NHS England is rolling out an ambitious national Diabetes Prevention Programme to try to prevent up to 100,000 people each year developing it. Professor Jonathan Valabhji, NHS England’s national clinical director for obesity and diabetes, says: “Tackling obesity and diabetes is one of the biggest healthcare challenges of our time and the numbers with T2D are rising.” Those referred will get personalised help to lose weight and bespoke exercise programmes over nine months.

A desperate need for new drugs

Once you develop diabetes, dietary changes and exercise may not be enough. There’s a limited range of drugs available now and Professor Nicholas Morton of the University of Edinburgh says we need to find new drugs that work in novel ways. He is interested in lean individuals whose genes allow them to stay thin even though they live the same western lifestyle that is making so many of us obese. A gene that codes for an enzyme that protects mice from obesity and its damaging effects holds promise. A drug called sodium thiosulfate, which is used to treat severe side effects of kidney disease, also acts to boost this enzyme and medicines like it could offer a different way of tackling diabetes.

Does surgery offer a chance of cure?

Simon O’Neill of Diabetes UK says there’s strong and growing evidence that if you are obese and have T2D, surgery works better than drugs and lifestyle advice. Surgery involves restricting the size of the stomach or bypassing the duodenum, where most absorption takes place. It also seems to cause changes in gut hormones, so people eat less and exercise more. Some people have had the surgery and not lost much weight, but their diabetes has still disappeared. It’s possible that people with diabetes who aren’t obese could benefit from the surgery, too. But, obviously, surgery has its downsides and risks. The holy grail would be a tablet that could mimic the gut hormone changes that surgery causes.

An end to needles?

Many people with diabetes, especially children, dislike the repeated finger-prick tests. But an alternative does exist. Continuous glucose monitoring (CGM) involves a small wearable device that tracks glucose levels constantly and can be set with alarms that go off when levels are too high or too low. However, at the moment, NHS provision of CGM is practically nil, according to O’Neill. The NHS may pay for devices for people who get no warning of dangerous hypos (when blood glucose is so low that it can cause coma or even death) and in children with T1D.

But what if you don’t want continuous readings?

A device called Freestyle Libre monitors your blood glucose all the time, but only gives you a reading when you swipe it. It’s a patch the size of a 50p piece that is positioned on the upper arm. A tiny filament is inserted into the skin that reads glucose levels in the fluid between skin cells. Parents can swipe their diabetic kids while they’re sleeping rather than wake them up for a finger-prick test. There’s an initial outlay of about £60 for a reader that should last a few years, then running costs of about £100 a month if used continuously.

Insulin pumps

Most diabetics in the UK still inject themselves with insulin three to four times a day. But insulin pumps that do away with the need to inject are increasingly popular. They consist of a fine tube inserted under the skin with a wearable pump that contains insulin, which is attached most of the time. In Sweden, 50% of people with T1D have an insulin pump, but in the UK only 6% of eligible adults and 19% of children have one. CGM devices can interact with insulin pumps if blood glucose levels are falling dangerously low. The health watchdog Nice has endorsed one of these devices for people whose T1D is generally well-controlled, but who get uncontrollable hypos.

The perfect solution would be for a CGM system to communicate directly with an insulin pump to deliver the correct dose without any input from the human wearing the devices. “In its entirety, that’s still a long way off,” says O’Neill. The pump would need to hold two hormones; insulin to lower blood glucose when it’s too high and glucagon to boost glucose levels if it’s too low.

Is there an app?

There are lots of apps to encourage weight loss, lifestyle changes and management of diabetes. A new app has launched this month to support people with diabetes to count carbs, scan supermarket products, plan meals at home and analyse typical restaurant dishes. Nutrino shows how daily food intake, activity, sleep and other parameters affect glucose levels. If you have a compatible CGM device and insulin pump, detailed data of your insulin requirements and diabetes control feed into the app, which can customise its suggestions to your needs. The app can also connect with wearable devices such as Fitbit to get a picture of how much you exercise.

Whenever the concept of sleep is discussed, there is common perception that we should rest for between six and eight hours every single night. While this is a long-standing belief, however, more recent studies have suggested that this is a generic assertion that has little foundation in fact.

More specifically, the Surrey Sleep Research Centre in the UK are now claiming that it is the quality of sleep that important rather than the quantity. Moreover, the optimal amount of sleep will vary for each individual, with the average length of time between five and nine hours in total. -–guardian.com

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