Type 2 diabetes affects approximately 3.5 million people in this country and is thought to cost the UK around £20bn per year in both direct and indirect costs.
This is a staggering amount of money spent on a condition largely caused by our lifestyle choices and environment.
On Doctor in the House, I try to help 39-year-old La-Vern. Her mother, Doreen, already has type 2 diabetes and is worried that La-Vern is going down the same route.
La-Vern is a busy, single mother who does two jobs and, as a result, is exhausted and stressed.
She has not yet crossed our diagnostic threshold where we would say she has type 2 diabetes, but her blood sugar and fasting insulin levels are not “normal” either. Her results suggested that she was on the road towards type 2 diabetes.
This is an ideal opportunity to practise true preventive medicine. Type 2 diabetes is a late event. By the time you get a diagnosis, things will have been going wrong in your body for many years.
La-Vern’s symptoms of fatigue have already affected her quality of life. However, her lifestyle is not only causing her to feel unwell, but is driving her towards a type 2 diabetes diagnosis further down the line.
This is one of the big problems in medicine today – things are often said to be black or white, normal or abnormal – but what about optimal?
I am an advocate for trying to recognise problems before they happen. Why should we wait for people to get a type 2 diabetes diagnosis before we take action?
Type 2 diabetes is often viewed as a dietary illness. That is partially true as diet is a big contributor.
However, other lifestyle factors such as insufficient sleep, long-term stress, and inappropriate physical activity all contribute, as well. For many of my patients, addressing these factors can be as important as their food choices.
Most cases of type 2 diabetes are caused by a condition called insulin resistance.
Insulin is an important hormone and one of its functions is to keep your blood sugar tightly controlled. If you are in optimal health and not insulin resistant, a sugary bowl of breakfast cereal will cause your blood sugar to go up. Your body will then release a little bit of insulin to bring it back down again.
As your health deteriorates and you start to become insulin-resistant, you need more and more insulin to keep your blood sugar under control. Your body has become deaf to insulin’s sound.
It is a little bit like alcohol – the very first time you have a drink, it may only take a few sips of wine to feel tipsy but as you become accustomed to drinking more and more, you need more and more alcohol to have the same effect – your body has become resistant to the effects of the alcohol.
This is similar to what happens in insulin resistance.
This raised level of insulin can itself cause many problems. And when the insulin can no longer keep your blood sugar under control – at that point, we give you a diagnosis of type 2 diabetes.
As I explained in a TED talk, there is a problem with blood sugar in type 2 diabetes, but it is not a blood sugar problem. By the…