Diabetes is a life changing illness which in 2019 effected approximately 9% of the world’s population, this figure is expected to have risen to approximately 11% by 2045 (Diabetics percentage worldwide 2019). There has been a continuously increasing trend with the World Health Organization estimated a rise of Diabetes cases from 108 million worldwide in 1980 to 422 million in 2014 (WHO, 2018). The number of Diabetics has increased more rapidly in low income countries.
Now for a brief history of the disease Diabetes. It has been discovered that ancient Indian, Greek, Egyptian and Chinese Physicians were aware of Diabetes, but they didn’t know what caused it or how to treat it. Being diagnosed with Diabetes was basically a death sentence. An Ancient Egyptian 3rd dynasty papyrus scroll from 1552BC described a disease suspected to be Diabetes. It was written by an ancient Egyptian physician called Hesy-Ra. Ancient native American transcripts from 1000BC have also been discovered describing a similar disease. In 100BC a Greek Physician called Aretueus named the disease ‘Diabetes’ which means ‘to siphon’ or ‘to pass through’. It was named this because of the large amounts of urine that passed through the body. ´The ancient Egyptians noticed that a person with diabetes had sweet tasting urine and It would attract locusts and other insects. That was one way of diagnosing the patient, by tasting their urine to see if it tasted sweet. Diabetes was referred to as the ‘sugar sickness’ before it was called Diabetes.
Diabetes occurs when the β-cells in the pancreas do not produce the hormone insulin, or the insulin produced is not used effectively by the body’s cells. Insulin acts as a key to the cells, letting glucose from the blood to enter. Without insulin the glucose will stay in the blood causing hyperglycaemia. Prolonged hyperglycaemia can lead to microvascular complications such as neuropathy, retinopathy and nephropathy (Vaz et al., 2018). The main symptoms of diabetes include extreme fatigue, extreme hunger, unexplained weight loss or weight gain, extreme thirst, frequent urination (especially at night), slow healing wounds and blurred vision. Diabetes is the seventh leading causes of death worldwide (WHO, 2018).
Type 1 is an auto-immune disease where the body’s own immune system attacks the β-cells in the islets of Langerham of the pancreas. In type 1 diabetes the onset of symptoms occurs more rapidly, and the person must immediately be put on insulin injections or an insulin pump, diet alone is not enough to treat type 1 diabetes (Dansinger, 2019). Type 1 diabetes is commonly referred to as ‘juvenile diabetes’, as it most commonly occurs in children and teenagers (Dansinger, 2019). Approximately 9-10% of the overall diabetes population in Ireland are type 1 diabetics (Diabetes Prevalence in Ireland, 2019).
Type 2 diabetes is caused by an unhealthy lifestyle including too much sugar in the diet and lack of physical activity (Dansinger, 2019). If caught early the effects of type 2 diabetes can be reversed with healthy diet and lifestyle changes. Unfortunately, many people can experience no symptoms for up to 12 years, and by then a lot of internal damage has occurred (Are you at Risk?, n.d.). The treatment of type 2 diabetes is usually less intense than the treatment for type 1 diabetes. It includes healthy diet, physical activity, regular blood sugar monitoring and possibly oral diabetes medication such as Metformin. Approximately 80-90% of the diabetes population in Ireland are type 2 diabetics (Diabetes Prevalence in Ireland, 2019). Over 845,165 adults > 40 in Ireland are at an increased risk of developing, or already have pre-diabetes. Furthermore, approximately 304,382 adults in the 30-39 age group are overweight and do not do the recommended 30 minutes per day for 5 days, or 150 minutes per week of physical activity (Dept. of Health and Ispos MRBI, 2018). Type 2 diabetes was usually only seen in the elderly. Worryingly there has been a rise in young children being diagnosed with type 2 diabetes (Candler et al., 2018). To learn more about insulin resistance have a look at my blog on the importance of fats.
The risk factors for developing type 2 diabetes include;
Being > 40 years old
Having a BMI of >25kg
Not taking 30 minutes per day or 150 minutes per week of exercise
Having a family history of diabetes
Having high blood pressure
Having high cholesterol
Developing gestational diabetes during pregnancy
Gestational diabetes is caused by specific hormones produced during pregnancy which work against the insulin. It usually appears during the second trimester and goes once the baby is born ´The treatment of Gestational Diabetes includes a specific meal plan, regular exercise, regular glucose testing and in some cases insulin injections.
Diabetes can also be surgically induced, steroid induced or be due to having Cystic Fibrosis ´Further research into Diabetes has revealed that there are more types of Diabetes than initially thought.
Treatment options for Diabetics
A Glucose meter is used to check how much glucose is in the blood. The normal levels are between 4 and 8. The finger is pricked using a small pen with a retractable needle and a small drop of blood is dropped onto a glucose strip and is then tested by the meter. This is a much more accurate (and less disgusting) way of keeping an eye on those blood sugar levels! ´A Continues Glucose Monitor , or ‘Sensor’ is a small device attached to the body which continuously checks the blood glucose (BG) in the body. The CGM has a very small cannula which is inserted under the skin. It tests the level of glucose in the body fluids. Because it is checking the level of glucose in the interstitial fluids and not the blood, the reading can sometimes be a few minutes behind a BG reading. The CGM enables a diabetic to see certain patterns in the BG levels which they wouldn’t necessarily be able to see by testing alone. Diabetics that are on insulin have to be careful to avoid low blood sugars, or ‘hypos’. These can be just as dangerous as high blood sugars and it has been shown that frequent low blood sugar episodes can have adverse effects on the brain.
Image 1: Glucose monitor
Diabetics with Type 1 Diabetes are required to take insulin. If they do not their blood sugar levels will become very high and this can lead to feeling tired, irritable, very thirsty, frequent urination and in more serious cases Diabetic ketoacidosis. ´Type 1 Diabetics are therefore referred to as ‘Insulin Dependant’. Insulin injections are one way Diabetics take insulin. There are two types of insulin that can be injected. Fast acting insulin and log lasting insulin.
Long lasting insulin is released slowly throughout the day whereas fast acting insulin works straight away. ´Type 1 Diabetics usually use both types of insulin. Another way Insulin dependant Diabetics can take Insulin is via an Insulin pump, which is an electronic device that continuously infuses fast acting insulin into the body instead of having to inject it . An insulin pump more closely replicates what a functional pancreas does. It is attached to the body via a small flexible tubing. The wearer receives a continues ‘Basel’ throughout the day and when carbohydrates are eaten or if the blood sugars are too high a ‘bolus’ of insulin can be infused manually. The pump can also be suspended (stops giving insulin) if blood sugars goes low. When used together the CGM and the insulin pump can make a closed loop system where the CGM will alert the insulin pump when blood sugars are starting to drop and the insulin pump will alert the wearer and suspend itself. It will also alert when the persons blood sugars are going high but as a safety mechanism insulin can only be given manually.
Image 2: Closed Loop System
Type 2 diabetes is mainly treated with healthy diet, physical activity and oral medications. These medications include; Metformin– it improves the body tissues sensitivity to insulin so the body uses it more effectively. Thiazolidinediones – this works similarly to Metformin Sulfanylureas– stimulates the pancreas to secrete more insulin. DRP 4 inhibitors – reduces blood glucose levels GLP 1 receptor agonists – Slows digestion which helps lower blood glucose levels. SGLT2 inhibitors – Prevents the kidneys from reabsorbing glucose from the blood so it is excreted in the urine. ´Insulin therapy is used as a last resort, or if the person doesn’t change their diet and lifestyle.
As of yet there is no cure for Type 1 Diabetes. With type 2 Diabetes if the person changes their lifestyle, eats healthier and exercises more they can live a normal life and maybe even reverse their Diabetes. For Type 1 Diabetics it’s not as easy. However there are a few less conventional treatments out there such as pancreas transplantation. This is of course a very risk procedure and would be a very last resort.
There is a lot of Diabetes research happening worldwide, primarily to find a cure but also to find ways to make diabetics lives easier.
One of these is islet transplantation. There are approximately 1 million islet cells in a healthy pancreas, they take up about 1/3rd of the overall cells in the entire organ. Islets are clusters that contain 3 to 4,000 cells that work to regulate blood glucose levels. The two types of cells are beta cells which release insulin to lower blood glucose levels and Alpha cells which release glucagon when blood sugars begin to drop. In a type 1 diabetic the beta cells are attacked and so they cannot release insulin. The Diabetes Research Institute have found a way to separate islet cells from a donor pancreas and then infuse them into the liver of a Type 1 diabetic through a catheter into the hepatic portal vein. It is a non-surgical procedure which does not require the patient to be put to sleep and it only take about an hour. At present this remains an experimental procedure only available through clinical trials, but it looks very promising as patients receiving islet transplants have not needed to take insulin for up to 10 years. For more information visit https://www.diabetesresearch.org/what-is-islet-transplantation
The Diabetes Research Institute (DRI) BioHub is a Bio engineered mini organ that mimics the role of the pancreas. There are 3 main research pathways being looked at in order to make the BioHub successful, these include Site, Sustainability and Supply. Researchers are working towards engineering a mini endocrine pancreas that will contain transplanted islet cells from donor pancreas. These cells will be protected from auto-immune attack that causes Type 1 Diabetes so the patient will not be required to take immunosuppressant drugs. There are a number of ways in which the cells can be protected including protective barriers, adding oxygen or other beneficial agents within the transplant environment. There are not enough donor cells to treat the millions of diabetics all over the world. DRI researchers are trying to develop ways to create a reliable and plentiful supply of insulin producing cells or even a ay for the patient to regenerate their own insulin producing cells. For more information check out https://www.diabetesresearch.org/BioHub
You know the BCG jab you might have gotten as a child? Well Dr Denise Faustman , MD, PhD has been carrying out clinical trials with the Immunobiology Laboratory at Massachusetts General Hospital (NGH) with the BCG vaccine. In 2018 Faustman Laboratory released a statement saying that patients were treated with two doses of the BCG vaccine four weeks apart, and they showed normal blood glucose levels for up to eight years after. It was an 8 year examination which included 3 groups of Type 1 Diabetics. One group was treated with 2 doses of the BCG vaccine. The other group was treated with 2 doses of a placebo and the 3rd group acted as a reference group. The vaccine works by genetically altering white blood cells so they can process glucose. They make up for the beta cells in the pancreas (insulin producing cells)which have been destroyed by the immune system in Type 1 Diabetes. If you’d like to read Dr Faustman’s paper yourself here is the link https://www.nature.com/articles/s41541-018-0062-8#Sec7
In order to control both type 1 and Type 2 Diabetes there are a number of supports that are essential. Although Diabetes is a life changing illness it can be kept under control with the right amount of support from professionals, family and friends. A Diabetic should never NOT be able to do something they want to do just because of their Diabetes, especially with all the new amazing medical technology and research trials out there. These professional supports include; Dieticians, Podiatry, Diabetic Retinopathy, Counselling, hearing tests and Education.
For more information on Diabetes you can visit https://www.diabetes.ie/. If you feel you may have Diabetes, type 1 or type 2, please see a doctor and get tested. Catching Diabetes quickly is so important to prevent damage. With type 2 Diabetes you can have no outward symptoms for up to 12 years! However irreversible damage could be occurring on the inside.