I was trying to explain to Mrs M, yet again, that she has to rethink her lifestyle if she is to control her diabetes. She still thinks that more or `better' pills are going to bail her out. In fact, she thinks that I have some `super-pills' that I am denying her. Mrs M is sadly, not alone in her belief, or indeed her Type 2 Diabetes.
This 36 year old obese Bangladeshi lady came to see me around a year or two ago with terrible boils on her legs and I suspected that these had an underlying cause. She certainly had a typical profile. Very overweight with several siblings already known diabetics. Over the last few months, she had started to drink large quantities of soft drinks and tea to slake an ever present thirst and was frequently running to the toilet to pass water. She was tired and moody. Looking back on her records, I noted that she had high blood glucose noted during the last two of her three pregnancies: an important clue.
I reached the diagnosis of diabetes by several means. Firstly, when she first came to see me, I tested her urine with testing strips and found it to contain a lot of glucose and to clinch the diagnosis, I sent her away for a fasting blood test to measure the blood glucose. Everybody's blood glucose changes over the day according to what they eat. However if it is high (above a specified level) when you have not eaten, that indicates diabetes.
To avoid confusion, I need to clarify that there are two forms of Diabetes:
Type 1 is a disease where the body produces little or none of a hormone called insulin which helps the body use the glucose fuel that it needs to power the different tissues. Thus the glucose floats around in the blood whilst the tissues are starved of energy. Type 1 diabetics are usually effectively treated with insulin and need to be so from an early age (generally children and adults) when they are generally diagnosed. Some are even babies when they start insulin.
In Type 2 Diabetics, initially there is enough insulin being produced, but the tissues cannot register the hormone. This also results in high blood glucose as well as leaving the tissues without fuel to work properly. The body tries to compensate by producing more and more insulin. Over time, the body cannot sustain this and ceases to produce enough insulin. Therefore although initially Type 2 can be treated by diet, then diet and tablets, eventually it may need treatment with diet, tablets and/or insulin. Therefore the old term for this type of Diabetes `non-insulin dependent Diabetes mellitus' is inaccurate.
Type 2 Diabetes is at epidemic proportions in the United Kingdom and unfortunately Muslim men and women are, as ever, over-represented. This disease is strongly linked to diet and to obesity. I am seeing new diabetics getting younger: some in their 20's and 30's
I hope to cover the important subject of Type 2 Diabetes, through Mrs M's story over the next few months. Next month, I will cover the reasons why optimum treatment of Type 2 Diabetes is so important.
In the meantime, if you are a diabetic I strongly urge you to visit the website www.diabetes.org.uk and consider joining the support charity Diabetes UK. The organisation offers a wealth of information and advice for a very nominal fee. Muslims are under-represented in the patient membership despite over-representation in the Diabetic population.
Dr Shahid |
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