Coping with diabetes

Sarah Caltieri, a bright, vivacious 24-year-old who has diabetes, has almost entirely lost her sight over a period of six months – a high price to pay for neglecting to monitor her blood and medication.

What is diabetes?

There are two kinds of diabetes mellitus – Type I and Type II. Type I is a lifelong condition that invariably requires insulin injections. This is because the pancreas is failing to produce enough insulin to allow the body to utilise sugar (glucose) properly and so keep the amount of it in the bloodstream at a reasonable level. Type II diabetes, on the other hand, can often be controlled by losing weight, a change of diet and/or tablets.

Type I diabetes also requires the rigorous monitoring of blood sugar levels and balancing of food intake, energy output and use of insulin. The aim is to keep blood sugar levels within a normal range to minimise the chances of developing the complications that can be caused by diabetes. These include blindness, kidney failure, heart attack and peripheral neuropathy – the loss of sensation in the hands and, particularly, the feet, which can result in gangrene and amputation.

Controlling the condition

In her teens, Sarah went through an unhappy period when she suffered from an eating disorder and ignored the advice of relatives and doctors to keep her diabetes under control. The result was the blindness that she is now having to come to terms with. Successive operations have given her a small amount of vision in one eye, but how long she will retain that is uncertain.

But it is not just rebellious adolescents who fail to monitor their diabetes. A study in Scotland showed that, out of 807 older people with Type I diabetes, 123 (16%) redeemed no prescriptions at all for glucose-monitoring strips over a three-year period. Only 161 (20%) redeemed enough prescriptions for daily testing. The equivalent figures for people with Type II diabetes were 21% and 17% respectively. These figures do not only represent human suffering – they are also a cause of huge concern to the NHS.

The increase in diabetes

Until recently, Type II diabetes, also called maturity-onset diabetes, was unknown in people of Sarah's age. As its alternative name suggests, it used to occur mainly in middle age, when there were fewer years left in which to develop the complications. Now, however, it is beginning to appear in children and teenagers.

One of its chief causes is obesity. As the levels of obesity rise in the US and the UK, so does the occurrence of Type II diabetes. Diabetes clinics in UK hospitals are becoming overwhelmed, and GPs are increasingly being required to take on more of the care of their diabetic patients.

Risk factors

• Your genetic inheritance may put you at risk of Type II diabetes. The closer a relative with diabetes, the more likely you are to develop it yourself. Afro-Caribbean and South Asian people in the UK are three to five times more likely to develop it than white people.

• Obesity is a leading cause: more than 80% of people with Type II diabetes are overweight. The more overweight and unfit you are, the greater your chances are of developing diabetes.

• Women who have temporarily developed diabetes during pregnancy are more likely to develop Type II later on.

• Your chances of having diabetes increase with age.

Warning signs

If diabetes is diagnosed early, it is possible to lead a full and healthy life. Unfortunately, it is often not diagnosed until damage has already been done to the heart, kidneys and eyes.

Diagnosis is carried out by a simple blood test. If you have some or all of the following symptoms, and especially if you fall into the risk categories, go to your GP for a check-up:

• excessive thirst
• unexplained weight loss
• a frequent need to go to the loo, especially during the night
• a fruity smell on the breath
• fatigue
• genital itching or episodes of thrush.

The Glycaemic Index

The Glycaemic Index (GI) is a relatively new way to categorise how quickly carbohydrate-containing foods raise blood sugar levels. Low-GI diets have been shown to help people lose weight, reduce peaks in blood glucose and improve levels of 'good' cholesterol.

You can find an exhaustive list of foods and their GI score on the Glycemic Index website from the University of Sydney. Some of the scores are surprising – potatoes vary in their GI score according to how you cook them, and chocolate rates lower than rice.

Clearly this does not mean that it is a good idea to replace rice with hefty lumps of chocolate. No one is suggesting that chips are good for you, even though they score lower than baked potatoes – the additional fat in chips simply slows down the absorption of carbohydrate. The index should be used to help you combine low-GI foods with high ones to slow down the rate of absorption as you follow a traditionally healthy diet.

Tesco now labels 50 low-GI and medium-GI foods in its stores and 500 on its website. As the incidence of diabetes soars, it seems likely that other supermarkets will follow suit.

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