Diabetes: The risks, causes and what can be done

Diabetes comes in two forms; Type 1 and Type 2. There are various risk factors for both but Type 2 is more likely to be reversible, or can be put into remission. Here to tell us all about diabetes, causes and what can be done about it is leading consultant endocrinologist in Bath, Dr Marc Atkin.

What are the first signs of diabetes?

Often with Type 2 diabetes, there aren't any symptoms at all. Sometimes it can just be tiredness or generally feeling under the weather. Though in more extreme scenarios it can be drinking lots, weeing lots, and potentially losing some weight. Those tend to be more around Type 1 diabetes and this tends to be a quicker process.

In Type 2 diabetes it's a relatively slow process and can creep up on people over a period of months, and even years. It's often not any symptoms at all, which is why it's important if you do have a family history of Type 2 diabetes, and you're at risk of diabetes, and there are calculators that you can look up online that can tell you that. Then it's important to have those blood tests that diagnose it early. 

What causes diabetes? Is it genetic?

In terms of Type 1 diabetes, it’s an autoimmune condition so that means the immune attacks the pancreas and stops the insulin cells working. That has got a genetic element to it, because if often runs in families. It can happen to anybody at any time. 

Type 2 diabetes, again, has got a very heavy genetic element to it, and again it tends to run in families. If you do have a family history of Type 2 diabetes then often you have a higher risk of developing Type 2 diabetes. The other things that contribute to Type 2 diabetes are weight, sedentary behaviour and age. Genetics and age, we can't really affect but there are things we can do about weight and there are things we can do about sedentary behaviour. 

What does it mean to be prediabetic?

This process with Type 2 diabetes is often a very slow process. That's one of the reasons you don't get an awful lot of symptoms with it. It can happen over a period of months or years. It's a continuum, so the blood sugars creep up gradually over a long period of time. 

We've recognised there's a particular cut off at something called an HPA1-C which is blood test that we do which tells us what your blood sugars have been like over the last three months. Once that number reaches 48 then that is a diagnosis of diabetes.

There's a period before that where that number would be around 42 to 47, and that's classed as pre-diabetes. That's somebody who's at risk of diabetes and as they get older, then their pancreas won't be able to produce quite so much insulin and there's a risk they'll eventually develop Type 2 diabetes. 

That's a good time for us to try and intervene, and try to make some changes on the weight and sedentary behaviour; make those lifestyle changes to try and prevent Type 2 diabetes occurring.

Who is most at risk of diabetes? 

Those that have either had Type 2 diabetes or gestational diabetes when they were pregnant, that is often the first sign that the sugar system is put under pressure is during pregnancy. If you're sugar system isn't that robust and strong, then you can actually develop diabetes in pregnancy. That disappears once you've had the baby. However, that tells us your sugar system isn't the strongest and therefore, there's a risk that if your weight goes up as you get older, then there's chance that that diabetes could come back again.

Those people with polycystic ovary syndrome, again, that's an indication there's a degree of insulin resistance there. And as they get older and become more sedentary, or put more weight on, there's a risk that they can develop Type 2 diabetes. 

If you have a family history of Type 2 diabetes and that particularly means in parents or siblings, then again you share the same genetics as those people and as such that puts you at risk. The weight and sedentary behaviour don’t give everybody Type 2 diabetes; you have to have the underlying genetics as well. If you've got the underlying genetics that's a good reason to be mindful of that risk. 

There are ways you can work those risks out. There are some online calculators. Diabetes UK do a particularly useful one that you can put your own details into that, and work out your own individual risk to see whether there's something you need to be mindful of for the future. 

Can diabetes be cured? 

That's a good question. In Type 1 diabetes, as yet, no we haven't come up with a cure. We're not very close to doing that because we can't stop that destruction at the moment of those cells that make the insulin. We can't stop that autoimmune process happening. 

In Type 2 diabetes that's slightly different. We tend to move away from the use of the word 'cure' because cure means that has disappeared entirely. We tend to talk about putting diabetes into remission. That means your genetics aren't going to change, and we can't change your age. You're only going to get older. So, we can't take that risk away entirely.

What we can do is reduce the chances of that developing into diabetes. That's by losing weight, and there's good evidence that actually, if you lose a significant amount of weight; around 5 to 10 per cent of your body weight, and you can push diabetes into remission. There's a chance it will come back in the future so that's why we don't use the word 'cure', but it's certainly possible to put things into remission. 

If you’re concerned you might be at risk of diabetes, arrange a consultation with Mr Atkin via his Top Doctors profile.