- 28 Nov, 2018
This Diabetes Week, Mary Farmer, our nutrition expert and former NHS dietitian, takes a look at diabetes, the public health problem that affects more people than cancer and dementia combined, and is threatening to bankrupt the NHS. And this despite the fact that it is a largely preventable condition.
Imbibing urine as a diagnosis tool
WHAT? I hear you gasp. What would you want to do THAT for?
If you were, in another life, the ancient Hindu physician, Sushrata, of around 6BC, that is exactly what you would do, should a patient come to you for help. His symptoms would include drinking more fluids and, of necessity, urinating more than usual. He would be very tired and losing weight. Sushrata noted that these patients’ urine smelled sweet and that the ants loved it! He therefore tasted his patients’ urine to diagnose – as it happens, quite correctly – the disease diabetes mellitus. The earliest references probably go back to ancient Egypt from 1500BC. It was the Greeks who gave us the name, which describes an outpouring of urine with a characteristic sweet taste, like honey, “meli” in Greek. My brother speaks fluent Burmese and in that language it is known as “his-gyo” (pronounced “see-yew”) meaning “sweet pee”! Today, it is a serious public health problem and threatens to bankrupt the NHS. Currently, treating diabetes accounts for around 10 per cent of the entire NHS budget at £9 billion. With a number of recent articles in the press on sugar intake, the sugar tax and obesity, it seems timely to look more closely at this largely preventable disease.
You can’t be a little bit diabetic
Patients sometimes arrived in my clinic saying that their doctor had told them that they had a “touch of diabetes”! Not true! That’s a bit like saying, “You are a touch pregnant”. No doubt their doctor was trying to be kind and let them down gently, or that blood tests were showing only moderate increases in blood sugar. But once these levels start to rise above the accepted normal, it is time to be concerned.
Type I diabetes an auto-immune problem
It is likely that the diagnosed diabetics of ancient times would have what we term Type 1 diabetes, which traditionally needs insulin to treat it. It is thought to be an auto-immune problem, related to a viral infection, and patients typically show low levels of vitamin D, now thought to be widely involved in infection prevention. Characteristically, it shows itself in the young.
Type 2 diabetes is related to lifestyle factors
More widespread is Type 2 diabetes, which is linked to poor diet and overweight. It used to be termed “mature onset” as it tended to occur in middle-age. Not anymore: worryingly, it is now affecting younger people – even teenagers and some pre-teens – and is connected with being overweight and inactive. The youngest ever was a little girl from Texas, aged three years old. (She weighed five and a half stone).
During digestion, the carbohydrate element of our food (sugars and starches) are broken down to a single molecule, glucose. It is in this form that it circulates in the blood and is essential to provide energy for all the biochemical reactions in the body, but especially as fuel for the brain.
Insulin keeps blood glucose levels within healthy limits
What keeps the blood levels within healthy limits is the hormone insulin, which is released by special cells in the pancreas. Not enough insulin and you can begin to see what might happen. The glucose levels rise. There comes a point when the level in the blood spills over and glucose appears in the urine. If things go unchecked, the patient feels thirsty and starts to drink a lot more; he also gets very tired, as all that energy-giving glucose is going down the pan. Infections can take more time than normal to heal.
Blood capillaries and nerve endings are too sensitive to cope with excess blood glucose
But more seriously, this now “overly-sweet” blood is bathing all our vital organs, including our delicate, teeny-weeny blood capillaries and nerve endings. These are extremely fragile and sensitive and can’t cope. It’s a bit like over-watering or over-nourishing a pot plant. It can die. Something similar happens to these delicate structures in the body, and if it happens to blood capillaries in the retina of the eye (retinopathy), the patient is likely to lose his sight. If the capillaries are unable to nourish the extremities properly, cells can die off and gangrene may result. If the nerve endings in the legs or toes become less sensitive (neuropathy), the patient may not realise if he has cut or knocked himself, or got into a bath or shower that is too hot, causing damage. The number of foot amputations amongst diabetics has risen to around 135 a week.
Diabetes and heart disease linked
If that wasn’t enough, there is a direct link between diabetes and being more susceptible to having heart disease. And … even worse, is the finding of a recent study from Finland suggesting that statins (widely prescribed for lowering blood cholesterol levels) may actually increase your risk of poor blood glucose control. It sounds like “damned if you do and damned if you don’t”. However, you may now see that it is paramount to keep blood glucose at a healthy level.
Fewer than 20% of diabetes patients are well controlled
Recent figures released by Diabetes UK show that over 4 million people have been diagnosed with Type 2 diabetes and that fewer than one in five of them has their diabetes well controlled. Surveys suggest that one in three adults (about 5 million) in the UK have blood glucose levels that are too high, and are therefore at risk. The older one gets, so the risk increases.
Our beloved pets are succumbing, as well
Even domestic pets are not escaping: a recent study by the insurer, “Animal Friends” suggested that the diagnosis of diabetes mellitus in cats and dogs collectively increased by a wopping 900 per cent in the last five years. Why? We, as their doting owners feed them too much, don’t exercise them enough and they get fat.
So what can be done?
I apologise for this grim account – there is no nice way of putting it: diabetes is a serious condition BUT can be treated and even better, prevented, if we are “blood-glucose” aware”. Paramount to this is avoiding being overweight: sounds easy on paper, and next time, I’ll give you some practical suggestions…
Further reading and resources
Part two of the diabetes nutrition blog – dietary advice
How to avoid diabetic amputations