By Dr David Delvin

Are you diabetic? Or do you have a friend or a relative who is diabetic?

You probably do - because diabetes is one of the commonest disorders in this country. Worldwide, tens of millions of people have it. In Britain, 1.2 million people have been diagnosed as diabetic, and it's thought that about another million have the disorder - but don't know it. Many of them feel tired and unwell, yet they don't realise that it's diabetes which is the cause of their troubles.

The incidence of this disease is increasing - so much so that anyone who is in the second half of life must be considered to be at risk of developing diabetes.

The longer you live, the more likely you are to get it.

MISUNDERSTANDINGS ABOUT DIABETES

Before I explain exactly what diabetes is, can I just clear up a couple of common misunderstandings about it?

Firstly, quite a few older people have the idea that there is something called 'eating diabetes' and something called 'drinking diabetes'. This was a concept that was popular back in the mid-20th century, but it doesn't really mean anything - so forget it.

Secondly, there's a bit of confusion, which arises from the fact that there's another disorder with a similar name: diabetes INSIPIDUS. This is a rare disease, and it has no connection with 'real' diabetes - whose full name is diabetes MELLITUS.

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WHAT IS DIABETES?

OK, so what is diabetes?

Well, your body runs on fuel - just like a car. But in humans, the fuel isn't petrol; it's GLUCOSE - which is a type of sugar.

In order to use that fuel, you need something called 'INSULIN'. This is produced by your pancreas - an organ which is located in the upper part of your tummy.

In diabetes, there just isn't enough insulin around. So your body can't burn it's fuel (glucose). Therefore - just like a car which isn't burning petrol properly - your body can't work efficiently. Your blood level of glucose keeps rising and rising.

Result: You get sick.

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SYMPTOMS OF DIABETES

Right, so you get sick. But, what are the actual symptoms of diabetes? They include:

· Thirst

· Passing lots of urine

· Tiredness

· Generally feeling rotten

Younger people may lose a lot of weight. In men, impotence ('erectile dysfunction') may be a problem. In women, recurrent vaginal thrush may be a symptom of diabetes. And in either sex, blurred vision can be a symptom.

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TYPES OF DIABETES

There are various different TYPES of diabetes, and the disease varies quite a bit in differing parts of the world. However, there are TWO important types which you should know about. They are:

· Insulin Dependent Diabetes

· Non-Insulin Dependent Diabetes

INSULIN DEPENDENT DIABETES is the type in which you have to have insulin injections - in order to keep your blood glucose down to normal levels. You also have to stick to a diet. Insulin Dependent Diabetes ('IDM') tends mainly to affect younger age groups. In the UK, about 400,000 people are on insulin jabs.

NON-INSULIN DEPENDENT DIABETES is the type in which you don't have to have insulin injections. Why not? Because it's possible to keep the blood glucose down by a combination of tablets and a strict diet. Indeed, sometimes this kind of diabetes can be managed by diet alone - plus regular exercise. Non-Insulin Dependent Diabetes (NIDDM') used to be called 'Maturity-Onset Diabetes' - because it mainly attacks people over-50s. But these days, it is also hitting a lot of younger folk. Most victims are overweight, and take little exercise.

BLOOD GLUCOSE (BLOOD SUGAR). In both kinds of diabetes, the idea is for you to keep your blood glucose at the right level - never letting it get too high or too low. If it gets too high, this could endanger your life - because you can slip into a 'diabetic coma'.

If it keeps on getting too high, that can expose you to the many complications of this disease. 

And if it gets too low, you can suddenly start feeling ill and pass out. Obviously, this could be disastrous in some circumstances - for instance, if you're driving.

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THE DIABETIC DIET

In order to keep their blood sugar down to normal limits, ALL diabetics need to stick to a special diet.

A surprising number of patients don't realise this, and think that if they take their insulin (or their tablets) everything will be OK. This isn't so.

You don't have to be rigid about this diet. The days when diabetics went round carrying spring-balances and weighing all their potatoes and bread are long gone!

But when you first get diabetes, the doctor should send you to a State-Registered Dietician, who will give you your own individual advice about what you should be eating. She will certainly recommend:

· Regular meals. Particularly if you're using insulin injections, you need to eat pretty much 'on the dot'. If you don't, there's a very real danger that you'll have attacks of low blood glucose ('hypos'), in which you can rapidly become unconscious.

· A diet which helps you avoid obesity.

· A diet low in fried and fatty foods.

· A diet rich in fruit and vegetables.

· A diet which is very low in SUGAR.

It's unlikely that the dietician will advise you to buy expensive 'diabetic' jams and other 'diabetic' food products. These are not really necessary.

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TREATMENT WITH INSULIN

If you have to be treated with insulin, this means that you're going to have to give yourself insulin jabs every day for the rest of your life (though just a few people do manage to come off it eventually). I know this doesn't sound much fund, but millions of diabetics - including vast numbers of children - have managed to do it successfully.

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INSULIN REGIMES.

Treatment with insulin is quite a complex business. Unfortunately, it's not just a question of 'bunging in' the same amount every morning, and leaving it at that. Most diabetics have to learn to vary their dose of insulin a little, depending on how their blood glucose levels are going - for instance, increasing the insulin if the glucose is too high.

These days, there are many different types of insulin - and it's really up to a specialist in diabetes to decide which is best for you. Insulin's fall into three groups:

· SHORT-ACTING - such as Soluble; Lispro; and Actrapid.

· LONG-ACTING - such as Protamine Zinc.

· INTERMEDIATE-ACTING- such as Insulatard and Insuman Basal.

Common 'insulin regimes' include:

· Twice-daily injections of a short-acting insulin mixed with an intermediate one.

· Three times daily injections of a short-acting insulin.

· Three times daily injections of varying types.

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TABLET REGIMES

Oral anti-diabetic drugs fall into three main groups:

· The suphonylureas - such as chlorpropamide, glibenclamide, gliclazide and tolbutamide.

· The biguanides - such as metformin.

· Other agents - such as acarbose, guar gum, repaglinide, pioglitazone and rosiglitazone.

All of these drugs have their own contra-indications and side-effects. The decision as to which to use should be made by a physician specialising in diabetes.

Before going on to any of them, the patient should be given a chance to control his diabetes by means of a strict diet - plus increased exercise (because exercise helps bring the blood glucose down).

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CONTROL OF DIABETES

As you can see by now, the essence of living successfully with diabetes is control of your blood glucose.

Although GPs and hospitals do check blood sugar whenever they can, any diabetic who wants to live a long and healthy life should check his own glucose at least once a day. This may seem a bit of a drag, but it pays rich dividends.

You should keep a written record of your tests, and show it to your doctors whenever you consult them.

In general, the aim is to keep your blood glucose levels between FOUR and SEVEN millimoles per litre in blood tests done before meals - rising to no more than TEN millimoles per litre after meals.

You'll find that these days, Diabetic Clinics and GPs do other blood tests which can tell how good your diabetic control has been over the last few weeks.

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MOST IMPORTANT!

If you're a diabetic (or the partner of a diabetic), you should most definitely consider joining the splendid 'self-help' organisation called Diabetes UK.

Formerly known as the British Diabetes Association, this charity does wonderful work in informing patients, doctors and the public about the disease - and in promoting research.

In fact, I reckon that the single most important thing in this article is the address I'm about to give you! It's:

Diabetes UK Central Office
10 Queen Anne Street, London W1G 9LH
Tel 020 7323 1531
Fax 020 7637 3644
Email info@diabetes.org.uk

Website www.diabetes.org.uk 

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Q. I'm a man of 60, and I've had diabetes for several years. I have now become impotent. Am I right in thinking that Viagra cannot help diabetics with potency problems?
A. No, you're wrong, sir - I'm glad to say! Viagra will help over 60% of men who have 'erectile dysfunction'. Furthermore, diabetics are among the very few groups of people who can get the drug FREE under the National Health.

Q. Does diabetes run in families?
A. Most certainly. However, if there's diabetes in your family, that doesn't mean that you're certain to get it. Nonetheless, you probably are more liable to it. So a good precaution would be to keep your weight down.

Q. Does diabetes invariably affect the eyes? I'm so afraid of becoming blind.
A. No, it's certainly not invariable. Unfortunately, a lot of diabetics do eventually run into eye problems. The best defence against this is to make sure that your blood glucose is always well-controlled. Also, have frequent eye checks, at intervals suggested by your doctor.

Q. I'm an Asian businessman - retired. Is it true that people of my genetic background are more liable to diabetes?
A. Absolutely, sir. People whose ancestors came from India, Pakistan or Sri Lanka are very susceptible to diabetes. So: eat sensibly, and watch your weight!

Q. If I suspected that I might be getting diabetes, how would I go about having a test?
A. That's very simple. You go to your doctor, taking a 'morning specimen' of urine with you. She will have it tested for sugar. If it's present, then BLOOD tests will be done.

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Q. Why don't doctors take blood pressure in the LEG, instead of the arm?
A. Mainly because this would be very inconvenient for everybody. Male patients would have to take their trousers off, and women would have to remove their tights. And the doctor would have to get down on the floor - to apply his stethoscope to your ankle.

Q. What actually keeps the blood pressure up?
A. It's a combination of the FORCE of the heart beating, plus the RESISTANCE of the blood vessels (tubes) through which the blood flows.

Q. Can a woman still suffer from PMT, even though she passed the menopause 10 years ago? My aunt gets monthly episodes of tension, and wonders if she should seek medical advice.
A. Well, you can't really have Pre-Menstrual Tension when you are no longer menstruating. However, it sounds as though your poor old auntie may have some similar hormonal problem. So I think she should certainly go to her GP, have a blood hormone test, and get some treatment.

Q. I'm 60, and I recently stopped HRT, as I wanted to lose weight. Unfortunately, my hot flushes promptly returned! How long will this last?
A. Unfortunately ma'am, these flushes could continue for years. If they haven't disappeared within a couple of months, I think you should seriously consider going back on HRT. It would be worth trying a different type from before - since you're previous brand apparently made you put on weight.

Q. I've just received a 'flier' about a new book called 'Arthritis Beaten Today - A Modern Miracle Against Arthritis'. It says there's a new discovery called 'CMO' - and that CMO is very good for arthritis and blood pressure. It even hints at a possible cure. Do you know anything about this stuff?
A. All my life, people have been bringing out books (particularly American books) about alleged 'cures' for arthritis and high blood pressure. None of them has ever turned out to work! CMO apparently stands for 'cerasomol-cis-9-myristolate'. I can't see why this formula could possibly cure arthritis, and there is no mention of it all in current top medical journals, such as the BMJ. If anything ever comes of it, the health authorities would of course inform your doctor immediately!

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