Following the recent news that around one million adults in England have undiagnosed Type 2 diabetes, now feels like a good time to shed some more light on this increasingly prevalent condition.
Being diagnosed with Type 2 diabetes is a challenging time for the patient with many people finding it emotionally overwhelming. And with over 90% of all diabetes cases being Type 2, GPs across the country are finding themselves having this conversation more and more.
We asked Dr Matt Capehorn, LighterLife’s medical director, to share his insights into the most common diabetes-related questions doctors currently get asked.
What are the most frequently asked questions about diabetes?
1) It’s just a touch of sugar diabetes, isn’t it, doctor? Everyone in my family has it. It’s not a problem, is it?
We don’t like it when patients refer to “sugar diabetes” because it gives the wrong impression that diabetes is just about blood sugar levels.
With Type 1 diabetes, the immune system damages the pancreas, which is the organ responsible for producing insulin. So, it’s unable to produce enough insulin to control blood glucose levels caused by the carbohydrates and sugar in the food we eat. In Type 2 diabetes, it’s because the body becomes resistant to the effects of its own insulin, which makes maintaining healthy blood sugars challenging.
We now know that in approximately 85% of patients with Type 2 diabetes this resistance is underpinned by the effects of dangerous “visceral” or tummy fat that lies in and around your organs, including the liver.
Reducing weight and increasing certain types of physical activity has been shown to reduce this type of fat, and studies, such as the DiRECT study (funded by Diabetes UK), have shown that Very Low Calorie Diets, like LighterLife’s TotalFast, can result in sufficient weight loss to result in a “reversal” of the diabetes.
Patients often have no symptoms at diagnosis and so feel that it’s not an issue. And as a result, they don’t make sufficient lifestyle and behaviour changes, or address factors like weight and physical activity and inevitably, their condition worsens..
Over time, this may result in very serious consequences like retinopathy (leading to blindness), nephropathy (kidney damage), and neuropathy (nerve damage to feet), together with an increased risk of limb amputation and cardiovascular or heart disease.
2) Can I still eat sugar if I am diabetic?
You do NOT have to avoid sugar if you have Type 2 diabetes. Obviously, if your body is struggling to control its sugar levels after eating, and given that prolonged high levels of sugar (hyperglycaemia) can lead to the long-term complications of diabetes, it’s worthwhile trying to reduce sugar intake. However, some sugars that are naturally occurring, such as those in fruit, dairy etc can be enjoyed as part of a nutritionally balanced and healthy diet.
The sugars that you should definitely try to reduce are those refined sugars in processed foods, snacks, and fizzy drinks, which are more likely to cause a sudden rise in sugar levels. If you make the necessary dietary and lifestyle changes, or take medication as prescribed, you should be able to manage your sugar levels correctly and still be able to enjoy a balanced diet with some sugar.
The most important dietary aspect as far as Type 2 diabetes is concerned is to reduce your weight back down to a healthy weight, which is best done by reducing calories, rather than restricting certain food types. A Very Low Calorie Diet like LighterLife’s TotalFast programme is ideal, especially as it’s nutritionally complete.
3) Am I automatically going to end up on insulin?
No. Patients with Type 1 diabetes can’t produce enough insulin for their body to manage sugar levels so they do need insulin. However, patients with Type 2 diabetes can often manage very well without ever having to consider insulin treatment.
The key is to maintaining good blood sugar control, and how we manage this condition, depends on the average level of your blood sugar over the previous few months. Getting an HbA1c blood test (taken by your GP/nurse/healthcare provider) tells us if your sugar levels are in a good place, and if they’re not, changes can be made to improve them.
If you work with your healthcare professionals then changes can be made to prevent you ever needing to take insulin to control your blood sugars.
However, it’s worth remembering that the longer you keep the dangerous visceral fat in your liver, the greater the risk is that you may start to produce less insulin, more like a patient with Type 1 diabetes. This emphasises the need to focus on your weight and getting back to a healthy BMI as early as possible after diagnosis. And LighterLife can help you with this.
4) Am I definitely going to end up blind, with kidney failure, and losing a limb one day?
No. The long-term complications of diabetes are all related to a consequence of long-term high sugar levels. You may be able to put your diabetes into remission with adequate weight loss.
Patients with diabetes don’t die from these complications, fatalities come from cardiovascular disease, which again is much more likely with poor sugar control. However, good sugar control reduces the risk factors again, so do work with your healthcare professionals to stay healthy.
5) Is there a “cure” for diabetes?
At present we have to rely on numerous ways to keep our average sugar levels in the healthy range as much as we can. We now understand the role of weight, visceral fat, and physical activity much more, and lifestyle and behaviour change can massively improve the way we manage diabetes types.
The last DiRECT study was very exciting because initial trials suggested that patients who do very well on Very Low-Calorie Diets, such as LighterLife, can “reverse” their diabetes, resulting in normal average sugar levels. In effect, they can put their diabetes into “remission,” which is the closest thing we may have to a “cure.”
Any other advice for Type 2 diabetics?
So, those are the most commonly asked Type 2 diabetes questions GP are currently being asked. Thank you to Dr Matt for his detailed and helpful answers.
If you don’t have Type 2 diabetes, and are worried about getting it, current evidence suggests that by far the best way of preventing it is to focus on reaching and staying at a healthy weight, incorporating exercise and healthy eating into your lifestyle.
Does this sound like a change you’d like to make? If so, you can find out more about our science-backed weight loss and weight management programmes here.
