The proof that you DON’T have to be overweight to get type 2 diabetes: The five slim people whose disease is linked to low-fat yoghurt, stress at work and even pregnancy
- More than 2.8 million Britons have been diagnosed with the Type 2 diabetes
- This staggering number is a huge rise compared with 700,000 two decades ago
- By 2045, one in eight people will have the condition if global obesity carries on
Type 2 diabetes is on the rise. More than 2.8 million Britons have been diagnosed with the condition, compared with 700,000 two decades ago.
And by 2045, one in eight people worldwide will have the condition if global obesity carries on at its present rate, according to new Danish research.
But while type 2 diabetes is often seen as a condition of the overweight, it would be a mistake to think that you’re immune just because you’re slim.
Unlikely candidates: These five slim people were shocked to discover they had type 2 diabetes
‘The more weight you put on, the less able the body is to produce insulin — a hormone that controls blood sugar levels,’ explains Dr Dushyant Sharma, a consultant diabetologist at the Royal Liverpool Hospital. ‘However, around five per cent of people with type 2 diabetes are a healthy weight.’
Type 2 diabetes happens when the body either doesn’t produce enough insulin, or it becomes ineffective at using the insulin that it does produce (known as insulin resistance). This leads to high levels of blood glucose which, over time, can cause serious complications such as kidney damage.
Here, five slim people who were shocked to discover they had type 2 diabetes share their stories. Dr Sharma and Dr Hisham Maksoud, a consultant endocrinologist at Spire Nottingham Hospital, explain why they developed the condition — and what lessons you can learn to reduce your risk . . .
GRANDMOTHER WHO ATE LOW-FAT FOOD
Unexpected: Elaine Goldwater, 63, developed it after a lifetime of healthy eating
Elaine Goldwater, 63, an administrator, lives in Lancashire with her husband Phil, 70, a taxi driver. They have two daughters and two grandchildren. Elaine’s body mass index (BMI) is 23, so within the healthy range (18.5 to 24.9). Elaine says:
‘One of the biggest shocks about being diagnosed with type 2 diabetes was learning that the low-fat yoghurts I’ve been eating because I thought they were ‘healthier’ could have contributed to my hidden sugar intake and to me then getting the condition.
‘Two years ago, I started feeling really tired. It was out of character as I’ve always been in good health, keeping an eye on my weight, eating lots of fruit and veg, and being fairly active. I like walking, and at work I’m always on the go.
‘My GP did various tests, including an HbA1c blood test, which gives a picture of your average blood sugar levels over the previous three months. My reading was in the low 50s, when normal is 42, and he diagnosed me with type 2.
‘I was shocked, though actually my brother had been diagnosed 30 years ago with type 2 diabetes when he was in his 40s, despite being slim and otherwise healthy.
‘My GP thought I could control my diabetes without medication and sent me on a course about how to do this. It was a real eye-opener. I thought I ate healthily, but I learned that low-fat yoghurts can be loaded with sugar.
‘I’ve now swapped them for natural yoghurt, and given up all cakes, biscuits and chocolate. After a year, I am now classed as pre-diabetic (your blood sugar level is higher than normal but not enough to be considered diabetes). I’d like to get it lower still.
‘That said, my brother, who since his diagnosis has always had good blood sugar control, is now, at the age of 70, on insulin — so I don’t know what the future will bring.’
EXPERT COMMENT: Dr Sharma explains that the older we are, the risk of diabetes increases because cells that produce insulin decline in number and function as we age.
‘Having a family member with type 2 increases the chance of getting the condition as it may be genetic. But Elaine’s brother was diagnosed 30 years ago, so if there was a genetic link you might have expected her to have developed it at a similar age to her brother.’
Elaine’s love of low-fat foods could have had an impact because of the hidden sugar, adds Dr Maksoud. (Manufacturers add sugar to make low-fat products taste better.)
‘Insulin works on supply and demand,’ he explains. ‘You have a reserve of insulin in the pancreas, and if you eat a lot of sugar, more insulin is used, so there is less left in reserve, which can lead to diabetes. People developing type 2 diabetes on a low-fat but sugary diet is something I see a lot.’
BUSINESSMAN WHO WAS STRESSED
Simon Salisbury, 62, is thought to have developed it after becoming too stressed
Simon Salisbury, 62, a chartered surveyor, lives in Manchester with his wife Tina, 56, a special needs administrator, and has three grown-up children. At 5ft 9in and 12 st, his BMI is 24. Simon says:
Sometimes I convince myself that I haven’t even got type 2. I only found out by chance, after a private health MOT six years ago revealed my blood sugar was high.
The diagnosis seemed to come out of nowhere, with no obvious symptoms — though, in hindsight, I’d been waking up in the morning feeling thirsty and sometimes at night too. But I wasn’t overweight, my diet was pretty good and I swam and played football.
Nor is there any diabetes in my family, though, sadly, my father died of a heart attack at age 56.
The only thing I could think of was that I was under a lot of stress running my own company.
I saw a diabetes consultant who put me on metformin and gliclazide, and these, as well as staying active and eating healthily, have got my blood sugar to normal. The thirst, such as it was, has gone and I’m no more tired than the next person.
EXPERT COMMENT: Stress can be a factor in type 2 diabetes, especially if it disrupts sleep, since this increases levels of the hormone cortisol — which normally subside at night — and this, in turn, can increase the risk, says Dr Maksoud.
‘Simon’s father had a heart attack at a fairly young age and I wonder if there was a missed diagnosis of type 2 diabetes — a risk factor for heart attack,’ Dr Maksoud says.
‘The condition can go undiagnosed for years, whilst the production of excess insulin can increase risk of heart attack or stroke. For this reason, type 2 can be more damaging than type 1 because people don’t know they have it, as symptoms are easy to miss.
‘Because of his family history, Simon should be especially careful about his diet, doing some brisk exercise such as walking for 30 minutes a day, making sure he sleeps well and having his blood pressure and cholesterol checked every year.’
30-SOMETHING GYM REGULAR
Francesca Libra, 32, is a keen fitness fanatic – but still developed the condition
Francesca Libra, 32, a writer, lives in Manchester with her husband Brad, 32, a businessman. Her weight, 9 st, and height, 5ft 7in, gives her a BMI of 20. Francesca says:
My consultant is always telling me that I’m a ‘mystery’. Even he can’t understand why a young woman who is a size 8-10 and does cardio workouts at the gym four times a week should develop the condition.
It was picked up quite randomly two years ago. I’d gone to see my GP for a thyroid test as I’d been feeling tired. He did tests and said my blood sugar was a touch high, but because I was such an unlikely candidate for diabetes, he said he’d see me again a few months later to check if it was just a blip.
There is diabetes in my family, but type 1. My father was diagnosed when he was a teenager and has been taking insulin since.
Further blood tests a few months later confirmed I did have type 2. (They said it wouldn’t be type 1, as typically it’s diagnosed younger and makes you ill very quickly.)
It took me about six months to come to terms with my condition — both physically and emotionally. I cut out carbs and ate more protein, such as chicken and eggs, to prevent spikes in blood sugar, but I couldn’t get my levels within the recommended range, so I was prescribed gliclazide and metformin. Now I’m at normal levels.
I can’t help wondering, over and over again, why it has happened
EXPERT COMMENT: Francesca’s situation is by no means typical, since she is not only slim and healthy but also so young, says Dr Maksoud. Type 2 usually happens in people from the age of 40.
Cases like this could be a condition that behaves like but isn’t type 2 diabetes. One possibility is maturity onset diabetes of the young, which is a form of diabetes caused by a gene mutation.
Or it could be latent autoimmune diabetes of adults — a form of type 1 diabetes that develops later in adulthood and is treated with injected insulin.
‘Alternatively, Francesca may have a health issue linked to insulin production, such as polycystic ovary syndrome, which can cause insulin resistance,’ he suggests.
He advises Francesca to raise this with her consultant, so she can get tested for these conditions, just to be sure that she does have type 2 diabetes — as if not, she may need different medication or insulin.
RUNNER TREATED WITH STEROIDS
Side-effect: Stewart Jeffries, 54, developed it after having chemotherapy for leukaemia
Stewart Jeffries, 54, a sales rep, lives in Manchester with his wife Janice, 60, a radiographer. They have three children and four grand-children. His weight, 11 st, and height, 5ft 6in, give him a BMI of 24. Stewart says:
People are always surprised when I tell them I have type 2 — I do think many don’t realise that it’s not just so-called ‘unhealthy’ people who get it.
And then they’ll say, ‘Oh, it’s only type 2.’ They underestimate how serious it can be if you don’t look after yourself, as it raises the risk of heart attack or stroke.
I was pretty shocked when I was diagnosed. Twelve years ago, I was successfully treated with chemotherapy for leukaemia, and ever since I’ve been determined to stay fit. I was never overweight but I took up running in 2011 and now run three times a week. I don’t smoke and I’ve also never been more than an occasional drinker.
Before my diabetes diagnosis, my only ‘bad’ habit was drinking sugary cola sometimes and eating chocolate a few times a week.
I hadn’t been feeling unwell, but on quite a long car journey four years ago, I found myself needing the loo every hour or so. I assumed it was a prostate issue, but blood tests revealed I had high blood sugar and type 2 diabetes.
They didn’t really know why I’d developed it, although my brother, who’s 18 months older, also has it.
I was able to control it through diet until three months ago, when my blood sugar levels became a nudge too high and I was put on metformin to help control them.
EXPERT COMMENT: Stewart’s treatment for leukaemia involved steroid drugs to protect him from the effects of chemotherapy, and this might have affected the function of the pancreas — insulin is released from the cells in the pancreas, says Dr Sharma. This can also happen with long-term use of steroids for other conditions.
However, having sugary drinks little but often, as Stewart did, may have had an impact too, as this can lead to a reduction in insulin production.
‘Short bursts of high levels of glucose, as you’d get from a sugary drink, over time can reduce the body’s ability to produce insulin and can, in some people, precipitate diabetes,’ Dr Sharma says
The fact that his brother has type 2 could suggest a genetic link. ‘If you have a parent, brother or sister with type 2 diabetes, then that increases your risk by 6 per cent.’
MOTHER WHO GOT IT IN PREGNANCY
Motherhood: Jenna Russell, 28, developed the condition during her pregnancy
Jenna Russell, 28, is a stay-at-home mother and lives near Grimsby with her partner John, 35, and their son Max, nine. At 5ft 8in and 10 st 8lb, she has a BMI of 23. Jenna says:
When I was about five months pregnant, I developed gestational diabetes. Basically, your body can’t produce enough insulin to meet the extra needs of the growing baby. It was quite unexpected.
But it didn’t worry me too much as I was told it would disappear once I’d had the baby. I was told to eat healthily and keep active.
After my son was born, I was tested every year for diabetes as a precaution My blood sugar readings were fine, though I did keep getting urinary tract infections. They could sometimes be really bad and I’d get pain in my kidneys too. At the age of 26, tests showed I had sugar in my urine and I was diagnosed with type 2.
Frankly, I was devastated. I was a young woman with a young child. It didn’t make any sense.
I was put on metformin but it made me terribly sick and I gave it up after several months. Now, I inject Victoza every day, which increases insulin production.
I try to keep active by swimming and going to yoga but I also suffer with unrelated fibromyalgia, which causes pain throughout the body, so it’s not always easy to exercise.
I think all this is especially hard for my son. When my diabetes causes an unexpected ‘hypo’ — when blood sugar falls too low, a side-effect of the drugs used to control the condition — I slur my words and I’m wobbly on my feet, which is quite scary for Max.
EXPERT COMMENT: Gestational diabetes affects 4 to 5 per cent of pregnant women and a third of them are at risk of developing type 2 diabetes within five to ten years, says Dr Sharma. It can be random but high blood pressure or family history of type 2 may increase risk.
In Jenna’s case, her urinary tract infections were a sign she was developing type 2, as increased sugar in the blood and then the urine enables bacteria to multiply.
Jenna’s fibromyalgia can make it difficult to stay active but she should try to get outside as much as she can as vitamin D is good for insulin resistance.
Dr Maksoud adds: ‘Jenna eats healthily but it’s important to eat more vegetables than fruit, as dates, grapes, melon, bananas and mango can all raise blood sugar.’
For more information, visit: diabetes.co.uk
THE TEST EVERYONE MUST HAVE
Diabetes is diagnosed in a number of ways, but traditionally this has been with a urine or blood test to check glucose levels.
The HbA1c blood test is a newer, more accurate test which can be used to diagnose the condition, though it’s more commonly given to monitor people already diagnosed with type 2 as it gives a picture of their blood sugar levels over 12 weeks.
When the body processes sugar, glucose in the bloodstream naturally sticks to a protein in red blood cells called haemoglobin, and the HbA1c test checks on how much of the haemoglobin has been ‘glycated’ in this way. The more glycated the haemoglobin, the higher blood sugar has been.
As red blood cells survive for eight to 12 weeks in the body before renewing, the test results give doctors a picture of a patient’s blood sugar levels over time.
A normal reading is 42; a reading of 48 means the patient has diabetes. The charity Diabetes UK says everyone in the UK with diabetes should be offered an HbA1c test at least once a year.
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