Understanding Diabetes: Definition, History, Backgrounds, Consequences, and UK Statistics

1. Contents: 1. Definition and History of Diabetes 2. Backgrounds and consequences of Diabetes 3. Diabetes in the UK

2. 1. Definition and History of Diabetes Diabetes (gr. “flow through”) mellitus (lat. “honey sweet”) describes a group of metabolic diseases with different causes. The name describes the main symptom, namely the expulsion of sugar with the urine. In modern age the physician Thomas Willis diagnosed this disease throughtasting urine samples of patients! Before him doctors in the antique did the same in India, Alexandria and Rome.

3. 1. Definition and History of Diabetes Thomas Willis (* 27. January 1621 in Great Bedwyn, Wiltshire near Oxford; † 11. November1675 in London) was an English physician. He is the founder of the anatomy of the nerve system. From this knowledge he deduced conclusions w. r. t. mental diseases. After him a lot of doctors investigated this disease and contributed to the great progress until today.

4. 2. Backgrounds and consequences of Diabetes Fundamentals The digestion apparatus changes the carbohydrate which is contained in the food (e. g. in fruits, potatoes, corn, rice etc.) into glucose.

5. 2. Backgrounds and consequences of Diabetes Fundamentals The glucose is then absorbed by the colon into the blood and afterwards distributed into the whole body.

6. 2. Backgrounds and consequences of Diabetes Fundamentals The pancreas produces in the so called Langerhans islets (beta-cells) the hormone insulin. Paul Langerhans (* 25. Juli 1847 in Berlin; † 20. Juli 1888 in Funchal, Madeira)

7. 2. Backgrounds and consequences of Diabetes Fundamentals The effect of insulin is threefold: First: It causes the transport of glucose to the cells, where glucose is consumed for energy production Second: It causes the storing of glucose in the lever and the muscles. Therefore the level of glucose in the blood is nearly kept constant during digestion.

8. 2. Backgrounds and consequences of Diabetes Fundamentals Third: It supports the production of fat and causes the fat to stay in the depots. One direct consequence of a severe lack of insulin is the loss of weight because the fat doesn´t stay in the depots.

9. 2. Backgrounds and consequences of Diabetes Consequences Another direct consequence of a severe lack of insulin is the increase of glucose in the blood because the transport to the cells and the storage in the liver are disturbed. This explains why the concentration of glucose rises even if diabetics don´t eat anything: The liver produces uncontrolled the glucose.

10. 2. Backgrounds and consequences of Diabetes Consequences Direct symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.

11. 2. Backgrounds and consequences of Diabetes Consequences If diabetes is left untreated this leads to further very important long-term consequences for patients (because of “long-term” often severely underestimated): • cardiovascular disease and stroke through deposits • chronic kidney disease • foot ulcers (later) • damage to the eyes

12. 2. Backgrounds and consequences of Diabetes Types • Type 1 DM: Results from the pancreas' failure to produce enough insulindue to loss of beta-cells. Risk factors include having a family member with the condition. The underlying mechanism involves an autoimmunedestruction of the insulin-producing beta-cells in the pancreas. • Detection 1: High glucose levels • Detection 2: Autoantibodies

13. 2. Backgrounds and consequences of Diabetes Types • Type 2 DM: Begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. The most common cause is a combination of excessive body weight and insufficient exercise.

14. 2. Backgrounds and consequences of Diabetes Treatment Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding smoking. Type 1 DM must be managed with insulin injections. • Type 2 DM may be treated with medications with or without insulin.

15. 2. Backgrounds and consequences of Diabetes Distribution As of 2015, an estimated 415 million people (8,3 % of adult population) had diabetes worldwide,with type 2 DM making up about 90% of the cases. Diabetes doubles the risk for an early death. The global cost of diabetes was estimated in 2014 as 612 billion $ Specifically in the US in 2014 the diabetes cost was 245 billion $.

16. 2. Backgrounds and consequences of Diabetes Diagnosis • Fasting blood sugar (FBS), fasting plasma glucose (FPG): 10–16 hours after eating ≥ 126 mg/dl (myself 70 mg/dl) • Plasma glucose ≥  (200 mg/dl) two hours after a 75 gram oral glucose load

17. 3. Diabetes in the UK

18. 3. Diabetes in the UK “They weren’t removing my leg,” he says. “They were getting rid of the infection that would have killed me.” Colin Rattray, 51 How did it come so far?

19. 3. Diabetes in the UK • Colin was diagnosed with type 2 diabetes 20 years ago. • He was 31, a successful executive in the hospitality industry and, as he puts it, he felt immortal. • “I didn’t understand it,” he says. “I didn’t want to understand it. So I ignored it.” • A sporty youth, he had ballooned in weight after a knee injury at 21. • At his heaviest, he weighed more than 30 stone (app. 190 kg). • 20 years on, Colin also realises he has himself to blame, not the doctors!

20. 3. Diabetes in the UK • In 2011 a toe developed an infection — something diabetics are prone to — and, within a few days, he was having his first run-in with the surgeon’s saw. “They took two toes and two metatarsal bones. It was a wake-up call.” • The irony is that, for the past three or four years, I have had good control of my blood sugar. • It was too late! Colin had developed neuropathy, a painful long-term side effect of diabetes in which high levels of glucose in the blood cause nerve damage

21. 3. Diabetes in the UK • Neuropathy: It usually starts in the hands or feet and works up. Without constant care, ulcers develop, bones weaken, infections spread easily and, because of the loss of feeling, injuries can go undetected. Dr. Jean-Martin Charcot (1825-1893) Charcot-Foot

22. 3. Diabetes in the UK • Obesity accounts for 80%-85% of someone’s risk of developing the disease. • Nationally, there are now a record 169 diabetes-related amputations every single week.

23. 3. Diabetes in the UK • The data on calorie consumption over time is patchy, but several studies have found, that the average amount we consume has gone down! • Why, then, aren’t we all thinner?

24. 3. Diabetes in the UK • First, we have become far more sedentary over the past three decades. • We eat more in restaurants, we eat more processed food, we eat more hidden sugar. • Today, despite years of warnings, the average Briton still consumes more than double the recommended daily amount of sugar. • Just as Colin said, it doesn’t sound too alarming what the GP is telling after diagnosis of diabetes 2!

25. 3. Diabetes in the UK • Richard Shaw was 54 when he decided he’d had enough of his “lifelong” condition as the GP told him. Three years earlier, the arts marketing executive was diagnosed with type 2 diabetes. • He read about new university studies, that a significant reduction of weight can result in a remission of diabetes type 2 . • “I declared war on my diabetes,” Shaw says.

26. 3. Diabetes in the UK • Six months after he decided to take action, Shaw was diabetes-free. • Book: Conquer Type 2 Diabetes: How a Fat, Middle-Aged Man Lost 31 Kilos and Reversed His Type 2 Diabetes (Hammersmith Books £12.99) • He points out that by recommending low-fat diets, as GPs do, doctors are encouraging patients to increase their sugar intake.

27. 3. Diabetes in the UK • Shaw: If you can get rid of the visceral fat quickly enough and the cell damage is limited, you can reverse T2. • “The importance of weight loss is reinforced by the first-year results of our trial”, says Dr. Douglas Twenefour, deputy head of care at Diabetes UK. • This showed that a weight-management programme that involves a low-calorie diet under close supervision from a healthcare team, and within the first few years of diagnosis, can put some people’s type 2 diabetes into remission. • It’s clear that the existing approach — of maintenance and lifestyle optimization — is not working!

28. 3. Diabetes in the UK • From an amputated patient: “If they can have an advert showing a cigarette turning into a tumour, why can’t they do something similar for a chocolate bar? Sugar is poison. If more people could see what it’s done to me, they wouldn’t touch it.