How to beat diabetes: Simple test to show if you need treatment

  • If you're in an at-risk group, you can get a free annual blood-glucose test
  • The earlier diabetes is picked up, the better the prognosis, expert says
  • One in three of us has raised blood-sugar levels, research suggests
  • Some experts call these levels 'stage one diabetes' or 'pre-diabetes'

So you think you might be at risk of type 2 diabetes — what next? If you are in one of the at-risk groups (over 25 and from a South Asian or Afro-Caribbean background, or Caucasian and over 40, particularly if you are overweight, obese or have a family history of diabetes) you can ask your GP for a free annual blood-glucose test.

'All the evidence shows that the earlier diabetes is picked up the better the prognosis, as it allows for better blood glucose control,' says Professor Anthony Barnett, a leading diabetes researcher based at Birmingham's Heartlands Hospital.

'A GP screening is best in a high-risk individual because it is free and they can then offer immediate treatment.'

Evidence shows that the earlier diabetes is identified the better the prognosis, experts say

Evidence shows that the earlier diabetes is identified the better the prognosis, experts say

If you don't qualify for this, some chemists, such as Lloydspharmacy, will do a risk assessment involving a questionnaire looking at such factors as weight, age, diet and family history.

If this indicates you are at risk of diabetes, you will be given a simple finger-prick blood test which checks your levels of glucose and gives immediate results. If your levels are above normal, you will be asked to come back and do a second test after fasting overnight.

There are home test kits, which will give you the same reading as a pharmacy test, but a pharmacist's interpretation will be more informed, says Professor Barnett.

People with borderline readings may benefit from a discussion with their GP, he adds.

To get the most accurate result from a home test kit, he suggests taking it at least 1-2 hours after a meal, or preferably before breakfast having fasted since 10pm the night before.

'After a fast, a blood glucose level over 6 would need further checking. with a post-meal check, anything over 8 should be reported to your GP.'

If you already have type 2, you may have been given a home testing kit to regularly measure your blood-sugar levels. There is now a new, more accurate, blood test (HbAIC) that people with type 2 diabetes are meant to have at least once a year (or more often if you have recently been diagnosed, your blood sugar remains too high or your treatment plan has changed; talk to your GP).

THINK YOU'RE SAFE? DON'T BE SO SURE

As many as one in three of us has pre-diabetes, research suggests. This is where blood-sugar levels are raised — ie, higher than they should be — but not high enough for a diabetes diagnosis.

A healthy blood sugar level after a 12-hour fast is up to 6 mmol/l (millimoles of sugar per litre of blood). A reading above 7 indicates diabetes.

If your reading is between 6 and 6.4, it suggests your body is producing insulin, but not using it effectively.

Some experts call this 'stage one diabetes' or pre-diabetes, because it makes you five to 12 times more likely to develop type 2 than someone with normal blood-sugar readings.

Worryingly, a study at Crittenton Hospital Medical Center in Detroit showed 36 per cent of people with pre-diabetes were found to already have coronary artery disease.

Some experts argue pre-diabetes is a confusing and misleading term as either you have type 2 diabetes or you don't. Nonetheless, the consensus is that raised blood-sugar levels are not healthy.

The problem is that initially you may have no symptoms of raised levels. But the closer your fasting blood-sugar reading is to 6.5, the more likely you are to develop early complications, according to Melanie Davies, professor of diabetes at Cardiff University.

This is when changes to cells at the back of the eye, known as retinopathy, can start.

This shows the pattern of your blood-sugar levels over the past two to three months by measuring the number of glucose molecules stuck to red blood cells. The advantage is that you don't need to fast for eight hours before it or wait around in the surgery for two hours after you eat sugar.

The test can also be bought over the counter (it involves a finger-prick test which you then send to a lab which will give you the results in 48 hours).

■ GlucoMen A1c test, from £17 from pharmacies (it may need to be ordered).

Epidemic you can't afford to ignore 

Diabetes is now one of Britain’s most common long-term health problems. Over the past 20 years, the number of adults in the UK affected has more than doubled to 3.8 million.

That figure is expected to reach 5 million by 2025. The vast majority have type 2 diabetes, the kind that develops in adulthood and is linked to lifestyle and being overweight.

The vast majority of people have type 2 diabetes, the kind that develops in adulthood and is linked to lifestyle and being overweight

The vast majority of people have type 2 diabetes, the kind that develops in adulthood and is linked to lifestyle and being overweight

But experts think a further 14 million could have ‘pre-diabetes’ — high blood-sugar levels that raise the risk of diabetes — without realising it.

Many people assume that it’s type 1 diabetes that’s the serious form because you need insulin injections.

But it’s wrong to think type 2 is nothing to worry about, says Simon O’Neill of Diabetes UK. If it’s uncontrolled, type 2 diabetes can lead to a host of painful and debilitating complications, ranging from impotence to blindness and amputation as a result of nerve damage.

Currently, one hospital bed in seven is occupied by a patient with diabetes — rising to one in three in some areas.

Type 2 is also known to increase the risk of heart disease — 80 per cent of people with diabetes die of cardiovas-cular disease and type 2 can shorten life expectancy by up to six years.

The good news is that in many cases type 2 diabetes can be controlled, thereby minimising complications and extending life expectancy — and in some cases, it can even be reversed.

In this fourth part of our unique How To Beat series, we help you identify if you could be at risk — and how to protect yourself.

And if you’re one of the millions who already has the condition, we’ve drawn on the latest thinking to help you manage it better, and possibly put it into remission.

WHY ARE SO MANY GETTING DIABETES?

The simple fact is that too many of us are too heavy, and having a Body Mass Index (BMI) above 25 is the single-largest risk factor for type 2 diabetes.

So why is being fat so significant?

Diabetes is caused by problems with the hormone insulin, which mops up sugar from the blood. Insulin is made in the pancreas — in a healthy body, cells in the pancreas sense when sugar levels in the blood rise after we’ve eaten.

FROM SIGHT TO YOUR SEX LIFE, THE WORRYING RISKS

The list of complications linked to poorly controlled diabetes make for alarming reading.

The damage is thought to be caused by AGEs, formed when glucose (sugar) attaches to proteins in the blood vessels, causing them to swell or leak. AGEs also create a sticky glaze, which can interfere with how the blood vessels behave. This leads to a range of problems:

EYES: Damage to small blood vessels leads to (fragile) new ones forming on the retina, the part of the eye that sends signals to the optic nerve. These can leak or burst (diabetic retinopathy), causing vision loss, even blindness.

HEART: People with diabetes are at up to a five times greater risk of dying from heart disease. This is linked to damage to the blood vessels but also because diabetes leads to raised cholesterol and high blood pressure.

KIDNEYS: Blood vessel damage affects kidney function, leading to a build-up of fluid and toxins — and kidney damage. Diabetes is the main reason people in the UK have dialysis.

SEX LIFE: Blood flow to the penis is affected, causing erectile dysfunction. In women, poor blood flow can cause vaginal dryness. Both sexes can experience low libido.

FEET: Damage to the nerves and blood vessels can cause poor circulation, affecting healing and leading to ulcers. Every week, 100 people with diabetes undergo an amputation.

BRAIN: Diabetes is linked to an increased risk of cognitive decline and Alzheimer’s — some experts refer to Alzheimer’s as ‘type 3 diabetes’. It’s thought that high sugar levels damage proteins in the brain.

This triggers the release of insulin, which picks up the sugar. The insulin molecules then attach to ‘receptors’, or docking stations, on cells in our liver, muscles and fat (the fat that’s typically in the abdomen); these cells respond by opening up to let the glucose in. The glucose is then stored in the muscles and liver as glycogen, ready to be released into the blood for energy.

If we eat a carbohydrate-based meal (carbs are broken down into sugar), our insulin levels rise in response; this tells the liver and the muscles to stop releasing their glycogen, as this would trigger a blood-sugar overload.

Conversely, when blood-sugar levels drop, insulin production stops, and glycogen is released from the liver and muscles to provide fuel. However, if you’re overweight — particularly if you are apple-shaped — this all goes awry.

Men whose waist is more than 40 in (102 cm) are five times more likely to be diagnosed with type 2 diabetes than those with a smaller waist, while women whose waist measures more than 35 in (88 cm) are three times more likely to develop the condition, says Public Health England.

This is partly because when we overeat, fat forms around the organs in the abdomen, including the pancreas, stopping them working properly. As a result, the pancreas doesn’t produce enough insulin.

WHAT IS INSULIN RESISTANCE?

Another problem is that cells around the body — particularly those in the muscles and liver — stop responding to the insulin the body does produce, which is known as insulin resistance.

As a result, sugar stays in the blood and you end up with constantly high blood-sugar levels.

Why exactly insulin resistance occurs is not clear. Some research suggests that specific fat cells in the abdomen secrete inflammatory chemicals that disrupt the way the body’s cells respond to insulin.

Another theory is that the chemical interactions in fat tissue — particularly belly fat — draw immune cells to the area, triggering low-level chronic inflammation.

Age is also a factor — your risk of diabetes increases over the age of 40, partly because we tend to gain weight, but also because the mitochondria (the tiny powerhouses in our cells) start to slow.

A diet high in sugary drinks not only makes you fatter but creates more sugar than the cells can take in

A diet high in sugary drinks not only makes you fatter but creates more sugar than the cells can take in

When this happens in the muscles, it makes them more prone to insulin resistance.

Inactivity is another factor. When we move around, our muscles become more sensitive to insulin, lowering blood-sugar levels. The reverse is also true.

As cells become resistant to insulin, the pancreas responds by trying to produce even more, but your body becomes increasingly unable to use it efficiently.

A diet high in sugary drinks, high-sugar convenience foods and refined carbs (such as biscuits) not only makes you fatter but creates more sugar than the cells can take in, leading to higher blood-sugar levels.

It might not even take that unhealthy a lifestyle to cause problems. A study published in the British Medical Journal in 2013 found that just one can of sweetened drink a day is enough to increase the risk of type 2 by 18 per cent.

Some specialists believe even diet drinks can raise your risk (because the sweeteners mimic the action of sugar in the body).

There’s also a genetic link to type 2 diabetes. If one of your parents has it, your risk increases by 15 per cent; if both parents have it, your risk increases by 75 per cent.

But it’s not just genes: experts believe lifestyle factors such as poor diet and inactivity, ‘inherited’ as family behaviour, are key.

And just because you’re skinny, you are not immune. Family history puts you at greater risk, regardless of your weight, as does polycystic ovarian syndrome (a hormonal disorder where cysts grow on the ovaries) regardless of your weight.

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