The scale of the problem type 2 diabetes presents in the UK is a little hard to grasp, so here are some scary numbers.
“In the UK at the present time there are four million people diagnosed with type 2 diabetes,” says Michael Gleeson, emeritus professor of exercise biochemistry in the School of Sport, Exercise and Health Sciences at Loughborough University.
“There’s also approximately one million people out there who we think have got it but haven’t been diagnosed yet. And then there are another 12 million or so who either have what we call prediabetes, the precursor to type 2 diabetes, or are at high risk of developing the condition within a few years. In total we’re talking about 20% of the whole adult UK population.”
A huge problem, then. However, it is one that can be fixed for many people through lifestyle changes. Gleeson is the author of Beating Type 2 Diabetes: Natural and Simple Methods to Reverse Diabetes for Good (opens in new tab), which provides evidence-based advice on how to get rid of the disease. We spoke to him for more info about the disease, as well as how to prevent and reverse it.
How does type 2 diabetes differ from type 1?
In type 1 diabetes it’s a lack of insulin production because your pancreas has been damaged, usually by an autoimmune disease, so you lose the cells that normally produce insulin. Therefore you require insulin replacements to correct that.
With type 2 diabetes the initial problem is with the tissues that normally respond to insulin. That’s your muscle, your liver and your adipose tissue – insulin makes those tissues take up glucose from the blood. Those tissues become less sensitive to the actions of insulin and therefore you get this raised blood glucose level. It’s not necessarily because of a lack of insulin, but because of a resistance to the action of insulin.
What are the main causes of type 2 diabetes?
There are a number of causes, but by far the biggest factor you can do something about is your bodyweight. With probably 80% of cases, people who develop type 2 diabetes are overweight. Not necessarily by a huge amount – we can be talking around 10kg. You might not really notice it. It mostly accumulates in your abdomen around your stomach. Unfortunately, that’s the most dangerous kind of fat to have when it comes to problems associated with health.
There are also certain things you can’t do anything about, like your age. With type 2 diabetes, the incidence among people who are 35-55 is probably about 6-7%. If you’re over 75 that proportion goes up to 24%. Race affects it as well – you’re more likely to develop it if you’re of Black or south Asian origin than if you’re Caucasian. It also tends to be a little bit higher in males compared with females. The biggest difference there occurs in the younger age groups. In the 35-55 year old age group twice as many men as women have type 2 diabetes. Women tend to get it when they’re older.
How do you prevent it?
Being overweight can be down to eating more than you actually need, so you’re in a positive energy balance. Also you’re not as active as you should be. One of the real benefits of exercise in helping to prevent type 2 diabetes is that when you do aerobic exercise, your muscles actually extract glucose from the blood to use as a source of fuel. That means after you’ve finished exercising and eat a meal containing carbohydrates, a lot of that will be directed to the muscles or the liver to replenish the glycogen stores. And exercise actually increases your sensitivity to insulin and therefore reduces your insulin resistance, which is the big problem that kicks off the start of type 2 diabetes.
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How can you tell if you’re at risk of developing type 2 diabetes?
Your BMI is one way to tell. If that’s over 25 and you’re Caucasian then that’s telling you you’re overweight. It’s not a perfect measure because it is just measuring weight and height so you could have that extra weight due to extra muscle – it’s also a good idea to look at other measures like your waist circumference and, if you can, get a body fat percentage measurement.
The simplest way to get a body fat percentage measurement is using a set of the scales that have an electrical impedance device built in, which will give you an estimate. There are scales we then use to determine if someone is “overfat” which is probably even more important than being overweight. For example for men aged 18-40 if you’re 21-24% fat you’re a bit overfat. For women it’s higher because they naturally have a little more fat – the overfat percentage is 31-36%. If you’re below those values you’re probably OK.
Are these scales accurate enough to use?
It’s an estimate and it’s not going to be 100% accurate, but if you measure it in the same way every time – after you get up in the morning, after you’ve been to toilet, before you’ve had a drink or anything to eat – then you can have a useful comparison to see whether you’re going up or down or staying stable.
How can you spot if you do have type 2 diabetes?
I was 10kg overweight when I was diagnosed with type 2 diabetes and to me it came as a complete shock. I didn’t have any symptoms and that’s quite often the case. There are certain signs you can look for. You tend to feel hungry, you feel more thirsty than usual, and partly as a result of that you frequently want to go to the toilet – you might notice having to get up in the night on a few occasions to go for a pee. You might feel tired, and sometimes people get numb or tingling in their hands or feet, because having high blood glucose is doing damage to your nerve endings.
But I can’t say I had any of that! I was working long hours and so I was tired most of the time, and I didn’t notice being more hungry or thirsty. I had the blood test because I’d been diagnosed with high blood pressure a few years earlier. I got into the habit of going to the doctors at least once a year and as part of that routine test they measured my long-term blood glucose levels, and that was above the threshold for diagnosis of type 2 diabetes.
How do you treat type 2 diabetes? Can you reverse it?
If you do get diagnosed officially with a blood test, then you can get rid of it, and the most effective way to do it is to lose that excess body fat you’ve got. It’s pretty straightforward. Becoming more physically active will improve glucose disposal, and will also help you to lose fat and lose weight. Adjusting your diet by cutting out some of the fatty and sugary foods, and reducing your daily calorie intake probably by about 500 calories or more, will also help you lose weight.
You can only lose weight by being more active or eating less, or for some people it’s drinking less alcohol. That can be a major cause of weight gain and type 2 diabetes. Those things will not only help you get rid of type 2 diabetes, but also improve your overall cardiovascular and metabolic health.
What can happen if you don’t reverse it?
If you don’t manage it well, or you don’t get rid of it, then you can expect to develop some of the associated health problems down the line.
You may lose feeling in your hands and your feet. One of the tests the diabetic nurse will do is to stick a pin into the bottom of your feet and ask if you can feel it. You lose the sense of pain, and one of the problems with that is that you don’t notice if you’ve got a foot sore, or an ulcer developing. Those can become a serious problem to the extent where you might have a toe, foot or lower limb amputated. If you’re type 2 diabetic your risk of having to have an amputation is 13 times that of a person who doesn’t have type 2 diabetes.
You can also develop damage to the retina of the eye because of high glucose levels. That can cause loss of sight – the chances of becoming blind are five times greater if you’re type 2 diabetic than if you’re not.
Kidney disease is another problem. You have three times the risk if you’re type 2 diabetic of developing kidney disease that might cause you to have a kidney transplant at some point, or go on haemodialysis.
Then there’s coronary heart disease. Your risk of cardiovascular disease is probably doubled if you’re diabetic. There’s an increased risk of dementia and stroke developing as well at an earlier age.
Your overall immunity is impaired as well. That’s why we’re seeing in the COVID-19 pandemic that people with diabetes and these underlying health problems are more susceptible to developing COVID-19 infections, and when they get it the symptoms are a lot worse. You tend to get more infections if you’re a type 2 diabetic, and even your healing of wounds, cuts and scrapes is slower than normal.
It’s a lot of nasty things, and at the end of the day becoming type 2 diabetic is probably going to knock somewhere between five and 10 years off your life. And the last years are not going to be a pleasant experience with all these health problems developing.
Nick Harris-Fry is a journalist who has been covering health and fitness since 2015. Nick is an avid runner, covering 70-110km a week, which gives him ample opportunity to test a wide range of running shoes and running gear. He is also the chief tester for fitness trackers and running watches, treadmills and exercise bikes, and workout headphones.
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