November is Diabetes Awareness Month and the 14th November is World Diabetes Day. 2021 is a very special World Diabetes Day, as it is also the 100th year anniversary of the discovery of insulin, which has been paramount in the treatment of diabetes, and has saved millions of lives.
Although diabetes is well known, many people still have misconceptions about the disease, and it is important to continue the conversation about what diabetes is, as well as how it impacts those who have it and how care for these people can be improved. It is a very prevalent disease – there are currently 537 million adults worldwide living with diabetes, which is about 1 in every 10 people, and this number is expected to grow to 643 million by 2030 [1]. Remarkably, diabetes is the cause of a death every 5 seconds, with as many as 6.7 million deaths attributed to diabetes in 2021 [1]. It is therefore very important that there is awareness of the fundamentals of diabetes.
First, let’s start with some essential information about the science behind diabetes. Diabetes is not a single disease but is subdivided into two main types: type 1 and type 2. Type 1 diabetes is an autoimmune disease where the body attacks and destroys specialised cells in the pancreas, known as beta cells, which produce the hormone insulin [2]. In type 2 diabetes, beta cells can usually still produce insulin, but less than normal, and cells in the body are usually less responsive to insulin. So, in both types of diabetes there is insufficient insulin [3]. Sugar (glucose) levels in our blood increase after we eat and the beta cells respond by releasing insulin, which causes uptake of glucose into cells and its storage as glycogen in muscle and liver. With insufficient insulin, because of beta cell destruction or dysfunction, glucose will remain in the blood, leading to hyperglycaemia, where blood glucose levels are too high. If blood glucose levels are high for prolonged periods this damages different cells in the body leading to complications that affect the nerves (neuropathy), eyes (retinopathy) and kidneys (nephropathy) [4]. Another serious symptom of diabetes is diabetic ketoacidosis, which is caused by a lack of insulin and as your body can’t use glucose as a fuel source without insulin, it breaks down fat to be used as fuel instead. However, this is inefficient and leads to the formation of ketones which are toxic and build up in the body, causing ketoacidosis, which can be life threatening [5].
So what’s the cure for diabetes? Unfortunately, there is no cure, but nowadays diabetes can be managed and treated very effectively, and treatment depends on whether a person has type 1 or type 2 diabetes. People with type 1 diabetes need to inject insulin to lower their blood glucose, as their body cannot make insulin [2]. This may seem simple now, but before 1921 if a person had diabetes it would often be a death sentence, as insulin had not been discovered yet and there were no treatment options. The first time that insulin was used in the treatment of diabetes was in January 1922, for a 14-year-old boy named Leonard Thompson [6]. Insulin saved his life and has saved millions of lives since. Initially clinical insulin was derived from the pancreases of cows and pigs because fortunately they are very similar to human insulin, and this continued for many years [7]. Now clinical insulin is made via recombinant DNA technology [8]. The insulin analogues made in this way can be basal (long acting) or bolus (short acting or rapid acting) insulins. Some people with diabetes will be on a basal-bolus insulin regimen, where they will inject a basal insulin usually once or twice a day to keep a healthy fasting blood glucose level. They will then inject a bolus insulin at mealtimes to stop their blood glucose levels going too high from the food they have just eaten [9]. Other people with diabetes will use an insulin pump, which will dispense insulin automatically throughout the day, and dispense more when they increase their carbohydrate intake [10].
Type 2 diabetes, on the other hand, is treated in a variety of ways. In some cases, drugs may not be necessary, and a controlled diet and exercise routine may be enough to keep blood glucose levels within a normal range. If drugs are necessary, then metformin is usually the first line treatment method and it has been used to treat people with diabetes for over 60 years [11,12]. It is the most widely used drug to treat type 2 diabetes, with over 100 million users worldwide [12]. It works mainly by switching off glucose production by the liver and it also increases glucose uptake into muscle. Sulphonylureas have also been used for decades to lower glucose levels in type 2 diabetes, and they do this by increasing the amount of insulin released from beta cells [13]. If metformin and sulphonylureas are not successful, drugs such as GLP-1 receptor agonists, which promote insulin release, or SGLT2 inhibitors, which increase glucose excretion, may be prescribed [11]. Some people with type 2 diabetes eventually require insulin to regulate their blood glucose levels, just as people with type 1 diabetes do. Effectiveness of glucose lowering therapies can be determined by people regularly checking their glucose levels by obtaining a small drop of blood and using a glucose meter [3].
Now let’s finish by tackling three common diabetes misconceptions [14]:
- People with diabetes can’t eat any sugar:
Due to diabetes being a disease that involves controlling blood sugar levels, it is true that those with diabetes need to be aware of their sugar consumption. However, it is important that people with diabetes (as well as those without) have a balanced diet, which includes sugar.
- Type 2 diabetes is mild:
No type of diabetes is mild. If type 2 diabetes is poorly managed it can lead to serious and potentially life-threatening complications.
- Type 2 diabetes only affects overweight people:
Although it is true that being overweight is a risk factor for developing type 2 diabetes, it is untrue that only overweight people can develop type 2 diabetes. In fact, around 20% of people with type 2 diabetes are of healthy weight, or underweight.
The theme of this year’s World Diabetes Day is increasing access to diabetes care, as millions of people around the world do not currently have appropriate access to care. As diabetes is a disease that can be deadly if it is not well-managed, it is of huge importance that people receive the medicine, support, and care that they need to avoid complications.
Awareness and understanding of diabetes is only truly possible by hearing the stories of those who live with diabetes, which you can do by clicking the link below:
https://www.diabetes.co.uk/diabetes-real-life-stories.html
Bibliography:
[1] Diabetesatlas.org. 2021. IDF Diabetes Atlas | Tenth Edition. [online] Available at: <https://diabetesatlas.org/> [Accessed 16 November 2021].
[2] Diabetes UK. n.d. Type 1 diabetes. [online] Available at: <https://www.diabetes.org.uk/type-1-diabetes> [Accessed 16 November 2021].
[3] nhs.uk. 2019. Diabetes. [online] Available at: <https://www.nhs.uk/conditions/diabetes/> [Accessed 16 November 2021].
[4] Mayo Clinic. 2020. Diabetes – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444> [Accessed 16 November 2021].
[5] Diabetes.org. n.d. Hyperglycemia (High Blood Glucose) | ADA. [online] Available at: <https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia> [Accessed 16 November 2021].
[6] Vecchio, I., Tornali, C., Bragazzi, N. and Martini, M., 2018. The Discovery of Insulin: An Important Milestone in the History of Medicine. Frontiers in Endocrinology, [online] 9. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205949/> [Accessed 16 November 2021].
[7] Diabetes. 2019. Animal insulin was the first type of insulin to be administered to humans to control diabetes. Animal insulin is derived from cows and pigs.. [online] Available at: <https://www.diabetes.co.uk/insulin/animal-insulin.html> [Accessed 16 November 2021].
[8] Diabetes. 2019. Human insulin is the name which describes synthetic insulin which is laboratory grown to mimic the insulin in humans. Human insulin was developed through the 1960s and 1970s and approved for pharmaceutical use in 1982.. [online] Available at: <https://www.diabetes.co.uk/insulin/human-insulin.html> [Accessed 16 November 2021].
[9] Diabetes. 2019. A basal-bolus injection regimen involves taking a number of injections through the day.. [online] Available at: <https://www.diabetes.co.uk/insulin/basal-bolus.html> [Accessed 16 November 2021].
[10] Mayoclinic.org. 2021. Type 1 diabetes – Diagnosis and treatment – Mayo Clinic. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017> [Accessed 16 November 2021].
[11] Mayoclinic.org. 2021. Type 2 diabetes – Diagnosis and treatment – Mayo Clinic. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199> [Accessed 16 November 2021].
[12] Rea, P. and Tien, A., 2017. Metformin: Out of Backwaters and into the Mainstream. American Scientist, [online] 105(2), p.102. Available at: <https://www.americanscientist.org/article/metformin-out-of-backwaters-and-into-the-mainstream> [Accessed 16 November 2021].
[13] Diabetes. 2019. Sulphonylureas are a class of oral medications that control blood sugar levels in patients with type 2 diabetes by stimulating production of insulin.. [online] Available at: <https://www.diabetes.co.uk/diabetes-medication/sulphonylureas.html> [Accessed 16 November 2021].
[14] Diabetes. 2019. Diabetes myths are just as important to understand as the facts of diabetes. Diabetes information is widely available, both from healthcare professionals and the Internet, but not all of it is true.. [online] Available at: <https://www.diabetes.co.uk/diabetes-myths.html> [Accessed 16 November 2021].
