If you are over 50 you may already have people in your peer group who have type 2 diabetes. As we age many of our organs become less flexible and cannot deal with extra workload. This is fairly obvious with our heart and lungs; we all know that we cannot do that 100 yard dash so easily as when we were 20. But the same problem also affects other organs including the pancreas which makes insulin. With extra workload e.g. a larger meal, the older pancreas is less flexible and does not make quite enough insulin. This means that our blood sugar becomes a little higher. Our metabolic flexibility is lower. Diabetes is diagnosed when the blood sugar levels have reached a certain higher level. For most people this does not make you feel unwell so there are no symptoms to make you rush to your GP.
Diabetes is becoming increasingly common in the UK and now affects 6.8% of the adult population in England. In Kensington & Chelsea there were over 10,000 people with diabetes in 2017/18 representing 4.8% of the population. About half of these are aged 40-64 years and one third are aged 65-79 years of age. Three of the main risk factors for diabetes are family history of diabetes, growing older and being overweight.
Diabetes diagnosed in people over the age of 60 is most likely to be type 2 diabetes, which will be managed with diet, exercise and tablet medicines initially. Physical activity definitely helps lower blood sugar levels in people with type 2 diabetes. Partly it does this because the exercising muscles take up sugar from the bloodstream and this happens without needing any extra tablet medicines. The effect is seen even with moderate physical activity e.g. brisk walking for 15 minutes, but is larger if the exercise is longer or more intense. So if you have type 2 diabetes rambling, swimming, gardening or dancing will all make a difference to your condition. In Kensington & Chelsea, the organisation “Open Age” promotes active life for older people with a wide range of activities on offer.
Another reason our pancreas gland may have more work to do is if we are overweight. Insulin works less well in overweight people due to changes in a number of chemicals in the body. This means that the pancreas needs to make more insulin to do the same job. In people with type 2 diabetes even modest amounts of weight loss (5-10% of body weight) helps lower blood sugar by making insulin work better.
One of the exciting developments in the diabetes field in the last few years is the news that people who have recently been diagnosed with type 2 diabetes may be able to put their diabetes to sleep,which is known as achieving diabetes remission. A number of studies funded by the charity Diabetes UK have shown that using a “very low calorie diet” approach people have been able to stop diabetes tablets and their blood sugar levels have returned to normal or near normal. This treatment approach is not for everyone as it is quite difficult; it involves an 800 calorie per day diet for at least 3 months, eating only liquid nutrient mixes and some green leafy vegetables. It should only be used in patients with newly diagnosed type 2 diabetes who are overweight and under medical supervision.
Dr Raj Chandok is a General Practitioner and Commissioner of Diabetes Services & Dr Kevin Baynes is a Consultant in Diabetes and Endocrinology, they work together in improving Diabetes care across NorthWest London including KCW as part of an award winning Diabetes Transformation Programme.
This article does note constitute personal medical advice. Please consult your Practice Nurse or GP and discuss further.