The hidden signs you could be at risk of diabetes

M I N D & B O D Y | W E L L B E I N G

New evidence suggests that more than 250,000 midlifers in the UK have type 2 without even knowing it. Libby Galvin reports

Could you have diabetes? It may not be something you have seriously asked yourself, especially if you’re not overweight, but new evidence suggests that more than 250,000 midlifers in the UK have type 2 diabetes without even knowing it, while experts at Diabetes UK estimate the true number could be closer to 850,000.

The condition is “a snake in the grass”, says Roy Taylor, a professor of medicine and metabolism at Newcastle University and author of Your Simple Guide to Reversing Type 2 Diabetes. Left untreated, it can lead to complications including heart attack and stroke, kidney disease, eye problems and nerve damage.

At the moment, only those considered high risk are tested for type 2 during the NHS Health Check (a general screening for everyone between 40 and 74). If your GP doesn’t flag you as a concern, they won’t include this HbA1c blood test in your midlife MoT — leaving you none the wiser.

A sensible diet can reverse type 2 diabetes.

That’s why a team of scientists at the University of Exeter examined the blood test results of hundreds of thousands of participants in the UK Biobank study, one of the largest biomedical databases in the world. Cross-referencing them with GP records, they discovered that 1 per cent who thought they were healthy were unwittingly living with type 2. And given these study participants represent an untypically healthy section of the population, experts are now calling for everyone aged 40 to 70 to be screened, to cut the time people might be living with the hidden condition.

Could you be at risk?

Dr Valter Longo, director of the Longevity Institute at the University of Southern California, has spent his entire career studying our biology, how it goes awry and how to repair it. He is not only unsurprised by the number of undiagnosed diabetes patients revealed by the study, he believes there could be millions more — if not with full-blown diabetes, then with metabolic precursors to it.

“I don’t remember any of my family having diabetes in southern Italy, but after moving to the US, now maybe half have either diabetes or cardiovascular disease,” says the Italian-American professor.

“There was a study in the US a few years ago showing that 90 per cent of Americans are metabolically unhealthy. Only 10 per cent have good metabolic health, meaning that they don’t have pre-diabetes, metabolic syndrome, diabetes etc. I would be very surprised if the UK numbers were that different.”

Cases of type 2 have doubled in the UK in the past 15 years, and 5.5 million people are predicted to develop the condition by 2030. Diabetes UK says the dramatic increase in obesity rates is the main driver — three in five adults in England are overweight or obese, the single greatest risk factor for developing the condition.

Why being slim doesn’t always mean healthy

Although putting on weight is an issue, we don’t have to get all that much heavier to be at risk. “People think that you need to eat a crazy amount of food to become diabetic. The reality is that if you eat 50 extra calories a day — two little sweets, or even a salad — eventually, you will put on weight,” Longo says.

The Exeter study found that GPs are much more likely to screen those who are obese — with a BMI over 30 — than anyone with a BMI under 30. However, overweight in terms of diabetes danger isn’t always the same as overweight on the bathroom scales.

“You could look thin — but as long as you have enough abdominal or internal fat, you are at risk,” Longo says. It’s what the term “skinny fat” was invented for: slim on the outside, unwell inside, because the fat that’s of concern surrounds your organs, not your thighs. Depending on your personal risk profile, diabetes could kick in without you looking unhealthy.

Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, points out that for those of south Asian or Black African heritage, or with a family history of type 2, the risk of diabetes comes into play at a much lower weight. “Different people need different levels of excess weight to develop diabetes,” he explains.

“My risk, even at the same body mass, is probably ten times yours because I’m south Asian, I’m male and both my parents have type 2 diabetes. That marks me out. When I put on weight, it goes to the wrong places more quickly.”

What are the warning signs?

Type 2 diabetes causes damage via two pathways, says Taylor. One is excess fat supplied to the organs, where it causes circulatory problems, heart trouble and stroke. That same excess fat also impacts the pancreas, interfering with the body’s ability to manage blood sugar levels, which causes damage to the small blood vessels in our eyes, kidneys and nerves.

By the time you have symptoms — which include going to the loo a lot, feeling very thirsty or tired, having cuts and wounds that take longer to heal, skin infections such as thrush, and blurred vision — uncontrolled high blood sugar could have done significant damage already. Which is why you must be alert to your risk factors long before you feel unwell.

“Even at the earliest stage, this damage is already under way,” Taylor says. “Type 2 diabetes is often not picked up until it’s already well established, because it gradually appears, without any symptoms at first.”

There is no easy way of telling whether you have fat in the wrong places unless undergoing a specialist full-body scan. So consider your family history, sex and ethnicity to help you to assess your personal level of risk — and if you’re concerned, ask your GP for an HbA1c test.

How to avoid type 2

Metformin, a tablet taken with meals to help control blood sugar levels, is the common treatment for managing type 2 diabetes, but by far the best news of recent years is that with lifestyle changes the condition is completely reversible.

“Once, this sort of diabetes was thought to be a life sentence,” Taylor says. “But as type 2 diabetes is due to too much fat inside the organs, by taking away this fat it’s possible to get rid of the diabetes altogether.”

He worked on a seminal Newcastle study in 2011, which found rapidly losing 10 to 15 per cent of body weight was enough to reverse diabetes. The extreme low-calorie diet used in the study, based on slimming meal shakes and non-starchy vegetables, has since been rolled out across the NHS.

The easier “fasting” diet

There are other, less extreme methods, including the 5:2 and the “fasting mimicking” diet created by Longo. Rather than prolonged calorie cutting, this magic-bullet programme involves cutting calories for just five consecutive days of the month: 1,100 the first day, 750 for the following four and then eating normally the rest of the month.

Longo’s research shows this not only helps people shed pounds but can also reboot cells involved in the control of blood sugar. “The ideal diet to lose weight and beat diabetes is high in legumes, high in wholegrains, nuts and vegetables, but limited in calories,” he advises.

The beauty of fasting mimicking is that to reap the benefits you only have to change your ways for five days a month — or perhaps even less. “We’re starting to see that five days [of fasting mimicking] every two or three months could be enough to begin this process of diabetes regression,” Longo says, adding that, unlike a long-term low-calorie lifestyle, the fasting diet has “very high rates of compliance”.

“Most people say, ‘OK, I could do that, if you leave me alone for the rest of the time’,” he adds. “And it really is enough to make a difference.”

Reference
https://www.thetimes.co.uk/article/signs-symptoms-diabetes-zt056nt88