Thursday, August 27, 2015

Diabetes: Type 2, Part 2: Creating Awareness



**Before we start - Please note – this blog is gonna be fact heavy, link heavy, lots of writing and reading and not many pretty pictures – I will try and keep things light, but I don’t want to depreciate Diabetes – it is a serious and growing illness in the UK, so really this week (after last weeks headlines re diabetes and the NHS) we are trying to create a little more awareness of the symptoms and what you can do to help yourself.  We’ve had over 192,000 views to our blog and page so far, so if that many people see this, then fingers crossed the message will be getting through.  Let’s do our bit – read on, like and share **


Diabetes risk factors (those at higher risk):

Type 2 diabetes (as explained in last weeks blog (http://nononsensenita.blogspot.co.uk/2015/08/diabetes-could-bankrupt-nhs.html) accounts for about 90% of all diabetes in the UK.  Our NHS has clearly stated now that increasing levels of obesity, lack of exercise, an increase in unhealthy diets all coupled with an aging population means type 2 diabetes is on a dramatic rise.

The problem is, type 2 diabetes takes time to develop, it comes on slowly usually after the age of about 40 but the tricky thing is it can take a good few years to realise that’s what’s causing your problems as the signs/symptoms may not be very obvious at first. It is very important however, that diabetes is diagnosed as early as possible because if left untreated it will get progressively worse.

The good news is, these days we are becoming slightly more aware of the risk factors as well as the symptoms, so earlier detection or indeed prevention can come into play. 

So to make sure everyone reading this is aware let’s highlight the risk factors.  Some risks are genetic and some preventable.  You are more at risk of type 2 diabetes if:


  • You are overweight – this is one of the leading factors – a high BMI or being overweight/obese is the number 1 risk factor leading to diabetes.  You are even more at risk if you carry that extra weight around your middle – for a woman a waist circumference more than 80cms (approx. 31.5 inches) and for man a waist higher than 94cms (or 37 inches) puts you at a higher risk.
  • You are from any of the following ethnic backgrounds – African, African-Caribbean, Chinese, South Asian (type 2 diabetes is 6 times more likely in people of South Asian descent, and India and China are currently regarded as the diabetes capitals of the world!)
  • If you have a parent or sibling with diabetes
  • If you have (or have ever had) high blood pressure and/or suffered a heart attack or stroke
  • If you are a woman with a history of PCOS or gestational diabetes (as mentioned in last weeks blog too LINK)
  • If you have a mental health disorder such as depression, bipolar or schizophrenia that you are taking medication for
I found a couple of handy tools at www.diabetes.org.uk and at www.nhs.co.uk where you can measure your risk factor
Just make sure you have your height, weight and waist measurements to hand and DON’T FREAK OUT if it looks like you are high, moderate or increased risk.  Testing myself I’m at the “increased” stage, but I know there are things I can do now to help. In fact the websites of course give you help, ideas, eating plans and even charts etc to help you help yourself should your results appear anything but low. Also, please remember this is only a home test, please take into account the other risk factors above, and at the symptoms listed below as well and of course see your doc if you really are worried. 


Type 2 diabetes symptoms:


The main symptoms of type 2 diabetes occur because glucose is staying in your blood, rather than being used as fuel/energy, therefore your body tries to get rid of it by urinating, leading to:

  • Urinating more frequently (especially at night)
  • Feeling thirsty all the time / increased thirst
  • Feeling tired particularly during the day and/or after meals
  • Unexplained weight loss / loss of muscle
  • Cuts or wounds that take a long time to heal
  • Dry eyes and/or blurred vision
  • Frequent episodes of thrush, or itching around the genitals
  • Often feeling hungry (shortly after eating)

Now we know who’s as risk, we know the symptoms to look out for and we can test ourselves (online), so before we look at what we can do to reduce our risks and avoid these symptoms – just so you know why we are banging on about it so much - here is what having type 2 diabetes can lead to and why we want to avoid it:
Type 2 diabetes can cause serious long term health problems (info points from www.nhs.co.uk / 2014)

You can download a booklet about diabetes and your heart from them too - https://www.bhf.org.uk/publications/heart-conditions/diabetes-and-your-heart


OK – that’s the scary stuff over with – but we need to know it so we understand WHY we need to look at preventing type 2 diabetes.  As we said upfront there are genetic risk factors we can’t do anything about.  But the good news is that on the other hand there ARE factors that the NHS have explicitly linked now with type 2 diabetes that we CAN totally do something about.  We can change/update lifestyle factors to keep us safe and out of trouble for as long as possible (and of course in the long run that will help avoid end stage or emergency treatment and therefore reduce the cost to the NHS – remember last weeks headline??)

The main preventable risk factor is OBESITY
If you measure over 30 on the BMI scale and especially if you carry the extra weight around the middle as already pointed out, then you will be at a higher risk of developing type 2 diabetes.  You can check your BMI on this chart:


or via the nhs BMI calculator here:  
 
HOWEVER – just a 5% reduction in body weight can lead to a 50% reduction in developing diabetes, as lower body weight improves blood glucose levels.  
QUESTION:
So if you need to lose this 5% body weight – how do you do it?
ANSWER:
There are no short cuts, it’s the same old mantra I’m afraid – you need to eat healthier, probably eat a little less and take regular exercise.

There are soooooo many DIETS out there that promise weight loss.  I’m not sure any of them are 100% effective and won’t go into pros and cons of any here, what I do know is that you need to find a healthy eating plan you can stick to – something that works for you, for life. We don't promote rapid weight loss diets, but healthy eating.  Rapid weight loss leads to yo-yo dieting as we are probably all aware off, loosing the weight, then piling it all back on again - plus some - this is NOT healthy and especially bad when considering diabetes risks.  PLUS everyone is different, weight loss / weight management is not a one size fits all scenario.  At no nonsense nutrition we do provide an 8 week weight management programme to kick start you into healthy eating habits as we realise it’s not easy, that everyone will need to do it differently and most need a little help and support in getting started on something that they can keep up for a long time to come.  We focus on simple, easy lifestyle changes and I’m happy to share a few common weight management tips here:

  • How about reducing portion sizes – most of us are guilty – even if we eat fruit and salad and all the things we think are good for us, we generally (as a nation) eat too much of them.
  • How about basing meals around the green stuff – ie filling half the plate with veggies before adding protein, carbohydrates – leaving less room for them means you will have to eat less of the foods with the higher calories!
  • How about avoiding, or at least cutting down on refined carbs/sugars – ie avoiding the white stuff – white bread, rice, pasta, flour and reducing your snacking on pastries, biscuits, cakes etc? 
  • It’s probably a good idea to keep an eye on your alcohol intake too – thinking about alcohol ‘portions’ too.  If you’re drinking at home maybe pour a smaller glass of wine, add more tonic and less vodka, and just a small bottle or half a beer/cider/ale yeah?  Remember alcohol is very high in calories and sugars and good for not much else (apart from giggles and hangovers obviously!)

For more tips or to find out more about the 8 week programme, or one to one consultations you can email us info@nitakothari.com

What about exercise and activity?  Movement is something we all lack too these days – more and more of us, especially those who are older (and at higher risk of diabetes) are leading a more sedentary lifestyle.  We rely on public transport or the car, we don’t tend to walk as much.  Not as many of us are in manual labour, but more are at desk jobs meaning we are sitting down pretty much all day.  We need to get moving.  What’s the best way?  WALKING FOR HEALTH.  At no nonsense we recommend walking as the easiest, cheapest and therefore most accessible form of exercise to incorporate into your daily/weekly schedule.  Check out more about walking for health on our website here: http://www.nitakothari.com/walking-for-health/

You can also check the details in this video from diabetes UK which will give you more ideas on how to lose that 5% too if you need.   


For more tips and info diabetes specific - see https://www.diabetes.org.uk/Guide-to-diabetes/Managing-your-diabetes/Healthy-eating/Top-tips/ for tops tips for eating healthy and https://www.diabetes.org.uk/Guide-to-diabetes/Managing-your-diabetes/Exercise/ for top tips on getting more exercise – both from diabetes UK.
For more info on a healthy diet if you have already been diagnosed with diabetes – you can download a guide here: http://www.diabetes.co.uk/diet-basics.html


OK - Lots of facts and links and a lot to take in there so thanks for sticking with us, I hope we’ve highlights the risk factors and outcomes of diabetes.  As this is such a growing disease and will apparently bankrupt the NHS if we don’t do something about it now, I really wanted to focus on it these last couple of weeks.  Of course, as usual there is so much more we could talk about – the treatments for diabetes, the glycaemic index and glycaemic load of foods, which ones to eat and to avoid if you are diagnosed, how and when to have checks, what diabetes tests involve at the GP…..etc.  As this is NOT a medical blog though these things are all better discussed with your health professional.  This we hope serves as a 2 part guide to the basics of diabetes  to raise a little more awareness and encourage you to look into your own risk factors and lifestyle changes that can help prevent the disease.

We would therefore encourage you to read the links, share this and help others become more aware – you can do this via our social media outlets:
Or by emailing info@nitakothari.com  for further info and/or a consultation and look at the 8 week weight management programme.

(If you are local to Reading and the South east of England see this link for volunteers: http://www.getreading.co.uk/news/reading-berkshire-news/diabetes-uk-looking-volunteers-tackle-9887870 )


www.nitakothari.com
 
**Please remember this is nutritional advice ONLY (as is all other information and advice contained in this blog and the websites and social media related to it) – none of the info or advice is intended to override any recommendation from your GP or health professional**

Thursday, August 20, 2015

"Diabetes could bankrupt the NHS"



This week and next (as it’s such a large topic) I wanted to talk about the facts behind the alarming headline that was splashed all over the news and media on Monday – it was reported that Diabetes in the UK had increased by 60% in the last decade and treating this increase would basically destroy and bankrupt our entire NHS…..so I figured we should look a little more at diabetes – its types, its symptoms, those at risk, the correlations between health/weight and diabetes, worse-case scenario outcomes and then prevention vs end stage medication (and NHS spending) and of course take a look and what we can do to help ourselves avoid diabetes.


“60% rise in diabetes cases in the last decade”

As this is no nonsense let’s start with the initial report from diabetes.org.uk:

And here are how a couple of the papers reported the new statistics:
The Guardian (http://www.theguardian.com/society/2015/aug/17/diabetes-bring-down-nhs-charity) have quoted a lot of the initial report, whereas the Independent (http://www.independent.co.uk/life-style/health-and-families/health-news/diabetes-could-bankrupt-the-nhs-after-60-rise-in-number-of-cases-charity-warns-10458353.html) has lead with the cost factor and used words and phrases such as “bankrupt”, “amputations”, “stroke”…. Using shock language and looking at worse-case scenarios on all counts for the health system and for people with diabetes.  Both are great reports and both give the facts and figures.  Maybe it takes sensationalism to make it to our conscious and get us talking about it, maybe with all repots just giving the facts and figures this would have passed the general population without issue, so I’m grateful for a little doom and gloom and the splashing of disaster headlines sometimes to raise awareness.

In any case and via any reporting what we can see is that there has been a 60% increase in those diagnosed with diabetes in the last 10 years in the UK.   I imagine this could be due to a number of factors including for example
1) the rate of diagnoses has increased due to better methods of diagnoses
2) the rate of awareness has increased leading to more people being tested and therefore more diagnosed 
3) even with 1 and 2, we can see the disease is on the increase
Looking more closely at number 3 I wanted to look at why diabetes is on the rise, what’s causing this rise and the correlation therefore between risk factors such as health, weight, obesity and diabetes.

Next week we will look further into these risk factors (as well at those at a higher risk due to age, ethnicity, gender), then into symptoms, outcomes, treatments and prevention and what we can do.

This week to start with I wanted to just give an overview of diabetes.


Types of diabetes:
For a start let’s break it down – there are 3 types of diabetes – TYPE 1 and TYPE 2 and Gestational Diabetes. Here is a handy video from www.diabetes.org.uk that helps explain what happens when you have diabetes in no nonsense terms that we love:






The following info is from www.nhs.uk and simply identifies each type.

Firstly: “Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood”.

Type 1 Diabetes  where the pancreas doesn't produce any insulin

Type 2 Diabetes  where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin

Gestational Diabetes - occurs in some pregnant women and tends to disappear following birth

For the purpose of this blog (and next weeks) we will only be focusing mainly on type 2 diabetes as this is on the increase, this is the type the NHS is spending the most amount of money on and this is type we may well be able to help ourselves prevent.

Type 1:
In type 1 diabetes, the body's immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body's organs.  Type 1 diabetes is often known as insulin-dependent diabetes. It's also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years. Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes. If you're diagnosed with type 1 diabetes, you'll need insulin injections for the rest of your life”.

It's important that type 1 diabetes is diagnosed as early as possible, so that treatment can be started as quickly as possible. Type 1 diabetes can't be cured, but treatment can blood glucose levels as normal as possible and control symptoms, to prevent more health problems developing later in life.  With type 1, your body can't produce insulin so you will need regular insulin injections to keep your glucose levels normal. With treatment, you will be shown how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do.

Type 2:
“Type 2 diabetes is where the body doesn't produce enough insulin, or the body's cells don't react to insulin. This is known as insulin resistance.  If you're diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels.  However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets. Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it's more common in older people”.

As with type 1, there is no cure for type 2 diabetes, however if you're diagnosed, you may be referred to a diabetes care team for specialist treatment, or your GP surgery may provide first-line diabetes care as in some cases, it may be possible to control type 2 diabetes symptoms with lifestyle changes, such as eating a healthy diet and taking regular exercise (which we will focus more on next week). However, as type 2 diabetes is a progressive condition, you may eventually need to take medication to keep your blood glucose at normal levels. This may be in the form of tablets initially, but move on to injected insulin at a later stage.  This is where the cost factor to the NHS comes in as the disease is both incurable and degenerative, so preventing and managing symptoms for as long as possible with a healthy diet and lifestyle will keep us fitter, healthier and lower our risks at the same time as saving the NHS money.


NICE care processes:
You will see from the news articles and the initial report from diabetes.org.uk that there are 8 NICE (The National Institute for Health and Care Excellence) recommended care processes recommended to the NHS to use when monitoring  patients at risk or diagnosed with type 2 diabetes.  These tests are completed annually and these functions are what we can try to prevent increasing with the use of diet, exercise and lifestyle change:
 


1) Measuring the effectiveness of diabetes treatment with blood test
2) Measuring cardiovascular risk factors (such as blood pressure)
3) Monitoring cholesterol
4) Checking your BMI – Body Mass Index
5) Cutting down / out smoking
6) Monitoring early complications: eye screening and foot health
7) Checking urine serum albumin (a protein made by the liver, the main protein of blood plasma)
8) Creatinine – testing kidney function

So these are the no nonsense basics – if you are interested you can find the full audit for care process and treatment targets in the resources section here (downloadable as a PDF): http://www.hscic.gov.uk/catalogue/PUB14970


So, after establishing these basics behind the headlines, next week we will look at:

  • Type 2 diabetes risk factors and those at higher risk
  • Type 2 diabetes symptoms
  • Treatment and worse case outcomes of type 2 diabetes
  • The correlation/link to obesity
  • And finally prevention vs end stage medication ie things we can do in relation to our own health, weight loss, exercise and lifestyle factors - things we can change now to prevent type 2 diabetes

I hope that’s been interesting so far and given an overview of the diabetes basics – if you want more info you can take a look at www.diabetes.org.uk ; www.diabetes.co.uk and www.nhs.uk or of course contact us at info@nitakothari.com

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**Please remember this is nutritional advice ONLY (as is all other information and advice contained in this blog and the websites and social media related to it) – none of the info or advice is intended to override any recommendation from your GP or health professional**