Dr Thomas Stuttaford answers your questions about diabetes

A. There are two main types of diabetes. Type 1 diabetes is an apparently acute condition that has a dramatic onset. In diabetes type 1, the predominant symptoms are the frequent passing of urine, excessive thirst, loss of weight, extreme tiredness and eventually confusion, coma and, if untreated, death. There may be may other symptoms, for example gastro intestinal troubles, abdominal pain, skin or other bacterial infections or blurring of vision that bring attention to the condition, but questioning will always reveal that there has also been loss of weight, frequent urination and thirst.

Diabetes type 1 is an auto-immune disease, it usually attacks younger people and rarely those over 25 to 30. There is often a family history but there is no association with previous obesity or lack of exercise. Insulin is always needed to correct the absence of it because of the failure of the pancreas.

Diabetes type 2 is a condition that tends to come on more gradually. It is often described as late onset diabetes, but this is an inaccurate description as it is now sometimes found in younger adults or even in children. Diabetes type 2 is the result of either a lack of insulin or the increasing resistance of the body’s cells to insulin, so that the amount of insulin needed is greater than the pancreas can produce.

Diabetes type 2 usually affects people who are overweight, under exercised and who may well show evidence of other features of the metabolic syndrome. The metabolic syndrome is associated with obesity, high blood pressure, heart strain, raised cholesterol levels and of course a higher than normal blood sugar, even if actual diabetes is not present. Diabetes type 2 may initially be treated by a change in lifestyle, to include more exercise and fewer calories in the diet. Additionally patients are usually prescribed hypoglycaemic tablets, taken by mouth, to reduce the blood sugar.

Age now figures less in the description of diabetes type 2 as obesity is more common in younger people than it used to be. Glucose levels vary according to the amount of exercise taken, the nature as well as the quantity of the food and the degree of stress and strain that the patient may be suffering.

Q. My 28-year-old son has had diabetes since he was 2. It is under good control with Pump Therapy. He has, however, started lifting weights and eating Protein Bars and Protein shakes on a daily basis. I am wondering if these would adversely affect his overall health? - Sohail, Ontario

A. By whatever means a patient receives his insulin it is likely that the amount needed will be less if they take regular brisk exercise that burns up the calories. The greater the proportion of protein in the diet the less likely they are to need large doses of insulin. However, the way to control diabetes is not to have an unbalanced diet, as this can lead to other troubles, but to alter the dose of insulin. It is important to keep the diet stable as the ambition must be to allow the patient to live as normal and free a life as possible. In patients with type 2 diabetes, the old-fashioned, high fat, low carbohydrate diabetic diet was responsible for a huge number of cases of cardiovascular disease that would have otherwise been avoided. Diabetes type 1, the type your son has, will never be controlled without insulin.

Q. I have had type 1 diabetes since the age of 14. I am now 35. I am the father of a one-year-old-boy and I am obviously concerned about his health and welfare.

I would like to know if my son is at a higher risk of developing diabetes because I have it. The only other member of our family to have had diabetes was his great-grandmother on my father’s side who had type 2 diabetes from the age of 60. I have also heard that type 1 can be triggered by viruses and would like to know more about this: are there any early signs of diabetes in an infant I should look out for? Finally are there any dos and don’ts regarding my sons development, eating habits etc? - Simon Greenwood, Lancashire

A. Your son is at a higher risk of developing diabetes type 1 even if he only has one first degree relative with it. In addition, you may well find, on close questioning, that other relatives have or have had one or another of the large group of auto immune diseases. Diabetes type 1 is an auto immune disease, as are rheumatoid arthritis, many skin diseases including psoriasis and vitiligo (the white de-pigmented patches on the skin) and a host of other conditions.

Although the symptoms that betray the presence of diabetes type 1 are dramatic and acute, it is likely that the pancreatic failure has been preceding for some months before the insulin level reaches the level at which it gives rise to the symptoms of thirst, loss of weight etc. The initial loss of pancreatic tissue may have been triggered by the effect of some environmental factor on an hereditary vulnerable system. It is thought that this factor could often be a viral infection; on other occasions stress whether psychological or physical has seemed to be the stimulus.

There are no cunning or high tech ways in which a child’s vulnerability to diabetes type 1 can be detected at birth or in early infancy. However very large babies born to diabetic women tend to be more prone to diabetes type 2 and other troubles in later life. So far as your own son’s case is concerned, discuss it with his GP but in general the secret to a long and happy life for a diabetic patient is to learn everything about the disease so that he becomes his own expert on the subject. With the help of his clinic he can then learn to control his diabetes by adjusting his insulin dose day by day to his lifestyle and diet. In my experience of treating diabetic patients it is important that so far as is possible the treatment should be compatible with having a full social life and rewarding career, just like his contemporaries. It is easier to do this if they try and keep to a regular routine.

Q. Please advise if there are any electronic implants available which test blood sugar levels and give warnings of low ( below safe driving ability) sugar levels?

I get no warnings apart from double vision at levels of approx 2.0, and I should like to avoid placing myself and others in danger when I am driving longer distances - Sheila, Pontefract

A. This is the sort of advance in the treatment of diabetes that is being worked on. As you will know, it is now easy to rapidly estimate your own blood sugar, whereas 25 years ago to measure this was a long and complex task for the path lab. I suspect from your comments that you are either keeping your blood sugar levels regularly at too low a level, or the pattern of your life varies, and you are not making the necessary adjustments in your insulin dose to take these into account. If you are sitting in a car for long distances you will not be expending many calories and thereby burning up glucose. As a result your dose of insulin may have to be reduced when you go for long car drives. Better to have a slightly higher glucose level than is desirable than have a fatal accident.

Q. My father has recently been diagnosed with type 2 diabetes. Could you please let me know which foods are good and which are bad – we are trying to structure some kind of diet for him and obtaining detailed information is proving hard. We have also put him on an exercise regime consisting of gentle cycling around our lake. Is this okay? Are there any additional alternative therapies we could follow to help reduce his sugar levels? Can he use a sugar substitute ie Sweet and Low? - Name and address withheld

A. Your father needs to have a lower calorie diet so that his waist band shrinks to under 37 inches. The diet should be balanced and should have a standard mixture of fat, carbohydrate and protein. The carbohydrate should, when possible, be in the form of slowly absorbed polysaccharides rather than rapidly absorbed, sweet, sugary substances. Avoid high calorie fast foods. The best way of planning a diet for your father is to go with him to see the dieticians at the local diabetic clinic. Ask them to make out a meal-plan for a fortnight or so. In this way you will learn what eating habits he should have and keep to.

Once someone has diabetes type 2 they are automatically in the high risk group for developing cardiovascular disease. The best exercise is brisk walking. It should be daily, so long as the weather is neither excessively cold, hot or humid. Once a patient is known to have diabetes type 2, he or she should have at least an hour’s brisk walk a day, rather than the half an hour to forty minutes that the rest of the world should be taking. They should avoid sudden, vigorous exercise, especially when also emotionally charged (as when rushing for a train or playing tennis). Gentle cycling is not enough. Sugar substitutes are, for a variety of reasons, not the answer to a diabetic person’s prayers, although some may be helpful during a transition phase.

Q. About 20 years ago I had a glucose tolerance test, which showed that I had low blood sugar levels on waking, and also during the day. There is diabetes in the family on my mother’s side, and a number of my cousins, aunts and uncles have it.

I already have an underactive thyroid. Am I at a higher risk of getting diabetes, and should I be having regular checks for this condition? I am 57 years old - Name and address withheld

A. You are more at risk of developing diabetes than other people, but this is because of your family history, and not because of your low blood sugar level in the past. Patients with both diabetes type 1 and 2 are liable to have a family history, but this tendency is stronger in those with type 1 than type 2. Relative hyperglycaemia, even a blood sugar greater than usual, it is associated with diabetes type 2. Conversely, relative hypoglycaemia, a blood sugar lower than most people have, has no association with diabetes.

There is a relationship between some forms of diabetes and thyroid disease but I would be surprised if this was applicable to you. However, there is also of course a likelihood that people with an undiagnosed, underactive thyroid gland could be overweight and under-exercised, and their risk of developing type 2 diabetes because of the weight and girth in middle age is greater than average.

Q. I have been taking Avandamet for some time now but have recently been informed of possible problems with this drug. Can you offer any advice? - Barney Lynch, Manchester

A. Avandamet is a composite drug that includes Avandia rosiglitazone. An analysis of statistics of people taking Avandia has shown that there could be some increase in the incidence of cardiovascular disease in them, as opposed to others who are taking a different treatment for diabetes type 2.

GlaxoSmithKline, who manufacture Avandia, are not impressed by these results and suggest that an association with cardiovascular disease may be more apparent than real. There could be other explanations for the apparent difference in incidence of cardiovascular disease.

Avandia and Avandamet have proved very useful in controlling blood sugar. You certainly shouldn’t give up your treatment immediately. We can be certain that if your blood sugar raced away you would be in trouble. Nor are we certain what effect Avandamet, which also contains metformin, has on the incidence of cardiovascular disease. You should see your GP because he, or she, is the only person who will know your personal condition. Keep in close contact with your surgery, follow their advice and be confident that they too will be watching the latest information on Avandia and will keep you informed.