You DON'T have to be fat and over 40 to develop diabetes...and I'm proof

By Lucy Elkins

'If I had been overweight or didn't look after myself then I might have understood it,' said Stephanie Spires on being diagnosed with type-2 diabetes

When Stephanie Spires started to feel exhausted every afternoon, the full-time mother put it down to the rigours of having a young child.

After all, her son was only two, and she had no reason to suspect there was anything wrong.

Stephanie, 35, who worked briefly as a catwalk model, has always exercised every day, has a slender size ten figure and eats well.

Her tiredness continued beyond her son’s early years, but she simply attributed this to passing 30.

Yet she used to feel so wiped out that she needed an afternoon nap most days, and would only manage to wake up again by setting an alarm.

Even so, she still managed to cycle, do a fitness video or go for an hour-long walk each day.

As she was so active she felt this explained her regular yearning for a glass of water every half an hour.

This continued for ten years. Then earlier this year she developed stabbing pains in her chest.

Her doctor ran some tests which revealed that while her heart was fine, she had type-2 diabetes, and would need to take medication straight away.

The condition is largely a disorder triggered by excess weight, in which the body fails to respond to insulin, which is crucial for controlling blood sugar. Ultimately, the body stops producing enough insulin.

It is normally thought of as something that affects people who are overweight and past 40. Yet as Stephanie discovered, this is not necessarily always the case.

‘When the doctor broke the news to me that I was a diabetic I felt quite emotional and shocked,’ says former nanny Stephanie who is single and lives in Ipswich with her 13-year-old son, Bradley.

‘If I had been overweight or didn’t look after myself then I might have understood it. But I was just 9½ st, quite slim for my 5ft 8in height.

‘My uncle had type-2 diabetes and it was thought that my grandad had it — however neither of them looked after themselves. To develop diabetes after all my efforts to stay healthy seemed terribly unfair.’

Earlier this month new figures showed that diabetes is reaching ‘epidemic’ levels in this country — the number of those affected has soared by more than 117,000 in the past year, to just under 3 million.

Around a tenth of NHS spending now goes on diabetes and its complications. Most diabetics have type-2 diabetes — unlike type-1 diabetes it does not run in families.

'I was just 9½ st, quite slim for my 5ft 8in height,' said Stephanie

People such as Stephanie who do not have weight issues may presume they are not at risk, but that’s not always the case.

‘Weight will be a factor for anyone who develops type-2 diabetes,’ says Naveed Sattar, Professor of Metabolic Medicine at the Institute of Cardiovascular & Medical Sciences at Glasgow University.

‘The problem is the tipping point at which their weight makes them vulnerable to developing diabetes varies from person to person.

‘Some people are genetically more prone to put on weight around their middle, liver and pancreas than they are to store it under the skin and that makes them more prone to diabetes.

‘When fat is stored in the liver and pancreas (where insulin is made) it interferes with the body’s ability to metabolise sugar. Generally men need to put on less weight than women to reach the tipping point.

'Ethnic groups have differing risks, too — any group apart from white Europeans needs to put on comparatively less weight to increase their risk. It is small minority of slim people who develop type-2 diabetes.

‘We still need further research as to why this happens, but it may be that these people store fat in the wrong place even when they are at a low weight or that their pancreas has lower insulin-making capacity.’

One issue with type two diabetes is detecting it. Diabetes UK estimates that around 850,000 people have the condition without realising, and on average people will have symptoms for ten years before being diagnosed.

By then they already have some of the complications associated with the condition, such as blurred vision or even heart disease.

‘This is because a lot of people will only have mild symptoms in the early stages of diabetes,’ says Professor Sattar.

‘They might feel a bit tired, go to the loo a bit more often and feel thirsty, but they won’t put two and two together and think, “I have diabetes”. Yet it is important to pick up diabetes early.’

Complications are common. Having diabetes raises the risk of cardiovascular disease twofold, and diabetic retinopathy — damaged nerves in the eyes — is the leading cause of blindness in the UK.

Barbara Young, chief executive of Diabetes UK, said detection and early diagnosis had to improve if ‘people are not going to suffer and diabetes is not going to bankrupt the NHS’.

So why aren’t we doing more to detect it early?

In fact, two years ago the NHS introduced a vascular check test (now known as the NHS Health Check) that was meant to be offered to everyone aged between 40 and 74 every five years. This would aim to identify those at risk of diabetes, and of coronary heart disease, stroke and kidney disease, too.

The number of those affected with diabetes in this country has soared by more than 117,000 in the past year, to just under 3 million

The test involves measuring height and weight, a family medical history questionnaire and taking blood pressure, blood sugar and cholesterol levels.

There are around 15 million people eligible for the test in England alone.

However between April and June this year (the latest available figures) only 2.7 per cent of those eligible were offered a check. But access to this test isn’t the only issue. Experts argue that blood sugar tests — crucial for diagnosis — are often not being offered.

Professor Sattar said: ‘GPs’ approach to the blood sugar tests has been very piecemeal. Some doctors do lots of sugar tests, others far less.

'Another issue is the fasting, which has to be done to allow sugar to be measured accurately — no other test (included in the NHS Health Check) requires the patient to fast. So if a patient comes in after a meal, the doctor cannot measure blood sugar.’

However, there is a new test that can be done quickly at a GP surgery, without the need for fasting. The glycated haemoglobin test is a blood test which checks the amount of sugar on a protein in the blood called haemoglobin. This gives an idea of a person’s average blood sugar level over the last two or three months.

‘The major advantage is that it’s more reliable than the test requiring fasting, and could be done when people come in for a vascular health check at any time of the day,’ says Professor Sattar.

This test is already in use in the UK as a way of assessing how well someone with diabetes is being managed — what is new is using it for diagnosis. So what is holding back the use of this test, which has been recommended by the World Health Organisation?

The Department of Health acknowledges that it is ‘more practical and patient-friendly’ and are finalising guidelines about who the test is most suitable for.

‘For the vast majority it will be a better test but there will be a minority of people for who it is not the better option,’ says Professor Sattar.

‘However, some GPs are already using it. I would hope it would be rolled out nationally within six months. Hopefully, we can start picking up those at risk sooner. By getting them to change their lifestyle and lose weight, we can delay the point at which they develop diabetes by ten to 15 years.’

For Stephanie, however, the diagnosis came too late. ‘I can’t have sugary foods and even have to limit fruit,’ she says.

Although treatment — with the drug metformin — brought her blood sugar levels down, they are now rising again. She’s been told she may need daily insulin injections.

‘I don’t want to have to do that, but for the sake of my son I will,’ she says.

‘People need to know that you don’t need to be overweight to be diabetic. I did everything right and still got diabetes.’

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