CAUSES OF DIABETES

Our 16-year-old daughter has just been found to have Type 2 diabetes. Apart from not needing insulin, are there any other differences between Type 1 and Type 2 diabetes?

It may come as a relief to be told that although your daughter has diabetes, she will not need insulin injections – at least for the time being. However, Type 2 diabetes is at least as serious a condition as Type 1. This is because young people with Type 2 diabetes, like adults with this condition, carry an extra threat of heart disease, though this will not apply to your daughter until she is much older. The risk factors include high cholesterol, triglycerides and blood pressure, and increased waist circumference (sometimes called the metabolic syndrome).

A study in America has looked at the frequency with which these risk factors appeared in different groups of young people aged 12-19 years. In the general population of American children, 6.4% in this age range had two or more of these risk factors. In young people with Type 1 diabetes, the frequency was 14%, while in those with Type 2 diabetes it was greater than 90%.

Although this information is bound to worry you, all these risk factors can be identified and corrected. It is important that your daughter has regular checks for body weight, cholesterol and blood pressure and if these are above the normal for her age, she should receive treatment to prevent or delay the risk of heart disease as she grows older. Some drugs used for treatment of cholesterol and blood pressure should not be used in pregnancy and your daughter needs to be aware of this.

I was very ill last year and developed diabetes, which has since got better. Can a severe illness cause diabetes?

Any serious medical condition (such as a heart attack or injuries from a traffic accident) can lead to diabetes. This is because the hormones produced in response to stress tend to oppose the effect of insulin and cause the glucose level in the blood to rise. Most people simply produce more insulin to keep the blood glucose stable. However, in some cases, if the reserves of insulin are low, the blood glucose level will climb. You had temporary diabetes, and the glucose level returned to normal once your stress was over. However, you will carry an increased risk of developing permanent diabetes later in life.

My latest baby was very big at birth. Would she have caused me to have developed diabetes?

No, the opposite is true. It is because you already had unrecognised diabetes that your daughter was big and any woman who has an unexpectedly big baby (more than 4 kg or 9 lb) should be tested for diabetes. If you had diabetes during pregnancy but your blood sugar returned to normal after your baby was born, you will continue to carry an increased risk of developing diabetes at some stage in the future.

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TREATMENT WITH INSULIN

Insulin was discovered by Frederick Banting and Charles Best in the summer of 1921. The work was carried out in the Physiology Department of Toronto University while most of the staff were on holiday. Before insulin was discovered, there was no treatment for people with diabetes and if they had what we now call Type 1 diabetes, death was inevitable, usually within a year of diagnosis. The first human to be given insulin was a 14-year-old boy named Leonard Thompson who was dying of diabetes in Toronto General Hospital. This was an historic event, representing the beginning of modern treatment for diabetes. It was then up to the chemists to transform the production of insulin into an industrial process on a vast scale.

There are two groups of people who need insulin. The first group are severely insulin deficient and cannot survive without it (Type 1 diabetes). The other group tends to develop diabetes later in life and they continue to produce some insulin (Type 2 diabetes). These people can usually be treated with diet and tablets initially but need insulin sooner or later.

Insulin still has to be given by injection because at present it is inactivated if taken by mouth. Inhaled insulin has just been released but it not available for general use in the UK. About a quarter of all people with diabetes are treated with insulin. Virtually everyone who develops diabetes when they are young needs insulin from the time of diagnosis. People diagnosed in later life may manage quite satisfactorily for many years on other forms of treatment but eventually many of them will need insulin to supplement the diminishing supply of insulin from their pancreas.

Most people dislike the thought of having to inject themselves but modern insulin pens and needles are so well designed that these fears usually disappear after the first few injections. In general, insulin injections become part of the daily routine.

TYPES OF INSULIN

Since the discovery of insulin, countless people with diabetes have injected themselves with insulin extracted from the pancreas of cows and pigs. In the last 20 years or so human insulin has become widely available. However, human insulin is not extracted from human pancreas in the same way beef or pork insulin is. A great deal of research went into producing ‘human’ insulin by means of genetic engineering. This means that the genetic material of a bacterium or a yeast is reprogrammed to make insulin instead of the proteins it would normally produce. The insulin manufactured in this way is rigorously purified and contains no trace of the original bacterium.

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