Charlotte Woodford looks at the challenges of the condition and hopes for future breakthroughs
Type 1 diabetes affects 400,000 people in the UK, with over 29,000 of them being children. Incidence is increasing by about four per cent each year particularly in children under five, with a five-fold increase in this age group in the last 20 years.
The UK has one of the highest rates of type 1 diabetes in the world, for reasons that are currently unknown. The Royal Surrey Hospital in Guildford has on average 10-16 newly diagnosed cases of children and young people each year and the numbers are expected to continue to increase.
One of the things I constantly have to do as a type 1 diabetic is explain the difference between type 1 and type 2 diabetes. They are very different in origin. Type 2 diabetes is in the vast majority of cases the result of someone’s lifestyle- being overweight and lack of exercise- which means they do not produce enough insulin or the insulin they produce does not work properly. Type 1 cannot be prevented. It is an auto-immune condition, classified in the same group of conditions such as multiple sclerosis. For reasons that are not yet fully understood, your immune system attacks and destroys the insulin producing cells in your pancreas, called beta cells. Insulin is crucial to life. When you eat, insulin moves the energy from your food (glucose), from your blood into the cells of your body. When the beta cells in your pancreas fail to produce insulin, glucose levels in your blood start to rise and your body can’t function properly. Over time this high level of glucose in the blood may damage nerves and blood vessels and the organs they supply. Last year diabetes related amputations reached a record high with 20 taking place every day in England.
How and why type 1 diabetes occurs is not known, although one theory is that it is caused by a virus. Whatever the cause, people with type 1 diabetes need to keep their blood sugar levels under control, calculating the carbohydrates that they eat and making sure they administer the right amount of insulin as a pancreas would if it was working properly. If blood sugars become too high or too low, there is a risk of going into a coma or concentration and energy levels dropping severely. It is a constant struggle to get it right but it certainly hasn’t been a barrier to achievement for our Prime Minister, Theresa May or record Olympian Sir Steve Redgrave who both suffer from type 1 diabetes.
And the good news is that things are rapidly improving. With greater awareness about the starting symptoms, parents and nurses are able to rapidly and easily admit the child to hospital to receive immediate care and then further education on how to cope with diabetes. In the past children would need to spend days in the hospital before they were released. But now, with improved insulins, quicker diagnosis, and crucial support from nurses it is normal for a child to be discharged within just 36 hours if there are no further complications! At Guildford’s Royal Surrey Hospital’s Cedar Centre there is excellent follow up care through dedicated diabetic nurses and specialist consultants, providing the back up and care that diabetics need on an on-going basis.
There have also been numerous advances over the last ten years improving how diabetes is managed on a day-to-day basis. One of the biggest breakthroughs has been ‘pump therapy’ which has replaced the need for multiple needle injections of insulin every day. I now wear an insulin pump which is around the size of a small mobile phone with a screen and buttons and that contains a cartridge of rapid-acting insulin. It can be programmed to deliver the insulin into the body through a thin plastic tube called an infusion set. New advances currently being trialled include technology to do ‘continuous glucose monitoring’, linking your real-time blood sugar levels to your pump for it to automatically administer the right amount of insulin into your body, in effect creating an artificial pancreas. Technology is also moving on with blood sugar testing systems, the meters are smaller, more user friendly and not so clinical looking. There are also new insulins appearing on the market, which are more fast acting such as ‘Fiasp’ or longer acting such as ‘Degludec’.
There are still some prejudices around type 1 diabetes that need to be expelled. The most common questions I’m asked are: has this got too much sugar in it? You can’t have that chocolate cake because you are diabetic. The answer to all these questions is no! While it is true that if you have type 2 diabetes which is usually the result of obesity then you are normally advised to significantly reduce sugar intake but on the whole, this is not the case with type 1. Of course I have to be sensible if my blood sugars are high but this certainly doesn’t mean being deprived of a Mars bar when desired! It’s an important message that having type 1 diabetes should not stop a person from doing anything they wish to do. The police and fire departments now employ people with type 1 diabetes which they previously didn’t as long as the person can show they have good diabetes control and good ‘hypo’ awareness (when your blood sugars drop).
Whilst type 1 diabetes is a terrible and permanent condition, technological and scientific breakthroughs are bringing with them renewed hope for sufferers. Some recent news reports are predicting that a cure is within striking distance. In the meantime, as Nigel Thorpe, the Royal Surrey’s excellent diabetic nurse and fellow type 1 sufferer, told me: ‘I'm a firm believer that the individual tells the diabetes what they want to do and when they want to do it and not the other way around.’
If you want more information on type 1 diabetes visit https://jdrf.org.uk/
