07 Jan 2020
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14 Jan 2020
Professor Ben Bridgewater: My risk is low but could I have diabetes?
In the second blog of his health improvement challenge using digital resources and information, our Chief Executive Professor Ben Bridgewater explores his risk of developing Type 2 diabetes and tests his blood glucose levels.
Last time, I blogged about my use of online tools to screen my health, and I discovered that my major modifiable risk factor was my weight. I am overweight, not to the point of obesity, but to the level where my risk of Type 2 diabetes is increased. According to the tools, I can decrease my risk by three times by reaching a target body weight of 12st 6 lbs. I have committed to screening myself for pre-diabetes as well, and before doing so I thought it might be useful to look at a bit of medical history of the causes of premature death.
Over time, with few significant exceptions, populations have been getting healthier and people are living longer. In the midst of the industrial revolution in the 1850 the average life expectancy of a man living in Manchester was 39. Major causes of death were infectious diseases driven by overcrowding and poor sanitation. By 1950 the male life expectancy in the UK had increased to 66 contributed to by public health initiatives, including better housing and sanitation, set alongside the introduction the of childhood immunisation programmes and the advent of antibiotics for infectious diseases. By the 1970s the biggest killers in the UK had become cardiovascular disease, cancer, and respiratory diseases, replacing their predecessors of measles, diphtheria, tuberculosis and pneumonia.
But the relentless, ongoing increase in life expectancy has now started to slow down, or possibly decrease. And while infectious diseases remain better controlled, new pharmaceutical and other treatments continue to become available and population health initiatives, such as smoking prevention programmes, are making a difference, obesity is on the increase. The prevalence has gone up by 65% in men, and 25% in women since 1991, and obesity now affects 29% of people in the UK in 2017. It has been estimated that by 60% of males and 50% of females will be obese by 2050.
Obesity contributes to excess mortality and many diseases including arthritis, hypertension, heart disease, stroke, cancer, and diabetes. The number of people in the UK living with a diagnosis of diabetes has doubled over the last 20 years and currently stands at about 3.7 million (6.6% of the population) with an estimated further 1 million having diabetes which is not yet diagnosed. in addition, pre-diabetes is now estimated to affect a third of the UK population; between 5% and 10% of people with pre-diabetes progress to diabetes every year.
In my previous blog I used the NHS online tool and the Diabetes UK website to give me an indication of my overall health, and specifically my risk of having Type 2 diabetes. Just to recap, my risk of diabetes was 9 (out of a maximum score of 47) – increased but not disastrously so, but given the scary complications of diabetes and an ability to influence the progression of the disease if detected early enough, I have spent more energy on this. We also happen to have a blood pressure monitor lying around at home and I have checked my BP – it is 130/85 which is OK, so nothing more to do there for now.
Many people have type 2 diabetes without realising it, which is one of the reasons why I want to exclude any chance that I have any increased risk. Typical symptoms can include feeling thirsty, urinating more often than usual, feeling tired all the time, unexplained weight loss, blurred vision and various skin symptoms. For the record, I have none of these symptoms at all.
People are more at risk of developing diabetes if they are over 40, have close relatives with diabetes, are overweight, or are from some specific ethnic backgrounds, so my only real risk factor is my weight. There are several ways diabetes can be diagnosed – the presence of glucose in your urine or an elevated glucose level in the blood. So, the quickest and easiest way for me to make diagnosis is to measure my blood glucose.
I have just been to the pharmacist and bought myself a blood glucose monitoring meter and test strips, at a cost of £14.99. Working out how to use the meter is straightforward – the only delay in getting a result was for me to be fasting. My measurement has come back at 5.4 mmol/l.
According to the WHO the threshold for making a diagnosis is a fasting plasma glucose of 7.0 mmol/L or more. Plasma glucose is usually measured in hospital laboratories – blood is taken and then spun down in the lab to separate the blood cells from the plasma, and the plasma is tested.
My DIY kit tests whole blood glucose, and so the thresholds are different – I have used an online tool to convert my blood glucose reading to plasma, which changes my blood glucose of 5.4 mmol/l to a plasma result of 6.0 mmol/L – so I don’t seem to have diabetes which is good.
But what about pre-diabetes; this is defined as an abnormal glucose metabolism, but not sufficiently severe to give a diagnosis of diabetes. Pre-diabetes is a potentially reversible condition, which we know is increasingly common across the world, again related to obesity. The WHO threshold for pre-diabetes is 6.1 – 6.9 mmol/l. So I don’t seem to have pre-diabetes according to the WHO, but I am close on this one off reading. The American Diabetes Association (ADA), on the other hand has a lower cut-off value for a diagnosis of pre-diabetes of 5.6 to 6.9 mmol/L so according to them I am pre-diabetic. I need to do something about this, more about which next time.