The pancreas secrets Insulin via the islets of Langerhans. Insulin transports
glucose to cells to be used for energy.
Insulin also increases the rate the liver takes in glucose to convert it into
glycogen. It controls the rate that the liver converts excess glucose into fatty
acids to be stored as energy in the adipose layer of the skin. By doing these
actions, insulin lowers glucose levels.
Insulin also helps with amino acid intake into cells and plays a part in the
process that converts amino acids into proteins.
Glucagon is also secreted by the islet cells. It works alongside insulin to
regulate sugar levels. Glucagon makes the liver release stored glucose.
Glucagon increases the rate that glucose is produces form liver proteins. So,
Glucagon raises blood sugar levels (Janson Cohen, 2005)
‘…any disorder of the metabolism causing excessive thirst and producing
large volumes of urine. Used alone, the term most commonly refers to
diabetes mellitus’ (Martin, 2002, pg.190).
This scenario looks diabetes mellitus. However, another type of diabetes is
called diabetes insipidus.
People with this often feel thirsty and produce large amounts of urine. This
condition is caused by a deficiency of Vasopressin (pituitary hormone). It is an
anti diuretic hormone and it regulates absorption of water in the kidneys.
Treatment for this condition is administration of vasopressin (Martin, 2002).
Diabetes mellitus is a condition in which the amount of glucose in the blood is
too high because the body cannot use it properly (Diabetes UK, 2006). The
sugars in the body are not oxidised to produce energy because there are
insufficient levels of insulin released from the pancreas (Martin, 2002).
There are two main types of diabetes: Type 1 and type 2.
In Type 1 diabetes the body is unable to produce any insulin. This type of
diabetes usually appears before the age of 40. This is the least common of
the two main types and accounts for between 5 – 15% of all people with
diabetes. This type occurs due to an autoimmune response to the insulin
producing cells in the pancreas. This results in the destruction of beta cells
and reduced ability to produce insulin (Jansen Cohen, 2005).
Type 2 develops when the body cannot make sufficient amounts of Insulin, or
when the insulin that is produced does not fulfil its function (known as insulin
resistance).Type 2 diabetes usually appears in people over 40. However, in
South Asian and African-Caribbean people it often appears after 25. It is also
increasing in children, especially those who are overweight. Type 2 diabetes
is the most common and 85 - 95% of all people with diabetes have this type.
This is the type of diabetes that is linked to obesity (Diabetes UK, 2006).
Other types of diabetes
There is also a type called maturity onset diabetes of the young. Diabetes UK
(2006) suggests that it affects 1-2% of people who have diabetes. It often
develops before the age of twenty five; it’s hereditary and is usually treated
with lifestyle changes, such as healthy eating changes and increases in
exercise. Maturity Onset Diabetes of the Young is due to a change in a single
gene that is passed from a parent carrying the affected gene to their child.
This is called autosomal dominance inheritance and changes to six types of
genes that have been identified accounts for 87% of MODY in the UK
(diabetes research, 2008). All children of an affected parent have a 50%
chance of inheriting the affected gene and developing MODY themselves. It
does not necessarily effect young people who are obese as it does not seem
to be linked to obesity (Diabetes.co.uk, 2008).
Another type of diabetes is latent autoimmune diabetes of adulthood (LADA).
The person does not exhibit all the normal signs of type 2. Instead they have
symptoms of both type 1 and type 2. A key tool in identifying this type of
diabetes is elevated levels of pancreatic autoantibodies amongst patients who
have recently been diagnosed with diabetes but do not require insulin
Gestational diabetes happens during pregnancy. It has symptoms like type 2,
in that the body cannot produce enough insulin to covert sugar to energy.
Mothers-to-be are screened at 24-28 weeks for this type of diabetes.
According to diabetes.co.uk (2008) gestational diabetes occurs in three to five
percent of all pregnancies which is means that one in 20 pregnant women will
develop gestational diabetes.
Pre diabetic stage
People who are in the Pre-diabetic stages are on the increase. This is largely
to do with the fact that it is linked to obesity. ‘Pre-diabetes is almost always a
precursor to the development of type 2 diabetes. It is characterised by the
presence of higher than normal blood glucose levels that are yet to reach
diabetic levels. The scale of the problem is enormous and growing, as
Western society and diet becomes more pervasive. Pre-diabetes is also a
critical stage, for it is at this point that sufferers still have the lifestyle choices
to turn their condition around. Early, decisive action can slow down or even
halt the development of type 2 diabetes. One of the most insidious aspects of
pre-diabetes is the fact that the sufferer often does not know that they have
the condition until type 2 diabetes has developed’ (Diabetes.co.uk, 2008).
Symptoms of diabetes include:
Increase of urination.
Changes/disturbances to vision.
Reoccurrence of thrush
Healing of wounds slows.
Abnormal blood glucose levels.
Presence of glucose and/or ketones in the urine.
According to diabetes UK (2006) people are more at risk if they are any of the
white and over 40
If they are black, Asian or from an ethnic minority and over 25.
‘African-Caribbean or South Asian people who live in the UK are at
least five times more likely to have diabetes than the white population’
(Diabetes UK, 2006).
Type 2 diabetes is in the family.
Overweight or have a waist measurement of over 31.5 inches for
women, 35 inches or over for Asian men or over 37 inches for white
and black men. 80% of people with diabetes are overweight.
Have had Previous MI.
Have had Previous CVE.
If a women has PCOS and is overweight.
Have impaired glucose tolerance.
Have impaired fasting.
If a women has had gestational diabetes.
Have severe mental health problems.
High cholesterol (NHS, 2007).
Women who have given birth to babies over 9lbs (NHS, 2007)
Diabetes can contribute towards major health issues, such as:
Coronary heart disease – The Framingham study (1948 – present day)
has identified that diabetes is among the influencing health factors that
contribute to CHD. These factors are all major CVD risk factors - high
blood pressure, high blood cholesterol, smoking, obesity, diabetes and
physical inactivity (National heart, lung and blood institute and Boston
Stroke – The Department of Health (2007) noted in their national stroke
strategy that diabetes was a risk factor for strokes and they highlighted
the importance of managing it according to clinical guidelines, therefore
management of risks that can lead to stroke. Diabetes was mentioned
alongside hypertension, obesity, high cholesterol and atrial fibrillation
as risk factors. It noted the importance of individuals monitoring and
taking responsibility and treating their own vascular risk factors – So
effective and active management by patients of their diabetes is
extremely important in the prevention of stokes.
The NHS (2007) noted in a project that ‘…A significant idea to emerge
during the course of the DHDS (diabetes, heart disease and stroke)
Pilot Prevention Project is the concept of thinking in terms of ‘the
vascular syndrome’, as opposed to individual diseases such as
coronary artery disease or diabetes. People who happen to be
diagnosed as having diabetes almost always have vascular disease
and the prevalence of diabetes in people with, for example, coronary
artery disease is significantly higher than in the general population…’.
In agreement with this idea of thinking of diabetes as a vascular disease
and not just a condition in its own right, there has been a recent move
towards screening for vascular conditions altogether.
On the 1st April 2008, Alan Johnson the health secretary announced a new
national programme. A press release on the Department of Health website
noted that Alan Johnson had stated that a national program to identify
vulnerability to vascular diseases will prevent up to 9,500 heart attacks
and strokes every year and save 2,000 lives. He also stated that it would
reduce health inequalities for people in deprived areas. The Department of
Health (2008) stated ‘…Initial results from modeling work carried out by
the Department shows that a vascular check program would prevent 4,000
people a year from developing diabetes. It could also detect at least
25,000 cases of diabetes or kidney disease earlier, allowing cases to be
better managed and improving outcomes…’
Below is detailed standard one of the National service framework
(NSF) for diabetes (Department of Health, 2001). This standard
focuses on the prevention of type 2 diabetes and highlights factors that
are linked to the onset of type 2 diabetes.
To reduce the number of people who develop Type 2 diabetes.
Standard 1 – prevention of type 2 diabetes.
The NHS will develop, implement and monitor strategies to reduce the risk of
developing Type 2 diabetes in the population as a whole and to reduce the
inequalities in the risk of developing Type 2 diabetes.
1. The number of people with Type 2 diabetes is rising, with an increasing
number of young people being diagnosed. Some risk factors for developing
diabetes (such as family history, increasing age and ethnic origin) are non-
modifiable. However, other risk factors (such as being overweight or obese,
having an adverse distribution of body fat and being physically inactive) are
modifiable and need to be the focus of prevention strategies.
2. The increase in Type 2 diabetes mirrors the increase in the proportion of
people, including children and young people, who are either overweight or
obese. Excessive body weight reduces the body's ability to respond to insulin
and is therefore a risk factor for Type 2 diabetes. Approximately one in five
adults in England is now obese (defined as a body mass index >30 kg/m2)
and two in five are overweight (defined as a body mass index 25-30 kg/m2).
The body's distribution of fat is also important. Excess fat stored around the
waist, referred to as central obesity, is also a risk factor for diabetes, whatever
the body mass index.
3. Regular physical activity lowers the risk of developing Type 2 diabetes by
increasing insulin sensitivity. This reduction in risk of diabetes is independent
of body weight. Physical activity rates are low across the entire adult
population - around six in ten men and seven in ten women are not sufficiently
physically active. Rates of inactivity are higher among older people and in
some black and minority ethnic communities.
4. Multi-agency action is required to reduce the numbers of people who are
physically inactive, overweight and obese, by promoting a balanced diet and
physical activity across the population. In order to have the greatest impact,
action must start in childhood. These interventions will also contribute to a
reduction in the number of people who develop coronary heart disease
(CHD). Both Type 2 diabetes and CHD are more common in people of South
Asian, African and African-Caribbean descent, and initiatives must include
elements developed with, and appropriate for, these communities.
5. Action is also needed to help those who are already overweight or obese to
lose weight, and people who are physically inactive to increase their levels of
physical activity. There is clear evidence that individuals who have impaired
glucose tolerance can reduce their risk of developing Type 2 diabetes if they
are helped to eat a balanced diet, lose weight and increase their physical
The overall prevalence of Type 2 diabetes in the population can be reduced
by preventing and reducing the prevalence of overweight and obesity and the
prevalence of central obesity in the general population, particularly in sub-
groups of the population at increased risk of developing diabetes, such as
people from minority ethnic communities, by promoting a balanced diet and
physical activity. (Level 4)
Individuals at increased risk of developing Type 2 diabetes can reduce their
risk if they are supported to change their lifestyle by eating a balanced diet,
losing weight and increasing their physical activity levels. (Level 1)’
(Department of Health, 2001, Standard 1).
Department of Health (DoH) [online] (2001) ‘National service framework for
diabetes’ www.dh.gov.uk (25th April 2008).
Department of Health [online] (2007) ‘National stroke strategy’ www.dh.gov.uk
(24th April 2008).
Department of Health [online] (2008) ‘ vascular checks will prevent thousands
of heart attacks and strokes’ www.dh.gov.uk (25th April 2008).
Diabetes.co.uk [online] (2008)’ pre diabetes’ www.diabetes.co.uk (23rd April
Diabetes research – peninsula medical school, [online] (2008) ‘what is
maturity onset diabetes of the young (MODY)?’, www.projects.ex.ac.uk (24th
Diabetes UK [online] (2006), ‘what is diabetes?’, www.diabetes.org.uk (23rd
Janson Cohen, B. (ed) (2005), Memmler’s: the human body in health and
disease (10e), Baltimore USA, Lippincott Williams and Wilkins.
Martin, E.A., (ed) (2002)’ Oxford concise colour medical dictionary’ (3e),
Oxford, Oxford university press.
National heart, lung and blood institute and Boston university [online] (2008)
‘History of the Framingham heart study’ www.framinghamheartstudy.org (24th
National Health Service (NHS) [online] (2007) ‘ Diabetes, heart disease and
stroke prevention project’ www.screening.nhs.uk (25th April 2008).
National Health Service (NHS) [online] (2007) ‘patient information leaflet:
diabetes’ www.cks.library.nhs.uk (24th April 2008).