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Dr Duncan

Diabetes, what can we do?

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I love coming across quirky medical stories that have a simple message, and one that I am particularly fond of is one about London bus drivers!

Back in 1951, a sharp eyed Doctor in London noted that London bus drivers seemed to die more frequently than their more active colleagues - the bus conductors, who were constantly rushing up and down the stairs shoutingFares please'. So he decided to do a survey and confirmed that the bus drivers were twice as likely to die of heart disease when compared to their athletic assistants who collected the money, even after eliminating other well known risk factors such as smoking and family history.

The research has its own unique place in the early folk-lore of epidemiology. Like a lot of things that we once knew, we seem to have “lost” that knowledge in the intervening years, and have become an increasingly sedentary society, that not only “sits and drives”, but probably eats as it sits and watches telly too!

All of this came to mind when reading a paper by Dr Emma Wilmott from Leicester University in the UK who looked at the length of time that people spent sitting and its link to the development of diabetes.
What she and her colleagues found was that “the greatest sedentary time compared with the lowest was associated with a doubling of diabetes, around a 2.5-fold increase in the risk of cardiovascular events, a 90% rise in risk of cardiovascular death and a 49% higher risk of all-cause mortality”.  So even if you are active for 30 minutes each day, you also need to be aware that if you sit on your behind for the other 23 and a half hours, then you may still be increasing your risk of developing diabetes and of having a heart attack.

What made me think of this was the fact that it is so important to try and reduce the risks of getting diabetes, because once you have it - at this stage anyway - you can’t get rid of it and it does have the potential to have some very serious complications. In another paper recently published, researchers have suggested that even if we screen more for diabetes in the community and then treat it appropriately, earlier intervention does not appear to improve life expectancy, despite previously held hopes for such screening programs . What this large UK study suggests to me is that we have to work even harder on reducing the number of  people who are at high risk of  developing type II diabetes such as the obese and those with a sedentary, inactive life-style. Because it would appear that once you step over the line and into diabetes, then it’s a whole different ball game where the body appears to be operating under a completely different set of metabolic rules.

Type II diabetes accounts for an increasingly larger percentage of those who have diabetes, but there is also the group who suffer from Type I or Juvenile Diabetes, which is a different sort of beast. Type I diabetes  produces the same eventual metabolic pathway as Type II diabetes with all the long term complications that can happen if the disease is not treated seriously.

Type II diabetes is where the body develops a resistance to insulin. Insulin is like the doorman at a posh hotel who opens the door for you - it does the same for glucose when it tries to get into cells providing the fuel to power them properly. If the doorman/insulin is not doing his job properly then glucose can’t get into cells and the cells start to malfunction. In Type I diabetes there appears to be a gut based immune malfunction whereby the body starts to destroy the cells in the pancreas that produce insulin, so that there is less and less insulin available and the cells become less and less efficient.

Scientists and researchers are making massive strides in combating this disease with improved insulin and better delivery systems: they are working on bio-engineered tissues that can be implanted to take over the role of those failed pancreatic cells.  At the same time they are attempting to reduce the impact of the “insulin deficit” challenge on various organs around the body - the heart, the kidneys, the eyes and the circulation.

But the huge area where we can all make a big contribution to prevention of diabetes in our own lives, the lives of our families and the various communities in which we live and work in, is to reduce the burden of overeating, of being sedentary and not being physically active. Eat quality food in smaller quantities, get off your backside more often during the day and get out to smell the roses down at the local parks and gardens: it’ll do your health the world of good.

Article written by Dr. Duncan Jefferson. For more articles by Dr. Duncan, click here. For more information on healthcare and private health cover, visit HBF Insurance at hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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