Gain Confidence in Treating Diabetes

Professor Saqib Mahmud is a GP with a passion for diabetes. He is proud to be the Early Action in Diabetes UK champion as well as a professor of diabetes and internal medicine. Here at MORPh, we are keen to assist practitioners to become comfortable treating diabetes patients. Anybody wishing to upskill in this area can apply to join our Diabetes Academy. Benefit from a series of webinars presented by leading experts including Professor Mahmud. Each attendee pairs up with a mentor to support them on their learning journey. We also provide a friendly peer-to-peer support group on Telegram.

Early Action in Diabetes

It is important to act early to avoid the complications that may be associated with diabetes. There are four pillars of early action, based on the Berlin Declaration which aims to affect policy change to drive early action on type 2 diabetes. The four pillars are:

• Prevention
• Early diagnosis
• Early control
• Access to correct interventions early on

Some statistics

Diabetes is the fastest growing health challenge worldwide. Growth is currently exponential, having grown from 285 million in 2009 to 463 million in 2019. Professor Mahmud refers to it as a time bomb.

• One person dies every 6 seconds from complications
• 1 limb is amputated every 30 seconds
• 50% of type 2 diabetics have complications at diagnosis. This means they were not diagnosed early enough.
• Diabetes is the leading cause of blindness worldwide
• It is also the leading cause of end stage renal disease requiring dialysis, which costs around £30,000 per patient per year
• If you have type 2, your stroke risk is 2.5 times higher
• Diabetics are four times more likely to have a cardiovascular event
• 50% of all non-traumatic amputations are as a result of diabetes complications

The cost of treating complications far outweighs the cost of drugs to treat diabetes.

Link between diabetes and obesity

Diabetes and obesity are closely interlinked. A woman with a BMI over 35 has an 80-90% risk of developing diabetes. A man with a BMI over 35 has around a 50% chance of developing it. The link between diabetes and obesity is why many newer therapies focus on both lowering glucose and weight reduction. Two out of three people in the UK are obese, hence experts referring to a “diabesity” epidemic. This is due to our poor lifestyle.

Professor Mahmud is concerned that many pharmacists, including himself, recommend things to their patients that they don’t do themselves such as increasing their exercise levels. Even little things make a difference, like getting up to turn the heating on instead of using an app on your phone to do it. Behaviours are habitual and environmentally cued. For example, the presence of an escalator makes people less inclined to use the stairs.

Blood glucose regulation

Normal blood glucose levels are between 4-6mM. After a meal, blood glucose rises, stimulating the release of insulin. Insulin promotes the removal of glucose from the bloodstream and it is stored in fat cells and muscle. The liver also stores some glucose, which is called glycogenesis. Glucose production in the liver is then inhibited. As glucose is disposed of, blood glucose levels decrease to normal. If there is no insulin to signal to the liver to stop making glucose, it will continue to do so.

If blood glucose becomes too low, glucagon tells the liver to make glucose or release stored glucose, therefore stabilising blood glucose levels. Glucagon also suppresses the appetite, maintaining normal metabolism.

What is diabetes?

Insulin is a key to open the locks of the cells because there is enough glucose. But without the ‘key’, the glucose will remain in circulation. Type 1 sufferers lose that key, completely because it is an auto-immune disease.

Type 2 is different. There is enough insulin or even too much, but it can no longer unlock the cells properly due to a fault with either the insulin or the cells. This is insulin resistance.

Type 2 diabetes is a condition where there is insulin resistance. Insulin deficiency then kicks in due to the insulin resistance. Blood sugar levels remain high at all times because it is not being stored correctly. The majority of cases we deal with are type 2 diabetes, which makes up 95% of cases with only 5% of all cases of diabetes being type 1.

Development of diabetes

As a person becomes overweight, the body develops insulin resistance. The body then thinks there is insufficient insulin, so it produces too much. Eventually, so much insulin is produced that the insulin production cells become overwhelmed and begin to die. Insulin resistance increases and insulin secretion initially increases but subsequently decreases which is when the patient develops diabetes.

Early into the onset of diabetes, a fasting glucose test might miss the diagnosis. A glucose tolerance test is better for early diagnosis.

Further information

To hear more from Professor Saqib Mahmud, check out our Diabetes Academy. We created the programme to support pharmacists in becoming advance practitioners in diabetes. During the programme, you will have access to experts including Professor Mahmud. Mentors will be on hand to help you on your learning journey, and you can put your learning into practice using a case based approach.