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Easter is a sign of a number of things: change, new life and reflection. Often in modern times, Easter has become all about indulgence with chocolate eggs and sweet treats being seen in shops from New Year. However, what also comes around annually are the jokes from high profile people linking indulgence and sweets with a serious condition called diabetes. This year we saw these jokes being publicised by a TV personality with over a million followers on Twitter.

Jokes are often seen as harmless, however they can perpetuate the stigma and misunderstanding of serious conditions, in this case diabetes. I feel it is important to share the real causes and consequences of diabetes and to share how it impacts on our family in particular, in a hope that we can educate and inform people the next time misinformation is used to gain a few laughs!

What is diabetes?

Diabetes in general is a condition where a person is unable to handle the breakdown products of carbohydrates (sugar) in a way a non-diabetic person would. This is important because the cells in our body rely on sugar to get energy, but this has to be done in a controlled way. There are two chemicals called hormones that are important – insulin and glucagon.

Insulin acts like a key to unlock a door. When sugar levels go up in our body, insulin is released by the pancreas to open the door in cells and let sugar in. Glucagon acts like a hedge trimmer, it breaks down stored carbohydrates to increase the sugar in our blood when they dip too low. Our pancreas is releasing these two hormones constantly to keep our blood sugar levels fairly constant.

People with diabetes have an issue with insulin specifically.

There are many different types of diabetes including gestational diabetes, which is seen in pregnancy, and steroid induced diabetes, which is brought on by medications. The two most well-known types however are type 1 and type 2.

What causes diabetes?

What doesn’t cause diabetes is eating too much chocolate!

Type 1 diabetes used to be known as “juvenile diabetes” because it is the type seen in 90% of diabetics under the age of 25. However, we now know that you can be diagnosed with type 1 diabetes at any age. Type 1 is caused by your own body attacking the pancreas which is called an autoimmune response. As your body attacks the cells that release insulin, the amount you can release diminishes, meaning your cells cannot get the sugar in to make energy.

The cause is unknown, but as it is decided by your genes you are destined to get it at some point from birth. Usually a trauma or illness triggers the immune attack. As the cause is your own body attacking itself, there is currently no cure. There are currently around 31,500 children with type 1 diabetes in the UK and the numbers are increasing.

Type 2 makes up the largest amount of diabetic cases with around 90% of all diabetes. This equals nearly 400 million people having type 2 diabetes worldwide and this figure is rising. Worryingly, it’s becoming more frequent in younger people. In type 2 diabetes, rather then not having enough insulin, they don’t respond to insulin the way a non-diabetic would, almost like the cells have switched off to the “open up” signal and so sugar again doesn’t enter the cells. The most common factors in the development of type 2 diabetes is having excessive body weight and insufficient exercise levels. With this type there are drug treatments to help and you can reverse the condition in some people with lifestyle changes.

If type 1 has no cure, how is it treated?

A type 1 diabetic has to take on the role of a pancreas. This essentially involves the regular testing of blood sugar levels and the administering of insulin either via an intramuscular injection every time you eat anything with more than 5g of carbohydrates or constantly via an insulin infusion device.

The amount of insulin given has to be accurate and involves a lot of maths! Type 1 diabetics need to factor in their current blood glucose levels, the amount of carbohydrates they are going to eat, the time of day, the type of food, their activity level and hormonal cycle.

Carbohydrate counting of food stuffs is an essential part of this calculation and can be quite difficult particularly when eating out (give it a go during your next meal!).

Too much insulin can lead to low blood sugar or hypoglycaemia which can lead to seizures, coma and death within minutes and so a type 1 who is “low” requires rapid consumption of fast acting sugar e.g. fruit juice or Lucozade.

So, in fact, chocolate may not cause diabetes, but it may well help to treat it!

The use of technology in diabetes is rapidly evolving and soon with the use of blood sugar monitors and insulin pumps, diabetics can soon have an artificial pancreas of sorts and live somewhat free of their diabetes.

Why is diabetes so serious?

In 2012, diabetes in total was the direct cause of 1.5 million deaths globally. Often, it can be deadly before you’ve even realised you are diabetic!

When sugars can’t enter your cells, they can’t make energy the way they would normally. This signals to your body to start breaking down fat tissue instead, which makes the blood acidic. This acidosis can develop with 24-48 hours of the first symptoms of type 1 diabetes and if untreated it can lead to unconsciousness and death, which is seen in 10 children in the UK every year.

As mentioned in type 1 diabetes, hypoglycaemic episodes can quickly lead to a patient entering a coma or dying within minutes. This can happen at any time day or night and so patients and/or their carers must be vigilant at all times.

What is more worrying when seeing public figures making jokes about diabetes is that there is increasing evidence of significant mental health concerns within children with type 1 diabetes, with nearly 40% of type 1 diabetic children seeking assistance from mental health support teams. It’s estimated around four out of 10 women, aged 15 to 30, take less insulin to lose weight. And for young men, it’s around one out of 10. The behaviours needed to manage type 1 can play a part in building these issues, for example - having to carefully read food labels, the focus on your weight when you go to the clinic, having to eat to treat lows, which can cause weight gain and guilt, being constantly aware of carbohydrates or calories in food.

Why does diabetes mean so much to me?

November 2nd 2018, our then one-year old Gracie was rushed to hospital in a semi-comatose state following a short illness. She was diagnosed as type 1 diabetic within 15 minutes and put on a drip of insulin overnight. In the three years since, she has adapted to her condition and made it her own, and despite our ups and downs, Gracie is completely on top of her diabetes and thriving. She still has at least six injections of insulin a day and we as her carers are still constantly watching her for lows, however her blood sugar monitor has revolutionised her management, even if we are still getting up most nights to give her fruit juice.

She is not afraid of telling anyone that she is diabetic and that her pancreas doesn’t work. If you’re lucky, she may even show you her “butt button” (the Dexcom, blood glucose monitor is attached to her bum!).

Most importantly, she sat down on Easter Sunday and tucked into her chocolate eggs with her siblings like most other children in the UK!

Dr Gareth Anthony Nye, Lecturer of anatomy and physiology for Chester Medical School and Ambassador for the Society of Endocrinology.

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