For most people, changes in lifestyle can help prevent or manage diabetes and its effects

COULD YOU be one of the thousands of people in Ireland on the brink of developing type 2 diabetes? Would you even know if you already had the condition? And what can you do right now to improve your blood sugar control and keep down the risk of complications like heart disease and damage to organs, eyesight and limbs?

Getting to a healthy weight, kicking cigarettes and making sure you keep physically active form the triple crown of preventing and managing diabetes, according to Dr Anna Clarke, health promotion and research manager with the Diabetes Federation of Ireland.

More than 180,000 people in Ireland have diabetes but as many as 60,000 of those are undiagnosed, says Clarke. Most have type 2, where the body responds poorly to insulin, a hormone that helps to remove sugar from the bloodstream into cells to burn it for energy. Excess sugar in the blood can damage blood vessels (and the tissues they supply) and nerves over time.

On top of that, about another 60,000 people are “pre-diabetic”, so unless they change their lifestyle they are expected to develop diabetes in the next five years, she adds.

And the age of diagnosis is coming down. “Ten years ago I would have said the average person diagnosed with diabetes was probably in their late 50s and possibly overweight,” says Clarke. “Now the average I’d say is early 50s, even possibly into their late 40s, and very overweight.”

Obesity is a driver of that trend, she notes. “Once you move to a BMI of 28 you are in the overweight category and your risk increases. But once you go over 30 , you are trebling your chance of developing diabetes.”

Losing excess weight will improve your body’s sensitivity to insulin, and so will quitting smoking, says Clarke.

And even if you are not losing weight, exercise improves the body’s ability to keep the circulation in good nick. “You can be healthy and overweight if you are exercising a lot – it improves insulin response and in a fitter person their heart is pumping better and that’s clearing the sludge out of their blood vessels,” says Clarke.

A family history where a father, mother or sibling has type 2 diabetes means you have to be even more on your guard, says Clarke.

If you are diagnosed with type 2 diabetes it means an ongoing watch. “There’s very little difference between preventing and managing, it’s about healthy eating and exercise. You may be able to bring your blood sugar levels back to normal through diet and exercise, and that’s great as long as you keep going with it, but you need to be monitored for the rest of your life,” says Clarke.

Yet while lifestyle change like increased physical activity can act quickly for most – even a single bout of exercise can change you metabolically – there are some special situations that could need more intervention.

A new study involving researchers at Trinity College and St James’s Hospital has found that young obese people aged 18-25 with type 2 diabetes seemed unable to respond normally to exercise at a cellular level.

The study looked at their muscle biopsies before and after three months of exercise, and compared them to a control group of obese young people who did not have type 2 diabetes.

“We found a very clear distinction between the two groups,” says Prof John Nolan, a consultant in endocrinology and metabolism and an author on the paper in diabetes care.

In particular, the young obese people with diabetes had low levels of a protein called mitofusin 2, suggesting that mitochondria in their cells were not responding normally to exercise.

“For some reason the physiological effect of exercise, which is very powerful in older patients, is unable to unlock the metabolic changes in young people with type 2,” says Nolan, of the Metabolic Research Unit at St James’s.

Dietary interventions have also been under the microscope in Lipgene, a pan-European project to look at diet and genes in people with the metabolic syndrome, which is often a prelude to diabetes.

The study of 500 people found that replacing saturated, animal fats with mono-unsaturated fats helped improve insulin sensitivity.

However, there were differences in the responses, says Helen Roche, associate professor of nutrigenomics at University College Dublin and a co-ordinator of Lipgene.

“Some people are less flexible,” she says. “We could identify categories of people who would respond either based on their genes or their habitual fat composition.”

But we should not just jump in and blame the genes instead of making lifestyle changes, she adds. “ are so complex from a genetic perspective you can’t say you have just one gene that’s going to cause it. You can’t take that cop-out clause, that’s just someone saying, ‘I don’t have to do anything’.”

This month the Diabetes Federation of Ireland has launched Tea for Diabetes 2010, which encourages people to host events to raise awareness of the condition. For details, visit www.diabetes.ie or tel: 1850-909909 or 01-8363022.