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'Hidden diabetes': the symptoms you might miss

One in 10 people over the age of 40 is now living with a diagnosis of Type 2 diabetes in the UK. However, delays to diagnoses caused by missed symptoms, and 12 months of lockdown restrictions, could be creating a ticking timebomb when it comes to our health. 

A new study undertaken by the University of Exeter revealed that those with Type 2 diabetes wait an average of 2.3 years, and sometimes more than five, before getting diagnosed. The findings, which are based on data from more than 200,000 patients, stress the importance of regularly screening people over the age of 40, who are more at risk of developing the condition. The wait to get diagnosed often leads to delays in getting treatment, which increases the risk of serious complications such as heart disease, strokes or eye problems. 

Dan Howarth, head of care at charity Diabetes UK, explains the delay could be down to how difficult it is to identify the symptoms of Type 2 diabetes; often they occur slowly, and are easily confused with other conditions. Normal blood sugar levels range between 3.5mmol/L and 6.9mmol/L, and the diagnosis point is generally 7mmol/L. “[However] you only start to get symptoms, such as needing the toilet more often, when your blood sugar levels are above 11mmol/L. Even then, people often don’t notice the symptoms and put them down to something else, such as their stress levels or their age,” explains Howarth.  

Although men are more at risk of developing Type 2 diabetes, the study showed that women are more likely to experience a delay to their diagnosis. “There is some speculation here, but it could be because women put their symptoms down to other factors such as hormones, stress or daily activities,” explains Howarth. Those who aren’t considered to be obese, or whose blood sugar was at the lower level of the diabetes range, were also more likely to have a delayed diagnosis. 

Lockdown has also been a driving factor in the number of undiagnosed diabetes cases: at least 60,000 cases of Type 2 diabetes in the UK were missed after lockdown began in March 2020, as patients were less likely to see GPs and get referred for checks, according to research from the University of Manchester. Experts are warning that the reduction in diagnoses rate means that the NHS now faces a “huge backlog” of undiagnosed patients. 

This comes at a crucial time for the nation’s health. Being obese is a crucial risk factor for developing Type 2 diabetes, yet over lockdown one in three people gained weight and decreased their physical activity. A separate study found that more than half admitted to snacking more, meaning that delays in diagnosis rates could only add to the number of people developing serious complications later down the line.

In patients with Type-1 diabetes, the body attacks the cells in the pancreas, which stops insulin from being created. In Type-2, the pancreas either doesn’t produce enough insulin or it becomes ineffective at transporting glucose - something known as insulin resistance. Dr Prash Vas, consultant in Diabetes at London Bridge Hospital, explains that Type-2 diabetes “exists on a continuum”. At its earliest stage it is known as prediabetes, which occurs when your blood sugar levels are just higher than normal, but not high enough to warrant a diagnosis with Type-2. 

“[Prediabetes] has no symptoms. As your blood sugar levels go higher, the body will mount symptoms. Even this group of individuals can have complications, such as a three times higher risk of developing eye problems such as diabetic retinopathy. There is also an increased chance of developing kidney problems and early nerve damage,” he says.

The good news is that prediabetes is reversible through lifestyle changes, such as a healthy diet and more physical exercise. However, a delay to diagnosis means you can lose the opportunity to “optimise your blood sugar levels” as early as possible, explains Dr Vas. He adds that high blood sugar levels often interplay with other metabolic conditions, such as high blood pressure, obesity and abnormal cholesterol - all of which can trigger an "inflammatory state" in the body. This balancing act influences how likely you are to experience serious complications later down the line.

Experts are also concerned about the rise in hidden diabetes, which is where people already have blood sugar levels that are above the World Health Organisation guidance. Research by the University of Exeter last year showed that half a million adults may have type 2 diabetes without realising.

Two well established symptoms to look out for are polydipsia and polyuria; feeling thirsty all the time and needing to go to the bathroom more often. “You feel like you want to drink sweet things, because the body is asking for sugar. Because you are drinking a lot, you end up urinating more often,” says Dr Vas. Another sign is unexplained weight loss.“If the body can’t use the glucose in its system, it will start to use alternative fuel such as fat,” he says. “Because the muscles, and other organs, are unable to access the blood sugar they need, you will also feel tired.”

Thrush is a lesser known sign of Type 2 diabetes. It usually occurs around the genitals, but also around the mouth, armpits and in between the fingers. “Because you are losing fluids - water, salt plus glucose - the content of your urine has changed, allowing for the formation of candida yeast [thrush],” says Dr Vas.

Skin changes are also something to be aware of. "Glucose and insulin help to regulate wound healing, so the process can be impaired by Type 2 diabetes,” he says. This increases the risk of wound infections - and in the worst cases, amputations - later down the line. 

One study found that insomnia could also be a risk factor associated with developing Type-2 diabetes. Researchers from the  Karolinska Institutet in Stockholm, Sweden, found that people with insomnia were 17 per cent more likely to develop diabetes than those without. 

Because of how tricky it can be to recognise symptoms, it is crucial to understand your risk factor. Being overweight, your ethnicity, your family history and smoking can all increase your chances of developing Type-2 diabetes, and regular screening is recommended for those who are at risk. “Screening and detecting early gives people extra years to understand their diagnosis, and hopefully prevent them suffering from more serious complications later down the line,” says Dr Pras. 

Reference: The Telegraph: Alice Hall  3 days ago