If it can hit an Olympic athlete like Michelle, it can hit anyone
AS A former Olympian who represented Great Britain in the triple jump for 15 years, Michelle Griffith-Robinson had rarely considered the possibility that she might be at risk of diabetes.
Slim and athletic, Michelle still trained several days a week and lived an active lifestyle in Devon with her husband, former Welsh rugby player Matthew Robinson, and their three sporty children.
But last September, while Michelle underwent exploratory tests for a suspected kidney problem, doctors gave her some shocking news – blood tests had revealed she was pre-diabetic. The readings showed that the 47-year-old, a personal trainer and lifestyle coach since retiring from sport in 2006, had blood sugar levels that put her right in the middle of the prediabetic range.
‘I was blown away,’ Michelle says today. ‘I walked into that room glowing with health, really fit, and you’d never have said I was at risk of developing type 2 diabetes.
‘But it just goes to show you can’t judge a book by its cover – it’s what’s going on inside that matters. If it can happen to me, it can happen to anyone.’
Pre-diabetes causes no symptoms and you may look and feel completely well – as Michelle’s case proves. So why, you might think, do you need to worry about it? After all, it means blood sugar levels are high, on the verge of type 2 diabetes but not yet the fullblown condition. Surely it’s a case of crossing that bridge when you come to it, if at all? Well, not so, according to the latest evidence.
It is well known that type 2 diabetes itself dramatically increases the risk of problems, from heart attacks and strokes to blindness, amputations and erectile dysfunction. That is why the four million
or so UK sufferers are usually given medication or other treatments to control the worst effects.
But many experts now believe that the microscopic damage to organs, nerves and cells caused by high sugar levels actually begins to happen far earlier than was previously thought. Those with pre-diabetes are also at risk of heart disease, kidney problems and possibly dementia.
Studies have shown that many of those with raised blood sugar levels can delay or even prevent the slide towards type 2 diabetes by making simple lifestyle changes to lose weight and by becoming more active. As diabetes expert Naveed Sattar, professor of metabolic medicine at Glasgow University, explains: ‘Being diagnosed means you can do something about it – this can make a huge difference to your health.’
A diagnosis of pre-diabetes offers a crucial opportunity – one that Michelle, who represented Great Britain at the 1996 Atlanta Games, grasped with typical determination. Over the past nine months, her lifestyle changes have had an impact.
She says: ‘My diet was already pretty balanced, but I changed it to include more eggs and mackerel, good lean sources of protein, and loads of veg as they’re packed with vitamins, minerals and fibre, and are also filling. I’ve cut down on fruit and now avoid sugary snacks or crisps. I snack on yogurt and walnuts instead.
‘I go running a couple of times a week and do a weights session in the gym. I’ve lost almost 10lb and my blood glucose readings show that I’m nearly out of the pre-diabetic range. I wasn’t fat but it’s all about how much fat your own body can tolerate.’
Michelle, whose mother is from Jamaica and father is from Barbados, is at increased risk of the condition because of her ethnicity.
It is thought those of African and Caribbean descent may store fat differently, accumulating it in the liver and pancreas, which then affects the production of insulin.
But in Michelle’s case, it is thought there is also a strong hereditary risk factor. Her mother, an NHS nurse for 25 years, was diagnosed with type 2 diabetes aged 58, and her grandmother in Jamaica died from diabetesrelated
complications. Four aunts and two cousins also have the condition.
Michelle is now determined to teach her own children – Reese, 15, Eden, 13, and five-year-old Elijah – to stay healthy. She says: ‘I might have been diabetic by now if I hadn’t taken action.’
THE SIMPLE TESTS THAT CAN SPOT A KILLER
ASTONISHINGLY, as many as one in three adults in the UK is already thought to be pre-diabetic – roughly 14million people.
That figure has tripled in just ten years, driven skywards by the rising tide of obesity. Yet most people have no idea they are living with the condition unless they have a blood test at their GP surgery. Indeed, pre-diabetes was once mainly picked up coincidentally, such as after a person had been admitted to hospital suffering from a heart attack.
But this is beginning to change, as doctors increasingly offer tests to detect blood sugar problems before they become severe.
One of them, known as a fasting plasma glucose test, involves eating nothing and drinking nothing except water for eight to ten hours before a sample of blood is taken from the arm. Those with pre-diabetes will have a higher than normal reading, but this only gives a snapshot of blood sugar at that moment.
Another, better indicator is a so-called HbA1c blood test. This gives a patient’s average blood sugar levels over the preceding two to three months.
HbA1c is what is known as gly
A third of people already have eye, kidney or nerve damage when type 2 diabetes is spotted
cated haemoglobin. This is made when glucose – a type of sugar digested from food – in the circulation sticks to red blood cells. The more glucose that stays in the circulation, the more HbA1c there is. The test looks for a percentage of blood as a whole made up of HbA1c, and this reading can tell doctors if you have pre-diabetes, or even type 2 diabetes.
It is possible to get a DIY athome testing kit to measure HbA1c at some pharmacists and online, which could indicate you are at risk of pre-diabetes. However, for a definitive diagnosis, it’s important to see your GP.
IT’S TIME TO GET WITH THE PROGRAMME
LIBBY Dowling, senior clinical adviser at the charity Diabetes UK, says: ‘We estimate more than half of all cases of type 2 diabetes can be prevented or delayed if we can intervene early. That means identifying people at increased risk of developing diabetes, and then helping them manage their weight and lifestyle. It’s important to recognise that type 2 diabetes is not a foregone conclusion.’
The Government is so concerned about the escalating number of cases that it is investing £90 million in a Diabetes Prevention Programme (preventing-diabetes. co.uk) in conjunction with Diabetes UK. The scheme is being rolled out in community centres, church halls and gyms across England, with 212,000 pre-diabetic patients referred by GPs last year.
Adults with raised blood sugar levels are offered monthly faceto-face meetings, usually in a group, with specialist nurses. The nurses give exercise tips and advice on making dietary changes to aid weight loss.
Some who struggle to attend regular meetings in person are given fitness tracking devices. The latest figures show that patients who lost about half a stone saw their blood sugar levels return to normal.
Prof Sattar says: ‘Studies also suggest people with pre-diabetes who tackle the problem successfully have fewer heart attacks in later life, less cardiovascular disease and lower mortality overall.’
ACT EARLY AND BOOST YOUR HEALTH
NOT everyone with pre-diabetes will go on to develop full-blown type 2 – and it is not currently understood why this is the case. For this reason, pre-diabetes has proved controversial.
Diabetes UK says it does not use the label, and it is not approved by either the World Health Organisation or the UK drugs watchdog NICE.
Concerns stem in part from the United States, where those with pre-diabetes are more likely to be prescribed drugs such as metformin to lower their blood sugar, leading to claims that people are being given medication unnecessarily.
Some British patients with prediabetes may be prescribed metformin, but this would be done on a strictly case-by-case basis determined by GPs. Dr Nicola Guess, of King’s College London, says: ‘Pre-diabetes is controversial because many won’t get type 2, and others will go back to normal. But the value in identifying it is that lifestyle changes can be super-effective in preventing type 2.
‘Patients with pre-diabetes are generally really glad that they’ve been told about it, so they can do something about it.’
Even if you have been told you have pre-diabetes, it may be tempting to avoid taking any action. But the earlier you act to reduce your weight, and protect your body against the effects of high blood sugar, the more you improve your long-term health.
In fact, some people with prediabetes may even already be at increased risk of heart problems.
Prof Sattar says: ‘Even if you manage to delay your diabetes for five years, that five years of not having diabetes has protected your blood vessels and the heart from damage caused by high sugar levels. The younger you develop type 2 diabetes, the higher the excess risk for mortality, heart disease and heart failure.
‘Get away from thinking type 2 is inevitable if you have pre-diabetes – that’s so important. Even if you can’t delay it for ever, those few extra years before being diagnosed will be a big health boost.’