Since the beginning of October (2016), I have been undergoing training to become a Health and Wellbeing Coach for a Diabetes Prevention Programme.
This programme is for those who are at risk of developing type 2 diabetes and to help prevent them developing this, through empowering them to make a change to their lifestyle.
The Diabetes Prevention Programme is being run around different locations and luckily for me, I have been selected to be part of the team in Hertfordshire. It runs for 9 months where we are involved in both 1 to 1 meetings with individuals and also group sessions, empowering attendees to make a change and support them through the maintenance of that change.
The training is very thorough and has included learning how to take and use a machine to measure an individual’s HbA1c, which is blood glucose (I’ll talk more about what this is, further down this blog); how to conduct the initial one to one assessments and the assessments for 3, 6, and 9 months into the programme; some technical parts about ensuring the quality of the programme and protecting vulnerable people; and how to run the group programme sessions each week.
When we think of diabetes, we think about individuals having excess sugar in their blood. Which in part is correct but it is also due to the individual being unable to remove the glucose (which is a simple sugar) from within the blood to the cells, where it can be converted to be used as energy or stored for future use.
There is a hormone called insulin, which helps to control our blood glucose level from getting too high, or in other cases dropping too low.
When we consume foods which are high in glucose and our blood glucose levels rise, insulin is released by the pancreas to act as a key to allow the glucose to enter the cell and to be used for energy. If you have too much glucose (a type of sugar), the insulin helps to store it in the liver to be used later and this is then converted into fat to be stored, if it is not used (which leads to a fatty liver).
When our blood glucose level rises, we release more insulin to control it.
It is also important to note that insulin is an anabolic hormone, which means that it promotes growth, and in excessive amounts it can lead to weight gain.
Before I go into the concern surrounding type 2 diabetes, I’ll first give a brief introduction about type 2 diabetes.
As you may or may not know, there are two types of diabetes (diabetes mellitus), these are 'Type 1 Diabetes', and 'Type 2 Diabetes'. Both involve blood glucose levels that are higher than normal, however they differ in their causes and development.
Type 1 diabetes is usually diagnosed in childhood and is believed to be due to genetics and viral infections.
It causes your body to attack the body’s insulin producing cells, which results in individual’s with type 1 diabetes being unable to produce insulin, leading to a dangerous build-up of glucose in the bloodstream.
This is where individuals will use insulin injection or pumps to allow insulin into their bloodstream to help remove the glucose (Diabetes UK, 2016a).
Type 2 diabetes is usually diagnosed in those over 30 and is when the cells become unresponsive to the action of the insulin, or our body is unable to produce enough insulin (Diabetes UK, 2016b).
When blood glucose is high, the pancreas releases more insulin to try and compensate for the resistance from the cells to move the glucose from the bloodstream. In this case excess glucose is then taken to the liver where it is stored as glycogen and when these stores are filled, it is then converted into fat and stored. This is when things go wrong and damage occurs (Diabetes UK, 2016c).
So now that we have looked at insulin’s role in controlling blood glucose and the different types of diabetes, we can look at why we are so concerned with type 2 diabetes.
Unlike type 1, type 2 is mainly caused by lifestyle factors and not genetics and viruses.
The risk factors include being overweight and obese; a waist size larger than 31.5 inches for women and 37 inches for males (carrying abdominal fat has been found to make the body less sensitive to insulin); eating an unhealthy diet; smoking; and leading a sedentary lifestyle with limited physical activity.
There are, also, risk factors that you cannot control. This includes having an immediate relative who has type 2 diabetes; and being from a South Asian or African-Caribbean descent (Diabetes UK, 2016c).
It also appears that males are more likely to develop type 2 diabetes than females (Diabetes UK, 2016d).
In the UK, the rate of diabetes (both) has increased from 1.4 million in 1996, to 3.5 million in 2015.
There are also many people who are undiagnosed with diabetes, so the estimate is that there are actually over 4 million people with diabetes. This is estimated to rise to 5 million by 2025 (Diabetes UK, 2016d). By 2040 it is believed that worldwide 624 million people will be living with type 2 diabetes.
Type 2 diabetes accounts for 90% of the cases which have been diagnosed and only 10% are type 1.
Diabetes is also an expensive condition for the NHS. It has been estimated that it costs the NHS over £1.5m an hour, or 10% of the NHS budget. This breaks down to £25,000 being spent on diabetes every minute (Diabetes UK, 2016e).
Keeping up-to-date with the latest research in the news, you probably, by now, have seen a running trend between foods being a villainous product which will kill us, to become the next saviour of the world. Even coconut was known as “the devil himself in liquid form” (The New York Times, 2011), and now here we are hearing about how these claims may have been incorrect and coconut oil may not be as bad as once thought.
There is the seesaw between us being told that fat is the problem causing weight gain and negative health implications, or that sugar is the cause. This is known as ‘The Sugar – Fat Seesaw’.
However, we are also now seeing how much sugar causes damage and inflammation to our body. Foods which are high in glucose lead to an increase in blood glucose and if those with type 2 diabetes are unable to control this, through either insulin resistance, or reduced production of insulin, it can lead to excess glucose being stored as glycogen in the liver and later converted into fat, instead of being used for energy.
The liver is a lean muscle and does not require much fat storage, so the fat is sent back into the blood which can lead to blood vessel damage (I’ll discuss this further in 'Complications Associated with Type 2 Diabetes', below).
Type 2 diabetes is usually found within adults and as we age, our risk of developing type 2 diabetes increases.
However, now we are finding that even children are being diagnosed, with the National Diabetes Paediatric Audit finding that there are 533 children and young people living with type 2 diabetes in the UK, which is a concerning number for something that can be prevented through lifestyle change. Sam Hadadi has written a blog on type 2 diabetes in children and what you can do here.
If not controlled, high blood-glucose levels can cause damage to the blood vessels, nerves and organs. It is not specifically the diabetes which may kill you but its increase in causing damage, that increases other risk factors mentioned below, is what may implicate it.
If you have diabetes, you are 5 times more likely to develop heart disease or have a stroke. If you do not control your blood glucose, it increases the plaque build-up in your arteries (atherosclerosis), which can lead to a decrease in blood supply or a blockage to your heart, or brain.
It can also cause nerve damage, leading to tingling or burning sensations from your extremities, or complete numbness. It can also damage nerves in your digestive system. If not careful of infections or lack of circulation to extremities, it can lead to amputation, with diabetes being one of the leading causes of amputations of the lower limbs throughout the world. The NHS reported that those with diabetes are 15 times more likely to undergo amputation than those without the condition (Diabetes UK, 2016f).
Type 2 diabetes can also cause damage to the retina in the eye, by causing a block or leaks within the blood vessels there, and if not treated can cause damage to your vision. The same goes for your kidneys - if not controlled, blood vessels in your kidneys can become blocked or leak, decreasing the efficiency of your kidneys (NHS, 2016). Currently type 2 diabetes can reduce your life expectancy by up to 10 years (Diabetes UK, 2016d)
It is important to be aware of your own risk of developing type 2 diabetes and Diabetes UK have created a simple online tool in which you input data, to assess your risk. All you need is a tape measure, a scale and to be aged 18+. Calculate your own risk here: riskscore.diabetes.org.uk/start.
As we always say, the best thing to do to reduce your risk, is to lead a healthy balanced lifestyle; limit your alcohol consumption; exercise regularly and stay active; reduce or stop smoking; and make sure you aren’t running yourself down.
The stress hormone cortisol has been linked to increasing insulin levels, leading to insulin resistance when your cortisol levels are increased (Reinehr and Andler, 2004. and Holt et al., 2007).
From what is known, type 2 diabetes is largely preventative and is caused predominantly by lifestyle factors, and if you talk to health professionals, prevention is better than intervention when preventative measures can be taken.
So, the aim is to help prevent those who are classified as ‘pre-diabetic’ from ending up developing type 2 diabetes.
Pre-diabetic includes those who are borderline becoming diabetic and so are at risk.
The aim of this programme is to empower individuals to make a change. It’s not us as Health & Wellbeing Coaches telling them what they should do, but giving them the knowledge to make an informed decision on what they would like to do, and how they would like to achieve it.
This programme is still in its early stages so, for Hertfordshire, finding out where and when we can carry out the initial assessment and the programme is being finalised, as well as getting people to take part in the programme. A very busy time for the line managers!! So whilst all this is taking place, all the coaches have been undergoing training.
The training has included:
I have also been trained now to take HbA1c - this is different to measuring blood glucose, as it takes an average of the blood glucose levels over a period of 6 weeks from the haemoglobin which has joined with glucose in our blood.
The higher your HbA1c score is, the more at risk you are at developing diabetes related issues. If your HbA1c is below 42mmol/mol then it is at normal; between 42-47mmol/mol is considered pre-diabetes; and 48+mmo/mol is when you have developed diabetes. We do these assessments 3, 6 and 9 months in, to see how their results have changed and whether they are making the progress they had set out to do.
I’m just involved on the nutritional side. Some of the topics that we talk about are introduction into insulin and blood glucose levels; diets and diet myths; fats awareness; carbohydrate awareness; food labels and exercise; and then improving long term health.
This training was fairly intense and a lot to take it but it was an amazing experience being able to learn from Trudi Deakin, who founded the programme. Trudi demonstrated the programme which is interactive in such a simple way, that kept it interactive between us all. Hopefully with a lot of practice I’ll be able to do the group sessions as well as she showed us how to do it.
Now I am just waiting for the go ahead (and to complete my first-aid training) and I’ll be out on the field doing all the things I have now learnt to do.
Type 2 diabetes is something that, for some, we can combat through change in lifestyle. I have learnt things on the course that I previously did not know myself.
Everything is a learning experience and you should utilise it to enhance your own knowledge. I think we should all equip ourselves with the knowledge that we need, so that we can make our own informed decisions on our health.
I’ll be keeping a diary on here so that I can update you all with the information that I am allowed to share. Hopefully I’ll have some more interesting information for you all!
Diabetes UK. (2016a). Type 1 Diabetes. Available here.
Diabetes UK. (2016b). Differences Between Type 1 and Type 2. Available here.
Diabetes UK. (2016c). Type 2 Diabetes. Available here.
Diabetes UK. (2016d). Diabetes Prevalence. Available here.
Diabetes UK. (2016e). Cost of Diabetes. Available here.
Diabetes UK. (2016f). Diabetes and Amputation. Available here.
Holt, H. Wild, S. Postle, A. Zhang, J. Koster, G. Umpleby, M. Shojaee-Moradie, F. Dewbury, K. Wood, P. Phillips, D. and Byrne, C. (2007). Cortisol clearance and associations with insulin sensitivity, body fat and fatty liver in middle-aged men. Diabetologia, 50(5), pp. 1024-1032. Available here.
NHS. (2016). Type 2 Diabetes – Complications. Available here.
Reinehr, T. and Andler, W. (2004). Cortisol and its relation to insulin resistance before and after weight loss in obese children. Hormone Research in Paediatrics, 62(3), pp. 107-112. Available here.
The New York Times. (2011). Once a Villain, Coconut Oil Charms the Health Food World. Available here.
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Daisy has a Master's Degree in Public Health Nutrition, which is Association for Nutrition (AFN) accredited. She, also, has a BSc degree in Psychology and Cognitive Neuroscience; and has completed an AFN accredited Diet Specialist Nutrition course. She is Lucy's sister and is the Lucy Bee voice on all aspects of nutrition and its effect on the body. In addition to this, Daisy is shadowing a nutritionist in Harley Street and working for an NHS funded project, The Diabetes Prevention Programme.