Five per cent of the Irish population and one in eight adults over the age of sixty are suffering from diabetes of which 85 per cent have Type 2 Diabetes.

There is major concern amongst health professionals about the present obesity epidemic which is stretching from small infants all the way up to adults of all ages. We know from multiple studies that the link between obesity and Type 2 Diabetes is extremely strong.

We are heading into a major health crisis over the next ten to twenty years as the incidence of this illness is projected to rocket.

So what is DM Type 2 and why is it regarded as such a serious condition?

In diabetes the main problem is having too high a blood sugar. In Type 1 Diabetes our pancreas is simply not producing Insulin at all; in Type 2 Diabetes the pancreas may be producing less Insulin but the real problem is that we develop resistance to the Insulin we do produce. The onset of Type 2 Diabetes is most commonly seen in middle age and later life ( although it is more frequently seen nowadays in adolescents and young adults due to an increase in child obesity and inactivity).

The concern with DM2 however is that the condition, over years, can begin to seriously damage the small and large blood vessels in the body. Damage to the latter increases greatly the chances of developing major heart attacks and strokes and interferes with the circulation to both legs ( particularly in smokers) leading to risks of gangrene. Damage to the small blood vessels can lead to damage to the eye, kidneys and even the nerve supplies to our legs. Diabetes Type 2 is therefore one of the main causes of coronary artery blockages needing stents and surgery; reduced vision and blindness; amputations; and even kidney

transplants!

The causes are a combination of genes and some key environment factors of which obesity is the number one. About 25 per cent of those who develop the condition will have a family history. Obesity is seen in three out of every five cases and we now know that abdominal obesity in particular seems to be a powerful trigger for insulin resistance. Lack of exercise is another risk factor as is a low fibre high fat intake.

Some people will present with thirst and passing a lot of urine. Others may present with weight loss, persistent fatigue, persistent vaginal thrush or may be picked up on screening for chest pain or erectile dysfunction. Many are found on routine screening.

In the past the first line of treatment was to put the sufferer on a diet aimed at reducing their carbohydrate intake. Nowadays many are also put on a drug called Metformin ( Glucophage). This drug acts by reducing production of glucose in the liver and also by decreasing glucose absorption from the gut and insulin resistance. Other drugs called Sulfonureas act on the pancreatic cells whipping them to produce more insulin– in an effort to overcome insulin resistance. There are newer drugs – all aimed at reducing blood glucose which may be added to the above. If all else is failing the person may end up on insulin itself.

However the real secret is to try and reduce the incidence of vascular incidents such as strokes and heart attacks. This is done by using a combination of aspirin to thin the blood; cholesterol lowering drugs, anti hypertensive's to reduce high blood pressure and to encourage smoking cessation. The real key is prevention – tackling obesity/ lack of physical exercise – best done by the whole household

changing their lifestyle!