Finger on the pulse: Diabetes: a silent epidemic

There's a secret epidemic sweeping the country, Non Insulin Dependant Diabetes Mellitus or NIDDM. It affects one in 20 people - four times the number of sufferers 30 years ago - and consumes 10 per cent of the National Health Service's total budget. It is not the type of diabetes that is treated with insulin injections, but the type controlled by diet or drugs - the type from which 90 per cent of diabetics suffer.

Diabetes is the result of the body's inability to produce insulin, or a problem with the body's response to it. Insulin controls the level of glucose in the body, which, without insulin, could build up to such an extent that it damages the heart, kidneys, eyes and nerves.

The condition often starts insidiously - you may urinate frequently, or be hungry but lose weight, or have recurrent boils or thrush, or a tingling or numb sensation in your feet or hands. And to complicate matters, all these symptoms can be attributed to other conditions, which is why diagnosis is often delayed. Most people don't know they have diabetes until they find themselves in hospital suffering from a stroke, heart attack or circulation problems, the risk of which is doubled with this type of diabetes.

So who is likely to get it? If a member of your family has NIDDM, then your chances of getting it are greater, but, so far, there is no screening available to identify potential sufferers. The risk increases as you get older and if you are very overweight and do little exercise. Women, who make up more than 55 per cent of diabetics, are more likely to become diabetic if they have given birth to a big baby, and they also have the added disadvantages of being more prone to urinary tract infections, vaginitis and cancer of the endometrium (the lining of the womb). Also African-Caribbeans and South Asians from the Indian sub-continent are particularly at risk of getting diabetes - facing as much as a one-in-four chance.

So, what can you do if you have NIDDM? The first step is to look at your diet and take exercise. Go for a low-fat, low-sugar, high-fibre diet. Fibre is important because it slows down the rate at which the body absorbs carbohydrate, which stops the surges in blood-sugar levels and the body's need for more insulin. A recent study published in the journal of the American Medical Association showed that diets that include breakfast cereals and yoghurt decrease the risk of diabetes, while the risk increases with diets that include fizzy drinks, bread, white rice, chips and mashed potatoes. And if that doesn't work? Drugs have been used to stimulate the pancreas to pump out more insulin, or to help the liver function more normally. Yet, 70 per cent of people with NIDDM still need insulin 20 years on.

So, where do we go from here? Trials are underway of anti-obesity drugs, which promote a feeling of fullness, speed up the burning of calories, and block the absorption of some dietary fats, and glucose blockers, which could reduce the effects of chronically high blood-sugar levels. There are also drugs being developed to reduce insulin resistance, so that the cells take up more glucose. And it is hoped that a genetic test can be developed that will provide an inexpensive screen for the risk of NIDDM.

Health professionals should be made aware of the enormity of this threat to the nation's health. And the public should be made aware, too. The financial cost to the NHS and the cost to individuals in terms of ill health are too great to ignore, especially as this silent epidemic is starting to talk in more than just a whisper.

Contact the British Diabetic Association at 10 Queen Anne Street, London W1M 0BD, 0171 323 1531.