Until recently, I had never met a young person with Type II or non-insulin dependent diabetes. Young diabetics were inevitably victims of Type I of the disease, in which treatment with insulin injections is needed once the diagnosis has been made.
Now, however, there is an increasing number of teenagers being diagnosed with the second type, which is usually controllable by means of diet and oral drugs.
It is part of a recent global epidemic of Type II diabetes which seems to have its origins in the levels of obesity affecting the Western world. The burger-munching, soft-drink-imbibing culture of young people, allied to a huge drop in physical-exercise levels, means teenagers are gaining weight. The result is a predicted doubling of the world diabetic population to 221 million by 2010.
The link between obesity and diabetes is largely explained by a phenomenon known as the Insulin Resistance Syndrome.
In the more familiar Type I diabetes, levels of insulin produced by the pancreas gland drop sharply, leading to the acute onset of the disease. However, in the Type II, insulin levels in some patients are actually raised; but the sensitivity of the body's cells to the hormone has dropped. Put another way, the cells have become resistant to insulin.
The latest research suggests Type II diabetes is a chronic and progressive disease in which many years lapse between the development of insulin resistance and the onset of apparent diabetes symptoms. The ongoing resistance to circulating levels of insulin eventually tires the pancreas out, insulin levels fall and the symptoms of thirst, passing large quantities of urine, weight loss and tiredness begin.
Exercise helps to combat insulin resistance, as does weight loss, particularly the loss of abdominal fatness.
The traditional Type II drugs, which mainly operate by increasing the secretion of insulin by the pancreas, do not combat insulin resistance. The good news is that the first of a new class of diabetes drug has just arrived on the market here. The glitazone group of drugs has been used in the United States for some years. These drugs are effective in lowering blood glucose levels, especially when used in conjunction with other anti-diabetic drugs such as metformin.
The new agent works by making body tissues more receptive to insulin in the bloodstream. The existing levels of insulin become more effective, blood-glucose levels are brought under control and the pressure on the pancreas to keep pumping out more of its insulin reserves is reduced.
Patients whose diabetes shows signs of poor control can now expect to be offered the new drug as an add-on to existing therapy.
Diabetics who take insulin can also expect new options. Insulin aspart, a modified form of insulin, promises a smoothing-out of the fluctuations in blood-sugar levels over 24 hours. The new type of insulin also promises a reduced number of hypos - attacks of very low blood-sugar levels which can cause diabetics to lose consciousness.
The ultimate development in diabetic care would, of course, be the ability to transplant the beta cells from a donor's pancreas. It is these cells which produce insulin in the gland. Another area of research is the possible development of an artificial pancreas. Bringing such a product to the market is heavily dependent on developing a reliable system of continuous glucose monitoring, something which is proving a stumbling block at present.
Diabetes can be particularly problematic during pregnancy. Diabetic mothers-to-be can now look forward to new technologies in the form of a continuous subcutaneous insulin infusion (CSII), in which a small pump injects a measured dose of insulin directly under the skin throughout the day. By dispensing with the need for separate insulin injections, blood-glucose levels are more tightly controlled, with a better outcome to pregnancy for both mother and child.
A recent European study assessing the economic impact of Type II diabetes concluded that the cost of looking after the 10 million patients with the disease across Europe is more than 28 billion euros.
All of which emphasises the importance of primary prevention by encouraging weight loss, healthy eating and increased exercise in the young.
The fast-food culture has seen a rise in levels of teenage obesity, and an attendant rise in diabetes