FIGURES from NHS digital reveal the cost of prescriptions for diabetes in England has surpassed £1 billion in the last year. Although this figure is almost double that spent ten years ago, it is only the tip of the iceberg, with an estimated total cost of £10 billion to deal with the devastating complications of diabetes including heart attacks, strokes, blindness and limb amputations.

Dubbed a modern health epidemic, the sharp increase in the number of individuals diagnosed with diabetes is mirrored by figures for those classified as overweight or obese. Type 1 diabetes cannot be prevented. Yet type 2, accounting for more than 90 per cent of cases, could be avoided or at least delayed in up to four fifths of individuals by lifestyle changes.

In the normal state, when you eat something containing sugar, your pancreas gland produces insulin. Sugar is then stored in the liver and muscles, to be used for energy later. In type 1 diabetes the pancreas does not produce insulin. In type 2, the pancreas is initially able to produce enough insulin, but because this is taken up by your fat cells rather than staying in the bloodstream, sugar levels in the circulation remain high. Over time this damages both nerves as well as arteries. Nerve damage results in painful sensations or lack of sensation, notably in the feet. Narrowed arteries may block completely, sometimes with the first sign being a heart attack or stroke.

Type 1 diabetes develops rapidly, usually in children, with the individual becoming ill quickly unless medical help is sought. However type 2 may stay undetected for several years, especially if your blood sugar level is only slightly raised. It is estimated that there are up to one million people in the UK with undiagnosed diabetes, who will unfortunately be developing complications as a result.

Symptoms to watch out for include excessive thirst, and needing to pass water all the time. You may find yourself losing weight without trying. Blurred vision is caused by the excess sugars causing the eyeball to intermittently swell. Recurrent thrush infection, particularly affecting the genitals is another potential sign. However, you may just feel very tired or weary. Diabetes is more common in certain ethnic groups, including South Asians and Afro-Caribbeans. If you have any concerns, the simplest thing to do is seek medical help. Raised sugars can be detected in a urine sample, but a blood test is required to make the diagnosis.

The number of treatment options has massively increased in recent years, and if your sugars are only mildly elevated and you don’t have any complications, it may be appropriate to have a trial of lifestyle changes for a few months, to see if this brings your levels within the normal range.

However, even if you need to start treatment, a healthy lifestyle should be continued, concentrating on stopping smoking and weight loss if needed, a balanced diet and alcohol within the recommended amounts.

Insulin is rarely the first treatment for type 2; don’t let this fear stand in the way of getting tested.


Question: I heard that taking acid medications long term can cause harm. Is this true? – Vernon, 60

Answer: Proton Pump Inhibitors (PPI), of which the most commonly prescribed is lansoprazole, are used to treat excess acid. They have been linked with an increased risk of abnormalities of some of the salts in your blood. Long term users may be more prone to infection with clostridium difficile, which causes diarrhoea, as well as having an increased chance of suffering pneumonia. However, these are outweighed by excess acid being in contact with your gullet, which is not designed to resist acid in the way your stomach is. Untreated, this increases your risk of cancer of the oesophagus. It is recommended that you use the lowest dose of PPI needed to control your symptoms, as well as making the appropriate lifestyle changes including weight loss, stopping smoking and sensible alcohol consumption. If you develop a worsening of symptoms while on a PPI that doesn’t resolve, you should still seek rapid medical advice.

Question: I’m worried my 20 year-old-son has Obsessive Compulsive Disorder. It used to be just repetitive checking of things, now he seems permanently anxious because of it. Gwendoline

Answer: Many of us will have some obsessions (thoughts) or compulsions (behaviours), however when these get to the point where they interfere with that person’s life, or cause distress, this can be said to be obsessive compulsive disorder (OCD). Often sufferers are reluctant to come forward as they feel embarrassed. However there is treatment. Cognitive Behavioural Therapy (CBT) can help address some of the thought processes. Medication, specifically anti-depressants may be appropriate, especially if anxiety or low mood is a key feature. Importantly OCD rarely improves without help, so please do encourage him to seek help.

If you have a question for Dr Zak, please email:


T: @AskDoctorZak

Dr Uddin’s advice is provided in good faith and in accordance with currently accepted evidence. However, this content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of a GP, or other qualified health provider, regarding a medical condition.