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Why cases are rising in the young

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Kat Linger decided to take an at-home health test because she liked the packaging. “I was researching for my job as a packaging designer and thought the branding of Thriva was cool, so I tried it,” says Linger. She thought she might find out she was lacking a certain vitamin or could do with some more iron. “Instead, it told me I was pre-diabetic,” she says.

In confusion, she signed up for another test, and another one after that. “I kept testing, and things kept getting worse. Eventually, my blood sugar level tests came back labeled ‘very much in the diabetic zone’. I knew I had to do something,” she says.

Linger started to do some research. She wanted to find out how this was possible. She was lean, had never been more than a size 12, worked out almost every day as a Team GB outrigger canoeist, worked for a nutrition brand and was just 38 years old – far from typical for someone with type 2 diabetes. Those at risk of the condition are generally middle aged or older, with an inactive lifestyle and with poor eating habits.

She puts her diagnosis down to a family history of insulin resistance (her father was diagnosed with type 2 diabetes in his forties) which wasn’t helped by her “relatively healthy but very Western diet” consisting of cereals, sandwiches and pasta.

Linger is one of the growing number of young people being diagnosed with the condition. Research released earlier this month by Diabetes UK showed that the number of people under 40 who have been diagnosed with type 2 diabetes jumped by 23 per cent between 2017 and 2021, from about 120,000 to 148,000. The charity is now warning that the number could rise to over 200,000 within five years.

Experts put this down to an increase in energy-dense food consumption and inactivity. Research shows that adults of working age in England average about 9.5 hours per day of sedentary time and, according to the government’s All Our Health campaigninactivity has risen by 20 per cent since the 60s.

type 2 diabetes presents itself in two ways,” explains Anita Beckwith, a clinical lead dietitian specializing in diabetes at Kings College Hospital. “Either it’s a deficiency of insulin, the hormone that regulates blood sugar, where the pancreas doesn’t produce enough of it. Or it’s insulin resistance, when enough is being produced but the cells stop responding to it over time. That means the body can’t take up glucose from the bloodstream to store, causing dangerously high blood sugar levels.”

Unlike type 1 diabetes, which is thought to be caused by an autoimmune reaction, type 2 is caused by metabolic changes in the body. It can be genetic, and you’re up to six times more likely to get type 2 diabetes if you have a parent, brother, sister or child with it too. People from South Asian, African-Caribbean or Black African descent are also more likely to get the condition.

Type 2 carries some stigma due to its link with excess weightbut Beckwith says it’s important to consider overall body composition and fat distribution, rather than BMI alone.

“Not all people with bigger bodies are at risk and not all people at risk are in bigger bodies,” she explains. “Central adiposity, which is fat around the midsection, is the single biggest factor, present in about 80-85 per cent of people who have type 2 diabetes or will develop type 2 diabetes. Storing fat mainly in the abdominal area, rather than your hips and thighs, is a more important cardiometabolic risk factor because it is linked with adverse metabolic profiles and greater inflammation.”

Kat Linger has to balance her needs as a diabetic and an athlete
Kat Linger has to balance her needs as a diabetic and an athlete
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According to Diabetes UKwaist circumferences over 80cm in women, 90cm in South Asian men and 94cm in most other men is associated with the largest risk, although this isn’t a failsafe measurement.

Another risk factor for the condition is age, with people over 40 historically more likely to have the condition. But according to the research from Diabetes UK, cases of type 2 diabetes in young people are rising faster than those in over-40s.

With the report showing that 65 per cent of 18-39 year-olds aren’t sure what the symptoms of the condition are, experts worry that there are also many more undiagnosed cases out there, as unmanaged type 2 diabetes can lead to serious complicationsincluding kidney failure and heart disease.

“One problem is that some healthcare practitioners don’t know to look out for the signs in younger people because they weren’t taught the condition could affect them,” says Beckwith.

“When I was training, type 1 was called juvenile-onset diabetes, while type 2 was called mature-onset diabetes, with a distinct starting point of 40 years of age. That’s changed now, but it shows that until recently there wasn’t the understanding of type 2 in young people,” she adds.

It doesn’t help that the symptoms are vague and easily confused with common effects of aging. Peeing more, particularly in the night, feeling thirsty and tired and having blurred vision can all be indications of diabetes, “but they are also just symptoms people associate with getting a little older, so people don’t think to worry,” says Beckwith .

That was also true for Linger, who says she had no signs that worried her enough to go to the GP before her diagnosis. Looking back over the years, though, something wasn’t quite right: “My colleagues and I used to joke about my desk narcolepsy because mid-afternoon I would be so tired that I’d fall asleep at work,” she says. “But I was in my twenties, working 12-hour days in London and then going out drinking, so I thought I was just tired.” Now, it seems obvious to her that crashing blood sugar was to blame.

Louise Hunt initially felt shame when she was diagnosed with type 2 diabetes at 32

For Louise Hunt, 34, a type 2 diabetic, a few instances of blurred vision did not ring any alarm bells about diabetes. “I honestly just thought it would go away by itself,” she says. Her diagnosis came a while afterwards, when some routine tests by her GP showed high blood-sugar levels.

It was March 2020, just as the UK went into lockdown and Hunt was already battling Crohn’s disease and a strangulated hernia. “The first six months were really, really rough,” she says. “I was in denial, thinking, ‘this can’t be right. How can I deal with an extra condition on top of everything else happening right now?’”

It was isolating, Hunt says, not only because it was during lockdown but because she didn’t know anyone else with both Crohn’s and diabetes. Her digestive disease meant she couldn’t follow the typical advice about swapping carbs for vegetables and eating high-fiber foods. Like a walking science experiment, she took her blood sugar levels before and after everything she ate and put them into a health monitoring app, Help. Over 10 months of testing, tracking and analyzing, she has found a way to keep her blood sugar steady and lose weight.

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“I have to be very mindful of not improving one condition while impacting another,” she says. “I didn’t make drastic changes, but I stopped having fizzy drinks, reduced my alcohol intake and slowly found swaps that allowed me to reduce the amount of carbs and increase my vegetables without causing me discomfort.”

She adds: “The one thing I do regret is that if I’d had a lower body weight, it might not have been so serious. That makes me upset, angry and frustrated – I’d gained around 20kg in the two years leading up to my diagnosis and if I’d taken it more seriously I may not have developed the condition.”

Hunt is grateful that she had access to her GP for the check-ups she needed, even during lockdown. “I felt really supported by my healthcare team. I wish I’d gone to them earlier, not because I think anything would change but because it would have given me more time to look after my health,” she says.

Many people don’t have the medical support that Hunt did. “With a condition like type 2 diabetes, there’s a lot of bias and shame which means people don’t get access to help,” says Beckwith. “People often assume personal responsibility, but it is much bigger than that.”

To stop the rise, Beckwith says public health strategy and campaigns must not focus only on personal choice but instead “must include policy to address the social and cultural determinants of health which also can be a barrier to accessing support”.

Right now, that’s more important than ever. Diabetes UK states that income, education, housing, access to healthy food and healthcare all impact an individual’s risk of type 2 diabetes, so it’s worrying that its latest research found 57 per cent of people have deprioritized their health, due to financial worries and nearly a quarter have avoided or put off medical checks.

“Tea cost of living crisis means people are going to have to make decisions about their food choices that aren’t related to preference or health, whether that’s skipping meals or choosing things that they know aren’t the healthiest choice,” says Beckwith.

Linger also strongly believes that better policy is needed, especially nutrition education. “It wasn’t until I saw a dietitian that my eyes opened as to what sugar and carbohydrates actually are,” she says. “I rarely ate biscuits and cakes but it was mind-blowing to me that healthy, starchy foods like sweet potatoes, when not eaten alongside fats and proteins, were also impacting my blood sugar. I think everyone should know information like that, diabetic or not.”

With self-education and technology, she has learned enough to put her diabetes into remission. “I track my sleep, use continuous glucose monitors when I can and follow educational experts online like @glucosegoddess who have taught me the importance of things like going for a walk after meals to slow the release of sugar,” says Linger. “In a way, I feel quite lucky to find out when I did because I have time to use these devices and I can try to limit the complications later.”

Linger is still in her “nutrition research mode”, trying to find ways to eat as an athlete. “There is absolutely no information out there about type 2 diabetes in sports,” she says. She’s worried that this not only reinforces the stereotype that those with the condition are lazybut that it can stop people with type 2 from understanding how to look after themselves when exercising.

“Learning how to fuel for my sport when all the advice out there is about sugary gels and sports drinks is impossible,” Linger says, although she has managed well enough to be part of the Team GB outrigger canoeing team that took home bronze for Team GB at the world championships this summer.

For Hunt, it’s been a mental process as well as a physical one. “I felt so much shame at having the condition at first. People started acting differently around me, as though I was going to go into hyper- or hypoglycemia right in front of them. But I’m a proactive patient, I’m looking after myself and I’m keen to change the perception of people with type 2 diabetes,” she says.

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