As a former Olympian who represented Great Britain in the triple jump for 15 years, Michelle Griffith-Robinson had rarely considered the possibility that she might be at risk of diabetes.
Slim and athletic, Michelle still trained several days a week and lived an active lifestyle in Devon with her husband, former Welsh rugby player Matthew Robinson, and their three sporty children.
But last September, while Michelle underwent exploratory tests for a suspected kidney problem, doctors gave her some shocking news – blood tests had revealed she was pre-diabetic. The readings showed that the 47-year-old, a personal trainer and lifestyle coach since retiring from sport in 2006, had blood sugar levels that put her right in the middle of the pre-diabetic range.
Michelle Griffith-Robinson, pictured with her three children, Elijah, left, Reese, top, and Eden, right, underwent a routine blood test last September which revealed she had pre-diabetes
‘I was blown away,’ Michelle says today. ‘I walked into that room glowing with health, really fit, and you’d never have said I was at risk of developing type 2 diabetes.
‘But it just goes to show you can’t judge a book by its cover – it’s what’s going on inside that matters. If it can happen to me, it can happen to anyone.’
Pre-diabetes causes no symptoms and you may look and feel completely well – as Michelle’s case proves. So why, you might think, do you need to worry about it? After all, it means blood sugar levels are high, on the verge of type 2 diabetes but not yet the full-blown condition. Surely it’s a case of crossing that bridge when you come to it, if at all? Well, not so, according to the latest evidence.
It is well known that type 2 diabetes itself dramatically increases the risk of problems, from heart attacks and strokes to blindness, amputations and erectile dysfunction. That is why the four million or so UK sufferers are usually given medication or other treatments to control the worst effects.
Michelle represented Great Britain in the triple jump for 15 years, including at the 2006 Commonwealth Games, pictured
But many experts now believe that the microscopic damage to organs, nerves and cells caused by high sugar levels actually begins to happen far earlier than was previously thought. Those with pre-diabetes are also at risk of heart disease, kidney problems and possibly dementia.
Studies have shown that many of those with raised blood sugar levels can delay or even prevent the slide towards type 2 diabetes by making simple lifestyle changes to lose weight and by becoming more active. As diabetes expert Naveed Sattar, professor of metabolic medicine at Glasgow University, explains: ‘Being diagnosed means you can do something about it – this can make a huge difference to your health.’
A diagnosis of pre-diabetes offers a crucial opportunity – one that Michelle, who represented Great Britain at the 1996 Atlanta Games, grasped with typical determination. Over the past nine months, her lifestyle changes have had an impact.
She says: ‘My diet was already pretty balanced, but I changed it to include more eggs and mackerel, good lean sources of protein, and loads of veg as they’re packed with vitamins, minerals and fibre, and are also filling. I’ve cut down on fruit and now avoid sugary snacks or crisps. I snack on yogurt and walnuts instead.
‘I go running a couple of times a week and do a weights session in the gym. I’ve lost almost 10 lb and my blood glucose readings show that I’m nearly out of the pre-diabetic range. I wasn’t fat but it’s all about how much fat your own body can tolerate.’
Michelle, whose mother is from Jamaica and father is from Barbados, is at increased risk of the condition because of her ethnicity.
Michelle, pictured with her family, including her former Welsh international rugby playing husband Matthew, second left, said she altered her lifestyle as a result of the diagnosis
It is thought those of African and Caribbean descent may store fat differently, accumulating it in the liver and pancreas, which then affects the production of insulin.
But in Michelle’s case, it is thought there is also a strong hereditary risk factor. Her mother, an NHS nurse for 25 years, was diagnosed with type 2 diabetes aged 58, and her grandmother in Jamaica died from diabetes-related complications. Four aunts and two cousins also have the condition.
Michelle is now determined to teach her own children – Reese, 15, Eden, 13, and five-year-old Elijah – to stay healthy. She says: ‘I might have been diabetic by now if I hadn’t taken action.’
THE SIMPLE TESTS THAT CAN SPOT A KILLER
Astonishingly, as many as one in three adults in the UK is already thought to be pre-diabetic – roughly 14 million people.
That figure has tripled in just ten years, driven skywards by the rising tide of obesity. Yet most people have no idea they are living with the condition unless they have a blood test at their GP surgery. Indeed, pre-diabetes was once mainly picked up coincidentally, such as after a person had been admitted to hospital suffering from a heart attack.
But this is beginning to change, as doctors increasingly offer tests to detect blood sugar problems before they become severe.
One of them, known as a fasting plasma glucose test, involves eating nothing and drinking nothing except water for eight to ten hours before a sample of blood is taken from the arm. Those with pre-diabetes will have a higher than normal reading, but this only gives a snapshot of blood sugar at that moment.
Michelle, whose mother is from Jamaica and father is from Barbados, is at increased risk of the condition because of her ethnicity
Another, better indicator is a so-called HbA1c blood test. This gives a patient’s average blood sugar levels over the preceding two to three months.
HbA1c is what is known as glycated haemoglobin. This is made when glucose – a type of sugar digested from food – in the circulation sticks to red blood cells. The more glucose that stays in the circulation, the more HbA1c there is. The test looks for a percentage of blood as a whole made up of HbA1c, and this reading can tell doctors if you have pre-diabetes, or even type 2 diabetes.
It is possible to get a DIY at-home testing kit to measure HbA1c at some pharmacists and online, which could indicate you are at risk of pre-diabetes. However, for a definitive diagnosis, it’s important to see your GP.
IT’S TIME TO GET WITH THE PROGRAMME
Could doctors detect it years before it strikes?
Diabetes warning signs could be picked up years before even pre-diabetes is diagnosed, according to some researchers.
One study, which followed 6,500 civil servants over a ten-year period, found it was possible to detect subtle early changes in blood glucose and insulin-resistance in those who went on to develop type 2 diabetes several years later.
The study, by scientists at University College London, suggested it may be possible to pick up ‘pre-pre-diabetes’ – which means action could be taken even sooner to protect the health of those most at risk.
Researchers monitored the group’s blood sugar levels and ability of their tissues to respond to the hormone insulin, involved in blood sugar control, over time.
Those who went on to develop type 2 – 505 people – showed a rapid acceleration in blood sugar levels which began three years before they were diagnosed with the condition. Their sensitivity to insulin also dropped steeply during the five years before diagnosis.
There were also changes noticed to the behaviour of the type of pancreatic cells that produce insulin.
Their activity increased in the three to four years before diagnosis, and then dropped as they struggled to cope with higher sugar levels.
Lead researcher Dr Adam Tabak said: ‘The most important message to come out of this kind of research is to explain how the disease develops and what its history is. We know lifestyle intervention can prevent more than 50 per cent of cases of type 2.’
But he added that it would be hugely expensive and time-consuming to intervene at this stage, and others warned more research was needed before such early tests could be reliable enough.
Libby Dowling, senior clinical adviser at the charity Diabetes UK, says: ‘We estimate more than half of all cases of type 2 diabetes can be prevented or delayed if we can intervene early. That means identifying people at increased risk of developing diabetes, and then helping them manage their weight and lifestyle. It’s important to recognise that type 2 diabetes is not a foregone conclusion.’
The Government is so concerned about the escalating number of cases that it is investing £90 million in a Diabetes Prevention Programme (preventing-diabetes. co.uk) in conjunction with Diabetes UK. The scheme is being rolled out in community centres, church halls and gyms across England, with 212,000 pre-diabetic patients referred by GPs last year.
Adults with raised blood sugar levels are offered monthly face- to-face meetings, usually in a group, with specialist nurses. The nurses give exercise tips and advice on making dietary changes to aid weight loss.
Some who struggle to attend regular meetings in person are given fitness tracking devices. The latest figures show that patients who lost about half a stone saw their blood sugar levels return to normal.
Prof Sattar says: ‘Studies also suggest people with pre-diabetes who tackle the problem successfully have fewer heart attacks in later life, less cardiovascular disease and lower mortality overall.’
ACT EARLY AND BOOST YOUR HEALTH
Not everyone with pre-diabetes will go on to develop full-blown type 2 – and it is not currently understood why this is the case. For this reason, pre-diabetes has proved controversial.
Diabetes UK says it does not use the label, and it is not approved by either the World Health Organisation or the UK drugs watchdog NICE.
Concerns stem in part from the United States, where those with pre-diabetes are more likely to be prescribed drugs such as metformin to lower their blood sugar, leading to claims that people are being given medication unnecessarily.
Some British patients with pre-diabetes may be prescribed metformin, but this would be done on a strictly case-by-case basis determined by GPs. Dr Nicola Guess, of King’s College London, says: ‘Pre-diabetes is controversial because many won’t get type 2, and others will go back to normal. But the value in identifying it is that lifestyle changes can be super-effective in preventing type 2.
‘Patients with pre-diabetes are generally really glad that they’ve been told about it, so they can do something about it.’
Even if you have been told you have pre-diabetes, it may be tempting to avoid taking any action. But the earlier you act to reduce your weight, and protect your body against the effects of high blood sugar, the more you improve your long-term health.
In fact, some people with pre-diabetes may even already be at increased risk of heart problems.
Prof Sattar says: ‘Even if you manage to delay your diabetes for five years, that five years of not having diabetes has protected your blood vessels and the heart from damage caused by high sugar levels. The younger you develop type 2 diabetes, the higher the excess risk for mortality, heart disease and heart failure.
‘Get away from thinking type 2 is inevitable if you have pre-diabetes – that’s so important. Even if you can’t delay it for ever, those few extra years before being diagnosed will be a big health boost.’
Dr Ellie Cannon’s diabetes Q&A
Mr GP has told me that I have pre-diabetes – am I going to get ill?
No, we test for pre-diabetes so you can do something about it. Dietary, exercise and lifestyle changes can help prevent you from developing type 2 diabetes, and reverse the pre-diabetes too. It’s also really important to know that pre-diabetes is a risk factor for other conditions such as heart disease, so smoking, high blood pressure and other things that might further raise the risk of a heart attack or stroke need to be looked at.
It’s an alarm bell: you need to take control and make the changes so you don’t get ill.
I have had two different tests for pre-diabetes, two months apart. The first was normal but the second indicated pre-diabetes. Which should I trust?
You should trust both tests. If the second one has indicated pre-diabetes, it means there is on average a higher level of blood sugar than before.
We see this if someone is heading into pre-diabetes, perhaps due to dietary or weight changes.
It could be the start of a downhill trend, so make sure you get a further test in three months. We normally check these levels quarterly for the best accuracy.
Will missing breakfast reduce and control my blood sugar levels?
For some people, fasting intermittently can be a very effective way to control blood sugar levels and even reverse pre-diabetes. But it is not a guarantee. There are two methods that people report working. The first is time-restricted eating, where you fast for 16 hours and eat only during one window each day – 1pm to 8pm, for example. Alternatively people opt for intermittent fasting on two days a week, when they cut down to 800 calories. It is not for everyone and is not guaranteed to work. Try it, and if you can, have another blood sugar test two to three months later.
Are meal-replacement shakes a suitable way of limiting my calorie intake?
Some data has shown us that using the shakes on a very low 800-calorie-a-day diet, for up to three months, can reverse type 2 diabetes, and also pre-diabetes. But it is difficult to maintain even for a week or two, so often fails. I’d advise a low-GI diet instead, which involves opting for foods known to take longer to digest and so keep us fuller for longer.
Med diet helped me shift the pounds
For Maggie Hartley, being diagnosed with pre-diabetes was precisely the catalyst for change she needed
For Maggie Hartley, being diagnosed with pre-diabetes was precisely the catalyst for change she needed. Despite various diets over the years, the pounds were proving more difficult to shift. When Maggie, 72, saw her practice nurse for a routine check-up in March, her BMI was over 30, which tips her into the obese category.
The nurse carried out an HbA1c blood test, which revealed blood sugar levels that were just over the threshold for pre-diabetes. ‘I wasn’t surprised at all,’ confesses Maggie, a retired PA from Bognor Regis, West Sussex. ‘I am overweight, and after the menopause your body shape does change. But I’m glad I found out. It gives you that opportunity to concentrate your mind and make those important changes that you thought really didn’t matter.
‘I’m far more motivated to stick to a healthy lifestyle.’
Maggie, left, now adheres to a Mediterranean diet, plays tennis twice a week and enjoys walking.
She eats a late breakfast of boiled eggs, cherry tomatoes and home-made spelt bread, a typical lunch is salmon with plenty of salad, and evening meals comprise roasted vegetables.
She has cut out processed meats and bacon and no longer buys biscuits.
Happily, her blood sugar levels have now returned to almost normal.