Dr Boardman

Brief Outline: Dr Shirine Boardman is a committee member for the Association of British Clinical Diabetologists and the British Endocrine Society. She is also a Fellow of the Royal College of Physicians.

Background: Dr Shirine Boardman is a diabetes consultant. She has a special interest in women's hormonal disorders.

What is diabetes type 2 - an introduction by Dr Shrine Boardman

Hi I’m Dr Shirine Boardman, a diabetes consultant, and I look after many patients with Type II diabetes as well as Type I diabetes.

 

Type II diabetes is increasing in ever epidemic proportions and is diagnosed when a patient has a high blood sugar though sometimes patients may find that they are told that they have sugar in the urine before they have the blood test done which confirms the diagnosis. The symptoms of diabetes may include running to the loo a lot and feeling extremely thirsty and having to pass water at night and feeling extremely tired and sometimes people get thrush or find that they are so prone to infection. And very often patients may have a family history of diabetes because we do know that there is a degree of inheritance involved and certainly if you’ve got a member of your family, a father or a mother who has diabetes the risk of diabetes is that much higher.

 

Type II diabetes can occur at any age. Obviously it’s more likely to occur as somebody grows older but it can occur in younger patients as well. And we know that in some communities such as the Asian community where diabetes is very prevalent it can actually be diagnosed 5 to 10 years before it does in a Caucasian population so that sometimes we see people in their 20s with Type II diabetes. And certainly in America now they are increasingly diagnosing it in adolescents as well where diet and exercise hasn’t been followed and the child grows up with significant weight problems. It’s now increasing in epidemic proportions and so preventing it is also becoming increasingly important.

Dr Boardman talks about managing diabetes and the benefits of exercise.

There’s a lot that people say about managing diabetes. People worry about things like insulin and tablets which might cause them to feel poorly but actually today with modern needles and new treatments that are coming along for diabetes the outlook is so much better. However one thing that I’d like to emphasise is that people don’t realise how important exercise is in the management of diabetes because by doing exercise we actually burn sugar. And sometimes instead of increasing the medication, having more insulin or more drugs if one were to do regular exercise every day we could actually consider using that exercise to burn the sugar and lower the blood sugar quite effectively instead of having to use a drug to do the same job. So I’d like to emphasise how important exercise is.

 

It doesn’t necessarily have to be about going to the gym every day of the week even brisk walks can be very effective or brisk gardening or brisk housework. There are so many ways that we can get the exercise in our daily lives and if you love dancing for instance a bit of music and dancing to music can be just as therapeutic both to the spirit as well as to the physical well being and bringing blood sugars down.

Dr Boardman explains what gestational diabetes is.

I look after women with gestational diabetes which is diabetes which is discovered in pregnancy because pregnancy causes a strain on the pancreas and blood sugars go up. The importance of this diagnosis apart from treating it properly in pregnancy so that the baby is protected is that after the baby is born the woman can take steps to prevent herself from going on to get diabetes in the longer term because having gestational diabetes can be a marker of the risk of getting it in the future and actually it’s a wonderful opportunity for a woman to take her health into her own hands and prevent.

Dr Boardman talks about the treatments for type 2 diabetes.

There are many treatments for Type II diabetes and we normally start with diet and exercise and move on to tablets. And as far as tablets are concerned there are lots of new ones appearing on the market which is really good news for patients with diabetes because some of the new treatments may not have the side effects that the older treatments have in that it may not cause weight gain which some of the older treatments may have caused. And in addition there are new injectable treatments that are arriving on the market that work differently to insulin but can control blood sugar without causing weight gain. And of course there is insulin as well that can be used and with the pens that are so easy to use these days and tiny little fine needles insulin treatment need not be feared like they did fear of it years ago. These days it’s so much easier to treat and patients don’t find it painful.

 

The other thing that’s becoming increasingly important in diabetes care is that we like patients to understand their own treatment' what raises their blood sugar, what they should be doing, what foods make it difficult to control their sugar, the importance of controlling their blood pressure and their cholesterol and taking these drugs which keep these levels down because it does prevent some of the ghastly side effects and complications of having diabetes over many years.

Dr Boardman talks about the health implications of type 2 diabetes.

Type II diabetes is very common. We think that about 2% to 4% of the population have Type II diabetes. Indeed in some populations such as the Asian Community it is even far more prevalent in up to 1 in 4 of the community could be diabetic. The importance of this condition is that the rise in blood sugar can lead to complications with the eyes, with the kidneys, lead to heart disease, heart attacks, strokes, amputations and even problems with the skin, problems with Candida, thrush, skin infections and also we are increasingly discovering that it may even affect the liver. So diabetes doesn’t just deal with one organ but appears to have serious effects on multiple organs in the body. And I forgot to mention it can cause nerve disease, painful nerve problems as well if the sugars are left to go very high. However there are many patients out there who have their sugars under control and don’t suffer any of these nasty complications. So it isn’t the end of the world if you do get diabetes and certainly with the treatments that are available many of these nasty complications which would be far more common in the past are being dealt with less and less as we advance with treatments available for the treatment of diabetes, high blood pressure and high cholesterol.

Dr Boardman discusses the advances in treatments.

I would say that the advances in diabetes care is substantial and I find that every six months if I don’t go for an update I’m left behind on the best way to manage our patients. So as a patient I think it’s really useful and important to keep in touch with societies like Diabetes UK which regularly put out leaflets and magazines in easily readable forms or to search the Internet and keep in touch with all the advances that are going on and to discuss it with your doctors if you’re not aware.

 

So the outcome in diabetes is so much better today than it was many years ago. Patients are living so much longer and there are substantially more treatments that are available for us today and we understand it so much better. Perhaps the most interesting part of all this recently is that we’ve discovered for some patients who have significant weight problems with diabetes that operations to bypass their gut can actually cure their diabetes very soon after the operation. This does suggest that perhaps it’s not just about the pancreas giving up and not having any insulin in patients with diabetes that there may be other things that are going on with the hormones in their gut that may be causing them to have high blood sugar and it may actually lead to more discoveries on drugs that might be able to control their blood sugar dealing with gut hormones. So these are very exciting areas of research and of course for those patients who have serious weight problems and can’t control their diabetes we know that this sort of surgery on their gut can actually cure diabetes and change their future for them.