Being diabetic does not necessarily rule a potential client out of the protection market, Helen Cliff charts the possibilities
Diabetes mellitus,the most common form of diabetes and generally referred to as simply diabetes, is a condition where the amount of glucose (sugar) in the blood is too high because the body cannot use it properly. Glucose comes from the digestion of starchy foods such as bread, rice, potatoes, chapatis, yams and plantain; from sugar and other sweet foods; and from the liver, which makes glucose.
Insulin is vital for life. It is a hormone produced by the pancreas that helps glucose enter the cells where it is used as fuel by the body.
Released into the bloodstream during and after eating, insulin causes the liver and muscle to take up glucose, thereby restricting the rise in blood-glucose levels. Between meals, when blood-glucose concentrations fall, insulin production decreases, preventing further absorption of glucose for storage and causing release of stored glucose as necessary.
In people suffering with diabetes, reduced insulin production by the Islets of Langerhans (hormone producing) cells of the pancreas or a poor tissue response to insulin (insulin resistance), means that storage of glucose for later use is impaired in varying degrees. This results in abnormally high blood-glucose levels (hyperglycaemia). The kidneys filter glucose from the blood and excrete it to the urine once the blood-glucose concentration exceeds a certain level. This can result in a chance of finding sugar in the urine (glycosuria), which may lead to the detection of an, until now, undiagnosed diabetic.
Main types
The main types of diabetes are insulin-dependent diabetes mellitus (type 1, or juvenile-onset diabetes) and non-insulin dependent diabetes mellitus (type 2, or adult-onset diabetes).
Type 1 develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. It is the least common of the two main types and accounts for between 5% and 15% of all people with diabetes. In type 1 the cells in the pancreas responsible for producing insulin have either been destroyed or produce no insulin. Since no natural insulin is available treatment involves injecting laboratory-manufactured insulin for effective control of glucose metabolism. Risk factors for type 1 include auto-immune disease and a family history of diabetes.
Type 2 develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly - known as insulin resistance. Type 2 is commonly associated with obesity and onset after the age of 30. However, in South Asian and Afro-Caribbean people it often appears after the age of 25. Recently, more children are being diagnosed with the condition, some as young as seven. Type 2 is the most common of the two main types and accounts for between 85% and 95% of all people with diabetes. Sufferers probably inherit a predisposition to glucose intolerance, which is exacerbated by obesity. Unlike type 1, type 2 is relatively common in all populations enjoying an affluent lifestyle. The incidence increases markedly with age, degree of obesity and lack of physical activity.
Risk factors include obesity, hyper-tension, prior history of gestational diabetes mellitus, family history, and certain medications.
Another type is gestational diabetes mellitus - also referred to as GDM. This starts or is first recognised in pregnancy in a previous non-diabetic woman. It usually becomes apparent during the 24th to the 28th week of pregnancy. In many cases, the blood-glucose level returns to normal after delivery. Risk factors are family history, obesity and birth weight over some nine pounds in a previous infant. Some 30% to 50% of individuals with a history of gestational diabetes develop type 2 within 10 years.
The name diabetes mellitus derives from the Greek word 'diabetes', meaning siphon or to pass through, and 'mellitus', the Latin for honeyed. It refers to a major symptom of diabetes, sugar in the urine, and is a far more acceptable name than the one it was known by in the 17th century - when it was called the 'pissing evil'.
Diabetes is a common disease and affects approximately 30 million people worldwide. The UK average is 3.5%. There are currently over two million people with diabetes in the UK and there are up to another 750,000 with diabetes who do not know they have the condition.
The main risk factors include:
n Having type 2 diabetes in the family puts a person at risk, and the closer the relative, the greater the risk.
n Statistics show that over 80% of type 2 diabetics are overweight. The more overweight and inactive a person is, the greater their risk.
n Afro-Caribbean or South Asian people living in the UK are at least five times more likely to have diabetes than the white population.
n People with circulatory problems, a history of heart attacks, strokes or high blood pressure may be at an increased risk of diabetes.
n Women with polycystic ovary syndrome who are overweight are at an increased risk of diabetes.
n Those with impaired fasting glycaemia or impaired glucose tolerance have a higher-than-normal level of glucose in their blood but do not have diabetes and as such should follow a healthy diet, lose weight if appropriate, keep active and get tested regularly for diabetes.
n Pregnant women can develop a temporary type of diabetes - gestational diabetes. Having this or giving birth to a large baby can increase the risk of a woman going on to develop diabetes in the future.
n Other conditions, such as raised triglycerides (a type of blood fat) and severe mental health problems, can also increase an individual's risk.
The more risk factors that apply to an individual, the greater the risk of having diabetes.
There seems to be some genetic link in diabetes, particularly type 2. But environmental factors also play a part. Eating sugar does not cause diabetes. However, eating a diet high in fat and sugar can cause an individual to become overweight. Being overweight increases someone's risk of developing type 2 diabetes, so if someone has a history of diabetes in their family, a healthy diet and regular exercise are recommended to control their weight.
Symptoms include increased thirst, going to the toilet to urinate all the time - especially at night, extreme tiredness, weight loss, blurred vision, genital itching or regular episodes of thrush and slow healing of wounds.
In type 1 diabetes the signs and symptoms will usually be very obvious, developing quickly, usually over a few weeks. In people with type 2 the signs and symptoms will not be so obvious or could even be non-existent. Taking early action is key so if any of the symptoms apply to an individual, they should ask their GP for a diabetes test.
In both types of diabetes, the symptoms are quickly relieved once the diabetes is treated. The main aim of treatment for both types of diabetes is to achieve blood-glucose, blood pressure and cholesterol levels as near to normal as possible. This, together with a healthy lifestyle, will help to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and arteries.
Although diabetes cannot be cured, it can be treated very successfully. Type 1 is treated by insulin injections and diet and regular exercise is recommended. Insulin cannot be taken by mouth because the digestive juices in the stomach destroy it. People with this type of diabetes commonly take up to four injections of insulin each day. If an individual has type 1 diabetes, their insulin injections are vital to keep them alive and they must take them on a daily basis.
Type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity. Tablets and or insulin may also be required to achieve normal blood-glucose levels. There are several kinds of tablets for people with type 2. Some help their pancreas produce more insulin. Others help their body to make better use of the insulin that their pancreas produces. A doctor will decide with their patient which type of tablet is going to work best for them and may prescribe more than one kind.
Type 2 diabetes is progressive and if it cannot be controlled through lifestyle changes and tablets the doctor may recommend that they take insulin injections.
Unfortunately, diabetes that is not properly looked after can cause many serious problems for the body. It is wise for an individual to take precautions against associated illnesses as soon as diagnosis has been delivered.
Excess glucose in the blood damages the blood vessels and nerves contributing to heart disease, strokes, kidney disease, impotence, peripheral vascular disease, nerve damage and damage to the back of the eye.
Uncontrolled diabetes is the most common cause of blindness in people of working age, although treatment can prevent blindness in 90% of those at risk. Diabetes is the second most common cause of lower limb amputation, trauma being responsible for most leg amputations.
Helen Cliff is life and disability underwriter at Aegon Scottish EquitableUnderwriting implicationsUnfortunately, diabetes is usually irreversible and while a reasonable lifestyle can be enjoyed by most, late complications can result in reduced life expectancy.
In order for an insurer to assess an application received from a diabetic, the underwriter obtains a report and or questionnaire from the client's GP. Due to the nature of this condition, usually the only cover considered is term assurance. Underwriters need to identify the type of diabetes and assess a client from the medical reports obtained, so that accurate terms may be offered.
Other information an underwriter requires include diagnosis, age at diagnosis, control of the condition, treatment compliance, any complications and any other risk factors.
Specifically, an underwriter will require results of the individual's glycated haemoglobin (HbA1c) test, which indicates the level of control over a longer period of time, rather than the daily glucose tests, which can vary. An underwriter will also require recent blood pressure readings together with glucose and cholesterol levels. They also need to know if the individual is suffering with damage to the back of the eye (retinopathy), kidney disease or any heart or vascular disorders.
In certain situations, an underwriter may wish to defer their decision where the individual has only been recently diagnosed, and there are no test results available. This is more likely to occur with a type 1 diabetic than a type 2, and the period is likely to be six months.
If a type 2's diabetic report shows they have optimal control (decided on by the levels of their HbA1c) with no complications and no other risk factors, it is possible that an underwriter could offer terms at ordinary rates, however, usually a rating ranging from plus 50% up to 300% could be applied to the basic premium. On a type 1 diabetic if there are no complications or risk factors present, an underwriter should almost always be able to offer cover, but a rating will always be applied to their premiums.
If a diabetic shows poor diabetic control, suffers with retinopathy, and has vascular complications present, cover would more often than not be declined.
