Diabetes

Diabetes Mellitus is a chronic condition in which there is too much glucose (sugar) in the blood. This occurs when either the body does not make insulin or the insulin that is made is not working effectively. Insulin is the hormone that allows glucose from the food we eat to move into the cells where energy is made. Glucose comes from carbohydrates such as sugar, cereals, pasta, rice, fruit, starchy vegetables and bread.

There are two main types of diabetes: type 1 diabetes and type 2 diabetes.

Type 1 diabetes

• It used to be known as insulin-dependent diabetes or juvenile-onset diabetes.
• It is more commonly diagnosed in children, teenagers and young adults although it may occur at any age.
• Occurs when the pancreas gland stops producing insulin.
• It is an auto-immune condition believed to be triggered by genetic and environmental factors.
• It is the least common, affecting 15% of all people with diabetes.
• Treatment is lifelong insulin administration via syringe, insulin pen or insulin pump every day, regular blood glucose testing, healthy eating plan and regular physical activity.

Type 2 diabetes

• It used to be known as non-insulin dependent diabetes or mature-onset diabetes.
• Occurs when the pancreas is not producing enough insulin or the insulin that is produced is not working effectively (insulin resistance).
• Lifestyle factors such as overweight/obesity and lack of physical activity might contribute to its development.
• Usually affects adults over the age of 45 years but is increasingly occurring at a younger age.
• It is the most common, affecting 85% of all people with diabetes.

Risk factors for type 2 diabetes  

• over 45 years of age with a family history of type 2 diabetes
• over 55 years of age
• over 45 years of age with high blood pressure
• over 45 years of age and overweight
• having had a heart attack or have heart disease
• over 35 years and Aboriginal, Torres Strait Islander, from Pacific islands or the Indian subcontinent or from a Chinese background
• having had gestational diabetes
• having polycystic ovarian syndrome and being overweight
• having impaired fasting glucose or impaired glucose tolerance (sometimes also called pre-diabetes). 

Gestational diabetes
During pregnancy some women may produce higher than normal blood glucose. This is known as gestational diabetes. Women who have had gestational diabetes are at greater risk of developing type 2 diabetes.

Other types of diabetes

• pre-diabetes or impaired glucose metabolism
• hypoglycaemia
• hyperglycaemia
• ketoacidosis

Pre-diabetes or impaired glucose metabolism

It is a condition in which blood glucose levels are higher than normal but not yet high enough for a diagnosis of type 2 diabetes. It is an early sign that the insulin is not working properly in carrying glucose from the blood into the cells. There are two conditions that fit into this category: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).

If left untreated this condition may develop into type 2 diabetes. In addition to the risk of developing diabetes, people with pre-diabetes are more likely to have a heart attack or stroke.

Higher than normal blood glucose levels requires further checking. The doctor may order an oral glucose tolerance test (OGTT) to find out more about the patient’s glucose metabolism.

Hypoglycaemia
This type of diabetic response can be referred to as a hypo, low blood glucose or insulin reaction, It occurs when blood glucose levels drop too low. It is most common with people who inject insulin but it can also be experienced by people who take certain tablets for their diabetes. It is does not generally occur in people with type 2 diabetes.

Hyperglycaemia
High blood sugar levels develop over hours or days and can result in hyperglycaemia. Symptoms, such as excessive thirsty or feeling tired, may not be obvious until blood sugar levels are extremely high.

Ketoacidosis
This is a serious condition that may be associated with illness or very high blood glucose levels with type 1 diabetes. It can also occur with type 2 diabetes. It is a sign of low insulin and develops gradually over hours or days. It is a serious medical emergency and must be treated immediately.

More information on each of the types of diabetes above can be found at Diabetes Australia under the heading ‘Understanding diabetes’. www.diabetesaustralia.com.au

Symptoms

If you experience one or more of the following symptoms, consult a doctor:

• excessive urination
• being more thirsty than usual
• irritability / mood swings
• blurred vision
• feeling tired and lethargic
• dry, itchy skin / skin infections
• having cuts that heal slowly
• always feeling hungry
• gradually putting on weight
• headaches - feeling dizzy
• leg cramps
•  tingling/numbness of the feet
• weight loss (in type 1 diabetes).

Sometimes there are NO symptoms at all; the only real way to know if you have diabetes is to ask your doctor for a blood test.

Management of type 2 diabetes

Diabetes type 2 management requires weight loss/maintenance, healthy eating and suitable physical activity. It may include oral medication/ insulin. Regular moderate exercise and healthy eating not only helps you to manage your weight, but also your blood glucose levels.

The dietary guidelines suggest meals which are:

• low in fat (particularly saturated fat)
• low in sugar
• high in fibre
• low in salt 
• in moderate serving sizes.

At different times in your life you need different quantities of food. For example, when you retire you may be less active and because you won’t burn so much energy you’ll need less food.

Before starting any new type of physical activity, talk to your doctor to be sure it is good for you and your health
 

Self-care

Diabetes can affect each person in a different way. By understanding the condition and with careful management the person living with diabetes can maintain a healthy lifestyle.

It is important to have regular test with your doctor, podiatrist, diabetes educator, dietitian, optometrist or ophthalmologist and other specialist as required to maintain your health and to help manage your diabetes.

People who will help you

Diabetes nurse educator - to understand your diabetes and what you can do to stay healthy; will explain how to test your blood glucose levels.

Dietitian - to choose healthy foods for diabetes.

Podiatrist - to understand how to prevent foot problems when you have diabetes.

Local doctor - for routine diabetes tests and help to keep a check on your blood glucose levels and other aspects of your health. S/he may refer you to the nearest diabetes centre.
 

National Diabetes Services Scheme (NDSS)
The NDSS provides blood and urine testing strips, syringes and needles, and insulin pump consumables at subsidised prices for people who register for its benefits.
It is an initiative of the Australian Government administered by Diabetes Australia and its agents in the states and territories.
Registration is free and open to Australian residents who have been diagnosed with diabetes and hold or are eligible for a Medicare card. Visitors from other countries may be entitled to temporary registration.
Registration and purchase of products can be done at Diabetes SA or at the scheme’s sub-agents.
Further information available at www.ndss.com.au
 

Useful contacts and resources

Diabetes SA 
for further information about diabetes, registration with the National Diabetes Services Scheme, purchase of products for the management of diabetes and education classes.. 
159 Sir Donald Bradman Drive, Hilton
Tel. 8234 1977

Diabetes Australia
Its website includes information on, and application forms for the National Diabetes Services Scheme. It also features fact sheets on a range of diabetes-related issues in English and other languages.

Diabetes in SA
Website maintained by the Department of Health, featuring fact sheets and the guide Managing Type 2 Diabetes in South Australia