Today marks the beginning of National Diabetes Week in Australia (9th-15th July). The theme this year is ‘Invisible Condition’, signifying that diabetes is often invisible. You can’t see if someone has diabetes, nor can you tell which type of diabetes they have. People with diabetes look just like everybody else.
Just how prevalent is diabetes?
According to Diabetes Victoria:
• It is the fastest-growing chronic condition in Australia
• Every day more than 80 Victorians develop diabetes
• There are 314,000 people living with diagnosed diabetes in Victoria
• Approximately 125,000 Victorians are living with un-diagnosed type 2 diabetes
• A further 500,000 people in Victoria are at high-risk of developing type 2 diabetes
• Diabetes impacts one in four Victorians over the age of 25
There is no cure.
So, what is diabetes?
Diabetes mellitus, commonly referred to as diabetes, encompasses a group of chronic and potentially life-threatening conditions, in which there is too much glucose in the blood. How does this happen?
Glucose (a sugar) is the body’s main source of energy. When it enters the body’s cells this energy can be used. However, the problem occurs when glucose does not enter cells, and stays in the body’s bloodstream.
Enter, insulin. Insulin is a hormone made by the pancreas. Its main job is to help move glucose from our blood into the cells of the body, to keep our blood glucose levels within a normal range. Therefore, without insulin, glucose builds up in the blood. If glucose builds up in the bloodstream over time, it can cause damage to nerves, the eyes and kidneys, and can cause strokes and heart attacks.
This process is essentially what occurs in people with diabetes – their body loses its ability to produce insulin, or their body begins to produce and/or use insulin less efficiently, resulting in high glucose levels in the blood. There are three main types.
The three main types
Type 1 Diabetes – previously ‘juvenile diabetes’ or ‘insulin-dependent diabetes’
Normally, your immune system is a wonderful thing. It has a large army of ‘defender cells’ which destroy foreign substances as soon as they enter the body. But in order for the immune system to be effective, it needs to be able to differentiate between ‘non-self’ and ‘self’ cells and substances. Typically, the body should not work against its own healthy cells. However, this is exactly what happens in people with type 1 diabetes.
Type 1 diabetes is an auto-immune condition, meaning that the immune system views its own cells as foreign or ‘non-self’, attacking and destroying them. During this process it also destroys the cells that make insulin, and as a result, the body can no longer make insulin. As described above, without insulin, glucose can’t enter cells and therefore this glucose accumulates in the blood.
Type 1 diabetes usually occurs in people under the age of 30, but research is still yet to determine the exact cause. Because we don’t know the cause, the condition can’t be prevented (it is not linked to lifestyle factors like type 2 diabetes). There is currently no cure, and as such people need to inject insulin daily for the rest of their lives.
Type 2 Diabetes – previously ‘mature-onset diabetes’ or ‘non-insulin dependent diabetes’
Type 2 diabetes occurs when the pancreas does not produce enough insulin for the body’s needs, or the cells don’t respond to insulin effectively (also called insulin resistance). It is a gradual progression, and as the body becomes more resistant to insulin, glucose starts to build-up in the blood.
Whilst there is a strong family history link to the development of type 2 diabetes, the risk of developing it is also greatly increased by these known lifestyle risk factors:
• being overweight or obese
• having low levels of physical activity
• smoking cigarettes
While it can often be prevented or delayed with these lifestyle changes, like type 1 diabetes, there is no cure.
This type of diabetes occurs during pregnancy. As a normal pregnancy progresses, hormones are made by the placenta which help the baby to grow. However, these hormones also stop the mother’s insulin working efficiently. By the end of the pregnancy, 2-3 times more insulin is needed to keep the blood glucose levels normal. Gestational diabetes develops if the body can’t produce enough insulin to meet this demand.
Usually gestational diabetes does not continue after the birth of the child, however mothers who have had gestational diabetes are more likely to develop type 2 diabetes in the future.
Technically not diabetes, at least 2 million Australians have ‘pre-diabetes’. This is a condition in which blood glucose levels are higher than normal, but not high enough to fit the diagnosis of diabetes yet. It is also referred to as ‘Impaired Glucose Tolerance’ or ‘Impaired Fasting Glucose’.
Pre-diabetes has no symptoms but risk factors are similar to those for type 2 diabetes and include:
• Being overweight or obese
• Having a family history of type 2 diabetes
• Physical inactivity
• Having polycystic ovarian syndrome (PCOS)
• Having had previous gestational diabetes
People with pre-diabetes are at a high risk of developing type 2 diabetes without treatment. This treatment often includes lifestyle changes to promote weight loss (if overweight).
What to look for?
Some types of diabetes have no obvious symptoms which is why they can often go undiagnosed for such a long time. However, if symptoms are present, these can include:
• Being more thirsty than usual
• Passing more urine
• Feeling tired or lethargic
• Blurred vision
• Nausea and vomiting
• Weight loss
• Mood swings
It is important to see your GP if you are worried about any symptoms or have any questions.
Been diagnosed with diabetes but not sure what to do now?
People living with diabetes need to measure their blood glucose levels daily. This is the only way to determine if their blood glucose levels are within an acceptable target range. You cannot see if someone living with diabetes has high or low blood glucose – this is all part of the invisibility of the condition. Lifestyle and/or medications are used to manage diabetes to ensure blood glucose remains in a controlled range.
It’s important if you are worried about any symptoms or have been diagnosed with diabetes that you follow the guidance of your GP and ask for a referral to see a dietitian and a diabetes educator.
If diabetes is not managed properly…
Diabetes-related complications don’t develop overnight, and can be largely prevented if diabetes is well-controlled and carefully managed. However, these complications are serious if left unchecked.
If blood glucose levels remain too high (hyperglycaemia) for a long period of time, it can lead to heart attack and stroke, kidney damage, loss of limbs and vision loss. Statistics from Diabetes Victoria say that:
• Heart attacks and strokes are up to four times more likely in people with diabetes
• Kidney damage is three times more common
• Amputations are 15 times more common
• Diabetes is the leading cause of preventable blindness in working age adults
In addition, depression and/or anxiety can accompany the condition.
Take home message
Diabetes is a serious and complex health condition. Around 1.7 million Australians currently have diabetes, with numbers growing daily. National Diabetes Week is a wonderful opportunity to raise awareness about all types of diabetes and how this condition affects Australians. Remember that while type 1 diabetes cannot be prevented, there are many lifestyle factors that can greatly reduce your risk of developing type 2 diabetes, so take action now. See your doctor if you are at all concerned and ask for a referral to see an Accredited Practising Dietitian who can help tailor a plan to suit your lifestyle.