Diabetes is a complicated and serious condition which can affect the entire body. The management of diabetes requires daily self care and if complications develop, it can have a significant impact on the quality of life and reduce life expectancy. While there is currently no cure for diabetes, you can live an enjoyable life by learning about the condition and effectively managing it.
There are various different types of diabetes; the three most common being type 1, type 2 and gestational diabetes. All types are complex and serious. Diabetes does not discriminate, anyone can develop diabetes.
When someone has diabetes, their body is unable to maintain healthy levels of glucose in the blood, for one reason or another depending on the type of diabetes. Glucose is a very common form of sugar, it is the main source of energy for our bodies. Unhealthy levels of glucose in the blood can lead to short term and long term health complications. Your blood glucose level is called glycaemia. Your glycaemic status can be tested by your doctor or monitored at home when necessary.
For our bodies to function properly we need to convert glucose (sugar) from food into energy. A hormone called insulin is essential for the conversion of glucose into energy. In people with diabetes, insulin is not produced in sufficient amounts by the body, or no longer produced at all. When people with diabetes eat glucose, which is in common foods such as bread, cereals, fruit and starchy vegetables, legumes, milk, yoghurt and sweets, it can’t be converted into energy and remains in the bloodstream, resulting in high blood glucose levels.
The implications of diabetes
Diabetes can be managed well but the potential complications are the same for type 1 and type 2 diabetes including heart attack, stroke, kidney disease, limb amputation, depression, anxiety and blindness.
We know diabetes:
- Is the leading cause of blindness in working age adults
- Is a leading cause of kidney failure and dialysis
- Increases the risk of heart attacks and stroke by up to four times
- Is a major cause of limb amputations
- Affects mental health as well as physical health. Depression, anxiety and distress occur in more than 30% of all people with diabetes
Early diagnosis, optimal treatment and effective ongoing support and management reduce the risk of diabetes-related complications.
The prevalence of diabetes is increasing
All types of diabetes are increasing in prevalence:
- Type 1 diabetes accounts for 10% of all diabetes and is increasing
- Type 2 diabetes accounts for 85% of all diabetes and is increasing
- Gestational diabetes in pregnancy is increasing
Type 2 diabetes is increasing at the fastest rate. There are large numbers of people with silent, undiagnosed type 2 diabetes which may be damaging their bodies. An estimated 2 million Australians are at high risk of developing type 2 diabetes and are already showing early signs of the condition.
Type 2 diabetes is one of the major consequences of the obesity epidemic. The combination of massive changes to diet and the food supply, combined with massive changes to physical activity with more sedentary work and less activity, means most populations are seeing more type 2 diabetes.
Genes also play a part with higher risk of type 2 diabetes in Chinese, South Asian, Indian, Pacific Islander and Aboriginal and Torres Strait Islander populations.
Currently, type 1 diabetes cannot be prevented. However, researchers are looking into the autoimmune process and environmental factors that lead people to developing type 1 diabetes to help prevent type 1 diabetes in the future. Fortunately, you can do a lot to reduce your risk of developing type 2 diabetes. People at risk can delay or prevent the onset of type 2 diabetes with the following lifestyle adjustments;
- Maintaining a healthy weight
- Regular physical activity
- Making healthy food choices
- Managing blood pressure
- Managing cholesterol levels
- Not smoking
Many people are unaware they are at risk. It is recommended to strive for this type of lifestyle regardless of whether you are at risk or not for the benefit of your overall health.
In type 1 diabetes, symptoms are often sudden and can be life-threatening; therefore it is usually diagnosed quite quickly. In type 2 diabetes, many people have no symptoms at all, while other signs can go unnoticed being seen as part of ‘getting older’.
Therefore, by the time symptoms are noticed, complications of diabetes may already be present.
Common symptoms include:
- Being more thirsty than usual
- Passing more urine
- Feeling tired and lethargic
- Always feeling hungry
- Having cuts that heal slowly
- Itching, skin infections
- Blurred vision
- Unexplained weight loss (type 1)
- Gradually putting on weight (type 2)
- Mood swings
- Feeling dizzy
- Leg cramps
Type 1 Diabetes Management
In type 1 diabetes, the pancreas produces little or no insulin which is vital for converting glucose into energy. People with type 1 diabetes need to do the job of the pancreas and replace the insulin via insulin injections or an insulin pump. The insulin acts to reduce the level of glucose in the blood.
Daily management practices need to be undertaken to keep Type 1 diabetes under control, including;
- Insulin replacement through lifelong insulin injections (up to 6 every day) or use of an insulin pump
- Monitoring of blood glucose levels regularly (as directed by your Doctor – can be up to 6 times per day)
- Following a healthy diet and eating plan
- Regular exercise
The aim diabetes management is to keep blood glucose levels as close to the target range as possible, your Doctor will discuss a blood glucose range that is safe for you, as this can vary between individuals. Keeping your blood glucose level at the optimum range is a careful balance between what food is eaten, physical activity and medication. Blood glucose levels which are too high, could result in hyperglycaemia or ketoacidosis. Blood glucose levels which are too low, could result in hypoglycaemia. It is important to learn about each reaction and respond appropriately. Ketoacidosis is an emergency and you must call emergency services immediately.
Type 2 Diabetes Management
In type 2 diabetes, your pancreas is still working but not as effective as it needs to. This means your body is building insulin resistance and is unable to effectively convert glucose into energy, leaving too much glucose in the blood. Type 2 diabetes can sometimes initially be managed through lifestyle modification including a healthy diet, regular exercise and monitoring your blood glucose levels.
- Eating well helps manage your blood glucose levels and your body weight
- Exercising helps the insulin work more effectively, lowers your blood pressure and reduces the risk of heart disease.
- Regular blood glucose monitoring tests whether the treatment being followed is helping to manage blood glucose levels or whether you need to adjust your treatment.
As with Type 1, the aim of management is to keep blood glucose levels as close to the target range as possible to help prevent both short-term and long-term complications. Your Doctor can help you with blood glucose monitoring, healthy eating and physical activity.
However, healthy eating and exercise are not always enough to keep blood glucose levels within the target range. Type 2 diabetes is a progressive condition. Over time the pancreas produces less insulin and the body may continue to be resistant to insulin if lifestyle changes such as weight loss and increased physical activity are not made. Insulin helps convert glucose into energy, which means that as type 2 diabetes progresses, the pancreas may not be able to produce enough insulin to meet the body’s requirements. To help the pancreas produce more insulin, or to make the insulin that the body produces work better, people with type 2 diabetes are often prescribed tablets to keep their blood glucose levels in the target range. Eventually, it may be necessary to start taking insulin to manage blood glucose levels. This is when your body is no longer producing enough insulin of its own. Sometimes tablets may be continued in addition to insulin.
If you require medication as treatment, it is important to note that this is part of the natural progression of the condition, and taking medication when required can result in fewer complications in the long-term. The tablets or injections are intended to be used together with healthy eating and regular physical activity, not as a substitute.
Gestational Diabetes Management
Gestational diabetes is diagnosed during pregnancy when your body cannot cope with the extra demand for insulin production resulting in high blood glucose levels. Gestational diabetes is managed by monitoring blood glucose levels, adopting a healthy eating plan and performing regular physical activity. Effective management of gestational diabetes will reduce the risk of complications during pregnancy and the birth of your baby. Your Doctor will help you monitor your blood glucose levels and develop a healthy eating and exercise plan.
Gestational diabetes can often be managed with healthy eating and regular physical activity. However, for some women with gestational diabetes, insulin injections will be necessary for the rest of the pregnancy. Approximately 10 – 20% of women will need insulin; however, once the baby is born insulin is no longer needed. This is safe for both you and your baby.
After the baby is born, gestational diabetes usually disappears. Please see https://www.diabetesaustralia.com.au/managing-gestational-diabetes for further information.
This article was written by April Stevens BSc. MD student.
30th December 2019.