Diabetes

Diabetes

Diabetes is a chronic condition in which the levels of glucose (sugar) in the blood are too high. Blood glucose levels are normally regulated by the hormone insulin, which is made by the pancreas. Diabetes occurs when there is a problem with this hormone and how it works in the body.
Our body relies on blood glucose for energy. Insulin stimulates the body’s cells to use this glucose as energy to fuel a wide range of functions. When a person has diabetes, the pancreas doesn’t make enough insulin or the body’s cells don’t respond adequately to the hormone.
The risk of diabetes increases with age: from 2.5 per cent in people aged between 35–45 years to 23.6 per cent in those over 75. Aboriginal people have one of the highest rates of type 2 diabetes in the world.
There are two main types of diabetes.
Type 1 diabetes is insulin dependent
Caused by an autoimmune destruction of insulin-making cells in the pancreas, which means insulin is no longer made
One of the most common chronic childhood illnesses in developed nations
Most common in people under the age of 30, but can occur at any age
Sometimes called insulin dependent diabetes mellitus, however this term is no longer in use.
Type 2 diabetes is non-insulin dependent
Caused by either inadequate levels of insulin or a failure of the body’s cells to respond properly to insulin – most people have both of these problems
Most common after the age of 40, although the age of onset can be earlier
Known to have been diagnosed in overweight teenagers and children
Often brought on by a lack of exercise or an unhealthy diet
Frequently, but not always, associated with being overweight, particularly when the excess weight is carried around the waist – it is also common in people with high blood pressure or heart disease
Found more commonly in people whose close relatives have diabetes and certain ethnic groups; however, the full picture about the role genes play in diabetes (the ‘genetic profile’) has not yet been worked out
Sometimes called non-insulin dependent diabetes mellitus, however this term is no longer in use.
Symptoms of high blood glucose
Most people do not have any symptoms when they develop type 2 diabetes and regular check-ups are needed to diagnose type 2 diabetes early. However, when the levels of glucose in the blood are particularly high (this is common in type 1 diabetes), symptoms develop.
These symptoms include:
Significant weight loss
Tiredness and lack of energy
Excessive thirst
Blurred vision
Increased risk of infections, such as thrush
Frequent urination.
Diabetes - diagnostic tests
The main diagnostic test for diabetes is taking a blood test to measure glucose, either when you have been fasting or at other times of the day. Diagnostic tests are also used routinely done during pregnancy to identify gestational diabetes.
High blood sugar levels harm the body
The hormone insulin helps to move blood sugars (glucose) into cells and convert glucose into energy. Diabetes is a condition characterised by abnormally high levels of glucose in the blood. This occurs because, either not enough insulin is made, or the cells don’t respond to the hormone.
Untreated, high glucose levels can cause serious damage to many parts of the body, including:
Kidney damage
Eye damage
Nerve damage to the feet and other parts of the body
Heart disease and circulation problems in the legs
Stroke
Impotence.
Accuracy of test results
Depending on the test used, the level of blood glucose can be affected by many factors including:
Eating or drinking
Taking medications that are known to raise blood sugar levels, such as oral contraceptives, some diuretics (water pills) and corticosteroids
Physical illness or surgery that may temporarily alter blood sugar levels.
Test procedures
Most diabetes tests require blood samples. Generally, a band is tightened around your upper arm to slow blood flow and cause the veins below the band to stand out. The intended needle site is swabbed with alcohol. The hypodermic needle is inserted into the vein and the blood is directed into a collection tube. The band may be removed from your arm while the blood is being taken.
You may need more than one collection tube, depending on the test. After the blood is taken, you are asked to press a cotton ball or gauze against the injection site. Once bleeding has stopped, the injection site is covered with a sticking plaster.
Tests to diagnose diabetes include:
Fasting blood glucose test – blood glucose levels are checked after fasting for between 12 and 14 hours. You can drink water during this time, but should strictly avoid any other beverage. Patients with diabetes may be asked to delay their diabetes medication or insulin dose until the test is completed.
Random blood glucose test – blood glucose levels are checked at various times during the day, and it doesn’t matter when you last ate. Blood glucose levels tend to stay constant in a person who doesn’t have diabetes.
Oral glucose tolerance test – a high-glucose drink is given. Blood samples are checked at regular intervals for two hours.
The most common test for diagnosis of diabetes is the fasting blood glucose test. Glucose tolerance tests are used when the results of the fasting blood glucose are borderline. They are also used to diagnose diabetes in pregnancy (gestational diabetes).
Immediately after the procedure
The fasting blood glucose test will confirm that the person has diabetes if it shows that the level of glucose in their blood is higher than normal when they are fasting.
Sometimes the test result of the fasting blood glucose test is borderline. If this is the case, a glucose tolerance test may be performed. This test will confirm diabetes if the person’s blood sugar levels stay high for a long time after the tests.
If a person doesn’t have diabetes, the results of the glucose tolerance test will show that their blood sugar levels fall within the normal range.
Possible complications
Possible complications of diabetes testing include:
Feeling faint or nauseous at the sight of blood or needles
Bleeding and bruising at the injection site
Infection of the skin at the injection site
Multiple injection sites if collecting the blood is difficult
Rarely, a reaction following the oral glucose tolerance test if the patient has diabetes mellitus or hypoglycaemia (low blood sugar levels) – medications may be needed
Long-term outlook
Gestational diabetes is a temporary condition that usually resolves by itself once the baby is born. Regular monitoring throughout the pregnancy is recommended.
There is no cure for diabetes mellitus, but the condition can be managed. Treatment depends on the type of diabetes (type 1 or type 2), but the general aim is to control blood sugar levels and keep them within the normal range. Treatment options may include:
Diet aimed at achieving healthy body weight
Regular exercise
Tablets or insulin injections
Medications to reduce the risk of heart disease or other diabetes complications.
Other blood glucose tests
A person with diabetes may regularly check their blood sugar levels at home using glucose test strips. This is a monitoring test, not a diagnostic test.
There are various tests your doctor may wish to perform if you have symptoms of diabetes, including a random blood sugar test, a fasting blood sugar test or an oral glucose tolerance test.
Factors that can affect the accuracy of test results include failure to follow pre-test instructions, recent illness, and certain medications including oral contraceptives, corticosteroids and antidepressants.
Be guided by your doctor, but generally there are no special instructions to follow after having a diabetes test.

Complications of diabetes

Diabetes is a condition in which there is too much glucose (a type of sugar) in the blood. Over time, high blood glucose levels can damage the body’s organs. Possible complications include damage to large and small blood vessels, which can lead to heart attack, stroke and problems with the kidneys, eyes, teeth, feet and nerves.
The good news is that the risk of most diabetes-related complications can be reduced. Regular check-ups and screening are important to detect complications early. Keeping your waist measurement, blood pressure, blood glucose levels and cholesterol within recommended ranges, and not smoking, will help reduce your risk.
If you smoke, stop now.
Complications of diabetes
The most common complications of diabetes include:
Damage to the large blood vessels of the heart, brain and legs (macrovascular complications)
Damage to the small blood vessels, causing problems in the eyes, kidneys, feet and nerves (microvascular complications).
Other parts of the body can also be affected by diabetes, including the digestive system, the skin, sexual organs, teeth and gums, and the immune system.
Diabetes and cardiovascular disease
Cardiovascular disease includes blood vessel disease, heart attack and stroke. It is the leading cause of death in Australia. People with diabetes often have increased cholesterol and blood pressure levels. Combined with increased blood glucose levels, this can increase the risk of cardiovascular disease.
Having a family history of cardiovascular disease, being inactive and smoking also increase the risk.
Large blood vessel damage and diabetes – reducing the risk
Damage to the large blood vessels can be reduced or even prevented. Strategies include:
Regular check-ups – see your doctor regularly.
Don’t smoke.
Lose weight if you are overweight – even a small weight loss, especially round the abdomen, helps reduce your blood pressure, blood glucose and cholesterol levels.
Be as active as possible – do at least 30 minutes of moderate physical activity on most, if not all, days of the week. If you have not been exercising, it is important to start off slow and gradually build up the duration and intensity of exercise. Speak to your doctor if you are unsure of the suitability of the exercise that you are planning to do.
Eat healthy food – follow a healthy eating plan. It is helpful to consult with a dietitian to look at your food habits and provide a guide about good food choices and quantities.
Test your blood – test glucose levels as recommended. Aim to keep your blood glucose levels within normal limits as advised by your doctor.
Regular medical check-ups are very important
See your doctor regularly and make sure you are checked for each of the following:
Cholesterol and triglycerides – have a test at least once a year. Aim for total cholesterol of less than 4.0 mmol/L and triglycerides of less than 1.5 mmol/L.
Blood pressure – have this checked every time you visit your doctor. It is important to keep your blood pressure under 130/80.
Blood glucose levels – have an HbA1c (glycated-haemoglobin) test every three to six months. This test shows an average of your blood glucose levels over the last 10 to 12 weeks. The goal for HbA1c for most people with diabetes is no more than seven per cent or 53 mmol/mol.
Medication – Take all medications as directed by your doctor.
Teeth and gums – see your dentist regularly for a check-up and clean your teeth at least twice a day.
Eye damage and diabetes – reducing the risk
Damage to the blood vessels at the back of the eyes (retinopathy) can occur without you being aware of it. Your vision may seem unchanged until the problem is severe. However, retinopathy can be detected in the early stages by having your eyes checked regularly, and action can be taken to prevent further damage.
Macular oedema is another problem that can occur with diabetes as a result of damage to blood vessels in the eyes. Cataracts and glaucoma can occur in anyone, but are more common in people with diabetes.
To reduce the risk of eye damage:
Have regular eye checks – everyone with diabetes should have a professional eye examination by an ophthalmologist or optometrist when they are first diagnosed and then at least every two years after that (children usually start this screening at puberty). It is important that you tell the person checking your eyes that you have diabetes. If retinopathy or other abnormality is found, eye tests will be required every year or more frequently, if advised by your eye care professional.
Manage your health – keep blood glucose levels, HbA1c and blood pressure within the recommended ranges.
Seek help quickly – if you notice any changes in your vision, notify your doctor or eye specialist immediately.
Kidney damage and diabetes – reducing the risk
People with diabetes are at risk of kidney disease (nephropathy) due to changes in the small blood vessels of the kidney. Kidney disease is painless and does not cause symptoms until it is advanced.
Kidney damage can be diagnosed early by detecting microalbumin (very small amounts of protein) in the urine. Screening is very important. If damage is identified early, the progression of nephropathy can be slowed or prevented with appropriate treatment.
Medications called ‘ACE inhibitors’ and ‘angiotension receptor antagonists’ help to protect the kidney from further damage. These tablets can also be used to treat high blood pressure.
To reduce the risk of kidney disease:
Have your urine checked – everyone with diabetes should have a urine check for microalbumin at least once a year.
Monitor your glucose levels – maintain blood glucose levels within the recommended range of 4–8 mmol/L. Have your doctor monitor your HbA1c every three to six months and keep HbA1c under seven per cent or 53mmol/mol.
Manage your blood pressure – keep your blood pressure less than 130/80 and cholesterol less than 4.0 mmol/L. If you already have kidney disease, keep your blood pressure under 125/75.
Reduce infection risk – see your doctor immediately if you think you have a bladder infection. Symptoms may include feeling the need to urinate more often, a burning sensation when passing urine, loss of bladder control and cloudy or sometimes bloody urine. Blood glucose levels will often be high when an infection is present.
Nerve damage and diabetes – reducing the risk
Nerve damage (neuropathy) is usually caused by high blood glucose levels, but it is also occasionally caused by other disorders or by drinking large amounts of alcohol. Damage can occur to the sensory (‘feeling’) nerves of the legs, arms, hands, chest and stomach, and to the nerves that control the actions of body organs.
To reduce the risk of nerve damage:
Ensure adequate blood glucose control – keep your blood glucose and HbA1c within recommended ranges.
Tell your doctor about any tingling, pain or numbness in your feet or hands.
Protect and care for your feet – avoid foot injury and inspect your feet every day for any abnormalities. These abnormalities include cuts, bruises, skin cracks (often on the heels), blisters, corns and calluses. Treat foot injuries promptly and don’t delay seeking attention from your doctor or podiatrist for foot problems.
Get regular foot checks – have a diabetes foot check by your podiatrist, doctor or diabetes educator at least once a year to detect changes in nerves as early as possible.
Limit alcohol intake – if you drink alcohol, have no more than two standard drinks per day for men and one for women. Have at least two alcohol-free days per week.
Skin problems and diabetes – reducing the risk
A common problem for people with diabetes is very dry skin on the feet, which can be caused by damage to the small blood vessels and nerves.
To reduce the risk of skin problems:
Ensure adequate blood glucose control – keep your blood glucose levels and HbA1c within recommended ranges to reduce the risk of skin infections.
Protect your skin – wear gloves when you use household cleaners and solvents. Avoid very hot baths and showers. Take care not to have your feet too close to heaters, especially if you have neuropathy, as you may not be able to feel the intensity of the heat.
Take care of your skin – use a cream or lotion on your skin after bathing, preferably one that is not perfumed. Use non-scented soaps.
Check your feet every day – if you have dry, rough or cracked skin on your feet, see your podiatrist or doctor. Protect your feet by wearing comfortable, supportive, well fitting footwear.
See your doctor – if your skin is very dry or irritated.
Teeth and gum problems and diabetes – reducing the risk
People with diabetes are at increased risk of tooth decay and gum infections, which can lead to poor control of blood glucose levels. Poor oral care is also strongly associated with an increased risk of heart disease.
To reduce the risk of teeth and gum problems:
Ensure blood glucose control – keep your blood glucose levels within recommended ranges.
Visit your dentist every six months (even if you wear dentures) – tell them you have diabetes and they will show you how to care for your teeth and gums.
Avoid dry mouth – drink water if you have a dry mouth. Sugarless gum can help increase saliva production.
Eat healthily – enjoy a wide variety of nutritious and healthy foods. Avoid snacking on sugary foods.
Erectile dysfunction and diabetes
Erectile dysfunction (impotence) is an ongoing inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance. Erectile dysfunction is a common problem for men of all ages and is more common in men with diabetes where reduced blood supply and nerve function can affect sexual function. Erectile dysfunction isn’t a disease, but a symptom of some other problem – physical, psychological or a mixture of both. Most cases of erectile dysfunction are physical in origin.
To reduce the risk of erectile dysfunction:
Ensure blood glucose control – keep your blood glucose and HbA1c within the recommended ranges.
Speak to your doctor to find out whether your erectile dysfunction is from physical or psychological causes, so that you can get the proper course of treatment.
Diabetes and reducing the risk of infections
Your immune system helps to prevent and fight infection. High blood glucose levels slow down the action of infection-fighting white blood cells. This makes it more difficult for the immune system to do its job.
To support your immune system and reduce the risk of infections:
Ensure blood glucose control – keep your blood glucose levels within the recommended ranges.
Get plenty of rest.
Wash your hands often.
Protect yourself against infection – everyone with diabetes should have a yearly influenza (flu) injection. Ask your doctor about a pneumonia injection.
See your doctor – at the first sign of an infection.
Low thyroid hormone levels and diabetes
Although diabetes doesn’t directly cause thyroid problems, studies show an increased risk of hypothyroidism (low thyroid levels) in people with type 1 and type 2 diabetes, especially in women over 40 years of age. Your doctor may recommend a test for thyroid function every five years
Diabetes-related complications include damage to large and small blood vessels, which can lead to heart attack and stroke, and problems with the kidneys, eyes, feet and nerves.
The risk of most diabetes-related complications can be reduced.
Regular screening is important to detect complications early and to keep your waist measurement, blood pressure, blood glucose levels, HbA1c and cholesterol within recommended ranges.
It’s very important that you don’t smoke if you have diabetes as it increases the likelihood of complications. 

Healthy eating for people with diabetes is no different than for everyone else.

Diabetes and healthy eating

Diabetes can be well managed with healthy eating, combined with regular physical activity and weight control. No special diets are required.
If you have diabetes, it is recommended that you follow a healthy eating plan based on high fibre carbohydrate foods such as wholegrain breads and cereals, vegetables and fruit. Limit your fat intake, especially saturated fat. Choose foods low in salt and consume only moderate amounts of sugars and food containing added sugars.
Reducing the serving size of your meals can also help you maintain a healthy body weight and better blood glucose control. It is recommended that you see a dietitian who can work with you to develop a healthy eating plan that is just right for you.
Healthy eating and diabetes
If you have diabetes, healthy eating can help you to:
Maintain general good health
Control blood glucose levels
Achieve normal blood lipid (fat) levels
Maintain a healthy blood pressure
Maintain a healthy body weight
Prevent or slow the development of diabetes complications.
No special diets are required
Healthy eating for people with diabetes is no different than for everyone else. You do not need to prepare separate meals or buy special foods, so relax and enjoy healthy eating with the rest of your family.
Physical activity
Along with healthy eating, physical activity is important. Be as active as possible. Try to do at least 30 minutes of moderate intensity physical activity most days and make the most of other opportunities to be active.
Basic eating guidelines
Follow this simple healthy eating plan if you have diabetes:
Eat regular meals throughout the day.
You may need to limit the serving size of your meals and snacks, as too much food will lead to an increase in body weight.
Include carbohydrates at each meal. Examples of carbohydrate foods are bread, cereals, pasta, rice, fruit, starchy vegetables, milk and yoghurt.
Do not restrict your carbohydrate intake. Aim for at least 130g per day.
Choose high fibre carbohydrate foods.
Select a variety of healthy foods from the different food groups. Include breads and cereals, fruits, vegetables, low fat dairy products and lean meats (or alternatives).
Limit saturated fats that are found in foods such as full fat dairy products (including cream, milk, icecream, yoghurt, butter and cheese), meat fat (trim the fat from meat and limit your intake of processed meats), fried foods, cakes, pastries and foods containing palm oil and coconut oil.
Consume small amounts of unsaturated fats like olive, canola or sunflower oil, monounsaturated or polyunsaturated margarines, oily fish, avocado, seeds and nuts.
Eat only occasionally baked items like cakes and biscuits, in small serves, even when they are low in fat.
Avoid lollies and sweet drinks (soft drink, cordial, sports drinks and energy drinks).
Don’t add salt when you cook or at the table and reduce the use of high salt foods.
Limit alcohol to two standard drinks per day, with some alcohol-free days each week.
Carbohydrates
Carbohydrates are the best source of energy for your body. Carbohydrates are digested in the body to form glucose in the blood. It is the amount of carbohydrate in your meal that has the greatest effect on blood glucose levels. By eating regular meals and spreading carbohydrate foods evenly throughout the day, you can maintain energy levels without causing large rises in blood glucose levels.
If you take insulin or diabetes medication, you may also need to eat snacks between meals. Check with your diabetes educator or dietitian for advice and information on how to get the right amount of carbohydrate in your meal plan.
Glycaemic index
Some carbohydrate foods release glucose into the bloodstream more quickly than others. Foods that produce a slower rise in blood glucose levels are described as having a low glycaemic index (GI) and can be helpful in blood glucose management.
Healthy carbohydrate foods that have a low GI include most high fibre breads and cereals, pasta, basmati or Doongara rice, fruit, legumes and low fat dairy products. Aim to include at least one ‘low GI’ food per meal.
Some low GI foods may be high in fat and energy – for example, icecream and chocolate. Always check the list of ingredients and the energy (calorie or kilojoule) content of packaged foods.
The GI values of foods are only an average, taken from ten healthy people who can show large variations. People with diabetes are advised to test their blood glucose levels to determine the effect of various foods on their own blood glucose levels.
Sugar
People with diabetes who follow a healthy eating plan can include some sugar in their diet. However, the sugar should be eaten in nutritious foods, such as high fibre breakfast cereals that contain dried fruit, or low fat dairy products, rather than in sweets or soft drinks.
You can use artificial sweeteners to replace some sugar if it helps to reduce your total energy intake and control weight.
Eat less fat – especially saturated fat
All fats are high in energy. Eating too much fat can lead to weight gain, which may make it more difficult to manage your blood glucose levels and can increase blood fats (cholesterol and triglycerides). The type of fat you eat is also important. People with diabetes have a greater risk of developing heart disease so try to eat less saturated fat.
Foods high in saturated fat include meat fat, full fat dairy foods, cream, solid cooking fats (such as butter, lard, copha and ghee), oils such as palm and coconut, and products that contain these fats (for example fried foods, some cakes and biscuits and convenience foods).
When you do eat fats, choose mainly:
Polyunsaturated fats and oils – found in polyunsaturated margarines (check the label); sunflower, safflower, soybean, corn, cottonseed, grapeseed and sesame oils; oily fish such as herring, mackerel, sardine, salmon and tuna; nuts and seeds.
Monounsaturated fats and oils – such as canola or olive oil margarines; canola and olive oil; avocados, nuts and seeds.
Eat moderate amounts of protein
The body uses protein for growth and repair. Most people only require one to two small serves of meat or other protein foods each day. Most protein foods do not directly affect your blood glucose levels. Protein foods include lean meat, skinless poultry, seafood, eggs, unsalted nuts, soy products such as tofu and legumes (dried beans and lentils). Legumes also contain carbohydrate, so they will impact on your blood glucose levels.
Some sample serves of protein foods that are low in fat include:
Half a cup of peas, beans or lentils
90g to 120g of fish, seafood, lean meat or poultry without the skin
2 eggs (try poached, scrambled with low fat milk or boiled rather than fried).
Sample meal plan
Choose foods that you like and that satisfy you. Include carbohydrate foods in each meal or snack to help manage blood glucose levels. You can eat your main meal at lunch or dinner.
Breakfast
Choose from:
One cup of high fibre breakfast cereal with low fat milk and one piece of fruit; or
Two slices of bread or toast – preferably wholegrain, wholemeal or high fibre white – with thinly spread margarine, peanut butter, jam, Vegemite, baked beans, grilled tomato or sardines
Water, tea, coffee or 100ml of fruit juice.
Light meal
One sandwich made with bread, one roll or six dry biscuits – preferably wholegrain or wholemeal – with thinly spread margarine or avocado
Lots of salad vegetables
90g to 120g of lean meat, skinless poultry or seafood; or two eggs; or 40g of fat reduced cheese; or a half a cup of legumes (such as beans or lentils)
One piece of fruit
Water, tea or coffee.
Main meal
One cup of cooked rice or pasta or one medium potato
Lots of other vegetables
90g to 120g of lean meat, skinless poultry or seafood; or half a cup of legumes (such as beans or lentils)
One piece of fruit or one small tub of yoghurt
Water, tea or coffee.
Between meal snacks
Not everyone needs to include snacks between meals. Talk to your diabetes educator or dietitian if you are unsure. If you do include snacks, select healthy choices such as fruit (fresh or canned in natural juice), low fat yoghurt, a glass of low fat milk, wholegrain bread, fruit bread or high fibre crackers
People with diabetes do not need a special diet.
Include a wide variety of healthy foods in your diet.
You may need to limit serving sizes to maintain or achieve a healthy weight.
Meals should be based on high fibre carbohydrates and be low in total and saturated fats, added sugar and salt.