Diabetes is on the rise throughout the world, affecting rich and poor alike. With current annual costs of over $6 billion in Australia, there are enormous implications for our health care system.
This article looks at:
We also translate some of the jargon surrounding diabetes.
It’s estimated that 4.4% of Australians have been diagnosed with diabetes – about 10% of whom have type 1, and most of rest type 2. However, experts believe that for every five people diagnosed with the disease there’s another four people who go undiagnosed. In other words, almost half of all people with diabetes don’t know they have it. It’s also estimated that almost one in six adults aged over 25 has pre-diabetes. Described as a “silent pandemic” in Australia, diabetes is on the rise.
For more information about medical conditions, see General health.
What is diabetes?
Our bodies obtain energy to operate from glucose in the bloodstream. Insulin is a hormone that helps get glucose from the bloodstream into cells where it’s needed for energy and storage (in the form of glycogen), and also plays a role in protein and fat metabolism. People with some form of diabetes – properly known as diabetes mellitus – have abnormal insulin function, putting them at risk of high blood sugar levels.
In type 1 diabetes, the body destroys its own insulin-producing cells in the pancreas. People tend to get it in childhood or adolescence, although some get it as adults. People with type 1 diabetes need to take insulin by injection or an insulin pump.
Type 2 diabetes tends to come on in older adulthood and is due to reduced production of insulin or reduced effectiveness of insulin (called insulin resistance). While onset typically occurs in people aged over 40 – and affects about 15% of over-65s – the disease is becoming more common in younger adults and adolescents, likely due to increased obesity in this age group. In its early stages, type 2 diabetes can be successfully managed with lifestyle modifications (diet, exercise and weight loss), though some people will need medication, and perhaps insulin.
Another common form of diabetes, specific to pregnant women, is gestational diabetes. While it often resolves after birth, women who’ve had gestational diabetes are at higher risk of type 2 diabetes in later years. It affects about 5-10% of pregnant women, though it’s been recommended that ideal blood glucose levels are lowered, meaning more women will now be diagnosed with gestational diabetes.
Finally, there’s pre-diabetes, where blood glucose levels are high but not high enough to qualify for diabetes. This is characterised by impaired glucose tolerance or impaired fasting glucose – see our Jargon Buster. While there’s a high likelihood people with pre-diabetes will go on to develop full-blown type 2 diabetes, lifestyle changes at this point – including modest weight loss, reducing saturated fat intake and increasing physical activity – can prevent it in more than half of all cases.
Who’s at risk?
Your risk of diabetes increases after age 40, is more prevalent among men than women and is higher among certain ethnic groups – for example, Indigenous Australians, Maori and Pacific Island peoples, as well as people born in India, certain Asian countries, the Middle East and north Africa. While genetics are involved, lifestyle factors such as diet and exercise, and especially body weight, can determine how or if these genetic tendencies are played out.
What’s so bad about it?
High levels of glucose in the blood lead to blood vessel damage, which in turn leads to the main complications of type 2 diabetes:
- Nerve damage and poor circulation in the feet, which can lead to ulcers and infections, ultimately necessitating amputation.
- Eye disease (diabetic retinopathy, glaucoma and cataracts), which can lead to blindness.
- Kidney disease, which may require dialysis or kidney transplant.
- Cardiovascular disease, including hypertension, stroke, coronary heart disease and angina, which is the main cause of death among diabetics.
Short periods of high blood sugar can cause damage, even if on average sugar levels are OK, which is why it’s really important for people with diabetes to constantly monitor and control blood sugar levels. Conversely, long periods of good control have a protective effect against future periods of less light control. Unfortunately, only about half of diabetics have adequate control over blood sugar levels.
Have I got it?
Symptoms of diabetes include tiredness, thirst, frequent need to urinate, slow healing of infections and blurred vision. However, many people have no symptoms, and it may be years before the diabetes is diagnosed. By that stage the disease has taken hold and vascular damage may have already occurred. Experts from the Baker IDI Heart and Diabetes Institute are calling for a national program to detect undiagnosed type 2 diabetes as well as population-wide measures to reduce risk.
A risk assessment questionnaire, the Australian Type 2 Diabetes Risk Assessment Tool (called AUSDRISK), determines your future likelihood of diabetes depending upon age, waist circumference (you’ll need a tape measure), gender, ethnicity and place of birth, lifestyle and previous instances of testing high on blood sugar (during pregnancy, for example). , People with elevated risk should consult their doctor and possibly have further testing.
Self-test blood glucose kits
are also available, and may seem more convenient than going to the doctor for a blood test. However, while they can reassure you that you don’t have high blood glucose levels at the time of the test, a fasting glucose test doesn’t tell you how well your body responds to high levels of glucose (after a meal, for example) nor provide a broader picture of short to long-term future risk.