Diabetes

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01 .Diabetes

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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.
 
 

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How do I prevent it?

There’s nothing you can do about your age, gender or ethnicity, but other risk factors are lifestyle-related. Keeping a healthy weight, eating a balanced diet with plenty of fibre, fruits and vegetables and doing regular physical activity are key preventative actions you can take.

However, it’s not just down to individuals. Baker IDI is calling for legislative and societal changes to support and facilitate healthy behavioural choices. This may involve changes to local town planning, the way food is marketed and even occupational health and safety regulations to reduce sedentary work practices.

Top 10 tips for avoiding diabetes

  • Exercise regularly and avoid long periods of sitting around.
  • Keep a healthy body weight
  • Get your two and five servings of fruit and vegetables every day
  • Fibre is your friend – eat plenty of it
  • Reduce saturated fats in your diet
  • Drive through the drive-thru – don’t stop! Also limit processed foods
  • Limit alcohol
  • Don’t smoke
  • Reduce your salt intake
  • Check your diabetes risk at www.ausdrisk.com.au

Diabetes & metabolic inflammation

Not everyone who has diabetes is obese, and not everyone who is obese has diabetes. This has led some to propose that obesity per se isn’t responsible for causing diabetes, but rather there are other factors that may contribute to both.

Obesity, diabetes and cardiovascular disease (including hypertension, dyslipidaemia and atherosclerosis) have been linked with a chronic low-grade systemic inflammation sometimes called metaflammation (a contraction of metabolic inflammation), which has various physiological effects, including changes to glucose and fat metabolism that lead to insulin resistance and weight gain.

Research into metaflammation began in the 1990s in the Harvard School of Public Health, and posits that our diet (food and drink) and lifestyle can have direct and indirect effects on the metaflammation process. There is emerging evidence in animals and humans that some nutrients, such as saturated and trans fats, excessive salt and sugar have an inflammatory effect, as do high glycaemic index foods, such as white rice and potatoes. Conversely, foods including fruit and vegetables, fish, nuts, cocoa and tea have demonstrated have an anti-inflammatory effect. Excessive alcohol appears to cause metaflammation, while moderate intake is protective.

This ties in with long-term studies that have found a higher risk developing diabetes among people with diets high in red and/or processed meats, low-fibre refined breads and cereals, fried potatoes and sugar-sweetened drinks, and low in fruit, vegetables – and wine!

Clearly, an unhealthy lifestyle can lead to weight gain, but even if it doesn’t, there are still health risks involved – including type 2 diabetes.

Type 1 diabetes on the increase

Unhealthy lifestyles may account for the increase in type 2 diabetes, but what about type 1 diabetes, which isn’t caused by anything you do or don’t do in life but the prevalence of which is increasing in some countries, including Australia? While viruses have been blamed for the disease, other theories and observations about increased risk of type 1 diabetes currently being researched include:

  • Babies born by caesarean section are 20% more likely to develop type 1 diabetes than vaginally born babies. Research has shown that the gut bacteria of caesarean babies is very different to that of vaginally born babies, and this has implications for immunity (type 1 diabetes is an autoimmune disease).
  • People living in high-latitude areas (such as Scandinavia, parts of Canada and southern Australia) are more susceptible to type 1 diabetes and other autoimmune diseases. This could be purely genetically-based, but it’s also been linked with vitamin D deficiency, which impacts on immunity. 
  • Endocrine-disrupting chemicals (EDCs) such as polychlorinated biphenyls, bisphenol A, phthalates and dioxin affect hormonal systems of the body. Insulin and vitamin D are hormones. EDCs are found at high levels in the food chain and environment, and at higher levels in people from developed countries – as is type 1 diabetes.
Often people with diabetes are so overwhelmed and despondent they are simply emotionally unable to adopt the measures recommended by their doctor to manage their diabetes successfully.
- Katrina Thornley, psychologist

Diabetes is not just a physical disease – it takes a huge emotional toll as well. Feelings of helplessness and despair are all too common, according to Katrina Thornley, a psychologist who counsels people with diabetes, and a diabetic herself.

“Often people with diabetes are so overwhelmed and despondent they are simply emotionally unable to adopt the measures recommended by their doctor to manage their diabetes successfully,” she says. “They often put it down to personal failure.”

Counselling can help people deal with stress, anxiety and depression associated with diabetes, as well as “diabetes burnout”, which occurs when people get fed up with having to constantly monitor blood sugar, count carbohydrates, exercise as prescribed and manage insulin and/or other medication. 

Counselling can also be useful for family members of diabetics who find themselves caught up in their loved ones dealings with diabetes.

People with diabetes are entitled to Medicare-funded sessions with registered psychologists, so ask your doctor for a referral. The Australian Psychological Society has a searchable database for psychologists with special interests, such as health-related problems or chronic disease management.

Jargon Buster

  • Impaired fasting glucose is blood glucose levels that are consistently high (though not high enough to qualify for diabetes) measured about 12 hours after eating. This indicates pre-diabetes.
  • Impaired glucose tolerance is determined by a glucose tolerance test, where blood glucose levels are measured before and after 75g of glucose is consumed. Glucose levels that are high (but not high enough to qualify for diabetes) at two hours indicate impaired glucose tolerance.
  • Insulin resistance is when cells become less sensitive to the effects of insulin as it helps transport glucose from the blood stream into cells. More and more insulin is produced by the pancreas in an attempt to deal with the circulating glucose. High levels of insulin measured in the blood indicate insulin resistance. 
  • The metabolic syndrome is a cluster of risk factors for cardiovascular disease: diabetes or raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood pressure.

More Information

Diabetes Australia is the national peak body for diabetes, and is committed to turning diabetes around through awareness, prevention, detection, management and the search for a cure.

Baker IDI Heart and Diabetes Institute is an independent, internationally renowned medical research facility which specialises in diagnosis, prevention and treatment of diabetes and cardiovascular disease.

Better Health Channel information sheet on diabetes, with links to specific types and related information

The AUSDRISK is the acronym for the Type 2 Diabetes Risk Assessment Tool developed as part of an Australian Government, State and Territory health initiative to assess a person's risk of developing Type 2 diabetes within the next five years.

Diabetes and the Environment is a 'clearinghouse' of information about causes of diabetes, in particular environmental causes of type 1 diabetes. Other types of diabetes and other causes are also covered. The site's author - an environmental scientist with type 1 diabetes -  sources and references the latest research in this area, and presents it in a clear, readable and entertaining manner.

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