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WHAT IS DIABETES? SIGNS, SYMPTOMS AND TREATMENTS

Are you thirsty, tired and spending a lot of time in the bathroom? These could be diabetes symptoms – but there are ways to treat and live with the condition.

More than 1.3 million Australians are known to have diabetes type 1 and 2, but the total number is probably higher. According to the Australian Institute of Health and Welfare, for every four people with diabetes, a fifth person doesn’t know they have it.

With one person diagnosed every five minutes, diabetes is one of the fastest growing chronic conditions. And, as yet, there is no cure. Fortunately, there are treatments and lifestyle changes you can make that may keep the condition under control.

What is diabetes?

Diabetes is all about how your body metabolises sugar– a key part of this is the hormone insulin which is  produced by your pancreas. It’s what enables glucose (from food) to enter cells and to be turned into energy.

Without insulin, you end up with high levels of glucose in the bloodstream (known as diabetic hyperglycaemia or high blood sugar) and that can eventually damage your eyes, kidneys and nerves, and may lead to heart disease and stroke.

Diabetes is currently the seventh most common cause of death by disease in Australia.

There are three main types of diabetes:

Type 1 diabetes occurs when the body’s immune system destroys the beta cells in your pancreas, so it produces very little or no insulin. We don’t know why that happens, and it can only be treated by replacing the absent insulin. It represents about 10% of all cases of diabetes.

With type 2 diabetes, you still have your beta cells, but either your pancreas makes an inadequate amount of insulin, or your body is unable to make use of it.

Gestational diabetes affects 15% of pregnant women in Australia. It’s caused by pregnancy hormones which can interfere with the body’s ability to make efficient use of insulin. Gestational diabetes usually resolves after the birth.

What causes diabetes?

Type 1 used to be referred to as ‘juvenile diabetes’ and is one of the most common chronic childhood diseases. However, it can occur at any age and research suggests half of all cases are diagnosed over the age of 30.

We don’t know what causes type 1 diabetes, but having it in the family puts you at higher risk. Other known risk factors include genetics, geography (the incidence increases as you move away from the equator) and being in the peak age brackets, which are four to seven and 10–14 years of age. Research is also underway into certain viruses, gut microbiome, environment and diet as contributing factors.

When it comes to type 2 diabetes, we have a much clearer understanding of the risk factors.

“Because of our lifestyles, getting type 2 diabetes has shifted from [age group] 50s and 60s to 30s and 40s,” explains Assoc Prof Andrikopoulos, CEO of the Australian Diabetes Society.

Things that may increase your chances of developing type 2 diabetes include:

  • age
  • family history and genetics
  • unhealthy diet
  • lack of physical activity
  • pre-diabetes (higher than normal glucose, but not high enough to cause diabetes)
  • being overweight
  • having had gestational diabetes.

Cultural background may also be a factor. Aboriginal and Torres Strait Islander people are three times more likely to develop type 2 diabetes than non-Indigenous Australians. And people of Pacific Islander, Maori, Asian (including the Indian sub-continent), Middle Eastern, North African or Southern European background are considered to be in a high-risk category.

Location, too, could play a part. Australians living in remote areas tend to have more risk factors and suffer double the rate of hospitalisations and deaths from diabetes compared to those in major cities.

If you want to know your potential risk of getting type 2 in the next five years, the AUSDRISK questionnaire is a good place to start. “If you score more than 12, you need to get tested,” says Assoc Prof Andrikopoulos.

Diabetes signs and symptoms to look for

“If you’ve got the classic signs of diabetes, then you need to see your GP,” says Assoc Prof Andrikopoulos.

Those classic signs – known as the 4Ts – are common to both type 1 and type 2:

  • tired – a level of fatigue that you can’t explain
  • thirsty – you can’t drink enough to satisfy your thirst
  • thinner – sudden weight loss without trying
  • toilet – going to the toilet more than usual.

If you have type 1 diabetes, symptoms can come on suddenly and may include:

  • having cuts that heal slowly
  • itching, skin infections
  • blurred vision
  • mood swings
  • headaches
  • feeling dizzy
  • leg cramps
  • bed-wetting in children who didn’t do so before.

“Many times, people with type 1 diabetes are diagnosed in hospital,” says Assoc Prof Andrikopoulos. “They’ll collapse with ketoacidosis (often referred to as a diabetic coma). That’s quite an acute situation. We want to avoid people going to the hospital to get diagnosed.”

Diabetes treatment options

Assoc Prof Andrikopoulos has been working in the field for 30 years and he says our knowledge of the disease and how to manage it has come a long way.

“You shouldn’t be worried at all,” he says, reassuringly. “The advances in technology, pharmacotherapy and in our understanding of lifestyle choices and interventions are huge.”

Managing any type of diabetes takes a team approach. Your first port of call is your GP. They will likely put you on a chronic disease management plan and can connect you with a credentialled diabetes educator who will coordinate your healthcare, arranging consultations with other specialists including a dietitian, exercise physiologist, podiatrist and ophthalmologist.

Type 1 has different treatment options to other types of diabetes. “Type 1 is an absolute deficiency of insulin, so the treatment is insulin. You’re replacing the hormone that’s not there,” explains Assoc Prof Andrikopoulos.

“With type 2 there’s a relative deficiency of the hormone insulin. You still have beta cells, but they don’t produce enough. You still have some insulin, so you try and make that insulin work better. You can do that behaviourally with respect to weight loss, and you can also do it pharmacologically,” says Assoc Prof Andrikopoulos.

He says the first line of therapy is putting together a lifestyle management program, and it’s critical to consider cultural and personal factors when deciding on appropriate diet and exercise that will work for the individual.

“We have the ability today to be much more person-specific in the way that we manage diabetes,” he says. “It’s not a one-size-fits-all.”

Health and wellbeing support

If you have diabetes or a heart-related condition and have had hospital cover (other than Accident Only Basic cover) for at least 12 months, you could be eligible for 6 free phone coaching sessions through the COACH Program.

Eligible members may also qualify for Healthy Weight for Life, an evidence-based program designed to help people over 18 with a BMI over 28 and type 2 diabetes, a chronic heart condition or osteoarthritis to lose weight. If you don’t meet the criteria above and have eligible extras cover, you can claim towards this the cost of this program or you may self-fund. Call HCF on 13 13 34 to find out more.

Healthy Weight for Life COACH Program
Words by Mariella Attard
First published October 2020

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What is gestational diabetes?

Despite coming with serious risks, you can manage gestational diabetes with the help of your GP and medication if you need to.

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