DIAGNOSIS AND MANAGEMENT KEY TO DEALING WITH DIABETES

Professor Jerry Greenfield, head of the Diabetes and Endocrinology Department at St Vincent’s Hospital in Sydney, says one in four people have diabetes or are pre-diabetic. About 80-90% of those with diabetes have type 2 diabetes.
“Many people with type 2 diabetes do not have any symptoms,” he says. “Their condition is often only picked up when their GP does a blood test or an annual screening.”
Type 2 symptoms can include feeling tired, going to the toilet a lot, feeling thirsty, blurred vision, numbness or pain in the hands or feet, and cuts or wounds that take a long time to heal.
Ignoring it can lead to heart attack, stroke, kidney disease, blindness, limb loss through amputation, and other conditions caused by damage to the vascular and nervous system.
Dr Greenfield says type 2 diabetes risk factors include: family history (genetics); prior diabetes in pregnancy (gestational diabetes); a history of polycystic ovary syndrome, a condition some women develop in their reproductive years; at-risk ethnic groups; Indigenous Australians; excess weight; and poor exercise.
“The importance of genetics cannot be under-estimated,” he says. “Although type 2 diabetes usually develops in older individuals, we are seeing younger and younger people with type 2.”
Gestational diabetes can develop during pregnancy. “It’s usually a form of diabetes that dissipates afterwards, but those individuals are at risk of type 2 and will need to be followed for life.”
While insulin may still be needed for individuals with type 2 diabetes, Dr Greenfield says there are other treatments, including a number of novel diabetes medications.
“There are also newer drugs that are beneficial as they reduce risk of heart disease. One class of medications work by increasing the excretion of glucose into the urine,” he says.
“Another is a weekly injection that reduces appetite and improves insulin production in the pancreas.
“But weight loss and dietary change are cornerstone treatments.
“In contrast, type 1 diabetes usually has onset at a young age, but we are seeing onset in older individuals now.
“Type 1 diabetes is due to an absolute deficiency in insulin production from the pancreas. Individuals with type 1 are dependent on insulin for their survival.”
Dr Greenfield says patients with type 1 often present for treatment with marked symptoms including excess thirst, problems such as passing urine frequently, weight loss, blurred vision, thrush, and lethargy.
“Untreated type 1 diabetes can lead to diabetic ketoacidosis, a condition where acid levels build up and individuals become very unwell, usually requiring hospitalisation,” he says.
“Engaging with diabetes educators, dietitians, exercise physiologists, and psychologists is key.
“There is a large team of healthcare practitioners who can support people with diabetes. They provide advice regarding dietary management and weight loss, the importance of glucose monitoring for certain people with diabetes, the importance of exercise, and awareness regarding ‘diabetes distress’.”

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LEARNING TO MANAGE DIABETES IS ESSENTIAL, BUT THERE ARE PEOPLE WHO CAN HELP.

Ninnette Kelly is the Diabetes Education Team Leader at Cabrini hospital in Malvern, Victoria.
Ms Kelly’s team provides information on all aspects of the condition, but mainly how to balance everything from monitoring and injecting, to diet and exercise.
“We provide education on what to eat, how to monitor their glucose levels, how to take medication safely, and sign them up to the National Diabetes Services Scheme,” she says.
Ms Kelly says teaching patients how to properly monitor their condition is essential.
“Testing is the key that links everything together. If you don’t know your sugar levels you don’t know how what you are eating or how you are exercising is affecting your levels.”
She says there are many “amazing” technologies to help monitor glucose levels now.
Fundamentally, blood glucose monitors that involve finger-prick testing are key. Some can be set up with alarms and alerts, or be Bluetooth linked to a phone and even forward blood glucose levels to your health professionals.
More advanced systems include glucose monitoring discs or sensors which are placed on the skin with flexible plastic cannulas under the skin and can provide glucose readings that can be read by swiping a reader or phone. Others can take readings in real-time and send glucose patterns to your phone or an insulin pump.
Ms Kelly says while these are great and suit some people, they can be expensive and not accessible to all, therefore basic finger-prick testing is the most commonly used system.
And while diet and weight management are important, being active is the key.
“Being active lowers your glucose levels and helps with blood circulation, which in turn helps prevent other diabetes complications such as nerve damage, heart attack or stroke, and blindness,” she says.
“And there is no such thing as ‘diabetic diet’. People with diabetes should be eating what we all should be eating, a little bit less fat, higher fibre, less carbs, more whole foods and vegetables and fruit – overall a balanced meal.
“Weight can be a ‘Catch 22’. If you are overweight it can be difficult to exercise to lose weight, and some diabetes medication can even promote weight gain and fat storage.”
Ms Kelly says dealing with diabetes also requires a good mindset.
“Diabetes is a long-term condition, so motivating factors determine how well people look after themselves. People who are a bit ‘flat’ or suffering from depression, are not going to test themselves, not going to eat as well, not going to exercise.
“So we need to look after the psychosocial aspect of their condition also, so they are better able to manage their diabetes.”

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For more information on diabetes:
Diabetes Australia
National Diabetic Services Scheme:
Baker Institute: