Everyone bandies around the term ‘diabetes’, thinking it’s got something to do with blood sugar. But what does it really mean? Dr Sam Hay delves into diabetes, explains the basics and debunks a few myths.
What actually is Diabetes?
Before I start, there’s a few things we need to explain, because unfortunately, Diabetes is not that simple! Glucose is a form of sugar. Insulin is a hormone, which turns glucose into usable energy throughout the body.
Both glucose and insulin get around our body in the blood stream. When we do those little finger prick tests we are measuring the ‘Blood Glucose (or sugar) Level’. When our body is working properly, insulin works where it should, energy is delivered and the levels of glucose in the blood are kept low and stable. But in diabetes, insulin doesn’t work – there’s either not enough of it, or our body becomes resistant to it.
When people with diabetes eat glucose, found in foods such as breads, cereals, fruit and starchy vegetables, legumes, milk, yoghurt and sweets, it can’t be converted into energy. This makes the levels of blood glucose go up, and when our body can’t maintain healthy levels of glucose, we run into both short and long term problems.
Diabetes is not just one condition. In fact, there are three main types:
- Type 1 Diabetes - This accounts for about 10% of diabetes cases in Australia. The onset is abrupt and the symptoms obvious. This is the type where insulin injections are needed to stay alive. It arises when our body’s own immune system attacks the insulin producing cells in the pancreas, drastically reducing the amount of insulin available to the body. We have no idea what causes this self attack, there’s no cure, and even more frustratingly, there are no changes to our lifestyle that make any difference. Classically, we think of Type 1 Diabetes as only occurring in kids. Unfortunately, we are seeing more and more cases in adults each year.
- Type 2 Diabetes - This effects about one million Aussies, accounting for 85% of all cases. But what’s even more alarming is that another half a million Australians don’t even know they’ve got it – so called ‘silent diabetes’. Type 2 Diabetes comes on slowly, a result of the body gradually becoming resistant to insulin, and eventually the pancreas burns out too. Risk factors are strongly linked to how many in your family also have diabetes, plus a bunch of lifestyle factors – but more on those a little later.
- The last form is Gestational Diabetes - Occurring during pregnancy, it usually disappears once baby is born. Effecting about 1 in 10 expectant Aussie mums, it’s associated with a raft of complications for mum and baby, plus carries a 18% risk of Type 2 Diabetes for mum down the track. But wait, there’s one more...
- Pre-Diabetes - This is the condition that sits between being normal and full-on diabetes, and effects 2 million Australians. It has no symptoms, and carries a massive risk of Type 2 Diabetes. But, the good news is with good management of risk factors it can be easily prevented or treated.
So how do you know if you’ve got it?
There are many signs you could have diabetes:
Being more thirsty than usual
Passing more urine
Feeling tired and lethargic
Always feeling hungry
Having cuts that heal slowly
Itching, skin infections
Unexplained weight loss (type 1)
Gradually putting on weight (type 2)
With a list like that, there’s little wonder why we test for diabetes so often – it causes nearly every common complaint! But the point is, diabetes can be subtle, symptoms mild and easily ignored, and that’s why so called ‘silent diabetes’ is such a massive issue. So by the time it’s diagnosed, complications are well established and people are in a world of hurt.
So what are the risk factors?
Pretty much everything that increases your risk for diabetes is exactly what you need to modify if you get diabetes. So all of the risk factors form the basis of both prevention and management.
- Being overweight - Especially those who have excess weight around the waistline (ie more than 94cm for men and more than 80cm for women). My tip is to measure yourself at the narrowest point of your stomach each time so you can accurately monitor how you are going.
- Being physically inactive - Don’t get hot and sweaty for more than two hours a week? You’re in trouble.
- Bad blood fats - Having high triglycerides and low HDL (good cholesterol) and/or high total cholesterol. Rely on your doctor for help measuring these with an easy blood test.
- Age over 45 - It’s the one risk factor we can’t do anything about. Age!
- Having high blood pressure - Again check in with your doctor for an accurate measure.
- Having a family history - of type 2 diabetes and/or heart disease.
- Smoking - ANOTHER reason to quit!
- Being Aboriginal or a Torres Strait Islander - Rates of diabetes amongst our indigenous communities is higher than other sectors of the public.
Myth: Eating lots of sugar causes diabetes
Fact: Well, it depends on how you look at it. Being overweight increases diabetes risk, and eating too many calories – such as lots of high sugar foods – can make you fat. So it’s more of an indirect risk. Drinking sugary soft drinks is linked to increased diabetes risk, but again, not confirmed if it’s a direct link, or related to other factors (such as weight gain). Eat a classic western diet chocka-block full of red meat, processed meat, high fat dairy products, sweets, and desserts? Then you’re definitely at greater risk. Want to assess your own risk? Diabetes Australia has a quick and easy risk calculator.
Myth: Being obese guarantees you’ll get Diabetes
Fact: Obesity is only one of the risk factors for Diabetes. Diabetes is a complex condition where many other risk factors compound with each person. Some people are just unlucky.
Myth: Only Type 1 Diabetics need insulin
Fact: People with Type 1 Diabetes depend on insulin every day. The mainstay of management for Type 2 Diabetics is diet control, risk factor management, then various medications. However, within 6-10 years 50% of Type 2 Diabetics will need insulin injections because their pancreas eventually burns out completely and no longer produces any insulin.
So you’ve worked out your risk, but how do you know you’ve actually got it?
It all starts with blood tests – simple, easy, and cost effective. A snap shot fasting blood glucose, a longer glucose tolerance test (where we measure your body’s response to a sugar hit over two hours), or the more ‘long term’ diabetes test of the HbA1C. Bottom line - which test you need is a little complicated – chat with your doctor about what’s right for you. The frequency of those tests depends on how bad things are, and how good YOU are at turning your risk factors (and life) around.
Already have pre-diabetes? Then you’re up for blood tests each year. Anyone with moderate or high risk needs immediate, then regular screening each year.
Low risk? Diabetes is too common to ignore completely, so all adults over 40 need to complete the risk calculator each year. Have a chat with your doctor about the need for blood tests along the way.
So you’ve got it, now what?
Anyway you look at it, diabetes sucks. Ultimately diabetes damages blood vessels. Damage the bigger ones – you get heart attacks and strokes. Damage the smaller ones - you go blind, your kidneys fail, and the nerves in your feet die off – combine that with poor blood supply, you end up with infections, ulcers, and amputations. What people don’t know is that diabetes also increases your risk of tooth decay, depression, sexual dysfunction, deafness, and Alzheimer’s Disease.
Makes booking that test sound easy and worth it!