Diabetes is a serious complex condition which can affect the entire body. Diabetes requires daily self care and if complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. While there is currently no cure for diabetes, you can live an enjoyable life by learning about the condition and effectively managing it.
There are different types of diabetes; all types are complex and serious. The three main types of diabetes are type 1, type 2 and gestational diabetes.
Type 1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin. We do not know what causes this auto-immune reaction. Type 1 diabetes is not linked to modifiable lifestyle factors. There is no cure and it cannot be prevented.
Type 1 diabetes:
- Occurs when the pancreas does not produce insulin
- Represents around 10 per cent of all cases of diabetes and is one of the most common chronic childhood conditions
- Onset is usually abrupt and the symptoms obvious
- Symptoms can include excessive thirst and urination, unexplained weight loss, weakness and fatigue and blurred vision
- Is managed with insulin injections several times a day or the use of an insulin pump.
Management, care and treatment
Type 1 diabetes is managed with insulin injections several times a day or the use of an insulin pump. While your lifestyle choices didn’t cause type 1 diabetes, the choices you make now can reduce the impact of diabetes-related complications including kidney disease, limb amputation and blindness.
Type 2 diabetes is a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce enough insulin in the pancreas. We do not know what causes type 2 diabetes. Type 2 diabetes is associated with modifiable lifestyle risk factors. Type 2 diabetes also has strong genetic and family related risk factors.
Type 2 diabetes:
- Is diagnosed when the pancreas does not produce enough insulin (reduced insulin production) and/or the insulin does not work effectively and/or the cells of the body do not respond to insulin effectively (known as insulin resistance)
- Represents 85–90 per cent of all cases of diabetes
- Usually develops in adults over the age of 45 years but is increasingly occurring in younger age groups including children, adolescents and young adults
- Is more likely in people with a family history of type 2 diabetes or from particular ethnic backgrounds
- For some the first sign may be a complication of diabetes such as a heart attack, vision problems or a foot ulcer
- Is managed with a combination of regular physical activity, healthy eating and weight reduction. As type 2 diabetes is often progressive, most people will need oral medications and/or insulin injections in addition to lifestyle changes over time.
What happens with type 2 diabetes?
Type 2 diabetes develops over a long period of time (years). During this period of time insulin resistance starts, this is where the insulin is increasingly ineffective at managing the blood glucose levels. As a result of this insulin resistance, the pancreas responds by producing greater and greater amounts of insulin, to try and achieve some degree of management of the blood glucose levels.
As insulin overproduction occurs over a very long period of time, the insulin producing cells in the pancreas wear themselves out, so that by the time someone is diagnosed with type 2 diabetes, they have lost 50 – 70% of their insulin producing cells. This means type 2 diabetes is a combination of ineffective insulin and not enough insulin. When people refer to type 2 diabetes as a progressive condition they are referring to the ongoing destruction of insulin producing cells in the pancreas.
Initially, type 2 diabetes can often be managed with healthy eating and regular physical activity. Over time most people with type 2 diabetes will also need tablets and many will eventually require insulin. It is important to note that this is the natural progression of the condition, and taking tablets or insulin as soon as they are required can result in fewer long-term complications.
Managing Type 2 Diabetes
While there is currently no cure for type 2 diabetes, the condition can be managed through lifestyle modifications and medication. Type 2 diabetes is progressive and needs to be managed effectively to prevent complications.
Gestational diabetes mellitus (sometimes referred to as GDM) is a form of diabetes that occurs during pregnancy. Most women will no longer have diabetes after the baby is born. However, some women will continue to have high blood glucose levels after delivery. It is diagnosed when higher than normal blood glucose levels first appear during pregnancy.
Gestational diabetes is the fastest growing type of diabetes in Australia, affecting thousands of pregnant women. Between 12% and 14% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy. All pregnant women should be tested for gestational diabetes at 24-28 weeks of pregnancy (except those women who already have diabetes). Women who have risk factors for gestational diabetes should be tested earlier in their pregnancy.
Management, care and treatment
Gestational diabetes can often be managed with healthy eating and regular physical activity. However, some women may need medication (metformin) and/or insulin injections to help manage gestational diabetes.
In type 1 diabetes, symptoms are often sudden and can be life-threatening; therefore it is usually diagnosed quite quickly. In type 2 diabetes, many people have no symptoms at all, while other signs can go unnoticed being seen as part of ‘getting older’.
Therefore, by the time symptoms are noticed, complications of diabetes may already be present.
Common symptoms include:
- Being more thirsty than usual
- Passing more urine
- Feeling tired and lethargic
- Always feeling hungry
- Having cuts that heal slowly
- Itching, skin infections
- Blurred vision
- Unexplained weight loss (type 1)
- Gradually putting on weight (type 2)
- Mood swings
- Feeling dizzy
- Leg cramps
How does diabetes affect the body?
When someone has diabetes, their body can’t maintain healthy levels of glucose in the blood. Glucose is a form of sugar which is the main source of energy for our bodies. Unhealthy levels of glucose in the blood can lead to long term and short term health complications.
For our bodies to work properly we need to convert glucose (sugar) from food into energy. A hormone called insulin is essential for the conversion of glucose into energy. In people with diabetes, insulin is no longer produced or not produced in sufficient amounts by the body. When people with diabetes eat glucose, which is in foods such as breads, cereals, fruit and starchy vegetables, legumes, milk, yoghurt and sweets, it can’t be converted into energy.
Instead of being turned into energy the glucose stays in the blood resulting in high blood glucose levels. After eating, the glucose is carried around your body in your blood. Your blood glucose level is called glycaemia. Blood glucose levels can be monitored and managed through self care and treatment.
Three things you need to know about diabetes:
- It is not one condition- there are three main types of diabetes: type 1, type 2 and gestational diabetes
- All types of diabetes are complex and require daily care and management
- Diabetes does not discriminate, anyone can develop diabetes
Diabetes is serious
Diabetes can be managed well but the potential complications are the same for type 1 and type 2 diabetes including heart attack, stroke, kidney disease, limb amputation, depression, anxiety and blindness.
We know diabetes:
- Is the leading cause of blindness in working age adults
- Is a leading cause of kidney failure and dialysis
- Increases the risk of heart attacks and stroke by up to four times
- Is a major cause of limb amputations
- Affects mental health as well as physical health. Depression, anxiety and distress occur in more than 30% of all people with diabetes
Why is diabetes increasing?
All types of diabetes are increasing in prevalence:
- Type 1 diabetes accounts for 10% of all diabetes and is increasing
- Type 2 diabetes accounts for 85% of all diabetes and is increasing
- Gestational diabetes in pregnancy is increasing
Type 2 diabetes is increasing at the fastest rate. There are large numbers of people with silent, undiagnosed type 2 diabetes which may be damaging their bodies. An estimated 2 million Australians are at high risk of developing type 2 diabetes and are already showing early signs of the condition.
Type 2 diabetes is one of the major consequences of the obesity epidemic. The combination of massive changes to diet and the food supply, combined with massive changes to physical activity with more sedentary work and less activity, means most populations are seeing more type 2 diabetes.
Genes also play a part with higher risk of type 2 diabetes in Chinese, South Asian, Indian, Pacific Islander and Aboriginal and Torres Strait Islander populations.