Diabetes 101

Diabetes is a disorder in which the body is unable to properly regulate blood sugar. As a result, blood sugar levels climb too high and this, over time, causes damage to various body tissues. More than 1 million Australians are currently living with diabetes, and the numbers are rising.

The role of insulin

In all cases of diabetes, the underlying issue is the body’s level of and/or reaction to the hormone insulin. Insulin’s job is to keep our blood sugar levels down, and our pancreas should naturally release some in response to increased blood sugar—after eating, for example. In the case of diabetes, the body either does not produce enough (or any) insulin or the cells of the body do not respond properly to it.

Types of diabetes

The three main types of diabetes are known as gestational, type 1 and type 2.

Gestational diabetes is a disorder that some women experience during pregnancy. It affects up to 4 per cent of pregnancies and can lead to a variety of complications for both mum and baby.

Type 1 diabetes usually starts very early in life. In this case, the body is unable to produce insulin. People with type 1 diabetes rely on injectable insulin for their survival and must maintain a proper injection schedule in order to keep their blood sugar levels under control.

Type 2 diabetes is the main form and accounts for about 90 per cent of all diabetes cases. It generally develops in adulthood (though an alarming increase in childhood cases of type 2 diabetes is now being seen). In this diabetes, either the pancreas does not produce enough insulin or the body does not respond properly to the insulin because cells have lost their sensitivity to it.

Symptoms

In early stages, the classic symptoms of diabetes are increased thirst, hunger and urination. Unusual and persistent tiredness, frequent infections and/or infections that do not heal well are also commonly seen.

Complications

For all individuals with diabetes, a long list of complications can arise if the condition is not well managed. These are the most common complications that can occur in anyone with diabetes.

Cardiovascular concerns

High blood pressure and increased risk of heart disease and stroke often accompany diabetes. As much as 80 per cent of deaths in diabetics are due to a heart attack or stroke.

Nervous system

Chronically elevated blood sugar levels can lead to nerve damage that may present as numbness or tingling and often affects the feet of those with long-term and/or poorly controlled diabetes.

Diabetics are at risk of foot infections because they cannot feel (and therefore may not properly care for) small cuts or other skin problems. Minor foot injuries can lead to serious infections, which, if left too long, may result in the need to amputate part of the foot and leg. This sounds extreme, but each week in Australia, around 85 diabetics undergo lower limb amputations as a result of complications from diabetes.

Eye disease

Diabetes tends to attack the retina, the back part of the eye that is rich in blood vessels. Known as diabetic retinopathy, this type of eye disease is the leading cause of blindness in Australians under age 60. It is extremely important that diabetics have annual eye exams to monitor their eye health.

Kidney disease

The kidneys are another common site of damage for diabetics. About one-third of people who have had diabetes for longer than 15 years will eventually suffer from kidney disease.

Depression

This concern is about twice as common among diabetics as it is in the general population. Although it is not clear what causes this increase in risk, factors that may contribute include the stress of living with a chronic illness and the direct impact of metabolic changes on the brain.

Diabetes and men’s health

In addition to the complications listed above, men with diabetes are also at increased risk of sexual health concerns. At least 50 per cent of men with diabetes will experience erectile dysfunction (ED) as a result of nerve, circulatory or other complications of chronically high blood sugar levels.

This is a serious issue not only for the sexual and emotional well-being of men, but also for their heart health. It has been shown that ED in diabetics can be an important early warning sign for future cardiovascular disease and is associated with a significantly increased risk of heart disease and stroke.

Diabetes and women’s health

Diabetes also presents additional complications for women. Women with diabetes can experience inconsistent menstrual cycles, including delays in the onset of their cycles (in the case of type 1 diabetics) and earlier onset of menopause. Diabetic women have also been shown to have about twice the risk of menstrual irregularities as nondiabetic women. 

This can have a big impact on a woman’s fertility, and diabetics may experience challenges when trying to conceive. Fertility rates improve, however, when blood sugar management is achieved.

Pregnancy

Diabetics who become pregnant are recommended to receive extra monitoring for blood pressure, eye health and other potential complications. Some medications used to treat diabetes complications such as high blood pressure may not be suitable during pregnancy and alternate medications may need to be prescribed.

Blood sugar levels should be very tightly controlled in order to avoid potential risks to the baby, such as foetal malformations that can occur if blood sugar levels are not maintained at a healthy level throughout pregnancy. On the other hand, hypoglycaemia (blood sugar that is too low) can be a serious concern for the pregnant diabetic (particularly type 1 diabetics) and must be avoided as well. For women using insulin, doses may have to be adjusted throughout the pregnancy.

Diabetes and seniors

The risk of type 2 diabetes increases with age, making seniors a vulnerable population. It is important for blood sugar levels to be checked as part of the regular annual physical for seniors, particularly because new onset diabetes may manifest differently in seniors and may only be caught by routine monitoring.

Diabetics are also at increased risk of complications over time, and so seniors with diabetes must be particularly aware of maintaining healthy blood sugar levels and have regular check-ups to monitor kidney, eye and cardiovascular health.

The neurological complications of diabetes can also present a particular challenge for seniors. Neuropathy can lead to problems with balance and coordination, which can increase the risk of falls. Falls present a major threat to the well-being of seniors because of the potential for fractures.

Risk factors for type 2 diabetes

Age

Being over 40 years old increases your risk of developing diabetes. This may be partially due to other factors associated with ageing, such as loss of muscle mass, decreased exercise and weight gain.

Genetics

Having a sibling or a parent with type 2 diabetes may also put you at risk.

Ethnicity

Individuals from certain ethnic groups are at a higher risk, including Pacific Islanders and those of Indigenous, Hispanic or South Asian descent. There are higher rates of diabetes among those born overseas compared with those born in Australia.

Obesity

Being overweight substantially increases your risk of developing diabetes. Obesity decreases the body’s sensitivity to insulin so that, even if your pancreas is working hard to pump out insulin, the body just cannot react to it appropriately.

Sedentary lifestyle

Exercise plays a very important role in maintaining healthy blood sugar levels and is a key factor in both diabetes prevention and management.

Smoking

Smokers are about twice as likely to develop blood sugar control problems as nonsmokers. However, even “passive smokers” (those exposed to second-hand smoke) are at an increased risk. Smoking, as is now well known, also increases the risk for heart attack, stroke and circulatory problems, all of which are more likely to occur in diabetics.

Prevention

Although certain risk factors for diabetes cannot be modified (age, ethnicity, genetics), the vast majority of them can. It is widely believed that type 2 diabetes is a preventable disease for most people and that lifestyle and dietary choices could save thousands from developing diabetes. The following are key preventive measures.

Weight loss and maintaining a healthy weight

As mentioned above, extra weight makes it much harder for the body to properly regulate blood sugar.

Smoking cessation

Butting out is one of the most important things that can be done to improve heath.

Regular exercise

Aim for at least 30 minutes of physical activity on most days of the week. Enjoy a combination of both cardiovascular exercise (such as brisk walking, cycling, jogging and dancing) and strength training (weights, Pilates, climbing or a similar activity).

Diet

Diets rich in vegetables and fresh fruit and low in refined carbohydrates and processed foods are associated with a decrease in diabetes risk. For those with diabetes, a similar diet that more tightly controls carbohydrate intake can help maintain healthier blood sugar levels.

Supplements for diabetes

While supplements may not necessarily prevent the onset of diabetes, some may reduce the risk of developing this disease. Supplements can also be helpful for those who have already been diagnosed, depending on their particular situation. Here are a few examples; however, always consult your health care practitioner to determine if they are right for you.

Chromium

This mainstay of complementary therapy for diabetes has been well used and well researched for many years, so you may already be familiar with it. But, while some studies have suggested that chromium can help diabetics by improving blood sugar control, other research has shown less promising results.

The most important factor in determining whether or not chromium supplementation will help is the patient. Some research suggests that those more likely to benefit from chromium are type 2 diabetics with insulin resistance and higher HbA1c levels. (HbA1c is a blood test that tells us about long-term blood sugar control.) Diabetics with good blood sugar control may benefit less from chromium supplementation.

Magnesium

This mineral plays a key role in hundreds of reactions that keep our body going, including those involved in blood sugar regulation. Increased intake of magnesium-rich foods such as nuts, leafy greens and beans has been associated with decreased risk of type 2 diabetes.

Magnesium supplementation may also be helpful for diabetics, especially those with depleted levels of this mineral. In elderly type 2 diabetics with low magnesium, supplementation may aid in the treatment of depression. In type 2 diabetics in general, an average daily dose of 360 mg of magnesium over approximately 12 weeks has been shown to help increase HDL (“good” cholesterol) levels and decrease fasting blood sugar levels.

Alpha-lipoic acid (ALA)

Another popular supplement for diabetics, ALA has been studied mostly for its ability to prevent and treat diabetic neuropathy. Overall, studies in the treatment of this condition show that ALA at a dose of about 600 mg a day can be helpful in relieving symptoms.

Diabetes and children

The majority of diabetes cases in children are type 1. It used to be essentially unheard of for children to have type 2 diabetes—hence one of the older names for this form of the disease: adult-onset diabetes. Unfortunately, type 2 diabetes cases are not only now seen in children, but are also rising at an alarming rate.

Almost all children with type 2 diabetes are overweight. And as childhood obesity rates soar (currently one in four Australian children are considered overweight or obese), so too will childhood type 2 diabetes.

Children with type 2 diabetes are at risk of the same complications as adults but can develop them much more quickly. These children are also more likely to suffer from high blood pressure and elevated cholesterol levels, increasing their risk of cardiovascular disease at a young age.