Dealing with Diabetes What’s the difference? Other types
The statistics and effects on the body are scarey
The latest figures from Diabetes Australia have just been released and the facts are shocking: more than a million Australians now live with diabetes and this figure is likely to double to an estimated 3 million in the next 20 years, with the prevalence tripling from 1.5% of Australians above the age of 25 to 4.7% between 1989 and 2015.
One of the most common diseases in Australia, diabetes mellitus (DM) is a chronic disorder which results in elevated blood sugar levels, and is divided into two primary types - Type 1 DM and Type 2 DM.
Type 1 DM occurs when the beta cells in the pancreas which produce insulin are destroyed by an autoimmune process. The body becomes ‘absolute insulin deficient’ with resultant hyperglycaemia. There are ‘susceptibility genes’ which can predispose someone to the early development of the disease.
Type 2 DM occurs when the insulin produced by the pancreas is not effectively utilised by cells in the body and the body becomes ‘insulin resistant’ with higher insulin resistance levels. There’s a progressive decline in the capacity to produce insulin, and patients with Type 2 DM will ultimately become insulin dependent. Around 10% of Australians with diabetes suffer from Type 1 DM and about 90% with Type 2 DM.
Gestational diabetes occurs in pregnant women where the placenta produces hormones that affect the mother’s insulin requirement during the pregnancy. This usually resolves following delivery and is treated with close monitoring of the mother’s blood glucose levels.
Secondary diabetes happens where hyperglycaemia occurs as a result of other medical conditions affecting the action or metabolism of insulin. This includes any disease of the pancreas, drug-induced diabetes, or a genetic syndrome associated with diabetes.
Irrespective of the cause or type of diabetes, persistent and untreated high blood sugar levels can have adverse consequences to various parts of the body including the heart, brain, kidneys, eyes and circulation to the limbs. Diabetes can also result in foot amputations, loss of eyesight, and kidney disease needing dialysis.
Type 1 Diabetes requires monitoring of blood glucose levels, taking insulin and keeping a healthy lifestyle involving exercise.
Type 2 Diabetes requires healthy diet and physical activity but may also include insulin therapy and medications including Metformin, Sulfonylureas, Meglitinides, and newer anti-hyperglycaemic agents.
Prevention through lifestyle management
Although diabetes is not curable, prevention, healthy lifestyle and proper diet can minimise the factors that lead to the disorder - including consistently being overweight, eating high GI foods, excessive sugar and alcohol intake and lack of adequate exercise.
With weight reduction and caloric restriction, better blood sugar control can be achieved. Engaging in a healthier lifestyle and physical activities helps improve the metabolic rate and keeps glucose levels in check.
Patients with Type 2 DM, have other cardiovascular risk factors such as high blood pressure, impaired lipid profile, overweight, and/or sleep apnoea. These factors can be improved with active lifestyle modification.
The treatment of Type 2 DM has evolved significantly over the last decade-a range of new antihyp erglycaemic agents targeting different organs is now available to work in concert to lower blood glucose levels. By combining both lifestyle measures and drugs, diabetes can be controlled and in some cases minimised.
Dr Sarina Lim is an endocrinologist at The San Hospital Wahroonga