Deal­ing with Di­a­betes What’s the dif­fer­ence? Other types

The sta­tis­tics and ef­fects on the body are scarey

Monthly Chronicle - - Health & Well-Being - WITH CON­TRI­BU­TION FROM EN­DOCRI­NOL­O­GIST DR SA­RINA LIM

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

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