Diabetes - A Sweet Touch

Diabetes mellitus ("sugar diabetes") has become one of the commonest diseases of older people and it is rapidly becoming more common. It has been calculated that in Australia alone almost 800,000 people have diabetes at this moment but only half of these people actually know that they are diabetic and far fewer keep their illness under optimal control.

The common understanding about diabetes is that diabetics cannot eat anythin sweet and that if they do they can lapse into comas;they need to have injections of insulin and eventually they go blind and get gangrene of their toes and feet. Unfortunately this image is based on half truths and prevents many people from having checkups to see if they have diabetes.

What Are The Main Types of Diabetes?

There are two major forms of diabetes :

What Damage Does Diabetes Do In The Body?

Poorly controlled diabetes causes slowly progressive damage to both small and large blood vessels throughout the body and therefore the tiny blood vessels in the kidneys and the light-sensitive parts of our eyes (the retinas) become damaged ultimately causing kidney failure and blindness. The larger blood vessels also become damaged and gradually develop blockages which can cause gangrene in the toes and feet as well as heart attacks and strokes.

Diabetics who smoke and/or have high blood pressure and/or high cholesterol levels in their blood are at much greater risk of developing damage to their blood vessels (see the article on risk factors on this website).

Why Do We Get Diabetes?

Diabetes is becoming increasingly common in our society largely because of our eating habits. We tend to eat too much and too often and what we eat tends to be far too rich in the simple and rapidly digested carbohydrates or sugars. When we eat a meal the pancreas released insulin directly into the blood and this hormone allows the body's tissues to use the glucose which is entering the blood from the stomach and intestines where the food is being broken down into its basic building blocks. If the food contains lots of glucose or simple sugars it can be absorbed into the blood very rapidly and the pancreas works overtime to produce lots of insulin to allow the high level of blood glucose to be used by the body's tissues. Therefore the insulin helps to keep the level of glucose within narrow limits.

Over a lifetime of eating too much food rich in simple carbohydrates our tissues become progressively less sensitive to the effects of insulin (ie. they develop "insulin-resistance") and type 2 diabetes is the end result of this process. Commonly those who develop this disease are considerably overweight (which also contributes to high blood pressure) and do very little if any regular exercise.

How Is Diabetes Treated?

This illness can often be very successfully treated without any medications - for many type 2 diabetics the only treatment necessary is changing the diet to have far fewer calories by having less fat and simple carbohydrates, and doing regular daily exercise. This gradually results in loss of weight and quite commonly, as weight drops so does the average blood glucose level.

With good control of diabetes the long term complications are either postponed or prevented entirely!

Some diabetics aren't quite so lucky and they require regular medications; a proportion of these eventually need one or two injections of insulin every day.

Who's Involved In The Care of Diabetic Patients?

Once the diagnosis of diabetes has been made by a patient's general practitioner the patient will commonly be referred immediately to the local "diabetes educator". This person is usually a qualified nurse who has had advanced training as a diabetes educator and specialises in the role of teaching people with diabetes all about the illness. They will teach diabetics how to measure their blood glucose levels and will help them to purchase a glucometer (the electronic device which measures glucose levels from a tiny drop of freshly-obtained blood applied to a disposable test strip protruding from the glucometer). Often the diabetes educator works with a dietitian who can advise patients about healthy diets.

All diabetics need to take responsibility for controlling their illness and they need to become experts in diabetes! Regular self-monitoring of blood glucose levels (also called "glucometry") is an essential part of good care of diabetes. Because of the long-term effects of diabetes on the eye, regular assessment by an "ophthalmologist" (eye specialist) is essential as those complications which lead to blindness can nearly always be detected at an early stage. Early treatment can prevent blindness but intervention at a late and advanced stage will often fail to prevent loss of vision!

Similarly diabetics are particularly prone to infections and if eyesight and body flexibility decline it becomes increasingly difficult to take adequate care of one's feet. For this reason diabetics are encouraged to have regular appointments with a podiatrist and make certain that they have well-fitting shoes.

Finally a general practitioner will commonly refer diabetics to see an "endocrinologist", a medical specialist who deals, amongst other disease, with diabetes, in order to ensure that the best possible treatment has been provided. Visits to an endocrinologist are usually quite infrequent and the general practitioner is usually the first port of call if a diabetic develops health problems!

The Bottom Line!