Diabetes

Diabetes or Diabetes Mellitus is a disorder characterised by
hyperglycaemia (high blood glucose levels) caused by impairment in
insulin secretion and/or action.

DESCRIPTION

When the food we eat is digested, most of it becomes glucose
(sugar), which the body uses for energy. In order for this to
happen, the glucose must leave the blood and enter the body cells.
The hormone that helps glucose enter the cells is called insulin.
It is produced by an organ called the pancreas. In Diabetes, the
pancreas either doesn’t produce insulin, or the body is unable to
use the insulin properly. This causes glucose to build up in the
blood instead of entering the cells, a process called
hyperglycaemia.

There are two types of Diabetes: type I and type II
Diabetes. 

TYPE I (Insulin Dependent Diabetes Mellitus-
IDDM) can occur at any age but most commonly develops before the
age of 30. It accounts for 10 to 15% of Diabetes cases. In Type I
patients, the pancreas produces little or no insulin.

TYPE II (Non-Insulin Dependent Diabetes Mellitus)
is usually diagnosed in people over 30 years, although it can occur
in children and teenagers. In Type II patients, the pancreas
produces insulin but the body does not use it properly. This is
called insulin resistance.

There is a third type of Diabetes called gestational Diabetes,
which only occurs during pregnancy. See the Gestational Diabetes
topic for more information.
 

Diabetes is a condition requiring life-long management. There
is no cure, but symptoms can be controlled with careful attention
to diet and medications. Poorly controlled Diabetes may lead to
serious complications. Complications of Diabetes include:

• Diabetic retinopathy (a progressive loss of vision that can
  lead to blindness).
• Diabetic neuropathy (nerve damage). This causes loss of
  sensation in the lower limbs and may lead to foot ulcers, joint
  problems and infections. Diabetes causes changes to the physiology
  of the foot such as decreased sensation (feeling) which can result
  in injuries to the foot going unoticed, less effective wound
  healing and changes to the foot. Limb amputations are sometimes
  necessary as a result.
• Diabetic nephropathy (kidney disease).
• Heart disease. 

See the Diabetes and Complications topic for more
information.

SIGNS AND SYMPTOMS

Symptoms include feeling thirsty all the time, urinating more
frequently, blurred vision, tiredness, numbness and tingling in the
feet or legs and recurrent infections.

TREATMENT OPTIONS

Diabetes is a serious condition requiring life long
management, which should address the following issues:

1. Regular screening for complications. Foot care, eyes, kidney
   health and blood sugar control should all be checked.
2. Education regarding ideal blood sugar levels and use of blood
   sugar measuring devices.
3. Reducing risk factors such as smoking, alcohol consumption and
   obesity.
4. A detailed, individual diet plan.
5. A suitable exercise programme.
6. Education about diabetes medications.
7. Education about concurrent illnesses such as hypertension, high
   cholesterol, kidney disease and heart disease.

DIET HINTS

There is no one “Diabetic Diet” that is suitable for all
people with Diabetes. Dietary needs will vary greatly depending on
the person’s age, health status, lifestyle and exercise
routine.

1. Consult a Dietitian, who will help you determine a meal plan
   suitable for your lifestyle. 
2. Foods with a high Glycaemic Index (GI) cause a more dramatic
   rise in blood glucose levels than foods with a low GI, therefore
   low GI foods are recommended. Low GI foods are mainly complex
   carbohydrates such as wholegrain bread, oats, high fibre breakfast
   cereals, pasta, barley, legumes, fruits, starchy vegetables such as
   corn and sweet potato and low-fat milk products. See the Glycaemic
   Index topic for more information.
3. Avoid excessive sugar intake from foods such as cakes,
   biscuits, chocolate and confectionery. 
4. Limit the intake of saturated (animal) fat. A diet high in
   saturated fat interferes with diabetes control, contributes to
   weight gain and affects blood fat levels. This increases the risk
   of complications. 
5. A recent, controlled study involving 37,000 women has found
   that middle age and elderly women with high levels of red meat in
   their diet have an increased risk of developing type 2 diabetes.
   This risk is increased in women who eat high levels of processed
   meats such as bacon and hotdogs. 
6. Limit alcohol intake to no more than two drinks per day, with
   two alcohol-free days per week. Studies show that a light to
   moderate alcohol intake can reduce the risk of developing Type II
   Diabetes. However alcohol may react with insulin or medications and
   lead to hypoglycaemia. Alcohol should not be consumed at the same
   time as medications, and should be consumed with a carbohydrate
   food.

PREVENTION

• At present, Type I Diabetes cannot be prevented, although with
  careful management the symptoms can be controlled. Researchers are
  hoping to develop methods to prevent Type I Diabetes in the near
  future. 
• Type II Diabetes tends to be linked to several risk factors.
  Those at risk of developing Type II Diabetes include:
• People over 50 with either hypertension (high blood pressure),
  obesity or a close relative with Diabetes.
• Anyone who is over 65.
• Anyone with a history of heart disease.
• Anyone who has had Gestational Diabetes.
• Aborigines, Torres Strait Islanders, Pacific Islanders, people
  from the Indian Subcontinent or people with Chinese
  backgrounds.

People who fall into one or more of these risk groups should
consult their Doctor for advice on preventing Type II Diabetes.
Exercise, weight management and a healthy diet can all help prevent
Type II Diabetes.

VITAMINS/MINERALS/HERBS

Always consult your Doctor before taking any supplement or
herbs. Nutritional supplements may only be of benefit if dietary
intake is inadequate.

• Chromium helps control blood glucose levels.
• Essential fatty acids, such as omega 3 essential fatty acids
  found in fish oil, help to reduce elevated triglycerides and reduce
  the severity of diabetic neuropathy.
• B Complex vitamins are involved in promoting healthy blood
  sugar metabolism.
• CoQ10 has a protective effect on blood vessels. Individuals
  with Diabetes and prediabetes are at risk of blood vessel
  injury.
• Vitamin C, vitamin E and the minerals zinc and magnesium may
  help to reduce urinary protein output (a marker of glomerular renal
  function) in patients with diabetic nephropathy.
• Alpha Lipoic Acid has been shown to help regulate blood sugar
  levels in type 2 diabetes. Alpha-lipoic acid may also be helpful in
  cases of diabetic neuropathy in type 1 and 2 diabetes.
• Garlic may stabilize blood sugar and help reduce risk of heart
  disease and other circulatory disorders by improving blood flow,
  lowering elevated blood pressure and reducing cholesterol
  levels.
• Psyllium has been shown to reduce blood sugar levels.
• Bilberry may help to prevent diabetic retinopathy and
  cataracts.
• Gymnema sylvestre is a herb that helps to control blood sugar
  and may play a role in alleviating Type 2 Diabetes-related
  symptoms

MEDICAL TERMS

Hormone: a chemical produced in the body that has certain
effects and functions in the body.

Ketones: A substance produced when fats are metabolised.
During hyperglycaemia excess amounts of ketones can be detected in
the urine.

ORGANISATIONS & SUPPORT GROUPS

See the Diabetes Australia topic on the Healthpoint.

PHARMACIST’S ADVICE

Ask your Pharmacist for advice.

1. If you have any queries regarding your medication for Diabetes,
   ask your Pharmacist. 
2. Blood glucose testing monitors are available to monitor your
   blood glucose. Ask your Pharmacist for advice.
3. Urinalysis testing strips can help detect excess glucose and
   ketones in the urine. These should be used in conjunction with a
   blood glucose monitor.
4. Sugar-free medications such as cough syrups are available.
   Remember to ask your Pharmacist for brands suitable for
   Diabetics.
5. Smoking increases the risk factors for other diseases such as
   heart disease and vascular disease. Ask your Pharmacist for help
   quitting smoking. Nicotine patches, nicotine chewing gum, nicotine
   inhalers and the QUIT programme are all available from your
   Pharmacy.
6. Foot care products such as wound dressings, corn pads, nail
   clippers and orthopaedic shoes can be recommended by your
   Pharmacist. A Podiatrist should always be consulted for any
   problems with the feet.
7. Exercise is vital, especially for Type II Diabetes. It reduces
   body fat, improves blood glucose control, lowers fat levels in the
   blood, lowers blood pressure and reduces the risk of heart disease.
   See the Exercising for Health topic for further information.
8. See the Vitamins/Minerals/Herbs section in this topic and ask
   your Pharmacist for advice on dietary supplements.