Diabetes - Causes, Symptoms & Management

Diabetes, rather than referring to a single disease, refers to a group of disorders where the common underlying feature is high blood glucose (sugar). Diabetes is a chronic disorder, meaning that once an individual is diagnosed, they are likely to have the condition for their lifetime.

For the body to function properly, it must tightly regulate the levels of glucose in the blood. We get our glucose supply from carbohydrate-rich foods such as pasta, bread, cereal, potatoes, sweets and fruits. The primary regulator of blood glucose is a hormone called insulin; its main function is to help the body's cells convert glucose into energy. Without insulin, the glucose in the blood cannot be used for energy, and consequently it accumulates. This causes higher - than - normal blood - glucose levels; a condition known as hyperglycaemia. In diabetes, the body either cannot produce any insulin, or it cannot produce adequate quantities of it; both of these conditions result in high blood glucose.

The three most common forms of diabetes are:

• Type 1 diabetes
• Type 2 diabetes
• Gestational (pregnancy) diabetes.

Type 1 Diabetes

Type 1 diabetes is a condition where hyperglycaemia is caused by a complete and sudden loss of insulin production. It is understood that the body's own immune system specifically targets and kills the cells that produce insulin. Genetic links to type 1 diabetes are present, and therefore those with a family history are at a higher risk of developing the disease. The disease most commonly develops and presents during childhood or puberty, and it progresses with age. As type 1 diabetes is caused by an individual's own immune system rather than an environmental factor, unfortunately it is not possible to prevent this disease from developing.

The sudden onset of hyperglycaemia in Type 1 Diabetes can bring on a number of symptoms. In an attempt to remove glucose from the blood, the body increases its urinary volume and frequency and this leads to a noticeable increase in thirst. As glucose cannot be used for energy, the body has to use its fat stores for energy. Consequently, individuals who develop type 1 diabetes often report sudden, unexplained weight loss. Other common symptoms may include fatigue, nausea, vomiting and drowsiness.

If not managed appropriately, type 1 diabetes can lead to a number of serious medical conditions; many of these can be fatal. If you have experienced some of the above symptoms, or are concerned that you may have type 1 diabetes, visit your Holdsworth House doctor for screening tests to be done.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes in Australia, making up approximately 85 - 90% of all cases of diabetes. Although high blood glucose is a hallmark of type 2 diabetes, the mechanisms by which this occur are quite different from type 1. Rather than an inability to produce insulin, in type 2 diabetes the cells of the body do not respond appropriately to insulin and therefore cannot take glucose from the blood to convert into energy. This is known as insulin resistance. Although the body tries to compensate by producing more insulin, it still cannot meet requirements, leading to a gradual accumulation of glucose in the blood, and finally a hyperglycaemic state.

Although there is a genetic influence associated with type 2 diabetes, the risk of developing the disease is markedly increased when combined with certain lifestyle factors. These include high blood pressure, inadequate physical activity, overweight/obesity and poor diet. More than 80% of patients diagnosed with type 2 diabetes are obese, and it is thought that this excess of body fat leads to insulin resistance.

There is a growing trend of obesity amongst children and adults in Australia, and with this has come an increased prevalence of type 2 diabetes, to the point where it is now the fastest growing chronic disease in Australia. Nearly 2 million Australians currently have diabetes; alarmingly nearly half of them are unaware that they have type 2 diabetes.

The most common symptoms of early type 2 diabetes include increased thirst, increased urinary output, lethargy and fatigue. Diabetics are more prone to infections, and often present following repeated episodes of infection such as thrush or boils. As type 2 diabetes has a more gradual onset than type 1, in the initial stage of the disease these symptoms may not appear as noticeable. Therefore if you have any of the above risk factors or a family history of type 2 diabetes, it is essential that you book a screening appointment with your doctor to allow early detection. If not diagnosed and appropriately managed, type 2 diabetes can lead to a number of insidious complications.

Gestational Diabetes

Gestational diabetes occurs in women during pregnancy, most often during the third trimester. During pregnancy, a mother's blood glucose levels are raised in order to accommodate for the energy requirements of the baby. In most cases, the body can adapt to this by increasing insulin output to regulate blood glucose levels. However, in about 3 - 8% of instances, the mother cannot produce adequate levels of insulin, causing her to become hyperglycaemic.

Whilst the exact cause remains unknown, some factors that are known to increase the risk of an individual developing gestational diabetes are overweight / obese, a family history of type 2 / gestational diabetes and Aboriginal / Torres Strait Islander descent.

Although it is unusual to develop symptoms during gestational diabetes, some women may experience increased thirst, increased urinary output, increased / unexplained fatigue and recurring episodes of thrush. If you are concerned that you are at risk of developing / have gestational diabetes, you are advised to see your Holdsworth House doctor to monitor your blood glucose levels and to implement a treatment plan if necessary.

If there is effective treatment of gestational diabetes, the mother's blood glucose levels should return to normal (free of complications) in the weeks following delivery. If not managed appropriately, gestational diabetes can lead to a number of health implications for the mother and the baby.

What are the complications associated with diabetes?

Diabetes can lead to a broad spectrum of health issues if not managed properly.

• High levels of blood glucose can cause damage and thickening of small blood vessels, leading to a decrease in blood supply to certain regions of the body; most commonly the kidneys, eyes and nerves.
• An impaired blood supply to the kidneys can cause irreversible kidney injury, and diabetes is now the second most common cause of kidney failure in Australia.
• When the blood supply to the eyes are impaired due to diabetes, this can lead to irreversible damage to the retina, causing poor vision and even blindness.
• The nerves providing sensation to peripheral areas of the body (commonly the legs and feet) can develop insufficient blood supply in diabetes. This can kill the nerves and cause a lack of sensation, predisposing an individual to ulceration and infection.

In type 1 diabetes specifically, the inability to use glucose for energy means that many cells rely on fat stores for fuel. As a by-product of breaking down fats for energy, the body produces chemicals called ketone bodies. In uncontrolled diabetes, these compounds accumulate in the blood and make it more acidic, a condition known as ketoacidosis. This is a medical emergency and can result in death if not promptly treated.

In extreme cases of diabetes, where an individual's blood glucose reaches very high levels, this can cause a huge urinary output, which, if not compensated for by water intake, can lead to coma and sudden failure of the kidneys.

In addition to the above issues, it is important that gestational diabetes is appropriately treated to prevent further harm to the mother or baby. Poorly controlled blood sugar levels may cause excessive growth of the baby: this can induce a miscarriage or stillbirth, or lead to difficulties during delivery. Moreover, women who have gestational diabetes are at increased risk of developing type 2 diabetes, as is their child.

Can diabetes be treated?

Diabetes can be treated, and it is important that you consult your Holdsworth House doctor to create an effective management plan. The key aims of treating diabetes are:

1. to monitor and regulate blood glucose levels;
2. to minimise / prevent short and long term complications;
3. to consequently maximise an individual's quality of life.

The key principle behind treating type 1 diabetes is lifelong insulin replacement by injecting insulin about 6 times a day, and frequent monitoring of blood glucose levels. This, in addition to a healthy diet and frequent physical activity will minimise risk of complications and allow an individual to lead as normal a life as possible.

As type 2 diabetes is primarily due to poor lifestyle, many of its symptoms and complications can be significantly reduced through lifestyle modification. These include weight loss, blood pressure control, a regular exercise regime and a healthy diet. Weight loss has been shown to markedly reduce insulin resistance in type 2 diabetics, and is a key goal of management. In some cases, medications may be prescribed to assists in blood glucose regulation and to manage other conditions such as high blood pressure. Through adequate management of type 2 diabetes and its risk factors, the risk of complications can be significantly reduced; allowing patients to maximise their quality of life.

Effective treatment of gestational diabetes involves education and timely management. If an individual develops this disease, early diagnosis by one of our doctors will allow prompt intervention and regulation of blood glucose levels. Ours doctors will also advise you on any lifestyle changes that you can make to minimise complications.

Our doctors are very experienced in dealing with all forms of diabetes. In some instances, you may also require care from other health practitioners such as dietitians or exercise physiologists. Your Holdsworth House doctor is able to assess your requirements and refer you to the appropriate healthcare service. By doing this, our doctors are able to provide you with a management plan that best suits your needs and allows you to treat your diabetes in the most effective way possible.

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