Diabetes – A snapshot

The following excerpt is from the ANMF’s Diabetes- A snapshot tutorial on the Continuing Professional Education (CPE) website.

Diabetes is a metabolic disease that causes high blood pressure. The hormone insulin moves sugar from the blood into the cells to be stored for energy.

With diabetes, the body either doesn’t make enough insulin or can’t effectively use the insulin it does make.

The body regulates the glucose level in the blood with the help of two hormones: insulin and glucagon. Insulin decreases blood glucose levels, while glucagon increases blood glucose levels.

Both insulin and glucagon are made in a group of cells within the pancreas known as the Islets of Langerhans. These clusters of cells contain alpha cells which secret glucagon, and beta cells that produce insulin.

Insulin decreases the glucose level in the blood by attaching itself to insulin receptors found in the cell membrane of muscle cells and adipose tissue. When the insulin receptors are activated, glucose is sucked into the cells. It then leaves the bloodstream and enters the cells.

The glucagon hormone acts oppositely. It helps the liver to produce new glucose molecules and then pushes these glucose molecules into the bloodstream.

Diabetes occurs when glucose in the blood becomes too high. There are different ways this can happen, so diabetes is categorised into different types.

The three many types of diabetes:

Type 1 (previously known as insulin-dependent or juvenile diabetes)
Type 2 (previously known as non-insulin dependent or mature onset diabetes)
Gestational diabetes mellitus (GDM)

The body needs glucose as its main source of fuel or energy. The body makes glucose from foods containing carbohydrates such as vegetables (like potatoes or corn) and cereal foods (bread, pasta and rice) and fruit and milk.

Normal blood glucose level (BGL) is 4-6mmol/L.¹

If undetected or poorly controlled, diabetes can lead to vision impaired, renal failure, lower limb amputation, MI, CVA and impotence.²

Statistics

An estimated 1.2 million Australians had diabetes in 2017-18, that being 4.9% of the population.²

As of March 31 2021, a total of 1,424,892 people with diabetes in Australia were registered with the National Diabetes Services Scheme (NDSS).¹

Aboriginal and Torres Strait Islander people are almost four times more likely than non-Indigenous Australians to have diabetes or pre-diabetes.¹

Globally, the International Diabetes Foundation (IDF) ninth edition Diabetes Atlas states that in 2019 463 million adults (20-79 years) were living with diabetes. By 2045 this is predicted to rise to 700 million.

They also state that the proportion of people with type 2 diabetes is increasing in most countries and that 79% of adults with diabetes were living in low and middle-income countries.³

Type 1 Diabetes

Type 1 Diabetes is an autoimmune condition in which the immune system is activated to destroy the pancreas cells, which produce insulin. It is not linked to modifiable lifestyle factors, cannot be prevented and has no cure. ⁽⁴⁾

It occurs when the pancreas does not produce insulin
It represents around 10% of all cases of diabetes and is one of the most common chronic childhood conditions
Onset is usually abrupt with obvious symptoms. These can include excessive thirst and urination, unexplained weight loss, weakness and fatigue and blurred vision
It is managed with insulin injections several times/day.⁴

Without insulin, the body burns its own fats as a substitute which releases chemical substances in the blood. Without ongoing insulin injections, these dangerous chemical substances will accumulate and can be life-threatening if not treated. This is a condition called ketoacidosis.⁴

Type 2 Diabetes

It is often a progressive condition in which the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to produce insulin in the pancreas.

It is associated with modifiable lifestyle risk factors.

Some people may be able to significantly slow the condition’s progression through changes to diet and by increasing the amount of physical activity they do. Type 2 diabetes also has strong genetic and family-related risk factors.⁵

Besides inherited genes, controllable lifestyle factors have been shown to contribute to excess fat deposits in the middle. These include alcohol, smoking, stress, lack of exercise and excess fat or simple sugars in the diet.⁶

Type 2 diabetes develops over a long period of time (years). During this time, insulin resistance starts, and this is where insulin is increasingly ineffective at managing blood glucose levels. As a result of this insulin resistance, the pancreas responds by producing greater and greater amounts of insulin to try and achieve some degree of blood glucose management.

By the time someone is diagnosed with type 2 diabetes, they have lost 50-70% of their insulin-producing cells.

Type 2 is usually treated by firstly increasing physical activity, decreasing carbohydrate intake and losing weight. Keeping blood pressure and cholesterol within the recommended range is also important. Sometimes oral hypoglycaemic medication and then insulin may be required.

Pre-Diabetes

Pre-Diabetes is a condition in which the blood glucose level is higher than normal but not high enough to be called diabetes. It is also known as Impaired Glucose Metabolism (IGM).

Risk factors are similar to those for type 2 diabetes, and treatment includes; a healthy diet plan, reducing weight and regular physical activity.⁷

Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus occurs in 12-14% of pregnant women. It happens because the changing hormone levels in the body have altered the body’s requirement for insulin. Management is achieved by controlling BGL’s while maintaining a healthy diet.

GDM usually occurs around the 24 to 28 weeks of pregnancy.⁸

This excerpt from the Diabetes – A snapshot tutorial will give you 15 minutes of CPD.

To access the complete course, please go to anmf.cliniciansmatrix.com NSWNMA, QNMU and ANMF NT members have access to the course for free.

The complete course covers: