Managing diabetes
Some estimates of the number of people in Australia with
diabetes are as high as 2 million. If there is one in five (1:5) Australians
with the diabetes, you will probably have to look after someone with the
illness, or you might already know someone who has it. On the other hand, that
sufferer might not even know about it, and that is part of the problem.
Diabetes is a problem with the body’s ability of to
manage sugar and, in particular, glucose. Because glucose and oxygen are the
essential fuels of the body, any disease causing problems with glucose
metabolism will affect many organs. Diabetics who don’t look after
themselves properly will probably die prematurely. Commonly, the cause of death
is stroke, heart attack or kidney failure. But there are also many
complications – such as blindness, dementia, leg amputations and leg
ulcers – that can make it a nasty disease with which to live.
Because we exercise less and eat more, our bodies need to
absorb the glucose we eat and store it into a form that can be used later.
Insulin is the key that opens up the cells to allow the glucose to be stored
inside them. Without the insulin, the glucose travels around the blood stream
being of no use to the person and leaks out into the urine.
If the glucose is measured in the blood, it will be high
(hyperglycaemia) because the sugar is not able to get into the cells. As you
get older, the body is not able to produce enough insulin to keep up with the
need to store and use the glucose. So, as you get older, you will naturally
become more prone to diabetes.
If you put on more weight, the insulin you do produce will
not be able to do its job because there are more and bigger cells for the
insulin to work on, and so you will start to develop diabetes. If you add a lot
of sugar to the diet, and are older and overweight, the chances of getting
diabetes are even worse. If there is a family history of developing diabetes in
old age, your own chances of getting diabetes (mature onset diabetes) is around
40 per cent.
Obviously, reversing the factors that put a strain on your
insulin production will reduce the need for high insulin production and stop
you getting diabetes. Losing weight means there is no need to spread the
insulin around so much extra fat, so each bit of insulin produced goes further.
If you eat less sugar, there is less need to produce insulin in the first place
and, if you exercise, the glucose is used up so it does not need to be stored
again, freeing up the insulin.
The next problem with diabetes is the damage it will cause to
your ageing body if you have other diseases as well. Heart disease is more
common in people with diabetes, and getting diabetes when you have a heart
condition makes your prognosis worse. It does the same with high blood
pressure, strokes and kidney disease. So anything that reduces your risk of
getting diabetes becomes more important if you have other medical problems.
So important is this that it has been recommended that
treatment for blood pressure should, for someone with diabetes, be different
from treatment for someone with just hypertension on its own.
Anyone with diabetes should aim to get their blood pressure
down to 130/85, whereas an otherwise acceptable level is 140/80. The same goes
for cholesterol treatments in which a diabetic needs to keep his or her
cholesterol levels lower than with other illnesses, because the combined damage
from diabetes and high cholesterol is worse than each disease on its own. It is
also that hypertension is more common with diabetes, and about 60 per cent of
people with diabetes will have hypertension.
How do we treat this terrible disease? The good news is that
proper treatment of the sugar levels will return your risk of complications to
the same level as any normal person. To do this, diet and exercise become the
first principles to manage down the demands on the body to produce insulin.
Less glucose to eat and more exercise help.
The next thing that a doctor can do is to give you tablets
that will help the pancreas produce more insulin. This group of tablets might
be the first treatment tried if exercise and diet does not work. There are also
tablets that can make the insulin work more efficiently, so they might be used
as well, either together with the other tablets or separately.
If this does not work, there is the injection of insulin that
will get the glucose level down and, these days, the insulin injections are
often in the shape of a pen. The doses of insulin can be dialled up quickly and
injected with a minimum of fuss.
The point of spending time to get glucose levels back to
normal is that a normal glucose level will reduce the risk of illness as well.
To do this, people can test their own blood before and after food and then
adjust their food and medication several times in a day to get the levels of
glucose nice and low.
One of the other breakthroughs has been the discovery of a
test called the glycosolated haemoglobin. This blood test can show the average
blood-glucose for the last three months. By getting these readings down to
normal, you can be sure that your diabetes is under control. Any diabetic
should check this test four times a year to manage his or her diabetes
properly.
Diabetes is a disease that has fatal complications if not
treated correctly. New treatments and our better knowledge of how to treat
diabetes can turn a potential life-shortening problem into a manageable
condition.
Early detection is now possible and prevention of all
complications is also possible with good control. Doctors, diabetes educators,
podiatrists, optometrists, pharmacists and, most important, the patient are
part of a team making the treatment easier and better. There are also other
help groups, such as Diabetes Australia, working to help anyone with diabetes.
Stay well and know you BGL (blood-glucose level).
Your questions answered
Dr Pearce will answer questions on any health
issue important to you. For his response, write to or fax the Police Journal
with your question. Those who write need not identify themselves.
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If you prefer to correspond by e-mail, send
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