The disease diabetes mellitus typifies the human body’s difficulties in handling increased sugar and fat, combined with less physical activity.
The challenge for us is to understand why we will get sick, and die younger, if we get diabetes.
The challenge for our health system is to manage the people – almost one in 10 – in the community who will get diabetes.
Western-style diets are high in carbohydrates or sugars. Fats in the food mean that, in Australia, most people eat more sugar and fat than they use each day. The body is pleased to have this extra fuel, having evolved over many years worried about famine.
The body stores this fat – or spare energy – in the abdomen near the liver and intestine. The storage around the abdomen is now part of what is known as the “apple” shape more common in men. This contrasts with the “pear” shape in women, who store their energy around their hips.
As the body deals with the energy in the abdomen, it produces more insulin from the pancreas. And, as the body produces more insulin to deal with the extra sugar, it takes more insulin to do the same work, known as “insulin resistance”.
With the higher sugar (diabetes) comes, for most people, high blood pressure (hypertension) associated with the higher fats in the blood (high cholesterol, high triglycerides). All of these things are related, and known as syndrome X.
Early death is the common outcome. Death results owing to premature heart disease, strokes and kidney damage. (Diabetes is the leading cause of kidney failure leading to kidney dialysis in Australia.) Syndrome X damages the blood vessels to the important parts of the body and, thus, causes the damage.
The possibility of changing sugars, fat and blood pressure to “reverse” this damage offsets the gloom which surrounds diabetes and syndrome X.
So here lies the personal challenge – and the community challenge.
The personal challenge is that, if you find yourself in this position, can you diet, exercise or take medication to fix the problems? The evidence is that, if the sugar levels go back to normal, the complications associated with diabetes will reverse.
Known for a long time is that, if, in younger people with diabetes (known as type 1 diabetes, juvenile onset diabetes, or insulin dependant diabetes – a slightly different disease from that of mature onset-type diabetes) one gets the sugar back to normal, the complications of diabetes seem to disappear.
A relatively new test called Haemoglobin A1C (HbA1C) tells us what the average sugar has been for the previous three months. If the HbA1C is in the normal level, the diabetes is well managed. If the diabetes is well managed, the complications of it are very small.
It is hoped that the management of syndrome X is the same as that of diabetes in young people. The plan is that, if the diabetes is well managed (blood glucose levels are normal), cholesterol is normal (Cholesterol less than 5, good cholesterol up and bad cholesterol down, low triglycerides) and hypertension is controlled (BP less than 125/75) by any means, one’s life expectancy becomes normal.
Anyone who has gained weight knows how hard it is to lose that weight. Imagine what it would be like to be told you have diabetes. (It is estimated that 3 per cent of Australians know they have diabetes, but 6 per cent who have diabetes, are near having it, or will get it, do not know.)
When you hear you have diabetes, you will be told you have to lose weight, exercise more, adopt a different diet, manage your blood pressure better than others have to, and get your cholesterol to a level lower than most people can achieve.
And the community challenge? The first part is to help people know about their own diabetes. The second part is how to treat the complications of diabetes if it does any damage.
Community education programmes exist to help Australians:
- Deal with the risks of diabetes.
- Increase their awareness of the best food and exercise regimes for their situations.
- Understand where help can be found.
Anyone in doubt should see a doctor to have his or her diabetes risks assessed. For those who have diabetes, many new developments help at all stages. Most of the work is being done in the prevention of complications, but worked is also being done on new treatments.
New tablets help the body make more insulin, keep the pancreas healthy and use the insulin and glucose in a better way. Insulin can be given in easier ways, and work is being done to develop insulin that can be inhaled.
Exercise programmes specifically to help diabetes sufferers have been developed, and increased awareness has come about in relation to ethnic variations in diet that impact on how diabetes is managed.
A group of people know as diabetic educators specializes in how to manage diabetes and the specific issues that arise (eg from what angle to inject insulin).
We are more aware of the complications diabetes causes to the eyes, and encourage more careful monitoring by the optometrist and ophthalmologists.
As well as all that, the glycemic index (a ranking of carbohydrates based on their immediate effect on blood glucose [blood sugar] levels) now features on food labels. So from the supermarket shelf to just about every part of medicine, there exists an increased awareness about managing diabetes.
Take the personal challenge and invest in a healthy future.
