As doctors in training, our learning is especially focused on the management of the most commonly seen medical conditions, the ones that you will be exposed to again and again in your medical practice. And when it comes to common conditions, you can’t get more common than diabetes. Diabetes is largely considered the epidemic of the 21st century, and one of the biggest challenges confronting Australia’s health system. An extensive Australian study in 1999-2000, known as the AusDIAB, found that 7% of adults aged 25 and over have diabetes, and follow-up studies in 2011-2012 have shown that every year a further 0.7% of the adult population develops diabetes. This amounts to whopping 280 Australians developing diabetes every single day. And the most terrifying thing is that for every person diagnosed, there is another Australian who is living life with undiagnosed diabetes, and that a further 1 in 4 Australians are considered to have pre-diabetes. It will come as no surprise then that 1 in 3 inpatients admitted in hospitals have diabetes, and it is highly likely that someone you know and love has the condition.
But what exactly is diabetes? Simply put, when someone has diabetes, it means that their body is unable to maintain healthy levels of glucose in the blood. Glucose is a form of sugar, which is the main source of energy for our bodies. It is found in a wide range of foods such as breads, cereals, fruit and starchy vegetables and sweets. When we are fit and healthy, a specialised gland in the body called the pancreas produces a hormone called insulin, which works to convert glucose from food into energy. In people with diabetes, insulin is either no longer produced (as is the case with Type 1 diabetes, an autoimmune condition where the insulin producing cells of the pancreas are attacked and destroyed) or the insulin is produced but the levels are either insufficient or the body develops resistance to it (as is the case with Type 2 diabetes, which is lifestyle induced). The result is that when people with diabetes eat glucose it can’t be converted into energy and instead the glucose stays in the blood resulting in high blood glucose levels which can be easily detected with a blood glucose monitor.
What exactly is the harm of having high levels of glucose in the blood, do I hear you say? When there are unhealthy levels of glucose in the blood, this can lead to many complications. We know diabetes is the leading cause of blindness in working age adults. It is one of the leading causes of kidney failure and dialysis. Diabetes increases the risk of heart attacks and stroke by up to 4 times and is a major cause of limb amputations. And the nerve damage caused by long standing diabetes can be especially devastating for men, resulting in erectile dysfunction and impotence. While this paints quite a gloomy picture, the good news is that for the 85% of diabetics who are classified as Type 2, these complications can be avoided through early diagnosis, lifestyle changes, ongoing support and monitoring. In subsequent posts we will talk a little bit more about Type 2 diabetes, including the risk factors, symptoms and best evidence based management.