Continuous glucose monitor and insulin pump (below)
Results from the Australian Diabetes, Obesity and Life Study, released in April 2001 show that nearly a quarter of Australian adults have either diabetes or impaired glucose metabolism. Of the 8% of Australians with diabetes, only half have been diagnosed.
There are three main types of diabetes:
Type 1 diabetes: This was previously called juvenile diabetes, or insulin-dependent diabetes. It is an autoimmune disease, in which the pancreas is attacked by the immune system so that it does not produce insulin. Once fully established insulin injections are needed to survive. Insulin injections can be given in syringes, in pens or via insulin pumps where a small plastic catheter continuously releases insulin under the skin (see pictures left).
Diagnosis is usually in childhood or young adulthood. Onset of symptoms is usually sudden.Symptoms can include excessive thirst and urination, unexplained weight loss, weakness and fatigue, irritability and blurred vision.
Type 2 diabetes: This was previously called adult-onset diabetes, or non-insulin-dependent diabetes mellitus (NIDDM). This is the most common form of diabetes accounting for over 90% of all cases.
Type 2 diabetes is characterised by varying degrees of insulin resistance and impaired insulin secretion.It is associated with obesity and weight reduction is an important part of successful treatment. Most patients can initially be managed with lifestyle and tablets, but many will ultimately require insulin.A genetic predisposition and lifestyle factors contribute to the development of type 2 diabetes.
Gestational diabetes: This is diabetes which comes on during pregnancy. See the pregnancy section on this website for more information on GDM
Management targets:
Glucose control - the general recommended target is an HbA1c<7.0%, but this target may be adjusted up or down depending on individual circumstances. HbA1c is a blood test that gives an indication of average glucose level over the past 2-3months.
Cholesterol - the general target is for a total cholesterol of <4 and LDL-cholesterol of <2.5. LDL-cholesterol is the 'bad' cholesterol that leads to deposition of fat in arteries. If you have had a heart attack or stroke the targets are more aggressive (LDL<1.8). Most type 2 diabetics require medication to achieve these targets.
Blood pressure - the general target is <130/80. If you have kidney disease or significant protein detected in your urine, then a lower target of <125/75 may be appropriate. Often, more than one blood pressure medication is needed to achieve these targets, particularly in people who have had diabetes for many years
Complications of diabetes: Potential complications of diabetes include heart disease, stroke and kidney disease. Blood vessels at the back of the eyes can also be damaged affected vision (called diabetic retinopathy). Nerves can also be damaged, most commonly in the feet which may lead to foot ulcers and rarely to amputations due to unrecognised injury.
With careful management of diabetes, many of these complications can be minimised or avoided. Regular screening for complications is important to enable them to be identified early so that steps can be taken to prevent further deterioration.
