What can we do to help tackle diabetes? WORDS: DR CARL WONG DR CARL WONG IS A LANE COVE-BASED GP AND SITS ON THE BOARD OF SYDNEY COMMUNITY SERVICES
One of my favourite childhood movies was the remake of author Roald Dahl’s Charlie and the Chocolate Factory starring Gene Wilder. The Chocolate room, ever-lasting gobstoppers, lickable wallpaper – it was a child’s dream! On reflection, I suspect though that if Willy Wonka was actually a real person, he would have a lot to answer for in regard to his contribution to a condition that affects one in 11 adults worldwide – diabetes.
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ith National Diabetes awareness week this month, now is a good time to remind ourselves about this country’s fastest growing chronic condition. According to Diabetes Australia and the Australian Institute of Health and Welfare (AIHW): -2 80 Australians develop diabetes every day (that’s one person every 5 minutes!) - 1 in 20 of Australian adults (5%) have some form of diabetes. - 1 1% of all hospitalisations are diabetes-related and - j ust over 1 in 10 Australian deaths have diabetes as a related cause.
It affects all ethnicities, with Indigenous Australians particularly being more affected – four times higher rates. But how does diabetes occur? A large part comes down to what we put in our mouths. When we eat sugar-containing foods, our body produces a hormone called insulin to convert these sugars into glucose which is then used to fuel our body, either immediately as energy, or stored in our liver and muscles for future use. Put simply, diabetes occurs when insulin is not working, leading to excessive glucose in our blood stream. The problem is either a complete lack of insulin (like in Type 1 diabetes, making up 10% of all diabetes cases), or ineffective/defective insulin (like in Type 2 diabetics, who make up the majority 85% of cases). The other significant group is gestational diabetes of which one in six women will develop during pregnancy, leading to a higher risk of later developing Type 2 diabetes over the next ten years. But whichever the specific cause, the excessive blood glucose levels lead to widespread complications if left undetected and uncontrolled. The effects are profound. It is the leading cause of preventable blindness in Australia. There are over 4000 limb amputations annually due to diabetic ulcers and wounds. Diabetics are between two or four times more likely to develop heart disease, and heart disease is their leading cause of death. Over 12,000 diabetic Australians are on dialysis or have received a kidney transplant. Clearly, preventing these complications are essential. So what can we do? Screening and early detection of diabetes is one big step. 28 TVO
Local endocrinologist, Associate Professor Sarah Glastras agrees ‘screening is incredibly important. You often will not know you have diabetes until it is very advanced, and many people will have had the condition for years before they are diagnosed. Many of the complications are picked up at the time of diagnosis. See your GP for a simple blood test.’ In most cases of Type 2 diabetes, there are no symptoms, leading to delayed diagnoses unless routine check-ups are done via your GP. Your GP will also be able to assess your risk of developing diabetes over the next five years via a risk calculator. Risk factors for Type 2 diabetes include: a family history of diabetes, older age, being overweight/ obese, having high blood pressure, insufficient physical activity, poor diet, and having an ‘apple shape’ body i.e. having more waistline fat. The best way to self-manage diabetes, whether that be via prevention or treatment once diagnosis is confirmed, is dietary and lifestyle modifications. Eat regular meals spread evenly throughout the day, with a diet lower in fats, particularly saturated fats. Exercising regularly maintains a healthy weight/lose body fat, lowers your blood pressure and reduces your risk of heart disease. Aim for 30 minutes to one hour of daily exercise - any exercise is good that keeps your body moving and your heart rate elevated. An important thing to know is that there is no ‘one size fits all’ approach. ‘The holy grail is weight reduction’ says Professor Glastras, ‘there is no single diet that is the best one. It’s a discussion with the patient, doctor and dietician as to what is the best diet to suit that person. Patients should move a lot to build up lean muscle mass as this will also reduce central waistline fat’. Treating patients with diabetes will likely need oral medication and possible injectable forms as well. Many people feel that injections should be avoided at all costs – not true! Type 1 diabetics need injectable insulin from Day One. Injectables are being used increasingly earlier in treating Type 2 diabetics to ward off complications and to assist with weight loss (an area of ever-growing future advancements). The child in me sometimes wishes there was a Willy Wonka who could invent confectionery that doesn’t contribute to diabetes but still tastes like the real thing. That would certainly be worth a Golden Ticket!
