Diabetes mellitus is a chronic illness of metabolism. There are several types, all with one feature in common: chronically elevated blood glucose levels unless managed. By definition, this level is now seen to be a blood glucose reading, taken before breakfast, of more than 7mmol/L. There are several major forms of diabetes.

Type 1

Type 1 diabetes, formerly called insulin-dependent diabetes, comprises around 7-10 per cent of the total cases of diabetes and is much more frequent in younger populations. Common acute symptoms of type 1 diabetes include:

• Insatiable thirst
• Weight loss of fat and muscle
• Increased urination with night-time urination
• Visual difficulties with blurring of vision
• Fatigue
• Difficulty concentrating and confusion

Type 2 — the silent epidemic

Type 2 is the more prevalent form of diabetes. It is linked to a personal genetic history of type 2 diabetes in your family, combined with the body changes that obesity and lack of physical activity cause. Thus, the colloquial term for this form of diabetes is “diabesity”.

Type 2 diabetes can manifest without major symptoms until serious complications occur, such as heart attack, kidney failure, early-onset blindness or numbness of the feet. The sinister way in which these symptoms progress makes this form of diabetes a “silent killer”. In Australia today, it’s estimated that only half the people with this form of diabetes know they have the illness. Alarmingly, those who don’t know they have diabetes may be walking “metabolic time bombs” until the above symptoms arise.

The number of people affected with type 2 diabetes is epidemic: around 600,000 to 700,000 Australians are currently aware of their diabetes. However, we need to make aware the equal number of Australians who currently have type 2 diabetes but haven’t yet been diagnosed.

These figures are expected to escalate, such that one in four Australians over the age of 25 is expected to suffer from type 2 diabetes in their lifetime. One in three children born in the US in 2005 is expected to have type 2 diabetes in their lifetime. As an esteemed professor of endocrinology stated recently, “If these figures were about cancer incidence, the government and public would be outraged!”

These figures suggest all of us will be affected by diabetes by only one or two degrees of separation. But by encouraging greater awareness of diabetes prevention and management strategies, we can do something about this “silent epidemic”.

Gestational diabetes

Gestational diabetes affects women who develop glucose metabolism problems during pregnancy. It appears to affect not only the mother’s health but also the child’s — with difficult labour due to the baby’s excessive growth from the high glucose, and a lifelong elevated risk of diabetes for both the mother and child.

GLUCOSE METABOLISM AND DIABETES

Glucose metabolism is a symphony of wonderfully efficient complexity, allowing the body to establish a stable, reliable level of this vital fuel source in the blood. When you consider that the brain, nerves, muscles and most organs require constant supplies of glucose, you can imagine that if the symphony gets “out of tune” the complications of diabetes will be seen in many of the body’s organs and systems, thus impeding the ability to live a full, healthy life.

Foods containing sugars such as fructose, sucrose, malt, lactose and so on are normally digested by enzymes in the gut to convert them to glucose, which the body may efficiently absorb. The body becomes aware of this process and releases the hormone insulin from the pancreas, a gland behind the stomach. The glucose is then transported to the liver where insulin allows it to be stored or released into the blood, the insulin acting on an insulin receptor to enable the cells to take up the glucose for energy.