What is Diabetes?
Diabetes mellitus refers to a group of conditions where there is too much glucose (our body’s form of sugar) in the blood. It’s important to have some glucose (around 4-7mmol/L) in the bloodstream to be able to think and concentrate and to feel well. The rest of the glucose needs to:
- enter the cells of the muscles to give us energy and
- stored in the liver ready to be released back into the bloodstream during times of fasting or stress.
When we eat carbohydrates (i.e. bread, pasta, rice, cereals, fruits, starchy vegetables, milk, yoghurt, etc.), our body breaks down those carbohydrates into glucose. Glucose is the best and most efficient source of energy for the body.
Insulin is the hormone produced by the beta cells in the pancreas and responsible for moving and storing glucose from the blood to other parts of the body. You can compare insulin to a key that unlocks the gates of the cells to allow glucose to enter.
When you have diabetes, your pancreas either no longer produces any or enough insulin, or the insulin it does make can’t do the job properly (keys are rusty) and the body’s cells do not respond to the insulin.
Both type 1 and type 2 diabetes are serious conditions. Over time, if glucose levels remain high they can result in health problems called diabetes complications, such as;
- Heart attack
- Kidney disease leading to dialysis
- Nerve damage to feet, foot ulcers and even limb amputation
- Eye disease leading to blindness.
Anyone can develop diabetes and all types of diabetes are complex, needing daily care and management.
(Source: Diabetes Australia)
What is the difference between type 1 and type 2 diabetes?
The differences between type 1 and type 2 diabetes comes from their cause, and how they are managed.
Type 1 diabetes is an autoimmune condition in which the pancreas stops producing insulin. In type 2 diabetes, insulin is still produced but it doesn’t make enough, or the insulin that is made does not do its job properly.
Type 1 diabetes cannot be prevented or cured. However, type 2 diabetes can be delayed (and even prevented), in some people, by adopting a healthy lifestyle consisting of regular exercise, a balanced diet and maintaining a healthy weight.
What is type 1 diabetes?
Type 1 diabetes is an autoimmune condition in which the pancreas is no longer able to produce insulin. This is because the body’s immune system destroys the beta cells in the pancreas that produce insulin.
Experts don’t know what the exact cause of type 1 diabetes is, but they think that an environmental trigger such as a virus, causes people who have certain genes to be at risk of developing it.
Although there is no cure for type 1 diabetes, researchers are working hard to understand more and possibly find a way to prevent or delay it.
The signs and symptoms of type 1 diabetes are those of high glucose levels, which is also called hyperglycaemia. In hyperglycaemia, glucose builds up in the blood, so the muscles don’t get enough energy. The body tries to get rid of this excess glucose through the urine. Because the muscles can’t get enough energy from glucose, the body starts breaking down fat stores to get energy. However, fat stores can only be used by the body for a short period of time before a person starts to feel unwell. The signs and symptoms experienced by someone with diabetes due to a lack of insulin are related to these processes.
Symptoms of type 1 diabetes are:
- Feeling very thirsty so the person drinks more
- Urinating a lot, and more often
- Feeling extremely tired because glucose is unable to enter the cells for energy
- Blurred vision because excess glucose in the blood sits behind the eyes
- Genital thrush or urine infection that doesn’t go away
- Wounds that heal slowly
- Weight loss because the body is breaking down fat for energy
- Acetone (like apple cider) breath because the body is trying to get rid of the byproduct of fat breakdown called ketones
If type 1 diabetes is not diagnosed in time, and insulin replacement does not occur, a person can develop a dangerous condition called diabetic ketoacidosis or DKA for short. When there is a lack of insulin, the body breaks down fat to get energy. The result of fat breakdown are acids called ketones. Ketones are acidic to the body and when they rise too high in the blood it leads to DKA and eventually death if the condition is not treated promptly.
People who are most at risk of developing diabetic ketoacidosis are:
- Those who are not diagnosed in time and thus not treated with insulin early enough
- People with diagnosed type 1 diabetes who have an illness or infection but their insulin doses are not enough or the illness is not treated eg. with antibiotics, during this illness period.
- People with type 1 diabetes who omit or forget to take their insulin
Diabetic ketoacidosis is life-threatening and requires urgent hospital treatment.
It’s important to note that diabetic ketoacidosis can be prevented in most cases by:
- Early recognition of symptoms and timely insulin treatment in people not yet diagnosed
- Appropriate management of sick days in people already diagnosed with type 1 diabetes
- People with type 1 diabetes always taking their insulin doses as required.
How is type 1 diabetes managed?
Type 1 diabetes is treated by replacing the insulin that the body is no longer able to produce. This is achieved with multiple insulin injections per day or an insulin pump which delivers insulin continuously and on demand.
The goal of diabetes management is to keep blood glucose levels in target range. This will help you stay well in the short term, as well as reduce your risk of long term diabetes complications, such as damage to the eyes, kidneys, nerves and blood vessels. However, there are many skills that people with type 1 diabetes need to learn in order to achieve target glucose levels. These include:
- Monitoring glucose levels regularly throughout the day with a blood glucose meter or glucose sensing device
- Counting carbohydrate
- Matching quick acting insulin to carbohydrate
- With the help of your diabetes health professional, working out the right insulin doses, rates and ratios for you
- Hypoglycaemia management
- Sick day management
- Managing exercise
- Annual cycle of care and regular diabetes health checks
How is type 1 diabetes diagnosed?
If you are experiencing symptoms of high glucose levels (listed above), consult your doctor immediately and ask for a diabetes health check. Early diagnosis of type 1 diabetes can prevent you feeling very unwell and leading to diabetic ketoacidosis.
A doctor will check for diabetes by:
- Checking your blood for excess glucose;
- Checking your blood or urine for ketones (ketones suggest a lack of insulin); or
- Ordering blood tests to look for autoantibodies (which can differentiate type 1 from other types of diabetes).
A person with suspected type 1 diabetes should be referred to the closest emergency department. All children and young people under 18 should be assumed to have type 1 diabetes until proven otherwise and therefore sent directly to hospital for immediate treatment and evaluation.
Who is at risk of type 1 diabetes?
In children, the peak age for diagnosis is between 10 and 14 years old whereas in early adulthood, the peak age for diagnosis is usually before 30 years of age. However, type 1 diabetes can be diagnosed at any age.
People with a family history of type 1 diabetes (as well as other autoimmune diseases such as coeliac or thyroid disease) are at higher risk of developing type 1 diabetes. However, most people diagnosed with type 1 diabetes have no family history.
What is type 2 diabetes?
Type 2 diabetes, also known as insulin resistance, is where the body still produces insulin but it may not make enough, or the insulin it does make is not effective enough to lower glucose levels to a normal range.
Type 2 diabetes is the most common form of diabetes. Whilst 8 to 9 out of 10 people have type 2 diabetes, only 1 out of 10 has type 1 diabetes. (Source: NDSS Fact Sheet).
What are the symptoms of type 2 diabetes?
The symptoms of type 2 diabetes are those of high glucose levels. They can be similar to those with type 1 diabetes described above, but usually without the rapid weight loss or ketones.
Unlike type 1 diabetes, the symptoms of type 2 diabetes are more gradual. Some people remain undiagnosed for many years because they experience no symptoms of diabetes. This is a problem because high glucose levels can still be silently damaging a person’s organs, nerves and blood vessels. Examples of complications that can be early signs of type 2 diabetes are foot ulcers, heart attacks or vision problems.
It is therefore very important that adults with diabetes risk factors and people over the age of 40 are screened regularly for diabetes.
People of aboriginal or Torres Strait Islander descent need to have diabetes health checks at a younger age because they have a higher risk of developing type 2 diabetes and diabetes complications.
How is type 2 diabetes managed?
Managing type 2 diabetes involves:
- Making and maintaining lifestyle changes such as Eating a healthy diet and doing regular physical activity
It may also involve taking glucose lowering medicine. These can come in the form of tablets, non-insulin injectable medications, or even insulin injections. Glucose lowering medications are used to keep glucose levels within your target range. Newer medications have other benefits as well that can help keep your heart and vessels healthy.
Even if you take glucose lowering medication, healthy eating and daily activity is still part of diabetes management.
How is type 2 diabetes diagnosed?
There are three types of blood glucose tests that a doctor can order to diagnose type 2 diabetes:
- A fasting blood glucose test sent to pathology (after having nothing to eat or drink for at least eight hours);
- An oral glucose tolerance test (OGTT), in which you are given a sugary drink after having a fasting, a 1 hour and a 2 hour blood glucose test; or
- An HbA1c check sent to pathology, which reflects your average blood glucose level over the last 10 to 12 weeks (this test does not require fasting)
(Note: if a person has a fasting blood or an HbA1c but has no symptoms of diabetes, they will need to repeat the same test on another day to confirm diagnosis)
Who is at risk of type 2 diabetes?
Anyone can develop type 2 diabetes. However, there are certain risk factors that make type 2 diabetes more likely, including;
- Having a family history of type 2 diabetes;
- Having pre-diabetes;
- Being above the healthy weight range;
- Having an inactive lifestyle;
- Ageing (particularly people over the age of 50);
- Being of Aboriginal or Torres Strait Islander background;
- Being from a Melanesian, Polynesian, Chinese, Southeast Asian, Middle Eastern or Indian background;
- Cigarette smoking; and
- High blood pressure and cholesterol.
The aim of diabetes treatment is to keep your glucose levels within the healthy range, and reduce the risk of diabetes complications.
Are there other kinds of diabetes?
There are other kinds of diabetes that other than type 1 or type 2 diabetes.
Gestational diabetes is diabetes that occurs in, and is diagnosed during, pregnancy. Gestational diabetes usually goes away after the baby is born. However, women with gestational diabetes are at higher risk of developing type 2 diabetes later in life.
Latent Autoimmune Diabetes in Adulthood (LADA)
Latent autoimmune diabetes in adulthood (a.k.a. type 1.5 diabetes) is an autoimmune condition just like type 1 diabetes. However, a person will usually not need insulin at diagnosis like someone with type 1 diabetes because their pancreas will keep producing some insulin for a little longer. People with LADA are often misdiagnosed as having type 2 diabetes because they share similar features to people with type 2 diabetes, such as being overweight around the abdomen, being in the older age group and not needing insulin at diagnosis.
Diabetes insipidus is not a type of diabetes mellitus as it is not about high glucose levels. The only similarity to diabetes mellitus is that a person has symptoms of increased urination and extreme thirst. This is caused by the lack of sufficient vasopressin, a hormone produced by the brain that instructs the kidneys to retain water.
Pre-diabetes occurs when blood glucose levels are higher than normal, although not high enough to be diabetes. There are no symptoms. People with pre-diabetes have a higher risk of developing type 2 diabetes and cardiovascular (heart and circulation) disease. However, with lifestyle changes, there is a chance that they can prevent or delay type 2 diabetes.
How can the Life! program help me reduce my risk of diabetes?
A health check from the Life! program is a simple 3-minute test that helps calculate your risk of diabetes. Once your risk has been determined, you can start working towards your health goals that prevent diabetes.
The Life! program is a free healthy lifestyle program that helps you improve your eating habits, increase your physical activity and manage stress. You can choose from a group course or the Telephone Health Coaching service.
Our experienced health professionals will help you make small changes to your lifestyle so that you can achieve your health goals and reduce your risk of type 2 diabetes and cardiovascular disease.
The Life! program is funded by the Victorian government and managed by Diabetes Victoria. You can check your eligibility for the program here.