What is diabetes and how do I manage mine? A guide for new diabetics

If you have recently been diagnosed with diabetes, you are not alone.


Diabetes is one of the most common conditions in Australia and worldwide (1). It is estimated that 5-7% of all Australians have diabetes and unfortunately, diabetes contributes to over 10% of all deaths in Australia (1). Therefore, understanding, preventing and managing diabetes is now a national priority.


Due to the sheer number of diabetic patients, it is really important that people with diabetes learn to self-manage their condition as best they can. Not only does this reduce the burden on the healthcare system, but it is also the best way for them to avoid the complications associated with diabetes.


In this post, I will briefly outline what diabetes actually is and how it is managed in the early stages.



Diabetes is a major health concern so it is important we all educate ourselves about it



What is diabetes?


Simply put, diabetes means there is too much sugar in the blood.


If you do not have diabetes or are unsure, see below for 'How do I know if I have diabetes?'



Why are my blood sugar levels high?


When you eat food, it gets broken down into sugar (also known as glucose). The sugar then enters your bloodstream to be distributed throughout the body.


In healthy people, the sugar is then taken up by the body (organs and muscles) to be used up as energy, and therefore sugar levels in the blood return to normal.


In people with diabetes, the sugar is not sufficiently taken up by the body and therefore remains in the blood, leading to there being too much sugar in the blood.


Diabetes means there is too much sugar in your blood

Why isn't my body taking up sugar from the blood?


Firstly, understand how this process normally works. When the body detects that the blood sugar levels are rising, it releases a hormone called insulin into the blood stream. Insulin then travels to various parts of the body, such as your vital organs and muscles, and sticks to special receptors on their surface. This signals to these organs and muscles to increase uptake of sugar from the blood.


Now, why your body is not taking up sugar from the blood depends on the type of diabetes you have.



Are there different types of diabetes?


Yes. There are 3 main types of diabetes:

  1. Type 1 diabetes - when there is insufficient insulin being produced or the insulin is not functioning normally. Type 1 diabetes typically begins from childhood and represents about 10% of all diabetics (2).

  2. Type 2 diabetes - the insulin being produced is no longer able to bind to its receptors due to insulin resistance. This represents about 85% of all diabetics (3). Pre-diabetes - As the name suggests, this is when the blood sugar levels are above normal, but not quite at the level of a diagnosis for diabetes. 1 in 3 people with pre-diabetes are likely to develop type 2 diabetes (4).

  3. Gestational diabetes - high blood sugar levels during pregnancy and following pregnancy. It represents about 12-14% of all new mothers (5).



What is insulin?


Insulin is a hormone that the body releases when there is too much sugar in the blood. Insulin's job is to communicate to the organs and muscles in your body to increase their uptake of sugar. When it works well, insulin helps to reduce the amount of sugar in the bloodstream.


While type 2 diabetes is initially managed through diet and exercise, and later by use of medications, some diabetic patients may need to inject insulin in order to manage their blood sugar levels.



What is insulin resistance?


Insulin resistance can develop when there is too much insulin being produced such that the receptors on which it is supposed to bind are no longer sensitive to it. Therefore, the sugar in the blood is not adequately taken up by the body leading to high levels of blood sugar. Ironically, the body responds by producing more insulin which leads to further reduction in insulin receptor sensitivity.



What's wrong with too much sugar?


Ask a kid in a candy store, and they will tell you, "Nothing!". And they are not entirely wrong.




The body needs energy to do anything and it gets this energy from the sugar in our foods. However, for the body to make use of that sugar, the sugar needs to be in the right place.


While the blood transports the sugar throughout the body, it is not designed to act as a storage for sugar. Therefore, when there is too much sugar in the bloodstream, it begins to cause damage to the blood vessels it passes through and places greater stress on certain organs such as the kidneys which filters the blood.



What are the consequences of diabetes?


If your diabetes is poorly managed, it may lead to one or more of the following complications:

  • Frequent urination

  • Kidney failure

  • Numbness in hands or feet

  • Amputations

  • Blindness

  • Heart attack or stroke


Good news is that not everyone experiences these complications. By managing your diabetes well and keeping your blood sugar levels as low as possible, you will greatly reduce your risk of developing these complications.



How do I know if I have diabetes?


Diabetes is amongst the silent diseases. Generally you will not feel your blood sugar levels rising or falling, until they either get really high or really low. Therefore, it is important to speak to your doctor who can then directly measure the level of sugar in your blood.


If you want to know whether you are risk of developing diabetes, you can complete a diabetes risk calculator.


You cannot feel your blood sugar levels so it is important to check them regularly

For you to be diagnosed with diabetes, one of the following must happen:

  • Fasting blood glucose test - being > 7.0 mmol/L on two separate occasions. This is when the doctor asks you to give a blood sample while in a fasted state (first thing in the Morning, before breakfast). If your blood sugar levels are high after the first one, the doctor will likely ask you to give another sample a few days later. If the blood sugar levels are high for both tests, you will be diagnosed with diabetes.


  • Two hour glucose tolerance test (also known as oral glucose tolerance tests OGTT). This test involves you drinking a very sweet beverage and the doctor/nurse taking samples of your blood at regular intervals. It is designed to see how well your body responds to an influx of sugar. Generally, if your blood sugar levels are above 11.1 mmol/L after 2 hours of drinking the beverage, and this occurs across two separate tests, you will be diagnosed with diabetes.


  • Blood test - HbA1c. The gold standard for diabetes diagnosis is when they measure the levels of a particular protein in the blood known as the HbA1c. While other tests for measuring blood sugar levels tell us about the current levels of blood sugar (which may go up or down through the day), HbA1c levels tells us about the blood sugar levels over the last 3 months. It is an indication of the amount of damage the high blood sugar may be causing to your body's tissues and blood vessels.



What is the goal of diabetes management?


To keep blood sugar levels as close to the target range as possible. However, the target range will vary from one individual to another. Please consult your doctor about what is the ideal target for you.



How is diabetes managed?


The first step in diabetes management should be through diet and exercise, sometimes referred to as lifestyle modifications.

Diet


What you eat directly affects your blood glucose levels. Therefore, it is very important that you clearly understand and maintain healthy eating habits.


Refer to the Australian dietary guidelines on the type, amount and frequency of meals you should be eating.


Types of carbohydrates you eat (cereals, breads, rice, fruits, chocolates etc) are of particular importance because these can affect your blood glucose levels most dramatically.



Healthy diet is essential to managing your diabetes

I find many times clients are simply unaware of how much sugar they are consuming because they do not know how to read food labels.


To learn more about your diet and get expert advice tailored for you, please see a dietician. Find a dietician near you.



Exercise


Regular physical activity and exercise are essential to lowering and maintaining blood glucose levels.



Physical activity can help lower your blood glucose levels


Exercise helps lower blood sugar levels by improving insulin sensitivity and thereby helping increase the body's uptake of sugar from the blood. Exercises can also increase the direct uptake of sugar by muscles.


Other benefits of exercise include weight loss, reduced blood pressure and improved heart health. These are all important in order to prevent complications of diabetes.


As with your diet, exercise also varies in type, amount and frequency.



There are different types of exercises. You can start with a simple home-based exercise program today

To learn more about your physical activity and exercise and get expert advice tailored for you, please see an accredited exercise physiologist (AEP). Find an AEP near you or simply contact us.



Medications


If your diabetes is not well managed through diet and exercise alone, your doctor will likely recommend some medications. Please refer to your GP to discuss which medicine is best for you.



Summary


In this post we discussed

  • what is diabetes,

  • types of diabetes,

  • diagnosis of diabetes,

  • common consequences of diabetes,

  • diabetes management through diet and exercise.



What's next?


To learn more about diabetes, please visit www.diabetesaustralia.com.au


Share - If you found this blog post to be useful, you can help your friends and family start their journey by sharing this post with them.


Get in touch - If you have a specific question, or would like to go through these steps with a clinician, we can help you with that either online or in clinic.


We are currently running group programs for type 2 diabetes in Kingswood (Penrith). If you would like to find out more or to request a call back, feel free to contact us.



References

1. Burden of Diabetes in Australia: It's Time for More Action (July, 2018).


(Links to other references are embedded in text)

ABOUT THE AUTHOR


Hassan Qureshi is the founder and owner of Holistic Exercise Physiology. He believes educating and communicating good science to the wider public is not only important but is the responsibility of every clinician. For this reason he started the Holistic blog.


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If you would like to see Hassan Qureshi, you can meet him online or visit him at a clinic.

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