Diabetes Information

What is diabetes?

Diabetes Mellitus (often referred to as simply “Diabetes”) is a condition where the body cannot maintain normal blood glucose levels.

Insulin is a hormone that helps glucose move from the blood into the cells. When the body does not produce enough insulin, the blood glucose level rises.

Australians are mainly affected by the following three types of diabetes:

• Type 1 (previously known as insulin-dependent diabetes or juvenile diabetes)
• Type 2 (previously known as non-insulin-dependent diabetes or mature onset diabetes)
• Gestational diabetes mellitus (GDM)

Types of diabetes

Type 1 diabetes is an auto-immune disease where the body’s immune system destroys the insulin-producing beta cells in the pancreas. This type of diabetes accounts for 10-15% of all people with the disease, can appear at any age (although usually occurs in people under the age of 40), and is triggered by environmental factors such as viruses, diet or chemicals in people who have a genetic predisposition. People with type 1 diabetes must inject themselves with insulin, usually several times a day, and they are required to follow a careful diet and exercise regime.

Type 2 diabetes is the most common form of diabetes, affecting 85-90% of all people with the disease. It is characterised by insulin resistance and relative insulin deficiency, and although the disease is strongly genetic in origin, lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are major risk factors for its development. Symptoms may not show for many years and, by the time they appear, significant problems may have developed, hence regular screening for diabetes through your GP is strongly recommended, particularly for people over the age of 50 and of certain ethnic backgrounds (in particular Aboriginal or Torres Strait Islander, Middle Eastern, Asian). People with type 2 diabetes are at higher risk of cardiovascular disease, such as heart attacks and strokes. People with type 2 diabetes are asked to make the necessary dietary changes, incorporate regular exercise into their life and most of the time require tablets. As the natural progression of the disease is an ongoing decline in beta cell function over time, most people with type 2 diabetes will require insulin treatment after 5-10 years.

Gestational diabetes is defined as “a carbohydrate intolerance of variable severity with the first onset or diagnosis during the current pregnancy” and is diagnosed through an oral glucose tolerance test. Somewhere between 5.5 and 8.8% of pregnant women develop GDM in Australia. Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity, poor obstetric history, polycystic ovarian syndrome and certain ethnic groups. Women with GDM will be prescribed a diet with restricted carbohydrate intake, which is spread out across the day in smaller portions, as well as that they are asked to do regular physical activity to help maintain glucose levels. In approximately one third of patients diet and exercise alone is not enough to maintain good glycaemic control and hence insulin treatment may be required. Tablets are generally not used in pregnancy as most would cross the placenta. Insulin is a much safer option as this will not cross the placenta and side-effects are minimal. While the carbohydrate intolerance mostly returns back to normal after the birth, the mother has a significant risk of developing type 2 diabetes, while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.

Complications

Diabetes affects nearly 1 million Australians, and many of these are not aware they have the disease. If undetected or poorly controlled, diabetes can lead to complications. Generally, the risk of developing diabetes increases with age. Research studies have shown that control of blood glucose, blood pressure, and cholesterol levels helps prevent complications in people with type 1 or type 2 diabetes and studies have also shown that good control in the beginning stages of the disease will have huge benefits later in life, as risk reduction persists in the long term. Complications can roughly be divided in 2 groups: macrovascular (such as heart attacks and stroke) and microvascular complications (including retinopathy (eye damage), neuropathy (nerve problems) and kidney problems).

Diabetes Prevention

Many cases of Type 2 diabetes could be prevented or delayed through simple lifestyle changes that lower the risks of diabetes and other chronic diseases, such as cardiovascular diseases and cancer. These risks include excess weight, poor diet, inactivity, smoking and too much alcohol. Even a moderate weight loss of -45 kg has been proven to make a big difference in lowering the risk for developing diabetes.

Services provided by Glebe Total Healthcare

Carolien van Geloven is a Credentialed Diabetes Educator with over 15 years experience. She can help you manage your diabetes and teach you more about all sorts of diabetes related topics, including:

• Types of diabetes, the signs and symptoms, treatment and prevention of high blood glucose levels and hypoglycaemia (low blood glucose levels)
• Self management strategies including strange situations such as: traveling with diabetes, sick day management, pregnancy in pre-existing diabetes or GDM, as well as prevention or management of diabetes complications
• Treatment targets and recommendations to help you and your doctor
• New medications and treatment options, the latest gadgets such as blood glucose meters, injection devices and insulin pumps
• And other related disease such as hypertension (high blood pressure), cholesterol, obesity and depression.

Carolien can also provide counselling, coaching and psychotherapy services.

Fees and charges

My fee schedule from 1st November 2010 will be as follows:

• New Patient for Diabetes Education
  • (1 hour appointment will be allocated) – $120
• Review for Diabetes Education
  • (1/2 hour appointment) – $60
  • (1 hour appointment) – $100
• Home visits (by negotiation)
  • (1 hour appointment will be allocated) – $120

Please note:
Fees are payable at the time of consultation; a reduction of fees can be negotiated particularly for students, pensioners and other disadvantaged people; please contact me for individual pricing.

Bulk billing is unfortunately not available at this time however patients will be able to claim back around $50 from Medicare (Item number 10951 – Diabetes Educator) if they present with an EPC referral.

Some Health Funds may provide rebates. Currently Medibank Private provides rebates to clients who have a “Package Bonus Entitlement” and I am registered with HCF as a provider for their clients with “Multicover”.

More information

The following websites contain useful information about diabetes:
http://www.bakeridi.edu.au/
http://www.adea.com.au
http://www.ext1d.com.au
http://www.diabetesaustralia.com.au/
http://www.jdrf.org.au