OVERVIEW

International Diabetes Federation estimates that the number of adults with diabetes in the world will increase by 55% in 2040.  Alarmingly, Africa is expected to show the biggest increase with an estimated increase of 140%!

Diabetes mellitus is a metabolic disorder caused by abnormal insulin secretion, action or both.  This means patients can have insulin deficiency from destruction of their insulin-secreting cells in the pancreas or have resistance towards the action of insulin.  This results in chronic hyperglycaemia (high sugar levels) and affects the metabolism of carbohydrate, fats and protein in your body.  People with diabetes are at an increased risk of developing cardiac, vascular, eye, kidney and stroke complications.

There are two principle forms of diabetes:

• Type 1 diabetes (formerly known as insulin-dependent) in which the pancreas fails to produce the insulin which is essential for survival. This form develops most frequently in children and adolescents but is being increasingly noted later in life.  This accounts for 5-10% of cases and these patients are prone to developing ketoacidosis and coma.  Latent autoimmune diabetes (LADA) is also classified as a Type 1 diabetes.   LADA patients are usually older than 25 years age (unlike the typical Type 1 diabetics who present younger) and are non-obese with no strong family history of diabetes (unlike the Type 2 diabetics).

• Type 2 diabetes (formerly named non-insulin-dependent) which results from the body’s inability to respond properly to the action of insulin produced by the pancreas. This accounts for 90-95% of diabetes cases. It is due to a gradual loss of insulin secretion together with insulin resistance.  These patients are usually older, obese and show a strong family history of diabetes.

• Potentially reversible diabetes conditions include prediabetes – when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes – and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.

SYMPTOMS

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a by-product of the breakdown of muscle and fat that happens when there’s not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as skin infections and thrush infections 

Who needs to be screened?

High risk adults of any age who are overweight (BMI>25kg/m² ) plus any of the following:

• Physical inactivity
• Hypertension (BP>140/90mm Hg)
• 1^st degree relative with diabetes
• High cholesterol
• Polycystic ovarian syndrome
• High risk race (Asian, Indian, Coloured)
• History of cardiac disease
• Diabetes in pregnancy or baby > 4kg

If none of the above risk factors, then from 45 years onwards.

How often do you need to be screened?

Every 3 years if initial screening results are normal.

Diagnosing diabetes:

Recommended testing to diagnose diabetes: Fasting plasma glucose or oral glucose tolerance test (OGTT) or HbA1c blood tests

Criteria for diagnosing diabetes:

• Fasting glucose >7.0 mmol/L
• OGTT > 11.1mmol/L
• Random glucose in a symptomatic patient > 11.1 mmol/L
• HbA1c > 6.5%

 

Recommended lifestyle changes for diabetics:

• Overweight and obese Type 2 diabetic patients should reduce calories by 500kCal, follow a low-calorie diet (800-1200 calories per day) with high fibre and low glycaemic index foods in order to lose at least 10kg.
• Moderate aerobic physical activity (walking) of at least 2 ½ hours per week at intervals not longer than 48 hours.  To assist weight loss and avoid regaining weight, need a more intense activity program of at least 4 ½ hours per week.
• Avoid smoking.
• Avoid excessive alcohol intake, limit to <2 units per day unless planning a low-calorie diet, in which case it is best avoided especially beer which has additional calories.

 

Should you be concerned about Diabetes for yourself or anyone in your family, please contact us at Blouberg Family Practice: 021 023 0480 or make an online appointment for an assessment (www.bloubergfamilypractice.co.za).