Diabetes - about diabetes
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Contents
Alert!
If a person who has diabetes becomes confused, obviously unwell or unconscious, that person needs urgent help. She may have a very low blood glucose level (hypoglycaemia) or ketoacidosis. It is important for family members, school staff and work colleagues to know how to recognise the signs, what to do and when to call for help.
Diabetes (diabetes mellitus) happens when the body can't use glucose for energy because of not having enough insulin. Glucose is made from food. Insulin, a hormone which is made in the pancreas, helps glucose go from the blood stream into the body's cells. It controls the levels of glucose in the blood.
If you have diabetes you will need to learn to manage it in order to have a healthy life, but then you will be able to do almost all of the things that anyone without diabetes can do.
This topic is about type 1 diabetes mellitus. For information about lifestyle with diabetes see 'Diabetes – living with diabetes'.
What is diabetes mellitus?
There are two main types of diabetes mellitus, type 1 and type 2 diabetes. Another type of diabetes (Gestational diabetes) occurs during pregnancy for some women (see the topic 'Diabetes in pregnancy').
Most young people who have diabetes will have type 1 diabetes (which may also be called juvenile onset diabetes, or insulin dependant diabetes mellitus [IDDM]).
- This means they will need to have insulin injections every day of their lives and they will need to be careful about what they eat and how much they exercise.
- Even so, people with diabetes are able to do pretty much everything that other people are able to do. They are not 'ill' but they do have a health problem.
Less than 10% of people with diabetes have type 1 diabetes. Most people who have diabetes have type 2 diabetes which they develop after the age of about 40 years.
Understanding diabetes
- The usual way that cells get the energy that they need, is that food eaten is broken down into smaller molecules (digestion).
- Complex carbohydrates (long and complex molecules) are broken into smaller, simpler carbohydrates, and eventually into glucose, which is the main energy source for most cells of the body.
- For cells to be able to use glucose it has to pass from blood through cell walls into the cell.
- To do this, insulin is used.
- Without insulin much less glucose gets into the cells.
Insulin is a hormone made in the pancreas.
- If your body produces little or no insulin, or does not properly use the insulin it does make, you have diabetes mellitus.
In type 1 diabetes, cells in the pancreas stop making insulin.
- The reason they stop is a complex mix of having vulnerable cells (due to factors in the genes) and the body's immune system triggered into 'overdrive' probably after a virus infection (maybe several different types of infections), killing the body’s own cells. Type 1 diabetes is an 'auto-immune disease' (‘auto’ means ‘self’).
It may not be easy to pick up the first signs of diabetes. These can be:
- increasing tiredness
- being more thirsty than usual
- passing more urine than usual
- loss of weight.
If these are not noticed a person could become very ill when his blood glucose (sugar) level gets very high and he develops ketoacidosis (see below).
A simple blood test (blood sugar level) will show whether the problem is diabetes.
The early treatment of diabetes is usually done in hospital with a specialist team which includes an endocrinologist (a medical specialist who treats people with disorders of the endocrine glands such as the pancreas), nurses, dietitians and diabetes educators. From then on the person with diabetes manages it with support from a diabetes team. Very little time needs to be spent in hospital.
Why
so much control? (Complications)
Before insulin could be produced, a person with type 1 diabetes quite quickly became very weak, lost a lot of weight and died.
- With insulin treatment this early death can be avoided, but insulin given in two, three or four injections a day cannot be exactly the same as having a body make just enough insulin for the amount of glucose needed by the cells at any one time.
- If the amount of insulin injected and the amount of food are not carefully monitored, complications of diabetes can still occur. These can include damage to kidneys, blood vessels, eyes and skin.
If you have diabetes you can still be fit and well, and able to take part in all your normal activities.
Is
there a cure?
As yet there is no cure for diabetes. There is a lot of research going on world wide to find a cure, including seeking ways of transplanting insulin making tissue, but no 'curative' treatment is available yet. At the moment, insulin will need to be injected every day for the rest of your life.
Food
You don't have to have special food for diabetes, just a normal, healthy diet!
You do need to cut down on eating food that contains a lot of sugar but most people would be better off if they did. If all family members go onto the same diet as the family member who has diabetes, it will be easier to manage for the family, and healthier for them all too.
Regular meals
If you are on insulin you will need to have regular food at regular times. Skipping meals (too tired, being out, sleeping in) can lead to 'hypos' if insulin doses remain unchanged.
Carbohydrates
- Carbohydrates are 'energy' foods and they are important in controlling diabetes. You will need to have a diet that is high in the right carbohydrates.
- The 'glycaemic index' (GI) is a way of rating how quickly carbohydrate is absorbed, whether it is quick or slow acting.
- There are quick-acting carbohydrates (high GI) and slow acting carbohydrates (low GI). Slow acting carbohydrates slow down the absorption of glucose and are better, while quick acting carbohydrates should be limited. This can be difficult at first to understand, so talking with a dietitian is useful.
Fats and proteins
- A diabetic diet needs to be well balanced.
- Some diabetic diets used to have high levels of fat and protein because all carbohydrates were thought to be bad, but it is now known that high fat, high protein and low carbohydrate diets lead to other health problems such as heart disease and obesity.
- You need fats and proteins for growth and maintenance of cells, but the amounts should be the same as those recommended for all young people. Your dietitian will be able to guide you.
'Junk' foods
- Someone once said that any food is 'junk' food if you eat too much of it.
- Most foods that we call 'junk' foods are high in fats, salt and sugar (simple carbohydrate), and they can muck up your blood sugar control if you eat too much, or you do not plan them into your diet.
- Too much fat, even if your blood sugar is controlled, will push your weight up.
When you don't feel like eating!
If you are sick, you might not feel like eating.
- How illness affects the amount of insulin needed is quite complex.
- You might need the same amount of insulin even if you eat less, or your insulin needs might change a lot.
- Make sure that you find out what might be needed before you get sick.
- You could need help from your doctor through your first 'cold' until you know what could happen.
- If you are quite unwell, you probably will need to see your doctor earlier than other people need to.
Bingeing
- Eating too much is not healthy for anyone. It can mess up control of diabetes.
- That can usually be managed without too much trouble, however complications can occur if overeating goes on.
- Some young people react to too much control from others by not managing their diet well. This might be a good time to renegotiate who really is 'in control' of your diabetes.
Remember - if you have diabetes, it is important to eat at regular times.
Managing insulin
- Insulin is destroyed by the digestive juices in the stomach, so it cannot be taken by mouth and must be injected. All young people with diabetes will need insulin injections (except if they have type 2 diabetes, which is rare in young people).
- There are several forms of insulin, some longer lasting than others. You could need two injections a day, before breakfast and before the evening meal, but some people may be on three or four injections depending on the mixture of insulin that is best for them.
- The injections can be given by pen or by syringe. Pens are easier and give more control. It will take time to work out a routine and to adjust insulin doses to meet your body's needs.
- Regular blood glucose testing is the best way of knowing how good diabetes control is. Urine testing (which used to be how control was measured) does not accurately reflect blood sugar levels, and is not good enough to keep a person really healthy.
- You will need to check your blood sugar levels several times a day, and record them so that you know what amount of insulin you need.
- Other blood tests (such as the Haemoglobin A1c) will be done to monitor long term control. You will need to talk with your doctor about these and other tests.
Hyperglycaemia usually develops slowly, although it can happen more quickly if the person is ill.
If the hyperglycaemia is not recognised and treated, it can lead to ketoacidosis, which is a serious emergency.
Each person needs to have a plan to manage hyperglycaemia. This includes working out why she has hyperglycaemia, so that the correct treatment can be given, and working out ways to avoid this happening.
Ketoacidosis
Ketoacidosis develops when the body, which is starved of glucose, starts to break down fats for energy.
The products of this breakdown of fats are called ketones, and the levels of ketones in blood and urine rise.
Signs of ketoacidosis
-
Confusion, drowsiness
-
Breath odour, which smells 'fruity' or like acetone (nail polish remover)
-
Rapid deep breathing
-
Being very thirsty (polydipsia)
-
Tummy pain, feeling sick (nausea) and vomiting, flushed cheeks
-
Dehydration because much more urine is produced than normal (polyuria)
-
Ketones in the urine (ketonuria)
-
Glucose in the urine (glycosuria) because of high blood glucose levels
-
Very high blood glucose (over 15mmol/l)
-
Eventual loss of consciousness and death, if untreated.
Treatment of ketoacidosis
This usually needs to be done in hospital.
-
Emergency treatment aims first to give a lot of fluid, usually using a saline 'drip'.
-
Insulin is used to bring the blood glucose level back to normal.
-
When she recovers, it is really important to work out why the ketoacidosis occurred, so she can try to stop it happening again.
Hypoglycaemia (low blood glucose)
What is a hypo? (Hypoglycaemia)
Hypoglycaemia is when blood glucose levels get too low (below about 4.0 mmol/L) usually as a result of:
- missed or delayed meals or snacks
- being unwell and not eating properly
- doing strenuous activity without eating extra food
- not taking the correct dose of insulin
- drinking too much alcohol.
Symptoms of hypoglycaemia
Symptoms will be a mixture of these:
- feeling shaky, anxious and weak
- sweating, going pale
- crying, being irritable
- being unable to concentrate, lacking co-ordination
- having slurred speech
- feeling hungry
- having a headache.
If not treated, the person may become confused or drowsy, and if severe, he may lose consciousness.
Treatment of hypoglycaemia
If conscious, give any of these:
-
glucose tablets
-
sugar or honey (2 to 3 teaspoons) dissolved in water
-
jelly beans or jelly baby lollies
-
sugary soft drink or fruit juice (not diet drink)
Follow this with complex carbohydrate food, eg. a sandwich or a drink of milk.
If unconscious:
- do not give any drinks or food by mouth
- inject Glucagon (if it is available and if someone is trained to give it)
If Glucagon is not available, or the person does not respond to Glucagon, call for urgent help (eg. call the ambulance service 000 in Australia).
A person with type 1 diabetes should always carry a source of fast-acting sugar.
Preventing
these emergencies
- It is not possible to prevent all episodes of high or low blood glucose. Many things can affect control, for example it may not always be possible for someone to eat exactly on time, and it can be difficult to control blood glucose when a person is unwell with what would otherwise be a minor illness such as gastro or the flu.
- It is important to monitor blood glucose regularly, and to develop a plan with the diabetes team for times when control is difficult.
Being in control
Some things that you may have to manage more strictly than other young people include:
- meal times - missing meals can lead to problems
- sleep-ins - you may have to wake up early to eat, have your insulin, etc
- alcohol - using it at all can be complicated
- exercise - you may need to carry extra food
- smoking - you should choose not to smoke, and avoid being around others who smoke - it makes some of the negative effects of diabetes worse.
- All doctors, dietitians etc. who work with people with diabetes know that people are not perfect. If you do 'go out of control', it is best to 'own up' and work out some plans for next time, rather than pretending that every thing is OK.
Diabetes will probably not be the main cause of most of the difficulties that you get into.
- If you find yourself getting angry about things, always think of other things too, and don't blame it only on the diabetes.
- Don't let others blame the diabetes either.
- Diabetes may be a health problem you have, but it should not be a cause of illness, anger or depression, social difficulties and not coping.
While for both main types of diabetes genetics is part of the cause of the diabetes, the vast majority of babies whose fathers or mothers have type 1 diabetes will not have diabetes themselves.
- The genetic component of the cause of type 1 diabetes is not a simple inheritance (like eye colour).
- Most of the people with the genes which mean they could develop type 1 diabetes, do not get diabetes.
- There is a need for some environmental trigger as well. This trigger may be a virus infection, which stimulates the body's immune system into destroying some of the cells in the pancreas which produce insulin.
- In comparison many of the people whose parents have type 2 diabetes will develop type 2 diabetes themselves, especially if they become overweight.
- If diabetes is well controlled a woman with diabetes and her developing baby should both be healthy, but uncontrolled diabetes can be risky for both and diabetes can be harder to control than usual during pregnancy.
- If possible, planning when to become pregnant gives the opportunity to ensure that diabetic control is the best that it can be.
- Women who develop gestational diabetes (diabetes triggered by being pregnant), and who need special care during the pregnancy, usually do not have diabetes after the pregnancy (although they may develop type 2 diabetes later in life).
- Uncontrolled diabetes during a pregnancy can cause harm to the developing baby (more frequent developmental problems, premature birth or still birth).
See the topic 'Diabetes in pregnancy' for some more information.
Medic Alert
It is important to wear medical alerting information. In Australia there is a Medic Alert disc now available with a sports Velcro anklet or bracelet. http://www.medicalert.com.au/
South Australia
- Diabetes Australia - South Australia (DA-SA)
An independent, not for profit, charitable organisation providing a range of services and products designed to meet the needs of people with diabetes.
159 Sir Donald Bradman Drive, Hilton SA 5033
-telephone: 08 8234 1977
http://www.diabetessa.com.au/
Australia
- Diabetes Australia
http://www.diabetesaustralia.com.au/home/index.htm
- National Diabetic Services Scheme (NDSS)
Funded by the Australian Government and administered by Diabetes Australia - South Australia (DA-SA). It provides an easy, low cost way for people with diabetes to purchase essential diabetic supplies. Lifetime registration is free. You need to fill in a registration form, get it signed by your doctor and return it to DA-SA.
http://www.diabetessa.com.au/aspx/about_the_ndss.aspx
- Juvenile Diabetes Research Foundation
A non-profit organisation dedicated to finding a cure for diabetes and preventing its complications through research.
- (08) 8338 3677
http://www.jdrf.org.au/
Juvenile Diabetes Research Foundation
http://www.jdrf.org.au/
The Queen Elizabeth Hospital Diabetes Service
http://www.diabetes.org.au/
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).