Diabetes, are you taking it seriously?
By Gaye Rutherford, Dietitian

This month marks National Diabetes Week (July 8th – 14th), a major goal of which is to promote awareness of diabetes throughout the Australian community. There is so much written about diabetes nowadays that I used to think why do we need a whole national week promoting diabetes awareness? However, I am increasingly finding that when asked what diabetes is, many people’s explanations are limited to “if you have diabetes you shouldn’t eat sugar.” This description in no way conveys the serious and largely preventable for many people health consequences of diabetes (nor is it strictly speaking correct!). Diabetes is undeniably the fastest growing non–infectious disease in the world. And as such I believe it is critical that everyone should have a much better basic understanding of what diabetes actually is – and more importantly how it can be prevented or at worst case effectively managed.

Is it a big problem in Tasmania? It sure is. Latest estimates are that around 30,000 Tasmanians are affected by diabetes, and another 65,000 have, often unknowingly, impaired glucose tolerance or pre-diabetes. Together, these figures suggest almost 20% of Tasmanians – or a staggering one in five – are or are likely to be directly affected by diabetes. This is one of the highest prevalence rates in the world!

Diabetes is a condition where there is too much glucose (or sugar) in the blood. Some level of blood glucose is critical for us to live – it’s one of the main energy sources for our bodies. Indeed, some organs (notably the all important brain!) can only use blood glucose for energy (most organs can use a variety of “petrols” so to speak, ranging from glucose in the blood or stored in muscles, to fat reserves). The glucose in our blood comes from eating foods containing carbohydrate, which through the digestion process get broken down into glucose (and some other simple sugars) and absorbed across the wall of the gut into the blood stream. Carbohydrate containing foods include bread, pasta, rice, cereals, fruits, starchy vegetables (notably potatoes and corn), milk and yoghurt, and the host of foods made from sugar (eg regular soft drink, lollies, cakes, etc). Getting the glucose out of the blood stream and into the body cells that want to use it for energy requires the assistance of a hormone called insulin. Diabetes occurs when the body does not make insulin or when the insulin that is made is not working properly, making it difficult or impossible for the body to clear glucose from the blood and consequently causing increased blood glucose levels. Over time, the health implications of unmanaged high blood glucose levels are devastating, and include heart attack, stroke, kidney failure, blindness, and amputation. I have recently seen a number of patients hospitalised with gangrenous feet as a long-term complication of diabetes, with the only treatment option being amputation (typically from the knee down), a pretty confronting reality and one which has really forced me to realise what a serious disease diabetes is. Its implications are far greater than just needing to avoid sugar.

There are two main types of diabetes, now called type 1 and type 2 (previously referred to as insulin-dependent or juvenile-onset, and insulin-independent or adult-onset) diabetes. Type 1 diabetes occurs when the body is unable to make insulin because the cells (in the organ called the pancreas) that normally fulfil this function are attacked by the body’s immune system. It usually develops at a young age, and persons affected have to rely on insulin injections to live. People with type 2 diabetes are usually insulin resistant, this means that they (at least initially) still produce insulin, but it isn’t working as well as it should. This causes their bodies to attempt to make more and more insulin until eventually (if not well managed) the cells producing the insulin fail, and these people must rely on insulin injections. The critical thing to know about type 2 diabetes is that it is a “lifestyle” disease and strongly associated with high blood pressure, high blood cholesterol, being overweight especially around the middle, and smoking.

All of these factors can be influenced and prevented by our lifestyle decisions, therefore the major cornerstones of preventing or effectively managing diabetes are:

	Eating a healthy diet;
	Getting regular physical activity;
	Maintaining a healthy weight; and
	Not smoking.

I know making the right lifestyle decisions isn’t always easy, and indeed many people don’t always know what “healthy eating” is, or how to go about losing weight, quitting smoking or fitting some physical activity into their busy lives. This was brought home for me recently by market research by AC Nielsen into our supermarket shopping habits. According to this research, the 20 most popular brands Australians put in their supermarket trolleys, in descending order, are: Coca-Cola (soft-drink); Longbeach, Winfield, Peter Jackson, Horizon and Benson & Hedges (cigarettes); Huggies (disposable nappies); Holiday (cigarettes); Tip Top (bread); Cadbury (confectionary); Nestle-Peters (ice cream); Pura and Pauls (milk); Yoplait (yoghurt); Sorbent (toilet tissue); Pedigree Pal (dog food); Nescafe Blend (coffee); Smith’s (snack food); Kleenex Cottonelle (toilet paper); and McCain (frozen vegies and potatoes). Commenting on this research, one newspaper noted “That’s a pretty accurate picture of what the average Australian is doing: smoking, drinking soft drinks [and] eating processed food.” Admittedly, as a leading dietitian pointed out, this ignores any purchases made in specialty fresh produce stores like green-grocers and butchers, but given the bulk of our food purchases are now made in supermarkets, it’s a pretty worrying picture.

The Fairbrother Health & Wellbeing Program is working to tackle each of these aspects and assist everyone understand and make appropriate lifestyle choices. We recently asked for expressions of interest for support to help quit smoking – less than 10 employees have taken us up on this. For those that have, a huge resounding congratulations, what an incredible positive steps towards better health. For the rest of our employees who continue to smoke (as sadly I know there are more than 10), I’d be very interested in hearing why you weren’t interested. We are also well underway with our optional health assessments, and have started a series of group education sessions on understanding what healthy eating is. Hopefully those who attended the May session in Devonport and June session in Hobart gained some useful knowledge and motivation at these sessions. The previously advertised Launceston session was postponed due to a lack of interest, but is now planned to go ahead in August. The tentative date is early afternoon on Saturday 18 August, with definite details to be circulated closer to August.

Back to the topic at hand, even if you do not currently have diabetes, there are some overwhelming reasons why I believe we should all know what it is and what we can do to prevent it. Firstly, and most obviously, so that you can make appropriate lifestyle choices to prevent yourself from developing diabetes at any stage. And secondly, because a major risk factor for developing diabetes has been found to be having a family history of diabetes. So not only can your lifestyle decisions affect your own health, they can directly affect the health of your children. I might not be able to influence whether any children of mine inherit my fairly boring straight hair or bumpy nose, but I know I can reduce their risk of developing type 2 diabetes by making sure I don’t develop it myself – I think that’s a pretty powerful motivator!

If you are interested in more information on diabetes, some great websites include:

	International Diabetes Institute, which has a great section on smart shopping and reading food labels: http://www.diabetes.com.au
	Diabetes Australia, for more detailed information on diabetes prevention and management, also links to some great publications including ‘Diabetic Living’, the Better Homes and Gardens lifestyle publication with great articles and tips on healthy eating: http://www.diabetesaustralia.com.au
	The ‘Don’t Ignore Diabetes’ website which has great basic information on how to prevent type 2 diabetes: http://www.dontignorediabetes.com.au/

Gaye Rutherford
Accredited Practising Dietitian
Fairbrother Health & Communications Manager