DIABETES - Full extract 

Mrs. Taranto's husband died some years ago and she now lives with her daughter's family. She is a cheery lady who loves her food. Each Christmas and Easter she brings in some Italian pastries. 

Her English is about as good as my Italian; we both speak about a dozen words. Usually her daughter or one of her grandchildren is able to act as an interpreter. Aside from being overweight and having arthritis in her knees, her general health has otherwise been good. 

When I saw her a few months ago it was obvious that she was not well. She had been suffering from a chest cold for a few weeks and had quite a cough. She also had a groin rash for which she was reluctant to be examined. With the help of her daughter, I was able to encourage Mrs. Taranto to allow us to give her a general check-up as well looking at her groin rash. She had bronchitis as well as vaginal thrush, not a common condition in women in their seventies. When I asked whether she could pass a urine specimen, she laughed. Apparently she had been passing plenty of urine, and would have no problems obliging. 

The urine tested positive for sugar. A finger-prick blood test showed a blood sugar of 16.5 mmol/litre, diagnostic of diabetes. I gave Mrs. Taranto and her daughter a general outline on what diabetes is and how it is treated. I also gave her a diabetes booklet written in Italian, and enrolled her in an Italian diabetes education course which is held each month at the local community health centre. 

Mrs.Taranto needed some topical treatment for thrush, as well as antibiotics for her bronchitis. I was interested to hear that her mother and an uncle had also been diabetic. When I reviewed her at the surgery a few days later, she was already feeling better. Her blood glucose was 11.5 mmol/litre, still a little high but moving in the right direction. 

To everyone's astonishment Mrs.Taranto has proved to be a model patient. She has now lost about 7kg and has even taken to going for a regular walk. Her last few blood sugars have all been in the normal range. She has seen a podiatrist and an eye specialist and is making good progress. I initially wondered whether she might require tablets for adequate control of her diabetes. So far this has not been required. 

Dietary sugar exists in various forms, and our bodies rely upon it for energy. The level of sugar in the bloodstream is very tightly regulated, mainly by a hormone from the pancreas called insulin. When this regulatory system fails, the blood sugar rises and a condition called diabetes mellitus occurs. ( mellitus in Latin means sweet ). The word "diabetes" is generally meant to apply to diabetes mellitus. However, there is a very rare and unrelated condition called diabetes insipidus which is caused by lack of a different hormone altogether, and is characterized by passing excessive amounts of dilute urine. 

There are two quite distinct types of diabetes mellitus... 

Insulin-dependent diabetes or Type I diabetes.  All children with diabetes are in this category. Some adults develop the condition as well. For some reason the body's immune system attacks its own pancreatic cells and insulin is no longer adequately produced. It may be of dramatic onset and the person may initially be very ill. Stabilization on Insulin is required.

Non-insulin dependent diabetes or Type II diabetes.  This type occurs in adults and is far more common. Sometimes it is called maturity-onset diabetes. Insulin is often produced in increased amounts but the body's organs like the liver and muscles fail to respond and a state of insulin-resistance is said to occur. Type II diabetes is a huge health problem in our community. It affects about 450,000 Australian adults and yet only a half of these people are aware of it. Around the world the incidence is increasing at an alarming rate, almost at epidemic proportions in some countries...probably due to lifestyle factors like diet, obesity, lack of exercise, and an ageing population.

In both types of diabetes mellitus, if the blood sugar remains high, various organs like the blood vessels and the nervous system become damaged. Visual loss, circulatory problems and kidney disease can result from blood vessel changes. Loss of sensation in the feet sometimes occurs; this may lead to the development of foot ulcers. Heart attacks and strokes are also more common in people with diabetes. When diabetes occurs in pregnancy there are increased risks for the baby. For this reason, a test for diabetes is often advised in pregnancies between 26 and 30 weeks gestation.

The telltale symptoms of diabetes are increased thirst, dry mouth and passing lots of urine. Other symptoms like fatigue, weight loss and skin infections may also be present. However, with the more common Type II diabetes, people often feel perfectly well and it can be quite difficult convincing them that they have a problem at all...let alone a problem that will necessitate some major changes to their lifestyle. Although diabetes may be suspected if a urine specimen tests positive for sugar, a blood test is necessary to confirm the diagnosis. Usually just a single blood test is required.

The treatment of diabetes has improved greatly in recent years. A careful approach to diet is important. Many patients with Type II diabetes can maintain their blood sugar close to the normal range with diet alone. (see diet advice sheets) If this does not occur, tablets are available to improve the body's response to its own insulin. For patients who require insulin, better delivery systems like injection-pens make the whole business of having to take insulin much easier to manage.

Education and a team-approach are vitally important in the management of diabetes. Patients and their families are encouraged to learn as much as possible about the condition. The GP, the dietician, the diabetes specialist, the eye doctor, the diabetes educator and the podiatrist all help in various ways. Diabetes Australia ( www.idi.org.au ) also provides excellent support and personal instruction. Foot-care, eye checks and how to recognize if the blood sugar drops too low, are just some aspects of diabetes that need to be covered. Because blood tests are far more reliable than checking the urine for sugar, people with diabetes are often taught to do their own blood tests so they can manage their diabetes more accurately.

Type II diabetes is more common in people with a family history. Likewise, being overweight, having high blood pressure, vascular disease, or elevated blood fats all increase the risks associated with the condition. Diabetes is seen more frequently in some population groups like aboriginals, Indians and Maltese. Interestingly, women who have given birth to large babies are also more at risk. All these people should have a simple screening blood test to see whether they have diabetes. Early diagnosis and treatment gives a much better outlook and will delay or even prevent diabetic complications.

Health tips:
* As well as the more typical symptoms, recurrent skin infections can be a clue to underlying diabetes. If you are prone to boils or repeated episodes of thrush, see your doctor for a urine or blood test.

* Type II diabetes is a condition that is, in many cases, fully preventable. All adults should have a regular health-check, including a urine test. Our diet should have an emphasis on natural foods like fruit, vegetables and complex carbohydrates. And don't forget the exercise.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004