News: Type 2 Diabetes (T2DM)

Did you know there are 3 main types of diabetes?

• Gestational diabetes – caused by hormonal changes during pregnancy
• Type 1 Diabetes – an autoimmune condition accounting for around 10% of all diabetes cases
• Type 2 Diabetes – representing 85% of all cases of diabetes

Today we will focus on Type 2 Diabetes (T2DM), a chronic disease that affects approximately 1 million Australian adults (2).  But, a further 2 million Australians have pre-diabetes which puts them at high-risk of developing T2DM.

As a Dietitian, I see a lot of clients who present with both pre-diabetes and T2DM who are having a difficult time managing their condition and their blood glucose levels (BGLs). It can be a really stressful situation but the positive news is that diet and lifestyle changes can have a big influence on how both these conditions are managed.  This is the area that I work closely with my clients and I’ll go into more detail later in this article, but for now let’s find out a bit more about T2DM. 

Evidence shows type 2 diabetes can be prevented or delayed in up to 58% of cases by following a healthy eating plan, maintaining a healthy weight and being physically active (1).

What is happening in the body of someone with T2DM?

When we eat carbohydrate foods, our bodies break them down into glucose which enters into our bloodstream from our digestive system. Our pancreas produces a hormone called insulin which also enters our bloodstream and takes this glucose from our blood and into our cells to be stored or to be used as energy. 

In someone with T2DM, the amount of glucose in the blood is higher than normal, so more insulin is required to transport this glucose into the cells. When this goes on for an extended period of time, a few different things happen. Firstly, the cells that produce insulin in the pancreas (beta cells) can become damaged from working overtime and so start to work less efficiently. Secondly, the body’s cells can become desensitised to insulin as they are constantly exposed to high levels of it in the blood. This means that the insulin that is being produced is unable to do its job, a term called insulin resistance.  

These two factors (less insulin being produced + insulin being less efficient) in combination are what lead to consistent high Blood Glucose Levels and a diagnosis of T2DM.

How is T2DM diagnosed?

T2DM can only be diagnosed via a blood test, and not via a urine test or blood glucose monitor (finger prick) test. Your test may either be a Fasting test (no food or drink for 8 hours) or an Oral Glucose Tolerance Test (OGTT), which is where you drink a small amount of glucose syrup and have your blood tested 2 hours later (2). 

A diagnosis of diabetes occurs when (4):

• Symptoms are present and the fasting blood test result is at or above 7.0mmol/L or the OGTT result is at or above 11.1mmol/L
• HbA1c (a measure of your BGLs for the past 3 months) blood test result is at or above 6.5%  
• There have been no symptoms and two abnormal blood glucose tests (as above) on separate days.

What are the main risk factors for developing T2DM?

You may be at risk of developing T2DM If you:

• are over 50 years of age and:
  • are overweight
  • have high blood pressure
  • have relatives that have diabetes
• have recorded a borderline blood glucose level (BGL) which falls in the range known as “pre-diabetes”
  • Impaired fasting glucose: range of 6.1-7.0 mmol/L (fasting= having not eaten)
  • Impaired glucose tolerance: range of 7.8-11.0mmol/L (2 hours after glucose sample- OGTT)
• have heart disease or have had a heart attack
• had gestational diabetes whilst pregnant
• have Polycystic Ovarian Syndrome (PCOS) and are overweight

Common symptoms of T2DM

Some people with T2DM present with no symptoms at all but these are common symptoms:

• Excessive thirst
• Frequent urination
• Feeling tired and lethargic
• Always feeling hungry
• Having cuts that heal slowly

 

• Itching, skin infections
• Blurred vision
• Gradual weight gain
• Mood swings
• Headaches
• Feeling dizzy
• Leg cramps

 

What are the risks associated with having T2DM?

Having T2DM can increase the risk of a number of other chronic diseases such as cardiovascular disease and stroke. It is very important to manage your BGLs as best as possible to reduce this risk, and to reduce the likelihood of developing other health complications. The main health complications associated with having T2DM include (6):

• Eye damage (retinopathy). Increased risk of certain eye diseases such as glaucoma and cataracts, and damage to the blood vessels in the eye, can potentially cause blindness.  
• Kidney damage (nephropathy). Increased risk of kidney disease and the need for dialysis and/or a transplant.
• Nerve damage (neuropathy). Loss of sensation, particularly in the limbs (hands and feet), which can result in tingling and numbness. 
• Heart and blood vessel disease. Increased risk of high blood pressure, stroke and heart attacks. 
• Poor wound healing. Combined with nerve damage, slow recognition of this can lead to infection, gangrene and possibly amputation. 
• Skin conditions
• Hearing impairment
• Dementia (including Alzheimer’s Disease)
• Sleep apnoea

What are the main treatments for T2DM?

The main treatments for managing T2DM include a combination of lifestyle interventions and medications. 

The first step, or “primary intervention”, in managing someone who is at risk of developing or has been newly diagnosed with T2DM, is dietary modification. This also includes modifying (increasing) physical activity patterns and is the first attempt to correct the blood glucose imbalance that is occurring in the body. 

Secondary interventions include the use of oral and injectable medications such as Metformin, Sulfonylureas, GLP-1 agonists, DPP-4 inhibitors and insulin. The appropriate dosage and selection of medications depends on the severity and length of time you may have had diabetes and will be individualised to each person by their doctor or endocrinologist.

What role does a dietitian play in helping to manage my T2DM?

As a Dietitian, my main role is helping you to understand how what you’re eating is impacting your blood glucose levels and how in turn this impacts on your overall diabetes management. As an expert in all things nutrition, I can help inform you on the right types of foods to be eating and in the appropriate quantities in order to successfully keep your BGL readings in the ideal range and reduce your risk of further health complications. 

During our consultations, we take a closer look at carbohydrate foods. This is because carbohydrate foods have the most direct impact on your BGLs and therefore the most direct impact on your diabetes management. Through a number of education sessions we look at the quantity, type and frequency of carbohydrates in your diet and we can adjust your plan as things change in your lifestyle. This is to ensure that we are doing as much as possible to reduce the risk of developing the health complications listed above. 

We also look at all other facets of your diet and lifestyle, including the nutritional profile of what you usually eat and how much physical activity you do. 

There are a number of factors, not just carbohydrate intake, which can affect your diabetes management and we address each of these during our initial and follow-up consultations.

Will I have T2DM for life or can I cure it?

With correct dietary and lifestyle modifications it may be possible to reduce your BGLs to below the diabetes or pre-diabetes range, and reduce or wean off your diabetes medications. However, the success of such attempts will likely depend on the length of time that you have had your diabetes and how well it has been managed previously. 

When BGLs are poorly controlled, over time the beta cells in the pancreas become less efficient and can be damaged.  Even if we have success in managing our T2DM through lifestyle interventions, this beta cell damage may not repair. This means that we would be more likely to require medications and interventions again in the future should the positive lifestyle changes stop and/or we were to have a setback such as an increase in weight. 

So once diagnosed, the risk of having T2DM for life may be present even when successfully managing it at a particular point in time. This is why long-term, maintainable healthy eating and physical activity patterns are the best way to reduce the consequences associated with T2DM. 

So what does this mean for you?

Screening and early detection of T2DM can go a long way to helping you effectively prevent or manage this condition. That’s why it’s important to be aware of the signs and symptoms and to seek help if you have some concerns or just want to be proactive with your health. 

If you feel like you or someone you know is struggling with controlling their eating or managing their BGLs, then seeking out some expert advice can be really valuable. Working together we can create a plan to suit your needs and lifestyle, and help you get on the right track to best manage your diabetes. Scroll down to book an appointment ↓↓

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(1) https://www.diabetesaustralia.com.au/about-diabetes/type-2-diabetes/

(2) ABS 2019a. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on Detailed Microdata File analysis. Canberra: ABS.

(3) https://www.racgp.org.au/afp/2012/june/oral-glucose-tolerance-testing/#:~:text=The%20oral%20glucose%20tolerance%20test,test%20results%20are%20not%20affected.

(4) diabetesvic.org.au

(5) https://www.diabetesaustralia.com.au/about-diabetes/pre-diabetes/

(6) https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193