With a family history of diabetes, from a young age, the deadly disease has been on my radar, and according to recent statistics, it should also be on yours.

Today alone, at least 300 people will develop type 2 diabetes in Australia, while at least a quarter of Australians will develop it in their lifetime. With 60 per cent of Australians classified as overweight or obese, it’s no coincidence.

But this isn’t a new revelation. For over 2,000 years, the disease has been affecting people throughout the world, and it was in the first century AD that a Greek by the name of Aretaeus termed the devastating nature of the disease as ‘diabetes’, the Greek word for ‘siphon’.

Neos Kosmos picked the brains of researcher Dr Christos Tikellis of the Baker IDI Heart & Diabetes Institute to give you the lowdown on everything you need to know about diabetes, its detection and prevention.

Neos Kosmos (NK): What exactly is diabetes?

Dr Christos Tikellis (Dr CT): To keep our body functioning, glucose must always be present in our blood. It’s as important as oxygen in the air we breathe.
To achieve this level of control is not easy. Some days you might eat a feast and follow it with baklava. Other times you might eat nothing at all. Yet through it all, our glucose levels will normally fluctuate only very slightly. This is achieved thanks to an elaborate system of checks and balances that carefully regulates how much glucose is going into the blood and how much is going out. Diabetes is the state in which this balance fails and glucose levels rise. As sugars are digested and absorbed from your diet, they trigger the release of hormones, the most important of which is insulin, which is made and released by the beta cells of the pancreas. Insulin coordinates the body’s response to rising blood glucose levels, telling the cells of the liver, muscles and fat to take away glucose from the blood (and store it for later use). It also tells the liver to stop making and releasing any extra glucose, which is rendered unnecessary by having just had a meal. Diabetes occurs when there is not enough insulin (or insulin function) to keep glucose levels under control.

NK: What are the factors that contribute to loss of insulin functions? Are there different types of diabetes?

Dr CT: Many different factors can contribute to the decline and loss of insulin’s functions. In some people, their immune system can inadvertently destroy the insulin producing beta-cells of the pancreas. This is called type 1 diabetes and accounts for around 10 per cent of all cases. It can occur at any age, not just in children and adolescents. Regular insulin injections are always needed to treat it. At present there is no way to restore the body’s ability to make its own insulin, but a cure may be possible one day.
The most common form of diabetes is type 2 diabetes, which accounts for over 90 per cent of cases. At least two million Australians currently have type 2 diabetes, and by 2030 it is anticipated that one in 10 adults in the world will have it. It is usually caused by having too much fat in the body, which increases the demand for insulin while at the same time reducing the ability to make enough.
Also, sometimes during pregnancy women temporarily develop gestational diabetes. It is thought to occur because the pancreas in not able to make the extra insulin (two to three times more than normal) required to control glucose levels during their pregnancy, so glucose levels start to rise.

NK: How does someone typically develop diabetes?

Dr CT: Type 2 diabetes usually starts out as a silent disease. The symptoms of fatigue, lethargy, poor vision, irritability, reduced libido, passing urine more frequently or having to get out of bed at night to go the toilet that go with diabetes may all be dismissed as signs of getting old or other problems. In the recent AusDiab survey of the Australian general population, for every one person who knew they had diabetes there was another one who had never been diagnosed. Even in those newly diagnosed with diabetes, it has been suggested that they may have had diabetes for an average of five to 10 years previously.

NK: Who is at risk of developing diabetes?

Dr CT: The most important reason for developing type 2 diabetes is becoming overweight or obese. (Unless they are very old), few individuals with a waist circumference in the healthy reference range will become diabetic. If you are obese, this makes you four times more likely to get type 2 diabetes and it will appear five years earlier than average.
Diabetes is not due to eating too much sugar (carbohydrate). Excess energy from too much fat, sugar or protein alone, or in combination, will do the job. When calories in whatever form are supplied in excess, the fat stores swell. If calorie excess continues, the body creates additional storage capacity, particularly around the internal organs (known as visceral fat). All fat, but especially visceral fat, is able to produce a release of chemical factors that interfere with the function of insulin, and lead to diabetes.
Most adults don’t engage in regular physical activity, and being sedentary significantly increases their risk of diabetes. Regular exercise is an important means to achieve and maintain weight control, and burn off dangerous (visceral) fat. Regular physical activity also acts to improve your body’s sensitivity to insulin, meaning your pancreas need to work less to do the same job; hence the survival of the fittest.
(Other factors: Ageing, diabetes tends to run in families, certain ethnic groups (e.g. Aboriginal and Torres Strait Islanders in Australia, Polynesians, Asian, Middle eastern, Hispanic and Black races, if you had diabetes during pregnancy, Polycystic ovary syndrome, heart disease, high blood pressure, high LDL cholesterol, Chronic depression, heavy smoking, your birth weight, certain medications.)
The best opportunity to reduce the risks associated with diabetes and even to cure diabetes itself is early in its course. This is why all those at risk of diabetes should consider getting tested for diabetes.

NK: If you have been diagnosed with diabetes, is it reversible?

Dr CT: Yes, in its early stages type 2 diabetes is reversible. Gastric bypass surgery and the massive weight loss it causes will ‘cure’ type 2 diabetes in over 90 per cent of cases. It requires major surgery that is not suitable for the vast majority of those diagnosed, but its success illustrates just how important waist control is for the prevention and management of type 2 diabetes, and how with the right diet and exercise regimen it is possible to substantially reverse the effects of diabetes. Type 1 diabetes is not reversible. Gestational diabetes usually goes away after the baby is delivered, but not always.

NK: Is developing diabetes avoidable?

Dr CT: There are substantial opportunities for every individual to reduce their chances of developing diabetes. Too often they are missed opportunities. As noted above, the most important reason for developing diabetes is becoming overweight or obese. So the most important way to reduce your risk is controlling your weight through eating less and exercising more. Most Australians consume more calories than required for our metabolism and daily energy expenditure. Consequently, if we eat fewer calories than we do now, while maintaining our supply of essential nutrients, we will reduce our risk of diabetes, as well as our waistlines. For most people, the most practical way to achieve this is to follow a diet (plan). Weight loss with meal replacements can also reduce the risk of type 2 diabetes, but these have not been tested in people with pre-diabetes. Regular physical activity is also an important means to achieve and maintain weight control, and to improve your body’s composition. But this is not all it can do! Thirty minutes of exercise every day, even without any weight loss, can reduce your risk of diabetes. Even a modest change in activity with increased walking and bicycling, when combined with a diet that reduced weight by only 2kg, was able to achieve a reduction in new cases of diabetes by two thirds. Different strategies will be suited to different people. What is important is that each individual takes the time to grasp these opportunities.

NK: Is there a test for early detection of diabetes? If so, what does the test entail?

Dr CT: Getting type 2 diabetes is a slow process that usually takes several decades. There are different ways to diagnose pre-diabetes. The old fashioned way was using a glucose tolerance test which involves drinking a large glass of glucose laden liquid and then testing your blood glucose two hours later to see what effect it has had. More recently Medicare have subsidised a blood test for diabetes that does not need you to drink sugar or be fasting for eight hours before it. This test has been used for decades in the management of diabetes, but only in the last 12 months has it been used to diagnose diabetes. It is called the HbA1c test or A1c. If your value is over 6.5 per cent you have diabetes. But if it is between 5.7 and 6.5 you are said to have pre-diabetes and have a risk of developing diabetes in the next five years.

NK: Do you have any diet tips regarding the maintenance of a healthy lifestyle if you are of risk of diabetes?

Dr CT: Most doctors recommend those with pre-diabetes adopt a Mediterranean diet, to reduce their risk of developing diabetes. Indeed one recent study showed that after a median follow up of 4.0 years diabetes incidence was reduced by half in those following a Mediterranean diet.

Diabetes usually occurs as a result of a combination of many risk factors. To estimate your own risk of type 2 diabetes, use the risk calculator at the following link: http://www.health.gov.au/internet/main/publishing.nsf/Content/diabetesRi…