Diabetes is a disease which represents a health challenge not only for the individuals affected, but for all of New Zealand, given that rates of diabetes are climbing ever higher.

It is estimated more than 200,000 New Zealanders have diabetes, with about half of that number still undiagnosed. Diabetes New Zealand, in its 'Diabetes Outcomes Model Update' in May 2007, says prevalence rates were 19% higher for 2006 than the rate predicted by the Ministry of Health in 2001. 

If people continue to develop diabetes at this rate, by 2021 the burden on the country’s District Health Boards to treat diabetes and its complications is estimated to be $1.6 billion. This represents 15% of the health budget, compared with 3% in 2006.

Flow-on economic burdens also stem from problems related to poor health, such as employment difficulties, the strain on social services, as well as the personal quality-of-life concerns for the individuals, their families and friends.

The problem is compounded by people who have diabetes yet are currently undiagnosed. These people often end up presenting with diabetes at a later stage, when they have already developed serious complications. This means they need more (and often more costly) health interventions, as well as having a poorer health outlook for themselves.

Worldwide problem

The diabetes problem is a worldwide one, with the International Diabetes Federation estimating that 246 million people worldwide now have diabetes (Diabetes Atlas, 3rd ed, 2006). Diabetes is expected to cause 3.8 million deaths worldwide in 2007, about 6% of total global mortality, about the same as HIV/AIDS. Using World Health Organization (WHO) figures on years of life lost per person dying of diabetes, this translates into more than 25 million years of life lost each year.

What is causing it?

The rise in type 2 diabetes in New Zealand and throughout many parts of the world is being attributed to increased levels of obesity. Type 2 diabetes used to be regarded as “age-onset diabetes” as it occurred later in life, but many younger people are now developing it, and even some overweight schoolchildren are at risk.

By contrast, people with type 1 diabetes usually have the condition as part of a genetic (inherited) or functional disorder.

The wrong diet and lack of exercise are major factors in becoming very overweight (obese) and, from there, often developing type 2 diabetes.

What happens in diabetes?

In diabetes, the body has difficulties either in producing or responding to insulin, a hormone which controls blood-glucose levels. Insulin is made in the pancreas and helps break down glucose (sugar) in the bloodstream so it can enter cells, eg, muscle cells and be converted into energy. In type 2 diabetes, glucose is unable to move into cells to be used or stored, so the glucose circulating in the blood can reach harmful levels.

Who is at risk of developing diabetes?

Maori, Pacific Island, Middle Eastern and Asian peoples have a higher risk of developing diabetes, also people whose blood relatives have diabetes, and those who are overweight, have high blood pressure or who do very little exercise, women who have had diabetes in pregnancy or had a baby weighing more than 4kg.

Symptoms that may be experienced are tiredness, extreme thirst, needing to urinate a lot, blurred vision, or frequent infections. However, many people may not experience any symptoms and not realise they have diabetes until it is at an advanced stage. Your doctor can arrange a blood test to see if you have diabetes. It is better to be diagnosed early, so you can start receiving treatment.

Complications of diabetes

Unchecked and uncontrolled, diabetes can lead to debilitating conditions, including heart disease and increased risk of stroke, damage to the eyes (possible blindness), ulceration on the legs and feet (possible amputation), kidney failure (possible dialysis) and impotence in men.

If you do have a diagnosis of diabetes, the good news is that maintaining optimal levels of blood-glucose will help keep complications to a minimum, and prolong the time before other parts of the body are affected. Greater control also means greater overall health and wellbeing, and many people with controlled diabetes are able to lead fulfilling lives.

How is it treated?

The main aim of diabetes treatment is to control blood-glucose levels, thereby reducing damage within the body. A combination of lifestyle changes and drug treatment are needed for this. The best drug treatment for you will be prescribed by your doctor. Most people will require more than one diabetes medication and possibly move onto insulin use, within 10 years of diagnosis. People who need to inject insulin and have a phobia or difficulty with needles can use a range of devices for this, such as pen injectors.

Side effects of treatment

Medications may have side effects, such as causing weight gain or occasional hypoglycaemia (“hypos” – where the blood-glucose levels drops to a dangerous level). In some cases, a slight increase in weight may be acceptable if greater blood-glucose control is achieved by using a particular medication (your doctor will discuss this). There can be conflicts, too, between other medications you may need to take, so it can be a balancing act for your doctor to get your medications just right. However, research is always continuing into newer drug treatments which may reduce side effects or other problems.

Monitoring blood-glucose

To be able to monitor your diabetes, it is often necessary to carry out regular pin-prick testing at home, where a small drop of blood, usually taken from a finger, is tested to give a blood-glucose reading. This is necessary while taking some medications, but not all. Another test, the HbAlc, in this case a laboratory blood test, gives a three-month average of blood-glucose levels and lets you see what your control is like on a longer term basis. 

Lifestyle changes part of treatment

Lifestyle measures which help control diabetes are very important and include regular exercise (preferably every day); not smoking; good diet (in general following heart health recommendations for lowering intake of fat – particularly of saturated fat, lowering salt intake, and increasing intake of fruits and vegetables); cutting out sugary drinks and foods; keeping alcohol use to a minimum; and weight loss (if overweight).

Get Checked programme

Regular medical checks are also essential to ensure you are not developing problems. The Government funds a “Get Checked” programme which gives people with diabetes one free health check per year. This allows your doctor to check, eg, your eyes, feet, blood pressure, blood-glucose control, to see how your medication is working for you, and help with any problems and queries you may have.

Getting tested for diabetes

If you fit into the at-risk categories for diabetes (see above under “Who is at risk of developing diabetes?”) ask your doctor for a diabetes test. It is far better to be diagnosed early and start to control the diabetes before complications begin.

Prevention is the best plan

Clearly, diabetes is not the easiest condition to live with. Ways to prevent getting type 2 diabetes include: healthy eating, keeping weight to a healthy level, exercising regularly, not smoking (or quit smoking), and asking your doctor for regular ‘heart health’ and general medical check-ups. If you have any concerns that you may have or may be developing diabetes, talk to your doctor about diabetes testing.

See also: everybody's Diabetes Centre

Compiled by everybody, July 2007.