History

Diabetes has been known as a disease for a very long time, with the first records of diabetes appearing as early as 1552 BC. Early treatments, described by a French physician in the 1870s, linked diabetes and diet, and individual diet plans featured as an important part of diabetic treatment.

The discovery of insulin is generally accredited to Sir Frederick Grant Banting and his team at the University of Toronto in 1921. Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923 for their discovery, marking the emergence of insulin treatment in diabetic treatment. This early insulin therapy was largely based on bovine/porcine insulin collected from abattoirs.

In 1955 the first oral hypoglycemic drugs were manufactured, and in 1959, Type 1 and Type 2 Diabetes were recognised as separate medical conditions for the first time, marking the emergence of the diabetic treatment regimes followed today. Top

Types of Diabetes

There are two main types of diabetes, referred to as Type 1 and Type 2 Diabetes respectively.

Type 1 Diabetes

Type 1 Diabetes (previously known as Insulin Dependent Diabetes, or Juvenile Diabetes) occurs when the pancreas produces very little insulin, or none at all.

In Type 1 Diabetes the Beta cells (in the pancreas), normally responsible for making and secreting insulin, die as a result of the body's immune system attacking them. With no cells are available to make the insulin, the affected person cannot use the glucose in the food that he or she eats, and the glucose levels in the blood rise. Should this happen, the there is a very high risk of death if the affected person is not quickly given supplemental insulin.

The incidence of Type 1 Diabetes has probably been underestimated in the past, and may represent 10% or more of people with diabetes. It usually starts in young people under the age of 30, including very young children and infants, and the onset is sudden and dramatic. Treatment of Type 1 Diabetes requires daily injections of insulin to survive, with insulin dosages carefully balanced with food intake and exercise programmes.

Type 2 Diabetes

Type 2 Diabetes (previously known as Non-Insulin Dependent Diabetes, Adult Onset Diabetes, Maturity Onset Diabetes, and others) is caused when insulin produced by the pancreas is either not enough or does not work properly.

In Type 2 Diabetes the beta cells in the pancreas are present, but, although insulin is produced, the amount of insulin available is less than the individual requires. Furthermore, in someone with Type 2 Diabetes, the insulin itself doesn't work as well as it should when it gets to the cell – a state called Insulin Resistance.

Approximately 85 - 90% of all people with diabetes are Type 2, and many people who have this condition are undiagnosed. Type 2 Diabetes occurs most commonly in people over age forty who are overweight, do not exercise and may have high blood pressure (hypertension) and high cholesterol.

Type 2 Diabetes may be treated successfully without medication, and often loss of weight alone will reduce glucose levels. Treatment may include improving diet, exercise, and pills, but sometimes supplemental insulin is also necessary.

Although Type 2 is, in itself, not life threatening, in many ways it is more dangerous than Type 1. The onset of Type 2 is gradual and hard to detect, and high blood glucose levels over a long period of time can cause serious damage to the delicate parts of the body and lead to blindness, heart attack/stroke, kidney failure, impotence and amputation.

Managing your health with Diabetes

Food

Food is important in keeping your body healthy – whether you have diabetes or not – however most people don't pay much attention to their basic nutritional needs.

In general, when choosing food you should limit your fat intake, and include a food from each of the food groups at each meal. If you are overweight, eat smaller portions, reduce your intake of fat, and limit the amount of alcohol you drink.

If you are diabetic, you should follow a nutritionally sound diet to realise three important benefits:

• Achieve and maintain good control of your blood glucose levels
• Regulate body weight
• Prevent or delay the potential long-term complications of diabetes

You should also consider visiting a dietician to work out a diet plan suitable to your own particular lifestyle.

Exercise

Regular exercise helps your body lower blood glucose levels, promotes weight loss, and reduces stress.

Always check with your doctor before starting any exercise routine, especially if you have led an inactive lifestyle, and stop exercising if you feel any pain or feel tired. In particular, you should discuss how to adjust your insulin and diet or food intake to prevent low blood glucose levels while exercising with your doctor.

Treating Type 1 Diabetes

The aim of diabetic treatment is to maintain your blood glucose levels within the normal range, which is 4 – 6 mmol/l. This may include healthy eating, exercise and insulin injections.

Good management of Type 1 Diabetes entails regular blood glucose monitoring: regularly testing your blood glucose levels and adjusting your treatment accordingly.

Treating Type 2 Diabetes

The three main categories of treatment for Type 2 Diabetes are diet, exercise and medication. In Type 2 Diabetes, diet and exercise alone are often all that is necessary to bring blood glucose down to manageable levels.

Sometimes oral medication is necessary. Oral medication, also known as hypoglycemic agents, help the body metabolise the glucose obtained from food. These drugs are not insulin, but they do stimulate insulin-producing cells to secrete more insulin, and they help overcome insulin resistance. The most important thing to remember is that tablets are used only as an addition to diet and exercise, never in place of them. Diet and exercise remain the mainstay of treatment.

Controlling blood pressure and blood cholesterol levels are also important components of treatment, and Type 2 Diabetics may eventually require supplementary insulin injections as well.

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Blood testing and monitoring

Blood Glucose

It is important to know how your insulin doses and treatment plan are affecting your blood glucose levels so that you can adjust your plan when necessary.

It is possible to keep a very close track of your blood glucose levels by testing and monitoring your blood yourself. You can purchase a meter from your local pharmacy or healthcare provider. Checking blood glucose requires obtaining a small drop of blood to place on a blood glucose strip. Talk to your diabetes educator, doctor or pharmacist about the various methods available and which one is right for you.

In South Africa, blood glucose levels are measured in millimols per litre. Good management entails regular blood glucose monitoring - that is, testing your blood glucose levels and adjusting your treatment accordingly. The normal range in people who do not have diabetes is considered to be between 4 and 6mmol/l. You are considered to be diabetic if your fasting blood glucose (blood test done before you have eaten breakfast) is over 7mmol/l or is over 11mmol/l at any other time.

Your doctor will advise you what levels to aim for, but it is generally accepted that keeping the glucose levels between 4 and 8 mmol/l will greatly reduce the risk of diabetic complications.

HBA1c

Haemoglobin binds and transports oxygen in the red blood cells, and, depending on how high or low the blood glucose level is, more or less glucose is bound to its hemoglobin during the blood cell's life span.

HbA1c is a measure of the percent of the haemoglobin in the red blood cells that has glucose bound to it, providing an average measurement of the blood glucose levels during the last 2-3 months. If HbA1c is monitored at regular intervals, this will provide a good summary of how good your diabetic control has been during that time.

HbA1c should be checked regularly every three to six months in all people with diabetes, with elevated HbA1C levels providing early warning of potential future complications. If this occurs, your doctor should recommend treatment measures appropriate to your situation to achieve better control, and then monitor your HbA1C levels more frequently (e.g. monthly) until better control is achieved.

Studies have shown that by maintaining controlled blood glucose levels it is possible to delay or even prevent the potential long-term complications of diabetes.

It is generally accepted that you should maintain HbA1C below 8%. The following guidelines are suggested by the South African Diabetes Association:

• 4 – 6% Non-diabetic range
• ‹ 7% Well-controlled diabetic
• 7% – 8% Acceptable diabetic control
• › 8% Poor diabetic control, needs attention

Hypoglycaemia Or Low Blood Sugar

This condition only occurs in people treating their diabetes with medication.

Hypoglycaemia is a condition in which blood glucose levels drop too low (generally below 3.5mmol/l). Symptoms include irritability, numbness in the arms and hands, sweating, confusion, extreme hunger, shakiness or dizziness. It should be treated immediately by eating or drinking a simple sugar such as a glucose sweet, or sugary cold drink followed by a sandwich or other form of carbohydrate. If left untreated, this condition can become severe and lead to unconsciousness.

Hyperglycaemia or High Blood Glucose

High blood glucose can result when food, activity and insulin or other medication are not balanced. High blood glucose may happen when you are ill, pregnant or under stress. Symptoms include thirst and\or dry mouth, glucose in the urine, large urine volumes and urinating more often, weakness and lethargy, blurred vision, and weight loss. Top

Long term complications

Living with blood glucose that stays over 8mmol/l for a long period of time can cause serious damage to the delicate parts of your body. High blood glucose for a long time damages the large and small blood vessels and fine nerve endings. If unchecked, this can cause problems that can lead to blindness, kidney failure, heart attacks, strokes and amputations.

It can be very frightening to think about this, but the good news is that, with early detection and good care, advances in medical treatment make it perfectly possible for you to stay healthy.

Long-term health issues with diabetes and how to manage them

Eye damage (retinopathy)	You should have your eyes checked by an ophthalmologist every year
Kidney damage (nephropathy)	Kidney damage can be detected by testing the urine for protein (microalbuminurea or MAU). All people with diabetes should have this test done every year
Vascular damage	Make sure that you test your blood pressure regularly and that you do some form of exercise.
Nerve damage (neuropathy)	Nerve damage leads to loss of sensation in the feet, and they become particularly vulnerable to wounds and infection, often leading to amputation. Take care of your feet by washing your feet daily, keeping the skin soft, wearing comfortable supportive shoes and not walking barefoot, and let your doctor examine your feet at each visit. Take any wounds, cuts and sores to your doctor and see a podiatrist every six months if possible.
Sexual dysfunction	Nerve damage can also affect sexual health, causing impotence or failure to have an erection in men and inability to achieve orgasm in women.
Infections	Infections, itchiness, sores, boils etc. are common as high blood glucose inhibits the action of the white blood cells, the body's main germ fighters.

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