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Diabetes: An Introduction by Ann Morris & Jodie Fleming

Welcome to our introductory article on Diabetes Mellitus. We are lucky to be joined by Diabetes Educator, Ann Morris, for a series of educational and informative articles about living with diabetes. Ann and I formed a successful partnership at St John of God Healthcare around seven years ago. I'm happy to say that Ann is a wholistic pracititioner who works from a biopsychosocial perspective, referring people regularly to mental health practitioners like myself, to assist her patients who maybe experiencing complications such as diabetes burnout, depression and anxiety. I'm proud to collaborate with her in practice, and also on these articles. We hope you find them useful.

Diabetes Mellitus is a chronic condition caused by a complete (as in Type 1 diabetes) or relative lack of insulin (as in Type 2). This causes high blood glucose (sugar) levels and requires management using a combination of healthy eating, regular exercise and weight loss (if required). Not everyone diagnosed with diabetes needs to lose weight but awareness of the importance of a healthy lifestyle and any changes needed, will help to manage this condition and reduce other risk factors such as heart disease while improving long-term health.

In healthy people, glucose is taken up efficiently by body cells. When we eat, carbohydrates from food are broken down into glucose. Once the digestive system releases it into the bloodstream, the glucose is available to all of the body's cells. Glucose is the main source of energy, so when glucose levels drop below normal, our ability to function mentally becomes impaired - you might feel spaced out and lose your ability to concentrate.

Excess glucose is stored in the liver as glycogen and also in the muscles for later use. The pancreas secretes a hormone called insulin whenever a surge of glucose hits the bloodstream. Insulin helps the body's cells to take up the glucose where it's used for immediate energy. Insulin also helps with the conversion of glucose into glycogen for future use. These actions lower blood glucose levels.

Classification or Types of diabetes includes the following:

Impaired Glucose Tolerance (otherwise known as Pre-Diabetes):
This may occur prior to the diagnosis of diabetes being made but may also be found in people whose blood glucose levels are higher than desired, but who never develop diabetes. Normal blood glucose levels are 3.5 to 7.8 mmol/L so if glucose levels exceed the upper level, impaired glucose tolerance is diagnosed.

Type 1 Diabetes:

T1 is an auto-immune condition caused by the body's immune system destroying the insulin producing cells in the pancreas. These are called Beta cells and this leads to a complete depletion of insulin.

Type 2 Diabetes:

T2 occurs when high blood glucose levels occur due to insulin resistance. This is often triggered by poor health i.e. a heart attack or stroke, steroid use, ongoing major stressors, depression, or poor lifestyle - including obesity, and lack of exercise.

Gestational Diabetes:

This type of diabetes occurs in pregnancy. At 26-28 weeks an Oral Glucose Tolerance Test is done on all women.

As diabetes is a chronic condition, it requires lifelong management. There are several lifestyle behaviours which are modifiable and assist in the management of diabetes. These include:
• healthy eating
• regular physical activity
• and, where required, medication. In Type 1 diabetes, insulin treatment is commenced at diagnosis.

The Diagnosis:

As well as the difficulty of receiving a diagnosis of diabetes mellitus for yourself or a loved one, people may also experience a degree of judgement and stigma around the diagnosis. Talking with a sensitive diabetes educator is going to help manage your feelings and start to provide informed choices for you and those close to you.

Denial, grief, shock and a degree of trauma are common and normal responses to receiving a diagnosis of a chronic condition and it is very important that education and support is made available as soon as possible to reduce the impact of the diagnosis and to assist with coping and managing the disease.

The diagnosis of diabetes can cause many feelings and responses depending on who in your family is diagnosed, the type of diabetes and past experiences with people you have known who developed diabetes. Often, Type 1 diabetes is diagnosed in young children and so their parents often experience the trauma and emotional responses as much, if not more than the child who still may not have a comprehension of the impact it could have on their lives.

Feelings following diagnosis may include but are not restricted to denial, grieving over the loss of your health or changes to your lifestyle, anger, frustration, a sense of failure, anxiety and fear. For anyone living with a chronic condition, risk of the development of depression and anxiety increases due to the chronicity of the illness.

Many people in the community believe that Type 2 diabetes is totally avoidable but in fact, while this type of diabetes is closely associated with lifestyle choices, a family history of diabetes is a contributing factor and increases your chances of developing diabetes.

Prompt referral to Diabetes Education services is essential in a timely manner to ensure active management is facilitated. Your doctor and diabetes educator will ensure that all of your physical and emotional needs are met by referring to appropriate external services including mental health services, if required.

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Ann trained at the Royal Melbourne Hospital and following her training worked at the Royal Children's Hospital in 1976 where her connection with Type 1 diabetes began. She has been in Diabetes Education since this time. Ann is a founding member of the Australian Diabetes Educators Association and an honorary life member. Ann was awarded the JDRF "Diabetes Educator of the Year for Impact and Relationships " in 2011, Diabetes Educator of the year, Victoria 2016 and Australian Diabetes Educator of the Year 2016. Ann is a Credentialed Diabetes who works in her own practice in Warrnambool and who describes herself as a psychologically sensitive practitioner, which she certainly is. You can contact Ann through her Facebook page AMCON Diabetes Management Services. 

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1 comment

  • Comment Link Rocky Tuesday, 18 July 2017 17:49 posted by Rocky

    This is such an important topic to address. Thank you both for doing so.

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