Group 9: The Pancreas and Diabetes
E-facilitator: Sophie

Learning outcomes:
Discuss the hormonal imbalance that causes diabetes.
Present a poster on an analysis of the prevalence of diabetes in our indigenous communities.


DIABETES


What is it?
Diabetes mellitus is a condition where the body cannot maintain normal blood glucose levels.
- This is caused by the bodies resistance to, or deficient production of the hormone insulin (which move from the blood into the cells)
- if the body does not produce or use enough insulin then the cells cannot use glucose and blood glucose levels rise
- hence this will result in the body resorting to breakdown its own fat and muscle to produce energy
- this could potentially result in either of the following, damage to heart, blood vessels, eyes, nerves and kidneys


Diabetes is a chronic condition marked by high blood glucose (sugar) levels. Our bodies rely on blood glucose for energy.

Blood glucose levels are normally regulated by a hormaone called insulin, which is made by the pancreas. Insulin stimulates the body's cells to use glucose as energy. When a person has diabetes, the pancreas doesn't make enough insulin, or the cells don't respond to the hormone.

Symptoms of High Blood Glucose
When there are high levels of glucose in the blood, the body loses its main source of energy, even though the blood contains large amounts of glucose. The buil-up of glucose in the blood can cause distressing symptoms and actual harm to the body's cells. Symptoms include:
  • Excessive desire to drink
  • Frequent passage of urine
  • Increased fatigue or lethargy
  • Severe irritation and itching
  • Excessive hunger
  • Blurred vision
  • Weight loss
  • Increased risk of Infections

Different types
Type1 (insulin dependant) –
this is when someone has a complete deficiency of insulin. This form requires insulin therapy to control their blood glucose levels which is given by injection.
Causes- diet, environment and genetics
Symptoms - sudden onset, normally age under 20 yr, symptoms at diagnosis, autoimmune mediated, no Beta cell function, no insulin production, insulin therapy required, normally no family history, not usually overweight
  • Is caused by an autoimmune destruction of insulin-making cells in the pancreas, which maens insulin is no longer made.
  • Is one of the most common childhood diseases in developed nations.
  • Can occur at any age.

Type 2 (non-insulin dependant)- When the patient has a reduced production of insulin or the body is unable to produce insulin for the body properly.
Causes – genetics, environment, increasing age, excess weight, physical inactivity, poor diet and nutrition, impaired glucose tolerance
Treatment – weight loss, dietary changes, lifestyle changes, quit smoking etc (initially) then later given tablets or injections
Symptoms - gradual onset, normally age over 35 yr, often no symptoms, erratic Beta cell function, insulin normal or raised, oral drugs may be used, family history common, usually overweight
  • Caused by either inadequate levels of insulin or insulin that doesn't work effectively ion the body.
  • Most common after the age of 40.
  • Most likely associated with obesity, particularly around the abdomen or upper body.
  • Responsible for 85 to 90 per cent of all diabetes in developed countries.

Untreated diabetes can cause long term damage
It untreated, high blood glucose levels can be life threatening. The damage to the body's cells can cause:
  • Kidney damage
  • Eye damage
  • Nerve damage to feet and other parts of the body
  • Heart disease and circulation problems in the legs
  • Stroke
  • Impotence


Prevalence
- Over 140, 000 people have type one diabetes, which represents 10-15% of the total population with diabetes
- Each day five more people are diagnosed with type one diabetes
- Type 1 diabetes is one of the most common chronic diseases of childhood. It is more common than cancer, cystic fibrosis, MS, rheumatoid arthritis and muscular dystrophy

Mortality
- is the 6th highest cause of death in Australia
- Risk of death among people with diabetes is 2 times higher compared to people without the disease. However, the increased risk is greater in younger people.
- Diabetes reduces life expectancy on average by up to 15 years

Complications
- The majority of people who have had type 1 diabetes for 20 years will develop health complications as a result of the disease
- People with type 1 diabetes are at substantially higher risk for serious complications than those with type 2 diabetes.
- People with diabetes are 5 times as likely to have heart disease and they develop it at a younger age
- Overall, 75% of people who suffer from diabetes will die of heart disease and/or stroke
- The risk for stroke is 2 to 4 times higher among people with diabetes
- Women with type 1 diabetes have 10 times the rates of cardiovascular complications than women without diabetes
- Diabetes is the leading cause of new cases of blindness among adults 20 to 74 years old. Among people with type 1 diabetes, 24% will develop retinopathy after 5 years, almost 60% after 10 years and 100% after 20 years
- Diabetes is the leading cause of kidney failure in Australia and people with type 1 diabetes are 4 times more likely to have kidney disease than people without diabetes
- Over 40% of people with type 1 diabetes develop severe kidney disease by age 50
- About 60-70% of people with diabetes have mild to severe forms of nerve damage, leading to loss of sensation in hands and feet, leg ulcers and impaired function of organs such as the heart, eye, stomach, bladder and penis
- People with diabetes are 15 to 40 times more likely to require a lower-limb amputation compared to the general population. Diabetes is the most frequent cause of amputation not the result of an accident
- 30% of men with diabetes suffer from impotence
- Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5-10% of pregnancies and spontaneous abortions in 15-20% of pregnancies
- Periodontal disease occurs with greater frequency and severity in people with type 1 diabetes, found in 30% of people over 19 yrs

Diabetes among the Indigenous community
Table 1: Diabetes - proportions of people reporting diabetes/high sugar levels as a 'long-term health condition', by Indigenous status, and Indigenous:non-Indigenous ratios, Australia, 2004-2005
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Age group (years)
Indigenous people
Non-Indigenous people
Ratio
15-24
1.0
0.5
2.0
25-34
4.3
0.6
7.2
35-44
10.0
2.0
5.0
45-54
20.7
4.0
5.2
55+
32.1
11.6
2.8

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Source: Australian Bureau of Statistics, 2006 [4].
Note: Ratio is the Indigenous proportion divided by the non-Indigenous proportion.
Diabetes is also a major contributor to Indigenous mortality, being responsible for more than 8% of deaths of Indigenous people living in Qld, WA, SA and the NT in 1999-2003 [15]. The numbers of deaths from ‘endocrine, nutritional and metabolic diseases’ (almost 90% of which were due to diabetes) were 7.5 times higher for Indigenous males than the number expected from rates for non-Indigenous males and 10.5 time higher than expected for Indigenous females. Among people aged 35-54 years, the death rate of Indigenous males was 21 times the rate of non-Indigenous males and the rate of Indigenous females 37 times that of non-Indigenous females.


Diabetes is a very serious problem for many Australians, but it is particularly so for Indigenous people as shown by the graph below

Table.gif
PERCENTAGE OF PERSONS REPORTING DIABETES – 2001
Source: National Health Survey: Aboriginal and Torres Strait Islander Results, 2001


Factors that contribute to Diabetes among the Indigenous population

- It has been suggested that high levels of central obesity, (which is particularly common among Indigenous people) may be linked to the 'thrifty genotype', and/or other genetic factors
- the increased consumption of snack foods, fruit-flavoured-juices, sugar-sweetened sodas, white bread, sugar, and canned meats in some Indigenous communities has been linked with the incidence of high blood pressure


- According to information collected in the 2001 National Health Survey, the percentage of Indigenous people taking no exercise was much greater than the percentage of non-Indigenous people – 43% compared with 30%

- Like most conditions affecting Indigenous people, diabetes is linked to socioeconomic status – the greater the environmental, social and economic disadvantage experienced by Indigenous people, lack of availability of transport, inability to speak english, the greater the levels of type 2 diabetes, associated complications, and other chronic conditions in the population


Diabetes-related complications among Indigenous Australians

- renal disease
- stroke
- retinopathy
- heart disease
- infections
- cerebrovascular disease
- neuropathy
- Diabetes is recognised as the main cause of legal blindness in the developed world
- In the Northern Territory in 1994, approximately 28% of Indigenous people with diabetes had some degree of retinopathy, which was vision-threatening in 13% of cases
- In terms of heart disease, it has been reported that at least 19% of diabetic patients are admitted to hospital as a result of cardiovascular complications
- Diabetics are also more susceptible to infections (particularly bacterial) than are non-diabetics
- A study of the hospitalisation of Indigenous diabetics in central Australia in the mid 1980s found that infection was the primary reason for admission in 60% of cases, which comprised 4.6% of all Indigenous admissions. Almost 21% of deaths of Indigenous diabetics in Australia in 1995 were attributed to infection. Based on health service records , it has been reported that bacterial infections are the second most common cause of death of Indigenous diabetics (after renal disease).


Management of diabetes

  • weight loss – which can reduce the need for medications (oral hypoglycaemics or insulin), reduce blood pressure in obese hypertensive subjects, and improve hyperlipidaemia;
  • dietary changes – mainly involving reduction in carbohydrate intake and increased mono-unsaturated fat and fibre intakes. Reducing meal size but increasing frequency can also improve glycaemic control;
  • increased physical activity – exercise can improve glycaemic control, hypertension and total serum cholesterol levels; and
  • medications – oral hypoglycaemic agents can help 'postpone' the complications of diabetes, but their role in glycaemic control deteriorates with time. Insulin therapy may be needed to achieve optimal glycaemic control

Hormonal imbalance

There is often hormonal imbalance in diabetes. Diabetes results in lack or excess of the hormone insulin in the bloodstream, excess of the hormone cortisol in the bloodstream, and other imbalances of catabolic hormones (breakdown tissues more then normal). The anabolic hormones (growth stimulating) that balance catabolic hormones are usually depleted by excess cortisol and important pathways for anabolic hormones are often not available when insulin is in excess. Thus, diabetes leads to dominant catabolic hormones and inhibited anabolic hormones in the bloodstream. This is great strain to the body.
Hormones run your body and imbalance in them will create negative influences. Therefore creating hormonal balance will aid in optimizing hormonal transport, proper physiology, manufacture of hormones, and many other effects that help run your body properly. One method used by modern science to create hormonal balance is called hormonal replacement therapy, replacing hormones to the lowest, optimal, youthful levels.
The newest ideas of hormonal replacement are to replace hormones in combinations that support and balance each other. For decades, replacing single hormones by themselves has often been the method used. However, when you change one hormone, others are affected. For decades, this idea of multi-effects on other hormones, from single hormone replacement, has not been well understood by the modern medical establishment. In other words, changing levels of one hormone leads to effects on other hormones, which can lead to imbalances. So the newest ideas are to replace hormones in combinations to maintain balance.
You need the latest ideas to benefit from the advances of endocrinology. We recommend the doctors from the American Academy of Anti-Aging Medicine, called A-4 doctors. They are cutting edge on hormonal sciences and are tested in order to become A-4 certified. The national number is 773-528-4333.
The idea is the important controlling hormones, mainly DHEA, (a steroid and sex hormone precursor) melatonin, growth hormone, testosterone in men and estrogen in women, cortisol, and thyroid are all re-balanced in combination with each other and with any other hormones that are replaced. If you let an A-4 doctor or other hormonal doctor, familiar with balancing hormones in combination, restore all of these hormones to balance, then you will begin to counterbalance the great hormonal imbalance of diabetes.
However, when you replace hormones one at a time, this may imbalance your other hormones, leading to grave problems. Therefore find a hormonal specialist that understands the value of balancing all of the controlling hormones in combination. Balancing the master, controlling hormones can counterbalance the negative hormonal effects from diabetes. This will aid diabetics.
In conclusion, one great problem of diabetes is hormonal imbalance. One method to restore hormonal balance is to balance the controlling hormones in the body. The method of replacing hormones should be in combinations of all the controlling hormones. Replacing hormones one at a time may lead to further imbalance, thus use only hormone specialists that understand the value of balancing all of the master, controlling hormones.

Quick Diabetes Facts:
  • In 1990, approximately 350,000 Australians had "diagnosed" diabetes and an estimated 300,000 Australians had "undiagnosed" diabetes, together representing 3.8% of the total population.
  • Diabetes is likely to affect 900,000 Australians by 2000 and 1.15 million Australians by 2010.
  • Juvenile diabetes (Type 1) or insulin dependent diabetes, which usually affects young people, ranks as one of the most common serious childhood diseases in Australia.
  • Diabetes is likely to have a higher incidence in children less than 20 years of age than cancer, cystic fibrosis, multiple sclerosis, juvenile rheumatoid arthritis and muscular dystrophy
  • Australian Aborigines suffer the 4th highest rates of Type 2 Diabetes in the world.
  • Risk factors for Type 2 diabetes such as obesity and physical inactivity are increasing in Australia.
  • Australian Aborigines and Torres Strait Islanders suffer exceptionally high rates of diabetic nerve damage, blindness and infection.
  • Australians with diabetes experience a reduced life-span and higher rates of eye, heart and kidney disease and stroke compared non-diabetic Australians.
  • The total cost of diabetes likely exceeds $ 1 billion annually (or about $2,800 per diagnosed case).
  • Cost effective strategies to prevent Type 2 Diabetes and reduce diabetic complications have been developed but are not in place in Australia.
    (Rise and Rise of Diabetes in Australia, 1996)