CLINICAL SERVICES
Diabetes
Type 2 Diabetes accounts for 90% of all cases of diabetes. It is a disorder of metabolism, and its primary characteristic is an elevated blood sugar level. This is caused by a relative lack of insulin together with insulin resistance where insulin does not work well in the body tissues. It occurs more commonly with older age, increasing body weight and where there is a family history. As symptoms are not always present, some people may have had the condition for many years before being diagnosed, and may even have complications at the time of diagnosis.
Type 1 Diabetes is an autoimmune disorder in which the immune system attacks the insulin producing beta cells in the pancreas. Lack of the hormone insulin then leads to high blood glucose levels and other associated effects. Type 1 diabetes often occurs for the first time in younger people but can occur at any time of life. Treatment with insulin is always required.
Gestational Diabetes is a form of high blood sugar which occurs for the first time in pregnancy. Excellent blood sugar control is essential to ensure the healthy development and growth of the baby and to improve pregnancy outcomes for mother and baby.
DIABETES IS THE MOST COMMON OF ALL ENDOCRINE DISORDERS AND AN INCREASING GLOBAL PUBLIC HEALTH PROBLEM
The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014 (source: World Health Organisation). The estimated figure for 2019 is 9.3%, predicted to rise to approximately 11% by 2045 (source: International Diabetes Federation).
1 in 2 people with diabetes are undiagnosed (source: International Diabetes Federation).
The greatest number of people with diabetes are aged between 40 and 59 years.
Diabetes prevalence has been rising more rapidly in middle and low income countries, such as South Africa.
Diabetes is a major preventable cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. It also reduces life expectancy.
Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
People with type 1 diabetes are likely to have early symptoms that come on suddenly. These include:
- Increased thirst
- Increased urination
- Weight loss
- Blurred vision
- Tiredness
Type 2 diabetes may occur without any symptoms, or symptoms may develop gradually. These include:
- Tiredness
- Increased urination
- Increased thirst
- Weight loss may or may not occur
- Frequent yeast infections (such as thrush)
- Slow healing of wounds or sores
- Blurred vision
Dr Ogilvie uses a multifaceted and multidisciplinary approach to diabetes, as promoted by the Centre for Diabetes & Endocrinology in Houghton, Johannesburg.
Every person is unique and therefore each individual’s care needs to be personalised to match their individual needs.
While the input of doctors and other health care professionals is important, individuals with diabetes make choices and decisions on a daily basis in dealing with their condition. Diabetes education is therefore vital in empowering patients with the knowledge, skills and confidence to manage their own care.
Individuals with diabetes need to be supported by a team of professionals to provide diagnosis, counselling, coaching, education, treatment, support and motivation. In addition to the doctor, input from a diabetes educator, dietician, podiatrist, ophthalmologist, pharmacist, biokineticist and psychologist (amongst others), is needed at different times to optimise care and quality of life.
It is not the doctor who is in charge of this team – it is the person with diabetes and where appropriate, their family.
Best practice requires that diabetes is ‘Treated to Target.’ Ideally every person with diabetes and all members of their support team will know their targets for:
- HbA1c (glycated haemoglobin)
- Blood glucose
- Cholesterol and other lipids
- Blood pressure
- Weight
These parameters need to be measured regularly and the care programme adjusted in order to achieve ongoing targets. Additionally, kidney function, growth (in children), and eyes and feet need to be checked.
- Regular activity and exercise
- Healthy and sustainable eating
- The right medication at the right dose at the right time