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How GP Can Help Manage Diabetes

June 24, 2017

 

Diabetes is increasing in prevalence among the Australian population, especially as people get older.  One of the contributing factors is that people are consuming more and more processed foods containing sugar.  This is a problem because people develop a subtle addiction for eating sugar.  Sugar creates an increased spike of insulin from the pancreas.  When sugar is absorbed into the bloodstream it creates an insulin spike and the insulin carries glucose into the cell, away from the bloodstream, which registers in the brain as low sugar and people become hungry again and want to eat more sugar.

 

Diabetes In Australia

When you compare Australian culture to a number of Asian societies, namely the Chinese, Vietnamese and Japanese.  We find that our diet contains elevated levels of sugar and salt in the processed food that we consume.  In contrast people in these Asian cultures eat very small amounts of processed foods.  Unfortunately, the general public is not educated as to the ills of processed food.  If you can keep processed food to a minimum, even if this means consuming more fats, then this will mean that you reduce your chances of getting diabetes.  For example, in Chinese culture they vary rarely have dessert after dinner.  This is purely a western pastime that ultimately increases our chances of developing diabetes.

 

Another major behavioural change for Australians is our inability to exercise after we leave school when formalised participation in sports stops.  People get too overwhelmed by their work-life and don’t have enough time to go to the gym.   Again, if you look at these Asian societies, people into their 70s, 80s and 90s are still exercising, often in a social context.  It is not uncommon for people to sleep for 8 hours, travel to work sitting down, work sitting down and then come home, watch TV sitting down.  There is very little physical exercise throughout the day.   Even the way that most people choose to socialise is very sedentary.  For example, going out for dinner, watching movies, or going to bar for a drink with friends.

 

Consequences of Diabetes

  • Vision impairment.  Diabetic retinopathy, which can lead to blindness.  All diabetics need to have an annual vison screening.
  • Cardiovascular disease.  People with diabetes are more prone to suffering heart attacks.  They get clogged arteries around their heart and require an operation to put in a stent or even a bypass surgery.
  • Kidney disease.  Leads to people feeling tired and developing exercise intolerance.
  • Peripheral vascular disease – they run the risk of occluding the blood supply to the small vessels in their toes.  This is a problem because it could lead to gangrene and needing to amputate their toes.
  • Irritability.  People with diabetes become more irritable.
  • High blood pressure.
  • Un-healing leg ulcers.  Venus leg ulcers
  • Anemia in type 2 diabetes.  Almost all patients with anemia have low B12 and ferritin levels or they are taking the drug metformin.  The risk of anemia is related to the duration of diabetes.  The longer a person has diabetes the greater their risk of developing anemia.

 

How GP Will Help You To Manage Your Diabetes

Your GP will order a series of blood tests to diagnose you with diabetes.  For example, they may order the H-bA1c Blood Test, Glucose Level in Blood Test and Urine Test – ACR.  Within the week you will know whether you have diabetes and will be sent to the dietitian to review your diet in the first instance.  You will be given a Enhanced Primary Care (EPC) Plan, which will allow Medicare to subsidise your trip to the dietitian.  In most good medical centres GPs will work alongside dieticians.  This is definitely the case at Ubuntu Medical.   If diet changes don’t help to control or treat your diabetes then the GP will typically put you on the drug metformin which helps to stimulate the pancreas to produce more insulin to lower the blood sugar level.  Your GP will review you monthly until diabetes can be stabilised.

What we are finding more and more is that people’s diet choices are more emotional than rational.  Your dietician or diabetes educator will ask you about your relationship to food and why you get what you eat.  People are increasingly choosing to comfort on sugars and sweets as a way of processing complicated emotions.  Sometimes the GP may even feel it is necessary for the person to speak with a psychologist about their relationship to food and diet choices.

 

Solutions to Treat and Manage Diabetes

  • Eating good fats.  For example, olive oil, coconut oil and ghee
  • Including more fibre into your diet (for example, vegetables)
  • Moderate intake of protein.  For example, nuts, seeds, eggs, chicken and fish.  Approx 100g of protein every day.
  • Exercise – depending on the age of the person.  Aerobic exercise for people in their 30s and 40s.  Exercising with a friend is recommended.  For people in their 50s and 60s it is recommended that they do less strenuous exercise, including golf and walking.  Follow the example of our Asian counterparts.
  • Attend a diabetes educator.  For example, dietician.
  • Take potassium chloride Iron phosphate (PCIP) with meals.  To enhance digestion and mucus membranes in their stomach.  Improves digestion by supporting the pancreas, which is problematic in diabetes.
  • Eat regularly (3 meals a day and 2 snacks).  Recognising that the body needs a variety of foods including essential fats, proteins and carbs.
  • Drink at least 8 titres of water per day

 

Dr Kathy O’Sullivan