With so many Australians living with, or at risk of, diabetes, it’s no wonder it’s dubbed the ‘silent pandemic’. Part of the problem is that type 2 diabetes tends to fly under the radar: Many people with type 2 don’t have any symptoms when they’re diagnosed. And since nothing seems to be wrong, they underestimate the condition. So what exactly is it?
Type 2 diabetes is a chronic condition that affects the way the body processes blood sugar (glucose). Your pancreas makes a hormone called insulin, which helps the glucose get into the body’s cells. If you don’t make enough insulin, or your body doesn’t respond as well to the insulin it does produce, you can’t move sugar from the blood into the cells. But, while you may not see it or feel it developing, type 2 can still do damage. “From start to finish, the process of developing [type 2] diabetes might take 20 years or more,” explains Dr Sultan Linjawi, an endocrinologist who specialises in diabetes. “If you look at when people are diagnosed and you average it out, by the time most people are diagnosed, 50 per cent of their insulin production capacity is already gone.” That’s why early detection and intervention is crucial – the more capacity for processing blood sugar you can retain, the better chance you have of keeping type 2 in check. There’s also a cluster of worrying conditions that tends to go hand in hand with type 2 diabetes as it develops, such as high blood pressure and cholesterol, obesity and sleep apnoea. “The rate of heart attacks for people with diabetes and borderline diabetes is almost the same,” Dr Linjawi points out. But the good news is that once diabetes is diagnosed, its associated health risks can all be managed.
A quick Google search of type 2 diabetes will show that symptoms can include blurred vision, excessive thirst and nasty skin infections such as foot ulcers. But these are severe, late-stage signs. “When someone has those symptoms, their blood sugar levels are profoundly abnormal,” says Dr Linjawi. Other signs are far more subtle and easy to write off, or can be attributed to other causes. Here are some to watch out for.
SYMPTOM #1 Ongoing Fatigue
Many people feel normal when they’re diagnosed with type 2 or prediabetes. But, says Dr Linjawi, they probably don’t recognise that their quality of life has taken a dive. “It’s quite interesting when I see a person who’s newly diagnosed and their blood sugar is high, and then you get their blood sugar down and they come back and say, ‘I feel so much better.’ They just didn’t realise – it’s like carrying 20 kilos on your back and when you take it off , you think, ‘Oh, that’s better.’” The reason behind the lethargy? When blood sugar can’t get to cells, cells can’t use it for energy. Instead, it winds up in the urine and, despite your kidneys’ best attempt to retain important nutrients such as sugar, plenty escapes through this route, leading to mild dehydration. “When sugar goes into your urine, you produce more urine, so water goes out,” says Dr Linjawi. “It’s like having a low grade hangover. It’s a similar situation: You drink a bit too much, so you pee a bit more and you get dehydrated. You don’t feel great, but you can still function.” While a powerful thirst and frequent urination are classic late stage symptoms of type 2 diabetes, the early signs of this process – often low-level fatigue – can be easy to blame on anything from a high workload to low iron to a crazy-busy family schedule. the early signs of this process – often low-level fatigue on anything from a high workload to low iron to a crazy-busy family schedule.
SYMPTOM #2 Hard of hearing
If you ﬁnd yourself cranking up the volume on the TV, or you can’t get through a conversation without asking people to repeat themselves, book in a blood sugar test. One US study suggests hearing loss could be an early diabetes symptom: people with higher than-normal blood sugar who didn’t yet meet the criteria for diabetes were 30 per cent more likely to have hearing damage than those with healthy blood glucose levels. It’s thought that diabetes can lead to hearing loss because it can damage the nerves and blood vessels of the inner ear.
SYMPTOM #3 Infections that won't quit
High glucose levels can interfere with the immune system’s ability to battle infections, delaying the healing process. Colds and flu drag on, wounds are slow to heal and women may experience recurrent vaginal infections. “People will say they have little wounds or scratches on their legs and it just takes longer to heal,” says Dr Linjawi. “The reason is because, if your blood sugar is above 10, it impairs the healing process. It might be that, as a woman, you get thrush a little more often and you don’t think anything about it. It could be that you’re more likely to get urinary infections. Sugar fuels the bacteria to grow, so that could be in your lungs and then your lungs end up with pneumonia, or it could be your bladder and you end up with a urinary infection.”
SYMPTOM #4 Night-time woes
“About half of people with type 2 diabetes have sleep- disordered breathing,” says endocrinologist Dr Osama Hamdy. So, if you’re diagnosed with the condition – characterised by loud snoring and daytime sleepiness – it’s a good idea to get your blood glucose levels checked, too. A recent Canadian study showed that 23 per cent of patients diagnosed with mild sleep apnoea went on to develop diabetes within five years. The connection isn’t completely understood, but there’s one important link between the two: Patients with sleep disordered breathing tend to release stress hormones during sleep, which can raise blood sugar levels.
SYMPTOM #5 Creeping weight gain
Being overweight is a major risk factor for developing type 2, and it’s a process that tends to creep up over time, says Dr Linjawi. “It might be that you’re in your 20s and you put on a bit of weight and you feel fine, but while that’s going on, it’s changing the way your body handles sugar through a process called insulin resistance,” he explains. “So, you go from being normal to putting on a little bit of weight, to becoming a bit insulin resistant, putting on a bit more weight and becoming more insulin resistant. Eventually, you’re not making enough insulin to get the sugar out of your blood.” Dropping just five per cent of your body weight can dramatically improve insulin sensitivity, he adds. “It doesn’t mean you have to lose 30 kilos in a week, it just means you have to start progressing from where you are to where you need to be.” The best insulin-sensitising weight-loss plan keeps your blood sugar low and steady. In a study, researchers put 52 insulin-resistant women and men on one of three healthy lifestyle plans for six months (one group got advice, another got lifestyle counselling and the third got a healthy diet). The experts found that only the healthy diet group improved insulin sensitivity – by a whopping 50 per cent.
Fast Fact: Taking a 15-minute walk after a meal can help regulate your blood sugar levels and reduce your risk of diabetes. So, instead of curling up on the couch after dinner, step outside!
It’s important to be proactive around testing, especially if you have a family history of diabetes or you’re over the age of 55. “If you’re younger and overweight, you should have a test, particularly if you carry extra weight around your stomach,” advises Dr Linjawi. The type of test is key, too. According to Dr Linjawi, many cases are missed because people have only had a random blood test rather than the gold-standard glucose tolerance test. “Some people have issues where their blood sugars are high when they wake up, known as fasting blood sugar levels,” he explains. “And there are other people whose blood sugar jumps up dramatically after they eat. If you’re just doing a random blood test, or even a fasting blood sugar test, unless you’ve done it after you’ve eaten a meal, you’re missing the 60–70 per cent of people who have high post-meal blood sugar levels.”
The glucose tolerance test involves having a blood test in the morning before food (a fasting blood test). You’ll then have a sugary drink and another blood test two hours later. If you’re diagnosed with diabetes, doctors can start you on a treatment plan right away. And if you’re told you have prediabetes, think of it as good news: this is your opportunity to wind back the disease with healthy lifestyle changes, such as diet and exercise. It’s all about managing risk, says Dr Linjawi, who adds that it’s crucial to keep on top of prediabetes with yearly check-ups. “Just because you don’t feel it, it doesn’t mean it’s not serious.”