Have you ever been in that situation where you go along for a regular check-up and your doctor looks at the scales, does the calculation for your healthy weight range, looks you in the eye and says,"You are a few kilograms over your healthy weight range."
It is one of the more awkward conversations we as general practitioners need to have with our patients. To be frank, most patients who are overweight know they are. Many women come in and tell me that before we even get started. But when your doctor tells you that your weight is in the unhealthy or medically obese range, it can come as a shock.
Decades of health messages have cut through so I find that most people are aware of the link between obesity and diabetes. So why has diabetes become one of the most serious health problems for Australian and New Zealand women? The first and most obvious reason is the epidemic of overweight and obesity.
Weight gain can creep up on you. One of the most common reasons patients tell me that they don't look after their health is that they are "too busy". Maybe a new job means you have less time to exercise, or you get home too late so picking up a pizza is a convenient option. Perhaps you had a baby and those extra kilograms stayed with you. A bigger dress size becomes your "new normal".
There are several different types of diabetes. In broad terms, they are Type 1, Type 2 and gestational diabetes.
Type 1 diabetes is a failure of the pancreas to make enough insulin to keep blood sugar levels normal. This results in high blood sugar readings.
It is treated with insulin injections or an insulin pump, careful diet and regular exercise.
Gestational diabetes can occur in pregnancy. It is a result of pregnancy hormones making it more difficult for your body to use insulin. In late pregnancy the body needs double or triple the amount of insulin to keep blood sugar levels normal. If your body cannot keep up, gestational diabetes results. We test for this routinely in pregnant women. It is usually managed with careful attention to diet and physical activity.
A woman who has had gestational diabetes has a high chance of developing Type 2 diabetes later in life.
Type 2 diabetes is the most common type, about 85-90 per cent of cases. The main risk factors are being overweight/obese and physical inactivity.
Diabetes is the fastest growing chronic condition in New Zealand and Australia. Yet so many women already have diabetes without knowing it.
The advice I give to patients is to have regular blood glucose testing after the age of 40. Your GP will tell you how often – generally one every three years for lower risk and every year if you are at higher risk.
I know it is tempting to think there is some magic pill to "fix" Type 2 diabetes, but diet and exercise will continue to be the foundation for managing diabetes and it really does take discipline. Some people need oral medication or insulin.
The latest dietary "discovery" is the benefit of intermittent fasting. There are several variations like the 5:2 diet (restricting kilojoules two days a week) or skipping meals. You will need advice from your doctor and a dietitian if you want to try this. This is NOT suitable for people with Type 1 diabetes, or if you are on blood sugar-lowering medication or insulin.
The gut microbiome is another fascinating area of interest. The Diabetes Australia Research Trust is funding an important study at The University of Queensland to see if probiotics can help women with gestational diabetes.
You may have no early symptoms. However warning signs can be there: fatigue, increased thirst, more trips to the bathroom to pass urine, blurred vision and high blood pressure or other risk factors. If you are overweight, don't do much exercise and you are over 40, arrange to have the blood test with your GP.
If you want to prevent yourself from developing Type 2 diabetes, you need to make sure your lifestyle works for you in the long-term, particularly if you are already overweight or you have a close relative with Type 2 diabetes or other risk factors.
Prevention steps are simple. They involve losing some weight and keeping it off with a reduced kilojoule diet, and being physically active every day. It is tempting to think you can just deal with it if you develop diabetes, but the damage could start before you know you have the disease.
Diabetes can cause stroke, heart disease, foot ulcers, eye problems and kidney disease. The longer you have diabetes, the more likely it is to affect your long-term health, so preventing or even delaying its onset as long as possible will preserve your health.
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