Diabetes and What’s New

Ninnette Kelly, a Diabetes Education Nurse Practitioner recently spoke at the Rotary Club of Rosanna about her career working in Diabetes Education for over 20 years. She has managed Diabetes Education Teams at Cabrini Hospital and St Vincent’s Hospital and worked in multiple settings such as community health, the hospital system and private practice. She has been involved in numerous research activities and has a special interest in diabetes technologies and utilising current tools to make the lives
of people with diabetes a little easier and often safer.

Diabetes is common, affecting almost 5% of our population. There are two types; Type 1 which usually presents earlier in life, has no known cause but quite possibly genetically linked, and requires lifelong insulin treatment, and the more common Type 2 which usually presents later in life and has a number of known and preventable risk factors such as obesity, sedentary
lifestyle and poor diet, and less preventable such as age. Type 2 is commonly managed by diet and tablets that lower blood sugar, but may require insulin. Insulin is broken down in the stomach so cannot be given as a tablet. Type 2 is probably substantially underdiagnosed.
For every few known cases there is probably another undiagnosed one out there. It may have few symptoms at first so Ninnette stressed the importance of regular check-ups for us all including a fasting blood sugar or Hb A1c test (better long-term blood sugar test which does not
require fasting).

Both types, but especially type 1, can lead to long term complications such as retinopathy (eye
disease), vascular disease (circulation failure, ulcers, gangrene), neuropathy (numbness,
weakness) and kidney failure. These long term complications are substantially reduced by good
blood sugar control. Methods of blood sugar monitoring and insulin delivery have greatly
improved in recent years, but available technology can be limited by cost.
Traditionally severe diabetics were managed by strict diet and lifestyle to keep things even, blood sugar monitoring by finger pricks at various times – fasting, after eating, morning, night – and a mix of long and short acting insulin bases on those results. More frequent monitoring (like six finger pricks/day) and smaller more frequent insulin injections gave better control. Recent years have seen the development of continuous blood sugar monitors that can be worn for up to a month, fairly comfortably and unobtrusively, and read by the user’s mobile phone. Insulin can be delivered by a continuous pump, and they too are getting smaller and more comfortable. Linking an insulin pump to a blood sugar monitor by artificial intelligence
effectively creates an artificial pancreas. Less finger pricks, less injections, more normal diet and lifestyle and much better diabetes control. But the availability of this newer technology under the PBS is limited to certain Type 1 cases on Health Benefit Cards and is expensive for others.
It was a fascinating account of modern diabetes management and advances but the main message for all of us in our age group is get your regular checks!

Peter Little
Rotary Club of Rosanna