The types of diabetes are:

• Type 1
• Type 2
• Gestational (Diabetes of pregnancy)
• Pre-diabetes
• Diabetes caused by other factors

Type 1 Diabetes

Type 1 diabetes occurs when the beta cells situated in the Islets of Langerhans of the pancreas are progressively destroyed by the immune system (referred to as an auto-immune disease), resulting in severe insulin deficiency. People diagnosed with Type 1 diabetes require daily insulin injections to stay healthy and well.

If you have been diagnosed with Type 1 diabetes mellitus a comprehensive education program is essential so you can self-manage your condition. People with Type 1 diabetes are encouraged to seek and participate in a shared care program with the general practitioner and diabetes specialist along with other members of the diabetes team. Please discuss with your GP and/or diabetes educator regarding appropriate referral.

Taking control of your Type 1 Diabetes

The key is keeping your blood glucose levels within the target range, which may be achieved with meal planning, exercise and appropriate insulin at the right time.

Checking your blood glucose levels regularly will help to identify insulin requirements.

How you can help to manage your diabetes

Understanding your diabetes is a matter of gaining information from a variety of sources and finding a health care team who supports you.

It is useful for you to know about:

• how food affects your blood glucose levels and diabetes
• monitoring blood glucose levels
• being physically active each day
• caring for your feet
• the effects of your medication and/or your insulin

Regular check-ups with your doctor and diabetes team are strongly recommended to help you to manage your diabetes and prevent complications.

If you have been diagnosed with diabetes you may be feeling somewhat bewildered and upset. Always feel free to discuss your situation with your diabetes team and remember to ask as many questions as you need. Ask for clarification if you don’t understand or get confused. This is one of the ways in which you can gain confidence in managing diabetes in your daily life. If you feel you are finding it difficult coping with diabetes, mention this to your health care team as they may be able to refer you to a psychologist to help provide the necessary support you need.

Type 2 Diabetes

Type 2 diabetes develops because of insulin resistance. The insulin in the blood does not work well enough on the cells of the body. This can progress to relative insulin deficiency over many years when the pancreatic islet cells are not able to make enough insulin.

You are more likely to develop type 2 diabetes if you identify with one or all of the following risk factors:

Type 2 diabetes is also a serious health condition that is associated with increased risk of cardiovascular disease and other complications. It is not just “a touch of sugar”.

Management of type 2 diabetes usually requires lifestyle adjustments and will, at some time require medication and/or insulin.

Taking control of your Type 2 diabetes

The goal of treatment is to maintain blood glucose as close to normal as possible and improve the body's use of insulin through:

• Including suitable portions of a wide variety of nutritious foods
• Regular activity and / or exercise
• Moderate weight loss (if required)
• Management of medications (if required)

Meal planning and daily activity can help you maintain healthy blood glucose levels, blood pressure, cholesterol and maintain a healthy body weight. Consulting your dietitian regularly can play a big part in helping you balance food, blood glucose levels and weight with your medical management.

If you are overweight, losing some weight will be a big part of your diabetes treatment.

Regular self-testing of blood glucose is important because it can help you identify when your levels are outside the normal range. Getting help from your diabetes health care team when this happens will help reduce your risks of developing diabetes complications.

You may need to include one or a combination of diabetes tablets to help you achieve satisfactory blood glucose levels. One type called Metformin, is commonly used to overcome insulin resistance and assist weight loss. Other tablets work by stimulating the pancreas to produce more insulin.

Type 2 diabetes requiring insulin

Type 2 diabetes is a progressive health condition that can lead to reduced insulin production. Many people with type 2 diabetes require insulin to help control blood glucose and reduce the risk of complications. You may be on tablets and insulin or on insulin alone.

There are a few people who will require insulin for a short period of time because of other conditions that affect their blood glucose levels. These conditions include infection, cortisone treatment such as prednisone, surgery, pregnancy and serious illness.

Starting insulin

Starting insulin is not as complicated as it used to be. When starting insulin most people with diabetes say they feel much better and `get their energy back.' It is important to monitor your blood glucose levels to help you achieve ‘good control’.

Starting insulin is not a replacement for your usual activity and healthy eating plan. Weight gain is often a side effect of starting insulin. Your doctor may refer you to see a dietitian to make sure that your meal pattern and insulin is compatible to your lifestyle. Your dietitian will help you devise a healthy eating plan that is relevant to your individual requirements.

It is also very important you continue to keep active each day e.g. walking 30-40 minutes most days. If you are having problems with exercising, an exercise physiologist or a physiotherapist may be able to assist you.

Diabetes and Pregnancy

Diabetes and pregnancy is a specialized area and needs to be managed by your antenatal team. Your doctor will refer you to the appropriate services.
If you already have pre-existing diabetes and you are planning a pregnancy, you need to discuss your plans with your doctor as soon as possible. He or she may refer you to a specialist clinic so you and your baby get the support and advice you need for a healthy pregnancy.

Gestational Diabetes

Gestational diabetes is usually a temporary condition that affects 8-12% of women during pregnancy. It is sometimes resolved after your baby has been born but the diabetes often re-occurs later in life. All pregnant women should be tested for gestational diabetes at or around the 26th week of pregnancy, especially if they are seen to be at risk, such as family history of diabetes or are overweight. Gestational diabetes is a risk factor for development of type 2 condition.

Pre-Diabetes (Impaired Glucose Tolerance, Impaired Fasting Glucose)

Pre-diabetes is a common condition where an individual has elevated blood glucose levels that are not yet in a diabetic range. Specifically it is either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). People with pre-diabetes have an increased risk of developing diabetes (about 60% within 5 years), as well as an increased risk of cardiovascular disease.

If you or your family member has been diagnosed with Pre-diabetes ask your GP to devise a Care Plan to help you work towards achieving positive lifestyle changes. Under this Care Plan, your GP may involve other health professionals such as a dietitian or exercise physiologist or referral to other lifestyle programmes to help you reach your goals and be regularly monitored for diabetes.

Other Causes of Diabetes

Steroid induced diabetes occurs when high doses of cortisone or prednisone, are prescribed for medical reasons (i.e. cystic fibrosis, asthma, chronic obstructive pulmonary disease (COPD) , rheumatoid arthritis or organ transplant). Sometimes people with these conditions may require insulin treatment to manage blood glucose levels that can go high on these therapies.

Small numbers of people (0.5%) may experience elevated glucose levels and diabetes that is associated with other causes such as:

• pancreatic disease
• trauma (surgery)
• haemochromatosis - a condition in which the body takes in too much iron from the diet.
• acromegaly - a hormonal disorder that results from too much growth hormone (GH) in the body
• Cushings Syndrome - occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time.
• some HIV medications
• some psychotic medications