[0:04]My name is Associate Professor Spiros Fourlanos, and I'm the Director of the Royal Melbourne Hospital Department of Diabetes and Endocrinology. Today we're here to discuss type two diabetes. Diabetes is essentially a disorder of carbohydrate intolerance or inability to fully handle glucose or sugar loads in food. the incapacity to make enough insulin by the pancreas for what the body needs. Often in parallel with a process called insulin resistance or a lack of responsiveness to insulin. When an individual is unable to produce enough insulin, that means there's not enough transport of glucose from blood vessels into tissues to be used for energy. 7% of people in Australia have diabetes. Roughly half diagnosed and half are unknown. So that means approximately 1.8 million people have diabetes in Australia. And type two diabetes is estimated to affect approximately 90% of that 1.8 million, with the remaining being predominantly type one diabetes. And then there's also many other sub-forms of diabetes, also known as secondary forms or type three diabetes.
[1:21]The symptoms of diabetes are classical, characterized by excessive thirst, excessive urination, unintentional weight loss, as well as blurred vision. But there can be other manifestations, for example, high glucose predisposes risk to infection, so people who have undetected diabetes may firstly present with infections, recurrent urine infections, thrush, for example, or recurrent chest infections. I'm Sophie, I'm a podiatrist at the Diabetic Foot Unit here at the Royal Melbourne Hospital. Foot problems occur for people living with type two diabetes primarily because diabetes affects the nerves and it affects the nerves in our feet first. What we have is the loss of sensation to our feet, and that means we can't feel damage occurring like cuts, blisters or sores that occur. And if we can't feel the pain associated with that, then these sores that are small to start with often become worse. Hello, I'm Associate Professor Cherie Chiang. I'm an endocrinologist and also the head of Chemical Pathology at Royal Melbourne Hospital. Glucose can be diagnosed in point-of-care testing that can be conducted in the GP clinic. The glucometer with a finger prick is the easiest way, and sometimes in our younger patients, a urine sample with a urine dipstick can also diagnose diabetes with high sugar. This is a really convenient sample to collect from children. The urine dipstick contains a square infused with an enzyme which changes colour when the urine glucose is high. The other two formal diagnosis of diabetes tests happen in our laboratory. The two-hour oral glucose tolerance test, whereby a subject will have their first baseline blood test fasted. They'll drink a 75 gram glucose drink, and they wait one hour for the second blood test, and wait another hour for the third blood test. So it's a total of three blood tests over two hours. The diagnosis is based on the "seven and eleven" rule. So if the fasting glucose is seven or higher or the two-hour glucose is 11.1 or higher, that would be consistent with diabetes. The last test is our HPA1C. So that is a single random blood test, it does not require fasting. The HPA1C has now overtaken the oral glucose tolerance test as the gold standard for diagnosis of diabetes. That blood test look at the amount of glucose residue stuck on hemoglobin inside red blood cells. So in someone with diabetes where they have high blood glucose all the time, there's a lot more glucose residue on the hemoglobin. So nowadays the cumbersome oral glucose tolerance test is only reserved for pregnant women or patients with abnormal red cell metabolism. For anyone who's got symptoms of diabetes, or are at risk of developing diabetes, you should definitely consult your GP, so you can have the appropriate test carried out for diagnosis.
