By Dale Cooke
Diabetes Queensland Dietitian
Type 2 diabetes is a progressive condition which usually starts
with insulin resistance (think rusty locks on all your cell doors
so glucose can't get in), moves on to pancreatic exhaustion (the
pancreas gets worn out trying to produce more and more insulin for
those rusty cell door locks), and can include high fasting levels
of glucose (the liver gets a bit leaky and leaks its glucose stores
overnight) in the morning in some people.
And while these all involve higher blood glucose levels (BGLs)
in the body, the longer term complications occur from high glucose
levels in the large and small blood vessels and around the
Day to day management involves managing BGLs as close to your
target levels as possible. If you don't have target BGLs, talk to
your GP, diabetes educator or endocrinologist to work out what is
best for you. They vary based on your age and
Management of other risk factors may prevent or provide early
diagnosis of long-term complications and is vitally important.
The evidence-based guidelines your health professionals follow
to guide you in your management of type 2 diabetes encourages them
to refer you to both group based and individual education
opportunities, as both have been shown to be effective.
It's good to join group-based programs, such as Diabetes
Queensland's DESMOND program, to learn the basics (or if you've had
diabetes for a while it may be a refresher) about managing your
diabetes and hearing the health journeys of others.
DESMOND group education has been shown to help people feel less
alone with their health issues when they hear how others are
The other evidence-based guideline your health professional
follows is the Annual Cycle of Care.
This set of checks/pathology/investigations was developed from
international studies and national strategies and frameworks for
A checklist was developed for GPs to use to ensure the health of
the person living with diabetes and to reduce the risk of
The Annual Cycle of Care, which your GP will prompt you about,
covers issues around managing your BGLs. Your GP may recommend you
see a diabetes educator for day to day practicalities, for
Following the cycle of care components may help you to slow down
the progression of the condition.
There is a check on achieving a healthy weight, eating
nutritious foods and increasing fitness.
A dietitian and exercise physiologist visit may help you with
The Annual Cycle of Care also focusses on slowing the longer
term complications to blood vessels and nerves by checking on
management of cholesterol and blood pressure to keep your heart,
brain, kidneys, eyes and extremities healthier.
You are recommended to have regular monitoring of your eyes
(optometrist), your feet (podiatrist) and your body's functions
(with regular blood pathology recommended by the GP) in the Annual
Cycle of Care.
A psychologist might also be helpful if you are having
difficulties with depression, distress and anxiety. They may help
you be motivated to make changes to your lifestyle. How you are
coping and your emotional status is part of the Annual Cycle of
We strongly recommend that you have a health team who you feel
you can honestly talk with, who make you feel confident in their
advice, who advocates for your health and gives you the tools you
need to understand your diabetes. This is your right, so please do
not be afraid about being proactive. This is your diabetes.
Remember, you may need to prompt your GP or healthcare
practitioner about when some of the components of your Annual Cycle
of Care need to be checked to make sure you are receiving the best
practice management for type 2 diabetes.