There is an "absolute tsunami" of type 2 diabetes hurtling towards us, and it is terrifying, Annette Parkes-Considine says.
But the registered nurse and credentialled diabetes educator is quick to point out that a diagnosis is not all "doom and gloom" as she pushes for changes allowing people to access support and medications earlier to slow, and perhaps even prevent, the progression of type 2 diabetes.
"Everyone comes to me the first time and says they know someone who knows someone who had an amputation and ended up on dialysis and went blind," Mrs Parkes-Considine, of Hunter Diabetes Centre, said.
"I give them that reassurance that with good management, the long term risks are greatly lowered. I give them the tools they need to look after their diabetes. I teach them about their medications. I teach them that while it tends to be a progressive condition, we can slow down that progression with medications, diet, and movement."
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Mrs Parkes-Considine, who herself has type 1 diabetes, said one person every five minutes was diagnosed with type 2 diabetes in Australia.
"And for every one we know of, there is two who don't know they have it," she said.
"But at the moment, you have to wait until you've actually developed type 2 diabetes before you can access any support.
"The person with type 2 has to have an HbA1c of seven before a lot of medications can be initiated. That needs to be lower so we can prevent the complications, so we can prevent the progression of that condition."
Mrs Parkes-Considine explained that people with pre-diabetes, or those in the early stages of type 2 diabetes, must wait until their blood sugars reached that higher level before they could access certain medications and "enhanced primary health care plans".
"These care plans offer five visits to use to see a dietitian, a diabetes educator, or another allied health service," she said.
"So they are basically waiting until that person develops diabetes before addressing these issues. But if they had access to dietitians and medications before they reached those type 2 diabetes levels, we would be so much better off."
Mrs Parkes-Considine said someone close to her had been told by her GP that unless she lost weight, she was all but guaranteed to develop diabetes.
"I asked her if they'd given her a diagnosis of pre-diabetes? 'No'. Did they send you off to a dietitian? 'No'. Exercise physiologist? 'No'. Did they start you on some medication to prevent the onset of diabetes? 'No'. Did they give you any idea of how to go about losing weight, because what you're doing isn't working? 'No'.
"I got a copy of her pathology and we went through everything. She lost weight and she is now also on medication to prevent the onset of diabetes, and - so far, so good.
"But we shouldn't be waiting to get people in that pre-diabetes phase to see a dietitian to change their diet, to move more, and start medications to slow down that progression.
"We need to be more proactive rather than reactive. We need to work as a team.
"The pressure on the health system is going to be enormous otherwise."
Mrs Parkes-Considine said that while there were a lot of diets that dangled the carrot of "remission", her advice to patients was to choose the diet right for them. The one they would stick to.
"I don't like to set people up to fail. They already feel like they are a failure anyway because they developed type 2 diabetes," she said.
"So what I always tell patients is that whatever changes we make have to be doable forever.
"What we advocate is a team approach, and that includes a GP, dietitian, an exercise physiologist, a diabetes educator, and if that person has complications or hard-to-manage diabetes, an endocrine review, so we are all singing from the same hymn book."
Mrs Parkes-Considine said there was a lot of "victim blaming" when it came to type 2 diabetes.
"That really upsets me," she said.
"I get a lot of 'guilty' people in my room who feel it is their fault. That they brought it on themselves. And I think a lot of that internal negativity comes from society and the generalisation of type 2 diabetes."
Mrs Parkes-Considine called for more sympathy, and empathy, while pointing out that people diagnosed with lung cancer were rarely shamed for their diagnosis, even if they had been a smoker.
"No one in their right mind would put their hand up to have diabetes," she said.
"Even skinny people can get type 2 diabetes, just like some people who are obese don't develop diabetes."
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