Matters of Interest: Type 1 Diabetes
The Hon. H.J. GUMBYS (15:47): I rise today to speak on a matter that is both a significant public health issue and also, for many South Australians, including myself, a deeply personal one. Type 1 diabetes has long been understood as a childhood condition, once commonly known as juvenile diabetes. That understanding is now being revised by the evidence, and the implications are significant for the many Australians being diagnosed as adults and, in too many cases, being misdiagnosed entirely.
The National Diabetes Services Scheme (NDSS) data shows that in Australia the largest group of people living with type 1 diabetes is aged over 60, outnumbering those under 20. I personally was initially misdiagnosed in my early 50s. All of a sudden, out of the blue I was experiencing the most chronic of chronic fatigue. I was constantly bone-dry thirsty, consuming almost two litres of water just overnight, obviously leading to a terrible night's sleep. This phenomenon, I later learned, was my body attempting to expel the excess sugar that it could not cope with. Most dramatically, I started losing a significant amount of weight, almost 20 kilograms in just over six weeks—I have since made a full recovery.
I was then diagnosed with type 2 diabetes, apparently treatable with a couple of tablets, a controlled diet and exercise. So I hit the treadmill and was consuming the lowest of low-carb meals, all to no avail, and my condition worsened. It was not until I insisted on yet another blood test that I received a warning from the pathology lab at 11.30 on a Friday night: I was advised to get to hospital now.
Ketones appear in bloodwork when the body enters ketoacidosis, when the body essentially begins eating itself. A ketone reading of 1.5 or higher is cause for alarm. My ketone readings were 11. I was later informed that I could have at any point slipped into a ketoacidotic coma, flirting with death.
New diagnosis in older adults now occurs at rates comparable to and in some populations exceeding those seen in children. This is not simply a disease of childhood. Part of the reason adult diagnoses are so frequently missed is a condition called latent autoimmune diabetes in adults (LADA), sometimes called type 1.5 diabetes. LADA is an autoimmune condition in which the body gradually destroys its own insulin-producing cells but does so slowly, over months or years, rather than acutely.
Because LADA presents in adulthood and progresses gradually, it is routinely mistaken for type 2 diabetes. When my GP contacted me in hospital days after my condition had been stabilised, he apologised for misdiagnosing me. The fact that I continued to get out of bed each day and front up for work did not fit his paradigm and had thrown his usual diagnostic framework out the door.
Diabetes Australia estimates that one in 10 people have LADA but are misdiagnosed with type 2 diabetes, meaning they are receiving the wrong treatment while their condition quietly worsens. Diabetes SA administers the National Diabetes Services Scheme in South Australia, supporting thousands of South Australians living with type 1 diabetes, including many diagnosed as adults and some who waited years for a correct diagnosis.
Through that same scheme Diabetes SA also delivers access to one of the most significant advances in diabetes management in recent memory: continuous glucose monitoring devices. Small sensors worn on the upper arm take glucose readings every minute and transmit them directly to a smartphone, with alerts for dangerous highs and lows and no finger pricks required. I am wearing one right now.
Since 2022, these devices have been subsidised through the National Diabetes Services Scheme for all Australians with type 1 diabetes. Previously, before being subsidised, these blood glucose sensors would cost patients close to $100 and last two weeks. Now they are around one-fifth of that price.
During COVID, these sensors became a game changer for me. I was able to attend phone consults with my endocrinologist and diabetes nurse from home where they could view my blood glucose fluctuations remotely and adjust my insulin ratios accordingly.
For people managing this condition every day the practical difference is profound. Parents can monitor a child's levels from another room. Adults sleeping through the night need not rely on the feeling of nausea and disorientation experienced from a hypoglycaemic low to rouse them from their sleep and, significantly, they can quickly check their blood glucose levels before they get behind the wheel of a car, ensuring they meet the safe blood glucose level of at least 5 to drive.
Newly diagnosed South Australians are able to manage their condition without the consistent intrusion that previous generations endured. Type 1 diabetes is an autoimmune condition, not lifestyle related, not age limited and too often misdiagnosed in adults. Getting the diagnosis right matters, and South Australians are finally receiving a health system that delivers just that.