DIABETES

Adjourned debate on motion of Hon. R.B. Such (resumed on motion).

Mrs VLAHOS (Taylor) (12:21): I would like to present another side to the member for Fisher's motion today. The rates of type 2 diabetes are rising in South Australia, and current estimates are that roughly 5.2 per cent of adults have type 2 diabetes; in fact, I have family members who suffer from it, too. In many people over the age of 60, the prevalence of type 2 diabetes is nearer to 14 per cent, and many are more at risk of developing type 2 in the future, mainly due to being overweight and physically inactive.

Treatment and ongoing management of type 2 diabetes result in considerable cost to our health care and hospital systems. In 2004-05, treatment costs directly related to type 2 diabetes were in the vicinity of $80 million. The impact and burden on the community of type 2 diabetes cannot be overstated. This is why the South Australian government and the commonwealth government have been investing heavily in awareness raising, prevention and treatment of and research into type 2 diabetes. Let me provide some more examples of this.

SA Health has been working actively in the area of prevention of type 2 diabetes and chronic disease more generally for many years. Much of this work has been targeted at addressing the underlying causes of type 2 diabetes, namely, being overweight and obesity. A range of programs and services have been implemented, including: the 2 and 5 messages and resources to encourage healthy eating; the Be Active 'Walk yourself happy' campaign and resources to encourage physical activity; and the Community Foodies program, a volunteer-led program to teach people about growing, purchasing and preparing healthy meals.

The Do It For Life, a personalised lifestyle-change program to help individuals at risk of type 2 diabetes identify and make the changes necessary to prevent chronic disease developing, will soon be replaced by a telephone coaching service that is currently available in New South Wales, the ACT, Tasmania and Queensland. This new service will deliver a similar one-on-one program but in a more cost-effective way that also provides greater reach and access for those in regional areas. Any adults seeking help to change their lifestyle habits to improve their general health, reduce their risk and better manage chronic disease will be able to access this service from anywhere in the state between 8.00am and 8.00pm Monday to Friday.

Through the Health in All policy work led by SA Health, other South Australian government departments have also introduced policies, programs and improvements to infrastructure to support healthy choices to encourage improved nutrition and increased physical activity with their staff. The new SA Public Health Act 2011 now covers non-communicable diseases such as type 2 diabetes within its role and responsibility. This will be reflected in regional public health plans that all South Australian local councils will also develop.

The public hospital system and health services in South Australia provide world-class services to diagnose, treat and manage type 2 diabetes. For example, diabetes nurses and nurse educators work across inpatients, outpatients and community health services to provide patients with ongoing treatment and management of type 2 diabetes. Community-based chronic disease, self-management programs are available to support patients with type 2 diabetes to adapt their lifestyles to ensure better compliance with medication, better diet and more physical activity to prevent complications and disease progression of this widespread disease.

The South Australian government also contributes to research on and monitoring of type 2 diabetes, its causes and impacts, through activities conducted by SA Health, as well as funding to our new SA Health and Medical Research Institute being based at North Terrace. I am confident that the South Australian government is making an appropriate contribution to the work to prevent and treat type 2 diabetes, and this work is complemented by that of the federal Australian government. The federal Australian government is also investing heavily to raise awareness and prevent and manage type 2 diabetes, and is providing the following programs:

It provides funds to Diabetes Australia, the peak body, to conduct awareness-raising activities, provide information to the public, and implement the National Diabetes Service Scheme, which provides low-cost medication and equipment to diabetes patients;

It worked together with Baker IDI to develop the AusDrisk screening tool to assist with easier identification of people at high risk of developing diabetes to encourage prevention and early intervention;

It works with the National Partnership Agreement on Preventive Health, providing $932.5 million over nine years nationally to address the rising prevalence of lifestyle-related chronic diseases by supporting programs in preschools, schools, workplaces and communities. The focus of this funding is on poor nutrition, physical inactivity, smoking and excessive alcohol consumption (including binge drinking); and

It is also funding the establishment and operation of five Medicare Locals based in South Australia, that have a role in delivering primary care to their communities, including primary prevention services.

In supporting this motion I note that the South Australian and Australian governments have already provided a comprehensive range of services, programs and research to ensure that the population is informed and assisted in making personal efforts to make healthy lifestyle choices within their own experience, to prevent the onset of chronic disease such as type 2 diabetes, and receive the best quality of care that is needed.

Dr McFETRIDGE (Morphett) (12:26): Polydipsia, polyuria, polyphagia; they are three presenting signs of the classic diabetic patient, both in the human world and the animal world. Polydipsia means that you drink a lot, polyphagia means that you eat a lot, and polyuria means that you wee a lot. If you ask any diabetic whether those are a problem with them, they will tell you they are a real issue in managing their lifestyle.

As a vet with over 22 years of practice I can say that about one in 80 dogs and one in 300 cats become diabetic (this is type 1 diabetes), and you have to manage them in exactly the same way as you do humans. Giving your cat or dog injections every day, twice a day in most cases, can be a good bonding experience for you and your pet; it certainly develops a level of trust. Then there is managing their diets as well.

I remember, as a vet student at university, our professor of ophthalmology, the late Douglas Slatter, had us in one day in surgery, and we took the cataracts out of a diabetic canary. I think that was probably a world first, and probably the only time that has ever happened.

However, while diabetes in the veterinary world is a very serious problem, and an increasing one, in human medicine it is becoming an absolute tragedy to see the number of Australians, and people around the world—old, young and in between—who are developing diabetes. Much of it, as in type 2 diabetes, is preventable. If we will stand on the scales and take a harsh look at them, or if you have talking scales and they say, 'One at a time please', then you can guarantee that you need to do something about your lifestyle to make sure that you do not develop type 2 diabetes.

There are so many people developing type 2 diabetes because they are not managing their lifestyle. Losing a bit of weight, staying active, getting your blood pressure down, just being a healthy person is one of the best things you can do not only for yourself but also for the Australian economy because these chronic diseases, such as type 2 diabetes, are having a massive impact on our health budget.

There are two types of diabetes. Type 1 relates to the pancreas, which is a spongy organ that sits behind the stomach. It does a couple of jobs. It produces some enzymes to help you digest your food, but it also produces insulin and glucagon, and insulin is the main hormone we are concerned with here. In type 1 diabetes your pancreas is not producing the insulin to enable you to take up the glucose that is an end product of the digestion of many of your foods.

The body responds from a lack of glucose by starting to digest your fats and you may have heard of the term 'ketone breath'. The by-product of metabolism of fats are ketone bodies and the breath of a poorly managed diabetic is quite terrible. You have ketones on your breath and you often hear of criminals occasionally being described as having a stinky—or 'Mr Stinky'—breath. There was one guy we remember for having a terrible breath and that can be a sign of diabetes.

Type 1 diabetes is a very severe form of diabetes where insulin is not being produced, or is not available to the body, so you are having to put insulin into your system with twice-daily injections to make sure that your blood glucose does not go too high so you do not have hyperglaecemia—that is too much glucose in your blood. If you put in too much insulin you have a hypo, you have a low level of blood glucose and you can faint. That is why, if you have a diabetic who is not managing themselves well and they have a hypo, they faint, but give them a lolly or a teaspoon of sugar in their mouth and they will recover very quickly.

Managing type 1 diabetes is something that we are all looking forward to be able to do in better ways, with insulin pumps and with islet implants into the pancreas so that the body starts producing insulin again. It is a very interesting area to see the development of research and methods that are being used because it is a very expensive part of medicine. We need to make sure our research is supporting our medical professionals in dealing with type 1 diabetes so they can help their patients and those suffering from diabetes can manage their diabetes.

In children, juvenile diabetes type 1 is an absolute tragedy for the whole family—never mind just the individual—because having to make sure that you are monitoring your child through the night so that they are not having a hypo, they are not going unconscious and dying from having a hypo is something that you have to do 24/7. You are managing that child all the time but particularly overnight. It has a massive impact, not just on the individuals but also on families.

Making sure we are supporting research and supporting advancements in the management of diabetes is something that this motion is aimed at doing and we all should be supporting it. I am glad to see the government is supporting it and I know that the government has done some good work and is providing funding for research.

Type 2 diabetes, as I said, is where the insulin is being produced by the pancreas—perhaps not as much as it should—but, for some reason, the body cells are not reacting to that insulin and able to use the glucose in the bloodstream. You then have a high blood glucose level and your system starts to react in a similar way, but a less severe way than a type 1 diabetic.

I will just mention one complicating factor in monitoring or detecting diabetes and that is haemoglobinopathies. I mention this because one of my constituents has been at me for years to encourage medical students and lecturers in the medical schools to discuss the frequency of haemoglobinopathies in patients because this can interfere with the detection of diabetes as a disease.

Haemoglobinopathies are where the haemoglobin is abnormal and does not carry glucose in the normal fashion. One of the measures of detecting whether you are diabetic is measuring your haemoglobin HbA1c and this is looking at the amount of glucose that is on the cells of the haemoglobin and gives a bit of an idea of what your glucose levels have been like for the last three months. When you have HbA1c levels above 6.5, that is showing that you are diabetic and less than 5.5 is that you are managing things well. In this particular case of my constituent, his HbA1c was perfectly normal, yet his blood glucose was sky high. This was missed by the doctors for a long time and so he was being an unmanaged diabetic which caused him a lot of distress.

I have written to the medical school. I have written to diabetes educators to make sure that they are educating both the professional and the laypeople involved in educating our medical students as well as people with diabetes on how to manage their diabetes and be aware that they may need to have a fructosamine test to test for their levels of HbA1c.

The end result of diabetes can be extremely severe. My father-in-law was a poorly managed diabetic, and he ended up getting severe vascular disease in his lower legs and developing some gangrene in his toes. You can have your toes amputated, feet amputated, legs amputated, and you can lose fingers. You need to manage your diabetes really well because it has severe consequences: as well as cardiovascular disease, there is kidney disease and, as I have said before with our diabetic canary, you can also get eye disease, such as diabetic cataracts. Diabetes should never be underestimated.

I think the latest figures have been put out there by the member for Taylor and certainly the member for Fisher. Millions of people now are either having to cope with their diabetic condition or are at risk of becoming a diabetic. We need to make sure that we are supporting this motion and supporting the people who are working in the areas of research and helping people who have diabetes, particularly those families with kids with diabetes, to manage those diabetic patients. It is so important. Like many lifestyle diseases, unfortunately type 2 diabetes is becoming more prevalent. We all need to take care of our own health, and we are the ones responsible for that.

Mr PENGILLY (Finniss) (12:35): I would also like to say a few words on this motion from the member for Fisher. I am very supportive of the matter. Interestingly enough, I am not sure how many people who work in this place, whether elected or otherwise, suffer from diabetes; there are probably a number with either type 1 or type 2. I actually urge colleagues on my side who I view with some degree of seriousness as having the potential for contracting type 2 diabetes to get themselves active, lose weight, watch their diet and be very careful. Sometimes they get rather annoyed by my approach, but I am not going to back off on it.

I would say to members on both sides of the house that if they have not had a glucose test (I am not going to go into all the medical terms the member for Morphett went through) to go and have one. Do the glucose test and have a blood test and do it regularly. It is imperative that you do. I have an auntie who is now 80 years old, and she has had type 1 diabetes for 60 years and is insulin dependent. She is very clever at managing the illness and is as bright today as she was all those many years ago. She has looked after herself exceptionally well, with a lot of support from her family.

Wherever possible I actively support any diabetes networks in my area or wider across the state as I think it is a terrific way to learn. I have watched people suffer considerably from not looking after themselves with diabetes. I have seen people I know well die from the effects of diabetes from not looking after themselves and losing limbs—toes, then legs, and the list goes on. It is horrendous. It is, in any way, shape or form, the last thing on earth you would want to have happen to you. If you have type 1 and you are insulin dependent, you manage it, generally speaking, quite well.

There are some people who just do not appear to be able to manage it and do not appear to want to follow doctors' orders. One friend of mine had a toe amputated due to being overweight and contracting diabetes. He gets around now, but I would not say he is in the best of health. One of his villainous mates gave him a pair of thongs for Christmas after he had his toe removed, but that is another story. I seriously say to members: get yourself checked out if you have not and keep an eye on it.

Of course, type 2 diabetes is a lifestyle disease, and I have grave concerns about the future of our Australian community, that with the number of overweight and obese particularly children who are coming through we will have an epidemic of type 2 diabetes across Australia before too long. You only have to look at what has happened in the United States where junk food seems so prevalent.

I was watching recently the debacle in Cleveland. It is a poor neighbourhood and the sheer size of the people they interviewed was absolutely frightening. That is the result of cheap food, poor education, lack of exercise and a number of other things. I would not like to think that it would happen to that extent in Australia; however, junk food is available all around the place. If you go to a fast food outlet it is filled up with kids, generally speaking, or families that do not have the money, perhaps, to buy healthier, better foods, all consuming the food in those places. They are chock-a-block full of sugar and things that are bad for you. That is why they taste good and that is why they sell them.

I think the message is loud and clear that we need to continue the education. We particularly need to educate children in schools and the teachers need to continue battling away on this. The diabetes education groups get out in the wider community and do all they can to encourage people to take care of themselves. It is something that is not going to go away. I have seen figures, I do not have them in front of me now but the member for Fisher may well have them there, but they are frightening figures. In this place with this motion, and I am presuming that a number of other speakers will want to speak about it, I think it was important to say a few words and for all of us to get behind and encourage governments of all persuasions, state or federal, to up the education on the potential for diabetes and to look further into diabetes research.

I am told that eventually there will be a cure for type 1 diabetes. There will, I suspect, be no cure for type 2 because it is the same, only different, but there will be a cure for type 1 diabetes. I know that many people are looking for that cure. We have not found a cure for the common cold, but we have found cures for other things. We have cures and treatments for many types of cancer but as time goes on more and more money will have to go into research on this disease alone. I am very supportive of the motion that the member for Fisher has put up and I have no doubt whatsoever that it will be supported by everybody in this place.

Mr PEGLER (Mount Gambier) (12:42): I rise to support the motion that this house notes the increasing incidence of diabetes and urges governments, both state and federal, to promote awareness of this disease, along with increased emphasis on prevention, treatment and research. Within my family we have members who have type 1 diabetes. I am one of those fortunate ones who have developed type 2 diabetes. It is probably, as the member for Morphett said, from eating and drinking too much. I have certainly changed my lifestyle. I was lucky enough that I did go to the doctor and had tests every year for many years so we have been able to control my diabetes through some tablets and also a change in lifestyle, with a bit more exercise and dieting.

What does particularly worry me, especially with men, is that they do not seem to go to the doctor often enough. I would certainly, and always do, encourage anybody that I see, particularly those who are carrying a bit of extra weight, to go and have a test every year. It is a very easy test to have: you do not eat anything after tea one night, then you go in the next morning and have a simple blood test, and that will show what your blood glucose levels are. It is very non-invasive and I think that, as a community, we must encourage all people, particularly when they are in their thirties (probably), to start having tests done and if they are going to run into problems or they have a disposition to type 2 diabetes that will be picked up early. Those people will be able to change their lifestyle, and they will end up living a lot longer and living a much healthier life. I certainly commend this motion; I think it is a great step in the right direction. If we can encourage people to go to their doctor, have the test done, they will be able to take the remedial action. I commend the motion.

Mr GRIFFITHS (Goyder) (12:45): I also support the motion, and I do so as a person who has been guilty of some of the lifestyle issues that have been commented on today. For me, it came home well and truly about three months ago when, after blood tests and glucose tests, I was identified as being 7.2; therefore, I am type 2, not a terrible level. I spoke to my mum, who has just retired after nearly 50 years as a nurse. She told me that she has nursed someone who was 60 and that she was surprised that that person was alive. She told me that, if I was 20, she would be concerned about me, but at 7.2 it is all about lifestyle issues.

All of us can learn a lesson from it. It comes down to an education and awareness opportunity and a chance to think about how we want to live into the future. I think the motion is a very good one in that it makes us do exactly that and to act appropriately early enough to prevent it from being an issue in our life. Sadly, to many like me—not someone like you, Mr Deputy Speaker; you are still very active, and I understand that—who choose to lead more of a sedentary life and who still enjoy things in life, they succumb to it. So, it is important that we deliver that message.

There are two things I want to talk about today, though, and one is the Juvenile Diabetes Research Foundation. There is a linkage that occurs between parliamentarians and those in our community who live with type 1. In my case, the young man I am paired with from my electorate, just north of Wallaroo in Goyder, is Nathaniel Snodgrass. I do not think that Nathaniel or his mum and dad, Andrew and Chris, would worry about my mentioning him.

I have been to their home and seen Nathaniel, who is the oldest of five children. They live on a farm just a little north of the town. They are a great family. They are involved in so many community activities, they attend church regularly and go to the Harvest Christian School at Kadina. For them, the fact that Nathaniel suffers from type 1 and the impact it has had on their family, even with the other children coming along subsequently, has made them think about what occurs in their life and it has impacted upon what they are doing. Nathaniel is a great young man. He is probably 15 now—time flies a bit, I suppose. I know that he is one of the people who self-injects and all that sort of stuff. I look at him with a lot of humility and respect.

I was pleased when the member for Finniss commented on the fact that there is a belief that type 1 can be prevented and is far easier to treat; that gives me hope. That is why it is not only important that we support the motion but that we recognise an opportunity to support organisations such as the Juvenile Diabetes Research Foundation and assist them in what they do so that we can help other young people across our community, too.

Finally, I want to talk about an older man in my electorate, who has since passed away, who always enjoyed himself, which is probably the easiest way to say it. He was a former publican. He was large, played footy. He came from quite a famous footy family; he had a cousin who played for Sturt (No. 20), who could ruck and all that sort of thing all day—

An honourable member interjecting:

Mr GRIFFITHS: Rick Davies—yes, this chap was a cousin of his. He has passed away, but he suffered terribly from type 2 diabetes. It was really exemplified to me that, when he was living at Port Victoria, he walked out on the jetty on a hot day. Because he was not wearing shoes, and with the lack of feeling he had in his body, he just about melted every bit of skin off the bottom of his feet. He suffered terrible pain from the treatment he had to have, the special shoes he had to wear, all because he was walking on things that were burning his skin off and he did not realise it, because he was out there by himself. I think that is an absolute tragedy.

Sadly, Wayne passed away last year on his 65^th birthday, but this has made me realise that everyone in our society, especially governments at all levels, has a responsibility to promote the issues about diabetes and the importance of people working on their lifestyle to try to prevent it. The motion is a good one and if it allows the message to get out there, even from brief words said by members, it is going to help the cause. I think we should all stand up and say yes to this one.

Mr VAN HOLST PELLEKAAN (Stuart) (12:49): I will be fairly brief but I do want to contribute because this issue is particularly important to me. My brother has type 1 diabetes and he was diagnosed when he was in his early to mid-20s, which came as quite a shock to all of us. He is living quite well with it and has a great family, two kids and wonderful prospects, but it will be something that will be with him all his life and it is something that I take very seriously. I wholeheartedly support the member for Fisher in his motion, particularly with regard to the awareness and emphasis on prevention aspect of his motion.

It is fair to break diabetes up into type 1 and type 2, as many people have. Type 1 just seems to come along. That is not really the medical term, but it just seems to come along and affect people in the way that it did my brother, who is a very fit, healthy, active person. He was an active surfer, a member of a surf club; he was doing all the right things; he was a healthy eater and that sort of thing. Like most people in their early to mid-20s, he might have had a beer or two too many upon occasion but he was really doing the right sort of thing.

Type 2 diabetes is the area that really concerns me and really worries me because it is on the way to becoming a pandemic. It is on the way to being a society-altering medical problem and what concerns me so much about that is that it is not even contagious. It is not contagious; you do not catch diabetes; you do not come in contact with it. You do not share diabetes with somebody; all you can share is bad habits.

Diabetes type 2, primarily—and I am not trying to categorise every single person who has it—is avoidable if you have reasonably good lifestyle habits. You do not have to be a saint. Most people in this chamber are not saints, but the reality is that if you do not exercise, if you do not eat reasonably well, if you do not watch your weight, if you do not do just the plain old common-sense things that everybody should be doing, you put yourself at risk.

That is the thing that is so incredibly frustrating about this, because guess what? If you put yourself at risk of type 2 diabetes, you put yourself at risk of just about everything else going around as well. You put yourself at risk of so many other things, almost every serious disease that we are aware of, like heart disease. I am talking about the major volume diseases that affect people. They are also helped if you have a good lifestyle. They are also helped if you get a reasonable amount of exercise and have a reasonably good diet, do not consume sugars and alcohol and other things to excess, so this is a particularly frustrating issue.

I support the member for Fisher wholeheartedly. I think awareness is the key; discipline is the key. By that I do not mean some stoic, rigid lifestyle. Just a bit of discipline to do the things that you know you should do to stay on roughly the middle road would be enough to help with type 2 diabetes. Thank you to the member for Fisher for bringing this forward; thank you for highlighting the fact that it is largely a preventable disease, particularly in the type 2 category, and I do share the member for Fisher's desire that we promote the awareness of this disease along with increased emphasis on prevention, treatment and research.

Debate adjourned on motion of Mr Treloar.