Paul Steel is a diabetes educator with Manningham Community Health Service in Victoria. He has both a personal and professional interest in haemochromatosis, the most common genetic disorder in Australia, occurring in about one in 300 people.

Hereditary haemochromatosis is a disorder of iron metabolism where the affected person absorbs too much iron from a normal diet.
     The excess iron accumulates in the body, particularly the liver, pancreas and heart. The symptoms can include lethargy, fatigue and joint pain. Liver problems, heart failure and diabetes are complications that can occur if haemochromatosis is left undiagnosed and untreated.
     The diabetes that occurs as a complication of haemochromatosis develops in quite a specific way: as iron accumulates in the body, it becomes toxic to the cells of internal organs, including those in the pancreas involved in making insulin.
     How serious diabetes gets will depend on the amount of iron accumulation and damage done to the pancreas.
     Treatment of haemochromatosis by the preferred method of venesection (similar to donating blood) can stop the progression of diabetes or, in some cases, reverse it. Unfortunately, it cannot reverse any damage already done to the cells of the pancreas.
     Recent studies have not demonstrated a significantly higher rate of occurrence among people with diabetes.
     In fact, people with elevated liver function tests and people who have a family member with haemochromatosis are at much greater risk. A new HFE gene test has been developed and will hopefully lead to earlier diagnosis before diabetes develops.
     In people with diabetes, haemochromatosis may impact on their day-to-day diabetes management. In the early stages of haemochromatosis treatment, the HbA1C blood test can show as low or normal and is not a reliable method of measuring blood glucose control until iron levels have returned to normal.
     During the initial course of venesection treatment, insulin secretion can improve markedly and glucose tolerance return to normal. People at this stage of treatment need to pay special attention when monitoring their blood glucose, in order to reduce risk of hypoglycaemia and assess whether medication needs to be reduced or ceased.
     Fruit juices containing citrus fruit should not be taken with meals as the vitamin C will enhance absorption of iron from the diet. Iron-fortified foods must be avoided.
     Men may experience loss of libido and deterioration of sexual function. Monthly testosterone injections will improve sexual function caused by haemochromatosis, unlike that caused by diabetes.
     Trials of population-based surveys that are being carried out in Australia will hopefully give us a much clearer picture of haemochromatosis.