Natalie Browne describes living with type 1 diabetes as like "walking a tightrope".
"You have to keep your sugar levels in line, otherwise you go high and you need insulin, you get angry, it creates bad moods. If you go low … it can also be quite dangerous," she said.
But it is a balance Ms Browne is used to navigating. She has been living with the condition for almost all of her life, since being diagnosed at age four.
"It's every day, it's 24/7. There's no taking a break, there's no day off," she said.
Ms Browne said the challenge had been constant, from her teenage years to pregnancy and motherhood, to working as a businesswoman.
"I wanted to rebel against having diabetes. It was hard," she said.
Ms Browne said the chronic condition remained largely misunderstood, still clouded by stigma and judgement.
"Most of the time if you mention that you're a diabetic, people will say things like, 'Well you don't look like a diabetic,'" Ms Browne said.
"I'm a type 1 diabetic, my pancreas does not work. I can't lose this disease by dieting or losing weight … I need insulin to keep myself alive."
Number of Australians living with diabetes has tripled in 20-year period
Renza Scibilia from Diabetes Australia agreed the condition had an "image problem".
"People tend to blame and shame people for developing diabetes," she said.
"Four out of five people with diabetes say that they feel stigmatised at some point."
Ms Scibilia said even beyond the stigma, living with diabetes was demanding and could often contribute to mental health issues.
"So it's understandable why people might be feeling burnt out or distressed by their condition."
Now, a new study shows the number of Australians living with the condition is increasing.
According to a report by the Australian Institute of Health and Welfare (AIHW), the number of people known to have diabetes in Australia tripled to more than 1.3 million between 2000 and 2020.
The institute said that amounted to an Australian being diagnosed with the condition every eight minutes or one in every 20 Australians living with diabetes as of two years ago.
But AIHW spokesman Richard Juckes said the increase in diagnoses could be attributed to a better understanding of the condition.
"Ninety per cent of diabetes is type 2 diabetes, which is the slow onset one that mostly affects older people. That's the main driver of the growth," he said.
"Part of that would've been better diagnoses. Twenty years ago, lots of people had diabetes without knowing it and now that's less the case."
Mr Juckes said almost 64,000 people were diagnosed with diabetes each year, an average of 175 diagnoses a day, excluding gestational diabetes.
And he said in 2020, diabetes was the underlying cause of death in about 5,100 cases, and was a pre-existing condition in 20 per cent of the 3,600 deaths due to COVID-19 between January 2020 and March 2022.
"It is also frequently associated with other chronic health conditions."
Ms Browne, who knows the risks and difficulties caused by diabetes well, welcomed the study, which was the first-time state-based registry data had been used to show the impact of diabetes on the Australian population.
But she said many Australians were successfully managing their diagnoses.
"It's never stopped me," she said.
"I've always said that diabetes doesn't rule me. I'll rule it, but it definitely makes things harder."
