Beware! It’s on the rise
Obesity and lack of exercise – these are the twin sisters that insidiously put us on the path to an illness we hardly realize we have unless we make a conscious effort to find out.
The biggest problem with diabetes is that there are no symptoms. "You just don't feel ill," says Prof. Chandrika N. Wijeyaratne, Consultant Physician and Endocrinologist, about this silent killer.
Explaining that epidemiological data clearly prove that having diabetes is a risk factor for cardio-vascular disease (heart attacks and strokes), she stresses that having "frank" or "established" diabetes is equivalent to having had one heart attack.
Earlier, considered a disease of the west, affecting the rich and the famous, now diabetes has the Asian region in its vicious grip. It has risen like a spectre in the lives of the wealthy and also the impoverished. The statistics, not only for Asia but also for Sri Lanka, provided by Prof. Wijeyaratne, are revealing and eye-opening.
- By 2010, diabetes is expected to rise to 80% worldwide and a huge 111% in Asia.
- In Sri Lanka, though the prevalence in the 1980's was 3 to 5% of the population, a 2002 study indicates it is over 14%.
- Almost every family has a first-degree relative (parent or sibling) with diabetes, while estimates are that half of those with diabetes are simply unaware of it.
- Estimates indicate that in the Sri Lankan population of 20 million, a shocking 1.5 million have diabetes.
- In a 2003 survey done among all pregnant women in Homagama, it had been found that 10% had gestational diabetes.
- A survey carried out at the National Hospital in Colombo in 2004 indicated that 16% of patients, admitted to hospital for both medical and surgical reasons, had diabetes - one in five. Of the 16%, those who had foot complications amounted to 42%.
Why should we be concerned and worried?
Diabetes, if not controlled, is a marker of premature death, strokes and heart attacks, says Prof. Wijeyeratne who is attached to the University of Colombo. "It also results in a poor quality of life, restrictive effects on lifestyle and end-organ damage. Kidney failure, feet problems, eyes, all are affected. There is also a massive economic burden on the patient, family and society."
Her advice is that everyone should try to catch the illness in the pre-diabetic stage. Then by simply reducing weight and engaging in exercise, one might be able to prevent it progressing. In the case of someone who has frank diabetes, what must be remembered is that it can be controlled with medication and regular check-ups.
Means of prevention
Eat less and exercise more, simple ways in which to prevent the onset of diabetes. "Earlier people used to drink a kahata (plain tea) but now we take milk tea loaded with sugar or sugary drinks. Unhealthy fast foods are available aplenty and children snack on these, instead of the kadala and mung which is nutritious," says Prof. Wijeyeratne adding that the main meal of the day should be breakfast, followed by a light lunch and a lighter dinner.
How many of us follow this? For most people in Sri Lanka, the heaviest meal is dinner, along with a sedentary lifestyle of watching TV and for many children, indulging in computer games rather than some sport or even just playing outdoors.
Whereas earlier we would have walked some distance, trishaws have made our lives easier, however, leaving us without any form of exercise, she says.
"The danger is that the age of Type 2 diabetics is becoming younger and younger. Excessive eating and no exercise are causing metabolic syndrome even in children. If the body mass index (BMI) is over 25 and there is a problem of central adiposity (fat deposited around the tummy), anyone can develop high blood pressure (from 140/90) and high cholesterol (high lipids - high triglycerides and low HDL). Metabolic syndrome if not dealt with can easily get into the pre-diabetes stage and then onto diabetes," said Prof. Wijeyeratne.
With a fast aging population, diabetes could cause a massive burden if the aged are also sick. Then they will need lifelong treatment, continuing investigations and measures to manage complications, she added.
|What is diabetes?
Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use insulin, a hormone made in the pancreas, to help them convert blood glucose into energy.
People develop diabetes because the pancreas does not make enough insulin or because the cells in the muscles, liver and fat do not use insulin properly, or both. As a result the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose - hyperglycemia - damages nerves and blood vessels, which can lead to complications such as heart disease and stroke, kidney disease, blindness, nerve problems, gum infections and amputations.
The three main types of diabetes are - Type 1, Type 2 and gestational diabetes.
- Type 1 diabetes - This is usually diagnosed in children, teenagers or young adults. Type 1 is an auto-immune disease that causes the body's system for fighting infection to turn against a part of the body. Here the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin.
- Type 2 diabetes - People can develop this most common form of diabetes at any age. It begins with insulin- resistance, a condition in which muscle, liver and fat cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin but with time loses its ability to secrete adequate insulin in response to meals.
- Gestational diabetes - This develops in some women during the late stages of pregnancy, caused by the hormones of pregnancy or by a shortage of insulin. This condition goes away after the baby is born, but a woman who has had it is more likely to develop Type 2 diabetes later in life.
What causes diabetes?
- Genetic pre-disposition
- Inter-generational effect - small and large birth weights (foetal programming)
- Lifestyle changes (sedentary)
- Rapid urbanization
- Obesity from childhood and adolescence
|Get your reports checked
|Readings on blood sugar tests issued by laboratories may lull the public into a false sense of security. Sometimes different "acceptable" ranges are given by various laboratories for blood sugar and cholesterol levels, MediScene understands. Without proudly claiming, "I may be having a touch of sugar", it is essential to check out such reports with a doctor, not necessarily a consultant, but the family doctor and get advice from him/her.
|What does DPTF do?
The Diabetes Prevention Task Force (DPTF) formed by the Sri Lanka Medical Association and encompassing organizations such as the Diabetes Association of Sri Lanka represented by Dr. Mahen Wijesuriya, the Ceylon College of Physicians represented by Dr. M.K. Ragunathan and the Endocrine Society of Sri Lanka represented by Prof. Chandrika Wijeyaratne and Dr. Noel Somasundaram, has drawn up an action plan not only to control but also to prevent diabetes in the country.
The DPTF, with the active support of the Health Ministry, has already trained curriculum developers of the National Institute of Education (NIE) with a view to changing the thinking of teachers and children.
It has also conducted in-service training for doctors, nurses, midwives and Public Health Inspectors (PHIs).