As many as 1 in 4 people might be pre-diabetic in urban and suburban Sri Lanka, speculates Consultant Dietician Sigrid de Silva. “It seems to be overrunning people,” she says adding that in many cases the development of the disease outpaces the awareness of it, so that people are often unaware they have developed diabetes until the more serious symptoms become apparent.
As the disease has spread to developing countries, an estimated 350 million people are affected by diabetes globally. As in the West, Sigrid believes that in Sri Lanka as well, the appearance of the disease is intimately linked with our poorly planned diets and sedentary lifestyles.
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| Poor diet a major factor in diabetes |
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| Sigrid busts the myth that toast has fewer carbohydrates than untoasted bread |
Sigrid recently released her new book, ‘Diabetes Wellness Management’ which tackles the subject of diabetes management with characteristic forthrightness. She addresses a wide range of subjects, from the problems posed by diabetics in denial to the health crisis created by the obesity epidemic and even offers a few tips on how to analyse the latest news on health and nutrition.
“In all developing countries, including Sri Lanka, cases of diabetes are on the rise,” she says explaining that a vast majority of patients reside in urban and suburban locales. “In many cases it starts when people begin to gain a lot of weight,” she says, explaining that obesity brings with it a myriad health risks. Type 2 diabetes, which is often seen in such patients, is becoming increasingly common as people are being diagnosed at an ever younger age. “Before they used to say you only had to start testing after 40 now I would say start testing at 20...if you’re fine, you won’t have to test again for another 2 years or so, but you should start early.”
In Type 2 diabetes, the Langerhans Islets of the pancreas do not produce enough insulin. In other cases of insulin resistance, insulin might simply be less effective or ineffective especially in people with excessive fatty tissue and/or abdominal obesity, says Sigrid. Effective Insulin is crucial because it controls blood glucose. With no known cure, the long term prognosis for poorly managed diabetes remains frightening - serious long-term complications include cardiovascular disease, chronic renal failure and retinal damage, says Sigrid. Wounds heal poorly in those with diabetes, often giving rise to the need for amputation.
Often the body’s response to the insulin produced is less than optimal. Many people with type 2 diabetes may not even know they have it until the more severe symptoms manifest. But diabetes is not the sole province of the overweight. Though Type 2 is more common than Type 1, the latter too is on the rise. Type 1 diabetes is usually diagnosed early. In this case the body makes little or no insulin and insulin must be injected daily to meet the needs of the body. The causes of Type 1 diabetes remain a cause for speculation. Genetics, viruses, and autoimmune problems have variously been considered the culprits.
A third type - gestational diabetes - occurs in pregnant women who do not otherwise have diabetes. Unfortunately, this sudden rise in their blood glucose reveals a vulnerability which could lead to the development of Type 2 diabetes and cardiovascular disease later in life.
Before Type 2 diabetes takes hold firmly, many people go through a phase labelled pre-diabetes. Here there blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes, says Sigrid, emphasising that this is a crucial stage where intervention is possible. In her book she offers concrete steps to help pre-diabetics reduce their risk of actually developing the disease. These include maintaining a healthy body weight, eating at regular intervals and reducing the intake of processed foods and simple carbohydrates.
As with her previous work, Sigrid has structured the book around a series of questions. She begin by addressing questions on how to identify you’re diabetic and how to interpret test results and the like. She also addresses the very real problem of ‘diabetic denial’ – as a disease, diabetes can be deceptive. “There’s no pain in the beginning,” says Sigrid, explaining that for many patients this leads them to treat the matter lightly, only realising the seriousness of their condition once their health has deteriorated significantly. She also pays particular attention to the thorny problem of uncontrolled diabetes which has been known to wreak havoc on the body.
While issues with medication can result in uncontrolled diabetes, it is often the result of a poor diet. Sigrid says many patients have confused ideas about what is good for them and what isn’t. Some for instance, are baffled that despite sticking to the likes of kurakkan and wholemeal flour, their blood sugar levels remain high. It is not at all about the type of flour, says Sigrid, explaining that other factors like dietary fibre can influence blood sugar and should be considered. She also busts myths such as the one about toast having fewer carbohydrates than untoasted bread or that seeni kehel (sugar banana) is good for diabetics.
The book is also filled with very practical advice on how to cope with diabetes on a daily basis. Multiple meal plans that cover three meals plus snacks and desserts are packed in, as are comprehensive lists of healthy foods.
Sigrid says the book has been written not only keeping her patients in mind, but their families as well. For starters, she recommends that the lifestyle and dietary changes be adopted by the family as a whole, considering that a genetic predisposition to developing the disease has been established. However, even more importantly, the diabetes diet shouldn’t really be considered a restricted diet – instead it’s about eating well balanced, nutritional meals at the correct time. There’s even room for the occasional treat, says Sigrid, emphasising that with consistency and care, the disease can be well managed. |
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