Beware! It’s on the rise

By Kumudini Hettiarachchi

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.