Diabetes The Silent Killer
Diabetes Mellitus comprises a group of disorders caused by the inability of human body either to produce any insulin or adequately initiate conversion of blood sugar into energy. It is a complex interaction of genetics, environmental factors and lifestyle choices, leading to high blood sugar levels in the body imposing tremendous burden on the individual’s health and lifestyle and in worst case scenario impairing functioning of multiple organs.
Diabetes is a worldwide phenomenon. The numbers of adults with diabetes in the world are estimated to increase by 51 per cent, from 366 million in 2011 to 552 million in 2030. By 2030 about 10 per cent of world’s population will be affected by diabetes. Eighty per cent of the diabetic population live in low and middle income group countries. Diabetes in Asia is five times more prevalent as compared to rest of the world. Most of the diabetics are in 40-59 year’s age group. Due to poor awareness and insufficient healthcare facilities about 50 per cent diabetics remain undiagnosed till downed by secondary complications.
Till 2009, India was known as ‘diabetic capital of the world’ and the city of Hyderabad as ‘diabetic capital of India’. Mercifully, In Fifth Edition of Diabetes Atlas published by International Diabetes Federation, China has piped India to claim this dubious distinction. The “Top Ten” countries of the world, in terms of diabetic population, are shown in the above Table. It is evident that diabetic population in India will increase by 65 per cent by 2030 as compared to China’s 44 per cent and USA’s 25 per cent.
In 2011, 61.3 million Indians (32.4 million males and 28.8 females) were affected by diabetes, of which 31.2 million remained undiagnosed. In 2011, in the age group of 20-79 years diabetes accounted for 737,000 deaths. By 2030, more than one million Indians will die due to diabetes. It is the most rapidly increasing (65 per cent over next 20 years) of all diseases. Eleven per cent of urban and three per cent of rural population of our country, above the age of 15 years are estimated to be affected by diabetes. Southern India shows disturbing prevalence of diabetes.
Economic burden on the nation as well as on an individual due to diabetes is tremendous. It affects productivity, burdens healthcare systems and eats into meager financial resources of the population. By a modest estimate, cost of medicines for a diabetic person is Rs 4000-6000 per month—simply unaffordable by the common man.
It is rather ironic that planners in India have not taken cognisance of diabetes which is going to affect 101 million Indians by 2030. Diabetes needs frequent tests, check-up, medication and even hospitalisation. Manifestations of diabetes are multi-disciplinary, as it affects heart, kidney, eyes, nervous system and various other organs. Neglecting diabetes means that the country would require more tertiary care hospitals to treat and manage such diseases. Unlike the West, there are no healthcare facilities for diabetics where such support is available, that is why about 50 per cent diabetics remain undiagnosed till hospitalised for some other disease. Diabetes has already acquired the proportion of an epidemic; it calls for formulating a national eradication/ control action plan on the lines of malaria, polio, TB, smallpox, leprosy etc.
Having diabetes means that your body does not make enough insulin, or properly utilises the insulin it produces. Insulin is a hormone, which is produced in the pancreas. It helps body cells use sugar, which comes from the food. Sugar or glucose, if properly transported to the cells provides energy to the body. The diabetes is of three types.
In this type of disease the human body fails to produce any insulin. The body immune system mistakenly attacks the cells in the pancreas; as these cells die blood sugar levels rises. It often affects children, though adults can also be affected. Patients with Type 1 diabetes need regular insulin injections to control their blood sugar levels. In India, about 4.2 people per 100,000 population are affected by this disease.
It is the most common form of the diabetes. In Type 2 diabetes, the body still makes insulin, but its cells cannot utilise it, due to “insulin resistance”. Consequently, high levels of sugar builds up in the bloodstream.
A SHOCKING REPORT
An alarming rise in Type 2 diabetes, traditionally known to affect adults, is worrying scientists. Doctors blame the rise in Type 2 diabetes on the stressful lifestyle. In India, diabetes and insulin resistance, a precursor to Type 2 diabetes, range between 12 and 16 per cent among urban children. A decade ago, the number of diabetics under 18 was 1 per cent.
Heriditary and the lifestyle are the major causes of Type 2 diabetes. 90 per cent of diabetics belong to this group. In this case, the body still can produce insulin, but it is not enough for the body functions or the insulin does not work properly. Type 2 diabetes builds up excess glucose in the blood, thereby causing serious health problems like heart disease, failure of kidneys and eye discomforts. This condition is called insulin resistance. This is related to overweight. Type 2 diabetes is seen mostly in people over 40 years of age.
But scientists in the US have diagnosed that unlike in developed countries such as the US, where obesity is driving Type 2 diabetes in children, 50 per cent children diagnosed with the condition in India have normal weight. “In the US, one in three (young persons) are overweight or obese. That, along with decreased physical activity, leads to Type-2 being diagnosed in the second decade of life,” said Dr Kenneth Copeland, cochair of the study that tracked 699 children of up to six years.
South Asians are at risk because of the way fat accumulates in their bodies. “Abdominal fat, irrespective of general weight, is a risk factor as it causes metabolic imbalances,” said Dr Timothy Lyons, head of scientific research and director, Harold Hamm DiabetesCenter in Philadelphia. The findings were presented at the American Diabetes Association’s 72nd scientific sessions on Saturday.
There’s also a strong genetic component that raises risk. “Asian Indians, along with Black Africans, Hispanics, Asians, native Americans and Pacific islanders are ethnic groups at greater risk of Type 2 diabetes,” said Dr Lori Laffel at the Joslin Diabetes Center in Boston, US.
There are some warning signs what parents can watch out for like increased thirst, increased need to urinate, increased appetite and fatigue, even blurred vision and frequent and slow healing infections.
Type 2 diabetes is not curable. It is a life-long condition but you can learn how to manage it with a complete change in the lifestyle. Apart from counseling, one can go for regular exercise, small frequent meals, high fibre, more of vegetables, low fats. This means avoiding fast food. One can also go for medication like Metfommin which is the key stone in treating Type 2 diabetes.
Gestational diabetes affects some pregnant women. It can also cause problems during pregnancy, labour and delivery. Women who are affected by gestational diabetes are more likely to develop Type 2 diabetes later.
Myths with Diabetes
Diabetes is an incurable disease. It can only be managed under proper medical supervision. Many alternate systems of medicines or their practitioners claim to have a cure for the disease, which is nothing but falsehood. People with diabetes should not jeopardise their health by seeking treatment from such unreliable sources.
People who are in the age group of 40-plus or lead sedentary life or overweight or have family history of diabetes or belong to certain diabetes-prone population groups, suffer from high blood pressure or have impaired fasting glucose/ impaired glucose tolerance or have bad lipid profile or ladies who have developed gestational diabetes during pregnancy could be potential victims of diabetes.
People with diabetes present one or more of the symptoms mentioned below:
► Excessive thirst or hunger.
► Loss of weight.
► Blurred vision.
► Frequent urination.
► Frequent infections or slow-to-heal wounds.
► Fatigue and irritable behaviour.
► Numbness in the limbs.
High levels of sugar in blood can lead to serious health complications. High blood sugar levels can harm multiple organs. People with diabetes are two to four times more risk-prone to heart disease. Among the adults (20-74 years) diabetes is main cause for blindness. Diabetics are most likely to suffer from chronic kidney disease. More than 60 per cent cases of nerve damage or amputations are from diabetic population.
Living with Diabetes
Managing Type 2 diabetes calls for making some changes in the food habits and lifestyle. Talk with your doctor about the changes which are needed for you. For example, it helps:
► Eat healthy, and lose weight.
► Be more active.
► Check blood sugar regularly.
► Check Glycated Haemoglobin (Hb A1C) level every three months.
► Take medicines for diabetes regularly.
► Get test for micro-albuminuria once in a year
Healthy Eating: Healthy eating, along with medicine if prescribed and regular physical activity, can help lower your blood sugar. Eating healthy is key to reducing your risk of health complications from diabetes.
Changing the way you eat can be hard. So make changes slowly. Start by adding high-fiber foods including fruits and vegetables. These fiber-rich foods may help stop spikes in blood sugar. Eat less meat and fewer sweets.
Physical Activity: Regular physical activity can lower blood sugar by decreasing insulin resistance. It can also reduce your risk of heart disease and high blood pressure. Eating healthy and being active can help you manage your weight. If your doctor says you need to lose weight, do it slowly. Work together to come up with a meal plan that will help you lose about one pound a week. Even losing a little weight may lower your blood sugar level and make you feel better.
It’s hard to do everything right every day. Just try to do some things right each day. Take small steps toward creating a healthy meal plan and activities that you can enjoy.
Type 2 diabetes is a chronic disease. Although there is no cure for it, a better control of blood sugar can help reduce the risk for diabetic complications. There are many sports persons, celebrities and common people who are leading an active life just because they have adjusted their lifestyle to control diabetes. Diet and physical activity may control the blood sugar at first, but the medicines need to be taken regularly. One may even need to use insulin. A patient has a major role in controlling his/ her blood sugar to prevent complications. With time, such lifestyle changes and treatments become a regular part of life. Support from family, friends and your healthcare team can help you deal with diabetes in long term.
Blood Sugar Control
For adults without diabetes the blood sugar range before meals is 80-120 mg/dl and below 180 mg/dl after meals. For diabetics blood sugar range before meals is 100-140 mg/dl and below 200 mg/dl after meals. By keeping blood sugar close to normal levels, one can reduce the risk of eye disease, kidney and heart disease, and other diabetes complications.
Be sure to write down when your blood sugar is higher or lower than your healthy range; you can also use the guidance contained in www.diabetes.com for diabetics. Share the record with your doctor. Make sure that you know:
► Your target blood sugar levels.
► When and how to test your blood sugar.
► Your A1C goal and how often you need an A1C test.
► How to handle very high and low blood sugar levels conditions.
Besides testing for blood sugar, your doctor may conduct other tests regularly because diabetes can affect many parts of the body over time. Here are some tests you may have to undergo:
► Micro-albuminuria Test: At least once a year, your doctor will test for protein in your urine. A positive test may mean that your kidneys have been damaged by diabetes or high blood pressure. The doctor may prescribe certain high blood pressure medicine(s).
► Cholesterol: Have your cholesterol and triglycerides levels checked at least once a year. Your LDL cholesterol should be less than 100 mg/dl (lower, if you have had a heart attack and have diabetes). The HDL cholesterol should be over 40 mg/dl for men and over 50 mg/dl for women. Triglyceride levels should be less than 150 mg/dl. If the cholesterol level is not controlled with diet and exercise, the doctor may prescribe medicine.
► Blood Pressure: Your blood pressure should be tested every time you visit your doctor. People with diabetes should try to keep their blood pressure below 130/80 mm Hg. High blood pressure can cause heart disease, eye disease, stroke, and kidney damage. Again, your doctor may prescribe medicine if your blood pressure doesn’t come down with diet and exercise.
► Feet: You should check your feet every day for calluses, bunions, sores, or discolored skin. These can lead to infections or ulcers, and, in people with severe nerve damage, they can lead to amputations. Your doctor should do a complete foot exam at least once a year.
► Eyes and teeth: Get an eye exam at least once a year. Ask a dentist to check your teeth and gums every six months.
Diabetes & Travel
To prepare for your trip, follow these steps:
► Discuss your travel plans with your doctor.
► Plan for changes in meal patterns, time zones, and activity levels.
► Take along twice as many medicines and supplies as you think you will need.
► Always carry medicines and snacks with you, and wear a medical ID bracelet or necklace.
► Wear comfortable, closed shoes, change them often, and never go barefoot. Check your feet every day.
► Find out how to get healthcare where you are going. Locate the nearest hospital or Red Cross centre in advance.
► Get any travel vaccinations you need at least one month before you go.
► Tell the airline and cruise-ship staff that you have diabetes. They can give you special meals.
► If you’re travelling by car, test your blood sugar before you leave. Stick close to your regular meal & medicine plan.
Diabetes at Workplace
Talk to your doctor about how to manage diabetes at work.
► Be sure to eat meals at about the same time every day; do not skip meals or snacks.
► Take your medicines and test your blood sugar as directed by your doctor.
► Describe the signs of low blood sugar to your colleagues. You may need their help if your blood sugar drops.
► Keep sugar snacks or glucose pills in your desk, in case your blood sugar gets too low.
► Tell the company nurse that you have diabetes.
► Keep tabs on your stress. Try deep breathing, relaxation, or take a short break from the office.
Along with your dietary plan the doctor may prescribe one or more medicines to help control your blood sugar. Most people take pills while others take insulin. Over a period of time, as your body changes, your doctor may make some changes in your treatment plan to change the dose or add new medicines or switch medicines.
Dealing with Sick Days
A cold or the flu can make it harder to keep your blood sugar in check. It is recommended that people with diabetes get a flu vaccination every year. When you’re sick:
► Check your blood sugar four times a day. If it’s higher than 300 mg/dL, use a home test to check your urine for ketones.
► Keep taking your diabetes medicines.
► Drink plenty of water or sugar-free drinks to stay hydrated.
► Try to eat as usual. If your stomach cannot handle it, try clear soups or gelatin.
► Check any over-the-counter medicines for sugar. Ask your pharmacist for sugar-free options.
► Call your doctor if your blood sugar is lower than 70 mg/dL several times a week, or if it stays higher than 240 mg/dL. Also, call if you’ve been vomiting or had diarrhea for several hours, or if your urine has high ketone levels.
Indian planners and leaders call nation’s 1200-million population as its ‘Human Resource’. By 2030, better part of this phalanx is going to be afflicted with diabetes and other related complications. Such situation will not only require increased healthcare budget but also eat into national productivity. There is a need to accept diabetes as a threat to national health and launch a “Diabetes Control Mission” without losing any time.
By Brig (Dr) Vinod Raghav
(The author is an acclaimed Pathologist in the Armed Forces.)