As I write this, we are having the ‘world health day’ where the focus is on the rising incidence of diabetes all over the world. According to the World Health Organisation, almost one in eleven people in the world has diabetes mellitus. The incidence is higher in certain areas and ethnic backgrounds. For instance in some countries like Turkey, Qatar and Kuwait the incidence is almost as high as one in six or even one in five.
In Pakistan, the incidence is probably quite high but exact statistics are not available. However, South Asians in the US have a high incidence of this disease so we can extrapolate that to Pakistan and presume that diabetes is also quite frequent among Pakistanis in Pakistan.
What exactly is diabetes? It is also commonly known as ‘having sugar’. When we eat food, most of it is used to provide energy for normal body functions. To provide energy, food is converted to glucose or sugar and this sugar fuels most body functions. The organ called ‘pancreas’ produces a hormone called insulin that makes it possible for the body to use glucose. If there is not enough insulin or if it does not work properly then the body cannot use all the sugar that it gets from food. When that happens the amount of sugar in the blood that is normally kept in a narrow range starts to go up. When the sugar in the blood exceeds normal levels, that condition is called diabetes.
Diabetes can occur in children because their body does not produce enough insulin. This is called juvenile or ‘Type I’ diabetes and is often an inherited tendency. Older people get diabetes due to different reasons, primarily ending in a situation where the production of insulin is either inadequate or the available insulin is not working properly. This is called adult onset or Type II diabetes. However, over the last few years, even children are starting to develop Type II diabetes. Today I will primarily discuss Type II diabetes because that is the most common type and its treatment and management is quite variable. For the juvenile type, treatment is limited to the use of external (by injection) insulin.
The next question is how does a person know that he or she has diabetes? As I mentioned above the body is unable to use up all the glucose that is available. This leads to a high blood sugar in the blood. However, to use a term we learned in medical school, the body is ‘starving in the midst of plenty’. As a consequence person with untreated diabetes might start losing weight. So, unusual and unexpected weight loss can be a tip off that the person has diabetes.
When the blood sugar level is high, it can act as water pills do. This can lead to the person going to the bathroom more often than usual to urinate. And the more a person urinates, the more thirsty one becomes. And since the body is not getting enough nutrition because it cannot use the available energy within the body, the person will often start feeling hungry and eat more often. These three symptoms are referred to as polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (increased hunger and food consumption). If suddenly a person starts to develop these changes, diabetes can be a possibility especially if these changes are combined with weight loss. Also, very high blood sugar levels can produce serious problems that require urgent medical help.
Before I go on to the way we treat adult onset diabetes I want to talk a bit about why we are seeing a worldwide epidemic of this disease and if it is possible to prevent this disease from occurring in the first place. The most important physical abnormality associated with the onset of diabetes is obesity. Obesity has many causes but the most common ones are excessive consumption of high calorie, high sugar content foods. This is aggravated by decreased levels of physical activity. In short more calories are consumed or eaten than are expended or used up. And these excess calories are stored in the body as fat. More fat we store, the fatter we become.
However, all overweight people will not get diabetes and that all diabetics are not overweight. Still there is definitely a correlation between obesity and diabetes. That said, it is important to emphasise that obesity or having excess body fat can be deceptive. Many people with diabetes are not grossly or excessively overweight but have what is referred to as central obesity or big bellies. Fat in the belly (abdomen) is generally thought to be worse than having just peripheral obesity. But that is a story for another day.
It is indeed possible to prevent or at least significantly delay the onset of adult type diabetes. The simple formula is: eat less, exercise more, and avoid foods that contain a high amount of easily digested sugar or starch. White rice, white bread, sugary cola drinks and a lot of sugar in drinks like coffee or tea should all be consumed as infrequently as possible. Vegetables, whole grains and non-animal source of proteins and fat are preferable.
The dramatic increase in the incidence of diabetes is associated with an increase in the incidence of obesity. This has to do with improving economic conditions as well as changing lifestyles. However, medical advice must also bear some responsibility. Some thirty years ago due to a rising incidence of fatty heart artery blockages, doctors started to advise people to consume less fat. But fat in the diet helps to fill us up so we eat less and fell less hungry. By avoiding fat in the food many people started eating a lot more of starchy foods to feel full. This is in part responsible for the epidemic of obesity and indirectly for the epidemic of diabetes that we see today.
People that feel that they might have diabetes should get blood tests to see if that is true. The commonest blood tests include measuring the amount of sugar in the blood. Also a blood test measuring ‘glycated haemoglobin’ (HbA1c) is often used. This measures the average blood sugar level over a period of three months prior to the test and is quite useful in determining the presence as well as the results of treatment for diabetes.
As far as treatment is concerned, the first thing people with a diagnosis of diabetes need to do is to attempt to lose weight, start exercising and restrict both the type as well as the amount of certain foods that they eat. This can make it possible for early diabetics to control their blood sugar without medicines. However, most diabetics will eventually need some type of medicine to control their blood sugar levels. This can include different types of pills and eventually might require insulin injections.
Untreated or improperly treated diabetes can lead to severe complications like blindness, heart attacks, kidney failure and limb loss. Developing diabetes requires a lifelong commitment to its treatment. Most diabetics can live a long and a relatively healthy life if treated properly.