Diabetes : No more a disease of the elderly

by Rohana JAYALAL

Diabetes is the most widespread disease in this country as well as the world over. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starch and other foods into energy which is needed for daily activities. The course of diabetes continues to be a mystery, although both genetics and environmental factors too account for it. There are two million children and adults in Sri Lanka who have diabetes. As revealed by the Fasting Plasma Glucose Test (FPG). A fasting blood glucose level between 100mg/dl and 125mg/dl signals that the patient has pre-diabetes. A person with a fasting blood glucose level of 126mg/dl or higher level is a diabetic.

There are two major types of diabetes called Type 1 and Type 2 diabetes. Type 1 diabetes is usually found in children and young adults and was previously known as juvenile diabetes. In Type one diabetes, the body doesn’t produce insulin. Type one is serious. It was the main type of diabetes mellitus (DM) in children from year 5 to year 7 age group. Annually around 70,000 children develop Type one diabetes. There is a rise of 3 percent of children suffering from diabetes each year at present. There are 440,000 children under 14 years who live with Type one diabetes in the world, and South East Asia has the highest number of children suffering from this type of diabetes and Sri Lanka too has the highest number of children and young adults suffering from Type 1.

Type 2 diabetes is the most commonest form of diabetes in Sri Lanka. In Type two diabetes, either the body doesn’t produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose to produce energy. When you eat food the body breakdown the sugar and starch into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells, when glucose builds up in the blood instead of going into cells it can cause two problems. Rightaway your cells may be starved of energy and over time high blood glucose levels many hurt your eyes, kidneys, nerves or heart.

Type one and Type two diabetes are serious, but people with diabetes can live long, healthy and happy lives. While diabetes occurs in people of all ages and races where some groups have a higher risk for developing Type 2 diabetes than others. Type 2 diabetes is more common among Negroes, people from Latin America, Asians and Pacific Islanders, as well as among the elderly population (those above 45 years).

However Type 2 among children and adolescents are on the rise, changes in behaviour patterns have affected this shift. Once considered a disease of the elderly, Type 2 diabetes has shifted down a generation, particularly in developing countries, with adverse economic impact in the last 20 years. Type 2DM has doubled in children.

Certain ethnic groups are at higher risk of developing Type 2DM - Europeans 5% and African, Asian and native Americans 80%. Asian children with “affluent” lifestyles run a greater risk of developing Type 2 and Asian children are more susceptible to develop Type 2 than Caucasians. Asian children in UK have 14 times higher risk of developing Type 2 than Caucasians. Although Type 2DM appears as milder illness its complications in children are severe with hypertension (high blood pressure), dyslipidaemia (abnormal blood fat levels), cardiovascular disease, polycystic ovarian disease and Metabolic syndrome.

Type 1 diabetes can occur in an older individual due to the destruction of pancreas by alcohol, though disease, or removal by surgery. It also results from progressive failure of the pancreaticbeta cells, which produce insulin. People with type 1 diabetes require daily insulin treatment to sustain life.According to report at least 90 percent of patients with diabetes have Type 2. This 2 kind of diabetes is usually recognised in adults usually after age 45. It was used to be called adult-onset diabetes mellitus, or non-insulin dependent diabetes mellitus. These names are no longer used because Type 2 diabetes does occur in younger people and some people with type 2 diabetes need to use insulin.

Type 2 diabetes is usually controlled with diet weight loss, exercise, and oral medications although more than half of all people with type 2 diabetes require insulin to control their blood sugar level at some point in their illness.Pre diabetes is a common condition related to diabetes. In people with pre diabetes, the blood sugar level is higher than normal but not high enough to be considered diabetics. Pre diabetes increases your risk of developing type 2 diabetes and heart disease or strokes. It can usually be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activities. This weight loss can prevent or at least delay the onset of type 2 diabetes. Most people are believed to have diabetes, but one third of diabetic adults don’t know they have diabetes so one million new cases occur each year, and diabetes is the direct or indirect course of at least 200,000 deaths each year.

Glaucoma

Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycaemia over a long period hyperglycaemia damages the retina of the eye, the kidneys, the nerves and the blood vessels. Damage to the retina from diabetes leads to blindness. Damage to the kidneys from diabetes is cause of kidney failure. Disfunctioning of nerves due to diabetes is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg imputations. So damage to nerves in the autonomous nervous system can lead to paralysis of the stomach and inability to control heart beat and blood pressure during postural changes. Diabetes accelerates atherosclerosis, which can lead to blockages or a clot. Such changes can then lead to heart attack, stoke and decreased circulation in arms and legs.

Diabetes predisposes people to high blood pressure and high cholesterol. These conditions independently and together with hyperglycaemia increase the risk of heart disease, kidney disease and other blood vessel complications.The courses of diabetes are genetic predisposition, physical inactivity, central obesity, improper food habits, mental stress, ageing and gestational diabetes and symptoms of diabetes mellitus are extreme thirst, frequent urination, loss of weight, tiredness and itching of the genitals (these are non-specific symptoms) Prof. Ravindra Fernado said at a recent seminar held at the Health Education Bureau organised by the National Diabetes Prevention Task Force, recently.

According to Prof. Fernando, management of diabetes can be done by life style measures such as healthy diet, exercise, reducing stress by drug treatment such as oral drugs and insulin and by prevention of complications such as optimum blood sugar control regular follow up and monitoring for complications.Diabetes statistics in Sri Lanka are as follows: urban 16%, overall 10.2%, rural 8.6% and plantation 4.4% in year 2006. The percentage of diabetics is increasing at present and the relevant data are being collected and rural and urban percentages are increasing due to bad habbits and activities, Dr. Charukshi Arambepol said.The number of diabetes patients would be 380 million (7.3%) by 2025 with an increase of 7 million per year. According to these medical specialists the highest increase of diabetics will be in Asia. Sri Lankan diabetics also will increase by then.

Psychological response to obesity or living with obesity

Many factors, both social and genetic have an influence on obesity. In the past, obesity was seen as a sign of wealth and health, the opposite of wasting and disease; today, some cultures still prefer their women obese.

In Sri Lanka obesity is more common among women than men and in the working classes than the professional and the managerial classes. It is sometimes seen in children, mainly in the youngest child in a family.Doctors convey the official medical view that obesity is associated with major illnesses, while ignoring the problems of thin people, forgetting that they too carry a high risk, in relation to some conditions (e.g. Peptic ulcer and neurosis). Some psychologists claim that obesity in the general population of middle age and older is associated with less reported experience of anxiety and depression than average.

Obese people fear an endless cycle of impulsive overeating and weight gain with progressive obesity, increasing humiliation and diminishing self-esteem. Research conducted by psychologist has centered on the question of whether the psychological effects of obesity or the psychological factors leading to it are more important.Overall, it must be emphasized that eating behaviour cannot be studied in isolation. It is associated with many other aspects of behaviour such as sleep patterns and physical and sexual activity.

Overeating or hyperphagia commonly occurs between both adolescents and in massive obese people and in others with a history of weight disorder. Overeating in childhood often seems to have been accentuated by the challenge of adolescence, when rapid growth (sometimes as a result of childhood over-nutrition), pubertal plumpness and initial low self-esteem have set the scene.

Many more females than males are seen in the medical clinic for obesity. Obesity is more common among females than males in most present-day western societies. For the female, fatness seems to be complexly bound up with her sexuality, both biological and social. Reaching puberty earlier than the male, she finds her shape beginning to change under the influence of hormones governing new fat deposition which confer upon her and those around her a sense of her biological ripeness and readiness for reproduction. At the same time it commands the attention of the male. By the age of 17, the majority of young women are striving to reduce their fatness, when clearly not all of them are obese in a statistical or medical sense. Fashion is not a sufficient explanation; the need to loose weight is often seemingly rooted in such need as conformity, the search for increased self-esteem, and the need to self-control.

The vast majority continue to struggle on, changing little in shape and remaining sensitive about it, until the mid-20s, after which they consider things in terms of marriage, motherhood, and other life roles, when many feel they can cease to be concerned about their weight. However, weight consciousness may remain a concerned to be rekindled at times of crisis. Perhaps it survives more strongly in those middle-aged obese women who still hope to become thinner, these women often seem mainly concerned with their over-eating.Women’s dislike of their fatness can also reflect a male preference for shapely women. The majority of men, while sometimes admiring such women, feel much less concerned about obesity in their own sex. The male with a hearty appetite is often admired; moreover, the female does not often condemn male fatness. The adolescent male will often have been more preoccupied with increasing his bulk than with reducing it.Massive weight gain might occur in adolescence, in relation to such experiences as loss (provoking over-eating) or sexual conflict (for which the immobility of massive obesity became protective). Treatment combining diet and psychotherapy is used to treat them.

It is likely that personality is merely one integrated aspect of our constitution that we deploy particularly in our search for optimal personal adjustment in life. It involves our relationships with others and it involves others. Our shape, eating patterns, energy balance and physical activity levels are a major aspect of such adaptation, and it is likely that these factors both contribute to and stem from other aspects of our personalities. It is very difficult to change our personalities and we cannot expect more or less than this of our obesity. However, those who wish to change their degree of obesity and its accompaniments can take heart from the knowledge that personality itself is not immutable.

Dr. R. A. R. Perera,

Consultant Psychologist

Treating cancer with homoeopathy on Nov. 22

The Homoeopathic Association of Ceylon will be conducting an awareness programme for the benefit of the public titled ‘Treating Cancer with Homoeopathy’. There will be a presentation by Ms. Vaish Sathasivam and Sally Michel followed by an open forum for members of the public. It is important to understand that food, environment, lifestyle and stress play a part in cancer and that Homoeopathy is an effective and safe option in treating cancer.

Sathasivam has been practising homoeopathy for ten years. She graduated from The College of Homoeopathy, Regent’s College, London and continued with her post-graduate studies with The Dynamis School for Advanced Homoeopathic Studies under Jeremy Sherr. She was also trained at Ainsworths Homoeopathic Pharmacy, London.Sally Michel is a co-founder of Nudefood, a company that aims to develop the organic food industry for the local market.

The main focus of the business is to develop awareness of issues that greatly affect the community such as health and nutrition, the environment and the fair-trade industry.

She is also a paediatric clinical nurse specialist in both fields of oncology and emergency and has worked with children with cancer for over 10 years in Australia and the Middle East. The event is free to the public, to be held on Saturday, Nov 22 at 5.00 p.m. Those interested may register with Vaish: 2665290.