World Diabetes Day falls on November 14:
A good lifestyle can prevent diabetes
Dr. Noel Somasunderam
Sri Lankans are facing a growing risk of developing diabetes as many
adopt lethargic lifestyles. Compared to those in the rural areas, the
upper class living in the urban areas are at a threat of developing
diabetes at a young age. The Sri Lanka Diabetes, Cardiovascular Study (SLDCS)
has predicted a 16.4% of diabetes prevalence last year in the urban
population as opposed to the 8.7% in the rural area.
The three principal types of the non-communicable disease, diabetes
are type 1, type 2 and gestational diabetes. Anyone who has a family
history of diabetes should be careful because sometimes you may not get
any warning signs. It might occur as a sudden bout of dehydration, need
to go to the bathroom or just plain drowsiness and inability to work.
People at a risk of family-inherited diabetes should go for regular
blood check-ups and lead a rather active but healthy lifestyle. Eating
the right meals at the proper time and exercising is important. There
are aspects of high blood glucose and low blood glucose that is
prevalent in diabetes.
High blood glucose (Hyperglycaemia) happens when your blood glucose
levels rise above the normal range (110mg/dL or 5.5 mmol/L) and in the
case of low blood glucose (Hypoglycaemia), blood sugar levels drop below
the normal range. Warning signs are sometimes individualised varying
from person to person. The symptoms for high levels and low levels are
similar so it is important to check the blood sugar level to determine
what's the real problem. Nowadays, there are glucometers to give a
random test about diabetes blood sugar levels but you need a proper
doctor's analysis to determine the proper result. Glucometers serve as
controls but do not serve as the main reading on diabetes since any
individuals' reading differs. The General Hospital of Sri Lanka and the
National Diabetes Association of Sri Lanka together with the support of
the Health Ministry's Education Bureau are working to spread the message
of preventing and combating diabetes. Dr. Noel Somasunderam, Consultant
Endocrinologist & Diabetologist of the Colombo General Hospital gave an
exclusive interview to the Sunday Observer with regard to diabetes.
Q: Please explain what is meant by diabetes and how one can get it.
Also, please explain what other conditions diabetic patients will be at
A: Diabetes Mellitus is a disease diagnosed when the glucose levels
are higher than normal. Essentially there are two types, Type 1 Diabetes
is usually diagnosed in children-the body does not produce insulin.
Treatment is with insulin lifelong and with the help of insulin and
other treatments, even young children with type 1 diabetes can learn to
manage their condition and live long, healthy, happy lives. Type 2
Diabetes is the commonest type and usually adults, but even children get
it. In type 2 diabetes, either the body does not produce enough insulin
or the cells ignore the insulin. Insulin is necessary for the body to be
able to use glucose for energy. When you eat food, the body breaks down
all of the sugars and starches into glucose, which is the basic fuel for
the cells in the body. Insulin takes the sugar from the blood into the
cells. The temporary gestational diabetes occurs in pregnant women who
have never had diabetes before but who have high blood sugar (glucose)
levels during pregnancy.
When glucose builds up in the blood instead of going into cells, it
can lead to diabetes complications. In addition, those with diabetes
develop high blood pressure and their cholesterol levels tend to be
abnormal. Together with high glucose, high blood pressure and abnormal
cholesterol leads to progressive damage to almost all cells in the body.
The commonest cause of death in diabetes is heart attack and the other
affected parts are the eyes (leading to blindness), kidneys (leading to
kidney failure) and nerves (leading to amputation of the feet). The good
news is that with the correct treatment and recommended lifestyle
changes, many people with diabetes are able to prevent or delay the
onset of complications. With modern diabetes treatment it is actually
possible to live a normal life, free of complications.
Q: About 2.1 million of the population in Sri Lanka suffer from
diabetes, how come this is so? Are there more incidence of inherited
diabetes than developed diabetes now than before?
A: Several research programs have identified that the number of those
with diabetes has been steadily increasing over time. One in every 5
adults in urban settings have diabetes and in rural areas one in every
12 have diabetes. Close to half of those above 60 years have diabetes
and in children it is very rare (although risk factors for future
development are found in them). Although we don't have a head count of
all the diabetics in the country at least 1-2 million can be estimated
to be affected. In hospitals we find those with complications of
diabetes occupying nearly one fifth of all beds. This kind of shockingly
high number of diabetics is seen throughout the South Asian region and
the commonest risk for this is the rapidly changing lifestyle. The Type
2 Diabetes that is mainly a lifestyle related disease is the one that
has been rising at alarming rates.
Q: Together with the government hospitals, how has the National
Diabetes Clinic helped diabetic patients?
A: The National Diabetes Clinic at National Hospital of Sri Lanka is
the largest diabetes clinic in the country. We cater to 300 patients
We serve as the ultimate referral point for those with complications
of diabetes. We also are a model of a patient centered, patient-friendly
clinic where good standard treatment is given free in a very friendly
environment. In addition, we also are developing a partnership with the
Colombo Municipal Council's medical services to develop a system where
all the patients with diabetes in the CMC area are screened for diabetes
and are treated well. We also are trendsetters in providing training for
doctors and other staff in diabetes care therefore ensuring that the
patients throughout the country get equal standards of care.
Q: How can healthy people prevent themselves from getting diabetes if
they are at a risk?
A: The onset of type 2 diabetes can be prevented or delayed through a
healthy lifestyle. This involves change of diet, increase in level of
physical activity, and maintenance of a healthy weight... with these
positive steps, one can stay healthier longer and reduce risk of
Q: In lieu of International Diabetes Day on November 14, how will Sri
Lanka commemorate it? What special events will be held?
A: Various events will be held at the national and local level and
screening programs for those at risk are also available in many
hospitals. The Health Education Unit or the Diabetes Clinics of all the
government institutions will provide information, assess risk and offer
treatment if necessary.
Q: What is the best way to combat the disease naturally through diet?
Is diet alone sufficient to combat diabetes or should regular insulin
shots be taken too?
A: Eating well is one of life's greatest pleasures. Fortunately,
having diabetes does not prevent patients from enjoying a wide variety
People with diabetes have the same nutritional needs as anyone
else.Learning to eat well-balanced meals in the correct amounts is the
secret. In most people what is required is to increase vegetables and
reduce the starch. This alone may be all that is required but each
individual is different and the final decision will depend on few
factors. E.g. those who are overweight will need a diet that will help
them to lose weight, those with abnormal cholesterol may need
restriction of fatty food, and special needs will need to be met during
childhood, pregnancy, etc.
Although changes in food are required for most it is important to
continue to lead an active life with adequate exercise and drug
treatment may be required in addition depending on the level of control.
Q: Are there any vaccinations or methods to prevent children of
diabetic patients getting the disease? Are there studies being done to
find a cure for diabetes?
A: Unfortunately there is no cure but prevention is possible. Several
interventions are being studied for prevention of Type 1 Diabetes. The
key to prevention of the biggest problem, Type 2 Diabetes is in the
hands of each individual. As it is an end result of an unhealthy
lifestyle prevention and control of diabetes are possible with change of
lifestyle to a healthy diet and active exercise pattern. In addition
control of weight is a powerful way to prevent or control diabetes.
Did You Know?
1. There is no cure for diabetes
2. Diabetes is increasing in pandemic proportions more than HIV Aids
3. In 2007, 246 million people worldwide were affected by diabetes
and 308 million people were affected by Impaired Glucose Tolerance (IGT).
Numbers are expected to rise to 380 million for diabetes and 418 million
for IGT by 2025
4. The highest prevalence rates will be in developing countries by
5. Globally, 7 million people will develop diabetes each year
6. Every 10 seconds 2 people develop diabetes
7. More young persons are at risk
8. Adopting a healthy diet and increasing physical activity can
prevent the development of Type 2 Diabetes up to 80%
9. Up to 50% of all persons with diabetes are unaware of their
10. Diabetes kills 3.8 million persons yearly, which is higher than
11. Every 10 seconds a person dies due to diabetes-related causes
12. There is a reduction of life expectancy of 5-10 years
13. 50% of persons with diabetes die of cardio vascular disease,
heart and strokes.
14. Diabetes in the developed world is ranked as the leading cause of
blindness, renal failure and lower limb amputations.
15. It has been estimated that between 5-10% of the total healthcare
spending of the world is spent on diabetes related conditions.
Diabetes Education and Prevention
The World Diabetes Day campaign is led by the International Diabetes
Federation (IDF) and its member associations. It engages millions of
people worldwide in diabetes advocacy and awareness. World Diabetes Day
was created in 1991 by the International Diabetes Federation and the
World Health Organization in response to growing concerns about the
escalating health threat that diabetes now poses.
World Diabetes Day became an official United Nations Day in 2007 with
the passage of United Nation Resolution 61/225. The campaign draws
attention to issues of paramount importance to the diabetes world and
keeps diabetes firmly in the public spotlight.
This year sees the first of a five-year campaign that will address
the growing need for diabetes education and prevention programs.
The need to increase diabetes awareness grows every year with the
increasing impact of the disease worldwide.
The latest data, recently published by the International Diabetes
Federation (IDF) in the 4th Edition of the Diabetes Atlas, show that 285
million people worldwide now live with diabetes. IDF predicts that the
total number will exceed 435 million in 2030 if the current rate of
growth continues unchecked.
Ahead of World Diabetes Day, IDF President Professor Jean Claude
Mbanya called for increased health promotion and political action in the
face of the epidemic. "Diabetes is claiming four million lives each
year," he said.
"It is ravaging communities and threatening economies. We must
improve care and stop the many millions at risk from developing the
disease. With a growing cost of over 376 billion dollars a year, either
we make healthy life choices available and affordable today, or pay
billions more tomorrow."
World Diabetes Day is a campaign that features a new theme chosen by
the International Diabetes Federation each year to address issues facing
the global diabetes community.
While the themed campaigns last the whole year, the day itself is
celebrated on November 14, to mark the birthday of Frederick Banting
who, along with Charles Best, first conceived the idea which led to the
discovery of insulin in 1922.
Diabetes Education and Prevention is the World Diabetes Day theme for
the period 2009-2013. The campaign slogan for 2009 is "Understand
Diabetes and Take Control". Diabetes is difficult.
The disease imposes life-long demands on the 285 million people now
living with diabetes and their families. People with diabetes must
deliver 95% of their own care, so it is of paramount importance that
they receive ongoing, high-quality diabetes education that is tailored
to their needs and delivered by skilled health professionals. In
addition, IDF estimates that over 344 million people worldwide are at
risk for type 2 diabetes.Type 2 diabetes can be prevented in the many
cases by helping and encouraging those at risk to maintain a healthy
weight and take regular exercise. The key messages for everyone are:
a. Know the diabetes risks and know the warning signs b. Know how to
respond to diabetes and who to turn to c. Know how to manage diabetes
and take control
Single embryo In-Vitro fertilization as successful as multiple
Many couples experiencing fertility issues who opt for In-Vitro
Fertilization (IVF) presume that the implantation of multiple embryos
will increase their chances having a healthy baby.
However, results of a recent analysis published in the New England
Journal of Medicine indicates that the use of two or more embryos
actually increase the likelihood of a multiple birth pregnancy. The
belief that multiple embryos increase the chances for parenthood comes
from the early days of IVF. During this time, doctors routinely
implanted half a dozen or more embryos into a woman's womb in hopes of
increasing the odds that at least one would grow into a healthy baby.
However, over the years, the procedure has greatly improved, which
has led to better results using fewer embryos.
The new study serves as a follow-up to research performed in 2004
that yielded similar results, and also supports the growing concern over
the health risks linked to multiple births that affect both mothers and
babies. Mothers who experience multiple birth pregnancies have a greater
risk of developing gestational diabetes, which is a diabetic condition
brought on by the pregnancy itself, as well as bleeding and pre-eclampsia
(a condition characterized by high blood pressure and the presence of
protein in the urine).
The increased health risks for babies include cerebral palsy, which
causes permanent disorders in the development of movement and posture,
as well as birth defects, developmental delays, and even death.
The latest analysis performed by Swedish researchers followed its
female subjects for a longer period of time, as well as through more
embryo implantations. The research team found that the use of one embryo
instead of two is almost as successful, and sig nificantly reduces the
risk of multiple births. For the study, Dr. Ann Thurin-Kjellberg of
Gothenburg University and her colleagues analyzed the records of 661
women who underwent implantation with a fresh embryo on their first try.
For those who were not successful the first time, implantations with
one or two frozen embryos were performed. The team continued to follow
those women whose earlier IVF procedures failed, up to a total of four
Of the women who received one embryo, 44 percent conceived on the
first attempt and gave birth to live babies. For the women who got two
embryos, 51 percent had a successful attempt. However, only 2.3 percent
of the women who received the single embryo had multiple births,
compared to 27.5 percent of those who had multiple embryos implanted.
There were a total of four sets of twins born to the single-embryo
mothers, versus 51 sets of twins, and one set of triplets, born to the
double-embryo mothers. Although it is common knowledge that the majority
of twins born will survive, it is of interest to note that their medical
expenses over the first five years of life are usually much higher.
Another finding of the analysis was that women receiving one embryo
were shown to be much less likely to have babies born prior to 37 weeks
of gestation, at a rate of 11.8 percent, compared to 25.5 percent for
the group receiving two embryos.
Although the researchers concluded that there is little downside but
plenty of upside to transplanting one embryo at a time, the use of
multiple embryos in IVF remains a subject of debate.
Advocates of the use of multiple embryos argue that multiple implants
boost the odds for a success, as well as for multiple births, and that
it is much less expensive than having IVF performed multiple times when
early attempts fail. In addition, avoiding the stress and disappointment
of a failed attempt is a key factor for some.