
Control risks of diabetes with healthy lifestyles
By Carol Aloysius
Diabetes continues to remain a leading cause for morbidity and
mortality globally and across Sri Lanka. Many factors have contributed
to this non communicable disease which has increased sharply in the past
two decades. Among the leading contributory causes are the unhealthy
lifestyles that modern society with its technological trappings have
forced us to adopt. Lack of exercise, diets saturated with high
cholesterol, food dripping with sugar and processed foods in place of
fresh high fibre meals accompanied with lots of fruits and vegetables
have made us obese and put us at risk of diabetes from a very early
stage. Many would-be mothers today, are also being diagnosed with
diabetes during pregnancy which puts them at risk of developing diabetes
at an early age, besides having an adverse impact on their unborn
children.
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Normal vision |
Vision with diabetic
retinopathy |
Health authorities are also concerned about the large number of
undiagnosed cases of diabetics who remain untreated for the disease and
become aware they have the disease only when it has advanced to a stage
when they develop other health complications due to diabetes.
While diabetes is not curable once a person develops it, it can be
controlled with regular prescribed medication and life style changes,
says a leading authority on the subject.
Professor of Reproductive Medicine, Dept. of Obstetrics and
Gynaecology, Faculty of Medicine, Colombo University and Hony.Consultant
Physician and Endocrinologist, De Soysa Hospital for Women, Dr Chandrika
Wijeyaratne discusses some of the golden rules to follow in minimising
modifiable risks to developing diabetes and the importance of
controlling it so that one can lead a normal life even when one becomes
a victim of this disease.
Following are excerpts from an interview with the Sunday Observer.
Q. Diabetes is still the leading non communicable disease in
Sri Lanka. Compared to a decade ago, has it shown a marked increase? If
so why?
A. It certainly is on the rise but remains second to high
blood pressure. The exponential rise is due to rapid societal transition
that has made our lifestyle more unhealthy.
Q. I understand a cross-sectional study was conducted by the
Diabetes Research Unit of the Colombo University with some 5,000 samples
collected of persons over 18 years during 2005 and 2006. Your comments?
A. This study confirmed that diabetes occurs from a young age
in adults over 20 years its prevalence was 1 in 10, an extremely high
figure.
Q. One of the findings of this study I believe was the very
large number of persons who had diabetes but were undiagnosed. It was
something like 15% diagnosed cases as against 36% undiagnosed cases. How
and what led to this?
A. No the study revealed that approximately 1/3rd of the
diabetics were unaware; this is a distinct improvement to the earlier
estimate that a half of diabetics were unaware of their condition.
Nevertheless, our concern as a group of professionals advocating for
Diabetes Prevention in the SLMA, is that even those who know of their
diabetes do not take adequate care to prevent complications.
The public response to take on the responsibility to minimise the
impact of diabetes is just as important to ensure secondary prevention.
Q. Commenting on the study again, I read that there was a high
number of pre-diabetics. Who are pre-diabetics? To what age group do
they fall?
A. Pre diabetics are those with FBS between 100 and 125 mg/dl
(Impared Fasting Glucose) and/ or with second hour value of the 75g OGTT
between 140-200 mg/dl. They are at a higher risk of developing diabetes
in the next few years. The age distribution of pre-diabetics is often
between adolescence and 40 years.
Q. What are the adverse effects that can impact on a
pre-diabetic?
A. Most importantly this group also has high blood pressure
and high lipids (colloquially cholesterol) with central obesity that
contribute to premature heart attacks and strokes etc. Therefore,
identifying them and preventing disease is very important.
Q. How can one detect if one is a pre-diabetic? Symptoms?
A. Blood glucose testing FBS or OGTT.
Q. Can you prevent getting diabetes if you find out you are at
pre-diabetic stage? If so how?
A. There are available measures to prevent this occurring
through lifestyle and a few medications such as metformin.
Q. Does diabetes affect men and women alike? At what age is it
more likely to get diabetes?
A. There is no gender difference. In fact women are now found
to be at greater risk simply because of less physical activity and
consumption of greater quantity of starch.
Q. What are the main risk factors that contribute to the
disease? Life styles?, Smoking? drinking, drug consumption? Wrong diets?
A. All of the above and I might say alcohol must be viewed as
added calories. Additionally mental stress is something we talk about
but cannot quantify and therefore often dismiss.
Q. Diabetes was once perceived as a disease of the West. But
according to recent statistics from WHO, over 80 percent of people in
Asian countries now have diabetes. Why is this?
A. Changes in lifestyle, easy access to unhealthy food,
consumption of unhealthy food and drink far exceeding our requirements
and socio-cultural trends towards sedentary occupations (such as the IT
revolution) has made us relatively small made Asians develop large
waistlines that considerably increases our risk
Q. How does a woman get diabetes during pregnancy? What is the
impact on the mother’s health? Will she get diabetes at an early stage
due to developing it at the pregnancy stage?
A. Pregnancy is a diabetogenic state due to the placenta
elaborating excess hormones that act against insulin. Therefore
pregnancy can unmask a previously unknown pre-diabtic woman. In the
short term, she is at greater risk of developing pregnancy complication
of high blood pressure, infections, excess water around the baby.
Additionally if she has high vblood sugar at conception (i.e. she was
unaware of her diabetes prior to conception) she is at greater risk of
miscarriage and the birth of a baby with congenital malformation.
We found almost a half of mothers who had become normal at two months
after the birth of their baby, having developed pre-diabetes or diabetes
within five years after their index pregnancy.
Q. What signs indicate she has developed diabetes at this
stage?
A. Very often there are no signs. Only a blood test will
reveal the problem. Therefore Sri Lanka is prioritizing universal
screening of pregnant women, through the excellent supervision by the
focal point for women’s health in this country - the Family Health
Bureau of the Ministry of Health linked with a SLMA program called
Nirogi Maatha funded by the World Diabetes Foundation
Q. If the baby she delivers is more than nine lbs, could she
be at risk of developing diabetes later?
A. This is indeed true. However, for Sri Lanka a birth weight
exceeding 3.5 kg (about 7.7 pounds) the mother has a greater likelihood
to develop diabetes in later life.
Q. What is the treatment?
A. This can be prevented by losing weight after the birth of
your baby through breast feeding and healthy lifestyle. Being aware of
the problem and checking your blood sugar annually is our
recommendation.
Q. Does the medication she is given to continue even after she
is no longer considered at risk of the disease?
A. Most mothers do not need the insulin or metformin they were
given during pregnancy after the birth of their baby. However they
should undergo an OGTT test six to eight weeks later when the doctor can
make a decision regarding the follow up
Q. What are the ‘golden rules’ to follow in order to prevent
getting diabetes?
A. Diabetes can be prevented. This needs a healthy life cycle
approach from pre-conception to childhood and adolescence and in young
adult life including during childbearing and child rearing. Healthy diet
and lifestyle are the jey to rpevention
Q. At what age should one start following them?
A. From the womb .
Q. Once diagnosed, should a diabetic continue with her drugs
for life, of can she /he stop when her diabetes is under control?
A. There is no complete cure for diabetes. However we can
control it – with a combination of drugs and lifestyle that must go hand
in hand.
Very often people with diabetes do not feel unwell. So, when they
find a drug prescribed by their doctor has brought down the blood sugar
– they stop the medication without continuing follow up by their
attending doctor. Quite often they get “misled” by claims of cure for
diabetes by non medical professionals. So we see them again a few years
down the line with complications of diabetes having set in. By this time
we cannot reverse the damage that has occurred.
Q. What is the role of diet in preventing diabetes?
A. Diet plays a major role in preventing excess fat getting
deposited particularly around the waist. This occurs mainly in the
liver.
Fat deposition in the liver has a major impact on the chemical
processes in the body, particularly carbohydrate and fat metabolsim
Q. Exercise?
A. Physical activity brings about a chain of chemical
reactions that reverse the trend for developing diabetes and excess body
fat. It increases your muscle mass, minimizes your aches and pains due
to inactivity and improves your mental well being
Q. Your advice to patients?
A. Do not consider yourself a patient - you are afflicted by
diabetes that can be easily overcome through your own efforts. There is
nothing to feel shy or frightened by the fact you have been diagnosed
with diabetes. Proper control with self management is your most valued
investment for a healthy future
Q. Your message to the public?
A. Eat, think and live healthy - these are the keys to a happy
and fulfilled life.
Higher breastfeeding rates likely with early skin-to-skin contact
Skin-to-skin contact between mother and infant in the delivery room
is associated with an increased likelihood for exclusive breastfeeding,
according to an abstract presented at a Conference and Exhibition in
Orlando. When combined with a mother's intent to breastfeed, the
likelihood was even greater.
In “Early Skin-to-Skin Contact in the Delivery Room Leads to an
Increase in Exclusive Breastfeeding during the Newborn Hospital Stay,”
researchers reviewed electronic medical records of single, late preterm
or term healthy births at a New York hospital. Study authors looked for
information on whether or not the mother and infant had skin-to-skin
contact in the
delivery room, as well as maternal age, intention to breastfeed,
gestational age, mode of delivery, admission temperature and glucose
testing on admission to the newborn nursery. They also noted the number
of formula feedings, birth weight, discharge weight and duration of
hospital stay.
In total, 150 newborn hospital records were reviewed, of which 53
percent of the infants had skin-to-skin contact with their mothers in
the delivery room.
Seventy-two percent of the mothers intended to breastfeed
exclusively, although only 28 percent actually did. The intention to
breastfeed and skin-to-skin contact were significantly related to
exclusive breastfeeding, independent of maternal age, mode of delivery,
parity and gestational age. When corrected for gestational age and
delivery mode, exclusive breastfeeding was significantly associated with
skin-to-skin contact.
“Breastfeeding is one of the easiest things we can do for babies to
make sure they're growing up healthy,” said study author Darshna Bhatt.
“While skin-to-skin contact is associated positively with exclusive
breastfeeding, the statistically significant factor is intention.” This
“synergistic effect” between intent and skin-to-skin contact increases
the odds that a mother will breastfeed, she said.
“We have to create a more interdisciplinary approach to increasing
awareness and intention,” Dr. Bhatt said. “When mothers declare their
intention to breastfeed, there really shouldn't be a reason why they
don't have skin-to-skin contact with her new infant in the delivery
room.”
- MNT
Green fingers or light DIY ‘cut risk of stroke for over-60s’
A spot of gardening or some light DIY are as good as rigorous
exercise for fending off heart attacks and strokes in the over 60s, a
study has found. Researchers in Sweden found that older people who
performed a high level of “non-exercise physical activity” (NEPA),
including everyday tasks like cutting the hedge, home repairs and even
car maintenance, were 27 percent less likely to suffer a major
cardiovascular problem.
Such low-level activity was beneficial whether or not people also
took part in organised exercise.
The study involved more than 4,200 people aged over 60. Participants
were monitored for more than 12 years and asked how often they performed
24 different NEPA tasks.
Those who performed the highest level of light day-to-day activity
were not only less likely to suffer from heart problems, they also had
“more preferable waist circumference”. Overall the group was 30 percent
less likely to die during the study period than the least active group.
“Our findings are particularly important for older adults, because
individuals in this age group tend, compared to other age groups, to
spend a relatively greater proportion of their active day performing
[routine activities] as they often find it difficult to achieve
recommended exercise intensity levels,” write the authors from Sweden’s
Karolinska University and the Swedish School of Sport and Health
Sciences. Christopher Allen, senior cardiac nurse at the British Heart
Foundation said: “Being physically active is important in maintaining
good heart health. But, as this study demonstrates, you don’t need a gym
membership to do that. “As long as they make you feel warmer, breathe
harder and make your heart beat faster, activities such as DIY and
gardening count towards the 150 minutes of moderate intensity activity
recommended for a healthy lifestyle.”
- The Independent
Young maternal age and quick pregnancies linked to high infant
mortality in South Asia
Having children early and in rapid succession are major factors
fuelling high infant mortality rates in the South Asian countries of
Bangladesh, India, Nepal and Pakistan where one in 14 births to young
mothers ends with the death of the child within the first year, say
researchers. Writing in the current online issue of the International
Journal of Gynaecology and Obstetrics, Anita Raj, professor of medicine
and director of the Center on Gender Equity and Health at UC San Diego,
and colleagues said younger maternal age (under 18 years old) and short
intervals between pregnancies (under 24 months) accounted for roughly
one-quarter of the infant mortality rate among young mothers in India
and Pakistan, a percentage that represents almost 200,000 infant deaths
in 2012 for those two nations alone.
In Bangladesh, only the short inter-pregnancy interval was linked to
infant mortality while in Nepal, only young motherhood was associated
with infant death.
Infant mortality is a significant public health issue in South Asia.
According to United Nations data, the infant mortality rate worldwide
is 49.4 deaths per 1,000 live births. In Pakistan, it is 70.90; India,
52.91; Bangladesh, 48.98 and Nepal, 38.71. By comparison, the infant
mortality rate in the United States is 6.81 and just 1.92 in Singapore
lowest in the world.
- MNT
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