World Diabetes Day, 14 November, is a day to create awareness on diabetes, a metabolic disorder with a fast rising incidence. The International Diabetes Federation (IDF) and World Health Organization launched the WDD in 1991. This date was selected to pay homage to the co-discoverer of Insulin, Dr Frederick Banting whose birthday fell on that day. Every year a new theme is selected for the WDD. Most countries of the world observe the day by organizing programmes participated by the general public, health care providers and policy makers. It is a day to raise awareness among all, old and young to fight against the disorder.
Mr X’s eyes have been giving him trouble of late. He goes to the doctor. After an examination and some laboratory tests he is informed that he has diabetes. The news comes as a shock to him.
But not to his doctor. It is now known that diabetes is a fast growing metabolic disorder. There are 415 million adults with diabetes worldwide. Simply put, 10.7 percent of the global adult population is living with it. IDF has estimated that by the year 2040 this figure will rise to 642 million or 11.2 percent.. This means one in ten adults has diabetes. About 80 percent of the people with diabetes live in the middle and low income countries and a majority are between 40 and 59 years of age, the most productive years of life. (International Diabetes Federation Diabetes Atlas, 2015)
What is diabetes?
Diabetes is a metabolic disorder caused by an absolute or relative lack of insulin leading to a raised blood glucose round the clock, Insulin is a hormone produced by the Beta cells of the pancreas.
There are three main types of diabetes:
Type 1 diabetes is an autoimmune disease in which the body’s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas stops producing insulin and a person with type 1 diabetes has to take insulin for life. At times the immune system is made to work in a harmful manner under the influence of viruses. Type 1 diabetes is usually encountered in children.
Type 2 diabetes is more frequently seen in adults who suffer from insulin resistance. This is a condition in which the body fails to use insulin properly (insulin resistance) and is combined with a relative insulin deficiency. On diagnosis, the pancreas is usually producing enough insulin, but the body cannot use the insulin effectively. After several years the insulin production gradually decreases causing the glucose level to rise in the blood. Type 2 diabetes is associated with fat accumulation in the body also called obesity. Fat deposited in the abdominal cavity and on the liver is a very high risk factor for Type 2 diabetes. This is the more common form of diabetes and is now occurring in children as well as the incidence of child obesity is on the rise.
Gestational Diabetes is diabetes diagnosed first in pregnancy. It is encountered morein women with a family history of diabetes.Women with gestational diabetes have a 20 to 50 % chance of developing type 2 diabetes within 5 to 10 years.
Diabetes in Pakistan
In Pakistan there are currently 10.1 million known diabetics and if measures are not taken to redress the situation, the figure is projected to rise to approximately 14.4 million by 2040. There are diabetics who have not been diagnosed, as was Mr X’s case. Diabetes Type 2 does not usually have symptoms. Only when complications set in is the diabetes discovered.
Pakistan is a low-income country with a population of 190 million. The Human Development Rank is 147 (a low human development category) out of 188 countries. The population living below poverty line (< 1 USD/day) is 28.1 percent. The adult Literacy Rate is 54.9 percent and among the illiterate people, 57 percent women and 29 percent men have no education. The Government’s GDP expenditure on health is 0.42 percent. (ECONOMIC SURVEY OF PAKISTAN 2015-2016)
The lack of knowledge and education is the main cause of inadequate healthcare, disease prevention and management. Poverty causes the individual to have priorities of which prevention of diseases is the least important. The Government of Pakistan does not invest sufficiently in public health which is an important cause of the rise in poverty levels creating a vicious cycle.
The World Diabetes Day
WDD is a reminder that each one of us should be responsible for contributing towards the prevention of diabetes. This year it calls for screening people at high risk for diagnosing diabetes, people with diabetes to prevent complications and known diabetics for better control. It is time for us to join hands in the crusade against diabetes.
Who are the people at high risk for diabetes?
- People with family history of diabetes as parents and siblings
- Obese, hypertensive and individuals with high triglyceride levelsleading to obesity
- People with a sedentary lifestyle with no physical activity
- Women with Polycystic Ovaries and history of diabetes during pregnancy
Blood Glucose Level
For Normal (Non-diabetic people)
Fasting Blood Glucose is between 70 – 100 mg/dl
90 minutes after a meal – below 140 mg/dl
BMI (Body Mass Index) is an index for measuring obesity. It is calculated by the following formula:
weight in kg divided by height in meters squared
In Asians, Normal is ≥ 23kg/m2
Overweight is between 24 & 29
>29 is Obese
Waist circumference is a measurement for central obesity
Normal figure for
Males ≥ 90 cm
Females ≥ 80 cm
For Prevention of Type2 Diabetes a healthy life style should be adopted.
EDUCATION- Learn about prevention of Diabetes and if you have Diabetes then learn to keep it in good control.
DIET should be healthy including all components as carbohydrates, proteins and fats in a smaller quantity. Eat atleast 40 Gm of fibre daily. Meals should be taken on time and early dinner is recommended. Breakfast is the most important meal of the day. It should not be omitted. Small and frequent meals help to keep the body weight down
Breakfast choices have to be wise by balancing calories with physical activity. Lean protein and whole grains provide energy and give a feeling of satiety.Proteins blunt hunger and give a feeling of fullness till lunchtime.
Whole grain cereal with added fruit and low-fat milk or Oatmeal with skimmed milk and nuts is a good choice. In the local setting there can be chapatti made of whole wheat flour and a veggie omelette. Eggs are a rich source of high quality proteins
Spot running is also a good choice.
SLEEP Seven hours sleep are essential for adults to maintain good health. Sleeping late upsets the nocturnal rhythm and has been proved to be a risk factor for Diabetes.
MENTAL RELAXATION can be achieved through meditation or Yoga.
STAY AWAY FROM SMOKING OR CHEWING TOBACCO
Good Health is the second big Blessing, the First being a Clear Conscience
Work to Prevent Diabetes
The writer is a consultant diabetologist who works at the Sindh Institute of Urology and Transplantation (SIUT), Karachi