Silent Killer



Diabetes is a progressive disease that can cause blindness, heart disease, stroke, kidney failure, and death if not managed properly. It not only kills its victims but also causes avoidable pain and suffering to their family members and a huge loss to the national economy. 

According to the World Health Organisation (WHO), currently 347 million people have diabetes in the world. Of them, 80 percent live in low-and middle-income countries. In 2011, 4.6 million people died of diabetes-related complications, which constituted 2.17 percent of the total deaths. By 2030, diabetes could, WHO estimates, be the seventh leading cause of death. 

Research suggests that people from South Asia are at an elevated risk of diabetes, especially Type 2. A combination of genetic, environmental and dietary factors contributes to it. South Asian food, which is high in refined carbohydrates, is a main contributor to diabetes. Increasingly sedentary lifestyle, particularly in urban areas, has been adding fuel to the flame.

WHO statistics show that India has the highest number of diabetics in the world, followed by China and the United States. 

Around 40 million Indians are estimated to have the disease now. That number could double by 2030. In Pakistan, according to surveys, 7.7 to 11 percent of the population have diabetes. In Bangladesh, more than 12 percent people are diabetic or pre-diabetic.

In Nepal, the number of people having diabetes is estimated to be between 436,000 (WHO) and two million (Third Diabetes Conference, Kathmandu, 2013). The cause of such disparity is that there has been no reliable survey. As in other countries, Nepal’s urban areas have higher prevalence rates as compared to rural areas.

What is diabetes?
Called madhumeha in Ayurveda, diabetes is a metabolic syndrome resulting in a high sugar level in blood. It can be caused either when the pancreas, agnyasaya in Ayurveda, fails to produce enough insulin or when the body cells become resistant to it.
We need sugar, known as glucose after digestion of the food we eat, to keep us alive and moving. It is to our body what petrol is to a car. However, this sugar causes diabetes when we have more of it than necessary. 

The level of sugar increases in our bloodstream when we eat food. The pancreas, which is located behind the stomach, releases insulin to transport sugar from bloodstream to body muscles and other tissues so that it is converted to energy or stored in the liver and muscle cells for future use. However, if the pancreas does not produce enough insulin or our muscles and tissues do not respond to insulin produced by it, sugar remains unabsorbed, making a person diabetic.

Types of diabetes
Type 1, Type 2, and gestational diabetes are most common forms of diabetes. Generally, children and young adults have Type 1 diabetes. However, it can be found at any age. Type 1 diabetes generally manifests itself when our own body’s immune system destroys the ability of the pancreas to produce insulin. 

Type 2 diabetes is the most common. It is strongly associated with older age, genetic disposition, obesity, and sedentary and unhealthy lifestyle. Less prevalent among children in the past, it has surprisingly become a major problem for them now, especially in the developed world. The main culprit, it is believed, is junk or fast food.

Gestational diabetes affects women during their pregnancy. It normally disappears after childbirth. However, 40 to 60 percent women having this problem could develop Type 2 diabetes later in life. 

Apart from these, there are other types of diabetes as well. For instance, Latent Autoimmune Diabetes (LADA) has symptoms of both Type 1 and Type 2 diabetes and about 10 percent diagnosed with Type 2 diabetes suffer from it. Neonatal diabetes mellitus (NDM) and maturity onset diabetes of the young (MODY) affect children and adolescents. Often, genetic defect in insulin action, diseases of the pancreas, infections, medications, and chemicals cause such diabetes.

Symptoms and effects
Excessive passage of urine, especially at night (polyuria), excessive thirst and dry mouth, excessive hunger (polyphagia), high blood sugar (hyperglycemia), blurred vision, weight loss, abnormal skin sensation (paresthesias), sores that do not heal, and fatigue are the main symptoms of diabetes. 

Some of these symptoms could be associated with other diseases as well. Therefore, when such symptoms appear, we must have a thorough check up to determine if the patient has diabetes or some other disease. If diabetes goes undiagnosed, the patient will have to pay a high price, including disability or sudden death.

Diabetes can affect our health colossally giving us a high level of pain and distress. If not controlled, this disease can affect primarily the eyes, heart, kidneys, feet and reproductive system. 

It can affect our eyes with diabetic retinopathy damaging the retina and making us blind. It can also cause serious heart attack and stroke, affecting the heart and blood vessels. According to the International Diabetes Federation (IDF), heart attack and stroke are the major causes of diabetes-related deaths. Diabetes can result in total kidney failure which requires either dialysis or kidney transplantation. It can also create nerve diseases; damage the toes, feet and lower limbs; and may lead to ulceration and sometimes amputation. Diabetes could also cause impotency.

The national economy suffers due to the victim’s decreased productivity and untimely death and increased health costs.

Sadly, there is no cure for diabetes. However, diabetes can be controlled and managed. Diabetes management includes medication and appropriate lifestyle, including a healthy diet reasonably free of sugar and fat content, light exercise and adequate sleep. The management goal should always be to avoid or alleviate diabetes-related complications.

Medication helps control diabetes. Before prescribing medicine, the general practitioner (GP) should always carefully assess the patient’s condition and choose one or multiple medicine/s depending on the assessment. Merely prescribing conventional and most popular medicine could further aggravate the patient’s condition. If necessary, the GP, who is not a specialist, should refer the patient immediately to a diabetes specialist for urgent care and attention. Otherwise the consequences could be disastrous, even fatal. Unfortunately, in Nepal, patients are seldom referred to qualified diabetes specialists/consultants.

Medicine must be supplemented by healthy diet, some exercise, and adequate sleep. A qualified dietician can prescribe a healthy diet that goes a long way in mitigating the problems associated with diabetes and prolonging the victim’s lifespan. But in Nepal, there is shortage of properly qualified dieticians. Unqualified dieticians can only exacerbate the patient’s condition.
Likewise, the exercise and sleep regime should be tailored to the patient’s specific condition. Too much or too little exercise or sleep could lead to avoidable pain, illness, and even untimely death. But all too often, patients in Nepal do not consult qualified exercise and sleep therapists to find out what is best for them and harm themselves with the wrong type and amount of exercise and sleep. 

As diabetes is on the rise worldwide, more so in South Asia, including Nepal, it must be tackled with the urgency it deserves. The government of Nepal should, therefore,recognize diabetes as a national health issue and launch a campaign against this fast-growing scourge before it assumes catastrophic proportions. It should invest in developing a workforce of doctors, dieticians and trainers specialized in treating and managing diabetes and encourage patients, through education and awareness programs, to lead a healthy lifestyle and seek timely help. 

Timely and appropriate action by the patients and government will prevent a diabetes catastrophe, help patients lead a reasonably good and long life, minimize pain and distress for the victims’ family, and mitigate the burden of this silent killer on the national economy.

Sharma is former foreign secretary and Khadka, an expert in diabetes, currently manages an Indigenous Medical Specialist Project at the Royal Australasian College of Surgeons in Melbourne.

 Published in Republica:  
Published on 2013-05-19 01:16:05

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