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Defy diabetes

Tuesday, November 20, 2018

Diabetes is a growing challenge in India which can be tackled, delayed or even prevented, doctors tell Ronita Torcato

Diabetes Mellitus. How sweet it sounds, this strange, ancient malady that afflicts the obese, the sedentary and the sweet-toothed.  Diabetes is a disorder of the endocrine system. Sufferers know it’s  a chronic condition. Doctors will tell you insulin makes the body stronger  – the production of very little insulin or none at all by the body results in diabetes. Approximately 10% of all diabetes cases in the world belong to what’s called Type 1 Diabetes — the body does not produce or respond to insulin, resulting in abnormal glucose levels in the blood. The rest can be categorised Type 2 — their bodies produce insufficient amounts of  insulin for proper functioning. Approximately 90% of all cases of diabetes worldwide are of this type. That’s not all. Pregnant women have close encounters with a third kind  called Gestational Diabetes.

Aretus the Cappadocian, a second century Greek physician who practiced in Rome, Italy and Alexandria, Egypt, gave the condition its name after keenly observing the intense thirst and excessive urination of patients. In the  1600s it was described as the "pissing evile". ‘Mel’ is the Latin term for honey and because the urine was sweet (on account of the presence of large quantities of glucose) the disease was named diabetes mellitus. 

How do people tell when they’re diabetic? Or let’s put it this way. When should you go see an endocrinologist (aka diabetes specialist?) When you feel the urge to pee all the time, intense thirst and hunger,  numbness and tingling in hands and feet, gain or lose weight rapidly, tire out easily and sustain cuts and bruises that take a long time to heal, if at all. Diabetes is responsible for skin infections, glaucoma, cataracts, even blindness; kidney failure, ulcers, sometimes,  gangrene which requires foot amputation. Diabetes causes erectile dysfunction  (male impotence)  hypertension and raises the risk of suffering from depression and anxiety.  It also adversely impacts cardio-vascular health (strokes/heart attacks) . And we are not even talking about decreased productivity and increased absenteeism.

In 2016, diabetes caused 1.6 million deaths.  The country singer Johnny Cash died of diabetes complications. He smoked like a chimney. Diabetics should stop smoking. Type 2 patients also  need to test their blood glucose. Hypoglycemia – low blood glucose – and  it’s opposite – Hyperglycemia, when blood glucose is too high, are bad news.  Actors Tom Hanks, Salma Hayek and Priyanka Chopra’s significant other, Nick Jonas suffer from diabetes.

The good news is patients can live ‘normally’ if  they exercise adequately, monitor blood pressure and cholesterol levels regularly, avoid tobacco products, adhere to healthy diets (which means NO to fried foods),  and take medication, notably, insulin.

The discovery of insulin is described as a genuine miracle of modern medicine,by Thea Cooper and Arthur Ainsberg, in the book, Breakthrough: Elizabeth Hughes, the Discovery of Insulin and the Making of a Medical Miracle.

Hughes, the daughter of an American jurist and politician, Charles Evans Hughes, was diagnosed with diabetes at age 11. The only accepted form of treatment then was starvation which reduced her to a bag of  bones. In Canada, researchers Frederick Banting and Charles Best identified insulin from animal pancreases – a miracle soon marred by scientific jealousy and business rivalry. Elizabeth became one of the first diabetics to receive insulin injections.  She recovered. And died an old woman  in 1981. That said, it must be noted diabetes prevalence has been rising more rapidly in middle-and low-income countries. It is a growing challenge in India with an  estimated 8.7% diabetic population in the age group of 20 and 70 years. 

The sad fact is  India has the dubious distinction of  representing 49 percent of the world’s diabetes burden, with an estimated 72 million cases last year, a figure expected to almost double to 134 million by 2025. In other words, diabetes is India's fastest growing disease, and needless to say, a serious public health challenge. Rich states have a higher incidence of diabetes. At 53 deaths per 1,00,000 population, Tamil Nadu  notched the highest death rate from diabetes, followed by Punjab (44) and Karnataka (42), all significantly higher than the national average (23).

Diabetes strikes Indians a decade earlier than the rest of the world, according to Anoop Misra, chairman, Fortis Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi.

Poet Sunanda Swarup is a pre-diabetic who takes after her father. “He became a diabetic later in life. I got to know when I went for my annual checkup. Now, I take precautions by walking for an hour daily and cutting down on sweets,” she says breaking off a chocolate bar and giving me one half.  Like Sunanda’s parent, our father was a diabetic too in his senior years. We have  a sweet tooth and thank the Good Lord we have been spared.

Some common queries

Two experts respond to frequently asked questions on diabetes

How often should doctors be visited to optimise diabetes management?

Dr. Anil Bhoraskar Senior Diabetologist SL Raheja Hospital – A Fortis Associate

A diabetic must visit a centre with a competent diabetologist, who has special skills to detect all the complications in the initial stages, and will then refer to other specialists such as a cardiologist, nephrologist, neurologist, foot specialist and ophthalmologist. A diabetic who has reasonably controlled diabetes, must see a diabetologist at least once in three months.

Dr Pradeep Gadge, leading Diabetologist, Gadge Diabetes Centre

Ninety-five per cent of severe vision loss from diabetic retinopathy can be prevented by early detection, timely treatment and an appropriate follow-up. Every diabetic patient is recommended to  do an eye examination once a year that includes  intraocular pressure (IOP) Refraction, and dilated eye examination. If newly detected, and if blood sugars are normal, the patient can be seen every three to five months. A long-standing diabetic patient with other complications may have to visit a doctor every month. And women with gestational diabetes have to be seen every after 15 days to one month for problems during pregnancy, including possible health problems for the mother and baby, and repeated urinary and vaginal infections.

Are there new medications that can be used to help manage diabetes?

Dr. Anil Bhoraskar There are many new agents which can control both high sugars and high blood pressure which also contributes to heart, kidney and brain disease.

Dr Pradeep Gadge There is a  new class of drugs in the market called SGLT2 inhibitors. These  are very beneficial for diabetic patients. They are also cardio protective and kidney protective.

Can the disease be controlled without drugs? What are the long-term changes and precautions that should be taken?

Dr. Anil Bhoraskar Changing the lifestyle, both in diet and physical activities, helps enormously in keeping weight under control. This will also control blood sugars, lipids and high blood pressure provided the patient adheres to this changed lifestyle, lifelong, which is difficult for most of the people who give it up some time; and have taken oral agents or insulin life-long. A healthy diet containing optimum nutritional factors should be a  matter of practice. Exercise should be like a ritual and not as matter of chance or accident.

Dr Pradeep Gadge Basically, diabetes depends on three factors—insulin, food and activity. A prediabetic or  a recently detected patient whose blood sugar levels are borderline, can control it through diet and exercise. A well balanced diet and lifestyle modification can help in managing diabetes. Every diabetic patient is recommended to do any sort of physical activity 150/minutes weekly or minimum 30 minutes every day.  It is important to consult your dietician and doctor before starting any exercise or diet.

Ronita Torcato

Short Takes

Diabetes is responsible for skin infections, glaucoma, cataracts, even blindness; kidney failure, ulcers, sometimes,  gangrene which requires foot amputation, to mention just a few of its effects.

The good news is patients can live ‘normally’ if  they exercise adequately, monitor blood pressure and cholesterol levels regularly, avoid tobacco, eat healthy meals and take medication.

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