Watch that insulin!

Diabetes is slowly but steadily rearing its head among the majority of Sri Lankans, and it’s time to take notice

Dubbed the new pandemic of obesity, the World Health Organization (WHO) Expert Consultation on the same subject warned back in 1997 that people in most countries around the world would face the risk of developing non-communicable diseases.

Nine years later, the rapidly changing statistics are coming in fast and furiously. While the highest rates of obesity are in several of the Pacific Islands, the lowest rates are in the lesser developed countries of Asia, with our closest neighbour India, recording just 0.5% obesity.

What of Sri Lanka? Can we let complacency wash over us, and assume that we fall into the same category as our giant neighbour?

Surveys indicate a sharp contradiction in the trends between the two countries. Whereas India is following more in the ‘Asian trend’, Sri Lanka is just the opposite – on a rollercoaster ride seemingly more like developed countries. In Sri Lanka, with the increase in life expectancy and decline of infectious diseases, the incidence and prevalence of non-communicable diseases has increased. The alarming rise in diabetic and pre-diabetic conditions such as being overweight and obese is due in large part to an unhealthy diet and a sedentary lifestyle associated with urbanisation.

In a society where ‘slim and fit’ even among children usually brings out comments like, “Are you starving your child?” and fast food in the form of fries and burgers has caught on like a forest fire, why should we be concerned about obesity?

The danger signals are clear – there is more and more evidence that obesity contributes to a higher incidence of cardiovascular disease and Type 2 diabetes mellitus.

The projections are that by 2020, Type 2 diabetes and cardiovascular disease will account for almost three-fourth of all deaths worldwide, with diabetes being identified as the silent killer, not only creeping up on urban middle-aged adults, but also affecting semi-urban and rural areas, and younger age groups.

What is diabetes?

Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use insulin, a hormone made in the pancreas, to help them convert blood glucose into energy.

People develop diabetes, because the pancreas does not make enough insulin, or because the cells in the muscles, liver and fat do not use insulin properly, or both. As a result the amount of glucose in the blood increases, while the cells are starved of energy. Over the years, high blood glucose – hyperglycaemia – damages nerves and blood vessels, which can lead to complications, such as heart disease and stroke, kidney disease, blindness, nerve problems, gum infections and amputations.

Age standardised prevalence – Diabetes

The three main types of diabetes are – Type 1, Type 2 and gestational diabetes.

Type 1 diabetes – This is usually diagnosed in children, teenagers or young adults. Type 1 is an auto-immune disease that causes the body’s system for fighting infection to turn against a part of the body. Here the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin.

Type 2 diabetes – People can develop this most common form of diabetes at any age. It begins with insulin-resistance, a condition in which muscle, liver and fat cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin, but with time, loses its ability to secrete adequate insulin in response to meals.

Gestational diabetes – This develops in some women during the late stages of pregnancy, caused by the hormones of pregnancy or by a shortage of insulin. This condition goes away after the baby is born, but a woman who has had it is more likely to develop Type 2 diabetes later in life.

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Awareness in Sri Lanka

Ulrik Uldall Nielsen, 34, is sipping his morning coffee in a Colombo hotel, when The Sunday Times meets him last week.

Ulrik Uldall Nielsen

Far away from his home in Denmark, Ulrik from the World Diabetes Foundation (WDF), is here to fine tune a major project in Sri Lanka, about to be launched in collaboration with his organisation. What’s so special about Ulrik?

Ulrik is an ideal candidate to act as a catalyst to make countries seriously look at the link issues of obesity and diabetes. For, he has had Type 1 (see main story) diabetes since he was 14.

“My life changed drastically,” he says, quickly adding, however, that you can live with it, you can travel and even win gold medals at the Olympics. “You can lead a full life, though at first it is hard work, because you have to learn how to eat again, how many carbohydrates you are taking in.”

Four-times Olympic gold medallist in rowing Sir Stephen Redgrave and famous Pakistani cricketer Wasim Akram are among those with diabetes, who are leading not only normal lives, but also excelling in their fields.

Stressing that no two people with diabetes will be alike, Ulrik who carries his own insulin wherever he goes, says, “You need to listen to your body very carefully.”

When in his home country, an integral part of his routine would be to check his blood sugar (glycaemia) levels in the morning and evening, but when travelling, at least four times a day, and then adjust it with insulin.

The WDF’s project in close collaboration with the Ministry of Health in Sri Lanka has three components, one of which is also another first.

The components are a healthy lifestyle campaign, providing information on how each and everyone of us can change the factors leading to diabetes; capacity building programmes for healthcare staff, with the Colombo South (Kalubowila) Hospital being a partner in the pilot phase in Colombo; and disease surveillance that will be conducted by the Epidemiology Unit.

The Epidemiology Unit’s mandate is to deal with communicable diseases, and this will be the first time that it will conduct this surveillance for a non-communicable disease, says Ulrik.

Prof. Devaka Fernando

Prof. Devaka Fernando, WDF’s Project Manager for Sri Lanka, who has been instrumental in carrying out important work with regard to diabetes in the country, emphasizes the need for a multi-disciplinary team to deal with diabetes, as in the case of many other conditions, such as stroke and heart disease.

A person with diabetes needs the skills of a doctor, a specialized nurse who can teach him/her the techniques of dealing with the condition such as injecting insulin, a dietician who will advise on the intake of food, an ophthalmologist to take care of the eyes and a podiatrist, the feet.

“All members of the team are of equal value,” he says, adding that the most important need is for the person with diabetes to be given the tools to monitor himself/herself.

“It is not only the patient’s right to be empowered, but also an obligation on the part of the medical team to transfer the knowledge to the patient he/she needs for such empowerment,” he adds.

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