The Growing Diabetes Epidemic

The International Diabetes Federation (IDF) is an umbrella organisation of over 230 national diabetes associations in 170 countries and territories. Its mission is to promote diabetes care, prevention and a cure worldwide. It collects, collates and publishes statistics related to diabetes.

According to the IDF, 415 million people around the globe suffer from diabetes today. This figure is expected to rise to 642 million by 2030, less than 15 years away, at which time 10% of the world’s population will suffer from diabetes.

The disease is a killer. In 2015, five million people died from diabetes.

Indeed, somewhere in the world, a person dies of diabetes (type 2 or type 1) every six seconds… and nearly half of these deaths are among people younger than 60 years of age.

Type 2 and type 1 diabetes

The most prevalent form of diabetes is type 2, which accounts for 90% of all cases in the developed world.

Our muscles are powered by glucose which is produced by the digestive process and delivered to the muscle cells through the blood stream. But insulin is needed to open receptors in the cells so the glucose can enter. Insulin is produced by the pancreas on demand.

In type 2 diabetes the insulin produced by the pancreas cannot open the receptor cells in the body’s muscle cells because the receptors are blocked by fat. In type 1, by contrast, the pancreas fails to produce insulin as required.

Type 2 is known as a life-style disease as it is triggered by poor diet and a lack of exercise. It is most closely associated with the developed world where people eat processed foods containing excessive fat, sugar and salt and follow sedentary occupations.

However, according to the IDF, it is no longer a rich-world disease. It is spreading rapidly in South-East Asia, parts of Africa and Mexico.

Diabetes in Africa

In Mauritius, for example, statistics show that 17% of the population are diabetic. However the IDF suggests that the figure may be closer to 24%, an extremely high prevalence.

Africa has about 7 million diabetics at the moment. However the WHO (World Health Organisation) predicts that this figure will have increased to more than 18 million by 2030. This astonishing rate of increase is being blamed on a growing reliance on processed foods.

According to the WHO, many people in Africa do not know they have the condition and thus are not being treated. As a result, in some parts of Africa, diabetes is responsible for more than four-fifths of deaths.

Diabetes in Mexico

In Mexico, over a third of the deaths of people aged 35 to74 years can be attributed to diabetes, according to a study published in the New England Journal of Medicine.

The participants included diabetics and non-diabetics aged 35 or older at the start of the study. They were monitored over 12 years and the mortality rates of those with diabetes were compared to the rates for the non-diabetics. The mortality rate for diabetics was 35 percent which is extremely high.

Nearly all the participants were type 2 diabetics. The researchers attributed the excess deaths to poorly controlled diabetes. There are at least two possible reasons for this lack of control.

The most commonly used medication to control diabetes in Mexico is sulphonylureas, used by nearly 70 percent. Only 20 percent of Mexican diabetics use metformin. Sulphonylureas lower blood glucose levels effectively by stimulating the pancreas to release more insulin.

This drug, however, causes weight gain, makes insulin resistance worse and gives rise to pancreatic burnout which makes the drug less effective after years of use. Users of sulphonylureas also show poorer heart health compared to users of other diabetes drugs.

Thus the medication used in Mexico may be a significant contributing factor to the high death rate from diabetes in that country.

Another key factor could be the very high consumption of sugar-sweetened drinks in Mexico. In 2014, the government imposed a tax on sugary drinks but it is too early to say whether is this is having an effect on the high rate of diabetes and related deaths in the country.

The cost of treating diabetes

The cost of treating diabetes is horrendous.

The IDF estimates that diabetes is responsible for 12 percent of health spending globally. Indeed, in some countries it represents a fifth of all healthcare expenditure.

This is not surprising as diabetes is not diagnosed until it is advanced… because in its early stages it has few symptoms. Indeed the statistics suggest that that globally one in two people who have diabetes are not aware they have the disease.

This means that by the time they are diagnosed the disease is well advanced and they require daily medication to control their diabetes rather than being able to rely on a change of diet and lifestyle.

In order to ensure that diabetes is diagnosed at an early stage, it is likely that governments will need impose mandatory screening… this may be made easier in the future with new non-invasive quick diagnostic techniques for predicting the risk of diabetes. These techniques do not require blood tests and could be performed during an annual check-up.

Diabetes and It’s Management

MANAGEMENT OF DIABETES

1. Diet Control:

There are clear evidence that diet control and weight loss in obese Type II diabetics, leads to improved carbohydrate metabolism, thereby reducing the amount of medication required to control glucose levels. Special attention should be paid to periods of illness, exercise and travel. Diet planning by a professional should be sought, but as a general guide:

  • Diet should include foods from each of the basic food groups.
  • Saturated fats less than 10% of total calories.
  • Carbohydrates 50-60% of total calories.
  • Protein 15-20% of total calories.
  • Consume 20-35 g of dietary fibre from a variety of food sources.
  • Diet should contain adequate vitamins and minerals.
  • Cholesterol limited to
  • Sodium intake limited to
  • Abstain from alcohol.
  • Use of artificial sweeteners within safe limits.

2. Physical Exercise and Weight Loss:

Maintain a sensible exercise plan to suit your age, aptitude, fitness and interest. Your doctor will often do a pre-exercise evaluation. If you have not been exercising for a while, start of slowly then build up intensity and duration as your fitness level improves. Guidelines for exercise are as follows:

  • Frequency : 3-5 days per week (daily if exercise of low intensity)
  • Intensity: 60-85% of maximum heart rate (or until you feel warm and sweaty)
  • Duration: 20-60 minutes each time
  • Type: Aerobic exercises such as brisk walking, jogging, cycling, swimming

Precautions for diabetics when exercising:

  • Use proper footwear to reduce chance of blisters and other foot injuries
  • Adequate hydration before, during and after exercise
  • Avoid exercise during periods of acute illness or if severely hyper or hypoglycaemic
  • Dose of medication may have to be reduced prior to exercise. This should be discussed with your doctor
  • In patients with severe diabetic retinopathy, activities such as weight-lifting and heavy competitive sports should be avoided.

3. Avoidance of Smoking

4. Medication

  • Sulphonylurea secretagogues – stimulates pancreatic insulin secretion and release (eg. tolbutamide, glibenclamide, glipizide, gliclazide, glimepiride).
  • Non-sulphonylurea secretagogues – stimulates pancreatic insulin secretion and release (eg. Nateglinide, repaglinide)
  • Biguanides – decreases production of glucose by the liver (eg. Metformin)
  • Alpha-glucosidase inhibitors – decreases carbohydrate absorption by the gut (eg. Acarbose)
  • Thiazolidinediones – increases tissue sensitivity to insulin (eg. Rosiglitazone, pioglitazone)
  • Insulin – replaces the deficient insulin (eg. Rapid-acting or long-acting insulin)

TARGETS FOR CONTROL:

Targets for Glucose control:

  • Non-diabetic levels: HbA1C 4.5-6.4%, Pre-meal glucose 4.0-6.0 mmol/L, 2 hour post-meal glucose 5.0-7.0 mmol/L
  • Optimal (target for most patients): HbA1C 6.5-7.0%, Pre-meal glucose 6.1-8.0 mmol/L, 2 hour post-meal glucose 7.1-10.0 mmol/L
  • Suboptimal (adequate for some): HbA1C 7.1-8.0%, Pre-meal glucose 8.1-10.0mmol/L, 2 hour post-meal glucose 10.0-13.0 mmol/L
  • Unacceptable (action needed in all patients): HbA1C >8.0%, Pre-meal glucose >10.0 mmol/L, 2 hour post-meal glucose >13.0 mmol/L

Diabetes 1 and 2 – Get Easy Control Or Face the Painful, Miserable Complications

WHAT IS DIABETES?

Diabetes is one of the biggest disease epidemics sweeping the world. By the year 2020, there will be over 280 million diabetics in the world. China,India and the US are the countries with the highest number of diabetics. Diabetes is a lifestyle disease that is brought on by the excessive intake of calories and a lazy or sedentary lifestyle (a lifestyle without much exercise).

Diabetes occurs when your body is unable to use the glucose that is obtained from your meal, successfully. Insulin is a hormone that is produced in your pancreas (an organ that is located behind your stomach). There are cells in the pancreas called beta cells which produce the insulin. Insulin enables your cells to transport glucose from your blood into your cells. Every cell in your body needs glucose to make energy which is used by the cell to carry out its function.

When your pancreas fails to make enough insulin, or the cells cannot use the insulin effectively (a condition called INSULIN RESISTANCE), glucose cannot be effectively transported into the cells. This sustained high level of blood glucose over weeks and months is what gives the symptoms of diabetes.

Diet, Exercise and Lifestyle play a very important role in managing diabetes.

TYPES OF DIABETES

There are 2 major types of diabetes – each caused by a different mechanism. Type 1 diabetes occurs in childhood or teenage years and is due to failure of the beta cells in the pancreas to make insulin. This type of diabetes requires insulin replacement a few times daily – this is life saving. The person with Type 1 Diabetes must be on insulin for life.

Type 2 Diabetes occurs when there is an overload of glucose coming into the body. This is usually from overeating foods that release glucose into the blood stream rapidly (high glycemic index foods). The type of foods that cause and aggravate diabetes are mainly carbohydrates or starches. Being overweight, not exercising and eating large amounts of starchy or carbohydrate rich foods can cause and aggravate diabetes.

There is a genetic pattern that runs in certain families that predisposes you to developing diabetes. However, it is your life style and selection of foods that brings on the diabetes earlier.

There is a 3rd type of diabetes that is due to the immune system destroying the beta cells of the pancreas. This is an autoimmune type of diabetes and has to be managed with insulin.

DIABETES TREATMENT

The 1st step in managing your diabetes easily is to know which type of diabetes you have. Type 1 diabetes will need insulin if you are to survive. Your doctor will guide you as to how many units of insulin you need to take and how often. Insulin is given as an injection, usually in the abdominal wall or thigh. Diet and exercise are crucial in Type 1 diabetes.

If you have Type 2 diabetes, a low GI (glycaemic index) diet is essential. Two types of medication are available that can be taken orally, if your doctor recommends them. The first class of drug (Metformin) improves the insulin resistance in your cells. Excessive fat accumulated around the organs in your abdomen is one of the biggest causes of insulin resistance and your diabetes not improving.

The second class of drug (Sulphonylureas) helps increase the secretion of insulin from your pancreas. Sometimes both drugs are needed in some diabetics. Your doctor will know when to add this second class of drug.

As you get older, you lose more beta cells in the pancreas (apoptosis or natural cell death with aging). The oral drug treatment may now not be enough and insulin may have to be started. You should not be afraid of starting insulin treatment as it can improve your control of the diabetes.

THE NEED FOR GAINING BETTER CONTROL OVER YOUR BLOOD SUGAR LEVELS

When blood sugar levels are persistently high in diabetes, the excessive blood glucose behaves like a toxin and begins to damage the inner lining (endothelium) of the arterial blood vessels causing plaque formation and a blockage to the oxygen bearing circulation. The tissue in the end organs that these blood vessels supply become deprived of oxygen and degenerate and malfunction. The end organs that are most affected by diabetes through this process are the kidneys, the heart, the eyes, the brain, the nerves of the body and the feet.

When these organs become damaged from the lack of oxygen due to blockage of the small blood vessels as a result of uncontrolled diabetes, serious complications arise. You want to avoid these serious and life threatening complications by learning how to easily control your blood glucose level.

Be aware that intense stress from whatever reason can cause your blood sugar level to go out of control. Infections anywhere in your body can cause your diabetes to rapidly spiral out of control. An often missed infection that may be causing your poor diabetes control could be a tooth or gum infection.

You must be aware that your blood sugar can go very low (hypoglycaemia) – this often happens in Type 1 diabetes, but can occasionally happen in Type 2 diabetes. An out of control diabetes most often means that you blood sugar level is very high (hyperglycaemia).

KNOWING THE FOODS THAT CAUSE YOUR DIABETES TO GO OUT OF CONTROL

Excessive intake of carbohydrates is the main cause of poor control of diabetes. Carbohydrates are starches such as bread, rice, potatoes, pastas, cereals, biscuits, pumpkin, squashes and butternut. Beer is very high in carbohydrates.

Food high in glucose, such as drinks with high amounts of sugar (fizzy drinks), fruit juices, cooked carrots and beetroot can also cause the blood sugar to go up rapidly.

IGNORANCE IS THE BIGGEST REASON WHY DIABETICS FAIL TO CONTROL THEIR BLOOD SUGAR

To gain easy control over your diabetes, you must invest some time in understanding the various aspects of what and why you must do certain things in your lifestyle, diet and exercise. Just knowing what to do in managing your diabetes, with the assistance of your doctor, can easily bring your diabetes under control.