World Diabetes Day —Living longer with Diabetes—

By Dr A D Singh
Diabetes is one of the most commonly known and talked about disease. The symptoms of this disease was described by the legendary Hindu physician Charaka in the 2000 BC. It is locally referred as “Eshing Pukchatpa”, meaning thereby that disease was known and common in this region also. It is a metabolic disorder characterized by high blood sugar level because of inadequate production or ineffectiveness of insulin, a substance produced in the body and which regulate use of carbohydrate and other substances in the body. It is a very common disease now. It is no longer a disease of the rich men as was thought earlier. The prevalence of the disease worldwide is increasing. India is fast becoming to be the ‘capital’ of diabetes with an estimated 31.4 million persons suffering from the disease in 2000. It is estimated that the number shall increase to 71.4 millions by 2030 as per WHO projection. Manipur is not lagging behind. The number of persons suffering from the disease is increasing every year, affecting all sections of people- urban, rural and hill. An early survey in 1990s showed that the disease is found in about 4.5 pc. It may be more now.

Diabetes causes fatigue, loss of weight, frequent passing of urine (some may not), increased appetite. In later years, it leads to high blood pressure, impairment and subsequent failure of functions of heart, kidney, vision, brain, nerves etc. It may take many years for the complications to be developed. It will be wrong to say that these complications can be completely avoided or cured. But experience has shown that these can be delayed for more years if the high blood sugar (glucose) level and associated high blood pressure, if any, is controlled and kept as near as possible at normal range. There lies the hope for living longer with diabetes.

There are two major types of diabetes- Type 1 which is usually seen in younger age group and is dependent on external source of insulin for treatment and the patient is prone to develop serious complication in the absence of insulin. The other one is known as Type Diabetes (T2 DM) and account for about 90 pc of the disease. This is commonly seen in older adults, the prevalence rises with advancing age. It is also more commonly seen in obese persons particularly with trunkal (abdominal) accumulation of fat around the waist and inside the abdomen known as visceral obesity. However, some thin persons may suffer from the disease due to other factors. The disease also show close familial and racial link. Present day life style of heavy fatty food and more sedentary habit with less of exercise and less of physical activities are known to be important contributing factors to the development of the disease. Clearly the causation of the disease is multi-factorial.

Management:

Proper diet and physical activities form very important part in the management of diabetes. The food we are taking is grouped into four viz. the starchy materials known as carbohydrates, fat, protein and micronutrients which include the much talked about vitamins and minerals. Carbohydrates are converted to simpler form of glucose. Glucose is the major source of energy of the body. In fact the brain cannot function without glucose in the blood. Fat found in oils of both animal and vegetable sources, is also a very good source of energy. It produces high energy from small amount. That is why it is known as high calorie diet and needs to be restricted in the treatment of diabetes. But it is essential for the production of hormones and has other functions. Protein supplies the building blocks of the body and its repair from time to time. A balanced diet should comprise of all these components in adequate quantity and proper proportion. Traditional dish of Manipuri is predominantly rich in carbohydrate without much fat and protein. But during the last three decades food habit of the people particularly in urban areas have changed with increased intake of fat both of animal and vegetable sources. Consequently, we are seeing more number of people with petulant abdomen which is the harbinger of diabetes. Doctor, what can I eat or what and how much I eat- is a question which every diabetic patient ask or want to ask. The knowledgeable doctor rattles out ‘your diet shall consist of 60 pc carbohydrate, 10-20 pc fat, 20 pc protein’ which only leave him more baffled and ashamed of his own ignorance. Generally speaking, persons who do more physical work eg. the manual workers shall need more calories ie. food than an office goer or business man who spend most of their time sitting. Likewise, pregnant women need more food than others. The main component of daily food, the carbohydrate which has been referred to above, is found in rice, wheat and pulses. Whether to eat rice or roti or both is a matter of personal choice. Often people say, he is taking roti/chapatti to reduce weight. There is no advantage or benefit of one over the other. What is important to understand is the equivalent amount of each item of food. 300 gm of cooked rice (roughly 4 large spoon) give equal quantity of energy as from 100gm of wheat flour- (this is enough to make 4 chapaties of 7cm diameter). This is known as food exchange. Normally a person with limited physical activities needs about 1800 calorie of food. This can be roughly derived from 300 gm of cooked rice or chapaties from 100 gm, 100 gm of fish or lean meat, 25 gm of pulse (one cup or medium katori) a small amount of oil (2 tsf of oil) and vegetables etc. It does not matter whether one take rice or chapatti, the important thing is the quantity. Whether a diabetic can take potato? Another piercing question! The answer is yes. But keep in mind, potato is a good source of carbohydrate. Adjust the quantity of potato against the amount of rice, one is taking. The other important component of a meal is the vegetables of all sorts which provide fibers. Fibers retard absorption of glucose and lower cholesterol. Add a good helping of fruit, the diabetic diet is ready. A small amount of snack in the afternoon or evening helps to avoid fatigue in the evening from unwanted low glucose level in the blood.

Exercise is another important component of avoiding and or controlling diabetes. It helps to reduce weight, more importantly shed the extra fat around the waist which is weighing one down. It improves circulation, improves utilization of glucose by the muscles, gives sense of wellbeing and relaxation. 30 minutes of brisk walking (quick pacing -100 pace/min) daily is all that you need. Walk the few blocks to your house. Other forms of exercise like working out on the gym, cycling, swimming are all acceptable. Even working standing rather than sitting helps. Cut the hours of sitting and lying. It really helps. However, persons who have high blood pressure should avoid sudden straining and heavy exertion as blood pressure may rise suddenly.

If reducing weight and strict adherence to controlled diet are not enough to control high blood sugar, a variety of anti-diabetic drugs which can be taken orally are available. The drugs prescribed by the doctors should be faithfully taken and blood sugar should be regularly monitored. Any untoward effect like cold sweating, confusion should be promptly reported to the doctor. It may be because of abnormally low blood glucose. The doctor may like to adjust the dose. Failure to take food after taking the drug may cause such symptoms. One should not completely starve while on anti-diabetic drug. Insulin is the ultimate drug for treatment of diabetes. All type 1 diabetes needs it. It is required in patients of type 2 diabetes when critically ill due to severe infection, heart attack and or associated complication affecting liver, kidneys, nervous system etc. It is also required while undergoing surgery or while diet, exercise and oral drugs failed to control the high blood sugar. Presently a variety of insulin is available. It may be grouped as short acting, intermediate or long acting depending on the duration of action of the insulin. Very pure form akin to human insulin made possible by genetic engineering, are available. The only inhibiting factor or disadvantage is that it has to be given by injection. So, many patients are reluctant to be on insulin. However, the administration of insulin is now simpler and more convenient due to availability of a pen like device by which the exact amount of insulin is delivered at the turn mand pressing of a knob. The needle is also so fine making the injection practically painless. Insulin is usually given before a meal. The usual advice is take food within 30 minutes after the injection to avoid any drastic fall of blood sugar, clinically known as hypoglycemia. This is characterized by cold sweating which may be profuse with low blood pressure, small or non-palpable pulse and subsequently becoming unconscious, if not treated in time and appropriately. Every diabetic patient or his family member must be aware of this condition for it is reversible by giving a few spoonful of sugar or glucose if acted promptly at the onset of the symptoms or otherwise it may be fatal. If the patient remains unresponsive to administration of sugar or it cannot be given because of unconsciousness, immediate medical help should be sought.

Hypertension or high blood pressure is commonly associated with diabetes. It should be affectively treated with the advice of the doctor who will know what drug is best suited for his patient. Regular check up of eye for vision and changes inside the eye (retina) is a must. So also six monthly check up of heart, lungs, kidney, foot and sensation of the limbs shall help to detect early damages to these organs which are commonly affected during the course of the disease. Early intervention helps to thwart complications.

It is therefore, clear that treatment or management of diabetes cannot be done without the full and active participation of the patient. This is however possible only when the patient understand the disease and understand the treatment regime being advised by his treating doctor. It is to create such an awareness among the public that this day the 14th of November is being observed as World Diabetes Day all over the world as per a resolution of the WHO. The theme of this year has been aptly chosen as ‘Diabetes: Protect Our Future’. This is to give special focus on children and young people who can made the driving force for the promotion and dissemination of education and preventive messages that is diabetes is preventable. But the way we live is putting our health at risk. The North East Diabetes Society, Manipur, has been observing the day by organizing awareness program and diabetes detection camps. Our massage is—strict control of high blood sugar (hyperglycemia), high blood pressure, regular exercise, shedding the extra bulge, avoiding smoking and fatty food is the perfect recipe to live longer for a diabetic.

The writer is former President, NEDS, Manipur.

14-Nov-2012 / 12:45 AM / Sangai Articles / 0 Comments