At no time has Sri Lanka experienced such a rapid surge in diabetes - ranked 3rd highest among the reasons why most people die. A recent survey indicates at least 10 % of the population suffers from diabetes and an additional 10% for pre-diabetics, making a grand total of 20% of the general population over 20 years of age. In addition several children who suffer from obesity are now on the brink of entering the pre-diabetic stage due to their ingestion of sugar high, starch and fat saturated foods and drinks. Health officials have warned we could be heading towards a diabetic epidemic unless we drastically change our food habits and exercise more.
However, we can easily ward off this dangerous trend that currently affects one fourth of a rising young number of Lankans by observing some simple cost effective lifestyle modifications and exercising a little will power of our own, , two experts from the National Diabetes Centre of Sri Lanka, Dr. Mahen Wijesuriya and Dr Chamari Warnapura opined. In an interview with the Sunday Observer on the eve of World Diabetes Day, they discuss what these Do’s and don’ts for preventing Diabetes 2 are. They also explain what Type 1 Diabetes is since most people are still unfamiliar with this condition which is compararively rare in Sri Lanka.
Excerpts…
Q: A recently released report of the Global Burden of Disease Data (GBDD) for Sri Lanka (2015) has ranked Diabetes as the 3rd (7.8%) highest cause for deaths in Sri Lanka and the third (7.9%) among five top causes of ‘Years Lived with Disability’ (YLD). It has also stated that next to Ischaemic Heart Disease, Diabetes was the cause for the 2nd main cause of ‘Disability Adjusted Life Years’ (DALY) Do you agree?
A. These figures may vary year on year. A recent report indicates we are closer to 10% for diabetes and an additional 10% for pre-diabetes, making it a total of 20% in the general population in the over 20 years age group.
Q: What is the estimated number of people currently living with diabetes in Sri Lanka?
A. Four million with abnormal sugar levels are thought to live in Sri Lanka and the number is increasing rapidly.
Q: Of them how many are adults and how many children?
A. Around 8.2% of the general population has Dysglycaemia (abnormal sugar levels) in the under 20 age group which is a matter of grave concern.
Q: Are there different types of diabetes? Which is the commonest type in Sri Lanka and where is the highest incidence to be found?
A. Generally speaking there are 3 types of diabetes: Type 1, Type 2 and Gestational DM. Type 2 are the commonest in Sri Lanka. The highest incidence of type 2 diabetes is found in urban settings where large numbers of people with unhealthy life styles live.
Q: How long does it take for Type 2 diabetes to develop in a person?
A. It occurs over the years. The causes for type 2 Diabetes are a combination of genetic predisposition, fetal nutrition, post natal lifestyles and stress. This combination was accepted unanimously by over 350 senior diabetiologists from 33 countries spearheaded by the Diabetes Association of Sri Lanka in 2002.
Q: What organs in the body are affected in diabetics?
A. In most diabetics, multiple organ afflictions are often seen-starting from the eyes and the brain followed by the heart, kidneys and feet.
Q: What are the symptoms to look for in 1) adults 2) children? Is there a difference?
A. To start with there may be no symptoms in adults which may develop later on in the disease. Around 50% remain asymptomatic initially. This is a potential dangerous situation where the illness can proceed to give rise to complications without the patient knowing anything about it. As for children, the illness is very sudden in onset and can be catastrophic and it is always symptomatic producing a state of altered consciousness and excessive passage of urine, thirst and increased consumption of food.
This may lead to a state of unconsciousness. It may be an end point if diagnosis and treatment is not instituted immediately due to diabetic ketoacidosis which is a metabolic complication. In children initial complications are metabolic and in adults the complications are most often related to organic changes.
Q: Can obese, overweight children become diabetic early in life?
A. Yes. Obese children should be specially considered for primary prevention of diabetes through a process of weight reduction which can entail a healthy diet and adequate exercise. The whole family should join hands with the obese patient to restrict unhealthy practices
Q: High fasting plasma glucose (10.7%) has also been ranked by the GBDD as the 2nd top risk factors for well being in Sri Lanka. Can you explain this condition?
A. Elevated plasma glucose could be either due to a state of diabetes or prediabetes.
In the development of diabetes, high plasma glucose shows up first in an intermediate state called prediabetes which later proceeds to a full blown illness of diabetes in most cases. The total percentage of persons having this situation is in excess of 4 million.
Q: If children with symptoms of diabetes are not treated in time, can it lead to early death?
A. Yes, if two conditions prevail: One is excessive amount of sugars in the blood leading to ketoacidosis. The other is the gross reduction of sugar due to excessive insulin therapy. This condition is called hypoglycaemia.
Both can give rise to states of unconsciousness and fits with an increased risk of death.
Q: What happens when the average range of blood sugar is exceeded? What organs are liable to be affected?
A. When these levels are exceeded problems may arise in the eyes, kidneys and the nervous system and slowly develop in the blood vessels going to the heart, brain and feet.
Q: Can diabetes remain undetected for several years?
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Diabetes update - Sri Lanka 415 million people have diabetes in the world and 78 million people in the IDF SEA Region; by 2040 this will rise to 140 million. There were 1.16 million cases of diabetes in Sri Lanka in 2015. Diabetes in Sri Lanka - 2015 Total adult population (1000s) (20-79 years) 13,724 Number of deaths in adults due to diabetes 16,318 Prevalence of diabetes in adults (20-79 years) (%) 8.5 Cost per person with diabetes (USD) 144.6 Total cases of adults (20-79 years) with diabetes (1000s) 1,161.7 Number of cases of diabetes in adults that are undiagnosed (1000s) 595.2 (from IDF SEA region report) |
A. Yes.
Q: What will happen if it is not diagnosed in time?
A. The excess sugars in circulation have the potential to damage the organs we have mentioned above.
Q: To discuss a subject which is still not well understood, Type 1 diabetes though rare in Sri Lanka still exists. What is this condition? How is it different from the more common type 2 diabetes?
A. Type 1 is a situation where the near total destruction of insulin production occurs mainly due to an autoimmune reaction. Type 2 is a situation which is dominated by insulin resistance which starts in early life and proceeds into adulthood in the presence of inadequate insulin rather than a total loss. The cause of Type 1 is not clear at present. Hence primary prevention is not established worldwide.
Q: Who is most at risk of developing type 1 Diabetes?
A. Mostly children from age 1 upwards with peaks of at around ages 5 and 12.
Q: What are the problems associated with type 1 diabetes?
A. The problems are day to day management in order to prevent high and low sugars with insulin therapy right through life and preventing chronic complications like the eye, the kidney and nerves at a later date.
Q: How is it detected?
A. Detection is through the testing of blood for sugar. Either in the fasting or the post prandial state. The management involves a holistic approach. Acceptance of the condition by the patient and parents is paramount leading to compliance. The basic therapy is insulin which can be either injected or given through an insulin pump.
Q: Are type 1 diabetics insulin dependents?
A. Yes.
Q: What are the symptoms to look for if they exceed the insulin dosage accidentally?
A. They may go in to a hypoglycaemic state which involves drowsiness, sweating, dizziness, fits, unresponsiveness and unconsciousness to name a few.
Q: Any immediate interventions in such a situation?
A. Establish a low sugar state first by testing. Immediately if a level of consciousness prevails, sugar in the most effective and absorbable form should be given in sufficient quantities without fear of a rise over the normal levels. This should be accompanied by food so that there is a continuum of supply of sugar through starch over a period of hours. If available, an intravenous infusion of dextrose would be best.
Q: Can both Type 1 and type 2 be inherited?
A. Type 2 is more likely to be inherited than Type 1 and have a significant familial aggregation.
Q: Type 2 Diabetes is closely associated with eating wrong foods. What advice can you offer on healthy diets to avoid getting diabetes?
A. Ideally, all fast food should be curtailed in quantity and frequency- especially those containing sugar, refined starches and excessive quantities of fat. The better option is to eat foods with high fiber natural products with minimal refinement or extraction, avoiding highly refined foods. A balanced diet is very important in today’s context considering the rise in non communicable disease including diabetes.
Q: What is a healthy diet?
A. A healthy diet entails having meals on time as well as controlling the quality and quantity of what you eat. It is vital to incorporate a well balanced diet to your daily routine to promote good health. This will include pulses such as gram, green gram, cereals, locally produced vegetables and fruits. Fish and chicken can be given in reasonable proportion avoiding the meats as they usually contain fat but they may still be consumed occasionally. This must be matched with some form of exercise on a regular basis to balance the input.
Q: Can exercise reduce diabetes risks?
A. Exercise forms an integral part of diabetes prevention coupled with a healthy diet and medication. It should be regular, for periods of about half an hour at least 3 times a week.
Q: Do’s and Don’ts for potential diabetics?
A. Don’t consume large quantities of refined foods such as sugar, jaggery, honey, treacle, cakes, puddings, ice cream, bread, buns etc on a regular basis. Don’t delay your meals as it would produce hunger which may be stimulus to eat more. Match your input with exercise on a regular basis. Cultivate peace of mind and avoid stress.