Facts about diabetes & obesity

By

The Ministry of Health

Obese patients can reduce the risk of developing diabetes by 50 per cent if they were to lose five kilogrammes.

Foot ulcers.

Diabetes Mellitus is a disease in which the amount of glucose (sugar) in the blood is too high.

This is either due to lack of the hormone insulin or the body's own resistance to insulin action.

There are two main types of diabetes:
Type 1 diabetes (insulin-dependent) in which the pancreas fails to produce insulin which is necessary for survival. This type usually develops most frequently in childhood and adolescents, but is increasingly noted in adults.

Type 2 diabetes (non-insulin-dependent) which results from the body not able to respond properly to the action of insulin. Type 2 diabetes is more common and accounts for around 90 per cent of diabetes cases worldwide. It occurs frequently in adults, but is being noted increasingly in adolescents.

Symptoms:
-Excessive urination
-Increased thirst
-Weight loss
-Tiredness
-Blurred vision
-Coma in severe cases

In Type 2 diabetes, most people may not be able to tell if they have the disease as no early symptoms may appear and the disease is only diagnosed several years later after its onset and sometimes when complications are already present.

Obesity & Diabetes
Obesity and overweight are major risk factors for chronic diseases, including Type 2 diabetes, cardiovascular disease, hypertension and stroke, as well as certain forms of cancer.

This is predominantly due to increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity.

The likelihood of developing Type 2 diabetes and hypertension also rises steeply with increasing body fatness. This disease now affects obese children even before puberty. Ninety per cent of Type 2 diabetes patients are obese or overweight.

Did you know 50 per cent of Type 2 diabetes can be prevented through weight management?

Complications associated with Diabetes Mellitus
Most of the complications that occur are due to damage of the small blood vessels and nerves in the organs of the body resulting in:
- Blindness
- Kidney failure
- Heart diseases
- Impotence
- Foot ulcers
- Limb amputation

What you can do to prevent diabetes

Here are some tips to prevent diabetes:
- Maintain a healthy weight: Excess fat prevents insulin from working properly.
Find out your BMI and commit yourself to losing weight if you are overweight (BMI > 25).
- Adopt healthy eating habits
Eat healthily. Include five servings of fruits and vegetables.
Choose foods with low saturated fat, low sugar and salt.
Boil, steam or grill your food and garnish with herbs to add taste and flavour.
- Exercise regularly
Regular physical activity uses up blood sugar and body fat. Choose activities which you enjoy and relatively simple to do.
Exercise at least 30 minutes, five times a week.
- Check your diabetes risk factors periodically If you have most of the risk factors for diabetes, please consult your doctor as soon as possible to have your blood sugar checked.

Ministry of Health - Public Awareness Programme

Source: Weekend 29 November 2008

Diabetes Mellitus

By

Dr PS Sugathan

Specialist Paediatrician and Head of the Department of Paediatrics and Neonatology

RIPAS Hospital - Ministry of Health

"The world is facing a growing diabetes epidemic of potentially devastating proportions... the World Health Organisation and the International Diabetes Federation are working together to support ongoing initiatives to prevent and manage diabetes and its complications, and to ensure the best quality of life possible for people with diabetes worldwide... It is time for 'Diabetes Action Now' - Dr Robert Beaglehole, Prof Pierre Lefèbvre, World Health Organisation

What is diabetes?
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin (as in Type I diabetes), or alternatively, when the body cannot effectively use the insulin it produces (as in Type II diabetes).

Insulin is a hormone that regulates blood sugar. It is also essential to process fat and protein. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

A fasting plasma glucose of more than 7 mmol l-1 ( 126 mg dl-1) or / and 2-hour post-glucose load value of more than 11.1 mmol l-1 ( 200 mg dl-1) confirms the diagnosis of diabetes mellitus.

Values less than these but more than normal values indicate prediabetic states like Impaired Glucose Tolerance (IGT) and Impaired Fasting Glycaemia (IFG): If you have pre-diabetes, you have a higher risk of developing type 2 diabetes.

How do the two types of diabetes differ?

The table given below gives the differences between the two types of diabetes:

Table: Comparison between Type I and Type II Diabetes

How is insulin resistance, pre-diabetes, and type II diabetes linked?

If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and excess glucose builds up in the bloodstream. Many people with insulin resistance have high levels of blood glucose and high levels of insulin circulating in their blood at the same time.

What causes insulin resistance?
Because insulin resistance tends to run in families, we know that genes are partly responsible. Excess weight also contributes to insulin resistance because too much fat interferes with muscles' ability to use insulin. Lack of exercise further reduces muscles' ability to use insulin.

Many people with insulin resistance and high blood glucose have excess weight around the waist, high LDL (bad) blood cholesterol levels, low HDL (good) cholesterol levels, high levels of triglycerides (another fat in the blood), and high blood pressure, all conditions that also put the heart at risk.

DIABETES FACTS
The World Health Organisation (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030.

In 2005, an estimated 1.1 million people died from diabetes.

Almost 80% of diabetes deaths occur in low and middle-income countries.

Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women.

WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015. What are the possible consequences of diabetes?

Depending on the type of the disease itself and the quality of management, diabetes can be a life- threatening and life-shortening disease. Diabetes can have immediate and severe (acute), as well as long-term complications.

Acute complications reflect the difficulties of maintaining a balance between insulin therapy, dietary intake, and exercise and include hypoglycaemia (lows), hyperglycaemia (highs), and diabetic ketoacidosis.

Long-term complications arise from the damaging effects of prolonged hyperglycemia and other metabolic consequences of insulin deficiency on various tissues.

While long-term complications are rare in childhood, maintaining good control of diabetes is important to prevent complications from developing in later life. Long-term complications include the following:

- Retinopathy (damage to inside layer of eye; leading eventually to blindness if not treated)
- Cataracts (hardening of the lens of eye leading to progressive impairment of vision)
- High blood pressure
- Progressive kidney failure
- Early heart disease
- Peripheral blood vessel disease
- Damage to nerves
- Increased risk of infection

Treatment
Let us now consider some aspects of care of a child with type I diabetes.

Insulin treatment

All children with IDDM require insulin therapy.

Only children with significant dehydration, persistent vomiting, or metabolic derangement, or with serious intercurrent illness, require inpatient management and intravenous rehydration.

A well-organised diabetes care team can provide all necessary instruction and support in an outpatient setting. The only immediate requirement is to train the child or family to check blood glucose levels, to administer insulin injections, and to recognise and treat hypoglycemia. The patient and/or family should have 24-hour access to advice and know how to contact the team.

Consultations
Experienced dietitians are involved in the patient's care, typically as a regular member of the diabetes care team. Review by eye specialist may be needed at diagnosis. All children with diabetes aged 12 years and older need a careful annual eye examination to identify and, if necessary, treat diabetes-related eye complications. Access to psychological counselling and support is desirable, preferably from a member of the diabetes care team.
Diet
Dietary management is an essential component of diabetes care. Dietary management of diabetes emphasises a healthy, balanced diet, high in complex carbohydrates (eg, cereals) and fiber and low in fat.

The aim of dietary management is to balance the child's food intake with insulin dose and activity and to keep blood glucose concentrations as close as possible to reference ranges, avoiding extremes of hyperglycemia and hypoglycemia and providing energy and protein adequate for growth and normal physical activities.

Activity
Diabetes requires no restrictions on activity; exercise has real benefits for a child with diabetes. Most children can adjust their insulin dosage and diet to cope with all forms of exercise. Children and their caretakers must be able to recognise and treat symptoms of hypoglycemia.

Hypoglycemia following exercise is most likely after prolonged exercise involving the legs, such as walking, running or cycling.

It may occur many hours after exercise has finished and even affect insulin requirements the following day. A large pre-sleep snack is advisable following intensive exercise.

Some key messages about diabetes
Diabetes is a major threat to global public health that is rapidly getting worse. Diabetes is a life-threatening condition

Worldwide, 3.2 million deaths are attributable to diabetes every year.

One in 20 deaths is attributable to diabetes; 8,700 deaths every day; six deaths every minute.

At least one in ten deaths among adults between 35 and 64 years old is attributable to diabetes.

Three-quarters of the deaths among people with diabetes aged less than 35 years are due to their condition.

Diabetes is a common condition and its frequency is dramatically rising all over the world
At least 171 million people worldwide have diabetes. This figure is likely to more than double by 2030.

In developing countries the number of people with diabetes will increase by 150% in the next 25 years.

The global increase in diabetes will occur because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles. A full and healthy life is possible with diabetes

Studies have shown that, with good management, many of the complications of diabetes can be prevented or delayed.

Effective management includes lifestyle measures such as a healthy diet, physical activity, maintaining appropriate weight and not smoking.

Medication often has an important role to play, particularly for the control of blood glucose, blood pressure and blood lipids.

Through the provision of optimal health care the risk of developing diabetic complications can be reduced substantially.

Helping people with diabetes to acquire the knowledge and skills to manage their own condition is central to their leading a full and healthy life. In many cases, diabetes can be prevented

The prevention of type I diabetes is not yet possible and remains an objective for the future.

The prevention of type II diabetes has been shown to be possible and requires action now.
Trials have shown that sustained lifestyle changes in diet and physical activity can reduce the risk of developing type II diabetes. For example, the Finnish Diabetes Prevention Study showed that a better diet, increased physical activity and modest weight loss could substantially reduce the development of type II diabetes in middle-aged adults at high risk.

The scale of the problem requires population-wide measures to reduce levels of overweight and obesity, and physical inactivity.

The urgent need for prevention
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type II diabetes. They include:

Increased physical activity - it is estimated that currently 60% of the world's population do not do enough physical activity, with adults in developed countries most likely to be inactive. Studies have shown that just 30 minutes of moderate exercise a day, five days a week, is enough to promote good health and reduce the chances of developing type II diabetes.

A healthy diet - eating between three and five servings of fruits and vegetables a day and eating less sugar and saturated fats has been shown to be important in maintaining appropriate weight, and therefore a lower risk of type II diabetes.

Weight loss - more than one billion adults worldwide are overweight; at least 300 million of whom are obese. It is estimated that well over half of all cases of type II diabetes could be avoided if excessive weight gain in adults could be prevented.

Non-smoking - people with diabetes are at greater risk of dying from coronary heart disease, stroke and peripheral vascular disease than people without the condition. Smoking increases the risk even further.

Conclusion
Most of the facts and figures about diabetes mellitus discussed in this article are relevant in the Brunei context in terms of magnitude and urgency. The scale of the problem and the increasing incidence of diabetes require population-wide measures to reduce levels of overweight and obesity, and physical inactivity. Informed policy decisions on transport, urban design, and on food pricing and advertising can play an important part in reducing the population-wide risks of developing type II diabetes. On the eve of the World Diabetes Day - November 14, 2008- let all of us rededicate ourselves for concerted and coordinated action to prevent and treat diabetes from childhood onwards.

- Ministry of Health Public Awareness Programme

Source: Weekend 15 November 2008

Safest plastics for food and beverages

By Lori Bongiorno

Some plastics are safer to eat and drink from than others. Here's a quick guide to help you make informed choices. If you want to dig deeper, take a look at the Institute for Agriculture and Trade Policy's Smart Plastics Guide (PDF).

It's worth avoiding the following plastics when you can. You can identify a plastic by looking at the recycling code number that appears inside a triangle at the bottom of many containers.

Polyvinyl chloride (PVC) can leach phthalates, known male reproductive toxicants. It can be identified by code 3. One way to avoid it in the kitchen is by choosing plastic wrap made from polyethylene rather than PVC. If a box is not labeled, find a brand that is or call the manufacturer.

Polystyrene is used in Styrofoam products. It may leach styrene (a neurotoxin) when it comes into contact with hot, acidic, or fatty foods. It's marked with recycling code 6.

Polycarbonate can leach bisphenol-A (BPA), an endocrine disruptor associated with a long list of health concerns. Baby bottles, "sippy" cups, 5-gallon water jugs, and reusable beverage bottles are typically made out of this plastic. Products may be marked with recycling code 7 (also includes any plastic that doesn't fit into the 1 to 6 recycling code categories) and/or the letters "PC."

In response to the widespread concerns about BPA, baby bottles and other items made from alternative materials are springing up. Experts say stainless steel is your best bet for reusable water bottles right now. ThinkSport and Klean Kanteen are two widely available brands.

The following plastics are considered safest for food storage. Glass and stainless steel are also good options.
Polyethylene terephthalate ethylene (PETE), code 1.

High-density polyethylene (HDPE), code 2.

Low-density polyethylene (LDPE), code 4.

Polypropylene (PP), code 5.

Here are some tips for using all plastics safely:

· Don't microwave food plastic containers. Chemicals are more likely to leach out when plastic is heated. "Microwaveable plastic" doesn't guarantee that chemicals won't leach. Cover foods in the microwave with wax paper or a plate. If you do use plastic wrap, then make sure it doesn't touch the food.

· Avoid putting hot foods in plastic containers. Let leftovers cool off before storing them in plastic.

· Take good care of plastics by not washing them with harsh chemicals, and dispose of scratched and worn containers. Research has shown that older, scratched items will leach more, says Kathleen Schuler at the Institute for Agricultural and Trade Policy. (Don't put them in the dishwasher if you want to be completely risk-averse, she suggests.)

[Environmental journalist Lori Bongiorno shares green-living tips and product reviews with Yahoo! Green's users. Send Lori a question or suggestion for potential use in a future column. Her book, Green Greener Greenest: A Practical Guide to Making Eco-smart Choices a Part of Your Life is available on Yahoo! Shopping.]

Parent's role in children's oral health

By

Dr Mary Cheong Poh Hua

Senior Dental Officer
Ministry of Health

The size of the fluoridated toothpaste to be used should not be more than the size of a pea. PHOTOS: MINISTRY OF HEALTH

The toothbrush of the child should be changed if the bristles begin to splay.

Parents, especially mothers, have a major role in the oral health of their children, in particular the young and very young children.

This is because very young children are totally dependent on adults, in most cases, their parents, for virtually everything; from feeding, bathing, toilet, sleeping to safety, nurturing and educating.

They are the most effective people to help instil habits in the child that contribute to good dental health.

However, the converse is also true, where parents are also responsible for developing habits in their children that contributes to poor oral health.


WHY IS THIS SO?

Dental disease/caries - multifactorial and preventable

We need to understand the cause and progression of dental disease and the factors that influence or modify the disease.

It is well known that dental disease, in particular, dental caries is a multifactorial disease that is influenced by lifestyle and is entirely preventable. The cause of dental disease is primarily bacteria (in particular Streptococcus Mutans) that are present in the mouth called plaque. The bacteria metabolise the sugars present in the mouth and produces acids as waste products.

These acids dissolve the minerals of the tooth structure and soften the enamel and later the dentine, causing cavities in the tooth.

However, other factors that influence this process are time; the frequency, type and amount of sugar that the tooth and bacteria is exposed to; the resistance of the tooth structure to acidity; the removal of bacteria from the teeth and mouth/the presence or absence of cariogenic bacteria in the mouth; the presence of intervention procedures such as fissure sealants, topical fluoride rinses or gel.

Studies have shown that preventive approach rather than curative approach plays a significant role in improving oral health status. It has been found that the presence of dental services alone was relatively unimportant in improving the oral health status of children. Other dental preventive and social factors play a significant role in improving the oral health status. Studies have indicated a relationship between the parental socio-economic characteristics and the oral health of their children. In addition, the primary socialisation process between the parents and their children in all aspects of life such as dietary practices, dental health awareness and perception will also influence the oral health status of their children.

Importance of early intervention and education for the child

It is very important to introduce good dental health care early in the child's life as this would most likely lead to good oral health in adult and would eliminate the negative psychological and emotional impact that dental pain and it's related treatment has on the younger age group and it's long term effect and implications to dental health in their adult life. There is also the greater chance of maintenance of good oral health later in life if primary health care (prevention of dental disease and promotion of dental health) is started at a young age.

Parental influence has the greatest impact on determining the dental caries of their young children, as they are largely dependent on their parents. A child is not a free agent. The ability of a child to act is limited by parental willingness and ability to assist the child. A child may be taught the importance of eating low-sugar foods. However, if his mother continues to serve high-sugar foods, the child will not be able to adopt healthier habits. Therefore, parental attitudes towards oral health are important factors in a child's oral health.
Since children are dependent on the adults for their general well being, including their oral health, it is therefore, important to recognise the role and responsibility of parents in providing early intervention and education for their children during their formative years.


The responsibility of pregnant mothers

Studies have shown that gum (periodontal) disease and poor oral hygiene are related to: -
Low birth weight, Premature birth and Heart disease
It is therefore important for pregnant mothers to be responsible to their babies by taking very good care of their oral health during pregnancy.


Recommended guidelines

Tooth brushing
Parents should brush their children's teeth from the moment the first tooth erupts till the child begins to develop the manual dexterity to brush independently with supervision at age two-seven years old.

Children's fluoridated toothpaste should be used for brushing the child's teeth only when the child can spit or rinse, usually from the age of two years onwards. Parental supervision must be emphasised. This is for plaque removal effectiveness and also to ensure that the child does not swallow any fluoridated toothpaste.

The size of the fluoridated toothpaste to be used should not be more than the size of a pea.

The toothbrush of the child should be of a small head, ie about the length of a 20 cents coin in diameter and the bristles should be soft. The toothbrush of the child should be changed if the bristles begin to splay

Infant feeding

Breast-feeding is preferred to bottle-feeding.

If bottle-feeding: -
Bottle-feeding are encouraged to be stopped by the age of one to three years old and should be replaced by a cup.
Bottle-feeding time should NOT be prolonged.
The bottle should NOT be in the child's mouth for extended periods of time. Bottle-feeding should NOT be a pacifier for the child. Appropriate attention and nurturing should be given and should NOT be replaced by bottle-feeding.
Bottle-feeding before sleep/nap should NOT be encouraged. Bottle feeds should NOT have any sugar or sweetened beverages added.

SNACKS
Sugary snacking should be discouraged and should be limited to less than three times a day.
Sweets/candies should not be used as rewards for good behaviour or good performance as this may encourage it to be a habit, which will jeopardise the oral health of the child.
When forced to give sugary snacks, it should only be during meal times and not in-between meals.
Parents should know the sugar contents of foods given to the child. Parents are encouraged to read and understand food package labels. Children are only allowed not more than 25 grammes (five teaspoons) of sugar per day and adults 50 grammes (10 teaspoons) of sugar per day. NOTE: One can/tin of sweet beverage contains about five to 10 teaspoons of sugar.

Child education
Parents should not instil fear in their children regarding dental health or dental treatment.
Parents should not threaten their children with "toothache" or dental pain and it's related dental treatment (injection, extraction) for bad behaviour or disobedience.

Dental Health should be taught in a positive manner that will build awareness in their children regarding their oral health care without undue fear that is unbeneficial to the child. This will cause the child to have a negative attitude towards dental health and indirectly jeopardise their dental health. The child may develop an irrational fear towards dental clinics and dental treatment later on in life when there is a need for it.

Source: Weekend 1 November 2008