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).
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?
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
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