Sunday November 15, 2009
D is for diabetes
By LIM WEY WEN
With awareness, we can detect diabetes early. With knowledge, we can get diabetes under control. With education, we can prevent diabetes and delay its consequences.
DIABETES may run in their families, but Chong Kuan, 61, and Tan Ban Tap, 52 shares little in common in the way they live with diabetes.
Having survived a few diabetes complications, Chong Kuan often reminds his friends and family to take precautions to prevent diabetes Chong, whose mother had diabetes for many years, never took it seriously until he gradually lost his eyesight and developed renal failure requiring dialysis three years ago.
“I never thought that diabetes could bring about such serious complications. That is why even after I was diagnosed with diabetes 30 years ago, I never took precautions. Carbonated drinks were still my favourite and I did not resist having my coffee or tea sweetened.”
Holding up his bottle of plain water, he says, “This is what I drink now, and even when I have the occasional cup of coffee or tea, I stay away from sugar.”
Tan, however, tried his best to prevent the disease since he was young. “As diabetes runs in my family, my siblings and I took precautions when we were young. I tried to cut down my sugar and carbohydrate intake, especially after I reached my 30s,” he says.
Although he knew his chances of developing diabetes later in life was high, he was still surprised when his cardiologist broke the news to him eight years ago.
“I was depressed when I was told I had impaired glucose tolerance then, because I have done everything I could – I cut down my sugar and exercise regularly. I thought I could avoid developing the disease,” he laments.
“I did experience what I later knew was the early warning signs of diabetes, but I did not think much of it then because blood glucose meters did not show any abnormalities,” he adds.
But let’s not talk about whether Chong could have avoided the complications he experienced – had he been more disciplined in his eating habits, or whether Tan could have found out he had diabetes before chest pains brought him to his cardiologist – had he sought a thorough check-up when he first noticed the warning signs of diabetes.
Because more importantly, their stories point to two common beliefs many still have about diabetes: that it is not that serious a disease and that as long as we eat healthily and exercise regularly, we will not develop diabetes.
Diabetes rising
The first belief – that diabetes does not bring much harm – is a myth. According to the American Diabetes Association, diabetes causes more deaths a year than breast cancer and AIDS combined. And, two out of three people with diabetes eventually die from heart disease or stroke.
The second, however, is only true to some extent. As doctors Amitabh Dash, Tejaswi Kumar, and NK Agarwal concluded in their review article Diabetes: A Paradigm and its Prevention, “It probably may not be realistic to suggest that we could totally prevent diabetes, but the studies so far suggest that diabetes is preventable to a large extent.”
And that coincides with the message the International Diabetes Federation wishes to convey this World Diabetes Day, which was celebrated yesterday.
“The International Diabetes Federation has chosen to focus on diabetes education and prevention for our World Diabetes Day campaign for the next five years because the world now has a diabetes epidemic,” says its president Professor Jean-Claude Mbanya in an email interview.
As studies show that there are over 285 million people with diabetes worldwide (and in the case of type 2 diabetes, many of these cases could be prevented), World Diabetes Day emphasises the need to support people with diabetes by providing ongoing, high-quality diabetes education. For people at risk of diabetes, the campaign aims to promote the message that prevention is possible, cost-effective, and even cost-saving.
A collective effort
Although diabetes awareness campaigns are getting more effective, Prof Mbanya reckons that there is more to be done to reach all target groups.
“This will be a huge challenge,” he says. “Affecting the required behavioural change and creating healthy environments will require unparalleled cross-sector collaboration. We will need to overcome powerful social, cultural, and market forces to make sure that healthy life choices are available and affordable.
“But beyond that we will need to break through the paradox that leaves many of us knowing what the healthy choice should be, but making the less healthy choice regardless.”
Consultant endocrinologist Dr Arlene Ngan thinks that prevention starts not only from the individual, but from society as well. While it is often our responsibility to take care of our own health, we also need accessible facilities to encourage physical activity and healthier food choices to make it easier for us to live a healthful life.
“There is no point in telling people that their kids need exercise when they can’t find any playgrounds around!” Dr Ngan explains.
Status: It’s complicated
Thirty minutes of exercise a day can reduce your chances of developing type 2 diabetes by 40%. In this picture, participants of the Sau Seng Lum Diabetes Walk start their 5km walk in support of the World Diabetes Day campaign to raise awareness on the prevention, early detection and proper management of diabetes. – Photo courtesy of IJM Corporation Berhad. What sets diabetes apart from other chronic diseases, says Prof Mbanya, is the reality that diabetes requires a person to be responsible for the majority of his or her care all of the time.
Every day, a person with diabetes needs to monitor blood glucose, adjust the dosage of medications according to blood glucose levels, exercise regularly and adjust his diet – things a person with high blood pressure, for instance, does not need to follow strictly.
When uncontrolled, diabetes can lead to many debilitating complications.
People who have diabetes are not only predisposed to heart and kidney disease, they are also at risk of losing their nerve function, eyesight, and even their limbs.
Early detection of diabetes should help in delaying those complications, but it is not always easy to detect due to our tendency to associate signs such as excessive thirst, frequent urination, and weight loss to changes in water intake, stress, and fatigue.
In fact, one in two people with diabetes do not know they have the disease until they get admitted into hospitals for heart attacks or renal failures, says Dr Ngan.
“That is why it is important to find out if you have it through regular screening so you can treat it early,” she adds.
For those in the high-risk groups (see Things you need to know about diabetes), Dr Ngan recommends annual blood glucose screening from the age of 35 years. Others can go for annual blood glucose screening after the age of 40 years as a person’s risk of developing diabetes increases with age.
According to Wong Peng Wah, vice president of charitable organisation Sau Seng Lum Dialysis & Stroke Rehabilitation Centre, 65% of their dialysis patients have had diabetes before going on dialysis. That is why the organisation had subsequently set up a Diabetes Care Centre to support and educate patients with diabetes to help them prevent further complications.
As one in two people who develop diabetes do not have overt symptoms, checking your blood sugar regularly can help you detect diabetes early Little things that count
Although diabetes can affect anyone, anywhere, and at any time, if it is any consolation, efforts to prevent it need not involve a total lifestyle overhaul.
Simple measures, such as training your taste buds’ to accept drinks that contain less sugar, or taking the stairs whenever you can, are already steps towards a healthier you.
After all, taste is acquired and health is to a large extent, a sum total of our choices in life.
● To learn more about diabetes and how you could prevent it, visit the World Diabetes Day website at www.worlddiabetesday.org.
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