By Aamir Amin Nowshahri

The spread of diabetes has often been described as a silent epidemic of epic proportions. United Nations (UN) figures suggest that compared to 108 million adults living with diabetes in 1980, the number had risen to an estimated 422 million in 2014.

aboutdiabetes1_600x450The global prevalence of diabetes has nearly doubled since 1980, rising from 4.7 per cent to 8.5 per cent in the adult population, according to the UN. The growth has been more in low and middle-income countries as compared to high-income countries.

As per official figures of the International Diabetes Federation (IDF), 415 million people were living with diabetes in 2015. According to estimates, this number is expected to rise to around 642 million or one in ten adults by the year 2050.

The situation in Kashmir is pretty much on similar lines. A study conducted by doctors of the Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in 2008 showed that the prevalence of diabetes in the select age group of 40 years had increased from 5.1 per cent in the year 2000 to 6.0 per cent in 2008.

Findings of this study were also compared with those of an earlier one conducted in 2000. On the basis of the results, and using statistical methods to arrive at a comprehensive result covering varied age-groups, doctors were able to estimate a relative increase of 18 per cent in the prevalence of diabetes in Kashmir in less than a decade.

The study was published in “Diabetes Clinical Research Practice” – an official journal of the IDF. (IDF is an umbrella organization of over 230 national diabetes associations in 170 countries and territories with a mission to promote diabetes care, prevention and cure worldwide.)

WHAT IS DIABETES?

Diabetes is a non-communicable metabolic disorder in which the pancreas does not produce enough insulin in the body. Diabetes can also occur when the body cannot effectively use the insulin produced by the pancreas.

Insulin is a hormone that helps the blood to carry glucose to all the cells in the body. If the body is not able to make enough insulin, or if the insulin doesn’t work the way that it should, glucose stays in the blood and doesn’t reach the cells. This elevated level of blood glucose leads to diabetes or pre-diabetes (when the amount of glucose in the blood is above normal but not high enough to be called diabetes).

Over a period of time, elevated levels of glucose in the blood (also commonly known as blood sugar) can have serious effect on every major organ system in the body, which may result in heart attacks, strokes, nerve damage, kidney failure, blindness, impotence and infections that can lead to amputations.

WORLD DIABETES DAY

Celebrated on November 14 every year, World Diabetes Day (WDD) was created in 1991 by the IDF and the World Health Organisation as a response to growing concerns about the escalating threat to public health posed by diabetes. In 2006, World Diabetes Day became an official United Nations Day with the passage of a United Nations (UN) Resolution.

WDD has a different theme every year. The theme for 2016 is “Eyes on Diabetes”.

TYPES OF DIABETES

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset diabetes) is characterised by deficient insulin production. People suffering from this type of diabetes require daily administration of insulin.

The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Symptoms of type 1 diabetes include excessive urination (polyuria), excessive thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur simultaneously.

There are many children in Kashmir who are less than 10 years old and suffering from type 1 diabetes.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin dependent of adult-onset diabetes) is caused when the body cannot utilise insulin effectively. A study conducted by the WHO in 1999 found that type 2 diabetes comprises 90 per cent of people with diabetes around the world. This type of diabetes is to a large extent caused by excess body weight and lack of physical activity.

The symptoms of type 2 diabetes are largely similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

In a worrying trend, type 2 diabetes, which was only being seen in adults until recently, has now also been reported to occur in children. (A three-year-old girl has been diagnosed with type 2 diabetes in Texas, USA)

Gestational diabetes

In gestational diabetes, pregnant women have blood glucose levels which are above normal but below those diagnostic of diabetes. Such women are at an increased risk of complications during pregnancy and the time of delivery. They are also at an increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than reported symptoms.

Impaired glucose tolerance and impaired fasting glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are immediate conditions in the transition between normality and diabetes. People with IGT and IFG are at a high risk of progressing to type 2 diabetes, although it is not inevitable.

Neonatal diabetes

Neonatal diabetes is a form of diabetes that is diagnosed under the age of nine months. It is caused by a change in a gene which affects insulin production. About 20 per cent of people with neonatal diabetes also have some developmental delay (like muscle weakness, learning difficulties) and epilepsy. Neonatal diabetes is very rare. There are two types of neonatal diabetes, transient and permanent. Transient neonatal diabetes does not last forever and usually resolves before the age of 12 months. It may however, recur later in life especially during teenage years. Permanent neonatal diabetes, as the name suggests, lasts forever and accounts 40 to 50 per cent of all cases.

RISK FACTORS

Increase in portion sizes of food items (which is common in Kashmir whether it is a marriage party or a condolence gathering) and consuming invisible calories (in the form of sugary drinks) are some of the most common habits that put one at the risk of getting diabetes. Skipping breakfast, which is the most important meal of the day, is also an unhealthy practice. Starting the day without having a good breakfast puts the body in energy conserving mode that is followed by hunger and overeating later in the day.

The traditional Kashmiri kitchen garden (waer) can come in handy when it comes to keeping diabetes at bay. Consuming produce vegetables, especially non-starchy ones like spinach, collard greens, tomatoes and broccoli help in blood sugar control and weight loss. Reduced consumption of such food items increases the risk of diabetes.

The risk of getting diabetes is also increased by converting many healthy food choices into unhealthy ones. One such example, which is popular in Kashmir, is that of deep frying fish with a lot of oil. Midnight munching (common among students) and indulging in starchy carbohydrates and trans-fats also increase the risk of getting diabetes.

EARLY SIGNS

Diabetes has a lot of early signs, but most of the times these signs are so subtle that they may not even be noticed. Some of the most common early indicators that should not be taken lightly are:

  • Frequent and/or excessive urination
  • Feeling excessive/perpetual thirst
  • Unexplained weight loss
  • Hunger pangs
  • Feeling tired all the time
  • Feeling moody and grumpy
  • Blurry vision
  • Slow wound healing
  • Tingling sensation in hands and feet
  • Recurring infections

WHO IS MORE AT RISK?

Factors that increase one’s risk for type 2 diabetes include:

  • Being over 45 years of age
  • Being from a high-risk ethnicity, like being an Asian or an Indian
  • Being overweight or obese
  • Leading a sedentary lifestyle
  • Having vascular disease (abnormal condition of the blood vessels)
  • Having high blood pressure
  • Having low levels of High Density Lipoproteins (also called good cholesterol) or high levels of triglycerides (Low Density Lipoproteins, also called bad cholesterol)
  • Having a first degree family member with diabetes
  • Having a history of gestational diabetes in last pregnancy or history of delivering a baby weighing over 9 pounds (4 kgs)
  • Having polycystic ovarian syndrome (PCOS) or other indicators of insulin resistance like fatty liver disease
  • Having a history of prediabetes

KEEP YOURSELF SAFE

There are some simple steps that everyone can take to reduce the risk of type 2 diabetes. These include:

Manage your weight. If you are overweight, losing 5-7 per cent of your body weight (for example, 6 kg if you weigh 90 kg) can help to prevent or delay type 2 diabetes.

Eat healthy. Choose water to drink instead of sugary drinks, and eat smaller portions. If you feel like consuming energy/fat rich foods, it should always be accompanied with vegetables/sprouts. High fibre and leafy vegetables help in lowering down blood sugar levels, and should be included in one’s diet. Two servings of milk in daily diet is a good option to keep blood sugar levels in check as milk has the right combination of carbohydrates and proteins. Pulses with husk and sprouts are a healthy diet option to keep blood sugar levels in check. Good fats such as Omega-3 and monounsaturated fats (MUFA) should be consumed as they are good for the body. Natural sources for these are canola oil, flax seed oil, fatty fish and nuts. These are also low in cholesterol and are transfat free.  Fruits that are high in fibre such as apple, orange, pear, papaya and guava should be consumed more. Fruits like mango, banana and grapes contain high sugar and should be consumed less. All refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees) should be avoided. Animal fat such as butter, egg yolk and other foods high in saturated fatty acids and cholesterol should be reduced to a minimum and replaced with vegetable oils, particularly polyunsaturated fats (PUFA). Salt intake should be reduced, irrespective of whether one is hypertensive or not. Cigarette smoking should be avoided by diabetic patients, and alcohol should only be taken in moderation. One should also make a habit of consuming small frequent meals rather than one or two large meals in a day.

Stay fit. Physical exercise plays an important role in preventing diabetes. One should indulge in physical exercise for at least 30 minutes, five days a week to help burn calories and lose weight.

Check vital parameters. One should develop a habit of keeping track of vital parameters when it comes to diabetes. Cholesterol, blood sugar and blood pressure should be regularly checked. Those who had developed gestational diabetes should get tested for diabetes six to 12 weeks after the baby is born and at least every three years after that as they are at an increased risk of getting type 2 diabetes in future.

THE WAY AHEAD

There is a need for aggressive public motivation to improve the level of awareness of the average citizen, especially in a resource crunched region like Kashmir. Of late there have been improvements on the front of public awareness, but a lot needs to be done still and all stakeholders should join hands to fight the battle with diabetes.

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