Managing Diabetes

Antonio M. Ajero, the editor in chief of Edge Davao, could no longer remember the symptoms but he was diagnosed with diabetes after the free annual examination that was offered by the University of Mindanao.  He was then the station manager of dxMC, a radio station of the UM Broadcasting Network.  This was in 1978.

“The first time, I was diagnosed to have a sugar level of 9 plus, I was simply given a list of things—food and drinks—to avoid.  Actually, it was a list for people who have gout,” he recalled.

Ajero followed the “avoid list” and did brisk walking.  The next time he had the annual exam, the numbers were down—chiefly sugar level and bad cholesterol.

Today, he is healthy as ever.  In fact, you cannot tell that he is diabetic.  “The general idea is trust and obey your diabetologist,” he said.

These days, he lives on semi-penury—that is, when he is in a situation wherein he cannot be choosy with his intake simply because there’s nothing else available.  “It’s worse now that I am a widower for the last 12 years,” he admitted.

Unknown to many, Ajero follows proper diet.  “I do my best about my intake,” he pointed out.  “I think exercise and avoiding risky food are the two best practices that matter to me.”

In the past, diabetes was known as a “disease of affluence” in industrialized countries.  But these days, it has also become a health problem in developing nations, including the Philippines.  In fact, for every 5 Filipinos, 1 is a diabetic.

In 2000, about 2.7 Filipinos were diabetics. The Geneva-based World Health Organization (WHO) predicts that by 2030, the number of diabetics in the country will surge to 7.7 million.

In the coming years, health experts foresee the Philippines to be part of the top countries in the world affected by diabetes due to the accelerated rate of citizens developing the “metabolism disorder,” as the Medical News Today (MNT) calls it.  Metabolism refers to the way your bodies use digested food for energy and growth. Most of what you eat is broken down into glucose. Glucose is a form of sugar in the blood—it is the principal source of fuel for our bodies.

“When our food is digested, the glucose makes its way into our bloodstream,” MNT explains.  “Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present—insulin makes it possible for our cells to take in the glucose.”

Insulin is a hormone released from the pancreas.  “After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop,” MNT says.

A person is said to have diabetes when the quantity of glucose in the blood is too elevated (known in medical science as hyperglycemia). “This [happens] because the body does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces,” MNT explains.

“This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements,” MNT adds.

Oftentimes, “doctors use the full name Diabetes mellitus, rather than diabetes alone, to distinguish this disorder from Diabetes insipidus, a relatively rare disease that does not affect blood sugar levels,” states The Merck Manual of Medical Information.

Two types

Actually, there are two types of diabetes.  Type 1 (formerly called insulin-dependent diabetes) occurs in only 10 to 15 percent of all cases and tends to occur in people under the age of 30 (that is why it is also called juvenile-onset diabetes).  Onset is normally sudden and dramatic.  More than 90 percent of the insulin-producing cells of the pancreas are permanently destroyed. The exact cause of it is unknown but it’s generally thought to be inherited.

Environmental factors may also be a trigger. “Scientists believe that an environmental factor—possibly a viral infection or a nutritional factor in childhood or early adulthood—causes the immune system to destroy the insulin-producing cells of the pancreas,” the Merck manual says.

As insulin-producing cells in the pancreas are damaged, insulin must be injected to keep the patient alive. “Aside from being safe, [insulin treatment] is cost effective compared with taking several classes of anti-diabetes pills at the same time,” points out Dr. Linda Lim-Varona, an internal medicine specialist.

Type 2 (called previously as non-insulin-dependent diabetes or adult-onset diabetes) is the most common form; it accounts for about 90 percent of all cases.  In this type, the pancreas continues to produce insulin, sometimes even at higher-than-normal levels.  But the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body’s needs.

Lifestyle disease

Diabetes is considered a “lifestyle-related condition” as it is caused by excessive weight, physical inactivity  and stress.  “If you look at the spread of the scourge around the world, Type 2 diabetes occurs as a country advances technologically, when people come out of the fields to sit behind desks,” said Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.

There might also be a genetic link as it often runs in families.  Certain diseases and drugs (like corticosteroids) can also affect the way the body uses insulin and can lead to develop this type of diabetes.

Type 2 diabetes may also “occur in people with excess production of growth hormone and in people with certain hormone-secreting tumors,” the Merck manual says.  “Severe or recurring pancreatitis and other diseases that directly damage the pancreas can lead to diabetes.”

Symptoms and complications

The two types of diabetes have similar symptoms.  Among the most common signs are excessive urination and abnormal thirst. Other symptoms include unusual hunger, rapid loss of weight or excessive weight, nausea and vomiting, blurred vision, drowsiness, itchy skin and skin disorders, cramps or numbness in the limbs and abdominal pain.

Those who are experiencing any of the above symptoms but do not believe they have diabetes are gambling with their health.  Augusto D. Litonjua, founding president of the Philippine Society of Endocrinology, said the complications that arise from diabetes include blindness, heart diseases or stroke, kidney trouble, impotence, renal failure and amputation.

“Blindness can occur 25 times more in diabetics than nondiabetics,” Dr. Litonjua stressed. “They are also twice as prone to heart attacks and strokes, 17 times more prone to kidney disease, five times more prone to gangrene and about 50 percent of men with long duration of diabetes are impotent.”

Sixth leading cause

Based on the date from the 2013 Philippine Health Statistics, diabetes is the sixth leading cause of death among Filipinos.  But what is alarming is that there are children, as young as five years old, who have been diagnosed with Type 2 diabetes.

“Screening for diabetes and educating the people on its signs, symptoms, ways to prevent and avoid complications play a great role in addressing this debilitating disease,” the Department of Health (DOH) says.

As stated earlier, more and more Filipinos are developing the disease.  “Diabetes keeps on increasing in prevalence, but we shouldn’t give up the fight against the disease,” urges Health Secretary Francisco T. Duque III. “It may be chronic and incurable, but diabetes can be managed. We need to strengthen multi-stakeholder collaboration in increasing awareness of this disease and for people to follow a healthy lifestyle.”

Prevention

Unknowingly, diabetes can be prevented.  A 10-year study conducted at the National Heart, Lung, and Blood Institute in Bethesda, Maryland, showed the five best ways to prevent diabetes.

First, you need to try to achieve your normal weight. Second, you need to be physically active.  Regular exercise will not only help you have a normal weight, it also makes people to have normal blood sugars.

The two other attributes pertain to vices: cigarette and alcohol consumption.  It was found that people who didn’t develop diabetes were nonsmokers or they had stopped smoking for at least 10 years already.

As for drinking, it has been shown that the more a person drinks, the more they are prone to engage in other unhealthy habits like eating too much, smoking and not getting enough exercise.

This brings us to the final attribute: foods.   You need to eat healthy foods. According to the lead author of the study, Dr. Jared Reis, among all five factors, being overweight was linked most strongly to diabetes risk.

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