Text by Henrylito D. Tacio
Photo: health.harvard.edu
(Second of Two Parts)
“Diabetes doesn’t need to be a life sentence of ill health,” wrote Lam Lye Cheng in an article published in Reader’s Digest some years back. “With prompt diagnosis, simple lifestyle adjustments and, if necessary, medications, people with diabetes can expect to have a long and productive life.”
Dr. Gauden Galea, a public health physician who was still with the regional office of the World Health Organization when interviewed by this author a couple of years ago, agrees: “Diabetes is not a death sentence. A normal life is possible with diabetes.”
History has proven this. Among those who have defied diabetes include Filipino singer Gary Valenciano, Soviet premier Yuri Andopov, Israeli Prime Minister Menachem Begin, French painter Paul Cezanne, American inventor Thomas Edison, American writer Ernest Hemingway, Oscar winner Spencer Tracy, Egyptian politician Gamal Abdel Nasser, and English author H.G. Wells.
But “we cannot win the war against diabetes if we do not know the enemy,” the Philippine Center for Diabetes Education Foundation said in a statement. “Get to know about the disease.”
For instance, diabetes tends to run in the family. “Diabetes is a hereditary disease passed on from generation to generation,” said Dr. Alberto Romualdez when he was the head of the Department of Health. “When there is a diabetic in the family, no matter how distant a relative the patient is, the characteristic is still passed on through the genes.
“If both parents have diabetes,” Dr. Romualdez pointed out, “the children’s chance of developing the disease is greater. It is very important therefore that everyone in a family with a diabetic member must prepare early to prevent the onset of the disease.”
Other predisposing factors include age and weight. Most diabetics discover the disease when they are past 40. On the other hand, three out of four diabetics are overweight. “Obesity is a risk factor for diabetes,” reminded Dr. Galea. “Fat also makes the control of blood glucose more difficult, causing lowered responsiveness to insulin.”
In the first part of this series, it was mentioned that there are two types of diabetes. Medical science says both types have very similar symptoms. Among the most common signs are excessive urination and abnormal thirst. “I was always thirsty. I had to go to the toilet frequently at night, and my urinal always had ants,” recalled former health secretary Juan M. Flavier on how he discovered he had diabetes.
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.
Among the two types of diabetes, it is type 2 that is most common. “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 the desk,” observes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.
The Philippines is moving to become an industrialized country. As such, more Filipinos are expected to suffer from type 2 diabetes. In fact, 85-90% of diabetes cases in the country are adult-onset.
In the past, diabetes was considered a disease of the wealthy. But these days, no one is spared. And diabetes is such a costly disease. “It affects all tissues and organs of the body,” says Dr. Alberto Romualdez, former secretary of health. “Once a person is diagnosed a diabetic, he or she will be on medications for the rest of his or her life and will die a diabetic.”
Augusto D. Litonjua, founding president of the Philippine Society of Endocrinology, says 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 non-diabetics,” Dr. Litonjua says. “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.”
Here’s bad news for pregnant women: studies showed birth defects occur in 5-10% of women with diabetes, four times higher than in women without diabetes.
Living with diabetes is a lifelong project. But nowadays, diabetes can, for the most part, be controlled quite well with treatment which is simple and highly successful. “The goals of treatment for diabetes are to improve the body’s use of insulin, reduce its need for insulin and thus provide glucose control in the blood,” a doctor explains.
Despite medical advances with new drugs and insulin formulations, diet remains “the cornerstone of diabetes treatment,” to quote the words of Dr. Cynthia Chua-Ho of the Far Eastern University Hospital.
Medical experts advise that 20-30 percent of the total dietary energy should come from fats and oils. Protein should not exceed more than 15% of the total energy required. The bulk, however, should come from carbohydrates: 55-65% of the total energy. But diabetics must talk with their doctor or dietician to know the suitable diet for them.
Generally, diabetic patients are advised to eat most of the following: legumes, lentils, cereals, fresh fruits (non-sweet), and vegetables. What about rice? “Rice is a traditional diet for Asians and provides a rich source of many essential vitamins and minerals,” explains Dr. Tham May Ked, senior medical officer of the Department of Health in Hong Kong. “For diabetics, the key is moderation.”
Likewise, diabetics must have small portions of foods rich in protein like fish, seafood, lean meat, skinless chicken, nuts, low-fat cheese, yogurt, and milk. They must minimize eating foods and drinks that contain a lot of simple sugar, such as honey, sweets, cakes, soft drinks, and beer, among others.
Since Type 2 diabetes is the most common form, health experts are focusing more research on the said type. Treatment involves one or more of the following:
Lose weight. “This is the number one priority,” says Dr. Stanley Mirsky, associate clinical professor at Mount Sinai School of Medicine of the City University of New York. Most diabetics, it has been observed, tends to live a sedentary life and eat a lot. Obesity may obliterate insulin receptors so sugar can’t enter the cells and remains in the blood. “If you’re overweight, diet and exercise will almost certainly help you lose some weight and get your blood sugar back to normal, and that may be all you need.”
Watch your diet. Actually, this is the first line of treatment for all types of diabetes. “Whether or not you need to lose weight, the kind and the amount of food you take in are important factors to improving your condition,” a doctor explains. “In many cases, Type 2 diabetes can be controlled by diet alone. Sugar levels start dropping rapidly, sometimes even before much weight is actually lost.”
Get moving. “Physical activity burns excess fat and increases muscle mass, reducing insulin resistance,” says Dr. Litonjua. “Try to get at least 15 minutes of physical activity every day this week. Then each week add 5 minutes, until you get to the recommended 30 minutes a day.”
Be especially particular about breakfast. “There’s some evidence that those with diabetes have a harder time with carbohydrates in the morning, when insulin resistance is greatest,” says Dr. Christine Beebe, chairman of the Council on Nutritional Science and Metabolism for the American Diabetes Association.
Dr. Rafael R. Castillo, a cardiologist at the Manila Doctors’ Hospital and editor-in-chief of Health and Lifestyle, also suggests: “A full, healthy breakfast refuels your body and jump-starts your day. If your blood sugar level is adequate, you feel good and function better, and this suppresses the tendency to overeat for your next meal.”
Understanding what the disease is and recognizing that there are things you can do really helps. “Knowledge is power particularly with this disease,” says one diabetic. “Because people don’t know much about it, the usual notion is to consider it as a grave disease. But if you dig deeper, it only becomes dangerous because most of the patients are not well-informed. The lack of information prevents them from taking the necessary precautions.”