Text and Photos by Henrylito D. Tacio
In 2002, the Geneva-based World Health Organization estimated some 177 million people around the world to have diabetes. By 2025, the figure will surge to 300 million. “Diabetes is going to be the biggest epidemic in human history,” commented Dr. Paul Zimmet, then the director of the International Diabetes Institute in Victoria, Australia.
In Asia, diabetes is becoming an enormous health problem. In the Philippines alone, over 7 million people are expected to have diabetes by 2030. Unfortunately, most of those having the disease don’t know they have it. In fact, many diabetics die “because it is already too late to remedy the situation,” to quote the words of Dr. Ricardo Fernando, director of the Institute for Studies and Diabetes Foundation.
But what is alarming is that Filipinos diagnosed with diabetes are getting younger. “Children as young as 5-years old have been diagnosed with diabetes,” reports the Philippine Diabetes Association (PDA), an umbrella organization of all associations involved in the care of diabetic patients.
“A doctor cannot tell that a child is diabetic until he starts to complain and usually that is already late as far as complications are concerned,” Dr. Fernando explained. “This disease has no cure. What doctors can do is just minimize the complications or push its onset a little later because the disease is more manageable among older people.”
The Merck Manual of Medical Information defines diabetes as “a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin.”
More foods 
More sweets
Insulin
Before probing deeper, let’s discuss first this hormone released from the pancreas called insulin. “Insulin controls the amount of sugar in the blood,” the Merck manual notes. “When a person eats or drinks, food is broken down into materials, including sugar, that the body needs to function.
“Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, sugar is converted to energy, which is either used immediately or stored until it is needed.”
The levels of sugar in our blood normally vary throughout the day. “They rise after a meal and return to normal within about 2 hours after eating,” the Merck manual informs. “Once the levels of sugar in the blood return to normal, insulin production decreases.”
“But with diabetes, something goes awry,” says Dr. Willie T. Ong, an internist-cardiologist who serves as a consultant in cardiology at Makati Medical Center. “The pancreas becomes irresponsible. It either stops producing the hormone completely or else produces too much, which leads to insulin resistance. Either way, concentration of sugar in the blood shoots sky-high.”
Of course, the body tries to eliminate the sugar. “The best to do is via the urine,” says Dr. Isadore Rosenfeld, author of The Best Treatment. “But since the kidneys can’t excrete sugar in lump form, the body must provide enough water to dilute or dissolve the sugar in order to flush it out.”
The net result of all this is that the person will spend more and more time in the bathroom to void the sugar and at the water tap to drink the much-needed extra water. This is the basis why the cardinal signs of untreated diabetes are frequent urination and great thirst. In women, the urine rich in sugar provides a suitable medium for fungus to grow in the vagina, hence the vaginal itching.
Two types
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,” the Merck manual states.
Actually, there are two types of diabetes. Type 1 (formerly called insulin-dependent diabetes or juvenile-onset diabetes) occurs in only 10-15% of all cases and tends to occur in people under the age of 30. Onset is normally sudden and dramatic. More than 90% of the insulin-producing cells of the pancreas are permanently destroyed. The exact cause 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 notes.
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.
Singer and actor Gary Valenciano also have this type of diabetes. His wife, Angeli, has saved the life of her husband several times already. “She has revived me a number of times, preventing me from falling into a diabetic coma,” he reveals.
Type 2 (called previously non-insulin-dependent diabetes or adult-onset diabetes) is the most common form; it accounts for about 90% 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.
Physical activity 
Loaded with sweets 
Less activities among children
It 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,” notes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.
There might also be a genetic link; it often runs in families. Certain diseases and drugs (like corticosteroids) can also affect the way the body uses insulin and can lead to developing 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.”
Usually, Type 2 diabetes occurs in people over 40, but it is now becoming more prevalent in children and teenagers. Studies have shown that most children diagnosed of having diabetes eat too much high-calorie junk food. “Across the globe, more people are consuming high-fat foods that are heavily processed and low in fiber,” the International Diabetes Foundation notes. “Increasingly, families are eating food prepared outside the home.”
The majority of children (some 85%) with Type 2 diabetes are overweight or obese at the time of diagnosis. The figure is quite alarming as only three percent of children were considered obese back in 1998, according to Dr. Yolanda Olivares of the Department of Health. Five years later, the figure rose alarmingly as 2.6% of children under five years were found overweight while five percent of children from six to 12 years old were found overweight. This means that these obese children are at increased risk of diabetes.
Symptoms and complications
The two types of diabetes 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,” recalls former health secretary Juan M. Flavier on how he discovered he had diabetes.
Other symptoms include unusual hunger, the 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, 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% to women with diabetes, four times higher than in women without diabetes.
Treatments
As stated earlier, people with Type 1 diabetes need daily insulin injections. Those with type 2 diabetes usually don’t need insulin injections. But 25 percent of them take drugs to improve sugar metabolism. “Treating Type 2 diabetes with drugs does reduce blood sugar, that’s true,” says Dr. Ong.
But in many cases, doctors are electing to treat Type 2 diabetes with diet and exercise. They find that this lifestyle approach does more than just reduce blood sugar.
“It does a lot more,” says Dr. James Barnard, professor of physiological science at the University of California. “The same regimen that puts diabetes on hold has a favorable impact on high cholesterol, high blood pressure, and obesity.” Those three, along with high blood sugar, are what doctors call the deadly quarter.
However, before doing anything, be sure to talk with your doctor. “We have been saying that diabetes is not a disease to be toyed with,” says Dr. Litonjua. “It should be viewed with concern because if left untreated then there may be serious consequences.”
Foods and more foods
The PDA experts attribute the increase of diabetic incidence in the Philippines to the lifestyle and culture of Filipinos. “For one, Filipinos love to eat,” PDA says. “Rice is the Filipinos’ staple food.”
Some studies have shown that the starch-rich staple can potentially release high amounts of sugar into the blood when digested. A 2007 study of Chinese women in Shanghai found that middle-aged women who ate large amounts of rice and other refined carbohydrates were at increased risk for diabetes compared to their peers who ate less.
In the United States, Americans who eat white rice on a regular basis — five or more times a week — are almost 20 percent more likely to develop diabetes than those who eat it less than once a month.
For another, Filipinos are fond of holding celebrations from fiestas, birthdays, weddings, and different holidays in which food indulgence is inherent and a crucial part of the celebrations.
“Filipinos have the best fatty, risky exotic foods,” PDA surmises. To name a few: “batsoy,” “bulalo,” liver and other organ meat, “sisig,” street foods (“isaw,” pork and chicken barbecue, “adidas”), and “lechon.”
Their condiments are among the world’s best: “bagoong” and “patis.” Filipinos also have the best and sweetest native delicacies and cakes, which are mostly prepared from rice: “puto,” “palitaw,” “biko,” and “bibingka,” among many others.
With these kinds of foods, less exercise, and too much stress, it is no wonder why there will be more diabetics in the Philippines in the years to come.
In 2002, the Geneva-based World Health Organization estimated some 177 million people around the world to have diabetes. By 2025, the figure will surge to 300 million. “Diabetes is going to be the biggest epidemic in human history,” commented Dr. Paul Zimmet, then the director of the International Diabetes Institute in Victoria, Australia.
In Asia, diabetes is becoming an enormous health problem. In the Philippines alone, over 7 million people are expected to have diabetes by 2030. Unfortunately, most of those having the disease don’t know they have it. In fact, many diabetics die “because it is already too late to remedy the situation,” to quote the words of Dr. Ricardo Fernando, director of the Institute for Studies and Diabetes Foundation.
But what is alarming is that Filipinos diagnosed with diabetes are getting younger. “Children as young as 5-years old have been diagnosed with diabetes,” reports the Philippine Diabetes Association (PDA), an umbrella organization of all associations involved in the care of diabetic patients.
“A doctor cannot tell that a child is diabetic until he starts to complain and usually that is already late as far as complications are concerned,” Dr. Fernando explained. “This disease has no cure. What doctors can do is just minimize the complications or push its onset a little later because the disease is more manageable among older people.”
The Merck Manual of Medical Information defines diabetes as “a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin.”
Insulin
Before probing deeper, let’s discuss first this hormone released from the pancreas called insulin. “Insulin controls the amount of sugar in the blood,” the Merck manual notes. “When a person eats or drinks, food is broken down into materials, including sugar, that the body needs to function.
“Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, sugar is converted to energy, which is either used immediately or stored until it is needed.”
The levels of sugar in our blood normally vary throughout the day. “They rise after a meal and return to normal within about 2 hours after eating,” the Merck manual informs. “Once the levels of sugar in the blood return to normal, insulin production decreases.”
“But with diabetes, something goes awry,” says Dr. Willie T. Ong, an internist-cardiologist who serves as a consultant in cardiology at Makati Medical Center. “The pancreas becomes irresponsible. It either stops producing the hormone completely or else produces too much, which leads to insulin resistance. Either way, concentration of sugar in the blood shoots sky-high.”
Of course, the body tries to eliminate the sugar. “The best to do is via the urine,” says Dr. Isadore Rosenfeld, author of The Best Treatment. “But since the kidneys can’t excrete sugar in lump form, the body must provide enough water to dilute or dissolve the sugar in order to flush it out.”
The net result of all this is that the person will spend more and more time in the bathroom to void the sugar and at the water tap to drink the much-needed extra water. This is the basis why the cardinal signs of untreated diabetes are frequent urination and great thirst. In women, the urine rich in sugar provides a suitable medium for fungus to grow in the vagina, hence the vaginal itching.
Two types
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,” the Merck manual states.
Actually, there are two types of diabetes. Type 1 (formerly called insulin-dependent diabetes or juvenile-onset diabetes) occurs in only 10-15% of all cases and tends to occur in people under the age of 30. Onset is normally sudden and dramatic. More than 90% of the insulin-producing cells of the pancreas are permanently destroyed. The exact cause 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 notes.
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.
Singer and actor Gary Valenciano also have this type of diabetes. His wife, Angeli, has saved the life of her husband several times already. “She has revived me a number of times, preventing me from falling into a diabetic coma,” he reveals.
Type 2 (called previously non-insulin-dependent diabetes or adult-onset diabetes) is the most common form; it accounts for about 90% 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.
It 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,” notes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.
There might also be a genetic link; it often runs in families. Certain diseases and drugs (like corticosteroids) can also affect the way the body uses insulin and can lead to developing 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.”
Usually, Type 2 diabetes occurs in people over 40, but it is now becoming more prevalent in children and teenagers. Studies have shown that most children diagnosed of having diabetes eat too much high-calorie junk food. “Across the globe, more people are consuming high-fat foods that are heavily processed and low in fiber,” the International Diabetes Foundation notes. “Increasingly, families are eating food prepared outside the home.”
The majority of children (some 85%) with Type 2 diabetes are overweight or obese at the time of diagnosis. The figure is quite alarming as only three percent of children were considered obese back in 1998, according to Dr. Yolanda Olivares of the Department of Health. Five years later, the figure rose alarmingly as 2.6% of children under five years were found overweight while five percent of children from six to 12 years old were found overweight. This means that these obese children are at increased risk of diabetes.
Symptoms and complications
The two types of diabetes 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,” recalls former health secretary Juan M. Flavier on how he discovered he had diabetes.
Other symptoms include unusual hunger, the 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, 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% to women with diabetes, four times higher than in women without diabetes.
Treatments
As stated earlier, people with Type 1 diabetes need daily insulin injections. Those with type 2 diabetes usually don’t need insulin injections. But 25 percent of them take drugs to improve sugar metabolism. “Treating Type 2 diabetes with drugs does reduce blood sugar, that’s true,” says Dr. Ong.
But in many cases, doctors are electing to treat Type 2 diabetes with diet and exercise. They find that this lifestyle approach does more than just reduce blood sugar.
“It does a lot more,” says Dr. James Barnard, professor of physiological science at the University of California. “The same regimen that puts diabetes on hold has a favorable impact on high cholesterol, high blood pressure, and obesity.” Those three, along with high blood sugar, are what doctors call the deadly quarter.
However, before doing anything, be sure to talk with your doctor. “We have been saying that diabetes is not a disease to be toyed with,” says Dr. Litonjua. “It should be viewed with concern because if left untreated then there may be serious consequences.”
Foods and more foods
The PDA experts attribute the increase of diabetic incidence in the Philippines to the lifestyle and culture of Filipinos. “For one, Filipinos love to eat,” PDA says. “Rice is the Filipinos’ staple food.”
Some studies have shown that the starch-rich staple can potentially release high amounts of sugar into the blood when digested. A 2007 study of Chinese women in Shanghai found that middle-aged women who ate large amounts of rice and other refined carbohydrates were at increased risk for diabetes compared to their peers who ate less.
In the United States, Americans who eat white rice on a regular basis — five or more times a week — are almost 20 percent more likely to develop diabetes than those who eat it less than once a month.
For another, Filipinos are fond of holding celebrations from fiestas, birthdays, weddings, and different holidays in which food indulgence is inherent and a crucial part of the celebrations.
“Filipinos have the best fatty, risky exotic foods,” PDA surmises. To name a few: “batsoy,” “bulalo,” liver and other organ meat, “sisig,” street foods (“isaw,” pork and chicken barbecue, “adidas”), and “lechon.”
Their condiments are among the world’s best: “bagoong” and “patis.” Filipinos also have the best and sweetest native delicacies and cakes, which are mostly prepared from rice: “puto,” “palitaw,” “biko,” and “bibingka,” among many others.
With these kinds of foods, less exercise, and too much stress, it is no wonder why there will be more diabetics in the Philippines in the years to come.
