Unhealthy lifestyles set off diabetes epidemic
14th Novemeber 2007
Today is World Diabetes Day, and the odds are that you or someone you know has diabetes or is at risk of developing it. Type 2 diabetes is becoming epidemic, and diet is an important factor in treatment and prevention, writes AMANDA BLANKFIELD
IN SA, the incidence of Type 2 diabetes is rising so high and so rapidly that the experts are calling it an epidemic. The experts say it is largely a disease of lifestyle the result of unhealthy living and obesity. It also raises your risk of other serious heart problems, all of which makes diet an important factor in both prevention and treatment of the condition.
A local fast food outlet has leapt onto the health band wagon by offering what it claims is a diabetic-friendly menu compiled with the help of an expert dietician. Its part of the growing diabetic food, with a variety of products in supermarket and speciality food stories that claim to be especially helpful for diabetics.
Specialists point out that healthy eating is not just for diabetics. In Britain, Diabetes UK and the UK Food Standards Agency are even calling for an end to the use of terms such as diabetic or suitable for diabetics on food labels . They say it makes people see diabetic labelling as a stamp of approval, and leads them to think that the food is beneficial or even essential for diabetics. So-called diabetic foods also tend to cost more than conventional products, and sugar-free and reduced-sugar versions.
If people do eat food and drinks containing added sugars they should do so sparingly, say nutrition specialists, as part of a healthy balanced diet. This advice applies to everyone, not just people with diabetes.
Today is World Diabetes Day, and as good a time as any to look at your risk level, and what you can do to prevent Type 2 diabetes. It is different from Type 1 diabetes, in which the pancreas does not produce enough insulin to metabolise glucose, that begins in childhood and is strongly linked to genetics.
Type 2 diabetes is the type in which the pancreas produces insulin, but the body is unable to use it effectively. Type 2 used to be called adult-onset diabetes, as it was most commonly seen in adults over 40. These days Type 2 diabetics are getting younger and younger, and the disease is being picked up in children below 10. The experts say one of the most dangerous myths about diabetes is that Type 2 is less serious than Type 1. Both have many of the same risks of complications and left untreated, both are life-threatening conditions.
The Heart and Stroke Foundation of SA says about 1,5-million South Africans have diabetes. Latest statistics show that diabetes rates vary among population groups; the highest rate (amongst people over 30) was in the Indian population, followed closely by the coloured and white groups. Black people living in rural areas averaged 3% while those living in the cities averaged 6%. Information from the South African Medical Research Council shows that diabetes caused 4,3% of all deaths in SA in 2000.
There is a genetic link to Type 2 diabetes, says Dr Adri Kok, an Alberton specialist physician in private practice, but other risk factors include obesity, high cholesterol and hyptertension medication (beta blockers and diuretics).
Effective treatment for Type 2 diabetes is to lose weight and keep it off. That means avoiding yo-yo diets that are dangerous, says Kok. And while we all need a healthy diet and regular exercise, diabetics need to control their lifestyle more urgently because of the increased risk of heart disease and other life-threatening diseases.
Kok says men with waists larger than 94cm and women with waists over 80cm in circumference are classified as overweight. Visceral fat around the abdomen is like an organ in itself because it secretes hormones, which increase blood pressure and cardiovascular disease risk, she says. This causes a danger of thrombotic clots in the blood vessels and heart.
Diabetics dont die from too much sugar in their blood, its heart attacks that kill them, Kok says.
The reality is that many people with diabetes are still undiagnosed or treated inadequately and therefore have a risk of developing complications. Long-term diabetes complications may be disabling or even life-threatening. The US Mayo Foundation for Medical Education and Research says these include:
n Heart and blood vessel disease
Diabetes dramatically increases the risk of various cardiovascular problems, heart attack, stroke, narrowing of the arteries and high blood pressure. A 2007 study shows that the risk of stroke more than doubles within the first five years of being treated for Type 2 diabetes. Around 75% of people withe diabetes die of some type of heart or blood vessel disease.
n Nerve damage (neuropathy)
Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers. Left untreated, all sense of feeling in the affected limbs could be lost.
n Kidney damage (nephropathy)
The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure.
n Eye damage
Diabetes can damage the blood vessels of the retina (diabetic retinopathy), and may lead to blindness.
n Foot damage
Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.
n Skin and mouth conditions
Diabetes makes people more susceptible to skin problems, including bacterial infections, fungal infections and itching.
Diabetes may lead to lower than normal bone mineral density, increasing the risk of osteoporosis.
n Alzheimers disease
Type 2 diabetes may increase the risk of Alzheimers disease. One reason for this could be that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose.
Kok advises diabetics to check their feet daily. Blood supply to the feet is critical as is a loss of sensation, she says. If patients feel no pain, only perhaps pins and needles or a hot sensation, they are unaware when they injure their feet. The skin forms a callous to protect the bone that is pressing against it. If the callous breaks down and becomes an ulcer that gets infected, a condition called cellulitis develops from this inflammation of skin, soft tissues and muscle. If neglected, the toes or feet may need to be amputated to prevent septicaemia spreading throughout the body.
Men have higher risk of vascular disease, but once a woman becomes diabetic, her risk of vascular disease is the same as for men.
And while orthodox treatment can be effective, it is not the only route.
Johannesburg technician Suresh Naidoo (not his real name) came close to having his foot amputated after developing cellulitis from his diabetes recently. After conventional medicine failed to help, Naidoo, 57, was recommended to Yeoville Greek traditional herbalist Theo Kotsonis.
Kotsonis says we are all like plants, and if you look after a plant, it will be healthy. He uses the practical herbal healing methods passed down over five centuries, and makes his medicines through distillation. I dont boil the plants because that kills all the healing properties, he says.
Naidoos condition has improved significantly, he has avoided amputation and says the herbalism treatment changed my life.
Kok says diabetes is a complex disease, new treatments are available, as are more aggressive applications of available treatments. Ensure you are receiving excellent diabetic care from your doctor. Complementary alternative interventions such as herbalists, reflexologists and homeopaths may assist in treating certain complications. Ultimately, strict glucose control must be your goal, she says.
WHAT YOU CAN DO
DIABETICS can control their condition by:
– Monitoring their blood-glucose levels regularly.
– Following a high-fibre, low-salt and low-fat diet.
– Maintaining a realistic weight, and reducing abdominal obesity.
– Quitting smoking.
– Checking their feet daily.
– Having regular check-ups to assess cholesterol, blood pressure and kidney function.