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Heartline Magazine July-September 2003
Silent killer : Dealing with Diabetes
Diabetes has been called "a disorder of the very engine of
life," and for good reason. In essence, diabetes is a condition in which the
normal transport of glucose from the blood stream and into the body's cells
fails, either because of the patient's inability to produce insulin, or because
the effect of insulin is "resisted" as happens in many obese individuals. If the
body cannot adequately "metabolize" glucose in this way, then the level of
glucose in the blood increases above acceptably "normal" levels, alternative
metabolic pathways come into play, and abnormal products are formed that have
adverse effects on the normal function of cells in a wide variety of blood
tissues. The cumulative effects of these abnormal products include damage to
several organs that are vitally important for healthy existence. These "vital"
organs include the heart and the kidneys, but additionally, a number of
non-vital organs are directly or indirectly damaged with consequent
deterioration in the quality of the individual's life. Thus damage to the eyes
may cause blindness, and damage to the blood vessels of the legs may lead to
gangrene and the need for the amputation of toes or larger parts of the legs.
Diabetics, particularly those with Insulin-dependent (Type
1) Diabetes, may die from the acute complications of the diabetic process, (e.g.
from the complication termed diabetic keto-acidosis). However, the great
majority of diabetics, who suffer from non-insulin dependent (Type 2) diabetes,
die from "Silent", slowly progressive, complications of persistently high blood
sugar levels, which is to say from "poorly controlled diabetes". These
complications include peripheral arterial disease affecting the heart, brain, or
lower limbs, loss of kidney function and nerve damage. Poor blood supply to the
feet can lead to "death" of tissues in the toes, and resulting complications
including infection that may progress to further tissue damage and "gangrene".
Ultimately, the severest cases may require amputation of the affected lower limb
above the knee. Diabetes is also the most frequent cause of blindness among
adults in Barbados.
There is no universal prescription for the management of
diabetes, but the more that diabetic patients learn about their disease, the
better equipped they are to manage their illness and to improve their prospects
of living a longer, healthier life. Effective education, however, calls for
patience. Trying to learn everything at once leads to confusion.
A most important factor in managing diabetes, especially in
children and young adults, is the support of the family. When family members
learn about diabetes, that knowledge helps them to be supportive, to recognize
the important symptoms, and to know how to respond.
Disease of the young
Diabetes is fast becoming a disease of the young. Forty
years ago Type 2 diabetes was rarely seen in people under 40. Now it is being
encountered in children. What's causing this increase in diabetes among youths?
Type 2 or non-insulin dependent diabetes, often called
"Maturity-onset Diabetes" in the past, has a strong genetic component. In the
past, this genetic predisposition became apparent with the increasing weight and
girth that was termed "Middle-aged Spread". Today, with 5% of our school
children being "obese" the genetic predisposition is becoming manifest at an
increasingly early age. It is easy to blame the "usual suspects ... increased
reliance on foods consumed outside the home, increased consumption of soft
drinks and fast foods, reduction of physical education in schools. Perhaps we
should be looking closer to home, at parents' responsibility for lifestyle
choices of their children. Parents, rather than the purveyors of junk food, must
take responsibility for the lifestyle choices of their children
Stark statistics
The World Health Organization estimates that worldwide more
than 140 million people have diabetes, and that number could double by the year
2025. The disease presents one of the most challenging health problems for the
21st century. At least 30 million people in India have the disease. What is
striking is that every other person suffering from diabetes is under the age of
40. In Singapore nearly one-third of the population between 30 and 69 years of
age have diabetes. In the United States about 16 million people have diabetes,
and each year some 800,000 new cases are diagnosed.
Millions of people have the disease but do not yet know it.
Because the early symptoms of diabetes are relatively mild, a person can have
the disease for a long time before it is diagnosed. That is why it is called a
"Silent Killer”.
The cost of diabetes
In Barbados, it is estimated that about 10% of the
population suffer from diabetes. A 1996 study showed that the length of stay for
diabetics in the Queen Elizabeth Hospital (Q.E.H) was about 14 days - twice as
long as for other pa tients, who averaged 7 days. For diabetics with foot
problems the length of stay was 2 to 3 months.
$13.4 million was spent annually in the public sector in
dealing with the disease; $11 million at the Q.E.H., and the remainder at
polyclinics and other institutions. About $20 million was spent in the private
sector, including the cost of drugs and fees.
The average cost per admission for diabetics at the Q.E.H.
in 1996 was $5,100. This equated to $364 per day. For those with foot problems
the cost was considerably higher.
But the true cost of diabetes, measured in terms of lost
productivity related to intercurrent illness, hospitalization, loss of function,
and early demise has yet to be determined. Barbados gives birth to, educates and
employs the overwhelming majority of its citizens in State-financed
institutions.
Such a society anticipates a "return" for its investment in
its people. Those re turns will diminish if the looming epidemics of obesity
and diabetes are not counteracted.
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