With World Diabetes Day on Nov. 14, it is timely to look at this disease and the impact that it is having upon society.
Diabetes is in many ways a “new” disease, in that it was rarely seen 100 years ago and, indeed, when I started practice 40 years ago, only a few patients in very old age had this condition.
We need to understand that there are basically two types of diabetes.
Type 1
The first — sometimes called diabetes Type 1 — can affect people of any age but often children. Of the 400 million people worldwide who have diabetes, Type 1 diabetes accounts for some 5–10 percent of this number. It is thought to be caused by a combination of genetic pre-disposition and an autoimmune process (perhaps triggered by external factors such as viruses). Its incidence is slowly increasing but also varies worldwide.
Type 2
By far the most common type of diabetes is called Type 2, or maturity onset diabetes, accounting for 90–95 percent of all patients. The prevalence of diabetes worldwide has increased from 4.7 percent in 1980 to 8.5 percent in 2014 and shows no sign of slowing. It threatens to become an epidemic. Its cost in the United States alone was $245 billion in 2012. These figures also hide the fact that there is a large variation of the prevalence across different countries and ethnic groups. This is partly explained by a genetic pre-disposition to the disease (as in the Indian subcontinent) and partly by cultural attitudes to diet (as in Ukraine).
The science of diabetes is not difficult to understand. We are at birth given a set amount of insulin — the chemical that removes sugar from our systems. The more refined sugars we eat the quicker we use this insulin. It is used much more quickly by eating refined sugar than by eating natural sugars in fruits and carbohydrates as in potatoes, carrots, or by eating such foods as bread, pasta, and rice. If we eat large quantities of refined sugars we need to use increasingly more and more insulin to neutralize the sugar in our body. This is called insulin resistance.
Symptoms of diabetes
The symptoms of both types of diabetes are easy to recognize. They are increased thirst, loss of weight, increased urination, a feeling of dryness and occasionally blurred vision. Patients often have a first degree relative with the disease. The diagnosis is made not only on the symptoms, but on two simple blood tests — a fasting blood sugar taken in the morning and a test that looks at long term deposits of sugar in red cell over the previous two months. A confirmatory test can be performed by studying how the body handles a dose of glucose over a period of two hours — this is called a glucose tolerance test. There are a series of more complex immune tests that endocrinologist may use to determine the cause of diabetes. Often patients can be diagnosed before the onset of true diabetes as tests can indicate poor glucose handling rather than complete diabetes. And those with a family history should have regular checks.
No refined sugar!
The treatment of diabetes depends upon the severity of the disease. All diabetics need to lose weight and stop eating refined sugars in the form of sugar in tea and coffee, sweets and confectionary made with refined sugars. Sugar containing drinks also contain large doses of refined sugars. Alcohol is also broken down to sugar in the body. In the stage of pre-diabetes loss of weight, dietary control and lifestyle changes can often prevent the development of more serious symptoms.
Medications help
Where dietary control fails, there are for Type 2 diabetes a number of medications that, with dietary and lifestyle measures, effectively control the disease. In its extreme form diabetes, if undiagnosed, can cause severe changes in the chemical elements of the blood and even lead to coma. Whilst this is a medical emergency it can usually be successfully treated. Those with Type 1 diabetes often require insulin treatment, whilst historically insulin injections often came from animals they are now almost entirely genetically engineered. Insulin pumps are now available to easily administer small doses of insulin that gives excellent control. Of course with some 400 million patients worldwide the pharmaceutical industry has a huge impetus to develop new treatments and some success has already been achieved with stem cell therapies.
Patients with both pre-diabetes and diabetes need to be regularly monitored by a physician who is conversant with international guidelines. Such monitoring includes control of blood pressure and weight, monitoring of blood sugars and kidney function and yearly inspection of the retina of the eye by a skilled ophthalmologist who can detect any damage to the blood vessels (that can leak) and repair these with laser treatment.
Challenge of prevention
Perhaps the biggest challenge is the prevention of diabetes, which is the responsibility of physicians, governments, parents and grandparents, and the mass media. Refined sugars are addictive to young children. They do not need it and parents and grandparents should stop using them as a source of energy.
Equally children and adults should drink water, not sugar-containing drinks. Governments need to tax products containing refined sugars. Pediatricians need to work with parents in changing the diet of children, especially those who are already obese.
People with diabetes
All over the world: 422 million
In Ukraine: 1.38 million
Undiagnosed in the world: 193 million
Undiagnosed in Ukraine: no data
Sources: World Health Organization, Ukrainian Diabetics Federation
Dr. Richard Styles is the chief medical officer of American Medical Centers in Ukraine, Georgia and Kazakhstan.
