Novem­ber is Di­a­betes Aware­ness Month

Jamaica Gleaner - - OPINION & COMMENTARY - Garth A. Rat­tray is a med­i­cal doc­tor with a fam­ily prac­tice. Email feed­back to col­umns@glean­ and garthrat­

NOVEM­BER IS Di­a­betes Aware­ness Month. World Di­a­betes Day was on Novem­ber 14. The day was cho­sen to pay trib­ute to Dr Fred­er­ick Bant­ing, the co-dis­cov­erer of in­sulin (in 1921), who was born on Novem­ber 14, 1891.

Di­a­betes mel­li­tus is po­ten­tially an ex­tremely dan­ger­ous, de­bil­i­tat­ing and deadly dis­ease. The most com­mon kind is type 2 di­a­betes. It was for­merly a dis­ease of adult­hood but is now be­ing di­ag­nosed in chil­dren. It is of­ten fa­cil­i­tated by ex­cess body weight and phys­i­cal in­ac­tiv­ity.

In this form of di­a­betes, the body is un­able to make good use of its own in­sulin, the hor­mone that helps to reg­u­late blood glu­cose lev­els. That is called in­sulin re­sis­tance. In re­sponse, the pan­creas in­creases its in­sulin pro­duc­tion but, over time, the pro­duc­tion wanes. When oral med­i­ca­tions pre­scribed to re­duce in­sulin re­sis­tance and oth­ers pre­scribed to ‘en­cour­age’ the pan­creas to pro­duce more in­sulin fail, in­sulin must be given by way of a tiny nee­dle.

Type 1 di­a­betes is far less com­mon. It starts from an early age and oc­curs in per­sons whose pan­creas fails to pro­duce ad­e­quate amounts of in­sulin. Th­ese peo­ple must be given in­sulin sev­eral times each day to sur­vive. The gen­e­sis of type 1 di­a­betes has no re­la­tion­ship to body habi­tus or phys­i­cal ac­tiv­ity.

The World Health Or­ga­ni­za­tion states that di­a­betes is ris­ing quickly in coun­tries like Ja­maica. The in­creas­ing global preva­lence of type 2 di­a­betes has been blamed on our ‘mod­ern’ life­style. The dis­ease leads to multi-or­gan dam­age (stroke, heart at­tack, blind­ness, kid­ney fail­ure), loss of limbs, poor im­mune func­tion, sus­cep­ti­bil­ity to nu­mer­ous in­fec­tions and even bowel dys­func­tion.

I try to ex­plain di­a­betes to my pa­tients in this way: if Mary and Jane are roughly the same size and age and if Mary has di­a­betes in a very bad way but Jane does not, who has more sugar in their body? Although the sim­plic­ity of the ques­tion makes peo­ple won­der if it’s a trick, just about ev­ery­one thinks that, since Mary is badly di­a­betic, she has more sugar on board. In fact, both Mary and Jane will have the same amount of sugar in their bod­ies, but Mary has her sugar in the wrong place. A lot of her sugar (glu­cose) is stuck in the blood stream and is un­able to get from the blood stream to the in­di­vid­ual cells to pro­vide nour­ish­ment. Sugar (glu­cose) is the main en­ergy source for liv­ing cells.

All starch (car­bo­hy­drates) must be bro­ken down to glu­cose in or­der to be used by the body. Ev­ery­one iden­ti­fies items like ground pro­vi­sions, wheat prod­ucts, rice and fruits of all kinds as starch. How­ever, many peo­ple do not re­alise that veg­eta­bles are starches too. Our bod­ies find it easy to break down most starches to glu­cose and ab­sorb them, but veg­eta­bles pro­vide a chal­lenge since they are dif­fi­cult to work on and we can’t to­tally di­gest them.


In­ter­est­ingly, there is even a negative calorie con­cept. If some­one only eats cel­ery (a very fi­brous and wa­tery veg­etable), when di­gested it pro­vides less en­ergy than the amount of en­ergy our bod­ies use up pro­cess­ing it and ab­sorb­ing the sugar from it. Other veg­eta­bles are not as un­yield­ing but eat­ing them works in our favour since they all pro­vide a lot of roughage, vi­ta­mins (if not over­cooked), min­er­als and not that much glu­cose.

The body needs in­sulin to al­low the glu­cose from the blood stream to pass into the cells. As stated before, in di­a­betes, the en­tire sys­tem fails and this leads to very se­ri­ous con­se­quences.

A lot of peo­ple are walk­ing around with no symp­toms and no idea that they al­ready have di­a­betes. It is there­fore wise to check for it in­ter­mit­tently. Preven­ta­tive ac­tion in­cludes high-fi­bre diet with re­duced sim­ple sug­ars, weight con­trol and in­creased phys­i­cal ac­tiv­ity. If di­ag­nosed, in ad­di­tion to proper diet and reg­u­lar ex­er­cise, med­i­ca­tions play an es­sen­tial role in con­trol­ling this in­cur­able dis­ease.

Di­a­bet­ics must ad­here to life­style mod­i­fi­ca­tions and take what­ever treat­ment is pre­scribed to fully con­trol their blood glu­cose. Many pa­tients hate tak­ing tablets and are ter­ri­fied of us­ing in­sulin in­jec­tions (if needed). The very sad fact is that, if not prop­erly treated, di­a­betes will cause ma­jor suf­fer­ing and an early death.

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