“The number of adults with diabetes has quadrupled worldwide in less than four decades,” a recent World Health Organisation study says. Presently, 442 million people worldwide are suffering from the illness, a number likely to more than double in the next 20 years. Researchers point to an ageing population and rising levels of obesity, a “defining issue for global public health”.
Although there is evidence that a large proportion of cases of diabetes and its complications can be prevented by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco, these measures are not widely implemented. Studies indicate that the number of children at risk of developing the disease is increasing. For the past few decades, more than 80 per cent of diabetes deaths occur in low and middle-income countries.
Developing countries like Pakistan, have registered a steep rise in chronic diseases like obesity, diabetes, cancer and cardiovascular diseases, previously considered Western “lifestyle diseases”.
The reason for this surge is a stressful and mostly sedentary lifestyle, besides lack of physical activity like walking and cycling. Another important factor of diabetes is replacement of traditional and nutritious food by high energy fast foods.
In Pakistan, diabetes and its complications are growing at an alarming rate, affecting more individuals and families; negatively impacting the economy and our society. Policies and partnerships at public and private sector levels are needed in order to beat diabetes. This would lead to initiatives such as public health campaigns to raise awareness among the general population, particularly those at risk of diabetes and its complications.
But first we will have to understand what diabetes is. It is a chronic disease that occurs either when our pancreas do not produce enough insulin (a hormone that regulates blood sugar) or when our body cannot effectively use insulin that it produces.
Exercise, no smoking and certain foods that you enjoy eating can help you deal efficiently with diabetes
Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time it leads to serious damage of the body’s systems, such as the heart, blood vessels, eyes, kidneys and nerves — causing chronic problems and early death.
Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.
Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. One per cent of global blindness can be attributed to diabetes.
There are two types of diabetes: type 1 diabetes and type 2 diabetes.
Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterised by deficient insulin production and requires daily administration of insulin. Type 1 diabetes is not preventable as its cause is not known, though it is thought to be the result of a combination of genetic and environmental factors.
Symptoms include excessive urination, thirst, constant hunger, weight loss, vision changes and fatigue, and may occur suddenly.
Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results due to the body’s ineffective use of insulin. Type 2 diabetes largely affects people who are overweight and are not physically active. Often preventable, it may have a genetic predisposition.
Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.
Prevention
Simple lifestyle measures have shown to be effective in preventing or delaying the onset of type 2 diabetes. For this, one should achieve and maintain a healthy body weight and be physically active — do at least 30 minutes of regular, moderate-intensity activity on most days. If weight is a problem then more activity is required. A healthy diet of between three and five servings of fruit and vegetables a day, and reduced intake of sugar and saturated fats is recommended. Avoid the use of tobacco as smoking increases the risk of cardiovascular diseases.
Diagnosis and treatment
Early diagnosis is important for proper management of diabetes. A simple, relatively inexpensive blood test can confirm the presence of the ailment.
Treatment of diabetes involves maintaining lower level of blood glucose and controlling other known risk factors that damage blood vessels. Giving up tobacco use can also protect against complications.
Interventions that are both cost- saving and feasible in developing countries include moderate blood glucose control. People with type 1 diabetes require insulin, while people with type 2 diabetes can be treated with oral medication, though they may also require insulin. Blood pressure control and foot care are important.
Other cost-saving interventions include: screening and treatment for retinopathy (which causes blindness); blood lipid control (to regulate cholesterol levels); screening for early signs of diabetes-related kidney disease.
These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.
It’s carbohydrate-rich foods like breads, cereals, rice, pasta, fruits, milk, and desserts that can cause blood sugar to rise. Your food plan should be focused on how many and what type of carbohydrates you will put on your plate through the day.
But it’s equally important to eat what you enjoy. You must eat enough to make you feel satisfied, avoid overeating and stay away from poor food choices. Here are seven foods that researchers say can help keep your blood sugar in check, make your meals exciting and, of course, keep you healthy.
Raw, cooked or roasted vegetables add colour, texture or flavour to your meals. You can eat them with dips, dressing or flavourful sauces. Eating hummus, salsa or balsamic vinegar and olive oil with your salad and crudités keeps you munching and filled up.
Spinach, sarson and kale, (if you can get hold of any locally) add loads of nutrition to your meal. Eat in omelette, soup, or salad. Stir fired with garlic and olive oil is quite tasty and crunchy. Sarson leaves taste good with hummus.
Plain water is great but you could infuse, lemon, orange or cucumbers in water with some mint to detox as well as cool your system through the day. Cold tea with a cinnamon stick or mint leaves does wonders too.
Did you know that one cup of melon has just 15 grammes of carbs? Fill up a bowl of water melon or kharbooza and munch away.
Red beans, lobia, peas, and lentils can be eaten as salad, chaat or as salsa with raw vegatables. Add corn, coriander, onion and tomato for a twist.
Good fat choices include olive oil, avocado, and fatty fish. Grill salmon and serve on of a bed of lettuce, romaine or spinach. Fish fat can be your dressing if you don’t want to add olive oil.
Cottage cheese, eggs, lean meats like chicken breast or a cup of yogurt can give good protein that keeps you filled up. Peanut butter on celery or apple is a nutritious and delicious snack. If you are munching on cold packed meat slices, check the sodium content in them.
Dr Zia ul Hasan and Dr Adil Zareef are associated with AIMS Diabetes Hospital & Research Centre, Hayatabad, Peshawar.
Published in Dawn, Sunday Magazine May 1st, 2016
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