With the incidence of Type 2 diabetes reaching epidemic proportions throughout South Africa, and the age of onset dropping, the fit, young and middle-aged men of this country should be much more aware of it than they are.
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What is diabetes?
Food, once digested, is turned into glucose, ready to be used as energy for all the body's functions. In this form it is carried in the blood stream to where it is needed or to be stored in muscles and the liver. Glucose is carried into the body's cells by a hormone called insulin, created by specialised cells in the pancreas, which is released when it is needed, after meals. If the body doesn't produce enough insulin, the glucose cannot be transported.
The resulting excess glucose in the vascular system can badly damage the blood vessels. The consequences include strokes and heart failure at a relatively early age, kidney failure and loss of limbs. The small blood vessels, especially in the feet and toes, are easily damaged and the nerves in the foot become insensitive. The result is that wounds and injuries to the foot don't heal, ulcers remain open and infections, including gangrene, penetrate easily. This leads to amputations of the foot and leg. Diabetes is the major cause of amputation.
Another result of diabetes is fluctuating blood sugar levels. High glucose level, hyperglycaemia (a hyper) and low level, hypoglycaemia (a hypo), affect mood, result in loss of consciousness and, if untreated, eventually the coma that results in death.
There are two types of diabetes. Type 1 usually strikes in childhood, even at birth, and means that the pancreatic cells produce no insulin. People with this condition always have to inject insulin, using different types at different times of the day; fast-acting, slow-acting or mixed.
Type 2 usually strikes later. It means the pancreas produces insulin, but not enough for the body's needs or that the body is insulin resistant and can't use it properly. People with this type, usually use tablets at first, for a daily kick-start to insulin production. Later, most graduate to injecting insulin. Type 2 can appear at any age but most white and coloured adults develop it at or over age 50, blacks between 35 and 45. South Africans of Indian and Malay origin tend to develop it earlier, around 30. It does run in families and specialists report that the age of onset is dropping radically.
Check the box of indications and if you recognise any of them, consult your GP and have a fast, easy, check. All it takes is a drop of blood, but the information it gives could save your life, your limbs or your sight. If this sounds dramatic, it's supposed to.
New equipment
There is still a lot of mystery surrounding diabetes. It has been known since the dawn of history and society has lost some outstanding individuals to it in the past. Now scientists have learnt so much more about the complex and subtle way food interacts with the body, that diabetics can eat almost anything provided they keep to the discipline prescribed. New and better equipment makes this possible. Today, a diabetic would use a glucometer to test a pinhead-size drop of blood to get an instant glucose reading. He then uses a 'pen' to inject pre-measured doses of insulin into his thigh or abdomen before eating.
While Type 1 diabetics test four times a day and Type 2 once or twice, their routines can now be flexible enough to take account of delayed meals, extra exercise or stress. The sophisticated meter keeps records of readings so the diabetic's progress can be followed and the dosage can be adjusted according to need. It is particularly useful for people whose eating habits can be disturbed by unpredictable events.
Dr Areti Philotheou, who runs the adolescent clinic at Groote Schuur Hospital, says the pen has increased the safety of her young clients. Teenagers live on snacks and irregular meals, but as long as they don't leave too long an interval between eating, they can use a sandwich and shot of insulin to keep going until a larger meal and higher dose. The insulin shot needs to be taken before the meal so a regular life, like a school schedule, is ideal and teachers are among those who find their routine easiest to follow.
Professor Francois Bonnici of UCT, vice president of the International Diabetes Federation, is alarmed that the age of onset is dropping since most diabetics only get diagnosed when some physical damage has already been caused. Fifty percent of diabetic amputations are preventable, much loss of sight could be prevented and impotence, a frequent symptom of diabetes can be reversed, he said. But a deep, penetrating wound in a foot that has been made insensitive by diabetic neuropathy will quickly become infected, develop gangrene and lead to the loss, not only of the foot, but part of the leg. It is important that diabetics never go barefoot or wear sandals; they should wear well fitting shoes for every purpose, avoiding pressure and blisters, and carefully dry and examine their feet every day.
One eventual result of uncontrolled diabetes, especially Type 1, may be a disturbance of fat metabolism. This can lead to sudden coma and death.
Management
Most people know that diabetes management depends on diet and that diabetics can't eat sugar. But diabetes management has three legs - diet, medication and exercise - each as important as the other. 'Eat regularly, shoot up at the right time and take a walk' could be the summation of the advice. In fact, the way diabetics eat is the way we should all eat. It is the basic prudent diet - low in fat and sugar, high in fibre and frequent, small meals. None of us need fried foods or sugar in our tea. The invisible fat in meats, nuts, avos and chocolate is more than enough for our needs. Sugar comes in many forms, fruit and vegetables and most processed foods including packaged snacks. So there is no need for the white stuff.
Adapting your eating habits to the demands of diabetes does not mean a dull, boring and tasteless diet. Many favourites are healthy and almost every dish in every style of cuisine can be easily adapted including traditional Indian food, which contains a lot of sugar and oil. Even eating out is in for the diabetic. The waiters in a good restaurant will know enough about the dishes on the menu to tell you what's in them and many restaurants these days include low-fat, low-salt, low-cholesterol and vegetarian dishes because the demand is growing.
If you are diabetic, don't go into a self-pitying huddle. It's far from the end of the world or the end of an active, enjoyable life. The first thing you need is information. Take your significant other and go to educative sessions offered by diabetic experts. If you are a member of one of the 45 medical aid societies that subscribe to the Centre For Diabetes, the lessons they provide will qualify you for free treatment. This can save you R800 a month if you are on insulin or R450 if you are on tablets - the cost of necessities under private care.
It is vital that diabetics are physically active. While many use a gym or walk to provide exercise, other pursue more demanding forms, taking part in many kinds of sport from tennis to weightlifting. It's not surprising that quite a few sports stars are diabetic. Exercise makes the body more sensitive to insulin, reducing the dose needed.
The risk factor
Who is at risk? Anyone who is overweight, who has diabetics in their families, smokes and hardly exercises. The newly diagnosed Type 2 will find that reducing body mass may allow his pancreas to cope without help. Diabetics live normal, active and successful lives. They pursue careers, get married, have children, excel in sports and intellectual pursuits and enjoy all the pleasures of life.
Famous South African diabetics include Albertina Sisulu and Mangosuthu Buthelezi, actors Ron Smerczak, Malcolm Terrey and Alvon Collison, Bafana Bafana striker Shaun Bartlett, and Boland cricket coach and former WP batsman Hylton Ackerman.
Guidelines for diet
Enjoy a variety of high-carbohydrate, low-fat foods.
Eat at least three regular meals every day. In some cases, reducing the size of regular meals and eating small snacks between meals, helps to improve blood sugar levels.
Carbohydrate foods should form the basis of each meal and snack. Foods that are absorbed slowly or have a high fibre content, are good choices - wholewheat bread, pastas, cereals and fruit.
Keep the pattern of carbohydrate intake consistent from day to day.
Eat small amounts of low-fat dairy, animal or plant protein foods every day.
Use small amounts of fat or oil. Spray a pan or wok rather than pour liquid oil in and use the oven or microwave as much as possible.
For eating out, one of the best cuisines is Thai, with plenty of variety and festive presentation. Avoid the few dishes with sugar. Even classic French cooking is okay if you tell the chef no sugar.
A handy reference is a glycaemic index where foods can be checked for low index levels.
Cooking for a diabetic needs is not difficult or complicated and there are good cook books available. The quarterly magazine Diabetes Focus always includes recipes.
Newly diagnosed diabetics should consult a clinical nutritionist who will help adapt your regular eating habits without depriving you of favourite foods.
Future remedies
Researchers constantly hunt for improvements in blood testing and insulin delivery systems. Ideally, both testing and delivery would be non-invasive. Insulin can't be taken by mouth because it gets digested in the stomach and not delivered into the blood stream. Experiments include a nasal spray, powder inhalant, ultra-sound and electric transdermal delivery. There are several experimental means of measuring glucose in blood without puncturing the skin, including an infra-red reading which reads through the skin and using a laser which punctures only to the top layer of the skin and measures interstitial fluid in place of a lancet which goes through the skin to where nerve endings register pain. Another method draws interstitial fluid up through the skin using a minute electric charge.
An insulin pump delivering through a catheter into the abdomen has been shown effective but it's a nuisance and there is an infection risk. An implantable sensor-pump is being researched. A recent development that shows hope is a group of drugs called Glitazones. They have proved effective but were withdrawn from the British market because of potentially fatal liver failure. The USA has not withdrawn them, believing that in some patients the benefits outweigh the dangers. They are still being tested. One of the most exciting developments is transplanting healthy insulin-making cells into the pancreas. Though this has run into rejection problems, new methods of overcoming this are at the animal testing stage.
The diabetes checklist
If you suffer from any of these ten warning signs, it's time for a blood glucose check.
Unusual thirst and urination
Extreme hunger
Sudden weight loss
Cuts, bruises and skin infections that heal slowly
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