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Diabetically Yours

November 14th was the Diabetic Day, and Health Watch goes diabetically yours too today with two significant personalities who are diabetic, coming out in a pen-talk to meet you on the disease, or more correctly the body disorder, and to tell you how one can live, a near normal life with diabetes, just by controlling it and not allowing the disorder to control the person.

Doctor and sportsman

These two persons who are in the pen-talk today, are a doctor, and a hockey player in Sri Lankas national team.

They have shown themselves that diabetes is no bar, for one to achieve life's goals to some extent, yet unfortunately the society to a large extent continues to discriminate diabetics in the employment and marriage fields they say.

The pen-talk

Dr. Manouri Samarakoon (Physician Colombo South Hospital).

The medical term for diabetes is 'diabetes mellitus', it means, 'Honey-sweet Diabetes'.

You might wonder why such a sweet term, when, the whole thing is bitter to most of the affected as they are discriminated in society.

Most of them finding it difficult to get employment, and even get a partner in marriage. We have to fight, (not the type of fight with guns and bombs were see today in society) but debate out these wrong social attitudes, from society, and Educate and enlighten the society on the subject.

Now on this question about the sweetness. It is being explained elsewhere in this article.

Easily controlled

Diabetes can be easily controlled and with a bit of change in life style, these people can lead near normal lives.

Diabetes is no bar to ones achievements in life as seem in the two personalities featured in the pen-talk today.

Come forward openly

The two in the 'pen talk' wanted to come forward openly here and say - "we are diabetic. So what? We have not allowed diabetes to control us, we have controlled diabetes and we are leading normal lives.

With the curtain going up you see Dr. Manouri Samarakoon (Physician Kalubowila Teaching Hospital) on one side and on the otherside is one of Sri Lanka's National Hockey Players Young Dayan Dissanayake.

Both of us have achieved our interests in life, myself a doctor and this boy in sports a hockey player in the National Team.

Diabetes no bar

Diabetes has been no bar to achieving our goals in life, to some extent. I say so because, myself as a doctor I want to fight against the discriminations thrust upon the diabetic patients in society, by the society itself.

I know Dayan Dissanayake, who has passed his 'O' Level, sat his 'A' Level, but unsuccessful in getting into the University is still trying to get into a job in a mercantile establishment. In many places he had been called for the interview, but failed to get selected owing to his diabetic condition.

Please remember this boy is a National Hockey player and played for Sri Lanka in several international tournaments, in Malaysia, India, Singapore etc. with his diabetic condition proving no disability. But so far he has been finding it difficult to get a firm to offer him a job.

I personally know this boy who is from an average family in Matale.

At least I hope this article will help to find him a job. Health Watch, myself and Prof. Devaka Fernando would be very happy if that happens. His address Dayan Dissanayake "Rathu Sevana", Dodandeniya, Matale. Tel.: 06630624.

Diabetes - what it means

To tell you what Diabetes is. In simple terms it is a state of malfunctioning in the body's ability to convert carbohydrates (sweet and starchy food you eat) into energy to power the body.

As I said earlier medically we call it diabetes mellitus. Diabetes is characterised by an abnormal concentration sugar in the blood stream.

What's wrong with high blood sugar?

As sugar builds in the bloodstream, the kidneys try to pump it out. To eliminate the sugar, the kidneys must dissolve it. The more sugar there is to be eliminated, the more urine that must be passed. You can see how this situation quickly leads to frequent urination, increased thirst and dehydration-three of the symptoms of diabetes. Although the kidneys effectively keep the body from becoming overrun with sugar, working double time wears out the kidneys sooner than normal.

Over a lifetime, such overwork eventually brings on kidney failure. But that's not the only problem with high blood sugar.

Can diabetes be life threatening?

Definitely. The very nature of the disease puts the sufferer at risk for serious complications. Some experts believe diabetes is now the nation's third or fourth leading cause of death.

If diabetes goes unchecked?

Diabetes hastens wear and tear on many crucial bodily functions. In particular, it attacks:

* The circulatory system. Diabetes leads to coronary heart disease, stroke and circulation problems in the hands and feet. These conditions are two to four times more common in people with diabetes, and they account for most of their hospitalizations. Heart attacks, hardening of the arteries, strokes, poor circulation in the feet, amputations-these are concrete and common examples of diabetes damage.

* The kidneys. Diabetes is the leading cause of kidney failure.

* The eyes. Diabetes eye disease, or diabetic retinopathy, is the major cause of new vision loss in people 20 to 74 years old.

* The nervous system. Nerve cells may be disturbed or damaged, causing severe pain or loss of feeling - a condition known as neuropathy.

What can be done about it?

Quite simple, you must learn to control your diabetes. Don't let it control you! Many people with diabetes have taken personal responsibility for managing their disease and, as a result, they live normal, productive lives.

If any disorder can be called a life-style disease, diabetes comes as close as any. Just by controlling blood sugar, the severity of diabetic complications can be prevented. So, the most obvious step is to get blood-sugar levels down to normal. For some people, that means taking insulin; for others, it means losing weight; do some, it means both. For all people with diabetes, it means paying particular attention to diet and exercise-what we mean by a lifestyle change. All of the experts in the field recount the importance of sound health habits that can help control diabetes and, in some cases, prevent it.

But whatever their lifestyles, the very first steps for all people with diabetes are to find out that they have the disease and to realize that they're not alone.

The numbers in Lanka

In the world, probably well over 100 million. In Sri Lanka estimated 2 million people are affected by the disease and that includes people of all ages, from children to the elderly. The number increases yearly: 5% per cent of Sri Lankans have been diagnosed with diabetes - and an equal amount have the disease but haven't been diagnosed yet.

Undiagnosed

Scientists estimate that the onset of the disease can be anywhere form 4 to 12 years.

That means someone, may have diabetes 5, 8, even 10 years before it's diagnosed, depending upon the kind of diabetes that person has, unfortunately, in that time the condition can damage the body.

Many people only find out about their diabetes once they're having trouble with their eyes, nerves, kidneys, blood vessels or heart.

Diabetes - the risk factors

* Diabetes and age - the vast majority of people with diabetes have Type 2 diabetes.

This type usually occurs in people over the age of 40. The older you are, the greater your risk of diabetes.

* Diabetes runs in families - research has shown that people are more at risk if there is a history of diabetes in close family members. The closer the relative, the greater your risk of diabetes.

* Obesity is a factor in diabetes - Over 80% of people with Type 2 diabetes are overweight. The more overweight you are, the greater your risk of diabetes.

* Diabetes and pregnancy - Some women when they are pregnant develop a temporary type of diabetes called gestational diabetes.

Having this or giving birth to a large baby (4 kg/81/21b or greater) can increase a woman's risk of going on to develop type 2 diabetes.

* Diabetes - the symptoms The symptoms of diabetes will usually be very obvious in younger people, but may not be obvious or not appear in older people.

* Increased thirst
* Passing urine all the time - especially at night
* Extreme tiredness
* Weight loss
* Genital itching or regular episodes of thrush
* Blurred vision

Health Watch Question box

Consultant Cardiologist Dr. D. P. Atukorale Replies:

Breathing Difficulty

V. Weeraratne, from Colombo 4, in her letter dated October 31 states - "My father 60 years old, normally a healthy person walks 3 km regularly every morning. A non-smoker drinks occasionally, doesn't eat red meat. One day recently while walking he had experienced a slight breathing difficulty (like out of breath) for a few minutes and experienced the same in the evening for about a minute, and after that he has been normal (no pain at all).

He took an ECG the next morning (copy enclosed). Presently he is quite O.K. Could you please let us know whether he needs medical attention in an ICU or nursing home. An early reply through the Health Watch would be appreciated.

Silent Heart Attack

Dr. Atukorale replies: Dear Mrs. Weeraratne, Your letter had got delayed in the post. Hence this delayed reply; sorry for it. According to the ECG your father had developed a major heart attack (myocardial infarction) on that day. The ECG shows evidence of that - Full thickness (Q wave) which is a myocardial infarction. A silent heart attack. These are not uncommon in diabetic patients, and in the elderly.

Please get him seen by your family doctor without delay.

There is no indication to admit him to an ICU or hospital at present, as he has already gone through the critical period, at home. He will benefit from a tablet of soluble aspirin daily. That's if he is not allergic to Aspirin, only. If he develops angina or difficulty in breathing again, get him to keep a tablet of Glyceryl Trinitrate (G.T.N.) under the tongue. It may help. After the clinical tests your family physician, if necessary may refer your father to a Cardiologist.

Exercises & Eye problem

N. V. Dayaratne, from Bope, Galle in his letter dated 31.10.01 states:- I have been a diabetic patient for 14 years. Still I don't have high blood pressure or any kind of heart disease. But I have problems with my eyes. I am doing exercises for 40 minutes 3 times a week, as advised by my doctor. I want to know whether it is enough doing exercises for 40 minutes, 3 times a week, to keep my heart healthy, and blood sugar under control.

Dr. Atukorale replies:-

Dear Mr. Dayaratne re-exercises to keep your heart healthy ideally you should exercise daily or at least 5 days per week 30-40 minutes a day.

Exercises will help you to control your diabetes and increase the (HDL) good cholesterol.

For your eye problems get referred to an Eye Specialist by your Family doctor early. Eye diseases due to diabetes can be cured or controlled if you see an eye specialist before things get complicated.

You have said that you have a healthy heart. Have you taken an ECG recently.Do you know that silent Coronary Ischaemic heart disease, without symptoms can occur in diabetic patients. Have you got your blood sugar and urine tested to see whether your diabetes is under control. Go to your family doctor and get it done.

Health Watch and I wish both of you good health. It has been a pleasure to answer your questions. Sorry for the delay in replying.

Your Questions on Heart Disease

Send your questions on heart disease direct to Dr. Atukorale, No. 14, Rajapakse Mawatha, Horton Place, Colombo 7.

Buerger's Disease: First description

This disease was first reported by Buerger in 1908, who described a disease in which the characteristic pathologic findings - acute inflammation and thrombosis (clotting) of arteries and veins - affected the hands and feet.

Buerger's disease is also known as thromboangiitis obliterans.

Who gets Buerger's disease (the 'typical' patient)?

The classic Buerger's disease patient is a young male (e.g. 20-40 years old) who is a heavy cigarette smoker. More recently, however, a higher percentage of women and people over the age of 50 have been recognised to have this disease. Buerger's disease is most common in the Orient, Southeast Asia, India and the Middle East, but appears to be rare among African-Americans.

Classic symptoms and signs of Buerger's disease:

The initial symptoms of Buerger's disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest.

The pain typically begins in the extremities but may radiate to other (more central) parts of the body. Other signs and symptoms of this disease may include numbness and/or tingling in the limbs and Raynaud's phenomenon (a condition in which the distal extremities - fingers, toes, hands, feet - turn white upon exposure to cold). Skin ulcerations and gangrene of the digits (fingers and toes) are common in Buerger's disease.

Pain may be very intense in the affected regions.

Despite the severity of ischemia (lack of blood flow) to the distal extremities that occurs in Buerger's, the disease does not involve other organs, unlike many other forms of vasculitis. Even as ulcers and gangrene develop in the digits, organs such as the lung, kidneys, brain, and gastrointestinal (GI) tract remain unaffected. The reasons for the confinement to the extremities and sparing of other organs are not known.

What causes Buerger's disease?

The association of Buerger's disease with tobacco use, particularly cigarette smoking, cannot be overemphasised. Most patients with Buerger's are heavy smokers, but some cases occur in patients who smoke 'moderately'; others have been reported in users of smokeless tobacco.

It has been postulated that Buerger's disease is an "autoimmune" reaction (one in which the body's immune system attacks the body's own tissues) triggered by some constituent of tobacco.

How is Buerger's disease diagnosed?

Buerger's disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger's disease (for Buerger's, there is only one treatment known to be effective: complete smoking cessation).

Diseases with which Buerger's disease may be confused include atherosclerosis (build-up of cholesterol plaques in the arteries), endocarditis (an infection of the lining of the heart), other types of vasculitis, severe Raynaud's phenomenon associated with connective tissue disorders (e.g. lupus or scleroderma), clotting disorders of the blood, and others.

Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger's disease. In the proper clinical setting, certain angiographic findings are diagnostic of Buerger's. These findings include a 'corkscrew' appearance of arteries that result from vascular damage (see figures below), particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions (blockages) or stenoses (narrowings) in multiple areas of both the arms and legs. In order to rule out other form of vasculitis (by excluding involvement of vascular regions atypical for Beurger's), it is sometimes necessary to perform angiograms of other body regions (e.g. a mesenteric angiogram).

Skin biospsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.

Treatment and course of Buerger's disease:

It is essential that patients with Buerger's disease stop smoking immediately and completely. This is the only treatment known to be effective in Buerger's disease. Patients who continue to smoke are generally the ones who require amputation of fingers and toes.

Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of anticoagulation (thinning of the blood with aspirin or other agents to prevent clots) have not proven effective. The only way to prevent the progression of the disease is to abstain from all tobacco products.

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