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Trapped in a stressful education system these students appear to be discussing what their future is going to be in case they manage to remain diabetic free and healthy.

Prof. Upali Ilangasekera, Professor of Medicine Peradeniya Medical Faculty and President of the Kandy branch of the Diabetic Association Sri Lanka, describes our education system, where the students for ever are kept on a stressful rat race to do well at any cost with no regard for health ends up making them as diabetically goaled, as most of the children end up as diabetic patients in their adolescent life.

Prof. Upali Illangasekera (MD, FRCPE, FCCP), Professor of Medicine Peradeniya Medical Faculty and President of the Kandy branch of the Sri Lanka Diabetic Association in an article sent to us to mark the November 14th World Diabetes Day has listed our present educational system where the mental stress subjected on the students due to the current rat race to do well at any cost needs urgent attention of all concerned, if we are to prevent diabetes in their adolescent age.

Prof. Illangasekera, has stated this in a lengthy article he has sent to this page on - "Preventing Death and Disability from Diabetes" to mark the World Diabetes Day which falls today (November 14).

Here are some excerpts from the article which we feel will benefit the reader and needs consideration by the health and education authorities.

Unfortunately in spite of several advances in the treatment, the exact cause of diabetes has not been elucidated. It is however thought to arise from an interaction between the genes of a person and adverse environmental factors.

These environmental factors include life style factor such as diet, lack of exercises, increasing weight, excessive consumption of alcohol and tobacco and mental stress. All these are features of the modern sophisticated way of life people wish to enjoy.

In the prevention of diabetes, there is nothing one could do to change the gene after some one is born. Furthermore, an exact 'diabetic gene' has not been identified so far. However regarding the environmental factors, action could be taken to minimize them. A suitable diet, plenty of exercise and avoiding alcohol and smoking would prevent diabetes in a large number of people. Furthermore, measures to reduce mental stress such as meditation too would help.

More recently, the nutrition of the baby while inside the womb of the mother and the nutrition following delivery too have been identified to be associated with diabetes in later life. Therefore, attention to the nutrition of the expectant mother and the newborn baby would be beneficial in the prevention of diabetes. In this respect, it has been shown that the 'catch up' feeding of low birth weight babies who are overfed to bring them up to the normal weight according to charts have been found to be detrimental. Breast feeding should be encouraged at least up to six months.

Furthermore, issues such as the nutritional requirements of the school going children and the mental stress they are subjected due to the current 'rat race' to do well at any cost should be addressed to urgently, if we are to prevent diabetics in the adolescents, a situation becoming a grave problem even in certain developed countries.

Diabetes, a chronic illness that was relatively uncommon several decades ago has reached epidemic proportions particularly in developing countries such as Sri Lanka.

Diabetes and its complications account for a large number of hospital admissions, absenteeism from work, lifelong debility and death. In addition to the social impact the economic cost of managing a large number of patients with diabetes would be prohibitive for the government which is already burdened by escalating health care costs, by an increasing patient population and an increasing demand for healthcare by the community.

Research has shown that those patients with diabetes who are well educated about the illness could manage it better and are therefore less likely to develop complications. The purpose of this article is to educate those affected by diabetes to adequately control it by themselves. During its preparation the author has utilized knowledge that has been accrued from recent research and also considered certain misconceptions and misunderstandings among patients in relation to diabetes.

Diabetes could virtually affect any organ or system in the body. When affected, they are called complications. The common complications of diabetes include strokes or paralysis, heart attacks, loss of vision, kidney failure, leg ulceration with resultant amputations and inability to walk due to involvement of the nerves which supply the limbs (neuropathy). Diabetes could also cause skin sepsis, involvement of the teeth and gums, delayed wound healing and increased susceptibility to infections such as tuberculosis and urinary tract infections.

A special type of diabetes which is present during pregnancy called Gestational diabetes could increase the risk of physical abnormalities of the newborn baby and also pregnancy related complications in the mother.

It has been conclusively shown that these dreaded complications of diabetes could be avoided, if it is managed properly. Proper management is facilitated by not only the knowledge and the commitment of the medical practitioners, but also that of the patient. Patient education is mandatory in treating diabetes and in this respect there has been an explosion of patient friendly educational material particularly in the electronic media such as the internet which however may not be available to most Sri Lankans at present.

The important objectives in the management of diabetes consists of early detection, reducing the high blood sugar, and identification, treatment and prevention of complications. On the part of the patient, these objectives could be achieved by adhering to a proper diet and medication, exercise and by improving the knowledge about diabetes. The medical officer too should possess adequate knowledge and commitment on his part to provide advise and guidance to the patient.

In a large number of patients with diabetes complications have already set in at the time of diagnosis. It is not uncommon for a patient to be diagnosed to have diabetes for the first time when they present with a complication such as a heart attack.

Therefore, early diagnosis is crucial because the earlier it is detected, better are the chances of preventing and treating these complications. The most important drawback for the early detection of diabetes is the total lack of symptoms in some patients. In the absence of symptoms, the patient feels that there is no need to get himself tested. Ideally every adult (over the age of 18) should have an annual checkup for blood sugar and cholesterol, but it is mandatory for the following categories of people to undergo this examination.

3. Those who are overwigiht or those who may not be overweight, but having fat deposited in the central part of the abdomen (central obesity)

The diet that one consumes not only influences the risk of that person getting diabetes, but it also plays an integral role in its management. This is also the area in which a lot of misconceptions and misunderstandings exists. In advising on an appropriate diet for a patient with diabetes - personal preferences, availability of food and even the religion and the culture too should be considered.

The objective of a diabetic diet is not only to bring the blood sugar down to normal but also to provide the necessary amount of calories needed for the day to day activities of the patient reduce the cholesterol, maintain the appropriate weight of the patient, maintain normal blood pressure, thereby reducing the risk of complication. The diet also should provide other ingredients in a diet such as a moderate amount of fat, proteins, minerals and vitamins.

The fuel that is needed for the function of the human body is derived from calories obtained in our meals. The number of calories needed by a person per day depends on his weight, age and occupation. The three main components of a diet consist of carbohydrates, proteins and fats consisting of different caloric values. The amount of calories needed by an Sri Lankan adult male indulging in a sedentary occupation would be between 1800 to 2000 calories. This would go up, if he is in an active occupation such as farming or being a labourer.

In practice, the author feels that the best diet suitable for the Sri Lankan diabetic patient is the traditional diet consumed by our villagers minus the sugar in whatever form it is consumed with restriction on the amount of carbohydrates.

The traditional Sri Lankan diet used to consist of brown rice, plenty of vegetables and fruits and a very moderate amounts of fats (mainly derived from vegetable sources such as coconut oil) and proteins. The intake of animal proteins are minimal in a traditional diet and there is evidence that in those who are vegetarians the risk of complication such as heart attacks and involvement of the kidneys is less. A person who is on a proper diabetic diet will not only achieve normal blood sugar levels, but also will feel well and maintain a normal weight.

1. Foods made from rice flour such as pittu, hoppers, roti and string hoppers could be substituted for rice: This is not true because rice taken as a grain is less likely to increase blood sugar. It is thefore advisable for diabetic patients to take rice even for all three major meals. Ideally, it should be rice with the covering (called 'Nivudu') which could be brown rice. One should be careful about some types of brown rice available in the market where the colour has been obtained by dyes.

3.Moderate alcohol consumption has a protective value in diabetics: This has been shown to be true by research studies conducted in the West, but in countries such as ours, it is best avoided particularly those on diabetic medication.

4.Kurakkan could be substituted for rice:not true as certain types could increase blood sugar more than even rice.

6.Dates could be used as a sugar substitute: Not true since the dates that are available in the market are tempered in a sugar solution to make it sweeter.

7.Coconut oil and coconut milk should be avoided:not true but that could be used in moderation.

8.Any amount of fruits could be consumed:not true, as fruits contain fructose which ultimately get converted to sugar in the body.

There is also a category of patients, usually coming from the middle or higher classes who 'overdo' what has been advised. They are over careful with the diet that sometimes they loose weight or develop very low blood sugar values, a condition called 'hypoglycaemia'.

An educational exhibition and a seminar on osteoporosis was held at the BMICH in Colombo to mark the world Osteoporosis Day which fell on October 20. Chief guest at the occasion was the Women's Affairs Minister, Amara Piyaseeli Ratnayake, who commended the Osteoporosis Society of Sri Lanka for organising the event in association with New Zealand Milk Lanka (Pvt) Ltd.

In addition to a series of lectures presented by the members of the Osteoporosis Society of Sri Lanka; Dr. Sarath Lekamwasam, Dr. Lalith S. Wijayaratne and Dr. Udul Hewage, a number of exhibition panels highlighted the crippling effects of osteoporosis, and the essential importance of calcium for strong healthy bones.

A novel feature was the presence of a stall giving the public an opportunity for a bone scan, which was run by Anlene. Osteoporosis, which is mainly seen in elderly women, affects 6 out of 10 Sri Lankan women causing their bones to become brittle and weak over time. Also known as Brittle bone disease, Osteoporosis has no cure. It is brought about by the continuous loss of calcium throughout a woman's life. Preventing this condition can only be done by a sufficiently high Calcium intake in your everyday diet.