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| Friday, 14 November 2003 |
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Today is World Diabetes Day Diabetes - A Chronic Hormonal Dysfunction by Aryadasa Ratnasinghe Today is World Diabetes Day. It is the primary global awareness campaign of the diabetes world. It represents the ideal opportunity to focus public attention worldwide on the causes, symptoms, treatment and complications of this most serious impaired hormonal function. According to World Health Organisation (WHO), at least 150 million persons suffer from diabetes throughout the world, and 66 per cent of them live in developed countries. The number of newly diagnosed persons with diabetes is increasing, irrespective of age, specially among the younger generation. In the old days, it was considered as a disease of the aged group. In many developing countries, the prevalence of diabetes, in persons between 20 and 30 years of age, is now higher than 10 per cent. In Sri Lanka, the prevalence of the disease is high as one million among persons of all ages. Even those who are 20 years old or less suffer from it. It has been attributed to changes in lifestyles, intake of fast foods and sweet products, over-eating and eating at irregular intervals, the lack of exercise and many other easy-going habits to which people have become conveniently addicted. The Diabetic Association of Sri Lanka (DASL), is the only non-governmental organisation (NGO), working actively for the betterment of diabetic patients, with its headquarters at Rajagiriya. Sri Lanka's ever National Diabetic Clinic, funded entirely by public donations opened its doors to the public in October 1955, and since then the DASL has been able to broaden its activities, to prevent the chronic disease raising its ugly head, with complications affecting health of individuals, and finally ending in death, unless controlled by diet, exercise and medicine. The word 'Diabetes' is derived from the Latin dia (a siphon) and benein (to go), and 'mellitus' meaning honey producing. In native medicine, it is known as madhu meha meaning the same thing. Therefore, those who suffer from diabetes must shun sweets and sweet-foods, which increase the risk of raising the blood-sugar level (the reference range being between 65 and 110 mg./dl.). A sugar level of 126 mg./dl., or above, is indicative of positive diabetes. from 110 to 125 mg./dl. is indicative of borderline diabetes. In a normal person, the fasting blood-glucose level, in the morning, is less ithan 110 mg./dl. There are three types of blood-sugar tests, viz: (a) Fasting Blood-Sugar Test (fasting for eight hours with no breakfast), (b) Post Parandial Blood-Sugar Test (testing after two hours from taking a meal) and (c) random Blood-Sugar Test (a haphazard test). Of these three, the fasting test is the most common and better recognised for purpose of ascertaing the blood-sugar content in the blood. Diabetes is a common metabolic disorder caused by the failure of the pancreas (sweetbread) to produce insulin (a protein secreted by the cells of the islets of Langerhans), in amounts needed to control sugar in the body. This condition gives rise to increase in the blood-sugar level above normal values (maximum range 110 mg./dl.), and spills over into the urine. But, the urine test is not 100 per cent correct, due to delay in the spill over. A person whose urine test is negative, may still be a positive case in the initial stage of diabetes. The earliest description of diabetes is mentioned in the old Indian medical treatises (the Charaka Samhitha and the Susustra Samhita) of the 6th century ad. The association of polyuria (diyavediyawa), containing a sweet tasting substance (madhu) was considered as a sign of diabetes. When ants were found around a drop of urine on the ground, it was considered to contain sugar, and the person a diabetic. The Arab physician Avicenna (960-1037), prescribed a mixture of lupine (a plant with flowers on long spikes), fenugreek (Trigonella foenum-graecum) or uluhal and zedoary (a species of curcuma possessing hypoglycenic activity). Till the beginning of the 20th century, little headway was made in the management of diabetes, and the patients were given large doses of boiled kotalahimbutu (Salacil reticulata) to drink to control diabetes. With the discovery of insulin in 1921, by Sir Frederick Grant Banting (1891-1941) and Charles Herbert Best (1899-1948), it has saved the lives of many diabetics, and still continues to do so. The test was conducted on a 14-year old boy Leonard Thompson, on January 1, 1922, with successful results. Today, the widely used drug is Metformin. According to medical opinion, diabetes is a serious and a progressive disease, but intensive treatment can substantially reduce the complications. It is said that no oral anti-diabetic drug causes complications, when used under medical advice. Exposing the tissues to high blood sugar content, for a long period of time, results in complications. On a data based complications of the disease show: loss of vision 46%, heart attack 24%, kidney failure 17%, limb amputation 7%, impotence 3% and others 3%. There are two principal types of diabetes. Type 1 (formerly known as insulin-dependent), is a condition where the pancreas fails to produce the necessary insulin essential for survival. This condition is most frequently seen in children and adolescents and increases later in life. Type 2 diabetes (formerly known as non-insulin dependent), results from the body's inability to respond properly to the action of insulin produced by the pancreas. It is much more common among individuals, and accounts for nearly 90 per cent of the cases. It occurs most frequently in adults, but adolescents are no exception. Both types are complex diseases finally leading to the same lethal situation. Hormonal influences on human sexuality begin at the moment of conception and continue throughout life. So, the susceptibility to diabetes is always positive. Generally, diabetes is a model for ageing. It is a chronic debilitating, degenerative disease, which, like ageing, may have as its concomitants, peripheral arterial disease, arteriosclerotic heart diseases, premature loss of limb, neuropathy and nephropathy. In addition, changes in sexual function, which sometimes accompany ageing, may also be one of its sequelae, e.g., impotence and female orgasmic dysfunction, loss of libido and infertility. The association between diabetes and impotence was first discovered in 1798, but it is now receiving increased attention, mostly among the young married couples. The precise etiology of diabetic impotence is unclear, but it has been postulated that four mechanisms are possible: (a) a type of diabetic neuropathy, (b) vascular changes, arteriosclerotic changes in penile blood vessels that impair pooling and trapping of blood in the corpora of the penis, (c) a disruption of biochemical or hormonal balance and (d) psychogenic factors. It is said that two or three of these conditions may exist together. The outlook of diabetes complications is alarming, as the incidence and prevalence of such complications are on the increase. The International Diabetes Federation in Belgium has drawn the attention to the costs of diabetes affecting everyone, everywhere. With the number of diabetes cases rapidly increasing, the costs are continuing to grow impacting heavily on the lives of individuals and families, the health-care sector, governments and societies as a whole. In most hospitals there are Diabetes Clinics, and Clinics outside hospitals to treat patients suffering from the debilitating disease. Diabetes neuropathy (nervous disorder) is a common diabetic complication, affecting a large number of people with diabetes. Neuropathy, sometimes in combination with peripheral vascular disease, often results in foot ulceration and amputation. Diabetes is said to be the most common cause of non-traumatic limb amputation. Therefore, every person who suffers from diabetes must take care to protect his legs from wounds without allowing them to become ulcerated. The whole world is now concerned with the development of diabetes as a chronic disease mostly prevalent in developed countries where health is not given its due place. The WHO has come to the rescue in assisting and developing and implementing national programmes, throughout the world, for the prevention of diabetes. The Global Strategy and the Prevention and Control of diabetes has given priority and has recognised as a disease with major health complications. The major countries with the highest diabetes prevalence in adult population are Papua New Guinea (16%), Mauritius (15%), Bahrain (16%), Mexico (14%) and Trinidad and Tobago (13%). Population growth, old age, urbanization, unhealthy eating habits and sedentary lifestyles have contributed seriously to the spread of diabetes. Mostly people with diabetes are unaware of their sickness, unless and until some diagnosis is made by physicians, in examining patients, who go for treatment, not knowing their sickness. Diabetes has been found to be the leading causes of kidney failure, but it depends on the severity of the disease and its duration. Screening and early detection of diabetic kidney disease are important factors for its prevention or control. It has been estimated that about 25% of patients with diabetes, develop chronic renal failure. Diabetic patients with proteinurea are at a higher risk in developing coronary artery disease. Next comes the eye. After 10 to 15 years, most people with diabetes show signs of mild damage to the back of the eye, known as Retinopathy. This condition affects the eyes, if it becomes significant or advanced. Good control of diabetes will help to prevent retinopathy. Cataract is the development of opacities in the lens of the eye which cause slow and progressive loss of vision. Senile cataract is the most common type, but cataracts may also follow excessive exposure to ultra-violet light or injury to the eye. If neglected, blindness will follow, losing complete vision. Diabetic neuropathy has been identified as a positive cause leading to impotence. Sometimes, a young married person, who is a male, may suffer from this unfortunate inability to have satisfactory sexual intercourse and its traumatic consequences with frustrated hopes. If this condition persists, the wife can obtain a divorce under the law. Sometimes, in the male, fear or failure, with accompanying decrease in erectile strength, may cause impotence, even though pathopsychologic problems are not so extensive. The development of gestational diabetes in women does not seem to result in a significantly indifferent prenatal mortality rate than that of the regular women. |
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