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| Saturday, 13 November 2004 |
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World Diabetes Day - Nov. 14: Diabetes mellitus - impaired hormonal function by Aryadasa Ratnasinghe "Today, there are more than 194 million people worldwide suffering from diabetes mellitus. Sixty five per cent of them live in developing countries and the prevalence of diabetes in persons aged 20 to 30 years, is higher than 10%, the principal factors being changes in westernised lifestyles, eating refined foods, lack of exercise and undue stress, that enhance the risk of developing the disease. According to medical opinion, diabetes is one of the leading causes of death due to coronary artery disease, other complications being heart attack, angina, kidney failure, gangrene of the legs, strokes and blindness." (WHO). Diabetes mellitus is a common metabolic disorder in which there is failure of the pancreas to produce sufficient insulin in amounts needed to control sugar metabolism. As a result, the blood sugar rises above normal values (110 mg/dl) and spills over into the urine. Fasting blood glucose levels of 126 or more indicate diabetes, and between 110 to 125 indicates borderline diabetes. The presence of sugar in urine is said to be unreliable. Although diabetes was earlier considered a model for ageing and mostly among the richer group of individuals, today it affects even children and those between 30 to 45 years of age, and hence it is no longer a disease of the elderly. As it is, according to WHO, diabetes is reaching epidemic proportions worldwide. The number of diabetic patients in Sri Lanka is well over one million (ratio 1:19), and the prevalence rate is 8% in rural areas and 14% in urban areas, the difference being mainly due to easy lifestyles. Diabetes is a chronic, debilitating, degenerative disease, and may have as its concomittants, peripheral arterial disease, arteriosclerotic heart disease, due to blocking of arteries, premature loss of limb, neuropathy (nerve damage), nephropathy (diabetic kidney disease) and retinopathy (eye disease). In addition, changes in sexual function may also be one of its sequelae, such as impotence in the male, orgasmic dysfunction in the female, loss of libido and infertility. The connection between diabetes and impotence was first recognised in 1798, by Dr. Rubin A. Babbit, though it then received little attention among the medical men. The precise etiology of diabetic impotence may be due to (i) diabetic neuropathy, (ii) vascular and arteriosclerotic changes in the penile blood vessels that impair pooling of blood in the corpora of the penis, (iii) disruption or bio-chemical or hormonal balances, and (iv) psychogenic factors, over fear or failure in the erectile strength. There are two types of diabetes mellitus. One is Type 1 which can affect people of any age, and it is found to be more common in children and adolescents. People with Type 1 are unable to produce enough insulin (a protein secreted by the Islets of Langerhans in the pancreas (sweetbread), in response to the increase in blood glucose concentration after a meal. The main function of insulin is to lowdown the blood glucose level, by accelerating its uptake by most tissues (except the brain), and promoting its conversion into glycogen (starch found in liver yielding glycose on hydrolysis) and fat (a complex mixture of many different triglycerides, each formed when three molecules of fatty acids combine with one of glycerol). Type 2 diabetes is most common in older people, above 50 years of age, and particularly among those who are obese. However, as a consequence of increased obesity and lack of exercise among the younger generation, this type of diabetes affects them. These patients do not always require insulin injections, and they can control the disease by selected food intake, excluding starchy foods, fast foods, yams and root-crops, sweet foods, and not over-eating. Tablets prescribed for Type 2 diabetes include Metformin, Dionil, Gliben Clamide etc., to reduce the rise in the blood sugar level above 110 mg/dl. There are three blood tests to ascertain the sugar level in the blood. The best and the most common is Fasting Blood Sugar (FBS), and the test should be done 8 hours after dinner. Then there is the Post Prandial Blood Test (PPBT), which is done exactly two hours after a heavy meal. Glucose Tolerance Test (GTT) can be done at any time of the day, by giving the patient glucose to drink. If the test reveals 200 mg/dl, he is a diabetic patient. Family history of diabetes is a major factor in developing the disease. The only way to escape there from is by eating moderately, avoiding junk foods and everything sweet or starchy. Vegetables, specially fibres, pulses, fruits are said to be the best. Moderate alcohol consumption is said to be harmless, according to research studies conducted in the West. But it is better to avoid liquor during medication to yield the best results. There is no permanent cure for diabetes, but it can be controlled by prophylactic treatment, either with insulin or with drugs. When the blood sugar level is 180 mg/dl, sugar appears in the urine, which drags water, and the result being the passing of lot of urine with a feeling of dryness and thirst. Losing weight in the abnormal way is a sign of the disease. The most worrying complications of diabetes are, loss of vision (46%), heart attack (24%), kidney failure (17%), limb amputation (7%), impotence (3%) and the rest being 3%. Tablet users are generally apprehensive of insulin, which is costly as well as inconvenient. In zygotic twins, if one has Type 2 diabetes, approximately 30% of the twins will also suffer from the chronic disease. If both parents were to suffer from diabetes, the risk factor is over 70%. The condition is not so serious in children whose parents are not diabetics. Uncontrolled diabetes during pregnancy, may cause congenital abnormalities to the foetus, bring forth large babies with complications to the mother. Sometimes, diabetes occur during pregnancy, but it disappears after childbirth. The secret of diabetes is that people are unaware that they suffer from diabetes, unless diagnosed by a doctor during consultation. An unhealing wound in the leg is a sign of diabetes, which finally leads to amputation. In some, the heels become so soft that they cannot walk barefooted on sandy soil or on gravel roads. Any injury to the heel may turn serious as gangrene sets in. In the old days, there were no tests to check on diabetes. When ants collected around a drop of urine, it was the signal that urine contained sugar. In ayurveda, diabetes is known as 'madhu-meha' (passing of sweet urine). In native medicine, the diabetics were advised to boil and drink 'kotalahimbutu' (Salacil reticulata) and eat 'karawila' (Mormodica charantia) to lowdown blood sugar. Unpolished rice and 'kurakkan' (Panicium metiaceum) formed the staple diet of the diabetic, because their starch content is low. Diabetes is among the leading causes for kidney failure. Kidneys are the urine producing organs of vertebrates. In humans the symmetrical, bean-shaped kidneys are situated in the upper rear part of the abdominal wall, one in each side of the vertebral column. Each kidney weights about 130 g., and consists of approximately one million nephrons (the functional units) and supporting tissue. In case of an emergency, one can be removed and man can exist with one at risk. Kidney failure occurs when both kidneys are severely damaged, giving rise to chronic renal failure. Any damage to the kidney can be detected only by the examination of urine for albumin or protein. During the Second World War (1939-1945), the sulfanamide group of drugs was used to treat infections. In 1942, it was found that this drug caused a fall in the blood sugar level. Biguanides were a group of anti-diabetic drugs, introduced in 1950, for the treatment of Type 2 diabetes. Now, there are new drugs to control diabetes and, if taken under medical advice, without a breach, they can do a better job than those old drugs. The Arabic physician Avicenna (960-1037), prescribed a mixture of lupin (Papilionaceae), fenugreek ('uluhal') and zedoary (species of curcuma of bitter and pungent taste) that possess mild hypoglycemic activity, to control diabetes. On January 1, 1922, insulin was injected to a 14-year old Leonard Thompson to very its effect on diabetes, and it proved a success. |
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