Diabetes is now an enormous health problem in the Philippines.
From January to December last year, diabetes ranked fourth as the leading cause of death in the country, data from the Philippine Statistics Authority (PSA) showed. Between 2015 to 2019, the average death toll was 32,991 but the figure went up to 37,265 in 2020.
Recent reports say over 7 million Filipinos are expected to have diabetes by 2030. But most of those having the disease don’t know they have it. In fact, many diabetics die “because it is already too late to remedy the situation,” to quote the words of the late Dr. Ricardo Fernando, who founded the Institute for Studies and Diabetes Foundation.
But what is alarming is that Filipinos diagnosed with diabetes are getting younger. “Children as young as 5-years old have been diagnosed with diabetes,” reports Philippine Diabetes Association (PDA), an umbrella organization of all associations involved in the care of the diabetic patients.
“A doctor cannot tell that a child is diabetic until he starts to complain and usually that is already late as far as complications are concerned,” Dr. Fernando explained. “This disease has no cure. What doctors can do is just minimize the complications or push its onset a little later because the disease is more manageable among older people.”
The Medical News Today (MNT) considers diabetes as “a metabolism disorder.” Metabolism refers to the way your bodies use digested food for energy and growth. Most of what you eat is broken down into glucose. Glucose is a form of sugar in the blood – it is the principal source of fuel for our bodies.
“When our food is digested, the glucose makes its way into our bloodstream,” MNT explains. “Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present – insulin makes it possible for our cells to take in the glucose.”
Insulin is a hormone released from the pancreas. “After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, as soon as glucose enters the cells blood-glucose levels drop,” MNT notes.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). “This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces,” MNT says. “This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.”
Several types
Oftentimes, “doctors use the full name diabetes mellitus, rather than diabetes alone, to distinguish this disorder from diabetes insipidus, a relatively rare disease that does not affect blood sugar levels,” explains The Merck Manual of Medical Information.
Actually, there are several types of diabetes. Type 1 (formerly called insulin-dependent diabetes or juvenile-onset diabetes) occurs in only 10-15% of all cases and tends to occur in people under the age of 30. Onset is normally sudden and dramatic. More than 90% of the insulin-producing cells of the pancreas are permanently destroyed. The exact cause is unknown but it’s generally thought to be inherited.
Environmental factors may also be a trigger. “Scientists believe that an environmental factor – possibly a viral infection or a nutritional factor in childhood or early adulthood — causes the immune system to destroy the insulin-producing cells of the pancreas,” the Merck manual notes.
As insulin-producing cells in the pancreas are damaged, insulin must be injected to keep the patient alive. “Aside from being safe, (insulin treatment) is cost effective compared with taking several classes of anti-diabetes pills at the same time,” points out Dr. Linda Lim-Varona, an internal medicine specialist.
Gary Valenciano also has this type of diabetes. His wife, Angeli, has saved the life of her husband several times already. “She has revived me a number of times, preventing me from falling into a diabetic coma,” the singer reveals.
Type 2 (called previously as non-insulin-dependent diabetes or adult-onset diabetes) is the most common form; it accounts for about 90% of all cases. In this type, the pancreas continues to produce insulin, sometimes even at higher-than-normal levels. But the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body’s needs.
The other types are gestational diabetes, impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG).
“Gestational diabetes is hyperglycemia with blood glucose above normal but below those diagnostic of diabetes,” the World Health Organization (WHO) explains. Gestational diabetes is common among women and it occurs during pregnancy.
This type of diabetes is diagnosed through prenatal screening, rather than through reported symptoms. “Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery,” the WHO states. “These women and possibly their children are also at increased risk of type 2 diabetes in the future.”
Both IGT and IFG are intermediate conditions in the transition between normality and diabetes. “People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable,” the WHO says.
Lifestyle-related condition
Diabetes is considered a “lifestyle-related condition” as it is caused by excessive weight, physical inactivity, and stress. “If you look at the spread of the scourge around the world, Type 2 diabetes occurs as a country advances technologically, when people come out of the fields to sit behind desks,” notes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.
There might also be a genetic link; it often runs in families. Certain diseases and drugs (like corticosteroids) can also affect the way the body uses insulin and can lead to developing this type of diabetes.
Type 2 diabetes may also “occur in people with excess production of growth hormone and in people with certain hormone-secreting tumors,” the Merck manual says. “Severe or recurrent pancreatitis and other diseases that directly damage the pancreas can lead to diabetes.”
Symptoms and complications
The two common types of diabetes have very similar symptoms: excessive urination and abnormal thirst. Other symptoms include unusual hunger, rapid loss of weight or excessive weight, nausea and vomiting, blurred vision, drowsiness, itchy skin and skin disorders, cramps or numbness in the limbs, and abdominal pain.
Those who are experiencing any of the above symptoms but do not believe they have diabetes are gambling with their health. Augusto D. Litonjua, founding president of the Philippine Society of Endocrinology, said complications that arise from diabetes include blindness, heart diseases or stroke, kidney trouble, impotence, renal failure, and amputation.
“Blindness can occur 25 times more in diabetics than non-diabetics,” Dr. Litonjua said. “They are also twice as prone to heart attacks and strokes, 17 times more prone to kidney disease, five times more prone to gangrene and about 50 percent of men with long duration of diabetes are impotent.”
Prevention
Unknowingly, diabetes can be prevented. A 10-year study conducted at the National Heart, Lung, and Blood Institute in Bethesda, Maryland showed the 5 best ways to prevent diabetes.
First, you need to try to achieve your normal weight. Second, you need to be physically active. Regular exercise will not only help you have a normal weight, it also makes people have normal blood sugars.
The two other attributes pertain to vices: cigarette and alcohol consumption. It was found that people who didn’t develop diabetes were non-smokers or they had stopped smoking for at least 10 years already.
As for drinking, it has been shown that the more a person drinks, the more they are prone to engage in other unhealthy habits like eating too much, smoking and not getting enough exercise.
This brings us to the final attribute: foods. You need to eat healthy foods. According to the lead author of the study, Dr. Jared Reis, among all five factors, being overweight was linked most strongly to diabetes risk.
Treatment
People with type 1 diabetes need daily insulin injections. Those with type 2 diabetes usually don’t need insulin injections. But 25% of them take drugs to improve sugar metabolism. “Treating Type 2 diabetes with drugs does reduce blood sugar, that’s true,” says Dr. Willie T. Ong, a well-known author of health books.
But in many cases, doctors are treating Type 2 diabetes with diet and exercise. They find that this lifestyle approach does more than just reduce blood sugar.
“It does a lot more,” says Dr. James Barnard, professor of physiological science at the University of California. “The same regimen that puts diabetes on hold has a favorable impact on high cholesterol, high blood pressure, and obesity.” Those three, along with high blood sugar, are what doctors call the deadly quarter.
But before doing anything, however, be sure to talk with your doctor. “We have been saying that diabetes is not a disease to be toyed with,” said Dr. Litonjua. “It should be viewed with concern because if left untreated then there may be serious consequences. The glimmer of hope here is that if you treat a diabetic really well, he will be as long as a person without diabetes, and probably with a better quality of life because he takes care of himself better than one without diabetes who lives recklessly.”
