by Jims Vincent Capuno
After 36-year-old Marilyn suffered angina pain two years ago, she was admitted to hospital on three different occasions. Intensive tests drew a blank, but for months she also suffered recurrent bladder infections and felt listless and tired. She had so little energy she could barely fix herself a meal or complete the household chores she used to do. She was constantly thirsty and noticed that she bruised more easily than usual.
Her family was very alarmed. Her two daughters begged her to see a doctor. So, one Saturday morning, they took her to a hospital, where Marilyn was diagnosed with diabetes.
Diabetes is a condition in which there is too much excretion of urine. It can be caused by a lack of the hormone that limits the amount of urine made, as in diabetes insipidus. It can also result from a high blood sugar level, as in diabetes mellitus.
What Marilyn is suffering from is the second type, which now affects one out of every five Filipino adults. Everyday, some 500 Filipinos are being diagnosed with this complex disorder that is mainly caused by the failure of the pancreas to release enough insulin into the body or by a defect in the parts of cells that accept the insulin.
Insulin, a hormone isolated by Frederic Banting and Charles Best in 1921, is released by the pancreas in response to increased levels of sugar in the blood. The hormone acts to regulate the body’s use of sugar and some of the processes involved with fats, carbohydrates, and proteins. Insulin lowers blood sugar levels and promotes transport and entry of sugar into the muscle cells and other tissues.
Medical science has identified four forms of diabetes mellitus. Type I, also called insulin-dependent diabetes, is the most serious form of the disease. It most often develops during childhood, although young adults also can develop this form.
Type II, also known as non-insulin dependent diabetes, usually begins after 40 years of age, but can occur at any age. This is the most common form of diabetes and it develops generally in overweight adults.
Gestational diabetes (previously called Type III diabetes) occurs in some women during pregnancy, but many women later develop Type II diabetes. The fourth form, called secondary diabetes, includes other types of diabetes linked to disease of the pancreas, hormonal changes, side effects of drugs, or genetic defects.
Of the four million Filipinos with diabetes, 75 percent do not know they have it. “Many people still do not know that they have diabetes,” said Dr. Tommy Ty Wiling, president of Diabetes Philippines. The Department of Health listed diabetes as the ninth leading cause of death among Filipinos today.
Unknowingly, diabetes tends to run in the family. “Diabetes is a hereditary disease passed on from generation to generation,” said former health secretary Dr. Alberto Romualdez. “When there is a diabetic in the family, no matter how distant a relative the patient is, the characteristic is still passed on through the genes.
“If both parents have diabetes,” Dr. Romualdez pointed out, “the children’s chance of developing the disease is greater. It is very important therefore that everyone in a family with a diabetic member must prepare early to prevent the onset of the disease.”
Unlike certain crippling diseases, which attack without warning, diabetes sends out warnings by displaying symptoms. Medical scientists list the following: frequent urination and great thirst; weight loss and extreme hunger; weakness and tiredness; and skin problems. Other symptoms include nausea and vomiting, blurred vision, drowsiness, cramps or numbness in the toes and fingers, and abdominal pain.
People with diabetes are at risk for heart disease, kidney disease, atherosclerosis, nerve damage, infection, blindness, and slow healing. “Diabetes is a very expensive disease,” Dr. Romualdez said. “It affects all tissues and organs of the body. There is no known cure. Once a person is diagnosed a diabetic, he or she will be on medications for the rest of his or her life and will die a diabetic.”
“Each person reacts to diabetes in his own way,” says The Doctors Book of Home Remedies. “This means each person has to be under a doctor’s care and constantly monitored. This need cannot be overstated. What’s good for your diabetic friend may be bad for you.”
Every diabetic’s goal is to maintain his or her blood sugar to normal level. “Half of all diabetics worldwide have poor control of their blood sugar levels,” deplores Dr. Willie T. Ong, who was chosen as recipient of the Outstanding Filipino Physician in 2007 given by the Department of Health.
The United Kingdom Prospective Diabetes Study (UKPDS) has found that better blood sugar control decreases the risk of serious eye disease by 25% and reduces kidney damage by 33%. In addition, better blood pressure control (as close to 120/80 as possible) reduces the risk of death by 33%.
To think of monitoring of blood sugar is easy and not painful. In his book, How to Live Longer, Dr. Ong informs: “A blood sugar tester costs around P4,000. Each strip would cost around P60. To lessen the pain, prick at the side of the little finger, which has fewer nerve fibers. If your blood sugar is not controlled, you can test your sugar once or twice a week. Record the dates and numbers in a notebook.”
Diabetics must be aware that diabetes is a killer disease. Diabetic coma is a life-threatening condition which can occur in patients with diabetes. It is caused by failure to take insulin or anything that increases the body’s need for insulin, as infection, surgery, injury, or stress.
Warning signs include a dull head, fatigue, extreme thirst, pain below the breastbone, nausea, dry lips, sunken eyes, and a fruity breath odor. The temperature usually rises and then falls. As such, the condition is a medical emergency.
About 40% of diabetics require oral agents for satisfactory blood glucose control, and some 40% need insulin injections. People with Type 1 diabetes are usually totally dependent on insulin injections for survival. Such people require daily administration of insulin. The majority of people suffering from diabetes have the Type 2 form. Although they do not depend on insulin for survival, about one third of sufferers need insulin for reducing their blood glucose levels.
But no matter what you do, diabetes slowly worsens with time, according to the UKPDS. Here’s a thought of wisdom from Dr. Ong: “For people taking medicines, it is often necessary to increase the dose, add other tablets or eventually start insulin treatment. People with diabetes need to be informed that every few years, additional drugs may have to be added including insulin. They should be reassured that it is not their fault but it is just the way diabetes works. People taking insulin injections will also often require dosage increases over time.”
The World Health Organization (WHO) predicts that the number of cases of diabetes in developing countries is likely to increase more than two-fold in the next 30 years. In 2000, there were 115 million diabetics. By 2030, the figure will go up to 284 million.
But this projected increase in diabetes worldwide can still be curtailed through attention to diet and physical activity. “For those who have diabetes, good management of the disease can delay or even prevent complications and disability. Promoting self-management by patients, proactive control of risk factors by health professionals and reorganization of health services to manage chronic conditions have all been shown to make a significant difference to patients,” said WHO in a statement.
