Diabetes and the metabolic syndrome


  • Health
  • Sunday, 22 Jun 2003

DON’T you know it’s not polite to ask a lady her age?” Rajesh teases, as she leads the writer into the living room. “I’m coming to 58,” she finally declares as she lowers her oversized body onto the sofa. She is very warm and friendly. Before long, we are chatting about her family. 

“My husband passed away five years ago,” she says. “My eldest son now runs ?” Rajesh’s sentence hangs in mid-air as she takes a breath. She then continues, “My eldest son now runs the family business.” 

She wheezes a little and says, “I’m sorry but I haven’t been feeling very well. It’s my heart. My doctor says that, with my diabetes, high blood pressure and heart disease, I’m like a walking time bomb.” She manages a feeble chuckle to lighten the gravity of her statement.  

Meeting Rajesh even for the first time, you can’t help agreeing with her doctor. She is stricken with a cluster of diseases that was once called the “deadly quartet”, or, going by its more contemporary name, the metabolic syndrome.  

The metabolic syndrome is characterised by insulin problems related to type 2 diabetes.  

Regular physical activity. besides burning excess calories, also reduces insulin resistance while improving glucose uptake and cardiopulmonary fitness.

Other features include high blood pressure, high levels of fats in the blood, obesity (particularly in the abdominal area), the presence of protein in the urine (microalbuminuria), and an excessive tendency for the blood to coagulate. 

Insulin is a hormone that stimulates body cells to take up glucose from the blood so that it may be used as fuel. Certain individuals, however, tend to develop a condition called insulin resistance.  

Due to obesity, an inherited tendency or some other reason, their cells become insensitive to insulin. As a result, the circulating glucose is unable to enter the cells and begins accumulating in the blood, instead. 

The body recognises that this is not a healthy state and tries to compensate for the situation. It goes into overdrive and starts producing excessive amounts of insulin (a condition called hyperinsulinaemia). 

Persistent insulin resistance and hyperinsulinaemia indicate that the body is having increasing difficulties in regulating its blood glucose levels. In people with diabetes, this disability is permanent. 

Managing the metabolic syndrome 

Insulin resistance and the other features of the metabolic syndrome are associated with higher risk of cardiovascular disease. This is why people with diabetes are especially susceptible, with more than two-thirds of them dying from heart attack or stroke. They need to seriously focus on controlling their blood glucose levels tightly as well as reducing their risk of cardiovascular disease. 

People without diabetes or insulin-related problems can have other features of the metabolic syndrome (eg obesity, high fats in the blood and so on). They should also beware. These features need to be carefully managed as they often pave the way for the emergence of insulin-related problems which culminates in diabetes. 

Whether you have diabetes or not, here are some essential steps to help you stay ahead of the metabolic syndrome. 

·Calculate your body mass index (BMI)  

Divide your weight by your height squared (weight (kg) / height2 (m)). A BMI over 25 indicates an increased risk of medical hazards. 

·Calculate your waist-to-hip ratio (WHR) 

Abdominal obesity occurs when a lot of fat is deposited at your belly. The result is an “apple-shaped” body.  

It would be more accurate, however, to divide the circumference at the narrowest point of your waist, by the circumference at the widest point of your hips. Women with a WHR of over 0.8 and men with a WHR of over 1.0 are at risk of the metabolic syndrome. 

·Check your blood glucose level 

You could be suffering from high blood glucose and not know it.  

Between now and August 31, 2003, you can take a quick and easy finger-prick test for just RM1 each time at any Guardian, Apex, Vitacare and Caring pharmacy in the country.  

       You are advised to consult your doctor if your readings are over 6.0 mmol/L before food or over 7.0 mmol/L two hours after eating.  

This community service is part of the ‘Donate To Diabetes’ campaign initiated by the OneTouch Centre by LifeScan. Funds collected will be donated to the National Diabetes Institute (NADI), Malaysian Diabetes Association and the Malaysian Endocrine & Metabolic Society. 

·Go for your medical check-up 

People over the age of 35 (and younger adults who are obese, have a family history of chronic diseases or other risk factors) are encouraged to get a medical check up at least once a year.  

They should be tested for high blood pressure, high blood lipids (cholesterol and triglycerides), urine microalbumin, and blood glucose.  

It would be great to also take a stress test to assess the health of your heart. Poor results in any of the above areas may signal an underlying problem and require your doctor to run more thorough tests or prescribe the necessary treatments.  

·Eat right to trim down 

People should consume only as many calories (energy) as their activities and lifestyle require. A professional athlete would need more calories than, say, a desk clerk. Excess calories will just get turned into body fat.  

If your BMI and WHR are on the high side, you need to gain control over your calorie intake. Obviously, you should not overeat. Also, minimise fats and oils in your food. If you have a penchant for sugar, beware. Sugar supplies ‘empty calories’. It makes good sense to cut down or even cut out the added sugar in your food and drinks.  

·Get physical 

Regular physical activity, however mild or moderate, can provide significant benefits. It helps burn excess calories.  

Furthermore, it also reduces insulin resistance while improving glucose uptake and cardiopulmonary fitness. If you have been sedentary for a long time, it is best to check with your doctor before putting yourself on a fitness routine.  

When you do start, remember to begin gently and slowly raise your activity level as your stamina increases over time. As the saying goes, you have to walk before you can run. 

Fight Against Diabetes, an educational programme by the National Diabetes Institute (NADI), is supported by educational grants from EQUAL Sensicare Bureau and OneTouch Centre by LifeScan (a Johnson & Johnson Company). For a free copy of the NADI Diabetes educational newsletter, please contact Tel: (03) 5621 140. 

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