DIABETES is a complicated disease. It has all the makings of a chicken-egg conundrum. Does diabetes, for instance, cause obesity and high blood pressure, or vice versa?
The “metabolic syndrome” allows us to sidestep this question. To put it simply, a person has this syndrome when all the following conditions are present: obesity, hypertension, low levels of HDL (good cholesterol), and high levels of triglyceride (bad cholesterol).
This syndrome is also characterised by insulin (a hormone that is produced in the pancreas) problems faced by diabetics.
Basically, the metabolic syndrome is a reference that relates one of the above conditions to the others, and shows that each increases the risk of the others occurring. It shows the broader picture of accumulated risk factors, instead of dwelling on whether the chicken or egg comes first.
Above all, it shows a clear link between these factors and cardiovascular diseases.
“Diabetes is derived from a Greek word that carries the meaning “sugar in urine”. It is a complex condition that can cause damage to the eyes, kidneys, blood-circulation and the heart.
“To put it simply, diabetes is related to a host of complications (the metabolic syndrome) which adds to the risk of serious diseases such as heart attacks,” says professor of medicine, Datuk Dr Khalid Abdul Kadir.
But before examining the links between diabetes and cardiovascular diseases, we have to look at the nature of diabetes. There are basically two forms of diabetes.
“Type 1 diabetes mellitus (previously called insulin-dependent diabetes or juvenile-onset diabetes) develops when the body’s immune system destroys the pancreatic beta cells that produce the insulin needed to regulate blood glucose. It usually emerges in children and accounts for 5% to 10% of all diagnosed cases. Possible causes for Type1 diabetes include autoimmune, genetic, and environmental factors.
“In Type 2 diabetes, however, the body still produces insulin but fails to use it effectively to convert glucose into energy. This condition is also known as insulin resistance and is one of the features of the metabolic syndrome. It accounts for 90% to 95% of all cases.
“If left untreated, both Type 1 and Type 2 diabetes become progressively worse and can lead to complications. However, Type 1 diabetes is generally discovered early because the typical symptoms (such as excessive thirst and passing of urine) are usually pronounced. In contrast, there are few outward signs and symptoms during the early stages of Type 2 diabetes, which means that diagnosis is often not made until the later stages, when the complications of the disease have started to develop,” explains Dr Khalid.
How though does one live with this condition?
“At the moment, there is no cure for diabetes. However, the condition can be controlled through a combination of medication and lifestyle management. For Type 1 patients, daily insulin injections are needed. Type 2 diabetics – depending on the severity of the disease – can sometimes be managed by diet and exercise alone; by diet, exercise and oral therapy (tablets); or by diet, exercise and insulin injections. In many cases, insulin is used in combination with oral therapies to help people with diabetes achieve treatment goals,” continues Dr Khalid.
It is also important to note that Type 2 diabetes can be prevented if people are aware of the risk factors causing it. And the prevalence of diabetes in developing countries show how diabetes and the metabolic syndrome are interrelated, that they are a symptom of modern and hectic lifestyles.
“Statistics have shown that diabetes is rising in developing countries such as Malaysia, Singapore and China. Obesity too is on the rise in these countries due to overindulgence in food and other vices as well as living a sedentary lifestyle. Thus we see a link between affluence and diabetes – as stress increases and obesity rises, the risk of diabetes and other complications increases. This is so as obesity can cause cells to become insensitive to insulin. On the other hand, insulin resistance could also cause an increase of visceral fats leading to obesity.
“And it looks now as though diabetes could reach epidemic proportions. In Malaysia about 10% of the population has this condition. What is more worrying is that studies have now shown a definite link between cardiovascular diseases and the rise in blood sugar level.
“A diabetic who has never had a heart attack before has a 20.2% chance of getting one as opposed to a 3.5% in a non-diabetic person – as shown in one of the studies. On the other hand, if both of them have had a heart attack before, the chances of the diabetic suffering another one is 45% as opposed to 18.8% for the non-diabetic. From here, we can clearly see that the chances of a diabetic getting a first heart attack is even higher than a non-diabetic’s chances of a relapse,” continues Dr Khalid.
How can one manage diabetes and the metabolic syndrome?
Well, studies have indicated that lifestyle changes are highly effective in preventing and managing Type 2 diabetes. In fact, scientists at the Diabetes Prevention Programme in the US have found that high-risk individuals who changed their diet, weight and exercise habits had the greatest success, lowering their incidence of diabetes by 58% when compared to individuals who did nothing.
“Diabetes management depends largely on satisfactory blood glucose control. The self-care plan is all about achieving and maintaining good control of the condition while continuing to live as normal a life as possible. It should be everyone’s aim to keep his/her readings below 6.1 mmol/L (before food), and 7.8 mmol/L (after meals),” says Dr Khalid.
Once, many people believed that diabetes was just a little harmless sugar in the blood. But we know that if left unmanaged, this little sugar could lead to loss of sight, limbs and a host of other metabolic complications, as well as increased risk of heart attacks.
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