Diabetes – sweet surrender


  • Health
  • Sunday, 04 Apr 2004

By Dr HEW FEN LEE

A FEW years ago, Time magazine ran a report on the global diabetes epidemic. One of the leading authorities on diabetes, Prof Paul Zimmet, said that as AIDS posed a major health problem in the latter part of 20th century, so is diabetes in the early part of the 21st century.  

This has turned out to be quite prophetic. The incidence of diabetes in Malaysia has increased from 6.3% in 1986 to 8.3% in 1996. This is a staggering increase within a short space of time. In fact, 50% of the people suffering from diabetes are going to come from Asia by 2010, a short six years from now. Why is there a global epidemic and what can we do about it? 

Peter (not his real name) is 18 years old. He has just started going to college with the ambition to be an engineer just like his father. He has always been overweight and his favourite past time, like most of his peers, is playing computer games. In fact he is quite a competent exponent of it, earning him the nickname “The Sumo Ninja” among his friends.  

Sumo is a description of his size. He does not mind that although he has always wanted to look a bit slimmer. During his SPM exam last year, he started to lose weight and began to feel tired and lethargic. He put it down to stress from exams. He was concerned about his frequent urination but he always had a tendency to drink a lot of water and soft drinks when he buried himself in his books.  

His parents were getting quite concerned after he lost almost 10 kg. Secretly, Peter was pleased about the whole thing. But a visit to the doctor immediately after the SPM exam confirmed the parents’ worst fear. Peter has diabetes!  

Peter is but one of the many examples of patients that many doctors see today. Not only are there more and more people with diabetes, there is also a tendency for newly diagnosed patients to be younger.  

Peter was not the youngest patient in the clinic either as he sat waiting for his turn to see the doctor. Fortunately, optimal diabetic control was quickly achieved with adjustment of his diet and his lifestyle. His staple diet was fast food and he needed a major adjustment to his diet. In fact there was a major change in the whole family’s lifestyle. Both his parents were and still are working and they ate out most of the time. Now, Peter’s mother is making an effort to prepare meals at home after work.  

For Peter, initially the most difficult thing was exercise. He had never been keen on exercise. Now he jogs for half an hour a day. He is beginning to get used to his new lifestyle, he is certainly lighter and fitter and he claims to be more energetic than before. He declared proudly to his doctor that he had his first date with a girl from his class last weekend.  

Is diabetes a death sentence? 

It is well known that diabetes can give rise to a variety of complications. Risk of heart attack and stroke is increased by more than two to three times. The feet may be affected and they may develop ulcers or gangrene, requiring hospital admissions and sometimes even amputation as a last resort when the ulcer becomes worse.  

It is also the most common cause of permanent blindness and kidney failure necessitating renal dialysis. Furthermore, more than half of the middle-aged men who have diabetes may suffer from erectile dysfunction.  

Thus, the complications of diabetes not only reduce life expectancy, but they also reduce the quality of life in many patients. Furthermore, there is also the additional burden, both social as well as economical, placed on the family in terms of providing care and medical therapy needed to treat the patients.  

There is also a wider ramification for the community as well as the whole nation. Given that there will be an increase in medical and nursing expenditure, coupled with a reduced income in the case of the patients and the family from loss of work, this means increased spending and reduced income on the part of the government as well.  

All the complications of diabetes mentioned above can be prevented. Good diabetic control, as well as lowering high blood pressure and high cholesterol levels, is the mainstay of prevention of complications. Regular check ups and monitoring with an endocrinologist or physician would help to troubleshoot problem(s) and not only treat them effectively as they arise, but more importantly, prevent these complications. Thus, diabetes is only a death sentence if we allow it to be.  

Lifestyle 

One of the reasons for the increase in the incidence of diabetes is the major alteration of lifestyle in less than one generation. Malaysia has progressed economically, and with that comes many social changes. Urbanisation with its ensuing lifestyle changes result in less physical activity and this is said to be one of the major causes for the exponential growth in diabetes. “Cocacolonisation” and “Ninetendonisation” are the terms coined to describe the fast food culture and the computer games culture prevalent among our youth. Thus the management as well as the prevention of diabetes demand major adjustments in lifestyle, not just in diet but also in terms of physical activity.  

As demonstrated in Peter’s case, diet and exercise play a major role in controlling diabetes. Can it also prevent diabetes? One study from the US has shown that 150 minutes of exercise a week reduced the risk of developing diabetes by a staggering 59% over a three-year period in a group of high risk individuals. This study, as well as many others from China, Europe and the US, has demonstrated that appropriate dieting and consistent exercise produce significant and encouraging protection against diabetes.  

There are also other studies which have shown that certain drugs can also prevent diabetes, and this is particularly so in those obese or overweight individuals who lose weight. Nevertheless, the degree of protection is still less than what was shown with diet and exercise. 

We need not advocate reversing economical progress to prevent diabetes, but we need positive efforts to address this problem which threatens to drain resources as well as impact negatively on individuals and families.  

The current school system places a lot of emphasis on academic performance, and so it should. However, it should not ignore the holistic development of our children. Many schools regard physical education (PE) classes as only a compulsory subject that give the pupils a break at best and at worst, many conscientious teachers see it at as an extra class where they can give supplementary lessons on other subjects.  

PE classes should be used to encourage the development of various sports and to inculcate the culture of sports in our younger generation. Sports should be seen as fun and healthy. To encourage excellence in sports is commendable, but we need to raise the base so that the peak of the pyramid can be elevated to a higher level. 

Many of the urban and suburban housing schemes are of very high density, depriving the residents of space and facilities for recreation. Sporting facilities are even more lacking. The government should look into the future development of townships and housing schemes to make sure these facilities are not only available but within easy reach of the community. There may be other concerns too, for example security and crime around certain parks, traffic flow and so on. This would encourage better usage, and hopefully in the long term a healthier, fitter community and population. 

At the end of the day, there needs to be a desire to implement the lifestyle changes at individual levels. Peter’s case has clearly demonstrated that. Healthy eating and regular exercise, coupled with cessation of smoking will not only control diabetes and reduce the risk of developing diabetes, but also reduce the risk of heart disease, which is presently the single largest cause of death in Malaysia. Together, we as individuals with the community and favourable government policies can work towards a healthier lifestyle and a better quality of life. 

  • This article is contributed by The Star Health & Ageing Panel, a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.  

    The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr PhilipPoi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Sarinah Low, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Keith Lim, consultant rheumatologist; Dr Ting Hoon Chin, consultant dermatologist.  

    The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. 

    The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. 

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