In 2007 a Canadian group declared that Saint Lucia had the highest per capita incidence of diabetes in the world. Official figures from the World Bank state that in 2016 14.6 per cent of the population had diabetes; the figure dropped to 11.6 per cent in 2017. However we are still a lot higher than the United States at 10.8 per cent, Canada at 7.4 per cent and the United Kingdom at 4.3 per cent. Changes in diet and lifestyle may have played a part in this steady decline but what exactly is diabetes?
Diabetes Mellitus (DM) is a metabolic disorder where the body is unable to control sugar (glucose) levels in the blood, either due to poor sensitivity to the protein insulin or poor production of insulin by the pancreas. Glucose comes from either our food or from the liver, where it is stored as glycogen, which is converted to glucose when blood sugar levels are low and we have not eaten for a while. Glucose is an essential source of energy used by muscles and it is also the main source of fuel for brain function. There are three types of DM, the first one is irreversible but the second two are classed as reversible, although it may take a lot of effort and discipline.
Type 1 DM, also known as insulin dependent diabetes mellitus (IDDM), is a chronic disorder where blood sugar is high (hyperglycemia), with disruption of the metabolism of carbohydrates, fats and proteins. High blood sugar is normally controlled by insulin. In this condition the pancreas produces little or no insulin at all. It tends to have a rapid onset and predominately affects children and adults under 30 years of age.
Type 2 DM usually occurs in adults and is known as non-insulin dependent diabetes mellitus (NIDDM). It can usually be controlled with diet and medication. Unlike Type 1 DM, the body does produce enough insulin. The problem is with the liver, fat and muscle cells which respond differently to insulin. This causes a build-up of sugar in the blood.
Gestational diabetes occurs during pregnancy. There may be no sign of diabetes before the pregnancy and, in most cases, it disappears after giving birth. High blood sugar levels can be a risk to both mother’s and baby’s health but by adopting a healthy lifestyle, eating nutritional foods and exercising, blood sugar spikes can be controlled. If diet and exercise alone are not effective then medication may be prescribed. Although it disappears after birth it can increase the risk of developing Type 2 DM.
There are known risk factors for developing DM. Some are present across all three types but some are unique: Type 1 DM – family history, pancreatic disease, infection or illness which can affect the pancreas.
Type 2 DM – obesity, sedentary lifestyle, impaired glucose intolerance, high blood pressure, abnormal cholesterol and triglyceride levels, gestational diabetes, ethnicity, age, family history, polycystic ovaries.
Gestational diabetes – obesity, glucose intolerance, ethnicity, family history, age. The symptoms of pre-diabetes and Type 2 DM are not always obvious and Type 1 DM may initially go unnoticed, but over a short period the loss of body weight, despite an increased appetite, raises the alarm. There are also other obvious signs like an unquenchable thirst and increased frequency of urination, although the increased trips to the bathroom are usually seen as the result of the increased fluid intake.
There are other symptoms that become more noticeable and it is these that often prompt a visit to the doctor. The most obvious are tiredness, a feeling of weakness, being easily irritated, blurred vision and numbness or tingling in the hands and feet. As the symptoms of DM are not always obvious, regular blood screening should take place in those who have high risk factors. If DM is suspected, then there several tests that can be carried out to confirm a diagnosis such as fasting plasma glucose test, an oral glucose tolerance test or a random plasma glucose test. Complications of DM are not immediate and develop slowly over a period of time. The most common cause of complications is uncontrolled blood sugar levels which increases the risk of:
• Cardiovascular diseases such as angina, heart attack and stroke.
• Nerve damage caused by damage to capillary walls, the small blood vessels that nourish the nerves. Symptoms include tingling, burning or pain which can start in the tips of the fingers and toes and spread upwards. But it isn’t only the limbs that are affected; it is also possible to experience damage to the nerves of the digestive system, causing nausea, vomiting, diarrhoea or constipation. It has even been known to cause erectile dysfunction in men.
• Eye problems such as glaucoma and cataracts are another regularly seen complication. If there is damage to the blood vessels of the retina, it can lead to blindness.
• Kidney damage which can progress to irreversible kidney failure.
• The need for lower limb amputation is another complication caused by infections. Poor circulation, decreased sensation, a higher risk of bacterial and fungal infection coupled with poor healing can increase the risk of losing a limb. All diabetics are therefore encouraged to practise good foot care.
Prevention is always better than cure and although Type 1 DM cannot be prevented, there are steps you can take to reduce the risk of developing gestational and Type 2 DM. Choose a healthy diet that is low in fat and high in fibre. Exercise for at least 30 minutes a day; it can be something as simple as a brisk walk or a swim. Keep your weight down; being overweight is one of the common risk factors for all three types of DM. Lastly, but importantly, manage your blood pressure. High blood pressure is a silent killer and not only a risk factor for DM.
Follow these steps to happier, healthier life.
