PAUL ZIMMET, Director of WHOs Collaborating Centre for Diabetes and the International Diabetes Institute in Australia said on 27-10-2005, “This is a Global Diabetes Tsunami” that will become the health crisis of 21st Century.” As per the report more than 400 million people will die globally due to Heart Disease and Diabetes. Why so many people will die globally? What is the reason? Whether it is due to the ineffectiveness of the modern medicines in dealing with degenerative diseases or due to the wrong life style? International Debate is required on this issue to
discover the cause of death.
If we look at the statistics, what is the percentage of diabetic population in India? It portends a very threatening and scary scenario. A few decades back it was a smouldering bush fire, now it is a raging inferno engulfing the whole nation. At present, India is having 35 to 40 million diabetics. This is expected to increase to 60 to 65 million by 2025,
this shows India is facing an economic devastation as a cost consequence of escalating diabetes epidemic.
Every one knows diabetes is a metabolic and vascular disease, where the carbohydrates, protein are deranged with serious effects (uncontrolled sugar for long duration), causing intensive morbidity and increased mortality. It is a typical example of unholy polygamy, which interferes and give birth to a number of complications. Each attendant complication cost lakhs of rupees because diabetic complications are ailments of long duration, slow progression due to repeated infections, and also frequent visits to the hospitals. It affects people’s earning very severely and pose a
serious economic burden, which is presently estimated to be Rs. 40,000 crores. This is expected to increase to Rs.1, 68,000 crores. By 2025, Further WHO and World Economic Forum predicted that chronic diseases bleed India to a tune of 236 Billion Dollars by 2015.
WHY is diabetes more in India? What is the reason? How to prevent it? If we could find correct solutions and implement them practically, we could reduce the diabetes by 50 to 60%. Our research scientists and doctors say Indians are genetically prone to diabetes. Can we accept it blindly? To what extent it is true? What relevance
it has got in the present context? I would like to give an example. According to the group of 85 researchers, lead by Chennai based diabetologist, V. Mohan, in a project funded by Bio-Technology, found that the single factor, the non performance of a particular gene – PPARGAMMA makes Indians more prone to diabetes. There might be an iota of truth in their findings. But diabetes may be in our genes. But most people won’t develop the disease, unless we allow it to do so. As seed germinates only if the soil is right. Genes express themselves if circumstances are favourable. It is believed that the Indians have a gene for starvation. For ages Indians were conditioned to starve, when there is affluence resulting in plenty to eat starvation genes goes cranky sending the feeble hearts and pancreatic glands into tailspin. At present, there is an outrageous evidence to say Indians are prone to diabetes due to diseased life style rather than genes, which ultimately harms our healthy genes and turning them against us.
AT PRESENT THERE IS AN OUTRAGEOUS EVIDENCE TO SAY INDIANS ARE PRONE TO DIABETES DUE TO DISEASED LIFE STYLE RATHER THAN GENES, WHICH ULTIMATELY HARMS OUR HEALTHY GENESAND TURNING THEM AGAINST US.
Wrong diet, impaired glucose tolerance, stress are the main reasons fordiabetes. How does wrong diet cause sugar? All the food is broken down into glucose, and then converted to other nutrients, like minerals, vitamins, amino and fatty acids, in proportion to the body requirements. This is a continuous process. This function can be hampered by
many factors, such as the build up of toxins caused by wrong diet, junk food and non-nutritional diet. Due to wrong diet body spends more time on digestion and does not focus on other functions like body building, repairs and fails to concentrate on protective and regulatary functions. Apart from this, body cannot cope with the food that cause toxicity and also excessive consumption of carbo hydrates like rice or milk results in the build up of mucous or gluten that cannot be eliminated easily and these toxins clog the normally porus cellular walls and suppress the sensors attached to them. Glucose cannot be absorbed by toxin coated cellular walls. This is one of the reasons, for more sugar.
Impaired Glucose Tolerance or a prediabetic condition is a pre-cursor to diabetes. It is also associated with metabolic syndrome (X) which includes obesity, high triglyceride, hypertension, higher level of C-reactive protein in blood due to the consumption of transfat (food items prepared from Vanaspathi and Dalda]. CRP is the concentration of protein in the blood serum produced in the liver. If it is high, it causes significant and serious lowering of high
density lipoprotein (HDL) good cholesterol, increase of low density lipoprotein (LDL) bad cholesterol, which causes insulin resistance. It affects body functions impair body metabolism in tissues, muscles, blood vessels, heart and pancreas, cause high incidence of diabetes and cardio vascular diseases among the age group of 30 plus individuals. 13 to 25% of urban adults are having higher percentage of C-reactive protein in their blood. Pre-diabetic conditions
like impaired glucose tolerance, impaired glucose fasting are being diagnosed at increasing frequency. If this trend continues, diabetes in India will increase by 59% compared to 41% in other Asian countries by 2025.
How The Stress Causes Diabetes?
In, Medical parlance stress is the body’s response to a situation or environment i.e., unwelcome, unwarranted and unplanned. Since the psychological stress can alter activities in the sympathetic nervous and adreno medullary system (supra renal glands situated at upper poles of both the kidneys) it increases the cortisol, adrenal hormone. It gives a strength to withstand the stress, though useful in the short term, these hormones are hazardous if allowed
to accumulate. Accumulation happens, when messages of threat or danger continues to be transmitted from the psyche for a long time, it enhances the secretion of glucagon and growth hormone and affects immune functions. Some biological pathways which are present could mediate a relationship between psycho social stress and diabetic onset. According to HINKLE and WOLF STUDY experiences of anxiety and tension were associated with decrease in glucose levels, whereas experiences of anger and resentment were associated with increase in glucose levels.
Diabetics experience a range of mood shifts with hyper glycemic (more sugar in the blood), hypoglycemic experience (less sugar). These can include periods of depression, elation or euphoria and irritability. Stress also causes obesity. When stressed the body releases a molecule NPY (Neuropeptide Y), which unlocks the body fat cells and makes them grow in both size and number, bodies having no rest secrete the increased amount of hormone called Ghrelin, which triggers sensation of hunger, make obese people to eat more because it reduces production of hormone Leptin in obese people which regulates appetite. According to the survey conducted by the AIIMS, 65to70% of the women, 50 to 55% of men in the cities are obese and apple shaped. since obesity is an independent risk factor for diabetes,
How can we expect this much of population to be free from diabetes? This has been evident from the statistics
that in children with obesity the prevalence of diabetes and impaired glucose tolerance is 37%, people with obesity have insulin resistance by more than 55% compared to those with normal weight and have hyperinsulinemia (increased insulin secretion by more than 40%]. For the first time in human history the number of over nourished people was equal to the number of under-nourished in the world that equals to 1.7 billion overweight people, meaning every fourth person on the planet is fat.
Three Stages in Treatment Plan
There are three stages, where prevention of diabetes is possible. Primary prevention, Secondary prevention and Tertiary prevention. Primary Prevention Is the prevention of disease from the beginning by resorting to healthy
lifestyle and exercise.
Three Stages in Treatment Plan There are three stages, where prevention of diabetes is possible. Primary prevention, Secondary prevention and Tertiary prevention. Primary Prevention Is the prevention of disease from the beginning by resorting to healthy lifestyle and exercise.
Is prevention of complications in diabetics who have not yet developed any complications. Successful diabetic
care depends on the harmonious partnership between the doctor, patient and the family members. Regular check-ups, medication, balanced diet, exercise and positive thinking plays a major role in keeping and controlling
the normal sugar level. With diet and exercise we can prevent 80% of the complications. Diabetics must take
balanced diet to get the required quantity of macro nutrients (carbohydrate proteins, fats) and micro nutrients
(minerals and vitamins) in right proportion and quantity and recommended dietary intake (individual
specific) is a must.
The meaning of recommended dietary intake from the nutrition point of view, is the amount of nutrient to be actually consumed in order to meet the requirement of the body that means the requirement of a particular nutrient is the minimum amount that needs to be consumed to prevent the symptoms of deficiency and also to maintain satisfactory levels of the nutrients in the body to prevent the diabetic complications. Diet For Diabetics Simple diet for diabetics, 50 to 55% of calories should come from carbohydrates, proteins, in the proportion of one gm per 1 Kg body weight, depending upon the kidney function. Complex carbohydrates like whole pulses and whole cereals and leafy and green vegetables is advisable to maintain the normal sugar level. How does walking will help to maintain
the normal sugar level? According to US National Institute of Health, exercising or walking (life long) reduces the risk of diabetic complications by 58%. Walking is an aerobic exercise that oxygenates our lungs, helps to take in more air. This increase intake of oxygen provides extra fuels to burn up food and release energy thus results in marked improvements in the vital efficiency of the lungs and entire cardiovascular system. All the organs, lungs, heart and joints strengthen with increased flow of blood- cell growth, blood circulation and digestion happening more efficiently. The net result is an increase in basal metabolic rate. Higher BMR means, we burn up calorie faster. This
helps in normalizing blood sugar.
Tertiary prevention (to prevent complications from worsening): This is a very difficult part of the treatment. It depends on the extent of damage to the organs like kidney, eye and lower limb and also to the nervous system. Insulin is the best remedy to prevent the complications. Insulin, which was discovered by Fredrick Bunting and Charles Best in 1921, since then it had saved millions of lives all over the world from the kidney, eye, heart and other organs from the damage. Modern medicines contribute immensely in the field of tertiary care, and saved millions of people especially in trauma, help in investigation and diagnosis to arrive at the mode of treatment to select. But
unfortunately, some times in tertiary care, drugs pushes the patient from fire to fire pit.
Majority of the patients fall under tertiary care are geriatric (elderly population). Lesser dosage of drugs is called for in many cases because altered pharmacokinetic and pharmacodynamics of (rate of destruction of drugs and removal from body). Most of the drugs are metabolized in the liver. With age the ability of the liver to degrade them diminishes and also there will be higher blood level of drugs due to reduced renal clearance and results in more toxicity, and which in turn reduce the alkaline, increases the acidic base and this activates freeradicals to attack tissues, cells and makes treatment ineffective. (Freeradicals are formed as by-products when oxygen is metabolized or burned by the body cells. When they start disrupting the structure of other molecules, it results in various health problems, as it causes general tissue deterioration, impair critical immune functions).
Hospital acquired infection is also a major cause of worry for critically ill patients. Serious infection among them
is ESBL (Extended Spectrum Beta Lactamase). It is an enzyme produced by bacteria like E-coli, Pseudomonas and Klebsiella, which are resistant to a large number of antibiotics, which therefore makes it difficult to treat infections. The enzyme was first isolated in Western Europe in mid 1980. Patients in ICU are at risk of being acquiring in procedures and intervention like the tubes in dialysis machines, ventilators and other medical equipments. As the indiscriminate use of anti-biotics results in the body acquiring high resistance, when a patient falls critically ill the body will not respond to anti-biotics commonly prescribed and result in serious complications. It’s incidence according to the study conducted by the Pharmaceutical Co., ASTRA ZENECA is between 59-68% compared to 15-
20% in Western countries.
S.B. Levy, writing in the NewEngland Journal of Medicine, says bacterial resistance to antibiotics is “a
major obstacle to the treatment of infectious disease, leading not only to treatment failures but also to increased costs. Who is going to compensate for treatment failures and increased cost incurred on repeated medications and surgeries? In India out of 700,000 formulations only 25 – 30% are actually proven, authentic and rational. If we
study each medicine in terms of cure and side effects, many drugs are found to be toxic, and redundant (useless).
In this context, Dr. Oliver Weldell Holmes wittily said: “If all the drugs in the world were dumped into the sea, it would be better for mankind and worse for the fishes.” If tertiary care would have been effective, why diabetic patients are 5 times more prone to heart attacks and 20 times more likely to develop kidney disease. 25 times more to vision loss, why lower limb is lost to diabetes every 30 seconds all over the world?
What we do when we are well, largely determines our continued well being and also how we respond to the treatment when we are ill. A scientific data is saying more clearly. “It is what we do hour by hour, day by day that determines the state of our health.” If there is cure for diabetes it is primary awareness. Diabetic who know most
live longest, because in this disease 50 to 70% of treatement lies with the patients by taking more responsibility
for their health. Finally I would like to conclude by quoting a saying from “Sumari Text” “Honour your body which is your representative in this universe. Its magnificence is no accident. It is the frame work through which your works must come, through which the spirit and the spirit within the spirit speaks, the flesh and the spirit are two phases of your actuality in space and time. Who ignores one, falls apart in shambles.”