Docmednews. Health News and Information » Diabetes

EXPLOSION OF DIABETES: A MAJOR PUBLIC HEALTH PROBLEM HOW & WHY?

admin — Sat, 14 May 2011 13:55:10 +0000

During the past century, there have been marked changes in the disease profile in the developed and developing countries. The noncommunicable diseases like diabetes, hypertension and heart disease have replaced the infectious diseases and are posing a major cause of morbidity and mortality.

The WHO study linked data from WHO developed global database on diabetes with UN demographic projections in order to estimate the number of people with diabetes in all countries of the world at 3 points in time – 1995, 1000 and 2025.

Introduction: According to the study by WHO, between 1995 and 2025, the number of people with diabetes in INDIA is projected to rise from 19 to 57 million, i,e. an increase of 195%, indicating global burden of diabetes.

In the developed countries the 1995 figure of 51 million diabetics is expected to rise to 72 million by 2025 (42% increase). By 2025, the developing countries v/ill be home to 76% of all persons with diabetes as compared with 62% in 1995.

Worldwise, 122% rise is projected from the total of 135 to 300 million. That is more than 2 fold global increase will occur because of population gain and growth, as well as from obesity, unhealthy diets and sedentary life style. These later factors are closely associated with urbanization and industrialization.

The 3 top countries with diabetes in 2025 are India (57 million ), followed by China (38 million) and the USA (22 millions).

*12\329\8*

TYPE 2 DIABETES AND AGING

admin — Fri, 06 May 2011 13:54:11 +0000

Prevalence of type 2 diabetes increases with aging. Harris found in 1990 that by the age of 65 years, 18% of the U.S. population has been diagnosed with diabetes. Some suggest that the increased prevalence of type 2 diabetes with aging is due to “aging genes.” In fact, 91 % of cases of type 2 diabetes are associated with environmental factors, and most can be prevented by a physically active lifestyle.

Seals et al studied glucose tolerance in athletes and sedentary men. Master’s athletes (60 years old) who averaged 8 miles/day of running did not have the age-associated higher rise in postprandial blood glucose and insulin. Moreover, the post-meal rise in blood insulin was half that occurring in the young, untrained men. Young, untrained subjects were able to maintain normal blood glucose levels in an oral glucose tolerance test by the pancreas compensating with a higher secretion of insulin. Increased postprandial rises in blood glucose and insulin in the “old, untrained, and lean” are called insulin resistance or the “pre-diabetic” state.

Thus, the insulin sensitivity of old Master’s athletes was higher than untrained young and old subjects. Old Master’s athletes had no insulin resistance, i.e., their physical activity levels were sufficient to totally prevent the so-called aging-associated increase in type 2 diabetes. The conclusion may be drawn that physical activity can delay/prevent the “age-related” onset of type 2 diabetes!

*9/282/5*

SCOPE AND IMPACT OF DIABETES IN THE U.S.:MORTALITY

admin — Tue, 22 Feb 2011 11:51:00 +0000

A representative cohort of 14,374 adults (aged 25-74) was identified in NHANES I in 1971-1975 and followed for 22 years. Death certificates were examined to determine cause of death in diabetic and nondiabetic subjects. Diabetes accounted for 5.1 % of the cohort but 10.6% of the deaths. Age-adjusted mortality rates were 57% higher in diabetic men than in women and 27% higher in African Americans than Caucasians with diabetes. Mortality was highest for insulin-treated patients and those with diabetes for 15 years or longer. Heart disease was listed most frequently—on 69.5% of the death certificates for people with diabetes. The excessive mortality, however, was not completely explained by differences in risk factors for heart disease. A twofold excessive risk can be attributed to other factors operative in the diabetic state. Similar findings were reported by Stamler in a 12-year analysis of diabetic men in the Multiple Risk Factor Intervention Trial (MRFIT).
Thus, despite underreporting of diabetes as a contributing factor on death certificates, mortality rates are substantially higher in people with diabetes compared with nondiabetics. Rates are higher in men than in women and in African Americans than in Caucasians. Life expectancy is markedly diminished. The majority of deaths are related to heart disease, suggesting that increased attention to management of cardiovascular risk factors can decrease the mortality rate and increase life expectancy for people with diabetes. These predictions are now strongly supported by prospective randomized trials directed at management of a variety of cardiovascular risk markers, including hypertension, dys-lipidemia, albuminuria, nephropathy, and the prothrombotic tendency that often occurs in diabetes.
*13\357\8*

CHRONOLOGY OF LANDMARKS IN DIABETES MELLITUS (HISTORY)

admin — Tue, 15 Feb 2011 11:49:34 +0000

Diabetes was described more than 2000 years ago in Egypt and in an ancient Indian Ayurveda by Indian physician Sushruta. For the past 200 years, it has featured in the history of modern medicine. After the dicovery of Insulin, work on diabetes at both cellular and clinical levels has expanded. Newer insulins, modern insulin delivery systems and home blood glucose monitoring systems have revolutionised the management of diabetic patients.
This chapter provides an overview of the chronologically important land marks in Diabetes.
HISTORICAL LANDMARKS IN DIABETES:
1500 B.C. : Egyptian Ebers Papyrus first described an illness associated with the passage of excess urine, found in tomb at Thebes.
500 B.C. : Diabetes was described in the Indian Ayurvedic literature as ‘Madhumeha’ or honey urine or sweet urine. For diagnosis testing of urine was the standard method up to 19th century.
2nd Century A.D.: ARETAEUS of Cappadocia gave the name Diabetes (‘a passer through’).
3rd Century A.D.: Scholars from China and Japan wrote about a condition associated with polyuria where the urine was sweet and sticky.
1647 : THOMAS WILLIS rediscovers the sweetness of urine and the name Mellitus (honey) was established.
1776 : MATHEW DOBSON of Manchester demonstrated that sweetness in urine was due to sugar.
1869 : PAUL LANGERHANS, a German scientist described islets of cells scattered throughout the pancreas. We know now these islands or islets consist of the insulin producing cells. At the end of his description Paul Langerhans wrote, “I admit frankly that I am not able to explain the nature and function of these cells”.
*1\329\8*

DIABETES AS DIGESTION-RELATED DISORDER

admin — Tue, 08 Feb 2011 11:48:04 +0000

In healthy people, the pancreas, a powerful enzyme-producing organ, produces the hormone insulin in sufficient quantities to allow the body to use or store glucose (blood sugar). When this organ fails to produce enough insulin to regulate sugar metabolism or when the body fails to use insulin effectively, a disease known as diabetes mellitus occurs. Diabetics exhibit hyperglycemia, or elevated blood sugar levels, and high glucose levels in their urine. Other symptoms include excessive thirst, frequent urination, hunger, tendency to tire easily, wounds that heal slowly, numbness or tingling in the extremities, changes in vision, skin eruptions, and, in women, a tendency toward vaginal yeast infections. Each year an average of 650,000 new cases are identified, with rapidly rising incidence rates in recent decades. Diabetes mellitus is among the leading causes of death in America and is a major contributor to cardiovascular disease (CVD), blindness, and renal failure. A recent CDC study indicated an alarming increase in diabetes cases, with an overall increase in prevalence in diagnosed cases of 4.9 percent in 1990 to 6.5 percent in 1998. Of grave concern was the fact that for people in their 40s, diabetes cases increased by 40 percent during the eight-year study. However, diabetes cases increased by over 70 percent for those in their 30s.
Of the estimated 16 million people with diabetes in the United States today, nearly 6 million are unaware that they have a problem. Many remain ignorant of their condition until they begin to show overt symptoms. How does a person become diabetic? The more serious form, known as type I (insulin-dependent) diabetes, is an autoimmune disease in which the immune system destroys the insulin-making beta cells, and it usually begins early in life. Type I diabetics typically must depend on insulin injections or oral medications for the rest of their lives because insulin is not present in their bodies. Adult-onset (non-insulin-dependent), or type II diabetes, in which insulin production is deficient or the body resists or is unable to utilize available insulin, tends to develop in later life. People with this form of diabetes can often control the symptoms of their disease with minimal medical intervention by maintaining a regimen of proper diet, weight control and exercise. They may be able to avoid oral medications or insulin indefinitely. A third type of diabetes, called gestational diabetes, can develop in a woman during pregnancy. The condition usually disappears after childbirth, but it does leave the woman at greater risk of developing type II diabetes at some point.
*1/277/5*

THE G.I. FACTOR: WHAT GIVES ONE FOOD A HIGH G.I. FACTOR AND ANOTHER FOOD A LOW ONE?

admin — Fri, 08 May 2009 13:47:29 +0000

Scientists have been studying what makes one food high and another low for more than fifteen years. There is a wealth of information that can easily confuse. We have summarised the results of their research in the following table which looks at the factors which influence the G.I. factor of a food.

The key message is that the physical state of the starch in the food is by far the most important factor influencing the G.I. value. That’s why the advances in food processing over the past two hundred years have had such a profound effect on the overall G.I. factor of the food we eat.

The degree of starch gelatinization. The starch in raw food is stored in hard compact granules that make it difficult to digest. This is why potatoes might give you a pain in the stomach if you eat them raw.

Most starchy foods need to be cooked for this reason. During cooking, water and heat expand the starch granules to different degrees, some granules actually bursting and freeing the individual starch molecules. This is what happens when you make a gravy by heating flour and water until the starch granules burst and the gravy thickens.

If most of the starch granules present have swollen and burst during cooking, the starch is said to be fully gelatinised.

The swollen granules and free starch molecules are very easy to digest because the starch-digesting enzymes in the small intestine have a greater surface area to attack. The quick action of the enzymes results in a rapid and high blood sugar rise after consumption of the food (remember that starch is a string of glucose molecules). A food containing starch which is fully gelatinised will therefore have a very high G.I. factor.

In foods such as biscuits, the presence of sugar and fat and very little water, makes starch gelatinisation more difficult, and only about half of the granules will be fully gelatinised. For this reason, biscuits tend to have intermediate G.I. factors.

*78\33\4*

DIABETES IN CHILDREN AND YOUNG PEOPLE: QUESTIONS ABOUT ILLNESSES AND EDUCATION

admin — Tue, 28 Apr 2009 08:57:26 +0000

I have heard that common childhood infections can be more dangerous for children with diabetes. Is this so?

No. It is probable that your child will have the usual childhood infections, and that he will become sick in the same way as other children. The main problem that you may encounter is the need to adjust the insulin dose during infection; usually a child’s insulin requirement increases when he is sick. Your doctor will tell you how to do this, and you will be guided by the blood glucose and urine ketones. Be sure to adjust the insulin dose back towards its previous level as soon as the illness is over and the blood tests are normal.

Also during an illness it is likely your child may lose his appetite. It will then be necessary to replace his ordinary meals with emergency fluids and other replacements for the carbohydrate part of his diet. You should consult the dietary section for details.

I want my child to have as good an education as possible, but he wants to leave school early and start earning. Should the fact that he has diabetes influence his decision?

It is always hard to generalize on such an important subject as a career or life occupation for a child. However we should realize that in the long run training and skills gained from education can lead to more interesting and better paid jobs with greater security. A child who is tempted to leave school because he is impatient to be earning may find he is worse off as an adult because of lack of education for advancement and promotion. Having diabetes may make the problem more difficult as he may require time off for illnesses as he gets older; security in one’s occupation is important for a person with diabetes in later life. Certainly skills may be learnt on the job and leaving school to become apprenticed may well be the correct decision for your child. Having diabetes should not affect this.

At all events it is wise to discuss the very important business of employment very fully with your child and perhaps discuss it with his schoolteacher and with his doctor. Sometimes it is helpful to have an interview with a vocational guidance officer who will assess both your child’s abilities and his inclinations. He can then make recommendations and suggestions about the type of work for which he is most likely to be suited, and the best way to become trained for it.

*85/54/5*