Sunday, April 09, 2006

Diabetes and Heart disease Part 2

Part 1 on Diabetes and heart disease can be found here.

Complications of diabetes.

The saying is true, that no one actually dies from diabetes itself anymore. The pre-insulin days, where patients were wasting away from severe high blood sugar and diabetic coma, is nowadays a rarity, with the advent of insulin. That’s why I guess, Dr Banting and Best won the Nobel prize for Physiology in 1925.

Patients with diabetes nowadays, develop kidney, eyes, brain and nerves, and heart and blood vessels complications. In fact all the diabetic complications are blood vessel related. Small blood vessel damage, cause eye problems, and kidney disease and kidney failure and nerve damage. Bigger blood vessel damage causes strokes, CAD with heart attacks and poor limb circulation resulting in possible amputation for some. Eventually diabetes translates to cardiac and vascular disorders as blood vessel wall become thickened and clogged up with sluggish circulation and damaged blood vessel wall cells.

Main target organs can become damaged, resulting in complications like kidney failure and renal dialysis, blindness, stroke, heart attack, angina attacks, angioplasties, bypass surgery, limb gangrene, poor healing wounds and limb amputations. What is also important to emphasize is that once you are afflicted with diabetes, your risk for every medical illness and operation becomes worse. Even common cough and colds take longer to recover in diabetics, and is more likely to be complicated. The BBC recently reported that obese people suffer more complications following motor vehicle accidents. It is as if diabetes weakens your whole body. All cardiac procedures carry a higher risk of complications and the outcome tend to be worse, in the short and long term, be it angioplasties, or bypass surgery. Of course, with our current understanding, we have learn to handle all these problems better, thereby making them safe even for diabetics.

Management of Diabetes

For those who are already diabetic, please know that your live is in your hands. Proper treatment by qualified medical practitioners, can do much to delay or even avoid complications. A careless attitude and non-compliance with medical treatment, invariably results in worse outcome and target organ failure.

The drugs for the insulin deficient type of diabetes, is a little different from the drugs use for the obesity, potbelly type of diabetes. There are very good drugs for both types as our understanding of the disease has improved tremendously. We have drugs that will help the pancreas to produce more insulin like the sulphonyl ureas, and insulin injections (for the insulin deficient kind) and drugs that sensitize the cells and tissue to insulin, like the biguanides and "glitazones" (for the insulin resistant kind). Soon we will have nasal spray insulin for easier administration. There is also an anti-obesity drug about to be launch, that promises to make the subject lose weight and lessen the risk of heart disease, acting through a new body system call the Endocanabinoid system. Interesting. Help for the potbellys is on the way.

Prevention is better than cure

Drug treatment for diabetes, though good, is not the best strategy, both for the patient and for the nation. It is much, much better that diabetes, especially the obese, potbelly type, be prevented. Potbelly is invariably the result of eating the wrong food and a sedentary lifestyle. We love junk food. Fast food, almost synonymous with junk food, is springing up all over the place. The French fries, are many a childrens’ regular diet. Add to it salt and a sugar rich carbonated drink, you have the classical diabetic, hypertensive diet. The promotions of course, draws the children and with them, the whole family.

This is the age of computerization and remote control. We want instant gratification, without ever having to move from our seat. We do not exercise enough. We love the elevators, even to go up 1-2 floors, or worse yet DOWN 1-2 floors, rather than use the staircase. Cycling to work, has been suggested, well let us see how many will follow.

Prevention then is relatively easy but involves sacrifice. Promoting a low salt diet (3 gms a day), with avoidance of carbonated drink would be a good start. Fruits and vegetables are healthy and should be encouraged. White meat is preferred. Except for service lifts, and lifts for the handicap and infirmed, lifts should go to every third floor. Remote controls for TVs and radios should be banned. Regularly walking 15 km a week. Regular check ups. All males above 40yrs and all females above 50 yrs should go for a medical checkup and screening. Maintaining a waistline of 34 inches (100 cm) or less and a hip to waist ratio of 0.9, and a BMI of 23-24 . Those are the targets.

Need I say more? I am sure you get the message. There is a cost to stay healthy in terms of lifestyle change but the dividends exist. As the saying goes, "Health is Wealth".

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