A Spoonful of Sugar
Issue 4 Mar / Apr 2004
According to Dr Shuja Shafi, chair of the Muslim Council of Britain's Health and medical committee, people of South Asian origin, many of whom are Muslims are five times more likely to develop diabetes compared with the general UK population. For every diagnosed diabetic there are several not yet diagnosed.
Words: Adeeba Ahmed BA(Hons), MB BChir, MA(Camb), MRCP is Specialist Registrar in Endocrinology, Diabetes and General Internal Medicine at Central Middlesex Hospital, London.
Diabetes is advancing through the world’s population at a ferocious speed and projections show by 2010 it may affect 250 million people – doubling the number of reported cases in little more than 10 years. Unless kept under control, diabetes cancause serious health complications but meticulous treatment keeping the blood sugar level in a strictly normal range can greatly reduce adverse effects.
What is Diabetes?
Diabetes is a condition in which the body loses its capacity to manage its fuel and energy resources. The energy every cell needs in order to function reaches it in the form of sugar (glucose). Most foods contain carbohydrates and proteins which are broken down by the liver to release glucose. This then travels through the bloodstream to the cells that need it. But cells aren’t able to take up glucose without the help of insulin, a hormone secreted by the pancreas gland which lies at the back of the stomach. The insulin molecules stick to the outer membrane of a cell and alter its structure to allow glucose to penetrate it. Normally the pancreas releases a surge of insulin after a meal, enabling glucose to enter any cell in the body. Diabetes has been described as ‘starvation in the midst of plenty’, since the body is unable to use the glucose circulating in the blood to make energy. This may be due to a complete absence of insulin (Type 1 diabetes) or a relative deficiency of insulin (Type 2 diabetes). Some people with type 2 diabetes are resistant to the effects of insulin.
Types of Diabetes
Type 1 diabetes is also known as juvenile-onset or insulin-dependant diabetes. It frequently affects young people and children and can cause dramatic symptoms from vomiting to diabetic coma. Type 1 occurs when the body’s immune system destroys the insulin-producing beta cells in the pancreas, depriving the body of insulin. It is treated by insulin injections. Very little is known about the causes of Type 1 diabetes. There is some evidence that it may be caused by a virus and suspicion has also fallen on cow’s milk which is thought could trigger an immune reaction and damage the pancreas. Breast-feeding is recommended.
Type 2 diabetes is on the increase and already accounts for nine out of 10 incidences of diabetes. It occurs when the pancreas continues to make insulin, but not enough insulin is made to absorb all the circulating sugar. The problem gets worse as the person becomes more overweight. Often the body’s cells become resistant to the insulin and can’t absorb glucose. This leads to high blood-sugar levels. The causes ofType 2 are better understood and can be attributed to a sedentary lifestyle – obesity and diabetes are closely linked so make sure you don’t add too much ghee to your food. Heredity also plays an important part.
Managing Your Diabetes
The ideal approach to Type 2 diabetes is to prevent it before it ever needs treatment. The key is weight reduction, with trials showing as little as five per cent weight loss is enough to prevent most overweight people with insulin resistance from developing overt diabetes.
Exercise is also vital as it increases insulin sensitivity in muscle cells and helps them to absorb sugar and lower your blood-sugar level. It is recommended by health experts to undertake 30 minutes of moderate intensity exercise on most days of the week – this could be as simple as walking to the mosque for prayers instead of taking the car or walking up the stairs to your fourth floor office instead of using the lift. An important point for people with Type 1 diabetes is to make sure they have eaten before taking exercise or blood sugar levels may fall too low.
Many supplements have been developed to thwart the onset of diabetes. The Kitchen Shrink: Foods and Recipes for a Healthy Mind written by nutritionist Natalie Savona points out the growing evidence that chromium, available as glucose tolerance factor or GTF, enhances insulin sensitivity and lowers blood-sugar levels. Fish, seeds and nut oils are also recommended due to their ability to be taken into cell membranes therefore helping maintain insulin sensitivity. All these may be used alongside prescribed treatments for diabetes – but insulin or tablets prescribed by a doctor to control diabetes should never be stopped.
Common symptoms of diabetes are:
- excessive urination including frequent trips to the bathroom at night
- intense thirst and hunger
- severe fatigue
As Type 1 diabetes progresses other signs of diabetes may include:
- dry skin
- blurred vision
- unexplained weight loss
- thin, malnourished appearance
As Type 2 diabetes progresses other symptoms may include:
- fatigue and/or nausea
- frequent urination
- excessive thirst
- weight loss
- blurred vision frequent infections and slow healing of wounds or sores
- blood pressure consistently at or above 140/90
- HDL cholesterol less than 35mg/dL or triglycerides greater than 250 mg/dL
Diabetes is not to be treated in isolation. It is essential to attend to all other aspects of your health too.
Smoking should be ceased as it interacts with diabetes in a host of harmful ways, and greatly increases the risk of developing heart disease, stroke and kidney problems.
A healthy diet that is low in refined sugars and saturated fats, not only reduces the chances of developing type 2 diabetes but also aids weight loss.
Blood pressure needs to be especially well controlled because high blood pressure damages blood vessels.
The feet are vulnerable as seemingly trivial problems such as ingrown toenails or minor skin injuries can rapidly escalate if not quickly attended to. Regular visits to a chiropodist are recommended.
Any kind of infection, particularly of the skin or (in women) the genito-urinary tract is likely to be made worse by diabetes and should be promptly treated.
Further information:
Diabetes UK is the leading charity working for people with diabetes. They fund research, campaign and help people to live with the condition. Call them on 020 7424 1000 or visit www.diabetes.org.uk
International Diabetes Federation works globally to raise awareness about diabetes and provide support for those people with diabetes. www.idf.org
If you have any queries about diabetes make sure you seek medical advice from your GP.
CASE STUDY
Dr Osman Bhatti and Dr Shanaz Husain speak to Mohamed Ferose, aged 71, who was diagnosed with diabetes 26 years ago. He has undergone different phases of treatment over the years, having been initially diet controlled before progressing to tablets. Now he has to control his diabetes with insulin injections.
“I used to be a fit person and exercised regularly. I was working on the railways at the time. One day I got a tingling feeling in my arms and I went to see the doctor about it. There he did a test on my urine and from then diagnosed me with diabetes. I did not have the other features associated with diabetes such as drinking lots of water or frequently needing to empty my bladder. It was quite a shock at the time as I felt healthy and had no other medical problems. There was also no family history of diabetes in my family.
I was initially told by my doctor to control my diet, but that did not work so I was put onto a tablet to help control my sugar. I still had to try and make sure that my diet was correct and cut out a lot of sugar. As my diabetes got worse, I was put onto another tablet and then in 2002 I was told by the doctors that I needed to be converted to insulin treatment. I was very hesitant initially but after some time, after I was taught the method of the injections I was started on insulin injections twice a day.
Diabetes is now a part of my life – you get used to it. It was a shock when I was first diagnosed, but now having gone on to the insulin I have just accepted it. You have to. I have to make sure that I monitor my blood sugar regularly and for that I always carry some glucose source with me in case my sugar levels drop too low. Also, I have to be aware about what I am eating and have to eat snacks regularly every 2 hours whilst I am on the insulin to make sure that my sugar levels stay stable.
My family understand all about diabetes. They have been very supportive from the moment I was diagnosed and together we found out exactly what it was. My wife, although not diabetic, helps me with my general dietary needs. We have to watch what we eat and when we cook we make sure that it is healthy and we usually don’t have any dessert. It makes a difference having the support of family as it helps in getting on with life, even though you still have to think about what you are doing and eating from day to day. My family know what to do if my blood sugar drops too low as well and can give me some sugar at the right time as they can recognise the symptoms. On insulin you have to watch your blood sugar more closely, as the glucose level can drop too low at times.
Diabetes does sometimes cause complications but by the grace of God I have been generally well. I have had some laser treatment on my eyes and have weak cataracts, but my vision is still there. In 1987 I had heart bypass surgery on three of my heart vessels as well. You have to get on with it and accept it.
In my experience I’ve found that the Muslim community don’t know much about diabetes so I tend not to talk about it. It is one of those things you don’t really know much about until you or someone close to you has it.
You have to be so careful about what you eat, especially when people offer you food. The insulin injections have to be taken at certain times as well, so that has to be done quite discreetly. Diabetes is a condition which is becoming more common and people should be aware of it as you need to know how to control your sugar. I have found my faith as a source of strength in helping me to accept the way in which my life has changed. Now I am on insulin and having to eat regularly it is very difficult to fast but you just have to accept the problem and try and live your life as best you can.”
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