Rawalpindi
Changes in lifestyle at individual level and a comprehensive policy on treatment and management of diabetes at national level along with high awareness among public on various aspects of the disease and its complications can be effective in preventing or delaying the onset of type 2 diabetes whose incidence is recording continuous rise in Pakistan.
Every year, World Health Organisation (WHO) selects a priority area of global public health concern as the theme of World Health Day, which falls on April 7, the birthday of the organisation. This year, the theme of World Health Day is “Beat diabetes” and main goals of World Health Day 2016 campaign are to increase awareness about the rise in diabetes and its staggering burden and consequences, in particular in low and middle-income countries: and trigger a set of specific, effective and affordable actions to tackle diabetes. These will include steps to prevent diabetes and diagnose, treat and care for people with diabetes.
Studies rank Pakistan 7th among the top 10 countries with the highest number of people living with diabetes. There are more than seven million people suffering from diabetes at present in Pakistan The diabetes prevalence rate in Pakistan is 12 percent, which is expected to rise up to 30 percent by 2030 and then Pakistan will rank 4th in the world. According to estimates, well over 90,000 people die due to diabetes and its complications annually in Pakistan out of which majority are women.
Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by pancreas that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.
Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood known as hyperglycemia. Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues such as blindness, heart attack, kidney failure, stroke, nerve damage, ulceration, infection and amputation of the toes, feet and lower legs.
There is a need to create awareness among public that simple lifestyle measures have proved to be effective in preventing or delaying the onset of diabetes. Maintaining normal body weight, engaging in regular physical activity, eating a healthy diet, avoiding tobacco smoking, alcohol drinking and stress and adequate sleep minimum eight hours daily can reduce the risk of diabetes, said Head of Community Medicine at CMH Lahore Medical College Professor Dr Muhammad Ashraf Chaudhry while talking to ‘The News’ in connection with World Health Day.
He said a healthy diet high in fruits and vegetables between three and five servings a day and low in sugar and saturated fats can help to prevent type 2 diabetes. Healthy food also includes whole grains and healthy fats found in olive oil, nuts, avocado, seeds and fish and beans and lentils. Drink at least 10 glasses of water per day, calorie free drinks and avoid sodas, soft drinks and energy drinks. Cut back on high calorie snacks. Watch portion sizes. Avoid fast or junk food and bakery items, he said.
He explained that obesity, particularly abdominal obesity is linked to the development of type 2 diabetes. If there is diabetes in the family, you should be careful not to put on weight over the years. Growth of the waist line, in particular, increases the risk of diabetes. Waist should not be more than 35 inches in men and 31 inches in women, he said.
He said weight loss improves insulin resistance and reduces hypertension. People who are overweight or obese should therefore be encouraged to achieve and maintain a healthy body weight. Thirty minutes of moderate physical activity along with five to 10 per cent weight loss reduces 58 per cent risk of diabetes, said Dr. Ashraf.
He further explained that the body mass index is used to assess whether a person is having normal weight or not. The index is calculated by dividing body weight (kg) by the square of body height (meters). If your body mass index is 25-30, you will benefit from losing weight. If your body mass index is higher than 30, the adverse health effects will start to show and it will be essential to lose weight, he said.
He added that physical activity is one of the main pillars in the prevention of diabetes. Increased physical activity is important in maintaining weight loss and is linked to reduced blood pressure, reduced resting heart rate, increased insulin sensitivity, improved body composition and psychological well-being. At least 30 minutes of moderate intensity physical activity (brisk walking) should be done daily. Taking 10000 steps a day (walking five miles per day) shows that you have active lifestyle, he said.
To a query, he said people should be aware of risk factors not only for diabetes but also for chronic diseases and should follow changes in lifestyle if needed to avoid these. “Smoking is well-established risk factor for many chronic diseases, including diabetes and its complications. As well as other harmful effects, smoking increases abdominal fat accumulation and insulin resistance. All smokers should be encouraged to quit smoking.”
He said that there is evidence of link between stress or depression and both diabetes and cardiovascular diseases. During stress, a hormone cortisol is released. Cortisol puts gas in the body’s tank; it tells the body to increase glucose, directs cells to resist insulin’s signals to absorb and store blood glucose. When cortisol levels are consistently high but there is no physical activity to buffer the effects of chronic stress, the consequence may contribute to type 2 diabetes, he explained.
He said learning strategies to deal with stress may lessen this effect. Learning relaxation techniques to respond to stress, identifying situations that cause stress and choosing to avoid them help you follow changes in your lifestyle that increases your enjoyment level. Getting regular exercise and saying your prayers regularly are excellent ways to overcome stress and depression, he said.
He said both short, less than six hour and long, greater than nine hours sleep durations may be associated with a higher risk of developing type 2 diabetes. Adequate sleep, eight hours per day must be ensured to reduce the risk of type 2 diabetes, said Dr. Ashraf. He said people must be aware of principal warning signs of diabetes that include frequent urination, excessive thirst, increased hunger, weight loss, tiredness, tingling sensation or numbness in the hands or feet, blurred vision, frequent infections and slow healing of wounds.
Diabetes can affect anyone. If left untreated, it is deadly. If you have these warning signs, consult your doctor immediately and get your blood sugar tested, he said.
Efforts to prevent and treat diabetes will be important to achieve the global Sustainable Development Goal 3 target of reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030, concluded Dr. Ashraf.