HEALTH & FITNESS

Diabetes is not curable, but fully controllable
Dr M.L. Kataria

According to an estimate by the World Diabetes Federation, India is home to over 50 million diabetics. Progressing as at present, this figure is likely to rise to more than 85 million in the coming decade. A diabetic has blood glucose higher than a fasting range of 80 to 120 mg% and over 150 mg% post-prandial level. The metabolism of glucose and its level in the blood are regaled to remain within normal ranges by insulin, a hormone secreted by the beta cells of islets of Langerhans in the pancreas, an abdominal endocrinal gland. Thus, the severity of diabetes is directly proportional to the quantum of insulin produced by the pancreas as a major factor.

Entering the age of old age
The Queen of England is going to be terribly busy during the final years of her reign, writing birthday telegrams to Britain's rapidly growing number of centenarians. Her successors, it would appear, will be even busier.

  • Health Notes

  • Drugs best suited for treating irritable bowel syndrome identified

  • Now, pond scum comes in aid of the fight against cancer

 

 

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Diabetes is not curable, but fully controllable
Dr M.L. Kataria

According to an estimate by the World Diabetes Federation, India is home to over 50 million diabetics. Progressing as at present, this figure is likely to rise to more than 85 million in the coming decade.

A diabetic has blood glucose higher than a fasting range of 80 to 120 mg% and over 150 mg% post-prandial level. The metabolism of glucose and its level in the blood are regaled to remain within normal ranges by insulin, a hormone secreted by the beta cells of islets of Langerhans in the pancreas, an abdominal endocrinal gland. Thus, the severity of diabetes is directly proportional to the quantum of insulin produced by the pancreas as a major factor.

Diabetes is a slow, long-term painless malady. It hardens and narrows the bigger blood vessels and chokes the end arteries and capillaries. Therefore, slowly, steadily and progressingly it undermines the functioning of all vital organs. The most vulnerable targets are heart, kidney, eyes, brain, feet and many more. Therefore, hypertension, myocardial infarction, loss of vision, stroke, renal failure and gangrene of toes and feet are its predictable long-term complications But, hopefully, most of these are now manageable with the development of modern science and technology. Nevertheless, prevention is better than cure.

While heredity plays an important role in the transmission of diabetes, a cursed gene has also been discovered, opening the avenue for genetic correction in times to come.

However, at present, if one or both parents are diabetic, almost all the siblings and their offspring, for generations, may be affected with the disease, usually following Mandelionl of inheritance.

Diabetes is no longer an urban rich manís luxury. It is almost equally prevalent in rural India and urban slums among all age groups.

Five decades ago, it used to appear after the age of 40 years. Over the decades it has advanced gradually and is being detected even at 25 to 30 years of age. Lately, juvenile diabetes among school-going adolescents has also been detected.

There are several risk factors besides heredity, which predispose, cause and precipitate the disease.

A sedentary lifestyle, rich diet, lack of exercise, alcohol, tobacco, intensity of perpetual mental strain, pesticides of various types used abundantly for cereals, vegetables and fruits, contamination of even sub-soil water by these are also being blamed for their toxic effects on pancreas. Lately, certain drugs like statins, frequently prescribed for lowering high blood cholesterol due to rich diet have been censured for not only affecting the liver functions, but also for disrupting the blood sugar metabolism.

Primarily, each state is responsible for the health care of its citizens. While most of the states are still in slumber, the Union Ministry of Health has shown concern about the diabetic epidemic. An announcement has been made to launch a national surveillance programme to detect diabetes and hypertension in 100 remote districts of 21 states, including 33 cities with a population of over 10 lakh, covering a total of about 20 crore people, over 30 years of age and pregnant women. There are lots of milestones, roadblocks and pitfalls between the announcement and implementation and achievement. The National Rural Health Mission, that commenced with a lot of fanfare in 2005, is in doldrums. Nevertheless let us hope for the best for the diabetes and hypertention programme.

In the meantime, the Indian Council of Medical Research, a down-to-earth, highly professional organisation, has launched a similar programme for eight north Indian states. Surely, each state is aware of its own diabetic burden.

We need to launch a vigorous two-pronged state-wise preventive and curative herculean drive against diabetes. A universal awareness drive about the disease and its complications should be launched by the Health Department in general and by the Education Department of each state in particular for adolescents and adults through universities, colleges and schools.

Half an hour of physical training and drill in schools during teaching sessions and one hour of compulsory games in the evening are no longer a common practice to keep every student physically fit. No wonder, several studies have confirmed that 25 to 30 % school-going adolescents are obese. Most schools concentrate only on team elevens and ignore the rest.

Instead of milk bars, several liquor vends in each village are a common disgusting sight. Besides pesticides, toxic country liquor is also an important factor for consideration to control rural diabetes.

The media can play an important role in creating awareness about diabetes by devoting more space and time in collaboration with professionals, who should be encouraged to contribute and disseminate through them all aspects of the disease to the common man.

The government should involve health care NGOs extensively to spread awareness about the disease, its fatal complications, preventive measures and life-long treatment, specially in rural areas and urban slums. Government officialdom abhors to share power and responsibility, through public/private participation, which can take a lot of load off their shoulders.

In every state, all the city and rural fathers can organise to take every man, woman and child off the daily normal humdrum and routine for one hour, collectively or individually, to devote to physical fitness and relax. If this dream comes true, we can prevent and eliminate many ailments. Physical fitness is the first step in the ladder of prosperity.

In this era of the common manís right to work, food, health and shelter and even information, as evident fron central legislation to this effect, modern sociologists are also suggesting the right to pre-matrimonial tests for certain hereditary, genetically generated and several other diseases, including diabetes, tuberculosis, HIV/AIDS and latent mental diseases to be test-confirmed by compulsory legislative compliance for their prevention and transmission to the partner or the offspring. Marriage laws to this effect donít seem to be far away.

A state-wise diabetes detection programme for all men and women above 25 years of age and school and college-going adolescents is imperative, for a diabetes register to facilitate treatment, follow-up and effective control of the disease.

A blood sugar and blood pressure assessment centre for a population of one lakh for every city and town, and a similar centre for every university, college and higher secondary school should be established on a priority basis.

Each collection centre needs mainly a lab technician, a colorimeter, and a BP apparatus with blood sugar estimation kit. The cost of equipment for each centre is within Rs 50,000.

The market is flooded with a variety of glucometers worth Rs 1,000 to Rs 2,000. Most of them are unreliable, giving wide variations in readings, sometimes even 10 to 20%, compared to the lab estimation. The strip coated with reagents costs about Rs 15 per strip, a rich manís luxury, only to get misled. A very strict quality and price control by the authorities concerned is required before these devices are permitted to flood the market.

The detection centre should be combined with the treatment centre under a doctor with certification in diabetology. A fortnightly quota of prescribed drugs for diabetes should be issued to the patient, free for BPL patients and at controlled rates for others.

There are a large number of drugs flooding the market at unaffordable rates for life-long consumption. At least five usually prescribed generic drugs, including insulin, metformins, glilazides, glimpride and pioglitazone at highly controlled rates should be available to each centre in a large quantity. This centre should perform like a DoT centre for TB patients.

A confirmed and registered diabetic must get a monthly blood sugar assessment and a quarterly review of drug resistance done because drug resistance is seen in 10 to 15 % of the diabetics. The dose of drugs, single or in combination, diet, weight and blood pressure of a diabetic need a regular quarterly review. Besides monthly and quarterly review, a half-yearly renal function tests, a lipid profile and fundoscopy of the eyes must be done at least once a year.

Uncontrolled diabetes predisposes to all types of infections of the chest, urinary tract, skin, blindness and gangrenes. Nevertheless, controlled diabetics are known to have lived a full span of a century of life.

Diabetes, though not curable, is totally controllable. It is a multi-disciplinary collective challenge to the individual, the community, the medical profession and the Central and state governments.

The writer, a retired Brigadier, is Member-Academic, Research Society for the Study of Diabetes in India, and a pioneer in rural diabetes.

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Entering the age of old age

The Queen of England is going to be terribly busy during the final years of her reign, writing birthday telegrams to Britain's rapidly growing number of centenarians. Her successors, it would appear, will be even busier.

There are currently 6,500 people aged 99 in the UK, which means that Her Majesty will post birthday felicitations to around 18 people every day over the coming year. But by 2047, the new monarch may have to raise the age bar ó otherwise he will be penning 260 birthday telegrams every day.

A third of babies born this year are expected to survive to celebrate their 100th birthday, according to new projections by the Office of National Statistics, compared to 12 per cent of people aged 65 in 2012. In 1961, when records began, there were just 626 centenarians in the UK; there will be 455,000 by 2060.

Before panic sets in about an "age time bomb", let us not forget that this is a good news story, which began unfolding in the 20th century as killer childhood infectious diseases were largely irradicated in the developed world. It is a success of humanity that developing nations strive to replicate.

Avan Aihie Sayer, professor of geriatric medicine at the Medical Research Council unit at the University of Southampton, said: "We are living longer and healthier... yet there is such bad PR about the whole thing. Ageism is so pervasive, yet is it an odd form of discrimination because unlike racism and sexism, we are all ageing."

The fact that most babies now survive childhood is the most significant reason for massive increases in life expectancy during the first two- thirds of the last century. In addition, improvements in maternal health over the same period means we are no longer as biologically old as we used to be: we are not only dying later, but we are also developing disabling illnesses later, according to Professor Finbarr Martin, President of the British Geriatrics Society.

"The things that kill people when they are old are affected by public health measures, in particular immunisation, central heating, and great improvements in social care, which means people are more likely to recover if they become ill or disabled," said Professor Martin. "The challenge for us is to try and squeeze disability and disease into the last few years of life."

One condition that becomes substantially more likely the older we get is dementia, which affects one in 14 people over 65, one in six over 80, and one in three over 90. Research into it received a cash injection as David Cameron announced a 140 per cent increase of public funds by 2015.

Hannah Clack, from The Alzheimer's Society, said: "As we all live longer and get better at curing other conditions, the number of people with dementia is going to rise exponentially. There are already 800,000 in the UK and this will double and cost triple within a generation."

But it is not only dementia that is a concern. Our buckling health service was set up to deal with single-organ acute conditions mostly affecting middle-aged people or younger pensioners. Yet the NHS, like the social care system, is now mainly used by frail very old people with multiple conditions, who have a range of complex problems that affect their ability to function independently.

Professor Sayer said: "This is where the big buck stops for government: how to provide health and social care for frail people with complex needs when you have a system that is currently not fit for the purpose."

It is, in some respects, all about the money as a rapidly ageing population means there are proportionately less taxpayers to foot the bills.

Jonathan Clifton, from the Institute for Public Policy Research think tank, said: "No solution to the funding of social care is fair or plausible without tapping into the wealth of the baby-boomers in some shape or form. We will need to find ways to release the equity pensioners have built up in their homes to help cover the cost of care, as well as encouraging the younger generations to insure themselves against future costs of care." ó The Independent

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Health Notes
Drugs best suited for treating irritable bowel syndrome identified

Washington: Two prevalent drug therapies ó rifaximin and lubiprostone ó have been identified as having the fewest side-effects for treating irritable bowel syndrome, according to a study.

Patients with irritable bowel syndrome often experience abdominal pain or cramps, excess gas or bloating and visible abdominal distension. Many drug therapies cause troubling side-effects of their own, including nausea, insomnia, palpitations and decreased appetite.

The findings are based on an analysis of more than two dozen large-scale clinical trials. ďFor the millions of patients who suffer from IBS, effective treatment options have been very scarce,Ē said Dr Mark Pimentel, a lead author of the study and director of Cedars-Sinaiís Gastrointestinal Motility Program. ó ANI

Now, pond scum comes in aid of the fight against cancer

Washington: Microbes found in pond scum could be used to develop a new test detecting the cells that spread cancer through the bloodstream from the original tumour to new sites in the body. In a report, scientists described how the test is intended to not only identify the spreading of cells, but also allow lab analysis of those cells so that doctors can decide on the most effective treatment.

Yoshinobu Baba, a renowned scientist who led the research using the pond scum microbe called Euglena, discussed promising results with new agents that can both produce images of diseased tissue and deliver treatments. Babaís team turned to Euglena in an effort to solve the medical problem of detecting the minute number of cancer cells that break off from the original, or primary, tumour site and travel through the bloodstream. Those cells, termed circulating tumour cells (CTCs), enable cancer to spread, or metastasise, and start growing at distant sites in the body.

Metastasis is the main reason why cancer can be such a difficult disease to treat. Detecting those cells would raise a red flag so that doctors could treat or more intensively monitor patients. Baba pointed out, however, that the small numbers of CTCs make that goal very difficult. ó ANI

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