Fay­ola KJ Fras­er

More than 500 mil­lion peo­ple in the world suf­fer from di­a­betes, ac­cord­ing to the In­ter­na­tion­al Di­a­betes Fed­er­a­tion.

 In a study con­duct­ed in T&T in 2021, di­a­betes preva­lence is marked at 14.8 per cent of the adult pop­u­la­tion, with al­most 150,000 di­a­bet­ic adults. No­vem­ber, card­ed as Di­a­betes Aware­ness Month is an op­por­tune mo­ment to share sto­ries, ed­u­cate and learn about this lifestyle dis­ease, which is not on­ly detri­men­tal to one’s health but can al­so take a toll on the re­sources of the pub­lic health­care sys­tem, as it is the gate­way to oth­er lifestyle dis­eases such as heart dis­ease, vi­sion com­pli­ca­tions, and strokes, all af­flic­tions that re­quire in­ten­sive med­ical treat­ment.

Al­though it is com­mon­ly dis­cussed in Caribbean house­holds, many peo­ple may not be well equipped with in­for­ma­tion sur­round­ing the dis­ease. Di­a­betes, a non-com­mu­ni­ca­ble dis­ease (NCD), as de­fined by the World Health Or­ga­ni­za­tion (WHO) is “a chron­ic dis­ease that oc­curs ei­ther when the pan­creas does not pro­duce enough in­sulin or when the body can­not ef­fec­tive­ly use the in­sulin it pro­duces”. In­sulin is a hor­mone that reg­u­lates blood glu­cose. Es­sen­tial­ly, in lay­man’s terms, peo­ple who suf­fer from di­a­betes can­not main­tain healthy lev­els of glu­cose (sug­ar) in the blood. Hy­per­gly­caemia, al­so called raised blood glu­cose or raised blood sug­ar, is a com­mon ef­fect of un­con­trolled di­a­betes and over time leads to se­ri­ous dam­age to many of the body’s sys­tems, es­pe­cial­ly the nerves and blood ves­sels. There are dif­fer­ent types of di­a­betes; all types are com­plex and se­ri­ous. The three main types of di­a­betes are type 1, type 2 and ges­ta­tion­al (oc­curs dur­ing preg­nan­cy) di­a­betes.  

The main dif­fer­ence be­tween type 1 and type 2 di­a­betes is that type 1 is be­lieved to be caused by an au­toim­mune re­ac­tion and de­vel­ops ear­ly in life.

Type 2 di­a­betes de­vel­ops over the course of many years and is re­lat­ed to lifestyle fac­tors such as one’s di­et, ex­er­cise, and ge­net­ics. Type 1 di­a­betes can be di­ag­nosed at any age, but it is more com­mon in chil­dren and young adults. It is not caused by di­et or lifestyle habits, and it can­not be pre­vent­ed or cured.

In type 2 di­a­betes, the body be­comes re­sis­tant to in­sulin, mean­ing that it does not use it ef­fec­tive­ly. This leads to high blood sug­ar lev­els that can dam­age var­i­ous or­gans and tis­sues. Type 2 di­a­betes usu­al­ly de­vel­ops in adults over the age of 40, but it can al­so oc­cur in younger peo­ple, es­pe­cial­ly those who are over­weight or obese. Type 2 di­a­betes can be in­flu­enced by ge­net­ic and en­vi­ron­men­tal fac­tors, such as fam­i­ly his­to­ry, eth­nic­i­ty, di­et, and phys­i­cal ac­tiv­i­ty. It can be man­aged with lifestyle changes, oral med­ica­tions, and some­times in­sulin in­jec­tions.

Dur­ing the course of Di­a­betes Aware­ness Month in No­vem­ber, there will be fur­ther ex­plo­ration of adults liv­ing with Type 1 di­a­betes, hav­ing con­tract­ed it dur­ing child­hood. How­ev­er, the present ar­ti­cle is fo­cused on teach­ing adults, es­pe­cial­ly those at risk due to fam­i­ly his­to­ry, to de­vel­op habits to lessen the like­li­hood of con­tract­ing di­a­betes.

 Mul­ti­pronged ap­proach need­ed

Dr Nadeem Kothdi­wala, a med­ical physi­cian in T&T ad­vis­es a mul­ti­pronged ap­proach of screen­ing, de­vel­op­ment of good lifestyle habits and con­sul­ta­tion with med­ical pro­fes­sion­als to help fight against this ill­ness. Dr Kothdi­wala sug­gests that peo­ple at risk due to fam­i­ly his­to­ry en­sure that they screen for pre­di­a­betes and di­a­betes of­ten (at least once every two to three years, or more of­ten if rec­om­mend­ed by your doc­tor). Pre­di­a­betes is re­versible with lifestyle changes; how­ev­er, many peo­ple are un­aware that they have it.

Our lifestyle in the Caribbean leaves us ex­posed to the silent at­tack of lifestyle dis­eases. Of­ten­times, ac­cord­ing to Dr Kothdi­wala, peo­ple mis­tak­en­ly be­lieve that on­ly foods with high sug­ar con­tent are dan­ger­ous. In a Tri­ni Sun­day lunch, for ex­am­ple, there are sta­ples of white rice, mac­a­roni pie, and oth­er foods with high car­bo­hy­drate con­tent that present risk when eat­en with high fre­quen­cy. In these meals, we al­so cook pro­teins co­pi­ous amounts of sug­ar and salt, and “wash it all down” with a tall glass of juice.

Dr Kothdi­wala ad­vo­cates for fol­low­ing bal­anced, healthy eat­ing plans, en­sur­ing low con­sump­tion of foods high in fat, cho­les­terol, salt, and sug­ar. Juices and soft drinks that con­tain dou­ble and triple the rec­om­mend­ed amounts of sug­ar in­take dai­ly should be com­plete­ly avoid­ed. He al­so sug­gests smok­ing ces­sa­tion for avoid­ance of lifestyle dis­ease. Peo­ple should al­so com­mit to mod­er­ate-in­ten­si­ty phys­i­cal ac­tiv­i­ty three to four times per week, such as walk­ing, cy­cling, swim­ming or oth­er­wise.

For those who live with di­a­betes, it is even more cru­cial to heed the med­ical ad­vice of doc­tors. Dr Kothdi­wala ad­vo­cates that peo­ple who are di­a­bet­ic should see a nu­tri­tion­ist for the best ad­vice. For those liv­ing with the dis­ease, there is a need for ex­treme lifestyle changes, and tak­ing med­ica­tion as pre­scribed by a doc­tor, in­clud­ing in­sulin in­jec­tions, pills or pumps, to help reg­u­late their blood glu­cose. When left un­con­trolled and un­man­aged, di­a­betes can cause life-threat­en­ing com­pli­ca­tions such as car­dio­vas­cu­lar dis­ease, chron­ic kid­ney dis­eases, foot and skin com­pli­ca­tions and eye dis­ease.

Dr Joy St John, di­rec­tor of Sur­veil­lance, Dis­ease Pre­ven­tion and Con­trol at the Caribbean Pub­lic Health Agency (CARPHA) has la­belled di­a­betes “a big prob­lem for years to come” which re­quires a great over­haul of the norms of Caribbean cul­ture.

The Min­istry of Health in T&T high­light­ed the need to bet­ter con­trol non-com­mu­ni­ca­ble dis­eases, such as di­a­betes, as dur­ing the COVID-19 pan­dem­ic, da­ta sug­gest­ed high­er mor­tal­i­ty and mor­bid­i­ty rates in peo­ple liv­ing with NCDs. The min­istry has al­so launched a TT Move Cam­paign, to en­cour­age peo­ple to get 30 min­utes of ex­er­cise a day or make 4,000 to 7,000 steps a day. With­out ur­gent at­ten­tion to this scourge of di­a­betes, hu­man lives and liveli­hoods will con­tin­ue to suf­fer, and ex­treme bur­dens will over­whelm the health­care sec­tor con­sum­ing health, fi­nan­cial and oth­er re­sources.