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| By Dr Harold Gunatillake |
| Diabetes, a disease marked by high levels of sugar in the blood, is more common than ever before. In Sri Lanka, diabetics have more than quadrupled in the past two decades. Not only are more people being diagnosed with diabetes, they’re also developing the disease at younger ages. Due to economic reasons, most people find it difficult to purchase a glucometer, which is in the price range of Rs 4,000 to Rs 5,000, and further every test strip costs over Rs 25. Testing daily blood glucose level, even just once, would cost a diabetic Rs 700 per month. |
In most developed countries a Medicare system helps the people for them to undergone a series of blood tests with no cost. In Sri Lanka the very basic tests costs over Rs 1,000 per item. As a consequence, people do not bother to undergo annual routine tests as a preventive measure, unless they are ill and a doctor prescribes them relevant diagnostic tests. Studies have shown that eating rice in bulk for the main meal can lead to increased insulin resistance. The spicy curries are stimulants and appetizers to eat more rice. In addition they indulge in “rice pullers’ meaning pickled delicacies for added taste. Insulin resistance (also called Insulin Resistance Syndrome) means your cells have become less sensitive to the effects of insulin, the hormone secreted by the pancreatic gland which helps glucose (from food) to enter cells where it is turned into energy. This provokes the pancreas to over-compensate by working harder and releasing even more insulin.
In simple terms, this combination of insulin-resistance and insulin over-production leads to two common outcomes: diabetes or obesity combined with high cholesterol and increased rates of heart disease. In the early stages there are no outward physical symptoms of insulin resistance. A glucose-tolerance test, which measures insulin and blood-glucose, can help verify if a person is insulin resistant. But many people who are insulin resistant produce enough quantities of insulin to maintain near normal blood-glucose levels. Most or all people in Asian countries, including Sri Lanka, eat rice as their main meal.
For breakfast too, foods like indiappams (String hoppers), rotties, are cooked using rice and wheat flour, causing further insulin resistance. Even for dinner, most families eat hoppers, paratas and other foods prepared with flour. Another issue with high carbohydrate intake in addition to insulin resistance is obesity caused by increase size of fat cells in the body. Anything that works to transport more glucose into fat cells will lead to the conversion of more fatty acids into triglycerides and more storage of fat (i.e. weight gain). The easiest and most effective way of achieving this fat storage environment is to eat carbohydrates.
The body breaks carbohydrates into glucose, causing blood glucose levels to rise and making glucose widely available for it. Furthermore carbohydrate breaking down into glucose causes releasing insulin and insulin facilitates fat storage. So, eat carbs and you gain weight easily and highly. Avoid carbs and the body can burn its own fuel – that means your body fat – i.e. weight loss.
How to improve Insulin Resistance?
People who are predisposed to insulin resistance, or those who suffer from a lesser form of insulin insensitivity, can help alleviate the problem by taking positive action, as follows: •Follow a balanced healthy diet plan, which follows the guidelines as contained in the Low Glycaemic Index Pyramid. In general, this entails reducing your intake of refined carbs and sugary foods, while upping your intake of healthy carbs from fruits, vegetables and beans. Good quality monounsaturated fats, lean protein and lower-fat dairy foods are also valuable elements in the diet. Data from the Insulin Resistance Atherosclerosis Study suggests that cutting back on refined grains and eating more whole grains in their place can improve insulin sensitivity.
• Introduce regular physical exercise into your daily lifestyle. Gradually build up to 30-45 minutes of physical exercise per day.
• For best results, consult your doctor before embarking on any dietary or fitness programme.
Complications
Most people are unaware of the disabling complication that they can get through negligence and ignorance in controlling these diseases. That’s alarming because the risks of complications from this common disease – which include heart attack, stroke, blindness, kidney failure, and amputation – become greater the longer you have diabetes. But there’s good evidence that rigorous blood sugar control can delay or even prevent the development of debilitating long-term complications. Such tight control is now possible thanks to innovations such as high-tech monitoring devices, improved medications, and nearly painless insulin injectors.
Diabetes is an expensive disease to cope with in developing countries. Most people cannot purchase the convenient insulin pens. One pen is over Rs. 1,000 and it contains injectable doses to last maximum only about a week. The poor need to visit the local hospital or the diabetic clinics daily for their soluble insulin shots and for checking blood sugar levels.
