Former Senator Juan Flavier and singer Gary Valenciano are just two of the four million Filipinos affected with diabetes. Fortunately, both know they have the disease. Unfortunately, more than three million people do not know they are diabetics. Out of the one mil-lion who know they are suffering from the disease, only 200,000 are undergoing treatment.

“People don’t take diabetes seriously enough,” says Dr. Eugene Barrett, past president of the American Diabetes Association. “It doesn’t strike terror into people’s hearts the way cancer does.”

In the Philippines, many die “because it is already too late to remedy the situation,” according to Dr. Ricardo Fernando, director of the Institute for Studies on Diabetes Foundation, Inc. (ISDF).

Diabetes was considered a disease of minor significance in the past. But today, “diabetes is taking its place as one of the main threats to human health in the 21st century,” Dr. Paul Zimmet, director of the Melbourne-based International Diabetes Institute, told this author.

In 2000, the Philippines was not in the list of countries with the most number of diabetics. But by 2030, with a projected 7.8 million cases, the Philippines would be ranked ninth after Japan.

Diabetes basics
Diabetes is a chronic and debilitating disease that affects how the body turns food into energy. Normally, the food we eat is converted into glucose and used or stored by the body with little problem. Circulating insulin hormone stimulates the uptake of sugar by the body’s cells. But with diabetes something goes awry. The pancreas either stops producing insulin completely (Type 1) or the body develops insulin resistance, a condition wherein the body’s cells do not respond to insulin (Type 2). Either way, concentration of sugar in the blood shoots sky high.

A survey by the Food and Nutrition Research Institute conducted in 1997 showed that four out of 100 adults aged 20 years and above have diabetes with an increasing prevalence of the disease after the age of 40. The majority of these have type 2 diabetes.

Advancing age has been cited as one of the risk factors for developing diabetes. A 1996 study by the Philippine Diabetes Association reveals that the blood sugar level among Filipinos increases after the age of 40.

But it doesn’t mean that children are spared from it. In a recent survey conducted in Metro Manila by the Philippine Center for Diabetes Education Foundation Inc., it was estimated that two out of every 100,000 children aged zero to 14 years have type 1 diabetes.

Dangerous Causes
Diabetes tends to run in the family. “Diabetes is a hereditary disease passed on from generation to generation,” explained former health secretary Dr. Alberto Romualdez. “When there is a diabetic in the family, no matter how distant a relative the patient is, the characteristic is still passed on through the genes.”

Obesity is another risk factor for diabetes. According to Dr. Mary Ann Lim-Abrahan, immediate past president of the Philippine Lipid and Atherosclerosis Society (formerly Philippine Lipid Society), most type 2 diabetic patients are overweight or obese and have too much fat in the abdomen. Children are also suffering from this type of diabetes because of the food they are eating.

“It’s more of a fatladen diet,” deplored Dr. Araceli Panelo, executive director of the ISDF. In fact, most parents even encourage their children to eat fatty foods such as fries, burgers and other junk foods available in fast-food chains.

Diabetes may send out warning signs by displaying symptoms. Medical scientists list the following: frequent urination and great thirst; weight loss and extreme hunger; weakness and tiredness; and skin problems. Other symptoms include nausea and vomiting, blurred vision, drowsiness, cramps or numbness in the toes and fingers, and abdominal pain.

Some studies have shown that people with diabetes have a higher risk of depression because they think there is no hope for them. New research in the United States suggests that depression may also drive the diabetes process.

In the Philippines, diabetes is ranked as among the top 10 killer diseases, due to its many complications. “Patients with diabetes have a higher risk of having a heart attack or stroke than people who do not have diabetes,” informs Dr. Rody Sy, associate clinical professor of the cardiology section of the University of the Philippines. In addition, diabetes is a leading risk factor for cardiovascular disease resulting in a four-fold chance of suffering from heart attack or stroke.

Dr. Jose Villaroman Jr., consultant cardiologist of the Philippine Heart Center, agrees. “The prevalence of coronary artery disease is more than doubled in diabetics compared to nondiabetics, and the risk of heart failure likewise increases,” he points out. “In fact, deaths due to heart disease triple among diabetics compared to nondiabetics. After a heart attack, diabetics have twice the risk of death and triple the rate of progression to heart failure compared to non-diabetics.”

Around 74 percent of diabetics are afflicted by an eye disease, sometimes without the patients being aware of it. The most common eye complication is diabetic retinopathy. It occurs when the tiny blood vessels in the retina, the light sensitive tissue at the back of the eye, becomes damaged. The symptoms of diabetic retinopathy vary depending on the stage of the disease, but the most common are blurred vision, floaters, flashes and sudden loss of vision.

People with diabetes are also four to eight times more likely to have foot problems and gangrene, and 17 times more at risk to develop kidney disease. Likewise, because of these numerous complications associated with diabetes, they have 1.5 times greater risk of hospitalization than nondiabetics.

As stated earlier, diabetes if not taken seriously can be deadly. Jaime Cardinal Sin, the hugely influential Roman Catholic spiritual leader who helped topple two Philippine presidents, died of multiple organ failure after a lengthy struggle with kidney problems and diabetes.

Treatment strategies
Despite medical advances with new drugs and insulin formulations, diet remains “the cornerstone of diabetes treatment,” points out Dr. Cynthia ChuaHo of the Far Eastern University Hospital. In general, the nutritional requirements of patients with diabetes are the same as those of non-diabetic individuals,” she explained. “A diabetic can probably continue to eat almost all the foods he likes with just a few changes.”

A “diabetic diet” involves ordinary foods, but the kind and the amount are strongly emphasized. Most likely, diabetics have to cut down on food which has a lot of sugar like candies, molasses, honey, softdrinks, and many kinds of desserts. They must also avoid foods with very high salt content like dried fish, bagoong, and sausages.

Dr. Augusto Litonjua, one of the country’s leading experts on diabetes, dispels the notion that diabetics should be prevented from eating more rice. “It’s what you do with rice that matters. If youfry or sweeten it, you add sugar and fat to your diet,” he explains. “Steamed or boiled rice is best for diabetics.”

But diet is not enough. For many diabetics, a regular exercise program may be recommended. A reduction in weight of five to 10 percent combined with regular exercise can lead to an improvement in blood glucose control and insulin resistance, while moderate weight loss can reduce high blood pressure as well.

Exercise programs, however, need to be appropriate to the person’s age and social, economic, cultural and physical status. “Talk to your doctor about the right exercise for you,” says Dr. Fatanah Ismail, principal assistant director of the noncommunicable disease section of the Ministry of Health in Kuala Lumpur. Most doctors recommend aerobic exercises, such as walking, jogging, aerobic dance or bicycling.

Dr. Gauden Galea, head of the World Health Organization’s Western Pacific Non-Communicable Diseases Division, summarizes: “Defeating diabetes is really about personal responsibility. Just cutting out the worst foods, taking the stairs or walking an extra 10 minutes to work can make the difference.”

Unlike cancer, diabetes is not a death sentence. “A normal life is possible with diabetes,” says Dr. Galea. History has proven this. Among those who have defied diabetes include Soviet premier Yuri Andopov, Israeli Prime Minister Menachem Begin, French painter Paul Cezanne, American inventor Thomas Edison, American writer Ernest Hemingway, Egyptian politician Gamal Abdel Nasser, and English author H.G. Wells.

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