Diabetes mellitus is a disease which is rapidly increasing across the country, especially in urban India. From a mere 3-4% of the population in urban adults as recent as the 1980s, most metropolitan cities report that at least one out of every eight adult suffers from diabetes; a number which rises to more than one of four adults after the age of 50 years. While the population affected in rural areas is relatively low in comparison with urban areas, it has also shown a rise in recent years, especially in states with higher development indices, like Kerala and Tamil Nadu.
One would expect that given such high prevalence rates, there would be a reasonable degree of public awareness about this disease, and its health implications. Recent studies indicate that the public awareness about diabetes is unacceptably low.
What do people know about diabetes?
Unfortunately, the consequences of this ignorance are compounded by a shroud of myths surrounding this condition. From misinformation around what food to eat, to incorrect causes of developing the condition, these old fashioned untruths cause various problems around living with, treating or even talking about diabetes. It is thus, the right time to discuss and dispel some prominent myths about diabetes.
Top Twenty Myths on Diabetes Prevention and Management
Diabetes does not result from an infection, hence, it is cannot be transmitted between people.
Diabetes is a hormonal disease and is basically caused by a problem with either reduced amount of insulin being produced by the beta cells in the pancreas, or resistance to the action of insulin, or a combination of both factors.
Diabetes often tends to run in families – probably as a result of inherited traits or common lifestyle and environmental factors. At the same time, the absence of diabetes in a family is no guarantee that an individual will not get the disease. While people with a family history of diabetes are at much higher risk of developing disease compared to those without a family history, several people without a family history go on to develop diabetes.
All of us, whether we suffer from diabetes or not, need all the three main dietary constituents – carbohydrates, protein and fat.
The proportion of these constituents and their quality varies depending on whether an individual is healthy or suffers from a disease like diabetes. When a person is diagnosed with diabetes, it is important to meet with a dietitian who is aware of the medical treatment planned. The dietitian can then help the patient balance medication with physical activity, life-style, and the amount and types of food that he /she eats.
As a general rule, the key components of a diet advised for a person with diabetes needs to address the following issues:
1. Total calories consumed.
2. How these are divided between major and minor meals?
3. Timing of meals
4. Relative contribution from carbohydrates, protein and fats, and the quality of each.
In continuation, it is pertinent to point out that a healthy diet for someone with diabetes is the same as a healthy diet for anyone else! A wholesome meal plan is based on whole-grain foods, lean protein, vegetables, and fruit. Such a diet is low in fat (particularly saturated and transfat), salt, and simple sugars. The so-called diabetic foods offer no special benefits. It is important to note that unrefined carbohydrates, rich in fibre, are preferred over refined carbohydrates. The tendency to use processed or refined food items must be curbed and the consumption of traditional coarse grains should be encouraged.
The most common form of diabetes in childhood is Type 1 diabetes previously referred to as insulin-dependent diabetes. This disease occurs because the body’s immune system destroys the insulin-producing cells in the pancreas. This is an irreversible process and once destroyed these cells do not recover and produce insulin. Hence, a child does not outgrow the disease and requires continued treatment and attention.
Eating sugar does not cause diabetes. Diabetes is caused by a combination of genetic and environmental factors. However, eating a diet that is high in fat and sugar can cause you to become overweight, which increases your risk of developing Type 2 diabetes.
In this context it is pertinent to point out that despite what has been propagated, a couple of biscuits will not cause a health crisis even for a diabetic. In fact, sweets can be eaten in moderation by people with Type 2 diabetes, as long as this is incorporated in a structured healthy meal plan and combined with exercise. But, while avoiding sweet treats is’t mandatory, limiting them is. Sweets often contain not only empty calories but a lot of sugar, a carbohydrate that raises glucose levels considerably. For better glucose control, diabetics should have dessert only after a low-(preferably unrefined) carbohydrate meal.
Many people who have Type 2 diabetes carry excess kilograms, and some are obese, but many elderly people with the condition aret particularly overweight.
In overweight individuals, it may be motivating to learn that even modest weight loss through healthier eating and increased activity can help keep long-term complications at bay.
Among Indians, even more than other ethnic groups, people may not be obese as per weight-based criteria, but have excess fat in their abdomen resulting in a big waist. Even these individuals who look skinny from their extremities, but have a slight bulge at their waist are equally at risk for developing diabetes so there is no comfort in being normal weight, if one is also not slim at the waist.
There is no such thing as mild diabetes or borderline diabetes " this is being in denial about a disease which can have grave implications for health. All diabetes is equally serious, and if not properly controlled can lead to serious complications. If one is not careful it does not take long for "mild diseases to convert to life threatening disease".
Once there is evidence that an individual has abnormal blood sugars the person concerned should take all the precautions advised to any patient with diabetes regarding food, physical activity, regular physical and laboratory tests. This will ensure that the disease is kept under control and does not progress to cause irreversible complications.
Almost all jobs can be done by people with diabetes. There may be some occupations, such as aeroplane pilots or train drivers, where there is a reluctance to employ someone with diabetes based on the premise that unconsciousness due to low blood sugars can endanger the life of passengers traveling on the plane or train. Other than few examples such as these, there is no job which cannot be done by people with diabetes, provided that they follow their doctors advice and look after themselves well.
With the current state of medical science and therapy, diabetes is not a curable disease; it can however be treated and controlled.
Insulin is a hormone produced by the pancreas which facilitates the uptake and utilization of glucose by different body tissues. Insulin given to patients with diabetes, as an injection, mimics this action. It is important to understand that appropriate treatment, matching the patients needs, food intake and physical activity can result in blood sugars being maintained at near normal levels but, this is not a cure. Once treatment is withdrawn, blood glucose levels will rise again.
It is not only insulin which does not cure diabetes, no available remedy at this point of time can cure diabetes.
Although is an integral part of diabetes management, it is equally important to ensure that other factors, such as diet and physical activity have been optimized before attempting an increase in insulin dose.
It is important that patients and their well-wishers appreciate this fact, or else there is a danger of them getting misled by quacks who promise a cure, but can end up causing significant damage to the health of the patient. This is even more critical in children with Type 1 diabetes a disease which requires insulin to be given for survival.
Some people have symptoms when their blood glucose is too high or low, others do not. Because some of the symptoms of high and low blood glucose are similar, it can be hard to know what symptoms mean. The only way to be sure is to have the blood glucose checked by a doctor.
There is evidence that diabetes-related complications can be prevented or delayed by following a self-care treatment plan that keeps blood sugar levels under control and by getting regular medical checkups. Many people with Type 2 diabetes also have high blood pressure and cholesterol. Keeping these twin conditions in check as well can also go a long way toward warding off complications such as nerve damage and kidney failure.
When a woman becomes pregnant, strict blood glucose control is required. If clinical practice guidelines are adhered to, the outcome of a pregnancy in a woman with diabetes can be as free of complications as in a woman without diabetes. While a woman with diabetes has to exercise greater care and caution while planning a pregnancy and when pregnant pregnancy is not a contraindication for an otherwise healthy woman with diabetes, who has well controlled blood sugar and no diabetic complications.
Since the earliest any pregnancy gets diagnosed is usually 6 weeks after conception, it is critical that a woman with diabetes achieves impeccable control of blood sugars before planning conception. This will ensure that the baby is exposed to a normal intra-uterine environment, from the very beginning. An unplanned pregnancy may expose the baby to an environment of high blood sugars till the pregnancy is diagnosed an exposure of 6 weeks of unacceptable conditions in the womb.
Diabetic labeling is often used on sweets, potato chips, ice-cream, biscuits and similar foods that are generally high in fat, especially saturated fat and calories.
People often misconstrue sugar-free foods to be calorie free this is inevitably not the case.
Most "sugar free" foods often are very calorie-rich, and the patient unwittingly has large quantities resulting in deterioration of blood glucose control. Professional organizations do not recommend eating diabetic foods, including diabetic chocolate, because they still affect blood glucose levels and may cause diarrhoea.
There is no reason to restrict going out or social interaction, even if it involves exposure to temptation, when the nature of food available may not be as optimally desired. It is important to remember that we are not dealing with a disease which is going to affect the individual for a few days or weeks. We have to manage a disease which stays with the patient for the entire lifespan and therefore any restrictive lifestyle interventions are unlikely to be sustainable, if they are not natural.
Everyone needs to relax and socialize - in fact, social interaction may be what the doctor orders to combat stress, which itself is detrimental to the patients health.
Moderate consumption of less desirable food items on an infrequent basis may be a preferred alternative to becoming a martyr to the disease the mental health implications of such curbs on lifestyle can have negative effects on a chronic disease such as diabetes.
Supporting the freedom to socialize and the flexibility to occasionally eat differently from what is prescribed, it is equally important to state that this is not to be considered as giving complete discretion to the patient to indulge and deviate from the doctors advice!
People with diabetes are encouraged to exercise as part of a healthy lifestyle. Staying active can help avoid complications associated with diabetes, such as heart disease.
Upcoming tennis player for India, Kyra Shroff and Wasim Akram, former Pakistan cricket captain are examples of people who continued to play their sport at the highest competitive level even after being diagnosed with diabetes and performed as well as any other team member without diabetes.
A similar myth is that children with diabetes cannot exercise - just the opposite is true. In fact, food intake, insulin, and physical activity are the basis for treatment of Type 1 diabetes. Exercise lowers the amount of blood sugar, which results in a person feeling better, helps avoid becoming overweight, and reduces the chances of developing long-term complications associated with diabetes.
A person with diabetes is no more likely to get a cold or another illness than someone who does not have the disease. However, the implications of an infection are different in a person who has diabetes any infection or illness can interfere with blood glucose control, putting the patient at risk of high blood glucose levels. This can be especially more dangerous in people with Type 1 diabetes, in whom infections, unless well treated may lead to a life threatening state (called diabetic ketoacidosis).
Although diabetes is the leading cause of blindness in adults in most parts of the world, it is far from inevitable that people with diabetes will become blind.
Patients with diabetes can reduce chances of developing diabetes complications, including eye complications by:
1. Controlling blood pressure, glucose, and blood fat levels
2. Staying active
3. Maintaining an ideal body weight and
4. Giving up smoking.
The general advice on toenail cutting applies to everyone. People with diabetes must keep their nails healthy by cutting them along the shape of the end of their toes. Nails should not be curved down the sides, or too short. It is safest to trim nails with nail cutters and to use a nail file to trim the corners of the nails.
As long as one is responsible and has good control of diabetes, research shows that people with diabetes are no less safe on the roads than anyone else. It is however, equally important that a patient with diabetes is aware of the adverse effect of uncontrolled blood sugars on driving the big concern being that an episode of hypoglycemia (low blood sugar) can result in unconsciousness, leading to an accident. Precautions, like stopping the car, and taking some food or toffee (which must always be available) to manage the effect of low sugar, before re-starting the journey are critical.
The most important goal for people with diabetes is keeping near-normal blood sugar levels in order to feel well and avoid long-term diabetes complications. The dose of insulin therefore is based on the persons needs, food intake, physical activity and other lifestyle related factors. Fine tuning an insulin dose, including increasing the dose of insulin, is merely an attempt to ensure good control of blood glucose.