– A Disease of Overeating
are digging our graves with our own teeth.
Moffet (1820-1908), Irish Poet and Educator
today’s world, many more people are dying from overeating than from starvation.
Hioland, Senior Vice-President Novo
Nordisk, world’s largest maker of diabetic drugs
Prosperity has its price. In the realm of disease, that price is
diabetes. The price of diabetes - blindness, gangrene, amputations, kidney failure,
neuropathy, diseases of large and small
arteries, and premature death. Among the
world’s peoples, 371 million have diabetes.
Many of these people are in poor and developing countries where people are
adopting urban lifestyles and consuming western foods.
rampant in American Indians, immigrants
to America, Pacific Islanders, Arab
countries, and in Vietman. Today’s New York Times features an article “Prosperity
in Vietnam Carries a Price; Diabetes.” The
price of diabetes in Vietnam is an
epidemic of amputation of gangrenous
limbs. Diabetes is a disease related to
genetic predisposition, rich diets, lack of exercise, and obesity. In Vietnam,
diabetes occurs in both the fat and the thin, and afflicts especially
those who move from the country into urban areas. In the U.S, diabetes in more prevalent in
obese, sedentary individuals.
Diagnosing and treating diabetes is like guerilla
warfare. Diabetic guerillas can strike
at any time in unexpected locations in almost any organ in the body, often with
little warning. You can be born with it,
but more often it comes later in the life in the form of type 2 diabetes. In the morbidly obese (those 100 pounds or
more overweight), you can treat it
surgically by shrinking or partially bypassing
Controlling diabetes is medical
guerilla warfare.. You have to approach it from different directions – high
tech and high touch, prevention and maintenance. Many high tech approaches,
which are essential disruptive innovations – insulin, inhaled insulin,
insulin-pumps, monitoring devices, other drugs, and transplants – have been
tried and work for many but often fail to stem the tide of complications.
For most doctors, controlling diabetes demands attention to preventive
details and instructing patients ( To get the attention of his patients,
Stanley Feld, MD, an endocrinologist in Dallas, had his diabetic patients sign
a contract saying they would either abide by his rules or not be his patients.
He also issued patients T-shirts bearing the words: “In Control!”).
For doctors, prevention entails,
•Precise blood glucose control.
•Inspecting the bottom of patient’s feet – something many obese diabetics can’t
do for themselves.
•Assessing loss of sensation in feet and lower limbs.
•Monitoring blood pressure.
•Checking blood lipids, blood creatinine
and creatinine clearance, and
•Protecting the kidney with new drugs.
•Making sure patients take oral diabetic agents and insulin correctly.
•Instructing patients on proper diets and having a nutritionist or dietician
re-enforce their message.
•Encouraging patients to lose weight and exercise (obesity is considered the
main precursor to most adult diabetes).
•Managing complications – blindness (the leading cause of adult blindness),
heart disease and stroke (causes 65% of deaths among diabetes), kidney disease
(accounts for 44% of case of kidney failure), and amputation (more than 60% of
lower-limb amputations occur in diabetics).
Among diabetics and their physician friends, there are few miracles, because
old habits are hard to break, and treatment regimens are hard to follow. But
there are disruptive innovations on the horizon. Until these disruptions mature
and take hold, the physicians’ best bet for controlling the vascular
catastrophes associated with diabetes is strict adherence to best practice
guidelines and rapt attention to clinical details.
Tweet: Diabetes is reaching epidemic levels in many
countries due to overeating and life
style changes relating to urbanization.
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