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14 November, 2017 11:29:35 AM
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World Diabetes Day: Understanding and living with diabetes

Diabetes can affect any part of your body. The good news is that you can prevent most of these problems by keeping your blood sugar level under control
Dr. Mohammed Abul Kalam
World Diabetes Day: Understanding and living with diabetes

World Diabetes Day falls every year on 14 November and is a day when millions of people around the world come together to raise awareness of diabetes, and what it’s really like to live with the condition. It’s a global campaign led by the International Diabetes Federation (IDF) with activity taking place around the world.
Diabetes is a chronic (long-lasting) disease that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. Your pancreas makes a hormone called insulin, which acts like a key to let the blood sugar into your body’s cells for use as energy. If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream, which over time can cause serious health problems, such as heart disease, vision loss, and kidney disease. Invisible changes in the body begin long before a person is diagnosed with type 2 diabetes. That's both bad news (no symptoms mean you won't know you have it) and good news (you can prevent or delay it if you're at risk).
Bangladesh has a disproportionately high diabetes population with more than 7.1 million, 8.4per cent or 10 million according to research published in WHO bulletin in 2013, of the adult population affected by the disease. The number will be 13.6 million in 2040. Nearly half of the population with diabetes, 51.2per cent, doesn’t know that they have diabetes and don’t receive any treatment. Bangladesh is home to a 161 million population, according to the latest census report. During 90s, the country has a relatively low diabetes affected population. In 1995 is was only 4per cent which grew to 5per cent in 2000 and 9per cent in 2006 to 2010. According to the International Diabetes Federation, the prevalence will be 13per cent by 2030.

Diabetes can affect any part of your body. The good news is that you can prevent most of these problems by keeping your blood glucose (blood sugar) under control, eating healthy, being physical active, working with your health care provider to keep your blood pressure and cholesterol under control, and getting necessary screening tests.

Cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to four times more likely than people without diabetes to die of heart disease or experience a stroke. Also, about 70per cent of people with diabetes have high blood pressure, a risk factor for cardiovascular disease.

People with type 2 diabetes have high rates of cholesterol and triglyceride abnormalities, obesity, and high blood pressure, all of which are major contributors to higher rates of cardiovascular disease. Many people with diabetes have several of these conditions at the same time. This combination of problems is often called metabolic syndrome (formerly known as Syndrome X). The metabolic syndrome is often defined as the presence of any three of the following conditions: 1) excess weight around the waist; 2) high levels of triglycerides; 3) low levels of HDL, or "good," cholesterol; 4) high blood pressure; and 5) high fasting blood glucose levels. If you have one or more of these conditions, you are at an increased risk for having one or more of the others. The more conditions that you have, the greater the risk to your health.

To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels. Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program. Quit smoking if you currently do. Get a hemoglobin A1C test at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months. Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

There’s a lot you can do to prevent eye problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.

In diabetic kidney disease (also called diabetic nephropathy), cells and blood vessels in the kidneys are damaged, affecting the organs’ ability to filter out waste. Waste builds up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.

There’s a lot you can do to prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.

Diabetic kidney disease happens slowly and silently, so you might not feel that anything is wrong until severe problems have developed. Therefore, it is important to get your blood and urine checked for kidney problems each year.

You can help keep your nervous system healthy by keeping your blood glucose as close to normal as possible, getting regular physical activity, not smoking, taking good care of your feet each day (see below), having your health care provider examine your feet at least 4 times a year, and getting your feet tested for nerve damage at least once a year.

Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg. Look for cuts, cracks, sores, red spots, swelling, infected toenails, splinters, blisters, and calluses on the feet each day. Call your doctor if such wounds do not heal after one day.

Gastroparesis, otherwise known as delayed gastric emptying, is a disorder where, due to nerve damage, the stomach takes too long to empty itself. It frequently occurs in people with either type 1 or type 2 diabetes. Symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, gastroesophageal reflux, and spasms of the stomach wall.

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums.

And like all infections, dental infections can make your blood glucose go up. Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth.

People with diabetes can have tooth and gum problems more often if their blood glucose stays high. Also, smoking makes it more likely for you to get a bad case of gum disease, especially if you have diabetes and are age 45 or older.

Many people with diabetic nerve damage have trouble having sex. For example, men can have trouble maintaining an erection and ejaculating. Women can have trouble with sexual response and vaginal lubrication. Both men and women with diabetes can get urinary tract infections and bladder problems more often than average.

Several studies suggest that diabetes doubles the risk of depression, although it’s still unclear why. The psychological stress of having diabetes may contribute to depression, but diabetes’ metabolic effect on brain function may also play a role. At the same time, people with depression may be more likely to develop diabetes.

The risk of depression increases as more diabetes complications develop. When you are depressed, you do not function as well, physically or mentally; this makes you less likely to eat properly, exercise, and take your medication regularly. In addition, diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes who come down with the flu may become very sick and may even have to go to a hospital. You can help keep yourself from getting the flu by getting a flu shot every year. Everyone with diabetes—even pregnant women—should get a yearly flu shot. The best time to get one is between October and mid-November, before the flu season begins.

The writer is a Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR),

Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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