August 20, 2016


Dr. Aung Soe (a) Aung Kyaw Moe
Retired State Medical Superintendent


The slogan mentioned above is meant for the World Health Day 2016 which falls on April 7. Since 1950, the World Health Organization (WHO) has been choosing a dynamic slogan every year          concerning the threat to public health around that particular year, for example, KNOW  YOUR  OWN  HEALTH  SERVICES (1950), HEALTH  FOR  YOUR  CHILD  AND  WORLD’S               CHILDREN (1951), HEALTHY  SURROUNDINGS  MAKE  HEALTHY  PEOPLE  (1952), HEALTH  IS  WEALTH (1953) and so on uptil today. In 1971 too, A  FULL  LIFE  DESPITE  DIABETES  was WHD  slogan.
This year’s slogan is concerned with DIABETES, as it was in 1971 too. Let me briefly claborate some points about Diabetes, a socio-economical disease.
Problable causes of diabetes
–    Type 1 : Destruction (possibly autoimmune) of insulin producing ß cells of pancreas, resulting in significatn insulin deficiency; patients require insulin.
–    Type 2 : Due to impaired insulin secretion (“burnout” of ß cells), insulin resistance (at level of peripheral insulin receptors), and increased hepatic glucose production : patient may or may not require insulin.
–    Glucose is toxic to nerve cells (resulting in neuropathy), blood vessels (resulting in heart disease, kidney disease, peripheral vascular disease, and hypertension, retinal cells (blindness) and many other cell types.
Diabetes should not be mistaken for : –
–    Insulin resistance syndrome (syndrome X)
–    Gestational diabetes
–    Pancreatic disease (pancreatitis, pancreatic tumour, infection)
–    Systemic disease resulting in pancreatic insufficiency (hemochromatosis, cystic fibrosis, hormonal changes)
Prevailing diabetes
–    Affects about 10 percent of community
–    Type 1 accounts for less than 10 percent of cases
–    Type 2 accounts for more than 90 percent; genetic predisposition : risk increases with increased age and weight.
–    Affects males and females roughly equally.
One should be alert to notice
–    Polyuria (frequent urination), polydipsia (increased thrist), polyphagia (excessive desire      for large meals)
–    Fatigue
–    Frequent infections
–    Retionpathy : blindness, cataracts
–    Nephropthy : Glomerulosclerosis, nephrotic syndrome, renal failure
–    Atheroselerosis : – Coro
nary Artery Disease
–     Peripheral Vascular Disease (foot ulcers, gangrene)
–     Cardio Vascular Accidents
–    Autonomic neuropathy : Orthostatic hypotension, gastroparesis, urinary retnetion, neurogenic bladder, impotency, arrythmias
–    Peripheral neuropathy : decreased sensation        Charot joints
–    Hypertension
How to know you have diabetes
–    There are numerous criteria. ADA criteria for diagnosis is : symptoms of diabetes plus random blood glucose more than 200 mg/dL or fasting blood glucose more than 126 on blood glucose more than 200 during oral glucose tolerance test (2 hours after glucose load)
–    Fasting blood glucose (more than 8 hours fasting)
–         blood glucose less than 110 is normal
–         110 – 125 is considered impaired fasting glucose (IFG)
–         126 or more is considered diabetes
–    Every person over 45 years to be sercened 3 yearly
–    HbA1C reflects glucose control over past 3 months.
–    Serum insulin : Greatly decreased in Type 1 DM, initially increased in Type 2, but falls as ß cells “burn out”
–    Signs and symptoms of end organ damage
–    Renal functions : Microalbuminuria (30-300 mg/24 hrs) signifies early stage nephropathy :  BUN / creatinine increase as renal function decreases.
To seek treatment from care givers
–    Be attached to your family doctor. Should consult in time to physician, surgeon, diabetician, endocrinologist, podalist, pathologist, ophthalmologist, nephrologist, urologist, rheumatologist diabetic nurse and others whenever necessary through your family doctor.
–    Carefully integrate low-sugar diet, exercise, insulin
–    Oral agents
–    Sulphonyurias : increase insulin secretion
–    Biguanides (metformin) : decrease hepatic glucose, weight loss
–    Thiazolidinediones : decrease insulin resistance
–    a-Glucosidase inhibitors : decrease carb absorption.
–    Orlistat : decrease fat absorption from gut
–    Insulin preparation
–    Rapid – acting, short duration : Regular, Lispo
–    Immediate acting – medium duration : NPH, lente
–    long acting : Ultraline, Glargine
–    combination 70/30 (70% NPH 30% regular)
–    Aspirin, antihypertensives (preferably ACE inhibitors for renal protective), statins, heart medicines
–    Patient should avoid self-medication.
Always bear in mind:-
–    Acute complications
–    Diabetic ketoacidosis (Type 1)
–    Non-ketolic hyperosmolar coma (Type 2)
–    Hypoglycemia
–    Chronic complications : end-organ disease
–    non traumatic leg ampulation
–    adult blindness
–    Morbidity is due to Myocardial Infarction, Cardio Vascular Accident, renal failure and infections
–    Regular monitoring of glucose, lipids, renal functions, Blood Pressure and peripheral neuropthy.
How to make healthy choices everyday to keep diabetes at bay
Smoking and tobacco consumption should be discouraged. Do not start smoking in public or in the vicinity of young children. Smoking and chewing tobacco should be strictly avoided during pregnancy.
Social drinking, if not controlled, could lead to chronic and severe alcoholism. People should be better informed regarding alcohol and illicit liquor.
Stress and strain often create mental, social and physical deterioration. Take vacation to get relaxed, and get proper rest and sleep. Balanced nutrition and regular exercise will promote your health.


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