Most health experts agree that the world is facing a huge increase in the number of individuals with diabetes. Dr Jace Clarke examines the causes of diabetes, who is most at risk, and what expatriates can do to limit the possibility of developing this life-long condition.
Diabetes is an increasingly common chronic condition that changes day-to-day life forever, and can have serious health consequences for individuals all over the world. In the United Kingdom for example, over the last 15 years the number of people diagnosed with the condition has increased by 85%*. Most cases will be Type 2 diabetes, fuelled by the rapidly rising level of obesity in the civilized world today.
Insulin is the human hormone which facilitates the essential transport of glucose into cells. Diabetes develops when either there is not enough insulin produced in the pancreas or the body develops a resistance to normal blood levels of insulin. Glucose is a breakdown product of sugars found in bread, rice, potatoes, fruit, some dairy products, sugar and other sweet food and drink that we consume.
Could you be at risk?
If you are white and over 40 years old, or African-Caribbean or South Asian and over 25 years old, and you identify with any of the following statements, you could be at greater risk of developing diabetes
• You are overweight or your waist is over: 80cm for women; 90cm for Asian men; and 94 cm for white and African-Caribbean men.
• You have high blood pressure or you have had a heart attack or a stroke.
• You have impaired glucose tolerance or impaired fasting glycaemia.
• You are a woman with polycystic ovary syndrome and you are overweight.
• You have had gestational diabetes as a result of pregnancy or you have given birth to a large baby.
• You have severe mental health problems.
• A close member of your family has Type 2 diabetes.
There are two main types of diabetes, Type 1 and Type 2. Type 1 diabetes usually appears before the age of 40, and especially in childhood, with no clear reasons for its onset. Type 2 diabetes accounts for 85% of all diabetes sufferers, and may prove to be preventable before retirement age.
Knowing the symptoms
In the UK, over 2.6 million people suffer with diabetes, with an estimated further half a million cases not diagnosed.
The signs and symptoms of diabetes are:
• Increased thirst
• Passing urine frequently especially at night
• Extreme tiredness
• Weight loss
• Blurred vision
• Genital itching or regular episodes of thrush
• Slow healing of wounds
In Type 1 diabetes the signs and symptoms will normally be very obvious, developing quickly, and usually over a few weeks. The signs and symptoms of Type 2 diabetes, however, may not be so evident. The best advice is to receive regular tests to ensure that your glucose levels are within the acceptable limits.
A simple 'dipstick' test may detect glucose in a sample of urine, but a blood test is needed to make the full diagnosis. If you are diagnosed, medication and/or insulin are often prescribed, and this is a life-long commitment together with regular specialist consultations and screening.
Follow a healthy diet, lose weight and take regular exercise
In general, our more sedentary way of life and poor diet, leave us susceptible to conditions like diabetes. Limiting fatty and sugary foods and drinks, managing portion sizes, and taking regular exercise, will keep blood glucose, blood pressure and cholesterol levels as near to normal as possible, helping to prevent the development of diabetes.
A proper diet is also an integral part of managing diabetes for those who already have the condition. Following a healthy, active lifestyle will improve well being, and decrease the risk of developing complications associated with diabetes such as a heart attack, stroke, amputation, blindness, kidney failure and nerve damage.
To help keep blood glucose under control, a diet of unrefined carbohydrates, including wholegrain breads, cereals, beans, peas, vegetables and whole fruits is essential. These low sugar sources of slow-releasing carbohydrates will help ensure that you get plenty of fibre in all of your meals, and keep you fuller for longer so that you don’t feel the need to snack or over-eat.
There are many specialised diets available to help prevent and manage diabetes, like the GI (glycemic index) diet. Ask your doctor to recommend the right one for you.
Financial considerations
It’s not just the well-being of your health that you will need to consider. As an expatriate with diabetes, the life-long treatment required can be costly. A good international private health insurance will provide generous financial cover for the regular consultations, tests and medication required to monitor and maintain the stability of a chronic condition like diabetes. Take heed though. Most insurances will not provide cover if diabetes is a condition that you have suffered from before joining the plan.
Diabetes is one of the biggest health challenges facing the civilized world today. If we are to restrict the number of us who develop diabetes and die from the condition and its complications, we all need to bring about lifestyle changes.
Dr Jace Clarke FFARCS MRCGP
*Source: Diabetes UK - Studies on the population of the United Kingdom.