The COVID-19 pandemic has highlighted unequal vulnerabilities of persons with noncommunicable diseases, as compared to persons without. This has forced health systems and governments around the world to increase the implementation of measures that target at-risk populations, to prevent noncommunicable diseases (NCDs), and more so diabetes.
Diabetes occurs when two processes are impaired – both connected to the body, dealing with the transportation of glucose sugar to the cells of the body via the blood. All carbohydrates and sugars are digested as glucose – which is small-molecule sugar for easier transportation to the cells that use it to produce energy for our activities. Too high a concentration of glucose in the blood, however, adversely affects several organs in the body, in addition to forcing the cells to break down other molecules – even our proteins – to obtain energy. The affected organs are the eyes, heart, kidneys and the feet, and cumulatively debilitates the patient in the early stages, and can lead to death in the end. Diabetes, for instance, increases heart attack risk by up to three times for men and five times for women.
Here is Guyana, the issue of diabetes has been brought to the forefront on Wednesday during the Trainer of Trainer event. At that training programme, Health Minister Dr Frank Anthony revealed that some 330 people in Guyana require dialysis treatment in order to live. For a small population, this figure is worrying. But to the minister’s credit, he did also reveal that as Guyana shifts gear to tackle diabetes, focus will now be directed not only on improvement to treatment, but early identification of persons at risk for diabetes and those who are considered pre-diabetic. To its credit, the Government in Budget 2023 allocated $863 million to support persons in need of dialysis.
Diabetes is one of the NCDs caused by the other three risk factors – unhealthy diet, physical inactivity and harmful use of alcohol. A programme to reduce these risks is within the capabilities of the Public Health Ministry, since it involves primarily education. There are verbal questionnaires that can indicate a predisposition in persons towards developing type 2 diabetes. If these are conducted early enough, a change of lifestyle to incorporate the abovementioned factors of regular exercise and controlled diet have been shown capable of averting the diabetic condition.
The body controls the level of glucose sugar in the blood at a safe, optimum level by secreting the hormone insulin from the pancreas whenever the level rises beyond that level. There are two types of diabetes: type 1, in which the body is unable to produce the hormone insulin; and type 2, in which the body is unable to use insulin effectively. Type 2 is the most common form, accounting for around 90 per cent of all diabetes cases worldwide. Type 1 is diagnosed very early on, and affects mostly children, while type 2 develops gradually and manifests its effects generally in adults approaching their 40s. In type 2 diabetes, the pancreas production of insulin could be impaired, as well as the mechanisms by which glucose sugar is transmitted from the blood through the cell walls.
The treatments for diabetes attempt to positively assist the impaired processes. There can be the direct intake of insulin at prescribed times, which is the only path for type 1 patients and type 2 patients at an advanced stage. There are also medications that stimulate the pancreas to produce more insulin, as well as some to assist in glucose transfer into the cells. It has been found that mild daily exercise also assists in the latter process, and coupled with a diet that is low on sugars, easily digestible carbohydrates, and high on leafy vegetables and lean protein, can significantly lower glucose levels in the blood.
According to the Health Ministry’s figures in 2022, diabetes is a major health problem as it affects 1 in 10 adults.
Over the past decade, the Government of Guyana has done a credible job of improving the facilities for dealing with diabetes-related medical complications. This must be continued, but conjoined with an even more robust programme to prevent the development of the condition.
