The Government has initiated steps to reduce the number of deaths from harmful tobacco usage in the population. But this is only one of the four risk factors that lead to the Chronic Non-Communicable Diseases that account for 70 per cent of all deaths here. The four main NCD’s – cardiovascular diseases, diabetes, cancer and chronic respiratory – disease amounts for the highest burden on mortality and morbidity.
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 to 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, kidney 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.
However, diabetes is one of the NCD’s 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 above mentioned 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 one 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 of leafy vegetables and lean protein, can significantly lower glucose levels in the blood.
Guyana had 61,800 cases of diabetes in 2014 leading to a rate of 14.3 per cent for the adult population (20-79 years) which is significantly higher than the world rate across the age spectrum. There were 1025 persons whose deaths were directly attributed to diabetes. These are very alarming figures.
Over the past decade, the Government of Guyana has done a credible job of improving the facilities for dealing with diabetes-related medical complications, such as infected and gangrenous feet in patients. This must be continued but conjoined with an even more robust programme to prevent the development of the condition.
We have avoided describing diabetes as a “disease” because of the impact of factors within the control in the individual to prevent or control the condition.
