By Henrylito D. Tacio
“An ounce of prevention is better than a pound of cure,” said Benjamin Franklin. This proverb is often used to mean that it is better to take precautions to prevent something bad from happening than to deal with the consequences of it happening.
Such is the case of diabetes. The International Diabetes Federation reported that one in 14 Filipino adults lives with diabetes, which Dr. Roy B. Ferrer – an internist and a Master of Science in internal medicine, majoring in diabetology – describes it as “a silent killer disease.”
Diabetes, Dr. Ferrer said, is mostly downplayed. Yet, it is one of the leading diseases of morbidity and mortality in the country. The Department of Health lists diabetes as the sixth leading cause of death among Filipinos.
Dr. Joshua Diao, a family doctor and education specialist whose interest is in diabetes in primary care, said 50%-80% of Asians – and that includes Filipinos – who have pre-diabetes don’t know they have it. Pre-diabetes means they have a higher than normal blood sugar level.
He based this data from the American Diabetes Association (ADA). “(The figure),” he clarified, “is the batting average for most countries in the region.”
Dr. Diao lamented that “less emphasis” is placed on pre-diabetes. “But it’s more important to manage it,” he added.
“If I were a lawmaker, I’d put more emphasis still on pre-diabetes than a diabetes treatment center,” he explained. “Diabetes to an extent is preventable.”
Diabetes is actually part of the non-communicable diseases (NCDs) program of the health department. “We’re doing a lot of screening in our hospitals already,” Dr. Diao said. “And we’re catching a lot of them.”
The Philippines accelerated the health sector reform by the passage of Republic Act 11223, more commonly known as the Universal Health Care (UHC) Law.
“UHC’s thrust is really preventive and promotive, so we decided to increase our focus also on it,” said Dr. Diao, who is with the Mayor Hilarion A. Ramiro Sr. Medical Center in Ozamiz, Misamis Occidental.
Patients who come in are being asked routine questions like a strong family history of diabetes, hypertension, cancer, tuberculosis (exposure), and vices. “If we deemed the patient is at risk, we do appropriate tests,” he said.
On a typical day, they screen at least 50 patients, especially those aged 20 years old and above. “We catch at least one to two pre-diabetic patients,” Dr. Diao said. “The same figure for diabetes.”
Those being caught are advised to do the following, based on the recommendation of ADA: routine check-ups every three months, nutrition counselling (every six months, if needed), and attend diabetes education and self-management classes (one-on-one). To be done annually are eye exams, dental exams, and foot screening.
Some years back, Reader’s Digest published an article of 10 diseases that most doctors missed to diagnose and impaired glucose tolerance (IGT) was one of them. “It is the same problem as diabetes but in a milder form,” explains Dr. Gauden Galea, a public health physician who has worked at the World Health Organization (WHO) since 1998.
IGT is considered as pre-diabetes stage. In fact, people with untreated IGT have a 50% of developing type 2 diabetes. Citing a commissioned study, Dr. Ruby Go of the Philippine Lipid Atherosclerosis Society said unlike normal diabetes, pre-diabetes has no symptoms.
Since there are no symptoms, people don’t know they have it. The only way a person would know if he or she has IGT is through the glucose tolerance test. “The glucose tolerance test identifies abnormalities in the way your body handles glucose after a meal – often before your fasting blood sugar level becomes abnormal,” the Mayo Clinic explains.
Most people eat three times a day. “After you eat, various foods are broken down in your gut into sugars,” explains Diabetes United Kingdom (UK). “The main sugar is called glucose which passes through your gut wall into your bloodstream. However, to remain healthy, your blood glucose level should not go too high or too low.”
The blood glucose level literally refers to the amount of glucose in the blood. A normal blood glucose level ranges between about 4 and 8 millimoles per liter (mmol/L). Blood glucose levels may be at the higher end of the range after eating and at the lower end of the range first thing in the morning.
“When your blood glucose level begins to rise (after you eat), the level of a hormone called insulin should also rise,” Diabetes UK says. “Insulin works on the cells of your body and makes them take in glucose from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into glycogen or fat (which are stores of energy).”
In instances where the blood glucose level begins to fall (between meals), the level of insulin also falls. Some glycogens or fat is then converted back into glucose which is released from the cells into the bloodstream.
Insulin, according to the ADA, is a hormone made by the pancreas that allows the body to use sugar (glucose) from carbohydrates in the food that a person eats for energy or to store glucose for future use. Insulin helps keep the blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia).
Insulin is a hormone that is made by cells called beta cells. These are part of little islands of cells (islets) within the pancreas. Hormones are chemicals that are released into the bloodstream and work on various parts of the body.
IGT happens when the blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis. But IGT, a person faces a much greater risk of developing diabetes. In fact, “one to three out of every 4 people with IGT will develop diabetes within a decade,” notes the diabetes.co.uk, the global diabetes community.
In the Philippines, one out of every five Filipino adults has either diabetes or at risk of IGT. Type 2 diabetes accounts for 90% of all cases in the country.
Aside from diabetes, people with IGT also face a greater risk of cardiovascular disease, including high blood pressure (hypertension), increased cholesterol levels, and being overweight or obese.
Among those who are most likely to develop IGT are those who are overweight or obese, have a family history of diabetes (this refers to a close family member with diabetes – a mother, father, brother, or sister), do little physical activity, and have other risk factors for cardiovascular disease such as high blood pressure or high cholesterol levels.
A woman who has polycystic ovary syndrome (a condition in which a woman’s high levels of testosterone prevented her ovaries from releasing eggs, which then became cysts), overweight or developed gestational diabetes during pregnancy is a candidate for IGT.
Because IGT has no signs or symptoms, sufferers may not know they have it. If symptoms occur, they are similar to the mild early symptoms of diabetes, which include excessive thirst and appetite, increased urination, weight loss, and fatigue.
If you think you are a candidate for IGT, then you need to take the glucose tolerance test. Before coming to a clinic, he must fast himself first. At the clinic, the doctor conducts the test where he measures the blood glucose of the patient. A standard glucose drink is given (containing 75 grams glucose for adults). Blood glucose is again measured two hours after the test. “Someone with IGT will get higher levels of glucose over a longer period,” says Dr. Galea.
According to the Geneva-based United Nations health agency, a person is said to have IGT if he has a fasting blood glucose of less than 7 mmol/L, and a blood glucose of 7.8 mmol/L or more but less than 11.1mmol/L after a two-hour oral GTT.
“If your blood glucose is measured by a blood test when you have not been fasting, this is called a random blood glucose level,” explains Diabetes UK. “If your blood glucose is measured after you have been fasting, this is called a fasting blood glucose level. A normal fasting blood glucose level is less than 6 mmol/L.”
“There is increasing evidence that if impaired glucose tolerance is treated, the progression to diabetes can be prevented,” says the website, patient.co.uk. “Also, it may be possible to prevent cardiovascular disease from developing. So, it is important to know if you have impaired glucose tolerance and to treat it in order to reduce your risk of developing diabetes and cardiovascular disease.”
Treatments that have been suggested include lifestyle changes and treatments with medicines. “Losing weight, exercising more and eating a healthy, balanced diet all help to treat IGT,” notes Diabetes UK. “Stopping smoking, sticking to the recommended weekly alcohol limits and keeping blood pressure in a normal range all help to lower the risk of IGT developing into type 2 diabetes.”
There are also drugs prescribed by doctors to treat IGT. “Medicines that have been, or are being, trialed include metformin, acarbose, a group of medicines called ACE inhibitors and another group of medicines called angiotensin-II receptor antagonists,” Diabetes UK reports.
Pre-diabetes can also be detected through impaired fasting glucose (IFG). The fasting glucose test involves testing blood sugar levels after a person has gone without food or drink (other than water) for at least eight hour.
Meanwhile, an estimated 8 million Filipinos are not aware that they are already entering the stage of “pre-diabetes,” according to health experts. – ###
(Photos courtesy of Dr. Joshua Diao)
