Nipping Diabetes in the bud!

Diabetes is rapidly becoming a global epidemic with the South Asian population being more prone to it. The dietary patterns which constitute a fair proportion of the socio-cultural fabric of the Asian region are conducive to this disease with alarming human, social and economic costs. Local research has revealed that a significant percentage of the urban as well as the rural population of Sri Lanka is pre-diabetic which calls for a multi-dimensional approach in ‘nipping it in the bud’.
“Empowerment of the community is crucial in this regard,” says Dr. Renuka Jayatissa, Head of the Department of Nutrition, Medical Research Institute, whose publication Beating Diabetes was recently launched, filling a long-felt lacuna in the diabetic care in Sri Lanka. An ambitious venture, Beating Diabetes is a reader-friendly publication with a practical approach to management of diabetes. The Nation takes a closer look.

By Randima Attygalle
Craving for a delicacy to which your rational mind will say a big ‘NO’ is an infuriating experience. Refraining from traditional sweetmeats amidst seasonal festivity is a laborious task. Claiming to be a ‘diabetic’ is indeed frustrating and management of the disease in the pre-diabetic phase is a small price to pay for a bigger health gain. “Witnessing diabetics refraining from an assortment of foods at various gatherings offered me food for thought for a compilation on the management of diabetes, giving them more options for a healthy diet and lifestyle management, and to enjoy with food that they like most and not denying them of all the simple joys of food,” says Dr. Renuka Jayatissa whose wealth of experience over a decade as a specialist in Community Medicine and Consultant Medical Nutritionist to the Ministry of Health (Department of Nutrition, MRI) has conceived Beating Diabetes.

Practical approach
Making clinical literature accessible to a larger audience, the publication has succeeded in unfolding a practical, localised approach to management of diabetes with contents dedicated to foods and festivals in Sri Lanka as well as cultural and religious paradigms. An interesting component of the publication is the section allotted to Buddhist clergy. “Prevalence of diabetes among Buddhist priests is fairly high since they refrain from food after 12 noon till morning next day and very often the lunch which is offered to them by the laymen contains high fat and sugar-associated foods and my aim is to provide the priests with a consistent carbohydrate diet with the recommended CHO choices,” explained Dr. Jayatissa.

The pictorial food guides facilitates better understanding of the disease and guidelines related to interpreting fasting blood sugar counts, Body Mass Index, cholesterol, etc. enable self-assessment of the same. “The main objective of this publication is to guide the diabetics, pre-diabetics (border-line category) and to enhance their clinical literacy,” says Dr. Jayatissa who believes that despite the high literacy rate Sri Lanka claims, the country’s population is grossly handicapped in clinical literacy.

“Very often patients are diagnosed with diabetes when they are under medical treatment for another inter-related ailment which the former has triggered or aggravated and it’s alarming news that even a considerable percentage of the youth population is diabetes-prone,” she adds.

According to Dr. Jayatissa, recent studies on diabetes reveal that a considerable percentage of the population is pre-diabetic, including the youth and 1/3rd of the diabetic populace goes undetected. “Today we cannot assume that one is more vulnerable to diabetes after the age of 40 years because the dietary patterns and sedentary lifestyle have dramatically altered the situation,” adds Dr. Jayatissa who further cites that the hitherto less vulnerable rural population today too claims a diabetic segment of 15%.

A global epidemic
The prevalence of low birth weight (less than 2.5 kg) in Sri Lanka which amounts to nearly 18% has largely contributed to diabetes raising its head in childhood and adolescence. These babies programme in such a way to cope with the limited quantity of insulin. When they become adults and are overfed, they cannot cope with such situations due to inadequate amount of insulin. The failure to maintain the normal blood sugar levels in adulthood precipitate diabetes and the numbers of such cases seem to be accelerating in the country according to Dr. Jayatissa.
Empowerment is vital in the management of diabetics which is fast becoming an epidemic globally. As estimated by the WHO, presently more than 200 million people worldwide are living with the disease and each year another seven million develop it. Altering the dietary patterns and lifestyle are the keys to diabetes management. Medical checkups to assess individual levels of diabetes are of immense help in preventing the disease, especially if one claims a family history of diabetes or falling into the pre-diabetes range. “With more people engaged in sedentary occupations today, we strongly recommend over-weight individuals, over 18 years to be assessed for diabetes,” advices Dr. Jayatissa.

Moderation – The golden rule
Eating in a selective manner in selective quantities is the cardinal rule in ‘beating’ diabetes with physical activity to complete it. “Apart from engaging in sporting activities or seeking a gym, there are common household activities that one can incorporate into daily routine,” says Dr. Jayatissa who identifies washing the vehicle, sweeping, stair walking and mopping as some of the commonest activities.
In the multi-ethnic locale we inhabit in, festivals are very much an integral part of the Sri Lankan culture and Beating Diabetes offers practical tips in enjoying the delicacies unique to each festival in moderation. “Most of the traditional delicacies contain a high level of sugar and fat and diabetics should be conscious of portion-control,” stresses Dr. Jayatissa who warns against excessive intakes of sweetened beverages and foods with high glycaemic food (GI) foods such as biscuits, pastries, etc.

Food manufacturing policies
Obligations on the part of the food manufacturers in addressing diabetes is a timely need believes Dr. Jayatissa who draws fine illustrations from sweetened beverages which often attract children. “As a country our palates are more geared to sweets and there should be policies concerning food manufacturers in reducing the sugar levels which are presently found in excess,” she opines adding that the Ministry of Health is to spearhead a sugar reduction strategy as a policy to control the high consumption of sugar in collaboration with food manufacturers. Stressing on the importance of reading food labels prior to purchasing processed food items, Dr. Jayatissa said in conclusion, “will give a clear idea to the consumer of the amount of sugar in each food item. Traffic light labeling is the other aspect to create awareness among consumers with red, amber and green. It will help to identify the food items with recommended amount of sugar without much hassle in reading labels.”