Explainer: what is diabetes?

To keep your body functioning, glucose must always be present in your blood. It’s as important as oxygen in the air you breathe. The brain can only function for a few minutes without either before it stops working altogether.

To achieve this level of control is not easy. Some days you might eat a banquet. Other times you might eat nothing at all. Yet through it all, glucose levels will normally fluctuate only very slightly. This is achieved thanks to an elaborate system of checks and balances that carefully regulate how much glucose is going into the blood and how much is going out.

Diabetes is the state in which this balance fails and glucose levels rise.

As sugars are digested and absorbed from your diet, they trigger the release of hormones, the most important of which is insulin, which is made and released by the beta cells of the pancreas.

Insulin coordinates the body’s response to rising blood glucose levels, telling the cells of the liver, muscles and fat to take away glucose from the blood (and store it for later use). It also tells the liver to stop making and releasing any extra glucose, which is rendered unnecessary by having just had a meal.

Diabetes occurs when there is not enough insulin (or insulin function) to keep glucose levels under control.

Many different factors can contribute to the decline and loss of insulin’s functions. In some people, their immune system can inadvertently destroy the insulin producing beta-cells of the pancreas. This is called type 1 diabetes.

Type 1 diabetes accounts for around 10% of all people with diabetes. It can occur at any age, not just in children and adolescents. Regular insulin injections are always needed to treat it. At present there is no way to restore the body’s ability to make its own insulin, but a cure for type 1 diabetes may be possible one day.

Type 2 diabetes

The most common form of diabetes is type 2 diabetes, which accounts for over 90% of cases. At least 1.7 million Australians currently have type 2 diabetes, and this number is expected to double over the next decade. At least a quarter of Australians will develop diabetes in their lifetime, mostly after the age of 60. By 2030 it is anticipated that one in ten adults in the world will have type 2 diabetes.

Any calories we eat that are in excess of those burnt by our metabolism or physical activities, are stored as fat. Most people develop type 2 diabetes because they cannot safely sequester all the excess energy from their diet as healthy fat, and a toxic waist starts to accumulate. This ectopic fat damages the beta-cells and produces resistance to insulin’s actions.

But while many Australians are overweight, only some develop type 2 diabetes. Some people are better than others in safely storing fat and/or remain capable of making enough insulin. However, others simply can’t sustain this extra workload and eventually there is not enough insulin (function) to keep glucose levels under control.

Some people develop type 2 diabetes without being very overweight. People of Asian descent, for example, are prone to lay down ectopic fat if they eat too much or are inactive. So gaining five kilograms almost doubles their risk of type 2 diabetes. By comparison, a five-kilogram weight gain in a Caucasian person has less than half this effect.

Physical activity and a good diet can reduce the risk of complications from type 2 diabetes. Michael Lokner

The best way to prevent type 2 diabetes is to rest your beta cells and lose your excess fat. Changes in the amount and types of sugar and fibre in your diet, for example, can reduce the strain on your pancreas. Reducing your waist through dieting and increased physical activity will burn fat and reduce its limiting effects on your metabolism.

The loss of insulin’s functions can have a number of effects on health and well-being. Type 2 diabetes usually starts out as a silent problem. The most common symptoms – fatigue, poor vision, irritability, reduced libido and passing urine more frequently – may all be dismissed as signs of getting old or other health problems. However, when suspected, diabetes can be easily identified by a blood test.

Diabetes can sometimes result in serious and life-threatening damage to blood vessels, heart, nerves, eyes, bladder and kidneys. This makes diabetes a leading cause of disability, illness and death in Australians.

Good management of type 2 diabetes can reduce the risk of complications. This involves interventions including diet, physical activity and usually medications to not only maintain good glucose levels, but also optimal blood pressure, weight and lipid levels. Close monitoring for early signs of complications also allows for their early detection and treatment.

In its early stages, type 2 diabetes is reversible. Gastric bypass surgery, for example, will “cure” type 2 diabetes in most cases. It requires major surgery that is not suitable for most people with type 2 diabetes. But it illustrates just how important waist control is for the prevention and management of type 2 diabetes.

Merlin Thomas is the author of Understanding Type 2 diabetes

Obesity causes Vitamin D deficiency — The Punch

Obesity can cause Vitamin D deficiency, according to a study published in a recent issue of PLoS Medicine.

The study, led by researchers from the D-CarDia collaboration, is the first to associate a high BMI with low Vitamin D levels. The implications of the finding are significant as it suggests that as obesity increases in the world so does Vitamin D deficiency, which can pose a serious range of health issues.

Over 42,000 people from 21 countries participated in the study. The researchers tried to identify any genetic variations that could be involved with BMI and Vitamin D to ensure that there were no other factors that could influence the results.

High BMI associated with low Vitamin D levels

They found that the association between high BMI and low Vitamin D was consistent among all different demographic groups. For each 10% increase in BMI there was a 4.2% drop in Vitamin D. Vitamin D scores appeared to have no link to BMI, indicating that the association between the two is more likely a Vitamin D lowering effect caused by a high BMI.

The authors said:

“We demonstrated that the association between BMI and lower (Vitamin D) concentrations in Caucasian populations from North America and Europe can be seen across different age groups and in both men and women. We also show that higher BMI leads to lower Vitamin D status, providing evidence for the role of obesity as a causal risk factor for the development of Vitamin D deficiency.”

The finding reveals the importance of monitoring and measuring Vitamin D levels among those who are obese. Vitamin D is essential for bone health as well as preventing cancer, diabetes and high blood pressure.

A recent study carried out by researchers from the University of Copenhagen found that low levels of Vitamin D can substantially increase one’s risk of heart attack and early death.

The authors concluded:

“Together with the suggested increases in Vitamin D requirements in obese individuals, our study highlights the importance of monitoring and treating Vitamin D deficiency as a means of alleviating the adverse influences of excess adiposity on health.Our findings suggest that population level interventions to reduce obesity would be expected to lead to a reduction in the prevalence of Vitamin D deficiency.”

It seems that obesity may place a person’s body into a vicious cycle of low Vitamin D and type II diabetes.

Researchers found that when somebody is both obese and has low Vitamin D levels, their risk of insulin resistance is much greater than if they have either factor alone. In other words, Vitamin D deficiency plus obesity, combined, increases your risk of developing insulin resistance much more than just obesity or just low Vitamin D.

Shaum Kabadi, from Dextrel University, said “Vitamin D insufficiency and obesity are individual risk factors for insulin resistance and diabetes. Our results suggest that the combination of these two factors increases the odds of insulin resistance to an even greater degree than would have been expected based on their individual contributions.”

Kabadi and team found that people with healthy levels of Vitamin D who were obese were nearly 20 times more likely to suffer from insulin resistance, compared to the rest of the population. However, obese people with low serum Vitamin D were 32 times more likely to have insulin resistance.


“Eat millet and steer clear of disease”

Overdependence on rice and wheat accelerates spread of urban ailments into the hinterland

To hundreds of women gathered at the Tamukkam Auditorium, it was a message that brought cheer. When the chairperson of Kalanjiam, a confederation of women’s self-help groups, Chinnapillai, recommended the consumption of millet on a daily basis, they cheered. Millet is the staple diet in many households.

The message was ‘boycott junk food; go back to small millets.’ The women and children had assembled at the Tamukkam Ground at the culmination of ‘Walkathon 2013,’ organised by Dhan Foundation with the theme — ‘Food security through agricultural biodiversity: relevance of small millets.’

Outside the venue were posters carrying information on the nutritious value of each variety of small millets such as ‘kezhvaragu’ (ragi) and ‘panivaragu’ (common millet).

Their samples were kept on display. Several speakers, including Lakshmikanthan of Vayalaga Iyakkam, explained how consumption of small millets controlled the spread of diabetes, high and low blood pressure, and anaemia. Exclusion of ‘God’s grain,’ the small millets, and overdependence on rice and wheat had accelerated the spread of urban ailments into the hinterland.

Palanichamy, the convenor of Walkathon 2013, showcased the potential of small millets to prevent malnutrition among women and children.

Pandiammal from Peraiyur recalled how food made from small millets provided them with the strength and stamina to labour in agricultural fields from dawn to dusk. The absence of millet in the daily diet was sending people to hospital, she noted.

M. P. Vasimalai, Executive Director, Dhan Foundation, speaking on the sidelines of the meet, said that the objective of organising the walkathon in 26 district headquarters in five States was to promote agricultural biodiversity through small millets. T

he Dhan Foundation had come out with a 10-point strategy to encourage cultivation of rain-fed millet. The strategy includes creation of farm ponds, preservation of oorunis (used for drinking water) and kanmais (used for irrigation) and development of orchards and seed farms.

Food processing centres to come out with value-added products such as cookies using small millets would be started in Peraiyur in Madurai district, and Anjatti and Javvadu Hills in Krishnagiri district. Research conducted by the Tamil Nadu Agricultural University showed that millets facilitated slow release of sucrose and glucose and helped in controlling diabetes.

They also had high nutritional value, he said.

The walkathon of women self-help groups and students began at the Mariamman Teppakulam. A group of differently abled persons participated in it from Gandhi Memorial Museum to the Tamukkam Ground. Prizes were given away to winners of drawing and essay competitions on agricultural biodiversity conducted for school students.