Diabetes has reached epidemic proportions globally and in Sri Lanka. Often this debilitating disease strikes a person unawares. Thousands are ignorant that they have the disease till it is at an advanced stage or complications have set in. While the focus of World Diabetes Day this year was on recognising early symptoms and preventing this condition, Sri Lanka Diabetes Federation President Dr.Prasad Katulanda feels the time is right to also discuss a subject that has hitherto been sidelined, namely, Diabetes in men. This condition can have serious negative health impacts on the patient, family and society as a whole, he says.
Excerpts from his interview with the Sunday Observer
SO. While World Diabetes Day focused mainly on diabetes prevention in general with more accent on women, Diabetes in men has been a sidelined issue. However, studies have shown that men with diabetes can have as many adverse health impacts as women. Do you agree? Do you have scientific evidence on this?
PK. Yes diabetes is a major issue in men as it is in women. Since most men compared to women are breadwinners and work outside their home compared to many women, men tend to neglect their diabetes more than women.
SO. What kind of Diabetes are men more likely to have? Is it type 2 diabetes? Have you any statistics on the prevalence of diabetes in men worldwide?
PK. Males and females get both, type 1 and type 2 diabetes without much difference.
SO. What is the estimated number of people with diabetes in Sri Lanka? There have been many figures trotted out recently. What is the latest figure and estimated percentage?
PK. A major study on diabetes at an island wide scale was done in 2006 (SLDCS – Sri Lanka Diabetes and Cardiovascular Study) and it showed that 10% of adults above 20 years had diabetes. In SLDCS the prevalence of diabetes in the Colombo District was 18%. An ongoing study on diabetes has recently shown over 25% of diabetes in the Colombo District and several smaller studies done during the last few years in Colombo and Jaffna has confirmed similar high figures. However, in government hospitals we mostly see women. Perhaps, the reason may be that due to work commitments many men with diabetes may be neglecting the disease.
SO. From your own experience, do you see an increase in the number of diabetics in general in Sri Lanka in the past decade? Why?
PK. There is a dramatic increase in the numbers both in men and women. The reasons may be due to the rapidly changing lifestyles and not reducing the intake of food in keeping with increasingly sedentary lifestyles. Most people spend time sitting for hours at work and watching TV during leisure. Today, we live in an instant culture with machines for everything – from transportation to domestic work, and washing clothes.
In addition, there is abundance of food, especially, sugar and oil rich food which make people obese. Obesity is a major cause for diabetes.
SO. What are the physical and health impacts of getting diabetes on the human body?
PK. People who get diabetes need to control the blood glucose to near normal levels. If not, it can cause damage to their kidneys leading to kidney failure, nerves leading to insensitivity of feet and nerve pain, eyes leading to blindness, heart attacks and strokes at a younger age. In addition, they are prone to many infections, blocks in the blood supply to the feet leading to amputation.
SO. According to studies people with diabetes are likely to experience heart disease and kidney failure, poor circulation leading to ulcers blood clots and retinopathy, Do you agree? How do these conditions occur?
PK. I have mentioned about these conditions above. They occur because high blood glucose is toxic to the cells of the body and leads to damage to the cells. Some of these damages occur to the small blood vessels of the above organs (microvascular damage) which leads to poor blood supply (ischaemia). In addition, poorly controlled diabetes aggravates deposition of lipid rich material (atherosclerosis) in big blood vessels (macrovascular disease). This also leads to heart attacks, stroke and peripheral arterial disease.
SO. Early symptoms to watch out for?
PK. If someone gets numbness in feet like walking on cotton wool, pins and needles, poor erections, passage of frothy urine, chest pain or calf pain on walking, discoloration of feet these are warning symptoms.
SO. Are there certain health impacts that are unique to men? If so what are they?
PK. Erectile Dysfunction (ED) can be considered a unique problem to particularly males when they don’t have good diabetes control. In this condition men cannot have proper erections to have sexual activity. This can happen due to damage to the autonomic nervous system as well as due to poor blood supply to the penis.
Several studies have shown that ED is present in a significant percentage of males with diabetes. This has negative implications for individuals and families.
SO. As an Endocrinologist, tell us what organs are affected most? Why?
PK. As many as eleven major signs and symptoms of Diabetes have been identified in a study in the UD which include Erectile Dysfunction (ED) Retrograde Ejaculation, bladder and urine issues. These problems as explained above occur due to damage to the autonomic nervous system and blood supply to the genital organs.
SO. Are there other factors which expose men as candidates for diabetes type 2
PK. Cigarette smoking.
SO. Does genetics play a role?
PK. Genetics play a vital role in pathogenesis of diabetes. If a parent has diabetes your risk goes up. If both have diabetes the risk is much higher.
SO. What about poor lifestyles such as smoking and drinking alcoholic beverages?
PK. Smoking is definitely a risk factor. Excessive drinking if associated with high fat meals which leads to obesity can increase the risk.
SO. A study has said that smokers are 30-40% more likely to develop diabetes than non smokers. The American Diabetes Association has confirmed there was a link between smoking and several health risks and that men were more likely to be exposed to these risks. Do you agree? What about Lankan men who smoke beedi and cigars?
PK. The risk is same for Sri Lankan men.
SO. How do you treat diabetes in men? Is it the same as with women? At what stage does treatment commence? What are the early signs that men must take seriously and seek a doctor’s advice?
PK. The way we treat diabetes is similar in men and women except when women are pregnant or breast-feeding when we don’t use certain medications. Anyone with diabetes needs to seek treatment even if the disease is mild and needs regular follow up with diet and exercise adherence. It is especially important to maintain the glycosylated haemoglobin level, which is also called HBA1C less than 7%. This gives an indication of the average blood glucose within the preceding 3 months in a diabetic person. Most complications are closely linked to HBA1C.
SO. How can one prevent getting the disease? What are the golden rules to follow?
PK. Anyone whether men or women need to have a healthy diet, regular physical exercise and prevent obesity. Ideally, a BMI less than 23 needs to be maintained – if this is difficult BMI of 25 is an acceptable alternative. In diet reduction of carbohydrates, especially, refined carbohydrates and sugar, a high fibre diet and taking more water is important.
SO. Are there gaps that need to be filled in this area? E.g. raising awareness among men and getting them to go for a medical check up early? What interventions has the Health Ministry taken in this direction?
PK. There is a big problem of getting men for regular check ups and follow up. This needs to be emphasised to the general public.
SO. Have you a message for Lankan men ( and women) liable to develop diabetes?
PK. Diabetes is a deadly and troublesome disease, which causes premature death and suffering. However, it can be preventable if one is determined and courageous to lead a healthy lifestyle. Early detection is also important as undiagnosed means untreated disease. If you detect early sometimes diabetes can be reversed at least for a few years. Early diagnosis and effective treatment can prevent the development of complications.
SO. What are the recent interventions by the Health Ministry to prevent diabetes?
PK. The Health Ministry has established the Non Communicable Disease (NCD) Bureau for tackling NCDs which include diabetes, hypertension, heart disease and chronic lung disease. In addition there are over 800 Healthy Lifestyle Centres established by the Ministry to screen people with NCDs which include diabetes. These Lifestyle Centres (HLCs) also engage in disease prevention.
SO. Your plans for the future to make Sri Lanka a diabetes free country?
PK. We need to educate people of the ways to prevent getting diabetes, the importance of early detection and the ways to prevent complications. We want to encourage people to use HLCs and follow regular medical advice. We are working with the Government to help people achieve better care.
SO. The SLCE and SLDC, recently united to conduct a diabetes Health Camp open to the public. What was the aim and the feedback from this camp held on November 11?
PK. On November 11 the Sri Lanka Diabetes Federation, Sri Lanka College of Endocrinologists, Sri Lanka Diabetes and CVD Initiative with the patronage of the NCD Bureau of the Ministry of Health joining hands with International Lions Club organized a massive screening program for diabetes, its complications, education program and seminar and an exhibition to educate the public on diabetes and its implications. In addition, hundreds of people had their feet and eyes checked for diabetic complications and also learnt how to eat healthily and to exercise to prevent diabetes.