Vitamin D-What, Where, When, How, Why?

Vitamins are not generally considered to be endocrine substance, but it is a organic dietary factors essential for healthy life. The term ‘ vitamin D ’ refers to two steroid like chemicals, namely ergocalciferol and cholecalciferol . Vitamin D is important for good health, growth and strong bones and may also help to prevent other diseases such as cancer, diabetes and heart disease. A lack of vitamin D is very common. Vitamin D is mostly made in the skin by exposure to sunlight.  A mild lack of vitamin D may not cause symptoms but can cause generalised aches and pains and tiredness. A more severe lack can cause serious problems such as rickets (in children) and osteomalacia (in adults), described below. Treatment is with vitamin D supplements. Some people are more at risk of vitamin D deficiency, and so are recommended to take vitamin D supplements routinely. These include all pregnant women, breast-fed babies, children under 5, and people aged 65 and over. Also, people who do not get much exposure to the sun, people with black or Asian skin types, people who do not go out in the sun and people with certain gut, liver or kidney diseases.  We have checked our own patients and found that 9/10 adults of South Asian origin are vitamin D deficient and something like 60% of our white patients are vitamin D deficient.  Most people present with aches and pains and tiredness.

What is vitamin D?

Vitamins are a group of chemicals that are needed by the body for good health. Foods that contain vitamin D include the following though many foods do not contain much vitamin D and exposure to the sun is a better source of vitamin D than foods. Vitamin D is a fat-soluble vitamin. Most foods contain very little vitamin D naturally , though some are fortified (enriched) with added vitamin D.  Foods that contain vitamin D include:

                -Oily fish (such as sardines, pilchards, herring, trout, tuna, salmon and mackerel).

                -Egg yolk.

                -Fortified foods (this means they have vitamin D added to them) such as margarine, some cereals, infant formula milk.

Action of Vitamin D

The 1,25 - (OH)2 -D 3 receptor belongs to a superfamily of nuclear hormone receptors, which bind to their ligand and alter transcription. The hormone travels in the bloodstream in equilibrium between bound and free forms. The latter form is freely able to enter cells, due to its lipophilic nature. The plasma 1,25 - (OH) 2 - D 3 - binding protein (DBP) recognizes the hormone specifi cally. 1,25 - (OH) 2 - D 3 binds to the nuclear receptor; the complex binds to specifi c hormone response elements on the target gene upstream of transcriptional activation sites, and new mRNA and protein synthesis result.

New proteins synthesized include osteocalcin, an important bone protein whose synthesis is suppressed by glucocorticoids. In the GIT, a calcium - binding transport protein (CaBP) is synthesized in response to the hormone – receptor activation of the genome.

Physiological actions of vitamin D

Bone-Vitamin D stimulates resorption of calcium from bone as part of its function to maintain adequate circulating concentrations of the ion. It also stimulates osteocalcin synthesis.

Gastrointestinal tract-1,25 - (OH) 2 - D 3 stimulates calcium and phosphate absorption from the gut through an active transport process. The hormone promotes the synthesis of calcium transport by enhancing synthesis of the cytosolic calcium – binding protein CaBP, which transports calcium from the mucosal to the serosal cells of the gut.

Kidney- 1,25 - (OH) 2 - D 3 may stimulate reabsorption of calcium into the tubule cells while promoting the excretion of phosphate. The tubule cells do possess receptors for vitamin D and CaBP.

Muscle-Muscle cells have vitamin D receptors, and the hormone may mediate muscle contraction through effects on the calcium fl uxes, and on consequent adenosine triphosphate (ATP) synthesis.

Pregnancy-During pregnancy, there is increased calcium absorption from the GIT, and elevated circulating concentrations of 1,25 - (OH) 2 - D 3 , DBP, calcitonin and PTH. During the last 6 months prior to birth, calcium and phosphorus accumulate in the fetus. The placenta synthesizes 1,25 - (OH) 2 - D 3 , as does the fetal kidney and bone. Nevertheless, the fetus still requires maternal vitamin D.

Other roles- Vitamin D may be involved in the maturation and proliferation of cells of the immune system, for example of the haematopoietic stem cells, and in the function of mature B and T cells.

Our main source of vitamin D is that made by our own bodies. 90% of our vitamin D is made in the skin with the help of sunlight.

Ultraviolet B (UVB) sunlight rays convert cholesterol in the skin into vitamin D. Darker skins need more sun to get the same amount of vitamin D as a fair-skinned person. The sunlight needed has to fall directly on to bare skin (through a window is not enough). 2-3 exposures of sunlight per week in the summer months (April to September) are enough to achieve healthy vitamin D levels that last through the year. Each episode should be 20-30 minutes to bare arms and face. This is not the same as suntanning; the skin simply needs to be exposed to sunlight.

So, vitamin D is really important for strong bones. In addition, vitamin D seems to be important for muscles and general health. Scientists have also found that vitamin D may also help to prevent other diseases such as cancer, diabetes and heart disease.

Who gets vitamin D deficiency?

Vitamin D deficiency means that there is not enough vitamin D in the body. Broadly speaking, this can occur in three situations:

1. Increased need for vitamin D

Growing children, pregnant women, and breast-feeding women.

2. Situations where the body is unable to make enough vitamin D

People who get very little sunlight on their skin are also at risk of vitamin D deficiency. This is more of a problem in the most northern parts of the world where there is less sun. In particular:

                 People who stay inside a lot or cover up when outside or use strict sunscreen

                 People with pigmented (dark coloured) skins and elderly people  

                 Some medical conditions can affect the way the body handles vitamin D.

                     People with Crohn's disease, coeliac disease, and some types of liver                                                     and kidney disease, are all at risk of vitamin D deficiency.

                 Vitamin D deficiency can also occur in people taking certain medicines -                                                  examples include: Carbamazepine, Phenytoin, prim done, barbiturates and some anti-HIV                    medicines

3. Not enough dietary vitamin D

Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.

How common is vitamin D deficiency?

It is very common. This is why we recommend a regular supplement to our patients.  A recent survey in the UK showed that more than half of the adult population in the UK had low vitamin D. This level is found to be greater in people who have dark skin.  In the winter and spring about 1 in 6 people has a severe deficiency. It is estimated that about 9 in 10 adults of South Asian origin may be vitamin D-deficient. Most affected people either don't have any symptoms, or have vague aches and pains, and are unaware of the problem.  80% of our Asian patients have been found to be deficient and 60% of our white patients have found to be deficient.

What are the symptoms of vitamin D deficiency?

Symptoms of vitamin D deficiency are tiredness or general aches.  Because symptoms of vitamin D deficiency are often very vague, the problem is often missed.

How is vitamin D deficiency diagnosed?

Vitamin D deficiency can be diagnosed by a blood test.  However, on balance if you have dark skin and live in the UK you should take supplements. It may be suspected from your medical history, symptoms, or lifestyle. A simple blood test for vitamin D level can make the diagnosis.

RECOMMENDATIONS – Your doctor will advise you if you have deficiency or insufficient vitamin D.  If you have a minor level of vitamin D deficiency we recommend patients buy vitamin D tablets equivalent to 10ug or 12.5ug.  Most are made from vegetables.   If you have been found to be deficient we would recommend you stay on this dose for life as treatment is often needed long-term because the cause of the deficiency, such as dark skin or not enough sunlight, is unlikely to be corrected in the future.  We have observed that it takes at least 6 months taking regular vitamin D for symptoms to resolve and the level of vitamin D to return to normal.  It should be noted that if you have severe deficiency the doctor may recommend that you take a higher dose of vitamin D for a limited time, often equivalent to 25ug for the first 3 months.  Please discuss this with your own doctor.  We recommend that patients buy vitamin D tablets as we are unable to prescribe vitamin D without calcium on the NHS and calcium prescriptions have been associated with increased kidney stones and it is for this reason that we recommend that our patients buy vitamin D.

Maintenance therapy after deficiency has been treated

The dose needed for maintenance maybe lower than that stated.  We advise patients to buy 10ug and take 2 a day.   When the body's stores of vitamin D have been replenished. maintenance treatment is often needed long-term, to prevent further deficiency in the future. This is because it is unlikely that any risk factor for vitamin D deficiency in the first place, will have completely resolved. The dose needed for maintenance may be lower than that needed to treat the deficiency.

Cautions when taking vitamin D supplements

Care is needed with vitamin D supplements in certain situations:

 1. If you are taking certain other medicines that can interact such as  Digoxin (for an irregular         heartbeat – atrial fibrillation),  Thiazide or diuretics (water tablets).                                                   

2. If you have medical conditions such as kidney stones, some types of                                                     kidney disease, liver disease or hormonal disease.

3. Vitamin D should not be taken by people who have high calcium levels.

4. You may need more than the usual dose if taking certain medicines such as Carbamezapine, Phenytoin. HRT or barbiturates. Multivitamins are not suitable for long-term high-dose treatment because the vitamin A which can be harmful in large amounts.

Are there any side-effects from vitamin D supplements?

It is very unusual to get side effects from vitamin D if taken in the prescribed dose. However, very high doses can raise calcium levels in the blood. This would cause symptoms such as thirst, passing a lot of urine, nausea or vomiting.

Prognosis (outlook) in vitamin D deficiency?

The outlook for vitamin D deficiency is usually excellent. Both the vitamin levels and the symptoms generally respond well to treatment. However, it can take time (months) for symptoms to resolve and for bones to recover.  Generally after 6 months of using Vitamin D tablets the patient feels a lot better and symptoms have improved.  This does not mean you need to stop taking the medication.  Vitamin D supplementation is for life.

Diabetes education booklet

Introduction to diabetes

Approximately 1.4 million people in the UK have diabetes and it is suggested by Diabetes UK that there could be another one million people with diabetes and are unaware they have it. The majority of people with diabetes (85% - 90% will have Type 2 diabetes). The remainder will have Type 1 diabetes.

Diabetes Mellitus is a condition in which the amount of sugar in the blood is too high. When we eat a meal the starchy and sugary carbohydrates are changed into sugar (glucose ) during dijestion and this sugar then  passes into the bloodstream. When the pancreas senses that there is a rising level of glucose in the blood it secretes a hormone called insulin. Insulin changes glucose into energy which provides fuel for the body. Insulin is vital for life because without it, the glucose could not be changed into energy and the body could not function without energy. It is often said that insulin acts like a key – unlocking the cell to allow the energy in. Obviously, like a car, we only need a certain amount of energy to provide for the requirements of the body. If we eat more than we need this will be stored as fat.

Signs and symptoms of diabetes

·         Excessive thirst

·         Frequency in  passing of urine

·         Blurred vision

·         Loss of weight

·         Tiredness

·         Mood changes

·         Frequent infections e. boils, thrush etc

Types of diabetes

There are two main types of diabetes:

·         Type 1 ( used to be called insulin dependent ) affecting children and young adults mostly

·         Type 2 diabetes ( used to be called non insulin dependent ) is commoner in the over 40 year olds although children as young as sixteen and obese are alsodeveloping Type2 diabetes

 Main Aim of treatment

The main aim of treatment of both types of diabetes is to normalise blood glucose levels to protect against long term damage to the eyes, kidneys, nerves,

heart and all the blood vessels. Some experts call diabetes “a blood vessel disease”  because preventing narrowing of the blood vessels is key to preventing complications.

Type 1 diabetes

The exact cause of Type 1 diabetes is unknown but thought to be due to a viral infection or environmental factors. In type 1 diabetes there is total destruction of the cells in the pancreas  ( beta cells ) that produce the insulin. The onset of type1 diabetes is acute, because as stated earlier insulin changes glucose into energy but in the absence of insulin, glucose builds up in the blood and is not turned into energy. In an effort to overcome the lack of fuel for the normal functioning of the body, fats and proteins are broken down instead. This is why

patients are often underweight at diagnosis.

Once treatment with insulin is started the patient will begin to feel better quickly and will regain the lost weight.

Treatment for type1 diabetes

People with Type 1 diabetes will need injections of insulin for the rest of their lives. Insulin is destroyed by the gastric juices so cannot be taken in tablet form.

People with Type1 diabetes will need a minimum of two injections daily and often more. They will also need to eat a healthy diet and take regular exercise and do regular self blood glucose testing

If you have been diagnosed with Type 1 diabetes please ask your health professional for the special  section on “ Insulin Ttreatment” which will give you much more specific and detailed information.

Type 2 diabetes

Type 2 diabetes occurs when the pancreas secretes less insulin than normal or when the insulin secreted fails to work properly (called insulin resistance). People who are overweight are five times more likely to develop Type 2 diabetes and four out of five people with Type 2 diabetes are overweight. Excess weight increases your body’s own glucose production and thus your body’s need for insulin too. At the same time, this extra insulin increases fatty acids stores and further increases insulin resistance. It becomes a vicious circle.

Type 2 diabetes is particularly associated with central excess weight ( apple shaped rather than pear shaped). Health risks increase when waist circumference is greater than 37inches (94cms) in men and 31.5 inches (80cms ) in women. Reducing calorie intake if you are overweight will help your body use insulin better by reducing insulin resistance.

You will find a whole section of this book devoted to healthy eating, weight control and exercise.

Type 2diabetes has a gradual onset. You may not feel any symptoms beyond a little tiredness which is often mistakenly attributed to age and working hard. As Type2 diabetes progresses  you may become aware of some of the signs already mentioned or you may be diagnosed  whilst being investigated for something else. It is suggested by experts that most people have had Type2 diabetes for at least five years before diagnosis.

The following people are at an increased risk of developing Type2 diabetes:

• Family history of diabetes
• Asian or Afro-Caribean origin
• Women who have had gestational diabetes
• Obese people
• People who take little exercise
• Older age
• People on certain medications eg steroids, and some anti psychotic medications

Treatment for Type2 diabetes

People with Type2 diabetes will be encouraged to eat a healthy balanced  diet and take regular exercise. They will be treated with diet only for the first three months after diagnosis (unless their blood glucose is very high and they are losing weight). If diet and exercise alone does not control your blood glucose levels you may also need to take tablets.

Diabetes and Driving in UK

Having diabetes does not mean that you cannot drive as long as you doctor says you are safe to do so – this is usually when your diabetes becomes stable and controlled. You will however have to plan in advance before getting behind the wheel of your car if you are on certain tablets for your diabetes and/or taking insulin.

You must by law inform the Driver and Vehicle Licensing Agency (DVLA) if

• Your diabetes is treated with tablets or insulin
• If your treatment changes from tablets to insulin or if insulin is added to the tablets
• If there are changes in your health or condition that may affect your ability to drive safely
• If you are applying for a licence for the first time, you must answer YES to the question about diabetes.

People Treated with Insulin

After you have written to the DVLA informing them of your insulin treatment, you will be sent a form (called “Diabetic 1”), asking for more information and for the name and address of your GP/ Hospital Doctor. You will be asked to sign a consent form allowing the DVLA to contact the doctor directly for more specific information on your diabetes control, eyesight and general fitness to drive.

This does not mean that you will be refused a licence – it just ensures safety for you and other drivers. Please answer all questions fully and honestly.

People Treated with Tablets

After you have informed the DVLA that you have diabetes, they will send you a letter explaining your responsibility to re-notify them if you start having insulin or have “hypos” (low blood sugar), or if you develop any of the complications of diabetes which could affect your ability to drive.

They will not normally ask you any other questions at this stage and you will normally expect to keep your “till to” licence.

Diet alone Treated patients

No restrictions on driving and do not need to inform DVLA.

Restricted Licences

Insulin treated – a driving licence will be issued to you for one, two or three years if you are treated with insulin. Just before expiry date, you will receive a reminder to renew your licence and you will be asked to return your current licence. You will be sent another “Diabetic1” form to confirm your medical condition. Renewals of restricted licences are free.

Tablets or diet treated – usually issued with a “till to” licence. When you reach 70 years of age, you will be expected (like everyone else in UK) to renew it every one to three years. There is a charge for this renewal.

Provisional licences – applies to insulin treated only – need to be renewed every one, two or three years.

When renewing licences, it is always sensible to keep a copy of the old licence or to make a note of the driver number, before sending to the DVLA. The process takes between six – eight weeks unless there are complications.

If you drive a motorcycle the rules for informing the DVLA are the same as for a car.

Eyesight Problems

Obviously it is important to have good distance vision and good field of vision (what you can see side to side when looking straight ahead). There are various tests that an ophthalmologist can do to carry out to test these factors. Your licence may be revoked if you fail a field of vision test, but you can appeal against it. There are different types of field of vision tests, some people do better on one type versus another. The DVLA will accept the results of any approved type of test.

Large Goods Vehicles (LGV) and Passenger Carrying Vehicles (PCV)

In 1991 the titles of HGV (heavy goods vehicle) changed to LGV

                    And PSV (public services vehicles) changed to PCV.

People treated with diet alone or diet and tablets are normally allowed to hold LGV and PCV licences, provided they are otherwise in good health.

People treated on insulin are not allowed to hold these licences. If you currently hold such a licence and start using insulin you must inform the DVLA and stop driving the vehicle immediately.

In 1996, the regulation on larger vehicles was extended to include medium sized vehicles. Anyone passing their driving test after 31^st December 1996 will only be given a licence to drive vehicles up to 3.5 tonnes.

Vehicles weighing 3.5 tonnes – 7.5 tonnes (Category CI ) and mini buses (DI) are now treated as Group 2 vehicles – normally there is a complete ban on insulin users obtaining a group 2  licence. However some CI licence holders can now apply for a medical assessment and can regain ability to drive these vehicles whilst on insulin. Please write to the DVLA for more information.

Taxis

The law does not bar insulin users from driving taxis, provided they are less than nine seats. As local councils issue licences the policy may vary in different parts of the UK. Some taxi authorities issue blanket restrictions. Please contact Diabetes UK and DVLC for more information.

Diabetes in Pregnancy (Gestational Diabetes)

If you need to commence insulin in pregnancy, you should notify DVLA immediately.

You will normally be allowed to continue driving but are recommended to stop if your control becomes unstable or if you do not have good warning signs of hypoglycaemia. You should re notify the DVLA six weeks after delivery if you are still on insulin, as your licence will need to be reassessed.

If you have problems relating to your driving licence, please discuss it with your diabetes team, who will be able to advise you. DVLA wish to issue licences, not to take them away – you can help by giving as much information as possible.

DO NOT DRIVE IF

·         You have difficulty recognising early signs of hypoglycaemia  (Section   )

·         You have started on insulin and your diabetes is not yet controlled.

·         You have problems with eyesight not corrected by glasses

·         You have numbness or weakness in your feet caused by nerve damage or circulation (neuropathy or ischaemia)

·         You have been drinking alcohol.

Precautions before Driving

• Long journeys need careful planning, allowing for regular stops if you are on specific tablets for diabetes and insulin.

Normally it is wise to have something to eat every two to three and half hours if you are on insulin and not to miss meals and not to delay meals if you are on tablets and insulin.

•  Test your blood sugar before driving and regularly during a long drive or if at work before you drive home at the end of the day or shift.

• ·Always carry quick acting glucose and slow release carbohydrate in the car at all times if you are on insulin or specific diabetes tablets.

• Always carry identification on your person and in the car stating your name, how your diabetes is treated and the name of your GP.

At the first sign of Hypoglycaemia

·         Stop driving as soon as it is safe to do so

·         Remove ignition key and move into passenger seat.

·         Immediately take glucose tablets or sugary drink (both may be required)

·         Follow this with slow release carbohydrate i.e sandwich, crisps, biscuits etc.

·         Wait for at least 15 – 20 minutes until you feel better, recheck blood if possible, if you do not feel better, take more glucose and biscuits and wait a further 15 minutes.

·       If you continue to feel unwell – call for help and do not drive – if considering using motorway emergency assistance, please remember you may be unsteady on your feet, so take extra glucose before walking.

Car Insurance

 The main potential danger of diabetes and driving is the possibility of having a hypoglycaemic episode which could impair your judgement and lead to an accident.

Since the Disability Discrimination Act came into effect at the end of 1996, insurers can only refuse cover if they have evidence of increased risk.

It is virtually important to inform your motor insurance that you have diabetes.

Your motor insurance may become invalid if

·         You fail to update them on changes to your treatment or physical condition

·         You fail to notify the DVLA as mentioned previously

·         You fail to comply with DVLA restrictions or recommendations

Diabetes UK Services   has an exclusive service that will search through a panel of insurers for the best quote,  - freephone 0800 731 7431.

Life Assurance / Insurance

Some people experience difficulty getting life cover. It is important that you declare your diabetes when applying for a new policy. Any life policy you hold at the time of diagnosis is unaffected.

Any difficulties ring Diabetes UK Careline 0845  120 2960

Or write to Diabetes UK Careline, 10, Parkway, London, NW1 7AA (operates a translation service also)

Travel Insurance

Many travel insurance policies exclude pre-existing medical conditions such as diabetes, you must check carefully if your policy includes or excludes diabetes.

Some insurance companies charge an extra £10 - £15 to include diabetes. It is worth having a letter to this effect from the insurers

Diabetes UK are continually expanding the service they offer. Please see relevant telephone lists at the back of this booklet.

Diabetes and Employment

An employer cannot by law refuse to employ you or dismiss you purely because you have diabetes, according to the Disability Discrimination Act (DDA1995).

Although most people with diabetes do not consider themselves to have a disability, diabetes is covered by the Act.

Certain professions are exempt from the DDA and can refuse to employ someone with diabetes, especially if they are treated with insulin, these include

·         Air line crew

·         Armed services

·         Off shore workers

·         Train drivers

·         Any work requiring LGV and PCV

·         Police force

However, if diabetes is diagnosed whilst in this employment, it may be possible to continue with some negotiable changes in your duties. 

Skin Pigmentations and Calcifications PowerPoint Presentation free Download

This "Skin Pigmentations and Calcifications" PowerPoint Presentation Includes

• Skin Pigments
• Hyper pigmentation
• Hypo pigmentation
• Addison’s disease
• Café Au Leit Pigmentation
• Neurofibromatosis
• Hyper-pigmented skin nodules
• Lack of pigmentation
• Vitiligo
• Ochronosis
• Haemosiderosis
• Haemachromatosis/Bronze diabetes
• Wilson’s disease
• Lipofuscins
• Exogenous pigments
• Heterotrophic calcification
• Dystrophic calcification
• Metastatic calcification
• Mechanism of calcification
• Chondrocalcinosis

Skin Pigmentations and Calcifications
PowerPoint Presentation Free Download

Would you know if you had diabetes?

There are an estimated one million people in Sri Lanka who have diabetes but don’t know it.

Don’t be one of them Know the risk factors

Diabetes is a bad news / good news / better news disease. The bad news is that diabetes is incurable medical science has yet to find a cure for one of the worlds most common illnesses. The good news is that diabetes is treatable. With proper medical treatment and a great deal of self-management, most people with diabetes can live normal-length lives with little or no restriction on their lift styles. The better news is that in the last few years, some very important new treatment modalities have come on the market to help make diabetes treatment even better.

What Is diabetes?

Diabetes is a malfunction in the body’s ability to convert carbohydrates - sweet and starchy foods into energy to power the body.

The medical name for this is diabetes mellitus, meaning, “honey sweet diabetes.”

As you might gather from such a name, diabetes is characterized by an abnormally high and persisted concentration of sugar in the bloodstream.

How high?

Blood-glucose levels vary during the course of the day. In normal adults, blood-glucose levels range between 60 and 100 milligrams per deciliter designated as mg/dl - of blood plasma when a person is fasting. By fasting, the medical profession means that the person hasn’t eaten for three or more hours (before breakfast for example. When listing blood sugar is over between 110 mg/dl doctors become concerned. In short your blood-sugar levels are too high.

So what’s wrong with high blood sugar?

As sugar builds in the bloodstream, the kidneys try to pump it out. To eliminate the sugar, the kidneys must dissolve it. The more sugar there is to be eliminated, the more urine that must be passed. You can see how this situation quickly leads to frequent urination, increased thirst and dehydration-three of the symptoms of diabetes. Although the kidneys effectively keep the body from becoming overrun with sugar, working double time wears out the kidneys sooner than normal. Over a lifetime, such overwork eventually brings on kidney failure. But that’s not the only problem with high blood sugar.

So you’re saying that diabetes can be life threatening?

Definitely. The very nature of the disease puts the sufferer at risk for serious complications. Some experts believe diabetes is now the nation’s third or fourth leading cause of death.

What can happen if diabetes goes unchecked ?

Diabetes hastens wear and tear on many crucial body functions. In particular, it attacks:

The circulatory system.

Diabetes leads to coronary heart disease, stroke and circulation problems in the hands and feet. These conditions are two to four times more common with people diabetes, and they account for most of their hospitalizations. Heart attacks, hardening of the arteries, strokes, poor circulation in the feet amputations-these are common examples of diabetes damage.

The kidneys.

Diabetes is the leading cause of kidney failure.

The eyes.

Diabetes eye disease, of diabetic retinopathy, is the major cause of new vision loss in people 20 to 74 years old.

The nervous system.

Nerve cells may be disturbed or damaged, causing severe pain or loss of feeling a condition known as neuropathy.

Diabetes must be treated seriously. People affected with diabetes generally require lifelong medical care to control the disease. In nearly all situation, they require at a minimum routine medical treatment-including daily self care. Left unchecked, diabetes shortens life. It is not a condition that goes away

What can be done about it?

Quite simple, you must learn to control your diabetes. Don’t let it control you! Many people with diabetes have taken personal responsibility for managing their disease and, as a result, they live normal, productive lives. If any disorder can be called a lifestyle disease, diabetes comes as close as any. Just by controlling blood sugar, the severity of diabetic complications can be prevented. So, the most obvious step is to get blood-sugar levels down to normal. For some people, that means taking insulin; for others it means losing weight; do some, it means both. For all people with diabetes, it means paying particular attention to diet and exercise, what we mean by a lifestyle change.

All of the experts in the field recount the importance of sound health habits that can help control diabetes and, in some cases, prevent it.

But whatever their lifestyles, the very first steps for all people with diabetes are to find out that they have the disease and to realize that they’re not alone.

How many people have diabetes?

In the world, probably over 100 million. In Sri Lanka estimated 2 million people are affected by the disease and that includes people of all ages, from children to the elderly. The number increases yearly.

5% percent of Sri Lankans have been diagnosed with diabetes and an equal amount have the disease but haven’t been diagnosed yet.

You mean some people have diabetes and don’t know it?

Approximately 1 million people, according to 1995 statistics.

How can that be?

Scientists estimate that the onset of the disease can be anywhere form 4 to 12 years. That means someone, may have diabetes 5,8, even 10 years before its diagnosed, depending upon the kind of diabetes that person has. Unfortunately, in that time the condition can damage the body.

Many people only find out about their diabetes once they’re having trouble with their eyes, nerves, kidneys, blood vessels or heart.

Diabetes-the risk factors

q Diabetes and age. The vast majority of people with diabetes have Type 2 diabetes. This type usually occurs in people over the age of 40. The older you are, the greater your risk of diabetes.

q Diabetes runs in families. research has shown that people are more at risk if there is a history of diabetes in close family members. The closer the relative, the greater your risk of diabetes.

q Obesity is a factor in diabetes. Over 80% of people with Type 2 diabetes are overweight. The more overweight you are, the greater your risk of diabetes.

q Diabetes and pregnancy. Some women when they are pregnant develop a temporary type of diabetes called ’Gestational Diabetes’. Having this or giving a large baby (4kg / 8½ lb or greater) can increase a woman’s risk of going on to develop Type 2 diabetes.

q Diabetes - the symptoms The symptoms of diabetes will usually be very obvious in younger people, but may not be obvious or not appear in older people.

q Increased thirst

q Passing urine all the time – especially at night

q Extreme tiredness

q Weight loss

q Genital itching or regular episodes of thrush

q Blurred vision

Diabetes is a serious and dangerous condition. But with knowledge and information coupled with treatment by qualified medical practitioners and good self-care it can be controlled.

Do yourself a favour. Make sure you know about diabetes and who’s at risk just in case it’s you. If you are at risk of having diabetes, it is vital you take steps now.

Have your self tested for diabetes?