BEIJING, May 1, 2013 (City Weekend) — My grandma used to say she had “the sugar” when she talked about her diabetes, which she often did while pricking the tip of her finger so she could check her blood sugar levels before digging into a nine-inch round cheese danish or a helping herself to spoonfuls of peanut butter, straight out of the jar.
She was just one of the 10.7 percent of Americans over the age of 20 living with diabetes. While the United States currently has the world’s highest prevalence rate, or percentage, of the adult population living with diabetes, China, a country in which waistlines are expanding as fast as the economy, is not far behind, with 9.7 percent of its population over 20 living with diabetes.
According to the American Diabetes Association, 25.8 million children and adults in the United States, or 8.3 percent of the entire population, currently have diabetes. In these terms, however, China takes the cake as the country that’s home to the world’s largest diabetic population. As of 2010, 90 million people in China were living with diabetes and another 150 million showed early signs of the disease.
While the numbers alone are alarming, what worries experts most is how quickly the numbers have grown and how fast they are expected to climb in the future—not just in China, where current rates are expected to more than double by 2030, but in the rest of the world, as well.
“The sugar”
Simply put, diabetes is a chronic, non-curable disease that causes high blood sugar. This can happen either because the pancreas is not pumping out enough insulin, a hormone crucial to the body’s ability to metabolize glucose, a kind of sugar, or because cells do not respond to the insulin that is produced.
For those without diabetes, insulin is constantly supplied in the proper proportion to remove and absorb glucose that would otherwise build up to toxic levels. It also helps to prevent the body from using fat as a main energy source. And when blood sugar levels fall below a certain point, it allows the body to start burning up sugar stored in the liver and muscles as a source of energy. Like most of our body systems, it is just one element in a very delicately orchestrated balance that allows us to do everything we need to do—read books, eat sandwiches, give hugs, ride bikes—every day, as long as it’s working.
My grandma called it “the sugar,” but it’s a little more complicated than that. She had type 2 diabetes mellitus, which used to be commonly known as either “non insulin-dependent diabetes” or “adult-onset diabetes.” Type 1 diabetes mellitus used to be referred to as “insulin-dependent diabetes mellitus” or “juvenile diabetes.”
But Dr. Stephanie Teoh, a family physician with International SOS, says that with changes in diabetes trends in recent years, the names have required a bit of re-tooling. “The ages are moving down. It’s definitely a phenomenon of the last generation,” she says of the increasing amount of children being diagnosed with type 2. “That’s why we’ve changed a lot of the names.”
According to Dr. Teoh, type 1 accounts for 10 to 15 percent of all cases of diabetes. While the exact cause is unknown, it’s believed to be an autoimmune disorder in which the immune system attacks the pancreas, the insulin-producing organ, causing it to stop producing insulin.
The onset of type 1 is most commonly diagnosed from infancy to the late 30s, as its former moniker suggests. It can be diagnosed even in otherwise healthy children and young people that have thin or normal body types. While there’s no definitive, proven reason why it occurs, there are also no known preventive measures that parents can take or lifestyle changes to ensure that their children remain unaffected by this type of diabetes and there is no cure.
Flip the coin over, and there’s type 2. This is the most common form of the disease, according to Dr. Teoh, accounting for 85 to 90 percent of all diabetes cases. While the pancreases of people with type 1 produce no insulin, those with type 2 either have pancreases that produce inadequate amounts of insulin or they have an insulin resistance in the body. Far more often than not, the onset of type 2 occurs in adults and can usually be prevented by the adoption of a healthier lifestyle featuring a well-balanced, nutritious diet and regular exercise.
Dr. Teoh offered a list of higher risks groups for type 2, which includes people with a family history of diabetes, people over 55, overweight people over 45, people over 45 with high blood pressure, women who gave birth to a child weighing over nine pounds and women who had gestational diabetes. Those with Chinese, Aboriginal and Indian subcontinent backgrounds, as well as those of African descent, are also all higher risk groups compared to Caucasians. Also at higher risk are people with apple-shaped bodies, where most of the fat is above the waist, versus a pear-shaped body, where the fat is stored below the waist.
So, while there’s nothing parents can do to prevent their child from getting type 1, they can encourage a healthy lifestyle with regular exercise and a diet high in fiber and low in fat, which the child would hopefully adhere to through adulthood, lowering his or her chances of developing type 2.
Diabetes symptoms
Dr. Teoh says type 1 symptoms appear in a matter of days or weeks. The sudden onset of symptoms, which include extreme thirst, frequent urination and sudden weight loss, is dramatic enough that a parent would notice quickly. “Usually it becomes fairly obvious the child is quite unwell. However, any parent who is concerned about symptoms should bring their children in for review even if children look well,” she says.
Other symptoms may include a loss of appetite, drowsiness or a fruity, sweet or wine-like odor on a child’s breath. So, unless a child has been dipping into the family wine collection, he or she should get tested immediately. The doctor may call for an Oral Glucose Tolerance Test, which requires a special diet 24 hours in advance and includes testing the blood sugar levels every couple of hours to determine the child’s blood sugar range.
For the most part, children with type 1 diabetes will require four to six insulin injections every day from day one, according to Dr. Teoh. The important thing, she says, is balancing insulin intake and output. “Factors that burn up glucose include illness, stress, hormones, puberty and activity level,” she says. “All changes occur day to day, especially in kids, who have more things that change frequently and unexpectedly.”
This makes monitoring so important, especially for parents, teachers, ayis and other caregivers, because it’s critical to watch for signs of hypoglycemia, or “hypos,” which is a condition that occurs when blood sugar levels are too low. When everything is in the right balance, a child should not experience hypos, but if they occur, they can be very easily managed, just like diabetes itself. At the beginning, a child should be given a fast-acting carbohydrate, like a couple of jelly beans or a juice box, to immediately bring the blood sugar level back up.
Dr. Teoh suggests assembling a “hypo pack” that a child can keep in his or her backpack at school. It should include the name of child, written descriptions of hypo symptoms, instructions for how to treat him or her in the case of a hypo, emergency contact information for doctors, hospitals, and relatives, and fast-acting and slow-acting carbohydrates. Kids with diabetes should also wear a medic alert bracelet, in case of an emergency when mom or dad isn’t around. Moreover, it’s especially important that good type 1 control and care continue in the teenage and college years, as hormones rage, stress builds and life becomes more erratic.
“Parents are really handing over the responsibility of injecting to teens, letting them take care of themselves,” she says of the tricky time when monitoring becomes both more important and less parentally-administered. “They can’t ever stop doing it, can’t ever get a break from it,” she says of injections.
Though diabetes is a life-long disease, if managed well, diabetics can have normal lives as well as normal lifespans. Diabetic complications, like blood vessel damage, which can lead to eye and/or renal damage, heart disease, stroke and nerve damage, can also be avoided through long-term, proper management.
A holistic approach
Karen Himlok, a specialist practitioner in holistic combination therapies, emphasizes balance and moderation. The first thing she does with diabetic patients, even children, is to get their diet and digestion “in the proper order.” She recommends five small easily digestable meals each day, as well as a diet that keeps blood sugar levels stable so as to avoid glucose spikes followed by rapid crashing—”that’s the main danger for a diabetic.”
“Sometimes you eat food that takes longer to digest, which overloads your digestive system and depletes your energy level,” she says, adding that it’s crucial to cut out all sugars and starchy carbs, and fill up on fiber-rich foods and complex carbohydrates, like beans, which have a protein component.
For people showing early signs of diabetes, she suggests a detox to “remove toxins, fats and excess sugars out of them.” She says in addition to oily fatty foods, diabetics should also avoid consuming ice and dairy to lessen the stress on the digestive system. She also recommends licorice root, salvia, astragalus and gentiana as part of a traditional Chinese medicine approach to treating diabetes along with ear acupuncture therapy that has proven to help some people.
From a TCM perspective, diabetes is a heat syndrome with emaciation-thirst components. “So, you have wasting and thirst at the same time, which is caused by the collapse of the yin of the kidney, spleen and lung meridians in the diabetic condition.” Therefore, it’s also important to constantly rehydrate the system with moisture- and antioxidant-rich fruits and vegetables, as well as foods like bitter melon and Chinese yam.
The holistic approach and lifestyle changes should still be used in tandem with regular insulin injections and blood sugar monitoring, in order to manage the case in the safest way.
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