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Medical Scribblings - 16 August 2007

The other day I was reading about the chronic diseases that we have suffered from for years which are now spreading to the poorer parts of the world. Even before they have gained a reasonable standard of living they seem to have been hit by the same plagues as ourselves but at a younger age - diabetes, heart disease, lung and bowel cancer etc etc. Its interesting looking back at the old medical text books where these conditions were considered a rarity compared with long descriptions about Tb etc. Two countries that are being particularly affected are Mexico where they love their Tortillas swilled down with coke and India where the new affluence has changed the eating from rough vegetarian to sugar, butter (gee is concentrated butter) and meat. Even when I was visiting Bangalore 25 years ago they were seeing the rise in cases of diabetes. It is also still fashionable and trendy to be seen smoking in many parts of the world.

I wonder if it might be of interest to explain about diabetes which sounds very simple but like most things turns out to be mind blowingly complicated. There are two types. Type 1 is what we used to think of as diabetes, that is a shortage of Insulin, a hormone that is needed by the cells in the body to use sugar. Without insulin your sugar level keeps on rising until you feel very ill and start to pass lots of urine as the sugar drags water out of the body. Nowadays it’s a fairly straightforward business to engineer insulin for you to inject. They are even starting to use insulin pumps for some people. Attempts have been made to inject insulin producing cells back into the body so that in theory you could start your own production. The results have been disappointing as this type of diabetes is caused by what we call an auto immune disease. That is the body attacks the insulin producing cells and destroys them. They have tried for a long time to get insulin in a pill form so that you could just swallow it. This again is fraught with problems as insulin is a protein and broken down once it gets into your stomach.

The other type of diabetes is Type 2 which is much more common. It seems to be that as people eat more sugar, get fatter and do little exercise their metabolic system needs more and more insulin to work and the insulin that is produced does not work properly. As I said earlier there is a lot of this already in the rich world but the poor are already catching up fast.

The reason that we worry about diabetes is that the high sugar level affects the tiny blood vessels in the body causing lots of damage. In particular the eyes, kidneys, heart and brain are affected, causing irreparable damage.

So the rather boring message is, as usual, to eat well, less sugar and fat, and take some regular exercise. If you have a family history of diabetes it is worthwhile having a fasting blood sugar done to try and catch the condition at an early stage.

John Schofield