After his newest adventures with medicine, the writer sometimes thinks he should be standing up in a room filled with other people with the same condition, as he builds up enough courage to confess: “Hi, my name is Brooks and I am a… diabetic.” Although there is an Alcoholics Anonymous, Narcotics Anonymous, even Overeaters Anonymous – there is no Diabetics Anonymous – but maybe there should be.
I could certainly use the emotional reinforcement. After years of never having to taking any medication for chronic conditions, now a handful of pills and those daily blood tests (ouch!) have begun, following a fateful diagnosis of adult onset diabetes.
According to the Mayo Clinic’s guidance on this disease, “In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear.” That’s usually for kids.
But the Mayo Clinic guidance goes on to explain, with “prediabetes — which can lead to type 2 diabetes —your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although as in type 1 diabetes, it’s believed that genetic and environmental factors play a role in the development of type 2. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.” The fault seems to be in ourselves, in our stars – and in our diets, or the lack of them.
In a way, of course, diabetes, perhaps even more than HIV/Aids, is a symptom of our age. At least for adults, diabetes is a lifestyle choice of sorts. We eat those lovely rich foods – and we eat too much of them. We drink too many sweet soda drinks. We sit too much, we exercise too little.
The diseases we collectively call diabetes mellitus all affect how your body metabolises blood glucose, or blood sugar. Glucose is obviously vital to your health because it is one of the key sources of energy for the cells that make up your muscles and tissues – your entire body. But, if someone has diabetes, it means they have too much of a good thing – too much glucose in the blood – and that leads to real health problems. Unchecked, it ruins your kidneys, your liver, can make you blind and, in even more extreme cases, so reduce blood circulation that the victim ultimately undergoes the amputation of limbs.
In my case, it should have been obvious to me that diabetes was coming on. But it was really easy to rationalise away almost any of the symptoms. There was that constant thirst, those 3am visits down the hall. These started to kick in after the cold feet and hands, and growing need for a mid-afternoon nap. But it was really easy to rationalise all of this away. Circulation obviously gets worse with age, that’s why my hands were cold. Thirsty, well I must have eaten food with too much salt. That afternoon nap? I’m in my 60s, why not? And even the cataract surgery in 2011 didn’t initially ring the tocsin for me, even though the impact of too much sugar in the blood is to harm nerve endings, such as the ones involved in sight. The eye surgeon had explained the median age for cataract surgery was 62 – and I was just six months ahead of that, so that seemed about right. All normal, sadly. But a fall in the night, a doctor’s visit to make sure there was no concussion and a set of worrisome blood readings finally made me sit up and pay attention – at least metaphorically.
And so now, every morning starts with a quick jab in the finger to extract some blood, put it on the test strip, get the reading and take several pills, one to help blood sugar be metabolised better and the other to stimulate whatever production of insulin is still capable in my pancreas – or, more specifically, those mysterious Isles of Langerhans, those clumps of cells inside the pancreas that produce the insulin hormone molecules that the body needs to regulate the absorption of that glucose.
And then there is the dietary change – out with white bread, no, out with almost every type of bread except those special low GI nutty breads that taste like coarse-ground mixed nuts. Lots and lots of salad, no potatoes, very modest amounts of sweet fruits, and fish, chicken, grilled, roasted or baked meats, gluten-free pasta, and only an occasional sip of wine or beer. And dessert? No, no desserts.
Now there are meals with smaller portions, but perhaps an extra mid-morning or mid-afternoon healthy snack to help even out that demon glucose level a bit more. But there will be no late-night browsing through the fridge to help sustain any late-night television watching. The cynic could say the diet generally tends to taste like sawdust, but maybe sawdust would have more flavour – if one added some soya sauce, sesame oil and chilies anyway.
The larger social problem for places like America – and South Africa – is that the rate of diabetes cases is rising steadily. Here in South Africa, for example, depending on what sources one looks at, among adults over 20 there are at least a million cases already – but some authorities claim the rate of incidence is nearly four times that. The Diabetes Society says, for example: “Research shows that approximately 4-6 million people in SA have diabetes and that most of these people are unaware that they have the condition.”
Among some groups, according to a range of medical studies, the rate of occurrence is skyrocketing, as with adult urban Coloured populations in the Cape where, presumably because of dietary habits, among other reasons, the level of incidence has already hit over 30%. Other studies report a prevalence figure of 3.4% for the 24 million South Africans between the ages of 20 and 79, with an expected increase to about 4% by the year 2025.
The Diabetes Society of South Africa explains: “There is an explosion of diabetes worldwide and developing countries like South Africa are the worst hit. The World Health Organisation predicts that in South Africa, the numbers will triple in the next 15 years. Although all groups are affected, those most at risk are the black community who are undergoing rapid lifestyle and cultural changes, and people of Indian descent who have a gene pool that makes them unusually susceptible to diabetes.”
Worldwide, even conservative estimates say the prevalence of diabetes is believed to be about 3% of total population in 2000, but it will rise to about 4.5% by 2030. With those percentages in mind, the total number of people with diabetes worldwide is projected to rise from 171 million in 2000 to 366 million in 2030. The increase in diabetes seems closely linked to a worldwide increase in obesity – ah, there’s that Big Mac, extra large Coke and crème caramel diet to take the blame again for something nasty.
Expanding on that point, the World Health Organisation has reported: “Currently more than 1 billion adults are overweight – and at least 300 million of them are clinically obese. Current obesity levels range from below 5% in China, Japan and certain African nations, to over 75% in urban Samoa. But even in relatively low-prevalence countries like China, rates are almost 20% in some cities. Childhood obesity is already epidemic in some areas and on the rise in others. An estimated 17.6 million children under five are estimated to be overweight worldwide.”
Besides the obvious health costs of obesity itself, the larger social cost of diabetes will grow substantially as well. Larger numbers of people with severe health problems will stretch the medical resources of many countries like South Africa. Growing numbers of partially or fully blind people will be a major drain on the finances of families and social welfare organisations. More people in need of dialysis or even liver or kidney transplants will further stretch straitened medical systems and services.
And all of these, taken together, may mean growing competition for treatment and support for diabetes sufferers – in competition with other severe diseases and chronic conditions such as HIV/Aids. In fact, by some estimates, diabetes-related healthcare costs will mushroom worldwide by between 213 and 396 billion international dollars a year by 2025 (an international dollar is a currency measure that relies upon purchasing power parity calculations). In some countries, these costs may end up consuming an extraordinary 40% of their respective total national health budgets.
Fortunately, as I am now learning, the medicines to cope with this disease generally do their jobs, as long as they are taken regularly, dietary regimens are followed religiously – and us generally sedentary types begin increasing exercise programmes to build up heart rates and circulation. But that means more than pushing oneself away from the dining table after a second or third helping. Willpower seems to be the magic ingredient. Sadly, that is not to be found in the medicine chest, but in the mind.
As a consequence of this writer’s fateful discovery about his body’s rebellion against gluttony or just good eating, he has comforted himself in describing a week’s worth of meals to die for – rather too literally for comfort, now it seems – but which shall never grace his table again, save as memories or delicious pictures in foodie magazines (See accompanying article). So, instead of a nice helping of French fries and a juicy burger with all the trimmings on a crusty bun, pass that great serving bowl’s worth of sawdust please. And don’t forget the artificial sweetener and the tray of organic, herbal seasonings. DM
Spector settled in Johannesburg after a career as a US diplomat in Africa and East Asia. He has taught at the U. of the Witwatersrand, been a consultant for an international NGO, run a famous Johannesburg theatre and remains on its board, and been a commentator for South African and international print/broadcast/online media, in addition to writing for The Daily Maverick from day one. Post-retirement, Spector has also been a Bradlow Fellow of the SA Institute of International Affairs and a Writing Fellow of the University of Johannesburg’s Institute for Advanced Studies. Only half humourously, he says he learned everything he needs to know about politics from ‘Casablanca.’ Maybe he's increasingly cynical about some things, but a late Beethoven string quartet, John Coltrane’s music, and a dish of soto ayam (one of Indonesia's great culinary discoveries) will bring him close to tears.
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