Without the White Coat
By Florentino P. Alerta II, M.D.

Diabetes in the Philippines… a clearer picture

When lay persons or ordinary folks talk about diabetes mellitus it always coincides with a very high level of sugar or too much sugar in the body (hyperglycemia). Others may not take the subject seriously but for some they will have their serum glucose checked. It is common mentality among the Filipino population that when complications or when the symptoms of a certain disease would become so unbearable especially when it comes to pain that's the time they will seek some medical intervention ending up in the emergency room of a medical institution. In the US, diabetes composed 5-10% of the population in which 5% have Type 1 diabetes of the young and a small portion equivalent to 1% related with genetic defects. But look on the percentage of the Type 2, or the adult type of diabetes: it comprises a whooping 85% of the population, of this percentage 10% are non-obese, and 90% are obese. This statistics are just pertinent to the US, but let us bring the picture to the Philippines, instead of an 85% in Type 2 diabetes our beloved Philippines surprisingly has 95% comprising the Type 2 diabetes (adult onset). If we gonna put a picture on diabetes the Type 2 form is much higher in percentage compared to Type 1 diabetes, mostly obese individuals are affected and in the Philippines it is the Type 2 form of diabetes that dominates the disease spectrum.

Let us go back to our elementary knowledge on Diabetes Mellitus, especially the Type 2 form which has a very high percentage of 95%. DM Type 2 is characterized by two features, an insulin resistance (post-receptor defect and not 100% genetically determined) and beta cell failure (insulin producing cell in the Islet of Langerhans of the Pancreas).Facts revealed that reducing the total amount of fat intake will reduce insulin resistance and by doing daily exercise will tend to improve insulin sensitivity. Given a larger picture there are environmental factors that will increase insulin resistance like obesity, a very high fat diet, aging, some medications, a sedentary lifestyle or physical inactivity and some gluco-lipoprotein toxicity. Viewing from genetic defects (beta cell failure) that will lead to Type 2 diabetes like production of cytokines/amyloid byproducts, intrauterine malnutrition, and affects on lipid and glucose metabolism.

Why insulin resistance? It could be an adaptive response on what we all eat or on the main fact we consumed a lot of carbohydrates per day. Because of this we will never have the time to burn it out or some may place it as an over nutrition with little exercise at all that leaves a lot of free fatty acids and glucose floating around leading to some increase in free radicals. Such will render stress in the oxidative process of the body then comes a lot derangement and dysfunction of our system like changes in the cardiovascular system (micro-vascular endothelial changes). An overall insulin resistance that will later lead to some metabolic changes (decreased insulin secretion of the beta cells that will eventually lead to impaired glucose tolerance). Time will come that death of the beta cells will set in during the process of diabetes. (signs of angiopathies are already seen in this stages, by that time some macrovascular complications of diabetes are much more pronounced).

Artherosclerosis which is due to excess fat is seen as a form of premature development on some worst complications of diabetes in which some will exit as coma due to effects of arteriosclerosis.

Early detection for high risk groups and individuals are being pushed looking on the C- reactive protein levels, the serum Pro-insulin and amyloid levels and lastly adiponectin levels.

We always advocate living a healthy active life of daily work-up and exercise, for short for some obese patient cutting or slashing the weight down, a lowered blood pressure that is not more than 120/80mm hg, and increasing the “good cholesterol-HDL” in turn lowering the “bad one-LDL”. A good and initial level of HbA1c. (guide on how successful our treatment of diabetes is), control of the Fasting blood sugar level on the normal level and lastly by quitting smoking. Remember the metabolic staging of diabetes, at Stage 0 which is normal, at Stage 1 there is peripheral insulin resistance (hyperinsulinemia), at Stage 2 to 3 there is already impaired glucose tolerance (B cell failure) and at Stage 4 there early diabetes which will eventually progress to Stage 5, the late stage of Diabetes Mellitus. Always remember that the cost of care goes up as complications of diabetes will set in and diabetes prevention and intervention will totally depend upon early diagnosis and recognition of risk groups and factors that are present.