What to eat? With the increase in prices of food commodities, many people could go for the easiest and sometimes cheapest option, despite the negative effect on their health. For others a luxurious standard of living could also lead to a similar wrong choice of food Sweet and sour In a diabetic's life, there comes a time when the sufferer must put the blues behind and embrace the blue circle, notes Gamal Nkrumah in commemoration of World Diabetes Day Putting a good face on things, many a diabetic is quite capable of bearing the disquieting sensations of tingling toes, itchy blotches in unsightly body parts and out-of- focus vision when sometimes everything becomes a blur, with a degree of equanimity. Bludgeoned by medical practitioners into insulin dependency, some diabetics would succumb to the blues or yell in frustration until they are blue in the face. But the storm invariably blows itself out and the diabetic finds out about adjusting to life anew. However, what is diabetes? Diabetes Mellitus, to use its proper medical term, is essentially an immune system disorder causing high blood sugar levels, or hyperglycemia. Millions of diabetics live on their nerves, expecting any moment to lapse into a diabetic coma, or more to the point breathe their last. Others lose their nerve and gobble down that suicidal mouthful of a proscribed morsel that ends their lives. Through it all, the thick and the thin, yoga, transcendental meditation, a scrupulous macrobiotic regimen or whatever it takes, most diabetics are survivors. That is especially the case when they can afford the foodstuffs that they are supposed to stick to, or if they have sufficient means for the state-of-the-art medication that is now readily available for well-heeled patients. Diabetes, like HIV/ AIDS, is a debilitating condition that weakens the immune system, and the success of coping with both diseases is inextricably intertwined with the standards of living and levels of education of the victims. In both cases poverty and illiteracy are lethal -- affluence and erudition are lifesaving. But the comparison abruptly ends there. And, to be fair, that rule applies to almost all diseases. Suffice it to say here that there are 400 million diabetics worldwide and some 40 million HIV/AIDS sufferers, a relatively insignificant number by comparison. Food, indeed, for thought. Diabetes is by no means a modern malady. The ancient Egyptians were apparently aware of the enervating ailment as shown in the Ebers papyrus, discovered in Luxor, and dating from 1552 BC -- the first recorded medical reference to diabetes mellitus. The Egyptians identified the disease as largely restricted to the privileged and priestly classes. Incidentally the Ebers papyrus prescribed treating diabetes with high fibre grains, the idea being to produce a natural glucose balance. The information encapsulated in the papyrus is another indication of the sophistication of the ancients. The ancient Egyptians obviously hit the nail on the head when they recognised the close correlation between diet, sedentary lifestyle and diabetes. More so than any other ailment, diabetes is a disease that is determined by diet. For diabetics, certain foods are poison and others are medicine -- albeit eaten in moderation. The state of the patient's mind is of vital importance, and ideally nothing must get on a diabetic's nerves. "I can walk round easily," Yara, a 27-year-old diabetic disclosed. "I keep a candy handy when that dreadful sinking feeling overwhelms me," she smiles and puts on a brave face. She was talking about hypoglycemia, a life threatening condition that results when the sugar level in the blood falls dangerously low. I can sense she is not really up for a windy campsite, though. "I need to nibble food regularly," she says as if reading my thoughts. "I know diabetics who exercise regularly. I don't. Sometimes I feel terribly exhausted and ill-tempered." It is hard not to feel a pang. "One of my favourite secrets, and most suitable for most diabetics, is feast on roast sweet potato, piping hot." Strange as it might sound, consuming sweet potatoes in moderation often proves to be beneficial for diabetics. According to the Glycemic Index (GI), an evaluation of the quality of carbohydrate-rich foodstuffs rating foods according to their effect on blood glucose levels, not all carbohydrates are unsafe for diabetics. Processed foods such as pasta and bread are high GI foods since they are digested more quickly, making one hungry sooner. Low GI food, on the other hand, are digested more slowly and hence leave one feeling fuller for far longer. Sweet potato, like carrots and papaya, are perfect for diabetics because they are low GI eatables and release sugar into the bloodstream at a slower rate. The International Diabetes Federation (IDF) and the World Health Organisation (WHO) conjured up the idea of the circle to symbolise life and health and the colour blue to depict the sky and to advertise the UN flag. Friday 14 November was World Diabetes Day, an annual event that was launched by the IDF in conjunction with the United Nations and its affiliate, WHO, to draw public attention to the world's most common chronic disease. The Chairman of the Egyptian Diabetes Care Association (EDCA) Gamal Gordon is an exceptionally diligent activist who is determined to stem the rising tide of diabetes in Egypt. EDCA has 26 clinics specifically serving diabetics in various governorates across the country, both in the Delta and Upper Egypt. The concept of tackling the problem of diabetes head on, Gordon emphasises, is to deal with it in an integrated fashion. It is against this backdrop that he is now labouring to found a hospital designed specifically for diabetics in Sixth of October City, including specialised units for paediatrics and ophthalmology since diabetic retinopathy is a serious complication associated with diabetes, and diabetic neuropathy. Gordon's story never fails to inspire. He brings the story of diabetes alive by telling it through the eyes of a broad spectrum of diabetics. He reveals the nuts and bolts of coping with diabetes -- simultaneously one of the most deadly diseases and one of the most easily controlled through fastidious dieting and systematic exercising. A blinkered diabetic might choose to see nothing wrong with him or herself until it is too late. Frequent urination, unquenchable thirst, insatiable hunger, blurry vision and irritability are all symptoms of this most common chronic contemporary disease, and it is particularly prevalent in the Arab world, not excepting Egypt. The Diabetes Report 2008: Developments and Opportunities in Drugs and Devices made that fact abundantly clear. According to Gordon, a patient is considered chronically diabetic when his or her body is unable to produce or properly utilise insulin, a hormone that is prerequisite for the conversion of sugar and starch into energy. Genetics are a determining factor, but there are other no less important factors in the proliferation of diabetes such as obesity, the lack of exercise and pollution (commonly denoted as environmental factors). "Insulin replacement therapy is the most prevalent form of medication in the Arab world even though there are sophisticated new technologies designed to treat various types of diabetes. What is of paramount importance is increasing the awareness of the public at large and diabetics in particular about the disease, its symptoms and side effects." The Fasting Plasma Glucose test (FPG) is considered the most efficient way to determine sugar levels in the bloodstream and whether a person is diabetic or not. A person is classified as diabetic if his or her fasting blood glucose level is 126 mg/dl or higher. Those with 100-125 mg are considered pre-diabetics -- a serious enough condition to warrant concern and regular medical supervision. Two types of diabetes are diagnosed: type one and type two. Type one diabetes denotes the body's inability to produce insulin. It mainly strikes children who are genetically disposed to diabetes and entails a complete loss of the functions of the pancreas, involving lifetime multiple daily injections of insulin. Often parents are unaware their children are diabetic -- even doctors misdiagnose the condition and the children are victimised as lazy, irritable and unsociable. Type two, on the other hand, indicates the body's incapacity to properly utilise insulin due to a partial loss of pancreatic function. It mainly strikes in middle age. The immune system falsely targets beta cells as enemies in a biological process of wrongful discrimination. The body attacks its pancreatic cells. As far as treatment is concerned, type one is insulin-dependent while type two is treatable using a combination of various techniques. "There are several factors that have led to the upsurge in the incidence of diabetes," Abdel-Rahman Shahin, official spokesman at the Ministry of Health and Population told Al-Ahram Weekly. "Chief among these factors are malnutrition, due in part to the world food crisis, the prevalence and popularity of junk food and fast food, and our increasingly stressful lifestyle. Stress, of course, is closely related to economic difficulties and social concerns." Shahin also pointed out that pollution -- aerial, environmental, visual, and sound pollution are all factors that prompt both stress and diabetes among the population at large. According to the UN report, the prevalence of diabetes in certain Arab countries has reached epidemic proportions, exceeding 10 per cent of the population in countries such as Jordan, Kuwait, Libya, Morocco, Oman and the United Arab Emirates. The Arab world covers a vast swathe of territory stretching from the Atlantic Ocean in the west to the Indian Ocean in the east. It comprises 22 sovereign states with a combined population of some 300 million people. The correlation between obesity and diabetes has been proven through scientific research. In the Arab world, obesity is associated with both wealth and poverty. While rich people indulge in overeating and a sedentary lifestyle that increases the incidence of diabetes, the impoverished masses are reduced to consuming unhealthy and cheap foodstuffs low in nutrients and rich in saturated fats and starchy carbohydrates. Eight out of 10 people who are obese are diabetic or pre-diabetic. Obesity has emerged as a serious and debilitating condition in many Arab countries, especially the oil-rich Gulf states, with rates fluctuating between 15-50 per cent of the population. Another closely related diseases that have reached pandemic proportions are hyperlipidemia, abnormally high lipids (including cholesterol) in the bloodstream (20-38 per cent of the population), and hypertension or high blood pressure (24-46 per cent of the population). Indeed cardiovascular risk factors generated by advanced stages of diabetes have become a s serious health hazard in many an Arab country. "Diabetes is especially costly for the health provider," explained Shahin. He extrapolated that in a country like Egypt with a tradition of social welfare and health provision the state is obliged under the stipulations of the constitution to provide for citizens who cannot afford medication and healthcare. Over the years, diabetics may suffer from complications such as diabetic neuropathy and gangrene necessitating the amputation of a limb. The treatments of such diseases are especially expensive for the average lower and middle income families and necessitate state intervention. It is in this context that state intervention in the health sector and medical care is prerequisite. Yet another complication associated with diabetes is the hepatitis C virus which affects the liver and which is particularly prevalent in Egypt. In spite of its oil wealth, most of the people of the Arab world struggle to get by. Diabetes is no respecter of persons. According to many medical practitioners, it is a "patient friendly disease". Accordingly, if the patient treats it well -- sticks to a strict diet -- it treats him or her well in return. The affluent and poverty-stricken suffer the consequences, but access to relevant medical information and appropriate therapies overwhelmingly favour the moneyed few. With the attendant environmental factors fast facilitating the spread of the disease, it is anticipated that diabetes will continue to be a scourge of the masses and an especially incessant headache for policymakers and health providers. Scientific researchers in Egypt, Africa, and the Arab world and beyond are testing drugs that could help diabetics survive and better cope with the illness. And, that alone is reason for hope in the region.
