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Saturday, November 23, 2013

Patients living positively with diabetes

They are unanimous after living decades with the condition that “although diabetes cannot be cured, it could be controlled and managed and patients could lead normal lives if they follow doctors’ instructions.”



      Ernest, Chelladurai and Heba told an audience, which included a group of journalists from the Intercontinental Region and a team of medical experts from Sanofi Pharmaceuticals at a recent forum in Frankfurt, Germany tagged ‘Sanofi’s Engagement in Diabetes’ how they have been coping with the disease and everything one needs to know.

     The Intercontinental Region is made up of four zones- Eurasia, Turkey and Middle East, South Asia and Africa.

        According to the International Diabetes Federation (IDF), the Region has the highest burden of diabetes.

      The team of experts from Sanofi included: a professor of endocrinology at Sapienza University Medical School, Rome, Italy, Aldo Maldonato, Senior Medical Director Diabetes at Sanofi, Dr. Didier Halimi, and Senior Director Diabetes at Sanofi, Catherine Levy, Dr. Jean-Marc Chantelot, Benedicte Denieul, and Dr. Eckhard Leifke.

      The took a tour of Sanofi Diabetes headquarters of Hoechst in Frankfurt and were later taken through a cooking course at Ketao Cooking School and Event Location in Frankfurt by a group of Chefs led by Stephanie Becker.

       The journalists learnt how to prepare meals tailored for diabetics. The journalists were divided into four groups and they made four menu: grilled pumpkin with marinated Mozzarella cheese in Vanilla and garlic dressing; parsnipsoup with chopped Maryoram; medium grilled beef or grilled fish with mashed eggplants and oven carrots with rosemary; and cream cheese cake made with coconut flour and stevia with autumn fruit sorbet.

       A vegetable-based meal for diabetics is supported by a large-scale new study published last week in the latest issue of the journal Diabetologia, which found that cutting down on meat and dairy products in favor of fruits and vegetables could dramatically reduce the risk of diabetes.

       Dr. Françoise Clavel-Chapelon’s team at the Centre for Research in Epidemiology and Population Health in Paris found that animal products, including meat, cheese, and egg yolks, trigger stomach acids linked to the disease. Yet fruits, including acidic fruits such as lemons and oranges, reduce the stomach acids before they can cause harm to the body.

         Clavel-Chapelon said: “A diet rich in animal protein may favor net acid intake, while most fruits and vegetables form alkaline precursors that neutralize the acidity.

      “Contrary to what is generally believed, most fruits such as peaches, apples, pears, bananas and even lemons and oranges actually reduce dietary acid load once the body has processed them.”
          The study involved nearly 66,500 women (from the French center of the European Prospective Investigation into Cancer and Nutrition) over 14 years, with findings showing that those with acidic diets were more likely to develop type 2 diabetes.

       Scientists gave the subjects PRAL scores, referring to the potential renal acid load in their diets, with those with scores in the top 25 per cent having a 56 per cent greater risk of getting diabetes than those in the bottom 25 per cent.

       Meats can have a PRAL value as high as 13.2, cheeses 26.8, and fish 10.8. In contrast, fruits and vegetables have negative PRAL values.

       Ernest Chigbu, who is the head of legal counsel at the City of Johannesburg Metropolitan Municipality narrated: “What happened to me was … it was on a normal Sunday Afternoon. I was out and about riding and going to see friends.

As I was driving about the area I live, I started feeling dizzy. This was preceded by concomitant need to pass urine on a larger scale than before. I just thought that may be it is normal and there is no problem about that. So I did not take care of that.

      “In that month of August 2009 when I felt a bit dizzy, I jut thought it will pass so I didn’t really worry about it. I was also feeling terribly hungry more than usual.

When I get hungry, if I get home I ask my wife to prepare something I wanted to eat. It can but I never eat it because I did not have the appetite. But I was hungry and I felt very weak, so I slept, it was a Sunday.

      “In the morning of Monday, thanks to my wife that insisted that I go and see a doctor or otherwise I would not have gone. So I was preparing to get myself to work, I thought I was feeling better and she insisted that ‘no, you have to go and see the doctor first, work comes latter.’ I said ‘I am fine, I woke up, I can go. Then she insisted lets go and see a doctor and see what he is going to say and then you can go to work later.

      “When I walked in the office of the family physician, he started performing blood glucose test and then he immediately admitted me into hospital. He said four or five years ago my blood glucose was about 29 or 32 (it corresponds to above 500 ml, which is about five times higher than normal). Immediately he asked me to go to hospital. I still wanted to drive my car.

      “He gave me a letter take to the hospital, which is about three kilometres from his office. But what I asked the doctor was ‘can I go to work?’ I still wanted to go to work and later go to the hospital. But what he said to me, ‘at your own risk. It is your responsibility. If you die at work I am not going to accept responsibility.’ That started saying something to me, ‘work wont stop let me concentrate on my health first.’

      “So I went to the hospital and immediately got admitted when I presented the note from the doctor, I became a patient in the hospital. I was on drips and then I was moved around, blood was being extracted from me for tests and so on and so on.

The doctor came in about lunch time to perform whatever he wanted to perform and then I was admitted to the hospital. I stayed in that hospital for two weeks. That was when I heard terms like sliding scale.

      “The doctor was saying to the nurses, ‘you got to put him on insulin on sliding scale.’ I didn’t know what that meant. They continued to do what they were doing and two weeks later the doctor felt I was good enough to be discharged and when I got discharged.

      “I was then permanently placed on insulin- quick acting one and long acting insulin. There was an individual from one of the pharmaceutical companies who was there to explain the insulin works.

You know I didn’t believe it. The doctor I think played with my mind because he said to me, ‘No okay sorry for this week. We will see how it works and we will take you off the insulin as you improve.’ That gave me the hope that one day I will not be on insulin. But I think he was just playing mind games to make me accept because I didn’t accept this kind of disease.

      “I was one of those people who said, ‘not me, not me, I will never suffer from that.’ But you know you don’t make those choices, they are something that happens naturally. Maybe I would have discovered earlier if I paid a visit to the doctor because my mother passed away a year or two earlier from diabetes.

      “We knew because she was going through public health programme that she would collect medication. She was not on insulin as it were but she was on many doses of tablets and so on. So none of us, the children, decided to go and check for our selves. We didn’t just worry, we said, ‘it has ended with her and we are clear.’

       “If not for my wife, I would not have gone that day and would have died because I was still feeling those symptoms of dizziness, lack of appetite but I was hungry.”

       Chelladurai experience was different. He explained: “I come from India, which obviously have the dubious reputation of being the world’s diabetic capital.

According to the IDF, 62 per cent of the population in India is affected by diabetes that is equal to the total population of Great Britain and very close to Germany, which is 80.5 million. So we have a very large population and more dangerous. It is predicted that in the year 2030 it will cross 100 million and it is growing at a very alarming rate.

       “I retired as manager for Qantas Airline in India and my profession was not affected by my diabetes. I was a good sportsman. I played hockey for India. In fact I just missed 1972 Munich Olympics. I was a good sportsman. Even today I played squash three days a week. The other days I walk for about one hour. So I was thinking I was a tough guy. My parents did not have diabetes, so I did not know much about diabetes.

      “In 1995, due to my job I travel extensively, I was in Tel Aviv with my wife. That night I was very thirsty, each time I drank water I needed more. I thought it was something not good.

Immediately when I returned to India I consulted a doctor. Doctor said, ‘oh you have diabetes and I will prescribe you some medicines. He put on drugs. I was very ignorant of diabetes.

I thought diabetes is like cold or fever and it will go after having a tablet or two. I had heard about it but I didn’t know it would come to me. I didn’t expect it. I was living in fools’ paradise because I was affected. I took the drugs and I did not change my lifestyle. I was not smoker and still played sports actively everyday. Maybe my eating was a little bit too heavy so my diabetes was not controlled.

       “I did consult another doctor later and he put me on insulin and my lifestyle changed significantly. The lifestyle changes were amazing. You feel healthy, you feel good. I used to do a lot of hunting too so a started again. I was 9.9 HbA1 and now it is 6.1 HbA1 and that is because of insulin.”

       The HbA1c assay is the gold-standard measurement of chronic glycemia and measures the amount of glucose that binds to hemoglobin over a period of three months.

        The HbA1c Test is often prescribed as a must-do blood test for pre-diabetic, type 1 diabetic or type 2 diabetic or even non-diabetics.

       Heba narrated her experience: “I was 22 when I discovered I had diabetes. I was a little bit older considering I have Type 1 diabetes. I was 22, I just finished my university education, my Bachelors degree. I was an athlete. I competed with the national team for fencing. So we just finished my participation in Pan Arab games and that was a high level competition in which we won the bronze medal for the team.

       “So I have been an athlete every since I was a child. I have played volleyball, I played track and field, high jump with the national team, school team and the university. For the past two years before that I have been practicing for about six hours a day. I just went out of the games, I was very fit, I was at my peak in my level of fitness.

       “So after the games we were in the transitional period. We were just relaxing in order to go back to practice. I continued practicing. I had some muscle pains, so I was going to the physiotherapist for sports medicine in order to deal with my issues. 

Then my weight started dropping and really fast and I had a very big appetite and I wanted to eat all the time. During my workout as I was getting up I had numbness in my feet and I did not know why.

       “My doctor took me to the lab and asked me to do some tests and I didn’t know why. He decided to add glucose test, it was a routine test, so I did that. We don’t have diabetes in my family so I did not bother. I knew about it, I knew it usually come to people who are older than 35 and 40. I had no idea of Type 1 diabetes and there is diabetes that come to children.

        “So when I went back to him with the test and he said to me, ‘I was wrong. The sugar level is in the 200ml, so they must have made mistake, you couldn’t have diabetes.’ He sent me the next day to test my sugar level again and they were right.

They said okay may be you are exhausted let us do some more test. I had to go on diet for two weeks and test everyday until my doctor I was actually seeing, my physician told my father, ‘no, this is Type 1 diabetes, there is nothing we can do. This permanent.’ I was ok but bothered.  

      “You couldn’t have imagined that somebody who was that fit, active and have played sports all life will be close to getting any disease. I was really healthy, living an active life. Then there was they saying, ‘you have Type 1 diabetes, you need to be taking insulin all your life and you need to control your blood sugar and everything will be okay.

      “When the doctor told me the situation, I accepted under three conditions. I told him I wont leave my sports team, I want to continue practicing with the sports team, I wont take injections and I want to eat what I want. Usually with diabetes people think you have to change all these thing.

He sent my dad to get the insulin pen and he put me on a set of controlled system where I have to monitor my glucose level at every meal and according to the readings I will just take my insulin and he told me play sports as normal, just participate and practice, have the doses before the activity or exercise and he asked me to take a snack or milk before my work out.

       “I do believe the way my physician handled my situation helped me to continue living positively and even sending messages to my coach, ‘train her the way you use to and she will be okay. I actually continued training with the national team until 2002, that was four years after. That was very helpful. It helped me live a life with diabetes. I did not allow diabetes to lead my way, you just change things and adapt to make it work for you.”

      Heba further explained: “With my decision in living an active life and continuing my sports career, I started communicating educationists about diabetes and they asked me to demonstrate fencing and use it to educate on diabetes and I did.

At the event another patient came to me and the husband was having diabetes and she said to me, ‘you have diabetes and you are young?’ I said yes, ‘but you are young?’ I said yes. I was 23 at the time. ‘But you play sports?’ I said yes.

      “The way he reacted and I affected his life and the wife was always scared and living on the edge. I felt I have affected a life. Because I deal with the everyday situation with diabetes it makes me feel there is a message behind it. It makes me feel that I can actually be a role model in telling people that you can lead a normal life so also with Type 2 diabetes.

     “The biggest thing that hit me when I got diabetes was how children deal with diabetes. You know I was 22. I was lucky I wasn’t two days old or two weeks old. I was a grown up, I could take care of myself, I know how to handle my sweet requirements in eating sugar and candy.

I can control my life, I wasn’t a teenager and this brought me to a point when I decided I want to show people that you can live a normal life because I did. I still do and work on it. It is not easy, it is not like you will always be on the top of you game and living perfectly with diabetes.

     “It is a road of course and it has its up and downs but you can work around it, you can be positive and deal with every situation that comes. So I started doing that 13 years ago as an athlete and then I wrote My Diabetes Story and I became an ambassador with My Diabetes Story.

This is to reach to more patients, reach to the community and children and tell them you can live an active life, to speak out about it because to speak out is very important not just to tell people that you may have special needs but because when you speak out and talk about your situation, it means that you are open about it and this helps you live a better life.

       “We recently established a Foundation, it is a Type 1 diabetes and children with Type 2 diabetes in Jordan. It is called Eradeh in order to be able get more involved with the education and touching lives. I love it because it makes me able to be a role model and to inspire people to live a positive life do what they want to do.

There is no limitation. You can do anything you want to do in spite of having diabetes. For a child it is a life time.

     “The children look up to us. We have been involved in so many counseling sessions so they look up to us, they open up and they look at you as a role model.

I am a grown up now and kids use to look up to grown ups and I just say to them I have diabetes just like them, my glucose level is checked constantly and I take insulin and I am living a long life.

It opens up their mind regardless of the situation in their homes whether their parents are close about it, very picky or ignorant because you have all three situations.”

      Reacting to herbal medicines and natural products as possible replacement for insulin, Maldonato said: “I am not knowledgeable enough about herbal medicines. My personal opinion is that herbs or other plant products have positive effects, which have been demonstrated by tradition but the problem is that it is difficult to associate dose and effect.

With drugs you can measures effectiveness with dosage you give and drugs have well defined effects whereas there are so many natural products that you cannot always be sure of the effect. For example we have a legume in Italy, which is known to lower blood glucose.

      “One very important thing is that if you need insulin you should never stop.  There is a case of a family of a 15-year-old diabetic girl who were advised to give her herbs. They stopped the insulin and she died. So when insulin is necessary it should never be stopped. This is the only sure very important thing.”

       Halimi was emphatic: “If you need insulin, there is no food or herbs that can replace insulin.”
        Sanofi, in partnership with IDF on World Diabetes Day November 14 launched an international campaign, and is working actively to increase disease awareness.   

       “Daily physical exercise and better food hygiene can reduce the risk of type 2 diabetes by 35 to 40 per cent,” Halimi.

        He added: “Through its patient outreach and support, Sanofi actively participates in the prevention of this global epidemic, which remains a threat to future generations. For nearly 90 years, the Group has been working to improve the lives of patients through innovation. Today, Sanofi is able to provide overall health solutions and customized services to people with diabetes.”

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