While there is recognition that diabetes in people has huge socio-economic repercussions, its serious impact on the individual is ignored, says Dr Dina Shrestha. In the coming years, the objective of
Dr Dina is to bring to centrestage the issue of diabetes among youth and women.
Dr Dina is a Senior Consultant Endocrinologist at Norvic International Hospital and Siddhi Polyclinic, President of South Asian Federation of Endocrine Societies and Immediate Past President of Diabetes and Endocrine Association of Nepal.
In a conversation with WOW’s Ankita Jain, she talks about how she is making a difference to health in the country, the diabetic graph in Nepal, and how regular follow ups act as a strategy for access and affordability of treatment. Excerpts from the interview:
Diabetes is a global health problem growing at such a rapid pace that the World Health Organisation describes it as an “epidemic”. Still people in Nepal don’t take it so seriously. Your comments.
Education and awareness can only bring about that change. I believe that they are not serious because they don’t know the detrimental effects it has on their future health and the generations. Type 2 diabetes largely being asymptomatic and the complications take decades to show which does not help the innocent and the unwary.
What is Type 2 diabetes and why is it so common in Nepal?
Type 2 diabetes is when the body does not make enough insulin or the insulin cannot be properly used (insulin resistance) which causes blood glucose to be high.
It is common in Nepal because we South Asians in general have a higher predisposition to Type 2 diabetes. Rapid urbanisation sedentary lifestyle, the food that we consume and how feasting is a social norm all contribute to the increasing incidence of this epidemic. It also has a strong link to genetics and family history and is inherited.
Which age group is more prone to diabetes and why?
When we talk about the risk, in theory people who are more than 35 years of age are at higher risk but now younger and younger people are being diagnosed and adolescent diabetes in not uncommon.
Does diabetes run in the family?
Diabetes runs in the family. There is a strong correlation of Type 2 diabetes and family history. Diabetes can cause depression and the fear of complications can be tangible especially in the elderly. Once a family member is diagnosed with Type 2 diabetes it would be advisable to change the lifestyle not only of the affected but the family as a whole to prevent other members especially the children from developing diabetes in future.
While there is recognition that diabetes in women has huge socio-economic repercussions, its serious impact on the individual is ignored. What has been your experience while dealing with women?
Women especially post-menopausal have a greater risk of diabetes complications particularly heart disease. But in our society women definitely seek help much later and do not come for regular followups and also tend to ignore their symptoms till it’s severe.
My personal experience for women and health has been that women themselves tend to neglect their health. They are always worried for their spouse, children and in-laws and tend to have a high tendency to “sacrifice” their health and wellbeing for the family.
Access to diabetes care is negligible as people in our country do not have access to medicines, technology, awareness, support and care needed to tackle this disease. How do we as a nation eliminate the risks?
Risk of diabetes cannot be eliminated but only minimalised. Support and care in Nepal due to our culture is abundant, however lack of awareness and education about the disease is crippling the society. Even at a health post, the diabetes drugs are available as they are listed as essential drugs and easily available.
Technology I do agree is lacking as insulin pumps, SMBG and telemedicine have not been adopted due to various reasons.
What are the impacts of diabetes mellitus on health care and national economy?
Diabetes as rightly labelled is a silent killer and its impact on health care cannot be undermined. From being the leading cause of blindness and leg amputations to increasing the risk of heart attacks and stroke it has a profound effect on the quality of the person’s life and life span. National economy is definitely affected as it affects the working and most productive years above 35. Our insurance policy is not the best and most people pay from their pockets and this is a financial drain.
IDF data shows total diabetes-related health expenditure at USD 56 million in 2019.
What does the diabetic graph in Nepal look like?
According to IDF, diabetes estimates 20-79 years at 3.9% in 2010 and now in 2019 it was 7.2%. By 2045 it is expected to be at 8.2%. It’s not a good graph.
In a country where the national healthcare system is so fragile , what measures should Nepal take to emphasise diabetes care and prevention?
A national healthcare system exists but may not be efficient and even broken in places. Diabetes care and prevention is very basic and anyone and everyone can do it but we just need enough motivation and also a positive affirmation from society.
We still have a mindset about weight loss, eating less and exercising not actually being good for health. Resting, eating a lot and gaining weight is a sign of good health and being prosperous. In the next two years for SAFES, I am therefore campaigning “think thin” in our region. We are not in the last century of malnourishment. Now in the 21st century even in Nepal, our issue is diabetes, hypertension, heart disease, and by now we should know that obesity can cause all this including cancer.
ACTT NOW (Active Children Today and Tomorrow), saying no to junk food, encourage outside games and withhold screen time is another campaign targeting children and adolescents in schools to spread awareness to safeguard our future and hope to curb the rising incidence.
We have to encourage and support our colleagues, friends and family who are trying to lose weight and eat correctly and not the other way.
We struggle in the clinic as when our patients lose weight, they come saying people they meet keep asking what happened and they get demotivated and scared. It’s almost a taboo to lose weight and denounce junk food.
Diabetics need follow-ups regularly and check-ups at least three or four times a year. Can this prevent complications and enhance longevity?
This is probably the most important message for today. Yes, diabetes can have dreadful complications but with good followup and control one can prevent it from happening. We can even say that one might have a healthier and more fulfilling longer life than the counterpart with the healthy choices, appropriate treatment and regular followups.
5 Lifestyle tips that every diabetic should follow
• No smoking
• Limit alcohol
• Exercise 30-45 minutes, 5 days a week
• Stop processed food and saturated fat
• Take care of your mental health and sleep