Can you prevent diabetes?

Dr. Geoffrey Frankson shares ways to maintain your body's insulin balance

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As recently as the 1970s, the idea of “preventing” diabetes mellitus had not yet crossed the minds of most doctors. There are certain types of diabetes with possible causes that they could have envisioned eliminating — such as viral infection and auto-immune dysfunction — but for what is by far the commonest type (non-insulin dependent diabetes mellitus, which affects one in eight adults, maybe one in five in some sub-groups) the best hope seemed to lie in improving “treatment”.

It is a false hope. The problem for doctors is that the prevention of diabetes mellitus is not like the prevention of polio or cholera or deaths from vehicular accidents. It is not a matter of finding a vaccine, or cleaning up the environment, or passing seatbelt legislation.  The prevention of diabetes requires a radical change in thinking about health care, a “paradigm shift”, not only on the part of doctors, but also on the part of the people whom they serve.

The ethics, the politics and the economics of health care have hitherto ascribed an essentially passive role to the citizen. His “rights” pertained to what he could reasonably expect to receive from the government and his physicians; his “demands” were focused on what treatment he should be able to get, and that, in turn, determined the cost of care — to the patient and to the society as a whole. Our health care system has been based on the simple observation that people fall sick and must be treated.

Contrary to the above, the prevention of diabetes is centred on what the citizen must do. Until now, his only real obligation has been to co-operate with those who were fulfilling their obligation to maintain his health. He has had to keep the place clean, take his tablets and pay his taxes, health surcharge, doctor’s fees, etc., and the system would take care of the rest.  The prevention of diabetes, however, requires that the citizen play an active role, even in the absence of any evidence of sickness. He is called upon to take personal responsibility for his everyday health, to the extent that failing to do so will be seen as an infringement on the rights of his fellow citizens.

Why an infringement? Because society can no longer afford the cost of care that is incurred as a direct result of a lack of personal responsibility. We are spending millions of dollars to treat cancer of the lung, 90% of which is caused by smoking. We are spending millions more to amputate the legs of diabetics, and the only way we will be able to reduce that expenditure is for diabetics to change their lifestyle. That is a change no one but the diabetic himself can bring about. The same goes for smoking and every major health problem facing us today.

The way in which diabetics choose to live is the single biggest cause of health care expenditure in Trinidad & Tobago today, a statistic soon to be matched in the other Caribbean islands. Unbelievable perhaps, but true, as a closer examination of the facts will reveal. Suffice it to note that the way in which diabetics live is in fact the way in which we all live. Because of their genetic predisposition, they go blind or lose their legs, but the same lifestyle causes the rest of us to suffer high rates of heart disease, stroke, cancer, cirrhosis, AIDS and accidental injury, all very expensive conditions to treat.

Personal choice is the number one factor determining the standard of health that citizens enjoy in the Caribbean today. Not the number of hospitals, or the quality of government health clinics, or how many doctors are on call at any one time, but the daily decisions we make about cigarettes, food, exercise, alcohol and sex. So strong has been our focus on treatment (and so influential the medical specialists) that our health care budgets have not even paid lip service to the need to influence choice.

Now we have no choice. Unless we make a conscious decision to promote healthier lifestyles, a quadrupling of our income from tourism, oil, bananas, bauxite or what have you, will not provide sufficient money to pay for the treatment that will be demanded should the health care reforms envisaged in all the islands really lead to equal access to medical care for all citizens.

Tips on maintaining your body’s insulin balance

• Have regular medical checkups to ensure that blood sugar levels are under control and to allow early detection of any complications that may occur

• Monitor blood sugar frequently

• Take insulin or oral medications as the doctor prescribes

• Eat healthily

• Exercise regularly

• Keep abreast of new research on the disease

• Develop strong support systems at home and with friends

• Be creative: you can find new ways to do the old things you enjoyed before diabetes

• Stay away from alcohol, drugs and substances which will deteriorate your health

• Have fun.


Dr Frankson is a medical doctor and director of the Wellness Centre in Trinidad.

Funding provided by the 11th EDF Regional Private Sector Development Programme Direct Support Grants Programme.
The views expressed on this website are those of the the authors and do not reflect those of the Direct Support Grants Programme.

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