KUALA LUMPUR, Nov 17 ― When British medical journal The Lancet in 2014 crowned Malaysia the most obese country in Asia, many Malaysians expressed their agreement over social media.
That study also said this affected almost half the population and that the condition has been on the rise in the continent for the past few years.
So, when in late July the National Diabetes Institute declared Malaysia having the highest rate of diabetes cases in Asia, and one of the highest in the world, are we surprised?
The International Diabetes Federation reported there were more than 3,492,600 cases of diabetes in Malaysia in 2017.
The correlation between unhealthy diets and the onset of Type 2 diabetes has been proven by many scientific studies conducted over the last decades.
“We see a rise in young people getting Type 2 diabetes in Malaysia. Some patients are in their late teens and early 20s. Also, half of those with diabetes do not know they have it.
“A lot of people are aware of the risk of bad diets but this has not transferred into action,” said Prof Datuk Dr Ikram Shah Ismail, who is the president of Diabetes Malaysia.
“In addition to awareness campaigns, we need other measures. For example, the soda tax that was announced in the recent Budget is a good start.”
In the Budget 2019 announcement, the government announced that an excise tax of 40 sen per litre on sweetened beverages will be imposed from April 1, 2019.
Dr Ikram also said the suggestion made in January to limit the opening hours of local eateries, was a good idea.
“We need to enforce the message to the public that obese people are more susceptible to diabetes.
“Although certain genes that one inherits may contribute to getting diabetes, ultimately the decision to lead a healthier life lies with that person.
“I’m glad to see that the government is taking this issue seriously.”
He applauded the increased of covered walkways in the city as it encourages Malaysians to walk more, especially to and from offices and train stations.
“If our 93-year-old prime minister can cycle around Putrajaya, we all can do it too, seeing many of us are much younger,” he said.
Diabetes 101
The Federation defines Type 1 diabetes as an auto-immune reaction where the body’s defence system attacks the cells that produce insulin.
People with Type 1 diabetes produce very little or no insulin.
The disease may affect people of any age, but usually develops in children or young adults.
People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood.
If people with Type 1 diabetes do not have access to insulin, they will die.
It has been reported that developing this type of diabetes is not related to being overweight.
Meanwhile, Type 2 diabetes is characterised by insulin resistance and relative insulin deficiency, either or both of which may be present at the time diabetes is diagnosed.
It is often, but not always, associated with overweight or obesity, which itself can cause insulin resistance and lead to high blood glucose levels.
Another form of diabetes is gestational diabetes that is a form of diabetes consisting of high blood glucose levels during pregnancy.
It develops in one in 25 pregnancies worldwide and is associated with complications to mother and baby.
Gestational diabetes usually disappears after pregnancy but women with GDM and their children are at an increased risk of developing Type 2 diabetes later in life.
November is known as Diabetes Awareness Month and the 14th is World Diabetes Day. The theme for 2018-2019 is “the family and diabetes”.
Family support
Dr Ikram said if a family has a history of diabetes, family screenings can help to establish diagnosis (if any) early.
“Statistics have shown half of those with diabetes do not know they have it. I want to advocate for early detection, which is more manageable than someone who has a chronic condition.
“The role of family is important when a family member has diabetes. You can show support by getting on board in diet change, exercise plan and blood sugar monitoring.
“Mothers are especially important because they are the ones in charge of meals. Mothers are particularly effective in advocating exercise for the whole family.
In addition, having diabetes is expensive. Dr Ikram said Malaysia does not subsidise syringes and newer medication with lesser damage to kidneys and heart are costly.
“Currently, such costly medication is not covered by most insurance providers. The public healthcare can only provide older generic drug that are more affordable.
“If the government are to provide the new meds, we will not have money for other things,” he said.
“Chronic diabetes can also lead to kidney failure and patients will need an organ transplant. However, the number of organ donors in Malaysia is low.
“Our country uses the opt-in approach. If we have an opt-out approach, healthy organs can be transplanted unless a person officially objects.
“I think the low rate of organ donation can be chalked up to ignorance, and cultural and religious sensitivities.”
Meanwhile, Diabetes Malaysia is always on the lookout for funds to carry out its awareness programmes. However, public donation is low.
One can be a member for RM10 a year or RM400 for life. For more information, visit the organisation’s Facebook page or go to its headquarters at 2, Lorong 11/4e, Section 11 in Petaling Jaya.
Life-changing diagnosis
Before Amri Rahim was diagnosed with Type 1 diabetes just over a year ago, his lifestyle was one many Malaysians can relate to.
He had long working hours without putting a priority on health and exercise. He also admitted to being gung-ho about going to the gym for a couple of months before going back to his unhealthy ways.
At his heaviest, Amri weighed 120 kilogrammes.
“This cycle went on for a good 15 years. Many friends and family members tried their best to talk me into changing my habits. But I had accepted that was how my life would be.”
Before his diagnosis, he had what was called an unquenchable thirst for about two weeks before being admitted to hospital for five days due to a fever.
“When I was obese I did think there was a possibility I could be diabetic but I was in denial. I didn’t take heed of the symptoms and didn’t want to go to the doctor.
“So, my condition was bad when I was admitted to hospital. I was put on an insulin drip and the doctor found that my blood sugar level was at 13mmol/L. Even then I tried to laugh it off, thinking that my condition was not terrible.”
However, Amri said his friends gave him some tough love, which includes the possibility of amputation as a result of unmanaged diabetes.
“During my hospital stay, I was taught how to administer insulin and monitor my blood sugar levels.
“A dietician also came to see me to help me understand the diet change I needed to follow to get healthy.
“After leaving the hospital, I decided to get more information of my condition. I also look into specific foods that friends suggested I try.
“I want to know whether these suggestions had merit and tried consuming healthier options.
“For example, I love peanut butter but it is bad for me so I would try to source for a healthier version. It also felt like I had a calculator in my mind, checking the food portions I could eat.”
The change in his lifestyle came gradually. Amri stopped eating out in public for a month after his diagnosis, saying it was difficult to estimate his portions and wanting to avoid high-calorie items.
“The first thing my doctor told me was that I needed to lose weight to improve my overall health. I started taking walks around my housing area. It was not easy.
“As time went on, I walked longer distances. But I was still unsure about going to the gym for exercise classes. I was afraid of people judging me.
“When I started losing more weight, I felt more liberated and confident. I challenged myself to do something different and that is when I took up spin classes.”
However, Amri has nothing to be ashamed of as he completed his first half marathon in April and training towards a full marathon next year. Now, he weighs about 73kg.
“I want to celebrate turning 42 by completing all 42 kilometres in a full marathon.”
He also brought up the stigmatisation of using syringes in public to check his blood sugar levels.
“For a while, I will do that in the toilet, which became tiring. In fact, most people just take a glance and don’t seem bothered. I guess it was just all in my head.
“But I feel people living with diabetes should talk openly about it. Normalise the conversation so people around you are aware about the symptoms, medication and so on.
“It is extremely important to have support from family and friends. Sometimes people around you can be negative but I’m lucky to have more supportive ones.”
Amri added his parents are giving healthier food options a try despite their traditional ways.
These days, he no longer spends 12 hours working. Instead, the flexibility of running his own business means he can squeeze in an hour a day being active; be it walking or at a spin class.
Diabetes is an expensive condition to have, he found.
On average, Amri needs two types of insulin as he falls under the resistant category, diabetes medication, and natural supplements.
“Fresh food and healthy replacements are expensive, exercise classes too. I see it as a priority though. I want to stay healthy and alive for as long as possible.
“I also consult my doctor before trying suggestions I often get from others. Sometimes, these suggestions are just myths.”
