World Diabetes Day Marked on November 14

“If you find honey, eat only what you need, Lest, surfeiting yourself, you throw it up.” Proverbs 25:16 (The Israel Bible™)

Everybody wants to live a sweet life – but to do this, remember that sugar is deadly! Go to any supermarket or kiosk and see piles of candies, soft drinks, cookies, cakes, starchy snacks and other inexpensive but tantalizing simple-carbohydrate junk foods waiting for you – and your children – to pounce on them.

They are responsible for the worldwide obesity and type-2 diabetics epidemic that has been diagnosed in more than 450 million people. And one in every two individuals with diabetes – some 220 million – has not yet been diagnosed. Unfortunately, many of them already have complications by the time they are diagnosed, including damage to their feet, eyes, kidneys and heart.

The US Sugar Research Foundation – an American sugar industry trade group – apparently withheld a study nearly half a century ago that found evidence in animals that the consumption of sucrose (common sugar) caused disease. This manipulation of science was disclosed in a research article just published in the prestigious open-access journal PLoS Biology. Highly sweet corn syrup and processed white sugar are integral parts of a huge amount of processed food products around the globe.

If nothing changes, the current younger generation in the US – the first expected to live shorter lives than their parents – will be in trouble. A third of young Americans are projected to develop diabetes in their lifetimes.

November 14 is World Diabetes Day, this year and the next with the “The Family and Diabetes.” A two-year time frame has been chosen to facilitate planning, development, promotion and participation and raise awareness of the impact that diabetes has on the family and support network of those affected.

Type-2 diabetes is largely preventable through regular physical activity, a healthy and balanced diet, and the promotion of healthy living environments. Families have a key role to play in addressing the modifiable risk factors for type-2 diabetes and must be provided with the education, resources and environments to live a healthful lifestyle, according to the International Diabetes Federation, which first introduced it in 1991.

November 14, chosen because it was the birthday of Frederick Banting, whose work with Charles Best led to the discovery of insulin in 1921, is set aside to spread awareness about the chronic and potentially debilitating and fatal disease, its causes, prevention and devastating effects on human lives.

 Diabetes is a chronic disease that occurs when the pancreas cannot make insulin – the hormone that regulates blood sugar — or when the body cannot make good use of the insulin it makes. It is the leading cause of heart disease, stroke, kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults. Chronic exposure to high levels of glucose in the blood affects various key organs and tissues – the eyes, blood vessels, kidneys, nerves, feet, heart and gums. Diabetics (and everybody else) should not smoke, as the habit reduces blood circulation to the limbs.

Type-1 diabetes, an autoimmune disease in which the pancreas is unable to produce insulin to metabolize sugar and starches and requires ongoing blood-sugar monitoring and regular insulin injections, represents the minority of cases. Type-2 diabetes, usually the result of unhealthful diets, overweight and lack of physical exercise, accounts for the vast majority of cases. Type 1 used to be confined to children and type-2 to adults, but more and more overweight children and teens are contracting it as well.

Early diagnosis and treatment are key to prevent the complications of diabetes and enable people to live healthy lives. As patients’ families are potentially affected by the disease, the signs, symptoms and risk factors for all types of diabetes are vital to helping to detect it early.

Diabetes can be costly for the individual and family who don’t enjoy national health insurance or decent private health insurance. In many countries, the cost of insulin injection and daily monitoring alone can consume half of a family’s average disposable income, and regular and affordable access to essential diabetes medicines are out of reach for too many.

But even if there is national health insurance, the cost of caring for patients – their medications, medical specialists, nurses and hospitalization – is huge and threatens to wreck countries’ economies. For example, the overall direct and indirect cost of diabetes in Israel – treatment as well as low employment and productivity – is nearly $3 billion a year according to Clalit Health Services (Israel’s largest health maintenance organization) and its National Insurance Institute.

The overall annual damage to Israel’s Gross Domestic Product due to diabetes is almost $2 billion: The rate of non-working people with diabetes who were of working age (up to 65) was 45% compared to only 35% among non-diabetics of the same age, causing significant losses to the economy.

Although Israel is blessed as the “land flowing with milk and honey” and has an excellent health system – with National Health Insurance that entitles all citizens to a basic basket of healthcare and medications – it has nearly 500,000 diagnosed diabetics and a few hundred thousand more who are unaware of it. Israel holds second place among OECD countries in the rate of amputations due to diabetes. Complications of the disease are the fourth leading cause of death in Israel.

Almost 800 amputations caused by lack of blood circulation to the limbs and the breakdown of blood vessels can be prevented if patients are helped to keep their blood sugar in check and to monitor their feet to prevent sores. Of an estimated 1,000 cases in which feet are amputated each year, some 80% are due to the neglect of diabetes and its symptoms, according to Prof. Itamar Raz, a senior diabetologist and head of the Health Ministry’s National Diabetes Council. Shockingly, Israel holds second place among OECD countries in the rate of amputations due to diabetes.

Diabetics in Israel are routinely invited to community health fund clinics and hospital outpatient clinics to undergo a foot examination at least once a year. However, not all patients go for the exam or know about proper footwear to prevent ulcers. Many are also ignorant about the need to contact a doctor urgently if there is any change in the appearance of the leg or foot.

Jewish immigrants from underdeveloped countries who are not used to Western diets usually fall into the trap of eating cheap, simple carbohydrates like white flour and sugar without being aware of their dangers. For example, Ethiopian immigrants to Israel and their children are twice as likely to develop diabetes than other Israelis. The Knesset’s Immigration and Absorption Committee, headed by Knesset Member (and former Ethiopian immigrant) Avraham Neguise held a discussion this week on the need for new immigrants to learn about dangers of diabetes.

In Ethiopia, the Jews exerted themselves without going to gyms. Once they come here, they take buses and elevators and eat too few vegetables and protein, leading to overweight and a sharp increase in the prevalence of diabetes among them. Educating them is complicated by the fact that older Ethiopian newcomers are not yet fluent in Hebrew so they can be taught.

Still, there is hope. New diabetes drugs and medical technologies – some of them developed in Israel – offer the promise of a better future. For example, Oramed Pharmaceuticals, located on a Jerusalem campus of the Hebrew University, hopes to revolutionize the treatment of type 1 and type 2 diabetes with an oral insulin capsule that it is currently developing and testing. Currently, insulin must be injected.

Another Israeli company named Dario makes a pocket-sized, personalized glucose meter combined with a real-time mobile application to track, monitor and manage diabetes from a smartphone.

A third Israeli firm named Betalin is developing an implantable micro-pancreas using a natural micro-scaffold and all the cellular components that is meant to be implanted in the body and function like a natural pancreas. Several local companies have developed electronic devices that provide improved, automatic monitoring devices that display blood glucose levels; these help patients know when and how much insulin to inject and others to eat properly, without raising the levels too high.

So, as in other medical fields, Israeli researchers are leading the way to better health around the world.

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