Diabetes affects one in 10 adults in Malta, a figure that is expected to double in 20 years' time if people continue leading sedentary lifestyles and overeating. With World Diabetes Day being celebrated on Monday, Ariadne Massa focuses on why you should put your best foot forward.

The sly disease

Amputations could be reduced by up to 50 per cent if diabetics took the necessary preventive measures and put their feet first, Joseph Azzopardi, head of the University of Malta's Department of Medicine advised.

Locally, the figure for amputations carried out at St Luke's Hospital because of to diabetes was not made available. However, somewhere in the world a leg is lost to diabetes every 30 seconds.

"The biggest mistake diabetics make is that just because they feel fine they neglect their health, until one day they start experiencing serious complications. Then it's too late for miracles," he said.

"Diabetes is not just about popping pills but learning to take care of your health," Prof. Azzopardi insisted.

This year, World Diabetes Day, being celebrated worldwide on Monday, is focusing on the theme of diabetes and foot care - put your feet first, avoid amputations.

Prof. Azzopardi, who also runs the hospital's Diabetic Clinic, said about 10 per cent of Maltese people over 18 already had diabetes, well above the European average of about two to three per cent.

Ninety per cent of the average 30,000 people with diabetes have the adult-onset Type 2. Of these, 27.8 per cent have problems with neuropathy (the nerves in their legs), while another 12.5 per cent have trouble with their circulation.

Diabetes in Malta and around the world is on the increase, mostly due to the fact that people are leading a more sedentary lifestyle, eating the wrong food and piling overly generous helpings on their plate.

The World Health Organisation presently estimates that there are 194 million people with diabetes around the world, but this is expected to shoot up to 330 million by 2025.

The future is not looking so bright for the Maltese either as they become increasingly obese. Recent figures released by the National Office of Statistics show Malta tops the lumpy league among EU countries, with 60 per cent of the population either overweight or obese.

Maltese children also have the highest rates of obesity in Europe and adult-onset Type 2 diabetes is slowly starting to manifest itself in a small number of teenagers as a result of obesity.

According to Prof. Azzopardi, doctors across the world, including Malta, are very worried because more children are developing diabetes.

Sadly a high number of those queuing up at the Diabetes Clinic this week were overweight. So why hadn't they made an effort to lose weight to avoid future complications?

"This is a phenomenon witnessed in diabetes clinics around the world. Education is not enough. Diabetics have to be persuaded to make sacrifices to lose weight. While some try it's hard for them to spend their entire life on a diet," Prof. Azzopardi pointed out.

But some have no choice: it's either lose weight or lose your eyesight. Isn't this incentive enough?

"It is important to strike a balance between making them aware of the complications while not making their life a misery. Some do take up the advice, but others don't bother, especially if they feel fine at the time," he said.

People are not so helpless against the ravages of this disease and a change in lifestyle and diet can, in the majority of cases, make a big difference.

"My advice is to eat less and walk more. If you can use the stairs instead of the lift do so; if you take the bus get down two stops ahead of your destination. The message is prevention," Prof. Azzopardi said.

Free blood glucose and foot monitoring

The Maltese Diabetes Association is embarking on a free blood glucose and foot monitoring initiative to mark this year's World Diabetes Day.

The association has teamed up with the Podiatry Association of Malta to provide this service and raise an awareness on how diabetics can take care of their feet and reduce the unnecessary suffering that foot complications can bring in the future.

"The Association endeavours to promote awareness on this condition since it feels that prevention and early detection is the key to control this condition and lead a normal life," said association vice-president Chris Delicata.

The following locations have been identified to encourage the public to avail themselves of this free service between 9.30 a.m. and 1 p.m.: today at the Plaza Complex, Sliema; on Wednesday at the Birkirkara local council; on Friday at Main Street Complex, Paola; and on November 19 at City Gate, Valletta.

The association is also holding its annual fundraising dinner on November 25 at the Coastline Suite, Coastline Hotel, Salina.

The evening, which costs Lm10 per person, will start with a welcome drink and canapés followed by a five-course dinner prepared by Island Caterers Limited. Flowing wine will be served throughout.

Entertainment will be provided by the Quacks Sixties Band, a popular group made up of Dr Malcolm Crockford, Dr James DeGaetano, Dr Anthony Bernard, Mario Mifsud and Adrian Curmi Dimech. For more information visit the website: www.diabetesmalta.org, or contact the organiser on 9942 9499 or via e-mail: cjd@diabetesmalta.org.

Put your feet first, prevent amputations

If you have diabetes (and you may not know it), taking care of your feet is essential. Remember that even if foot problems are painless they can still be serious.

Things to do

¤ Check your feet daily for cuts, blisters, bruises or colour changes, swelling and open sores. Report them to your healthcare team without delay. Use a mirror to see the soles of your feet or, if this is difficult, seek help from someone else.

¤ Always protect your feet. Wear suitable footwear inside and outside your home to avoid injuring your feet.

¤ Check inside your shoes for stones, sharp objects and rough places before putting your shoes on.

¤ Buy new shoes late in the day. This is because feet become more swollen towards the end of the day and you can be more sure that your shoes are not too tight and fit well.

¤ Wearing socks can help prevent injury. Make sure they are not too tight and wash them daily. Make sure they have no holes.

¤ Always wash your feet with soap and water. Take care to wash between your toes. Dry your feet carefully, especially between the toes. Use oil or lotion to keep your skin soft.

¤ Cut toe nails straight across and file any sharp edges.

¤ Have your feet checked periodically by a healthcare professional.

¤ Keep any wounds covered with clean dressings.

Things to avoid

¤ Avoid pointy-toe shoes, high heels, stilettos and strapless and backless shoes.

¤ Don't wear tight socks.

¤ When washing your feet be careful that the water is not hot enough to burn them.

¤ Don't use a heater or hot water bottle to warm your feet.

¤ Avoid walking barefoot whenever possible. If this cannot be avoided, you must be extremely careful and avoid the risk of burns from hot surfaces in hot climates.

¤ Never try to treat your own feet with corn medicines or razor blades. Always seek help from a professional if you have a problem.

¤ Avoid becoming overweight.

¤ Don't smoke - smoking damages the supply of blood to the feet.

¤ Don't wear jewellery on your feet.

This information, provided by the International Diabetes Federation, is not intended to replace the advice of your healthcare team.

Diabetes: Your questions answered

What is diabetes?

Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugars to build up in your blood.

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations.

The number of people in Malta suffering from diabetes is calculated to be 30,000, but according to the Maltese Diabetes Association this figure is expected to increase by 20 per cent by 2025. At least 50 per cent of all people with diabetes are unaware of their condition.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have some or none of the following symptoms:

¤ Frequent urination

¤ Excessive thirst

¤ Unexplained weight loss

¤ Hunger

¤ Vision changes

¤ Tingling or numbness in hands or feet

¤ Feeling very tired much of the time

¤ Very dry skin

¤ Sores that are slow to heal

¤ More infections than usual.

Types and risk factors of diabetes

Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for about five to 10 per cent of all diagnosed cases of diabetes. Risk factors are less well defined for Type 1 diabetes than for Type 2 diabetes, but autoimmune, genetic and environmental factors are involved in the development of this type of diabetes.

Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes accounts for the majority of all diagnosed cases of diabetes. Risk factors for Type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and race/ethnicity.

Gestational diabetes develops in about two per cent of all pregnancies but usually disappears when the child is born. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing Type 2 diabetes.

Other specific types of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections and other illnesses.

Can diabetes be prevented?

A number of studies have shown that regular physical activity can significantly reduce the risk of developing Type 2 diabetes. It also appears to be associated with obesity. Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop Type 1 diabetes, but prevention, as well as a cure, remains elusive.

The Maltese Diabetes Association

This association is a voluntary, non-governmental organisation aimed at educating its members and the general public on diabetes and how to prevent complications arising from it. Its mission is to improve the lives of people with diabetes and to work towards a future with fewer complications and more awareness on this condition. For more information call on 2122 1518.

Some of the above points are courtesy of the Centre for Disease Control and Prevention in the US.

Living with diabetes

Four years ago Kenneth Zammit Tabona weighed, in his own words, a monumental 110kg, ate like a wart hog and did absolutely no exercise.

Today at a trimmer 79kg, the 49-year-old artist and columnist normally turns down the calorie-laden canapés at receptions, makes healthy choices and fits in a 45-minute walk every day.

This complete transformation was not the result of some overnight realisation that being healthy mattered, but a life sentence declaration that he had Type 2 diabetes.

"I took the news quite well, until I bought a book on the subject, which said that this type of diabetes usually hit middle-aged people. I hadn't ever considered myself to be middle aged until then - funnily enough this was a worse shock," he said.

Though a number of relatives in his family are diabetic, Mr Zammit Tabona never thought he could be at risk and lived a normal, overall sedentary, lifestyle.

The trouble started fours years ago when he was still working at HSBC Bank and he started getting narcoleptic attacks, where he would suddenly doze off in mid-conversation.

Another peculiar symptom materialised. Mr Zammit Tabona, who never indulged in soft drinks, started the habit of attacking the machine in the afternoon and guzzling six cokes in a matter of a few hours.

"I was thinking that I had suddenly developed a liking for coke. Until one day the drinks machine conked out and I lost it - I became irrational and hysterical and stormed off in a shaking rage. To top it all off I was also waking up to go to the bathroom three to four times a night. That's when I started suspecting that something could be very wrong," he said with a smile as he recalled those erratic days.

A visit to the doctor and a blood test confirmed that he had Type 2 diabetes. He was referred to a specialist who did not beat about the bush - he had to lose weight drastically, change his lifestyle and eating habits, and do exercise - and plonked a bottle of pills on the desk.

"I'm not into pill popping and was eager to keep off medication as much as I can. The specialist told me that I could avoid taking them as long as I achieved good results in three months," he said, lighting a cigarette.

Despite taking his diagnosis seriously and making great sacrifices to adopt a healthier diet, smoking is the one habit Mr Zammit Tabona cannot kick.

Being invited to numerous receptions and throwing launch parties for his paintings, learning to say no has not been easy, but despite a few blips here and there, he has things under control.

The hardest bit was giving up huge helpings of some of his favourite traditional dishes such as timpana and ross il-forn, and restricting himself to only the occasional glass of red wine and a just square of his favourite chocolate.

"I've made healthy living a way of life. I have to make it clear, I'm not a health freak, I'm just cautious. I don't throw a wobbly if I'm invited to dinner and there's a fatty dish. Instead I eat a small portion and make up for it with a long walk he next day.

Mr Zammit Tabona believes that you don't have to be a crusader about the whole thing.

"In the beginning I used to drive everybody mad asking if there was sugar in the tea, root vegetables in a particular dish and so on. Then you realise that people are silently saying: 'oh my God, the diabetic is coming'. There are so many things that are worse than diabetes that you just have to get on with it," he said.

"You just have to take it as a challenge... when I faced it head on I managed - I feel that I have shed 10 years off my life, which is an added bonus."

"Diabetes is a very capricious and sly disease. It's easy to forget all about it and become slipshod, but you're condemned to a continual regime for the rest of your life if you want to avoid having your legs amputated or going blind in the future."

Helpful websites:

www.diabetesmalta.org
www.ndep.nih.gov
www.diabetes.org
www.idf.org
www.diabetes.ca
www.diabetes.org.uk
www.jdf.org

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