Malaysians' unhealthy lifestyle leads to diabetes

When they found out that their eight-year-old son Akmal Alif had type 1 diabetes, Zuraini Ahmad and Mohd Azhan Abdul Rahman reacted the way many parents in their situation would - they broke down and asked, "Why him?".

"We could not accept it at first. He was so young and we didn't know anything about diabetes. Would he be able to grow up and live a normal life? Is diabetes fatal? " recalls Zuraini, 54.

Now 16, Akmal is the youngest of their five children and was a healthy child. But when he turned eight, his parents started noticing that something was wrong.

"He was losing weight, weak and had dark circles around his eyes. He was also always thirsty and needed to pass urine often. After he used the toilet, there would be ants around. We knew something was not right," shares Mohd Azhan, 55.

A visit to the doctor confirmed that Akmal had type 1 diabetes.

Also known as juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is a chronic condition where the pancreas produces little or no insulin at all.

Insulin is a hormone that allows sugar or glucose from the carbohydrates in the food we eat to enter cells to produce energy. Insulin also helps store excess glucose for future use and helps keep blood sugar levels from getting too high or too low.

Without insulin, glucose will remain and build up in the blood while the cells in the body starve from the lack of sugar. The body begins to break down its own fat and muscle, resulting in weight loss which is one of the common symptoms of the disease.

To treat his condition, Akmal had to learn how to give himself insulin injections to compensate for the lack of insulin in his system.

Akmal and his parents also had to learn how to measure the appropriate dose of insulin to take each day based on the food he ate (how much carbohydrates and sugar he had per meal) or the amount of exercise he did each day.

The amount will increase as he grows and puts on weight, explains Zuraini.

"In the beginning, it was hard to come to grips with everything. It seemed that our whole lives revolved around trying to monitor Akmal's sugar levels, injecting him with the right doses of insulin, making sure the food he ate was healthy had didn't contain too much sugar and carbohydrates we really had no time for anything else.

"By the end of the first year of his diagnosis, we gradually got the hang of it all and it got easier. By the time he was nine years old, Akmal could inject himself with insulin, under our supervision at first, and this made things much easier," says Zuraini, 54.

Akmal is now 16 and healthy. He is studying hard to achieve his dream of becoming a heart surgeon.

They are even able to look at the bright side of his diagnosis.

"If I didn't have diabetes, I think I might be obese because I really like to eat. With diabetes, I am forced to control what I eat," says Akmal who enjoys baking cakes and pastries.

"Yes, I do eat desserts, although not all the time." As he has to live with diabetes, Akmal says that when it comes to Science lessons in school, he has a leg up over his friends.

"In school, we have a chapter in Science on the function of our vital organs and I was the only one who knew all about the pancreas and its functions. My friends also began asking me about diabetes and they wanted me to explain to them about insulin and what its function is in the body and I get to tell them all," says the soft-spoken teenager with a smile.

Because his family has to be vigilant about what Akmal eats, Zuraini says they have all begun eating better and opting for healthier, rather than tasty choices.

"It's automatic now. When we go grocery shopping, we check the nutritional value of the food we buy. Instead of buying instant noodles which contains so much carbohydrates, we eat rice. If eaten in the right portion, rice is much better.

"We eat much more vegetables and fruits than we used to and although we still fry some dishes, we use less oil. So, thanks to Akmal, we are all a lot healthier now," Zuraini says.

Wake up call

Assistant consultant oncologist Dr Farah Zaffar Hayat was so convinced she couldn't possibly have diabetes that she told the lab worker that he had made a mistake when her blood test results came back positive during a routine annual check-up.

But the second test also came back with results that confirmed Dr Farah was a type 1 diabetic.

"It was not easy accepting it. I went through the many steps of acceptance which started with denial. I was angry with God and kept telling myself it can't be true. But in the end, there was nothing to do but take the medication and insulin, otherwise I would not get better.

"I found it difficult. As a doctor, I advise patients every day on their health and there I was with diabetes. But then, mine was not due to anything I did and so it made it easier to accept eventually," she says.

Accepting the diagnosis was only the first step. Dr Farah found that she had to change her lifestyle to manage her diabetes.

"I had to exercise, eat on time and inject myself with insulin. More importantly, I had to completely change the way I ate. Carb counting is very important.

"When I found out I had diabetes, I stopped eating a lot of things like carbohydrates and so on. But that wasn't a good idea either as I used to have hypoglycemic incidences when I started my insulin jabs. So, I had to make sure I eat on time.

"I never used to have breakfast. But now that I have diabetes, I had to force myself to have breakfast. I never used to snack but now I have to make sure I have snacks with me at all times," she says.

For 43-year-old Salwa Seban, her wake up call came last year when her doctor warned her of the risk of kidney damage if she didn't control her sugar levels.

"I was diagnosed with diabetes about six years ago and was on medication. But I didn't really change my diet or exercise. When my doctor told me a year ago that I was risking my kidneys …that really got to me.

"I have five children and I didn't want them to be burdened with looking after me and taking me to dialysis," she says.

The first step Salwa took was to see a dietician and learn about counting calories and measuring her carbohydrates and sugars.

She also started exercising - running, doing zumba, boxing and hiking.

These days, eating healthily is second nature to Salwa who willingly forgoes her old favourites like pisang goreng (though she admits this delicacy is the hardest to resist), nasi lemak and roti canai.

"Now I pack my lunch to work. I eat salads, wraps and bake my chicken instead of frying it. Actually, it wasn't that hard once I set my mind to it. I think it's all a matter of changing our mindset. Now when I go to a buffet, I don't get tempted and just choose what's healthy," she says.

Watching their mother change her diet has piqued the curiosity of her children, aged 20, 18, 15, 12 and three.

"Initially they kept telling me I was eating too little. But I explained to them why I am changing my diet and they are all very supportive. They eat the healthier food I make for them although they also want to eat fast food from time to time," she says.

Time to change

The key to curbing the increase of diabetes cases in the country, says family medicine specialist Dr Raja Ahmad Shaharul Raja Abdul Malek, is through education and awareness programmes.

"People have to take ownership of their health and their lives. If you don't, how can you control it? Most patients don't know what medicines they are taking and some don't take their medications regularly.

"Many patients feel that once they are on medication, they can eat anything they like. What they don't realise is that even though the medicine helps the insulin work better it will lose its effectiveness in the long run," he says.

"The best way is to control your sugar as much as possible through your diet and by being active," he emphasises.

Unfortunately, he laments, many diabetics are complacent about their health and recovery.

"They know sugar is bad and so they tell me they don't understand why they have diabetes as they don't take much sugar.

"What they don't realise is that glucose doesn't only come from sugar. Anything you eat is broken down and becomes glucose - simple and complex carbohydrates, for example becomes sugar once broken down.

"Know what you are eating, control your portions and utilise the excess sugar in the body by doing exercise. These are the easiest and best ways you can control your sugar levels on your own," he says, adding that even those who don't have diabetes should eat healthily and exercise," said Dr Raja Ahmad Shaharul.

Why diabetes is a problem in Malaysia

Diabetes is a big problem in Malaysia, says Dr Raja Ahmad Shaharul Raja Abdul Malek, family medicine specialist at Beacon Hospital in Petaling Jaya.

According to statistics by the International Diabetes Federation, there are 3.2 million Malaysians living with diabetes. It is estimated that almost half of those with diabetes are undiagnosed, unaware that they are living with a chronic disease.

Last year, there were more than 34,400 diabetes-related deaths reported in the country.

"It is a huge problem. There are two types of diabetes, type 1 and 2. Type 1 is a autoimmune condition where the pancreas is unable to produce insulin. This type of diabetes usually develops in early adolescence and has a larger predisposition to being genetical.

However, type 2 diabetes is largely a problem with sugar control. In Malaysia, 90 per cent of those with diabetes are type 2, which is very preventable. It cannot be cured but can certainly be treated largely just by changing one's diet and by exercising.

"But, we Malaysians make bad lifestyle and diet choices. We don't exercise and this is where the problem lies," says the UK-trained doctor who specialises in the early detection and treatment of chronic diseases like diabetes.

Dietician Gurdip Kaur says that the availability of food practically 24-hours and the Malaysian culture of eating supper doesn't help.

"We Malaysians are so proud of our food. While that is fine, we have to be smart in choosing what and when we eat. Unfortunately, we don't and we lead unhealthy lifestyles," she says.

Doctor Shaharul feels that alarm bells should be ringing and that more has to be done by the government to educate people about healthy eating and living as statistics indicate very definitively how unhealthy Malaysians are as a nation.

The latest National Health and Morbidity Survey, for example, reveals that the percentage of Malaysians above the age of 18 with diabetes has shot up to 31 per cent compared to 15.2 per cent four years ago.

"Also, we are the fattest nation in this region! How did that happen? And, Malaysia is the eighth largest consumer of sugar in the world. That's huge!" says Dr Shaharul.

If our diet and size isn't worrying enough, a 2012 survey published in the medical journal the Lancet puts Malaysia as the laziest nation in Southeast Asia and among the laziest in the world with more than 60 per cent of its adults failing to meet the recommended amounts of activity (such as walking briskly for 30 minutes or more five times a week or doing vigorous exercise for 20 minutes at least three times a week).

"We have to do something about it. It's serious as it is and with uncontrolled diabetes, people are at risk of many other serious health complications. If uncontrolled, diabetics will have a higher risk of developing heart problems, strokes, eye problems, nerve issues, kidney .. a lot of other problems can happen from uncontrolled diabetes.

"But, if you are a diabetic and you control your sugar and exercise, you can, to a large extent, lead a normal life," says Dr Shaharul.