Diabetes mellitus is a progressive disease that develops when the pancreas does not produce enough insulin - or when the body cannot effectively use the insulin produces.

This disease is becoming a very serious problem in our country these days – a phenomenon which is thought to be due to the particular susceptibility we folk of South Asian ancestry have for the condition. Our ageing population and changing lifestyles also don’t help.

Unlike in the affluent countries of the West, there has been limited research carried out in Sri Lanka regarding this disease. The prevalence of Diabetes here has been determined by epidemiological surveys rather than a surveillance programme.

A recent research study was carried out by the Diabetic Research Unit (DRU) of the Colombo Medical Faculty’s Department of Clinical Medicine, in collaboration with the Oxford Centre for Diabetes, Endocrinology and Metabolism to assess the prevalence not only of Diabetes but also of the condition termed Pre-Diabetes. The latter is a precursor stage of Diabetes, which if allowed to progress, will go on to Diabetes. The good news is that if the condition is detected at this early stage, intensive lifestyle changes can prevent Diabetes proper from coming on.

Called the Sri Lanka Diabetes and Cardiovascular Study (SLDCS), the island wide research project recruited five thousand individuals form its study sample. Among the most important findings were

• The prevalence of Diabetes island-wide was 10.3% - in other words, one in ten of Sri Lankan adults (a total of over 1.3 million people) has Diabetes.

• 11.5% of our adult population (that is 1.5 million people ) was in the Pre-Diabetic stage – which means that for every known Diabetic, there is another Sri Lankan adult who will shortly develop the disease

• Diabetes was more common in urban residents (16%) compare to rural folk (9%)

• Over one third of the people who were found to have Diabetes did not know that they had the disease!

The stark truth is that Sri Lanka has one of the highest diabetes prevalence rates among all the countries of the world.

The unfortunate thing about Diabetes is that unless someone’s blood sugar levels are very high, they may not manifest any symptoms of the disease - and this is the reason why it is quite common for diabetes to be undetected in its early stages.

The level of glucose (sugar) in a person’s blood is usually measured in millimoles per litre (mmol/L). However, in a few countries, such as the United States and Sri Lanka, it is still common to use different units, milligrams per 100 millilitres (mgm/100 ml). The normal range for blood glucose (known as Blood Glucose Level and denoted by the acronym BGL) is between 3.5 and 8 millimoles per millilitre (63 and 144 mgm/100 ml).

Typical symptoms of Diabetes manifest if the blood glucose level goes over 15 mmol/L (270 mgm/100ml). These include

• tiredness

• lack of energy

• thirst

• frequent urination

• excessive hunger

• blurred vision

• delayed healing of wounds

• infections such as thrush

.The diagnosis of Diabetes is made by measuring a person’s BGL, the blood being taken from a vein (venous blood sample) and measured in a pathology laboratory. A blood test made on blood obtained from a finger-prick sample, while it is adequate for monitoring diabetes control, is not accurate enough to make a definite diagnosis of the disease.

A person who has a BGL greater than 7 mmol/L (126 milligrams per 100 ml) on a blood sample taken after 12 hours fasting, or who has a BGL greater than 11 mmol/L (200 mgm/100 ml) on a blood sample taken at other times (known as a "random sample") can be diagnosed as having Diabetes.

Sometimes, a Glucose Tolerance Test is done to diagnose Diabetes. Here, a fasting sample is taken and the person given a dose of 100 Grams of glucose to drink, following which blood samples are taken after 1 hour and 2 hours. Based on how the body handles this glucose load, a confident diagnosis of Diabetes can be made.