Sri Lanka’s silent epidemic

By Kiyara Fernando

“Diabetes affects 366 million people worldwide, and 2.1 million of them are Sri Lankans (10.3% of the local population). This is in the over 20 age group.  It is a global pandemic that puts millions at risk, and the age of onset of this illness has decreased significantly,” said Dr. Mahen Wijesuriya, Secretary of the Diabetes Association of Sri Lanka.

“Diabrisk-SL”, a research study conducted in collaboration with Kings College London at the National Diabetes Centre shows that one in three persons have central obesity while one in five are overweight in the study population of urban young between the age of five to 40 years.  This is due to the fact that over 40% are physically inactive, he added.

“In the high risk group, 8.2% of urban youth under 20 years and 22.1% between 20-40 years have abnormal glucose tolerance while 60% had abnormal lipids which could lead to diabetes if left uncorrected.”

National Diabetes Centre, Sri Lanka

The National Diabetes Centre is the only centre dedicated to education and care of diabetes patients. Since its inception in 1995 the prevention of diabetes has become a primary goal.

The Centre liaises with the Government and non-governmental organisations with respect to policy planning especially in preventive care of diabetes. DASL (Diabetes Association of Sri Lanka) is affiliated to the International Diabetes Federation (IDF) comprising over 204 Diabetes Associations spread across 160 countries. Through the services provided by the NDC (National Diabetes Centre), the DASL provides clinical services, direct and indirect education and research. Services offered by the Centre include Single Visit Screening, Childhood Obesity/Young People’s Diabetic clinic, Insulin bank and other laboratory services.

Diabetes Association of Sri Lanka is located at National Diabetes Centre, Colombo, Sri Lanka Tel 94 777 374 795. Online access: www.diabetessrilanka.org or www.facebook.com/pages/Diabetes-Association-of-Sri-Lanka.

Key facts you should know about diabetes

What is Diabetes Mellitus?

Diabetes Mellitus is a state of increased blood sugar due to impaired insulin action either due reduced production or increased resistance to insulin action.

Are there different types of diabetes?

Yes. The key types are:

Type 1 diabetes (previously known as insulin-dependent diabetes) 


Type 1 diabetes is an auto-immune disease where the body’s immune system destroys the insulin-producing beta cells in the pancreas. This type of diabetes, also known as juvenile-onset diabetes, accounts for 10-15% of all people with the disease. It can appear at any age, although commonly under 40, and is triggered by environmental factors such as viruses, diet or chemicals in people genetically predisposed. People with type 1 diabetes must inject themselves with insulin several times a day and follow a careful diet and exercise plan.

Type 2 diabetes (previously known as non-insulin dependent diabetes)


Type 2 diabetes is the most common form of diabetes, affecting 85-90% of all people with the disease. This type of diabetes, also known as late-onset diabetes, is characterised by insulin resistance and relative insulin deficiency. The disease is strongly genetic in origin but lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are major risk factors for its development. Symptoms may not show for many years and, by the time they appear, significant problems may have developed. People with type 2 diabetes are twice as likely to suffer cardiovascular disease. Type 2 diabetes may be treated by dietary changes, exercise and/or tablets. Insulin injections may later be required.

What are the warning signs?

• Weight loss
• Excessive thirst
• Excessive urination
• Constant hunger
• Extreme tiredness/lack of energy
• Slow-healing wounds
• Recurrent infections
• Altered/blurred vision

Why is diabetes called

a silent killer?

It is a silent killer as it can damage major organs with minimal symptoms, leading to sudden life threatening complications.

What are the complications?

• Kidney failure – 20% of persons with diabetes die of kidney failure
• Heart disease and strokes – 50% of persons with diabetes die of heart disease  
• Blindness – 2.5 million persons with diabetes go blind annually globally
• Amputation – one million amputations occur annually globally

Does diabetes have a high mortality rate?

Yes. Globally, it kills four million persons annually, i.e. one person every eight seconds. In Sri Lanka 100 persons die every day of heart disease and diabetes related illnesses.

Why are the prevalence rates so high?

It is due to rapid urbanisation leading to unhealthy lifestyles.

Does type 2 Diabetes affect the young?

Yes. It is important to note that age of onset of the illness has decreased with more young people affected.

Can it affect anyone?

Yes. No age, sex or ethnic group is spared.

What are the Sri Lankan diabetes figures?

• 8.2% of urban young (under 20 yrs)have abnormal glucose levels
• 100 persons die every day of diabetes related illness which is 30% of all cause mortality
• Over two million people have diabetes in SL. 10% of the total population
• Urban – 16%; Rural – 8%
• 23% of urban young (under five to 40 yrs) are at high risk (two or more risk factors – Diabrisk-SL research done at National Diabetes Centre)
• In the Diabrisk-SL study (app 23,000 urban young screened): 50% were under 16 yrs; 70.6% increased waist/central obesity; 51.1% increased BMI (correct weight for your height); 60% had abnormal lipids.

Managing the diabetes pandemic is your best solution

Is there a cure for diabetes?

No. Not at the present state of knowledge. There is no cure and only prevention is possible.

What can you do

about it?

• Primary prevention is the only way to stem the tide of the pandemic.  This is the best way as prevention is possible before the illness.
• Secondary Prevention is too little too late but can be achieved through good blood sugar control to keep complications at bay

How do you primarily prevent type 2 diabetes?

• Physical – increase Body Mass Index (weight to height ratio)/increased waist/reduced exercise/first degree family history. Biochemical – dysglycaemia (abnormal glucose tolerance.
• Identification of risk factors more important than diagnosis of illness
• Lifestyle modification (LSM) – Adequate and correct nutrition to maintain ideal body weight, adequate exercise, and reduced stress. The biggest benefit in LSM is that it is simple, low cost and no medication is required. However, it needs initiative and commitment to be practiced in the long term to be effective.

What is correct nutrition in Lifestyle Modification?

What is good for a diabetic is good for all. The golden rule in nutrition is quality, quantity and timing.

• Quantity consumed should ensure ideal body weight. It should be in proportion to growth, pregnancy and exercise.
• Quality should ensure a healthy, balanced diet, which contains high fiber natural foods that are low in calorie content.
• Timing is paramount as delayed or skipped meals will augment hunger leading to increase consumption. 3 modest meals evenly spread throughout the day is ideal. If a meal is delayed a small healthy snack should be consumed to keep hunger at bay.  School children should eat 4 small meals per day at regular intervals.

What is a balanced diet?

A diet that contains adequate amount of all the necessary nutrients in right proportions required for healthy growth and activity. No single food contains all the items the body requires. It is important that your diet is varied.Choose food from all the food groups and balance your diet.

Eating a balanced diet can:

• Prevent many long-term illnesses
• Increase your life expectancy by keeping your heart and body healthy
• Help maintain ideal body weight

Healthy/natural foods to be eaten

• Starch products in the way of cereals and pulses minimally milled – high fibre such as green gram, gram, cowpea, red rice, whole wheat flour (atta), Red rice flour, Soya, Uludu, kurakkan, etc.
• Vegetables and fruits                                                                                                                           
• Fish and chicken
• Home cooked meals

Refined foods to be avoided

• Sugar, jaggery, honey and treacle
• Processed food such as sausages, bacon..
• Beef, mutton, pork
• Polished rice flour and products thereof        
• Polished wheat flour and products thereof
• Oils and fats
• Fried and tempered food   
• Fast foods – fast to prepare, fast to absorb and fast to produce illness

Alcohol and cigarettes should be avoided

Adequate exercise

Exercise is essential for all persons of all ages on a regular basis

• Vary the exercise so that boredom does not set it.
• The golden rule in exercise is that it should be continuous and regular
• Choose an exercise activity that you like and exercise regularly i.e. walking, jogging, cycling, swimming and dancing.
• Try to do your exercise with family or friends.

Recommended exercise regime should be;

• Children need to play for at least one hour per day
• 30 min x 3 times per week – Adequate
• 30 min x 5 times per week or more – Good
• Less than 30 min less than three times per week – Inadequate
• If you need to burn fat, you should engage in continuous exercise 45-60 min x 3-5 times per week

Sedentary activities such as sleeping, reading and watching TV should be engaged upon for short periods of time only.

Stress reduction

Stress results from an unhappy state of mind

nIf you are faced with any stressful problems, discussing your problem with a parent, friends, religious leaders and teachers who may be able to help

• Meditation, yoga and other relaxation methods can reduce stress
• Being happy with your lot in life helps to minimise stress