The mission of World Kidney Day is to raise awareness of the importance of our kidneys to overall health and to reduce the frequency and impact of kidney diseases and its associated health problems worldwide. The objectives of the World Kidney Day 2010 were the followings:

* Raise awareness about our “amazing kidneys”

* Highlight that diabetes and high blood pressure are key risk factors for chronic kidney disease (CKD)

* Encourage systematic screening of all patients with diabetes and hypertension for CKD

* Encourage preventive behaviours

* Educate medical professionals about their key role in detecting and reducing the risk of CKD, particularly in high risk population

* Stress the important role of local and national health authorities in controlling CKD epidemics. Health authorities worldwide will have to deal with high and escalating costs if no action is taken to treat the growing number of people with CKD. On World Kidney Day all governments are encouraged to take action and invest in further kidney screening

* If detected early, CKD can be treated by reducing other complications and dramatically reduced the growing burden of deaths and cardiovascular disease worldwide

Kidney diseases are silent killers which largely affect the quality of life. There are, however, several easy ways to reduce the risk of developing this kidney disease.

Seven golden rules:
i) Keep fit and active
ii) Keep regular control of your blood sugar level
iii) Monitor your blood pressure
iv) Eat healthy and keep your weight in check
v) Do not smoke
vi) Do not take over the counter pills on regular basis
vii) Check your kidney function if you have one or more of the high risk factors

Diagnosis of CKD with Diabetes:
People with diabetes should be screened regularly for kidney diseases. The two key markers of kidney diseases are eGFR and urine albumin. Kidney diseases are present when eGFR is less than 60 ml/min.

The Americal Diabetic Association (ADA) and National Institute of Health (NIH) recommend that eGFR can be calculated from serum creatinine at least once a year in all people with diabetes.

Urine albumin is measured by comparing amount of albumin to the amount of creatinine in a single urine sample. When the kidneys are healthy, the urine will contain large amount of creatinine but almost no albumin. Even small increase in ratio of albumin to creatinine is a sign of kidney diseases. Kidney diseases is present when urine contain more than 30 mg of albumin per gram of creatinine, with or without decrease eGFR. The ADA and NIH recommend annual assessment of urine albumin excretion to assess kidney damage in all people with type 2 diabetes and people who have type 1 diabetes for 5 years or more.

Good care makes a differencePeople with diabetes should:
* Measure their HbA1C level at least twice a year which should be kept less than 7%

* Regular insulin injection, intake of other medicines, meal planning, physical activity and blood sugar monitoring

* Blood pressure should be checked several times a year which should be kept <130/80 mmHg

* Regular intake ACEI or ARB medicine for controlling high blood pressure

* To measure effective eGFR yearly

* To estimate urine albumin atleast once a year to check kidney damage

* To take reduce amount of protein in the died at to seek health from the dietitian regarding meal planning

In conclusion early detection and treatment of kidney diseases are the best way to prevent CKD in order to reduced substantial burden of health budget.

Smoking increases your risk of getting type 2 diabetes
Some recent research shows there is a significant relationship between diabetes and smoking. The more you smoke, the more chance you have of getting diabetes. If you smoke 16 to 25 cigarettes a day, your risk for type 2 diabetes is 3 times greater than a non-smoker. When you quite smoking, your risk decreases during the years that follow.

Smoking affects the way insulin works in your body
In type 2 diabetes, the body does not respond to insulin made by the pancreas. Insulin helps blood glucose enter into the cells for fuel. When you smoke, your body is less able to respond to insulin. When your body resists insulin, your glucose level increase in the blood. Resistance does not start to reverse until you do not smoke for 10 to 12 hours.

Smoking makes it harder to control your diabetes
Studies show that smokers have poorer glucose control than non-smokers do. Smokers who quit have the same blood glucose control as non-smokers. When you have type 1 or type 2 diabetes, glucose control is very important. The HbA1c test checks how well you control your glucose level over 3 months. The goal is to keep your A1c at 7 percent or less. When you have diabetes and you smoke, your A1c level increases. If you quit smoking, your A1c level may decrease to the same level as a non-smokers.

Smoking increases your risk for getting other problems from diabetes
When you have diabetes and smoking habit, your chances are greater for getting other health problems form diabetes — complications. You can get serious eye problems, kidney problems, nerve problems, heart and blood vessel disease and so on.

Even for people who do not have diabetes but smoke, the risk of getting other health problems is greater. The more and the longer you smoke, the more your risk increases. Smoking and diabetes together greatly increase the danger of getting complications. To lower your risk, you must control your glucose levels and quit smoking. Diabetic people will be benefitted in many ways when they quit smoking.

Experts’ views
All smokers need stop smoking in a clear, strong and personalised manner. Ask every tobacco user if s/he is willing to make and attempt to stop smoking at this time (within the next 30 days for example).

Assist all people with smoking cessation. For those unwilling to attempt cessation at this time, stress the 5 R’s.

Relevance: provide individualised information on the hazards of smoking.

Risks: Emphasise the increased risks of heart disease and diabetes complications arising from the combination of smoking and diabetes.

Rewards: Review benefits of smoking cessation.

Roadblocks: Assure people of your willingness to assist in their efforts to stop smoking.

Repetition: Review people’s thoughts about cessation during their following visit.

Key messages
* Review major steps of smoking cessation

* Set a date to stop smoking

* Identify likely relapse triggers and make specific plans for coping with them before stopping smoking

* Assess for nicotine replacement therapy

* Discuss any concerns about weight gain and other concerns related to diabetes

* Make referral for additional smoking cessation support, prescribe nicotine replacement, provide self-help materials, or otherwise assist in a specific plan

* Arrange for ongoing contact

* Schedule follow-up contact either in person or via telephone

* Follow-up contact should occur soon after the date set to stop smoking, preferably within the first week.

The scoop on sugar

For years, people with diabetes were warned to avoid sweets. But what researchers understand about diabetes nutrition has changed.

* Total carbohydrate is what counts. It was once assumed that honey, candy and other sweets would raise your blood sugar level faster and higher than would fruits, vegetables or “starchy” foods such as potatoes, pasta or whole-grain bread. But this is not true, as long as the sweets are eaten with a meal and balanced with other foods in your meal plan. Although different types of carbohydrates can affect your blood sugar level differently, it is the total amount of carbohydrate that counts the most.

* But don’t overdo empty calories. Of course, it is still best to consider sweets as only a small part of your overall plan for diabetes nutrition. Candy, cookies and other sweets have few vitamins and minerals and are often high in fat and calories. You will get empty calories — calories without the essential nutrients found in healthier foods.

Have your cake and eat it, too
Sweets count as carbohydrates in your meal plan. The trick is substituting small portions of sweets for other carbohydrates — such as bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt or potatoes — in your meals. To allow room for sweets as part of a meal, you have two options:

* Replace some of the carbohydrates in your meal with a sweet.

* Swap a high carb-containing food in your meal for something with fewer carbohydrates and eat the remaining carbohydrates as a sweet.

Let’s say your typical dinner is a grilled chicken breast, a medium potato, a slice of whole-grain bread, a vegetable salad and fresh fruit. If you would like a frosted cupcake after your meal, look for ways to keep the total carbohydrate count in the meal the same. Trade your slice of bread and the fresh fruit for the cupcake. Or replace the potato with a low-carbohydrate vegetable such as broccoli. Adding the cupcake after this meal keeps the total carbohydrate count the same.

To make sure you are making even trades, read food labels carefully. Look for the total carbohydrate in each food, which tells you how much carbohydrate is in one serving of the food.

Consider sugar substitutes
As part of diabetes nutrition, artificial sweeteners can offer the sweetness of sugar without the calories. Artificial sweeteners may help you reduce calories and stick to a healthy meal plan — especially when used instead of sugar in coffee and tea, on cereal or in baked goods. In fact, artificial sweeteners are considered free foods because they contain very few calories and don’t count as a carbohydrate, a fat or any other food in your meal plan.

Examples of artificial sweeteners include:

* Acesulfame potassium

* Aspartame

* Saccharin

* Sucralose

Artificial sweeteners don’t necessarily offer a free pass for sweets.

* Keep an eye out for calories and carbs. Many products made with artificial sweeteners, such as baked goods and artificially sweetened yogurt or pudding, still contain calories and carbohydrates that can affect your blood sugar level.

* Sugar alcohols are not calorie-free. Sugar alcohols, another type of reduced-calorie sweetener, are often used in sugar-free candies, chewing gum and desserts. Check product labels for words such as “isomalt,” “maltitol,” “mannitol,” “sorbitol” and “xylitol.” Although sugar alcohols are lower in calories than is sugar, sugar-free foods containing sugar alcohols still have calories. And in some people, sugar alcohols can cause diarrhea.

Reconsider your definition of sweet
Diabetes nutrition does not have to mean no sweets. If you are craving them, ask a registered dietitian to help you include your favorite treats into your meal plan. A dietitian can also help you reduce the amount of sugar and fat in your favorite recipes. And don’t be surprised if your tastes change as you adopt healthier eating habits. Food that you once loved may seem too sweet — and healthy substitutes may become your new idea of delicious.

Doctors may soon be able to diagnose inherited diseases such as cystic fibrosis, thalassaemia and sickle cell anemia in fetuses by simply testing a blood sample taken from the mother.

Until now, prenatal diagnoses of such disorders have been possible only through invasive procedures like amniocentesis, which carry a risk of fetal miscarriage.

Amniocentesis is the extraction of a small amount of fluid from the sac surrounding a developing fetus.

But scientists in Hong Kong and Thailand may have found a way to diagnose in fetuses such “monogenic” diseases, which are caused by a single error in a single gene in the human DNA.

This is only possible because fetal DNA circulates in maternal blood, a discovery Lo and his colleagues made several years ago.

Many scientists have since been trying to find the best way to differentiate fetal DNA from maternal DNA, before they can even get down to looking for any anomalies in the fetal DNA. But these efforts have not met with much success.

In an article published in the Proceedings of the National Academy of Sciences, Lo and his colleagues said they had devised a counting system that could “bring non-invasive prenatal diagnosis of monogenic diseases closer to reality.”

Using highly precise digital blood testing technology, both mutant and normal DNA sequences are counted in maternal plasma and that is then used to calculate the number of mutant genes inherited by the fetus and to determine the probability of the fetus developing any monogenic disease.

Lo, however, noted that the accuracy of this method would depend on the concentration of fetal DNA in maternal blood.

Thalassaemia is a blood related genetic disease that can result in reduced fertility or even infertility. Early treatment can improve the quality of life of patients.

Cystic fibrosis affects the respiratory, digestive and reproductive systems and can lead to fatal lung infections.

In a study of more than 11,000 U.S. veterans with type 2 diabetes, the investigators found that over a decade, those diagnosed with depression consistently had a higher average hemoglobin A1C level — a standard measure of long-term blood sugar control.

The findings are concerning, in part, because studies have found that diabetics have a higher risk of depression than non-diabetics. It is estimated that about 30 percent of people with diabetes also suffer from depression at some point.

“Our study shows that depression is a major and important comorbidity in people with type 2 diabetes,” Dr. Leonard Egede, one of the researchers, said.

He and his colleagues at the Medical University of South Carolina, in Charleston, report their study findings in the journal General Hospital Psychiatry.

Briefly, the researchers analysed records from 11,525 mostly male veterans treated for type 2 diabetes between 1997 and 2006. At the outset, 6 percent also had a diagnosis of depression. On average, the researchers found, this group consistently showed a higher hemoglobin A1C level over the years.

The difference between groups was small — a gap of 0.13 percent overall — but for any one person, even a slightly higher hemoglobin A1C, sustained over time, can raise the risk of diabetes complications, Egede noted.

The reasons for the findings are not clear, but one possibility is that dealing with depression makes it harder for diabetics to manage their blood sugar with lifestyle measures and medication.

Mr Fahim, a 45-year-old business executive of a reputed organisation in the city, tried hard. When dieting did not work, he began taking pills to lower his blood sugar and pricking his finger several times a day to measure his sugar levels. They remained high. So he agreed to add insulin to his already complicated regimen.

Blood sugar was always in his mind. But in focusing entirely on blood sugar, he ended up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes. He was also missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. He assumed everything would be taken care of if he could just lower his blood sugar level.

Most diabetes patients try hard but are unable to control their diseases in this way and most of the time it progresses as years go by. Like many diabetes patients, he ended up paying the price for his misconceptions about diabetes. Last year, Mr Fahim had a life-threatening heart attack.

Diabetes goes undetected in many heart patients. It is a silent threat for many people who end up with heart disease because these patients do not feel the actual intensity of pain due to nerve damage as a consequence of diabetes. Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure. So, controlling blood sugar is not enough.

In part it is the fault of proliferating advertisements for diabetes drugs that emphasise blood sugar control, which is difficult and expensive and has not been proven to save lives. And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight. Again, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. The doctors typically spend just 5 minutes with diabetes patients, far too little for such a complex disease.

Mr Fahim found all that out too late. So, no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation. So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke.

Dr Md Rajib Hossain

Diabetes is the disease which direly needs support of the family members to a major extent. With the support from the families, they can lead normal lives even with deadly diabetes.

Like every year, yesterday was observed as the World Diabetes Day which is the primary global awareness campaign for diabetes.

56 percent respondents think that their family members know that it is possible to lead normal life with diabetes. Again, 27 percent respondent’s family members believe that any disease can happen to anybody. Family members of 10 percent respondents consider that long term treatment is required for diabetes.

It has been found from the research that the diabetics suffer from lack of confidence, do not feel comfortable in attending family and social functions, can not participate fully in household affairs as they feel tired and cannot wake up early and also they remain depressed and suffer from anxiety. The role of family is very critical in resolving these daily life problems of the patients. A sympathetic and patient consideration approach of the family members can make the life of the patients more comfortable and meaningful.

The society can also play an important role by creating an enabling environment for the diabetics. A food choice for the diabetes patient should be available in the family and social gatherings so that the people with diabetes do not feel uncomfortable in those situations.

The state should take a leading role in disseminating basic information about prevention and it should also encourage and facilitate the awareness programmes of the NGOs. Media can address awareness programmes focusing on prevention and management of diabetes. It is also evident from this research that there are misleading information prevailing in the society about diabetes. So, an aggressive communication programme is needed to inform the mass people about the real facts of diabetes.

An organised intervention by the government, health NGOs, citizen groups, media and other stakeholders is the need of the time for developing a diabetes-aware society through lifestyle research, family care, social communication, establishing patient support forum and policy making.

A careful and systematic approach of diabetes management can ensure a healthy life of diabetes patients and can help manage the most common form — type-2 diabetes.

Diabetes mellitus ( DM) is not a single entity but rather a heterogeneous group of disorders in which there are distinct genetic patterns as well as other etiological and pathophysiological mechanism that lead to impairment of glucose tolerance. There are two types of diabetes, those are:

Type 1 diabetes: Type 1 diabetes is an immune system disease where the body makes little or no insulin. It usually begins in childhood or teens. Children with type 1 diabetes need daily insulin shots to help their bodies use food. Type 1 diabetes often runs in families.

Type 2 diabetes: Type 2 diabetes is a disease where the body cannot make enough or cannot properly use insulin. Although this form of diabetes usually occurs most often in adults, it is becoming more common in youth. The average age of diagnosis of type 2 diabetes in youth is 12-14 years. It is more common among girls than boys.

Most of the children suffer from type 1 diabetes, so insulin is the treatment of choice. Some are treated with oral drugs. But proper nutritional plan and exercise can reduce the blood glucose effectively.

When choosing foods for a child who has diabetes, it is important to know how different foods affect blood glucose levels. Children who have diabetes basically need the same foods that all children need to grow and thrive. The recommended calorie intake is based on size or surface area of the child.

The following guideline will help provide a healthy diet to help control a child’s diabetes:

Offer balanced meals at regular intervals every day; Learn how different foods affect the child’s blood glucose level; Offer healthy snacks between meals; Encourage the child to drink water when thirsty; Choose whole-grain foods with higher fiber contents; Limit sweets, regular soft drinks, pastries, candy, jam, and honey; Limit saturated fat and cholesterol; Avoid trans fat (found in foods with hydrogenated or partially-hydrogenated oils) etc.

Aerobic exercise, that gets the heart beating faster and uses the large muscles, can help keep blood glucose levels in balance. It can also help lower cholesterol and blood pressure. Exercise also can help the child sleep better, feel more relaxed and even help concentrate better.

Hypoglycemia during or in the 2-8 hours after exercise can be prevented by careful monitoring of blood sugar level before, during or after exercise, sometimes by reducing dosage of insulin or giving extra snacks

Signs of low blood glucose include confusion, grouchiness, irritability, tiredness etc.

If the child has signs of low blood sugar, check blood glucose levels. If the level is under 70 mg/dL, try one of the following:

Have the child drink ½ cup of grape or orange juice, 1 cup of milk, a juice box, or ½ can of a regular (not diet) soft drink Give the child 1-2 tablespoons of sugar or honey

Parents cannot manage there child’s diabetes alone. The stress imposed on the family around the time of initial diagnosis of DM may lead to feeling of shock, denial, sadness, anger, fear and guilt. Meeting with a specialist to express these feelings at the time of diagnosis helps with long term adaptation. The physician must discuss various aspects of child’s diabetes with the child as also with the parents. The exercise has got to be a continuing programme. This needs a good rapport between the physician on one hand and the child and the family on the other hand. Parents need to learn administration of insulin injection, blood sugar testing, recognition of warning signals of hypoglycemia, hyperglycemia, ketoacidosis, infection etc.

Although children can be taught to perform many of the tasks of diabetes management. They do better when supportive — NOT over bearing-parents continue to be involved in management of their disease. Schools have the responsibility to provide diabetic students with a medically safe environment as well as equal access to the same opportunities and activities enjoyed by other students.

Diabetes is a very complicated and life threatening disease. There is no cure for diabetes, it can be controlled. So people of all corners should work together and create awareness, so that a diabetic child can lead a healthy, active and fun-filled life.

Dr Abu Sayeed Shimul