CAIRO: About one year ago, 37-year-old Nagat Farag was diagnosed with a slight flu. Some weeks later she still seemed exhausted and had no appetite for food. Sayyed took his wife once again to the doctor. This time a urine analysis was done. The same night, she was taken by an ambulance to the emergency room with critically high blood sugar levels. Nagat was finally diagnosed with diabetes mellitus and prescribed with insulin injections twice a day. Diabetes is now one of the world's biggest killers, claiming 3.8 million lives every year worldwide, roughly six percent of total world mortality, which is the same as HIV/AIDS and malaria combined. As for the number of diabetics, according to the UN, more than 240 million people worldwide now have diabetes and this is expected to increase to 380 million by 2025. Egypt is among the global top 10 in terms of the percentage of the population with the illness. Almost five percent of Egypt's population ¬- 4 million people - is diabetic. Other countries in the top 10 include the US, Russia, Germany, Japan, Pakistan, Brazil, Mexico. According to World Health Organization (WHO) figures, 80 percent of people with diabetes live in low and middle income countries. But despite the alarming figures, the scale of the problem is still widely underestimated. Physician Dr Salah Ghazaly Harab, told Al-Masry Al-Youm newspaper that a third of Egypt's population suffers from the illness, while many others borderline diabetics. Ninety percent of kidney failure cases in Egypt are due to diabetes, he said. "Correct and early diagnosis is essential, said Mary George of the National Diabetes Institute, underscoring the importance of using appropriate diagnostic criteria. "It is an integral component of clinical care and forms the basis for self-management. In Egypt, treatment shouldn't only consider lowering the blood glucose but should also focus on correcting the risk factors of non-communicable diseases such as smoking, obesity, physical inactivity and hypertension, she said. Since the day of her diagnosis, the lives of Nagat and her family have changed drastically. While Nagat and her husband knew almost nothing about diabetes, as soon as she contracted it, they became experts. Today, they speak about blood sugar levels, different measures of medication and long-term results. "Diabetes means that the body is not able to regulate the level of glucose in the blood by supplying the appropriate amount of insulin, Sayyed explains. "This hormone is necessary to transport the glucose from the blood into the cells where it's needed. Doses of insulin cost Nagat nothing because she has medical insurance. However, the early days were difficult, as she had to make payments daily to the nurse who injects her. Later on she learned how to inject herself without any assistance. Whenever she feels dizzy, Nagat eats candy or any sweet food until she feels better. In cases of Type 1 diabetes, the pancreas ceases to produce insulin, and the hormone has to be provided with injections, usually five or six per day. Type 1 diabetes is found predominantly among young people. Type 2 diabetics, such as Nagat, still produce a certain amount of natural insulin, but often suffer from a gradual insulin resistance. They are by and large treated by oral anti-diabetes medication, and in some cases a few insulin injections will be required. In the beginning it was painful for Nagat to take the injections, but after some weeks she got used to it. Three-year-old Ali Mahmoud has been diagnosed as Type 1, and takes six insulin shots per day. His family was shocked by the diagnosis, but were reassured when they were told about patients who developed the disease 30 years ago and are still alive. After getting back from the diabetes clinic Ali followed a strict schedule regulating everything from the time he wakes up in the morning to food and insulin injections, as well as regular monitoring of his blood sugar. "The blood sugar tests - up to six per day - are very important,'' says his father. "According to the test results we can calibrate the right amount of insulin and prevent dangerous cases of extremely high or low glucose levels, the so-called hyper- or hypoglycaemia. Furthermore, once a month Ali's father meets with his son's physician to discuss the results and the development of his case. In what is called "Intensified Insulin Therapy , the patient - or in Ali's case, his parents - monitor blood sugar levels and administer the right amount of insulin every day. This method of treatment is growing in popularity and is in contrast to the more common doctor-mediated approach which involves regular trips to a physician. Ahmad Nour follows the self-check method of diabetes treatment. "Regular self-testing gives me certain independence, and enables me to keep a flexible lifestyle, says the 23-year-old. "I can independently change my daily life according to changes in my work schedule or free time activities like sports. His physician, he says, supports this kind of treatment and is also content about the long-term results he has achieved. This flexibility is especially important for a toddler like Ali, who can't understand the complex relations between his meals, the insulin injections, his physical activity and the level of glucose in his blood. "No one can predict Ali's appetite, or when he feels energetic or wants to play quietly-just like any child his age, his father explains. All of these factors can affect the level of blood glucose, and his doctor is a proponent of this type of therapy since it enables patients to react quickly and independently. However, while it has many advantages, not all physicians encourage their patients to undertake self-monitoring. Dr Haitham Murad who has first-hand expertise in treating Egyptian diabetics, outlined two major problems. "Firstly, the patients must have a thorough knowledge of the disease, with some exposure to general medical and biological facts in order to manage this therapy, he says, pointing out that this form of independence could otherwise turn out to be extremely dangerous. "This intensive treatment is recommended only for people with a certain level of education and, even more important, only for highly-motivated patients who are willing to spend a lot of time and energy in treating their diabetes carefully. You can't let all people nurse themselves'' he explains. Moreover, as the major dangers of diabetes are not short-term but long-term complications - such as damage to the eyes, heart, kidney, and liver - Dr Murad thinks that "it's quite important to visit the doctor regularly, at least once a month, so he can discover [them] earlier and treat any complications. The monitoring carried out by the three-year-old Ali and Ahmad Nour requires a glucose meter. The small apparatus, which tests blood samples taken from the fingertip of the patient, sells for a few hundred pounds. Even more expensive is the monthly cost of the test strips used with these meters. Some diabetics find solace in sharing their experiences with other sufferers, either through the internet or meeting with patients in clinics or hospitals. Hanan Reda, a 22-year-old student and long-time sufferer said she maintains contact with other diabetics through a specialist website - www.diabetes-eg.com - on which she can also read the latest research on the illness, frequent inquiries from patients, and advice on how to treat herself independently. "It gives me the feeling that I am not alone and not a peculiarity, she says. Since her childhood, Hanan has always aroused people's pity. "They say things like, you can't do this, you can't eat that, poor girl . That's not helpful at all. I can eat everything, just not too much of some things. And anyway, eating is not everything in life. Despite the chances of the number of diabetics in this country doubling, Dr Hassan isn't alarmed: "It is a common, dangerous and costly disease - but it is controllable and preventable.
