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The Silent Timebomb
Diabetes is rising at alarming rates, particularly in youngsters

Jean is middle-aged and overweight -- just the sort of person likely to suffer diabetes. And she does. In fact, the Hong Kong housewife already showed signs that she might develop the disease when she was having her first child more than 10 years ago. Her body had trouble breaking down glucose during pregnancy.

At the time, doctors tried to help her through a combination of diet and medicines. But by the time Jean was 40, diabetes had set in. She has the most common, or type 2, form of the disease, when patients slowly lose the ability to make their own insulin or are unable to properly utilize the hormone which regulates blood glucose levels. (Type 1 stems from the destruction of pancreatic cells that produce insulin, and sufferers require a hormone injection every day.)

Warning Signs
Symptoms of Type 2 diabetes can be very mild, so sufferers often do not know they have a problem. What are the indicators of potential trouble?

•  Diabetics typically suffer chronic thirst. And because this drives them to drink more fluid, they urinate more frequently.

•  Dry, itchy skin and blurred vision

•  Many patients feel irritable, nauseous and are easily tired

•  Loss of feeling in the hands and feet

•  Recurring infections of the gum, skin, vagina and bladder may also point to an emerging ailment

Jean is among the 10% of people suffering diabetes in Hong Kong. And prevalence of the disease is growing not just in the SAR but throughout Asia. In Thailand, the figure has now risen to about 12% from the 5.3% that the World Health Organization noted about six years ago. Singapore saw its incidence of diabetes double from 4.8% to 10% over the same period, while the figure rose from 5.4% to 8% in Malaysia.

What's even more worrying, the patient profile is getting younger. Type 2 diabetes typically strikes people over 45, especially if they're obese. But now the disease affects even 11-year-olds in Hong Kong. According to Dr. Juliana Chan, a specialist at the SAR's Prince of Wales Hospital, more and more Asians under 40 are developing the disease. Last year, a Hong Kong study found that 28% of 3,427 diabetics surveyed had their condition diagnosed before the age of 40. "This shows an increasing incidence of young onset diabetes," says Chan. Indeed, the mean age of newly diagnosed patients has dipped to 50 years, compared with 57 years in 1990, she adds.

A similar picture is forming in Singapore, where doctors say that sufferers may be as young as 10 years old. Last year, the KK Women's and Children's Hospital was treating some 15 child diabetics and another 10 youngsters with problematic symptoms. Eight years ago, doctors at KK saw only one such case. Other Singapore hospitals report a parallel trend.

Risk factors for diabetes include a history of the condition in the immediate family, being overweight, high blood lipids, hypertension, gestational diabetes (when the condition occurs during pregnancy ) and age (over 45).

Jean's two children certainly fall into the high-risk category. Not only are they overweight, her parents and many of her siblings are diabetics. That's why Chan advises her to keep a close eye on the children's health even though their glucose levels remain within normal range: "They need to be kept under surveillance to detect the disease early."

Asia's alarming surge in diabetes, especially in affluent communities, is one of the consequences of adopting unhealthy lifestyles, for instance, overindulging in rich food and little physical activity. Indeed, Hong Kong children now have some of the highest blood-fat levels in the world. A survey last year found that many kids in the city engage in less than an hour's exercise each week though they spend plenty of time in front of a television or playing computer games. Though genetics is a factor -- experts say obese Asians are twice as susceptible to high blood pressure and diabetes than Caucasians of the same height and weight -- lifestyle plays a big role in what Chan calls the "silent" disease.

Because the early symptoms are relatively mild, diabetes often goes unrecognized. While parents think their kids sweat a lot because they're fat, profuse perspiration may be a symptom of incipient diabetes. Tiring easily and constant thirst are also warning signs. Some children develop a dark band at the back of the neck. Doctors advise parents to get their children tested if they are in high-risk categories.

A chronic disorder, diabetes is marked by excess glucose in the blood and urine. Unless treated properly, it can lead to other long-term problems such as kidney damage, amputations due to infection of the feet, nerve disorders and eye diseases that lead to blindness. The disease is also a leading contributor to heart disease and stroke. Sufferers often develop multiple conditions including hypertension and protein in urine.

Worse, experts warn, the younger the patients are, the more prone they are to developing complications. That's not to say teenage sufferers are likely to have their legs amputated. By planning their meals, not smoking, holding their weight down and exercising regularly, diabetics can keep their condition under control and lead normal lives. People like 24-year-old Maggie Cheng, one of Chan's patients, become so adept she can estimate the effect a meal will have on her body from a glance at the food on her plate.

Of course, doctors play an important role in helping their patients to understand their ailment and to lead healthier lives. But individuals must be receptive to these warnings too, says Chan. While doctors can prescribe medication and insulin, a balanced diet and regular workouts are also crucial. "Diabetes is a public-health problem. Patients cannot just rely on doctors to cure them. They have to take a role in looking after themselves," she says. Everyone, Chan warns, is potentially at risk from diabetes if they don't take the need for healthy habits seriously.

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