 Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.  The current WHO diagnostic criteria for diabetes– fasting plasma glucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose ≥ 11.1mmol/l (200mg/dl).

 Diabetes kills 3.8 millions persons yearly, which is higher than HIV Aids.  Every 10 seconds a person dies due to diabetes- related causes  There is a reduction of life expectancy of 5-10 years  50% of persons with diabetes die of cardio vascular disease, heart and strokes.  Diabetes in the developed world is ranked as the leading cause of blindness, renal failure and lower limb amputations.  It has been estimated that between 5-10% of the total healthcare spending of the world is spent on diabetes related conditions.

 Earlier people used to walk from one place to another to buy all the stuff they want. But nowadays all things can be purchased at one stop; the supermarket.  Consuming high sugar diets.  Lack of unintentional physical exercises; earlier people used to grind flour, and do various kitchen chores using manual ways. But nowadays urban people are using various machines for theses things.  Stressful life style.  Consuming highly processed foods with low fibers such as instant foods.  Entertainment gained through passive ways. Eg: watching TV,browsing facebook; doing these activities for longer hours  Not eating fresh fruits and vegetables.

Urban life style Sedentary jobs & fast foods Obesity Insulin resistance Diabetes mellitus : type 2

 Sedentary urban life styles combined with easy availability of overly processed food items have made people give up the normal exercise that,the body gets from hard physical work.  The consumption of highly processed and artificially flavored food items all through the day has overwhelmed the human body with a flood of carbohydrates.  the consequent overdose of insulin, to which the body develops a resistance, by turning off its insulin receptors, as a continuous overdose of insulin is toxic to the body.

 Obesity increased adipocyte mass increased levels of free fatty acids and increased production of adipokines free fatty acids impair glucose utilization in skeletal muscle, promote glucose production by the liver, and impair beta cell function The increased production of free fatty acids and some adipokines may cause insulin resistance in skeletal muscle and liver.

 Therefore this combination of poor physical exercise and faulty eating habits leading to insulin resistance has led to what is called Type-2 diabetes which is spreading very fast among urban dwellers all over the world.

 Urbanization is associated with a drastic decrease in physical activity, changes in dietary habits, and additional psychological stress.

A Cross –sectional study conducted between 2005 and  Standardized prevalence for Sri Lankans aged ≥20 years – 10.3%  Prevalence in the urban population was 16.4%  Prevalence in the rural population was 8.7%  Prevalence of pre-diabetes in urban and rural population was 11.5%  Overall prevalence of some form of dysglycaemia (sugar problems) was 21.8% Ceylon Medical Journal

Recently, type 2 diabetes has increasingly been reported in children and adolescents, so much so that in some parts of the world type 2 diabetes has become the main type of diabetes in children. The global rise of childhood obesity and physical inactivity is widely speculated to play a crucial role. Healthy eating and lifestyle habits are a strong defense against the disease.

 Type 2 diabetes (sometimes called non- insulin-dependent or adult-onset diabetes) happens when the body cannot effectively use the insulin it produces. Often preventable, it can result from excess body weight and physical inactivity, and sometimes, a genetic predisposition.

Genetic factors Environmental factors

 Type 2 DM has a strong genetic component.  The disease is polygenic and multifactorial since in addition to genetic susceptibility, environmental factors (such as obesity, nutrition, and physical activity) modulate the phenotype.

why not ? Can I escape my fate Genetic predisposition Environmental factors

The major lifestyle alterations usually advised in persons with diabetes are:  Relief of stress by relaxation exercises or yoga  Increased physical activity  Stop smoking and tobacco consumption in any form  Stop alcohol consumption or limiting it to small quantities  Eating at regular intervals, and in proper quantities and composition that ensures a balanced intake of all nutrients  Drastically reduce intake of saturated fats and simple sugars  Weight reduction if you are overweight

 Adopting a healthy diet and increasing physical activity can prevent the development of Type 2 Diabetes up to 80%.

LIG

 N.D. Masakorala  O.G.W. Muthukumarana  K.R.D.O. Nadeera  K.K.M. Nethmini