A long, complication-free life with diabetes

The big news this World Diabetes Day is one of hope — the possibility of a long, complication-free life with diabetes. Success cases of people who have lived over 40 years after being confirmed as diabetic, even 50 years and 60 years have been documented by city diabetologists.

A study done at Dr. Mohan's Diabetes Specialities Centre (DMDSC) here, by V. Mohan, R.M. Anjana, Ranjit Unnikrishnan and B. Parthasarathy has proven just this.

In about two lakh patients from various DMDSC units whose medical records were analysed, over 200 people have lived 40 years with diabetes. Over 20 have lived for over 50 years, and though smaller in number, there are people who have lived over 60 years after they were diagnosed.

“We ensured that we picked up only those who had confirmed diabetes and were on treatment, all types of diabetes — Type 1, Type 2, Maturity Onset Diabetes of the Young (a genetic disorder inherited that causes disruptions in insulin production) and fibrocalculous pancreatic diabetes (caused by pancreatitis),” Dr. Mohan says.

He goes on to add, “It is generally believed that diabetes affects the lifespan. There is not too much data on this, particularly from India. A couple of Western studies estimated that diabetics live 8-10 years less. In 2006, our CUPS study that followed up 1,262 individuals for six years concluded that the overall mortality among diabetics was higher in Chennai.” In Chennai it was 18.9 per 1,000 person-years; comparatively among the non-diabetic population it was 5.3.

However, no one looked at the other side — the longevity of patients with diabetes, Dr. Mohan says. “We now know it is possible among a significant group of people.” While genetic studies to see if this group has a protective longevity gene will be done, there is much to learn from their life and control of diabetes, he adds.

Dr. Unnikrishnan, director, DMDSC, says: “They are certainly not sick, or dying, they have a fairly good quality of life. Over 25 per cent of the people who have lived for over 40 years have no complications — of the heart, kidney, eyes, or foot.”

Children who had Type 1 diabetes detected as early as three years are now grandparents and great grandparents. Dr. Anjana, director, DMDSC, says: “This busts the myth that kids with Type 1 diabetes will not live long enough or even that they will be unable to bear children.”

Another myth — that over time every diabetic moves to insulin — has also been busted. Dr. Unnikrishnan says, “Almost 25 per cent of the T2 who have completed over 40 years of living with diabetes are still taking only tablets.”

However, the key is to focus on what is common between the members of this group.

According to Dr. Mohan, “One thing is very clear. They have all been meticulous with treatment for their condition. It also does not matter what the type of treatment is. Some of our older patients had none of the sophisticated, expensive drugs that are available now and, they have lived to tell the tale.”

The pattern is clear: They have all been somewhat careful with diet, had regular exercise, periodic blood sugar tests, kept their three month average (HbA1C) as close to 7 as possible.

The key, Dr. Mohan explains, is to keep the blood sugar under control for the first 10 years.

“If you don't do this, whatever else you try later, the game is lost. The message is that if you take your disease seriously right from the beginning, a long and healthy life is indeed possible.”

Among Cell-Phone Junkies, Rash on the Rise

If you're an incessant cell phone user and a mysterious rash appears along your jaw, cheek or ear, chances are you're allergic to nickel, a metal commonly used in cell phones.
While allergists have long been familiar with nickel allergy, "cell phone rash" is just starting to show up on their radar screen, said Dr. Luz Fonacier, head of allergy and immunology at Winthrop University Hospital in Mineola, N.Y.
"Increased use of cell phones with unlimited usage plans has led to prolonged exposure to the nickel in phones," said Fonacier, who is scheduled to discuss the condition in a larger presentation on skin allergies Nov. 14 at the American College of Allergy, Asthma and Immunology annual meeting in Phoenix.
Symptoms of cell phone allergy include a red, bumpy, itchy rash in areas where the nickel-containing parts of a cell phone touch the face. It can even affect fingertips of those who text continuously on buttons containing nickel. In severe cases, blisters and itchy sores can develop.
Fonacier said she sees many patients who are allergic to nickel and don't know it. "They come in with no idea of what is causing their allergic reaction," said Fonacier, also a professor of clinical medicine at the State University of New York at Stony Brook. Sometimes, she traces her patients' symptoms to their cell phones.
In 2000, a researcher in Italy documented the first case of cell phone rash, prompting other research on the condition. In a 2008 study published in the Canadian Medical Association Journal, U.S. researchers tested for nickel in 22 handsets from eight manufacturers; 10 contained the metal. The parts with the most nickel were the menu buttons, decorative logos on the headsets and the metal frames around the liquid crystal display (LCD) screens.
Cell phone rash is still not well known, said allergist Dr. Stanley M. Fineman, a clinical associate professor at the Emory University School of Medicine in Atlanta. While he's treated more cases of nickel allergy caused by piercings than by cell phones, "it's good for allergists and dermatologists to have cell phone contact dermatitis on their radar screens," he said.
Nickel allergy affects an estimated 17 percent of women and 3 percent of men. Women typically develop cell phone rash more often because they are more likely to have been sensitized to nickel after ear piercing, or had an allergic reaction to nickel-containing jewelry. If you get rashes from costume jewelry or the metal button on your jeans, you're probably nickel-sensitive, said Fonacier.
To treat cell phone rash, you can apply a mild over-the-counter corticosteroid, she said. (Ask your doctor about how long you can safely use it.) Then, keep the nickel-bearing parts of your phone off your face.
"Buy a phone cover, opt for a hands-free device, use the speaker phone or switch to a phone that doesn't contain nickel on surfaces that touch your skin," she said. Consult an allergist if the rash lingers.
If you know you're nickel-allergic, go online and order a nickel spot-test kit before you buy a new phone, Fonacier suggested. "Put a drop of the liquid [dimethylglyoxime] on a cotton swab and dab the swab on those parts of the phone where nickel is typically found," she said. "If the applicator turns pink, the phone contains a good amount of nickel."
Some researchers believe the United States should regulate nickel more stringently, as some European countries do, said Fonacier. Since 1994, the EU Nickel Directive has limited nickel release from consumer products that come into direct, prolonged contact with skin. Since then, the prevalence of nickel sensitivity has gone down in Germany and Denmark, according to studies published by researchers in those countries.
The best remedy for cell phone dermatitis is not to get it in the first place, said Fonacier. "Just as you cannot tell a woman not to wear cosmetics because she is allergic to fragrance, you cannot tell people not to use cell phones because they are allergic to nickel. There would be no compliance," she said. "So prevention is the key."