The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 28 May 2011 09:15 PM PDT Diabetes can be a frustrating and challenging disease to treat. An additional new class of drug, a once-daily injection, is now available for type 2 diabetes patients. A NEW once-daily diabetes jab to help maintain control over blood glucose levels and reduce weight was recently launched in Malaysia by Novo Nordisk. Liraglutide, a once-daily human glucagon-like peptide-1 (GLP-1) injection, is said to help patients achieve normal blood sugar levels. The injection can be taken at any time of the day, irrespective of meals. "Liraglutide represents an important advancement in the treatment of type 2 diabetes. It is a new drug to control diabetes, and it reduces blood sugar only when the sugar level is high. Thus, it avoids a common side effect of other medications, namely, low blood sugar (hypoglycaemia)," says Sanjeev Shishoo, vice president of Novo Nordisk, Oceania and South East Asia. Malaysia is the first Asean country to launch the drug, he says. Liraglutide is available in 30 countries, including the United States, Canada, Britain, Germany, France, Denmark, Japan, Russia and India, since it was first launched a year ago. In an extensive clinical development programme prior to the launch, 4,445 patients (18 to 80 years old) with type 2 diabetes in 41 countries (including Malaysia) received the injections. Different class Diabetes is a metabolic condition where people experience raised blood sugar levels because of either a partial or complete reduction of insulin production in their body. GLP-1, a key hormone, appears impaired in people with type 2 diabetes and may be a reason why they are at risk for abnormally high blood glucose levels. Incretins are hormones in the human gut that help the body process sugar properly. Incretin-based therapies represent a new class of treatment for type 2 diabetes. Natural GLP-1 also has other benefits, such as reducing appetite, lowering blood pressure, and improving heart function. Many complications Diabetes results in enormous health costs due to the many serious complications that arise from the condition (blindness, kidney failure, limb amputations, and cardiovascular disease, to name a few). Less than 5% are type 1 diabetes, while the most common is type 2 diabetes, which makes up 95% of cases. The causes of type 2 diabetes are insufficient insulin produced by the pancreas, insulin resistance, and overproduction of glucose by the liver, all of which give rise or cause hyperglycaemia (high blood glucose), says Prof Datuk Dr Mafauzy Mohamed, senior consultant endocrinologist at Hospital Universiti Sains Malaysia. "Overproduction of glucose is due to the lack of insulin to suppress the liver from producing glucose. Secondly, glucagon (level) is rather high," says Prof Mafauzy, who is also director of the Health Campus, Universiti Sains Malaysia. Glucagon (hormone) allows the liver to produce glucose, especially during fasting. In type 2 diabetes, the liver still produces glucose even though the glucagon level is high, he notes. Diabetics, he says, have two to four times the risk of dying from heart attack or stroke. Life expectancy of people with diabetes is reduced by five years due to complications. Diabetes is the number one cause of renal failure, adult onset blindness and non-traumatic amputations. Some 60% to 70% of patients have nerve damage if diabetes is not controlled (for example, injuries to feet and impotence in males). A global problem Presently, 285 million people in the world have diabetes, and the number is expected to rise to 438 million by 2030, reveals Prof Mafauzy. The rate of increase in diabetes cases is staggering. In Malaysia alone, 1.8 million people were diagnosed with diabetes in 2010, a significant increase from 1.4 million in 2006. "In 1986, the national prevalence of diabetes was 6.3%; in 2006, it was 15% (14.9%). That's almost a 150% increase in the rate of diabetes over 20 years," Prof Mafauzy says. By 2030, it is predicted that an estimated 2.5 million people will be diagnosed with diabetes in Malaysia. Prof Mafauzy says Indians (19.9%) top the ethnic groups of people with diabetes, followed by Malays (11.9%), and Chinese (11.4%). In 2010, diabetes was responsible for more than 23,800 deaths in Malaysia. Premature deaths due to diabetes can be prevented or delayed by 10 to 20 years if diabetes is kept under control, Prof Mafauzy emphasises. Previously, diabetes was thought to be "a disease of the rich." That's not so now. "There is only a 2% difference of people with diabetes in the rural areas (10.5%) compared to urban areas (12.1%). Even in the West, rural folks have a higher incidence of diabetes than urban folks, he says. Diabesity The increase in cases of diabetes is due to increasing affluence and obesity. "There is a joke that Malaysians are on a "see-food" diet. We eat whatever we see. We're constantly eating (except when sleeping)," Prof Mafauzy says. "The main cause of diabetes now is obesity or diabesity (obesity related diabetes)," he notes. Two-thirds of diabetics are overweight or obese. If they had better control over their weight, the prevalence of diabetes could be reduced by half. If your body mass index (BMI) is more than 40, you're close to six or seven times the risk of getting diabetes than if you are of normal weight (BMI of 18 to 25). The prevalence of overweight and obesity has doubled in 10 years. In 1996, the prevalence of overweight and obesity was 21%, but in 2006, the prevalence went up to 43% (almost double), notes Prof Mafauzy. Treating diabetes Oral monotherapy, oral combination, oral-insulin combinations, and multiple insulin injections are some of the ways of treating diabetes. In Malaysia, the control of diabetes is deemed "not satisfactory" and is causing a high prevalence of related complications. Consultant endocrinologist Prof Datuk Dr Khalid Abdul Kadir says despite medications (oral tablets or insulin injections) to treat diabetes, more than 70% of patients do not achieve the level of blood sugar accepted as control targets. As type 2 diabetes progresses, sugar control deteriorates. Patients are started on oral medicines. Then two or more medications are combined to control blood sugar. With multiple medications, there is an increased risk of hypoglycaemia and weight gain, says Prof Khalid. "There is a need for better control of blood sugar; perhaps one agent that will not cause increase in weight, but a decrease, because diabetes is also called "diabesity", which is diabetes and obesity. If we can reduce obesity, we can reduce problems associated with diabetes," he emphasises. He speaks about a new understanding on the mechanism of glucose control due to the identification of "new" gut hormone, GLP-1. "In normal individuals, gut hormones play an important role in blood glucose control. When the small gut detects food, it starts secreting gut hormones which circulate in the blood and have specific effects on the body in response to what you eat," he says. "If you don't eat and drink water only, you don't produce this hormone. If you drink Coca-Cola, the levels go up very high," he says. The development of liraglutide is based on this GLP-1 hormone. Prof Khalid says: "Liraglutide is able to bring type 2 diabetes to sustained target glucose level and there is low risk of hypoglycaemia. Within 26 weeks, patients can lose on an average up to 3.4kg of weight with liraglutide." In patients who are overweight, the weight loss is even more pronounced. Liraglutide is available as a simple pen device, along with one of the thinnest needles around, that makes injection virtually painless. One injection can last up to 24 hours, hence the drug is administered only once daily. The pre-filled, multi-dose pen delivers doses of 0.6mg, 1.2mg or 1.8mg of the drug. The cost of the injection for a month is about RM650 (on 1.2mg dose daily). Liraglutide is recommended for patients with type 2 diabetes who are unable to achieve normal blood sugar level with one or two anti-diabetic drugs. It should not be used in patients with type 1 diabetes mellitus, or for the treatment of diabetic ketoacidosis. Liraglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). This is because animal data has shown that that a rare type of thyroid cancer, known as medullary thyroid cancer, is associated with liraglutide, although the relevance of this finding to humans remains unknown. The US Food and Drug Adminstration has "approved liraglutide because the Agency believes that the benefits of this drug to patients with type 2 diabete mellitus outweigh potential risks associated with its use. To ensure that the benefits continue to outweigh any risks, the FDA has required a Risk Evaluation and Mitigation Strategy (REMS) as part of the drug approval. This REMS includes a patient Medication Guide and a Communication Plan. "FDA has also required additional studies to better understand the risks associated with this medicine, in addition to a large cardiovascular safety trial, that is now required as part of the development of most diabetic medications." Full Feed Generated by Get Full RSS, sponsored by USA Best Price. |
| Posted: 28 May 2011 09:13 PM PDT Get close to nature and enjoy a break from the hustle and bustle of city life on the foothills of Fraser's Hill. SOMETIME last year, I received a surprise message, inviting me to bring my family as guests to a six-star luxury vacation resort perched on the hill slopes at the base of Fraser's Hill, surrounded by lush virgin jungle. The resort is named Casabrina Vacation Villas, after the owner's daughter, Sabrina. It is a beautiful name, most appropriate for a beautiful holiday retreat. Upon enquiring from my host why I deserved this gift, he told me that I had "healed him" in the past. It turned out that he had attended my qigong and health seminars, followed my advice, and was able to stop most of his prescription drugs (he is the typical corporate high-flyer who was too busy with business to bother about his health, and like most of them, ended up being prescribed many drugs for a myriad of health problems). Now he only has to take one, and is trying hard to stop this one too. He takes his supplements regularly and walks rigorously almost every morning. He wanted to thank me and share his healing story with me. Since his resort was completed, he has been staying there quite often, sometimes commuting every weekend from his home in Petaling Jaya to Casabrina. He does at least an hour's walk (including the qigong walk) very early in the mornings, up and down the road that leads from the entrance (at main road level) to the top of the property. He feels healthy and robust. A fresh clean environment, good nutrition, regular exercise, and qigong can really do wonders! Coming to Casabrina As I was busy, I had to delay my trip for several months. So in early February this year, just before the Chinese New Year holidays, I drove my family on a leisurely drive to Casabrina for a well-deserved break. It is about an hour's drive from Kuala Lumpur. The route to Fraser's Hill on the eastern side takes you past Bentong, on the way to Raub (in Pahang). After turning into the road leading to Fraser's Hill, it is just a short drive in the fresh, cool environment before you reach the resort. Upon arriving, we had to drive up the narrow tarred road up the hill to the villas. The climb was easy, although at times the slope was quite steep. We were greeted by the housekeepers and shown our rooms. They also served as maids-in-waiting to cater to all our needs, and served us at meal times. They were young ladies from the nearby kampongs. Although the website (www.casabrina.net) had given my family a preview of the villas, the setting and the luxurious rooms, being there – savouring the fresh cool air, the vibrant flowers, the towering trees, the vast expanse of tropical jungle, and the birds dotting the wide blue sky – was distinctly different and literally breathtaking, and we decided then and there that we didn't want to go home! Presently, there are two exclusive villas "of unique tropical-rustic and modern architecture, built with love and meticulous attention to its natural surroundings by Felix Tee and designed by renowned Balinese architect AA Yoka Sara" (excerpts from website). There will be nine more villas, each with a distinct theme, when the whole resort is completed. We stayed at Villa Amertani, which "stands tall with rhythmic roughly hewn timbre pillars that seemingly echo the expanse of the rainforest. Teakwood balconies bring you closer to the tree line and panoramic views of distant mountains, while an emerald horizon pool reflects the sky and horizon. Sumptuously decked and beautifully laid out to accommodate four bedrooms and a large living area housed in glass from floor to ceiling, revealing all the wild beauty of the surrounding ancient rainforest." All the bedrooms and bathrooms are spacious and luxurious. The dining area is open air, so you get to indulge in the cuisine while enjoying the beautiful scenery and the freshness of nature. There are two huge LCD TVs for you to enjoy shows or catch up on the news should you want to. Villa Aranya is smaller and just a short walk away. It is "secluded in a luxuriant secret garden, evokes a sense of timelessness perfect for honeymooners and romantic getaways. Its two bedrooms, sparkling pool and gardens create an intimate setting in rhythm a stone's throw from ancient rainforest." My host stays here whenever he comes. The next surprise was to discover that we were the only guests, with the host, three housekeepers and a chef fully devoted to keeping us happy and well-fed. Casabrina cuisine After unloading our bags, we enjoyed the first of the many meals served to us during our stay. The resort itinerary states that there are six daily meals. On the first day, we could only cope with three meals, starting from lunch. In as much as we loved the food served, we asked to skip supper because our stomachs were too full. For the next three days, we stuffed ourselves with the best of East and West cuisine, complemented with local fruits, and local kuehs for the morning and tea breaks. In three days I gained 3kg, the most I had ever gained in such a short time in my life. That should give you a clue of how delicious the food was, as I am particularly careful about my weight. It was too good to resist. My wife and children also gained between 1kg to 3kg each. The chef was a young man from Penang who was adept at preparing local meals, and many varieties of Eastern and Western dishes. Since Pahang is famous for its river fish, we got to enjoy several fish dishes, and the family cleaned up the fish to the bones! Since the chef is there at your service, you can request whatever dish you prefer, and he will try to oblige. Unfortunately, I am not much of a gastronomist. So I just left it up to the housekeepers to suggest to us the best dishes. Indeed, they made the right choices and I never ate more in my life than in the three days there. Rest, relax and recharge Although the resort does make arrangements for guests to go for a wide range of activites (eg forest canopy walk; white-water rafting at the nearby Jeram Besu Recreation Park; adventure at Kuala Gundah Elephant Sanctuary; lakeside fishing; picnic at waterfalls; visit to Orang Asli settlement; helicopter ride over ancient forest and eco-sites; and many more), we decided to spend most of the time at the villa, to immerse ourselves in the pristine air and endless greenery, and to enjoy the in-house facilities – the sauna, jacuzzi, and swimming pool. Every day, we walked up and down the 3km winding narrow road within the resort. The air is ever-fresh, while the trees and the scenery give you peace of mind. On the way up, you will surely sweat profusely if you don't stop to rest. Along the way, there are many fruit trees, including rambutans and durians. Since the road is on the hill slope, at some stretches, you can pick the durians off the branches! However, when I was there, the fruits were still small. They must be ripe for the picking now (though durians are best allowed to fall off by themselves to ensure they are truly ripe). I did the qigong walk uphill and continued with qigong exercises at the helipad near the peak, where the road ends. Here, you can get a panoramic view of the two villas. The luxuriant jungle foliage is a sight to behold. There are always birds, insects and the occasional monkey to remind you that you are close to nature and its natural inhabitants. Being here is a great stress-reliever, and a fantastic break from the hustle and bustle of city living. We did visit one of the several eco-resorts-cum-training-centres not far from Casabrina. We had to go by four-wheel drive through muddy roads to reach the eco-resort situated in the middle of the hilly jungle. As it had just rained, so you can imagine how rough the ride was. That was the only adventure we had. We spent most of the time relaxing, swimming, eating, walking and exploring Casabrina itself. So if you want to have a lazy holiday, to rest, relax, recharge yourself with the cool, fresh forest air, and enjoy scrumptious food, this is the place to go. And if you want adventure, there are also many activities to choose from. ■ Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. Full Feed Generated by Get Full RSS, sponsored by USA Best Price. |
| Posted: 28 May 2011 05:11 PM PDT PUT simply, a goitre is an enlarged thyroid gland. It can be diffusely or uniformly enlarged, or it can be a "nodular goitre" – where one or more nodules or "lumps" are present. Occasionally a solitary nodule may develop in a normal sized gland. The causes of goitres and nodules are many, ranging from the normal physiological enlargement during puberty and pregnancy, to cancer at the other extreme. Do you have a goitre or nodule? One simple way to detect this would be to stand in front of a mirror and swallow. The thyroid gland moves upwards with swallowing and any significant enlargement will be visible. The gland is located at the front of the neck and shaped like a butterfly. If the entire gland is enlarged, then the "butterfly" will be seen to move upwards with swallowing. If only a part of it is enlarged, then only a localised nodule or "lump" will be seen moving up. From the doctor's viewpoint, it is helpful to differentiate between diffuse enlargement and nodular (lumpy) enlargement of the goitre as this may offer a clue to its aetiology. However, in some cases, there may be an overlap. For a diffusely enlarged goitre, the causes include: ·Physiological enlargement of puberty and pregnancy. ·Iodine deficiency (found in pockets of the country, especially in East Malaysia). This may be nodular as well. ·Autoimmune thyroid disease (this may, sometimes, be nodular). This group of diseases, as its name implies, is due to "bad" antibodies produced by the body. These antibodies may over-stimulate the gland, giving rise to a hyperactive gland or "hyperthyroidism"; or they may damage the thyroid gland, causing hypofunction or "hypothyroidism". Graves' Disease is the commonest cause of hyperthyroidism in this country. Examples of hypothyroidism would include Hashimoto's disease and postpartum thyroiditis. Certain drugs may also cause a goitre, eg lithium, amiadarone. The causes for a nodular or "lumpy" goitre include: ● Multinodular goitre, by far the commonest. The goitre consists of multiple "lumps", hence its name! This tends to run in families and the goitre may sometimes become so large that it causes tracheal (windpipe) and oesophageal obstruction. This will manifest as difficulty in breathing or swallowing. Cysts may also develop. Occasionally, bleeding into a cyst may cause sudden enlargement and pain. Note that the presentation may just be a "sore-throat" and an unobservant doctor may miss the diagnosis. ● Various types of thyroid cancer (papillary carcinoma is the commonest). ● Solitary nodules, especially in males, should be viewed with suspicion because the chance of cancer is higher. Investigations Blood: Checking the thyroid function is essential – this should include free thyroxine (fT4) and thyroid stimulating hormone (TSH) levels. These two tests alone will categorise patients according to their hormonal status; whether they are euthyroid (normal), hyperthyroid, or hypothyroid. Thyroid antibody levels are sometimes indicated (eg TPO antibody, microsomal antibody or thyroglobulin antibody). Scans: The simplest would be an ultrasound scan. This is invaluable in differentiating diffuse from nodular goitres as small nodules are often missed on palpation. Occasionally, a CT scan may be required to detect retrosternal extension (extension down into the chest) of a goitre. Retrosternal extension is dangerous because this leads to obstruction of the windpipe and oesophagus. These scans may also pick up suspicious lymph nodes, suggesting cancer. Radionuclide scans (using a radioactive compound) are used to determine whether the goitre or nodules are "hot" or "functioning". Only functioning thyroid tissue will take up the isotope. A whole body scan may be indicated to assess metastatic (widespread) thyroid cancer. Fine needle aspiration cytology (using a needle to "suck up" tissue from the gland) may be indicated for suspicious nodules when cancer is suspected. Assessing the resultant smear requires an experienced cytologist. If such a cytologist is not available, the procedure is next to useless. Management This will depend on the underlying cause of the goitre or nodule. For physiological goitres, no treatment is necessary. They will often resolve spontaneously. Otherwise, management will depend on the hormonal status of the patient: whether euthyroid (normal thyroid hormone levels), hyperthyroid, or hypothyroid. The cardiac consequences of hypo- and hyperthyroidism may be serious. If the patient is hyperthyroid due to a "toxic" goitre, treatment will be along the lines of anti-thyroid drugs, surgery, or radioactive iodine. If the patient is hypothyroid, then replacement therapy with thyroxine hormone is often all that is required. If euthyroid, then it is either surgery or watchful waiting. This, of course, will depend on the underlying cause. If cancer is suspected, then radical surgery will be required. In most other cases, the cause will be a non-toxic multinodular goitre. If it is small, and there are no symptoms of obstruction, then half-yearly or yearly observation will suffice. Some patients, especially ladies, may request surgery for cosmetic reasons, even though the goitre is small. The risks of surgery should be fully discussed with the surgeon as complications may occur, even in the best of hands. Injury to the recurrent laryngeal nerve (which controls the voice box) leading to loss of voice is one of the dreaded complications. Following surgery, close follow-up is mandatory as some patients may become hypothyroid and will require life-long thyroxine replacement. Thyroid disease is not uncommon. To aid in diagnosis and management, the thyroid gland should be assessed to determine whether it is diffuse or nodular. Definitive management will depend on the actual diagnosis and the functional status (whether euthyroid, hypothyroid or hyperthyroid) of the patient. In any case the necessity for life-long follow-up should be stressed. Note: This article is featured in conjunction with the International Thyroid Awareness Week 2011, held annually in May, to raise awareness and educate people about the critical role the thyroid plays in our wellbeing. For further information on thyroid dysfunction, please visit these following websites: www.thyroidweek.com or www.thyroid-fed.org. ■ This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. Full Feed Generated by Get Full RSS, sponsored by USA Best Price. |
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