Around 200,000 people in Malaga province have diabetes, a silent illness which is often related to genetics, unhealthy diet and a sedentary lifestyle. However, there are a lot of myths about diabetes, such as that people who suffer from it must not have sugar. In this interview, the president of the Diabetics Association of Malaga (Adima), Esther Galicia, talks about the illness, the myths, and advances in its treatment.
–What is the situation with diabetes in Malaga at the moment?
–Looking at where we were last year because of the Covid pandemic, we can say that things are better but not ideal, because people with Type 2 diabetes are still not getting all the check-ups they need. We always differentiate between Type 1 and Type 2 diabetes.
–And what is the difference?
–In Type 1 the immune system attacks the beta cells, and insulin needs to be administered right from the start if the patient is to survive. The main difference is that under the Andalusian and Spanish health service, Type 1 is monitored by the endocrinology services in hospitals. During the pandemic endocrinologists kept in contact with these patients and they continue to be monitored. However, people with Type 2 diabetes, who take tablets and don't need insulin, or need it but not five or six times a day, are monitored by their GP. And that's where we have a problem, because chronic patients could not see their doctor, only speak to them by phone. That is still often the case, and it is a major difference between treatment for the two types of diabetes.
–Isn't Type 2 diabetes associated with a lack of exercise, obesity and an unhealthy diet?
–And genetics, too. The problem we have with Type 2 diabetes is that there are patients aged 20 to 25 who have their own ways of doing things and it is much more difficult to persuade them to change than it is with children or teenagers. Comparing the two types of diabetes, one cannot say that one is more or less serious than the other. It is a very personal thing. My daughter, for example, has Type 1 diabetes and receives excellent treatment, thanks to the Andalusian health service. But I also know patients with Type 2 who are dependent on insulin but are not continually monitored because the flash system is not going to be implemented until January.
–What is the flash system?
–It is a device to measure glucose levels in the blood. It is the size of a two-euro coin and you wear it on the back of the arm. It inserts a filament into the patient's interstitial tissue and records the measurements, which can be read on a mobile phone app. It can also transmit data to the Cloud, facilitating tele-medicine. The measurements are sent 24 hours a day, seven days a week.
–Which patients have the right to a flash monitor under the health service?
–Those with Type 1 diabetes. At first it was subsidised for people under the age of 18, then expanded to others. In March the Junta de Andalucía agreed to finance a flash system for patients with Type 2 who are insulin-dependent if they met certain criteria, and from September it has been available for people who are dependent on others, live in care homes or have some type of dementia. From January GPs will be able to prescribe it for all patients with Type 2 diabetics who are insulin dependent if they can see that they are monitoring their diabetes properly. Everyone must use it properly, because if they don't it will be withdrawn. Bear in mind that the sensor costs 120 euros a month to use. All they ask of patients with a flash system is that they look after themselves properly.
–So do people with the flash system still have to prick their finger to check their glucose level?
–No. It replaces that. The measuring device is very reliable. Apart from cases of hypoglycemia, when capillary blood glucose testing is necessary, patients do not have to prick their finger. Otherwise they would have to do it at least 15 times a day. The information sent by the flash system is equivalent to two tests an hour. It is a very important step forward. Dangerous situations such as serious hypoglycemia, which can lead to a diabetic coma, can be avoided because the information is provided early enough for something to be done. It has improved quality of life 100 per cent.
–How many people in Malaga province have diabetes?
–Around 200,000. It is calculated that 15 per cent of the population has diabetes and of them, four per cent are Type 1. In the hospitals in Malaga city alone they are seeing about 5,000 patients with Type 1.
–Do children cope better than adults with diabetes, and stick to the treatment?
–In general, yes. We work with them but it also depends on the families so the children don't feel different from others. They know that the insulin is part of their lives and if it isn't used properly it could cause hypoglycemia or hyperglycemia. Children are used to following rules. Our summer camps are organised specifically for that, so they don't feel alone and they learn to manage the illness.
–How often does someone with diabetes need to inject themselves with insulin?
–Every time they eat, so five times, plus slow insulin, so six times, and sometimes more if they need to make corrections. So anything from six times a day upwards.
–How much of what we hear about what diabetics can eat is a myth?
–It is a mistake to think that food for someone with diabetes is any different. It's a case of following an enjoyable and healthy diet which all the family can have. Another myth is that there is good diabetes and bad diabetes. Or that Type 1 diabetes can be cured. Or that diabetics can't have sugar. It is deluded to think that something with no sugar is suitable for diabetics, because it is the carbohydrates that we have to control.
–So someone with diabetes can have sugar?
–Yes, of course. They can eat the same food as someone who isn't diabetic. What they have to do is calculate and control the carbohydrates they consume. Those are found in fruit, flour, sugar, nearly all sweeteners, pasta, pulses, cow's milk and yoghurts, for example.
–How much influence does genetics have on diabetes?
–Someone whose parents and siblings have Type 2 diabetes are very likely to have it as well. In my household nobody is obese, we are all slim, but we are genetically vulnerable to Type 2 diabetes although my daughter is actually Type 1.
–What advice would Adima give to people to prevent them getting Type 2 diabetes?
–First, don't wait till you're 60 to start looking after yourself. With regard to food, if you eat healthily 80 per cent of the time, the odd occasion when you give in to temptation won't matter. Gradually make small changes, like cooking traditional meals and becoming more active. You don't have to do 10,000 steps a day, but move: walk, climb stairs or get off the bus or metro a stop before you need to. It's a case of introducing healthy habits into everyday life and then sticking with them.