DIABETES Rationale for teachers Diabetes is increasing rapidly in India due to major changes in the way we live (our life style). It affects those who take less exercise, too much fatty foods and sweet foods or alcohol. It can cause serious damage to many organs in the body and not only shorten life but also our ability to enjoy life. It is not so common in people who need to work physically hard and are poor (though in them another type of diabetes occurs less commonly). It affects those who are able to leave hard physical work and who have studied a little and able to raise their income moderately like many of the plus 2 students today. Diabetes therefore used to be a disease of the rich but is becoming a serious problem for those who are poor but not as poor as before. The type of diabetes that affects most people usually does not cause symptoms in the early stages till a serious problem has developed.

Objectives:  Diabetes is a new disease that is affecting more and more Indians.  It slowly damages the eyes, heart, kidneys and nerves causing early death and disability  Though there are different types of diabetes, the most common type in India is caused by too little exercise, too much fatty foods and being overweight. It is not just caused by eating too much sugar.  We can therefore prevent it by taking exercise- what is healthy exercise and how can we fit it into our life style  Prevent it also by taking the right food and making sure we are not overweight.  Who should be screened for diabetes and when  Treatment of diabetes needs lifelong care and monitoring by health staff

Needed  Chart of human body with pin up pictures of healthy and also sick eyes, heart, kidneys  Chart of a action of insulin and another of what blocks it s action  Mask of an older day and modern day spirit of sickness  Cloth to stuff a person’s shirt to make them look fat Awareness creation

(Teacher to act this if possible. If it is difficult to get an actor to say the second spirit’s story well, teacher can act as both spirits by changing masks quickly) The year is 1950. The spirit of sickness is talking happily to itself. ‘See I cause misery to mankind by causing so many sicknesses. I killed Somu by causing diarrhea. He did not know that I entered his body through as a germ he could not see when he ate without washing his hands (heh heh). I killed Valli through the TB germs that entered her lungs when someone else with Tb coughed on her. I killed Naveen through tetanus by entering his wound on his leg (ha ha). It’s too easy to kill people through germs they cannot see. They are so stupid they still think sickness is caused by curses. I wonder what it will be like in 50 years. Let me go to 2007.” The spirit jumps into the year 2007! Aha I am in 2007 now. What will it be like? Suddenly he gets scared and shouts in pain and runs and hides behind a desk. Oh no what is this? People are not stupid anymore they know about my tiny germs that they cannot see with their eyes. They have found ORS to treat diarrhea and penicillin for pneumonia and other medicines to kill TB germs. People are living longer- I can’t live in 2007; I must get back to 1950! Just then a 2007 stylish spirit of sickness comes with sunglasses on a mask and combing his modern stylish hair (but with horns and a face that is evil). ‘So you are my grandpa from 1950 eh? Heh heh! You are too old fashioned to be able to kill people today with germs. They know how to fight you now, especially these clever people who come to the SHE classes- pointing at the students. But you know they are still a little stupid! They do not know that I have also changed and I do not have to work through germs alone anymore Heh heh. I have found more hidden ways of not just killing them but making life more miserable to live with. Ha Ha. Look at Murugan! (Show a fat man- picture or actor made fat with clothing stuffed up the shirt who is finding it hard to breath and cannot walk easily) He is only 38 yet he is so short of breath he cannot walk because his heart has failed. Look at his legs, he cannot walk easily and they hurt him every day! And there are so many people like him Ha ha. And he is only 38 but looks like an old man. How do you ask did I hurt them all? Well it is a secret that they need to find out- but it is they themselves who are hurting their body! They do not know that there are now many new diseases, which can kill and cause misery in more slow and hidden ways than before. They will never realize how these new sicknesses come.’

Discussion: What do you think these new sicknesses are and what causes them? (Class is likely to say AIDS, cancer, smoking, alcohol, and drugs- list them. If you have discussed mental illness- list that also. If they say diabetes- list it also. Of these which is caused by germs? (Only one AIDS). Do you think that we need to be stupid like the spirit said and not understand new ways in which we get hurt today? Let’s look at Murugan and see why he is so miserable with shortness of breath with difficulty walking.

Kannan and Murugan are 2 sons of a poor farmer who lived in a rural area. The father could not educate both boys so the older Kannan insisted that he would help the father in the field while Murugan studied. Murugan studied like you to plus 2 then went to help his uncle in a town where his uncle ran a shop. After 10 years his uncle sold his shop to Murugan and left. Kannan and Murugan are now married and busy and they began to see each other less often. Kannan remained on his small land in the country (rural) area and he works hard every day while Murugan had much more money in the town though he also has to work hard in a different way. Murugan is now aged 35 and Kannan is 37. The difference is that Kannan is healthy while Murugan is miserable and unhappy with his health. Look at their lifestyle.

Conduct an Interview of Kannan and Murugan The teacher acts as the interviewer. 2 students are given a script to read. One is Kannan given a farmer’s head gear and his body is thin. Murugan is fat and breathless.

In the interview the script should read so that it shows the difference in 1. Diet: Kannan eats a good breakfast with rice or ragi or wheat foods that are in use in the area you are teaching. Murugan often has a rushed breakfast as he sleeps late and gets up a little late in town so has to hurry to the shop. In between Murugan eats lots of fried snacks like vadai. Bonda and drinks lots of tea or coffee with sugar. Kannan hardly takes anything during the day other than water and one tea or coffee. Murugan eats lunch in a hotel, as he cannot go back home and takes oily foods cooked in the hotel. Kannan eats lunch at home or what he took with him to work like rice and sambar. Evening main meal is the same but Murugan takes more snacks in-between at teatime. Murugan also takes a brandy glass at many nights at home. 2. Exercise: Murugan does hardly any exercise and sleeps at afternoon. His shop workers do all the physical work. Murugan only sits in a shop. He goes to work on a TVS50. When he gets home he watches TV and helps the children with homework but not play with them. Kannan does hard work all day and plays with his children. He watches TV but only a limited amount. In this story why do you think Murugan gained weight? He gained weight because he  Had no exercise  Ate too much oily food and snacks between main meals  Too much sugary foods in tea, snacks and also alcohol These differences not only make Murugan increase in weight but they also cause another important change in the body. If you have time- go back to the spirits at the awareness creation. Ask the class to state the difference in lifestyle and diet between the 1950s working man and the shop keeper now? From that re emphasise that diabetes was rare only 50 years ago because people did more physical work and ate less oily d or sugary food. Lets look at why less exercise and fatty and sugary food causes diabetes.

The food we eat contains glucose. Glucose is present in all foods not just sweet foods. In the intestines, the food is digested to release glucose. (Use chart) Using a picture of a body with healthy organs show in a simple way show that the carbohydrates CHO (mavuchathu) absorbed in the intestines has to go to all the organs in the body so that energy is supplied. For CHO to enter these organs, insulin is needed. Insulin is produced in the pancreas. Without insulin the glucose collects in the blood. In people like Murugan who take little exercise, eat too much fats and sugar the body becomes resistant to the action of insulin- the insulin does not work and glucose stays in the blood. Use chart to summarize what can block the action of insulin. Lack of exercise, fats and sugary foods cause some increase in weight (not necessarily a lot of weight increase) but the action of insulin is blocked. Its like the keyholes becoming blocked.

What harm will too much glucose in the blood cause? These harms occur slowly over months without the person realizing they are becoming sick. Use chart  It causes tiredness and lack of energy because the organs cannot get glucose to use for energy without insulin.  High blood glucose damages the heart (people can get heart attacks early and get short of breath like Murugan)  It causes the kidneys to fail  It can damage the eye causing blindness  Little wounds do not heal and can become serious sometimes causing loss of a limb  The nerves in the legs get damaged causing numbness and pain. There are many other changes that occur so that you can see that diabetes is a disastrous illness to have. These changes become worse if a diabetic person also smokes beedi or cigarettes.

What can you do if you have diabetes? If you get diabetes you can control it and stop it causing harm by making changes to your diet, exercise and taking medicines. However the treatment is for life, as diabetes cannot be cured once it occurs.

Should you screen for diabetes? More importantly, many people do not know they have diabetes till their organs have become damaged! That is because early on diabetes hardly causes any symptoms! So are there ways of finding diabetes early? One good news is that there are tests to find diabetes early before it causes damage to the heart, eyes and kidneys. You can test the urine or blood for glucose. Who do you think should be screened for diabetes with these tests? (Discuss)  People who are fat at any age every year  People over the age of 40 every year  People who have a family history of diabetes- screen every year after 30  People who are pregnant and overweight because during pregnancy the body needs extra insulin.

Prevention of diabetes Because diabetes is a life long disease, it is better to prevent it than wait for it to occur. How can you prevent it- remember Murugan and discuss 1. Ways we can increase exercise levels- these must be ways that we enjoy or else we cannot continue them in our life. What we need is only 30 minutes of physical work that makes us a little short of breath. Slow walking or housework is not enough! Suggestions could be  Running, walking or cycling- will only be sustained if it is enjoyable (like in young people going together for early morning) or we fit it into our daily work routine (like cycling to work or to the shops).  Gardening  Playing with children and watching less TV  Men can help wives collect water on cycles  If you are working in an office during lunch time go for a fast walk  Etc discuss ideas that can be continued n life

2. Importance of a good diet. Discuss  Importance of a good breakfast to prevent you getting hungry during the day and eating harmful snacks  Less oily or fried food- asks the class to mention common oily snacks they eat. Oil can be hidden in biscuits, cakes as well. Most of the oil we eat is not found in meat! Its safe to eat meat once or twice a week.  Less sweet foods  Avoid more high intakes of alcohol. Anything more than 1 glass of brandy/day is unsafe.