As tasty pastries and sugary holiday cheer is exchanged throughout the workplace in Hawaii, I am reminded that diabetes and obesity are directly and indirectly among the leading causes of illness and reduced productivity. Although Hawaii was just deemed the healthiest state by one set of measures, just because the mainland is worse off doesn’t mean we are where we should be. Much remains to be done to optimize health and productivity.

Most diabetes is caused when a diet high in sugars results in the cells of the body becoming insensitive to the message sent by insulin from the pancreas. Blood sugars tend to float up and then stay up. High blood sugars come not only from candy, soda and ice cream. In fact, white rice, white bread, white pasta and white potatoes are almost as sugary when they hit the blood stream as the stuff that is sweet to the taste.

To know how quickly a certain food you like increases blood sugar, just look up the term "glycemic index." All foods are rated on a scale of 1-100. The higher the number, the greater the risk that a given food will contribute to diabetes. Some of the healthiest and most available foods are part of the traditional Hawaiian diet. Taro, sweet potatoes and fish are as good as it gets. Although plate lunch may also seem traditional, it’s not. A healthy diet and regular, enjoyable exercise is the best way to prevent diabetes and optimize chances for a long life.

Diabetes causes many other debilitating illnesses. Those who have diabetes must have routine evaluations in addition to checking blood sugar. These include routine:

» Eye exams to check for retinal damage that could cause blindness.

» Heart evaluations to look for signs of blocked coronaries or electrical problems that could result in a heart attack.

» Kidney exams by checking both blood and urine to avoid dialysis and the need for a kidney transplant.

» Foot exams to check for infections that could lead to systemic infection or amputation.

Most health providers work hard to get these items taken care of for their diabetic patients. It turns out that there are another set of five common problems closely associated with diabetes and obesity that are too often overlooked. They include:

» Management of chronic pain : One source of pain in those with diabetes is a type of nerve sickness called diabetic neuropathy. In addition, especially when combined with obesity and a sedentary lifestyle, patients also suffer from pain in the muscles and joints.

» Treatment of sleep apnea: Sleep apnea is when people stop breathing multiple times while sleeping. This may result in waking. For those with both diabetes and obesity, there is a 78 percent chance of sleep apnea. The problem is so widespread that last year Manakai O Malama opened a sleep center. Sleep apnea itself raises the risk of stroke, heart attack and weight gain.

» Identification of blood vessel disease in the legs: It is easy to mistakenly pass off lower extremity pain, especially in the obese, as related simply to tired bones and joints. Often, the actual source of pain are veins and arteries in the lower legs. Simple tests in the primary care office can find these problems.

» Understanding depression: The pain and disability that arises from obesity and diabetes can make it difficult to work and maintain a healthy network of friends. The additional problem of social isolation tips many into major depression which is treatable.

» Prescription drug abuse: The combination of the above problems also may result in prescription drug addiction. While these medications may be legally prescribed, there is a growing problem in which these medications are diverted and sold illegally on the street.

The countless years of productive life lost will continue to mount as long as obesity and diabetes remain commonplace. The depth of human suffering that results from these illnesses is even more daunting. The most sensible strategy is prevention with a healthy diet and regular physical activity. However, once the disease sets in, the primary care community has a daunting task to minimize human suffering and social costs.