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Shifting paradigms in diabetes care

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Today is World Diabetes Day

The prevalence of diabetes worldwide has nearly doubled since the 1980s. Globally about 422 million people have diabetes according to the World Health Organization and the majority of them live in low and middle-income countries. Around 1.5 million deaths are directly attributed to diabetes each year. A century after the discovery of insulin, millions of people with diabetes around the world still cannot access the care they need.

In this setting the theme for World Diabetes Day 2021-23 has been declared- ‘Access to Diabetes Care.’ The management of diabetes has today taken a shift involving a more holistic approach, points out Consultant Endocrinologist at the Sri Jayewardenepura General Hospital, Dr. Dimuthu Muthukuda. In an interview with the Sunday Island, she throws light on these shifting paradigms which are aimed at enhancing the quality of life of those with diabetes.

by Randima Attygalle

Q: How relevant is this year’s theme ‘Access to Diabetes care’ in a Sri Lankan context?

A: Since the discovery of insulin in 1921, there had been many strides forward in terms of the varieties of insulin – both oral and injectable. Today there are both national and international guidelines pertaining to diabetes care. Despite these, people with diabetes all over the world are challenged in accessing diabetic care. We are at a satisfactory level in delivering diabetic care within our freely accessible and well-structured health care system. Our limiting factor is the non-availability of the ideal device for insulin delivery which is the insulin pen. What we have in the state health sector for cost reasons is still the syringe and the needle. However, we are constantly improving our services for increased accessibility.

Q: What is the current ‘diabetes picture’ here at home?

A: In terms of the numbers, our situation is quite alarming. Recent studies show that the prevalence of diabetes in suburban areas of the island is about 20%. The situation in the rest of the South East Asian countries is no better. The major triggers of diabetes in our part of the world are obesity and being overweight. Today obesity has reached pandemic proportions and is as dangerous as COVID. Worse, there is a sizeable proportion of school children with diabetes.

The accumulation of fat in the abdomen which is called ‘abdominal or central obesity’ is common among South East Asians. This reflects the tendency for a person to develop diabetes. The other major risk factor is insulin resistance. This condition is closely linked to obesity and diabetes and this inter-connectivity leads to a very vicious cycle.

A few decades ago when we talked of a person with diabetes, it was a middle-aged or an older person that we visualized. This is no longer the case. Today many children, adolescents and young adults are diabetics.

Q: What are the most common types of diabetes?

A: Type 1, Type 2 and Gestational diabetes are the common types. In Type 1, the body does not produce any insulin and there is life-long insulin dependency. Very often children under 10 years develop this type although symptoms could occur in adolescence as well.

Type 2 is the most common, where the body does not use insulin which is produced by the pancreas effectively. This insulin resistance is also attributed to obesity where insulin is prevented from working well at tissue-level. Although Type 2 is called ‘adult-onset diabetes,’ today we see many young people developing it giving enough time to develop other complications. After about 10-15 years of having Type 2 Diabetes, the pancreas can get exhausted and it could stop producing insulin. Therefore initially although a person can manage Type 2 with drugs, later he/she may need insulin as well.

Diabetes during pregnancy is what is known as gestational diabetes. The long term consequences of this type could be serious. If a pregnant woman has gestational diabetes, there is a 50% chance of her children getting it. There is also the risk of children being obese. This is why we say that when we manage diabetes of an expectant mother, we also manage the condition in the next generation.

Q: Who are at high risk of developing diabetes?

A: Being a South Asian per se is a risk factor. Besides that, being overweight or obese, appearance of blackish velvety skin behind the neck, having a family history of diabetes (children whose both of whose parents have diabetes have more than 75% chances of developing the disease) and children of mothers with gestational diabetes and people who are on certain drugs such as steroids are at high risk.

Q: Can you throw light on the new interventions in managing diabetes?

A: Today the global trend is to look at the condition from a positive perspective. The traditional understanding was that the moment a person is diagnosed with diabetes, he/she becomes a ‘diabetic’ or a ‘diabetic patient’. Imagine a person being diagnosed at 15 or 20 with diabetes; are we going to call that person a ‘diabetic’ for the rest of his/her life? What will be his/her social and psychological well being in that case? Today diabetes is considered as a condition which you need to manage. Instead of calling ‘diabetics’ or a ‘diabetes patients’ we call them ‘individuals with diabetes’.

A few decades ago the most feared thought was going on a ‘diabetic diet’. Today we are talking of a healthy diet for everyone in the family; we are talking about giving advice to the whole family because it has to be essentially a family affair. For instance, you are going to cook a healthy meal for the entire family and not only for the member with diabetes.

The pharmacological management landscape of diabetes has also changed. Instead of the gluco centric approach which looked only at glycemic or sugar control, today a holistic approach is in place which is known as ‘cardio-renal’ approach. This looks at reducing cardio-renal complications (kidney and heart related complications). Although morbidity and mortality due to diabetes is largely heart attacks, the root cause is underestimated because the cause of death goes as ‘heart attack’ and most of these heart attacks can be prevented. To strengthen the cardio-renal management of people with diabetes, our health sector is trying its best to make the latest cardio-protective drugs available in government hospitals.

In diabetes management, we not only address sugar levels but the entire spectrum of micro vascular and macro vascular complications. When diabetes is mismanaged both small (micro) and big (macro) vessels can be damaged. While micro vascular damage will involve the retina of the eye, kidneys and nerves, macro vascular damage will lead to stroke, heart attack and peripheral vascular disease. As Endocrinologists, our ultimate goal is to prevent people from getting micro and macro vascular diseases. To realize this, we encourage people with diabetes to monitor their blood glucose levels at home using glucometers. It is imperative that they have good metabolic control and healthy cholesterol levels. Diseases such as ischemic heart disease and non-alcoholic fatty liver should also be kept at bay. Then only can we prevent amputations and even death. Today we look at the bigger picture.

Another new trend is what we call ‘diabetes remission’. New clinical trials have shown that in case of recent onset of diabetes, if a person is able to lose weight coupled with a healthy diet and exercise and also with the use of drugs such as Metformin, a person can go into a remission for a long period of time with a fully normalized blood sugar levels.

Q: What measures are in place to empower people with diabetes, so that they become independent and can improve their quality of life?

A: Sri Lanka College of Endocrinologists (SLCE) carries out many educational programmes including training of trainers and health care personnel. Guidelines are also developed by the SLCE.

Education and awareness is very much a part of Endocrinology Units of state hospitals today. We look at the entire metabolic picture and deliver a comprehensive diabetic care delivery through our clinics.

Q: What is the role of diet and exercise in preventing and managing diabetes?

A: Eating in moderation is the key and rather than what you eat, you need to be mindful of how you eat. Managing portions is crucial here. Our plate should ideally have 1/4th of rice and the rest should be green leaves, fish, etc. People should also be more creative and intelligent in their food choices. Mixing food which contains more sugar with fibre-rich food for example, can be a smart way of eating. It is not realistic to stay away from delicacies during festive seasons, nor depriving a child of sweets; the key is enjoying what you like in moderation. Eating fruits in between meals is encouraged so that they serve the dual purpose of having a snack as well as fulfilling the daily fruit requirement. Processed food and fast food should be minimal.

In terms of exercise, we encourage at least half an hour of physical activity such as brisk walking, cycling, swimming or aerobics, at least five days a week. Exercising itself can help minimize insulin resistance.

Even people with disabilities are encouraged to exercise their muscles while being seated or lying down.

Q: What challenges do you see for people with diabetes during the pandemic and how can they be mitigated?

A: When a person has poorly controlled diabetes, his/her immunity is compromised and chances of catching infections are very high. So it is essential that people manage their diabetes and take their drugs diligently. Mismanaged diabetes can result in COVID pneumonia. Even during the lockdowns, we ensured that drugs reached people and most clinics operated uninterrupted in the best interest of the public.

We see more people becoming sedentary during the pandemic. Both children and adults are spending a considerable time before computer screens with little or no exercise. This could make them susceptible to obesity which is a precursor to diabetes. Hence, children should be encouraged to indulge in some kind of physical activity and even adults should regularly take breaks from their desks and take a short walk around.

Q: Finally, how important do you think it is to adopt a multidisciplinary approach to combat diabetes instead of making it the sole responsibility of the health sector?

A: Although management of diabetes has to be customized, it is very crucial that we have a multi modal approach with the participation of schools, policy makers, employers and media to prevent the numbers from escalating. Today we have the traffic light system for certain foods, however there is still a question of consumer literacy. We also see children being the target of advertisers and there is a need for regulation here. Hence it is imperative that all stakeholders get together in preventing diabetes which could take a toll both on individual productivity as well as the health sector.



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Life style

Enduring charm of June weddings

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In white,every bride becomes a vision of timess elegance

June has long been celebrated as the month of brides, a season synonymous with romance, elegance and new beginnings . In Sri Lanka, where wedding are cherished as family occasions, every bride dreams of looking her absolute best on her special day. Few names in Sri Lanka are so closely associated with bridal beauty as Ramani Fernando, a pionear of Sri Lanka’s hair and beauty industry whose expertise has transferred countless brides over the decades. She has become a trusted authority on bridal styling, beauty trends and the act of creating timeless wedding looks. In this interview, Ramani Fernando shares her insights on the enduring appeal of June weddings, evolving bridal trends, and how today’s bride can achieve confidence and elegance on their big day!

(Q) Why is June traditionally known as the month of brides?

(A) June has long been associated with weddings because, historically, it was considered a month of prosperity, happiness, and new beginnings. In many cultures, it was believed to be an auspicious time to start married life. Over the years, this tradition has continued, making June one of the most popular wedding months around the world.

(Q) What makes June bridal unique in Sri Lanka?

(A) In Sri Lanka, June weddings often combine elegance with the beauty of the season. Brides tend to choose softer, lighter looks that complement the warm weather, while still embracing our rich cultural traditions. It’s a beautiful balance of timeless bridal glamour and modern sophistication.

(Q) What are the biggest beauty trends you are seeing this year in terms of dressing, hair, and makeup?

(A) This year, we are seeing a move towards effortless elegance. Brides are choosing natural, radiant makeup that enhances their features rather than masking them. Hairstyles are softer, with textured buns, romantic waves, and elegant ponytails. In fashion, classic silhouettes with modern details such as delicate embellishments and clean lines are very popular.

Radiating grace, beauty and joy

(Q) How have bridal hairstyles and makeup evolved over the years?

(A) When I first started, bridal looks were much more structured, with heavier makeup and very intricate hairstyles. Today, brides prefer a more natural and personalised approach. The focus is on enhancing individuality while ensuring the bride looks timeless, both in person and in photographs.

(Q) How can brides balance tradition and contemporary beauty trends?

Radiant bride in yellow

Where elegance meets expertise – Ramani’s signature touch for modern brides

(A) The key is to stay true to who you are. I always encourage brides to respect traditions that are meaningful to them while incorporating modern elements that reflect their personality. A bride should feel authentic, comfortable, and confident rather than simply following trends.

(Q) Beyond makeup and hair, what helps a bride feel confident on her wedding day?

(A) Confidence comes from preparation, self-belief, and being surrounded by people who genuinely support you. When a bride feels comfortable in her own skin, is well-rested, and knows she is loved, that confidence shines through far more than any beauty treatment ever could.

(Q) How has the bridal industry changed since you first started your career?

(A) The bridal industry has evolved tremendously. Brides today have access to global inspiration, through social media, and are much more informed about beauty, fashion, and styling. There is also greater emphasis on personalisation, allowing every bride to create a look that reflects their unique story and personality.

(Q) What has been your most memorable bridal transformation?

(A) It is difficult to choose just one because every bride is special. However, the most memorable transformations are often those where a bride sees herself in the mirror and becomes emotional—not because she looks different, but because she feels like the very best version of herself. Those moments stay with me forever.

(Q) What continues to inspire you after decades in the bridal industry?

(A) The joy of being part of one of the most important days in a person’s life continues to inspire me. Every bride brings a new story, a new dream, and a new vision. Seeing the happiness, confidence, and excitement on a bride’s face is what keeps my passion alive even after all these years.

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Silver jubilee of grace and elegance

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From Moscow to Colombo

The Russian Classical Ballet concert “Once upon a silver stage, conducted by the Russian School of Ballet and dancing, will be presented on June 27, 2026,at Sri Lanka’s iconic Nelum Pokuna Mahinda Rajapakse theatre Colombo with grandeur, This significant event will provide students with the opportunity to showcase their talent to thier proud parents. The School, which started with four little girls wanting to be prima ballerinas, celebrates its success and achievements of 25 years in its Silver Jubilee celebrations at this remarkable event.

(Q) What can audiences expect from this year’s ballet concert?

(A)We are expecting Russian Classical Ballet enthusiasts, parents, Diplomats and Ballet critics.

(Q) How does this performances differ from previous productions?

(A) The Russian School is celebrating its 25th anniversary in Sri Lanka, and the teachers have prepared a mesmerizing performance of Russian Classical Ballet to celebrate and to make the occasion memorable

(Q) What are the highlights of the programme?

(A) Over 700 students from age 4 to 45 years will be on one stage showcasing their talents on Russian Classical Ballet who are currently taking lessons at The Russian School of Ballet & Dancing

(Q) What challenges were involved in bringing such a large scale production to the stage?

(A) Training such a large number of students with variation of age is a challenge. We also face a challenge when it comes to accommodate the students in a Theatre in Sri Lanka. We have to perform the same show twice to make amends for that challenge

(Q) The school is celebrating a significant milestones. How has the journey evolved are the past 25 years?

(A) It is a wonderful progress, for a school which initiated with four little girls and standing tall and strong with 700 students maintaining it’s standards by the management, teacher, students and parents support.

(Q) How has interest in ballet grown among Sri Lankan students over the years?

(A) It’s an amazing interest. We are conducting classes from Monday to Saturday, weekdays from 2.00pm to 6.00pm and Saturdays from 8.00am to 6.00pm, with 12 teachers working through the week. We also maintain a waiting list with at least 500 students annually. We have a huge demand for the art of Russian Classical Ballet in Sri Lanka, not only in Colombo, but outstation, too. We can only accommodate the students for Russian Classical Examination annually with the Vaganova syllabus

(Q) What role does Russian ballet training play in shaping young dancers?

(A) The training does not only shape them in dancing and techniques. They also shape the qualities, discipline and talentsof students from their childhood, especially for little girls to become ladies.

(Q) What makes Russian classical ballet unique compared to other dance forms?

(A) Russian Classical Ballet is an old form of dance and which is highly athletic, expressive and strictly disciplined style of Ballet that originated in the 18th century in Russia which is also the most prominent dance form in the world today. We are privileged to be able to learn and share the art form in Sri Lanka through the Cultural Section of The Embassy of Russian Federation in Sri Lanka to the Ballet lovers.

(Q) How does the school contribute to cultural ties between Sri Lanka and Russia?

(A) The school constantly shares it’s knowledge with Sri Lankan ballet lovers and enthusiastic though examinations, concerts, dance recitals, performances and universities. The Russian Cultural Centre in Colombo has brought down Bolshoi Dancers, Russian Classical Ballets. Younust Dancers. Classical Music Performers many times to Sri Lanka since late the1990s.

Over 1500 students annually examined for Russian Classical Ballet graded exams in Sril Lanka under the guidance of Dr Oxana Karnovich.

(Q) How does ballet help bridge cultural boundaries?

(A) Ballet is an universal art which speaks its own language. Ballet connect different cultures, facilitate cross-cultural communication, and foster mutual understanding.

(Q) Are there plans for international collaborations or performances abroad?

(A) Yes. We are already collaborated with the National Ballet Academy in Moscow under the patronage of Dr Oxana Karnovich -Oxana Karnovich of the Moscow State Academy of Choreography. Holding the position of Senior Lecturer at the Department of Choreography and the History of Ballet at the Moscow State Academy of Choreography, Dr Oxana Karnovich chaired the examinations, while imparting invaluable knowledge and expertise to aspiring dancers as well as our brilliant and growing staff of teachers. Oxana is also an Associate Professor at the Department of Vocal Art and Opera in the Moscow State Institute of Music. With a Ph.D. in Art History and Criticism, her extensive academic background enriches the knowledge and expertise of both our students and teachers, highlighting the dedication to preserve the artistic heritage of ballet.

By Zanita Careem

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Sando: The missing warrior tusker of Ruhuna

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In the vast wilderness of southern Sri Lanka, where ancient forests merge with open grasslands and seasonal waterholes sustain an abundance of wildlife, few elephants have captured the imagination of nature lovers quite like Sando (T011).

A giant among giants, Sando is not merely another tusker roaming the forests of Ruhuna. He is a symbol of strength, dominance, resilience and mystery.

For years, his annual movements through the forests, bordering the Yala National Park, were eagerly anticipated by wildlife enthusiasts, safari operators, photographers and conservationists.

His arrival often signalled the beginning of a period of heightened excitement, within the park, where visitors hoped to catch a glimpse of one of Sri Lanka’s most iconic wild elephants.

Today, however, Sando’s whereabouts remain unknown.

His disappearance for nearly three years has sparked concern, speculation and heartbreak among those who have followed his remarkable journey through the wilderness. Yet despite the uncertainty, many refuse to abandon hope that the giant tusker still roams the forests of Ruhuna, hidden deep within landscapes rarely visited by humans.

According to wildlife enthusiast Chamdika Lakmal of Wild Tuskers of Sri Lanka, Sando represents one of the finest examples of Sri Lanka’s remaining wild tuskers.

He told The SundayIsland: “Sando is unlike most elephants we see in the southern region. His physical appearance, stature and confidence make him truly exceptional. Whenever he appeared, people knew they were witnessing a remarkable animal.’’

Sando primarily inhabited Blocks 3 and 4 of the Ruhuna National Park. During his annual musth period, usually between January and March, he undertook a well-documented journey through Buttala, Gonagan Ara and Galge before entering Yala National Park’s Block 1. These movements became familiar to many wildlife observers who followed his seasonal travels, year after year.

The annual migration was more than just a movement from one location to another. It was a dramatic display of nature’s hierarchy. Musth is a period of heightened testosterone levels in bull elephants, making them more aggressive and dominant. During this time, Sando transformed into an even more imposing figure.

Estimated to be between 35 and 45 years old, he was widely regarded as one of the most powerful bulls in the region. His immense size and fearless demeanour ensured that few rivals challenged him directly.

One of the most famous episodes, associated with Sando, involved a confrontation with Gamunu, another legendary tusker of Yala. The encounter reportedly resulted in Gamunu losing one of his tusks, further cementing Sando’s reputation as a dominant force among Sri Lanka’s wild elephants.

For many observers, however, Sando’s appeal extended beyond his strength.

Unlike the typical “Ruhunu Getaw” elephants commonly seen in the southern dry zone, Sando possessed a distinctive physique. His body proportions and overall appearance gave him the look of an ancient war elephant, the kind depicted in historical chronicles carrying kings and warriors into battle.

“Whenever you looked at him, you felt as if you were seeing a living relic from Sri Lanka’s ancient past,” Chamidika said. “He had an extraordinary presence that photographs could never fully capture.”

Sri Lanka’s tuskers are themselves a rarity. Wildlife experts estimate that only a small percentage of the country’s male elephants possess tusks. This makes animals such as Sando particularly valuable from both ecological and cultural perspectives.

Historically, tuskers occupied a special place in Sri Lankan society. They featured prominently in religious ceremonies, royal processions and folklore. Even today, they remain powerful symbols of national heritage.

Their rarity, however, also makes them vulnerable.

Throughout Sri Lanka, wild elephants continue to face numerous threats, including habitat fragmentation, human-elephant conflict, poaching and accidental deaths. Expanding agricultural activities, infrastructure development and increasing human settlements have placed growing pressure on elephant habitats.

For tuskers, the risks can be even greater.

Their ivory makes them attractive targets for poachers, despite strict wildlife protection laws. Across Asia and Africa, ivory poaching has devastated elephant populations, and conservationists remain vigilant against similar threats in Sri Lanka.

These concerns intensified earlier this year when wildlife officials discovered the carcass of a tusker in the Kotiyagala area. The animal’s tusks had reportedly been removed by poachers. News of the discovery spread rapidly among wildlife enthusiasts.

Because Sando had not been seen for such a long period, many feared the worst. Could the carcass belong to the missing giant?

The possibility sent shockwaves through Sri Lanka’s wildlife community.

For many photographers and safari operators who had spent years documenting Sando, the prospect was devastating. Social media platforms were flooded with expressions of concern and calls for further investigations.

Yet the mystery deepened.

A year earlier, skeletal remains, believed to belong to a tusker, had also been discovered near Buttala. Once again, fears emerged that Sando’s fate had finally been uncovered.

However, officials from the Department of Wildlife Conservation later determined that the skull was significantly smaller than what would be expected from an elephant of Sando’s size. The remains, therefore, could not be conclusively linked to the missing tusker.

For conservationists, this finding offered a glimmer of hope.

Despite the absence of confirmed sightings, there have been occasional reports from remote sections of Yala and surrounding forests describing a large tusker bearing a striking resemblance to Sando. None of these observations have been verified, but they continue to fuel optimism among wildlife enthusiasts.

According to Chamidika, history provides reasons to remain hopeful.

“There have been several instances where dominant bulls disappeared from their known ranges for many years before returning unexpectedly. Until there is definitive evidence, we should not assume the worst.”

Indeed, wildlife records contain numerous examples of mature bulls vanishing from familiar territories only to reappear years later.

Such behaviour may be linked to changes in habitat use, competition, food availability or breeding opportunities. Elephants are highly intelligent and adaptable animals capable of travelling vast distances through landscapes that remain inaccessible to people.

As August approaches, anticipation once again builds among those who know Sando’s traditional routes. Reports from Athiliwewa, Pelwatta, Gonagan Ara and Buttala will be monitored closely for any sign of the missing giant.

For now, Sando’s story remains one of Sri Lanka’s most compelling wildlife mysteries.

His disappearance has highlighted not only the challenges facing elephant conservation but also the deep emotional connection many Sri Lankans share with their wildlife.

In an era when biodiversity is under increasing pressure, the fate of a single tusker has become symbolic of a much larger struggle to protect the nation’s natural heritage.

Whether Sando eventually emerges from the forests of Ruhuna or remains forever a mystery, his legacy is already secure. He represents the wild spirit of Sri Lanka’s elephants—powerful, resilient and endlessly captivating.

Until definitive evidence proves otherwise, conservationists, safari guides, photographers and elephant lovers across the country will continue to hope that somewhere in the vast wilderness of the south, the warrior tusker of Ruhuna still walks unseen, carrying with him one of the greatest untold stories of Sri Lanka’s wild places.

By Ifham Nizam

 

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