Ref: CHB/News Bulletin/001/2012

DIABETES AND YOU - Cases of Diabetes in our community are alarmingly on an increase, this is from a quick survey carried out by CHB through some of our Jamaats in Africa, including some Jamaats in Madagascar. Diabetes is a source of several complications, including eye sight loss, kidney failures, heart attacks etc.

What is Diabetes?

diabetes_1Diabetes mellitus commonly known as diabetes or 'sugar' is a condition where blood sugar remains high due to lack of, or resistance to, a hormone called insulin.

After a meal, sugar in the blood, increases. This stimulates the release of a chemical called insulin from the pancreas. Insulin helps to push the blood sugar into the cells of the body where it is utilized to make energy.

In diabetics there is either less insulin in the body or the insulin does not work properly. As a result sugar cannot move into the cells to generate energy.  The lack of energy results in tiredness and in some patients, weight loss may result. In addition the accumulating sugar in blood vessels damages them.

How is diabetes diagnosed?

Diabetes is diagnosed on the basis of classical symptoms and a casual plasma glucose of more than 200mg /dl (11mmol/l). The classical symptoms of diabetes are increased thirst, increased hunger and increased urination.

However, as most patients do not experience any symptoms till diabetes becomes complicated, diabetes is most often diagnosed on the basis of fasting blood tests which show a blood sugar above 126mg/dl (7mmol/l). Alternatively, a patient may be given a sugar mixture to drink and the body's response after two hours checked. This is called a glucose tolerance test. A sugar above 200mg/dl (11mmol/l) is the cutoff above which diabetics are diagnosed.

Recently the American Diabetic Association has approved of a test called glycated Haemoglobin (HbA1c) to diagnose diabetes. This test shows the blood sugar pattern over three months. A value above 6.5 % is used to diagnose diabetes.

To confirm the diagnosis these tests must be repeated on two separate days and be in the diabetic range.

How is diabetes treated?

As insulin works less in the presence of fat, one of the most important modes of treatment is to lose weight. This can be accomplished by a combination of regular physical exercise and a reduced calorie diet.

For those patients with mild diabetes simply losing weight and reducing sugars in food can be enough to treat them. Most patients do require medication to help them control their sugars, while some require insulin.

Depending on the type of diabetes, insulin may need to be started right at the beginning of the disease or have to be added to the treatment later.

What sort of medicine is used to treat diabetes?

There are several types of medications for diabetes. These include drugs that stimulate secretion of insulin, drugs that sensitize the body to the insulin it naturally produces and insulin itself.

For most patients with Type 2 Diabetes treatment in the early stages begins with lifestyle modification followed by the addition of either an insulin stimulator or sensitizer.

Drugs that stimulate release of insulin are preferred in patients who are thin whereas obese patients are usually put on insulin sensitizers.

If a patient's sugars are not well controlled despite adequate lifestyle changes and the addition of one medicine your doctor will likely use more than one type of medicine in combination to control the sugar.

If combinations of different drugs fail to control or if the sugar is very high your doctor may decide to start you on insulin.

All Type 1 Diabetic patients need insulin right at the onset of their illness. However, most type 2 diabetics (Non insulin Dependent Diabetics) do eventually require insulin treatment. This is because with time the body's insulin stores get exhausted and drugs are not able to increase the effect of the body's own insulin any further.

How Does Diabetes affect the body?

The sugar that accumulates in the blood of diabetics damages the blood vessels. As blood vessels supply blood throughout the body, diabetes is a disease that affects the whole body.

In the brain diabetics are at higher risk of stroke. Diabetics tend to form cataracts earlier and can go blind from diabetic eye disease. Diabetics are also at higher risk of heart disease, kidney failure and decreased circulation to the feet. Due to the poor blood supply the nervous system also does not function properly and diabetics develop problems with feeling. This is usually first seen in their feet.

As a result of decreased sensation and poor blood supply to the feet diabetics are at risk of forming ulcers in the feet which may get infected and spread rapidly.
Diabetics also suffer from a decreased immunity and are thus prone to infections.

The diabetic hospital visit

What happens and why is it needed?

Every diabetic needs to visit his or her physician between two to four times in a year for monitoring of progression of their disease as well as monitoring of their sugar control.

diabetes_2

At the first diabetic visit your doctor will need to ask you a number of questions about how long you've been diabetic, what medications you use, what your current level of control is and whether you have any complications. He or she will also need to know if you have ever had a diabetic emergency (very low or very high sugars).

Your doctor will then examine you. This examination will cover the whole body inclusive of the feet. Your doctor will do a detailed examination of the feet inspecting the skin, assessing the circulation to the feet and the feeling in the feet.

You will then be asked to do blood tests, urine tests and have an eye and dental check up.  All diabetics need to have their feet examined every three to six months, their eyes checked by a specialist every year, and a dental check up every year.

Blood tests are ordered to monitor for complications of diabetes. These include kidney tests once a year, cholesterol tests once a year and three month average sugars (HbA1c) every three to six months. Your doctor may also want to check your thyroid hormone at your initial visit.

All diabetics require a special urine test once a year. This is called urine for microalbumin or a spot urine albumin to creatinine ratio. These tests pick up early damage to the kidneys.

The list of tests and frequency of visits sounds quite exhaustive but help to pick up diabetic complications early saving suffering and increased costs later. For example a patient who visits his physician earlier is likely to have his diabetic foot disease picked up earlier than one who doesn't and so can be warned about how to prevent ulcers and infections of the feet so that he doesn't need an amputation later.

What sort of diet should I follow?

diabetes_3The Mayo Clinic Diabetic diet guide states that "rather than a restrictive diet, a diabetes diet is a healthy-eating plan. In fact, a diabetes diet is the best eating plan for most everyone."

A diabetic diet aims to provide adequate nutrition while minimizing the blood sugar surge that normally occurs after a meal. Certain foods have higher sugar content than others. Eating for diabetes doesn't mean cutting out foods completely. It means eating smart and knowing how much of what to eat.

For instance a one third cup of boiled rice contains as much sugar as half a cup of maize or one six inch chapatti.

So if you choose to eat two chapattis they will yield the same amount of sugar as one chapatti and a one third cup of boiled rice.

As a diabetic you can even enjoy sweets and desserts. For instance, if you're in the mood for a doughnut then cut out the regular two chapattis at lunch completely. Eating desserts as part of the meal instead of separately helps the sugar rise slower making it a healthier way to enjoy a dessert.

However this shouldn't be overdone as desserts usually contain fats and simple carbohydrates which have their own disadvantages.

diabetes_4Learning how to eat smart takes some time initially but with a little effort can be learned. Exchange lists of carbohydrates are easily available online. Complex carbohydrates such as those found in whole grain rather than white flour provide a slower and more sustained release of sugars which diabetic patients can utilize better.

In addition to preferential consumption of complex sugars over simple sugars, the use of high fibre foods retards the absorption of sugar from the gut. Thus consumption of fresh fruits and vegetables is encouraged. As fruits do contain a high amount of fruit sugar, fruits have to be carefully selected. Moreover fruit juices, being extracted from a number of fruits, need to be taken in small quantities.

Unless a diabetic suffers from certain severe kidney complications, protein consumption is usually encouraged while fat consumption is discouraged. This is because,  protein is important for repair of tissues, while fat which contains double the amount of energy that proteins or carbohydrates do is usually stored in the body.  As stated above fat decreases the effect of insulin thus worsening diabetic control.

diabetes_5As blood vessels of diabetics get narrowed sooner than most people consumption of fats should be avoided in order to stay healthier longer. Instead of deep frying food, food should be baked or grilled.

Use of lean meats such as chicken and especially fish is considered healthy, while eating large amounts of red meat, butter and cream are discouraged.

To be continued..........................

Dr Nasreen Hirji
Extracted from www.bbc.co.uk

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