Preventing Diabetes Health Problems – November is Diabetes Awareness Month

November is Diabetes Awareness Month.

This year’s theme is Take Charge of Tomorrow: Preventing Diabetes Health Problems.

In 2021, The International Diabetes Federation estimated that 14.8 per cent of the population of T&T (148, 900 persons) were living with Type 2 Diabetes and that 2,365 deaths that year were attributable to Diabetes. By 2045, this is expected to increase, with approximately 177,600 people living with Type 2 Diabetes in T&T.

What is Diabetes?

Diabetes is a condition where the body is unable to properly respond to high blood sugars (or glucose). High blood glucose is usually prevented by a hormone called insulin that is produced by the pancreas. When insulin does not work properly (due to insulin resistance) or if the pancreas cannot produce enough Insulin, glucose stays in the blood stream instead of going into cells, thus causing high blood sugar levels. This causes far-reaching health implications like damage to the nerves, kidneys and eyes, heart disease and stroke. Diabetes is one of the leading causes of kidney failure, limb amputations, and blindness worldwide.

What is the difference between type 1 and type 2 diabetes?

In Type 1 Diabetes, the pancreas cannot produce any Insulin. These people need Insulin injections to survive. It is usually diagnosed early in early in life, but it can present at any age.

So far there are no readily available treatments to prevent the development of Type 1 Diabetes but if you have a family history of it, there are some specialized blood tests that can help predict your risk of developing it.

Type 2 diabetes, which is more common, is a lifestyle disease. In Type 2 diabetes, the body produces insulin – in fact insulin levels may be higher than someone without type 2 diabetes. The problem is that the body is resistant to insulin, and it cannot work properly. Initially this may be treated with diet, lifestyle, and tablets.

Late in type 2 diabetes, the pancreas may burn out and produce less insulin. Although insulin injections become necessary at this stage, it does not mean that it has become type 1 diabetes.

As the management of both Type 1 and Type 2 diabetes can be quite different, it is necessary to establish the right diagnosis.

Another condition that requires significant attention is prediabetes. This is where blood sugars are higher than normal but not yet at levels to be classified as overt diabetes.

Most people will progress to type 2 diabetes within a few years if no changes are made to their diet and lifestyle. As Prediabetes alone increases your risk of heart disease, it is not a condition to be ignored.

How is diabetes diagnosed?

Diabetes is diagnosed by one of these laboratory blood tests:

– Fasting blood sugar of more than 126 mg/dL

– An oral glucose tolerance test of more than 200mg/dL (blood samples are drawn before and after you have had some glucose to drink)

-HbA1c of 6.5 per cent or more (this gives an average of blood sugar levels over the past three months)

What are some of the common symptoms or signs of type 2 diabetes?

Common symptoms are excessive thirst, urinating frequently, feeling hungry all the time, unintentional weight loss, Acanthosis Nigricans (darkening at the cheeks, neck, and armpits), erectile dysfunction in men and recurrent yeast infections in women.

How can persons prevent type 2 diabetes?

Type 2 diabetes is a lifestyle disease, and it also tends to run in families.

If you have a parent with Type 2 diabetes, your risk of developing it automatically increases by at least 25 per cent. Women with Polycystic Ovarian Syndrome and Gestational Diabetes (diabetes that occurs due to pregnancy) are also at an increased risk.

The key to prevention is to eat in moderation, exercise and maintain a healthy weight. In fact, in some persons who are newly diagnosed with type 2 diabetes and overweight, losing 10 per cent of their body weight may lead to Remission of type 2 diabetes.

What is usually the first line treatment for diabetes?

This is usually diet and lifestyle modification.

First line medication is traditionally Metformin, but there has been a recent shift to choosing first line medication that is more tailored to the individual in terms of their risk of heart and kidney disease and promoting weight loss.

What is the target range for blood sugar once on treatment?

Targets for well controlled diabetes are:

-Fasting blood sugar less than 120mg/dL

-Blood sugar 2 hours after meals less than 150mg/dL

-HbA1c of 7 per cent

Depending on your overall health, your doctor might recommend either higher or lower ranges.

What is a diabetic diet?

This is simply a healthy, well-rounded diet that should be followed by everyone, with or without diabetes.

As a general rule, it is helpful to divide your plate into quarters:

-1/4 should be carbohydrates or starch (e.g., rice/roti/bread/provision, whole grain and wholewheat is better)

-1/4 should be meat products if you consume meat

-1/2 should be beans, vegetables, salad

Minimise the intake of processed food and avoid sweetened drinks as much as possible.

Pay attention to the ‘Total Sugar’ content on the nutrition labels of packaged food, especially drinks, keeping in mind that 1 teaspoon of sugar is approximately four grams.

Be wary of the type and quantity of fruits you consume. While fruits are beneficial for their fibre and vitamin content, some of them can cause significant blood sugar spikes (e.g., mangoes, over-ripe bananas, grapes)

If you are struggling with what to eat, consider seeing a dietitian or nutritionist.

Do you have any tips for persons managing their diabetes?

Remember that you are the one managing your diabetes day to day.

Check your blood sugars (fasting and two hours after meals), keep a log of it and keep a food diary.

This will help you to determine which foods spike your blood sugar so you can make changes.

If my blood sugars have been good, do I need to see a doctor?

Because diabetes affects the eyes, kidneys, nerves and increases risk of heart attack & stroke, you need to be screened at least once a year to reduce the chances of these complications or to catch them early.

A typical screen would be:

· A physical exam

· Blood tests for diabetes control, kidney function, cholesterol.

· Eye screening

· Heart tests such as an ECG.

Is there anything that can significantly impact type 2 diabetes in T&T?

I believe with proper nutrition education, starting at a young age, we can empower our population to significantly reduce the chances of developing type 2 diabetes or to reduce the rate of complications in those already diagnosed with type 2 diabetes.

Dr Melinda Nancoo
Specialist Physician Endocrinology, Diabetes, and Internal Medicine Office
Locations: Golden Care Medical Services, Arima Sanjivani Women’s Hospital, St Augustine The Stroke and Diabetes Center, Piarco Premier Heart Care, Woodbrook