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DIABETESDIABETES

Presented by Sue Frye- DIABETES ACTIONPresented by Sue Frye- DIABETES ACTION084 228 0993084 228 0993

Managing DiabetesManaging Diabetes

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Chronic disease & wellnessChronic disease & wellnessAll diabetics do not develop complications. If the

blood sugar levels are carefully controlled, in both Types 1 and 2 diabetes, complications may never develop. But in order to achieve this, lifestyle changes that are consistently maintained are also necessary.

Potential to increase productivityWellness programmesChallenges in implementationImbibe a culture of health & wellness

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The Global Challenge of Chronic DiseaseThe Global Challenge of Chronic Disease

Chronic diseases caused approximately 60% of deaths worldwide in 2006 – wear a wear a MedicAlert MedicAlert braceletbracelet – speaks for you when you cannot

These included HIV/Aids, cancer, chronic respiratory diseases, diabetes with the resultant cardiovascular disease (stroke & heart disease); amputations; dialysis and blindness.

Deaths from chronic diseases will increase by 17% over the next 10 years, from 35 million to 41 million.

Only 3% of health expenditure was directed at prevention and public health in 2004 – prevention is not adequately financed.

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Trend in deaths from chronic and communicable diseases from 2005 to 2030

0

10

20

30

40

50

60

70

2005 2015 2030

World Health Organisation

Communicable diseases Chronic diseases

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AGE IS NOT A FACTOR

Chronic disease is not simply an issue for Chronic disease is not simply an issue for older generations.older generations.

Almost half of the people who die from chronic diseases are younger than 60 years

We are also reaching pandemic proportions amongst our young people!!

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Causes and the economic cost of chronic disease

The most important modifiable risk factors are poor diet, inadequate physical activity and tobacco use.

It is projected that 388 million people will die, worldwide, from chronic disease in the next 10 years. WHO estimates that 36 million of these deaths could be averted.

By 2025 Diabetes could be the first non-communicable disease to cause a negative growth rate.

This converts into millions of Rands annually

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PREVENTION RATHER THAN CURE

Helping to prevent a chronic disease such as diabetes requires the following:

A change in behaviourTaking responsibility for your healthEating a healthier dietMore exerciseThere are no ‘quick fixes’ – a Russian Roulette

approach!! Individuals have the ultimate responsibility for ensuring

they do not suffer from the risk factors – BUT given the right environment, incentives and tools they can be helped!

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PREVENTATION RATHER THAN CURE

Therefore aim for programmes and strategies to tackle these areas

Extend these strategies to your home

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The impact on the workplace

It is absolutely vital that everyone is made aware of the symptoms of diabetes;

Regular blood sugar monitoring, together with BP and Cholesterol monitoring – the ‘Devil’s Triangle’ = ►☻◄

If higher than normal blood sugar levels are noted, >9% mmℓ the person should be sent for immediate further investigation. An HbA¹c should be conducted if there is any doubt.

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Main symptoms of Diabetes

• Tired and listlessTired and listless• Frequent urinationFrequent urination• ThirstyThirsty• HungryHungry• Mood swingsMood swings• Sores and bruises that take longer to healSores and bruises that take longer to heal• ConstipationConstipation• DiarrhoeaDiarrhoea • Erectile DysfunctionErectile Dysfunction• Difficulty in conceivingDifficulty in conceiving

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What is Diabetes? Diabetes is a condition in which the body is unable to use sugar

correctly. Our body cells need to provide energyenergy for living – just as a car needs

petrol! Our fuel comes from the food we eat, which is digested in the

stomach and flows into the blood stream as glucoseglucose, a form of sugar;

To get into the body cells, the glucose needs the assistance of a hormone, called INSULININSULIN.

Normally the pancreas makes the insulin which carries the glucose in the blood into the cells. In diabetes the pancreas fails to supply enough insulin, or the insulin does not work properly.

When the body cannot utilise the glucose in the food, sugar levels start rising and medical intervention is necessary.

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Trends in Diabetes Prevalence

The number of people with diabetes has increased frighteningly during the past 20 years.

According to WHO – the number of people worldwide with diabetes increased from 30 million in 1985 to 171 million in 2000. We are currently standing at 16% above the predicted global rate of diabetes for the year 2010 – where will we be by then?

WHO has predicted that the global diabetes prevalence in adults will reach 6.4% by 2030, representing a 60% increase since 1995 and a 39% rise from 2000 to 2030.

Type 2 – previously known as “adult onset” diabetes – now found in children as young as 6 years. REASON FOR THIS is the change in diet and lack of exercise. Obesity due to bad eating habits – take away foods and lack of exercise.

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Benefits of taking control

Outcomes

BP reduction/control Reduction in Cholesterol

levels Hba1C [%<9] Reduced Stroke/heart

attack rate Reduced Amputation

rate Reduced Dialysis rate Reduced Blindness rate Reduced Impotence rate

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Diabetes Action

Type 1Occurs when the pancreas stops producing insulin. It usually starts in young people and may occur very suddenly. As Insulin is a hormone it must be injected

Type 2Is caused when the insulin which the pancreas produces is either not sufficient or does not work properly. Many people with Type 2 Diabetes are undiagnosed and it is during this time that the complications start.

MANAGING YOUR DIABETESThe goal of diabetes management is to bring your blood sugar levels to between 5.5 & 7.00 mm/l.

There is no such thing as a ‘diabetic diet’ – only a healthy way of living. This is why the ‘team’ of dietician, diabetic educator, ophthalmologist, podiatrist and psychologist are vital.

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EDUCATING FRIENDS & FAMILYOnce a person has been diagnosed with Diabetes it is vital

that friends & family, are educated to recognise the signs and symptoms of a sugar ‘low’ hypoglycaemia or a ‘high’ hyperglycaemia and how to assist.

Everybody responds differently to illness but a person with diabetes usually has a more severe reaction. The ‘patient’ should be closely monitored.

Always keep a note of emergency numbers of the person suffering with Diabetes.

Diabetes is like a marriage – “for better or worse, till death do us part” and yet marriage, in most cases is wonderful – nothing to be scared of!!

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•There are more people dying of diabetes complications than AIDS

•Every 10 seconds a person dies from diabetes-related causes.

•Every 10 seconds two people develop diabetes.

•Every 3 seconds a lower limb is amputated worldwide.

•Diabetes is the fourth leading cause of global death by disease.

•At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%.

•Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.

•Diabetes is the largest cause of kidney failure and blindness 

•People with type 2 diabetes are over twice as likely to have a heart attack or stroke

•Cardiovascular disease is the major cause of death in diabetes, accounting for some 55% of all diabetes fatalities

•All damage caused by elevated blood glucose levels is not reversible

•People with diabetes face the near certainty of premature death.

•95% of Diabetics are type 2 : 90% of the complications are in type 2 diabetics

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CONTROL IS POSSIBLE

In human and economic terms, diabetes is one of our most costly diseases and threatens to become the greatest public health problem of the modern era. A well controlled person with diabetes is a person who is a vital cog in the wheel of industry.

For every 1% a person’s HbA¹c IS LOWERED the following results occur:Deaths are reduced by 21%Heart attacks are reduced by 14%Microvascular Complications by 37%(kidneys & eyes)Peripheral vascular disorders 43%

LET US FIGHT LET US FIGHT TOGETHER TOGETHER FOR A BETTER WORLD FOR OUR FOR A BETTER WORLD FOR OUR PEOPLE SUFFERING WITH DIABETES. THERE IS NO SUCH PEOPLE SUFFERING WITH DIABETES. THERE IS NO SUCH

THING AS MILD DIABETES!THING AS MILD DIABETES!

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DIET – No such thing as a Diabetic Diet, just a healthy way of eating

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CARDIOVASCULAR DISEASEThe Diabetic Scenario

More than 65% of people with diabetes die from heart disease & stroke

With diabetes, heart attacks occur earlier in life & often result in death

Nearly all people with diabetes have abnormal cholesterol levels which contribute to their increased risk for heart attack & stroke

Approx. 73% of adults with diabetes have BP of ≥ 130/80 mmHg

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CHECK BLOOD CHOLESTEROL LEVELS REGULARLY

Cholesterol is a soft, fatty substance found in every cell of our body. We acquire Cholesterol in 2 ways – we make it ourselves in our liver &

we get it from the food we eat. Cholesterol plays a vital role in the day to day functioning of our bodies. It cannot travel around on its own because it will not dissolve in water. Instead it is

transported as part of structures called lipoproteins. Think of these as lorries!! LDL (low density lipoprotein – lorry) OR

HDL – high density lipoprotein (lorry) The LDL transports cholesterol from the liver to the tissues. It is the major cholesterol

transporter in the blood. HDL removes excess cholesterol from the tissues and brings it back to the liver for

reprocessing or removal from the body altogether. As a general rule, HDL cholesterol is ‘the good guy’ and LDL cholesterol and triglycerides

are ‘the bad guys’. If too much LDL cholesterol is circulating in our bloodstream, over time it slowly builds up in the inner walls of the arteries.

The optimal goal for Diabetics is a LDL of less than 2.6 mmol/L Your HDL can be a bit higher

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The food pyramid

A healthy diet is NOT difficult;

Shift the “C” from compulsive eating to controlled eating

To assist with recovery and prevention a low GI diet is absolutely vital.

The rate at which a food releases its sugar.

Low GL (Glycaemic Load)

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LOW GI vs LOW GL

Glycaemic LOADIt is a unit of measurement used to

measure the amount of sugar and starch in foods

If you keep to a LOW GL diet You will stop producing more glucose

than you can use; You will not suffer from food cravings Your body will be reprogrammed to

burn fat rapidly; You will be able to lose weight and

sustain your weight loss permanently and thereby improve your blood glucose levels.

Glycaemic INDEXIs a scale of measurement that tells

you how fast the sugar content of a food is released into your bloodstream and is absorbed;

When we eat carbohydrates – starches, fruit, vegetables, dairy products, legumes and sweet things – they are digested in the stomach and then absorbed into the bloodstream in the form of glucose.

Not all carbohydrates are digested and absorbed at the same rate. This means that different carbs have different effects on blood glucose and blood insulin levels.

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DIETARY GUIDELINES

Enjoy a variety of meals; Make starchy foods the basis of most meals – foods rich in

carbohydrates. A starchy food that has a low GI and/or is high in fibre;

Use fat and salt sparingly; Eat plenty of vegetables and fruit every day; Eat beans, peas, lentils and soya regularly;

Chicken, fish, milk (low fat), meat or eggs could Chicken, fish, milk (low fat), meat or eggs could be eaten daily;be eaten daily;

Drink lots of water If you drink alcohol – never drink on an empty stomach

When carefully planned, people with diabetes can enjoy a When carefully planned, people with diabetes can enjoy a wide variety of foods, including sugar!!wide variety of foods, including sugar!!

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Diabetes Complications

Nephropathy [kidney disease]

CARDIOVASCULAR COMPLICATIONSStrokes, heart attacks, heart disease.

Neuropathy [nerve damage] This leads to loss of sensation in the feet and they become particularly vulnerable to wounds and infection – often leading to infections, gangrene and then amputation

Retinopathy [eye damage]

Impotence & difficulty falling pregnant

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HIV/AIDS therapy and Diabetes

ARV Drugs used in HIV cause metabolic problems such as lipoatrophy

Lipoatrophy - is the abnormal distribution of body fat. This is also associated with abnormal blood levels of lipids and an increased risk of diabetes, hypertension and cardiovascular death.

The commonly used HIV therapy drugs can contribute to an increase in Auto Immune Disease;

Diet and exercise and special medication can help treat this condition

There may be a second epidemic of diabetes that follows the successful implementation of HIV drug treatment, because of this complication

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ACTION GROUP

When it comes to getting proper care for patients with diabetes the playing fields are totally uneven especially with regards to knowledge and education.

We are hoping to become YOUR VOICE in the wilderness of Diabetes. There are so many barriers facing people with Diabetes and our aim is to lead the learning process. Details of our courses are available.

Contact DIABETES ACTION on – 0842280993 or on the HIV911 database or www.diabetesaction.co.za

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IN CONCLUSION

There is no such thing as mild diabetes!!There is no such thing as mild diabetes!!Everyone must take greater cognisance Everyone must take greater cognisance

of the wellness of their friends and of the wellness of their friends and family members.family members.

A controlled person with diabetes is a A controlled person with diabetes is a constructive member of your TEAM.constructive member of your TEAM.

Remember that DIABETES is not a Remember that DIABETES is not a DISEASE but a treatable CONDITION.DISEASE but a treatable CONDITION.

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A WAKE UP CALL

If current trends continue, by the If current trends continue, by the year 2025 Diabetes is going to be year 2025 Diabetes is going to be the first non-communicable the first non-communicable condition to cause a negative condition to cause a negative population growth population growth