kisukari magazine 02

2nd Edition - June 2014KSH 200/-

A publication of Diabetes Kenya

Live a normal life Netanjee Van Niekerk

Diabetes& FASTING

Bene!tsExercise

of

Exercise & DiabetesExercise is in some sense, the perfect drug for diabetes.....

PAGE 14Gestational DiabetesDietary changes and exercise maybe enough to keep your blood sugar levels under control ....

PAGE 15New kids on the BlockIncretin is a hormone released in your body that stimulates production of insulin....

PAGE 10Fasting & DiabetesFor a successful Ramadan fasting....

PAGE 8Major challenges associated with proper man-agement of diabetes...

PAGE 3Diabetes WorkshopDiabetes workshop, to train healthcare person-nel on management of diabetes...

PAGE 19Eat WellRecipe: Cranberry-Almond Granola...

PAGE 20Sweet FreedomHow does sugar affect the digestive system and additionally affect other functions...

PAGE 22Diagnosis & TreatmentDiabetes is a disease in which your body cannot control the amount of sugar in your blood...

PAGE 23Children & Diabetes

PAGE 12Life with DiabetesTalking to Natanjee Van Niekerk

Chief Editor: Salwa ShahbalGraphic Designer: Nabeel Najib ([email protected])Social Media Editor: Aggrey ShiunduAdvertisement Manager: Dr. Gaman MohamedPublisher: English Press LtdCover Picture: Natanjee Van Niekerk (T1 DM Patient/Competitive Swimmer)

Kisukari Magazine is a quarterly magazine (4 times a year). The main objective of this innovative informative magazine of Diabetes Kenya is creating diabetes awareness, education and empowering the Kenyan public.

ContactsPhone: +254 722 297 071Email: [email protected]: facebook.com/Diabetes.Kenya

Gold Sponsor

Disclaimer: The information in this magazine is for information purposes only. Diabetes Kenya makes no representations or warranties about the accuracy and reliability of any content in the magazine. Any opinions expressed are those of their authors and do not necessarily present the views of Diabetes Kenya. Through this magazine you may link to third party websites that diabetes Kenya has no control over. Inclusion of such websites and/ or advertisements does not imply recommendation or endorsement by diabetes Kenya. Diabetes Kenya does not take any liability with regard of your accessing such sites. Information in this magazine is about medical issues but should not be construed as medical advice.

contents...

Staying true to our vision “excellence in the prevention and management of diabetes” the Diabetes Kenya team including Dr. Acharya, Dr. Gaman, Ms. Atieno Jalang’o and Dr. Shahbal held a full day diabetes workshop, to train healthcare personnel on management of diabetes. All attendees were awarded with certi!cates of participation at the end of the event. We look forward to more of such trainings all over the country.

Diabetes Workshop 16th May 2014Mombasa

4 ⁄ Kisukari magazine

From the Chairperson

From theChief Editor

Message

Dear Readers,

Welcome to the second edition of Kisukari. Thank you for your overwhelming response and support. This edition is dedicated

and the challenges associated with fasting.

We are also covering sports in people living

keeping active to keep sugars in control. We kicked off the IDF foot project at Kenyatta national hospital grounds a few weeks ago and attended to scores of excited Kenyans head to toe with educational empowerment and foot screening services on the day.

We are looking forward to strengthening fruitful partnerships with all our well wishers, in the Pharma industry, corporate world and the diabetes family at large to join hands with us in our programmes to make

Dear Readers,

Like many other little dots connecting lives, food and faith are one of them. Food brings people together always, be it a simple dinner at home, an event, a birthday, a wedding. Food brings joy to the table. Faith on the other hand, connects all of us on a more spiritual level, the feeling of belonging and togetherness that every human being craves for. For this we focus our main article on fasting and diabetes, welcoming the holy month of Ramadhan for the Muslims but also acknowledging all the other faiths that fast, be it during lent or for personal reasons.

Fasting is not just about lack of feeding but an overall change in attitude, a moment where everyone wants to be the best they can be. With the fasting comes with it the celebrations and the feasting, and this is where the catch is for most diabetic patients. It is my hope that this article will open up your minds to a safer fast without affecting your sugars. Plan for your fasts with your doctor, they are there to

life easy sailing for every person, young and old and from any background, living with diabetes in Kenya.

TOGETHER WE CAN.

assist you in the process not to stop you from practicing your faith, so have faith in them too.

I wish all our Muslim brothers and sisters a blessed Ramadhan and ask you to kindly keep Kenya and us in your prayers. Stay healthy.

can’t see the whole staircase”Martin Luther King Jr.

VISIONTo be a market leader and centre of excellence in laboratory diagnostic industry in the region.

MISSIONTo provide high quality, accessible and competitive pricing for tests done in the laboratory to the Kenyan Citizenry.

CORE VALUES Professionalism Excellence in customer service High quality delivery of services

Ethics and integrity Innovation through ICT solutions Transparency and Accountability

INTRODUCTIONPathologists Lancet Kenya is a

leading ultramodern and independent pathology laboratory service with its main laboratory and headquarters in Upper Hill Nairobi, and other branch laboratories in Nairobi and across the country. Across all these branches, PLK implements quality and adherence to international standards of excellence, and are linked through a dedicated fibre-optic and wireless network that allows our pathologists to access, monitor, supervise and electronically sign out all reports in all our laboratories, thus ensuring that international expertise is injected in every result. Our systems are highly automated with barcoding and centralization of records, including electronic reporting of results through E-mail and other electronic alternatives to hard copy reporting, including PathPortal and the development of Apps for both Android and Apple platforms.

Our value o!erings include: Ultra modern state of the

art infrastructure and modern services

Competitive pricing and e!cient turnaround time (TAT)

Internationally accredited quality and LEAN services

Specimen courier collection and electronic result delivery

Automatic delivery of reports to doctors through ICT solutions:

- PathPortal- Auto E-mail - Lancet mobile App

Wide test menu with over 3,800 tests (routine to specialized tests). Some of the areas where Lancet

Kenya has distinguished itself internationally include:

- Molecular Pathology; PCR/DNA ANALYSIS

- Histology and Cytology; Immunohis-tochemistry

- Flow cytometry and cytogenetics:

- Hematology and coagulation tests as well as bone marrow studies.

- Microbiology: bac-teriology, mycobac-teriology, mycology, parasitology and virology.

- Chemical Pathology/Toxicology

- Wellness checks- Public-Private

partnerships (PPP) initiatives

Branches of pathologists lancet Kenya….

PATHOLOGISTS LANCET KENYA5th Avenue o!ce suitesOpp. Tra!c HQ – Upper hill5th Ngong Avenue I Ngong road Switch board: 0703 061000Land lines : 020 273 5123, 271 6701/ 020 250 8456, 271 6697Mobile: 0729 111 110 / 0736 493 100

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GENERAL ACCIDENT HOUSE0703061050Mobile: 0726995860

PROF NELSON AWORIDirect Line(s):0703061051/2Mobile: 0726839341

LANCET PARKLANDSPark Place O!ce Suites0703061100Mobile : 0729 909409

LANCET EASTLEIGHAt Alliance Medical CentreDirect Line(s): 0703061090/1Mobile: 0717 414682

LANCET BURUBURUAcacia BuildingSwitch Board:0703061000/1

Mobile: 0717414708

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LANCET KIBRAAt Sheikh Mahmud MemorialClinic Tel:0703061000

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LANCET MALINDIAt Tawfiq HospitalTel:0703061074/5/6Mobile: 0721143766

LANCET KISUMUWedco Centre Unit 3Kenya Re- PlazaTel:0703061080/1Mobile: 0726838773/0735 457665

LANCET ELDORETKVDA Plaza, Tel: 0703061120/1/2Mobile: 0714 403 655

LANCET THIKAThika ArcadeTel:0703061000Mobile: 0717414684

LANCET NAKURUWest Side MallTel: 0703061000Mobile: 0720654351

LANCET GARISSAAt Alliance Medical Tel: 0703061110Mobile: 0704819799


dk OVERVIEW

VISION: Excellence in the prevention and management of diabetes!

MISSION: A Diabetes Free Kenya!

MOTTO: “An Anchor of Hope” against the rising tide of the diabetes epidemic in Kenya.

OVERVIEW: Formerly called the Kenya Diabetes Association (KDA), the association was first registered in 1972 by the late Dr. Eric Mngola. A change of name and new registration was necessitated towards the end of 2009, leading to the birth of Diabetes Kenya Association (DK) on 11th March 2010. A duly elected National Executive Committee team, under the Chairmanship of Dr. (Mrs.) Kirtida Acharya, Physician, Endocrinologist and Diabetologist run the day-to-day activities of the association on a purely voluntary basis.

Diabetes Kenya Association is a non-governmental, non-profit organization, officially registered with the change of name in March 2010, working and lobbying to better the lives of people affected by diabetes.

Diabetes Kenya, the national representative body for diabetes in Kenya, is the sole accredited associate member - in Kenya - of the International Diabetes Federation (IDF), which is the umbrella organisation of over 200 national diabetes organizations in over 160 countries, representing the interests of a growing number of people with diabetes and those at risk. DK representatives are actively involved in a number of working committees of the International Diabetes Federation. Our association works closely with the Ministry of Health, global and major local pharmaceutical companies as well as corporate sponsors who have already awoken to the devastating effects of diabetes and other Noncommunicable diseases; mainly cardiovascular diseases, cancers and chronic respiratory diseases. They have made diabetes education and prevention a major part of their corporate social responsibility programmes.

Diabetes Kenya Association rolls out a yearly calendar of events, which involves free blood sugar screening, educational and prevention camps as well as other diabetes related activities to bring to light the diabetes epidemic in our country.

Diabetes education is important and accounts for 50% of diabetes treatment.

MANDATE:

Promoting public awareness of diabetes, its symptoms, risks, prevention and control.Supporting and organizing of training for people who live or work with diabetes.Lobbying for better understanding of patients’ needs and for affordable care and medicationFostering enabling partnerships and linkages for the fight against diabetesEnabling diabetes related researchAddressing issues related to and including Epidemiology of Diabetes and its complications

OUR NETWORK: Diabetes Kenya Association works closely with Kenya’s Ministry of Health. Our National Office in headquartered in Nairobi and includes branch offices countrywide, enabling rapid dissemination of information and resources within State and Provincial Health Facilities.

THE NATIONAL EXECUTIVE COMMITTEE OF DIABETES KENYA IS ACTIVELY INVOLVED WITH:

University medical departmentsState and provincial health departments Doctors specializing in diabetes in Kenya Specialist health care workers Private medical practitioners and other diabetes related health care workers Non-government organizations working in related fields within the primary health care sector.Industry, including global pharmaceutical companies and other companies servicing people with diabetes.

Diabetes Kenya is primarily a volunteer organisation and relies heavily on people with diabetes and their families, who pool their talents, share their knowledge, resources and experience and give of their time to help each other.

As we all know – to do nothing is no longer an option. We no longer have the luxury to afford having bystanders. It is time to give diabetes and other NCDs the attention they deserve. Diabetes has many faces but few voices. We hope to encourage as many people to come together as possible in eradicating diabetes from our country.

Let Us Unite in the Fight Against Diabetes!

Kisukari magazine ⁄ 7

We look forward to your continued support. . .

Friends of Diabetes KenyaDear Readers, !nd below di"erent categories of supporting Diabetes Kenya by being a friend of Diabetes Kenya.

a) Individual category Minimum Donations - 500 ksh per month, payable quarterly

b) Corporate category Minimum Donations - 5000 ksh per month payable quarterly Bene!ts - free copy of our quarterly magazines - Regular Information on Diabetes from diabetes Kenya on email - Acknowledgement in our magazine (Kisukari)

Corporate Sponsorship for Diabetes Kenya Bronze sponsor Ksh 100,000/- per year Bene!ts - 5 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine with appearance of logo

Silver sponsor Ksh 250,000/- per year Bene!ts -10 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine (Kisukari) with appearance of logo - Acknowledgement during DK functions, banners during DK functions -25% discount on advertising in Kisukari magazine

Gold sponsor Ksh 500,000/- per year Bene!ts - 20 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine (Kisukari) with appearance of logo - Acknowledgement during DK functions, banners during DK functions - Acknowledgement plaque at DK o!ce -50 % discount on advertising in Kisukari magazine


Diabetes is due to a total lack of insulin (Type 1) or little insulin produced by the pancreas (Type 2)

Fact 1

Newer needles and pens have made this a painless process.

Fact 4

Diabetes

One of the major challenges associated with proper management of diabetes are societal myths. Below we try demystifying some of these myths with corresponding facts.

Diabetes DEMYSTIFIED

By: Dr. Salwa Shahbal

Diabetes is caused by eating too much sugar

Insulin injections are painful

If you have diabetes, you cannot be active

Being active/exercising improves glucose control. Talk to your doctor before trying any new exercise.

Fact 2

Myth 1Myth 2

Myth 3Using insulin means you have failed

Type 1 diabetic patients have to use insulin because they have no insulin. Type 2 diabetics, use of insulin depends on control of the diabetes and disease progression.

Fact 3

Myth 4

Diabetes can happen to anyone, whether thin or not thin. As much as obesity is a risk factor, thin people can still get diabetes due to many other reasons and it is advisable to lead a healthy lifestyle despite body size.

Fact 5

Fact 6

Both are serious if not well controlled.

Diabetic patients follow a healthy diet that we should all follow. They just plan their meals carefully and practice portion control.

Fact 7

We are seeing more cases of type 2 diabetes among the youth due to unhealthy eating habits and lack of exercises.

Fact 9

Lifestyle changes are part and parcel of good glucose control and cannot be stopped even if one is on medication.

Fact 10

Myth 5

Myth 6

Myth 10

Thin people do not get diabetes

Type 1 diabetes is more serious than Type 2

Myth 7

Diabetic patients follow a special diet

Diabetes can happen to you even with no family history.

When you start diabetes medication you do not need to exercise or worry about the food you eat

Fact 8

Myth 9

Only adults’ get Type 2 diabetes

Myth 8I cannot get diabetes because it does not run in my family



Fasting For Religious Purposes

All the major religions recommend or command one form of fasting or the other. Various religions have different form of fast where differences are noted in terms of

intake . There are several fasts noted .These factors must be considered when giving advice on fasting.

General PrinciplesThe health provider should be consulted to seek advice whether fasting can be embarked upon on medical grounds.Advice from the religious leader should also be sought as to whether (s)he can be exempted. Check the level of average blood sugar control using HbA1c or fasting blood glucose. Those in very poor control should be discouraged from embarking upon fasting. Drug dosage adjustment is required for patients with fasting blood glucose < 4.5 mmols/l.

If on insulin or oral medicines that increase insulin secretion drugs dosages and timing will require adjustment during the period of food denial to meet calorie intake.A total fast is not recommended for anyone with diabetes. Adequate hydration is important even during the period of fastingSelf-blood glucose monitoring is mandatory for people with diabetes who elect to fast. Once-a-day monitoring is adequate for patients on diet only or diet with metformim. In patients on insulin ,oral medications that increase insulin secretion, Home blood glucose monitoring should be done at least three times a day. Doctor and patients should agree on how to handle abnormal results of blood sugar monitoring before start of fast. If hyperglycaemia is marked, retesting should be more frequent and the urine tested for ketones.Vigorous activity should be avoided during period of fast.

Fasting

Most commonly fasting occurs due to either religious or cultural reasons . Religion and culture are an important aspect of life.

An appreciation of one cultural or religious context is critical to understanding the behaviours and environments that govern an individual’s daily life. Many diabetics wish to follow there religious convictions and may end up fasting without their doctors advice and knowledge. Care givers must be aware of this and must be able to give advice on persons who can fasting and also give appropriate advice on diet and treatment adjustments for those who can fast.

By: Dr. Gaman Mohamed

People who fast should have ready access to their health-care providers during the period of fast.Breaking of the fast should be done if:1. One is on a total fast and blood

sugars are blow 3.9 mmols/l .2.

intake should immediately drink a sweetened drink ( half a glass of Juice ) once their sugars are below 4 mmols and should recheck blood sugars after 15 minutes .If sugars remain low the fast should be broken and a meal with carbohydrate consumed .

3. If blood glucose levels rise excessively to 16.5 mmol/L or higher.

Clear guidelines should be set as to when to terminate the fast, e.g. Frequent hypoglycaemia, intercurrent infection.Compensatory eating with fried foods and sweets should be avoided when one opens their fasts .

Diabetes & Fasting


Diabetes and Ramadan

the Islamic faith is based. The purpose of fasting is to develop God-consciousness and self-control, improve health by reducing or eliminating impurities in the body and to increase awareness of the plight of the poor,

exempts people with a medical condition that may affect their heath from the duty of fasting. Many patients often prefer not to accept this exemption. A survey in Kenya on 300 diabetic Muslims indicated that 89 % of type 2 dia-betic Muslims have fasted during Ramadan. A larger study by Salti and colleagues showed that during Ramadan, 42.8% of patients with type 1 diabetes and 78.7% with type 2 diabe-tes fasted for at least 15 days.

Fasting with Diabetes during Ramadan

Persons with diabetes may be able to fast during Ramadan. However, their chronic metabolic disorder can place them at high risk for various complications if their eating patterns such as the amount of their meal and

Here are some risks diabetics should be aware of:

A diabetic may undergo risk for the development of hypoglycemia resulting from decreased food intake. Reduction in intake of blood glucose-lowering medications may cause blood glucose levels to rise, resulting in hyper-glycemia.

may cause one to lose body water and become dehydrated. There is an increased risk for the devel-opment of diabetic ketoacidosis, particu-larly if you are grossly hyperglycemic before Ramadan.

Due to the potential risks listed above a dia-betic should talk to their doctor or healthcare professional about making the appropriate changes in their diabetic treatment plan. A

doctor will be able to classify respective pa-tients in various risk categories namely, high risk or low risk. High risk patients are patients on insulin or who have type 1 diabetes and have had poor glycaemic control with high and low blood sugars. Pregnancy or patients with severely impaired kidney or heart func-tions also fall under the high risk category. Low risk patients are patients who are well controlled on diet and/or oral anti -diabetic medications.

Management during Ramadan

Nutrition Meals should be evenly spread out with three equal sized meals, one early evening, one late evening and one before dawn would be the

ideal meal pattern. The common practice of ingesting large amounts of foods rich in car-bohydrates , fats and sweets especially during the sunset meal, should be avoided. The fast

bread and whole meal chapatti) are recom-mended.

Exercise & ActivityNormal levels of physical activity should be maintained to prevent weight gain. Excessive physical activity may lead to a higher risk of hypoglycemia and should be avoided in patients on insulin. Taraweh prayers should be considered a part of daily physical activity and the same precautionary measures should be taken. Drugs that cause increased insulin secretions and have a long duration of action should be avoided. Shorter acting agents in this class may be used under doctors instructions .

InsulinPatients on insulin should have a review with their doctor prior to fasting. Several changes maybe recommended based on the type of insulin, dose of insulin and the time of given insulin administration. In most cases in patients on insulin, doses will be reversed whereby larger doses are given in the evening while smaller doses are given in the morning .

Blood Glucose MonitoringBlood glucose monitoring is vital for patients on insulin who are fasting . It is recommended that blood sugars are done before and one and half hours after meals. This would not only enable treatment adjustments to be done but also prevent acute complications.

Breaking the FastIt is recommended that fasting should be im-mediately terminated if any of the following should occur:

If blood glucose levels drop dramatically to 3.3mmol/l (60 mg/dl) or lower. If blood glucose levels reach 3.9mmol/l

start of the fast and especially if insulin, sulfonylureas or meglitinides are taken at the pre-dawn meal. If blood glucose levels rise excessively to 16.5 mmol/l (300 mg/dl) or higher.

Conclusion

Many authors on the subject confer that pa-tients on treatment for diabetes with drugs or exercise and diet and a few Insulin dependant diabetics who insist on fasting, can fast if they are carefully managed and have been found to be suitable to fast by their doctors.

All diabetics must consult with their doctors prior to fasting to ensure that their condition allows them to fast and to have the necessary advise and drug treatment adjustments.

Source: www.daralliance.org

Coffee and dates are the common starters used to break the fast for Muslims.

For successful Ramadan fasting implementation of the three pillars of


Talking toNetanjee Van Niekerk

At the age of 12, my symptoms of diabetes started to show, although I didn’t discover it was diabetes because of my intense

-mal. A day after my 13 birthday (27th July 2009), I was diagnosed after a urine sample and measure of glucose done by my doctor as a general test I do every year. My tests indicated high glucose levels as a result of being admitted into hospital for further exami-nation and evaluation of the extent it had reached.

Due to the hypo’s and hyper’s of my blood sugar levels and the lack of enough insulin my pancreas is producing: Type 1.

3. What type of treatment were you started on and what are

This is actually really funny, because for a long time the doctors had no idea what to do with me or how much of what they needed to give me to get my blood sugar level under control. So they started me on 12 units of [NovoRapid] for every meal along with 10units of [Levermere] twice a day. This was WAY too much and every hour I would drop into a low and I would eat (not having the right information and education) biscuits and stuff.. The in-consistency was unpleasant and unhealthy, so the doctors took me off [LeverMere] completely and decreased my [NovoRapid] dose. The “honeymoon phase”, the swimming (yes I kept on swimming) and just the way my body is so sensitive to the insulin gave me the nickname “medical marble” of diabetic treatment. But back then it was the insulin pen and only the insulin pen, but now I have this amazing little machine-like pancreas attached to me called the Insulin Pump and let me just say- it is so much better and easier to keep everything under control. So I started with the NovoRapid in-sulin pen and now I am on the insulin pump that uses the 100ml vile

Life story


good and the badWhen I was diagnosed I was a newly teenager, knew little about life and was a care-free little girl. I was at the end of what we called Primary School going to High School. This event felt like a slap-in-the-face across my path and suddenly I had to take a huge responsibility of my own life that I wouldn’t even think about before. I mean the biggest responsibility about my life was brush my teeth and wash all over when I showered, not watch your diet, keep your sugar under control and test your blood sugar every two hours. The responsibility of my life in my hands was a big change, I was and am always responsible and disciplined (everything swimming taught me), but never to this degree of importance. Not being able to eat what I used to eat was probably the hardest and also adapting my diet to be able to train my best and perform even better at galas had a fun, but unwanted experimenting time period which to this day I think set me back a bit, but when I mastered it (don’t get me wrong it is still trial and error today as training changes) it helped me catch up and even go above where I was before. The better effect of it all taught me that being healthy is not just a “once off thing” but a continuous lifestyle and to be healthy means changing your diet, sleeping habits, internal chemical control (don’t worry too much about that) and EXCERCISE!!! It has taught me that all foods in moderation, which to eliminate and which to eat more of.

a healthy way and sometimes I just bake anything I want to and feed my family haha. Triathlon training is a new hobby these days and writing poems.

intensity in order to perform the best as what I possible can and have enough energy to train with power, speed and endurance that

-

(to go faster) and drop most of the excess body fat that slowed me

having the right diet can have a major impact on my performance;; the healthier the diet and the body, the cleaner the “engine” and eventually the faster one will swim.

7. Do you think being on the pump has made it easier in

DEFINITELY!! When I was still using the insulin pen, it was a gamble every time I entered the swimming pool about how my blood sugar will react after a couple of minutes of swimming and brought about a lot of stress especially when you have no idea what the set (what type of training) will be like. When I was put on the pump, I got excited because some of the responsibility that gave me a lot of stress would be lifted from my shoulders up to a point. My blood sugar is monitored 24/7 with the sensor and the pump is what I call “a pancreas outside of my body that I give guidance to”. It helps me monitor my blood sugar levels before, during and after training and most importantly during galas / swimming meets. To explain a bit: when your blood sugar levels are too high in training or galas the blood sugar levels will only

keep on increasing and eventually the muscles will suffer a lack in

sugar levels are too low, it will only keep dropping and the weak feeling will kick in reducing output. So keeping it just right, is key to doing the best at what you possibly can.

accepted among them or become an outcast? I hate it when people categorize me and give me a label and this was my greatest fear of being labeled as the “diabetic girl”. The weight control was a big issue, as I picked up weight at the beginning before I started losing it again after a while – this doesn’t happen to most newly diagnosed people though.

Firstly and something everybody needs to realize when dealing with diabetes, nobody will classify you as “the diabetic” when you are yourself and have fun, people will totally forget about the diabetes. If you are obsessed with it, everybody else will be. When I found the right balance of insulin and the right diet, the extra body fat dropped off me so quickly! But accepting yourself is key and just be responsible with what you do – have fun, but just do it responsibly.

10. What advice would you give a 15 year old newly

I know there will come a stage you will be angry, disappointed and embarrassed to explain to your friends why you will not be able to eat certain things or drink certain drinks. But if your friends are true friends they will accept it and will give you the support through the whole new process. Adopt a new, healthier lifestyle and ask for help if you don’t understand why certain things are happening and how you should handle different things when something happens with your blood sugar, diet, insulin etc. Help your parents understand and prove to them through your actions that you know what you are doing and that they can trust you – trust me it takes the world of stress of their shoulders and

Do what you are supposed to do: keep your blood sugar under control, watch your diet and make sure you give insulin when you should.Most importantly: don’t stop living! This is not a death sentence and does not limit your ability to succeed in your sport, hobbies and that what makes you. Don’t blame yourself for the diagnoses;; it is out of your control. Don’t throw yourself a pity-party, that won’t help you with any-thing but rather see this as an opportunity to change yourself to a healthier you.LIVE YOUR LIFE AS NORMAL. Have fun, set goals, and go achieve them. Remember, Diabetes does not control you;; you are


Complications Of GESTATIONAL DIABETES

Most women who develop ges-tational diabetes go on to have healthy babies. Dietary changes and exercise maybe enough to

keep your blood sugar levels under control though at times medication is needed too. It is important to keep your blood sugar levels in check because poorly controlled diabetes can have serious short and long term effects for you and your baby.

COMPLICATIONS THAT MAY AFFECT YOUR BABY:

Excessive Birth Weight:Extra glucose in your blood stream crosses the placenta which triggers your baby’s pancreas to make extra insulin this can cause your baby to grow too large (macrosomia). Very large babies those that weigh 9 pounds or more maybe too large to enter the birth canal or the baby’s head may enter the canal but then his shoulders get stuck. In this situation called shoulder dystocia, your practitioner will have to use special maneuvers to deliver your baby.Delivery can sometimes result in a fractured bone or nerve damage both of which heal without permanent problems.In very few cases the baby may suffer brain damage from lack of oxygen during the pro-

your practitioner may recommend you do a caesarian section.

Early Birth & Respiratory Distress Syndrome:A mother’s blood sugar may increase her risk of early labor & delivery of her baby before its due date. Babies born early may experience

respiratory distress syndrome –a condition

(The lungs of babies whose mothers have diabetes tend to mature a bit late).

Low Blood Sugar (Hypoglycemia):Sometimes shortly after birth your baby may have low blood sugar because his body will still be producing extra insulin in exposure to your excess glucose. This is much more likely if your blood sugar levels were high during pregnancy and especially during labor.Your baby’s blood sugar will be tested at birth and continue to be checked as needed.

Feeding your baby as soon as possible after birth preferably by breast feeding can help prevent or correct hypoglycemia. In severe cases of hypoglycemia he will be given in-travenous glucose solution. This can prevent serious problems such as seizures, coma and brain damage that might result if the condition were to go unnoticed.

Type 2 Diabetes:Babies of mothers who have gestational dia-

Gestational diabetes

By: Dr. Ifrah Hersi

betes have a higher risk of developing obesity and type 2 diabetes mellitus later in life.

Polycythemia:If your blood sugar is especially poor your baby is at risk for polycythemia (an increase in number of red blood cells) and hypocal-caemia (low calcium in the blood) and your baby’s heart function could be affected as well.

COMPLICATIONS THAT MAY AFFECT YOU:

Delivery of a large baby and the maneuvers needed to deliver a broad shouldered baby can lead to injuries to the vaginal area and require a large episiotomy for you.

High Blood Pressure & Pre Eclampsia:Gestation diabetes raises the risk of high blood pressure as well as pre eclampsia a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby. It particularly occurs to those who are obese before pregnancy or whose blood sugar levels are not well controlled.

Future Diabetes:If you have gestational diabetes you’re more likely to get it again during a future preg-nancy. You’re also more likely to develop type 2 diabetes mellitus as you get older.

However making healthy lifestyle choices such as eating healthy foods and exercising reduce the risk of future type 2 diabetes.

It is important to keep your blood sugar levels in check because poorly controlled diabetes can have serious short and long term e!ects for you and your baby.

Source: wikipedia.com


NEWKIDS ONTHE BLOCK

I ncretin is a hormone released in your body that stimulates production of insulin. If you remember, type 2 diabetes is due to little insulin in your body. New drugs called incretinmimet-ics (because they mimic the action of the natural hormone incretin) are available for type 2 diabetic patients now.

They stimulate your pancreas to release insulin after you eat.They reduce production of glucagon by your pancreas. Glucagon is a hormone that prompts your liver from producing glucose.

therefore preventing your sugars to go too high after meals.

The drugs are currently not in tablet form but injections and are cur-rently not available in the Kenyan market.

DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors) on the other hand are tablets and are available in the Kenyan market.

DPP-4 inhibitors prevent the breakdown of incretin hormone above therefore making it work for longer. Incretin hormone then controls your sugars the same way as mentioned above.

Examples of the DPP-4 inhibitors in the market:

VildagliptinSitaglipinSaxagliptin

All medication for diabetes needs to be prescribed by your doctor depending on your sugar control. DPP-4 inhibitors can be used as monotherapy (alone) or in combination with other drugs like met-formin. Normal dose is between 50mg to 100mg. While saxagliptin is 2.5 to 5mg.

Research shows that incretinmimetics improve glyceamic control (HBA1C) by approximately 0.5% to 1.0%.They are weight neutral meaning they have no effect on weight gain/loss.Low risk of hypoglyceamia (low blood sugar).

A major disadvantage in our set up in Kenya is the cost which I believe will go down if more patients use the drugs. Like any other drugs, they

starting any medication.

Some of the symptoms of an allergic reaction may include:

Shortness of breath;;

Swelling of the face, lips, tongue or other parts of the body;;Rash, itching or hives on the skin.

Stop the drug and report any of the above immediately to your doctor

Swallow the tablets whole with a glass of water. Taking it at the same time each day will have the best effect. It will also help you remember when to take it. It does not matter if you take this medicine before or after food.

New Kids...

IncretinMimeticsBy: Aggrey Shiundu (Pharmaceutical technologist)

Obesity & Diabetes

Diabetes&Exercise

movements which require energy expenditure in excess of resting energy expenditure as a result of contracting skeletal muscles.

and repetitive bodily movement performed to improve or maintain one or more components of physical activity.

There are two main types of exercise:Aerobic exercise - Repeated rhythmic and continuous movement of the same large muscles for at least 10 minutes at a time, e.g. Walking, jogging, swimming.Resistance exercise –consists of activities that use muscle strength to move weight or resist load such as weight lifting and exercise with weight machines.


By: Dr. Gaman Mohamed


Exercise is one of the four key pillars in successful diabetes management. It is free and most people can not get enough of it and is the crux of healthy living. Exercise is, in some sense, the perfect drug for diabetes. Different types and intensity of

exercises can be discussed with the patient’s health provider to enable the patient exercise safely and effectively.

Burning of extra body fat especially around the organs and over the stomach regionBuilds muscle strengthStrengthens bonesLowers blood pressureLowers LDL (“bad”) cholesterolRaises HDL (“good”) cholesterolImproves blood circulationMakes heart disease and stroke less likelyBoosts energy

Enhances self esteem and self assurance and a sense of well being resulting in decreases in stress levels and an overall improvement in quality of life

During exercise, the body needs extra energy or fuel (in the form of glucose) for the exercising muscles. For short bursts of exercise, such as a quick sprint to catch the matatu or bus, the muscles and the liver can release stores of glucose for fuel. However, when one continues exercising, the muscles take up glucose from the blood stream up to about 20 times the normal rate. This helps lowers blood sugar levels. At the same time insulin levels may drop in anyone not taking insulin so the risks of hypoglycemia or low blood sugar is minimized.

But intense exercise can have the opposite effect if done for less than 10 minutes and actually temporarily increase one’s blood glucose levels right after one stops exercising. This is especially true for many people with diabetes. The body recognizes intense exercise as a stress and releases stress hormones that cause the body to increase available blood sugar to fuel muscles.

Planning an exercise programA history and physical exam are needed to detect diseases of the heart, blood vessels, eyes, kidneys and the nervous system in a person with diabetes. This would be especially useful for patients above the age of 35 years, patients with Type 2 diabetes of greater than 10 years duration or Type 1 diabetes of greater than 15 years duration. In the presence of diabetic retinopathy (a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye) vigorous aerobic or resistance exercise may be contraindicated. However, swimming, walking, low impact aerobics, stationary cycling and endurance exercising maybe undertaken in the presence of severe peripheral neuropathy (damage to the peripheral nervous system), non-weight bearing activities may be safer such as swimming, cycling, rowing, chair exercises and arm exercises.

Diabetics may suffer from Autonomic Neuropathy (AN) which is a condition that results from damage to nerves that assist in organ and or-gan system functioning. This nerve damage disturbs signal processing between the autonomic nervous system and the brain. This can affect blood pressure, heart rate, perspiration patterns. Patients with autonom-ic neuropathy should undergo cardiac investigation before beginning any physical activity that is more intense. There are no restrictions of participants with diabetic kidney disease.

Choosing an exercise programThere are two types of exercise: aerobic and anaerobic. Aerobic exercise uses oxygen to help release energy from fat cells. Anaerobic exercise does not use oxygen to burn fuel. Ideally, a diabetic’s exercise program will include both types of exercise.

The level of exercise is described as light, moderate, or strenuous. What is light exercise for one person may be moderate exercise for someone else. Depending on the person’s light exercise one may not breathe heavily, but the pulse rate may increase slightly. Moderate ex-ercise involves noticeably heavier breathing, with a pulse rate increase to more than 100 beats per minute. Strenuous exercise involves rapid breathing with a pulse rate between 125 and 160 beats per minute, depending on age.

One approach to exercise is the lifetime activity model. In this model, one would accumulate a total of 30 minutes of moderately intense physical activity each day. Lower intensity activity (e.g., light house-work) can be done more often and/or for a longer period of time. The

routine, three different times every day.We currently have several software programs available on android phones in Kenya that are able to count steps. Another approach is the 10,000 Steps Program;; 10,000 steps is equal to 5 miles. Using a pedometer or software on phones that can count steps, helps make walking a daily contest with oneself.

Preparation for exercise One must check blood glucose levels If blood glucose is low (less than 3.9mmol/l) before one begins to exercise, hypoglycemia must be treated and exercise withheld at that time. If blood glucose is less than 5.6mmol/l an additional carbohydrate must be added. If one has type 1 diabetes avoid exercise if fasting glucose levels are >13.8mmol/l and ketosis is present or if glucose levels are >16.6 mmol/l, irrespec-tive of whether ketosis is present. Gradual warming up of the muscles is necessary by doing low-intensity aerobic exercise such as walking or marching in place for 5–10 minutes, then stretch for 5–10 minutes

The recommendation for people with diabetes is 30 minutes of moderate aerobic exercise 5 times per week or 20 minutes of vigorous activity 3 times per week. For people with diabetes, anaerobic exercise is recommended 3 times a week.


before beginning more intensive exercise. This helps prevent muscle cramps and injury. As one completes the aerobic exercise session, gradually decrease the intensity by doing

period with about 5–10 minutes of stretching exercises. This is called a cool down. It will help to prevent aches and muscle cramping later. Other important aspects as one prepares to exercise includes precau-tion to the feet including appropriate foot wear and socks and proper hydration before and in-between exercises.

Nutrition and Insulin adjustments during exercise When one exercises regularly and takes insulin, a decrease in insulin dose on exercise days or eating an exercise snack may be required. Exercising around the same time each day will make planning insulin changes and snacks easier and more consistent. Reducing insulin doses is particularly useful for those who exercise regularly.

The decision about which to decrease insulin is based on the timing and type of exercise and the insulin treatment plan. The risk for hypo-glycemia is less when the level of insulin in the body is lower.

Avoid exercise for 1–2 hours after injecting rapid or short-act-ing insulinAvoid planning the exercise program during the time one’s insu-lin is peaking.Exercise before the morning insulin doseExercise 1–3 hours after eating.

The risk for nighttime hypoglycaemia is greater after exercise in the evening. The harder the body works during exercise, the more glucose it uses. The amount and timing of snacks depends on the intensity of the exercise, the duration of the exercise, the pre-exercise blood glucose, and the individual response. Balancing food and insulin with activity will require advice from the healthcare team and one may need to eat extra carbohydrates several hours after the exercise program. The longer and more intense the exercise, the longer that glucose will be lowered after exercise has stopped. Everyone has his or her own response to exercise. Monitoring blood glucose levels helps one under-stand their response to any adjustments made which may be necessary for each activity.

include:

Discussing with one’s healthcare providers on the exercise plan to ensure it is safe as well as checking to see if a change in the meals or medications is necessary.Choosing an activity that is enjoyable and thus making it a regular activity.Monitoring blood sugars before and after exercising. If the work out is for more than an hour then one must check their blood sugar levels regularly during the workout, so as to know whether a snack is required. One should always keep a small carbohydrate snack, like a fruit or a fruit drink, glucose or boiled sweets on hand in case blood sugar gets low.Work slowly into an exercise regime -Ease into it. Start with 10 minutes of exercise at a time if one has not been active then gradually work up to 30 minutes a day.Be good to the feet by wearing good shoes and practice proper foot care.Hydrate. Drink water before, during and after exercise to prevent dehydration.Stop if there is any unexpected pain. Mild muscle soreness is

WHATEXERCISE DOES

50%Reduces the incidence of diabetes by approximately

27%Lowers the risk of Stroke by

40%Reduces the incidence of high-blood pressure by approximately


RecipeCranberry-Almond Granola

PREPARATION

1. Position racks in the top and bottom thirds of the oven; preheat to 325°F. Coat 2 large baking sheets with sides with cooking spray.

2. Whisk apple juice concentrate, maple syrup, oil and brown sugar in a medium saucepan. Bring to a simmer over medium-high heat, stirring occasionally. Remove from heat; stir in cinnamon and salt.

3. Mix oats, wheat germ, almonds and sunflower seeds in a large bowl. Stir in the juice mixture; toss to coat.

4. Spread the granola evenly on the prepared baking sheets.

5. Bake the granola for 15 minutes, stirring once or twice. Reverse sheets top to bottom and back to front. Continue baking until lightly browned and aromatic, stirring frequently, about 15 minutes more.

6. Transfer the baking sheets to wire racks; stir 1/2 cup dried cranberries into the granola on each sheet. Let cool completely.

INGREDIENTS

Cooking spray 2/3 cup(s) juice, apple 1/2 cup(s) maple syrup 1/3 cup(s) oil, almond, or oil, canola 1/4 cup(s) sugar, brown, dark, packed 1 tablespoon cinnamon, ground 1/2 teaspoon salt 5 cup(s) oats, rolled, (not quick-cooking) 1 cup(s) wheat germ, toasted 1 cup(s) nuts, almonds, coarsely chopped 1/2 cup(s) sunflower seeds 1 cup(s) cranberries, dried, divided

QUICK INFO:

19 Servings, Contains Nuts, Contains Wheat/Gluten, Vegetarian, Good for Leftovers, GERD-Friendly, Heart-Healthy, Diabetes-Friendly.

NUTRITIONAL INFO (Per serving)

Calories: 262, Saturated Fat: 1g, Sodium: 67mg, Dietary Fiber: 5g, Total Fat: 11g, Carbs: 37g, Cholesterol: 0mg, Protein: 7g Carb Choices: 2 Recipe Source: eatingwell.com Prep Time: 10 minsCook Time: 35 minsRest Time: 20 minsTotal Time: 1 h 5 mins

Source: www.bambuhome.com

Source: www.thefreshfridge.com

Eat well...

Sweetfreedom

Q How does sugar affect the digestive system and additionally 1. -

mation that is felt as stomachaches or a disturbance in digestive movement resulting in constipation. Or it may stimulate bowel movement causing diarrhea.

2. Carbohydrates, especially sugar, contribute to heartburn (GERD). Reducing simple carbohydrate (sugar) intake has helped a lot of

3. Candida in the intestinal tract feeds off sugar. As the Candida yeast gets stronger with sugar ingestion, symptoms appear related

common symptom. When the organism gets stronger, it is capable of penetrating the bowel wall the getting into other organs. The more toxins released, the greater the negative effect on the body--headaches, fatigue, abdominal pain, and joint pain--the list goes on. Once the body regains control over Candida, you’ll feel a LOT better!

Q There are several ways that help you to resist the sugar cravings:

1. Don’t have it in the house.2. Find a buddy or a support system (spouse, family, and friend) that

shares in your desire to remove sugar from your life. 3. Create non-food rewards for each step or day or week of success.4. Set a timer for 15 minutes. Often the craving will disappear by that

time.5. Use fruit as your only sweet taste. Over time, the fruit gets

sweeter and sweeter.6. Try less and less sweet per day over a week or two week period.7. Use healthy sweeteners like Stevia, Xylitol, Agave.

Q I’ve heard that yeast overgrowth can cause sugar cravings. YES! Yeast loves sugar, needs sugar for metabolism, and seems to

send a message to the body to crave it. Most yeast (usually Candida) is permitted to gain a foothold in the body after the recurrent use of

the intestinal tract that keep the Candida under control. The Candida then become stronger, morph into a more aggressive form, bore through the intestinal wall and spread to other areas of the body. The organism releases a toxin, which manifests as any number of symptoms, includ-ing rashes, headaches, fatigue, joint aches, bloating and gas, menstrual irregularities. The treatment begins with absolutely no sugar intake and restrictions of fruit (too much sugar) and yeast. Probiotics (the good bacteria of the intestinal tract) in the 5 to 10 billion ranges is critical. If ongoing! There are medications that may be needed to bring better control of the organism.

Q NONE! We would get a better handle on controlling cravings for re-

be-what is a healthy level of carbohydrate intake per day? Requirement for carbohydrates is different for every individual depending on age, gender, activity level, weight and basal metabolic rate. We get plenty of carbohydrates when we eat legumes, vegetables, fruit and whole grains. The nutrients found in those foods are what our bodies need. On the other had, our body does need proteins and fats, and minimum require-

Source: www.cookingclassy.com

By: Ranjan PatelClinical NutritionistDiabetes Educator

A typical carbonated soft drink will have 200 calories

contains 12.5 teaspoons of sugar

About sugar



Diagnosis&TreatmentSource: Brett Davies

By: Dr. Farah Sherdel

DiabeTES & CHILDREN

Diabetes is a disease in which your body cannot control the amount of sugar in your blood. Remember the insulin(the key) that has to open the door of your cells? Well, in diabetes, there is a problem with this key and as a result you experience all those symptoms we mentioned in our last article, that make you feel rather dull and sick all the time, sometimes sleepy in class.

How can diabetes be diagnosed?The doctor will be able to tell if you have diabetes by doing a test that measures the level of your sugar(glucose) in your blood. This could be a fasting glucose test done !rst thing in the morning after you have not eaten anything for at least 8 hours or a random sugar(glucose) test which can be done at any time of the day. You could also be sent for another blood test called a glucose tolerance test which measures how your blood sugar


WORD JUMBLE

D I A B E T E S M E T E R V I R U S I N S U L I N B L O O D K I D S G LU C O S E TA B L E T D O C T O R H E A R T

changes over time after you have had a sugary drink. If you have to do this test then you must not eat anything for at least 8 hours.

So, can diabetes be cured?No, it cannot but the good news is, it can be treated! It is vital that you get the correct treatment from the time of diagnosis so that you do not have problems to the eyes, brain, heart, kidneys, feet and nerves. The important

thing for you to remember is that in order to control your diabetes you must eat a healthy diet which means stopping all those sweet and unhealthy stu" and exercising regularly. In Type 1 diabetes, you must top up your insulin with insulin injections so that all the sugar can go into the cells. In Type 2 diabetes, you may require tablets and /or insulin injections.

In both types of diabetes, you must always keep the two ‘Ms’ in mind – Monitoring and Managing. This means that you must check your blood sugars by using a glucometer. This helps you know whether the treatment is working or if your doctor needs to make some adjustments. A team approach is required involving you, your family and/or caregiver and the school working together with your doctor, diabetes educator and dietician.

REMEMBER, as long as you do not miss your injections and check your sugars as often as you can, there is no reason why you cannot go out there and have loads of fun with your friends!

“

A young boy gives himself an insulin shot at the Diabetes Association of T&T’s Annual Diabetes Children’s Camp.

Source: Taureef Mohammed (www.guardian.co.tt)

kisukari magazine 02

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