Diabetes Mellitus (commonly called Diabetes) is a serious condition that causes a person’s blood glucose (or blood sugar) to become abnormally high over a prolonged period. Glucose is vital to our health because it is an important source of energy for the cells in the body. Insulin is a hormone that is produced by the Pancreas, which is a large gland located behind the stomach. Insulin is responsible for controlling blood glucose; it moves glucose from the blood into the cells.
There are two main types of diabetes. In Type 1 Diabetes the body's immune system attacks and destroys the cells in the pancreas that produce insulin. Roughly 10% of persons with diabetes have Type 1, and they require insulin daily. In Type 2 Diabetes the cells in the body become resistant to the action of insulin, and the pancreas is unable to make enough to overcome this resistance. This is the most common type of diabetes (roughly 90%).
Normal blood glucose levels are between 4.4 and 7.2 mmol/l (80 and 130 mg/dl) before meals, and less than 10.0 mmol/l (180 mg/dl) two hours after meals. (To convert mg/dl to mmol/l you can divide by 18.)
Although the exact cause of Diabetes is unknown, there are several risk factors. You are at higher risk of getting diabetes if:
1. You have a parent or sibling with diabetes
2. You are overweight or obese
3. You are physically inactive
4. You are black or Asian
5. You are older, especially over 45 years
6. You have Hypertension
The symptoms of diabetes vary depending on how much sugar is in the blood. Also, some persons do not have any symptoms, and can have the disease for years before being diagnosed. The more common symptoms are:
A blood test is done in order to confirm the diagnosis. Your doctor may or may not choose to repeat the blood test, depending on your symptoms. There are four possible ways of diagnosing diabetes.
COMPLICATIONS of Diabetes
(These are normally emergencies)
Diabetic Ketoacidosis (DKA)
DKA is a serious condition that occurs when the blood glucose is very high (usually above 15mmol/l). When the cells cannot get energy from glucose, the body begins to burn fat, and this process produces ketones. Ketones are poisonous chemical that make the body more acidic. Symptoms of DKA include, frequent urination, increased thirst, fatigue, abdominal pain, nausea and vomiting, blurred vision, changes in breathing, fruity smelling breath and confusion. Persons should be taken to a hospital IMMEDIATELY.
Hyperosmolar Hyperglycemia Syndrome (HHS)
HHS is a serious condition that also happens with extremely high blood glucose levels (often over 40mmol/l). Some symptoms include excessive urination, increased thirst, disorientation and drowsiness; HHS can lead to severe dehydration, coma and even death. Persons with extremely high blood glucose levels must be treated in the hospital.
This occurs when the blood glucose levels are too low (usually below 4 mmol/l). It can happen suddenly, and occurs when someone misses/ delays a meal, or take more medication or insulin than needed. Some signs include trembling, feeling shaky, sweating, being anxious, palpitations, tiredness, headache and lack of concentration. Having something sweet to eat/drink can improve symptoms, if not you should go to the hospital.
(These occur in persons who have had diabetes for several years)
Excess sugar in the blood can lead to atherosclerosis. This is a condition where the arteries become narrowed and hardened due to a buildup of plaque around the artery wall. These plaques disrupt the flow of blood in the blood vessels. Below are some examples of the complications that can be caused by atherosclerosis.
Plaques in the coronary arteries (that supply the heart) can block blood flow resulting in a HEART ATTACK.
A blockage in the blood vessels of the brain can lead to a STROKE.
Decreased blood flow to the kidneys can lead to KIDNEY FAILURE. If severe, this may require dialysis or a kidney transplant.
Diabetes, can lead to CATARACTS, GLAUCOMA, RETINOPATHY (disease of the retina in the eye) and BLINDNESS.
Damage to the nerves can lead to many complications. If the nerves that innervate the bladder, sex organs, intestines and stomach are damaged, then this could result in frequent URINARY TRACT INFECTIONS, DECREASED AROUSAL, CONSTIPATION and GASTROPARESIS. (In gastroparesis, the stomach looses its ability to move food through the digestive tract, and this leads to bloating and vomiting.)
Damage to the nerves in the legs or feet can lead to symptoms such as: decreased sensation, numbness, weakness, tingling (pins and needles) and Pain (burning, shooting or stabbing). Because of the reduced sensation in the feet, persons often get injuries that go unnoticed. This can lead to ulcers, infections, deformed feet and amputations.
Plaques may develop in the arteries of the legs, which may disrupt blood flow. Persons may begin to notice pain/ cramping in the calves when walking or exercising (claudication). Additionally, they may suffer with leg pain especially at night that is only relieved by hanging the legs over the bed. At more severe stages, the skin of the toes or other parts of the feet may turn black. Theses are all symptoms of Peripheral Arterial Disease, which may require surgery to treat.
The first line treatment for most persons with Type 2 Diabetes is Lifestyle Modification. A healthy diet and regular exercise can help some persons maintain normal blood sugar levels.
If a healthy diet and increased physical activity fails to control blood sugar, then you may have to be started on medication. Metformin is usually the first medication prescribed for persons with diabetes. Most medications work by stimulating the pancreas to produce more insulin or by reducing insulin resistance.
Persons with Type 1 disease may have to be started on insulin immediately. Persons with Type 2 disease may be started on insulin immediately or after oral medication fails to control blood sugar.
A healthy diet is key to prevent and treat Diabetes. Your diet should contain mostly fruits, vegetables, whole grains, nuts, legumes, and some meat. Avoid processed foods and foods high in sugar as much as possible. There is no such thing as a “Diabetic Diet”; eating healthy would lead to improvement in overall health. (See a nutritionist if you would like further advice and a detailed meal plan prepared for you.)
Weight loss for persons who are overweight/obese, could lead to a significant improvement in blood sugar control. It would also reduce the risk of developing other diseases.
Exercise not only helps to control blood sugar, but it is also good for overall health. It is recommended that you do a minimum of 150 minutes, of moderate intensity exercise per week, and this should be spread over 3 to 5 days. Walking, running, bicycling and swimming, are all good examples.
Some persons notice an increase in blood sugar whenever they are in stressful situations. Reducing “stress” is very important for blood sugar control and overall health.
Cigarette smoking and Alcohol
Quit smoking cigarettes; they contribute to the formation of plaques in the arteries that can lead to heart attack, stroke, peripheral arterial disease, and other conditions.
Alcohol should also be avoided as much as possible. Limit your intake to no more than 14 units per week. Visit the link below to show you how to calculate your alcohol units. https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/
Persons with diabetes would benefit from attaining a blood glucose meter. This is a simple test system for use at home to measure the amount of sugar (glucose) in the blood.
Checking your blood sugar can help you to monitor how well the medication is working. It can also help you to know if you have dangerously high or low levels of glucose and can also help you to understand how diet, exercise, stress and illness affect your blood sugar levels.
If you have Type 1 Diabetes, it would be best to monitor your blood sugar everyday and keep a diary of the results. If you have Type 2 Diabetes, your doctor can advise you on how often your blood sugar should be monitored. These “blood glucose meter” tests can also be done at a health clinic or at a pharmacy.
Taking your medication every day will allow you to achieve optimal blood sugar control. Some medications have side effects such as weight gain, weight loss, hypoglycemia, etc. Talk to your doctor if you are uncomfortable with any side effects, as there are other kinds of medications available.
Whether you use a syringe or an insulin pen, do not inject insulin in exactly the same place each time, otherwise hard lumps may develop. The lower part of the stomach, the upper buttocks and the front and side of the thighs are good areas, (You should rotate your injection sites often.)
Manage hypertension and other illnesses
If you have other illnesses such as Hypertension and High Cholesterol, you should ensure that these are properly controlled, since this would decrease your chance of developing complications.
Doctor visits/ Medical checkup
All persons with Diabetes must have regular medical check ups (at least twice a year). Your doctor will need to have several tests done in order to ensure that you are not developing complications from the disease. This is also when your medication may be adjusted based on how well your blood sugar has been controlled.
Persons with Diabetes should have their eyes checked by an ophthalmologist (eye doctor) at least once a year. Identifying and treating any conditions of the eyes early can prevent blindness.
I hope these tips on DIABETES were helpful; Remember YOUR HEALTH IS INVALUABLE!
By Dr. J. Lawarna Matthew
American Diabetes Association
Visit http://www.diabetes.org/diabetes-basics/ and https://www.diabetes.org.uk/ for more information.
First of all, not all fats are bad! (Our diets should contain more of the good fats, instead of the bad ones)
Fats are essential to our diets; they are one of the three main food groups, along with carbohydrates and proteins. Fats function as energy sources for the body, and play a vital role in maintaining body temperature, and promoting healthy cell function. They are also important for some vitamins such as A, D, E, and K, which are fat-soluble, meaning they can only be digested and absorbed with fats.
Cholesterol is a fatty substance and is vital for the normal functioning of the body. It's mainly made by the liver, but can also be found in some foods. Cholesterol is carried in the blood by proteins called lipoproteins. The two main types of lipoprotein are:
Triglycerides are the most common type of fats in the body. They are made up of glycerol and three fatty acids chains. Triglycerides can be separated into two groups (Unsaturated and Saturated), based on the presence or absence of carbon double bonds in their molecular structure. Saturated fatty acids have no double bonds. Unsaturated fatty acids can be classified as monounsaturated (one double bond) or polyunsaturated (two or more double bonds). Unsaturated fatty acids can also be classified as Cis or Trans according to the arrangement of the hydrogen atoms around the double bond in the fatty acid chain. Cis and Trans fatty acids behave very differently in the body. Most foods actually contain a combination of fats.
Click the links below to see images and a video on Fats (including fatty acid molecular structure).
Polyunsaturated fats have more than one carbon double bond in the fatty acid chain. Oils that contain polyunsaturated fats are typically liquid at room temperature but start to turn solid when chilled, such as olive oil. These fats can help reduce bad cholesterol levels in the blood. Oils rich in polyunsaturated fats also contribute vitamin E to the diet. They also provide essential fats that your body needs but cannot produce itself, such as omega-6 and omega-3 fatty acids.
Foods high in polyunsaturated fat include a number of plant-based oils, including:
Monounsaturated fats have only one carbon double bond in the fatty acid chain. They are also typically liquid at room temperature, and reduce bad cholesterol levels in the blood.
Foods high in monounsaturated fats include plant based liquid oils such as:
Saturated fats are fat molecules where the fatty acid chains have no double bonds in their structure. Eating foods that contain saturated fats could raise the level of LDL cholesterol in your blood and increase your risk of heart disease and stroke (however, research has shown that some saturated fats raise the level of HDL too). Saturated fats are typically solid at room temperature. They occur naturally in many foods; the majorities are from animal sources, including meat and dairy products.
Examples of foods with saturated fat are:
Trans Fats (or Trans unsaturated fatty acids) are so called because of the arrangement of the hydrogen atoms around the double bonds in the fatty acid chain. Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels. They also increase your risk of developing heart disease, stroke and diabetes.
Naturally occurring trans fats are found in animal products like milk and meat. Artificial Trans fats are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid; they are commonly called “partially hydrogenated oils”. Trans fats are bad for overall health and should be avoided as much as possible. You can identify Trans fats in food by looking for “partially hydrogenated oils” in the ingredient lists. You can also determine the amount of Trans fats in a particular packaged food by looking at the Nutrition Facts panel. However, products can be listed as “0 grams of Trans fats” if they contain less than 0.5 grams of Trans fat per serving.
Trans Fats can be found in many foods including:
· French fries
· Fried chicken
· Pie crusts
· Frozen pizza
· and more
The American Heart Association recommends that adults who would benefit from lowering LDL cholesterol reduce their intake of Trans fats and limit their consumption of saturated fats to 5 to 6% of total calories. (For someone eating 2,000 calories a day that’s about 11 to 13 grams of saturated fat.)
Eat a diet that consists mostly of fruits, vegetables, whole grains, legumes and nuts. Poultry and fish are recommended more than red meat.
AVOID PROCESSED FOODS AS MUCH AS POSSIBLE. When purchasing processed foods, avoid those made with “partially hydrogenated” oils.
Use naturally occurring, unhydrogenated vegetable oils such as canola, safflower, sunflower or olive oil most often.
Limit how frequently you eat foods that may contain trans fats, such as doughnuts, cookies, muffins, cakes and fries.
In general, try to reduce the amount of vegetable oil, cheese and butter you use when cooking.
Reduce saturated fat in meat. The amount of saturated fat in meats can vary widely, depending on how it is prepared.
Select lean cuts of meat with minimal visible fat. Also, trim all visible fat from meat before cooking.
Remove the skin from chicken or turkey before cooking.
Grill and boil meats more often, instead of pan-frying. Use a rack to drain off fat when broiling, roasting or baking.
Stews, boiled meat, and other dishes in which fat cooks into the liquid can be refrigerated. Then, the hardened fat can be removed from the top.
Limit processed meats such as sausage, nuggets, salami and hot dogs. Many processed meats are high in saturated fat. They also contain a lot of salt.
Eat more fish. Choose oily fish such as salmon, trout and herring, which are high in omega-3 fatty acids. Prepare fish baked, grilled or boiled rather than breaded and fried. (Shrimp and crawfish are lower in total fat and saturated fat than most meats and poultry.)
Eat less meat. Try meatless meals more often. Meat doesn’t have to be eaten everyday; you can replace it with legumes (peas or beans). These meals can still be delicious, nutritious and satisfying. Visit the website below for quick, and simple meatless recipes that you can try.
I hope these tips on FATS were helpful; Remember YOUR HEALTH IS INVALUABLE.
Dr. J. Lawarna Matthew
American Heart Association
Visit https://healthyforgood.heart.org/eat-smart/articles/dietary-fats for more information.
Dr. J. Lawarna Matthew