Diabetes

Diabetes is a complex, chronic (long standing, Long term) illness that requires continuous medical care with many factors coming into play for risk-reduction strategies beyond just controlling the rise and fall of blood sugar. Ongoing patient self-management education and support are very important to preventing serious complications and lowering the risk of long-term complications.
Diabetes can be classified into the following general categories:
1. Type 1 diabetes occurs when the immune system destroys cells in the pancreas called beta cells, these cells are the ones that make insulin. Insulin is a hormone that helps move sugar or glucose from the food you eat into your body’s tissues so your cells can use it as fuel for energy. When the beta cells in the pancreas are destroyed, the glucose does not move into your cells because there is no insulin to do it. As a result the sugar builds up in your blood leaving your cells to starve, and ultimately resulting in high blood sugar (hyperglycemia).
2. Type 2 diabetes (due to a progressive loss of insulin secretion on the background of insulin resistance). It was previously referred to as “non–insulin-dependent diabetes” or “adult-onset diabetes,” and accounts for 90–95% of all diabetes. This form of diabetes is mostly found in older age, obesity, physical inactivity, family history of diabetes, history of gestational diabetes and certain ethnic groups such as Blacks and Hispanics. Type 2 diabetes however, has been increasingly diagnosed in children and adolescence. With Type 2 diabetes the pancreas is usually producing enough insulin but for unknown reasons the body cannot use the insulin effectively (insulin resistance). Over the years the production of insulin decreases, and unique and similar problems result as in type 1 diabetes. Some of the symptoms include:

• Fatigue
• Nausea
• Frequent urination
• Unusual thirst
• Weight loss
• Blurred vision
• Frequent infections
• Slow wound healing

Not everyone will have the same symptoms, in fact there are some people who have no symptoms.
 
3. Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes). Women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes within 5 to 10 years.
 
4. Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS or after organ transplantation)
The American Diabetes Association’s (ADA’s) “Standards of Medical Care in Diabetes” is intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. (https://docs.com/drquan/3729/ada-standards-of-medical-care-in-diabetes-2016)
Some general changes that were included in the ADA’s summary of revisions stipulates that the ADA has taken a position to state that diabetes does not define people and as such  the word “diabetic” will no longer be used when referring to individuals with diabetes in the “Standards of Medical Care in Diabetes.”
For the classification and diagnosis of diabetes, The order and discussion of diagnostic tests which are; fasting plasma glucose (FPG), 2-h plasma glucose (2-h POG) after a 75g oral glucose tolerance test, and A1C criteria,  were revised to make it clear that no one test is preferred over another for diagnosis.
Below are the criteria for the diagnosis of diabetes:

• FPG $126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours
• 2-h PG $200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.*
• A1C $6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.*
• In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dL (11.1 mmol/L).

For the relationship between age, BMI, and risk for type 2 diabetes and prediabetes, The ADA revised the recommendations which is now to test all adults beginning at age 45 years regardless of weight. Testing is also recommended for adults with no symptoms who are of any age, are overweight or obese and who have one or more additional risk factors for diabetes.
The ADA also acknowledged the change in technology and included a recommendation that encourages the use of new technology such as apps and text messaging in effecting lifestyle changes to prevent the onset of diabetes.
Diabetes Care in Patients with HIV
The recommendation for Patients with HIV is that they should be screened for diabetes and prediabetes with a fasting glucose level before starting antiretroviral therapy and 3 months after starting or changing it. If initial screening results are normal, checking fasting glucose each year is advised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for progression to diabetes.

Managing Diabetes Through Nutrition and Exercise
Your doctor may or may not put you on medication to help control your diabetes, but whatever the course of treatment is, diet and exercise play a crucial role.
Why is Diet Important?
Eating a healthy diet can:

• Help you control your blood sugars and blood lipids
• Help you maintain a healthy weight or lose weight if you are overweight
• Allow you to take less medication or avoid taking medication for your diabetes depending on your health status and with your doctor’s recommendation.
• Prevent complications from high blood sugars like nerve problems, kidney problems, and vision problems.
• Prevent other complications like heart disease and circulatory problems

 

Eating healthy means eating in moderation from the six Caribbean Food groups, having three balanced meals per day is a good way to start including healthy snacks between meals. Fruits and vegetables are good to use as snacks. As much as possible reduce fats, sweets, sugars and salt. Obtain carbohydrates mainly from fruits, vegetables, whole grains, legumes, and low-fat or skim milk. These foods are the best carbohydrate sources, because they are usually high in fiber and high in nutrients your body needs.
Foods containing fats are higher in calories than carbohydrates, so eating less fat can help you lose weight, especially if you are overweight or obese.
Use lean meats and poultry and include fish, nuts, and legumes to help reduce your intake of saturated fats and cholesterol. Speak with your dietitian or nutritionist, they would be better able to tailor a diet for you that fits your specific needs such as your food likes/dislikes, your activity level, foods that are available to you, your weight loss/fitness goals etc. all this and more would be considered when planning your diet.

Physical Activity/Exercise.
Before starting any exercise plan, always discuss it with your doctor first. Try to incorporate physical activity into your daily life by doing things that require more activity, e.g. Taking the stairs instead of the elevator, dancing to your favourite music, walking to distances that are close, and even parking your car a little further in the parking lot so you can increase your steps.

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