Diabetes Report Eyes on Diabetes Tuesday 14 November 2017 A complimentary supplement distributed with The Malta Independent.
02 Diabetes Report
Diabetes Report 03
World Diabetes Day
New treatment for diabetes show great promise Itâ€™s still diabetes â€“ Type 2 Staying on top of diabetes Diabetes in pregnancy In case of emergency
THE BLUE CIRCLE has been the global symbol for diabetes since 2006. According to the INTERNATIONAL DIABETES FEDERATION the purpose of the symbol is to give diabetes a common identity. It aims to: support all existing efforts to raise awareness about diabetes; inspire new activities, bring diabetes to the attention of the general public; brand diabetes; and provide a means to show support for the fight against diabetes.
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New treatments for diabetes show great promise Developments in new procedures and products designed to combat diabetes are offering hope to those with the disease. Around 42 million people worldwide have type 1 diabetes, a condition where the pancreas produces little to no insulin leaving their bodies unable to process sugars. They spend a lifetime taking insulin supplements to redress the balance as far as possible. Today, researchers are working on stem cell therapy based treatment which can automatically release insulin into the body whenever it is needed. Patients with high risk type 1 diabetes are the main targets for this treatment, which uses stem cells to produce pancreatic insulin cells. Recent developments have improved the success of previous attempts in this field because the stem cells can now mature within the body itself through an implant. Clinical trials into whether the stem cells could develop fully into islet cells, the type of cells necessary to produce insulin, were successful. Initially, the number of cells in the implants were not enough to actually treat patients; the idea was first to ensure such cells could actually be grown. Consequently, an organisation that funds type 1diabetic research has given implants to two patients. Patients who receive this treatment will need to take immunosuppressive drugs, to protect the grown cells from the bodyâ€™s immune system, and although this is just a functional cure and is not about the actual causes of the condition, it is good news that at last cell therapy is showing such progress. New techniques and better drugs may also mean islet cell transplantation, using new insulin-producing cells from a donor pancreas, will prove another possibility for long term success. Pancreas transplants, which mean patients would no longer need to receive insulin are promising but do not always work. Up to now
ting easier too. Exciting, major advancements have been made in the fields of insulin pumps, pens, glucometers; smartphone technology and mobile applications are available to get more accurate blood glucose readings and drug treatments are improving all the time. Anyone who has to use a lancing method to monitor their blood will welcome a new device named Genteel. Its inventor, bioengineer Christopher Jacobs,
there are serious risks involved in the procedure, which can be higher than having the disease itself. However, they may be considered worth it for those whose diabetes is seriously difficult to manage or who also need a kidney transplant. A better option is perhaps an artificial pancreas. Last year the first such gadget was approved for
type 1 patients aged 14 or over. Also known as closed-loop insulin delivery, it is an implanted device linking a continuous monitor, which checks blood sugar levels every five minutes, to an insulin pump. The pump automatically delivers the amount of insulin needed according to the monitor. Management of diabetes is get-
looked at the connection between blood capillaries and nerves and designed a device that reached the blood capillaries, but avoided the deeper-set pain nerves. It is the fist tool of its kind to draw enough blood not only from a finger but from other parts of the body. Medicines are developing all the time making drug regimes simpler and offering medication that limits past side effects and also the risks from other illnesses linked to diabetes. People with type 2 diabetes will benefit from the current research too. Groundwork for clinical trials is underway on a new drug to restore insulin sensitivity and lower blood sugar safely, without causing the adverse side effects that early examples produced. Because the current insulin-sensitising drugs can cause their own issues, this is indeed good news. And while hopes for a vaccine against diabetes are some way away from being fulfilled, research and trials into vaccine therapy are on-going and the outlook is more promising than it has been. A diagnoses of diabetes might be shocking and fearsome, but today so much more is understood and being learned about the condition. Medical science is moving forward at rates unheard of only a few years ago and although there is no actual cure for diabetes at the moment, there is every sign of one in the future and constant improvements in treatment and care for the present.
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It’s still Diabetes Cases of Type 2 diabetes are rising dangerously everywhere. In some countries it is now being referred to as a new plague.
Something in the region of 90 percent of diabetics have type 2 diabetes and all too often the attitude is that ‘it‘s only type 2’. Well, that is neither sensible nor helpful. Just because it does not require regular insulin injections shouldn’t mean this version of the disease can be taken more lightly. Basically it is a medical condition; a metabolic disorder in which the levels of sugar, or glucose build up in the bloodstream and there is not enough insulin to move the sugar into the cells that use it for energy.
The body then has to rely on alternative energy sources, in the tissues. Medical soap operas, always an impressive way to get health messages across, are making passing references to record numbers of amputations, and dressing their film sets with warning posters about ignoring symptoms and eating the right foods. And government health ministries worldwide are seriously concerned about both the present and long term effects the disease is having on their budg-
ets and care programmes. All with good reason, as diabetes can cause a wide variety of serious medical and health problems if not treated properly. This illness hits people from all walks of life, at any age; children and young teens, the middle-aged and over 60s. But there is something each one of us can do to help avoid it because it is very much influenced by diet and exercise and general lifestyles. And before you groan: ‘Oh that again, there‘s nothing wrong with mine‘, read on, for your health’s sake. You may be surprised. We are now consuming, often unconsciously, at least 10 times more sugar than we need, just by not bothering to check what we eat or being plain greedy over sweet treats. But it’s not all about sweets things either – any idea how much sugar there is in breakfast cereals, baked beans, ketchup and spicy sauces, bread; even fresh fruit juice, peas and carrots? Not to mention that the average size of the portions we eat today is nearly double that of our predecessors. Type 2 diabetes can be slow in developing. Its symptoms including constant hunger, or thirst, lethargy, weight loss, dry, itchy skin, tiredness and blurry vision can easily be ignored. But they should not, because as they progress they become more dangerous. Infections develop, wounds heal too slowly, eyes can be affected, feet hurt and there can be damage to the peripheral nerves, which send information from your brain and spinal cord, causing weakness, numbness and pain in the hands, feet other areas of the body. As the symptoms become more severe they are potentially very dangerous. More than two or three of these symptoms is a hint that you should see a doctor. They may all appear with no other problems, blamed on the strains of everyday life, but why risk it when diabetes can become life-threatening if it’s not treated, and waiting until it becomes an emergency will make it that much harder to deal with. Without treatment diabetes can become life-threatening. It can affect the heart. People with type 2 are more likely to have high blood pressure, abnormal cholesterol and high triglycerides. If they also smoke and or are obese, that’s a double whammy. They are even more at risk of a heart attack than the type 1 sufferers. Women diabetics have twice the chance of another heart attack after their first one. And four times the risk of heart failure compared to women who don’t have diabetes. But if this sounds alarmist it need not be. Caught in time type 2 is comparatively easy to manage. A change in the way we eat, the amount we drink, how when and where we exercise could literally decide whether we even develop type 2 diabetes, never mind how much of a hold it gets on our life. Following the guide lines for avoiding or living with it need not mean denying ourselves everything we enjoy, just finding those that do us good. It will mean also fitter families all round and that can only be a good thing.
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Choose your food carefully and take plenty of exercise.
Staying on top of diabetes You can manage your condition and control it; not the other way round
body processes it; meaning no two diabetics’ eating habits will be the same. Eating healthy foods and exercising regularly can go a long way towards controlling high blood pressure and cholesterol and complementing any medication you may be taking, as well as insuring you avoid too much sugar or high carbohydrates.
Whatever type of diabetes you have, making a commitment to take command of the issues it presents can reduce adverse symptoms and give you more freedom to get on and enjoy life. Keep a healthy outlook Regular annual or half-yearly appointments with an optician will show up any signs of retinal damage, cataracts and glaucoma. And, since regular diabetes checkups may not flag kidney, circulation or foot problems, make sure you seek regular screening for these. High blood sugar can weaken the immune system so keep up to date with inoculations such as flu jabs and any other vaccinations your specialists recommend. Pamper yourself, especially your feet. Wash them every day in lukewarm water and dry them thoroughly, especially between the toes, with a soft towel. Then moisturize with you favourite lotion. Check for blisters, cuts, sores, redness or swelling. If you find a foot problem that doesn’t seem to be healing consult your doctor. Always carry a note or wear an attractive piece of jewellery that says you have diabetes, and have a glucagon kit with you in case of a low blood sugar emergency. It would be helpful for everyone if family, friends and colleagues know how to use it. Learn all you can about your diabetes and keep up with developments in research and treatment. Joining a group will provide sup-
port and good friendships with people who know the problems and share the triumphs that go with being diabetic. If you can’t find one you like, start your own! Always seek advice from professionals; that’s what they are there for. And, remember, nothing is ever too trivial to mention if it is something you are concerned about. Take a good look at known ‘vices’ because while smoking is dangerous for everyone, it is even more of a no-no for diabetics. The risk of heart attack, strokes, nerve damage and kidney disease, all known complications of diabetes, increase enormously for smokers. If you drink alcohol, do so responsibly. Alcohol causes high or low blood
changes in glucose levels, depending on how much you drink and whether you eat at the same time. if you eat at the same time. It’s really best to drink alcohol only with a meal. And you need to be aware that the effects of what you drink is based as much on your gender, weight and metabolism as the number of units you swallow, if not more. Eat like a king, or queen If everyone adopted at least some of the rules for healthy eating that diabetics need to follow, we would all be so much healthier. Think about consulting a dietician if you don’t already have one, just for reassurance about the food and drink choices you make, and
an easy way to establish a routine for meals that suits you. There is so much choice and plenty of information about what to eat and what to avoid that everyone‘s likes and dislikes can be allowed for when combining menus. Nothing need be completely off limits. Even items that you might think of as ‘forbidden’ could be a rare treat – in very small amounts, although they won’t help you nutrition-wise, and managing your diabetes is lot easier to do if you mainly stick to the safest options. Keeping your cholesterol under control is also very important; so is allowing for the fact that your life style has a profound effect on the food you eat and the way your
Live the life you love. With constant up-dates about research and new information readily available, brilliantly designed gadgets to help monitor the blood and an improving awareness of everything diabetics face from employers, restaurateurs and health food stores, it is certainly easier for anyone with diabetes to deal with it these days. But stress, from whatever source, will raise its ugly head now and again and the hormones the body can produce to fight it can interfere and prevent insulin from working efficiently. Any sentiments and changes in behaviour this causes aggravate the situation and it becomes a vicious circle. Choose a method of relaxing that suits you; the possibilities are endless for every type of personality and all mood swings. Find a place, locality or just somewhere in your mind to escape to whenever you can. And treat yourself for no good reason sometimes to up the feel good factor. Boosting morale works wonders too. Take risks, within reason. Make time for other people and activities that will take you out of yourself and offer ways for you to prove how much you can do. All your triumphs, large and small, are a great encouragement when things aren’t going so well.
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Diabetes in pregnancy Being a diabetic need not prevent you from becoming a mother, it just means extra care and attention before and during pregnancy. As soon as you decide to start a family consult your doctor as there are many things you and your partner can do to give your baby the best start in life. The first is being as healthy as you possibly can. You will also need to plan time off for sufficient rest and exercise, draw up a healthy eating plan and double check your methods for monitoring your blood sugar levels, as this will be more important than ever while you are pregnant and after your baby is born. Most women who have type 1 or type 2 diabetes will have a healthy baby, but there is a higher risk of some complications. These include the baby being large and the need for an induced labour or caesarean section; the chance of miscarriage, due to high glucose levels preventing an embryo from implanting in the uterus, or the baby being stillborn. Sometimes a baby may have related health problems after birth which, require extra hospital care, and there is a greater chance of obesity or diabetes in later life. On the other hand, these risks can be considerably reduced by ensuring your diabetes is well under control and you have all the professional help and advice you need before you become pregnant. Your head start will be to get your weight to a normal level. Controlling glucose levels is much more difficult if you are even a little over weight. Getting your A1C levels below 6·5 and keeping your daily sugar levels under control for at least three months before trying for a baby will help your body prepare for pregnancy. Make a meal out of planning a good diet. Find good things that you love. This is especially im-
Gestational diabetes Gestational diabetes develops during pregnancy affecting how your cells use sugar, or glucose. It causes high blood sugar levels that can affect your pregnancy and your baby’s development, but it can be controlled by eating healthily, taking the right exercise and any necessary medication. This can prevent a difficult birth and keep you and your baby healthy. Blood sugar levels usually returns to normal soon after delivery. But gestational diabetes may develop during a future pregnancy and leave patients at risk of type 2 diabetes. Monitoring you blood sugar will help you maintain a healthy level.
portant because while you are pregnant hormones can lead to a build-up of sugar in the blood which can cause problems for the baby, and low blood sugar levels after birth. Meals should be light and high in fibre; oatmeal, brown rice, whole wheat bread and pasta, plus as large a variety of different coloured fruit and vegetables as possible. It’s also good to include foods rich in iron, red meat or tofu, and reduced fat versions of yoghurt, hard cheese and milk or milk substitutes that are high in calcium, and drink litres of water! And while making delicious meals is OK, weight watching must become second nature. You will already have discussed which oral medicines and supplements you can take, but make sure you are receiving enough iodine and folic acid. Once pregnancy is confirmed Plan to have your baby in a hospital where you will have the
support of a consultant-led maternity team. The treatment regime you usually follow will probably need adjusting, so consult your specialist immediately for advice on the hormonal insulin requirement changes that occur through the different stages of the pregnancy, and if you suffer from morning sickness. Keeping a daily record of your blood glucose levels will be very useful here, especially if you also make a note of what you eat as this will help you work out which foods are doing the least harm and the most good. It will also help you avoid extreme hypoglycaemic and hyperglycaemic episodes, as the warning signals for these often change during this time. The drugs you may still be taking for diabetes-related conditions like high blood pressure may need to be changed. You can expect your blood glucose levels to be monitored more often and more frequent screening of your eyes and to check kid-
Leading by example Last February, the Maltese soft drinks industry announced that by 2020 it will reduce added sugars in its products by 10%, contributing to the delivery of the recent European soft drink industries’ 10% sugar reduction commitment. This initiative responds to changing consumer preferences regarding sugar intake, and the calls from Member States and the European Commission for a coordinated approach to reformulation and sugar reduction. The soft drinks industry is the first sector to come forward with a commitment in response to the EU’s general 10% added sugar reduction target. GSD Marketing Ltd is actively working with local and European stakeholders in
driving sugar reduction. Next year, through the Coca-Cola franchise, GSD Marketing Ltd will be introducing in the local market two reformulated soft drink beverages which will contain less sugar. We are estimating that we will reach the 2020 target by next year, therefore two years in advance. “As a company, we have always grown by listening and responding to our consumers, stakeholders and society at large. We are proud to be able to achieve the 2020 target ahead of its schedule and we will continue to lead by example in driving positive change”, said George Douglas Saliba, Public Affairs and Communication Manager at GSD Marketing Ltd.
ney function. As you will know, everyone’s methods for managing diabetes is their own and your advice should come only from someone who knows your medical history and is qualified to give it. Extra help Taking advantage of all the appointments you are offered or advised to make is an excellent way of avoiding possible complications from the know side effects of diabetes appearing during pregnancy. This is also the perfect time to accept all the offers of help that will come your way from excited family and friends. Of course, you can manage and are quite capable of getting on with it, but don’t disappoint them, they obviously want to support you as much as they can so do let them. You won’t regret it. It will give you more space to enjoy making baby preparations and anyway, who doesn’t enjoy a little spoiling now and again?
Risk factors and symptoms These include a pre-disposition to gestational diabetes, a family history of type 2 diabetes, being over 35 and obesity. Symptoms can often be unnoticeable, or the same as you would have with any pregnancy. But you will have checks for the disease as part of your overall pre-natal care. Should you develop gestational diabetes, checkups will be morefrequent, most likely during the last three months of pregnancy. Your doctor will check your blood sugar level and your baby’s health. You may also be referred to a diabetes specialist and dietician so you will have all the information and assistance you need. Best for baby Keeping blood glucose levels normal will greatly lessen the chance of having a heavier baby. Just after your baby is born, his or her blood will be checked to make sure the sugar levels are normal. Your blood sugar level will also be tested then and again six weeks later. The results of these tests will decide if any further monitoring is necessary. We are lucky that we live in an age when research can provide so much knowledge and progress has given us so many means to combat all forms of diabetes, providing early diagnosis and specific care that mean safer pregnancies for all mothers.
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In case of emergency The number of people with diabetes is on the rise so it is a good idea to be prepared in case someone shows symptoms that could be serious. Would you know what to do if someone near you had a sudden reaction to irregular blood sugar levels? Hyperglycemia and hypoglycemia are two conditions that pose a particular risk to those with diabetes. Knowing the difference between the two, the symptoms and what to do when faced with a case of either could be extremely important, even lifesaving. Hyperglycemia is when the blood sugar levels are too high. Symptoms of hyperglycemia include: excessive thirst • tiredness • blurred vision • hot, dry skin and a smell of acetone on breath How to help. If the person has their medication nearby offer as-
sistance but only help if you are asked to. See that he or she drinks plenty of water to help flush out the excess sugar out and prevent dehydration. Seek medical aid if symptoms do not improve. Hypoglycemia is when the blood sugar goes below normal levels. An easy way to remember is to think ‘hypo equals low‘. Symptoms of Hypoglycemia include: clumsiness, trouble talking, confusion, loss of consciousness, seizures, hunger, sweating, shakiness, and weakness.
How to help ensure the patient is sitting or lying comfortably, loosen any tight clothing and offer a small source of sugar, any form of sugar could save a patient’s life if blood sugar is low, or some fruit juice or a soft drink; but never a diet drink. Repeat this every 15 minutes and when the patient recovers provide some carbohydrates such as a sandwich, dry biscuits and cheese or fresh fruit. If there is no improvement or the patient becomes unconscious, call for an ambulance.
Other symptoms indicating a diabetes emergency that needs urgent medical treatment are: numbness in the hands or feet, intense stomach pain, intense muscle weakness, signs of a heart attack – chest pain and shortness of breath, seizures, fruit-scented breath and signs of a stroke – the face droops, speech is slurred speech and the patient may lose consciousness. Do not try and treat a diabetic emergency at home, always call the emergency services immediately. By the time the diabetes symptoms have overwhelmed the body home treatment may not be enough and delaying medical care could cause serious problems or even death. However careful a diabetic is, emergencies can arise. So, for more information contact The Malta Diabetic Association, firstname.lastname@example.org. There is also their subgroup DAISY (Diabetes Association In Support of Youth) on email@example.com. Being prepared, if only to call the medics and offer support in a calm reassuring way to all involved is as valuable a skill as you may ever need. It will help
you understand what a family member or close friend with diabetes faces day to day and is a practical way of being there for them, just in case.
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