Diabetes Report Childhood Diabetes Sunday 18 February 2018 A complimentary supplement distributed with The Malta Independent on Sunday.
02 Diabetes Report
Photo: Danielle Macinnes
Sugar and why we should avoid it
Daniela Allen ROBERT LUSTIG, a Professor of Paediatrics at the University of California in San Francisco warns that children are manifesting increased rates of adult diseases that also include Type 2 diabetes. The problem is sugar and the effect it has on the body’s metabolic system. Sugar consumption has caused the rates of diseases such as diabetes, hypertension and heart disease to soar in most countries, including Malta. Sugar, made up of glucose and fructose, is converted to fat in the liver. It then gets deposited into fatty tissue or in the arteries while increasing the risk of chronic disease in the liver. Once consumed, sugar stimulates the reward centre of the brain, which then makes the body want it more. Hence making it also ‘addictive’ just like alcohol. “Sugar by itself furnishes energy. It is like alcohol, it’s got calories but not nutrition. In excess, it can fry Robert Lustig your liver just like alcohol,” says Prof Lustig who focuses his work mainly on the impact of sugar on diabetes and other chronic metabolic illness. He says the focus should be on controlling the dosage of sugar taken. Prof Lustig is the author of many articles, chapters, and reviews on childhood obesity, including the academic volume “Obesity before birth”, and the popular books “Fat Chance: beating the odds against sugar, processed food, obesity, and disease” and “The Fat Chance Cookbook”. He is also President of The Institute for Responsible Nutrition, a non-profit
dedicated to eradicating childhood obesity and Type 2 diabetes, by changing the global food supply. Prof Lustig was invited to Malta by Narrative Structures PR to mark World Health Day in 2016. In Malta he spoke about type 2 Diabetes and said “children are getting the diseases of alcohol without consuming alcohol – type2 Diabetes. Obesity is clearly a trend you want to stop in Malta.” Hidden sugar is like a ticking bomb, he had said “You have to understand what your diet is doing not just to your diet or your children’s diet but to society in general. Sugar causes diabetes in the same way that cigarettes cause lung cancer.” Last month Diabetes awareness was also marked with a seminar on diabetes awareness Andrew Boulton organized by MEP Dr Francis Zammit Dimech, the Malta Diabetes Association and with the support of Her Excellency The President of Malta Marie-Louise Coleiro Preca. Renowned for his work in the field, Professor of Medicine ANDREW BOULTON at the University of Manchester in the UK, Consultant Physician at the Manchester Royal Infirmary and Voluntary Professor of Medicine at the University of Miami, Diabetes Research Institute in the US was invited as key note speaker.
Prof Andrew Boulton who is also President Elect of the International Diabetes Federation said that a diet rich in foods such as the Mediterranean diet which includes fruit and vegetables reduces the risk of developing diabetes, heart disease and arthritis. “Research suggests that a high fibre diet is beneficial for the bacterial content of the bowel, it nourishes the millions of gut bacteria that we all carry – this is important because it helps reduce chronic inflammation, stimulates our immune system, promotes health and helps in the treatment of disease such as inflammatory bowel disease.” Diabetes mellitus (or diabetes) is a chronic, lifelong condition that affects the body’s ability to use the energy found in food. There is currently a global epidemic of type 2 diabetes and Malta has one of the highest prevalence of diabetes in Europe, said Prof Boulton. According to the IDF, diabetes currently affects 425 million adults worldwide and is set to affect close to 700 million people by 2045. The disease associated with numerous debilitating complications affecting the eyes, heart, kidneys, nerves and feet is also one of the leading causes of death worldwide. The International Diabetes Federation states that diabetes is the ninth leading cause of death in women globally, causing 2.1 million deaths per year and while there are currently over 199 million women living with diabetes, this total is projected to increase to 313 million by 2040.
Children at risk of sugar overloads
Nicky Roser We all know that hereditary diabetes is prevalent in Malta and the number of children with type 1 diabetes proves this. These children and their parents learn to live with the disease and adjust to its requirements. But, in the case of type 2 diabetes it is not only hereditary factors that can lead to it developing. As in the rest of the western world, from school reception classes to secondary school students, confirmed cases are rising
What are the causes? Those with a family history have a large chance of becoming diabetic, but being overweight is the biggest risk factor for developing type 2 diabetes. The long term effects of being overweight in childhood are serious but they usually only appear later in life. Diabetes is one that does not wait. Malta has one of the highest numbers of obese and morbidly obese children and teenagers in Europe. Lack of energetic exercise has a big effect too. Children today spend less than half the time their predecessors did on outdoor and, or, indoor sports and activities. They are transported to school from distances that could easily be walked; they rarely go running about the open air or on errands, as they used to. Too many hours of study and long hours poring over a screen have replaced the ways energy is used up. The fact that type 2 is largely preventa-
ble in most cases goes to show that, that parents, medical personnel, dieticians and school teachers should be looking out for vulnerable children to ensure that enough information and support is available to prevent their children getting the disease. Children are also at risk if their mothers have diabetes that was not kept under control during pregnancy and changes in hormone levels during puberty can cause insulin resistance and decreased insulin action which in turn may contribute to the development of type 2diabetes.
Photo: Sharon McCutcheon
COMPARED WITH OTHER EU COUNTRIES MALTA’S CASES OF CHILDHOOD DIABETES ARE FAR TOO HIGH. WHAT IS BEING DONE ABOUT IT?
Symptoms and effects Symptoms are not easy to spot so if you think a child may be likely to develop diabetes look out for the following signs: Unusual and heavy tiredness, excessive thirst, Frequent urination, increased hunger, cuts that take too long to heal, and dark patches on the skin, usually on the neck or under arms. Diabetes 2 needs proper diagnosis but dangerously high numbers of children with symptoms will develop the fullblown version, which can lead to longterm health complications such as heart disease, kidney failure and blindness, so no symptoms should be ignored.
How you can help? If a child has diabetes there are many ways parents can him or her come to terms with it and give themselves reassurance that their child is can have as normal a life as possible. Young diabetics don’t like to feel different from their friends so give them strategies that help them blend in and enjoy as many activities as possible, in and out of school. Encourage them to step up to the mark and own their condition by explaining it to their peers and admitting when they are fed up or feeling anxious. Parents of younger children could perhaps offer to give an age-appropriate talk to their children’s class or hand round books to explain the disease. School should understand that when a child needs time away from lessons occa-
Photo: Patrick Fore
Diabetes Report 03
sionally. A child also deserves sympathetic support if very understandable bout of sadness, depression or anger prompt displays of bad behaviour. However worried parents are, they should keep a lid on any anxieties or feelings of guilt they may feel. Children pick up on these and in turn may feel it is their fault and they are letting their parents down by causing problems, or not always achieving as much as everyone else because of their diabetes. Listening to everything your child says, or does not say; instilling the belief that he or she will be able to cope and allowing them to discuss their illness and question their doctor on their own, will go a long way to encouraging independence and confidence. Welcome their friends who give them confidence and a sense of belonging, and concentrate on all the things they have in common and can do together. Do resist the urge to lower your expectations or overprotect children with diabetes. It is realistic and optimistic backup to pursue their aims and interests they need not mollycoddling. Although they might welcome some short, sharp ways of retaliating is some young bully uses their condition to bully or tease, using
humour and body language and knowing how to report such treatment to the right person at the time. Remember too that the siblings of a child with diabetes may find certain things difficult, especially if their brother or sister may seem to be getting more attention. When a child is newly diagnosed introduce diet changes gradually, make everyone’s food the same as far as possible. The ones who don’t have diabetes will always have chances to eat what they enjoy but there will be less friction all round. It is too great a burden, and unfair, to expect siblings to monitor a diabetic in the family. They should, however understand the importance of not giving them drinks and snacks they must not have, and never use their illness as ammunition in an argument. If the condition and what it entails is explained, children will understand why their brother or sister sometimes takes so much of their parents’ attention. Spending some special time with them alone, praising them for looking out for their sibling and pointing out that each child is unique and special in their own way will do wonders in keeping jealously at bay, and help form strong bonds with rich rewards.
04 Diabetes Report
Valor: leading the Spanish chocolate market for over 130 years. The main characteristic of Valor 0% sugar added chocolate is that it has the same superlative taste as ‘regular’ Valor chocolates but without added sugar. Valor chocolate has the widest range of 0% sugar added chocolate, suitable for people who want to stay in shape or who need to avoid sugar. Now you can also try the delicious drinking chocolate as well as their pure cocoa powder which can be used both to make hot chocolate as well as for baking. Enjoy the pleasure of chocolate without giving up the sense of indulgence. To find our which stores in your vicinity stock this brand, send an email on storelocator@jcallejaltd.com. For more information: Web: www.jcallejaltd.com Facebook: J. Calleja Import & Export Ltd
The Maltese Diabetes Association The Maltese Diabetes Association is a voluntary nongovernmental organisation aimed at educating its members and the general public on diabetes and how to prevent complications arising from it. Their mission is to improve the lives of people with diabetes and to work towards a future with fewer complications and more awareness on this condition. The Maltese Diabetes Association has 1000 members and the association is a member of the International Diabetes Federation (www.idf.org) and it is also registered with the Commissioner of Voluntary Organisations in Malta (VO/0704). The current headquarters are at 74/1, Melita Street, Valletta.
Services The Maltese Diabetes Association offers the following services:• Educational Talks for persons suffering from Type 1 Diabetes and Type 2 Diabetes. • Family Support Group • Juvenile Diabetes Support Group – DAISY • Weekend “Live-ins” for teenage members. • Annual Summer Camp for Juvenile and Teenage members. For more information t=you can conatct the association on EMail: info@diabetesmalta.org Website: www.diabetesmalta.org Facebook: Find us on Facebook/Maltese Diabetes Association
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. omething 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 budgets and care programmes. All with good reason, as diabetes can cause a wide variety of serious medical and health problems if not treated properly.
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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 lifethreatening 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.
06 Diabetes Report
BEING A DIABETIC NEED NOT PREVENT YOU FROM BECOMING A MOTHER, IT JUST MEANS EXTRA CARE AND ATTENTION DURING BEFORE AND DURING PREGNANCY. s 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 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
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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 important 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.
Photo: Camila Cordeiro
Diabetes in pregnancy 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 probably need adjusting, so consult you 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 you blood glucose levels will be very useful here, especially if you also make a note of what you eat as this will help you workout 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 kidney function. As you will know, a 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?
Gestational diabetes
Risk factors and symptoms
Best for baby
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.
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 more-frequent, 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.
Keeping blood glucose levels normal will greatly lessen the chance of having a heavier baby and of Just after your baby is born, his or her blood will be checked to make sure the sugar levels are normal. You 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.