DIABETES

What is diabetes?

What causes it?

How does it affect the body?

How is it detected?

How do we treat it?

IMPORTANT WORDS

INSULINPANCREASINSULIN RECEPTORSGLUCOSEINSULIN RESISTANCEOBESITY – Body mass index (BMI)

Diabetes in PNG – Historical Perspective

In 1962 two gentleman by the surnames of Hingston and

Price carried out a survey to find out how common diabetes

was in Port Moresby.

They tested a total 1057 people in Port Moresby and found only 2 people with diabetes.

The traditional village physically active lifestyle and high-

fibre diet was protective against type two diabetes and

other lifestyle diseases.

CURRENT SITUATION...and future trend

AUSTRALIA (From Diabetes Australia) www.diabetesaustralia.com 280 Australians develop diabetes every day Over 100,000 Australians have developed diabetes in the

past year. Diabetes is the fastest growing chronic condition in

Australia Almost 1.1 million Australians currently have diagnosed

diabetes. PNG

The International Diabetes Federation estimates 204,000 people living with diabetes in 2013. This figure is set to rise to over 392,000 by 2030. There is a great need for local data (Centre for diabetes research and care)

Normal situation

In diabetes the glucose (sugar) has a hard time entering the cells and so the sugar level in the blood is too high.

In normal circumstances when we ingest starchy foodsthey are broken down and enter the blood stream asGLUCOSE (a form of sugar). This results in a rise in our blood glucose which leads to the release of a special protein called Insulin from the organ called the pancreas. INSULIN acts like the key to the door of the cells which when opened allows glucose to enter the inside of the cells where it is converted into energy.

INSULIN IS KEY

TWO TYPES OF DIABETES

Type 1The pancreas in unable to produce enough Insulin to allow glucose to enter the cells.

Type 2Is when the pancreas produces insulin but the receptors on the cells don’t recognise the insulin.

“INSULIN RESISTANCE”

Insulin resistance INSULIN (the key) is being produced by the PANCREAS

but the keys are not quite fitting the locks (INSULIN RECEPTORS).

NORMAL HAPPY CELL

The door cannot open so the glucose (SUGAR) cannot get inside the cell. (TYPE 2 Diabetes) GLUCOSE CAUSES PROBLEMS WHEN IT HANGS AROUND OUTSIDE IN THE BLOOD

TYPE 2 diabetesType 2 diabetes usually affect people over 40

yearsIs the most common type of diabetes

accounting for about 85 – 90% of all people with diabetes.

Type 2 diabetes tend to run in families

It has a strong association with being physically inactive, OBESITY and a diet high in kilojoules (energy foods).

OBESITY Causes insulin resistance

DIAGNOSIS OF DIABETES

One of the puzzling thing about type 2 diabetes is that it often has no symptoms and many thousands of people are carrying on with life unaware that they have a serious disorder.

About half of those who have it have not yet been diagnosed.

IF YOU ARE 40 years and over IT IS WORTH GETTING A TEST.

Symptoms if present

Excessive and frequent urination Excessive thirst Tiredness and lack of energy A tendency to get infections –

especially of the skin Slow healing ulcers Itching, especially of genitals

Some people have minor degrees of symptoms that they attribute to other factors such as getting old

How diabetes affect the body

In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation...much the same in PNG

Who at RISK

People over the age of 35 Especially those that are obese or overweight,

have a first degree relative with type 2 diabetes or have high blood pressure

Women who have had gestational diabetes

Overweight women with polycystic ovarian syndrome

People with cardiovascular disease such as coronary disease and strokes

People on long-term cortisone

What are the lifestyle risk factors?

Sedentary lifestyle/low physical activity Overweight and obesity, especially of

waist High blood pressure High blood cholesterol Cigarette smoking Unhealthy eating habits (eg refined

sugars, high fats, fast foods)

TestingPeople at risk should have a blood glucose test organised by their doctor.

There are several tests used by the doctors, including a fasting blood glucose test and a special test called a glucose tolerance test, which measures the rise in blood glucose after a drink of glucose.

How is type 2 diabetes managed

The first line of management is through a good lifestyle based on a proper diet and lifestyle. An easy way to remember the basics of a healthy lifestyle for diabetes is by remembering the acronym N.E.A.T.

N – Nutrition – control the intake of fat and carbohydrates. Aim for a body mass index of 25

E – Exercise at least 30 to 40 minutes per day. Consider joining a sporting club, gym, or organise a fun group with friends to meet regularly for exercise so you can keep your motivation up

A – Avoid or keep to a minimum the ingestion of toxic substances – alcohol, cigarettes etc

T – Tranquillity – find time for rest and recreation. Manage your stress, work hard but

do not burn yourself out. Find a hobby like making a traditional bilum or painting or gardening (grow your own ibika).

Medication

If diet and exercise do not work, your doctor might prescribe tablets called oral hypoglycaemics to control your blood sugar. Sometime insulin may need to be added.

Good control of your blood sugar helps prevent and or delay the long term complications of

Diabetes. It is important to also control your weight,

blood pressure and blood cholesterol within the specific limits and sometimes your doctor may prescribe medications for these as well.

Aims of diabetes care Fasting blood glucose: 6.1 – 8 mmol/L HbA1c (a special and important test):

less than 7% Total cholesterol: less than 4 Blood pressure: less than 130/80 or if there is

kidney problem less than 120/80 Ideal weight - Aim for a BMI less than 26 Low fat diet, high in fibre and complex

carbohydrates No cigarettes No alcohol or keep it at a minimum Exercise: 30 minutes per day 4 – 5 time a week.

This educational booklet is not a substitute for proper medical advise from a

qualified medical practitioner.

Patients should always manage their condition in collaboration with their chosen

medical practitioner.

Thank you for reading and please assist the dissemination of this information to as many people as you can,

Sincerely,

Dr. Poyap J Rooney

More patient education material can be found on www.diabetespng.com