AOD Magazine 3rd ISSUE_January 2016

Action TAKE

ON DIABETES

EYE CHECK-UPS Why you need to go

LIFT IT!

Weight training

LIVE A HEALTHY LIFE

ISSUE 3 | JANUARY 2016

FIT FOR LIFE

Yousef Mohammad Noor Abu Kharmah proves a healthy and active life with diabetes is possible

Find out how to

COUNT YOUR CARBS 5 QUICK TIPS How to use an insulin pen

YOUR FREE COPY

Don’t give up on your dreams because of diabetes.

Use the QR code to view the magazine online.

Javier Megias, Novo Nordisk Cycling Team member, has type 1 diabetes

WHY it is important to take action on diabetes DIABETES

affects an ever-increasing number of people in Qatar.

In Qatar:

16.7%

In the Middle East and North Africa (MENA) Region:

OF QATARI ADULTS HAVE DIABETES2

40%

DO NOT KNOW THEY HAVE DIABETES2

5.8%

OF QATARI ADULTS HAVE PREDIABETES AND ARE AT RISK OF DEVELOPING DIABETES2

The number of people suffering with diabetes is increasing at an alarming rate in Qatar and the Middle East and North Africa (Mena) region. It is crucial to detect diabetes in its earliest stages before complications develop. That’s why screening is important.

Dr Mohammed Bin Hamad Bin J AL-Thani, Director of Public Health Department, Supreme Council of Health

4 in 10 ADULTS HAVE DIABETES

1

Only a few people living with diabetes successfully manage their condition USING THE ‘RULE OF HALVES’ (SEE GRAPH BELOW), IT IS POSSIBLE TO ESTIMATE FROM THOSE DIAGNOSED WITH DIABETES HOW MANY WILL RECEIVE THE TREATMENT THEY NEED AND OF THEM, THE PERCENTAGE WHO WILL GO ON TO HAVE GOOD BLOOD SUGAR CONTROL AND AVOID COMPLICATIONS. 100%

59%

People with diabetes2

People with diagnosed diabetes2

47%

People with diabetes receiving care3

19%

13%

People with diabetes achieving targets3

People with diabetes avoiding complications4 *

1. International Diabetes Federation, IDF Diabetes Atlas update poster, 7th ed.

Brussels, Belgium, 2015 2. International Diabetes Federation. IDF Diabetes Atlas update poster, 6th ed.

Brussels, Belgium, 2013 3. Bener et al. (2012) Does good clinical practice at the primary care improve the outcome care for diabetes patients? Gender differences, Primary Care Diabetes 6: 285–92 4. Elshafei et al. (2011), Prevalence and determinants of diabetic retinopathy among persons ±40 years of age with diabetes in Qatar: a community-based survey, Eur J Opthalmol 21 (1): 39–47 *

Due to scarce literature on diabetes-related complications in Qatar, recent literature on diabetic retinopathy has been used as a reference point for complications.

Action on Diabetes: SENIOR PROJECT MANAGER Herluf Nis Thomsen ASSISTANT PROJECT MANAGER Adham Salem Published in association with Action on Diabetes and our partners the Supreme Council of Health, Hamad Medical Corporation, Primary Health Care Corporation, Qatar Diabetes Association-Qatar Foundation, Maersk Oil and Novo Nordisk. Published by Last Mile, Denmark ACCOUNT DIRECTOR Craig Ludwig EDITOR Nicole McCreedy ART DIRECTOR Natasha Johnson IMAGES istockphoto.com, wikipedia, freepik.com Copyright© Action on Diabetes. All rights reserved. While all precautions have been taken to ensure accuracy of information, neither the editor and publisher, nor Last Mile can be held liable for inaccuracies, injury or damage that may arise.

Take Action on Diabetes January 2016

Action TAKE

ON DIABETES

What’s in this issue Diabetes Community

2

Community news .Become informed and get involved with your diabetes community.

3

A word from the editors .Insulin is an effective treatment that controls blood sugar levels. Ask your doctor about the best treatment plan for you.

13 Weight training can help improve insulin sensitivity. Sign up to become a member at the Qatar Diabetes Association gym.

Javier Megias is a professional cyclist who was diagnosed with type 1 diabetes as a teenager. Read the interview.

21

4

95 years of innovation in diabetes treatment .Key milestones that have improved diabetes treatment.

5

Ask the experts You asked. We answered.

FEATURE

6

Yousef Mohammad Noor Abu Kharmah Active and fit with type 1 diabetes.

10 12

13

Action TAKE

ON DIABETES

EYE CHECK-UPS Why you need to go

LIFT IT!

Weight training

LIVE A HEALTHY LIFE

FIT FOR LIFE

Yousef Mohammad Noor Abu Kharmah proves a healthy and active life with diabetes is possible

Find out how to

21

COUNT YOUR CARBS 5 QUICK TIPS How to use an insulin pen

COVER

PHOTOGRAPHER JALAN COVER PROFILE YOUSEF MOHAMMAD NOOR ABU KHARMAH SHOT ON LOCATION QATAR DIABETES ASSOCIATION

YOUR FREE COPY

Don’t give up on your dreams because of diabetes.

Use the QR code to view the magazine online.

17

ISSUE 3 | DECEMBER 2015

Javier Megias, Novo Nordisk Cycling Team member has type 1 diabetes

Your Health Your eyes and diabetes Get the facts.

5 Quick tips for using an insulin pen Learn how to use an insulin pen.

Move more & Eat right Lift it! .Strength training improves your control over blood sugar levels.

Carb counting Manage your carbohydrate intake.

Type 1 diabetes Interview: Javier Megias .Novo Nordisk cycling team member takes top spot at USA Pro Challenge event.

DO YOU HAVE A QUESTION? GET IN TOUCH!

Visit www.action-on-diabetes.qa to subscribe and receive an email with a link to every new issue. Email: magazine@aodnews.com

January 2016 Take Action on Diabetes 1

DIABETES COMMUNITY

Community news BE INFORMED AND BECOME INVOLVED. GET YOUR FLU SHOT

Having diabetes puts you at a higher risk of getting the flu, particularly if your diabetes is not well controlled. Flu also makes it more difficult to manage diabetes. A yearly flu shot is therefore highly recommended if you have diabetes to avoid getting the flu.

WHAT IS FLU? Influenza, commonly known as ‘the flu’, is a highly contagious viral infection spread by coughs and sneezes. Symptoms include: a high fever, runny nose, sore throat, muscle pains, headache, coughing and feeling tired.

NOVEMBER 14 IS WORLD DIABETES DAY

Led by the International Diabetes Federation, World Diabetes Day (WDD) unites the global diabetes community around diabetes awareness and advocacy. Watch the press for details about Action on Diabetes and partner activities.

WHERE TO GET A FLU SHOT A National Diabetes Center or your local healthcare provider.

DID YOU KNOW? World Diabetes Day is held on November 14 each year to mark the birthday of Frederick Banting, who co-discovered insulin with Charles Best in 1922.

UPLOAD YOUR WORLD DIABETES DAY PHOTOS!

Use the QR code or URL to post your photos on the International Federation website: www.idf.org/wdd-index

WDD in Kirkuk city, Iraq.

2 Take Action on Diabetes January 2016

DIABETES COMMUNITY

A word from the editors DIABETES TREATMENT: IT’S NOT JUST INSULIN

S

uccessful treatment of diabetes, where blood sugar levels are well controlled, makes all the difference to long-term health.

Achieving a balanced diabetes treatment by following a healthy lifestyle can be the key to living with both type 1 and type 2 diabetes.

Diabetes treatment is individualised and varies from person to person. There are many factors that must be taken into account when your doctor is putting together a treatment plan for you, such as the type of diabetes you have, your personal health, and your medical history.

effective treatment for bringing blood sugar levels to target, thereby reducing your risk of future health complications. Also, keep in mind that insulin is used worldwide and that people who use insulin are still able to lead full and active lives (see our cover profile).

A successful diabetes treatment entails working closely with your doctor and diabetes management team to find and keep to a regimen that works best for you.

All the best!

Most importantly, treatment should always include home blood sugar testing, a controlled diet, regular physical activity, and in some cases oral medication and/or insulin.

As insulin is injected, you may be fearful of administering it. However, insulin is the most Dr. Walaa Fattah Mahmood Al-Chetachi, Dr. Badriya Al Malki (SCH) | Dr. Abdullah Al Hamaq, Katie Nahas (QDA-QF) Manal Musallam Othman, Joanna Butler (HMC) | Dr. Fawziya Ali Khalaf, A. Al-Khalaf, Hilalia Ahmed (PHCC)

Facebook https://www.facebook.com/Actionondiabetes Twitter https://twitter.com/Action_Diabetes

CONNECT WITH US

YouTube https://www.youtube.com/user/ActiononDiabetes

January 2016 Take Action on Diabetes 3

95

DIABETES COMMUNITY

years of innovation in diabetes treatment

Every person with type 1, and some people with type 2 diabetes, needs to take insulin to control their blood sugar levels. However, animal insulin – the first effective drug to treat patients with diabetes – was discovered less than one hundred years ago.

1920s

Frederick Banting, MD, and assistant Charles Best, MD, successfully extract insulin from dog pancreases. This discovery leads to the commercial production of insulin in 1923.

1930s

A decade after insulin is available to the public, manufacturers develop a variety of slower-acting insulins, the first being protamine insulin.

1950s

Researchers notice that some people with diabetes still produce their own insulin, which leads them to identify “insulin-dependent” (type 1) and “non-insulin-dependent” (type 2) diabetes.

1940s

A standardised insulin syringe is designed and put into production.

1960s

Glucagon, a hormone produced by the pancreas that raises low blood sugar levels, is introduced as a treatment for severely low blood sugar levels.

1970s

The glucometer, a medical device to determine the approximate concentration of sugar in the blood, is developed. The first insulin pumps are invented.

2000s

Long-acting insulin, which controls blood sugar consistently for an entire day or longer, is introduced.

4 Take Action on Diabetes January 2016

1980s

The first insulin pens are made available, making the administration of insulin more convenient with this combination of medication and syringe in one handy unit.

2010s

1990s

Medical trials show that keeping blood sugar levels as close to normal as possible slows the onset and progression of eye, kidney and nerve diseases caused by diabetes.

A gut hormone-based medication, GLP-1 receptor agonist, used to treat type 2 diabetes, is shown to reduce body weight.

Ask the Q &A experts

DIABETES COMMUNITY

DOES BEING DIAGNOSED WITH DIABETES MEAN I WILL HAVE TO GO ON INSULIN? If you have type 2 diabetes, you may or may not have to take insulin injections, depending on a variety of factors. If blood sugar levels are well controlled through oral medications and a healthy diet and regular exercise, then a person with type 2 diabetes may be able to avoid insulin injections. However, insulin is considered the most effective treatment available for lowering extremely high blood sugar, and reducing the risk of complications such as heart attack, stroke, kidney disease, blindness and amputation.

THE EXPERTS WE ASKED

IS IT SAFE TO TRAVEL WITH DIABETES? With proper planning, you can still enjoy the experiences of travelling to new places or visiting family and friends.

These tips will help you prepare: Go for a medical exam before you leave to make sure your diabetes is in good control.

Pack extra medications to ensure you are covered for travel delays or misplaced supplies.

Carry a prescription from your doctor for insulin or oral medication in case of an emergency.

Discuss your insulin needs and time changes with your doctor or diabetes educator to adjust your dosage as necessary.

Carry snacks and low blood sugar treatment.

Low blood sugar (hypoglycaemia) can strike any time, and you may not be able to easily get food while travelling.

Carry some identification that you have diabetes. This should be with you at all times Dr Samya Al Abdullah is the senior consultant in family medicine for the Primary Health Care Corporation.

Dr Amal Mustafa Adam is the medical coordinator at the Qatar Diabetes Association.

DO YOU HAVE A QUESTION? Email us at: qatardiabetes@qf.org.qa

January 2016 Take Action on Diabetes 5

COVER PROFILE

6 Take Action on Diabetes January 2016

COVER PROFILE

Fit for life DIABETES IS A LIFE-LONG CONDITION AND IT CAN HAVE SERIOUS HEALTH CONSEQUENCES. HOWEVER, WITH CAREFUL MANAGEMENT, PEOPLE WITH DIABETES CAN – AND DO – LEAD FULL, HEALTHY AND ACTIVE LIVES. AS YOUSEF MOHAMMAD NOOR ABU KHARMAH, THE FIT 23-YEAR-OLD STUDENT WITH TYPE 1 DIABETES, PROVES.

Y

ousef is studying to be a nurse at the University of Calgary in Qatar. Diagnosed with type 1 diabetes at the age of eight, Yousef has spent most of his life learning how to manage his condition. Living with diabetes plays a big part in his daily routine and life choices, including his decision to study nursing.

“Having type 1 diabetes is one of the reasons I chose to study nursing because I want to serve my community,” says Yousef.

DIAGNOSED WITH TYPE 1 DIABETES As a young boy, Yousef’s parents became concerned when he began to urinate frequently and seemed to be thirsty often. He also had spells of dizziness and showed signs of fatigue, drowsiness, and blurred vision. Due to these symptoms, his parents took him to the medical centre for a check-up where he was diagnosed with type 1 diabetes.

At first they were worried and upset. However, Yousef says: “Over time my parents came to accept my condition. They came to live with it in a friendly, positive way because it changed our lifestyle to be healthier, including our food choices: how food is cooked and when we eat.

Our family also began to exercise and take part in sports.”

January 2016 Take Action on Diabetes 7

COVER PROFILE

MANAGING DIABETES WITH INSULIN The body doesn’t produce insulin in people with type 1 diabetes. As a result, Yousef injects himself with insulin after each meal.

His family, especially his mother, has been a great support in his life in the daily management of his condition.

He explains: “I learned how to control my blood sugar levels through experience and dealing with my condition.” However, he admits: “It was difficult in the beginning to test my blood sugar levels three to four times daily and to control it with correct doses of insulin because it can be stressful.”

But, he says, “eventually, it becomes easier and now, with experience, I am good at regulating my blood sugar levels”.

EXERCISE AND DIABETES Being physically active is still an important aspect of Yousef’s life. He is a member at the Qatar Diabetes Association gym in Doha. “I train at the gym four to five days per week,” he tells us. He also plays football with the University team. Occasionally he swims for exercise and also enjoys participating in Palestinian folklore dancing (dabka) with a traditional band.

Today, Yousef understands exactly how much insulin his body will need to maintain his blood sugar levels within a normal range.

Low blood sugar levels can occur when taking part in physical activity. As a precaution he always takes sweet juice with him and stops exercising if he feels fatigue or weakness.

My advice for individuals with diabetes is to adjust your lifestyle according to your condition. Learn about insulin; understand the dose, when and where to inject yourself.

Always check your blood sugar levels, eat healthy, exercise, manage stress factors in your life, avoid smoking cigarettes and drinking alcohol.

Yousef Mohammad Noor Abu Kharmah

8 Take Action on Diabetes January 2016

Wellness at work

AS PART OF THE ACTION ON DIABETES CAMPAIGN, MAERSK OIL QATAR HAS IMPLEMENTED A HEALTH AWARENESS AND WELLBEING PROGRAMME FOR EMPLOYEES. THE PROGRAMME INCLUDES FITNESS INITIATIVES FOR STAFF, LIKE PARTICIPATION IN THE NATIONAL SPORTS DAY. WORKPLACE SCREENING The workplace diabetes screening campaign is an Action on Diabetes initiative aiming to raise awareness among employees of the condition and its risk factors. During the week that the customfitted diabetes screening bus was parked outside Maersk Oil offices, 587 employees were screened and 11 were found to be unaware of having high blood sugar. At the company’s National Sports Day event, employees and their families were able to visit the bus for health advice and testing.

ENCOURAGING POSITIVE HEALTH Maersk Oil supports employees in living a healthy lifestyle by: • Arranging talks on health • Offering special discounts to the gym • Organising family sport activities after work hours • Providing healthy meals at the canteen • Screening for diabetes at work • Giving advice on managing diabetes and its risk factors

Clara Ridrigues, nurse, photographed on the Action on Diabetes Bus at the Maersk Oil QP employee event on National Sports Day, Aspire Zone.

January 2016 Take Action on Diabetes 9

YOUR HEALTH

YOUR EYES AND DIABETES HIGH BLOOD SUGAR LEVELS CAN DAMAGE YOUR EYES. A COMMON COMPLICATION RESULTING FROM UNCONTROLLED DIABETES IS DIABETIC RETINOPATHY. LEFT UNTREATED, IT CAN LEAD TO VISION LOSS OR BLINDNESS. THIS IS WHY IT IS IMPORTANT TO HAVE YOUR EYES TESTED REGULARLY.

CATARACT

HOW YOUR EYES WORK

GLAUCOMA

It helps to understand how the eye works when talking about how diabetes can damage your sight. The front of our eyes (the part we look out of) is called the ‘lens’. The ‘retina’ is at the back of our eyeballs. Light coming in through the lens is projected onto the retina. The retina converts the light particles into electrical signals. These signals then travel to our brain where the images we see are produced. Damage to your ‘retina’ is usually serious (and also often more common in those with diabetes).

People with type 2 diabetes are also 40% more likely to develop another common eye disease, glaucoma. Glaucoma occurs due to an increase in fluid pressure inside the eyeball. The pressure restricts blood flow to the retina and optic nerve, slowly causing damage which gradually leads to permanent loss of vision.

Cataracts are a common part of aging. A cataract is where the eye’s clear lens grows cloudy and blocks light.

Moreover, people with diabetes are 60% more likely to develop cataracts. People with diabetes tend to develop this eye disorder at a younger age, and their cataracts worsen at a much quicker pace.

American Diabetes Association. Eye complications.

DIABETIC RETINOPATHY This is damage to the blood vessels in the eye and the retina caused by diabetes. The retina is a lightsensitive layer of nerve cells fed by a network of tiny blood vessels. This living tissue needs a good blood supply to keep it healthy. In diabetes it is damage to the blood vessels in the retina that can cause problems. The blood vessels can become leaky, blocked, or too small to let through enough blood.

10 Take Action on Diabetes January 2016

Diabetic retinopathy is the most common complication of diabetes in Qatar.

Zirie, M.A., Yousef, M.F., & Al Mashaly, A. (2003).

Complications of diabetes mellitus among patients attending outpatient clinics in Qatar. Qatar Medical Journal, 12(2), 129-132.

YOUR HEALTH The RETINA is a thin layer of nerve tissue located in the back of the eye. It’s sensitive to light, which allows it to accept the images of what you see.

The retina is fed by the small blood vessels in your eye and depends on that blood flow to function well.

The MACULA, in the centre of the retina, is responsible for detailed central vision — the focus vision needed for reading or threading a needle, for instance.

The EYE LENS is the clear tissue through which images are focused onto your retina.

The VITREOUS BODY is the clear, jelly-like substance that fills the eye and is attached to the retina.

The signals picked up on the retina travel to your brain through the OPTIC NERVE so you can interpret what you see.

Eye problems from diabetes are the most common cause of blindness in people of working age.

Regular optometrist check-ups are important to avoid vision loss.

DIABETES AND EYE DAMAGE You may not be able to prevent eye damage entirely, but you can certainly do a great deal to reduce your chance of getting it. Many new advances in the prevention and treatment of eye damage related to diabetes are being developed, and existing damage can often also be halted, or prevented from deteriorating.

Eye damage due to diabetes must be diagnosed early for it to be successfully stopped or treated. If damage is detected late there is often not much that can be done to save your sight.

HOW YOU CAN DELAY OR PREVENT EYE DAMAGE • If you have diabetes, you must go for regular, full eye check-ups • Report any changes in your sight urgently and immediately to your doctor • Quit smoking (smoking causes damage to blood vessels) Make sure you maintain healthy: • Blood sugar levels • Blood pressure (high blood pressure has been shown to aggravate eye problems) • Cholesterol levels

January 2016 Take Action on Diabetes 11

YOUR HEALTH

5

Quick tips for using an insulin pen

FOR DECADES, TAKING INSULIN REQUIRED A SYRINGE AND VIAL, BUT NOW MANY PEOPLE WITH DIABETES OPT FOR THE INSULIN PEN. Insulin pens can make taking insulin more convenient because they combine the medication and syringe in one handy unit. While there are a number of different brands and models available, most insulin pens are either reusable pens or disposable pens.

1

Remove the protective cap and attach the pen needle to the top of the pen.

2

Portable, discreet and easy to use.

Is an insulin pen right for you?

Speak to your healthcare provider.

3

Dial the dose prescribed by your doctor.

Always prime your insulin pen before each injection. Dial two units on your pen and press the button in the air. This is called an “air shot” or “priming”, which is important to remove any air bubbles and ensure the pen needle is working correctly.

Use the QR code to watch a video with easy to follow instructions on how to use an insulin pen.

12 Take Action on Diabetes January 2016

4 5

Inject the insulin into the area you discussed with your doctor. Press the dose button to deliver the insulin. When the knob is all the way down, count to ten and then withdraw the needle from your skin.

Remove the needle after each injection and dispose of properly.

Recap the pen until your next dose.

MOVE MORE

LIFT IT!

STRENGTH TRAINING IS A GREAT TOOL FOR DIABETES MANAGEMENT AND SHOULD BE ADDED TO YOUR WORKOUT PLAN. HERE IS WHY AND HOW YOU SHOULD GET STARTED.

January 2016 Take Action on Diabetes 13

MOVE MORE

SAFETY TIP

Monitor blood sugar levels before and after exercising (and during if necessary) to avoid severe highs and lows.

Strength training, especially if combined with cardio or aerobic exercise, has been shown to have a positive impact on long-term blood sugar control in people with diabetes.

USE YOUR MUSCLES

If you’ve never done strength training, start slowly and try not to overdo it. Steady progression is key. For instance, with exercises involving handheld weights, choose a weight that you will be able to lift for one set of 8 to 10 repetitions (reps). Then, work up to completing 15 reps. Always rest your muscles between sessions.

14 Take Action on Diabetes January 2016

WAYS TO IMPROVE STRENGTH AT HOME

Use objects like canned goods or filled water bottles to do simple repetition exercises at home. Activities such as carrying your food shopping parcels or performing heavy-duty housework are also forms of strength training you can include as part of your routine.

LIFTING WEIGHTS AT THE GYM

Weight machines or free weights, also known as dumbbells, are equipment at the gym you can use to build and maintain muscles.

Ask the staff at your gym how you should properly use the weights, or consider getting a personal trainer to learn the best exercises for you.

MOVE MORE

EXERCISES TO GET STARTED Here are three exercises you can either do at home or in the gym.

Chair dips. Sit on the edge of the chair, with your arms behind you. Place your palms on the edge, fingers pointed toward you. Lift your buttocks off the chair and walk your feet forward, making sure your knees don’t bend past your toes. Slowly bend your elbows, lowering your body down, and then straighten.

This works several upper-body muscles, including back upper arm, parts of the shoulder and chest muscles.

Wall squats. Stand with your back against a wall, feet about a foot in front of you. Bend your knees as you lower your back along the wall until you are in a position similar to one you’d be in if sitting in a chair. Hold for several seconds, then return to standing.

Curls. Hold a dumbbell in each hand, arms at your sides with palms facing up. Holding elbows steady, curl up your forearms to bring the weights almost to your shoulders, then return to starting position. If you don’t have dumbbells, try this with two soup cans or water bottles. Curls work the biceps (muscles on the front of upper arms).

3-5%

After the age of forty, inactive adults can lose three to five percent of muscle mass and strength per decade.

BENEFITS OF STRENGTH TRAINING Here are a few reasons to include strength training in your programme:

Improves your body’s sensitivity to insulin

Active muscles use sugar from the bloodstream to power them, which can help clear out excess sugar from the body. Toned muscles also store sugar in the body more effectively.

Prevents muscle loss as you get older

It helps to maintain and build strong muscles and bones, reducing the risk of osteoporosis and bone fractures.

Promotes weight loss

Muscles help burn calories and this in effect is good for weight loss, a goal for many people with type 2 diabetes.

1. Zacker, RJ. Strength Training in Diabetes Management. Diabetes Spectrum, 18(2): 71-75. Available at: http://spectrum.diabetesjournals.org/content/18/2/71. full.pdf+html

January 2016 Take Action on Diabetes 15

MOVE MORE

JOIN THE GYM!

Opening hours Sunday – Thursday: 8am–12pm and 5–8pm.

Monday and Thursday: 8am–4pm for ladies.

ALREADY DIAGNOSED WITH DIABETES OR AT RISK? THE QATAR DIABETES ASSOCIATION PROVIDES COUNSELLING WITH DIABETES EDUCATORS AND DIETICIANS TO HELP MANAGE DIABETES AND ITS RISK FACTORS. VISITORS CAN ALSO REGISTER WITH THE QDA GYMNASIUM. Personal training Experienced instructors at the gym assist members to set up an exercise programme suited to their level of fitness, age and health status. Instructors provide guidance during their session to help progress members’ training and ensure their safety while using the facilities. The benefits of exercise and its impact on blood sugar are also discussed.

What the gym offers Aerobic exercise classes for cardio fitness are available.

There is also circuit training and a variety of equipment used to develop strength.

Light weights, elastic bands, exercise and

16 Take Action on Diabetes January 2016

medical balls and sticks are some of the equipment commonly used in the gym.

The gym has a separate section for men and women.

Meet the trainers The senior trainer at the gym is Ahmed Ali Mostafa Mursi, who has a Bachelor’s degree in Sport and has been working with the Qatar Diabetes Association for the past 12 years.

Fatima Alzahra Hadoosh is a certified swimming and aerobic trainer with ten years experience working with people who have diabetes.

Where to find us The gymnasium is located at the Qatar Diabetes Association in Al Muntazah area on the ground floor. Telephone: 44547334

MOVE EAT RIGHT MORE

IF YOU’RE NEWLY DIAGNOSED WITH DIABETES, YOU MAY WONDER WHY YOU NEED TO COUNT CARBOHYDRATES AT ALL. THE FACT IS THAT OF THE THREE MAIN NUTRIENTS IN FOOD, CARBOHYDRATE, PROTEIN, AND FAT, CARBOHYDRATES (CARBS) HAVE THE GREATEST EFFECT ON YOUR BLOOD SUGAR.

CARB counting January 2016 Take Action on Diabetes 17

EAT RIGHT

Carb counting is one way to manage what you eat when living with diabetes. Being more aware of the carbs you eat throughout your day can help increase your understanding of the impact of food on your blood sugar.

Matching your carb intake with your medication and physical activity will assist you in controlling your blood sugar levels. Well-controlled blood sugar levels will improve how you feel day-to-day and prevent the long-term complications of diabetes.

What is carb counting?

CARB COUNTING INVOLVES CALCULATING GRAMS OF CARBOHYDRATE CONSUMED AT MEALS AND SNACKS BY IDENTIFYING:

WHICH FOOD CONTAIN CARBS Most carbohydrates come from starchy and sugary foods. Examples of food that contain carbohydrates include cereals, bread, rice, pasta, legumes, milk, yoghurt, starchy vegetables, fruit, soft drinks, cookies, cakes and desserts.

WHY COUNT CARBS? BECAUSE IT CAN HELP YOU:

1. Discover the effect of food on your blood sugar 2. Add more variety to your meals

Food that are mostly protein like red and white meat, cheese and/or fat like butter or oil don’t contain carbohyrates.

HOW MUCH FOOD DIFFERS IN CARB CONTENT SOME FOODS ARE RICHER THAN OTHERS, FOR EXAMPLE:

3 dates have the same amount of carb as 3 cups of popcorn.

1 cup of rice contains the same amount of carb as 1 cup of pasta.

1 cup of fresh juice has 2 times more carb (or sugar) than 1 cup of milk.

18 Take Action on Diabetes January 2016

MOVE EAT RIGHT MORE

HOW DOES CARB COUNTING WORK?

Your health team will educate you on: 1. Identifying carb sources in food.

2. Recording your food and beverage taken at a chosen meal.

3. Monitoring your blood sugar prior to and two hours after your meal. This will help you decide whether the carb in your meal was adequate or in excess.

4. Setting your carb goals for each meal using your food record.

TIP: When you are learning to count

carbohydrates, measure the exact serving size using measuring cups and spoons to help train your eye to see what portion sizes look like until you get a good idea of the weights and volumes of different foods. Measuring foods at home can make you feel more comfortable with estimating portion sizes when eating out.

HOW TO READ AND UNDERSTAND NUTRITION LABELS Always start by checking serving size and amount of servings per container.

Note: In order to keep a varied choice of food, you will learn how to use carbohydrate food lists to estimate the amount of carb in your meals.

Remember that the amount of calories and nutrients is per single serving.

Compare different foods and make your own better choice.

1 CUP OF RICE CONTAINS 45 GRAMS OF CARB.

1 CUP OF YOGHURT HAS 12 GRAMS OF CARB.

1 MEDIUM ORANGE HAS 15 GRAMS OF CARB.

REMEMBER YOUR TARGET BLOOD SUGAR VALUES: Before meals 70-130mg/dl Post meal <180 mg/dl

TRY THIS APP! Diabetes in Check: Coach, Blood sugar levels and Carb Tracker.

Database of over 80,000 foods!

Download to iPhone and iPad.

Choose foods high in fibre, calcium and iron and lower in sugars, saturated fat and salt.

• • • • •

Aim for less than 3 grams of total fat per 10g. less then 1.5 gram of saturated fat per 100g.

0.2 grams or less of trans-fats per 100g. less than 5 grams of sugar per 100g. less than 120mg of sodium per 100g.

NUTRITION LABEL Nutrition Information Servings per package: 1 Serving size: 90g Average Quantity Average per serving Quantity per 100g Energy Protein Fat, Total Saturated Trans Cholesterol Carbohydrate Sugars Dietary Fibre Sodium Potassium Magnesium Calcium Iron Vitamin D

912 kJ (218Cal) 13.5g 6.9g 1.1g 0.016mg 22.9mg 24.0g 3.0g 2.6g 390mg 209mg 26.0mg (8%RDI) 28.7mg (4%RDI) 1.0mg (9%RDI) 0.1µg

1010 kJ (242Cal) 15.0g 7.7g 1.3g 0.017mg 25.4mg 26.6g 3.3g 2.9g 434mg 232mg 28.9mg 31.9mg 1.2mg 0.1µg

Ingredients: White Toast Bread, Smoked Turkey Slices, Mayonnaise low fat, lettuce, tomato Allergens: wheat, egg, may contain milk Reference: Supreme Council of Health State of Qatar

January 2016 Take Action on Diabetes 19

EAT RIGHT

NUTRITIONAL FACTS

ime: Prep t nutes 30 mi thy a heal Eat as ous nutriti salad!

Serving size : 1 cup Calories : 158 Kcal Carbohydrate : 20g : 5g Protein Fat : 7.5g Saturated fat : 1g Dietary fibre : 5g Sodium : 183mg : 458mg Potassium

CHICKPEA TABBOULEH Ingredients ½ cup fine bulgur wheat Hot water to cover and soak bulgur 2 bunches fresh parsley, thick stems removed 4 Tbsp minced fresh mint ½ cup peeled, seeded and diced cucumber 3 scallions, finely minced (about ½ cup) 3 small tomatoes, diced (about 2½ cups) ½ medium red bell pepper, seeded and diced (about ½ cup) 1 cup canned chickpeas, drained and rinsed Dressing 3 Tbsp fresh lemon juice 3 Tbsp olive oil ¼ Tbsp salt 20 Take Action on Diabetes January 2016

Instructions 1. Rinse the bulgur wheat and add it to a small bowl. Pour hot water over the bulgur, cover, and let soak for about 20 minutes, until doubled in size. Drain excess liquid, if any, and place the bulgur in a large bowl.

2. Chop the parsley to a medium-fine consistency. Add the parsley to the bulgur wheat, and add all the remaining salad ingredients. Cover and set aside.

For the vinaigrette dressing, whisk together the ingredients in a small bowl. Toss into the salad; taste and adjust any seasonings. Add more lemon juice if desired. Serves 6.

TYPE MOVE 1 DIABETES MORE

NOVO NORDISK PROFESSIONAL CYCLING TEAM MEMBER JAVIER MEGIAS FINISHED IN 2ND PLACE IN THE USA PRO CHALLENGE FOR CYCLISTS HELD IN AUGUST. HIS ACHIEVEMENT IS A BIG VICTORY FOR THE TEAM. January 2016 Take Action on Diabetes 21

TYPE 1 DIABETES

Javier started cycling at the age of nine and was hooked. But in his mid-teens he slipped into a coma and was hospitalised.

When he woke up Javier was told he had type 1 diabetes and would never be a pro athlete. Determined to follow his dream, Javier kept cycling. Today, he is a member of the Novo Nordisk professional cycling team and has recently finished one of the respected races in the US, the USA Pro Challenge, for the 5th time.

Megias is the only rider in the race’s history to finish all five editions. The race is one of his favourites of the year; the incredible landscape and views, along with the fans and the race organisers are what keep him coming back.

A PLATFORM FOR IMPROVING THE AWARENESS OF DIABETES

The USA Pro Challlenge is one of the most important races on the cycling annual calendar in the United States. A second place win in a race of this calibre is an important victory for the Novo Nordisk team.

Team Novo Nordisk is the first professional cycling team for cyclists living with type 1 diabetes. The team’s mission is to inspire, educate and empower everyone affected by diabetes. Getting a podium win at a high profile race like this provides a great platform to reach people with the Novo Nordisk team message.

22 Take Action on Diabetes January 2016

Don’t let diabetes cause

you to give up on your dreams.

Remember that diabetes doesn’t have to be a barrier for dreaming big. If you actively manage your diabetes, you can still chase your dream.

Javier Megias, Spain, Age 31

MANAGE YOUR DIABETES ON RACE DAYS

A doctor travels with the team and each cyclist works closely with the medical staff to find a regimen that works best for them as individuals. To race to the best of their ability, Megias and the other team members need to keep their blood sugar in a target range.

He explains: “During a race I aim to check my continuous glucose monitor, which I keep in my jersey pocket, every 10 to 15 minute.

If my blood sugar is above target, I may take medication. If my blood sugar is below target, I may eat or drink something with carbohydrates.”

Educate yourself about diabetes ACTION ON DIABETES HAS CREATED TWO EASY-TOUNDERSTAND CARTOON VIDEOS TO HELP YOU KNOW MORE ABOUT LOOKING AFTER YOUR HEALTH WITH DIABETES. MISS SUGAR

What is Diabetes?

Diabetes is a silent ‘killer’.

You may have diabetes and not be aware of it. That is why it is important to have your blood sugar levels checked.

Because high blood sugar levels are a sign of diabetes.

Use the QR code to watch the Miss Sugar: What is Diabetes? cartoon on YouTube.

DIABETES COMPLICATIONS High blood sugar levels over many years can lead to diabetes-related complications such as heart attack, stroke, kidney disease, blindness and limb amputation.

Maintaining blood sugar levels within the recommended range (HbA1c ≤7) can help you avoid complications.

ORDER YOUR FREE MAGAZINE COPIES

Action Action Action TAKE

ON DIABETES

LIVE A HEALTHY

LIFE

TAKE

ON DIABETES

ER 2014 ISSUE 1 | NOVEMB

Meet the Al Wakra diabetes care professionals

Need inspirat Look inside.

GET THE FACTS

KNOW YOUR CARBS

Sugar, starch and fibre

s

Your feet and diabete

EAT MORE FIBRE ,

LIVE LONGER

The ancient artichokes the heart of goodnes 5 Fibre rich foods

&

R YOU FREE COPY Use the QR code to view the magazine online.

ISSUE 2 | JUNE 2015

Tackling diabetes as a team

WALK YOURSELF FIT! ion?

Love aerobics with all your heart

I choose to live well with diabetes. t abou Abdul Redha talks tes living with diabe

Use the QR code to view the magazine online.

TAKE

LIVE A HEALTHY LIFE

LIVE A HEALTHY

ON DIABETES

EYE CHECK-UP S

Why you need

to go

LIFT IT!

Weight training Find out how to

COUNT YOUR CARB S

ISSUE 3 | DECEMB ER 2015

FIT FOR LIFE

Yousef Mohammad Noor Abu Kharmah proves a healthy and active life with diabetes is possible

5 QUICK TIPS

How to use an insulin pen

YOUR FREE COPY

YOUR FREE COPY

TASTE SENSATIONS

Try our chicken biryani

Submit your own recipe Use the QR code to view the magazine online.

LIFE

Don’t give your dreamup on of diabetes. s because Javier Megia

s, Novo Nordisk Cyclin Team member has type 1 diabe g tes

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LEARN MORE www.action-on-diabetes.qa