Kisukari Magazine 02

A publication of Diabetes Kenya

Diabetes & FASTING Benefits of Exercise Live a normal life

Netanjee Van Niekerk

2nd Edition - June 2014 KSH 200/-

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contents...

PAGE 3

Diabetes Workshop Diabetes workshop, to train healthcare person-­ nel on management of diabetes...

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'LDEHWHV 'HP\VWL¿HG Major challenges associated with proper man-­ agement of diabetes...

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PAGE 10

Exercise & Diabetes Exercise is in some sense, the perfect drug for diabetes.....

Fasting & Diabetes For a successful Ramadan fasting....

PAGE 19

PAGE 12

Eat Well Recipe: Cranberry-­Almond Granola...

Life with Diabetes Talking to Natanjee Van Niekerk

PAGE 20 PAGE 14

Gestational Diabetes Dietary changes and exercise maybe enough to keep your blood sugar levels under control ....

PAGE 15

New kids on the Block Incretin is a hormone released in your body that stimulates production of insulin....

Gold Sponsor

Sweet Freedom How does sugar affect the digestive system and additionally affect other functions...

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Diagnosis & Treatment Diabetes is a disease in which your body cannot control the amount of sugar in your blood...

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Children & Diabetes

Chief Editor: Salwa Shahbal Graphic Designer: Nabeel Najib (bilobrown@gmail.com) Social Media Editor: Aggrey Shiundu Advertisement Manager: Dr. Gaman Mohamed Publisher: English Press Ltd Cover Picture: Natanjee Van Niekerk (T1 DM Patient/Competitive Swimmer) Kisukari Magazine is a quarterly magazine (4 times a year). The main objective of this innovative informative magazine of Diabetes Kenya is creating diabetes awareness, education and empowering the Kenyan public.

Contacts Phone: +254 722 297 071 Email: kdiabass@yahoo.com Facebook: facebook.com/Diabetes.Kenya Disclaimer: The information in this magazine is for information purposes only. Diabetes Kenya makes no representations or warranties about the accuracy and reliability of any content in the magazine. Any opinions expressed are those of their authors and do not necessarily present the views of Diabetes Kenya. Through this magazine you may link to third party websites that diabetes Kenya has no control over. Inclusion of such websites and/ or advertisements does not imply recommendation or endorsement by diabetes Kenya. Diabetes Kenya does not take any liability with regard of your accessing such sites. Information in this magazine is about medical issues but should not be construed as medical advice.

Diabetes Workshop 16th May 2014 Mombasa Staying true to our vision “excellence in the prevention and management of diabetes” the Diabetes Kenya team including Dr. Acharya, Dr. Gaman, Ms. Atieno Jalang’o and Dr. Shahbal held a full day diabetes workshop, to train healthcare personnel on management of diabetes. All attendees were awarded with certificates of participation at the end of the event. We look forward to more of such trainings all over the country.

Message

From the

Chairperson Dear  Readers, Welcome  to  the  second  edition  of  Kisukari.  Thank  you  for  your  overwhelming  response  and  support.  This  edition  is  dedicated  VSHFLÂżFDOO\ WR WKH KRO\ PRQWK RI 5DPDGDQ and  the  challenges  associated  with  fasting. Â

life  easy  sailing  for  every  person,  young  and  old  and  from  any  background,  living  with  diabetes  in  Kenya.  TOGETHER  WE  CAN.

We  are  also  covering  sports  in  people  living  ZLWK GLDEHWHV DQG WKH PDQ\ EHQHÂżWV RI keeping  active  to  keep  sugars  in  control.  We  kicked  off  the  IDF  foot  project  at  Kenyatta  national  hospital  grounds  a  few  weeks  ago  and  attended  to  scores  of  excited  Kenyans  head  to  toe  with  educational  empowerment  and  foot  screening  services  on  the  day.  We  are  looking  forward  to  strengthening  fruitful  partnerships  with  all  our  well  wishers,  in  the  Pharma  industry,  corporate  world  and  the  diabetes  family  at  large  to  join  hands  with  us  in  our  programmes  to  make Â

From the

Chief Editor Dear  Readers,

Like  many  other  little  dots  connecting  lives,  food  and  faith  are  one  of  them.  Food  brings  people  together  always,  be  it  a  simple  dinner  at  home,  an  event,  a  birthday,  a  wedding.  Food  brings  joy  to  the  table.  Faith  on  the  other  hand,  connects  all  of  us  on  a  more  spiritual  level,  the  feeling  of  belonging  and  togetherness  that  every  human  being  craves  for.  For  this  we  focus  our  main  article  on  fasting  and  diabetes,  welcoming  the  holy  month  of  Ramadhan  for  the  Muslims  but  also  acknowledging  all  the  other  faiths  that  fast,  be  it  during  lent  or  for  personal  reasons.  Fasting  is  not  just  about  lack  of  feeding  but  an  overall  change  in  attitude,  a  moment  where  everyone  wants  to  be  the  best  they  can  be.  With  the  fasting  comes  with  it  the  celebrations  and  the  feasting,  and  this  is  where  the  catch  is  for  most  diabetic  patients.  It  is  my  hope  that  this  article  will  open  up  your  minds  to  a  safer  fast  without  affecting  your  sugars.  Plan  for  your  fasts  with  your  doctor,  they  are  there  to  4 ⠄ Kisukari magazine

assist  you  in  the  process  not  to  stop  you  from  practicing  your  faith,  so  have  faith  in  them  too.

I  wish  all  our  Muslim  brothers  and  sisters  a  blessed  Ramadhan  and  ask  you  to  kindly  keep  Kenya  and  us  in  your  prayers.  Stay  healthy. ³)DLWK LV WDNLQJ WKH ¿UVW VWHS HYHQ ZKHQ \RX can’t  see  the  whole  staircase�

Martin  Luther  King  Jr.

VISION

Kenya has distinguished itself internationally include: - Molecular Pathology; PCR/DNA ANALYSIS - Histology and Cytology; Immunohistochemistry - Flow cytometry and cytogenetics: - Hematology and coagulation tests as well as bone marrow studies.

- Microbiology: bacteriology, mycobacteriology, mycology, parasitology and virology.

- Chemical Pathology/ Toxicology - Wellness checks - Public-Private partnerships (PPP) initiatives

To be a market leader and centre of excellence in laboratory diagnostic industry in the region.

MISSION

To provide high quality, accessible and competitive pricing for tests done in the laboratory to the Kenyan Citizenry.

CORE VALUES

Professionalism Excellence in customer service High quality delivery of services Ethics and integrity Innovation through ICT solutions Transparency and Accountability

INTRODUCTION

Pathologists Lancet Kenya is a leading ultramodern and independent pathology laboratory service with its main laboratory and headquarters in Upper Hill Nairobi, and other branch laboratories in Nairobi and across the country. Across all these branches, PLK implements quality and adherence to international standards of excellence, and are linked through a dedicated fibre-optic and wireless network that allows our pathologists to access, monitor, supervise and electronically sign out all reports in all our laboratories, thus ensuring that international expertise is injected in every result. Our systems are highly automated with barcoding and centralization of records, including electronic reporting of results through E-mail and other electronic alternatives to hard copy reporting, including PathPortal and the development of Apps for both Android and Apple platforms.

Our value offerings include: Ultra modern state of the art infrastructure and modern services Competitive pricing and efficient turnaround time (TAT) Internationally accredited quality and LEAN services Specimen courier collection and electronic result delivery Automatic delivery of reports to doctors through ICT solutions: - PathPortal - Auto E-mail - Lancet mobile App Wide test menu with over 3,800 tests (routine to specialized tests). Some of the areas where Lancet

Branches of pathologists lancet Kenya‌.

GENERAL ACCIDENT HOUSE 0703061050 Mobile: 0726995860 PROF NELSON AWORI Direct Line(s): 0703061051/2 Mobile: 0726839341

LANCET NYALI Links Plaza Tel: 0703061000 Mobile: 0722 355 796

LANCET PARKLANDS Park Place Office Suites 0703061100 Mobile : 0729 909409

LANCET MALINDI At Tawfiq Hospital Tel:0703061074/5/6 Mobile: 0721143766

LANCET EASTLEIGH At Alliance Medical Centre Direct Line(s): 0703061090/1 Mobile: 0717 414682 LANCET BURUBURU Acacia Building Switch Board: 0703061000/1 Mobile: 0717414708 LANCET ONGATA RONGAI Kins Arcade Biulding Ground Flr; Unin No. 11 Tel: 0700167295

PATHOLOGISTS LANCET KENYA 5th Avenue office suites Opp. Traffic HQ – Upper hill 5th Ngong Avenue I Ngong road Switch board: 0703 061000 Land lines : 020 273 5123, 271 6701/ 020 250 8456, 271 6697 Mobile: 0729 111 110 / 0736 493 100

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LANCET MOMBASA OLD TOWN At Ocean Medical Centre Tel: 0703061000

LANCET KIBRA At Sheikh Mahmud Memorial Clinic Tel:0703061000 LANCET MOMBASA MAIN LAB Biashara Building Tel: 0703061070/1/2 Cell: 0721143766/ 0736 489282

LANCET KISUMU Wedco Centre Unit 3 Kenya Re- Plaza Tel:0703061080/1 Mobile: 0726838773/0735 457665 LANCET ELDORET KVDA Plaza, Tel: 0703061120/1/2 Mobile: 0714 403 655 LANCET THIKA Thika Arcade Tel:0703061000 Mobile: 0717414684 LANCET NAKURU West Side Mall Tel: 0703061000 Mobile: 0720654351 LANCET GARISSA At Alliance Medical Tel: 0703061110 Mobile: 0704819799

dk OVERVIEW

VISION: Excellence in the prevention and management of diabetes!

MISSION: A Diabetes Free Kenya!

MOTTO: “An Anchor of Hope” against the rising tide of the diabetes epidemic in Kenya.

OVERVIEW: Formerly called the Kenya Diabetes Association

(KDA), the association was first registered in 1972 by the late Dr. Eric Mngola. A change of name and new registration was necessitated towards the end of 2009, leading to the birth of Diabetes Kenya Association (DK) on 11th March 2010.

A duly elected National Executive Committee team, under the Chairmanship of Dr. (Mrs.) Kirtida Acharya, Physician, Endocrinologist and Diabetologist run the day-to-day activities of the association on a purely voluntary basis.

Diabetes Kenya Association is a non-governmental, non-profit organization, officially registered with the change of name in March 2010, working and lobbying to better the lives of people affected by diabetes.

Diabetes Kenya, the national representative body for diabetes in Kenya, is the sole accredited associate member - in Kenya - of the International Diabetes Federation (IDF), which is the umbrella organisation of over 200 national diabetes organizations in over 160 countries, representing the interests of a growing number of people with diabetes and those at risk. DK representatives are actively involved in a number of working committees of the International Diabetes Federation.

Our association works closely with the Ministry of Health, global and major local pharmaceutical companies as well as corporate sponsors who have already awoken to the devastating effects of diabetes and other Noncommunicable diseases; mainly cardiovascular diseases, cancers and chronic respiratory diseases. They have made diabetes education and prevention a major part of their corporate social responsibility programmes.

Diabetes Kenya Association rolls out a yearly calendar of events, which involves free blood sugar screening, educational and prevention camps as well as other diabetes related activities to bring to light the diabetes epidemic in our country.

Diabetes education is important and accounts for 50% of diabetes treatment.

6 ⁄ Kisukari magazine

MANDATE: t t t t t t

Promoting public awareness of diabetes, its symptoms, risks, prevention and control.

Supporting and organizing of training for people who live or work with diabetes.

Lobbying for better understanding of patients’ needs and for affordable care and medication Fostering enabling partnerships and linkages for the fight against diabetes Enabling diabetes related research Addressing issues related to and including Epidemiology of Diabetes and its complications

OUR NETWORK: Diabetes Kenya Association works closely with Kenya’s Ministry of Health. Our National Office in headquartered in Nairobi and includes branch offices countrywide, enabling rapid dissemination of information and resources within State and Provincial Health Facilities.

THE NATIONAL EXECUTIVE COMMITTEE OF DIABETES KENYA IS ACTIVELY INVOLVED WITH: t t t t t t t

University medical departments State and provincial health departments Doctors specializing in diabetes in Kenya Specialist health care workers Private medical practitioners and other diabetes related health care workers Non-government organizations working in related fields within the primary health care sector.

Industry, including global pharmaceutical companies and other companies servicing people with diabetes.

Diabetes Kenya is primarily a volunteer organisation and relies heavily on people with diabetes and their families, who pool their talents, share their knowledge, resources and experience and give of their time to help each other.

As we all know – to do nothing is no longer an option. We no longer have the luxury to afford having bystanders. It is time to give diabetes and other NCDs the attention they deserve. Diabetes has many faces but few voices. We hope to encourage as many people to come together as possible in eradicating diabetes from our country.

Let Us Unite in the Fight Against Diabetes!

Friends of Diabetes Kenya Dear Readers, find below different categories of supporting Diabetes Kenya by being a friend of Diabetes Kenya.

a) Individual category Minimum Donations - 500 ksh per month, payable quarterly b) Corporate category Minimum Donations - 5000 ksh per month payable quarterly Benefits - free copy of our quarterly magazines - Regular Information on Diabetes from diabetes Kenya on email - Acknowledgement in our magazine (Kisukari)

Corporate Sponsorship for Diabetes Kenya Bronze sponsor Ksh 100,000/- per year Benefits - 5 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine with appearance of logo Silver sponsor Ksh 250,000/- per year Benefits -10 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine (Kisukari) with appearance of logo - Acknowledgement during DK functions, banners during DK functions -25% discount on advertising in Kisukari magazine Gold sponsor Ksh 500,000/- per year Benefits - 20 free copy of our quarterly magazines - Regular Information on Diabetes from Diabetes Kenya on email - Acknowledgement in our magazine (Kisukari) with appearance of logo - Acknowledgement during DK functions, banners during DK functions - Acknowledgement plaque at DK office -50 % discount on advertising in Kisukari magazine

We look forward to your continued support. . .

Kisukari magazine â „ 7

Diabetes

Diabetes DEMYSTIFIED

One of the major challenges associated with proper management of diabetes are societal myths. Below we try demystifying some of these myths with corresponding facts. By: Dr. Salwa Shahbal Myth 1 Myth 2

Diabetes is caused by eating too much sugar

If you have diabetes, you cannot be active

Fact 1 Diabetes is due to a total lack of insulin (Type 1) or little insulin produced by the pancreas (Type 2)

Fact 2 Being active/exercising improves glucose control.

Talk to your doctor before trying any new exercise.

Myth 3 Using insulin means you have failed

Myth 4 Insulin injections are painful

Fact 3 Type 1 diabetic patients have to use insulin because they have no insulin. Type 2 diabetics, use of insulin depends on control of the diabetes and disease progression.

8 â „ Kisukari magazine

Fact 4 Newer needles and pens have made this a painless process.

Myth 5

Fact 5

Thin people do not get diabetes

Diabetes can happen to anyone, whether thin or not thin. As much as obesity is a risk factor, thin people can still get diabetes due to many other reasons and it is advisable to lead a healthy lifestyle despite body size.

Myth 6 Myth 7 Diabetic patients follow a special diet

Type 1 diabetes is more serious than Type 2

Fact 6 Both are serious if not well controlled.

Fact 7 Diabetic patients follow a healthy diet that we should all follow. They just plan their meals carefully and practice portion control.

Myth 8 I cannot get diabetes because it does not run in my family

Fact 8 Diabetes can happen to you even with no family history.

Myth 9

Myth 10

Only adults’ get Type 2 diabetes

Fact 9 We are seeing more cases of type 2 diabetes among the youth due to unhealthy eating habits and lack of exercises.

When you start diabetes medication you do not need to exercise or worry about the food you eat

Fact 10 Lifestyle changes are part and parcel of good glucose control and cannot be stopped even if one is on medication.

Kisukari magazine â „ 9

Fasting

Di abetes  &  Fasting By: Dr. Gaman Mohamed

Fasting  For  Religious  Purposes All  the  major  religions  recommend  or  command  one  form  of  fasting  or  the  other.  Various  religions  have  different  form  of  fast  where  differences  are  noted  in  terms  of  GXUDWLRQ RI IDVW WLPLQJ RI FDORULF DQG ÀXLG intake  .  There  are  several  fasts  noted  .These  factors  must  be  considered  when  giving  advice  on  fasting.

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General  Principles ‡ ‡ ‡

The  health  provider  should  be  consulted  to  seek  advice  whether  fasting  can  be  embarked  upon  on  medical  grounds.

Advice  from  the  religious  leader  should  also  be  sought  as  to  whether  (s)he  can  be  exempted.  Check  the  level  of  average  blood  sugar  control   using  HbA1c  or  fasting  blood  glucose.  Those  in  very  poor  control  should  be  discouraged  from  embarking  upon  fasting.  Drug  dosage  adjustment  is  required  for  patients  with  fasting  blood  glucose  <  4.5  mmols/l.

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If  on  insulin  or  oral  medicines  that  increase  insulin  secretion   drugs  dosages  and  timing  will  require  adjustment  during  the  period  of  food  denial  to  meet  calorie  intake.

A  total  fast  is  not  recommended  for  anyone  with  diabetes.  Adequate  hydration  is  important  even  during  the  period  of  fasting Self-­blood  glucose  monitoring  is  mandatory  for  people  with  diabetes  who  elect  to  fast.  Once-­a-­day  monitoring  is  adequate  for  patients  on  diet  only  or  diet  with  metformim.  In  patients  on  insulin  ,oral  medications  that  increase  insulin  secretion,  Home  blood  glucose  monitoring   should  be  done  at  least  three  times  a  day.  Doctor  and  patients  should  agree  on  how  to  handle  abnormal  results  of  blood  sugar  monitoring  before  start  of  fast.  If  hyperglycaemia  is  marked,  retesting  should  be  more  frequent  and  the  urine  tested  for  ketones.

Vigorous  activity  should  be  avoided  during  period  of  fast.

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People  who  fast  should  have  ready  access  to  their  health-­care  providers  during  the  period  of  fast.

Breaking   of  the  fast  should  be  done   if: 1.  One  is  on  a  total  fast  and   blood  sugars  are  blow  3.9  mmols/l  .

2.  3DWLHQW RQ IDVWV WKDW DOORZ Ă&#x20AC;XLG intake  should  immediately  drink  a  sweetened  drink  (  half  a  glass  of  Juice  )  once  their  sugars  are  below  4  mmols  and  should  recheck  blood  sugars  after  15  minutes  .If  sugars  remain  low  the  fast  should  be  broken  and  a  meal  with  carbohydrate  consumed  .

3.  If  blood  glucose  levels  rise  excessively  to  16.5  mmol/L  or  higher.

Clear  guidelines  should  be  set  as  to  when  to  terminate  the  fast,  e.g.  Frequent  hypoglycaemia,  intercurrent  infection.

Compensatory  eating  with  fried  foods  and  sweets   should  be  avoided  when  one  opens  their  fasts  . Â

Most  commonly  fasting  occurs  due  to  either  religious  or  cultural  reasons  .  Religion  and  culture  are  an  important  aspect  of   life.  &XOWXUH GHÂżQHV QRUPV IRU YDOXHV EHOLHIV DQG MXGJPHQWV DERXW ZKDW LV JRRG ZKDW LV GHVLUDEOH DQG KRZ LQGLYLGXDOV VKRXOG EHKDYH An  appreciation  of   one  cultural  or  religious  context  is  critical  to  understanding  the  behaviours  and  environments  that  govern  an  individualâ&#x20AC;&#x2122;s  daily  life.  Many  diabetics  wish  to  follow  there  religious  convictions  and  may  end  up  fasting  without  their  doctors  advice  and  knowledge.  Care  givers  must  be  aware  of  this  and  must  be  able  to  give  advice  on  persons  who  can  fasting  and  also  give  appropriate  advice  on  diet  and  treatment  adjustments  for  those  who  can  fast.

10 â &#x201E; Kisukari magazine

Source: Â www.daralliance.org

Diabetes  and  Ramadan  5DPDGDQ LV RQH RI WKH ÂżYH SLOODUV RQ ZKLFK the  Islamic  faith  is  based.  The  purpose  of  fasting  is  to  develop  God-­consciousness  and  self-­control,  improve  health  by  reducing  or  eliminating  impurities  in  the  body  and  to  increase  awareness  of  the  plight  of  the  poor,  KXQJU\ DQG WKH VLFN 7KH 4XUÂśDQ VSHFLÂżFDOO\ exempts  people  with  a  medical  condition  that  may  affect  their  heath  from  the  duty  of  fasting.  Many  patients  often  prefer  not  to  accept  this  exemption.  A  survey  in  Kenya  on  300  diabetic  Muslims  indicated  that  89  %  of  type  2  dia-­ betic  Muslims  have  fasted  during  Ramadan.  A  larger  study  by  Salti  and  colleagues  showed   that  during  Ramadan,  42.8%  of  patients  with  type  1  diabetes  and  78.7%  with  type  2  diabe-­ tes  fasted  for  at  least  15  days. Â

doctor  will  be  able  to  classify  respective  pa-­ tients  in  various  risk  categories  namely,  high  risk  or  low  risk.  High  risk  patients  are  patients  on  insulin  or  who  have  type  1  diabetes  and  have  had  poor  glycaemic  control  with  high  and  low  blood  sugars.  Pregnancy  or  patients  with  severely  impaired  kidney  or  heart  func-­ tions  also  fall  under  the  high  risk  category.  Low  risk  patients  are  patients  who  are  well  controlled  on  diet  and/or  oral  anti  -­diabetic  medications.  Management  during  Ramadan Nutrition  Meals  should  be  evenly  spread  out  with  three  equal  sized  meals,  one  early  evening,  one  late  evening  and  one  before  dawn  would  be  the Â

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A  diabetic  may  undergo  risk  for  the  development  of  hypoglycemia  resulting  from  decreased  food  intake.  Reduction  in  intake  of  blood  glucose-­ lowering  medications  may  cause  blood  glucose  levels  to  rise,  resulting  in  hyper-­ glycemia. /LPLWDWLRQ RI Ă&#x20AC;XLG LQWDNH GXULQJ WKH IDVW may  cause  one  to  lose  body  water  and  become  dehydrated.  There  is  an  increased  risk  for  the  devel-­ opment  of  diabetic  ketoacidosis,  particu-­ larly  if  you  are  grossly  hyperglycemic  before  Ramadan.

Due  to  the  potential  risks  listed  above  a  dia-­ betic  should  talk  to  their  doctor  or  healthcare  professional  about  making  the  appropriate  changes  in  their  diabetic  treatment  plan.   A Â

Blood  Glucose  Monitoring Blood  glucose  monitoring  is  vital  for  patients  on  insulin  who  are  fasting  .  It  is  recommended  that  blood  sugars  are  done  before  and  one  and  half  hours  after  meals.  This  would  not  only  enable  treatment  adjustments  to  be  done   but  also  prevent  acute  complications.  Breaking  the  Fast It  is  recommended  that  fasting  should  be  im-­ mediately  terminated  if  any  of  the  following  should  occur: Â

Fasting  with  Diabetes  during  Ramadan     Persons  with  diabetes  may  be  able  to  fast  during  Ramadan.  However,  their  chronic  metabolic  disorder  can  place  them  at  high  risk  for  various  complications  if  their  eating  patterns  such  as  the  amount  of  their  meal  and  Ă&#x20AC;XLG LQWDNH DUH JUHDWO\ DOWHUHG Here  are  some  risks  diabetics  should  be  aware  of:

Insulin Patients  on  insulin  should  have  a  review  with  their  doctor  prior  to  fasting.  Several  changes  maybe  recommended   based  on   the  type  of  insulin,  dose  of  insulin  and  the  time  of  given  insulin  administration.  In  most  cases  in  patients  on  insulin,   doses  will  be  reversed  whereby  larger  doses  are  given  in  the  evening  while  smaller  doses  are  given  in  the  morning  .

Â&#x2021; Â&#x2021; Coffee  and  dates  are  the  common  starters  used  to  break  the  fast  for  Muslims.

6RXUFH KWWS ZZZ KXIÂżQJWRQSRVW FD

ideal  meal  pattern.  The  common  practice  of  ingesting  large  amounts  of  foods  rich  in  car-­ bohydrates  ,  fats  and  sweets  especially  during  the  sunset  meal,  should  be  avoided.  The  fast  VKRXOG QRW EH WXUQHG LQWR D IHDVW +LJK ¿EHU IRRGV H J +LJK ¿EHU FHUHDOV ZKROH PHDO bread  and  whole  meal  chapatti)  are  recom-­ mended.

Exercise  &  Activity Normal  levels  of  physical  activity  should  be  maintained  to  prevent  weight  gain.  Excessive  physical  activity  may  lead  to  a  higher  risk  of  hypoglycemia  and  should  be  avoided  in  patients  on  insulin.  Taraweh  prayers   should  be  considered  a  part  of  daily  physical  activity  and  the  same  precautionary  measures  should  be  taken.  Drugs  that  cause  increased  insulin  secretions  and  have  a  long  duration  of  action  should  be  avoided.  Shorter  acting  agents  in  this  class   may  be  used  under  doctors  instructions  . Â

Â&#x2021;

If  blood  glucose  levels  drop  dramatically  to  3.3mmol/l  (60  mg/dl)  or  lower.  If   blood  glucose  levels  reach  3.9mmol/l  PJ GO LQ WKH ¿UVW IHZ KRXUV DIWHU WKH start  of  the  fast  and  especially  if  insulin,  sulfonylureas  or  meglitinides  are  taken  at  the  pre-­dawn  meal.  If  blood  glucose  levels  rise  excessively  to  16.5  mmol/l  (300  mg/dl)  or  higher.

Conclusion

Many  authors  on  the  subject  confer  that  pa-­ tients  on  treatment  for  diabetes  with  drugs  or  exercise  and  diet  and  a  few  Insulin  dependant  diabetics  who  insist  on  fasting,  can  fast  if  they  are  carefully  managed  and  have  been  found  to  be  suitable  to  fast  by  their  doctors.  For  successful  Ramadan  fasting  implementation  of  the  three  pillars  of  IDVWLQJ LV LPSRUWDQW QDPHO\ GUXJ UHJLPH DGMXVWPHQW GLHW FRQWURO DQG GDLO\ DFWLYLW\  All  diabetics  must  consult  with  their  doctors  prior  to  fasting  to  ensure  that  their  condition  allows  them  to  fast  and  to  have  the  necessary  advise  and  drug  treatment  adjustments.

Kisukari magazine â &#x201E; 11

Life story

Talking  to

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Netanjee Van Niekerk

At  the  age  of  12,  my  symptoms  of  diabetes  started  to  show,  although  I  didnâ&#x20AC;&#x2122;t  discover  it  was  diabetes  because  of  my  intense  VZLPPLQJ VLJQLÂżFDQW ZDWHU LQWDNH DQG ZHLJKW ORVV VHHPHG QRU-­ mal.  A  day  after  my  13  birthday  (27th  July  2009),  I  was  diagnosed  after  a  urine  sample  and  measure  of  glucose  done  by  my  doctor  as  a  general  test  I  do  every  year.  My  tests  indicated  high  glucose  levels  as  a  result  of  being  admitted  into  hospital  for  further  exami-­ nation  and  evaluation  of  the  extent  it  had  reached.  Â

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Due  to  the  hypoâ&#x20AC;&#x2122;s  and  hyperâ&#x20AC;&#x2122;s  of  my  blood  sugar  levels  and  the  lack  of  enough  insulin  my  pancreas  is  producing:  Type  1. Â

3.      What  type  of  treatment  were  you  started  on  and  what  are  \RX RQ QRZ" Â&#x2021;

12 â &#x201E; Kisukari magazine

This  is  actually  really  funny,  because  for  a  long  time  the  doctors  had  no  idea  what  to  do  with  me  or  how  much  of  what  they  needed  to  give  me  to  get  my  blood  sugar  level  under  control.   So  they  started  me  on  12  units  of  [NovoRapid]  for  every  meal  along  with  10units  of  [Levermere]  twice  a  day.  This  was  WAY  too  much  and  every  hour  I  would  drop  into  a  low  and  I  would  eat  (not  having  the  right  information  and  education)  biscuits  and  stuff..  The  in-­ consistency  was  unpleasant  and  unhealthy,  so  the  doctors  took  me  off  [LeverMere]  completely  and  decreased  my  [NovoRapid]  dose.  The  â&#x20AC;&#x153;honeymoon  phaseâ&#x20AC;?,  the  swimming  (yes  I  kept  on  swimming)  and  just  the  way  my  body  is  so  sensitive  to  the  insulin  gave  me  the  nickname  â&#x20AC;&#x153;medical  marbleâ&#x20AC;?  of  diabetic  treatment.  But  back  then  it  was  the  insulin  pen  and  only  the  insulin  pen,  but  now  I  have  this  amazing  little  machine-­like  pancreas  attached  to  me  called  the  Insulin  Pump  and  let  me  just  say-­  it  is  so  much  better  and  easier  to  keep  everything  under  control.   So  I  started  with  the  NovoRapid  in-­ sulin  pen  and  now  I  am  on  the  insulin  pump  that  uses  the  100ml  vile  RI 1RYR5DSLG 0\ GRVDJH KDYH GHFUHDVHG VLJQLÂżFDQWO\ DV ZHOO Ĺš Â

+RZ KDV GLDEHWHV DIIHFWHG \RXU OLIH" 3OHDVH WHOO XV WKH good  and  the  bad Â&#x2021;

Â&#x2021;

Â&#x2021;

When  I  was  diagnosed  I  was  a  newly  teenager,  knew  little  about  life  and  was  a  care-­free  little  girl.  I  was  at  the  end  of  what  we  called  Primary  School  going  to  High  School.  This  event  felt  like  a  slap-­in-­the-­face  across  my  path  and  suddenly  I  had  to  take  a  huge  responsibility  of  my  own  life  that  I  wouldnâ&#x20AC;&#x2122;t  even  think  about  before.  I  mean  the  biggest  responsibility  about  my  life  was  brush  my  teeth  and  wash  all  over  when  I  showered,  not  watch  your  diet,  keep  your  sugar  under  control  and  test  your  blood  sugar  every  two  hours.   The  responsibility  of  my  life  in  my  hands  was  a  big  change,  I  was  and  am  always  responsible  and  disciplined  (everything  swimming  taught  me),  but  never  to  this  degree  of  importance.    Not  being  able  to  eat  what  I  used  to  eat  was  probably  the  hardest  and  also  adapting  my  diet  to  be  able  to  train  my  best  and  perform  even  better  at  galas  had  a  fun,  but  unwanted  experimenting  time  period  which  to  this  day  I  think  set  me  back  a  bit,  but  when  I  mastered  it  (donâ&#x20AC;&#x2122;t  get  me  wrong  it  is  still  trial  and  error  today  as  training  changes)  it  helped  me  catch  up  and  even  go  above  where  I  was  before.   The  better  effect  of  it  all  taught  me  that  being  healthy  is  not  just  a  â&#x20AC;&#x153;once  off  thingâ&#x20AC;?  but  a  continuous  lifestyle  and  to  be  healthy  means  changing  your  diet,  sleeping  habits,  internal  chemical  control  (donâ&#x20AC;&#x2122;t  worry  too  much  about  that)  and  EXCERCISE!!!  It  has  taught  me  that  all  foods  in  moderation,  which  to  eliminate  and  which  to  eat  more  of.   Â

keep  on  increasing  and  eventually  the  muscles  will  suffer  a  lack  in  VXIÂżFLHQW HQHUJ\ WR SHUIRUPÂŤ RQ WKH RWKHU KDQG ZKHQ \RXU EORRG sugar  levels  are  too  low,  it  will  only  keep  dropping  and  the  weak  feeling  will  kick  in  reducing  output.  So  keeping  it  just  right,  is  key  to  doing  the  best  at  what  you  possibly  can.  Â

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)RU PH LW LV DOZD\V WKH FDVH RI ZKHQ SHRSOH ÂżQG RXW ZLOO , EH accepted  among  them  or  become  an  outcast?  I  hate  it  when  people  categorize  me  and  give  me  a  label  and  this  was  my  greatest  fear  of  being  labeled  as  the  â&#x20AC;&#x153;diabetic  girlâ&#x20AC;?.  The  weight  control  was  a  big  issue,  as  I  picked  up  weight  at  the  beginning  before  I  started  losing  it  again  after  a  while  â&#x20AC;&#x201C;  this  doesnâ&#x20AC;&#x2122;t  happen  to  most  newly  diagnosed  people  though.  Â

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Firstly  and  something  everybody  needs  to  realize  when  dealing  with  diabetes,  nobody  will  classify  you  as  â&#x20AC;&#x153;the  diabeticâ&#x20AC;?  when  you  are  yourself  and  have  fun,  people  will  totally  forget  about  the  diabetes.  If  you  are  obsessed  with  it,  everybody  else  will  be.  When  I  found  the  right  balance  of  insulin  and  the  right  diet,  the  extra  body  fat  dropped  off  me  so  quickly!  But  accepting  yourself  is  key  and  just  be  responsible  with  what  you  do  â&#x20AC;&#x201C;  have  fun,  but  just  do  it  responsibly.

:KDW DUH \RXU KREELHV" Â&#x2021;

0\ KREELHV 6ZLPPLQJ ¿JXULQJ RXW ZD\V WR EDNH WKLQJV LQ a  healthy  way  and  sometimes  I  just  bake  anything  I  want  to  and  feed  my  family  haha.  Triathlon  training  is  a  new  hobby  these  days  and  writing  poems.

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$V , PHQWLRQHG EHIRUH ÂżQH WXQLQJ D GLHW WKDW ÂżWV P\ WUDLQLQJ intensity  in  order  to  perform  the  best  as  what  I  possible  can  and  have  enough  energy  to  train  with  power,  speed  and  endurance  that  ZLOO EHQHÂżW PH LQ WKH ORQJ UXQ 7KH QHZ GLHW LV DOVR PXFK KHDOWK-­ LHU WKDQ LW ZDV EHIRUH DQG LW GHÂżQLWHO\ KHOSHG PH GURS P\ WLPHV (to  go  faster)  and  drop  most  of  the  excess  body  fat  that  slowed  me  GRZQ 7KH PDLQ WKLQJ KRZ GLDEHWHV LQĂ&#x20AC;XHQFHG P\ VZLPPLQJ LV FKDQJLQJ P\ GLHW IRU WKH EHWWHU RI P\ VSRUW , KDYH ÂżJXUHG RXW WKDW having  the  right  diet  can  have  a  major  impact  on  my  performance;Íž  the  healthier  the  diet  and  the  body,  the  cleaner  the  â&#x20AC;&#x153;engineâ&#x20AC;?  and  eventually  the  faster  one  will  swim. Â

10.      What  advice  would  you  give  a  15  year  old  newly  GLDJQRVHG 7\SH GLDEHWLF" Â&#x2021;

7.      Do  you  think  being  on  the  pump  has  made  it  easier  in  UHJDUGV WR \RXU VZLPPLQJ WLPHV" Â&#x2021;

DEFINITELY!!   When  I  was  still  using  the  insulin  pen,  it  was  a  gamble  every  time  I  entered  the  swimming  pool  about  how  my  blood  sugar  will  react  after  a  couple  of  minutes  of  swimming  and  brought  about  a  lot  of  stress  especially  when  you  have  no  idea  what  the  set  (what  type  of  training)  will  be  like.  When  I  was  put  on  the  pump,  I  got  excited  because  some  of  the  responsibility  that  gave  me  a  lot  of  stress  would  be  lifted  from  my  shoulders  up  to  a  point.  My  blood  sugar  is  monitored  24/7  with  the  sensor  and  the  pump  is  what  I  call  â&#x20AC;&#x153;a  pancreas  outside  of  my  body  that  I  give  guidance  toâ&#x20AC;?.   It  helps  me  monitor  my  blood  sugar  levels  before,  during  and  after  training  and  most  importantly  during  galas  /  swimming  meets.  To  explain  a  bit:  when  your  blood  sugar  levels  are  too  high  in  training  or  galas  the  blood  sugar  levels  will  only Â

Â&#x2021;

Â&#x2021; Â&#x2021;

I  know  there  will  come  a  stage  you  will  be  angry,  disappointed  and  embarrassed  to  explain  to  your  friends  why  you  will  not  be  able  to  eat  certain  things  or  drink  certain  drinks.  But  if  your  friends  are  true  friends  they  will  accept  it  and  will  give  you  the  support  through  the  whole  new  process.  Adopt  a  new,  healthier  lifestyle  and  ask  for  help  if  you  donâ&#x20AC;&#x2122;t  understand  why  certain  things  are  happening  and  how  you  should  handle  different  things  when  something  happens  with  your  blood  sugar,  diet,  insulin  etc.   Help  your  parents  understand  and  prove  to  them  through  your  actions  that  you  know  what  you  are  doing  and  that  they  can  trust  you  â&#x20AC;&#x201C;  trust  me  it  takes  the  world  of  stress  of  their  shoulders  and  VDYHV \RX IURP D ORW RI ÂłQDJJLQJ´ DIWHU WKH ÂżUVW FRXSOH RI PRQWKV Do  what  you  are  supposed  to  do:  keep  your  blood  sugar  under  control,  watch  your  diet  and  make  sure  you  give  insulin  when  you  should.

Most  importantly:  donâ&#x20AC;&#x2122;t  stop  living!  This  is  not  a  death  sentence  and  does  not  limit  your  ability  to  succeed  in  your  sport,  hobbies  and  that  what  makes  you.  Donâ&#x20AC;&#x2122;t  blame  yourself  for  the  diagnoses;Íž  it  is  out  of  your  control.  Donâ&#x20AC;&#x2122;t  throw  yourself  a  pity-­party,  that  wonâ&#x20AC;&#x2122;t  help  you  with  any-­ thing  but  rather  see  this  as  an  opportunity  to  change  yourself  to  a  healthier  you.

LIVE  YOUR  LIFE  AS  NORMAL.  Have  fun,  set  goals,  and  go  achieve  them.  Remember,  Diabetes  does  not  control  you;Íž  you  are  LQ FRQWURO RI LW Ć&#x201D; Kisukari magazine â &#x201E; 13

Source: wikipedia.com

Gestational diabetes

Complications Of GESTATIONAL DIABETES By: Dr. Ifrah Hersi

M

ost women who develop ges-­ tational diabetes go on to have healthy babies. Dietary changes and exercise maybe enough to keep your blood sugar levels under control though at times medication is needed too. It is important to keep your blood sugar levels in check because poorly controlled diabetes can have serious short and long term effects for you and your baby.

COMPLICATIONS THAT MAY AFFECT YOUR BABY: Excessive Birth Weight: Extra glucose in your blood stream crosses the placenta which triggers your baby’s pancreas to make extra insulin this can cause your baby to grow too large (macrosomia). Very large babies those that weigh 9 pounds or more maybe too large to enter the birth canal or the baby’s head may enter the canal but then his shoulders get stuck. In this situation called shoulder dystocia, your practitioner will have to use special maneuvers to deliver your baby.

Delivery can sometimes result in a fractured bone or nerve damage both of which heal without permanent problems.

In very few cases the baby may suffer brain damage from lack of oxygen during the pro-­ FHVV RI WKH GLI¿FXOW GHOLYHU\ %HFDXVH RI WKLV your practitioner may recommend you do a caesarian section.

Early Birth & Respiratory Distress Syndrome: A mother’s blood sugar may increase her risk of early labor & delivery of her baby before its due date. Babies born early may experience 14 ⁄ Kisukari magazine

respiratory distress syndrome –a condition WKDW PDNHV EUHDWKLQJ GLI¿FXOW IRU WKH EDE\ (The lungs of babies whose mothers have diabetes tend to mature a bit late).

Low Blood Sugar (Hypoglycemia): Sometimes shortly after birth your baby may have low blood sugar because his body will still be producing extra insulin in exposure to your excess glucose. This is much more likely if your blood sugar levels were high during pregnancy and especially during labor.

Your baby’s blood sugar will be tested at birth and continue to be checked as needed.

It is important to keep your blood sugar levels in check because poorly controlled diabetes can have serious short and long term effects for you and your baby.

Feeding your baby as soon as possible after birth preferably by breast feeding can help prevent or correct hypoglycemia. In severe cases of hypoglycemia he will be given in-­ travenous glucose solution. This can prevent serious problems such as seizures, coma and brain damage that might result if the condition were to go unnoticed.

Type 2 Diabetes: Babies of mothers who have gestational dia-­

betes have a higher risk of developing obesity and type 2 diabetes mellitus later in life.

Polycythemia: If your blood sugar is especially poor your baby is at risk for polycythemia (an increase in number of red blood cells) and hypocal-­ caemia (low calcium in the blood) and your baby’s heart function could be affected as well.

COMPLICATIONS THAT MAY AFFECT YOU: Delivery of a large baby and the maneuvers needed to deliver a broad shouldered baby can lead to injuries to the vaginal area and require a large episiotomy for you.

High Blood Pressure & Pre Eclampsia: Gestation diabetes raises the risk of high blood pressure as well as pre eclampsia a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby. It particularly occurs to those who are obese before pregnancy or whose blood sugar levels are not well controlled.

Future Diabetes: If you have gestational diabetes you’re more likely to get it again during a future preg-­ nancy. You’re also more likely to develop type 2 diabetes mellitus as you get older.

However making healthy lifestyle choices such as eating healthy foods and exercising reduce the risk of future type 2 diabetes.

New Kids...

NEW

KIDS ON THE BLOCK

Incretin Mimetics By: Aggrey Shiundu (Pharmaceutical technologist)

I

ncretin is a hormone released in your body that stimulates production of insulin. If you remember, type 2 diabetes is due to little insulin in your body. New drugs called incretinmimet-­ ics (because they mimic the action of the natural hormone incretin) are available for type 2 diabetic patients now.

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They stimulate your pancreas to release insulin after you eat.

They reduce production of glucagon by your pancreas. Glucagon is a hormone that prompts your liver from producing glucose.

7KH\ KDYH DQ DGGHG EHQH¿W RI PDNLQJ RQH IHHO IXOO IRU ORQJHU therefore preventing your sugars to go too high after meals.

The drugs are currently not in tablet form but injections and are cur-­ rently not available in the Kenyan market.

DPP-­4 inhibitors (dipeptidyl peptidase-­4 inhibitors) on the other hand are tablets and are available in the Kenyan market. +RZ GR WKHVH ZRUN" DPP-­4 inhibitors prevent the breakdown of incretin hormone above therefore making it work for longer. Incretin hormone then controls your sugars the same way as mentioned above.

Examples of the DPP-­4 inhibitors in the market:

Vildagliptin Sitaglipin Saxagliptin

+RZ WR XVH WKHP" All medication for diabetes needs to be prescribed by your doctor depending on your sugar control. DPP-­4 inhibitors can be used as monotherapy (alone) or in combination with other drugs like met-­ formin. Normal dose is between 50mg to 100mg. While saxagliptin is 2.5 to 5mg. %HQH¿WV RI '33 LQKLELWRUV

Research shows that incretinmimetics improve glyceamic control (HBA1C) by approximately 0.5% to 1.0%.

They are weight neutral meaning they have no effect on weight gain/loss.

Low risk of hypoglyceamia (low blood sugar).

A major disadvantage in our set up in Kenya is the cost which I believe will go down if more patients use the drugs. Like any other drugs, they KDYH VLGH HIIHFWV DQG \RX QHHG WR GLVFXVV ZLWK \RXU GRFWRU ¿UVW EHIRUH starting any medication.

Some of the symptoms of an allergic reaction may include:

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Shortness of breath;; :KHH]LQJ RU GLI¿FXOW\ EUHDWKLQJ Swelling of the face, lips, tongue or other parts of the body;; Rash, itching or hives on the skin.

Stop the drug and report any of the above immediately to your doctor +RZ WR WDNH LW" Swallow the tablets whole with a glass of water. Taking it at the same time each day will have the best effect. It will also help you remember when to take it. It does not matter if you take this medicine before or after food.

Kisukari magazine ⁄ 15

Obesity & Diabetes

&

Exercise Diabetes By: Dr. Gaman Mohamed

There  are  two  main  types  of  exercise: 3K\VLFDO DFWLYLW\ FDQ EH GHÂżQHG DV ERGLO\ movements  which  require  energy  expenditure  Â&#x2021; Aerobic  exercise  -­  Repeated  rhythmic  and  continuous  movement  of  the  same  large  muscles  in  excess  of  resting  energy  expenditure  as  for  at  least  10  minutes  at  a  time,  e.g.  Walking,  a  result  of  contracting  skeletal  muscles.  jogging,  swimming. ([HUFLVH KRZHYHU LV WKH SODQQHG VWUXFWXUHG and  repetitive  bodily  movement  performed  to  Â&#x2021; Resistance  exercise  â&#x20AC;&#x201C;consists  of  activities  that  use  muscle  strength  to  move  weight  or  resist  load  improve  or  maintain  one  or  more  components  such  as  weight  lifting  and  exercise  with  weight  of  physical  activity. machines.  Ś 16 â &#x201E; Kisukari magazine

E

xercise is one of the four key pillars in successful diabetes management. It is free and most people can not get enough of it and is the crux of healthy living. Exercise is, in some sense, the perfect drug for diabetes. Different types and intensity of exercises can be discussed with the patient’s health provider to enable the patient exercise safely and effectively. ([HUFLVH KDV VHYHUDO EHQH¿WV ZKLFK LQFOXGH

Burning of extra body fat especially around the organs and over the stomach region Builds muscle strength Strengthens bones Lowers blood pressure Lowers LDL (“bad”) cholesterol Raises HDL (“good”) cholesterol Improves blood circulation Makes heart disease and stroke less likely Boosts energy

Choosing an exercise program There are two types of exercise: aerobic and anaerobic. Aerobic exercise uses oxygen to help release energy from fat cells. Anaerobic exercise does not use oxygen to burn fuel. Ideally, a diabetic’s exercise program will include both types of exercise.

The level of exercise is described as light, moderate, or strenuous.

What is light exercise for one person may be moderate exercise for someone else. Depending on the person’s light exercise one may not breathe heavily, but the pulse rate may increase slightly. Moderate ex-­ ercise involves noticeably heavier breathing, with a pulse rate increase to more than 100 beats per minute. Strenuous exercise involves rapid breathing with a pulse rate between 125 and 160 beats per minute, depending on age.

Enhances self esteem and self assurance and a sense of well being resulting in decreases in stress levels and an overall improvement in quality of life +RZ GRHV H[HUFLVH KHOS WR FRQWURO EORRG VXJDUV" During exercise, the body needs extra energy or fuel (in the form of glucose) for the exercising muscles. For short bursts of exercise, such as a quick sprint to catch the matatu or bus, the muscles and the liver can release stores of glucose for fuel. However, when one continues exercising, the muscles take up glucose from the blood stream up to about 20 times the normal rate. This helps lowers blood sugar levels.

At the same time insulin levels may drop in anyone not taking insulin so the risks of hypoglycemia or low blood sugar is minimized.

But intense exercise can have the opposite effect if done for less than 10 minutes and actually temporarily increase one’s blood glucose levels right after one stops exercising. This is especially true for many people with diabetes. The body recognizes intense exercise as a stress and releases stress hormones that cause the body to increase available blood sugar to fuel muscles.

Planning an exercise program A history and physical exam are needed to detect diseases of the heart, blood vessels, eyes, kidneys and the nervous system in a person with diabetes. This would be especially useful for patients above the age of 35 years, patients with Type 2 diabetes of greater than 10 years duration or Type 1 diabetes of greater than 15 years duration. In the presence of diabetic retinopathy (a condition occurring in persons with diabetes, which causes progressive damage to the retina, the light sensitive lining at the back of the eye) vigorous aerobic or resistance exercise may be contraindicated. However, swimming, walking, low impact aerobics, stationary cycling and endurance exercising maybe undertaken in the presence of severe peripheral neuropathy (damage to the peripheral nervous system), non-­weight bearing activities may be safer such as swimming, cycling, rowing, chair exercises and arm exercises.

Diabetics may suffer from Autonomic Neuropathy (AN) which is a condition that results from damage to nerves that assist in organ and or-­ gan system functioning. This nerve damage disturbs signal processing between the autonomic nervous system and the brain. This can affect blood pressure, heart rate, perspiration patterns. Patients with autonom-­ ic neuropathy should undergo cardiac investigation before beginning any physical activity that is more intense. There are no restrictions of participants with diabetic kidney disease.

The recommendation for people with diabetes is 30 minutes of moderate aerobic exercise 5 times per week or 20 minutes of vigorous activity 3 times per week. For people with diabetes, anaerobic exercise is recommended 3 times a week.

One approach to exercise is the lifetime activity model. In this model, one would accumulate a total of 30 minutes of moderately intense physical activity each day. Lower intensity activity (e.g., light house-­ work) can be done more often and/or for a longer period of time. The LGHD LV WR ¿W PLQXWHV RI DHURELF SK\VLFDO DFWLYLW\ LQWR RQH¶V XVXDO routine, three different times every day.

We currently have several software programs available on android phones in Kenya that are able to count steps. Another approach is the 10,000 Steps Program;; 10,000 steps is equal to 5 miles. Using a pedometer or software on phones that can count steps, helps make walking a daily contest with oneself.

Preparation for exercise One must check blood glucose levels If blood glucose is low (less than 3.9mmol/l) before one begins to exercise, hypoglycemia must be treated and exercise withheld at that time. If blood glucose is less than 5.6mmol/l an additional carbohydrate must be added. If one has type 1 diabetes avoid exercise if fasting glucose levels are >13.8mmol/l and ketosis is present or if glucose levels are >16.6 mmol/l, irrespec-­ tive of whether ketosis is present. Gradual warming up of the muscles is necessary by doing low-­intensity aerobic exercise such as walking or marching in place for 5–10 minutes, then stretch for 5–10 minutes Kisukari magazine ⁄ 17

before  beginning  more  intensive  exercise.  Ś  This  helps  prevent  muscle  cramps  and  injury.  As  one  completes  the  aerobic  exercise  session,   gradually  decrease  the  intensity  by  doing  ORZ LQWHQVLW\ DHURELF DFWLYLW\ IRU Âą PLQ DQG WKHQ ÂżQLVK WKH H[HUFLVH period  with  about  5â&#x20AC;&#x201C;10  minutes  of  stretching  exercises.  This  is  called  a  cool  down.  It  will  help  to  prevent  aches  and  muscle  cramping  later.   Other  important  aspects  as  one  prepares  to  exercise  includes  precau-­ tion  to  the  feet  including   appropriate  foot  wear  and  socks   and  proper  hydration  before  and  in-­between  exercises.

Nutrition  and  Insulin  adjustments  during  exercise   When  one  exercises  regularly  and  takes  insulin,  a  decrease  in  insulin  dose  on  exercise  days  or  eating  an  exercise  snack  may  be  required.  Exercising  around  the  same  time  each  day  will  make  planning  insulin  changes  and  snacks  easier  and  more  consistent.  Reducing  insulin  doses  is  particularly  useful  for  those  who  exercise  regularly.

The  decision  about  which  to  decrease  insulin  is  based  on  the  timing  and  type  of  exercise  and  the  insulin  treatment  plan.  The  risk  for  hypo-­ glycemia  is  less  when  the  level  of  insulin  in  the  body  is  lower. Â&#x2021; Â&#x2021; Â&#x2021; Â&#x2021;

Avoid  exercise  for  1â&#x20AC;&#x201C;2  hours  after  injecting  rapid  or  short-­act-­ ing   insulin Avoid  planning  the  exercise  program  during   the  time  oneâ&#x20AC;&#x2122;s  insu-­ lin  is  peaking.

Exercise  before  the  morning  insulin  dose Exercise  1â&#x20AC;&#x201C;3  hours  after  eating.  Â

The  risk  for  nighttime  hypoglycaemia  is  greater  after  exercise  in  the  evening.  The  harder  the  body  works  during  exercise,  the  more  glucose  it  uses.  The  amount  and  timing  of  snacks  depends  on  the  intensity  of  the  exercise,  the  duration  of  the  exercise,  the  pre-­exercise  blood  glucose,  and  the  individual  response.  Balancing  food  and  insulin  with  activity  will  require  advice  from  the  healthcare  team  and  one  may  need  to  eat  extra  carbohydrates  several  hours  after  the  exercise  program.  The  longer  and  more  intense  the  exercise,  the  longer  that  glucose  will  be  lowered  after  exercise  has  stopped.  Everyone  has  his  or  her  own  response  to  exercise.  Monitoring  blood  glucose  levels  helps  one  under-­ stand  their  response  to  any  adjustments  made  which  may  be  necessary  for  each  activity. ,Q VXPPDU\ VRPH XVHIXO WLSV RQ VWDUWLQJ H[HUFLVH DV D 'LDEHWLF include:  Â&#x2021; Â&#x2021; Â&#x2021;

Â&#x2021; Â&#x2021; Â&#x2021; Â&#x2021; Â&#x2021;

Discussing  with  oneâ&#x20AC;&#x2122;s  healthcare  providers  on  the  exercise  plan  to  ensure  it  is  safe  as  well  as  checking  to  see  if  a  change  in  the  meals  or  medications  is  necessary.

Choosing  an  activity  that  is  enjoyable  and  thus  making  it  a  regular  activity.

Monitoring  blood  sugars  before  and  after  exercising.  If  the  work  out  is  for  more  than  an  hour  then  one  must  check  their  blood  sugar  levels  regularly  during  the  workout,  so  as  to  know  whether  a  snack  is  required.  One  should  always  keep  a  small  carbohydrate  snack,  like  a  fruit  or  a  fruit  drink,  glucose  or  boiled  sweets  on  hand  in  case   blood  sugar  gets  low.

Work  slowly  into  an  exercise  regime  -­Ease  into  it.   Start  with  10  minutes  of  exercise  at  a  time  if  one  has  not  been  active  then  gradually  work  up  to  30  minutes  a  day.

Be  good  to  the  feet  by  wearing  good  shoes  and  practice  proper  foot  care.

Hydrate.  Drink  water  before,  during  and  after  exercise  to  prevent  dehydration.

Stop  if  there  is  any  unexpected  pain.  Mild  muscle  soreness  is  QRUPDO 6XGGHQ SDLQ LV QRW Ć&#x201D; 18 â &#x201E; Kisukari magazine

WHAT EXERCISE DOES Reduces the incidence of diabetes by approximately

50% Lowers the risk of Stroke by

27% Reduces the incidence of high-blood pressure by approximately

40%

Eat well...

Recipe

Cranberry-Almond Granola Source: www.thefreshfridge.com

QUICK INFO:

PREPARATION

19 Servings, Contains Nuts, Contains Wheat/ Gluten, Vegetarian, Good for Leftovers, GERDFriendly, Heart-Healthy, Diabetes-Friendly.

1.

Position racks in the top and bottom thirds of the oven; preheat to 325°F. Coat 2 large baking sheets with sides with cooking spray.

NUTRITIONAL INFO (Per serving)

2.

Whisk apple juice concentrate, maple syrup, oil and brown sugar in a medium saucepan.

Bring to a simmer over medium-high heat, stirring occasionally. Remove from heat; stir in cinnamon and salt.

3.

Mix oats, wheat germ, almonds and sunflower seeds in a large bowl. Stir in the juice mixture; toss to coat.

4.

Spread the granola evenly on the prepared baking sheets.

5.

Bake the granola for 15 minutes, stirring once or twice. Reverse sheets top to bottom and back to front. Continue baking until lightly browned and aromatic, stirring frequently, about 15 minutes more.

6.

Transfer the baking sheets to wire racks; stir 1/2 cup dried cranberries into the granola on each sheet. Let cool completely.

Calories: 262, Saturated Fat: 1g, Sodium: 67mg, Dietary Fiber: 5g, Total Fat: 11g, Carbs: 37g, Cholesterol: 0mg, Protein: 7g Carb Choices: 2 Recipe Source: eatingwell.com Prep Time: 10 mins Cook Time: 35 mins Rest Time: 20 mins Total Time: 1 h 5 mins INGREDIENTS t t t t t t t t t t t t

Cooking spray 2/3 cup(s) juice, apple 1/2 cup(s) maple syrup 1/3 cup(s) oil, almond, or oil, canola 1/4 cup(s) sugar, brown, dark, packed 1 tablespoon cinnamon, ground 1/2 teaspoon salt 5 cup(s) oats, rolled, (not quick-cooking) 1 cup(s) wheat germ, toasted 1 cup(s) nuts, almonds, coarsely chopped 1/2 cup(s) sunflower seeds 1 cup(s) cranberries, dried, divided

Source: www.bambuhome.com

Kisukari magazine ⁄ 19

About sugar

Sweet

freedom By: Ranjan Patel Clinical Nutritionist Diabetes Educator

Q Â

How  does  sugar  affect  the  digestive  system  and  additionally       DIIHFW RWKHU IXQFWLRQV" 1. Â

2. Â 3. Â

6XJDU LV DQ LQĂ&#x20AC;DPPDWRU\ VXEVWDQFH VR FRQWULEXWHV WR LQĂ&#x20AC;DP-­ mation  that  is  felt  as  stomachaches  or  a  disturbance  in  digestive  movement  resulting  in  constipation.   Or  it  may  stimulate  bowel  movement  causing  diarrhea.

Carbohydrates,  especially  sugar,  contribute  to  heartburn  (GERD).   Reducing  simple  carbohydrate  (sugar)  intake  has  helped  a  lot  of  SHRSOH ZLWK WKHLU UHĂ&#x20AC;X[ Candida  in  the  intestinal  tract  feeds  off  sugar.   As  the  Candida  yeast  gets  stronger  with  sugar  ingestion,  symptoms  appear  related  WR LQĂ&#x20AC;DPPDWLRQ RU WR[LQ UHOHDVH $ GLVFKDUJH RU LWFKLQHVV LV D common  symptom.   When  the  organism  gets  stronger,  it  is  capable  of  penetrating  the  bowel  wall  the  getting  into  other  organs.   The  more  toxins  released,  the  greater  the  negative  effect  on  the  body-­ -­headaches,  fatigue,  abdominal  pain,  and  joint  pain-­-­the  list  goes  on.  Once  the  body  regains  control  over  Candida,  youâ&#x20AC;&#x2122;ll  feel  a  LOT  better! Â

Q  +RZ FDQ , UHVLVW WHPSWDWLRQ WR HDW VXJDU" There  are  several  ways  that  help  you  to  resist  the  sugar  cravings: 1.  2.  3.  4.  5.  6.  7. Â

Donâ&#x20AC;&#x2122;t  have  it  in  the  house.

Find  a  buddy  or  a  support  system  (spouse,  family,  and  friend)  that  shares  in  your  desire  to  remove  sugar  from  your  life.  Create  non-­food  rewards  for  each  step  or  day  or  week  of  success.

Set  a  timer  for  15  minutes.  Often  the  craving  will  disappear  by  that  time.

Use  fruit  as  your  only  sweet  taste.   Over  time,  the  fruit  gets  sweeter  and  sweeter.

Try  less  and  less  sweet  per  day  over  a  week  or  two  week  period.

Use  healthy  sweeteners  like  Stevia,  Xylitol,  Agave.

Q Â

Iâ&#x20AC;&#x2122;ve  heard  that  yeast  overgrowth  can  cause  sugar  cravings.    ,V WKLV WUXH" YES!   Yeast  loves  sugar,  needs  sugar  for  metabolism,  and  seems  to  send  a  message  to  the  body  to  crave  it.   Most  yeast  (usually  Candida)  is  permitted  to  gain  a  foothold  in  the  body  after  the  recurrent  use  of  DQWLELRWLFV 7KHVH DQWLELRWLFV NLOO WKH JRRG QRUPDO Ă&#x20AC;RUD EDFWHULD LQ the  intestinal  tract  that  keep  the  Candida  under  control.   The  Candida  then  become  stronger,  morph  into  a  more  aggressive  form,  bore  through  the  intestinal  wall  and  spread  to  other  areas  of  the  body.   The  organism  releases  a  toxin,  which  manifests  as  any  number  of  symptoms,  includ-­ ing  rashes,  headaches,  fatigue,  joint  aches,  bloating  and  gas,  menstrual  irregularities.   The  treatment  begins  with  absolutely  no  sugar  intake  and  restrictions  of  fruit  (too  much  sugar)  and  yeast.   Probiotics  (the  good  bacteria  of  the  intestinal  tract)  in  the  5  to  10  billion  ranges  is  critical.   If  ongoing!  There  are  medications  that  may  be  needed  to  bring  better  control  of  the  organism.

Source: Â www.cookingclassy.com

Q  +RZ PDQ\ JUDPV RI VXJDU DUH KHDOWK\ SHU GD\" A  typical  carbonated  soft  drink  will  have  200  calories  LQ D RXQFH VHUYLQJ $OO RI WKRVH FDORULHV FRPH IURP VXJDU DQG VXJDU FRQWDLQV FDORULHV SHU WHDVSRRQ %\ WKLV PHDVXUHPHQW D RXQFH VHUYLQJ contains  12.5  teaspoons  of  sugar

20 â &#x201E; Kisukari magazine

NONE!   We  would  get  a  better  handle  on  controlling  cravings  for  re-­ ÂżQHG VXJDU LI ZH ODEHOHG LW D WR[LQ RU D SRLVRQ $QRWKHU TXHVWLRQ PLJKW be-­what  is  a  healthy  level  of  carbohydrate  intake  per  day?  Requirement  for  carbohydrates  is  different  for  every  individual  depending  on  age,  gender,  activity  level,  weight  and  basal  metabolic  rate.  We  get  plenty  of  carbohydrates  when  we  eat  legumes,  vegetables,  fruit  and  whole  grains.   The  nutrients  found  in  those  foods  are  what  our  bodies  need.   On  the  other  had,  our  body  does  need  proteins  and  fats,  and  minimum  require-­ PHQWV KDYH EHHQ HVWDEOLVKHG IRU WKRVH Ć&#x201D;

Kisukari magazine â &#x201E; 21

DiabeTES & CHILDREN

Diagnosis &Treatment By: Dr. Farah Sherdel

Source: Brett Davies

Diabetes is a disease in which your body cannot control the amount of sugar in your blood.

Remember the insulin(the key) that has to open the door of your cells? Well, in diabetes, there is a problem with this key and as a result you experience all those symptoms we mentioned in our last article, that make you feel rather dull and sick all the time, sometimes sleepy in class.

22 ⁄ Kisukari magazine

How can diabetes be diagnosed?

The doctor will be able to tell if you have diabetes by doing a test that measures the level of your sugar(glucose) in your blood.

This could be a fasting glucose test done first thing in the morning after you have not eaten anything for at least 8 hours or a random sugar(glucose) test which can be done at any time of the day. You could also be sent for another blood test called a glucose tolerance test which measures how your blood sugar Ź

changes over time after you have had a sugary drink. If you have to do this test then you must not eat anything for at least 8 hours.

So, can diabetes be cured?

No, it cannot but the good news is, it can be treated! It is vital that you get the correct treatment from the time of diagnosis so that you do not have problems to the eyes, brain, heart, kidneys, feet and nerves. The important

WORD JUMBLE +IV aW] ÅVL \PM NWTTW_QVO _WZL[ WV aW]Z W_V ' DIABETES METER

A young boy gives himself an insulin shot at the Diabetes Association of T&T’s Annual Diabetes Children’s Camp.

Source: Taureef Mohammed (www.guardian.co.tt)

thing for you to remember is that in order to control your diabetes you must eat a healthy diet which means stopping all those sweet and unhealthy stuff and exercising regularly. In Type 1 diabetes, you must top up your insulin with insulin injections so that all the sugar can go into the cells. In Type 2 diabetes, you may require tablets and /or insulin injections.

“

REMEMBER, as long as you do not miss your injections and check your sugars as often as you can, there is no reason why you cannot go out there and have loads of fun with your friends!

VI RUS I NSULI N B LOOD KIDS G LU COS E TA B L E T DOCTOR H EART

In both types of diabetes, you must always keep the two ‘Ms’ in mind – Monitoring and Managing. This means that you must check your blood sugars by using a glucometer. This helps you know whether the treatment is working or if your doctor needs to make some adjustments. A team approach is required involving you, your family and/or caregiver and the school working together with your doctor, diabetes educator and dietician. Ɣ Kisukari magazine ⁄ 23

24 â &#x201E; Kisukari magazine