A publication of Diabetes Kenya
Diabetes in a NUTSHELL WHY HOW WHEN Insulin Pump
Obesity & Diabetes
1st Edition - March 2014 KSH 200/-
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CONTENTS PAGE 6
Diabetes  Kenya Formerly  called  the  Kenya  Diabetes  $VVRFLDWLRQ .'$ WKH DVVRFLDWLRQ ZDV ¿UVW registered  in  1972...
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Faces  of  Diabetes Currently  there  are  over  286  million  people  living  with  diabetes  worldwide...
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Diabetes  &  Our  Bodies Illness  arises  in  our  bodies  as  a  result  of  these  high  sugars  in  the  immediate  stage....
Insulin  Pump an  Insulin  delivery  device  used  by  persons  living  with  Diabetes...
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Obesity  &  Diabetes In  traditional  cultures  weight  gain  is  regarded  as  an  indicator  of  wealth...
Life  with  Diabetes True  story  told  by  Rita  Agasaro
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Insulin  Storage  &  Safety Storing  your  insulin  in  the  refrigerator  is  recommended,  injecting  cold  insulin  can  sometimes  make  the  injection  more  painful....
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Gestational  diabetes is  a  condition  in  which  women  without  previously  diagnosed  diabetes  exhibit  high  blood  glucose  during  pregnancy...
Diabetes  &  Your  Right  to  Care In  traditional  cultures  weight  gain  is  regarded  as  an  indicator  of  wealth...
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Diabetes  Education Will  equip  you  with  the  necessary  skills  and  knowledge  to  live  with  Diabetes...
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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:  Shirley  Kwamboka  (T1  DM  Patient)
Gold  Sponsor
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
Pictorial Contents
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The 2013 World Diabetes Congress (WDC) that was held in Melbourne between the 2-6 December. It was the biggest medical conference that has ever been held in Australia, with over 10,000 delegates from over 130 countries, including world experts in science and health, diabetes sufferers, and their carers from all around the globe. Kisukari magazine â „ 3
Message
From the
Chairperson Hello  beloved  family,  welcome  to  our  ¿UVW HGLWLRQ RI NLVXNDUL WKH LQQRYDWLYH informative  magazine  of  Diabetes  Kenya.  Our  vision  is  a  “diabetes  free  Kenyaâ€?.  We  may  not  become  totally  free  of  the  heavy  shackles  of  the  approaching  menacing  tsunami  of  diabetes  and  non  communicable  diseases  but  we  would  like  to  empower  every  Kenyan  to  be  able  to  prevent  diabetes  especially  type  2  with  corrective  lifestyle  and  effective  education  practices.   And  for  those  who  are  already  living  with  diabetes  whether  type  1  or  2  or  diabetes  in  pregnancy,  whether  young  or  old,  urban  or  rural  we  would  like  them  to  be  well  versed  with  their  management  and  support  them  in  the  best  way  possible  to  live  life  to  the  fullest  and  to  avoid  complications.  We  have  had  novel  events  to  acknowledge  diabetes  and  celebrate  world  diabetes  day  and  lit  up  iconic  national  monuments Â
in  blue  in  keeping  with  the  international  community  during  November  diabetes  month.  We  have  held  powerful  motivational  patient  empowerment  workshops,  trained  medical  or  lay  personnel. We  have  also  had  out  of  the  box  public  awareness  forums  where  young  type  1  kids  have  performed  skits  to  educate  the  public  and  various  screening  events  at  faith  based  organizations  and  other  venues.  We  are  fortunate  to  have  harnessed  strategic  partnerships  with  pharma  industry  and  other  well  wishers  which  will  go  a  long  way  to  help  us  with  our  noble  mission  in  helping  Kenyans  living  with  diabetes.  Our  core  resource  is  purely  voluntary  based  but  our  desire  to  serve  keeps  our  torch  of  hope  burning  bright. Â
From the
Chief Editor I  am  humbled  at  the  opportunity  to  be  ZULWLQJ WKLV RQ RXU ¿UVW UHOHDVH .LVXNDUL LV D quarterly  publication  of  diabetes  Kenya  whose  main  objective  is  creating  diabetes  awareness,  education  and  empowering  the  Kenyan  public.  From  the  current  IDF  atlas  (6th  edition)  diabetes  is  on  the  rise  with  more  than  half  of  WKH FDVHV LQ $IULFD WKHVH ¿JXUHV DUH VFDU\ EXW attitude  is  everything,  lets  look  at  the  glass  as  half  full  and  we  can  conquer  this  giant  called  diabetes. .LVXNDULœV ¿UVW UHOHDVH LV WRXFKLQJ RQ different  aspects  of  diabetes  like  how  it  comes  about  written  in  simple  language  for  you  to  understand.  The  key  to  understanding  GLDEHWHV LV E\ ¿UVW NQRZLQJ KRZ LW DIIHFWV our  bodies.  The  main  article  touching  on  the  recent  most  convenient  way  of  insulin  delivery  especially  for  our  Type  1  patients  through  pump  therapy  with  a  follow  up  article  on  living  with  diabetes,  a  touching  story  about  a  young  girl’s  life  who  was  diagnosed  with  diabetes  at  the  age  of  10.
4 â „ Kisukari magazine
With  that  I  would  like  to  say  thank  you  to  all  who  made  this  possible  and  most  importantly  you  the  reader,  enjoy  the  magazine. “Education  is  the  most  lethal  weapon,  because  with  it  you  can  change  the  world�  (Nelson  Mandela) Stay  healthy:
World Diabetes Day 14th Nov. 2012 Kisumu
Volunteers at a past Diabetes Kenya event to commemorate World Diabetes Day in Kisumu where screening, nutrition counselling, health education and free medical consultation were done. Later on the clock tower was a lit blue circle for support of diabetes. Some of the sponsors and volunteers were also handed certificates of appreciation by Dr. Acharya and Atieno Jalang’o , Chairperson and organizing secretary Diabetes Kenya Kisukari magazine ⠄ 5
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 Non-Communicable 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
FAces of Diabetes
THE MANY FACES OF DIABETES By: Dr. K.S. Acharya
T
he  tsunami  of  type  2  diabetes  and  non-Âcommunicable  disease  has  hit  across  the  globe  and  Kenya  with  devastating  re- sults.  While  the  developing  world  is  still  grappling  with  the  epidemic  of  communicable  diseases  like:  HIV,  malaria  and  TB,  the  non-Âcommunicable  disease  with  diabetes  in  the  steering  wheel,  have  created  a  colliding  double  burden  to  contend  with. Currently  there  are  over  286  million  people  living  with  diabetes  world- wide.  A  huge  underestimate  due  to  lack  of  national  diabetes  registers  in  most  countries,  double  that  number  of  people  with  pre-Âdiabetes   or  LPSDLUHG JOXFRVH WROHUDQFH DQG SURMHFWHG ÂżJXUHV H[WUDSRODWHG WR RYHU 380  million  by  2030,  over  ž  of  these  people  are  in  economically  chal- lenged  or  developing  countries  like  ours!  Our  national  prevalence  rate  is  postulated  at  3-Â7%  but  certain  hot  spots  have  prevalence  of  11%.  Just  like  the  rest  of  the  world,  majority  of  Kenyans  (over  85%)  have  type  2  diabetes  previously  known  as  adult  onset  or  non-Âinsulin  dependent  diabetes  both  misnomers  as  children/teenagers  can  get  it  too  and  over  60%  of  patients  in  with  6  years’  time  become  insulin  users! Type  2  diabetes  is  a  subtype  of  diabetes  that  has  proved  to  be  the  most  challenging  to  manage  as  its  aetiopathogenesis  is  complex  and  multifunctional.  It  wears  many  masks  often  presents  silently,  50%  of  patients  are  asymptomatic  at  diagnoses,  picked  up  in  ordinary  screening.  It  is  thought  to  be  caused  by  an  interplay  of  generic  and  environmental  factors  hence  it  is  dubbed  as  by  many  as  “diabetes  by  invitation!â€?  or  “lifestyle  diabetesâ€?.  Family  history,  being  overweight  or  obese,  sedentary  lifestyle,  unhealthy  diets,  excess  alcohol,  smoking,  insulin  resistance,  polycystic  ovarian  syndrome  coexistence,  fatty  liver,  VOHHS DSQHD V\QGURPH SUR LQĂ€DPPDWRU\ VWDWHV DQG RYHU FKURQLF VWUHVV all  contribute   to  type  2  diabetes. Type  2  diabetes  is  preceded  by  a  pre-Âdiabetic  state  of  impaired  glucose/  hyper  insulin  emic  state  which  can  be  detected  by  simple  screen- ing  measures  like  an  oral  glucose  tolerance  test.  This  is  a  wonderful  opportunity  to  predict  and  prevent  type  2  diabetes  in  a  huge  cohort  at  risk.  People  may  help  curb  the  rising  epidemic  and  prevention  is  better  and  cheaper  than  cure!  It  is  like  looking  at  a  crystal  ball  and  changing  someone’s  future  and  averting  them  from  lifelong  diabetes  with  no  cure! More  and  more  children  and  youths  are  increasingly  developing  type  2  diabetes;Íž  a  condition  that  belonged  to  the  older  adult  population,  and  there  is  a  need  to  start  effective  advocacy  and  preventive  educative  programs  and  campaigns  early,  health  awareness  and  NCP/diabetes  prevention  in  school  curriculum  to  curb  the  diabetes  ,  form  effective  partnerships,  strategies  with  various  ministries  education/  youth/ag- riculture  for  innovative  modalities  to  enable  effective  life  plus  health  changing  practices. Lifestyle  and  effective  polypharmacy,  regular  checkups  including  of  8 â „ Kisukari magazine
sugar,  blood  pressure,  weight,  cholesterol,  foot,  nutrition,  eye,  den- tal  checkups,  regular  education,  empowerment  forums,  counselling  when  needed  are  mandatory  in  the  holistic  management  of  the  patient  living  with  diabetes.  An  empowered  educated  compliant  patient  will  live  longer  and  better  and  will  motivate  other  patients.  Conversation  maps,  support  groups,  peer  educators,  patient  educators  and  empower- ment  workshops,  responsible  media  reporting,  thinking  out  of  the  box  strategies  all  make  a  difference  to  improve  the  quality  of  the  life  of  the  person  living  with  diabetes. Many  patients  have  myths,  misconceptions,  fears  and  need  for  a  forum  to  express  and  dispel  them.  Most  health  care  personnel  need  to  be  available  and  approachable  to  answer  these  questions.  The  dreaded  complications  of  diabetes  are  very  much  avoidable  with  good  and  effective  management  and  need  to  be  addressed  Move more, Eat adequately  at  each  visit.  Men  need  to  be  less, Don’t smoke, able  to  discuss  erectile  Don’t stress, Please Sort  any.  Neuropathy  dysfunction.  think, Before you has  to  be  looked  for  and  man- aged  optimally.  drink, Laugh a lot Our  dialysis  units  are  not  equipped  adequately  and  costs  and enjoy what are  prohibitive  you’ve got! so  it  is  vital  to  salvage  kidney/renal  function  by  simple  early  micro  albumi- nuria  testing  and  good  sugar,  blood  pressure,  and  cholesterol  control  (a  stitch  in  time  saves  nine!) Depression  is  very  common  and  often  missed  in  our  diabetic  patients  and  has  to  be  looked  for  and  adequately  addressed,  as  it  contributes  to  consequences  and  reduces  the  quality  and  quantity  of  life.  Diabetes  should  not  defeat  or  daunt  anyone,  with  adequate  education,  empower- ment  and  team  effort;͞  every:  and  any  Kenyan  and  their  families  living  with  diabetes  should  live  with  hope  because  together  we  can  defeat  diabetes!
Nutshell...
Diabetes in a nutshell By: Dr. Priscilla Ngacha
M
any  of  us  have  heard  of  dia- betes.  It  could  be  that  we  are  either  living  with  it  or  a  family  member,  child  or  friend  has  and  LV OLYLQJ ZLWK LW :H ÂżQG LW VFDU\ ZKHQ LW LV mentioned  to  us  and  we  may  even  view  it  as  a  death  sentence.  The  good  news  is  that  it  is  pre- ventable  and  if  one  is  diagnosed  with  it,  it  can  be  managed  with  the  help  of  your  physician.  But  what  exactly  is  it?  And  are  there  different  types  of  Diabetes? Diabetes  Mellitus,  or  simply  diabetes,  is  a  group  of  metabolic  diseases  in  which  a  person  has  high  blood  sugar,  either  because  the  pancreas  does  not  produce  enough  insulin,  or  because  cells  do  not  respond  to  the  insulin  that  is  produced.  This  high  blood  sugar  produces  the  classical  symptoms  of  polyuria  (frequent  urination),  polydipsia  (increased  thirst),  and  polyphagia  (increased  hunger). There  are  three  main  types  of  Diabetes: 1.TYPE  1  DIABETES  This  is  mostly  diagnosed  in  children  and  young  adults. It  results  from  the  body’s  failure  to  produce  insulin.  This  form  was  previously  referred  to  as  “insulin-Âdependent  diabetes  Mellitusâ€?  (IDDM)  or  “juvenile  diabetesâ€?.  The  patient  has  to  constantly  inject  insulin  or  wear  an  insulin  pump  so  as  to  be  able  to  control  their  sugars. 2.TYPE  2  DIABETES This  is  mostly  diagnosed  in  adults.  It  results  from  insulin  resistance  a  condition  in  which Â
cells  fail  to  use  insulin  properly,  sometimes  FRPELQHG ZLWK DQ DEVROXWH LQVXOLQ GHÂżFLHQF\ This  form  was  previously  referred  to  as  non  insulin-Âdependent  diabetes  Mellitus  (NIDDM)  or  “adult-Âonset  diabetesâ€?.  In  this  type  of  diabetes  sugar  control  is  mainly  through  oral  drugs.  Some  patients  are  also  required  to  inject  insulin  so  as  to  achieve  good  sugar  control. In  the  early  stage  of  type  2,  the  predominant  abnormality  is  reduced  insulin  sensitivity.  At  this  stage,  hyperglycemia  can  be  reversed  by  a  variety  of  measures  and  medications  that  improve  insulin  sensitivity  or  reduce  glucose  production  by  the  liver.  Type  2  diabetes  is  preventable 3.GESTATIONAL  DIABETES This  other  major  form  of  diabetes  occurs  when  pregnant  women  without  a  previous  diagnosis  of  diabetes  develop  a  high  blood  glucose  level.  If  one  is  diagnosed  with  Gesta- tional  diabetes  this  is  seen  as  a  risk  factor  for  developing  type  2  diabetes  in  future. OTHER  TYPES  OF  DIABETES: Pre-Âdiabetes:   indicates  a  condition  that  oc- curs  when  a  person’s  blood  glucose  levels  are  higher  than  normal  but  not  high  enough  for  a  diagnosis  of  type  2  DM.  Many  people  des- tined  to  develop  type  2  DM  spend  many  years  in  a  state  of  pre-Âdiabetes.  This  is  a  growing  concern  in  our  country  at  the  moment. Latent  autoimmune  diabetes  of  adults  (LADA)  is  a  condition  in  which  type  1  DM Â
78,000 the number of children developing type1 diabetes, globally, every year
80%
of type2 diabetes cases are belived to be preventable by changing diet and levels of physical activity
develops  in  adults.  Adults  with  LADA  are  fre- quently  initially  misdiagnosed  as  having  type  2  DM,  based  on  age  rather  than   the  cause. There  are  other  uncommon  forms  of  diabetes  Mellitus  which  include  congenital  diabetes,  which  is  due  to  genetic  defects  of  insulin  VHFUHWLRQ F\VWLF ¿EURVLV UHODWHG GLDEHWHV DQG steroid  diabetes  induced  by  high  doses  of  glucocorticoids. So  from  the  above  summary  of  the  types  of  diabetes  we  can  now  all  be  able  to  begin  to  understand  the  different  forms  of  diabetes  that  are  we  are  dealing  with.  Always  remem- ber  that  diabetes  is  Preventable  and  if  one  is  diagnosed  with  it  then  it  can  be  well  managed  and  you  have  a  big  role  to  play  by  taking  a  proactive  role  of  your  health. Kisukari magazine ⠄ 9
Insulin pump
Insulin Pump
The Insulin pump is an Insulin delivery device used by pers Insulin into their bodies .The pump is a small, pager-sized p connected to the body by means of a thin tube or is worn d wirelessly controlled with a separate device. The pumps co a small battery operated pump, and a computer chip for co
T
he  Insulin  pump  is  an  Insulin  deliv- ery  device  used  by  persons  living  with  Diabetes  to  deliver  Insulin  into  their  bodies  .The  pump  is  a  small,  pager-Âsized  portable  device  weighing  about  100g  connected  to  the  body  by  means  of  a  thin  tube  or  is  worn  directly  on  the  body  (patch  pump)  and  wirelessly  controlled  with  a  sepa- rate  device.  The  pumps  consist  of  a  reservoir  ¿OOHG ZLWK LQVXOLQ D VPDOO EDWWHU\ RSHUDWHG pump,  and  a  computer  chip  for  controlling  insulin  delivery. History  of  Insulin  pump  therapy In  the  early  1960s  ,  Dr.  Arnold  Kadish  of  Los  $QJHOHV &DOLIRUQLD GHYLVHG WKH ÂżUVW LQVX- lin  pump.  It  was  worn  on  the  back  and  was  roughly  the  size  of  a  backpack.  It  was  only  un- til  the  early  1980s,  that  Insulin  pump  therapy  was  being  considered  as  a  possible  alternative  form  of  insulin  delivery  for  patients  with  type  1  diabetes.
source: Â www.nature.com
Image  above:  Insulin  Pump  therapy  equipment. Image  below  :  directions  for  the  use  of  Insulin  Pump  therapy.
Principles  of  Insulin  pump  therapy The  principle  of  Insulin  pump  therapy  or  Con- tinuous  Subcutaneous  Insulin  Infusion  (CSII)  is  to  deliver  Insulin  to  the  body  attempting  to  mimic  insulin  delivery  in  a  Normal  person.  The  pump  is  programmed  to  deliver  small  amounts  of  insulin  continuously  throughout  the  day  and  night  (Basal  rate)  which  meets  the  insulin  requirements  when  one  is  not  eating. Extra  doses  of  insulin  (’bolus’  doses)  are  delivered  at  meal  times  and  at  times  when  blood  glucose  is  too  high  based  on  the  user’s  programming  to  cover  mealtime  or  snack  time  insulin  requirements.  Some  pumps  have  in Â
10 â „ Kisukari magazine
built  continuous  glucose  monitoring  capa- ELOLWLHV 7KH ÂżUVW RI LWV NLQG /RZ *OXFRVH Suspend  feature,  exclusive  to  Paradigm  Veo  insulin  pumps,  works  by  suspending  insulin  delivery  for  up  to  two  hours  when  an  indi- vidual’s  sensor  glucose  value  reaches  a  preset  low  sensor  level.  Once  the  threshold  is  met,  the  insulin  pump  will  alarm  and  suspend  all  insulin  delivery  for  two  hours.  However  the  patient  can  resume  Insulin  delivery  at  anytime.  Pump  training  is  usually  begun  after  established  regular  care  with  a  health  care  provider.  After  the  patient  has  been  found  to  be  suitable  for  pump  therapy  several  classes  are  initiated.  These  classes  include  pump  basics,  pump  initiation  and  advance  pumping.  Training  on  carbohy- drate  counting  is  also  undertaken  during  pump  training. Insulin  pump  therapy  can  be  started  at  any  age.  There  is  no  best  age  to  begin  using  a  pump  the  time  is  right  when  person  with  dia- betes  and  their  family  are  ready  and  willing.  However,  for  young  children  (under  10  years  of  age),  who  do  not  yet  have  the  ability  to  take  the  necessary  steps  to  determine  the  insulin  dose  or  to  handle  hypo  (low  blood  sugars)  and  hyperglycemic  (high  blood  sugar)  episodes,  pump  use  depends  on  family  commitment  to  provide  the  necessary  24  hour  care  and  access  of  parents  to  the  child  during  the  day  while  he/ she  is  not  at  home  (at  school,  playschool).  Older  children  (above  10  years  of  age)  can  acquire  the  necessary  skills:  planning  and  programming  pre-Âmeal  bolus  doses  based  on Â
Therapy
sons living with Diabetes to deliver portable device weighing about 100g directly on the body (patch pump) and onsist of a reservoir filled with insulin, ontrolling insulin delivery. By: Dr. Gaman Mohamed blood glucose level, and planning carbohy- drate consumption and physical exercise. The basal rate will be regulated by the Health Care Team. Adolescents can operate the pump on their own. At this age, adult involvement may be required due to a tendency to perform less self-monitoring blood glucose Candidates for Insulin pump therapy Pump therapy may not be suitable for all Diabetics on insulin therapy. The ideal CSII candidate would be a patient with type 1 'LDEHWHV RU DEVROXWHO\ LQVXOLQ GH¿FLHQW W\SH 2 Diabetes who is on multiple Injections of Insulin and monitors his sugars several times a day. They must be motivated to achieve tighter blood glucose control, willing and able to participate and interact with the health care provider to improve their knowledge and skill in insulin pump therapy. In the western world, pumps are commonly used with type 1 diabetic subjects, whereas in India 80% of pumpers are type 2 Diabetic subjects.
Insulin Pumps in Kenya Insulin pump therapy is a relatively new concept in Kenya over the last few years. There has been a growing interest in pump therapy amongst both physicians and patients.
In Kenya we have an estimated 50 insulin pump users majority of whom are type1 diabetic and are below the age of 35. A survey on close to 25 pump users attending the Comprehensive Diabetes Centre indicated not only improved blood sugars and less blood VXJDU ÀXFWXDWLRQV EXW DOVR DQ LPSURYHG VHQVH of well being when on pump therapy. •
Advantages Insulin pump usage aims to mimic to some extent the natural production of Insulin by a healthy pancreas. This ability to copy physiology is the key to the following advantages of pump therapy listed below: t t
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Enables increased flexible adjustment of insulin dose to food intake Enables users to lead a flexible and spontaneous lifestyle in terms of meal times, physical exercise, etc. Ability to vary the basal rate dose in accordance with varying requirements during the day, thus reducing fluctuating blood glucose levels and hypoglycemic episodes. An increase the basal rate dose during the second half of the night assists in overcoming the dawn phenomenon and preventing high blood glucose values in the morning without having to pay the price of nighttime low sugars. Insulin pump therapy can, in correctly selected patients, result in improved blood sugar control without increased frequency of severe hypoglycemia. Newer generation pumps have the ability to have in built continuous glucose monitoring capabilities with audible alarms when sugar levels rise or fall. The paradigm VEO insulin pump from Medtronic has an in built automatic pump shut down when sugars are in the hypoglycemic range.
Disadvantages t
Image below: Insulin pump Patient symposia attendees in Kenya
t
As only short-acting insulin is used, accidental disconnection of the infusion set will cause insulin deficiency within a short while with the risk of developing ketone acid bodies which is potentially a medical emergency. However it has been noted that with appropriate pump training and recommended glucose measurement when on pump therapy this risk is similar to other type 1 Diabetic patients using multiple insulin injections. A risk of infection at the infusion site if the insertion site isn’t changed after three days
Kisukari magazine ⁄ 11
Life story
Life with Diabetes By: Rita Agasaro
I am 10 years and 4 months old and I was diagnosed with Type 1 diabetes on 13th September 2013 which was one week from my 10th ELUWKGD\ , VWD\HG DW WKH *HWUXGH¶V &KLOGUHQ¶V KRVSLWDO IRU ¿YH GD\V and my mum also stayed with me. Before that I had experienced lots of weight loss, extreme hunger, extreme thirst and going to the toilet all the time. I also had headaches and felt like vomiting. That is when I went to hospital. Many people who were my family and friends came to visit me. My week in hospital was very hard because I had to learn about diabetes and accept that I will have to change my lifestyle. I would not be able to eat some foods that I loved whenever I wanted to. I had good doctors and nurses who were taking care of me and encour- aging me. My family accepted the condition and said that I should have a positive attitude and they said that we would all be together in this. For three days at the hospital, the nurses used syringes, those with long needles, to inject insulin. I really hated this as it was painful. Then I switched to the insulin pens which were so much better and easier for me to use than the syringes which I never learnt to use. But I had to inject myself 5 times in a day. After I left the hospital, I had good days when my BGL (Blood Glucose Levels) was in the normal range but other times it could go very high or low. For example, for two weeks in November my BGL was really high, above 17mmol/l. Sometimes my BGL went to the twenties and one time my glucometer read HI. I was in Arusha at that time and I went to see the doctor who stays in Moshi which is not too far from Arusha. I was testing a lot for ketones but thank God the results showed slight traces or negative. When I went to the doctor, he said that I was entering puberty and he changed my insulin dosage a number of times. We would call him every day until my BGL stopped being too high. In December 2013, I did a lot of research on the insulin pump on the internet and YouTube. I really wanted the pump because I did not like WR LQMHFW P\VHOI WRR PDQ\ WLPHV DQG WKH SXPS ZDV ÀH[LEOH $W ¿UVW P\ mum said that the price was too much but when she started watch- ing the YouTube videos and doing her own research on the pump she thought twice. I was so excited when I went to get the insulin pump in Nairobi. We had to go for training at the Comprehensive Diabetes Centre for 10 days on how to use the pump. I have now been on the pump for two weeks and I love the pump because I stopped giving my- self insulin injections every day and it is easy to use. I also don’t have WR HDW VWULFWO\ DW FHUWDLQ WLPHV VR LW LV ÀH[LEOH , VWLOO FRQWLQXH WR WHVW P\ BGL 6 times or more in a day. So far I am managing my diabetes by eating healthy food and always counting my carbohydrates. I also get a lot of support from my family and I thank God for all the blessings He has given me.
12 ⁄ Kisukari magazine
diabetes in africa...
Diabetes in Africa
The Africa Region (AFR), where diabetes was once rare, has witnessed a surge in the condition. Estimates for type 1 diabetes suggest that about 39,000 people suffer from the disease in 2013 with 6.4 new cases occurring per year per 100,000 people in children <14 years old.
Nigeria South Africa Ethiopia Tanzania (United Republic of) Congo (Dem. Republic of the)
million
Number of people with diabetes 2013 between the age 20-79 years.
76%
Top 5 countries for number of people with diabetes (20-79 years), 2013 Countries/territories
19.8
Millions 3.9 2.6 1.8 1.7 1.6
39.1 (Thousands)
Number of children with type 1 diabetes (0-14 years), 2013.
Deaths in Africa are due to Diabetes people under the age of 60 years.
522,600 Total deaths due to diabetes
Source: IDF diabetes atlas, 6th edition
324,000 women , 198,600 men
Kisukari magazine ⁄ 13
Insulin storage
INSULIN STORAGE & SAFETY By: Aggrey Shiundu Pharmaceutical technologist
Insulin is a naturally occurring hormone secreted by the pancreas. Many people with diabetes are prescribed insulin, either because their bodies do not produce insulin (type 1 diabetes) or do not use insulin properly (type 2 diabetes).
Insulin  Storage
Syringe  Reuse
Syringe  Disposal
Although  manufacturers  recommend  storing  your  insulin  in  the  refrigerator,  injecting  cold  insulin  can  sometimes  make  the  injection  more  painful.  To  avoid  this,  many  providers  suggest  storing  the  bottle  of  insulin  you  are  using  at  room  temperature.  Insulin  kept  at  room  temperature  will  last  approximately  1  month.  Remember  though,  if  you  buy  more  than  one  bottle  at  a  time  to  save  money,  store  the  extra  bottles  in  the  refrigerator.  Then,  take  out  the  bottle  ahead  of  time  so  it  is  ready  for  your  next  injection.
Reusing  syringes  may  help  you  cut  costs,  avoid  buying  large  supplies  of  syringes,  and  reduce  waste.  However,  talk  with  your  doc- tor  or  nurse  before  you  begin  reusing.  They  can  help  you  decide  whether  it  would  be  a  safe  choice  for  you.  If  you  are  ill,  have  open  wounds  on  your  hands,  or  have  poor  resist- ance  to  infection,  you  should  not  risk  insulin  syringe  reuse.  Syringe  makers  will  not  guaran- tee  the  sterility  of  syringes  that  are  reused.
Itâ&#x20AC;&#x2122;s  time  to  dispose  of  an  insulin  syringe  when  the  needle  is  dull  or  bent  or  has  come  in  contact  with  anything  other  than  clean  skin. If  you  can  do  it  safely,  clip  the  needles  off  the  syringes  so  no  one  can  use  them.  Itâ&#x20AC;&#x2122;s  best  to  buy  a  device  that  clips,  catches,  and  contains  the  needle.  Do  not  use  scissors  to  clip  off  nee- GOHV ² WKH Ă&#x20AC;\LQJ QHHGOH FRXOG KXUW VRPHRQH or  become  lost.
Here are some tips to keep in mind when reusing syringes:
Here are some other tips for storing insulin:
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Do not store your insulin near extreme heat or extreme cold. Never store insulin in the freezer, direct sunlight, or in the glove compartment of a car. Check the expiration date before using, and donâ&#x20AC;&#x2122;t use any insulin beyond its expiration date. Examine the bottle closely to make sure the insulin looks normal before you draw the insulin into the syringe.
If  you  use  regular  insulin,  check  for  parti- cles  or  discolouration  of  the  insulin.  If  you  use  NPH  or  lente,  check  for  â&#x20AC;&#x153;frostingâ&#x20AC;?  or  crystals  in  the  insulin  on  the  inside  of  the  bottle  or  for  small  particles  or  clumps  in  the  insulin.  If  \RX ÂżQG DQ\ RI WKHVH LQ \RXU LQVXOLQ GR QRW use  it,  and  return  the  unopened  bottle  to  the  pharmacy  for  an  exchange  and/or  refund.
14 â &#x201E; Kisukari magazine
t t t t
t t
Keep the needle clean by keeping it capped when youâ&#x20AC;&#x2122;re not using it. Never let the needle touch anything but clean skin and the top of the insulin bottle. Never let anyone use a syringe youâ&#x20AC;&#x2122;ve already used, and donâ&#x20AC;&#x2122;t use anyone elseâ&#x20AC;&#x2122;s syringe. Cleaning it with alcohol removes the coating that helps the needle slide into the skin easily. Insulin Storage and Syringe Safety Store your current bottle of insulin at room temperature to avoid painful injections, but keep extra supplies in the refrigerator. Syringes can be reused safely, but it must done carefully to avoid contamination. Dispose of syringes in containers that prevent the needles from causing harm and check medical waste requirements for your area.
If  you  donâ&#x20AC;&#x2122;t  destroy  your  needles,  recap  them.  Place  the  needle  or  entire  syringe  in  an  opaque  (not  clear)  heavy-Âduty  plastic  bottle  with  a  screw  cap  or  a  plastic  or  metal  box  that  FORVHV ÂżUPO\ 'R QRW XVH D FRQWDLQHU WKDW ZLOO allow  the  needle  to  break  through,  and  do  not  recycle  your  syringe  container. Your  area  may  have  rules  for  getting  rid  of  medical  waste  such  as  used  syringes.  Ask  your  refuse  company  or  city  or  county  waste  authority  what  method  meets  their  rules.  When  travelling,  bring  your  used  syringes  home.  Pack  them  in  a  heavy-Âduty  holder,  such  as  a  hard  plastic  pencil  box,  for  transport.
Individuals living in the community use syringes to treat medical conditions or to inject illegal drugs. These injections result in billions of used syringes every year. Safe disposal of used syringes is a public health priority.
2014 GRAND FINALE
BY SUZIEBEAUTY & EWAMAK DESIGNS LTD The  evening  of  Friday  28th  February,  at  the  poignant  blue  lit  breezy  SRROVLGH JDUGHQV DW 6DURYD 3DQDIULF KRWHO WKH ÂżUVW HYHU 0LVV SOXV Kenya  beauty  and  talent  pagent  took  place.  This  event  was  the  brainchild  of  Suzie  and  Nyandia,  two  beautiful  powerful  women  from  suzie  beauty  and  Ewamak  designs,  the  organizers  of  this  event  who  EHOLHYH LQ EHDXW\ EH\RQG GHÂżQDEOH ERXQGDULHV DQG UHVWULFWLYH VL]HV They  together  with  Diabetes  Kenya  and  other  partners  wanted  the  event  and  the  cause  to  transcend  above  shallow  accepted  norms  of  beauty  and  embrace  health  particularly  diabetes  as  a  cause,  look  at  LQQHU EHDXW\ FRQÂżGHQFH WDOHQW DQG KROLVWLF LGHDOV RI WKH LQGLYLGXDO The  winner  of  the  contest  would  be  the  diabetes  ambassador  for  Diabetes  Kenya  besides  winning  a  5  year  modelling  contract  and  being  on  the  cover  for  couture  magazine.  There  was  free  sugar  and  blood  pressure  and  screening  services  available  throughout  the  event  for  all  present. There  was  a  glass  catwalk  over  the  pool  which  was  lit  up  and  which  the  models  gracefully  walked  over.  The  evening  was  extremely  entertaining.  There  was  live  music,  a  lovely  ambiance,  delicious  bitings  and  vibrant  bubbly  emceeing  by  Lynda  Nyangweso.  There  was  an  animated  slideshow  and  health  talk  on  diabetes  entitled  â&#x20AC;&#x153;Beauty  and  the  beastâ&#x20AC;?  by  Dr  kirtida  Acharya,  the  national  chair  of  Diabetes  Kenya.  The  beast  is  diabetes  and  the  talk  highlighted  how  to  avoid  the  beast  RU KRZ WR WDPH WKH EHDVW DQG OLYH ZLWK LW LI RQH KDV GLDEHWHV 7KH ÂżUVW contestant  reveal  was  in  Denim  and  white.  The  judging  panel  consisted  of  international  model  Ajuma  Nasenyana,  former  Ms  Kenya  Juliet  Achieng  and  couture  magazines  Olive  Gachara.  This  was  followed  by  titillating  comedy  by  Chipukeezy.  The  second  reveal  and  personality  display  by  contestants  portrayed  their  various  talents  including  their  RZQ FRPSRVHG SRHPV VLQJLQJ DQG GDQFLQJ $ SRHP RQ ÂżJKWLQJ diabetes  got  loud  applause  from  the  audience.  This  was  followed  by  a  riveting  vocal  performance  by  Juliet  Achieng  accompanied  by  energetic  dancers  one  of  which  took  a  dive  in  the  pool.  The  third  and  ¿QDO UHYHDO E\ FRQWHVWDQWV VKRZHG RII WKHLU FXUYHV DQG FRQÂżGHQFH WR the  best  draped  in  gowns  by  Vivo.  They  walked  over  the  glass  catwalk  RYHU WKH SRRO IRU WKH ÂżQDO URXQG 7KH ZLQQHU ZDV )DLWK -XOLH 0DODOD who  was  crowned  admist  appreciative  applause  from  the  crowd.  This  was  a  magical  evening  where  inner  beauty,  health,  goodness,  talent  and  happiness  all  came  together  to  create  a  winner!  The  winner  was  crowned  by  J.S  Vohra  of  Sarova  Hotel  who  were  also  the  sponsors.
Dr. K.S. Acharya Kisukari magazine â &#x201E; 15
Obesity & Diabetes
Gestational Diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose during pregnancy especially during the third trimester. The condition currently occurs in about 18% in all pregnancies.
By: Dr. Ifrah Hersi What causes gestational diabetes? Pregnancy is characterized by insulin resistance and hyperinsulinemia (high levels of insulin in your body) thus it may predispose some women to develop diabetes. According to research it shows resistance starts from placental secretion of diabetogenic hormones as well as increased maternal adipose (fat) deposition, decreased exercise and increased caloric intake. Therefore these hormones help the baby develop but also block the action of the mother’s insulin in her body. Gestational diabetes occurs in women ZKRVH SDQFUHDWLF IXQFWLRQ LV QRW VXI¿FLHQW WR secrete adequate amounts of additional insulin to overcome the insulin resistance created by changes in diabetogenic hormones during pregnancy she may need up to three times as much insulin. In a nut shell gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy, without enough insulin glucose cannot leave the body and be changed to energy. Glucose builds up in the blood to high levels this is called hyperglycaemia. Who is at risk for gestational diabetes?
source: www. peopleanddiabetes.com
16 ⁄ Kisukari magazine
Being overweight prior to becoming pregnant ( if you are 20% or more over your real body weight) Being a member of a high risk ethnic group (Hispanic, African American, native American or Asian) Having sugar in your urine. Impaired glucose tolerance or high fasting glucose (blood sugar levels are high but not high enough to be diabetes) Family history of diabetes (if parents or siblings have diabetes) Previously giving birth to a baby over 9 pounds Previously giving birth to a still born baby Having gestational diabetes with a previous pregnancy +DYLQJ WRR PXFK DPQLRWLF ÀXLG D condition called polyhydramnios)
Join us in our next issue to get to know the complications of gestational diabetes.
our bodies... source: Â www.static.ebony.com
DIABETES& OURBODIES By: Docktor Njathika, MBChB.
O
ne  might  ask  how  exactly  Dia- betes  causes  harm  to  our  bodies.   Diabetes  Mellitus  is  a  condition  in  which  the  blood  glucose  level  is  constantly  above  the  normal  range  (or  ac- ceptable  levels).   Illness  arises  in  our  bodies  as  a  result  of  these  high  sugars  in  the  immedi- ate  stage,  as  well  as  the  long  term  effects  of  chronically  elevated  blood  glucose.
Diabetes  and  the  Eye These  complications  are  medically  referred  to  as  diabetic  retinopathy.  Â
undergo  an  initial  ophthalmological  evalua- tion  to  ascertain  whether  these  effects  have  ensued  and  thereafter  regular  follow  up.   This  evaluation  can  be  carried  out  in  primary  care  facilities  by  simply  dilating  the  pupil  and  examining  the  retina  with  an  eye  examination  tool  known  as  a  fundoscope.   Once  abnormali- WLHV KDYH EHHQ LGHQWL¿HG WKHQ VXFK SDWLHQWV should  be  referred  for  further  evaluation  by  a  specialist  to  establish  the  degree  of  retinal  damage  and  advice  on  a  suitable  treatment  option.
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The  long-Âterm  complications  of  diabetes  Mellitus  occur  in  our  body  as  a  result  of  dam- age  to  blood  vessels.   This  damage  occurs  to  large  blood  vessels  (macrovascular)  as  well  as  small  blood  vessels  (microvascular).   As  a  result  of  this,  certain  sensitive  organs  are  particularly  at  risk,  from  this  such  as  the  brain,  the  eyes,  the  heart  and  the  kidneys.   In  addition  to  this,  other  complications  such  as  impaired  gastrointestinal  function,  skin  mani- festations,  hearing  loss  as  well  as  sexual  dys- function  may  arise.  It  is  harm  to  these  organs  that  often  reduces  quality  of  life  for  people  living  with  diabetes  and  also  predisposes  them  to  premature  death  in  the  worst  case  scenario. The  next  series  of  articles  we  shall  Endeav- our  to  highlight  what  exactly  happens  in  each  of  these  organs  when  blood  glucose  levels  are  out  of  control  in  the  long  term.   Complications  with  small  blood  vessels The  organs  which  are  particularly  at  risk  to  these  complications  include  the  eyes,  the  kidneys  and  the  nerves.   There  are  several  theories  that  have  been  put  forward  by  the  researchers  but  most  of  them  attribute  a  high  blood  glucose  level  alters  metabolism  and  leads  to  by  products  in  the  blood  stream  which  alter  the  protein  structure  of  these  tissues  lead- ing  to  their  impaired  function.
According to the World health organization (WHO), it is estimated that more than 75% of patients who have had Diabetes Mellitus for more than 20 years will have some form of diabetic retinopathy.
In  2005,  WHO  estimated  diabetic  retinopathy  to  be  responsible  for  4.8%  of  the  37  million  cases  of  blindness  in  the  world.   Clinical  studies  have  however  shown  that  appropriate  treatment  can  reduce  the  risks  by  more  than  90%.  (WHO,  2006).  Persistently  high  blood  sugar  leads  to  production  of  substances  through  unusual  metabolic  pathways  that  lead  to  an  overgrowth  of  the  small  blood  vessels  in  the  eye  and  depo- sition  of  toxic  substances  in  the  retina.   This  extensive  damage  to  the  retina  (the  part  of  the  eye  responsible  for  receiving  images)  results  in  blindness.   Diabetic  retinopathy  is  progres- sive  and  may  be  diagnosed  at  various  stages  depending  on  the  duration,  which  one  has  lived  with  the  condition  untreated.
This progressive damage has been shown to be delayed by controlling the blood sugar through effective medication and diet.
Modalities  of  Treatment  for  already  established  diabetic  retinopathy  depends  on  the  stage  of  the  eye  disease.   Some  of  these  in- clude  â&#x20AC;&#x2DC;laser  photocoagulationâ&#x20AC;&#x2122;  for  early  stage  disease  and  Vitrectomy  for  later  stage  compli- cations.  These  treatment  options  may  however  be  costly  especially  in  developing  countries  and  may  only  be  available  in  secondary  and  tertiary  level  facilities  which  are  often  not  readily  accessible  to  many  patients. Therefore,  it  cannot  be  over  emphasized  that  regular  screening  for  diabetes  and  prompt  treatment  for  diabetes  is  crucial  in  preventing  complications  in  the  eye  and  averting  blind- ness. Â
All diabetic patients should undergo an eye check at least once a year!
It  is  very  important  that  once  someone  has  been  diagnosed  to  be  diabetic,  they  should  Kisukari magazine â &#x201E; 17
Obesity & Diabetes
Obesity & Diabetes
By: Ranjan Patel Nutritionist, Diabetes Educator.
In traditional cultures weight gain is regarded as an indicator of wealth DQG D WKLQ SHUVRQ LV ORRNHG XSRQ DV SRRU RU ZRUVH VWLOO SUREDEO\ DIÀLFW- ed with HIV/AIDS. But that is far from the truth. The rapidly industri- alizing world has given birth to a highly mechanized society. The urban population is exposed to fast and junk foods, which are calorie laden DQG QXWULHQW GH¿FLHQW DQG WKLV VLWXDWLRQ LV ZRUVHQHG E\ LQGLVFULPLQDWH advertising and marketing. The alarmingly high rate of obesity in both adults and children has cascaded into other Non-Communicable Diseases such as Type 2 Dia- betes. The fact that obesity and Type 2 Diabetes are closely associated, have been proven by many studies. Obesity is a strong risk factor for developing Type 2 Diabetes while weight-lose improves the manage- ment of blood glucose levels in diabetic people.
“Diabetes and obesity are the biggest public health challenges of the 21st century” (International Diabetes Federation)
Type 2 Diabetes is linked to insulin resistance where cells become less sensitive to insulin, a hormone produced by the pancreas in response to glucose in the blood. Fat cells are more resistant to insulin than muscle cells. As obese people carry more fat cells than muscle cells, this predisposes them to developing Type 2 Diabetes. Losing just 5-7% of ERG\ ZHLJKW FDQ PDNH D ELJ LPSDFW LQ WKH HI¿FDF\ RI PHGLFDWLRQV DQG dramatically slow the progress of the disease, thus reducing long-range complications.
source: www.sugardelite.com
So why is the population of the world growing wider at the girth? The answer is simple- we are eating more and moving less. We are consum- ing highly processed foods heavy in unhealthy fats, sugars and salt. 7KH QXWULHQWV DQG ¿EUH IURP QDWXUDO IRRGV KDV EHHQ VDFUL¿FHG IRU WKH KLJK GHPDQG IRU WKH VRIW DQG ZKLWH EUHDGV DQG ÀRXUV 0RVW LPSRUWDQW- ly, we have moved away from our traditional food habits. Prevention of obesity must start early in life. Healthy eating and active lifestyle education needs to be reinforced from early childhood. As we all know you can’t teach an old dog new tricks.
18 ⁄ Kisukari magazine
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Right to care
Diabetes and your Right to Care By: Jonah Mngola
K
enya’s new constitutional dispensation has brought in and recognized a foray or rights. Article 26 of the Constitution recognizes the right to life and emergency treatment, it provides for the protection of such a right.
Article 27 delves into the right to equality and freedom from discrimination, it places an obligation on the part of the State and every person not to discriminate directly or indirectly against any person based on their health status. It goes on further to provide that the State shall take legislative and other measures to give full effect to the realisation of such a right. The right to equality and freedom from discrimination goes hand in hand with the right to human dignity as provided for under Article 28 of the Constitution. 20 ⁄ Kisukari magazine
These rights are not to the exclusion of Diabetics and one must recognize their fundamental importance as there are enshrined in the Constitution of Kenya, which is the supreme law of the Republic of Kenya and binds all persons and all state organs vide Article 2 of the Constitution. This means that a Diabetic enjoys the right to life and the right to emergency treatment, thus it is on that basis that medical institu- tions, medical practitioners, the state or any other person cannot deprive them of such rights. Diabetics, both the young and old, come face to face with stigmatization. Stigmatiza- tion can be done away with through Diabetes education and awareness, dissemination of adequate information on diabetes to Diabetics
and the general public. The state has a part to play in ensuring in ensuring equal protection of diabetics and their freedom from stigmati- zation. All these constitutional fundamental rights and freedoms enjoy the equal protection of the law and authority is vested upon the courts to uphold and enforce such rights vide Article 22 as read together with Article 23 of the Constitution of Kenya. Courts may grant such appropriate relief’s including;; a declaration of rights, an injunction, a conservatory order, a declaration of invalidity of any law that denies, violates, infringes or threatens a right or fundamental freedom in the Bill of rights, an order for compensation;; and an order for judicial review.
References: Harrison’s, Principles of internal medicine, 18th edition;; Prevention of Blindness from Diabetes Mellitus, A WHO consultation in Geneva, Switzerland November 2005.
Diabetes care...
DIABETES
EDUCATION
its role in Diabetes care By: Atieno Jalangâ&#x20AC;&#x2122;o
source: Â www.oopgo.com
It is very important that you attend a recognised education program to ensure you are capable to take care of your diabetes safely.
D
iabetes  is  a  lifelong  disorder.  It  is  results  from  the  body  not  being  able  to  use  glucose  that  we  get  from  food.  Your  body  may  not  produce  any  insulin  resulting  in  type  1  diabetes;͞  or  it  may  be  resistant  to  insulin  action  causing  type  2  diabetes.
If  you  have  diabetes  you  have  to  maintain  a  balance  between  your  energy  you  take  in  (from  food)  and  the  energy  you  use  (in  exercise  and  body  processes).  If  the  balance  is  lost  it  can  either  result  in  high  or  low  blood  glucose.  To  have  a  good  quality  of  life  you  need  to  have  blood  glucose  controlled  at  between  4  â&#x20AC;&#x201C;  8mmols  or  at  least  not  above  10mmols.  If  you  are  able  to  do  this  then  you  can  enjoy  a  fairly  long  life  without  many  complications.  If  you  are  poorly  controlled  you  are  more  likely  to  develop  complications  early  and  you  may  not  live  long.  Apart  from  blood  glucose  control,  educa- tion  enables  you  adjust  your  lifestyle  and  adopt  healthy  living  patterns. Diabetes  education  will  equip  you  with  the  necessary  skills  and  knowl- edge  to  enable  you  manage  living  with  Diabetes.  It  is  very  important  that  you  attend  a  recognised  education  program  to  ensure  you  are  ca- pable  to  take  care  of  your  diabetes  safely.  The  education  you  receive  is  IRU \RX WDLORUHG WR \RXU VSHFLÂżF FLUFXPVWDQFHV LW ZLOO GHSHQG RQ \RXU age,  sex,  occupation,  lifestyle  etc.  The  association  is  currently  facilitating  the  roll  out  of  a  new  interactive  Diabetes  Education  tool  in  Kenya.   Conversation  Map  tools  engage  three  to  ten  persons  living  with  Diabetes  in  a  meaningful  session  that  enables  them  learn  from  each  other,  set  diabetes  care  goals  and  work  on  them.  Anyone  who  is  interested  can  contact  the  association  to  be  booked  for  a  session.  It  is  therefore  important  you  know  what  and  when  to  do  for  good  out- comes  with  Diabetes.  In  our  next  issues  we  will  be  looking  at  what  you  need  to  know  on  different  aspects  of  Diabetes  care. Â
You are welcome to send us questions or suggestions to The Educator - KISUKARI Email : kdiabass@yahoo.com Tel : 0722 297 071 Kisukari magazine â &#x201E; 21
Children &
Diabetes
source: Â www.macleans.ca
By: Dr. Farah Sherdel
22 â &#x201E; Kisukari magazine
our children...
A little about diabetes Diabetes means too much sugar(glucose) in the blood. Sugar comes from the foods we eat not necessarily just the sweet stuff but also foods like bread, cereals, pasta, rice, fruit, starchy vegetables and dairy items. When food gets digested it is also broken down into sugar that your body needs for energy to run and play! The pancreas which lies behind your stomach then produces Insulin (key) a hormone that opens the door to all body cells (door) for glucose to enter and give you energy!
QUESTION: So how do you get diabetes?? ANSWER: If your key (Insulin) is missing completely (Type 1 diabetes) or its not working properly (Type 2 diabetes)
Symptoms SCRAMBLES Can you unscramble these words? The end result in both Type 1 and Type 2 diabetes is too much sugar in the blood, with little or none getting into the bodyâ&#x20AC;&#x2122;s cells. As a result of all this sugar circulating in the bloodstream, you might feel thirsty, tired, hungry, passing urine frequently and having blurry vision.
S I LU N I N EGSOU LC RSEAPNCAE TSEEIABD GY R E N E MROH ONE
Kisukari magazine â &#x201E; 23
24 â &#x201E; Kisukari magazine
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