Kisukari Magazine 04

A publication of Diabetes Kenya

ECONOMIC BURDEN OF DIABETES G.I INDEX Plan your meal

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RECIPE: Fillet with Pg 20 Shallot, Zucchini & Tomato

4th Edition - April 2015 KSH 200/-

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Only one third (36%) of physicians expect people with type 2 diabetes to make lifestyle changes following diagnosis**

Only 2 in 5 people with type 2 diabetes exercise more after diagnosis to reach blood sugar goals

T RE

NS

Yet, physicians only expect half (52%) of people with type 2 diabetes to reach blood sugar goals**

IM E

BLOO

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Only half (51%) of people with type 2 diabetes make dietary changes after diagnosis

Half of physicians agree that using two or more therapies early is important to control blood sugar levels and decrease the risk of complications

TR

Following diagnosis, two thirds (63%) of people with type 2 diabetes say they understand the importance of blood sugar goals

EN

DS UG AR

TA R

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GE

STY LIF E

Novartis Pharma AG partnered with leading medical experts to conduct a global survey of 337 physicians and 652 people with type 2 diabetes mellitus (T2DM) to examine the main reasons why CHAN GES people with type 2 diabetes do not reach blood sugar goals.3,4*

Less than half of physicians (49%) believe people with type 2 diabetes will take their T2DM medication as instructed

Lowd Sugar Bloo

Only 3% of people with type 2 diabetes fully understand the risks of hypoglycemia

Developing vision problems is the leading concern for people with type 2 diabetes, with half saying it is their biggest fear

Only 1 in 5 (21%) people with type 2 diabetes say heart disease is their top concern

More than 9 out of 10 (92%) physicians discuss the risks and complications of T2DM at diagnosis...

Yet, only half of people with type 2 diabetes recall the topics being discussed

S RISK ON S AND COMPLICATI For more information on this survey and T2DM, please contact sandra.waite@novartis.com Time 2 Do More in Diabetes™ was a global survey of physicians and people with type 2 diabetes, conducted by Novartis Pharma AG in collaboration with Dr. David Strain, Royal Devon & Exeter Hospital, UK and Prof. Matthias Blüher, University Hospital Leipzig, Germany. *The survey was fielded in the U.S., UK, Japan, Brazil, India and Spain **Physicians were asked to make their assessment based on an average 50 year old person with type 2 diabetes

REFERENCES 1. International Diabetes Federation. IDF Diabetes Atlas sixth edition, 2013. http://www.idf.org/diabetesatlas/introduction.

Accessed November 14, 2013.

2. Brown JB et al. Secondary failure of metformin monotherapy in clinical practice. Diabetes Care 2010;33(3):501-50.

3. Strain WD et al. Time 2 Do More: Addressing Clinical Inertia in the Management of Type 2 Diabetes Mellitus. Diabetes Research and Clinical Practice 2014. DOI: dx.doi.org/10.1016/j.diabres.2014.05.005 4. Time 2 Do More in Diabetes survey. Novartis data on file 2013.

2014 @ Novartis Pharma AG – Time 2 Do More in Diabetes™ is a trademark owned by Novartis AG

CONTENTS

PAGE 10

PAGE 18

PAGE 11

PAGE 20

Life for a Child There are over 20,000 children living with Diabetes in Kenya....

Contraception for Diabetics The complications of diabetes are becoming more common in women ...

GO Blue Breakfast People with both Type 1 and Type 2 diabetes can travel all over the world ....

Eat Well Fillet with Shallot, Zucchini & Tomato ...

PAGE 22

PAGE 6

Exercise in Children with Diabetes Exercise in persons with Diabetes makes one healthier and happier, whether one is playing a sport or exercising for fun or at a competition, Diabetes shouldn’t hold one back ...

Economic Burden of Diabetes All over Africa, patients struggle to buy syringes to self-administer insulin ...

PAGE 8

PAGE 23

But Nobody Understands Natasha hira tells us about her life with diabetes ...

Healthy Games

PAGE 12

Glycemic Index & Diabetes What are the effects of your blood sugar levels with every meal you eat ....

PAGE 16

Back to Basic Exercise How it helps you lose weight, sleep better and feel more energetic ...

Gold Sponsor

Chief Editor: Salwa Shahbal Graphic Designer: Nabeel Balala (bilobrown@gmail.com) Social Media Editor: Aggrey Shiundu Advertisement Manager: Dr. Gaman Mohamed Publisher: English Press Ltd Kisukari Magazine is a tri-annual magazine (3 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.

2 â „ Kisukari magazine

Vibrant 2015 EXPO 30th Jan 2015 Oshwal Grounds Diabetes Kenya participated with gusto at Hindu council of Kenya,Vibrant 2015 Expo held at Oshwal grounds from 30 Jan to 1st Feb. Over these three energy filled days, enthusiastic volunteers from Diabetes Kenya including Dr kirtida Acharya, Jalango Atieno, Ranjan Patel, Sushma Joshi and lochlabs staff worked tirelessly all day to screen, consult, educate, and empower patients. We were kindly given free tent space to share with Medanta Africare labs that carried out the same services. In addition there were motivational exercise sessions. Patients received free nutrition, education and specialist consultations. There were also adjuvant ophthalmic, dental and ENT services on site by colleagues, entertainment galore for all ages, and exhibits in the main hall.

On Sunday Dr Kirtida Acharya, National Chair Diabetes Kenya also gave a public lecture at the auditorium on diabetes and non communicable diseases and importance of preventing them. We are very grateful to the enthusiastic visionary National chairperson of Hindu council of Kenya Mr. Nitin Malde and his very able organizing committee Vibrant Expo Kenya for so cordially embracing and accommodating Diabetes Kenya Kisukari magazine â „ 3

Message

From the

Chairperson Dear Readers, Welcome to our 4th issue of kisukari the diabetes magazine that takes you through an amazing myriad journey into the enigmatic world of diabetes.

This edition focuses on world diabetes day and this year’s theme of blue breakfast day which was celebrated globally on November 14th here in Kenya. Diabetes Kenya and our enthusiastic partners celebrated at the sarova Stanley hotel with an energetic passionate programme with a powerful message. We kick started with a healthy sumptuous breakfast, spruced ourselves with

diabetes and non communicable diseases and nutrition. There was free screening for all present. There are many more interesting articles in this edition and we welcome inputs and feedback from our readers. This year IDF meeting will be on the idyllic freezing backdrop of Vancouver Canada where we will In the mean time keep healthy be happy and don’t forget to start your day with BREAKFAST!!

We were beautifully entertained by soulful music, guitar and vocals by talented type 1 diabetes musicians, watched enthralling dance performances by our young patients living with diabetes, were educated on

From the

Chief Editor Dear readers, of you are having a good 2015 so far. It’s our second year of print and I must say the journey has been one interesting learning curve for the whole Kisukari team. With this I would like to say that we at Diabetes Kenya decided to make Kisukari a tri-annual magazine to give our volunteers more time to give us their feedback. We are excited to diabetes and society at large and this year you will see new and exciting things happening with the magazine. several articles dealing with all aspects of diabetes from lifestyle, nutrition, exercising to complications, not forgetting our last page on diabetes and children. Our main article is dealing with the economics of diabetes having diabetes not only on the patient but also to the family and economy at large.

4 ⁄ Kisukari magazine

This is to show that diabetes has both direct and indirect effects on society and not just a disease for diabetes patients but also our full responsibility. We all need to stand together in As always I leave you till next time with some of my favourite quotes: “ I can do things you cannot, you can do things I cannot; together we can do great things.” Mother Teresa.

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

M0462

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

COVER story

ECONOMIC BURDEN OF DIABETES

By Aggrey Shiundu

P

revious Kisukari articles have explained that diabetes is a chronic illness that affects glucose metabolism in the body. Diabetes has no cure and for this it is essential that we look at the economic burden this disease has on the population. According to the World Bank, 72% of deaths due to chronic diseases occur in low-income countries. Regrettably, these countries bear the dual burden brought about by infectious and chronic diseases. Diabetes is undoubtedly for us a public health concern epidemiologically and economically. It accounts for 3.8 million deaths worldwide per year, a number similar in magnitude to the mortality attributed to HIV/AIDS. The American Diabetes Association (Association) released new research on March 6, 2013 estimating the total costs of diagnosed diabetes have risen to $245 billion in 2012 from $174 billion in 2007, when the cost was last examined.

All over Africa, patients struggle to buy syringes to self-administer insulin. In Kenya, where the per capita GDP is estimated at $1,200 a year, most diabetics, even with government subsidies, are still unable to afford diabetes health care and this goes beyond just insulin.

It also often happens that even when the patient has the means to pay for insulin, which in many African countries is listed as an essential drug, the shelves are empty. While the capital city quite often is well served, the peripheral areas remain well underserved. Even in the cities, the shortages are at times common.

In the last decade, diabetes has become a health problem in developing countries and has been found in a wide variety of atypical forms.

6 â „ Kisukari magazine

Its burden is huge in developing countries due to lack of basic means for reaching diagnosis and a reasonable glycaemic (blood sugar) control. The prevalence of type 1 diabetes mellitus varies from country to country in the African sub-region. The low number of health care providers with the requisite knowledge, expertise, and experience in the care of children with diabetes is another major issue. Diabetes of the patient population, their needs, medical problems, and social constraints

Economic and cost of management of diabetes mellitus The cost of management of diabetes mellitus is complex and multidisciplinary therefore expensive in poor resource countries where majority of the population live below a dollar per day. Diabetes mellitus exacts three broad categories of economic costs.

1.

Direct costs on health care: This includes costs on purchase of medications, and glucometers for those that can afford it. Also the cost on visits to the health care facility and to see the professionals both general and specialist and money spent on hospitalization both for the diabetes and diabetic complications

2.

Indirect health care costs: These include care of nursing homes and informal care by relatives. Societal expectations about the appropriate place for professional and informal care certainly

have important economic consequences. Relatives and friends, who care for the patient, may lose productive hours at their work or business.

3.

Productivity costs: This includes the loss of earnings from mortality and morbidity that is time taken by otherwise economic individuals with diabetes to treat their condition and disability associated with diabetes and its complications. In developing countries with scarce resources, it is still possible to put in place effective programs to combat diabetes. Some patients in developing countries travel great distances to medical care facilities, to attend to medical visits and check-up. This discourages individuals from seeking an early diagnosis and is lost to follow up.

Pain and suffering are also sometimes included in this approach.

A small study that looked at the economic impact of diabetes in Mombasa by Dr.Salwa Shahbal, concluded that patients spend upto 50% of their GDP on diabetes consults and medication alone.

Diabetic awareness, on the one hand, is one aspect that virtually all of Sub-Saharan Africa lacks. Studies have demonstrated that the lack of patient awareness on diabetes accounts for the high non-compliance rates leading to serious complications. This is propagated by the lack of national guidelines, poverty, and ignorance.According to the international diabetes federation atlas, 6th edition, the highest number of diabetic deaths in Africa occurs in patients who are less than 60 years old. Less than 60 years is still the working economy in Kenya and if we loose these patients this early this causes a tremendous challenge to the economic growth of our country.

The cost-of-illness (COI) approach This is a commonly used method that sets out to capture the economic impact of disease. It views the cost of NCDs (Non communicable diseases like diabetes) as the sum of several categories of direct and indirect costs. The categories typically considered in this approach are: personal medical care costs for diagnosis, procedures, drugs and inpatient and outpatient care; non-medical costs, such as the costs of transportation for treatment and care; non-personal costs like those associated with information, education, communication and research; and income losses.

We urge doctors in the country to take this up as a challenge and come up with research Kenya and we also urge all Kenyans that prevention is CHEAPER than treatment!

(Diabetes has no cure ‌‌ yet)

Kisukari magazine â „ 7

INTERVIEW

But NoBody UNDERSTANDS By: Natasha Hira

T

does not, and will not, ever limit you from eating anything or doing anything you desire.” A phrase that in those initial months you hear more often than you’d like from optimistic nurses, doctors, and most importantly family mem-

The advice from family members, who are undoubtedly strangers to type one diabetes, is somewhat inevitable. The one challenge of diabetes is that everyone around you believes that they understand you, and more importantly your condition. This of course is far from the truth.

The cold truth is that very few people around you will be able to relate. You’ll have all these problems that are somewhat alien to yours friends. They won’t understand how irritating it is to be woken up by a sensor because for some reason your blood sugar continues to plummet down. They won’t understand how unattractive the black freckles on with maintaining an HbA1C within normal range. And sometimes you’ll be somewhat jealous of those around you with perfectly functioning pancreases.

But if you ask me, that challenge becomes somewhat of a success in the long-run. The success you’ll feel when one day you maintain your blood sugar within the ‘normal’ range. The success of visiting your diabetologist with a clear idea of how to adjust your insulin settings, or actually operate the pump. And before you know it, you’re living a healthier lifestyle than 99% of your friends, with a sidekick pump attached to your pocket that always sparks conversation. Eventually, someone will ask you about your pump and continue to do so for the rest of your friendship. Like the friend of mine in university, who insists on asking me if I’m ‘okay’ every time I glance at my pump. Despite the fact that most people can’t relate to you (except of course fellow type one diabetics) its all worth it when one person can.

The people in high school, university or even at home may those who will try. Diabetes affects so much more than your health, it affects you socially. And for me, it’s brought me closer to people just by their willingness to attempt to relate to me. The friends of mine, who can probably sense symptoms of a hypo before I can myself, are friends I know I’ll always have around for a lifetime. And for those times, when even my friends and family can’t relate, I have a diabetes online community (DOC). The website I visit most frequently on a bad diabetes day is http://whatdiabetesshouldcallme.tumblr.com. Because on those days it’s pretty great knowing that despite all the ‘nonbetics’ around me, there are several other teenagers just like me!

8 ⁄ Kisukari magazine

DiabeTES & CHILDREN

Life For A Child

source: wikipedia.org

Program in Kenya By: Atieno Jalango

T

here are over 20,000 children living with Diabetes in Kenya. Most of them like their counterparts in developing nations do not have access to Insulin and other diabetes care supplies. Lack of Insulin thus remains a common cause of death in these children and many do not live beyond a year after diagnosis. It is estimated that 80100,000 children and youth around the world are in urgent need of assistance to enable them care for their diabetes.

The International Diabetes Federation “Life for a Child” Programme was established in 2000 with support from Diabetes NSW (formerly Australian Diabetes Council) and HOPE worldwide in response to the above challenges.

The Kenyatta National hospital Life for a child program commenced in 2012. The program is headed by a Paediatric Endocrinologist, Dr Lucy Mungai assisted by Matron Mujomba and a team of 3 nurses. The program operates under the auspices of the Paediatric endocrinology clinic that is held every Tuesday at the hospital, and currently takes care of close to 250 children with diabetes. The program enjoys cooperation from the hospital administration and the pharmacy department, the latter who assist with the storage distribution and accountability for the Insulin supplies. The program is also supported by the National Diabetes Association – Diabetes Kenya.

The program covers at least

Under the program the Children’s care and supplies will continue until they are twenty three years of age. The centre provide children with Diabetes the following services:-

Countries and over

Clinical care and follow-up of Diabetes / any co-morbidities Diagnostic services Diabetes Education Risk Assessment Counselling

children worldwide The program raises monetary or in kind donations from individuals, families or organisations in order to assist children living with diabetes in developing countries. Participating care centres receive supplies that enable them to provide the ongoing clinical care and diabetes education to children living with diabetes.

The centres in turn are accountable to the program management team based in Sydney, Australia. Each year each centre provides to the management team.

10 ⁄ Kisukari magazine

Apart from these the centre under the program has been able to collaborate with some of the parents of the children attending the clinic. They have come together and registered a support group. They encourage one another and together are exploring and working towards income generating activities, they also address psychosocial issues affecting them and their children.

The centre and the parents group, last year on the 6th and 7th of December 2014, held a diabetes camp at the resurrection Gardens in Karen, Nairobi. 30 teenagers attended the two day camp. They participated in a number of activities that included prayers, games, dances, chat time and edutainment (DVD shows, Q& A sessions) as well as Self-monitoring of blood glucose. The event was covered by a lo-

The Programme aims to provide on a graduated basis, care supplies in response to the needs of the given child population accessing the centre which include: t t t t t t

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The level of support will therefore differ from centre to centre. cal TV network – NTV. The bulk of the funding for the camp was from the LFAC and the rest from local companies. The centre hopes to partner with the local association to ensure the camp is held on an annual basis.

The LFAC program has not been without its challenges. Most of the earlier challenges during its initiation were addressed in collaboration with Diabetes Kenya and the hospital administration. Last year import challenges that saw the loss of a batch of Insulin have since been addressed and the future looks bright. The program does not address the economic challenges many of these children face, hopefully their parents will work towards addressing this.

LFAC at Kenyatta National Hospital is a lifeline for many Kenyan Children who would otherwise have succumbed to diabetes.

It has overcome numerous challenges and we trust it will raise future champions who will make a difference in our country.

contraception...

CONTRACEPTION FOR DIABETICS

By: Dr.Guled Yusuf Consultant Obstetrician/gynecologist, Agakhan Hospital Mombasa.

A

s a population subset we have a progressively increasing number of diabetics. Accord-

United States 1.85 million women of reproductive age ( i.e 18-44 years) have diabetes mellitus and an estimated 500,000 women of this age bracket have undiagnosed diabetes. The complications of diabetes are becoming more common in women of reproductive age; therefore there is a growing need for careful contraceptive counseling in women with diabetes. A contraceptive plan is essential for these clients, which takes into account the relative safety of methods available based on clinical evidence.

When considering contraceptive options for women with diabetes mellitus, assessing both highest for long term contraceptive methods, less for short term hormonal therapies and lowest for barrier/behavioural methods.

types of contraceptives available to women.

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Long Term Methods Contraceptives that don’t rely on active participation of the patient have the highest safety ratings for diabetics, regardless of severity of disease. The copper T IUD, Levonorgestrel intra uterine system and the sub dermal implant offer three excellent choices for patients.

Placement takes a few minutes and provides long term reversible contraception (5- 10 years) with rapid return to baseline fertility after removal. The intra uterine devices exert their effects by impairing sperm motility, thickening of cervical mucus and prevent implantation. The sub dermal implant releases low levels of progestin causing ovulation inhibition and thickening of cervical mucus.

It has no effect on carbohydrate metabolism and hence no effect on diabetes mellitus. The most common side effects of the implant are irregular bleeding and weight gain which can be a deterring factor for its use.

Short Term Methods These include the pills, the injectable, the vaginal rings and the transdermal patch. The pills are the most widely used contraceptives and confer very good contraceptive effect by inhibiting ovulation. The progesterone only for women who are breastfeeding exclusively women who cannot use estrogen containing contraceptives due to risk of clot formation.

The combined pill, the patch and the vaginal ring all contain both estrogen and progesterones. The combined pill is taken cyclically for 3 weeks with 1 week breaks for your menses the ring monthly. Combined contraceptives have an added advantage in that they confer These include improvement in acne, reduction of dysmenorrhoea, decreased menstrual Estrogen containing contraceptives are generally not recommended for women who have had diabetes for more than 20 years and also for those with proven end organ damage or at risk of developing blood clots. With careful selection in consultation with your doctor these methods have been found to be very safe for diabetics.

Progesterone Only Contraceptives These include the progestin only pill and

the transdermal patch already discussed and depomedoxyprogesterone acetate (DMPA) commonly referred to as depo. It is administered every 3 months and is widely used and preferred in our country because it provides excellent contraceptive cover and is private.

However it has an adverse effect on lipid and carbohydrate metabolism and is therefore NOT recommended for diabetics.

The rest of the methods listed in our table above require a lot of input from the user and are dependent on user consistency thereby not to discourage diabetics who are disciplined and for whom this works. The choice of contraceptive method is a personal one at the end of the day. To this end the healthcare The following is a list of questions that will help you in making that crucial decision.

1.

2.

3.

4.

How long before your next pregnancy.

Is it months, 1 year, 5 or more years?

What contraceptive methods have you used in the past? Any pros and cons?

How frequently do you want to take or change your birth control?

Do you have any other risk factors that would limit your options for example smoking, age over 35, a history of a heart attack, stroke or blood clot, uncontrolled high blood pressure, migraines with visual changes and liver or gall bladder disease.

In conclusion we have seen that most forms of reversible contraception are safe for use by diabetics. The permanent methods i.e sterilization is safe for both males and females who have completed their desired family size. From our discussion it is apparent that contraceptive counseling is essential for women with diabetes mellitus. This is because physicians are so focused on the diabetes management that they are less likely to have this discussion on contraception with their patients. Physician need to address contraceptive choices with their patients with diabetes mellitus because use of appropriate contraceptive results in lower risks of morbidity and mortality compared with the risks of pregnancy. Talk to your doctor to further explain the best choice for you.

Kisukari magazine â „ 11

GI & DIABETES

Glycemic Index & Diabetes By: Dr. Farah Sherdel

T Knowing the GI index is good for meal planning & portion control and should not act as a barrier for diabetic patients to enjoy their food!

12 ⁄ Kisukari magazine

he glycemic index, or GI, is a measure of how a carbohydratecontaining food raises blood glucose levels. Foods are ranked from 0-100 based on how they compare to a reference food, usually either glucose or white bread. A food with a high GI will raise the blood glucose levels more than a food with a low or medium GI.

What happens when you eat a meal?

GI charts only identify the effect different foods have on your blood sugar levels when eaten alone but say nothing about the amounts. Therefore, portion sizes are still relevant in maintaining blood glucose levels.

The GI of a food is different when eaten alone than it is when combined with other foods. Remember when combining different GI foods, the overall GI of the meal changes.

Meal planning when eating a high GI food, for instance, involves combining it with other low GI foods to balance out the effect on blood glucose levels.

Remember using the GI may be helpful in there is no one diet or meal plan that works for everyone with diabetes. What’s important is to follow a meal plan that is suited to your personal preferences, lifestyle and helps to achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

What Affects the GI of a Food?

Several factors may affect the GI of the food.

The overall nutrient content of a food will affect its GI. Fat and protein tend to lower the GI of a food by affecting the absorption of carbohydrate.

This explains why chocolate, high fat crisps, whole milk have a low GI value.

Cooking method- how long a food is cooked. Al dente (‘until barely tender’) pasta has a lower GI than soft pasta.

Ripeness and storage time- The more ripe the fruit or vegetable the higher the GI The structure of the carbohydrate processed instant oatmeal has a higher GI than rolled oats. Due to processing, the starch in the instant oats is easily exposed to digestive enzymes, which in turn break it down and enter the bloodstream more rapidly causing the blood glucose levels to rise.

Some foods have low GI values which acts as a physical barrier, slowing down the absorption of carbohydrate into the blood.

Size of the grains- whole grain foods have a low GI than if they

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Kisukari magazine ⁄ 13

dk OVERVIEW

VISION: &YDFMMFODF JO UIF QSFWFOUJPO BOE NBOBHFNFOU PG EJBCFUFT MISSION: " %JBCFUFT 'SFF ,FOZB MOTTO: i"O "ODIPS PG )PQFw BHBJOTU UIF SJTJOH UJEF PG UIF EJBCFUFT FQJEFNJD JO ,FOZB OVERVIEW: 'PSNFSMZ DBMMFE UIF Kenya Diabetes Association

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MANDATE: t t t t t t

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OUR NETWORK: %JBCFUFT ,FOZB "TTPDJBUJPO XPSLT DMPTFMZ XJUI ,FOZB T .JOJTUSZ PG )FBMUI 0VS /BUJPOBM 0GGJDF JO IFBERVBSUFSFE JO /BJSPCJ BOE JODMVEFT CSBODI PGGJDFT DPVOUSZXJEF FOBCMJOH SBQJE EJTTFNJOBUJPO PG JOGPSNBUJPO BOE SFTPVSDFT XJUIJO 4UBUF BOE 1SPWJODJBM )FBMUI 'BDJMJUJFT THE NATIONAL EXECUTIVE COMMITTEE OF DIABETES KENYA IS ACTIVELY INVOLVED WITH: t t t t t t t

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%JBCFUFT ,FOZB JT QSJNBSJMZ B WPMVOUFFS PSHBOJTBUJPO BOE SFMJFT IFBWJMZ PO QFPQMF XJUI EJBCFUFT BOE UIFJS GBNJMJFT XIP QPPM UIFJS UBMFOUT TIBSF UIFJS LOPXMFEHF SFTPVSDFT BOE FYQFSJFODF BOE HJWF PG UIFJS UJNF UP IFMQ FBDI PUIFS 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. . .

stay fit

Exercise Back to basics By: Swaleh Balala

Six time triathlon national champion and fitness instructor

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16 ⁄ Kisukari magazine

“

Trying to manage diabetes without being physically active is like a singer performing without a microphone.

1 Get a Pedometer

6 Set specific, attainable Goals

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7 Don’t set goals too high

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8 Connect with a “mentor” or become one

2 Take a Walk

9 Test yourself regularly

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3 Get Into the Pool

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4 Working out with friends

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5 Reward yourself

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10 Use visual cues

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11 Write it all down

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12 Pick Up the Pace with Interval Training

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Kisukari magazine ⁄ 17

YEAR EVENT... the healthy choice can be the easy choice and the various steps that individuals can take to make informed decisions about what they eat.

Special focus will be placed on the importance of starting the day with a healthy breakfast.

All campaign activities will continue to be informed by the slogan “Diabetes: protect our future.”

The key messages of the campaign include: Healthy eating begins with breakfast Make healthy food the easy choice Healthy eating: make the right choice

GO BLUE FOR BREAKFAST

W.D.D 2014 HEALTHY EATING AND DIABETES By: Ranjan Patel Clinical Nutritionist, Diabetes Educator

W

orld Diabetes Day (WDD) is celebrated every year on November 14. It is the leading global diabetes

recognized by the United Nations and led by the International Diabetes Federation (IDF).

The World Diabetes Day 2014 campaign on healthy living and diabetes.

For 2014, IDF underlined the importance of the simple, cost-effective intervention that is a healthy breakfast, to lessen the global burden of diabetes and save billions in lost productivity and healthcare costs. The key messages of the campaign aim to raise awareness of how

The World Diabetes Day 2014 campaign saw the launch of a new initiative to engage the global diabetes community by encouraging everyone to GO BLUE FOR BREAKFAST by organizing a healthy breakfast activity in their local community on World Diabetes Day - 14 November - or during the month of November.

Diabetes Kenya Association marked this event with a sumptuous healthy breakfast and Hotel in Nairobi on Saturday 15th November.

Although a wet and gloomy morning, it did not deter passionate supporters of diabetes from turning up in large numbers. We had the pleasure of The Hon Mr Justice Richard O. Kwach as the chief guest. He gave an encouraging and motivating speech, in honor of the event. He highlighted the value of traditional foods and importance of exercise in preventing and managing diabetes. Justice Kwach gave his testimony with a touch of humour about his own experience with diabetes.

Invited VIP Guest Dr Joseph Kibachio, the Head of the NCD Control Unit from the Ministry of Health, emphasized the urgency to stated that treatment of the long-range complications of uncontrolled diabetes is not only unaffordable but also unavailable to majority of the affected people.

The Master of Ceremony Mr George Oraro of Family TV steered the whole program with ease and expertise. Starting with an introductory speech by the Chairperson of Diabetes Kenya Association, Dr. Kirtida Acharya.

There were performances by our very talented young artists most of whom are people living with diabetes.

Miss Khyati Gala living with Type 1 diabetes, very eloquently gave an insight of how it has been for her growing up with diabetes. Miss Deshna Shah living with Type 1 diabetes enthralled the crowd with a dance performance of Bharat Natyam, an Indian traditional dance.

An extremely talented musician Michael

Njenga, who lost his sight to inadequately managed diabetes, entertained the audience with traditional musical instruments and singing.

Mike Stone who has beaten all odds of Type 1 diabetes and come out a winner serenaded the people with his guitar strumming.

At one time the stage came alive with a group, demonstrating expert Karate moves. These enthusiastic and agile young people together with their coach Caleb Atemi of Taikan Academy had traveled all the way from Thika to support this event.

Apart from the entertainment that morning there was also informative and educational presentations on Lifestlye and Nutrition by Alice Ojwang and Ranjan Patel.

The highlight of the day was the vast array of beautifully served food meeting everybody’s palate. The fruit display was very enticing and appetizing. The guests were lost for choice when it came to the cakes, scones, biscuits and pastries. Many of who could not believe that people with diabetes can also be allowed to indulge in these delicacies.

Traditional foods like arrowroots, cassava,

The key point to be noted was that this display was an educational demonstration highlighting choice, variety, tradition and culture. sweet potatoes and green vegetables also featured on the menu. Not to be missed were the traditional Indian breakfast dishes too. All guests heartily enjoyed the breakfast and jokingly made promises that they will start each day with breakfast. It was unanimously agreed that everybody ate and learnt at the same time.

Truly a breakfast not to be forgotten.

A great applause goes to the diabetes screening team who took this opportunity to patiently test for blood sugars for anybody who wished.

Diabetes Kenya owes the success of this event to our volunteers and the generous support of our pharmaceutical partners and donors.

Diabetes Kenya wishes to acknowledge the support of The Asian Weekly and Family TV for media coverage, Sarova Stanley for hosting the event and Julian Manjahi for the photography.

Kisukari magazine ⁄ 19

EAT WELL

Image: glamourinthecounty.com

Fillet with Shallot, Zucchini & Tomato Calories 195 Carbohydrate 10 g Dietary Fiber 3g Cholesterol 35 mg Saturated Fat 0.7 g Sodium 520 mg Fat 4.5 g Protein 26 g 20 â „ Kisukari magazine

This Recipe Serves 4 people This dish is filled with color and extra nutrients from the added veggies.

INGREDIENTS

PREPARATION

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SOURCE: www.diabetes.org

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DiabeTES & CHILDREN

EXERCISE IN CHILDREN -*7*/( 8*5) %*"#&5&4 By: Dr.Gaman, consultant diabetologist.

E

xercise in persons with Diabetes makes one healthier and happier, whether one is playing a sport or exercising for fun or at a competition, Diabetes shouldn’t hold one back. Many of the people with the best-controlled Diabetes are those who exercise regularly and making exercise part of ones life from an early age is useful.

Why Is Exercise Important?

It lowers blood sugar levels and helps people feel better and boosts ones mood It helps maintain proper body weight and builds muscle Help keep the heart rate and blood pressure lower Reduces fat levels in the blood It may help improve blood circulation to the feet All exercise is great — from walking home from school or walking to the kiosk to buy milk and bread or riding a bicycle in the estate at home to playing team sports. The biggest challenge is always the start but once you start and feel better, it’ll be easier to continue. Worth noting is the BEST EXERCISE IS THE ONE YOU LIKE if you hate Jogging or swimming but you do it because you are told, you probably wont exercise regularly and you will always look for excuses.

One way of making exercising fun is to turn it into a game and do it with your friends!

Exercise Tips Check your blood sugar: Your doctor will tell you when to test your blood sugar. You might need to do it before, during, and after exercise.

Insulin: Your doctor might also might advice you on changes in your insulin dosage for exercise or sports. Try and avoid 22 ⁄ Kisukari magazine

injecting insulin in the part of your body used for your sport before practice (like injecting your leg before playing football). This may cause a faster than anticipated action of the Insulin and may cause a low blood sugar Eat right and carry water and snacks: You might need extra snacks before, during, or after exercise and your Doctor or Diabetes Educator can advise on the type of snack and amounts .You may need to snack and drink water while playing.

Carry your supplies: If you will be exercising away from home, carry testing supplies, Insulin medications, your emergency contact information Inform your close friends or teachers: Your close friends should know that you are Diabetic and what they need to do incase you have a low blood sugar and need help.

Ketones: Children with type 1 Diabetes shouldn’t exercise if they have substances called ketones in their blood. This normally occurs when ones blood sugar is high (above 13 mmol /L) when this happens, exercise can make things worse, and out if you have ketones and they are also glucometers than can measure ketones in the blood What to Watch For during exercise During exercise one may get a low sugar (hypoglycaemia) or a high sugars (hyperglycaemia). Higher sugars can occur if one starts exercise with high sugars.

You may have low blood sugar if you are:

You may have high blood sugar if you:

When feeling any of the above one should stop playing a sport or exercising and check their blood sugar and or take appropriate action including talking to your parents or consulting your Doctor if needed.

TV, play station and mobile games are not part of exercising! These actually encourage snacking and hence risk of weight gain.

In conclusion Diabetes shouldn’t be an excuse for someone not to exercise. It is possible to plan or mold exercise around your Diabetes.

Healthy GAMES

Jobs & Careers

Crossword

Kisukari magazine â „ 23

The Division is organized into global business franchises and an Oncology business unit responsible for the commercialization of various products:

Cell and Gene Therapies