Each one teach one: training students for diabetes and nutrition peer education in schools

OBJECTIVE: To provide a Diabetes (DM) in-school support system; to enable peer education in a general setting without discrimination. DESIGN AND METHODS: 200 student leaders aged 10-14 were chosen from 18 schools. We used the Novo Nordisk “Changing Diabetes in Children” presentations to teach about DM and Nutrition. 162 questionnaires were given to assess the students’ knowledge of type 1 DM. RESULTS: 22 (13.5%) students said in type 1 DM the body makes insulin but more insulin is needed, while 67 (41.4%) said the body does not make insulin and the treatment is pills and plenty water only. 33 (20.4%) said Diabetes affects only old people, 126 (77.8%) said all children can get DM. 157 (96.9%) said eating a variety of vegetables, legumes and some fruits are important in Diabetes management. 11 (6.8%) and 9 (5.6%) respectively, said if their friend had Diabetes they should not play or talk with them anymore and 142 (87.7%) said they should show love and support. 147 (90.7%) said if they learnt about Diabetes, everyone should learn too, 15 (9.3%) said they should keep it to themselves, share with family or “their secret keepers” only. 96 (59.3%) said children with Diabetes can take part in all activities and 23 (14.2%) said if they have DM they cannot go to school. CONCLUSION: Diabetes and nutrition education is necessary for understanding the illness and to facilitate students with DM. Good teaching aids are needed and the “Changing Diabetes in Children” tools were beneficial.

The incidence and prevalence of type-1 diabetes mellitus

AIM: To determine the incidence, prevalence of type-1 diabetes mellitus (DM) and the presence of islet-cell antibodies (ICAs) in people of African ancestry in the Bahamas. METHOD: Hospital records of type-1 DM were reviewed. Seventeen consecutive patients had postmeal C-peptide and ICA determined. RESULTS: The incidence and prevalence of type-1 DM in the Bahamas were: incidence:- 10.1/100 000, age 0-14 years; and prevalence- 31/100 000, age 0-24 years. Only two out of 17 (11.8 per cent) patients had ICAs. CONCLUSION: Type -1 DM is common in children of African ancestry in the Bahamas. ICAs were absent in the majority of patients.

Glycaemic control and cardiovascular risk factors among patients with Type 1 diabetes mellitus in Trinidad [abstract]

Healthcare providers working at the primary care setting are often faced with the challenges of providing standard medicare in the absence of adequate resources and facilities. We assessed long-term glycaemic control and cardiovascular risk factors among patients with Type 1 diabetes mellitus at primary care clinics in an attempt to suggest an intervention programme to prevent long-term diabetic complications. Twenty-five (14 females, 11 males, mean age: 53.7 ñ 3.2 years) patients with Type 1 diabetes mellitus (mean (SE) duration: 15.7 ñ 2.0 years) attending two primary care clinics in Trinidad were studied after an overnight fast. Weight, height, waist and hip circumferences and blood pressure were measured and blood sample was taken for glucose, glycated haemoglobin, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and creatinine determinations. There were no significant differences in the glycaemic exposure and the measured cardiovascular risk factors between male and female patients (p> 0.05). However, more than one-half (56 percent) of the patients had truncal obesity while 96 percent had glycated haemoglobin levels> 7.0 percent. The prevalence rates of hypercholesterolaemia (84 percent), hypertriglyceridaemia (28 percent) and increased LDL-cholesterol levels (88 percent) were high. About 48 percent of the patients had diastolic blood pressure> 83mmHg while 40 percent had total-cholesterol/HDL-cholesterol ratio greater than 6. We report that patients with Type 1 diabetes mellitus attending primary care clinics in Trinidad had poor glycaemic control and high levels of classical cardiovascular risk factors. These patients are at great risk of progressing to cardiovascular disease and therefore efforts at strict glycaemic control and protection against long-term diabetic complications should be intensified at primary care levels. (AU)

Diabetes in the Caribbean

For the past 20 years, diabetes mellitus has been among the leading causes of death in the Caribbean. Its prevalence is set to double within the next two decades. Its potential to cause incapacity and premature death in individuals in the prime of their economic life has serious implications for the Caribbean and for developing countries throughout the world. From an epidemiological viewpoint, type 2 diabetes mellitus contributes the major burden, accounting for up to 90 percent of caseload. Not surprisingly, much more data are available for this form of diabetes. Most of the remaining 10 percent of cases are of type 1 diabetes but also part of the picture is J-type diabetes, which was originally introduced to the world literature from Jamaica in the 1950s. It represents an unusual and interesting form of diabetes that has since been recognised outside the region. Increased awareness, improved diagnosis, screening of high-risk individuals and groups, and strategies aimed at prevention of obesity are all crucial. At the same time, there is a need to address the huge gaps in the availability of care, as well as the quality of the care itself. We must face up to a situation which involves increasing disease burden, scarce resources, inaequate services, and poor attention to the quality of care. Cost-effective systems are required that are specific to Caribbean needs. Recent elucidation of the pivotal influence of the in-utero environment in programming future cardiovascular risk offers a strategic leverage point for intervention. Close attention to maternal health, ensuring a healthy fetal environment, could positively influence the next generation (AU)

Prevalence of open angle Glaucoma in a diabetic population in Martinique [abstract]

PURPOSE: To determine the prevalence of open angle glaucoma in a hospital based sample of diabetic patients living in Martinique. METHOD: A retrospective study was conducted over 23 months. A total of 917 diabetic patients were examined, and received complete eye examination. A chart was established with all examination data, patient ID, non-ophthalmological data (blood pressure, body mass index, type of diabetes...) and ophthalmological data with intraocular pressure and optic disc cup. RESULT: Glaucoma was present in about 9.8 percent of patients and there were 3.28 times more females than males. With the type of diabetes: 1.11 percent were Type 1, 18.89 percent were type 2, and 80 percent were insulin treated but not all insulin dependent. CONCLUSION: The prevalence of the dibetic retinopathy is similar in the glaucomatous group to that in the non-glaucomatous group. High blood pressure was present in 80 percent of glaucoma patients versus 58.8 percent in the non-glaucoma group. The 9.8 percent prevalence of glaucoma represents the first data on open angle glaucoma ever measured in Martinique. High blood pressure is a major risk factor for glaucoma in Martinique. Diabetes also represents a risk factor for glaucomas in Martinique. The female:male ratio was 3:1. (AU)

The role of C-peptide in the classification of Diabetes Mellitus

We investigated twenty-one insulin-using patients, who had all been labelled as having diabetes mellitus (IDDM) or type one diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.(AU)

A survey of knowledge, attitude, practice and perception of Diabetics on insulin therapy in St. Thomas, Jamaica

This cross sectional survey of diabetics on insulin therapy sought to identify the level of knowledge of patients on insulin regarding diabetes and insulin therapy and to ascertain the preception, attitudinal and behavioural practices of these clients as it relates to insulin therapy and self administration in St. Thomas, Jamaica. A total of 107 clients were interviewed using a structured questionnaire which was administered as an interview schedule. Three focus group discussions were also conducted. Knowledge was high in the area of responses to whether or not insulin lowers the blood sugar, what is to be done if the respondents felt bad after taking insulin and also where insulin is injected. The highest percentage response to the question assessing knowledge was found in clients who used insulin between 5-9 years. There was poor knowledge in the questions addressing identification of insulin by type and brand and in addition most persons felt it was alright to miss insulin for a day. This could influence the practices being carried out by diabetics and quite likely place them at high risk for hypoglycaemia and hyperglycaemia. Most respondents had a fair attitude towards insulin therapy when compared to the length of use of insulin. Most persons also showed a fair attitude towards their treatment particularly those with over ten years of use. The role of health education and other types of support for diabetics on insulin therapy were identified among factors that could facilitate better as it impacts readily on these clients especially the elderly and the indignet in their ability to care for themselves (AU)

Diabetes in the Caribbean

The dawn of the 21st century will see a 51 percent increase in the prevalence of diabetes mellitus in the Caribbean. In 1994 there were 105,000 cases of Type 1 diabetes (IDDM), and 913,000 cases of Type 2 (NIDDM). By the year 2010, it is estimated there will be 184,000 and 1,597,000 cases respectively. These trends are thought to be a result of rapid cultural change with a consequent impact on diet and lifestyle, which is further compounded by an ageing population. The role of diabetes education is well recognised and healthcare workers are helped by influential community members who are empowered as 'lay diabetes facilitators' and who will help to manage the condition in the community. More epidemiological studies are being made as these small island nations undertake an assessment of the burden diabetes places on their society and economy (AU)

Diabetes in the peri-menopausal period - position statment

OVERVIEW OF DIABETES MELLITUS: Diabetes mellitus is a common disorder among Afro-Caribbean people. Generally, two types of diabetes mellitus are recognised: a). IMMUNE MEDIATED DIABETES (Type 1 or "Juvenile on-set") In this order, the insulin producing cells of the pancreas are destroyed, leading to failure in the production of insulin. b). The more common - Type II (approximately 90 percent) in which there is a relative lack of insulin production or an inability to utilize insulin properly. This type tends to occur in overweight persons of 45 years old or more. The tendency to both types of diabetes is inherited. In addition, diabetes can present for the first time in pregnancy. The hormone of a normal pregnancy can block the normal action of insulin, causing the mother to have a relative resistance to insulin. This condition occurs in about 5 percent of all pregnant women and is called Gestational Diabetes. The signs and symptoms of diabetes mellitus. *High blood sugar levels, *High urine sugar levels, *Frequent urination, *Extreme hunger, *Extreme thirst, *Extreme weight loss, *Weakness and tiredness, *Irritability and mood changes, *Nausea and vomitting, *Repeated prolonged infections (skin, gums, vagina), *Blurred vision, *Tingling in the hands and feet, *Dry itchy skin, *Coma. The gestational diabetic is frequently asymptomatic. Diabetes, if uncontrolled, is a silent killer, leading to blindness, kidney disease, circulatory and nerve disease leading to amputations, heart disease and stroke. Many people do not become aware that they have the disease until one of the complication develops. DIABETES IN OBSTETRICS AND GYNAECOLOGY: Diabetes is a multi-symptom disorder and has long been known to affect the function of the female genital tract. The onset of the first period may delayed in the diabetic pubertal female. During the reproductive years, uncontrolled diabetes may similarly delay or prolong periods. The patient has frequent episodes of vaginal candidiasis and fungal intertrigo. The absence of frequent periods in the diabetic woman who is well controlled leads to an increased likelihood of endometrial cancer later in life. The diabetic pregnant women (whether the diabetes existed prior to pregnancy or not) has further risks. The uncontrolled diabetic who becomes pregnant has a higher risk of fetal abnormality (AU)[tructated at 2500 characters]

Diabetes education for the adult - position statement

An overview of the challenge in providing diabetes education for the adult induces consideration of: diabetes education components which are relevant; nutrition as the cornerstone of diabetes treatment; and cultural and societal influences on eating behaviours and food choices. In providing nutrition education, current recommendations suggest categorisation of goals of nutrition therapy for type 1 and for type 2 disease. Thereafter, an individualised medical nutrition therapy is advisable. This involves oulining components of the nutrition assessment and personal goals, devising strategies and tools for successful implementation and evaluation. In the final analysis, the question must be asked: "Can we make a difference?"(AU)

A survey of knowledge, attitude, practice and perception of diabetics on insulin therapy in St. Thomas, Jamaica

This cross-sectional survey of diabetics on insulin therapy sought to identify the level of knowledge of patients on insulin regarding diabetes and insulin therapy and to ascertain the perception, attitudinal and behavioural practices of these clients as it relates to insulin therapy and self administration in St. Thomas, Jamaica. A total of 107 clients were interviewed using a structured questionnaire which was administered as an interview schedule. Three focus group discussions were also conducted. Knowledge was high in the area of responses to whether or not insulin lowers the blood sugar, what is to be done if the respondents felt bad after taking insulin and also where insulin is injected. The highest percentage response to the question assessing knowledge was found in clients who used insulin between 5-9 years. There was poor knowledge in the questions addressing identification of insulin by type brand and in addition most persons felt it was alright to miss insulin for a day. This could influence the practices being carried out by the diabetics and quite likely place them at high risk for hypoglycaemia and hyperglycaemia. Most respondents had a fair attitude towards insulin therapy when compared to the length of use of insulin. Most persons also showed a fair attitude towards their treatment particularly those with over ten years of use. The role of health education and other types of support for diabetics on insulin therapy were identified among factors that could facilitate better practices. Keen attention should be paid to the socio economic environment as it impacts readily on these clients especially the elderly and the indigent in their ability to care for themselves.(Au)

Yoga exercise versus traditional exercise in the control of non-insulin diabetes mellitus - Poster presentation

The sample population was selected from 3 municipals of Havana City. The population size was selected using the programme EP16 with the option statcalc. From a population size of 17,068 diabetics, a sample size of 100 diabetics was calculated as the minimum population size required to obtain a confidence level of 95 percent. Patients were divided into two groups (yoga and traditional group) and were matched according to the following criteria: Age +/- 5 years, Sex, Type of treatment, Evolution of NIDDM, BMI. The two groups of 63 diabetics were matched according to the criteria described above and were then grouped as "yoga exercise group" and "traditional exercise group". Biochemical analysis was done at the start of the investigation, and included: HDL - C Tryglyceride, LDL - C, Total cholesterol, Glycated haemoglobin, Insulinic receptors, Microalbuminuria, Blood glucose, quantification of T3, T4 Insulin, GH, and TSH, Oxidative stress enzymes serum, creatinine. The Second Stage: Both groups had similar diet and practised their respective physical exercise at the same duration and frequency for periods of 3 and 6 months. The biomedical analysis was done at these intervals. The biochemical analysis at the start showed: In most cases there were alterations in lipid metabolism, renal function as seen as hyperlipidaemia and hypercortisolaemia and a reduction in the union and internalization of insulin in the receptors of lymphocytes. There was a correlation between GH and T4. These findings show that it is necessary to deepen the investigation of these patients as there exists a difference in the laboratory results and the clinical manifestations of endocrine metabolc diseases.(AU)

Knowledge, attitudes and practices of young persons with Diabetes and their caregivers in Jamaica

In the Caribbean diabetes is a leading cause of chronic ill health. It is rated between the fourth and fifth cause of mortality. The prevalence and incidence continue to rise. Insulin Dependent Diabetes (IDDM) is not as prevalent as non insulin dependent diabetes (NIDDM) but the mortality risk of IDDM is higher than of NIDDM. The quantitative cross sectional study was conducted from February to April 1998 to determine the knowledge, attitudes, and practices of young persons with diabetes, and their caregivers. The data was collected by telephone survey which were used as interviews to 27 young diabetics and 27 caregivers. Respondents were members of the Junior Diabetes Association and Camp Yellow Bird, as well as out-patients of the University Hospital and Bustamante Hospital for Children. The survey showed that the majority of caregivers and young diabetics had fairly good knowledge, attitudes and practices. The scores ranged from 51 percent for young diabetics to 70.3 percent for caregivers. The majority of young diabetics and their caregivers were concerned about the future of young diabetics. There were some areas which needed strengthening, such as education of self monitioring of blood glucose, insulin administration and the problems often seen as young diabetics (AU)

Knowledge, attitudes and practices of young persons with diabetes and their caregivers in Jamaica

In the Caribbean diabetes is a leading cause of chronic ill health. It is rated between the fourth and fifth cause of mortality. The prevalence and incidence continue to rise. Insulin dependent diabetes (IDDM) is not as prevalent as non insulin dependent diabetes (NIDDM) but the mortality risk of IDDM is higher than of NIDDM. The quantitative cross sectional study was conducted from February to April 1998 to determine the knowledge, attitudes, and practices of young persons with diabetes, and their caregivers. The data was collected by telephone surveys which were used at interviews to 27 young diabetics and 27 caregivers. Respondents were members of the Junior Diabetes Association and Camp Yellow Bird, as well as out-patients of the the University Hospital and Bustamante Hospital for Children. The surveys showed that the majority of caregivers and young diabetics had fairly good knowledge, attitudes and practices. The scores ranged from 51 percent of young diabetics to 70.3 percent for caregivers. The majority of young diabetics and their caregivers were concerned about the future of young diabetics. There were some areas which needed strengthening, such as education on self monitoring of blood glucose, insulin administration and the problems often seen as young diabetics.(AU)

The practical experience and diabetes

Exercise is frequently recommended in the treatment of diabetes mellitus. Recent studies have improved our understanding of the acute and long-term metabolic and hormonal effects of physical activity in both healthy controls and in people with diabetes. In insulin dependent diabetes mellitus (IDDM), exercise by itself does not have a significant effect on overall glycaemic control and should be encouraged primarily for its nonglycaemic benefits. Hyperglycaemia is the predominant risk associated with exercise in individuals in IDDM and can be reduced by adjusting the insulin and diet prescription in response to information obtained from frequent self-monitoring of blood glucose. In contrast, in non-insulin dependent diabetes mellitus (NIDDM), exercise improves one of the most prominent basic pathophysiologic features of this condition, namely, insulin resistance and, as a consequence, is an important component of management along with diet and/or drug therapy. In addition to the positive effects on overall glycaemic control, exercise in NIDDM also results in non-glycaemic benefits in these patients. The subgroup of NIDDM individuals who have mild moderately impaired glucose tolerance appears most likely to benefit from exercise. However, because people with NIDDM frequently have other concurrent medical conditions, the adverse effects of exercise, particularly in relation to cardiac risks, must be monitored. In both IDDM and NIDDM, appropriate medical screening and patient education before starting on an exercise programme are mandatory to achieve the best quality of life. It is an important component of the management of diabetes, but its role in the therapy for NIDDM and IDDM is clearly distinct. Since exercise programmes have not been shown to have a significant independent beneficial effect on glycaemic control in IDDM subjects, the emphasis must be on developing strategies to allow safe participation in exercise consistent with their lifestyles. Exercise is encouraged in IDDM for its importantly nonglycaemic benefits. Individuals with IDDM should be appropriately screened and educated before starting and exercise have to be individualized, general guidelines regarding frequency of self monitoring of blood glucose, nutrient adjustment, insulin dose regimen modification, and the choice of injection site are appropriate. The majority of diabetic patients have NIDDM.(AU)

The practical experience of exercise and diabetes

Individuals with diabetes mellitus are being encouraged to engage in regular sports and other recreational activities for a variety of reasons. These include personal enjoyment, to overcome a sense of feeling different from peers, to feel better from both a physical and psychological perspective, and to enjoy the numerous health benefits of regular activity. Increasing evidence supports the important role of increased physical activity levels in reducing cardiovascular risk, and important consideration in people with diabetes. The major challenge to the individual with type 1 diabetes and the health care provider is to devise a strategy to accommodate increased exercise safely without an excessive risk of acute metabolic decompensation. This is best accomplished with an individualized treatment algorithm which takes into account the patient's food and insulin pattern, the type and duration of exercise, and his or her previous experience with similar types of exercise. Because of interindividual differences, frequent testing of blood glucose levels is important to gauge the response to exercise. Development of an individual routine with regard to the time of day of exercise, and its relation to meals, allows for a greater degree of predictability of the response to exercise. Insulin regimens which provide increased numbers of injections (3 - 4 per day), or the continuous delivery of subcutaneous insulin, generally provide the patient with greater ease in making appropriate adjustments of insulin doses before and after exercise. In patients with type 1 diabetes, these include Multiple Dosing of Insulin regimens which provide short-acting insulin before each meal with bedtime intermediate-acting insulin, or the use of an insulin pump. The latter offers distinct advantages for the endurance athlete, who needs to provide a constant delivery of a small amount of insulin over the duration of exercise. Anecdotal reports of the use of fast-acting Humalog (lispro) insulin in the insulin pump suggest that this may allow for more rapid adjustments in insulin dosing immediately before and after exercise, without loss of glycaemic stability. In type 2 diabetes, the individuals is less prone to ketosis, but may s till develop marked hyperglycaemia due to exercise, especially if dehydration occurs. In addition, the usual presence of insulin resistance makes these individuals less likely to develop significant degrees of hypoglycaemia during or after exercise.(AU)

Exercise in the treatment of type 1 diabetes

REVIEW OF FUEL METABOLISM DURING AND AFTER EXERCISE: Increased skeletal muscle glucose uptake induced by exercise *regional effects (exercised vs nonexercise muscle) *type of exercise (concentric vs eccentric). Importance of skeletal muscle glycogen depletion and replention in glucose homeostatis. Role of the liver in glucose production *hormonal control. Ketone body metabolism *importance of ambient insulin and counterregulatory *hormone concentrations at the onset of exercise. Amino metabolism *acute catabolic effects of exercise *post-exercise anabolic effects of exercise. METABOLIC RESPONSE TO EXERCISE IN TYPE 1 DIABETES: Glycaemic response to acute exercise *dependence on ambient insulin concentratios *effects of intensity and duration of exercise *accelerated ketogenesis in the insulin-deprived state *intact net protein anabolic effect following exercise *altered mechanisms in the insulin-deprived state. CLINICAL EFFECTS OF PHYSICAL EXERCISE IN TYPE 1 DIABETIC SUBJECTS: Risks of hypoglycaemia *during exercise *following exercise, long-term benefits of increased physical activity *glycaemic control * cardiovascular risk factor reduction, Risk of worsening diabetic complications due to exercise *retinopathy *proteina *neuropathy *peripheral *autonomic *cardiovascular disease. CLINICAL STRATEGIES TO PREVENT METABOLIC DECOMPENSATION BY EXERCISE: Carbohydrate intake *before and during exercise *following evening exercise. MULTIPLE DOSING OF INSULIN (MDI) REGIMENS: adjustments of short-acting insulin preparations for exercise, regular vs humalog (lispro) insulin, insulin pump (CSII) therapy, regular vs humalog insulin. RESOURCES FOR THE PATIENT AND THE HEALTH CARE PROFESSIONAL: published materials, International Diabetes Athletes' Association (IDAA).(AU)

Exercise in the treatment of the pregnant woman with diabetes

There are no clear-cut studies of the effect of exercise in the pregnant woman with diabetes. Typically, the foetal heart rate is monitored to decided on the safety of the exercise and the prescription should be individualised. Even in pregnant women without diabetes, infants tend to be small for gestational age if the mother actively exercises or works hard during the pregnancy. Experimental work has proven that upper arm exercises are the safest from of exercise compared to bicycling, walking on a treadmill or rowing exercises. One study which administered arm ergometry exercises is gestational diabetes, achieved with insulin. The hormonal changes of a normal pregnancy are antagonistic to insulin action and this is compounded by the presence of diabetes. In gestational diabetes there is a decrease in insulin sensitivity. Benefits were first observed within 4 to 6 weeks of the initiation of exercise therapy, showing that exercise in gestational diabetes will obviate the need for insulin. Those who are already exercising and wish to continue, especially for those with diabetes for longer than 10 years, should undergo stress testing and the exercise specially tailored. Exercise is not generally recommended for pregnant women with type 1 diabetes. There are no clear-cut benefits for pregnant women with type 2 diabetes in terms of glucose control but there would be an increased sense of well being and physical conditioning.(AU)