Take Charge of Your Health
An article by Dr. Kirtland Culmer

Diabetes in the Bahamas
The September 4, 2000 edition of TIME magazine quotes from a report of a recent edition of a journal called Diabetes Care as follows:- “As a fat and happy U.S. gets fatter still, the incidence of diabetes is rising too, striking more people in younger and younger age groups---and threatening them with everything from blindness to amputations to heart attacks”. The heading of the Time article was headed The Diabetes Explosion. We have been having a diabetic explosion in ther Bahamas for a long time, and even though you may see many news items discusing this disease, we may be wise to take a look with a view to TAKING CHARGE.

In previous editions of this article, I discussed some of the most life threatening diseases like heart and cerebrovascular diseases, and how overweight, obesity and diabetes can impact on them. So many of my patients and my friends talk about themselves or others as having a “touch” of sugar so as to indicate that they do not really have diabetes. If you have a “touch”, you have the disease, and you should now learn how to deal with it. Diabetes mellitus is a group of diseases characterised by high levels of blood sugar resulting from defects in insulin secretion, insulin action, or both. Diabetes can be associated with serious complications and premature death, but if we take measures (take charge), we can reduce the likelihood of such consequences.

Diabetes is very common in the Bahamas. 50 to 60 percent of us will get diabetes at some time in life, and 50 to 65 percent of these will have high blood pressure as well. There are several types of diabetes:- Type 1 diabetes occurs when the pancreas no longer produces any or very little insulin. This accounts for 10% of diabetics. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not use the insulin effectively. 90 percent of diabetics are in this category. Gestational diabetes occurs in 4 percent of pregnancies and is a risk to mother and baby. Other types of diabetes result from some genetic diseases, surgery, drugs, malnutrition, infections, and other illnesses.

It is obvious that the most prevalent of the diabetes is type 2, and this is the one that demands the most attention. It used to be called middle age diabetes, and was assumed to be the least serious, but we are alarmed that we are now seeing type 2 in the twenties and thirties..especially in the overweight and obese. Diabetes is not contagious. It cannot be caught from anyone. It is a lifelong disease, therefore we must be strongly motivated to prevent or control it. Here are some of the complications that we may see especially if the disease is not controled. Heart disese is the leading cause of diabetic death. The risk of stroke is 2 to 4 times higher in people with diabetes. Diabetes is the leading cause of blindness in adults 20 to 74 years. Diabetes is one of the leading causes of end stage kidney disease requiring dialysis. Diabetes causes severe forms of nerve diseases. Perhaps the majority of limb amputations are due to diabetes. Dental diseases are common in diabetes. Diabetes causes complications in pregnancy. Diabetics are more likely to get infections.

The treatment for diabetes must be precise and consistent to maintain the blood sugar levels as close to normal as safely possible. Too high or too low may cause serious problems. Type one diabetics must take their daily insulin injections,and balance them with meals and activity, and close monitoring of blood sugar. Type 2 diabetics must adhere to their diet and or medications, blood testing, exercise and weight control.

Research to date has shown definitely that good diabetic control reduces complications. In the many years that I have been treating diabetics, I have seen very few complications in patients who adhere to their treatment regimen. I have seen tragic consequences in those who deny that they have the. disease, and those who treat it with indifference. I sincerely believe that some diabetics actually increase their life span to normal by their improved lifestyle changes, and probably outlive their so-called normal friends who continue a life of abuses. It is well documented that type 2 diabetes can be prevented by diet, exercise and significant weight loss. Tests are ongoing to prevent Type 1 diabetes by giving small doses of insulin to high risk individuals..those with a strong family history of the disease.

TAKE CHARGE OF YOUR DIABETES. Find a doctor who will monitor your diabetes control and check for complcations. Learn as much as you can about the disease from diabetes educators like nurses, dietitians,doctors,exercise specialists,and mental health counsellors. Plan your meals properly and carefully,have a well planned exercise program, take your medicines as indicated above, and get your tests as recommended by your doctor. You may also join the Bahamas Diabetic Association where you will find useful guidance, comradie, assistance and education.

The ultimate responsibility for your health lies with you, but whether you are a government clinic patient or a private patient, you need to have the knowledge to guide your doctor into giving the appropriate care. If you have insurance or are a member of a managed care plan, it would be of great benefit to you if they place great emphasis on the prevention of diseases and have a wellness program. Your diabetic team should consist of your doctor, nurse, dietitian, pharmacist, a foot doctor and an eye specialist (opthmologist).

Take note that in taking charge of your health, whether you are aiming at preventing diseases or managing an existing disease, the main effective theme is that of adopting a clean and healthy lifestyle. This will have a great resultant spin-off of health to your mind, body, and,please God, your spirit.