November is Diabetes Awareness Month and Wednesday, November 14 was World Diabetes Day.
During the month of November, all over the world, diabetes associations, public health units and community groups are organizing community forums, risk assessment screenings and general information sessions on diabetes.
This month the Canadian Diabetes Association (CDA) launched its “What a Cure Means to Me” campaign inviting people living with diabetes to share their stories.
These stories could result in a very thick book since an estimated nine million Canadians are living with diabetes or pre-diabetes – a condition that, left unchecked, puts people at risk of developing type 2 diabetes. In addition, more than 20 people are diagnosed with diabetes every hour on a daily basis.
Unfortunately, diabetes is a household name to many people from the Black community (people of African descent).
Experienced registered nurse, diabetes educator, founder and president of the Caribbean Chapter of the Canadian Diabetes Association, Kathy Nelson, knows diabetes like the back of her hand. Kathy lives with diabetes and lost her father to complications from the disease. Several of her siblings also have diabetes.
Since founding the Caribbean Chapter of the CDA in 1999, the chapter has been extremely active. Through the Caribbean Chapter’s monthly meetings with invited specialists (dieticians, optometrists, endocrinologists, chiropodists, exercise physiologists, cardiologists, etc.), Kathy has been able to provide one of the most comprehensive community-based diabetes education programs.
During Diabetes Awareness Month I thought it would be appropriate to have a conversation with Kathy about diabetes in the Black community.
What specific diabetes message needs to be repeated in the Black community?
We need to continue to strengthen our message around high blood pressure and its connection to diabetes. High blood pressure is a strong risk factor for the development of type 2 diabetes, the most common form of diabetes (over 90 per cent of cases). Many people in our community who are being treated for high blood pressure and/or high cholesterol, particularly if they are carrying extra weight around the waist, need to ask their physician to conduct a haemoglobin A1C test.
What is a haemoglobin A1C test?
The haemoglobin A1C test has become the recommended standard for type 2 diabetes diagnosis in adults. Previously a diagnosis of type 2 diabetes was made if your blood sugar levels were elevated following an overnight fast or a two-hour oral glucose tolerance test. The beauty of the A1C test is that you do not have to fast. It can be taken any time of the day.
Red blood cells have a 90-day life cycle before dying. The haemoglobin A1C test, done over a three-month period, gives an average of your blood sugar control over the three months. If your A1C score is consistently 6.5 or greater, you have type 2 diabetes.
In July 2011 the Canadian Diabetes Association recommended the use of the A1C test as a diagnostic tool for type 2 diabetes in adults. People with type 2 diabetes and those at risk are strongly encouraged to do whatever they can to keep their haemoglobin A1C steadily below 6.5. That means you may need to walk more, eat better, and take your medication.
If I am one of the nine million Canadians living with diabetes, what can I do to keep it under control?
Diabetes is not just about high blood sugar. To live well with type 2 diabetes you cannot focus solely on controlling high blood sugar levels, you must also monitor and control high blood pressure and high fat/cholesterol levels in the blood. High blood pressure and high fat/cholesterol damages the small and large blood vessels throughout the body, such as the blood vessels in the eyes, kidneys, heart, and the blood vessels that supply the brain, legs and feet.
High blood pressure and high cholesterol are not only controlled by the medication prescribed by your physician, they are also controlled by your dietary measures and physical activity. For example, eat more fruits and vegetables high in fibre, especially soluble fibre like Jamaican yellow yams and sweet potatoes. These foods help you feel full longer and they slow the rate at which these starchy foods are absorbed, which helps prevent a rapid or sharp rise in blood sugar levels.
Soluble fibre is the soft fibre that helps control blood glucose/sugar, and reduces cholesterol. Soluble fibre is found in oat bran, oatmeal, dried beans and lentils, fruits such as apples and strawberries and, as stated before, Jamaican yellow yams and sweet potatoes. The insoluble fibre is the bulky fibre that helps to prevent constipation. Many foods contain both soluble and insoluble fibre. The CDA recommends 25-50 grams of fibre daily.
You must also consume less salt (sodium), which tends to raise blood pressure. Try to keep to one teaspoon (2,400 milligrams) of sodium per day. Whenever possible, cook your own food in order to control how much salt is added to your meal.
Read the nutrition labels. As you read the labels, focus on the sodium carbohydrate, fibre and fat (saturated and trans fat) content of the food.
Diabetes is not an easy disease to manage. You will need a social worker and a team of health professionals, including a nurse, dietician, diabetes educator, foot and eye care specialists, and an endocrinologist to help you. But education in self-management is the key to success because you have to live with it.
You recently returned from the 15th Annual Canadian Diabetes Conference in Vancouver. Which presentations were you most intrigued with?
One of the highlights for me was the presentation on “Diabetes and the Gut”. Often people with long-term diabetes can develop a digestive condition called gastroparesis, or delayed stomach emptying. With gastroparesis the stomach fails to consistently and efficiently move food into the small intestine for further digestion and absorption.
For people with diabetes, that means the food is not being absorbed into the blood circulation and your diabetes medication such as insulin is not able to interact with it and help control blood sugar levels.
Some of the symptoms of gastroparesis include vomiting of undigested food several hours after a meal, heartburn, bloating, feeling full after only a few bites, high and low blood glucose (sugar) levels. The research presented suggests this is occurring in up to 30-40 per cent of people with type 2 diabetes.
The delayed emptying of the stomach is due to damage to the nerves responsible for stomach contractions needed to move food from the stomach into the small intestines. These people are being encouraged to eat smaller meals more frequently, which will improve the likelihood of it being able to enter the small intestine.
Another presentation that interested me was “Enhanced Diabetes Care in Long Term Care Facilities”. This presentation revealed that too many people working in long-term care facilities are not as well educated on type 2 diabetes as they should be. That includes registered nurses and personal support workers.
We need to be able to recognize the signs of low blood sugar, which often leads to fainting, falls and subsequent injury and fractures. Elderly people may be developing problems with their vision or dexterity (smooth control of their hands and fingers), which can interfere with their capacity to take their medication and eat their meals independently.
If we are not able to pick up on these things quickly it can have a significant impact on their health. In some ways I feel this is a population being left out in the cold and this is an issue I want to address.
What activities are you and the chapter planning for in the coming months and New Year?
The next Caribbean Chapter Meeting will be on Tuesday, November 27, at 6:30 p.m. at the Anglican Church of the Nativity at Neilson Road and Tapscott Road in Scarborough. The topic of discussion will be “Managing your Diabetes with Physical Activity” with Dr. Michael Surin. In the coming year, we will continue our regular chapter meetings with special guests and prepare for the Fourth Annual Black Diabetes Expo in April, 2013 at the Jamaican Canadian Association’s centre.
For more information about the Caribbean Chapter of the CDA, please call Kathy at 416-987-0339.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the Founder and Past President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org
By Dr. CHRISTOPHER J. MORGAN