SUMMARY

2. SUMMARY • What is diabetes? • What causes diabetes? • Type of diabetes. • What causes it? • Diabetes symptoms. • Treatments for Diabetes. • What type of nutrition do you plan when you have diabetes? And how do you normalize or maintain a good weight with diabetes?

3. What Is Diabetes? The Balance of Glucose and Insulin: Diabetes is a disorder that affects the way your body uses food for energy. Normally, the sugar you take in is digested and broken down to a simple sugar, known as glucose. The glucose then circulates in your blood where it waits to enter cells to be used as fuel. Insulin, a hormone produced by the pancreas, helps move the glucose into cells. A Healthy pancreas adjusts the amount of insulin based on the level of glucose. But, if you have diabetes, this process breaks down, and blood sugar levels become too high. There are two main types of full-blown diabetes: • People with Type 1 diabetes are completely unable to produce insulin. Type 1 is typically diagnosed in children and young adults, and the cause is still unknown.   • People with Type 2 diabetes can produce insulin, but their cells don't respond to it. In either case, the glucose can't move into the cells and blood glucose levels can become high. Over time, these high glucose levels can cause serious complications. Type 2 diabetes is the most common form of diabetes and it is usually caused by lifestyle factors.  

4. What Causes Diabetes? To understand diabetes, first you must understand how glucose is normally processed in the body.                                        How glucose normally works? Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin. The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas. Your liver acts as a glucose storage and manufacturing center. When you haven’t eaten in a while, for example, your liver releases stored glucose to keep your glucose level within a normal range. Causes of type 1 diabetes In type 1 diabetes, your immune system — which normally fights harmful bacteria or viruses — attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Causes of prediabetes and type 2 diabetes In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although excess fat — especially abdominal fat — and inactivity seem to be important factors. Causes of gestational diabetes During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. As your placenta grows larger in the second and third trimesters, it secretes more of these hormones — making it even harder for insulin to do its job. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood. This is gestational diabetes.

7. Type of Diabetes Type 1 Diabetes: • A person with Type 1 diabetes can't make any insulin. Type 1 most often occurs before age 30, but may strike at any age. Type 1 can be caused by a genetic disorder. The origins of Type 1 are not fully understood, Scientists believe that it may be a virus that triggers the immune system to attack the cells and permanently destroy them. But all of the possible causes still have the same end result: The pancreas can no longer make the insulin necessary to transport sugar from the blood into the other cells of the body for energy. Sugar builds up in the blood and over time can damage internal organs and blood vessels. Frequent insulin injections are needed for Type 1. Type 2 Diabetes: • A person with Type 2 diabetes has adequate insulin, but the cells have become resistant to it. Type 2 usually occurs in adults over 35 years old, but can affect anyone, including children. The National Institutes of Health state that 95 percent of all diabetes cases are Type 2. Why? It's a lifestyle disease, triggered by obesity, a lack of exercise, increased age and to some degree, genetic predisposition. Gestational Diabetes: • Gestational diabetes (GDM) is defined as a carbohydrate intolerance that normally develops during the 24th through the 32nd week of pregnancy. This condition affects 2 percent to 5 percent of all pregnant women and is the most common disease affecting pregnancy (2). Gestational diabetes often can be controlled by diet, but insulin is sometimes necessary to maintain glycemic control. An elevated blood glucose level during pregnancy is associated with an increase in complications for both mother and child. Following pregnancy, normal blood glucose tolerance usually returns. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 5-10 years.

9. Diabetes Symptoms Type 1 Diabetes Symptoms The symptoms of Type I diabetes often come on suddenly and very severely. They include: being exceptionally thirsty • dry mouth • the need to urinate often • weight loss (even though you may be hungry and eating well) • feeling weak and tired • blurry vision Type 2 Diabetes Symptoms Sometimes, people with Type II diabetes don't notice any symptoms or the symptoms are experienced gradually. They include: blurry vision • cuts or sores that are slow to heal • itchy skin, yeast infections • increased thirst • dry mouth • need to urinate often • leg pain Gestational diabetes Symptoms • Generally, gestational diabetes may not cause any symptoms, however, the woman may experience excessive weight gain, excessive hunger or thirst, excessive urination or recurrent vaginal infections.

10. Treatment for Diabetes TreatmentofType 1 Diabetes • At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization. • The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs. • These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels. Treatment of Type 2 Diabetes • Each individual diagnosed with Type 2 Diabetes will have a different treatment plan. One specifically tailored for that individual's needs. Overall, there are four main goals for a diabetic. • Lowering your blood sugar • Keeping your blood sugar as close to normal as possible • Controlling blood pressure and blood cholesterol • Preventing serious health problems related to diabetes • Below you will find some things that can help you achieve these goals. • Diet - eating vegetables, whole grain foods, and lean protein will help you with your blood sugar levels. • Exercise - Exercising regularly can also help control your blood sugar levels. • Medication - if a change in diet doesn't control your blood sugar levels, there is the possibility that medication can help bring your blood sugar levels under control. Treatment of Gestational diabetes • Treatment for gestational diabetes includes eating a carefully planned diet, getting plenty of exercise, maintaining a healthy pregnancy weight, monitoring glucose levels and, if necessary, daily insulin injections.

12. Diabetes Symbols 32 new symbols to support talking about Diabetes and healthy living. The Communicate: In Print update will install a new wordlist called diabetes.cwl. You will need to load this wordlist as your subsiduary list to access the symbols.

13. What type of nutrition do you plan when you have diabetes? And how do you normalize or maintain a good weight with diabetes? • This is a difficult question for many. To complicate matters more, there is really no certain diet for diabetics to follow. Many people do not understand the needs of diabetes nutrition guidelines. And many people also can't understand how closely tied to good diabetic control the food you eat can be.For some great nutrition tips and easy healthy recipes, check out The Healthy Eating Guide • The American Diabetes Association has what is referred to as the Diabetic Food Pyramid. This pyramid was designed much like the old one, but provides better information on diet guidelines to help you stay in control of your blood glucose levels, and weight. This new food pyramid is divided up into six groups. The size of the groups varies. The larger the group, the more servings per day you can consume. • The grains and starch allowances are of the largest group. This includes foods such as whole grains, pastas, breads, cereals, potatoes, corn, beans and peas. The alloted number of servings per day is between 6-11. To lose weight, you should stick with the lower number of 6 servings. • The next group down is vegetables. Vegetables are naturally low in fat, of course. This makes them good food for everyone. Cabbage, cauliflower, carrots, tomatoes, lettuce, and cucumbers are examples of the vegetable group. The alloted number of servings is between 3-5 every day, though it does not hurt to go above that number.

14. Diabetes and Nutrition

16. Gestational Diabetes Sample Menu: Herbed Grilled Chicken and rice with strawberry salad Herbed Grilled ChickenIngredients: 4 oz. boneless chicken breast½ tbsp olive oil½ tsp. dried oregano¼ tsp. fresh thyme½ tsp. dried rosemary Directions: Preheat either grill or broiler. Rinse and pat dry chicken. Combine olive oil and herbs together to form a paste and rub on chicken to coat. If possible, cover with plastic wrap and let marinate, refrigerated, for about 30 minutes. Grill or broil chicken, approximately 6-8 inches from heat source, for 4-6 minutes on each side until cooked.    Brown RiceIngredients: 3 tbsp brown rice¾ cup water Directions: Place rice in a small pot with tight-fitting lid and cover with about 2 1/2 times the amount of water (4 tablespoons of rice, about 3/4 cup water). Bring to a boil, uncovered, on high heat; reduce heat to low, cover tightly and cook for about 40-45 minutes, or until water is absorbed and rice is tender. Strawberry SaladIngredients: 2 cups mixed green salad5 cherry tomatoes2/3 cup sliced cucumber1 1/3 tbsp Italian low fat dressing1 cup sliced fresh strawberries Directions: Add cherry tomatoes, sliced cucumber, and fresh strawberries to mixed green salad. Mix dressing in salad and enjoy. Nutrition Information per serving:  437 calories; 33 gm protein; 49 gm carbs; 13 gm fat; 8 gm fiber; 400 gm sodium Today’s Type 2 Diabetes Diet Recipe: Cinnamon French Toast (Cinnamon Helps Control Sugar Levels in Type 2 Diabetics) Ingredients: 1 whole egg plus 2 egg whites1/2 cup fat-free skim milk1/4 tsp. vanilla extract1/8 tsp. cinnamon8 slices breadButter 1. In a shallow dish, whisk together egg and egg whites, milk, vanilla, and cinnamon. Dip each slice of bread quickly in egg mixture to coat one side, flip over with a fork, and quickly coat other side. 2. Place slices of bread in large nonstick fry pan coated with butter and warmed over medium heat. Cook until golden, turn over, and continue cooking until other side is golden. If cooking French toast in two batches, re-coat fry pan with cooking spray between batches. Nutrition Facts for Cinnamon French Toast: Servings – 4Serving Size – 2 slicesPreparation Time – 5 minutesStarch Exchanges – 2Calories – 167Calories From Fat – 27Total Fat – 3 gSaturated Fat – 1 gCholesterol – 54 mgSodium – 302 mgCarbohydrate – 27 gDietary Fiber – 1 gSugars – 3 gProtein – 8 g • Mozzarella Cauliflower Bake Sent in by Stacey • YIELD: Serves 2 Per portion:GI: 0 GL: 0 • Ingredients • ½ head of Cauliflower, rinsed and chopped into 1 inch floweret’s – 2 cups • 1 Large Fresh Tomato, rinsed and chopped • ¼ cup Mozzarella Cheese – shredded • 1 Extra Large egg, beaten • ¼ cup Parmesan Cheese – grated • 1 Tbsp Extra Virgin Olive Oil • Preparation • Spread Extra Virgin Olive Oil over bottom and sides of 6 x 8 inch glass baking dish • In a medium sized bowl, beat egg and add cheeses, stirring until combined • Arrange cauliflower and tomato in baking dish • Pour egg and cheese mixture over cauliflower/tomato combination • Bake at 325 degree oven for 20 minutes. • Nutrition Facts Calories: 164; Carbohydrates: 7g; Fiber: 3g; Protein: 12g; Fat: 9g; Saturated Fats: 0g; Sodium: 273mg.

17. Ripas Hospital To Introduce Diabetes Education Project - this April to decrease the number of diabetes patients, which has hit younger patients. (Written by Rasidah H A B Monday, 15 March 2010 08:33 The Brunei Times) www.brudirect.com/.../ripas-hospital-to-introduce-diabetes-education-project.html - World Diabetes Day at JPMC - IN CONJUNCTION with World Diabetes Day, Jerudong Park Medical Centre (JPMC) held a public forum to disseminate information on the disease. The theme for this year’s World Diabetes Day is ‘Understand Diabetes and Take Control’. Dr ArvindBamanikar, Senior Consultant Physician at JPMC highlighted that the current scenario of diabetes in Brunei has a prevalence status of about 25 per cent of the figures from screening health figures. (written by Edwin Eng Nov 14th, 2009 The Brunei Times) news.brunei.fm/.../world-diabetes-day-at-jpmc Keeping women's health in check - WITH diabetes ranked as third leading cause of death in Brunei, the public were advised to take better care of their health. (Written by Syed Rory Malai Hassan , Monday, March 15, 2010 The Brunei Times)www.bt.com.bn/.../keeping-womens-health-check

18. Quiz • 5. The population group with increased risk for developing type 2 diabetes is which of these? • Caucasians • Latinos • Native Americans • B and C • 6. Gestational diabetes occurs only during pregnancy. Why? • hormones related to the fetus cause insulin resistance • pancreas can't produce enough insulin • fetus manufactures excessive sugar • A and B • 7. How does gestational diabetes affect the baby? • causes birth defects • baby produces more insulin • immediately after birth, the baby develops low blood sugar • B and C • 8. How does exercise benefit people with diabetes? • improves oxygen flow • reduces insulin resistance • regulates blood pressure • all of the above • 1. What percentage of all people with diabetes have Type 2 diabetes? • 10% • 25% • 90 to 95% • 50% • 2. Uncontrolled diabetes can damage which of these organs? • eyes and kidneys • Liver • Kidney • heart • 3. What does insulin do? • changes sugar into usable form • helps cells take in sugar • helps cells keep out sugar • triggers adrenaline • 4. Which is the most significant risk factor for type 2 diabetes? • Obesity • race • gender • age

19. Quiz • 13.Early management and control of diabetes will help avoid complications that may arise later. People with diabetes are at increased risk of developing which of these? • heart disease • cancer • neurological damage • a and c • 14.Why are controlled eating and exercise so important if you have diabetes? • they keep depression at bay • eating raises blood sugar; exercise lowers it • being overweight can be dangerous for people with diabetes • b and c • 15.Type 1 diabetes occurs when the beta cells in the pancreas are destroyed. What destroys them? • the immune system • environmental toxins • free radicals • bacteria • 16.A reversible diabetic condition can develop as a side effect of some drugs. Which of these can cause elevated blood sugar? • Ibuprofen • antidepressants • thyroid medications • oral steroid medications • 9. Diabetes mellitus results from which of these? • bacterial infection • high cholesterol • body chemistry errors • too much salt • 10. There are two categories of diabetes: type 1 and type 2. How many people with diabetes have type 2? • 10 to 15 percent • 30 to 35 percent • 45 to 50 percent • 90 to 95 percent • 11. A certain gland or organ malfunctions in a person with diabetes. Which gland or organ is it? • pituitary gland • pancreas • adrenal glands • kidneys • 12. Why is insulin critical in the chemistry of blood sugar? • it enables glucose to enter cells • it lowers blood pressure • it raises cholesterol • it stabilizes sucrose levels

20. Quiz Answer • 5. The population group with increased risk for developing type 2 diabetes is which of these? • Caucasians • Latinos • Native Americans • B and C • 6. Gestational diabetes occurs only during pregnancy. Why? • hormones related to the fetus cause insulin resistance • pancreas can't produce enough insulin • fetus manufactures excessive sugar • A and B • 7. How does gestational diabetes affect the baby? • causes birth defects • baby produces more insulin • immediately after birth, the baby develops low blood sugar • B and C • 8. How does exercise benefit people with diabetes? • improves oxygen flow • reduces insulin resistance • regulates blood pressure • all of the above • 1. What percentage of all people with diabetes have Type 2 diabetes? • 10% • 25% • 90 to 95% • 50% • 2. Uncontrolled diabetes can damage which of these organs? • eyes and kidneys • Liver • Kidney • heart • 3. What does insulin do? • changes sugar into usable form • helps cells take in sugar • helps cells keep out sugar • triggers adrenaline • 4. Which is the most significant risk factor for type 2 diabetes? • Obesity • race • gender • age

21. Quiz Answer • 13.Early management and control of diabetes will help avoid complications that may arise later. People with diabetes are at increased risk of developing which of these? • heart disease • cancer • neurological damage • a and c • 14.Why are controlled eating and exercise so important if you have diabetes? • they keep depression at bay • eating raises blood sugar; exercise lowers it • being overweight can be dangerous for people with diabetes • b and c • 15.Type 1 diabetes occurs when the beta cells in the pancreas are destroyed. What destroys them? • the immune system • environmental toxins • free radicals • bacteria • 16.A reversible diabetic condition can develop as a side effect of some drugs. Which of these can cause elevated blood sugar? • Ibuprofen • antidepressants • thyroid medications • oral steroid medications • 9. Diabetes mellitus results from which of these? • bacterial infection • high cholesterol • body chemistry errors • too much salt • 10. There are two categories of diabetes: type 1 and type 2. How many people with diabetes have type 2? • 10 to 15 percent • 30 to 35 percent • 45 to 50 percent • 90 to 95 percent • 11. A certain gland or organ malfunctions in a person with diabetes. Which gland or organ is it? • pituitary gland • pancreas • adrenal glands • kidneys • 12. Why is insulin critical in the chemistry of blood sugar? • it enables glucose to enter cells • it lowers blood pressure • it raises cholesterol • it stabilizes sucrose levels

22. Useful links www.bt.com.bn/en/archive/all/2008/1?page=6 Ministry of Health http://www.moh.gov.bn/healthpromotions/healthtopics.htm