DIABETES AND VIRGIN ISLANDERS
Diabetes (diabetes mellitus) is sometimes referred to as the "sugar" by many Virgin Islanders. Diabetes is a serious public health problem in our community. According to the Virgin Islands Diabetes Prevention and Control Program, diabetes was the third leading cause of death in 1996, and the fourth in 1997.

The "Sugar" Research studies show that, gram for gram, sugars, like table sugar, do not raise blood glucose any more quickly than do other carbohydrates, like potatoes, rice or pasta.  This research holds true for people with type 1 and type 2 diabetes. Source: American Diabetic Association. (diabetes.org)

Data from the survey, Behavioral Risk Factor Surveillance System (BRFSS) of 1999, show that about 8% of USVI residents over age 18 are diagnosed with diabetes. Those with the highest incidence are over 65 years old, are of African descent or Hispanic, have less than a high school education, and have a body mass index over 30 (which indicates obesity). To calculate your BMI, click here.

In addition, there has been a marked increase in Virgin Islands children diagnosed with Type 1 diabetes since 1980.
Source: Centers for Disease Control and Prevention (cdc.gov).

Other risk factors for diabetes are:

• giving birth to a child weighing more than 9 pounds
• elevated blood pressure decreased HDL cholesterol levels
• increased triglyceride levels

Take this diabetes risk test to see if you are at risk for developing diabetes. Diabetes is more common in African Americans, and Hispanics.Click here to take the test.

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SYMPTOMS
Some symptoms of high blood glucose include the 3 Ps: excessive urination (polyuria), excessive thirst (polydipsia), excessive hunger (polyphagia). Weight loss, blurred vision, tingling or numbness in hands or feet, extreme fatigue, frequent skin, bladder or gum infections. are also symptoms.
Source for this section: Centers for Disease Control and Prevention

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TYPES OF DIABETES
Type 1 Diabetes (formerly known as insulin dependent or juvenile diabetes), results from the body's failure to produce insulin, or lack of the body's ability to use insulin properly (insulin resistance), or both. Insulin is the hormone secreted by the pancreas that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have Type 1. Persons with Type 1 diabetes require insulin from an outside source (needle injections or an insulin pump) to survive.

Type 1 includes elevated blood sugar levels (hyperglycemia) which, if uncontrolled, can lead to such vascular complications as blindness, limb amputations, kidney disease, heart disease, stroke and nerve damage.

Danger of HYPOglycemia People receiving insulin for Type 1 diabetes are at risk for hypoglycemia, a condition where insulin has brought blood sugar levels too low. If after an injection, enough calories aren't eaten, particularly carbohydrates, hypoglycemia can occur. When this happens often enough, the person may develop hypoglycemia unawareness, and are at risk for coma or death. Reference: Tracs, 2002

Type 2 Diabetes (formerly known as non-insulin dependent, or adult onset diabetes), results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Approximately 90-95% (17 million) of Americans who are diagnosed with diabetes have type 2 diabetes.

Gestational Diabetes affects about 4% of all pregnant women, or about 135,000 cases in the U.S. each year. This form of diabetes is usually temporary, but there is an increased risk of developing it in later years.

Pre-Diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. It is estimated that at least 20.1 million Americans have pre-diabetes.
Source for this section: American Diabetes Association (diabetes.org)

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COMPLICATIONS
By the time diabetes is diagnosed 50% of patients already show early signs of complications, such as blindness and kidney failure. Diabetes is also associated with heart disease, stroke and coma. In addition, it poses an economic burden on our community with increased out of pocket costs for acute and ambulatory care.

But diabetes CAN be controlled and for those who are at risk for developing the disease, there are ways to delay the onset of this disease. Eating the proper foods, maintaining your weight, regular exercise, and monitoring your blood glucose can help you to prevent and control diabetes.

Diabetes is diagnosed by a blood test prescribed by your doctor. If you have been diagnosed with diabetes, there are ways to prevent complications:

Monitor your blood glucose levels regularly, or as your health care providers prescribes. Regular testing helps you determine how well your diabetes management program of meal planning, exercising and medication (if necessary) is doing to keep your blood glucose as close to normal as possible. That way, the more likely you are to prevent diabetes complications such as eye disease, nerve damage, and other problems.

Have an annual eye exam in which the pupils are dilated. This exam can find any problems early (such as diabetic retinopathy), so that you can get treatment immediately. Even if you can see well, you should still have a dilated eye exam annually. Diabetic retinopathy damages the tiny blood vessels in the retina. Diabetes can also increase your risks of developing cataracts (where the lens of the eye becomes cloudy), or glaucoma (when pressure builds up inside the eye).

Protect your feet from injury. Diabetes causes damage to small blood vessels, resulting in decreased circulation to your extremities, making it difficult for sores to heal. Check your feet everyday, and make sure your doctor examines your feet during your regular visits. Keep your feet in good shape by:

• Checking them everyday for sores, cuts or bruises. Use a mirror, if necessary, to inspect the bottom of your feet.
• Wash feet every day in warm water and pat dry. Do not rub hard.
• Do not put oil or lotion between your toes, which can cause irritation.
• Trim your toenails very carefully to avoid cutting your skin. If your nails are brittle, soak them in warm water and do not attempt to cut them yourself. Consult with your healthcare provider.
• Wear socks and comfortable shoes that protect and do not squeeze your feet (avoid shoes that go between your toes).
• Never go barefoot, even at home.

Source for this section: VI Department of Health (www.usvidiabetes.org).

Can Lead to Amputation People with diabetes mellitus have decreased blood flow in small blood vessels, which lead to impaired wound healing and increased susceptibility to infection. If left untreated, infection can lead to gangrene and amputation. Reference: Rudolph, 2002

Link between Diabetes and Alzheimer's Disease - For some time, researchers have known that people with diabetes have a greater risk of developing Alzheimer's disease and other forms of dementia than those without diabetes.
Source: Joslin Diabetes Center ,joslin.org.

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CHILDREN AND TEENAGERS
The onset of Type 1 is usually severe and often requires hospitalization at the time of diagnosis. Children with Type 1 diabetes will need insulin injections to manage their blood sugar and avoid going into diabetic coma. The onset of Type 2 diabetes may be less severe, and children with Type 2 diabetes may go undiagnosed for months to years.

It is important that children who are obese and have a family history of diabetes be carefully monitored for the signs of diabetes.

The good news is that much can be done to help reduce a child's risk of developing type 2 diabetes. The recently completed nationwide Diabetes Prevention Program conducted at The Joslin Center in Boston, and other institutions showed that people with pre-diabetes can reduce their risk of developing diabetes by 58 percent if they lose a modest amount of weight and begin a program of 30 minutes of physical activity daily.

Leading by example is one way parents and other adults can help. Getting kids to eat healthier and exercise more is a challenge in today's video game and fast food culture. But it's a fact of life that children respond best when adults set the example by engaging in physical activity and practicing healthy eating habits.
Source for this section: Joslin Diabetes Center (joslin.org).

Local Camp for VI Kids Camp DAVI (Diabetes Association of the Virgin Islands) is located at the Virgin Islands Resource Station in St. John, and run by the University of the Virgin Islands. See bottom of page for contact info.

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HOW TO PREVENT AND CONTROL DIABETES

• Eat a wide variety of foods every day
• Be physically active every day
• Eat high-fiber foods such as fruits, vegetables, whole grains and beans
• Use less added fat
• Use less added sugar
• Use less added salt and sodium; avoid saltfish, cured meats and table salt
• Use Mrs. Dash or Light Sazon instead
• If you choose to drink alcohol, limit the amount and drink it with food
• Use the Diabetes Food Pyramid.

Source: American Diabetes Association, 2004 (www.diabetes.org/about-diabetes.jsp)

The Diabetes Food Pyramid makes it easier to remember what to eat. For a healthy meal plan that is based on your individual needs, you should work with a registered dietitian with expertise in diabetes management. You can find one at the Department of Health at 340-777-9251 in St. Thomas, or at 340-773-1311 in St. Croix.

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DIAGNOSING DIABETES
In general, people who have a fasting plasma blood glucose in the 100-125 mg/dl range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test, and at two-hours your blood glucose is 140-199 mg/dl, you have "impaired glucose tolerance". Either of these is medical terminology for what your doctor is probably referring to when he says you have "pre-diabetes". Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have "pre-diabetes"".
Source: Joslin Diabetes Center (joslin.org).

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DRUGS FOR TYPE 2 DIABETES
Type 2 diabetes results when the body is unable to produce the amount of insulin it needs to convert food into energy. Sometimes the body is actually producing more insulin than is needed by a person to keep blood sugars in a normal range. Yet blood sugars remain high, because the body's cells are resistant to the effects of insulin. Physicians and scientists alike believe that type 2 diabetes is caused by many factors, including insufficient insulin and insulin resistance. They increasingly believe that the relative contribution which each factor makes toward causing diabetes varies from person to person.

Up until the last few years, there was only one type of diabetes medication available for treating type 2 diabetes. But newer drugs can be prescribed by your doctor, that can work to control your blood glucose levels. You can find more detailed information about drugs for pre-diabetes and diabetes, and about glucose tolerance blood tests at www.joslin.org.
Source: Joslin Diabetes Center (joslin.org).

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HERBAL THERAPY

CAUTION: Ask your doctor about using herbal remedies, especially if you are taking prescription medication! Drug and herbs can interact and create serious side effects! If you use herbs to prevent or treat any disease, you must continue to get regular check ups and diagnostic testing to determine if prescription medication is necessary. DO NOT REPLACE MEDICATIONS WITH HERBS without a physical examination and diagnostic testing.

Many Virgin Islanders use plants and herbs to treat their health. In "Traditional Plants of St. Croix, St. Thomas and St. John" (1997), Toni Thomas lists the following local plants as being used to treat diabetes: Licorice, Maiden Apple, Old Man's Beard, Ginger Thomas, Yellow Cedar, Lignum Vitae, Maubi Bark.

For treatment of kidney problems: Beggar's Tick, Spanish Needle, Love Bush, Leaf of Life, Clapper's Bush. For treatment of sores: Aloe (externally), Guinea Blister, Doctor Bush, Bay Cedar, Bitterbush, Christmas Bush.

In Mosby's Nursing Drug Reference (Skidmore-Rush, 2006), these herbs are listed for treating diabetes or for increasing blood flow: Angelica, Bilberry, Borage, Evening Primrose, Garlic, Gingko, Eleuthero (Siberian Ginseng), Fenugreek. For sores or chronic wounds: Tea Tree Oil, Gotu Kola.