Dr. Kim Jebodsingh giving her presentation on Day 2 of the conference.
Day 2 was a combination of topics which included “Fertility Issues in Diabetes”, Diabetes and Its Affects on the Eye, “The Role of Testosterone in Sexual Dysfunction in Men With Diabetes” and “Reversing Diabetes in Barbados”.
Quick Look at Topics of the Day
Fertility & Diabetes
Dr. Roberta Corona from the The Fertility Clinic in Barbados gave a brief presentation on some of the many issues women with diabetes face when seeking to start a family. One of the major talking points were PCOS (Polycystic Ovarian Syndrome). According to Diabetes.org, “5 to 10 percent of women in the U.S. have this syndrome” and as a result there can be fertility issues. Dr. Corona outlined that some of the reasons for this condition includes “hormonal imbalance, high levels of testosterone” and health complications like “high blood pressure, cholesterol, insulin resistance and obesity” which are classic elements of “metabolic syndrome”. A women with diabetes at child bearing age, this pose a threat to their life for “heart attack and stroke”.
According to Mayo clinic, diagnosis of metabolic syndrome
“Several organizations have criteria for diagnosing metabolic syndrome. According to guidelines used by the National Institutes of Health, you have metabolic syndrome if you have three or more of these traits or are taking medication to control them:
- Large waist circumference — a waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men
- High triglyceride level — 150 milligrams per deciliter,(mg/dL), or 1.7 millimoles per liter (mmol/L), or higher of this type of fat found in blood
- Reduced high-density lipoprotein (HDL) cholesterol — less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of this “good” cholesterol
- Increased blood pressure — 130/85 millimeters of mercury (mm Hg) or higher
- Elevated fasting blood sugar — 100 mg/dL (5.6 mmol/L) or higher”
Dr. Corona ended with the point that “metabolic control can help fertility”.
Prof. Hugh Jones
Erectile Dysfunction (ED) and Diabetes
From Day 1 of the Diabetes Conference, Dr. Hugh Jones’ main theme for his presentation was “link of low testosterone and poor health of diabetic men”.
According to American Diabetes Association, “some men with diabetes have impotence, also called erectile dysfunction (ED). ED is when a man can no longer have or keep an erection”. Dr. Jones highlighted fact that ED and low (T) testosterone count are common problems of men with diabetes.
Low testosterone in (Type 2) diabetic men should be better screened since according to Dr. Jones can be an indicator of coronary heart disease which can lead to death.
“The study was run by a group led by Professor Hugh Jones of Barnsley Hospital NHS Foundation Trust and the University of Sheffield. It analysed data from 581 men with type 2 diabetes at Barnsley Hospital, looking back at their testosterone levels as measured between 2002 and 2005. The patients were then followed up for an average of six years, and mortality rates were compared between men with normal testosterone levels and those with low levels.
The results showed that testosterone levels were on average significantly lower in men who died compared with those who did not, and that the mortality rate was considerably higher in the low testosterone group (17.2%) than in the normal testosterone group.”-NHS UK.
Dr. Jones purported that there is evidence that “testosterone replacement treatment” can have some positive effect, “reducing the death rate in men with Type II diabetes”.
Diabetes and The Eye
Dr. Kim Jebodsingh & Ms. Petra Bridgemohan-A look at Diabetes’ Complication-Eye Health
Ophthalmologist Dr. Kim Jebodsingh spoke about “The Many Ways Diabetes can Affect the Eye”. In her presentation, she discussed some of the common conditions she have found in her practice. She noted the significant signs of deterioration of eye seen in screening of diabetic patients who suffered from stroke. Also, she reported that “80 percent of patients over 60 years has vitreous degeneration”, condition commonly known as “floaters” is not serious however persons with diabetes can have “retinal detachment” (due to vitreous degeneration) which is severe trauma to the eye.
Other serious conditions include “diabetic papillopathy (which is swelling in the eye that can result in visual loss) as well as diabetic retinopathy. She stated that “99 percent of Type 1 and 60 percent Type 2 have retinal neuropathy”.
On the optometry side, Ms. Petra Bridgemohan spoke about her field in homeland Trinidad and Tobago. As indicated in T&T media, she explained there is a need for better outreach to patients (particularly those in the rural setting) who are in need of the eye exams and eye care.
Diabetes “Reversal” Study
Dr. Karen Bynoe, one of the key members of the Diabetes Reversal Study gave her findings on the last day of the 2nd Annual Multidisciplinary Conference. Here are some of her major finding in the study which lasted for 8 months. It is important that the study would be thought of as “ambitious” to reverse diabetes but found possibility of placing patients’ diabetes in “remission”.
- There were 25 participants
- Persons were excluded if they were on insulin
- Patients were seen weekly, 2 months and at end of the program
- Communication was face-to-face, in-depth interview, social media (particularly Whatsapp, Facebook)
- Patients were given nutrition support
- Persons had to do 150 minutes exercise (moderate/vigorous)
The overall results were that participants did lose weight and their blood sugar normalised. One patient had lost 22 pounds in the 8 week period. One of the psychological benefits from the exercise was that with the group support and medical attention, persons were highly motivated.
Cons of the Study
Individuals’ main complaint was constipation as they were placed on a restrictive diet which included meal replacement drinks. Other issues came with cost maintain the diet, which (was mostly natural foods (no processed meals) “costly”, “difficult at time to find healthy foods and social pressures of living in “obesogenic environment”.
The initiative was funded by Virgin Unite and it was a pilot study one of first of its kind to be done in the Caribbean.
What is DSN?
DSN or Diabetes Specialist Nurse is “a trained nurse with special expertise in the care and treatment of diabetes, a DSN can be an invaluable source of information, advice and support, for example if you have to start using insulin, if your blood sugar becomes uncontrolled or if other health problems emerge that complicate your diabetes.” (saga.co.uk)
Diabetes Specialist Nurse, Tracy Bushell at the Barbados Diabetes Foundation gave her presentation during the Insulin Workshop on 2nd Day of Diabetes Conference.
In her presentation, Ms. Bushell focused on the correct way of administering insulin.
Here are some of the areas which she highlighted in her presentation
- Insulin should be injected at room temperature
- Abdomen is the best place to inject insulin
- Insulin should be injected at 90 degree angle
- Pinching of skin is not necessary
- Insulin should not be injected in the arms
- Insulin should be injected into fat not muscle
- Needles should be changed ever 1-3 injections
Other areas covered by DSN Bushell were “examining pattern fasting, pre-/post meals, hypoglycemia and causes for insulin changes”.
UK based DSN Jo McBride also participated in the workshop with DSN at Queen Elizabeth Hospital, Kevamae Sobers as chair.
For more information, please contact Barbados Diabetes Foundation at 417-5980.
More Than A Diet, A Change of Life
We have all been on a diet at some point of our lives. We may have lost weight while being on this diet. But are we still on this diet today? Probably not. At the 2nd Annual Multidisciplinary Diabetes Conference, Hibiscus Health Caribbean Inc had a chat with the President of Ideal Nutrition West Indies, Fabiola Leconte about her program.
According to Ms. Leconte, the Canadian based company worked closely with a medical practitioner and the patient is also monitored by Ideal Protein team.
How it Works?
Ideal Protein is “more than a product, it is a method”. It is “4 phase program” which gives clients “a complete approach to weight management”. Their program provides food to their clients which are not available in your supermarket. Each product provided by the company is specially formulated for their clients. It consist of “3 protein meals (Breakfast, Lunch, snack), this includes 4 cups of vegetables and selected salad”. The diet is “low carb and low fat”. However, Ms. Leconte warned that the diet is not for everyone.
“This diet is not for persons with medical complications e.g. kidney or liver damage”, said Ms. Leconte.
As a result, persons who go on the diet will be closely supervised by a doctor. Eventually, the patient will be weaned off the foods of ideal protein and eat regular food but continuing to follow the general education given on nutrition and healthy habits.
For more information
Ideal Nutrition West Indies
Contact Ms. Leconte at 226-978-5941
“Obesity is a disease”-Obesity and Nutrition Workshop
Savannah Hotel, June 19, 2016-Canadian Registered Dietitian and Nutrition Consultant, Helene Charlebois captivated her audience through her anecdotes about obesity in her practice and personal life. She reinforced the fact that “obesity is a medical problem” and our food was not only cure but it can also cause malaise.
It is a fact that many people battling to eat healthy with the hope they will avoid non-communicable diseases like diabetes and hypertension. Others are not aware of the harm or they do not care what damage they are doing to their bodies. However, for most of us the food we eat is not a choice, it often “modified” without our knowledge either with added sugars and fats or chemicals to make the food “easier to mass produce, ready to eat and cheaper to produce”.
Ms. Charlebois asked her audience to change their way of thinking.
“Obesity is a disease. We have to treat obesity to treat people with diabetes,” she said.
Obesity: Getting Bad Foods Out of Schools
Ms. Charlebois is a strong advocate of changing the behaviours of children starting in the school and other public institutions like hospitals. In Canada, Ms. Charlebois admits that her colleagues and other like minded institutions are seeking to “take unhealthy drinks and foods out of the schools”. This action has not been without resistance from the parents of these children. Many parents believe their children should eat what they want. But Charlebois argues that eating healthy is “a part of their education”.
“If they (parents) want to give their children pop (soda), they can do it at home,” Charlebois said.
Treating Obesity Like A Illness
Obesity is not a simple illness to treat. There are the physical and medical aspects of obesity as well as the psychological one. For Ms. Charlebois, the patient must come to “self-awareness” about their disease. Then, their overall health must be evaluated particularly with women who are often battle with weight gain and obesity.
Obesity and Women
Women who are struggling with their weight often have other hormonal and medical issues to conquer before dealing with weight management. Some of these conditions can complicate weight loss and maintaining healthy weight.
- “slow loser” -some people because of their gene make-up are unable to loss weight like other people
- PCOS-polycystic ovarian syndrome can make it difficult for women to lose weight (high testosterone, high cholesterol etc.)
- Food Allergies eg. celiac disease
Having a Plan And Sticking to It
Ms. Charlebois explained to her audience that no matter what diet you adopt, “you will lose weight”. However, the key to keeping the weight come by staying consistent and “being on that diet for the rest of your life”.
Finding A Diet Daily Rhythm
Here are some of the suggestions made by Ms. Charlebois to finding a rhythm when it comes to dieting.
- Balance out your three meals per day and healthy snacks (Calorie daily intake 2000 calories
- Eat more in the morning (particularly protein)-stay away from liquid meals
- Slowly reduce your starch intake as the day wines down i.e. there should little to no starch (potatoes, pasta, rice) when having dinner.
- Getting your 150 minutes per week of vigorous to moderate exercise
- Switch from a carbohydrate based diet to one which is “plant based”
- Cut out sugary beverages-is not possible have small amount of juice over soda
- Create a meal journal of your planned meals-it will be a guideline
- Trying drink a bit of fiber before your last meal (dinner) to keep you from overeating
- Trying to maintain your diet
Barbados from a Glance
For Ms. Charlebois who had an opportunity to taste Barbadian cuisine, she realized that Barbadian has an excellent range of foods however it is important to deal with portion size and this must start in the home.
- Charlebois explained that changes to diet happens at home and it must be adopted by all the family members to have an impact.
- Learn about measuring equipment, what is 1/2 a cup-measuring using your hand
- Throw out all storage containers used (lunch containers), over-sized plates
- Do not place foods being eaten on dinner table, encourages overeating e.g. Christmas lunch, birthday parties, social functions
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Early Detection Through Regular Screening Best
Paediatrician Dr. Paula Michele Lashley shared a similar sentient to Dr. Brathwaite as she wished to see more screening in patients who have been diagnosed or have risk factors for Type II diabetes. In her practice, she spoke about the “signs” which may be present in patients and may lead to diagnosis of diabetes such as “darkening of the skin at the back of the neck, being overweight, a family history with diabetes and elevated blood pressure”. Dr. Lashley advised her colleagues with “obesity in children (being) doubled in Barbados”, it is important to make “blood pressure testing more routine as well as utilizing Random Blood Sugar along with Oral Glucose Tolerance Test and Fasting Plasma Glucose in children and teenagers”.
Darkening around the neck in young children and adolescents a possible sign of diabetes. (Photo Credit: Youtube)
What is Oral Glucose Tolerance Test?
According to WebMD, “the oral glucose tolerance test (OGTT) measures the body’s ability to use a type of sugar, called glucose, that is the body’s main source of energy. An OGTT can be used to diagnose pre-diabetes and diabetes”. Dr. Lashley recommended that testing should be due as early as age 10 (at the onset of puberty).
What is Fasting Plasma Glucose?
This test checks your fasting blood glucose levels. Fasting means after not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
Other Testing for Children/Adolescents with Diabetes II
Diabetes Type 1 does not have the conspicuous signs like Type 2. For those with Type 2, other test should be done specially Fasting Lipids at diagnoses. Also, screening for Polycystic Ovarian Syndrome (PCOS) should also checked as well.
“Digging Deeper”: Looking at Men, Testosterone, Pre-diabetes and Diabetic Foot
Some of the audience members at the 2nd Annual Multidisciplinary Diabetes Conference 2016 at the Savannah Hotel.
With the attendance of more than 100 Health professionals, the 2nd Annual Multidisciplinary Conference welcomed UK based Endocrinologist, Professor Hugh T. Jones to give Key address on “Testosterone and Diabetes in Men” at the Savannah Hotel’s Hastings Conference room.
However, before his presentation, a representative from Ministry Health and Acting Chief Executive Officer, Cally Boyea who spoke about the present “diabetes epidemic” in Barbados. Mr. Boyea who emphasized that “there is no facility in the Barbados or the Caribbean which offers the treatment for persons living with diabetes like The Barbados Diabetes Foundation”. With the Ministry of Health official reporting “19 percent of the Barbados population is diabetic or pre-diabetic” and further admitted that with “global Health expenditure of diabetes reaching over USD 300 billion dollars and likely to reach just USD 500 billion dollars”, the public health sector is unable to “sustain the care for the growing number of diabetics”.
High Numbers Staggering
Although most in medical field like to refer to diabetes as a “disease”, it is affecting the local population in a significant way. Dr. Diane Brathwaite, clinical director of The Barbados Diabetes Foundation give her presentation which examined the importance of screening and treating of people with pre-diabetes. Using 2015 statistics from Ministry of Health, “it was was reported 18.7 percent of the Barbadian population are diabetic while 40 percent are pre-diabetic”. With Western countries like United States, its population is faced with women leading in numbers of obesity and being physically inactive.
Changing Culture, Mass Screening Needed
Dr. Brathwaite spoke to her fellow medical practitioners and allied health professionals about growing trend, high incidences of people being diagnosed with pre-diabetes and the fact that “11 percent of these individual will be developing Type II diabetes in the future”.
But with present cultural traditions of “everything being sweet”, Dr. Brathwaite admitted that it was important to have “mass screenings for those who are at risk or pre-diabetic”.
NEXT: Paediatric Screening: Is There A role for This Barbados?-Dr. Paula Michele Lashley