You might think we have enough reasons to take our type 2 diabetes crisis seriously.
Bermuda ranks third highest for diabetes among the Organisation for Economic Co-operation Development countries, with 13 percent of adults diagnosed, compared with 10 percent in the United States.
Three-quarters of adults in Bermuda are overweight or obese and more than half the population is black: two factors that increase the likelihood of developing the disease. Yet, despite repeated messages about the need to live healthily, the number of patients on dialysis continues to increase up to 15 percent each year.
According to Dr Annabel Fountain, as a country, we’re still too passive about the illness that cuts life expectancy by six years for 50-year-old patients and can lead to kidney failure, heart disease, vision loss and foot amputation.
Some of Dr Fountain’s patients have had type 2 diabetes for two decades but had never even seen a dietician or had their feet examined until they met her.
“Part of the problem is that lots of people say: ‘It’s in my family, it’s not my fault,’ without really understanding the amount of power an individual has to control their health,” said Dr Fountain, the medical director at Fountain Health, who specialises in diabetes. “If an individual has low health expectations, it’s an uphill battle. I’m trying to help them understand that it’s not inevitable, that they can make an impact on that trajectory.”
In short, type 2 diabetes means your body has become resistant to insulin, the hormone which keeps blood sugars at a normal level. Your pancreas responds by making more insulin but eventually it cannot keep up, meaning your blood sugar rises, which causes serious problems for your heart and kidney.
The process happens slowly, and increases if you have too much fat tissue, meaning you are at greater risk of type 2 diabetes as you age – but don’t let that fool you into thinking it’s an older person’s disease.
“We have people who are younger than 45 who are developing type 2 diabetes,” Dr Fountain said.
“We have had people who are on dialysis with significant other complications secondary to type 2 diabetes before the age of 30. I’m more worried about my patients who have disordered glucose metabolism in their 20s and 30s than people in their 70s or 80s. I’m very worried that they aren’t going to make it to retirement age unless they make significant changes.”
Symptoms of uncontrolled type 2 diabetes include increased thirst and hunger, frequent urination, unintended weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, numbness or tingling in the hands or feet and areas of darkened skin in the armpits or neck.
Most patients don’t have any symptoms until sugars are very high, meaning up to one-third of people with diabetes don’t know they have it. Many people in their 20s are referred to Dr Fountain for other endocrine conditions who have abnormal glucose results.
“I take the opportunity to make sure that they get appropriate education. I refer them to a dietician and make sure they are mindful to lose weight and just be healthier,” she said.
The message in Bermuda has often focused on urging people to live more healthily to the extent that Dr Fountain believes patients are being blamed for their own choices.
“Of course, there’s some of that, but if you continually sabotage people by having Coca-Cola everywhere, or if you are at work doing a night shift and the only thing available to eat is chocolate, chips and soda from a dispensing machine, it’s not very easy to make good choices,” she said. “Fresh food is cripplingly expensive. I do think there’s a lack of understanding in our population about the cost of food and the way we could stretch our dollars further if we had time.”
Large sections of the island’s population work in the service sector, which adds to their stress levels, disrupts circadian rhythms and reduces quality sleep.
“Bermuda is quite a stressful place to live. Stress increases cortisol levels. People with excess cortisol have increased blood sugars and are more likely to be obese,” Dr Fountain said. “Many, many people have more than one job. Some people have three jobs. That also impacts the time they have available to do things like cooking meals from scratch. It means they are more likely to eat on the run: fast food and convenience food which are usually not good for us. If they are struggling to pay for electricity, insurance, medications or rent, they’re more likely to opt for cheaper, processed foods.”
Healthy eating, physical activity, good sleep, rest and stress management can all help reduce your chances of developing type 2 diabetes. And even if you are diagnosed with the illness, the future does not have to be grim. Technology and improvements in medicine mean that it is easier to manage type 2 diabetes and even reverse it. The Bermuda Diabetes Association and Bermuda Hospitals Board have nutrition classes run by diabetes educators and dieticians.
Dr Fountain pointed to the benefits of FreeStyle Libre sensors, which are distributed island-wide by the Diabetes Association: “The patient can at any moment tap the little machine and it will tell them what their sugar is doing, whether it’s going up or down and their average,” Dr Fountain said.
“Less than five years ago, people had to prick their finger which is painful. They would only do it once a day even if we begged them. I have always said the hard work of diabetes management is not done in any medical office, it’s in managing it yourself.
“Now people can experiment with foods, they can say I’m going to have a juice or pizza or salad or go for a walk and see the effects of these foods on their monitor. It’s really, really empowering to reinforce healthy choices.”
See your primary care physician at least once per year for health monitoring and support. For more information, visit www.diabetes.bm.