What is Diabetes?
Diabetes is a silent, chronic (long-lasting) health condition that affects how your body manages, uses and store glucose (sugar), which is the main energy source of the body.
The body breaks down most of the food consumed into sugar (glucose) and releases it into the bloodstream. When the blood sugar goes up, it signals the pancreas to release a hormone called insulin. Insulin acts like a key to let the blood glucose into the body’s cells for use as energy. If you do not have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin, so the glucose can get into your cells. 
With diabetes, this system is affected, whereby your body doesn’t make enough insulin or can’t use it as well as it should. This results in too much blood sugar in your bloodstream. Over time, it can lead to serious health problems such as heart disease, vision loss and kidney disease. 
What Is Diabetes? | 2 Minute Guide | Diabetes UK - YouTube
Diabetes - Living Life to the Full​

How common is Diabetes?
Worldwide, around 537 million people have diabetes. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.7 to 8.5% in the adult population. 
In Malta, 10.1% of all 20 – 79-year-olds suffer from diabetes, representing 33,260 people in 2013. The number is expected to increase to 11.6% by 2025.
The global increase in the prevalence of diabetes seen in recent years has been attributed mostly to obesity, poor diet, and lack of physical activity. The World Health Organization projects diabetes as the 7th leading cause of death and estimates that there will be 366 million adults with diabetes in 2030

What are the different types of diabetes?
The most common types of diabetes are Type 1, Type 2 and Gestational diabetes.
Type 1 diabetes
Type 1 diabetes is thought to be caused by an autoimmune reaction whereby your immune system attacks and destroys the cells in your pancreas that make insulin. This type of diabetes is usually diagnosed in children and young adults although it can appear at any age. People with Type 1 Diabetes need to take daily doses of insulin. 

Type 2 Diabetes
With Type 2 Diabetes, your body is unable to produce or use insulin well and cannot keep blood sugar at normal levels. You can develop Type 2 diabetes at any age; however, it occurs mostly in middle-aged and older people. Type 2 diabetes is the most common type of diabetes.

Gestational Diabetes
Gestational Diabetes develops in some pregnant women who have never had diabetes prior to pregnancy. Most of the time, this type of diabetes goes away after the baby is born. However, it increases the mother’s risk of Type 2 Diabetes later on in life. 

What are the symptoms of diabetes?
The common symptoms of diabetes include
•    Going to the toilet more often, especially at night
•    Increased thirst
•    Feeling more tired than usual
•    Losing weight without trying to
•    Genital itching or thrush
•    Cuts and wounds that take long to heal
•    Blurred vision
•    Numbness of hands and feet. (use images from booklet)

What health problems can people with diabetes develop?
Over time, high blood glucose leads to problems such as
•    Heart disease
•    Stroke
•    Kidney disease
•    Eye problems
•    Dental disease
•    Nerve damage
•    Foot problems

What changes help in controlling diabetes? 

Lifestyle changes 
Although diabetes cannot yet be cured, it can be managed very successfully. Lifestyle changes like adopting a healthy, balanced diet low in fat, sugar and salt with a moderate intake of fruit and a high intake of vegetables and dietary fibre (e.g. red kidney beans, oats and barley), will have enormous health benefits and even allows one to continue normal day-to-day life. Healthy eating dietary guidelines are available to help in this lifestyle change. Contact the Health Promotion and Disease Prevention Directorate on 2326 6000 for your free copy or download it from here.

Eating well
Eating well is always an important part of treatment for diabetes. People living with diabetes should include portions from all the food groups: complex carbohydrates, fruit, vegetables (including non-starchy vegetables – cauliflowers, cabbage), legumes (bigilla, cannellini and lentils), milk and milk products, meat, fish, eggs, and good fats and oils. Highly processed foods should be avoided. Taking steps towards eating a balanced diet will help to control blood glucose levels, blood fats (including cholesterol) and blood pressure. Seek the advice of a dietitian for more information on healthy meal plans.

Weight management
Weight reduction is the most effective way of lowering blood glucose levels and improving type 2 diabetes. By adopting small but sustainable changes in dietary habits while increasing the level of physical activity, can help in achieving the desired weight loss. 
The Health Promotion and Disease Prevention Directorate in collaboration with Mater Dei Hospital and Primary Health Care provide free group weight management programmes for people living with diabetes. Please ask your diabetologist (at Mater Dei or Health Centre) or contact the Health Promotion and Disease Prevention Directorate on 23266000 for more information.

Keeping active
Physical activity combined with healthy eating and any diabetes medication will help manage the condition. Physical activity will help to control and improve the level of sugar in the blood, blood pressure and the level of fat (including cholesterol) in the blood.
Adults aged 18-64 years should carry out at least 150 minutes of moderate intensity aerobic physical activity throughout the week or at least 75 minutes of aerobic vigorous intensity physical activity or a combination of both. This may be broken up into 10-minute bursts throughout the day and should be at a pace where one feels slightly out of breath to gain the full benefits. Examples of aerobic moderate intensity physical activity may include brisk walking, swimming, or dancing. Examples of aerobic vigorous intensity physical activity may include running, fast swimming or playing a sport. There are additional health benefits to increasing activity to 300 minutes of moderate intensity physical activity per week. Muscle strengthening activities should also be done involving major muscle groups on 2 or more days a week.

If you are less mobile, there are still benefits from increasing activity levels. Armchair exercises, gentle walking and stretching programmes will all help to keep one as mobile and as fit as possible.
Children and adolescents with type 2 diabetes who are between 10 and 17 years of age should aim for 60 minutes of activity every day. Daily activity can be increased by decreasing screen time (time spent watching TV or in front of the laptop). Children and adolescents should limit screen time to less than 2 hours a day.
Before starting any new activity, it is important to speak to your family doctor or diabetes nurse especially if taking insulin injections.

Exercise will also help prevent the long-term complications of diabetes. Activities such as walking, swimming, cycling, gardening and housework can all help. Being active is not only good for the body but will also help to reduce stress.

Quit smoking
Smoking is particularly dangerous for people with diabetes as it increases the chances of developing serious health problems of the blood vessels and nerves and can also cause lung and mouth cancer. Giving up can be hard but getting the right support will make it easier to quit. 
If you want to quit smoking, the Health Promotion and Disease Prevention Directorate offers free tobacco cessation services to assist you to stop smoking. Call freephone on 8007 3333 for further information or to make an appointment.

What further support is available?
A shared care diabetes programme between the Primary Health Care Department and the Department of Endocrinology and Diabetes in Mater Dei Hospital has now been in place for over 4 years. Through this programme, patients with diabetes are followed up at the respective health centres and managed by a multidisciplinary team of health care professionals comprising of Doctors, Nurses, Podiatrists, and ophthalmologist all with a special interest in Diabetes. All data is collected in a computerised system which also serves as register of all diabetic patients.


HPDP is currently participating in an EU project Care4Diabetes. This lifestyle project will aim to improve the health of people with Type 2 diabetes using the four main pillars; nutrition, exercise, relaxation, and sleep, all under supervision and with the contribution of a multidisciplinary team (MDT). The scope of the project is to improve current practices of Type 2 Diabetes and foster lifestyle changes that will reduce the burden of Type 2 Diabetes and its related behaviours, both at societal and personal level.

Website - Care4Diabetes4JointAction (c4djointaction.eu)