Diabetes is currently the fastest growing disease in the world. According to the International Diabetes Federation (IDF) 9.2% of the adult population in the Eastern Mediterranean are affected by Diabetes. A sedentary lifestyle and bad eating habits are the 2 risk factors for the increasing prevalence of Diabetes. The serious long term consequences of uncontrolled Diabetes include heart attack, stroke or kidney problems.

Type 1 Diabetes cannot be prevented till now but we can prevent its complications: (acute complications like hypoglycemia and hyperglycemia and long term complications like retinopathy, nephropathy and vasculopathy).

Type 2 Diabetes can still be prevented through lifestyle adjustment: regular exercise and healthy diet. People with type 2 Diabetes may not detect the symptoms at early stage and only discover they are diabetic following a routine investigation or a blood test prior to some surgery.

- The Center's specialists are developing a Diabetes Prevention Program for all types of Diabetes, aiming to:

• Promote early detection of Diabetes through community education about early signs and risks factors.
• Increase awareness concerning complications of Diabetes: (neuropathy, retinopathy, nephropathy and vascular complications).
• Spread community awareness about the importance of a healthy and balanced diet and its role in preventing Diabetes.
• Encourage sports and physical activities.
• Respect Diabetics rights and promote laws to prevent all kind of discrimination.
• Develop statistics and accurate data on the incidence of Diabetes.
• Disseminate the publication and recent studies about Diabetes.

This program seeks to fight against this looming pandemic. It will be implemented in collaboration with all concerned governmental and private organization mainly the Ministry of Public Health, Ministry of Social Affairs, Ministry of Sports, Ministry of Education and Diabetes Endocrinology Society, Community Health centers and others.

- Practical recommendations:

Know Diabetes risk factors:

The risk factors for type 2 Diabetes include:

• Overweight (BMI>27 Kg/m2)
• Family history of type2D in first degree relatives
• Sedentarity (lack of physical activity)
• Hypertension
• Dyslipidemia (HDL-cholesteroles<35, Triglycerides > 250 mg/dl)
• Women with polycystic ovaries
• Delivery of babies > 4kg of weight
• Belonging to a race/ethnicity with a high incidence of T2D
• Previous abnormality of glucose tolerance

For early detection of Diabetes:

• In the absence of risk factors, screening is recommended every 3 years, starting at age 45.
• In the presence of one or more risk factors screening is recommended at presentation.

Screening includes any of the following tests (confirmed twice):

• Fasting plasma glucose
  • Normal < 100 mg/dl
  • Diabetes > 126 mg/dl

• Plasma glucose 2hours after oral hyperglycemia (75 g glucose)
  • Normal < 140 mg/dl
  • Diabetes > 200 mg/dl

• HbA1c
  • Normal < 5.7%
  • Diabetes > 6.5%

Individuals with fasting glucose100-126 mg/dl, 2 hours glucose140-200 mg/dl or HbA1c 5.7-6.5% are considered predisposed and at increased risk of developing T2D in the future.

Know the symptoms of Diabetes:

Symptoms of diabetes indicating immediate medical consultation:

• Polyuria (frequent urination)
• Polydipsia (excessive thirst)
• Polyphagia (increase appetite )
• Weight loss

Prevent acute and chronic complications of Diabetes:

Poorly controlled diabetes predisposes to acute and chronic complications:

• Acute complications : Hyperglycemias with ketosis
• Chronic complications :
  • Retinopathy
  • Nephropathy
  • Neuropathy
  • Atherosclerosis (coronary and peripheral)
  • Foot ulcers

Strict glycemic control has been demonstrated to avoid the onset and to delay the progression of all complications.

Create your healthy-eating plan:

- Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar.

As stated by Mayo Clinic,

A diabetes diet simply translates into eating a variety of nutritious foods in moderate amounts and sticking to regular mealtimes.

Rather than a restrictive diet, it is rich in nutrients and low in fat and calories, with an emphasis on fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone.

- Recommended foods

Quality is much more important than quantity. Make your calories count:

• Healthy carbohydrates. During digestion, simple carbohydrates and starches complex carbohydrates break down into blood glucose. Focus on the healthiest carbohydrates, such as fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products.
• Fiber-rich foods. Dietary fiber includes all parts of plant foods that your body can't digest or absorb. Fiber can decrease the risk of heart disease and help control blood sugar levels. Foods high in fiber include vegetables, fruits, nuts, legumes (beans, peas and lentils) and whole-wheat flour.
• Eat heart-healthy fish at least twice a week. Fish can be a good alternative to high-fat meats. They have less total fat, saturated fat and cholesterol than do meat and poultry. Fish are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. However, avoid fried fish.
• 'Good' fats. Foods containing monounsaturated and polyunsaturated fats - such as avocados, almonds, pecans, walnuts, olives, and canola, olive and peanut oils -can help lower your cholesterol levels. Eat them sparingly, however, as all fats are high in calories.

- Foods to avoid

Diabetes increases your risk of heart disease and stroke by accelerating the development of clogged and hardened arteries. Foods containing the following can work against your goal of a heart-healthy diet.

• Saturated fats. High-fat dairy products and animal proteins such as beef, hot dogs, and sausage... contain saturated fats. Get no more than 7 percent of your daily calories from saturated fat.
• Trans fats. These types of fats are found in processed snacks, baked goods, shortening and margarines and should be avoided completely.
• Cholesterol. Sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, shellfish, liver and other organ meats. Aim for no more than 200 milligrams (mg) of cholesterol a day.
• Sodium. Aim for less than 2,000 mg of sodium a day.

- Putting it all together: Creating a plan

There are a few different approaches to creating a diabetes diet that keeps your blood glucose level within a normal range. With a dietitian's help, you may find one or a combination of methods that works for you.

• Counting carbohydrates. Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. It's important to make sure your timing and amount of carbohydrates are the same each day, especially if you take diabetes medications or insulin. Otherwise, your blood glucose level may fluctuate more.
  A dietitian can teach you how to measure food portions and become an educated reader of food labels, paying special attention to serving size and carbohydrate content. If you're taking insulin, he or she can teach you how to count the amount of carbohydrates in each meal or snack and adjust your insulin dose accordingly.

• The exchange system. A dietitian may recommend using the exchange system, which groups foods into categories such as carbohydrates, meats and meat substitutes, and fats.
  One serving in a group is called an "exchange" and has about the same amount of carbohydrates, protein, fat and calories - and the same effect on your blood glucose - as a serving of every other food in that same group. So, for example, you could exchange - or trade - one small apple for 1/3 cup of cooked pasta, for one carbohydrate serving.

- A sample menu

Your daily meal plan should take into account your size as well as your physical activity level. The following menu is tailored for someone who needs 1,200 to 1,600 calories a day.

• Breakfast. Whole-wheat pancakes or waffles, one piece of fruit, 1 cup of low-fat milk.
• Lunch. Chicken kabob, 1/2 cup of steamed broccoli, 1/2 cup of cooked rice, 1/2 cup of juice.
• Dinner. Vegetarian Pasta prepared with broccoli, carrots, zucchini and Parmesan cheese, 1 cup of low-fat milk.
• Snacks. Six homemade crispy corn tortilla chips, 1/2 cup fresh vegetables with a seasoned garlic sauce.

Practice sport and exercise:

It is recommended for most people especially for individuals at risk or with type 2 Diabetes, to practice sport.

• Sport and exercise are one of the keys to successful Diabetes treatment. It is an effective tool for preventing type 2 Diabetes and potential diabetic complications.
• Sport and exercise promote weight loss and maintenance, help with stress management, and facilitate muscle and hepatic cells glucose uptake and increase insulin sensitivity.
• At least, 150 minutes per week should be devoted to moderate physical activity.
• Moderate activities can include: Walking, jogging, swimming, cycling, aerobic exercises, dancing and gardening.
• The physical activity should be distributed over at least three days per week.
• Before starting an exercise program, patients with Diabetes should undergo medical evaluation for macrovascular and microvascular complications that exercise can exacerbate.
• In the absence of contraindications, people with type 2 Diabetes should perform resistance exercises three times per week, targeting all major muscle groups.
• A medical evaluation and clearance from the physician are necessary before beginning a more vigorous and intensive program.
• Team sports can increase compliance and ensure safety during exercise.
• If diabetic patients want to participate in a competitive sporting event, they should work with a professional to develop an appropriate training regimen.
• In individuals without Diabetes, exercise - induced hypoglycemia is rare. For patients with type 2 Diabetes, using insulin or some oral medications, hypoglycemia can occur during prolonged exercise. Monitoring BG level is recommended before and during exercise to prevent it.