By Amy Harris

In Maine, diabetes is a leading cause of heart disease and stroke. Before the COVID-19 pandemic dramatically altered the health landscape in the United States, diabetes was the seventh leading cause of death in the U.S. In this November issue, Amjambo Africa provides information about diabetes prevention to help Mainers lead longer, healthier lives.

What is diabetes?

Diabetes is a long-lasting, chronic disease that impacts how a person’s body turns food into energy – which happens when the body breaks down most food into a sugar called glucose. After eating, the amount of sugar released into the bloodstream (the blood sugar level) rises. In response to this rise, the body secretes a hormone called insulin, which helps cells, tissues, and muscles use the sugar for energy. Insulin thereby lowers the body’s blood sugar level.

If someone has diabetes, their body either: 1) can not make enough insulin (Type 1 diabetes); or 2) can not use the insulin it makes as well as it should (Type 2 diabetes and gestational diabetes). Over time, elevated blood sugar levels in the body can lead to serious health problems. Diabetes-related health conditions include vision loss, kidney disease, stroke, and heart disease.

What is prediabetes?

Doctors diagnose people who have high blood sugar levels as prediabetic because these people are at risk for developing diabetes. Prediabetes progresses to Type 2 diabetes if blood sugar levels stay elevated over time. Type 2 diabetes is the most common form of the disease. The Maine Center for Disease Control and Prevention (Maine CDC) estimates that approximately seven out of every 20 Mainers is prediabetic.

What is gestational diabetes 

Pregnancy-related changes put some women at risk for developing a temporary type of diabetes called gestational diabetes. Jess Doughty, a family nurse practitioner caring for people with diabetes at Maine Medical Partners Endocrinology and Diabetes and Endocrinology Center and Women’s Health Division of Maternal and Fetal Medicine, Division, observed,“[T]he African community has a very high rate of gestational diabetes that is increasing with time. All African immigrant women must be tested for gestational diabetes early in pregnancy … to prevent complications from diabetes for both mother and baby. Gestational diabetes is not the same in everyone – some women will need insulin to help control their blood sugars, and some will not, while some will be able to use activity to help with diabetes management, and some may not be able to do this. But all women with gestational diabetes need education and regular visits with a diabetes specialist to make sure mother and baby are both as healthy as possible until delivery.”

For many women, even those who must use insulin during pregnancy, symptoms of gestational diabetes go away once their baby is born. However – and this is contrary to what many people believe – this does not mean they are cured of the disease. Women who have gestational diabetes have a much higher risk (40-50% higher) of developing Type 2 diabetes later in life.

Abdulkerim Said, executive director of New Mainers Public Health Initiative, reports that many members of the African community in the Lewiston/Auburn area became worried about diabetes as a health risk after several children developed obesity and Type 2 diabetes. “Diabetes is a major concern in New Mainer communities, but there is no education or resources for us to do anything about it ourselves,” he said. “The hardest thing here is the schedule. In Africa, we ate fresh vegetables and fresh fish. We washed our clothes and dishes by hand and carried our own water from the well. We don’t have backyards or gyms to exercise in here, or 30 minutes a day for a workout.” Said spoke of multiple families who had been referred to a dietician for education about diabetes nutrition, but the only option they were given for translation was a telephone operator. “A phone interpreter for diabetes education does not work for New Mainers. Mothers want to help their children, but they don’t know what to do.”

What are diabetes risk factors?

Several risk factors predispose people to develop diabetes. These include having prediabetes or gestational diabetes, being overweight, being age 45 years or older, having a parent, brother, or sister with type 2 diabetes, being physically active less than 3 times a week, having had gestational diabetes or giving birth to a baby who weighed more than 9 lb. (4 kg.), or being of African American, Hispanic/Latino American, American Indian, or Alaska Native heritage (some Pacific Islanders and Asian Americans are also at higher risk). 

What are the symptoms?

Diabetes affects people of all ages, races, sizes, and cultures, but most people with pre-diabetes do not know they have it. There are very few recognizable symptoms of Type 2 diabetes, however the American Diabetes Association lists the following possible symptoms:

  • Urinating often
  • Feeling very thirsty
  • Feeling very hungry – even though you are eating
  • Extreme fatigue
  • Blurry vision
  • Cuts/bruises that are slow to heal
  • Weight loss – even though you are eating more (Type 1)
  • Tingling, pain, or numbness in the hands/feet (Type 2)

Ignoring these symptoms can lead to health problems ranging from prediabetes to Type 2 diabetes, heart disease, and stroke. That is why it is important to see a doctor once a year and have one’s blood sugar level checked.

How is diabetes treated?

There is not yet a cure for diabetes. Diabetes requires close monitoring of blood sugar levels and regular doctors appointments. Insulin is the primary medication used to treat Type 1, Type 2, and gestational diabetes.

Unfortunately, diabetes medicines and regular visits to the doctor are costly, making the high cost of diabetes care impossible to afford for those living in Maine who do not have access to MaineCare. This includes many people of color, including immigrants.

Some people with Type 2 diabetes can control their blood sugar levels with healthy eating and frequent exercise, but others need medication or insulin.

Foods containing carbohydrates are broken down into sugars, just like glucose. Some foods contain simple carbohydrates that release lots of glucose very quickly into the bloodstream. This causes a quick spike in blood sugar levels. Simple carbohydrates with lots of sugar should be eaten in small quantities by those working to prevent diabetes because the carbohydrates we eat impact our blood sugar levels. Balance is key. Some examples of simple carbohydrate foods from a typical African diet are milk, cassava, fufu, white rice, plantains, bananas, beans (of any kind), and mango. Some examples of these foods in the typical American diet are cakes, cookies, chips, white bread, and soda. To stay healthy and prevent diabetes, the goal is to keep blood sugars at an even level over the course of the day, without blood sugar spikes. Foods called complex carbohydrates take more time for the body to digest, and release glucose into the bloodstream gradually. Some examples are brown rice, whole grain bread, lentils, broccoli, tomatoes, and chickpeas.

How to prevent diabetes?

Maintaining a healthy body weight, avoiding smoking, eating a balanced diet, and getting regular physical activity are the most effective ways of avoiding diabetes.

However, if someone is diagnosed with prediabetes, losing a small amount of weight and adding regular physical activity can lower the risk of developing Type 2 diabetes. A small amount of weight loss means around 5% to 7% of one’s total body weight, or just 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or another similar activity. That’s just 30 minutes a day, five days a week.

The National Diabetes Prevention Program, led by the U.S. Centers for Disease Control and  Prevention (CDC), offers behavioral lifestyle change education programs at no cost through many Maine hospitals and community organizations. More information is available at www.cdc.gov/diabetes/prevention/find-a-program.html. Or visit the Maine CDC’s newly launched RETHINK Diabetes ME site at rethinkdiabetes.org/. 

Living in the U.S. is a risk factor 

The stress that accompanies acculturation, the Western diet, working long hours or overnight shifts, and being physically inactive – which immigrants experience the longer they live in the U.S. – all contribute to the documented risk for developing diabetes. Social determinants of health such as racism, access to medical care, citizenship status, and employment have all been shown to magnify the risk of developing diabetes.

At the same time, research shows that improving diabetes education among immigrants and people of color are key to lowering the risk of sickness. For this reason, the Maine CDC is working with community organizations such as Maine Access Immigrant Network (MAIN),  and with community health outreach workers (CHOWs) to provide culturally competent education and improve health care access in people’s primary languages. The partners expect that, as screening initiatives multiply and policy makers, healthcare system leaders, and social service agencies invest in the prevention of diabetes, rising case numbers will be controlled. The healthy future of many people living in Maine is at stake.