By Radhika Ganesan

Diabetes has become a major health threat to the whole world; indeed, the greatest increase will be contributed by India, which has already been declared by the World Health Organization (WHO) as the country with the largest number of diabetics in the world. Diabetes is frequently not diagnosed until complications appear, and approximately one third of all people with diabetes may be undiagnosed, though diagnosed many people are not aware of their condition.

Late detection of diabetes often means that at the time of diagnosis complications have already damaging the eyes, kidneys and nerves. These complications are costly in the physical, financial and psychosocial sense. Early detection and treatment of diabetes may not only improve glycemic control, but also improves blood pressure and lipids.
Who should be screened? In general all adults should be screened at regular intervals
o Family history of diabetes (i.e., parents or siblings with diabetes)
o Overweight (Body Mass Index >25 kg/m2)
o Age >45 years
o Previously identified impaired fasting glucose (IFG) or impaired glucose tolerance (IGT)
o Hypertension (>140/90 mmHg)
o Hyperlipidemia (HDL - 250 mg/dL or both)
o History of gestational diabetes or delivery of a baby over 9 lb (4.1 kg) (ADA -Diabetes Care 2004)

What are the Screening test for Diabetes

Fasting Plasma Glucose: The fasting plasma glucose (FPG) test is the standard test for diabetes. It is a simple blood test taken after eight hours of fasting. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes.

Oral Glucose Tolerance Test: The glucose tolerance test may be more accurate than the FPG in certain groups (e.g., women with a history of gestational diabetes). The test uses the following procedures: I) after an overnight fast Fasting Plasma Glucose test is performed. ii) After this test a person receives 75 g of glucose (100 g for pregnant women) blood samples are taken every half an hour {(fasting-30mts-60mts-90mts-120mts-(five times)} to measure the blood glucose. It not only helps in detecting diabetes but also help to detect the pre-diabetic status, Impaired Fasting Glucose (IFG) & Impaired Glucose
Tolerance (IGT))

Is it important to detect pre-diabetic stage? Yes! Because it is "preventable"
Criteria for the diagnosis of diabetes mellitus

Normal DIABETES

Symptoms of diabetes + Random plasma glucose o Blood pressure check up, regular at every visit for Hypertension (High blood pressure) - should be 40
o An electrocardiogram (ECG), that provides information about the status of heart
o Chest X ray, information about the lungs and shape of the heart and vascular system (aorta and blood vessels)
o Carotid Intima-media Thickness (IMT), marker of early atherosclerosis

Diabetic Nephropathy (Kidney Damage): Person with diabetes are several times more prone to kidney disease than the general population. The earliest manifestation of kidney damage is microalbuminuria, (tiny amounts of protein called albumin are found in the urine). Symptoms include Protein in the urine, High blood pressure, burning during urination, frequent urination, puffiness and swelling around the eyes, hand & feet, excessive itching, nausea, vomiting & weakness.

About 20% of type 2 patients show evidence of microalbuminuria upon diagnosis of diabetes, however, only a small percentage of type-2 diabetics eventually develops kidney disease. Microalbuminuria typically shows up in type 2 diabetics who have high blood pressure. Normal: 15yrs will develop diabetic retinopathy in their lifetime.
Who are more prone to Diabetic retinopathy? : Uncontrolled blood sugar, longstanding diabetes, Hypertension with diabetes & Genetic predisposition.

What are the stages of retinopathy? : Mild non proliferative diabetic retinopathy (NPDR), Moderate-non proliferative diabetic retinopathy, severe retinopathy, Maculopathy and Proliferative diabetic retinopathy. Treatment: Retinopathy can be treated through laser photocoagulation. Screening test: Patients with diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist right from the day of diagnosis of diabetes and every year thereafter. Early detection, timely treatment, appropriate screening and care reduce the risk of vision loss & 90% of diabetes related blindness.

All patients should be regularly screened for risk factors and encouraged at each health care visit to pursue a healthy lifestyle that includes a healthy diet, adequate exercise, weight control and stress reduction. 'Try for good control to be sure, but don't try for perfection. Perfection lasts for a moment, and diabetes lasts a lifetime'. The main theme is to be focus on to 'live a Healthy Life Despite Diabetes'.

The world is facing a new epidemic; type II diabetes. It is vital that smaller groups that have already faced an epidemic of type II diabetes be researched to learn what can be done to help reduce the treatment and to identify what is not worth repeating. Type II diabetes is also know as adult-onset diabetes and it often comes later in life. Native American populations have long faced a greatly increased percentage of type II diabetes. In fact the Pima natives of Arizona have the highest rate of type II diabetes in the world (Wheelwright). They know well that it is a deadly disease. By looking both at the history that has led up to the current diabetes epidemic in native populations and the preventative methods and their relative success rate, world health organizations could better prepare to help reduce the severity of the inevitable diabetes epidemic. National health care associations should begin a world wide prevention program for type II diabetes based on the experience of a population (Native Americans) that has already undergone such an epidemic like this before.

With estimates of the number of people worldwide with type II diabetes exceeding 300 million by 2025 it is vital that health organizations understand the devastating costs both monetarily and personally of this illness (Polikandrioti 217). Diabetes is a life changing and expensive illness. It is estimated that the treatment of diabetes in the United States now costs over $132 billion annually. Diabetes is the sixth leading cause of death in the United States (Type 2). The $132 billion is only the United States' cost but proportionally higher costs hit other economies. China will lose "$558 billion in foregone national income due to heart disease, stroke and diabetes alone" over the period from 2006-2015 (Diabetes). It is not only the monetary cost that makes diabetes such a challenging illness. According to the World Health Organization, diabetes increases the risk of heart attack, stroke, limb amputation, blindness, kidney failure, nerve damage, and at least doubles the risk of death (Diabetes). This cost of diabetes was echoed by a study done by O'Connor, Crabtree and Nakamura that found that the mortality rate of Navajos increased from 17% to 39% with diabetes (216). The cost both monetarily in humanitarian loss that is caused by type II diabetes makes the illness one worth trying to prevent.

The good news about this impending epidemic is that type II diabetes is in many cases a preventable illness. This is important because illnesses that can be prevented are far easier and less expensive to prevent than to treat after onset has occurred. It is often referred to as an illness of lifestyle (Miller). Although there can be genetic factors at play, much can be done with a person's lifestyle to prevent or delay the onset of the illness. The World Health Organization states that maintaining a healthy body weight, staying physically fit and eating a healthy diet can all help to reduce the risk of type II diabetes (Diabetes). Prevention for most cases of type II diabetes can be done through the seemingly simple act of getting people to live healthy lives, with regular frequent exercise and consistently a healthy diet. People who live healthier live are also less likely to get other chronic health problems like heart attack and stroke. A focus on prevention would not only help to reduce the prevalence of type II diabetes but also help in the overall wellbeing and general health of the people who were already being treated, thus world health organization should focus prevention on confronting this epidemic.

Prevention is possible. Treatment is very expensive and often cannot fix the problem. Therefore, prevention becomes the logical, practical and effective focus. If world health organizations are able to implement a successful prevention program that is able to convince its members to live a healthier life style then the overall health care need of that group will be reduced. The United States paying a staggering $132 billion annually makes it vital for the survival of aid organizations to do what they can to reduce the cost of treating major illnesses (Type II). A successful prevention program will not only reduce the number of people with type II diabetes within the community but it will also help to improve the general health of community thus reducing the cost of health care to the community further. Preventative medicine is almost always less expensive and often more effective than treatment, because it allows for the problem to be corrected before it becomes a full blown illness. This is not to say that treatment will not be important, but just that the money of health organizations can and will go further if they put their focus in to the prevention, while still preparing for treatments as necessary.

With the type II diabetes epidemic at the world's door step, it is a challenge that all the world health organizations use that knowledge which has been gained by the group (Native Americans) that has already suffered from this epidemic. Native American tribes have had to face their own diabetic crises and have done a large amount of work to find what is most successful in the reduction of type II diabetes within their own tribes. Type II diabetes is a relatively new problem to the Native American populations, but the number of type II diabetes cases has risen very quickly (Edwards 33). With the quick rise of type II diabetes with in the Native community and the history of studies that have been done in the treatment and prevention of the illness for this community; Native Americans are a very good focus group for health organizations to consider. The studies that have been done on prevention programs for Native Americans could be very easily applied, and expanded on to help world organizations to reduce this epidemic before it comes.

Native Americans' have the highest rate of type II diabetes in the world; the Pima in particular are the highest or any subgroup worldwide (Wheelwright). The reasons that type II diabetes is so high in this population are not known, but it is thought that here might be a genetic element. With such alarming numbers of type II diabetes it is important to understand how the Native American population got to this point and see if there are any trends in common with the world situation today. Prior to the 1940's diabetes was virtually unheard of, but ever since the 1960's the prevalence has been on the rise (Edwards 33-4). This rise is thought to be in part due to their food history and culture. Native Americans had a diverse food history prior to colonization, but after colonization the natives were forced to live on non-traditional lands and eat government hand-outs for food. Much of this food was of low quality, meaning that here is not much nutritional content for the caloric intake and led to many Natives being malnourished. Even as recently as the late 1990's one in four Native household had elements of malnutrition (Edwards 32). Today most native diets more closely resemble the western diet than their traditional diet. The combination of the loss of their traditional diet with the replacement of that diet with low quality government food, especially highly processed grain like flour seems to have been a big part of, if not the cause of the increase of diabetes in the Native population. Let us hope that there is time before the world mimics the history of the Native American populations, but that will require action now.

The story around that world today looks much like that of the history books telling of the treatment on Native Americans in the 1940's. There are many groups of people world-wide in developing nations who are starving to death or are severely malnourished. Many governments throughout the world are now providing food aid of a similar kind to world populations that are facing starvation or famine. Famine is a sociological issue, starvation is a physiological change within an individual. Both can result from unintended consequences of the political and economic patterns of western nations like the United States. Food aid tends to come in the form of inexpensive food products, mostly heavily processed grains. Heavily processed grains are very cheap because wheat, corn and rice are relativity easy to grow and subsidized by our government. Once processed such grains can last for a long time. The problem with such grains is that the human body breaks them down to sugar very easily, thus making its consumers more likely to get type II diabetes (Miller). This type of food aid sets up a structure similar to that which was created in the 1950's and 1960's with the Native Americans. The groups that are being given the aid become reliant on that food and lose their native food culture. As well as losing their native food culture, the groups are also staying malnourished, because they are not getting everything that they need from the food aid. Although this type of aid may be offered with the best of intentions, it also has hidden consequences, like type II diabetes. It is in places where aid like this is going that world health organizations need to focus on prevention.

There is another sleeping dragon in the room when it comes to the cause of the world epidemic of type II diabetes; westernization. Companies like McDonalds are now all over the world serving western fast food. This food is well known in America for causing chronic health problems like diabetes. Another western adaptation that is contributing to the diabetes epidemic is soda. Coke -A-Cola is sold in every country around the world and it is full of sugar. A diet that it very high is sugar will increase a person's risk for getting type II diabetes (Miller). Government food aids along with the strong westernization of the rest of the world are placing the world at an enhanced risk of diabetes. The result of western aid programs and diet are being seen in the dramatic increase of type II diabetes world wide that is going on now. It is the role of western culture, in particular western food culture, that we are witnessing as the cause of the drastic spike in the number of type II diabetes cases world wide. It is western culture that has gotten us in to this mess, it should be the western health organizations that help to get us out.

For prevention programs of any kind to work it must instill the drive to change, and make those changes not only preferable but also achievable. Many people will want to change if they know that it will be better for them, but if that change is very hard or expensive they simply will not do it. For example, if you want a dietary change part of your program to work, you must not only tell people that their way of eating is bad for their health but also make them not desire to eat such foods. A study on the effectiveness of prevention programs in Native American populations found that:
"The major identifiable barriers were not lack of knowledge of healthy dietary practices and the value of exercise but preferences for high fat foods and large servings and less physically active lifestyles. Perhaps more important were a lack of personal confidence, a lack of skills and a lack of social support for bringing about desired changes" (Hood)

For a program to be successful it must not only present the information to the individual, but must also give that person the tools to make the desired changes, and make those changes more desirable. Cultural involvement, personal empowerment, social support and skills training, as well as a focus on preventative health measures all need to be involved in any successful prevention program.

In order to successfully create prevention programs worldwide it is vital that world health organizations look to see what makes programs that are now in use successful. Because of the Native Americans' abnormally high level of diabetes and the large number of prevention programs in place within the community, they are particularly a good focal group. Successful diabetes prevention programs in Native American populations all have a combination of traditional methods and personal/community empowerment. In 2009 a group of researchers did a review of the literature on diabetes prevention in Native American communities, and found five programs that were exceptionally effective (Edwards 32). All the successful programs incorporated a large amount of personal and/or community support in addition to a focus on healthy living (Edwards 35). Having a strong support system, both individual and community, helps to make this prevention program far more effective. For world health organizations to make a program successful they should look at success of these five programs and mimic their value of a strong support structure. The individual culture of the target group must be taken into account in order to create a successful prevention program with an appropriate support network.

With a diabetic epidemic breathing down the on the world, it is time for world health organizations to make an earnest effort to help prevent diabetes in as many cases as possible. Type II diabetes is a very expensive to treat, but fortunately in many cases it is preventable or at least can be delayed. With the cost of treatment being so high, it is very important that prevention become the focus, but in order to be effective it is very vital that they make sure the programs that are implemented are as effective as possible. Native American populations have undergone a progression similar to that of the coming world population. Highly successful prevention programs follow the pattern of the Native American programs that incorporate element of the individual cultures and focus on personal empowerment and a strong support network.

Diabetes is a disease that affects millions of people in the U.S. alone. A simplified definition of diabetes is when your body does not produce enough insulin to properly use the right kind of sugar into your bloodstream. This can have devastating effects on the body, as the cells do not get all of the fuel they need for energy and growth. While all of the causes of diabetes are not fully understood, eating raw foods helps to reduce some of the currently known risk factors. Therefore, it makes sense to choose a diet of raw foods whether you have been diagnosed or not.

Dietary needs of diabetics
Diabetics still require the same levels of nutrition as everyone else, maybe even more so. Nutrition is one of the most important elements for controlling diabetes properly. As you will see, following a raw food menu will fit in with diabetic nutritional recommendations. Here are some basic tips on eating right.

Choose a wide variety of fruits and vegetables. (Diabetics may need to limit starchy vegetables)

• Avoid processed grains such as white flour, and white rice.
• Opt for whole grains instead.
• Add lentils and beans (like pinto, garbanzo, or kidney beans) to your diet.
• Eat fish a few times a week.
• Consume non-fat dairy products.
• Reduce high-calorie snacks and like cake, cookies, chips, and ice cream.

Raw foods for diabetes
Most of these recommendations fit in well with the raw food lifestyle. The main difference is that the food would not be cooked, as raw foodists eat raw, uncooked, unprocessed and organic food. Fish and dairy products may or may not be a part of your raw foods diet. People that eat raw foods are already reducing their risk for disease, including diabetes.

If you have diabetes and are thinking about a raw foods program, you can see how it is an ideal choice. A raw food diet helps those with diabetes by sticking to the current dietary guidelines. The reason raw foodists do eat uncooked food is because all of the naturally occurring enzymes. These enzymes promote optimum health and digestion. Diabetes is a serious disease, so be sure to check with doctor before switching to raw foods. Take some time to explain what the raw foods diet is all about. Be sure to continue monitoring your blood sugar level according to your doctor’s instructions. Some diabetics eating raw foods have seen remarkable improvements in their condition.

Eat to Beat Diabetes
When it comes to maintaining good blood sugar levels, a healthy diet is vital. People with diabetes have to take extra care to ensure their diet is properly balanced with their insulin and oral medications.

The right meal plan will help any diabetic improve blood glucose levels, blood pressure and cholesterol numbers.
All diabetics must control their refined carbohydrate intake. These types of carbohydrates increase blood glucose levels. While some promote health, others when eaten often and in large quantities, may increase the risk for diabetes.

Carbohydrates come from a wide array of foods including fruit, vegetables, beans, milk, popcorn, potatoes, cookies, spaghetti and corn. The most common and abundant ones refined in are sugars, fibers and starches. It is advised diabetics avoid white bread, rice and pasta, along with foods containing unnaturally added sugars.

The body will convert all types of refined carbohydrates into glucose. Eating extra servings of rice, pasta and bread will make blood sugar rise.

Diabetics should consume carbohydrate-rich foods close to their natural form. These items have greater vital nutrient density. Whenever possible, replace highly processed grains, cereals and sugars with natural whole-grain products.

Eating complex carbohydrates rich in fiber significantly lower blood sugar levels. It is capable of slowing down the digestion and absorption of carbohydrates and increasing the sensitivity of tissues to insulin, thereby preventing rises in blood sugar.

It is recommended diabetics eat 13 fiber-rich servings of fruits, veggies, beans and grains daily. Soluble-fiber rich foods include orange and grapefruit segments, prunes, cantaloupes, papayas, raisins, lima beans, zucchini, oatmeal, oat bran and granola. Other foods high in soluble fiber include barley, peas and strawberries.

The glycemic index system, or GI, is a good guideline for diabetics to follow.
Invented in the early 1980s by University of Toronto researchers, the glycemic index ranks carbohydrate foods by their effects on blood sugar levels.

The GI assigns carbohydrate-containing foods a number based on how they affect blood sugars. The longer the body has to break an item down into glucose, the slower the rise in blood-sugar levels, and the lower the GI. Adding a half a teaspoon of cinnamon to any meal can stabilize blood sugar swings.

Many diabetics also supplement with vitamins, herbs and medicinal teas. Incorporating natural ginseng into a diet can produce positive affects. This herb, which is recognized throughout China to have healing properties, has been known to help improve fasting blood glucose levels and increase insulin secretion.

The easiest method to control diabetes is through proper diet. An eating plan high in fiber and low in refined carbohydrates will ensure the best strategy to beat the disease.

To complicate matters even worse, there is no specific diet for diabetics. Help is available to make sure you have the information you need to learn and understand about diabetes diet guidelines.

Not following diabetes diet guidelines, is a common mistake made by most diabetics. Much diabetes doesn’t understand the needs of diabetes diet guidelines…or how closely tied to good diabetic control the food you eat can be.

The American Diabetes Association has what's called the Diabetes Food Pyramid. Designed much like the revised (2005) version of the USDA's Food Pyramid, this pyramid provides excellent information and diabetes diet guidelines to help you gain control of your blood sugars, your weight, and your diabetes.

Gain Better Control of Your Diabetes Today Using Diabetes Diet Guidelines
The diabetes food pyramid is divided into six groups. The size of the groups varies. The larger the group, the more servings per day of foods within that group should be consumed. Grains and starches (carbohydrates) is the largest group. This includes foods such as rice, pasta, breads, and cereals, potatoes, corn, peas, and some beans. The recommended number of servings per day is 6-11. Most people should use the lower number of servings.

The next group is vegetables. Vegetables are naturally low fat. This makes them a good food choice for everyone. Spinach, broccoli, cabbage, cauliflowers, carrots, tomatoes, lettuce, and cucumbers are examples of vegetables in this group. Please note the more starchy vegetables like potatoes, corn, and others are in the grains and starches group. The recommended number of servings per day for this group is 3-5.

The middle layer of the Diabetes Food Pyramid is fruit. This group also contains some carbohydrates. Berries, melons, apples, bananas, peaches, grapes, and other fruits are found in this group. The recommended number of servings is 2-4 per day.

Following the fruits is the milk group. This includes milk and milk products. For those trying to reduce their weight and cholesterol choose low-fat dairy products. Recommended servings are 2-3 per day.

The meat group includes chicken, beef, turkey, fish, eggs, dried beans, cheese, and peanut butter. You only need 4-6 ounces servings per day. At the top of the pyramid are the fats, sweets, and alcohol group. This group should be avoided. Most recommend keeping your portion sizes small and only having these foods on special occasions.

While diabetes diet guidelines do have some basic principles the best meal plan for you can only come by consulting with a nutritionist, with diabetes experience. Nutritional needs of diabetes vary from person to person. For example, a thin type 1 diabetic with kidney disease won't have the same needs as an overweight type 2 diabetic

By evaluating your needs individually, diabetes diet guidelines can be established especially to meet your specific health and weight needs. Don't think of the diabetes diet guidelines as a diet.

Special Diabetic Diet-How to Live Healthily Again By Eating the Right Food
What exactly is a “diabetic diet”? Diabetic diets are not related to fad weight-loss diets. The word “diet” actually just refers to the food that a person eats each day. Everyone in the world who is eating is on a diet! There is actually no such thing as a single "diabetic diet", because the diet that a person with diabetes follows to help manage his or her blood sugar levels is based on the same nutrition principles that any healthy person, with or without diabetes, should follow for good health.

If you are diabetic, there are some things that you may want to change about your eating habits in order to help you maintain your blood sugar levels at a healthy level. Your dietitian can help you to plan your personalized diabetic diet plan, meaning that you will have a simple plan to follow to help you make food choices for each meal and snack throughout the day.

Someone with diabetes needs special care because it can no longer handle drastic changes in eating, especially when it comes to carbohydrates. Someone without diabetes may be able to skip breakfast and lunch, and then eat a huge dinner late at night, and this person’s body will be able to compensate. If you are diabetic, this type of irregular eating can be hazardous because your body cannot handle the lack of and then inundation with food (shown in your blood sugar level).

The diabetic diets were created to help diabetics feed their bodies in a very controlled, regular way. Diabetic individual cannot skip meals or overeat at meals. They need to eat certain amounts of food at regular intervals, just to maintain a consistent blood sugar level.

This might sound confusing, but don’t worry- your diabetic diet will make it easy for you to keep track of your food intake. Let’s take for example, the popular exchange list from the American Diabetes Association breaks foods up into similar groups. There are, for example, the “lean meats,” “the dairy,” “the fruits,” and more. A dietitian would create your daily diet plan specifying the number of servings of each of group to be eaten at each meal or snack.

For example, if you have to have one fruit and one carbohydrate for your morning snack, you know that you can choose one item from the list of fruits and the list of carbohydrates. This quickly becomes habit for people using this diet tool, and will help diabetics to maintain good blood sugar levels throughout the day.