Living with diabetes – a question of balance


World Diabetes Day

14 November marked World Diabetes Day and was observed the world over with the illumination of historic buildings of the blue light that has become synonymous with the disease. Cayman joined the international push to recognise and understand diabetes with a fun afternoon of activities and education at Camana Bay as well as the lighting of several buildings in blue, signifying solidarity by Cayman with the world as it unites in the fight. Business Editor Lindsey Turnbull finds out what it is like to live with this highly prevalent condition and how the local Diabetic Support Group is trying to raise awareness and assist others on island with diabetes.

Background to diabetes

Type 1
In Type 1 diabetes (formerly called ‘juvenile-onset’ or ‘insulin-dependent’), the pancreas completely stops producing any insulin, a hormone that enables the body to use glucose (sugar) found in foods for energy. Instead of the body converting glucose into energy, it backs up in the blood stream and causes a variety of symptoms, including fatigue.
Type 1 diabetes is different from Type 2 diabetes because it is treatable only with insulin, delivered either via multiple syringe injections, insulin pen, or through an insulin pump.

Type 2
Type 2 diabetes is a chronic condition in which the body fails to properly use and store glucose. Instead of converting sugar into energy, it backs up in the bloodstream and causes a variety of symptoms.
Type 2 (formerly called ‘adult-onset’ or ‘non insulin-dependent’) diabetes results when the body doesn’t produce enough insulin and/or is unable to use insulin properly (this is also referred to as ‘insulin resistance’). This form of diabetes usually occurs in people who are over 40 years of age, overweight, and (or) have a family history of diabetes, although today it is increasingly found in younger people. Treatment can take the form of medication taken orally or insulin administered via syringe, insulin pen, or pump.

Gestational diabetes
Gestational diabetes is a form of diabetes that occurs only during pregnancy. According to research gestational diabetes usually strikes between the 24th and 28th week of pregnancy, affecting a total of four percent of all pregnancies. Rates of gestational diabetes are on the rise in the United States, particularly in the African American, Hispanic, American Indian and Alaskan native communities, however, any woman can develop gestational diabetes during pregnancy. Although gestational diabetes generally disappears after the birth, women who have had gestational diabetes have a fifty percent risk of developing Type 2 diabetes in 10 to 20 years after the birth of the child.

Adam’s story – Type 1 diabetic
In 2006, while living in Bermuda with his parents and elder brother, Adam McWatt was a normal healthy young boy who suddenly became constantly thirsty and at the same time began urinating far more frequently than normal.
Mum Melissa McWatt was concerned for her son and sent a urine sample off to the doctors believing Adam had a urinary infection.
“My husband Mike and I were shocked to discover that Adam was actually a Type 1 diabetic and would be insulin dependent for the rest of his life,” she says.
The adjustment was huge as Melissa and Mike began the daily round of checking Adam’s blood glucose levels at least seven times a day as well as administering his insulin four times daily via insulin pen as well as quarterly medical checks with pediatric endocrinologists at Boston’s Joslin Diabetes Center (a leading institution in the field of diabetes care and education) and the nearest specialist centre to Bermuda.
Adam was fortunate in that his parents caught his condition early on and have ensured that he receives the best possible medical care through their persistent quest for knowledge in how to best cope with diabetes and ensure that he lives a long and healthy life.
“Adam requires monitoring 24 hours a day/ seven days a week to ensure his blood sugars remain as level as possible,” Melissa explains. “However, after his first year on insulin we changed from an insulin pen to an Animas pump which administers him small doses of insulin throughout the day as well as greater amounts just before mealtimes. We have found the pump to be an effective way of maintaining stable glucose levels as the pump mimics the pancreas and Adam is now also able to check his blood sugar himself, which makes things easier and gives him independence.”
Adam leads the normal active life of a nine year old boy. Hockey is his passion, as well as soccer, baseball and swimming. He also loves to play the saxophone and likes to dabble in painting as well. He has also participated in raising awareness by talking on the radio about what it is like to live with diabetes.
His parents monitor him closely at all times. “We take his blood sugar reading just before he plays a sport and we always ensure that he has a fruit juice or some chocolate if he needs to increase his sugar levels before he exerts himself,” Melissa says.
Adam now attends the University of Miami for follow-up care.  Here the doctors monitor Adam’s haemoglobin levels for the previous three month period and can detect any sharp spikes in his glucose levels (either too low or too high). 
Melissa says it is a constant balancing act because it is not only food consumption that affects Adam’s blood sugar readings. “Usually Adam’s levels are quite stable but we sometimes get the odd spike. Emotion, mood and stress can affect his blood glucose readings as can illnesses as simple as the common cold. We have to be constantly vigilant because a child cannot express their emotions as easily as an adult and thus Adam is not necessarily aware of the impact of these emotions on his glucose levels.”

Maureen’s story – gestational diabetes  
Maureen Barclay, 31, found out that she had gestational diabetes after a positive result from her routine glucose screening test at the beginning of her third trimester. Maureen has a family history of diabetes as her mother has Type 2 but even so the diagnosis came as something of a surprise to her.
“At first I found it all quite intimidating, there was a lot of information and to me it seemed quite complicated, but after a week or two I got into the swing of things and it wasn’t as bad as I had originally thought,” she says.
The initial guidance by her doctor was to advise Maureen to try to control the sugar levels with diet.
“If that failed then I would need to take insulin,” she says. “I was given a goal that my blood sugar was to be below and told to test my blood sugar one hour after each meal. Thankfully my levels were within the given range and I didn’t need to start taking insulin.”
Maureen was also referred to a dietician for nutritional advice who, she says, offered advice on portions, the right Types of food to eat and when to eat them.
She says the experience was not too challenging for her, but admits, “The only time I did feel slightly deprived was over the Christmas period when I really had to watch I didn’t overeat or indulge any festive treats.”
Immediately after the birth of her son two year’s ago Maureen’s sugar levels returned to a normal level. “I’m pregnant with my second baby just now and the gestational diabetes has returned, although this time round my sugar levels have not been as high,” she says.
A great role model for other women who have had to cope with gestational diabetes, Maureen says, “I’d advise other women who develop gestational diabetes to be conscious of healthy food choices, to find out as much information as they can and to try and relax about the whole thing.”
Maureen has since given birth to daughter Evie.

Here to help
The Diabetic Support Group was formed in November 2006 by Christina Rowlandson, herself a Type 1 diabetic who felt that there was a tremendous need for diabetics and their families to get together and support one another in Cayman.
Christina recalls the shock she felt in March 2005 when she was diagnosed and how she quickly became aware that there was no local authority on diabetes.
“Instead I was attended to at the University of Miami Diabetes Research Institute where I received full endocrinology evaluations and up-to-date treatment. My hope is that more persons diagnosed with diabetes also have the opportunity to go to the DRI.”
Soon after being diagnosed, I also undertook the DRI’s ‘Mastering Your Diabetes’ diabetes education course so that by the end of it I was very well versed in what I needed to do to protect myself from both short and long term complications. I feel immensely blessed to receive care from the DRI which as well as providing expert clinical care is a powerhouse of cure-focused research and beacon for professional diabetes education. My wish is that others can also benefit from the DRI’s diabetes education programmes.”
Over the next couple of years Christina invited the University’s physicians to come to Grand Cayman and Cayman Brac to give seminars including a doctor of podiatric medicine, a paediatric psychologist, several endocrinologists, as well as a nurse who was a certified diabetes educator and insulin pump trainer.
The educators addressed everything from foot issues and coping skills for young adults with diabetes, to the differences between Type 1 and Type 2 diabetes and the latest advances in diabetes treatment. Dr. Luigi Meneghini also delivered a seminar for doctors and other health care practitioners.
“I also advertised local activities to help attract Type 1 diabetics who were happy to share their stories and who felt like they could help others also,” she confirms.
Seven months ago Christina met Melissa McWatt and since that initial meeting the pair has made great strides in raising awareness and forging support. They kicked off by hosting a second family fun day at the Britannia golf course which gave families with diabetes in the family (child or adult) the chance to get to know one another better in a fun and friendly environment.
World Diabetes Day on 14 November was another opportunity for DSG Cayman to reach out to the community, educate individuals about diabetes and have some fun along the way. 
Christina says: “We served as the overall event coordinator and were pleased to work together with the Diabetes Association (event sponsor), the Health Services Authority and service clubs including Lions, Rotaract Blue and Kiwanis. DSG Cayman also sponsored the lighting of Pedro St James National Historic Site in support of the International Diabetes Federation lighting challenge. An enormous thank you to those who contributed most generously to World Diabetes Day by providing funds, goods and services to help make the event such a success. A special mention is deserved of Lions Productions who staged audio-visual equipment for celebratory remarks by local dignitaries.
The event was held at Camana Bay’s brand new The Crescent location, at which the fountain was lit blue for the occasion and there was a host of fun and educational games for children as well as useful information on hand for parents and opportunities for screening for those who wanted to know if they were at risk of becoming diabetic.
Health Minister Mark Scotland also gave an address to the audience. His focus was very much on prevention (at least as far as Type 2 diabetes is concerned; Type 1 is not preventable) via ensuring that government invests in programmes to assist young people in leading healthy lives.
He said: “We will continue to work with other ministries, agencies and departments in order to create an environment that assists people to make healthy choices. In this regard, we already have some noteworthy initiatives on the ground, such as the Children’s Health Task Force that is piloting a multi-component program within schools to teach children to make healthy lifestyle choices and maintain healthy weights.”
Scotland also said that the community was working together as a whole to beat the disease: “Cayman is also blessed with an active volunteer population, and many non-governmental organisations are already helping to create healthier communities. For instance, we held a very successful sports camp programme this past summer in which hundreds of children participated. This represented part of my ministry’s goal to get all our children active, and we will continue to expand the initiative.”
Pastor John Jefferson Snr was also on hand giving the prayer for the event. He also told the audience of his own diabetes and how helpful it was to have regular diabetes support meetings.
Although DSG Cayman is still relatively young, the organisers are already energetically working to raise funds to help diabetics on island better cope with living with the disease. For example DSG Cayman is working with Rotary Sunrise on the staging of a classical fundraising evening on March 4 2010.
Melissa says: “There are some terrific camps in the States geared up especially for children with diabetes. The children have a lot of fun as well as learn how to cope with their diabetes. I believe more children in Cayman could benefit from such programmes if we could raise the funds necessary to send them.”    

Next month we speak with individuals who cope with their Type 2 diabetes and learn how to lead a healthy lifestyle to help prevent the development of this disease.


Adam McWatt after he attended the Joslin camp. He won the “Cayman Sensation” certificate as the first person to attend the camp from the Cayman Islands since inception over 30 years ago