Diabetes On the Rise In Barbados

Submitted by Dr Georgie Porgie (feel free to ask any questions)
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“Chronic diseases, including the quartet of silent killers, obesity, hypertension heart disease and diabetes, now represent the most significant health care problem and the most important cause of mortality confronting the English-speaking Caribbean. Significantly all of these conditions have the same strong lifestyle components as risk factors and demand a common approach to prevention and management. In Barbados it is estimated that 25,000 people have diabetes and if the present trend continues this figure may double by 2020. Recent figures suggest that diabetes and its related complications account for a huge burden of disease and debt much of which may be preventable.”

Go to Barbados Diabetes Website

Those who want to delve into the very technical side of the disease can view this presentation.

36 thoughts on “Diabetes On the Rise In Barbados

  1. Dr. Georgie Porgie:
    How do you propose this could/should be managed?
    For donkeys years I have been led to believe what you are stating above to be true. I have had some experience of witnessing some of the above.
    However, governments of ‘All colours’ don’t seem to take it as a matter of concern,although the number of extra days off sick among some are alarmingly high.
    One can take a look around most shops; read the labels on most soft drinks to see the high contents of much added sugar.
    Non sugary drinks are more expensive and sometimes there are none available.
    Fruit and vegetables are priced too high when compared to those in neighbouring countries, EU and USA.
    WE drive our kids to school with some sugary drinks and snacks for break time. We deny our kids extra playtime, preferring them to read or view the latest movie.
    Do parents need to be educated the same as governments or is it no government’s business to get involved?

    We have a host of fast foods outlets readily available; should we close them and encourage our children back to ground provisions?

    Just yesterday I was in a conversation relating to above subject. A gentleman stated :”Why bother about what we eat and drink when A PILL can be had for most diseases!”

  2. Hants
    Thanks for your kind remarks. Leo
    You ask some good but hard questions. Let me try to answer some. The best way to benefit from the ppts would be to systematically ask questions by stating slide number and raising issues not fully understood.

    e.g re :”Why bother about what we eat and drink when A PILL can be had for most diseases!”
    In the case of diabetes, the available medication may be effective only for a short time, and some of the newer agents have even been discontinued.
    Re We have a host of fast foods outlets readily available; should we close them and encourage our children back to ground provisions?
    We should certainly encourage everyone to return to ground provisions and other foods because they have low glycemic indices. Ground provisions contain starch which burn energy to digest and absorb, and do not readily provide the quantity of glucose that are found in sweet sugary drinks. We ought to avoid anything that involves FRUCTOSE CORN SYRUP. We don’t burn as much energy in walking, running etc so we must all reduce our sugar levels. Increasing use of ground provisions means increased fiber in the diet and decreased levels of colon cancer.
    I don’t know we will close the fast food outlets in a democracy. But there may be other methods to make them compliant or less accessible. LOL
    Re Do parents need to be educated the same as governments or is it no government’s business to get involved?
    RE most soft drinks …AND the high contents of much added sugar. Sacharin tabs and xylitol are good substitutes. The sugar industry overseas got saccharin outlawed when its increased use caused them to fear competition. We can easily make xylitol from the cane fibre we discard from our cane production process.
    We ought to avoid aspartame because of its possible side effects, I am told. This is something that I have to research in depth.
    Note that some fruit like mangoes and water melons have high sugar levels.
    Managing sugar is not easy. BUT it is as dangerous as alcohol or cocaine- it is very addictive! Just as addictive!.

    • We are truly living in a fool’s paradise. Back to Leo’s point. Our lifestyle will continue to fuel NCDs which based on our policy position means an expanding health budget. Eating fast food and all the lifestyle trappings will not change and we know it.

  3. Do a test, get a bowl of Sugar, white- sugar , salt,
    after smelling all 3 in that order then go back to the Sugar and see if it smells like salt.
    Any place where there is white-sugar ,the rates will go up for Diabetes

    Barbados need to tax the hell out of white-sugar or dont put it on the store ,

  4. @ Georgie Porgie | December 31, 2012 at 12:07 AM |
    “I don’t know we will close the fast food outlets in a democracy. But there may be other methods to make them compliant or less accessible. LOL”

    Indeed, laugh out loud at any suggestion of closing these fast food outlets!
    We have at least three generations who have been brought up mainly on fast food and where their parents’ kitchen is just a showpiece for the latest in household gadgetry.

    Since we seem to agree that both smoking and drinking are major threats to our health and should not be banned but penalized to suit the dangers resulting from these addictive habits why not treat processed food and drinks with high levels of sugar with the same approach?
    We tax tobacco and alcohol to the hilt not only to provide an easy source of revenue for the treasury but also as a falsely held view that it would act as a deterrent and create a type of ‘financial sinking fund’ to help defer the future costs of caring for those addicts/victims who suffer the health challenges arising from addiction.

    The miller has previously proposed the imposition of “Fat & Sugar” taxes.
    The Sugar tax can be imposed at the point of production or wholesale distribution to facilitate easy assessment and collection.
    The Fat tax can be imposed on all fast food outlets with turnovers in excess of $400,000 per annum (the exempt ceiling can be discussed and negotiated just like the VAT registration threshold). The tax would be a fixed annual imposition, say $ 400,000 per retail outlet and payable at time of annual renewal of business licence. Again the limits and other terms and conditions can be discussed, negotiated and agreed upon. The businesses cannot claim that they will have to absorb the tax since they will be expected to pass on the additional costs to the consumers just like any other business expense.

    We are sure that the government can use the Fat, Sugar and Salt (FSS) impositions to not only deter consumption for general good health but also assist in reducing its “obese” fiscal deficit.
    Now here is free advice to the MoF for next year’s budget.

    The tax of mobile phones can also be revisited but instead of making it a specific tax ($4.00 per month) why not make it ad valorem; say 5% on each top up or on monthly bill for the contract service.

    People now consider mobile phones not as a device for serious business use, selected convenience and emergency calls but more of showoff gadgets and toys for the youth.
    Let them pay for this privilege to offset the increasing cost of ‘free’education.

  5. PLANTATION DEEDS | December 31, 2012 at 12:25 AM |
    re Any place where there is white-sugar ,the rates will go up for Diabetes
    Barbados need to tax the hell out of white-sugar or dont put it on the store ,
    AGREED We should tax white sugar because it is stupid to sell our sweeter brown sugar and then buy back the more processed white sugar more expensively. We must have some sugar in our diets, BUT we should avoid white sugar. Apparently it is absorbed faster and the way it is used tends to help us to imbibe empty calories.

    David | December 31, 2012 at 7:09 AM |
    re Eating fast food and all the lifestyle trappings will not change and we know it.

    Observing(…) | December 31, 2012 at 8:11 AM |
    Informative as usual GP. THANKS
    NCD’s have a massive economic cost. TRUE
    Do our powers that be have the testicular fortitude to do something like this?

    David | December 31, 2012 at 8:48 AM |
    Maybe with the current debate about milk and PHD there is a big opportunity.


    As LEO opined, folk who are reading diet books etc and trying to lose weight and eat right find that they can not find enough affordable low calorie foods .

    I once tried successfully in the 80’S using Campbell soups under 100 calories for breakfast and lunch. These have become increasingly expensive, as they are imported.

    We can probably try to mimic the making of such soups in our homes to break the monotony and by using herbs for flavor reduce the sodium content in the imported soups in the supermarket.

    Maybe we need to form food growing co-operatives that can assist. Initiatives like this is what the so called constituency organisms should be working on.

    David I believe we know what we should do, but we need to get the will to do it. Hard sometimes

    Another problem is the finding of substances like leptins etc Trying to master some of this. Will report on my understanding in due time

  6. The problem with the high incidence of diabetes as i see it and very few people want to address it, as has been continually repeated,it is a lifesyle disease unless genetic, and even then you get to control whether you want to have the disease or keep it. Bajans love sugar, sweetbread, cakes and every destructive diet imaginable, thats why everyone keeps dancing around the topic while sufferers are losing limbs on a daily basis, no way would the average bajan change their diets, that would be unbajan and defying the eating culture. How do you stop someone from drinking six sodas a day and eating four extremely sweet cakes. Diabetes is there to stay unless the education actually seeps through the brains, that if you change your diet, unless too late, the disease actually disappears. Many more would have to die over a period of several more decades.

  7. @ Georgie Porgie | December 31, 2012 at 9:54 AM |

    Thanks, GP, for the commendation.
    I must also agree with you and support your call for our people to include more plant material in our diets. Our young people are eating less and less plan-based foods such ground provisions, fruits and especially herbs which are natural medicines.

    It can be argued that our people’s general health can improve if, in addition higher water intake, more plant-based foods are consumed to mitigate the effects of the excess refined sugars, salt, animal flesh and other fats our people seem to enjoy in abundance.

    Our local doctors need to step up to the plate and help educate our people instead of prescribing synthetic drugs to their ‘hooked junkies’ to earn commissions from the pharmaceutical giants and their local drug barons called distributors.
    One thing you can say about Dr. Sparman he shares his knowledge and gives his advice freely to the people. “Stay close to the plant”, Dr. AS! Wishing you a healthy 2013!

  8. Here is an interesting article from UWI, Mona on the Unitarian Hypothesis for the causation of diabetes, that indicates that diabetes is even more complicated than we think. ENJOY
    Quite different nutrition-related environmental factors influence the development of type 1 insulin-dependent diabetes (IDDM) and type 2 non-insulin-dependent diabetes (NIDDM). IDDM is characterized by progressive beta-cell destruction which leads to complete insulin deficiency; at the time of diagnosis 80-90% of beta cells have been destroyed.

    In children there is epidemiological evidence that high intake of nitrites and N-nitroso compounds, early introduction of cow’s milk to the diet and short duration or absence of breastfeeding increase the risk of IDDM.
    Studies in experimental animals suggest that cow’s milk and soy proteins may be diabetogenic. There is current interest in the effects of free radical scavengers, particularly niacin and natural and synthetic antioxidants on the incidence of IDDM.

    These findings from ecological, animal, and human case-control studies remain to be evaluated in prospective cohort studies covering infancy and childhood and finally in human intervention trials. NIDDM is characterized by insulin resistance which is complicated by impaired insulin secretion at the time of appearance of hyperglycaemia and clinical diabetes. Its preclinical development is insidious and poorly defined, and there is little direct evidence that the same factors which influence metabolic control in clinical diabetes also affect the preclinical development of the disorder. Obesity, particularly of the abdominal type, is common in people who develop NIDDM, and weight control by appropriate diet and physical activity is probably the most important measure for preventing NIDDM.

    High (saturated) fat intake seems to be associated with insulin resistance, obesity and increased risk of NIDDM, and diets high in carbohydrate seem to protect from glucose intolerance and diabetes, mainly owing to their high fibre content.

    Over the years, several clinical syndromes have been described in diabetes mellitus. Although world opinion has settled somewhat on the main two types, the debate continues as to how the ‘formes frustes’ syndromes fit in and what if any implications there are for the accepted aetiology of the disease. Type 1, insulin dependent diabetes mellitus, results from pancreatic inadequacy as a result of a variety of insults such as autoimmune attack, toxic damage, etc. Insulin administration is at the core of the therapeutic approach. Type 2, non insulin dependent diabetes mellitus, results from reduced responsiveness of the target tissues to insulin and as such, an insulin resistance syndrome is described. Lifestyle adjustment and oral hypoglycaemic agents are the mainstay of therapy.

    Over the years, however, insulin insufficiency will develop in most cases and insulin therapy required in order to achieve normoglycaemia. The aetiology of these main two types has been maintained to be distinct from each other and as such types 1 and 2 are described as two separate developmental conditions.
    Furthermore, the variant patterns, such as malnutrition related, drug induced, intermittent or phasic insulin requiring, gestational, temporary, stress related, etc., all present a challenge as to how they fit in aetiologically.

    The Unitarian Hypothesis, by presenting this overall cascade of biochemical and physiological interactions, brings a logic which embraces the points of entry of a variety of insults, all of which can lead to the clinical picture of hyperglycaemia and its attendant adverse outcomes.

    The hypothesis buttresses the belief that nature – the genetic predisposition which directs potential antibody development; and nurture – the environmental influences such as nutritional status (over- or under-), infective and toxic attack, can aggravate or initiate aspects of the cascade of reactions leading to hyperglycaemia.

    The causative agents functioning internally within the cascade are imputed to be free radicals, oxidizing molecular species and antibodies and the corollary to this overview concept would be that a situation that minimizes the genesis and accumulation of these three agents would minimize the development of diabetes mellitus. Currently the debate is rife about the use of free radical scavengers and antioxidants in the treatment and prevention of diabetes mellitus. The verdict is still out on this approach.

    Our research on rootcrops such as yams and cassava, staple foods in tropical countries, indicates the presence of cyanoglycosides such as linamarin, which on digestion yields cyanide radicals. These radicals are pancreatotoxic especially in the undernourished state.
    Dog models however, have shown that free radical scavengers such as riboflavin, Vitamin B(2), is protective against this toxic damage.

    Further, scientific investigations have clearly demonstrated the role of antibody attack and have been able to ward off the appearance of type 1 diabetes mellitus in susceptible individuals, by the early use of immunosuppressive therapy such as cyclosporin.

    Thus the Unitarian Hypothesis demonstrates how all types of clinical syndromes being described in diabetes mellitus are not necessarily variants of a specific illness but rather manifestations of a central process of membrane damage–>antibody response–>insulin inadequacy (quantitatively or qualitatively); and the future intervention in containing this disease may well lie in focusing on preservation of the integrity of the body’s cell membranes.

  9. @GP

    If part of this hypotheses is true then lifestyle becomes a big issue as far as early intake of cow’s milk by babies over the bubbie. Lord help us!

  10. DAVID

    BUT WHAT THESE GUYS ARE SAYING IS VERY SERIOUS AND MIGHT BE A VERY MAJOR ISSUE …….lifestyle becomes a big issue as far as early intake of cow’s milk by babies over the bubbie.

    Lord help us INDEED!




  11. In my layman’s opinion we are paying the price for progress to near so called first world status.
    We are suffering for convenience temptation.

    Fruit and vegetables are not expensive in Barbados. Everytime I visited Barbados in the last 15 years there has been an abundance of reasonably priced fruit and vegetables. But you have to walk to get them.
    Roebuck street,James street.in Bridgetown and walk bout speightstown and you can buy in small quantities from the hawkers side a de street.

    The problem is that we Bajans really love to eat nuff. So we eat nuff Rice an nuff pork an chicken and NOT enough vegetables.

    So a compromise may be to start treating fruit and vegetables like medicine.

    Veggies may not taste sweet like piece a pork fat or a fried chicken leg but at least tek some veggie medicine with yuh proppa pork.

  12. millertheanunnaki | December 31, 2012 at 10:49 AM |
    Our local doctors need to step up to the plate and help educate our people instead of prescribing synthetic drugs to their ‘hooked junkies’ to earn commissions from the pharmaceutical giants and their local drug barons called distributors.

    Man that is very naughty man! It is the naturopaths who literally earn commissions from the pharmaceutical giants and their local drug barons called distributors.

    I went to the chap in Worthing in 2008. He charged exorbitant for blood tests that he wanted repeated all the time. When I returned to the USA, and asked for the source for fat burning preparation he refused, as he was literally getting commissions from his suppliers.

    I don’t have any thing against naturopaths, as I have read some of their literature. In fact we had a set of posts on BU a few years ago on natural products.

  13. Oh yeah, thanks for reminding me, most Bajans will tell you straight up they hate to drink water, a soda would suffice thank you very much. We will be burying plenty of them. There was a lady who sold natural herbal plants in the SuperCentres and these same idiots looked down on her and had alot of nasty remarks to drop, they only bought her products when they saw white or indians purchasing them. Luckily for her she had the good sense to leave Barbados. You just cannot change a certain type of mentality, it takes hundreds of years, none of us have that time.

  14. GP, thanks for the info. It is so desperately needed whether we want to admit it or not.

    I have a friend that gave birth several months ago and the baby born with diabetes. The mother or father family does not have anyone in their families that are diabetic.

    It’s my understanding the great grand mothers/fathers and forward, they all took tests to find out which one in the family was diabetic unknown to them.

    Is this a case that it has to start somewhere?

    That’s a hard one for the family.Never heard of congenital diabetes before. It might not be genetic in this case going from the family history you have given. It might be autoimmune.Perhaps the mom picked up a virus during the pregnancy or something, and the baby developed antibodies that destroyed the beta cells of the pancreas during their development.

    If you notice the article from UWI, Mona, you will see that we are learning new information on factors that may cause insulin levels to be insufficient or inoperable

  16. @Well,well “How do you stop someone from drinking six sodas a day and eating four extremely sweet cakes.”

    Have that person spend 10 or more years in time and money caring for a diabetic parent, spouse or child and that will cure them soon enough. hundreds of doctors visits and hospital visits. Amputations, medical bills, renovations to accommodate the diabetic, cancelled holidays and other special occasions.

    That will cure them.

    I don’t drink sweet drinks. Well I lie. I drink them maybe once a month. Other family members the same. We have been scared onto the path of healthy living.

    I cook a pot of soup at least once a week. Wash your hands as soon as you walk in the door, and put a cup of dried peas or beans on to boil. Change out of your work clothes. In another pot, braise a piece of fish or skinless chicken or a piece of tender black belly lamb, Peel and grate large carrot or two, cut up a butter nut squash or a good piece of pumpkin, peel and cut up a medium yellow sweet potato and a piece of yam, and whatever else you like. Good. Gather up a bunch of herbs, whatever you like or whatever you have on hand.Add the herbs, add the cut up and or grated veggies and the braised fish, fowl or lamb to the pot,. Bring to the boil, lower to a simmer. Find something else to do for 45 minutes or so. BAFBFP may have some suggestions. Or go for a walk if somebody else is in the house to watch the stove.

    Soup ready. Enjoy.

    Who say the young people don’t love ground provisions. Little Johnny and his friends love this.

    It ya must have dumplings, make power dumplings, whole wheat flour, corn meal, oats, a little, little sugar if you must. About 1 tablespoon, as this soup makes 4 servings, that is 1/4 teaspoon sugar per person per serving. If making soup for BAFBFP add a little linseed to the dumpling mix.

    Immediately refrigerate the leftovers.

    Heat and serve the next day.

    2 good meals in ya stomach.

    Today Little Johnny put away some yam pie with tomatoes, sweet peppers, onions and garlic with no complaints. And it only takes about an hour to make 2 days worth.

    And what is wrong with some spinach and/or cabbage or chinese cabbage with some brown rice and some steamed fish.

    And a little coo-coo with nuff, nuff okras, and some cucumber and pear on the side

    Eat whatever fruits or vegetables are in season. Make friends with and suck up to people who have gardens or ground. Accept gifts of mangoes, breadfruits, potatoes, spinach, chinese cabbage (easiest thing in the world to grow, any idiot can grow this in very little space), and other fruits and vegetables from them.

    If you have space, plant a fruit tree, or plant a few banana trees in the yard. Green bananas pickled with cucumber, onions, lime juice and bonny pepper go down real good, real cheap.

    It is still possible to eat good cheap in Barbados but you must spend some time in the kitchen, and if you have the time, strength and space in the garden.

    But if you want to eat brand name foreign food you will always be in potta.

  17. @ Dr. GP

    Thanks again. Sent personal comments under separate cover.

    I make J’s soup every week. Have it for lunch when I return from the gym. No salt, at first I ate it fast, now I am accustomed to it, the Dr. tells me to put back in some salt. LOL. If I am hungry at night, I nuke a mug full in the micro. I think with the exercise, this is what helped me lose 50 pounds in 3 years. Now I have to have a neck lift, ha, ha, ha.

    Today I went out and bought yam, christophene and plantains. Some spring greens and mangoes. They did not have any Caribbean avocadoes and I dont like those ugly little things from Mexico.

    I dont know where J. lives, but I know she grows almost every thing she eats. So be careful. She works during the week and spends most of the weekend planting, weeding and reaping her acreage. You may be expected to pull a weed or two. ha, ha, ha.

  18. @ Dr. GP

    I forgot, you had a thing with JC. I think Simple Simon lives St. Peter or St. Thomas for some reason. She smart, went to uni in Toronto, watch her.

  19. Simple Simon, if i was not so far, I would beg for an invitation for lunch or dinner, seriously, why did you have to do that???

  20. Don’t know how we can change the eating habits, maybe instilling the mantra “YOU ARE WHAT YOU EAT” and showing graphic photos might help some.

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  21. David,
    Carmen Fraser was preaching this message decades ago; especially the message of “eating what we grow’ and growing our own food. She was a pioneer, but as usual her own people; we Bajans, denigrated her, her messages, and her attempts to educate us. A visit to the little shop that carries her name, on Princess Alice highway, will be revealing and educational. I asked before., Why do we have to import New Zealand Lamb, when Bajan Black Belly Lamb is better. All we have to do is increase our production of these animals.

  22. Growing up there were quite a few diabetics around, including one in my immediate family. They stuck to a strict regime of vegetables ,and especially christophenes , no salt, and nothing overly sweet. They observed protecting their feet from the danger of being cut , or punctured by a nail of some other protrusion. In my village and the many surrounding villages, there were just about three amputees,all men .
    Then again, these peopled cooked their own meals, and made their own “soft” drinks. The incidences of hereditary diabetes was quite uncommon.

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