epidemic levels, she hopes that by educating the public, she can save the lives of those with the disease and those at risk. Co-director of the Bermuda Diabetes Foundation (BDF), the Bermudian nurse received specialised training in diabetes from institutions in Canada and the United States and is certified 10 We're on a mission to improve health! Centre at King Edward VII Memorial Hospital (KEMH). Diabetes occurs when the body cannot properly convert sugar and starch. It is due to a deficiency in the production or effectiveness of the hormone insulin. It can lead to severe health problems. "Our mission statement is to improve health with people with or at risk for diabetes,said Dr. Meng. "Diabetes,'' added Mrs. Jones, "is a dangerous, chronic disease due to absolute or relative insulin deficiency that results in high glucose. If you are over forty years of age, overweight, or if you smoke, you could be placing yourself at risk for diabetes. If the community would eat healthy foods and exercise moderately, these factors could delay or prevent diabetes and, in many cases, its ugly complications.'' Diabetes affects communities in many serious ways, said Mrs. Jones. Not only can it kill its victims, but its control can be very costly. Education is the best means of prevention she said, and as such, there are certain facts which should be known: Diabetes is an epidemic that is on the increase worldwide and is a serious, costly, public health problem.

In 1996, one in nine adult Bermudians had diabetes. This translates to about 4000 people on the Island and it is estimated that there will be 6,400, Bermudians with diabetes by the year 2000 and 8,400 with the disease by the year 2010.

As in other parts of the world, diabetes is a prime cause of coronary artery disease, the leading cause of death in Bermuda. Diabetes is also the main cause of kidney failure, blindness and lower limb amputation on the Island.

Diabetes has many serious, disabling and debilitating consequences. It damages many body organs including, but not limited to, the eyes, kidneys, nerves, heart, brain, legs and skin.

People with diabetes have a 2 to 4-fold increased risk of heart attack and stroke and a 4 to 8-fold risk of heart failure and circulation problems to the legs resulting in gangrene.

Acute and long-term complications of diabetes can be prevented and minimised through integrated care. In diabetics who do not yet have eye, kidney, and nerve complications, lowering blood glucose to close to normal levels can reduce the risk of developing such problems by fifty to seventy percent. For those who already have them, lowering the blood glucose to close to normal can similarly delay their progression.

In patients with diabetes and coronary artery disease, lowering high blood cholesterol can decrease the risk for kidney disease, stroke and heart attack.

Proper foot care can reduce the risk of lower limb amputation in diabetics.

Daily inspection is the key to early identification of foot problems. Examine the skin between, and on the bottom of toes. Look for signs of cracking, peeling, and red or irritated skin. Check carefully every day for corns, callouses, ingrown toenails, ulcers, cracks, or injuries. These can become infection points.

It was in 1996, the date marking the 75th anniversary of the discovery of insulin, that the Bermuda Diabetes Association (BDA) conducted the first ever epidemiology study on diabetes in Bermuda -- the Bermuda Diabetes Epidemiology Project. The mission was to determine the magnitude of diabetes in Bermuda and had three specific goals: To determine the prevalence of diabetes in adult Bermudians.

To determine the status of diabetes care in Bermuda in 1996.

To define the cardiovascular risk profile of Bermudians with diabetes and compare it with that of Bermudi Bermuda's duel with diabetes about the incidence of diabetes in Bermuda: Of the 999 adult participants, 10.7 percent had diabetes. In the 35-64 year age group, 12 percent or almost one in eight Bermudians, have diabetes and in the 65-plus age group, almost one in three women and one in five men have diabetes. The Island's diabetes and impaired glucose intolerance rates were also found to be higher than the global rate.

About 21 percent of adult Bermudians with diabetes were treated with an organised meal plan and exercise; 54 percent were taking tablets and 25 percent were using insulin to lower their high blood glucose.

Bermudians with diabetes were found to have a higher blood pressure than Bermudians without diabetes and, 74.5 percent of Bermudians with diabetes had high blood pressure while only 23.6 percent of those tested without diabetes had high blood pressure.

A follow-up study of the 999 participants funded by the Bermuda Health Alliance began last month and is to continue over the next ten years.

The head of the follow-up study to the Epidemiology Project, Jaqui Neath-Myrie, plans to make sure the 100 participants will not join the swelling ranks of those with the disease.

Mrs. Neath-Myrie, the project's research coordinator, said a major goal was to be able to show that a proper diet and exercise could help fend off diabetes.

"I'm excited about this,'' she said. "I'm really looking forward to it and I'm determined to make sure that none of the participants develop diabetes.'' The long-term research project will focus solely on those with impaired glucose tolerance.

"Impaired glucose tolerance is when the body is not using food properly,'' she explained. "A large amount of it remains in the blood. These individuals have a high risk of becoming diabetic.'' The study includes participants from the Bermuda Diabetes Epidemiology Project of 1996. When the results of that study were announced last May, Bermuda Diabetes Association president Exercise helps the study. "It's pointless to spend so much time and money on doing a project such as this to put it on the shelf,'' Mr. Smith said at the time. The study will provide the Island with a base to compare and measure future data. Mrs.

Neath-Myrie said about half of the 59 people identified with impaired glucose tolerance from the project will be taking part in the follow-up study. "We will put them on a proper diet and exercise programme and we'll monitor them via regular testing,'' she explained. Participants will visit King Edward VII Memorial Hospital for dietary evaluation and then return three times a year for blood tests and blood pressure readings. And as the research coordinator of the first long-term study by the Bermuda Diabetes Association, Mrs.

Neath-Myrie said she believed it was her job to make sure participants stick out the project. "I plan to keep up the motivation level of the participants so that they don't drop out,'' she said. "I will also liaise with the doctors, participants, dietitians and lab technicians.'' Mrs. Neath-Myrie also said that an interim report on how the study was evolving would likely be released about midway through the ten-year project. PHOTO Co-director of the Bermuda Diabetes Foundation, Debbie Jones Dr. Meng Hee Tan, Director of the Diabetes Centre at King Edward VII Memorial Hospital As part of the 1996 epidemiology study by the Diabetes Association, lab worker at King Edward VII Memorial Hospital, Richard Mickiewicz prepared the blood samples before they were analysed for sugar, fat and cholesterol levels Insulin fills the receptors. Sugar enters the cell, is used for energy and the blood sugar level drops Jacqui Neath-Myrie HEALTH HTH