of the Island's leading care groups. According to Debbie Jones, co-ordinator of the Diabetes Education and Counselling Centre at King Edward VII Memorial Hospital (KEMH), although most people realise what they must do to get their lives on track, many require help to do it. "I think people are aware,'' she said. "I see more people riding push bikes on the road, more people out walking, more people out jogging, and all the exercise clubs are utilised.

"What we're suggesting is that if big business could get involved and say, have an exercise programme during the workday, we would find that productivity would improve, sick days would decrease, people would feel good. I don't think they understand how critical a change of lifestyle is. There are things we can do to make a difference, but it will take a community effort, not just a select group.'' According to Mrs. Jones, this point was driven home while at a recent conference on diabetes in New Orleans, Louisiana where the fight against the disease was likened to the battle against cigarette smoking in public places in America. "It was a situation that felt so similar to ours,'' she said. "And what came across was, that the reason the anti-smoking campaign was so successful in the United States, was because big business got involved. It didn't allow smoking in airplanes, in the workplace, in movie theatres and even in some restaurants. So we really need that community effort.'' Today, diabetes affects some 30 million people in the Americas and by the year 2010 that number is expected to rise to 45 million. Although the most virulent form of diabetes is (Type 1), which renders people insulin-dependent, the most common form of diabetes is Type 2 which can be Don't smoke, drink moderately! Bermuda Diabetes Association in 1979, and joined the Diabetes Centre at KEMH when it opened in 1990. The Centre operates on a referral basis, offering expert advice and counselling on every aspect of the disease. "We do in-patient treatment as well, but the out-patient work we do is much better because they have made the decision that they want to come and make changes to their lifestyle. And what that programme does, is it teaches them how to manage diabetes by eating sensibly and exercising,'' she said. "And if they are on medication, it teaches them the importance of it and how to administer it successfully. "Many, once they've started the programme, come off the medication in Type II Diabetes although not in Type I, or insulin-dependent diabetes. In those cases, the pancreas is not making any insulin and so they have to be on it for the rest of their lives. Type II Diabetes is more of a lifestyle issue. A change in their lifestyle where they're eating sensibly and doing more exercise makes a big difference.'' Through an epidemiology study conducted last year, the Bermuda Association along with other countries in the Americas, hopes to have diabetes recognised as a global epidemic and see that the necessary education follows. The largest investigative medical survey ever held in Bermuda, the study targeted random participants to complete questionnaires and undergo interviews and tests given by the Bermuda Diabetes Association. The results of the study are now being analysed in Nova Scotia and are expected to be published in June and presented in major medical journals worldwide as well as at this year's Diabetes Conference in Helsinki, Finland. "The actual nuts and bolts of the study, where we did the interview and lab sampling, finished in December of 1996. Then, all statistical analysis had to happen. Every single question asked on the survey is being analysed as to what the makeup of the Bermuda population is doing. For example, how many people in the survey have quit smoking, how many patients had a history of high blood pressure and how many families there are with high blood pressure.

"It's hard to realise what goes into this. There were lots of questions, the survey took about an hour to do. Every single question is analysed and then has to be broken down into separate categories such as male, female and age groups and we want the analysis to be right. So although the lab analysis is complete, we still don't have the final data yet. But the good thing is that once we know this information and it becomes public knowledge, there are things we can do to make a difference. "I guess the good thing is that one of the things it does seem to be showing, in the preliminary findings, is that there are less people in Bermuda who don't know they have diabetes than there are in other countries. Also, people here are quite aware of what diabetes is and when they get the symptoms, they go for treatment fairly quickly. We've also found that those whose relatives have a history of diabetes are asking to have themselves tested and also have annual blood tests to see if they have diabetes.'' Benefits gained as people become more aware of, and work to prevent the onset of Type II Diabetes, could spread to other areas of health as well, Mrs. Jones explained. "Lack of exercise means so much,'' she said.

"It affects the way you feel, the way you think, the way you study; it all adds up. We're finding that younger and younger people are being diagnosed with diabetes, with high blood pressure, and are having heart attacks. It is a big issue and not only one of health care dollars. "Some of the lifestyles which are responsible for Type II Diabetes, are also responsible for increased heart disease, increased strokes and increased high blood pressure. And by making a change, it will have an effect on all diseases. People can't say, `I don't have diabetes so I don't have to worry.' Everybody's at risk for having a heart attack. So we're looking not only at the high incidence of diabetes in Bermuda, but the high incidence of risk factors for heart disease.'' PHOTO Graph Once you have decided to quit smoking, do not be alarmed if you notice these symptoms, they mean you are on the road to recovery HEALTH HTH