 Good morning. Welcome back to why in the morning you are watching the white 2 5 4 channel My name is drama chaché. Remember that you're watching health on Monday a day on which we focus on particular health Issues and we also bring experts on different health issues to come and join us So this is health Monday once again remember that if you want to reach out to us you can do so on our social media pages that is Actually, you first of all have to put the hashtag health on Monday and hashtag why in the morning and then post on off Social media handles that's Facebook and Twitter why 254 channel and then on Instagram. That's why 254 underscore channel I myself am a Twitter guy. You can find me enjoy underscore much actually on Twitter alone today We've got two wonderful guests and doctor and a counselor We are having a talk about diabetes and we have an expert on diabetes on set with us today Her name is dr. Cyrus Aquala Karibu Sanedaktari And our other guests she's actually a counselor She she assists dr. Soquala out in explaining at the counseling ex the counseling Perspective and the importance of counseling when it comes to diabetes is that right? Thank you Yes, and I name is Pauline Machio Karibu Nisana Yes, and actually dr. Sayra you actually work with MP shy is that right? Yes? Yes, and that's wonderful to hear How long have you been working specifically when it comes to diabetes? When did you decide to focus on? Diabetes alone becoming an expert on it Yeah, so I From 2013 onwards. I've actually been focusing more on diabetes. I was I'm physician by Qualifications I'm finishing my undergrad I did a med in internal medicine and then I decided to go on to diabetes looking at the You know the burden of diabetes and the need in the country, right? The need in the country. We'll talk more about that need just a little bit later on Maybe you can define for our viewers who are watching who don't know maybe they're not very well vests What diabetes is and how many types there are? so They beat is broadly a different broad definition is that it's a condition Which is associated with the problem with the usage of insulin of sugar in your body Problem extends beyond sugar, but we'll focus on sugar. So if there is a problem with either the Production of a hormone called insulin, which I'll explain a bit in detail Or the use of that hormone which takes the sugar into the cells of the body And when you've got sugar circulating in the blood and it's related consequences that is actually defined as diabetes That's diabetes. I see. All right. And how many types are there specifically? So depending on now the basic mechanism, there are four different you can classify diabetes in four different types Yeah, there's step one diabetes. There's type two diabetes. Then there's the pregnancy related diabetes Which is known as gestational diabetes. Yeah, and then there's the other specific types Which are related to conditions like hormonal problems You know cancer of the pancreas excessive alcohol consumption causing destruction of the pancreas and Conditions related to other specific genetic types. So they are basically four different classifications However, the common ones the type one and type two diabetes that we all hear about Yeah, and of course gestational diabetes is also pretty common. I look at pregnancy Related diabetes. Yes, I see and you've said type one and type two are the most common ones and that there are others which come from Over usage of alcohol some come from pregnancies But today we want to focus on type one and actually next week We'd like to focus on type two and see how to work around that and do stay tuned in next week as well Do send your questions for next week as well if you're interested in learning about type two diabetes Which is actually the one that's affecting our youth even than type one diabetes. Is that right? Okay, so can we talk about maybe before we go into treatment? How it affects why is it that type two affects younger people usually? Why is it that younger people tend to acquire type two rather than type one? Actually is the other way around I think so type one diabetes is the commonest type of diabetes in children and young adults is Ideally, it's actually type one diabetes So let me just go a bit in what is type one and what is type two? I'm sure viewers are wondering what the different types are okay, so you see in your body You've got this hormone called insulin So whenever you eat food which contains carbohydrates carbohydrates are the sugars which could be simple sugars or complex sugars You know the starches the potatoes rice flowers those are complex carbohydrates They're not sweet to taste, but they're still sugar So all these are converted into your stomach or into your digestive system into glucose Which is the simplest form of carbohydrate. Okay, that is taken up by your body and that is then Circulates in your blood and it gives a sensation It's like a sensor to a part of your body known as your pancreas Now the pancreas is like a master factory producing different things which help in digestion of your food Okay, one of the substances produced is insulin. Okay, insulin is like a key. You know, it's like a key which When the sugar comes in it tells the pancreas to produce this key And when the key is produced is it goes with the sugar to different parts of the body and there are some parts Which are specific to energy production So those parts then the pancreas the key opens the doors and the sugar goes in and that's how you get energy You remember we used to say we eat food to get energy. Yes, that is actually how it works Right, so whenever there's a problem in the production of these key called insulin or the action of the key Yeah, which is known as insulin resistance. So that is when you get diabetes either type one or type two specifically Yeah, right type one is when there's complete You know secession like closure of that factory. So basically there's no insulin production by the body Type two is when insulin is produced But basically it cannot work because like let's say there's a blockage in the key Let's say because of obesity excessive fat not eating the right food having a family history So type one diabetes affects about five to ten percent of all people with diabetes Whereas type two affects up to eighty to eighty five percent of people living with diabetes. Okay The point diabetes is basically so, however, even though it affects five to ten percent It is the commonest type in children and in young adults Okay, however, we are seeing more and more of type two setting in in younger people because of the fact that we have changed our lifestyles Yes, so yeah, so that's the basic core difference between type one and type two now The reason why after after now that you've defined type one and two now Let's go into the reason why it's affecting young people nowadays even more than it used to because I think this problem has actually It's exacerbated when it when it's come to the past 10 20 years It's not something that used to be there. Let's say in our parents days or something Can we maybe touch on that? Yeah, so You see type one diabetes if you you just need to understand the causes of both of them Okay, type one diabetes the exact cause unfortunately is not known However, what is thought is that there is what is known basically is that type one diabetes occurs because of destruction of your pancreatic cells which are producing the insulin Mainly because your own body's immune system for any reason it starts attacking those beta cells those cells that produce insulin Okay, and why that happens why the the immune system goes have a is not completely understood It could be because of genetic predisposition some genetic composition that you have which makes you more prone to get it On top of which probably you had a viral infection or bacterial infection in the past Which now puts you at a higher which you wouldn't even know that you had it probably or it was some some other infection Which your body detected as foreign, but now it's detecting your own body parts as foreign and that is one as auto immunity So that causes destruction of that part of the pancreas which produces insulin Okay, other causes like basically attributions have been made to you know the specific Geographic regions for example as you move far further away from the equator The risk of getting type one diabetes is more why that is exactly not very clear and it's not clear Exactly that is the the the the presentation. Yeah, okay, I have multiple theories. I'm not going to go into the details of that right then There's a specific age Basically although it can occur at any age from you know birth all the way even up to the age of 30 years Anyone later with the name changes to something known as Lada, but basically it can still occur even later But most common age is up to the age of 34 type 1 diabetes Okay, and yeah, basically then the treatment for type 1 diabetes I think we're going to focus on a bit later So now if you look at that to diabetes why it is becoming more and more common in younger people Like I said type 2 diabetes the Ideological the cause causative factors if you look at it, there's more known about the Potential risk factors for type 2 diabetes So having a family history put you at a very very high risk of developing type 2 diabetes I haven't happened in the fact that maybe someone in your family someone in your family So the question you asked which was very good is why the rise in type 2 or type 1 diabetes over the last few years So we have changed our lifestyles grossly Okay over the last few years What mine and your grandmother used to do is not what we are doing at all So you see they there were no cars So used to walk around they used to be physically active. Yeah, they used to eat from their farms Yeah, they used to eat fresh food organic 100% you know they used to grow their own food eat their own food And there was a lot more physical activity Then what we have there was a lot less variety of foods to eat Wow So the traditional african food is actually what the african body is adapted to your genetics are made for that kind of food You know the original Ugarli Sukumar the typical Original food, you know the the typical traditional food, right? And we have bombarded it with a lot of things which the body is not able to take the fries Burgers that you know African body unfortunately is not adapted to take that so even at a much less Weight you see people developing diabetes faster in our community in our in our people, you know in our country So that's the main reason I think which is the shift from a healthier lifestyle to more of a westernized or rather an unhealthy Form of lifestyle you see that when we changed our habits, right? So that's where things kind of went wrong And then we saw the other we saw the other side of diet when it came to how it affects us to the point that Diabetes is now being acquired by younger people and if we could now talk since we've talked about food Maybe we can talk about the diet How can we improve our food? Is it to go back to what we originally started off with and just What we came what our grandmother's used to eat should we just go back to that kind of food? And that's the best one for us is that's the kind of vibe I'm getting from what you're saying Because a lot of young people nowadays you are very right for the pizza or oh, yeah People are getting things delivered at their houses and things that become so easy true Not only that the billboards have come up everywhere with these wonderful mouth-watering pictures of french fries and burgers and I have a time I look at them I want to eat that food and so these are the things that we keep I feel Coming into minds of our youth and then they get even more interested in that and now it's affecting them in such a bad way Maybe we can talk about ways we can change these effects now that we've discussed what diabetes is who it's affecting How it's affecting them now. How can we change things? How can we turn this around a little bit? So the basic core change I think starts from attitude Yeah, we need to like I told you we know the risk factors and it's totally diabetes even high blood pressure Cardiovascular disease you hear a person of 37 years old having a heart attack. Did you used to have that in the past? No Yeah, so it's a whole basically it needs a whole overall attitude change in ourselves in our systems You know, it's fashionable now to eat out to go to KFC to go to you know different fast food places I'm not specifically talking about KFC But basically different fast food places and grab what is available the kind of lifestyles We have developed the kind of jobs. We are now at it does not give us even enough time to prepare Most of the times the right kind of foods to eat So in as much as the change has to come at multi level But at least from the point of an individual who is probably whoever is watching right now. Yes What you need to understand is that I'm not saying we go back to what our grandmothers used to it Because even when they used to eat what they used to eat they used to work it out Okay. So the whole point is the the basic take-home message is that carbohydrates is what is mainly the culprit in most of these situations Okay, so if you could just cut down on your carbohydrate portions Okay, if you're eating the carbohydrate you try to eat it You know the the right kind of carbohydrate in the right portion So let's say just as an example if you want to eat this okay, you ask me what is healthy eating that? Yeah, so they are different different types of diets which have been recommended generally It's the Mediterranean diet and the dish diet especially if you've got hypertension I don't want to go into the details of those many but in in in short if you're looking at our Population you have to look at what is available What is affordable and what people can like you see what is your choice what you like to eat And you have to cater like a tailor it according to that So if you have your plate your portion, right? So at least half of your portion should constitute vegetables whether it is cooked or uncooked That means the salads the cooked you know Sukumas the bogas whichever you are doing the uncooked and the cooked okay Quarter of that portion should be protein Okay, if you're in a growing stage then you need more of the protein Okay, proteins means things like the meat proteins. I mean the animal proteins and the plant-based, right? Yes, I'm not advocating that we don't do animal proteins They're equally important for certain of your body function is right, of course However, if you can do more of plant-based proteins like the legumes, you know the grains you go more towards plant-based Then a quarter of your plate would constitute your carbohydrate So the smallest portion should actually be the carbohydrate, but look at our African meal What we have now moved to the biggest portion is the carbohydrate That's the rice the potato is the largest portion And there's a small bogas somewhere on the side and there's a small protein somewhere which may not even be there Yeah, so balancing your portions and going more towards eating more of You know vegetables and fruits again fruits are also important But remember if you have diabetes then you don't have to eat too many fruits at a go specifically to space them So realistically speaking the diet that we even tell patients with diabetes to follow is actually what everybody should ideally be eating You know, it's a healthy meal. It's just a healthy diet. It's something that consists of every single part of the Healthy part of diet that we should be consuming. Exactly. So you've talked about attitude you've talked about dieting and You have brought a counselor along with you and later on I would like for her to explain the importance of the counseling aspect When it comes to helping people with diabetes, but if we could finish on if we could finish off on with the treatments you've spoken of The attitude of people and also the the diet at least the most important things. There's another big portion to it That's the physical activity, right exercise. Yeah, so that is extremely important along with what you're eating Right. All right, because physical activity like exercise you ideally you should be exercising at least 30 minutes in a day at least Ideally everybody what every one of us, you know at least 150 minutes in a week of moderate intensity Physical activity which could be and the best thing is to vary it and I say if you are young if you're especially youth Even older patient even my patients who come to me with type 2 diabetes Sports is one of the best ways to be indulging in physical activity. You know why because you love doing it You see work if I tell a patient just walk 30 minutes in a day. That's really boring at times You know you can't walk 30 minutes in a day every day. Yeah, personally when it's difficult for me You have to have variation so even with physical activity. We should be more sporty I don't know why the whole concept of sports has just come out of our Systems, you know, and especially you see a person reaching the age of 35 36 They say now they're too old for sports. We need to establish again this whole culture of sports within our youth Yes, you know, they should be yes, you know availability of Opportunities to be able to go and play out there and that is literally the best form of physical activity We can indulge in that's true because the shortest distances even our young people have to either use a bike Or are you going to take a bus or an uber or if a young person is driving the shortest distances? Nobody's interested in even walking. But yeah, I would encourage even just to the kiosk or something Walk to the supermarket walk. And if you're not carrying too many groceries, that's good exercise, too Like you said change it up a little bit. Yeah, you see we say even like most of our people are working Right. We are majority for patients even in the working the working group people Yes, and so they tell you what time do I have to exercise just simple things like if you are going to work Park your car at the furthest and even if you have to take a car You know we live very far from work most of the times in Nairobi Park your car at the furthest and that you can and walk that distance climb the stairs Don't use lift right simple things which you can do, you know in your routine don't use lifts That's something we are doing too much even to the third floor. Exactly God's sake to the third floor Miss Pauline Curry was Anna we've not heard anything from you I'd like to please touch on the counseling aspect when it comes to diabetes and what it what is the importance of it and How can people connect these two aspects? So, thank you. Yes when it comes to Counseling in terms of diabetes management. Yes, it's one of the Core factors that we need to take care of Because we understand when you are diagnosed with diabetes at first It's quite distressing So most of the clients will come with what we call diabetic related distress. Yes, so If we don't work with them from the word go because we understand we have to talk to them and For them to understand it's something that is lifelong, but manageable. Yes, because once you are diagnosed with diabetes then you have to Live with it. It never goes. It's never goes So they have to understand from the word go. Yes, but it can be managed in terms of medication Be cured, but it can be managed. Yes So in terms of medication because you understand like for type 1 insulin is insulin insufficient in your body So you have to understand from the word go that you have to get those jobs of insulin You get clients are afraid of the pricks, but you just walk with them that the medication is important Then you have to tell them about Lifestyle modification the way dr. Sokwala said about diet because you understand the youth junk Have a lot they take a lot of snacking. There's a lot of junk food So you just have to help them understand that they have to have a little bit of attitude change In terms of diet management for the sake of the management of diabetes This is the group that also have good Behavior risky group of behavior, you know in adolescent we have what we call identity crisis So their peers Is their world? So most of the time they'll be asking themselves why me? Why the diabetes? Why not Michael my Classmate so they might be distressed So if you don't walk with them just for them to understand that it's manageable is not going to make them Not attain their future and personal goals in life Then they are able to understand Because if you don't talk with them again, they'll start engaging in risky behaviors alcohol use Drug use because they are distressed so to capture all this and prevent all these things from happening and and even leading to depression, which is also one of the most common causes of Diabetes is one of the most common causes of Depression is it? Yes 30% 30 to 40% of people with diabetes have depression 30 to 40% of people who have diabetes have some form of depression Because they look at it like a Like a lifelong condition, right? So most of the time if there's no good support system, especially from the family level and that's why we say it's diabetes and the family You're not only dealing with the individual but the individual and the family because of all the social support system that We give in terms of emotional support Medication and finances diabetes is quite expensive and also information The right information when to do what to do and what time and we want to whom to consult is quite important I see because you know like this a non-communicable diseases. Everybody's a doctor nowadays They have all people coming Everybody we call them the people who treat us with the what we call them I Detox the form some form of detoxification So sometimes you might get the wrong information So it's just to inform them that The hospitals and the doctors who are qualified in that area who can work with you in terms of your diabetes management So it's not from the word go. Mm-hmm. There's drug at the aren't remember. You have to take insulin forever So that is the way we work with them. I see from the word go and you both Specifically in MP shall hospital you are in the diabetes care center Yes, specific diabetes care center. And so what interests me is Kenya as a whole You know, I look and I see right what you said our food is changing We eat more like what we eat more like Westerners than most African countries do actually a lot of African countries Don't have as much fast food as we do I think it's probably us and South Africa that have too much fast for an Egypt or something But there are African countries who have stuck and they're very little fast food and they continue to eat Their homemade meals and everything. What can we do as a country? I know what we can't close down and shut down everything We can't tell our kids. Oh, you can never eat crisps ever again. What can we do as um an Older generation to protect our younger people when it comes to diabetes Is it is it through more advocacy is it through more awareness or what I think you see We've tried to take it from up down. Okay, that means like a lot of programs a lot of education is geared towards parents You know towards adults The way to deal with it according to me is to go down up Starting education on health right from school You know from the time the child gets into school You start that's where I think our advocacy programs should focus more on yeah So that you are starting healthy eating behaviors right from that route, you know, you see if you start shutting down places I mean, that's really not the right way to probably approach it but it is if you're looking at what is available and what is choice by choice what you go and Pick you see so if you if you are to tackle such a problem and it has to come from both ways I think from the government aspect. There's a lot that is happening at the moment There's the whole ncd alliance. We've come up with several guidelines on nutrition Physical activity even healthy food availability in schools. There's quite a lot that is going on their guidelines coming up on diabetes It's self on high blood pressure, you know for made very easy for people the public and also for the healthcare providers So that at their level is happening in that aspect. I think the aspect of looking at the whole food industry and Optimizing what is made available to the people out there also needs to look into so for example if there is a fast food restaurant Why can't they also have options for healthier eating? You see so it could still be fast food, but it could be a healthier fast food option You get it. I see preparing a salad is I think equally not going to take equal Not so much time as preparing chips for example, right? So if you are preparing the fast or a sandwich a healthy sandwich You know always like the whole point is the fast foods if they're just added on to this aspect of you know having Basically policies that you should have a healthier option as well Something like that just something simple then from schools Can teens you know advocating what the can teens are providing health education in schools and Basically providing more time for play Providing more time for physical activity. You get it. I can nowadays even schools You see what happens in schools a child goes from morning. In fact, they are schools which open at seven I was surprised for a four five-year-old So you start the child goes to school at seven seven thirty and all the way till three. They are there You know and then they come home with home activity, you know and hardly any physical activity you go to the school There's hardly one you know their playgrounds, but they're empty yeah many a time So I think if it starts from that grass root level it really will make a difference I am telling if you walk if you if you are even on our roads. Do you have a bicycle lane? No, there's no bicycle. We're whatever. I mean if I was a cyclist I would be I would fear the road like anything because there's no place where you can cycle you Cycling to work a simple, you know option which happens in many Europe. Yeah, and many you always have a set in mind Yeah, people are in suits and they're cycling to work and that's healthy. You see you're physically exerting You see availability of parks for example, okay availability of more of areas where people can go out and you know just recreational and Workouts, you know, right now go to a gym. How many people can afford going even to a gym? Or even to a club, you know a sports club It's really very limited people who have access to those if you make more of these available and advocate for the same Think we'll hit it at a larger level. I see. Thank you so much for that Then also at home. Okay, okay, you understand even in homes nowadays Then people the children are now having indoor games instead of out there either on their phones For PlayStation, you know like our days when you'd go out and play a game called cutting and what not Then you'd come back to the houses You really burned a lot of calories and then it would be helpful nowadays even at home We can even start at home. We're just so that yeah, you just don't fall on you're not on PlayStation Which is not a helping for the kids so we can advert Make parents help the children understand that physical activity like bicycle riding, you know Because of the way dynamics of life bicycle riding nowadays It looks more classy, but it's still physical if you can buy a bike or if those ones who cannot afford can Just go out and play the normal usual games. Then it will help out Yes, I do appreciate you inside Unfortunately, I am being told that we do need to wind up and we do need to pay for it for the next show Which is going to be youth and politics with here the world baby, but before we do that, please remember that sorry by the way Internet is not really working today, and I've not been able to get you the questions that Our viewers were supposed to do that But next week we are covering diabetes type 2 and we do expect for things to run the same And I hope that we can still have you on set. Maybe we can focus more about the counseling aspect and also Learn a bit more about diabetes part 2. Thank you so much for coming Dr. Sokwala and also fully macho. Thank you so much. I do appreciate your time My name is Joy Machache coming up next is Hilda Wadidi and do remember that if you have anything ready for next week That you want to ask Dr. Sokwala do do so on our Facebook and our Twitter And you have to do hashtag health on Monday and ask anything you want to ask about diabetes and Dr. Sokwala will be here or our counselor fully macho will be here to answer the questions next Monday. Thank you so much Thank you. Thank you You