As the number of people with diabetes grows worldwide, in Nicaragua type 2 diabetes is exploding. Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.*
23% of our adult patients are treated for diabetes. Almost one in four patients.
My daughter-in-law, Dr. Cassie Iutzi, was helping students on a delegation learn about the diabetic patients they had seen in their home visits by explaining, “Having high glucose in the blood and kidneys is like have glass running through the body. It tears up organs.”
As most of you know, a high sugar and carbohydrate diet with low cardio exercise leads to type 2 diabetes. Throughout Nicaraguan history, the poor have survived on sugar and carbohydrates as a cheap source of calories, energy, as they toiled in the fields under the hot tropical sun. Nicaragua grows sugar cane and it is cheap.
Rice and corn tortillas, carbohydrates, fill the belly. Sometimes when drought hits, people survive on hand-made corn tortillas with salt. Fish and chicken are too expensive to add to the diet more than for special occasions. Tropical fruit which is really high in fructose is used as a drink… blending the fruit, straining it, and then adding sugar and water to make refresco. Remember sugar is cheap, fruit is more expensive.
Vegetables, except maybe yucca which is just starch and fiber, are also outside the budget for the very poor. Sometimes cabbage is added to a meal, and perhaps tomatoes.
We teach people about what they eat and drink, but when your money is limited, so are your options for what you eat. We are looking forward to having a kitchen** to train people on cheap ways to eat, with good nutrition, and have the food still taste good.
We teach about exercise, but when it is blistering hot, when one has to guard one’s hut or house, when one is depressed, when one has children overflowing in a tiny yard… exercising seems impossible.
Therefore, consistently, we provide diabetes medications, monitoring, and monthly doctor visits… it is the least we can do to minimize the “glass” flowing through these wonderful people’s veins.
*Oxford English Dictionary
**We have the funds to finish a training room and kitchen in our unfinished third clinic building.
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