THE DIABETES MANUAL
BY
DR PATRICIA MUGISHA
DR EMMANUEL MUGISHA
Contents
DEFINITION OF TERMS 3
NORMAL GLUCOSE CONTROL IN THE BODY – KEY PLAYERS 4
WHAT IS DIABETES? 5
TYPES OF DIABETES 5
Type 1 Diabetes: 5
Type 2 Diabetes: 5
Gestational Diabetes Mellitus: 5
WHO IS AT RISK OF DIABETES? 6
HOW DO YOU KNOW YOU HAVE DIABETES? 8
TESTS FOR DIABETES 8
TESTS FOR SUGAR LEVELS IN THE BODY – RANGES 9
WHAT PROBLEMS CAN ARISE IF DIABETES IS NOT WELL CONTROLLED? – COMPLICATIONS OF DIABETES. 10
LIFESTYLE CHANGES; THE CORNERSTONE OF CONTROLLING DIABETES. 11
DIABETIC DIET AND NUTRITION 12
Practical Advice On Maintaining a Healthy Diet. 12
The Diabetes Plate Method 13
A SAMPLE WEEKLY MEAL PLAN FOR THE DIABETIC 15
TREATMENT OF DIABETES 18
ADHERENCE TO MEDICATION 19
ROLE OF EXERCISE IN DIABETES; 19
INSULIN 19
TYPES OF INSULIN 19
THE INSULIN PEN 20
INSULIN INJECTION SITES 20
THE GLUCOMETER (“GLUCOSE-METER”) 21
HOW TO USE A GLUCOMETER 21
THE PENTAD FOR DIABETIC TREATMENT 22
PSYCHOLOGICAL STRESS AND DIABETES. 22
OXIDATIVE STRESS AND DIABETES. 23
THE BYAMAKA IMMUNOLOGICAL OPTIMIZING PROTOCOL 23
MIXTURE OF LIFE (MOL) AND ABSOLUT PLUS 24
REFERENCES: 25
DEFINITION OF TERMS
Pancreas: An organ in the abdomen that is responsible for the production of insulin in our bodies.
Insulin: Is a substance (hormone) produced by the pancreas to regulate the amount of sugar in the blood.
BMI: – Body-Mass Index – A measure of body fat based on height and weight that applies to adult men and women.
ADA: American Diabetes Association
Glucometer: A device used to measure and record blood sugar levels. (“Glucose-meter”).
Calorie: A measure of the energy value of food and drink.
WHO: World Health Organisation
CDC: Centres for disease control and prevention.
Oxidative stress; Is a condition that arises when there is an imbalance between free radical formation and the capability of cells to clear them.
Free radicles; Are unstable substance made in the body that can damage cells, causing illness and ageing.
Scavengers; These are substances such as antioxidants (preventers of oxidative stress), that help protect cells from damage caused by free radicals.
NORMAL GLUCOSE CONTROL IN THE BODY – KEY PLAYERS
Insulin – Pushes Sugar (Glucose) from blood into body cells.
Glucagon – Removes Sugar from its stores in the liver and pushes it into blood.
Other hormones that increase blood sugar – Cortisol, Adrenaline, Growth hormone.
Normal blood sugar levels:
When you haven’t eaten anything for 8 hours or more your blood sugar should be between 4.0mmol/L to 5.4mmol/L (72-99mg/dl)
If glucose is measured atleast 2 hours after eating, it should normally be between 5.5mmol/L to 7.8mmol/L. (140mg/dl)
Target Blood Sugar for diabetics;
Before meals = 4 to 7 mmol/l
After meals = Under 9mmol/l for people with type 1 diabetes and under 8.5mmol/L for those with type 2 diabetes.
WHAT IS DIABETES?
In simple language, diabetes is a chronic disease characterised by high levels of blood sugar.
TYPES OF DIABETES
The most common types of diabetes are:
i. Type 1 Diabetes
ii. Type 2 Diabetes
iii. Gestational Diabetes
Type 1 Diabetes:
This type occurs when the pancreas produces little or no insulin by itself.
Represents about 10% of all cases of diabetes.
Type 2 Diabetes:
This type occurs when the pancreas does not produce enough insulin (Reduced insulin production) and/or the insulin does not work effectively and/or the cells of the body do not respond to insulin effectively, a condition called insulin resistance.
Represents 85-90% of all cases of diabetes.
Gestational Diabetes Mellitus:
A form of diabetes that occurs during pregnancy. Most women will no longer have diabetes after the baby is born.
It’s usually diagnosed between 24 to 28 weeks of pregnancy.
Note that gestational diabetes is not caused by lack of insulin but by other hormones produced during pregnancy that can make insulin less effective. (insulin resistance.)
Babies born to these mothers may be bigger than normal, a condition called macrosomia and are at risk of having low blood sugars, a condition called Hypoglycemia.
WHO IS AT RISK OF DIABETES?
You can answer the following questions to determine whether you are at risk or not.
(Partially Adapted from the FINDRISC Assessment tool for Diabetes)
• What is your weight and height? Is your BMI Normal? (Check BMI table to know if your weight is appropriate for age) (Overweight/Obese = Positive Risk)
• Are you physically active for more than 30 minutes a day? (Not active = Positive risk)
• Do you eat vegetables and fruits atleast 4 times a week? (No = Positive risk)
• Have you ever taken medication for high blood pressure on a regular basis? (Yes = Positive Risk)
• Do you smoke tobacco or drink alcohol? (Yes = Positive Risk)
• Have you ever been found to have high blood glucose e.g In a health examination, during an illness or during pregnancy? (Yes = Positive Risk)
• Has your grandparent, Aunt, Uncle or First cousin been diagnosed with diabetes (Type 1 or Type 2)? (Yes = Positive Risk)
• Has your parent, brother, sister or your own child been diagnosed with diabetes? (Yes = Positive Risk)
BMI = WEIGHT IN KILOGRAMS
(HEIGHT IN METERS)2
BMI STATUS
Less or Equal to 18.4 Underweight
18.5 to 24.9 Normal
25.0 to 39.9 Overweight
More than or Equal to 40 Obese
Interpretation of results from Risk Assessment Questions;
High Risk for developing diabetes:
If 4 or more of the above questions is positive for risk, then routine screening for diabetes is recommended. (ADA recommends re-screening every three years, even when screening test results are normal) Very strict lifestyle changes must be initiated. (See recommended lifestyle changes under section D)
Moderate Risk for developing diabetes:
If 2 to 4 of the above questions are positive for risk, then strict lifestyle changes are recommended with or without routine screening.
Low Risk for developing diabetes:
If only 1 or none of the above questions is positive for risk, then no routine screening is recommended. However, it is always good to live a healthy lifestyle even in absence of risk factors.
HOW DO YOU KNOW YOU HAVE DIABETES?
TESTS FOR DIABETES
Tests that can be done to find out if you are diabetic include;
Random blood sugar; – You can take this test whether you have eaten food or not.
Fasting blood sugar; – One is required to have spent 8 to 10 hours without eating in order to take this test.
Oral glucose tolerance Test (OGTT); – Used to measure how well your body can process a large amount of sugar. It’s the gold standard for diagnosis of diabetes.
Haemoglobin A1c (HbA1c) Test; – This test gives an estimate of how well blood sugar has been controlled in your body over the previous 3 months. Based on how much sugar is attached to your red blood cells.
Other tests that may be done to fully understand the patient’s condition include; C-peptide test, Full blood count, Renal function Tests, Liver function Tests, Urinalysis, Lipid profile, D-dimers, Cardiac enzymes, Electrocardiogram +/- ECHO, Brain CT Scan.
Note that these are tailored to individuals based on the clinician’s assessment and not routinely done for all patients found to have abnormal blood sugar results
TESTS FOR SUGAR LEVELS IN THE BODY – RANGES
Note:
The units used to record blood sugar levels are either mg/dl or mmol/L.
Some glucometers are calibrated to mg/dl and others to mmol/L.
To change from mg/dl to mmol/L, Divide the value in mg/dl by the figure 18.
For example, 125mg/dl in mmol/L will be 125/18 = 6.9mmol/L
Therefore, a fasting blood sugar of 7mmol/L or more indicates you are diabetic.
WHAT PROBLEMS CAN ARISE IF DIABETES IS NOT WELL CONTROLLED? – COMPLICATIONS OF DIABETES.
NOTE; Complications may occur in the short term(Acute) or long term(Chronic).
Acute complications commonly include Diabetic Keto-Acidosis (DKA) which is the most common presentation for patients that have just been newly diagnosed with diabetes. It is a medical emergency. And may lead to death if poorly managed. It’s important that this condition is managed at a well-equipped facility. Routine blood sugar check-ups are therefore important for early diagnosis of DKA.
A patient in DKA will have very high sugar levels, sometimes not recordable using the ordinary glucometers. The patient will have deep, laboured breathing and a sweet smelling breathe. They may be sweating profusely.
LIFESTYLE CHANGES; THE CORNERSTONE OF CONTROLLING DIABETES.
DIABETIC DIET AND NUTRITION
Practical Advice On Maintaining a Healthy Diet.
1.Fruit and vegetables
Eat atleast 5 portions of fruit and vegetables per day; intake can be improved by;
• Always including vegetables in meals.
• Eating fresh fruit and vegetables as snacks.
• Eating fresh fruit and vegetables that are in season.
2.Fats
Reducing the amount of total fat intake to less than 30% of total energy intake helps to prevent unhealthy weight gain for example;
• By steaming or boiling instead of frying when cooking.
• Replacing butter and ghee with oils rich in polyunsaturated fats e.g soybean, canola and olive oil.
• Eating reduced fat dairy foods and lean meats or trimming visible fat from meat.
• Limiting consumption of baked and fried foods and pre-packaged snack e.g doughnuts, cakes, pies, cookies, biscuits.
3.Salt
Reduce salt intake by;
• Limiting the amount of salt and high sodium condiments e.g soy sauce, fish sauce when cooking and preparing meals.
• Not having salt or high sodium sauces on the table.
• Limiting the consumption of salty snacks.
• Choosing products with lower sodium content.
4.Sugars.
• Limiting the consumption of foods and drinks containing high amounts of sugars e.g sugary snacks, candies and sugar-sweetened beverages e.g sodas.
• Eating fresh fruit and raw vegetables as snacks instead of sugary snacks.
The Diabetes Plate Method
Easiest way to create healthy meals that can help manage blood sugar.
Using this method, you can create perfectly portioned meals with a healthy balance of vegetables, protein and carbohydrates.
All you need is a plate that is not too big. Recommended size = 9 Inches.
If your plates are larger than this, try using a smaller salad or dessert plate for your meals.
THE PLATE
Fill half the plate with Non Starchy Vegetables
These are high in vitamins, minerals and fibres making them an important part of a healthy diet.
Examples include;
Broccoli Green beans
Cabbage Carrots
Cauliflower Eggplants
Mushrooms Okra
Celery Cucumber
Asparagus Brussels sprouts
Tomatoes Zucchini
Leafy greens eg bugga, dodo, nakati, sukuma-wiki
Salad greens eg lettuce, spinach
Peppers eg green, red and yellow bell peppers
Fill quarter the plate with Protein
Protein can be animal or protein based
Plant based sources of protein include;
Beans
Cowpeas
Lentils
Chickpeas
Nuts eg groundnut sauce
Tofu
Animal based sources of protein
Chicken Eggs
Turkey Cheese
Fish eg tilapia, salmon, Nile perch
Shellfish eg shrimp, clams and lobster
Fill the last quarter of the plate with Carbohydrates
Limiting your portion of carbohydrate foods to one quarter of your plate can help keep blood sugars from rising too high after meals.
Examples include;
Starchy vegetables eg pumpkin, matooke, butternut squash, plantain, yam, sweet potatoes
Whole grains eg unprocessed maize, brown rice, quinoa, oats and popcorn
Whole grain products eg bread (brown salt bread) and pasta
Drinks
Choose water or a low calorie drink. Water contains no calories or carbohydrates and has no effect on blood sugar
Other drinks include;
Unsweetened tea
Unsweetened coffee
Sparkling water
Flavoured water or sparkling water without added sugars
Plain yoghurt with fruit or nut toppings
Important tips revolving around food!
As you have your lunch, avoid drinking as you eat, rather drink a glass of water 30mins before your meal.
Eat fruit whole rather than as juice to reduce sugar spikes as a whole fruit has lots of fibre compared to fruit juice where most fibre is removed.
Eat loads of seeds. Because of their life giving potential, they are loaded with nutrients that promote health and fight disease. Seeds include; chia seeds, sim sim, pumpkin, flax and sunflower seeds.
Avoid sugary drinks eg sodas and processed juices.
Make soup as a way to increase your vegetable intake.
Another good way to get a variety of vegetable in the diet is to learn to make smoothies.
Avoid processed food. Eat natural whole food.
Using an air fryer is better than using a dip fryer, obviously because of the varying amounts of oil used in the cooking process.
A SAMPLE WEEKLY MEAL PLAN FOR THE DIABETIC
DAY BREAKFAST LUNCH SUPPER
MONDAY Smoothie, eggs, nuts Peas, dodo, matooke/kalo fish, nakati, matooke/ pumpkin.
TUESDAY Steamed vegetables, eggs, green tea beans, bbuga, matooke or yam Chicken, spinach, matooke/butternut squash
WEDNESDAY Fruit salad + eggs + green tea, nuts lentils, sukuma, pumpkin/sweet potatoes, kalo G.nuts, cabbage, matooke/ pumpkin/yam
THURSDAY Eggs + smoothie Fish, cabbage, matooke/kalo/yam Chickpeas, broccoli + carrots, pumpkin/yam
FRIDAY Katogo/vegetable soup + tea/coffee Beans + ntula/cabbage + matooke/ pumpkin/ kalo/ yam Mushroom sauce + bugga + matooke/brown rice
SATURDAY Vegetable soup, eggs Chicken, cauliflower + carrots, quinoa/yam/ irish Lentils, green beans +peppers, pumpkin/plantain
SUNDAY Smoothie, nuts, eggs Fish, spinach + egg plants, matooke Peas, cabbage, plantain/matooke
Every food listed above has preparation variations for example;
Chicken & fish – fried (soup/stew), boiled, luwombo, air fried.
Beans & Peas – fried or boiled
Eggs – boiled, baked, fried, scrambled
Leafy greens – steamed or fried
Nuts include roasted groundnuts, almonds, cashews, walnuts etc.
The trick is to get creative with your groceries and create interesting meals to help you stick to healthy eating.
SAMPLE RECIPES!
1. Smoothies;
All you need for a smoothie is a good high power blender, the food produce and a glass. No sieving required. All you have to do is blend/puree to the smoothness of your liking and enjoy.
a) Green smoothie:
Milk – 1½ cups of milk or and nut milk
Spinach – 2 cups fully packed
Banana – 1 banana (frozen is best)
Apple – 1 apple sliced into pieces
Avocado – ¼ avocado
Add all of the ingredients to a blender and blend for 30seconds on high or till smooth, serve and enjoy.
b) Orange carrot smoothie:
Milk – 1.5cups dairy or nut milk
Orange – 1 orange
Carrot – 1/3 cup grated carrots
Seeds – 1 tablespoon flax or chia seeds
Cauliflower – ¼ cup blanched then frozen cauliflower
Add to a blender, blend till smooth and enjoy.
2. Vegetable soup
Ingredient list:
• Olive oil (1 Table spoon)
• 1 onion (large, chopped)
• 2 carrots (peeled, chopped)
• 2 garlic cloves (minced)
• 2 celery stalks (chopped)
• 1 sweet potato (large, about 2 cups, chopped)
• 1 butternut squash/pumpkin (peeled, chopped)
• 1 cauliflower (chopped)
• 1 small cabbage (sliced)
• 4 tomatoes (diced)
• 1 litre of vegetable stock
• 2 teaspoons of Italian seasoning
• ½ tsp. cracked black pepper
• 1 tsp. salt
• 2 tbsp. chopped parsley (fresh)
Instructions
i. Heat up a large pot over med-high heat and add olive oil
ii. Throw in onion, carrot and celery and cook for 3-5 minutes or until onions are translucent.
iii. Add in garlic and cook for 1 minute.
iv. Add in sweet potatoes, butternut squash and cauliflower and cook for 5 minutes
v. Top with cabbage, diced tomatoes, vegetable stock and spices and give it a stir.
vi. Bring to a boil and then let simmer uncovered over medium heat for 30 minutes.
vii. Top with fresh parsley and serve warm.
viii. Will keep for a week in refrigerator and freezes well for several months.
3. Lentil soup.
Ingredients.
• 1 tbsp. olive oil 1 medium onion, chopped
• 2 carrots, chopped 4 garlic cloves, minced
• 2 tsp. cumin 1 tsp. curry powder
• ½ tsp. dried thyme 4 diced tomatoes
• 4 cups vegetable broth 2 cups water
• Pinch of salt black pepper
• 1 cup brown or green lentils, picked over and rinsed
Instructions
i. Warm the olive oil in a large pot over medium heat. Add the olive oil.
ii. Once the oil is shimmering, add the chopped onion and carrot and cook, stirring often until the onion has softened and is turning translucent, about 5 minutes.
iii. Add the garlic, cumin, curry powder and thyme. Cook until fragrant while stirring constantly, about 30 seconds.
iv. Pour in the diced tomatoes and cook for a few more minutes, stirring often, in order to enhance flavour.
v. Pour in the lentils, broth and water. Add salt and black pepper. Raise heat and bring the mixture to a boil, then partially cover the pot and reduce the heat to maintain a gentle simmer. Cook until lentils are tender but still hold their shape.
vi. Optional: blend about 2 cups of the soup and add it back to the pot, this helps to thicken the soup,
vii. Add the chopped greens and cook for 5 more minutes.
viii. Serve while hot. Leftovers will keep well for about 4 days in the refrigerator, or can be frozen for several months.
TREATMENT OF DIABETES
Depending on what type of diabetes you have and how well your blood sugar is controlled, your doctor will give you either tablets or injectable insulin.
WHILE ON MEDICATION FOR DIABETES, WATCH OUT FOR SIGNS OF LOW BLOOD SUGAR (HYPOGLYCAEMIA)!!! AND QUICKLY TAKE A SNACK OR SWEET DRINK.
ADHERENCE TO MEDICATION
Once medication is started, strict adherence to the medication as per doctor’s instructions is very important.
Non adherence can lead to poor blood sugar control and acute complications such as DKA. (Mentioned above) as well as subsequent chronic complications such as diabetic foot, chronic kidney disease, stroke, heart disease, disease of blood vessels, eye diseases such as cataracts and blindness.
ROLE OF EXERCISE IN DIABETES;
Scientific evidence exists to show that regular exercise improves on the sensitivity of tissues to insulin and ultimately improving glucose uptake by various tissues in the body. This gradually reduces on the blood sugar levels.
It is especially important in the diabetic whose pancreas produces insulin but their tissues are insensitive to the insulin, a common characteristic of type 2 diabetes.
INSULIN
It’s a drug that has the exact structure as that of the naturally produced insulin in our bodies.
The bodies of some diabetics do not produce enough insulin. It has to be replaced and it is delivered via injection using an insulin needle and syringe.
Your doctor will tell you how much insulin you need daily.
We have both short acting and long acting insulins. Meaning some of it is removed from the body quickly and the other can act for many hours before it is removed from the body.
It is given shortly before a meal therefore ensure you have food ready to eat before you give the insulin otherwise it may lower your sugar levels very fast and you go into hypoglycaemia (low sugar levels in blood) and possibly even into shock.
Other delivery systems such as the insulin pen may also be used to deliver the insulin.
The insulin syringe is calibrated and you can pick off the exact amount you need.
The insulin needle is so short that it only penetrates the just up to the layer below the skin. (subcutaneous Layer) – see image.
Insulin should be stored at low temperatures in a refrigerator preferably but can also be placed in a cold corner of the house on the floor in absence of a fridge.
TYPES OF INSULIN
Short- Acting Insulin e.g Actrapid (acts- rapidly)
Long Acting Insulin e.g Mixtard
THE INSULIN PEN
INSULIN INJECTION SITES
THE GLUCOMETER (“GLUCOSE-METER”)
A device used to measure and record blood sugar levels.
Different types of glucometers are on the market and your doctor can advise you on where to get one. It comes along with glucose strips and prickers. You may need cotton swabs to clean the blood after pricking the finger.
It’s important to always take a reading before the major meals; breakfast, lunch and supper.
Also, when you get symptoms of low sugar or high sugars as explained above, it’s important to take a blood sugar reading.
HOW TO USE A GLUCOMETER
THE PENTAD FOR DIABETIC TREATMENT
PSYCHOLOGICAL STRESS AND DIABETES.
This is a question that most of our patients have been asking on multiple occasions and we are sure many more people out there are still asking if psychological stress is related to diabetes.
Stress may arise from a very demanding job to domestic violence whether physical or psychological to social isolation, unemployment, poverty, loss of loved ones etc.
Several studies have suggested that chronic exposure to stress (both physical and psychological) may have an influence on development of high blood sugar.
The two suggested theories are:
Long term exposure to stress leads to high levels of some hormones in the body called “stress hormones” or counter-regulatory hormones such as glucagon, epinephrine, cortisol and growth hormone. If these hormones stay long in blood circulation, they cause high blood sugar and also high blood pressure.
People that are under chronic stress usually engage in unhealthy lifestyles such as overconsumption of alcohol, excessive tobacco smoking and eating unhealthy foods. Scientific evidence exists to show that these themselves are risk factors for developing diabetes and high blood pressure.
OXIDATIVE STRESS AND DIABETES.
Both Clinical and Experimental studies have showed that oxidative stress plays a big role in the development and acceleration of the complications of diabetes. (As stated above). There’s evidence to support the fact that high sugar levels in blood induce the formation of free radicles and impairs the antioxidant defence system in patients with diabetes.
The antioxidants in the body are part of the body’s defence and they counterbalance the toxic reactive oxygen species. Common anti-oxidants include; Vitamins A, C, E, Glutathione, and some enzymes such as catalase, glutathione peroxidase and superoxide dismutase.
High sugars however disturb the antioxidant system and in part will lower the body’s defences against disease and stress.
THE BYAMAKA IMMUNOLOGICAL OPTIMIZING PROTOCOL
This protocol is based on the principle that an optimally functioning immune system is capable of building up defence against disease and sometimes without need for drugs against this disease.
That supplying the body with antioxidants reduces the risk of oxidative stress and therefore reduce the occurrence of complications of diabetes (and other chronic illnesses). This ultimately improves on the health outcomes of these patients.
Drugs on the market under this protocol include MOL (Mixture of Life) and Absolut plus; containing scavengers and antioxidants such as; Hypoxis, selenium, plant sterols, spirulina, beta carotene, Vitamins C and E along with the B complex vitamins.
We recommend that the diabetic patient adds this product to their usual anti-diabetes regimen and to take it for atleast 3months consecutively then every other month thereafter.
Adding a potent immune booster has been showed to improve health outcomes in patients with chronic illnesses because the body’s immune system is constantly under stress.
MIXTURE OF LIFE (MOL) AND ABSOLUT PLUS
Mixture of Life – A product of Byamaka Pharmaceuticals Co. LTD, Mbarara, Uganda.
These products were formulated by Ph. Byamukama Aggrey, a senior pharmacist in Mbarara and are manufactured in by Farmos Health, Bultfontein, South Africa.
They have been in existence for over 15 years and has showed tremendous results in patients with illnesses such as;
• Infectious diseases such as; HIV/AIDS, Hepatitis B and C
• Autoimmune conditions such as Rheumatoid Arthritis, Lupus
• Metabolic diseases such as Diabetes Mellitus, Metabolic syndrome
• Malnutrition
• Chronic Liver and Kidney disease
• Hypertension
• Cancers
It’s important to note that these products are not to be used in isolation without the primary medications for the specific illnesses but rather as a supportive drug to improve outcomes in these patients.
Regardless of whether we have chronic illnesses or not, our body cells undergo constant wear and tear as we age.
Immunosenescence is a process of immune malfunction that occurs with age and is closely related to development of infections, autoimmune diseases and malignant tumors. Keeping our immune system well moderated is therefore important as we age.
These products therefore are not only restricted to use in chronic illness but can also be used by individuals without apparent disease, just to keep their immunity in check.
REFERENCES:
Diabetes Australia; The National Diabetes Services Scheme; diabetesaustralia.com.au; September 2022.
Godelieve Johanna Maurice Vandersmissen et al. Int J Occup Med Environ Health; Evaluation of the Finnish Diabetes Risk Score (FINDRISC) for Diabetes screening in occupational health care; 2015.
CDC; Centres for disease control and prevention; Tests for Type 1 diabetes, Type 2 diabetes and prediabetes.; August 2022.
Conor Seery; Living with diabetes; journal, diabetes.co.uk, the global diabetes community; 15th January 2019.
Johns Hopkins Medicine; Journal; Gestational diabetes Mellitus; 2022.
Uganda Clinical Guidelines, 2016.
Ian B. Wilkinson et Al; Oxford Handbook of Clinical Medicine; tenth edition; 2017
Diabetes Diseases; The Diabetic booklet; Ministry of Health Uganda 2009.
Fatmah A Matough et Al; The role of Oxidative stress and antioxidants in diabetic complications; Sultan Qaboos University Medical Journal; 2012.
Lisa Bryan; article: 5 low sugar smoothies that taste amazing; www.downshiftology.com; August 2019.
Tianyi Et. Al; Research Article; Physical Activity and Nutritional Influence on Immune function; An Important Strategy to Improve Immunity and Health Status, October 2021.
Lian Jiangyao et Al; Immunosenescence: a key player in cancer development. Journal of haematology and oncology 13, 151 (2020). https://doi.org/10.1186/s13045-020-00986-z
Cathy Lloyd et Al; article; Stress and Diabetes; American diabetes Association; Diabetes Spectrum April 2005; 18(2):121-127; https//doi.org/10.2337/diaspect.18.2.121
Ph. Happiness Aggrey Byamukama; Infectious AIDS, The Healing Power of Photosynthesis; Revelations and Visions; 2014.
Ph. Happiness Aggrey Byamukama; Infectious AIDS; The healing power of photosynthesis; Hypothesis and Nutraceuticals; 2016.
THE PHOENIX
A mythical creature that cyclically regenerates, obtains new life by rising from the ashes of its predecessor.
In times of doubt and confusion, it symbolizes strength, transformation and renewal. For only from the ashes of who we were, can we rise up to become who we’re to be.
At times there will be fire; this we can’t avoid. But it’s up to us to decide whether it will consume or it will purify us.
“It’s not the strongest or the most intelligent of the species that survive, but those that are most adaptive to change.” – Charles Darwin
ABOUT THE AUTHORS
Dr. Patricia and Dr. Emmanuel Mugisha are medical doctors with Bachelor’s degrees in medicine and surgery from King Cesar University.
They are a happily married couple and are strong believers in God being at the centre of their marriage and their careers.
They have a special interest in the chronic diseases Hypertension, Diabetes and HIV/AIDS.
They strongly believe that health education is the core of patient care yet in most cases there’s usually very little time during the consultation, for the doctor to give fully detailed medical information to the patient about their condition in the easiest way they understand it. So many questions therefore remain unanswered in the mind of the patient.
The authors have interacted with Diabetic patients and realised that most diabetics don’t fully understand their condition and how to live positively with it. This has inspired the content in this book and they hope it shall be of benefit to the diabetic, their families and friends.
Contacts;
Tel; 0774774042 / 0780813885 / 0700264048
Email; themugishalibrary@gmail.com
