Wait a minute, what is happening to all of us. I thought things were hard. I expected us to suffer from malnutrition and b starvation, due to the biting economic crunch. But look right left and center protruding tummies, overweight and obesity. What is happening to all of us. Are we trying to obviate or escape our problems by taking solace in excessive consumption of junk foods. Which eventually results in diabetes. God have mercy.
My patients call diabetes different and several names. Doc, I have sugar. I have sugar problem. Sugar trouble, sugar disease, sugar sickness, or simply sugar. I have the sugars. I have sweet blood or hyperglycemia.
Sugar problem was rare in the olden days, not now, with the advent of of fast food. 90% Nigerians are either diabetic, borderline or heading towards extreme obesity. How can we do this to ourselves. If you are big and fat you are blinded by the euphemism that you are living well. Which according to legendary Fela, translates to “suffering and smiling”
In the 70s, when I was in University of Jos, Prof Ikeme, of blessed memory, taught us that the olden ways of diagnosing diabetes, is to tell a patient to go and urinate under a tree, then come back after 2 hours. If ants had gathered around the urine, then the person had diabetes.
Diabetes had been known for several thousand years. Late in nineteen century, when diabetes was well recognized as an abnormality in carbohydrates metabolism – the ability to burn sugar, several Scientists discovered that the experimental removal of certain cells, the islets of Langerhans, from the pancreas, produced diabetes in dogs. This observation led to the 1921 discovery and isolation of naturally produced insulin.
Insulin is a hormone produced by the islets of Langerhans. Injection of insulin into the bodies of people with diabetes proved to be the first, and to this day, the most effective means of treating the disease.
Diabetes mellitus is a silent killer, according to Prof Olayink Adeyosola Adijat, and one of the leading causes of death globally. Its complications include, damage to the brain, heart, kidneys and limbs. More than 50% of people living with the disease are oblivious of it, especially in Nigeria, where poor health care unhealthy diet, sedentary lifestyle and poverty persist.
Diabetes mellitus is a metabolic disease, which occurs as a result of impairment in insulin secretion and or the activity of the insulin. It is a chronic problem in which blood glucose (sugar) can no longer be regulated. There are two reasons for this.
First – the cells of the body become resistant to insulin. Insulin works like a key to let glucose (blood sugar) move out of the blood and into the cells, where it is used as fuel for energy.
Second – when the cells become insulin resistant, it requires more and more insulin to move sugar into the cells, and too much sugar stays in the blood. Overtime if the cells require more and more insulin, the process cannot make enough insulin to keep up and begins to fail.
You are more likely to develop diabetes Mellitus if you are not physically active and are overweight or obese. To see if your weight puts you at risk for diabetes mellitus, check your Body Mass Index(BMI) chart.
Certain genes may make you more likely to develop diabetes mellitus. The disease tends to run in the families, and occurs more often in some racial ethnic group. People whose parents had diabetes have a genetic predisposition, meaning they are more likely to get diabetes Mellitus themselves.
The risk of developing diabetes mellitus increases with age, as the person gets older, but for women having polycystic ovarian syndrome or history of gestational diabetes during pregnancy. Low birth weight is thought to predispose to diabetes due to poor beta-cell-development and functions. The avoidable risk factors to diabetes mellitus include obesity, overweight, physical inactivity, high blood pressure, excessive diet, and impaired glucose metabolism.
The patients’ pancreas stops producing insulin or produces insulin intermittently. The reasons for the pancreatic shutdown are unknown, the suspicion is that there is undue stress on the pancreas.
Patients with diabetes Mellitus can usually be treated by oral tablets. Diabetes is having a blood glucose level, what we call Fasting Blood Sugar (FBS), greater than 126mg/dl. For Africans the range of FBS is 75 to 125mg/dl. While Random Blood Sugar (RBS) ie after eating is 85 to 135mg/dl. A non fasting glucose greater than 200mg/dl along with symptoms of diabetes done over 6 weeks should be suggestive of diabetes mellitus.
The manifestations of diabetes Mellitus during early stages often does not present any symptoms at all, still you should be aware of the symptoms and early warnings such as
Frequent urination and extreme thirst.
Sudden unexpected weight loss.
Increased hunger.
Blurry vision.
Dark velvety patches of skin called acanthosis nigricans.
Fatigue.
Wounds that won’t heal.
The high blood glucose seen in diabetes can damage blood vessels, nerves, and organs, leading to a number of potential complications. We know that efforts will be made to treat diabetes to avoid complications. Which include
Heart disease and and stroke
Nervous system damage.
Diabetic retinopathy
Kidney disease
Foot ulceration.
Usually symptoms of hypoglycemia arise during treatment. A typical episode begins with a feeling of hunger, light headedness, lack of concentration and weakness, and quickly develops into sweating, palpitations and tremor. The patient loses consciousness if he does not receive glucose. The condition is known as hypoglycemic coma.
In the management of diabetes Mellitus, diet, insulin, oral hypoglycemic agents, and the patient’s full understanding, are essential. The principle of successful treatment are to balance the patient’s needs, both for calories and insulin, in the initial period of establishing control, and in the subsequent period of maintaining control with oral hypoglycemic.
Although carefully controled diet is an essential part of the diabetics care in industrialized society, the place of diet is less established in Africa in general and Nigeria in particular.
The ideal is to give one tenth of the total daily calories as grams of carbohydrates, but this is seldom practicable because protein and fat may be prohibitively expensive for the poor patient.
If he is taken insulin, the patient must take some carbohydrate, such as pap or gruel with sugar about midday, to avoid hypoglycemia, and he must have his main meals of carbohydrates in the morning and evening.
If he travels, the patient must have lumps or cubes of sugar to eat if he develops symptoms of hypoglycemia.
The oral hypoglycemic drugs act by Stimulating B-cells of the pancreas to secret insulin. But they should not be used to establish control in diabetes with ketosis, and traditionally are not suitable for young insulin-dependent diabetic patients, or those who have had diabetic keto-acidosis or have complications.
In larger towns where there are many diabetics, It is best to establish a diabetic clinic. At this clinic much of the routine supervision can be done by members of the health team other than the doctor, and they should also visit the homes of patients whose diabetes is difficult to control. Always be medically guided.
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