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Doris Obinna
As the world marks the World Diabetes Day today, the theme for this year’s celebration, “The Family and Diabetes,” is urging families to learn more about the warnings signs of diabetes and find out their risk of type 2 diabetes.
The International Diabetes Federation (IDF) is today raising awareness of the impact that diabetes has on the family and support network of those affected, and promoting the role of the family in the management, care, prevention and education of diabetes.
Research conducted by IDF in 2018 discovered that parents would struggle to spot this serious life-long condition in their own children. Despite the majority of people surveyed having a family member with diabetes, an alarming four-in-five parents would have trouble recognising the warning signs. One-in-three wouldn’t spot them at all.
The findings underline the need for education and awareness to help people spot the diabetes warning signs early.
Narrating his ordeal, Ighiwotho Okeoghene said, “I am type 1 diabetes patient. I was diagnosed with diabetes at a very tender age. I developed ulcer foot when I was in the university and it affect me so much that on my left leg my five toes were all amputated.
“I needed surgery; and was admitted in Ikeja general hospital and Gbagada general hospital a couple of months. My legs started being and because I was using them, I also put my left leg on the floor, it healed and was bent, so I needed to do corrective surgery and I had to go India for my surgery where the doctors performed the infrastructive surgery on my left leg, it was a success, 90 per cent done which I still thank God for.
“I am alive today and God is helping me manage it the best possible way that I can. I went through a great ordeal when I was in Nigeria here, the leg got so bad to a point whereby maggot started coming out from my legs and it was actually the fault of the hospital I went to and stayed in Festac town.
“The doctor took me and told me that if I knew this killed me because there was pulse, he used razor blade to cut my leg that was where the whole complication started from.
I think there is a way he should have done it, although he is a gynaecologist, who doesn’t have business with foot ulcer.”
According to Okeoghene, “My complication started from there. I went to India in 2012 and 2013. This started since 2006 and it was then the complications started that we went to the general hospital, where if actually tool me almost four to five months before I saw the surgeon and he came, looked at my foot and said it needs to be amputated.
“They took me to the theatre twice; they amputated four times on my leg. At the end of the day I went to India. When I came back I have been able to manage my right foot, even though I still had little complications it is much better here in Nigeria.”
Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues. It’s also your brain’s main source of fuel.
If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes and gestational diabetes, which occurs during pregnancy but may resolve after the baby, is delivered.
The Course Coordinator, Rainbow Specialist Medical Centre, Dr. Afokoghene Isiavwes, said diabetes education knowledge is low in Nigeria owing to the fact that symptoms can be quiet until complications sets in. Also, they say to reduce the burden of diabetes burden in Nigeria, there is the urgent need to implement ideas that would reduce the burden.
Explaining further, she said a first responder is a person with specialised training who is among the first to arrive and provide assistance at the scene of an emergency.
According to her, “you would agree with me that diabetes is a global emergency, with associated complications. With the absence of podiatry training, which helps to reduce diabetes amputations, you would agree with me that our diabetes foot first responders must be trained to stand in the gap till formal university training begins.”
She stressed that an individual with initial “ray-amputation” (a surgical removal of a dead diabetes toe) could end up with repeated surgeries on the same limb, sometimes ending with an “above-knee amputation,” a surgical procedure performed to remove the lower limb at or above the knee joint when that limb has been severally damaged) in this case by diabetes mellitus.
In Nigeria, according to her, many people have little or no knowledge of diabetes and its complications.
Isiavwes said: “It is estimated that the rate of foot ulcer among people living with diabetes is between 8.3 per cent and 19 per cent in the different zones of the country.
“The rate of amputation is also estimated to be as high as 53.2 per cent in people with foot ulcer in some centres, thereby making diabetes foots the most common cause of non-traumatic amputation in the lower extremities in Nigeria.
“Diabetes foot disease is a leading cause of hospital admissions in Nigeria and the economic burden becomes quite significant, knowing most of the health expenditure in the country is from out of pocket expenses.
Professor of Endocrinology and Diabetology, Department of Medicine, College of Health Sciences, University of Abuja Teaching Hospital, Felicia Anumah, stressed that diabetes have become a huge problem in Nigeria presently, with increasing complications, which are most times dangerous and could result to death of the affected individual, if not addressed on time.
According to Anumah who is also the Dean, Faculty of Clinical Science, University of Abuja, the prevalence of diabetes foot right now varies from between 0.3 per cent and 19 per cent, depending on the type, with amputation rate as high as over 50 per cent.
She noted however, that the problem most time with the diabetes foot patient is that, by the time he/she gets to the health centre where the right and proper care can be given, it is usually late, as about 50 per cent of the only option to save that person’s life is amputation.
According to World Health Organisation (WHO), a lack of knowledge about diabetes means that spotting the warning signs is not just a problem for parents, but is an issue impacting a cross-section of society. This is a major concern, due to the signs being milder in type 2 diabetes, the most prevalent form of the condition, responsible for around 90 per cent of all diabetes. One in two people currently living with diabetes are undiagnosed. The vast majority of these have type 2 diabetes.
Left untreated or unmanaged, diabetes can lead to life-changing complication. These include blindness, amputation, kidney failure, heart attack and stroke. Diabetes was responsible for four million deaths in 2017.
This November, IDF is urging people to test their diabetes knowledge and assess their risk of type 2 diabetes.
WHO report on diabetes in Nigeria shows that 425 million people have diabetes in the world and more than 16 million people in the African Region (AFR); by 2045 it will be around 41 million.
Causes
To understand diabetes, first you must understand how glucose is normally processed in the body.
How insulin works
Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).
The pancreas secretes insulin into the bloodstream. The insulin circulates, enabling sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
The role of glucose
•Glucose a sugar is a source of energy for the cells that make up muscles and other tissues.
•Glucose comes from two major sources: food and your liver.
•Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
•Your liver stores and makes glucose.
•When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.
Causes of type 1 diabetes
The exact cause of type 1 diabetes is unknown. What is known is that your immune system, which normally fights harmful bacteria or viruses attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.
Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.
Causes of prediabetes and type 2 diabetes
In prediabetes which can lead to type 2 diabetes and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it’s needed for energy, sugar builds up in your bloodstream.
Exactly why this happens is uncertain, although it’s believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.
Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.
Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can’t keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.
Signs and symptoms
According to experts, diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe.
Some of the signs and symptoms of type 1 and type 2 diabetes are: Increased thirst, frequent urination, extreme hunger, unexplained weight loss and presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin).
Also, fatigue, irritability, blurred vision, slow-healing sores as well as frequent infections, such as gums or skin infections and vaginal infections.
“Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it’s more common in people older than 40.”
Treatments
Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy weight and participating in regular activity also are important factors in managing diabetes.
An important part of managing diabetes as well as your overall health is maintaining a healthy weight through a healthy diet and exercise plan:
•Healthy eating. Contrary to popular perception, there’s no specific diabetes diet. You’ll need to center your diet on more fruits, vegetables and whole grains foods that are high in nutrition and fiber and low in fat and calories and cut down on animal products, refined carbohydrates and sweets. In fact, it’s the best eating plan for the entire family. Sugary foods are okay once in a while, as long as they’re counted as part of your meal plan.
Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes.
•Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it’s used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. Get your doctor’s okay to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven’t been active for a while, start slowly and build up gradually.
Lifestyles and home remedies
Type 1 diabetes can’t be prevented. However, the same healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes can also help prevent them:
Eat healthy foods: Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom.
Get more physical activity: Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can’t fit in a long workout, break it up into smaller sessions spread throughout the day.
Lose excess pounds: If you’re overweight, losing even 7 per cent of your body weight for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds (90.9 kilograms) can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
Sometimes medication is an option as well. Oral diabetes drugs such as metformin (Glucophage, Glumetza, others) may reduce the risk of type 2 diabetes but healthy lifestyle choices remain essential.
Have your blood sugar checked at least once a year to check that you haven’t developed type 2 diabetes.
Alternative medicine
Numerous substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren’t any alternative therapies that are currently recommended to help with blood sugar management.
If you decide to try an alternative therapy, don’t stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won’t cause adverse reactions or interact with your current therapy.
Additionally, there are no treatments alternatives or conventional that can cure diabetes, so it’s critical that people who are receiving insulin therapy for diabetes don’t stop using insulin unless directed to do so by their physicians.
Coping and support
Living with diabetes can be difficult and frustrating. Sometimes, even when you’ve done everything right, your blood sugar levels may rise. But stick with your diabetes management plan, and you’ll likely see a positive difference in your A1C when you visit your doctor.
Because good diabetes management can be time-consuming, and sometimes overwhelming, some people find it helps to talk to someone. Your doctor can probably recommend a mental health professional for you to speak with, or you may want to try a support group.
Sharing your frustrations and your triumphs with people who understand what you’re going through can be very helpful. And you may find that others have great tips to share about diabetes management.
