Every November 14, World Diabetes Day is commemorated, which is an opportunity to raise awareness about the impact of the disease on the health of people. It also seeks to highlight the opportunities to strengthen the prevention, diagnosis, and treatment of diabetes. This year, the theme is “Education to Protect Tomorrow”. Experts, in this report, explained to Isioma Madike how lifestyles changes can reduce diabetes
Dr. Rotimi Adesanya, a family physician and fellow of the Academy of public health, calls diabetes mellitus elevated blood sugar level or blood glucose level. “It’s a metabolic disorder that is characterised by elevated blood sugar or what we call blood glucose, which results in damage to the eye, heart, kidney and to several parts of the body,” he added. According to Adesanya, diabetes mellitus could be genetic; inherited. “It could be acquired while growing up from lifestyles, what we eat; the kind of activities that we engage in could also predispose us.
Some could be from pancreatic conditions. Pancreas is an organ in the abdomen. Pancreatic cancer could cause that; some may be from medication, from overweight, obesity. These are the main causes. “Diabetes happens due to problems with insulin, it has to do with insulin deficiency. It could be as a result of no insulin at all like what we see in type 1 diabetes mellitus whereby there is no production of insulin. Or what we see in type 2 where there is resistance to the insulin or the insulin is not enough to control the blood sugar level,” he said. He explained why many call diabetes “The Silent Killer”.
According to him, it is because in many cases, people do not know that they have diabetes since it can take a long time before symptoms appear. Adesanya said that type-2 diabetes is largely preventable and treatable non-communicable disease that is rapidly increasing in numbers worldwide. While type 1 diabetes, according to him, is not preventable but can be managed with insulin injections.
A Consultant Physician and Endocrinologist at Evercare Hospital, Dr. Chinyere Udo, has also described diabetes mellitus as a chronic disorder that would occur when the body could neither produce sufficient insulin nor be able to effectively use the insulin it produced.
She said: “Deficiency of this hormone, results in persistently elevated blood glucose levels, the hallmark of diabetes. Diabetes, especially when poorly controlled, is associated with severe complications leading to limitations in quality of life or death. Its complications include increased susceptibility to infections, heart disease, stroke, blindness, kidney failure, and lower limb amputations.
“While diabetes may affect anyone, certain persons – obese persons, individuals with a sedentary lifestyle, those with a family history of diabetes, and women with a history of giving birth to large babies have a higher risk,” Udo stated in a statement in commemoration of World Diabetes Day. The Medical Director, Crest Hospital, Isuti, Igando, Lagos, Dr. Abayomi Waheed, affirmed that diabetes mellitus is a group of diseases that affect how the body uses blood sugar (glucose). Glucose, he added, is an important source of energy for the cells that make up the muscles and tissues. It’s also the brain’s main source of fuel, he said.
The main cause of diabetes, according to him, varies by type. But said no matter what type of diabetes one has, it can lead to excess sugar in the blood. “Too much sugar in the blood can lead to serious health problems. “Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes happens when blood sugar levels are higher than normal. But the blood sugar levels aren’t high enough to be called diabetes. And prediabetes can lead to diabetes unless steps are taken to prevent it.
“However, gestational diabetes happens during pregnancy. But it may go away after the baby is born,” he said. According to the Diabetes Association of Nigeria (DAN), one in every 11 Nigerians has diabetes. The association has also said that type 2 diabetes is silently becoming more widespread because patients are often asymptomatic.
The challenge, according to DAN, is that those who have been diagnosed also struggle to check their blood glucose level. The World Health Organisation (WHO) described diabetes as a chronic disease caused by the body’s inability to produce required amounts of insulin – the hormone that regulates blood sugar – or to efficiently use the insulin it produces. However, early diagnosis of the disease generally increases the chances for successful treatment. But, if not well controlled, diabetes may cause blindness, kidney failure and could lead to limb amputation, in addition to other longterm consequences.
Waheed told this reporter that delays in presentation are dangerous as it could lead to complications or even death. He also said that the disease is one of the leading causes of non-traumatic lower limb amputation worldwide, including in Nigeria. He noted that education and screening are major components of early detection and urge people to adopt better lifestyle choices to reduce the prevalence of diabetes. He said: “It is important for diabetes patients to always inspect their feet. They should also seek medical advice promptly if they notice any change in colour of their feet or blisters or wounds.
The advice is: do not delay,” he said. In like manner, Adesanya said to effectively combat the growing diabetes epidemic, patients must eat less sugar, do more exercise, and remember to take their medications. For management of diabetes to be effective, patients, physicians, and the healthcare system must all play important roles. This, he said, could be very expensive, especially when complications set in. Though the burden could be prevented through awareness and enlightenment of the public, Adesanya further said. “Screening is also very important as it helps to know if one is pre-diabetic. There is one way to reduce the progression of diabetes, as those with a family history are at high risk of developing the disease. “If your fasting blood sugar is above 100, but below a 127, we say you have pre-diabetes and if your value is greater than 127, then you are diabetic. It is important people know their numbers and blood sugar level regularly,” he said.
Mayo Clinic in Rochester, Minnesota, USA, in one of its presentations said that diabetes symptoms depend on how high one’s blood sugar is. Some people, especially if they have prediabetes or type 2 diabetes may not have symptoms, it said. In type 1 diabetes, symptoms, according to Mayo, tend to come on quickly and be more severe. Mayo Clinic, a nonprofit organisation committed to clinical practice, education and research, providing expert, is a whole-person care to everyone who needs healing. However, Mayo Clinic listed some of the symptoms of type 1 diabetes and type 2 diabetes to include: Feeling thirstier than usual, urinating often, losing weight without trying, and presence of ke-tones in the urine. Ketones, it said, are a byproduct of the breakdown of muscle and fat that happens when there’s not e n o u g h available insulin. O t h e r symptoms are feeling tired and weak, feeling irritable or having other mood changes, having blurry vision, having slow-healing sores, getting a lot of infections, such as gum, skin and vaginal infections. “Type 1 diabetes can start at any age. But it often starts during childhood or teen years, while type 2 diabetes, the more common type, can develop at any age. Type 2 diabetes is more common in people older than 40
When to see a doctor
According to the Mayo experts, “one can see a doctor if you think you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your health care provider. The earlier the condition is diagnosed, the sooner treatment can begin. “And if you’ve already been diagnosed with diabetes. After you receive your diagnosis, you’ll need close medical follow-up until your blood sugar levels stabilize.”
To understand diabetes, it’s important to understand how the body normally uses glucose. Insulin is a hormone that comes from a gland behind and below the stomach (pancreas). The pancreas releases insulin into the bloodstream. The insulin circulates, letting sugar enter the cells. It lowers the amount of sugar in the bloodstream. As the blood sugar level drops, so does the secretion of insulin from the pancreas. 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 the liver. Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. The liver stores and makes glucose.
“When glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose. This keeps your glucose level within a typical range. The exact cause of most types of diabetes is unknown. In all cases, sugar builds up in the bloodstream. This is because the pancreas doesn’t produce enough insulin. “Both type 1 and type 2 diabetes may be caused by a combination of genetic or environmental factors. It is unclear what those factors may be,” Mayo Clinic said.
Risk factors for diabetes, according to experts, depend on the type of diabetes. Family history may play a part in all types, they said. “Environmental factors and geography can add to the risk of type 1 diabetes. “Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes immune system cells (autoantibodies). If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes. “Race or ethnicity also may raise your risk of developing type 2 diabetes. Although it’s unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk. Prediabetes, type 2 diabetes and gestational diabetes are more common in people, who are overweight or obese,” Mayo experts said.
Long-term complications of diabetes develop gradually, experts say. “The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications.
Eventually, diabetes complications may be disabling or even life-threatening. In fact, prediabetes can lead to type 2 diabetes,” Adesanya said. He listed possible complications to include: Heart and blood vessel (cardiovascular) disease. Diabetes, he said, majorly increases the risk of many heart problems. These can include coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). He said: “If you have diabetes, you’re more likely to have heart disease or stroke. Too much sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.
“Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. It could also lead to kidney damage (nephropathy). The kidneys hold millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood. Diabetes can damage this delicate filtering system.
“Diabetes can equally damage the blood vessels of the eye (diabetic retinopathy). This could lead to blindness. Foot damage too. Nerve damage in the feet or poor blood flow to the feet increases the risk of many foot complications. Hearing problems are more common in people with diabetes also.” However, type 1 diabetes can’t be prevented. And there are healthy lifestyle choices that help treat prediabetes, type 2 diabetes and gestational diabetes, the doctors say.
“Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Eat a variety to keep from feeling bored. Try to get about 30 minutes of moderate aerobic activity on most days of the week. Or aim to get at least 150 minutes of moderate aerobic activity a week. “For example, take a brisk daily walk.
If you can’t fit in a long workout, break it up into smaller sessions throughout the day. Lose excess pounds. If you’re overweight, losing even 7% of your body weight can lower the risk of diabetes. For example, if you weigh 200 pounds (90.7 kilograms), losing 14 pounds (6.4 kilograms) can lower the risk of diabetes. “But don’t try to lose weight during pregnancy. Talk to your provider about how much weight is healthy for you to gain during pregnancy. To keep your weight in a healthy range, work on long-term norchanges to your eating and exercise habits. Remember the benefits of losing weight, such as a healthier heart, more energy and higher self-esteem.
“Sometimes drugs are an option. Oral diabetes drugs such as metformin (Glumetza, Fortamet, others) may lower the risk of type 2 diabetes. But healthy lifestyle choices are important. If you have prediabetes, have your blood sugar checked at least once a year to make sure you haven’t developed type 2 diabetes,” Mayo Clinic experts said.
With the recent increases and future projected increases in the incidence of type 2 diabetes mellitus and with the incidence increasing in teenagers and young adults, the already substantial public health effect of diabetes and diabetic retinopathy will become greater in years to come, according to experts. Despite the strength of the evidence that optimizing control of glucose, blood pressure, and lipid levels will reduce the incidence and progression of diabetic retinopathy, metabolic control, the experts say, remains suboptimal for many patients with diabetes. They are worried that many patients do not follow recommended guidelines for regular eye examinations, which is unfortunate because there is good evidence that with regular follow-up and intervention with photocoagulation as indicated, severe vision loss from diabetic retinopathy is uncommon.
Yet, diabetic retinopathy is a leading cause of severe vision loss in adults. “The current health care system too often fails to adequately manage diabetes and is lacking in providing proper education and motivation for patients to optimize their metabolic control.
“In addition to treating retinopathy, ophthalmologists can play an important role in educating and motivating patients to achieve better metabolic control, which, if successful, potentially could do more to reduce the progression of retinopathy than any of the ocular treatments currently in the armamentarium of the ophthalmologist,” Abayomi said. Diabetes Day is the primary global awareness campaign focusing on diabetes mellitus and is held on November 14, each year. It was led by the International Diabetes Federation (IDF), and each World Diabetes Day focuses on a theme related to diabetes.
Topics covered have included diabetes and human rights, diabetes and lifestyle, diabetes and obesity, diabetes in the disadvantaged and the vulnerable, and diabetes in children and adolescents. While the campaigns last the whole year, the day itself marks the birthday of Frederick Banting who, along with Charles Best, first conceived the idea, which led to the discovery of insulin in 1922. Established in 1991 by the International Diabetes Federation with support from the World Health Organisation (WHO) in response to growing concerns about the health and economic threat posed by diabetes, World Diabetes Day became an official UN day in 2006.