Dealing with Diabetes (Pt. 2)

So, you have Diabetes…..

It is not the end of the world

Excess body weight is the most important risk factor for diabetes. Several studies from within and outside Sub-Saharan Africa have confirmed that the prevalence of diabetes increases with increasing Body Mass Index (BMI). Being obese makes you 20 times more likely to have diabetes than somebody with a normal BMI and losing just 10% of body weight can cut risk in half. The best option would be to avoid gaining excess weight as shedding weight can be a tedious process. Without proper guidance and encouragement, many attempts at weight end in futility. However, there is no doubting that the two pronged approach of diet and exercise is important in losing weight and none can be successful without the other.
Dietary changes involve reducing caloric intake and changing dietary constituents. Refined carbohydrates like white bread and white rice should be shunned in favour of whole grains. Refined carbohydrates have a high glycemic index i.e. they cause a sustained spike in blood sugar levels and this increased the risk of diabetes. A reduction in total caloric intake is recommended and sizes of food portions can be reduced as long as a balanced diet is maintained.
Sugary drinks are a no-no. Processed fruit juices and carbonated sugar-sweetened beverages should be off your list if you have an increased risk of diabetes. The high glycemic load can overwhelm the body’s glucose control mechanisms. This is compounded by the fact that consumption of these beverages and fruit juices leads to an increase in body weight which increases the risk for diabetes. Artificially sweetened drinks are not as dangerous as their sugary counterparts, but this doesn’t mean they are totally safe. Studies are have controversial and are not yet conclusive. However, it is safe to say that consumption of artificially sweetened beverages in moderation will not increase risk. Water and tea are healthier, but less fanciful, substitutes.
For the proteinaceous aspect of diet, limiting the consumption of red meat (beef, pork and lamb) and processed meat (hot dogs, luncheon meats and bacon) can help to reduce risk. Even consumption of these foods in small quantities can greatly increase risk. Reasons why they are so dangerous are varied and the high sodium and nitrite content may be to blame. Healthier alternatives include fish and poultry (remove the skin and not fried). Yogurt and low fat dairy also helps to reduce risk.
Then, of course, you can never go wrong with eating vegetables. Green leafy vegetables are very protective.
If you smoke, you will have to quit. Smokers are 50 percent more likely to have diabetes than non-smokers.
On the other hand, alcohol consumption in moderation – a drink a day for women and up to two drinks a day for men – may be of some positive effect. They also have salutary effects on the heart, reducing the risk of heart disease. Consumption of higher quantities will increase risk. If you don’t drink alcohol, this is not an invitation to start, you can get the same benefits by losing weight exercising more and changing your eating habits.
Some nutrients like Vitamin D may be helpful in people who have pre-diabetes but not diabetes. Some studies have shown that Vitamin D may improve the sensitivity of the body’s glucose control mechanisms.
Above the level of the individual, there still remains much to be done. The first step is proper gathering of data. There is a need for epidemiological data and proper estimation of the burden and incidence of the disease, particularly in the high-risk populations. This prevents under-budgeting and ensures that the most vulnerable don’t get left behind. Another point of note is that diabetes-related expenditure is still very low in Nigeria. This is reflective of the bigger problem of health care in Nigeria where the majority of monetary allocations goes into recurrent expenditure. Proper infrastructure for diagnosis and management needs to be available at primary, secondary and tertiary care levels. The current system only provides specialist care in the tertiary centres and a few secondary centres clustered in urban areas. Access to insulin and oral hypoglycaemic agents remains beyond the reach of those who require them the most. The IDF has reported that the cost of insulin preparations is higher in sub-Saharan Africa than anywhere else in the world. Even those who can afford medication are beset with the problem of erratic supply.
Diabetes is a chronic disease and the long term economic and human costs of managing the disease are enormous. Preventive measures are at the heart of successful government interventions. Media campaigns aimed at behavioural modification can be very cost-effective. Increasing the awareness by the population of facilities for detection and monitoring will decrease the incidence of long-term complications like blindness. Training of local health support workers at the community level is also a priority as they are often the first point of contact for many patients in the rural areas. They are also in the best position to ensure local adaptation of government programs as they already understand the nuances and cultural mores of the environment.
The role of diabetes associations cannot be overstressed. The efforts of the Diabetes Association of Nigeria are laudable but they are in great need of support. These associations can serve as think-tanks and perform research and advocacy on issues that are peculiar to this environment. They can assist in the process of data gathering. National associations also play a crucial role in imparting education at different levels of health care and to the community at large. Patients should be encouraged to join these associations as they help promote consistent use of medication and provide fora for diabetics to seek solutions to challenges.
Every year, the world celebrates World Diabetes Day on the 14th day of November. This is in response to the alarming rise of cases of diabetes globally.I find it prudent to listen to the Harvard School which has summarised diabetes prevention in five words worth remembering: stay lean and stay active.

Dealing With Diabetes (Pt.1)


They are a common sight in our hospital clinics and wards, a recurring decimal across the landscape. Sometimes they hobble as a result of lower limb amputations, and other times, their eyesight is the victim. Regardless of the part of the body under plague, the culprit is the same. Diabetes.
In 2014, diabetes and its complications were responsible for nearly 106,000 deaths across Nigeria. Alarmingly, 77.6% of these deaths occurred in adults under the age of 60 thus, it is not ‘a disease of old people’ as is commonly thought. All these fatalities constituted a large part of the 481,000 deaths that were estimated to occur across Africa.
At the risk of oversimplification, diabetes occurs when the body cannot effectively control its sugar levels. Virtually every cell and organ in the body depends on one simple sugar, glucose, for most of its energy needs. When the body’s glucose control mechanisms fail, the high concentrations of glucose wreak havoc all through the body. Cardinal symptoms to watch out for in diabetes are increased frequency of urination and increased thirst. The list of problems associated with, or caused by, diabetes is endless – male and female infertility, kidney failure, nerve damage, stroke, blindness etc. Newer studies are establishing correlations with Alzheimer’s disease, dementia, frozen shoulder and sleep apnea.
Figures from the International Diabetes Foundation (IDF) have indicated that 3.75 million people (ages 20 – 79) have diabetes in Nigeria. Of this number, 1.7 million people do not know they have the disease. These figures are underestimates as epidemiological data from Nigeria is only starting to improve. Nigeria, and much of Africa, now faces an increase in the incidence of non-communicable diseases like diabetes and hypertension. This upsurge in the face of known problems like malaria, HIV/AIDS et al is due to increased urbanisation and changes in lifestyle such as physical inactivity among urban dwellers and, surprisingly, in rural areas.
There are many forms of diabetes. Most people will have a form known as Type 2 Diabetes. It used to be called adult onset diabetes since it was not seen in children, however, rising rates of obesity in children have proved that diabetes is no respecter of youth. In addition to the millions of people who have established diabetes, a larger number have “pre-diabetes”. A person with pre-diabetes has not distinct symptoms, they only have a blood glucose level which is higher than normal – but not in the range of diabetes. Without adequate intervention, up to 70% of people with pre-diabetes will progress to Type 2 Diabetes within 10 years or less. Studies conducted among various Nigerian populations have reported pre-diabetes in populations as young as university undergraduates.
The good news is that not everybody with pre-diabetes has to develop full blown diabetes. Healthy changes in diet, body weight and exercise habits will prevent progression to diabetes and may even send pre-diabetic blood sugar levels back to their normal range.
A host of genetic and environmental factors are responsible for diabetes. However, not everybody with genetic predisposition to diabetes will develop the disease as environmental factors are more important. Thus, it is safe to say that diabetes is not curable but preventable. Several clinical trials and prevention programs have demonstrated that simple lifestyle modifications have the capacity to prevent diabetes. These benefits extend beyond the realm of diabetes and lower the risk of heart disease and some cancers.

So, If you have diabetes, what do you do?