WDD 2019: Diabetes And Family; “Your Role”, “My Role”, “Why Wait!”
Diabetes is a leading cause of blindness, amputation, heart disease, kidney failure and early death. Simple action can reduce the risk.
This is a chronic condition that occurs when the pancreas is no longer able to produce insulin, or when the body cannot make good use of insulin if produces. Insulin is a hormone produced by the pancreas that act like a key to let glucose from the food we eat to effectively pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broke down into glucose in the blood, insulin helps the glucose into the cells. Not being able to produce enough insulin leads to a raise in the levels of glucose in the blood. Over time, the resulting high levels of glucose in the blood (known as hyperglycaemia) cause damage to many organ and tissues in the body, leading to the development of disabling and life-threatening health complications.
Diabetes remains one of the global health challenges. According to the International Diabetes Federation (IDF) in 2017, there are approximately 425 million people living with diabetes (PLD) worldwide, while about 212 million (50% of PLD) people living with diabetes remain undiagnosed. Though there are two contrary reports on the statistic of PLD in Nigeria. IDF estimated that about 1.7 million people with a prevalence of 2.2% are living with diabetes in the country, this is entirely the population of Ebonyi State. while a contrary report in a recent research made by the National Center for Biotechnology Information (NCBI) has it that, there are about 11.2 million Nigerians (that’s put together the population of 6 states –Yobe, Taraba, Ebonyi, Nasarawa, Bayelsa and the Federal Capital Territory) living with diabetes mellitus with a 5.77% prevalence.
The pooled prevalence of diabetes mellitus in the six geopolitical zones of Nigeria were 3.0% in the North-West, 5.9% in the North-East, 3.8% in the North-Central Zone, 5.5% in the South-West, 4.6% in the South-East, and 9.8% in the South-South zone. Risk factors for the pooled prevalence of diabetes mellitus were a family history of diabetes mellitus (4.6%); urban dwelling (6.0%); unhealthy dietary habits (8.0%); cigarette smoking (4.4%); older age (6.6%); physical inactivity (4.8%); and obesity (5.3%).
According to NCBI, the prevalence figures reported by IDF is widely perceived to have grossly under-report the true burden of diabetes mellitus in Nigeria, given that they are derived through the extrapolation of data from other countries. It is also important to note that the last time a nationwide population estimate of diabetes was undertaken in Nigeria was during the 1992 Nigeria National Non-Communicable Diseases (NCD) survey, where diabetes mellitus was said to be 2.2 % of the population. Since then, there has been no nationwide health (Diabetes) survey in Nigeria (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984944/#!po=15.6250).
Diabetes and its associated complications are estimated to have caused about 5 million deaths more than that caused by TB, HIV and malaria combined. But proper access to medications and supplies could have prevented these deaths. Having said these, one may wonder “what diabetes is, its causes and symptoms, care and management, and its preventions”.
Theme: Diabetes And Family; “Your Role, My Role” / “Why Wait!”
The theme of this year’s event is family and diabetes. It reflects on the need and measures for a collective effort among family members to protect each other from the risk factors of diabetes. These can be achieved through support regulation and control of what we eat, why we eat it, when it should be eaten. Simple steps can prevent one from developing diabetes, it is also important to know that diabetes only become visible only when various organ has been damaged. So why wait!
WHAT LIFT4AFRICA IS DOING
Since our inception in 2018, we have been contributing our quota in various medium which includes;
Awareness Creation and Education Public Enlightenment: LIFT4Africa has carried out various awareness through radio broadcast, social media sensitization and various community outreaches. The aim is to give tips on reducing the risk of being diabetic, while also enlightening and improving the knowledge and capacities of people with diabetes and their families on the public on the need to know about diabetes, its cause, why it is important to get diagnosed, how to manage, care, reverse, how to prevent the risk factors of diabetes and how to take charge of their own care.
We have also conducted diabetes screening using fasting and random blood glucose test as a tool for diagnoses, where we’ve been able to impact the lives of over 350 persons from various communities in Imo State, Nigeria. From the diagnoses, have being able to identify, counsel and referred about 100 potential diabetics to various health care centres for reconfirmation and have also followed up on about 23 confirmed diabetics to ensure an improved healthy lifestyle. We also intend to;
Advocacy for Various Health Policies
With the support of other relevant stakeholders and various civil society organizations, move for
- Implementation of local adoption comprehensive lifestyle programmes for people at risk of developing type 2 diabetes and those with type 1 diabetes.
- Encourage fiscal policies and other public measure to promote healthier diets.
- Subsidizing cost, availability and affordability of insulin usage for type 1 diabetes, and cost-effective medications for type 2 diabetes prevention.
Research has proven that 50% which translates to about 212 million of those living with diabetes remain undiagnosed. Thus we believe that through awareness creation, diabetes/glucose screening with various health policies in place, this percentage and number of those who are undiagnosed would be reduced while the lifestyle and the general health and wellbeing of those identified diabetic would be expected to improve.
TYPES OF DIABETES
There are basically three main types of diabetes:
- Type 1 diabetes
- Type 2 diabetes
- Gestational diabetes
TYPE 1 DIABETES
Type 1 diabetes is caused by an autoimmune reaction, in which the body’s defense system inappropriately attacks the insulin-producing beta cells in the pancreas. As a result, the body can no longer produce the insulin it needs. Why this occurs is not fully understood, but is likely to result from an abnormal immune response to an environmental factor, such as a virus, in genetically predisposed individuals. The disease can affect people of any age, but onset usually occurs in children or young adults.
In type 1 diabetes, the body is no longer able to produce enough insulin it needs. People with this form of diabetes needs a daily dose of insulin to control the level of glucose in their blood. Without insulin, a person with Type 1 diabetes would die.
Type 1 diabetes is diagnosed by an elevated blood glucose level along with the presence of excessive thirst and dry mouth, frequent urination, blurred vision, constant hunger, lethargy, bed wetting and weight loss.
TYPE 2 DIABETES
Type 2 diabetes is the most common type of diabetes, about 90% of all diabetes cases. It usually occurs in adults but is increasingly seen in children and adolescents. In type 2 diabetes, there is a combination of inadequate production of insulin, and an inability of the body to respond fully to insulin (insulin resistance). Although the exact causes for the development of type 2 diabetes are still not known, there are several important risk factors. The most important are excess body weight, physical inactivity and an unhealthy diet. Other factors that play a role are ethnicity, family history of diabetes, past history of gestational diabetes and increasing age.
In contrast to people with type 1 diabetes, most people with type 2 diabetes do not require daily insulin treatment to survive. The cornerstone of treatment of type 2 diabetes is the adoption of a healthy diet and increased physical activity. Type 2 diabetes progresses such that after several years of good glucose control with lifestyle changes, the blood glucose levels can rise, so additional medications are needed to maintain good glucose control.
The symptoms of type 2 diabetes may be similar to those of type 1 diabetes but are often less severe, and may develop more slowly. Symptoms may include frequent urination, excessive thirst and blurred vision. In some cases, type 2 diabetes may not be associated with any overt symptoms, and as a result, many people with type 2 diabetes remain unaware of their condition for a long time. However, during this time the body is already being damaged by excess blood glucose. As a result, many people already have evidence of complications such as eye disease when they are diagnosed with type 2 diabetes.
GESTATIONAL DIABETES (GDM)
Hyperglycaemia that is first detected at any time during pregnancy is classified as either: Gestational diabetes mellitus or diabetes mellitus in pregnancy. Pregnant women with slightly elevated blood glucose levels are classified as having gestational diabetes, whilst women with substantially elevated blood glucose levels are classified as having diabetes mellitus in pregnancy. GDM usually disappears after pregnancy, but women and the children that where affected stand an increased risk of developing Type 2 diabetes later in live.
Overt symptoms of hyperglycaemia during pregnancy are rare and difficult to distinguish from normal pregnancy symptoms but may include increased thirst and frequent urination. Women with hyperglycaemia detected during pregnancy are at greater risk of adverse pregnancy outcomes. These include very high blood pressure, pre-eclampsia (a syndrome of high blood pressure, fluid retention and urinary protein loss) and foetal macrosomia (a significantly larger than an average baby), which can make vaginal birth difficult and risky.
CARE, MANAGEMENT AND PREVENTION
The care, management and prevention of all the three (3) types of diabetes are similar, while Type 1 diabetes cannot be prevented it is important to note that diabetes risk factors can be managed. Poor management of diabetes can lead to damages in many organs of the body. High cholesterol, high blood pressure and obesity also increase diabetic’s risk of developing complications.
- Daily administration of insulin (Rapid, Short and Intermediate acting Insulin) for type 1 diabetes and seldom for type 2
- Oral medications
- Healthy Nutrition (healthy diet no smoking maintain healthy body weight)
- Physical Activity
PREVENTION is most important to you if you are at increased risk of diabetes-
- Know You Or Your Family’s Unique Risk:
– Is there a sign of overweight in the family?
– Have a family history of diabetes
– Are age 45 years and older
– Have high blood pressure
– Have high cholesterol
– Have had a heart disease
– Have had gestational diabetes
– Diagnosed with pre-diabetes (also known as impaired fasting glucose).
- Get Moving – More physical activity and exercise. Moderate physical activity on most days of the week helps manage weight, reduce blood glucose levels and may also improve blood pressure and cholesterol. The goal is to get at least 30 minutes per day weekly or at least 5 days a week. Increased physical activity helps lose weight, lower your blood sugar, boost your sensitivity to insulin — which helps keep your blood sugar within a normal range and may also improve blood pressure and cholesterol.
- Fix Your Diet. Here are some tips:
- Reduce your intake of foods that are high in calories, sugar and fat.
- Increase intake of foods high in fibre e.g. fruits, vegetables, beans, whole grains and nuts
- Replace sugary drinks and fruit juice water.
- Eat a variety of fruits and vegetables every day
- Eat plenty of whole grains
- Having healthy food at home helps you avoid eating out too much
- Fibre may help: reduce ones’ risk of diabetes by improving your blood sugar control; lower your risk of heart disease; promote weight loss by helping you feel full
- Manage Your Weight: lose extra weight especially around your abdomen. Weight loss, especially for people overweight, can improve your health and prevent diabetes.
- Limit Alcohol Intake: Too much alcohol can lead to weight gain and may increase your blood pressure and triglyceride levels. Men should have no more than two standard drinks a day and women should have no more than one.
- Quit Smoking!!! Smokers are twice as likely to develop diabetes as non-smokers.
- Control your blood pressure.
- See your doctor for regular check-ups
Following these simple steps helps diabetics reduce his or her risk factors of complications.
People with diabetes have an increased risk of developing a number of serious health problems. consistently, high blood glucose leads to serious disease affecting the heart, blood vessel, eye, teeth, kidney, nerves etc. maintaining blood glucose level, blood pressure and cholesterol at a close to normal can help delay or prevent diabetes complications. Major complications include;
Cardiovascular Disease: diabetes most time affects the heart and blood vessels and may cause fatal complications such as coronary artery diseases which lead to heart attack and stroke. This is the most common cause of death in people living with diabetes.
Kidney Disease (Diabetes Nephropathy): this is caused by the damage of small vessels in the kidney leading to the kidney becoming less efficient or to fail altogether. Kidney disease is much more common in people with diabetes than in those without diabetes.
Nerve Disease (Diabetes neuropathy): Diabetes can cause damage to the nerves throughout the body when the blood glucose level and blood pressure are too high. This can lead to a problem with digestion, erectile dysfunction etc. the most affected area is usually the feet. Damages in this area can lead to pain, tingling and loss of feeling. Noticing these (loss of feeling ) is very important because it can allow injuries to go unnoticed, leading to serious infections and possible amputation. However, these amputations can be prevented, but even when amputation takes place the persons life can be saved follow-up. It is advised that people with diabetes should regularly examine their feet
Eye Disease: (Diabetes Retinopathy): most people with diabetes will develop some form of eye disease causing reduced vision or blindness. This can be managed through regular eye checks and keeping blood glucose lipid level at or close to normal.
Pregnancy Complications: women with any type of diabetes during pregnancy risk a number of complications if they don’t carefully monitor or manage their condition. To avoid organ damage to the fetus women should achieve target glucose level before conception, this would aid minimize complications. An increased sugar level can lead to the fetus adding excess weight, this can lead to a problem in delivery. Children who are exposed to high blood glucose in the womb are at a greater risk of developing diabetes in the future.
Oral Complications: people with diabetes have an increased risk of developing inflammation of the gums if blood glucose is not managed. The regular oral checkup should be established to ensure early diagnoses, especially among people previously undiagnosed diabetes and prompt management of any oral complications in people with diabetes.
There is good news and this good news is that Type 2 diabetes can be reversed, and to achieve these, one needs a very high level of discipline and commitment. Recent study has shown that diabetes is not limited to the presence of excess sugar in the blood, but also a problem of FAT, (this does not necessarily imply physical fat –obesity; because there are persons with lesser Body Mass Index (BMI) as low as 18% but still suffers from diabetes) but this according to research is as a result of the presence of fat in the liver due to excess calories or high propensity of the body to store fat around the organ. This, therefore, makes the liver to poorly respond to insulin by producing too much glucose. As too much fat passes onto the pancreas, it causes the insulin-producing cell to fail.
Weight loss and physical activity have been attributed as a key factor in reducing liver fat. It is pertinent to note that loosing 1 gram of fat from the pancreas can restart normal insulin production and is able to reverse Type 2 diabetes. A 10-15 kg reduction of body weight can also reduce fat from the pancreas and liver, thus returning their normal function and normal production of insulin. This reversal can further be achieved by getting the blood glucose level below 6% or 42mmol/mol over a period of time without taking medications though on an improved diet and physical activity is needed. This process is also known as putting diabetes into remission.
RECOMMENDATION/ CALL TO ACTION
Life Transformation for Africa Initiative (LIFT4Africa) therefore calls on the Federal government of Nigeria, the government of Imo State, Civil Society Organizations (CSOs), philanthropist and international organizations to come together and contribute in alleviating the prevalence of diabetes in Nigeria and the world at large. Having said this, we request the;
- Access, Availability and Affordability of;
- Reduced cost of medicines and supplies
- Increased physical activities among individuals
- Develop equitable insurance scheme
- Public Education and Sensitization
- Improve education on existing health professionals on diabetes and other non-communicable diseases (NCDs)
- promote education for PLD and their caregivers
- implement awareness campaign on prevention of type 2 diabetes
- Type 2 Diabetes Prevention
- Strict implementation of a locally-adapted comprehensive lifestyle programme for people at risk
- Legislations on fiscal policies and other public measures to promote healthy diets.
- Availability of cost effective medication for type 2 diabetes prevention and a comprehensive lifestyle programme.
Stated above also reflects the needs and priority of people living with diabetes, but could be summarized as;
- Ensuring access and affordability of medicine and care
- Improve diabetes education for healthcare professionals and people living with diabetes
- Priorities type 2 diabetes prevention effort by raising awareness to;
- Identify individuals at risk
- Tackling the disease and having and how to avoid it
There is very poor data, statistics and record of people living with diabetes in Nigeria, this has made it difficult to properly ascertain the or near accurate number of those living with diabetes. Though with the available record, it is clear that there has been a significant increase in the prevalence of diabetes mellitus in Nigeria affecting all regions of the country with the highest prevalence noted in the South-South while the North-East has the lowest prevalence according to geopolitical zones in Nigeria. Urban dwelling, physical, advancing age, and unhealthy diet are an important risk factor for diabetes mellitus among Nigerians. However, it is important to know the actual prevalence of diabetes mellitus in Nigeria to facilitate a proper health resource allocation, advocacy and planning. Finally, it is sad to say that the major reason for the rising number is due to economic/financial constraint and poor attitude towards diagnosis or screening which is common among Nigerians.