19th November, 2012
By Billy Bakare
Diabetes Mellitus occurs throughout the world, but it is more common in more developed countries .However, it has been predicted that the greatest increase in prevalence is expected to occur in Asia and Africa due to the trend of urbanization and lifestyle changes, mostly the adoption of ‘western style ‘diet.
Global statistical data has shown that as at the year 2010, an estimated 285 million people had Diabetes Mellitus and it has been predicted to almost double this figure by the year 2030. In Africa, 14.7 million adults are estimated to have the disease in 2011, with a regional prevalence of 3.8% and with Nigeria having the largest number of people living with diabetes in Africa with an estimated burden of about 1.7 million, the number that is expected to increase to 4.8 million by the year 2030.
Diabetes Mellitus is a life-long disease marked by elevated levels of sugar in the blood either because the body does not produce enough insulin or because cells do not respond to the insulin that is produced. Insulin is the principal hormone that regulates uptake of Glucose from the blood into most cells. It is released into the blood stream by beta cells found in the Islet of Langerhans in the pancreas in response to rising levels of blood glucose, typically after eating.
Therefore, if the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin or if the insulin itself is defective, then glucose will not be absorbed properly by those body cells that require it nor will it be stored appropriately in the liver and muscles. The resultant effect is persistent high levels of blood glucose, poor protein synthesis and other metabolic derangements.
Diabetes is a Latin word which in turn comes from ancient Greek, literally meaning a passer through or siphon. While the word Mellitus comes from classical Latin word meaning sweetened with honey or honey sweet. Therefore, .Diabetes Mellitus is the passage of glucose that are not absorbed by the body into urine and blood. It is divided into 3 main types namely- Types 1 , 2 and 3.
Type 1 results from the failure of the body to produce insulin formally known as Insulin Dependent Diabetes Mellitus [ IDDM] or Juvenile diabetes. This type affects mostly children. It requires that the sufferer inject insulin. It is partly inherited and then triggered by certain viral infections. Type 2, on the other hand, occurs as a result of the failure of the body cells to properly utilize insulin, sometimes combined with an absolute insulin deficiency. It can also be referred to as Non Insulin Dependent Diabetes Mellitus [NIDDM] or adult onset diabetes. This type is due primarily to lifestyle factors and sometimes could be genetic.
Other causes of diabetes include genetic defects of beta cell function, genetic defects of insulin processing or insulin action and exocrine pancreatic defects. Type 3 also known as Gestational Diabetes occurs only during pregnancy, where a non diabetic woman suddenly develops high blood glucose level.
Other forms of diabetes mellitus include congenital diabetes which is due to genetic defect of insulin secretion , cystic fibrosis related diabetes, steroid diabetes induced by high doses of glucocorticoids.
Types 1 and 2 are chronic conditions that cannot be completely cured but have been treatable and controlled with injection of insulin and drugs. Pancreas transplants have been tried with limited success in type 1, gastric bypass surgery has been successful in many with morbid obesity and type 2 diabetes. Gestational Diabetes Mellitus usually resolves after delivery.
Signs and symptoms of diabetes include, loss of weight, frequent urination[polyuria],increased thirst[polydipsia], increased hunger[polyphagia] , blurred vision, skin rashes among others. These symptoms may develop in weeks or months in type 1 diabetes, but may manifest slowly or be completely absent in type 2.
Blood testing for fasting blood glucose and urine test are the commonest laboratory tests usually carried out in the detection of diabetes. These tests are done mostly in the morning before the patient eats anything.
Without proper treatment, many complications may arise from the disease. These may be acute or long term. The former include hypoglycemia [ low blood sugar level], damage to blood vessels around the eyes and legs, blockage of blood supply to vital organs like the heart and the kidneys.
These invariably lead to devastating long term complications like ischemic heart diseases [ angina pectoris and myocardial infarction] and stroke. It damages the blood capillaries resulting in diabetes retinopathy affecting blood vessels around the eyes leading to reduced vision and potentially blindness .It also leads to scarring of kidney tissues, resulting in loss of protein in the urine and eventually chronic kidney disease requiring dialysis.
Together with vascular disease in the leg, diabetics have the risk of getting diabetes foot ulcers, which are difficult to treat, leading to gangrene, occasionally requiring amputation. It also affects the nervous system causing numbness, tingling and pain in the feet.
Various measures can be employed in the control of this disease in addition to insulin and medications. These are, maintenance of a healthy body weight, adding beans and other legumes like peas and lentils which are rich in protein, fibre ,vitamins and minerals to diets. These appear to help people with type 2 diabetes improve their blood sugar control through binding of cholesterol, keeping it from being absorbed in the guts and lowering the risk of heart disease. Regular exercises are also very essential to prevent obesity.
Also tobacco and alcohol consumption should be avoided, eating of fruits and vegetables and losing of excess weight if obese should be encouraged.
Among major stakeholders across the world, it is important that emphasis is placed on preventing the prevalence of the disease through sensitization of the public because majority of the people affected are not aware. This usually leads to people being brought into hospitals with diabetes coma or stroke. All tiers of governments, the organized private sector and other stakeholders must jointly fashion out ways to subsidize the cost of insulin, provide places for screening and treatment in addition to training the health workers who will administer these drugs.
Additionally, the Primary Health Centres should also be strengthened to screen people and to offer advices where necessary. Similarly, the Federal Government must expedite action on its proposed plan to begin free treatment of children with the ailment. Also, recreational facilities should be provided for patients while employers should organize annual health screening for their employees as it is being practiced by the Lagos State Government where workers are being urged to go for free medical check- ups on their birthdays.
Finally, to ensure that the rate of occurrence of this disease is drastically reduced in the country, all hands must be on deck to check the threat it poses to the well being of our people. The time to do it is now!
•Bakare is of the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja