Diabetes is a disorder of glucose, protein and fatty acid metabolism in which there is a relative or absolute deficiency of insulin usually characterized by hyperglycemia.
It is often thought that food containing sugar and tasting sweet are the reasons why blood sugar is raised. Apparently all starch and carbohydrate food are broken down into simple sugars such as glucose and fructose which are detected in high levels when insulin is deficient.
The hormone insulin is vital in metabolism, uptake and storage of end products of digestion. It allows the body cells absorb glucose, fatty acids, amino acids and potassium. Any deficiency of insulin can affect the levels of these metabolites in the blood. Diabetes is a universal disease with a prevalence value >240million and rising. We all know someone who has it if we don’t have it and we are all responsible for its treatment and management. There are not enough doctors, let alone diabetologists, to manage it alone.
Diabetes is associated with risk factors such as lack of exercise, obesity, and excess intake of alcohol. Diagnosing this disease involves a combination of symptoms and laboratory investigation.
Symptoms include polyuria (excessive urination), polydipsia (excessive thirst), unexplained weight loss, visual blurring, genital thrush, lethargy etc.
Raised venous glucose is detected once Fasting Blood Sugar (FBS) value is >or equal to 7mmol/l or Random Blood Sugar value is >or equal to 11.1mmol/l. These values could be checked on two separate occasions and an oral glucose tolerance test (OGTT) 2h value >or equal to 11.1mmol/l, HbA1C of 6.7% (is it also confirmatory).
Diabetes can be of two major types
· Type 1 DM
· Type 2 DM
Type 1 Diabetes is usually of juvenile onset but can occur at any age. It is caused by insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells. It is associated with other autoimmune diseases. Concordance is 30 in identical twins indicating environmental influence.
Type 2 Diabetes (formerly non insulin dependent diabetes) appears to be prevalent at epidemic levels in many places, mainly due to changes in lifestyle but also better diagnosis and improved longevity. Occurs in adults older than 40 years. This is caused by decreased insulin secretion with or without increased insulin resistance. There is greater than or equal to 80 concordance in identical twins indicating stronger genetic influence than type 1 DM. It usually progresses from a phase of impaired glucose tolerance (>7.8mmol/l but less than 11.1 mmol/l OR impaired fasting glucose (>6.1 but <7mmol/l)
In Nigeria, Type 2 Diabetes is more prevalent. Preventing disease starts from getting to know certain risk factors and avoiding them. Non modifiable risk factors such as age and genetics (family history of DM) apparently help one to know how pressing and important it is to focus on the modifiable ones like stopping alcohol, avoid a sedentary lifestyle and avoid excessive calorie intake.
A simple 30 minutes exercise in the morning increases insulin sensitivity in the body cells thereby increasing absorption of glucose and then preventing high blood glucose. Apart from these, ensuring that one is active and not just sedentary also helps glucose absorption. WHO recommends an average man should take 10,000 steps in a day. Some people already have platforms or work that ensures they take these steps without knowing while some may have to register at the gymnasium to achieve that.
With the far East Asians, martial arts has been of great help.
High calorie food intake should be reduced especially in obese people who are trying to shed some weight. Other primary prevention includes avoiding overdose of antiretroviral, thiazides, antipsychotics and anti-tuberculosis drugs. Treat other predisposing factors to high blood glucose such as renal failure, obesity, polycystic ovary, Hyperthyroidism. Subscribing to Regular medical checkups is important for prevention, early discovery, treatment and management of any health condition.
Prevention they say is better than cure but I would also say prevention is as good as cure. Let us make sure we save ourselves from this silent killer disease called Diabetes and impact the world in good health.
Doctor Abimbola Olayemi
Senior Medical officer, Lagos, Nigeria.
Email: dazzlet93@yahoo.com.
