Professor of Medicine at the University of Nigeria Nsukka College of Medicine and Consultant Physician and Endocrinologist at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Professor Christian Okafor talks with LARA ADEJORO on the how a poor man can manage diabetes
What is diabetes ?
Diabetes is a metabolic disorder, particularly affecting carbohydrates, proteins and fats in the body, which leads to an increase in blood sugar levels in people with this disease. This is the result of the body’s inability to process carbohydrate loads effectively due to shortage of a hormone called insulin or when insulin is relatively available, the body may not be as sensitive to it.
What causes diabetes?
The cause is basically when the hormone called insulin, which is produced by an organ in the abdomen known as the pancreas, is significantly reduced. This hormone causes the sugar to rise neither too high nor too low. So, when there is a deficiency in the production of this hormone, blood sugar begins to rise and this is usually what is seen in children when they develop diabetes, as a result of damage to this organ. called the pancreas.
In adults, you can still have enough insulin, but the body resists insulin, which is why it is called insulin resistant. It is common in adults, especially in fat or obese people.
Apart from these, diabetes can also arise from other mechanisms, but generally, some of the risk factors for diabetes can be changed and some cannot be changed, such as your race, gender, and age. But there are many others that can be changed, which are physical inactivity, people who accumulate excess fat due to physical inactivity or junk food consumption, people who develop hypertension, people who develop abnormal cholesterol, smoking and having a positive family history of diabetes.
What are the symptoms of diabetes?
Some symptoms may be obvious while others may be hidden. The most obvious are passing urine frequently and are characterized by the amount of urine produced, which will differentiate it from someone with a urinary tract infection; which alone causes the person to drink excessively. Sometimes this can be accompanied by overeating. Depending on the environment, the person may find that after urinating, you might find ants coming to where the person urinated because those ants are attracted to the excess sugar in that urine. Some people may not have these classic symptoms, some people may get diabetes by ‘accident’, for example, people who are asked to take medical tests and find out they have diabetes. There are other people whose diabetes complications might be the first things they will present and it is during the investigation of the cause of this problem that they will discover that they have diabetes.
What are the complications associated with diabetes?
Diabetes can lead to many complications. Some complications can occur due to low sugar; this is commonly found in people with diabetes who are taking medication. Sometimes blood sugar can drop, much more than the body needs. Additionally, you have complications that occur when blood sugar levels are too high, some of them short-term, while others are long-term. Those that occur over a long period, when the body has been exposed to high blood sugar for a long time, could be classified into those that affect small blood vessels and those that affect large blood vessels. Those that affect small blood vessels, known as diabetic microangiopathy, include those that affect the eye, known as diabetic retinopathy; the kidneys, called diabetic nephropathy, and those that affect the nerves, diabetic neuropathy. These affect small vessels, so they are called microvascular complications.
Those that affect the large vessels can affect organs like the brain, where they can cause stroke, they can affect the heart where they can cause myocardial infarction, they can affect the large vessels of the legs, known as peripheral arterial disease, so in these people there is a loss of blood flow to the leg which will become gangrenous.
Then, in addition to long-term complications, when blood sugar levels are high, it can affect the immune system, which puts people with diabetes at risk of frequent infections. It can affect any of the organs of the body – chest, urinary tract, etc. It can also cause boils and vaginal discharge in women.
What are the statistics on diabetes in Nigeria?
We have some data, but I will refer to that made by one of us here. From the research results, we are supposed to know that about 5.7% of Nigerians are living with diabetes. This represents approximately 10 million Nigerians living with diabetes. According to this report, the lowest number of people with diabetes was found in the Northeast zone and the highest in the South-South zone, which is relatively related to lifestyle. Apart from this, some people have diabetes but are not diagnosed. This is usually around 50% of the population. We also have other people with sugar handling abnormalities and these numbers are the ones that will make sense to us.
We also need to know that there are stages people go through before developing diabetes and many people fall into this category. However, these figures may differ from those put forward last year by the International Diabetes Federation. Theirs was sort of extrapolated, so this research conducted by Professor Uloko in Nigeria gives us accurate data.
Can you shed more light on why South-South is leading the number?
Mainly, there are certain practices that they used to adopt at that time, especially for women when they wanted to get married. It’s just to restrict them to restricted places so that they look impressive and attractive, maybe to their suitors, but in general, exposure to wealth is a major factor that makes them have a high rate of ‘obesity. The South-South is the oil producing region of the country and they are quite exposed to more wealth compared to other regions. Thus, people tend to become inactive and exposed to unhealthy, high calorie foods and end up having high rates of obesity.
What is the prevalence of leg amputation in diabetic patients?
Diabetic foot diseases are quite common among Nigerians and even across the world. In diabetic neuropathy, which is when sugar damages the nerves in such a way that people lose feeling in those legs, and because of that, they can develop injuries without knowing it. This complication affects about 95% of people with diabetes. Thus, many people are affected by diabetic foot injuries. Eye problems are also common. The threshold value used to define who has diabetes comes from people who have experienced changes in the inner part of their eye called the retina. Diabetic eye diseases such as glaucoma and cataracts are common in people with diabetes. It is recommended that they have their eyes checked annually.
How to effectively manage diabetes?
Diabetes care is broad. First of all, the best management is to prevent it and this means that we must check our risk exposures. Some of the risk factors can be changed. Since we know that most of these risk factors are related to our lifestyle and lifestyles. If people can live in such a way that they do not develop these risk factors, it will go a long way to minimizing the development of the disease. Eating right and being physically active can help lessen the number of people who develop diabetes and reduce the consumption of high-calorie foods.
If a person has developed diabetes, he will also need to be guided by medical professionals who will involve endocrinologists to help him with the necessary medications that will help him control blood sugar. It is important to note that we do not cure diabetes, but we can control it. Thus, following all the guides will help patients achieve good blood sugar control and also reduce their risk of developing diabetes complications. When diabetes complications are involved, the number of specialists needed to manage these patients will increase.
With the high cost of drugs, how can a poor man manage his diabetes?
When it comes to Nigeria, most Nigerians live below the poverty line and the best advice is to follow the guidelines stated earlier to prevent the development of diabetes as it is costly to manage. But if they have developed diabetes, they can still be helped by health specialists. When it comes to medications, there are different types of medications and the costs vary, so it is the responsibility of health care providers to help them access the medications they can afford. Moreover, it is a family disease in the sense that it is an individual who is affected, the financial burden falls on family members and it can affect the quality of life of the family. For the poor, the best approach is to do everything possible to ensure that they do not develop diabetes, but when this happens it is advisable to eat properly, the natural foods we have and have access to certain drugs. There are certain drugs that people in the lower categories of social and economic class can afford.
The truth remains that out-of-pocket diabetes management funding is heavy and in order for us to cope, people with diabetes will need help from the government and the pharmaceutical industry.