A professor of medicine at the College of Medicine, University of Nigeria Nsukka and Consultant Physician and Endocrinologist at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Professor Christian Okafor, speaks with LARA ADEJORO on how a poor man can manage diabetes
What is diabetes?
Diabetes is a metabolic disorder, particularly bordering on carbohydrates, protein, and fats in the body which result in a rise in the blood sugar of people having that disease condition. This is a result of the inability of the body to effectively process carbohydrate loads as a result of the shortage of a hormone called insulin or when the insulin is relatively available, the body may not be so sensitive to it.
What are the causes of diabetes?
The cause is basically when the hormone called insulin, which is produced by an organ in the abdomen known as the pancreas, is drastically reduced. That hormone makes the sugar not rise too high and too low. So, when there is a deficiency in the production of that hormone, the blood sugar will begin to rise and this is commonly what you see in children when they develop diabetes, as a result of damage to this organ called the pancreas.
In adults, you can still have insulin in fairly good amounts but the body resists the insulin, so, it is called insulin resistant. It is common in adults, especially in people who are fat or obese.
Outside these, diabetes can also arise from other mechanisms but generally, some of the risk factors of diabetes can be modified and some cannot be modified, like your race, gender, and age. But there are quite a lot of other ones that can be modified, which are being physically inactive, people who accumulate excess fat as a result of physical inactivity or eating junk foods, 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 of the symptoms can be obvious while some may mask themselves. The obvious ones are frequent passage of urine and which is characterised by the amount of urine made is much, this will differentiate it from someone having an infection of the urinary tract; that on its own makes the person drinks excessively. Sometimes, it may be accompanied by eating excessively. Depending on the environment, the person might find out that after urinating, you might discover that ants are coming to the place the person urinated because those ants are attracted by the excess sugar in that urine. Some people may not have these classical symptoms, some people may be found to have diabetes by ‘accident’, for example, people who are asked to go for medical tests and found out that they have diabetes. There are some other people whom the complications of diabetes might be the first things they will present with and it is in the course of investigating what brought that problem that they will discover that they have diabetes.
What are the complications associated with diabetes?
Diabetes can cause a lot of complications. Some complications may arise as a result of low sugar; this is commonly found in people who have diabetes and are on medications. Sometimes, the blood sugar can go low, much more than the body requires. Also, you have complications that arise when the blood sugar is too high, some of them on a short-term basis, while others on a long-term basis. The ones that occur on a long time basis, when the body has been exposed to high blood sugar for a long time, could be classified further into those that affect the small blood vessels and those that affect the larger blood vessels. Those that affect the small blood vessels, known as diabetic microangiopathy, include those that affect the eye, known as diabetic retinopathy; kidneys, known as diabetic nephropathy, and those which affect the nerves, diabetic neuropathy. These affect the smaller vessels, so they are called microvascular complications.
The ones that affect the larger vessels could affect organs like the brain, where it can cause stroke, it can affect the heart where it can cause myocardial infarction, it can affect the large vessels in the legs, known as peripheral artery disease, so, in such people, there is a loss of blood flow to the leg that will become gangrenous.
Then, aside from the long-term complications, when the blood sugar is high, it can affect the immune systems whereby the people living with diabetes are exposed to frequent infections. It can affect any of the organs in the body – the chest, the urinary tract, etc. It can also make them have boil and vaginal discharges in women.
What are the statistics on diabetes in Nigeria?
We have some data but I’ll refer to the one done by one of us here. In the research findings, we are meant to know that about 5.7 per cent of Nigerians are living with diabetes. That is about 10 million Nigerians living with diabetes. According to that report, the lowest number of people living with diabetes was found in the North-East zone and the highest was found in the South-South zone and that has to do relatively with lifestyle. Apart from that, some people have diabetes but are not diagnosed. This usually constitutes about 50 per cent of the population. We also have other people with abnormalities in sugar handling and these figures are the ones that will make meaning to us.
We also need to know that there are stages people pass through before they develop diabetes and a lot of people fall into this category. However, these figures may differ from that that were put forward last year by the International Diabetes Federation. Theirs was kind of extrapolated, so this research carried out by Prof Uloko in Nigeria gives us accurate data.
Can you throw more light on why the South-South is leading with the figure?
Primarily, there are some practices they used to adopt in those days especially for women when they want to get married. It’s simply about restricting them to restricted places so that they will appear impressive and attractive, maybe to their suitors but generally, exposure to wealth is a major contributor 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. So, people tend to become inactive and exposed to unhealthy and calorie-laden foods and eventually have high obesity rates.
What is the prevalence of leg amputation among diabetes patients?
Diabetic foot diseases are quite common in Nigerians and even globally. In diabetic neuropathy, which is when the sugar damages the nerves such that people lose sensation in those legs, and on account of that, they can develop injury without knowing. That complication affects about 95 per cent of people with diabetes. So, a lot of people are affected by diabetic foot injuries. Eye problem is also common. The cut-off value used to define who has diabetes was derived from people who had some changes in the inner part of their eye called the retinal. Diabetic eye diseases like glaucoma and cataract are common in people living with diabetes. It is recommended that they should get an annual check on their eyes.
How can diabetes be effectively managed?
The management of diabetes is broad. First of all, the best management is to prevent it and it means we need to check our risk exposures. Some of the risk factors can be modified. Since we know that most of those risk factors border on the way we live, and our lifestyles. If people can live in a way that they don’t develop those risk factors, it will go a long way to minimise developing the condition. Eating properly and physical activity can help to mitigate the number of people developing diabetes and reduce the consumption of high dense calorie foods.
If one has developed diabetes, they will also need to be guided by healthcare professionals which will involve endocrinologists to aid them with necessary medications that will help them to bring the blood sugar under control. It is important to note that we don’t cure diabetes but we can control it. So, abiding by all the guides will help the patients to achieve good blood glucose control and will also reduce their chances of developing diabetes complications. When diabetes complications are involved, the number of specialists required to manage those patients will increase.
With the high cost of medications, how can a poor man manage diabetes?
As far as Nigeria is concerned, most Nigerians are living below the poverty line and the best advice is to follow the instructions said earlier to prevent the development of diabetes because it is costly to manage. But if they have developed diabetes, they can still be helped by healthcare specialists. When it comes to medications, there are different types of medications and the costs vary, so it is the responsibility of the healthcare providers to help them to be able to access drugs they can afford. Also, it is a family disease in the sense that it is one individual that is affected, the financial burden is on the family members and it can affect the quality of lives of the family. For the poor, the best approach is to do everything possible to ensure that they don’t develop diabetes but when it happens, it is advised that they eat appropriately, the natural foods we have, and access some medications. There are some medications that people on the lower cadre of the social economic class can afford.
The truth remains that funding diabetes management from the pocket is heavy and for us to be able to navigate that, people living with diabetes will need assistance from the government and the pharmaceutical industry.