By Ojoma Akor
Beni Agama, 55, observed that he experienced increased thirst , frequent urination, unexplained weight loss, and fatigue for a long time before he went to the hospital, and was diagnosed of diabetes three years ago.
He said his late father suffered from diabetes too and that if he had gone for medical tests and treatment earlier, he wouldn’t be suffering from complications such as blurred vision and wound in his leg (diabetes foot) as he is suffering today.
He however, added that he has been trying to modify his lifestyle and take his medications regularly in order not to worsen his condition.
Aliyu Yakubu, 62 a retired civil servant said living with diabetes has not been easy for him.
“I struggle to raise money to buy my injections and medications. It has not been easy maintaining the meals recommended for me. There is need for intervention of government to ensure subsidized screening and treatment for diabetes,” he said.
The World Health Organisation (WHO) describes diabetes as a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.
According to a Professor of chemical pathology and metabolism, Prof. Jibril Mohmmed El-Bashir, diabetes is a group of metabolic diseases characterized by increased levels of glucose in the blood resulting from defects in insulin (a hormone that regulates the level of sugar in the blood) secretion, insulin action, or both.
Prof. El-Bashir, said that the types of diabetes are: Type 1 diabetes (Insulin-dependant diabetes), Type 2 diabetes (non-Insulin-dependant diabetes), gestational diabetes mellitus and diabetes mellitus associated with other conditions or syndrome.
He said clinical manifestations of diabetes include fatigue and weakness, sudden vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal and recurrent infections.
A diabetologist and consultant endocrinologist, Prof. Olufemi Fasanmade said over 55, 000 people are estimated to have lost their lives to diabetes in Nigeria last year.
Prof. Fasanmade who works with the College of Medicine and Lagos University Teaching Hospital, Idi-Araba, Lagos, said 48,375 deaths from diabetes were recorded in 2021, about 50,000 in 2022 and about 53, 000 in 2023.
He said four million people out of the 24 million people living with diabetes in Africa are in Nigeria, adding that the continent is projected to have the highest increase in the burden of diabetes in the next 20 years.
He explained that diabetes is a growing social problem worldwide , and that the healthcare expenditure from diabetes is about a $1 billion, “And this is like a 300% increase over the last 15 years,” he said.
The expert said that a study on diabetes prevalence in Nigeria revealed that the South-South geopolitical zone has the highest number of people living with diabetes .
He said, “The North-East zone came a distant second , followed by South West, and the North-West has the lowest prevalence.”
While saying that Type 2 Diabetes accounts for 90% of all diabetes cases, he said risk factors for Type 2 diabetes include family history, weight, unhealthy diet, physical inactivity, and age.
Risk factors
Prof. Fasanmade also said there were risk associated with taking unapproved or substandard medicines. He said they cause
uncontrolled blood sugar , emergency hospital admission, disease complication, adverse reactions and death.
He advised Nigerians to purchase diabetes medicines from only from Pharmaceutical Society of Nigeria ( PSN) approved suppliers, ensure the packs bear a NAFDAC Registration numbers, and report cases of suspected adverse events among others.
A consultant endocrinologist in Ilọrin, Dr Ayeni Olawale Charles, said diabetes used to be common among the elderly before, but that type 1, especially, has increased among the youth because of diet and environmental factors.
Prof. Jibril Mohmmed El-Bashir said physical inactivity and smoking are some of the factors that could increase one’s risk of diabetes.
He said emotional stress, diet, medication and genetic factors were some of the other factors that put people at risk of diabetes.
Explaining physical inactivity as a risk factor, Prof. El-Bashir said prolonged television watching is associated with a significantly increased risk of type 2 diabetes.
He said that men who watched TV more than 50 hours per week had a nearly threefold increase in the risk of type 2 diabetes compared with those who spent less than one hour per week watching TV.
He further said several dietary factors have been linked to an increased risk of diabetes, such as low vitamin D consumption; early exposure to cow’s milk or cow’s milk formula; or exposure to cereals before 4 months of age.
He said, “Consumption of red meat, processed meat, and sugar-sweetened beverages is associated with an increased risk of diabetes.”
On smoking, he said several large prospective studies have raised the possibility that cigarette smoking increases the risk of type 2 diabetes.
He said, “In a meta-analysis of 25 prospective cohort studies, current smokers had an increased risk of developing type 2 diabetes compared with nonsmokers.
“A definitive causal association has not been established, a relationship between cigarette smoking and diabetes mellitus is biologically possible based upon several observations.”
He said smoking increases the glucose concentration after an oral glucose challenge.
“Smoking may impair insulin sensitivity. Cigarette smoking has been linked to increased abdominal fat distribution and greater waist-to-hip ratio that may have an impact on glucose tolerance,” he added.
The expert said medications were also a risk factor for diabetes, adding that there are drugs known to antagonize the effects of insulin such as adrenal corticosteroids and oral contraceptives.
He also said that physiologic or emotional stress causes prolonged elevation of stress hormone levels which raises blood glucose levels, placing increased demands on the pancreas.
He added that genetic factors may play a part in the development of all types of diabetes, noting that autoimmune disease and viral infections may be risk factors in Type I diabetes mellitus.
“Exposure to cow milk and cereal before four months can increase diabetes in children, that is why breast milk is better. Some hypertensive drugs also increase concentrates of plasma glucose level concentration in the blood,” he added.
How to detect diabetes early
Medical experts have said it is important for people to check their blood sugar level regularly to detect diabetes early and also ensure that the blood glucose level of those who already have the disease is in a healthy range.
They said it is very important for people who have close relatives who suffer from diabetes to go to hospital to check their blood sugar. Which If not well controlled, may cause blindness, kidney failure, lower limb amputations and other conditions.
Dr Nura Umar Sanda, a physician said Type 2 diabetes is the most common type in Africa and usually starts from 40 years and above while Type 1 is very common in Europe and other climes and could start from childhood.
He said , “If any of your parents or sibling has diabetes, try and go to the hospital and check your blood sugar, if it is high measures will need to be taken as diabetes grows slowly and affects other organs.
“If it is detected early, you may just need diet, exercise and healthy lifestyle but if it is detected at a late stage, it then requires taking drugs and insulin injections every day. So people should try and go to the hospital to check their blood sugar. It is not expensive. It is just N500,” Dr Sanda said during an awareness walk and free screening exercise organised by the Diabetes Help and Enlightenment Organisation (DHEO) in collaboration with Nisa Premier Hospital .
Dr Hauwa Bala, another physician said diabetes could affect anyone in the family, and that family support is critical in preventing and managing the disease.
“Diabetes is a generic disorder which is chronic and almost like a life time illness. So support from the family members for whoever the patient is in the house is very important. It will help the patient get and adhere to his or her medications, make the food in the house more diabetic friendly, and make the patient and family live healthier and happier,” she advised.
The founder of Diabetes Help and Enlightenment Organisation (DHEO), Hajiya Aisha Bukar Ali, said people should not see diabetes as a death sentence once they are diagnosed with the disease because it could be managed with healthy lifestyles.
She said: “You can manage it through being mindful of what you eat, exercise and keeping to your medication as well as follow up with your doctor.”
Ways to manage diabetes
Prof. El-Bashir outlined ways to manage diabetes mellitus as: nutritional therapy, exercise, education monitoring and medications.
While noting that diabetes is highly prevalent, he said prevention, lifestyle changes and management of diabetes were important because of the complications of the disease such as diabetic retinopathy (an eye disease caused by the high blood sugar from diabetes), erectile issues and psychological issues.
Other complications, according to the expert, are heart-related issues, kidney failure, skin infections, psycho-sexual dysfunction, depression, poor quality of life, premature death and costs, among others.
Also, Prof Sunny Chinenye, a consultant endocrinologist at the University of Port-Harcourt Teaching Hospital, said there is a need for the integration of detection and management of diabetes at the primary healthcare level in the country, adding that tertiary health facilities are overwhelmed, with his hospital recording an average of 150 diabetes patients per week.
