By Grace Atieno Jalang’o
Diabetes Mellitus is a chronic disorder affecting over 380 million people worldwide.
In Kenya it is estimated that over 1.2 million live with diabetes and a similar number are living with it but not yet diagnosed.
Diabetes results from your body being unable to handle blood glucose levels. It may be a result of a total or relative insulin lack due to a variety of factors.
Total insulin lack leads to type 1 diabetes, while relative insulin lack leads to type 2 diabetes. When you have diabetes, your body is unable to effectively take up and use the nutrients in your blood stream.
The glucose therefore accumulates in blood and you get high blood sugar levels. The underlying cause of both type 1 and 2 is genetic and hereditary respectively, however environmental factors come into play to trigger off the process.
If you have type 1 diabetes you will require insulin therapy for life. Type 2 diabetes is a progressive condition and management will depend on the stage at which you are diagnosed, this may range from healthy eating and exercise to oral medication, insulin, surgery and even other injectable therapies.
Prediabetes is considered a transitory stage as one begins to manifest with diabetes. When you have pre-diabetes, your body loses the ability to respond to rapid glucose rises such as when you take in simple e.g. soda, sweets.
It is often referred to as glucose intolerance. 40-60 per cent of persons with pre- diabetes will end up having type 2 diabetes. It is managed by instituting life style changes such as healthy eating, reducing simple sugar intake and regular physical activity. In a few cases, medication may also be prescribed.
Diabetes mellitus type 2 is associated with lifestyle. The main defect in type 2 is insulin resistance. This is genetically determined, however when you are overweight, obese or inactive (sedentary) then diabetes can then be expressed.
Other risk factors include factors such as stress, alcohol abuse, smoking, drug abuse, prolonged use of steroids Diabetes type 2 is preventable; this is possible by lifestyle modification.
If you have any of the risk factors, then addressing them will reduce the risk of you getting diabetes The disease is a complex condition and requires good effort in management, good care results in good outcomes.
It is managed by ensuring the client is well educated (diabetes education) and by life style modification focussing on healthy eating, avoiding alcohol, tobacco, regular physical activity and psychosocial support.
Oral medication and or insulin/ other injectables may also be necessary depending on type of diabetes. If the person can afford they should be advised to buy a blood glucose meter to self- monitoring of blood glucose.
The person with diabetes should be well equipped to ensure they are able to execute care. Depression must be assessed for and managed. Diabetes can present with acute or chronic complications. Acute complications often occur suddenly and are not related to duration of diabetes.
They result from extremes in blood glucose levels. On the one hand, Low blood sugar leads to a state of hypoglycaemia and if not treated promptly by simple sugars, can lead to coma and death. On the other hand, high blood sugar leads to diabetes ketoacidosis or non ketotic hyperglycaemic states, both are life threatening.
These complications are life threatening, however they can be avoided by good diabetes education and instituting appropriate care. It is important that if you have diabetes, you attain recommended care goals.
These include maintaining blood glucose range of 4 to 10 mmols, HbA1C (glycosylated haemoglobin) levels below 7 per cent, and blood pressure levels blow 130/80 mmHg. You also need to do a yearly risk assessment to check your overall control, and assess lipid levels, do a complete blood count, retinal examination, kidney and liver function tests, dental check-up, assessing heart function.
Jalang’o is a Clinical Officer, Diabetes and Public Health Specialist Lecturer School of Medicine and Health Sciences Kabarak University and National Secretary Diabetes Kenya Just like a storm, chronic diabetes complications cast a shadow before manifest: if they are detected early before they are advanced, a lot more can be done to manage them, maintain quality of life and prevent premature death.
Diabetes care has evolved over the years to more novel approaches, from insulin syringes and needles to insulin pens, insulin pumps and even new therapeutic molecules. However, the outcome for many people has not changed and a good number end up with debilitating conditions.
It is a chronic disorder and can be depressing. This is critical as the main care giver is the person with diabetes: if you are depressed, you cannot effectively execute self-care. What you know or don’t know, and what you do or do not do is eventually what carries the day. 1,300 children under the age of 18 years have diabetes Diabetes care is about empowering the patient to make informed decisions and make the most of limited resources.
However, most health care settings are skewed to the acute care model and do not embrace a patient centred chronic care model. This poses great challenges to achieving optimal outcomes, increasing the human and economic costs of care. Secondly, in as much as the world has made great progress in technologies for care: they are costly; a lot is still to be desired as most of these advances are still out of the reach to many people who live with diabetes.
Nutrition is the mainstay of diabetes therapy. If you have diabetes, you need to adopt a healthy eating plan. The so called diabetic diet is a medical myth. If you have diabetes, ensure that you seek assistance from a nutritionist to enable you to adopt healthy meal planning.
This enables you choose a balanced diet consisting of all food groups in the right proportions. It also ensures you are not restricted but rather eat in moderation, a variety of foods in each food group.
It is not about eating less but rather eating right. Potentially every Kenyan is at risk of developing diabetes Mellitus, it is therefore important that we are well informed of the risk factors and make effort towards meaningful lifestyle changes.
The human and economic costs of diabetes can cripple our economy. If no action is taken today, we are faced with a grim future, because with the current trend, the incidence of diabetes in Kenya may double in the next decade. However all is not lost, forewarned is forearmed; it begins with you and me, the desire for health and a healthy nation.