Let’s talk about diabetes
By Dr Brighton Chireka
Every year World Diabetes Day on the 14th November brings diabetes to the attention of the world. On the 9th Spetember 2015 on ZimOnline Radio Thunderbolt with Mike Tashaya and crew, we discussed this important topic about diabetes mellitus. The show was interesting as we had some patients sharing their stories and also a pharmacist giving us a detailed view of the disease .
In view of the discussion that took place I have compiled another article on this important condition. We know diabetes is a huge problem for the whole world. We know that 382 million people have diabetes in the world and it is estimated that 592 million people will be living with diabetes in 2035. In Zimbabwe there were 600 thousand cases of diabetes in 2013 and it is estimated that about 450 thousand of adults have diabetes that is not diagnosed . In the UK there are 3.2 million people diagnosed with diabetes and an estimated 630 thousand people have the condition but do not know about it. You may be one of these people who are unaware that there have diabetes. I hope that by writing this article some of you will go and get diagnosed . This article is focusing mainly on making you get screened for diabetes and also encourage healthy living. It has deliberately left out the details of treatment which can be covered in detailed by your health care professional otherwise this article will be too long.
Diabetes is a common life long health condition where the amount of glucose (sugar) in your blood is too high because the body cannot use it properly. This is because your pancreas (gland behind stomach) does not produce any insulin , or not enough insulin to help glucose enter your body’s cells- or the insulin that is produced does not work properly ( known as insulin resistance)
Insulin is the hormone produced by the pancreas that allows glucose to enter the body cells ,where it is used as fuel for energy so we can work, play and generally live our lives . It is vital for life . Glucose comes from digesting carbohydrate and is also produced by the liver. If you have diabetes , your body cannot make proper use of this glucose so it builds up in the blood and cannot be used as fuel.
There are two main types of diabetes : type 1 diabetes and type 2 diabetes . Diabetes develops when glucose cannot enter the body’s cells to be used as fuel . This happens when there is no insulin to unlock the cells as in type 1 diabetes or there is not enough insulin or the insulin is there but not working properly as in type 2 diabetes.
In type 1 diabetes, the body’s immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body’s organs. Type 1 diabetes is often known as insulin-dependent diabetes and is also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during teenage years. Type 1 diabetes is less common than type 2 diabetes. About 10% of all people with diabetes have type 1 diabetes. If you are diagnosed with type 1 diabetes, you will need insulin injections for the rest of your life. You will also need to pay special attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced – for example, by eating a healthy diet and carrying out regular blood tests.
Type 2 diabetes is where the body does not produce enough insulin, or the body’s cells do not react to insulin. This is known as insulin resistance. Type 2 diabetes is far more common than type 1 diabetes. In the UK, around 90% of all adults with diabetes have type 2 diabetes. If you are diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet and monitoring your blood glucose level. However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets. Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it is more common in older people.
What are the symptoms of diabetes?
One can experience different signs and symptoms of diabetes, and sometimes there may be no signs. Many people have type 2 diabetes for years without realising it because early symptoms tend to be general. Some of the signs commonly experienced include: feeling very thirsty, very hungry and very tired, urinating frequently , particularly at night, weight loss and loss of muscle bulk, unexplained weight loss, tingling sensation or numbness in the hands or feet, frequent infections and slow-healing wounds, blurred vision, lack of interest and concentration and at times if it’s severe can have vomiting and stomach pain.
I have mentioned a lot of common symptoms which can be caused by other problems and my message to you is that please do not ignore these symptoms. See your health care professional who will assess you and advise accordingly.
What are your chances of getting diabetes mellitus?
The chances of getting type 1 diabetes are still being researched but having a family member with type 1 diabetes mellitus slightly increases the risk of developing the disease.
Several risk factors have been associated with type 2 diabetes and include: family history of diabetes, overweight, unhealthy diet , not exercising, increasing age as we get older, high blood pressure, certain ethinicity, history of diabetes in pregnancy called gestational diabetes and poor nutrition in pregnancy, all increases one’s chance of developing type 2 diabetes. Changes in diet ( to western diet ) and physical activity ( no longer walking , now using cars) related to rapid development and urbanisation have led to sharp increases in the number of people developing diabetes. Addressing these factors will reduce our chances of developing this disease. Go and see a health care professional if you have most of these risk factors as you may have diabetes.
There are tools that can be used to quickly identify people who may be at a higher risk of type 2 diabetes and who need their level of risk further investigated. A good example is the eight scored Finnish Type 2 diabetes Risk Assessment Form. It takes a couple of minutes to complete and can be done online . You do not necessarily need a doctor to complete it. The reverse of the form contains a brief advice on what you can do to lower your risk of developing the disease ,and whether you should seek advice or have a clinical examination by a health care professional. I will cover in general what you need to do to reduce your risk but if you need the form please feel free to click below
What can you do to reduce your chances of getting diabetes?
There is a lot of evidence that lifestyle changes such as achieving a healthy body weight and moderate physical activity can help to prevent the development of type 2 diabetes. The international diabetes federation recommends healthy living as part of the fight against diabetes and the World Diabetes Day theme for 2014-2016 is Healthy Living and Diabetes. The power is in your hands to fight this condition as research has shown that 30mins of exercise a day can reduce your risks of developing type 2 diabetes by 40%. This physical activity is one of the main pillars in the prevention of diabetes . By increasing physical activity one is able to maintain weight loss which can lead to reduced blood pressure, reduced resting pulse, increasing insulin sensitivity and improve body composition and psychological well-being
Obesity , particularly abdominal obesity , is linked to the development of type 2 diabetes. I know most of us take those big bellies to be a sign of wealthy and good living ( “zvirikufaya” syndrome ). I am sorry to disappoint you and tell you that the opposite is true ,it is a sign of poor health and can lead to diabetes .Losing those kilograms of weight improves insulin resistance and reduces high blood pressure hence reducing one’s chance of getting type 2 diabetes.
Smoking is not good for you as it increases the abdominal fat accumulation and insulin resistance. I encourage all smokers to quit smoking and I want you to bear in mind that you may gain weight during the process of quitting smoking. In view of this I suggest you also get dietary advice as well to avoid weight gain. Try to manage the cravings and withdrawal symptoms of smoking by using short bouts of physical activity as a stress- relief activity rather than eating snacks.
I wrote last time about depression and I encourage you to revisit the article if you feel stressed or depressed as there is evidence of a link between depression and both diabetes and stroke or heart attack.
Make sure that you are having enough sleep. Not sleeping enough such as sleeping for less than 6 hours and over sleeping such as sleeping for more than 9 hours may be associated with higher risk of developing type 2 diabetes.
What are the complications of diabetes?
If you do not do anything about your diabetes which will be a sad thing indeed then you will quickly develop complications These complications include how diabetes affects your eyes (retinopathy), heart (cardiovascular disease), kidneys (nephropathy), and nerves and feet (neuropathy). Here is a brief description of these 4 common complications of diabetes .
Damage to the heart and blood vessels is collectively known as cardiovascular disease and people with diabetes have a higher chance of developing it. The term cardiovascular disease (CVD) includes heart disease, stroke and all other diseases of the heart and circulation.
Diabetic retinopathy or ‘retinopathy’ is damage to the retina (the ‘seeing’ part at the back of the eye) and is a complication that can affect people with diabetes. Retinopathy is the most common cause of blindness among people of working age in the UK.
Kidney disease can happen to anyone but it is much more common in people with diabetes and people with high blood pressure. Kidney disease in diabetes develops very slowly, over many years. It is most common in people who have had the condition for over 20 years. About one in three people with diabetes might go on to develop kidney disease, although, as treatments improve, fewer people are affected.
Neuropathy is one of the long-term complications of diabetes which affects the nerves. Nerves carry messages between the brain and every part of our bodies, making it possible to see, hear, feel and move. Nerves also carry signals that we are not aware of to parts of the body such as the heart, causing it to beat, and the lungs, so we can breathe. So, damage to the nerves can cause problems in various parts of the body. Diabetes can cause neuropathy as a result of high blood glucose levels damaging the small blood vessels which supply the nerves. This prevents essential nutrients reaching the nerves. The nerve fibres are then damaged or disappear. Symptoms can include: tingling and numbness and loss of ability to feel pain which is dangerous as one can injure themselves without knowing and end up with ulcers in feet and in some cases it can lead to amputation of the toes or even the whole foot. Some of the symptoms include impotence (inability to keep an erection). Many men are shy to talk about this and I encourage you to discuss this with your healthcare professional.
What can you do to avoid neuropathy?
It is the same message that you need to keep your blood glucose (sugar) levels within your target range. You can achieve this by changing your lifestyle and if not enough then you may need tablets or insulin to control you blood sugar levels. Having your feet checked at least once a year is very important and telling your diabetes healthcare team if you think you’re developing any signs of neuropathy. If you think you’ve lost sensation in your feet, protect them from injury and check them every day. And talk to your diabetes healthcare team for more advice.
In conclusion may I make it clear that both type 1 and type 2 diabetes are serious and people must take action to deal with these two conditions. There is no such thing as mild diabetes . If people with type 2 diabetes are diagnosed early when they do not have complications , they can manage their condition through exercise and diet. However as the time goes by most people will require oral drugs or insulin. One need to make sure that their blood glucose level is maintained at or close to normal and also maintaining blood pressure and cholesterol at normal level does help to delay or prevent the complications of diabetes. I encourage everyone who is diabetic to make sure that they do have regular monitoring by their health care professional and for those who suspect they have diabetes to go and see their health care professional as well for diabetic screening.
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I hope that this article will make at least one person pause and reflect about their health and visit their health care professionals. Please feel free to share this article, comment or email me.
This article was compiled by Dr Brighton Chireka who is a GP in Folkestone Kent. You can contact him on firstname.lastname@example.org
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.