DIABETES mellitus simply called diabetes or just sugar in street lingo is a metabolic disorder characterised by persistently elevated blood sugar levels. The control of blood sugar levels is mainly by the hormone insulin released by the pancreas an organ found in the abdomen.
So when the blood sugar levels are high, the pancreas releases more insulin which in turn will push the sugar out of the blood stream into the tissues. So for someone to develop diabetes mellitus there’s either low insulin production or poor uptake of the sugar by the tissues or both.
Diabetes affects at least 8.8 percent of the global adult population and causes 4.2million deaths per year according to the 2019 statistics. It is the seventh leading cause of death globally. Individuals who suffer from diabetes have a double chance of early death compared to those who don’t.
There are mainly two types of diabetes. Type 1 used to be called insulin dependent or early onset diabetes due to the fact that it mainly affected children or adolescents and needed insulin injections from the onset. Type 2 diabetes used to be called non insulin dependent or late onset due to the fact that it normally develops in adulthood and doesn’t require insulin at first.
But the nomenclature changed to only Type 1 and Type 2 due to the fact that even those with Type 2 will eventually need to be on insulin injections. The third type is called gestational diabetes mellitus as it only affects pregnant women. And normally after delivery the blood sugar levels come back to normal.
Type 1 normally affects slim, young individuals and the cause is genetic. The pancreas fails to secret enough insulin and therefore the mode of treatment is insulin therapy from the onset. Type 2 typically affect middle-aged to elderly people who are obese and do not exercise. In Type 2 the pancreas releases enough insulin but the tissues’ uptake of the blood sugar is limited so treatment is firstly with oral hypoglycaemic agents that is tablets to lower blood sugar levels.
The signs and symptoms of diabetes also depend on the type. Type 1 patients mainly present with an episode of having collapsed and in a diabetic coma. Type 2 mainly present with a history of polyuria (passing plenty of urine), polydipsia (drinking plenty of water) and polyphagia (eating plenty of food). Other symptoms of diabetes could be blurred vision , tingling sensation in the hands and feet, poor wound healing and lethargy. If you have any of the above symptoms please go and get checked for diabetes mellitus.
To make a diagnosis of diabetes mellitus we just need to check the blood sugar levels. If the blood sugar levels are high then we can make a diagnosis of diabetes. Normal blood sugar levels range from 3,3 to 11.1mmol/L. So anything greater than 11,1 means there is a problem with blood sugar control. The normal levels will also depend on whether one has eaten or if one is fasting. The blood sugar test can be done by a health professional using a simple machine called the glucometer. To authenticate the results we normally need a fasting blood sample to be sent to the laboratory first.
The treatment of diabetes will depend on the type. Type 1 diabetes treatment normally would require admission at first as they present in a coma most of the time. They will need plenty of intravenous fluids and definitely insulin injections from the onset. Type 2 diabetic patient highly unlikely need admission on presentation because they normally present walking. They normally respond well to oral hypoglycaemic agents like metformin. But their treatment also entails lifestyle changes like cutting on fatty foods, stopping any refined sugar intake, taking plenty of fruits and vegetables, drinking plenty of water and exercising regularly.
We say a diabetic patient should not take any soft drinks or juices even if they are labelled diet or diabetic or sugar free or anything of that nature. The only drink for a diabetic is water. Anything with refined sugars like cakes, chocolates, etc, is a no, no. Fast foods and take aways are also prohibited. Diabetes patients should eat small frequent meals. This means in a day a diabetic patient should eat up to 5 meals that are spaced by say 2 to 3 hours. But the meals have to be small. When it comes to sadza we prefer mugayiwa, sadza rezviyo or remhunga to refined sadza. And the maximum amount of sadza should be the size of your fist. You should eat boiled foods not fried foods.
We say a diabetic especially type 2 should exercise more frequently. Ideally they should exercise 30minutes daily. And the exercises should be aerobic or cardiac exercises that burn fat and not strain the heart.
Diabetes is a lifestyle not a mere condition. Taking medication or injections only without living the lifestyle of a diabetic patient is not enough. Every diabetic patient should have a diabetes bracelet either on their wrist or ankle. This serves to draw urgent specific attention in the event one collapses even in the streets. A diabetic patient should always have some sweets or glucose or just sugar in their pockets or handbag. At times the blood sugar can go below normal and you need to just take something sweet to get back to normal.
The signs of hypoglycemia (low blood sugar) include irritability, sweaty palms, blurring of vision and ultimately collapsing. So if you are diabetic and you start feeling any of these please quickly take something sweet. Every diabetic patient should have their own glucometer at home to check their own blood sugar levels from home. No diabetic patient should smoke cigarettes.
Diabetes affects individuals from head to toe. There is no organ that is spared by the purge of diabetes. In the head it can give you strokes. You can get blind from diabetes. Taste sensation can be lost due to diabetes. In the chest it can give you coronary artery disease and heart disease. In the cardiovascular system it can also cause high blood pressure. In the abdomen it can affect your kidneys and give you renal failure. Peripherally it can cause gangrene that will eventually lead to amputations. The complications of diabetes are vast and unlimited. But the good thing is if well managed none of these complications will come to you.
Remember a healthy you a healthy me to a healthy world. By Josephat Chiripanyanga
Josephat Chiripanyanga is a Harare medical doctor and can be contacted as firstname.lastname@example.org