Diabetes disease in The Gambia

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:

Prevention and treatment involve a healthy diet, physical exercise, not using tobacco and being a normal body weight. Blood pressure control and proper foot care are also important for people with the disease.

Type 1 diabetes must be managed with insulin injections. Type 2 diabetes may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby.

What is diabetes and high risk is this disease for the Gambian population?

I recently was talking about the diabetes disease, caused by high sugar level in human blood to a friend who is a qualified psychologist and he responded to me as we were talking about this disease, which is incurable disorder of the blood sugar in human.

In our conversation, he said I wonder why the word “sugar” is being used as the most romantic and meaningful in a loving relationship. How great will you feel if someone called you every day just to say “Hey sweetheart”. In Psychology to call someone sweetheart it means to remind you that you are missed, loved, and you are very special.

Also this impression used as sweet, sweaty for the most beautiful individual and most beautiful, expensive gifts and presents. “Why a high sugar level is being found in human blood as such harmful and become incurable disease in human biology?” And my explanation to him was as follow:

Diabetes disease in medical term is a disorder of metabolism - the way the body uses digested food for growth and energy. Most of the food people eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When people eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

What are the types of diabetes?

The three main types of diabetes are

• Type 1 diabetes

• Type 2 diabetes

• Gestational diabetes

Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection—the immune system—turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live for the rest of his or her life.

Symptoms of type 1 diabetes usually develop over a short period, although better cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic death.

Type 2 Diabetes

The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicity’s. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents, especially among African-American, Mexican-American, and Pacific Islander youth.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.

What is Gestational Diabetes?

Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes have a 40 to 60 percent chance of developing type 2 diabetes within 5 to 10 years. Maintaining a reasonable body weight and being physically active may help prevent development of type 2 diabetes.

How is diabetes diagnosed?

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and non-pregnant adults. The test is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

• A blood glucose level of higher after an 8-hour fast. This test is called the fasting blood glucose test.

• A random - taken at any time of day - blood glucose level of 200 mg/dL or higher, along with the presence of diabetes symptoms.

What are the scope and impact of diabetes?

Diabetes is widely recognised as one of the leading causes of death and disability in the world and also in The Gambia. In 2006, it was the seventh leading cause of death. However, diabetes is likely to be under reported as the underlying cause of death on death certificates.

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

Who gets diabetes?

Diabetes is not contagious. People cannot “catch” it from each other. However, certain factors can increase the risk of developing diabetes.

Type 1 diabetes occurs equally among males and females but is more common in whites than in nonwhites. Data from the World Health Organisation’s Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown.

Type 1 diabetes develops most often in children but can occur at any age.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African-Americans, American-Indians, some Asian-Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos. National survey data in 2007 indicate a range in the prevalence of diagnosed and undiagnosed diabetes in various populations ages 20 years or older:

How is diabetes managed?

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require one or more diabetes medicines - pills, insulin, and other inject able medicine - to control their blood glucose levels.

Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control - it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and the use of medications, if needed. By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by a person’s health care team and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low - a condition known as hypoglycaemia - a person can become nervous, shaky, and confused. Judgement can be impaired, and if blood glucose falls too low, fainting can occur.

What are the risk factors for heart disease and stroke in people with diabetes?

Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.

You can’t change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:

Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.

Having abnormal blood fat (cholesterol) levels.

LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries—the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.

Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.

HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

Where in The Gambia people can go for check up and get diagnosed?

Fortunately in most public and private health facilities, Hospitals, health centres throughout the country having facilities for diagnose, treatment and advice on diabetes, also getting information from “Diabetes Association in The Gambia”, E-mail( mail@diabetes) call Dr Azadeh health show on West Coast radio every Tuesday from 6-7 pm and text to 00220 7774469/3774469. email to azadehhassan@yahoo.co.uk

Author Dr Azadeh Senior Lecturer at the University of The Gambia, Senior Consultant Physician and Senior Consultant in Obstetrics & Gynaecology