What
do we know about increasing Diabetes disease in The Gambia
World
Diabetes Day falls every year on 14 November and is a day when millions of
people around the world come together to raise awareness of diabetes, and what
it’s really like to live with the condition. It’s a global campaign led by the
International Diabetes Federation (IDF) with activity taking place around the
world. This year we want everyone to know diabetes. So we’re talking about the
complications diabetes can lead to and how to avoid them.
Understanding
how serious diabetes is means knowing that in the Gambia it leads to a number
of young and early deaths every single day. That diabetes causes blindness and
kidney disease. That every week there are many cases of heart failure, strokes
and lower limb amputations caused by diabetes.
World
Diabetes Day is the primary global awareness campaign focusing on diabetes
mellitus and is held on November 14 each year.
World Diabetes Day focuses on a theme related
to diabetes. Topics covered have
included diabetes and human rights, diabetes and lifestyle, diabetes and
obesity, diabetes in the disadvantaged and the vulnerable, and diabetes in
children and adolescents. While the campaigns last the whole year, the day
itself marks the birthday of Frederick Banting who, along with Charles Best and
John James Rickard Macleod, first conceived the idea which led to the discovery
of insulin 1922.
History
World
Diabetes Day was launched in 1991 by the IDF and the World Health Organization
(WHO) in response to the rapid rise of diabetes around the world.
By 2016, World Diabetes Day was being
celebrated by over 230 IDF member associations in more than 160 countries and
territories, as well as by other organizations, companies, healthcare
professionals, politicians, celebrities, and people living with diabetes and
their families. Activities include diabetes screening programmers, radio and
television campaigns.
What
is diabetes and high risk is this disease for the Gambian population?
I
recently was talking about the diabetes disease which 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.
Prevention
and treatment often involve a healthy diet, physical exercise, not using
tobacco, and being a normal body weight. 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 and some oral
medications can cause low blood sugar, which can be dangerous. Gastric bypass
surgery has been successful in many with severe obesity and type 2 DM.
Gestational diabetes usually resolves after the birth of the baby.
Globally,
as of 2013, an estimated 382 million people have diabetes worldwide, with type
2 diabetes making up about 90% of the cases. This is equal to 3.3% of the
population, with equal rates in both women and men. In 2011 diabetes resulted
in 1.4 million deaths worldwide, making it the 8th leading cause of death. The
number of people with diabetes is expected to rise to 592 million by 2035.
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.
Gestational
Diabetes (diabetes during pregnancy)
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 non-whites. 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.
Prevention
There
is no known preventive measure for type 1 diabetes. Type 2 diabetes can often
be prevented by a person being a normal body weight, physical exercise, and
following a healthy diet. Dietary changes known to be effective in helping to
prevent diabetes include a diet rich in whole grains and fibber, and choosing
good fats, such as polyunsaturated fats found in nuts, vegetable oils, and
fish. Limiting sugary beverages and eating less red meat and other sources of
saturated fat can also help in the prevention of diabetes. Active smoking is
also associated with an increased risk of diabetes, so smoking cessation can be
an important preventive measure as well.
Complications
All
forms of diabetes increase the risk of long-term complications. These typically
develop after many years (10–20), but may be the first symptom in those who
have otherwise not received a diagnosis before that time.
The
major long-term complications relate to damage to blood vessels. Diabetes
doubles the risk of cardiovascular disease and about 75% of deaths in diabetics
are due to coronary artery disease. Other “macro vascular” diseases are stroke,
and peripheral vascular disease.
The
primary micro vascular complications of diabetes include damage to the eyes,
kidneys, and nerves. Damage to the eyes, known as diabetic retinopathy, is
caused by damage to the blood vessels in the retina of the eye, and can result
in gradual vision loss and potentially blindness. Damage to the kidneys, known
as diabetic nephropathy, can lead to tissue scarring, urine protein loss, and
eventually chronic kidney disease, sometimes requiring dialysis or kidney
transplant. Damage to the nerves of the body, known as diabetic neuropathy, is
the most common complication of diabetes.
The symptoms can include numbness, tingling, pain, and altered pain
sensation, which can lead to damage to the skin. Diabetes-related foot problems
(such as diabetic foot ulcers) may occur, and can be difficult to treat,
occasionally requiring amputation. Additionally, proximal diabetic neuropathy
causes painful muscle wasting and weakness.
There
is a link between cognitive deficit and diabetes. Compared to those without
diabetes, those with the disease have a 1.2 to 1.5-fold greater rate of decline
in cognitive function.
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 Gambia”,
E-mail( mail@ diabetesgambia.org), E mail azadehhassan@yahoo.co.uk or text only
DR AZADEH. 7774469/3774469.
Author:
DR AZADEH Senior Lecturer at the University of the Gambia, Senior Physician and
Senior Obstetrician& Gynaecologist, Clinical director of Medicare Health
services.
