Health Matters: Worldwide Diabetes awareness 14th November

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.