The risks of deathly Diabetes disease

Diabetes can cause blindness, heart disease, kidney failure, and amputation of limbs, sudden and overnight death

These are the common risks of someone with undiagnosed and untreated diabetes disease.

DR AZADEH Senior Lecturer at the University of the Gambia focusing in this issue on these risk factors of this incurable but easy diagnosed and treatable disease in the Gambia in continuation of last week article about this disease.

DR AZADEH how serious is this disease and how can someone be diagnosed and treated in the Gambia?

First of all I must re-emphasise that diabetes in incurable and that means that there is no cure for this disease. Treatment involves medications, diet and I strongly recommend exercise to control blood sugar and prevent symptoms.

Not diagnosed and not treated diabetes disease can damage blood vassals and nerves and decrease the body’s abilities to fight infections. Someone with this disease may not notice a food injury until an infection develops and the wound will take weeks to eventually heal up. During these prolonged healing process often death of skin and other tissues can occur. Diabetes is the most common condition leading to amputation of limbs.

Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

Causes, incidence, and risk factors

Insulin is a hormone produced by the pancreas (an organ inside the stomach) to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

- A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.

An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because:

- Their pancreas does not make enough insulin

- Their muscle, fat, and liver cells do not respond to insulin normally

- Both of the above

There are three major types of diabetes:

Type 1 diabetes

Is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.

Type 2 diabetes

Is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity (over weight) and failure to exercise.

- Gestational diabetes

Is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life.

Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (early type 2 diabetes).

There are many risk factors for type 2 diabetes, including:

- Age over 45 years,   A parent, brother, or sister with diabetes

- Gestational diabetes or delivering a baby weighing more than 9 pounds

- Heart disease, High blood cholesterol level, Obesity ( over weight )

- Not getting enough exercise, Polycystic ovary disease (in women)

- Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

Symptoms

High blood levels of glucose can cause several problems, including:

- Blurry vision, Excessive thirst, Fatigue, Frequent urination

- Hunger, Weight loss

However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

Signs and tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.

The following blood tests are used to diagnose diabetes:

- Fasting blood glucose level --

- Normal: Less than 5.7%

- Random blood sugar( when eaten earlier) about 6-7%

- Pre-diabetes (early stage of diabetes ) fasting: Between 5.7% - 6.4%

- Diabetes: fasting 6.5% or higher

- Symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

How well treatment is working.

The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

The long-term goals of treatment are to:

- Prolong life, Reduce symptoms, Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

These goals are accomplished through:

- Blood pressure and cholesterol control, Careful self testing of blood glucose levels

- Education, Exercise, Foot care, Meal planning and weight control, Medication or insulin use

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

- How to recognise and treat low blood and high blood sugar , What to eat and when, How to take insulin or oral medication, How to test and record blood glucose, How to test urine for (type 1 diabetes only)

- How to adjust insulin or food intake when changing exercise and eating habits

- How to handle sick days, Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems.

SELF-TESTING

If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.

WHAT TO EAT

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet.

People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.

People with type 2 diabetes should follow a well-balanced and low-fat diet.

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral drugs.

People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin.

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. 

EXERCISE

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

Here are some exercise considerations:

- Always check with your doctor before starting a new exercise program.

- Choose an enjoyable physical activity that is appropriate for your current fitness level.

- Exercise every day, and at the same time of day, if possible.

- Monitor blood glucose levels before and after exercise.

- Carry food that contains a fast-acting carbohydrate in case you become lack of sugar during or after exercise.

- Carry a diabetes identification card and a cell phone in case of emergency.

- Drink extra fluids that do not contain sugar before, during, and after exercise.

You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

Expectations (prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.

Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Complications

Emergency complications include:

- Diabetic (lower blood sugar), (high blood sugar) and coma

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:

- Abdominal pain, Deep and rapid breathing, Increased thirst and urination

- Loss of consciousness, Nausea, Sweet-smelling breath

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):

- Confusion, Convulsions or unconsciousness, Dizziness, Double vision

- Drowsiness, Headache, Lack of coordination, Weakness

Prevention

Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

Currently there is no way to prevent type 1 diabetes.

There is no effective screening test for type 1 diabetes in people who don't have symptoms.

Screening for type 2 diabetes in people with no symptoms is recommended for:

- Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years

- Overweight adults (BMI greater than 25) who have other risk factors

- Adults over 45, repeated every 3 years

To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

Regularly have the following tests:

- Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).

- Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL, less than 70 mg/dL in high-risk patients).

- Get yearly tests to make sure your kidneys are working well

- Visit your optician (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.

- See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

- Make sure your health care provider inspects your feet at each visit.

- How to get information and help in the Gambia?

Everyone interested to get information about this very common disease, get diagnosed and treated can visit every Government, NGO and Private Health facilities throughout the country, The Point Newspaper and DR AZADEH on 7774469/3774469.