Diabetes: Celebrating The Silent Killer

With the worsening incidence of diabetes sweepiing across the world, EZRA IJIOMA examines the different types of diabetes and reasons for its high incidence in Nigeria.

In 2003, when he was 21 years old, Ken developed a puzzling, unquenchable thirst. He also had to urinate frequently—eventually about every 20 minutes. Soon Ken’s limbs began to feel heavy. He was chronically tired, and his vision became blurry.

A visit to the doctor confirmed that Ken had more than the flu—he also had Type 1 diabetes mellitus—diabetes, for short. Ken spent six weeks in the hospital before his blood-sugar level stabilized. Ken is not alone in this.

“Your blood tests came back with significant abnormalities.

You need immediate medical attention,” the doctor’s told Deborah. “That night, I kept thinking there must have been a lab error,” she says. “I told myself I just couldn’t be sick.”
Like many people, Deborah thought that she was reasonably healthy, so she ignored the nagging symptoms. She blamed her persistent thirst on the antihistamines she was taking. She attributed the frequent urination to an excess intake of water. And the tiredness—well, as a working mother, why won’t she be exhausted?

But then a blood test confirmed that diabetes was the culprit. It was difficult for Deborah to accept the diagnosis. “I told no one about my illness,” she says. “At night, when the family was asleep, I would stare out at the darkness and cry.”

Upon learning that they have diabetes, some, like Deborah, experience a flood of emotions, including depression and even anger. “I went through a tearful period of denial,” says Karen, who was also diagnosed with diabetes.

The World Health Organisation (WHO) in its latest release said that the prevalence of diabetes has reached epidemic proportions. It predicts that developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70 per cent of people with diabetes live in low - and middle income countries.

Once a rich man’s disease, diabetes has scaled the wealth barrier to afflict the poor as the embrace the habits of the rich.

An estimated 285 million people, corresponding to 6.4 per cent of the world’s adult population, will live with diabetes as at 2010. The number is expected to grow to 438 million by 2030, corresponding to 7.8 per cent of the adult population.

WHO’s figures show that while the global prevalence of diabetes is 6.4 per cent, the prevalence varies from 10.2 per cent in the Western Pacific to 3.8 per cent in the African region. However, the African region is expected to experience the highest increase. India has the world’s largest diabetes population, followed by China with 43.2 million.

According to the Federal Ministry of Health data collected in 1998, which is the most recent, the prevalence rate of diabetes in Nigeria is 2.2 percent, which translates to over 20 million persons living with the disease then.

“There’s no diabetes that’s not bad. It’s all serious” said Anne Daly, of the American Diabetes Association. Diabetes is a silent killer

According to Dr. Ofem Onang, the chairman of National Medical Association, Cross River State Chapter, diabetes is a disorder of carbohydrate, protein and fat metabolism characterised by relative and absolute lack of insulin.

Dr. Onang, who specialises in diabetes and endocrinology at the University of Calabar Teaching Hospital, said that as a metabolic disorder, diabetes can be broadly categorised into Type 1, Type 11, Gestational and Secondary diabetes.

He said, “Type 1 diabetes occurs in people with absolute lack of insulin because of autoimmune process. It usually occurs in young people below 30 years. And Type 2 diabetes occurs in people with relative lack of insulin. Maybe, the body is producing insulin but this is not being absorbed by the body cells. It could also be that the body is not producing enough insulin.”

People with Type 1 diabetes need injections of insulin every day in order to control the levels of glucose in their blood. Without insulin, people with Type 1 diabetes will die.

Type 2 diabetes is often, but not always, associated with obesity, which itself can cause insulin resistance and lead to elevated blood glucose levels. It runs in the family. There are several possible factors in the development of Type 2 diabetes. These include: Obesity, diet and physical inactivity, increasing age, insulin resistance, family history of diabetes, less than optimum intrauterine environment and ethnicity (Africans are more susceptible than Caucasians).

Also there is the gestational diabetes mellitus, which he said occurs in pregnant women, who may show varying intolerance for glucose. The danger here, Dr. Onang said is, “These women though not diabetic before pregnancy, may have the tendency to develop Type 2 diabetes later. So the doctor treating such women should caution them on this inherent danger.”

There is also diabetes coming from sources like reactions to substances like steroids, anti-retroviral drugs and Cushing’s syndrome, which, Dr. Onang said, is an endocrine disorder characterised by excessive secretion of glucocorticoids.

“Our lifestyle is changing as we embrace Western lifestyle. We no longer exercise but consume all kinds of junk food in the name of enjoying fast foods. Nigerians are increasingly consuming sugar and other substances that leave them susceptible to diabetes,” laments Dr. Idris Omede, the president of Nigeria Medical Association.

Similarly, Dr. Dan Wagner, a clinical and natural pharmacist from the United States and who carried out free diabetic counselling and treatment in Nigeria in 2005, noted the increasing number of Nigerian adults predisposed to diabetics.

He and his team meticulously recorded their observations and he wrote, “Generally, we discovered a higher-than-normal rate of adult-onset diabetes (NIDDM), especially in men in their 30’s and 40’s. It would be premature to establish what the main cause could be.

“I suspect that they have a predisposition to diabetes from heredity; however, their diets are high in starch (mainly from potatoes and cassava), with a lack of vegetables, higher-than-normal sugar use, and most disconcerting, a heavy consumption of sugar-laced soft drinks, including Coca-Cola and Fanta.

“Keep in mind that in any third-world country (I imagine even in our own country), you would rarely drink tap water. So if they can afford it, many people will buy purified bottled water. But it is disturbing to discover that bottled water in Nigeria is actually more expensive than Coca-Cola.

“Many Nigerians consume 2-8 bottles of soft drinks a day. There is little doubt in my mind that this practice is a contributing factor to the high incidence of diabetes.”

Dr. Onang couldn’t agree less with Wagner. “If by 1998, according to FMOH data, the prevalence rate of diabetes in Nigeria was 2.2 per cent”, he said, “You can imagine what the rate will be now given how much we have embraced unhealthy foreign lifestyle.”

He continues, “Nowadays, there is what is called Diabetes Prevention Program. This is saying that we can prevent diabetes by modifying our lifestyle such as lose weight, exercise regularly, stop smoking, reduce alcohol intake and eat balanced diet.”

Little wonder, the diabetes atlas website lists the campaign goals of the world diabetes day as to: encourage governments to implement and strengthen policies for the prevention and control of diabetes and its complications.

“We are more interested in creating awareness than legislation. NAFDAC [National Agency for Food and Drugs Administration and Control] should compel fast food outlets to warn consumers on the health implications of feeding on junk foods,” Dr. Idris said. “The scourge is on the rise and we are all involved. We must start now.”