John was diagnosed diabetic at 40, but instead of
focusing on the disease, he ignored it. After all,
he didn’t feel sick. But gradually, his health was
failing.
File Photo: Breast examination
Today, John, now 60, is a shadow of his old self.
Over the last 20 years, he has watched his body
slowly disintegrate. A host of circulatory problems
arising from his diabetic condition has cost him
his vision, as well as nerve and bony damage to his
left foot. Worse still, he is concerned about his
heart. He has reason to because more than two
thirds of people with diabetes die of stroke and
other heart-related problems.
Although John is finally getting treatment, his
prospects could have been much better if medical
intervention had come much earlier. Diabetes is a
chronic disease that quietly consumes the human
body, to the extent that you cannot walk, you
cannot stand, you cannot function and ultimately
you cannot live.
There are millions of people like John in Nigeria.
Six million Nigerians have diabetes. About half of
this number of persons have their cases diagnosed
and even less are under treatment. This makes
Nigeria the country with the highest number of
diabetic patients in Africa. In fact diabetes is the
most common chronic illness that is being managed
all over the country.
Diabetes is a chronic disease that occurs when the
pancreas is no longer able to produce insulin, or
when the body cannot make good use of the insulin
it produces. Insulin is a hormone made by the
pancreas, that acts like a key to let glucose from
the food we eat pass from the blood stream into
the cells in the body to produce energy.
The disease may remain undetected for many
years and the diagnosis is often made when a
complication appears or a routine blood or urine
glucose test is done. It is often, but not always,
associated with overweight or obesity, which
itself can cause insulin resistance and lead to high
blood glucose levels. People with type 2 diabetes
can often initially manage their condition through
exercise and diet. However, over time most people
will require oral drugs and or insulin.
In Nigeria, an estimated five million people are
suffering from diabetes. If this sounds bad,
experts warn that the scenario is likely to get
even worse as the number of diabetics is expected
to double within the next 20 years, to the extent
that 63 percent of undiagnosed and many that are
diagnosed are not being correctly controlled. As
much as 76 percent of deaths due to diabetes
occur in people under the age of 60 in Africa. The
bad news continues.
That the cost of diabetes management is
prohibitive and gradually increasing is equally
worrisome. Already, most patients seen at
Federal and state teaching and specialist
hospitals are often at the late stage when
effective treatment is too late and only palliative
measures can be administered.
What is the community doing about diabetes?
What is it doing to subsidise some of the drugs for
its treatment? What about the availability, and
education of the public and at community level?
Just last week, some medical experts expressed
concern over the burden of diabetic disorders and
the rising cost of its management in the country.
Consultant Physician/Endocrinologist, Obafemi
Awolowo University, OAU, Ile Ife, Osun State,
Prof. Babatope Kolawole, said the magnitude of
diabetes in the country is too alarming to be
ignored. He noted that according to statistics,
the prevalence of diabetes varies. It is a disease
of urbanisation and from previous studies, the
highest burden is in Lagos which has a prevalence
of over 7 percent per population.
Kolawole blamed urbanisation and lifestyle factors
as well as physical exercise as factors driving the
epidemic and recommends that reliable preventive
measures must target these. “Diabetes is a risk
factor for so many other problems, and also
contributes a lot to disorders such as kidney
disease, blindness and amputation of the foot in
Nigeria. It can precipitate emergencies that can
lead to death and these are the issues related to
poorly treated or untreated diabetes and no
effort should be spared in instituting preventive
measures at all levels of healthcare delivery in
the country.”
On his own, the Chief Medical Director, Lagos
State University Teaching Hospital, LASUTH, Prof.
Adewale Oke, said most diabetes cases seen at
the hospital are in the late stage. “The
commonest complications I see involve the blood
vessels and the heart. It is a common cause of
myocardial infarction and can affect the heart
muscles. There can be heart failure, and renal
failure. When you are passing too much water
without any explanation, you should investigate,”
he urged.
Oke, an experienced cardiologist noted that Lagos
State is thinking of starting a health insurance
scheme to cover diabetes. “It has been read at
the state House of Reps. but is yet to be passed,
and once that is happening there will be better
for management of diabetes especially in the area
of drugs for management.”
One of the big worries about diabetes, according
to Dr. Dorothy Esangbedo, an experienced
paediatrician and renowned endocrinologist, is
the increasing burden of diabetes in infants and
children. Esangbedo, who is also President, Union
of National African Paediatric Societies and
Associations, UNAPSA, regretted that even
infants and children are not spared the burden of
diabetes.
“There is increase in diabetes in children. Taking
a situation report today, you will find that
diabetes in children is lower in Africa than Europe
and the Americas, but in terms of trends over
time, the rate of increase is even more in sub-
Sahara Africa so much so that they are saying to
us that in decades to come, diabetes would be one
of the major problems we will be facing.”
The signs and symptoms of diabetes in a child are
actually the same as in the adult. The only
difference is that the child cannot complain so the
mother has to be the one to notice these
symptoms, so just like the adult will have problem
of excessive passing of water so will the child.
“The mother can then notice that the child is
passing urine too frequently, and she can also
notice that the child is too thirsty and babies tend
to present with infections as skin lesions and that
is when you see frequent occurrence of skin
infections in the child or certain effects of
pigmentation of the skin.
This is also a sign that the mother needs to
complain about that child. They also tend to be
weak, they will not grow, will have weight loss and
most importantly, the doctor will want to know if
there is family history of diabetes because that is
a major pointer that diabetes is possible and tests
should be done.”
If there is gestational diabetes, Esangbedo notes
that it could affect the child in future and it is an
indication that both the mother and the child
should be closely watched for diabetes. “In the
future, It is usually a good pointer because even
though the mother recovers from pregnancy, she
should still be closely monitored so that she can
quickly put in place the lifestyle strategies that
would prevent the onset of the disease.”
With the recent introduction of its brand of
insulin, Sanofi, a global healthcare leader,
describes this as commitment to improving access
and ensuring availability to high-quality,
efficacious solutions to improve the management
of diabetes for patients. In addition to better
support patients in the management of the
disease, Sanofi is supporting opening of 12
dedicated diabetes and hypertension clinics in
partnership with health authorities. The first
clinic was recently inaugurated, at LASUTH.
“We believe in Public-Private partnership, that is
why we are standing by the State government to
fight NCDs as a whole and diabetes in particular,”
said Head of Medical and Regulatory, Sanofi, Dr.
Inoussa Fiffen. “By doing so, we believe that the
management of diabetes should be decentralised
and for the meantime, we need to focus on the
rural areas so that the journey of the diabetic is
smooth.”
http://www.vanguardngr.com/2015/02/stop-diabetes-stops/