DIABETES AND THE WAY FORWARD

Diabetes Mellitus is a chronic metabolic disorder characterized by fasting and / or postprandial (after meals) hyperglycaemia with blood glucose levels that are above the normal limits. In simple words, it is a condition that prevents the body from properly using energy from food.

Diabetes occurs when the pancreas is not able to produce any insulin or if produced not in sufficient quantity or the body does not respond to the insulin produced (insulin resistance). This causes the blood glucose to rise in the blood stream which can lead to some deleterious effects especially when not promptly diagnosed.

CLASSIFICATION OF DIABETES MELLITUS

Majority of cases of diabetes mellitus is divided into two broad categories based on aetiology:

1. Type 1 diabetes mellitus – this is as result of immune mediated destruction of the beta cells of the pancreas resulting in absolute deficiency of insulin secretion. This type is seen commonly in the younger age group. It was previously known as juvenile onset diabetes. 
2. Type 2 diabetes mellitus- this type of diabetes is commonly in the elderly or people above the age of 30years. It is usually of a gradual onset and there is usually a strong family history of diabetes. Here there is insulin secretion but not the body is resistant to it (relative insulin deficiency). It is common in overweight or obese people with sedentary lifestyle and high calorie food intake especially of processed, energy- dense foods high in sugar and fat. The evolution of the type 2 diabetes mellitus follows through different stages. Impaired fasting glucose and impaired glucose tolerance are the prediabetes stage. These people do not meet the criteria for diabetes but values are nevertheless too high to be considered normal. They may go on to develop diabetes in future if their glycaemic status is not maintained by lifestyle modification.

Other specific types of diabetes mellitus could be as a result of

1) Gestational diabetes- this is glucose intolerance with its onset first noticed during pregnancy.

2) Pancreatic disease such as cystic fibrosis, pancreatectomy, fibro calcific pancreatitis.

3) Endocrinopathies such as acromegaly, Cushing’s syndrome, hyperthyroidism, phaechromocytoma.

4) Drug induced- thyroid hormones, glucocorticoids, thiazides etc.

5) infections- congenital rubella, mumps, cytomegalovirus.

6) Genetic syndrome association such as Down’s syndrome, Turner’s syndrome etc.

7) Maturity onset diabetes of the young (MODY).

COMPLICATIONS OF DIABETES MELLITUS

Diabetes is a multiorgan disease i.e. it affects all organs of the body. This is why diabetes could be a very debilitating disease if not well managed. Below is a list of the complications of diabetes;

• Eye complications - Glaucoma, cataracts, diabetic retinopathy, and some others.
• Foot complications - neuropathy, ulcers, and sometimes gangrene which may require that the foot be amputated
• Skin complications - people with diabetes are more susceptible to skin infections and skin disorders
• Heart problems - such as ischemic heart disease, when the blood supply to the heart muscle is diminished
• Hypertension - common in people with diabetes, which can raise the risk of kidney disease, eye problems,  and stroke
• Mental health - uncontrolled diabetes raises the risk of suffering from depression, anxiety and some other mental disorders
• Hearing loss - diabetes patients have a higher risk of developing hearing problems
• Gum disease - there is a much higher prevalence of gum disease among diabetes patients
• Gastroparesis - the muscles of the stomach stop working properly
• Ketoacidosis - a combination of ketosis and acidosis; accumulation of ketone bodies and acidity in the blood.
• Neuropathy - diabetic neuropathy is a type of nerve damage which can lead to several different problems.
• HHNS (Hyperosmolar Hyperglycaemic Nonketotic Syndrome) - blood glucose levels shoot up too high, and there are no ketones present in the blood or urine. It is an emergency condition.
• Nephropathy - uncontrolled blood pressure can lead to kidney disease
• PAD (peripheral arterial disease) - symptoms may include pain in the leg, tingling and sometimes problems walking properly
• Stroke - if blood pressure, cholesterol levels, and blood glucose levels are not controlled, the risk of stroke increases significantly
• Erectile dysfunction - male impotence.
• Infections - people with badly controlled diabetes are much more susceptible to infections
• Healing of wounds - cuts and lesions take much longer to heal

MANAGEMENT OF DIABETES

Because diabetes causes multiple organ damage, its management is usually via a multidisciplinary approach. It involves the dietician or nutritionist, neurologist, ophthalmologist, surgeon, chiropodist, just to mention a few.

Management could be divided into the pharmacologic and non- pharmacologic management. The non- pharmacologic management is most especially for those within the prediabetes range although it still applies to all. It involves:

• Maintaining optimal weight using the BMI to calculate your expected weight for height.
• Calorie restriction- been careful want you eat and how much you eat. 
• Plant based diet rich in monounsaturated and polyunsaturated fatty acids.
• Avoiding Trans-fatty acids and limiting saturated fatty acids.
• Exercise is recognized as a part of the management of diabetes. Its benefit is as a result of increased tissue sensitivity to insulin improving glycaemic control, reducing blood pressure, improvement in dyslipidaemia and maintenance of body weight. The types of exercise recommended are strengthening exercises, aerobics, flexibility exercises and endurance exercises.
• Cessation of smoking.
• Adequate sleep.

Pharmacologic treatment is the use of drugs in the management of diabetes. There are various classes of hypoglycaemic agents that can be used ranging from the use of insulin to the use of oral hypoglycaemic agents depending on the type of diabetes, severity or level of control. The use of drugs aims to reduce the progress of disease stage by slowing down the development of complications.

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