Taming the rising cases of diabetes mellitus in Nigeria

When Sa’eed Usman (not real name), a newly wed 25-year-old man had fever, he took drugs for some days, but when the fever subsisted, he invited a friend, who owns a private medicine store, to administer dextrose saline drip on him for some days. During the days he was receiving the dextrose saline drip, Usman […]

When Sa’eed Usman (not real name), a newly wed 25-year-old man had fever, he took drugs for some days, but when the fever subsisted, he invited a friend, who owns a private medicine store, to administer dextrose saline drip on him for some days.

During the days he was receiving the dextrose saline drip, Usman lost appetite and could not even take liquid as meal. When his condition deteriorated, he was finally rushed to a hospital where a test was conducted on him and his sugar level was found to be very high.

Unfortunately, it was too late and within two hours of arrival at the hospital, he died, leaving behind a young wife who was five-months-old pregnant and aged parents.

Unknown to Usman, his wife, friends and family, he had type 1 diabetes, and the dextrose saline drip that was meant to cure him, only escalated the situation that led to his death.

On his part, Francis Bulus, a 45-year-old resident of Gombe metropolis, had a history of diabetes in his family, as both of his parents were diagnosed with the disease before their death.

Bulus was addicted to one of the carbonated soft drinks, and according to him, he was not doing much exercise and a bottle of his favourite drink was always his last meal daily before going to bed.

When he had a small boil on his leg, he thought it was normal boil and would heal eventually, but unknown to him, he had diabetes and that small boil led to a serious ailment that resulted in the amputation of his leg.

“Although my parents had diabetes, I never bothered to test whether I had it or not, until when I had the boil that refused to heal despite taking several antibiotics.

“When it persisted, I decided to visit the hospital. I was diagnosed with type 2 diabetes and that small boil that I did not take seriously tied me to the hospital bed for over six months. I was lucky to survive but my leg had to be amputated. As you can see, I am now walking with a prosthetic leg,” he said.

For Abubakar Alhaji Abubakar, when he started to experience excessive urination than he normally had, he rushed to hospital where he was diagnosed with type 2 diabetes.

He said, “Both my parents had diabetes, so when I began to urinate excessively, almost 16 times daily, I decided to take a test and when the result came out, I was confirmed to be diabetic. From that moment, I changed my lifestyle and also started watching my diet.”

The three cases above are similar to stories of over 11 million people that are currently living with diabetes mellitus in Nigeria, according to the Diabetes Association of Nigeria (DAN).

Medical experts described diabetes as a group of diseases that are characterised by excessive glucose in the blood. It is one of the deadly non-communicable diseases.

Dr Fatima Mahdi Muhammad, a Consultant Endocrinologist at the Specialist Hospital Gombe, said diabetes usually results from a lack of insulin in the body where there is a deficiency in the action of insulin.

“Insulin is a hormone secreted by an organ close to the stomach known as the pancreas. When the hormone is not as active as it should be or when its action on the body is not sensed, it results in a lot of sugar in the blood. It means the sugar in the blood cannot go into the muscles or fat cells and remain in the vessels,” she explained.

She stated that people that developed diabetes tend to develop complications because the disease has no easily recognised symptoms.

“A person will be going about his normal daily activities but his sugar level is 7.7. We know that the symptoms of diabetes are excessive urine, like a person going to the bathroom four or five times a night, excessive taking of water and weight loss.

“These three are cardinals. We do not want people to reach that stage before they are diagnosed with diabetes because it is already becoming complicated. The commonest way diabetes presents itself is asymptomatic. So, it is a disease that we are supposed to pursue and find rather than wait for symptoms to occur. The legacy effect is that the earlier you start the treatment, the better the outcome of diabetes is,” Dr Fatima explained.

The consultant endocrinologist cautioned that family history is one of the risk factors that increases the likelihood of diabetes, especially among the young people.

On abstaining from sugar and sticking to diabetic food, Dr Fatima shed more light on the foods that people with diabetes should take.

“People should understand that everything we take is broken down to sugar, but taking refined sugar increases the risk of diabetes because of what we call glucotoxicity. Every time we take refined sugar, insulin is brought to absorb it. The timing for those refined sugar is different from if you had taken your ‘masa’ or ‘tuwo,’ because the timing of degradation is different.

“That is why we tell people to take a lot of vegetables because the degradation time is slower than in refined sugar where insulin comes out immediately you consume it. The excessive insulin that keeps coming out due to constant consumption of refined sugar causes the glucotoxicity to the pancreas. The receptors are downgraded because the insulin is tired of coming out. It comes out to work on the sugar anytime you consume it. After a few years, it becomes overworked,” she explained. 

The medical expert warned people to watch their diets and lifestyle, saying that diabetic patients are four times more likely to have a heart attack than non-diabetic patients.

She said, “Diabetes is the number one leading cause of neuropathy in the advanced world, that is kidney disease that needs dialysis. It is also the second cause of amputation, while in this part of the world, studies have shown that it is the number one cause of loss of limbs. It is also the number one cause of loss of vision. If you see a person with an amputation in Nigeria, the likelihood of him being diabetic is 50 times.”

On what could be done to reduce the prevalence of diabetes, Dr Fatima called for more awareness.

She said, “We have to raise awareness so that people can know that diabetes is treatable but not curable, and a patient can live a normal life because there are so many medications.

“The World Health Organisation (WHO) has advocated for 18 years for all those who have risk factors to be checked every year. For instance, even an 18-year-old who is obese and has a family history of diabetes should have his glucose checked every year. Those who have no risk factors should begin to check their glucose levels from age 30.”

The medical doctor added that another preventive measure is a change of lifestyle.

“We also should not go to sleep immediately after eating. We should bring back the habit of trekking not-so-far distances. If you frequent the mosque for your daily prayers as a Muslim, you can decide to go to a farther mosque for one or two prayers,” she advised.

Dr Fatima also debunked the insinuation that diabetic patients should abstain from taking sugar and also stick only to diabetic foods.

“In terms of diets, diabetic teaching has changed. In the past, diabetic patients didn’t take carbohydrates and sugar, but now the only thing that is removed from a diabetic diet is refined sugar. A diabetic patient can take carbohydrates. In fact, 50% carbohydrate is advocated for in their meals. This is because if you take only protein without carbohydrates, you will lack energy, as carbohydrates give energy. Therefore, we advise that the diabetic diet should have 50 percent carbohydrates, 25 percent protein and probably 10 percent of fats, while vegetables should be at least 50 percent of what the person is taking.

“We should take vegetables either dry or fresh. Diabetic patients can consume carbohydrates such as rice, yam and pasta, so long as they add vegetables. However, the quantity should not be excessive but enough, while refined sugar should preferably be at 0 percent.”

The consultant endocrinology also assured that with proper treatment, a diabetic patient can live a normal life for 80 to 90 years.

She said, “People with diabetes can live for a very long time like healthy people. For instance, former British Prime Minister Theresa May had Type 1 since age six, but her development and education were not impaired. So, patients can live up to 80 years if caution is taken early. 

“According to a study done in Aminu Kano Teaching Hospital (AKTH), 50 per cent of type 2 patients come with complications and that is what we are trying to avoid. We want to diagnose and treat it early so that it doesn’t cause complications. A diabetic patient can live a normal life, eat normal food, and so long as he is taking proper medications, he can live until his appointed time without any complications. That is the advocacy we want for diabetes.”

Dr Fatima also discarded claims by some herbalists that diabetes is curable.

On the diabetic situation in Gombe State, the medical expert said, “there is no study in Gombe, but from my local research a few years ago, the prevalence was about 4 per cent, although the sample size was a very small population. We noticed that in 2005, it took a week before you had an admission for a diabetes patient.

“Currently, you could hardly go by a day without having a diabetic patient in your admissions summary. The problem also goes along with poverty. A person could be battling a communicable disease; is poor, has diabetes, and cannot afford basic diabetic emergency, not to mention chronic diseases. These are observances.”

She said it is mostly lifestyle that is fuelling diabetes in Gombe, adding “though family history has always been there, but lifestyle is the major cause because we take a lot of sugar. Sugar doesn’t have to be refined. If you are taking ‘tuwo’ excessively, it is sugar. The only energy cells know is glucose. Everything is melted and absorbed as glucose. Taking a lot of ‘tuwo’ is not correct; we are supposed to eat with caution.” 

She said another reason is the habit of not walking.

“We use vehicles, motorcycles and tricycles. The government should encourage people to walk by having some sidewalks, like how advanced countries have made provisions for pedestrians,” she said.

Dr Fatima also advised the Gombe State government to embark on massive awareness campaign, adding that the main problem in Gombe is awareness, especially for those living in rural areas.

“We also need awareness because a lot of people are not aware that excessive eating or sleeping is a factor. Eating only food or eating fried yam at night is not advisable. This is in addition to our culture of eating ‘suya’ at night and going to bed immediately. Although meat is protein, they usually cut the fatty parts. They also sprinkle oil on it before wrapping. Even the paper bag that the meat is wrapped in is soaked with oil. Oil has the most calories among foods. Garden eggs and oranges should be consumed as substitutes at night.”

“But most importantly, diabetes is not a death sentence. It can be managed, especially if a person presents himself early. He can live normally without urination complications or weight loss. People should take their medications regularly and adhere to injection dosages,” she advised.

 

This report is published for the Media-EIS Fellowship Program, a collaborative partnership among Breakthrough Action-Nigeria, Nigeria Centre for Disease Control (NCDC), and Africa Field Epidemiology Network (AFENET).