DIABETES MELLITUS AND PREVENTIVE MEASURES

Photo by Pavel Danilyuk from Pexels

Diabetes mellitus is a clinical syndrome characterized by hyperglycemia due too absolute or relative deficiency of insulin. Lack of insulin affects the metabolism of carbohydrate protein and fat and cause a significant disturbance of water and electrolyte homeostasis.

In another way, Diabetes is a lifelong condition characterized by high blood sugar resulting from lack or insufficient production of insulin, insulin resistance (inaction) or both.

There are three main types of diabetes.

1. Type 1

• It results from absolute lack of insulin.

• It is of a sudden on set and can develop at any age but usually occurs before the age of 30 and especially in childhood. The causes of this are when the pancreas cannot produce insulin. Account for about 5 to 10% of all cases of diabetes

• People with type 1 diabetes need insulin for survival.

2. Type 2:

• Type 2 diabetes develops when the body cannot make enough insulin or when the insulin that is produced does not work properly (known as insulin resistance).

• Usually appears in people over the age of 40, but it is becoming more common in the young.

• It can be controlled by a healthy diet, increased physical activity and oral drugs and later may eventually require insulin for control.

3. Diabetes during Pregnancy (Gestational Diabetes):

• Diabetes detected for the first time during pregnancy.

• GDM occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy.

• GDM usually disappear risk of Type 2 diabetes.

4.Hormonal diabetes mellitus:

• Caused by use of exogenous estrogen/progesterone.

Sign and Symptoms

• They include:

• Frequent urination.

• Excessive thirst.

• Extreme hunger.

• Unexplained weight loss.

• Increased fatigue.

• Irritability.

• Blurred vision.

• Itching of the private parts in women.

• Slow healing of cuts and wounds.

• Impotence-failure to sustain an erection.

• Numbness, burning sensations, pins and needles of the feet and hands

Risk Factors

The risk factors of diabetes can be grouped into two categories:

1. Those that cannot be modified:

• Advancing age

• Family history of diabetes

2. Those that are modifiable:

• Overweight and obesity

• Alcohol use

• Tobacco use

• Physical in activity

• A stressful lifestyle

• Unhealthy diet

Management of Diabetes

The goal of diabetes management is to improve the quality of life and productivity of people living with diabetes. There are two modalities of managing diabetes:

• Non-drug method (use of proper diet and physical activity).

• Use of Drugs e.g. diabetes tablets for lowering blood sugar and insulin.

• Diabetes education and counselling goes hand in hand with these two methods.

Education

Community members including people living with diabetes need to know that diabetes is

a serious life long disease that has no cure, but can be controlled.

• The pillars of management include:

              o Diabetes education,

              o Knowing what foods to eat, how much and how often to eat,

              o Knowing the importance and precautions of exercise,

              o How and when to take diabetes medications.

• That community should know and be encouraged to seek regular medical checkups which is essential for early detection of the disease.

• People with diabetes need to know how to identify diabetes related emergencies arising from low or high blood sugar levels and when to seek medical help.

• Pregnant mothers to be encouraged to check their blood sugars regularly.

• Complications of diabetes are preventable.

• Good blood sugar control is essential to prevent long term complications of diabetes.

• Those people with diabetes have to look after their feet to prevent injuries and thus, prevent ulcers and amputations.

• Eating a healthy diet and increasing the level of physical activity should be the first steps in the management of newly diagnosed people with diabetes and have to be maintained.

Good Dietary Practices in the Management of Diabetes Mellitus

• Appropriate diet and physical activity is important in maintaining an ideal body weight.

• Reduced intake of animal fat, salt and refined foods is recommended.

• Locally available foods high in fiber, vegetables and fruits should be encouraged in the community.

• The nutrition is to retrain diabetes educator can help you know the appropriate food portion sizes to meet your dietary requirement.

• Eat a variety of foods in at least three meals a day.

• Alcohol and tobacco products use should be avoided.

• Water is essential for normal body functioning. Atleast eight glasses of water should be taken per day.

Physical Activity

§ Regular physical activity helps in:

• Increasing insulin sensitivity thus improving blood sugar control.

• Controlling blood pressure.

• Improving blood flow in the heart and vessels

• Weight loss and maintenance of healthy body weight.

• Giving one a sense of well-being.

§ Physical activity should be regular (-3 days/week, lasting at least 20-30 min. per session and be of at least moderate intensity.

§ Examples of physical activities you can involve yourself include;

• Housework

• Gardening

• Walking

• Climbing stairs

§ Examples of exercises suggested for prevention and control:

• Fast walking

• Cycling

• Jogging

• Playing games

• Weight lifting

• Rope jumping p

• Swimming

• Indoor exercises sit ups and pressups.

§ Activities like; walking, climbing steps (instead of taking lifts) should be couraged.

§ People with diabetes require proper medical assessment before engaging in vigorous physical activity.

§ Proper shoes must always be worn during exercises to avoid injury to the feet.

Management of Diabetes by using Drugs

Diabetes is managed by use of medicines that can either be:

§ Oral blood sugar lowering tablets.(click here for anti diabetic drug classification)

§ Insulin injection.

It is important to note that;

§ Oral tablets are used when an individuals blood sugar control is not achieved using the combination of dietary modifications and physical activity/exercise.

§ Patients currently using tablets to control their blood sugar may at one time in the future need insulin as these tablets may no longer work in them.

§ In some cases, or all tablets or insulin injection may be given at the time of diagnosis of diabetes if the blood sugar is extremely high, ie. a fasting blood glucose level more than 11 mmol/L or random blood glucose level more than 15 mmol/L

§ Individuals with type 1 diabetes must be on insulin for survival.

Principles of Insulin Administration

§ The injection sites most commonly used for insulin are the abdomen, the thigh and the outer upper arm.

§ The rate of absorption is fastest on the abdomen.

§ The thigh should be avoided as an injection site when exercise is going to be done, as this will increase the rate of absorption of the insulin.

§ One area should be used for an injection at a particular time of day, e.g. the abdomen is the site for the morning injection and the thigh is the site for the evening injection. Within these areas, the injection site is to be rotated, to avoid formation of a hard scar (seen as a lump).

§ Injection on these scars should be avoided as insulin absorption is not predictable.

§ The injection should be done at a 90-degree angle with the skin using the recommended insulin administration syringe and needle.

§ The needle should be held in place for 10 seconds after injection before withdrawal

Prevention

§ Eat healthy foods: more vegetables and fruits, less carbohydrates, fats, sugars and salts.

§ Exercise regularly:

             1. Atleast 30 minutes of brisk walking everyday will help.

             2. Walk short distances; don't board a vehicle, Encourage children to have daily physical exercises

§ Avoid smoking, if a smoker seeks assistance to quit smoking

§ Avoid harmful use of alcohol: excessive use of alcohol is dangerous to health.

§ It's good to know you are healthy; Visit your nearest health facility for checkups for diabetes and blood pressure.

§ Early diagnosis and proper treatment prevents complications of diabetes.

§ Don't wait until you are feeling unwell.

§ Check your Body Mass Index (BMI)