Diabetes mellitus is a chronic condition which is poorly understood by the ordinary person and it’s management causes nightmares for both the physician and the patient. In this article I will explain some basic facts and dispel some myths about the disease. I will also discuss what the diagnosis means to the patient as well as to their family and friends in terms of lifestyle and dietary changes as well as monitoring and medication.
Myth 1: Diabetes is caused by eating too much sugar.
What is diabetes mellitus?
Diabetes is a disease in which the body is unable to produce or respond to the hormone called insulin. Insulin is a hormone that is involved in the metabolism of carbohydrates and regulating the amount of glucose in the blood. Those with a basic understanding of Latin may recognize the word mellitus, which means sweet. When you have diabetes, there’s too much sugar in your blood because your body can’t deal with it. Based on the definition, there are 2 types of this disease. Type 1 DM where the body lacks the cells that produce insulin in the pancreas. These cells would have been destroyed by the person’s immune system. This type usually starts early in life (in childhood) and the treatment requires insulin injections. Type 2 DM on the other hand develops when the cells of the body cannot respond to insulin and the pancreas is not producing enough insulin. This type develops later in life and is more common. The treatment is usually in the form of tablets but some people will eventually require insulin injections.
Myth 2: Diabetes is a disease of the rich and affluent.
How do I get diabetes?
Type 1 DM is largely genetic, meaning it is passed from your parents and there is nothing much you can do to avoid it. There are also very rare instances where a viral infection may trigger your immune system to cause type 1 DM. Type 2 DM on the other hand is largely (but not exclusively) a result of lifestyle. A high amount of fat causes the cells of the body to become resistant to insulin. Being overweight therefore is a risk factor for developing type 2 DM. Not all overweight people will develop diabetes, only those who do not produce adequate insulin. 90% of people who develop type 2 DM are overweight. It is therefore not surprising that exercising and eating healthy are the most effective ways of preventing diabetes. In Zimbabwe the prevalence of diabetes has been increasing in a way that mirrors the lifestyle of the modern society. It is Zimbabwean culture to celebrate chubbiness (i.e obesity ) especially in children but research shows that these children have a higher risk of developing diabetes in adulthood. We also associate obesity with wealth, a trend that those who are really wealthy have moved away from.
How do I know I have diabetes?
The only way to be certain that you have diabetes is to visit your physician who will do the appropriate tests. However there are certain signs and symptoms that should prompt you to visit the physician. These include:
- Polydipsia (increased thirst)
- Polyuria (increased urine amount and frequency)
- Polyphagia (increased appetite )
- Weight loss
A general feeling of weakness and tiredness is also very common in diabetic people. While there will be high levels of glucose in your blood, your body will be unable to use this glucose. A phenomenon that old physicians loosely termed starvation in the midst of plenty, a metaphor that many Zimbabweans can identify with.
What does the diagnosis mean?
Having a chronic illness is never easy, it takes a lot of mental and physical strength. From a physician’s point of view, diabetes is probably the second worst disease that one can have, after cancers (a topic for another day). The diagnosis of diabetes means your whole lifestyle has to change and those who resist this change usually pay in body parts.
Dietary changes are where most Zimbabweans lose the war with diabetes. We generally love our food and we love it sweet. The dietary restrictions are strict and frustrating for someone who has just been diagnosed. This is the cornerstone of managing diabetes. The key elements of a diabetic diet are:
- Fruits, vegetables and whole grains
- Moderate amounts
- Regular meals (no skipping meals)
- Avoid excess carbohydrates and fats
Most patients make the mistake of thinking that only sugar should be avoided. But basically all carbohydrates are converted to sugars in the body and should be limited.
In addition to dietary control, regular exercise is also very important. Diet and exercise are usually the first steps in managing diabetes before the introduction of medicines.
Myth 3: Diet soda is for diabetic people
What makes Diabetes so nasty?
Diabetes has many complications which can affect virtually any part of the body. High blood sugar levels impair the body’s immune system and predisposes diabetes patients to overwhelming infections that are usually very difficult to treat. Trivial infections can quickly become life threatening and they usually do.
Another complication of diabetes is damage to nerves, such that patients often complain of numbness usually in the feet and hands. It also damages blood vessels resulting in poor blood circulation to the feet and other organs (eyes, kidneys). A combination of damaged nerves, poor blood supply and an impaired immune system is probably diabetes’ most lethal tri-factor. Millions of people have had their legs amputated as a result of a very tiny scratch sustained while doing garden work or walking round the yard barefoot. Such trivial injuries often go unnoticed because people with diabetes have impaired sensation resulting from the damaged nerves. Infections quickly enter the broken skin and spread rapidly because the immune system is weak. When you finally notice the wound and visit your doctor, they will prescribe antibiotics but because of the poor blood supply to your feet, the antibiotics will not easily get to their intended destination. Not uncommonly, the choice comes down to your foot or your life.
Low blood sugar (hypoglycemia) is just even more life threatening to a diabetic. Many people have woken up in the emergency rooms simply because they were too busy and they skipped a meal. It is advised that every diabetic should have a bracelet that has their diagnosis written on it, more often than not when a diabetic collapses, a bit of sugar will bring them back to life like a miracle. Even more often, when a diabetic collapses people run around and perform CPR which is unnecessary, because no one has a clue what is going on, until the person is dead. Every competent physician always advises their DM patients to carry sweets or good old sugar whenever they travel, this advice should never be ignored.
The discussion on diabetes can not be exhausted, but suffice to say it is a very serious disease that can be successfully managed if a doctor and a patient cooperate fully. An occasional visit to the physician to refill your prescription is definitely not enough. Daily efforts have to be made to eat right, exercise, take your medication, check your blood sugar, take good care of your feet while also participating in the Zimbabwean hustle. After all, you play the hand that fate deals you and diabetes mellitus is far from a Royal flush.
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