A lecturer at the Department of Physiology, College of Medicine, University of Lagos, Dr. Agbaraolorunpo Francis, discusses diabetes and how to manage it with TOLUWANI ENIOLA

What is diabetes mellitus?
Diabetes mellitus is a disease condition in which there is a chronic rise in the level of blood glucose as a result of abnormal glucose (blood sugar) regulation, resulting from insulin deficiency or insulin poor performance. There are two types of diabetes, Type 1 and Type 2.

What are the differences between type 1 and type 2 diabetes?
Both types are characterised by abnormal elevated blood glucose (sugar) above the physiologically normal range. Type 1 results from destruction to insulin-producing cells (beta -cells of islet of Langerhans) of the pancreas. It also results from the low-level of insulin in the glucose-regulating hormone. It is also referred to as juvenile diabetes (common in children).

It can also result from autoimmune condition. An example is when the body’s immune or defence system is hypersensitive, resulting in the self-destruction of its own organs. This implies that the insulin-producing cells of the pancreas are destroyed by the body defence system.
Type 2 diabetes results from the inability of insulin to regulate blood glucose effectively and efficiently. It is otherwise evident by the low performance of insulin, the insulin inability to transport glucose into body cells effectively.
It is also referred to as insulin resistance or glucose intolerance diabetes. The reason is that the cells resist the insulin and the individual cannot tolerate glucose in his system. There is normal /high/low progressive fall in insulin level due to insulin overproduction as a result of insulin resistance. Type 2 can be caused by being overweight, obesity and excessive fat in the body. Type 1 is less common than Type 2.

What are the common causes of diabetes?
The predisposing factors include auto-immune disease, genetic factor (family history), diseases of the pancreas, lifestyles issues such as sedentary lifestyle, being overweight, obesity, eating high calories and junk meals. Others include poor eating habits such as eating late, consumption of too much-refined sugars (sweets, refined drinks) and over westernisation of diets.

What warning signs should a person look out for?
Diabetes may not present warning symptoms. Signs to note include excessive hunger/eating with associated weight loss, excessive thirst/drinking of water with excessive urination (frequency in the day and at night). Other signs include blurring of vision, abnormal behaviour–irritability, confusion, fainting, unconsciousness, dryness of skin, recurrent multiple boils in the skin, delay skin wound healing, loss of sensation in the fingers and toes etc.

What is a healthy glucose level and why is it important to maintain?
Normal fasting level is 70-99mg/dl (3.9-5.5mmol/L). For diabetes, it is FG -126mg/dl (7mmol/L). The reading of 80-130mg/dl (4.4-7.2mmol/L) is a target for diabetes.

What is pre-diabetes?
These are individuals with a high risk of developing diabetes on the basis of their present blood sugar/glucose and associated risk factors for diabetes (overweight, obesity, family history, cardiovascular risks such as hypertension, abnormal and high blood fat such as high triglyceride, high LDL cholesterol, low HDL cholesterol.) Pre-diabetic individuals must be monitored for lifestyle adjustments so as not to progress into full-blown diabetes. On the basis of laboratory diagnosis, it involves individuals with normal but high fasting glucose (impaired fasting glucose)-IFG- greater than 110mg/dl (6.1mmol/L), according to WHO criteria.

How are diabetes and heart/kidney diseases related?
Diabetes results in a dangerous level of blood glucose/sugar and abnormality in fat metabolism which damages the interior of blood vessels to the heart and the kidney. This could result in progressive damage and death of the cells and tissues of the heart and kidney. The consequence is progressive kidney disease and failure results, the blood vessel to the heart are narrowed, resulting in coronary heart diseases and heart attack.

How often should one check his blood glucose?
The warning signs listed above may necessitate it. It should be done annually as part of regular medical check-up.

What can individuals do to reduce their risk of developing diabetes?
They should go for regular medical counselling, lifestyle training and discipline by sticking to weight reduction plans, especially for those who are overweight and obese. Weight monitoring, especially for those with abdominal and thigh obesity, is crucial. They should avoid eating late and cut down on refined sugar (drinks). Regular exercises and living an active lifestyle are also crucial.

Is diabetes hereditary?
Yes, it is in some people. The tendency to be diabetic is high when both parents have the condition. But it is not in all cases.

What are the treatment plans?
Treatment plans include lifestyle adjustment as enumerated above. Also, nutritional intervention, drug management as well as insulin therapy are needed. There may also need oral glucose regulating drugs.

What are some tips for maintaining a proper diet and exercise through the holidays?
It boils down to discipline, determination, planning and goal-setting.

What food should people with diabetes eat?
No special food. Just maintain a good diet.The rule is to stick to a balanced diet in small portions taken in well planned intervals. This should include adequate vegetables and proteins.

What are some strategies people can implement to manage diabetes?
They should take their doctors’ instruction seriously. Self-management should be avoided. They can use self-glucose monitoring devices to monitor their response to specific meals; before the meal and two hours after the meal.

Why is it difficult for some people with diabetes to stay consistent with their care?
There are many factors responsible for this. One is the cost of medication, depression and suicidal tendency in those on insulin injection. Others include spiritualisation of the condition which makes those with the condition to be defiant to their doctors’ counsel; lack of support from a family member as well as past experience with the complication of medication.

How much exercise should diabetic individuals do weekly?
Exercise is as important as the use of medication for the management of diabetes. Exercise is very effective to reduce blood glucose level by enhancing glucose transport to the cells that require them. Exercises could be very useful for those with Type 2 diabetes because it facilitates glucose tolerance and reduces insulin resistance and helps in weight reduction. Exercises are also beneficial to pre-diabetic. It can also help in reducing the amount of medication necessary for the control of diabetes. The amount of exercise recommended for a diabetic patient is three to four times weekly for at least 30 minutes a day.

What is the link between blood pressure, blood sugar and eye health?
High blood pressure and high sugar/glucose can damage the interior of the small blood vessel to the eyes. This can result in partial or total visual impairment/blindness.