DIABETES
Overview
Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst and hunger as well as fatigue.
Diabetes is diagnosed by blood sugar (glucose) and urine testing. The major complications of diabetes are both acute and chronic. The objectives good diabetes management can only be achieved by strict blood glucose control and regular screening for diabetes complications. Regular follow-up of all individuals with diabetes is therefore important to assess their metabolic control. The promotion of appropriate diets still remains a powerful weapon in the fight against diabetes. Diabetes is a chronic treatable disease but not a curable disease. Insulin cannot be replaced.
What Is Diabetes
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. It is due to multiple genetic and environmental factors, which result in defects in the action or secretion of insulin thereby causing a disturbance in the metabolism of carbohydrates, fat and protein. Insulin is a hormone made by the pancreas which helps glucose from food eaten get into your cells to be used for energy. Blood glucose is your main source of energy and comes from the food you eat. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
Over time, having too much glucose in your blood can cause health problems.
Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” It is also called ‘asekyire yadea’ among the Akans in Ghana.
Many individuals with diabetes do not complain of symptoms. There is therefore the need to screen all patients (including pregnant women) attending health facilities to exclude diabetes. Type II diabetes is on the increase and is a major public health concern. It is increasing in line with increasing life expectancy, urbanization, sedentary living and the development of obesity. A diagnosis of diabetes is suggested when the fasting whole blood glucose levels is 6.1 mmol/L or more and / or random blood glucose, takes 2 hours after a meals or 75g glucose load (1.75 g/kg body weight in children) is 10.0 mmol/L or more.
TYPES OF DIABETES
The most common types of diabetes are type 1, type 2, and gestational diabetes.
Type 1 Diabetes
In type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.
Type 2 Diabetes
In type 2 diabetes, your body does not make or use insulin well. Type 2 diabetes can be developed at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.
Gestational Diabetes
Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.
Other Types Of Diabetes
Less common types cystic fibrosis-related diabetes monogenic diabetes, which is an inherited form of diabetes.
Secondary Diabetes
“Secondary” diabetes refers to elevated blood sugar levels from another medical condition. Secondary diabetes may develop when the pancreatic tissue responsible for the production of insulin is destroyed by disease, such as chronic pancreatitis (inflammation of the pancreas by toxins like excessive alcohol), trauma, or surgical removal of the pancreas.
Hormonal Disturbances
Diabetes can also result from other hormonal disturbances, such as excessive growth hormone production (acromegaly) and Cushing’s syndrome. In acromegaly, a pituitary gland tumor at the base of the brain causes excessive production of growth hormone, leading to hyperglycemia. In Cushing’s syndrome, the adrenal glands produce an excess of cortisol, which promotes blood sugar elevation.
What Goes Wrong In Diabetes?
The body’s response to blood sugar requires the coordination of an array of mechanisms. Failure of any one component involved in insulin regulation, secretion, uptake or breakdown can lead to the build-up of glucose in the blood. Likewise, any damage to the beta cells, which produce insulin, will lead to increased levels of blood glucose.
Simply put, in Diabetes there is either Insufficient, total lack of and/or dysfunction of insulin in the blood. This is characterized by abnormally high levels of glucose in the blood. Whereas non-diabetics produce insulin to reduce elevated blood glucose levels (i.e. after a meal), the blood glucose levels of diabetics remain high. This can be due to insulin not being produced at all, or not in quantities sufficient to be able to reduce the blood glucose level.
SYMPTOMS
Many patients with diabetes do not have symptoms. Their diabetes is only detected on screening test. Patients presenting with symptoms may have the following:
- Polyuria – passage of large amount of urine
- Polydipsia – Thirst and excessive drinking of water
- Polyphagia – excessive eating from excess hunger or increased appetite
- Recurrent boils
- Pruritus vulvae
- Unexplained weight loss
- Presence of ketones in the urine (ketones are a by product of the breakdown of muscle and fat that happens when there’s not enough available insulin)
- Fatigue
- Irritability
- Blurred vision
- Slow-healing sores
- Frequent infections, such as gums or skin infections and vaginal infections
RISK FACTORS
The risk factors for type 2 diabetes include:
- being overweight
- a family history of diabetes
- having a high-density lipoprotein (HDL) cholesterol level lower than 40 mg/dL or 50 mg/dL
- a history of high blood pressure
- having gestational diabetes or giving birth to a child with a birth weight of more than 9 pounds
- a history of polycystic ovary syndrome (PCOS)
- being of African-American, Native American, Latin American, or Asian-Pacific Islander descent
- being more than 45 years of age
- having a sedentary lifestyle
DIAGNOSIS
A diagnosis of diabetes is suggested when the fasting whole blood glucose levels is 6.1 mmol/L or more and / or random blood glucose, takes 2 hours after a meal or 75g glucose load (1.75 g/kg body weight in children ) is 10.0mmol/L or more.
TREATMENT /MANAGEMENT
Treatment or management of diabetes is than through the pharmacological and non- pharmacological. Goal of Treatment involves control of hyperglycemia to relieve symptoms and prevent complications while minimizing hypoglycemic episodes.
Treatment may be
- Diet and exercise
- For type 1 DM, insulin
- For type 2 DM, oral antihyperglycemics, insulin, or both
- Often other plant medicine may be added to prevent complications
Non –Pharmacological Treatment
In patients who usually have Type 2 diabetes, diet alone should be tried first. When diet fails to achieve satisfactory control, non-obese patients are usually treated with orthodox or herbal medication.
Patient Education
Education about causes of Diabetes, diet, exercise, drugs, self-monitoring with fingerstick testing, and the symptoms and signs of hypoglycemia, hyperglycemia, and diabetic complications is very important to optimizing care. Most patients with type 1 Diabetes can also be taught how to adjust their insulin doses. Education should be reinforced at every physician visit and hospitalization.
Diet
All patients with diabetes require diet therapy. All patients must have individualized meal plans. Eating a diet high in fresh, nutritious foods, including whole grains, fruits, vegetables, lean proteins, low-fat dairy, and healthy fat sources, such as nuts. The total caloric content (portions) of meals must be reduced and the amount of fiber in the meal increased in those who are also overweight or obese.
Patients must avoid
- Alcohol, tobacco smoking.
- Avoiding high-sugar foods that provide empty calories, or calories that do not have other nutritional benefits, such as sweetened sodas, fried foods, and high-sugar desserts.
- Refraining from drinking excessive amounts of alcohol or keeping intake to less than one drink a day for women or two drinks a day for men.
Exercise
Regular, simple exercise (e.g. walking 45 mins to 1hour daily) is helpful in ensuring good blood glucose control. All advice on exercise must give consideration to the patient age and the presences of complication and other medical conditions.
Pharmacological treatment of Diabetes.
Diabetes is managed using different plants that has the ability to enhance the production of insulin, increase the sensitivity of insulin receptors or/and enhance metabolism.
Plants commonly used in Ghana for the management of diabetes are:
- Phyllanthus amarus
- Allium cepa
- Mangifera indica
- Momordica charantia
- Psidium guajava
- Anthocleista nobilis
- Desmodium adscendens
- Vernonia amygdalina
- Lippia multiflora
- Nauclea latifolia
Dandelion - Tetrapluera tetraptera
- Catharantus roseus
- Bridelia ferruginea
- Sclerocarya birrea
- Moringa oleifera
- Zyziphus mauritiana
- Ageratum conyzoides
- Azadirachta indica
- Launea taraxacifolia
Complications
- Acute: Short term complications of diabetes could be
- Severely elevated blood sugar levels due to an actual lack of insulin or a relative deficiency of insulin:
- Symptoms of diabetic ketoacidosis (Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis.) include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death.
- Abnormally low blood sugar levels due to too much insulin or other glucose-lowering medications: dizziness, confusion, weakness, and tremors.
- Chronic: Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life threatening. Possible complications include: Impotence, foot gangrene/ulcer, poor vision, stroke, heart attack, infertility, large babies, recurrent still births, miscarriages, renal failure.
Prognosis
Diabetes has a good prognosis with i) Early diagnosis ii) regular management and a Worse if otherwise
Prevention and Control
Diet soft drinks, which contain a sweetener and not glucose, may however be used. Avoid risk factors
Reference
Ghana Herbal Pharmacopoeia (1992), 3,32,46,56,100. The Advent Press: Accra, Ghana.
Mshana, N.R., Abbiw, D.K., Addae-Mensah, I., Ahiyi, M.R.A. et al (2000). Traditional medicine and pharmacopoeia. Contribution to the revision of Ethnobotanical and Floristics Studies of Ghana. Organisation of African Unity/Scientific, technical and research committee.
Diabetes Symptoms, (Type 1 and Type 2) https://www.medicinenet.com/diabetes_mellitus/article.htm Accessed May 27, 2019
An overview of diabetes types and treatments. https://www.medicalnewstoday.com/articles/323627.php. Accessed May 27, 2019
What is Diabetes? https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes. Accessed May 27, 2019
