I'm quite certain that the majority of individuals reading this have heard the word "diabetes". Many would have had their Health Care Provider say these words to them "Your diagnosis is diabetes mellitus". For many, they immediately feel they are in a rollercoaster.

A BRIEF OVERVIEW OF DIABETES
Diabetes is a disease of sugar metabolism. I will give a brief description of sugar metabolism in a normal individual called Mr A.

1. Mr A eats food and the food is immediately broken down (or converted) to glucose (sugar). Glucose is the body's main source of energy, which is why the food we eat is converted to glucose. Its like travelling to a foreign country, you need to change your currency notes to that of your destination country otherwise it will be impossible to buy.
2. After the meal, the level of glucose in the blood (blood glucose level) begins to rise.
3. The brain senses this rise and directs the pancreas (an organ in the abdomen) to release insulin into the blood stream.
4. Insulin now "leads" glucose into the cells. It acts like a key which unlocks the door of the cells so glucose can go in.
5. The level of glucose in the blood stream begins to drop.
6. The brain again senses the drop and directs the liver (an organ in the abdomen which stores glucose in addition to other functions) to release glucose from its store house.
7. This is how the blood sugar level is maintained within a range.

 

For a diabetic individual, the metabolism is still the same with some modification(s) in steps 3, 4 and 5. These modifications will be outlined in the steps below for diabetic Mr A.

1. same as above
2. same as above
3. depending on the type of diabetes
1. Type I diabetes: Insulin is not produced by the pancreas and thus there is no key to unlock the door of the cell for glucose to go in.
2. Type II diabetes: Insulin is produced but the cells are relatively resistant or insensitive to insulin. It's like when a key which previously has been opening a door becomes faulty and you have to struggle with the door lock before it opens. (Quantity of insulin produced may also be less than required)
4. Glucose remains in the blood stream and does not get into the cells of the body.
5. The level of glucose in the blood continues to rise till it begins to pour into the urine.

We can also use this model to explain the common symptoms of diabetes which are;
Polyphagia (excessive hunger): because glucose is not getting into the cells readily, the cells become starved of energy and they "cry" out to the brain. The brain interprets it as a need for food and responds by making diabetic Mr A hungry. As he eats, he only gets hungrier because the cells still don't get glucose and keep crying to the brain.

Polydipsia (excessive thirst): inability of glucose to get into the cells of the body results in the blood becoming too concentrated (high osmolality). The brain senses this and responds by making Diabetic Mr A thirsty. The thirst is however not quenched because the blood remains very concentrated as a result of glucose being unable to get into the cells.

Polyuria (excessive urination): As a result of drinking large volumes of water, Diabetic Mr A ultimately passes out large volumes of urine.

Weight Loss: despite a voracious appetite, Diabetic Mr A keeps loosing weight. This is as a result of the glucose not getting into the cells. Despite a high glucose level in the blood, the cells are starved of energy and leanness results.

Kindly ask your Health Care Providers to discuss other symptoms of diabetes mellitus as well as the complications some of which are listed below. Also discuss Gestational Diabetes, Pre diabetes and metabolic syndrome (syndrome X).

Diabetes tends to affect all systems of the body and has various complications which your Health Care Provider can explain to you. But a summary of the major ones are listed below

1. Heart disease and stroke.
2. Kidney disease.
3. Eye disease.
4. Foot and leg problems.
5. Sexual problems.
6. Stomach and intestinal problems.
7. Problems with teeth, skin and gums.

 

Management of diabetes
Based on the model of diabetes described above, I will attempt a brief explanation of the concepts in managing diabetes. Before going on, I want to emphasize that the management of diabetes rest solely on you the patient and not on your Health Care Provider. The Health Care Provider like a captain guides you while the daily tasks rest on you. Failure to achieve good control of blood sugar implies failure of the patient to play his/her part. This is called self management and the key parts are;

1. Monitoring blood glucose.
2. Following a meal plan.
3. Taking medication.
4. Getting regular exercise.

 

Monitoring blood glucose;
It is clear from the models above that the problem is insulin which results in excessive amount of glucose in the blood stream. Diabetes mellitus can be managed effectively when we (the patient and the Health Care Provider) "assist" insulin and the brain in their functions.

1. The brain senses the levels of glucose in the blood and acts appropriately. A diabetic patient needs to "sense" what level his/her blood glucose level is. This can only be achieved with the use of glucose meters. Do you have one?
1. Check you blood sugar before every meal.
2. Check it again two hours after every meal.
3. Check you blood sugar before exercise.
4. Check it again immediately after exercise.
5. Can check at any other time.
2. If you do not own a glucose meter, then you are not ready to get a good control of your blood sugar.
3. For the first three months it is advisable to monitor your blood sugar as indicated above and you will have a better understanding of what makes your blood sugar go up and go down.
4. Remember to take your blood sugar log to your doctor on every visit.

Following a meal plan;
You need to speak to a dietician or an expert in nutrition for a meal plan. A strict chain of "do's" and "don'ts" have never been effective in achieving a good control of blood glucose. Remember you still need a balanced meal. Key points here are

1. Establish consistent eating patterns.
1. Eat meals and snacks at regular times every day.
2. Don't eat between meals except for planned snacks.
3. Don't skip meals.
4. Eat about the same amount of carbohydrate each day.
5. Evenly space your carbohydrates through out the day.
2. Choose food wisely.
1. Eat lots of fruits and vegetables.
2. Eat more whole grains.
3. Choose unsaturated fats and oils
4. Choose heart healthy proteins
5. Select low fat diary products
6. Limit your sodium, sugar and alcohol intake
3. Control your portion size.
1. Measure of weigh it
2. Eat slowly
3. Read the label
4. Develop "hand-eye coordination". (Using your hand to estimate portion sizes).

The essence of a good meal plan is to ensure that your blood sugar levels does not fall too low or rise too high.

Taking medication;
Depending on the type of diabetes you have been diagnosed of, your Health Care Provider may prescribe medications for you. It could be pills or injections. Do not feel shy to ask your Health Care Provider any questions concerning your medications. Take the medication(s) as directed by your Health Care Provider and if you encounter a problem with any of the medications, report to your Health Care Provider as soon possible.

Getting regular Exercise
In diabetes, exercise is important for the following reasons

1. Lowers you blood glucose and improve your body's ability to use glucose.
2. Helps reverse insulin resistance.
3. Helps to control blood pressure and cholesterol.

It's important to discuss with your health care provider before commencing any exercise programme.

With this brief overview of diabetes, I believe you should be ready to start your fight against diabetes and win. Remember you need;

1. A glucose meter.
2. Keep a record of your daily blood glucose measurement.
3. Visit your health care provider regularly for check ups and blood test.
4. Follow all the advice of your health care provider.
5. Observe the key parts of active self management.

Good luck and welcome to ANASO DIABETES LOG COMMUNITY.

 

 

DR C. C. ANASO.