INTRODUCTION
According to the World Health Organization, a few decades back diabetes was an uncommon disease, in both developed and developing countries. Today, the story is different. It is currently estimated that over 143million people worldwide are affected by the disease. This figure is ever increasing, by 2020 over 220million people are expected to be living with diabetes, if the current trend continues.
In the United States alone, there are 18.2 million people (6.3% of the population) living with diabetes. While another 13million people have been diagnosed with diabetes. Unfortunately, 5.2milion (or nearly one third) are unaware that they have the disease.
The figure for Nigeria is not readily available, but it is estimated that over 1.5million people have diabetes in Nigeria.
In developed countries, most patients of diabetes are over sixty, but in developing countries, diabetes is found to affect people in their prime.
WHAT IS DIABETES?
Diabetes Mellitus (or simply diabetes) is derived from the Greek word 'Diabeinein', meaning 'To pass through' describing copious urination, and Mellitus from the Latin word meaning 'Sweetened with honey'. These two words signify sweetened urine or sugar in urine.
Diabetes is a disease in which the body does not produce or properly use Insulin. Insulin is a hormone that is needed, in the body, to control the rate at which sugar, starch and other food are converted into glucose required as energy for daily life. The hormone is produced and released
into the blood by an organ called 'Pancreas'. This insulin help to maintain the blood glucose level within a normal range. The World Health Organization (WHO) puts this normal range between
60 - 100mg/dl (Before taking any food for the day, hence this value is called Fasting Blood Glucose). In health, despite several demands for glucose in different situations, the blood glucose rarely exceeds this value.
After a meal the liver stores the glucose from the meal as glycogen and releases it into the blood in between meals. The role of insulin is the control of this storage and release of glucose. It ensures that the amount of glucose in the blood at every particular time does not go beyond or below the normal range.
TYPES OF DIABETES.
According to the World Health Organization (WHO), five classes of diabetes are recognized, these are; Insulin Dependent Diabetes Mellitus (IDDM) or Type I Diabetes, Non Insulin Dependent Diabetes Mellitus (NIDDM) or Type II Diabetes, Gestational Diabetes, Diabetes Insipidus and Bronze Diabetes.
INSULIN DEPENDENT/TYPE I DIABETES : This type of diabetes was initially called Juvenile onset diabetes because it affects adolescents and young adults. It is caused by a sudden failure of the pancreas to produce Insulin. It is, therefore, an acute disease, presenting with thirst, polyuria (passing large amount of urine), diuresis and weight loss. Type I diabetes is not common, it accounts for less than 10% of all diabetes cases.
NON-INSULIN DEPENDENT/ TYPE II DIABETES : This is the most prevalent type of diabetes, accounting for more than 80% of all diabetic cases. It is found in adults and the elderly. This type of diabetes develops gradually over a long period of time (unnoticed) and is characterized by insufficient insulin, deficient insulin in the blood or the inability of the body to utilize the insulin resent (Insulin resistance). Because of its slow and gradual occurrence, it is mostly undetected until one or more of its long-term complications appear.
Unlike in Type I Diabetes, the Insulin in the blood of a Type II diabetic may be normal or even high, but lacks the desired effect, due to insulin resistance, and this is prevalent among obese people.
GESTATIONAL DIABETES : This type of diabetes occurs during pregnancy and disappears after delivery, within 3weeks. An estimated 3% of all pregnancies are accompanied by gestational diabetes and almost half of these patients are prone to developing permanent diabetes later in life.
WHAT CAUSES DIABETES???
As with hypertension and other non communicable diseases, no clear cut cause(s) can be attributed to the most prevalent type of diabetes (Type II Diabetes, Type I diabetes being secondary to failure of the pancreas). However, some factors are known to increase one's chances of becoming diabetic and these are called risk factors. For example, indolent and well-fed populations are 2 - 20times more likely to develop type II diabetes than active and lean population of the same race. Some other factors known to increase one chances of getting diabetes include:
OBESITY : It is estimated that three quarter (¾) of all Type II diabetes patient are obese. Indolent and affluent lifestyles tend to contribute to this. It is believed that a 10kg loss of weight can reduce fasting blood sugar level by almost 50md/dl. An active lifestyle with frequent exercise is also known to increase Insulin sensitivity.
The International standard for measuring overweight and obesity is based on a value called BODY MASS INDEX (BMI). This value is derived by dividing the body weight (in Kilograms) by the square of height (in metres).
i.e. BMI = Body weight (Kg) / Height2 (Metres).
Note: 1ft = 0.305metres.
For adults, a BMI less than 25kg/m2 is preferred.
25 - 29kg/m2 is considered overweight and above 30kg/m2 is Obesity.
FAMILY HISTORY : A family history of diabetes increases one's chances of getting the disease. In such a situation, leading a healthy lifestyle and constant monitoring of one's blood sugar level becomes very important.
AGE AND RACE : Most Type II diabetes patient are over 40yrs at presentation of the disease. However, the proportion of increase in the incidence of this disease with age is higher for those with a family history of diabetes, obese and probably those leading sedentary lifestyles. Moreover, diabetes tends to be more prevalent among Africans, African Americans, Latinos, Native Americans and Asian Americans. Belonging to any of the races is a risk factor in itself.
HISTORY OF GESTATIONAL DIABETES : in a woman also increases her chances/possibility of developing permanent diabetes later in life.
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