By Maxwell Bisala Konlan RD, LD, MPH. (Senior Dietician, University of Ghana Hospital)
What is diabetes?
Diabetes is a condition in which a person has high blood sugar (glucose) in the blood either because there is less insulin production or because the cells of the body do not respond to the insulin that is produced. Insulin is a chemical (hormone) in the body that helps cells to take up glucose from the blood so it can produce energy for the body. It also helps the body store excess glucose in the blood in a different form and in another part of the body.
What happens after eating?
After food consumption, the carbohydrates in foods are broken down into a simple sugar called glucose. After the breakdown insulin is produced to remove the sugar (glucose) from the blood into the cells of the body for nourishment. The problem of people with diabetes is that, after breakdown of carbohydrates into sugar either insulin is not enough or the cells of the body do not respond to insulin produced. It could also be a combination of both, hence making it difficult to remove the sugar from the blood. This failure to remove the excess sugar from the blood results in high blood glucose (sugar) levels in the blood leading to diabetes.
What are the signs and symptoms of diabetes?
High levels of diabetes will trigger the following symptoms and signs.
- Frequent urination
- Frequent thirst
- Unintentional weight loss
- Blurred vision
- Frequent hunger
- Fatigue and dizziness
- Difficulty having erection or sustaining erection during sex in men.
What are the types of diabetes?
There are mainly three types of diabetes which include;
- Type 1 diabetes
It accounts for 10% of all diabetes cases. Occurs when the body produces very little or no insulin at all due to destruction of the insulin-producing (beta) cells of the pancreas. There is no known cause. Evidence, however, suggests it may be associated with genetics and environmental exposure leading to destruction of the beta cells.
- Type 2 Diabetes
Type 2 diabetes accounts for 90% of all diabetes cases. It’s mostly common among overweight or obese people. The risk of type 2 diabetes is directly proportional to the increase in weight. It is the most common cause of diabetes. Majority of diabetes cases are related to type 2 diabetes. In Type 2 diabetes, the body produces insulin but cells of the body to not respond to the insulin that is being produced. This type of diabetes is highly preventable because it is lifestyle associated.
- Gestational diabetes
Gestational diabetes occurs during pregnancy due to certain hormones produced during pregnancy, impairing insulin action leading to high blood sugar. Gestational diabetes mostly resolves after birth. Women with gestational diabetes are likely to get diabetes if they do not adapt to healthy life style and behavioral change.
What causes diabetes?
Researchers have not been able to ascertain the causes of diabetes, however it has been associated with certain risk factors. These risk factors do not directly cause diabetes but can put one at risk of diabetes. They include;
- Family history of diabetes
- Being obese or overweight
- Increasing age
- Unhealthy eating pattern (Excess carbohydrate intake, excessive fat intake, late night eating, low intake of fruits and vegetables, excess consumption of processed or refined foods)
- Excessive alcohol consumption
- Lack of exercise
What is the current prevalence of diabetes in Ghana and globally?
According to the World Health Organization (WHO) diabetes is currently ranked the sixth leading cause of death worldwide. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Diabetes prevalence has been on the rise more rapidly in middle and lower income countries.
WHO reports that between a period of 2016 to 2017, Ghana was ranked sixth among other countries in Africa with the highest reported cases of diabetes. Undiagnosed diabetes accounts for 70% of diabetes cases in Ghana. The above ranking of diabetes prevalence in Ghana among other Africa countries is a cause for concern.
What are the complications of diabetes?
- According to WHO, diabetes is a major cause of kidney failure. High sugar levels in the blood can destroy small blood vessels in the kidneys and result in kidney failure.
- Diabetes is the major cause of leg amputation in the world. Wounds of people with poorly controlled diabetes does not easily heal and small wound such as needle prick in the foot can escalate into a bigger wound which may lead to leg amputation.
- Diabetes is also a major cause of blindness. Excess blood sugar in the blood can cause destruction of tiny blood vessels in the eye, cutting blood supply to the eyes which can contribute to blindness. The initial buildup of sugar in the blood is mostly associated with blurry vision and can later progress to blindness if not addressed.
- Diabetes can increase one’s risk of blood clots and put one at risk of stroke or heart attacks.
- Diabetes can lead to impotence in men. High amount of sugar in the blood can result in erectile dysfunctional and difficulty maintaining erection during sex.
How do I know I have diabetes?
The gold standard for knowing you have diabetes is to do a blood sugar test. There are several of such tests which include;
- Fasting blood glucose (FBS). This test is done first thing in the morning when you have not eaten or drank anything for at least 8 hours. With reference to WHO, a fasting sugar of greater than 7mmol/l on 2 or more separate occasions depicts diabetes.
- Another test that can be done is random blood sugar (RBS). This test is done after the patient has eaten. An RBS of greater than 11.1mmol/l on 2 or more separate days depicts diabetes.
- Another test that can be done to confirm diabetes status is glycated hemoglobin. It measures the sugar control for the patient for the past 3 months. It is the most accurate biochemical indicator to confirm a person’s diabetes status after an initial high FBS and RBS values. A glycated hemoglobin of more 7% depicts diabetes.
- In pregnancy, the FBS, RBS and glycated hemoglobin can be used as monitoring indicators but not too sensitive for diagnosing diabetes due to maternal hemo-dilution and hence for that matter, oral glucose tolerance test is the gold standard for diagnosing diabetes in pregnancy. An oral glucose tolerance test of 7.8 after 2 hours confirms gestational diabetes.
- Mahan, L. K., Escott-Stump, S., Raymond, J. L., & Krause, M. V. (2012). Krause’s food & the nutrition care process. Elsevier Health Sciences.
- hptts://care.diabetesjournals.org/content/diacare/38/Supplement_1/S8.full.pdf (Date accessed, 17th November, 2019)
- World Health Organization. (2011). Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation (No. WHO/NMH/CHP/CPM/11.1). Geneva: World Health Organization.
- Lorenzo, C., Williams, K., Hunt, K. J., & Haffner, S. M. (2007). The National Cholesterol Education Program–Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes care, 30(1), 8-1
ABOUT THE AUTHOR
Maxwell Bisala Konlan is a Senior Dietitian at the University of Ghana Hospital. He has a background in Dietetics and Masters of Public health in the same University with four (4) years of working experience. Maxwell is a young enthusiastic young professional who is committed to improving the lives of people in the community through health promotion and education. His interest in improving food environments has inspired him to partner with “Tasty treats Ghana” one of the biggest food service company in the University of Ghana to set up a special diet services to provide healthy meals to people who want to eat healthy or living with chronic diseases within the university of Ghana campus. Aside his work as a Dietitian, He is also a nutrition consultant for Executive Heart Centre and a part time Lecturer at Oak City College Nursing School.