Diabetes mellitus and Depression

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Diabetes mellitus is a metabolic disorder resulting in characteristic rise in plasma blood glucose. There is also a cascade of hormonal disturbance as the body try to compensate for this disorder.
The first time a person is diagnosed with diabetes, there seems to be a weight of emotions tied to that person. There is confusion as to what to eat, how to leave and loads of many questions like ‘why me’, ‘what will people say’ amongst others.
The initial reaction or response to this early stage goes a long way to tell how someone copes with diabetes later in life. The early stage of diagnosis if not properly managed by the doctor and relations, then depression automatically finds a root.
Depression could result if one no longer take interest or pleasure in things you used to enjoy doing, you have trouble falling asleep, wake often during the night, or want to sleep a lot more than usual, you wake up earlier than usual and cannot get back to sleep, you eat more or less than you used to, you quickly gain or lose weight. Feeling down once in awhile is normal. But feeling really sad and hopeless for 2 weeks or more might be a sign of serious depression.
Research has shown that depression mostly arises in persons diagnosed with diabetes following periods of denial, anger and frustration.
Diabetes clinics cannot do without the services of Diabetes Educators who are crucial in handling the initial stage of diagnosis and the period of living with the condition.
It is important to make the patient realize that diabetes is not a death sentence, people can have a full and normal life even with diabetes. Relations of people with diabetes must be made to know their responsibilities of care and support. Diabetes must be handled as a team, where the person with the condition is the team leader who takes decision in other for the goal to be attained.
Relations must be on the watch for signs of depression and inform the physician or any member of the diabetes care team promptly.
The following are useful tips on detecting depression:
• You have trouble concentrating, other thoughts or feelings distract you, you have no energy, you feel tired all the time, you are so anxious or nervous, you can’t sit still, you cry often, you feel you never do anything right and are a burden to others, you are less interested in sex, you sad or worse in the morning than you do the rest of the day, you feel you want to die or are thinking of ways to hurt yourself etc.
If someone Notice these sign in oneself or a relation or loved one call for urgent attention.
Some researchers are looking at the bidirectional tendency of depression and diabetes. Some school of taught suggest that people with depression if unattended to could develop type 2 diabetes but the mechanism is still hypothetical but one could infer that insulin resistance might be responsible.
Living with diabetes is not easy, considering the daily challenge of what to eat, what the blood glucose level is and the cost of medications.
Diabetes therefore should be seen as a journey not a destination, hence persons with diabetes requires a lot of support, encouragement and goodwill to make the journey without wearing the clothes of depression.

LIVING WITH DIABETES IN RURAL AREA- SUBSAHARAN AFRICA PERSPECTIVE.

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Diabetes mellitus is a metabolic disorder in which the individual lacks the ability to control normal metabolism of carbohydrates, protein and fats, due to absence or partial activity of Insulin.
Over the years, many theories and practices have emanated towards alleviating this condition. Ranging from orthodox medical approach to trado-medical practices. It is even worthy of note that some traditional healers or herbal doctors make bold to say they have gotten cure. I however, have not seen anybody who is totally cured, hence in my practice as a diabetes Educator, I constantly remind my patients that there is no cure yet but it can be managed. With all these chaos of medical practice, the person who suffers most are those living with the condition, especially those in rural area.
The information and practice of medical practitioners in rural area is in most cases at parallel to what is obtainable in cities. For instance in rural area of sub-Saharan Africa, many patients are being told not to eat anything containing carbohydrate but to concentrate on proteins in form of beans. I have met people who thrive on beans three times daily for nearly 5 to 10 years for the period of their encounter with diabetes. This makes life unpalatable, uninteresting and not fun.
Persons living with diabetes should be encouraged to balance their meals around the food classes of carbohydrate, protein, vitamins, fibres and roughages inform of vegetables, unsaturated fats and fruits. These food items are commonly available in our environment, the challenge is patronage. Like the saying by Dr Joslin in 1934 “Diabetics who knows the most, live longer and healthier”.
The importance of diabetes education both to patients living in rural area and cities cannot be overemphasized. Our traditional methods of information dissemination like ‘town criers’, market places, churches, mosques, community meetings should be exploited even drama in local languages needs to be encouraged as a means of improving and empowering those living with diabetes.

World Diabetes Day 2010 Celebration

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Finally, World Diabetes Day celebration for the year 2010 has come.It was a great day for us here in Jos, North Central Nigeria. Many stake holders who were involved in the celebration. There was participation by pharmaceutical companies like Taylek drugs company ltd, Pharmacy Plus ltd, Fixcon Networks Ltd to mention but a few. Highlights of the occasion was the presentation of a drama by lenscope media on the need for diabetes Education and poem recitation by the youngest people living with diabetes on the plateau. The youngest is mr Phinas who is 3 years old. The government of plateau state was appropriately involved and media houses where not left out, FRCN, NTA where adequately represented. Coupled with all these celebration Aung Sang suu kyi was released in far away Burma. It was indeed a happy day for me because diabetes is finally having a voice in Nigeria.

ADDRESSING DIABETES EDUCATION NEEDS USING THE POWER OF MOTION PICTURES.

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With the increasing prevalence and incidence of diabetes globally, it is pertinent that diabetes education be incorporated into school curricula. However, for those who are out of school or not opportune to enjoy formal education, it becomes a challenge towards meeting their educational needs.
Majority of the problems of diabetes is fueled by ignorance. It is eminent across board both in on the part of health professionals and persons living with diabetes.
With the outcome of motion pictures, new revolution evolves on how stories and information are passed across to different class of the population. With the introduction of home videos in Nigeria in the 90’s, Africans all over the world got new ways of listening, seeing and feeling the challenges of Africans as told by Africans. These medium has been used to address challenges of female genital mutilation, the problems and ways of preventing vesico vaginal fistula. These medium is equally being exploited to send home the message of HIV infection prevention. This medium is also useful if properly organized by professionals to address the paucity of information and ignorance surrounding diabetes prevention strategies.
As we celebrate this year’s World diabetes day 2010, with a theme of “Diabetes Education and Prevention”, the motion picture as a tool for diabetes education should be considered using local languages like Hausa, Swahili, French, and English. This will help fight ignorance which is fueling the increase incidence of diabetes and other non communicable diseases.

Congressional Briefing by Global Diabetes Initiative to US Congress - Expectations

Following the discussion held at the UN summit on Millennium Development goals assessment, the world has began to retrace its steps to look inwards on neglected concerns. I recently did a write up on Millennium development goals and Diabetes, it was quite alarming at what the statistics are saying concerning the prevalence and incidence rate of diabetes, cancer amongst others.
On September 27th, 2010, Researchers from Albert Einstein College of Medicine of Yeshiva University held a Congressional briefing in Washington D.C, focusing attention on the alarming Global diabetes epidemic.
It is no longer news that incidence of diabetes is increasing worldwide at a rate that exceeds most other diseases. The WHO estimates that by the year 2030, more than 366million people will be suffering from diabetes, a figure far higher than number of persons living with HIV/Aids. Unfortunately majority of this figure about 298million will live in developing Countries especially sub Saharan Africa.
This Congressional briefing is a welcome development and I strongly subscribe to publication of the outcome of such briefing for the consumption of other Legislatures and parliaments across the World.
Like the Words of Wisdom by Ban Ki Moon “Diabetes and other NCDs are public health emergency in slow motion”

DIABETES AND WEIGHT MANAGEMENT STRATEGIES

Weight loss is one way to lower blood glucose and to reduce risks for heart and blood vessel disease. Being overweight is a risk factor for developing diabetes even if one is healthy and not yet diabetic, being overweight could predispose an individual to insulin resistance.
Persons with insulin resistance lack the ability to utilize insulin properly. It is difficult to lose weight for most people. Losing 10 to 20% of weight can have a big impact on an individual’s blood glucose levels.
Losing weight too quickly often results in rebound, hence it is important that it should be slow and steady process. The body weight is determined by the following factors:
- The type of food we eat.
- Physical activity level
- Body build and heredity
- Body chemistry
- Medicines.
Physical activity helps the body to respond better to insulin. If you are overweight, losing weight and maintaining a healthy weight also helps the body respond better to insulin.
The Body Mass Index (BMI) is a relationship of the body weight to height. The internationally accepted standard adopted by National Institutes of Health, National Heart, Lung and Blood Institutes, Clinical Guidelines on the Identification, evaluation and treatment of Overweight and Obesity in adults, the evidence report states that:
Underweight (BMI <18.5)
Normal (BMI 18.5 – 24.9)
Overweight (BMI 25.0 – 29.9)
Obesity Class 1 (BMI 30 – 34.9)
Obesity Class 2 (BMI 35 – 39.9)
Obesity Class 3 (BMI ≥ 40).
A calorie is a measure of stored energy. Eating fewer calories is one way to lose weight. The minimum recommended calories to obtain needed vitamins and minerals is 1200 for adult females and 1500 for adult males. Fad diets and quick weight loss plans can harm health and interfere with diabetes management weight loss of no more than one ib per week is recommended. Awareness of the calorie content of food can also help one choose foods to gain weight or avoid weight loss.
It is important to note that carbohydrates, protein and fat all contribute calories when digested. Hence the teaching by health care providers especially in Africa that people living with diabetes should only eat proteinous foods should be condemned. Fat provides more calories per gram than carbohydrate or protein and is most easily changed into body fat.
Foods high in water and or fiber have fewer calories per bite. Fresh fruits, vegetables and whole grains heave the lowest calorie per bite. These foods tend to require more chewing, take longer to eat and help you feel full and satisfied without lot of calories.
Exercise helps with weight management by burning calories, relieving stress, and maintaining muscle mass. Exercise helps persons with type 2 diabetes improve blood glucose levels by improving insulin sensitivity and decreasing glucose output from the liver.
In some parts of Africa, weight gain is a sign of affluence and well being hence people spend so much money to gain weight but with education and awareness on the dangers of overweight and obesity keeping moderate weight should be encouraged

The Prevalence of Diabetes mellitus in Nigeria updates and challenges

Diabetes mellitus is a metabolic disorder that affects the way the body handles basic food components like carbohydrates, protein and fats. This is mostly due to lack or abnormaly in action or effect of the hormone insulin.
Diabetes mellitus is old with man. Globally, there are different prevalent levels varying from country to country, race and ethnic groups. The International Diabetes Federation in its recent publication came up with prevalence and incidence values around different regions and countries of the World.
Nigeria with over 250 tribes and different culture and food values, the prevalence values has not been uniform though the International Diabetes Federation recorded 3.9% in its current Diabetes Atlas.
Over the past 30years the prevalence of Diabetes has been increasing steadily. In 1971, a hospital survey by Osuntokun et al in Ibadan estimated a prevalence of 0.4%; In 1989, while screening for Diabetes during a World Diabetes Day(November 14) in Lagos metropolis, Ohwovoriole et al found a prevalence of undiscovered Diabetes of 1.6%; A national survey in 1992 by the Non-communicable Disease Expert Committee of the FMOH recorded a prevalence of 2.2% (National)- Lowest 0.5% in Mangu, Plateau State and highest 7% in Lagos Island; A survey by Puepet 1994, in urban adults in Jos metropolis discovered a prevalence of undiscovered Diabetes to be 3.1%; by 2004, a second survey in Jos recorded a prevalence of 10.3%.
The progressive increase in the prevalence rates of Diabetes is associated with lifestyle changes; overweight and obesity, physical inactivity, alcohol consumption, dietary changes and cigarette smoking- factors that are potentially modifiable.
So much attention is being given even recently to Communicable diseases like HIV, Tuberculosis and Malaria at the detriment of the emerging epidemic of Non-Communicable disease like Diabetes, hypertension and heart disease. Over 30% of our elite population including decision-makers is Diabetic. More painfully so, the majority of the Nigerian Diabetic population cannot afford meaningful treatment; and over 80% of the healthy population are ignorant about Diabetes.
There is a need for more sponsored independent studies on prevalence and incidence rates around the different states of the Federation or geopolitical zones in collaboration with the Federal Ministry of Health, to ensure proper documentation for future references and to provide proper policy framework and guidelines for legislators. This is to help formulate appropriate health policies towards prevention and care for people living with diabetes and also to regularize and standardize the treatment guidelines. This is important and urgent because presently there is no nationally accepted guideline for management of diabetes in Nigeria like we have for malaria or Hiv infection.
These standards will help the patients because presently there are pools of information and misinformation even among health care professionals who have not been in touch with current realities and publications on diabetes management.
In some parts of this great country Nigeria, some health care professionals still advice persons living with diabetes not to eat any carbohydrate but only proteins when current research findings advocates use of complex carbohydrates and other food groups in moderate quantity.
The Federal government of Nigeria through the Federal Ministry of Health needs to quickly act through the Diabetes Association of Nigeria which have chapters in many states of the Federation and other stake holders associations and non governmental organizations to ensure uniformity of standards of care and practice.