Diabetes is not a death sentence

Diabetes is a chronic medical condition in which the levels of blood sugar (blood glucose) are too high.

As explained by Dr Nancy Kunyiha, a diabetes specialist, 3.3 per cent to 7 per cent of Kenyan population has diabetes. Surprisingly, 65 per cent  of those living with the condition do not know that they have it.

There is an increasing number of people living with diabetes across all the adult population.  Diabetes has no cure hence though it can be controlled through diet and insulin injections.

Dear doc,

Kindly explain the difference between diabetes type I and type II?

Jean.

Dear Jean,

Diabetes type I, also known as juvenile or insulin-dependent diabetes usually affects younger children. It can occur in newborn children in rare occasions as neonatal diabetes. The actual cause is not known but it is thought to be as a result of damage to the cells in the pancreas (islets) that makes them unable to produce insulin.

This means that children who develop diabetes require insulin for life and cannot survive without insulin. On the other hand, Type 2 Diabetes usually affects an older population ( above 40 years) but more recently it is occurring in younger people( less than 35 years) due to the increase in obesity in our populations and globally. Type 2 is attributable to several factors which include genes, rate of natural pancreatic cell decline, and increased insulin resistance which is contributed to by eating poorly and being obese or overweight. As compared with type I, in type 2 diabetes the pancreas still produces some insulin but it is not enough to keep sugars normal and there is insulin resistance which means that fat prevents insulin from working as it should to lower sugars. Type 2 may be managed with exercise, diet and tablets and/or insulin, but type 1 is solely managed with insulin and a healthy lifestyle.

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Dear doc,

What are the risk factors for diabetes type 2?

Greg.

Dear Greg,

Normally, risk factors are categorised as modifiable and non modifiable. Non-modifiable are factors that a person can do nothing about. These include being age 40 and above, previous gestational diabetes, previous delivery of a large baby over 4kg, and a history of diabetes in the family (genetics) whereby having a first degree relative for example, mother, father, or sibling with diabetes puts a person at risk of developing diabetes type 2. 

Africans are at a greater risk of diabetes type 2. Modifiable risk factors (which a person can prevent) include inactive or sedentary lifestyle, excessive consumption of alcohol, poor eating habits that can cause obesity. Being obese means that insulin produced does not work as well as it should.

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Dear doc,

How long does it take for blood sugar levels to go back to normal in women with gestational diabetes and is there a risk of developing diabetes in future?

Vanessa.

Dear Vanessa,

Usually, women with gestational diabetes (a type that develops in pregnancy) will have their sugars going back to normal immediately after delivery. However after six weeks it is recommended that blood sugar level is tested to ensure that sugars are normal.

About 60 per cent  of females with gestational diabetes will develop diabetes at some time in their lives and therefore must recognise this as a risk for diabetes.

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Dear doc,

When can a person stop medication and start managing diabetes with diet ALONE?

Wanja.

Dear Wanja,

Diabetes managed with diet alone usually happens when one is able to modify lifestyle with significant diet changes and weight loss.

However, as the pancreas also age with time, it is not always easy to stay off therapy for life and many times  use of medications will be introduced at some point.

It is therefore very essential that even if one is on diet that is monitoring sugars, he or she should continue medication even with normal levels over the years.

If one has been on therapy, it is advisable that diet only treatment decisions are made with the doctor with certainty that sugars have been very well controlled before medications are withdrawn.

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Dear doc,

How do pills and insulin injections work in treatment for diabetes?

Kyle.

Dear Kyle,

Pills work in various ways. Metformin, one of the most widely used in type 2 diabetes works in the liver and muscle to improve insulin use. There are some tablets called sulphonylureas that work by stimulating the pancreas to produce insulin.

There are various other groups of drugs that work in different ways affecting various hormones in the body to improve insulin production and use and others that work locally by reducing absorption of glucose in the intestine like acarbose.

Your doctor would usually guide on what treatment combination is suitable for you. Most people living with diabetes will require more than one medication to control diabetes well. Insulin works by supplementing the work of the pancreas in type 2 diabetes.

As the pancreas function declines then one would require insulin instead of or with tablets to control diabetes.

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KNOW YOUR BODY

Insulin regulates blood sugar

THE DIGESTIVE TRACT breaks down sugars, starches and carbohydrates present in foods into glucose which is easily absorbed in the blood.

Blood glucose is very essential to health as it acts as fuel that gives the body energy it requires to carry out its functions. Nerves and the brain also depend on a steady supply of glucose for their functioning.

In order for the body cells to be able to absorb glucose and utilise it for energy, insulin must be present. Insulin is a hormone that is produced naturally in the body by pancreas, a gland that is located behind the stomach.

The pancreas contains a mass of cells known as islets. Within the islets are cells called beta cells which manufacture and release insulin into the bloodstream. Once glucose has entered into the bloodstream, the pancreas reacts by releasing insulin into the blood.

Insulin stimulates body cells to absorb glucose for energy and helps lower the levels of glucose in the bloodstream by reducing production of glucose in the liver.

Insulin also stimulates the muscle tissue and the liver to store excess sugar as a future source of energy. The extra sugar is stored in form of glycogen. The pancreas releases just enough amount of insulin in response to a meal in order to prevent blood glucose from getting too high.

If blood glucose cannot get into the cells, it ends up accumulating in the blood stream. If not treated, high levels of blood glucose (hyperglycemia) can result into lasting complications.

INSULIN RESISTANCE

In addition, when blood glucose gets to a certain level, it is eliminated by kidneys through urine. This can result in a need to pass urine more frequently, a situation which can make a person feel thirsty, hungry and tired.

When in normal state, the body is able to make the amount of insulin it needs. This process is usually automatic in persons who are not diabetic. However, in diabetes there are problems with insulin.

The body may not be producing enough insulin or the insulin produced is not working as it should be. Due to these problems with insulin, the blood sugar level in the blood stream can become too high hence causing serious problems to the health.

The body is almost always producing some amount of insulin, referred to as basal amount of insulin. This is needed because when sleeping and between the meals, the liver continuously releases some of the stored glucose into the bloodstream so as to provide the nerves and brain with glucose.

Basal amount of insulin guarantees an ideal balance between the amount of glucose being utilised by the body cells and that being produced by the liver. This balance is essential in preventing either high or low levels of glucose.

Insulin resistance is a condition where the body is producing insulin but it is not able to utilize it well. Consequently, higher levels of insulin are needed to enable absorption of glucose into the cells. With time, the pancreas becomes unable to keep up with the body’s increased demand for insulin.

Insufficient insulin production leads to accumulation of excess glucose in the blood and this can result into prediabetes, type II diabetes, and other health problems. Some people may not be aware that they are insulin resistance, until the time they develop type II diabetes. However, knowing that you are insulin resistance early in life can often help in preventing or delaying the onset of diabetes by making necessary lifestyle changes.

What is the normal blood sugar level? Fasting blood sugar (when one has not eaten for 8 -12 hours) = 4 to 5.6 mmols/l. Some guidelines use 6mmols/l as the upper limit.

Normal levels after eating = 4 to 7.8 mmols/l