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How Deborah is rising above diabetes


Diabetes: A fighter's journey

People with type 1 diabetes cannot produce insulin because the beta cells in our pancreas

The beeping of my alarm wakes me up at exactly 6am. Like all other mornings, my first thought is my glucometer kit. I need to check my blood sugar levels.

A drop of blood is all I need to check the sugar levels and, so, I take my kit, which has needles, strips and the glucometer. I prick the tip of my finger with a needle and press it to extract a drop of blood.

Pricking my finger is no longer painful as I have been doing this for so long. I put a strip into the glucometer then place a drop of the oozing blood on it. This minor procedure will let me know if my sugars are on dangerous levels.

As I wait for the reading, I think about the previous night’s dinner. I breathe easy when I remember it comprised high fibre and minimal starch. From a young age, my mother has been adamant that I should always stick to a proper diet. “Always keep the starch at a minimum,” she said on countless occasions.

I also remember taking my shot of Lantus, which is a long-acting insulin I take before bed. This means my blood sugar should not be low. However, I still need to check. The glucometer beeps with a blinking number indicating good news: my sugars are not too low. But, I need to eat something, otherwise, the sugars will go low fast.

THE JOURNEY

My name is Deborah Bosire and I am 21 years old. I have been living with type 1 diabetes for the last 16 years.

I remember the time when my sugars went so low that I collapsed. I was in primary school and as any normal child of that age, I loved playing. Naturally, I am very competitive and I liked testing my limits and because of this, I often went overboard.

On that day, I played longer than I should have and, consequently, my sugars went so low that I collapsed. Luckily, my sister, who knew of my condition, was around and she nursed me back to consciousness.

Living with diabetes requires patience and self-discipline — elements that I had to painfully acquire as I grew up. I need to stick to a strict daily routine that revolves around checking my blood sugars, eating a proper diet, exercising and taking my insulin shots.

Every morning before I take breakfast, I have to do some light exercises. I spend about 40 minutes jogging and stretching. Because of my condition, I cannot do vigorous exercises. However, I try as much as possible to exercise. This is important because it helps my body absorb energy.

After a quick shower, I take my first shot of Humalog — a short-acting insulin that I take during the day before meals. I will need to take two more in the course of the day before any major meals. I never miss a meal, not because I love food, but my life depends on it.

Most people have the usual bread and tea for breakfast. I, on the other hand, minimise on starch and have plenty of food rich in fibres. The insulin I took before breakfast will regulate my blood sugar and break down the sugars from the food I just ate. This, and the occasional sip of water and midmorning snacks, will ensure I have enough energy for the morning part of my day.

BEING DIAGNOSED

I was first diagnosed with type 1 diabetes at five years old. My mother, a health professional, noticed I had swellings under my eyes that would not go away.

The doctor said my body was not producing insulin, so I was not able to breakdown sugars as other people would. Surprised, my mother insisted on a second opinion. The results were the same. My pancreas, which is the body organ that produces insulin, was not functional. Simply put, I would be dependent on insulin shots for the rest of my life.

Insulin medication is a life-saving hormone that complements the lack of insulin production by the pancreas in a type 1 diabetes patient. The hormone helps the body to break down sugars from carbohydrates for energy.

People with type 1 diabetes, like me, cannot produce insulin because the beta cells in our pancreas are either damaged or destroyed. Therefore, we take insulin shots to replace what we lack and help us avoid complications.

As a chronic disease, diabetes is categorised as one of the four main types of non-communicable diseases, which, together with the other three (cancer, chronic respiratory diseases, and cardiovascular diseases), are among the leading causes of deaths per year globally.

However, unlike type 2 diabetes that is associated with an individual’s lifestyle and is more common around the world, type 1 does not have any known cause. It is so far the most common endocrine disorder in children and adolescents worldwide.

CHANGE OF LIFESTYLE

With the diagnosis, my life completely changed. I had to learn from a tender age what and when to eat, how to play and my limits.

I needed to monitor my sugars several times each day, so that they don’t go too low or too high. I can’t go anywhere without my insulin shots. I am on a fixed insulin dose therapy that comprises Humalog and Lantus.

Humalog insulin takes about 30 minutes to work and stays active for five to eight hours while Lantus takes about one to two hours to be active and lasts for 24 hours.

At first, I was bothered since the injections were painful, but I got used to them. The insulin also causes lumps in my skin. Because of that, I interchange my injection spots. I inject my thighs, upper arms and sometimes my abdominal muscles to allow other areas to heal. However, I now use insulin pens that are less invasive and not painful at all.

Although insulin is available in the market, it is expensive especially because it is a lifelong medication. I am among the fortunate individuals who benefit from the diabetes programme at University of Nairobi, where I am a student. The university provides all my insulin medication.

I use five vials of Humalog and one vial of Lantus every month. In the pharmacies, one vial of Humalog and Lantus costs Sh1,350 and Sh950 respectively. In total, I use about Sh7,700 worth of insulin shots every month.

LEARNING SELF DISCIPLINE

People with diabetes can lead normal lives. We just need to limit our indulgence. Growing up, it was difficult to explain to my friends why I could not play for long periods or why I could not eat whatever they were eating.

This social pressure was more intense in my teenage years and now as a campus student. I need to limit everything I do. For example, I cannot hike for long distances, I cannot drink too much alcohol or party.

With diabetes, it is not just the fact that your sugars may go low and you may have hypoglycaemia, there are many health effects the condition has to the body. People with my condition are prone to kidney failure, as well as eye, feet and nerve complications.

However, over the years I have realised letting my close friends know about my condition helps me manage it better.

Being a diabetic has, however, not stopped me from accomplishing my goals.

Diabetes is a chronic disease characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism that are a consequence of the body not being able to process blood glucose, commonly referred to as blood sugar.

According to Dr Nancy Ngugi, a consultant physician and the head of the diabetes and endocrine clinic at Kenyatta National Hospital, although insulin shots and medication are easy to find in pharmacies and hospitals in Kenya, they have not been subsidised by the government.

Insulin is essential in not only improving the quality of life of diabetic patients, but also in preventing the occurrence of diabetes-related complications. This can only be done by adhering to a strict schedule of prescribed dosages.

Doctors recommend that the advisable region for insulin shots injections are in the abdomen, at least five centimetres from the navel. This is because the abdomen area can absorb insulin best.

A patient can also inject insulin on the top outer area of the thighs. However, insulin is usually absorbed more slowly from this site, unless exercise is followed immediately after. Other injection regions include the outer area of the arms and the buttocks.

Doctors, however, advise that patients interchange the location of the injections as using the same spot every time can form bumps or pits in the skin. Other common side effects of insulin include initial weight gain, hypoglycaemia (when the blood sugar drops too low), anxiety or depression and a cough when taking inhaled insulin.

“Insulin shots are meant to replace what the body does not have or cannot produce. If you take the shots in the right dose, there will be no major side effects to worry about. If the dose is too high, the sugar will go low and a patient will get hypoglycaemia,” says Dr Ngugi.

Hypoglycaemia causes symptoms such as sweating, dizziness, weakness, loss of consciousness, coma and even death. Dr Ngugi further emphasises that patients with type 1 diabetes should never neglect insulin as it is a life-saving drug for them. “If they are not on insulin, they will go into a coma and die,” she adds.

Insulin is essential in not only improving the quality of life for diabetic patients but also in preventing the occurrence of diabetes-related complications. This can only be done by adhering to a strict schedule of prescribed dosages, which is essential in keeping blood sugars within the normal range.

MANAGING DIET

A proper diet is critical in the management of diabetes. Nutritionist Betty Okere says most people are not aware of the sources of sugars in food as they only avoid high-sugary diets such as soda and bread.

But, Dr Okere says even foods considered healthy such as sweet potatoes and blended juices can contribute to too much sugar in the body if consumed in large quantities. “The mistake comes in when people say a certain food is healthy so I can eat as much as I can,” she adds.

A healthy nutrition, as well as frequent exercise, are also critical in preventing insulin resistance, which is a pathological condition in which cells fail to respond normally to insulin. During this occurrence, excess glucose is not sufficiently absorbed by cells even in the presence of insulin, resulting in high blood sugar.

A possible contributor to insulin resistance is too much carbohydrates, a factor that Dr Okere says is common in Kenyan meals which mostly comprise bread, rice and ugali.

Too much carbohydrates contributes to high sugars in the body and as a consequence, probabilities of obesity and a risk factor to diabetes even for those who do not have the condition. In addition, there are records of low diabetes screening and awareness in the country, which further contribute to the late detection.