It’s inevitable. This rite of passage every diabetic patient often pass through in a typical Nigerian
hospital setting.

Mrs Kolade, a 45 year old civil servant, woke at 6am to check Fasting Blood Glucose , in
preparation for her monthly doctor’s appointment. She got a result of 4.8mmol/L. In her bid to
meet up with the doctor’s appointment, she rushed out without taking her breakfast. As usual, the
process of retrieving her folder took another hour.  As she maneuvered herself towards the
doctor’s office, the familiar sonorous voice of the Chief Nursing Officer welcomed her.” When
would this people be through with their regular recitation and let us into the doctor’s room, don’t
they ever get tired? , She muttered while scrambling for a space to sit. Tired and hungry, she
stared endlessly at the Nurse waiting for her turn to see the doctor. After an agonizing 3 hours, It
was her turn to see doctor. She got into the doctor’s room and barely sat before bombarding him
with several questions on her condition and the management.  The overwhelmed doctor who had
nothing less than a 100 patient waiting, had to summarize his answers, As he gave his concluding
remarks ,he emphasized that the CNO’ s morning talk would have done more justice to her
questions.

Exhausted, Disappointed and Despaired. She took few steps towards the exit door, held the door
handle and….. It was another hypoglycemic episode.

This article will not only enlighten you but empower you towards a better diabetes management.
Diabetes Mellitus (DM), a chronic medical condition characterized by a blood sugar level which
is too high and an abnormal metabolism (body breakdown) of carbohydrate, protein and fat.  It
has an alarming global prevalence of 366 million, a figure expected to rise to 552 million by
2030 with Africa set for the highest incidence of growth during this period. This condition
affects everyone. If you are not a diabetic yourself, you almost certainly have a family member,
friend or colleague affected by this chronic disease.

Some years back, I worked in an endocrine team and I realized that a vast number of patient
suffer and die from DM complications and not as a result of the disease itself. It hurts so bad to
listen to experiences involving health information has been misinterpreted or poorly
communicated. It will interest you to know that the literate are not left out. Ignorance is not only

potentially dangerous (a vast number of diabetes sufferers are undiagnosed, risking serious
complications); it also makes life very difficult for people living with diabetes.
Well, the truth is this; Diabetes cannot be cured medically, but a diabetic can live a healthy
life.as long as its complications can be properly managed through strict compliance with
prescribed drugs, proper dietary intake and regular open relationship with one’s doctor. Thus, a
diabetic patient needs to know that he/she is the most important stakeholder and therefore he/she
needs to be empowered with the right information.

SYMPTOMS OF DIABETES– Make a point to learn the symptoms of diabetes and share this
information with friends and family.
For Type 1 diabetics, Drinking a lot of water, Passing a lot of urine (more than 4 episodes at
night) Eating a lot of food , Rapid weight loss, deep, rapid breathing, dry skin and mouth, flushed
face, fruit breath odour, nausea or vomiting (inability to keep down fluids) and stomach pain.
For type 2 diabetics, they include skin or other infections that are more frequent or heal slowly
eg. Candidiasis (commonly known as Yeast), fatigue, hunger, increased thirst, increased
urination, blurred vision, erectile dysfunction and pain or numbness in the feet or hands.
Now, I am going to break down some common myths about this condition in simple terms.

1. Many people believe that ”only fat people get diabetes”. However, DM is not
exclusively a “fat people’s disease. Though being overweight or obese increases your risk
of developing type 2 diabetes, being thin does not safeguard you from diabetes. There are
many other factors such as family history, ethnicity and age that also play a role. In fact,
one of the first symptoms in people who develop Type 1 Diabetes often is rapid weight
loss. Diabetes can also develop in an elderly person  who is thin but whose pancreas is
not functioning properly any more.

1. ‘If I have to go on insulin, it means my diabetes is really bad’
Many people believe that having to take insulin means you are doomed. On the other
hand, there are also people who believe not having to take any medication means their

diabetes is nothing to worry about. Whether you have to go on insulin or not is
determined by your body’s blood sugar (glucose) control. Sometimes changing your diet
is enough to control blood glucose. However, in the case with type 1 diabetes where the
pancreas has stopped producing insulin, artificial insulin is necessary.

1. ‘Eating too much sugar causes diabetes’
The belief that eating too much sugar causes diabetes is one of the most
common misconceptions around diabetes. There are three main types of diabetes. None
of them are caused by too much sugar, but rather by the pancreas which does not work as
it should.

Type 1 DM usually occurs among children and teenagers. Surprised? , How does it happen?
Here, the body cannot produce adequate insulin due to genetic destruction of the pancreas-
An organ that produces insulin. As a result, the glucose absorbed from the stomach and
intestine will not be transferred to the body tissues. So what happens? The level of sugar in
the blood keeps getting higher and higher.

Type 2 DM occurs more in the elderly, fat, sedentary and people with a positive family
history of diabetes. In this case, the pancreas is still able to produce insulin but the production
may be insufficient to deal with the glucose level in the blood. On the other hand, the
pancreas may be producing enough insulin but the body tissue may resist it. This is called
Insulin-resistant syndrome.

Gestational DM occurs in pregnant women. The hormonal change prevents insulin from
working as it should and it usually resolves 6 weeks after delivery.

1. “Diabetics have to follow a special diet”
Many people believe that diabetics have to give up on great, tasty foods and follow a
bland, boring meal plan. There is, however, no such thing as a “special diet for diabetics”

as they generally have to follow the same basic guidelines of a healthy non diabetic
person.
What about those special diabetic foods on the shelves? They generally offer no special
effect and can still raise blood sugar levels, especially with diabetics who tend to see
“diabetic foods” as free foods and subsequently overindulge.
Taking consideration of your weight, food preferences and lifestyle, you should have
55%carbohydrate, 20%protein and 10%fat per meal intake.
The following are the food types to reduce because of its high glucose context

•  Yam and its products
•  Refined sugar and Honey
•  Pastries
•  Saturated oil e.g. groundnut oil, palm oil, margarine.
•  Red meat
•  Canned oily fish.
•  Pineapple, Ripe banana/ Plantain , Pawpaw, Sugarcane
•  Ice-cream and carbonated soda drinks, e.g. Coca-Cola.
•  Alcohol and Cigarette

You can “play around” with these foods to ensure steady blood sugar levels and sustained energy
levels.

•  Wheat bread, Brown bread, Oatmeal, Plantain flour
•  Garden egg
•  Beans
•  Boiled Unripe Plantain
•  Irish Potatoes
•  Custard, Corn pudding
•  Soya beans milk
•  Snail, Crayfish, Gizzard, Dried Fish, and Locust beans

•  Mushrooms
•  Fruits like Grapefruit, Carrots, Cucumber, Cabbage, Pear, Vegetables, Apples, Pears,
  Oranges, Peaches, Plums and Strawberries
•  Artificial sweetener and Crackers Biscuits

Let’s take a pause at this moment and reflect on what we have read so far. I always tell my
patients that “Information is Power”, but permit me to rephrase it as “Timely Information is
Power”. I understand the complexities of our health system, long waiting times, out of pocket
expenditures, poorly motivated staff, ethical decadence, the list is simply endless. You have
choose either to make yourself vulnerable to these, or soar above the storm.

The good news is this; I am here to empower you to take charge of your health ,up to a level
that your doctor’s input would be a mere supplement. Next week, I will shed more light on
how we can identify signs of diabetic complications and the purpose/ importance of your routine
investigations.
Stay tuned. It’s all about you and your health.