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Tag: Diabetes

  • Club organises free diabetes, hypertension screening

    Rotary Club of Lagos Palmgrove Estate will hold a free Diabetes and Hypertension Camp to commemorate the World Diabetes Day. It will conduct the free medical check-up and consultation camp on diabetes and hypertension at the Indian Community Association (ICA) premises in Palmgrove Estate, Ilupeju, Lagos from 9am to 2pm on Saturday, November 16.

    According to the chapter’s past president, Mr Mukesh Bhatt, the club took it upon itself to raise awareness about the two health situations because of the alarming rate of increase. Participants at the camp would have the opportunity of early detecting and counselling in order to prevent life-threatening ailments. “We will access the patients and the doctors will advise them on how to manage their health challenges,” he said.

    On what informed the to programme Bhatt explained: “During our Free Eye Operation Camp, we came across several patients who also have hypertensive and diabetes cases and they don’t even know about it.”

    Dr Latha Ravi Kumar, an endocrinologist and diabetes specialist, said over 70 per cent of patients who attend public health institutions in Lagos State have been found to be hypertensive, while about 12 per cent are diabetic. She said what was more disturbing is that most of the patients were not even aware that they had the life-threatening ailments.

    According Dr Kumar, while deaths as a result of these two health challenges are increasing, the World Health Organisation had estimated that the figure would hit double-fold rate by 2015. “We all therefore have to work together to prevent the disaster by determining our status on time and avoiding stress, unbalanced diet, alcoholism, smoking and unhealthy lifestyle,” she counselled.

    Dr Sami Tahir of the Ahmadiyya Muslim Hospital, Apapa, Lagos, also lamented that in the last five years, hypertension has become as common as malaria in hospitals in Lagos State. “We have to let out people know that early detection and management is important to avoid organ damage,” he said, adding that “once the organ is damaged, it cannot be reversed,” he said.

    In the past, Rotary Lagos Palmgrove Estate had embarked on several projects that touched on the lives of the underprivileged. These included free artificial limbs for over 40,000 low-income citizens and scholarships to indigent students.

  • Diabetes

    The term diabetes,when not specified, refers to Diabetes mellitus, a serious metabolic disorder characterized by defects in the body’s use of carbohydrates. The other kind of diabetes is Diabetes insipidus, which is quite a different and relatively rare condition, in which an individual passes large quantities of pale, dilute urine, with consequent dehydration and excessive thirst.

    Diabetes mellitus is a syndrome in which the basic defect is the absence or shortage of the hormone called insulin. This hormone is carried by the blood to the kidneys, where it limits the outflow of water in the urine.

    The great majority cases of Diabetes insipidus are due to a tumour or inflammation in the region of the pituitary gland, thereby suppressing ADH production. Physical damage in form of fracture of the base of the skull or surgery in the pituitary area can also cause Diabetes insipidus. In addition, there is a rare inherited form of Diabetes insipidus where the production of Anti-Diuretic Hormone is normal, but the kidneys do not respond to the circulating hormone.

    As earlier stated, in Diabetes mellitus, an organ in the body (called the pancreas) is found not to be functioning properly. Insulin is a hormone produced by the Beta cells in the Islets of Langerhans in the pancreas. Insulin is carried by the blood to all parts of the body. The body’s cells use glucose (blood sugar) as their fuel. They have receptors to which insulin becomes attached. This binding of insulin enables the cells to use glucose by converting it into energy or storing it as fat. Any defect in this process, either in the pancreas, where insulin is being produced, or at the sites of attachment of insulin to the cells, would interfere with the body’s use of fuel to produce energy.

    Apart from the malfunctioning of the Pancreas, one other cause of this disorder is unbalanced diet. Most of us consume denatured food in one way or the other. Also, food additives and unhealthy drinks, whether soft drinks, teas, coffee or liquor may predispose one to metabolic imbalance.

    The symptoms of diabetes include: frequent urination, loss of flesh, inordinate appetite, constant hunger, mental depression, progressive weakness, great thirst, dry tongue and impaired vision. The person could be irritable, restless and morose. The loss of energy is due to the loss of sugar, which is needed to generate the energy for daily activities.

    In Holistic Lifecare, it is strongly advised that imported styles of living (i.e. cooking, eating & drinking) must be looked into especially on the use of food additives and colourants in fast foods and so-called take-away. Heavy starchy foods should be cut down drastically, if they cannot be avoided, pending total recovery from the ailment.

    As we make efforts to repair a malfunctioning pancreas, there are some fruits and vegetables known to be helpful. These include carrots, paw-paw, cucumber, onions, garlic and lettuce, combined with soya-milk mixed with guinea-corn pap or porridge.

    Control: The Holistic remedy that has been popularly suggested for the control of Diabetes is a combination of the natural extracts of some herbs scientifically called Anchomanes difformis, Pergularia daemia, Vinca rosea and Viscum album.

    For further information and consultation on Holistic Lifecare research and services, especially on Blood Infections, Infertility, Sexually Transmitted Diseases, Chronic Debilitating Conditions as well as mental and social problems, please call on: 0803-330-3897 or visit: Mosebolatan Holistic Lifecare Centre, Adeyalo Layout, Ogbere-Tioya, Off Olorunsogo Express Bridge, Ibadan. Website: www.holisticlifecare.com. Distance is no barrier, we can send remedies by courier if need be. We also have facilities for accommodation, admission and hospitalization in a serene and homely environment.

  • Don: Fasting prevents diabetes, cancer

    A nutritionist, Dr Ramota Karim, says fasting is capable of preventing nutritionally-induced diseases such as diabetes, hypertension and cancer.

    Dr Karim, a lecturer at the University of Ilorin, told the News Agency of Nigeria (NAN) yesterday that fasting allows the digestive system to rest and flourish.

    “Nutritionally-induced diseases, such as diabetes, hypertension and cancer can be prevented with fasting.

    “The physiological effects of fasting are numerous and these include lowering of blood sugar, cholesterol and systolic blood pressure related to diabetes and hypertension.

    “A good break for the digestive system would make it rest, heal and flourish better,” she said.

    According to the nutritionist, fasting eliminates a load of accumulated toxins in the body and allows the liver to regenerate and work efficiently.

    She added that it was not advisable to breakfast with heavy food and acidic fruits.

     

  • Health hazards of processed meats

    Health hazards of processed meats

    The consumption of red and processed meats has been linked with heart disease, cancer and now Type 2 diabetes. A recent study by the Harvard School of Public Health looked at a variety of meats such as beef, dried meats and sausages to determine their impact on blood sugar control.

    The study involved 123 000 people over a 20-year period and found that an elevated red meat intake over a four-year period resulted in a 48 per cent elevated risk of diabetes in the following four years. This link equates to an even greater risk of death via associated heart attacks and strokes.

    One’s diabetic risk dropped significantly when red meat consumption was reduced by more than a half serving per day. A half serving per day equates to approximately half the size of a deck of cards of meat.

    “The association of red meat and cardiovascular disease are quite clear,” said Walter C. Willett, Harvard School of Public Health’s chairman of the department of nutrition. “It does look as though replacing red meats with other major sources of quality protein — nuts, legumes, chicken and fish — is a good thing to be doing.”

    Not all meats are created equal and some should not even be suitable enough to be considered food. Processed meats often contain more sodium, preservatives and nitrates that, according to Willett, “cause chemical reactions that may create compounds that are toxic.”

    A similar study analysed nutritional data from 184 000 cancer-free individuals and found people who at the most red and processed meat died earlier. The results found the amount of meat a person ate before their colon cancer diagnosis was tied to their risk of dying within eight years. About 43 per cent of the test group that ate 10 servings of red or processed meat per week died during the follow up period.

    “It’s another important reason to follow the guidelines to limit the intake of red and processed meat,” said Marjorie McCullough, the study’s lead author from the American Cancer Society.

    Three or four servings of red or processed meats per week are a good target for people, according to McCullough. “We’re not saying people need to be vegetarians. It’s really just limiting intake and making it more the exception than the rule.”

    Distinguishing good meats from bad

    It’s important to note that most studies fail to effectively distinguish between processed meat and unprocessed, as well as overcooked or charred meats. A “red-meat-is-bad” approach is a major mistake as not all red meats are bad for you.

    However, processed meats such as sausages, deli meats, etc. contain high amounts of omega-6 fatty acids, mold called mycotoxins, nitrates and a variety of preservatives. All of these compounds can be correlated to an increased risk of diabetes, heart disease and cancer.

    One common problem historically with nutritional questionnaires is that they are not highly specific in regard to the type and quality of meats. The good news, researchers at the Harvard School of Public Health conducted a systematic review to distinguish between the types of meat. They defined unprocessed red meat as any meat from beef, pork or lamb that hasn’t been smoked, cured, salted or have any chemical preservatives.

    The outcome of this review confirmed processed meats caused a 19 per cent higher risk of Type 2 diabetes. The researchers did not find a higher risk among individuals eating unprocessed healthy red meats, such as beef, pork or lamb.

    Heart disease, cancer and diabetes are chronic diseases that are affected by the amount of inflammation in one’s body. One’s diet is an important determining factor through the ratio of omega-6 and omega-3 fatty acids. Omega-3s are anti-inflammatory while omega-6 fatty acids are pro-inflammatory.

    This is the mechanism by which processed meats produce inflammation and disease in the body. The ideal ratio of omega-6 to omega-3 is between 2:1 and 4:1 according to health experts across medical specialties. Processed and fried foods have been found to produce ratios between 20:1 and 50:1.

    All meat contains some omega-6s but processed, preserved, cured and overcooked meats contain higher levels of oxidized toxins and these toxins have been found to be readily absorbed into bodily tissues and cause inflammation.

    Dry-cured meats are commonly contaminated with mold toxins. Mold toxins – also called mycotoxins—can cause cancer, heart, liver and kidney disease. Unhealthy red meats and poor-quality processed meats can also suffer the effects of antibiotics, growth hormones and other unnatural animal raising techniques. Antibiotics have been found to affect healthy gut bacteria that are needed to absorb many vitamins, minerals and nutrients from one’s diet.

    The nitrates in processed meats, especially bacon, have received a lot of negative press. They can contain up to 50 per cent more nitrates than healthier, unprocessed meats. Nitrates have been found to impair the release of insulin that is characteristic in diabetes. The negative effects on insulin and blood sugar control helps explain the Harvard School of Public Health’s findings that processed foods increased the risk of diabetes.

    To compound the issue, the British Journal of Cancer found eating processed meats increased the development of pancreatic cancer by up to 38 per cent. A similar study conducted in Hawaii concluded that those who ate the most processed meat showed a 67 per cent greater risk of pancreatic cancer over those who did not eat processed meat. Pancreatic cancer is one of the types of cancers that boast the highest mortality rate amongst all cancers.

    A compound called nitrosamines in processed meats have been linked to increased risk of stomach cancer as well. The best way to avoid nitrosamines is to avoid overcooking and charring processed meats. It’s important to cook meat on moderate-to-low heat to avoid charring.

    Foods to look out for

    Foods that are high in nitrates include canned meats, corned beef, smoked and frozen fish, bacon and sausages. Convenience foods and pre-prepared frozen dinners are often the worst offenders. Bologna, ham, pastrami, prosciutto, roast beef, salami, pepperoni and other cured sandwich meats should be limited.

    Processed foods often have food labels to help identify the chemical culprits. The major chemicals to look out for include phosphates, nitrates, texturizers, stabilizers, thickeners and monosodium glutamate (MSG). Phosphates are added to help retain moisture and add flavour in meats. Sodium nitrate basically stains the meat to look fresh and extends its saleability. MSG is a powerful flavour enhancer but has been linked to numerous medical conditions and should be avoided altogether.

    Become an informed consumer and protect yourself and family from processed meat induced heart disease, cancer and diabetes. Substituting fish, nuts, legumes and lean meats instead of chemical-laden processed meats will help promote a healthy omega-6 to omega-3 ratio, reduce inflammation and reduce your chance of becoming a statistic.

    Couillard, an international healthcare speaker and columnist for numerous newspapers, magazines, websites and publications, works in collaboration with the World Health Organization’s goals of disease prevention and global healthcare education. He can be reached via drcorycouillard@gmail.com

     

  • Diabetes: Nigeria leads in Africa, says WHO

    Diabetes: Nigeria leads in Africa, says WHO

    Which country has the highest number of people suffering from diabetes in Africa? It is Nigeria, say the World Health Organisation (WHO); International Federation of Diabetes (IFD) and Diabetes Association of Nigeria (DAN).

    Nigeria, according to them, also has the highest mortality rate from the disease.

    Provost, College of Health Sciences, Osun State University Prof Olutayo Alebiosu made these known at the launch in Lagos of a monitor to check the level of sugar in diabetics.

    Also quoting WHO, he said 60 per cent of deaths were caused by chronic non-communicable diseases such as diabetes and heart failures.

    With the monitor, there is hope for the over one million people suffering from diabetes and over 3.85 million with low glucose in Nigeria. The device will help them check their sugar level better.

    Bayer Contour Ts Blood Glucose Monitoring device is an easy-to-use metre, which enables individuals and families monitor their blood glucose without any assistance from a health care provider. It can also be used in hospitals by doctors to get instant result for their patients with 100 per cent accuracy.

    Diabetes is a chronic condition that arises when the pancreas do not produce enough insulin, or when the body cannot effectively use the insulin produced. Insulin is a hormone made by the pancreas that helps ‘sugar’ (glucose) to leave the blood and enter the cells of the body to be used as ‘fuel’. When a person has diabetes, either the pancreas does not produce the insulin it needs (Type 1 diabetes) or the body cannot make effective use of the insulin produced (Type 2 diabetes). According to the IFD, diabetes is the fourth leading cause of death in most developed countries. Each year, three million deaths worldwide are attributable to diabetes-related causes.

    Death, Alebiosu said, occurred because of improper diagnoses or the poor management of the disease, “since its management is very expensive and not affordable by majority of sufferers. While sufferers of HIV/AIDS and Tuberculosis receive medications and do laboratory tests free, there are no subsidies for diabetes care. But with Bayer Contour Ts Blood Glucose Monitoring Device, which is developed by the company that discovered Aspirin over a hundred years ago, then Nigeria is better for it, for its accuracy as recorded in other clinics around the globe.

    “Bayer Contour TS (Total Simplicity) Blood glucose monitoring devices are innovative products — from easy-to-use meters to accurate testing supplies that have helped millions of people globally to manage their diabetes for more than 70 years. Diabetes Care with Bayer Contour TS is dedicated to helping simplify the lives of people with diabetes, empowering them to take charge of their health as well as providing timely information on their blood sugar profile.”

    He said: “Living with diabetes can be overwhelming at first, but once the patient learns to manage it, the affected individual can lead a full, active life. And while there is no cure for diabetes, it can be treated. That is where Diabetes care with Bayer Blood Glucose monitoring devices comes in, offering a portfolio of easy-to-use, proven accurate diabetes management products. Both the patients and health conscious individuals can learn to manage their blood sugar effectively. Bayer’s long tradition of product innovation in diabetes care goes all the way back to 1941, so I recommend same to Nigeria.”

    Guest lecturer at the launch and a consultant at the Ahmadu Bello University Teaching Hospital Zaria, Prof. Geoffrey Onyemelukwe, called for a lifestyle change, especially by urban dwellers, from processed foods to natural foods such as fruits, vegetables, fermented drinks like burukutu, palm wine and others to stem the diabetes pandemic. He said regular exercise of up to 150 minutes a week can help in preventing the onset of diabetes.

    Onyemelukwe called for the establishment of a National Diabetes Centre to provide a framework for the management of the disease, saying that diabetes has killed more Nigerians than HIV/AIDs, malaria and cancer.

    Chief Executive of Abiagait Health Solutions Limited, Mr. Isaac Thompson Amos, said his organisation decided to partner with Bayer Health Care, Germany to bring the Bayer Contour TS Blood Glucose monitoring system to help government in providing quality health care for the people. He noted that the product is the best in the market and is marketed in over 100 countries.

    Amos said Abiagait is discussing with the Ministry of Health and other healthcare related agencies to take the products to the grassroots. “As the product can be used in the hospital, at home, work places or even religious organistions to test the blood sugar with instant result,” he stated.

  • Diabetes mellitus; symptom check list, complications ( IV) Edtd

    Diabetes mellitus; symptom check list, complications ( IV) Edtd

    : Continued from last week

     

    Peripheral arterial disease Again, the presence of a blister in the foot that refuses to heal may for the very first time force a patient to the hospital. For others it may be troublesome electric shock type of feeling along parts of the distal upper and lower limbs where gloves and stockings are usually worn.

    Diabetic patients who also have other conditions of the musculoskeletal system such as, knock knee(valgus deformity), bow legs(varus deformity), flat feet( pes planus), anatomically significant leg length inequality, bent spine(scoliosis, kyphosis, kyphoscoliosis) are at increased risk for diabetic foot ulcer, in this conditions, there is alteration in the normal biomechanics of the spine in weight transmission and distribution from the lumbar vertebrae(lower backbone) through the sacrum (holy bone) to the waist , thigh, leg and arches of the feet . More weight than is allowed is borne by one foot at the expense of the other

    It is believed that inflammatory and apoptotic events occasioned by AGE occurring at different levels incuding the vasa nervorum are responsible for these abnormal sensation , progression to complete loss of sensation occur with the passage of time and persistence of hyperglycemia.

    Under these conditions, a patient loses the ability to feel pain in the feet and legs. He may step on a mounted nail and be pierced without knowing it, There very many spaces in the plantar area of the foot where infection and pus can spread and within a short period, the whole foot is nothing but a bag of pus up to the ankle, a situation that will definitely involve amputation of one or both feet. Simple avoidance behavior such as good personal hygiene with emphasis on foot care, wearing loose fitting shoes, and regular monitoring of blood glucose will prevent or reduce these problems

    A diabetic patient may have striking pains in the limbs when he tries even mild physical activity, the pains disappears when he rests the affected limb (intermittent claudication). In some people this may pass without further problems, but may be the first symptom that the limbs are about to develop serious problems

    The risk of developing diabetic foot ulcer increases under the following settings;

    •a parent, auntie, uncle, brother or sister had a similar problem

    •the patient is a male adult older than 35 years

    •the patient is obese with BMI, 30 and above, particularly gyenoid or pear type where fat is distributed around the buttocks, waist, thigh, and legs

    He (patient) smokes; diabetic patients who smoke are at a particular risk of developing end arteritis obliterans (obliteration of end arteries) usually followed by gangrene

    patient has had diabetes for over 10years and control of blood sugar has been erratic, despite good medical supervision patient has abnormal musculoskeletal deformities

    patient habitually wears tight fitting shoes

    Impotence (Erectile dysfunction) in Diabetes Mellitus requires special attention, because it is quite capable of resulting in marital disharmony especially if couples had been very sexually active before illness began. Sexual activities involve the central, and the autonomic arms of the Nervous system. Even without any chronic disease conditions, the interest and stamina for sex decline as early as age 25, and earlier in some men and women. Diabetes mellitus more common in middle age, is commonly seen in association with hypertension and the drugs used in the treatment of both conditions reduce libido and cause impotence. These issues when added to the primitive idea that the man should at all times initiate sexual intercourse place the man in a position of disadvantage and hopelessness. The symptoms range from weak to flaccid appearance, but can hopefully be completely reversed with a loving, patient, reasonable and understanding wife with the supervision of the family physician. Decreased synthesis of nitrous oxide(NO) due to advanced gycosylated end products which also alters the elastic properties of vascular endothelium account for 60% of the etiology, apart from other psychosomatic issues. Excessive sweating and anxiety make the situation worse, because in that condition, the blood vessels in the penis are actually collapsing instead of dilating, or opening, return of venous blood to the heart is reduced, making it difficult for the Heart to supply blood to itself so it can sustain life, for this reason, attempt to use a performance enhancing drug to force the heart to pump more blood to where it is mostly needed, will create a physiological crisis for the body. When blood is shunted from a heart that is already battling to supply itself, the rest can be worked out.

    Obesity and Diabetes Mellitus:- diabetic patients who are obese are more likely to have poor wound healing abnormal orientation of the feet , anatomically significant leg length inequality, and abnormal weight bearing during activities of daily life poor spine, hip and foot muscle alignment , ulcers form as a result of the loss of the sense of pressure, pain, two point discrimination and touch.

    Macrovascular complications

    Coronary artery disease:- Lipids especially the bad cholesterol low density and very low density lipoproteins (LD&VLD) are elevated where as the good cholesterol ,high density cholesterol (HDL)is low. Moreover, Diabetes Mellitus is associated with narrowing of the coronary vessels, wasting and loss of cardiac muscle tissue. Because signs of small heart attacks (micro infarcts) are commonly absent, sudden death may occur without the warning symptom of left sided chest pain radiating to the inner left arm and inner left neck

    Cerebrovascular disease (CVD)

    Stroke may occur after minor arguments ,minor physical exertion or even while sleeping. One side of the body may be paralyzed with or without loss of consciousness. Deposits of AGE in the walls of arteries in the brain, causes them to lose elasticity, and become plastic . They are liable to rupture at any moment of agitation, slight increase in blood pressure or sudden large drop in blood pressure(law of Laplace). Diabetic patients with congenital or acquired blood filled outpocketting of the blood vessel wall(aneurysms) in the arterial circle of Willis are particularly vulnerable

    Fatty Liver In Diabetes Mellitus

    Fatty liver and hypertension are both included in the entities that constitute the metabolic syndrome. The liver is like a factory in the human body ,and as such is the main site of storage of unutilized glucose as well as the breakdown of glycogen. In diabetes mellitus increased deposits of triglycerides and increased need for increased production of glucose from non carbohydrate sources may result in fatty liver. The matter is not yet settled as to which one comes first, since there are very many other alternative pathways involved, but it is enough to stress that the appearance of fatty liver in type 2 Diabetes mellitus should be taken seriously.

    Non Vascular Complications

    Gastroparesis

    may develop in the older patient with type 2 diabetes mellitus, mainly from abnormalities in the parasympathetic chain of the ANS. Hyperglycemia on its own causes delayed gastric emptying, bloating and easy fullness with small meals

    How ever many people live with diabetes mellitus for years without complications, but are few.

    Infections

    When blood sugar remains persistently high, the body becomes a living reservoir for small organisms inside and outside the body, outside the body, fungal infections with candidisis of the skin, bacteria infections with staph aureus can take the form of recurrent boils, and can even appear as badly smelling infection of the outer ear(otitis externa), offensive vaginal itching with or without abnormal discharge, Escherichia coli, (ecoli), can colonize the urinary bladder(cystitis with frequency, urgency and strangury) , the urethra in women (shorter in women, 3or 4 cm compared to 10-11cm in men), and can climb up to cause ascending pyelonephritis , or even frank kidney infection

     

     

     

     

     

    Dermal complications;

    Skin complications are usually coincidental with those just described, with little differences, protracted wound healing and skin ulcerations are common features of Diabetes mellitus , but can be so bad as to cause wound dehiscence or wound break down forcing the surgical team to go back into the theatre several times for the same surgery, each successive surgery carrying a higher risk .Sometimes Typhoid perforation may occur in a diabetic as a complication with very challenging consequences for the surgical team

    Type 1 Diabetes mellitus is as a result of autoimmune conditions and hence the association with vitiligo, a skin condition where the dark melanin producing cells normally present in the skin of black people are attacked and destroyed by cells of patient’s own immune system, the condition appears as white patches all mover the body and has no known cure.

    On the other hand, very dark spots may appear in the skin of the armpit, back of elbow and hands and , they are called ancathosis nigricans and their appearance is not a good sign for diabetic patients on insulin. They are different from the milder diabetic pretebial spots,

    Growth factors summoned to rectify damage caused by age are believed to be partly responsible . these include epidermal growth factor, insulin-like growth factor I, growth hormone, etc

     

     

    RCCOMMENDATIONS

    Know the medical history of your family so you PLAN how to tailor your life style with regards to food drinks , travel and stress management. You must avoid sugar and excess carbohydrates, wheat in whatever forms should be taken only in moderation.

    Stick with a Doctor, seek opinion from other Doctors as you deem reasonable but remain connected with one you can see at any time , no matter the number of sophisticated gadgets you have, they are no substitutes for your Doctor

    Single lab tests do not diagnose Diabetes mellitus, clinical symptoms and signs together with blood and urine tests are considered and confirmation established before diagnosis is made

    Diabetes mellitus can cause damage to important organs like the Heart, Kidneys , Brain and the eyes, long before the patient becomes aware, any unusual observations in these areas should be brought to the attention of your Doctor

    If you are diabetic and already have complications such as ulcers in the limbs, the situation has gone beyond seeking solution from alternative medicine practitioners. Surgery to save life with insulin carefully calculated to control blood sugar will serve you better when combined in the province of a well established center

    Avoid performance enhancing drugs ; they can kill your heart . wait until your condition is stable, plan your exercise to go with your diet program and exercise with common sense; using mild hands and legs exercise with short walking either alone or in combination, you can to test your physical strength and your ability to have successful coitus without endangering your health. The supervision of your physician or dietician must never be ignored

    Skin complications of insulin injection site can also occur; they may be unsightly but pose no danger . unusual thickening or loss of pigment should be made known to the care giver

    Attention to other risk factors for vascular disease (smoking, dyslipidemia, hypertension) and improved glycemic control are also important.

  • Diabetes mellitus; symptom check list, complications ( III) Edtd

    Diabetes mellitus; symptom check list, complications ( III) Edtd

    What is being done here is an attempt to present the how and why of some of the complications of Diabetes mellitus with the hope that patients and those who bear the burden of caring for them will understand one or two things that will give them grace and hope to persevere.

    Young diabetic patients sometimes argue that, their parents or close relatives, smoked cigarettes, took as much alcohol as they could without developing any of the complications they see around. Reason is that God created us equal in the big sense of creation, but there are differences at levels too numerous to mention; it is important also to note that, the natural chemicals known as enzymes which speed up biochemical reactions in the body are not only inherited, but are also specific. Moreover, there are people with gene types , such that they ican drink two cartons of beer, or six bottles of Gin or Whisky with only minimal damage because thye have these enzymes that can very quickly neutralize the toxic degradation products of ethanol. The same goes for cigarettes and Ciga. So people have these specific enzymes that operate to reduce or prevent some people from going down with the twenty or more recognized diseases that can be caused by smoking. These enzymes in some individuals undergo changes in many ways(mutation). In a family of fat people for instance, one person may be thin and healthy because the enzyme responsible for transfer of cholesterol and lipids from the Liver and intestine to the tissues may have undergone changes. Even in Hiv/Aids, mutation in the Chemokine cellular receptors CCR5 and CXR4 which are required as coreceptors by the virus for successful infection explains why some people can have repeated receptive sexual intercourse with Hiv positive partners and remain seronegative

    For chronic complications which may be classified as, vascular, or non vascular, micro vascular, when the small and tiny blood vessels are involved or macro vascular when the large blood vessels, arteries and veins are involved, patients tend seek medical help long after they have had the problem, as Doctors call it present late, and so what we see are combinations of these complications , and it becomes difficult to draw a clear line

    Deposits of unutilized sugar forming complex molecules with proteins to generate Advanced Glycosylated End products (AGE) as has been discussed are largely responsible for most of the complications of diabetes mellitus

    On the other side of the problem, the presence of hyperglycemia, gives rise to increased production of diacylglycerol. This results in activation of protein kinase C . Excessive phosphorylation through these pathways alters the transcription of genes responsible for a number of proteins including those responsible for the structural integrity of many cells, tissues and organs throughout the body, such as the brain, heart, skeletal muscles.etc

    We may recall that under normal conditions, the metabolism of glucose occurs by pathways that result in the formation of energy and water to drive most of the activities necessary for the cells to function normally, as well as in the production of pyruvates which go into the krebs cycle for more energy, but in conditions of excess glucose, alternative pathways are employed, which result in the production of oxygen coupled molecules. These then react with others in the body to damage cell membranes and related structures. There is also increased movement of reactants through the Hexosamine pathway. This favours the generation of fructose-6-phosphate(F6P), and consequently the excessive production of growth factors and alteration of endocrine properties of vascular endothelium; reflex stimulation of the Renin Angiotensin System (RAS) for instance is translated to increased resistance at the renal arterioles. Renal hypertension then creates a vicious cycle that may eventually cause irreversible kidney damage, which is seen as a major complication of Diabetes mellitus

    Abnormal bleeding pattern is another complication of Diabetes Mellitus that may declare itself as a serious emergency; it may be due to excessive production of platelet-derived growth factor, increased platelet aggregation or decreased activity of fibrinolysins. Diabetic patients particularly those who are also hypertensive are therefore usually advised to exercise extreme caution when asked to take blood thinners such as vitamin E, Aspirin or herbal products known to affect blood clotting system

    Especially for type 2 Dm, with Chronic complications, problems may begin very softly, with, few non specific warning signs of tiredness and loss of strength, heart beat may be faster than normal even when the patient is resting.

    Frequent micturition, and especially nocturia, when a patient who had never been woken up by the urge to urinate finds himself or herself getting up four to five times in the night to do so, though a common symptom may also herald serious onset of an acute or chronic complication. This should be different from not being able to hold urine or urinating frequently accompanied with some sweet pain which occurs in urinary tract infection or UTI. As was discussed, excess glucose in blood draws water from the cells so that two things can happen; to dilute the excess glucose with the water, remove the excess glucose through urine formed in the kidneys, this starves the cells of water and those cells passing through a center in the Brain sends signals to the patient to drink more water leading to polydypsia and then more urine is made in a cycle that leaves him weak, dry and thin.

    Microvascular complications

    Retinopathy and Neuropathy.

    The eyes are often used by physicians as windows to the brain, and in many cases, by the time the eyes begin to show signs of damage, they are likely to search for similar tissue damage in other parts of the body. Blurred vision, seeing shadows, or black spots, all due to involvement of the light sensitive retina at the back of the eye may appear for the first time in a patient with advanced stage of the disease. An eye specialist may then discover damaged blood vessels in the eye. He could use the shape and pattern of bleeding to tell whether bleeding was as a result of hypertension(hypertensive retinopathy )or diabetes mellitus as in diabetic retinopathy.

    Another piece of equipment in the office of the eye physician or general practice Physician, Tonometer can measure the pressure in the eye ball and draw attention to the condition called glaucoma, another complication of uncontrolled high blood sugar. What ever the manifestation, the mechanisms may include the following;

    •direct damage to the tiny blood vessels of the vascular portion of the eye

    •dumping of abnormal proteins, protein products, fibrin residues and fibrin degradation products blocks regular flow of free fluid between the chambers of the eye leading to abnormal increase in the pressure of the eye ball. In addition, similar deposits of fats, sugar, calcium and protein complexes along the inner walls of blood vessels cause narrowing of the caliber of the small vessels, and also cause them to break when they try to expand to accommodate blood.

    •attempt by the body to repair the damage by issuing signals for growth of new blood vessels(angiogenesis)

    •obliteration of the bipolar paraneurones , and their supporting cells in the light sensitive back of the eye ball, the retina

    • disorganization , and disruption of the flow of fluid across the chambers of the eye as result of blockade of canals(schlem) etc, all these will manifest in several different patterns and that is why you must seek medical advice from appropriate quarters . There you will receive additional information, and will know what you can safely do for yourself and others you shouldn’t attempt.

    Peripheral arterial disease Again , the presence of a blister in the foot that refuses to heal may for the very first time force a patient to the hospital . For others it may be troublesome electric shock type of feeling along parts of the distal upper and lower limbs where gloves and stockings are usually worn .

    Diabetic patients who also have other conditions of the musculoskeletal system such as, knock knee(valgus deformity), bow legs(varus deformity), flat feet( pes planus), anatomically significant leg length inequality, bent spine(scoliosis, kyphosis, kyphoscoliosis) are at increased risk for diabetic foot ulcer, in this conditions, there is alteration in the normal biomechanics of the spine in weight transmission and distribution from the lumbar vertebrae(lower backbone) through the sacrum (holy bone) to the waist , thigh, leg and arches of the feet . More weight than is allowed is borne by one foot at the expense of the other

    It is believed that inflammatory and apoptotic events occasioned by AGE occurring at different levels incuding the vasa nervorum are responsible for these abnormal sensation , progression to complete loss of sensation occur with the passage of time and persistence of hyperglycemia.

    Under these conditions, a patient loses the ability to feel pain in the feet and legs. He may step on a mounted nail and be pierced without knowing it, There very many spaces in the plantar area of the foot where infection and pus can spread and within a short period ,the whole foot is nothing but a bag of pus up to the ankle, a situation that will definitely involve amputation of one or both feet. Simple avoidance behavior such as good personal hygiene with emphasis on foot care , wearing loose fitting shoes, and regular monitoring of blood glucose will prevent or reduce these problems

    A diabetic patient may have striking pains in the limbs when he tries even mild physical activity ,the pains disappears when he rests the affected limb( intermittent claudication). In some people this may pass without further problems, but may be the first symptom that the limbs are about to develop serious problems

    The risk of developing diabetic foot ulcer increases under the following settings;

    . a parent , auntie, uncle , brother or sister had a similar problem

    . the patient is a male adult older than 35 years

    .the patient is obese with BMI ,30 and above, particularly gyenoid or pear type where fat is distributed around the buttocks, waist, thigh, and legs

    He ( patient) smokes;diabetic patients who smoke are at a particular risk of developing end arteritis obliterans(obliteration of end arteries) usually followed by gangrene

    patient has had diabetes for over 10years and control of blood sugar has been erratic , despite good medical supervision

    patient has abnormal musculoskeletal deformities

    patient habitually wears tight fitting shoes

    Impotence(Erectile dysfunction) in Diabetes Mellitus requires special attention, because it is quite capable of resulting in marital disharmony especially if couples had been very sexually active before illness began. Sexual activities involve the central, and the autonomic arms of the Nervous system . Even without any chronic disease conditions, the interest and stamina for sex decline as early as age 25, and earlier in some men and women. Diabetes mellitus more common in middle age , is commonly seen in association with hypertension and the drugs used in the treatment of both conditions reduce libido and cause impotence. These issues when added to the primitive idea that the man should at all times initiate sexual intercourse place the man in a position of disadvantage and hopelessness. The symptoms range from weak to flaccid appearance , but can hopefully be completely reversed with a loving, patient , reasonable and understanding wife with the supervision of the family physician. Decreased synthesis of nitrous oxide(NO) due to advanced gycosylated end products which also alters the elastic properties of vascular endothelium account for 60% of the etiology, apart from other psychosomatic issues . Excessive sweating and anxiety make the situation worse, because in that condition, the blood vessels in the penis are actually collapsing instead of dilating, or opening ,return of venous blood to the heart is reduced , making it difficult for the Heart to supply blood to itself so it can sustain life, for this reason, attempt to use a performance enhancing drug to force the heart to pump more blood to where it is mostly needed , will create a physiological crisis for the body . When blood is shunted from a heart that is already battling to supply itself, the rest can be worked out.

    Obesity and Diabetes Mellitus:- diabetic patients who are obese are more likely to have poor wound healing abnormal orientation of the feet , anatomically significant leg length inequality, and abnormal weight bearing during activities of daily life poor spine, hip and foot muscle alignment , ulcers form as a result of the loss of the sense of pressure, pain , two point discrimination and touch .

    Macrovascular complications

    Coronary artery disease:- Lipids especially the bad cholesterol low density and very low density lipoproteins(LD&VLD) are elevated where as the good cholesterol ,high density cholesterol (HDL)is low. Moreover, Diabetes Mellitus is associated with narrowing of the coronary vessels, wasting and loss of cardiac muscle tissue. Because signs of small heart attacks (micro infarcts) are commonly absent, sudden death may occur without the warning symptom of left sided chest pain radiating to the inner left arm and inner left neck

    Cerebrovascular disease(CVD)

    Stroke may occur after minor arguments ,minor physical exertion or even while sleeping. One side of the body may be paralyzed with or without loss of consciousness. Deposits of AGE in the walls of arteries in the brain, causes them to lose elasticity, and become plastic . They are liable to rupture at any moment of agitation, slight increase in blood pressure or sudden large drop in blood pressure(law of Laplace). Diabetic patients with congenital or acquired blood filled outpocketting of the blood vessel wall(aneurysms) in the arterial circle of Willis are particularly vulnerable

    FATTY LIVER IN DIABETES MELLITUS

    Fatty liver and hypertension are both included in the entities that constitute the metabolic syndrome. The liver is like a factory in the human body ,and as such is the main site of storage of unutilized glucose as well as the breakdown of glycogen . In diabetes mellitus increased deposits of triglycerides and increased need for increased production of glucose from non carbohydrate sources may result in fatty liver. The matter is not yet settled as to which one comes first ,since there are very many other alternative pathways involved, but it is enough to stress that the appearance of fatty liver in type 2 Diabetes mellitus should be taken seriously .

    NON VASCULAR COMPLICATIONS

    Gastroparesis

    may develop in the older patient with type 2 diabetes mellitus, mainly from abnormalities in the parasympathetic chain of the ANS. Hyperglycemia on its own causes delayed gastric emptying, bloating and easy fullness with small meals

    How ever many people live with diabetes mellitus for years without complications, but are few.

     

    Infections

    When blood sugar remains persistently high, the body becomes a living reservoir for small organisms inside and outside the body, outside the body, fungal infections with candidisis of the skin , bacteria infections with staph aureus can take the form of recurrent boils, and can even appear as badly smelling infection of the outer ear(otitis externa), offensive vaginal itching with or without abnormal discharge, Escherichia coli,(ecoli), can colonize the urinary bladder(cystitis with frequency, urgency and strangury) , the urethra in women (shorter in women, 3or 4 cm compared to 10-11cm in men), and can climb up to cause ascending pyelonephritis , or even frank kidney infection

    Dermal complications;

    Skin complications are usually coincidental with those just described, with little differences, protracted wound healing and skin ulcerations are common features of Diabetes mellitus , but can be so bad as to cause wound dehiscence or wound break down forcing the surgical team to go back into the theatre several times for the same surgery, each successive surgery carrying a higher risk .Sometimes Typhoid perforation may occur in a diabetic as a complication with very challenging consequences for the surgical team

    Type 1 Diabetes mellitus is as a result of autoimmune conditions and hence the association with vitiligo, a skin condition where the dark melanin producing cells normally present in the skin of black people are attacked and destroyed by cells of patient’s own immune system, the condition appears as white patches all mover the body and has no known cure.

    On the other hand, very dark spots may appear in the skin of the armpit, back of elbow and hands and , they are called ancathosis nigricans and their appearance is not a good sign for diabetic patients on insulin. They are different from the milder diabetic pretebial spots,

    Growth factors summoned to rectify damage caused by age are believed to be partly responsible . these include epidermal growth factor, insulin-like growth factor I, growth hormone, etc

     

     

    RCCOMMENDATIONS

    Know the medical history of your family so you PLAN how to tailor your life style with regards to food drinks , travel and stress management. You must avoid sugar and excess carbohydrates, wheat in whatever forms should be taken only in moderation.

    Stick with a Doctor, seek opinion from other Doctors as you deem reasonable but remain connected with one you can see at any time , no matter the number of sophisticated gadgets you have, they are no substitutes for your Doctor

    Single lab tests do not diagnose Diabetes mellitus, clinical symptoms and signs together with blood and urine tests are considered and confirmation established before diagnosis is made

    Diabetes mellitus can cause damage to important organs like the Heart, Kidneys , Brain and the eyes, long before the patient becomes aware, any unusual observations in these areas should be brought to the attention of your Doctor

    If you are diabetic and already have complications such as ulcers in the limbs, the situation has gone beyond seeking solution from alternative medicine practitioners. Surgery to save life with insulin carefully calculated to control blood sugar will serve you better when combined in the province of a well established center

    Avoid performance enhancing drugs ; they can kill your heart . wait until your condition is stable, plan your exercise to go with your diet program and exercise with common sense; using mild hands and legs exercise with short walking either alone or in combination, you can to test your physical strength and your ability to have successful coitus without endangering your health. The supervision of your physician or dietician must never be ignored

    Skin complications of insulin injection site can also occur; they may be unsightly but pose no danger . unusual thickening or loss of pigment should be made known to the care giver

    Attention to other risk factors for vascular disease (smoking, dyslipidemia, hypertension) and improved glycemic control are also important.

  • Breast cancer survivors may be more likely to develop diabetes

    Breast cancer survivors may be more likely to develop diabetes

    New research from Women’s College Research Institute and the Institute for Clinical Evaluative Sciences indicates that post-menopausal breast cancer survivors have an increased risk of developing diabetes compared to women who haven’t had breast cancer.

    These research findings build on what is already known about a relationship between breast cancer and diabetes.

    “There’s increasing evidence showing that patients with diabetes have a higher risk of several types of cancer, and worse prognoses when they get it compared to those without diabetes,” says Dr. Lorraine Lipscombe, a scientist at Women’s College Research Institute and lead author of the study. “This study was to see whether the reverse was true: whether cancer patients might have a higher risk of future diabetes once they survive their cancer.”

    The results showed a small but significant increase in diabetes risk among post-menopausal breast cancer survivors.

    Dr. Lipscombe and her colleagues used health databases from Ontario to identify 24,976 post-menopausal survivors of early stage breast cancer diagnosed between 1996 and 2006, and a comparison group of 124,880 women the same age who did not have breast cancer. None of the women had diabetes at the start of the study.

    During 12 years of followup, 14,576 women were diagnosed with diabetes: 2,440 cases in breast cancer survivors and 12,136 in the comparison group. The researchers found that the breast cancer survivors were more likely to develop diabetes than the comparison group. The risk was 7 per cent higher in breast cancer survivors two years after diagnosis, but increased over time to 21 per cent higher 10 years after diagnosis.

    “Among postmenopausal breast cancer survivors we found that compared to age-matched women who didn’t have breast cancer, they had a small but significant increase in developing diabetes over time, and the risks started to go up in the majority of women after two years from their cancer diagnosis,” Dr. Lipscombe says. “But we also found that among the women who got chemotherapy the risk actually increased early on after their diagnosis.”

    There was a different pattern among breast cancer survivors who underwent chemotherapy. In this group, the diabetes risk was concentrated in the first two years after diagnosis, with a 24 per cent higher risk of diabetes among breast cancer chemotherapy patients compared to the comparison group. There was no increased risk after that two-year period in women who had chemotherapy.

    “We don’t know why that is but we wonder if something about the chemotherapy might have unmasked or brought out diabetes in women who were vulnerable to getting it, and brought it out at that stage instead of later,” Dr. Lipscombe says. “One possibility is, we know that in most cases when a patient gets chemotherapy they get medications called glucocorticoids, or steroids, which we know increase propensity for diabetes.”

    Dr. Lipscombe notes that the study cannot determine the reasons for the relationship between breast cancer and diabetes, but says one possibility is that there are shared risk factors between the two conditions, such as obesity and insulin resistance, and this may lead to a common risk for both breast cancer and diabetes.

    “This study raises awareness of an association between cancer and diabetes that warrants further research,” says Dr. Lipscombe, adding that the results also suggest that as breast cancer patients are surviving more long-term, there is a need to pay more attention to some of the long-term health consequences that may affect these women.

    “Further work needs to be done to understand what those consequences are, but in the mean time one potential issue for them is an ongoing increased risk of diabetes, and so greater attention to preventive measures such as healthy lifestyle, regular exercise and keeping to a healthy weight might help to mitigate that risk,” Dr. Lipscombe says. “We also need to understand what are some of the other risk factors for that population that may put them at higher risk, and so they need to speak to their doctors about what their risk factors might be and whether they should be screened more closely for diabetes.

     

  • NAFDAC to develop herbs for cancer, diabetes, hypertension, HIV/AIDS

    NAFDAC to develop herbs for cancer, diabetes, hypertension, HIV/AIDS

    The National Agency for Food and Drug Administration and Control (NAFDAC) is to develop local herb drugs for cancer, diabetes, hypertension and HIV/AIDs among other terminal diseases.

    It has raised an Experts Committee to work on developing such drugs.

    NAFDAC will also intensify its campaign on herbal drugs/medicine, and supplements regulation by testing them for safety, efficacy and toxicity (SET).

    Speaking at a stakeholders meeting in Lagos, NAFDAC Director-General Dr Paul Orhii, said herbal medicine practitioners who sell their products without listing them would go to jail.

    Under SET, he said products must be tested for safety, efficacy and toxicity, among others, before they are listed. The drugs will be withdrawn once it is proven that they endanger public health.

    SET, he added, is the gold standard for effective regulation of herbal products and supplements to ensure the protection of lives.

    Chairman, National Association of Nigerian Traditional Medicine Practitioners (NANTMP) Prof Thomas Omon said 80 per cent of Nigerians rely solely on traditional medicine for treatment.

    This, he said, means that no fewer than 128 million people take herbs, supplements and herbal drugs to achieve healthy life and wellness.

    He said the practitioners will cooperate with the agency to ensure effective regulation of herbal products. “If there is anything we have not done, tell us we will do it. The regulation of our practice will not only be of benefit to Nigeria but also the world at large.

    “If some medicinal cures are discovered in our country, it will transform the economy. So we must not be sheepish buyers of foreign medicine. We must develop our practice,” Omon added.

    He identified high fee for the renewal of licence for listed products as one major obstacle practitioners are confronting and which NAFDAC must revisit.

    On other challenges, Omon berated the Federal Government for its failure to establish a school where people can be trained and practitioners can be re-trained.

    “Lack of school has left much to desire in terms of training and research. There is no school, no hospital to do practical where practitioners can unveil what they have because I’m an advocate of what people call ‘seeing is believing’ (SIB). This is a situation where patients who have been treated will speak for themselves and the whole world can see it.

    He urged the agency to back its words with action to ensure that local production of herbal drugs in treating some of the ailments usually afflicting the people, such as malaria, diabetes and cancer, among others receive a boost.

    Omon said the expert committee set up to develop herbal drugs for the country was a step in good direction, stressing that the group should not go the way other groups have gone, when they went under without achieving anything.

    Vice-President, NANTMP, South east, Dr Eugene Nwachukwu, said the move to regulate traditional medicine was a positive one because charlatans who make fabulous claims of cure can be detected and punished accordingly. This, he said, will also ensure that only true or genuine practitioners are recognised as it will ensure sanctity in the profession.

    Nwachukwu expressed satisfaction with the Experts Committee, saying: “It is made up of accomplished practitioners, they will do a wonderful job. But, we the practitioners still need to help them by ensuring that we educate ourselves on the dos and don’ts so that the country can move forward in traditional medicine.”

    NANTMP’s assistant Secretary-General, Dr Charles Onuchukwu, said people who think they can just formulate anything without necessary procedure will be curbed because there will now be guidelines for practitioners. Also, training will be organised to develop or build the capacity of practitioners so that they can be armed with what is expected of them.

    He said: “We alone cannot regulate or control the practice. The fact that there will now be government’s hand in it is a good development that will move the profession forward.

    “The country is good at making laws but implementation or enforcement has always been a problem, this new development would go a long way in ensuring that the practice is regulated.”

    On research and development, he said traditional medicine practitioners can now have a joint research because of the inauguration of the ‘Experts Committee’ that will come up with formulations that can help address diseases such as cancer, diabetes and HIV and AIDS, which do not have orthodox cure.

    “The intellectual property can also be protected by the committee set up,” he added.

    Vice-President, Moringa Association of Nigeria, North central, Jacob Odiba, said the issue of regulation and collaboration with NAFDAC was an excellent idea that will move the practice and the country forward.

    He said traditional medicine practitioners have been crying for regulation and collaboration with the agency for a very long time, adding that now, “Together efficacious and safe medicines can be developed for the country. It is the practitioners that are killing the country. So, if we can lift the country again by ourselves, that will be great,” he said.

    Making reference to the book of Proverbs in the Bible, Odiba said there is no ailment without a cure, stressing that God has endowed the people with knowledge to produce efficacious medicine.

  • Diabetes mellitus; symptom check list, complications ( 11) Edtd

    Diabetes mellitus has been described as a group of metabolic disorders where behind the various manifestations is a purely biochemical problem; that of excess sugar or inappropriate level of sugar in the blood . We need to distinguish between Diabetes Mellitus, and Diabetes Insipidus since both conditions are characterized by frequent passage of abundant quantities of urine, excessive thirst accompanied by drinking of water, weight loss, loss of strength etc.

    Diabetes Mellitus is a problem of the pancreas, an organ in the Abdomen, and it involves relative or absolute lack of the hormone insulin as a result of which the blood and urine contain excess sugar . Diabetes insipidus on the other hand is a problem arising from the posterior path of the pituitary gland ;an organ located in the brain. Similar to Diabetes Mellitus, there is a problem with a regulatory hormone; this hormone called Vasopressin is deficient. Vasopressin, Argipressin or simply antidiuretic hormone (ADH) has many functions in the body. It regulates water and electrolyte status of the body by promoting the retention of water via concentration and reduction in the quantity of urine produced. The urine in Diabetes Insipidus as opposed to Diabetes Mellitus has no sugar, and the condition is not common

    Concerning Diabetes mellitus, reasons for the excess blood sugar have been suggested;

    •Insulin secretion is either in very low quantities, or is not produced at all, as in the case of the type 1 diabetes.

    •Too much glucose from too much food, carbohydrates, sugary and fatty foods, alcohol or sugary drinks, as occurs in the more common type 2 diabetes mellitus.

    •Glucose and insulin are produced in appropriate quantities but not adequately utilized, by target tissues and organs.

    Whatever the reasons, untreated or poorly treated diabetes mellitus means that the level of sugar in the blood remains higher than normal and the excess sugar will after a period ranging from five to ten years depending on other factors, join other molecules found naturally in the body . The compounds so formed will go on to cause damage to many important organs of the body. Common problems that may arise include, difficulties having and maintaining a useful erection( erectile dysfunction), blindness , stroke, with paralysis, heart attack, kidney disease and kidney failure, severe chest infection , death of mother and child through child birth , very bad feet and leg infection resulting in amputation of feet and legs. These may develop with little or no chance to do anything to save the situation

    The problem and need for increased sensitization

    Diabetes mellitus and Hypertension are becoming more prevalent in Black people compared with non-blacks.

    Diabetes mellitus is increasingly being found in association with hypertension, another non- communicable disease which is also now surpassing the levels found in peoples of the white race, in terms of prevalence, the exact nature of this association is being studied, and patients should be willing to participate and even fund research in these areas

    Unlike type 1 diabetes , type 2 diabetes which occurs in over 90% of the population is being reviewed regularly with regards to definitions, classification, association with other conditions like hepatitis, obesity, cancer, including breast cancer, thyroid disorders etc. Updates in respect of new findings don’t get to most patients , who continue to ingest and inject whatever they are told will take care of the ailment

    Diabetes mellitus tends to reactivate human tuberculosis, a communicable disease with a very high prevalence and mortality in Nigeria and awareness of this fact is often difficult to accept particularly amongst rural communities.

    Complications associated with Diabetes mellitus such as co- infection with pulmonary , spinal or disseminated tuberculosis are equally now more common in black populations.

    For both hypertension and diabetes mellitus, Complications can be present in a patient long before a diagnosis is made. They can also emerge during ancillary investigations, treatment and in some cases, after what may seem to the patient as the disappearance of the disease. For instance, the effect of excess blood sugar can cause serious damage to nearly all structures in the human body from the head, neck and brain(with the eyes), through the, the lungs, heart and blood vessels to the gonads, genitals, skin, muscles and skeleton. Blurred vision, persistent

    Severe pains in the eyes may be present in one patient for over five years before one of the them pushes the patient to seek help

    Increasing number of cases of diabetic ketoacidosis (DKA ) are being seen in emergency rooms, ER(casualty) and intensive care units(ICU); patients are mostly young adults and middle aged, who are not aware of possible complications of Diabetes mellitus. They party , smoke and drink with their non diabetic friends, until they are rushed to the Hospital in coma or semi consciousness from DKA. The ingredients for DKA are provided when a diabetic patient gets so much calories from alcohol that he does not feel hungry but his cells are starving for glucose and water, and so his organs unknown to him are not functioning well ; the body attempts to correct the situation by mobilizing all resources available . In the situation of only small quantities of insulin or no insulin at all being produced , the over all effect of these counter measure is best described as diabetogenic; Glucagon , growth hormone, cortisol, sympathetic or cathecolamines are all released in excess ;glucose has to be sourced from alternative sources of carbohydrate in the body such as the liver(glycogenolysis), muscles(gluconeogenesis), These activities will result in formation of dangerous acids(ketoacids) and fats some of which will form destructive complexes that will eventually be deposited in the liver, kidneys, brain and other major organs. Excess free fatty acids elsewhere in the body can generate abnormal electrical activities in the heart(ECG changes) and brain(abnormal EEG wave Parttern) ,which may pose serious diagnostic challenges , hence emphasis is that a diabetic patient should everything within his power to avoid Excessive Fasting, Alcohol, Smoking And Dietary Indiscretion.

    Some of the complications of diabetes mellitus are redeemable, especially when the patient understands his problems, and he is willing and able to participate in the management of his condition. Some Other complications are not so reversible and getting the patient to accept unpleasant situations he has no power to change is not easy in practice.

    While many patients have access and are able to afford sophisticated Medicare ,there are others who can not afford even analysis of urine. Beyond that, rural dwellers present with complications or manage to do so when all other alternatives have failed.

    Another issue is that for older diabetic patients(Seniors)the burden of care is heavy, there are no such facilities as geriatric nursing homes here in this country ,and physicians have no time for extra burden of training a home based care giver or counseling the diabetic patient that may have developed suicidal ideation or his wife how to develop coping mechanisms to help deal with unavoidable intrapsychic conflicts associated with potential and actual amputees.

    Prevention fatigue arising from dietary restrictions that are too rigid, coupled with pressure from spouse and significant others on issues bothering on sex are driving diabetic patients to the more flexible alternative, herbal or traditional or herbal remedies. Such patients are likely to ignore the symptoms of blindness for quite sometime before going for eye check. They also more likely to be forced to try performance enhancing drugs that could trigger heart attack, and run into drug induced hypoglycemic coma or hyperglycemic hyperosmolar states where very high levels of blood sugar and electrolytes are detected. By making a few statements emphasizing that patience, understanding and not drugs should be the preferred avenues to happiness, homes and lives can be saved.

     

     

     

     

    Finding solutions is no longer limited to the patient and just one Doctor, involvement of Government and non governmental agencies, trained people from many different disciplines including traditional healers have proven to be of immense benefits, but patients in the higher social classes and those who are rich rely mostly on sophisticated equipment, and the few consultant physicians who are already so overworked in the Teaching Hospitals and private clinics that they are in no position to spend time on health education. It is widely accepted for instance that getting a patient with a gangrenous diabetic foot ulcer to go in for amputation is best handled when a counselor is in attendance.

    Children and adolescents are now being diagnosed to have maturity onset type 2 diabetes mellitus and type 1 auto immune type are being found in older diabetic patients; yet food and drinks containing sugar in many different forms flood the market every day and mothers make the freely available for children and adolescent. Flooding supermarkets and refrigerators with sugary fruit juice, and baked products with fatty and oily ingredients is a sure way to produce very unhealthy children with uncertain future. Baby fat cells don’t go away ; they only shrink and can swing back and begin to grow with very little support

    Behavior change in favor of healthy life style takes time and perseverance, and experts in the field are few, besides not many diabetic patients appreciate the importance of seeking help from even the few ones that are available

    •On the matter of complications, age and whether or not the patient has type one or type two is no longer relevant because, more cases of type two are been seen in people below the age of 30 and in adolescents who are obese with body mass index BMI( weight measured in kilograms divided by the square of height in meters) in excess of 30.

    •Only a few bottles of alcohol can trigger DKA in a young diabetic of 25 years just as acute viral infection can trigger severe immune reaction resulting in complete obliteration of the insulin producing beta cells of the pancreas in a 45 year old non obese woman

    •With new frontiers in health technology emerging every day. The different types of Diabetes mellitus are being redefined in order to more effectively capture important variables such as age, sex, gender, race, environment ,etc. At present, the recognized types of Dm include type 1, 2, pregnancy associated or gestational diabetes mellitus, drug and Alcohol induced Dm, Chemical Dm, which may arise from the use of chemical weapons of mass destruction, biological and immune Dm, Hiv/Aids related Dm , Dm due to cancer either by direct invasion, directly or from distant sites spreading by lymph , blood or both, others as may not be known, and direct trauma wiping out the entire population of the insulin producing cells of the pancreas.

    •Multiple genes including those that encode Class 11 (MHC)major histocompatibilty molecules are more common in type 1 Dm, but emerging viruses are now being studied in respect of their ability to trigger immune response , cause damage to the beta cells of the pancreas which come out of their previously concealed environment to become attacked by own immune defense system. Memory cells are then later produced that will further damage whatever similar insulin producing beta cells are available.

    Insightful commentaries such as can be taken from here and other sources can be useful to the interested and hopeful diabetic patient. He and those affected by his illness can also use what ever small bits of information they can gather as the basis for decision making , action, and most importantly caution

    Recall that the Late Michael Jackson repeatedly asked for the Wonderful Drug Propofol, not only for his pain but also for the additional wonderful experience which the drug provides when it is administered by the usual intravenous route. A trained nurse had refused to administer what would have been a killer dose, but his personal well paid Physician had no choice if he wanted to keep his job, and so accepted to be persuaded and did give the killer dose of Propofol. In some possibly similar circumstances, when professional caution or clinical judgement becomes clouded , as a result of interplay of intrigues or simply because not much is known about consequences of unguided actions, drugs known to rapidly lower blood sugar , blood lipids, blood electrolytes and drugs known to bring down high blood pressure could take the life of a patient.

     

    WHO ARE THOSE AT RISK ?

    The probability of having the complications of diabetes increases when a patient is of African descent, and he is aged above 35 years. Others are as summarized below;

    Though it depends on several other factors, blood sugar levels persistently higher than 10mmols after 8 hours of fasting should warn a diabetic patient to go get a comprehensive physical examination and this should be followed by organ function investigations. All relevant tests as directed by the Physician, should be done ,as far as can be afforded

    •Treatment with insulin, primarily as a result of being a type 1, or type 2 diabetic or as a result of the presence of complications or other disease conditions

    •Relatives of people who have diabetes, especially if such relatives have had problems leading to amputation, heart disease, stroke ,kidney failure or heart disease

    •Patients with hypertension and with blood pressure above 140 /90mmhg

    •Obese individuals, not exercising and not on lipid lowering drugs

    •Diabetic patients also taking certain categories of drugs for depression, hormonal contraceptives, thyroids etc

    · Mixing English drugs , supplements and herbal remedies, which may react to form compounds that will either shoot up blood sugar or crash it

    Other situations that are commonly associated with complications are

    · Wrong administration of insulin injection , mostly by untrained persons

    · Medication for other conditions such as for depression, Alzheimer dementia, etc

    · Suddenly going off drugs following instruction from a prayer house, or ‘’experienced person’’

    · Carelessness ,poor adherence to treatment and non pharmacologic instructions, a young adult male or female diabetic who drinks and smokes against medical advice may go into diabetic keto acidosis while having a party. The sequence of events that follow may be so dramatic that survival chances are slim

    · Overdosing with the wrong impression that one could achieve a cure

    · Presence of co morbidities or other disease conditions especially when ignored by the patient

    · Sudden or gradual emergence of stressful conditions, as in surgery, pregnancy, bereavement,

    · Patients will have been on insulin, primarily or as a result of the presence of other disease conditions

    · Diabetic Patients whose relatives have had complications of diabetes mellitus, especially if such relatives have had problems leading to amputation, , stroke ,kidney failure , hearing loss or blindness. Over 20 genes have been identified in connection with Diabetes mellitus

    · Diabetic patients with hypertension and blood pressure above 140 /90mmhg may go on to develop heart problems, kidney damage that may require dialysis or stroke with paralysis

    · Complications such as fatty liver, heart attack and kidney failure may also arise in obese individuals, not exercising and not on lipid/fat lowering drugs

    · Complications have been documented in Diabetic patients taking maceptives, thyroids etc

    BETTER UNDERSTANDING OF THE COMPLICATIONS OF DIABETES MELLITUS;WHAT BENEFITS?

    · Improved understanding of the nature of his illness better makes a diabetic patient more confident in his ability to seek and receive medical care

    · Health education improves illness perception and assists patients towards taking action . To that extent, when a physician or therapist puts a patient who is diabetic on exercise / diet program designed to effect a change in life style and ensure that he does not go on to develop hypertension, he is expected to know that he alone bears the responsibility if out of his choice , hypertension ensues to complicate his DM as part of the syndrome of metabolic diseases , which also includes, obesity , particularly, the android, truncal or apple type obesity with BMI in excess of 30 kg/m2

    · He is a better patient, takes his drugs when prescribed, and according to dosage formulations and schedules,

    · He is less likely to default because he is aware of the consequences, he knows why he is being asked to do certain things like exercise, refrain from certain life style , considered unhealthy

    · Awareness of certain symptoms will gradually translate into knowledge that will enable patients elicit those symptoms which herald serious complications

    The patient knows what laboratory tests to do and is able avoid performing tests that are expensive and unnecessary

    DANGER SYMPTOMS AND SIGNS RELATED TO COMPLICATIONS

    First is to note there may be no symptoms, even of uncomplicated Diabetes mellitus

    The common features of Diabetes mellitus with or without complications include Polyuria, polydypsia, chronic vaginal discharge , vulval pruritus, recurrent boils, obesity, in particular with fat deposit around the upper body , gyenoid obesity commoner in women with fat deposits around the thighs are less dangerous , loss of strength, exercise intolerance, abnormal sensation like electric shock stings in hands and feet, impotence,

    About 2000 years ago Greek Physicians and Anatomists observed that people who had the illness characterized by frequent passage of large quantities of water remained ceaselessly thirsty , rapidly lost weight and with time went into coma. They concluded that such people were excreting their flesh in urine. Loss of flesh body fat and oil in the urine of a diabetic patient partly explains the characteristic, loss of muscle mass, weakness and mouth odor seen in untreated diabetes mellitus and can lead to very serious problems if not promptly and effectively handled.

    Before insulin was discovered loss of consciousness or coma was the major complication of diabetes mellitus, and 50% of patients died through combinations of events leading to coma. Though the use of different formulations of insulin have brought miracles to many patients, the insulin syringe can become murder weapon even in the hands of a trained medical person , as may also be the case when handled by someone whose professional thoroughness is doubtful

     

    ACUTE COMPLICATIONS OF DIABETES MELLITUS.

    Hypoglycemia

    Any attempt to rapidly bring down blood sugar or blood pressure disobeys natural laws of physics and the reaction tips the patient in the direction sometimes of no return. Consultant physicians can use their wealth of experience to control some situations , but they would rather that patients didn’t get into such roads; and that can only be achieved through patient education usually outside the consulting clinics of Central or Teaching Hospitals

    An example of acute complication is when insulin injection is given for a high, falsely high or low blood sugar reading, and the blood sugar drops so low that the patient becomes, unconscious, has a seizure, does not recover or recovers with permanent brain damage, deafness or paralysis.

    Diabetic ketoacidosis(DKA) And Hyperglycemic Hyper osmolar state (HHS ),

    Both can occur in the different types of diabetes mellitus, but DKA is commoner in type 1, where insulin is usually required.

    Diabetic ketacidosis is a more severe condition that can arise suddenly from several possible causes, involves loss of fluid and electrolytes from the body , and quickly ends in coma and death if not handled properly and carefully.

    The other acute complication that can arise as an emergency situation, is hyperglycemic hyperosmolar state .The condition is not common, and patients often have antecedent or coexisting mild or serious conditions like septicemia, pneumonia, heart disease, cancer etc.

     

    WHO ARE THE DIABETIC PATIENTS AT RISK OF DEVELOPING DKA .

    Known diabetic, on insulin, young patient, below the age 35 years, non obese, taking insulin without adequate supervision, mixing herbal preparations with English drugs, hypertensive, uses cocaine and alcohol occasionally, but at times allows friends persuade him take more than usual , infections eg pneumonia, sepsis, urinary tract infection, myocardial infarction, pregnancy

    Principal features to watch out for are excessive thirst, abnormal breathing pattern, fast shallow, breathing that may make the patient reach a respiratory rate of up to 80 per minute, and more , followed by slow , deep sighing respiration , though this may arise in other conditions of brain affection, other features such as severe nausea, vomiting, pain in the abdomen, mouth dour of someone that took lots of fruits, severe weakness, add up to help make the diagnosis.

    hyperglycemic hyperosmolar state HHS

    For the hyperglycemic hyperosmolar state(HHS), patient is elderly and known to have had type 2 Diabetes mellitus with a history of several weeks of weight loss , loss of appetite in addition to other diseases such as hypertension kidney disease etc.

    The other symptoms of DKA may be present except that abnormal breathing pattern, abdominal pains and vomiting are typically absent

    both these conditions are in the province of specialist endocrinologists and every effort should be made to get patient to hospital . the resources in terms of personnel, including laboratory prrsonnel and equipment to manage these cases may over stretch even some secondary health centers, they very quickly lead to death or end in permanent disability if not handled quikly and properly

    When such cases are brought to the casualty department, they are usually the first real opportunities for young Doctors in training to demonstrate how much or little they have understood or know about practical laboratory procedures which they learnt as medical students and and internal medicine, which they had to study in some detail.

    It is on this basis that it is in appropriate for any one to attempt to manage such cases if he never went through the experience. Qualified medical Doctors irrespective of age and sex are normally made to pass through the grill of managing many of the complications of Dm within the boundaries of their academic and professional qualifications

    CHRONIC COMPLICATIONS

    The chronic complications of DM affect many organ systems and are Characterized by anatomical and functional changes, involving blood vessels , their supporting tissues and others.

    The nature and pattern of Problems announcing the emergence of complications depend on the type of diabetes mellitus , age of the patient, type of medication among others and can be grouped arbitrarily as acute , chronic, or acute on chronic. Chronic conditions can also be vascular, involving the blood vessels or non vascular, when tissues other than blood vessels are affected. Vascular lesions may affect only the small or very tiny blood vessels(microvascular complications )or the major arteries and veins( macrovascular complications)

    In general the longer the time some one has diabetes mellitus, the higher the person’s chances of developing these complications that may lie hidden in the brain, eyes, heart, kidneys, liver . they usually become apparent in the second decade of hyperglycemia. Some may declare themselves after five years, some, about ten years, or more. Some cases of type 2 may be diagnosed during investigation for something else in a hospital, while others may live out their life

    BASIC SCIENCE

    Scientists in Anatomy , molecular biology ,biotechnology and public health , pharmacology and others have in collaboration with other physicians in internal medicine, surgery, and others gone from genetic linkage analysis , creating artificial pancreas, beta cell transplant technology to issues in stem cell research, and regenerative medicine. Advanced knowledge is assumed for any one involved in the research leading to the various attempts aimed at finding solutions but basic science tries to provide minimal but useful information for anyone interested in keeping pace with literature traffic interest in these and related subjects

    The major problem in Diabetes mellitus as has been discussed is excess blood sugar . it is believed that the excess sugar forms dangerous compounds with certain amino groups attached to proteins inside and outside the cells called advanced glycosylation end products(AGE).

    These compounds are deposited in the filter apparatus of the kidneys ,where they now force many different reactions to occur first in the kidneys, and then other parts of the body. The damaging processes go on as long as blood glucose remains higher than normal . Damage to the central cells of the glomerulus, the messangial cells reduces kidney function , increases blood pressure and creates a vicious cycle that could finally cause kidney failure

    At the same time, impotence, one major complication of Diabetes mellitus results from the damage done to blood vessel walls by the accumulated AGE products ; this also reduces the secretion of Nitrous oxide, a compound responsible for maintaining penile erection by ensuring that tiny blood vessels remain open and engorged with blood(there is no bone in the penis).Controlled exercise that focuses on the lumbosacral region of the vertebral column , meant to reduce the dominance of the sympathetic over the parasympathetic chain of the autonomic nervous system on the hypothalamo cardiac genital axis involved in penetrative sexual intercourse. This provides longer lasting effect, rather than the use of drugs that may overwhelm the cardiac component of this axis and cause sudden death

    Some complications ,in particular those affecting the eyes and the filter apparatus of the kidney result from attempts by the body to repair the damage done by these abnormal deposits . for instance, vascular endothelial growth factor is increased locally in proliferative diabetic retinopathy. Abnormal production of transforming growth factor stimulates basement membrane production of collagen and fibronectin, which by way of complex adhesion molecules go on to damage, stiffen and distort the elasticity of vascular structures. Damage to the messangeal cells in the central portion of the kidney glomerulus causes leakage of albumin and other high molecular weight proteins , which appear in urine