Honey-sweet & dangerous: Diabetes is on the increase, especially in Africa.
Subject: Diabetes (Diagnosis)
Diabetes (Risk factors)
Author: Wietersheim, Simone von
Pub Date: 07/01/2011
Publication: Name: Sister Namibia Publisher: Sister Namibia Audience: Academic; General Format: Magazine/Journal Subject: Social sciences; Women's issues/gender studies Copyright: COPYRIGHT 2011 Sister Namibia ISSN: 1026-9126
Issue: Date: July, 2011 Source Volume: 23 Source Issue: 2
Geographic: Geographic Scope: Namibia Geographic Code: 6NAMI Namibia
Accession Number: 264175223
Full Text: Three to four spoons of sugar in our tea or coffee is the norm in Namibia, drinking Sprite or Coke instead of water has become a new habit, and driving by car or taxi instead of walking has become part of modern life. As a result, more and more men and women, and even children, are severely overweight or obese. Unfortunately this is still seen by many, especially the older generation, as a sign of good health or wealth, while thin people are seen as poor or possibly infected with HIV. However, obesity is a serious risk factor for unhealthily high sugar levels in the blood, also called Diabetes Type 2. Just as high blood pressure, Diabetes is today a typical "national disease" that is becoming more and more prevalent in southern Africa due to lifestyle changes. Experts estimate that 3.5 million South Africans have Diabetes, while in Namibia, Diabetes ranks as one of the top 10 diseases and among the top 15 in-patient causes of death. Dr. Simone von Wietersheim gives information and advice on signs, symptoms and treatment.


Mrs N., a 46 year old teacher from Mariental, is the next patient in my consulting room. When I call her name, an overweight lady is slowly getting up from her chair and walks into my room, breathing heavily. "Doctor, I don't know what is going on," she starts explaining immediately. "I have been tired and weak for weeks, and I am passing too much urine. Even at night I have to get up several times to go to the toilet. And I am constantly thirsty. My friend said I probably have a urine infection and I must see a doctor for a urine test. But the pee is not burning at all."

Because I see Mrs N. for the first time, I ask her about her medical history as well as her family's medical history. I learn that she has been on treatment for high blood pressure for three years, receiving her tablets regularly at a Mariental clinic. Her parents also suffered both from high blood pressure, and her father was also on treatment or Diabetes until he died from a heart attack, aged 62. Mrs N. has three children and has never had an operation.

From the symptoms that Mrs N. described to me, and also because of her family medical history and her obesity, age, and high blood pressure, I have a strong suspicion that she might suffer from Diabetes. This is confirmed when I do a Glucose Test of her blood and of her urine. Since her sugar level in the blood is very high, I start her on an anti-diabetic treatment immediately. But I also strongly advise her to change her diet, to exercise and to lose some weight to assist the treatment of the diabetes AND of the high blood pressure. I ask her to come to regular follow-up consultations over the next few months so that I can monitor her blood glucose level and her weight, and optimize her treatment.

What is Diabetes?

The medical term 'Diabetes mellitus' means, translated directly, 'Flowing through, honey-sweet'. The disease was named like his because the urine passed by people with Diabetes has a sweet taste--and in earlier days the diagnosis of Diabetes was made by tasting the patient's urine! How does this happen?

The sugar that we take in with our food (called 'glucose' in its digested form) is normally absorbed into our blood stream. A hormone called Insulin then helps to move the glucose from the blood into the body's cells, where it is stored for energy. People with Diabetes, however, either don't produce enough Insulin, or their cells don't respond adequately to Insulin. This leads to very high levels of glucose in the blood. A part of the glucose is removed by our kidneys and excreted into the urine--therefore its sweet taste. When the Glucose level in the blood remains constantly high, it can cause severe problems over time. It can lead to strokes, heart attacks, kidney problems, blindness, impotence and death.

It is important to know that there are two types of Diabetes: The symptoms of Type 1 Diabetes usually develop quickly, and at a young age. It is treated with Insulin injections, because the body is unable to produce any Insulin at all. Type 2 Diabetes is much more common. It usually develops in people after the age of 40 and develops gradually. The body still produces Insulin itself, but either it does not produce enough or the body's cells are 'resistant' to Insulin. This article deals with Type 2 Diabetes only.

Who is at risk to develop Diabetes?

The most important risk factor is being overweight, because fat interferes with the body's ability to use Insulin. Diabetes can, however, also develop in thin people, especially in the elderly. Also, Diabetes runs in families. So, if a parent, brother, sister or child of yours has Diabetes, your risk of getting Diabetes is increased. Other important risk factors are a too little physical activity, age above 45, high blood pressure, high cholesterol or smoking and drinking excessively. Diabetes can also develop during pregnancy. Therefore regular pre-natal care is very important.

What are the signs and symptoms c-7 Diabetes?

In the beginning stages of Diabetes, most of the time there no symptoms at all, and the disease can progress undetected for many years. As the blood sugar levels rise more and more, the following symptoms might develop:

* You might always be tired.

* You might be always thirsty and frequently need to urinate,

* You might have blurred vision.

* Cuts, sores and infections might be healing very slowly.

* Your skin might be dry and itchy.

* You might lose weight.

* Men might become impotent.

How is the diagnosis made?

Very often a diagnosis of Diabetes is made during a routine check-up, since the disease only shows symptoms at a far-progressed stage. This is done by a blood test, which measures the amount of glucose in the blood. The doctor or sister will draw some blood from your veins and send it to the laboratory. He or she can also do a quick test by pricking your finger with a small needle and check your blood sugar level with a Glucose Meter. Another indicating test is to check your urine for sugar with a "dipstick".

If you are diagnosed with Diabetes, your doctor will usually advise you to have other tests done as well, to rule out additional risk factors such as high cholesterol, high blood pressure, as well as beginning complications of the illness such as kidney failure, heart disease, eye problems or defects of the nervous system. These tests should be repeated at regular intervals to detect any abnormalities as early as possible.

How is Diabetes treated?

Diabetes is a life-long condition. Some people can control it with lifestyle changes alone. The most important changes are a healthy and balanced diet, losing weight and regular physical activity. Reduce the intake of fat, salt and sugar, and take in regular meals with lots of fibres, especially fruits and vegetables. If you are overweight, try to lose weight. Also do some physical activity. It is generally recommended to exercise at least five days a week, for a minimum of 30 minutes. Ideally you should get at least mildly out of breath and mildly sweaty. You can also spread the activity over the day, for example doing some brisk walking, cycling, swimming or even dancing for fifteen minutes twice per day.

If lifestyle changes alone cannot reduce the blood sugar levels enough, you will require anti-diabetic medication IN ADDITION. There are various drugs that reduce the blood glucose levels, and it is quite common to use a combination of two or more drugs to achieve the optimal effect. Good follow-up and cooperation between healthcare provider and patient is needed to find the best treatment for every individual. Only if the blood glucose level cannot be controlled with oral medication and a healthy lifestyle, there is a need for injecting Insulin on a daily basis.

RELATED ARTICLE: How can I see if I am overweight?

It is optimal to have a Body Mass index (BMI) between 18 and 24. BMI is calculated by taking your body weight (in kilogram) and divide it by the square of your height (in metres).

Example: Mrs N. weighs 97kg and her height is 1.61m.

The square of 1.61 is 1.61x1.61 = 2.5921 97 divided by 2.5921= 37.4. So her BMI is way above the optimum of 18-24, making her seriously overweight.


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