Gambians and the Scourge of Diabetics/Why Are Many Gambians Dying Young? (Take Two)

Wednesday, October 3, 2012

Why Are Many Gambians Dying Young? (Take Two)

On the Scourge of Diabetes and How to Confront it

By Bakary M. Jallow

Diabetes Mellitus is a chronic disease that is having its foot prints on Gambian soil. It is a group of diseases that is characterized by abnormal blood glucose (sugar) levels. Diabetes has the potential to affect almost every organ in the body if not managed well. Complications from diabetes can lead to problems of the eyes (Retinopathy), kidneys (Nephropathy), heart (ischemia or heart attack), skin (Non-healing wounds, gangrene), and nerves (Neuropathy), etc.

According to the World Health Organization (WHO) data on The Gambia, the mean fasting blood glucose levels of Gambians are steadily rising from 4.9 mmol/L in 1980 to 5.6 mmol/L in 2008 for females. In males, it has risen from 5.15 mmol/L in 1980 to 5.42mmol/L in 20087. The mean normal blood glucose level for humans is about 4mmol/L or 72mg/dl. The normal fasting (8 hrs without food) blood glucose level is between 70-130mg/dl and less than 180mg/dl after meals (4).

The scourge of diabetes does not affect The Gambia alone; it is a worldwide crisis, which if not slowed down, will take a toll on populations across the globe. Diabetes is pandemic and The Gambia is not an exception to this. The WHO has estimated that 346 million people worldwide have diabetes and 3.4 million died from the consequences of high levels of blood sugar in 2004. Eighty percent of all diabetes occurs in low and middle income countries of which The Gambia is a part (6). Up until last year, according to WHO, The Gambia had not integrated programs or did not have a specific policy/program or action plan to help curb the rise of diabetes (7). So as citizens, we are left with a few options or none to fend for ourselves against this terrible disease. Our only way out is to inculcate prevention strategies in our daily routines or lifestyles. This will require behavior and lifestyle modifications.

Diabetes is categorized into different types. It is categorized as Pre-diabetes; Gestational diabetes; Type I Diabetes also known as Insulin Dependent or Juvenile on-set diabetes; Type II Diabetes also known as Non-Insulin Dependent Diabetes or Adult on-set diabetes  (5). All types of diabetes share one common characteristic and that is: “abnormal glucose (sugar) levels.”

Type I Diabetes occurs when an individual is not producing insulin and Type II Diabetes occurs when an individual is not producing enough insulin to move sugars into body cells or when an improper usage of insulin is happening in the body. Insulin is a hormone in the body that is produced by the pancreas that facilitates the movement of food products such as glucose into cells to produce the energy we need for our day-to-day activities. Gestational Diabetes is diabetes that occurs during pregnancy (1).

Signs and symptoms of diabetes are but not limited to: frequency in urination, fatigue, weakness, extreme hunger and thirst, non-healing wounds, tingling and numbness, dry skin and weight loss. Diabetic patients deal with another extreme blood sugar level called hypoglycemia which is low blood sugar levels. The signs and symptoms of hypoglycemia are: confusion, thirst, hunger, sweating, restlessness, shaking, blurred or double vision, loss of consciousness, seizures etc (2). Hypoglycemia can be triggered by not eating enough food or the effect of insulin or oral hypoglycemic on the body.

Like I stated in my last article, one has to be responsible for one's own health. You are just risking dying prematurely if you sit and wait for help from politicians. Get out and do something about your health and don’t let anyone dictate how you are going to live your life. With the advent of all these imported canned foods to The Gambia, it is getting harder and harder as the days go by to live a life without exposing oneself to diabetes precursors. It is rather unfortunate that we in The Gambia look at canned foods as the way to go in terms of living healthy. It is disheartening to see people in The Gambia take pills such as “Geigedo” to increase their weight. The notion that looking “Fat” means you are living a luxurious life is obnoxious! People doing that are slowly but surely killing themselves as one of the risk factors for getting diabetes is being obese or overweight.

So what can GAMBIANS DO TO PREVENT AND DELAY DIABETES and its nefarious effects (if inevitable)?

• First and foremost: Know your status by getting tested for diabetes. Fasting blood sugar levels help doctors in diagnosing diabetes. It is important to know your Hemoglobin A1C levels. This will help the doctor to know your blood sugar levels for a period of 2-3 months retrospectively.
• Eat healthy by eating small, frequent portions during the day which should include servings of fruits and vegetables. Eating white rice three times a day is not advisable. White rice has been associated with significant increase risk for diabetes (1).
•  Minimize sugar and sweeteners consumption. The “Wonjos”, “Atayas”, “Pancakes” “Gingers”, “Charkeres” ‘Tees” just to name a few, are getting sweeter by the day in The Gambia. We got to cut down on fried foods such as “Benachin”, “Chu” and the likes if we want to be around for a while.
• Read canned food labels before consumption. I hope the government will make sure food product importers label the foods they import. Look for high fat, salt and cholesterol contents and avoid them.
• Exercise regularly by moving around. Walking around the neighborhood, walking to school or the market, weeding the back yard, playing with children are exercises one can benefit from if you can’t do strenuous exercises like running or playing soccer. We have to dismantle the “Ataya Vous” my fellow citizens and find other ways of socializing with friends and family.
• Maintain a healthy body weight.
• Quit smoking if you are a smoker (3).

***Healthcare workers: please DO NOT advice diabetic patients not to eat at night. “Suta Domoroo bula” is a common sorry advice from some of our healthcare personnel in The Gambia. Advising a diabetic patient not to eat at night is predisposing him/her to hypoglycemia (low blood sugar) which is deadly. Diabetics should eat small frequent meals to achieve optimal blood sugar levels.

Diabetes and hypertension used to be foreign to our dear land but not anymore. One of the biggest problems facing our nation is the staggering number of undiagnosed diabetes and hypertension cases confronting us, rather unknowingly. Help our nation in determining the extent of the diabetes problem by getting tested.

References
1. BMJ (March 15, 201). White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. Retrieved from: https://www.bmj.com/content/344/bmj.e1454

2.  Centers for Disease and Control and Prevention (July 25, 2012).Diabetes Public Health Resources. Basics About Diabetes. Retrieved on August 23,2012 from: https://www.cdc.gov/diabetes/consumer/learn.htm

3. . Mayo Clinic (January 25, 2012). Diabetes. Lifestyles and home remedies. Retrieved on August 23, 2012 from: https://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=lifestyle-and-home-remedies

4. MidlinePlus (April 19, 2010). Blood Glucose Monitoring.  Retrieved on August 23, 2012 from: https://www.nlm.nih.gov/medlineplus/ency/article/003438.htm

5. National Diabetes Educational Program (n.d). The Facts About Diabetes: A Leading Cause of Death in the U.S. Retrieved on August 20, 2012 from: https://ndep.nih.gov/diabetes-facts/index.aspx

6. World Health Organization (August 2011). Diabetes. Fact sheet  N0 312. Retrieved on August 22,2012 from:  https://www.who.int/mediacentre/factsheets/fs312/en/

7. World Health Organization (2011). NCD Country Profile. Gambia. Retrieved on August 20,2012 from: https://www.who.int/nmh/countries/gmb_en.pdf

Related/Also by the author: "Why Are Many Gambians Dying Young?" (Take One)

About the author: Bakary M. Jallow, RN, BSN, MPH, is an Infection Preventionist Clinician with the John C. Lincoln Hospitals Network, and also an editorial board member of My Basse. He lives in Phoenix, Arizona, USA, with his wife Mariama Korka Bah-Jallow and their young daughter.