World Diabetes day: The 3Ps of Diabetes Mellitus you need to know.

Introduction:

Diabetes Mellitus ( DM) is a medical condition caused by insulin deficiency or body’s resistance to insulin. Insulin is a hormone which aids in carbohydrate metabolism It is the commonest Endocrine disorder. In this condition, there’s an increased blood glucose(sugar) level.

Before I continue, let me share this story with you.

During my obstetrics and gynecology posting. I met this patient who was married for 6years with no child. She presented with her husband (Tochi) a 34 year old man, on her 4th visit, it was found that he had erectile dysfunction. After thorough examination and investigations, it was discovered he had Diabetes Mellitus and this led to the his inability to sustain an erection.

However, with adequate medical care, they finally had a baby girl.

This year I was in the ward with a few of my friends when we heard there was a paediatric emergency. We rushed to the ward and it was Tochi’s younger sister. She was 15years with diabetic ketoacidosis (a complication of diabetes). The girl was diabetic and wasn’t properly diagnosed and managed. They lost her 💔

If Tochi had brought his whole family for screening, she won’t have died.

Epidemiology

8.8% (415 million ) of adults aged 40-59yrs have diabetes
To rise beyond 642 millions in 2040 (1 in 10 adults)
175 million cases undiagnosed
75% live in low-and middle –income countries.
Caused 5.1million deaths in 2013
Every 6 seconds a person dies from DM
Africa: ≈ 19.8million adults (4.9%);
Nigeria has the highest no of people living with DM (3.9million)

Types

Has two major types: Type 1 and type 2

Type one is more commonly seen in those below the age of 30years and in children.

Type 2 is the most common type. Above 90% of the cases. Has strong family tendency. And seen more in adults above 40 years. There’s increasing prevalence of this type.

Other forms include Gestational diabetes (seen in pregnancy); Hybrid forms of DM; secondary DM etc

Risk factors

1. Autoimmune disorder (For type 1) whereby the body sees the cells which secrete insulin as “foreign” and destroys them.

2. Environmental factors: viruses like HIV, mumps,EBV; some drugs and chemicals.(type 1)

3. Diets: Nitrosamines (found in diets like smoked meats) and coffee have been proposed as potentially diabetogenic toxins.

Bovine serum albumin (BSA), a major constituent of cow’s milk has been implicated since children who are given cow’s milk early in infancy are more likely to develop type 1DM than those who are breastfed

Studies show that type 2 DM is associated with overeating especially when combined with obesity and under activity.

4. Genetic predisposition for both types especially type 2.

5. Obesity: the risk of developing DM increases tenfold in people with a body mass index (BMI) of more than 30kg/m²

Symptoms

Type 1

It runs a very short course.

Type 2

About 80% of Nigerians don’t know they are diabetic, and 50% globally because it has a slow onset

Both present with

Polyuria

Polydypsia

Polyphagia

Forget the medical jargon. Just so you don’t forget the 3Ps: Polyuria (excessive urination), polydypsia (increased thirst for water) and polyphagia (increased appetite)

Weight loss/gain

Hyperphagia( predilection for sweet foods)

Erectile dysfunction

Eye problems

Recurrent infections like recurrent vaginal infection can be a symptom of DM

Etc

Diagnosis

The diagnosis of DM is made from
the presence of diabetic clinical features and
biochemically confirmed increased blood sugar.

Presence of diabetic clinical features
Polyuria, polyphagia, polydypsia unexplained weight loss etc are necessary but insufficient for diagnosis

Whenever you notice any of these symptoms please see a physician. If there’s history of DM in your family, also see a Doctor.

However, regular medical check up is advised because Type 2 which is the more common form can run a long course unnoticed!

Complications

They can not be exhausted. Too numerous to mention. Many patients present with complications

Kidney failure

Stroke

Blindness

Damage to blood vessels and nerves

Recurrent infections

Diabetic ketoacidosis

Diabetic foot ucler

Coma/death

Etc

Prevention

Healthy diet

Exercise

No smoking/excessive alcohol consumption

Weight loss if overweight

Exclusive breastfeeding is encouraged

Regular screening

Adherence to doctors advise to prevent complications

Today the 14th of November 2020, is WORLD DIABETES DAY. I hope we all join hands to fight this common enemy. Get yourself screened!

Disclaimer: name, dates, or any other identifying details of the patients in this story were changed to protect privacy.