Mrs. Temitope Osho (Nee Olowolekomo) is the Head, Department of Nutrition and Dietetic, Orile-Agege General Hospital, Agege, Lagos State. She holds a first degree in Nutrition and Dietetics from the Federal University of Agriculture, Abeokuta, Ogun State.Osho joined Lagos State Health Service Commission in 2010. In this interview with Wilson Adekumola, she says diabetic individuals can live longer. Excerpts;
Temitope Osho
From your experience with different diabetic patients, how can you describe diabetes?
Diabetes is a condition where there is high level of sugar in the blood. High level of sugar and diabetes can be used interchangeably. In other words, Diabetes mellitus is a group of metabolic disorder or disease that results in too much sugar in the blood (high blood glucose).
What happens in a diabetic patient?
Our bodies break down the food we eat into glucose and other nutrients we need which absorbed into the bloodstream. The glucose level in the blood rises after a meal triggers the pancreas to make hormone insulin and release it into the bloodstream. In people with diabetes, the body either can’t make or can’t respond to insulin properly. Insulin works like a key that opens the doors to cell and let the glucose in. Without insulin glucose cannot get into the cells (the doors are locked and there is no key). And so, it stays in the blood stream. As a result, the level of sugar in the blood remains higher than normal. Higher sugar levels are problem because they can cause a number of health problems. The risk factors of diabetes are ; high calorie and low fibre diet, obesity, family history, physical inactivity (sedentary lifestyle), age, tobacco use, excessive alcohol consumption, high blood pressure and gestational diabetes.
What are the causes of diabetes?
Many things can cause diabetes but the common one is lifestyle or poor dietary habit. Because if you don’t eat right you are at the risk of high blood sugar level. Eating too much carbohydrate can cause a lot of damage to our body. Diabetes comes into being as a result of pancreas that is infected in our system. What pancreas does is that it produces insulin that breaks down the food we eat, after the food is broken down, insulin will convert it to glycogen that will be stored in the liver. During fasting or anytime we have not eaten, the pancreas will reprocess the glycogen in the liver to glucose that we use those period so that we don’t collapse or go to coma. But if the insulin is not effective or sufficient there will be kind of sugar in your blood or urine.
That is why we can use both blood and urine to check our sugar level. So, it is not because I am eating sugar that causes it. We have a lot of people that are eating sugar every time yet they are not affected because their pancreas is still functioning well. As a matter of fact, we discourage eating too much of sugar as they may damage the beta cells of the pancreas. Our poor lifestyle or dietary choices can affect the pancreas to malfunctioning. Secondly, if you are obese or overweight it will affect the body ability to use insulin. That is why we encourage maintaining your weight according to your age.
Thirdly, diabetes could be hereditary. It could run in a family but if you have a healthy lifestyle it can reduce the risk of being diabetic. If it runs in your family you can combat the risk through healthy lifestyle. And again if you are not active you are prone to diabetes. Physical inactivity is dangerous to our health. That is why we always enjoin you to incorporate regular and moderate physical exercise. You can jug or do a little walking on daily bases irrespective of your age; you can dance to any music of your choice. I also urge you to have a small garden where you can plant vegetables; this will help you to maintain your sugar level.
You talked about age and weight, what is the specific weight for a particular age?
It depends on individual and the activities we partake. There is no specific weight for a particular age. There is a particular height for a certain age. We need to maintain healthy weight for our height. Apart from diabetes, obese or overweight can expose us to some dangerous health condition like High Blood Pressure, heart disease, and many more.
You said diabetes could be hereditary; in this case, at what age can someone notice it?
Diabetes is in three forms. We have type1 which is called Juvenile Onset Diabetes. It is common among children. This is a result of pancreas not producing insulin at all. Based on this fact, such children will have to live their lifespan on insulin injection. It could be discovered at the age of 9 years. It is even noticed in some children at birth. Anyone with type1 diabetes will surely depend on insulin injection throughout his or her lifespan because the pancreas is not producing insulin at all. We have another one, type2 diabetes. It is called Adult Onset Diabetes. It is normally notice in adult at age of 45 years and above but it could be observed earlier than that because of poor dietary choices or lifestyle. There is gestational diabetes; it is common among pregnant women.
When one is pregnant especially at the second or third trimester, the pregnancy hormones will interfere with the body’s ability to use insulin. But after she is put to bed, the sugar level goes back to normal. We also have pre-diabetes but this is the sugar level that cannot be called diabetes because it is not high enough. You may not need to bother; however, it should be avoided. If you wake up in the morning and your sugar level is within the range of 70-115 is still ok. When it is 120 you are pre-diabetics. A fasting blood sugar level below 100mg/dl (5.6mmoi/l) is normal. A fasting blood sugar level from 100-125mg/dl (5.6-7.0mmoi/l) is pre-diabetes. A fasting blood sugar level of 126mg/dl (7.0mmoi/dl) or higher indicates type2 diabetes. But when you notice your sugar level is above 126, after you have checked it like three times consecutively you need to see a doctor. You can also see a dietician for advice on your diet. You can engage in a lot exercises. But by and large, see a medical doctor. It can be regulated.
It has become apparent that diabetes has continued to grow as a major concern in our country and around the world and the complications continue to grow; does that mean there can’t be a cure?
Yes, there is no cure for diabetes. Diabetes is not curable but it can be treated and well managed without the fear of complications. The reason for treating and managing diabetes very well is to avoid complications like heart and blood vessels disease, nerve damaged (Neuropathy), kidney damaged (Nephropathy), eye damaged (Retinopathy), hearing impairment, for damaged (ulcer), amputation, sexual dysfunction, depression and all that.
What are the symptoms of diabetes?
Symptoms of diabetes include; frequent urination, increase taste and hunger, weight loss, fatigue (tiredness), blurred vision, frequent infections, slow healing sores, area of darkened skin, usually in the armpits and neck. These are the early signs. But with time it starts affecting kidney, heart, skin etc. that is complication stage. When you urinate and you observe it is foamy, it could be an early sign of diabetes. Don’t waste time. Quickly go and see your doctor. It is advisable to see doctor at least twice a year.
Apart from medical palliatives, we observed that there are natural or alternative medicines some concerned health workers claimed can cure diabetes or reverse the condition, how will you react to this?
Well, I will not dispute the fact that alternative medical therapists are really trying. But my concern is that most patients abandon their drugs while taking alternative cure. Like I said diabetes is not curable but it can be controlled and well managed. If you believe herbs can cure it and you now leave your drugs it may result in more havoc or complications. I will advise if you want to take alternative medicine do not abandon your drugs. You can just stick to medical advice because those herbs are toxic and it may affect the kidney.
Besides, alternative medicine and medical palliative may not work in harmony. I am not saying alternative medicine is bad or it cannot work but I will advise you to put individual on trial. Experiment alternative medicine for a short time and go for lab test to confirm its potency. Please don’t avoid your drugs. I have seen cases after taking alternative medicine they were still rushed back to emergency unit of the hospital for medical attention. Once the pancreas is defected it is not reversible or curable. You only need to take drugs to regulate the rate at which glucose is released in the blood. Drugs are used to maintain normal sugar level. I don’t think they have discovered drugs that cure pancreas.
There is a notion that diabetes is a terminal disease. What is your take on this?
That is not true. Diabetes is not a death warrant. I have seen people who have been living with diabetes for the past 25-35years and they are still alive now. It is not a terminal disease as they say. If your sugar level is well controlled through your drugs and medical advice with regular exercise you can live your normal life. If you avoid side complications there won’t be risk of death. You need to also follow dietary counseling. I have seen people who have been living with it for several years. At a time your drugs will be reduced. For instance, a patient that is taking 1000g of metformin tablets can be reduced to 500g even 250g as the case may be.
Is it true that the drugs we take also have adverse effect?
Whatever has positive can also have negative aspect but not to all. Like I said, if you change your life style the drugs will be reduced. I know someone who started clinic using up to 7 drugs but now she uses 3. That is how the drugs keep on reducing. There is a way our body make use of drugs that it won’t have negative effect on us.
What are things to do and foods to eat in order to control or prevent diabetes?
For the diabetics I will say it is individualized. Food that works for one may not work for another. It is a question of lifestyle, sugar level, weight and other activities. Healthy lifestyle choices can help bring blood sugar to normal or at least keep it from rising towards the level seen in type2. Eating healthy diet, that is, choose foods low in fats and calorie and high in fibre. Focus on fruits and vegetables, and whole grains such as wheat bread, brown rice oat meat etc. But diabetic patient must avoid direct table sugar. Even honey should not be taken because the end product of honey is still sugar.
Honey is only good for people without diabetes. Pastries like gala, biscuits, chin-chin should be avoided because they have been refined, as a result of that the body still uses it as glucose. Beverages like Bournvita or Milo should not be taken. You can eat all foods just that it must be high in fibre and quantify it. If you want to increase the fibre in your rice you can combine it with cucumber, beans, moimoi, or vegetables. It is fibre that helps reduce the rate at which glucose is released in our blood. Variety, they say, is the spice of life. Endeavour to eat variety of foods and you must not go without meal.
You need to quantify the calorie you take per day because in diabetic patient we do the calorie count. Calorie is different in individual. Diabetic patient can eat like every other person but the quantity differs. Once their foods are quantified and they take their drugs, they need to incorporate regular exercise. Regular physical exercise about 30 minutes daily like brisk walking, jogging, and skipping is also therapeutic. In fact, dance to any music of choice. This will help the heart to function well. If you are overweight, losing weight can reduce the risk and complications of type2 diabetic individuals. Stop smoking as it may up the risk of type2 diabetes. Avoid the use of tobacco. Take medication as needed. Take necessary drugs as prescribed by doctor. Medications to control cholesterol and high blood pressure might also be prescribed. If all these things can be observed they will live as if they are not diabetic.
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