Prof. Isaac Adewole, Nigeria’s health minister has recently inaugurated the National Steering Committee for the Diabetes Awareness and Care Project (DAC) in Abuja.

At the inauguration, he said the federal government was committed to safeguarding the health of Nigerians and improving diabetes care in the country.

He said: “The Non Communicable Disease Division of the Federal Ministry of Health in Collaboration with the Health Strategy and Delivery Foundation (HSDF), with the support from the World Diabetes Foundation (WDF), has embarked on this project, which will first be implemented in two states of the country namely FCT and Imo Sates,” he added .

Adewole said the aim was to increase diabetes awareness and improve the two way referral state between Imo state and the Federal Capital territory.

He emphasized that “the finalization of the National Guideline for prevention and control of diabetes in Nigeria which took place earlier this month is an integral part of this project”

“It is expected that the Guideline will ensure standardized protocol for medical care and patient self – management education to prevent acute complication and reduce the risk of long term complications among Nigerians living with the disease”.

Adewole said that the project was to last for three years- from 2018 to 2021. He also commended the World Diabetes Foundation and Health Strategy and Delivery Foundation for the support and efforts to ensure the project becomes a reality.

In his welcome address, the Permanent Secretary, FMOH, Mr. Abdallahi Mashi, who was represented by the Director, Public Health, Dr. Evelyn Ngige, said that the prevalence of diabetes in Nigeria was increasing with current WHO figures estimates at 3.4 per cent, while local studies carried out by researchers have figures from 3-10 per cent.

This is a step in the right direction and we hope it improves diabetes awareness and gets proper implementation.

 

The keto diet, favoured by Kim K , has become increasingly popular in the Nigerian space for a few years now . In a recent report by researchers in the Journal of Physiology, keto diet is said to be linked with an increasing risk of developing type 2 diabetes.

Keto diet became popular for its perceived ability to cause weight loss and reverse type 2 diabetes but ironically, a study by ETH Zurich and University Children’s Hospital Zurich found that this low carb but high fat diet contributes to insulin resistance, making it difficult for the body to respond to normal level of insulin, increasing the blood glucose level and causing your pancreas to get to do more work.

Insulin is an hormone released into the blood by the pancreas and used to control blood sugar levels , it also signals the liver to stop producing sugar. If this mechanism is impaired, the liver would no longer respond and would continue sugar production. This is called insulin resistance.

This increased risk was noticed during the early stage of the diet, according to the study which compared different diets; a high fat diet and a ketogenic diet in two groups of lab mice.

Keto diet was invented in the 1920s as a way to cure epilepsy.

The difference between keto diet and regular low carb diet is that it restricts both carbohydrate and protein intake instead of just carbohydrate intake. It is said to create a lower insulin environment and ultimately reduce fat stores.

Researchers however say more research has to be done in this area.

 

 

 

Source : Eurekalert

LATE-NIGHT snacking can be very indulging but not only does it increase our waist lines, it affects our sleep.

It also puts us at risk of diseases such as diabetes and increases the level of the stress hormone cortisol in our bodies.

Here’s why you should ditch the habit. 

Our bodies crave high-sugar, high-fat and high-salt foods, with typical late-night snack foods including fizzy drinks, juice, chocolate, ice cream and alcohol, some people even take major heavy meals like ‘a bowl of rice’ or ‘eba’ late in the night.

It can be a really difficult habit to stop especially in urban areas like Lagos where heavy traffic might cause you to get in late hungry and necessarily need to eat.

Drinking alcohol also makes us more likely to make bad food choices and indulge our cravings for greasy takeaway food such as deep fried chicken, chips and pizza.

Here are five reasons you should give up the bad habit of snacking before bedtime.

Weight gain

Eating in the hours just before we go to sleep leaves us little time to burn off those extra calories. We eat and then head on to bed without having to use the food for any activity and so we get to store up fat. There is a significant relationship between late-night snacking and a higher body fat percentage.

Impaired hormone response

This is a disturbing effect of late night eating over a long period of time.  Eating late at night can reduce the ability of insulin to remove glucose from the blood.

Over a prolonged period of time, late-night eating may lead to an increased risk of diabetes.

 

Poor sleep

Eating or drinking just before bedtime can negatively affect your sleep quality and quantity, There is a significant association between high intakes of sugary foods and caffeine before bed and poor slow-wave sleep and rapid eye movement (REM) stages of sleep.

Your body spends some of the energy it needs to help repair the worn out body tissues to digest your ingested food. Taking alcohol at night can also cause you to be sleepy the next day.

Increased food intake the following day

Ironically, eating a big meal late at night doesn’t mean you will consume less the next day. You’ll want to eat more!

Eating late at night may enhance the amount of food you consume the following day due to the impaired insulin response and poor blood sugar control leaving you feeling hungrier overall

Increased cortisol

Interestingly, researchers have found a link between eating late at night and higher levels of the stress hormone, cortisol. As well as being an overall health hazard, high levels of cortisol in the body pose a risk factor for increased abdominal fat.

The findings may also suggest that the more stressed individuals are, the more likely they are to eat late at night rather than earlier on in the day.

To break the habit of late-night snacking, its good to eat a balanced dinner with a focus on protein to keep us fuller for long, and de-stressing with a bath, a walk or a movie to give ourselves time to wind down from the day.

Everyone is different, identify your own triggers for late night eating and avoid them. If you can’t, then you can get healthier snacks options e.g bananas, an apple, greek yoghurt , carrots or even water!

 

On August 4, 2017, Ms Megan Davidson, 27, commited suicide after battling with diabetes and diabulimia.

Megan was driven to suicide after her battle with her eating disorder and diabetes.

She died three days after she was discharged from mental health services after they thought she did not to have clinical depression and had full capacity according to the inquest.

On the morning of her death she had texted therapist, Renata Harris, saying: ‘Please make sure the emergency services find my body so my parents don’t have to.’

The 27-year-old’s body was found by police who had eventually been alerted by the therapist who received Ms Davison’s text message.

Ms Davison had previously tried to kill herself at the end of 2016 through an overdose.

The therapist decided the text had no ‘immediate implications’ and so did not tell anyone about it for almost an hour.

When police were contacted they went to Ms Davison’s home in Cheshunt, Hertfordshire, and found her body.

 

Megan is not alone,

The word diabulimia is a merger of the word diabetes and bulimia.

Though this word is not officially recognized, Diabulimia describes the situation where somebody deliberately and regularly reduces the amount of insulin they take due to concerns over their body weight and/or shape.

The American Diabetes Association indicates that 30-40 percent of female teenagers and young female adults with diabetes alter or skip insulin to control their weight. “If you have diabetes, then the risk of developing an eating disorder is about twice as likely than if you didn’t,” says Ronald Steingard, M.D., of Walden Behavioral Care in Waltham, MA and research consultant for Harris Center for Eating Disorders at Harvard University.

 

Individuals suffering from diabulimia intentionally misuse insulin for weight control, including:

• Decreasing the prescribed dose of insulin
• Omitting insulin entirely
• Delaying the appropriate dose
• Or, manipulating the insulin itself to render it inactive

 

On the long term, there is severe hypoglycemia and weight loss because the body would break down fats for energy since there is no insulin to help the tissues utilize glucose effectively.

Diabulimia is a mental health issue and health care providers should be able to recognize this and refer appropriately for psychological help if need be.

Although, this might not be popular among Nigerians, it just might  be because we do not have enough statistics and so many people with mental health issues do not regularly reach out for help.

Warning signs and symptoms of diabulimia

Emotional and behavioural

 

• Secrecy about diabetes management
• Increased neglect about diabetes management
• Avoiding diabetes related appointments
• Fear of low blood sugars
• Fear that “insulin makes me fat”
• Extreme increase or decrease in diet
• Extreme anxiety about body image
• Restricting certain food or food groups to lower insulin dosages
• Avoids eating with family or in public
• Discomfort testing/injecting in front of others
• Overly strict food rules
• Preoccupation with food, weight and/or calories
• Excessive and/or rigid exercise
• Increase in sleep pattern
• Withdrawal from friends and/or family activities
• Depression and/or anxiety
• Infrequently filled prescriptions

 

Physical 

• A1c of 9.0 or higher on a continuous basis
• A1c inconsistent with meter readings
• Unexplained weight loss
• Constant bouts of nausea and/or vomiting
• Persistent thirst and frequent urination
• Multiple DKA or near DKA episodes
• Low sodium and/or potassium
• Frequent bladder and/or yeast infections
• Irregular or lack of menstruation
• Deteriorating or blurry vision
• Fatigue or lethargy
• Dry hair and skin

It would be of immense help if

• Psychological factors should always be considered, assessed and excluded in all episodes of DKA.
• Sufficient time, resources and training must be in place to enable diabetes healthcare professionals to identify and support people with diabulimia effectively.
• 

References

1) Colton, P. A., Olmsted, M. P., Daneman, D., Farquhar, J. C., Wong, H., Muskat, S., & Rodin, G. M. (2015). Eating disorders in girls and women with type 1 diabetes: a longitudinal study of prevalence, onset, remission, and recurrence. Diabetes care, 38(7), 1212-1217.

2) Svensson, M., Engström, I., & Åman, J. (2003). Higher drive for thinness in adolescent males with insulin‐dependent diabetes mellitus compared with healthy controls. Acta Paediatrica, 92(1), 114-117.

3. http://www.dailymail.co.uk/news/article-5554981/Patient-27-killed-asked-therapist-note-send-Dignitas.html
4. Nationaleatingdisorders.org

 

 

Diabetes is a condition that sadly has no cure but what is even more saddening is that there are people out there who are exploiting innocent people just in the bid to get them cure.

This was the case of Adeniyi Adewunmi, a self-acclaimed herbalist who allegedly swindled a businessman of 190 million claiming he’ll cure his diabetes.

The case was brought before an Igbosere Magistrates’ Court in Lagos where the accused, aged 43, is standing trial on a four count charge on conspiracy, fraud and stealing.

The Prosecutor, Friday Mameh said before court that the offences were commited between Feburary 2016 and January 2018.

“The accused and others still at large approached the complainant, one Mr Lawrence Akanbi, and told him that he is suffering from diabetes, asthma and spiritual attack”.

“The complainant believed because he was actually suffering from the ailments stated by the accused”.

“The accused used the opportunity to ask the complainant for money till the money amounted to N190m,” Mameh said.

The complainant, hoping for a cure, noticed his symptoms were rather getting worse and the accused arrested by the police.

The accused however denied the allegations.

The Magistrate, Mrs F.O. Botoku, granted him bail in the sum of N20m, with two sureties who must not be less than grade 16 in the civil service  in like sum.

The case was then adjourned the case until Feb. 12 for trial.

 

 

 

Source : The Punch Newspapers

Before the discovery of insulin, the chances of having a baby with diabetes was really slim, but thanks to Banting and Best, the discovers of insulin, this century has seen better outcomes for mothers living with diabetes and their children. In Nigeria 1.7 percent of pregnant women have diabetes out of which 61 percent is gestational diabetes.

Pregnancy in itself is a diabetogenic state i.e pregnancy raises blood sugar levels in normal conditions . Diabetes may complicate pregnancy because a woman had diabetes before pregnancy  (pregestational diabetes which can be type 1 or type 2)or she developed diabetes during the course of her pregnancy (gestational diabetes). Gestational diabetes usually resolves few weeks after the baby is born. However, in about 60-70 percent of women, there is a recurrence in subsequent pregnancy.

 

The challenge

The body is more resistant to insulin during pregnancy to allow more glucose available to sustain the growth of the baby. This makes the body require more insulin production. In people with gestational diabetes, the pancreas can’t keep up with the production of insulin required and so the blood has excess glucose.

The main effects of diabetes in pregnancy is that it increases the risk of miscarriages in early pregnancy it increased risk of babies with congenital malformations e.g with cardiac problems . This is in people with poorly controlled diabetes. It is not uncommon to see people with diabetes developing hypertension and infections in pregnancy.

Too much glucose gets into the baby’s blood and causes accelerated growth of organs especially in the middle and late stages of pregnancy.  This results in big babies, too big to enter the birth canal and can cause the baby’s shoulder to be stuck (shoulder dystocia) making caesarean section necessary in some cases.

Shortly after birth, your baby may have low blood sugar (hypoglycemia) because his body will still be producing extra insulin in response to your excess glucose.

The baby is at risk of hypoglycemia immediately after birth because the baby was used to having excessive insulin action while in the womb. It is recommended that the mothers breast feed their babies shortly after birth to help reduce this.

There is also a a higher risk of having breathing problems because the lungs do not mature well enough and the baby might have neonatal jaundice.

Who should be more concerned?

Women above 35 years

People whose immediate relatives have diabetes

People who have had big babies (4.5kg and above) in the past.

People who weigh beyond 90kg or have a BMI above 30.

People who have had stillbirths without a known cause.

People who have had babies with birth defects

People with polycystic ovarian syndrome.

 

What to do?

Mums-to-be  need to check their sugar levels early in pregnancy during their first trimester.

A woman with diabetes or impaired blood sugar levels should consult with a doctor- both an obstetrician and a physician- even before the start of pregnancy. A dietician also plays a role of helping to maintain a healthy diet.

A diet of someone with gestational diabetes should be between 1500-2000 calories and there should be good combination of carbohydrates with protein and fats.  An HbA1c of between 4-6 is the usual target.

It is also important to take folic acid (5mg) before aiming at pregnancy for people at risk.

People living with diabetes before pregnancy would need to really monitor their sugar levels closely has pregnancy can alter their feeding patterns and they might require higher levels of insulin.

A woman who has had diabetes in previous pregnancy is advised to have yearly medical checks as she’s at risk of developing type 2 diabetes in the future.

The pre-pregnancy states are very important. A woman with good glycemic control before pregnancy is more likely to have a better outcome.