By Chioma Obinna
The management of diabetes has remained a major problem among Nigerians. This may not be unconnected with the fact that Nigerians are ignorant of the disease, the role of diet and physical activity in curtailing it. According to experts, the low level of diabetes-related health expenditures has prevented a very small proportion (0.6 percent) of diabetes-related deaths.
Meanwhile, the International Diabetes Federation says Nigeria, in 2015, recorded over 1.56 million cases of diabetes and 949.9 undiagnosed cases. The country also recorded the highest mortality rate from the disease in the world with over 82,869, deaths in the same year. And, by the Diabetes Association of Nigeria, DAN, estimates, 1 in every 11 Nigerians has diabetes and the ratio is one of the worst in the world.
Chioma Obinna spoke to some diabetic patients, one of whom has lived with the disease for 28 years, about the challenge of getting treatment for diabetes. They also spoke about the financial implication and ways to prevent complications from diabetes.
Tunde Famoye and Akanbi Olanrewaju Adeniran are hoping for a better management of diabetes in Nigeria.
“Living with diabetes for 28 years has not been easy”, 59-year-old Akanbi Olanrewaju Adeniran told Sunday Vanguard. At 21, Akanbi never dreamt of having a condition as serious as diabetes. Even when the news was broken to him by his doctor, it took him time to assimilate it. It was real, his doctor insisted. He had to face it. Before now, diabetes was associated in this part of the world with the aged. Today, it is no longer so, as diabetes also occurs in children.
Akanbi had no inkling that the frequent headache that was prompting him to visit his doctor regularly was as a result of diabetes until that fateful day his doctor decided to run a blood sugar level test on him. Today, Akanbi is an amputee, no thanks to diabetes.
Diabetes occurs when the body can no longer control the amount of sugar in the blood because of problems linking to hormone insulin. High levels of blood sugar can cause damage to the heart and blood vessels, nerves, kidneys, eyes and feet, among other things.
According to experts, about 90 percent of people who have diabetes have type 2 diabetes, which is linked to lifestyle factors such as obesity and inactivity. Type 1 diabetes, once called juvenile diabetes, commonly develops among children.
“I never knew that the frequent headache and urinating then was as a result of diabetes,”
“After I was diagnosed with diabetes; I accepted my fate since God gives individuals different challenges in life. However, my deepest challenge in this journey has been finance.”
Challenges and cost of treatment
Akanbi, one-time big trader, lost his business to diabetes. According to him, his ordeal took a different dimension when he was involved in an accident in 2001. “I used to be a trader, but today, I am idle. It was in the process of the treatment that I lost everything in my business,”he stated.
“My world came crashing when my wife died. I was treated at the Lagos University Teaching Hospital, LUTH, where I knew Dr Afoke Isiavwe. I later found out that my father also had diabetes.
“Diabetes is one condition I don’t wish for my enemies because the moment I was diagnosed, I was placed on insulin. I used to spend not less than N3,500 then for a bottle of insulin. Every month, I was expected to use two bottles and that would cost N7,000. Today, the cost has risen to N11,000.”
Without any means of livelihood, Akanbi, who is living off family and friends, recalled that the most challenging time was when he needed to run tests or replace insulin and there was no money or anybody to assist.
“The most trying period is when you go to people for assistance and you are being posted up and down. Some will give excuses and some will tell you to your face to go and try other people. “Poverty is not good especially when you have a condition that requires money like diabetes.”
Akanbi, who called on the Federal Government to subsidise drugs for diabetes, as is done for HIV drugs, said: “There is need for government to subsidise diabetes drugs, so that amputees like us, with no means of livelihood, can benefit from it.
“As an amputee, I would love to work, but who can give me a job? Government should be able to empower us by giving us employment. If we are employed, we will be able to assist ourselves and we will live longer. I have a child who has graduated since 2012 but has no job. If my son is working, at least, he will not desert me when other people are no longer ready to help due to the economic situation in the country”.
He advised diabetic patients not to commit suicide but keep to doctor’s instructions and fellow monitor their blood sugar levels.
Diabetes and cold
The story of Tunde Famoye,, another amputee from diabetes complication, is also heartbreaking. He is also a proud diabetic patient. It all started three years ago when he suddenly developed strange cold right inside his office. “I thought it was malaria. I am a very lucky person. If you had seen my leg, you would have screamed, he said.”
Tunde was living his life to the fullest until that fateful day, three years ago, when he developed cold and pains. The cold was almost like the one associated with pregnancy.
Battling complications of diabetes
“I was asked to go home. The next morning, I went to the clinic and I was treated. On the third day, the cold became worse. Then I was having serious pains under my feet. I asked someone to check my feet, it was discovered that there were broken tiny pieces of glass and meanwhile pus was already coming out from the same spot”, he narrated. “I went to hospital; series of tests were done and, when they checked my blood glucose, it was 450.
They started treatment in the clinic. It was getting worse every day. I was on this treatment for three weeks. On the third week, they said I should be referred to the General Hospital. When I got there, right from the Accident and Emergency , I was given 17 drips and the leg got burst and water was coming out of it. I was admitted. Within a few hours, the water took over the whole leg. The doctors immediately carried out surgery on the leg even though they never believed I was going to survive.
“After the surgery, the doctors left the place open because the bacterium was still in there. Even the medical officer at the General Hospital could not believe I was still alive when he saw me the next morning.
“I was placed on insulin permanently. Insulin was considered a wonder drug when it was discovered in 1921. It remains a mainstay of treatment for millions of patients, and yet decades after its introduction, there are still no generic forms of insulin available.
“While on the bed I tried to inquire how much the cost was. I went online and was searching what diabetes is”.
Sacrifices
“Meanwhile, it was not easy for my family. I had to deny myself and my children of a lot of things. Early this year, I had to punish myself in the way of disciplining my body since I could no longer afford insulin. I was asked to avoid so many things. I was on light foods.
However, by February, things became tougher and there was no money to buy drugs or insulin, even strips for my glucometer, an instrument I use to check my blood sugar level. For three weeks, I did not take insulin, and no money to go to hospital”.
When help finally came Tunde’s way, he rushed to do one of the tests required to check his condition. “When I finally got help from somebody, I went to do tests and also saw the doctor who asked me to do away with insulin. He finally placed me on tablets”.
Advice to other diabetic patients
If you have diabetes, you must discipline your body. And the only way out is by controlling it. It is all about control, without which you are inviting complications which may lead to amputation.
Burden of diabetes
Tunde and Akanbi stories are just a tip of the iceberg of the many complicated cases of diabetes in Nigeria which often end up in amputation or death. Hospital records showed that many Nigerians are dying due to hyperglycaemic events resulting from ignorance.
In 2015, statistics showed that 415 million people were living, with diabetes globally and more than 14 million of them in Africa and it is estimated that, by 2040, the figure will more than double. According to the Chairman, Lagos State Chapter of the Diabetes Association of Nigeria, DAN, Alhaji Hameed Abiodun, 1 out of 11 Nigerians have diabetes and a large number of them are unaware.
Unfortunately, the cost of diabetes treatment has been increasing but it is often overlooked.
Why we have epidemic of diabetes – Isia-vwe
Explaining why Nigeria is witnessing epidemic of diabetes, the Project Coordinator, Diabetes Podiatry Initiative of Nigeria, Dr. Afoke Isiavwe said many Nigerians eat more and move less, hence the increase in the number of the diabetic and complications from the disease.
Isiavwe said lack of exercise and improper diet, are major factors fuelling the epidemic.
She described the condition as a global emergency, disclosing that not less than 415 million people were affected in 2015, adding that 50 percent of persons affected do not know.
Emphasizing the implications of untreated diabetes, she said early detection avoids poor out comes, regretting that many people already have complications even at diagnosis levels.
According to her, 50 percent of new patients with Type II diabetes already have one or more complications at diagnosis level.
In a chat, a microbiologist and Accu-Chek Strategic Account Manager, Roche Products Limited Diabetes Care, Mrs. Folasade Olufemi-Ajayi, blamed the increasing prevalence of diabetes on ignorance.
She called for massive awareness on diabetic epidemics, and also called on the Federal Government to find ways to make diabetes treatment cheaper, through the National Health Insurance Scheme.
Speaking on why structured self-monitoring of blood glucose (SMBG ) is important, she explained that looking at HbA1c levels is not enough as postprandial hyperglycemia is an important marker for complications.
According to her, structured SMBG and systematic data analysis can help people with diabetes make lifestyle changes and inform therapeutic decision-making. She said that SMBG identifies hypoglycemic events, identifies postprandial blood glucose excursions, effects of different meals and snacks, effects of physical activity and effects of medications.
On the benefits of SMBG, she explained that patients have immediate access to the information, encouraging patients to become more involved in their own management; reduce dependence on health care professionals and increase patient motivation to keep blood glucose within target among others.
Advocating for self-monitoring, she said: “Self-monitoring enables patients to achieve appropriate metabolic control, avoiding hypoglycemia and reducing the likelihood of developing long-term complications of hyperglycemia such as blindness or renal failure”
What is diabetes?
Diabetes, often referred to by doctors as diabetes mellitus, is a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination); they will become increasingly thirsty (polydipsia) and hungry (polyphagia).
Tips on diabetic foot-care
Take care of your diabetes
Check your feet every day, look out for colour changes, red spots, cuts, swelling and blisters.
Be more physically active
Keep your feet clean with daily washing in clean water, keeping them dry, especially in – between the toes
Keep your skin soft and smooth by rubbing skin lotion over the tops
Trim your toe nails when needed
Never walk barefoot, as it increases your chances of injuring them
Protect your feet from hot and cold temperatures
Never use hot water bottles, heating pads, or electric blankets
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