INTRODUCTION

According to the World Health Organization, a few decades back diabetes was an uncommon disease, in both developed and developing countries. Today, the story is different. It is currently estimated that over 143million people worldwide are affected by the disease. This figure is ever increasing, by 2020 over 220million people are expected to be living with diabetes, if the current trend continues.

In the United States alone, there are 18.2 million people (6.3% of the population) living with diabetes. While another 13million people have been diagnosed with diabetes. Unfortunately, 5.2milion (or nearly one third) are unaware that they have the disease.

The figure for Nigeria is not readily available, but it is estimated that over 1.5million people have diabetes in Nigeria.

In developed countries, most patients of diabetes are over sixty, but in developing countries, diabetes is found to affect people in their prime.

WHAT IS DIABETES?

Diabetes Mellitus (or simply diabetes) is derived from the Greek word 'Diabeinein', meaning 'To pass through' describing copious urination, and Mellitus from the Latin word meaning 'Sweetened with honey'. These two words signify sweetened urine or sugar in urine.

Diabetes is a disease in which the body does not produce or properly use Insulin. Insulin is a hormone that is needed, in the body, to control the rate at which sugar, starch and other food are converted into glucose required as energy for daily life. The hormone is produced and released
into the blood by an organ called 'Pancreas'. This insulin help to maintain the blood glucose level within a normal range. The World Health Organization (WHO) puts this normal range between
60 - 100mg/dl (Before taking any food for the day, hence this value is called Fasting Blood Glucose). In health, despite several demands for glucose in different situations, the blood glucose rarely exceeds this value.

After a meal the liver stores the glucose from the meal as glycogen and releases it into the blood in between meals. The role of insulin is the control of this storage and release of glucose. It ensures that the amount of glucose in the blood at every particular time does not go beyond or below the normal range.

TYPES OF DIABETES.

According to the World Health Organization (WHO), five classes of diabetes are recognized, these are; Insulin Dependent Diabetes Mellitus (IDDM) or Type I Diabetes, Non Insulin Dependent Diabetes Mellitus (NIDDM) or Type II Diabetes, Gestational Diabetes, Diabetes Insipidus and Bronze Diabetes.

INSULIN DEPENDENT/TYPE I DIABETES: This type of diabetes was initially called Juvenile onset diabetes because it affects adolescents and young adults. It is caused by a sudden failure of the pancreas to produce Insulin. It is, therefore, an acute disease, presenting with thirst, polyuria (passing large amount of urine), diuresis and weight loss. Type I diabetes is not common, it accounts for less than 10% of all diabetes cases.

NON-INSULIN DEPENDENT/ TYPE II DIABETES: This is the most prevalent type of diabetes, accounting for more than 80% of all diabetic cases. It is found in adults and the elderly. This type of diabetes develops gradually over a long period of time (unnoticed) and is characterized by insufficient insulin, deficient insulin in the blood or the inability of the body to utilize the insulin resent (Insulin resistance). Because of its slow and gradual occurrence, it is mostly undetected until one or more of its long-term complications appear.

Unlike in Type I Diabetes, the Insulin in the blood of a Type II diabetic may be normal or even high, but lacks the desired effect, due to insulin resistance, and this is prevalent among obese people.

GESTATIONAL DIABETES: This type of diabetes occurs during pregnancy and disappears after delivery, within 3weeks. An estimated 3% of all pregnancies are accompanied by gestational diabetes and almost half of these patients are prone to developing permanent diabetes later in life.

WHAT CAUSES DIABETES.

As with hypertension and other non communicable diseases, no clear cut cause(s) can be attributed to the most prevalent type of diabetes (Type II Diabetes, Type I diabetes being secondary to failure of the pancreas). However, some factors are known to increase one's chances of becoming diabetic and these are called risk factors. For example, indolent and well-fed populations are 2 - 20times more likely to develop type II diabetes than active and lean population of the same race. Some other factors known to increase one chances of getting diabetes include:

OBESITY: It is estimated that three quarter (¾) of all Type II diabetes patient are obese. Indolent and affluent lifestyles tend to contribute to this. It is believed that a 10kg loss of weight can reduce fasting blood sugar level by almost 50md/dl. An active lifestyle with frequent exercise is also known to increase Insulin sensitivity.

The International standard for measuring overweight and obesity is based on a value called BODY MASS INDEX (BMI). This value is derived by dividing the body weight (in Kilograms) by the square of height (in metres).

i.e. BMI = Body weight (Kg) / Height2 (Metres).

Note: 1ft = 0.305metres.

For adults, a BMI less than 25kg/m2 is preferred.

25 - 29kg/m2 is considered overweight and above 30kg/m2 is Obesity.

FAMILY HISTORY: A family history of diabetes increases one's chances of getting the disease. In such a situation, leading a healthy lifestyle and constant monitoring of one's blood sugar level becomes very important.

AGE AND RACE: Most Type II diabetes patient are over 40yrs at presentation of the disease. However, the proportion of increase in the incidence of this disease with age is higher for those with a family history of diabetes, obese and probably those leading sedentary lifestyles. Moreover, diabetes tends to be more prevalent among Africans, African Americans, Latinos, Native Americans and Asian Americans. Belonging to any of the races is a risk factor in itself.

HISTORY OF GESTATIONAL DIABETES: in a woman also increases her chances/possibility of developing permanent diabetes later in life.

YOU CAN PREVENT/DELAY DIABETES!

Diabetes have no permanent cure once it develops, it is managed al through life. But you can prevent ever falling into this life long pain. Before diabetes present in people, it is almost always preceded by a situation called PRE DIABETES. A situation where the blood glucose is higher than normal, but not yet enough to be diagnosed as diabetes. Saddening, however, you cannot know when you fall into this category, if you have not being monitoring your blood glucose regularly.

Pre Diabetes is itself a serious medical situation, though can still be reversed by making changes in diet pattern and increasing physical activity. To determine one's blood sugar a test called Fasting Blood Glucose has to be conducted. This test measures the amount of glucose (sugar) in one's blood before taking any meal for the day. It is measured in milligrams per deciliter (mg/dl).

A value below 100mg/dl is generally accepted to be normal, while a value greater than 100mg/dl but less than 120mg/dl is not full diabetes yet, so it is regarded as Pre diabetes. An individual with a pre diabetes blood glucose level need to take urgent steps to reduce his blood glucose or risk life long diabetes.

It should be emphasized, however, that the racial and genetic factors predisposing to diabetes are still beyond human comprehension and control. It makes common sense, therefore, to reduce all human controllable factors to the barest minimum. Most of these factors have to do with social occupational and diet habits.

The following tips can help reduce your diabetes risk:

* Reduce weight. Obesity seems to be the single most significant factor in diabetes. Reducing body weight and fat and maintaining an average body weight is very essential. To this end a body mass index (BMI) less than 25kg/m2 for males and less than 24kg/m2 for females is recommended.

* Increase Physical Activity. It is an established fact that diabetes is more common among people that lead a sedentary affluent lifestyle. Simple dynamic exercises like brisk walking for 30-50mins daily or 3-5times weekly has been shown to be very helpful. Exercise reduces bodyweight and fat, increases functionality of the heart, reduces the chances of diabetes and also boosts emotions and healthy living.

* Cut down or cut out alcohol. Alcoholic intake of more than 2units per day has been shown to adversely affect the body. Alcohol being an addictive drug makes it very difficult to maintain a definite amount of intake for a long time. It is better therefore to strive to cut out alcohol completely.

* Avoid Smoking. Cigarette smoke has been shown to contain several poisonous substances. Cigarette smoking and alcohol have been related to several disease. Stopping smoking will definitely reduce the chances of several other ailments apart from diabetes.

* Lean good eating habits, such as;
* Cut down on fatty food and junks
* Eat more of fish and poultry (without the skin is better).
* Garlic reduces blood pressure cholesterol; add it to your meal plan once in a while.
* Cut the number of eggs you take to 3- 4 weekly (better boiled than fried).
* Reduce salt intake to less than 5.8grams daily.
* Eat more of vegetables and fibre rich food, especially fruits.
* Finally, constantly monitor your fasting blood glucose, as this is the only way to know when you are getting into trouble.

CONCLUSION

Diabetes and Hypertension being so interlinked requires a comprehensive plan of care, and this revolves round one's dietary habits, social and environmental factors. Several lifestyle changes like regular exercise, maintaining a moderate body weight, reduction of fat intake and high fibre diet all help to live a normal healthy life. These measures are known to increase insulin sensitivity and also reduce blood pressure.

Conclusively, it is very important to create a more health conscious individuals in the populace. A people who practically believe that it is better and cheaper to prevent an illness than to treat it, when it has become stronger. Moreover, preventive health cannot be divorced from regular medical checks, as this two go hand in hand. There is no way to detect several non-communicable diseases without undergoing regular medical checks. The importance of these checks cannot be over emphasized.
Be alive to your health. Know your Blood glucose values and live a healthier life free from the pains of diabetes.

Mr. Adefemi Kazeem is a graduate of Human Anatomy from a Nigerian University and who wishes to specialize in Public Health, soon. You can contact him by e-mail ? yemupz@yahoo.com; Phone ? 234-803-613-6741.