UNDERSTANDING DIABETES MELLITUS

INTRODUCTION
Diabetes is a chronic debilitating disease that affects people of all races although it may be more prevalent in some races and among certain group of individuals.
Before we proceed, let us understand broadly two types of Diabetes:

1 Diabetes insipidus: This type of Diabetes occurs as a result of diseases of the brain usually known as central diabetes and disease of the kidneys and discrbed as nephrogenic diabetes insipidus
Diabetes insipidus is rare occuring about 3 cases in about 100,000 population in USA
2 Diabetes mellitus: This is the more common type of Diabetes and occurs as a
result of abnormal carbohydrate metabolism. We will dwell on the second type of Diabetes- Diabetes mellitus.

Definition
Diabetes mellitus may be defined as a metabolic disorder characterized by hyper glycemia and classically manifests in three Ps namely;
polyuria ( excessive urination)
Polydipsia (excessive thirst)
Polyphagia (excessive eating)

Other symptoms include:

• Extreme weakness
• weight loss
• Easy fatiguability
• Dizziness
• Tingling sensation in the hands and feets
• Dryness of the mouth
• Visual disturbances including cataract
  and glaucoma

Classification of Diabetes mellitus
There are two types of Diabetes mellitus based on the age at which Diabetes mellitus occurs.
Type 1: Diabetes mellitus ( Insulin Dependent Diabetes mellitus, IDDM)
Also known as Juvenile onset Diabetes mellitus. This type of Diabetes mellitus occurs before the age of 30 years and the patient depends on Insulin for survival.

Type 2: Diabetes mellitus (Non Insulin Dependent Diabetes mellitus,NIDDM)
This is also known as maturity onset Diabetes mellitus. It occurs after the age of 30 years and does not depend on Insulin unless complications occur.

Causes of Diabetes mellitus
There are no particular agents that are known to cause Diabetes mellitus but certain things are known as risk factors

• Infection: This is most common in type 1 Diabetes mellitus. Some childhood infections particularly viral infections can destroy the pancreatic cells where insulin is produced.
• Autoimmune diseases such as autoimmune pancreatitis. This is also common in type 1 Diabetes mellitus.
• sedantary lifestyle
• Obesity or any case of overweight
• Family history
• High Blood pressure
• Race
• Certain diseases of the ovary eg.
  Polycysticc ovarian syndrome

Complications of Diabetes mellitus
Diabetes mellitus has multiple organ effects.

Diabetes can affect the brain to cause neuropathy and stroke.
It can affect the eyes to cause blurring of vision, retinopathy, cataract, glaucoma and total blindness.
It can affect the kidneys to cause nephropathy and kidney failure.
It can affect the limbs leading to diabetic foot and eventual amputation.
Management of Diabetes mellitus
Strict management of Diabetes mellitus is very important to avoid long term morbidity and mortality. Management procedure includes the following:
Dietary management
Exercise
Walking
Hiking
Biking
Swimming
Weight Reduction for obesed patients
Blood glucose monitoring
Medication
Dietary management
Dietary management is the main stay of Diabetes control. In some cases, strict dietary control alone can keep the glucose level perfectly under control. Dietary management involves;

• Reduced alcohol intake
• Reduced sugar intake
• Reduced fat intake
• Reduced carbohydrate intake
• Increased fruit intake
• Increased vegetable intake

The Diabetes diet
The Diabetes diet is the diet that can supply just enough calories to meet the person's metabolic needs and still keep the glucose level low and usually involves the intake of fruits, vegetables and whole grains.

Fruits that are good for the Diabetic patient with low glycemic index

Healthy grains for the Diabetic patient
These are grains that have low glycemic index and include
Whole wheat flour
Wheat bread
Brown rice
Corn
Barely
Oatmeal
Beans
Cowpeas
Planning diet for the Diabetic
One of the big challenges that Diabetics have is reduced range of choice of diet, making meals loathsome. This can be minimized by planning the diet.
Breakfast
Green tea - add a little quantity of honey
with Wheat bread
OR
Wheat pap - add a little quantity of honey
With Beans cake
OR
Plantain porridge spiced with scent leave or any other leave
Launch
Wheat flour with large quantities of vegetables
OR
Brown rice (jollof) eaten with Fresh vegetables or with banana
OR
Cow peas cake
This preparation is very delicious and supplies adequate calories to keep you going through out the day
Super
Quacker oatmeal plus Avocado pear
OR
Water yam poridge prepared with fresh tomatoes. This is special preparation by my local community, very delicious. If you need it, I can send the formula.
OR
Fresh goat pepper soup
This may be taken with one of the beverages with zero sugar

There are more varities of meal combinations that can supply enough calories to support the metabolic needs of the body and still keep the blood glucose within the acceptable normal range.

The Diabetic patient can also scan through the list of glycemic index of all food substances to enable them make informed selection.

Prevention of Diabetes mellitus

1. For the obesed or overweight patient, it may be necessary to reduce weight
2. Regular exercise will also help the over weight patient to shed weight and bring the glucose level under control.
3. Eat healthy food:
   Carbohydrate - wheat flour
   Protein - fish, beans, cowpea
   Fat - unsaturated fats eg. avocado
   pear
4. Reduce alcohol intake.
5. Avoid sedantary lifestyle.
6. Strict dietary measure may mean avoiding the intake of beverages and other drinks and taking only water.

Conclusion
Diabetes mellitus is a chronic debilitating illness associated with serious morbidity and mortality. Strict control measures will reduce complications. Individual lifestyle will help to prevent the occurrence of the disease as Prevention is better and cheaper than cure.