Diabetes Mellitus: Symptoms And Treatment in Nigeria 2021

Diabetes mellitus, commonly known as diabetes, is a chronic disease of the disorder of Fats, Proteins, and carbohydrate metabolism which occurs when the pancreas does not produce enough insulin or the body cells are not sensitive enough to utilize the insulin produced by the pancreas. The disease is characterized by Hyperglycaemia (increased blood sugar).

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Untreated high blood sugar from diabetes illness can cause damages to your eyes, nerves, kidneys and other parts of your organs.

Types of Diabetes Mellitus in Nigeria

• Type 1 diabetes formerly known as (Insulin-dependent, or childhood-onset) Diabetes which occurs due to autoimmune destruction of the beta cells of the pancreas leading to a lack of insulin in the blood. It occurs before the age of 35. About 10% of people with diabetes have this type.
• Type 2 diabetes formerly called (non-insulin-dependent or adult-onset diabetes) which results from the body cell’s insensitivity to insulin, occurs after the age of 35 and this accounts for over 90℅ cases of Diabetes mellitus. Sugar builds up in the body as a result of insulin-resistant of the body.
• Gestational diabetes this is diagnosed in a nondiabetic pregnant woman at 2nd or 3rd trimesters of pregnancy, due to high levels of insulin counter-regulatory hormones such as cortisol.
• Prediabetes these occur as a result of higher blood sugar than the normal range, but it’s not high enough for a diagnosis of type 2 diabetes.

A rare condition called diabetes insipidus is not the same as diabetes mellitus, although has a similar name. It’s a different condition in which the kidney removes too much fluid from the body.

Risk Factors

The risk factors of Diabetes Mellitus in Nigeria include:

• Ageing
• Family history
• Obesity
• Autoimmune diseases
• *Drugs such as glucocorticoids, thiazide diuretics etc.

Diabetes Symptoms

Diabetes symptoms are caused by rising blood sugar. Below are the general symptoms of diabetes:

• Polyuria, polydipsia, polyphagia
• weight loss
• Abnormal large baby weight (at birth).
• Declined eyesight
• Peripheral neuropathy
• Dehydration
• Presence of sugar and ketones in the urine
• Sores that don’t heal
• Extreme tiredness

Diabetes Prevention

• Regular exercise
• Regulate the intake of sugar
• Quit smoking
• Avoid a sedentary lifestyle
• Eat a high fibre diet

Diabetes Diets

For proper management of Diabetes mellitus, a healthy diet is a keystone. Some of the foods recommended for diabetic patients include;

1. Green Leafy Vegetables

Green leafy vegetables contain essential vitamins, minerals, and nutrients. And have little effects on blood sugar.
Leafy greens, including spinach and kale, are a key plant-based source of potassium, vitamin A, and calcium. They also provide protein and fibre, Broccoli, cauliflower which is rich in vitamin C have antioxidant activities.

Green leafy vegetables include:

• spinach
• collard greens
• kale
• Lettuce
• cabbage
• bok choy
• broccoli
• Cauliflower

One small-scale study suggested that kale juice may help regulate blood sugar levels and improve blood pressure in people with subclinical hypertension. In the study, people drank 300 millilitres of kale juice per day for broccoli.

People can include green leafy vegetables in their diet in salads, side dishes, soups, and dinners. Combine them with a source of lean protein, such as chicken or tofu.

2. Whole Grains

Whole grains contain high levels of fiber and more nutrients than refined white grains.

Eating a diet high in fibre is important for people with diabetes because fibre slows down the digestion process. Slower absorption of nutrients helps keep blood sugar levels stable.

Whole wheat and whole grains are lower on the glycemic index (GI) scale than white bread and rice. This means that they have less of an impact on blood sugar.

Good examples of whole grains to include in the diet are:

• brown rice*
• whole-grain bread
• whole-grain pasta
• buckwheat
• quinoa
• millet
• bulgur
• rye
• People can swap white bread or white pasta for whole-grain options.

3. Fatty Fish

Fatty fish is a healthful addition to any diet. Fatty fish contains important omega-3 fatty acids called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

People need a certain amount of healthful fats to keep their body functioning and to promote heart and brain health.

The ADA report that a diet high in polyunsaturated and monounsaturated fats can improve blood sugar control and blood lipids in people with diabetes.

Certain fish are a rich source of both polyunsaturated and monounsaturated fats. These are:

• salmon
• mackerel
• sardines
• albacore tuna
• herring
• trout
• People can eat seaweed, such as kelp and spirulina, as plant-based alternative sources of these fatty acids.

Instead of fried fish, which contains saturated and trans fats, people can try baked, roasted, or grilled fish. Pair with a mix of vegetables for a healthful meal choice.

4. Walnuts

Nuts are a very essential addition to the diet. Like fish, nuts contain healthy fatty acids that help keep the heart-healthy.

Walnuts are especially high in omega-3 fatty acids called alpha-lipoic acid (ALA). Like other omega-3s, ALA is important for good heart health.

People with diabetes may have a higher risk of heart disease or stroke, so it is important to get these fatty acids through the diet.
Walnuts also provide key nutrients, such as protein, vitamin B-6, magnesium, and iron.

People can add a handful of walnuts to their breakfast or to a mixed salad.

Learn about other beneficial nuts for diabetes here.

5. Citrus Fruits

citrus fruits, such as oranges, grapefruits, and lemons, have antidiabetic effects.
Eating citrus fruits is a great way to get vitamins and minerals from the fruit without the carbohydrates.
Some researchers believe that two bioflavonoid antioxidants, called hesperidin and naringin, are responsible for the antidiabetic effects of oranges.

Citrus fruits are also a great source of:

• Vitamin C
• Folate
• Potassium

Learn about other beneficial fruits for diabetes here.

6. Berries

Berries are full of antioxidants, which can help prevent oxidative stress. Oxidative stress is linked with a wide range of health conditions, including heart disease and some cancers.

Studies have found chronic levels of oxidative stress in people with diabetes. Oxidative stress occurs when there is an imbalance between antioxidants and unstable molecules called free radicals in the body.

Blueberries, blackberries, strawberries, and raspberries all contain high levels of antioxidants and fibre. They also contain important other vitamins and minerals, including:

vitamin C
vitamin K
manganese
potassium
People can add fresh berries to their breakfast, eat a handful as a snack, or use frozen berries in a smoothie.

7. Sweet Potatoes
Sweet potatoes have a lower GI than white potatoes. This makes them a great alternative for people with diabetes, as they release sugar more slowly and do not raise blood sugar as much.

Sweet potatoes are also a great source of:

• Fiber
• Vitamin A
• Vitamin C
• Potassium

People can enjoy sweet potatoes in a range of ways, including baked, boiled, roasted, or mashed. For a balanced meal, eat them with a source of lean protein and green leafy vegetables or a salad.

8. Garlic

Garlic is a high source of vitamins such as vitamins B-6 and C. Vitamin B-6 is involved in carbohydrate metabolism. Vitamin C may also play a role in maintaining blood sugar levels.

Diabetes Treatment
Doctors treat diabetes with different medications. Some of these drugs are taken as injections while others are taken orally.

Treatment Of Type 1 Diabetes Mellitus in Nigeria:

Insulin is the main treatment for type 1 diabetes because it replaces the hormones your body cant produce. We will discuss the four types of insulin that are most commonly used. I will differentiate them on how quickly their onset of action is and their duration of action.

• Short-acting insulin onset of action is within 30 minutes and duration of action is 6-8 hours
• Rapid-acting insulin onset of action is within 15 minutes and its duration of action is 3-4 hours
• Long-acting insulin onset of action is a few hours after administering injection intravenously and its duration of action is 24 hours or more.

Treatment Of Type 2 Diabetes Mellitus in Nigeria

Practising a healthy lifestyle such as daily exercise and eating healthy diets can help diabetic patients manage type-2 diabetes. If lifestyle changes aren’t enough to lower your blood sugar level.

In the treatment of Type 2 diabetes mellitus, different drug classes are used, Below are some drugs used in treating type-2 diabetes:

• Sulfonylureas: It helps in stimulating your pancreas to release more insulin. Examples are Glipizide, Glyburide and Glimepiride.
• Meglitinides: It stimulates your pancreas to release more insulin. Examples are Repaglinide(Prandin) and Nateglinide (Starlix).
• Biguanides: It reduces the amount of glucose your liver produces. An example is Metformin (Glucophage).
• Alpha-glucosidase inhibitors: It slows your body’s breakdown of sugars and starchy foods. Examples are Acarbose(Precose) and miglitol (Glyset).
• Thiazolidinediones: Helps insulin work better. Examples are Pioglitazone(Actos) and rosiglitazone (Avandia).
• Glucagon-like peptides: GLP-1 receptor antagonists: Changes the way your body produces insulin. Examples are Dulaglutide (Trulicity), exenatide (Byetta), and liraglutide (Victoza).
• DPP-4 inhibitors: Improves your blood sugar without making it drop too low. Examples are saxagliptin (Onglyza), Linagliptin (Tradjenta) and sitagliptin (Januvia).

INSULINS

Insulin is a protein hormone that is used as a medication to treat high blood glucose. This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. It is also used along with glucose to treat high blood potassium.

Mechanism of action

Insulin initiates its action by binding to a glycoprotein receptor on the surface of the cell. This receptor consists of an alpha-subunit, which binds the hormone, and a beta-subunit, which is an insulin-stimulated, tyrosine-specific protein kinase. Activation of this kinase is believed to generate a signal that eventually results in insulin’s action on.

1. TYPES OF INSULIN
   Insulin is usually given subcutaneously, either by injections or by an insulin pump. Insulin is characterized by the rate at which it’s been metabolized by the body, yielding different peak times and durations of action faster-acting peak quickly and are subsequently metabolized, while longer-acting insulins tend to have extended peak times and remain active in the body for more significant periods.

1. RAPID ACTING
   Examples of rapid-acting insulins (peak time at ~1 hour) include:
   Insulin lispro (Humalog)
   Insulin aspart (Novolog)
   Insulin glulisine (Apidra)

1. SHORT ACTING
   Examples of short-acting insulins (peak time between 2-4 hours) include:
   Regular insulin (Humulin R, Novolin R)
   Prompt insulin zinc (Semilente).
   INTERMEDIATE ACTING
   Examples of intermediate-acting insulins (peak time between 4-10 hours) include:
   Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
   Insulin zinc (Lente).
2. LONG ACTING
   Examples of long-acting insulins (duration ~24 hours, often with no peak) include:
   Extended insulin zinc insulin (Ultralente)
   Insulin glargine (Lantus)
   Insulin detemir (Levemir)
   Insulin degludec (Tresiba).

SULFONYLUREAS
This class enhances the release of insulin(insulin secretagogue)used in type 2 diabetes. examples are, glipizide, glimepiride and glyburide.

MECHANISM OF ACTION
Sulfonylureas bind to adenosine triphosphate-sensitive potassium channel (K-ATP channel) in the beta cells of the pancreas. This leads to the inhibition of those channels and alters the resting membrane potential of the cell, causing an influx of calcium and the stimulation of insulin secretion.

DOSING
Glipizide is taken as a 2.5 mg to 10 mg tablet, a single dose or in two divided doses, 30 minutes before breakfast. Glimepiride is available as a 1, 2, and 4 mg tablet, taken once a day with breakfast or twice a day with meals. For patients at increased risk for hypoglycemia, such as older patients or those with chronic kidney disease, the initial dose could be as low as 0.5 mg daily. Glyburide is available as a 1.25, 2.5, and 5mg tablet, taken as a single dose or two divided doses.

ADVERSE EFFECTS
Sulfonylureas: Syncope, dizziness, nervousness, anxiety, depression, hypoesthesia, insomnia, pain, paresthesia, drowsiness, headache, diaphoresis, pruritus, increased lactate dehydrogenase, diarrhoea, flatulence, dyspepsia and vomiting.

CONTRAINDICATIONS
ketoacidosis.Hypersensitivity to the drug or sulfonamide derivatives, type 1 diabetes mellitus, and diabetic ketoacidosis.

GLITINIDES
Glitinides are also insulin secretagogues, similar to sulfonylureas with some overlap in binding sites, used in type 2 diabetes. Examples include: Rapaglitinide and nateglinide

MECHANISM OF ACTION
Meglitinides exerts its effects via different pancreatic beta-cell receptors, but they act similarly by regulating adenosine triphosphate-sensitive potassium channels in pancreatic beta cells, thereby causing an increase in insulin secretion. Example; Nateglitinide, repaglinide.

DOSING
Repaglinide is available as a 0.5, 1, or 2 mg tablet, taken orally as two to three divided doses in a day.

ADVERSE EFFECTS
Hypoglycemia to weight gain, headache, upper respiratory tract infection.

CONTRAINDICATION
Hypoglycemia, weight gain, headache, upper respiratory tract infection), and cardiovascular ischemia.

BAGUANIDES
Biguanides act to reduce hepatic and renal gluconeogenesis used in type 2 diabetes. example; Metformin

MECHANISM OF ACTION
Metformin increases hepatic adenosine monophosphate-activated protein kinase activity thus reducing hepatic gluconeogenesis and lipogenesis as well as increasing insulin-mediated uptake of glucose in muscles.

DOSING
Metformin is the first drug of choice in patients with type 2 diabetes mellitus. It is given orally in 500 to 1000 mg tablets twice a day.

ADVERSE EFFECTS
Metformin: Gastrointestinal upset such as diarrhoea, nausea and vomiting, flatulence, chest discomfort, flushing, palpitation, headache chills, dizziness, taste disorder, diaphoresis, nail disease, skin rash, decreased vitamin B12 serum concentrate. Also in less than of patients it metformin causes cholestasis and lactic acidosis.

CONTRAINDICATION

Metformin: Hypersensitivity to the drug, severe renal dysfunction (eGFR less than 30 mL/minute/1.73, and metabolic acidosis including diabetic ketoacidosis.

THIAZOLIDINDIONES
These drugs regulate gene expression by binding to PPAR-Gamma and PPAR-Alpha, used in type 2 diabetes, examples include; pioglitazone, Rosiglitazone.

MECHANISM OF ACTION
Thiazolidinediones bind to peroxisome proliferator-activated receptor gamma to increase peripheral uptake of glucose and decrease hepatic.

DOSING
Pioglitazone is given as 15, 30, or 45 mg tablet daily. Rosiglitazone, when rarely used, is given as 2, 4 and 8 mg daily.

ADVERSE EFFECTS
Edema (less than or equal to, hypoglycemia (less than or equal to, cardiac failure (less than or equal to, headache, bone fracture (less than or equal to, myalgia, sinusitis, and pharyngitis.

CONTRAINDICATIONS
Hypersensitivity to the drug, New York Heart Association Class III or IV heart failure, serious hepatic impairment, bladder cancer, history of macroscopic hematuria, and pregnancy.

DPP-4 INHIBITORS
These drugs block the degradation of GLP-1, raises circulating GLP-1 levels used for type 2 diabetes.Examples include;sitagliptin,linagliptin,saxagliptin.

MECHANISM OF ACTION

DPP-4 inhibitors inhibit the enzyme dipeptidyl peptidase 4 (DPP- 4) and prolong the action of the glucagon-like peptide. This inhibits glucagon release, increases insulin secretion, and decreases gastric emptying thus decreasing blood glucose levels.

• DOSING
  Among the DPP- 4 inhibitors, Linagliptin is available as 5 mg daily, Vildagliptin is given as 50 mg once or twice weekly, Sitagliptin as 25, 50, and 100 mg once daily, and Saxagliptin as 2.5 and 5 mg once daily.
• ADVERSE EFFECTS
  Sitagliptin: Hypoglycemia, nasopharyngitis, increased serum creatinine, acute pancreatitis (including hemorrhagic or necrotizing forms), and acute renal failure.
  *Saxagliptin*
  : peripheral oedema, headache, hypoglycemia, urinary tract infection, lymphocytopenia, and acute pancreatitis.
  *Linagliptin*: Hypoglycemia, increased uric acid, increased serum lipase; more than three times upper limit of normal), nasopharyngitis, and acute pancreatitis.
• CONTRAINDICATIONS
  Linagliptin: No dose adjustment needed.
• ALPHA-GLUCOSIDASE INHIBITORS
  These drugs inhibit intestinal glucosidase used in type 2 diabetes. Examples; Acarbose, miglitol.
• MECHANISM OF ACTION
  Alpha-glucosidase inhibitors competitively inhibit alpha-glucosidase enzymes in the intestine that digest the dietary starch thus inhibiting the polysaccharide reabsorption as well as the metabolism of sucrose to glucose and fructose.
• DOSING
  Alpha-glucosidase inhibitors are available as a 25 mg, 50 mg, 100 mg tablet, given three times a day just before meals.

ADVERSE EFFECT
Flatulence that tends to abate with time, diarrhoea, abdominal pain, and increased serum
transaminases.

CONTRAINDICATIONS
Hypersensitivity to acarbose, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, ulcers of the intestine, partial intestinal obstruction, digestive and absorptive issues.

Source: https://healthforbes.com/diabetes-mellitus-symptoms-and-treatment/