Prof. Ejiofor T. Ugwu – a professor of medicine, consultant physician and endocrinologist at the Enugu State University Teaching Hospital, is the National President Diabetes Association of Nigeria (DAN). In this radio interview monitored via Nigeria Info – by PharmaTimes Editor, MORGAN NWANGUMA, the expert makes some shocking revelations concerning a disease that is cutting short the lives of some thirty thousand Nigerians annually; he proffers solutions on the prevention and management of diabetes Miletus.
According to Prof. Ugwu, more than 11 million people are living with diabetes in Nigeria, and this he said, represents perhaps less than half of those who have this condition because the rest are not yet diagnosed. Amongst the so many concerns that people often raise include a very serious misconception which is – the belief that as long as nobody in the family history has had diabetes it automatically means they cannot come down with the disease. Another one is the question of whether someone e.g. a seven year old child who frequently urinates is as a result of diabetes; that is also a very wrong notion to conclude, the expert noted. “Diabetes is just one of the causes of frequent or excessive urination, but there are other things – even as simple as urinary tract infection, that can make one pass excess urine, etc”. The best thing to do, Ugwu said, is to take that 7 year old child to a qualified medical expert to ascertain whether it is diabetes that is responsible or not, and treat the real cause.
But is it possible that taking some certain medications for other ailments excessively can make the drug work overtime and thereby cause diabetes? This he affirmed. “There are a group of drugs like steroids, e.g., prednisolone, and dexamethasone – and people abuse these drugs a lot especially women, and sometimes men who have some sort of joint pains and they go to some of these patent medicine dealers and they mix all sorts of drugs for them. Most of the time some of these steroids are mixed together for them to take out of shared ignorance without knowing that taking these can predispose them to diabetes. It is the same with some other drugs out there and any qualified expert knows the drugs that when abused (or used for too long) can lead to diabetes; if there is need they prescribe them just for short term usage but once there is prolonged use, risk of developing diabetes is high.”
Another issue is whether diabetes is cancerous – can it lead to cancer? “It is not”, Ugwu said; however, stating that one of the facts about diabetes is that it can expose one to contracting certain kinds of cancers. It is scientifically proven that diabetes patients are at a higher risk of developing cancers than individuals who do not have diabetes. So, cancers like ovarian cancer, endometrial cancer, prostate cancer, etc can be contracted. Thus being diabetic for instance, is a risk factor for some of these cancers. But diabetes in itself according to the expert is not a cancerous condition.
Sometimes during the cold or rainy season or when the weather is cold, some people discover they urinate frequently within a day; is that a sign of diabetes? Likewise in the dry or hot season, one hardly urinates or just urinates like once in a day – what is that? “It is not every frequent urination that is a sign of diabetes. There are different ways through which the body gets rid of waste: the body loses water in different ways. The body loses water through urine, stooling, sweating as well as through breathing. You will notice that during cold weather or rainy season, people sweat less. And so during the cold season the avenue by which people lose water will now be channelled towards urination like in the rainy season (in Nigeria). That explains why the average individual – whether they have diabetes or not tend to urinate more frequently during the cold weather. However, if you’re urinating unduly – if you have to wake up in the night, 3 or 4 or 5 times to urinate, then instead of ascribing it to the coldness of the season, it is better to go check it out to ensure that diabetes or any other ailment is not lurking around the corner,” Prof Ugwu said.
Is it possible for anyone to come down with diabetes mellitus after the age of 70?
“Indeed after the age of 70 it becomes even more possible than for those who are below 70 because as you age, the organs in your body also age. And so those at this age are more likely to develop type2 diabetes than those in their 40s and 50s or 60 because their pancreas will be aging alongside their chronologic age, and their insulin secreting capacity begins to decline; insulin resistance may increase. Also, remember that once we’re 60, 70, and 80 and above, physical activity becomes less – that is the reason for that.”
Some schools of thought seem to insinuate that doctors sometimes just want to push out these drugs to patients even with their side effects; maybe it’s a myth, but let’s get the truth here: what is the proper way to manage especially type2 diabetes?
Prof. Ugwu said, “There are four major strategies in managing type2 diabetes. The first is through diet: if the person is guilty of an unhealthy diet, they have to embrace a healthy dietary pattern. Secondly, you have to increase your level of physical activity especially if the person is sedentary. The third is medication, and this is where healthcare experts come in. I do not encourage any diabetic patient to self medicate because we know the potential side effects of the medications we use to manage diabetes; we know what is called contraindications. For instance, if you have diabetes and I have diabetes, it doesn’t follow that we have to take the same medication; a medication that is helpful to me may be harmful to you – based on several factors, and that’s why they should be prescribed only by qualified medical experts. There are different classes of medications for managing diabetes; in managing diabetes now, you have to ‘personalise’ the patient. If for example, the patient is obese, you will not administer the same type of drug to him as the one you will give to a patient who’s slim or lost so much weight. And if the patient has organ dysfunction such as kidney problems, there are some anti-diabetic medications they shouldn’t take otherwise it may worsen the kidney problem. It is not enough to take medication; there is also a need to monitor the efficacy of the medication to ensure they achieve the desired goals. When monitoring, we’re not just monitoring the glucose; you have to monitor complications – look at the eyes, check the kidney, look at the nails, etc.”
Is diabetes a metabolic issue, bearing in mind that carbohydrate or glucose consumption have been blamed for this condition?
It still boils down to one of those myths that say that diabetes is caused by the consumption of carbohydrates or glucose. “That is not true”, Ugwu emphasises. “Every human being needs carbohydrates and glucose – that’s where we generate our energy from. These are not the problems; the problem lies in the type of carbohydrates that you consume – the quality as well as the quantity of the carbohydrates. And you cannot stop eating carbohydrates in an attempt to cure your diabetes. Secondly, the brain cannot use any other source of energy except glucose. As such, if you stop eating or reduce you carbohydrate consumption to a very low amount that you’re no longer getting sufficient glucose from your food, your body will start manufacturing its own glucose to feed the brain; that’s what is called gluconeogenesis – the body will get the raw materials from you – from inside your body. And so the body will start melting your adipose tissue i.e. the fat in your body, your muscles, and after depleting glycogen stored in your liver; and you now see the individual getting leaner and leaner, with muscle wasting (atrophy); and the person gets weaker and weaker. So the blood sugar will still be high even when you’re not eating carbohydrates because the body is going to be manufacturing glucose to supply the brain. Remember that an unhealthy diet is just one of the risk factors; that you’re eating the right quantity and quality of carbohydrates does not mean you cannot develop diabetes. What if you have a family history? What if you have a sedentary lifestyle? What if you’re overweight or obese? What if you’re taking medications that are diabetogenic?”
Some people have talked about reversals – is it possible? He said, this pertains to when we refer to complex carbohydrates and processed foods, etc. “Now, this refers to any food that has undergone some kind of processing – that machine has worked on it, whereby particles like the chaff, the back etc, have been removed, and has been turned into a fine flour i.e. a refined carbohydrate. So let’s try as much as possible to eat natural foods that are as close to nature as possible; Imagine the kind of foods that our grandfathers and forefathers ate. This is in addition to being physically active. The World Health Organisation recommends that every adult should have at least a hundred and fifty minutes per week – of aerobic moderate intensity activity; this could be in the form of brisk walking, jogging, swimming, dancing, cycling, etc. Whichever one you can do provided you’re not sedentary; do this in addition to watching your weight, ensuring you’re not overweight or obese.” Ugwu gave a piece of advice stating that, “whatever you know you’re consuming that can predispose you to diabetes, just drop it!” For instance, he added: “There are some people who no longer eat with water; each time they order food, they buy soft drinks – that is unhealthy. A bottle of soft drink contains nothing less than 12 to 14 cubes of sugar. Accessing healthcare is getting expensive, and beyond the reach of an average Nigerian; the rate of fatality is very alarming – the annual death rate from diabetes is over thirty thousand. The Diabetes Association of Nigeria (DAN) which I represent is therefore calling on the Federal Government to declare a state of emergency in diabetes. The Nigerian government needs to subsidise diabetes medications immediately; also the government should as a matter of urgency remove importation tax imposed on imported diabetes medications and consumables. They also need to expand the National Health Insurance Scheme – to include most of the diabetes medications and consumables especially in the rural areas.
English