Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder characterised by elevated blood glucose (blood sugar) levels resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes — the most common form, accounting for over 90% of cases — is a growing epidemic in Nigeria and across sub-Saharan Africa, driven largely by urbanisation, dietary change, and physical inactivity. Type 1 diabetes results from the immune system destroying insulin-producing cells in the pancreas and requires lifelong insulin therapy. Gestational diabetes occurs during pregnancy. All forms of diabetes can lead to serious complications if not well managed, but with proper treatment and lifestyle adjustment, people with diabetes can live long and healthy lives.

Type 2 diabetes often develops slowly and may have no symptoms for years. Common symptoms of all forms of diabetes include: • Frequent urination (polyuria), including at night • Excessive thirst (polydipsia) • Unexplained weight loss despite eating well • Increased hunger (polyphagia) • Blurred vision • Tingling, numbness, or burning sensation in hands or feet • Wounds and sores that heal slowly • Recurrent infections (skin, urinary tract, gum, vaginal) • Fatigue and lack of energy • Darkened skin patches in body creases (acanthosis nigricans): a sign of insulin resistance Type 1 diabetes can present suddenly with nausea, vomiting, abdominal pain, and rapid breathing (diabetic ketoacidosis — a medical emergency).

Insulin is a hormone made by the pancreas that allows glucose from food to enter cells and be used for energy. In diabetes, this process is disrupted: Type 1 Diabetes: The immune system mistakenly attacks and destroys the insulin-producing beta cells of the pancreas. The cause is not fully understood but involves genetic susceptibility and environmental triggers (possibly viral infections). It is not caused by diet or lifestyle. Type 2 Diabetes: The body becomes resistant to insulin and/or the pancreas progressively loses its ability to produce sufficient insulin. This is strongly linked to lifestyle factors including physical inactivity, poor diet, and excess body weight — especially abdominal fat. Gestational Diabetes: Hormones produced by the placenta during pregnancy can block the action of insulin, leading to temporarily elevated blood glucose. It usually resolves after delivery but increases lifetime risk of Type 2 diabetes.

Type 2 diabetes risk factors (the most common form): • Overweight or obesity, especially abdominal obesity • Physical inactivity • Family history of diabetes (parent or sibling) • Age 35 and older • History of gestational diabetes or delivery of a baby weighing over 4 kg • Prediabetes (blood sugar higher than normal but not yet in the diabetic range) • High blood pressure • Abnormal cholesterol levels • Polycystic ovary syndrome (PCOS) • Diet high in refined carbohydrates, sugar, and processed foods • History of poor sleep or night shift work Type 1 diabetes risk factors: • Family history of Type 1 diabetes • Certain gene variants

Poorly controlled diabetes damages blood vessels and nerves throughout the body over time. Major complications include: Cardiovascular: • Heart attack and coronary artery disease • Stroke • Peripheral artery disease Nervous system (diabetic neuropathy): • Tingling, pain, and loss of sensation: most often in the feet • Digestive problems, erectile dysfunction, and other autonomic dysfunction Kidneys (diabetic nephropathy): • Protein loss in urine, progressive kidney damage, and eventual kidney failure requiring dialysis Eyes (diabetic retinopathy): • Damage to retinal blood vessels, leading to vision loss and blindness: a leading cause of blindness in adults Feet: • Diabetic foot ulcers and infections: can lead to gangrene and amputation Other: • Increased susceptibility to infections • Impaired wound healing • Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS): acute, life-threatening emergencies

Type 2 diabetes is largely preventable through lifestyle changes. Even with a family history, the disease can often be delayed or avoided: Healthy eating: • Reduce consumption of refined carbohydrates, white rice, sugary drinks, and processed foods • Eat more vegetables, legumes, whole grains, and lean proteins • Control portion sizes Physical activity: • Aim for at least 30 minutes of brisk walking or other moderate exercise on most days • Reduce prolonged sitting: break up sedentary time throughout the day Weight management: • Achieving even a 5–10% reduction in body weight significantly lowers diabetes risk in overweight individuals Regular screening: • Get fasting blood glucose or HbA1c checked regularly after age 35, especially if overweight • Prediabetes is reversible with lifestyle change: early detection matters For those already diagnosed: • Take prescribed medications consistently • Monitor blood glucose as directed • Attend regular follow-up appointments for eye, kidney, and foot checks • Avoid smoking and limit alcohol