BY AWELE OGBOGU
Living with diabetes is not a death sentence, but in Nigeria that is only a consolation for millions living in the throes of the disease due to poverty, wrong treatment and late diagnosis occasioned by a decrepit healthcare system as well as a growing sedentary lifestyle and unhealthy diets. Medicines used to treat diabetes are not available, worse still millions of Nigerians do not know their diabetes status, so a good number of the population may never know what hit them until they are down with diabetes.
Hence diabetes touted to be a silent killer, is ‘treated with respect’ like it is done to a powerful foe. But it is all due to the faltering steps of a nation whose hospitals, according to a popular Nigerian cleric, Bishop Wale Oke “are nothing but glorified morgues while millions of scarce foreign exchange are ferreted abroad annually to pay for medical tourism for the rich, mostly corrupt politicians.
An Asaba-based private medical practitioner, Dr. Max Okere called for “resolute governmental direction. Regulatory agencies at the national and sub-national levels should step up awareness of diabetes as a national public health issue, what needs to be done individually and collectively to prevent and diagnose it and keep the disease in the public and political spotlight.
Like Dr. Okere, over the years medical experts have raised concerns about the exponential rise in the prevalence of diabetes in Nigeria. In 2021, the IDF estimated that Nigeria has about 3.6 million citizens with diabetes. Okere said “In 2022, it was indicated that 11.2 million Nigerians are living with the disease.” He was not farther from the truth. Last year, the WHO estimated the prevalence of diabetes in Nigeria to be 4.3 per cent, largely attributed to lifestyle changes caused by urbanisation and its outcomes. These include industries producing unhealthy diets, including sugar-sweetened drinks, lack of exercise, tobacco use and harmful use of alcohol. In addition, “lack of education for those living with all types of diabetes and access to affordable treatment, including insulin, has been affecting the management of the disease in the country.”
Another medical doctor, Dr. Paul Uriah agreed that “diabetes is a silent killer and one of the leading causes of deaths nationally. It is a chronic condition brought about by either insufficient insulin (the hormone regulating blood sugar levels) production by the pancreas or inefficient insulin utilisation by the body. Uncontrolled diabetes results in high blood sugar, which over time seriously harms many different body systems.” He added that, “diabetes is not only closely associated with high blood pressure, obesity and hereditary factors, its complications include damage to the brain, heart, kidney and limbs. It exposes its victim to blindness, kidney failure, heart attacks, stroke and lower limb amputation.
Sadly, the medics observed that medicines used to treat diabetes are very expensive, thus putting them out of the reach of most Nigerians. Tragically also, due to weak or a total lack of food safety regulations, even the fruits consumed by Nigerians are being increasingly contaminated with artificial and toxic ripeners, which further pre-disposes public health to more harm. Not too long ago, NAFDAC raised the alarm over ripening of bananas with carbide, but did nothing to stop brisk sales of the harmfully ripened bananas riddled with black spots.
“Local governments should urgently revive effective primary healthcare services in rural areas. More citizens need to be sensitised and educated about the disease and how to prevent it. Through partnerships with other organisations and reformed health insurance, the government can enable citizen’s access to medicines for treating diabetes. Food safety agencies should prohibit the use of toxic artificial sweeteners and ripeners.” Okere and Uriah resolved that governments should combat this silent killer now not later.
Asked: “how can one be suffering from diabetes and not even know? Uriah replied: “sadly, statistics reveal that an estimated five million Nigerian adults suffer from diabetes with less than 50 per cent of these patients being aware of their condition. This according to research, means half of the adults with diabetes do not even know they have it and late diagnosis can lead to serious complications.”
The condition, Okere stressed, is usually silent until complications set in. “In those lucky to have symptoms, these may include passing plenty urine, excessive thirst, hunger, weight loss and weakness. Others may notice poor vision and frequent boils on their body or poorly healing wounds. Pregnant women may experience miscarriages, still births or very large babies.” That makes diabetes one of the most common non-communicable disorders today. It is a chronic metabolic disease characterised by high levels of blood glucose.
According to experts, a diabetic has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine.
The Medical Director, Rainbow Hospital, Dr. Afoke Isiavwe said “diabetes is almost becoming an epidemic.” Isiavwe who is the Co-ordinator, Diabetes Podiatry Initiative Nigeria, also regretted that millions of Nigerians do not know their diabetes status. He recommended diabetes screening to detect the disease even before symptoms appear. “Screening helps in the early diagnosis of diabetes so that the appropriate treatment can be instated at the early stage. It is a medical fact that diabetes under control is usually associated with lesser complications than when not properly managed.”
Dr. Okere who is a consultant endocrinologist said diabetes could bring about other health complications like blindness, kidney failure, leg amputation, strokes, heart attacks and erectile dysfunction.”
Therefore, he said “everyone should be encouraged to know their status by screening but most importantly, people at a higher risk for diabetes, like those with a family history should particularly undergo screening.” Dr. Okere appealed for policies that would mandate the routine checking of blood glucose just like blood pressure. She said if this is made compulsory in hospitals, “we will be able to detect early pre-diabetes stages and this will reduce progression into complications.” He added that increased frequency of diabetes in Nigeria can be reduced by encouraging exercise, discouraging excess food and drink intake and promoting regular screening.
He advised on eating plenty of foods high in fibre such as fruits, vegetables, beans, whole grains, nuts and seeds. “Fibre in diet helps reduce the risk of diabetes by improving blood sugar control, lowering risks of heart disease and promoting weight loss. Whole grains may also reduce the risk of diabetes and help maintain blood sugar levels. Many foods made from whole grains come handy, including bread, pasta products and many cereals. “There is a greater epidemic coming our way in Nigeria with children being trained with all sorts of sugar sweetened drinks, instead of fruits and this will lead to increased incidences of diabetes.”
A person living with type 2 diabetes, Mrs. Osarenkhoe Chima-Nwogwugwu, saying that living with the condition is not a death sentence, revealed she has lived with it for 21 years. “My parents lived with diabetes until they passed on. People don’t understand how to live with diabetes because of the stigma, discrimination, misinformation and the myths about living with diabetes.
“When people manage diabetes when they are diagnosed with it, they will know that it is just a condition. I have managed mine for the past 21 years, I eat healthy meals, I go for regular checks ups and I also exercise regularly”, Chima-Nwogwugwu said. She said it is unfortunate that diabetes care is not prioritised in Nigeria. “I know that many people living with the condition pay out-of-pocket.
“Diabetes care in Nigeria is poor. Most of us pay from our pockets, which is not happening in countries with low diabetes rates. Even when we have the money to pay, we may not be able to access care because doctors are living the country for greener pastures”, Chima-Nwogwugwu added.
The experts revealed that half of the 22 million Nigerians living with diabetes are unaware that they have the killer disease, warning that the number may double by 2045 if urgent measures are not taken to address the rise. The physicians noted that already, no fewer than 20 million Nigerians are with pre-diabetes, a condition in which blood sugar is high and could likely become Type 2 diabetes if there is no intervention. They expressed concern that only a fraction is receiving proper care and treatment among those diagnosed with diabetes.
The senior physicians agreed it would cost Nigeria at least a trillion naira to provide treatment to poor Nigerians living with the chronic disease, which so far has no cure but can be treated when detected early. They agreed that diabetes is the most common cause of limb amputation, kidney failure, heart attacks, stroke, blindness and cancer.
“Teenagers are developing diabetes and are at greater risk of coming down with the listed complications.” The fact that people with diabetes are at a higher risk of developing and dying from other major diseases, was also of major concern to the experts.
Uriah while disclosing the frightening diabetes figures, called for collective efforts of relevant stakeholders and the government to prevent the degenerative disease. He reiterated that “millions of Nigerians have diabetes and half or more don’t even know that they have the disease. We are dealing with a slow-moving catastrophe in Nigeria.
“We know that we have 11 million Nigerians living with diabetes. But we also know that probably an additional 11 million people have diabetes that has not been diagnosed. “We believe that 22 million Nigerians have diabetes. We also know that there are about 20 million Nigerians with pre-diabetes, which is borderline diabetes. It would cost us at least a trillion naira to provide treatment to poor Nigerians presently with diabetes, talk less of when (as expected) the numbers rise further.
“Our national budget for this year is 1.7 trillion, so we are politically overwhelmed. But we can aggressively prevent this disease through diet, exercise and screening. We are having more cases of diabetes because we are not as active as our forefathers were. We should get checked every year.” The medical director also said the reason many Nigerians are unaware they have diabetes is because they do not yet have symptoms. “To some of them, a health check could spring surprises.”
“For many years, there will be no symptoms; it is only later that they may start having symptoms like drinking too much water and urinating frequently. But they may have no symptoms, which is why it is important to go for health checks. It is important to know that limb amputation, kidney failure, heart attacks, stroke and blindness are serious complications of diabetes. We should all get our yearly check up, especially after age 30”, he advised. Dr. Uriah urged Nigerians to shun a sedentary lifestyle, be more active and embrace a healthy diet.
Uriah, also an expert in endocrinology attributed the rise in diabetes cases to changes in dietary habits and other aspects of westernization. He said obesity and diabetes also increase the risk of heart attacks, stroke, blindness and cancer, noting that diabetes places an extra burden on individuals and families affected, especially for the majority of patients who are unable to access quality healthcare.
The endocrinologist said the major challenge with diabetes, especially in Nigeria was that many patients report late to the hospital when the disease has advanced, making treatment and care difficult. This has made Nigeria the record holder of the highest diabetes prevalence rate in Sub-Saharan Africa. But is the country willing or capable of overcoming this unenviable record before it is consumed by it?
