by Momodou A.I. Tekanyi
School of Medicine
University of The Gambia.

Introduction
It is astonishing to mention that disease conditions (like noncommunicable diseases) which were peculiar to the western world are becoming an order of the day in developing countries, The Gambia inclusive and in which diabetes isn’t an exception. This is what made me write about this disease to help some of my mums and dads victimized and the public at large in enabling them get a little about it.

What is Diabetes?
Diabetes mellitus is defined by the WHO, as a disease characterised by an excessive increase in the blood glucose concentration on three different occasions (i.e. hyperglycaemia) determined by measuring its concentration (fasting blood glucose [after an overnight fast] ≥ 7.0 mmol/L or random blood glucose [any time of the day] ≥ 11.1 mmol/L).

The increase of which can be as a results of insulin deficiency (TYPE I, which can be autoimmune [A] self immune or idiopathic [B] of unknown cause), insulin resistance (TYPE II), gestational during pregnancy (TYPE III) or secondary to diseases like infections, exocrine diseases i.e. pancreatic diseases, etc (TYPE IV).

The most common and cause of writing, is the type II diabetes which has a strong relationship with the lifestyle and is predominantly found in the older age group (particularly women). Patients with gestational diabetes also have a high chance of developing type II diabetes later in their lives i.e. those women with normoglycaemia(normal glucose concentration) and only diagnosed of diabetes during their pregnancy which can lead to complications like macrosomia(delivering very fat babies).

Once diagnosed, diabetes mellitus (except gestational diabetes) is for life and is strongly twined with cardiovascular diseases like hypertension hence the most essential is the PREVENTION and CONTROL.

Presentations (Signs & Symptoms)
This range from polyuria (excessive urination), polydepsia (increasing thirst), tiredness, weight gain to pruritus balanitis or vulvae combined with other associating symptoms. The patterns of presentation are similar in both type I and II but vary in their intensity and duration. Type I (commoner in the young) has a rapid development with a short duration unlike type II that takes a slow developmental trend with a longer periodicity and often leads to systemic complications.

Risk Factors
This is the most important to the society because it tells how and what increases the chance of being a victim of the disease because majority of the populace are ignorant of things that predispose them to diabetes. Thus, they have to be really sensitized on such issues to decrease the morbidity and mortality related to the disease.

However, the factors involved in the development and complication of diabetes are largely centred on the lifestyle particularly in type II diabetes (the commonest) and complications relate mostly to the late diagnosis or delay in seeking medical intervention.

Such factors like uncontrolled diet (high sugar consumption), sedentary lifestyles, smoking, bleaching (which decreases the defensive or protective potentials of the skin thus increasing the vulnerability to local and systemic infections together with skin cancer), types of clothing (tight & nylon clothing) which increases the risk to abrasion, uncontrolled of associated diseases like hypertension, hyperlipidemia (high lipids), etc can all contribute to the development of diabetes and severe systemic complications consequently leading to the death. The increase of which (risk factors) has been a contributing factor to the increase burden of diabetic cases in developing countries.

“The boarding of vehicles in travelling short distances like going to the market instead of walking to exercise the body which utilises the glucose in the production of energy and consumption of food stuffs sugary foods stuffs & those highly rich in fat (as in mayonnaise, butter, oil etc) instead of rich vegetative diets as a means of demonstrating richness, wearing of tight dressings like shoes & clothing for seduction, bleaching of the skin for beauty, smoking to show transition from childhood to adulthood, increasing obesity taking as a sign of relief from constrains and a start to freedom”, to name but a few are all awry concepts and identifiable risk factors failed to be taken into consideration. What a predicament to our being that needs the call for change! Or else, our hospitals shall continue to be transits to the grave yards.

What are the Complications of Diabetes?
The complications of diabetes have a wide range of systemic distribution, counting from diabetic foot, retinopathy (as a results of haemorrhage of capillaries of the retina which can lead to blindness), neuropathy (diseases of the impulse conduction pathway of the nervous system), nephropathy (diseases of the kidneys causing proteinuria i.e. protein lost in urine), encephalopathy (diseases of the brain) to ketoacidosis (which can lead to coma i.e. loss of consciousness).

But the most leading complications and as cause of seeking medical attention & admissions at the hospitals are diabetic foot and ketoacidosis presented at late stages of the disease. Diabetic ketoacidosis occurs as a result of increase synthesis of ketone bodies (proteins) manifested by the presence of acetone in urine with other signs and symptoms of diabetes consequently leading to coma and often death in the absence of prompt and correct medical intervention.

Unlike ketoacidosis, the diabetic foot is as result of ulceration of the foot mostly but can involve any part of the body leading to infections. Other attributing factors like wearing of tight clothing (as in shoes) which can cause abrasions subsequently leading to ulceration and because the blood supply particularly to the lower extremities in diabetic patients are usually diminished due to the low elasticity of the blood vessels coupled with invasion by micro organisms (bacteria) which consume the excessive glucose thus extending their living and causing more infections in the absence of the blood cells (WBC) that fight against them.

This leads to the prolongation of the infections which can cause severe systemic infections and subsequently to death due to conditions like septic shock in the absence of the amputation of the part(s) involved. And this has accounted for about 75% of the causes of amputations done in the hospitals. Smoking can be a prerequisite to the harvesting of cardiovascular(heart & blood vessels) complications like hypertension, myocardial infarction(death of heart muscles), etc as diabetes causes decreased elasticity of the blood vessels due to the high amount of glucose in the blood thus increasing the vascular resistance resulting to hypertension (increase blood pressure).

What is the role of the health sector in quelling the burden of risk factors?
This is a question that has to be answered collectively by all heath professionals in order to vanquish the accelerating burden of noncommunicable diseases in our country. It has to be a due mandate to all heath professionals, to initiate and implement preventive and supportive measures for patients (like diabetics) to use for their betterment and for the benefit of the health system in general.

It is sad to say that the mortality rate of our nation attached to these diseases shall continue to increase if health education and promotion at community level regarding non communicable diseases aren’t taken into consideration. But credit goes to the government for the availability of the community doctors program, graduates of which shall work in the community to combat such menaces like diabetes yet still there is need to complement government’s efforts towards the attainment of the MDG by initiating tangible means well before the graduation of these community doctors.

 Therefore, the community has to be sensitised on health education, promotion and prevention to surmount the increase of non-communicable diseases for all to live a happy, and healthy living.