Coping with increasing cases of diabetes in Uganda

Africa has highest proportion of undiagnosed diabetes cases. File photo.

The 2016 World Health Day theme “Beat Diabetes” is timely given the diabetes upsurge in the country.
Uganda, like many other sub-Saharan countries, has seen a rise of diabetes cases. According to ministry of Health, the increase in cases is due to the rapidly changing lifestyles. These among others include less activity and exercise.
Figures from ministry of Health indicate that 1.4 per cent of adults in Uganda suffer from diabetes.
Dr Gerald Mutungi, the head of non-communicable diseases department in the ministry of Health, says that type two of diabetes is most common among adults, contributing to 90 per cent of diabetes cases.
The ministry, however, says it is yet to do a study on the prevalence of diabetes among children.
“It has been difficult to diagnose children with diabetes. Some of the children have been put on quinine drips and die because health workers mistake diabetes in children for Malaria fevers,” says Dr Mutungi.
Dr Mutungi explains that the alarming rate is catalysed by the positive attitude towards obesity yet it is a key contributor to diabetes.
“We celebrate obesity instead of condemning it. People who are overweight are instead considered successful and given front seats at ceremonies,” Dr Mutungi says.
He adds that as a result of the changing lifestyles, people exercise less but use a lot of boda boda and consume a lot of alcohol.
To increase awareness about diabetes, Dr Mutungi says the ministry has partnered with other non-governmental organisations and media to sensitise people on diabetes. However, he quickly points out, “we have not yet reached everywhere.”
Although ministry of Health confirms the increase in the prevalence rate of diabetes among adults, the country has done only one study.
However, according to the World Health Organisation (WHO), the estimated national prevalence of diabetes was 98 000 in 2000 and expected to rise to 328 000 by 2030.
It also indicates that the prevalence of diabetes is particularly high in urban areas with eight per cent of the residents in Kampala, likely to have type 2 diabetes.

Elsewhere
According to a new report by WHO, diabetes now affects nearly one in every 11 people.
The report warned cases had virtually quadrupled from 108 million in 1980 to 422 million in 2014.
BBC reports that high blood sugar levels are a major killer - linked to 3.7 million deaths around the world each year, it says.
What is diabetes?
Dr Fredrick Nakwagala, a senior consultant physician at the Endocrinology unit, Mulago hospital, describes diabetes as a group of diseases in which the body cannot handle blood sugar leading to its rise which destroys many of the body organs.
The vulnerable body organs, he states include the liver, heart, reproductive organs and the placenta in the womb.
Dr Nakwagala says although there
are no specific signs for diabetes, usually patients who are diabetic experience loss of weight, eat a lot, blurred vision, dizzy and low sexual power. In women, sufferers are prone to Candida infections and repeated miscarriages.

Complications
Dr Nakwagala says apart from death, there are other complications including social and economic.
“Blindness, stigma, amputation and, visual loss due to diabetes leads to poverty and marriage breakups due to the high cost of treatment and impotence,” he says.

Treatment
For type one, patients are usually treated with insulin through daily injections, while type two patients are given tablets and told to change their diet and life style such as daily physical exercises.
“But later on, as the type two diabetes patients grow older, usually 16 years later, the pancreas gives up on producing insulin and they start depending on daily insulin injections like the type one patients,” Dr Nakwagala explains.

Diet
Agnes Chadia Baku the head of nutrition at the ministry health says there is no specific food or guidelines for people with diabetes but patients are discouraged from foods with a lot of fats and starch
“Fatty and starch rich foods are discouraged among the patients because the latter tend to increase their sugar content while the former increases the body size yet obesity is a key element in that causes diabetes,” Chadia says.
Globally chronic diseases are projected to become the leading cause of death by 2030 and majority of the cases will be in Africa.

Types
There are four types of diabetes according to Dr Nakwagala. Type one, he says occurs in children when the anti-bodies destroy the pancreas and therefore there is no insulin in the body.
Sadly, for children the cause is unknown.
“Although the cause of diabetes in children is not known, sometimes it is hereditary and the child patient has to be injected with insulin on a daily basis, “Says Dr Nakwagala.
Type two of diabetes on the other hand is common among adults usually more than 30 years and all people who are obese due to insulin resistance when the body cannot react to it (insulin).
“Type three, comes as a result of disorder of the pancreas as a result of chronic diseases like HIV/ AIDs, cancer, injuries from accidents and some drugs. Type four, also known as gestational diabetes occurs in women who are pregnant and disappears as soon as she gives birth, “he says.”

Most vulnerable
Children at puberty
Obese Children
Pregnant women
Any one obese
People who do not do any activity
People with pancreas diseases
People who use dexamethasone for lightening and treating flue.

Costs in shillings
Daily Testing – 12,000
Glucometer -20,000
Insulin-100,000 per month
Needles-50, 000 per month
Tablets-100,000 per month