What it means to live a healthy life with diabetes

A nurse assists Mary Jjingo Nantongo to check her blood sugar levels using a glucometre. Nantongo has been living with diabetes since 2005. Photo by Rachel Mabala

What you need to know:

The burden of diabetes is increasing globally, particularly in developing countries such as Uganda. Obesity and physical inactivity are key contributing factors. But how can a person manage the condition and live a healthy life?

Patrick Ssendijja has been living with diabetes since 1990. The 62-year-old farmer, who lives in Buddo village, Wakiso District says before he developed the disease, he lived a normal life, tilling his land.

But when he started feeling thirsty all the time, which was accompanied by blurred vision, he realised that there was a problem with his health.

“The condition affected my work as a farmer. I decided to go to Mulago National Referral Hospital where tests were taken, which showed that my blood sugar level was too high,” says Ssendijja. He was diagnosed with type 1 diabetes. At the time, Ssendijja says he used to take a lot of alcohol, which also damaged his pancreas.

“I was a little sacred because no one in my family had ever been diagnosed with diabetes. No one took the disease seriously at the time,” he says. At Mulago, Ssendijja spent two weeks as doctors treated him for other symptoms that he had developed. He was later introduced to Dr William Lumu, a diabetes specialist at Mengo hospital.

“The doctor gave me tablets which I used for a while, although it was not effective in regulating my blood sugar levels. My vision continued to get blurred,” explains Ssendijja.Dr Lumu advised him to use insulin (hormone that regulates the amount of glucose in the body). After being taken through the process of using the insulin, Ssendijja says he now self-administers it.

“Every morning, I inject the insulin on my right upper arm, thigh or even on the stomach. The injection helps to regulate my blood sugar and I have found this convenient to use,” says Ssendijja.
He says the monthly dose for the insulin costs Shs150,000. However, this cost can differ from one patient to another, depending on the severity of their disease.

On top of insulin, Ssendijja says he also uses a glucometer to monitor and record his sugar levels. However, he uses the machine after every two weeks. On top of diabetes, Ssendijja says he has to deal with hypertension. “At the moment, this is the biggest challenge I have to deal with,” he says.

His diet
Ssendijja’s convenient way of managing the disease though has been through maintaining a strict, healthy diet. He avoids eating starchy foods and concentrates on fruits and vegetables.

“I also jog and do push-ups every morning. If you are diabetic and do not do exercise, that is a recipe for disaster,” he says. The health and exercise plan is usually drawn by the doctor and the patient.

Nantongo’s story
Mary Jjingo Nantongo, 56, is a mother of three. The resident of Nakulabye, a Kampala surburb says she was diagnosed with diabetes nine years ago.

“At the time, I was working with Barclays Bank. I could feel thirsty at all times and when I told my family about it, they advised me to go and see a doctor,” says Nantongo.

She adds: “I went to a clinic on Luwum Street where tests were carried out that revelaed I had type 2 diabetes.” Nantongo then went to another doctor who gave her tablets to regulate her sugar levels. Nantongo says she takes insulin tablets called glyformin after every meal.

“I also take lorsaten tablets once a day to manage hypertension,” says Nantongo. She notes that whenever her sugar level is not balanced, her body becomes weak. This happens mostly after spending several hours without eating food.
This, she says is why diabetic patients are advised to avoid fasting or skipping meals, as it could lead to irregular blood balance in the body.

Keeping fit and healthy
For Nantongo, exercise and diet are powerful tools in regulating the level of blood sugar in the body. “I have stopped eating oil foods. I boil the vegetables and eat little starchy foods such as posho, rice, sweet potatoes. The doctor also recommended that I eat matooke because it has less starch,” she explains.

Doctor’s take
Dr Lumu, also the chairperson of the Uganda Diabetic Association, says when a person has diabetes, their blood sugar is higher than what it should be for a normal person. Blood sugar that is a result of the food we eat can be controlled by insulin. Insulin controls the level of blood sugar and a person becomes diabetic when there is either no production or the insulin produced is not able to control the blood sugar (defective),” he says.

Types of diabetes
“In situations where there is no production of insulin at all, a person suffers from type I diabetes,” says Dr Lumu. Type II diabetes on the other hand, happens when insulin production is insufficient or defective

Risk factors
Dr Lumu says several factors increase a person’s risk of developing the different types of diabetes.
For instance, a damaged pancreas, resulting from the use of certain drugs or alcohol consumption can increase the risk of developing type 1 diabetes.

Type 2 diabetes can arise from genetic factors such as age and obesity. Dr Lumu says estimates in Uganda show about two to four million people may be diabetic, although majority of these may not be aware of their status.

Management
According to Dr Lumu, diabetes can largely be managed by making lifestyle changes and following a strict health plan. “People living with diabetes should eat a lot of leafy vegetables and fruits and engage in regular physical activity. This helps to check blood sugar, cholesterol and blood pressure levels, as well as the general wellbeing of the person,” says Dr Lumu.

These exercises can include aerobics, brisk walking and jogging for at least 30 minutes every day. He says self-monitoring is also crucial. “Every diabetic patient should have a small book where they can record their blood sugar level before and after meals. This record should be shown to the doctor during every visit.
Dr Lumu says if diabetes is managed well, patients can lead normal lives.

Challenges
Dr Lumu says many people do not follow the recommended treatment plan, while others opt to seek services from traditional herbalists.
“Treating diabetes is costly so some people find it hard to go for consultation and have the tests done regularly,” notes Dr Lumu.

Where to get services
All public hospitals across the country provide free diabetes diagnosis and treatment, while some private facilities also offer the service at a fee.

At private facilities, the cost of treatment depends on the type, stage and associated complications that a person may have. Averagely, a person may pay between Shs50,000 and Shs200,000 per month.

Smoking is a health hazard for anyone, but for people with diabetes or those at a high risk of developing the disease, it can contribute to serious health complications.

According to health experts, diabetic people who smoke have higher blood sugar levels, making the disease more difficult to control and putting them at risk of developing complications such as blindness, nerve damage and kidney disease.

If you have diabetes, watching what you eat is one way you can stay healthy. People with diabetes are advised against eating starchy foods, even though they contain fibre because starch raises blood glucose and leads to weight gain, another predisposing factor for diabetes.
Fatty foods are also discouraged because they increase the body’s production of cholesterol, which can clog the blood vessels blocking blood floor to the heart, which can lead to an attack.

COMMON SYMPTOMS

•Excessive thirst, increased food and water intake.
•Frequent urination.
•Body weakness.
•Poor eyesight.
•Wounds that take long to heal.
•Burning sensation in the feet (feeling of pins in the feet)
•Impotence.
•Recurrent vaginal candidiasis.

GLOBAL FACTS ABOUT DIABETES

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. We outline some of the key facts about the disease.

•About 347 million people worldwide have diabetes. Common risk factors include obesity and physical inactivity.
•Diabetes is predicted to become the seventh leading cause of death in the world by the year 2030. Total deaths from the disease are projected to rise by more than 50 per cent in the next 10 years.
•Type 1 diabetes is characterised by a lack of insulin production and type 2 diabetes results from the body’s ineffective use of insulin.
•A third type of diabetes is gestational diabetes. This type is characterised by hyperglycaemia, or raised blood sugar, which is common during pregnancy.
•Type 2 diabetes is more common than type 1 diabetes. Type 2 accounts for around 90 per cent of all diabetes worldwide. Reports of type 2 diabetes in children, previously rare have increased worldwide. In some countries, it accounts for almost half of newly diagnosed cases of diabetes.
•Cardiovascular disease is responsible for between 50 to 80 per cent of deaths in people with diabetes.
•In 2004, an estimated 3.4 million people died from the consequences of high fasting blood sugar.
•About 80 per cent diabetes deaths occur in low- and middle-income countries, with the most affected age group being 35 and 64.
•Diabetes is a leading cause of blindness, amputation and kidney failure.
•Type 2 diabetes can be prevented. Thirty minutes of regular moderate physical activity and a healthy diet can drastically reduce the risk of developing type 2 diabetes.
•Type 1 diabetes cannot be prevented.