Endocrinologist debunks Diabetes myths
Education is key to the management of diabetes Dr. Moleele
Forty to fifty percent of people with diabetes do not have any symptoms. The big problem with this is that they do not actually know that they have diabetes.
In simple terms, this means that most of them are sitting on a ticking time bomb, and that there is nothing that prompts them to access the care that they need, in order to manage the symptoms, as well as prevent complications that might arise, says Consultant Physician and Endocrinologist, Dr. Gontle Moleele.
Dr. Moleele did her undergraduate studies at Glasgow University School of Medicine and her specialist training at Nottingham, UK. She worked overseas for seven years, and returned to Botswana in 2009.
Endocrinology is a branch of medicine that deals with diseases and disorders of the glands such as Diabetes. According to the International Diabetes Federation ( IDF), close to 200 million are undiagnosed.
Worldwide, it is estimated that there are 537 million people living with Diabetes. IDF estimates that this number will likely rise to above 700 million by the year 2040.
Dr. Moleele who is also the Hospital Superintendent at Bokamoso explains that a lot of the advocacy that they do centres around raising awareness of diabetes, symptoms and the importance of presenting early, because the earlier treatment is started the better, and the greater the risk of complications is reduced.
“Earlier treatment means better outcomes,” she explains.
She was speaking with Botswana Guardian ahead of the International Diabetes Day which is celebrated on November 14. This year the commemorations will be held under the theme: ‘ Education to protect tomorrow.’ The day is commemorated on the birthday of Sir Frederick Banting, who co- discovered insulin alongside Charles Best in 1922.
Diabetes causes complications that are divided into micro vascular or small vessel complications and large vessels complications. The small vessels complications include eye- disease which can lead to blindness, kidney disease which can lead to kidney failure and the need for dialysis, and neuropathy, which is where diabetes affect the nerves to the feet.
The problem with neuropathy, Dr. Moleele points out, is that it can cause pain in the feet. But principally, it causes numbness of the feet, which can lead to possible injury without one being aware of it. “We try by all means to educate patients with diabetes to avoid foot injuries, or foot ulcers of any type as it can become difficult
to heal and the patient requires amputation. The problem with neuropathy is that it is associated with the risk of amputation,” she explains.
She further notes that the earlier the diagnosis is made, and earlier treatment is started, the greater the risk of these complications is reduced.
Education and awareness of how the condition is managed is key in the fight against one of this leading Non- Communicable Disease. Selfmanagement when they already have high levels of glucose in the body is also important.
She explains that contrary to some myths that once one is diagnosed with diabetes, they will need to inject themselves, this is further from the truth. Not all diabetes patients require insulin, she notes.
“An important component of treatment is selfmanagement, and lifestyle management. They have to control the amount of glucose that they have as they already have high levels of glucose in the body. “It is important for them to exercise, both to control the weight but also because exercising utilises glucose in the body, and will reduce blood glucose levels,” she notes. Where lifestyle alone does not allow for the patient to achieve their targets, she points out that they will consider the addition of tablet medication. Step One, is diet and exercising, and Step Two is tablet medication which works in different ways to lower blood glucose. Patients can go for many years controlling diabetes with just lifestyle and tablets without a need for insulin.
Contrary to popular belief that Diabetes patients eat food that is not tasty, or special food, she points out that this is further from the truth. She advises them to cut from their diets hidden sugars, found in foods that will not be associated with propensity to raise blood glucose, and this includes fruit juices. Beyond that, she tells clients to eat the same food but pay attention to portion control and fibre content. Portion control, she says is as important as cutting out glucose, even if you are eating the right food but if the portion is right not for you, it will raise the blood sugar. “Fibre is important as it helps regulate your bowel action, and slows down blood glucose absorption,” she notes. She also advises that when people buy food items such as sorghum meal, they should go for the darkest one as it is high in fibre.
“We say to our patients that you can eat the same food but cut out the glucose and manage the portion. The easiest way with portion control is to use your fists, what we say is that looking at your plate, half of it or two fists should be vegetables, and one fist should be starch and one should be protein,” she says. She explains that they can choose brown rice over white, and maize meal which also has a variety that is a little rough.
Diabetes is a condition where people either do not have insulin at all, or they do not produce enough insulin. The role of insulin is to regulate or control blood glucose levels in the body, which means if you don’t have enough insulin in the body, you experience higher than normal blood glucose levels, she says. And all the symptoms relate to this higher- than- normal blood glucose levels. Diabetes primarily has two types which is Type 1, and Type 2. In Type 1, one does not produce any insulin at all, and are treated with insulin given through an injection. Type 1 diabetes is an autoimmune condition, which means that you produce antibodies which attack and destroy the pancreas, which is the factory for insulin gland, causing the lack of insulin.
“It affects 10 to 15 percent of all people with diabetes,” she explains. The bulk of patients at her clinic present Type 2 diabetes which accounts to at least 60 percent of the cases. Type 2 is completely different from Type 1, and is mainly a lifestyle disease. The risk factors include family history, lifestyle conditions such as obesity, and inactivity. People should reduce the risk of Diabetes by adopting a healthy lifestyle, and they can do that by keeping their weight to as normal as possible, eating a healthy diet, and exercising. Often times, patients will come displaying a number of symptoms that include excessive thirst, excessive urination, dizziness, tiredness, blurred vision and weight loss.
“If you go to any clinic or see a healthcare professional with these symptoms, they will automatically consider that you have diabetes and check your blood glucose,” she explains.
The majority of her patients range from the ages of 35 to 70, with the majority being in the 55- 65 age bracket, but are seeing younger people including teenagers with Type 2 diabetes.
Education is very key in the management of diabetes, as well as raising awareness, she says. Patients need to be educated on the medication that is used, as well as side effects such as low blood sugar that will present as excessive hunger and can lead to over eating.
Managing a patient with diabetes is a team effort, including dietician, doctors and the nurses. This is particularly crucial as a patient spends a few minutes with the doctor, and the rest of the time they are alone. “We need to empower them to provide that self- care when they are not with a healt care professional,” Dr Moleele says.