Diabetes – Sierra Leone’s most deadly enemy

Sierra Leone Telegraph: 16 May 2015

There has been a worrying increase in the incidence of diabetes in Sierra Leone.

Doctors are concerned that in addition to Ebola, malaria and other diseases, diabetes is now taking centre stage.

They are right to be worried, as it is a chronic, lifelong disease once acquired and can lead to serious complications.  Diabetes is quite common across the country, but much more prevalent in Freetown.

It is a disease that affects children and young people and commonly referred to as Type 1 diabetes, with Type 2 affecting mostly adults.

Type 1 occurs, due to the inability of the body to produce insulin in the pancreas, which is responsible for breaking down sugars in the body after eating. This defect may be a genetic factor or environmental.

This type of diabetes can only be treated with insulin. Dietary restrictions and regular exercise are also important.

Are the well off in Sierra Leone eating and drinking themselves to preventable early death?

Type 2 diabetes is mainly caused by obesity, overweight, poor diet and lack of exercise. It can be treated with antidiabetic tablets.

There is another type of diabetes which occurs in pregnant women and is known as gestational diabetes, as it first occurs during pregnancy. It is essentially type 2 diabetes. It can lead to mothers having very large babies if undetected, which could lead to death of mother and child.

How would you know that you have diabetes?

There are many symptoms, such as thirst, frequent urinating, skin infections, thrush of the mouth – skin and genitals, weight loss, blurred vision, feeling of having a ‘fuzzy head’ where they cannot think clearly at work for example.

It could sometimes be diagnosed for the first time as the patient is admitted in a diabetic coma. Sometimes patients feel constantly unwell.

The complications of poorly treated diabetes are enormous. The accumulation of sugar in the blood if untreated, starts to attack the small blood vessels right from the very early stage of the disease.

The organs most at risk are the eyes – leading to gradual blindness, kidneys leading to kidney failure and hypertension , brain – leading to strokes, toes and fingers which may result in amputations. This is why it is so important to identify the problem as early as possible to start treatment.

Sierra Leone cannot afford to have an explosion of diabetes – it has far too many other problems to deal with.

Diabetes medication is not cheap and it has to be taken daily. Insulin is injectable only and has to be stored in a fridge.  This could be an expensive necessity, and sometimes impossible,  with the present lack of electricity across the country.

As a result, other ways of storage are used – such as constantly buying ice cubes to keep the insulin in cold storage. Clean needles must be used as well, which are expensive, and if reused, could lead to infection.

Various reasons have been given for the increase in the incidence of diabetes in Sierra Leone. But the most likely factor is poor diet and poor lifestyles, especially among the affluent class, whose overindulgence in all the wrong foods, alcohol, and the daily use of cars- with very little walking is of serious concern.

The Sierra Leonean daily diet, which largely consists of imported polished rice, could be contributing to the increase in diabetes too. The daily use of palm oil in cooking also makes for a deadly recipe.

What can be done to prevent diabetes?

Lifestyle changes are essential. The whole family has to be involved to encourage change. Politicians and those in position of influence must set a better example and promote healthier lifestyles.

Diet

• Brown rice, Sierra Leonean ‘ruff res’, bulgur are good and better than the imported rice.
• Cassava leaves, potato leaves, krain krain leaves, bitter leaves, stew, banga soup are all good, but the amount of palmoil/groundnut oil used should be drastically reduced. Many people cook with a pint or two of oil in a pot of soup – this is too much and can be reduced to 4 or 5 tablespoons.
• There should be days of no oil at all – ‘weit soup’.
• The amount of food as well should be reduced.
• Eat out less in restaurants as home cooked meals tend to be healthier.
• It is important to reduce the intake of cakes, rice bread, soft and fizzy drinks, biscuits and the amount of butter or margarine used.
• Increase fruit and vegetables. Sierra Leone has an abundance of fruit and vegetables during the rainy and dry seasons. These can be very expensive however and not within the reach of the average person.
• There has been a proliferation of ‘rose apple’ in the country – which does not even grow in Sierra Leone. But there are home grown fruits like ‘jelly cokenat’ which is abundant and cheaper. Mangoes and oranges are also plentiful. However, too much of one thing is good for nothing, so limiting fruit to 2 or 3 daily is sufficient. Vegetables apart from cooked ones can be salad leaves 2 or 3 times a week. However, it is better to avoid eating our usual ‘african salad’ on a regular basis. African salad is salad leaves garnished with baked beans, luncheon meat, salad cream, etc, which are extremely sweet and full of fat. So plain salad leaves on the side of a plate of stew helps.
• Stopping smoking and weight loss if overweight are important.
• Reducing alcohol is important as wine, beers and spirits contain a lot of sugars and contribute to diabetes.
• Exercise – walking daily for at least 20 minutes is good. Jogging on the spot at home for 10 – 15 minutes daily is good.

How can health professionals help to reduce the high incidence of diabetes?

This needs doctors, nurses, chiropodists, eye specialists, dieticians to be actively involved to give advice and manage the condition adequately.

Some doctors are running a diabetes clinic in Freetown, so if you suspect you have diabetes, it is important to see a doctor for diagnosis and management.

Regular checks are important to ensure patients are adhering to treatment and that the disease is controlled.

All pregnant women should be routinely tested for diabetes at presentation. All women who deliver large babies should be immediately checked for diabetes.

Diabetes is an expensive disease, which if not treated on time, could lead to serious consequences. We must reduce the weekly deaths from diabetes and its various complications.

The government of Sierra Leone should prioritise diabetes as a national prevention programme. Routine checks for blood sugar levels and the continuous monitoring across regions must be initiated.

That which cannot be measured – cannot be managed.