Diabetes is a long-term condition in which the level of sugar (glucose) in the blood is too high. It happens when the body does not make enough insulin, the hormone that moves sugar from the blood into cells, or cannot use insulin properly. Diabetes is increasing rapidly in Nigeria, and many people do not know they have it. Early diagnosis and good control prevent most complications.
Key facts
- Type 2 diabetes makes up about 9 in 10 cases and is linked to weight and inactivity.
- Many people have no symptoms for years.
- A simple blood test diagnoses diabetes.
- Uncontrolled diabetes damages the heart, kidneys, eyes, nerves and feet.
- Healthy eating, activity and medicines can keep blood sugar in a safe range.
Types of diabetes
- Type 1 diabetes: the immune system destroys the insulin-making cells of the pancreas. It usually starts in children and young adults, and people need insulin for life.
- Type 2 diabetes: the body does not respond well to insulin and gradually makes less of it. It usually affects adults over 40 but is increasingly seen in younger people.
- Gestational diabetes: high blood sugar that develops in pregnancy. It usually goes away after birth but raises the future risk of type 2 diabetes.
- Prediabetes: blood sugar higher than normal but not yet in the diabetes range. Lifestyle changes can prevent it progressing.
Risk factors for type 2 diabetes
- Being overweight, especially around the waist
- Physical inactivity
- Family history of diabetes
- Age over 40
- Diet high in refined carbohydrates and sugary drinks
- High blood pressure and high cholesterol
- History of gestational diabetes or having a baby weighing over 4 kg
Symptoms
- Passing urine often, especially at night
- Being very thirsty
- Feeling very tired
- Unexplained weight loss
- Blurred vision
- Cuts and wounds that heal slowly
- Frequent infections, such as thrush or skin infections
- Tingling or numbness in the hands or feet
Diagnosis
Diabetes is diagnosed with blood tests:
- Fasting blood glucose of 7.0 mmol/L (126 mg/dL) or higher
- HbA1c, which reflects average blood sugar over 2 to 3 months, of 48 mmol/mol (6.5%) or higher
- Random blood glucose of 11.1 mmol/L (200 mg/dL) or higher with symptoms
- Oral glucose tolerance test, often used in pregnancy
A single high reading without symptoms is usually repeated to confirm the diagnosis.
Complications
- Heart attack and stroke
- Kidney disease
- Eye damage (retinopathy) and cataracts
- Nerve damage causing pain or numbness, especially in the feet
- Foot ulcers and infections, which can lead to amputation
- Erectile dysfunction
- Emergencies: very high sugar (diabetic ketoacidosis or hyperosmolar state) and very low sugar (hypoglycaemia)
Treatment and management
Healthy eating
- Fill half your plate with vegetables and choose fibre-rich carbohydrates such as beans, unripe plantain and whole grains in controlled portions.
- Cut down on white rice, white bread, pastries and large portions of swallow.
- Avoid sugary drinks, including soft drinks and sweetened juices.
- See our guide to Food as Medicine.
Physical activity
Aim for at least 150 minutes of moderate activity a week, such as brisk walking. Activity helps the body use insulin.
Medicines
- Metformin is usually the first medicine for type 2 diabetes.
- Other tablets and injections may be added, such as sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors or GLP-1 receptor agonists.
- Insulin is essential in type 1 diabetes and often needed in type 2 over time.
Monitoring
- Check HbA1c every 3 to 6 months. A common target is below 53 mmol/mol (7%), but your doctor will set your personal target.
- Check blood pressure and cholesterol regularly.
- Have yearly eye, kidney and foot checks.
- Use a home glucose meter if advised.
Look after your feet
Check your feet every day for cuts, blisters and colour changes. Wear well-fitting shoes, do not walk barefoot, and get any wound checked early.
Low blood sugar (hypoglycaemia)
People on insulin or sulfonylureas can have low sugar. Signs include shaking, sweating, hunger, confusion and irritability. Take a quick sugar source, such as a glass of juice, soft drink or glucose tablets, then a snack. Seek emergency help if the person is drowsy or unconscious.
When to see a doctor
Get tested if you have symptoms, are over 40, overweight, or have a family history of diabetes. Seek emergency care for vomiting, abdominal pain, deep fast breathing, confusion or drowsiness in someone with diabetes, or a foot wound that is red, swollen, smelly or black.
Frequently asked questions
Can diabetes be cured?
Type 1 cannot currently be cured. Some people with type 2 can bring blood sugar back to normal (remission) through significant weight loss, but it needs ongoing care.
Can herbal remedies replace my diabetes medicine?
No. Stopping medicine for herbs can lead to dangerously high blood sugar. Talk to your doctor before trying any supplement.
