By Azeem Khan
THE thirst was unbearable; she was drinking water at frequent intervals. Everywhere she went she had to take along liquids, and at nights, there was a big bottle by the bedside to quench her now bone-dry mouth.Mildred was under the belief that she was going through “some phase” and perhaps that was a sign until she decided to see a gynaecologist because of other episodes she was witnessing.
The gynaecologist did not reveal what possible diagnosis he had in mind, but requested that she do some tests. Mildred decided to go straight away to a private hospital and get it done. The blood was drawn, and then it came the day for the results – September 26th, 2014.
Mildred said she had never felt so terrible in her 35 years of life. The doctor, after reading the test results, disclosed that Mildred has diabetes mellitus, a group of metabolic diseases in which a person has high blood glucose (blood sugar), either because insulin production is insufficient, or because the body’s cells do not respond suitably to insulin, or both.
Patients with high blood sugar will typically experience frequent urination; they will become increasingly thirsty and hungry – all signs and symptoms Mildred was experiencing.
The doctor wanted to hospitalise her for further observation, but she declined and begged the doctor for a prescription, promising that she will start taking medications for her Type 2 diabetes immediately. He acquiesced and she promptly filled it at a nearby pharmacy.
The reality hit that her life would forever be changed with that diagnosis. It was what she called a death sentence, because she saw how her mom suffered with the same illness.
Mildred is only one of many thousands who have diabetes, Type 1 or Type 2, and that this Non Communicable Disease (NCD) is not only a burden to sufferers, but takes a toll on the government’s coffers.

Prevalence
In 2011, it was estimated that about 40,000 Guyanese had diabetes, and in 2014, this jumped to about 62,000, with many more unaware they have the life- threatening illness. In 2014, the global prevalence of diabetes was 9%, according to the World Health Organisation (WHO) which predicts that this disease will be the seventh leading cause of death by 2030. Most of the deaths (80%) occur in low and middle- income countries.
Worldwide, around 387 million adults aged between 20 and 79 have diabetes, a number that is expected to rise to 592 million by 2035. In 2013, the International Diabetes Federation (IDF) estimated that five countries have more than 10 million people with the condition:the U.S., China, India, Brazil and Russia.

Types
There are type 1, type 2 and gestational diabetes. Type 1, was previously known as insulin-dependent, juvenile or childhood-onset and is characterised by a lack of insulin production and necessitates daily administration of insulin. The cause for this type is not known and it is not preventable with current knowledge. Type 2 is caused by the body ineffectively using insulin. It is mainly as a result of lack of physical activity and obesity and accounts for 90% of those affected by diabetes. Gestational diabetes is hyperglycaemia with blood glucose values above normal, but below those diagnostic of diabetes, occurring during pregnancy, according to the WHO. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery.

Diabetes and its consequences
This disease can impair the heart, blood vessels, eyes, kidneys, and nerves and increases the risk of stroke and heart disease. The WHO, quoting a multinational study, said 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). Patients can suffer from reduced blood flow, neuropathy (nerve damage) foot ulcers, and subsequent infection and this may lead to amputation of limbs.
Then there is diabetic retinopathy, a critical cause of blindness, and occurs as a result of long-term, amassed destruction to the small blood vessels in the retina. Diabetes is among the principal causes of kidney failure, the WHO reports.

Prevention
Lifestyle changes play critical roles in delaying or preventing the onset of diabetes, according to physicians.
A most recent study states that obese women who skip breakfast may be on their way to acquiring diabetes.
Healthy diets and exercise are key factors to prevention of diabetes.

Managing type 2 diabetes
It’s is no secret that this type of the illness is on the rise, so a person who is afflicted can do a lot to deal with it. Sue McLaughlin, president of Healthcare and Education for the American Diabetes Association says that ” Basic principles of good health like eating right, exercising regularly and maintaining a healthy weight can be as effective as medicine in the management of type 2 diabetes for most people.”
She recommends a diet that includes fresh fruits and vegetables like broccoli, carrots and lettuce, whole grains, beans, lean meats, and low- fat dairy products. Diabetics should avoid white rice, white bread and sodas as these drive sugar levels up. Physical activity such as walking helps push glucose out of the blood and into the cells, resulting in better blood- sugar levels, McLaughlin advises.
So with all this advice from Mc Laughlin, what has Mildred done about her illness? She has been encouraged to join a clinic in her district and has been maintaining her doctor’s appointments!
Educating the young
Inculcating changes at a young age definitely helps, as such, the Public Health Ministry plans to target schoolchildren; to encourage them to eat healthy and be active.
Junior Health Minister Dr Karen Cummings said the disease “has to be attacked from all fronts in terms of education and educating parents as well because they are the ones who give their children the money.”
She is on record as saying that, “We want to target our schools, childhood obesity is also on the rise, persons are no longer exercising and eating healthy, they rely on fast foods and we have to change this sort of lifestyle,” she said.
Dr. Cummings said the coalition government plans to extend the pilot School Feeding Programme in Regions 1, 7, 8, 9 to the coastland, targeting the most vulnerable, to ensure they have a balanced diet.
There will be focus on primary care. Patients will be spoken to about their medications and why they need to take them. “We are going to improve the patient-doctor relationship, so that they can know about the disease. I find that the average person does not know about diabetes and what it can do to them,” Dr Cummings said.
The all-important foot care
Dr Kumar Sukhraj, head of the Diabetic Foot Care clinic at the Georgetown Public Hospital, says patients must take extreme care with especially their feet as this can help to lessen foot complications.

He stated in an article he wrote on November 1, 2015 that currently in Guyana there are many diabetic patients who develop complications with their feet. His advice for diabetics include:
1. Keep your blood sugar in your target range as much as possible, to prevent infection, speed healing and prevent further damage to blood vessels and nerves.
2. Wash your feet with mild soap and warm water every day. Dry the areas between toes and around nail beds to prevent fungal infections like athlete’s foot.
3. Inspect your feet carefully every day and check between the toes. Use a mirror if needed to detect any problems such as cuts, blisters, red spots, or swelling.
4. Cut toenails straight across and not too short. You should be able to see a small rim of white nail beyond the pink nail bed. Have a trained professional trim your nails if you cannot do it yourself to avoid ingrown toenails and to avoid cutting your toes.
5. Be more active and do activities such as walking. Wiggle your toes and rotate your ankles for a few minutes several times a day to help blood flow to your feet.
6. Apply lotion to the tops and bottoms of feet daily. Do not apply lotion between the toes to prevent skin from cracking.
7. Wear socks with loose fitting elastic. Avoid knee-high stockings. Change socks often if your feet sweat a lot. Tight elastics cut off circulation. Prevent fungal infections by keeping the area dry.
8. Check the insides of shoes daily before putting them on. Use your hand to check for cracks, sharp edges, and loose objects. Any objects or rough edge in your shoe can cause blisters or breaks in the skin.
9. Shop for shoes late in the day, when your feet are most swollen, and make sure they fit well to avoid injuries such as corns and blisters. Take off both of your shoes at every doctor’s visit so your doctor or nurse should check both of your feet.
10. Contact your health care provider immediately when you find a problem such as broken skin. Most foot problems are much easier to treat when they are treated right away.

Patients who have foot issues can visit the GPHC’s Foot Clinic for assistance.

Medication and testing
There are many different types of diabetes medicines, or anti-diabetic drugs, and this includes insulin and tablets. Common tablets are metformin and glyclazide. Insulin is the most common type of medication used in type 1 diabetes, administered through injections. Insulin is also used in type 2.
A glucometer, a small machine is an extremely useful tool for diabetics. Regular testing will ensure that patient knows how his or her body responds to certain foods and will therefore guide him or her in determining what foods are better to eat. It will also save that person from many complications.

Conclusion
So how has Mildred been coping with her “death sentence?” She related that she is taking her medications, tablets – metformin and glyclazide, taken one each in the morning and evening.
“Do you feel like it’s still a death sentence?”
“No. As a matter of fact I am a different person. My life has changed! I have lost weight, I have changed my diet and I make time to exercise in the park.
“Today, I feel better and I am proud to say, yes, my life is different!
“No more do I pity myself, I am still sad that I am afflicted but I have been managing. While it’s not been smooth sailing, I believe that while diabetes leads to death, I no longer see it as a death sentence.”
She even has some advice for others. “Take control of your life. Only you can do it. Be conscious of what you eat, exercise and be careful not to get your feet especially, punctured!”
So for diabetics, the ball is in your court, and as Mildred advises, take control. Control is the key to being on top of the game where diabetes is concerned.

(The writer, Azeem Khan, works with the Government Information Agency)