Thread by @DrSeunO

DIABETES

To understand diabetes, one need understand how the body process glucose derived from things we eat and drink.

Let create a picture.

So you get some nice meal.
Eba, Amala, Akpu, Pizza, Ice-cream, Cola drink etc
#Medmadeeasy

The food and drink is mixed with various chemicals - breaking down the complex molecules to smaller one that can be absorbed by the intestine

The intestine absorbs these smaller particles from the mixture. Since we are talking diabetes, we will focus on glucose.
#Medmadeeasy

Glucose is absorbed through the intestine into the blood.
Once in the blood, the PANCREAS senses the glucose and releases a hormone called INSULIN.
Insulin is like a key, it goes to all the cell in the body and opens the door for glucose to enter.
#Medmadeeasy

With glucose safely in the cells. It reacts with oxygen and produces the following.
1) CO2 - released into the blood, transported to the lungs
2) Water - eliminated by the kidneys
3) ATP - this is the direct FUEL of the body.
#Medmadeeasy

Without ATP, there is no energy, without energy, hustle cannot be pursued.
If the cells cannot take up all the glucose in the blood. The remaining is taken to the liver cells to be stored for future use.
#Medmadeeasy

Let see what happens in DIABETES.

Diabetes is the presence of EXCESS glucose in the BLOOD STREAM as a result of either

#Medmadeeasy

1. The pancreas does not produce Insulin AT ALL
2. The pancreas produces insulin but it's not enough to move all glucose into the target cells.
3. The target cells are not responding to the insulin.

#Medmadeeasy

Number 1, that is Type 1 diabetes.

Number 2 or/and 3, that is Type 2 diabetes.

I'll focus on type 2 diabetes because it make 98% of all diabetes.
#Medmadeeasy

Glucose in the body is useful if it is inside the cells. However, in the blood stream, it is USELESS, TOXIC AND DANGEROUS.

Let create the usual profile of someone who is likely to be diabetic.

At this junction, let's have some fun. 😁
#Medmadeeasy

I want you to get a pack of "gogo", "M and M", Smitties

I want you to set aside one for the following.
If any of these applies to you, just set one aside.
#Medmadeeasy

1) AGE > 45
2) Black African, African-American, Asian, African-Caribbean
3) OVERWEIGHT defined as BMI> 24.5.. Take 2 gogo😁😁
4) If you store more fat in your abdomen, that is if you are Apple/Android Shaped instead of Pear/Gynoid Shaped
Cc: Medicosnote.com #Medmadeeasy

5) INACTIVITY , if all you do is move from your house into your car, sit through traffic, move into your office and back into your car... Take one gogo 😁

6) For females; during antenatal, your doctor had to keep an eye on your sugar control. Take one gogo
#Medmadeeasy

7) A family history of diabetes in parents, aunt, uncles, siblings, Take another gogo

8) For females, you have been diagnosed of Polycystic Ovarian Syndrome (PCOS), Please take another gogo.

>3, you have 75% of developing Diabetes in your lifetime
#Medmadeeasy

What are the symptoms of diabetics.
Let compare what is ment to happen to what happens in diabetics.

Sugar is needed in the cell to help generate energy. So diabetics are usually ALWAYS TIRED because their sugar/glucose is in the blood.
#Medmadeeasy

Sugar is suppose to be in the cell. It is the food of the cells that energy is generated from. With sugar not in the cell, the cells are constantly hungry. DIABETICS ARE CONSTANTLY HUNGRY (POLYPHAGIA).
#Medmadeeasy

Since the cells can't get their required food (glucose), they must find another way to stay alive. They feed from smaller molecules of protein and fat. The muscles is made of protein, so there is a gradual process of feeding on muscles causing WEIGHT LOSS
#Medmadeeasy

DIABETICS LOSE WEIGHT. Infact the narrative is
"Dr I'm eating a lot and I'm still losing weight"

#Medmadeeasy

Sugar in the blood stream increases the concentration of blood, this causes OSMOSIS. Fluid moves out of the cell into the blood to reduce the concentration. The shift makes the cells thirst; diabetics are ALWAYS DRINKING WATER (POLYDIPSIA).
#Medmadeeasy

With the persistent intake of water and the shift of fluid from the cells into the blood stream to correct the concentration of the blood. The kidneys has a lot of fluid to pass out.
#Medmadeeasy

Also they continue to eat as they are hungry, the concentration of glucose reaches a stage that it start spilling into the urine, this pulls fluid from the kidney cells, making LARGE volume of urine (POLYURIA)
#Medmadeeasy

So the common symptoms of diabetics are
1) POLYURIA
2) POLYDIPSIA
3) POLYPHAGIA
4) WEIGHT LOSS

Summary.
Sugar DON'T CAUSE diabetes, problem with the pancreas does.
Symptoms of diabetes are caused by the presence of sugar in the blood stream. Sugar should be in the cell for it to be useful.
In the blood stream, sugar is USELESS, TOXIC AND DANGEROUS..
#Medmadeeasy

Now that we understand the problem...
How do we take care of it.

To help diabetics, we need to look at two different things.

1) Treating the disease (if possible "cure")
2) Help the patient manage the disease burden.

TREATING THE DISEASE

A double prong approach is best way to manage diabetes.

Lifestyle Changes:
A) Increase fiber intake.
B) Increase low glycemic index carbohydrates (wholegrain, fruits, vegetables)
C) Healthcare provider should make use of dietician.

D) Exercise... Exercise increase the sensitivity of the cells to Insulin.
E) Weight loss; achieving an ideal weight is vital to a successful management plan for diabetes. It's also important loss the "tommy" fat.

Medication:

There are different class of drugs used in managing diabetes... Lets look the Mechanism of Action (MOA, Advantages and Disadvantages.

Let start with the most popular one.

1. Metformin:
MOA: It increase the sensitivity of the cells to Insulin. It also tells the liver cell not to release the ones they stored.

ADV: It is very cheap to purchase. It doesn't cause

Ds'ADV: Metformin can literally make you shit in your pants. It causes diarrhoea.

2)SULFONYLUREAS
MOA: They FORCE the pancreas to more insulin. They also help the cell make better use of the insulin.

ADV: Combined with Metformin, they create an additional effect.

Ds'ADV: they can cause hypoglycaemia. They also cause weight gain; which is against what we want

Also because we are beating/forcing the pancreas to produce more insulin, eventually one day it will give up on us. That is when a type 2 diabetics becomes a type 1 diabetics.

THIAZOLIDINEDIONE
MOA: They increase the kidney excretion of the sugar.

Ds'ADV: it make your urinary tract, a walking petri dish. Because it cause the kidney to pass out more sugar, there is a high chance of RECURRENT URINARY TRACT INFECTION.

GLIPTINS
MOA: They increase the uptake of glucose by the cells. They tell the liver cells to to release it storage.

ADV: They help with weight loss. They are useful in people who have a heart disease.

Ds'ADV: They are crazily expensive.

MEGLITINIDES:
MOA: They increase the cell uptake of glucose. They also force the pancreas to produce more insulin.

ADV: They have a rapid onset of action and short duration of activity. They can be useful in people who don't have a set feeding time

Ds'ADV: Hypoglycaemia.

There are other classes of drugs that are used in the treatment of diabetes, these are the most used one.
Whatever class is used, the general consensus is that METFORMIN is the first line of treatment.

MANAGING THE DISEASE BURDEN

Healthcare Providers(HCP) must endeavour to look beyond the disease and look at the patient.
Being a chronic disease, diabetes come with more than just sugar control.

A long term relationship must be developed between the HCP and the patient. This relationship should be one that assess the sugar control, reinforce the planned agreement between both parties, Access the possible side effects of the medications and encourages lifestyle changes.

It is not uncommon to find that diabetics are DEPRESSED. Imagine the cost of medication to the finances, the daily use of medication is not something one is excited about.

Depression is more likely when the patient feels he/she is not making positive strides despite taking their drugs regularly and adjusting their lifestyle in view of the disease.

In such situations, it is important to involve people that can re-enforce their determination to manage their illnesses.
In the face of depression, groups such as @MentallyAwareNG will be a add-on advantage.

In the face of looming financial issues, it is also worth talking to them about how their finances can be shaped to help accommodate the burden of disease.
As diabetes is a chronic disease and Nigeria where most health payment are out of pocket,

They should be introduced to HMOs. This will allow them recieve their health support without having to worry so much about the finance to themselves.

As I said... Diabetes can be "cured". Meaning, have the appropriate blood sugar without having to use medication. I must say that it requires determination, persistence and resilience. As well as friends and family support.
Have a look at fixingdad.com

For those who haven't developed diabetes but based on the profile we earlier created, find themselves at risk.
A preventive approach should be the focus.

Regular Work out... Adopt a life of exercise.
Drink water and lots of it... Adopt it as your primary beverage.
LOSS WEIGHT if you're Overweight or Obese
Follow a Low Carbohydrates diet.
Avoid a sedentary lifestyle.
Avoid large portion of food... Don't be an ijewuru.

Eat High Fibre diet.

Thank you all for reading and sharing.

Next topic on #Medmadeeasy will be Hypertension.

@threadreaderapp unroll