REPORT: Living with diabetes in Nigeria — full of difficulties, complications

A NEW day has just started. Aliu wakes up, puts on the light and sits up to check his feet thoroughly. This is a daily ritual of a diabetic patient. Then he noticed a small blood clot on the left foot, and went straight for a medical check-up.

Getting to the hospital, his doctor told him the foot had to be amputated urgently. That is the only way he could live, his doctors said as a matter of fact.  Nearly 80 per cent of people who have diabetes will eventually die of clot-related causes, according to expert.  At that time, Aliu was left with no other option than to accept his fate.

It was a decision to live the rest of his life on the wheelchair.

The following day, the fifty-four-year-old Aliu had his left foot amputated, spending nearly N3 million for the surgery.

In an interview with The ICIR, five months after the surgery,  Aliu said he sometimes forgot he no longer has his left foot and attempts to engage in some activities. But when he remembers he is now handicapped state, he feels helpless. “The loss hinders my movement,” he said.

During one of his visits to the diabetes clinic of Federal Medical Centre in Jabi, Abuja, Aliu’s daughter gently wheeled him into the hall.  The remaining of his left leg, wrapped with a brown bandage, was dangling above the footrest,

He told The ICIR he was diagnosed with type 1 diabetes when he was fifty years old. Type 1 diabetes, also known as insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.

His doctors had told him that diabetes is genetic. If someone has a family of diabetes, a member of that family is at a very high risk of getting diabetes, especially the type 2  which is highly hereditary.  But Aliu’s case is different. His was triggered by a lifestyle that was less than healthy.   He told The ICIR that he had indeed enjoyed himself consuming too many sweet stuff.

“Though I don’t take beers, I take a lot of sodas. I am sweet-coated with a little exercise,” Aliu said, with a short laugh.

Aliu wheeled out of diabetes clinic at FMC, Jabi after meeting with his doctors on November 6.

Now he spends more than N22,000 on the medications every month to maintain his health. A daily diet of insulin and other drugs keeps his heart beating.

Another patient of diabetes at FMC, Tunji, said he has been treating the disease since 2005 when he was 50 years old.

Thirteen years ago, Tunji woke up in the middle of the night to urinate, not once but four times. Throughout the day,  he visited the restroom more frequently than the usual.

At first, he thought maybe it was just a natural thing at that period. But after some days of abnormal urination, he became more concerned.

Days after, another sign showed up. He had gone to use the restroom of his master bedroom more frequent than usual. His wife who had noticed the frequency of his visit to the loo asked:  ‘Are you feeling okay?’”

“I said ‘yes, I am, why?’”  “You are losing weight, you are urinating more than the usual, so I think you should go to the hospital,” Tunji recalled during an interview with The ICIR.

Though he said he did not have a heavyweight, he had thought that his little weight then was natural. But his wife’s concern got him to become more worried.

After he came to the hospital, following some medical tests, Tunji was diagnosed with a type 2 diabetes. The type 2 diabetes is more common than type 1. It occurs when the body becomes resistant to insulin or doesn’t make enough insulin.

The now 63-year-old Tunji said he takes his doctors’ advice at heart. He said he has modified his lifestyle and engaging more in physical activities. “I jug everyday and I have been taken my medication well with the doctor’s prescription,” said Tunji.

He lamented how he could have used the money he usually spends on treatment for something much better. “Saving the money in bank alone would have to give me a rich bank account,” Tunji said.

Diabetes means the high level of blood glucose or sugar in the body, according to the World Health Organization (WHO).

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Insulin helps control blood glucose levels by signalling some cells like liver, muscle and fat cells to take in glucose (sugar) from the blood. When the body has had enough energy, insulin signal the liver to take up glucose and store it. So that there will be a normal sugar level in the bloodstream.

For people living with diabetes, access to affordable treatment, which include the daily use of insulin, is critical to their survival, according to  WHO.

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, and it is prevalent in middle- and low-income countries such as Nigeria.

Diabetes in Nigeria, who is at risk?

According to the International Diabetes Federation (IDF), an estimated number of 1.7 million people had diabetes in Nigeria in 2015.

“The lifestyle of many Nigerians encourages diabetes,” Janefrances Chukwu, a consultant endocrinologist of FMC, Jabi in Abuja told The ICIR.

Janefrances said our lifestyles which mainly rest on the food we eat can trigger diabetes, and that many Nigerians eat “more of fried and over processed food” which need to be stopped and be replaced with “more of natural food.”

The consultant added that physical exercise should be a part of every Nigerian’s life. “A lots of us are indoor most of the times,” she said. “It is important to do some kind of exercise at least thirty minutes a day.” Engaging in those exercises, according to the doctor, would help burn some glucose (energy) in the body.

Similarly, during the 2018 Sanofi Diabetes Summit, Olufemi Fansamade of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, said Nigerians are becoming less active.

“So many schools don’t even have a playing field and many pupils and students attend extra lessons, on getting home again they do homework,” Fansamade said.

He said most children would even spend more time playing games on phones and laptops rather than engaging in outdoor activities.

“So, we are becoming less physically active and that is reflecting in the increase in weight of children and adults, leading to increased rate of diabetes and hypertension,” the LUTH doctor said.

The FMC consultant endocrinologist said there are some people who are highly vulnerable to having diabetes. These include the people who have a relative with diabetes, the women who have diabetes during their pregnancy and those who are obese.

She added that any Nigerian who is above forty years of age is at high risk of diabetes. Also, people who have a history of hypertension could also have diabetes.

Janefrances said some of the symptoms of diabetes at the early stage, included unusual urination, excessive thirst and reduction in weight, while some patients walk around with no symptoms at all.

With shadowy-like symptoms, she said it is very important for all Nigerians to go for a regular check-up, especially to conduct the test of sugar level in the blood every three months.

But when the blood sugar has become very high, the consultant said many would have nausea and start to vomit which will cause weakness of the body. At that point, some could lose consciousness.

As diabetes could lead to other chronic diseases like loss of sight, kidney failure and heart disease, the endocrinologist encouraged patients to follow their doctors’ advice to prevent complications.

    She said diets modification, increase in exercise, taking of medications as recommended are the best to live as a diabetic patient. Also, Janefrances said the patients should take feet checking as a daily routine, as well as the checking their blood sugar. The patients also need to do regular eye examination.

    The consultant said the disease has become a large financial burden on the patient.  “They need to buy their medications, they need to eat the right food and they need to check their blood sugar hence a need for a glucometer and strips,” she said.

    While the National Health Insurance Scheme covers some of the drugs, some were not covered. “Diabetes patients have to pay out of their pockets to get some medications,” the endocrinologist said.

    And this is partly the reason why the number of diabetes patients increases in Nigeria, experts have said.

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