Thousands of Kenyans are living with diabetes. Some follow strict doctor’s advice, while others have shifted to fad cures, which the medics say can cause harm.
Dr Hilda Nabiswa, a diabetologist and physician, breaks down the tales and myths of diabetes. She developed an interest in diabetes because of an incident with her grandfather.
“I had given him medication for his diabetes, which he suddenly stopped taking. I noticed that his sugar levels were getting higher and higher and that he was having heavy bouts of diarrhoea. Upon inquiry, I found out that he had been taking some medicines, which had been given to him with the promise that they would permanently cure his diabetes.”
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“I then realised that there was a lot of misinformation circulating about diabetes. I had already finished my master’s degree from the Aga Khan University, and so I went and did a certificate in diabetology and endocrinology from the University of Southern Wales, then came back to practice in diabetology.”
There are two types of diabetes. Type 1 normally occurs in young people through no fault of their own, they are just born with a pancreas that cannot produce enough insulin on its own to utilise sugar, thus they grow up with diabetes.
“Type 2 diabetes, however, is lifestyle-induced and affects about half a billion people in the world, a number that will only get worse because of the changes in our lifestyle. This type of diabetes comes together with hypertension because both of them are induced by the kind of lifestyle people live,” says Dr Nabiswa who works at the Kenyatta Hospital (KNH).
She raises concern over the rising number of overweight Kenyans and living sedentary lives, a leading risk factor for diabetes.
“We drive a lot to work, pile a lot of weight, and do not do enough exercise and because of that, we gain a lot of fats which make our bodies unable to utilise or break down sugars leading to insulin resistance. Insulin resistance is how diabetes is formed.”
The doctor talks about how she gets a lot of patients who wonder why they have diabetes yet they eat healthy foods.
“People believe that as long as it comes from the ground, it has no side effects forgetting that even the fruit salads they eat are packed with sugar, which for a diabetic person is still problematic.”
This is why you get to see a lot of these cases in the Mount Kenya region whose diet is rich in starch that predisposes them to weight gain and eventual diabetes.
The reason people have diabetes is that the insulin in their bodies is not functioning in the way that it should, she says.
“A normal person should be able to eat a lot of cake without anything happening because sugar can be utilised by insulin. If you have enough insulin in your stores, functioning properly, your sugar levels should never go high. But when you have sugar that cannot be utilised by the insulin in your body, this is where you have insulin resistance.”
Dr Nabiswa says insulin can be looked at as a key that opens the door to the cell allowing sugar to flow from the blood into the cell.
I ask her how she handles Type 1, diabetes patients.
“I usually refer them to a group called young and sweet, which is a group of young people living with Type 1 diabetes who have learned how to live with and manage it all while supporting each other,” she says.
Dr Nabiswa says credible websites that offer information on diabetes and its management include the Diabetes Doctor, the International Diabetes Federation, the World Diabetes Foundation and the World Health Organisation.
On the future of diabetes treatment, she says Kenya is a very unequal opportunity place where some can afford to go to high-end places while others cannot.
“To be honest, one will get good treatment only if they have money, unfortunately.”
She puts no price cap on the amount needed only noting that one will pay 10 times more in the private hospitals than KNH where she plies her trade.
The highlights of her career are when she weans someone off their medication.
Dr Nabiswa explains it is when one is treated until one completely stops taking their medication “something that happens to some patients”.
“Weaning off happens through lifestyle management and it is a cause of joy for the practitioners.”
She talks of diabetes treatment of late being patient-centred.
“We look at our patient’s surroundings and their resources and use these to individualise their care. This involves helping them understand that they are at the centre of their treatment so that they take ownership, which includes, checking their sugar regularly, measuring their blood pressure regularly, visiting an eye doctor at least once a year and getting their feet checked. When they do this themselves, it becomes more cost-effective and ceases being a burden.”
“Good education is important, which is why I closely work with nutritionists, physiotherapists and companies that offer diabetes education.”
Misinformation floats around regarding the use of supplements as a treatment for diabetes. “Many times, it is not true,” she says. “People are not also informed of what to eat. Some delve off into keto diets hoping to cure diabetes.”
She advises people to source their information on treatment and management from professionals and experts as opposed to relying on wrong information from the internet.
“There is also a wrong notion that diabetes is a jail sentence where one cannot come out of, another lie.”
“If someone manages their weight and makes correct choices regarding their lifestyle, they can even reduce their medication or completely be weaned off it.”