By Salihu Lukman, PhD
Twitter Handle: @SalihuLukman

Published in Daily Trust Newspaper: Tuesday, November 19, 2019

Diabetes can be broadly classified into two groups, diabetes mellitus, and diabetes insipidus. Type 2 diabetes (TTD) falls under diabetes mellitus and it is the most common type of diabetes. TTD is a chronic disease in which the body is unable to effectively control the levels of glucose (sugar) in the blood, which can lead to severely high blood glucose levels (hyperglycemia). The symptoms of TTD range from increased thirst, recurrent urination, excessive fatigue, and slow healing of wounds. As the disease continues, more severe complications can develop, including skin disorders, sexual dysfunction, kidney disease, nerve damage, and vision loss. Pretty much every organ could potentially be damaged. Type 2 diabetes develops when the pancreas begins to produce less insulin (a hormone that controls blood sugar levels) or when the body becomes less sensitive to the effects of insulin—known as insulin resistance. A simple blood test can diagnose TTD. Once it’s been confirmed, treatment depends on factors such as age, weight, blood sugar level, and how advanced the disease is. For some people, this might mean being dependent solely on lifestyle modifications such as weight loss, dietary changes, and exercise. For others, managing TTD may require supplemental insulin and/or oral diabetes medications. Other types of diabetes mellitus include type 1 diabetes, type 1.5 diabetes or Latent Autoimmune Diabetes in Adults (LADA), gestational diabetes and type 3 diabetes (Alzheimer’s disease). TTD is the result of one of two conditions: Either the pancreas begins releasing too little insulin. Insulin is a hormone released within a few minutes of eating to help the body store glucose, or the body isn’t able to respond satisfactorily to insulin (insulin resistance).

The following are the risk factors for TTD: obesity, sedentary lifestyle, genes, age, ethnicity, tobacco use. The following tests can be used to diagnose diabetes. The test may be repeated if the results are inconclusive: fasting blood sugar test, glucose tolerance test, fasting plasma glucose test (FPG), hemoglobin (Hb) A1c test and random blood sugar test. Use the following ranges to interpret a random or fasting glucose test: fasting: 70 – 126 mg/dL [3.9 – 7 mmol/L], 1 hr after a meal: 160 – 200 mg/dL [8.9 – 11.1 mmol/L], 2 hr after a meal: 140 – 180 mg/dL [7.8 – 10 mmol/L], random: less than 200 mg/dL [11.1 mmol/L], hypoglycemia: less than 70 mg/dL [3.9 mmol/L]. Hyperglycemia is defined as any level greater than these ranges depending on whether it is a fasting or random test. To convert from mg/dL to mmol/L, you should divide by 18. You should know this conversion factor because some glucometers measure in mg/dL while others in mmol/L.

With this short preamble on diabetes, let me take you on a journey through my personal experience with diabetes. It all started with recurrent development of boils on different parts of my body (e.g. groin, thigh, breast, armpit, eye, nostril, ear, buttocks, etc.) during my adolescence. A boil is a gargantuan whitehead – which is different from acne pimple or zit – that infects hair follicles, often caused by the bacteria Staphylococcus aureus or other fungi. It is also called a furuncle or abscess. You can think of a boil as a large pimple that is ‘boiling over’. After completing my undergraduate studies and I started to work, these boils continued to bother me, day in, day out. I was advised to go for a complete medical check-up in order to find out the exact cause of these recurrent boils. I did a complete check-up at the Sick Bay (Medical Centre), ABU Zaria, in around 2017- from blood culture, random blood sugar to HIV. When the chief technologist mentioned HIV, I opened my eyes wider in awe. He enlightened me that there was a need to include HIV because boils can be caused by a weakened immunity and HIV is one disease that can weaken one’s immunity. That was my first HIV test and it was negative. Random blood sugar test (RBST) is a blood test conducted on a non-fasting person. Fasting here refers to abstaining from food overnight for at least 8 hr. Well, all other tests came out negative except RBST which came out positive. Based on the fact that an RBST can be above normal especially if one ate a little too much carbohydrate before the test was conducted, a fasting blood sugar test (FBST) was conducted to confirm whether I might be diabetic or not. My mother was diagnosed diabetic a few years before she died in her early 60s. My father, till in his 90s, used to make his sugar drinks (tea, pap, etc.) extremely sugary, he never had diabetes. I also used to make my sugar drinks extremely sugary, I took after my father since when I was a little kid. Back to my medical tests, the FBST came out negative. Given my family history of diabetes, I was advised to be cautious with my meals and to engage in regular exercise. I cannot remember my exact weight at the time, but it was close to 76 kg since my estimated Body Mass Index (BMI) was about 24.5 kg/m2 – just about becoming overweight (25 – 29.9 kg/m2). BMI is an indirect measurement of estimating body fat levels based on weight and height measurements which has been found to be a fairly reliable indicator of body fat. It is a simple calculation that can be used to determine health risk due to excess body fat levels and is given by weight (kg) divided by the square of height (m). BMI results can be interpreted as follows: interpreted as follows: below 18.5 = underweight, 18.5 – 24.9 = normal weight, 25.0 – 29.9 = overweight, 30.0 – 39.9 = obese, over 40 is considered morbidly obese. I was not doing any kind of exercise before that time. I had patronized the aerobic class at Teejay Gymnasium, Teejay Hotel, Zaria, for 1 month and later bought table tennis which I used to play with my friends daily at my home. But there was no change in my diet or portion size at all. I used to eat a large quantity of food at a go. For that, my friends nicknamed me Mai Baho (one with a big eating bowl) during my undergraduate days in ABU. I like Indomie noodles and used to patronize it frequently. My favorite dishes were Tuwon Shinkafa (thick white rice pudding) and Jollof spaghetti pasta. Three years later, i.e. in 2010 before I left Nigeria for my PhD in Saudi Arabia, I weighed 83 kg. In Saudi Arabia, I would go out for some workouts like brisk walking and weight lifting and later started using a treadmill. During this period (2010 – 2013), I did not make any attempt at changing my diet (rice, Irish potatoes, pasta, Indomie, juice, yogurt, mutton, beef, chicken, sweetened snacks, soft drinks, etc.) except using a sweetener instead of sugar in my tea which I later changed to honey. I was gradually adding more weight despite the stress of PhD and the infrequent workouts. In 2012, I began to experience chronic headaches and malaise which let to some series of medical tests to find out the exact course. Vitamin D deficiency was identified and treated which lead to final check-up tests in September 2013. This final test included HbA1c test and it was found to be 9.6 % which represents estimated average blood glucose (eAG) of about 229 mg/dL [16.7 mmol/L]. I weighed 90 kg. My vitamin D and other test parameters were within normal ranges. You can convert your HbA1c into estimated average blood sugar (eAG) and vice versa using this formula: 28.7 X HbA1c – 46.7 = eAG.

HbA1C test is a blood test that shows ones’ average blood sugar levels for the previous 2 – 3 months and it is also called A1C test, hemoglobin A1c, glycated hemoglobin, or glycosylated hemoglobin test. It a broader test when compared to the previously listed instantaneous diabetes tests and it can be used for the diagnosis and monitoring of diabetes. It is recommended by the American Diabetes Association (ADA) to run this test for everyone whose age is 45 years and older irrespective of other risk factors. A repeat should be done once every 3 years if the results are normal in the first instance. Are you 45 years and above and have you had a glycated hemoglobin test?

Dr. Salihu Lukman an assistant professor at the University of Hafr Al-Batin and writes from Saudi Arabia. Email: slukman@uhb.edu.sa