Diabetes: A Global Threat—A Personal Story from Zambia

Diabetes is a growing global health crisis affecting millions of people, including right here in Zambia. My Mother, born 15 September 1948, was diagnosed with diabetes about 10 years ago. Recently, she had to undergo an above-the-knee amputation on her right leg, a heart-breaking outcome of this silent disease.

In Zambia, the prevalence of diabetes has been steadily increasing, reflecting global trends of rising non-communicable diseases. Based on the 2017 Zambia STEPS survey, about 4.8%* of adults have diabetes, and many more are in the pre-diabetic stage. Diabetes is more common in older age groups, with prevalence increasing significantly in those aged 45 years and older.

I was encouraged to write this article by Anna at Lusaka Times (LusakaTimes.com), who understood this heart-wrenching personal tragedy that has befallen my family. Never did we imagine that our very own beloved parent would undergo endless days, weeks and months of agony and sleeplessness to the point of confusion and hallucination, where death becomes a more preferable option to facing excruciating pain day after day. No one came to our rescue! But as a family we have pulled together to get through this enormous challenge.

Know this crucial information: Diabetes can be controlled and even reversed, but only if we act early!

The Global Diabetes Epidemic

• According to the World Health Organization (WHO), over 422 million people globally suffer from diabetes. In Zambia, the rise of Type 2 diabetes mirrors this global trend due to poor diet and lifestyle choices.
• Dr. Suneel Dhand explains, diabetes is largely a result of metabolic issues. Refined sugars, processed foods, and sedentary living have led to widespread insulin resistance, the precursor to Type 2 diabetes.

Food Habits and the Cause

• Dr. Eric Berg, an expert in nutrition, emphasizes that food choices are key to preventing and reversing diabetes. Diets high in sugar, processed grains, and unhealthy fats are dangerous! A healthy diet rich in vegetables, lean proteins, and good fats, such as avocado and fish, can prevent or reverse the disease.
• In Zambia, local staples like ‘nshima’ (refined white maize meal), refined white sugar and sugary beverages contribute significantly to the rise of Type 2 diabetes.

Risk Factors

The main contributing factors that cause diabetes include:

• Obesity. High rates of overweight and obesity, particularly in urban areas, are driving the diabetes epidemic.
• Physical Inactivity. A sedentary lifestyle is a significant contributor, with many Zambians not engaging in sufficient physical activity.
• Diet. Diets high in processed foods and sugars and low in fruits and vegetables exacerbate the risk of diabetes.
• Genetics and Family History. Family history also plays a crucial role, increasing susceptibility.

Prediabetes and Early Warning Signs

• Michigan Foot Doctors stress that symptoms like tingling in the hands and feet are critical early warning signs. These symptoms indicate nerve damage, often linked to uncontrolled blood sugar levels. I was surprised to learn that persistent tingling in the hands and feet may be an already too late indication of nerve damage!
• In Zambia, where healthcare access may be limited, many ignore these signs until it’s too late. My mother’s delayed diagnosis led to nerve damage, resulting in poor circulation and, eventually, gangrene.

Managing and Reversing Diabetes

• Dr. Eric Berg advocates for a low-carb, high-fat diet (keto), which has been shown to improve insulin sensitivity and reverse Type 2 diabetes in many cases.
• Regular exercise and intermittent fasting can also be powerful tools in managing and potentially reversing the disease.

Treating Diabetes: What Works?

1. Dr. Dhand recommends metformin and insulin therapy, but stresses that lifestyle changes are essential for long-term management

• Metformin Therapy. Metformin is an oral medication commonly prescribed to treat Type 2 diabetes. It works by lowering glucose production in the liver and improving the body’s sensitivity to insulin, allowing for better blood sugar control. It is often the first line of treatment for people with Type 2 diabetes because it helps maintain stable blood glucose levels without causing significant weight gain.
• Insulin therapy involves injecting insulin, a hormone that helps the body use glucose for energy. It is essential for Type 1 diabetes and often used in advanced Type 2 diabetes when the body cannot produce enough insulin or regulate blood sugar effectively. Different types of insulin (rapid-acting, long-acting) are used depending on the patient’s needs, and therapy is tailored to maintain blood glucose levels within a target range.

Both therapies aim to prevent complications, such as nerve damage and poor circulation, which can lead to serious conditions like amputations.

2. Regular blood sugar monitoring is critical. Michigan Foot Doctors also emphasize foot care as crucial, particularly for patients at risk of amputation due to poor circulation. They recommend:

• Daily foot inspections – Check for cuts, blisters, redness, or swelling
• Moisturizing – Apply lotion but avoid between the toes to prevent fungal infections
• Wearing proper footwear – Use shoes that fit well and avoid barefoot walking
• Trimming nails carefully – Cut nails straight across to avoid ingrown toenails
• Seeking early medical attention – Visit a healthcare professional at the first sign of foot issues

These practices are vital for preventing complications like ulcers or amputations.

Caring for a Diabetic Patient

• Taking care of someone with diabetes involves a holistic approach—diet, medication, and physical care.
• When managing diabetic patients at home, it’s essential to regularly check feet, follow the treatment plans, and encourage physical activity to promote circulation.

What foods can we eat?

Turning to traditional local foods can be an effective strategy as these foods are nutrient-dense and help regulate blood sugar levels while providing necessary vitamins and minerals. Some excellent local alternatives include:

1. 1. Nshima made from Millet or Sorghum
      Why? Traditional Nshima is often made from white maize meal, but using millet or sorghum, which have lower glycemic indexes, helps in controlling blood sugar levels. These grains are also rich in fibre, which aids in digestion and prevents spikes in blood sugar
   2. Sweet Potatoes (Chimbwali)
      Why? Unlike regular potatoes, sweet potatoes have a lower glycemic index and are rich in fibre and antioxidants like beta-carotene. They help in slower digestion, reducing the rapid rise of glucose levels
   3. Pumpkin Leaves (Chibwabwa)
      Why? Rich in vitamins and fibre, pumpkin leaves support a healthy digestive system and help in blood sugar regulation. Their nutrient profile helps combat inflammation, which is essential in managing diabetes
   4. Okra (Delele)
      Why? Okra is a traditional vegetable in Zambia known for its fibre content, particularly soluble fibre, which is beneficial for controlling blood glucose levels by slowing sugar absorption.
   5. Groundnuts (Peanuts)
      Why? Rich in healthy fats and protein, groundnuts help in stabilizing blood sugar levels. Eaten in moderation, they make for a good snack that doesn’t cause rapid spikes in glucose
   6. Cassava Leaves
      Why? Also rich in fibre and low in carbohydrates, cassava leaves are a nutrient-dense vegetable that supports a healthy diet for diabetes management, especially when paired with other high-fibre foods
   7. Beans and Cowpeas (Lupins)
      Why? Both are rich in fibre and protein, helping manage diabetes by reducing post-meal glucose spikes and improving insulin sensitivity
   8. Baobab Fruit (Mbuyu)
      Why? A superfood packed with fiber and vitamin C. It has a low glycemic index, meaning it slowly releases sugar into the bloodstream, making it ideal for diabetics and for preventing diabetes.
   9. Moringa
      Why? Moringa leaves and seeds are high in antioxidants and have anti-inflammatory properties that help in controlling blood sugar levels. It is widely used in traditional remedies to manage diabetes.
   10. Fish (Kapenta, Bream, Buka-Buka, etc)
       Why? Fish is a great source of lean protein and omega-3 fatty acids, which help in managing inflammation and maintaining steady blood sugar levels.

Incorporating these foods, combined with lifestyle changes like increased physical activity and reducing processed sugars, can greatly reduce the risk of diabetes.

Diabetes is Preventable

Diabetes is a silent killer, but it doesn’t have to claim more lives. My mother’s amputation is a stark warning for all Zambians. Watch your diet, stay active, and pay attention to the early warning signs. As Dr. Dhand, Dr. Berg, and the Michigan Foot Doctors advise, it’s never too late to make lifestyle changes that can save your life.

It is said that every cloud has a silver lining: My Mother, once active, vibrant and a leader in the community and government, has shown a strong will to survive this tragic event at the fragile age of 76. In spite selflessly serving her constituency and country, she has not once expressed nor expected any special treatment or concern from her country. I feel let down by our government, but I am inspired by my Mother’s tremendous courage and resolve. Get well soon Mother, I love you dearly!

By C. Chipampata

References:

Dr. Suneel Dhand (https://youtu.be/MxeugC5yxFw?feature=shared)

Dr. Eric Berg (https://youtu.be/xpH45c2BrMM?feature=shared)

Michigan Foot Doctors
(https://youtu.be/8U9b36D43xI?feature=shared)

Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management – PMC (nih.gov).

Zambia : Government Concerned Over Rise in Diabetes Cases In Zambia lusakatimes.com

Prevalence and correlates of pre-diabetes and diabetes among a national population-based sample of adults in Zambia: results of the first national STEPS survey in 2017 |
International Journal of Diabetes in Developing Countries (springer.com)