Written by, Eneregbu Akunna Isobel. (Registered Dietitian According to the American Diabetes Association (ADA), diabetes is a group of metabolic disorder characterized by hyperglycemia (high level of glucose in the blood) resulting from defects in insulin secretion, insulin action, or both. This disease was named diabetes by a Greek physician, which means “to flow through,” because of the large amounts of urine generated by patients. Later, the Latin word mellitus, which means “honeyed,” was added because of the amount of glucose in the urine. Diabetes Mellitus is one of the leading causes of death in the world. An estimated 23.6 million people in the United States and 366 million people worldwide have diabetes according to center for Disease Control and Prevention. The number of adults with diabetes will rise to 439 million in the year 2030. In addition diabetes underlines or contributes to, several other major diseases including heart disease, stroke, hypertension, blindness and kidney failure. Statistics in Nigeria in Africa, Nigeria has the highest number of people with diabetes. According to WHO, Nigeria has the highest mortality rate from the disease. Approximately 1,218,000 people are affected and an estimated 3.85 million people have impaired glucose tolerance says International Diabetes Federation (IDF). According to Diabetes Association of, Nigeria an estimate of 6 million people have full blown diabetes mellitus. the who/IDF report of 2011 alerted that diabetes mellitus will continue to be a major threat to public health beyond the year 2030. Classification of Diabetes Mellitus Diabetes as it is commonly called is clinically classified into four distinct types namely: Type 1diabetes: In type 1 diabetes, the body develops antibodies to its insulin And destroys the pancreatic cells that produce the insulin (the hormone that regulates blood glucose, creating an insulin deficiency). Type 1 diabetes is usually diagnosed in children and young adults hence its former name “juvenile diabetes.” The patients require insulin injections in order to regulate their blood sugar, another reason it was called “Insulin Dependent Diabetes Mellitus (IDDM).” Type 1 diabetes can account for 5% to 10% of all cases of newly diagnosed diabetes. Type 2diabetes was previously called “adult onset diabetes” because it usually occurs in adults over the age of 40. Although, the onset of type 2 diabetes can be at any age – even during childhood – such is mainly caused by obesity. The primary defect in type 2 diabetes is insulin resistance, a reduced sensitivity to insulin. Patients who have Type 2 diabetes do not have an absolute dependence on injectable insulin for their survival (especially in the early stages), a reason for its other name “Non-Insulin Dependent Diabetes Mellitus (NIDDM).” The hyperglycemia can often be controlled by dietary means only and physical activity, or with an oral hypoglycemic drug. Many individuals are asymptomatic and their glucose elevation may be detected as the result of a routine blood test. Thus most people lose 50% of pancreatic beta cell function by the time it is detected because Type 2 diabetes is progressive. Gestational diabetes also known as “gestational diabetes mellitus” (GDM) or “diabetes during pregnancy” is a type of diabetes that is diagnosed in the course of a pregnancy. It associated with an increased risk of developing Type 2 diabetes in later life. Gestational diabetes can occur between the sixteenth and twenty-eighth week of pregnancy. If it is not responsive to diet and exercise insulin injection therapy will be used. It is recommended that a dietitian or a diabetic educator be consulted to plan an adequate diet that will control blood sugar for mother and baby. Secondary diabetes occurs infrequently and is caused by certain drugs or by a disease of the pancreas. Among these types of diabetes mellitus Type I and Type II are major types with the later composing of 90-95% of diabetic cases. Causes of Diabetes Mellitus Diabetes Mellitus according to the British Medical Association Medical Dictionary is caused by insufficient production or absence of the hormone insulin by the pancreas or resistance of tissue to insulin action. Risk Factors of Diabetes Mellitus Although the causes of diabetes mellitus have been mentioned above, the risk of developing it is substantially increased by obesity (especially abdominal obesity), poor dietary habits, aging, physical inactivity, heredity, race, smoking, and excessive alcohol consumption etc. These are explained below. Obesity: This in itself can directly cause some degree of insulin resistance (Whitney and Rolfes, 2011) which is one of the causes of Type II diabetes. Obesity has led to a dramatic rise in the incidence of Type 2 diabetes among children and adolescent. Poor dietary habits: High intake of foods high in saturated fats (in the form fatty foods like pastries such as burgers cakes etc. fatty meat) and low in dietary fiber increases the risk of type 2 diabetes according to WHO. Aging: Insulin resistance increases with aging giving rise to incidence and prevalence of Type 2 diabetes among the elderly according to American Diabetes Association. Physical Inactivity: Studies have clearly indicated that increased physical inactivity has the potential to substantially enhance insulin sensitivity hence reduce the risk of developing Type 2 diabetes. Heredity: A strong family history of autoimmune disorder (a condition in which the body develops antibodies to its own proteins and then proceeds to destroy cells containing these proteins) predisposes one to Type 1 diabetes. Individuals who have both parents with Type 2 diabetes have a 50% chance of having the disease Race: Type 2 diabetes is more common in certain ethnic populations, such as Native Americans, Hispanic Americans, Mexican Americans, African Americans, Asian Americans, and Pacific Islanders. Gestational Diabetes: Children born to mothers who have gestational diabetes tend to develop obesity in childhood and are at risk of developing type 2 diabetes at an early age. Also women who had gestational diabetes are prone to develop Type 2 diabetes. Symptoms of Diabetes The following are common symptoms of diabetes. There is what I call the 3P’s they are polyuria (excessive urination), polydipsia (excessive thirst) and polyphagia (excessive hunger/appetite) others include weakness, fatigue, glycosuria (excess glucose in the urine), loss of weight (typical of type 1 diabetes), frequent infection, blurred vision, hyper glycaemia, ketouria (ketones in urine), ketonaemia, (ketones in the blood-ketones are product of fatty acid breakdown due to inability of the body to use carbohydrate for energy), the ketones can cause diabetes coma by increasing the acidity of the blood. How Do I Know I Have Diabetes For to know and be sure you have diabetes a physician must make the diagnosis. You may be required to run the following tests (other test may be conducted to identify the type of diabetes): Glycated hemoglobin (A1C) test; Random Blood Sugar (RBS) test; Fasting blood Sugar (FBS) or Fasting Plasma Glucose (FPG); Oral Glucose Tolerance Test (OGTT). Complications Of Diabetes Mellitus Uncontrolled diabetes can lead to the following complications: Diseases of the Large Blood Vessels; Diseases of the Small Blood Vessels; Diseases of the Nerves and Hypoglycemia Other complications include urinary tract infection, sexual dysfunction (weak erection). Prevention of Diabetes It is especially important to make diabetes prevention a priority if you’re at increased risk of diabetes, for example, if you’re overweight or have a family history of the disease. Do the following: Cultivate a healthy body weight; watch your diet; get more physical activity; do not smoke and limit alcohol intake and exercise. BREAKFAST 3 slices of whole wheat bread 1 cup cut up raw vegetables 3 tablespoons skimmed milk in tea or coffee (decaffeinated). 1 egg boiled 2 tsp. margarine 1 apple Midmorning snack 1/8 cup groundnuts 5 medium-sized garden eggs 1 ring pineapple (#50) SAMPLE MENU FOR DIABETIC (UNCOMPLICATED) PATIENT BASED ON 1800 CALORIE DIET LUNCH supper OR OR 1 oz meat (lean) 1 cup jollof rice 2 tsp. vegt.oil 1 cup cooked Vegt 4 small tangerine 1 oz fish 1 cup cooked beans with 1 teaspoon of palm oil 1/2 cup cooked vegetables 1small banana Mid afternoon Snack 5 salt less crackers or plain biscuits 1 large cucumber Evening snack 1 cup low fat yoghurt/skimmed milk 1 slice bread 1 medium size guava 1oz fish 1cup of porridge plantains (unripe) 2 tsp. palm oil 1 cup cooked vegt. (Ugu) 1 medium size Orange 1 oz meat 1 cups cooked pasta (spaghetti) with 1teaspoon of vegt. Oil 1 cup vegetable salad. 1 medium size (N50) pineapple Note No salt should be used at the table. Avoid processed meat, cheese, tinned or canned foods- in order to prevent hypertension. Use only one teaspoon in cooking per day i.e. 1/3 teaspoon per meal. Chicken should be skinned before consumption. Use cooking methods that require minimum amount of fat such as boiling, steaming, or baking method of cooking. Serving adjustments using handy measures ½ cup cooked rice = a cupcake wrapper full 1 slice of bread = audiocassette tape 1 cup vegetable = a fist 1 oz nuts = 1 handful 1 oz cooked meat, poultry, or fish is about the size of a matchbox. 3 oz cooked meat, poultry, fish = your palm; a deck of cards 1 medium size fruit = a fist 1 cup milk= 3 tablespoons of milk in 250ml of water.

By Ebiye Beedie, BSc (Hons) Optometry, MCOptom With the dry season not too far away, I thought it appropriate that this edition of Eye Matters be dedicated to discussing the effect the sun has on our eyes. It is loved for tanning the skin, encouraging crop growth and lifting our moods, but the truth is the sun is not always on our side. Although we may all be aware of the dangers to our skin and the importance of sunscreen, do we know how to protect our eyes? UV Radiation If you cast your mind back to those science lessons in secondary school, you may recall learning about the Electromagnetic Spectrum. All we need to know, for the purposes of this article, is that within this spectrum are various types of radiation, each with different wavelengths (see Figure 1). One type of radiation emitted by the sun is Ultraviolet radiation, commonly referred to as UV. UV radiation has very short wavelengths and can be split into three types – UVA, UVB and UVC, with UVA having the longest wavelength and UVC the shortest. While UVC is usually absorbed by the ozone layer, UVA and UVB are free to reach us here on earth. The effect on us UVA can be absorbed by the lens in the eye. As we have seen in previous editions of Eye Matters, the lens is responsible for ensuring light is focused on the eye. To do this effectively, it is essential that it is transparent. When UVA is absorbed by the lens over time, it reduces this transparency and can lead to cataracts or exacerbate existing ones. This can cause blurred vision and eventually affect everyday activities. UVB has a shorter wavelength than UVA, which means it is absorbed by structures closer to the front of the eye. At risk of damage by UVB radiation is a structure called the cornea, which, like the lens is essential for focusing light. Long-term exposure to sunlight can cause damage to the cornea that can negatively affect vision. However, very high exposure to UVB over a short period time (when skiing, for example) can cause a severe response and lead to a condition referred to as ‘snow blindness’. Fortunately, this condition tends to be reversible and symptoms are short-lived. Protection There are several options, all of which aim to reduce exposure. 1. Wear a hat: Not only are hats a great accessory, but they also cover your eyes by casting a shadow over them, protecting them from the sun and its potentially harmful UV rays. 2. Sunglasses: Sunglasses have a legal requirement to block UVA and UVB light, which means they prevent UV radiation from entering our eyes and being absorbed by the structures. 3. Contact lenses: Now for those who wear contact lenses, you should be aware that some actually have UV protection, providing additional protection for your eyes. This is best when used with sunglasses and not as an alternative to them. This article has summarised UV radiation, the effect on our eyes and ways to reduce UV exposure. So let us enjoy the sunny Harmattan season, knowing that our eyes are protected... because your eyes matter.

By Ebiye Beedie, BSc (Hons) Optometry, MCOptom It has been said that vision is the sense we most fear losing. However, according to the World Health Organisation, up to eighty percent of blindness worldwide is avoidable. Eye Matters aims to shed light on the workings of our eyes and the importance of maintaining eye health while providing a platform to address common questions. You may be surprised to learn that one of the smallest organs in the body is composed of so many vital parts. In this introductory edition of Eye Matters, we will have a brief look at how our eyes work. Before we do, let's have a quick look at the parts of the eye involved. The cornea is a transparent window at the front of the eye that covers the iris and pupil. Usually the most noticeable part of the eye, the iris is the coloured part and surrounds the pupil which is a hole that light passes through. The lens can be found behind the pupil and is a transparent surface that directs light to the very back of the eye. The retina is a light sensitive tissue at the back of the eye. Lastly, we have the optic nerve which sends signals from the retina to the brain. Although we use them everyday, few of us are aware of how our eyes actually work. So how do we see the food we eat, the people we love and even this very article? The answer lies with light. Light is reflected off the objects we look at and bent by the cornea. It enters the eye through the pupil (the size of which is controlled by the iris) before reaching the lens where it is bent some more before reaching the retina. At the retina, this light is converted into an electrical signal by several light sensitive cells. This electrical signal is then transmitted to the brain along the optic nerve. It is your brain that tells you that you have seen something. This article has summarised how our eyes allow us to see. Subsequent editions will cover common eye conditions, address FAQ and shed light on eye matters. Because your eyes matter.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the National Agency for the Control of AIDS (NACA), the number of HIV infections in Nigeria is on a decline. However, over 50% of new infections is found among young people. Statistics like this should get everyone really worried because it reveals a vulnerability that is often ignored – young people are the most affected by the failing health system in Nigeria. It is only logical to conclude then that if young people bear the brunt of the many health problems in Nigeria, they should be at the front line advocating for better health care and services in Nigeria. The new government came in on the mantra of change and one of the promises made was that of improved health services for everybody, and as Dr Chikwe Ihekweazu of Nigeria Health Watch puts it, “We are hopeful for change. But as responsible citizens, we must learn to hold our government accountable for the promised change”. WHY? Large Population Of Nigerians Are Young People The National Bureau of Statistics estimates that young people between the ages of 15-35 make up about 40% (70 million) of Nigeria’s total population. 40% is a large percentage to ignore and if the young people in Nigeria will come together to demand that government invest more in the health of its citizens, I bet no government, whether present or future, will be able to ignore them.   Young People Are Largely Affected By The Issues As mentioned earlier, young people are largely affected by the issues. It is the case that there is usually a lot of emphasis on maternal and child health as well as geriatric care while adolescent and youth health is largely ignored. Despite the fact that there are policies and numerous adolescent and youth health strategies, there is almost no implementation and nobody is asking questions. Young people need to start asking questions and holding the government accountable.   Young People Are Strong, Passionate And Creative It goes without saying that the strength of a nation lies in its young people. The Nigerian youth, despite all odds is determined to succeed and they always find innovative ways to become pace setters in every field. Imagine the results if all 70 million young people in Nigeria were to bring all that strength, passion and creativity into advocating for better health services in Nigeria.   Young People Are Active Users Of New Media The world is in the age of Industrial Technology and the young people of this generation are often referred to as the “millennials”.New media often  referred to as social media has become an indispensable tool for social change and young people in Nigeria have not been left behind. Nigerian youths are one of the most active users of social media in the world. Now, if they were to channel all that activity on social media into advocacy and campaigns for better healthcare, the government will notice, the world will notice and they will have no choice than to act.   Young People Are Future Leaders The saying that “youths are the leaders of tomorrow” has become a cliché, giving a lot of young people a false sense of entitlement. Now more than ever, young people have to prove themselves worthy to take on the leadership mantle. Advocacy gives young people an opportunity to engage with the issues as well as the government and can be very good training for that future leadership position.   HOW? How then, can young people become health advocates?   Be Knowledgeable About The Issues Knowledge, they say is power. The reason a lot of young people either do not get involved or are unable to see their advocacy efforts to a logical conclusion is because they lack knowledge of the issues. So, before you embark on any advocacy effort, it is advisable to learn as much as you can about the issue. Exchange your knowledge for power!   BE INTERESTED IN THE ISSUES It is not just enough to be knowledgeable about the issues, you have to do something with that knowledge and you have to be interested enough to want to do something. Think about the friends and loved ones who have been lost unnecessarily as a result of the failure of the Nigerian health system, think about how you are directly affected by these all too evident gaps in the system- make it personal!   Engage After interest comes engagement. The combination of knowledge and interest should make you want to engage with the issues. Engagement may be as complex as engaging policy makers or as simple as a twitter post or signing a petition. Just do something, take action!   Be Consistent In Your Efforts Consistency is key in any advocacy effort – results will not come overnight and sometimes, may be so little, you want to give up. Celebrate your successes, no matter how little and keep pushing. Only those who persevere and are consistent in their advocacy efforts are sure to get desired results.   Set Good Examples Ah! Never underestimate the power of exemplary behaviour. That little action you think no one notices may just be what spurs another young person into action or deters them completely. So, set good examples always.

Pregnancy, which should naturally be a cause for joy, is a challenging period for most women. Sadly, chief amongst these challenges are issues related to mental health that are often overlooked in the Nigerian antenatal care system. It is not uncommon to find women change behaviourally during pregnancy or after childbirth and in some women, it is so bad that those around them may want to stay away from them during this period. Some of these changes may be due to the myriad of changes that occur within and without the body during pregnancy and after childbirth. Very few people, if anyone at all, would want to admit to having mental health issues, but let us face it, at one point or the other in our lives, we have all had to deal with at least one mental health issue – depression, anxiety, mood swings or an eating disorder. Within the past year, there has been a lot of conversation around mental health, based on the Sustainable Development Goals (SDGs) principle of “no one left behind”.  Yet, as part of these discussions, we should also talk about mental health issues that are related to pregnancy. Pregnancy-related mental health issues are specifically related to pregnancy and the period after birth. A lot of women suffer from mild to self-limiting, devastating, life-long mental health problems during this period and there is still a lot of misconception about this, as a result of too little or no information at all available. A lot of pregnant women and mothers, therefore, suffer in silence while the problem gets bigger. According to the World Health Organisation (WHO), globally, about 10 per cent of pregnant women and 13 per cent of women who have just given birth experience, primarily, depression. In developing countries, this is even higher – 15.6 per cent during pregnancy and 19.8 per cent after childbirth. In severe cases, mothers’ suffering might be so severe that they may even commit suicide. Some common mental health issues associated with pregnancy include: Anxiety Many pregnant women suffer from anxiety during pregnancy, especially if it is their first. They may become anxious about how the pregnancy will affect their bodies (every woman is bound to gain some weight during pregnancy and only very few regain their former weight and body shape after childbirth), their capability to carry the pregnancy to term and the baby’s health or, generally, about things that could go wrong during the pregnancy. For those who have had past experiences of a difficult pregnancy or childbirth, they may become anxious that the experience may be repeated. Depression Depression, like anxiety, is very common amongst pregnant women. In developed countries where women are screened for depression during pregnancy, about 15-20 per cent of them turn out to be depressed. In developing countries such as Nigeria, there is no data to this effect. Pregnant women may become depressed for any of a number of reasons, some of which may include an unplanned pregnancy, stress during pregnancy, relationship or marital stress, having unrealistic expectations concerning the baby, lack of social or familial support, previous traumatic experiences during pregnancy, having a sick or unsettled baby and a family history of pregnancy-related or genetic illnesses. Eating Disorders Generally, women tend to have larger and exotic appetites during pregnancy. In some women who already have eating disorders, this may become exacerbated during pregnancy and can have serious health effects on both mother and child. Post-natal Depression This is when a woman develops depression some time during the first few weeks after childbirth. If left untreated, it can go on for about a year and may affect the level of care a mother gives to her baby. Post-partum Psychosis This is a very serious mental health problem that poses a serious risk for both mother and child. Some sufferers may go on to commit suicide or murder their babies. It does not usually resolve itself fully without treatment. Other mental health issues that may be associated with pregnancy and childbirth include bipolar or multiple personality disorders, schizophrenia, substance use and addiction. Now that we have talked about the problems, what are the solutions or treatment options? First off, having a mental health problem is nothing to be ashamed of, because a whole lot of other people also have the same problem and there is always help for those who seek it. Keeping quiet about your mental health status only makes you sink deeper into it. Here are a few tips for dealing with and overcoming mental health problems in pregnancy: Be open about your problems; know that you are not alone. Have a solid support base during this period – spouses, family, close friends that you can always talk to about how you feel and who will always be ready to help you. Talk to your doctor during your antenatal visits about any emotional changes you may be experiencing. Your doctor may refer you to a specialist who deals with such cases. Know your history: many mental problems are genetic and so may not be resolved so easily. Knowing if you or any member of your family has a history of mental health issues will help you prepare and thus reduce the risk of further complications. If you are also on any drugs that treat mental illness, such as anti-depressants, you should talk to your doctor. You may need to be taken off the drugs before you get pregnant, because some of these drugs may have a negative effect on the baby. Ensure, though, that you talk to your doctor before you stop medication. Eat healthy, balanced meals Find time to engage in something you enjoy. This helps you relax and lifts your mood. Get regular sleep. COO of Silver Lining for the Needy Initiative (SLNI), a stakeholder NGO in the delivery of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services in Northern Nigeria, Hauwa Abbas Hadejia says, “It is vital to continue stressing the importance antenatal and postnatal care play in preventing harm to mother and child. For this reason, we must increase efforts in training and ensure that healthcare providers incorporate basic mental health topics into physical care education.”