Type 1 Diabetes Mellitus: An Explainer for Africans

By Nr  Chinonso Cynthia Ukah. BNSc, RN, RM. Freelance Health Writer and DLHA Volunteer. 

 

An African lady performing a finger prick blood glucose check on herself opposite a  pink map of Africa bearing type 1 diabetes label. 

Human image credit: Freepik

 

Highlights

• Type 1 diabetes occurs when the body doesn't produce insulin

• It can develop at any age, not just in childhood

• Early diagnosis and treatment are essential for preventing complications

• In a child, common symptoms include the sudden onset of bed wetting, mood changes, nausea, vomiting and stomach pain

• Proper management involves insulin therapy, blood sugar monitoring, and lifestyle adjustments

 

Introduction

Diabetes mellitus is a health condition that affects how our body uses food for energy. In Type 1 diabetes, an autoimmune condition, the body's immune system mistakenly attacks the insulin-producing cells in the pancreas. This results in little or no insulin production. Insulin is like a key that helps sugar from our food enter our body's cells. Without it, sugar builds up in our blood, which can make us very sick.

 

How Common is Type 1 Diabetes in Africa?

According to the International Diabetes Federation, as of 2021, approximately 24 million adults in Africa have diabetes, with Type 1 diabetes accounting for about 5-10% of these cases. [1] However, these numbers vary significantly across different African countries.

Recent studies in Nigeria and Sudan found that about 1 in every 1,000 to 3,000 people have Type 1 diabetes. [2] But the disturbing problem is that many Africah might have it without knowing.

That's why health researchers are calling for more research in African communities. They want to find out how really common Type 1 diabetes is, and help those who need treatment.

It is important that you are well informed about Type 1 diabetes, as this can help you identify the symptoms early and get help. Should you or someone you know have Type 1 diabetes, early  healthcare seeking will produce better healthcare outcomes generally.

 

How Do I know That I Have Type 1 diabetes?

Type 1 diabetes is becoming increasingly common in Africa, with recent studies showing it can develop at any age. [3] Recognizing this condition early is imperative for proper management. Here's how you can identify if you or someone you know may have Type 1 diabetes:

Step 1: Know the Signs

Look out for these common symptoms:

• Excessive thirst (like you've eaten too much salt)

• Frequent urination (including waking up several times at night to urinate)

• Unexplained weight loss (even when eating well)

• Extreme tiredness (fatigue that doesn't improve with rest)

• Constant hunger (even after meals)

• Blurred vision (difficulty seeing clearly)

These signs are common to various types of diabetes but some symptoms are more specific to Type 1 diabetes and they include:

• Sudden onset of symptoms (often within weeks)

• Nausea, vomiting, and stomach pain (due to secerely high blood sugar)

• Fruity-smelling breath

• Mood changes and irritability

• New bed-wetting (in children)  [4]

 

Step 2: Seek Medical Testing

If you notice these signs, especially if they develop quickly, visit a healthcare provider immediately. Only medical tests can confirm Type 1 diabetes. These usually include:

• Blood sugar tests

• Glycated hemoglobin (A1C) test

• Special antibody tests for Type 1 diabetes

• C-peptide test to check insulin production

Type 1 diabetes can affect anyone, at any age. In sub-Saharan Africa, studies show that the peak age of onset is often after 18-20 years. [3]

 

How Does the Body Use Glucose?

Think of glucose as fuel for our body, similar to petrol for a car. We get this fuel mainly from the foods we eat, especially staples in many African diets like cassava, maize, pap, and rice. Our body breaks down these foods into glucose, which then travels in our blood to energize our cells. This process of breaking down food and using glucose for energy is called glucose metabolism. [3]

The pancreas, a special organ tthat is located in your belly and behindthe stomach, plays an important role in glucose metabolism. It produces two important hormones: insulin and glucagon. These hormones manage the amount of glucose in our blood, responding when levels are high (hyperglycaemia) or low (hypoglycaemia). [3]

Insulin opens the doors of our body's cells, allowing glucose to enter and provide energy. Glucagon, on the other hand, signals the liver to release more glucose into the blood when levels are low. In Type 1 diabetes, the body doesn't have this insulin and this disrupts the delicate balance of the body leading to problems with glucose metabolism. [2]

 

What Goes Wrong in Type 1 Diabetes?

Type 1 diabetes is an autoimmune condition where the body's defense system malfunctions. Normally, our immune system protects us against harmful invaders like viruses and bacteria. However, in Type 1 diabetes, it mistakenly identifies the insulin-producing beta cells in the pancreas as threats and destroys them. [4]

When autoimmunity happens in te pancreas, 

• The pancreas can no longer produce insulin.

• Without insulin, glucose (sugar) can't enter the body's cells.

• Glucose builds up in the bloodstream, leading to high blood sugar levels.

• The body's cells don't get the energy they need to function properly.

This process is not caused by lifestyle factors or eating too much sugar. It's a malfunction of the body's immune system. [2, 4]

 

Risk Factors for Type 1 Diabetes

The exact cause of Type 1 diabetes remains unknown, which is why ongoing research, especially in African communities, is important. [3,4] Several risk factors have been identified but having these factors doesn't guarantee that you will develop the disease. They include:

1. Genetics

Having a family member with Type 1 diabetes increases the risk. [2]

2. Environmental triggers

Certain viruses, particularly enteroviruses, or early exposure to cow's milk proteins may play a role. Some studies also suggest that vitamin D deficiency might be a factor. [4]

3. Geography 

Type 1 diabetes is less common in countries near the equator, including many African nations, but it still affects people in these regions. [2, 3]

4. Age

It can occur at any age, but is often diagnosed in childhood or young adulthood. Many Africans are developing the disease at an older age. [3, 4]

5. Other autoimmune conditions

Having one autoimmune condition may increase the risk of others, including Type 1 diabetes, due to shared immune system dysfunctions. [4]

6. Ethnic considerations

Some studies suggest that certain ethnic groups may have a higher genetic predisposition, though more research is needed in this area. [3, 4]

 

Diagnosis

Diagnosing Type 1 diabetes involves several tests to measure blood glucose levels and confirm the body's inability to produce insulin. [2, 3] These tests not only help diagnose diabetes but also differentiate Type 1 from other forms of diabetes. Key diagnostic tests include:

Blood glucose tests

This includes random, fasting, and oral glucose tolerance tests. You might have diabetes when you have glucose values of:

• Random blood sugar ≥ 200 mg/dL (11.1 mmol/L) with symptoms

• Fasting blood sugar ≥ 126 mg/dL (7.0 mmol/L)

• 2-hour glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test

HbA1c TestloHbA1c testing

This test measures your average blood sugar levels over the past 2-3 months. A level of 6.5% or higher indicates diabetes, while a range of 5.7% to 6.4% suggests prediabetes. [2, 3]

Autoantibody tests

This test helps your doctor confirm the autoimmune nature of Type 1 diabetes and distinguishes it from other types. [5]

 

Challenges of Diagnosing Type 1 Diabetes in African Healthcare Settings

Diagnosing Type 1 diabetes in Africa faces several challenges. These contribute to the alarming statistic that Africa is expected to see, that is, a 134% increase in diabetes cases by 2045 which is a whopping 55 million potentially affected Africans. [1, 6] These challenges are:

1. Limited access to diagnostic equipment and laboratories 

2. Lack of awareness about Type 1 diabetes symptoms

3. High cost of testing for patients in remote areas

4. Shortage of trained healthcare professionals to interpret results accurately

5. Limited access to insulin and blood glucose monitoring supplies

6. Lack of refrigeration for insulin storage in some areas

7. Insufficient diabetes education programs

 

Why is Early Diagnosis of Type 1 Diabetes Important?

• To prevent a well-known fluid and chemical imbalance in the body (e.g. diabetic ketoacidosis (DKA): This life-threatening condition can occur when diabetes goes undiagnosed or untreated. [5, 6]

• To reduce long-term complications: Early management helps prevent or delay complications affecting the eyes, kidneys, nerves, and heart. [3, 5]

• To improve quality of life: Proper treatment allows individuals to lead normal, healthy lives. [6, 7] 

• To reduce healthcare costs: Early intervention is more cost-effective than treating advanced complications. [7]

• To educate patients and families: Early diagnosis allows for timely diabetes education, improving self-management skills. [6, 7]

 

Common Misconceptions about Type 1 Diabetes in Africa

Several myths about Type 1 diabetes persist in Africa. Addressing these misconceptions is essential for better understanding and management of the condition. [4, 5, 6]
 

• Myth 1: Type 1 diabetes only affects children

Reality: Even though it's often diagnosed in childhood, it can develop at any age.
 

• Myth 2: Type 1 diabetes is caused by eating too much sugar

Reality: It's an autoimmune condition not caused by diet.
 

• Myth 3: Traditional remedies can cure Type 1 diabetes

Reality: Even though some traditional medicines may help manage symptoms, they cannot cure Type 1 diabetes or replace insulin.
 

• Myth 4: People with Type 1 diabetes can't lead normal lives

Reality: With proper management, individuals with Type 1 diabetes can live full, active lives.
 

• Myth 5: Type 1 diabetes is infectious 

Reality: It's not infectious and cannot be spread from person to person.

 

Conclusion

If you or someone you know experiences symptoms of Type 1 diabetes, it's important to seek medical advice promptly. Early diagnosis and treatment can make a significant difference in long-term health outcomes. [4, 5, 6] With the right care and support, people with Type 1 diabetes can thrive and achieve a healthy life.

 

References

1. International Diabetes Federation. IDF Diabetes Atlas. Diabetes around the world , 2021. 10th edn. Brussels, Belgium. [Internet, n.d.] Cited 2024 Jul 25. Available from here.

2. Motala AA, Omar MAK, Pirie FJ. Epidemiology of type 1 and type 2 diabetes in Africa. J Cardiovasc Risk. 2003;10 (2):77–83. doi: 10.1177/174182670301000202. Available from here.

3. Katte JC, McDonald TJ, Sobngwi E, Jones AG. The phenotype of type 1 diabetes in sub-Saharan Africa. Front Public Health. 2023;11:1014626. DOI: 10.3389/fpubh.2023.1014626. Available from here.

4. World Health Organization. (2023). Global Report on Diabetes. [Internet]. April 5,2023. [Cited 2024 July 25, 2024]. Available from here,

5. Atun R, Davies JI, Gale EAM, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622-667. doi: 10.1016/S2213-8587(17)30181-X.  Available from here.

6. World Health Organization Regional Office for Africa. Atlas of African Health Statistics 2022. Brazzaville: [Internet, n.d.]. Cited 2024 Jul 25. Available from here.

7. World Health Organization Regional Office for Africa. Diabetes prevention, care challenges in Africa [Internet]. Brazzaville: WHO Regional Office for Africa; 2021 Nov 17 [Cited 2024 Jul 25]. Available from here.

 

Related:

Type 2 Diabetes: What Africans need to know

Management of type two diabetes in Nigeria

 

 

Published: August 18, 2024

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