Sometimes cough, malaria are telltales of diabetes

Prompt treatment of all diseases
is important.Cases of diabetes are on the rise in Africa and experts are warning that in some cases, common diseases like malaria and cough may lead to diabetes, reports Sade Oguntola.

Mrs. Joke Adenuga is a 60-year old trader living in the suburb of Ibadan. Penultimate week, she was rushed to the hospital after she became unconscious. She had complained of loss of appetite, malaria and coughing at night to her daughter two days before. Her daughter bought some medications and cough syrups for her but rather than the situation getting better, she collapsed while taking her breakfast.

The daughter, a teacher at a nearby school to where the woman was staying never envisaged such a thing could happen until she was sent for that her mother had been rushed unconscious to the hospital. When the doctor asked that several batteries of test be done to ascertain what actually was the problem with her mother, she still was deeply thinking why malaria fever and cough could degenerate to require the woman collapsing and requiring to be hospitalized.

However, at the end of the investigation, it turned out that what was really the bigger problem responsible for Mrs. Adenuga falling unconscious was actually the fact that her blood sugar was too high, in other words, she had diabetes.

Cases of emergencies arising from diabetes was the theme of the Nigerian Society of Endocrinology and Metabolism (NSEM) maiden one-day South-West zonal conference held at the Paul Hendrickse lecture theater of the University College Hospital (UCH) Ibadan.

Dr (Mrs.) Rosemary Nkem, consultant physician and endocrinologist, Obafemi Awolowo University Teaching Hospital, Ile-Ife, said especially among the elderly, many are rushed to the hospital unconscious after they may have had infections like malaria and chest infections like cough and pneumonia only to be found to have a very high blood sugar level signifying diabetes.

According to her, the reason why diabetes is discovered in this haphazard way is because they may not have signs or symptoms indicating they have diabetes.

“It may not present with any symptom. Even when someone is passing lots of urine and drinking lots of water, the person may not know he is ill or think of diabetes as the cause. But the person who does not experience all these things may not even think anything is wrong with his or her body, especially in the elderly. Even when an elderly person is ill, sometimes some people don’t take them seriously. They think it is problem with old age and this could actually be a problem of diabetes.

“Sometimes, some of them later develop stroke and it may have been the rather too high blood sugar level that led it,” she said.

Dr. Nkem said that in some cases it could just be a chest infection, urinary tract infection or pneumonia that will be the first sign that something is wrong with them. Sometimes, it may be malaria or things like diarrhoea and vomiting that will kick-start the high blood sugar level.

“Common infection, like cough, chest problem malaria, may be the first thing to bring them to the hospital for complications of diabetes. But most of them even come in coma, unconscious and sometimes, they have this illness and you check the blood sugar and it is very high in the range of what you call a hyperglyceremia emergency. By the time they come in coma, they would either have been seen at either the primary health care centre or the general hospital or have self-medicated and this may now worsen the problem,” she declared.

While several things could make a person lose consciousness, she said usually part of investigations that the doctor will require includes a blood sugar test because that is the time many people are discovered with the problem. “ What I will advise is that when people are ill, they should look for a doctor to look after them and never think everything that is fever is malaria, that they can overlook.”

However, she said that does not rule out a person already with diabetes also falling unconscious when such does not take the commensurate amount of drugs to support the calorie intake.

According to Dr Jokotade Adeleye, a consultant physician and endocrinologist, Department of Medicine, UCH, Ibadan, from a total of 211 patients with diabetes with emergencies seen in UCH, over a three-year period, the worrisome thing was that there was 33 per cent mortality rate- about three out of 10 of them in that series ending up dying due to marked increase in blood sugar level and an accumulation of ketone, a by product of the breakdown of fat in the body.

“One thing we noticed to be common and precipitating factor for these emergencies, was either non-compliance with laiddown treatment for diabetes or poor compliance (people not taking their medications or with medications; infections such as chest infections, urinary tract infections, infections of the skin, foot ulcers that were infected.

Given that some of these patients were diagnosed to have diabetes for the first time when they develop these diabetic emergencies, Dr. Adeleye said it is important for persons with diabetes to be very involved in their management, not just stop treatment, comply with therapy, make their clinic appointments and generally get to know about the disease and get involved in its care.

She also emphasised that it is important for healthcare providers to have knowledge about diabetes its management and its manifestations so that the untold and worrisome cases of death due to diabetes can be prevented when those suspected with the problem are referred early to appropriate experts.

Similarly, Dr Omolola Ayoola, a consultant paediatrician said cases of children coming to the hospital for one health problem only for them to be found to have diabetes is not rare either.”I see on the average one or two in a month. But one is 100% to the family because it is a life-time problem, so in that sense it is important. “

According to her, “their parents before then did not even know they have diabetes until they become unconscious. They think they are just unwell, because of malaria or that they are not just themselves and nobody checks their urine or blood sugar level until they collapse and go into coma.”

She stated that for such an emergency situation when not properly handled might lead to loss of life and other forms of disabilities in the children including low IQ. Even in a case where the child falls into coma because of non-compliance to treatment from the doctor, she said such a child may have problem with intellect and school performance, have difficulty walking and so on.

Dr. Babatope Kolawole, also a consultant physician and endocrinologist and Chairman, NSEM southwest zone, said most cases of death from diabetes are related mainly to the complications of the disease. According to him, the most important short-term complications of the disease are those emergencies that result from very high blood sugar level, stressing that this is very rampant and a major reason several diabetic patients are referred to teaching hospitals.

As an association, he said there is a move to do an audit of the cases seen at teaching hospitals, and come up with information that will guide in the development of a policy or protocol guidelines for treating diabetes, especially at the primary and secondary health care levels in order to prevent people dying from associated complications of diabetes.