HEALTH: Diabetes

Harriet Kaufman Adwoa,

 Registered Nurse, RN
 Masters in Science Nursing, MSN


The most important step in taking control of diabetes is to recognize the symptoms and take action. We have to ask ourselves why this illness is increasing in a society where it was hardly known (4/1000 people to 8 out of 100 people). It is either that it went unnoticed, people have been in denial or that the changes we are going through as a people are making us unhealthier. Why does Ghana have the highest incidence of diabetes in the entire African continent? Certainly our stressors are not more than any other country. If there is a genetic component then our ancestors too would have had to have diabetes, so why the increase? We know that exercise (physical work) helps to keep the blood sugar at a healthy low so maybe we’ve moved away from eating foods that nourished our bodies and we’ve moved away from activities that kept us healthy. Diabetes strikes many people and doesn’t care whether a person is rich or not so what is happening?

One problem that affects us here is a lot of superstition and superstitious behaviour. We may think that this problem that is happening to us or a loved one is brought about by juju or spiritual practices (or lack of). We may go to a traditional healer who also doesn’t recognize the symptoms of diabetes and treats us with something that helps the immediate problem (like a woman who gets medicine for fitaa) but doesn’t do anything about the sugar that’s increasing in our blood. Or we may go to a faith healer who doesn’t do anything at all but make some words over our head. So, the first thing is to recognize the signs of diabetes. If you experience

Fatigue Excess thirst Constant hunger Increased urination Mood swings Regularly occurring yeast infections Sudden weight loss Blurry vision

See a doctor and make sure they check you for diabetes. The test is simple. In many cases it may be no more than a finger stick to see if there’s too much sugar in your blood.

The normal level of sugar in the blood is between 90 to 120 milligram of sugar per 1 decilitre of blood or 90 - 120mg/dl. If you haven’t eaten anything that level should be under 105mg/dl and approximately two hours after eating that level should be under 120mg/dl. If a doctor checked your urine it should be free of sugar AND ketones (the end product of fat digestion). If any of the above results are higher than the norm, you may have diabetes and your doctor will want to do a further blood test to verify.

Checking your blood sugar
You will have to learn to check your own blood sugar with a monitor that is called a glucometer (gluco = sugar, meter = measure). If you are unable to do this, a loved one or someone who lives with you may be able to learn and do this for you. But this is something you will have to carry with you at all times. In the beginning you may be asked to check your blood sugar right before you eat and one hour after each meal ends, then again at bedtime. This is to help you balance the foods you eat. Normal values are:

Before a meal – 80 to 120 mg/dl
After eating – under 180 mg/dl
Before going to bed – 140 mg/dl

Values go up and down depending on what you’ve eaten, your activity and your stress level (illness). The good thing about self-checking is that you see immediately how your diet, activity and other things affect you and your sugar levels.

Since it is not easy to distinguish between type 1 and 2 diabetes, your doctor may have to give you different medications in the beginning until he/she sees that it/they is/are keeping your blood sugar at a normal level. The medications are: Insulin which is injected into the belly, the thigh or the upper arm (sites where we have more fat). The medication may have another name but is a synthetic make of the hormone that is supposed to be produced in our pancreas. Type 2 diabetics usually don’t have to take insulin. If this is the medication for you, you will be taught how to give yourself the injection or someone who lives with you may be taught if you have difficulty. For emergency purposes it is best to have another person who knows how to give the medication anyway. Teaching includes measuring out the medication, drawing it up into a syringe and how to inject it with sterile technique. Don’t worry! It is a small needle and the sting is less than a mosquito’s bite.

Oral hypoglycaemic or medications, like pills, to take by mouth that lower the blood sugar by different mechanisms. It is not within the scope of this booklet to describe them all, nor their side effects but you will want to know what medication you are using and how it could affect you.

Some people have to take a combination of Insulin and oral hypoglycaemic until they have their routine under control. With diet management, exercise activity and the medicine you should live a normal, healthy life. Again, it will be up to your doctor to decide what medication and what times you should take it/them.

The best thing about exercise in a diabetic is that it is known to increase the ability of the cells to make use of the sugar in the blood. We also know that it helps in maintaining an ideal body weight, it improves heart activity, helping to lower blood pressure, it lowers cholesterol – the bad fat that can do harm to the heart and blood vessels, it lowers stress and it helps to improve general well – being. Those sound like great reasons to start exercising to me.

Before you do start an exercise program with known diabetes check with your doctor. There are some concerns and warnings about exercise:

Beware of dehydration! Drink about ½ litre of water or juice (fresh is best as it doesn’t have as much sugar as commercial juice) two hours before starting exercise and drink frequently if doing an extended exercise routine (like an aerobics class at the gym).

Check your blood sugar before starting and take a small snack (6 cream crackers or ½ sandwich with ground nut paste) if your blood sugar is less than 100 mg/dl.

Check your blood sugar after completing your exercise program.

If you have to give yourself an injection, do not inject into an area that’s likely to be involved in heavy activity (for example, you are doing sit ups which stress the stomach muscles – do not inject your insulin into the stomach!) Always have 8- 10 pieces of hard toffees with you (you will only take those if you have a hypoglycaemic reaction – shaky, sweaty and anxious).

If at all possible, exercise with someone who could recognize the signs of hypoglycaemic shock and would know how to help you (in case you were to lose consciousness).

Dietary considerations
This is the most difficult thing for us to change because so much of who we believe ourselves to be is in the foods we eat. The foods our mothers prepared for us become our comfort foods – the foods that make us feel good and that we dream about when they are not around.

Like most nutritional diets, the diets for diabetes are based on a certain amount of calories (calories are the amount of energy it takes to digest or use the foods we eat) to either help you to lose weight, gain weight or maintain weight. For example, the average woman, not overweight, nor underweight usually needs about an 1800 calorie diet. Pregnant women usually need about 2200 calories. Men also need about 2000 to 2200 calories depending on their daily activity. A healthy diet is focused on these principles: eat low fats, whole grains (red rice as opposed to polished white rice) which have lots of fiber (that helps to keep your bowel clean and free of constipation), fresh fruits and vegetables and keep added sugar, salt and alcohol to a minimum. The bulk of your foods will come from starchy things like corn, yam, plantain, potato, cassava, bread, rice, millet and beans. Beans are extra special as they are also a good source of protein, plus they have a lot of fiber. The more natural the food, the more fiber and so ‘whole’ is best. While fufu is a national favourite, it does not contain the fiber because it has been pounded out. Accra or Fante kenkey are much better than white kenkey because they use the whole grain (corn).

The next most important foods are vegetables and fruits. While fruits are technically sugar foods, the amount of vitamins, minerals and goodness you get from them make them essential. It is usually best to take fruits later in the day as opposed to first thing in the morning and eat them a few hours after eating heavier, harder to digest foods. Fruits digest fast compared to meats, fats and whole, starchy foods. When eating vegetables, try to keep them as near to raw and natural as possible. One of the best, most important foods that we could eat are GREENS. Those are kontomre, gboma, potato leaf, cassava leaf, callaloo and moringa. They should and could be added to every meal that you eat!!! Not only do they contain incredible amounts of nutrients that the body needs but they do help to regulate/stabilize blood sugar.

The following list will give you an idea of how many servings you can eat of each food type with different caloric intakes. Remember that a person who needs to gain weight will need more calories and one who needs to lose weight will want to take less. This is not intended for you to “treat” yourself but as a guideline to know how you should and can eat. Your doctor will be the best one to determine how many calories you will need. Also beware - you should not be getting your calories from sweets. Toffees are for you to carry around for emergency purposes only!!!!!

CALORIE AMOUNT 1200 1500 1800 2000 2500
Food Type Number of Servings
Starch 5 7 8 9 11
Fruits 3 3 4 4 6
Vegetables 2 2 3 4 5
Milk/Yogurt 2 2 3 3 3
Meats/fish 4 4 6 6 8
Fats 3 4 4 5 6


For clarification, one cup is equal to ½ a margarine cup or the small margarine cup.

Starch – one serving equals

Vegetables – one serving equals

Fruits – one serving equals

Milk products – one serving equals

Meat – one serving equals

Fats – one serving equals

Sugars – one serving equals (sugar should be avoided but is included for understanding)

It is best for the diabetic to eat 6 small meals per day. In fact we could all benefit from that plan so that our blood sugar remains constant without many fluctuations. The schedule would be breakfast at 7am, lunch at 1pm and dinner at 7pm with 3 snacks at 10am, 4pm and 10pm. Basically you are taking in nourishment every three hours with the last being a bedtime snack. If you are accustomed to larger meals you could keep those heavier then the snacks. The bedtime snack is important so that you don’t become hypoglycaemic during the night’s sleep. Your doctor will plan your medications around your meals.

Let’s do a sample meal for a person who is going to be on a 2,000 calorie diet. They can have servings as written in the list above.

Breakfast at 6am: 2 boiled eggs with 2 pieces of brown toast and a small salad.

First snack at 9am: 2 small bananas with a cup of yoghurt and 5 cream crackers.

Lunch at 12 noon: 1 to 2 cups of waakye and 1 chicken leg with ½ cup tomato stew.

Second snack at 3pm: 1 slice of brown bread with some groundnut paste.

Dinner at 6pm: one kenkey with fish and vegetable stew and another small salad.

Bedtime snack at 9pm: 2 small oranges.

Although I have not included drinks it is understood that you will be drinking throughout the day. Avoiding dehydration is essential. The recommended amount of fluid intake per day is 4 litres. I also have not included milk because I know not everyone drinks milk but may add it to their porridge, tea or coffee (although caffeinated beverages are not recommended). This can be calculated into the whole meal plan.

The most important thing for Ghanaians is to add more vegetables into the diet and when possible have them raw. Because fats are limited you don’t have to stop eating nkateE nkwan or abE nkwan, but have them in moderation.

Some alternative foods are helpful to reducing the amount of sugar in the blood and those are aloe vera juice, moringa and dandelion root. If you grow your own aloe vera then you can make the juice fresh every morning. It is refreshing if mixed with some lime or lemon. Beware cause it will also help to clean out your bowel. I have seen locally produced aloe vera juice as well as foreign aloe juice so it is possible to get it if you don’t have your own. Moringa grows everywhere and can be used for many things, but one of it’s benefits is that it helps to lower blood sugar. It also has so many other amazing qualities that you will benefit when you eat it. It can be eaten fresh, or washed and ground into powder once dry. The dry moringa is concentrated so contains more nutrients spoon for spoon then the fresh one. Dandelion root can be made into a tea or a drink and can be used fresh or dried. It can be confused with another similar plant called chicory so make sure the back of the leaves are not hairy! They should be smooth. Chicory won’t do you any damage but does not have the wonderful properties that dandelion has. Dandelion leaves are delicious too and can be eaten raw. The root is known to cleanse the liver (important for sugar regulation) and the pancreas (important for insulin production).

Stress reduction
I have spoken briefly about the stress reaction and what it does to the body. To review, in a moment of intense stress the glands above our kidneys (the adrenal glands) release two main hormones, adrenaline and cortisol. Adrenaline is what gives us the energy to do what’s needed. Your house is on fire and your child is stuck inside. You manage to jump over an 8 foot wall, charge through the fire and rescue your child. This is not something you could do on the average day. That is adrenaline working. To help accomplish that, cortisol is released and takes the stored sugar from the liver putting it back in the blood stream so it’s available to the cells that will need extra energy (like your legs that just jumped over that wall). Along with that increase of sugar you are supposed to have an increase of insulin to manage all that sugar. The cortisol stays in the system after the stress or shock has occurred to make sure everything functions as it should. Usually in any given stressful situation this functions perfectly. But what happens with continued, constant stress is that cortisol stays in the system, building itself up in the blood stream. This puts your sugar, insulin, fat and other necessary minerals way out of line creating long term problems in the body. PROLONGED STRESS IS NOT GOOD!!!!

While the example I have given is extreme, stress can be any thing that happens to us. We are sleeping peacefully and all of a sudden the church next door starts a revival service that lasts all night long and we know that we have to be awake early to prepare for work. That is stress, even if we like the idea of a revival. Our water is cut off and we have used up the last of our stored water and have no more….. that is stress. Getting malaria or any other illness causes stress to our body. Pain, whether it is emotional or physical also causes stress. Being stuck in traffic causes stress. Drugs, poor diet, hunger, no sleep, alcohol, caffeine and nicotine stress our bodies too.

So what can we do???????

If you smoke, drink alcohol or use drugs try to stop immediately.

Be mindful of the foods that you eat and eat to stay healthy.

Practice saying no when you don’t want to do something and stick to it. People will respect you in the long run.

When someone does something to anger you, count to ten and take a deep breath before reacting. You may be able to just walk away from the problem person.

Rest! It has been said that we humans need to get at least 7 hours of uninterrupted sleep to restore our body’s minerals and to rid us of stress. Depending on your daily activities, that figure may be greater.

Change your thoughts, change your attitude. It helps to understand that thoughts have no basis in reality but they sure do control our moods. When we are thinking something that is affecting our mood/health and it is spiralling out of control, we can ask ourselves two major questions. 1. is this true? 2. how are these thoughts making me feel? If the answer to the second question is that you are feeling bad, well by all means, change the thoughts. You have a choice here. If the answer to the first question is ‘no’ then we have no business thinking it in the first place. Every problem has a solution, even if it’s a solution we may not like.

Meditate. This is not the same as praying or asking for something to occur. Meditation is a way of quieting the mind – getting those thoughts to be quiet. You sit quietly and focus on your breath. When thoughts try to invade your peace, pay them no mind! Literally. Just continue quietly counting your breaths.

Learn how to do deep breathing. Taking deep breaths has a very soothing effect and works right along with meditation.

Take a yoga class. Yoga like meditation and deep breathing is very soothing.

Take a walk just because. You are not going anywhere, you are just walking. Take time to look at the things around you without attaching any judgement to any of it. Just observe - a flower, a broken bottle, the wall to the neighbour’s compound etc etc. no judgement.

Do some quiet garden work or wash clothes or dishes. Those routine activities sometimes help to calm the spirit.

Start saying positive affirmations. An example of those are – I have the perfect job for me, making enough money to make ends meet. I see myself healthy and whole. My family is full of love and joy. The key is not getting stuck in “I want”. Create your own affirmations and see how many positive experiences you can imagine.

Becoming ill means anything that could raise your blood sugar beyond normal levels such as fever, vomiting and diarrhea as well as stress or a wound.

TAKE YOUR MEDICATION: If you have been given medicine by your doctor continue to take it unless told otherwise

Eat regular meals if you are able and include 240 ml. (approximately one cup) of no-calorie fluids for every hour awake: Broth Decaf tea Sugar free minerals Water

If you are not able to eat a meal, drink one of the above with the following every hour while awake:



CHECK TEMPERATURE:   Check this every four to six hours

REPORT FINDINGS:   Notify your doctor if you have:

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