Sandra Wekesa @wekesa_sandra

Fear, distress and anxiety is what best describes the feelings Newton Ngugi has been having for the past four months. 

As a diabetic, one of the groups of people at risk, he can boast about all the diabetes management lessons he has acquired from his doctor and support group for the past six years.

Not knowing what the future holds, the 25-year-old has proven to be resilient amidst all the anxiety, “I have been trying to stay calm and make sure I am okay, especially since there has been a lot of misguided information regarding us and Covid-19,” he says.

Stuck in a dilemma of whether to go to hospital or not, Ngugi has had to come up with ways of self management that has seen him not visit a hospital or develop diabetes complications since the pandemic hit Kenya.

“Most of us are afraid of going to the hospital even for regular check-up, because we have been told we are vulnerable.

But even if we go, we are most likely to be attended to after hours of waiting by different doctors because most diabetes centres are still closed and the focus is on coronavirus,” he says. 

For Ngugi, the coronavirus came with layoffs that affected him. Consequently, he lost his health insurance cover that rendered him unable to buy his medication.

 “Although I don’t have a source of income, one thing I am really happy about is the support groups that have been my comfort place.

They have been a shoulder to lean on throughout the pandemic and also comforted me when I felt so low.

Especially since it is important to manage ones stress with diabetes,” he says. 

According to International Diabetes Federation Atlas, just over half a million adults were living with diabetes in Kenya in 2019.

This total is estimated to triple over the next 25 years. However, a high number of Kenyans with diabetes, an estimated 40 per cent, are unaware of their condition, putting them at a higher mortality risk when infected with Covid-19.  

Ngugi is one of the many people living with diabetes who have been consumed by the fear hovering among diabetic patients.

Although he has developed ways of managing the illness, it is still important to ensure that he goes for his regular check-up. 

Unmasking diabetes

Dr Jacob Shabani, Chair, Department of Family Medicine at Aga Khan University Hospital, Nairobi, says various studies have documented that diabetic people have greater risk of death from Covid-19 infection.

“But while there is some truth in this, it’s important to note that, it is mainly uncontrolled diabetes that lowers the patient’s immunity.

This happens because with prolonged periods of high blood sugars, white blood cells, responsible for producing immunoglobulins (antibody that neutralise pathogens such as bacteria and viruses), get damaged by excess glucose and fail to multiply adequately to make immune elements,” he says. 

Therefore, he highlights, one has to ensure the body is well prepared to fight the disease, through regular appointments, avoiding self diabetes management and ensuring they have a telemedicine component so that their care can continue. 

Dr Shabani adds that patients turning out to be Covid-19 positive and develop severe complications are those who are already diabetic, or were not aware they had diabetes, so their sugar control has worsened.

He explains further that some death cases in patients with Covid-19 occur when they get diabetes complications such as diabetes ketoacidosis (when the blood sugar is very high and acidic substances called ketones build up to dangerous levels in your body) or low blood sugars that they end up with increased acidity and complications. 

 The pandemic,  the doctor says, will worsen diabetics’ control of their condition and unmask people who had diabetes and didn’t know. 

“With these revelations, it is important to get your sugar checked and be aware of your diabetes status.

This will avoid late discovery and prevent complications. At Aga Khan University Hospital, we keep our regular services open to take care of our patients who have diabetes, hypertension and other chronic illnesses.

We remind them on how they can safely obtain care, get medications renewed and get check-ups to ensure they achieve the control they desire.

We have also made sure that we keep a record of the people with these chronic illnesses and we make an effort to call those who have not come for their care as expected and remind them to keep their appointments,” he says.

He advises people with chronic illnesses not to just refill their medications and treat symptoms without advice from their regular doctor because they might not know whether they are controlling their sugar or not and in that way, put themselves at risk.

He also says they should stay at home and avoid unnecessary gatherings; however, they should visit their regular doctor or at least contact them telephonically.

“Patients with chronic disease will mitigate against their vulnerability if they keep their physical distance, avoid overcrowding, always wear a mask if they have to go out.

They should also wash their hands regularly with soap and water or alcohol based sanitisers,” he adds.

Dr Catherine Kanari, Clinic  lead, Amref health Africa, says diabetes is a known risk factor for developing severe Covid-19 complications, adding that people with the condition are more vulnerable in the society.

Although most adults with diabetes fear going for their regular checkups, Kanari emphasises on them for they ensure sugar levels are stable just in case one contracts the coronavirus.

Failure to which, she highlights diabetics could be prone to developing other diabetes complications such as blindness or heart attack or stroke that may result in death. 

Kanari further says that despite the virus being relatively new for health workers, study indicate it damages insulin producing cells, which are important for regulating blood sugar levels leading to rapid health deterioration.

Access to home care

“Although most diabetic people are vulnerable, further studies indicate that the virus might also trigger diabetes.

Therefore, ensuring you follow the World health Organisation (WHO) Guidelines of staying safe and staying home to prevent transmission,” says Kanari.

In addition, people with diabetes are most likely to be vulnerable because when the body doesn’t make enough insulin to break down sugar, it uses ketons, which is an alternative source of fuel that is quite complex for a body with low immunity to process.

“One way we can deal with this and win the battle is by ensuring we enlighten people on the importance of management of diabetes and the importance of taking care of themselves and regularly checking their sugar levels.

If a patient is able to access a glucometre and check their sugar levels by themselves, the better because then they would have avoided the whole process of going to the hospital and putting themselves at risk,” she says.

Furthermore, the government need to quantify and make data of people who are vulnerable more accessible in order to ensure that diabetic patients and even patients with other chronic illnesses access better home based health care hence reducing mortality rate of people living with this diseases.