The phantom itch was the worst part. Issa Hassan would instinctively reach down to scratch his leg, only to be struck by the reality of its absence.

The 46-year-old resident of Kenya's Nairobi had dismissed the small sore on his foot as nothing serious. New shoes rubbing, perhaps. But that wound became a slow catastrophe. It refused to heal, turned black, and spread up his leg until amputation became his only chance of survival.

"I thought it was just from my new shoes," Hassan tells TRT Afrika. "As a diabetic, you are told to check your feet, but life gets busy. What initially seemed just another foot sore got worse, so much so that doctors said amputation was the only way to save my life."

His case isn't an exception. Diabetes claims limbs and lives across Africa every year, highlighting the lacunae in healthcare systems still geared towards fighting infectious diseases rather than the chronic conditions now spreading through the continent's rapidly urbanising populations.

Hassan navigates the world on crutches, but the physical loss of a leg isn't what keeps him awake at night.

"My greatest challenge is the cost of treatment. The insulin, the test strips, the visits to my doctor...It eats up my pension from my previous job as a teacher. I worry about how I can continue to afford the treatment to stay alive for my family," he tells TRT Afrika.

Medication shortage

Aisha Bello can relate to Hassan's anxiety. This 34-year-old software engineer from the Nigerian city of Lagos has Type 1 diabetes. For her, insulin availability has become a monthly crisis.

"The scariest moment is when you go to a pharmacy and your specific type of insulin is out of stock," she says.

"It's a race against time. You feel the panic rising because, without it, my body starts to shut down. I have to call every contact I have, and sometimes visit up to three pharmacies."

As Kenyan endocrinologist and public health researcher Dr Annette Ochola puts it, Africa is in the middle of a "perfect storm", sandwiched between two epidemics.

"We are witnessing a rapid epidemiological transition," Ochola tells TRT Afrika.

"While we continue to fight infectious diseases like malaria and HIV, we are simultaneously experiencing an explosive growth in non-communicable diseases like diabetes. This is driven by rapid urbanisation, dietary shifts towards processed foods high in sugar and fat, and more sedentary lifestyles. Healthcare systems, already stretched thin, are struggling to cope."

Late diagnosis makes matters worse. By the time many patients discover they have diabetes, serious complications would have developed.

"Many patients are diagnosed late, often when life-threatening complications like gangrene or kidney failure have already set in," Ochola says.

"The cost of consistent care is prohibitive. Insulin and glucose monitoring are not luxuries; they are lifelines. But when these are not accessible or affordable, the likely outcomes are amputations, blindness, and even premature death."

Continental patterns

The International Diabetes Federation identifies North Africa, Southern Africa and West Africa as the regions with the highest numbers of diabetic adults on the continent.

Egypt has one of Africa's highest prevalence rates, driven largely by dietary changes and rising obesity. Mozambique and South Africa have had an explosion of cases linked to rapid urbanisation and lifestyle changes.

Nigeria being the continent's most populous country means its growing number of diabetics is straining national health infrastructure.

Experts believe much of this is preventable. Up to 70% of Type 2 diabetes cases can be stopped or delayed through lifestyle changes. This is why World Diabetes Day, observed globally on November 14, is treated as crucial platform for education, advocacy, and policy change.

For Hassan, the day is an occasion to share his painful personal journey with the world, couched as a cautionary tale.

"I tell my story so that others may not lose a leg like I did," he tells TRT Afrika. "We need people to know that this 'sugar disease' is a silent killer. We need governments to make diabetes medication cheaper. We need to fight this scourge together."