Diabetes is a life-long chronic disease, but it can be managed. Balancing the food you eat with exercise and medicine (if prescribed) will help you control your weight and can keep your blood glucose in the healthy range. More importantly, it will help to prevent or delay complications which could affect overall well-being such as blood circulation problems and the formation of foot ulcers that may require amputation. Further complications of diabetes include heart disease, blindness and kidney failure1.
According to a 2015 report by the International Diabetes Federation (IDF), about 10 per cent of Singaporeans have diabetes. This puts Singapore just behind United States in disease prevalence. A strong cause for alarm, this statistics is a wake-up call to the poor choices we have made in our diets and lifestyles. Dr Goh Kian Peng, a senior endocrinology consultant, puts a spotlight on the different types of diabetes and if diagnosed, how we can overcome it.
Type-1 and Type-2 Diabetes
In diabetes, the pancreas produces too little or ineffective insulin, a hormone which lets body cells use blood sugar for energy. Hence, diabetics have higher blood sugar levels than a normal individual.
“The symptoms of diabetes are mainly related to hyperglycemia (high sugar level in the blood stream) such as increased thirst and urination. Patients with Type-1 may even report loss of weight. The quality of life is commonly affected as patients also experience tiredness or loss of energy,” Dr Goh said.
There are two major types of diabetes: Type-1, often diagnosed in younger patients, and Type-2, which is commonly is caused by unhealthy lifestyle and diet.
Type-1 usually starts from young, as it develops from the body’s inability to release insulin. This often happens when the body’s immune system goes wayward and attacks insulin producing cells in the pancreas. As a result, the treatment is insulin injection.
Type-2, however, arises from the body’s resistance to insulin. Dr Goh reveals it is “related to our modern lifestyle and risk factors like obesity”. When we consume sugary food and are not active enough, the body responds less to insulin over time, and the pancreas’ production of insulin slows, leading to diabetes. In Singapore, it is a growing trend, with Ministry of Health’s research showing a rise in adult diabetes prevalence.
While little can be done to prevent Type-1 Diabetes as it is an autoimmune disease, you can avoid Type-2 diabetes by developing a healthier lifestyle and diet.
Getting diabetes through pregnancy
You can also get diabetes through pregnancy, usually during the 2nd or 3rd trimester of pregnancy. Gestational diabetes occurs because the placenta produces hormones which make it more difficult for insulin to work; causing the blood sugar levels to rise.
“Gestational diabetes affects 7-10% of all pregnancies.About 30-80% of patients with gestational diabetes go on to develop diabetes sometime later in their life.” Dr Goh explained.“Obesity is one risk factor that we can potentially control. Do your best to achieve and maintain a healthy BMI prior to pregnancy. Having a well-balanced diet with a higher proportion of complex carbohydrates to simple carbohydrates may also help to reduce the risk.”
While people know diabetes relate to high sugar levels in the body, not many have the right set of beliefs. For example, many think diabetes can be prevented by just avoiding sugary drinks.The truth is, many common foods have “hidden sugar”, as their high carb content becomes sugar in our bodies, leading to insulin spike.
A May 2016 article in the Straits Times revealed a Health Promotion Board’s research that rice is worse than sweet soda drinks for diabetes. In fact, eating a plate of white rice each day raises the risk of diabetes by 11 per cent across the population.
Staying ahead of your diabetes
Many people diagnosed with diabetes continue to live an engaging and fulfilling life. After the initial shock of a diabetes diagnosis wears off, you and your family will begin adjusting to life with diabetes. With proper planning, control and management of the disease, you can resume all of your normal dayto-day activities, such as working, exercising or going out to eat.
“Eating a well-balanced diet and keeping our Body Mass Index (BMI) at a healthy range between 18.5 and 24.9 are important lifestyle adjustments to help reduce the effects of diabetes or even prevent them,” Dr Goh said.
If you are a smoker, it is encouraged you quit too as smoking increases risk of serious diabetes complications such as heart and kidney diseases. And if you are in the prediabetic range, you will need both lifestyle adjustments and close monitoring with regular screening.
“For patients with diabetes, it is a standard practice to measure the three-month average sugar control known as HbA1c, with the aim to keep it between 6.5 and 7 per cent. The reason is, complications will increase if it is above seven per cent,” Dr Goh said. “Also, specialist’s advice should be sought if it is more than seven per cent even after six months of treatment.”
Some health experts are urging at-risk Singaporeans to get screened at a younger age and also advocating better support for diabetic patients to manage their condition2. This is because about 50 per cent of diabetics do not realise they have the disease as the symptoms are not obvious.
Diabetes and pregnancy
When a woman with diabetes gets pregnant, the sugar level control becomes even stricter than her non-pregnant counterparts.
“High blood sugar has deleterious effect not just on the mother but the infant as well,” Dr Goh explained. “As a result, we need to monitor these levels multiple times a day. When diabetes control is not adequate even with dietary restrictions, insulin injections becomes necessary. And it is continued even after delivery as long as the mother is breastfeeding.”
The good news is, it is rare for children to inherit diabetes even if the genetic factors present themselves. Though, it is good for parents with diabetes to look out for symptoms and signs like failure to thrive, poor feeding and high irritability. As they are nonspecific, they can be easily missed, complicating the child’s health and delaying treatment.
Preventing onset of complications
While diabetes is not life threatening immediately, if left untreated or mismanaged, it can lead to serious complications ranging from necrosis of fingers and toes that requires amputation to organ failures and heart diseases. Diabetes also has far-reaching effects on our day-to-day lives, as it can affect wound healing and increase chance of infection.
“It is also for this reason that precautions need to be taken when diabetic patients go for any surgical operations. Heart function should be evaluated before the surgery; and if you are on blood thinners as well, the risk of uncontrolled bleeding has to be assessed and prepared for,” Dr Goh said. “Unless it is an emergency procedure, it is better for the surgery to be scheduled at a time when diabetes control is good.”
Fortunately, medications that can control diabetes and reduce the risk of surgical complications are available when emergency operation is needed.
However, “this risk will still be higher than in a patient with good control before operation,” Dr Goh added.
Article contributed by Dr Goh Kian Peng, an accredited doctor of Mount Alvernia Hospital.