DIABETES

What is Diabetes?

Diabetes is a medical condition in which blood glucose levels remain persistently higher than normal.  This damages the inner lining of arteries, causing obstruction to blood flow. Small or tiny arteries that supply the retina, kidneys and nerves are likely to be affected first, which is why diabetic persons are prone to developing blindness, kidney failure and non-healing ulcers in the feet which may require amputation.

Eventually, if diabetes remains poorly-controlled, larger arteries supplying the brain and heart may become affected as well, leading to stroke and heart attacks, which may be fatal.  The root cause of diabetes is either the lack of insulin in the body or the the ineffectual usage of insulin by the body.  

Diabetes is steadily becoming more common in Singapore.  This may be due in part to an ageing population, unhealthy diets and sedentary lifestyles.

There are three types of diabetes:

Type 1 Diabetes

·     no insulin is produced due to damaged pancreatic cells

·     usually diagnosed in children or young adults although it can occur at

         any age

·     insulin is absolutely necessary for treatment

Type 2 Diabetes

·     insulin produced is insufficient or ineffective (insulin resistance)

·     usually occurs in people over 40 years old, particularly those who are

         overweight and physically inactive

·     more younger adults and children are developing Type 2 Diabetes

·     can be controlled with proper diet and exercise but most diabetic

          persons require oral medicatio or insulin or both.

Gestational Diabetes Mellitus (GDM)

·     Occurs in about 2-5% of all pregnancies.  Women who were not     

         diagnosed to have diabetes previously show high blood glucose

         levels during pregnancy.

·     needs specialised obstetric care to reduce serious complications to     

         the unborn baby

·     insulin is needed for treatment

·     complications are sudden and life-threatening

When do I need to check myself for diabetes?

Age >40 years with a family history of diabetes

Strong family history of stroke or heart attack

Presence of symptoms such as:

·         constant tiredness

·     constant hunger

·     frequent thirst despite drinking lots of water

·     itchiness especially around the genital area

·     passing excessive urine during day and night

·     weight loss despite good appetite

·     poor healing of cuts and wounds

Complications of Diabetes

Uncontrolled diabetes can lead to acute emergencies such as ketoacidosis (very high blood glucose with acid build-up) and severe hypoglycaemia (very low blood glucose). Both situations cause a diabetic person’s condition to deteriorate rapidly and may be life-threatening.

The long-term complications of diabetes include:

·     coronary heart disease such as angina, heart attack

·     stroke

·     kidney disease

·     foot disease such as ulcers and gangrene requiring amputation

·     nerve disease which can lead to problems such as impotence and

         diarrhoea

How should diabetes be managed?

Persons with pre-diabetes can be managed with lifestyle modification and medication to prevent diabetes from occurring.

For persons who are already diabetic, effective treatment is available to slow the development of complications in whichever stage of the disease. Every one percentage point reduction in glycated haemoglobin reduces the risk of stroke and heart attack by 25 percent. It may even be possible to cure early diabetes in obese persons through lifestyle modification and weight loss surgery.

Lifestyle changes

·     Reducing carbohydrate intake and avoidance of pure sugar in drinks

          and beverages are absolutely important.  Persons with type 1

          diabetes may be taught carbohydrate-counting to help them better     

          adjust their insulin dosages.     

·     Achieving at least 150 minutes of moderate-intensity exercise

         (ie. 50-70% of predicted maximum heart rate).

Medication

Several categories of medication are available to lower blood glucose.

·     Biguanides & Thiazolinedidiones: enhances insulin sensitivity and     

         reduces glucose production by the liver

·     Sulphonylureas: enhances insulin release from the pancreas

·     Sodium-Glucose Co-Transport Inhibitors: promotes excretion of

         glucose through the kidneys

·     Alpha-Glucosidase inhibitors: reduces dietary absorption of glucose

·     Dipeptidyl peptidase 4 inhibitors: reduces appetite and promotes

          insulin release by the pancreas during food intake

·     Glucagon-like peptide 1 agonists: powerful effect on reducing                      

          appetite and promoting insulin release by the pancreas during food

          intake

·     Insulin: both rapid and basal insulin may be necessary in persons

         with long-standing diabetes. Insulin delivery devices now allow

         persons to administer insulin easily and safely. Insulin pumps are also

         available to persons with type 1 diabetes.

Apart from lowering blood glucose, persons with diabetes must lower their blood pressure and cholesterol to target as well in order to minimise cardiovascular risk. Blood glucose should be monitored periodically at home.

Why do I need a diabetes specialist?

At Gleneagles, we want to help you live with your diabetes and yet enjoy quality living. Our team of endocrinologists and allied health professionals will tailor treatment strategies are personalised and effective, and aim to prevent or slow the development of complications in whatever stage of the disease you are in. We are also well-equipped to manage your diabetes in any medical circumstance you may be in, such as before/after surgery, pregnancy and chemotherapy, to ensure that your condition is being treated in the most appropriate manner.