Managing diabetes, a silent killer

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Diabetes is one of the silent killers, it may not have any symptoms. So, regular health screenings are important to check for diabetes, especially if you are over 40 or have a family history of diabetes.

What is diabetes?

It is a medical condition in which the blood glucose levels remain persistently higher than normal.

It happens when insulin - the hormone that enables glucose to enter our cells to produce energy - is either lacking or not working properly. Too much glucose in the blood can lead to serious health problems.

How serious is the war on diabetes in Singapore?

The prevalence of diabetes among Singapore residents increased from 8.2 per cent in 2004 to 11.3 per cent in 2010. The prevalence of diabetes in adults here was 12.8 per cent in 2015.

This is expected to progressively increase as our population rapidly ages and becomes increasingly sedentary.

How will I know if I have diabetes?

It is best to visit your GP to check for diabetes if you feel thirsty all the time despite drinking a lot of water and pass a lot of urine both in the day and at night; feel constantly tired; are losing weight; have poor healing of wounds; or have itchy skin.

Diabetes is one of the silent killers, it may not have any symptoms. So, regular health screenings are important to check for diabetes, especially if you are over 40 or have a family history of diabetes.

If you are diagnosed to have diabetes, a close follow-up with your doctor is important.

Tips on living well with diabetes

  • People with diabetes know that they need to take control of their eating habits because blood sugar levels in the body are directly affected by the foods we eat.
  • A diabetic diet is an eating plan that is high in nutrients and fibre, low in fat, sugar and salt, and moderate in calories
  • The only difference is that you need to pay more attention to your food choices
  • Controlling carbs: If you have diabetes, excessive intake of carbohydrates will lead to high blood sugar levels and poor control of diabetes.
  • Load up on greens: Loading up on vegetables, especially green leafy ones, will assist in blood sugar and weight control, and promote a healthy heart.
  • Choose wisely when eating out: Reduce your food portion size by requesting for less noodles/rice, and avoid dishes with thick gravy or fried foods with flour/bread coating
  • Order more vegetables and have a serving of fruit for dessert.
  • Regular mealtimes: For individuals who are on fixed doses of insulin and/or taking oral medication for diabetes, it is important to maintain regular mealtimes to prevent fluctuation in blood sugar levels and to optimise the effects of the medication.
  • Be active: The reason exercise is so important is because it increases cell sensitivity towards insulin. This means that cells are better able to use any available insulin to take up glucose during and after each physical activity.
  • You can start slowly with a 30-minute brisk walk three times per week and work your way towards a more intensive regime.
  • This helps you to have better blood glucose control and maintain a healthier body weight.
  • If you have diabetic complications such as heart disease, nerve problems or kidney failure, seek the advice of your doctor or an exercise specialist about appropriate exercises to do.
  • Shoes that fit: Comfortable footwear is also important as diabetes causes nerve insensitivity in the feet.
  • Poorly-fitted shoes can lead to foot complications such as ulcers, blisters or corns.
  • Stick to medications: In order to ensure blood sugar targets are achieved, most people with type 2 diabetes will require oral medication and/or insulin, along with living a healthy lifestyle.
  • Keeping clinic appointments: You need to take a proactive role in the management of your healthcare in order to prevent or delay the development of diabetic complications.
  • It is very important to follow the medication dose and timing prescribed by your doctor. It is dangerous to skip medication, or adjust medication dosage and timing without checking with your doctor.
  • Self-monitor blood sugar levels: Regular monitoring of your blood glucose gives you a basic understanding of how your diet, medication and physical activity affects your body and how you can manage it.
  • In general, individuals with diabetes should have comprehensive physical examinations once a year and have their diabetes assessed at least every three to six months.
  • Too little sleep can increase the risk of diabetes, and if you already have diabetes, sleep deprivation can lead to poor blood sugar control.

Will I have to give up cake and chocolate if I am diabetic?

Cake and chocolate are rich in sugar, but a little of them once in a while is fine.

You will still be able to add some sweetness to your life even if you have diabetes - by sharing the cake with a friend instead of eating an entire slice, having a small piece of dark chocolate instead of a whole bar of milk chocolate, or baking with diabetic cake recipes.

Are diabetic patients more prone to developing certain health complications?

1 person diagnosed with kidney failure every 5 hours in Singapore

  • Every five hours, a person here is diagnosed with kidney failure.
  • According to figures from the Renal Registry, 1,730 people suffered renal failure last year, an increase from 1,657 the year before, reported The Straits Times
  • At least one new dialysis centre had to be set up every year for the past few years to cope with the rising numbers.
  • According to the National Kidney Foundation's latest annual report, there were 424 people on the kidney transplant waiting list in 2013, but only 68 received a transplant.
  • NKF encourages more friends and families to donate their kidneys as out of the 68, 34 were from cadaveric donors and the other 34 were from living donors.
  • The rise in the number of obese Singaporeans has resulted in more cases of diabetes and a corresponding increase in kidney patient numbers.
  • The NKF is building five more dialysis centres to add to the existing 25 and they will be operational by next year.
  • Most of their patients are poor and cannot afford the high cost of treatment.
  • Thus, 40 per cent of them pay nothing, 20 per cent pay $50 or less a month, and the rest pay whatever they can afford, according to the NKF's 2014 annual report.

Long-term diabetes can affect the heart, blood vessels, kidneys and eyes, and lead to coronary heart disease, stroke, kidney failure, blindness, numbness, skin ulcers and erectile dysfunction.

Cardiovascular disease continues to be the leading cause of death among diabetics in adults.

In 2009, 46.4 per cent of patients here who suffered their first heart attack were diabetic.

Diabetes also increases the likelihood of erectile dysfunction by three times. Chronic pain was found to be prevalent in 60 per cent of female diabetics and 38 per cent of male diabetics.

How serious can diabetes get if it is left untreated?

Advanced kidney failure will lead to a need for dialysis.​Photo: The Straits Times

Besides the symptoms of diabetes causing discomfort and the increased risk of complications, if left untreated, diabetes can result in coma and death.

Advanced kidney failure will lead to a need for dialysis. If the toes or feet become gangrenous, limbs will need to be amputated.

What is the worst case of diabetes you have seen?

If the toes or feet become gangrenous, limbs will need to be amputated. Photo: The Straits Times

An elderly lady with diabetes who had kidney failure and gangrene of her toes, which led to amputation of both legs.

She fell into depression after becoming wheelchair-bound.

The suffering she went through, and the distress the disease caused the family, made me realise how destructive diabetes can be.

What is in your arsenal to fight diabetes and the health complications that come with it?

Besides lifestyle modification, oral medications or insulin injections may be necessary to control the blood sugar, blood pressure and cholesterol levels.

When treating diabetes, the co-morbidities must also be treated. For example, I prescribe statins such as Lipitor for high cholesterol, Viagra for erectile dysfunction, Celebrex for chronic pain, and anti-hypertensive medication for high blood pressure.

Patients may need laser treatment for eye complications to prevent blindness.

For those with kidney complications, regular monitoring of their kidney function is needed to prepare them for dialysis.

Smoking increases the risk of complications. Hence, smoking cessation is also important.

fjieying@sph.com.sg

Dr Philip Koh is the chairman of the medical board at Healthway Medical Group.


This article was first published on Dec 5, 2016.
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