Sweet danger

Diabetics must take responsibility in managing the disease, writes Aneeta Sundararaj
380 million diabetics in the world today

You’ve just returned from a party where you ate and drank with abandon. Yet, you need to have something sweet before you turn in for the night. You open the fridge and reach out for that piece of cake. Then, it’s off to bed.

Have you ever wondered, though, whether such indulgence may cause you to develop diabetes some day?

“Diabetes is now an epidemic,” says Dr Loong Yik Yee (consultant physician and gastroenterologist). He does not mince his words when he adds: “People are just lazy.

They take the easy way out with everything. They opt for fast food all the time and don’t exercise. They can’t even be bothered to walk across the hall to talk to their colleagues. They use their handphones to call instead. They don’t understand how bad diabetes can be.”

What is diabetes?

“People think they have diabetes when their urine is sweet or there is too much sugar in their blood. This is not entirely correct,” he explains.

Diabetes is a metabolic disease where the body does not produce or properly use insulin (a hormone needed to convert sugar into energy). Diabetes is characterised by high levels of blood sugar.

Three main types Type 1 diabetes (also called “Juvenile-onset Diabetes”) manifests mainly in children. It is where the body’s immune system attacks and destroys its own insulin-producing cells in the pancreas. A person with Type 1 diabetes requires daily injections of insulin to live.

Type 2 diabetes (also called “Adult-onset Diabetes”) occurs when the body makes enough insulin, but cannot use it effectively.

The third type is gestational diabetes. As the name suggests, it occurs during pregnancy and disappears when the pregnancy is over. That said, those who have gestational diabetes are at a greater risk of developing type 2 diabetes later in life.

Dangerous complications “The World Health Organisation says that there are 380 million diabetics in the world today and this number is set to rise,” says Dr Loong. “It is the complications of diabetes such as heart attacks, blindness and kidney failure that are terrible. The worst, I think, is when they suffer from strokes and become paralysed. Can you imagine what it’s like to have half your body alive and the other half dead?”

Other complications range from peripheral nerve damage, painful muscle wasting and cataracts to retinal detachment, optic nerve damage, urinary tract infection and possible kidney failure.

Of particular interest to consultant vascular surgeon Dr Liew Ngoh Chin, is a condition called neuropathy. When this occurs, a patient may not feel any sensation in the feet.

Worse, if his diabetes remains uncontrolled, the patient may end up having the limbs amputated.

As such, in addition to all the recommended forms of treatment, Dr Liew now advocates a consultation with a podiatrist. “There are very few podiatrists in this country, but they are so important because a patient’s foot reflects his systemic problems.”

A podiatrist will show the diabetic how to take proper care of his feet and this will include acquiring proper footwear, preventing callouses and trimming one’s nails.

Holistic management Dr Chan Siew Pheng (consultant endocrinologist) suggests that healthcare professionals look at the management of diabetes as an organic whole: “It is no longer acceptable to manage diabetes alone. It is necessary to manage a patient’s hypertension and cholesterol levels as well. Each causes its own problems. But when a person has all three, you have what’s called the deadly triad.

Also, diabetics must not expect instant gratification. They must understand that proper control in the initial stages of diabetes will translate to protection for the heart for the next 10 to 20 years. In this way, we can reduce the risk of the patient developing other diseases like cardiovascular disease and strokes.”

Dr Chan has developed a novel method to help diabetics manage their disease: “They must know their ABCs,” she says. A stands for A1c test (also known as HbA1c test).

This test will give you results that reflect your average blood sugar levels over a three month period. “Many people will fast a few days before the blood is taken and the ‘fasting blood’ test will show that things are OK. With the A1c test, we can get a more accurate picture of their blood sugar levels.”

B stands for blood pressure and C is for cholesterol. Needless to say, Dr Chan insists that these be kept under control as well.

Dr Hew Fen Lee (consultant physician and endocrinologist) goes one step further and insists that education is the cornerstone of diabetic treatment. Healthcare professionals must teach a diabetic about his disease and how he should take responsibility for managing it.

Dr Hew also quotes the Diabetes Prevention Programme which studied the effects of diet, exercise and a drug called Metformin on the onset of type 2 diabetes. “The study found that those who were given metformin had a 31 per cent reduction in the progression of the disease.

Those who were asked to exercise 150mins a week (30mins, 5 times a week), had a 58 per cent reduction in the progression of the disease,” says Dr Hew.

On the need for people to exercise, Dr Hew again goes a little further: “Asking people to exercise alone is of no use. A lot of them will say yes and do nothing. But even those who want to, sometimes they have no place to go to exercise. Although we have parks, the issue is safety. When we read of crimes happening in parks, people become scared and won’t go there.”

Healthy body, healthier mind Dr Hew wants people to change their mindset. “We should inculcate a culture of sports that is not limited to excellence. This means that we should concentrate on the importance of exercise and not those who excel. Just concentrating on sporting heroes is not enough. Get people to move their bodies a little more. Some employers are already investing in gym memberships for their staff.”

Dr Hew illustrates the importance of the points he makes in the following way: Say you employ a driven and motivated 30-year-old executive in your company. Over the course of the next 20 years, he works at least 12 hours a day and hardly takes time off. Throughout, your sales skyrocket. In time, the employee has become an indispensible member of your team. The problem is, by the time he’s 50, he is a chronic diabetic. All the profits the company has gained are being eaten away because, as a responsible and caring employer, the company will have to fund the employee’s medication and make financial provision for future hospitalisation for treatment of complications of diabetes.

If this situation continues unabated, and no one takes this epidemic seriously, diabetes will cripple the health budgets of most developed and developing countries.

Myths about diabetes

Myth 1: Western drugs used to treat diabetes are bad.
Dr Chan Siew Pheng says that, on the contrary, these drugs work and can improve a diabetic’s quality of life.

Myth 2: Supplements are better than medicines
Supplements are just that. They will not cure you of the disease.

Myth 3: Diabetes will not kill you.
Diabetes alone may not kill you, but its complications certainly will. Dr Chan remains frustrated that many people do not see that link between diabetes and an early death.

Myth 4: There is no need to seek treatment for diabetes
Many are in denial and refuse to seek treatment for diabetes. The lack of urgency may result in more complications of diabetes arising than is necessary.

Who should be screened for diabetes?

In addition to those who may have symptoms of diabetes, the following too should be:
• A person who is above 35 years old
• A person who is obese
• A person who has a BMI (Body Mass Index) of more than 25
• People suffering from hypertension or high cholesterol
• Those who have a family history of diabetes
• Women more than 24-weeks pregnant
• Women with a history of gestational diabetes
• Women who suffer from Poly-Cystic Ovarian Syndrome

Source: Aneeta Sundararaj