While genetics and family history play a part in the chronic disease, there are ways to keep it at bay.
Diabetes mellitus, commonly referred to as diabetes, is a long-term illness where there are high levels of sugar in the blood. The body needs sugar to make energy, and the hormone insulin controls the amount of sugar in the blood. A person with diabetes either produces too little insulin, or does not respond well to what is produced, leading to a build up of sugar in the blood. In Singapore, diabetes is the 10th leading cause of death. One out of nine people aged 18 to 69 has diabetes – that’s more than 400,000 people, and this number is projected to hit 600,000 by 2030. It can affect anyone of any age or race, although 90 per cent of those with Type 2 diabetes are over 40 years old. If not managed well, diabetes can steadily deteriorate and cause severe complications; studies show that about half of patients have diabetes-related complications at the time of diagnosis.
Know the types
- TYPE 1 (INSULIN-DEPENDENT DIABETES)
People with Type 1 diabetes cannot control their blood sugar properly because their pancreas produces little or no insulin as their immune system mistakenly destroys the cells that produce the hormone. Type 1 is more common in young people and is often diagnosed in childhood, although it can affect older adults too. Treatment comprises daily insulin injections to control blood sugar.
- TYPE 2 (NON-INSULIN DEPENDENT DIABETES)
About 90 per cent of those with diabetes have Type 2, whose risk increases with age. People with Type 2 diabetes can produce insulin, except their body does not use it effectively due to genetics and an unhealthy lifestyle. Type 2 diabetes is linked to obesity and inactivity, but can be managed with diet, exercise and oral medication. If these fail, insulin injections may be necessary.
- GESTATIONAL DIABETES
Some women develop diabetes during pregnancy. While this usually goes away after the baby is born, it may return in future pregnancies. Dr Kevin Tan Eng Kiat, consultant at Kevin Tan Clinic for Diabetes, Thyroid & Hormones and vicepresident of the Diabetic Society of Singapore, says having gestational diabetes puts you at a higher risk of developing diabetes in the years ahead – up to seven times more than women without gestational diabetes. Dr Soon Puay Cheow, senior consultant endocrinologist at Soon Diabetes, Thyroid and Endocrinology Clinic, says “this risk can drop to less than 25 per cent” if you can get back to a body mass index (BMI) of 19-23 after delivery.
Do you know your risks?
The risk of developing Type 2 diabetes is linked to family history and genetics – when both parents have the disease, it increases your risk by 50 per cent. But that doesn’t meant you are doomed to it. “There are things you can’t change, such as sex (diabetes affects more men than women) and age (diabetes is more common as you get older),” says Dr Tan. There are, however, things you can do to reduce your chances of the disease. “If you lead a sedentary lifestyle, start exercising. If you’re overweight, start eating better and lose weight. If you have medical conditions such as high blood pressure and high cholesterol, a healthy diet will help,” he adds.
It can become complicated
If left untreated, diabetes can lead to severe complications: Kidney failure, which requires dialysis. “Kidney complications from poorly controlled diabetes account for about half of the kidney-failure patients on dialysis in Singapore,” says Dr Soon. Kidney disease from diabetes starts with protein leaking into the urine. Over time, more protein leaks into the urine and your legs may swell. It comes to a point where you produce little urine and become breathless from the accumulation of water in the lungs. The kidneys finally shut down and that is when you’ll need dialysis. Eye damage, which can lead to retinopathy and blindness. In retinopathy, tiny blood vessels in the retina leak blood and other fluids, causing blurred vision. Peripheral vascular disease, which causes nerve damage that may result in the need to amputate the feet and legs, and narrowing of the ar teries (atherosclerosis) which increases the risk of heart attack and stroke. High blood pressure, high cholesterol and smoking can worsen these complications.
New hope in treatments
New medications, both oral and via injection, are also being developed. “They may be more expensive but they help in weight loss and bring down blood glucose levels, without causing low blood sugar,” says Dr Tan. A new group of drugs, known as dipeptidyl peptidase-IV (DPPIV) inhibitors, works by preventing the release of glucagon-like peptide (GLP), a gut hormone, after a meal. “GLP increases insulin after eating, by slowing down intestinal contractions and allowing for the absorption of glucose,” explains Dr Soon.
“An injectable form not only controls diabetes but also helps reduce weight.” In Singapore, the latest group of diabetes drugs was launched this year; known as Sodium-glucose cotranspor ter-2 (SGLT2) inhibitors, they prevent some 90 per cent of glucose re-absorption from the kidneys. However, Dr Soon warns that these drugs should be avoided by patients with recurrent urinary infection or moderate to late stage kidney failure.
A more invasive treatment is bariatric surgery or surgical intervention for obese patients, says Dr Tan. “This comes close to a cure for Type 2 diabetes patients who are very overweight – usually with a BMI of above 30. The weight loss brought about by the surgery, together with other alterations in the body’s physiology, can lead to a reduction in medication for diabetes, blood pressure and cholesterol.” And a new method of administering insulin may just prove to be a breakthrough for the treatment of diabetes. “In the US, insulin is now available as a powder that can be inhaled via an inhaler device similar to what asthma patients use,” says Dr Tan.
“This has revolutionised the concept of insulin delivery and is a boon for people who are afraid of injections.”
Diabetes symptoms to look out for:
Many people with diabetes do not exhibit any symptoms, so be sure to go for regular check-ups and blood tests.
By Sunita Shahdadpuri, Simply Her, November 2015