Diabetes Mellitus

What is Diabetes?
Diabetes is a condition caused by the lack of the hormone insulin produced by the pancreas, or when the hormone is ineffective. It is a common chronic disease - one of the top ten-killer diseases in Singapore.

What Does Insulin Do?
Insulin is required to move glucose from the bloodstream into the body cells for usage or storage. When this fails, diabetes develops. The high amount of glucose in the blood leads to the glucose being spilt over into the urine, hence forming a 'sweet urine'.

What are The Negative Effects of Diabetes?
The high blood glucose level in diabetes produces chemical reactions in the small blood vessels and nerves, causing reduced blood flow to many organs and nerve damage. The high blood glucose also makes it easier for germs to multiply and weaken the immune system. All these lead to many serious complications such as high blood pressure, heart attack, stroke, kidney failure, blindness, coma, impotence, infections with poor healing, numbness of hands and feet, and wounds on feet that do not heal, leading to amputations.

Are There Different Types of Diabetes?
Yes. The main types of diabetes are Type 1 and Type 2. Type1 is the more serious type where the person does not produce any insulin at all due to damaged pancreatic cells of which the cause is unknown. This type occurs commonly in childhood and adolescence but may also occur in elderly people. They need constant insulin injections and complications are more sudden and life-threatening.

Most diabetics are Type 2. It occurs more frequently in people over 40 years old, particularly those who are overweight and physically inactive. The insulin produced is not enough or not effective enough. This type of diabetes may be controlled with proper dieting and exercise but most diabetics will also need oral medication.

What are The Risk Factors For Diabetes?
There is no clear cause of diabetes, but medical studies show that you are more likely to get it if you

have a family member with diabetes
have high blood pressure (>140/90 mmHg)
have high blood cholesterol (>5.2 mmol or 220mg/dl)
are overweight (body mass index >25)
have a history of heart disease
do not exercise regularly
are over 40 years of age
smoke

Signs and Symptoms of Diabetes

Regardless of your gender or race, see a doctor to test for diabetes if you have the any of the following symptoms:

frequent thirst despite drinking lots of water
passing excessive urine during day and night
constant hunger
weight loss despite good appetite
constant tiredness
poor healing of skin cuts and wounds
itchy skin especially around the genital area
Note that some diabetics may not experience any symptoms at all.

Diagnosis of Diabetes
If you have any of the risk factors or any of the signs and symptoms listed above, consult your doctor to have your blood checked. If you are over 40 years of age, check your blood glucose level at least once every 3 years.

Control of Diabetes
Diabetes is a life-long disease. It cannot be cured but it can be controlled to prevent the development of the many serious complications by :

proper diet - your doctor or dietician will advise you to take multiple (4-6) small meals a day that is low in salt, sugar, fat and oil but contains enough complex carbohydrates (e.g. rice), some lean meat or fish and vegetables.
weight control - lose extra body weight by wise dieting and careful exercise. Insulin works better in a lean healthy body.
medicine - you may need oral tablets and/or insulin injections as prescribed by your doctor. Follow the instructions very carefully and keep detailed records of your treatment.
home blood glucose monitoring -your doctor will monitor your progress with the help of your daily home blood glucose records. This will show if you condition is under control or you need more medicines or further change in diet.
regular exercise -this helps your body to use glucose more efficiently, but you have to check with your doctor on the type of exercises you can do. Start slowly and maintain a regular exercise programme and be careful of how much to eat and when to take your medicines around your exercise time.
quit smoking -smoking increases all the risks associated with diabetes.
reducing high blood pressure and high blood cholesterol level -these will help to keep diabetes under control and protect against its complications.

This article is contributed by Singapore Medicine.

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