NAVIGATION

The Essentials of Diabetes

Benhao DONG, Medical Director of Inpatient Services, Chair of Internal Medicine, Internal Medicine Physician

Diabetes is a chronic condition in which blood sugar levels are higher than normal (hyperglycemia), as a result of either the body not producing enough insulin – a hormone which regularly removes excess glucose from the blood – or because the body does not respond to the insulin that is produced.

How does this seemingly harmless sugar problem affects your health?

Diabetes increases the risk of heart disease and stroke. About 50% of people with diabetes die from a cardiovascular disease, primarily heart disease and stroke.

Diabetic neuropathy, or damage to the nerves as a result of diabetes, affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. It most commonly affects lower limbs, particularly the feet and the legs. This increases the chance of foot ulcers and eventual limb amputation.

Damage to the retina in the eye (retinopathy) caused by diabetes is a significant cause of blindness. Blindness from diabetes can occur as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind and about 10% develop severe visual impairment.

Moreover, diabetes is among the world’s leading causes of kidney failure. About 10-20% of people with diabetes die of kidney failure. The overall risk of death amongst people with diabetes is at least double the risk of their peers without diabetes.

Although incurable and potentially deadly, all types of diabetes can be manageable to minimize the complications mentioned above through a combination of correct lifestyle choices, maintaining a healthy body weight and medication.

What are the different types of diabetes?

  • Type I diabetes

Type I diabetes is related to insufficient insulin production. The exact cause of Type I diabetes is unclear and it is not preventable. A patient with Type I diabetes requires a daily injection of insulin.

  • Type II diabetes

Of all the people with diabetes in the world, 90% have Type II diabetes. This form of diabetes is caused by a combination of genetic and environmental factors. The condition results from the body’s ineffective use of insulin.

  • Gestational diabetes

Gestational diabetes is a condition in which women have elevated blood sugar level (hyperglycemia) during pregnancy. It is usually detected during pre-natal screening. This condition confers a high risk of developing diabetes later in life.

  • Pre-diabetes

Pre-diabetes describes the intermediate stages between normal blood sugar regulation and diabetes. This condition is usually found during a health screening. Early recognition and management of pre-diabetes may slow down the progression to or even prevent the development of full-blown type-II diabetes.

Who is at risk for diabetes?

Some people are more at risk than others. Consider getting screened for diabetes if you:

  • Are 45 years old or older
  • Are overweight (with a body mass index of 25 or greater)
  • Have a family history of diabetes in a first-degree relative
  • Are habitually physically inactive
  • Have delivered a baby weighing more than 4.1 kilograms (9 pounds)
  • Have a history of gestational diabetes
  • Have hypertension (blood pressure ­140/90 mmHg)
  • Have dyslipidemia – an abnormal amount of fat and cholesterol circulating in the blood
  • Have pre-diabetes
  • Have polycystic ovary syndrome
  • Have a history of vascular disease

What can you do to prevent diabetes?

You can actively prevent diabetes from happening to you. Minimize your chances of getting diabetes through regular physical exercise to achieve and maintain the optimal body weight for your stature. Changing your diet will also help to prevent diabetes. Consult a dietician to create an appropriate diet. In addition, certain medications may reduce your likelihood of developing diabetes. Please talk to your doctor for more information about these options.

Should you be diagnosed with diabetes, there are several important things you can do to maintain your health. First, create a diet and exercise routine that you can stick with. Maintaining a healthy lifestyle is even more important than medication. Make sure that you schedule regular follow-up appointments with your doctor to ensure you are doing the right things for your diabetes. Diabetics should schedule an annual eye exam to detect retina damage and prevent blindness.

Always remember the ABCs of diabetes management:

  • A is for the HbA1C

Your HbA1C is a reliable measure of your average blood sugar in the last 8-12 weeks. A doctor can use your HbA1C to determine how well you are managing your blood sugar. Aim for a target of less than 7% on your HbA1C test.

  • B is for Blood Pressure

The target blood pressure for diabetics is less than 130/80mm Hg.

  • C is for Cholesterol

Your LDL (low density lipoprotein) target for diabetics is less than 2.58mmol/L (100mg/dL). LDL can be called ‘bad’ cholesterol. Too much LDL in your blood will deposit fat in the arteries and reduce blood flow.

If you have been just diagnosed with diabetes…

Do not panic. Remember that diabetes management is a long-term process in which you have some control. The complications mentioned above result from chronic, uncontrolled diabetes.

Do not feel overwhelmed by the amount of new information you have received. Dealing with diabetes is like learning to drive a car. You must learn the basics first, such as how to start the car and how not to veer off road. Your doctor is your instructor who fine tunes your skills by adding new lessons as you feel comfortable with learned ones step by step.

Do not delay treatment. You may have few or no symptoms before the diagnosis is made, but early evaluation is crucial for avoiding health complications that are already developing.

Do not lose hope. Having diabetes does not necessarily mean you can’t enjoy the food you like. With proper diet management, you can learn how to achieve a lifestyle with which you’re comfortable without interfering with your glycemic control.

References:

1. UpToDate

2. http://www.diabetes.org

3. WHO, Media Centre, Diabetes, January 2011