Diabetes: what is it and what can be done to prevent it?

In 2019, diabetes was the ninth leading cause of death in the world, with an estimated 1.5 million deaths caused directly by diabetes. The number is still rising quickly today, as many countries are faced with an aging population. Diabetes is a major cause of blindness, kidney failures, heart attacks, strokes, and lower limb amputation. In this post, I will be talking about what exactly is diabetes and what we can do to prevent it.

Diabetes, also known as Diabetes Mellitus is a condition where the body is unable to produce sufficient insulin or is unable to respond properly to insulin, resulting in abnormally high levels of glucose in the blood. There is another condition known as diabetes insipidus, which is a condition characterized by large amounts of dilute urine and increased thirst. (Not to be confused with each other, and will be covered in another blog post!)

There are three main types of diabetes, namely type 1, type 2, and gestational diabetes.

• Type 1 diabetes is usually due to the body being unable to produce sufficient insulin and is present in children.

• Type 2 diabetes is the most common form of diabetes and is due to the body being unable to utilize insulin properly. It usually occurs later in life and can be prevented.

• Gestational diabetes occurs during pregnancy and goes away after giving birth. However, it can affect the baby’s health and increase the propensity of getting type 2 diabetes later in life.

Why should I care about it?

Diabetes is known for causing serious complications.

• 40% of stroke patients were diabetic

• 50% of heart attack patients were diabetic

• 66% of new kidney failures are diabetes-related

Common symptoms:

• Frequent hunger

• Frequent thirst

• Frequent urination

• Unexplained weight loss

• Constant and extreme fatigue

• Blurred vision

• Wounds healing slowly and poorly, increasing the risk of gangrene

• It is also a source of concern if ants appear to be attracted to your urine

Values related to blood glucose levels in your health screening report:

• Fasting glucose levels (taken in the morning before meals)>7.0 mmol/L

• Glucose levels 2 hours after meals >13.0 mmol/L

• HbA1c >7%

HbA1c refers to the percentage of glycosylated hemoglobin in the body, which is indicative of the average amount of glucose in the bloodstream over the past three months.

How do I know if I am at risk of diabetes?

• History of diabetes in the family (one or more parents with diabetes)

• The prevalence of diabetes increases with age

• Obesity. The most common way to determine if you are overweight is via your BMI.

  • BMI is measured using weight (kg) / (height (m) ^2)

  • For Asians, the cut-off point is BMI =23.5

How does one prevent diabetes/how can I better control my diabetes?

• Go for regular health screenings and checkups

• Eat-in moderation and choose healthier options.

  • Choose more whole grains

  • Eat more fruits and vegetables

  • Reduce intake of sugar and saturated fat

  • Meals should be smaller and taken at frequent times of the day

• Adopt an active lifestyle: stay fit by engaging in at least 150 minutes of physical activities weekly

• Aim for a healthy weight

• Do not smoke

• Limit alcohol intake

How can I prevent complications if I already have diabetes?

• Foot care:

  • Wash foot daily with soap and water

  • After washing, dry thoroughly, especially in between the toes

  • Keep toenails short, trimming straight across to avoid ingrown toenails

  • Moisturise feet daily to prevent dryness and cracking of the skin

  • Examine foot daily for injuries and open wounds

  • Use shoes that fit well and wear cotton socks that have loose-fitting elastic socks

• Eye care:

  • Go for regular eye checkups once a year

• Skincare:

  • Wash every part of the body while bathing using mild soap and warm water

  • Dry all parts of the body using a clean towel

  • Pay attention when washing and drying skin folds in areas such as under the breasts, abdominal folds, and groin area.

  • Apply moisturizing cream to make sure that the skin is moist and soft

• Dental care:

  • Brush your teeth twice a day minimally. Some suggest thrice a day after every meal but twice is the minimum

  • Use a soft toothbrush to prevent gum injury

  • Rinse your mouth every meal or snack

  • Do annual dental checkups

Pharmaceutical treatment:

The most commonly used oral medication to control type 2 diabetes is Metformin, which is a biguanide.

In Singapore, the brand name most frequently used is Glucophage. Metformin works by decreasing the absorption of glucose (a type of sugar) from the intestines, decreasing the production of glucose by the liver, and increasing the absorption of glucose by muscles and organs.

Other commonly used medications are:

1. Sulfonylureas (Glipizide) stimulate the release of insulin from the pancreas.
   

2. Dipeptidyl-peptidase-4 inhibitors (Linagliptin) prolongs the action of endogenous incretins and thus stimulates the pancreas to increase insulin release when high glucose levels are detected. It also suppresses glucagon release and glucose production by the liver.
   

3. Glucagon-like peptide-1 receptor agonist (Liraglutide) is frequently administered via subcutaneous injections and results in the initial rapid release of insulin by your pancreas. It also suppresses glucagon release and reduces appetite. It is seldom given simply because it is not an oral medication and is less convenient to administer at home.
   

4. Sodium-glucose cotransporter 2 inhibitors (Empagliflozin) reduce the reabsorption of filtered glucose in renal tubules. Patients taking medications in this class may notice ants being attracted to their urine.
   

5. Alpha-glucosidase inhibitors (Acarbose) can be given in pregnancy as they are not absorbed into the body. It slows down intestinal carbohydrate digestion and must be administered with food.

Of course, there are many other types of medication suitable for the treatment of diabetes. What the doctor prescribes usually depends on how suitable you are for the respective medications. Do check with your healthcare professionals if you have any inquiries regarding your diabetes medications.

Common FAQs regarding medicine use:

1. Is there a possibility that the dosage of my medicines will be lowered if I can control my blood glucose levels? Yes, but the likelihood of this is very small. Do not stop the medications on your own without supervision. Do clarify with your healthcare provider if you have any doubts.
   

2. Is the anti-diabetes medicine I'm taking addictive? No, and you have to take your medications as prescribed or your blood glucose will not be controlled.
   

3. My stomach feels uncomfortable after taking the pills. Is something wrong? Some medications may cause discomfort to the stomach. This is especially common when you first start on metformin. It can be prevented by taking the medication together with meals. If the discomfort persists and interferes with your quality of life, consult your healthcare professional to see if there are any alternatives that may be more suitable for you.
   

4. My friend/relative suggested that I take some herbs to help with diabetes. Can I take it together with my diabetes medications? Before you start on any herbs or complementary medications for diabetes, you should check with your pharmacist to prevent any complications that may be fatal.
   

5. I am taking oral medications for my diabetes. Does that mean I do not have to control my diet and can take as much sugar as I want? No, you still have to control your sugar intake to prevent your condition from worsening.

Insulin:

If your diabetes condition is still not controlled despite the above medications, your doctor may prescribe insulin. Insulin is a hormone usually produced by the pancreas that helps the body use sugar taken in via food for energy, or to store it for future use, controlling the amount of glucose in the bloodstream. The pancreas also secretes glucagon, which has the opposite effect as insulin.

There are four main types of insulin prescribed by the doctor:

1. Rapid-acting insulin which is used to control the high blood sugar observed after meals.
   

2. Fast-acting insulin, with similar use as rapid-acting insulin.
   

3. Intermediate-acting insulin which is used to control fasting glucose, keeping glucose levels lower between meals
   

4. Long-acting insulin, with has the same usae as intermediate-acting insulin but requires less frequent dosing because the effects can last longer.

A less widely used type of insulin is ultra-long-acting insulin.

The dosages are measured in units per kg. How much insulin is given is dependent on the patient’s blood glucose levels before insulin therapy, as well as the type of insulin prescribed.

If you are taking insulin, it is important to eat at regular times and not vary your diet too much in order to facilitate titration and to help your healthcare professionals determine how much insulin and medicines are needed.

Common FAQs regarding insulin use:

1. I heard that insulin is bad for you, so I don’t want to start on it. If it is suggested that you start insulin, you should start it and use it as prescribed as it is the most effective substance to control blood glucose levels. However, it is still important to control sugar intake, or the blood sugar level will still remain uncontrolled.

Complementary medicines

Common traditional Chinese medicines (TCM) herbs used:

1. Panax ginseng (Korean ginseng)

2. Momodica charantia (balsam pear)

3. Lagerania siceraria (bottle gourd)

4. Psidium gnajava

These herbs increase carbohydrate (sugar) metabolism and utilization, reducing the amount of glucose within the blood.

However, if you would like to try using these herbs, remember to consult your doctor or pharmacist. This is to prevent adverse effects such as hypoglycemia (low blood sugar).

Other useful methods present in TCM are:

1. Qigong: It emphasizes the connection between the mind and body. Specific Qigong exercises are present for diabetes.
   

2. Tuina: It stimulates acupuncture points in the body to create balance and harmony in the system. It also stimulates blood circulation which can prevent gangrene.

Essential oils:

Lavender oil has been used to heal wounds faster, reducing the likelihood of gangrene, one of the many complications of diabetes. It can also help with relaxation, which may also reduce the release of glucose into the bloodstream due to the action of stress hormones.

Many oils used in aromatherapy can also reduce infections that usually take longer to resolve in diabetic patients.

Hope the above information was useful in helping you understand diabetes better. Below are a few links and resources you can explore to know more:

• Buckle, J. (2001). Aromatherapy and diabetes. Diabetes Spectrum, 14(3), 124-126. (accessible here)

• Covington, M. B. (2001). Traditional Chinese medicine in the treatment of diabetes. Diabetes spectrum, 14(3), 154-159. (accessible here)

• Ji, L., Tong, X., Wang, H., Tian, H., Zhou, H., Zhang, L., ... & Yang, H. (2013). Efficacy and safety of traditional Chinese medicine for diabetes: a double-blind, randomised, controlled trial. PloS one, 8(2), e56703. (accessible here)