As mentioned in our previous article, diabetes is on the rise in Singapore and inadequate management and poor education results in many individuals with prediabetes progressing to the next stage of the disease in the coming years. Another shocking statistic is that nearly four Singaporeans undergo diabetes-related amputations a day. However, as the first line of defence against diabetes, doctors are sharing their insights on the topic and we continue our conversation with Dr Chua Chong Bing of Healthway Medical to find out what are some of the myths and some realistic ways to manage the disease.
Q: What are some misconceptions surrounding diabetes?
|A diagnosis of diabetes means you automatically need insulin
|This is the case for Type 1. In some cases, proper diet, exercise and oral medications can keep Type 2 diabetes under control for some time before insulin becomes necessary. The key to managing the disease is to make a lifestyle change. That means no smoking, adopting healthier eating habits, exercising regularly, taking medications on time and tracking your progress regularly with your family doctor.
|Diabetes is not serious
|Diabetes is, in fact, a serious disease and is a major cause of blindness, kidney disease, heart attacks, stroke and amputations. According to the World Health Organization (WHO), an estimated 1.6 million deaths in 2016 were directly caused by diabetes.
|Eating too much sugar causes diabetes
|Any diet high in calories – from sugar or another source – contributes to weight gain, which increases one’s risk of Type 2 diabetes. While it would be beneficial to eat less sugar, simply eating too much sugar alone does not cause diabetes.
|“I’m not overweight, so I won’t get diabetes”
|While staying slim dramatically reduces the risk of getting diabetes, individuals with a healthy weight can still develop diabetes. Genes can play a role and having an excess of visceral fat (fat around the organs of your body) could lower your insulin sensitivity, putting you at risk of Type 2 diabetes.
|Those with diabetes need dialysis
|With diabetes, the blood vessels in your kidneys suffer damage, which means that they will no longer effectively filter your blood. Left untreated, this can result in kidney failure and the need for dialysis to clean out waste from your bloodstream. This is an outcome that all doctors are trying to help their patients prevent. Tight blood sugar control can lower the risk of all diabetes complications, including kidney failure.
|Those with Type 2 diabetes cannot eat sugar
|While it is true that people with Type 2 diabetes should eat a healthy diet and that these diets are generally low in sugar, it may not be necessary to avoid sugar entirely.
Q: What are some of the common food and beverage choices that contribute to the onset and aggravation of diabetes?
Studies have shown that diets heavy in junk food – characterised by soft drinks and fried foods, increases the risk of Type 2 diabetes. Several types of food are also known to increase the risk of Type 2 diabetes, including:
|Highly processed carbohydrates
|Heavily processed carbohydrates such as those made with white flour, white sugar and white rice, are essentially whole foods stripped of important brain and fibre, as well as healthy vitamins and minerals. To reduce your risk, limit your intake of such foods in favour of whole-grain options.
Also try to limit the intake of gravy, sauces and syrups as these can contain added sugars.
|Sugary beverages such as sodas and sweet teas are linked to an increased risk of Type 2 diabetes. The excess calories lead to weight gain and the sugar load might also increase insulin resistance. According to the Health Promotion Board, drinking an additional 250ml of sugar-sweetened beverages everyday increases a person’s risk of diabetes by 18 to 26%.
One of the best ways to minimise the effect of sugar on your health is to limit your intake of sweetened beverages, including fruit juices. When choosing your food or drink at the coffee shop or grocery store, look out for the Healthier Choice symbol, which indicates that it is a healthier option compared to others. While at the coffee shop, order your coffee or tea “siu-dai” (with less sugar) or “kosong” (without sugar) to further reduce your sugar intake.
Another way to reduce your sugar intake is to read the nutritional facts label on the back of packaged foods and/or drinks. You’ll be surprised at the amount of sugar added to sauces, juices, salad dressings, cordials and even health drinks!
|Red and processed meats
|Both red and processed meats are linked to Type 2 diabetes. It is suspected that the high heme levels in red meat (the substance which gives red meat it’s scarlet colour) could directly increase the risk of diabetes. Processed meats such as bacon and hot dogs contain high levels of nitrates and nitrites, which could trigger insulin resistance. While it is not necessary to completely remove meat from your diet, you should reduce the daily intake of these types of meat and switch to other sources of protein. For example, poultry, fish and eggs can all be incorporated into a healthy diet with a substantial serving of vegetables. Furthermore, soy-based proteins such as tofu and tempeh contain high amounts of protein while being low in calories.
Q: What are the complications associated with diabetes?
Long term complications of diabetes develop gradually and the longer you have diabetes (and the less controlled your blood sugar), the higher the risk of complications. Diabetes destroys your blood vessels from the inside out. Without healthy blood vessels, essential nutrients and oxygen cannot reach their target organs, and the organs slowly begin to fail.
The complications affect the large and small blood vessels and include:
|This includes heart disease peripheral vascular disease and stroke by increasing the risk of plaque formations in the blood vessels, causing blockages that restrict blood flow to the heart, brain and sometimes the limbs
|Nerve damage (neuropathy)
|Excess sugar can injure the walls of the capillaries that nourish the nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers, gradually spreading upwards.
|Kidney damage (nephropathy)
|The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from the blood and this delicate filtering system can be damaged by diabetes. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
|Diabetic blindness (retinopathy)
|The eyes contain very fine blood vessels supplying nutrients to the eyes and are easily blocked by plaques, causing the slow death of the cells in the eye, leading to blindness.
By keeping your blood glucose level in a healthy range through meal planning, physical activity and medications, you can avoid long term complications of diabetes.
Q: How does diabetes medication work?
Those with Type 1 diabetes need lifelong insulin therapy and patients will need to receive it either through injections or an insulin pump as insulin cannot be taken orally (the stomach enzymes will break down the insulin).
As for those with Type 2 diabetes, the body produces insulin but is unable to use it well. The medication thus work in 3 ways:
- Help the body to use the insulin better by increasing the body’s sensitivity to insulin
- Increase the production of insulin, or
- Get rid of extra sugar in the blood
The decision about which medications are best depends on many factors, including the patient’s blood sugar level and any other health problems. As such, your doctor might combine drugs from different classes to help control the blood sugar in several different ways.
Q: What else can be done to manage the disease, aside from medication?
If you are diabetic, you will need to carefully track your diet to prevent blood sugar levels from getting too high. This generally means watching your carbohydrate intake as well as limiting over-processed and low-fibre foods.
If you have Type 1 diabetes you will need to manage your glucose levels by matching your insulin to your diet and activity. If you have Type 2 diabetes, you may manage your blood sugars with diet and activity alone or add medications as needed.
Getting on top of your condition and managing it effectively is key to controlling its symptoms and preventing more serious health problems. As diabetes is a progressive disease that may require re-evaluation and change in the treatment plan over time, which also means frequent visits to the doctor are necessary. This regular maintenance can be costly and deter individuals from seeking medical advice, which can aggravate the condition.
With the introduction of CHAS Green, all Singaporeans regardless of income bracket will be eligible for subsidies for chronic conditions such as diabetes at general practitioner (GP) clinics located island-wide. This will help lighten the financial burden on families, and hopefully improve the management and education of this disease. GPs will also work with each patient to develop a holistic treatment plan to help control their blood sugar levels.
Q: Why the importance of consistently monitoring the disease and what individuals with diabetes should look out for on a daily basis?
Monitoring and keeping track of blood glucose levels is very important because it’s the main form of keeping diabetes under control. To avoid the complications of diabetes, you must control your blood glucose very well to minimise the risk of excessively high sugar levels. This will allow you to prevent the complications of diabetes.
Patients who use insulin must be mindful to not skip meals, especially if you’ve already given yourself an insulin shot, as your blood sugar may go too low. Patients who don’t use insulin must also not skip meals, especially if you are taking certain diabetes medications which can cause your blood sugar to plunge (hypoglycaemia), causing dizziness and fainting.
You should also review your progress with your family doctor. It is recommended that you take have fasting blood tests at least twice a year. This will help your doctor to intervene as necessary, and to prevent the many complications of diabetes.
Tracking your daily diet and exercises may also help you during your visits to the doctor, to help provide doctors with more detailed information on your condition before they develop a customised treatment plan for you.
To find out more about Healthway Medical clinics, please visit https://www.healthwaymedical.com/gp-family-medicine/.