Are You At Risk?

Diabetes & sugar

The World Health Organisation has projected that 2.48 million Malaysians will have diabetes by the year 2030. Discover the truth about this deadly disease and protect yourself and your loved ones.

Zaifa Khatum Abdul Mohamed Ibnu, Diabetes Care Centre Diabetes Nurse Educator

Zaifa Khatum Abdul Mohamed Ibnu, Diabetes Care Centre Diabetes Nurse Educator

“If you eat too much sugar, you’ll get diabetes,” sounds like something your mum would tell you when you were younger to stop you from eating too many sweets. The truth is, there is much more to protecting yourself from diabetes than avoiding sweets.

Many people have the wrong ideas about the disease that affects so many Malaysians. According to the National Health and Morbidity Survey 2011, 2.6 million adult Malaysians (18 years and above) suffer from diabetes mellitus. Sunway Medical Centre’s Diabetes Care Centre Diabetes Nurse Educator, Zaifa Khatum Abdul Mohamed Ibnu helps to clear the air.

Insulin is the key

 According to Zaifa, diabetes mellitus — commonly referred to as diabetes — is a condition in which the body does not produce enough insulin (a type of pancreatic hormone) and is unable to respond properly to insulin action (insulin resistance). Therefore, this will result in an abnormally high level of sugar in the blood. There are two kinds of diabetes —Type 1 diabetes and Type 2 diabetes.

Type 1 diabetes is when the person is unable to produce any or very little insulin. Most of the time, the cause of it is unclear but it is believed that the body’s own immune system attacks and destroys the cells where the insulin is made.

Type 2 diabetes is the most common form of diabetes. It happens because the body is unable to produce enough insulin or is unable to respond to insulin action as well as it should (insulin resistance). Causes of Type 2 diabetes are linked to obesity, genetic risk factors, inactivity and age.

Type 2 diabetes

East Vs West

There are several risk factors that have been associated with Type 2 diabetes which includes a family history of diabetes, being overweight, indulging in an unhealthy diet, physical inactivity, age, high blood pressure, ethnicity, impaired glucose tolerance, history of gestational (pregnancy-related) diabetes and poor nutrition during pregnancy. Impaired glucose tolerance is a category of higher than normal blood glucose but below the threshold for diagnosing diabetes.

Zaifa says, “There are studies which show that Asians have a higher risk of developing Type 2 diabetes compared to those from the West. In fact, Asians are more likely to develop the disease even at a lower BMI (Body Mass Index). This higher risk is due to the fact that Asians — especially South Asians — naturally having less body muscle and more abdominal fat, which increases insulin resistance,”

This means that even though some Asian populations currently have a lower prevalence of being overweight or obese compared to populations in the West, statistics show that there is a disproportionately higher percentage of people with diabetes. “Currently, 60 percent of the world’s diabetic population are Asian,” Zaifa points out.

Storm clouds on the horizon

Common warning signs of diabetes include increased thirst, increased hunger (even after eating), dry mouth, frequent urination, unexplained weight loss, fatigue, reduced concentration, blurred vision, and headaches.

According to Zaifa, the development of Type 1 diabetes is usually sudden and dramatic while the symptoms can often be mild or absent in people with type 2 Diabetes, making this type of diabetes hard to detect.

Acanthosis Nigricans

Some individuals with Type 2 diabetes present with skin darkening (velvety discolouration) around their body fold and creases especially around the armpits, groin and neck. This is called Acanthosis Nigricans (see image 1). “This change typically occurs in people who are obese or have diabetes because obesity can cause insulin resistance, which may lead to high levels of insulin in the blood that affects the skin cells,” explains Zaifa. Insulin resistance can eventually lead to Type 2 Diabetes, therefore Acanthosis Nigricans can be an early sign that you have diabetes or are at risk of developing the condition.

Complicated relationship

It is very important to take action and control your diabetes once it has been diagnosed. Zaifa says that if your blood sugar level is not controlled well from the start, the long-term effects of having a high sugar level in the blood will compound. This will alter the mechanism of cells in the blood vessels and also increase the risk of atherosclerosis (build-up of fats, cholesterol on the artery walls).  The alteration of cells and increased risk of atherosclerosis, may lead to all kinds of health problems including stroke, heart disease, eye disease, kidney failure, nerve damage and sexual dysfunction.

If you think you display the signs and symptoms of diabetes, do not hesitate to see a general physician or an endocrinologist. The doctor will perform assessments based on your risk factors and symptoms (if any). Zaifa explains, “The common assessment is a fasting blood test (eight hours of fasting before the test) and the HbA1C test. The HbA1C test indicates how well your diabetes is being controlled with medication and/or lifestyle changes, and together with the fasting glucose test, will give a clear indication for type 2 diabetes,”

In some cases, the patient will be advised to do an oral glucose tolerance test (OGTT), a test where the first blood sample will be taken at the fasting level. Then the patient is given 75 mg of glucose water and a second blood sample will be drawn after two hours of ingesting the glucose water. This test is also used to test for gestational (pregnancy-related) diabetes

Words of wisdom

People with diabetes have reduced or impaired insulin function, therefore they must be diligent in their food choices especially their carbohydrate intake. They should avoid sugary drinks and food, take their medication on time, eat consistently and stick to consistent meal portions and eat at regular times, advises Zaifa.

Other than medication and diet, it is important to incorporate exercise at least three times a week at a minimum of 30 minutes per session. “Exercise can help with weight maintenance and help with insulin function. People with diabetes who are overweight or obese will need to exercise more often to reduce weight because weight reduction will reduce the fat level in their body which improves insulin function. Therefore, there is less need to take medication,”says Zaifa.

Additionally, people with diabetes will need to have regular follow-ups with their doctors at least twice a year to screen for other complications, to monitor the progress of the disease and ensure that they have the proper medication. Zaifa stresses that it is important to know that diabetes mellitus is a progressive condition which means that the insulin level and its functions may reduce over time. Thus, those who suffer from diabetes need to see their doctor regularly to he can monitor and possibly revise their diet and exercise routine as well as their medications.

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