DIABETES

A lot of people live with Diabetes. Even worse, there are a fair number of people who are actually Diabetic but only realise it when they get checked for another medical complaint. This is why it's important to get your health screening blood tests done regularly!

WHAT IS DIABETES?

Diabetes is a metabolic disorder in which your body doesn't process dietary sugar normally. There is a deficiency of the hormone Insulin, which helps in the regulation of your blood sugar levels, and as a result, your blood sugar levels can swing either way, to be either too low or too high. Either extreme of the range is dangerous for you. We'll go through this in a bit more detail later on in this article.

People with Diabetes tend to be overweight, and also suffer from some poor lifestyle factors like an unhealthy diet, and a sedentary lifestyle. They tend to have a higher Insulin resistance in their tissues, which means that their tissues are more resistant to the effects of Insulin. This usually results from obesity.

When you do not watch your diet and indulge in refined sugars on a regular basis, your body tends to store more fat, and this causes Insulin resistance. Not exercising also reduces our Insulin sensitivity, thereby increasing our Insulin resistance.

Your pancreas (an organ in your body that produces Insulin) then has to work harder to produce more Insulin to make up for this Insulin resistance. Given enough time, this organ will fatigue and its ability to secrete Insulin will become insufficient. When that time comes, you may need to receive Insulin injections.

WHY SHOULD I BOTHER?

Diabetes is dangerous because of the complications it can cause. Over time, overly high blood sugar levels will cause damage to your blood vessels, affecting your organ function.

Some of the dangerous complications include heart attacks, strokes, kidney failure, blindness, numbness in your hands and feet, foot ulcers and infections, and diabetic comas (caused by very high or very low sugar levels).

Also, the complications caused tend to be permanent. For example, if you are unfortunate enough to develop kidney damage because of having poorly-controlled Diabetes for an extended period, it is permanent. Its progression can be slowed down by managing your chronic medications and taking some special medications, but it never really improves back to a normal level of function. As it progresses, you may even go on to require regular dialysis sessions since your damaged kidneys can no longer perform their normal functions.

Some of these complications are also actually LIFE-THREATENING, like if you get a heart attack or a bad foot infection.

There isn't such a thing as 'the not-so-bad' kind of Diabetes. All Diabetes will progress and worsen if left untreated and un-managed, and all people with poorly-controlled Diabetes will go on to develop medical complications from it at some point in their lives.

Control your Diabetes, and don't let it ruin your life!

WHAT SHOULD I DO?

LIFESTYLE CHANGES

YOU are in charge of your health. YOU control the food that goes in your mouth, the exercises you do (or don't do) and the lifestyle choices you make every day. You can have the best doctor in the world, and the best medications, but if you do not do your best to live a healthy lifestyle, everything else is in vain.

DIET

You are what you eat. If you eat junk food, you're going to have terrible health, and there's really no way around that. If you eat healthy foods on a regular basis, you'll be able to live a longer, healthier life.

You should aim to have a healthy diet which is LOW IN REFINED SUGARS, SALT AND UNHEALTHY FATS, and HIGH IN FIBER with a BALANCED INTAKE OF HEALTHY FAT, LEAN PROTEIN AND COMPLEX CARBOHYDRATES. We have several articles on how to eat healthy, please do check them out under our 'Diet' section.

Refined sugars (like those in cakes, pastries, white bread and white sugar) and unhealthy fats can cause obesity, and increase your risk of developing Insulin resistance, and Diabetes.

Stick with complex carbohydrates for your meals, such as Basmati rice, multigrain bread, and pasta.

Try to look for foods with a 'Healthier choice' logo, or those with a 'Low-GI foods' label. These complex carbohydrates are healthier, and reduce your risk of developing Diabetes, or of having it worsen.

A high dietary salt intake increases your risk of developing Hypertension, and together with Diabetes, it increases your risk of developing heart and kidney disease.

Unhealthy food tastes good, mostly because of the high fat, salt and sugar, and the amount of processing the food goes through before it reaches you. All these things make the dish taste good, but they're really bad for you.

On the other hand, while there are several ways of making healthy food taste good, some people feel that these health foods can never be as palatable as the comfort foods they are used to enjoying.

It can be difficult to stay disciplined with a healthy diet because of things like this. Try to take small steps, and make little changes to your diet. Over time, you'll find you get used to eating healthy foods, and may actually find junk food unpalatable because of how oily, salty or sweet they are.

A lot of people also feel motivated to continue with a healthy diet once they start losing some of the extra fat they've accumulated.

Stay disciplined!

EXERCISE

Exercise (done right) is good for you. It'll help you to maintain a healthy weight, reduce your risk of developing some chronic medical conditions, improve your general health, and improve your mood. There's so many reasons to maintain a regular exercise routine, and so many benefits for you to gain.

It's difficult to get going with regular exercise if you aren't a very active person, and it's also difficult for some people to set aside some time for exercise a few days in the week because of their work and family commitments. Just remember that nothing worth having comes easy.

Exercise is good for you, and if you can make the time to try and keep fit, after doing it for some months, you will see a definite improvement in yourself, and you'll be happy you put in the time and effort to make this change.

Try to do a mix of aerobic and anaerobic exercises, 3 to 5 days a week. A mix of different kinds of exercises helps you lose weight faster, rather than doing the same exercise every day. Check out our 'BASIC EXERCISE' page to get started.

SMOKING

Smoking is a big no-no for your health. It may help you to feel good, and alleviate some stress, but it is terribly bad for your health.

Cigarette smoke contains chemicals KNOWN to cause CANCER. If you smoke, and continue to smoke, there is actually a pretty high chance that you are going to develop a smoking-related cancer, such as lung or colon cancer.

It's also bad for your general health, and increases the risk of you developing clogs in your blood vessels, which can cause heart attacks and strokes. This risk is a lot higher when you have chronic medical conditions like Diabetes, Hypertension and Hyperlipidemia.

Try and quit smoking if you can, and if you need some help, speak to your local drug store pharmacist. They can prescribe some Nicotine lozenges and patches to help wean you off your habit.

HOW DO I CHECK

FOR DIABETES?

Head down to your neighbourhood clinic to ask them about the blood tests they can do to check if you have Diabetes. Most clinics offer a generic health screening package that includes a fasting sugar level to check for Diabetes. Speak to the clinic staff to find out when you can get yours done, and remember to fast overnight before doing your blood test.

You should consider starting this health screening once you hit 40 years old, and you can do this health screening package every year. You may even want to start doing your health screening panel earlier if you have a very strong family history of Diabetes.

HOW DO I MONITOR MY DIABETES?

There are two ways to monitor your Diabetes. One is done by your doctor, and the other by you.

Every 3 to 6 months, your doctor will do a 'HbA1c' check. This stands for 'Glycated Haemoglobin', is a percentage value, and indicates your Diabetes control over the past 3 months.

A reading above 7% indicates that your control can be improved, although your doctor may opt to allow for a higher reading for some special cases. The higher your percentage value is, the worse your Diabetes control is.

It changes at an earliest of every 3 months, so checking it earlier will not indicate very much.

This blood test can only be done by clinics, so there currently isn't any machine that you can buy and use to check this value at home. It is usually checked by taking a blood sample, but there are now some clinics that are able to perform this check with a simple fingerprick test in the clinic.

Your doctor will also check some other important things like your blood pressure, cholesterol levels, and kidney function at least annually.

On your part, you can get a simple 'Glucometer', which is essentially a kit to check your blood glucose levels at home.

There are several steps to take in using it, so do check with the pharmacist in the store you get it from, or bring your machine down to your neighbourhood clinic and ask them to run through how to use it with you. Make sure you write the steps down so you don't forget how to use it.

You can monitor your glucose readings at home, and can consider checking it at some intervals:

(i) before a meal (breakfast, lunch or dinner),

(ii) 2 horus after a meal,

(iii) before bedtime, and

(iv) if you feel very giddy or unwell.

You can check your glucose readings once to twice daily, and alternate the timings that you check your readings on that day (for example, you could check your pre-breakfast and bedtime readings today, and your pre-lunch and post-dinner reading tomorrow).

- Prior to a meal, your fasted sugar readings should be between 4 and 7 mmol/L.
- 2 hours after a meal, your blood sugar readings should be between 5 and 7.8 mmol/L (but may go up to 10 mmol/L).
- Before going to bed, your blood sugar readings should be between 4 and 8 mmol/L.

- If you feel giddy, you should check your blood sugar level to make sure it is not too low ( < 4 mmol/L).

Print out this chart, and write down the time you took your glucose readings, and the values. You can bring this chart along to show to your doctor at your check-up, so your doctor can adjust your medication doses for you. You can also download the chart by clicking here.

WHAT DO I DO IF MY BLOOD SUGAR LEVEL IS LOW?

Hypoglycaemia can happen when you miss a meal, take too much medication, or when you are unwell.

Your blood sugar level will drop below 4 mmol/L before you start feeling symptoms. You may feel giddy, have cold sweats, and feel as though you are about to pass out. If your blood sugar level drops too low, you may actually faint.

You should try to have some snacks nearby in case this happens. Start by taking a sugary drink (such as 'Milo' milk) to quickly push up your blood sugar levels, and then take some slower-digesting carbohydrates (like a biscuit) to maintain this rise in blood sugar.

Pop down to your neighbourhood clinic to get checked, and find out what the cause of the low blood sugar was. Your medication doses may need to be adjusted, so if you are visiting a clinic you do not normally go to, do remember to bring your Diabetes medications along.

You must be aware of the symptoms of low blood sugar levels, because they can actually be dangerous if they drop too low and are left untreated.

ANNUAL EYE AND FOOT CHECKS

People with Diabetes are at risk of developing some problems in their eyes and feet.

The abnormal blood sugar levels can affect the blood vessels in your eyes, and lead to vision problems if left untreated. You can reduce your risk of this by maintaining a good level of control over your Diabetes.

However, you should still go for annual eye checks at your neighbourhood polyclinic, where they will check your visual acuity (by asking you to read some numbers off a chart), and take a photograph of the lining of your eye to check for any abnormal changes.

If there is a problem, you'll have to see an eye specialist, as some patients may need some kind of treatment like 'laser therapy'.

Diabetes can also affect your nerves, causing numbness in your hands and feet.

In your foot, this numbness can be dangerous, because if you accidentally step on something and get a small cut, your Diabetes can cause the wound to quickly fester and become infected, and infections tend to progress faster and take longer to recover in Diabetics.

Your neighbourhood polyclinic nurse will help you check your foot sensation with a special plastic filament, to see which areas of your feet are at risk of getting an ulcer. You should go get this check done every year.

You can also supplement this annual foot checks by checking your own feet every day, looking for small cuts and wounds, and seeing a doctor to get these wounds checked and dressed.

DO I NEED MEDICATIONS?

Most people with overt Diabetes do actually require medications, even with a strict diet and exercise regime.

Your doctor may start off by asking you to try lifestyle changes if you are in the 'pre-diabetic' range, but if your blood tests don't look good, you may need to start taking some medications straightaway to help you control your blood sugar levels faster.

There are different kinds of medications, that work through different mechanisms to control your blood sugar. All have potential side effects, although not everyone suffers from these side effects. Speak to your doctor about the medications you can try and any potential side effects.

If you are one of the unfortunate few to have some side effects with your medications (like some diarrhoea with a medication called 'Metformin'), do go back and see your doctor and let them know what you're going through.

The worst thing you can do is to simply stop the medication and just ignore your condition until the next doctor's review. Your Diabetes will progress unhindered, and may be in a worse state when you see your doctor.

WILL I NEED INSULIN INJECTIONS?

Unfortunately, the disease process is such that you may eventually go on to require Insulin injections to control your blood sugar levels. It depends on your blood tests, and how your 'HbA1c' readings progess with time.

Diabetes ultimately leads to 'pancreatic insufficiency', where your body's organ is unable to produce a sufficient quantity or Insulin to keep up with your metabolic requirements.

This does happen in people who have been Diabetic for a very long time, as the organ may eventually 'fatigue'. If you've been controlling your diet and trying to live a healthy lifestyle, you do not need to feel bad about eventually requiring Insulin - it is simply part of the Diabetes disease process, and nothing to be ashamed of.

Another group of people who may need Insulin injections are those who do not take care of their health and medical conditions.

Some people neglect to take their medications, miss doses, forget to exercise, and make poor diet choices on a regular basis. These lifestyle factors will cause your Diabetes to worsen, and Insulin injections may actually be the only way to control your blood sugar levels then.

You may still continue to be on some oral medications, which can be taken together with Insulin injections. Your doctor will go through your medication regime with you, and decide what oral medications should still be continued.

SICK DAY PLAN

You also need to have a ‘sick day’ plan. This is what you should do when you are unwell with a flu or upset tummy.

First off, you should speak to your doctor about which medications to avoid when you are sick, as some medications can potentially cause a kidney injury or trigger a diabetic crisis if you are unwell or dehydrated.

You should monitor your blood glucose levels intensively, roughly every 4 to 6 hours. Your blood sugar levels can go either way, to become dangerously low or high when you are unwell, and both can trigger a Diabetic crisis, when you need to be managed in a hospital.

As above, your normal blood sugar levels should be:
- Prior to a meal, your fasted sugar readings should be between 4 and 7 mmol/L.
- 2 hours after a meal, your blood sugar readings should be between 5 and 7.8 mmol/L (but may go up to 10 mmol/L).
- Before going to bed, your blood sugar readings should be between 4 and 8 mmol/L.

You should continue with your medications, and coax yourself into eating at your normal mealtimes. If your appetite is poor, you can take in a simple carbohydrate meal (like
'Milo' milk or white bread) to maintain your blood sugar levels.

Apart from food, it is very important to maintain your hydration! Make sure you drink adequate amounts of water through the day (you can aim for approximately 1.5 L of water, although you may have some restrictions on the amount of fluid you can drink if you have heart or kidney disease. Your doctor can tell you more based on your medical condition.)

However, if you are at risk of dehydration (If you have a lot of vomiting or diarrhea), there are some medications that should be stopped, like some blood pressure medications (ACE-inhibitors or ARB medications, and diuretics) and diabetic medications (like Metformin), as there is a risk of triggering a kidney injury or Diabetic crisis. Your doctor can go over your list of medications with you and give you some instructions.

If your blood sugar levels can rise to dangerous levels, it can cause a Diabetic coma. Some warning signs would be worsening nausea and abdominal pain, or extreme lethargy or even confusion. If you notice these signs in yourself or your loved ones, you need to go to a hospital immediately.

WRAP IT UP!

Diabetes is a difficult condition to manage, as it involves you making a lot of significant changes in your lifestyle. Take heart, for this condition, your health really is in your own hands. If you are strict with your diet, exercise regularly, take your medications, and go for your regular check-ups, you should be able to manage it well and slow down its progression.