What is diabetes?



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Diabetes hit the headlines recently, after the Ministry of Health declared war against the disease. But how much do you know about this ailment?

Diabetes mellitus, commonly referred to as diabetes, is a long-term illness where there are high levels of sugar in the blood. The body needs sugar to make energy, and the hormone insulin controls the amount of sugar in the blood. A person with diabetes either produces too little insulin, or does not respond well to what is produced, leading to a build-up of sugar in the blood.

In Singapore, diabetes is the 10th leading cause of death. One out of nine people aged 18 to 69 has diabetes – that’s more than 400,000 people, and this number is projected to hit 600,000 by 2030. It can affect anyone of any age or race, although 90 per cent of those with Type 2 diabetes are over 40 years old.

If not managed well, diabetes can steadily deteriorate and cause severe complications; studies show that about half of patients have diabetes-related complications at the time of diagnosis.

Type 1
(Insulin-dependent diabetes) People with Type 1 diabetes cannot control their blood sugar properly because their pancreas produces little or no insulin as their immune system mistakenly destroys the cells that produce the hormone. Type 1is more common in young people and is often diagnosed in childhood, although it can affect older adults too. Treatment comprises daily insulin injections to control blood sugar. 

Type 2 (Non-insulin dependent diabetes) 
About 90 per cent of those with diabetes have Type 2, whose risk increases with age. People with Type 2 diabetes can produce insulin, except their body does not use it effectively due to genetics and an unhealthy lifestyle. Type 2 diabetes is linked to obesity and inactivity, but can be managed with diet, exercise and oral medication. If these fail, insulin injections may be necessary.

Gestational Diabetes Some women develop diabetes during pregnancy. While this usually goes away after the baby is born, it may return in future pregnancies. 

Dr Kevin Tan Eng Kiat, consultant at Kevin Tan Clinic for Diabetes, Thyroid & Hormones and vice-president of the Diabetic Society of Singapore, says having gestational diabetes puts you at a higher risk of developing diabetes in the years ahead – up to seven times more than women without gestational diabetes. 

Dr Soon Puay Cheow, senior consultant endocrinologist at Soon Diabetes, Thyroid and Endocrinology Clinic, says “this risk can drop to less than 25 per cent” if you can get back to a body mass index (BMI) of 19-23 after delivery.

Related: How to eat healthier during pregnancy

The risk of developing Type 2 diabetes is linked to family history and genetics – when both parents have the disease, it increases your risk by 50 per cent. But that doesn’t meant you are doomed to it.  

“There are things you can’t change, such as sex (diabetes affects more men than women) and age (diabetes is more common as you get older),” says Dr Tan. 

There are, however, things you can do to reduce your chances of the disease. “If you lead a sedentary lifestyle, start exercising. If you’re overweight, start eating better and lose weight. If you have medical conditions such as high blood pressure and high cholesterol, a healthy diet will help,” he adds.

If left untreated, diabetes can lead to severe complications:

Kidney failure, which requires dialysis. “Kidney complications from poorly controlled diabetes account for about half of the kidney-failure patients on dialysis in Singapore,” says Dr Soon. Kidney disease from diabetes starts with protein leaking into the urine. Over time, more protein leaks into the urine and your legs may swell. It comes to a point where you produce little urine and become breathless from the accumulation of water in the lungs. The kidneys finally shut down and that is when you’ll need dialysis. 

Eye damage, which can lead to retinopathy and blindness. In retinopathy, tiny blood vessels in the retina leak blood and other fluids, causing blurred vision. 

Peripheral vascular disease, which causes nerve damage that may result in the need to amputate the feet and legs, and narrowing of the arteries (atherosclerosis) which increases the risk of heart attack and stroke. 

High blood pressure, high cholesterol and smoking can worsen these complications.

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