Health + Wellness

Misconceptions and complications of Diabetes

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The Active Age spoke with Dr Chua Chong Bing, a Family Physician from Healthway Medical (Lengkong Tiga) about diabetes. Part one of the Q&A can be found here. This is part two of the Q&A.

The Active Age (AA): What are some misconceptions surrounding diabetes?

A diabetes diagnosis means you automatically need insulin: This is the case with Type 1 diabetes but not with Type 2 diabetes. 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, regularly exercising, 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 WHO, an estimated 1.6 million deaths were directly caused by diabetes in 2016.

Eating too much sugar causes diabetes: Any diet high in calories—from sugar or another source—contributes to weight gain. Weight gain increases your Type 2 diabetes risk. While it would be beneficial to eat less sugar, simply eating too much sugar 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.

You will need dialysis: When you have diabetes, the blood vessels in your kidneys suffer damage, which means 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 to prevent. Tight blood sugar control can lower the risk of all diabetes complications, including kidney failure.

People with Type 2 diabetes cannot eat sugar: It is true that people with Type 2 diabetes should eat a healthy diet, and these diets are generally low in sugar. However, it may not be necessary to avoid sugar entirely.

AA: What are some of the common food and beverage choices that contribute to the onset and aggravation of diabetes?

Dr Chua: Studies have shown that diets heavy in junk food—characterised by soft drinks and fries increases the risk of Type 2 diabetes.

Several types of food are also known to increase the risk of Type 2 diabetes. These include:

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 bran and fiber, as well as healthy vitamins and minerals
  • To reduce your risk, limit your intake of foods made with processed carbohydrates, such as breads, muffins, cakes, crackers, and pasta, in favour of whole-grain options.
  • Try to limit the intake of gravy, sauces and syrups as these can contain added sugars.If possible, cut down on portion sizes.
  • Eat half a portion of your regular meal – this includes your char kuey teow or chicken rice as it will limit your caloric intake

Sugar-sweetened drinks

  • Sugary beverages like 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 increase insulin resistance.
  • According to the Health Promotion Board, drinking an additional 250ml of sugar-sweetened beverages every day increases a person’s risk of diabetes by 18 to 26 percent.
  • One of the best ways to minimise the effect of sugar on your health is to limit your intake of sugar-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 and tea “siu-dai” (with less sugar) or “kosong” (with no sugar) to reduce your sugar intake further.
  • Another way to reduce your sugar intake is to look at the nutritional facts label on the back of packaged food or drinks. You would be surprised to find the amount of sugar that is added into sauces, juices, salad dressing, cordials, and even health drinks!

Red and Processed Meats

  • Red meat and processed meat are both 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 color) could directly increase the risk of diabetes.
  • Processed meats such as bacon and hot dogs contain high levels of chemicals such as nitrates and nitrites, which could trigger insulin resistance.
  • While it’s not necessary to completely remove meat from your diet, you should reduce the daily intake for these types of meat, and switching to other sources of protein. For example, chicken breast, salmon, small fish such as sardines, small portions of poultry and eggs, and occasional beef 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 having low levels of calories. Other plant-based proteins such as nuts and seeds, seafood and dairy products are also viable alternative to red meat.

AA: What are the complications associated with diabetes?

Dr Chua: Long-term complications of diabetes develop gradually. 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.

There are two types of complications, namely complications affecting large blood vessels, and small blood vessels.

Large blood vessel complications include: Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including 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 your limbs.

Small blood vessel complications include:

Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Kidney damage (nephropathy): The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. 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 which supply nutrients to the eye. These vessels 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.

AA: How does diabetes medication work?

Dr. Chua: Anyone who has Type 1 diabetes needs lifelong insulin therapy. Insulin cannot be taken orally to lower blood sugar because stomach enzymes will break down the insulin, preventing its action. Therefore, patients will need to receive it either through injections or an insulin pump. Oral medication is not effective for this type of diabetes.

If you have Type 2 diabetes, your body makes insulin but is unable to use it well. Diabetes pills work in three ways:

  • To help your body to use insulin better by increasing the body’s sensitivity to insulin
  • To increase the production of insulin, or
  • To get rid of extra sugar in your blood

The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have, and your doctor might combine drugs from different classes to help you control your blood sugar in several different ways.

AA: What else can be done to manage the disease, aside from medication?

Dr. Chua: If you have diabetes, you will need to carefully track your diet to prevent blood sugar levels from getting too high. This generally means watching carbohydrate intake as well as limiting over-processed, low-fiber 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.

AA: What is 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 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.

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