Diabetes is a medical condition in which the blood glucose levels remain persistently higher than normal. It is becoming more common in Singapore

This may be due in part to ageing population, unhealthy diets and lack of exercise.

Insulin is a hormone produced by the pancreas that allows your body cells to use blood glucose (sugar) for energy. Food is converted into glucose before it is absorbed into our bloodstream. The pancreas then releases insulin to move the glucose from the bloodstream into the body cells for use or storage. People with diabetes are unable to fully use the glucose in their bloodstream because:

• they lack insulin in the body

• insulin is ineffective for them

Types of Diabetes

There are three major types of diabetes:

Type 1 Diabetes

• no insulin is produced due to damaged pancreatic cells

• usually diagnosed in children or young adults although it can occur at any age

• insulin is needed for treatment

• complications are sudden and life-threatening

Type 2 Diabetes

• insulin produced is not enough or not effective (insulin resistance)

• occurs more frequently in people over 40 years old, particularly those who are overweight and physically inactive

• more younger adults and children are developing Type 2 Diabetes

• can be controlled with proper diet and exercise but most diabetics also need oral medicationg

Gestational Diabetes

• Occurs in about 2 to 5 percent of all pregnancies. Women who were not diagnosed to have diabetes previously show high blood glucose levels during pregnancy.

• Needs specialised obstetric care to reduce serious complications to the unborn baby.

Signs and Symptoms

The common symptoms of diabetes are:

• frequent thirst despite drinking lots of water

• constant hunger

• constant tiredness

• itchy skin especially around the genital area

• passing excessive urine during day and night

• weight loss despite good appetite

• poor healing of cuts and wounds

Complications

Uncontrolled diabetes can lead to high blood glucose (hyperglycaemia) and low blood glucose (hypoglycaemia). Both situations can cause a diabetic to become very sick very quickly and even go into a coma.

The long-term complications of diabetes include:

• coronary heart diseases such as angina or heart attack

• stroke

• eye disease

• kidney disease

• foot disease such as numbness, ulcers and even gangrene

• nerve disease which can lead to problems such as impotence and diarrhoea

Screening and Diagnosis

Diabetes can be detected through a blood glucose test.

You have diabetes mellitus if your

• random blood glucose is 11.1 mmol/L or higher

• fasting blood glucose is 7.0 mmol/L or higher

Treatment

Diabetes is a life-long disease. It can be controlled if you do the following:

Your diabetes may be controlled through diet or a combination of d iet and medication. Follow your doctor's instructions on diet and/or medication.

Oral medication

All medicines must be taken regularly at the correct dosages at the prescribed times as advised by your doctor. Examples of medicines for diabetes are:

• Sulphonylureas (SUs)

• Non-SU Secretagogues

• Biguanides

• Alpha-Glucosidase Inhibitors

• Thiazolidinediones

As with all medicines, sometimes side effects such as skin rashes, eye swelling, vomiting, diarrhoea may occur and these have to be reported to your doctor at once.

Insulin

There are different types of insulin. Some are short-acting and others are long-acting, while still others are a mixture of both. Your doctor will prescribe the exact amount of the specific types of insulin you need.

• Follow instructions carefully and do not make any changes without consulting your doctor.

• Always keep all insulin bottles plus an extra spare bottle in the refrigerator when not in use.

• Short-acting insulins by themselves or as part of a mixture need to be injected about 30 minutes before a meal.

Self-care

A diabetic person has to take extr a care of his body to maintain good health.

Foot Care

As a diabetic, you have a higher risk of foot problems. In serious cases, it can lead to amputations. Taking care of your feet is very important:

• Wash your feet daily with soap and water.

• After washing, dry them fully, especially in between the toes.

• Keep your toe nails short, trimming them straight across to avoid ingrown toenails.

• Moisturise your feet daily to prevent dryness and cracking of the skin.

• Examine your feet daily for scratches, cuts, blisters and corns. Use a mirror to check the sole of your feet.

• Use shoes that fit well and wear clean cotton socks which have loose fitting elastic tops.