Virtual health talk sheds light on facts, misconceptions and misunderstanding about disease
Diabetes is a condition that affects how one’s body can turn food into energy.
WE often hear about diabetes and its relation to sugar, but do any of us really understand the disease and how it occurs?
In reality, diabetes is often misunderstood.
Not every case is due to over-consumption of sugar – an assumption that may have derived from the Malay term for diabetes, ‘kencing manis’ (literally, ‘sweet urine’).
A virtual health talk, which was recently conducted by Lions Club International–District 308-A2, Region 4 of Zone 9, shed some light over the subject.
Moderated by local Lions Club member Le Jia Jia, the session had general ophthalmologist Dr Chieng Lee Ling, general physician Dr Tan Jie En and dietician Chai Sheau Ping – all from Miri Hospital – as the key speakers.
Cases on the rise
Dr Tan says the number of diabetes cases recorded in Malaysia is on the rise – latest data from the National Health and Morbidity Survey shows that one in five people aged 18 and above, has diabetes.
According to Dr Tan, the number of diabetes cases recorded in Malaysia is on the rise – the latest data from the National Health and Morbidity Survey shows that one in five people aged 18 and above, has diabetes.
This translates into 3.9 million adults in the country having this disease.
“A cause for alarm here is that one in two individuals with diabetes never knew that they had the disease, until diagnosis,” she pointed out during her segment of the virtual talk.
Analysing the prevalence of cases based on ethnicity, she said the survey listed the Indian community as having recorded the highest percentage at 31.4 per cent, followed by the Malays at 21.6 per cent, Chinese at 15.1 per cent, Sarawak Bumiputeras at 12.2 per cent, Sabah Bumiputeras at 11.1 per cent, and other groups at 8.6 per cent.
Meanwhile, the National Diabetes Registry Report 2020 stated that from the total of 1,698,683 diabetics enrolled, 99.03 per cent of them were diagnosed with Type 2 Diabetes Mellitus (T2DM), followed by those with Type 1 diabetes at 0.59 per cent, and other types at 0.06 per cent.
The majority of the patients diagnosed with T2DM were aged between 55 and 59, constituting 16.59 per cent from the total, while the average age of diagnosis was 53.
Female patients, of both T1 and T2, made up a huge percentage of diabetics enrolled, at 57.02 per cent, with the percentage of male patients at 42.99 per cent.
By definition
A medical assistant administers insulin injection to a patient with diabetes. — AFP photo
Diabetes is a condition that affects how one’s body can turn food into energy.
Naturally, most of the food entering the body would be break down into sugar – or glucose – before being released into the bloodstream. When the body’s blood sugar goes up, it would signal the pancreas to release the hormone insulin, which acts like a key that would allow blood sugar enter the body’s cells to be used as energy.
As mentioned earlier, there are two types of diabetes – Type 1 and Type 2.
Type 1, also known as ‘juvenile diabetes’ or ‘insulin-dependent diabetes’, is a condition where the pancreas fails to produce sufficient amount of insulin.
Type 2, commonly known as T2DM, is a condition where the cells fail to respond to insulin properly or are resistance against insulin. Gradually, the pancreas fails and is unable to produce enough insulin to keep up with the demand of converting sugar into energy.
T2DM causes the sugar level to remain high in the blood as it (sugar) cannot be converted into and used as energy.
Dr Tan said that in many T2DM cases, the individuals never knew that they were diabetics.
She listed a number of identifiable risk factors such as the family history, abnormal blood cholesterol/lipid levels, and history of gestational (pregnancy) diabetes.
“If a person is more than 40 years old, he has every reason to have regular blood sugar checks to see whether he is a diabetic, or close to being one,” she pointed out, while listing frequent urination, excessive thirst, increased hunger, experiencing significant weight loss, tiredness, lack of interest and concentration, numbness in the hands and feet, having blurred vision, getting frequent infections and suffering from slow-healing wounds as common symptoms of diabetes.
“It is crucial to understand that high-sugar level can easily produce a viable environment for bacteria to thrive; therefore, a person with diabetes, if he’s not careful, would get frequent infections.”
Misleading beliefs
Diabetes has emerged as one of the fastest-growing global health emergencies of the 21st century, affecting the lives of over 537 million adults and being the cause of death of 6.7 million people around the world in 2021.
However, Dr Tan expressed concern about some people who were still misled by the myths surrounding diabetes.
One myth, in particular, stated that an overweight or obese person would develop T2DM.
In this regard, Dr Tan stressed that while obesity could be a risk factor, there were other aspects as well.
“It is a fact that there are people with T2DM who have average weight, or are slightly overweight,” she said.
Another misleading belief was that the medication for diabetes could damage the kidneys, said Dr Tan.
“Such thing is seriously misleading as it may cause diabetic patient to not take any of the medication prescribed to them, doing more harm than good.
“This is actually the most-asked question amongst the public.
“The medication does not harm the kidneys. It is the high level of blood sugar that is harmful not only to the kidneys but also to other vital organs in the body.
“Pairing the medication with healthy lifestyles is necessary for diabetics to keep their blood sugar level under control because only by getting it under control can they prevent the complications of diabetes,” she said.
Understanding insulin
According to Dr Tan, there are cases where insulin injection functions as an add-on to the existing treatment of a diabetic. — AFP photo
Dr Tan also addressed the enquiry about insulin shots.
“One must understand that this actually depends on the types of cases. For Type 1 patients, they require insulin shots from the start as the pancreas produces little or no insulin.
“As for those with T2DM, several conditions would warrant the administration of insulin shots – the functions of the pancreas may decline over the years and oral medication alone may not be good enough.
“Thus, there are cases where the insulin injection functions as an add-on to the existing treatment.”
Nonetheless, Dr Tan said regardless of Type 1 or Type 2, obtaining consultation from the doctors and identifying the most viable treatment would be crucial.
Loss of sight
Dr Chieng delivers his presentation.
In his segment, Dr Chieng started off by warning that both Type 1 and 2 diabetics would become blind if they failed to take care of their health accordingly.
He pointed out that in 2020, diabetic retinopathy represented four per cent of the total identified causes of blindness around the world; in Malaysia, however, the percentage was already at 10 per cent, based on data in the National Eye Survey 2013.
“The reason behind this shocking figure, I believe, was due to the lack of awareness of blindness caused by diabetes,” stressed Dr Chieng.
“Only half of the total known diabetics would do eye examination once every six to 12 months; 36.4 per cent of them would do it once every one to three years; 8.1 per cent would only undergo eye examination once in more than three years,” he added.
According to the ophthalmologist, there are four major complications from diabetes that can adversely affect sight, namely the development of cataract, eye stroke, glaucoma and diabetic retinopathy.
Amongst the four, diabetic retinopathy constituted the majority of cases, said Dr Chieng.
MyHEALTH, the online portal unit of Ministry of Health, defines this condition as retinopathy (damage to the retina) caused by complications from diabetes.
Specifically, having too much sugar in the blood over time can damage blood vessels throughout the body, including in the retina – the light-sensitive layer of tissue at the back of the inner eye. In turn, damaged blood vessels can swell and leak fluid into the retina, which can cause poor vision and eventually, lead to blindness.
Dr Chieng said the condition would usually start off with no early signs, but gradually the symptoms would appear and it would get worse from there.
The symptoms would include having blurry or double vision, experiencing pain or pressure in one or both eyes, and also seeing rings, flashing lights, or dark, floating or blank spots in one’s vision.
A condition called macular edema may occur in a diabetic retinopathy, where the macula, the central part of the retina, swells from the leaking fluid and thus, causes blurred vision.
When new vessels grow on the surface of the retina, they can bleed into the eye and cause vision impairment as well.
Dr Chieng said based on reported cases, about 80 per cent of Type 1 and T2DM individuals would develop diabetic retinopathy. In this regard, he stressed that regular eye-screening must be done, so as to help arrest deterioration to the eyes.
“Currently, there’s no way to stop the progression of diabetic retinopathy, but there are ways to slow down the progression and they include having good control of one’s sugar, blood pressure and cholesterol levels, exercising regularly, and going for regular check-ups.
“Ninety-eight per cent of diabetic retinopathy cases could be prevented, I assure you; more importantly, those with diabetes must seek the relevant treatment in a timely manner,” he pointed out.
Blood sugar control
Chai says the most crucial part of meal-planning for a diabetic is monitoring the total carbohydrate intake.
Notwithstanding the earlier notes about the misunderstanding over the relation of diabetes and sugar intake, checking one’s blood sugar levels is still crucial in finalising a diagnosis.
Moreover, keeping one’s blood sugar levels close to normal would prevent many complications.
In her segment, Chai listed meal-planning as amongst the dietary principles in blood sugar control.
“Diabetics are highly discouraged to avoid missing or skipping their meals, because regular meal-times are meant to synchronise with medication times.
“Perhaps the most crucial part of meal-planning is monitoring the total carbohydrate intake, which is the primary strategy towards achieving good blood sugar control,” said the dietician.
“The food that provides sugar in blood comprises mainly carbohydrates which, in turn, can be divided into two groups – refined sugar and complex carbohydrates.”
Elaborating, she said products with refined sugar content would cover all types of sugary treats such as sweet biscuits, cakes and ice-cream; those with complex carbohydrates would be items that might not taste sweet but after being digested by the body, they would release sugar into the blood vessels – examples of such food would be rice, bread, milk, fruits, noodles and all types of potatoes.
“Maintaining good blood sugar control involves having regular meal-times and at the same time, controlling one’s carbohydrate intake.
“Diabetics have no choice but to strictly follow the recommended intake of carbohydrates in their diet to control their blood sugar level.
“This is what the Health Ministry advocates in its ‘Suku-Suku Separuh’ (Quarter-Quarter-Half) concept of ‘an ideal healthy plate’ – a quarter consists of rice (or other options of carbs), another quarter comprises good proteins (fish, meat, poultry, eggs or tofu), while the remaining half-portion is filled with vegetables and fruits.
“Also recommended is drinking eight glasses of water daily.
“Initially, this concept was introduced as ‘a diabetic plate’, but over time, it has proven to be beneficial to the healthy people too,” said Chai.
Another means to make meals more suitable for a diabetic’s diet is replacing a regular food item with a better, healthier variety – such as replacing white rice with wholegrain brown rice or basmati rice, or getting wholemeal bread instead of the typical white bread.
Not without setbacks
Nonetheless, Chai also pointed out the danger of complacency amongst those with diabetes in terms of meal-planning.
“There have been cases where diabetics were successful in getting their blood sugar level under control after adopting good meal plans, but later, they began to take things for granted and gradually, this led to them losing all control over the very thing that they had worked hard to achieve.”
As per recommended by the Health Ministry, the targeted blood sugar levels for those with Type 1 and 2 diabetes.
For Type 1, the seemingly ideal blood sugar range should be four to eight millimoles per litre (mmol/L) when fasting or before taking meal, and 5 mmol/L to 10 mmol/L after meal (at least 1.5 hours).
For Type 2, the target range is between 4.4 mmol/L and 7 mmol/L when fasting or before taking meal, and 4.4 mmol/L and 8.5 mmol/L after meal (at least 1.5 hours).
“For a diabetic, if the check-up result showed good blood sugar control, it means that the dietary modifications along with the medication are working well.
“The intention behind good meal-planning is to get the diabetes under control, enabling the patient to enjoy a long, healthy life ahead,” said Chai.
from Borneo Post Online https://bit.ly/3pFpaXA
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