diabetes

Dr Chin Shi Yei, Primary Care Doctor

1 November, 2023

Access to Diabetes Care

Diabetes is a chronic condition that arises when the pancreas fails to produce sufficient insulin or when the body can’t effectively use the insulin it produces. Insulin acts as a key, regulating blood glucose by allowing it into cells for energy. In the absence of enough insulin or when cells resist its effects, excess blood sugar accumulates.

Hyperglycemia, also known as elevated blood sugar, is a common consequence of uncontrolled diabetes. Over time, it inflicts severe damage, particularly to the nerves and blood vessels.

Plasma glucose issues encompass a continuum, progressing from prediabetes (including impaired fasting glycaemia and impaired glucose tolerance) to full-blown diabetes mellitus.

Types of Diabetes

diabetes

Type 1 diabetes

Type 1 diabetes, previously referred to as insulin-dependent, juvenile, or childhood-onset diabetes, arises due to insufficient insulin production, necessitating the daily administration of insulin. Researchers believe it results from an autoimmune reaction in which the body mistakenly attacks itself, disrupting insulin production. Type 1 diabetes affects approximately 5-10% of individuals with diabetes. It can manifest at any age, although it commonly begins in childhood, and its symptoms typically emerge rapidly.

diabetes

Type 2 diabetes

Type 2 diabetes, previously known as non-insulin dependent or adult-onset diabetes, disrupts the body’s utilization of sugar (glucose) for energy. It hinders proper insulin usage, potentially causing elevated blood sugar levels when untreated. Roughly 90-95% of diabetes cases are type 2, and it typically develops over several years. Many risk factors contribute, including excess weight, insufficient exercise, and genetic factors. Notably, what was once primarily an adult condition is now becoming more prevalent among children.

diabetes

Gestational diabetes (diabetes while pregnant)

Pregnant women who have never had diabetes can develop gestational diabetes. These women face an elevated risk of pregnancy and delivery complications. Furthermore, both these women and potentially their children are at a heightened risk of developing type 2 diabetes later in life. Diagnosis of gestational diabetes relies on prenatal screening, not reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG)

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) represent intermediate stages in the progression from normal blood sugar levels to diabetes. In these cases, blood sugar levels exceed normal but don’t reach the threshold for a type 2 diabetes diagnosis. Individuals with IGT or IFG face a significant risk of advancing to type 2 diabetes, although it’s not an inevitable outcome.

Symptoms of Diabetes

Symptoms of diabetes may occur suddenly. In type 2 diabetes, the symptoms can be mild and may take many years to be noticed. 

Feeling very thirsty

Needing to urinate more often than usual

Blurred vision

Feeling tired

Losing weight unintentionally

Complications of diabetes

Diabetes progressively harms blood vessels in the heart, eyes, kidneys, and nerves. Individuals with diabetes face an elevated risk of health complications such as heart attacks, strokes, and kidney failures. It can also inflict permanent vision loss by harming eye blood vessels. Nerve damage and impaired blood flow often result in foot problems for many with diabetes, potentially leading to foot ulcers and, in severe cases, amputation.

Screening and Diagnosis

Healthcare professionals should conduct diabetes screening for both symptomatic and asymptomatic individuals with risk factors. The early detection of diabetes can be achieved through cost-effective blood glucose testing.

Screening tests involve the use of capillary plasma glucose, while diagnostic tests encompass fasting blood glucose, the Oral Glucose Tolerance Test (OGTT), and HbA1c measurements.

Treatment/Care

Managing diabetes involves crucial lifestyle adjustments like regular exercise, weight control, and a healthy diet.

Type 1 diabetics depend on insulin injections, while Type 2 diabetics may use medications like metformin, sulfonylureas, SGLT-2 inhibitors, alongside medications for blood pressure and statins to reduce complications.

4 Steps to manage diabetes in your life

A healthcare team can help you manage diabetes through clinic visits, routine medical testing, lifestyle education, nutritional advice, or counselling. But, when all is said and done, you’ll likely spend much more time on self-care than on clinic visits. You have the most power concerning your diabetes management.

Step 1: Learn more and understand your diabetes
★ Know type of diabetes you are having
★ Learn where you can go for support
★ Learn how caring for your diabetes helps you feel good today and in the future.
Step 2: Know your diabetes ABC
A – A1c Test, B – Blood pressure, C - Cholesterol

★ Know what your A1C, blood pressure, and cholesterol numbers are and what they should be. Your ABC goals will depend on how long you have had diabetes, other health problems, and how hard your diabetes is to manage.

★ What you can do to reach your ABC goals
★ Write down your numbers to track your progress.
Step 3: Learn how to live with diabetes
★ A healthy meal plan
★ Ways to be more active
★ Know how and when to test your blood sugar and how to use the results to manage your diabetes
★ Discuss how your diabetes plan is working for you each time you visit your health care team
Step 4: Get routine care to stay healthy
★ Regular follow up with tests ordered by health care team (eg blood tests, blood pressure check, foot exam, dental exam, eye exam etc)
★ Vaccinations (flu, pneumonia, Hepatitis B etc)
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Diabetes care is a lifelong responsibility and managing diabetes can be challenging and requires awareness. The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations and plan accordingly. Wherever you’re at with your diabetes, know that you have options and that you don’t have to be held back. You can still live your best life. All you have to do is take action and stick with it.

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