What is Diabetes?
 

Image Credit: International Diabetes Federation 

World Diabetes Day is celebrated annually worldwide to increase public awareness about diabetes as a serious global health issue. The global sign for diabetes awareness is the blue circle signifying the community's collective response to the diabetes epidemic worldwide. World Diabetes Day is commemorated each year on 14 November, Sir Frederick Banting's birthday, along with Charles Best co-discovered insulin in 1922. 

CDC reported that 463 million people are diagnosed with diabetes worldwide. An estimation of 700 million people will have diabetes by 2045 worldwide. 1 in 5 persons in Malaysia has type 2 diabetes, according to the National Health and Morbidity Survey 2019.  

Diabetes is a chronic disease leading to increased blood glucose levels (sugar) due to ineffective insulin utilization by the body or insufficient insulin production by the pancreas. There are two types of diabetes- Type 1 Diabetes known as Diabetes Insipidus & Type 2 Diabetes known as Diabetes Mellitus. 

Deficiency in insulin production is a hallmark of type 1 diabetes which requires daily insulin therapy. Type 1 diabetes usually occurs during childhood, and its cause and means of prevention are unknown but it is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). On the other hand, Type 2 diabetes usually occurs in adulthood and results from the body's inefficient use of insulin. Type 2 diabetes is more common and affects more than 95% of those with diabetes. This type of diabetes is primarily caused by increased body weight and physical inactivity. 

Who is at higher risk of diabetes? 

People who are at higher risk of diabetes include: 

1. Age 45 years or older 

2. Those with a family history of diabetes 

3. African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander.

4. Overweight or obese 

5. Sedentary lifestyle: physically inactive or work that requires prolonged sitting 

6. Imbalanced diet (high in calories and low fiber intake) 

7. Prediabetic condition 

8. History of gestational diabetes (diabetes that develop during pregnancy or gave birth to a child that weighed at least 9 pounds) 

Do take note if you do experience these “4T” symptoms that may indicate diabetes such as:

1. Thirst- excessive drinking, unable to quench thirst

2. Toilet- frequent urination, especially at night 

3. Tiredness- feeling fatigue and excessive napping 

4. Thinner- increased weight loss over a short period of time 

5. Other less common symptoms- vision loss, vomiting, abdominal pain, mood swings, lack of focus, frequent infection 

These signs and symptoms can appear out of nowhere. Inform your doctor or local pharmacist who can help you do a finger prick glucose test for screening purposes or HbA1c test to confirm the diagnosis of diabetes. Symptoms of Type 2 diabetes may be frequently less severe and less marked compared to Type 1 diabetes. Hence Type 2 diabetes may not be easily discovered until complications have already developed. 

Risk factors & Adopting a healthy lifestyle  

Here are some tips to manage your diabetes using ABCs: 

1. A: Measure your average blood glucose level every 2-3 months. Maintain your blood glucose level within the target range as recommended by your doctor. 

2. B: Attempt to maintain a blood pressure of below 140/90 mm Hg (or the target your doctor sets).

3. C: Keep your cholesterol levels under control. 

4. s: Prevent or avoid smoking as smoking increases risk of diabetes and heart diseases. 

Daily lifestyle to prevent or delay type 2 diabetes: 

1. Healthy exercise- at least 30 minutes of regular exercise daily 

2. Achieve healthy body weight for those who are overweight or obese 

3. Maintain a healthy diet with sufficient nutrients and reduce intake of processed food, sugar and saturated fats 

Follow up with your healthcare professionals! 

Medications used by Type 1 diabetes is commonly insulin therapy to provide you with insulin that your pancreas is unable to produce. However, it is important to take note of symptoms of low blood glucose level (hypoglycaemia) such as tremor, sweating, increased heart rate, dizziness, confusion etc when your blood glucose level drops below 3.9mmol/L after insulin administration as it indicates an emergency! 

During low blood sugar levels, raise your blood sugar level by adopting the 15-15 rule: have 15 grams of carbs (e.g. 1 tablespoon of sugar, 3-4 glucose tablets) and monitor your blood sugar after 15 minutes. Have another dish if it's still below your intended range. Repeat these steps until reaching the target range (4.4-7.2mmol/L). 

Image Credit: Accu-Chek 

Your body still produces insulin if you have type 2 diabetes, but it no longer uses it effectively. In order to maintain healthy blood sugar levels, your body is unable to produce enough insulin. Your treatment's objective is to improve the way your body uses insulin or to get rid of surplus glucose in your blood. Oral pills make up the majority of type 2 diabetic prescriptions, and each of them work differently to help control blood glucose level. It is also possible to utilize injectables or insulin. Some of these medicines combine different diabetes drugs. Your doctor will advise you on which diabetes drug is most suitable for you. 

Do follow up with your healthcare professionals to monitor your blood glucose level to ensure your diabetes is well controlled! You can visit your local pharmacist to get them to help you measure your blood glucose level, cholesterol level and blood pressure! 

Diabetes rarely causes direct death in humans. However, uncontrolled diabetes can lead to serious health complications involving other organs which can be detrimental to health: 

Hence for diabetic patients, it is advisable to check with your healthcare professionals including the ophthalmologist, podiatrist, dentist, neurologist, nephrologist etc at least once yearly. 

Written by Rosamund, Bpharm(Hons)
Reviewed by Dr. Syamim Asyraf Shahidan, MBBCh 

Reference 

1. ABOUT WORLD DIABETES DAY. International Diabetes Federation. Available from http://worlddiabetesday.org/about/ 

2. A Complete List of Diabetes Medications. Healthline. Available from https://www.healthline.com/health/diabetes/medications-list 

3. Diabetes Basics. Center for Disease Control (CDC). Available from https://www.cdc.gov/diabetes/basics/index.html 

4. Diabetes statistics 2022. Single Care. Available from https://www.singlecare.com/blog/news/diabetes-statistics/ 

5. Diabetes. World Health Organisation (WHO). Available from https://www.who.int/news-room/fact-sheets/detail/diabetes 

6. How To Treat Low Blood Sugar (Hypoglycemia). CDC. Available from https://www.cdc.gov/diabetes/basics/low-blood-sugar-treatment.html#:~:text=For%20low%20blood%20sugar%20between,it's%20in%20your%20target%20range. 

7. Prevalence of type-2 diabetes and prediabetes in Malaysia: A systematic review and meta-analysis. PLOS ONE. Available from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263139#:~:text=Diabetes%20is%20expected%20to%20affect,%25%20%5B14%2C15%5D. 

8. Risk Factors for Type 2 Diabetes. NIDDK. Available from https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes 

9. Screening for Diabetes Complications. Diabetes.co.UK. Available from https://www.diabetes.co.uk/diabetes-complications/screening-for-diabetic-complications.html#:~:text=For%20adults%2C%20make%20sure%20you,Cholesterol%20screening

10. SIGNS AND SYMPTOMS – TYPE 1 DIABETES. Diabetes Ireland. Available from https://www.diabetes.ie/signs-and-symptoms/ 

Written by

Rosamund, Bpharm(Hons)