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Diabetis - Who is at risk?

AMONG the general population, those who:

·Have Type 2 diabetes mellitus (T2DM) symptoms

·Have a parent, brother, or sister (first-degree relative) with T2DM

·Have had heart disease

·Have abnormal blood cholesterol levels (HDL, or “good” cholesterol, level below 0.9mmol/L or triglyceride level above 1.7mmol/L)

·Have high blood pressure (above 140/90mm Hg; on therapy for hypertension)

·Have a clinical condition associated with insulin resistance

·Are overweight (BMI over 23; or waist wider than 80cm for women and 90cm for men)

·Do not exercise regularly (less than three times a week, 20 minutes at a time)

·Are women with polycystic ovarian syndrome

Pregnant women who:

·Have a BMI over 27

·Have delivered a baby weighing 4kg or more

·Have a bad obstetric history and/or current obstetric problems

·Have gestational diabetes mellitus

·Have glucose in their urine at the first prenatal visit

·Are over 25

TAKE ACTION: If you have any of the risk factors above, ask your doctor to screen you immediately. If you do not have any of them, ask your doctor to screen you annually from age 30 and up.

Overweight children and teenagers (over 120% of ideal weight) who have:

·A first- or second-degree relative (aunt, uncle, grandparent, nephew, niece, half-sibling) with T2DM

·A mother who has had gestational diabetes mellitus

·An Indian ethnic background

·Signs of insulin resistance or conditions associated with it

TAKE ACTION: If your child or teen meets any two of the criteria above, make sure he or she is screened for T2DM at least every two years from age 10 onwards, or at the onset of puberty if puberty occurs before then

Mythbusting

As a private hospital diabetes centre manager, nurse Yong Lai Mee is charged with educating patients, nurses, and the public on diabetes management. Here, she clears up some common misconceptions.

Myth #1: Diabetic drugs cause complications

Drug therapy doesn’t lead to complications - it prevents them, stresses Yong. Unfortunately, many of her patients think oral diabetes medication causes renal failure, so they try to reduce the amount they take and then get discouraged when they have to take more. “They don’t know that diabetes is a progressive disease,” she says.

Myth #2: Insulin is the end of the line

Nowadays, patients whose diabetes is newly diagnosed can be put on any available treatments straightaway - diet and exercise control, drug monotherapy, or insulin therapy - whichever efficiently achieves blood sugar control.

Yong explains: “Treatment no longer goes ‘stage by stage’. Patients can pick up any of these treatments. (But) today in our society, insulin therapy acceptance is very low. People think that if a person is on insulin, his diabetes is very severe and he is going to die soon. So we have patients who insist to the end they don’t want it, even though the benefit is greater (than their current therapy).”

Myth #3: Once my blood sugar is stable, I can self-medicate

Proper diabetes management requires periodic reviewing with a doctor so your treatment can be tweaked from time to time for optimal effect. Patients who self-medicate miss out on this vital process.

Such patients, says Yong, “take the prescription, purchase the medication over the counter, and continue taking it without coming back for review. But they don’t know how to monitor their blood sugar and take it based on their feelings - ‘When it is high, I take, when it is low, I don’t take.’ That causes a lot of poorly controlled blood sugar.”

Myth #4: This special diet will cure my diabetes forever

Often, patients will try to wean themselves off their diabetes drugs, notes Yong. The usual pattern is to follow the diet strictly and progressively omit taking their medication. So no drugs for one day in the first week, then two days in the next, then three, and so on, until they are no longer taking any.

“This is a myth,” says Yong. “But patients would rather buy this than the doctor’s recommendation because they do not want to have diabetes. They want to be cured, and will explore all kinds of ways to get cured. These patients are exposing themselves to higher blood sugar levels and much damage can be done by the time they come back to the hospital to see a doctor.

“Diabetes is incurable,” Yong drives home. “It is controlled by diet, exercise, and medication. You’re talking about beta cell failure (beta cells in the pancreas produce insulin). You need these drugs to stimulate insulin production. By controlling diet alone, you can only limit a certain amount of blood sugar.” — LEE TSE LING

- THE STAR

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