By Island Hospital | Nov 13, 2024 5:05:27 PM

What is Diabetes?

The Different Types of Diabetes

What Causes Diabetes?

Risk Factors of Type 1 Diabetes

There is no known cause of what triggers that response in the first place because the body could be attacking itself for years before type 1 diabetes is diagnosed. Some of the risk factors of type 1 diabetes are:

• Age – Type 1 diabetes can manifest at any age, but is known to start before the age of 40. It is often diagnosed in children between 4 to 7 years old and between 10 to 14 years old.
• Family History – Having an immediate family member with type 1 diabetes puts you at a slightly higher risk of also developing type 1 diabetes or developing it at an earlier age.

The risk factors for type 1 diabetes are not as well-defined compared to the known risk factors for type 2 diabetes and prediabetes. Weight, however, is not believed to be a factor for type 1 diabetes.

Risk Factors of Type 2 Diabetes

On the contrary, being overweight is strongly linked to the development of prediabetes and type 2 diabetes.

As with type 1 diabetes, nobody knows what exactly causes the cells to become resistant, although a few factors are known to increase a person’s risk developing type 2 diabetes:

• Age – Most cases of type 2 diabetes are diagnosed in people at the age of 45 and above. It is recommended to get screened for diabetes every year for patients aged 45 and above.
• Genetics – As with type 1 diabetes, a strong family history of diabetes increases a person’s risk of type 2 diabetes.
• Environmental Factors – A sedentary lifestyle means the body does not burn enough sugar for energy, making your cells less sensitive to insulin.
• Being Overweight – Excess weight and fatty tissue will raise the insulin resistance of your cells.

It is important to note that not all people who have type 2 diabetes are overweight; it can still develop in individuals who have their weight under control.
Type 2 diabetes prevention is also not just for the old, as the incidence rates in children and young adults continue to rise.

Risk factors for Gestational Diabetes

During pregnancy, the placenta produces more hormones to sustain a woman’s pregnancy, but these hormones increase the cells’ insulin resistance.

The pancreas will produce additional insulin to counter this effect, but there are cases where the pancreas cannot keep up with the surge of hormones.

Thus, gestational diabetes occurs. Similar to type 2 diabetes, the risk factors for gestational diabetes are:

• Family History – A family history of diabetes increases your risk of developing gestational diabetes during pregnancy and type 2 diabetes after pregnancy
• Being Overweight – Being overweight before pregnancy may affect your body’s insulin sensitivity; this may also carry over into your pregnancy.

Screening For Diabetes

How would I know if I have diabetes?

Pre-diabetes and diabetes rates are very high amongst Malaysians. It makes sense to be screened for diabetes, particular if you are in a high risk group (as outlined in the sections above).

Screening includes a blood test (glucose tolerance test), HbA1C level test, a fasting or random (non-fasting) blood glucose level test. Your doctor will guide you throughout your screening.

Screening should be carried out if you have symptoms of diabetes:

• Tiredness
• Unexplained weight loss
• Passing more urine than usual either during the daytime or night time
• Excessive thirst
• Blurred vision
• Frequent infections in the genitalia or frequent itching

If you have no symptoms, then screening should be carried out if you are overweight or obese (BMI greater than 23 kg/m2) or have a waist circumference greater than 80cm (for women) or 90cm (for men) AND have one or more of the following risk factors:

• First degree relative with diabetes mellitus
• History of heart disease
• Hypertension (blood pressure greater than 140/90) or currently receiving treatment for hypertension
• Previously pre-diabetes
• Low HDL (lower than 0.9) or increase Triglyceride (greater than 2.8 mg/dL)
• History of previous gestational diabetes or baby weighing more than 4kg
• Polycystic ovarian syndrome (for women)
• Being physically inactive

(Reference: Malaysian Consensus guidelines on Diabetes 2015 (5th edition))

Complications of Diabetes

When you look at the statistics of leading causes of death, diabetes may not be among the top five causes. However, most death certificates list the primary disease as the cause of death without listing that their primary disease was caused by diabetes.

Hence diabetes can be both a direct and indirect cause of death for millions.

Mild episodes of high blood sugar can be treated easily and may also return to normal sometimes. However, when your blood sugar levels are very high and remain high for a long period of time, it can lead to life-threatening complications.

Diabetes is a disease which is associated with many complications. This means that early good control can prevent or delay some of the complications described below:

1. Diabetic ketoacidosis (DKA) happens when your body starts breaking down fat into a type of acid called ketones. Too much of this acid in your blood causes it to become acidic and can lead to a diabetic coma, making this a life-threatening condition if not managed properly.
2. Hyperosmolar hyperglycaemic state (HHS) or severe dehydration is caused when your body is trying to get rid of excess sugar through your urine. The increased frequency of urination causes thirst, headaches and drowsiness as dehydration sets in.
3. Diabetic peripheral neuropathy (nerve damage) is caused by high blood sugar damaging the nerves close to the surface of the skin. It usually affects the lower half of the body (legs and feet) before affecting the arms. Nerve damage will cause you to:
   • • feel numbness or become unaware of certain injuries
     • increase your sensitivity to the point you feel pain even while remaining still
     • worst-case, the nerve damage will reach a point of requiring amputation of the affected limb to relieve the pain or symptoms

High blood sugar can also cause damage to the blood vessels, triggering a response that will cause plaque build-up and hardening of the arteries (known as atherosclerosis).

By damaging the blood vessels, a number of other complications can develop:

1. Diabetic Kidney disease (Chronic Kidney Disease) – High blood sugar damages the blood vessels in your kidneys. This may cause end-stage renal failure and may even lead to other health complications.
2. Hypertension (high blood pressure) – A damaged blood vessel will not be able to stretch well, increasing a person’s blood pressure. High blood pressure can lead to cardiovascular disease and also kidney disease; with the reverse being true. A person whose kidneys are affected by diabetes may also end up developing high blood pressure.
3. Cardiovascular disease (CVD) – High blood sugar will damage your blood vessels over time, increasing your risk of CVD. People with diabetes tend to develop CVD at a younger age compared to those without, and CVD is one of the most common causes of death among adults with diabetes.
4. Stroke – A person with diabetes has a 1.5 times higher chance of having a stroke, which can be traced back to how high blood sugar levels damages the nerves and blood vessels.
5. Damage to the eyes – Diabetes can cause swelling in the macula, the part of our eye that we use to read, drive and see people. The swelling and damage caused by high blood sugar will eventually lead to loss of vision and even blindness if not treated early.
6. Glaucoma – A disease that damages the nerves connecting our eyes to our brain, and diabetes doubles the chance of someone having glaucoma.

Other complications include diabetic coma, depression, and amputations due to the infection of an injury to the feet.

Managing diabetes

Part 1: Prevention and Lifestyle Choices

There is currently no cure for diabetes as it is a chronic disease. While type 1 diabetes cannot be prevented, prediabetes, type 2 diabetes, and gestational diabetes can be prevented by avoiding a sedentary lifestyle.

1. Exercise Regularly

Exercise for about 30 minutes a day, go for a walk, cycle around on a bike or do some swimming. With adequate exercise and physical activity, your body will:

• Require more energy; which it gets from breaking down sugar.
• Reduce your blood sugar as it breaks down sugar for energy
• Increase your cells’ sensitivity to insulin as sugar breaks down and enters your cells

30 minutes of moderate physical activity does not have to be in one go; you can split it into smaller sessions throughout the day.

2. Lose Excess Fat and Weight

Lose excess weight, as the risk of diabetes increases with your weight and waist circumference.

Ideally, your BMI should be within 18.5 – 23; any value higher than 23 is considered as being overweight. Aim for a 5 – 10% weight loss.

This will improve your diabetes or reduce the risk of progression to diabetes by 50%.

If you are pregnant, then it is recommended for you to speak with your doctor first on how much weight is healthy for you to put on during pregnancy, rather than think about losing it.

3. Maintain a Healthy Diet

A healthy diet is important in diabetes management, especially one high in nutrition, fibre, whole grains and protein.

Cutting down on fats, calories, refined carbohydrates and sweets also helps to keep your blood sugar under control.

Of course, there is no specific diet for all diabetic patients, the recommended amount of food depends on each person; thus it is best to create a meal plan for yourself by discussing with your doctor and dietitian.

Part 2: Medical Help

Apart from lifestyle changes to manage your blood sugar, most diabetics require more than just lifestyle changes. A diabetes treatment plan often includes one if not all of the following:

1. Insulin therapy

Insulin therapy is often used to keep a person’s blood sugar levels within a healthy range. There are many types of insulin (fast-acting, short-acting, long-acting) and which is best depends on the person.

Because your blood sugar changes throughout the day, it is best to discuss with your doctor to determine which works best for you.

2. GLP 1-RA

There are newer agents called GLP 1-RA that are suitable for some type 2 diabetics.

3. Diabetes Medications

Diabetes medications are often prescribed depending on the patient’s needs and symptoms.

Some medications will stimulate your pancreas to produce more insulin, some help your body break down sugar, some help to reduce your blood sugar.

4. Bariatric Surgery (Weight-loss surgery)

Bariatric surgery is not considered as diabetes-specific treatment, but obese individuals with type 2 diabetes experience significant improvements to their blood sugar levels.

In most cases of patients, the surgery sends type 2 diabetes into remission due to weight loss and improved insulin sensitivity. The body’s blood sugar can often be controlled without the need of medication.

Not everyone is eligible for bariatric surgery, however.

5. Treatment and Screening for Comorbid Illnesses

Your doctor will discuss your options for treatment and screening for comorbid illnesses like kidney disease, heart disease, or nerve damage.

Coping With Diabetes

Coping with diabetes can be a challenge as there are significant changes to one’s lifestyle and finances.

Complications can be depressing, which is why understanding the disease is the first step to coping. Guidance is important.

Patients are empowered to look after themselves with help from the doctor, nurses and dietitian to guide them along the way.

Take the First Step Towards Better Diabetes Care

We hope this article provided valuable insights into managing diabetes effectively.

Our Diabetes Centre offers comprehensive care for all types of diabetes, including Type 1, Type 2, Gestational (pregnancy-related), and other related disorders.

Our commitment to excellence has earned us local and worldwide recognition:

• A finalist for Malaysia’s Flagship Medical Tourism Hospital Programme
• A place on Newsweek’s lists of World’s Best Hospitals 2024
• A place Best Specialized Hospitals Asia Pacific 2024 (Cardiology).

Take control of your health today. Book an appointment with Island Hospital’s expert diabetes care team today!