1. Could you explain the differences between Type 1, Type 2 and gestational diabetes?
Diabetes Mellitus (DM) is a metabolic disease characterized by elevated blood glucose due to impaired or absent insulin secretion or action. Insulin is produced by the pancreas, an organ behind the stomach and is essential for triggering cells to take in sugar from the blood as fuel to produce energy. A malfunction of this process leaves cells without energy and too high blood sugar, which can cause macro and micro vascular issues together with organ damage.
There are 2 main types that account for nearly all DM patients. Type 1 DM affects roughly 5-10% of patients and is a result of the body irreversibly destroying its own insulin producing cells. People with Type 1 DM usually develop rapidly progressing symptoms at a very young age and must use daily insulin injections to control their blood sugar. Strategies for Type 1 DM prevention are still being researched, but there are ways to control and prevent the condition from lapsing into total insulin dependence by using immunosuppressants if detected early enough.
Type 2 DM affects 90-95% of patients and in contrast, develops as a result of the body’s cells developing insulin resistance or insufficient insulin secretion by the pancreas. As such, it occurs more gradually and generally affects older patients due to decline in cellular function as a result of ageing. In mild cases, oral insulin sensitising medicines or drugs that trigger additional secretion of insulin may be used instead of insulin injections. Interestingly, research has shown that exercise, weight management and diet control may also help stimulate the body to regain its blood glucose control. Thus physicians usually prescribe a combination of drug and lifestyle changing therapies for this group of DM patients.
Other types of DM are much less common and may occur as a result of other diseases or conditions. For example, gestational diabetes may develop due to hormone imbalance during pregnancy. Also, long-term use of certain medications, like steroids, may induce a resistance to insulin too.
2. Why is it important to watch your diabetes risk, even if you’re slim?
Symptoms of diabetes may not be immediately apparent to many sufferers and furthermore, the general profile of people with the more dangerous absolute insulin dependency in Type 1 DM is slim individuals.
Generally, high blood sugar in DM may have no symptoms at all. However, some patients may notice as unusual or frequent thirst, hunger and urination. Tiredness, blurry vision and weight loss can also occur. In chronic cases, it can lead to loss of sensation or tingling sensations in the extremities, slow wound healing, itchy skin and poor sexual function.
Type 1 DM patients are at high risk for a life-threatening condition called diabetic ketoacidosis (DKA) due to their complete lack of insulin production. DKA occurs when the body switches to burning fat for energy too rapidly, causing the acidic by-products (called ketones) to build-up in the blood. Ketones poison the body and may trigger a heart attack, kidney failure or swelling of the brain.
3. What are the factors that can raise your risk of diabetes, even if you’re of a healthy weight range?
Type 1 DM risk is mainly genetic, although some studies are being conducted to observe if certain viral exposure during pregnancy or infancy is causal factors.
Type 2 DM has many risk factors.
The family history of DM and being an Asian/Hispanic or African American woman might confer a higher risk of developing the disease in one’s lifetime. Obesity and regular consumption of sugary beverages are also a well-studied risk factor. A high body-mass index (BMI) of above 35kg/m2 contributes to up to twice the risk of developing DM as compared to a person with BMI <22kg/m2. Furthermore, abdominal obesity, more common in males, is associated with groups of patients that develop the highest insulin resistance.
Smoking impairs insulin sensitivity, and this may affect individuals exposed to regular second-hand smoke too. Stopping the habit can reverse the risk, with benefits seen within 5 years and a comparable risk to non-smokers only 20 years after cessation.
Sleep duration and quality can affect DM risk too, with lesser than 6 hours or more than 10 hours per day attributing to higher risk. Furthermore, difficulty in falling asleep and frequently waking up mid-sleep are clinical risk factors too.
4. Could you share 5 bad eating habits to avoid, to help lower your risk of diabetes?
1) Avoidance of high sugar beverages
Sugared drinks cause high blood sugar spikes, associated with the development of insulin resistance and obesity. These include soft drinks, beverages with lots of sweetened condensed milk and even some seemingly healthy fruit juices. Switch to alternative drinks like unsweetened or mildly sweetened teas, barley or water.
2) Avoid supper
Bedtime snacking can cause obesity and affect sleep quality. Unutilized energy from the food acts as a stimulant and the excess energy will slowly be converted to fats as energy storage for the body. Drinking water, chewing a sugar-free gum or going to bed early can help quell the bedtime urge for food as an alternative.
3) Avoid buffets
Heavy meals stress the body’s ability to produce sufficient insulin. Furthermore, gross overconsumption of food to meet your money’s worth may lead to unwanted obesity, a risk factor for DM. Do limit food intake and have adequate exercise to maintain a healthy BMI.
4) Avoid napping after a meal
Same as eating before bedtime, unutilized energy from the meal will lead to health repercussions, including DM. Walking around after a meal or helping with clearing the dishes can aid in digestion and lessen the impact of food-induced narcolepsy
5) Avoid snacking
Snacking at a movie or in front of a video game can lead to pointless loading of carbohydrates, some of which are sugar-rich foods that can mess up insulin control. Substitute by using carrot or cucumber sticks if you must or avoid the habit altogether.
5. In May 2016, HPB targeted white rice in its campaign against diabetes, due to its high glycemic index. Could you explain what is the glycaemia index and why it matters?
Besides taking into account the quantity of food that may increase blood glucose, another factor that can affect control is the Glycemic Index (GI) of the food. GI is a relative scale to glucose on which carbohydrates are ranked by how fast they increase blood sugar levels after consumption. Foods that are easily digested and quickly absorbed have higher GI levels than foods that are slow to process in the body. Thus, even small quantities of maltose sugar, which has a GI of 105 may spike blood sugar levels more sharply than a larger serving of fructose sugar (GI of 25) for example.
HPB recommends changing white rice (GI of 64) for brown rice (GI of 55) to lessen the impact of post-meal blood glucose spikes. Post-meal spikes may complicate adequate insulin control in both DM and healthy individuals. This usually results in a high energy state after a meal, but quickly switches to fatigue and hunger again shortly after, thus causing obesity and possibly causing cardiovascular complications in DM patients from the blood glucose spikes. 6. What other lifestyle changes would you suggest, lower the risk of diabetes?
6. What other lifestyle changes would you suggest, lower the risk of diabetes?
Type 2 DM can be largely avoided by adopting a healthier lifestyle. Increased physical activity and weight control are related to a low developmental risk of DM. Several lifestyle modifications are associated with lower DM risk and also better control of blood glucose in people with the disease. The HPB recommends at least 150 minutes of regular moderate activity a week (e.g. brisk walking, swimming or cycling) coupled with the aim of achieving an ideal BMI of between 18.5kg/m2 and 23.5kg/m2. A healthy weight should help in the prevention of DM and associated metabolic diseases.
Mediterranean diets or one consisting of high consumption of low GI foods like fruits, vegetables, dairy products, whole grains, beans, nuts or seeds may help prevent an onset of DM.
Some studies on chromium supplements did indicate better glucose control, but mainly with those with already elevated blood glucose levels.
Additionally, sources have indicated vitamin D, selenium, bitter melon or iron intake helping with blood glucose levels but are not well-studied enough to be conclusive.
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