not just about a sweet  tooth

Mention diabetes and people instantly think "too much sugar". But there’s more to this chronic disease than that.

1 What exactly is diabetes? Type 1 diabetes is when the body fails to produce insulin, the hormone which allows glucose to enter the cells of the body and fuel them. The vast majority with diabetes have type 2 diabetes. This results in insulin resistance – the body fails to use insulin properly, combined with relative insulin deficiency. 2 What if diabetes is untreated? People with diabetes are at increased risk of many complications, such as heart and kidney disease, nerve damage, eye, skin and foot complications and depression. 3 What are the latest findings on diabetes? Some new findings are: • New modes of insulin delivery. Being developed are inhaled insulin, oral insulin and transdermal (through the skin) insulin patches • New classes of drugsa) incretin enhancers, also known as DPP-IV inhibitors, taken orally. One such drug, sitagliptin, has shown similar efficacy to conventional drugs with fewer side effects in areas like low blood sugars and weight gain, b) incretin mimetics, given as a subcutaneous injection twice a day.

My dad has just been diagnosed with diabetes. How can we help? Diabetes is a chronic disease. However, with proper medical care, along with the appropriate lifestyle modifications, the condition can be kept under control. Weight control is crucial. This can be done by adopting proper dietary habits (partial meal replacements can help) and exercising regularly. Anyone not in the habit of exercising must seek advice from a doctor first. In general, your dad should reduce total fat (especially saturated fat) and salt intake; increase daily fibre intake; control his total daily intake of carbohydrates, including sugar; and stop smoking if he smokes. He will also need to check his blood sugar at home regularly using a glucometer, as well as go for regular medical checkups and eye, foot and urine screenings. While it is not necessary for your dad to take medication for diabetes for the rest of his life, he may need medications to help control his blood pressure and cholesterol levels.

preventing diabetes If you are in the high-risk group A person who is a smoker, overweight or physically inactive, has high blood pressure or cholesterol levels, is at higher risk of diabetes. You can help prevent the development of type 2 diabetes by making changes in your diet and increasing your level of physical activity. You may even be able to return your blood glucose levels to the normal range. While some medications may delay the development of diabetes, diet and exercise generally work better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10 per cent reduction in body weight has been shown to produce a 58 per cent reduction in diabetes. If you already have diabetes: People with type 1 diabetes generally require insulin therapy from the onset and for the rest of their lives. The majority of people with type 2 diabetes may be started on lifestyle interventions (see above), oral agents, and some may require insulin therapy.

Men are at risk for type 2 diabetes if they have • a close relative with type 2 diabetes mellitus  • BMI ≥ 25kg/m2  • hypertension • coronary heart disease • dyslipidemia (low HDL cholesterol and/or high triglyceride levels) • a history of impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). Those at risk should do a fasting blood glucose test starting from age 30.

"As with many chronic diseases, the treatment of diabetes does not and should not rest solely on medicines. It is important to be empowered with knowledge about diet, nutrition and the importance of regular exercise." – Dr Goh Su-Yen, Director, Diabetes Clinical Services, Singapore General Hospital

"Being diagnosed with diabetes is a life-changing event. Be supportive. For instance, going with him for his medical checkups occasionally will help you understand his condition better and see where you can help." – Dr Tham Kwang Wei, Head, Obesity Services, Department of Endocrinology, Singapore General Hospital

The Diabetes Centre at Singapore General Hospital provides a full range of services: from testing, podiatry service, education and counselling to treatment for diabetic patients. It also treats diabetes in pregnancy and runs specialised clinics for Type 1 Diabetes, young Type 2 Diabetes and self-management courses for patients and families. Call 6222-3222 (main line) or visit www.sgh.com.sg.