Diabetes Management

Introduction 

Diabetes mellitus is a chronic illness, caused by the inability of the pancreas to secrete enough of a hormone called insulin or the body losing its ability to use insulin.

Insulin controls the transfer of sugar (glucose) from the bloodstream into body cells. For people with diabetes, the absence or insufficient production of insulin results in elevated blood sugar levels or hyperglycaemia.

According to data from the International Diabetes Federation, 230 million people worldwide have the disease and this is expected to affect 350 million people by 2025. 

Diabetes and Heart Disease 

People with diabetes are two to four times more likely to develop coronary artery disease and stroke. It is often associated with other cardiovascular risk factors, such as high blood pressure, increased total cholesterol and triglyceride levels, decreased HDL (High-Density Lipoprotein) cholesterol levels, and obesity.

Insulin resistance, a condition where the body does not respond efficiently to insulin, can predispose a person to both diabetes mellitus and cardiovascular disease.

There are two distinct types of diabetes: Type I insulin-dependent diabetes, and Type II non-insulin-dependent diabetes.

Insulin-dependent diabetes usually develops rapidly and at an early age. Non-insulin-dependent diabetes generally develops more slowly and is more common in sedentary and overweight individuals. There is a tendency for this latter type of diabetes to run in the family.

Both types of diabetes significantly increase the risk for cardiovascular disease.

Treatment and Lifestyle Changes 

Type I diabetes will require a regular dose of insulin, as prescribed by a doctor.

Mild Type II diabetes may be controlled through diet and exercise, with little or no medicine. However, most Type II diabetes will eventually require oral medications to control the blood sugar level, and possibly insulin injection in the later stage of the disease.

The basic treatment strategy is to maintain good control over the amount of glucose in your blood, eat a balanced diet, exercise regularly, and watch your weight. These will prevent the onset of diabetes mellitus.

1. A balanced diet – You should avoid foods high in cholesterol and saturated fats such as animal fats, whole milk products, eggs, red meat such as beef and lamb, coconut milk and palm oil. Instead, choose lean meat, fish and low-fat dairy products and increase your intake of fruits and vegetables. Watch your sugar intake as well, opting for foods and drinks that are less sweet.

2. Exercise regularly – It is important that you exercise at least three times a week. Although there are many kinds of physical activities you can do, walking is one of the best forms of exercise. Check with your doctor on which types of physical activities are suitable for you.

3. Watch your weight – Calculate your Body Mass Index [BMI = Weight (kg) / Height (m) x Height (m)], which will give you a good idea of whether you are keeping a healthy weight. A healthy range should be between 18.5 and 22.9. The ratio for waist and hip [Waist (cm) / Hip (cm)] is also important, which should be less than 1. Women should aim for a waist of 80cm and men less than 90cm.

BMI and waist circumference serve as convenient and fairly accurate measures of body fat. If the BMI is high but the waist circumference is normal, as with bodybuilders, there is no worry of excess body fat. If the BMI is normal but the waist circumference is large, as with men who have little fat around the face and arms but carry a potbelly, there is a worry of excessive intra-abdominal fat that carries a higher risk of coronary artery disease.

The ratio for waist and hip (waist/hip) is also important. It should be less than 1. Women should aim for a waist of 80cm and less than 90cm for men.

Body Mass Index (BMI) Classification by Public Health Action in Asians
Body mass index = Weight (kg)/ Height (m) x Height (m)

                        Source: Health Promotion Board

Waist Circumference: High-Rsk, Gender-specific Thresholds

   Source: MOH Clinical Practice Guidelines 5/2004 (Obesity)