Diabetes mellitus, usually simply called ‘diabetes’, is a condition of abnormally high blood glucose. If levels are sufficiently high, the glucose begins to filter through the kidneys and appears in the urine. Urine-attracting ants may be the first sign that something is wrong. In fact ‘mellitus’ is a Latin word denoting sweet urine.
At least 11 percent of Singaporeans have diabetes. Singapore has been found to have fourth highest diabetic rate in the world. With rising affluence, this is a trend in Asian countries.
What is glucose ?
Glucose, the type of sugar that exists in our blood, is the chief source of fuel for energy for our body cells. It is derived from carbohydrates such as rice, bread, noodles and table sugar (sucrose). Insulin, a hormone produced by the pancreas, is needed to transport glucose into cells from the blood.
What is a normal level?
Normally, glucose levels are maintained within narrow limits 4-5.5 mmol/L before food and up to 7 mmol/L two hours after eating. In diabetes mellitus, this control of blood glucose levels is lost, resulting in many undesirable effects on the body.
How does diabetes mellitus (DM) develop?
There are two distinct types of DM.
In Type I, the pancreas is damaged by abnormal antibodies and cannot make insulin. Without insulin, glucose cannot be brought into cells and remains at a high level in the blood. The affected person, starved of energy, rapidly loses weight. As sugar holds water and brings it along into the kidneys and bladder, the patient passes large quantities of urine and consequently has excessive thirst and dehydration.
Type 1 DM patients require lifelong
insulin injections. This type of DM is
rare in Singapore but may be seen in
Caucasian populations. It can occur
suddenly at any age, even childhood.
Almost all DM in Singapore is Type 2
DM. Here, there is sufficient insulin,
but cells have developed a resistance
to insulin due to long-standing dietary
excesses causing more and more
demand for insulin. Excessive fat also
makes insulin act poorly.
Type 2 patients may not have the
typical diabetic symptoms at all
as they still have insulin. As such,
diabetes may be present for years and
cause damage to organ systems before
it is ever detected by a blood test. In
Singapore, 50 percent of patients have
already some organ damage at the
point of diagnosis.
Type 2 diabetes’ incidence
increases with age, and those with
a family history are more likely to
develop it. Although associated
with older people, with today’s
consumption patterns, there is an
alarming trend for patients to start
developing it in their 20’s and 30’s
or even earlier.
Many infections such as abscesses,
chest and urine infections as well as
fungal infections can be caused by
uncontrolled diabetes. Many patients
are diagnosed at the point when they
seek medical attention for a severe
Blindness can result from damage to
the retina of the eyes. Cataracts form at
a faster rate. High blood glucose also
damages the kidneys. In Singapore,
diabetes is the leading cause of kidney
Atherosclerosis, which blocks off
blood vessels, is caused by diabetes,
together with high blood pressure,
high cholesterol and smoking, (the
four big villains). Heart attacks result
when heart arteries are blocked;
strokes when brain arteries are
blocked; gangrene of feet when
arteries to the legs are blocked. One or
more amputations are carried out per
day from diabetes In Singapore.
Poor wound healing, caused by poor
blood supply due to narrowed blood
vessels caused by advanced diabetes.
One may hear someone saying
‘I am OK as my wounds heal well’.
However, by the time poor wound
healing occurs it may be too late. The
ability to heal cannot be used as an
indication whether diabetes is present
or under control. Blood testing is still
the required method to establish the
In Type 1 DM, severe symptoms drive
the patient to the doctor. In Type
2 diabetes, the only sure way for
diagnosis is by a blood glucose test.
Blood glucose above 7 mmol/L after
an eight hour fast or 11.1mmol/L after
a meal on two occasions indicates
diabetes. Intermediate levels like
fasting level of 6.1-6.9mmol/L or 7.8-
11.1 after meals indicates a likelihood
of developing it in the future, a
condition called prediabetes.
To ensure that the sugar levels have
been ideal on a daily basis and not
only on the day of the doctor’s visit,
another blood test, HbA1C is done
which reflects the average control
over three months. A well-controlled
diabetic must have an ideal level of
HbA1C, as protection of organs from
damage can only be possible if blood
sugars are maintained consistently
everyday and not on and off.
The cornerstone of diabetic
Various diabetic tablets may be
prescribed for Type 2 diabetes. Insulin
may be required in advanced cases of
Type 2 diabetes. It is advantageous for
diabetics to invest in a home blood
glucose meter to monitor themselves.
Glucose levels in diabetics can also fall
too low (hypoglycaemia) for example
if a person takes their medication and
then did not have their meal. Sugar
needs to be consumed immediately in
such an emergency.
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
Singapore General HospitalTel: 6321 4377
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