Is diabetes an age-related disease?
Diabetes can affect anyone of different age groups.
Type I diabetes, where the pancreas produces little or no insulin (a hormone that regulates glucose in the body) at all, is common among younger people. However, although rare, older people may still get Type I diabetes if the pancreas is damaged due to physical injuries, chemical injury (e.g. alcohol, surgical removal of the pancreas), or other diseases.
Type II diabetes makes up the majority of diabetes cases and is more common in the older population. Type II diabetes occurs when the pancreas is still producing insulin but the body does not respond to the insulin either partially or completely, a condition known as insulin resistance.
Besides an aging pancreas, Type II diabetes is mostly caused by obesity resulting from the cumulative effects of unhealthy diet and sedentary lifestyle over the years. As obesity is a risk factor of Type II diabetes, more young adults are having Type II diabetes due to an increasing rate of obesity in the younger population.
How harmful is diabetes? Why do I have to make so much effort to ensure my blood sugar level falls in the optimal range?
If diabetes is not well-controlled, the body cells are not able to take up and use glucose as its main energy source due to insulin resistance. Furthermore, the high levels of glucose present in the blood will start to bind to the body tissues (especially in the blood vessels) and cause damage.
Damaged blood vessels can rupture easily and, depending on their location, may eventually lead to a heart attack, stroke, kidney failure, or blindness, among many other possible complications.
It is good to have low blood glucose; however there is a limit to how low it can go as your body relies mainly on glucose to provide energy. When your blood glucose level drops below 4mmol/dL, your brain will start to get fuzzy as it can only use glucose as its energy source.
In a prolonged absence of adequate blood glucose, the brain may go into a coma, and it may even result in death. Therefore, it is extremely crucial to maintain an optimal amount of blood glucose to prevent complications from both high and low blood glucose levels.
Can a high intake of food containing large amounts of sugar lead to diabetes?
While some associations have been observed between diets high in sugar and diabetes, the dietary risk factor of diabetes is still mainly associated with high calorie intake. This means that taking large amounts of unsweetened food such as bread or rice will also put you at risk.
A high calorie intake coupled with the lack of physical activity will eventually cause obesity which is another risk factor for the development of Type II diabetes. A decreases intake of fresh fruits and vegetables may also be associated with the development of diabetes.
Dietary recommendations to manage high blood pressure, high cholesterol, and weight loss would also be beneficial to deter the progression of diabetes as they are all closely related. Hence, taking too much sugar may not directly cause diabetes, but it’s still probably a good idea to go easy on the desserts.
Why do I have to measure my blood sugar at home? Isn't testing it during my doctor's visit sufficient?
The purpose of the Self-Monitoring of Blood Glucose (SMBG) at home is to measure the control of blood glucose over a period of time. Besides that, it is also useful to gauge the effectiveness of medication, diet, and daily physical activities on blood glucose levels at home without the hassle of going to the clinic.
Since a majority of the complications arise from prolonged high blood glucose, one single point of blood glucose measurement may not provide sufficient information on the current diabetes control measures.
In addition, for doctors to do any meaningful adjustment to the treatment regimen, you may be required to do the SMBG testing more frequently and at specific timings as directed. This is for a more optimal control of your diabetes and also to minimise any possible side effects.
Why are my doctors and pharmacists so obsessed with my HbA1c despite the fact that I have been measuring my blood glucose via the SMBG?
A high HbA1c value is closely associated with many damages to the body, such as damage of the eyes, kidneys, nerves, etc.
HbA1c helps to measure how extensively red blood cells are affected by the prolonged exposure to high blood glucose levels. Unlike SMBG readings which change erratically depending on the time of measurement (e.g. before or after meals, after medication, etc.), HbA1c values will not change until after three months when the red blood cells turn over.
As blood glucose can be controlled quickly with medication or with fasting, SMBG does not accurately reflect the degree to which the body is being affected by spikes of blood glucose. These spikes can occur in between medication or by random bingeing. Medication compliance issues are more easily detected using HbA1c measurements rather than SMBG which is why doctors are more concerned with HbA1c.
Are insulin injections the only way to deal with diabetes?
Although insulin injections are very effective in controlling blood glucose levels, there are many other oral diabetic medications available, especially when the diabetes is less severe. Some oral medications for diabetes have less side effects (e.g. weight gain) compared to insulin injections, while some may be able to increase body sensitivity to insulin.
In addition to any medical intervention, patients should also follow a strict lifestyle modification to achieve good blood glucose control and prevent the progression of diabetes.
These lifestyle modifications include:
- Changes in diet
- Increased physical activity
- A proper weight loss regimen
Diabetes that is not well controlled by oral medication eventually requires the addition of insulin.
Since western medication for diabetes has so many side effects, would natural products be a better option?
The medication available for diabetes management has gone through many years of clinical research before being approved to be used as indicated. On the other hand, natural products do not have (and are also not required to have) such stringent testing. Thus, the efficacy, safety, and side effects of natural products have not been tested sufficiently and thoroughly enough to be used as the first line in the management of diabetes.
Even when researchers set out to prove (or reject) the effectiveness and safety of natural products, they are unable to substantiate their points consistently. This is due to the inconsistency in quality and quantity of the active components extracted from natural sources. These components can differ with batches, species of the plant source, weather and soil condition of the plantation site, and many other environmental factors.
The perception of natural products having fewer side effects is largely due to the lack of a proper side effects reporting system. Furthermore, it is not uncommon to hear of natural products being adulterated with western medication and remaining undetected until consumers suffer severe complications after taking the products.
Until more proof of the safety and effectiveness of natural products is available, switching from the conventional western medication to natural products may not really be the best decision. If you are having side effects from taking western medication, do consult your doctor or your pharmacist for advice.
For more information on the prevention or treatment of diabetes, ask your pharmacist today.
