What is Diabetes Mellitus?
Diabetes Mellitus is a metabolic disease in the field of Medical Endocrinology, which is characterized by higher than normal blood sugar levels.
Patients with Diabetes Mellitus are unable to produce or use insulin effectively, hence blood sugar cannot be taken up and utilized by body cells, causing physical distress and organs damage.
Based on the genetic and acquired causes, diabetes can be generally divided into type 1 Diabetes Mellitus (autoimmune disease), type 2 Diabetes Mellitus (insulin deficiency and resistance), Gestational Diabetes Mellitus and other types of Diabetes Mellitus (such as genetic defects, pancreatic diseases, surgery and drugs, etc.)
Typical symptoms of high blood sugar include increase drinking, urinating and eating, and weight loss. Since patients may not recognize these red flags easily, it is not surprising that some patients may already have Diabetes Mellitus-related complications including cardiovascular issues (stroke and myocardial infarction), kidney issues (impaired kidney function), retinal issues (impaired vision), neurological issues (numbness and tingling in the hands and feet) and lower limbs issues (ulcers and infections) etc. when they are just newly diagnosed with Diabetes Mellitus.
Diabetes Mellitus can be diagnosed through blood tests and managed by blood sugar monitoring, lifestyle modification, and medications (oral and injectable) when required.
Through the efforts of patient and collaboration with healthcare professional, most Diabetic Mellitus patients can manage their blood sugar levels effectively and live freely.
Who is at Risk for Diabetes Mellitus?
People with any age, gender or race can suffer from Diabetes Mellitus. Even so, different types of Diabetes Mellitus can relate to certain risk factors and ethnic groups.
Type 1 diabetes is an autoimmune disease which happens when the pancreas is unable to function (e.g. produce insulin) effectively. It mainly affects children, teenagers and young adults who has strong family history of type 1 diabetes.
Type 2 diabetes is caused by a mixture of insufficient pancreatic function and insulin resistance, which is closely related to obesity, lack of exercise, and poor diet and lifestyle. It mainly affects adults with risk factors such as first-degree family history of type 2 diabetes; ladies who had Gestational Diabetes Mellitus before are also at higher risk of developing type 2 diabetes later in life.
Regarding the cause of Gestational Diabetes Mellitus, it is due to change of hormones during pregnancy and is closely related to age, body weight, past history of Gestational Diabetes Mellitus and polycystic ovarian syndrome. Patients with Gestational Diabetes Mellitus often have first-degree family history of Diabetes Mellitus.
Other types of Diabetes Mellitus are usually caused by pancreatic diseases, genetic defects or the effects of drugs. Most of these patients have history of other diseases, pancreatic surgery or drugs use.
The old saying 'nip it in the bud' is always true. The best way to prevent Diabetes Mellitus is to follow a healthy diet and lifestyle, exercise regularly and keep a good weight control. If you have the above-mentioned high-risk factors or belong to a high-risk group, you should consider schedule health check-ups on a regular basis to detect and manage your blood glucose.
The life of living with Diabetes Mellitus – disease management and lifestyle modification
Living with Diabetes Mellitus is not only just an understanding of the disease but also is a project on how to accept and adapt glucose abnormality. It needs a great deal of courage and determination for patients to adjust to the changes; these changes include psychological adaption, diet control, exercise planning, medical treatment, and blood sugar monitoring etc. All of them are essential to spark great influence on the disease prognosis.
From the moment of being diagnosed, patient can already overwhelmed by the depressed and anxious feeling towards the future. With this in mind, family and friends may provide the best support and comfort, followed by patient support groups and psychologist.
Diet control plays a crucial part in Diabetes Mellitus management. Since everyone is unique in their nutritional needs, dietitian can assist in making dietary decisions. In general, choosing food with low glycemic index, high-quality protein and healthy fat, avoiding processed food and alcoholic beverages, controlling carbohydrate ratio strictly and increasing the proportion of dietary fibre are the keys of diet control. Eating on a regular schedule and avoiding overeating are also essential in stabilizing blood sugar level.
Adequate and personalized regular physical activities including aerobic exercise and strength training are effective for reducing insulin resistance and managing body weight. However, one should bear in mind that exercising with an empty stomach can be a devastating situation for people with Diabetes Mellitus, hence patients should consume small amount of carbohydrates before exercising. Likewise, patients should carry sugar bars when exercising in order to prevent hypoglycemic (low blood sugar) emergency. Checking own blood sugar level before and after exercise could also help to monitor blood glucose and take necessary actions promptly. In addition, patient should check the skin integrity of one's feet on a daily basis and seek medical help for persisted wounds or blisters.
A variety of medications including oral and injectable drugs are available for treating patient with different diabetic conditions. Patient should take one's medications according to medical advice and never change the dosage and frequency. Patient should also keep a good record of own blood sugar trends.
Last but not least, no matter how busy life gets, patient should make room for follow-up medical appointments in order to have physical and medication evaluations, regular checkups on eye conditions, kidney functions, blood pressure profile, cholesterol levels, lower limbs and heart conditions, etc. and consider appropriate vaccinations to maintain a good quality of life.
The nightmares of uncontrolled Diabetes Mellitus
The consequence of uncontrolled Diabetes Mellitus is hyperglycemia induced acute and chronic complications, both can be fatal if left untreated. Acute complications include diabetic ketoacidosis and hyperosmolar hyperglycemic state; while chronic complications are vascular disease, nephropathy, retinopathy, neuropathy, foot damage and effects on other organ systems.
Diabetic ketoacidosis happens when our body starting to break down fats as the main energy source as a result of insulin insufficiency, and acids namely ketones were built up in the bloodstream during the process. The accumulation of ketones in blood would cause serious physical distress. Patients may experience shortness of breath, vomiting, abdominal pain, confusion and coma.
Hyperosmolar hyperglycemic state is caused by persisting severe excess sugar in blood and results in severe dehydration. Patients may experience extreme thirst, convulsions and shock.
Regarding to the various chronic complications of uncontrolled Diabetes Mellitus, vascular diseases can lead to atherosclerosis, which is thickening or hardening of the blood vessel wall. Atherosclerosis may result in high blood pressure, myocardial infarction, stroke, and peripheral vascular disease that patient can be at risk of amputation.
Nephropathy can lead to glomerular damage, which results in the diminishing effectiveness of filtering protein. In the long run, patient may develop proteinuria or even renal failure which require renal dialysis.
Retinopathy can lead to retinal damage, which would result in retinal haemorrhage, macular edema, cataracts and glaucoma. In some severe cases, patient may even develop blurred vision and blindness.
Neuropathy can lead to issues of multiple systems. For example, peripheral neuropathy can cause numbness, tingling sensation, or even loss of sensation in both hands and feet; while autonomic neuropathy can cause gastrointestinal discomfort, abnormal heart rate, urinary dysfunction and/or sexual dysfunction.
Foot damages includes the damage to both the blood vessels and nerves in feet, causing poor blood circulation, making them vulnerable to infection and ulcers, which in turn increases the risk of amputation.
The impact of chronic complications on other systems are related to the immune system, skeletal system, cognitive system and psychological system, which would not be further discussed here.
In summary, uncontrolled Diabetes Mellitus can lead to a variety of serious events. Fortunately, most complications can be prevented or delayed by maintaining blood sugar at optimal level.
Myth & truth No.1: Will diabetes affect my taste buds?
Occasionally, there are Diabetic Mellitus patients complain of taste alteration; they feel that their taste buds are either less responsive to taste or loss of function, although rare Diabetes Mellitus can possibly affect taste sensation.
The nerves that associated with taste sensation are connected to the taste buds on our tongue. When taste buds are stimulated, they send signals through these nerves to our brain so that we could recognize sweetness, saltiness, sourness, bitterness, etc.
However, consistently high blood sugar level can affect the oral environment and damages the nerves and blood vessels in tongue, preventing them to perceive accurate gustatory information.
Furthermore, hyperglycemia can weaken one's perception of sweetness, causing them to feel that the food is not sweet enough, which in turn adds fuel into the fire by provoking the impulse of searching for foods richer in sugars.
Hyperglycemia can also damage the blood vessels in tongue as a result of vascular disease, which affects its blood supply and results in impaired taste perception.
Likewise, Diabetic Mellitus patients may be more prone to salivary gland hypofunction, which decreases the production and secretion of saliva and causes dry mouth. The oral environment of dry mouth can lead to bacterial growth and thus infection.
Last but not least, certain hypoglycemic medications and antibiotics can also alter the perception of taste.
In summary, the solution of solving taste alternation is to tackle the root cause, which is managing blood glucose well. Controlling blood sugar level to optimal level, strengthening oral care, drinking adequate water and controlling diet are the keys to relieve the symptom.
Patient should seek medical advice early if oral or taste problems persist or conditions deteriorate i.e. worsening oral environment, malnutrition and weight loss, etc.
Myth & truth No.2: Will the urine from people with Diabetes Mellitus attract ants?
For this question, we have two facts that are undeniable. Firstly, our urine should not attract any ants. Secondly, sweetness would attract ants. Thus, whether the urine from Diabetic Mellitus patients will attract ants would depend on the content of its sugar level.
When the sugar content in blood is way too much that exceeds kidneys' ability to deal with, it will be excreted in the urine, resulting in the presence of sugar content in urine. The higher the blood sugar content in urine, the higher in its sweetness level and scent; which in turn more attractive it is to ants.
Even so, we should not interpret this phenomenon as the way of diagnosing and monitoring Diabetes Mellitus. Blood tests and home blood sugar monitoring are the proper ways of disease diagnosis and monitoring after all.
Not surprisingly, consuming food that are super rich in sugar, or taking some of the Diabetic Mellitus medications may also lead to the presence of sugar content in urine. Hence, it is advisable to seek medical attention and assessments (e.g. blood and urine tests) early when there is any doubt.
Myth & truth No.3: foamy urine – does it mean I have Diabetes Mellitus?
There are various causes behind foamy urine; it could be a temporary and unharmful event, or it could be a chronic disease related conditions.
Temporary and unharmful causes include as strong urine stream hitting on the toilet bowl, concentrated urine due to dehydration, chemical reaction between urine and toilet cleanser or chemicals etc.
Chronic disease related conditions include hypertension, rheumatic disease, Diabetes Mellitus, and bacterial infections or other diseases that may lead to kidney failing from filtering proteins or other substances out from urine. Patient with chronic disease may have other signs and symptoms such as dysuria and edema, etc.
Since there are lots of reasons behind the phenomenon of foamy urine, we should not take foamy urine as the baseline for diagnosing and monitoring disease.
All in all, consulting a doctor or taking up a health checkup would help to solve the puzzle.
Myth & truth No.4: Can eating less meal per day decrease blood sugar level in people with Diabetes Mellitus?
Diet control is an essential part in controlling blood sugar level. However, simply reducing the number of meals may not only fail to control blood sugar but also may cause other issues.
For example, some Diabetic Mellitus patients will skip one meal in a day (i.e. breakfast or lunch) hoping to reduce total sugar intake. Instead of stabilizing the blood sugar, they may actually have a more fluctuating blood sugar level due to involuntary hunger induced overeating at the other meals.
In addition, certain Diabetic Mellitus medications or insulin have requirement for regular meal schedule in order to prevent hypoglycemia.
Therefore, the key of diet control for diabetes is NOT to skip meals but to focus on personalized diet content, such as low glycemic index food, high quality protein, high fiber, optimal fat intake…etc. Patients should establish regular and consistent eating habits according to their health conditions, body weight, medications, blood sugar level, calorie needs and dietary preferences.
Dietitian would be the best buddy of Diabetic Mellitus patients during their journey of diet control.
Did you know…
The ideal range of blood sugar level.
People without diabetes history
Fasting: Less than 5.6 mmol/L
People living with diabetes
Fasting: 4 – 7 mmol/L
2 hours after eating: 5 – *8/10 mmol/L [*subjects to individual needs]
Remarks: This information is a general guideline only. Individual targets may vary based on different factors like age, health conditions and medications.
> If you have any questions or concerns, please feel free to schedule a consultation appointment with our Endocrinologist.
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