Diabetes Mellitus
Diabetes Mellitus (DM) is a chronic metabolic disease. The pancreas does not produce enough insulin or the body cannot use insulin effectively. As a result, sugar accumulates in the blood and the excess sugar is excreted in the urine.
Types of DM
- Type 1 diabetes: It accounts for 5% to 10% of DM patients. It is more common among children and young adults. Due to failure of the pancreas, little or no insulin is produced, onset of disease is usually more sudden. Patients with Type 1 diabetes require daily administration of insulin to stabilize the blood sugar level.
- Type 2 diabetes: About 90% to 95% of diabetes cases are type 2 diabetes. It mainly affects the middle-aged or elderly, especially those with family history, obesity, poor eating habit or lack of exercise. The body fails to produce enough insulin or use insulin effectively. Symptoms usually develop gradually and some people may have no obvious symptoms in the early stage.
Treatment depends on the severity of the disease. For mild cases, diet control with appropriate exercise may already suffice. Others would need oral hypoglycemic drugs. For those with poorly controlled DM, insulin may be required. - Gestational diabetes: It is a disease developed during pregnancy, which subsides after delivery. These women may have higher risk of developing type 2 diabetes later.
- Secondary diabetes: It refers to diabetes that is caused by other diseases (e.g. mumps, chronic pancreatitis or long term use of steroids).
Symptoms
Some patients have no obvious symptoms, and the condition is only found after blood tests. Symptoms may include:
- frequent urination and excessive thirst
- tiredness and unexplained weight loss
- itchiness of skin especially private parts
- poor wound healing
Elderly diabetic patients may also have the following symptoms:
- Urinary incontinence
- Impaired vision
- Falls
- Recurrent infections
- Decreased memory
- Confusion
- Dehydration
Complications
Acute complication: Loss of consciousness may occur when the blood sugar is too high (diabetic ketoacidosis, hyperosmolar nonketotic coma) or too low (hypoglycemic coma). These are emergency situations and the patient should be sent to the hospital right away.
Chronic complication: Long term high blood sugar damages the blood vessels and can cause serious health complications, such as coronary heart disease, hypertension, kidney failure, cataract and retinal degeneration. These can lead to blindness, stroke, chronic skin ulcer or gangrene, which may require amputation if not treated properly. Thus, a well-controlled blood sugar level is of utmost importance to reduce the risk of chronic complications.
Treatment
- Maintain an optimal body weight: Insulin works better if the excess body weight is reduced.
- Eat a healthy diet: Avoid food with high calorie and high sugar content so that the demand for insulin is reduced. Some mild cases may be controlled by dietary management without medication.
- Regular exercise: It improves blood glucose control, reduces cardiovascular risk, contributes to weight loss and improves well-being. Resistance exercise also enhances skeletal muscle mass and endurance, and hence may reduce the risk of fall in the elderly.
- Drug treatment: This includes oral hypoglycemic agent and insulin. Always take the drug as advised to avoid any adverse effects.
In addition, patient should pay attention to lifestyle modification. Remember, a regular routine in terms of meals, rest, and work life balance, no smoking and regular follow-up are essential to control diabetes and prevent complications.
Prevention
Healthy lifestyle is the best defense to reduce the risk of developing diabetes. It includes a healthy balanced diet, an optimal body weight, regular physical activity, no smoking, avoid secondhand smoke exposure and no alcohol.
For more information, please visit the website "Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings 【Patient Version】"