“Ask Dr. HKSH” - What is Diabetes


Q1. How is diabetes mellitus classified?
Diabetes Mellitus can be classified into 4 types of: Type 1, Type 2, other specific types and gestational diabetes. Type 1 diabetes mellitus is caused by an autoimmune reaction that attacks insulin-producing cells, causing severe insulin deficiency upon onset. Most patients suffer from type 2 diabetes mellitus, and cannot put blood glucose under control due to central obesity-induced insulin resistance and inadequate insulin secretion. Other specific types of diabetes mellitus include MODY (Maturity Onset Diabetes of the Young) or high glucose caused by medications and endocrine disorders. And as the name implies, gestational diabetes has to do with abnormal blood glucose levels during pregnancy.

Q2. Does diabetes affect the middle-aged and the elderly only?
Age is a major risk factor of diabetes mellitus. In the past, Type 1 diabetes mellitus or MODY is more common in youth. As childhood obesity is on the rise, type 2 diabetes mellitus now affects not only the middle-aged and elderly but also the younger population. In the US, the prevalence of type 2 diabetes mellitus in youth has increased from a mere of 3% in the 1990s to 20% in the 2000s. The trend is worrying.

Q3. Is it less worrying for young patients of Type 2 diabetes mellitus in terms of conditions and complications ?
Of course not. The earlier the onset, the longer will the impact be. Most young patients do get worse because they pay no heed to the importance of blood glucose control. A US study tracing 500 young type 2 diabetes patients found that, 13 years after the onset, when they aged around 27, 55% of them had already developed diabetic nephropathy. 32% had diabetic neuropathy and 14% suffered from diabetic retinopathy. The situation is worrisome.

Q4. How can I detect the early signs of diabetes mellitus?
Excessive thirst and urinary frequency are classical signs of diabetes, but it only occurs when the blood glucose level is extremely high. The fact that half of the diabetic patients are asymptomatic and it will lead to a delay in diagnosis and treatment. Therefore, people aged from 45 onwards should check their blood glucose level every 2 to 3 years. Those who are overweight or obese, i.e. Asians with a BMI over 23, and have one other risk factor of diabetes, such as family history, high blood pressure or dyslipidemia, should start the screening early.

Q5. How can I prevent diabetes mellitus?
The increasing prevalence and younger onset of diabetes mellitus in recent years seems to be closely associated with the rising incidence of obesity. The most effective ways to prevent diabetes mellitus are a healthy dietary habit and regular aerobic exercises. If you are overweight or obese, set sights on a 7% weight loss. If you are diagnosed to have pre-diabetes, you may consider taking metformin to reduce the chance of developing diabetes mellitus.

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