23.DEC.2016 6 MIN READ | 6 MIN READ

It is estimated that by the year 2030, 18.4% of Singaporeans will develop diabetes.

More and more people today are developing diabetes. Dr Daniel Wai, endocrinologist at Mount Elizabeth Hospital, talks about the ways to avoid it from the latest research.

What is diabetes?

Diabetes mellitus is a disease characterised by having high blood sugar.

Normally, our body makes insulin whenever we eat and the blood sugar starts to rise. The insulin makes sure that the sugar goes into the cells of our body to be used or stored, and prevents the liver from making too much sugar. In individuals with diabetes, there is not enough insulin around to do that.

What causes type 1 diabetes?

There are 2 types of diabetes. Type 1 diabetes is an autoimmune disease where the body’s white cells destroy the insulin-making cells in the pancreas. So the patients cannot make much insulin at all, and they need insulin injection for life. It is thankfully very rare, accounting for about 5% of all diabetes.

What causes type 2 diabetes?

Type 2 diabetes is believed to be a disease of over-nutrition, and is related to an urbanised lifestyle and increasing obesity.

It is believed that each of us have a definite amount of fat storage capacity. When that capacity is exceeded by chronic over-nutrition (eating too much and always sitting around), the body does not want any more additional fat, and becomes resistant to insulin.

At first, the pancreas makes more insulin to overcome the insulin resistance. However, the pancreas eventually fails to do that and the sugar starts to rise, causing pre-diabetes (impaired fasting glucose or impaired glucose tolerance). At the same time blood triglycerides (fat in the blood) and free fatty acids start to rise in the blood.

Both the increased sugar and the free fatty acids are poisonous to the pancreas, causing a vicious cycle when the pancreas continues to be damaged. This further damages the pancreas and causes the sugar and free fatty acids to go higher!

Eventually, the increased insulin production is not enough to overcome the insulin resistance, and the patient develops diabetes. By the time diabetes occurs, only 50% of the pancreas function is left.

Diabetes and its complications

Uncontrolled diabetes causes many complications. The sugar sticks to everything in the body, from blood vessels walls, white blood cells, and all kinds of proteins, preventing their normal function. There are 2 main types of complications: big blood vessel disease and small blood vessel disease.

Big blood vessel disease refers mainly to heart vessel blockage causing heart attacks, brain vessel blockage causing strokes, and leg vessel blockage. Small blood vessels disease refers to damage to small vessels in the eye causing blindness, kidneys causing kidney failure, and nerves causing nerve damage.

The combined effect of nerve damage and blood vessel blockage cause bad foot infections, sometimes requiring amputations. Diabetes is the most common cause of end stage kidney failure requiring dialysis, accounting for 63.5% of all new cases in 2008. Diabetes is the top cause of chronic ill health in Singapore.

Rising prevalence of diabetes

About 11.3% of Singaporeans have diabetes, based on the National Health Survey 2010. It is estimated that by the year 2030, 18.4% of Singaporeans will develop diabetes. More alarmingly, half the people with diabetes in Singapore are not aware that they have diabetes. As more people suffer from diabetes, its accompanying complications such as blindness, kidney failure and amputation will increase.

Avoiding diabetes

Since diabetes is a disease of over-nutrition, we need to correct that. Half of all Singaporeans eat more than they need energy-wise. The majority of Singaporeans are office workers, sitting at a desk most of the day. When we reach home we just want to relax on our sofas. Some of us work till late at night, getting only 3 or 4 hours of sleep.

To avoid diabetes, we need to make some changes!

Ways to prevent diabetes

Sleep more. A lack of sleep leads to increased appetite, which makes us eat more, and raised stress hormones. These two combine to raise our risk of diabetes.

Burn more energy. Regular exercise is important. Go to a gym to work out, or hit the swimming pool. Go to the park over the weekend for some rollerblading or cycling. Visit the botanic gardens in the evening and let the kids run wild – you will burn some energy as you chase after them. Take the stairs more often and do some house work.

Take the right foods. Many studies have been done to look at diets that will increase or decrease the risk of developing diabetes:

Foods that may increase your risk:
Fast food
Soft drinks
Fruit juice
White rice

Foods that may decrease your risk:
Coffee
Black tea
Fruits
Brown rice
Soy
Full cream milk
Green leafy vegetables
Moderate alcohol

Conclusion: We can do it!

Diabetes is going to become a major health issue for our society. Fortunately, it can be prevented by simple changes in our lifestyle: Sleep more, exercise more and eat healthy.

References:

National Health Survey 2010. Ministry of Health Singapore

Sicree R, Shaw J, Zimmet P. IDF Diabetes Atlas fourth edition. The Global Burden. Diabetes and IGT.

Phua HP, Chua AV, Ma S, Heng D, Chew SK. Singapore's burden of disease and injury 2004. Singapore Med J. 2009 May;50(5):468-78.

7th Report of the Singapore Renal Registry 2007/2008. Dr Lina Choong with Ministry of Health Singapore.

Singapore Nation Nutrition Survey 2004. Health Promotion Board.

Odegaard A et al. Coffee, tea, and incident type 2 diabetes: the Singapore Chinese Health Study. Am J Clin Nutr 2008; 88:979–85.

Mueller N et al. Soy intake and risk of type 2 diabetes mellitus in Chinese Singaporeans. Eur J Nutr DOI 10.1007/s00394-011-0276-2.

Odegaard A et al. Western-Style Fast Food Intake and Cardiometabolic Risk in an Eastern Country. Circulation. 2012;126:182-188.

Odegaard A et al. Soft Drink and Juice Consumption and Risk of Physician-diagnosed Incident Type 2 Diabetes. Am J Epidemiol 2010;171:701–708.

Muraki I et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013;347:f5001 doi: 10.1136/bmj.f5001

Sun Q et al. White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women. Arch Intern Med. 2010;170(11):961-969.

Mozaffarian D et al. Trans-Palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults. Ann Intern Med 2010; 153: 790-799

Carter P, et al. Fruit and vegetable intake and incidence of Type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 341: c4229. DOI: 10.1136/bmj.c4229.

Joosten M et al. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Am J Clin Nutr. 2010 Jun;91(6):1777-83.

23.DEC.2016
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Wai Chun Hang, Daniel
Endocrinologist
Mount Elizabeth Hospital

Dr Wai was born in Hong Kong and was awarded the Ministry of Education scholarship to pursue his studies in Singapore. Subsequently, he decided to make Singapore his home. He obtained his Bachelor of Medicine and Bachelor of Surgery degree from the National University of Singapore in 1998 and obtained his membership of the Royal College of Physician (United Kingdom) and Master of Medicine (Internal Medicine) Singapore in 2001. He later underwent advanced specialist training in the Singapore General Hospital and completed it in 2006.

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