According to the Ministry of Health, about one in three Singaporeans is at risk of developing diabetes at some point in their life. Short for diabetes mellitus, diabetes can be grouped into Type 1 or Type 2, with the common characteristic being high blood sugar. Endocrinologist Kevin Tan, who is the vice-president of Diabetes Singapore, answers questions about the condition and shares how new innovations in diabetic care can help.
Q: What is the difference between Type 1 and Type 2 diabetes and can the conditions be reversed?
While both conditions are characterised by high blood glucose levels, Type 1 diabetes is caused by the body’s own immune system destroying insulin-producing cells in the pancreas. With Type 2 diabetes, it is a result of the ineffectiveness of insulin action on reducing blood glucose levels.
Type 1 diabetes accounts for less than 5 per cent of all diabetes cases, while Type 2 diabetes accounts for the majority of all diabetes cases, which is over 90 per cent. There is also gestational diabetes which is diabetes occurring during pregnancy. Although both Type 1 and 2 diabetes are not reversible or curable, they are treatable.
Q: Who is at higher risk of developing diabetes?
For Type 1 diabetes, there is a genetic risk, but the environmental contributors are unclear. For Type 2 diabetes, those at risk include people with a family history of diabetes, who are older, overweight, sedentary, as well as those who have hypertension and high cholesterol. Certain ethnic groups, women who have had gestational diabetes, and those who have conditions like polycystic ovarian syndrome are also predisposed to diabetes.
Q: How should people with diabetes manage their condition effectively?
Managing diabetes is an ongoing process. Depending on the diabetes type, management of the condition can vary from oral medications, insulin injection to insulin pump therapy. In addition to these, it’s important to make good lifestyle choices to keep blood sugar levels stable. These include:
- Counting carbohydrates in drinks, snacks, and meals
- Getting regular exercise, daily if possible
- Getting regular health checkups
For individuals with Type 1 diabetes, it's important to understand that it is an autoimmune disease where the body fails to produce insulin, which is crucial to control blood sugar levels. Without insulin, high blood sugar can seriously harm our organs. Managing Type 1 diabetes involves a lifelong commitment to insulin therapy and vigilant blood glucose monitoring.
Being overweight is the main environmental driver for Type 2 diabetes. Reducing weight with healthy eating and a reduced calorie intake coupled with regular exercise and increased physical activity can help prevent Type 2 diabetes and manage diabetes when present. High blood pressure and high cholesterol are accompanying conditions that usually affect a person with diabetes and management of these are just as important as blood glucose control.
Q: What are some of the latest innovations and technologies in diabetes management?
In terms of medication, there are now new classes of drugs that not only lower blood glucose but also help to reduce weight, heart and kidney complications, as well as mortality.
Painful insulin injections can also be made easier through sleek, smart insulin pen devices with finer needles. With the evolution of technology, smart pens are able to connect with a software application that gives reminders for the next shot, and helps track insulin injections as well as how much active insulin remains in the body.
As an alternative to multiple daily insulin injections with the use of either traditional insulin pens or the newer version of smart insulin pens, there are also insulin pumps available. These require one skin puncture every three to four days, deliver insulin continuously under the skin and can be paired with a glucose sensor to form a “closed-loop” system where the glucose level detected by a glucose sensor is communicated to the insulin pump and an algorithm calculates the insulin delivery.
There are also painless glucose sensors that are attached to the skin surface for between seven to 14 days, accurately measuring blood sugar levels every five minutes. These are able to give a more comprehensive picture of blood sugar fluctuations over a 24-hour period to aid lifestyle and food choice decisions – offering more data points than finger pricking would allow. With pre-programmed alerts of high or low glucose levels, individuals can take pre-emptive action. These readings can also be shared with caregivers, such as parents of young children with Type 1 diabetes, who may be anxious about their child’s condition.
Q: What advice on diabetes management would you give to parents of children with Type 1 diabetes?
Children and adolescents with Type 1 diabetes may face challenges in managing their condition, requiring support from family and caregivers. This impacts the quality of life for both kids and their parents or caregivers. However, advancements in medical and technological fields have significantly improved, and with the focus on leveraging technology, there's hope for simplifying diabetes management and enhancing lives. Parents should remain hopeful, encouraging a focus on living life to the fullest rather than solely on the disease.
