Screen for diabetes if you have slow-healing wound

Q I am a 45-year-old man with a family history of type 2 diabetes. I am 1.7m tall and weigh 85kg. I take multi-vitamin supplements daily and usually jog or cycle at the park on Sundays. I have never done any health screening.

I eat out at hawker centres most of the time . I had a cut recently and it is taking a long time to heal. Although I have not seen any ants in the toilet area, should I be worried about diabetes?

A Poor wound healing is a classic symptom of diabetes.

While having ants in the toilet area may imply the presence of diabetes, absence of this sign does not exclude it either.

Most of my newly diagnosed diabetic patients are asymptomatic and diagnosed only through early screening.

The underlying pathology of type 2 diabetes is insulin resistance. This is in contrast to type 1 diabetes which is due to a deficiency in insulin production.

While having ants in the toilet area may imply the presence of diabetes, absence of this sign does not exclude it either.

The main contributing causes to type 2 diabetes include family history and being obese around the waist area (central obesity).

You do belong to the high-risk category and, coupled with your slow-healing wound, it is important for you to screen for diabetes.

To diagnose this condition, a fasting glucose level is required.

Levels above 126mg/dl implies presence of the disease. In cases where levels are close to 126mg/dl, an oral glucose challenge test is recommended. This is a test where blood sugar levels are measured two hours after consuming 100mg of glucose.

In the management of diabetes, it is paramount to address your weight as your body mass index puts you in the obese category.

When it comes to weight loss, there is no lack of diets promising instantaneous results. Many of them limit your nutritional intake and tend to fail in the long run.

The cornerstone to achieving a healthy weight includes good eating habits, regular physical exercise and a balancing of calorie intake and expenditure.

For healthy eating, I often recommend the Mediterranean diet. It is difficult but not impossible to select a Mediterranean- diet type of meal at hawker centres.

With its emphasis on fish, lots of vegetables, nuts and olive oil, the Mediterranean diet has been linked to a healthier heart and greater longevity. Lean red meat and chicken can occasionally be substituted for fish.

Also important in the management of diabetes is to take note of the glycemic index of the food you eat. Food with a high glycemic index would lead directly to having a high sugar level after meals, which is detrimental to health.

Regular physical activity is important if you are trying to lose weight. However, your current exercise regimen may not result in much weight loss.

I would suggest up to 300 minutes of exercise per week for weight loss. This translates to 60 minutes of physical activity five days of the week. It need not be 60 minutes at one go but can be split up into a few shorter sessions.

To prevent injury, it is also not advisable to stress the same muscle group or joints daily.

For a proper exercise prescription, I will have to take into consideration your general fitness and sports abilities, as well as physical hindrances and personal interest.

Supplements are useful. But just like exercise, one shoe does not fit all. Supplements like alpha lipoic acid, chromium picolinate and CoQ10 may be useful. As diabetes is often associated with heart diseases, omega 3 can also be recommended.

Medication is often necessary to ensure good sugar-level control except for those with the mildest of diabetes or who are pre-diabetic.

Many diabetic patients develop irreversible complications from diabetes due to initial resistance to management.

Do follow your doctor's advice if medication is necessary.

Upon being diagnosed with diabetes, it is important to screen for diabetic-related complications affecting the cardiovascular system, kidneys and eyes.

With early diagnosis of diabetes and a holistic management involving lifestyle changes, supplements and medications, and careful surveillance for possible complications, it is possible to lead a healthy life despite this chronic and potentially debilitating disease.

Dr Derek Koh

Head of department and resident physician at the Thomson Lifestyle Centre

Brought to you by

A version of this article appeared in the print edition of The Straits Times on July 05, 2016, with the headline 'Screen for diabetes if you have slow-healing wound'. Print Edition | Subscribe