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Understanding Diabetes

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Understanding the various complications that may arise from having diabetes can help you recognise warning signs and manage your condition better.

In Singapore:

Type 1 versus Type 2 Diabetes

  • Type 1 diabetes often begins in childhood and is also termed as insulin-dependent diabetes. The pancreas does not produce insulin which regulates the amount of glucose in the blood. Type 1 diabetics require patients to carefully monitor their blood sugar levels regularly, plan their meals and take medication and insulin.

  • Type 2 diabetes account for most of the diabetic cases in adults. The pancreas is able to produce some insulin, but the insulin may be insufficient or the body cells are resistant to it. Type 2 diabetes can be controlled with medication, weight management and proper nutrition.

What Can Occur If I Have Diabetes?

Retinopathy

  • A disease of the retina which can lead to impaired vision and is responsible for 2.6% of blindness worldwide

  • It affects 35% of patients with Type 2 diabetes

  • Proliferative retinopathy (the most severe form that can cause blindness) affects 7% of patients with Type 2 Diabetes

Neuropathy

  • A disease or dysfunction of one or more peripheral nerves, typically causing numbness or weakness. When the nerves of the toes, feet, legs, fingers, hands and arms are affected, peripheral neuropathy occurs

  • Neuropathy affects up to 30 to 50% of people with diabetes and can progress to end-stage renal disease (ESRD)

  • At least 80% of cases of ESRD are caused by diabetes or hypertension, or a combination of both

Neuropathic Pain

  • A shooting or burning pain

  • Occurs in 11% to 32% of people with diabetes and peripheral neuropathy

Lower-Extremity Amputation

  • Foot ulceration has been reported in 6.3% of people with diabetes and higher in people with Type 2 Diabetes than in Type 1 Diabetes (6.4% versus 5.5% respectively)

  • People with diabetes are 10 to 20 times more likely to require lower-extremity amputation (amputation of the lower limb, including the hip, thigh, leg, ankle, and foot) than people without diabetes

Pregnancy Complications

  • Pregnant women with pre-existing diabetes (excludes gestational diabetes) have a higher risk for complications for both mother and foetus

  • They are likely to experience a four to five-fold increase in perinatal death and a four to six-fold increase in stillbirths

Cancers and Dementia

  • Type 2 diabetes is a risk factor for the development of certain types of cancers and dementia

  • Diabetic patients have a two-fold greater risk of developing cancers of the liver, pancreas and endometrium, and a 1.5-fold greater risk for cancers of the colon, rectum, breast and bladder

  • Relative risk of vascular disease ranges from 2.3 to 2.5 and Alzheimer’s disease ranges from 1.5 to 3.8

Cardiovascular Disease

  • Cardiovascular disease occurs two to four times more in people with diabetes than people without diabetes

Screening Tests

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Diabetic Retinal Photography

Diabetic retinal photography is a screening test which helps prevent blindness caused by diabetic retinopathy, an eye disease common among diabetic patients.

Diabetic retinopathy is a leading cause of blindness in Singapore. It occurs when high blood sugar cause damage to the blood vessels of the light-sensitive tissue at the back of the eyes (retina). The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this condition.

In the early stage, diabetic retinopathy may show no symptoms or only cause mild vision problems. Eventually it can cause blindness.

Some symptoms are:
  • Spots or dark strings floating in your vision (floaters)
  • Blurred vision
  • Fluctuating vision
  • Impaired color vision
  • Dark or empty area in your vision
  • Vision loss

Foot Screening

Foot problems are common causes of chronic disabilities in patients with diabetes.

Neuropathy (a type of nerve damage, typically causing numbness or weakness) is common in diabetic patients. It occurs because high blood sugar damages the nerve fibres in their bodies. Foot injuries can go undetected when the legs and feet are numb due to neuropathy.

Early identification and intervention of those at risk, will prevent complications and reduce the need for amputations.

Diabetic retinal photography and foot screening are recommended to be done annually.

References:
Supplement to the Journal of Family Practice, Vol 67 No 6, 2018
https://www.healthhub.sg

https://www.nkfs.org
https://www.nrdo.gov.sg
https://www.mayoclinic.org

Enquire about Diabetic Foot Screening / Retinal Photography