DIABETES IS THE MOST COMMON CAUSE OF BLINDNESS AMONG WORKING-AGE ADULTS
“1 in 5 Malaysians is diabetic, which equals to an estimated 4.6 million Malaysians, and diabetic eye disease affects 1 in 3 diabetics. That means about 500,000 of these people will experience vision-threatening eye disease,” says Dr Peh Khaik Kee.
DIABETIC RETINOPATHY IS A DIABETES-LINKED EYE DISEASE THAT CAN LEAD TO VISION LOSS
According to Dr Peh, diabetes affects the eye in several ways:
It causes changes to the lens, leading to blurry vision.
Increased pressure in the eye can lead to glaucoma.
Damages the nerves that control the eye muscles, giving rise double vision.
Damages the blood vessels in the retina, leading to diabetic retinopathy.
Dr Peh shares: “Diabetic retinopathy has become of epidemic proportions. A large part of this issue is due to poor awareness. Many people with diabetes do not undergo regular eye exams to check for signs of the condition.”
REGULAR EYE EXAMS ARE IMPORTANT BECAUSE EARLY STAGE DIABETIC RETINOPATHY DOES NOT SHOW ANY SYMPTOMS
Vision loss occurs at late-stage diabetic retinopathy—this is when most people affected by this disease seeks medical help.
Unfortunately, the vision loss is permanent, and at that stage, there is little to be done to improve the person’s eyesight.
On the other hand, should diabetic retinopathy be detected at its early stages, treatment can be prescribed to help slow down or stop the vision loss over time.
“That is where the importance of screening comes in,” Dr Peh said.
EYE SCREENING FOR DIABETIC RETINOPATHY IS MORE COMFORTABLE THESE DAYS
In the past, such screening can involve staring at a bright light for up to 5 minutes for each eye, which can be very uncomfortable for some people.
Dr Peh shares that the eye screening process has improved since. “These days we have ultra-widefield fundus cameras that can capture a single, 150-degree field view of the retina; 3 times more field view than a standard camera.”
He adds that the camera captures images in under 1 minute, with up to 98% accuracy in detecting and grading retina disease when combined with targeted slit-lamp examination.
Thus, the screening process is faster and hence the person undergoing screening will have a more comfortable experience, while at the same time offering a high accuracy rate in detecting diabetic retinopathy.
EYE SCREENING MAKES A DIFFERENCE
“Diabetic eye screening was formally initiated in the UK in 2009, and by 2014, diabetes is no longer the commonest cause of blindness in working adults in the UK. That is the difference that screening makes,” says Dr Peh.
WHO SHOULD GO FOR EYE SCREENING?
Dr Peh encourages those with a family history of diabetes to have their blood sugar screened, and those diagnosed with diabetes should see an ophthalmologist to have their retina examined.
People with diabetes are living longer now, which is incredibly exciting. Still, they are vulnerable to accelerated muscle loss or sarcopenia, an often-overlooked condition that occurs in people with type 2 diabetes.
MUSCLE LOSS IS NORMAL WHEN WE AGE
It is normal for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60. Muscle strength declines even more rapidly; at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.
HOWEVER, PEOPLE WITH TYPE 2 DIABETES ARE LIKELY TO EXPERIENCE ACCELERATED MUSCLE LOSS OR SARCOPENIA
While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss.
Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.
Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.
Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.
THE LINK BETWEEN SARCOPENIA AND TYPE 2 DIABETES
The link is well established.
In a study of Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.
A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass.
A link between low muscle mass and diabetes has been found in several other populations as well.
Multiple studies have also linked diabetes to reduced muscle strength. The effect sizes were smaller in women, but the trend was the same for both genders.
This association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.
HOW TYPE 2 DIABETES LEADS TO SARCOPENIA
While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood.
The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway.
Inability to make new proteins at a rapid pace to replace muscles that have been degraded naturally
One of the key roles of insulin is to drive nutrients, such as glucose, from the blood into skeletal muscle tissues and stimulate protein synthesis.
In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissues, and the muscles cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.
Decreased function of mitochondria
The mitochondrion is the ‘energy plant’ structure in most cells of the body.
Individuals with diabetes frequently have decreased mitochondrial function, which appears to contribute to the impairment of muscle function.
Type 2 diabetes can damage the nerves outside of the brain and spinal cord, usually at the hands and feet (peripheral neuropathy)
Diabetes can promote sarcopenia via peripheral neuropathy. This condition can affect nerves that control proper muscle contraction.
Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.
Other possible factors?
Still, other factors also may play a role in causing muscle loss in the context of diabetes.
Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process.
CAN LOWERING BLOOD GLUCOSE HELP PREVENT MUSCLE LOSS?
The growing body of research on the connection between diabetes and sarcopenia has raised an important question of whether lowering blood glucose help preserve muscle mass.
There’s currently little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating and preventing muscle loss among older adults with diabetes.
However, key clinical trials on which clinical management guidelines for blood glucose have been based on unfortunately often exclude the participation of older adults, so there’s no way to know at present.
Hence, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.
THE ROLE OF EXERCISE
While diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, no medication is as beneficial for treating sarcopenia as physical activity.
Physical activity is always recommended to promote fat loss and maintain muscle mass, both of which can improve glucose levels in people with type 2 diabetes.
This recommendation applies equally to both younger and older adults.
Researchers especially recommend muscle strengthening exercise and resistance activities.
Progressive resistance training is the proven method for the prevention and improvement of sarcopenia.
Resistance exercises in more detail
Resistance training doesn’t require more than your own body weight.
Using resistance to engage the muscles causes a surge in growth-promoting hormones that signal the body to produce more muscle tissues.
Not only do these signals encourage the growth of new muscle tissue, but they also help to reinforce existing muscle tissues by making them stronger.
Some body weight resistance exercises you can try include:
Push-ups; try an easier version with your knees on the ground, if you need to.
With progressive resistance training, you need to exercise your muscles against an increasing external force 2 to 3 times a week for at least 8 to 12 weeks.
This is progressive, meaning that the number of repetitions, sets, or load should be increased gradually over time based on your capabilities and progress.
As the resistance exercises program develops, more advanced resistance exercises that can be done include barbells, kettlebells, and medicine balls or floor-based exercises.
In terms of exercise order, the American College of Sports Medicine (ACSM) recommends multi-joint exercises to be performed before single-joint exercises for a particular muscle group, and that within each session the larger muscle groups be exercised before smaller muscle groups.
As older adults with sarcopenia are also likely to be at an increased risk for falls and display reduced cardiorespiratory fitness, exercise programmes for them often involve a combination of exercise modes that includes resistance exercises, balance training and aerobic training.
For older adults with sarcopenia
Walking around the block 4 to 5 times.
Do some weight lifting.
Sit on and get up from a chair as fast as possible, and do this 10 times in a row and getting up ten times in a row as fast as possible.
If you are not used to being physically active, or you have health conditions that can affect your ability to exercise, consider consulting a physiotherapist or a personal trainer to advice. They can help you develop an exercise programme tailored to your needs, health status, and personal enjoyment.
Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.
DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?
People with diabetes are more likely to have:
Periodontal or gum disease
Persistent bad breath
Tooth decay or cavities
Oral fungal infections
Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.
Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.
If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.
Persistent plaque or tartar buildup causes irritation to the gums
The gums can become red and swollen, and bleeding may occur.
This is the first warning sign that it’s time to visit the dentist.
Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.
The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.
At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed
In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.
Diabetes and certain drugs can reduce the production of saliva in our mouth
Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.
Without the presence of saliva, there is a higher risk of tooth decay and gum disease.
Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.
In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.
Smoking will worsen the condition further.
In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.
HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis
The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.
However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.
Your dentist may prescribe some medications to kill the fungus responsible for the infection.
If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.
For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.
Only in severe cases are saliva substitutes prescribed.
Burning mouth syndrome is usually more complicated and will require specialist attention.
A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
Quit smoking. Smoking will worsen gum condition and overall health.
Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.
HELPS TO IMPROVE YOUR DIABETES MANAGEMENT
This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.
After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.
LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY
The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.
NOT JUST FOR PEOPLE WITH DIABETES
Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.
RECOMMENDED BY EXPERTS
It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.
Indeed, the United Kingdom has already taken steps to do this.
All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!
Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.
Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038
The theme of World Diabetes Day in 2022 is Education to Protect Tomorrow, which calls for the need for better access to quality diabetes education for healthcare professionals and people living with diabetes.
During the recent World Diabetes Day (WDD) 2022 celebration in Putrajaya, which was jointly organized by the Endocrine Institute of Putrajaya Hospital, the Malaysian Endocrine & Metabolic Society (MEMS), and Novo Nordisk Pharma Malaysia, the experts present reflected on the need to raise public awareness among Malaysians on diabetes.
After all, the latest National Health and Morbidity Survey reported 1 in 5 adult Malaysians has type 2 diabetes!
EFFORTS NEED TO BE DOUBLED TO STOP RISING PREVALENCE
Dato’ Dr Asmayani Khalib, the Deputy Director-General (Medical), Ministry of Health Malaysia, said: “The rising number of people affected by diabetes is putting added strain on healthcare systems. Healthcare professionals require quality diabetes education on how to detect and diagnose the condition early and provide the best possible care; while people living with diabetes need access to ongoing education to understand their condition and carry out the daily self-care essential to staying healthy and avoiding complications.”
Datuk Dr. Zanariah bt Hussein, the Head of the Endocrinology Subspecialty Service of the Malaysian Ministry of Health, felt that, as more Malaysians are diagnosed with diabetes, current efforts need to be doubled to stop this rising number from escalating further.
“Access to quality diabetes education is a goal we must all strive in, to educate and empower not only patients and the community but also family members who are providing support and care,” she said.
DIABETES EDUCATION KEY TO SUSTAINABLE LONG-TERM DIABETES CARE
“The focus on access to diabetes education is a critical aspect that will enable sustainable long-term care, with both healthcare providers and people living with diabetes receiving quality diabetes education,” said Richard Abela, the Vice President and General Manager of Novo Nordisk Pharma Malaysia. “This is an essential component of diabetes care as we develop a patient-centric approach in care, that is sustainable for lifelong chronic disease management.”
Most of us have heard it by now: the 2019 National Health and Morbidity Survey from our Ministry of Health revealed that more than half of Malaysians are overweight or obese. Given that type 2 diabetes is closely linked to overweight and obesity, it’s therefore not surprising that the prevalence of this chronic disease in this country is high—the highest in Asia, in fact!
Furthermore, there is a misconception that, for people with diabetes, eating healthily means giving up all the foods and beverages they used to enjoy. This is not true, that the key to a healthy, balanced diet for people with diabetes lies with keeping count of one’s carb and calorie intake, so that these are within the recommended amount for the person.
Recognizing the prevalence of type 2 diabetes and the need to empower Malaysians with this condition to prepare healthy, diabetes-friendly meals that they will enjoy, Alpro Pharmacy together with sugO35, a personalized diabetes care service provider, has prepared a series of recipe books for people with diabetes.
Last November, Teroka FUN Resipi Diabetik was released in conjunction with World Diabetes Day.
This is the second volume in the series, following the first volume, U-Turn Diabetic the Fun Way.
“One of the most frequently asked questions from our diabetic patients is ‘What can I eat?’,” dietitian Chua Kai Jia shares with us.
5 GREAT THINGS ABOUT TEROKA FUN RESIPI DIABETIK
It contains 25 diabetes-friendly recipes utilizing common ingredients used in Malaysian dishes. Each ingredient gets a chapter of its own, with fun facts and nutritional information about these ingredients.
These recipes are prepared by nutritionists and dietitians.
These dishes will appeal to Malaysians of all races, and they are also affordable to prepare and tasty to eat—proof that someone with diabetes can still enjoy delicious meals as long as they pay attention to what and how much they eat.
Chua shares that this book will be useful to people with diabetes and their loved ones when it comes to adhering to a healthy, well-balanced (and tasty!) diet while keeping their blood glucose levels within a healthy range.
The content is in Bahasa Malaysia and Chinese, making it accessible to a large majority of Malaysians.
HOW TO GET YOUR COPY
Digital You can sign-up to get your free copies of the 2 recipe books using the links below. All links open in a new tab.
The first volume is out of print. Volume 2, Teroka FUN Resipi Diabetik, is still available, however, for RM59.90. You can obtain a copy here (link opens in a new tab).
HealthToday is not associated with Alpro Pharmacy and sugO35. This article is presented for information purpose only, as we believe that these books can be of use to readers. We do not get any income from downloads or purchases through the links on this page.