A Dermatologist Shares Essential Skincare Tips for People with Diabetes

WORDS DR GAN TECK SHENG

FEATURED EXPERT
DR GAN TECK SHENG
Consultant Dermatologist
Tung Shin Hospital

The stakes are high when it comes to diabetes management.

High blood sugar is not just a number; it affects various bodily components, including your skin.

For many, a skin problem serves as an early warning sign of diabetes. Those elevated glucose levels are often the culprits behind the dry, itchy skin.

But here is the lifestyle twist–many individuals living with diabetes are not aware of the vital role that proper skin care plays. It is not just about administering insulin and watching your diet; it is about a comprehensive approach to well-being that includes your skin.

GENERAL SKIN CARE
Use gentle cleanser when bathing or showering.
  • Avoid bar soaps as they strip away natural oils and disrupt skin barrier function.
  • Also avoid cleansers that contain perfumes and harsh detergents as they may cause irritation and redness to the skin. Instead, use gentle cleansers to help maintain hydration and prevent skin dryness.
Bathe or shower the right way.
  • Use lukewarm water as hot water strips away natural oils and damages the skin.
  • Keep your baths or showers short, ideally no longer than 10 minutes.
Dry your skin carefully.
  • After a bath or shower, dry your skin with gentle pats.
  • Remember to dry the skin between your toes, armpits and other skin folds. Intertrigo—rashes and inflammation caused by skin-to-skin friction—occurs more easily in warm moist environments.
Apply moisturizer every day.
  • Keep your skin moisturized and prevent cracks that lead to infection.
  • Pick a hypoallergenic, fragrance-free moisturizing cream or ointment.
  • Apply after bathing or when your skin is dry or itchy.
FOOT CARE
Check your feet daily.
  • First, dry your feet carefully.
  • Make sure to check between your toes and your feet for rashes, cuts, sores, or any other changes to the skin.
  • Use a mirror if you cannot see your soles.
Wear shoes that fit well.
  • Always wear shoes and socks to avoid injury.
  • Wear closed, well-fitting shoes with cushioned sole.
  • Check if there is any object or pebble inside your shoes before putting them on.
Treat dry, cracked heels.
  • Apply urea cream on dry, cracked hills every day before getting into bed. This will help in preventing the development of non-healing sores and serious skin infections.
Take care of your toenails.
  • Keep your toenails short and trim them straight across.
  • Gently smooth any sharp edges with a nail file.
  • Do not let the sides of your toenails grow into the skin.
See a doctor for treatment of corns and calluses on your feet.
  • Do not remove corns or calluses with sharp objects. Any skin injury on the feet may increase the risk of ulcers and infection, especially patients with diabetic neuropathy.
  • Be cautious when using over-the-counter products, as these products may irritate your skin.
Treat all wounds immediately.
  • Wash wounds with antiseptic and water.
  • Only apply antibiotic cream if recommended by your doctor.
  • Cover the wound with an adhesive bandage.
  • Perform daily dressing to help your skin heal.
SEE A DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING
  • Reddish and swollen skin.
  • Pain or tenderness.
  • Honey-coloured crusts.
  • Change in the colour and temperature of your feet.
  • Wound that is weeping or leaking pus.
  • Thickened or discoloured nails.

First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

If You Have Diabetes, You Need to Do This for Your Kidneys!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KENNETH LAI KOAH KIEN
Consultant General Physician and Nephrologist
Bukit Tinggi Medical Centre

Diabetic kidney disease, also known as diabetic nephropathy, develops when one’s kidney has trouble filtering waste from the blood.

An overview of diabetic nephropathy. Click the image to view a larger, clearer version.

When left untreated, the affected kidney may eventually fail and one would need either a kidney transplant or dialysis.

SYMPTOMS USUALLY SHOW UP UNTIL THE DISEASE IS AT AN ADVANCED STAGE, AND BY THEN, IT CAN BE MUCH HARDER TO MANAGE

According to Dr Kenneth Lai Koah Kien, it can take many years for diabetes to substantially damage the kidneys.

“Even then, the symptoms usually don’t show up until late in the course of the disease,” he says.

WHAT ARE THE SYMPTOMS, ANYWAY?
  • Unusual weight gain
  • Swollen ankles
  • Nausea or vomiting
  • Frothy urine
  • Lethargy
  • Urine breath
  • Itching
  • Reduced appetite
  • Swelling of the leg.
  • Blurring of visions and floaters (the eye can also be affected by kidney disease)
SO, WHAT SHOULD SOMEONE WITH TYPE 2 DIABETES DO TO DETECT DIABETIC KIDNEY DISEASE EARLY?

Dr Kenneth recommends the following:

If you have other health conditions alongside type 2 diabetes, keep them well-controlled too along with your diabetes

“These patients would need to monitor their co-morbidities closely with their doctors. These include hypertension, obesity, hypercholesterolemia, and smoking. All these are mercenaries of death together with diabetes,” he says.

Go for kidney disease screening

Recommended screening tests include:

  • A urine test called urine ACR to look for protein leakage
  • A simple blood test called serum creatinine test to look at kidney function

As for when one should start screening:

  • For type 2 diabetes, screening should start on the date of diagnosis.
  • For type 1 diabetes, screening should start 5 years after the onset of type 1 diabetes.

Advice for People With Health Conditions That Will Be Fasting This Ramadan

WORDS LIM TECK CHOON

For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.

WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
  • There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
  • While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
  • Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
  • If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
  • If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
  • People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
  • Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
  • If you have gastric problems, break your fast by eating moderate amounts of foods.
  • Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
  • Also, it’s best to avoid drinks that are high in caffeine, such as coffee.

Oral Health Tips From a Dentist for People With Diabetes

WORDS DR LAU LAKE KOON

FEATURED EXPERT
DR LAU LAKE KOON
Dentist
Koks Dental Surgery

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
  • Oral ulcers
  • Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
Progression of gum disease, from gingivitis to the more serious periodontitis. Click on the image to view a larger, clearer version.

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.

Comparison of normal tooth and a tooth with periodontitis. Click on the image for a larger, clearer version.

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.

Fungal infections

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.

Dry mouth

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.

HELPFUL TIPS
  • 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.

Have Diabetes? Here’s an Improved Way to Track Your Blood Sugars

WORDS LIM TECK CHOON

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