What is diabetes mellitus?

Diabetes mellitus occurs when our body is unable to maintain healthy levels of glucose resulting in high blood glucose. Insulin is a hormone that helps us turn blood glucose into energy. When the pancreas cannot produce enough insulin or the body does not use insulin effectively, this can lead to high blood glucose levels. This condition can lead to various complications if not well-managed. It is therefore important for people with diabetes to have regular medical follow-up, learn and apply diabetes self-care knowledge and skills to manage the condition well.

Different types of diabetes?

Treatment varies depending on the type of diabetes mellitus and the main types are:

• Type 1 Diabetes

  Type 1 diabetes is an autoimmune disorder, in which the body’s immune system attacks the insulin-producing cells. About 5-10% of individuals with diabetes have type 1 diabetes.

  People with type 1 diabetes make very little to no insulin and require lifelong insulin therapy. Without insulin therapy, blood glucose levels continue to rise to high levels and may lead to a serious condition called diabetic ketoacidosis (DKA).





• Type 2 Diabetes

  About 90% of individuals with diabetes have type 2 diabetes, the most common form of diabetes. It usually affects people who are above 40 years old, overweight, and physically inactive. With increasing rates of childhood obesity, there has been an increasing number of children and teenagers with type 2 diabetes.





• Gestational Diabetes (GDM)

  Gestational diabetes is a form of diabetes that develops during pregnancy. GDM is diagnosed through an oral glucose tolerance test (OGTT) usually performed at the 24-28th week of pregnancy. High blood glucose levels may affect the developing baby. Treatment of GDM usually consists of modifying dietary intake of carbohydrates and regular blood glucose testing. Insulin injection treatment may be required if dietary measures alone fail to control blood glucose levels sufficiently.

  GDM usually goes away after childbirth, but women with previous GDM are at higher risk of developing type 2 diabetes in the future and will need regular screening for type 2 diabetes.

Diabetes Related Complications

Hypoglycaemia and Hyperglycaemia Crisis

People with diabetes on insulin therapy or taking certain oral diabetes medications may experience hypoglycaemia. This occurs when there is mismatch of food intake, exercise and medications. It is important to recognize the symptoms of hypoglycaemia and treat it promptly to raise blood glucose to safe levels. Without proper treatment, blood glucose level can continue to fall and lead to more serious complications such as falls and loss of consciousness.

Symptoms of hypoglycaemia include:

• Sweating
• Hunger
• Dizziness
• Feeling shaky
• Inability to concentrate or confusion
• Fast heartbeat
• Irritability

These symptoms need to be treated urgently with sugar intake which will resolve the symptoms rapidly.

Hyperglycaemic crisis is a serious condition caused by extremely high blood glucose levels, leading to severe dehydration. It is often triggered by acute illness, infection, or medication non-compliance and requires emergency/urgent treatment. People with a new diagnosis of type 1 diabetes can present with a hyperglycaemic crisis.

Symptoms of a hyperglycaemic crisis include:

• Persistent high blood glucose level (.jpg>33mmol/L for type 2 diabetes, and .jpg>14mmol/L of type 1 diabetes)
• Excessive thirst and dry mouth
• Increased urination
• Fever
• Nausea and vomiting
• Shortness of breath
• Abdominal pain
• Drowsiness or confusion
• Hallucinations
• Convulsions or Seizures
• Coma

Chronic Diabetes Complications

Uncontrolled diabetes, in the long term, can lead to damage of various organs such as the eyes, heart, kidneys and nervous system. Uncontrolled diabetes is a major cause of blindness, kidney failure, heart attack, stroke and lower limb amputation. Early detection, close monitoring and effective management of diabetes are key strategies in preventing and delaying the development of chronic diabetes complications.

Risk factors of diabetes

Type 1 Diabetes

The exact cause for type 1 diabetes remains unknown and is thought that genetics and viruses may play a part in its development. Factors that may increase the risk of developing type 1 diabetes may include:

• Family history of type 1 diabetes
• Presence of other autoimmune diseases

Type 2 Diabetes

People may have an increased risk of developing type 2 diabetes if they:

• Have a family history of type 2 diabetes
• Are physically inactive
• Are aged 40 years and above
• Have a body-mass index (BMI) of 23kg/m2 or higher
• Have high blood pressure
• Have high cholesterol or abnormal lipid levels
• Have (non-alcoholic) fatty liver disease
• Have impaired glucose tolerance and/or impaired fasting glucose
• Have a history of gestational diabetes

With the understanding of these risk factors, individuals can make a conscious effort to reduce their risk of diabetes by adopting a healthy active lifestyle. A screening test once every 3 years is recommended for people aged 40 years and above.

For a person between 18 and 39 years old, your risk of diabetes can be assessed through the Diabetes Risk Assessment tool and you should get a health screening if at risk.

Gestational Diabetes

Women may have an increased risk of developing gestational diabetes if they:

• Are overweight or obese
• Are aged 35 years and above
• Have a family history of type 2 diabetes
• Previously gave birth to a baby who weighed 4kg or more at birth
• Had gestational diabetes in a previous pregnancy

People with type 2 diabetes may not experience symptoms, and hence diagnosis may be delayed for months or even years. In type 1 diabetes, symptoms tend to occur suddenly and be severe.

Some symptoms of diabetes are:

• Increased thirst and dry mouth
• Frequent urination
• Increased hunger (even after eating)
• Unexplained weight loss
• Blurred vision
• Slow-healing sores or cuts
• Frequent infection – such as yeast infection of the skin and groin infections