Diabetes is characterised by high levels of sugar (glucose) in the blood. It is a chronic disease, that if not managed well, would lead to other health conditions such as heart disease, kidney failure and blindness.

But how is diabetes diagnosed? What are the differences between Type 1 and Type 2 diabetes? Is diabetes reversible?

Dr Teh Ming Ming, Senior Consultant from the Department of Endocrinology at Singapore General Hospital, a member of the SingHealth group, answers everything diabetes.

Dear Dr Teh, is it true that prolonged intake of avorstatin can cause diabetes in some patients? My dad has been prescribed avorstatin since last year to manage his cholesterol but I read that a side effect of taking it is type 2 diabetes. If this is true, is there anything he can do to minimise the risk? He's also on medication for blood pressure.

Answered by Dr Teh Ming Ming, Senior Consultant from the Department of Endocrinology at Singapore General Hospital.

There have been various studies looking at the link between statin use and diabetes but no definite conclusion has been drawn. It may not be easy to settle the issue once and for all. Many of the patients with high cholesterol and high blood pressure are at risk of developing diabetes. On a more practical note, lifestyle changes should help to reduce the risk of developing diabetes. Hence, it is important that your father has a healthy diet and exercises regularly in order to reduce the risk of developing diabetes.

Dear Dr Teh,
My blood glucose is well controlled, sometimes I feel nauseous and experience symptoms of hypoglycemia after exercising. Usually I have a snack before exercising, so I’m not sure what is causing these symptoms. May I know how often I should test my blood sugar, and what should I do if it is too high or too low? Thank you!

Answered by Dr Teh Ming Ming, Senior Consultant from the Department of Endocrinology at Singapore General Hospital.

I would recommend at least checking your fasting blood glucose in the morning if you are on once daily insulin injection. I would advise you to check the evening blood sugar before dinner too if you are on twice daily premixed insulin injection such as Novomix 30 or Mixtard 30 which is the common premixed insulin preparations in Singapore. On the other hand, if your insulin regimen consists of injecting once daily long -acting insulin together with short- acting insulin before each meal, I would advise you to check blood sugar before your meals and at bedtime in addition to the morning fasting blood glucose.

Moreover, I would also advise you to check your blood before exercise and after exercise. Typically, we consider blood sugar below 4 mmol/l as low blood sugar. If you are regular experiencing episode of blood sugar below 4 mmol/l after exercising, I would advise you to have a carbohydrate rich snack to boast your blood sugar before exercise. If you find that blood sugar is running low after the exercise, you can have sugary drinks to bring your blood sugar up. There may be other strategies available in preventing low blood sugar after exercise but this very much depends on your insulin regimens. You can discuss this with your doctor at your next diabetes outpatient clinic appointment.

It is difficult to advise you here exactly what to do if the blood sugar is too high as it depends very much on your insulin regimen. This is best done via a face to face consultation with your doctor who looks after you for your diabetes. One of the strategies which you can try is avoiding the food which pushes your blood sugar up in the first instance. If you have already tried avoiding food which pushes up your blood sugar but blood sugar level is still high, you can increase the doses of insulin injection. As there are various preparations of insulin available, it is difficult to standardise this piece of advice. I would advise you to discuss this with the doctor about how to adjust your insulin doses in response to the high blood sugar reading at your next diabetes clinic appointment.

Dear Dr,

I have been told that there are signs of diabetic retinopathy in my eyes, and that I will have to get injections for my eyes. This worries me. Is diabetic retinopathy reversible? Many thanks in advance.

Answered by Dr Teh Ming Ming, Senior Consultant from the Department of Endocrinology at Singapore General Hospital.

Injection treatment for diabetic retinopathy is beneficial for the eyes so it is important that you have the treatment as advised by your eye specialist. There are different types of diabetic retinopathy and some of them are not reversible. Fortunately, treatment for diabetes retinopathy can help to stop the damage to the eyes and may restore the vision in some cases. The equally important issue here is prevention of further sight -threatening diabetic retinopathy through good control of diabetes. You can improve your control of diabetes through combination of lifestyle changes and taking appropriate diabetes medications which are prescribed by your doctor.

It has become a habit for me to eat at night (around say 11pm & after). This started when i used to exercise at night after work. If i don't eat, i may go hungry and it could affect my sleep.

Questions:

1. If i eat & sleep, would it cause a problem in term of my blood sugar level and my cholesterol level?
2. What type of food/snack/supper should i eat before bed?

Your blood sugar and your cholesterol levels may be affected if you eat before bedtime. The resulting effects of eating on blood sugar and cholesterol depend largely on what has been eaten.

The best thing is to avoid eating before bedtime. As sleeping is associated with a prolonged period of inactivity so the energy expenditure is low during sleeping.  Hence, the excess calories may be stored in the body and this in turn may promote weight gain. If one has to take snack before bedtime, the usual advice regarding healthy low calorie snack still applies.

Dear Dr Teh,

My granny is 82 years old and has been managing her diabetes well until recently. She’s been showing signs of dementia and last I visited her, she said her eyes are not so good and I saw her feet and toes look a bit dark. There are no bruises on her soles though. What can I do to take better care of her?

Answered by Dr Teh Ming Ming, Senior Consultant from the Department of Endocrinology at Singapore General Hospital.

You can go along with your grandmother when she next attends the clinic appointment for her diabetes. Most polyclinics and hospitals offer eye screening to the diabetes patients annually to pick up eye changes associated with diabetes. Appropriate treatments or monitoring strategies can be deployed to tackle the changes in the eyes associated with diabetes. Similarly, most healthcare institutions also offer checking of the feet of the diabetes patients annually to make sure that the feet are fine. The blood vessels and the nerve fibres of the feet can be affected by poorly- controlled diabetes. This can manifest in the form of pain on walking or pain at night or recurrent foot ulcers which heal poorly.

I was prescribed Simvastatin 10 mg (half tab per day) many years ago together with my diabetic medicine. My diabetes is under good management. My last two blood tests in March 2017 and Feb 2018 showed my cholesterol as 3.75 and 3.28 and triglycerides as 1.1 and 1.05. I asked whether I could discontinue with Simvastatin as I am retired and could better control my oily food intake and more exercise time. The doctor seems reluctant and continue to prescribe Simvastatin. Is it safe to continue with the medicine? Thank you.

It is generally safe to continue with continue to take Simvastatin.  But you would need to pay attention to unusual musculoskeletal pain which is a rare side -effect of simvastatin. However, most patients tolerate simvastatin well.

I’ve just been diagnosed as pre diabetes as my HBA1c result came in at 5.8. Plus my BMI at 23.5. I’m quite scared as I don’t want to get diabetes. The nurse told me I had to try to lose some weight and exercise a bit more. Plus cut some carbohydrates from my meals.. If I do this diligently from now on, will it work and stop me from getting diabetes?anything else I should do to be definitely effective? Please help and advise me!! I heard somewhere that pre diabetes is curable but diabetes is not...

I think the nurse's advice regarding healthy lifestyle is a piece of prudent advice. The Hba1c of 5.8% is close to the pre-diabetes Hba1c cut-off of 6-6.4%. The actual number is not that crucial but it is the long term of progression of Hba1c into diabetes range which is worrying.   Paying attention to diet and regular exercises help to prevent diabetes. Cutting down on   carbohydrates, salt and oily food  intake as well as regular exercises are all beneficial for health. There is everything to play for at this stage as lifestyle intervention may help to prevent progression to diabetes.