Diabetes, if not properly managed, can lead to complications such as blindness, kidney failure, limb amputation, foot/leg diseases and heart problems.

Similarly, uncontrolled high blood pressure (also known as hypertension) may result in damage of the heart and blood vessels, and increase the risk for stroke or heart attack.

Dr Ian Phoon, Associate Consultant and Dr Andrew Ang, Family Physician, at SingHealth Polyclincs, give detailed answers to your questions.​


Question by ireneneo

Dear Docs,

If a diabetic patient ever regulates his/her blood sugar levels to the normal range over a prolonged period of time, is it possible for the patient to stop medication completely?

Answered by Dr Ian Phoon, Family Physician, Pasir Ris Polyclinic

Hi. It depends on a few factors, including how long the diabetes has been, and how much medication the patient is on. The longer the diabetes, the less the body is able to produce enough insulin (a body hormone) to control the blood sugar, and the less likely the patient can maintain the sugars without the medicaiton. The more medication needed to keep the sugars within “normal” range, the less likely one can stop all medications.

Most type 2 diabetics are overweight. Too much body fat causes resistance to the action of insulin (body hormone for controlling blood sugars). If one is able to maintain a healthy weight (BMI = Wt[kg] / Ht [m]2 between 18.5 – 23), then there may be a chance that the medication may be stopped. Some elderly patients who have lost weight, because their appetite is smaller, may sometimes be able to control their blood sugars without medication.

In general, most patients on oral diabetic medication will need it lifelong. Once a diabetic, it stays with you for life. But it can be controlled with diet, exercise and medication. Do discuss with your doctor if your medication can be reduced, if your control has been good. But after your medication has been reduced, you’ll need to monitor if your blood sugar creeps up again.


Question by seesweeling@yahoo.com

Hi Doctor

Whenever I go to the Polyclinic to take my blood pressure, the reading is always very high, about 140 or 150 over 80 or 90. Sometimes even 160 over 90.

However, when I monitor my BP at home, it is always very normal, about 120 or 130 over 70 or 80. I have been diagnosed with hypertension some years ago and I am currently on the drug irbesartan 150 mg.

Please tell me why my blood pressure reading is not so high when I take it at home. I take my BP at home every day. Do I need to buy a new machine to take my blood pressure.

Thank you.

Swee Ling

Answered by Dr Andrew Ang, Family Physician, Geylang Polyclinic

Hi,

Blood pressure varies widely during the day and can be influenced by factors such as smoking, caffeine intake, stress and exercise. You may have what we call “White coat effect” as your clinic blood pressure readings are above 140/90mmHg while your home blood pressure readings are normal (Traditionally doctors used to wear “white coats”). Many patients are anxious when visiting the doctors which result in some of them having higher blood pressure readings in clinic.

However, before we can arrive at that conclusion, you will need to periodically check your machine for accuracy. This can be done by having your blood pressure taken in the clinic with both your home blood pressure set and manually by your doctor. Thus we suggest that you bring your home blood pressure set to the clinic during your next doctor’s appointment.


Question by ange_angel886

Hi, I would like to get your advice on Vitamin D which recently medical report in US stating that vitamin D supplementation improved pancreatic B cell function – important for making insulin – and helped control the rise of blood sugar, is this true?

Thanks & Best Regards

Angelene

Answered by Dr Ian Phoon, Family Physician, Pasir Ris Polyclinic

There have been some studies suggesting that low vitamin D levels may be associated with the onset of new diabetes, and that supplementation may reduce its incidence. Those prone to low vitamin D are those that tend to stay indoors, or tend to wear long sleeves, since sunlight on the skin is needed to make vitamin D.

However, there’re many other factors that can cause diabetes, or pre-diabetes (high blood sugars, but not high enough to cause diabetes), that may be more important. This includes

  1. Genetics (close family members with diabetes)
  2. Being overweight
  3. Eating too much calories (not just sweet things)
  4. Sedentary lifestyle
  5. Age (older adults are more prone)

While 1) and 5) cannot be changed, 2) – 4) should be managed with a healthy diet, with less carbohydrates, oils and fats, and more fibre, fruits and vegetables; and an active lifestyle, aiming for about 150 mins of moderate intensity exercise a week.

For those who already have diabetes, there is little evidence that supplementation of vitamin D alone can improve the control of the blood glucose.


Question by plsy2010

I have been monitoring my blood pressure recently and it appears to hover between 135-140/80. Had changed my diet in the past 11 months, reducing my salt and sugar intake. I am worried that I may need to go on medication. If that is the case, what are the side effects of high blood pressure medicine and will it affect my kidneys? Thanks.

Answered by Dr Andrew Ang, Family Physician, Deputy Clinic Director, SingHealth Polyclinics - Pasir Ris

Hi,

When you measure your blood pressure at home, it should be done after sitting down for at least 5 mins, and not soon after drinking coffee.

Home blood pressure (BP) readings should on average, be below 135/85 mmHg, so it does sound like you have hypertension. But please verify this with your doctor.

Hypertension is a silent disease - it can damage organs (e.g. heart, and kidneys) slowly without causing symptoms. The need to start medication for hypertension is dependent on a few factors, which will be assessed and decided by your doctor. Once commenced, the treatment will most likely be lifelong. The main goal of hypertension treatment is the prevention of long-term complications e.g. stroke, heart attack, and kidney failure, by bringing down blood pressure. In general, hypertension medication does not cause kidney damage, and may even protect your kidneys.

There are several classes of medication for hypertension, each with different side effects. Most people tolerate them well without side effects, especially if a low dose is used. If your diagnosis of hypertension is confirmed and oral medication deemed necessary, your doctor will discuss the choice of medication with you. It is not uncommon that two or more drugs of different classes may be needed to control your blood pressure, depending on your body's response to the treatment.

Lifestyle modification is an important cornerstone of hypertension management. In addition to reducing your salt intake (including sauces, and soup stock), you should try to stay active. The Health Promotion Board recommends about 30 minutes of moderate intensity exercise (like brisk walking, cycling or swimming) five days per week, but any increase in physical exercise can help control your blood pressure.


Question by evelynyee

Dear Doctor,

I'm 48 & seems like on my pre-menopause stage. Recently, I'd a very bad flu with hot flushes together & it really make my recovery very slow. I was also have HBP Reading of 170-180/105-110, but the polyclinic doctor wanted me to monitor my HP Reading fr another 2 wks before deciding on whether shd I be given any HBP Medicine. Pls adv whether is it menopause due to hot flashes causes HBP or does HBP causes hot flashes? Thks!

Evelyn Yee

Answered by Dr Andrew Ang, Family Physician, Geylang Polyclinic

Hi

On average, women become menopause around the age of 50 years old. Symptoms of pre-menopause include hot flushes, and irritability, and the mensus may not come so frequently, so it does sound like you are pre or peri-menopausal. It may help to avoid hot or spicy foods, use wet wipes, and fan yourself to keep yourself cool. A small study has noted an association between frequent hot flushing and higher blood pressure, but it is unclear if the flushing alone can lead to hypertension.

High blood pressure does not cause hot flushes. In fact, high blood pressure often does not cause any symptoms. Thus it needs to be checked regularly.

Your bad “flu” is likely due to a viral infection, and is separate from your peri-menopausal symptoms. But the stress of being sick with the “flu” and your flushing may temporarily push up your blood pressure. This is most likely the reason why your polyclinic doctor asked you to monitor your blood pressure for another 2 weeks, to see if it comes down once your “flu” recovers. If the blood pressure is still high (more than 140 / 90 mmHg), then you may have hypertension, and may need to start medication for this.


Reposted by administrator

Hi,

I'm taking high blood pressure medicine for more than 2 yrs and wishes to check if this will aggravate my current conditions because recently took CT scan and report indicated a small foci of scarring in my left kidney.

Answered by Dr Andrew Ang, Family Physician, Geylang Polyclinic

Hi.

High blood pressure itself may cause kidney scaring if not controlled. So the blood pressure medication you’re taking may helps to prevent or reduce this damage. High blood pressure medication does not cause scarring of the kidneys.

There may be other causes of scarring of the kidneys such as a previous kidney infection or kidney stones. Sometimes the cause is uncertain. You can check with your doctor what is likely cause of this scaring is.

Do check with your doctor if your blood pressure is under control (less than 140 / 90 mmHg in the clinic). If you’re monitoring your blood pressure at home, it should be less than 135 / 85 mmHg. Also do check with your doctor if a blood test has been done to check the function of your kidneys.

A diet low in salt and regular exercise are other ways to help control your blood pressure.


Question by turquoise

Dear Doctors,

Is there any other medications for DM Type 2 as I really don't like to be injected with insulin as there's redness, itchiness and made abdomen very hard till difficult to inject. I have many drug allergies too.

I am able to tolerate only 1/2 of the 750mg of glucophage.

Thank you.

Answered by Dr Ian Phoon, Family Physician, Pasir Ris Polyclinic

There are several types of classes of medication for diabetes. Some are taken orally, and some are injected.

Diabetes happens when the body lacks insulin, or is not able to produce enough to control one’s blood sugars (mostly because the body does not respond effectively to insulin). Perhaps that’s why you’re on insulin. Other reasons may be because you were not tolerant to other oral diabetic medications, or that your diabetes cannot be controlled with other oral medication. Do check with your doctor if other oral diabetic medications are suitable for you.

Glucopharge (metformin) can sometimes causes abdominal bloating or a feeling of indigestion. It makes the body more responsive to insulin. It is best taken after your meals, and not before, or on an empty stomach. This may help reduce the side effects. Also, sometimes it may take a while for your body to get used to metformin, and gradually increasing the dose from a low dose may be better tolerated.

You may want to check with your diabetic nurse on whether you’re giving the insulin the correct way. It does sound like you may be injecting the same area too many times, causing the skin to harden. You should avoid these hardened areas when injecting insulin. Choose a different site in your abdomen to give your insulin each time to avoid this hardening. Also, if you’re re-using your needle, it may cause some irritation. Do use a fresh needle for each injection.


Question by xoxuer

Hi, can you recommend some of the GSL runny nose/blocked nose medicine that is not containing paracetamol and suitable for high blood pressure and diabetes? thanks

Answered by Dr Andrew Ang, Family Physician, Geylang Polyclinic

Hi, I’m not sure what you mean by “GSL”.

Medication safe for blocked or runny nose include the antihistamines like loratadine, cetirizine, chlorphenaramine, and polaramine, and should not have any effect on hypertension and diabetes.

Medications classified as “decongestants” like pseudoephedrine (tablet) and oxymetazolin (nose spray), may transiently raise the blood pressure. It can be used with some caution in those with high blood pressure, since these medications are often only used for short periods (3-5 days). But it may be best avoided if your blood pressure is uncontrolled. You can monitor your blood pressure at home with a digital blood pressure machine.

If you have a sensitive nose (often sneezing or getting a blocked nose in the morning or evening), you may need a steroid nose spray to control this, such as mometasone (Nasonex), fluticasone (Avamys, Flixonase) or budesonide (Rhinocort).

If you’re still not sure which medication is suitable for you, do consult your doctor or pharmacist.


Ref: S13