Winning The Battle Against Diabetes: Types, Symptoms, Causes, and Treatment Options

In this article, Dr Saiful Kassim, resident consultant endocrinologist at Gleneagles Hospital Kuala Lumpur explains everything you need to know about diabetes, its causes, symptoms, and effective treatments.

What is Diabetes?

Diabetes is a chronic condition that occurs when your blood glucose levels are too high. is the body’s primary energy source, derived from both the food you eat and the glucose produced by the body. Normally, the pancreas secretes insulin, a hormone that helps transport glucose into your cells for energy. In diabetes, either the body doesn't produce enough insulin or the cells become resistant to it, leading to elevated blood sugar levels.

Types of Diabetes: Who Is Affected and How to Manage the Risks

There are several types of diabetes, each affecting different groups of people. Understanding the different types and associated risk factors is crucial for early detection and effective management.

1. Type 1 Diabetes

• Who It Affects: Typically diagnosed in childhood, but it can occur at any age. Type 1 diabetes is an autoimmune condition in which the immune system attacks insulin-producing cells in the pancreas.
• Prevention: It cannot be prevented. Early diagnosis and insulin therapy are necessary for managing the condition.

2. Type 2 Diabetes

• Prevention: This type is more common in adults, especially those over the age of 40, but it is increasingly being diagnosed in younger people due to rising obesity rates. People with a family history of diabetes, those who are overweight or obese, and individuals from certain ethnic backgrounds (e.g., South Asian, African-Caribbean, and African heritage) are at higher risk.
• Prevention and Management: Type 2 diabetes can sometimes be prevented or its onset delayed with lifestyle changes such as maintaining a healthy diet, regular physical activity, and weight management. Early medication intervention can help control blood glucose levels and reduce the risk of complications.

3. Gestational Diabetes

• Who It Affects: This type occurs during pregnancy and affects some women, typically around the second or third trimester. Women with a family history of diabetes, those who are overweight, or those carrying a larger baby are at increased risk.
• Prevention and Management: Gestational diabetes can often be managed through dietary modifications and regular exercise. Although it usually disappears after childbirth, women who have had gestational diabetes are at higher risk of developing type 2 diabetes later in life. Postpartum monitoring of blood glucose levels is essential.

What are the Latest Malaysian Trends in the Incidence of Diabetes?

Malaysia has the highest incidence of diabetes in the whole of South-East Asia. The rate of diabetes has escalated from 11.2% in 2011 to 18.3% in 2019, affecting nearly 1 in 5 Malaysians. There are several causes of growth, but the main ones are dietary decisions involving the intake of highly refined carbohydrates and a lack of exercise, which contribute to diabesity (Diabetes-Obesity syndemic). By 2025, 7 million Malaysians are anticipated to have diabetes.

An estimated 95% of all diabetes cases are type 2 diabetes, while 5% are type 1 diabetes. However, we tend to forget the iceberg underneath the sea - Pre-diabetes or Impaired Glucose Tolerance (IGT), which affects 1 in 2 individuals and if uncontrolled will eventually be diagnosed to type 2 diabetes.

Diabetes is Expensive!

At least 5% of Europe's overall healthcare expenditures are related to diabetes. However, developing nations have had the biggest growth. When compared to a patient without diabetes, a patient's overall life expectancy with diabetes is lowered by 25%.

What are the symptoms of diabetes?

Type 2 Diabetes Symptoms

Most people with type 2 diabetes are asymptomatic in the early stages, making it harder to diagnose. Often referred to as the "silent disease," it may go unnoticed until complications arise, such as:

• Diabetic retinopathy (eye disease)
• Diabetic nephropathy (kidney disease)
• Diabetic neuropathy (nerve damage, especially in the feet)

As insulin deficiency progresses, common symptoms include:

• Polydipsia (excessive thirst)
• Polyuria (frequent urination, especially at night)
• Unexplained weight loss

If left untreated, these symptoms can worsen over time, eventually leading to more serious complications.

Type 1 Diabetes Symptoms

Type 1 diabetes presents with more noticeable and rapid symptoms, including:

• Rapid weight loss
• Polydipsia (feeling thirsty all the time)
• Polyuria (frequent urination during the day and at night)

In both types of diabetes, blood glucose tests (like A1c and fasting blood glucose) are essential for diagnosis. Many people may not know they have diabetes until a routine checkup.

At-Risk Groups

• Individuals with a family history of diabetes (parents, siblings).
• Obesity, which leads to insulin resistance, is a key risk factor for type 2 diabetes.

Diabetes derives from the Greek term "syphon," which refers to how the fluid exits the body through the man's body rather than staying there

Causes of Diabetes, Risk Factors, and Reversibility

Causes of Diabetes

There are various causes of diabetes, and these can vary depending on the type. For type 1 diabetes, genetics and autoimmune diseases play a significant role. It occurs when the immune system attacks and destroys the insulin-producing beta cells in the pancreas, leading to insulin deficiency.

Type 2 Diabetes Causes and Risk Factorss

Type 2 diabetes is primarily seen in middle-aged and elderly individuals, but it is increasingly affecting younger populations, including children, with childhood obesity driving this trend.

Type 2 diabetes is caused by:

• Impaired insulin secretion from the pancreas.
• Insulin resistance occurs when the body’s cells do not respond well to insulin.

This condition is often exacerbated by an obesogenic environment, which promotes physical inactivity and unhealthy eating habits, such as large portions of refined carbohydrates (e.g., white rice, white bread, cereals, and sweets like chocolates).

Risk Factors for Diabetes

• Genetics (family history of diabetes).
• Obesity, which leads to insulin resistance and is a primary driver of type 2 diabetes.
• Sedentary lifestyle and poor dietary choices.

Reversibility of Diabetes

While diabetes cannot be completely "cured," it can be brought into remission through significant lifestyle changes. This is why endocrinologists prefer the term "remission" rather than "reversal," as diabetes can recur if diet and exercise guidelines are not followed consistently.

The most effective approach to achieving diabetes remission includes:

• Following a balanced, healthy diet.
• Incorporating regular exercise to manage body weight and improve insulin sensitivity.
• Consulting with a doctor to manage blood glucose levels and consider medications that help control diabetes and reduce obesity as a risk factor.

Treatment of Diabetes: Latest Medications and Treatment Options

Treatment for Type 2 Diabetes

The first line of treatment for type 2 diabetes focuses on lifestyle changes. These include:

• Dietary modifications to reduce refined carbohydrates and maintain a balanced diet.
• Regular exercise (30 minutes daily, 5 days a week).
• Smoking cessation to reduce overall cardiovascular risk.

The goal is not only to improve glycaemic control but also to reduce obesity, which is a key risk factor for type 2 diabetes (known as diabesity). Effective treatment also aims to lower the risk of heart disease, as conditions like hypertension and high cholesterol contribute to 70-80% of deaths in people with type 2 diabetes.

Medications for Type 2 Diabetes

1. SGLT-2 inhibitors:

   These medications help lower blood glucose levels by causing the kidneys to excrete excess sugar through urine, leading to calorie loss and potential weight loss (up to 300 kcal/day). They not only help control blood glucose but also reduce the risk of kidney disease progression and lower the chances of heart failure. Nephrologists and cardiologists widely use these.

2. GLP-1 Receptor Agonists:

   These newer medications help with weight loss and reduce the risk of heart disease and mortality. In recent studies, GLP-1 receptor agonists have been shown to reduce weight by up to 16.8%, making them crucial for managing obese patients with diabetes.

Treatment for Type 1 Diabetes

For type 1 diabetes, the primary treatment is insulin, as patients are insulin-deficient. While some individuals may still have some remaining insulin secretion (often referred to as the honeymoon period), this typically diminishes over time, making insulin a lifelong necessity. The discovery of insulin 101 years ago by Banting & Best revolutionized diabetes care and earned them the Nobel Prize.

What is the Suggested Lifestyle for Diabetes? How Do I Need to Change to Control my Condition?

Managing diabetes requires a comprehensive approach that includes a healthy diet, regular exercise, and lifestyle changes. Below are the recommended lifestyle changes to help manage type 1 and type 2 diabetes:

Dietary Recommendations for Diabetes

• Hydration: Drink water or low-calorie beverages (e.g., barley), avoiding sugary drinks like Teh Tarik or sodas that can spike blood sugar levels.
• Healthy Eating Plan:
  • Eat regular, balanced meals and aim for 5 portions of fruits and vegetables daily.
  • Focus on high-fiber foods like whole grains, legumes, brown rice, and basmati rice.
  • Avoid tropical fruits high in sugar and stick to low-sugar fruits like kiwis and guavas.
  • Limit high glycaemic index foods such as roti canai, mashed potatoes, and white bread.
• Portion Control:
  • Be mindful of portion sizes, especially when eating out. Stop eating when you are about 80% full.
  • Avoid eating late at night (within 4 hours of sleep).
• Healthy Snacks:
  • Choose nuts and high-fiber fruits, such as berries and green apples, as snacks.
  • Avoid processed snacks such as biscuits and cakes that are high in trans fats and salt, as they can harm your heart health.

Recommended Foods for Diabetes

• Fish:Consume 2-3 servings of fish per week, particularly those rich in omega-3 fatty acids, as they help lower triglyceride levels and reduce the risk of cardiovascular disease in people with diabetes.

Other Key Lifestyle Changes

• Avoid "Diabetic" Foods: Be cautious with foods labeled as "diabetic" that contain artificial sweeteners like sorbitol or fructose, which are not recommended for managing blood sugar.
• Quit Smoking:Smoking significantly increases the risk of heart disease and diabetes complications, so quitting is essential for better blood glucose control and overall health.

Exercise for Diabetes Management

• Regular Physical Activity
  • Aim for 30 minutes of exercise at least 5 days a week to improve insulin sensitivity and manage blood glucose levels.
• Resistance Training:
  • In addition to aerobic exercise, include resistance exercises (e.g., weightlifting) 2-3 times per week. This has been shown to provide extra benefits, including better blood glucose control and improved cardiovascular health.
  • Regular exercise can reduce long-term mortality by 50-60% in individuals with type 2 diabetes compared to those with poor fitness levels.

Take Control of Your Diabetes with Gleneagles Hospital Kuala Lumpur

Managing diabetes effectively is crucial to maintaining a healthy, fulfilling life. With the right lifestyle changes, medications, and regular monitoring, you can control your blood glucose levels and reduce the risk of complications. At Gleneagles Hospital Kuala Lumpur, our expert endocrinologists provide personalised care and the latest treatment options to help you manage your diabetes.

Contact us today to schedule a consultation and take the first step towards better diabetes care and overall health.

Written by

Dr Saiful Bahari Kassim

Consultant Endocrinologist and Head of the Department of Endocrinology

Gleneagles Hospital Kuala Lumpur