Managing Diabetes During COVID-19 Pandemic

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The Diabetes Complication Everyone Forgets and Simple Tips to Manage Your Diabetes During This Pandemic COVID-19

An alarming 7 million adults, both diagnosed and undiagnosed, are estimated to be affected by diabetes in Malaysia by the year 2025.

Diabetes has become a lifestyle disease, which most people don’t even know they have. Currently, 1 in 5 adults or about 3.9 million people over the age of 18 in Malaysia have been diagnosed with diabetes.

According to the latest National Health and Morbidity Survey, the prevalence rate of diabetes among adults aged 18 years and above has increased from 13.4% in 2015 to 18.3% in 2019.

This increasing trend is worrying, despite many studies establishing that Type 2 Diabetes can be prevented. In this article, we explore on what this increased prevalence means, and what we can do to reduce the burden of diabetes on the population.


What Are The Symptoms Of Diabetes?

Symptoms of diabetes are different in the two main types of diabetes mellitus (DM). Type 1 diabetes mellitus (T1DM) is less common in Malaysia (< 5%). Symptoms are more severe such as weight loss, thirst and passing increased amounts of urine (polyuria).

Type 2 diabetes mellitus (T2DM) is commonly asymptomatic in the early stage, but as the disease gets more serious, the diabetic individual will notice thirst and polyuria. Often, Type 2 diabetes mellitus (T2DM) is discovered when the patient presents with complications of diabetes such as heart attacks or stroke, or nerve, kidney or eye complications or problems with leg ulcer or infection. Increased tendency to infections especially fungal is common and can present as pruritus vulvae.

 

How Is Diabetes Diagnosed?

Diabetes is diagnosed by measuring blood glucose. Detection of sugar in the urine is unreliable in diagnosis, it tends to be found late in the natural history of diabetes mellitus (DM). Fasting glucose (after at least 8 hours overnight fast) is a common test and levels above 7.0 mmol/L is diagnostic. Levels of 5.7 to 6.9 mmol/L is a feature of pre-diabetes (or impaired fasting glycaemia). A random blood glucose above 11.1 mmol/L is diagnostic of diabetes mellitus (DM). Measurement of HbA1c can be used to diagnose diabetes mellitus (DM) if above 6.5%. If necessary, a glucose tolerance test is done when 75 gram of glucose is given and a 2-hour blood sample is checked, level above 11.1 mmol/L is diagnostic.


What Risk Factors Increase The Likelihood Of Diabetes?

Main risk factors for Type 2 diabetes mellitus (T2DM) are being overweight (especially central obesity with increased abdominal girth) and having a sedentary lifestyle. This leads to an insulin resistant state where the body does not respond to the circulating insulin.

Underlying genetic predisposition is demonstrated by having positive family history of Type 2 diabetes mellitus (T2DM) (one parent 20-30% risk, both parents up to 50% risk). A previous history of gestational diabetes mellitus or GDM (detected after 24 weeks of pregnancy) also demonstrates underlying metabolic risk factors for Type 2 diabetes mellitus (T2DM). Increasing age also adds to the risk for Type 2 diabetes mellitus (T2DM).

 

What Can Be Done To Reduce The Risk Of Diabetes?

Those at risk should be screened with fasting blood glucose measurement at least annually. Everyone is encouraged to avoid a sedentary lifestyle and to maintain a normal body weight to reduce risk of diabetes mellitus (DM).

 

How Does Diabetes Cause Nerve Damage?

Nerve damage in diabetes mellitus (DM) is due to chronic high blood glucose, which causes accumulation of substances like sorbitol in the nerves, causing metabolic dysfunction of the nerves. This can be reversed with good control. Later with prolonged bad glucose control, the nerves are damaged by structural changes due to abnormal blood vessels supplying the nerves and the nerves are damaged by ischemia, and this is largely irreversible.

 

Are People With Diabetes More Likely To Get COVID-19?

Yes, individuals with obesity and diabetes are more likely to get COVID-19

 

Do People With Diabetes Have A Higher Chance Of Serious Complications From COVID-19?

Individuals with poorly controlled diabetes mellitus (DM) have a higher chance of serious complications as they have impaired immunity, more likely to have other co-morbidity as renal impairment, and are prone to lung infections.

 

Treatment Options

The most important aspect of treatment in Type 2 diabetes mellitus (T2DM) is lifestyle modification and dietary modifications to encourage weight loss - reduced calories, reduced carbohydrate, and regular exercise.

This will improve the insulin resistance state. Regular exercise also utilizes the glucose. If the glucose level, fasting and after meals (post-prandial), and the HbA1c do not get to target levels, drugs are added appropriate to the metabolic perturbation.

Drugs like metformin helps to improve insulin action. Other drugs that affect insulin release are then considered. These drugs are given orally or subcutaneously. In the long run, some individuals with diabetes require insulin therapy. Surgery for refractory and marked obesity will benefit some individuals. Underlying complications like hypertension, heart disease, renal failure is treated appropriately.

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