Hi, for Type 1 diabetes, insulin will be the only option as the underlying cause of type 1 diabetes is the inability of the pancreas to release any insulin. But insulin injections will be able to keep Type 1 diabetes patients safe and healthy - without insulin, they can fall seriously ill with a condition called Diabetes Ketoacidosis and can be life-threatening.

Type 2 diabetes can be treated with tablets and even insulin as well. It does depend on how the glucose levels and HbA1c levels are before doctors can discuss on treatment options for patients.

Intensive lifestyle changes can improve chances of coming off medications in about 7-10% of type 2 diabetes patients. But this also depends on a few factors - how long has the diabetes been, is the patient already requiring insulin and how much weight has been lost with the lifestyle intervention. Those with shorter duration of diabetes, only taking tablets and able to lose more weight with intensive lifestyle changes have better chance of being taken off medications.

Hi, it can be frustrating if diabetes targets have not been reached despite your best efforts. But remember that diabetes is a condition that at times needs more than lifestyle adjustment because as we age, it can get harder to control.

Your doctor will usually individualise your treatment for you- factors to be taken into consideration would be if there is any underlying kidney, liver or heart disease, if weight is an issue. 

In most patients, tablets like metformin is usually one of the first medications that doctors may start. But there are many other options as well and it will be good to discuss this with your doctor.

Hi, I would say that we have made big strides in the options we now have for treating diabetes over the last few years. We also have technology helping us treat diabetes and monitor glucose levels. These have all improved quality of life for patients with diabetes.

Glucose monitoring used to be only via fingerpricks or urine dipstick. But we now have continuous or flash glucose monitoring devices without the need for multiple fingerpricks daily.

We have many more medication options: tablets that not just control glucose, but protect the heart and kidney; insulin that have much lower risk of hypoglycemia than before; tablets/injections which can help glucose control and weight loss.

We also have much better insulin pumps for our type 1 diabetes patients which are able to deliver insulin in a more finely calibrated way with the ability to prevent low sugar episodes.

There are new research ongoing which looks promising that can get much better diabetes control and greater weight loss than what we currently have. Looking forward also to more data on weekly insulin injections rather than daily ones. 

So there are new and exciting therapies in the pipelines. But definitely, much has changed over the last 10 years and have given patients more options and better quality of life.

Hi, I would suggest cutting out food that have added sugars first such as sugar sweetened beverages, fruit juices, confectionaries. Quench thirst with water, non-sweetened tea/coffee. Replace unhealthy snacks with a handful of baked nuts, greek yogurt, a small fruit or cheese with crackers. 

There are many different diets which can help with weight loss and they can all be used as long as you are aware of the issues with each of them and you have a health care professional guiding you along. Some diets may not be suited to certain health conditions. They can all lead to weight loss but the difficulty is in consistently keeping to these diets. 

For weight loss in diabetes patients, it will be important to get your doctor's advice. There are certain diabetes medications which can help control your diabetes and promote weight loss. And if you do want to embark on certain diets, your doctor will need to advice you if the diet is suitable based on whether you have other health conditions like kidney problems and risks of low sugar.

Hi, I do see patients who are newly diagnosed with diabetes in my clinic. Most have had health screening tests done and finding that they now have diabetes when they did not feel unwell is a bit of a shock.

Others went for screening as they felt unwell with symptoms of thirst, increase urination and weight loss and to know the diagnosis and to be able to start on treatment can be a relief to them.

But most patients will need time to adjust to having diabetes as a chronic condition as it does mean changes to their diet and lifestyle and having to take medications as well. 

It does help when I take time to walk through what diabetes is and  what to expect in the treatment, because being uncertain and fearful about what to expect is very stressful. Giving them practical tips about how to manage their diet and exercise, adjusting their medications and encouraging them throughout helps to keep them on track.

They tend to do well with the treatment plan if they get the encouragement they need both from their family and from their health care team.

Hi, having high blood sugars can suggest underlying diabetes but should be confirmed with a repeat blood test. 

It may not entirely be due to an improper diet or lack of exercise, as many cases of type 2 diabetes can run in the family. Depending on whether you are on any other types of long term medications such as steroids, they can also lead to high blood sugar.

The basic management of high blood sugar/diabetes would be regular exercises at least 150 min of moderate intensity exercises weekly, together with a healthy diet comprising of vegetables, proteins and portion controlled carbohydrates, and omitting refined sugars (cookies, candies, soft drinks).

Besides that, if sugar levels are quite high, medications can be started.

Hi Kerstin,
This is a great question. Many people think those with liver condition such as fatty liver will have symptoms. This is quite the opposite! On the contrary, patients with chronic liver conditions like fatty liver do not have symptoms at all until very late stage where cirrhosis (liver hardening) occurs. Then they may feel fatigue. In more severe cases of liver cirrhosis from NAFLD (non-alcoholic fatty liver disease), patients may develop ascites (fluid collection in the abdomen), muscle wasting, or intestinal bleeding.

For the condition of fatty liver related to obesity - the best way is to reduce obesity and getting back to normal weight.

The lifestyle modification in this era I would say is to avoid ultra-processed foods, foods high in sugar content (such as sugar beverages, candies), avoid overeating, avoid eating too fast, regular exercises (at least 45 mins of cardiovascular workup about 2-3 times a week). 
Going outdoors, reduce screen time, avoid late dinner/supper, sleep well, avoid "stress-relief eating".
All these are difficult to achieve, so the treatment plan and lifestyle modification has to be tailored to the individual.

From time to time, drink and enjoy your coffee - coffee is actually good for fatty liver :)

Hi Pa-Kihn
Thanks for the question. I would say there are many medications out there in the market which aims to reduce weight and in term reduces the severity of the fatty liver. You are absolutely right, reducing the amount or severity of liver fat, reduces the risk of progressing to more severe form of fatty liver like cirrhosis.

There are also several drugs in the research pipeline that aims to work on the different pathways of fatty liver to reduce the 'liver fat'. For now, I would say the most effective medications that reduces the degree of fat in the liver are those medications that works for you and can help you lose weight. 

GLP-1 agonist for example, works on the appetite pathway as well as reversing the insulin resistance (that will eventually lead to diabetes). So patients on this drug tend to have reduced appetite, reduced intake, and improvement in insulin sensitivity which reduces the amount of the fat in the liver.

If you can lose 7-10% of your body weight, you have a very good chance at reducing the amount of fat in the liver. I always tell my patients lifestyle modification is more important than medications alone, because you carry the lifestyle changes with you for the rest of your life!!

Hi Renega
Thanks for your question.
The most common causes of fatty liver globally is obesity /overweight and excessive alcohol intake. Generally when we talk about fatty liver, we often associate it with 'fat' and being overweight.

Your doctor can do investigations like liver test to see if there is any 'inflammation'. Ultrasound scan can be done to confirm or exclude fatty liver. 

Another sensitive way is to perform Fibroscan (transient elastography) which can quantify the degree of liver fat and ascertain the degree of 'liver scarring' present. Such test is available in certain Gastroenterologist clinic,  you may need to call to find out if the Fibroscan is available.

It is understandable to be concern and worried if the lymph node is present for so long.  First,  it is important to ascertain that the swelling is due to a lymph node.  An examination is needed to properly assess this lump.  Please see your GP for a detail check up and treatment.  If necessary, an aspiration or biopsy may be to determine the nature of the swelling and the underlying cause. 

The chance of it being due to your hypothyroidism is low.