Diabetes

Hi, it would depend on the individual patient. In patients on insulin who have a history of hypoglycemia (low blood sugar), we would need to be cautious with sleeping pills because they can get very drowsy and be unable to respond by waking to take food and drink if their sugar levels drop. Diabetes patients who have kidney impairment also need to have careful dosing of sleeping pills because they can get too drowsy when the sleeping pill isn’t cleared from the body  properly

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, besides medications, the best way to lower blood sugar would be lifestyle changes - exercise and diet control. If your weight is too heavy, it will also help your diabetes control if you can lose 5-10% of your weight gradually over 6 months in a healthy way.

If diabetes control is poor, the best bet would still be using medications like insulin and metformin. Getting good control is the main goal, rather than delaying the use of medications and risking complications from diabetes.

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, in general, consuming excessive amounts of sugar/carbohydrates/fats will not be healthy as these are calorie dense and increases body weight and body fat. When body weight and fat increase, so does insulin resistance therefore increases the risk of diabetes, as that is one of the root cause for diabetes.

Will advise you to avoid sugary foods and control portion of fats and carbohydrates to stay healthy.

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, it sounds like you may have prediabetes? It's a good thing that you are finding out how you can prevent the onset of diabetes, because there is alot that you can do about it.

Regarding diet, it would be prudent to reduce the amount of refined carbohydrates for example, cookies, cakes, candies, sugar sweetened drinks. To try take more fibre and protein in your diet and reduce the portion of carbohydrates such as a smaller portion of rice/noodles/pasta. Together with increase exercise and weight loss, it can reduce risk of diabetes by more than 35% over the next 3-7 years.

In the even of being diagnosed with diabetes, diet and exercise will still be necessary. At times, we may add in medications to help control the blood sugar levels. 

Hi @Kaose07 , some patients may be able to have their type 2 diabetes go into remission. It depends on how severe the diabetes is and how long the diabetes had been. 

Those who have shorter duration of diabetes and are able to have diabetes controlled with oral medications alone, if they have very strict diet control and exercise with the help of dieticians and doctors and they manage to lose alot of weight healthily (if they were overweight before), that can help them come off medications and still have normal glucose readings.

Obese patients who undergo bariatric surgery can also experience remission from diabetes.

Hi @Kaose07 , ideal blood sugar reading pre meals should be between 4-7 mmol/L. Post meal sugar levels should be <10 mmol/L. If these targets can be consistently met most of the time, this translate to good control and we should see a HbA1c reading that is <7%, which is ideal. 

Having said that, patients who have specific medical conditions may have looser or stricter targets and your doctor will have to discuss and individualize targets with you.