Understanding diabetes beyond high blood glucose

Diabetes is frequently understood as a “sugar problem” due to consumption of sweet foods and beverages, pointing to a limited perspective. On the contrary, it is a significant medical condition that silently affects patients’ organs, and obstruct their hormones, to the extent of endangering their limbs.

Although diabetes is common in Malaysia, the stigma remains and many feel discriminated against. The majority of young adults with diabetes are unaware they have it, as indicated by the National Health Morbidity Survey 2023 where 84 percent of adults aged 18-29 with diabetes do not know they have diabetes. [https://iku.nih.gov.my/images/nhms2023/key-findings-nhms-2023.pdf]

Dr Lim Chong Wei, a consultant endocrinologist, highlighted the significance of awareness, early detection, and empathy. “Diabetes is a chronic health condition, but it’s manageable. Taking it seriously early helps prevent serious complications. For many, it’s about changing the conversation before it’s too late,” he said.

While diabetes is manageable, complications usually arise before symptoms are experienced. For example, diabetic nephropathy is one of the most common complications of diabetes where early signs like albuminuria remain undetected without testing. If not tested regularly, patients may present with late-stage disease and need dialysis or even a transplant, said Lim.

Diabetic complications also include neuropathy, myocardial infarction, stroke, and dementia. When blood glucose is poorly controlled, patients may have silent strokes and memory issues from as early as age 50—considerably earlier than in healthy people. “I’ve had patients in their 30s coming in with a stroke or nerve problems, and only then we find out they’ve had undiagnosed type 2 diabetes for years,” said Lim.

He pointed out that diabetes is caused by several factors including genetic conditions, hormonal disorders like Cushing’s or acromegaly, and long-term steroid therapy, which results in weight gain and insulin resistance. Therefore, type 2 diabetes is not always a result of poor lifestyle choices, contrary to global assumption, he said.

Another important aspect of physical health affected by diabetes is reproductive health. While men may have erectile dysfunction and low testosterone levels, women may experience fertility issues that may be linked to polycystic ovarian syndrome (PCOS).

Beyond physical effects, diabetes management can also impact mental health. About 30-40 percent of patients may go through depression at some time during their lives. “People living with diabetes carry a significant burden including having to change their diet, lifestyle, take regular insulin injections, managing hypoglycaemia and coping with stigma. These can be overwhelming for them, and we need to be more supportive instead of judging people living with diabetes,” Dr Lim urged.

Early screening, intervention may help improve outcomes

Lim recalled a patient in his 30s presented for a routine health screening and was diagnosed with early type 2 diabetes. The patient was advised to follow lifestyle changes and prescribed medication. The end result is that he lost weight and successfully put diabetes into remission while regaining control of his health. Early intervention completely changed his life and prevented future complications with medication and lifestyle changes, Lim said.