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Wednesday, July 27, 2011

Prevention is better than cure


Prevention is better than cure

By Dr L.Y. KAM


Pre-diabetes is a problem where a person’s blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. It can be reversed.

MOST people have heard about diabetes and know what it is about, but not many are aware that there is a condition called pre-diabetes. Pre-diabetes is a problem where a person’s blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.

Pre-diabetes is also known as borderline diabetes, impaired glucose tolerance (IGT), or impaired fasting glucose (IFG). People with this condition are in a “gray zone” between normal and diabetes, but are at risk of developing full-blown type 2 diabetes, with all its complications.

Tell-tale signs

It is normally hard to tell whether a person has pre-diabetes as there are almost no symptoms or signs. Some symptoms appear so slowly that most people do not realise they are affected by the condition until it is too late.

It is recommended that people watch for symptoms that are similar to that to type 2 diabetes:

·Constant hunger

·Unexplained weight loss

·Flu-like symptoms, including weakness and fatigue

·Blurred vision

·Slow healing of cuts or bruises

·Tingling or loss of feeling in hands or feet

·Recurring gum or skin infections

·Recurring vaginal or bladder infections

Testing for fasting blood sugar (blood glucose levels after you fast for about 10 hours) and two-hour postprandial glucose (blood glucose levels two hours after your meal) is useful for identifying the early development of diabetes.

Screening

One of the ways to determine whether a person has pre-diabetes is through the fasting plasma glucose (FPG) test. During the FPG blood test, the glucose level in the body is measured after an eight hour fast. This test is to help determine if the body metabolises glucose correctly.

Fasting plasma glucose screening is recommended for people aged 30 to 45 and should be repeated at least every three years. Earlier and more frequent screening is recommended for people with high risk factors. The risk factors are listed below:

·Family history (parent or sibling)

·Dyslipidemia (triglycerides > 200 or HDL < 35)

·Overweight or obese (body mass index > 25)

·History of gestational diabetes or infant born with birth weight greater than 4kg

·High risk ethnic group

·Hypertension (systolic blood pressure >140 mmHg or diastolic blood pressure > 90 mmHg)

·Known vascular disease

·Markers of insulin resistance (PCOS – polycystic ovarian syndrome, acanthosis nigricans)

Early detection

If no preventive measures are taken to arrest pre-diabetes, the pancreas would gradually be unable to produce enough insulin to overcome insulin resistance, resulting in glucose levels rising to abnormally high levels.

Prolonged high levels of glucose in the blood would eventually lead to type 2 diabetes and bring about serious complications like blindness, kidney diseases, gangrene, which may require amputation, heart attack, stroke and hypertension.

Since diabetes is one of the major causes of premature illness and death worldwide, it is important for the disease to be detected early. In developing countries, less than half of people with diabetes are diagnosed. Taking action early on pre-diabetes can help prevent type 2 diabetes and more serious health problems.

For some people with pre-diabetes, early intervention can actually return elevated blood sugar levels to the normal, healthy range.

Prevent diabetes by making the right choices

Although pre-diabetes is a serious condition, it is reversible through changes made in daily life routines such as increasing the level of physical activity, achieving a healthy weight, and following a healthy balanced diet.

Studies have shown that lifestyle changes could help to prevent or delay the onset of type 2 diabetes, especially among people at high risk.

·For people with pre-diabetes, lifestyle changes, including a 5% to 7% weight loss and at least 150 minutes of physical activity per week, can reduce the rate of onset of type 2 diabetes by 58%.

·Blood glucose control reduces the risk for eye, kidney, and nerve diseases among people with diabetes by about 40%.

·Blood pressure control reduces the risk for heart disease and stroke among people with diabetes by 33% to 50%. It reduces the risk for eye, kidney, and nerve diseases by about 33%.

·Detecting and treating diabetic eye disease with laser therapy can reduce the risk for loss of eyesight by 50% to 60%.

·Comprehensive foot care programmes can reduce amputation rates by 45% to 85%.

Dietary and lifestyle recommendations

Many studies have shown that a low-carbohydrate diet and regular exercise is a very valuable prevention and treatment tool in diabetes and pre-diabetes. The following are some recommended dietary and lifestyle recommendations for people with pre-diabetes or diabetes:

1. Eat a high fibre and low fat diet, and control your total calorie intake

The total calorie intake is more important than the amount of carbohydrate intake alone. Different people have different calorie requirements, depending on their activities, type of work, hours of sleep, and other factors.

As a guide, the following calories are recommended:

a. Overweight: 1000 to 1500 kcal per day.

b. Elderly, mild, normal weight: 1500 to 2000 kcal per day.

c. Young, active: 1500 to 3000 kcal per day.

2. Eat small regular meals

Meals must be regular and the day-to-day intake as consistent as possible. It is better to eat small meals at short intervals than to eat large meals at long intervals.

3. Protein intake

Protein sources such as lean meat, egg white, skimmed milk and fish can be taken freely provided you are aware of their high calorie value and it does not exceed your daily calories requirement for the day.

4. Avoid alcohol

Alcohol does not need insulin for metabolism but if taken on an empty stomach, can induce hypoglycaemia.

5. Limit amount of fried foods

Fat will increase the risk of vascular damage and therefore intake of fat should be minimised. Food rich in saturated fat include animal fat, coconut oil, milk cream, lard, butter and egg yolk. Overall, fat should not account for more than 30% of your total calorie intake.

6. Check your blood glucose regularly even when under medication, and especially when you feel unwell.

7. Exercise regularly at least 45 minutes per day, five days a week

Foods to take and avoid

Glucose (except for instances of low blood sugar level), sugar, honey,gula melaka, jam, kaya, sweets, chocolates, soft drinks, packet drinks, cakes, pies, pudding, moon cakes, canned fruits in syrup, sweet biscuits, condensed milk, ice-cream, icing, packet snack food should be avoid or taken infrequently.

Eat all kinds of leafy vegetables, beans, bean sprouts, cucumber, celery, peas, mushrooms, onion, garlic, ginger.

Apart from regular exercise, reducing weight by as little as 5% to 10% can also have a significant impact on overall health. The Diabetes Prevention Program (DPP) was a major multicentre clinical research study done in the United States aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin could prevent or delay the onset of type 2 diabetes in study participants. The study found a 16% reduction in diabetes risk for every kilogram of weight loss.

Pre-diabetes is reversible, but diabetes is incurable. By making the right choices and taking the right actions, people with pre-diabetes can prevent it from progressing to full blown diabetes.

The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

1 comment:

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