Diabetes and Treatment History of A Petient

Diabetes is another world health killer after cardiovascular disease and cancer. It is estimated that 50% of the diabetics have no symptoms and is thus also a silent killer. It was reported that in 2006 about 2.1 million Malaysians now have diabetes (New Straits Times, 7 April 2006) compared with 1.2 million in 2005 (The Star, 20 November 2005). The number is alarming.

The Minister of Health (Malaysia) also revealed that the prevalence of diabetes among adults has increased from less than 1% in 1960 to 8.3% in the 1990s (Nanyang Siang Pau, 2 December 2006). Diabetes is a threat to Malaysians. The government is facing an uphill task to keep the number of diabetics down, particularly for those in their prime. In the meantime, more and more young people have diabetes. Findings from a national health and morbidity study showed that the number of diabetic patients in their 30s rose from 6.3% (1986) to 8.3% (1996). If the Malaysians do not change their lifestyle, including daily diet, it is projected that by 2015, about 12% of the national population will have diabetes (New Straits Times, 12 November 2006).

Diabetes refers to too much sugar in the blood. The typical symptoms of diabetes are feeling thirsty, easily hungry, physically weak, weight loss, tiredness, poor eye sight, skin itchiness, hand and foot numbness, slow wound recovery, poor urination and erectus dyfunctioning. If it is not properly managed, it could result in a variety of complications such as heart disease, stroke, kidney disease (diabetic nephropathy), eye disease (diabetic retinopathy), nerve damage (diabetic neuropathy) and damage to blood vessels and impotence.

There are three types of diabetes. Type 1 diabetes occurs when the body does not produce insulin or produces it only in very small quantities. It accounts for about 10% of all diabetes cases. Normally occurs among individuals below 20 years of age, this type of diabetes is related to the build-up of glucose in the blood. Since the body cannot convert glucose into energy, it begins to break down, stored as fat for fuel. The result is the increasing amounts of acidic compounds in the blood called ketone bodies.

Type 2 diabetes is imbalance in the body’s insulin production and the ability of cells to use insulin. About 90% of all diabetes cases in developed nations are Type 2. There is a strong relationship between obesity and Type 2 diabetes. It is estimated that about 80% of diabetics with this form of the disease are significantly overweight. Diabetic patients usually also have high rates of cholesterol and triglyceride abnormalities, obesity and high blood pressure. All these could lead to cardiovascular diseases.

The third type of diabetes is called gestational diabetes or pregnancy-induced diabetes. It is a temporary condition that occurs during pregnancy. This type of diabetes normally goes away after giving birth.

To know whether a person has diabetes, the method used is Oral Glucose Tolerance Test (OGTT). This test is primarily used to measure how well the body can use or metabolize glucose, the main form of sugar in the body. The test involves two steps. The patient needs to fast for 8 to 10 hours the night before the test. He or she is then given a solution of glucose (75 g) to drink. Blood samples are taken between 0 to 120 minutes to confirm the occurrence of diabetes. During these two points of time, if the OGTT results is more than 7.0 mmol/L and 11.1 mmol/L respectively, diabetes is confirmed.

To treat diabetes, insulin dosage is normally prescribed by the doctor. In some serious cases, injection of insulin is necessary. The diabetics have to depend on modern drugs to control the sugar in the blood. The experience of a friend (a 57-year-old male in 2009) reveals diabetes treatment in our modern society.

1980s: Confirmed to have hypertension and was given a drug to control blood pressure. He believed that hypertension is inherited as other siblings also face the same problem.

1995: Confirmed to have diabetes and began to take medicine prescribed by doctors. While working part-time as a general worker in the United States of America, he drank 4 to 5 litres of soft drinks a day and took fast food during lunch and dinner.

1998/9: Continued to take medicines as hypertension and diabetes remained. He ate a lot of chocolates and potato fries to fight the cold weather in the United Kingdom, after moving from the US. Felt very thirsty and tired after taking such food.

2004-5: Everyday, he had to take medicine called Glibenclamide tablet BP 5 mg to control diabetes. Medicine for hypertension was consumed when necessary as the blood pressure dropped to 140/85 mm HG in 2004. He also consumed food supplements purchased by his daughters. He felt that modern medicines are able to control the diabetes and high blood pressure. This could partly be due to the eating of salad, drinking of water and daily exercise. Despite all these, he occasionally felt waist and back pain.

2006: In early 2006, he was a given stronger dose by the doctor. Metformin (one and half tablets each time, thrice a day) and gliclazide (2 tablets each time, twice a day) are taken to control sugar level. Perindopril (half a tablet, before food, once a day) is for hypertension. Simvastatin (1 tablet, before sleep) is taken to control cholesterol. He fasted for a few days to reduce body weight and improve health condition. It did not help much as he was not willing to give up the nice and tasty foods. By the end of the year, he was told by the doctor that he had to take care of his health because of high blood, diabetes and high cholesterol. More importantly, there is symptom that his kidneys are showing signs of weakness.

2007-2009: Other than medicines for his hypertension, diabetes and cholesterol, he was prescribed an additional anti-coagulant medicine.
a) Blood pressure–Perindopril, 4 mg, PO Tab/Cap, once daily, 6 months.
b) Sugar level–(a) Metformin, 750 mg, PO/Tab, 3 times daily after meal, 6 months, and (b) Gliclazide, 160 mg, PO/Tab, 2 times daily before meals, 6 months.
c) Cholesterol–Simvastatin, 20 mg, PO/Tab, at night, 6 months.
d) Anti-coagulant–Aspirin, 75 mg, PO/Tab, once daily, 6 months.

In the meantime, his kidneys continued to show signs of weakness.