Hong Kong – Media OutReach – 15th November 2022 – Since 2006, "World Diabetes Day" has been promoted globally every year on 14th November to raise awareness of diabetes worldwide. In the past, diabetes was considered a long-term illness for middle-aged and elderly people. However, recent data shows that with changes in living environments, daily routines, and dietary habits, the risk of diabetes is no longer limited to this age group. Currently, there are 700,000 people with diabetes in Hong Kong, accounting for 10% of the total population, meaning one in every 10 people is a diabetic patient, and the condition is becoming increasingly prevalent among the younger population. Therefore, diabetes is now a disease that requires attention from everyone. Although diabetes cannot be cured, establishing good lifestyle and dietary habits can help manage the condition, allowing patients to lead a good quality of life. Three doctors from different specialities share in detail various aspects of diabetes to deepen understanding and learn how to prevent diabetes.
Dr Wong Cheuk Lik Dr. Wong Cheuk Lik （Endocrinology and Diabetes
Dr. Wong Cheuk-lik stated that the causes of diabetes vary depending on the type. Type 1 diabetes is caused by insufficient insulin, due to autoimmune problems where antibodies attack pancreatic cells. Type 2 diabetes is characterised by severe insulin resistance, often influenced by genetics. Patients frequently have a family history, combined with environmental factors such as lack of exercise and obesity. Besides insulin resistance or deficiency, other factors like abnormal secretion of certain gut hormones (incretins) and increased glucose reabsorption by the kidney tubules are also involved. In people with diabetes, the alpha cells of the pancreas may release excessive glucagon, and all these factors combined can lead to Type 2 diabetes. Furthermore, there are genetic forms of diabetes or specific types, including MODY (Maturity Onset Diabetes of the Young) and mitochondrial diabetes. In addition to the causes mentioned above, diabetes can also be induced by certain medications, such as steroids, or be a consequence of some endocrine disorders.
High-risk groups primarily target type 2 diabetes: obesity; a family history of the condition, such as parents or siblings who have had it; having had gestational diabetes or polycystic ovary syndrome, or having high cholesterol all increase the likelihood of developing diabetes. Therefore, it is best to get checked after the age of 35.
Early diabetes has no symptoms, so early screening and early treatment are necessary. By the time symptoms appear, complications and problems with high blood sugar are usually present. If you frequently experience dry mouth, sudden unexplained weight loss, or increased appetite, these could be signs of high blood sugar or Type 1 diabetes. More severe symptoms include ketoacidosis, general malaise, difficulty breathing, or stomach pain.
Furthermore, diabetes can also trigger other complications, including diabetic eye disease, causing blurred vision, retinal or vitreous haemorrhage, which also affects sight. Some people even have kidney issues, which can lead to diabetic nephropathy, diabetic neuropathy, diabetic eye disease, diabetic fractures, osteoporosis, cardiovascular problems such as coronary heart disease, stroke, and also fatty liver. In the long term, obese diabetics with fatty liver have an increased risk of cirrhosis and liver cancer.
Numbness and tingling in the hands and feet, like being pricked by needles. More severe cases can lead to diabetic foot, where wounds become ulcerated and infected, leading to hospitalisation where diabetes is then discovered. Other symptoms include skin changes, such as brown circular patches on the feet, and itching in the lower body, similar to a fungal infection, which are also symptoms.
To prevent diabetes, weight management, diet and exercise are essential.Large-scale studies have shown that paying attention to diet and exercise, combined with losing 5 to 10% in weight, yields better results than medication alone. Furthermore, there are now medicines available to help prevent diabetes, the most common of which is metformin. In contrast, the causes of diabetes in middle-aged and older adults are similar to those in the general population.However, as people age, the body’s ability to secrete insulin deteriorates and gradually declines. Coupled with a lack of exercise, muscles become less efficient at utilising glucose and less sensitive to it, which indirectly leads to reduced insulin sensitivity. A sedentary lifestyle can lead to weight gain in middle age, and obesity increases insulin resistance.Furthermore, central obesity causes visceral fat to release adipokines, which trigger inflammation and disrupt the proper functioning of insulin. Other common ailments among middle-aged and older adults, such as joint problems, can lead to a natural reduction in physical activity, which in turn exacerbates the issue.Furthermore, some middle-aged and older adults may experience worsened blood glucose levels and an increased risk of developing diabetes due to medication-related issues, such as the use of corticosteroids (which are prescribed to treat many conditions).
Recommended Mediterranean diet
In terms of diet, it's important to maintain a balanced and healthy eating pattern, and current international guidelines don't state that any particular pattern is definitively the best. However, clinical research findings suggest that the Mediterranean diet, which emphasises plant-based foods such as vegetables, legumes, nuts, seeds, fruits, and grains, along with fish, seafood, and dairy products, can help prevent the risk of developing diabetes, and also helps to reduce the risk of some cholesterol and cardiovascular diseases. Plant-based oils like olive oil are preferable for cooking.
Other dietary patterns, such as vegetarian diets or low-fat diets. A low-fat diet is defined as one in which fat accounts for less than 30% of total daily calorie intake. A low-carbohydrate diet also helps to prevent blood sugar levels from rising too sharply, thereby reducing the likelihood of weight gain.A low-carbohydrate diet is defined as one in which carbohydrates account for less than 30–40% of total daily calorie intake. Other dietary recommendations include choosing foods with a low glycaemic index and reducing the consumption of refined foods.
Eating specific foods in a certain order slows the rise in blood sugar.
Eating vegetables and meat first, then carbohydrates, can slow down absorption, thus slowing the rise in blood sugar. When eating carbohydrates, don't eat a large amount all at once; you can divide the total portion evenly throughout a meal to slow the rise in blood sugar. Since everyone's needs differ, it's best to consult a dietitian to determine suitable portions. However, generally speaking, a rough allocation can be followed, such as 40 grams of carbohydrates for breakfast, and 50 to 60 grams for lunch or dinner, with small snacks in between.
Avoid excessive absorption of hidden carbohydrates
Often, patients are unaware of what contains carbohydrates. Besides grains, including rice, noodles, and bread, root vegetables are frequently overlooked. These include potatoes, pumpkins, sweet potatoes, lotus root, and kudzu, all of which contain carbohydrates. Furthermore, as these ingredients are often used in soups, even if the solids are not consumed, the carbohydrates dissolve into the soup, causing a sudden rise in blood sugar.
水Eating the peel slows down the rise in blood sugar.
When eating fruit, pay attention to portion sizes. Wash fruit with skins thoroughly and eat the skins too, as the dietary fibre can slow down blood sugar absorption. Additionally, dairy products also contain carbohydrates; drinking too much at once, or adding too much milk to tea or coffee, can also have an impact.
When diabetics are fasting for weight loss, they need to be mindful of certain things.
The initial idea behind intermittent fasting was for weight loss, requiring calorie intake to be reduced by half of normal portions. This has been clinically proven to help with weight reduction. However, eating such a small amount daily proved too difficult for many to sustain, leading to weight regain when they returned to normal eating habits. Consequently, various alternative fasting methods have emerged that seem easier to implement and accept.
However, if diabetics wish to lose weight through fasting, they must follow the instructions of medical professionals. If taking hypoglycaemic medication or insulin, the dosage needs to be adjusted if fasting suddenly. Furthermore, if fasting leads to eating too little, it can cause malnutrition, reduced protein intake, and insufficient micronutrients, vitamins, and minerals, which also carries risks. If carbohydrate intake is too low, some patients may develop ketosis. This could lead to ketoacidosis, particularly in type 1 diabetics or those taking multiple oral hypoglycaemic agents, so everyone should be aware.
In summary, diabetes is a chronic disease, specifically an endocrine-related metabolic disorder within internal medicine. According to the Department of Health, diabetes ranks tenth among the top ten causes of death for citizens in Hong Kong. Kidney disease ranks sixth, stroke ranks fourth, and heart disease ranks third. Diabetes indirectly increases the risk of heart disease, stroke, and kidney failure. Cancer is the leading cause of death among the top ten diseases, and individuals with diabetes have a higher risk of developing cancer. For example, high blood sugar levels allow cancer cells to consume more glucose to survive. Furthermore, excessive insulin can stimulate cancer cells to grow more vigorously. Excess insulin also contributes to hormonal imbalances in men and women, increasing the risk of cancers such as bowel cancer and pancreatic cancer, as well as female cancers including breast cancer and ovarian cancer.
Dr. Lin Dong Dr Lam Tung General Practitioner
Dr. Lam Tung states that in recent years, the number of overweight children globally, including in Hong Kong, has become severe. This is because adults are tending to marry later, with many choosing to have only one or two children, leading to a lower birth rate. Parents also tend to dote on their children and favour using food or drinks as rewards. However, these rewards are typically high-sugar, high-fat foods. Combined with a lack of exercise among children, this results in childhood obesity occurring worldwide, including in Hong Kong.
If young children are too overweight, they are more likely to develop type 2 diabetes, leading to increased blood sugar levels, which in turn can cause high cholesterol, high blood pressure, joint pain, difficulty breathing, and even non-alcoholic fatty liver disease. These are all common complications of childhood obesity.
Fat children who do not improve their lifestyle habits tend to remain obese into adulthood. Obesity in adults can lead to greater insulin resistance. If insulin resistance is high, insulin cannot control blood sugar properly, which can lead to type 2 diabetes. This is why childhood obesity is said to cause diabetes in adulthood.
Dr Fu Chiu Lai Dr. Fu Chiu Lai Cardiology
Dr. Fu Chao-li stated that diabetes is closely related to heart disease, with over 30% of diabetic patients dying from cardiovascular disease. Furthermore, many diabetic complications are intrinsically linked to the vascular damage caused by diabetes.
Complications include diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy, all of which are closely related to diabetes-induced vascular disease.
The commonly heard "three highs" refer to diabetes, high blood pressure, and high cholesterol. People with the "three highs" are at risk of life-threatening conditions such as acute heart attack, stroke, and acute limb ischaemia. Long-term chronic illnesses can lead to ischaemic damage of various organs, such as chronic kidney failure, dementia, and peripheral vascular disease.
When diagnosed with diabetes and unfortunately experiencing heart problems as well, it is important to maintain a positive attitude and face your illnesses proactively. Take your medication on time as instructed by your doctor, adhere to dietary restrictions, and exercise regularly. Regular follow-up appointments and check-ups are essential for preventing acute sudden illnesses and protecting your safety.
To prevent diabetes and heart disease, you should follow your doctor's instructions, be mindful of your diet, take medication as prescribed, and avoid prolonged sitting by engaging in regular exercise. Discontinue bad habits such as a late nightlife, smoking, and excessive drinking. Maintain a balance between work and daily life, always remain vigilant, and seek immediate medical attention if any unusual symptoms arise.
Hashtag: # World Diabetes Day
