Controlling Diabetes

PEOPLE with Type 2 diabetes have a treatment option - a drug called Sitagliptin.

Sitagliptin belongs to the dipeptidyl peptidase-4 group of drugs (DPP-4) which is used to enhance the body's own ability to lower blood sugar (glucose) when it is elevated.

It comes in the form of tablets and is taken once a day, alone or in combination with other drugs. "Type 2 diabetes is a highly prevalent and serious chronic condition, a growing epidemic with clear un-met medical needs," said senior consultant endocrinologist Prof Datuk Dr Mafauzy Mohamed. "It is one of the most significant diseases affecting the modern age, and is the fifth leading cause of death globally."

Reports show that more than 98 per cent of the nearly 1.2 million Malaysians with diabetes have Type 2 diabetes. Unfortunately, more than half are unaware that they have the disease. Patients with diabetes can develop heart disease, kidney disease, blindness, vascular or neurological problems that can lead to amputations, and they can suffer increased mortality.

"People with Type 2 diabetes need to be proactive in taking measures to control the disease because it can lead to other health complications," said Dr Mafauzy.

He said when blood sugar is elevated, incretins work in two ways to help the body regulate high blood sugar levels. They trigger the pancreas to increase the release of insulin and signal the liver to slow down glucose production.

"The mechanism of action of DPP-4 inhibitors is different from currently available classes of glucose-lowering agents. The inhibitors work by enhancing a natural body process that lowers blood sugar, the incretin system," said Dr Mafauzy.

Sitagliptin was approved by the Drug Control Authority of Malaysia in June 2007. The Type 2 diabetes pill from Merck Sharp & Dohme is a prescription medicine and patients are advised to seek their doctors' opinion regarding the suitability of this medication for their conditions.

"Side-effects have been reported in less than five per cent of patients on the medication, and include stuffy or runny nose, upper respiratory tract infection and headache," said Dr Mafauzy.

unhealed wound due to diabetes
"Patients need to not only look beyond medical treatment options but seriously consider a change in their lifestyle activities as well as diet. Malaysians need to learn to take care of their own health and be disciplined about keeping to healthy diet and regular exercise."

Another consultant endocrinologist, Dr Yap Piang Kian, said "When a patient is given a dose of glucose by mouth, the sugar will be absorbed and the blood glucose level will rise. In response to this, insulin is released by the beta cells of the pancreas to enable the glucose to be stored in the muscles and liver, to be used when the need arises. Because glucose can be stored for future use, we do not have to eat continuously to function and can manage with only a few meals a day."

He said the DPP-4 inhibitors can be taken orally, an advantage for injection-shy patients.

"Unlike exenatide, this group of drugs is weight-neutral, that is, it neither causes weight loss nor weight gain. It should be noted that most of the older anti-diabetic agents, with the exception of metformin, cause weight gain."

Perhaps the biggest advantage of this class of drugs, said Dr Yap, is that they are "smart"; they only exert their effects when the blood glucose level is raised, so that the risk of hypoglycaemia is minimised.

Hypoglycaemia, or a low blood sugar level, is one of the dreaded complications of diabetes treatment because it is distressing to patients and may even lead to death.

The mimetics and enhancers work well by themselves or in combination with other traditional anti-diabetic agents. To date, he said, no significant adverse side-effects have been identified. However, these drugs are relatively new and it may take years for uncommon adverse reactions to surface.


Diabetes is a disorder where the pancreas produces insufficient insulin or the insulin is not effective. This insulin imbalance causes the body's blood sugar level to rise, and eventually causes damage to various organs in the body.


Type 1 Diabetes
* Accounts for about 5% of people with diabetes
* Occurs mainly in young people below 20 years
* Caused by an inability of the pancreas to produce insulin or insufficient amounts.
* These people need insulin injections.

Type 2 Diabetes
* Accounts for about 95% of people with diabetes.
* Usually develops in people older than 30 years.
* The body can't effectively use the insulin that is produced.
* Controlled with diet; exercise and / or medications / insulin.
* Linked to obesity and sedentary lifestyle.

What should my blood sugar level be?

The normal and target blood glucose ranges are:
Normal blood glucose levels in people who do not have diabetes:
Fasting 4.4 - 6.1 mmol/L
Non-Fasting 4.4 - 8.0 mmol/L
Normal blood glucose level in people who have diabetes:
Fasting 5.0 - 7.2 mmol/L
Non-fasting less than 10.0 mmol/L

Reference: American Diabetes
Association Guidelines and The Malaysia Clinical Practice Guidelines 2005

What are the signs and symptoms of Diabetes?
* Frequent urination.
* Excessive thirst.
* Fatigue.
* Unexplained weight loss.
* Sudden vision changes.
* Tingling or numbness in hands or feet.
* Slow healing wounds.

What are the risk factors for diabetes?
* A family history of diabetes.
* Overweight.
* Age over 40 years old.
* History of big baby.
* History of diabetes in pregnancy.

What are the complications of Diabetes?
* Kidney failure.
* Heart disease and stroke.
* Eye complications.
* Nerve damage.
* Limb amputation.
* Impotence.

Over 3,000 new cases of end stage kidney failure are diagnosed annually in Malaysia, more than 55% of them are diabetic.

How does diabetes affect your body and kidneys?
* May damage small blood vessels in your body and affect your kidneys, eyes, skin, nerves, muscles, intestines and heart. High blood pressure and hardening of the arteries can develop, which can lead to heart disease.
* High blood sugar makes the kidneys work harder and results in progressive damage to the small filtering units of the kidneys and leads to leakage of protein in the urine.
* Diabetics are also at increased risk of urinary tract infections due to high sugar content in the urine.

I have diabetes, how will l know if my kidneys are affected?
* In the early stages, there may not be any obvious symptoms. However, you should see your doctor and get your urine checked for protein.

Once your kidneys fail, you may have:
* Fatigue.
* Nausea, vomiting.
* Swollen legs, ankles, feet or puffy eyes.
* Weight gain due to fluid retention.
* Breathlessness.

How can I prevent diabetic kidney problems?
* Carefully follow prescribed treatment to control blood sugar.
* Control blood pressure to130/80 mmHg.
* Control cholesterol level with diet and medication if necessary.
* Get urine checked for protein annually.
* Get blood checked for kidney function.
* Treat urinary tract infections early
* Adopt a healthy diet that is high in fibre, low in fat, sodium and cholesterol.
* Aim to achieve and maintain healthy body weight.
* Exercise 30 minutes a day, at least 3 times a week.
* Quit smoking.

Kidney disease is a silent killer! Signs and symptoms occur late in kidney disease. Screening tests are vital, especially if you are at high risk.

The progression of kidney disease can be slowed or stopped if detected early.

Busting myths on diabetes

1. Myth: All forms of diabetes is inherited

Fact: Not everyone who gets diabetes inherits it. People tend to inherit the risk of developing Type 2 diabetes more than type 1. You are considered at risk for developing Type 2 if any first-degree relative has diabetes.

2. Myth: People with diabetes should never eat sugar and sweets

Fact: Sugar and sweets do raise your blood glucose, but people with diabetes can safely eat sugar as part of their meal plan. And just to clear up another myth, you can't get diabetes from eating too much sugar.

3. Myth: You can have borderline diabetes for many years.

Fact: There is no such thing as `borderline diabetes'. You either have it or you don't. You have diabetes if: a) Your fasting blood glucose readings are greater than 126 mg/dl, or b) Your random blood glucose is above 200 mg/dl on at least two separate occasions.

4. Myth: Once you start taking pills or insulin, you can eat anything that you want.

Fact: The pills or insulin that you take for diabetes are more effective when they don't have to work as hard to lower your blood glucose. Combining your medicines with a healthy meal plan and physical activity gives you the most for your money.

5. Myth: There are no natural remedies for diabetes.

Fact: The most natural remedy is eating a healthy diet and exercise. Healthy eating and physical activity help to lower your blood glucose levels.

6. Myth: Insulin causes impotence

Fact: Some men who have diabetes may become impotent, but not because they take insulin. Impotence or erectile dysfunction is caused by damage to nerves caused by many years of high blood glucose.

7. Myth: The best way to judge your blood sugar level is by the way you feel.

Fact: Some people have symptoms when their blood glucose is too high or low, others do not. Because some of the symptoms of high and low blood glucose are similiar, it can be hard to know what your symptoms mean. The only way to be sure is to check your blood glucose.

8. Myth: It's a good idea to soak your feet every day if you have diabetes.

Fact: This used to be a common practice, but soaking your feet can make your skin dry and is no longer recommended.

9. Myth: If my blood sugar is usually over 180 mg/dl, that must be normal for me.

Fact: No. Just because your blood glucose level is usually high, this does not mean that this is good. High blood glucose levels that are above recommended goals do damage to many organs and systems in your body.

10. Myth: Type 2 diabetes is not serious.

Fact: This is a very dangerous myth, because people who believe this may not take proper care of themselves. All types of diabetes are serious, and need to be taken seriously by people who have it and their families.

11. Myth: I don't have a family history of diabetes, so I won't get it.

Fact: Some people are born with a greater chance of developing diabetes than others. However, plenty of people diagnosed with the disease don't have a family history of diabetes. Your weight and lifestyle can be factors in whether you develop diabetes.

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