Ruth Kam Heart & Arrhythmia Clinic
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Diabetes is a dreadful disease with many complications like coronary heart disease, kidney failure, stroke, infections, leg amputations etc.
Diabetes is more than just a little too much sugar in the blood or in the urine. It has been called an inflammatory disease where the body reacts with increased levels of messenger molecules that can lead to cell damage and atherosclerosis.
Diabetics who get heart disease also have worse outcomes. Diabetes may damage their nerves so that they are unable to feel pain when they do get a heart attack. Hence they seek medical attention later, which means that they get treated later and get more complications because more heart muscle is lost. For the same reason, diabetics may not feel pain when they get cuts or injuries to their feet and only seek help when infection sets in. That is why they end up with limb amputations when the infection cannot be controlled or when the limb becomes gangrenous.
Diabetics tend to have more severe forms of heart disease, more multi-vessel disease, more kidney problems as well as heart disease and higher rates of kidney complications after interventions like stenting or surgery. Wound healing may be impaired as well, as the immune system is not functioning as well.
Diabetes can be conveniently divided into 2 groups – juvenile or insulin dependent diabetes and adult onset diabetes, which is usually not insulin dependent until the later stages. Adult onset diabetes is very much a lifestyle related disease, closely correlated to obesity and physical inactivity. As obesity reaches epidemic levels in the world, so too has the rate of diabetes. Industrialization made possible the mass production of crops to feed the masses and also paved the way for the manufacture of many of the packaged foods that we find on the shelves of our supermarkets today. These foods are cheap, because they contain very little nutrients apart from sugars, salt and cheap fats. In fact, it seems ironical that it costs more to prepare a healthy nutritious meal from scratch then it is to just pick a packet of, say, instant noodles from the shelves today. These chemicals that we put into our bodies everyday are to a large extent responsible for many of the diseases that we suffer from today – cancer, diabetes, obesity, hypertension, stroke, heart and kidney disease, and the list goes on.
Because of the many complications that diabetes leads to, it makes sense to take action to reverse many of these habits. I see many patients who are on their way to becoming diabetic, overweight, having high fasting blood sugar and high cholesterol. Many of them have seen that, by just cutting back on refined sugars and starches, and doing some exercises, they are able to lose a few kilograms and see all their blood tests come back to normal levels. The exercise need not even be vigorous – walking everyday for an hour or taking the stairs might be enough – the key is to do it consistently. For some, it may mean having to take less medication to control their diabetes, even though they may not be able to come off it altogether.
“But doctor, I have no time to exercise”. A familiar excuse that I’ve heard ad nauseum. Even if that were really true for some, I encourage them to make small changes within their busy lives. Take the stairs instead of the elevators, park further from the office and walk the remaining distance. There are more creative ways of increasing energy expenditure than you can imagine. For those who make the effort, the results are sweet. The important thing to remember, is that for any method to succeed it has to be sustainable. In other words, no amount of crash dieting or boot camp will keep that weight off forever. While it is natural for anyone to fall off the wagon at any point in time, the trick is to get back on track again. Life is all about balance, anyhow.
“The inferior physician treats the complications of the disease. The average physician treats the disease. The superior physician prevents the disease ” – An ancient Chinese saying
DR RUTH KAM
Cardiologist

MBBS (Singapore)
MRCP (Int Med) (UK)
M Med (Int Med) (Singapore),
FAMS (Cardiology), FRCP (Edin)
Ruth Kam Heart and Arrhythmia Clinic
3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre.
Tel: 6333 6866
www.arrhythmia.com.sg