Do I have DIABETES?

This post can be considered as part of introduce myself again. Here I will share you some of my knowledge and experiences about diabetes.

I would always observe my patients the moment they step into my clinic. Trying to guess what is going on with them.

In the early phase of my life as a doctor, I could not tell. But after a while, I would know what was wrong with them and I would prepare myself with series of questions in my head, like an inspector, and ask those questions to get more info.

Most patient who comes in, especially if I know them very well, I could tell by just observing them.

Diabetes can cause marked lost of weight for most people.
Most of the time, they could be very anxious thinking that they might suffered a terminal illness such as cancer.

There are two types of diabetes. Type 1 and Type 2. I will mainly referring to Type 2 as this is the commonest type that affect the asians. Usually the onset is later in our life. Type 1 mainly affect the caucasians and onset mainly in early part of their life.

Those who have diabetes will normally presented with marked lost of weight. This is because of the high concentration of sugar in their blood.
This sugar are poorly filtered by the kidneys which caused it to be secreted out in their urine bring together with it a lot of water. Which lead to another symptom. Frequent urination.

Very frequent urination or polyuria.
A patient who are about to be diagnosed with diabetes will also complaint the need to pass urine or the number 2more frequent than usual. This will lead to another symptom which is thirsty.

Thirsty.
They become very thirsty because they are loosing so much water from urination. We have a term for that. Among peers, it is called polydipsia.

Patient may also complaint about being hungry all the time. They usually have a very strong urge because they got hungry all the time.

With all the symptoms above, 90% of the time, we can almost certain that the patient in question can be diagnosed as having a diabetes.

As scientist, we will do a series of investigations. The most basic that a doctor will normally ask from patient is to give a urine and blood samples to be investigated.

When doing this investigation, I wanted to know if there are sugar inside urine, which we called the condition as glycosuria. Normally if there are sugar in the urine, patient may complaint about the present of ants on the toilet floor or bowl.

As for blood, I need to know the level of sugar. If the blood were taken randomly, anything above 7.6mmol/l OR 140mg/dl (approx) will increase the posibility being diabetic and If taken after fasting over night, anything above 5.6mmol/l OR 100mg/dl (approx)

According to our SOP, we need to have regular reviews to ensure that the diagnosis is right.

So if we have the symptoms mentioned above, don't forget to consult your GP. And if the diagnosis is correct, we usually prescribe single type of medicine sometimes several of them depending on the severity on the first visit.

Why do we need to know the symptoms?
We need to "catch" the diabetes as early possible in order to delay complications of diabetes. One of the example is chronic kidney disease or CKD. CKD have 5 stages, stage 5 is the worst.
Diabetes is the NUMBER 1 cause of CKD.

In stage 5, a kidney specialist or aNEPHROLOGIST will prescribe those patient with haemodialysis three times a week for four hours every session each and every week.

I was doing my round on patient in our dialysis centre in North Borneo Sabah.

The patient in the picture was recently dialysed about a year ago. He lost his leg right after he was prescribed with dialysis due to diabetes complications.

Most diabetes complications arised from the damage of blood vessels. The smaller the blood vessels, the easier it got damaged.
Most of our organs have the smallest blood vessels what we call capillaries.

Kidney have a lot of capillaries.

DIALYSER Image source

This is the main component of the dialysis machine. It acts as a kidney.

Afraid? Don't be. Even if you cannot avoid getting diabetes, at least we can delay the onset of CKD especially to stage 5 CKD. The most important thing is to equip ourselves with basic knowledge about it.
This is why we need to know whether you are at risk of getting diabetes.

Don't forget to consult your GP to check whether you need to see the specialist or not. Because most patient with diabetes can be treated at GP level.

Let me end by telling you my experience treating patient with diabetes. The year was 2016. A young boy, 17 years old who was obese, accompanied by his mother requested me to do a full blood investigation on him

So I did and a couple of weeks I got the results. All was normal, except his blood sugar which was very high. His urine shows the present of sugar.
So I arrange another couple of reviews and investigations to confirm the diagnosis. At first, the patient and family were reluctant to start the medicines and I understand. After careful explanation they agreed.

But at the same time I advised my patient to reduce his weight. He was very good following my advices. To cut story short, 5 months later, with much reduced body weight, I stopped giving him medicines.
This is an example of happy ending story for that boy. But I reminded him that his chances of getting diabetes is much greater compare to his peers. The weight need to be maintained to normal Body Mass Index or BMI.

Who knows, you may outlive someone you k ow without diabetes.

Me before reviewing my patients.

Thank you for reading.