WE have the highest incidence of diabetes in the whole of South-East Asia. Our prevalence is almost 1 in 5 and rising year on year.
There are many reasons for this but it's mainly dietary choices which include highly refined carbohydrates and lack of exercise.
Diabetes is expected to hit 7 million Malaysians by 2025.
It is an expensive disease. Diabetes accounts for at least 5 per cent of total healthcare costs in European countries. The biggest rise is in developing countries.
The overall life expectancy in a patient with diabetes is reduced by 25 per cent compared to a person without the disease.
The commonest type of diabetes is type 2 diabetes and most patients are asymptomatic. It behaves like a "ninja" until one has complications of diabetes such as eye disease (diabetic retinopathy) or kidney disease (diabetic nephropathy) or foot nerve issues (diabetic neuropathy).
If you have diabetes, most of the time, you will only know when you have a medical checkup.
The ones most at-risk would-be those with a strong family history in their first-degree relatives such as their siblings or parents. Other risk factors for type 2 diabetes include obesity which leads to insulin resistance.
Type 2 diabetes is caused by both impaired insulin secretion from the pancreas and "resistance" to the action of insulin at its target cells.
It's mainly driven by an obesogenic environment that encourages underactivity and snacking and eating large portions of refined carbohydrates such as cereals, chocolates, white rice and white bread.
One can "reverse" diabetes; but endocrinologists prefer to call it "remission" of diabetes as similar to other chronic medical conditions, diabetes can "recur" in the future if diet and exercise are not followed.
TURN IT AROUND
The ideal way to get diabetes into "remission" is to review one's diet and exercise regimen and to see a doctor to start on appropriate medications to control blood glucose and also reduce obesity.
The starting point of treatment for type 2 diabetes is diet and other lifestyle modifications such as exercise 30 minutes daily, 5 days a week and quitting smoking.
The main aims are not only to reduce the weight of patients with diabetes and improve glycemic control; but also to reduce risk factors for heart disease such as high cholesterol (hyperlipidaemia) and hypertension which account for 70-80 per cent of deaths in type 2 diabetes.
The dietary recommendations are essentially the same for type 1 and type 2 diabetes. Indeed one has to follow a healthy eating plan such as quenching thirst with water and other low calorie drinks such as barley and avoiding sugary drinks like our Teh Tarik.
Eating regular meals and avoiding fried and sugary foods and consuming five portions of fruit and vegetables a day is also important.
One is advised to avoid tropical fruits which are high in sugar and keep to the "greens" such as guavas and kiwis.
Have high fibre and low glycaemic index foods including whole grains, legumes or brown rice while the best white rice is basmati rice.
Rice should always be considered as a side dish and not the main part of the meal which is what we tend to do in Malaysia.
Limit consumption of high glycaemic index starchy foods such as roti canai, mashed potatoes and white bread.
Be aware of the portion size of the meal, especially when eating out in restaurants and stop eating when you are 80 per cent full; please do not overeat or eat after 8pm (within 4 hours of sleep).
For snacks in between meals, avoid convenience foods such as biscuits or cakes which are high in saturated and trans-fats and salt which is bad for your heart. Use nuts and low calorie and high fibre fruits such as those from the berry family and green apples.
One is also advised to have 2-3 servings of fish per week as fish oils are rich in omega -3 fatty acids and have lower triglyceride levels. Fish intake is associated with a lower risk of cardiovascular disease.
WATCH THE SUGAR
But do be careful of "diabetic" foods that contain sorbitol or fructose as sweeteners as these are not recommended.
Exercise should also be tailored to the individual patient, according to his or her physical condition and lifestyle. Simple advice would be as above: 30 minutes per day for at least 5 days a week while resistance exercise such as weightlifting, performed 2-3 times per week provides extra benefits.
Regular exercise can reduce long-term mortality by 50-60 per cent in type 2 diabetes patients.
*The writer is an endocrinologist at Gleneagles Hospital Kuala Lumpur.