Tuesday, March 27, 2007

Sunday Night Clinic

Our clinic is opened from 6.30pm to 10pm on Sunday nights for your convenience!

Monday, March 26, 2007

Can Diabetes be Prevented?

Diabetes is a devastating disease. Anyone who has a family member with diabetes will understand this. It takes a downward course and patients will need to keep increasing their medications as the get older. For some it might get so bad that they need to inject themselves with insulin daily. Uncontrolled diabetes will also lead to a host of other problems like heart disease, kidney disease, blindness and numbness and poor circulation in the legs which may eventually lead to an amputation.

The good news is that Diabetes can be preventable if spotted early. So the question is, how do I know if I am at risk of diabetes and how do I prevent it?

You are a candidate for Diabetes if you:
1. Are overweight ie your BMI is more than 25kg/m2 BMI = Weight in kg/(Height in m)(Height in m)
2. Have high blood pressure (>140/90mmHg)
3. Have a first degree relative with diabetes
4. Had diabetes during pregnancy
5. Have polycystic ovary disease
6. Have heart disease
7. Have Cholesterol problems
8. Have Impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT)
Now the important thing I want to look at today is the last point. IFG and IGT are conditions recognized as prediabetic conditions. That is to say, people with such conditions will go on to develop diabetes if nothing is done. IFG is defined has having a fasting blood glucose level of 6.1 to 7.0 mmol/l. Diabetes is defined as having a fasting blood glucose level greater than 7.0 mmol/l. So if you have done a screening test and the test results come back and you are told you have no diabetes, it means that your fasting glucose levels are below 7 mmol/l. BUT unless the results are explained to you by your doctor, you might have a level between 6.1-7.0 mmol/l which would be overlooked.

Why is IFG and IGT important?

There have been several studies that show that early intervention in people with IFG and IGT can prevent the development of diabetes! So there is a certain group of people out there in whom diabetes can be prevented but they still may not know about it!

So what do you do?

1. If you are above 40 years of age, then you should at least know your fasting glucose levels. It is easily checked by visiting your family doctor.

2. If you have any of the risk factors above, you should check your blood glucose level at least yearly to make sure that you spot the early signs of diabetes.

3. If you have already done a screening test, see if the fasting glucose levels are in the range of 6.1-7.0 mmol/l. If it is than go visit your family doctor immediately to get it properly assessed. You might just prevent yourself from developing Diabetes and a whole lifetime of medications and complications by doing so!

For more information on Diabetes Mellitus, please click here

Monday, March 12, 2007

A Diabetic's Checklist

A 60 year old man walked into my clinic the other day to get his diabetes medication. This was the first time I am seeing him. He said he was taking a certain type of medication for the last 5 years and this has not been changed.

So I went through some preliminary questions to see how well his diabetes is being controlled.

What was your last HbA1C reading?
He replied: "What is HbA1C?"

Ok, when was your last blood test done?
He replied: "Never had any blood test"

How is your fasting blood glucose levels?
He said the last time it was tested it was a bit high

When was the last time you did a Retinogram?
He said: "What's that?"

At the end of the consultation, I told him there was quite a few things he needed to do to manage his diabetes because it was clearly not under good control.

To which he replied: "I just want to take my usual medication, that's all I need"

I hope you are shocked, because if you are not, you should be.

Diabetes affects 8.2% of the Singaporean population. Uncontrolled diabetes will invariably lead to other more critical problems like heart disease, kidney disease, eye problems and may even cause legs to be amputated. This man was heading towards an inevitable fate and he does not even know it.

Diabetes is a disease that is best managed by the patient himself in consultation with his Family Doctor and may involve other paramedical persons like the podiatrist and dietician.

Since it is such a long topic and I don't want to bore you, I will just quickly distill the most important information so that if you know of anyone with diabetes, you can sort of tell if his condition is managed properly.

Things a Diabetic Patient needs to do:
1. Ensure his Fasting Blood Sugar is between 4.0-8.0 mmol/l.

2. The HbA1C needs to be done at least twice a year or more often if necessary. The HbA1C gives an indication of how well the blood glucose level has been controlled in the last 2 to 3 months. The levels should be between 4.5-7.0%

3. The Blood Pressure must be kept below 130/80mmHg and monitored every 3 months

4. The Cholesterol levels must be checked at least yearly to ensure that it is below 2.6mmol/l or 100mg/dL

5. The BMI should kept between 18.5-22.9kg/m2. ie, he should lose weight if he is too fat!

6. A Retinogram, which is a photograph of the retina (back of the eye), should be done yearly.

7. Urine and blood tests should be done at least yearly to screen for early kidney problems

8. The feet should be checked at least yearly to screen for early nerve deterioration.
Diabetes is a progressive disease. That means that diabetics will invariably have to keep increasing medications as they age. Uncontrolled diabetes coupled with high blood pressure and cholesterol is a recipe for disasters like heart attacks, strokes and kidney failure. On the other hand, all these problems can be avoided and the person can lead an almost normal life without suffering severe disabilities if it is managed well. So it is important to MANAGE the disease from the start rather than waiting till something goes wrong.

More information about diabetes can be found here.

Wednesday, March 07, 2007

ALERT! Hand, Foot and Mouth Disease reported in our area

I have been seeing quite a number of Hand, Foot and Mouth Disease cases in the last 2 days and I hope parents will take note of this. Some of these suspect cases only have ulcers at the back of the mouth without the spots on the hands and feet. These are strictly speaking not HFMD but a variant known as Herpengina. Both of these conditions are caused by the same Coxsakie Virus. If your child is complaining of a sore throat and fever, please consult your Family Doctor and don't allow them to attend school

Teenage Eating Disorders: Anorexia and Bulimia

There are three main types of eating disorders that affect mainly teenaged and younger females. They are Anorexia Nervosa, Bulimia Nervosa and Binge eating. We will focus on the first 2 conditions in this blog.

Since most patients with these conditions will fail to recognize that they have a problem, I hope that this article will help you recognize the condition in the people you know so that you can help them seek medical attention. Conditions such as Anorexia Nervosa can potentially be fatal. Remember Karen Carpenter who sang "Yesterday once more"? Her death in 1983 from Anorexia Nervosa was one of the key events that brought this disorder into the limelight.

So how do you tell if a person is suffering from these disorders?

Anorexia Nervosa

People suffering from Anorexia Nervosa have an obsessive desire to lose weight through dieting and fasting leading to extreme weight loss. The condition is easy to spot. They are usually teenaged girls who refuse to eat and lose a lot of weight over a short period of time. They look haggard and they skin becomes dry and scaly. They may also be obsessively excercising and counting their calories.

It is important to note that when these people look at themselves in the mirror, they DO NOT see a thin person. ie they have a distorted view of themselves.

Bulimia Nervosa

These people are harder to spot because though they want to lose weight they are less successful than those with Anorexia Nervosa. Rather then not eat, they will secretly binge eat lots of stuff, frequently desserts, and then try to lose all the extra calories by inducing a vomit, fasting or resorting to the use of laxatives or diuretics to effect weight loss.

Bulimia usually begins later than Anorexia and affects women from 17 to 25. (Remember Princess Diana?) You may be able to spot them because they may frequently excuse themselves to go to the bathroom after eating or they might eat lots of food but fail to gain weight. They may also be always trying to lose weight and excercising. Sometimes you may be able to see erosion of the skin at the base of their fingers because they would frequently stick their fingers into their mouths to induce vomiting.

Severe and repeated vomiting may lead to loss of electrolytes which can become a medical emergency.

How to manage these eating problems.

This is a primarily a behavioural and psychological problem and there are often problems in the family relationships like crisis, sexual and physical abuse, drug and alcohol abuse that may need to be addressed. Problems with self esteem in this age group often stem from lack of acceptance from friends. It may be that they are not accepted because of their being overweight.

The disorder thus needs to be managed by a multidiciplinary team comprising the doctor, behavioural expert and dietician. Severe anorexia is an emergency and the patient may need to be warded.

In Singapore, children below 19 with eating disorders may be referred to IMH while those above 19 can be referred to SGH which has a specialised clinic dealing specifically with the disorders discussed above.

More information on Anorexia and Bulimia can be found here

Reference: John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia