Dr Tay Tunn Lin

The Silent Killer

Type 2 diabetes is at its core, a disorder where the body is unable to properly regulate blood glucose levels as a result of its cells being resistant to the hormone insulin. Persistently high blood glucose levels can eventually lead to debilitating conditions of the circulatory, nervous and immune systems.

Often referred to as a silent killer, statistics from the International Diabetes Federation show that of the approximate 700000 individuals with diabetes in Singapore, 50% remain blissfully unaware of their condition. Unlike infections such as Hepatitis B, where one clearly tests either positive or negative, diabetes exists on a spectrum, meaning diagnosis, especially in its early stages, can prove challenging.

Moreover, we tend to operate under the assumption that type 2 diabetes affects only the obese and the unfit, when in fact, it is an equal opportunity killer. Indeed, senior consultant endocrinologist at Livingstone Endocrine, Diabetes and Thyroid Clinic, Dr Tay Tunn Lin, strongly discourages complacency. “Type 2 diabetes doesn’t differentiate between young and old, lean and overweight – in fact, we are diagnosing more and more people in their 20s and 30s with the disease,” she advises.

How then are we to know whether diabetes is lurking in the road ahead? Here are 4 signs that type 2 diabetes might be sneaking up on you.

You drink plenty of water. You aren’t working out like crazy. But you feel thirsty all the time.

Excessive thirst in diabetes, or polydipsia, stems from high blood sugar levels. Insulin plays a crucial role in facilitating the uptake of glucose by our cells. When our cells don’t respond well to insulin however, excess glucose accumulates in the bloodstream. In order to return blood glucose levels back to normal, the kidneys are called upon as backup, absorbing and filtering out glucose into urine, drawing out water in the process. The result – more frequent trips to the bathroom, and a seemingly unquenchable thirst.

You sustained a cut recently. It looked pretty minor. But it’s now been weeks and the wound hasn’t healed.

Diabetes can also severely affect the body’s ability to heal itself even after sustaining the smallest of wounds. Elevated blood glucose levels can lead to the narrowing and stiffening of blood vessels, limiting the supply of blood, and in turn, the supply of oxygen and nutrients required for swift wound healing, that can be delivered to the injury site.

In addition, diabetes can also bring about neuropathy, or the damage of nerve cells, particularly in the body’s extremities, making it harder for us to tell if we are injured. The numbing of sensation in the hands and feet could lead to us unknowingly subjecting ourselves to repetitive trauma, turning what might have been a minor cut into a potential medical emergency.

Your vision has been getting blurrier as of late.

Blame it on diabetic retinopathy, a progressive disease of the eyes that if left unchecked, can lead to irreversible vision loss.

Our retinas are supplied with blood through a complex network of tiny blood vessels. In pre-diabetic individuals, excess glucose accumulates in these blood vessels, clogging them and eventually causing microaneurysms, where small amounts of blood leak into the retina, causing swelling. At this early, or non-proliferative stage, vision may not be affected, meaning one might have the disease and not even know about it.

Eventually however, as more blood vessels are blocked, the body receives signals to start growing new blood vessels in the retina. The problem? These new blood vessels are often fragile, further increasing the risk of fluid leakage and even bleeding. Eyesight begins to deteriorate, and you may begin to see sudden flashes of light, or small dark shapes floating across your field of vision.

You start noticing strange patches of dark skin.

These dark patches of skin with a thick, velvety texture are characteristic of acanthosis nigricans, a skin pigmentation disorder that can be traced back to high levels of insulin in the bloodstream, as is common in pre-diabetics. Insulin, in high concentrations, is believed to stimulate the proliferation of skin cells in certain regions of the body, most commonly in the folds of the armpit, neck and groin, resulting in asymptomatic but unsightly areas of dark and thickened skin.

Ultimately, knowledge is power. Being able to identify and recognise the red flags of type-2 diabetes empowers us to take greater control over our health, grabbing the bull by its horns before we land ourselves in irreversible situations. And at the end of the day, help is always around the corner. Consult a doctor should you notice any of the signs of pre-diabetes or diabetes. And get yourself screened regularly to detect diabetes early from age 40 and receive timely treatment, nipping the problem in the bud.

Article reviewed by Dr Tay Tunn Lin, Senior Consultant Endocrinologist at Livingstone Endocrine, Diabetes & Thyroid Clinic.