Diabetes Mellitus

Diabetes mellitus is a condition caused by a relative lack of insulin secretion to meet the body’s demands. Insulin, a hormone produced by the pancreas, facilitates the entry of glucose from the bloodstream into cells. Without adequate insulin, two significant issues can arise:

• Short-term effects: In severe diabetes, high blood glucose levels remain unused, potentially leading to acidosis and coma.
• Long-term effects: Prolonged high glucose levels can damage the eyes, kidneys, nerves, heart, brain, and extremities.

Diabetes can be broadly divided into two categories

Type 1 DM is caused by autoantibodies (antibodies that attack its own body) produced by the immune system attacking beta cells. The triggering event could be a viral infection but mostly unknown with genetic predisposition for autoimmune diseases. Very often the presentation is sudden as DKA (Diabetic Ketoacidosis) and commonly in children.

Type 2 DM is most a commonly a metabolic disease due to sedentary life style and excessive calories intake causing progressive weight gain. Leaner patients may have a stronger family history of DM with poorer insulin production and earlier age of onset in adulthood.

The success of DM control lies in appropriate choice of medications and self-management (dietary control, monitoring and compliance with medications).

Importance of Regular Monitoring

Ongoing monitoring is essential for effective diabetes management. Key investigations during follow-ups include:

• HbA1c: Reflects the average blood glucose levels over the past three months. Our clinic provides rapid HbA1c testing with results available in just six minutes.
• Fasting blood glucose, lipid profile, liver enzymes (AST and ALT), potassium, and creatinine (kidney function tests).
• Self-monitoring glucose in the form of finger pricks and 24-hour glucose monitoring e.g. Dexcom and Freestyle Libre. Self-monitoring can prevent hypoglycemia (low blood glucose) and alert poorer control from poor choice of diet or inadequate medications.

Annual assessments include:

• Eye screening for diabetic retinopathy.
• Foot screening for nerve and vascular damage.
• Urinary protein tests (albumin/creatinine ratio or 24-hour urinary albumin excretion).

Oral Treatment Options

Our clinic offers a comprehensive range of treatment options for Type 2 Diabetes Mellitus, including:

• Medications to improve insulin action, such as Metformin and Actos (Pioglitazone).
• Newer sulfonylureas like Diamicron MR and Amaryl.
• DPP4 (Dipeptidyl peptidase 4 ) inhibitors (e.g., Januvia, Trajenta and Galvus) which helps to prolong the action of GLP1 (Glucagon-like Peptide 1). GLP1 is naturally secreted by the small intestine when foods pass down. These drugs help to improved insulin secretion after a meal.
• Oral GLP1 like Rybelsus which was launched in Singapore in 2021 is a landmark in the management of DM which is effective in glucose control and weight management.

Injectables in the management of DM

• Rapid-acting insulins like Novorapid, Humalog-insulin lispro and Apidra (glulisine).
• Peakless, long-acting insulin such as Lantus (glargine).
• Incretins represent a group of hormones that are produced by the small intestines and pancreas that influence insulin action and metabolism. Currently there are 3 hormones; GLP1, GIP (Gastric Inhibitory Polypeptide) and Glucagon. Daily injection such as Victoza (Liraglutide) is a less favourable choice. Weekly injectables such as Trulicity (Dulaglutide), Ozempic (Semaglutide) and Mounjaro (tirzepatide) are popular choices because of convenience and efficacies. They are available at our clinic.
• Combination of long-acting insulin and GLP1 has great advantages because it is done as a single injection and could control diabetes and reduce weight gain from insulin treatment alone. Soliqua is a single daily injection treatment which contains glargine and lixisenatide (a GLP1).

Why Choose Us?

The ultimate treatment for severe DM (Type 1 and Insulin requiring Type 2) is a close-loop insulin pump which represents an artificial pancreas. It requires 24-hour glucose monitoring as input for appropriate amount of insulin release from the insulin pump. Newer insulin pod systems are being developed which can use 3^rd party 24-H glucose monitoring such as Dexcom as input to determine insulin release.

Our clinic has decades of experience in managing insulin pumps and we are capable of guiding patients in harvesting this ever evolving technology in management of severe diabetes.

Our clinic is dedicated to providing personalized, evidence-based care for diabetes management. With state-of-the-art diagnostic tools and a wide range of treatment options, we ensure optimal outcomes for our patients. Take control of your diabetes and achieve better health with our expert guidance and support.