Tag Archives: Diabetes mellitus type 2

A New Class of Diabetes Medication Arrives in Singapore

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Despite current treatment including insulin, only 40% of patients in Indonesia35% of patients in Singapore and 22% of patients in Malaysia have good diabetes control.

A new class of medication called the SGLT2 inhibitor has been approved in Singapore, the first one being Invokana (canagliflozin). It has a unique mode of action for the treatment of type 2 diabetes mellitus.

In the kidneys when blood is pushed through a glomerulus (the smallest operating unit in the kidney), glomerular filtrate (earliest urine) is formed. It contains glucose (sugar), different ions, water and waste products. The good stuff is retained through reabsorption. Glucose is reabsorbed through the SGLT2 channels.

SGLT2 inhibitors block the action of the SGLT2 channels, so glucose is lost in urine. Thus the blood glucose drops and diabetes control improves. Patients also lose weight as they are losing energy in the urine. The glucose in the urine also drags water with it and thus patients’ blood pressure drops.

The most important benefit is that it is not dependent on insulin secretion, so the risk of a dangerously low blood sugar (hypoglycemia) is prevented. With this extra class of oral medication, patients may be able to delay their use of insulin.

There are side effects though. First, the sugar in the urine increases the risk of a urine tract infection and fungal infection around the urethra. Second, patients can get dehydrated unless they replenish their fluids with an extra glass of water.

I am very glad that we now have another weapon in the treatment of diabetes.

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Avoid Glibenclamide for patients who are elderly or have renal failure

Finger prick meter

Photo credit:  Gualberto107/freedigitalphotos.net

Glibenclamdie (glyburide in America) is a common and useful drug for type 2 diabetes. It is effective and the blood sugar lowering effect long-lasting. However, the strength is also a weakness: it can sometimes be so powerful that the patient can suffer prolonged hypoglycemia (low blood sugar level).

The Health Sciences Authority of Singapore had looked at the data and found that in Singapore, patients who are above 60 or those with kidney failure have a much increased risk of severe and protracted hypoglycemia. They have now advised all doctors to avoid using glibenclamide in those patients.

There are many other alternative drugs in the same class such as gliclazide and they are also generics, available at a low price at our clinics.

If you are taking glibenclamide and had recently turned 60 or have renal failure, please do not stop your medicine immediately, but talk to your doctor about it.

Tom Hanks has Type 2 Diabetes

Tom Hanks 2009

Photo credit: Wikipedia

I love Tom Hanks. From Forrest Gump to Angels & Demons, I have always enjoyed watching him perform. He is professional, willing to gain or lose 20kg just to fit into the look of a role.

He has just declared that he has developed type 2 diabetes mellitus at age 57. Also, he has been having “high sugars” (likely prediabetes) from age 36.

Type 2 Diabetes mellitus is a disease of high blood sugar, when the body cannot make enough insulin to bring the sugar down in the blood. It happens especially in people who are overweight and obese, because when they gain fat tissue, their body becomes resistant to the effect of insulin. At first, the pancreas makes more insulin to overcome this resistance and their blood sugar is still normal. Over time, however, the pancreas becomes weak and blood sugar starts to rise a bit (prediabetes) and then a lot (frank diabetes).

8.3% of Americans have diabetes, and 11.3% of Singaporeans have diabetes. The high blood sugar wreaks havoc in the body, getting attached to everything in the body, preventing their normal function. If uncontrolled, diabetes can lead to blindness, kidney failure, amputations of the lower limbs, heart attacks and strokes. Fortunately, good control of diabetes can prevent all these complications.

The most important thing is through lifestyle modifications. The most important thing is to control the amount of carbohydrate intake and exercise regularly. Tom Hanks has said that he would not be taking on roles that require weight gain any more. Well he is someone that can lose 26 pounds (12kg) just through sheer determination, so I think he can do it.

Indeed, Tom Hanks has had quite a good run with his prediabetes. He only “graduated” from prediabetes to diabetes after 21 years! In Singapore, a study done by Prof ES Tai showed that 35% of patients with prediabetes develop diabetes in 8 years. So Mr Hanks have largely avoided developing diabetes at a much earlier age, and should be congratulated.

It is also very encouraging to know that celebrities like Tom Hanks would openly admit their chronic medical condition. It can lead to better recognition of the illness by the public, and lead to healthy discussion by patients at risk and their doctors. Well done Mr Hanks!