Tag Archives: Singapore

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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Universal Screening of Gestational Diabetes Proposed

Pregnancy

Photo credit:  Stuart Miles/freedigitalphotos.net

The U.S. Preventive Services Task Force (USPSTF) has just recommended that all pregnant women be screened for gestational diabetes. For health care professionals, the document is here.

In pregnancy, the baby and the placenta induces a higher of sugar level in the mother, to ensure that the baby will have enough sugar for use and growth. Normally, the mother’s pancreas will work harder to overcome this by making more insulin. However, sometimes that fails and blood sugar starts to rise, causing gestational diabetes. The main problem of gestational diabetes is that the baby has too much sugar and so grows to too big a size, sometimes more than 4kg. This may make giving birth difficult.

Gestational Diabetes was last reported in Singapore to affect 13.8% of all pregnant mothers in 1988.

Fortunately, the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial cleared showed that proper treatment to normalize the blood sugar helps to prevent complications . For healthcare professionals, the paper is here.

Because effective treatment protects the mother and baby, all women in the US are now encouraged to have an oral glucose tolerance test (OGTT). In Singapore, women who are high risk are encouraged to have the OGTT. These risk factors are: obesity, family history of diabetes, previous gestational diabetes, and previous birth to a baby heavier than 4kg.

In pregnancy, diet and exercise is key to control the blood sugar. A lot of pregnant women can control their blood sugar with simple changes to their diet by decreasing refined carbohydrates such as white sugar, white rice, rice-based noodles (bee-hoon) and white bread.

However, in severe cases insulin will be needed. Oral medication are generally not advised for pregnant mothers.

To know more, here is a video shot by Leonny Atmadja from Our Channel.

The Hidden Danger of Taking Supplements

herbal pills

Photo credit:  cjansuebsri / freedigitalphotos.net

My patients often ask me whether they can take herbal supplements to help their liver or kidneys. I must say that I am increasingly becoming skeptical of the quality of the supplements. A group of Canadian researchers had recently found that many herbal supplements do not contain any of the plants that they are supposed to.

Worse still, in some circumstances, some people develop severe liver failure requiring transplant. There has been a spike in reports of liver failure caused by supplements. Some of the cases were caused by high-dose green tea extracts for weight loss, and others from undeclared steroids in the supplements.

In Singapore, the Health Science Authority had banned a few supplements that damaged livers: kava-kava from Germany/Switzerland, OxyElite Pro from America, and black cohosh supplements.

Adulterated pills from ‘traditional medicine’ herbs had been found to be adulterated with corticosteroids resulting in Cushing’s Syndrome: weight gain, decreased immunity and other side effects. Indeed similar ingredients had been found with Malay traditional treatment as well (Pili Ajaib).

I would therefore advise staying away from most of these supplements until the regulations are changed to proactively monitor them.

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.

Asian Students are tops in Academic Assessment Again!

Asian girl reading

Photo Credit: By Sira Anamwong from freedigitalphotos.net

The OECD has just published the Programme for International Student Assessment (PISA) report. Who are the top 7?

1. China-Shanghai

2. Singapore

3. China-Hong Kong

4. Taipei

5. Korea

6. China-Macao

7. Japan

What do they have in common? A Confucian culture. Even in America, Asian American students do well academically.

Foreigners may not realize how important studying is in the Asian family. Ever since Confucius taught about the importance of studying and opened a sort of a school, Confucian countries have put lots of importance on studying. The pressure is immense. In Singapore it is not uncommon for a parent to take a year off work to help their child to take the primary school leaving exam.The highest scoring candidates in exams become mandarins. Some popular Chinese saying shows how important it is:

1. All trades are lowly except for studying

2. Study hard and you will find great wealth and a beautiful wife in the books

Ahem. Certainly very chauvinistic. But this is ancient China after all.

There is of course a huge downside: children who have poor grades think they are failures. A lot of children, even those who are successful in the system, are burnt out by the time they enter university and end up hating lifelong learning.

Doing well in life requires more than just grades, and it may shock those top scorers when they start working and learn that grit, determination, EQ, connections and pure luck are far more important. I do try to teach my children those things as well.

3 Scientifically Proven Way to Prevent Diabetes: sleep, move, eat

Tsunami

Photocredit: Danilo Rizzuti/freedigitalphotos.net

My article on the Coming Tsunami of Diabetes: how to dodge it has just been published.

Diabetes is an extremely serious problem in Singapore. 1 in 9 adults have it and by 2030, 1 in 5 adults are going to get it.

I personally love the first scientifically proven way: sleeping. Not sleeping enough increases our stress hormones (adrenalin and cortisol) which raises our sugar, and increases our hunger hormone so we want to eat more.

The second is what all doctors say: exercise. I had previously written about the power of exercise.

The third is to eat healthy. Avoid artificially processed starch such as white bread,  white rice and juices. Whole grains should be taken instead. Yes even Michelle Obama supported it.

Remember: sleep, move, eat.

World Diabetes Day Singapore 2013

WDD 2013

Mark the day – 10 November 2013. As diabetes affects 11.3% of Singaporeans, the number of families with one or more members are becoming very high. This year the Diabetes Society of Singapore is going to have an event packed with activities at the Suntec Convention Centre. There are tons of free stuff there:

Free Hba1c test (cost $30)

Free eye photos (cost $30)

Free feet check (cost from $25 at least)

Free consultation with diabetic nurse educators, pharmacists, dieticians (cost from $25 each)

Total free stuff: $160 plus the goodie bag!

In fact since every year the DSS celebrates the World Diabetes Day, you can just get your eyes and feet checked free of charge over there, as they are supposed to be screened yearly as well.

Pravin, a patient with type 1 diabetes will also be there to share his experience. He was diagnosed to have type 1 diabetes at age 7, but had learnt to live with the illness, and is now an engineer. He also runs marathons, climb mountains and volunteers overseas to help other people with diabetes.

So just go to Suntec this Sunday!