Bitter Sweet Dreams- The Star

The article below were taken from Sunday Star, i just want to share this with u guys out there, so please be extra careful if u are one of the candidate for it...well me of course im on the risky side...i had close relatives having it...so got to get extra watch on my sugar content.......please enjoy the refreshing diabetic knowledge,,.....

LEE TSE LING meets two diabetic patients who reach out with their cautionary tales.

GETTING off on the wrong foot with diabetes cost Teh Yuen Kim his right one, when what began with a small cut on a toe ended with a surgeon cutting off his entire foot and half a calf.

The amputation that finished Teh Yuen Kim’s days of unencumbered walking took place in early September last year, but the underlying problem began long before that.

An Ipoh boy, Teh (53) lives and works in KL, specialising in information technology networks. Among his 11 older siblings, he has two brothers and a sister who have type 2 diabetes mellitus (hereafter referred to simply as “diabetes”) - the incurable disease that results from a progressive deterioration of the body’s sugar processing machinery.

Despite this, Teh did not think he was at any risk of developing the disease or complications, himself.

Lesson #1: If you have a parent, brother, or sister with diabetes, you are at risk of developing diabetes yourself. Get screened and learn how to prevent it.

Single, independent, and seemingly healthy, Teh rarely saw a doctor in the last 15 years, even though he admits his blood sugar levels during this time were “quite borderline”.

“That was my problem,” he says. “I very seldom fall sick. (When) you feel like nothing can go wrong with you, you have a false sense of security.”

Lesson #2: Regular medical check ups are important. Even if you have no symptoms of diabetes, you should be screened for it annually from age 30 onwards.

When Teh sustained the cut on his toe, he didn’t pay much attention to it since it stopped bleeding and seemed to heal. In hindsight, he realises he just couldn’t see the havoc that was being wreaked internally.

Teh Yuen Kim ... I thought kurang manis (less sweet) is sufficient, but it's not.

As weeks went by, his foot became tender enough to make him limp, but he assumed he had gout (a painful inflammation of the joints caused by urate deposits in and around them). Eventually, when the foot started oozing pus, he saw a general practitioner. Amongst other things, the GP measured his blood sugar level, and recommended he visit a hospital for treatment.

By the time Teh finally did, most of the tissue in his right foot had died and blood had stopped circulating to his right foot, ankle, and lower calf. The infection had caused his body to stop responding to his own insulin, and his blood sugar was through the roof at 26 (“normal” is under 5.6).

“It just took three to four months for the toes to turn black,” he recounts. “The sole was almost totally gone. Three of my toes were gangrenous. There were two more toes left. The orthopaedic surgeon told me even if they save the two toes, they wouldn’t last long because blood wasn’t flowing to them. So in another three to six months they would go too.

“That’s when I found out I was diabetic. I didn’t realise diabetes can cause the leg to deteriorate so badly.”

Lesson #3: High blood sugar damages nerves and narrows blood vessels, resulting in insensitivity to pain from cuts and infections and low blood flow to extremities like the feet and toes. This slows healing. When blood flow stops altogether, tissue death (gangrene) occurs, and amputation is often necessary to save the remaining living tissue.

For Teh, coping with the loss of his leg is more difficult than coping with diabetes. It took him four months of rehabilitation to learn to walk with a prosthetic leg. Till today, activities that require its removal, like bathing and sleeping, remain challenging and uncomfortable.

“When the prosthesis is on, there is pressure on the leg. When you take it off, there isn’t, and blood flows in. That can feel painful,” he explains. “At night, after you take off the prosthetic leg, the (living) leg will swell. In the morning it’s a very tight fit and (the prosthesis) is harder to put on.

“Every now and then, I forget I don’t have half of my leg. So when I wake up, I feel its there, get up, and then I will fall down like mad!”

To help himself live independently, Teh needed to make home improvements and learn new skills.

“I spent quite a lot of money renovating my bathroom and stairs. I can’t afford to let my leg get wet, so I had to cover my car park quite well, and I put in an automatic gate.

“There’s not much feeling in the right leg. But I’ve found if I use my left leg to brake instead of my right, I can control the car quite well. It has to be an automatic car. I don’t think I can drive a manual car anymore.”

Lesson #4: Patients who accept their diabetes, take ownership of it, and take proactive steps to manage it better will do better than patients who don’t.

Another skill Teh has learnt is how to watch his blood sugar level like a hawk.

“I check once a day, but alternate the time. One day I’ll do it just after I wake up, before breakfast. Another day, I’ll do it before lunch. Then before dinner. Then before I sleep. From that, I keep a record.

“The most accurate reading is in the morning - after fasting. Other periods show the effect of what you’ve eaten. You can see whether you should eat more of something or less of something.

“Now, with my experience with monitoring, I know everything has sugar. Something can look innocent, like roti canai or chapatti, but it can be quite high in sugar. I thought kurang manis (less sweet) and all that is sufficient, but it’s not,” he warns.

Lesson #5: Effective control of blood sugar doesn’t just come from reducing intake of actual sugar. Maintaining an active lifestyle, healthy weight, trim waistline, and low blood pressure and cholesterol level also contribute.

A. S. Xavier ... Don’t put on weight. Do some exercise. Go on a diet. Don’t be like me, don’t get into this situation.

Unfortunately for A. S. Xavier, our second interviewee, he was initially unaware of these factors, and his search for a quick cure was nearly his undoing.

Originally from Klang, Xavier (74) is an ex-electrical engineer, specialising in power generation. Having previously worked in factories in Pahang and Sarawak, he now lives in Subang Jaya, Selangor.

His diabetes was diagnosed in his late 30s when, at the prompting of his friend, a medical assistant working in the same factory, he visited his family doctor to be screened. He told his doctor he was experiencing frequent toilet visits, constant thirst, and a constant craving for sweet things, but didn’t understand how these symptoms were connected with diabetes.

Lesson #6: Learn to recognise the early signs of diabetes and see a doctor if they develop - excessive urination, constant thirst and/or hunger, effortless weight loss, cuts and bruises that are slow to heal, tiredness and lethargy, sudden vision changes, very dry skin, and tingling or numbness in the hands and feet.

“The doctor gave me two pills,” he recalls, “one to take in the morning and one in the evening, and said ‘Come back in one week to check your blood.’ I don’t know what my blood sugar level was then. I didn’t even know then there was such a measurement.

“He didn’t say a word about how dangerous it was, what I should do. The only thing he would say was ‘Ah, this week you’re alright. Keep your blood sugar level low.’ He said don’t take sugar, don’t take sweets, don’t drink coffee with sugar, don’t take too much rice.”

Lesson #7: Managing diabetes effectively requires knowledge and planning. Bombard your doctor with specific questions and take notes. Eg how do I prevent this complication? How do I follow this treatment and what are the side effects? What value exactly is “high” or “low” blood sugar? How will my treatment regime change over time? How do I time my medication and meals? What should I do if I miss a dose? How often should I check my feet/eyes? How should I watch my blood sugar when I exercise, travel, or am ill?

Xavier didn’t think his condition was serious, partly because his doctor was so blasé, partly because his mother had been coping so well with diabetes for as long as he could remember.

“I thought, what is so special about it? My mother is diabetic and she’s all right, she’s fit, she can walk for miles. She took care of it so well - followed her doctor’s instructions, took her medicines, cut down on starchy foods, all these things. And she was healthy up to 84. She never told us about it or the dangers. I didn’t know, until it was too late.”

Lesson #8: Teach your children about diabetes and the importance of healthy lifestyle choices early on, especially if they are at risk of developing the disease.

Diet control and drug therapy kept Xavier in reasonably good health until three years ago, when his kidney function began to deteriorate. His doctor suggested he prepare himself for haemodialysis by undergoing surgery to enlarge a vein in his arm so it could withstand repeated needle insertions.

At the word “surgery,” Xavier blanched, afraid of going under the knife. Around the same time, ie towards the end of last year, he heard about a doctor practising in Klang who claimed he could treat his kidneys without dialysis, much to Xavier’s delight.

“I thought ah, that’s good!” he exclaims. “That’s nice, that’s what I want. That doctor would take a bottle of medicine - what it is, I don’t know - mixed it with distilled water and then dripped it into my bloodstream. Once a week, I would go in for one and a half hours’ treatment, which was supposed to bring out all toxic matters in my body.

“Then, bad luck, the doctor had to go somewhere for two weeks. She said ‘No need to worry, just take care of yourself.’ The third week, I couldn’t go for treatment. I thought if two weeks can go without problem, one week should be ok without problem.”

But it wasn’t. By the end of the third week, it was January, and Xavier was in a poor state. His chest felt severely congested and his phlegm was full of blood. Weak, nauseous, and dizzy, he needed his daughter-in-law and maid to walk him down the stairs and to the car, step-by-step. In the car on the way to the emergency department of the nearest hospital, he collapsed. While wheeled through the hospital on a gurney, he barely registered what was going on as faint voices floated in and out.

Lesson #9: Complementary and alternative medicine (CAM) has its place in the treatment of diabetes, NOT its cure. Learn more about CAM for diabetes at diabetes.niddk.nih.gov/dm/pubs/alternativetherapies/ and ALWAYS inform your about any CAM you’re taking.

He woke up to find a tube embedded in his chest, through which emergency dialysis had been performed to clear out the toxic waste that had accumulated in his body. Progressive damage to the microscopic filters in his kidneys (“nephropathy”) due to poor blood sugar control and delaying haemodialysis had lead to complete kidney failure.

Lesson #10: You can’t cure diabetes. You can only manage, and because it is progressive, its management must be reviewed regularly with your doctor.

Xavier was 72 when his kidneys failed. He had been earning a living right up till then. If he could do without his four-hour dialysis sessions three times a week, he imagines he’d still be working and travelling to visit his children here and in Australia, Germany, and Singapore. Since he can’t, and after all he has been through, he has resolved to never let it happen to them.

“I warn them every now and then. When I see them taking too much rice, sugar, starch, I tell them it’s not good. I tell them not to put on weight. Better do some exercise. Go on a diet. Don’t be like me, don’t get into this situation.

“Older people, what they say to the younger generation doesn’t seem to carry weight. They assume we’re talking grandfather stories. But now my children have observed what happened to me and what’s happening to me now. Seeing me with this problem has really given them a shock.”

Xavier wishes he could have had the access to sound medical advice people nowadays take for granted, eg through educational clinics, talks, and the Internet.

“(Back then) unfortunately, whether it was my stubborn mind or the information they were trying to convey to me then, it didn’t go into my head,” he owns. “Possibly because I was not aware of what the dangers were. Probably because I kept referring to my mother. That sort of attitude led to this problem. So I only hope people pay some attention to this.”