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Doctors' Notes

The Many Faces of Diabetes

If the world were a village of 100 people, five villagers would have had diabetes in 1980. Today, nine. Despite advances in medicine and improved access to health care, the percentage of population with diabetes has nearly doubled.

Many diseases attack a particular part of the body, but diabetes can give rise to a wide range of complications. Organs with many blood vessels, e.g., eyes, limbs and kidneys, are vulnerable to the complications of diabetes. In addition to physical damage, diabetes may cause memory decline and depression. 'Half of the patients on dialysis have diabetes,' said Prof. Ronald Ma, Head of Division of Endocrinology and Diabetes, Department of Medicine and Therapeutics, Faculty of Medicine.

People are living longer throughout the world, and more people are affected by age-related diseases than ever before. Meanwhile, some diseases are becoming more common among young adults. Diabetes is a case in point. One out of every five diabetics in Hong Kong is diagnosed before turning 40. Lifestyle determines destiny. Office workers eat out a lot and inevitably take in excessive sodium and sugar. Long working hours and lack of exercise also bring on a higher chance of developing diabetes.

Professor Ma took one of his patients' case as an example: 'He was on the right side of 30 when he was diagnosed with early-onset diabetes. When he felt better, he stopped returning for consultation or taking medicine. He was admitted to hospital two years later because of blurred vision, only to find that his kidney function was down to 20% and he will require dialysis for the rest of his life.'

Pregnant women are just as susceptible to diabetes. Due to hormonal changes, they are likely to develop insulin resistance resulting in higher glucose levels, a condition known as Gestational Diabetes Mellitus (GDM). More than one in six pregnant women would develop GDM. People used to believe that GDM affects only mothers-to-be. However, a study published by the Faculty of Medicine in 2017 showed that children born to mothers with GDM would have a much higher risk of hyperglycaemia and overweight than other children of the same age.

'Diabetes is a silent killer,' said Professor Ma with a chopping gesture, for diabetics have to live with the disease for the rest of their lives. In Shakespeare's play Measure for Measure, when Claudio is asked why he is under restraint, he replies, 'From too much liberty, my Lucio, liberty: as surfeit is the father of much fast, so every scope by the immoderate use turns to restraint.' Claudio's words also speak to diabetes: temperance keeps diabetes away.

M. Mak

This article was originally published in No. 522, Newsletter in Sep 2018.

diabetes Ronald Ma Head Division of Endocrinology and Diabetes Department of Medicine and Therapeutics Faculty of Medicine