I'm a kid and I have type 2 diabetes
Teenager Hilman Hanuar is one of growing number of youngsters here with adult-onset diabetes
He was only 14 when he was diagnosed with type 2 diabetes.
At the time, student Hilman Hanuar was 1.75m tall and weighed over 110kg - more than twice the average weight of a boy his age.
"I was shocked when I was told I had type 2 diabetes. That was during the fasting month that year. My mind went blank and I didn't know how to react," Hilman, now 16, told The New Paper.
Hilman is a typical example of kids and youth in Singapore today with type 2 diabetes.
Type 2 diabetes or adult-onset diabetes is the most common in Singapore and occurs when the body is unable to produce enough insulin or use it properly.
About 20 years ago, type 2 diabetes accounted for only 5 to 10 per cent of childhood diabetes. Today, that number has increased to more than 30 per cent.
Dr Yvonne Lim, Associate Consultant with the Division of Paediatric Endocrinology at the National University Hospital (NUH), said the hospital has seen a rise in child patients with type 2 diabetes.
"Before 2012, the number of newly diagnosed type 2 diabetes was less than 20 a year. Compared to 10 years ago, the number has increased by 100 per cent," she said.
Hilman, who is a patient at NUH, said he has always been big.
"I was told I was born special," he said with a laugh.
He was teased in primary school, but Hilman said he took it in his stride as he is a "happy-go-lucky kid".
"I was never in any want of food," he said.
"My family is in the catering business and at times, I was put in charge of the dessert section whenever there were events."
Meals at home were prepared by his grandmother "and they were Malay-styled dishes, usually cooked with coconut milk".
In school, Hilman said he would indulge in his favourite drink every day - canned green tea.
But since his diagnosis, things have changed "for the better, but not drastically", he added.
"Changing my diet and lifestyle was a challenge at first, but my doctors and the dietitian said to take baby steps," said Hilman, the vice-head of students' council at Yuan Ching Secondary School.
Apart from taking his medication regularly, his best friends, whom he told of his condition, also chip in to make sure he keeps to his diet.
"They make sure I drink only water every day instead of green tea," he said.
"And when I do buy the tea, they would make sure I drink very little and they would finish the rest for me."
Hilman said he has halved the amount of rice he eats and increased the variety of vegetables.
"I used to only take broccoli but now I eat all kinds of greens," he said, adding that he still indulges in his grandmother's desserts but "in tiny portions".
Today, Hilman stands at 1.78m and has since lost 2kg - weighing in at 108kg. He managed to cut down his blood glucose level from 10mmol/l (millimole per litre) to 5.5mmol/l.
Blood glucose typically varies from 4mmol/l to 6mmol/l for people without diabetes.
"But I need to do more," he said.
When it came to the question of exercise, Hilman became sheepish, admitting that he should do more.
"Last year, I was going with my schoolmates on an adventure trip to Selangor. So to increase my stamina, I trained by climbing stairs in school and running 10km every week," he said.
"Now I walk up and down the stairs to and from my flat every day."
When asked which floor he lives on?
"The second storey," he answered, with a cheeky grin.
Diabetes mellitus is a condition where the body fails to use blood glucose or blood sugar properly. This is because the body is either not producing enough insulin, or its cells do not respond properly to insulin, or both.
There are three types of diabetes:
The pancreas produces little or no insulin. Its onset is usually sudden and the symptoms include increased urination, thirst or dry mouth, hunger, weight loss despite normal or increased eating, blurred vision, frequent or continuous infections and tingling or pain in the hands, feet or both.
TYPE 2 (ALSO KNOWN AS ADULT-ONSET DIABETES)
This occurs when the body either resists the effects of insulin or does not produce enough insulin to maintain a normal blood sugar level.
About 80 per cent of people with type 2 diabetes are overweight. Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet or doing plenty of exercise. The symptoms are similar to type 1 diabetes.
This only affects expectant mothers and diagnosis is usually made during pregnancy.
Head of the Department of Endocrinology at the Singapore General Hospital (SGH) Goh Su-Yen said diabetes increases one's risk for serious health problems.
"Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. People with diabetes also have a higher risk of developing infections. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation," she said.
Dr Goh said while modest changes in physical activity and diet can lead to long term benefits for individuals, Singapore's challenge is to translate the information from well-established international clinical trials into real-life programmes that are economically and logistically sustainable.
"Any intervention for diabetes, hypertension and obesity must be wedded to a campaign of awareness and detection, and accompanied by systematic interventions to ensure access and adherence to prescribed regimens.
"It will be interesting to chart the impact of the recent 'sugar tax' implemented in Britain, on actual consumption and long-term hard targets of lowering obesity and diabetes rates," she said.
Obesity: The root of diabetes
The number of adults worldwide estimated to be living with diabetes has grown nearly four times over 35 years - from 108 million in 1980 to 422 million in 2014, the World Health Organisation (WHO) said.
It attributed this to "the way people eat, move and live".
According to an International Diabetes Federation (IDF) report last year, Singapore has the second-highest proportion of diabetics among developed nations after the US.
It said 10.53 per cent of people here aged between 20 and 79 are estimated to have the chronic disease. Only the US fared worse, with a percentage of 10.75.
This is not surprising, according to local doctors, because Singaporeans are becoming less active and eating more high-calorie diets, both of which increase the risk of diabetes.
Dr Yvonne Lim, an Associate Consultant with the Division of Paediatric Endocrinology at the National University Hospital (NUH), said the root of the problem is obesity, which itself is one of the most challenging medical conditions to manage.
"The lack of motivation and the attraction to computers and smart phones are all a hindrance to treating obesity," she said.
"To be successful, we need to increase the child's motivation and help him identify how he can increase his physical activity by doing things he's interested in.
"If they love computer games, they can consider using video games that are also a form of exercise. And if they have no time to go out, consider home exercises like climbing stairs or skipping."
To intervene, NUH has a multidisciplinary weight management clinic, called the Youth Lifestyle Change Clinic, which includes an occupational therapist who advises on how to motivate oneself and counsels parents on strategies to motivate children to keep a healthy lifestyle.
Khoo Teck Puat Hospital (KTPH) started a Diabetes In Youth (DIY) programme in 2013 to monitor young patients with diabetes. The goal is to reduce loss to follow-up and treatment, and to encourage them to take better control of their condition.
Its doctors had found out from a cross-sectional review of all patients under 30 years old that those with type 2 diabetes for the past three years had more complications than those with type 1 diabetes with an average of seven years.
Its diabetes specialist, Dr Phua Eng Joo, said many young people with type 2 diabetes have few or no symptoms.
"With a sense of invulnerability, they may not perceive the long term benefits of medical treatment and lifestyle interventions, or appreciate the harm of suboptimal blood glucose control. As a result, young individuals with type 2 diabetes have poorer clinic attendance and are more likely to default on follow-up and medication adherence," he said.
Dr Phua added that many are also "transitioning into young adults" - assuming more responsibility for self-care, financial independence, relationships, body image and self-esteem, ansd new educational directions. These often compete with the demands of diabetes management.
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