Living with more than just diabetes
Retired senior banker Peter Lim not only has diabetes, he also has heart failure and partial blindness. He shares his story to bring more awareness.
Peter Lim never thought he could get Type 2 diabetes. “I often travelled to Borneo for work and led an active life there – constantly hiking mountains and diving. I would have never thought I’d be diagnosed with the illness.” It was back in his early 40s when he found out while doing a body checkup prior to purchasing health insurance. “It honestly came as a surprise. I couldn’t believe that I had diabetes as I felt healthy,” said the retired senior banker.
The father of three shared that it could be the lifestyle he had back then that could have caused his diabetes. “There were many occasions where I had to wine and dine key clients which involved frequent consumption of rich food as well as hard liquor/alcohol.”
After his diagnosis, he had to accept it and learn to manage his condition, including taking his medications diligently and modifying his lifestyle. “I worked closely with my doctor to modify my lifestyle habits which include better food choices.”
Peter explained that he made a number of changes to his diet. Firstly, he portions his intake – “I only consume half of my meals each time and I give the other half away.” Secondly, he stopped bulk-buying, adding, “I previously bulk-buy fruits as they were cheaper in quantity but I ended up eating all of them. Now, I only purchase a single serving and share the extra with my friends.”
Thirdly, he minimises his consumption of unhealthy foods. “I’ve minimise my intake of alcohol, especially beer, chocolates and oily foods. Once in a while, if I’m craving for a beer, I have half a can and give the other half to my friend. If I’m alone at home, I drink a quarter of a can and keep the remainder in the fridge for a couple of days before sipping on it again.”
Though he does not take insulin for his diabetes, he does however take medications for his multiple ailments, some of which relate back to his diabetes. “I am taking a total of eight types of medications currently and they help me with managing my diabetes, eyesight, heart failure and prostate issues. Living with diabetes for me is about managing more than one ailment and this is because the risk factors of some of these conditions are closely linked to each other.”
Peter added: “My illnesses are inter-related. Truth be told, I was first diagnosed with heart failure when I was working in Borneo. I exercised regularly when I was there but one day, I felt breathless during a hike and decided to consult a doctor. They did some tests on me and spotted abnormalities in the imaging process. I came back to Singapore to seek a second opinion and the doctor confirmed the diagnosis of heart failure.
“A few years later, the doctors told me that my high blood sugar levels had caused damage to the back of the eye, rendering partial blindness. While I’m unable to undo the damage, the medications I’m on can help stop my vision from getting worse.”
As such, he ensures he takes his medications during the day and at night, and shared that he “pretty much goes about my life the same as before”. The only change is that he has stopped driving completely as his eyesight has made him unsafe to be on the roads.
Despite all this, he stays positive about his life. “I try to manage my ailments and go about my daily life as normal as can be. Now, I am still able to go about my daily activities, such as cycling and walking long distances – and I do so quite regularly.” He also shares his story to help educate the public on the importance of managing diabetes and the other ailments that come with it.
“I truly believe that it is crucial for Singaporeans to be aware of their lifestyle habits, get proper screenings done in a timely manner and take proactive steps to manage their illnesses. If you feel unwell or that something is not right with your body, do not hesitate to speak to your doctor and do the necessary checks so that you can take steps to manage it. Catching any disease in the early stages is important to prevent disease progression and more damage done to the body,” said Peter.
SIDEBOX: Dealing with multiple ailments
Ageless Online asks Dr Kevin Tan, consultant diabetologist and endocrinologist at Mount Elizabeth Medical Centre and the vice-president of Diabetes Singapore, about Singaporeans dealing with multiple ailments as a result of diabetes:
Can you share what the new and effective treatment methods for diabetes patients who have multiple ailments like Peter has?
- Many risk factors behind Type 2 diabetes and heart failure are similar and have substantial overlaps. For patients like Peter, it is key to focus on the various medical conditions the patient has when prescribing new therapies.
- Recent clinical trials in patients with diabetes and heart failure with reduced ejection fraction have shown that patients can benefit from SGLT2 inhibitors – for instance, a reduction of cardiovascular death or hospitalisation due to heart failure. These clinical trials also showed similar benefits in patients with heart failure with reduced ejection fraction, without diabetes.
- The goals of treatment for patients with multiple ailments like Peter are: To maintain or improve the quality of life in part by preventing the diabetes-related complications that he has, to his heart and eyes from getting worse, as well as to prevent other complications, like kidney damage and failure from developing, as well as to reduce the early mortality from diabetes that heart conditions can bring.
What is the prevalence in Singapore of those with multimorbidities?
- Approximately 440,000 Singapore residents (18 years and above) had diabetes in 2014 and the number is estimated to grow to one million in 2050.
- For heart failure, almost 4.5 percent of Singaporeans (approximately 260,000) live with the condition as compared to one to two percent in the US and Europe.
- Hence, the number of patients with multimorbidities – a term commonly used as a reference to people with multiple health conditions that require complex and ongoing care – is on the rise. This ranges from 50 to 98 percent of people older than 65 years based on different studies.
- In Singapore, 25 percent of the resident population will be older than 65 years by 2030. And with that, 16.3 percent of the Singapore population will have more than one chronic condition inclusive of diabetes and heart failure.
How has this affected the lives of some of the patients you have seen?
- In my years of practice, patients with multimorbidity frequently present with lower functional capacity, higher health care utilisation, usage of multiple medications, and higher mortality rates in addition to the risk attributed by the individual diseases.
- They affect quality of life and health by having to cope with multiple conditions at one time, having to spend more on healthcare because of more specialist visits and more medications to take and unfortunately also shorter lifespan. There is also a psychological impact brought about by the stress of all this.
Can you share how patients are making the necessary adjustments and doing the best they can?
- Like Peter, many patients have had to make lifestyle adjustments to ensure that they can still go about doing their favourite activities or enjoy their favourite foods from time to time. Singapore being a food paradise can be quite a challenge for those living with chronic conditions, such as diabetes and heart conditions.
- Patients will need to be educated to make smarter and healthier dietary choices and make the necessary lifestyle adjustments, such as eating more complex carbohydrates to keep their blood glucose level in a constant and safe range.
- They need to remain positive and not let their illnesses overwhelm them. It helps to focus on their loved ones and to find strength in their love and encouragement.
- They also need to work with their doctor and take the necessary medications that would help them control their various illnesses better.
Anything else to add?
There is much truth in the common adage – “Prevention is better than cure”. There is much to gain from upstream diabetes prevention and managing their diabetes well even before the complications of diabetes ensue. The newer class of medication can also be of benefit to prevent, for example heart or kidney complications.