KUALA LUMPUR, Dec 13 — Diabetes is a disease characterised by high blood sugar levels.

Hence, many may wonder whether it is caused just by eating sweets.

Although it may be true that having large amounts of sugary food daily may increase one's risk of diabetes, it seems sugar intake is just one piece of the puzzle.

To take a look at the bigger picture of the causes of diabetes, Malay Mail reached out to senior consultant endocrinologist Prof Dr Chan Siew Pheng for some insights.

According to her, diabetes is a condition where blood sugar levels are too high, hence many might come to think that sugar is the cause.

She noted that a high sugar diet on its own will not increase your risk of diabetes, only if your sugar intake results in weight gain.

"Many other factors including your overall diet with excess food intake that results in weight gain, lifestyle and genetics also impact your risk of developing diabetes.

"This is a common misunderstanding Malaysians have towards sugar and diabetes.”

Dr Chan said there are two main types of diabetes — Type 1 and Type 2.

According to her, Type 1 diabetes occurs when the immune system attacks the pancreas and destroys its ability to produce insulin, which is most common among young people.

"Type 1 diabetes is not caused by sugar nor is it caused by anything else in your lifestyle,” said Dr Chan, who is also Malaysian Endocrine and Metabolic Society president.

On the other hand, she said, Type 2 diabetes occurs when the body’s cells no longer respond to the insulin and the pancreas does not produce enough insulin to compensate for the ineffective insulin action.

"With Type 2 diabetes, it is more complex.

"You are more likely to get diabetes if you are overweight or obese and lead a sedentary lifestyle with little or no physical activities.”

Dr Chan said such a lifestyle may lead one to gain weight due to excess calories gained through food and drinks that contain a lot of calories.

"These calories can then make you put on weight, which is the main risk factor for developing Type 2 diabetes.

"A high-carbohydrate diet that consists of rice, noodles, bread, roti canai, etc, whereby the carbohydrate is broken down into sugar in our blood can also cause an increase in the risk of diabetes.”

If you wonder why obesity may lead to diabetes is because excess body fat can cause resistance to insulin action and the more fat one has, the more resistant the cells become to insulin.

Looking beyond diet and lifestyle

Dr Chan said diabetes is a complex disease and the risk factors are not limited to only diet and lifestyle.

According to her, family history and age may contribute to one’s risk of developing diabetes.

"Your risk of developing diabetes increases if a parent or sibling has diabetes.”

Dr Chan said genetics plays a major role in the risk of developing Type 2 diabetes.

"If you have been diagnosed with diabetes, there is a good chance that someone in your family has diabetes as well.

"Several gene mutations have been linked to the development of Type 2 diabetes, which can interact with the environment to further increase your risk of diabetes.”

She also noted that those who are overweight and have a family history of diabetes are more likely to develop diabetes compared to someone who has the genetics for developing diabetes but manages his or her weight well.

"Apart from that, the older you get, the greater your risk of developing diabetes.

"This may be caused by doing less physical activity, weight gain and losing muscle mass.”

Diabetes diet myths

One of the very first steps to managing diabetes is making the right dietary changes, but to get started, it is vital to know two of the most common myths clouding the topic.

1. Cutting down on sugar is enough

According to Dr Chan, the biggest diabetes diet myth is that consuming too much sugar is the sole cause of Type 2 diabetes.

"We’ve established that this is not true, but many believe that they can manage their diabetes just by cutting down on their sugar.

"This is shown in the Malaysian Diabetes Index survey that we conducted earlier this year, where one in three Malaysians believe in such a myth.”

Dr Chan said cutting down on sugar alone isn’t enough if one wishes to manage the blood sugar levels.  

"You also have to reduce or maintain your weight goal, exercise regularly and eat a healthy diet in order to manage your condition, as well as to prevent and manage diabetes complications that are life-threatening like heart disease, stroke, nerve damage and kidney damage.”

2. Carbohydrates are completely off-limits

Dr Chan said carbs shouldn’t be seen as the enemy of diabetics.

"More importantly you should consider the type and quantity of the carbs that you eat depending on the glycemic index (GI), a measure of how quickly foods with carbs may impact blood sugar levels.

"Food that is low in GI may be a better option than those with a high GI.”

For example, Dr Chan said, carbs that are low in GI include rolled or steel-cut oats, whole grain bread, dried beans and legumes as well as low-starch vegetables such as spinach, broccoli and tomatoes.

Diabetes in Malaysia

According to the National Health and Morbidity Survey in 2019, there are approximately 3.9 million Malaysians living with diabetes.

The report stated that the prevalence rate has risen from 13.4 per cent to 18.3 per cent from 2015 to 2019.

That’s approximately one in five adults in Malaysia.

Dr Chan said Malaysia has become the most obese Asian country over the last three decades.

"With the continued rise of obesity in Malaysia, there are numerous health risks, including diabetes.

"People living with diabetes are also getting younger and younger, due to the unhealthy lifestyle habits among Malaysians.”

Dr Chan said with more accessible services that deliver food to one's doorstep, it is now very easy to find various types of food options without thinking about the health risks they pose.

She also noted that education on diabetes is still lacking in Malaysia, which causes a knowledge gap among the people.

"Without proper disease awareness, Malaysians will continue to live in ignorance and not make the necessary lifestyle changes in order to manage and prevent themselves from developing diabetes.”