And furthermore, the longer time that they are uncontrolled, the greater the risk that they’re going to develop all of the complications. And it’s the complications that we’re really scared of. Because once the complications are there, they cannot be reversed.
And that’s what I keep on telling the patients: “You cannot cry anymore when the complications are there because I cannot help you.” So, the thing is let us prevent these complications from coming in. So now that I can still help you, we don’t have complications, so help yourself also. Be more controlled.
KM: Pero, doktora, sige let’s inject some fear factor ano. Kasi may mga tao na kahinaan ‘yun, e. Let’s talk about the complications. And again, going back to the cardiovascular, for example. What are the complications that may arise from diabetes?
Dr. Ayi Faller: Well, first and foremost, the most important thing is that this one, it’s actually not the fear factor thing. I tell the patients, “Kinukwento ko po ito sa inyo kasi ito po ‘yung mga facts.” Okay.
So, fact number one, it’s like 80% to 90% of diabetics, they eventually die of a cardiovascular disease. Cardiovascular disease encompasses all those diseases of the heart, like chronic heart disease, cerebrovascular disease or stroke, and peripheral vascular disease, or all blood vessel diseases that supply your heart, your brain, your upper and lower extremities.
So, with that in mind, that means that if you’re a poorly controlled diabetic, you have a great risk to develop a heart attack, a stroke, or a lower extremity amputation. So that means ‘yung mga non-traumatic amputations o pagkaputol po ng mga paa o daliri, sa paa. Sometimes, the majority of them, like 60% to 80% of them, are secondary to diabetes. So that’s one.
The second complication that we’re really scared of is the renal failure. So, diabetes accounts for a little, about half, of all new cases of patients who have to have renal replacement treatment. That means either hemodialysis, or peritoneal dialysis, and diabetes is the number one cause of end-stage renal disease, or renal failure in the Philippines and worldwide.
And if you combine diabetes with hypertension, they account for 80% percent of all patients on dialysis. So, it’s really a very bad thing to be diabetic and have another comorbidity like hypertension.
Not only that, but diabetes also accounts for blindness. These are other complications that we’re really scared of, aside from the neuropathy. Neuropathy is when your nerves are, or your “ugat pandamdam,” they’re all going crazy.
So, when you touch something, and it’s supposed to be hot, the patient with diabetes will feel it to be just warm, so they keep their hand on it, and then before they know it, they’re already having burns. I have a lot of patients like that.
Neuropathy is also one of those complications of diabetes that decreases the quality of life of a diabetic. So that’s the reason why we always tell the patients, “Please, help us help you in preventing these complications from setting in by having better sugar control.”
KM: Right. And we’ve been talking to the patients so far, doktora, but I think we also need to address the carer, or the other members of the family, noh? Kasi minsan, it’s the support. So, the patient doesn’t feel, I guess, alone, or singled-out, ‘di ba?
So, what is your advice to the carers, or the family members of a diabetic patient?
Dr. Ayi Faller: Usually, when a patient with diabetes would seek consultation in the clinic, I always tell them, “Bring a family member along.” These family members are now aware of the condition of their relatives, so they would be more supportive.
And sometimes, I really talk to the relatives because sometimes they get to be too strict, and the patient now doesn’t get to eat anything, and they get to be sad, and then ‘yan, panget na. So, I just tell them, “You just encourage mommy or daddy to be eating the better foods, and then encourage them to be working, like walking around, moving.”
So, I tell the relatives, “You should be a part of the treatment regimen of your relatives.” And I also tell them, “Since you are relatives, you also may develop this later on. So, it’s good for you to be learning about this now.” So that’s the role of the family. They should be part of the support group of the patient.
KM: Okay, wow. We’ve covered everything, doktora, from the kinds of diabetes to the causes, exercises, diet, okay. Even the family, or carers, support. And complications, most importantly. Oh my gosh, parang, una muna po, wala po sa atin can afford to be sick, ‘di po ba? Lagi nating sinasabi ‘yun.
Dr. Ayi Faller: Especially now.
KM: Especially now. So part of avoiding that, pati ‘yung gastos, kung ganon po tayo mag-isip, is to really stay healthy and to follow our doctor’s advice.
And ako, para sa akin, hindi ko na po hihintayin ang diagnosis na diabetic ako bago ko pa i-adopt ‘yung mga tips na shinare ni Doc Ayi just now.
So, we’re going to the last stretch of our interview, Doc Ayi. Let’s just talk about two myths, ‘no. Let’s debunk two myths na may kinalaman sa diabetes. Una muna, ang mga payat, hindi nagkaka-diabetes. Diba ‘pag sinabing diabetes, ‘yun ‘yung mga morbidly obese. Is that a myth, this is true or false, and why? What is the fact?
Dr. Ayi Faller: Well, it is a myth. Even the thin people get diabetes. And actually, nowadays, they say na, “You’re diabetic, but you’re fat.” So that’s one. Actually, obesity really leads to a lot of metabolic abnormalities including sugar, increase in blood pressure, increase in cholesterol levels, so it’s accepted. It’s a proven fact that being overweight and obesity will lead to diabetes.
But what about the thin people? So sometimes, they are thin because they are already diabetic and they are poorly controlled, so that’s why they are thin. And if it runs in the family, then even having a thin frame, body frame, but you’re having a very bad lifestyle, then you can still be diabetic.
So regardless of what your body frame is, if you’re small, medium, large, extra large, triple large, it doesn’t matter. We all have to live healthily so we will not be diabetic. So even if it runs in your genes, as I’ve said earlier, we can put a stop to it. Just keep a healthy lifestyle.
KM: Okay, Doktora. Loud and clear. Hindi lang po ang overweight o obese ang pwede maging diabetic, pwedeng ‘yung mga skinny din, kasi nga, baka may diabetes na. Ganito ka-importante ‘yung annual exam, ‘no Doktora? ‘Yung annual check.
Dr. Ayi Faller: Yes, correct. That’s very important ‘cause sometimes, we actually find a lot of newly-diagnosed diabetics just on the annual exam.
KM: Yeah. Oh my gosh, that reminds me, I have to have mine soon. Okay, second myth, Doktora. I know a lot of, mga 20-somethings noh, “Parang mabilis pa naman metabolism ko eh, so okay lang. Tsaka na ako mage-exercise ‘pag when I’m in my mid-30s to my 40s,” ‘di ba, ‘yung parang nandun na sa age na may onset na. Is that fact, is that a myth, or is that wrong? What are the facts?
Dr. Ayi Faller: That’s a very, very bad myth. Very very wrong. It’s quite saddening that the youth nowadays or the young adults, they just want to work, work, work, and not take care of their health because just like what you’re saying, ‘cause they think they’re still very young and eventually they can catch up later on with exercise, and sleep, and no stress, and all of that.
But actually, the fact is, nowadays, we see a lot of very young adults who have diabetes. And you know, Kai, sometimes it’s so scary because a 28-year-old diabetic will have a stroke, or will have a heart attack. And it’s so sad because they’re not even in their 30s yet; they’re not even at the height of their careers, or chosen paths in life, and yet they already have these complications primarily because they’re really very big, they have this “panget na lifestyle,” just eating anything in sight, not exercising, drinking a lot of the sugar beverages, and all of that.
So, it’s really sad that we have a lot of young adults who are already diabetics, and a lot of them, aside from having all these cardiovascular diseases, have renal failure. So, we also have a lot of young diabetics who are on dialysis. So, it’s very sad. It’s really very sad, so please, don’t do that.
When you’re diagnosed to be diabetic, then you really have to follow a good lifestyle, take your medications, and see your doctor. And if you’re not yet diabetic, don’t wait. Just like what Kai had said, don’t wait to be diabetic. Practice a healthy lifestyle so you don’t get to be diabetic later on.
KM: Okay. Yeah. And then we are repeating this like a broken record because it is a very important message that we really want to para, may plan po sa inyo. And please spread the word. Share po ninyo ‘tong interview natin with doktora para mas marami pang makaintindi kung ano ba talaga ‘yung causes, anong komplikasyon ng diabetes, and, how will it affect talaga our life and our family?
But at the same time, even after getting diagnosed, it’s not a life sentence. ‘Wag pong mawalan ng pag-asa, makinig sa doktor, at sundin ang doktor, okay. So, Doc Ayi, for my last question, pwede rin siyang repeat e. Pero ulitin natin para sa mga nanonood na, kasi ang viewers namin dito sa Hello Doctor, madami ang meron nang suspetsa, noh.
They’re looking up symptoms, or either that or na-diagnose na sila, or they’re caring for a patient. So ano ang inyong mensahe sa kanila? What is your message to them, as far as diabetes is concerned?
Dr. Ayi Faller: Okay. So actually, for those people who already have diabetes, you don’t have to be living a lonely life. You don’t have to be sad. All you have to do is discipline yourselves, accept that you are diabetic. You can live with it, be happy with it, you just have to make sure that you have a good diet, and enough exercise. Basically, a good lifestyle: no smoking, no intake of alcohol, less stress. All of these can make you have a good quality of life even if you are diabetic.
Of course, you have to know what your other risk factors are because diabetes – they have a gang of friends. May barkada ‘yan, eh. Hypertension, hypercholesterolemia meaning increased cholesterol levels, increased blood pressure, so you also have to look into this because if you are not able to control the blood pressure or the cholesterol, and you’re just controlling the blood sugar, then you can still get the other complications like cardiovascular diseases, renal failure and all of that.
So, it would be best for you to know what your risk factors are, go visit your doctor, and there are a lot of websites also that can help you for this one. There’s like the For Your Sweetheart website and in this, you will be taught all about diabetes and its complications.
There’s also the Framingham Risk Assessment test there, so you would know if you have the risk to develop all of the cardiovascular diseases also that may be present in diabetes. So, again, it’s easy to live with diabetes, you just have to live healthy and be disciplined. Visit your doctor regularly.
KM: Okay. Thank you for that Doc Ayi. So ‘yung website po is for-your-sweetheart-dot-PH (foryoursweetheart.ph). Okay. Bisitahin niyo po ‘yun right after watching this interview.
So, there you have it, Doc Ayi Faller, president of the Alliance of Clinical Endocrinologists in the Philippines. I learned so much in this one hour, I mean, we publish a lot of stories on diabetes, but you know, it’s always good to keep learning, to keep re-learning.
And I appreciate message being repeated over and over again because like, today, ang excuse ko, doktora, nag-memedicate pa ako e, ‘di comfortable earbuds ko e, pero ‘yung bike ko naghihintay oh. Parang, “Ay, buong araw ka na namang nakaupo.” Alam mo ‘yun, doktora? I think we can never get enough reminders to take care of our health.
Yes. And especially, Kai, I just want to say, because a lot of our people are just working from home and the majority are just sitting down and all of that. We have to remember that now, sitting is the new smoking. If smoking kills, sitting kills as well.
So, I always tell the patients who are working from home, “Every now and then you have to get up and walk around. Try to exercise while you’re working from home. Take advantage of this COVID pandemic when we’re just at home.”
I think it would be nice because you get to really have time for yourself so you can exercise, look into the food that you’re eating, unlike before when we’re still working outside, we have to hurry because of the traffic and all of that so you have to make more time for work.
But now, since you’re working from home, then I guess, now we can take care of our family, and ourselves. So that’s I think the plus point of having the quarantine.
KM: Yeah. I agree, Doc Ayi. Sometimes, I miss — I used to work in a building that was 40 to 45 minutes away from my condo, and I really walk. I walk going home.
Uy, wow. Really? That’s nice.
KM: Yeah, and it was also kind of, you decompress, so by the time you get home, you’ve let go of your work mode, and you’re ready to be in the home mode. And I miss that.
Yeah, that’s true.
KM: I had friends who would say, “Wow, kawawa ka naman, mag-grab ka na lang.” Parang, ba’t pa ako naging kawawa, naglalakad nga ako e.
Yeah, but you know, walking really relieves you of stress. It clears your mind. That’s what I tell the patients, “Walking is really a very very good exercise. Not just for your body, but for your mind as well.”
KM: For the creative mind, people like us, we have to think of ideas. You look around randomly, and just by looking at people, new ideas go into your head. So, yeah.
Walking. Brisk walking, right?
KM: Yes. So, thank you, Doc Ayi. Thank you for spending an hour with us talking about diabetes and cardiovascular health.
KM: And for your sweetheart dot PH (foryoursweetheart.ph). Everyone, please visit that website right after watching this.
So, this has been Kai Magsanoc of Hello Doctor Philippines, for our very first #AskTheExpert video interview. Please join us again for the next one, as we talk to another medical expert about another pressing medical issue whose conversation needs to happen now. Until then, stay well and be safe.
Learn more about diabetes, here.