Cover Tackling diabetes begins with tackling obesity (Photo: Getty Images)
Tackling diabetes begins with tackling obesity (Photo: Getty Images)
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In conjunction with World Diabetes Day, Dr Malathi Karupiah, consultant endocrinologist at Prince Court Medical Centre talks about the disease, offering advice for actionable change
Diabetes is projected to afflict seven million Malaysian adults aged 18 and older by 2025, according to a recent study on the prevalence of Type 2 diabetes and prediabetes in Malaysia. The increasing trend comes from a range of causes, including rising rates of obesity, physical inactivity and an ageing population. A World Obesity Federation report predicts 41 per cent of the nation’s adults will be obese by 2035.
In 2023, the Malaysian Ministry of Health launched a Sugar Advocacy Plan to combat excessive sugar consumption and reduce the prevalence of non-communicable diseases (NCDs) like diabetes. Earlier this year, the ministry launched the Kurang Manis campaign in Putrajaya to promote healthier drinking habits. Reception was tepid, reflecting a broader cultural resistance to change. In 2025, Malaysia will raise duties on sugar-sweetened beverages by 40 sen per litre. Under Budget 2025, The Health Ministry’s allocation is second highest at RM45.3 billion, putting into perspective the economic burden of safeguarding national well-being.
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Dr Malathi Karupiah, consultant endocrinologist at Prince Court Medical Centre, acknowledges these governmental efforts. “It’s not easy to get everyone on the same page to understand how bad diabetes is. Hopefully, the tax price will help people think twice.” Food addiction has strong ties to Type 2 diabetes, “So, the challenge becomes about trying to get people to overcome addiction,” Karupiah says, comparing the difficulty on par to halting alcoholism and smoking.
Above Dr Malathi Karupiah, consultant endocrinologist at Prince Court Medical Centre (Photo: Prince Court Medical Centre)
Dr Malathi Karupiah, consultant endocrinologist at Prince Court Medical Centre (Photo: Prince Court Medical Centre)
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Diabetes can be a silent killer, showing no symptoms for some. Others should note: “Unintentional weight loss, poor wound healing, increased frequency to urinate resulting in disturbed sleep, craving sweets, increased thirst, the formation of boils and even vaginal candidiasis are all possible warning signs of diabetes. The appearance of skin tags, a blackish discolouration around the neck, and darkening of the knuckles and armpits are also signs of insulin resistance that overlap with polycystic ovary syndrome (PCOS).”
“People need to know their family history,” Karupiah says, discussing the risk factors for developing diabetes besides obesity. “It’s important for parents to screen themselves, so their children have that knowledge.” While diabetes was once considered a disease of the old, Karupiah observes the age gap is closing. “I’ve seen kids as young as 12 become diabetic, and their families struggle to accept it, but the onset of diabetes can occur even at a young age. Pregnant women should also be aware of gestational diabetes and screen frequently.”
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Addressing preexisting conditions that make a person more susceptible to Type 2 diabetes, Karupiah points to the factors of metabolic syndrome, including abdominal obesity, high blood pressure, impaired fasting glucose, high triglyceride levels and low HDL cholesterol levels. Chronic kidney disease, heart disease and a fatty liver also increase diabetic risk. “Fatty liver affects one in five adults. Just because you’re lean (with less subcutaneous fat) doesn’t mean you don’t have visceral fat wrapped around your organs.”
Above Diabetes can be a silent killer, showing no symptoms for some
Diabetes can be a silent killer, showing no symptoms for some
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Asked about the link between declining mental health and diabetes, Karupiah describes it as a chain reaction. “When there are mental health issues like anxiety and depression, a person is more likely to remain sedentary and self-soothe with food to improve their emotional state. It can lead to obesity and then diabetes. A healthy lifestyle accounts for good mental, emotional and physical health.”
Acknowledging that Malaysia is a food haven and locals often show love to one another through food, Karupiah suggests it is wise to take a mindful approach towards consuming healthier meals with appropriate portions. “I often say that losing weight is not a sprint, it is a marathon. You have to pace yourself. Understand that change doesn’t happen overnight, and we are on the same journey to break the bad habits developed throughout our lives.”
While ordering drinks, Karupiah says it’s best to skip the added sugar entirely. “I don’t believe in asking for ‘kurang manis’ (less sugar). Choose a plain ‘limau ais kosong’, with no sugar. Avoid condensed milk entirely, be it in teh tarik, kopi, banding, or anything else.” Condensed milk contains around 11 grams of sugar per tablespoon. The American Heart Association recommends no more than 24 grams of sugar daily for women and 36 grams for men. This estimate accounts for both added and naturally occurring sugars.
Above Consistency and discipline are difficult to cultivate, but key to curbing many diseases
Consistency and discipline are difficult to cultivate, but key to curbing many diseases
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“We’ve cultivated the habit of eating rice with every meal, and most rice is high in starch. Whole grain basmati rice and brown rice are good options, high in soluble fibre,” Karupiah says, with whole grains shown to reduce blood cholesterol levels. It is equally important to learn to choose food with a low glycemic index (GI), with foods on the low end of the scale having little effect on spiking blood sugar levels. Low-GI foods include green vegetables, most fruits, raw carrots, kidney beans, chickpeas and lentils, while high-GI foods include white rice, white bread and potatoes.
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Karupiah also advocates Malaysians opt for smaller plates to improve portion control. “The rule is quarter-quarter-half, with half your plate filled with leafy green vegetables and the remaining portions allocated to your carbs and protein.” Increasing fibre intake slows digestion, helping regulate blood sugar and cholesterol levels. The doctor also recommends making a habit of savoury meals for breakfast. “Lean chicken or eggs, with a slice of wholemeal bread, makes a better option to start your day with low to normal sugar levels.”
Glycemic variability (GV) refers to fluctuations in blood sugar throughout the day. The aim should be a steady increase and decrease over drastic swings of highs and lows. “Studies show that constant shifts impact the whole body, causing inflammation. Diabetes deteriorates the eyes, heart, kidneys, nerves and vessels. As a result, the disease can even lead to the onset of vascular dementia.”
Above Food addiction has strong ties to Type 2 diabetes
Food addiction has strong ties to Type 2 diabetes
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In terms of advancements available in Malaysia, the continuous glucose monitor (CGM) has been a game changer for diabetics, according to Karupiah. “Many patients were reluctant to monitor their sugar readings,” she says, old methods involving drawing blood. “The CGM painlessly adheres to skin and can be scanned, offering real-time glucose readings. Seeing is believing, as they say. This technology allows my patients to observe which foods spike their sugar, helping them learn what to avoid and giving them greater agency to control their health,” Karupiah says.
Working towards weight loss and lowering the risk of diabetes requires equal efforts in reducing calorie intake and exercising. “I advise my patients to aim for a five-kilometre walk, which should take 45 minutes to an hour each day or every other day,” Karupiah says. She further notes that your chosen activity should be enjoyable, so staying active does not feel like a chore. “Consistency and discipline are difficult to cultivate, but key to curbing many diseases.”
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Images: Getty Images
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