Can You Get Diabetes Even If You Rarely Eat Sugar? — Dr. Jayalaksmi Ramasamy (UCSI Hospital)

Introduction

Welcome back to the Medifly Podcast. Today's episode is recorded at UCSI Hospital, and our guest is Dr. Jayalaksmi Ramasamy, a specialist in internal medicine currently practising at UCSI Hospital, with a special interest in geriatric medicine.

The Most Common Conditions in the Indonesian and Malaysian Population

Host: As a specialist in internal medicine, you see a very wide range of diseases and conditions. Thinking specifically about Indonesian and Malaysian patients — what are the three to five most common conditions you encounter?

Dr. Jayalaksmi: I think Indonesians and Malaysians come from the same roots, so the pattern is very similar. The most frequent cases I see right now are:

1. Type 2 diabetes
2. High cholesterol (dyslipidaemia)
3. Cardiovascular disease — including heart attacks — and hypertension

The reason our population is so vulnerable to these risk factors comes down to lifestyle. Our diets are high in sugar, high in glycaemic index, and high in fat. On top of that, we are exposed to long working hours and chronic stress, all of which raise the risk of developing these diseases.

Age Is No Longer a Barrier

Host: Most people assume that if you are still young and active, you are unlikely to get these diseases. Is that actually true?

Dr. Jayalaksmi: If you had asked me that question ten to twenty years ago, perhaps yes — but not anymore. Age is no longer a barrier. Whether you are young, middle-aged, or elderly, we all carry the risk. The youngest cardiovascular patient I have seen was 18 years old — the primary reason being obesity. I have also seen a hypertension patient as young as 25 years old. All of this ties back to their lifestyle, diet, and daily routine.

"Age is no longer a barrier — whether you are young, middle-aged, or elderly, we all carry the risk."

Myths and Misconceptions: The "Triangle" of Conditions

Host: What are the most common misconceptions people have about diabetes, hypertension, and cholesterol?

Dr. Jayalaksmi: The biggest misconception about diabetes is this: most people think that if they consume more sugar, they will get diabetes, and if they avoid sugar entirely, they are safe. That is not how it works.

Everyone needs to understand that there are two types of diabetes — Type 1 and Type 2. Type 1 is more common in younger patients and children; Type 2 is more prevalent in older patients. Diabetes is not simply about what you consume. Even if you do not eat sugar, you can still develop diabetes, because it depends on whether your organs produce sufficient insulin, and on insulin sensitivity. If insulin function is impaired, blood sugar control breaks down regardless of diet.

"Even if you do not consume sugar, you can still get diabetes. It depends on whether your organs produce enough insulin, or on insulin sensitivity."

This is exactly why routine health screening is so important — even when you are young. Early screening allows for early detection and early treatment, which helps avoid the many serious complications that come with these diseases, including damage to the eyes, kidneys, and heart.

Most patients who come to me are already at an advanced stage. By the time they arrive, the kidneys are already affected, the eyes are already affected. Treatment at that point becomes very challenging — and it takes time for patients to come to terms with their diagnosis. This is a challenge not only for the patient, but also for us in explaining the situation to them.

Treatment: From Lifestyle Modification to Surgery

Host: Can these three conditions be treated with medication alone, or are there surgical procedures needed when things are caught late?

Dr. Jayalaksmi: It is a stepwise approach. For patients who have this trio — hypertension, diabetes, and dyslipidaemia — many are also simultaneously dealing with obesity. We begin with lifestyle modification and medical therapy. If those two steps fail, we allow time for medication to work. If medication is also not effective, we proceed to surgery.

We perform metabolic surgery — similar to a sleeve gastrectomy. This reduces the risk of disease progression and, at the same time, also treats the obesity. So yes, surgery does have a role, but it is the last step.

Complications: What Happens If Left Untreated

Host: I have heard that if diabetes is left untreated, it can lead to amputation. Is that true?

Dr. Jayalaksmi: Yes. The complications are not caused by diabetes itself, but by poorly managed diabetes. The worst outcomes arise from the complications:

• Cardiovascular disease — patients may not survive a heart attack.
• Non-healing wounds — because diabetes is uncontrolled, wounds cannot heal properly, and amputation becomes necessary.
• Kidney failure — untreated hypertension and diabetes damage the kidneys, which can ultimately require dialysis.

So it is not diabetes itself, but the complications of unmanaged diabetes that make a patient's condition so serious.

"It is not the diabetes itself, but the complications of diabetes, that make the patient's condition so difficult."

The Most Common Complications Seen Recently

Host: What are the top complications you are encountering most frequently right now?

Dr. Jayalaksmi: Over the past year, the two most common are:

1. Diabetic kidney disease — we are screening for this very carefully now, including through urine microalbumin sampling.
2. Cardiovascular complications — many patients present with poorly controlled diabetes and no cardiac symptoms at all, yet when we investigate, there is already evidence of coronary artery disease — mild coronary artery disease that has been developing silently.

Procedures Performed in Internal Medicine

Host: What procedures have you been performing most frequently in the past one to two years?

Dr. Jayalaksmi: Beyond managing diabetes, hypertension, and obesity, we also handle haematological conditions and kidney-related problems. Frequently performed procedures include:

• Insertion of an internal jugular vein catheter (IJC) to initiate dialysis
• Trephine bone marrow aspiration to examine bone marrow abnormalities and diagnose underlying haematological conditions

Obesity as a Growing Concern

Dr. Jayalaksmi: Obesity is something I have been managing a great deal lately. Some patients present with body weights exceeding 100 kilograms. We start with counselling, initiate treatment, and we are seeing encouraging results. I am quite pleased with the outcomes so far.

Genetics Versus Lifestyle

Host: What about the genetic argument — if my parents had diabetes, does that mean I will definitely get it too?

Dr. Jayalaksmi: Genetics may account for approximately 10% of the risk, but the remaining 90% still comes down to your lifestyle. That is why early health screening and a healthy lifestyle remain critically important regardless of family history.

Key Symptoms: When to See a Doctor

Host: What are the main symptoms people should watch for that would signal they need a check-up?

Dr. Jayalaksmi: The most common warning signs right now are dizziness and persistent fatigue. These two symptoms can appear across all of these conditions — high blood pressure, low blood pressure, high blood sugar, low blood sugar, and high cholesterol. Please do not ignore them.

People often ask whether frequent thirst and frequent urination are signs of diabetes. Yes, they are — but those symptoms usually appear only at a fairly advanced stage. Do not wait for those symptoms to appear.

"Don't wait for symptoms to appear. If you have been feeling fatigued for the past two weeks and your lifestyle is otherwise fine, that is a symptom you should not ignore — go for a health screening."

Other warning signs include:

• Chest pain
• Difficulty completing simple physical activity — for example, needing to stop multiple times while climbing one flight of stairs. This can be an early sign of heart disease.

Advice for Prevention

Host: If you could give one or two pieces of advice to help people prevent these diseases, what would they be?

Dr. Jayalaksmi: My special interest is geriatric medicine, and one thing I want people to understand is that as we age, our bodies naturally change — but so much of this can be prevented or slowed down. Prevention is the best medicine. Before you can prevent something, however, you need to know what you are dealing with — so get screened as early as possible.

My two specific recommendations:

1. Watch your coconut milk intake. I trained in India and studied for four years in Padang — coconut milk is in everything. It is high in cholesterol. For Indonesians especially, be very mindful of how much coconut milk you consume in your diet.

2. Get vaccinated. The air quality in our cities means we are vulnerable to respiratory illness. If you have the opportunity to receive a pneumococcal or influenza vaccine, please do so — not just for yourself, but encourage your elderly parents to do the same.

"Prevention is the best medicine. But before you start preventing, you need to know what you're trying to prevent — so get your medical check-up as early as possible."

Closing

Thank you to Dr. Jayalaksmi for her time and insights. Dr. Jayalaksmi is currently practising at UCSI Hospital in Negeri Sembilan, approximately one to one-and-a-half hours from Kuala Lumpur. The hospital offers a direct pick-up service from the airport. If you would like to consult with Dr. Jayalaksmi, her profile is available on the hospital website. Leave any further questions about internal medicine in the comments below.