A widely circulated Ministry of Health statistic from 2010 revealed that 1 in 9 Singaporeans suffer from diabetes. However, the 8 that are living diabetes-free may want to ask themselves the question, “How diabetic am I?” as everyone has a daily blood sugar level, and our bubble tea-loving lifestyles of the young to the middle-aged are so unhealthy that Singapore is placed second only to the United States in incidence of diabetes. Besides one’s diet, there is a lot more to managing diabetes and if this disease isn’t addressed holistically, it is estimated (by the same study) that an estimated 1,000,000 Singaporeans will be living with diabetes by 2050.

Thus, we spoke to Dr Chua Chong Bing, a family physician of Healthway Medical, in a 2-part special to find out more about diabetes and how one is able to look out for signs early-on and possibly, reverse its effects.

Q: What does it mean to be prediabetic?

Prediabetes is a precursor to diabetes and it should be considered as a warning sign. An individual is considered pre-diabetic if his or her blood glucose level (blood sugar level) is higher than normal but not high enough to be considered as diabetes. It is an indication that you could develop full-blown type 2 diabetes if you do not make immediate and lasting lifestyle changes. Some ways to prevent this from happening include making healthy decisions about your diet, maintaining a healthy weight and incorporating exercise into your daily life.

A fasting blood sugar test is one of the common ways to test for diabetes. To ensure an accurate reading, a blood sample is taken after fasting for at least 8 hours overnight. A fasted sugar level between 6.1-6.9 mmol/L¹ is considered prediabetes, and anything above 7.0 mmol/L indicates type 2 diabetes.

Additional tests such as an oral glucose tolerance test can also be done to measure the blood sugar level 2 hours after 75g of glucose has been consumed. A level fo 7.8-11.0 mmol/L is considered prediabetes while anything more than 11.1 mmol/L is considered to be diabetic.

It is always recommended to consult your family physician regularly to track your progress and take appropriate action where necessary.

Q: What is the difference between Type 1 and Type 2 diabetes?

There are three main types of diabetes.

Type 1 diabetes

Type 1 diabetes occurs when the body doesn’t produce enough of the hormone insulin, which is the hormone that tells the cells in the body to receive sugar from the blood. Without enough insulin, glucose is unable to enter the cells and thus, remain in the bloodstream.

Type 1 diabetes can occur at any age but it is more common in children and young adults. Its exact cause is still unclear but it is likely to be due to both genetic and environmental factors, which leads to the destruction of the cells that are in charge of manufacturing insulin.

A person with Type 1 diabetes will need to take insulin for the rest of their life as they have no natural ability to produce insulin. Not doing so can result in ever-increasing blood sugar levels and dangerous complications.

There are more children with Type 1 than Type 2 in Singapore. However, the prevalence of Type 2 diabetes in children is increasing due to the widespread increase in childhood obesity.

Type 2 diabetes

This is the most common form of diabetes, with over 90% of diabetics in Singapore suffering from Type 2 diabetes. With Type 2 diabetes, the pancreas usually produces some insulin. However, the amount produced is either not enough for the body’s needs or the body’s cells are resistant to it. People who are obese are at a particularly high risk of developing a number of chronic diseases, including Type 2 diabetes and its related medical problems.

Gestational Diabetes Mellitus

The third type of diabetes is Gestational Diabetes Mellitus (GDM), which develops during pregnancy and occurs either when a mother is unable to produce enough insulin or the insulin is not working well enough to cause glucose to enter the cells. This leads to excess glucose in the bloodstream, which can be passed onto the baby.

According to a study done by the Agency for Care Effectiveness at the Ministry of Health in Singapore, up to 1 in 5 women are at risk of GDM, putting them at an increased risk of certain conditions during pregnancy. The health risks include higher birth weight of the baby, premature birth, low blood sugar levels in the baby during birth and the development of high blood pressure.

Gestational diabetes typically goes away following pregnancy. A doctor will check the woman’s blood sugar levels shortly after delivery and then again within 6 weeks. For mothers who have had gestational diabetes, they are also at risk of developing Type 2 diabetes later in life.

Q: How do you track and interpret your blood glucose levels, even for those without diabetes?

If you do not have diabetes, then tracking your blood glucose levels daily will not be necessary.

Screening for diabetes is recommended for adults who have an increased risk of having diabetes as mentioned earlier, or at age 40 for those without any risk factors. A fasting blood glucose level drawn at the doctor’s can determine whether one has diabetes or not.

If you do have diabetes, tracking will help you understand your condition and how different foods, medications and activities affect your condition. If you take insulin to manage your diabetes, your doctor may recommend blood sugar testing a few times a day, depending on the type and amount of insulin you use.

Testing for blood glucose levels is usually done with a monitor called a glucometer, which works by analysing a small amount of blood drawn usually from the fingertip. Testing is usually recommended before meals and at bedtime if you’re taking multiple daily injections. Those managing Type 2 diabetes with oral medications or with diet and exercise alone may not need to test blood sugar daily.

All diabetics should ideally test their fasting blood glucose levels and their HbA1c² levels twice a year at their doctor’s to track how well their sugar is maintained over a period of time. More frequent blood tests to track one’s progress may be necessary if there have been recent therapy changes or worsening of diabetes. This will ensure optimum levels of treatment given and to perform necessary tweaks to one’s treatment programme to achieve target levels.

Q: What are some unexpected risk factors or warning signs for diabetes?

Type 1 is classified as an autoimmune disease, meaning that your immune system sees your body’s own tissue as foreign invaders and attacks itself. In the case of Type 1 diabetes, the pancreas is unable to make insulin because the immune system is attacking it and destroys the cells that produce insulin. Researchers are still working to fully understand what causes or triggers Type 1 diabetes but without any conclusive findings, it is currently difficult to prevent the diseases. However, patients who have a family history of Type 1 diabetes are at risk of getting the disease.

The onset of Type 2 diabetes can be gradual and the symptoms can be mild during the early stages. As a result, many people may not realise that they have the condition. Anyone can develop Type 2 diabetes but certain factors can increase one’s risk, including:

Being 45 years old or older
Living a sedentary lifestyle
Being overweight or obese
Eating an unhealthy diet
Having a family history of diabetes
Gestational diabetes
Polycystic Ovary Syndrome (PCOS)

The risk factors for developing GDM is similar to developing Type 2 diabetes but also includes:

Being pregnant at 35 years old or older
A past history of diabetes in pregnancy
A past history of delivering babies heavier than 4kg
Suspected macrosomia (when a baby is larger than average at a particular gestational age)
History of unexplained stillbirth

Most patients do not present with symptoms when they first have diabetes, making it difficult to detect. However, some can manifest and they include:

1. Frequent urination

When blood sugar levels are high, the kidneys try to remove the excess sugar by filtering it out of the blood. This can lead to a person needing to urinate more frequently, especially at night.

2. Increased thirst

The frequent urination that is necessary to remove excess sugar from the blood can result in the body losing water and over time, causing dehydration and leading a person to feel more thirsty than usual.

3. Always feeling hungry

People will diabetes often do not get enough energy from the food they eat as when the digestive system breaks the food down to glucose, not enough of the glucose moves from the bloodstream into the cells. As a result, people with Type 2 diabetes often feel hungry, regardless of how recently they have eaten.

4. Feeling very tired

Those with Type 2 diabetes can feel tired or fatigued because of the insufficient sugar moving from the bloodstream into the body’s cells and dehydration from the increased urination.

5. Blurry vision

An excess of sugar in the blood can damage the tiny blood vessels in the eyes, causing blurry vision. This blurry vision can occur in one or both eyes and may come and go. High levels of glucose in the blood can also cause glucose to accumulate in the lenses of the eyes, which can affect one’s ability to focus on an object. If a person with diabetes goes without treatment, the damage to these blood vessels can become more severe and permanent vision loss may eventually occur.

6. Slow healing of cuts and wounds

High levels of sugar in the blood can also damage the body’s nerves and blood vessels, impairing blood circulation and the body’s ability to deliver protective mechanisms and nutrients to an affected area. As such, even small cuts and wounds may take weeks or months to heal. Slow wound healing also increases the risk of infection.

7. Tingling, numbness or pain the hands and feet

As mentioned in point 6, high blood sugar levels can affect blood circulation and damage the body’s nerves. This can lead to pain or a sensation of tingling or numbness in the hands and feet. This condition is known as neuropathy and it can worsen over time, leading to more complications if a person does not get treatment for their diabetes.

8. Bad breath

Without enough insulin to allow the glucose into the cells, the body starts to burn fat stores and this reaction produces ketones as a side product. The ketones can cause bad breath in the mouth.

Do look out for the second part of this article regarding the misconceptions of diabetes and how to manage diabetes, which will be published next week. For more information about Healthway Medical Clinics, please visit https://www.healthwaymedical.com/gp-family-medicine/.

¹mmol/L stands for millimole per litre, a standard measurement for blood sugar level
²HbA1c level refers to your average blood glucose levels for the last two to three months

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