Manage and Prevent Diabetes
With diabetes raised as a key health concern for Singaporeans, here’s everything you need to know about preventing and managing it
with our six-page health update
It’s official: Singapore has one of the highest rates of diabetes in the world among developed nations, and is second only to the United States. Today, 11 per cent of adults here aged 18 – 69 is diabetic, and Type 2 diabetes is Singapore’s fastest growing disease. Our high consumption of sugar and lack of an active lifestyle have been blamed for this high rate of diabetes, which also puts sufferers at risk for more serious medical issues like heart attacks, stroke and kidney failure.
No wonder diabetes was raised during Prime Minister Lee Hsien Loong’s National Day Rally speech as a “health crisis” for Singapore. “It is precisely because many people are not worried [about diabetes] that I am worried. It is precisely because many people do not take diabetes seriously that it has become a serious problem,” he said.
PM Lee suggested Singaporeans learn to manage their weight by eating less and healthier, consuming less sugar and soft drinks, and exercise more by incorporating walking and step-climbing into their everyday routines. He also reminded Singaporeans to go for regular medical checkups to see if they are at risk for diabetes, as one in three Singaporeans are estimated to be at risk of developing the disease.
Few diseases affect every part of the body the way that diabetes does. Perhaps your weight is creeping up, and you already have pre-diabetes or blood sugar problems and want to do something about that, or maybe you’ve already been diagnosed with type 2 diabetes. Either way, the key to dealing with type 2 diabetes and its precursors is knowledge.
In this health special, you’ll find out more about diabetes and its causes, and the most effective ways to prevent it, manage it and, in many cases – beat it.
What is Diabetes?
Diabetes is a condition where there is too much sugar in the blood. It’s a serious and complex condition which can affect the entire body. If complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. This health special deals mainly with type 2 diabetes – the most common type – but it’s worth knowing about the three main types:
TYPE 1 DIABETES
An auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin. Experts don’t know what causes this auto-immune reaction, and it’s not linked to lifestyle factors.
TYPE 2 DIABETES
This is known as a ‘lifestyle disease’. It develops when the body becomes resistant to the normal effects of insulin and/or gradually loses the capacity to
produce enough insulin, leading to high blood sugar levels.
This is a form of diabetes that occurs during pregnancy and usually goes away after the baby is born. It is diagnosed when higher than normal blood sugar levels first appear during pregnancy. It is a risk factor for developing pre-diabetes and type 2 diabetes.
Pre-diabetes is a condition in which blood sugar levels are higher than normal as a result of insulin resistance, although not high enough to be diagnosed as type 2 diabetes. Prediabetes has no symptoms but if you have it, your risk of developing type 2 diabetes is significantly increased.
What is insulin resistance?
Insulin is a hormone made in the pancreas. When we eat foods containing carbohydrates, they are broken down into glucose (sugar) in the blood. Insulin transfers glucose to from the blood into the liver and muscle cells for energy. As long as your body can keep up with the amount of insulin it needs, blood sugar levels stay in the healthy range. In people with insulin resistance, the muscles and the liver resist the action of insulin, so the body produces higher amounts to keep the blood sugar levels within a normal range. This is when type 2 diabetes can begin to develop.
Some research has shown that insulin resistance, independent of diabetes, is associated with heart disease. Scientists believe insulin resistance is largely caused by excess weight and physical inactivity.
Are you at risk?
Being overweight or obese is the most significant risk factor in developing type 2 diabetes, but even people who are slim may be carrying dangerous levels of fatty tissue on the inside. The most important thing to remember is that you are in control of your own health and, even if you have other risk factors, a healthy lifestyle can protect you from type 2 diabetes in most cases. It can also significantly improve your quality of life if you’ve already been diagnosed.
Why are more people getting type 2?
It’s no secret that many Singaporeans have a less-than-ideal diet that’s too high in refined carbohydrates and bad fats – and we’re not as active as we once were, thanks to electronic devices. These are both significant risk factors for the disease. So it stands to reason that if we change those risk factors, there’s a good chance we can stop the tidal wave of type 2 diabetes cases.
Pre-diabetes and type 2 diabetes risk factors
Anyone can develop type 2 diabetes at any age, but some of us are at particular risk. It pays to be aware of the risk factors so you can act quickly if you’re concerned. Some of these risk factors can be changed, and others can’t.
WEIGHT The more fatty tissue you have, the more resistant your cells become to insulin.
INACTIVITY The less active you are, the greater your risk. Physical activity helps you control your weight, uses up sugar as energy and makes your insulin work better.
FAMILY HISTORY Your risk increases if a parent or sibling has type 2 diabetes.
AGE Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults. GESTATIONAL DIABETES Women who had gestational diabetes when pregnant. BIRTH WEIGHT Women who have given birth to a child over 4.5 kg.
POLYCYSTIC OVARY SYNDROME For women, polycystic ovary syndrome – characterised by irregular menstrual periods, excess hair growth and obesity – increases the risk of developing diabetes.
SMOKING Tobacco use can increase insulin resistance and stimulate stress hormones which can increase blood glucose levels and make it more difficult to manage prediabetes and diabetes.
HIGH BLOOD PRESSURE Having blood pressure which is over 140/90mm of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
ABNORMAL CHOLESTEROL AND
TRIGLYCERIDE LEVELS If you have low levels of high-density lipoprotein (HDL), or ‘good’ cholesterol, your risk of type 2 diabetes is higher. People who have high levels of triglycerides (another type of fat carried in the blood) also have an increased risk of developing type 2 diabetes.
Getting a diagnosis
Type 2 diabetes is sometimes suspected when you are showing early signs of complications, such as a vision problem.
Although finger-prick tests can reveal a higher-than-normal blood sugar level, you need one or more of these three laboratory blood tests to diagnose type 2 diabetes:
• Random blood glucose test;
• Fasting blood glucose test and, if necessary; • An oral glucose tolerance test (OGTT).
One of the main aims of diabetes care is to prevent long-term complications. So after diagnosis, you will be offered the following checks and tests to look for signs that any complications may be developing.
• Blood pressure.
• Foot examination.
• Dental check.
• Tests to check kidney, cholesterol and thyroid function and your average blood glucose level (HbA1c).