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

Singapore Women's Weekly (Singapore) - - CONTENTS -

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:


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.


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.


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.

• Weight.

• Blood pres­sure.

• Foot ex­am­i­na­tion.

• Den­tal check.

• Tests to check kid­ney, choles­terol and thy­roid func­tion and your av­er­age blood glu­cose level (HbA1c).

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