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Diabetes is a chronic medical disease that causes high blood sugar. It is common and millions worldwide has been affected by this condition. In 2014, there are 440 000 Singaporeans with diabetes, and this figure is estimated to reach 1 million by 2050. This accounts for 10% of disease burden locally. Poorly controlled diabetes also leads to complications such as cardiac events, stroke, blindness, nerve damage, kidney disease and infections.
What causes Diabetes?
Blood sugar levels are controlled by insulin, and the pancreas is the vital organ for insulin production. When there is an impairment in production or resistance to insulin, there is a build-up of blood sugar, and diabetes ensues.
Types of Diabetes
There are different types of diabetes, but the most common 2 are Type 1 and Type 2.
Type 1: This is caused by insufficient insulin production, due to pancreatic cell destruction by the body’s immune system. Typically presenting during childhood/adolescence, patients with this condition will require lifelong insulin.
Type 2: More commonly diagnosed in adults, this is due to insulin resistance. However, genetics, unhealthy diet and sedentary lifestyle are also contributing factors. These patients are usually treated with oral medications. Some may require insulin if their sugars are not well controlled despite oral medications.
Screening for Diabetes
National screening for diabetes occurs at 40 years old in Singapore via Screen for Life (SFL). However, you may wish to screen earlier if you are worried, or are experiencing symptoms suggestive of the disease.
The fasting glucose test checks the fasting sugar at the particular morning of the sampling, and has been the traditional method to screen for diabetes. In recent years, Singapore has also recognised another screening method, known as the HbA1c test. The HbA1c test gives the average reading of the sugars over the past 3 months. Both tests involve blood taking, and are not superior to each other to diagnose diabetes. However, doing both tests together are helpful in detecting pre-diabetes, and for monitoring purpose.
In the event that your fasting glucose and/or HbA1c is abnormal yet doesn’t meet the criteria for diabetes, you may be asked to undergo an oral glucose tolerance test (OGTT), to determine the status of your condition.
What is Pre-diabetes and why is this important?
Pre-diabetes is a condition where the blood sugar level is abnormal, but has not reached the stage of diabetes. This condition increases the risk of diabetes, and many patients do subsequently progress into diabetes. Making dietary or lifestyle modifications in the early stages can slow this progression down.
Pre-diabetes is divided into 2 categories: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).
Symptoms of Diabetes
Not all diabetics present with symptoms. Many are detected through health screening.
Type 1 diabetics usually present acutely, whereas Type 2 diabetics may exude some symptoms such as:
- Excessive thirst
- Frequent urination
- Lethargy
- Unintentional weight loss
- Frequent infections (e.g. vaginal thrush, poor healing wounds)
Those with pre-diabetes do not have symptoms.
Management of Diabetes
Diabetes is a lifelong condition, but it can be kept under control through the following means:
- Diet
Reduction of sugar is key. This can be achieved by reducing the amount of sweet food and drinks. Carbohydrates are also converted into sugar, hence, cutting down on high carbohydrate food will indirectly help with sugar reduction. This also helps with weight loss.
The American Diabetes Association recommends a low-carbohydrate diet, but does not state a recommended amount in grams. However, a low carbohydrate diet suggests around 45-60g of carbohydrates per meal, for a total of about 200g per day.
We recommend a visit to the dietician to gain a deeper insight about the amount of calories required by the individual, and for advice on choosing the appropriate food options. There are many dietary regimes available online these days (e.g. intermittent fasting, ketogenic diet), but do exercise caution when following the advice of online sources, as these regimes may not be suitable for everyone, and if not done appropriately, may result in potential health issues.
- Exercise
Moderate intensity exercise is encouraged. Jogging, cycling, swimming, aerobics are some options to consider. Aim for a healthy BMI of <23. Studies strongly recommend 30 minutes of exercise 5 times a week.
- Eliminating/Control other cardiovascular risk factors
Diabetes is a risk factor for cardiovascular events. Other risk factors such as smoking, high blood pressure and high cholesterol further increases the risk for these events. Patients should stop smoking, and visit their doctor to ensure that their blood pressure and cholesterol levels are normal/well-controlled.
- Medications
There are various medications that treats diabetes. Although all medications aim at lowering blood sugar, some might provide additional benefits compared to others. The doctor will usually run a panel of lab tests, and take your medical history into consideration, before deciding which medications might be suitable for you. It is crucial that the patient be compliant to the medications, visit his doctor for regular labs to monitor his progress, and to seek medical help if he feels unwell during the course of treatment. Self-titration of medications should not be attempted without a doctor’s advice, as it will make monitoring of one’s condition challenging. In certain cases, it can cause potentially life-threatening outcomes.
Other things to take note of in Diabetics
- Vaccinations
Diabetics have a lower immune system compared to normal individuals, making them more susceptible to severe infections. The National Adult Immunisation Schedule (NAIS) in Singapore currently recommends all diabetic patients to be vaccinated with flu and pneumococcal vaccinations.
- Treat wounds with care
Wound healing is slow in diabetics. As diabetics have an increased risk of wound infections proper wound care is vital. Do not hesitate to seek medical attention if the wound is worsening, as delays can result in hospitalisation for aggressive intravenous treatment or even amputation.
- Regular eye and foot checks
All diabetics are recommended to do yearly eye and foot screenings. The eye screening aims to identify any diabetic eye complications, and to treat it at its earliest stage. This helps to prevent blindness. Diabetics may suffer from nerve damage as a complication, resulting in decreased sensation especially in the foot. They may sustain wounds unknowingly, and these wounds may ulcerate or get infected. Foot screening aids in picking it up early, so that patients are aware and can be advised on how to manage this.
Summary
Diabetes is a chronic condition that can potentially result in many complications. Although it is incurable, it can be treated and many patients go on to lead happy and “close to normal” lives when it is well controlled. Screening is important so that treatment can be commenced early when detected. Keeping diabetes under control will help to slow down progression and delay any complications that may occur in the future.
DR+ Medical & Paincare Tampines
Dr. Michelle Phua is an experienced female doctor (family physician) at DR+ Medical & Paincare Tampines Clinic. She provides comprehensive healthcare services ranging from chronic disease management, men & women’s health, children’s health, dermatology, geriatric care, health screening & medical check-up, minor surgical procedures, vaccination/ immunisation and travel health.
Dr. Phua sees herself as a down-to-earth Generalist, and is happy to serve patients of all ages in the heartlands, treating a wide variety of cases from acute to chronic.
Address: 844 Tampines Street 82, #01-135, Singapore 520844
Contact number: +65 6223 3722
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