Diabetes, is a long-term illness characterised by a high sugar (or glucose) level in the blood. The food we eat is converted to sugars which easily transported around the body to use to make energy in the cells. Our body produces a hormone called insulin, to closely adjust the level of sugar in the blood stream according to when it is needed. Diabetes is either due to the body producing too little insulin or is unable to respond well to the insulin produced. Over time, high sugar levels can give rise to problems like infections, blindness, kidney disorders, stroke and heart disease.
In Singapore, one out of 9 people aged 18 to 69 have diabetes. That’s about 11.3% of our population or more than 400,000 people!
Diabetes can affect people of any age or race. However, 90% of people with diabetes are over 40 years old.
Some risks of diabetes mellitus include:
More than 40 years of age
High risk race/ethnicity
Women who have delivered a baby (who weighed ≥ 4 kg) or were previously diagnosed with gestational diabetes
Hypertension (blood pressure ≥ 140/90 mmHg) or on therapy for hypertension
Women with polycystic ovarian syndrome
IGT or impaired fasting glycaemia (IFG) on previous testing
History of cardiovascular disease
Types of Diabetes Mellitus
There are two main types of diabetes:
Type 1 (Insulin-dependent diabetes)
This type can develop quite quickly, over days or weeks, as the pancreas stops making insulin. The body’s own immune system destroys the insulin producing cells in the pancreas. The patient needs insulin injections to control their blood sugars. It usually happens to young people. It can also occur in older adults, but less commonly.
Type 2 (Non-insulin dependent diabetes)
About 80% of all persons with diabetes belong to this group. This is more common in people who are overweight or obese. With type 2 diabetes, the illness and symptoms tend to develop gradually (over weeks or months). Sometimes there are no symptoms. This is because people with type 2 diabetes still make insulin (unlike type 1 diabetes). However, people with type 2 diabetes do not make enough insulin for the body's needs, or the body is not able to use insulin properly. Type 2 diabetes usually starts in middle-aged or elderly adults but is increasingly being seen in children and in young adults. Type 2 diabetes can be controlled by diet, exercise and medicines. If these fail, insulin injections may be needed.
Some women develop diabetes during pregnancy – gestational diabetes. A family history of diabetes is an important risk factor. Gestational diabetes usually disappears after the baby is born, but it may reappear during next pregnancies. In some women, gestational diabetes leads to diabetes mellitus in the future. The patient needs specialist care during the pregnancy to reduce any complications to the baby.
Symptoms of Diabetes
If you are experiencing one or more of the following symptoms associated with diabetes, consult your doctor. Increased urination
Fatigue or drowsiness
Poorly healing cuts or bruises
Increased hunger and thirst
Rapid weight loss
itchy skin especially around the genital area
Nausea and vomiting
Loss of feeling in hands or feet
At present, no cure is available for diabetes. But with regular self-monitoring of blood glucose and a proper combination of diet, exercise and medication, people with diabetes lead active, healthy lives. If not managed well, can deteriorate steadily to cause devastating complications such as blindness, nerve damage, kidney failure, heart disease and limb amputation. Studies show that about half of patients already have diabetes-related complications at the time of diagnosis.
Prevention (From Health Promotion Board, Singapore)
Maintaining a Healthy Weight
If you are overweight, aim to lose some weight. Studies have shown that losing five percent of your weight can very much improve your diabetes control.
A Body Mass Index (BMI) between 18.5 and 23 is considered healthy. You can calculate your BMI using the following formula:
BMI = Weight (kg) ÷ [Height (m) x Height (m)]
Eating a proper diet
Besides insulin and medicines, eating a healthy diet helps you keep your blood glucose under control. It also helps to maintain your weight at a healthy level.
Use the Healthy Diet Pyramid.
Adopt a well-balanced diet which includes a variety of food
Eat an appropriate and consistent amount of carbohydrate or starchy food at each meal to help achieve a constant blood sugar level.
Have regular meals at similar timing each day. This provides a regular and constant amount of sugar from the food you eat to reduce fluctuations in your blood sugar level.
This is also important for those on medications and/or insulin therapy to allow the action of the medication/insulin to match your food intake, hence preventing hypoglycaemia (low blood sugar).
Eat more fibre-rich food. Fibre helps to slow down the rate at which sugar is being released into the bloodstream, keeps you full and improves bowel function.
Include two servings each of fruit and vegetables daily.
1 serving of fruit = 1 small apple or 1 wedge papaya or 10 grapes (small)
1 serving of vegetables = 100g cooked vegetables (¾ mug) or 150g raw vegetable
Include wholegrain products in your diet such as wholegrain or whole-meal bread, oats, chapati, brown rice, whole-meal biscuits etc.
Eat less fat or oily food especially saturated fat and trans fat. Limit intake of saturated fat (butter, lard, ghee and fat/skin on meat) and trans fat (e.g. fried food, baked goods, shortening and partially hydrogenated vegetable oil) as they increase the risk of fat deposit in the blood vessels (atherosclerosis) which may lead to higher risk of heart disease and stroke. Choose healthier fat sources such as polyunsaturated or monounsaturated fat e.g. sunflower oil, canola oil, sesame oil, peanut oil, olive oil.
Reduce intake of salt:
High salt intake is associated with high blood pressure, which may lead to an increased risk of developing kidney disease, stroke and heart disease.
Add less salt and sauces during cooking. Limit intake of processed food e.g. fishball, ham, hotdog, salted vegetables, pickles, and canned food. Cut down on gravies added to rice or noodles. Spice up your meals with natural herbs and spices such as ginger, garlic, onion, chilli, pepper, lemon, vinegar.
Engage in regular physical activity
Regular physical activity is an important part of your diabetes control. It helps to prevent the onset of complications. Exercise also helps to control your weight and keeps your heart healthy.
1. Consult your family doctor before starting any exercise programme.
2. Set realistic goals: Take small steps at first. Pick an activity you are sure you will be able to do. You can increase the frequency and intensity later when you feel comfortable doing more.
3. Develop your exercise plan:
Use the F.I.T.T. formula
F = Frequency: how often will you exercise?
I = Intensity: how hard will you exercise?
T = Time: how long will you exercise?
T = Type: which types of exercise will you choose?
4. Start acting on your plan!
How Do I Get Started? How Often Should I Exercise? How Long Should I Exercise?
Exercise regularly, no matter what exercise you choose to do. Aim to do 150 minutes of moderate intensity exercises per week. Each exercise should last at least 10 minutes. If you have not been active, start slowly and build up.
Aim to work at a moderate level of intensity. Working out at this level makes you feel warm and breathe more heavily, yet still able to talk comfortably but not sing. You can start increasing the intensity of your exercise once you feel comfortable doing more.
You can start with 10 minutes a day. It can be as easy as walking five minutes from your block, then turning around and walking back. After a week, add another 10 minutes of exercise. Build up to 30 minutes. You may also exercise 10 minutes three times a day to make up the 30 minutes.
What Type of Exercises Can I Do?
The best form of exercise is something you enjoy doing, and preferably using large muscle groups in your body constantly, over a period of time.
The three main types of exercises are:
Aerobic exercises: also called cardiovascular or endurance exercises. These include walking, jogging, swimming, dancing and ball games.
Flexibility exercises: including stretching, which help to loosen muscles and joints. Do these exercises slowly, holding each stretch for a few seconds.
Strengthening exercises: these make your muscles stronger by working them harder. Strengthening exercises are usually done against resistance, such as lifting weights. Do not hold your breath while doing strengthening exercises.
Do not smoke
Smoking worsens the narrowing of blood vessels already caused by diabetes. It reduces blood flow to many organs and leads to many serious complications.
Limit your alcohol intake
Alcohol interferes with your meal plan and blood glucose control, especially if you are taking insulin or medicines for your diabetes.
A diabetic person has to take extra care of his/ her body to maintain good health.
As a diabetic, you have a higher risk of foot problems. In serious cases, it can lead to amputations. Taking care of your feet is very important:
Wash your feet daily with soap and water.
After washing, dry them fully, especially in between the toes.
Keep your toe nails short, trimming them straight across to avoid ingrown toenails.
Moisturise your feet daily to prevent dryness and cracking of the skin.
Examine your feet daily for scratches, cuts, blisters and corns. Use a mirror to check the sole of your feet.
Use shoes that fit well and wear clean cotton socks which have loose fitting elastic tops.
See your family doctor for screening of your feet every year.
If you have any corns or any wounds that are not healing well, seek help from your doctor as soon as possible.
Diabetes can cause severe eye problems where the small blood vessels in the eyes become damaged (diabetic retinopathy) and can lead to blindness.
It is important to have regular eye check-ups at least once a year. You can get your retinae (inside surfaces of your eyes) photographed by a procedure called retinal photography to detect any damage to small blood vessels. The doctor might also perform laser photocoagulapathy, a form of high-powered light and heat energy, to prevent further damage.
Avoid skin injury as diabetes makes the skin more prone to many problems such as rashes, infections and colour changes.
Wash every part of the body while bathing using mild soap and warm water.
Dry all parts of the body using a clean towel.
Pay attention when washing and drying skin folds in areas such as under the breasts, abdominal folds and groin area.
Apply moisturising cream to keep skin moist and soft.
Treat all cuts and scratches at once, wash with soap and water and then apply mild antiseptic lotion.
See a doctor if the skin injury does not heal in two to three days.
Dental care is important as many infections start in the mouth.
Brush your teeth twice a day – after breakfast and before bedtime.
Use a soft toothbrush to prevent gum injury.
Rinse your mouth after every meal or snack.
Floss your teeth gently after meals to remove food particles between your teeth.
Dental check-ups: Inform your dentist that you have diabetes and visit him at least once a year.
At-risk individuals, such as those with a family history of diabetes or who are overweight (body mass index ≥ 23 kg/m2), should go for screening before 40 years old.
Regular screening should be carried out every 3 years for people whose screening results have been found to be normal.
Regular health screening for diabetes is recommended once every three years for people who are 40 years or older.
Try the Diabetes Risk Assessment tool by Health Promotion Board. Make an appointment with the doctor to asses your risk and arrange a check.