Diabetes

If you have diabetes, it will escalate your risk of developing cardiovascular disease. Diabetes is also associated with high blood pressure and high blood cholesterol.

9.1% of Singaporeans aged 18 to 74 years had diabetes, a increase from 5.5% in 2021-2022, and the highest prevalence was in the group of older adults between 70 to 74 years old at 22.0%, a decrease of 2.2% from 2021-2022, according to the National Population Health Survey 2024. There is no treatment that will eliminate diabetes completely, but with medication, weight management, healthy diet and physical activity, a healthier lifestyle can help you manage the disease.

What is Diabetes?

Diabetes is a long-term illness characterised by a high sugar (or glucose) level in the blood. Someone with diabetes is either producing too little insulin or is unable to respond well to the insulin produced.

Insulin is a hormone produced by the pancreas to regulate our blood sugar level within a normal and physiologic range. There are several different types of diabetes, some of which are more prevalent than others.

The two most common types of diabetes are:
Type 1 Diabetes
Insulin-dependent Diabetes Mellitus (IDDM) – a condition in which insulin production is absent. This type of diabetes usually starts during childhood and is also referred to as “juvenile diabetes”. It is managed through regular insulin injections throughout their life.

Type 2 Diabetes
Non-insulin-dependent Diabetes Mellitus (NIDDM) – a condition in which the body still produces insulin but in insufficient amounts. The patient is usually treated with oral medications, either with or without insulin injections, diet modifications and physical activity.
The most common form of diabetes in the general population, Type 2 diabetes often develops from pre-diabetes.

Pre-Diabetes
Pre-diabetes happens when your blood sugar level is higher than normal, but not high enough to be diagnosed as Type 2 diabetes. This condition is reversible through the adoption of a healthy diet and regular physical activity.

Reasons for Diabetes

You are at an increased risk of developing Type 2 diabetes if you:

• Are 40 years old and above
• Have a parent or sibling with diabetes
• Have a Body Mass Index (BMI) of 23.0kg/m² or higher
• Lead an inactive lifestyle
• Consume too much alcohol
  • Heavy use of alcohol can cause inflammation in the pancreas and limit its ability to produce sufficient insulin for the body
• Have high blood pressure
• Have abnormal blood cholesterol/lipid levels
• Have a history of gestational diabetes
• Have impaired glucose tolerance or impaired fasting glucose

Signs and Symptoms

People with Type 2 diabetes may have no symptoms at all. However, if there are any symptoms, they are often mild and go unnoticed. These symptoms would include:

• Having blurred vision
• Poor healing of cuts and wounds
• Feeling hungry all the time
• Itching skin especially around the genital area
• Feeling thirsty despite drinking lots of water
• Feeling tired
• Losing weight despite a good appetite
• Frequent passing of urine

Other symptoms might include vomiting, diarrhoea, constipation, erectile dysfunction and dizziness.

Complications

Diabetes can affect the body and it usually worsen without notice. Over time, having too much glucose in the blood can damage several organs. A person with diabetes is more likely to have heart disease than a person without diabetes, such as coronary heart disease, heart failure, diabetic cardiomyopathy and so on. Some other complications would include:

• Alzheimer’s disease and dementia
• Eye disease
• Skin and mouth infections
• Heart and blood vessel damage, e.g., atherosclerosis, stroke, peripheral artery disease and kidney disease
• Foot disease, such as numbness, ulcers and even gangrene
• Nerve damage, also known as diabetic neuropathy – numbness in fingers, hands, toe and feet or tingling, burning or shooting pains from the fingers or toes.
• Osteoporosis – commonly found in patients with Type 1 diabetes

When to see a doctor?

If your fasting blood sugar level is relatively high (7mmol/L or greater), please consult your doctor.

Diabetes screening is conducted through a non-fasting or fasting blood glucose test, and it is recommended for individuals aged 40 years old and above, with a family history of diabetes or a history of gestational diabetes to go for health screening every three years.

Your doctor may conduct one of the three blood glucose tests:
1. Non-fasting Blood Test (HbA1c)
HbA1c is a blood test that gives an indication of your average blood glucose/sugar levels over the past three months.

2. Fasting Blood Glucose (FBG) Test
This is a blood test usually done in the morning, as it requires a fast of at least 8 hours before the blood sample is taken.

3. Oral Glucose Tolerance Test (OGTT)
An OGTT consists of two blood tests; the first administered after an 8-hour fast, and the second 2 hours after consuming a sugary beverage.

Managing Diabetes

Lifestyle changes such as maintaining a healthy BMI, eating healthy and engaging in regular, moderate-intensity aerobics physical activity may reduce the progression of pre-diabetes and Type 2 diabetes and control Type 1 diabetes. They can also minimise other risk factors such as high blood pressure, high blood cholesterol, heart attack and stroke.

In many instances, medications must be accompanied to better control blood glucose levels.

Healthy Diet

For patients with pre-diabetes or diabetes, it is important to watch their diet, one way would be to limit the intake of refined sugars and foods that release sugar during digestion, including starches, breads and fruits. They can include the following ingredients for a better diet:

• Healthy carbohydrates like whole-grains, legumes (e.g., beans, peas and lentils), fruit and vegetables. During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Look for foods that is low with Glycaemic Index (GI) as higher in GI would suggest a higher blood glucose.
• Fibre-rich foods such as vegetables, fruit, legumes, whole-wheat flour and wheat bran. Dietary fibre includes all parts of plant foods that your body cannot digest or absorb.
• Heart healthy fishes at least twice a week. For example, cod, tuna and halibut have lesser total fat, saturated fat and cholesterol than most meat and poultry. Fish such as salmon, mackerel, tuna and sardines are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides. Avoid fried fish and fish with high levels of mercury, such as tilefish, swordfish and king mackerel.
• Good fats but in moderation like avocados, nuts (e.g., almonds, pecans and walnuts), healthier oils (e.g., canola and olive oil). Foods containing monounsaturated and polyunsaturated fats can help lower your cholesterol levels.

Active Lifestyle

Regular physical activity helps lower insulin resistance. This means your body can use its own insulin more effectively. For your overall cardiovascular health, aim for 150 – 300 minutes of moderate-intensity aerobic physical activity each week and incorporate muscle and bone strengthening activities (e.g., weight training, pilates, body weight calisthenics) at least 2 times per week. Join some class exercises if you enjoy working out with peers and like-minded friends.

Medication

Patients with type 2 diabetes will be given medication if lifestyle changes are not sufficient to lower their blood sugar. Some medications will include:

Summary

Diabetes is a chronic condition and can lead to many life-threatening conditions, including heart attack and stroke. It is never too late to start adopting heart-healthy habits to manage your blood sugar levels.

Join Cardiologists Assoc Prof Jack Tan, Dr Natalie Koh and Endocrinologist Dr Tham Kwang Wei in the webinar which unveils the link between three chronic conditions – obesity, heart disease and diabetes, and tips to manage and reduce risks.