What is diabetes
Diabetes is a condition where blood glucose or blood sugar is higher than usual. In Singapore, one in three people is at risk of developing diabetes. By 2050, if nothing is done, it is estimated that about one million Singaporeans will be living with diabetes.1
Type 1 Diabetes
In individuals with Type 1 Diabetes, the pancreas produces little or no insulin. As there is no insulin to allow the glucose to enter the cells, it builds up in the bloodstream. Type 1 diabetes tends to show up early in life and has a genetic link.
Type 2 Diabetes
In Type 2 Diabetes, one develops insulin resistance and at some point, the pancreas is no longer able to produce enough insulin to overcome the resistance. Type 2 Diabetes is also linked to genetics but there are also lifestyle risk factors involved, such as obesity, and tends to develop as life progresses.
First signs of having diabetes
The first warning signs of diabetes include feeling more thirsty than usual, extreme fatigue, having blurry visions and having slow-healing sores. These symptoms are typical for both Type 1 and Type 2 diabetes. The onset of symptoms may be sudden for people with Type 1 diabetes, while people with Type 2 diabetes may experience these symptoms gradually. Unfortunately, by the time symptoms develop, diabetes is usually already severe and may have started to cause damage to some organs. For many, early diabetes may not present with any symptoms and can only be detected through a blood test.
Jump to the following sections:
How to test for diabetes
Blood Glucose Test
Once every three years, one should go for diabetes screening. It is conducted through a non-fasting or fasting blood glucose test. If diagnosed, whether it’s type 1 or 2 diabetes, diabetics would have to manage diabetes well to prevent additional symptoms and complications. Kidney failure, blindness, amputations, and even stroke and heart disease are some of these complications. Taking medications prescribed by a doctor and measuring one’s blood sugar are some ways to manage diabetes. Other than that, diabetics can also reach out to professionals for regular checks and screenings, and on a daily basis, they can simply eat right and exercise!
Diabetic Foot Screening
A common complication of diabetes in Singapore is the narrowing of blood vessels in the lower limbs and impaired sensation in the lower limbs. Together, these can often lead to disease of the lower limbs that can result in amputation. As the risk of amputations in diabetics is 20 times higher than in non-diabetics, it is recommended that diabetics receive an annual foot screening by their healthcare provider2 in order to detect such complications early.
Diabetic foot screening generally involves a series of assessments where the healthcare worker would ask questions about one’s health and check one’s shoes for proper fit. The healthcare worker would also look out for abnormalities in the foot structure and skin. He/She would also check on the foot’s sensitivity to touch using specialised instruments and assess how well blood is flowing in one’s foot by assessing pulses in the foot.
There are minimal risks to diabetic foot screening, so to minimise complications from diabetes, Dr Darren Chen from NTUC Health Family Medicine Clinic recommends diabetics get their feet screened at least once a year. More screenings or further evaluation may be needed if the following symptoms are present3:
Tingling
Numbness
Pain
Burning sensation
Swelling
Difficulty walking and pain
Diabetic Retinal Photography
Other than diabetic foot screening, diabetic retinal photography is another screening test that diabetics should go for annually. Regular eye tests will allow for diabetic retinopathy to be detected early. In the early stages of diabetic retinopathy, one may not yet experience vision problems. As diabetic retinopathy progresses to a more advanced stage, one might notice:
Floaters
Blurred vision
Double vision
Eye pain or redness
Difficulty seeing in the dark
Damage caused by diabetic retinopathy is likely to be permanent and irreversible. Screening will help detect early retinal changes so that referrals can be made to eye specialists for interventions in order to reduce the risk of deterioration and blindness.
How to manage diabetes: 2 essential ways with a healthy lifestyle
Eat right
A diabetic's daily food intake is important in managing diabetes. Diabetics should choose nutrient-rich foods with minimal added sugar and moderate amounts of oil.
Consuming too much foods, especially sugary and oily ones can cause a rise in blood sugar due to the high caloric content of sugar and oils. Excess calories (whether from fat, carbohydrates, protein or alcohol) contribute to fat gain. Excess fat makes it harder to control blood sugar as it secretes hormones which increase insulin resistance. Constant high blood sugar levels can cause nerve, kidney and heart damage.
Sugar and oils still have their place in a diabetic's diet. Canola, olive and corn oil contain healthy fats which will provide the body with a source of fatty acids. Fatty acids are not produced by our bodies and can only be obtained by consuming the right foods.
A diabetic's diet involves eating three meals a day at regular times. In each of these meals, people with diabetes should focus on a balanced diet based on the portions in the healthy plate model. This can be achieved whether eating at home or eating out, as various stalls offer vegetable and protein options.
The Plate Method can be used when they plan their meals, as recommended by the American Diabetes Association4.
The Plate Method:
Half of the plate could be filled with non-starchy vegetables such as cabbage, mushrooms, asparagus
A quarter of the plate would include lean protein such as chicken, salmon and eggs
Another quarter would be for carbohydrates such as whole grain bread, brown rice, quinoa
For an accompanying beverage, water would be the best choice as it has no caloric content and has no effect on blood sugar. Unsweetened coffee or tea could also be considered.
Understandably, some people may have the habit to snack between meals. On this, Anna Lim, PULSE TCM’s Lead Clinical Dietitian has a tip for diabetics, “People with diabetes should be aware of what they are eating in between meals. Even foods which do not taste sweet can contain starch, which is ultimately digested into sugar. This includes anything made with grains (such as curry puffs, chee cheong fun, biscuits, kueh/cake), potatoes, sweet potatoes or corn. Such food items can contribute significantly to blood sugar spikes, though most people don't consider them as significant because they are not eaten as a meal.”
Exercise to manage diabetes
According to Harvard Medical School, exercise lowers blood glucose levels and boosts one’s body's sensitivity to insulin, countering insulin resistance5. Elders should consider incorporating 30 minutes of exercise 5 times a week into their schedule. For our elders aged 65 and above, the Singapore Physical Activity Guidelines (SPAG) has 5 tips to provide:
Incorporate simple strength training exercises such as resistance band exercises when watching your favourite shows. According to a Canadian study in 20186, apart from increasing your strength, exercising with resistance bands may provide benefits to blood sugar control.
Walk or play sports with your family and friends; this is a great way to be active while spending quality time with your loved ones.
Make use of the outdoor fitness equipment around your community spaces or your built environment as you brisk walk around your environment.
Engage in varied multi-component physical activity at home or in a structured group setting, which can combine aerobic, muscle-strengthening, and balance training into a session.
Play and try different sports with friends at publicly available sports facilities
Summary
Once one is diagnosed with diabetes, one should get appropriate support and treatment and live healthily. NTUC Health Family Medicine Clinic offers health screening for early detection and treatment of diabetes as well as diabetic foot screening and diabetic retinal photography. With professional support, physical activity and a good diet, diabetics would be on their way to managing diabetes well and preventing complications.
Sources
Ong, Y. K. (2021). Speech by Mr Ong Ye Kung, Minister for Health, at World Diabetes Day 2021. https://www.moh.gov.sg/news-highlights/details/speech-by-mr-ong-ye-kung-minister-for-health-at-world-diabetes-day-2021
Ang, G. Y., Yap, C. W., & Saxena, N. (2017). Effectiveness of Diabetes Foot Screening in Primary Care in Preventing Lower Extremity Amputations. https://annals.edu.sg/pdf/46VolNo11Nov2017/MemberOnly/V46N11p417.pdf
Medline Plus. (2021). Diabetic Foot Exam. https://medlineplus.gov/lab-tests/diabetic-foot-exam/
Mayoclinic. (2021). Diabetes diet: Create your healthy-eating plan. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
Harvard Health Publishing. (2021). The importance of exercise when you have diabetes. https://www.health.harvard.edu/staying-healthy/the-importance-of-exercise-when-you-have-diabetes
Sigal, R. J. et al. (2018). Resistance bands training improved strength and glycemic control: The DARE-Bands Trial. https://www.canadianjournalofdiabetes.com/article/S1499-2671(18)30504-5/fulltext
Diabetes Care Community. (2020). 10 fruits and vegetables for diabetes diet. https://www.diabetescarecommunity.ca/diet-and-fitness-articles/diabetes-diet-articles/10-fruits-and-vegetable-for-diabetes-diet/
