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Understanding Diabetes

Diabetes, also known as Diabetes mellitus, is a disease whereby a person has a high level of glucose in the blood. During digestion, our body transforms the food particles into simple sugar form known as glucose. The glucose is then absorbed into the blood for our body to be utilised as energy. Hormones known as insulin, produced by the pancreas, will then help glucose in the blood to enter the body cells where they will be converted into energy stored for future use.

The insulin released in a diabetic patient, however, is either insufficient or unable to absorb glucose from the patient's blood well. As such, the unabsorbed glucose are accumulated and stored in the blood.


  • Frequent urination
  • Increased thirst
  • Rapid weight loss
  • Constant Hunger
  • Fatigue
  • Blurred vision
  • Numbness in hands or feet
  • Itchy skin, especially in the genital areas
  • Slow healing of cuts and wounds

It is important to note that symptoms can sometimes appear mild. In some cases, patients with diabetes do not even experience the above symptoms until it has reached the final stage of diabetes. It is therefore crucial for those who are at risk of getting diabetes to have regular medical checks of their blood glucose level.


There are three types of diabetes: Type 1 diabetes (insulin-dependent), Type 2 diabetes (non-insulin-dependent) and gestational diabetes. Extra demands on the pancreas cause some women to develop diabetes during pregnancy, known as gestational diabetes.

People with Type 1 diabetes have high blood glucose levels because the pancreas is not able to produce sufficient insulin. Type 2 diabetes (non insulin-dependent) is the commonly-known type of diabetes. It is estimated that more than 90% of people with diabetes are diagnosed with Type 2 diabetes. Patients with Type 2 diabetes are able to produce some insulin. However, the insulin produced may not be effective in keeping the blood glucose at a healthy level.

The causes for Type 1 diabetes appear to be different from those for Type 2 diabetes, though the exact causes for both diseases are unknown. Type 1 diabetes is often triggered by exposure to the environment such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically pre-disposed people. Type 2 diabetes, on the other hand, is strongly influenced by genes and lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet.

Are you at risk?

Risk factors for Type 2 diabetes include old age, obesity, family history of diabetes, past history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

The risk factors are less well defined for Type 1 diabetes but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

Gestational diabetes occurs more frequently in certain ethnic groups, and in people with a family history of diabetes. Obesity also increases a woman's risk of getting diabetes. Women who have had gestational diabetes are at increased risk of developing Type 2 diabetes at a later stage in life.


The following tests are used for diagnosis:

  • A blood glucose test, which requires a patient to fast for at least 8 hours prior to the test, helps to measure your blood glucose. This test is used to detect diabetes or pre-diabetes.
  • An oral glucose tolerance test, which measures your blood glucose after fasting at least 8 hours without food and 2 hours after a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.
  • During a random blood glucose test, your doctor can check your blood glucose level without requiring the patient to fast beforehand. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. Positive test results can be confirmed by repeating the fasting blood glucose test or the oral glucose tolerance test on a different day.

Test results that are positive are repeated with the same testing process on a different day to confirm the diagnosis of the disease.

What happens when you have diabetes?

Untreated or uncontrolled diabetes can lead to serious complications. Diabetes can affect the blood vessels and the heart, causing heart disease and stroke due to poor blood circulation. A persistent high blood glucose level damages the small vessels in the body, particularly in the areas such as the eyes, kidneys and nerves.

Without proper control of the disease, diabetes can lead to blindness, kidney disease, numbness in the hands and feet and impotence. Diabetic patients may find that they often injure themselves easily without realising it. In addition, wounds or infections from these injuries will tend to take a long time to heal.

Good control of diabetes, however, helps to reduce the risk or delay the onset of these complications.


Maintaining a healthy diet combined with regular dose of exercise and insulin injections are the basic form of therapies for patients with Type 1 diabetes. The amount of insulin consumed by the patient, however, must be balanced with the food intake and daily activities. Blood glucose levels of the patient must also be closely monitored through frequent blood glucose testing.

Patients with Type 2 diabetes are required to follow a healthy diet, exercise regularly and undergo frequent blood glucose testing in order to keep their diabetes at bay. In addition, most patients with Type 2 diabetes will require oral medication, insulin or a combination of both to control their blood glucose level.

Diabetic patients will need to be responsible for their own condition. They will need to track their blood glucose level and monitor them at a healthy level. They can also seek help from healthcare providers who are able to assist them in managing their diabetes such as endocrinologists who are specialised in diabetic care, ophthalmologists for eye examinations, podiatrists for routine foot care and dietitians for a better management of diabetes.


A number of studies have shown that regular physical activities can significantly reduce the risk of developing Type 2 diabetes. Type 2 diabetes is usually associated with obesity. Therefore, maintaining a healthy weight and lifestyle is essential to significantly reduce the risks of developing Type 2 diabetes.


Find out more information from:

Health Promotion Board
Diabetic Society of Singapore
National Diabetes Education Program
NHS Choices
American Diabetes Association
Diabetes WA
Diabetic Life


1. What is pre-diabetes?

Pre-diabetes is the state that occurs when a person's blood glucose (sugar) levels are higher than normal but not high enough for a diagnosis of diabetes. Studies have shown that many people with pre-diabetes develop Type 2 diabetes in the following 10 years.

2. What is Type 1 and Type 2 diabetes?

A person with Type 1 diabetes has high blood glucose levels because the pancreas is not able to produce enough insulin. Type 1 diabetes usually begins at a young age often with dramatic symptoms. People with Type 1 diabetes must be given insulin injections daily. To control their blood glucose levels, they have to learn how to balance the foods they eat and the activities they do with the insulin they take.

Type 2 diabetes is the most common type of diabetes and about 90% of people are estimated to have this type of diabetes. A person with Type 2 diabetes is able to produce some insulin but this may not be effective in keeping the blood glucose level normal. Type 2 diabetes usually comes later in life, often after the age of 40. Many people may not realise they have diabetes as the symptoms begin gradually. Type 2 diabetes can be controlled by diet, exercise and oral medications. Insulin injections may be needed if these measures fail to provide good control.

3. What are the steps I should take to control my diet?

When you have diabetes, it is important to watch your portion size, especially for carbohydrates, as they have a greater impact on your blood glucose levels. Keep your portion size within the recommendations of your Dietitian. Good carbohydrate sources include whole-grains, legumes, fruit, vegetables and low fat milk. It is also important to limit intake of food which are high in salt, saturated and trans fat and cholesterol.

4. Can I still drink alcohol?

If your blood glucose level is under control (i.e your HbA1c is within target range), you may drink alcohol within the recommended amounts (i.e 1 standard drink for women and 2 standard drinks for men per day). Be careful if you are on insulin injection as taking alcohol can lower your blood glucose level even further and put you at risk of hypoglycaemia (low blood sugar).

5. How can I make my favourite recipes more healthy?

Studies show that it is the total amount of carbohydrates that affect the blood glucose levels. As most sugary food are 'empty calories' and contain high amounts of fat and calories, it is best to limit intake. Instead go for food which contain natural sugars like fruit, raisins or low fat milk.

Don't throw away your favourite recipes and cookbooks just because you have been diagnosed with diabetes. You can adjust your favourite recipes so that you eat healthier. Go for recipes which use healthy cooking methods like steaming, boiling, baking, grilling and stewing.

6. Why is physical activity important in people with diabetes?

Engaging in regular physical activity is an important part of managing diabetes. Physical activity helps to improve your blood glucose control and reduces your risk of cardiovascular diseases such as heart attack and stroke. Physical activity also keeps your heart healthy and helps control your weight.

Consult your doctor before starting any exercise programme. It is safe to exercise if your blood glucose level is within 5.5 to 13.8 mmol/l. Ensure that you are able to recognise symptoms of low blood glucose such as feeling shaky, nervous and confused. If this should happen, stop your activity and take something such as sweets, fruit juice or chocolate to raise your blood sugar level. When exercising, drink plenty of fluids and wear comfortable clothes and shoes that fit well. A combination of aerobic exercises (e.g. walking, cycling, jogging, or swimming) and strength training can lower your blood glucose level better than if you do either alone.

7. How does medication help my diabetes?

Your medication lowers your blood glucose level and reduces the risk of complications. It makes the pancreas release more insulin, helps the body to respond more effectively to insulin and slows down the absorption of glucose in the intestines.

This article is reproduced with the permission from Agency for Integrated Care (AIC) and Singapore Sliver Pages.

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