Diabetes mellitus is a chronic condition where the body struggles to control blood sugar (glucose) levels. Glucose, the main source of energy for our bodies, needs the hormone insulin to move from the bloodstream into the cells. In diabetes, either the body does not produce enough insulin or cannot use it effectively, leading to high blood sugar levels. 

Over time, uncontrolled diabetes can cause serious complications affecting the heart, kidneys, eyes, and nerves. There are three main types of diabetes, explained below. But regardless of the type, early diagnosis and proper management are key to preventing complications and maintaining a good quality of life.

Diabetes is a relatively common disease in Singapore, with 1 in 9 people aged 18 or older having it in 2017.

It's important to note that many people with diabetes, especially type 2, may not experience noticeable symptoms in the early stages. Regular health screenings are crucial for early detection. However, if symptoms do appear, they can include the following. If you experience any of these symptoms, it's essential to consult a doctor for proper diagnosis and treatment. Early detection and management of diabetes can help prevent serious complications.

When diabetes is not well-managed, high blood sugar levels over time can damage various parts of the body. It's important to work closely with your healthcare team to manage your diabetes and reduce the risk of these complications. Some potential complications include:

Screening for diabetes should be considered in all adults who have one or more risk factors for diabetes as shown below. In those without risk factors, testing should begin at 40 years old. It is recommended to approach your family physician to screen for diabetes if these categories apply to you.

Risk factors for diabetes include:

• • Overweight / obesity (body mass index > 25.0 kg/m2)

  • First degree relative with diabetes mellitus

  • High risk race / ethnicity

  • Women who have delivered a baby 4 kg or more; or previously diagnosed with gestational diabetes mellitus

  • Hypertension or on therapy for hypertension

  • High blood cholesterol

  • Women with polycystic ovarian syndrome

  • History of cardiovascular disease

Screening will be done with one or more blood tests, and you may need to come fasted for the blood tests, depending on your doctor's instructions.

Why Monitor at Home?

If you have been diagnosed with diabetes, it would be good to monitor your own blood sugar levels at home, and not just during clinic visits. This can provide you with valuable real-time information about how your body is responding to food, physical activity, stress, and medications. Since what works well for one person with diabetes may not work the same way for another, this knowledge empowers you to make informed, personalised decisions about your daily care and work in partnership with your healthcare team to achieve optimal blood glucose control. 

Additionally, home monitoring can help you detect if your blood sugar level is dangerously high or low at any time. Both of these situations could lead to medical emergencies if left untreated (See section on 'Emergencies'). By detecting them early, you could take appropriate action, such as adjusting your diet, increasing fluid intake, or taking extra medication as advised by your doctor, and avoid these dangerous situations.

Furthermore, seeing the direct impact of your lifestyle choices on your blood glucose levels can be a powerful motivator to stick to your diabetes management plan, as positive results can reinforce healthy habits. The records of your home blood glucose monitoring also provide valuable information for your doctor during your appointments, allowing for more informed discussions and adjustments to your treatment plan. 

What Methods are Available?

What Are My Home Targets?

What Do I Need to Take Note of?

• It is essential to receive proper training from a healthcare professional (doctor, nurse, or diabetes educator) on how to use your chosen monitoring device correctly, perform the tests accurately, and interpret the results.

• Ensure that your glucometer and test strips are within their expiry dates and stored correctly to maintain accuracy. Regularly calibrate your continuous glucose monitoring system as instructed.

• Home blood glucose monitoring is a valuable tool but should not replace regular check-ups and guidance from your healthcare team!

Living well with diabetes involves actively managing your blood sugar levels and adopting healthy habits. It is not only about taking medications, and in fact, diabetes can be managed effectively with good lifestyle changes alone! Managing diabetes is a lifelong journey that requires commitment and consistency. You are not alone on this journey, do work closely with your doctor to develop a personalized management plan that fits your lifestyle and needs. 

The goal of diabetes management is to keep your blood glucose within a target range to prevent or delay long-term complications and maintain a good quality of life. 

Here are the key aspects of diabetes management:

• Portion Control: Be mindful of your portion sizes to help manage your blood glucose and weight. Limit intake of oily or fried foods to a maximum of 2 times per week.

• Limit Sugary Foods and Drinks: Reduce your intake of sugary drinks (sodas, fruit juices), sweets, desserts, and processed foods high in added sugars. 

• Choose Complex Carbohydrates: Opt for complex carbohydrates like brown rice, wholemeal bread, and oats, which are digested more slowly and help maintain stable blood glucose levels.

• Eat Regularly: Try to eat meals and snacks at regular times to help regulate blood glucose.

• Consult a Dietitian: A registered dietitian can provide personalized meal plans and guidance tailored to your needs and preferences. In Singapore, you can find dietitians in hospitals, polyclinics, and private practice.

• Aim for Variety: Engage in a mix of aerobic exercises (like brisk walking, swimming, cycling) and strength training exercises.

• Frequency and Duration: Aim for at least 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic activity per week, spread over at least 3 days. Include strength training at least two days a week.

• Start Slowly and Gradually Increase: If you are new to exercise, start with shorter durations and lower intensity, gradually increasing as you get fitter.

• Find Activities You Enjoy: Choose activities you find enjoyable to make it easier to stick to a regular routine.

• Check with Your Doctor: Before starting a new exercise program, especially if you have any health concerns, check with your doctor if it is suitable for you.

If lifestyle changes alone are not enough to control your blood sugar, your doctor can prescribe some medication to lower your sugar levels. It's crucial to take your medications exactly as prescribed by your doctor and to understand how they work and any potential side effects. Don't stop or change your medication without consulting your doctor. These are some types of medication available:

• Oral Medications: Many people with type 2 diabetes take oral medications to help lower their blood glucose levels. There are different types of medications that work in various ways.

• Insulin Injections: Some people with type 2 diabetes and all people with type 1 diabetes require insulin injections to manage their blood glucose. Insulin can be administered using syringes, insulin pens, or insulin pumps.

• Other Injectable Medications: Newer injectable medications, such as GLP-1 receptor agonists, are also available for some individuals with type 2 diabetes.

• Doctor's Appointments: Attend all scheduled appointments with your doctor for monitoring your diabetes management, adjusting medications if needed, and discussing any concerns. Your doctor may order blood tests if necessary to assess your blood sugar control, kidney health, and cholesterol levels regularly. You should still go for your appointments even if you do not experience any symptoms.

• Eye Examinations: Have regular eye checks (usually annually) to screen for diabetic retinopathy.

• Foot Examinations: Have your feet examined regularly by your doctor or a podiatrist to check for any signs of nerve damage or poor circulation.

If you have diabetes, you are more vulnerable to certain infections, and vaccinations are crucial for preventing serious illness. Here are the recommended vaccinations to take:

• Influenza (Flu) Vaccine: Annual flu shots are highly recommended for everyone with diabetes aged 6 months and older.

• Pneumococcal Vaccine: This protects against pneumococcal bacteria, which can cause pneumonia, meningitis, and bloodstream infections. There are two types: PCV13 and PPSV23. Your doctor will advise on the appropriate schedule. People aged 65 and above require two doses, one year apart.

• COVID-19: Recommended for everyone to get a booster shot every year.

• Hepatitis B Vaccine: Recommended for all patients under 60 years old with diabetes. It may be considered for adults over 60 after discussion with a doctor. 3 doses are required.

• Tdap Vaccine: Protects against tetanus, diphtheria, and pertussis (whooping cough). A booster is recommended every 10 years.

• Other Vaccinations: Depending on your individual risk factors, your doctor may recommend other vaccines, such as the MMR vaccine (for measles, mumps, and rubella), chickenpox vaccine, and HPV vaccine.

If your blood sugar goes too high or low, there could be a rapid deterioration of your health status. It is important to recognise the symptoms of these situations and take action quickly to prevent an escalation.

High Blood Sugar (Hyperglycemia)

If your blood sugar level increases too much, you may reach a state of diabetic ketoacidosis, where the blood becomes too acidic. Other than the usual symptoms of diabetes mentioned in the 'Symptoms' section, you may experience these more serious symptoms:

• Breathlessness 

• Fruity-smelling breath 

• Nausea, vomiting   

• Abdominal pain 

• Drowsiness / Confusion

• Loss of consciousness

If you or someone you know has these severe symptoms, check the blood sugar level using a glucometer or continuous glucose monitoring system. Here is what to do if your blood sugar is confirmed to be too high, or you do not have a glucose monitoring device:

Low Blood Sugar (Hypoglycemia)

Some medications such as insulin or other glucose-lowering medications may cause your blood sugar levels to drop too low, especially if you have skipped a meal. Early symptoms include:

• Intense hunger

• Tremors

• Sweating

• Fast heartbeat

• Lightheadedness

• Headache

• Restlessness

If left untreated, more severe symptoms may develop:

• Blurred vision

• Slurred speech

• Seizures

• Drowsiness / Confusion

• Loss of consciousness

If someone around you becomes drowsy, confused or unconscious, do the following: 

If you or someone you know is experiencing the other less life-threatening symptoms of hypoglycemia:

1. Check the blood sugar level using a glucometer or continuous glucose monitoring system. A value of less than 4 mmol/L confirms hypoglycemia. 

2. Give them 15 grams of sugary food or drinks (examples: 1 tablespoon of sugar, 1 can of soft drink, 6-7 sweets). This is why it is important for people with diabetes on medication to always carry sweets with them. 

3. Recheck blood sugar level. If still low, give another round of sugary food/drinks. If the sugar levels remain low after giving two rounds of sugary food/drinks, seek medical attention.