Learn more about diabetes and ways to fight this chronic condition.

[TAB-WRAPPER] [TAB TITLE="Be Aware" COLOR="#e94f00"]

What is Diabetes?

There are different types of diabetes:

Type 2 Diabetes

Type 2 diabetes is usually found in people aged 40 and above who are overweight and physically inactive. In some people, the condition is mild and they are able to control their blood glucose with just diet and exercise. However, if the condition gets worse, they may require oral medication or insulin injections in addition to making lifestyle changes. For those who are overweight or obese, losing weight can be significantly beneficial, even if it is a small amount.

Type 1 Diabetes

Usually diagnosed in children or young adults although it can occur at any age, type 1 diabetes results when the pancreas no longer produces insulin. Hence, persons with type 1 diabetes need insulin injections daily.

Gestational Diabetes

Due to the hormonal changes in pregnancy, some women may show high blood glucose levels during pregnancy. These women require specialised obstetric care to prevent complications to the unborn child. In gestational diabetes, the blood glucose levels often return to normal after delivery. However, these women may be at an increased risk of developing type 2 diabetes later in life.

Pre-Diabetes

Pre-diabetes is when your blood sugar level is higher than normal but not high enough yet to be diagnosed as Type 2 diabetes. Studies show that if pre-diabetic persons lose weight and maintain a healthy Body Mass Index (BMI), adopt a healthy diet and engage in regular physical activity, they can reduce their risk of developing type 2 diabetes

[ACCORDION-WRAPPER] [ACCORDION Header="Risk Factors"]

Diabetes can affect anyone. Knowing your risk of diabetes will help identify the changes you need to make to your lifestyle.

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

[/ACCORDION] [ACCORDION Header="Prevention"]

Leading a healthy lifestyle improves overall health and reduces the risk of developing diabetes. Age and family history increase one's risk of diabetes. So do being overweight or obese, having an unhealthy diet, and not having enough exercise. Uncontrolled diabetes can lead to serious complications. However, the risk of diabetes can be reduced by leading an active and healthier lifestyle.

For people living with diabetes, a healthy lifestyle can complement other treatment options such as insulin and oral medication to better manage the condition. Take small but significant steps to adopt a healthier lifestyle today to see the positive impact they can have on your health later. As you get used to these small changes, they become a part of your daily routine and taking control of diabetes can only get easier.

[/ACCORDION] [ACCORDION Header="Screening"]

Diabetes is a ‘silent’ disease in its early stages, and you can feel perfectly well until complications occur. However, a late diagnosis can result in serious and irreversible complications that could have been otherwise prevented through screening. It is therefore important to get yourself screened even if you feel perfectly healthy and experience no symptoms, for regular health screening is the best way to detect diabetes early and obtain timely treatment.

GOING FOR SCREENING

Screening for chronic diseases, including diabetes, is recommended under HPB's Screen for Life programme for those 40 years old and above. It is conducted through a fasting blood glucose test, done once every three years.
Under HPB's Screen for Life programme offered by most CHAS GP clinics, chronic disease screening (including the doctor consult charges) is available at the following subsidised rates :

Pioneer Generation

If you are a Pioneer Generation cardholder, the screening test and the first post screening consultation (if assessed that a consultation is required) will be $0.

Health Assist (CHAS) Card Holders

If you are a CHAS cardholder (blue or orange card), you will only need to pay $2 for the screening test and the first post screening consultation (if assessed that a consultation is required). Applicable for both males and females aged 40 and above.

Other Eligible Singaporeans

You will only need to pay $5 for the screening test and the first post screening consultation (if assessed that a consultation is required). Applicable for both males and females aged 40 and above.

Permanent Residents

You will only need to pay $10 (excluding GST) for the screening test. The prevailing doctor consultation rates will be charged accordingly by the respective CHAS GP clinics.

*These rates are only applicable at CHAS GP clinics for the screening tests that are covered under the enhanced Screen for Life subsidies.

CLINICS

Health screening is available at many private medical clinics and polyclinics. Visit our directory for the list of screening locations, or click here to locate your nearest CHAS GP clinic offering SFL screening services.

Learn more about the screening tests and subsidies you are eligible for at screenforlife.sg.

[/ACCORDION] [ACCORDION Header="Test and Diagnosis"]

You can test for diabetes by going for a blood glucose test. There are two types of blood glucose tests:

Fasting blood glucose test

Oral glucose test

[/ACCORDION] [ACCORDION Header="Financial Assistance"]

Health Screening is heavily subsidised for Singaporeans and Permanent Residents. Under HPB's Screen for Life programme offered by most CHAS GP clinics, chronic disease screening (including the doctor consult charges) is available at the following subsidised rates :

Pioneer Generation

If you are a Pioneer Generation cardholder, the screening test and the first post screening consultation (if assessed that a consultation is required) will be $0.

Health Assist (CHAS) Card Holders

If you are a CHAS cardholder (blue or orange card), you will only need to pay $2 for the screening test and the first post screening consultation (if assessed that a consultation is required). Applicable for both males and females aged 40 and above.

Other Eligible Singaporeans

You will only need to pay $5 for the screening test and the first post screening consultation (if assessed that a consultation is required). Applicable for both males and females aged 40 and above.

Permanent Residents

You will only need to pay $10 (excluding GST) for the screening test. The prevailing doctor consultation rates will be charged accordingly by the respective CHAS GP clinics.

*These rates are only applicable at CHAS GP clinics for the screening tests that are covered under the enhanced Screen for Life subsidies. Learn more about the screening tests and subsidies you are eligible for at screenforlife.sg.

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Medisave, MediShield Life, ElderShield and Medifund schemes can help Singaporeans offset their medical expenses. Additionally, under the Chronic Disease Management Programme (CDMP), persons with diabetes can also use Medisave to help defray part of outpatient treatment fees and reduce out-of-pocket costs.

[/ACCORDION] [ACCORDION Header="Myths and Facts"]

There are many myths about diabetes which people think to be true. This can be harmful as it leads to an incorrect understanding of diabetes. Get the facts below, and learn more about this chronic disease.

MYTH

Diabetes is caused solely by eating too much sweet food.

FACT

Diabetes occurs when the body fails to produce enough insulin – the hormone responsible for reducing blood glucose levels. Although eating sweet food does not directly cause diabetes, a diet high in sugar and fat can lead to obesity, which causes the body to be less sensitive to insulin, thus increasing the risk of developing type 2 diabetes.

MYTH

Diabetes can be cured.

FACT

Diabetes is a chronic medical condition that has no cure. However, the condition can be controlled with lifestyle changes and, in some instances, medication.

MYTH

?

FACT

Persons with type 1 diabetes are not able to produce insulin due to an immune disorder affecting the pancreas. That is why they require regular insulin injections to control their blood glucose levels. On the other hand, persons with type 2 diabetes are able to produce insulin, but it may not be enough or may not work properly. Such persons may be prescribed oral medication or insulin injections, or a combination of both by their doctor.

MYTH

People with diabetes will eventually have their feet amputated.

FACT

Amputation refers to the removal of a limb or parts of a limb (e.g. foot) as a result of gangrene or death of body tissues from poor blood flow. It happens in people with long standing diabetes that is poorly controlled. People who take care of themselves by going for regular check-ups, taking medication, and living healthy lifestyles can avoid such complications.

MYTH

People with diabetes should avoid carbohydrates at all costs.

FACT

Carbohydrates are an important part of a healthy, balanced diet. As carbohydrates are found in many foods, including fruits and vegetables, it is not practical to avoid carbohydrates totally. A better option would be to replace the intake of refined, starchy carbohydrates (e.g. white rice) with whole-grains (e.g. brown rice) instead.

MYTH

People with diabetes can safely consume snacks that have “no added sugar”.

FACT

Snacks and candies labelled “no added sugar” or “for diabetics” can be alternative snacks since the former may contain relatively lower sugar content. However, this also means that the sugar in these snacks could have been replaced with artificial sweeteners. Hence, it would be good practice to look at the product contents before purchase, and to consume them in moderation, as snacks labelled “no added sugar” are usually low in nutrient quality.

MYTH

People with diabetes feel unwell.

FACT

Not everyone with diabetes feels unwell. In fact, many people with diabetes do not have any symptoms, particularly during the early stages of the condition. They can have diabetes for months, even years, without knowing it. This is why it is important to go for regular health check-ups, so that you can detect the condition early.

[/ACCORDION] [ACCORDION Header="Signs and Symptoms"]

People with type 2 diabetes can feel well and not experience any symptoms at all. However, there may also be symptoms that develop gradually and are sometimes so mild they go unnoticed.

Here are some symptoms that diabetes can cause:

[/ACCORDION] [ACCORDION Header="Complications"]

The high blood glucose (hyperglycemia) levels in uncontrolled diabetes can damage both nerves and blood vessels. As blood vessels supply blood to various organs, this can eventually lead to complications such as:

[/ACCORDION] [ACCORDION Header="Tips For Caregivers"]

Being diagnosed with diabetes can be overwhelming. As a caregiver, you want to help your loved ones enjoy the fullest and healthiest life possible.

RECOGNISE SIGNS AND SYMPTOMSs

Know what signs and symptoms to look out in a crisis so you can help the person seek immediate attention. Some crises to look out for are:

Diabetes occurs when the body fails to produce enough insulin – the hormone responsible for reducing blood glucose levels. Although eating sweet food does not directly cause diabetes, a diet high in sugar and fat can lead to obesity, which causes the body to be less sensitive to insulin, thus increasing the risk of developing type 2 diabetes.

Hypoglycemia (low blood glucose)

SIGNS AND SYMPTOMS

Shakiness, sweating, weakness, dizziness, irritability, hunger, headache, mood swings, staggering gait

WHAT TO DO:

• Check blood glucose level to confirm; give a glass of fruit juice or 3 to 4 teaspoons sugar in water. Keep some sweets like a bar of chocolate to take for when symptoms occur
• Repeat the above measures in 10 to 15 minutes if blood glucose level is still below 4.0 mmol/l
• Seek immediate medical attention if symptoms persist or if the patient loses consciousness

Diabetic ketoacidosis

SIGNS AND SYMPTOMS

Thirst, fatigue, frequent urination, drowsiness, blurred vision

WHAT TO DO:

• Check blood glucose
• Check urine for ketones if blood glucose is over 240 mg/dl (> 13 mmol/l)
• Continue to drink plenty of water
• Seek medical attention if symptoms persist

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) or diabetic coma is a life-threatening condition that develops when there is too little insulin in the body. This is more common in persons with type 1 diabetes. Without insulin, the body cannot use glucose (sugar) and breaks down fat and protein for energy instead. In the process, it produces a poisonous substance known as ketones. If left untreated, diabetic ketoacidosis can be fatal.

SIGNS AND SYMPTOMS

Abdominal pain, nausea, vomiting, extreme drowsiness, rapid breathing, flushed skin, sweet fruity odour to breath

WHAT TO DO:

• Check that blood glucose levels are above 15mmol/l
• Check urine for ketones. Urine dipstick tests for ketones are available for home use
• Seek immediate medical attention

CHECK THEIR BLOOD GLUCOSE LEVEL

Help the person monitor their blood glucose levels. This requires conducting a blood glucose test at home using a glucometer. Ask the doctor or nurse to help you buy a glucometer.

Tips on taking a blood sample by finger prick:

• Wash your hands thoroughly before doing the test
• Ensure the person's hand is clean. You can rinse the hands in lukewarm water, then dry them to improve circulation for a better sample
• Do gentle massage of the hands before pricking the finger to improve circulation
• When pricking the finger, use the side of the fingertip rather than the front top so it's less painful
• Apply gentle pressure on the finger pad with the sides pushed out to get a better sample

Your doctor will advise how often the blood test is required.

MANAGE THEIR DIET

Get help from a dietician on how to plan meals and adjust the diet. Make positive affirmations each time the person makes a healthy food choice and encourage them to maintain a healthy and well-balanced diet. Here are some tips:

• Use My Healthy Plate as a guide for planning meals
• Choose a variety of foods from the four food groups
• Keep meals regular
• Be mindful of portion sizes when serving food

ENCOURAGE THEM TO BE PHYSICALLY ACTIVE

Encourage the person to move around more and sit less. Let them know that they do not have to exercise long and hard to reap health benefits. Short bouts of activity break up prolonged seating and improves fat metabolism.

During physical activity, be on the lookout for signs and symptoms of hypoglycemia (low blood glucose). Have some sweets or fruits (e.g. apple) on standby, in case they feel dizzy or weak.

GIVE THEM THEIR MEDICATION

Most persons with diabetes may also have other medical condition(s) such as high blood pressure, high blood cholesterol level, and may be on medication for such problems. Know what medication(s) the person under your care is taking; understand how it works and its potential side effects. Inform the doctor immediately if the person experiences any reaction to the medication(s).

As a caregiver, ensure that medication is taken or given (in the case of insulin injections) on time and regularly as prescribed by the doctor. Some people with diabetes are afraid of insulin injections, which causes non-compliance in their treatment. Helping them overcome their fear is an important role you can take on.

CARE FOR THEIR FEET

Foot care is very important in persons with diabetes. The person with diabetes may develop foot problems arising from either nerve damage, also called neuropathy, or poor circulation. When sensory nerves of the foot are damaged, the ability to feel sensations, such as pain, is lost and one may be unaware of a wound or breakdown of skin that can lead to infection. Diabetic foot ulcers are serious because they do not heal well and cause gangrene that can lead to amputation.

It is important to keep the blood glucose level under control to minimise the risk of foot problems. As a caregiver, ensure that you assist in the care of the feet every day:

• Wash and inspect feet daily and seek medical care if you spot a problem
• Look for changes in skin colour or feeling
• Gently rub skin lotion over the feet, but not in between the toes
• Trim toenails straight across and file the edges
• Protect feet from extreme temperatures
• Use proper and comfortable foot wear at all times

Additionally, visit the doctor at least once a year for foot examination, and more often if foot problems arise.

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Nutrition

Fill half of your plate with fruit and vegetables

Fill a quarter of your plate with whole-grains

Choose water

Limit alcohol intake

Use healthier oils

Learning about food groups

If you have diabetes, it is important that you understand how different foods affect your blood glucose levels. Foods are classified into four food groups and they are:

To keep your blood glucose levels within a steady healthy range, choose meals and snacks from each food group every day. The amount of food you consume is just as important as the type of food so learn to control your portion sizes.

[/TAB] [TAB TITLE="Adopt an Active Lifestyle" COLOR="#f48500"]

Physical Activity

Before you start planning an exercise routine, take some time to learn more about the variety of physical activities and the benefits they can provide for your body. You will then be able to combine physical activities and get the most out of your exercise routine.

Choose activities that you enjoy and love doing to fit your lifestyle.

Engage in physical activity

The good news is you can:

Besides aerobic activity, you should also engage in activities that strengthen your muscles two or more days a week. Start with lighter weights or fewer repetitions, and slowly increase the weight over time. A repetition refers to a complete movement of an activity, or the number of times you perform an exercise movement; e.g. 10 sit-ups = 10 repetitions, 15 squats = 15 repetitions. Choose activities that work on different large muscle groups.

TYPE	BENEFITS	EXAMPLE
Aerobic activity makes you breathe harder and your heart beat faster	Increases heart and lung fitness Controls weight	Brisk walking, dancing, cycling, jogging, swimming, and playing badminton
Muscle-strengthening activity works on the major muscle groups – the legs, back, chest, belly, shoulders, and arms	Increases bone strength and muscular fitness Controls weight Improves balance	Push-ups, pull-ups, sit-ups, and squats, working with resistance band and weight training

Exercise at the correct level of intensity

Intensity refers to how hard your body is working during aerobic activity.

INTENSITY	HOW DO YOU KNOW	EXAMPLES
Moderate-intensity aerobic activity	You are still able to talk but not sing or whistle, and are perspiring	Brisk walking (5 km/hr)
		Leisure cycling (<16 km/hr)
		Leisure swimming
		Playing badminton (doubles)
		Line dancing
Vigorous-intensity aerobic activity	You find yourself breathing hard and fast, and find it hard to hold a conversation with someone	Jogging or running
		Swimming continuous laps
		Playing badminton (singles)
		Cycling at a fast pace
		Playing football or basketball

FOR YOUR SAFETY: If you have a medical condition, are very overweight or obese and/or have not been exercising for a long time, see your doctor before you start an exercise programme.

[/TAB] [TAB TITLE="Take Control" COLOR="#007dc4"]

Self-Care

[ACCORDION-WRAPPER] [ACCORDION Header="Aim For a Healthy Weight"]

Being overweight puts you at risk of numerous health problems including diabetes. Here are some things you should know about why it's important to maintain a healthy weight and how to manage your weight effectively.

How To Achieve A Healthy Weight

In order to achieve a healthy weight, it is important to first understand the dangers of obesity. Obesity is a condition in which excess body fat accumulates and puts you at risk of a variety of health problems. This excess fat may reduce life expectancy and increase the risk of other health problems - so it is vital to maintain a healthy weight.

Know Your BMI

There are many ways to measure body fat. However, the simplest is by calculating your Body Mass Index (BMI). BMI measures the relationship between your weight and height to measure the amount of body fat you have. The higher your BMI, the higher the amount of fat in your body.

Keep an eye on your BMI

Calculate your BMI and keep your BMI in the healthy range (18.5 – 22.9 kg/m2) through an active lifestyle and healthy eating.

Calculate your BMI

Are you in the healthy range? Use this tool to calculate your Body Mass Index (BMI) now to know your health risk.

A BMI value of 23 and above indicates that your weight is outside of the healthy weight range for your height. Find out more on how to achieve and maintain a healthy BMI through a healthy and active lifestyle.

Losing Weight The Right Way

Weight management is all about energy balance. To maintain your weight, you must balance the amount of energy you get from food and drinks with the amount of energy your body uses for daily physical activity. Consuming more energy than you need will lead to weight gain, while burning more energy than you consume will lead to weight loss.

[/ACCORDION] [ACCORDION Header="Quit Smoking"]

Smokers are more likely to develop type 2 diabetes. People with diabetes who smoke experience more problems with their diabetes control than those who don’t. They are also more likely to end up with diabetes complications.

What’s more, smoking damages the blood vessels and reduces blood flow to many organs. So if you have diabetes and smoke, you are at a higher risk of serious complications, such as heart disease, amputation, and stroke.

If you do not smoke, continue to stay smoke-free and enjoy the health benefits it brings.

If you smoke, make the decision to quit smoking today. The good news is that there is a range of support strategies to help you quit smoking. It is a matter of finding the right one for you.

Choose a quit method that suits you best

You can choose to:

Whichever method you choose, remember there’s no magic formula to quitting. For professional help, call QuitLine at 1800 438 2000.

You will be encouraged to know that many people make several attempts to quit smoking before they manage to successfully break free from the habit. So if you fail to quit on the first attempt or experience any relapses long the way, do not give up and try again.

[/ACCORDION] [ACCORDION Header="Mental Well-being"]

Stress can raise blood pressure and blood glucose levels. It can also affect how well you manage medical conditions. Here are some tips to improve your mental well-being:

Have enough sleep

Besides causing you to lose focus and increasing the risk of accidents, sleep deprivation has been linked to several health conditions including heart disease, high blood pressure, stroke, and diabetes. Lack of sleep may be associated with an increase in hunger and appetite, as well as obesity. If you experience problems sleeping and it is affecting your personal and work life, see a doctor to rule out underlying medical conditions.

Think positive

The way you think affects how you feel about people, things and situations as well as how you respond to them. The ability to think positive and embrace optimism is linked to many health benefits. It doesn’t suggest burying your head in the sand and ignoring problems you have. Positive thinking simply means that you approach the negative things in life in a more positive and productive manner. Not only does it help you cope better with stressful situations, it also reduces the harmful effects stress has on your body. It is also believed that positive people tend to take better care of themselves. They eat more healthily, get more physical activity, do not smoke, and do not drink alcohol in excess.

Be mindful

Being mindful is to be aware of your thoughts, feelings and environment, moment by moment. Instead of harping on the past or worrying about the future, mindfulness brings your attention to the present – helping to clear your mind of mental clutter and focus on positive feelings and thoughts. Take time to breathe in and breathe out, to savour the food you eat, or simply to enjoy the sunset – these are all simple and effective ways of being mindful.

Managing stress

Stress, especially chronic stress, can have a negative effect on blood glucose levels. People under stress tend not to take care of themselves. They may drink and eat excessively, exercise less or not have enough sleep. They may forget or not have the time to check their blood glucose or prepare healthy meals.

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