Are you borderline diabetic?

Are you borderline diabetic?
PHOTO: The Straits Times

Most of us are aware of the risk factors, causes and consequences of Type 2 diabetes.

Now here's a related condition that affects a significant number of Singapore women every year but is less often talked about: Prediabetes.

With this condition, your blood glucose level (blood sugar level) is higher than normal, but it's not high enough to be considered diabetes.

According to Dr Stanley Liew, endocrinologist and consultant at Raffles Diabetes & Endocrine Centre, Raffles Hospital, prediabetes is usually without symptoms and can be detected only through a blood test.

Depending on the blood test used, the condition may be categorised as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

The Ministry of Health's National Health Survey, last conducted in 2010, revealed that 14.4 per cent of people in Singapore between the ages of 18 and 69 had IGT.

The figure was higher in women (15.2 per cent) than in men (13.5 per cent) and those percentages are thought to be on the rise.

Dr Daniel Wai, an endocrinologist at Mount Elizabeth Hospital, recommends being screened if you are over 40, have a family history of diabetes, are overweight, or have been diagnosed with gestational diabetes or have delivered a baby weighing 4kg or more.

Other reasons for a screening include having polycystic ovarian syndrome, which causes insulin resistance and could result in diabetes or pre-diabetes, as well as hypertension, high cholesterol, heart disease or sleep apnoea.

The world standard unit for measuring glucose in blood is mmol/l, which stands for millimoles/litre. A normal fasting glucose reading is 6.1 mmol/l or less.

In a prediabetic person, that reading is between 6.1 and 6.9 mmol/l, and in a person with diabetes, it is 6.9 mmol/l or higher.

Dr Wai said: "If you are considered a high-risk person with more than one of the risk factors for developing pre-diabetes, or if you already have a high fasting sugar level, you'll be given an Oral Glucose Tolerance Test, which measures your body's ability to use glucose."

The test involves downing a sweet drink. You will be required to fast the night before, which means no drinking or eating until after the test. Your blood is drawn while you are fasting, and then you will be asked to consume the drink in one go. Your blood is drawn a second time, two hours after you have had the drink.

"After two hours, if your blood sugar level reads 7.8 mmol/l or less, it's normal. If you're prediabetic, your reading will range between 7.8 and 11.0 mmol/l, and if you're diabetic, that reading will show up as 11.0 mmol/l or higher," explained Dr Wai.

Even if the test reads normal, it should be repeated every three years if you are considered in the high-risk group.

ADDITIONAL SCREENING

If your fasting blood sugar level - after not having anything to eat or drink for eight hours - is elevated, your doctor may recommend an additional screening to diagnose which group of prediabetes you fall under - IFG or IGT, added Dr Yong Lok Sze, a family physician at Lifescan Medical Centre.

Prediabetes may not be full-blown diabetes, but it is still a problem because it means that you are at a higher risk of developing diabetes and cardiovascular diseases.

"Prediabetes can progress to diabetes if healthy lifestyle changes are not made," Dr Liew explains. "Without intervention, prediabetes is likely to become diabetes in 10 years or less. The progression to diabetes for patients with prediabetes is up to 10 per cent per year."

If you were recently diagnosed with prediabetes, lifestyle changes can stop it from developing into diabetes. One of the most effective changes is losing weight, and exercising more, said Dr Liew.

"The US Diabetes Prevention Program revealed that people with prediabetes can lower their risk of developing Type 2 diabetes by 58 per cent, simply by losing 7 per cent of their body weight and performing moderate exercise, such as brisk walking, 30 minutes a day, five days a week."

Diet changes are also crucial.

Dr Yong said: "You should limit your intake of sugar, sweet treats (cake, candy, jam and honey), and unhealthy fat, such as the kind found in fried food, chips and pastries. At the same time, you should increase your intake of fibre, vegetables and fruit."

The Diabetic Plate is commonly prescribed to control prediabetes or diabetes, Dr Yong added. This meal-planning approach involves filling half your plate with fruit and non-starchy vegetables (stir-frying, steaming, roasting and boiling are recommended).

Another quarter of the plate should contain whole grains such as multi-grain bread, wholemeal bread or brown rice, and the final quarter of the plate should contain healthy proteins like fish, lean meat, poultry, seafood, eggs and/or low-fat dairy products. Aim for at least two servings of fish a week.

Other recommended lifestyle changes include keeping your blood pressure and cholesterol levels under control, quitting smoking and getting between seven and eight hours of sleep every night.

tnp@sph.com.sg


This article was first published on March 13, 2017.
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