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.


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."

Tips on living well with diabetes

  • People with diabetes know that they need to take control of their eating habits because blood sugar levels in the body are directly affected by the foods we eat.
  • A diabetic diet is an eating plan that is high in nutrients and fibre, low in fat, sugar and salt, and moderate in calories
  • The only difference is that you need to pay more attention to your food choices
  • Controlling carbs: If you have diabetes, excessive intake of carbohydrates will lead to high blood sugar levels and poor control of diabetes.
  • Load up on greens: Loading up on vegetables, especially green leafy ones, will assist in blood sugar and weight control, and promote a healthy heart.
  • Choose wisely when eating out: Reduce your food portion size by requesting for less noodles/rice, and avoid dishes with thick gravy or fried foods with flour/bread coating
  • Order more vegetables and have a serving of fruit for dessert.
  • Regular mealtimes: For individuals who are on fixed doses of insulin and/or taking oral medication for diabetes, it is important to maintain regular mealtimes to prevent fluctuation in blood sugar levels and to optimise the effects of the medication.
  • Be active: The reason exercise is so important is because it increases cell sensitivity towards insulin. This means that cells are better able to use any available insulin to take up glucose during and after each physical activity.
  • You can start slowly with a 30-minute brisk walk three times per week and work your way towards a more intensive regime.
  • This helps you to have better blood glucose control and maintain a healthier body weight.
  • If you have diabetic complications such as heart disease, nerve problems or kidney failure, seek the advice of your doctor or an exercise specialist about appropriate exercises to do.
  • Shoes that fit: Comfortable footwear is also important as diabetes causes nerve insensitivity in the feet.
  • Poorly-fitted shoes can lead to foot complications such as ulcers, blisters or corns.
  • Stick to medications: In order to ensure blood sugar targets are achieved, most people with type 2 diabetes will require oral medication and/or insulin, along with living a healthy lifestyle.
  • Keeping clinic appointments: You need to take a proactive role in the management of your healthcare in order to prevent or delay the development of diabetic complications.
  • It is very important to follow the medication dose and timing prescribed by your doctor. It is dangerous to skip medication, or adjust medication dosage and timing without checking with your doctor.
  • Self-monitor blood sugar levels: Regular monitoring of your blood glucose gives you a basic understanding of how your diet, medication and physical activity affects your body and how you can manage it.
  • In general, individuals with diabetes should have comprehensive physical examinations once a year and have their diabetes assessed at least every three to six months.
  • Too little sleep can increase the risk of diabetes, and if you already have diabetes, sleep deprivation can lead to poor blood sugar control.

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.

This article was first published on March 13, 2017.
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