Whether you have diabetes or you are providing care to a loved one with diabetes...

Effective self-care is required to manage diabetes.

This includes understanding diabetes control targets, performing home glucose monitoring, and making some necessary changes to lifestyle.

For November's "Ask the Specialist", Dr Ami Nagashima, Senior Staff Registrar from the Department of Post-Acute and Continuing Care at SingHealth Community Hospitals (SCH), will answer your questions on how to manage diabetes better, whether you are a patient with diabetes or a caregiver.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.

1. Question by tomcat99sg
Hi Dr Nagashima,
My niece, sister in law are diabetic but they refused to change their unhealthy lifestyle and are kind of in denial stage. I have shown them enough articles on the risk of being diabetic but they continue to eat high carbo and oily foods with a lack of exercise. They simply don't have the courage to make a change or are unwilling to change. 
Is there any suggestion that you can provide? Thank you!

Answered by Dr Nagashima:
Hi tomcat99sg, 
It must be frustrating for you that they do not make any lifestyle changes despite their diabetes. Perhaps you can talk to them and seek to understand if there are any challenges they are facing.

Diabetes causes complications in the long-term if left poorly controlled or uncontrolled. It is important for them to understand this and seek medical consult. A multidisciplinary team, including the dietitian and diabetic nurse educator, will be able to advise them on feasible lifestyle modifications and diet choices. 


2. Question by heartquake
just being diagnosed as type 2 diabetes and have yet to start being on medication yet. what would be the blood glucose range to keep within for before meal (fasting) and after meals 1 or 2 hrs to be considered in the good range?

So in the event if I had to start on medication in future, would there be a chance that the medication can be stopped as I understand some overseas treatment plan do allow patient to stop medication if things are in good control.

Answered by Dr Nagashima:
Hi heartquake,

In general for most diabetic patients, it will be good to keep fasting glucose level at 4-6.9mmol/L, and post-prandial (2 hours after meals) glucose level at 4-9.9mmol/L. However, the blood glucose target range differs for people in different age groups, and with different medical conditions or risk of hypoglycaemia (low sugar level). Thus, it will be advisable to get an individualised target level from your doctor. 

Yes, there may be a chance that medication can be stopped subsequently if your diabetes control is good. Like most other chronic conditions, non-pharmacological interventions are very important for good diabetes control. Some patients actually do well with just lifestyle modifications such as adequate exercise and a balanced diet. Please consult with your doctor before stopping your medication.


3. Question by 9richard
Do you have any diabetes telegram or whatapps support group as I am not sure what can or cannot eat as my mum has diabetes.

Answered by Dr Nagashima:
Hi 9richard,
I recommend Healthhub, which has information about diabetes and the types of food that diabetic patients should avoid or include in their diets. (Diabetes Pocket Guide - Healthhub.sg) You can also find useful information on diabetes care on HealthXchange.sg, such as this article on diabetes management.


4. Question by mshong
Hi Dr, I have type 2 diabetes. My doc now give metformin twice a day when the previous doc gave another time release medication (cannot remember the name). Is time release med better? And is it necessary for me to get a home blood glucose monitor kit?

Answered by Dr Nagashima:
Hi mshong,
Metformin (immediate-release) is usually taken 1 to 3 times per day, depending on your condition and dose requirement, while Metformin (extended-release) is taken once a day. They are essentially the same medication. Your doctor may discuss with you and recommend one formulation over the other, depending on your compliance to medications and the possible side effects that patients may get.

It is good to have a home glucose monitoring kit to check your blood glucose at the recommended frequency and times of the day, as advised by your doctor. The record of the readings will also be useful for optimising your medications and diet as well. 


5. Question by GB Low
Hi Dr,
My sugar level is normally within the range of 120 and 130 + but not exceeding 140. I am not on medication and control my diet by limiting Carb and sugar intake. I have noticed that if I take fruits on a regular basis my sugar levels tend to rise. 

What can I do more to keep it better in control. What target should I set. I am Chinese 76 years of age and do not drink nor smoke. What should be the most ideal sugar level for me and how do I manage it. Thank you.

Answered by Dr Nagashima:
Hi GB Low,
Fruits contain sugar, but they also contain vitamins and minerals, which are beneficial for our health. When taking fruits with meals, you may consider reducing your intake of carbohydrates to help keep your glucose level in better control.

Generally, we aim for a haemoglobin A1c (HbA1c) level of less than 7.0% for most diabetic patients. However, the target range for diabetic control may differ for different people, depending on the other medical conditions that they may have and their risk of hypoglycemia. Thus, my advice is for you to consult your doctor who can assess your medical history and recommend a target for you. 


6. Question by wonggeo
Hi, I'm not under treatment for diabetes and the results of the regular blood tests appear good. However, I've been getting results of 3.7mmol/L reading some mornings before food and on occasions with readings of 7.6/11.5 mmol/L some hours after meal. My normal fasted morning readings range between 4.6 - 5.6mmol/L.

I would like to have a better understanding of what might be triggering this large swing and it there are tests to rule out pre-diabetes. I'm 66 yrs old, generally in good health & active.

Answered by Dr Nagashima:
Hi wonggeo, 

Your home glucose monitoring results may vary depending on factors such as your caloric intake, exercises, and the timing of the tests done (e.g. may be higher if done too soon after a meal). 

To confirm the diagnosis of diabetes or pre-diabetes, I would recommend you to see a doctor to do the appropriate blood tests. Your doctor may arrange for a fasting blood glucose test, an oral glucose tolerance test or HbA1c. These tests will provide a more accurate diagnosis of your blood glucose control. 


7. Question by Mdm Ho
Dear Dr,
I am 67 years old female. Since I knew I have gestational diabetics, I have been controlling my sugar intake Previously my HBA1c reading was 7.01. But thru more exercises and dieting, I manage to achieve the following: HBA1c 6.7% and HBA1c blood (1FCC) 50 (MMOL/MOL).
I am very confused. I use to follow up at Polyclinic. Every time is a different attending doctor. Some doctors scolded me for not on medication. Some doctors say is not necessary for this HBA1c reading of 6.7%. If possible, I do not want to be on medication. I am already on atorvastatin 20 mg for high cholesterol.

Appreciate your advice.

Answered by Dr Nagashima:
Dear Mdm Ho, 
Generally, we aim for a haemoglobin A1c (HbA1c) level of less than 7.0% for most diabetic patients. However, the target range for diabetic control may differ for different people, depending on the other medical conditions that you may have and your risk of hypoglycemia. 

It is good that your HbA1c has improved with non-pharmacological interventions such as exercise and a well-balanced diet. Like most other chronic conditions, non-pharmacological interventions are very important for good diabetes control. However, I will strongly recommend you to continue regular follow-ups with your doctor for checks of your HbA1c and fasting glucose to ensure good control of your condition, and review the need to start medications if necessary.


8. Question by Yuni
Dear Dr Nagashima,
My sister is diabetic many years, she consume a lot of diabetic medicine as per doctor description. A friend suggested to used insulin instead of oral medicine. She said insulin more safe than oral medicine. Can I have your advises please. Which is better. Insulin or Oral medicine. Thank you very much.

Answered by Dr Nagashima:
Hi Yuni, 
It is not accurate to say that insulin is safer or better than oral medication, or vice versa. The suitability of insulin or oral medications for treatment of diabetes depends on different factors such as the control of diabetes, side effects of medications, and preference and profile of the patients. In particular for patients with poorly controlled diabetes, insulin may be initiated. I will recommend your sister to speak to her doctor and discuss regarding the most suitable choice of medications for better control of her diabetes. 


About Dr Ami Nagashima

​Dr Ami Nagashima is a Senior Staff Registrar with the Department of Post-Acute and Continuing Care (PACC) at Sengkang Community Hospital (SKCH), which is under the SingHealth Community Hospitals (SCH), a member of the SingHealth group.

Dr Ami graduated from the Yong Loo Lin School of Medicine NUS in 2012 and completed her MRCP (Membership of the Royal Colleges of Physicians) in 2016, and the GDFM (Graduate Diploma of Family Medicine) in 2021.

In her current role at SKCH, Dr Ami works with her multi-disciplinary team to care for inpatients, and optimise their medical conditions before their transition back to the community.

Ref: K21