You can live well with diabetes!

According to the National Population Health Survey 2022, about 8.5% of Singapore residents aged 18 to 74 years have diabetes.

Diabetes (also known as Type 2 Diabetes Mellitus) is a condition that continues to pose a major public health challenge.

The prevalence increases sharply with age, affecting more than one in five adults aged 60 years and above.

Living well with diabetes involves:

• Developing sustainable habits around balanced nutrition,
  
  
• Regular physical activity,
  
  
• Medication adherence when prescribed, and
  
  
• Routine health monitoring

Many people with diabetes can lead full, active lives by working closely with their healthcare team to create personalised management plans.

Modern diabetes care focuses on empowering individuals with practical skills for daily management, from understanding blood glucose patterns to making informed food choices and staying active in ways that suit their lifestyle.

If you have questions about living with diabetes and want to learn more about effective management strategies, don't miss this opportunity to submit your questions to Dr Sun Jingfeng.

Knowledge and support are your strongest tools to managing diabetes better!

Dr Sun graduated from Duke-NUS Medical School in 2016 with an M.D. degree and obtained MRCP (UK) in 2019.

She received her Master of Medicine in Family Medicine in 2022, Graduate Diploma in Dermatology and MCFP(S) (Collegiate Member of the College of Family Physicians) in 2024.

She is currently a Family Physician at SingHealth Polyclinics.

1. Question by Gerard

Hi Dr,

I need to take my daily dose of long acting lanctus which last the usual 24 hours.

Is there any difference in taking it in the morning or night? I noticed my FBG in the morning is a little high. Would taking the long-acting insulin jab at night - help with bringing the FBG lower in the morning?

Thank you for your advice!

Answer by Dr Sun Jingfeng

Dear Gerard,

Lantus is a long-acting insulin with a small, gentle peak and its sugar lowering effect generally lasts for about 24 hours, it is injected once a day and can be taken either in the morning or at night, as long as it is taken at the same time every day.

The ideal fasting glucose should be below 7.0 mmol/l. If your fasting blood glucose (FBG) in the morning is consistently high, shifting your Lantus injection to night-time may help to lower your morning fasting blood glucose readings, as it can better cover the early morning rise in blood sugar.

However, please discuss with your doctor first if you are planning to change the timing of your Lantus injection. Do also watch for low sugars in the middle of the night. e.g. waking up with cold sweats.

You can also try to control your morning fasting blood glucose by limiting your night-time intake of carbohydrates and exercising regularly.

Do continue to monitor your blood glucose regularly and discuss any adjustments with your doctor.

2. Question by Jim

Hi Dr,

There are 9 essential amino acids and 2 essential fats. However, there are no nutritionally essential carbs.

Why not simply make this a part of your public education message and give people a choice?

Wouldn't that provide an even better chance to control runaway high blood sugars (for many who believe that carbs are a "must") and even possibly accelerate the path to remission? Or at least better control?

Answer by Dr Sun Jingfeng

Dear Jim,

Carbohydrates, including sugars, starches and fibres, are an essential nutrient and is the main source of energy in our diet. Our body converts carbohydrates into glucose, which provides the fuel needed for our daily activities, carbohydrates is an important component of a healthy and balanced diet.

We should limit, rather than omit carbohydrates completely, as doing so may lead to low blood sugar level, which can be dangerous especially in individuals with diabetes who are taking diabetes medications or insulin.

What matters is the type and amount of carbohydrates that is being consumed.

The Health Promotion Board’s Healthy Plate recommends limiting carbohydrates to about ¼ of our plate, and to choose carbohydrates with higher-fibre like brown rice, basmati rice, wholemeal bread, or oats and cut down on sugary food and drinks.

Eating a balanced diet, staying physically active, and using medications when needed remains the safest and most effective way for most people to achieve good glucose control.

3. Question by Karis

Dear Dr Sun,

Based on recent reading for my blood glucose, a doctor said I am a diabetic but no prescription of any medication.

My questions are:

a) My fasting blood glucose levels are below 7 mostly and HBA1C is below 6.4, these reading are within normal, why am I a diabetic? When do you define a patient as diabetic?

b) If doctor diagnosed me as diabetic, why no medication?

c) Under what circumstances do you think I need medication?

Note: I am age 70 (female)

On 5 mg Amlodipine and 5 mg ATORvastatin every night.

Thank you for your time.

Answer by Dr Sun Jingfeng

Dear Karis,

a) Diabetes is diagnosed based on the following criteria by American Diabetes Association (ADA) and World Health Organization (WHO). A person is considered to have diabetes if any of the following results are met:

• Fasting glucose ≥ 7.0 mmol/L or
• 2-hour Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L or
• Random glucose ≥ 11.1 mmol/L or
• HbA1c ≥ 6.5%

And in the absence of symptoms (thirst, passing a lot of urine, unexplained loss of weight), this test should be repeated on a separate day to confirm the diagnosis.

Locally in Singapore, we also diagnose diabetes based on a single glucose tolerance test of 11.1 mmol/L or more, if the initial fasting glucose was ≥ 6.1 mmol/L.

Based on the info you provided, it does not appear that you have reached the above threshold for diabetes.

However, you should check with your clinic about your historical records. That is, was there ever a time when your fasting glucose was ≥ 6.1 mmol/L and a 2 hour glucose tolerance test (need to drink the sugary drink) ≥ 11.1 mmol/L?

If you had no symptoms, was these test results repeated on a separate occasion? You can clarify with your doctor how the diagnosis was made.

b) Based on your current glucose readings, it looks normal, thus no medication is needed to lower your blood sugar. It is possible that a patient has very mild diabetes that only requires diet control and exercise without medications.

c) When you should be on medication depends on your discussion with your doctor, but generally, it can start if the HBA1C is ≥ 6.5%.

4. Question by Ms Tan G N

Hi Dr Sun,

I underwent subtotal pancreatatomy, at tail end of pancreas, in 2007.

I understand that if I have diabetes, my treatment will be that of insulin therapy.

My fasting blood glucose reading was 6.1 in late August this year at the polyclinic. I am on low carbohydrate diet.

Can you please advise me how to conduct insulin therapy if I am diabetic?

I understand that it is possible for the blood glucose reading to fall too low after insulin injection. Reading too low that warrants emergency attention or else enter into a coma. I am now 64 years old.

Your advice as a family physician is much appreciated. Thank you.

Answer by Dr Sun Jingfeng

Dear Ms Tan G N,

While a subtotal pancreatectomy (partial pancreas removal) may increase your risk of developing diabetes, not everyone who has this surgery will require insulin as you still have remnant pancreas, which can continue to produce insulin to control blood sugar.

This is in contrast with someone who had his entire pancreas removed, which will likely require lifelong insulin therapy.

Based on your current fasting glucose of 6.1 mmol/L, this is in the pre-diabetes range. You can try to control your sugar through diet control and exercise and you do not require medications for now.

A person is considered to have diabetes if any of the following results are met:

• Fasting glucose ≥ 7.0 mmol/L or
• 2-hour Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L or
• Random glucose ≥ 11.1 mmol/L or
• HbA1c ≥ 6.5%

If you do develop diabetes in the future, your doctor may still consider oral diabetic medications to control your sugar rather than insulin, as you still have part of your pancreas, which produces insulin, preserved.

Insulin therapy is usually started if your HbA1c ≥ 10% or if your sugar is not well controlled despite being on 3 oral diabetic medications, or if you are experiencing symptoms of diabetes such as extreme thirst, loss of weight and frequent urination, or if you have your pancreas totally removed.

The dose of insulin usually starts at a low dose and adjusted gradually based on your blood sugar readings. Your doctor or diabetic nurse educator will teach you how to inject insulin safely, how to monitor your blood sugar, and what symptoms to look out for if you were to start on insulin.

5. Question by Ms Tan J W

Dear Dr Jingfeng,

I would like to ask:

Certain food places sell healthy bentos of 45% high concentrated wholegrain with high nutrition value. Will it improve health for my diabetic mother in the long run?

Thank you for your advice.

Answer by Dr Sun Jingfeng

Dear Ms Tan J W,

Wholegrains are generally a healthier choice compared to refined carbohydrates because they contain more fibre and tend to cause a slower rise in blood sugar. Do also control the portion of the wholegrains, as it can still raise blood sugars if the portion is too large.

To control sugar, each meal should ideally consist of:

• ¼ plate carbohydrates (preferably higher fibre like brown/ basmati rice, wholegrains, wholemeal bread or oats)
• ¼ plate protein such as fish, chicken, tofu or eggs, and ½ plate vegetables

If your mother enjoys such healthy bentos and eats them in appropriate portions as part of a balanced diet, they can certainly be included in her diet. You can also use a glucometer to monitor her blood sugar before and after she has her meals.

6. Question by Jerry

Hi Dr. Sun,

I am 71 years old and I was just told by my cardiologist that he is treating me for diabetes.

I have been prescribed with a medication called Glucophage 850mg.

I have never been treated for diabetes before and I have concerns that this may be serious.

Kindly pls advise me regarding my diagnosis. Is my diabetes serious?

I have been treated for BP for decades and it all well under control.

I am active in sports…single tennis at least twice a week and I am active in business.

Pls let me know, many thanks Dr Sun.

Answer by Dr Sun Jingfeng

Dear Jerry,

A person is considered to have diabetes if any of the following results are met:

• Fasting glucose ≥ 7.0 mmol/L or
• 2-hour Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L or
• Random glucose ≥ 11.1 mmol/L or
• HbA1c ≥ 6.5%

In the absence of symptoms (thirst, passing a lot of urine, unexplained loss of weight), this test should be repeated on a separate day to confirm the diagnosis. In Singapore however, we can use a single HbA1c value of 7.0% or more to diagnose diabetes.

From your blood test results, your HbA1c of 7.0% shows that you have mild diabetes and is not considered severe currently.

You can control your sugar level with lifestyle measures, by continuing being physically active (continue your regular tennis), keeping a healthy diet, and taking your medications regularly. Do continue to follow up with your doctor regularly to monitor your sugar levels and blood pressure.

Here are some lifestyle modifications you can adopt to control your glucose:

• Lose about 5% of your body weight if you are over-weight or obese
• Not just reduce sugary food and drinks, but reduce the amount of carbohydrates (rice, noodles, bread, pasta, potatoes etc) you take to about ¼ of your plate, or a fist-sized portion
• Consider carbohydrates with higher fibre like brown/ basmati rice, whole meal bread or oats
• Take about a ¼ of your plate with lean / white meats like chicken and fish, and take about ½ a place of fruits and vegetables
• Stay physically active. Aim to brisk walk, cycle or swim at least 3-5 times a week, for 30 minutes each time
• Avoid or minimise alcohol like beer
• If you are smoking, try to cut down or quit

Ref: G25