Diabetes in Singapore: Diabetes Treatment Options

Diabetes is one of the most prevalent chronic conditions in Singapore. It is a condition that is characterised by elevated levels of blood sugar, which in the long term will have negative impacts on almost all parts of the human body, including the heart, kidneys, brain and even skin. 

What are the symptoms? 

Diabetes may often have no symptoms at an early stage, which is why screening is important. In later stages of Diabetes where sugar levels are much higher, below symptoms can occur.

1. Increased Thirst (Polydipsia):
   • Feeling unusually thirsty and unable to quench your thirst.
2. Frequent Urination (Polyuria):
   • Needing to urinate more often, especially at night.
3. Extreme Hunger (Polyphagia):
   • Feeling hungry even after eating.
4. Unexplained Weight Loss:
   • Losing weight without trying, despite eating more (common in Type 1 diabetes).
5. Fatigue:
   • Feeling unusually tired or lethargic.
6. Blurred Vision:
   • High blood sugar levels can affect your retina or lens, leading to blurred vision.
7. Slow-Healing Sores or Cuts:
   • Wounds take longer to heal due to poor blood circulation and high blood sugar.
8. Frequent Infections:
   • Recurring infections, such as urinary tract infections (UTIs), yeast infections, or skin infections.
9. Tingling or Numbness in Hands or Feet:
   • A sign of nerve damage (diabetic neuropathy), often caused by prolonged high blood sugar.
10. Dry Skin and Itching:
    • Skin may become dry and itchy due to dehydration and poor circulation.
11. Darkened Skin Patches:
    • Areas of darkened skin, particularly in the neck, armpits, or groin (a condition called acanthosis nigricans), often associated with insulin resistance.

Who should get screened?

Screening is recommended for individuals who have risk factors for diabetes, including:

1. Age:
   • 40 years and above: Routine screening is recommended.
   • Younger individuals with risk factors should also consider screening.
2. Family History:
   • A parent or sibling with diabetes.
3. Overweight or Obesity:
   • BMI ≥ 23 kg/m² 
4. Sedentary Lifestyle:
   • Physical inactivity increases diabetes risk.
5. History of Gestational Diabetes:
   • Women who had diabetes during pregnancy.
6. Polycystic Ovary Syndrome (PCOS):
   • A condition linked to insulin resistance and diabetes
7. High Blood Pressure or High Cholesterol:
   • These conditions are often associated with diabetes.
8. Ethnicity:
   • Higher risk among Malays and Indians compared to Chinese in Singapore.

How do I get screened? 

Screening and diagnosis for diabetes is done through a blood test, which can be any of the three below. Diabetes is NOT diagnosed via finger prick testing. 

1. Fasting Blood Glucose Test (fasting required) 
2. Oral Glucose Tolerance Test (OGTT) (fasting required)
3. HbA1c Test (fasting not required)  

As a Singaporean or Healthier SG-patient of our clinic, you can do the SFL (Chronic) test for free. This can be done every three years. 

Diabetes screening is also part of all our health-screening packages starting from the base tier. 

Management 

1. Lifestyle and Diet

• Follow a balanced Diet:
  • Focus on whole, unprocessed foods like vegetables, fruits, whole grains, lean proteins, and healthy fats.
  • Use the Healthy Plate Method: Fill half your plate with non-starchy vegetables, a quarter with lean protein, and a quarter with whole grains.
• Carbohydrate Management:
  • Choose complex carbs (e.g., brown rice, oats, quinoa) over refined carbs (e.g., white bread, sugary snacks).
• Limit Sugary Foods and Drinks:
  • Avoid sweetened beverages, sweets, and processed snacks.
• Eat Regularly:
  • Avoid skipping meals to prevent blood sugar spikes or drops.
• Aim for 150 Minutes of exercise per Week:
  • Engage in moderate-intensity aerobic exercise (e.g., brisk walking, cycling, swimming) for at least 30 minutes most days.
• Include Strength Training:
  • Do resistance exercises (e.g., weight lifting, resistance bands) 2–3 times per week to improve insulin sensitivity.
• Stay Active Throughout the Day:
  • Avoid prolonged sitting; take short walks or stretch regularly.
• Achieve or Maintain a healthy weight
  • Weight loss of 5% can greatly improve sugar control and insulin sensitivity for patients who are overweight.

2. Medications 

If indicated, our doctors will advise you to start on regular oral medications for diabetes. Common medications include:

• Metformin – most common initial drug for diabetes
• SGLT-2 Inhibitor e.g Forxiga, Jardiance – new drug that is proven to have beneficial effects on the heart and kidneys for diabetic patients 

These medications should be taken daily and not stopped without consulting your doctor. 

3. Screening for Complications
   • Yearly Foot Screen 
   • Yearly Eye Screen
   • Screening for co-morbid ischaemic heart disease e.g Treadmill ECG
   • Screening of kidney function and protein in urine through regular blood and urine tests as instructed by your doctor