Lose weight? Exercise? Maybe another day, you tell yourself, tucking into your plate of chicken rice and washing it down with some "dinosaur" drink. Sure, the weighing machine has been displaying higher numbers of late, and you’ve had to upsize your clothes – the way you’ve been upsizing your fast food meals.
But you’re feeling fine, so everything’s okay, right?
That’s the insidious thing about pre-diabetes, the stage before it becomes full-blown Type 2 diabetes. There are no symptoms, no signs that your pancreas isn’t producing enough insulin for your body to make use of sugar. There are also no indications that the excess sugar is building up in your blood stream, leading to higher-than-normal blood sugar levels but not high enough for a diagnosis of Type 2 diabetes.
One in seven people in Singapore have pre-diabetes, and 50 per cent of patients with Type 2 diabetes do not even know they have the condition.
HEART DISEASE, KIDNEY DAMAGE AND ERECTILE DYSFUNCTION
Pre-diabetes, in itself, is a sign of diabetes and the accompanying elevated blood sugar level only shows up in blood tests. As for those pre-diabetes symptoms that you may have read about on the Internet – hungrier and thirstier than normal, weight loss despite eating more, going to the bathroom more frequently, and feeling more tired than usual – they "already point to a more advanced stage of diabetes," said Dr Vivien Lim, Gleneagles Medical Centre’s endocrinologist.
A blood test done in the doctor's office is the definitive way of finding out where your blood sugar levels stand. Doctors usually test for the impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both. According to the World Health Organization, you have pre-diabetes if your fasting blood glucose ranges from 6.1mmol/L to 6.9mmol/L. Diabetes is defined as equal to or greater than 7mmol/L.
Any food that increases the risk of being overweight or obese will predispose you to diabetes.
About one in seven people in Singapore have pre-diabetes, and 50 per cent of patients with Type 2 diabetes do not even know they have the condition, said Dr Lim.
Here’s why it doesn’t pay to ignore your blood sugar levels. When the bloodstream gets flooded with sugar, it can cause damage to the vessels that supply blood to the vital organs. This is because high levels of sugar in the blood turn the life-sustaining liquid into a damaging soup that causes the blood vessels to harden over time.
A cascade of problems can follow. At first, the high blood sugar level saps your energy, makes your vision blurry, and messes with your mood and concentration. From there, it is a slippery slope to cardiovascular disease, heart attacks, strokes, kidney damage and, if you’re male, erectile dysfunction.
You will be more susceptible to infection, blindness, and nerve damage. You’ll heal from injuries slowly, if at all, putting simple cuts at risk of turning into situations that require amputations.
NOT JUST SUGAR – IT’S YOUR WEIGHT
Diet is a big part of the pre-diabetes equation. But it goes beyond cutting down on sugar and desserts, and swapping white rice for brown one. It is also about the char kuay teow, nasi lemak (especially when paired with fried meats), nasi or mee goreng, and orh luak you’ve scarfed down, said Dr Lim.
READ: Commentary: Unable to look sideways? Unusual signs of diabetes often unnoticed, ignored or denied
"This is an area that is prone to misconceptions,” she said. "We know that being overweight or obese predisposes one to diabetes. Hence, any food that increases the risk of being overweight or obese will predispose you to diabetes."
And the experts have the research to substantiate it.
Type 2 diabetes is caused by excess fat in the liver and pancreas, according to Professor Roy Taylor of Newcastle University, who spent four decades studying the lifestyle condition. The excess fat in the liver causes the organ to respond poorly to insulin and produce too much glucose. The excess fat in the pancreas leads to the cells that produce insulin to fail.
But you are not doomed to a lifetime of insulin shots if you have been diagnosed with Type 2 diabetes. Losing less than 1g of fat from the pancreas through diet can re-start the normal production of insulin, said Prof Taylor.
"The good news for people with Type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all-important, tiny amount of fat out of the pancreas," he said in the Science Daily article.
Without intervention, at least 35 per cent of those with pre-diabetes will progress to Type 2 diabetes within eight years.
The same reversal can also be said of pre-diabetes, according to Dr Khoo Chin Meng, senior consultant with the Department Of Endocrinology at the National University Hospital.
“Studies have shown that those who lose weight or reduce their waistlines within a year of receiving a diagnosis of pre-diabetes are significantly more likely to return to normal glucose tolerance than adults who don’t,” he said. Without intervention, at least 35 per cent of those with pre-diabetes will progress to Type 2 diabetes within eight years, he added, citing the Prediabetes Appropriate Care Guide.
Exercise will also help to re-sensitise the body to absorb sugar from the blood, said Dr Lim. However, she cautioned that not every patient with pre-diabetes will succeed in reversing it. “Having weight loss does not necessarily guarantee pre-diabetes reversal. And, in general, it is likely to occur only in those who are overweight or obese.”
ARE YOU AT RISK OF PRE-DIABETES?
As it turns out, there are individuals who are at higher risk of developing pre-diabetes than others. As established earlier, those who are overweight or obese (a BMI higher than 30) belong to this group, said Dr Khoo. Certain ethnic groups, such as Indians and Malays, are more prone as well. Other factors include a family history of diabetes, a history of cardiovascular disease, hypertension, gestational diabetes, polycystic ovary syndrome, and/or being over the age of 40.
“If you have multiple risk factors, that should alert you to screen for pre-diabetes,” said Dr Khoo. If you don’t have any risk factors, screening for diabetes is recommended for age 40 and above. Weight is again a big indication of risk; those with obesity should consider getting screened at an even younger age, he said.