What is pre-diabetes?
Pre-diabetes is a condition where your blood sugars are abnormally elevated, but lower than that of diabetes. Around 14% of Singaporeans have pre-diabetes and if nothing is done to change our dietary habits and adopt a healthier lifestyle, 35% of these individuals will progress to diabetes within 8 years.
A healthy diet and active lifestyle is essential in preventing or delaying the progression to diabetes and reducing the risk of cardiovascular disease in people with pre-diabetes.
How will I know if I have pre-diabetes?
Pre-diabetes does not cause any symptoms so it is important to go for regular health screening to check your fasting blood sugar, even if you are feeling well. It is recommended that anyone 40 years and above should undergo regular health screening, which includes a fasting sugar and cholesterol profile.
You should go for testing at a younger age if you have risk factors like being overweight or obese, or having a sedentary lifestyle, a family history of diabetes or a personal history of other medical conditions such as high blood pressure or gestational diabetes.
What is an Oral Glucose Tolerance Test (OGTT)?
Normally, your fasting blood sugar level should be 6 mmol/L or less. In pre-diabetes, this level is elevated at 6.1 – 6.9 mmol/L. In diabetes, this level is 7 mmol/L or more. Your doctor will order an Oral Glucose Tolerance Test to further diagnose if you have Impaired Fasting Glucose or Impaired Glucose Tolerance.
An Oral Glucose Tolerance Test is a fasting blood test that determines how your body responds when you take a sugar load. You will have your blood test done after an 8 – 10 hour fast, then you will be given a sweetened fluid to take. This is a measured amount of 75g of sugar. After 2 hours, your blood will be taken again. In normal individuals, the sugar level in the blood after 2 hours of ingestion should be within the normal range.
||Fasting blood glucose (mmol/L)
||Blood glucose, 2 hours after glucose load (mmol/L)
|Impaired fasting glucose (IFG)
||6.1 – 6.9
||Less than 7.8
|Impaired glucose tolerance (IGT)
||Less than 7
||7.8 – 11
||More than 7
||More than 11
Pre-diabetes = IFG or IGT
What should I do if I have pre-diabetes?
Adopting healthy eating habits and implementing lifestyle changes will help prevent or delay the onset of diabetes.
Portion a healthy plate
You should fill your plate with mainly vegetables and a small portion of fruit. Fill a quarter of the plate with lean meat, fish, poultry (skinless), eggs, low-fat dairy or soy products. Fill a quarter of the plate with whole grains such as brown rice, rolled oats, whole grain bread or cereal. Avoid or minimise refined carbohydrates such as sugar, white rice or white bread.
Many individuals overlook the calories and sugars in sweetened beverages. You should opt for plain water instead of soda, sweetened drinks and fruit juices.
Eat less fat
You should avoid pastries, fried food and food containing coconut milk or cream. Use less oil when cooking and opt for healthier oils such as olive oil, sunflower oil, rice bran oil.
Increase physical activity
It is recommended to perform at least 150 minutes of moderate-intensity exercise every week. Allow for no more than 2 consecutive days without exercise.
Studies have shown improved blood sugar control when prolonged sitting is interrupted every 30 minutes with 3 minutes or more of standing or light intensity activities, such as overhead arm stretches, torso twists, side lunges or walking in place.
Maintain an ideal weight
Maintaining an ideal weight is important for reducing the risk of progression of pre-diabetes, and reducing the overall cardiovascular risk. If you are overweight, you should aim to lose weight gradually by reducing your calorie intake and exercising regularly. If you are overweight or obese, visit your doctor and ask for a weight management programme to help you lose weight.
Quit smoking and limit alcohol intake
Smoking makes control of blood sugar levels more difficult and also affects circulation by increasing the heart rate and blood pressure and making the blood vessels narrower. You should quit smoking to improve your control of pre-diabetes and reduce the overall cardiovascular risk.
Follow up with your doctor regularly
It is important to follow up regularly with your doctor to monitor your weight and other risk factors of cardiovascular disease. Your doctor will also check your blood pressure and cholesterol levels, and periodically recheck your blood glucose profile. Your doctor may discuss options of starting medications if a trial of lifestyle change does not help your condition. Medication for pre-diabetes is not as effective as lifestyle changes and should only be considered after a trial of intensive lifestyle intervention.
Article contributed by Dr Wong Pei Ying, family physician at Parkway Shenton, International Plaza