Managing Your Diabetes
Understanding Diabetes What is diabetes? Diabetes (or specifically diabetes mellitus) is a condition in which a person has high blood sugar. Most of the food we eat gets broken down into a kind of sugar called glucose. Our cells then take up this glucose and use it for energy. To take up glucose, the cells need insulin, a hormone produced by our pancreas, a gland found behind our stomach.
Insulin acts like a key that opens a gate in the cell walls, allowing glucose to enter our cells to be used for energy. People with diabetes either do not make enough insulin, or the insulin they make does not work properly. As a result, the glucose remains in the blood and the level increases over time.
Why did I get diabetes? The exact cause of diabetes is unknown. It may not be something that you have done. People who are more likely to have diabetes are those who: •
have a family history of diabete
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are over 40 years ol
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are of certain ethnic groups (In Singapore, Indians have the highest prevalence of diabetes compared to Chinese and Malays
have impaired glucose tolerance (where blood glucose level is higher than normal, but not enough to be considered as diabetes
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are overweight (Body Mass Index over 23)
have high cholesterol, hypertension, polycystic ovarian disease, and/or heart diseas
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are women who have had abnormal blood glucose levels during their previous pregnancies (gestational diabetes)
You are not alone! The 2010 National Health Survey shows that 11.3% of adult Singaporeans between the ages of 18 to 69 years old have diabetes mellitus. This means that about 500,000 adults in Singapore have diabetes! Types of diabetes There are two main types of diabetes •
Type 1 diabetes - where the pancreas stops making insulin.
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Type 2 diabetes - where the insulin produced does not work well enough.
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Most people have Type 2 diabetes, especially those who are older. This book is meant for people with Type 2 diabetes.
How does it affect me?
People with diabetes can live long, healthy, normal lives as long as they keep their blood glucose levels under control. Although diabetes cannot be cured, it can be controlled. If you do not manage or control your diabetes well, your blood glucose levels can reach very high or low levels. These situations can be dangerous and can lead to other serious problems. These problems can happen •
very quickly (acute) which may cause death and should be treated as emergencies
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over a period of time (chronic) - where the organs become affected or damaged by diabetes
Commonly, the blood vessels, both big and small may be damaged causing:
Heart disease
Kidney failure
Stroke
Blindness from diabetic retinopathy, cataract, glaucoma
Diabetic foot problems
Sexual dysfunction
You can prevent these problems by taking steps to control your diabetes. As diabetes is a life-long disease, it is very important for you to take care of your condition yourself. Even though your doctor, nurse and other healthcare providers will be able to help you, most of the day-to-day care is still up to you.
So, what can I do about it? You can start taking charge of your own health! Many people with diabetes have done it and so can you. Start by taking small steps in these areas:
Eat right. It is the most important way to control your blood glucose level.
Keep active. Exercise can help you lower blood glucose, lose weight and feel more energised.
Keep your blood pressure and cholesterol levels under control.
Take medicines if you need to, according to instructions.
Check your blood glucose regularly.
Go for eye screening and foot check-up every year.
Take good care of your feet.
Do NOT smoke.
If you drink alcohol, limit the amount. Check with your health care professional how much you can drink.
Take care of your teeth. People with diabetes are more prone to gum infection.
Learn to cope with stress.
Managing Diabetes As a person with diabetes, you cannot be in the care of a doctor or a nurse all the time. Therefore, it is very important for you to learn how to manage your diabetes well. The main goal is to keep your blood glucose at an optimal level - not too high and not too low. How do I manage diabetes? Diabetes is normally treated first with weight loss, diet and exercise. When these fail to work, oral medications will be given. If these are not enough to control diabetes or if your diabetes is long-standing, your doctor will consider giving you insulin. Maintaining a healthy weight If you are overweight, aim to lose some weight. Studies have shown that losing 5% of your weight can very much improve your diabetes control. A Body Mass Index (BMI) between 18.5 and 23 is considered healthy. You can calculate your BMI using the following formula: BMI = Weight (kg) ÷ Height (m) x Height (m) For e.g. if you weigh 60kg and are 1.70m tall, your BMI will be 60 ÷ (1.70 × 1.70) = 20.8 Eating a healthy diet There is no special diet for people with diabetes. You can enjoy the same healthy meals as everyone else. However, you have to be very careful about the amount of carbohydrates you eat everyday, as carbohydrates can cause blood glucose levels to rise the most. The amount of fat and protein taken has to be closely monitored too, since they indirectly affect your blood sugar levels. Use the healthy diet pyramid below as a guide to make sure your meals are balanced and come from different food groups.
This is how your plate should look like if you were to follow the healthy diet pyramid way of eating, using a 12-inch plate.
Rice & Alternatives ¼ of Plate
Fruit 1 serving
Meat & Alternatives ¼ of Plate
Vegetables ½ of Plate
Tips from other patients about healthy eating •
I drink diet soft drinks instead of regular ones.
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I bring a little bag of walnuts around with me to snack on when I'm hungry.
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I used to skip breakfast, but now I have breakfast every morning to give me more energy.
Tips for healthy eating in diabetes Eat small and regular meals. •
Eat breakfast, lunch and dinner at regular times, and have a small snack in between these meals. You can keep your blood glucose levels within the target range by spreading the carbohydrates that you eat evenly throughout the day.
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Reduce amount of fats, salt and sugary foods
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Eat more foods that are high in fibre, including whole grain products
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Match your meal times to the timing and frequency of your medications
If you choose your food wisely, you may be able to control your diabetes with fewer medications. Eating regularly and healthily is the key to good diabetes control. Your dietitian will be able to assist you further in your meal plan.
Exercising regularly How do I keep active? If you have decided to start an exercise programme, congratulations! Getting fit is part of staying healthy and fighting against diabetes. Still, it does not mean you have to exercise for hours each day to achieve your goal. You can manage your diabetes better just by being active. It can be just a few minutes of walking a day, or even cycling for 5 minutes everyday. Together with your meal plan and medications (where needed), regular exercise improves and controls diabetes by: •
Lowering your blood glucose level
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Controlling your weight
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Improving blood flow
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And many other benefits
How do I get started? 1. Talk to your doctor or physiotherapist: Find out what exercises are suitable for your current condition. A physiotherapist can assess your fitness level and help you develop an exercise plan. 2. Set realistic goals: Take small steps at first. Pick an activity you are sure you will be able to do. You can increase the frequency and intensity later when you feel comfortable doing more. 3. Develop your exercise plan: Use the F.I.T.T. formula F = Frequency: how often will you exercise? 1 = Intensity: how hard will you exercise? T = Time: how long will you exercise? T = Type: which types of exercise will you choose? 4. Start acting on your plan!
How often should I exercise? Exercise regularly, no matter what exercise you choose to do. This is especially so if you are taking insulin. Aim to do 150 minutes of moderate intensity exercises per week. Each exercise should last at least 10 minutes. If you have not been active, start slowly. How hard should I exercise? Aim to work at a moderate level of intensity. Working out at this level makes you feel warm and breathe more heavily, yet still able to talk comfortably. You can start increasing the intensity of your exercise once you feel comfortable doing more. How long should I exercise? If you haven't been exercising, you can start with 10 minutes a day. It can be as easy as walking 5 minutes from your block, then turning around and walking back. After a week, add another 10 minutes of exercise. Before long, you will be able to exercise up to 30 minutes. You may also exercise 10 minutes three times a day to make up the 30 minutes.
What type of exercises can I do? The best form of exercise is something you enjoy doing, and preferably using large muscle groups in your body constantly, over a period of time. The three main types of exercises are: Aerobic exercises Also called cardiovascular or endurance exercises. These include walking, jogging, swimming, dancing and ball games.
Walking
Cycling
Aerobics
Ball & racket games
Swimming
Dancing
Flexibility exercises
Stretching
Yoga
Strengthening exercises
Lifting weights
Working out with resistance bands
Tips from other patients about exercising •
I take part in line dancing at the community centre.
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I park further away in the car park to help me walk a bit more.
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I alight from the bus one stop earlier to walk a longer distance home.
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I climb the staircase instead of the lift or escalator.
What exercises can I do if I have trouble walking?
Water aerobics
Cycling
Upper body stretching
Lifting weights while sitting
Some tips from other patients with trouble walking: •
I can still sit in my chair and lift weights. I just use mineral water bottles.
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I do what I can. I wheel myself around instead of having someone always pushing me in my wheelchair.
Example of a 1-month exercise plan Week
Type of exercises
Frequency
Intensity
Time
1
Walking
3 times (Mon, Wed, Fri)
Low
20 min (5:30pm - 5:50pm)
2
Walking
3 times (Mon, Wed, Fri)
Moderate
20 min (5:30pm - 5:50pm)
3
Walking
4 times (Mon, Wed, Fri, Sun)
Moderate
30min (5:30pm - 6pm)
4
Walking
5 times (Mon, Wed, Fri, Sat, Sun)
Moderate
30min (6рm - 6:30pm)
Safety precautions Before you start... Check your blood glucose level just before you exercise. If your blood glucose level is: •
Below 6mmol/L (100mg/dl) Eat a small low-fat snack before exercise
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Above 22mmol/L (370mg/dl) Do not exercise now. Drink more water.
Other precautions to take... •
If you are above 40 years old, or have underlying heart disease, consult your diabetes care team before considering vigorous exercise
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If your feet are numb, you can't see clearly or have bleeding in the eye, consult your diabetes care team before exercising
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If you are exercising right before your next meal, take a small snack half to one hour before you exercise
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If you are on insulin, you will need even more care during and after exercise to prevent a low blood glucose level. Your diabetes care team will be able to advise you on this. © Khoo Teck Puat Hospital Pte Ltd 2025. All rights reserved. All information correct as of DEC 2025 No part of this document may be reproduced, copied, reverse compiled, adapted, distributed, commercially exploited, displayed or stored in a database, retrieval system or transmitted in any form without prior permission of Khoo Teck Puat Hospital Pte Ltd . All information and material found in this document are for purposes of information only and are not meant to substitute any advice provided by your own physician or other medical professionals. DM.PE.01.1225