Care at NUH

Understanding Diabetes

What is diabetes mellitus

Diabetes mellitus is a medical condition characterised by elevated blood sugar levels.   

When carbohydrates are consumed, the body converts them into sugar. The pancreas then secretes a hormone called insulin, which helps cells absorb sugar for energy. In diabetes mellitus, either the pancreas does not produce sufficient insulin, or the body struggles to use it effectively, leading to increased blood sugar levels.    

Prolonged high blood sugar can damage vital organs like the eyes, kidneys and nerves. Individuals with diabetes also face a higher risk of heart attacks and strokes.

However, with appropriate treatment, the risk of diabetes-related complications can be significantly reduced.  

Effective diabetes management involves: 

  • Adopting a balanced diet to regulate blood sugar levels 
  • Engaging in regular exercise to maintain a healthy body weight 
  • Taking prescribed medications consistently to normalise blood sugar levels  
  • Maintaining blood pressure and cholesterol levels within healthy ranges 

Your healthcare provider will also recommend regular screenings for your eyes, feet and kidneys to detect early signs of complications. 
With diligent care, many individuals with diabetes lead long and fulfilling lives. 

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What is gestational diabetes mellitus

Gestational diabetes mellitus (GDM) affects approximately one in five pregnant women in Singapore. It typically develops during the middle or later stages of pregnancy. 

Should I be screened for GDM? 

All pregnant women are generally screened for GDM between 24 to 28 weeks of pregnancy. Early screening may be necessary if you have risk factors such as: 
• A body mass index (BMI) over 25kg/m2 
• A previous child weighing more than 4 kg at birth 
• A personal history of GDM 
• Known prediabetes 
• Family history of diabetes 
• Age 40 years or older     

How will I be tested? 

GDM is diagnosed using an oral glucose tolerance test (OGTT). The procedure involves: 

  • Fasting from midnight before the test day (only plain water is allowed) 
  • Undergoing a fasting blood sugar test the following morning 
  • Drinking a glucose solution within five minutes after the fasting test 
  • Having blood samples taken at one-hour and two-hour intervals post-drink 

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How does GDM affect my baby and me? 

Maintaining normal blood sugar levels is crucial for a healthy pregnancy. Abnormal levels can lead to: 

  • For the baby: Increased risk of being larger than average, which can complicate delivery. There's also a heightened chance of the baby experiencing low blood sugar levels or jaundice after birth. 
  • For the mother: Increased risk of high blood pressure during pregnancy, preterm birth, the need for induced labour or caesarean section, and stillbirth. 

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How is GDM treated? 

Managing GDM effectively involves: 

  • Working with a dietitian to develop a personalised eating plan, focusing on well-balanced meals and appropriate carbohydrate intake 
  • Safe exercises, such as walking or swimming for 30 minutes on most days, may be beneficial. Consult your doctor to determine suitable exercises. 

Do I need medication for GDM? 

Injectable insulin may be necessary if blood sugar levels are not controlled through diet and exercise alone. 

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How do I monitor my blood sugar? 

You will need to purchase a glucometer to monitor your blood sugar level. The diabetes care nurses will advise 
you on: 
• Blood sugar monitoring 
• Frequency of blood sugar monitoring (typically seven tests a day, two to three days a week or more if required)  
• Blood sugar targets 
• Recording and reporting of blood sugar readings and food intake 

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What happens after delivery? 

An OGTT is required six to 12 weeks after delivery to check if abnormal blood sugar levels have normalised. 

Women with a history of GDM are at an increased risk of developing diabetes later in life. Preventive measures include a healthy diet, active lifestyle and maintaining a healthy body weight. Regular diabetes screenings every one to three years are recommended. 

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