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Dodging Diabetes

Ways to avoid the tsunami of diabetes

20328980_xlDiabetes mellitus is a disease of high blood sugar. Normally, our body makes insulin whenever we eat and the blood sugar starts to rise. The insulin makes sure that the sugar goes into the cells of our body to be used or stored, and prevents the liver from making too much sugar. In diabetes, there is not enough insulin around to do that.

There are two types of diabetes. Type 1 diabetes is an autoimmune disease where the body’s white cells destroy the insulin-making cells in the pancreas. So the patients cannot make much insulin at all, and they need insulin injection for life. It is thankfully very rare, accounting for about 5% of all diabetes. Type 2 diabetes is believed to be a disease of over-nutrition, and is related to an urbanised lifestyle and increasing obesity.

The Development of Diabetes

It is believed that each of us have a definite amount of fat storage capacity. When that capacity is exceeded by chronic over-nutrition (eating too much and always sitting around), the body does not want any more additional fat and becomes resistant to insulin. At first, the pancreas makes more insulin to overcome the insulin resistance. However, the pancreas eventually fails to do that and the sugar starts to rise, causing pre-diabetes (impaired fasting glucose or impaired glucose tolerance). At the same time, blood triglycerides (fat in the blood) and free fatty acids start to rise in the blood. Both the increased sugar and the free fatty acids are poisonous to the pancreas, causing a vicious cycle when the pancreas continues to be damaged. This further damages the pancreas and cause the sugar and free fatty acids to go higher! Ultimately, despite the increased insulin level, it is just not enough to overcome the insulin resistance, and the patient develops diabetes. By the time diabetes occurs, only 50% of the pancreas function is left.

The Coming Diabetes Tsunami

According to the National Health Survey 2010, 11.3% of all Singaporeans currently have diabetes.1 It is estimated that by the year 2030, 18.4% of Singaporeans will develop diabetes.2 More alarmingly, half the people with diabetes in Singapore are not aware that they have diabetes. As more people suffer from diabetes, all the complications such as blindness, kidney failure and amputation will increase.

Effects and Complications

Uncontrolled diabetes causes many complications. The sugar sticks to everything in the body, from blood vessels walls, to white blood cells, and all kinds of proteins, preventing their normal function. There are two main types of complications – big blood vessels and small blood vessel disease. Big blood vessels disease refers mainly to heart vessel blockage causing heart attacks, brain vessel blockage causing strokes, and leg vessel blockage. Small blood vessels disease refers to damage to small vessels in the eye causing blindness, damage to kidneys causing kidney failure, and damage to nerves causing nerve damage. The combined effect of nerve damage and blood vessel blockage cause bad foot infections, sometimes requiring amputations. Diabetes is the most common cause of end stage kidney failure requiring dialysis, accounting for 63.5% of all new cases in 2008.3 Diabetes is the top cause of chronic ill-health in Singapore.4

Avoiding the Diabetes Tsunami

Since diabetes is a disease of over-nutrition, we need to correct that. Half of all Singaporeans eat more than they need, energy wise.5 Singaporeans are burning less and less energy as we work in the knowledge economy, mostly using our brains as we sit in the office most days. When we reach home we just want to chill on our sofas. Some of us work until late at night, sleeping only three or four hours a night.

To avoid the diabetes tsunami, we need to make some changes! First, the good news – sleep more. A lack of sleep causes us to be hungrier so we eat more, and increases our stress hormones. These two combined raise our risk of diabetes. Next, burn more energy. Regular exercise is important. Go to a gym to work out, or hit the swimming pool. Go to the East Coast Park or other parks over the weekend for some rollerblading or cycling. Visit the Botanical Gardens in the evening and let the kids run wild; you will burn some energy as well as you chase after them. Take the stairs more often and do some house work.

Many studies have been done to look at diets that will increase or decrease the risk of developing diabetes:

Increases Diabetes(8,9,10,11) Prevents Diabetes (6,7,10,11,13,14)
Fast food

Soft drinks

Fruit juice

White rice



Black Tea


Brown rice


Full cream milk

Green leafy vegetables

Moderate alcohol

Note that brown rice decreases the risk of diabetes, while white rice increases it. Also fruits decrease the risk of diabetes, but juices increase it. By taking more of food that prevents diabetes and less the food that increases diabetes, we can surely avoid getting diabetes!


Diabetes is going to become a major health issue and cause lots of disability. Fortunately, it can be prevented by simple changes in our lifestyle: Sleep more, exercise more and eat healthy.



1. National Health Survey 2010. Ministry of Health Singapore

2. Sicree R, Shaw J, Zimmet P. IDF Diabetes Atlas fourth edition. The Global Burden. Diabetes and IGT.

3. 7th Report of the Singapore Renal Registry 2007/2008. Dr Lina Choong with Ministry of Health Singapore.

4. Phua HP, Chua AV, Ma S, Heng D, Chew SK. Singapore’s burden of disease and injury 2004. Singapore Med J. 2009 May;50(5):468-78.

5. Singapore Nation Nutrition Survey 2004. Health Promotion Board.

6: Odegaard A et al. Coffee, tea, and incident type 2 diabetes: the Singapore Chinese Health Study. Am J Clin Nutr 2008; 88:979–85.

7. Mueller N et al. Soy intake and risk of type 2 diabetes mellitus in Chinese Singaporeans. Eur J Nutr DOI 10.1007/s00394-011-0276-2.

8. Odegaard A et al. Western-Style Fast Food Intake and Cardiometabolic Risk in an Eastern Country. Circulation. 2012;126:182-188.

9. Odegaard A et al. Soft Drink and Juice Consumption and Risk of Physician-diagnosed Incident Type 2 Diabetes. Am J Epidemiol 2010;171:701–708.

10. Muraki I et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013;347:f5001 doi: 10.1136/bmj.f5001

11. Sun Q et al. White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women. Arch Intern Med. 2010;170(11):961-969.

12. Mozaffarian D et al. Trans-Palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults. Ann Intern Med 2010; 153: 790-799

13. Carter P, et al. Fruit and vegetable intake and incidence of Type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 341: c4229. DOI: 10.1136/bmj.c4229.

14. Joosten M et al. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Am J Clin Nutr. 2010 Jun;91(6):1777-83.

Dr Daniel Wai is a Consultant at Parkway East Hospital’s Diabetes, Endocrine and Endovascular Centre.
Posted by ezyhealth on Dec 4 2013. Filed under 40s–60s. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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