Medically Reviewed by M Thiviya, R.N.
Many of us can be at risk for prediabetes, a condition that can progress to diabetes if we are not careful. Prediabetes is also known as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), and happens when we have blood sugar levels that are higher than normal, but not high enough to be diagnosed with diabetes. Researchers have forecasted that one in four Singapore residents aged 21 and above may have prediabetes by 2035.
While this might sound like scary news, there are ways to control and even reverse prediabetes. With a better awareness of prediabetes and taking simple steps to manage your condition, you can prevent it from seriously affecting your health.
Symptoms of Prediabetes
Doctors have not determined an exact cause for prediabetes. However, it is a serious condition that can remain undetected for a long time because it has no obvious symptoms. If left untreated, it can increase your risk of diabetes, heart disease and stroke.
Risk factors for prediabetes include:
- Being overweight
- Having a family history of type 2 diabetes or heart disease
- Having an inactive lifestyle
- Having high blood pressure
- Sleeping at irregular times
Prediabetes can progress to type 2 diabetes if we do not take good care of our health. Prediabetes is more likely to progress to diabetes in older people and those with other diabetes risk factors, like being overweight.
Signs that your prediabetes may have progressed to diabetes include:
- Blurred vision
- Increased thirst
- Numb or tingling hands and feet
- Urinating a lot
Range for Prediabetes
Our blood sugar levels vary throughout the day. It tends to be lowest just before meals and are highest in the hours after a meal. You can check your blood glucose levels by going for a blood sugar test. Blood sugar levels are measured in millimoles (mmol) per litre (L).
A healthy blood sugar level would range from 4.0 to 5.4 mmol/L with fasting. A fasting blood sugar level from 6.1 to 6.9 mmol/L indicates prediabetes. You are considered to have diabetes if your fasting blood sugar level exceeds 7.0 mmol/L.
For non-fasting blood glucose levels, a reading below 7.8 mmol/L is healthy, 7.8 to 11.0 mmol/L indicates prediabetes, and a reading higher than 11.1 mmol/L indicates diabetes.
Prediabetes is often referred to as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on the type of test used for diagnosis.
Both IGT and IFG are measured in terms of fasting plasma glucose or 2h post-load glucose.
Fasting plasma glucose refers to the amount of sugar present in your blood when you have not eaten for 8 hours, while 2h post-load glucose refers to your blood sugar level 2 hours after consuming a special sugary drink that’s provided as part of the blood glucose test.
Random blood sugar level checks may also be performed. This refers to taking a blood glucose reading at any time of the day, and uses the non-fasting blood glucose ranges to classify individuals as being healthy or having prediabetes or diabetes.
Always check with your healthcare provider before deciding to get a blood sugar test. Once you get an initial blood test, you should follow up on your blood tests every 6 months.
Prediabetes in Singapore
The International Diabetes Federation has found that Singapore has the second-highest proportion of diabetics among developed countries. According to the Ministry of Health, 14 per cent of Singaporeans between the ages of 18 to 69 have been diagnosed with prediabetes as of 2017.
Singaporeans aged 18 to 35 can check their diabetes risk with the free Diabetes Risk Assessment. Those aged 40 and older can receive subsidised health screenings through Screen for Life. For up to just $5, you can receive a screening to check if you have diabetes or other chronic illnesses like high blood pressure and high blood cholesterol.
10 Tips to Reverse Prediabetes
1. Avoid Refined Carbohydrates
Refined carbohydrates are made from grains which have been processed to remove most of their nutrients and fibre. Refined carbohydrates are less healthy because they have a lot of calories which make us gain weight easily, but few nutrients. They are also not good for prediabetes as they can cause your blood sugar levels to increase quickly.
Refined carbohydrates are found in foods like white rice and white bread. To reduce your blood sugar levels and potentially reverse prediabetes, switch to eating unrefined whole grains instead. Unrefined whole grains retain many nutrients and contain a lot of fibre which helps our digestion. They are also digested more slowly and therefore release sugar gradually into the bloodstream. Examples of foods with unrefined whole grains include brown rice and wholemeal bread.
2. Cut Back on Sugar
Food and drinks with a lot of added sugar can cause our blood sugar levels to increase quickly. For people with prediabetes, it can cause blood sugar levels to rise above healthy levels because their bodies are less sensitive to insulin, the chemical that helps our bodies manage blood sugar levels. Sugary food and drinks can make prediabetes worse and increase our likelihood of developing diabetes in the future.
Avoid soft drinks and made-to-order sweet drinks, like bubble tea, as much as possible. Daily sugar calories should be limited to not more than 180 kcal for an adult female and not more than 210 for an adult male. One cup of bubble tea, for example, contains enough sugar to reach the daily recommended intake. If you are craving a healthy sweet treat, try eating fruits. Fruits like apples, blueberries, and oranges have a low glycaemic index, meaning they will not cause blood sugar levels to rise quickly after you have eaten them.
3. Drink Less Alcohol
Alcohol may not be good for people with prediabetes as it can reduce our body’s ability to manage blood sugar levels. Heavy drinking can cause blood sugars to drop below healthy levels. When blood sugar levels fall below normal levels, it can cause dizziness and shakiness. Drinking a lot of alcohol can also contribute to other chronic illnesses like liver cirrhosis.
A general rule of thumb is that women should not have more than one standard drink a day while men should not have more than two standard drinks a day. A standard drink is equivalent to one can of beer, half a glass of wine, or one nip of spirits like whiskey or gin.
4. Eat Healthier Foods
Prediabetes can also be improved if we add more healthy foods to our diet. A healthy diet would include complex carbohydrates, protein, and fibre.
Complex carbohydrates give us energy over a longer period of time. They can be found in whole-grain foods like brown rice and wholemeal bread, and in starchy vegetables like potatoes. Protein in foods like meat, fish and eggs helps in blood sugar control and losing body fat. If you are vegetarian or vegan, you can also find protein in plant-based foods like tofu, lentils, and chickpeas. Fibre causes food to be digested slower which makes us get hungry less quickly. When we get hungry less quickly, we are therefore less likely to snack, helping us manage our blood sugar levels. Green leafy vegetables, like celery or kai lan, are a good source of fibre.
You can use the My Healthy Plate application by the Health Promotion Board to plan well-balanced meals to achieve a healthy diet.
5. Get Sufficient Sleep
Prediabetes can be caused or become more serious if we get too little sleep. Getting insufficient sleep can make our bodies less sensitive to insulin. When our body’s resistance to insulin is affected, it becomes harder for our bodies to control blood sugar well. High blood sugar levels can also affect our sleep quality, making it harder for our bodies to get the rest it needs.
Healthy adults should aim to get 7 to 8 hours of sleep a night. To get a good night’s rest, make sure your room is dark and comfortable so that it is easier for you to fall asleep when you get in bed. Avoid using electronics shortly before bed as the blue light from computer and phone screens can make us feel more awake, making it harder to go to sleep.
6. Keep an Active Lifestyle
Adding more physical activity to your lifestyle can increase your body’s sensitivity to insulin. Different types of exercise also have other benefits like improving fitness, muscle mass and balance. You should try to incorporate different types of exercise like aerobic exercises, strength training and flexibility exercises into your daily schedule.
7. Lose Weight
Being overweight is a risk factor for prediabetes to progress to diabetes. Weight is measured relative to height according to the Body-Mass Index, or BMI. You can calculate your BMI using the Health Promotion Board’s online BMI Calculator. Having a BMI between 18.5 to 23 means that you have a healthy body weight.
Aerobic exercises are helpful for weight loss as they focus on removing extra calories, making them useful for reversing prediabetes. Examples of aerobic exercises include cycling, swimming, running and even brisk walking. Aim to balance regular aerobic exercise with a well-balanced diet to achieve weight loss.
8. Reduce Portion Sizes
Reducing the portion size in your meals can help to reverse prediabetes by cutting down the number of calories you take in. All food contains calories that provide the daily energy our body needs. However, eating too many calories can cause us to gain weight easily. It can be helpful for people with prediabetes to watch their caloric intake as being overweight can lead to a higher risk of diabetes in the future.
9. Quit Smoking
The nicotine found in cigarettes can increase the risk of prediabetes progressing to diabetes. Nicotine makes insulin less effective, causing the body to require more insulin to keep blood sugar at a healthy level. The health problems that smoking can bring, like lung disease and heart failure, could make prediabetes even harder to manage. Stopping smoking can reduce your risk of serious health problems.
10. Visit your Healthcare Provider Regularly
If you have been diagnosed with prediabetes, you should follow up regularly with your healthcare provider. Your healthcare provider can help you monitor your blood sugar levels to check your progress. They can also advise you on the next steps to take to manage prediabetes.
Our Care Professionals at Homage can help with managing prediabetes and diabetes. Our team doctors, nurses, therapists and caregivers can help with vital signs monitoring, medication prescription and administration and developing a personalised exercise plan just for you.
Prediabetes can be a serious condition, but the good news is, it’s reversible! Changing our lifestyle and avoiding activities and foods that can make it worse can help to manage prediabetes. We hope this article can help you take a few simple steps towards reversing prediabetes today.
If you have or are at risk of prediabetes, our house call doctors can give you personalised advice on your diet and share tips on how to better manage the condition. You can also consult a doctor online through a video call.
Take action today to reverse prediabetes. Call our care advisors at 6100 0055 to learn more about how we can help.
- Baker, J. A. (2020, December 29). Sweeter than soda? The hidden sugars in bubble tea. CNA. https://www.channelnewsasia.com/news/singapore/bubble-tea-sugar-content-sweeter-than-coke-soda-11063316
- BMI Calculator. (n.d.). HealthHub. Retrieved February 15, 2021, from https://www.healthhub.sg/programmes/93/bmi-calculator
- Boh, S. (2017, October 16). Why are Singaporeans so prone to diabetes? They can’t produce enough insulin. The Straits Times. https://www.straitstimes.com/singapore/why-are-singaporeans-so-prone-to-diabetes-they-cant-produce-enough-insulin
- Campbell, A. P., & Rains, T. M. (2014). Dietary Protein Is Important in the Practical Management of Prediabetes and Type 2 Diabetes. The Journal of Nutrition, 145(1), 164S-169S. https://doi.org/10.3945/jn.114.194878
- Carbohydrates | American Heart Association. (2018, April 16). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/carbohydrates
- Center for Tobacco Products. (2020, May 4). Cigarette Smoking: A Risk Factor for Type 2 Diabetes. U.S. Food and Drug Administration. https://www.fda.gov/tobacco-products/health-information/cigarette-smoking-risk-factor-type-2-diabetes#:%7E:text=Smokers%20are%2030%20to%2040,type%202%20diabetes%20than%20nonsmokers.&text=Smoking%20can%20also%20make%20managing,to%20regulate%20blood%20sugar%20levels.
- Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care, 39(11), 2065–2079. https://doi.org/10.2337/dc16-1728
- Contributor, N. T. (2019, August 3). An easy guide to mmols. Nursing Times. https://www.nursingtimes.net/students/an-easy-guide-to-mmols-09-02-2012/
- Harvard Health Publishing. (2012, March). Cutting calories to control diabetes. Harvard Health. https://www.health.harvard.edu/healthbeat/cutting-calories-to-control-diabetes
- Harvard Health Publishing. (2020, January 6). Glycemic index for 60+ foods. Harvard Health. https://www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods
- Lim, J. (2016, April 13). Singapore is No. 2 nation with most diabetics: 5 things about diabetes. The Straits Times. https://www.straitstimes.com/singapore/singapore-is-no-2-nation-with-most-diabetics-5-things-about-diabetes
- Nathan, D. M., Davidson, M. B., DeFronzo, R. A., Heine, R. J., Henry, R. R., Pratley, R., & Zinman, B. (2007). Impaired Fasting Glucose and Impaired Glucose Tolerance: Implications for care. Diabetes Care, 30(3), 753–759. https://doi.org/10.2337/dc07-9920
- Ministry of Health Singapore. (2017, November 14). MOH | MINISTRY OF HEALTH STUDYING MEASURES TO BETTER SUPPORT PERSONS WITH PRE-DIABETES [Press release]. https://www.moh.gov.sg/news-highlights/details/ministry-of-health-studying-measures-to-better-support-persons-with-pre-diabetes
- My Healthy Plate. (n.d.). HealthHub. Retrieved February 14, 2021, from https://www.healthhub.sg/programmes/55/my-healthy-plate
- Pre-diabetes. (n.d.). Healthdirect. Retrieved February 10, 2021, from https://www.healthdirect.gov.au/pre-diabetes
- Prediabetes – Your Chance to Prevent Type 2 Diabetes. (2020, January 8). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/prediabetes.html.
- Sleep & Glucose: How Blood Sugar Can Affect Rest. (2020, December 4). Sleep Foundation. https://www.sleepfoundation.org/physical-health/sleep-and-blood-glucose-levels
- Wong, L. Y., Toh, M. P. H. S., & Tham, L. W. C. (2016). Projection of prediabetes and diabetes population size in Singapore using a dynamic Markov model. Journal of Diabetes, 9(1), 65–75. https://doi.org/10.1111/1753-0407.12384
- What is a Healthy Weight? (n.d.). HealthHub. Retrieved February 14, 2021, from https://www.healthhub.sg/live-healthy/410/Healthy%20Weight