Font Sizes:

Guide to Managing Diabetes

You can lead a fulfilling life even with diabetes!

/sites/assets/Assets/Programs/WOD/images/guide-to-managing-diabetes.jpg?Width=140&Height=140

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

You can lead a fulfilling life even
with diabetes!

Eat sensibly, get active and take your medication regularly

Diabetes is Serious

What is diabetes?

Diabetes is a condition where your body cannot manage sugar properly resulting in too much sugar in your blood.

What is pre-diabetes?

Pre-diabetes is when your blood sugar levels are higher than normal but not high enough to be diagnosed with diabetes.

Diabetes is a Serious yet Common
Condition in Singapore!

1 in 3 Singaporeans is at risk of developing diabetes

1 in 9 Singaporeans has diabetes

1 in 3 individuals with diabetes does not know he or she has it

1 in 3 individuals diagnosed with diabetes continues to have high blood sugar levels

2 in 3 individuals individuals with newly diagnosed kidney failure have diabetes

1 in 3 individuals individuals with diabetes have eye disease

About 4 individuals with diabetes undergo amputations everyday

Complications

Diabetes can Cause Complications for
Your Body

Risk Factors

What Increases Your Risk of Developing
Pre-diabetes and Type 2 Diabetes?

Family member(s)
known to have diabetes

History of diabetes
during pregnancy

40 years of age
and above

Body Mass Index (BMI)
of 23.0 kg/m2 or higher

Inactive
(sedentary) lifestyle

Unhealthy
eating habits

How Diabetes Develops

1
Blood sugar levels spike
Blood sugar levels spike when you eat food
rich in sugar and/or refined carbohydrates

White rice

Noodles

Prata

White bread

Kueh

Fruit juices and sugar-sweetened beverages

2
Pancreas works harder
High blood sugar levels cause
your pancreas (insulin factory) to work harder

Overworked pancreas

Frequent intake of sugar and refined carbohydrates causes stress, fatigue and eventual damage to your constantly overworked pancreas.

Insulin is a hormone that helps to control the blood sugar level in your body.

3
Excess sugar stored as fat
Excess (unused) sugar in your body is stored
as fat

Where is the fat located?

Apple-shaped body

Consequences of excess fat in the body
  • High blood sugar
  • High blood pressure
  • High cholesterol

There may be excess fat in your body even if you look thin

4
Excess internal fat causes damage
Excess internal fat can cause damage

Healthy organs

Normal insulin level

Normal blood sugar level

Fatty organs

Pancreas produces less insulin

High blood sugar level

5
Cells less sensitive to insulin
How insulin works in a healthy person

Insulin moves sugar (glucose) into the cells, which is then used to generate energy and maintain normal body functions.

Excess internal fat makes cells less sensitive to insulin

Body cells cannot sense insulin properly so the pancreas has to produce more insulin to do the same work.

Managing Your Condition

1
Stay in the Healthy Range
Manage pre-diabetes and type 2 diabetes well

Speak with your care team as your targets may vary

Healthy eating habits and regular physical activity and exercise can help you achieve target levels of blood sugar, blood pressure and cholesterol.

2
Eat Healthy
My Healthy Plate

Eat 2 servings of fruit daily, by having fruit with or in between meals

  • Choose water
  • Use healthier oils
  • Be active
My Healthy Plate
  • ¼ plate
  • Wholegrains

e.g. brown rice, multigrain bread, rolled oats

  • ¼ plate
  • Meat, tofu and others

e.g. chicken breast, fish, tofu, legumes, lean meat

  • ½ plate
  • Vegetables

e.g. leafy greens, eggplant, mushrooms

  • 1 serving
  • Fruit

e.g. 1 medium apple, 1 handful of blueberries, 1 wedge of papaya

Complete your meal with 1 serving of fruit
My Healthy Plate: Chinese
My Healthy Plate: Malay
My Healthy Plate: Indian
My Healthy Plate: Western
  • Choose water
  • Use healthier oils
  • Be active
3
Get Active
Regular physical activity benefits you in many ways

Improves productivity Boosts attention, memory and creativity

Improves overall mood Reduces stress and improves mental health

Increases health benefits Reduces risk of colon cancer, heart diseases, diabetes and high blood pressure

Increases fitness levels Improves strength and stamina

4
First Small Steps: Food
My first small step towards My Healthy Plate

Bak chor mee Have more vegetables

Nasi briyani Have less rice or noodles

Mee rebus Have less gravy, leave
the gravy behind

5
First Small Steps: Drinks
My first small step towards healthier drink choices
6
First Small Steps: Activity
My first small step towards getting
active everyday

Take the stairs instead of the lift

Brisk walk for 10 minutes

Walk around every hour

Take 10,000 steps daily

Get off one bus stop earlier and walk

Exercise with family and friends

T & CM

Examples of Traditional and
Complementary Medicine (T&CM)

Traditional Chinese Medicine and acupuncture

Traditional medicines like Ayurveda

Herbal medicines and supplements

What I need to do if I am on T&CM

Continue with Western medicine unless otherwise advised by your doctor

Seek advice from a T&CM practitioner before taking herbal medicines or supplements

Continue to monitor your blood sugar as advised

What I need to know about T&CM

In Singapore, Traditional Medicine (TM) typically refers to Traditional Chinese Medicine (TCM), Traditional Malay Medicine (TMM) and Traditional Indian Medicine (TIM), while Complementary Medicine (CM) refers to all other forms of medicine that are non-mainstream, e.g. chiropractic, osteopathy, aromatherapy, etc.

Scientific studies on effectiveness of T&CM for diabetes and its complications are inconclusive or insufficient.

Only Traditional Chinese Medicine practitioners are licensed in Singapore.
List of TCM practitioners www.tcmpb.gov.sg

Caregivers and Family

1
Signs and Symptoms of Stress
Am I experiencing caregiver stress?

Common signs and symptoms

Finding no meaning in caregiving

Loss of appetite

Insomnia

Chronic fatigue

Feeling hopeless and helpless

Withdrawal from family and friends

2
Managing Stress
How can I manage caregiver stress?

Practise Self-Care

Get enough rest

Positive self-talk

Physical activities and other hobbies

Meditation, yoga, taichi, or qigong

Seek Support

Talk to supportive friends and family

Join support groups

Make use of respite care

Seek professional help

3
A healthier life together
How can I help my loved one live a healthier
life?

Cook and have healthy meals together

Walk or exercise together

Accompany your loved one to medical appointments

Praise your loved one for self-management efforts

Plan social events around diverse activities

Pair healthy food with positive events

Food Choices

Fibre-rich food

Wholegrain starchy food

Whole fruit

Fruit juices

Dried Fruit

Meat and alternatives

Skinless chicken breast

Beans

Lentils

Egg

Prawn, white fish, salmon

Tofu

Fruit

Dragon fruit

Guava

Papaya

Pear

Orange

Apple

Vegetables

Broccoli

Eggplant

Capsicum

Cabbage

Kailan

Mushrooms

Starchy Vegetables
(counted as carbohydrates)

Potato

Sweet Potato

Yam

Corn

Pumpkin

Peas

Meal Choices

Consider your meal choices, whenever possible
  • Different food types have varied effects on how blood sugar is released
  • The Glycaemic Index (GI) ranks the carbohydrates in food according to how they affect blood sugar levels
  • Carbohydrates with a low GI value are digested slowly and cause a lower and slower rise in blood sugar levels
  • Carbohydrates with a high GI value are digested at a faster rate and cause a very sudden increase in blood sugar levels

Did you know?
Excess sugar in your body is converted to fat and stored in your body

Cooking Tips

How can I cook healthy and yummy meals?

Healthier cooking methods

Stir fry

Boil or steam

Grill or bake

Reduce salt, instead use natural seasonings (e.g. herbs and spices)

Choose healthier cooking oil (e.g. sunflower, olive or canola)

Remove all visible fat before cooking

Festivities

How can I continue with healthy eating during
festivals and celebrations?

Plan meals ahead

Opt for healthier products

Use healthier cooking methods

Eat in moderation

Avoid alcohol as much as possible

Maintain medication schedule and insulin dosage

Opt for healthier products

  • Choose a variety of vegetables and wholegrain food

Use healthier cooking methods

  • Stir fry, boil or steam, bake or grill

Avoid alcohol as much as possible

  • Do not drink alcohol on an empty stomach.
  • If drinking alcohol is unavoidable – limit to 1 standard drink per day (10 g of alcohol)

Appropriate Exercises

What exercises are appropriate for me?
Step 1: Determine mobility level
1. On your own, do you have any difficulty standing up from a seated position without using your arms? Yes No
2. On your own, do you have any difficulty walking for about 1 bus stop (~400m) without resting and using walking aids? Yes No
3. On your own, do you have any difficulty climbing up 10 steps without resting, using handrails or walking aids? Yes No
4. On your own, do you have any difficulty getting up from the floor without using furniture or other aids? Yes No

Count how often you answer ‘Yes’

  • Full mobility

    ‘Yes’ 0 or 1 time

  • Limited mobility

    ‘Yes’ 2 or more times

Step 2: Determine activity level
Sedentary

seldom exercise

Semi-active

some exercise

30 minutes, 3 times per week, at less than moderate intensity (can talk but can’t sing), for past 3 months

Active

regular exercise

30 minutes, 3 times per week, at moderate intensity (can talk but can’t sing) to high intensity (can only say a few words) for past 3 months

Step 3: Get relevant handouts

Each category refers to a set of physical exercises customised for the patient’s mobility and activity levels. This assessment tool is designed for use by individuals as a guide to calibrate their physical activity based on their mobility and activity levels. Complete steps 1 to 3 to identify the relevant category of handouts for the individual.

Exercise Recommendations

Exercise Recommendations

F

Frequency

3 to 7 days per week

I

Intensity (moderate)

Can talk but can’t sing while exercising

T

Time

Aim for 30 minutes per day, 5 days per week or 150 minutes per week

One way to keep FIT is enjoying 30 minutes
of brisk walking, 5 days per week

Exercise Safely

How can I exercise safely?

Start slow if you have not been physically active

Wear comfortable clothing and appropriate footwear (well-fitted shoes with adequate support)

Check your feet for wounds before and after exercising

Exercise at a cooler time (mornings or evenings, or in a cooler environment)

Bring along healthy snacks or sugar-containing sweets, in case of hypoglycaemia (low blood sugar)

Keep hydrated

Exercise with family and friends

When exercising, please rest or stop if you experience

Symptoms of hypoglycaemia (low blood sugar of < 4 mmol/L)

Hunger

Hand tremors

Abnormally fast heartbeat

Fatigue

Mood changes (e.g. anxiety, irritability, nervousness)

Dizziness or headaches

Or any of these symptoms

Difficulty breathing

Pain (especially in the chest or abdomen)

To note: Delay or postpone exercise if you are feeling unwell. Always listen to your body.

Monitoring

1
How to monitor
Different ways to test your blood sugar level
Done at home using a glucometer
What is blood sugar level?

“At the moment” level of sugar (glucose) in your blood

Done at the clinic
What is HbA1c?

(Glycosylated haemoglobin)

  • Sugar (glucose) attached to protein in red blood cells
  • Shows your average blood sugar level over 3 months
For individuals with type 2 diabetes, consider self-monitoring (using a glucometer), if you are
  • At increased risk of developing hypoglycaemia (low blood sugar)
  • Pregnant with pre-existing diabetes or Gestational Diabetes Mellitus (GDM)
  • Experiencing acute illness
  • Having difficulty achieving glycaemic goals
  • Fasting for religious reasons (e.g. Ramadan)
2
When to monitor
When to test your blood sugar level

Before a meal or 2 hours after

When you experience hypoglycaemia (low blood sugar) symptoms (e.g dizziness, hunger

Before or after exercise

When you are sick and not feeling well

Monitor your blood sugar level before and after meals
Too High

Risk of hyperglycaemia

Before food

> 7.0 mmol/L

2 hours after food

> 10.0 mmol/L

Optimal
Before food

4.0 to 10.0 mmol/L

2 hours after food

4.0 to 10.0 mmol/L

Too Low

Risk of hypoglycaemia

Before food

< 4.0 mmol/L

2 hours after food

< 4.0 mmol/L

Your targets may vary depending on your condition; discuss this with your doctor or care team.

3
Hypoglycaemia low blood sugar
Common signs and symptoms of
HYPOglycaemia
(low blood sugar of < 4 mmol/L)

Hunger

Hand tremors

Abnormally fast heartbeat

Fatigue

Mood changes (e.g. anxiety, irritability, nervousness)

Dizziness or headaches

Changes in behaviour (e.g. confusion, weakness, unclear speech)

Drowsiness

If you experience HYPOglycaemia symptoms
or your blood sugar level is low (< 4 mmol/L)
  • Step 1
  • Drink half a glass
    of sweetened drink.

    OR

    Eat 3 soft candies (sugar-containing)
    or sugar (glucose) tablets.

  • Step 2
  • After 15 minutes, check blood sugar level.

  • If symptoms persist or blood sugar level is low (< 4 mmol/L), repeat steps 1 & 2 one time.

    If symptoms persist after second attempt, seek medical advice (if your doctor is unavailable and it is an emergency, head to the A&E).

    If symptoms resolve or
    blood sugar level is ≥ 4 mmol/L, go to step 3.

  • Step 3
  • Eat a light snack (e.g. bread, biscuits) or have your next meal earlier to prevent blood sugar levels from dropping again.

  • Record what happened prior to experiencing hypoglycaemia. If hypoglycaemia is
    frequent, do a medication check with your doctor.

How can I prevent HYPOglycaemia
(low blood sugar)

Do not skip meals even when busy.

Bring a few sugar-containing sweets along whenever you go out

Eat extra carbohydrates before any exercise or strenuous activity

Do not take diabetes medication or insulin injection in the morning when fasting for a blood test

Closely follow instructions on when to take your medication, especially in relation to meals

If you experience hypoglycaemia frequently, check with your doctor if your medication needs adjustment

4
Hyperglycaemia high blood sugar
Common signs and symptoms of
HYPERglycaemia
(high blood sugar)

Increased thirst

Frequent urination

Increased hunger

Blurred vision

Headachess

Weight loss

Slow-healing cuts

Blood sugar level > 15 mmol/L

If you experience HYPERglycaemia symptoms
or your blood sugar level is high (> 15 mmol/L)
1

Check your blood sugar level more often

2

Drink plenty of plain water

3

Seek medical advice if your blood sugar level is persistently > 15 mmol/L (i.e. remaining very high for more than 24 hours)

5
Regular checkups
Go for your regular check up to detect and
prevent complications

The frequency of tests may vary depending on your condition

Assessment/Test
At least every 3 to 6 months
  • Weight and height (BMI)
  • Blood pressure
  • HbA1c (blood sugar)
  • Stress, emotional well-being
Assessment/Test
At least once a year
  • Lipid profile (cholesterol)
  • Kidneys
  • Eyes
  • Feet

Kidney failure

Blindness

Amputation

Heart attack

Stroke

Treatment

1
How medications work
Medications work in different ways, on different body parts
A

Liver, fat tissues and muscles
E.g. Pioglitazone, metformin

Reduces amount of sugar made by the liver, and increases the sensitivity of fat, liver and muscle cells to insulin

B

Liver and pancreas
E.g. Linagliptin, sitagliptin

Helps the pancreas produce more insulin and reduce amount of sugar made by the liver

C

Kidneys
E.g. Dapagliflozin, empagliflozin

Prevents the kidneys from re-absorbing sugar

D

Intestines
E.g. Acarbose

Slows down breakdown of starch and absorption of sugar from the intestines

E

Pancreas
E.g. Glipizide, tolbutamide, gliclazide

Helps the pancreas produce more insulin

2
Taking medications
Take your medication as prescribed

Take your medication(s) regularly at the correct time(s)

If you miss a dose, take it as soon as you remember; if it is time for the next dose, skip the missed dose

Eat meals regularly to prevent hypoglycaemia (low blood sugar)

Avoid taking alcohol with medication

Inform your healthcare professional if you are:

Taking metformin before going for any scans (e.g. X-ray) or procedures

Pregnant or planning to get pregnant before taking medication

Experiencing persistent symptoms of hypoglycaemia (low blood sugar)

3
Insulin therapy
Insulin therapy
Insulin injections can help
  • Improve blood sugar control
  • Prevent or delay complications
Insulin injections may cause
  • Hypoglycaemia (low blood sugar)
  • Potential weight gain
Insulin allows sugar (glucose) into the body cell
How different types of insulin affect your blood sugar level throughout the day
Legend
  • Mealtime insulin
  • Basal insulin (long-acting or intermediate acting)
4
How to inject insulin
Part 1: How to draw insulin from a vial
Gather your supplies

1. Vial

2. Syringe and plunger

3. Swab

Preparation

Follow these steps to prepare your single or mixed insulin

1. Gather your supplies
(syringe, insulin, alcohol swabs)

2. Wash your hands with soap and running water then dry your hands thoroughly

3. Roll the vial insulin (if the insulin is cloudy)
between the palms of your hands to mix it and/or warm it up to body temperature

4. Clean the rubber stopper on the vial with an alcohol swab

Part 2: How to draw a dose (single)
If you are drawing a SINGLE dose

After completing part 1 (preparation), follow these steps to draw a SINGLE dose of insulin into the syringe

1. Draw air into the syringe to the level prescribed for your insulin dose

2. With the vial standing upright, inject the air dose into the vial by pushing down the plunger

3. Turn the vial and syringe upside down, ensure the needle tip is covered by the liquid

4. Pull back the plunger to withdraw insulin to the level of the prescribed dose

5. Gently flick the side of the syringe to remove air bubbles, if needed

Part 2: How to draw a dose (mixed)
If you are drawing a MIXED (clear + cloudy insulin) dose

After completing part 1 (preparation), follow these steps to draw a MIXED dose of insulin into the syringe

1. Draw air into the syringe to the level prescribed for your cloudy insulin dose

2. Insert the syring into the cloudy vial and infect the air dose into the vial by pushing down the plunger remove the syringe without drawing the insulin

3. Draw air into the syringe to the level prescribed for your clear insulin dose

4. Inject the air dose into the clear vial in an upright position

5. Turn the vial and syringe upside down ensure the needle tip is covered by the liquid

6. Slowly pull back the plunger to withdraw clear insulin to the level prescribed

7. Removed the partly filled syringe from the clear vial and insert it in the vial of cloudy insulin

8. Turn the vial and syringe upside down, and slowly withdraw to the level prescribed for total amount of insulin (clear + cloudy)

Part 3: How to inject insulin

Step-by-step guide to injecting insulin into your chosen site

1. Clean your chosen site with water and tissue

2. Lift the skin with your thumb and finger on the chosen site. With your other hand, hold the syringe (like a pencil, keeping fingers off the plunger) close to the chosen site at a 90 degree angle

3. Push the syringe all the way into the pinched skin fold, then push the plunger all the way down to deliver insulin into the fatty tissue

4. withdraw the needle from the skin at the same angle that it was inserted and then release the skin fold

5
How to use an insulin pen
Insulin pen
How to prepare an insulin pen for injection

1. For cloudly insulin roll the pen in between your palms in a horizontal motion 10 times

2. Clean the rubber membraine with an alcohol swab before attaching the insulin needle onto the insulin pen

3. Dial 2 units by turning the dose selector

4. Hold the insulin pen with the needle upwards and tap the cartridge gently with your finger a few times to let air bubbles collect at the top of the cartridge

5. With the insulin pen still pointing upward, press the push button all the way (in the dose selector should return to "0", and a drop of insulin should appear at the needle tip)

6. Select the dose of insulin you need

How to inject insulin with an insulin pen
1

Wash your hands with a soap and water

2

Dry hands with a tissue paper or hand towel

3

Select the injection site at your abdominal area

4

Clean the chosen site with water and tissue

5

Wait for the site to dry

6

Pinch a skinfold using your thumb and index finger

7

Inject the insulin at 90 degrees perpendicular to the injection site

8

Inject the dose by pressing the push-button all the way in until '0'

9

Keep the push-button down fully for at least 6 seconds (to ensure the full dose has been injected) and as you withdraw the needle from your skin

10

Place the outer needle cap on the table. Direct the needle tip into the outer needle cap without holding on to it (to prevent finger stick injury). Unscrew and dispose the needle after it covered

11

Store the insulin pen at room temperature after injection, away from direct sunlight and heat

6
Where to inject insulin
Insulin Sites
Suitable sites for insulin injection

Visual guide to show where you can inject insulin

To note
  • Different sites absorb insulin at different rates. Insulin is absorbed the fastest in the abdomen and slowest in the thighs
  • Rotates sites (e.g right and left thigh) to avoid swelling as this may affect insulin absorption
Site rotation

Move 2 fingers along from your last insulin injection site

  • Rotate injection sites by moving 2 finger's breadth along from your last injection site until you have used an entire area
  • Move to a new injection area every 1 to 2 weeks
7
Storage and disposal of insulin
Insulin storage

Quick tips on storing and handling your insulin

1. Write the date on the vial on the day you open it

2. For open vials or pens, store them at room temperature and away form direct sunlight

3. For unused vials or pens, store them in the fridge, not the freezer

4. Avoid shaking the insulin vial excessively to prevent air bubbles forming

5. Discard the insulin if expired (30 days after openning), contaminated, or if there are insoluble particles

How to safely dispose of used syringes and insulin pen needles

Proper disposal protects cleaners from accidental injuries, and prevents your used syringes and insulin pen needles form falling into the wrong hands

1. Place used syringes and insulin pen needles in a hard puncture-resistant container with a securable lid

2. Label the container "Used syringes and insulin pen needles"

3. Seal the container when it is full

4. Discard the container down the rubbish chute or in a rubbish bin

To note: Discard all used syringes and insulin pen needles do not reuse them. Containers that are suitable for safe disposal must be hard plastic, metal or sharp container, such as an empty detergent bottle or metal tin

Foot and Dental Care

1
Foot complications
Poorly controlled diabetes can lead to foot
complications

Nerve damage can make your foot feel numb and change its shape, increasing your risk of getting calluses and ulcers.

Extremely poor blood circulation (vasculopathy) can cause wounds to heal poorly; an amputation may be required to save your life.

2
Foot care practices
Good foot care practices

Monitor feet every day
Watch out for:
Blister, wounds, corn, callus, or toenail abnormality
Redness, swelling, bruise, or increase warmth

Maintain good foot care and hygiene
Clean feet daily with mild soap and water
Use a pumice stone or foot file to gently remove hard skin
Avoid cutting nails too short; cut them straight across and file corners

Moisturise regularly
Avoid using harsh soap
Apply moisturiser daily but not between each toe
Avoid scrathing skin as it may lead wound or bleeding

Wear well-fitting and covered footwear
Wear well-fitting covered shoes with socks
Home sandals are recommended
Check and remove any stones or sharp object inside shoes before wearing them

Apply simple first aid for small wounds
Clean small wounds with saline before applying antiseptic and covering with a plaster
Home sandals are recommended
Seek medical help if there is no improvement after two days or if there is signs of inspection

Seek medical help if wound is not healing well or worsens
If signs of infection are present, such as redness, swelling, increased pain, pus, fever, or the wound start to smell, seek medical help as soon as possible

Seek immediate medical attention if your foot is cold, pale, discoloured, numb, painful or unable to move

Where to go for further help
  • Go to your doctor for advice, and if needed you can get a referal to a podiatrist for further management
  • Seek early review by a podiatrist if your foot feels numb (e.g you are unable to feel your footwear properly)
3
Footwear
Good footwear is important

Ideal features of supportive footwear

Remember to
  • Choose socks with tops that are not too tight
  • Wear a pair of cotton socks or stockings with your shoes at all times
  • Wear well-fitted covered shoes
  • Check and remove any stones or sharp object inside your shoes before wearing them
  • Use suitable footwear for different activities (e.g exercise with sports shoes, do daily shopping with sandals or sports shoes, and use bedroom slippers with cushioning at home
4
Oral care
Keep your mouth healthy

Brush your teeth and tongue at least twice a day (in the morning and before sleeping) for 2 minutes with fluoride toothpaste

Use a soft-bristled toothbrush; change every 3 months or when bristles spread out

If you wear dentures, clean them after every meal; remove, clean and soak dentures in water before sleeping

Clean in between your teeth with a floss or interdental brush at least once a day

Tilt the brush at an angle to your gum line, moving it in small circular motions across all front, back and chewing surfaces of your teeth, not forgetting the back molars

Visit a dentist every 6 months to 1 year to have your teeth checked; inform the dentist that you have diabetes, how your blood sugar control is and what medication you are taking

5
When to see the dentist
See your dentist if you have ...

Persistent bleeding gums

White patches in your mouth

Receding gum lines

Loose or shaky adult teeth and/or widening gaps between your adult teeth

Pain in your mouth

Bad breath or dry burning sensation in your mouth

Self-Care

1
Manage stress
How can I manage stress?

Physical and mental stress can affect blood sugar levels

Eat healthy

Stay active

Get enough rest

Plan well and prioritise your activities

Make time for yourself daily

Talk with someone who is supportive and understanding

Diabetes can increase stress
  • Accepting your diagnosis
  • Adjusting to treatment and changes in your life
  • Managing relationships

Physical and mental stress can change blood sugar levels

Examples of poor social support
  • The significance of your condition is downplayed
  • You are blamed for your condition
  • Your life is micromanaged
What to do if you experience poor social support
  • Share how you feel, including what was unhelpful
  • If negative support persists, seek professional help
Relaxation techniques
that can help to relieve stress

Deep breathing

Progressive muscle relaxation

Listening to music

Creative hobbies

Walking and other physical activities

Yoga, taichi, qigong and meditation

2
Fasting safely
How can I fast safely (for religious reasons)?
Before fasting

Consult your doctor if it is safe for you to fast

Adjust your diet with your healthcare professional

Adjust your medication or insulin dose with your doctor

During fasting

Self-monitor blood sugar levels regularly and check for symptoms of hypoglycaemia (low blood sugar)

If your blood sugar level is low (< 4 mmol/L), stop your fast and take a sweetened drink

If symptoms of low or high blood sugar persist, stop your fast and seek medical attention

When should I not fast?

Frequent hypoglycaemia (low blood sugar) or poorly controlled diabetes

Serious conditions such as nerve disorders, heart problems or uncontrolled hypertension

Pregnant or breastfeeding

Sick

Not been following your prescribed medication, diet and physical activities

3
Falling sick
What to do when I am sick?

Feeling unwell, e.g. fever, cough, runny nose, vomitting and diarrhoea

See your doctor

Get plenty of rest

Continue to take medication or insulin as prescribed

Check your blood sugar level more often

Drink plenty of water

Have small, frequent meals or fluids (e.g. soups, diluted juices or sweetened drinks)

When do I have to see my doctor?

Chest pains, shortness of breath, fruity breath, dry lips or tongue

Severe vomiting or diarrhoea for more than 6 hours

Blood sugar levels that are persistently low (< 4 mmol/L) or high (> 15 mmol/L)

Loss of appetite

Skin sores

4
Travelling overseas
How can I prepare for travel?

See your doctor for a vaccination, if possible

Check with your care team on medication and insulin dosage

Bring a medical letter or diabetes card regarding your diagnosis and medication

Get insurance coverage

Put necessary medication or insulin items in your carry-on bag

How can I manage my diabetes while abroad?

Drink plenty of water

Watch your food and calorie intake

Hand carry sugar-containing sweets

Always wear protective shoes

Hand carry medication or insulin items

Take medication as prescribed

Self-monitor your blood sugar level regularly

Know where to seek help

5
Alcohol
Alcohol affects medications and liver
functions, and causes HYPOglycaemia
(low blood sugar)

Don’t drink!If drinking is unavoidable:

Do not skip meals

Limit to 1 standard drink per day, choose light beer or wine spritzer

Choose low-calorie light beer or dilute mixers with water

Your blood sugar level is under control

You do not have low blood sugar (< 4 mmol/L) or experience low blood sugar symptoms

What is 1 standard drink?

300 ml light beer

100 ml wine

30 ml spirit or liqueur

Where to go for further help

National Addictions Management Service (NAMS)
6732 6837
https://www.nams.sg/

HPB QuitLine
1800 438 2000
https://www.healthhub.sg/programmes/88/IQuit

6
Smoking
Smoking increases risk of diabetes and its
complications, and insulin resistance

Quit smoking!Managing common withdrawal symptoms

Warn family and friends of potential irritability

Distract yourself by doing something else

Do light exercises like brisk walking to lift your mood

Take small, regular meals

Do stretching exercises

Join the I Quit 28-Day Countdown

Goals

1
Focus on what is important
Consider different areas of your life
and which of these are important to you

Relationships

Health and physical well-being

Work and career

Personal and spiritual growth

Recreation and leisure

Identify the areas of life that are important to you
  • What are some lifestyle changes you are thinking of making or have made?
  • How might/ did these changes contribute to important areas of your life?
2
Setting my goal
Setting my goal

Example of healthy eating goal

Step 1: Where do you want to be?
Where I am now:

“I love having fried chicken everyday!”

Where I want to be:

Manage my weight better
Eat more veggies and less fried food

This goal is important to me because:

I want to be healthier and look better

Step 2: Set your goal

I will ...

  • ActionStick to My Healthy Plate
  • Day/TimeLunchtime on Mondays and Thursdays
  • LocationAt work
  • Time periodFor the next 3 months
  • Start dateFrom 14 January
Step 3: Identify and work around potential barriers
1

What might get in the way
Colleagues suggest having fast food for lunch

What I can do
Suggest to try out eateries with healthier options

Person(s) who can help
My colleague James likes vegetables

2

What might get in the way
I have a particular craving for curry puffs when I’m stressed

What I can do
Unwind in other enjoyable ways, like walking or listening to music

Person(s) who can help
Walk and chat with my neighbour in the evening

3

What might get in the way
There is a stall that sells delicious fried food, on my way home

What I can do
Take an alternative path home

Person(s) who can help
NIL

Complete the handout
How important is it for you to change right
now?
How confident are you that you can make
this change?
3
Keeping up with my goal
Keeping up with my goal

Example of physical activity goal

Step 1: Write down the original goal

I will ...

  • ActionBrisk walk for 30 minutes
  • Day/TimeMondays, Wednesdays and Fridays after dinner at 8pm
  • LocationAlong the park connector
  • Time periodFor the next 4 weeks
  • Start dateFrom 18 June
Step 2: Solve the problem
1

What got in the way
I couldn’t get off work on time

How can I work around it?
Do lunchtime exercises or pick a day without 5pm meetings

2

What got in the way
Poor weather

How can I work around it?
Do indoor exercises

3

What got in the way
Low energy level

How can I work around it?
I can sleep earlier the night before or pick a weekend day to exercise earlier

Step 3: Revise your goal

I will ...

  • ActionDo lunchtime exercises and brisk walk
  • Day/TimeLunchtime exercise on Mondays
    Brisk walk on Wednesdays and Saturdays
  • LocationOffice gym, park connector
  • Time periodAnother 4 weeks
  • Start dateFrom 18 July
Complete the handout
How important is it for you to change right
now?
How confident are you that you can make
this change?

Finance

1
Outpatient Bill
How your outpatient bill may be covered
How your outpatient bill may be covered
1

Government Subsidies
Available at public specialist outpatient clinics (SOCs), polyclinics and CHAS GPs
Refer to government subsidy pages for more information

2

Employee benefits/Private Medical Insurances (PMIs)

3

MediSave/Chronic Disease Management Programme (CDMP)
Refer to MediSave pages for more information

4

Out-of-pocket payment (OOP)
This is determined after deducting government subsidies, available employee benefits and private medical insurances, and the amount that the patient wishes to deduct from MediSave

2
Subsidies
Government subsidies

at subsidised specialist outpatient clinics (SOCs) and polyclinics

Household with income
Household Monthly
Income Per Person
Subsidy at subsidised SOCs^Subsidy at
polyclinics

Additional PG / MG subsidy
Subsidised
services
Subsidised
medications
Subsidised
medications
for adults*
$1,200
and below
70%75%75% PG: Additional 50% off the remaining bill
MG: Additional 25% off the remaining bill
$1,201 to $2,00060%
Above $2,000/
Unassessed
50%50%50%
Households no income
Annual Value#
(AV) of Home
Subsidy at subsidised SOCs^Subsidy at
polyclinics

Additional PG / MG subsidy
Subsidised
services
Subsidised
medications
Subsidised
medications
for adults*
$13,000
and below
70%75%75% PG: Additional 50% off the remaining bill
MG: Additional 25% off the remaining bill
$13,001
to $21,000
60%
Above $21,000/
Unassessed
50%50%50%

^To receive subsidies for Public SOC visits, you will first need to be assessed and referred by a CHAS clinic or polyclinic. The doctor will refer you to a Public SOC as a subsidised patient where eligible

*Children (18 years or younger) and elderly (65 or older) already receive 75% subsidy for subsidised medications at the polyclinics

#The AV of your home is the estimated annual rent if it is rented out. It is assessed by IRAS.

Government subsidies at CHAS GPs

From 1 November 2019

PCHI (Per Capita
Household
Income)
Above $2,000$1,201 to $2,000$1,200 and belowAll Merdeka Generation seniors receive CHAS benefits,regardless of income or AV ofhomeAll Pioneersreceive CHAS benefits, regardless of income orAV of home
AV (Annual Value)
of Home
(For households with no income)
Above $21,000$13,001 to $21,000$13,000 and below
Acute (common
illnesses)
-Up to $10 per visitUp to $18.50 per
visit
Up to $23.50
per visit
Up to $28.50
per visit
Simple ChronicUp to $28 per visit, capped at $112 per yearUp to $50 per visit, capped at $200 per yearUp to $80 per visit, capped at $320 per yearUp to $85 per visit, capped at $340 per yearUp to $90 per visit, capped at $360 per year
Complex ChronicUp to $40 per visit, capped at $160 per yearUp to $80 per visit, capped at $320 per yearUp to $125 per visit, capped at $500 per yearUp to $130 per visit, capped at $520 per yearUp to $135 per visit, capped at $540 per year
Dental-$50 to $170.50 subsidy per procedure (denture, crown, root canal treatment only)$11 to $256.50 subsidy per procedure (dependent on procedure)$16 to $261.50 subsidy per procedure (dependent on procedure)$21 to $266.50 subsidy per procedure (dependent on procedure)
Recommended Health Screening under Screen for Life (SFL) Screen for life A fixed fee of $5 with SFL Invitation letter, for recommended screening test(s) and first post-screening consultation, if requiredA fixed fee of $2 with SFLInvitation letter, for recommendedscreening test(s) and first post-screeningconsultation, if requiredA fixed fee of $2 with SFL Invitation letter, for recommended screening test(s) and first post-screening consultation, if requiredFree with SFL Invitation letter, for recommended screening test(s) and first post-screening consultation, if required
Pioneer Generation eligibility
  • Born on or before 31 December 1949
  • Received citizenship by 31 December 1986
Merdeka Generation eligibility
  • Born from 1 Jan 1950 to 31 Dec 1959; and
  • Received citizenship on or before 31 Dec 1996
OR
  • Born on or before 31 Dec 1949; and
  • Received citizenship on or before 31 Dec 1996; and
  • Did not receive Pioneer Generation Package
Type of visit
Acute (common illnesses)
  • Capped at 24 visits for common illnesses per patient per calendar year, across all CHAS clinics, from 2020 onwards
Simple
  • “Simple” refers to visits for a single chronic condition
Complex
  • “Complex” refers to visits for multiple chronic conditions, or a single chronic condition with complication(s)

Refer to MediSave pages for the list of chronic conditions under the Chronic Disease Management Programme (CDMP) for CHAS Chronic conditions

Screen for Life
  • Recommended health screening refers to screening for diabetes, high blood pressure, high blood cholesterol, colorectal cancer and cervical cancer
3
MediSave for outpatient bills
Chronic Disease Management Programme (CDMP)
  • Specific chronic diseases
  • Requires 15% co-payment
  • Part of MediSave500, i.e. up to $500 per year
    - Patients can tap on accounts of immediate family members (i.e. spouse, parents and children)
    - Patients who are SC/PR can tap on grandchildren’s and sibling’s MediSave
To start using MediSave for the Chronic Disease Management Programme (CDMP)
  • Visit a clinic/ doctor who is registered with MediSave for CDMP to:
    - Be certified by a doctor that you have one of the listed chronic conditions
    - Sign the MediSave authorisation form
  • If you are using multiple accounts, your family members’ consent will have to be provided

 

1Patients can tap on accounts of immediately family members (i.e. spouse, parents and children); Patients who are SC/PR can tap on grandchildren’s and sibling's MediSave

2Patient’s own and spouse’s account may be used, provided spouse is also ≥ 60 years old

Flexi-MediSave
  • For patients ≥ 60 years old
  • Can be used for the 15% co-payment under CDMP
  • Up to $200 per patient per year2
  • Can be used at Specialist Outpatient
    - Patient’s own and spouse’s account may be used, provided spouse is also ≥ 60 years old
MediSave
  • National medical savings scheme
  • Can help to pay for personal or immediate family members’ hospitalisation, day surgery, and certain outpatient expenses
MediSave500
  • Scheme for outpatient care
Flexi-MediSave
  • Can be used at Specialist Outpatient Clinics (SOC) in public hospitals and national specialty centres, polyclinics, and participating Community Health Assist Scheme (CHAS) Medical GP clinics
Partners
Cluster Partners
Brought to you by
Acknowledgements
Patient Empowerment for Self-care Working Group
Chairperson
  • Dr Eric Khoo (NUH)
Advisors
  • Assoc Prof Sum Chee Fang (AdMC/KTPH)
  • Prof Tai E Shyong (NUHS)
Members
  • Dr Anthony Chao (Boon Lay Clinic & Surgery)
  • Mr Arumugam Ardhanari (Patient)
  • Ms Chee Ching Yee (SHP)
  • Ms Christine Chern (NHGP)
  • Ms Fidlya Binte Kamsani (Caregiver)
  • Dr Kalpana Bhaskaran (DS)
  • Dr Agnes Koong Ying Leng (SHP)
  • Ms Julia Lee (TOUCH Diabetes)
  • Ms Lim Poh Choo Patsy (SHP)
  • Mr Yong Ming Fung (AIC)
  • Dr Low Kang Yih (NHGP)
  • Ms Ng Soh Mui (NUP)
  • Dr Jonathan Pang (Frontier PCN)
  • Ms Christina Tan (Patient)
  • Dr David Tan Hsien Yung (NUP)
  • Ms Brenda Tan Yue Lin (HPB)
  • Dr Wong Mei Yin (NHGP)
Community Support Advisor
  • Ms Julie Seow (formerly Life Coach at TOUCH Diabetes)
Professional Groups
Association of Diabetes Educators Singapore (ADES)
  • Ms Lim Pei Kwee (KKH)
College of Family Physicians (CFPS)
  • Dr Ng Lee Beng (SGH)
Pharmaceutical Society of Singapore (PSS)
  • Ms Irene Quay Siew Ching (KKH)
  • Ms Debra Chan (TTSH)
  • Ms Lim Kae Shin (KKH)
  • Ms Lim Shu Fang (TTSH)
Podiatry Association Singapore (PAS)
  • Ms Heng Li Wen Marabelle (SGH)
Singapore Nutrition and Dietetics Association (SNDA)
  • Ms Ong Li Jiuen (CGH)
  • Mr Chad Han (NUH)
  • Ms Izabela Kerne (Advanced Laparoscopic Surgery)
  • Ms Koh Pei Ling (AdMC/ KTPH)
  • Ms Loh Win Nie (CGH)
Singapore Physiotherapy Association (SPA)
  • Mr Muhammad Jazimin Bin Haron (KTPH)
  • Ms Junisha Binte Jumala (CGH)
  • Dr Cindy Ng Li Whye (SGH)
  • Ms Soh Seok Chin Cindy (NHGP)
  • Ms Virginia Tai (SHF)
Sport Singapore, Ministry of Culture, Community and Youth (MCCY)
  • Mr Kenneth McGeough (Sport Singapore)
  • Mr Aw Boon Wei (Sport Singapore)
Singapore Tamil Teachers’ Union (STTU)





162
Guide to Managing Diabetes
Back to Top