The number of adults estimated to be living with diabetes has nearly quadrupled over 35 years, the World Health Organisation (WHO) has said, warning that it has increased drastically because of "the way people eat, move and live".

Singapore has the second-highest proportion of diabetics among developed nations, a report in 2015, by the International Diabetes Federation (IDF) revealed.

In honour of World Health Day on April 7, we take a look at diabetes and its treatment options.

1. Key Facts



Students perform a flash mob at the Ministry of Health in Hanoi, Vietnam, on April 7, 2016. PHOTO: EPA



Diabetes is caused by having too much sugar in the blood. Insulin is a hormone that controls blood glucose levels.

There are two types of diabetes.

Type 1 is genetic and unpreventable. It occurs because the pancreas naturally does not produce enough insulin.

Type 2, related to weight management, is caused by lifestyle factors such as alcohol intake and a lack of exercise.

Obese people are at risk of developing Type 2 diabetes, which is a result of blocked or reduced insulin receptors. Over 90 per cent of diabetics suffer from Type 2 diabetes.

A diabetic registers at least 11.1 mmol/l for blood sugar levels taken after two hours in an oral glucose tolerance test (OGTT).

Poor control of diabetes can cause blood circulation problems and the formation of foot ulcers that may require amputation.

Complications of diabetes include heart disease, blindness and kidney failure.

2. Prevention



A man has his blood glucose screening at the Ministry of Health in Hanoi, Vietnam, on April 7, 2016. PHOTO: EPA



Diabetes can be prevented, at the pre-diabetes stage. Pre-diabetics have a reading between 7.8 and 11 mmol/l for blood sugar levels, two hours after an OGTT test.

In Singapore, 12 per cent of the population suffer from pre-diabetes. One-third of which will become diabetic, another one-third will remain pre-diabetic. With exercise and weight-loss, the remaining one-third can revert to normal glucose levels.

"If a pre-diabetic could lose 5-7% of body weight and increase exercise, the rate of progression from pre-diabetes to diabetes could be halved," Professor George Dailey, a senior consultant in the division of Diabetics & Endocrinology at Scripps Clinic, California, said.

Exercise and lifestyle changes help both diabetics and pre-diabetics.

3.Exercise



Regular exercise leads to increased metabolism. PHOTO: ST FILE



Regular exercise leads to increased metabolism. Muscles adapt to take up more blood sugar, in response to increased activity. This lowers the sugar levels in the blood.

"Some studies have shown an increase in glucose sensitivity for at least 16 hours from just a single session of exercise," said Mr Ray Loh, an exercise physiologist at the Sports Medicine and Surgery Clinic at Tan Tock Seng Hospital.

However, diabetics require different amounts of exercise, depending on how fit they are.

Dr Joan Khoo, consultant endocrinologist and director of Changi General Hospital's Diabetes Centre, recommends 150 minutes a week of moderate aerobic exercise, like brisk walking, cycling and swimming, for most patients.

To prevent over-exertion, the number of hours should be distributed across at least three days a week.

Diabetics should consult their doctors before deciding on a suitable exercise programme.

All diabetics should wear comfortable shoes to exercise.

Over time, some diabetics develop peripheral neuropathy, which is nerve damage in the arms and legs. They are less sensitive to injury or pressure. Hence, they may develop blisters and sores after exercising, without proper footwear.

Test your blood sugar with a glucose meter before, during and after exercise. The body draws on sugar from the blood, after the body uses up reserve sugar in the muscles and liver.

If your blood sugar before exercise exceeds 13.9 mmol/l, take a urine test before exercising. Refrain from exercising if the urine test registers the presence of ketones.

Ketones are a sign that the body's insulin levels are too low to break down sugar for energy.

Instead, the body breaks down fat, producing ketones. Ketones will cause the urine test strip to turn from beige to purple.

The darker the shade of purple, the higher the level of ketones in the urine.

Diabetics with high levels of ketones can develop diabetic ketoacidosis, a life-threatening condition.

They should consult their doctors and reduce blood sugar levels, so they can exercise safely.

4. Eating habits



People with Type 2 diabetes can reduce their blood sugar levels by eating in moderation and losing weight. PHOTO: ST FILE



People with Type 2 diabetes can reduce their blood sugar levels by eating in moderation and losing weight.

Carbohydrates are the nutrients that break down to form blood sugar. They are the body's main source of energy.

A common myth is that diabetics should avoid carbohydrates. Everyone needs carbohydrates, but diabetics are recommended to consume them in moderate portions, according to Health Promotion Board.

Meal replacements, like low-calorie drinks and nutrition bars, contain slow-releasing carbohydrates in moderate amounts.

Slow-releasing carbohydrates keep blood sugar levels constant. Meal replacements also contain vitamins and minerals.

Soft drinks often contain high levels of sugar. Consuming two or more soft drinks a week leads to a 30 or 40 per cent higher chance of contracting type 2 diabetes, said Associate Professor Koh Woon Puay of the Yong Loo Lin School of Medicine.

Space out meals. The body's sugar levels increase after every meal and it takes two hours for sugar levels to return to pre-meal levels.

5.Taking medicine regularly



Medicine for diabetes. PHOTO: THE NEW PAPER



Half of diabetics do not take their medication regularly, according to survey results released by the Diabetic Society of Singapore in August 2012.

Slightly more than one in four, or 27 per cent of respondents, said it was frustrating to take different types of oral tablets, the same study revealed.

Diabetics can opt for combination pills, like Kombiglyze XR.

Approved for use in February 2012, it combines two existing types of medication called saxagliptin and metformin. Most patients need to take it only once a day, with dinner.

Both types of medication reduce blood sugar levels, but metformin works on the liver and saxagliptin affects the pancreas.

Taken on its own, the short-acting version of metformin is consumed twice a day, while the long-acting one is consumed once.

Saxagliptin is taken once a day.

Before consuming medication, diabetics should check with their doctors about any potential side effects of the pills.

Sources: American Diabetes Association, Mayo Clinic, Health Promotion Board, MSD, Kombiglyze XR