Key Takeaways

• In people with type 2 diabetes, the body’s cells are less responsive to the hormone insulin.

• Insulin helps sugar pass from the blood into the cells in order to provide them with energy. When cells don’t respond normally to insulin, they are not able to take up sugar from the blood, and blood sugar levels rise.

• The major risk factors for type 2 diabetes include family history, being overweight, physical inactivity, and older age.

• Screening tests can catch type 2 diabetes in its early stages. This usually involves an HbA1c test or fasting glucose test.

• Lifestyle changes, including exercise and a healthy diet, are important in managing type 2 diabetes. Weight loss is often very beneficial.

• Medications can also be helpful. There are both oral and injectable options, with various pros and cons to each one. Different patients may benefit from different medication options.

Diabetes is a general term for a condition in which the body has trouble controlling blood sugar. There are several different types of diabetes, which have different origins. In people with type 2 diabetes, the body’s cells are resistant to insulin, which is a hormone that helps to keep blood sugar from rising too high.

Type 2 diabetes is by far the most common type, accounting for about 95% of all cases of diabetes. This type of diabetes is becoming increasingly common in Singapore, which is believed to be largely due to changes in lifestyle. 

Without proper management, type 2 diabetes can cause serious health complications, including kidney disease and vision loss. However, the risk of these complications can be significantly reduced by taking actions to help keep blood sugar under control. This involves lifestyle changes, such as a healthy diet and increased exercise. Some people with type 2 diabetes also benefit from taking oral or injectable medications that can help to control the condition. 

In people with type 1 diabetes, the body cannot make enough insulin, and they need to take insulin through injections or an insulin pump. Most people with type 2 diabetes do not need to take insulin, although it can be helpful in certain cases. 

Although it’s important to take type 2 diabetes seriously, it’s definitely possible for people who have this condition to live a long and healthy life. In fact, research has found that it’s possible to put type 2 diabetes into remission, which means that your blood sugar levels are under control without diabetes medications. It’s important to have the right medical support in order to help you gain control of your blood sugar and protect your long-term health.

Causes and Risk Factors of Type 2 Diabetes

Type 2 diabetes occurs because the body’s cells become resistant to insulin. This means that they don’t respond normally to insulin.

Normally, when blood sugar begins to rise after a meal, insulin is secreted. This hormone acts on many different cells throughout the body, causing them to take up glucose (sugar) from the blood and either use it for energy or store it for later. When the cells take up glucose, this removes it from the bloodstream, which keeps blood sugar levels from rising too high.

In people with type 2 diabetes, the body’s cells become insulin resistant, meaning that they don’t respond normally to insulin. Although insulin is produced, it’s not able to trigger the cells to take up glucose from the blood. Because of this, blood sugar levels can rise. 

Although anyone can potentially develop type 2 diabetes, certain factors make it much more likely. These include:

• Body weight. People who are significantly overweight are far more likely to develop type 2 diabetes. In fact, those with a body mass index (BMI) in the obese category are six to ten times more likely to develop type 2 diabetes as those who are thin. Maintaining a healthy body weight is one of the best ways to reduce your risk of type 2 diabetes.

• Family history. A person is more likely to develop type 2 diabetes if their parents or siblings also have this condition.

• Age. Type 2 diabetes becomes increasingly common as people get older, and usually develops in people aged 40 or above.

• Smoking. Smoking increases your risk for type 2 diabetes by 30 to 40%.

• Physical inactivity. Regular exercise helps to maintain a healthy body weight, and also helps to maintain insulin sensitivity in the cells, which reduces the risk of type 2 diabetes.

• Previous gestational diabetes. People who previously had gestational diabetes (which develops during pregnancy) are more likely to develop type 2 diabetes later in life.

• High blood pressure or cholesterol. People with high blood pressure, high triglycerides, or low HDL cholesterol (“good cholesterol”) are more likely to develop type 2 diabetes.

Symptoms of Diabetes Type 2

In the early stages, insulin resistance often doesn’t cause any symptoms. In fact, many people with type 2 diabetes are not aware that they have the condition. This is why screening tests are important. Even if you feel completely healthy, you could have diabetes.

As the condition progresses, people may start to develop symptoms. Some of the early symptoms of insulin resistance may include:

• Weight gain, especially around the midsection

• Darkening of the skin of the armpits and back of the neck

• Increased numbers of skin tags (small, painless growths on the skin)

• High blood pressure

If you have these signs, then a test called HOMA-IR may be indicated. By checking the levels of both insulin and glucose in your blood, this test can detect insulin resistance.

At first, the body compensates for insulin resistance by producing extra insulin, and a person’s blood sugar may remain normal. When insulin resistance becomes more severe, then blood sugar may begin to rise. This can lead to a variety of symptoms, including:

• Increased thirst

• Frequent urination

• Increased hunger

• Fatigue

• Headaches

• Frequent skin infections or vaginal yeast infections

• Slower healing of wounds

People with these symptoms should have a test of their blood sugar levels. This could include a fasting blood glucose test, which checks your level of blood sugar when you haven’t recently eaten, and/or a hemoglobin A1c (HbA1c) test, which checks your average blood sugar levels over the past three months.

Prediabetes

Type 2 diabetes develops gradually over time. There’s an early stage of the condition which is known as prediabetes. In people with prediabetes, blood sugar is somewhat higher than normal, but it’s not high enough to be diagnosed with diabetes. This indicates that insulin resistance has started to develop, but is not yet severe enough to cause diabetes.

If it’s not managed, prediabetes greatly increases the risk of type 2 diabetes. Approximately 70% of those with prediabetes eventually go on to develop type 2 diabetes. However, this progression is not inevitable, and prediabetes can even be reversed in some cases. Lifestyle changes are very important at this stage, and can decrease the risk of progression to diabetes by 40 to 70%. Medications that promote insulin sensitivity may also be helpful in people with prediabetes. 

Complications – Things to Watch Out For

When blood sugar is too high, this causes damage throughout the body. This occurs because excess sugar binds to proteins, changing them chemically and interfering with their function. 

If type 2 diabetes is left untreated, then a person’s average blood sugar levels will be too high. This causes long-term health complications, including:

• Vision loss

• Foot problems, which can lead to amputation

• Heart attacks and strokes

• Kidney disease

• Nerve damage

• Gum disease

• Sexual problems

Keeping blood sugar under control greatly decreases the risk of these long-term complications. Lifestyle changes are generally the cornerstone of treatment, with medications sometimes being used alongside these.

A serious complication called diabetic ketoacidosis (DKA) can also develop when blood sugar levels are very high. It occurs because the body begins breaking down fats for energy when it can’t access sugar. This process produces ketones, which are an acidic substance. The ketones change the acidity of the blood, leading to DKA. 

DKA is more common in people with type 1 diabetes, when insulin levels are very low. However, it can also occur in people with type 2 diabetes, when the body is very resistant to insulin or when the pancreas has stopped secreting enough insulin. It causes symptoms like nausea and vomiting, confusion, abdominal pain, and a “fruity” smell to the breath. Giving insulin (through injection or an insulin pump) will generally reverse DKA. If you develop potential symptoms of DKA and you don’t normally take insulin, seek medical care immediately.

While keeping blood sugar from rising too high is important, blood sugar that’s too low can also be a problem. Low blood sugar is known as hypoglycemia, and causes symptoms like shakiness, confusion, and fatigue. If left untreated, it can cause seizures and even death. Certain diabetes medications can raise the risk of hypoglycemia, so it’s important to watch out for potential signs and to test your blood sugar if you believe it may be low. Taking a small amount of sugar (such as drinking some fruit juice) will generally correct hypoglycemia if it occurs.

Testing for Type 2 Diabetes

For people who have possible symptoms of type 2 diabetes, it’s important to get tested as soon as possible. Research has shown that the earlier you begin treating type 2 diabetes, the lower your risks of long-term health complications. Delaying testing could have long-term health consequences, so if you have any concerns, seek testing.

In Singapore, you may be eligible for a subsidized screening if you're aged 40 years or older. If you’re eligible, you can receive a screening test for diabetes for just $5. You can check your eligibility here. For those who are not eligible, most GP and specialist clinics offer this testing for about $15 to $25.

Here at NOVI Health, screening for diabetes or prediabetes is included as a part of a complete health assessment. Your customized assessment can also include testing for other common health problems. Many serious health issues don’t cause obvious symptoms in their early stages, so it’s important to receive screening even if you feel healthy.

HbA1c Test

The hemoglobin A1c test, commonly abbreviated as HbA1c, checks your average blood sugar levels over the past three months. This test works by looking for a particular form of the protein hemoglobin which is formed when blood sugar levels are high. The HbA1c test is often performed using a finger prick, and results are available in just a few minutes. If you’re already having blood drawn for other tests, then the test can also be performed on a blood sample drawn from a vein, although the results generally take a few days to come back in this case. A level of 6.5% or higher indicates diabetes, while a level of 5.7 to 6.4% indicates prediabetes.

HbA1c has the advantage that it’s not significantly affected by your most recent meal, because it’s checking average blood sugar levels over a longer period. This makes it a convenient option for screening. However, this test can sometimes miss cases of diabetes. It can also be affected by conditions that affect your body’s production of red blood cells, such as anemia. If this test shows that you may have diabetes, you’ll need another test to confirm the diagnosis.

Fasting blood sugar test

Another way to diagnose diabetes is to check the levels of glucose in your blood when you haven’t recently eaten. This is usually done first thing in the morning, before you have taken your breakfast. The test involves a finger prick to obtain a drop of blood, and results are available within a few minutes. A fasting glucose level of less than 100 mg/dL (5.6 mmol/L) is normal. A level of 126 mg/dL (7.0 mmol/L) or higher indicates diabetes, while a level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicates prediabetes.

A fasting blood glucose test can catch cases of diabetes that HbA1c might miss. However, because the test requires fasting, it’s less convenient than other options. The test is generally repeated in order to confirm the diagnosis.

Random blood sugar test

A blood glucose level can also be tested at a random time, regardless of whether you’ve been fasting. This is known as a random blood glucose test. Like a fasting glucose test, it’s performed via finger prick, and takes just a few minutes to give results.

Blood glucose levels are highly dependent on what and when you’ve eaten, so the results of a random blood glucose test will be highly variable. However, a very high glucose level (200 mg/dL/11.1 mmol/L or higher) indicates that you would benefit from additional testing for diabetes. 

Because this test is more convenient to perform than a fasting glucose test, it may help to encourage more people to get tested. However, the HbA1c test is another alternative that doesn’t require fasting, and it’s usually preferred over a random blood glucose test.

Oral glucose tolerance test

This test is the most involved. Your fasting glucose level is generally checked first. You then consume a drink with a measured amount of glucose. Your blood glucose is checked again one or more times over the next few hours, to see how your body processes the sugar in the drink.

The oral glucose tolerance test can catch cases of diabetes that other types of tests would miss. However, because it’s more difficult to perform, it’s not commonly used for screening in the general population. This test may be recommended if diabetes is suspected, but other tests have given borderline results. For example, you may have symptoms of diabetes, but your fasting glucose level is less than 126 mg/dL (7.0 mmol/L).

Is Type 2 Diabetes Remission Possible?

Although it’s important to take type 2 diabetes seriously, it’s certainly not inevitable that you’ll experience severe health complications. In fact, many people are able to manage type 2 diabetes and live long and healthy lives. There’s no cure for type 2 diabetes, but some people do go into remission. This means that your blood sugar levels are normal without medication. Type 2 diabetes remission can be achieved through staying dedicated to a healthy lifestyle plan.

If tests have shown that you have diabetes, then it’s important to consult with a medical professional as soon as possible. You may prefer to consult with your regular GP, or you could choose a diabetes specialist. Working together with your doctor, you’ll develop a plan for managing diabetes and protecting your long-term health.

Although your doctor is an important part of your diabetes treatment team, many people find it challenging to create and stick to a healthy lifestyle plan. Having support in this process can be very helpful. This is why NOVI Magnum, our holistic diabetes management plan, includes access to a team of professionals, including nutritionists and health coaches.

As featured in CNA Insider’s Talking Point | How Can I Manage It, And What Happens If I Don't?

Monitoring

People with diabetes need to monitor their blood sugar regularly. This allows you and your doctor to see how your body is reacting to your current diabetes management plan, and to adjust the plan as needed to achieve good control of your blood sugar. For most people with type 2 diabetes, the goal is to keep HbA1c under 7%, fasting glucose between 80 and 130 mg/dL (4.4 to 7.2 mmol/L), and blood glucose two hours after a meal lower than 180 mg/dL (10.0 mmol/L). Some people may have slightly different goals than this. Your treatment team will discuss your personalized blood glucose goals with you.

Depending on your situation, you may need to check your glucose levels multiple times a day, once a day, or even less often. Some people use finger sticks to test their glucose levels, while others use a continuous glucose monitor (CGM), which reports glucose levels to your smartphone every few minutes. HbA1c is usually checked two to four times a year. Your doctor will recommend a specific testing plan that will best serve your needs.

Healthy Lifestyle

For people with type 2 diabetes or prediabetes, healthy eating is important. It’s best to limit sugar and other refined carbohydrates (such as starches), because these cause a quick spike in blood glucose. Fruits, vegetables, and whole grains provide a slower release of carbohydrates, preventing these blood sugar spikes. Protein also helps to slow down the absorption of carbohydrates, so ensuring that you eat protein along with any carbohydrates is also helpful.

In looking for the best “diabetes diet,” some people come across the idea of low-carb eating. Although reducing your carbohydrate intake may be beneficial, extremely low-carb diets can have unwanted side effects, such as raising your LDL cholesterol (“bad cholesterol”) levels. Some people also benefit from intermittent fasting, which involves restricting your window of eating to particular times. If you decide to try either of these plans, it’s best to talk with your doctor or nutritionist to ensure that you choose a plan that’s safe for you and allows you to meet your body’s nutritional needs while also managing your blood sugar. 

For people who are overweight, weight loss is often very helpful in controlling type 2 diabetes. In fact, studies have shown that diabetes remission most commonly occurs after sustained weight loss. It’s crucial to lose weight in a healthy way, to ensure that you’ll be able to maintain your new healthier weight. 

Exercise is also crucial for controlling blood sugar and maintaining a healthy body weight, in addition to numerous other health benefits. Before you begin a new exercise plan, it’s also a good idea to check in with your doctor, especially if it’s been a while since you last exercised regularly. This will ensure that you don’t have any health conditions that you’d need to consider when you develop your exercise plan. Our NOVI health coaches can assist you in developing a safe and effective exercise plan and staying committed to it.

Medication

Although lifestyle changes can make a significant difference, people with type 2 diabetes may also benefit from medications. There are a number of different medication options. These include oral medications as well as injectable ones. Some diabetes medications can also help to promote weight loss, which is beneficial because excess body weight tends to worsen insulin resistance. In some cases, people with type 2 diabetes benefit from taking insulin, either through injections or an insulin pump.

There is no “one size fits all” option for the best diabetes medications. You’ll need to consult with your doctor to determine whether medications are recommended to help manage your type 2 diabetes, and if so, what the best option would be for you. Your doctor will consider various factors, including your current blood sugar level and lifestyle and any other medical conditions that you may have, when deciding which medications to recommend. 

Our NOVI Health team of doctors, nutritionists, and health coaches can help you learn all of the skills that you need to stay healthy and live a fulfilling life with type 2 diabetes.

Learn more about NOVI Magnum, our holistic diabetes treatment program.