Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a type of diabetes that affect one in five pregnant women in Singapore. In most cases, GDM develops in the middle or towards the end of one's pregnancy.

Generally, all pregnant women will be screened for GDM at 24 to 28 weeks of their pregnancy. You could be screened earlier if you have any of the following risk factors:

• Body mass index (BMI) > 25kg/m²
• Previous baby > 4 kg at birth
• History of GDM
• Known prediabetes
• Family history of diabetes
• 40 years old and above

GDM is diagnosed using an oral glucose tolerance test (OGTT). You are required to fast from the midnight before the test (only plain water is allowed). The next morning, you will do a fasting blood sugar test, following which you will be required to drink a glucose drink within 5 minutes. Your blood will then be taken at the 1-hour and 2-hour interval.

Normal blood sugar level is essential for healthy pregnancies and babies.

Abnormal blood sugar level can result in the following:

• your baby growing bigger than average. A big baby increases the chance of injury during delivery as the baby’s shoulder may be stuck in the pelvis.
• your baby has a higher chance of a low blood sugar level or jaundice after birth.
• you having a higher chance of developing high blood pressure during pregnancy, preterm birth, needing induced labour or caesarean section, and stillbirth (death of baby in the womb).

Healthy eating and exercise can help you to manage GDM and optimise your blood sugar.

A dietitian will work with you on a personalised eating plan. You will learn to have well-balanced meals to support your pregnancy, and advice on carbohydrate amount and portion sizes.

Most pregnant women can exercise safely, such as walking or swimming 30 minutes on most days. You may wish to discuss with your doctor to see if such exercises are suitable for you.

You may need injectable insulin if your blood sugar levels are not within targets with diet and exercise.

You will need to purchase a glucometer to monitor your blood sugar level. The diabetes care nurses will advise you on:

• blood sugar monitoring
• frequency of blood sugar monitoring (typically 7 tests a day, 2 to 3 days a week or more if required)
• blood sugar targets
• recording and reporting of blood sugar readings and food intake

You are required to do an OGTT 6 to 12 weeks after delivery to determine if the abnormal blood sugar levels have resolved or persist after delivery.

Women with a history of GDM have a higher risk of diabetes later in life. You can prevent diabetes by adopting a healthy lifestyle, i.e. healthy diet, active lifestyle and healthy body weight. You are advised to go for diabetes screening once every 1 to 3 years.

Diabetic retinopathy is a complication of diabetes mellitus. It is the most common reason for vision loss among people with diabetes.

When blood sugar levels are persistently high, it injures small blood vessels in the retina of the eye. This will eventually lead to vision problems and even blindness in some.

The good news is that it is preventable.

Keeping your blood sugar levels and blood pressure normal can prevent serious eye problems. Your doctor will also arrange for you to undergo regular eye tests.

In the early stages of diabetic retinopathy, your sight may be normal. It is only in the later stages when one will notice vision problems. Eye tests allow diabetic retinopathy to be detected in the early stages. If treatment is given early, blindness can be prevented. Therefore, it is important for people with diabetes to undergo regular eye checks before vision problems surface.

One of the complications of diabetes is kidney disease. Our kidneys carry out important functions. They contain millions of tiny filters to remove small waste products from our blood into our urine.

In diabetic kidney disease, high sugar levels damage the filters, causing them to leak and lose their function. Over time, when diabetic kidney disease worsens, the kidneys may fail completely.

However, kidney failure in diabetes is preventable.

Keeping your blood sugar levels and blood pressure normal can prevent kidney problems.

Your doctor will also arrange for you to undergo regular blood and urine tests to monitor your condition.

If you have diabetic kidney disease, your doctor will prescribe medications to lower your blood pressure and prevent the kidney disease from getting worse.

In early stages, diabetic kidney disease begins with leakage of small proteins into the urine. You will feel well and have no symptoms. However, this can be picked up early with a simple urine test, so that steps can be taken to prevent diabetic kidney disease from getting worse.

People with diabetes are at increased risk of serious diseases of the heart and blood vessels (cardiovascular diseases).

Diabetes causes damage to blood vessels in your body and cause them to become blocked. This can lead to serious complications such as heart attacks and strokes.

However, the good news is that you can do something to reduce your risk of heart attacks and strokes.

Heart attacks and strokes can be prevented by making a few changes to your life:

1. Eat healthy. Plan your meals.
2. Stay active
3. Don't smoke
4. Reduce your weight if you are overweight

In addition to the above, work with your healthcare team to lower the following into your target range:

• Blood pressure
• Cholesterol
• Blood sugar

With all these steps, you can prevent complications of diabetes, stay healthy and live well!