Managing Diabetes Effectively: A Comprehensive Guide

Diabetes is a metabolic disorder that is characterized by resistance to insulin, insufficient insulin secretion, or both. Insulin is a crucial hormone responsible for keeping the body’s blood glucose levels within the normal range. In diabetes, issues with insulin will result in excess blood sugar in the bloodstream, potentially leading to serious health problems such as heart disease, kidney disease and vision loss. 

In this article, we will be exploring the types of diabetes, measures to prevent the development of diabetes, medication options available, as well as some self-monitoring tips in diabetes.

Understanding Diabetes

The number of cases of diabetes is ever growing and has increased from 108 million globally in 1980 to 422 million in 2014. As of 2023, over 400,000 people in Singapore live with diabetes and that number is projected to increase to 1 million by 2050. In addition to causing health complications, diabetes can bring significant financial burden on patients and their families, as well as on the economy in the form of increased medical costs and decreased productivity. It was reported that the cost of burden from diabetes in Singapore is expected to rise from beyond $940 million in 2014 to $1.8 billion in 2050.

The rising prevalence of diabetes and its consequences are concerning and underscores the need for increased awareness and proactive measures to address this growing health challenge in order to control and prevent the progression of serious health problems.

Types of Diabetes

A. Type 1 Diabetes: The Autoimmune Condition

Type 1 diabetes mellitus, previously referred to as insulin-dependent diabetes, makes up 5-10% of diabetic cases. It is an autoimmune condition where there is insufficient secretion of insulin due to an absolute deficiency of pancreatic β-cell function, whose function is to make insulin. It typically manifests in children but can occur at any age. While risk factors for Type 1 diabetes are not clearly defined, studies have demonstrated the influence of family history in its development. This type of diabetes requires lifelong insulin therapy.

B. Type 2 Diabetes: Lifestyle and Genetic Factors

Type 2 diabetes mellitus is the most common form of diabetes, making up an estimate of >90% of persons with diabetes mellitus. In type 2 diabetes, the body does not make sufficient insulin or does not respond well to insulin (insulin resistance). Unlike type 1 diabetes, type 2 diabetes can be prevented and managed with conscious and healthy lifestyle choices. Risk factors for type 2 diabetes include:

• Older age (40 years or older)
• Family history of diabetes
• Lack of physical activity (less than 3 times a week)
• Obesity (BMI of 23.0 kg/m2 or higher)
• Abnormal lipid levels
• High blood pressure
• Impaired glucose tolerance or fasting glucose

C. Gestational Diabetes: Diabetes during Pregnancy

As its name suggests, gestational diabetes is a type of diabetes that arises during pregnancy. Caused by hormonal changes during pregnancy, it is the most common medical complication and metabolic disorder associated with pregnancy. It is important to identify and manage gestational diabetes as it might cause several issues including:

• Increased risk of high blood pressure
• Increased risk of developing type 2 diabetes after delivery
• Delivery of a large baby which requires a cesarean section (C-section)
• Premature delivery which may cause respiratory and other health issues in the baby

Risk factors for gestational diabetes include:

• Obesity (BMI of 23.0 kg/m2 or higher)
• Family history of gestational diabetes
• > 35 years old

D. Prediabetes: A Wake-up Call

Prediabetes is a condition where blood sugar levels are higher than normal, but not sufficiently high to be classified as type 2 diabetes. Not everyone with prediabetes will progress to developing type 2 diabetes, making it paramount to be aware of the condition and prevent its progression. Prediabetes and type 2 diabetes share the same risk factors and it is possible to prevent the development of these conditions.

Diagnostic Measures: Identifying Diabetes

Early detection of diabetes is crucial in mitigating its impact on people and the healthcare system. As of 2019, diabetes was the sixth leading cause of mortality and burden of disease combined in Singapore. Early detection allows for a proactive approach to manage the condition such as incorporating healthier lifestyle choices and appropriate medication management, improving quality of life and overall well being. In addition, research shows that timely diagnosis and management of diabetes reduces cardiovascular morbidity and mortality as well as risk of developing long-term diabetes-related complications such as heart disease, kidney disease and vision loss.

Diabetes is commonly referred to as the ‘silent killer’ as it may lead to serious health complications even before symptoms become noticeable. Even so, symptoms associated with diabetes may not necessarily be obvious. These include but are not limited to:

• Frequent urination, especially at night
• Increased thirst and hunger
• Unintended weight loss
• Blurry vision
• Slow wound healing
• Frequent infections

Types of Tests For Diabetes and What They Mean

In order to avoid serious complications of the disease, regular early screening is vital. Several tests are available for detection and monitoring of diabetes.

A. Fasting Plasma Glucose (FPG) Test

FPG test is often used to measure blood glucose levels in diabetics and prediabetics. It measures the level of glucose in the blood after no calorie intake for at least 8 hours. For healthy individuals, FPG levels of 4.0 to 5.9 mmol/L is appropriate.

B. HbA1c Test

HbA1c test, or Hemoglobin A1c test, is commonly used to monitor glucose levels in diabetics for treatment optimisation. It measures the average amount of glucose in one’s blood over the past 3 months by the principle that glucose stays attached to hemoglobin in red blood cells (RBC) for their entire lifespan of about 3 months. For most patients, a target of ≤7.0% provides a reasonable balance between reducing risk of microvascular complications and hypoglycaemia.

C. Oral Glucose Tolerance Test (OGTT)

Like the FPG test, the OGTT is also used to measure blood glucose levels in diabetics and prediabetics. In this test, blood glucose is measured once after 8 hours of no calorie intake, followed by another measurement of blood glucose 2-3 hours after consumption of a standardized serving of 75g of glucose. This is to measure the body’s ability to process sugar. A blood sugar reading of 140mg/dL or below at the 2-hour mark is considered within the normal range. Readings falling between 140-199mg/dL suggest a pre-diabetic condition, while a level of 200mg/dL or above indicates the presence of diabetes.

Prevention: Steps to Mitigate Risk

A. The Role of Diet in Managing Blood Sugar

Research has shown that a considerable number of people who have type 2 diabetes not only tend to consume an excessive amount of meat products, but also tend to consume fewer servings of fruits and vegetables than recommended. This emphasizes the importance of education and awareness of healthier food choices for people with prediabetes and diabetes.

Recommended Foods

• Vegetables
• Non-starchy: broccoli, greens, carrots
• Starchy: potatoes, corn, green peas
• Fruits
• Oranges, melon, berries, apples
• Grains
• Wheat, rice, oats, bread, pasta
• Protein
• Lean meat, skinless chicken and turkey, egg, fish
• Dairy (non-fat or low-fat)
• Milk, yogurt, cheese

Foods to Avoid

• Fried foods and foods high in saturated and trans fats
• High-sodium foods
• Sweets
• Candy, ice cream, baked goods
• Beverages with added sugars
• Juice, regular soda, regular sports or energy drinks
• Alcohol
• Limit to 1 drink a day for women, 2 drinks a day for men

B. Exercise: A Pillar of Diabetes Prevention

Physical activity is beneficial in diabetics as it helps in weight loss, increases insulin sensitivity in the body, controls blood sugar levels and ultimately reduces the likelihood of developing heart disease and nerve damage associated with diabetes. It is recommended to have at least 150 minutes of moderate intensity aerobic physical activity per week in addition to resistance strength training. Do keep in mind that consulting with a healthcare professional before starting any exercise regimen, especially for individuals with pre-existing health conditions is important as well

Best Exercises for Diabetes Management

1. Staying Active at Home

2. Staying Active Outdoors

4. Scheduling

It is beneficial to have a regular exercise schedule to form habits and optimize outcomes. You can explore using reminder or calendar applications for your exercise sessions as this helps to build a routine!

Medications: Navigating Treatment Options

According to the Agency for Care Effectiveness (ACE) guidelines, a general HbA1c goal of ≤7.0% is appropriate for patients with Type 2 diabetes. However, healthcare professions may personalize these goals based on patients’ individual circumstances such as pre-existing conditions and age. In diabetes management, it is crucial to focus on both controlling blood sugar levels and reducing risk of heart and kidney disease.

There are several classes of medications available for the treatment of diabetes.

A. Oral Medications: Supporting Your Treatment Plan

 

1. Metformin: The First Line of Defense

Metformin (e.g. Glucophage XR) remains the first line of treatment in Type 2 diabetes in combination with an appropriate diet and exercise. It works by concurrently decreasing the production of glucose by the liver and increasing insulin sensitivity hence increasing glucose uptake and utilization. The common side effects of metformin are generally mild and include gastrointestinal upset and metallic taste. These can be managed by taking metformin with or after food.

2. Glipizide: Stimulating Insulin Production

In cases where Type 2 diabetes cannot be managed by diet and exercise alone, healthcare professionals may consider the use of glipizide. It works primarily by stimulating the secretion of insulin, increasing the uptake of glucose. As it is used to stimulate insulin secretion, it should be paired with food to avoid cases of drastic blood glucose drop in fasting state. While glipizide has similar efficacy as metformin, the former is less preferred due to its association with greater weight gain and risk of low blood glucose.

3. Sitagliptin: Enhancing Your Body's Insulin Release

Sitagliptin (e.g. Januvia) is usually used as a second or third-line agent in the management of type 2 diabetes, in combination with other anti-diabetic medications. It works by inhibiting an enzyme, ultimately increasing insulin secretion and reducing glucose production. However, its effect on blood glucose reduction is smaller and may be associated with pancreatitis which manifests as abdominal pain, fever, nausea and vomiting.

4. Dapagliflozin: A New Age in Diabetes Treatment

In addition to controlling blood glucose levels in diabetes, dapagliflozin (e.g. Forxiga) has been reported to bring about several other benefits including:

• Reduction of major adverse cardiovascular events
• Reduction of hospitalization for heart failure
• Reduction of adverse kidney outcomes

While dapagliflozin’s effect on the reduction in blood glucose levels are not as remarkable as that of metformin, its additional advantages position it as a preferred agent in diabetic patients with concomitant heart or kidney problems. Side effects of dapagliflozin include low blood pressure, increased frequency of urination and low blood glucose.

5. Acarbose: Slowing Down Carbohydrate Absorption

Acarbose (e.g. Glucobay)  is used in type 2 diabetes management when high blood glucose levels cannot be managed by diet alone. It works by delaying absorption of glucose, hence reducing blood glucose levels after a meal. One of its most common side effects is flatulence, which is a major cause of drug discontinuation in diabetics.

It is important to take note that if any of the side effects experienced with these medications are intolerable, or if you develop severe reactions such as difficulty breathing, swollen eyes, lips, mouth or throat, you should visit a doctor or the A&E immediately. If your blood sugar levels remain uncontrolled or become too low, and you feel dizzy or light-headed, it will be appropriate for you to visit a doctor as well.

B. Semaglutide Injectables: The Latest Trend

Belonging to a class of medications called Glucagon-Like Peptide-1 (GLP-1) agonists, Semaglutide acts like the naturally occurring hormone, GLP-1, that is released from the gastrointestinal tract. GLP-1 has several actions on managing blood sugar:

1. Delays stomach emptying
2. Increases glucose-dependent insulin release
3. Decreases glucagon, a hormone that increases blood sugar levels
4. Improves β-cell function, the cells responsible for insulin production
5. Decreases appetite

Ozempic® (semaglutide) is indicated for the treatment of insufficiently controlled diabetes in addition to diet and exercise, when metformin is considered inappropriate.

Being a once weekly subcutaneous injection, it is a convenient option for diabetes management. Additional benefits conferred by Ozempic® include reduced risk of major heart events like stroke, heart attack or death, as well as weight loss.

While benefits of starting on Ozempic® seem promising, it is important to take note the most common side effects:

• Nausea and vomiting
• Diarrhea
• Stomach (abdominal) pain
• Constipation

Signs of serious side effects to watch out for:

• Severe pain of the stomach (abdominal) area that will not go away
• Visual changes
• Feeling dizzy, lightheaded, sweating, slurred speech, weakness
• Dehydration
• Swelling of your face, lips, tongue or throat
• Difficulty breathing
• Pain in the upper stomach (abdominal) area, fever, yellowing of the skin or eyes, clay-coloured stools

Insulin Pen: A Lifesaver for Many

Insulin is the most effective agent in lowering blood glucose and is indicated in all types of diabetes. It works by facilitating glucose uptake in muscle and fat tissue and reducing glucose production by the liver, thereby reducing overall blood glucose levels.

A. Types of Insulin

 

	Rapid-acting	Short-acting	Intermediate acting	Long-acting		Pre-mixed
Example	Novorapid® Humalog® Apidra®	Actrapid®	Insulatard®	Levemir®	Lantus®	Humalog® Mix  Novomix® 30  Mixtard® 30  Humulin® 30/70
Target Blood Glucose	Post-meal	Post-meal	Fasting	Fasting		Variable
Onset	5-15 min	30-60 min	1-2 hours	0.8-2 hours	1.5 hours	Variable
Instructions	15 min before meals	30 minutes before meals	Regardless of meal timings, at the same time everyday			Variable

 

B. Correct administration of an Insulin Pen

An insulin pen is preloaded with insulin to be delivered into the innermost layer of the skin. Although more costly, insulin pens offer convenience and simpler administration compared to insulin vial syringes. To reap the benefits of insulin therapy safely and comfortably with insulin pens, it is vital to have the correct administration technique.

Steps to use an insulin pen:

1. Wash your hands with soap and water
2. Dry your hands with a towel or tissue
3. Select an injection site at your abdominal area
4. Clean the selected site with water and tissue
5. Wait for the area to dry
6. Using your thumb and index finger, lift up a skinfold
7. Inject insulin at 90o perpendicular to the injection site
8. Inject the dose by pressing the push-button all the way in until ‘0’
9. To ensure the full dose has been injected, keep the push-button down fully for 6 seconds and as you withdraw the needle from your skin
10. Place the outer needle cap on the table. To prevent finger stick injury, direct the needle tip into the outer needle cap without holding onto it. Unscrew and dispose of the used needle after it is covered.
11. Store the insulin pen at room temperature after the injection, away from direct sunlight and heat.

Glovida-Rx: Personalized Medication Counseling

A. The Benefits of Choosing Glovida-Rx

Glovida-Rx offers a wide range of diabetes medication, ranging from oral medications to injectables. Discover our extensive range of medications tailored for your diabetes control and find the right fit for your diabetes care plan. For more information on diabetes medications, you may visit our page here or contact our pharmacists on WhatsApp at +65 8101 5555.

B. How Our Pharmacists Ensure Your Health and Safety

Our pharmacists are equipped with the expertise and knowledge to cater to your queries and provide valuable insights into medication options in Singapore. They are able to advise you on managing your diabetes more effectively, ensuring that your treatment is optimized. Do not hesitate to reach out to us!

Self-Monitoring: Empowering Patients

Why is self-monitoring crucial in diabetes?

Being proactive in your own diabetes management is important. Self-monitoring of your blood sugar levels provides you with a better understanding of how your lifestyle options and diabetes medications affect your sugar levels. This helps to guide you on the necessary lifestyle changes that you may need to consider such as adjusting your diet and physical activity. It also helps to build an individualized blood sugar profile, which provides your healthcare professional with more information on your diabetes control, allowing for appropriate modification of treatment options.

Monitoring your own blood sugar levels regularly also helps to identify when your blood sugar falls too low or goes too high as these situations may be dangerous.

Seek prompt medical attention if you experience any of the following:

• Weight loss with excessive thirst and frequent urination
• Your blood sugar at any point of the day remains persistently high at >16mmol/L
• FPG remains consistently above 10mmol/L

Tips and Tricks for Effective Monitoring

There are a few ways to monitor your blood glucose. Depending on personal preference, some patients may prefer a more convenient option of continuous blood glucose monitoring while some patients may prefer the more affordable option of daily finger pricking.

For patients who decides to conduct daily self-monitoring of blood glucose by finger pricking, below are some tips that may help:

1. Set reminders

It may be convenient for you to set reminders on your phones so that you will remember to monitor your blood glucose at specific times of the day as advised by your healthcare professional.

2. Test strips storage

It is important to check for the expiry date of your test strips to ensure accurate test results. Test strips should also be stored away from sunlight and moisture to prevent any inaccurate results.

3. Keep a journal

If your glucose meter does not have an in-built function for history, you may consider using an app or a written journal to note down your blood sugar levels so as to create a profile and keep your healthcare professional informed.

4. Ensure your meter and supplies are on hand

It may be useful to bring your lancets, alcohol swabs, testing strips and meter with you when you are away for trips

5. Prevent infections

Always clean the area with an alcohol swab before you prick to reduce the risk of infections.

Conclusion

 

Understanding the different types of diabetes as well as recognising signs and symptoms early is extremely important for timely diagnosis and intervention. In this article, we have discussed the nuances of diabetes in hopes that you are better able to understand this ever-growing and concerning condition in Singapore.

Preventing and treating diabetes does not just involve medications, but also several other factors like lifestyle and proper monitoring. It is vital to recognise how these factors play a part so that we can properly address the condition.

Glovida-Rx: Providing Personalized Diabetes Management

At Glovida-Rx, we firmly believe that informed and shared decisions are crucial for patients’ well-being. We are committed to educate patients, offer tailored diabetes management and support to individuals on their health journey. Remember that the journey to better health requires dedication and consistency. Our pharmacists can guide and support you through this journey by offering valuable insights, personalized advice and ensuring medication adherence to optimize your well-being. Visit our website www.glovida-rx.com.sg for more information and contact us at +65 8101 5555 for any queries.

Wellness Starts with You: Embracing Lifestyle Changes

Managing diabetes requires a proactive approach. It involves making informed and conscious choices regarding one’s diet, physical activity and overall lifestyle. While there are general tips to better manage diabetes enclosed within this article, it is beneficial to receive personalized advice available via consultation with healthcare professionals to ensure optimal treatment effectiveness. Embark on your journey to better health and do not hesitate to contact our friendly pharmacists on Whatsapp at +65 8101 5555 now!

References:

Abushamat, L. A., McClatchey, P. M., Scalzo, R. L., & Reusch, J. E. B. (2023, January 6). The Role of Exercise in Diabetes (K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W. W. de Herder, K. Dungan, A. Grossman, J. M. Hershman, H. J. Hofland, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, R. McLachlan, J. E. Morley, M. New, J. Purnell, F. Singer, C. A. Stratakis, & D. L. Trence, Eds.). PubMed; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK549946/

ACE. (2023). Target audience. https://www.ace-hta.gov.sg/docs/default-source/acgs/acg-t2dm-personalising-medications.pdf

Adaikan, K., & Ng Li Whye, C. (n.d.). Diabetes & Exercise. Www.healthxchange.sg. https://www.healthxchange.sg/diabetes/essential-guide-diabetes/diabetes-exercise-control-blood-glucose-levels-physical-activity

Barry Car, D., & Gabbe, S. (1998, January). Document - Gale Academic OneFile. Go.gale.com. https://go.gale.com/ps/i.do?id=GALE%7CA20331127&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=08918929&p=AONE&sw=w&userGroupName=anon%7E259e121e&aty=open-web-entry

Benjamin, E. M. (2002). Self-Monitoring of Blood Glucose: The Basics. Clinical Diabetes, 20(1), 45–47. https://doi.org/10.2337/diaclin.20.1.45

Burch, E., Ball, L., Somerville, M., & Williams, L. T. (2018). Dietary intake by food group of individuals with type 2 diabetes mellitus: A systematic review. Diabetes Research and Clinical Practice, 137, 160–172. https://doi.org/10.1016/j.diabres.2017.12.016

CDC. (2020, January 8). Prediabetes - Your Chance to Prevent Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/prediabetes.html#:~:text=Prediabetes%20is%20a%20serious%20health

Centers for Disease Control and Prevention. (2022a, January 28). Get Active! | Diabetes | CDC. Www.cdc.gov. https://www.cdc.gov/diabetes/managing/active.html#:~:text=Being%20More%20Active%20Is%20Better

Centers for Disease Control and Prevention. (2022b, March 11). What Is Type 1 Diabetes? Centers for Disease Control and Prevention; CDC. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html

Centers for Disease Control and Prevention. (2022c, April 5). Diabetes Risk Factors. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/risk-factors.html

Centers for Disease Control and Prevention. (2022d, July 7). What is Diabetes? Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/diabetes.html#:~:text=With%20diabetes%2C%20your%20body%20doesn

Centers for Disease Control and Prevention. (2022e, December 30). Gestational Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/gestational.html

Centers for Disease Control and Prevention. (2023, September 7). Diabetes Symptoms. CDC. https://www.cdc.gov/diabetes/basics/symptoms.html

Choo, F. (n.d.). Screening vital to detect silent killer. Www.healthxchange.sg. Retrieved February 24, 2024, from https://www.healthxchange.sg/news/screening-vital-to-detect-silent-killer

Cleveland Clinic. (2023, January 3). Blood Sugar Monitoring: Why, How & When To Check. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17956-blood-sugar-monitoring

Dansinger, M. (2023, January 28). Best Exercises If You Have Diabetes. WebMD. https://www.webmd.com/diabetes/ss/slideshow-exercises-diabetes

Diabetes Singapore. (2022, January 12). The Singapore demographics of Diabetes - Diabetes SG. Diabetes Singapore. https://www.diabetes.org.sg/about-diabetes/the-singapore-demographics-of-diabetes/

Diabetes UK. (2015). Getting Active and Staying Active. Diabetes UK; Diabetes UK. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/exercise

HealthHub. (n.d.). hyperglycaemia. Www.healthhub.sg. Retrieved March 6, 2024, from https://www.healthhub.sg/programmes/diabetes-hub/hyperglycaemia

HealthHub. (n.d.). self-monitoring-of-blood-sugar. Www.healthhub.sg. https://www.healthhub.sg/programmes/diabetes-hub/self-monitoring-of-blood-sugar

HealthHub. (2023a). diabetes-are-you-at-risk. Healthhub.sg. https://www.healthhub.sg/live-healthy/diabetes-are-you-at-risk

HealthHub. (2023b, May). Diabetes-Treatment-Insulin. Www.healthhub.sg. https://www.healthhub.sg/a-z/medications/diabetes-treatment-insulin

Herman, W. H., Ye, W., Griffin, S. J., Simmons, R. K., Davies, M. J., Khunti, K., Rutten, G. E. H. M., Sandbaek, A., Lauritzen, T., Borch-Johnsen, K., Brown, M. B., & Wareham, N. J. (2015). Early Detection and Treatment of Type 2 Diabetes Reduce Cardiovascular Morbidity and Mortality: A Simulation of the Results of the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Europe). Diabetes Care, 38(8), 1449–1455. https://doi.org/10.2337/dc14-2459

Holland, K., & Basina, M. (2012, January 20). 6 Keys to Successful Blood Sugar Monitoring. Healthline. https://www.healthline.com/health/type-2-diabetes/blood-glucose-monitoring#abnormal-glucose-levels

Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2016). Glucose tolerance tests: What exactly do they involve? In www.ncbi.nlm.nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK279331/#:~:text=Oral%20glucose%20tolerance%20tests%20(OGTT

Kamrul-Hasan, A. B. M., Hannan, M. A., Alam, M. S., Rahman, M. M., Asaduzzaman, Md., Mustari, M., Paul, A. K., Kabir, Md. L., Chowdhury, S. R., Talukder, S. K., Sarkar, S., Hannan, M. A., Islam, Md. R., Iftekhar, M. H., Robel, Md. A. B., & Selim, S. (2023). Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh. BMC Endocrine Disorders, 23(1). https://doi.org/10.1186/s12902-023-01292-8

Managing diabetes: Blood glucose - Diabetes SG. (n.d.). https://www.diabetes.org.sg/resource/managing-diabetes/

MOH. (2014). Diabetes Mellitus MOH Clinical Practice Guidelines 1/2014. https://www.moh.gov.sg/docs/librariesprovider4/guidelines/cpg_diabetes-mellitus-booklet---jul-2014.pdf

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2019). Diabetes Diet, Eating, & Physical Activity | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

NTFGH. (n.d.). Error. Www.ntfgh.com.sg. https://www.ntfgh.com.sg/Our-Services/Clinical-Services/Documents/Endocrinology/Insulin-related/How%20to%20use%20an%20insulin%20pen-1.pdf

Seah, S., & Yang, C. (2023, November 15). War against diabetes: Doctors seeing rise in patients below 40 due to lifestyle habits, early screening. CNA. https://www.channelnewsasia.com/singapore/war-against-diabetes-singapore-doctors-seeing-rise-young-patients-below-40-lifestyle-habits-stress-early-screening-treatment-3921976#:~:text=More%20than%20400%2C000%20people%20in

What Is Ozempic®? | Ozempic® (semaglutide) Injection 0.5 mg or 1 mg. (n.d.). Www.ozempic.com.https://www.ozempic.com/why-ozempic/what-is-ozempic.html#:~:text=Ozempic

World Health Organization. (2023, April 5). Diabetes. World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/diabetes