Type 2 diabetes is a chronic condition where the body becomes resistant to insulin or doesn’t produce enough of it, leading to elevated blood sugar levels.
What is type 2 diabetes?
Type 2 diabetes is a chronic metabolic disorder that disrupts the way the body regulates and uses glucose (sugar) for energy. It occurs due to a combination of the body becoming resistant to the effects of insulin — a hormone that helps glucose enter the cells — and not being able to counter this resistance through increased insulin production. Over time, this leads to elevated levels of glucose in the bloodstream, a condition known as hyperglycaemia.
Unlike type 1 diabetes, which is usually diagnosed at a younger age and is the result of autoimmune destruction of insulin-producing cells, type 2 diabetes typically develops later in life (though increasingly at a younger age) and is strongly associated with both lifestyle and genetic factors. Increasing rates of obesity and sedentary behaviour have led to Dr Dinesh seeing an increasing number of cases in younger populations, including adolescents.
In the early stages, type 2 diabetes does not cause noticeable symptoms. Even asymptomatic diabetes, left untreated, can damage various organs and systems, including the eyes, kidneys, nerves, and cardiovascular system. This causes loss of sight, eventual dialysis, numbness in the feet, giddiness and even erectile dysfunction. It also increases the risk of serious complications such as heart disease, stroke, and limb amputation.
Type 2 diabetes occurs when the pancreas produces insufficient insulin or the body becomes resistant to its effects, resulting in persistently high blood sugar levels.
What causes type 2 diabetes?
The primary cause of type 2 diabetes is the body’s inability to use insulin properly, a condition known as insulin resistance. In a healthy individual, insulin (a hormone produced by the pancreas) allows glucose from the bloodstream to enter the cells, where it is used for energy. In type 2 diabetes, the body’s cells respond less effectively to insulin, meaning glucose remains in the blood rather than being taken up by the cells.
To compensate, the pancreas initially increases insulin production. However, over time, this compensatory mechanism begins to fail. The insulin-producing beta cells in the pancreas become dysfunctional and cannot produce enough insulin to overcome the resistance. This combination of insulin resistance and eventual insulin deficiency leads to persistently high blood glucose levels, which is a hallmark of type 2 diabetes.
This underlying defect develops gradually over many years starting initially with prediabetes and is driven by a complex interaction of metabolic disturbances, including:
Impaired insulin signalling — the pathways that allow insulin to trigger glucose uptake become faulty.
Lipotoxicity — excess fat, especially around internal organs, disrupts normal metabolic function and contributes to insulin resistance.
Glucotoxicity — chronic high glucose levels themselves damage the insulin-producing cells, further impairing insulin secretion.
Abnormal liver glucose output — the liver may continue to release glucose into the bloodstream even when it is not needed, exacerbating hyperglycaemia.
Hormonal disturbances — such as excess cortisol and thyroid issues, this is rare but is something an endocrinologist will consider in every patient as it can be reversible.
Unlike type 1 diabetes, which is caused by autoimmune destruction of insulin-producing cells, type 2 diabetes arises from this gradual metabolic failure — not from a single, sudden trigger.
While type 1 diabetes is caused by an autoimmune attack on insulin-producing cells, type 2 diabetes results from insulin resistance and gradual pancreatic dysfunction.
How common is type 2 diabetes in Singapore?
Type 2 diabetes is a significant and growing public health concern in Singapore. As of 2021, approximately 14.9% of adults aged 20 to 79 were living with diabetes, equating to around 711,800 individuals. Projections indicate that this number could rise to nearly 900,000 by 2045.
The prevalence of diabetes has been steadily increasing over the decades. In 1990, about 7.3% of adults aged 18 to 69 had diabetes; this figure is expected to double to 15% by 2050.
Ethnic disparities are evident in Singapore’s diabetes statistics. Studies have shown that ethnic Malays and Indians have a higher risk of developing type 2 diabetes compared to Chinese individuals, even after accounting for factors like body mass index and lifestyle.There seems to be an increased amount of body fat distributed to the abdominal area which may result in this disparity in these ethnic groups.
What are the symptoms of type 2 diabetes?
Type 2 diabetes often develops gradually, and many people may not experience noticeable symptoms in the early stages. In some cases, the condition is only diagnosed during routine blood tests/ health screening or when the diagnosis is late, when complications arise. As blood sugar levels rise, especially when blood sugar levels rise above 10 mmol/l certain signs and symptoms may become more apparent.
Common symptoms include:
Frequent urination (polyuria) — excess glucose in the blood gets filtered by the kidneys and water follows, leading to increased urination. Dr Dinesh has found that this often starts with patients noticing an increased amount of times that they have to wake up to pass urine.
Excessive thirst (polydipsia) — frequent urination results in dehydration, which in turn triggers persistent thirst, often for sugar-containing drinks. Dr Dinesh noted that many of his patients have a thirst for fruit juices or soft drinks.
Increased hunger (polyphagia) — the body’s inability to use glucose for energy may lead to constant feelings of hunger.
Unexplained weight loss — despite eating more, individuals may lose weight because the body starts breaking down fat and muscle for energy and loses calories in urine. Patients may mix this up with thoughts that dieting has worked and they’ve lost weight intentionally.
Fatigue — inadequate glucose uptake into cells leads to a lack of energy, resulting in persistent tiredness or weakness.
Blurred vision — high blood sugar levels can cause the lens of the eye to swell, affecting the ability to focus. This is reversible. Unfortunately diabetes can also cause irreversible damage to the back of the eye (retina).
Slow-healing wounds — elevated blood glucose impairs circulation and affects immune function, slowing down the healing process.
Numbness or tingling in hands and feet — persistent high blood sugar can damage nerves, leading to peripheral neuropathy which can result in injury without pain and subsequent foot ulcers and infection (contributed by a malfunctioning immune system and poor circulation)
Recurring infections — Immunosuppression in people with uncontrolled type 2 diabetes results in patients being more prone to infections, particularly of the skin, gums, urinary tract, and genital area.
Type 2 diabetes may cause blurred vision due to fluctuating blood sugar levels affecting the eye’s lens.
Who is at risk of type 2 diabetes in Singapore?
Type 2 diabetes is a growing health concern in Singapore, influenced by a combination of genetic, lifestyle, and socioeconomic factors. These include:
Ethnicity — individuals of Indian and Malay descent are more likely to develop type 2 diabetes compared to Chinese, even at lower body mass indices or with similar lifestyles.
Age — the risk increases significantly after the age of 45 due to age-related declines in insulin sensitivity and pancreatic function.
Overweight or obesity — excess fat, especially around the abdomen (visceral fat), contributes to insulin resistance, a key factor in type 2 diabetes development.
Sedentary lifestyle — physical inactivity reduces insulin effectiveness and contributes to weight gain and metabolic dysfunction.
Unhealthy diet — frequent consumption of refined carbs, sugary beverages, and high-calorie processed foods increases the risk of impaired glucose control.
By making targeted and sustainable changes to daily habits, it is possible to improve insulin sensitivity, maintain healthy blood glucose levels, and significantly reduce the likelihood of developing the condition. Dr Dinesh says addressing prediabetesthrough early health screening before it becomes type 2 diabetes is the most effective way of preventing type 2 diabetes.
Healthy eating, regular exercise, and weight management can help prevent type 2 diabetes.
Here are some of the ways to prevent type 2 diabetes:
Maintain a healthy weight — excess body fat, particularly around the abdomen, is a major contributor to insulin resistance. Losing just 5% to 10% of body weight has been shown to significantly reduce diabetes risk in overweight individuals.
Adopt a balanced diet — focus on whole foods such as vegetables, fruits, whole grains, lean proteins, legumes, and healthy fats. Minimise intake of refined carbohydrates, sugary beverages, and processed snacks.
Be physically active — regular exercise improves insulin sensitivity and helps regulate blood sugar. Aim for at least 150 minutes of moderate aerobic activity (like brisk walking or cycling) per week, along with strength training twice weekly.
Limit sedentary time — long periods of sitting can increase insulin resistance. Try to break up sedentary time by standing or walking for a few minutes every hour.
Get enough sleep — inadequate or poor-quality sleep is linked to hormonal imbalances and reduced insulin sensitivity. Adults should aim for 7 to 9 hours of restful sleep each night.
Manage stress effectively — chronic stress triggers hormone changes that can raise blood sugar and promote unhealthy eating habits. Mindfulness, relaxation techniques, and regular exercise can help reduce stress levels.
Monitor your health — if you are at risk, regular screening for blood glucose levels and metabolic indicators can help detect early warning signs such as prediabetes.
How is type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed using specific blood tests that assess your blood sugar levels, in serial testing. These tests help determine whether your glucose control falls within the diabetic range.
Fasting blood glucose test — measures your blood sugar level after at least 8 hours without food. A result of 7.0 mmol/L or higher indicates diabetes.
HbA1c test (glycated haemoglobin) — reflects your average blood sugar levels over the past 2 to 3 months. An HbA1c reading of 7% (48 mmol/mol) or higher confirms diabetes.
Oral glucose tolerance test (OGTT) — involves testing your blood sugar before and two hours after consuming a glucose drink. A two-hour reading of 11.1 mmol/L or above is diagnostic of diabetes.
Random blood glucose test — checks your blood sugar at any time of day, regardless of meals. A level of 11.1 mmol/L or higher, alongside symptoms of diabetes, may confirm the diagnosis.
What are the treatment options for type 2 diabetes in Singapore?
At The Metabolic Clinic, we use a personalised treatment framework that includes specialised cutting-edge medical therapy, nutritional support, exercise and close monitoring to help you achieve stable, long-term control.
Lifestyle changes
This is the foundation of diabetes management. It includes:
Healthy eating — focusing on a balanced diet rich in fibre, whole grains, vegetables, lean proteins, and healthy fats while limiting sugary and processed foods in order to achieve a calorie deficit.
Physical activity — regular aerobic and resistance exercises help improve insulin sensitivity and support weight control through an increased metabolism
Weight management — losing even a modest amount of weight can significantly improve blood sugar control.
Oral medications
If lifestyle measures are not enough, oral medications may be prescribed to help regulate blood glucose.
These are used in more advanced cases or when additional support is needed:
GLP-1 receptor agonists — improve blood sugar control, promote satiety, and support weight loss in addition to proven cardiovascular and kidney benefits Dr Dinesh commented that this treatment has been revolutionary in diabetes and helps break the cycle of weight gain and worsening diabetes with conventional diabetes treatment.
Insulin therapy — insulin may be required if blood sugar remains uncontrolled despite oral or other medications. The treatment is personalised to the individual patient.
Regular blood sugar monitoring is essential for managing and preventing complications in diabetes.
Blood sugar monitoring
Monitoring blood sugar is a key part of managing type 2 diabetes. It helps you understand how your body responds to food, physical activity, stress, illness, and medication — and gives you the information needed to make day-to-day decisions that keep your blood glucose within a healthy range.
We guide patients on how often to check their blood sugar, which device to use, and what their target ranges should be. Some people may benefit from checking their levels once or twice a day, while others — especially those on insulin — may need more frequent monitoring.
We also offer advice and help educate on using continuous glucose monitors (CGMs), which track glucose levels throughout the day and night. These devices provide a clearer picture of glucose trends without the need for finger pricking, and can be especially helpful for patients experiencing fluctuating blood sugar or asymptomatic hypoglycaemia. Dr Dinesh finds that patients prefer CGM to conventional blood glucose monitoring devices that require repeated finger pricking.
Patient education and support
Managing type 2 diabetes effectively requires more than just medications — it involves understanding how the condition works, recognising what affects your blood sugar, and knowing how to make daily decisions that support your health. That’s where patient education and support come in and what Dr Dinesh prides himself on.
We offer one-on-one education sessions that cover essential topics such as how to monitor your blood glucose, adjust your diet, incorporate physical activity, and understand how your medications work. We also guide you on how to respond to changes in your readings, manage sick days, and prevent or recognise complications early.
Summary
Type 2 diabetes is a long-term condition where the body struggles to use insulin properly, leading to raised blood sugar levels over time. It often develops slowly and may not cause symptoms in the early stages. In Singapore, the number of people affected is rising steadily, but the condition can be managed with the right combination of lifestyle changes, medications, and regular monitoring.
At The Metabolic Clinic, we focus on helping you understand your condition and manage it in a way that suits your needs and daily life. If you’ve been diagnosed with type 2 diabetes or are concerned about your risk, schedule a consultation with us for a full assessment and personalised care plan.
Frequently Asked Questions (FAQs)
Can type 2 diabetes be reversed?
In some cases, individuals can achieve remission through significant lifestyle changes, such as weight loss and increased physical activity. However, ongoing management is essential to maintain normal blood sugar levels.
Is type 2 diabetes hereditary?
Yes, genetics play a role. Having a family history of type 2 diabetes increases your risk, but lifestyle factors like diet and exercise are also significant contributors.
Can thin people develop type 2 diabetes?
Absolutely. While obesity is a common risk factor, even individuals with a healthy weight can develop type 2 diabetes due to factors like genetics, age, and physical inactivity. This is especially true for those who tend to put on abdominal fat easily.
What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is an autoimmune condition where the body attacks insulin-producing cells and is usually diagnosed in younger individuals. Type 2 diabetes involves insulin resistance and is more common in adults, though it is increasingly seen in younger populations.
Can prediabetes turn into type 2 diabetes?
Yes, without lifestyle changes, prediabetes can progress to type 2 diabetes. However, with early intervention through diet, exercise, and weight management, it’s possible to delay or even prevent the onset of diabetes.
Can stress affect blood sugar levels?
Yes, stress can lead to hormonal changes that increase blood sugar levels. Managing stress through techniques like exercise, meditation, or therapy can help maintain better glucose control.
Are there specific foods I should avoid with type 2 diabetes?
It’s advisable to limit foods high in refined sugars and saturated fats. Focusing on a balanced diet rich in whole grains, lean proteins, and vegetables can aid in blood sugar management.
How often should I have my eyes and feet checked?
Individuals with type 2 diabetes should have annual eye examination to detect retinopathy and regular foot checks to prevent complications like ulcers or infections.
Can I travel if I have type 2 diabetes?
Certainly. Planning is key—carry your medications, monitor your blood sugar regularly, and maintain your meal and activity routines as much as possible.
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