Question 1

What is diabetes?

Accepted Answer

Blood glucose
          Carbohydrates in food turn into glucose after digestion, entering the blood and becomes blood glucose, the main source of energy for the body.

Insulin
          Insulin is a hormone secreted by the pancreas. It helps blood glucose to enter the cells of different parts of the body to provide energy.

If the body functions normally, the blood glucose level will fluctuate in a normal range.

When a person lacks insulin or has resistance to insulin, the blood glucose will be unable to enter body cells and builds up in the blood. Sustained high blood glucose levels cause diabetes. Prolonged high blood glucose levels may damage blood vessels and organs, thus causing lesions.

https://diabetesrisk.hk/what_is_diabetes

Question 2

What is the definition of diabetes?

Accepted Answer

The following level ranges are used by healthcare professionals for diagnosing diabetes:

I.Fasting glucose : ≥7(mmol/L)；or
II.OGTT (Oral Glucose Tolerance Test) 2 hour glucose :≥11.1(mmol/L)；or
III.Glycated haemoglobin (HbA1c) :≥6.5%

* Fasting glucose: after fasting for a period of 8 hours
** OGTT: 75-gram oral glucose tolerance test
# Glycated haemoglobin (HbA1c) : average blood glucose level over the past 2 - 3 months

(Note: In the absence of unequivocal hyperglycemia, result should be confirmed by repeat testing)

Question 3

How to diagnose diabetes?

Accepted Answer

We can diagnose diabetes from the blood test(draw blood), which include:

Fasting and 2-hour postprandial blood glucose (Oral Glucose Tolerance Test; OGTT)

Glycated haemoglobin (HbA1c)

Question 4

Diabetes symptoms

Accepted Answer

Symptoms of diabetes often go unnoticed. If you have the symptoms listed below, your situation may be worsening. Seek medical attention and undergo a diabetes assessment as soon as possible.

Question 5

What complications can diabetes cause?

Accepted Answer

Prolonged high blood glucose levels may damage large and small blood vessels, the nervous system and organs.

Brain
           Stroke that causes hemiplegia (total or partial paralysis of one side of the body)

Eyes
          Diabetic retinopathy, impaired vision, blindness, glaucoma and cataract

Heart
          Coronary artery disease and heart failure

Kidneys
          Proteinuria, kidney failure, ultimately requiring dialysis or a kidney transplant

Feet
          Numbness, wounds heal with difficulty, susceptibility to infection, ulceration and even amputation

Can we prevent these chronic complications?

The key is to take preventive actions by understanding your risk factors, taking blood tests and monitoring your blood glucose levels regularly. Chronic complications are not inevitable.

Question 6

What are the ABC targets of diabetes?

Accepted Answer

ABC targets are:
A = HbA1c (your average blood glucose level over the past 3 months)
B = Blood pressure
C = Cholesterol

If people with diabetes can maintain below health indicators in range, the risk of developing diabetes complication can be greatly reduced.

Question 7

How to manage if you have diabetes?

Accepted Answer

While diabetes cannot be cured, it can be effectively controlled through continuous self-management. A reliable healthcare team is crucial to successful diabetes management and to working out a collaborative care plan that includes the following features:

Medication
             Medication is very important to people with diabetes. You should follow meticulously the instructions of doctors and the directions on drug labels and should not change medication in any way without consulting your healthcare professionals.

Healthy diet
             If people with diabetes have an unhealthy diet, their blood glucose levels are difficult to regulate and the possibility of complications develops. Therefore, a balanced diet is very important in diabetes self-management.

Moderate exercise
             Moderate exercise is very important for diabetes management. It can help to increase insulin sensitivity, control weight and improve heart and lung function. Everyone should maintain sufficient levels of physical activity.

Ideal weight and waist measurement
             Being overweight and obese is closely associated with a variety of diseases. People with central obesity have high risks of developing hypertension, dyslipidemia, cardiovascular diseases and cancer. Their mortality rate is also higher.

Moreover, obesity would raise your ”bad” cholesterol and lower your “good” cholesterol. Obesity may also result in resistance to insulin and elevate blood glucose to high levels, thus developing type 2 diabetes.

Self-monitoring of blood glucose
             Continued self-monitoring of blood glucose is very important in diabetes care so you can know if the blood glucose level is within the normal range and can take immediate corrective action if necessary. In addition, testing the blood glucose level regularly can help you understand how food or physical activity can affect your blood glucose levels. By adjusting your food intake/activities level, you can control your blood glucose levels.

Foot care
             Prolonged high blood glucose levels may damage blood vessels and peripheral nerves, leading to foot problems such as numbness and reduced sensitivity. Poor blood circulation may also make wounds prone to infection and difficult to heal, causing ulceration and even necrosis and eventually amputation. Therefore, in addition to undergoing yearly screening for diabetes complications and checks of your feet by healthcare professionals, you should spend a few minutes carrying out your own foot checks and care every day in order to reduce problems.

Quitting smoking
             Each cigarette contains more than 4,000 chemical substances, more than 7,000 chemicals were identified in the cigarette smoke (eg. cyanide, arsenic, etc.). Which include harmful substances and 69 types of carcinogens. Nicotine, tar and carbon monoxide are the most harmful substance. Hence, smoking accelerates the occurrence of diabetic complications such as renal failure, heart disease and retinopathy.

Regular medical appointments
              Generally, patients who are in stable condition will follow up every 2-4 months. Regular appointments can help professionals understand your health condition and state of diabetes. Such appointments are also useful opportunities for you to put questions to your doctors.

Regular diabetes screening
             According to international guidelines, people with diabetes should have a screening for diabetes complications every 1-1.5 years in order to receive an update on your health condition and prevent such complications. Besides, it is recommended to test the glycosylated haemoglobin (HbA1c which reflect the average blood glucose level) every 4-6 months, especially for those who treated with multiple medications to ensure that the blood glucose is well controlled. For screening, you can visit hospitals or diabetes assessment centres.

Diabetes education

More information，please check：
             https://diabetesrisk.hk/cs_management_of_diabetes

Question 8

How can people with diabetes achieve ABC goal?

Accepted Answer

Maintain a balanced diet, consume carbohydrates at regular time and follow healthy dietary principles.

Choose foods with low glycemic index, low sodium, low saturated fat and high fiber.

Do regular exercise for 30 to 45 minutes a day, 3 to 5 times a week; or 150 minutes a week of aerobic exercise (such as walking after meals). Resistance exercise is recommended 3 times a week.

Quit smoking or avoid passive smoking.

Achieve and maintain a normal body weight. If you are overweight or obese, try to lose 3-5% of your body weight.

Monitor blood glucose regularly (fasting, 2 hours before meals and 2 hours after meals). Proper recording of blood glucose can help to understand the relationship between blood glucose, food intake, exercise and drug dosage. This information can also help to make appropriate choices and adjustments to maintain a balanced lifestyle.

Monitor blood pressure regularly is strongly recommended if you have hypertension.

Take medication correctly and on time.

For more information on blood pressure and blood lipids, please visit:

Blood pressure: https://diabetesrisk.hk/what_is_blood_pressure  
Blood lipid: https://diabetesrisk.hk/what_is_cholesterol

Question 9

What is the “5678” blood glucose target?

Accepted Answer

“5678” blood glucose target

This refers to the finger-prick reading of 5mmol/L to 6mmol/L when fasting and between 7mmol/L to 8mmol/L after meals. When your blood glucose levels exceed "5678", it is suggested to seek advice from healthcare professionals.

Question 10

What is pre-diabetes?

Accepted Answer

Pre-diabetes is when blood glucose levels remain higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes usually do not have any symptoms and usually discovered during blood test. If it is untreated or poorly controlled, 15-30% of these pre-diabetics will develop Type 2 diabetes in 5 years.

Pre-diabetes should 
Engage in normal weight

Healthy diet

Moderate exercise

Check the blood glucose every 1 to 2 years. Detect diabetes early and receive appropriate treatment.

Question 11

What is the definition of pre-diabetes?

Accepted Answer

The following level ranges are used by healthcare professionals for diagnosing pre-diabetes:

I.Fasting glucose : between 5.6-6.9(mmol/L)；or
II.OGTT (Oral Glucose Tolerance Test) 2 hour glucose :between 7.8-11(mmol/L)；or
III.Glycated haemoglobin (HbA1c) :between 5.7-6.4%

* Fasting glucose: after fasting for a period of 8 hours
** OGTT: 75-gram oral glucose tolerance test
# Glycated haemoglobin (HbA1c) : average blood glucose level over the past 2 - 3 months

(Note: In the absence of unequivocal hyperglycemia, result should be confirmed by repeat testing)

Question 12

What is diabetes genetic test? What is the difference between general blood glucose test?

Accepted Answer

General blood glucose test is used to diagnose diabetes when blood glucose is no longer at normal level. However, diabetes is a disease that causes gradual decrease in body function. Until the body can no longer effectively control blood glucose, the glucose level will go out of range eventually. Thus, there is no warning signal for you to improve the situation before developing diabetes. By combining congenital genes and acquired high-risk factors, DForeseeprovides early prediction on the risk of developing diabetes when blood glucose is still in normal range, so that you can effectively prevent the onset of diabetes.

Question 13

What does it mean if the diabetes genetic test result shown high risk of diabetes? What should I do?

Accepted Answer

High risk of diabetes in DForesee means that you have a higher risk of developing diabetes at this moment or within 10 years. You should undergo an oral glucose tolerance test (OGTT) and improve acquired modifiable risk factors (such as body weight and smoking habits) in order toidentify whether you have pre-diabetes and reduce the chance of developing diabetes at early stage.

Question 14

Prevention of diabetes

Accepted Answer

By consistently leading a healthy lifestyle, diabetes is preventable:

Have a more balanced diet by increasing the intake of dietary fibre including vegetables, fruits and unrefined grains. Reduce intake of food with a high sugar and/or fat content.

Engage in regular and continuous exercise. Do aerobic exercise at moderate level, such as brisk walking, or at high intensity at least 3 days a week to achieve the target of at least 150 minutes per week in total.

Get adequate and good quality of rest and sleep. Be happy and relax.

Remember to have regular body check.

More information, please check：
              https://diabetesrisk.hk/maintaining_an_ideal_weight

Question 15

What is high blood pressure (hypertension)?

Accepted Answer

Blood pressure indicates the force of blood pushing against the walls of the arteries when the heart pumps.

Systolic blood pressure = the pressure when the heart contracts
Diastolic blood pressure = the pressure when the heart relaxes between beats

Question 16

How to improve/control blood pressure

Accepted Answer

Maintain a healthy weight

Follow a healthy eating plan，eg.the Dietary Approaches to Stop Hypertension (DASH) or Limit sodium in your diet

Move more
             - Healthy adults are recommended to aim for at least 150 minutes of moderate-intensity aerobic activities such as fast walking per week along with 2 sessions of muscle strengthening activities on non-consecutive days.

Limit alcohol intake
             - Do not start drinking alcohol but if you do, limit your intake.

Emotional well being
             - Getting enough exercise and sleep may help for better emotional well being.
             - Seek help from friends and health professional if needed.

Monitor your blood pressure regularly

Medications
            - If lifestyle intervention is not enough to manage your blood pressure, you may be advised to take medications along with lifestyle intervention. There are many available medication to lower blood pressure and here are some examples.

More information, please check：
             https://diabetesrisk.hk/what_is_blood_pressure

Question 17

Definition of overweight and central obesity

Accepted Answer

To determine whether or not you are centrally obese or overweight, use the following criteria:

Waist circumference：≥90cm/36 inches(Male) or 80cm/32 inches(Female)
BMI：≥23kg/m²
             (BMI：Weight(kilograms)÷height(metres)÷height(metres))

Question 18

What are the key points of weight control?

Accepted Answer

To effectively control your weight, you should improve your diet and exercise, and maintain a healthy lifestyle. Do not use short-term diets to lose weight quickly.

Evidence shows that weight loss at a rate of 1-2 pounds per week is more sustainable.

The risk of developing diabetes of overweight people can be gradually decreased by losing every 3-5% of their body weight.
 
The cholesterol levels of obese or overweight people can be improved by losing 10% of their body weight.

The blood pressure levels can be well-managed if you control your body weight to a normal level.

BMI is not the lower the better. If you are too thin, it may also be detrimental to your health.

Body weight can be lost effectively by understanding your daily calorie requirements, controlling calorie intake and increasing exercise.

People with diabetes or other diseases should consult professional medical or healthcare personnel (such as doctors, nutritionists etc.) to implement weight loss programs with their assistance.

Question 19

How to caculate the daily calories intake?

Accepted Answer

The below table to calculate the required daily calories per person:

Example：
Transportation worker, 55kg (standard weight)
Daily calories required: 55kg X 40kcal = 2,200kcal

Question 20

How to controlling the absorption and consumption of calories?

Accepted Answer

You can easily control your body weight by controlling the absorption (diet) and consumption (exercise/daily activity) of calories. 
You will lose 1 pound in a month by using an additional 100kcal per day and a total of 3,500kcal per month.

You will gain 1 pound in a month by absorption of an additional 100kcal per day and a total of 3,500kcal per month.

Use Citybite calories and food nutrient calculator to know more about informations.
           - WhatsApp chat bot
              https://bit.ly/3sM7ue9 
           - Citybite App
              https://citybite.adf.org.hk

More information, please check：
              https://diabetesrisk.hk/maintaining_an_ideal_weight

Question 21

How to eat smart to stay healthy?

Accepted Answer

If people with diabetes have an unhealthy diet, their blood glucose levels are difficult to regulate and the possibility of complications develops. Therefore, a balanced diet is very important in diabetes self-management.

Eat an appropriate portion of food at each meal, comprising mainly grains and cereals. Eat more vegetables and consume an appropriate amount of meat, milk and fruits and reduce the intake of oil, salt and sugar.

Follow a diet of ”3 Low, 1 High", meaning low fat,low sodium and high fibre.

Eat regular food portions at regular intervals and have many meals but with only small amounts each time in order to maintain stable blood glucose levels.

Learn about the carbohydrates counting (especially the people who are overweight/obese )and exchanges of various types of food from professionals such as dietitians. Learning to choose and eat appropriate amounts of carbohydrates can help to control blood sugar effectively.(especially the people who are using insulin treatment )

Avoid fasting for long periods of time (especially the people who having diabetes )

Avoid drinks with high sugar content and control your intake of food containing sugar (including fruit). Choose sugar-free beverages or drinks using sugar substitutes such as sugar-free tea and diet soft drinks.

Avoid eating too much and reduce the chance of postprandial hyperglycaemia. Take your time to enjoy you meal, which can also give you more satiety.

Eat more high-fibre foods such as brown rice, whole wheat bread, cereals and vegetables, etc., which not only make you feel full but also slow down the rise of blood glucose levels. Soluble fibre also helps to lower cholesterol levels.

Choose low glycaemic index (GI) foods such as whole grains, beans, lentils, kiwi fruit and apples. The carbohydrates in low GI foods will be digested and absorbed by the body at a relatively slow rate compared with those in high GI foods, and hence will have less influence on blood sugar levels.

Use cooking methods like steaming, boiling, simmering and stewing.

Instead of salt, you can use lemon juice, ginger, onion, garlic, pepper, allspice, curry powder and natural herbs for seasoning.

Use oil which contains unsaturated fats for cooking such as corn oil, peanut oil, canola oil and olive oil; and control the use of cooking oil.

Use fresh ingredients and enjoy cooking at home.

Reduce the frequency of dinnier out and avoid saving too much  snack at home (eg. biscuit, candy)

More information, please check：
             https://diabetesrisk.hk/cs_healthy_diet

Question 22

What is Glycaemicindex?

Accepted Answer

The GI measures how food containing carbohydrates affects blood glucose levels. To calculate GI, please use the following method as follows:

The carbohydrates in the low GI foods will be digested and absorbed relatively slowly compared with those in high GI foods, and hence will have less influence on blood sugar levels. If people with diabetes want to control their blood glucose levels, they should choose low GI food.

Please find examples of high, middle and low GI foods as follows:

Question 23

What are the key points of DASH diet?

Accepted Answer

Studies have shown that the DASH diet can help reduce high blood pressure, improve cholesterol levels, and reduce the risk of developing heart diseases.

Key points including:

Encourage consumption of fruits, vegetables and whole grains.
 
Moderate consumption of low-fat or non-fat dairy products, poultry, fish, beans; nuts, seeds and vegetable oils with high unsaturated fats (such as olive oil).

Consumption of foods rich in dietary fiber, potassium, magnesium and calcium.

Limit consumption of foods containing saturated fats and fatty foods, including high-fat meats, full-fat dairy and palm oil

Limit daily intake of sodium to less than 2,000mg (equivalent to about 1 teaspoon of salt or 2 tablespoons of sauce oil). Blood pressure levels can be further improved when daily intake reduced to 1,500mg.

Try to be as low in sugar as possible and reduce your intake of added sugar.

Question 24

How to implement a low-salt (sodium) diet?

Accepted Answer

Choose more fresh foods and reduce consumption of imported processed foods (such as sausages, bacon and pickled vegetables).

Make good use of herbs and spices (such as garlic, ginger, onion, basil and pepper) instead of high-sodium seasonings (such as chicken powder, soy sauce, fermented bean curd and ready-made sauces) during cooking.

Make your own sauces with fresh fruit or vegetables.

Learn to read food labels and choose low-sodium foods as much as possible.

Question 25

The sport tips

Accepted Answer

Moderate exercise is very important for diabetes management. It can help to increase insulin sensitivity, control weight and improve heart and lung function.

Do exercise regularly and avoid sitting too long (eg. 1 hour).

Do at least 30 minutes at time and 3-5days a week for about 150 minutes (eg.brisk walking, jogging, cycling, Tai Chi, swimming, ball games and dancing )

More information，please check：
              https://diabetesrisk.hk/moderate_exercise

Question 26

The benefits of qutting smoking

Accepted Answer

Each cigarette contains more than 4,000 chemical substances,
          Which include harmful substances and 43 types of carcinogens.  
           (eg. Nicotine, tar and carbon monoxide etc.)

Smoking greatly increase your risk of heart disease. Smoking accelerates the occurrence of diabetic complications such as renal failure, heart disease and retinopathy.

Advantages of quit smoking
             - Reduce the risk of lung cancer, oral cavity cancer, nasopharynx cancer, larynx cancer, pancreas cancer

- Protect your family and friends against hazards of secondhand smoke

- Save money from buying cigarettes

- Smell fresh and build up a healthy image

Question 27

How to quit smoking?

Accepted Answer

Mark down your reasons for quitting and set up a plan to quit.

When you start to quit smoking, you'll still have urges for a cigarette. As your urge will last for just a few minutes, you will be able to get it over.

- Delay
                When you want to buy, pick up or light a cigarette, slow down your action and steps, recall your reasons of quitting. In a few minutes, you will get over your urge.

- Distraction
               Wash your face, listen to your favourite music or talk to others in order to let yourself 'calm down'. You may also take a short break or do some stretching exercises for diverting your attention on the urge.

- Deep breathing and drink water
               Deep breathing and drinking water could help you defeat your urge to smoke. You can relieve your stress and regain your concentration by doing breathing exercise slowly.
             - Avoid triggers

Avoid environment that is filled with secondhand smoke and refuse any invitation to smoke.

- Avoid drinking alcohol as it may lower your vigilance to smoking.

- Avoid caffeine-containing drinks such as coffee, strong tea, cola, etc. These drinks may provoke cravings.

- If you used to smoke when you feel bored, why not do something else such as planting, keeping pet, jogging, doing exercise and making use of community resources, such as participating courses in community centres.

Question 28

More Information

Accepted Answer

Asia Diabetes Foundation：
Website  www.diabetesrisk.hk 
Facebook  www.facebook.com/diabetesrisk.hk 
Instagram  www.instagram.com/diabetesriskhk 
YouTube   www.youtube.com/@diabetesriskhk

Question 29

References

Accepted Answer

American Diabetes Association http://www.diabetes.org 
Centre for Food Safety http://www.cfs.gov.hk 
Department of Health-Healthy HK http://www.healthyhk.gov.hk 
Diabetes HK http://www.diabetes-hk.org 
Smart Patient Website http://www21.ha.org.hk 
Centre for Health Protection http://www.chp.gov.hk 
The University of Sydney http://www.glycemicindex.com 
The Joint FAO/WHO Expert Committee on Food Additives (JECFA) http://www.fao.org/food/food-safety-quality/scientific-advice/jecfa/en 
The Scientific Committee on Food (SCF) https://ec.europa.eu/food/sci-com/scf_en 
International Diabetes Federation http://www.idf.org 
National Institute of Diabetes and Digestive and Kidney Diseases, NationalInstitutes of Health http://diabetes.niddk.nih.gov 
The Prince of Wales Hospital Charitable Foundation http://www3.ha.org.hk/pwh/pwhcharity/dmpatient_c.htm#check
Tobacco and Alcohol Control Office http://www.tco.gov.hk 
World Health Organization http://www.who.int 
The Hong Kong Institute of Diabetes & Obesity The Chinese University of Hong Kong http://www.hkido.cuhk.edu.hk/Centres/CUHKYaoChungKitDiabetesAssessmentCentre.aspx 
U.S. Food and Drug Administration https://www.fda.gov 
Leisure and Cultural Services Department - Healthy Exercise for All Campaign http://www.lcsd.gov.hk/tc/healthy 
Hong Kong Dietitians Association https://www.hkda.com.hk 
Hospital Authority http://www.ha.org.hk

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