High blood sugar

High blood sugar is an alarming topic worldwide. World Health Organization (WHO) has recorded that 422millions of adults are having diabetes mellitus. High blood sugar is also known as hyperglycemia. It is a spectrum of disease in which it ranges from prediabetic, consisting of impaired fasting glucose and impaired glucose tolerance to overt Diabetic Mellitus. Prediabetic is also known as high blood sugar when the sugar level is higher than normal but not yet enough to develop diabetes. High blood sugar happened when your body has a little hormone called insulin or your body cells are resistant to insulin.

According to Malaysia National Health and Morbidity survey (NHMS) 2019, the prevalence of the population having high blood sugar is 23.6%, which is around 5million adult individuals in Malaysia are prediabetic. They have a higher risk of having diabetes in the future. Besides, NHMS also showed that among 1 in 5 adults in Malaysia (3.9million) is having Diabetes mellitus.

Source: Malaysia National Health and Morbidity survey 2019

Why do we have high blood sugar?

Our body required sugar as an energy source to work functionally. Every time when we eat the foods, the foods will turn out to glucose in our blood vessels. The blood sugar needs to enter our body cells to be used. Insulin hormone acts as a key to open the lock of our body cells which then allows sugar goes into the cell. In normal conditions, our body will maintain our blood sugar in a balanced state by our liver and pancreas.

Things get haywire when our insulin cannot function properly either due to low insulin or insulin become non-sensitive. In these conditions, we will get high blood sugar as sugar cannot go into the cell and remained in the blood vessels. This resulted in prediabetic or diabetes mellitus.

The following risk factors could lead to insulin resistance or high blood sugar:

  • Family history of diabetes mellitus
  • Overweight or obese (BMI ≥ 23kg/m2)
  • Sedentary lifestyles
  • Hypertension, High cholesterol
  • History of Gestational Diabetes Mellitus
  • Polycystic Ovarian syndrome
  • Hormonal problem such as crushing disease

The table below depicts the classification of venous blood glucose levels. All the blood glucose level finding is based on venous blood glucose level and not capillary blood glucose (glucometer). Always consult your doctor if you have a query about your health conditions or blood results.

ClassificationFasting blood
glucose level
(mmol/L)
Random blood
glucose level
(mmol/L)
Normal<6.1<7.8
Impaired fasting
glucose (Prediabetic)
6.1-6.9<7.8
Impaired glucose
tolerance (Prediabetic)
<7.07.8-11.0
Diabetic Mellitus≥7.0≥11.1
Table 1: Classification of venous blood glucose level

what are the symptoms with high blood sugar?

The symptoms of high blood sugar are the same as hypertension and high cholesterol. It’s ranges from asymptomatic to symptomatic. Someone will not know he or she is in a high blood sugar state unless they get tested in a clinic or pharmacy.

However, we still can look for some symptoms of high blood sugar which are:

  • Easily tired
  • Easily thirsty
  • Frequent urination
  • Easily hungry and increase appetite
  • Weight loss
  • frequent infection such as urinary tract infection or skin infection

What’s the complication of high blood sugar?

we have often heard about diabetes can lead to amputation of the legs. Besides diabetic foot, what are the other complications of high blood sugar? Below are the complications of long term high blood sugar:

  • cardiovascular disease
  • Diabetic emergency such as diabetic ketoacidosis
  • Low blood sugar (hypoglycemia)
  • Diabetic Kidney disease
  • Visual problem
  • Diabetic foot
  • Sexual dysfunction
  • Oral health problem

Are there any lifestyle modifications for high blood sugar?

Weight Reduction. Weight reduction is important for those with high blood sugar and who are overweight or obese. According to American Diabetes Association (ADA), sustained weight loss of ≥7%-10% within 6 months has been proven to effectively revert or delay the progression of prediabetes to diabetes.

Exercise. Physical activity has been proven to be effective in reducing weight and blood sugar. It is recommended to do exercise for at least 150minutes per week and with no more than 48-72hours without exercise. This is because the insulin-sensitive effect of exercise does not last beyond 48 to 72 hours. For example, 30minutes of brisk walking, jogging, cycling, gardening, badminton and etc for 5 days or more per week.

Stop Smoking. Smoking tobacco including cigarettes, electronic cigarettes, cigars, vapes, shisa, and pipes can lead to many complications in people with high blood sugar. Research has shown that smoker has poorer blood sugar control and many cardiovascular complications. Someone should seek their medical practitioner if they willing to quit smoking.

Always check your cholesterol and blood pressure. People with high blood sugar should regularly check their blood cholesterol levels annually and blood pressure regularly. All these risk factors have been associated with an increased mortality rate.

What could we eat in high blood sugar?

Mediterranean diet. According to National Institute for Health Care Excellence (NICE), a Mediterranean diet that focuses on low calorie, low fat, high fiber diet, whole grains, fruits and vegetables, and minimal refined sugar has shown to beneficial in revert or delay the progression of high blood sugar.

High fiber diet. People with high blood sugar should take at least 20-20g of fiber per day. Example of fiber foods include fruits, vegetables, legumes, and whole-grain cereals

Whole grains. Research has shown that substituting white rice with brown rice and wholemeal bread will reduce and delay the progress of prediabetes to diabetes. Malaysian Dietary Guidelines have recommended Malaysian use whole grains as 50% of the total grains intake.

Avoid sugar-sweetened beverages and choose food that is low or medium in glycemic index. Try to avoid sugar-sweetened beverages and replace them with plain water as this will reduce the risk of developing diabetes mellitus. Besides, choose food that is low or medium in the glycemic index as foods that are high in glycemic index tend to raise the glucose level higher. Examples of low or medium glycemic index foods are all-bran breakfast, barley, brown rice, basmati rice, cereals, wholemeal and etc.

Follow the Healthy eating plate. A healthy eating plate showed the portion of foods that a person should take. It consists of 1/2 plate of fruits and vegetables, 1/4 plate of noodles, rice, and other carbohydrate sources, and 1/4 plate of protein sources.

Picture 2: Healthy Eating Plate

Last but not least, always check your sugar level if you are in the high-risk group as high blood sugar will go into diabetes if early intervention or lifestyle changes are not taken. Always consult your doctor and dietician if you are in high blood sugar or diabetes. They will provide a suitable medical or diet plan for you in treating high blood sugar.

References

Ali MK, Bullard KM, Saydah S, Imperatore G, Gregg EW. Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014. Lancet Diabetes Endocrinol. 2018;6(5):392-403.

American Diabetes Association. (2019). 5. Lifestyle management: standards of medical care in diabetes—2019. Diabetes care42(Supplement 1), S46-S60.

Bajaj, S. (2018). RSSDI clinical practice recommendations for the management of type 2 diabetes mellitus 2017. International journal of diabetes in developing countries38(1), 1-115.

Ministry of Health Malaysia (2015). Malaysian Dietary Guidelines.

Ministry of Health Malaysia (2020). National Health and Morbidity Survey 2019: Non-communicable diseases, healthcare demand, and health literacy. Retrived from http://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf

Ministry of Health Malaysia (2021). Clinical Practice Guidelines on Management of Type 2 Diabetes Mellitus (6th ed.).

Mudaliar U, Zabetian A, Goodman M, et al. (2016). Cardiometabolic risk factor changes observed in diabetes prevention programs in US settings: a systematic review and meta-analysis. PLoS Med 2016;13:e1002095

National Institute for Health and Care Excellence (NICE). (2017). Type 2 diabetes: prevention in people
at high risk.
Available at https://www.nice.org.uk/guidance/ph38.

Seah JYH, Koh W-P, Yuan J-M, van Dam RM. (2019). Rice intake and risk of type 2 diabetes: the Singapore Chinese Health Study. European Journal of Nutrition. 2019;58(8):3349-3360.

World Health Organization (WHO). (2020). Disbetes. Retrived from https://www.who.int/news-room/fact-sheets/detail/diabetes.

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