Diabetes

At a glance

Diabetes is a condition in which the sugar (glucose) in your blood is not used properly,
so blood sugar stays high.

The frightening part is not the high blood sugar itself, but that it damages your blood vessels over a long time.
The eyes, kidneys, nerves, heart and brain are affected one after another.

So the goal of diabetes care is not "to feel fine today"
but "to protect your eyes, your kidneys and your feet 10 years from now".

Diagnosis criteria

By the standard of the diabetes center at Asan Medical Center (서울아산병원), you have diabetes if any one of the four below applies.

| Test | Diabetes criterion |
|---|---|
| Fasting blood sugar (after fasting 8 hours or more) | 126 mg/dL or higher |
| 2-hour post-meal blood sugar (oral glucose tolerance test) | 200 mg/dL or higher |
| HbA1c (glycated hemoglobin) | 6.5% or higher |
| Random blood sugar + typical symptoms (frequent urination, thirst, weight loss) | 200 mg/dL or higher |

Prediabetes

There is a range that is not diabetes yet, but is not normal either.

| Type | Criterion |
|---|---|
| Impaired fasting glucose | Fasting blood sugar 100~125 mg/dL |
| Impaired glucose tolerance | 2-hour post-meal blood sugar 144~199 mg/dL |

Asan Medical Center explains that
"at the prediabetes stage, changing your lifestyle can prevent or delay type 2 diabetes".

This is the most important fork in the road.
Many people brush it off, thinking "so it is not diabetes".
But this is almost the last moment when you can turn it around.

This page is reference information that summarises official sources.
Always talk to a medical professional about diagnosis and treatment.

Typical symptoms

• Frequent urination — you pass urine often, and a lot of it. You wake up at night to use the toilet
• Constant thirst — you keep drinking water. Your mouth feels dry
• Constant hunger — you feel hungry even after eating
• Weight loss — you lose weight even though you eat well

But most people have no symptoms

These symptoms appear when blood sugar is already quite high.
In the early stage you feel nothing.

So with diabetes you must not wait for symptoms.
You have to find it through the blood sugar number on your health check-up.

These changes can also be a sign

• Wounds that heal slowly
• Feeling tired all the time
• Blurry vision
• Tingling or burning in the hands and feet
• Itchy skin, or skin that becomes inflamed easily

If you heard this at your check-up

• "Your fasting blood sugar is a little high" — 100~125 is prediabetes. Do not brush it off
• "They want to check your HbA1c" — this test shows your average blood sugar over the past 2~3 months
• "They said to come back for a repeat test" — please go. Diabetes is not diagnosed from one number

Check even without symptoms if this is you

• Someone in your family (parent or sibling) has diabetes
• You are obese, or your waist has grown
• You have high blood pressure or high cholesterol
• You had gestational diabetes
• A past check-up showed fasting blood sugar of 100 or higher

Where to go first — a local clinic is enough

Diabetes is not a condition you should take to a big hospital first.

• Internal medicine / family medicine — you can start at a local clinic
• Endocrinology — the department that specializes in diabetes. Good if your blood sugar is hard to control, or if you start insulin

Diabetes is a condition you live with for life.
The best hospital is the one close to home that is easy to visit.
The worst thing is skipping months because it is too far.

Departments you meet because of complications

With diabetes you end up visiting several departments. That is normal.

• Ophthalmology (eye) — retinal screening. You go regularly even without symptoms
• Nephrology (kidney) — if your kidney function has worsened
• Neurology — nerve damage, such as tingling in the hands and feet
• Orthopaedics / plastic surgery / vascular surgery — if a wound or ulcer appears on your foot
• Cardiology — to manage your heart risk at the same time

When you go to a big hospital

• When blood sugar is hard to control and your medicine has to be changed several times
• When you start insulin treatment, or need it adjusted
• When a complication appears and needs specialist treatment
• When you have type 1 diabetes

Once you are stable at a big hospital, it is good to go back to a local clinic for your ongoing care.
Hospitals call this 'sending back' (회송), and it is nothing to be embarrassed about.

If you visit the outpatient clinic of a tertiary hospital, you need a referral letter (진료의뢰서) for national health insurance (건강보험) to apply.

You can search for local hospitals on the map.

It is found at the national health check-up

Diabetes is most often found first in the fasting blood sugar number of the national health check-up (국가건강검진).
Always check the fasting blood sugar item on your result sheet.

• Under 100 — normal
• 100~125 — prediabetes. You need to start managing it
• 126 or higher — possible diabetes. Get tested again

Check who is eligible and how often at the National Health Insurance Service (국민건강보험공단).

Tests done at the hospital

• Fasting blood sugar — a blood test after fasting for 8 hours or more
• HbA1c (glycated hemoglobin) — a test that shows your average blood sugar over the past 2~3 months. Being careful the day before does not improve it. You do not need to fast
• Oral glucose tolerance test — you drink 75g of glucose dissolved in water, and your blood sugar is checked 2 hours later
• Random blood sugar — blood sugar measured at any time, regardless of meals

Why is it measured several times

Diabetes is not diagnosed from a single number.
Blood sugar rises and falls with your general condition, with stress, even with a cold.

So you are tested again on another day, or other items are checked as well.
Being told "let's test again" is not a bad sign. It is the normal procedure.

Measuring blood sugar at home

After diagnosis, many people measure their own blood sugar at home.

• Your medical team decides when you measure (fasting or after a meal) and how often
• Write your numbers down and bring them to your appointment. They are the basis for adjusting your medicine
• Do not raise your own dose or skip meals just because a number came out high

Please read this section if you read nothing else.
With diabetes complications, by the time symptoms appear it is often already late.
That is why you have these tests on a set schedule even when you feel fine.
Yet a great many people do not know this and never have them.

The following is based on materials from the Korean Diabetes Association.

Eyes — fundus (retinal) examination

• With type 2 diabetes, you should have a fundus examination every year from the moment you are diagnosed
• With type 1, it starts within 5 years of diagnosis, then every year
• If the test is normal, the interval is sometimes stretched to once every 2~3 years
• If signs of progression are seen, it is checked more often

"My eyes see fine, so why?"
Diabetic retinopathy does not blur your sight until it has progressed quite far.
Once you notice it, it is already late. This is not a test you go to because you cannot see. It is a test you go to before you cannot see.

Kidneys — urine and blood tests

• With type 2, a microalbuminuria (small amounts of protein in urine) test every year from diagnosis
• With type 1, every year from 5 years after diagnosis
• Serum creatinine is measured every year, whether or not albuminuria is present

Kidneys give no symptoms as they get worse.
By the time you swell up or see foam in your urine, it has often already progressed.

Nerves — hand and foot examination

• Once at the time of diagnosis, and after that at least once a year
• A foot with reduced sensation is checked every 3~6 months
• For autonomic neuropathy too, type 2 starts at diagnosis, then at least once a year

Feet — a comprehensive foot examination every year

You should have a comprehensive foot examination every year.
The doctor looks at your feet, feels the pulse on the top of the foot and at the ankle, and checks whether sensation is still there.

The feet are the most frightening place in diabetes.
When the nerves go numb, a wound does not hurt, so you carry on without noticing.
Meanwhile it deepens, and in some cases it leads to amputation.
At your appointment, say "please take a look at my feet" first. You will need to take off your shoes and socks.

Heart and blood vessels

• Cardiovascular risk factors are assessed every year
• Cholesterol is usually tested every year (once every 2 years if your risk is low)

The most common cause of death in people with diabetes is cardiovascular disease.
Do not look only at blood sugar. Manage your blood pressure and cholesterol as well.

In short — have these at least once a year

• Eyes (fundus examination)
• Kidneys (urine microalbuminuria + blood creatinine)
• Feet (comprehensive foot examination)
• Nerves (sensation in hands and feet)
• Cholesterol

Your own testing schedule is decided by your medical team.
The above is a general standard, and it changes with your condition.
At your appointment, ask "which tests do I need this year?"

Diabetes treatment does not work with medicine alone.
Diet, exercise and medicine go together.

Control targets

These are the general targets given by the Korean Diabetes Association.

| Item | Target |
|---|---|
| HbA1c | under 6.5% |
| Fasting blood sugar | 80~130 mg/dL |
| 2-hour post-meal blood sugar | under 180 mg/dL |
| LDL cholesterol | under 100 mg/dL |
| HDL cholesterol | 40 or higher for men / 50 or higher for women |
| Triglycerides | under 150 mg/dL |

Blood pressure matters too. The association explains that careful blood pressure control is important to prevent kidney and blood vessel complications,
and that medication is considered when systolic pressure is 140 or higher, or diastolic pressure is 85 or higher.

Targets are different for each person.
If you are older, or your risk of low blood sugar is high, the target is set more loosely.
Ask your medical team "what is my target percentage?" and keep it in mind.

Diet and exercise

• For what to eat and how much, it is most accurate to have nutrition counselling. Big hospitals and public health centers (보건소) provide it
• Starving yourself is not treatment. It leads instead to low blood sugar and to binge eating
• With exercise, doing it steadily is what matters. Walking is enough

Medication

• Tablets — there are several kinds, and they work in different ways
• Injections (insulin and others) — used when they are needed

Using insulin does not mean your illness has got worse.
"Once you are on insulin, that is the end" is not true.
It is the method that suits your body now, and some people go back to tablets later.

Do not stop your medicine on your own

Better blood sugar means the medicine is working. It does not mean you are cured.
If you stop, it goes back up. Always discuss any change with your medical team.

Low blood sugar — the most urgent situation in diabetes care

Blood sugar that drops too low is dangerous too. It is in fact more urgent.

Suspect low blood sugar if you feel like this.

• Cold sweat, shaking hands
• A pounding heart
• Sudden, severe hunger
• Dizziness and weakness
• Slurred speech, or a foggy mind

What to do right away

1. Take something sweet that is absorbed quickly (juice, candy, sugar water and so on)
2. After a short while, measure your blood sugar again
3. If it has not improved, take some more; if it still does not improve, go to a hospital

⚠️ If the person is unconscious or drowsy, do not put anything in their mouth.
It goes into the airway. Call 119 immediately.

What to prepare in advance

• Always keep candy or glucose tablets in your bag or pocket
• Tell your family and your colleagues at work, "if I act like this, it is low blood sugar"
• It helps to carry a card or a tag showing that you have diabetes

When you are ill, with a cold or something similar

When you are ill you cannot eat well, but that does not mean you may stop your medicine as you please.
On the other hand, taking your medicine without eating brings on low blood sugar.

• Drink plenty of water
• Measure your blood sugar more often than usual
• If you cannot eat for some time, call your hospital and ask

It is good to ask in advance at your appointment.
"What should I do about my medicine when I am ill and cannot eat?"

There is a benefit if you get your care at a local clinic

If you get steady care at a local clinic for a chronic condition such as high blood pressure or diabetes,
there is a program that lowers your out-of-pocket cost.

Its name and conditions have changed over the years, so
ask the local clinic you attend, "is the chronic disease management program available here?"
If you qualify, the clinic registers you.

Things to know

• Diabetes is not a condition where the special cost-sharing program for serious illness (산정특례) applies automatically, as it does for cancer.
• However, in cases such as needing dialysis because of a complication, a separate special cost-sharing program exists.
• Out-of-pocket costs for tests and medicines differ from item to item.
• Supplies for home blood sugar testing (test strips and so on) have set conditions for support. Check with your hospital or with the insurance service.

Use your public health center as well

Many public health centers run free
nutrition counselling, exercise programs, blood sugar measurement and education for people with diabetes.
Call the public health center near you and ask.

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date. Always
check the latest rules at the National Health Insurance Service.