Oct - Dec 2015 - Diabetic Society of Singapore

Transcription

MCI (P) 028/09/2015
D
iabetes
Singapore
Issue 55 OCT - DEC 2015
Publication of Diabetic Society of
T P HEALTHY HAWKER
BREAKFAST PICKS
WHAT’S
IN YOUR
K PI?
WORLD DIABETES DAY
SINGAPORE
SUNDAY
EXERCISE:
15 NOV 2015
Beyond lowering
blood sugar
The Gift of
Forgiveness
3
DSS man
FROM
04
S BUZZ
S
D
6
0
6
ee
committ
agement
2014/201
S
T
N
E
T
CON
A WORD
ENT
PRESID
E
C
I
V
E
TH
S
ROGRAM
REACH P
T
U
O
T
S
PA
AT
FF RETRE
DSS STA
ORATION
B
A
L
COL
DSS-NTU WS
BAY
E
S BY THE
DSS DSG N ION TO GARDEN
CURS
SG50 EX
FOUNDER
Dr Frederick Tan
Bock Yam
PATRON
The Honourable
Minister for Health
08
11 EYE SITE
LLS
HOTO TE
EVERY P
ADVISOR
Dr Warren Lee
PRESIDENT
Mr Yong Chiang Boon
VICE-PRESIDENTS
Dr Kevin Tan Eng Kiat
Dr Ben Ng
HON SECRETARY
Ms Esther Ng
ASST HON SECRETARY
Mr Stanley Lim
HON TREASURER
Mr Seah Peck Hwee
ASST TREASURER
Ms Caroline Lim
COMMITTEE MEMBERS
Dr Yeo Kim Teck
Mdm Rohanah Pagi
Ms Kalpana Bhaskaran
Ms Juliana Lim
DA
ADAN AN
B
AN PADA
RNER
O
C
H LAKUK
E
E
L
O
R
B
A
S
E
C
BET
APA DIA
TING
IG
R
E
TH HT FOO
A STORY
ARE FORGIVENESS
F
HEARTTHW
E GIFT O
12
OKOUT
O
C
4
1
AY TEOW
FRIED KW KEN
IC
CURRY CH
ER SIDPEICK UP A CUPPA...
T
H
G
I
L
E
OU
TH
T TIME Y
E
THE NEX
E CENTR
H
T
T
A
T
S
A
F
K
A
E
BR
18
2 FEATURE
2
4
2
S SOUR
ET TURN
E
WHEN SW
P
LUCOSE
SHAPEYOUND LOWERING BLOOD G
BE
4
l team
A WORD FROM THE VICE-PRESIDENT
editoria
THAT TIME OF THE
YEAR AGAIN...
W
Our commemorations in Singapore will be on Sunday, 15 November as a full day public event
at Suntec City Convention Centre, Level 3. The theme is centred on the connection between
Diabetes and Overweight. The two are intricately linked and sometimes misunderstood.
In Type 2 diabetes, obesity hastens the onset of diabetes and accounts for the increasing
prevalence of diabetes among younger people. Being overweight makes insulin action in
the body less effective (insulin resistance) and makes diabetes harder to control.
Losing weight is, hence, an important facet of diabetes lifestyle management and losing
weight is extremely difficult! In Type 1 diabetes, insulin use can sometimes contribute
to excessive weight gain and this again compounds the problem of managing one’s
blood sugars well. Additionally, conventional medication for diabetes sometimes leads
to weight gain working against a person’s best efforts to lose it!
There is much to educate and be made aware of—preventing obesity can prevent
Type 2 diabetes and lower its prevalence. Newer medication that have come into the
market over the last five years or more for treating diabetes are now better for weight
control and some even help in weight loss!
This year, a vital partner in the fight against obesity and diabetes is the Obesity and
Metabolic Surgery Society of Singapore (OMSSS). Surgeons from the Society will
be speaking on Bariatric or ‘Weight-loss” Surgery and how it can provide a ‘’cure”
for Type 2 diabetes. Look out for them at the public talks on World Diabetes Day.
See you on World Diabetes Day Singapore , 15 November !
DR KEVIN TAN ENG KIAT
Vice-President
Diabetic Society of Singapore (DSS)
Diabetic Society of Singapore (DSS) was founded by Dr Frederick Tan
Bock Yam on 25 September 1971 to help diabetes patients manage
their condition.
DSS is a non-profit organisation affiliated to the International Diabetes
Federation and the National Council of Social Service. DSS gratefully
accepts donations of any amount to help fight diabetes. All donations
are tax exempt. Cash donations must be made in person at our HQ.
Cheque donations should be made payable to Diabetic Society of
Singapore. You may also make online donations via www. sggives.org/
diabetes.
Managing Editor
Charlotte Lim
Editor (Dietetics)
Janie Chua
Editorial Consultants
orld Diabetes Day is round the corner once again. 14 November is commemorated
worldwide on the birthday of Sir Frederick Banting who co-discovered insulin, the
first medication for diabetes, which has saved millions of lives.
As part of our side events, there will be a walk on Saturday morning at the
Singapore Zoological Gardens (Mandai). Call our DSS hotline 6842 6019 / 6842
3382 for more information and if you are interested in participating in the walk.
Editor-in-chief
Dr Yeo Kim Teck
DSS Mgmt Committee
Writers
Henry Lew (psychologist)
Kohila Govindaraju (nutritionist)
Ray Loh (physiologist)
Rodiah Hashim (DSS)
Contributors
Dr Yeo Kim Teck, Chan Sau Leng,
Lock Poh Leng , Rose Tan, Dr Goh
Kian Peng, Chan Sau Leng.
Concept & Design
Charlotte’s Web Communications
Photography
Dreamstime.com, Shutterstock & sxu.hu
Printing
Stamford Press Pte Ltd
Advertising
George Neo
Esther Ng
Advertisement Bookings
T: 6842 3382 or E: editor@diabetes.org.sg
Feedback editor@diabetes.org.sg
Back Issues www.diabetes.org.sg
Diabetic Society of Singapore HQ
Blk 141 Bedok Reservoir Road #01-1529
Singapore 470141
T: (65) 6842 6019 /3382
Disclaimer
The views, opinions and recommendations given by the contributors of
Diabetes Singapore or are merely for general reference. All materials in
this newsletter are for informational purposes only. The individual reader
should consult his own doctor or specialist for his personal treatment or
other medical advice. DSS and Diabetes Singapore Editorial Board disclaim all
responsibilities and liabilities for content expressed in this newsletter including
advertisements herein. All contents of the newsletter are the copyright of the
contributors and newsletter. Reproduction in any form is strictly prohibited
unless with written permission.
6
ZZ
DSS BU
DSS Staff Retreat
Rodiah Hashim
It was a welcome respite from their daily routine. DSS staff enjoyed a 2D1N retreat to
Batam on 22 August 2015 which also celebrated nurses’ day. Amidst the fun activities
and shopping, the nurses managed to squeeze in their bi-monthly meeting as well.
All in all, they all had a fruitful and relaxed weekend.
DSS Collaboration with NTU
Rodiah Hashim
DSS was approached by Nanyang Technological University to help in their
research study which seeks to understand the behaviours of people with diabetes
in Singapore and their caregivers. Focus Group Discussions were held at our DSS
HQ and education centre in Bedok and participants were duly compensated.
DSS would like to thank the participants and their caregivers for coming forward
to share their experiences. We hope with their participation and contribution, we
can accomplish our mission to raise public awareness of diabetes and to enable
people with diabetes to manage their condition and lead a healthy and productive
life.
FOR THE
LATEST ON
DSS EVENTS,
LOG ONTO
www.diabetes.org.sg
For enquiries,
please contact
6842 6019.
Diabetes Singapore Oct - Dec 2015
Past Outreach Programs
13 Sep 2015
Health Screening at Masjid Abdul Gafoor
26 Jul 2015
Health Screening at Hindu Endowment Board Health Fair 2015 at Sri Perumal Temple
7
Rodiah Hashim
Support Group Team Leaders Workshop
Continuing Education for People with Diabetes
DSS organised a workshop over two days—19 July and 1 August 2015—for the
DSS support group team leaders to help them provide better support to members.
Conducted by Mdm Lai Yee Khim, a nursing consultant with DSS, with invited
speakers Dr Ben Ng and Mr Henry Lew, participants learnt about the A to Z of diabetes
management from its prevention and actions to take, to complications, nutrition, selfblood glucose monitoring, exercise, stress and sick-day management.
There was positive interaction among participants and the informative sessions
left participants empowered and asking for additional workshop days. As diabetes
management continues to develop, DSS will conduct these sessions on a regular basis
to keep those leading the group updated.
DSS Support Group
Meet & Share
The DSS Support Group (DSG) members
met up on 11 July 2015 to share what
healthy dishes they have cooked. From
sandwiches to salads to chicken curry, all
agreed that meals for people with diabetes
need not be bland and boring. Do look out
for more of these meet and share sessions
on our website, www.diabetes.org.sg
Care to join us for our next DSG meeting
or outing? Ring Juliana at 9278 2084 for
information or to register.
DSG CALENDAR 2015
* Please bring along your own blood
glucose metre for all DSG activities
*Please wear a pair of good walking
shoes and bring along an umbrella for all
outdoor activities.
SG50 Excursion to Gardens by the Bay
Rodiah Hashim
In celebration of SG50, Gardens by the Bay opened up both their conservatories
to registered VWOs and senior citizens. Normally priced at $20, complimentary
entry was offered till the end of August. Not to miss out on a good opportunity,
DSS organised a weekday trip 28 August 2015 for both members and their support
group members.
As early as 8.30am, a bus load of members waited at the Eunos MRT Exit A car-park
for the bus to transport them to the Gardens. Upon arrival at 10.00 am, they were
in time for a guided tour of the Flower Dome. It was surely a morning of lores and
legends as 10 local folktales were brought to life through the creative use of orchids
and other flowers in “From Tales to Legends” – a SG50-commemorative floral display
in the Flower Dome.
Saturday, Oct 31, 4pm
Park Connector (PCN) Walk
Central Route 9 (7 km)
Buangkok MRT Passenger Service

Saturday, Nov 28, 4pm
Park Connector (PCN) Walk
Central Route 10 (7.1 km)
Riveria LRT Passenger Service
8
R
ORNE
CARE C
Apa Diabetes Boleh Lakukan
Pada Badan Anda
Translated by Rodiah Hashim
Komplikasi Diabetes
Jika ia tidak dikawal, diabetes boleh menyebabkan pelbagai
komplikasi yang boleh memberi kesan kepada hampir setiap
organ dalam badan.
1
Penyakit jantung
Penyakit jantung adalah salah satu komplikasi diabetes
yang paling biasa. Dalam lawatan pejabat, doktor anda boleh
melakukan pelbagai ujian untuk memeriksa penyakit jantung
dan membantu anda mengelakkan sebarang masalah berkaitan
jantung yang serius. Pada setiap lawatan, doktor anda akan
memeriksa tekanan darah anda. Paras kolesterol dan trigliserida
boleh disemak pada lawatan pertama anda. Pemeriksaan asas
EKG juga perlu diperolehi sebagai sebahagian daripada rekod
perubatan yang lengkap. Ketahui lebih lanjut mengenai faktorfaktor risiko peribadi anda dengan penyakit jantung, seperti
sejarah keluarga atau sama ada anda merokok, dan kemudian
merumuskan satu pelan pencegahan yang termasuk penurunan
berat badan, senaman tetap, dan pengurusan tekanan, serta
menjaga tekanan darah anda, kolesterol, dan trigliserida pada
tahap yang normal.
2
Strok
Tanda-tanda dan simptom strok termasuk kelemahan
secara tiba-tiba pada sebelah muka atau badan; kebas di muka,
lengan, atau kaki; gagap; masalah penglihatan dengan keduadua mata; atau pening. Jika anda mempunyai simptom tersebut,
pergilah berjumpa doktor dengan segera. Anda mungkin akan
dirujuk kepada pakar neurologi atau pakar strok lain. Bacalah lebih
lanjut mengenai tanda-tanda amaran strok dan juga mengetahui
cara untuk mengelakkan masalah serius ini daripada berlaku
kepada anda.
4
Neuropati diabetes (Kerosakan Saraf)
Dari masa ke masa, diabetes boleh menyebabkan
kerosakan saraf yang menghasilkan simptom kebas, membakar,
atau sakit. Jika kulit anda menjadi kebas, anda mungkin tidak
perasan luka kecil yang boleh berkembang menjadi ancaman
kesihatan yang lebih besar. Periksa kaki dan tangan anda setiap
hari untuk kemerahan, kalus, retak, atau kerosakan kulit. Jika anda
mendapati adanya simptom ini sebelum lawatan yang dijadualkan
berikutnya, segeralah beritahu pakar penjagaan kesihatan anda.
5
Retinopati diabetik
Untuk melindungi penglihatan anda, semua pesakit
diabetes perlu berjumpa pakar mata (doktor mata) sekurangkurangnya setiap tahun. Sebagai sebahagian daripada peperiksaan
mata, doktor akan mengembangkan mata anda supaya dia boleh
melihat bahagian belakang mata (retina) dan menentukan sama
ada penyakit kencing manis yang menyebabkan kerosakan.
Pada pesakit diabetes jenis1, peperiksaan tahunan ini harus
bermula dalam tempoh tiga hingga lima tahun pertama diabetes
untuk pesakit yang berumur 10 tahun atau lebih. Mereka yang
mempunyai diabetes jenis 2 perlu melakukan pemeriksaan mata
pertama mereka apabila mereka telah didiagnosis. Mereka yang
mempunyai komplikasi mata mungkin perlu berjumpa pakar
mata mereka dengan lebih kerap. Pesakit diabetes wanita yang
hamil perlu melakukan pemeriksaan mata menyeluruh semasa
trimester pertama dan kerapkan susulan dengan doktor mata
semasa kehamilan mereka. (Cadangan ini tidak dikenakan kepada
wanita yang mengalami penyakit diabetes semasa mengandung.)
6
Gastroparesis
3
Nefropati diabetes
(Penyakit Buah Pinggang)
Jika anda mempunyai diabetes, ujian air kencing perlu dilakukan
setiap tahun untuk mencari nefropati diabetes - penyakit buah
pinggang. Ujian baseline darah kreatinin juga perlu dilakukan
untuk menentukan fungsi buah pinggang anda. Pakar penjagaan
kesihatan anda juga akan memeriksa tekanan darah anda secara
tetap, kerana kawalan tekanan darah tinggi adalah penting dalam
melambatkan penyakit buah pinggang. Tekanan darah hendaklah
tidak kurang daripada 130/80. Bacalah mengenai simptom
lain penyakit buah pinggang dalam topik kesihatan ini, seperti
bengkak kaki yang berterusan. Ketahui bila untuk memanggil
doktor anda untuk mengelakkan masalah yang serius.
Diabetes meningkatkan risiko gastroparesis. Dengan
gastroparesis, saraf ke perut rosak dan berhenti berfungsi dengan
betul. Ini menyebabkan perut mengambil masa yang lama untuk
mengosongkan kandungannya dan menjadikannya sukar untuk
menguruskan paras glukosa darah. Kadang-kadang, menukar
diet anda boleh membantu. Terdapat beberapa ubat-ubatan
dan rawatan untuk gastroparesis. Berbincanglah dengan doktor
anda tentang cara-cara untuk mengelakkan komplikasi diabetes.
Mintalah maklumat mengenai tanda-tanda amaran awal supaya
anda boleh mendapatkan rawatan semasa ia paling berkesan.
9
10 Things Diabetes Can Do to Your Body
Stroke
7
Disfungsi erektil
Eye damage
Heart
disease
Dental
problems
Infection
Diabetes meningkatkan peluang untuk menyebabkan mati
pucuk, atau impotensi. Bagi sesetengah lelaki, mengamalkan
gaya hidup yang lebih sihat, seperti berhenti merokok, bersenam
secara tetap, dan mengurangkan tekanan, mungkin adalah yang
diperlukan untuk menyelesaikan masalah mati pucuk. Dalam topik
kesihatan ini, anda juga akan belajar mengapa ia penting untuk
berbincang dengan pakar penjagaan kesihatan anda tentang
mati pucuk anda, doktor anda boleh mengesyorkan ubat lain termasuk ubat-ubatan, alat penyempitan vakum (VCD), dan lainlain alat bantuan mati pucuk - yang boleh membantu.
8
Masalah Kulit
Kidney
disease
Sebanyak satu pertiga daripada pesakit diabetes akan
mempunyai keadaan kulit yang berkaitan dengan penyakit mereka
pada suatu masa dalam hidup mereka. Tahap glukosa dalam darah
yang tinggi menyediakan tempat pembiakan yang baik untuk
bakteria dan kulat dan boleh mengurangkan keupayaan badan
untuk memulihkan diri sendiri. Mujurlah, keadaan kulit adalah
yang paling mudah dicegah dan dirawat jika dikesan awal. Jika
kulit anda tidak dijaga dengan betul bagi pesakit diabetes jenis
2, satu keadaan kulit yang kecil boleh berubah menjadi masalah
yang serius dengan kemungkinan akibat yang teruk.
9
Jangkitan
Digestion
problems
Erectile
dysfunction
Skin
problems
Diabetes jenis 2 melambatkan keupayaan badan anda untuk
melawan jangkitan. Glukosa darah yang tinggi menyebabkan
ketinggian kadar gula dalam tisu badan anda. Apabila ini berlaku,
bakteria berkembang dan jangkitan boleh berkembang dengan
lebih cepat. Bahagian tubuh yang biasa di jangkiti adalah pundi
kencing, buah pinggang, faraj, gusi, kaki dan kulit. Rawatan
jangkitan awal boleh mencegah komplikasi yang lebih serius.
10
Masalah pergigian Diabetes
Nerve
damage
Source: www.webmd.com/diabetes/diabetes-complications-10/types-of-complications
Mereka yang mempunyai diabetes menghadapi
risiko yang lebih tinggi daripada biasa untuk mendapat masalah
kesihatan gigi dan mulut yang serius. Semakin kurang atau
tidak terkawal gula darah, semakin besar kemungkinan masalah
kesihatan gigi dan mulut akan timbul. Ini kerana diabetes
yang tidak terkawal akan merosakkan sel-sel darah putih,
yang merupakan pertahanan utama di dalam badan daripada
jangkitan yang boleh berlaku di dalam mulut. Sama ada anda
mempunyai diabetes atau tidak, pastikan anda berjumpa doktor
gigi anda untuk pembersihan dan pemeriksaan yang kerap untuk
mengelakkan masalah gigi yang serius.
10
R
ORNE
CARE C
THE RIGHT FOOTING
Rose Tan
Diabetes Nurse Educator
Diabetic Society of Singapore
“Why did my doctor send me here to have my feet checked when
there is nothing wrong with my feet?”
of the blood vessels may cause the skin to be excessively dry and
more liable to cracks.
A similar thought ran through my head when I was sent to National
University Hospital for training under orthopaedic surgeon Assoc
Prof Abdul Aziz bin Mohd Nather from Department of Orthopaedic
Surgery, Yong Loo Lin School of Medicine NUS. Thanks to him and
his team of podiatrists, I had to eat humble pie. I thought I knew a
lot, but I was wrong.
Diabetes patients can develop many complications especially
if their sugar is not well controlled. One of the most dreaded
complication of diabetes is foot problems like gangrene and ulcers.
There are many lessons to be learnt on how to teach my diabetes
patients to prevent complications, the DO’s and the DON’TS of
feet care, and how to test for minor neurological impairment and
Diabetic Foot.
While many people with peripheral artery disease have mild or
no symptoms, some people may have muscle pain or cramping in
their legs or arms that is triggered by activity.
If you have a history of diabetes, I advise you to make an
appointment with DSS or their doctors to have your feet checked
yearly.
Diabetes patients do not often think that the circulation in their legs
could be impaired and that their skin may be more prone to picking
up certain bacterial and fungal infections. Long term complications
DO THE FOLLOWING:
Dry your feet properly with a soft towel.
Use a mirror to inspect the soles and ask for help if
your eyesight is poor.
Keep the skin supple by applying moisturising
lotion or cream.
Inspect your feet daily in a well-lighted place for:
1. Breaks in skin
2. Cuts
3. Scratches
4. Blisters
5. Sores
6. Discolouration
Have proper foot wear and no high heels for the
ladies.
Feet should feel warm throughout and not have
spots, swelling or tenderness. For people with
diabetes, even minor wounds take longer to heal
and require more care.
One has to keep the feet clean and dry daily. Wash
your feet thoroughly with lukewarm water using a
mild soap.
DO NOT soak feet for more than five minutes
and pay special attention to the skin between the
toes.
The following are research findings by
Medtronic International Ltd:
15-30% of
patients with
lower extremity
arterial
disease will
progress from
claudication
to critical limb
ischemia and
lead
to amputation.
25% of foot ulcers will get
infected and 15% of those
will require amputation.
Every 30
seconds a
leg is lost
due to
diabetes.
Two-thirds of elderly
patients undergoing
amputation do not
return to independent
life.
EYE
Every Photo
Tells a Story…
SITE
11
Dr Yeo Kim Teck
Apple Eye Centre
Senior Consultant Ophthalmologist
THE RETINAL PHOTOGRAPHY PROGRAMME IN DIABETES
The diabetic retinal photography screening programme kicked off in 1991. The raison d’etre for the programme was the detection of
diabetic eye disease (retinopathy). Some collateral benefits include the detection of a myriad of other eye conditions such as cataracts,
age-related macular degeneration, retinal detachment, epiretinal membrane and vein occlusions. Even rare retinal conditions can make
a cameo appearance in the humble retinal photograph. Yes, every photograph tells more than a story. We will revisit these conditions in
greater detail in the next edition of Eye Site.
Do note that while a retinal photograph can show up eye diseases that affect the central portion of the eye , lesions in the peripheral of
the eyes will only show up in a full eye examination. The retinal photograph is not a substitute for a full eye examination and is more of a
screening tool.
LAR
AGE-RELATED MACU
DEGENERATION
IC GLAUCOMA
DIABETIC MACULA
R ED
DIABETIC MACULO EMA OR
PATHY
RETINAL DETACHMENT
ADVANCE CHRON
12
ARE
HEARTW
The Gift of Forgiveness
Henry Lew, Psychologist
I
n our daily management of our chronic
illness such as diabetes, there are times
we cannot help but have thoughts such
as “What did I do wrong that caused my
blood sugar to go up?” And along with
those thoughts come feelings of guilt and
frustration directed at ourselves.
Or, sometimes, we encounter personal
differences with others and get hurt by
them. We end up feeling angry, betrayed,
sad, etc. And when our mood is affected,
it makes it harder for us to focus on our
health.
Whether it is the first or second scenario,
we often try to make ourselves feel better
by listening to music, talking to others and
doing things we like. But the distress might
still linger on. It may be helpful in such
situations to try a little forgiveness.
Forgiveness is not just a concept. Nor is it
merely a feeling or simply a thought. It is
the act of overcoming our own internal
strong negative emotions towards a
transgressor (someone who hurt us in one
way or another) and replacing these with
more positive feelings.
One of the most striking examples in the
modern era of the power to forgive is that
of the late South African President Nelson
Mandela. Nelson Mandela, was sentenced
to life imprisonment in 1963, on charges
of attempting to undermine the State of
South Africa.
On his release from prison 27 years later,
Mandela did not call for revenge, but for
forgiveness. In doing so, amidst escalating
civil discord, his actions proved critical in
Why do we need to forgive? First and
foremost, so that we can focus on improving
our health again.
When we experience negative emotions
like self-blame, it takes away our energy
and attention from taking active steps to
problem solve better ways to manage our
diabetes. Forgiving ourselves and others
help us to focus again back to our health
goals and work towards what we value in
life
Steps to Reach Forgiveness, adapted from
Worthington, offers us some guidance
on how we can let go of those negative
emotions of hurt. It includes the following
steps:
THE ALTRUISTIC
GIFT OF
FORGIVENESS
COMMIT &
HOLD ON
RECALL THE HURT
EMPATHISE
As much as we do not like
it, we need to face what
hurt us before
we can feel better.
Try to understand why
the other person acted
that way. And if it is
yourself, consider the
circumstances that led
you to behave in that way.
Don’t beat yourself
up for it.
Remember an incident
when you made a mistake
towards another and was
forgiven and how it felt.
Remember that
empathising does not
mean you are condoning
the harmful act; you are
just considering the facts
more objectively beyond
your emotions.
Recognise how good it
felt and how much it
helped you.
There will be times
when you blame
the other person again
or yourself again,
recognise these feelings
do come back again.
You are in a position
to give such a gift to
the other person who
offended you.
Focus on your goals to
have better health and
wellness and engage in
forgiveness again.
Ask yourself, what is
hurting you the most?
helping to unify a nation that had been torn
asunder by the policies of apartheid.
What is forgiveness?
Do you feel being taken
advantage of by the other
person?
Do you feel you let others
down and cannot forgive
yourself?
Forgiveness is a process
and may involve
loops and circles.
As Confucius (479-551BC) said,
“To be wronged is nothing, unless you continue to remember it”.
As difficult as it may be to forgive, it is not impossible to forgive.
14
UT
COOKO
Fried Kway Teow
serves 4
by Chan Sau Ling
Dietitian, NHGP
INGREDIENTS
Kway Teow 400g
Lean beef, sliced 100g
Medium prawns, peeled and deveined 12
Egg, lightly beaten
2
Bean sprout120g
Medium carrot, cut into thin strips 2
Spring onions or chives, chopped
½ cup
Garlic cloves, finely chopped 3
Canola oil
1 tablespoon
METHOD OF PREPARATION
1. Heat the oil in a wok over a medium-high heat.
2. Add the garlics and sauté for a few minutes.
3. Stir fry the beef and prawns with garlic for 2 to 3 minutes
or until they are just cooked. Dish onto a serving plate
and set aside.
4. Add the Kway teow and seasoning. Stir-fry for 1 to 2
minutes or until mixed.
5. Add the egg and stir fry for 30 seconds. Add the bean
sprouts, carrot, half the spring onion/chives and stir fry
for 2 minutes or until egg is just cooked.
6. Add the beef and prawns into the mixture and stir fry
until combined.
7. Sprinkle with the remaining spring onion/chives.
Mix the seasoning:
Dark soy sauce 1 tablespoon
Light soy sauce 2 tablespoons
Fish sauce
½ Teaspoon
Sugar1 teaspoon
PepperA dash
NUTRITION INFORMATION per serving
Energy264 kcal
Protein17g
Carbohydrate
30g
Total Fat8g
Saturated Fat
2g
Dietary Fibre
2g
Cholesterol 152mg
Sodium685mg
Carbohydrate exchange: 2 exchanges
16
UT
COOKO
Chicken Curry
serves 4
by Chan Sau Ling
Dietitian, NHGP
INGREDIENTS
Chicken thigh 400g
(boneless and fat removed)
Onion150g
Green capsicum,sliced 30g
Chili powder ½ teaspoon
Turmeric powder
½ teaspoon
Curry powder
1 teaspoon
Curry leaf
2g
Ginger 1 teaspoon
Garlic, crushed
2g
Salt
¼ teaspoon
Pepper¼ teaspoon
Canola oil
1 tablespoon
Low fat evaporated milk
450g
METHOD OF PREPARATION
NUTRITION INFORMATION per serving
(without rice)
Energy264 kcal
Protein27g
Carbohydrate
16g
Total Fat10g
Saturated Fat
1g
Dietary Fibre
1g
Cholesterol 109mg
Sodium379mg
Carbohydrate exchange: ~1 exchanges
1. Rub the chicken thigh with salt.
2. Heat oil in a frying pan and fry the onions until translucent.
3. Remove the onion for the pan and add chili powder, turmeric powder, curry powder, curry leaf, ginger and garlic.
4. Cook gently for a few minutes.
5. Add chicken and fry on all sides until golden.
6. Add the onions and evaporated milk.
7. Simmer, then cover pot for 20 minutes or until chicken is tender.
8. Remove lid and cook for another 5 minutes.
9. Garnish with capsicum slices, and then serve.
18
GHTER
THE LI
SIDE
The next time you
pick up a cuppa...
Lock Poh Leng
Chief Dietitian
Parkway Hospitals Singapore
F
or people with diabetes, the key strategy in meal-planning is to eat a healthy and balanced diet with special focus on eating a
consistent amount of carbohydrate at meals and snacks on a daily basis to keep your blood glucose under good control.
For all people with diabetes, the best choice of beverage is something without added sugar or which is low in carbohydrate
content, i.e., between 0g and not more than 5g (0-5g) of carbohydrate.
If you add sugar or honey or condensed milk to your tea, coffee or other beverages, every one teaspoon level of sugar or
honey or condensed milk will contribute 5g carbohydrate (sugar), which equals 20kcal. You may wish to substitute sugar,
honey or condensed milk with an artificial sweetener.
Please avoid beverages such as Coca-Cola, 100 Plus and Bandung as these are concentrated in sugar/carbohydrate and they
cause the blood glucose level to rise rapidly.
For people with diabetes, who count carbohydrate as a meal planning method to control diabetes, the maximum amount
of carbohydrate allowed to be consumed as a beverage is 15g but on the condition that this 15g of carbohydrate must
be exchanged for other types of carbohydrate such as starch, fruit, milk, starchy vegetable or beans so that the amount of
carbohydrate consumed at a meal remains consistent.
For other beverages bought from the supermarket, check the food labels to determine the Total Carbohydrate content of the
beverage based on its serving size or the serving you intend to consume.
Carbohydrate (g) & Calorie Content (kcal) of Common Beverages
Espresso
regular
1g
4kcal
Capuccino
1 cup
13g
76kcal
Coffee with
condensed milk
1 cup
15.3g
113kcal
Coffee Latte
with low fat
milk & sugar
1cup
10.3g
110kcal
Coffee, brewed
1 portion
0.6g
3.1kcal
Coffee
powder,
instant
1 teaspoon
0.7g
3.4kcal
19
Café Mocha
½ cup
12g
92kcal
Chinese Tea,
1 cup
0.3g
1kcal
Soyabean milk
unsweetend
1 cup
3g
83kcal
Milo powder
2 level
tablespoons
14g
140kcal
Horlicks
powder
2 level
tablespoons
16g
77kcal
Tea/Green Tea
1 bag
0g
1kcal
Ginger Tea,
sweetened,
1 cup
12g
74kcal
Barley
water,
sweetened
Bandung
1 glass
32g
153kcal
1 glass
14g
55kcal
AVOID
AVOID
Coke Light/Zero
Coca-Cola,
regular
1 can
35g
140kcal
Reference:
1.
2.
Food Composition Guide Singapore, Health Promotion Board, 2010
The Doctor’s Pocket, Calorie, Fat & Carbohydrate Counter, The Calorie King, 2002 Edition.
100 Plus
1 can
22g
85kcal
1 can
0g
0kcal
AVOID
20
R SIDE
GHTE
THE LI
T
S
A
F
K
A
RE
B
E
R
T
N
E
C
T THE
A
Kohila Govindaraju
Nutritionist
The Berries Nutrition Consulting
W
e are spoilt for choice whenever we go to the food centre
but choosing the right meal to start off the day can be
tricky when the fare before you at the stalls is heavy on
the grease and starch.
If your breakfast dish lacks fibre, just grab a fruit to balance it up.
The fruit not only keeps you full, but the Vitamin C in the fruit will
also help you absorb the iron from the egg and other vegetarian
protein sources.
Lest you decide to skip breakfast, DON’T! Here’s why.
You should also consider the amount of sodium in the food. The
recommended amount of salt per day is 1 teaspoon/5g (2300mg
sodium). It is wise to spread the sodium too, throughout the
day.
•
Skipping breakfast may increase the risk of Type 2 diabetes.
•
It improves the cognitive function, and helps to maintain
your weight.
•
It gets you moving. People who eat breakfast are more
physically active during the morning as it provides your
body and brain with fuel after an overnight fast.
•
Breakfast reduces the risk of obesity, high blood pressure,
diabetes and heart disease.
HOW MUCH TO EAT?
A normal healthy person requires roughly around 1800 to 2000kcal
per day (45-65% from carbohydrates, 10-35% from protein and 2035% from fat).
WATCH OUT FOR FOODS HIGH IN
SALT AND CALORIES...
TAUHU GORENG
(1 SERVING, 403g)
Energy 769 kcal
Carbohydrate 58g
Protein 35g
Total fat 43g
Saturated fat 17g
Sodium 4094mg
Diabetes Singapore Apr - Jun 2015
The total calories should be spread all throughout the day
including snacks. Breakfast, lunch, dinner should be around 500
calories each and 100 to 150 kcal during snack time (mid-morning,
tea time and supper).
WHAT TO EAT?
You should always eat a healthy breakfast.
Pick two to three foods from the following list:
Bread and grain (cereals, toast)
Oats porridge, chicken or fish porridge
Milk and milk products (low-fat milk/yoghurt)
Banana, apple, orange, kiwi.
Egg is a good protein choice for breakfast. It is a complete protein
with all the essential amino acids. Grilled chicken is also a good
breakfast choice. Quinoa and soybean are also considered as
complete protein.
While soups are healthier than fried foods, drinking
them is not. Leave the soup as sodium content is
relatively high.
References:
www.hpb.gov.sg
http://www.mrbean.com.sg/
www.caloriecount.com
Here are some healthier breakfast
choices in your neighbourhood
food centres you can go for.
STEAMED YAM CAKE
(1 PIECE, 133g)
Energy 192 kcal
Carbohydrate 37g
Protein 3g
Total fat 3g
Fibre 1g
Cholesterol 2.6mg
Sodium 579mg
FRIED BEE HOON
(1 PLATE, 199g)
Energy 250 kcal
Carbohydrate 46g
Protein 6g
Total fat 5g
Saturated fat 2g
Fibre 3g
Sodium 819mg
SLICED FISH
BEE HOON SOUP
(1 BOWL)
Energy 349 kcal
Carbohydrate 48g
Protein 22g
Total fat 7.6g
Fibre 3.3g
Cholesterol 28mg
Sodium 1413mg
DOSAI (1SERVING,
80g)
Energy 87 kcal
Carbohydrate 8g
Protein 2.5g
Total fat 0.4g
Fibre 1.7g
Sodium 235mg
WANTON NOODLE SOUP
(1 BOWL, 545g)
Energy 290 kcal
Carbohydrate 41g
Protein 19g
Total fat 4.9 g
Fibre 1.6g
Cholesterol 11mg
Sodium 1803mg
TOAST (2 SLICES
WHOLEMEAL, 50g) WITH
ONE EGG (BOILED/
POACHED, 50g)
Energy 216 kcal
Carbohydrate 24.15g
Protein 11g
Total fat 6.8g
Saturated fat 1.7g
Fibre 4g
Cholesterol 214mg
Sodium 326mg
CHEE CHEONG FUN,
PLAIN WITH SAUCE
(1 PIECE, 101g)
Energy 133kcal
Carbohydrate 26g
Protein 2.5g
Total fat 2.2g
Saturated fat 1g
Fibre 1.22g
Sodium 271mg
TAU HUAY
(1 BOWL, 285g)
Energy 184 kcal
Carbohydrate 28g
Protein 2g
Total fat 4.5g
Saturated fat 0.7g
Sugar 28g
Sodium 4g
PEANUT PORK
PORRIDGE
(1 BOWL, 291g)
Energy 211 kcal
Carbohydrate 19g
Protein 12g
Total fat 9g
Fibre 1g
Cholesterol 22mg
Sodium 385mg
22
EE
TU
IT
AE
SR
EY
FE
When Sweet
Turns Sour
Dr Goh Kian Peng
Senior Consultant, Endocrinologist
Saint-Julien Clinic for Diabetes & Endocrinology
Mount Alvernia Medical Centre
E
very five hours in Singapore, there is one person diagnosed
with kidney disease who requires dialysis or a kidney
transplant. That works out to be about five a day, or over 1,700
new cases a year.1
So far the results from these and other studies are promising for
diabetics. It is heartening to learn that the risk of major complications
such as kidney disease can be reduced with proper treatment and
appropriate lifestyle interventions.
This fresh statistic, reported in May 2015, reflects the state of
Singapore’s diabetic affairs. Our nation ranks fourth on the world
scale for the number of kidney failure cases of which 60% are caused
by diabetes.1
Diabetes may be a chronic condition, but patients can continue to
lead long, healthy and productive lives. This can be achieved with
proper treatment with the help of their doctors, nurses, allied health
professionals as well as with the support of family and friends.
Diabetes is a chronic disease that has been on the rise nationwide
as well as in many developed countries. If not managed properly,
it can lead to many serious complications such as end-stage renal
disease. Research has clearly shown that one way to reduce the
risk of complications is to control the sugar or glucose level well,
particularly in the early stages of diabetes.
The ADVANCE-ON study published results showing the
reduction in end stage kidney disease in the group with good
blood glucose control compared to the group with less stringent
blood glucose control. Here is a chart summing up the results.
Kidneys are the body’s trash pickers, filtering 115 to 140 litres of
blood every day to remove the waste products of energy production
by the body. An early sign of kidney damage as a result of poor
diabetes control is the presence of small amounts of blood protein
leaking into the urine, also known as microalbuminuria (micro –
small, albumin – blood protein, uria – in urine).2
Left uncontrolled, the high glucose levels weaken the kidneys further
and the protein leakage worsens. Over time, the kidney function
progressively deteriorates finally leading to end-stage kidney failure.
At this point, the only treatment options available are dialysis and
kidney transplantation.
The ADVANCE study, published in 2008, was a clinical study involving
more than 11,000 Type 2 diabetics over a five-year period. The
patients were split into two groups. One group was put on a good
glucose control regimen involving the use of a gliclazide modifiedrelease diabetic medication. The other group was placed in a less
stringent glucose control treatment protocol. At the end of the
study, the group with good glucose control had a 21% relative risk
reduction in nephropathy or kidney damage.3
From this study, 8,500 patients were later followed up on for another
five to six years in the ADVANCE-ON study. During this period, the
group that experienced the good glucose continued to reap the
benefits, which translated to an almost 50% reduction in end-stage
kidney disease. The results were published recently in the September
2014’s issue of The New England Journal of Medicine.4
Figure 1. Cumulative incidence of end stage renal disease (%)
in the standard control arm versus the intensive arm.
References:
1.
2.
3.
4.
5.
http://www.nkfs.org/kidney-disease/leading-causes-of-kidney-failure/causessymptoms-and-treatment/
http://www.diabetes.org/living-with-diabetes/complications/kidney-diseasenephropathy.html
ADVANCE collaborative groups. Intensive Blood Glucose Control and Vascular
Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2008;358:2560-72.
S. Zoungas et. al. Follow-up of Blood-Pressure Lowering and Glucose Control
in Type 2 Diabetes. N Engl J Med 2014;371:1394-1406.
The author has no conflict of interests to declare.
24
SHAPE
UP
BEYOND
LOWERING
BLOOD GLUCOSE
E
xercise is extremely
safe and effective in
managing diabetes and
its complications. Despite
the emphasis on exercise
as the key element in the
management for Type 2
diabetes, the level of physical
activity among those with
diabetes is still low.
Singapore (Figure 1) website
show that heart-related
diseases are the main causes
of mortality in Singapore
from 2012 to 2014, and data
from the National Diabetes
Education Program (NDEP)
shows that 65% of those
with diabetes died because
of heart disease.
Many individuals with Type
2 diabetes still think that
exercise is just a blood sugar
lowering tool. They feel that
as long as they take their
medication regularly, eat the
right food, and have their
blood glucose levels under
control, they will be fine.
Both heart disease and
inactivity mortality can be
prevented through physical
activity.
The benefits of exercise in
diabetes per se go beyond
blood glucose lowering
effects. It can help increase
blood sugar tolerance and
sensitivity at rest and reduce
the risks of diabetes related
diseases such as heart
disease.
Statistics from the MOH of
The two most common
barriers that prevent people
with diabetes from regular
exercise are the fear of going
into hypoglycaemia and
rising blood glucose after
exercise.
Ray Loh
Exercise Physiologist
Sports Medicine and Surgery Clinic
Tan Tock Seng Hospital
PRINCIPAL CAUSES OF DEATH
〈 Total No. of Deaths
2012
2013
2014
18,481
18,938
19,393
30.1
30.5
29.4
16.8
18.5
19.0
16.1
15.5
16.0
9.3
8.9
8.4
5.6
4.9
4.7
2.8
3.1
3.6
2.4
2.6
2.6
2.4
2.4
2.0
1.9
2.0
1.9
2.1
1.6
1.8
〈 % of Total Deaths
1. Cancer
[ ICD10 : C00-C97 ]
2. Pneumonia
[ ICD10 : J12-J18 ]
3. Ischaemic heart diseases
[ ICD10 : I20-I25 ]
4. Cerebrovascular diseases
(including stroke)
[ ICD10 : I60-I69 ]
5. External causes of morbidity and mortality
[ ICD10 : V01-Y89 ]
6. Hypertensive diseases
(including hypertensive heart disease)
[ ICD10 : I10-I15 ]
7. Urinary tract infection
[ ICD10 : N39.0 ]
8. Nephritis, nephrotic
syndrome & nephrosis
[ ICD10 : N00-N07, N17-N19, N25-N27 ]
9. Other heart diseases
[ ICD10 : I00-I09, I26-I51 ]
With a better understanding
of acute exercise effects
in Type 2 diabetes and
following
the
simple
recommended guidelines on
Page 26, exercise can be safe,
effective and enjoyable.
10. Chronic obstructive lung disease
[ ICD10 : J40-J44 ]
Notes:
- The Mortality Tabulation List of the International Classification of Diseases - Tenth Revision has
replaced the Ninth Revision as the adopted code set for the derivation of causes of death
w.e.f Year 2012.
- For data prior to Year 2012, refer to http://www.moh.gov.sg/content/moh_web/home/statistics/
Health_Facts_Singapore/Principal_Causes_of_Death.html
- Refers to the top 10 principal causes of death only
Figure 1. 10 main causes of death in Singapore from 2012 to 2014
26
SHAPE
UP
The following are some recommended actions to be taken before, during and after a workout to avoid adverse exercise effects. Visit
your doctor to consult him on the type of physical activity you are going to do before embarking on any exercise program. Check with
your certified health-care providers if you are facing difficulties, or having doubts about your blood glucose levels response to the
exercises you are performing.
BLOOD GLUCOSE
LEVELS
SCENARIO
ACTION
<3.9mmol/l
Before workout
Take snack
Wait for 15 to 30 minutes before re-SMBG
Proceed with activity once BG is between 5.6 & 16.7mmol/l
<3.9mmol/l
During or after workout
Take snack
- Avoid future physical activity before bed due to
the risk of delayed post-exercise hypoglycaemia
during sleep
- Check with doctor, might need to adjust
medication
3.9 to 5.5 mmol/l
Last meal >2 hours ago before Take snack
workout
Proceed with activity once BG is between 5.6- & 6.7mmol/l
3.9 to 5.5 mmol/l
Last meal <1 hour before
workout
3.9 to 5.5 mmol/l
After 60 minutes of moderately Take snack
intense activity or 30-45
wait for 15 minutes before re-SMBG
minutes of intense activity
Proceed with activity once BG is between 5.6 & 16.7mmol/l
5.6 to 16.6 mmol/l
Within range before workout
5.6 to 16.6 mmol/l
BG raises but still within range Wait 1 to 1.5 hour & re-SMBG
after workout
-If BG remain elevated, lower intensity of activity
on next workout
-If BG return to normal range, continue with
same intensity on next workout
-If BG drops below 3.9 mmol/l, take snack, avoid
future physical activity before bed due to the
risk of delayed post-exercise hypoglycaemia
during sleep
>16.6 mmol/l
On oral medications and feeling Proceed with light to moderate activity & re-SMBG
well
after 10 to 15 minutes of activity
If BG rises : stop activity
If BG drops : continue
>16.6 mmol/l
On insulin or not feeling well
SMBG : Self-monitoring of blood glucose
BG : Blood glucose
Wait for another 15-30 minutes before re-SMBG
Proceed with activity once BG is between 5.6-16.7mmol/l
Proceed with activity.
Go to doctor to check for ketones.
Avoid activity.
28
WDD