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TRANSCRIPT
DiabetesSingapore
Issue 45 APR-JUN 2013
Publication of Diabetic Society of
MIC
A (P) 148/09/2012
DIABULIMIA
Gestational Diabetes
Overcome Your Fear of Needles
Shake Off the Salt
CONTENTS
DSS m
anagement com
mittee
2012/2014
PATRONProf Arthur Lim
ADVISORDr Warren Lee
PRESIDENTMr Yong Chiang Boon
VICE-PRESIDENTSDr Kevin Tan Eng KiatHj P.M. Mohd Moideen
HON SECRETARYMs Esther Ng
ASST HON SECRETARYMs Rohanah Bte Pagi
HON TREASURERMr Stanley Lim
COMMITTEE MEMBERSDr Yeo Kim TeckMs Kalpana BhaskaranMr Greig PriceMs Juliana Lim
04 PRESIDENT’S MESSAGE
06 DSS BUZZ
EAT RIGHT WITH DIABETES
HEALTH SCREENING
TRAVEL HEALTH TALK
DSG DIARY
COOKING TO MANAGE DIABETES
EDUCATIONAL TOUR
DSS EXERCISE PROGRAMME
AGM NOTICE
EXCURSION TO HORT PARK
10 CARE CORNER
GESTATIONAL DIABETES: SHOULD YOU BE EATING FOR TWO?
12 HEARTWARE
NEEDLING FEAR
16 COOKOUT!
SEMARANG SPRING ROLL
VIETNAMESE RICE PAPER ROLL
18 THE LIGHTER SIDE
SHAKE OFF THE SALT
Q&A
22 SPECIAL FEATURE
DIABULIMIA
25 SHAPE UP
MAKE EXERCISE A FAMILY AFFAIR
26 DIABLOGUE
FRENCH FEASTING
COVER PHOTO: © Red2000 | Dreamstime.com
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edito
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teamA WORD FROM THE PRESIDENT
Editor-in-chiefDr Yeo Kim Teck
Managing EditorCharlotte Lim
Editor (Dietetics)Janie Chua
Editorial ConsultantsDSS Mgmt Committee
WritersHenry Lew (psychologist)
Kohila Govindaraju (nutritionist)Cindy Ng (physiotherapist)
Rodiah Hashim
ContributorsDr Warren Lee; Estonie Yuen Wing
Ting, Pravin Rajwani; Clair Ong; Gusti Nyoman Kaler and Noldy Herling
Bawiling.
DesignCharlotte’s Web Communications
PhotographyDreamstime.com & sxu.hu
Printing Stamford Press Pte Ltd
AdvertisingGeorge Neo
Esther Ng
Advertisement BookingsT: 6842 3382 or E: [email protected]
Feedback [email protected]
Back Issues www.diabetes.org.sg
Diabetic Society of Singapore HQBlk 141 Bedok Reservoir Road #01-1529 Singapore 470141 T: (65) 6842 6019 /3382
DisclaimerThe 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.
The recent budget 2013 debated in Parliament unveiled hope for all citizens and healthcare providers:• SingaporeansmaygetamoreflexibleMedisavescheme.• InsuranceschemessuchasMediShieldandElderShieldplayagreaterroleintheir
healthcare bill.• Thegovernment’sshareofhealthcarespendingwillincreasefromthecurrent30per
cent to 40 per cent “ and even more in the future”, in order to share the burden of healthcare cost increases.
Government subsidies which are primarily given to hospital care could extend to other areas of the healthcare system, such as specialist outpatient care, primary care, preventive healthcare, dialysis and long-term care.
We hope that more subsidies will eventually extend to Volunteer Welfare Organisations such as DSS. We certainly look forward to obtaining extra funding from Ministry of Health to provide better services and to upgrade our existing equipment.
On the human resource level, the society hopes to receive more training grants for our nurses to learn new skills and raise our service standard.
As we anticipate more requests for community outreach and activities in the coming years, we are in the midst of consolidating our operations to revamp our centre and mobile services. The society will also review the roles in the short and long-term to serve the community at large.
Within the society, we wish to help our diabetes support group grow by acquiring new knowledge and reinforcing self-care management. They will make excellent health ambassadors of DSS by helping us promote a healthy lifestyle to all in the community.
Onceagain,Iwouldliketothankourboardmemberswhovolunteertheirtimeandeffort, all our staff for their dedication, and all donors and well-wishers for their kindness and generosity. Thank you very much!
Mr Yong Chiang BoonPresidentDiabetic Society of Singapore
Diabetic Society of Singapore 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.
HELP ALL AROUND
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D SS kicked off this year’s health screening events with its first event at Blk 313, Bishan on 20 January 2013. Booked as early as October 2012, the event was organised by the Active Ageing Committee of Thomson/Shunfu Residents’ Committee to provide free health screening for residents in the constituency. With volunteer nurses from Singhealth Polyclinics, DSS aims to be able to
support this community event thoughout the year.
On Sunday, 10 Mar 2013, Tampines East Community Club held their Healthy Lifestyle@Tampines East Community Club. Organised by the Women’sandMalayActivityExecutiveCommittees,theeventhadresidentsscreenedforBMI,BloodPressure,FaecalOccultandBreastCancer. Residents were later invited to a mass aerobics exercise, followed by health talks in Mandarin. DSS wishes to thank nurses from Singhealth Polyclinics for giving up their day of rest to help us in our on-going campaign to raise diabetes awareness in the heartland.
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Following the success of our Retreat for adult with Type 2 Diabetes last year, DSS was approached by Soyjoy to collaborate with them and organise a workshop on diet and
lowGIIndex.‘EatRightwithDiabetes’washeldonSaturday26January 2013 at Orchid Country Club (OCC) and was attended by both members and the public. Participants learnt how to read food labels, shop the right way and eat the right foods.
SeniordietitiansMrWonTinChiangandMrForWeiChek,fromNHGP and Mt Alvernia Hospital respectively, gave talks and led the way to the nearby supermarket for the label reading sessions. Mr Derrick Ong, accredited dietitian and director of Eat Right Nutrition Consultancy, gave advice on choosing the right foods while Miss Kalpana Bhaskaran, section head of Nutrition Research in Temasek Polytechnic, delivered some interesting facts on managing diabetes with Glycaemic Index.Thehighlightofthesessionwasthesharingondiabetes by DSS Vice-President Mr Hj P M Mohd Moideen. The interactive session with our panel of speakers was spiced with voluntary sharing, questions and answers.
DSSwishestothankSoyjoyfortheirsponsorshipoftheevent,NTUCFairpriceatOCCforgraciouslyhostingoursupermarkettours, the speakers and definitely the participants for the success of the workshop.
Travel Health TalkWhat diseases am I exposed to when I travel? What steps can I take to prevent these diseases? My travel first-aid kit? What should I bring along? How do I travel with diabetes?
These questions were answered during the Travel Health Talks forum held at Bedok Diabetes Education & Care Centre Activity Room on Saturday, 2 March 2013. Supported by the
Health Promotion Board, the talks were delivered by speakers from theTsaoFoundationandSinghealthPolyclinics.Participantsweretaken through two hours of comprehensive do’s and don’ts.
Here are some of the general tips:•Besafeandbewell-prepared.•Visityourdoctor/travelclinicfourweeksbeforetravel.•Bevigilantagainstinfectiousdiseaseswhenyoutravel.•Practisegoodpersonalhygiene.•Donotbecomplacent,evenifyouaretravellinginatourgroup.•Providedetailsofyourtraveltoyourfamily.
For people with diabetes•Carryandweardiabetesidentification•Havediabetesmedicalinformationavailable•Followusualmeals,exercise&medications.•Callairlinesfortravellingwithsyringeandlancetinformation
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Walking @ Punggol Waterway
Everyone looked eager to start our morning walk at Punggol Waterway. Juliana, the event organiser,
introduced us to some new faces at Punggol MRT station where we gathered, and swiftly got us going
with the exercise and conversation. A five to ten minute walk from the MRT station and bus terminal, the
Punggol Waterway Park is so tranquil that it had such a calming effect on all of us. Although the sun was pretty
harsh on our poor heads! These days, rain or shine, it makes sense to carry an umbrella everywhere you go.
Wereachedtheadventurebridgethatledustothechildre
n’splayground.Itwasadelighttoseechildren
playing with wild abandon in the water play area while their parents exercised in the fitness
corner, an excellent place to work out with your family! We spent few minutes soaking
in a panoramic view of the arc from the heart wave wall before we moved along
the edge of the river. We shared our food experiences with Cantonese cuisine
(no conversation seems ever complete in Singapore without talk of food!) while
side-steppingsomecurious-lookingyellow-spottedmillipedesonourpath.It
looks like they were enjoying the walk just like we were, and we were careful
not to spoil their fun!
We hope more can join us the next time round! The more, the merrier!
Care to join us for our next DSG outing/meeting? Ring Juliana at 9278 2084 for information. DSG CALENDAR 2013OUT NOW ON www.diabetes.org.sg
By Rodiah Hashim
Health Screening
Eat Right with Diabetes
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COOKING TO MANAGE DIABETES
Participants will get to cook a healthy meal
and taste it too…
Date : Saturday, 4 May 2013
Time: 2.00pm to 4.00pm
Venue: Block 8, Level 5
FoodProductionLab,
Temasek Polytechnic
21 Tampines Avenue 1
$5.00 only for DSS member
$10.00 for non-members
Educational Tour Yakult & Unicurd Food FactoriesDate: Tuesday, 30 April 2013
Registration forms for both events are available at www.diabetes.org.sgFor enquiries, please contact 6842 6019.
$8.00 for DSS members; $10.00 for non-members
Diabetic Society of Singapore
ORGANISED BY
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9.30am Gather at Newton Hawker Centre Carpark9.45am LeaveforUnicurdFoodFactoryatSenokoAvenue10.30am StartofUnicurdFoodFactoryTour11.30am Leave for lunch at nearest food centre 1.30pm LeaveforYakultFactoryatSenokoSouthRd2.00pm StartofYakultFactoryTour3.30pm Leave for Newton Hawker Centre Carpark
DSS EXERCISE PROGRAMMEat Tan Tock Seng Hospital
Duration per session : 1 hourSaturday, 23 March 2013 to 8 June 2013
12 Exercise Sessions plus Educational Topics (Online Tutorial)
Session 1 & 2: Exercise PrecautionsSession 3 & 4: Home ExerciseSession 5 & 6: Ways to Increase PASession 7 & 8: Exercise MotivationSession 9 & 10: Healthy DietsSession 11: Goal SettingSession 12: Programme Review
* Each session consists of warm up and cool down exercises and education. * Participants are required to bring their hypocount kit to every session.
UPCOMING EVENT 1
UPCOMING EVENT 2
Date: Sunday, April 21, 2013Time: 2:30pmVenue: Victoria Room, Level 3 SAFRA Toa Payoh 293, Lorong 6, Toa Payoh Singapore 319387
Diabetic Society of Singapore will be holding its
42nd Annual General Meeting.
JOIN US!
EXCURSION TO HORT PARK IN JUNE!
DETAILS ON OUR DSS WEBSITE SOON!
LOG ONTO WWW.DIABETES.ORG.SGOR RING 68423382.
DSS HQ @ BedokBlk 141 Bedok Reservoir Road #01-1529 Singapore 470141Tel: (65) 6842 6019 /3382 Fax:(65)68423118Opening Hours: Mon-Fri8.30am-5.00pmSat 8.30am - 12.30pm
Hong Kah Diabetes Education & Care CentreBlk 528 Jurong West St 52 #01-353 Singapore 640528 Tel : (65) 6564 9818, (65) 6564 9819 Fax:(65)65649861Opening Hours: Mon-Fri 8.30am-5.00pmSat 8.30am - 12.30pm
Central Singapore Diabetes Education & Care Centre
Blk 22 Boon Keng Road #01-15 Singapore 330022
Tel : (65) 6398 0282 Fax:(65)63980275
Opening Hours: Mon-Fri8.30am-5.00pm
Sat 8.30am - 12.30pm
FOR THE LATEST ON
DSS EVENTS, LOG ONTO
www.diabetes.org.sg
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For enquiries, please contact
6842 6019.
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Gestational Diabetesby Estonie Yuen Wing Ting, dietitian, National Healthcare Group Polyclinic
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Gestational Diabetes or GDM is a
temporary form of diabetes that
occurs during pregnancy and
usually goes away after the baby is born.
Hormonal changes during pregnancy
alter the body’s requirement for insulin. To
manage GDM effectively, it is important
to control blood glucose levels while
maintaining a healthy diet.
Will GDM affect me?There is greater chance of developing Pre-
eclampsia* and Urinary tract infections.
Women who develop GDM are at high
risk of developing type 2 diabetes later in
life but this risk can be reduced through
lifestyle modifications. It is important
that you receive dietary advice as well
as education about your pregnancy and
lifestyle issues.
Will GDM affect my baby?Your baby will not be born with diabetes
but if your GDM is not well controlled, it may
affect your baby. The baby grows too large
because extra glucose crosses the placenta
into the baby’s blood. The baby’s pancreas
then makes extra insulin to cope with this
and the baby grows too large (a condition
called Macrosomia), which increases the
risk of complications during delivery.
GDM is usually managed by following a
healthy well-balanced eating plan taking
into consideration the carbohydrate intake
and physical activity. For those who are
unable to manage GDM with diet and
activity alone, medication or insulin is
needed.
Healthy Eating2 helps control your blood glucose levels.
2 helps meet nutritional requirements for
you and your growing baby.
2 helps achieve suitable weight gain.
2Research has shown that including
small amounts of added sugar (e.g., a
small spread of jam on toast, a teaspoon
of Milo in milk) does not significantly
increase blood glucose level. However,
taking excessive sugar and sugary foods
makes it difficult to control diabetes and
may contribute to excessive weight gain.
Try to minimise your intake of foods such
as:• Sugar(raw/brown/white,
honey, etc.)• Honey,jamorsyrup• Chocolates,desserts,biscuits
and sweets• Softdrinksandsweetened
drinks• Flavouredmilk
• Cannedfruitinsyrup
1 Watch the sugar
Eat regularly and consider carbohydrate intake 4 Consider the fats
in your dietItisimportanttohaveregularmealsbecauseskippingmealsusuallyleadsto
over-eating and can cause poor blood glucose control. Carbohydrate is still your
importantsourceofenergy.Itisrecommendedthatyoudistributecarbohydrate
evenly throughout the day into six to eight meals and snacks with smaller amounts
of carbohydrate (15 to 45g) at breakfast and mid-meals. To know your carbohydrate
requirements and the amount you need for each meal, you may consult your
dietitian to get an individually designed diet plan.
Should you be eating for TWO?
Food items Serving size for 15g CHORice, cooked (white/ brown) ¼ bowl or 3 heaped tablespoons
Bread 1 slice
Crackers, plain/wheat 3 pieces
Oats 3 Tablespoons
Whole fruits, e.g., apple, orange and pear
1 fist size
Cut fruits, e.g. watermelon, papaya and honeydew
1 slice
Low fat milk 1 cup 300ml
ComplexcarbohydratesandsomelowGlycaemicIndex*fooditemsarerecommended.Whole-grains, wholemeal bread, cereals, beans, vegetables and fruits are some good choices. (*Refertothearticle,“TheHighsandLowsofGlycaemicIndex”,inDiabetesSingaporeIssue38,Jul-Sep 2011, which is available online at www.diabetes.org.sg/publications)
3 How much weight should you gain?Weight gain during pregnancy varies and your expected weight gain depends on your pre-
pregnancyweightstatusasmeasuredbytheBodyMassIndex(BMI).
BMI = Weight (kg)
_________________________Height (cm) x Height (cm)
IF PRE-PREGNANCY BMI IS
RECOMMENDED WEIGHT GAIN DURING PREGNANCY SHOULD BE
<18.5 12.7 – 18.1 kg
18.5 – 24.9 11.3 to 15.9 kg
25.0 – 29.9 6.8 to 11.3 kg
≥30 5 – 9.1 kg
Reference:HealthyStartForYourPregnancy,HealthPromotionBoard(HPB)AdoptedfromInstituteofMedicineGuidelines(IOM2009)
Pregnancy is not a time to diet as this may
deprive the baby of nutrients needed for growth.
Insufficientweightgainisalsolinkedwith
preterm birth. Gaining too much weight during
pregnancy can also cause problems such as high
blood pressure, complications in delivery, and
longerhospitalstaysforyouoryourbaby.Ifyou
are gaining too much weight, try to minimise the
intake of high-fat, high-sugar foods and exercise
regularly.
• Avoiddeepfriedfood,fastfoodandjunkfoodas most are high in fat. Select snacks with the Healthier Snack Symbol.
• Chooseleanmeatandskinlesspoultry.Removeall visible fat and skin before cooking. Avoid fatty meat (e.g., bacon, sausage, corned beef, Chinese sausage or lapcheong and luncheon meat.)
• Chooselowfatdairyproducts(e.g.,skimmedmilk, low fat yoghurt and reduced fat cheese).
• Substitutecookingfatsuchaslard,gheeorblended vegetable oil with polyunsaturated or monounsaturatedoils(e.g.,oliveoil,sunfloweroil). Substitute butter with transfat-free polyunsaturated/monounsaturated margarine. Replace coconut milk and cream with skimmed/low fat yoghurt or milk.
• Chooselowfatcookingmethodssuchasgrilling,baking, steaming, boiling and microwave; avoid deep frying.
Eating a lot of fats may result in excessive weight gain
and poor blood glucose control. All fats are equally
high in energy, which can contribute to weight gain so
consume or use them in moderation.
5 Am I getting enough nutrients?
Energy, protein and many other nutrients are important for growth
and development; therefore it is important to eat according to the
Healthy Diet Pyramid to meet your baby’s and your nutritional
requirements.
Recommended food servings:FOOD
GROUPSEXAMPLE OF ONE SERVING
NO. OF SERVINGS
Pregnancy Lactation
Rice & alternatives
½ bowl cooked rice or noodles
5 - 7 5 - 7
Fruits&Vegetables
1 fruit¾ mug cooked vegetables
4 - 5 4 - 5
Milk/ milk products
1 cup milk2 slices of cheese
3 4
Meat & alternatives
90g cooked meat /fish
2 2
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It’s small and thin but it can strike terror in the hearts of even the strongest and biggest. Almost everyone hates needles. Unfortunately for some, the fear of needles can be so intense that it can drive people away from seeking medical or dental treatment.
As for insulin treatment and dialysis, you simply cannot escape from needles. What can you do to overcome your fears?
NEEDLING FEAR by Henry Lew, psychologist
The needle may be seen not only as a potential
source of physical discomfort, but also a
threat to your lifestyle
and livelihood.
Validate your child’s fears and do not minimise them. Express
empathy for their fears, reluctance,
avoidance and frustration.
Frame the message about the need to have insulin
injections positively and link it to one of the goals that they would like to attain.
Before you read on, check the boxes below to see which of these reactions may be associated with a fear of needles.
shallow breathing feeling sick nausea intense fear feeling dizzy and light-headed dry mouth palpitations sweating trembling recurring disturbing images of needles in your mind persistent thoughts about needles/injections
Any of the above may be associated with fear of needles. This is why it can be so overwhelming and difficult for someone with a fear of needles . “Will power” alone is not enough to manage this range of reactions.
How bad can fear of needles be? To those of us who are generally healthy and do not need to come into contact with needles that often, it may not be very much of a concern. But to those of us with a chronic illness like diabetes where we need to monitor our glucose level regularly (i.e., that means pricking our fingers for blood), or if we need to inject insulin regularly, it is a huge concern.
Fear of needles can result in:
Any of the three behaviours may make it harder to manage diabetes and put us at greater health risks.
Irregularglucose
monitoring
Irregularinsulin doses
Refusal of
blood tests
STEP 1 Sort out and deal with your other associated fears
Fearofneedlesmayberelatedtootherfears.
These associated fears could intensify or complicate the fear of needles:
•Fearthatyouwouldloseyourlifestyleorevenemploymentifyoustartregularinsulinorglucosemonitoring.Peopleoftenperceive the regime of regular insulin and glucose monitoring as too time consuming that it may affect their work. Or they feel it is inconvenient to execute outside the home, that carrying them out may mean giving up your active lifestyle. The needle may be seen not only as a potential source of physical discomfort, but also a threat to your lifestyle and livelihood.
•Fearthatyourconditioncouldbecomeworse.Manypatientsthinkthatoncetheyareoninsulin,itmeansthattheirdiabetic condition has become so bad that oral medications no longer help. They think that they will starting to lose their sight and even limbs.
•Fearofmakingmistakeswhileperforminginjection.Patientsnewtoinsulininjectionmaynotbeconfidentenoughtoperform the injection on themselves. Or if they are elderly, they may find the procedure too complicated. As such, they may fear that they could make a mistake when they inject themselves and experience more pain, have injuries or put their health at further risk.
To overcome these associated fears:
•Forthefearoflosingemploymentandlifestylehabits,andthefearoftheirhealthworsening,findoutmorefromyourhealthcareprovider,otherdiabetespatientsorlookupbooks,magazines,ortheInternet.Youwillfindthattherearemanydiabetes patients who still enjoy a good quality of life and employment even when they make blood glucose monitoring or insulin injection a regular part of their lives.
•Forthefearofmakingmistakeswhileinjectinginsulin,speaktoadiabetesnurseeducatorwhowillpatientlyguide you through the steps of insulin injection and help you gain confidence at a comfortable pace.
You could ask them if a family member could tag along and learn, so that you have someone for support at home, too.
And, of course, nothing beats the age-old saying, practice makes perfect.
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Consider these tips:
•Activelyandintentionallyfocusonthereasonsyouareinjectinginsulineachtimeyoustarttofindyourselfgettingfearful,such as being able to participate in more activities with your loved ones.
•Pinchyourskin,usefinerorshorterneedlestoreduceyourpain.Exploreandlearnfromyourhealthcareproviderwaysand products you can use to ease the pain.
•Beforeyouinjectinsulinorprickyourfingerstomonitoryourbloodglucose,relax.Takeafewdeepbreaths,orcountto10to relax. Perform brief relaxation exercises.
•Donotavoidthetopicofneedles.Readup,findoutmoreaboutit,asthiswillhelpyoutogaintheconfidenceyouneedtoface your fear.
•Tryobservationallearningtoallayyourfears.Findopportunitiestowatchotherpatientswhoareexperiencedinjectthemselves.
•Explorewithyourhealthcareprovidertheoptionsofaninjectionpenwheretheneedlesarenotseenandyoudonothave to witness your skin being pricked.
•Graduallybuildyourconfidenceinfacingyourfearsbyfirstlookingattheneedlesuntilyouarenotscared,thenholdingitinyourhandsuntilyouarenotscared.Injectatlesspainfulareaslikethestomachbeforeexploringalternatesitesforinjection.
Parents who need to inject for their children with diabetes:
•Youmaynothaveafearofneedlesbutresearchshowsthatparentstendtobeanxiouswheninjectingtheirchildren.Thiscould actually make the fearful child more anxious. Take deep breaths and relax before you do anything for your child.
•Learnfromandworkcloselywithyourchild’snursecliniciantomanageyourchild’sneedleanxiety.
•Validateyourchild’sfearanddonotminimiseit.Expressempathyforhisfear,reluctance,avoidanceandfrustration.
•Framethemessageabouttheneedtohaveinsulininjectionspositivelyandlinkittooneofthegoalsthatthey wouldliketoattain.Forexample,theyneedtheinsulintobehealthysothatcantakepartinthesporttheylike.
•Preparethemwayinadvance;tellthemthatitwillsoonbetimeforaninjection.Donotrestrainor spring up on them and inject them out of the blue, as this may increase, if not perpetuate,
their fear of needles and injections.
•Helpthemtorelaxbeforeaninjection.Soothethemwithanactivityorplay.
•Asmuchasyoucan,distractthemthroughouttheprocess.Talktothemtotaketheirattention away from the needle.
STEP 2 Facing your fear of needles
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INGREDIENTS
t Cook and serve vegetables just before eating to retain maximum nutrient value.
t Useunsaturatedoils(e.g.sunfloweroil,canolaoil,olive oil) instead of saturated oils (e.g. ghee, butter, blended vegetable oil) to reduce your risk of heart disease.
t Fruitandvegetablesarelowinsodiumandhighin potassium. This helps to maintain a healthy blood pressure.
HOT TIPS
t Try different dipping sauces such as sweet-salty-spicy-sour Nuoc Cham sauce which is a combination of fish sauce, lime juice, brown sugar, chopped garlic and red chilli.
t This dish can also be eaten for lunch or dinner. Add meat such as chicken, duck, pork, or beef instead of prawns.
HOT TIPS
1. Heat sesame oil and add garlic. Sauté until fragrant then add all vegetables and oyster sauce. 2. Add salt & pepper to taste. 3. Put aside to cool.4. Layer the popiah skin on the plate and put cooked vegetables in the middle and roll.5. Mix chilli sauce with Maggi Sweet and Sour Mix.6. Serve popiah with sauce.
METHOD OF PREPARATION
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Popiah skin 10 pcsBamboo shoot, sliced thinly 50gmCarrot 50gmBean sprouts 25gmLong beans, sliced 25gmOyster sauce 1 tbspChilli sauce 2 tbspWhite sesame oil 1 tbsp Maggi Sweet and Sour Mix 1 tbspGarlic, chopped 1 tbspSalt 1/4 tspPepper 1/4 tsp
INGREDIENTS Rice paper sheets 9 pcsMedium prawns 9 pcs Japanese cucumber 1Carrot 1/2Bean sprouts 150gDried black fungus 50gChopped peanuts 1/2 cupSpring onion 1 stalkCoriander leaves 1 stalkVermicelli (optional)Basil or mint leaves (optional)
Peanut sauce:Peanut butter 3 tbspHoisin sauce 2 tbspLime juice 1 tsp
This dish provides a good serving of vegetables. Vegetables and fruits are rich in vitamins, fibre and phytochemicals (beneficial plant substances, e.g., carotenoids and flavonoids) that help to lower the risk for some cancers.
NUTRITION INFORMATION per roll: Energy 54 KcalCarbohydrate 8gProtein 1gFat 2gSaturated fat 0.3gCholesterol 0mgDietary fibre 0.5gSodium 173mgCarbohydrate Exchanges = ~ 0.5
NUTRITION INFORMATION per roll: Energy 75 KcalCarbohydrate 8gProtein 4gFat 3gSaturated fat 0.5gCholesterol 10mgDietary fibre 3.2gSodium 262mgCarbohydrate Exchanges = ~ 0.5
Semarang Spring Roll by Gusti Nyoman Kaler and Noldy Herling Bawiling, Kintamani Restaurant
Vietnamese Rice Paper Roll by Clair Ong
1. Blanche bean sprouts. Do not overcook.2. Boil vermicelli. Drain and rinse with cold water.3. Boil prawns till cooked. Drain and rinse with cold water. Peel, devein and cut lengthwise into half. 4. Shred cucumber & carrot. 5. Dip rice paper in water (cold or warm, or according to instructions on the pack) for 20 to 30 seconds.
Gently remove sheet from water and drain on paper towel. Place sheet on a clean work surface.6. Layer the filling: prawn slices, dried black fungus, cucumber, carrot, bean sprouts, spring onion, coriander
leaves and peanuts. 7. Foldinfromthesidesandthenfromthetop.Rollupfirmlytoenclosefilling.8. Serve as a snack or side dish.
METHOD OF PREPARATION
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We eat far more amounts of salt than we need and the long-term effects can be pretty serious. Sodium helps to maintain the right balance of fluidsandfunctionofnerveimpulses&muscles.
Though it is an essential electrolyte in our body, excess amounts of sodium which our kidneys cannot get rid of fast enough can lead to osteoporosis in women (even if calcium intake is normal), water retention and hypertension (the major cause of heart attacks and stroke). Weight loss in overweight individuals, only if accompanied by a low sodium diet, can help reduce hypertension.
The Recommended Daily Allowance (RDA) for sodium is 2000mg aday.Thatistheequivalenttojustateaspoonoftablesalt!Itis a relatively small amount when compared to the amount of sodium found in processed and packaged foods.
Our current food supply is full of hidden and higher sources of sodium, especially preserved foods. The thing about sodium is that it can sneak up in foods when we least expect it. Some foods, although high in salt, may not taste salty. Our taste buds get used to it so that we may not notice how salty thefoodactuallyis.Forsomeindividuals,sodiuminfoodsconsumed frequently can add up over time and show up in our appearance, like puffiness of the face (our face too, is an accurate indicator of our health!), heavy bags under our eyes, and swelling of the body that makes our jeans tight.
Some bread and cereals have hidden sources of sodium. Did you know that a glass of milk (250ml) contains 80 to 120mg of sodium? Chips, bite-size sausages, cold cuts, all common partyfoods,areloadedwithsodium.Soischeese!Itisthereforealways wise to stick to the right portion size.
So, how can we be vigilant when salt is in everything?cThe first step is to make smart choices with our groceries. Take time to read the label. Reading labels will help us to compare the products. Check the nutritional panel for sodium and choose the product with low sodium. Opt for 400mg or less sodium per serving.
cThe following are a few of the many forms of sodium: • Monosodiumglutamate(MSG)• DiSodiumInosinate• DiSodiumPhosphate• SodiumNitrite• SodiumNitrate• SodiumBenzoate• SodiumAscorbate• SodiumCitrate• SodiumBi-carbonate(BakingSoda)• BakingPowder
The higher the number of sodium in the ingredients list, the higher the amount of sodium the product has!
cBeware of fat-free and low-fat food products that may be high in sodium.
cLimit the use of salt while cooking and refrain from using salt shakers on the table.
cSqueeze fresh lemon juice on steamed vegetables and broiled fish/chicken and brown rice.
cGarnish cooked vegetables with cooked or baked garlic. Raw onion can be added to liven up meats and vegetables.
cUse mushroom, sweet corn, scallion (green onion), cilantro (coriander leaves), mint leaves and parsley to garnish soups, salads, cooked rice and pastas.
{ the LIGHTER side }
Shake the Salt
offby Kohila Govindaraju, freelance nutritionist
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References:www.nhlbi.nih.govwww.hpb.gov.sgwww.mayoclinic.comwww.heart.orgDonald E Hrickik, MD, Jackson T Wright, Jr., MD, PhD, Michael C Smith, MD, Hypertension Secrets, 2002Nancy R Cook, associate professor, Jeffrey A Cutler, former senior scientific adviser, Eva Obarzanek, research nutritionist,Julie E Buring, professor, Kathryn M Rexrode, assistant professor of medicine, Shiriki K Kumanyika, professor of epidemiology, Lawrence J Appel, professor of medicine, Paul K Whelton, president and chief executive officer, Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP), BMJ2007;334doi: http://dx.doi.org/10.1136/bmj.39147.604896.55(Published 26 April 2007)
Here are some healthy ways to enhance the flavour of your dishes:
HIGH-SODIUM FOODS HEALTHY LOW-SODIUM OPTIONSFrozen meal Choose frozen meals with less than 400mg of sodium per
serving.
Preserved canned vegetables and beans Limit the consumption of these products. Rinse the canned vegetables and beans before cooking/serving. Rinsing may only help to reduce less than 50% of the salt. Go for fresh or frozen vegetables with no salt added.
Processed or cured meats : ham, bacon, luncheon meat, sardines, anchovies, smoked salmon, sausage, mock meats, etc.
Choose fresh, lean meat, fish and plant-based protein sources.
Condiments like soy sauce, marinades, dressings, teriyaki sauce, pasta sauce, salsa, BBQ sauce, taco sauce, garlic salt, onion salt, etc.
Read labels and use lower versions of sodium. Choose low-sodium varieties. Look for salt-free seasoning. Make your own salad dressing with oil, lime juice, mint leaves and vinegar.
Restaurant meals (sit-down and Fast Food) Many restaurant meals contain enough sodium required for the whole day! Request for low-salt preparations or share large portions with family members.
Soups and broths Homemade soup garnished with herbs.
Dietslowinsodiumreducetheriskofhypertensionandstroke.Fruitsandvegetablesarelowinsodiumandaregoodsourcesofpotassium,magnesium,andfibrethathelpcontrolhypertension.Fruitssuchasbanana,papaya,orange,cantaloupes,prunes,apricots,kiwi, grape fruit, and dried fruits including dates, raisins and vegetables such as broccoli, potatoes, tomatoes, bamboo shoot, greens (swiss chard, spinach, beet, mustard) are good sources of potassium. However, do consult a dietitian if you have a high potassium level.
A change from unhealthy habits to healthy habits will yield extraordinary results. Even a modest reduction in consuming foods with excess salt and fat combined with modest increase in physical activity can make a difference.
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Sodiumretentionisoneofthemechanismsinfluencingthe development of hypertension in diabetes patients. Frequentrisesinbloodpressurearesaltsensitivewhich
canbecontrolledbyreducingdietarysodium.Inadditionto its effect on raising blood pressure, several studies have associated high sodium intake with evidence of target organ damage.
Check out the amount of sodium in the following:
A teaspoon of soya sauce (light) 365mg Dark soya sauce 200mgReduced-salt soya sauce 185mgRegular serving of french fries 200mgOne medium salted egg 350mg A plate of mee goreng 1800mgChar kway teow 1460mgChicken rice 1290mgNasi briyani with chicken 1660mg
WARNING! Sodium sensitivity
The Recommended Daily Allowance for sodium is 2000mg a day.
That is equivalent to just a teaspoon of table salt, a relatively small
amount compared to the amount of sodium found in processed and
packaged foods.
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by Kohila Govindaraju, freelance nutritionist
Celery is one of the so-called super foods that is high
in antioxidant and anti-inflammatory
nutrients.
Pectin in celery has theanti-inflammatoryeffects. Apigenin found in celery and parsley helps to reduce the oxidative stress. Itisalsoanexcellentsourceof vitamins, especially vitamin K, vitamin C and folate.
Choose celery that is crisp, tight and compact, snaps or cracks easily, and with stalks that do not splay or slantout.Itcanbeaddedtosoups, stews and salads.
Just be warned that chopping celery or storing it in the
refrigerator for a long time will reduce these wonderful phytochemicals.
You may eat celery on a low sodium diet. Just mix two stalks with other low calorie & sodium vegetables such as cucumber and butterhead lettuce!
I eat about five stalks of celeryevery day. Is that all right? Why start your
day with wholemeal?
Wholemeal contains all parts of grain kernels such as fibre-rich bran and nutrient-rich germ.
Fibremakesusfeelfulllonger and prevent over-eating. These wholemeal foods are healthier but at the same time can be rather costly.
No worries! There are healthy alternatives that are also cheaper, too.
How about starting your day with brown rice porridge? You don’t need much, just half a cup of brownricewilldo.Formore nutrient density, crack an egg on top of it.
Or go for half a bowl of plaincornflakesandatablespoon of oats with
low-fat milk, garnished with banana and raisins or almonds.
You can also try barley congee with fish and vegetables, garnished with green onion.
Foralightlunch,trywholemeal chappati roll stuffed with scrambled egg or bean curd, a good source of protein.
Wholemeal chappati and vegetable curry (with tomato,onion, spices but coconut milk is a definite no-no) is also easy to prepare for any meal of the day.
Similarly, spaghetti with mushroom tomato sauce is an excellent meal because, surprise, surprise, spaghetti has a lowGIvalue!
I am on a tight budget. Can you suggest some less expensive alternatives to wholemeal breads?
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Did you know that diabetes is associated with increased risk for eating disorders?
Disordered eating is often seen in people with diabetes, but the type of disordered eating behaviour varies with the type of diabetes and the profile of the patient.1
Disordered eating and associated behaviours in diabetes can be dangerous, because it can lead to severe hypoglycaemic episodes and recurrent diabetic ketoacidosis. People with type 1 diabetes and disordered eating patterns and behaviour patterns may skip meals, skip insulin, or exercise excessively while not eating enough carbohydrate and thus experience hypoglycaemia, hyperglycaemia or recurrent unexplained ketoacidosis.
People with this problem may be overweight or slim or have normal weight but they often have poorly controlled diabetes because the erratic dosing, exercise and food intake make it very difficult for the diabetes team to make the correct recommendations for insulin doses and because very often there is a strong element of denial. Sometimes the patient is supposedly on enormous doses of insulin (e.g., 1.5-2 u/kg/day) but has been skipping one or more doses so the real insulin doseperdayisfarless.Iftheyareactuallyadmittedtohospitaland given all the prescribed insulin, they could have severe hypoglycaemia.
People with type 2 diabetes mellitus seem to exhibit more of binge eating disorders and some may intentionally omit oral hypoglycaemic drugs, resulting in poor glycaemic control, and weightloss.Insomeways,itisthesamewithbothtype1andtype 2 diabetes.
Diabulimia is the intentional skipping of insulin doses in an effort to lose weight. While not yet an officially recognised medical entity, it is a well known part of the spectrum of disturbed eating behaviours that are known to affect people with (mainly type 1) diabetes mellitus.
by Dr Warren Lee, paediatric endocrinologist
What happens when a patient does not take enough insulin or oral medication?
There will not be enough insulin to allow glucose to enter the cells. The body then switches to the use of fat, which encourages loss of fat tissue, but at the same time, because the signal goes out to increase glucose production, the body will also break down muscle in order to produce more glucose.
Eventually, the body composition changes such that the percentage body fat increases and overall muscle bulk and physical fitness will suffer. The blood ketones will go up, sometimes because of starvation ketones and sometimes because of insufficient insulin. The patient’s energy levels tend to fall, where there may be hair loss, and possibly an increase in the size of the liver due to fatty infiltration while the muscle bulk and muscle tone falls drastically. This is called Mauriac Syndrome.
A recent Australian study of 124 teenagers with type 1 diabetes aged 13 to 18 showed that disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% versus 25.9%).
Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, althoughrestraintwasnotevidentinmales.Insulinmanipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use
(0.8%) were less common.2
Another Canadian study among 98 teenage girls with type 1 diabetes, studied at nine to 14 years at baseline and five years later at 14 to 18 years, showed that depression and disturbed eating behaviour were common and frequently concurrent inthiscohort.Itwasencouragingthatpoormetaboliccontrol was not yet strongly associated with either depression or DEB. At year five, 12.2% of girls reported current depressive symptoms, 49.0% reported current DEB, and 13.3% had a full or subthreshold eating disorder (ED), and 75.0% of girls with depression also endorsed DEB versus 45.3% of girls without depression (p = 0.05).3
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Diabulimia is the intentional
skipping of insulin doses in an effort to lose weight. While not yet an officially recognised
medical entity, it is a well known part of the spectrum of disturbed
eating behaviours that are known to affect people with
(mainly type 1) diabetes mellitus.
Risk Factors & Clinical Signs
Risk factors for the development of eating disorders in type 1 and type 2 diabetes include female gender, increased body weight, dissatisfaction with one’s own body, a history of dieting, and a history of depression. Patients tend to be in denial of the problem.1 This causes lots of problems for the treating doctor.
Clinical signs that should raise suspicion are: poor glycaemic control, missed clinical appointments, recurrent episodes of diabetes ketoacidosis, and even recurrent hypoglycaemia secondary to intentional overdosing of medications.1
Ifyouarecheckingtheirbloodglucosepatterns,lookoutforpatterns of highs and lows and unexplained persistent ketones in the blood (blood ketones strips are available which can be used in certain brands of blood glucose metre). There may be a history of always wanting to go to the gym and extreme avoidance of carbohydrates in the daily diet.
Itisimportantthatdoctors,caregiversandlovedonesbeawareand open about this problem. Management of disordered eating behaviour in this group needs to be a multi-disciplinary effort. Greater awareness and, hence, early detection and frank discussion in interactive sessions have shown to be effective. Often, the doctor has to work with a psychiatrist or psychologist experienced in eating disorders.
Some patients will also have problems with schoolwork and school attendance. Some have argued that prevention includes not being obsessive about dietary restrictions and portions when the patient is younger, so that there is less risk of rebound later. This is also a strong argument for the use of basal bolus therapy or insulin pump therapy rather than twice a day mixed insulin injections, because the dietary restrictions in basal bolus therapy would be less onerous.
However, people with diabetes and disordered eating can recover and get better with regard to their eating patterns and diabetes control.Ittakeseffort,ittakestimeanditrequiresthatthepatient, the care team and the family members develop insight and a determination to face the problem squarely.
Clinical signs that should raise suspicion are:
poor glycaemic control, missed clinical appointments,
recurrent episodes of diabetes ketoacidosis,
and even recurrenthypoglycaemia secondary to intentional overdosing
of medications.
References:1 Curr Diab Rep. 2012 Dec 25, Epub ahead of print] Eating Disorders in Adolescents with Type 2 and Type 1 Diabetes. Pinhas-Hamiel O, Levy-Shraga Y.)
2 J Paediatr Child Health. 2012 Dec 2. Disturbed eating behaviours and thoughts in Australian adolescents with type 1 diabetes. d’Emden H, Holden L, McDermott B, Harris M, Gibbons K, Gledhill A, Cotterill A.)
3PediatrDiabetes.2013Feb19.doi:10.1111/pedi.12016.[Epubaheadofprint]Depression, disturbed eating behavior, and metabolic control in teenage girls with type 1 diabetes. Colton PA, Olmsted MP, Daneman D, Rodin GM.
Dr Warren Lee is a paediatric endocrinologist in private practice at Camden Medical Centre. He is concurrently a Senior Consultant (part -time) at the Endocrinology Service, KK Hospital and was previously Head of the Endocrinology Service and the General Ambulatory Paediatric & Adolescent Medicine Service at KK Hospital.
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by Cindy Ng, principal physiotherapist, Singapore General Hospital
Make Exercise a Family Affair
When exercise feels like play, your
whole family will
enjoy it more and be more likely
to stick with it.
For more information, visit www.bddiabetes.com BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company. © 2011 BD, SEAPM112011-182.*Photographs from Dieter Look and Kenneth Strauss: "Nadeln mehrfach verwenden?" Diabetes Journal 1998, 10: S. 31-34
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July2,9,16,23
Tue 6-8pm
October3,10,17,24Thu 6-8pm
April3,10,17,24Tue, 6-8pm
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Course Fee: $21.00 per person (4 sessions) For registration, please call the respective centres.
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These classes are o�ered at:South West DEC: Blk 528 Jurong West Street 52 #01-353 Singapore 640528 Tel: 6564 9818DSS@Bedok: Blk 141 Bedok Reservoir Road #01-1529 Singapore 470141 Tel: 6842 3382Central Singapore DECC: Blk 22 Boon Keng Road #01-15 Singapore 330022 Tel: 6398 0282
Join our comprehensive 4-week program
Topics include:
Guidelines on diabetes self-care
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Please ring 9711 0132 for an appointment.
Our trained and experienced diabetes nurse educators will be available to provide the following services:• Diabetes Retinal Photography• Diabetes Foot Screening & Foot Care Advice• Individual & Group Diabetes Education (including self blood glucose monitoring & insulin injection technique)• HbA1 c (glycosylated haemoglobin)
DIABETES
CARE
ON WHEELS
Time is of the greatest essence in
our hectic Singaporean lifestyle,
and so it is often a challenge to
find time to exercise. But busy
parents can combine family time with
exercise time.
Exercisingasafamilyhasmanyperks.It
can double up as quality time and keep the
family healthy together. There are other
benefits too, namely better fitness, stress
relief, weight control and fun!
Besides, inactive children are likely to
become inactive adults. Making family
activities and fitness part of your child’s life
at an early age can go a long way toward
helping them form healthy habits for life.
Research has also shown that children who
exercise do better in school and have fewer
behaviour problems.
Rather than have your children glued to
the television or their iPads, get them
to move away from a sedentary lifestyle
at a young age and associate activity
or exercise with togetherness and
community.
When exercise feels like play, your whole
family will enjoy it more and be more
likely to stick with it. As a parent, you are a
powerful role model.
Ifyoufindwaystobemoreactiveevery
day, your kids will follow your lead. All it
takes a little commitment.
To get started, try these tips:• Asafamily,makealistof
activities everyone can do and enjoy together during the week.
• Keepafamilyphysicalactivitylog.
• Plansomethingspecialthatinvolves being active at the weekend, like a walk in one of our parks or a charity run.
Bonding within the family can be done
with a simple activity such as washing the
car or taking an evening walk after dinner
whiletalkingaboutschoolandwork.It
does not need to be 30 minutes long;
even15minutesisqualitytime.Itisalways
heartwarming to see parents kicking ball
orplayingFrisbeeor‘catching’withtheir
children or participating in fun walks or
runs together.
There are many recreational activities
such as strolling or walking in the park
whichcandonebyanyoneofanyage.If
you’ve just had a new baby, take the baby
in the pram and take a walk together.
Generally, adults should work toward
10,000 steps a day Children aged six to
12 need more steps — at least 12,000 for
girls and at least 15,000 for boys. Other
activities include walking the dog, cycling,
rollerblading, swimming or rock climbing.
Those with young children can join them
in games like hopscotch, jump rope, and
hide-and-seek.
To increase the intensity of the activity,
consider hiking at Bukit Timah Nature
Reserve or exploring Hort Park or “The
TreeTop Walk’ which is accessible from
MacRitchie Reservoir Park. Try exercising
for a good cause and register the family
for a charity walk or run. A number of such
events are targeted at families.
Time waits for no man, or family. So, get
moving with the children and enjoy!
Log onto
www.diabetes.org.sg
for 2013
calendar.
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The holidays are usually a time of family, friends and feasting. This period of revellry, from December
toFebruary,includesChristmas,NewYear and Chinese New Year. Throw in the occasional birthday party and regular family gatherings and you have a series of temptations and indulgences even the most disciplined of diabetics cannot resist. So, how do we NOT pack on so much weight and increase our HBa1C to the point that our doctors start their spiel on the‘complications’ofbeingadiabetic?
Here’s my strategy.
1Everyyear,IhaveseveralcompanylunchesduringChineseNewYear.Ihad
toattendtwo‘LoHei’lunchesthisyearandIinformed everybody at my table that I am diabetic.
You’d be surprised at the response Somebody’s aunt, uncle, or friend would have diabetes and this gets the conversation (and education) going. Then comesthewillpower:IwouldeatabitofeverythingandwhenIfeelfull,Ihaveaconvenient excuse not to have seconds. How can anyone argue with a medical condition? The good thing about telling your fellow diners about your condition is that they become your watchdogs and tend to keep a close watch on your intake!
One critical thing to remember is to titrateyourfastactinginsulindosage.Iusually give myself one to four units more. Moderation is the key to these events andIhavetobethick-skinnedenoughtosay,‘No,thankyou’,evenifitisthebossshoving food onto my plate.
2My next tip is ‘do it the French way’. Andno,Idon’tmeanaddingbutterto
everything.Justdon’tsay‘no’toanythingbut have a little of everything.
Both my aunt and sister were born in February.Sowethrewasurprisepartyforthem this year serving everything they like to eat; chicken curry from Kazakhstan (homemade),meerebus,Indianrojak,Hokkien mee, chicken rice and three different types of cake. Being a diabetic herself, my sister made her speciality which is her sugar-free strawberry cheese cake. SoIhadabitofeverything,eventhesweetcakes,justliketheFrenchwoulddo.
Now,you’dthinkIhavegotthisdownpat.ButeventhoughIhadnotmorethantwospoons of each cake, my sugar levels were still slightly elevated at the end of that night. So, do not believe for one moment that you can have your sugar-free cake andeatit.Frommyexperience,sugar-free
foods may raise my sugar levels faster mostlybecauseIthinkitwon’tandwillendup eating too much. My sister’s cake is one of those traps.
3This brings me to my last tip: Exercise! IwouldbelyingifIsaidIexercised
regularlyduringthisholidayperiod.It’sthe season for great excuses and, lately, minehasbeen,“It’sraining!”
There is no special method to breaking out ofthisabyssoflaziness.Forme,thebestway to break this cycle is to start small, even if it is really raining!
• Run for half an hour instead of an hour.
• Exercise at home on my cheap stationary bike which I bought online.
• Climb up and down the stairs of my HDB block.
IfIstartdoingsmallexercises,Icangradually work my way up back to my usualroutine.Bytheway,ifIknowIamgoingtohaveabigfeast,Itrytosqueezein a run before that. This helps to raise my metabolic rate to burn off those sugars. Igettoenjoyanightoffeastingwithfamily and friends without getting into any trouble! You can, too!
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