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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Press_DSS_TRUEbalance Advert A4.ai 1 19/3/13 10:44 PM

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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: editor@diabetes.org.sg

Feedback editor@diabetes.org.sg

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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20{ the LIGHTER side }

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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25SHAPE UP

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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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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