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APR TO JUN 2018 ISSUE 65 Singapore

MCI (P) 033/09/2017

DIABETES

GET UP & GO!Type 1 Diabetes Kids Need to be Active

MOVING ONrecovering from surgery

Diabetes & Cholesterol

Diabetes ScreeningWhy it’s so important

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CONTENTS

DS management committee 2016/2018FOUNDER Dr Frederick Tan Bock Yam

PATRONThe Honourable Minister for Health

ADVISORDr Warren Lee

PRESIDENTMr Yong Chiang Boon VICE-PRESIDENTSDr Kevin Tan Eng KiatDr Kalpana Bhaskaran

HON SECRETARYMs Esther Ng

HON TREASURERMs Evelyn Hah

COMMITTEE MEMBERSDr Yeo Kim TeckMdm Rohanah PagiMs Juliana LimMs Maurine LamDr Gabriel YeeMr Nadir Maruf

04DS MESSAGETHE IMPORTANCE OF EARLY DETECTION OF PRE-DIABETES CONDITIONS

05DS BUZZ CONEY ISLAND WALKINAUGURAL CITIZENS’ JURYFIRST QUARTER DS DSG MEETINGDS MEMBERS RETREATDSG MEET & SHARE SCHEDULE

10 CARE CORNERKEEPING KIDS WITH TYPE 1 DIABETES ACTIVE

12HEARTWAREMOVING ON:RECOVERING FROM MAJOR SURGERY

14 SPECIAL FEATURES DIABETES SCREENING: WHY YOU SHOULDN’T WAITDIABETES & CHOLESTEROL

18 COOKOUT CAULIFLOWER FRIED RICE VEGAN TEMPEH SALADCHAYOTE WITH PEPPERY MUNG DAL

21THE LIGHTER SIDELEAN GREENS: GETTING MUCH OUT OF ALMOST NOTHING

22SHAPE UP 5 GREAT WORKOUTS FOR TYPE 2 DIABETES

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editorial team

On 25 September 1971, Dr Frederick Tan Bock Yam founded the Diabetic Society of Singapore (DSS) to help diabetes patients manage their condition. On 1 January 2018, DSS officially changed its name to Diabetes Singapore.

Diabetes Singapore is (DS) a non-profit organisation affiliated to the International Diabetes Federation and the National Council of Social Service. DS gratefully accepts donations of any amount to help fight diabetes. All donations are tax-deductible. Please make cash donations in person at any of our centres. Cheque donations should be made payable to ‘Diabetes Singapore’. You may also make online donations via https://www.giving.sg/diabetic-society-of-singapore.

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.

Editor-in-chiefDr Yeo Kim Teck

Managing EditorCharlotte Lim

Editor (Dietetics)Abbie Sim

Editorial ConsultantsDS Management Committee

WritersDr Yeo Kim Teck (ophthalmologist)Henry Lew (psychologist)Kohila Govindaraju (nutritionist)Ray Loh (physiologist)Juliana Lim (DSG)

ContributorsDr Daphne Gardner Michelle HoiArumugam Ardhanari

Concept & DesignCharlotte’s Web Communications

Printing Stamford Press Pte Ltd

Advertisement BookingsT: 6842 3382 or E: editor@diabetes.org.sg

Back Issues www.diabetes.org.sg

DS HQ @ Hong KahBlk 528 Jurong West St 52#01-353 Singapore 640528Tel : (65) 6564 9818Fax: (65) 6564 9861

Central Singapore Diabetes Education & Care CentreBlk 22 Boon Keng Road#01-15 Singapore 330022 Tel : (65) 6398 0282Fax : (65) 6398 0275

DS MESSAGE

Mr Yong Chiang Boon

PresidentDIABETES SINGAPORE

A focused long-term strategy has now been put in place and is in the process of being implemented.

Our focus for the future will also be the early detection of pre-diabetes conditions to help prevent or delay the onset of diabetes. It is estimated that one in seven Singaporeans aged 18 to 69 does not yet have diabetes but is at risk, a state known as pre-diabetes. Dr Daphne Gardner of the Singapore General Hospital has contributed an educational piece on the importance of diabetes screening. Please read her article on Page 14.

To overcome the shortage in nursing staff, we embarked on a recruitment drive and were successful in getting three new qualified nurses to join us in early 2018. This will help us to oversee the capacity issues faced earlier. With the launch of the Primary Care Networks (PCNs), we are now seeing a significant pick-up in demand for our mobile bus. The recent recruitment of nursing staff has also helped us meet this demand. We are also considering adding one more mobile bus to our operations.

Since Diabetes Singapore (DS) is a small organisation in terms of staff size, any increase in its distribution must be done through collaborations. In this regard, Management is actively working on this with various grassroots organisations to increase the outreach of DS. These include government-sponsored entities and the PCNs.

We are in the midst of upgrading our infrastructure platform to better serve our members and the public. I also sincerely hope our dedicated DS management committee will bring fresh programs and activities to serve you better in 2018. Thank you for all your support, too!

IMPORTANCE OF EARLY DETECTION OF PRE-DIABETES CONDITIONS

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DS BUZZ

24 FEB 2018CONEY ISLAND WALK

We were blessed with another lovely, sunny and windy afternoon as 16 eager participants gathered for our second monthly walk of 2018. Of the 18 participants, two ladies were already on Coney Island from

2.56pm. At around 3.30pm, pre-walk Blood Glucose (BG) readings were taken at a discreet corner of the MRT station by Christine Lee, with readings recorded by Michael Lee. With all participants accounted for at 4pm, we moved towards the Punggol Bus Interchange and boarded bus number 84, alighting at Punggol End Road.

The scenic walk through the “forested trail” finally stopped at “Beach Area A” where creative poses by willing participants were captured by our camera man, Hwee Leng. We exited the island towards the entrance of Punggol Waterway Walk to take the post-BG readings. All, except one participant (who took a piece of “nian gao” during the walk), posted reduced blood glucose readings and they were happy to know that the walk did them good.

We took bus number 84 back to Punggol Bus Interchange. Most of us proceeded to The Sapling to celebrate Chinese New Year together. DSG SG wishes to thank the dedicated Assistant Leaders for their efforts and to Diabetes Singapore for her unwavering support.

DS OUTREACH PROGRAMS MAR 2018

31 March 2018Diabetes Management

Talk (Mandarin) Lions Befrienders @

Raffles Town Club

18 March 2018Diabetes Talk @ Kassim Mosque in collaboration

with KDF

20 March 2018Diabetes Talk @YTL PowerSeraya

Pte Ltd

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DS BUZZArumugam Ardhanari

Here are the 12 suggestions presented by the jury:

1. #DrinkPlainWater campaign led by citizens to make plain water more accessible and reduce liquid calories.

2. Popularise the Health Promotion Board’s existing “My Healthy Plate” guideline to raise awareness about healthy eating among consumers and hawkers.

3. Incentivise stair-climbing at places like MRT stations to encourage Singaporeans to be more active.

4. Form a peer support group to link patients who have controlled their diabetes and their caregivers with newly diagnosed patients.

5. Promote healthy cooking at home through cooking classes, food preparation competition and other cooking communities.

6. Raise awareness of online patient support groups as a means to provide quick and timely guidance to manage the disease.

7. Strategic advertising to promote healthier food choices and other purchases.

8. Raise the Medisave claim limit from $450 to $700 for those under the Chronic Disease Management Programme.

9. Set up a rewards system to motivate diabetes patients to take better care of themselves - for example, they could get grocery vouchers if their diabetes is better-managed over a period of time.

10. Improve the communication skills and empathy of healthcare practitioners.

11. Increase awareness of and motivation to consume healthy foods in schools.

12. Improve canteen food in schools.

Source:http://www.straitstimes.com/singapore/health/first-citizens-jury-presents-its-recommendations-on-how-to-combat-diabetes

INAUGURALCITIZENS’ JURY After seven weeks of online discussion, brainstorming

sessions, getting advice from various experts of their

respective field of expertise, formulating recommendations,

voting and three full-day meetings, the inaugural Citizens’

Jury set up by the Ministry of Health submitted their report

to Senior Minister of State for Health Amy Khor and other

senior civil servants on 13 January 2018.

Seventy-six people from different walks of life, full of love

and passion, were tasked to come up with ideas on how

to prevent and manage diabetes here in Singapore. The

group was divided into 12 sub-groups and worked on their

selected topics. Twelve major ideas were finally selected

and three other minor ideas were also included so that

none of the ideas were left out.

Minister promised that all these ideas will be reviewed with

various Government departments and agencies and come

up with action item in three months’ time. On the other

hand, some ideas were accepted on the spot such as the

jury’s “Drink Plain Water” campaign and the suggestion to

install more water coolers at community clubs and cultural

institutions to stave off cravings for sugary drinks.

We are very thankful to Diabetes Singapore for giving us

this opportunity to take part in this pioneer programme

by the government. We are also grateful for the active

participation and valuable contributions of Albert Lim,

Hwee Leng, Christina Tan, Dr Kalpana (vice-president

of Diabetes Singaopore), Rama, Juliana Lim (Diabetes

Support Group leader) and Arumugam Ardhanari who

were involved in various sub- groups. All of us enjoyed the

experience and exposure, and look forward to seeing the

recommendations implemented.

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DS BUZZJuliana Lim

Our first DS DSG Gathering was held on 3 March 2018 at Toa Payoh Community Club’s Mini Theatre, Level 3. The program consisted of a talk by Dr Matthew Tan, Consultant Endocrinologist from Diabetes and Endocrine Care, speaking on “Controlling Diabetes and Self-Coping Strategies” and a talk on “Oral Hygiene” by Ms Annie Joseph, representative of DentYucral.

Most participants had assembled at the Toa Payoh Commu-nity Centre’s Mini Theatre at about 8.30am. Dr Matthew Tan started his talk on Controlling Diabetes and Self-Coping Strat-

egies by go-ing through the various symptoms of diabetes and its compli-cations. He also showed how to make h e a l t h i e r food choices.

Dr Tan, speaking from his own medical experience, spoke of how one of his patients (a diabetic of more than 20 years, consuming three types of diabetes medication and who was also on insulin), had a high HbA1c of 19%, when he first consulted Dr Tan. After some time, through sheer will power (by exercising) the patient brought down his HbA1c reading to about 6.5%. His medication was reduced and he was taken off insulin.

Dr Tan emphasised the need to have a good working relationship with one’s doctor to enable the doctor and patient to control one’s condition. This success story was followed by queries on diagnosis, management of diabetes and medication.

The next talk was presented by Ms Annie Joseph from DentYucral on “Oral Hygiene”. Ms Annie started off by asking the audience how often they visited the Dentist and was pleasantly surprised that most participants visited their dentist every four to six months. She also proclaimed that one’s “mouth is the window to one’s health” as dentists are able to see signs of diseases before they are manifested.

Ms Annie also touched on the importance of Dental Health for Diabetics and the various health problems related to diabetes—gum disease, cavities, mouth ulcers, impaired salivary glands function, delayed wound healing and a greater

tendency to infection.

Some tell-tale signs of Per idonta l Disease are bad breath, bad taste in the mouth, loose teeth and tender,

bleeding or red gums. Ms Annie then introduced to us “Den-tYucral”, the toothpaste made for diabetics. Compared with other toothpaste it has five extra ingredients that helps in wound healing, tissue regeneration, stimulates blood circula-tion, contains emollient/moisturiser and is anti-bacterial/anti-inflammatory too.

Participants were then invited to take part in a survey whereby they were given a full-sized tube of DentYucral to use for two weeks. They will then be interviewed to give feedback on the product. The event wrapped up with a broadcast of DSG events for the next three months by DS DSG Team Leader, Juliana Lim.

3 MARCH 2018First Quarter DS-DSG Members Gathering

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DS MEMBERS RETREAT

Diabetes Singapore organised a day retreat on 17 March 2018 for members of the Society at Village Hotel Bugis from 9am to 5pm. The theme was: Managing Diabetes—Achieving Your Sweet Dream

in 2018.

The opening address by DS vice-president Dr Kalpana Bhaskaran outlined the programme for the day and presented the new name, Diabetes Singapore, and new logo. Dr Kalpana also left us a profound message: Fight complications instead of only fighting diabetes!

At 10am, the emcee Ms Siti introduced our first speaker Dr Tan Hwee Huan, Senior Consultant, Diabetes Care at Admiralty Medical Centre. Dr Tan teased us by asking if we had heard of the “magic pill” and the stories of people with diabetes who were “cured”. Many were excited and eager to learn about this “magic pill”. Dr Tan then told us the story of her patient (Mr D) who had diabetes for 28 years but was not able to control his sugar level due to his lifestyle. He was urged to use the magic pill - “DESMM” (Diet, Exercise, Stressor/Support, Monitoring and Medication) to manage his sugar level. With persistences, he succeeded in reversing his high A1c levels to near normal even after his insulin was taken off. Dr Tan also emphasised that good control at the onset of diabetes will enable one to have better control in later life. She ended her talk by leaving us her magic numbers of <7% for A1c, 4-8mmol before food, and <10mmol two hours after food.

We then had a motivational talk by Dr Griva Konstadina from NTU – Lee Kong Chian School of Medicine. She had us in stitches as we played the “Fist” game. Many had difficulty in opening the clenched fist and only one pair of players played the game right. By asking for permission to open her fist, the player consented by opening her clenched fist. Dr Griva demonstrated that when we have problems with others, we have to soften our approach. Many agreed that “people are more willing to change when they know they are completely free NOT to change”.

Just before the sumptuous buffet lunch, we had a panel discussion led by Dr Tan Hwee Huan, Dr Griva Konstadina, Dr Kalpana Bhaskaran and Ms Loh Hooi Lee. The session ended at 12.30pm followed by participants recording their blood glucose levels. At 1.45pm, we gathered for a tough but fun “Word Search” game. We then had an invigorating workout session with a 15-minutesWalking Exercise (1.0 Mile Happy Walk).

Ms Chan Yoke Ling, a Diabetes Nurse Educator, spoke on New Trends in Blood Glucose Monitoring and the interpretation of Glucose Reading. She also explained the different ways and types of continual monitoring available. Most hospitals offer this service which is a good measure of knowing why and how our glucose levels are affected by the food we eat and our moods.

Juliana LimDS BUZZ

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DS BUZZJuliana Lim

Diabetes Support Group SG

Meet & Share Join us for our next support group event! Call Juliana at 9278 2084 for more details or to register.

28 April 2018 (Sat)Walk @ Tampines Eco GreenTime: 3.30pm – 6.30pmMeeting Point: Tampines MRTMaximum number of pax: 40

12 May 2018 (Sat)Visit to Kale FarmTime: 3.30pm – 6.30pmMeeting Point: To be confirmedMaximum number of pax: 40

26 May 2018 (Sat)Walk @Dairy Farm Nature Farm – Wallace TrailTime: 3.30pm – 6.30pmVenue: Hillview MRT Station, Exit AMaximum number of pax: 40

2 June 2018 (Sat)DSG 2nd Quarterly Gathering with DSS MembersTime: 2.00pm – 5.30pmVenue: TBAMaximum number of pax: 100

30 June 2018 (Sat)Walk in Ancient City Trail @Fort CanningTime: 3.30pm – 6.30pmMeeting Point: Dhoby Ghaut MRT Passenger Service, Exit BMaximum number of pax: 40

28 July 2018 (Sat)Walk @ Changi BeachTime: 3.30pm – 6.30pmMeeting Point: Meet at Tampines East MRT Passenger Service, Exit B, take bus 9 and alight at 18th stop after boarding(27 min bus journey) Maximum number of pax: 40

18 August 2018 (Sat)Walk in Civil TrailTime: 3.30pm – 6.30pmVenue: Dhoby Ghaut MRT Passenger Service, Exit CMaximum number of pax: 40

All meals at own expense unless otherwise stated

Mr Pang Er Jun from CO Wealth Advisory Group spoke on their AIA Insurance Policy Plan for people with diabetes. Years ago, people with diabetes could not be insured at all, but now, AIA has not only become the “First to Score Against Diabetes” by insuring people with diabetes but also has included a Vitality Programme in which the insured is able to earn Vouchers from Cold Storage, Uber/Grab and Starbucks just by exercising to keep healthy.

Our tea-break at 3.10pm was followed by another round of blood glucose readings. To sweeten the deal, “no sugar” ice cream in cups were available to all.

A very bubbly Ms Hamida Binte Zam from Temasek Polytechnic talked about Goal Setting For A Better You. She explained that writing down our goals helps keep our subconscious mind active. Studies have shown that writing down our goals activates our left brain while only thinking about it works the right brain.

Ms Hamida revealed that in a 1979 study at Harvard, 87% of people did not write down their goals, 10% thought about

their goals and 3% actually wrote down their goals. After 10 years, the 10% had made twice as much money as those of the 87% group. However, the 3% who wrote down their goals had made ten times more money than the rest of the group.

Prizes in the form of NTUC Gift Vouchers were awarded to the participants of the team who found the 18 hidden words in the word search game as well as to three participants who contributed much during the retreat.

Mr Venkatesh Narasiah, Executive Director of DS, thanked everyone who came for the retreat and emphasised the long term strategic vision of DS, including clinical activities, partnerships and collaborations, attracting new members and encouraging each volunteer/member to be an ambassador for Diabetes Singapore.

The retreat ended promptly at 5pm. All participants benefitted with much knowledge gleaned from the esteemed speakers and had an enjoyable day with many looking forward to the next retreat.

CARE CORNER

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Children, regardless if they have type 1 diabetes, need to be active. Teaching the importance of exercise and physical activity early on will form healthy habits that will serve your child well into adulthood. But physical activity also impacts blood glucose (blood sugar) levels, and as a parent, you need to know how to respond to these changes.

This article explains how to incorporate physical activity into your child’s routine and keep his or her blood glucose level within a stable range.

For people with diabetes, being active provides a slew of important health benefits. These include lowering blood glucose levels and improving your body’s ability to use insulin.

In essence, exercise helps your child control his or her diabetes. In the long run, this will reduce the chances of your child experiencing certain health problems related to diabetes.

Keeping Kids with Type 1 Diabetes Active

Amy Hess-Fischl

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Activities for Your Child with Type 1 Diabetes

Being active is most beneficial when it is done on a

regular basis. That is why you should find out what

activities interest your child the most. If your child

actually enjoys the activity, then it greatly increases

the odds that he or she will continue to participate. If your

child is interested in sports, then sign him or her up for

games. But do not worry if your child does not want to

participate in an organised activity. Encourage your child to

play outside with friends, ride a bike, or walk the dog.

Also, take advantage of the many opportunities you have

each day to set a good example for your child. Take the

stairs instead of the elevator. If you live a short distance

to shops, then opt not to drive and walk with your child

instead. Go on a walk together after dinner. Although they

aren’t intense bouts of exercise, these activities will help

form healthy habits that make a difference.

The ultimate goal is to get your child moving. A good

guideline to follow is that your child should get one hour of

physical activity in each day. That might sound like a lot, but

remember, it does not have to be strenuous activity.

Blood Glucose &Physical Activity

Physical activity can cause blood glucose to drop. If your

child’s blood glucose level falls too low, it can cause

hypoglycaemia.

Here are a few ways you can help reduce the effect of

physical activity on your child’s blood glucose level:

• Give your child extra carbohydrates, e.g. sports drinks that contain sugar and electrolytes such as sodium and potassium, before the activity.

• Check your child’s blood glucose level before, during, and after the activity.

• Prepare a kit that contains snacks, glucose tablets, fruit juice, water, and any medications that your doctor recommends for your child to take to practices and games.

• Be sure to check blood sugar levels more frequently after the activity and overnight to assess if insulin doses need to be adjusted.

If your child is in organised sports, make sure the coach

knows that he or she has diabetes. Explain to the coach

how to respond if there is a problem related to your child’s

condition.

Also, your child should wear a medical identification

bracelet that alerts others to your child’s diabetes, should

an emergency occur. Your child should wear this bracelet at

all times, not just during exercise and physical activity.

Though there are precautions you need to take, it is

important that your child engages in regular physical activity

when he or she has type 1 diabetes. The benefits greatly

outweigh the risks, so do not be afraid to encourage your

child to exercise and be physically active. With the proper

preparation, your child can fully enjoy the same activities as

every other child.

Source: https://www.endocrineweb.com/guides/type-1-children/physical-activity-children-type-1-diabetes

HEARTWAREHenry Lew

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MOVING ON RECOVERING FROM MAJOR SURGERY

The common misconception with surgery is that we go in and get fixed and all will be well. Unfortunately, human beings are not machines. There is fear of pain and the real pain itself, and the feeling of never being the same again. There are pre-surgery anxieties about things going wrong or whether you can cope with any post-surgery changes. Then there is the question of care—who will be there for you, with you, while you are recuperating.

Some surgeries may fix things, other surgeries change us so drastically physically. There are times when surgeries are completely unexpected and leave us reeling from the shock of losing something within, and having to deal with the

aftermath of physical and emotional scars.

Often, changes in our lives take place before surgery as preparations are made. We talk about some of the challenges that individuals face may before and after surgery and offer useful tips to help you overcome those challenges.

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HEARTWARE

About the author: Henry Lew works as a psychologist and enjoys coming up with creative ways to engage his patients and readers.

Before SurgeryChallenge: Fears and Worries

Some individuals may worry about the success or failure of the surgery. Others may be concerned about side effects or impact to their daily life and function. It gets more confusing when we hear conflicting information or “stories” from different people or websites. These fears are legitimate; after all our body, health and life may be impacted. However, we must be careful not to allow them to consume us and affect our quality of life.

Solution: Research and Clarify with ExpertsUncertainty, worries and concerns tend to feed more confusion and fears. The best way to manage them is to adopt the attitude of a scientist and find out the answers in an objective manner from the experts already working with you. Your healthcare professionals are the best experts. They know your condition the best, and they are able to clarify the accuracy and relevance of information. You may want to jot down your concerns and queries on your phone or a piece of paper and show it to your healthcare team on your next visit.

Challenge: Anxiety over Impending ChangeSome surgeries may change certain aspects of our lives. We may not be able to eat certain types of food or do certain activities or perform certain functions after surgery. Some may be temporary, others may be permanent. As a result, some individuals may want to eat more of certain food or do more of certain activities.

Solution: Use Our Health as Focus and Acknowledge What Remains

While we may want to engage in certain behaviours before surgery, we do not want to lose sight of our goal. Should we eat something in excess if it is not healthy for us in the long run? Would it not defeat the goal of the surgery which is to make us well and healthier? It may be helpful to look beyond the temporary or permanent loss.

After SurgeryChallenge: Feeling Weak, Helpless, Discomfort and Pain

During the initial period after surgery, some of us may feel weak and experience a considerable amount of discomfort and even pain. For those with wounds, we may be concerned about aggravating the wound. We may feel frustrated that our diet and movements are restricted. Our sleep may be disrupted for many reasons.

Solution: Know the Signs to Look Out for and Get Help from Others

Before you leave the hospital, ask a lot of questions, such as what signs to look out for that indicate that you need to seek immediate medical attention. Where do you go or whom do you turn to in case of emergencies? Ask others to support you for the time being while you recover from surgery. Recognise that you will eventually work your way towards being more independent and restoring your health as best as you can.

Challenge: Body ChangesSome surgeries may leave our body changed in a certain way. Some of these body changes could affect the way we look. Or it could affect the way we do things. Some of these changes may be felt only at certain moments. These body changes can make us feel self- conscious and vulnerable at times.

Solution: You are More Than This Recognise that you are more and bigger than your physical self. Some of the physical changes may make you more dependent on others, and it is not a sign of weakness, or a burden. It is just a different way of functioning that you may still be figuring out for the moment. Deep inside you, you are still the same you, regardless of the state of your health or body. Going through surgery is a tough journey. Be kind to yourself. Treat yourself as you would towards a friend who is recovering from a surgery. The journey may not be easy, but you are more than the journey.

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SPECIAL FEATUREDr Daphne Gardner

‘Mr L’ was a ‘Master L’ when he first came through the clinic doors. At the age of 13, he had been referred to the endocrine clinic for further evaluation as the school health service had detected that his weight put him in the ‘at risk’ category. Standing at 1.78m tall, and with a weight of 86.7kg, this put his body mass index at 27.3 kg/m2 (overweight category). He had hyperpigmentation (areas of darkened skin) behind his neck, and on his armpits, signs which suggested a state of resistance to insulin. He was otherwise feeling well and was doing well academically.

He underwent a 75g oral glucose tolerance test, during which a fasting blood sample is taken, followed by ingestion of 75g of quick acting carbohydrates before a second blood sample is taken two hours later. A fasting glucose level of > 7mmol/l or a two-hour glucose level of > 11.1mmol/l would be categorised as diabetes, whilst a level that is not normal yet falling just below these thresholds would be categorised as pre-diabetes.

Master L’s fasting glucose level was 4.5 mmol/l; with the two-hour glucose reading at 12.1 mmol/l, this put him in the category of diabetes. Having type 2 diabetes at 13 years of age was expectedly a devastating diagnosis for him and his parents. They were astounded especially since he did not have symptoms and had a previous normal 75g oral glucose tolerance test just two years prior

to this.

DIABETES SCREENING: WHY YOU SHOULDN’T WAIT

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There is a happy twist to this story, for Master L and

his family took on board the gravity of the situation

and as a whole family, implemented impressive

lifestyle changes. The previously favoured sugary

drinks and snacks were removed, portions at mealtimes were

reduced, dietary choices were skewed towards healthier

options and physical activity became a regular feature.

Over the next year, he lost a substantial amount of weight

(close to 10kg), with noticeable improvements to the dark

patches of skin suggesting reduced insulin resistance. Two

subsequent tests at age 14 years and 15 years were entirely

normal, showing he no longer had diabetes. Now at 22 years

of age, he still remains under yearly follow-up. Lifestyle changes

implemented years ago are still in place, maintaining his body

mass index at a healthy 21.8kg/m2 and keeping diabetes at bay.

This is not a preamble but rather a real-life account to

demonstrate a few key points in support of screening for

diabetes.

1Diabetes does not just affect the middle-aged or

the elderly. It can affect young ones too, through a

combination of familial disposition (inherited set of

genes) and an overweight/obese status.

2Studies show that Asians develop type 2 diabetes at

a younger age, and those who are diagnosed young

tend to have poorer cardiometabolic outcomes.

Asians also tend to suffer from the detrimental effects

of excess weight at lower weight thresholds. Therefore,

someone who is visually not ‘large’ can be metabolically

unhealthy.

3A normal glucose test at this point in time does

not guarantee normal glucose levels in the future,

as clearly demonstrated in the account above. That

is why screening guidelines would often suggest repeated

screening at regular intervals even if the initial test results

are normal.

In fact, the onset of type 2 diabetes is often insidious, and

many may not know they have the condition. The symptoms

of fatigue, blurred vision, poor healing wounds may often go

unnoticed or are attributed to other causes.

The later stage symptoms come on only when glucose levels

are higher, resulting in thirst, frequent urination and weight

loss; this occurs when the high levels of glucose exceeds

the kidneys’ ability for glucose reabsorption, and passes out

through the urine, drawing out water along with the glucose.

Consequently, individuals with type 2 diabetes may go on

for years without exhibiting symptoms, during which time

diabetes-related complications could already set in. Inadequate

blood glucose control leads to damage in the small blood

vessels in the eyes, kidneys and nerves (leading to blindness,

kidney failure or loss of feelings in fingers or toes) and the

large blood vessels (resulting in heart attacks or strokes).

Since those with early onset diabetes may not exhibit physical

signs or symptoms, focus may be better placed on the risk

factors for developing the condition, early detection through

screening, and intervening early in those who are nearly

developing diabetes (ie the pre-diabetes stage).

The Diabetes Risk Assessment tool by HealthHub

seeks to offer recommendations for targeted screening

in those who are younger (age 18 to 39 years) through a

risk stratification tool that combines age, gender, weight

status, family history, previous history of gestational diabetes

and presence of hypertension (high blood pressure). The

weightage of these risk factors towards the risk score is not

clearly described; a previous history of gestational diabetes

automatically defines high risk with this risk scoring system, in

line with what has been described in clinical studies.

Individuals with type 2 diabetes may go on for years without exhibiting symptoms, during which time diabetes-related complications could already set in.

“

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SPECIAL FEATURE

Those who are above 40 years of age are already deemed to

be at high risk and therefore should undergo screening. There

are nationwide efforts to make screening affordable and hence

widely accessible across the island.

It is estimated that one in seven Singaporeans aged 18 to 69

does not yet have diabetes but is nearly there, a state known

as pre-diabetes. The conversion rate to diabetes is high in these

individuals, and intervention through lifestyle modifications and

the use of medications has been shown in other countries to be

very effective in preventing the onset of diabetes.

The Pre-DICTED (Pre-Diabetes Interventions & Continued Tracking to Ease out Diabetes) programme led by SingHealth Duke-NUS Diabetes Centre

and funded by the Ministry of Health seeks to recruit local

participants with pre-diabetes and monitor the diabetes

conversion rate over three years.

Participants who are randomised to treatment arm will attend a

series of group-based lifestyle intervention programmes over six

weeks, with cash incentives offered to those who have achieved

and maintained a five percent or more weight loss from baseline.

Either standard care or treatment arm participants who are still

are at high risk of developing diabetes after six months will be

given an oral glucose lowering medication known as metformin.

The study is currently still in the recruitment phase and further

information can be found on www.predicted.com.sg.

We are battling diabetes on many fronts as a nation, and knowing

the enemy is the key to victory. Looking out for the symptoms

of diabetes, going for pre-emptive screening and implementing

early lifestyle changes should be instrumental in turning the tide

of the diabetes battle in Singapore.

Dr Daphne Gardner is a senior consultant with the Department of Endocrinology, Singapore General Hospital. Graduating from Oxford University, United Kingdom, she did part of her specialty training in Plymouth (Devon) and attained her AST in Endocrinology in 2011. Dr Gardner has published in several journals in the field of diabetes and regularly presents in international meetings. Her main interests are in young individuals with diabetes, including type 1 diabetes incorporating education and technology, monogenic diabetes and transition services. When not thinking about diabetes, she enjoys time with her two young boys and nature activities.

It is estimated that one in seven Singaporeans aged 18 to 69 does not yet have diabetes but is nearly there, a state known as pre-diabetes.

Looking out for the symptoms of diabetes, going for pre-emptive screening and implementing early lifestyle changes should be instrumental in turning the tide of the diabetes battle in Singapore.

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17

Cholesterol is a type of fat found in the blood. There are two main types of cholesterol in the blood: high density lipoprotein (HDL) and low density lipoprotein (LDL). The

LDL cholesterol is often referred as “bad” cholesterol because too much of it is unhealthy. Hence, it should be kept low to help protect your heart. By contrast, HDL which is the “good” cholesterol is a healthy fat that helps clear fatty deposits from your blood vessels and protect your heart. Triglycerides are a form of fat that the body makes from sugar, alcohol or other food sources. Elevated triglycerides can add to your risk of a heart attack or stroke at high levels, similar to the effect of high cholesterol.

People with diabetes tend to have lower HDL cholesterol levels and raise triglyceride and LDL cholesterol levels, which can cause narrowing or blocking of the blood vessels. This blockage, when severe, can increase your risk for a heart attack or stroke. This common condition is called diabetic dyslipidemia. Studies have shown that with lifestyles changes, like eating a healthy diet and regular physical activity, can significantly improve both cholesterol and blood sugar control. (See recipes on page 16 & 17)

Healthy eating tipsHere are some healthy eating tips to help you manage your cholesterol:

• Choose foods lower in fat • Limit saturated fats intake• Avoid high trans-fats food such as pastries, cakes, bakery buns and fast food• Limit deep-fried food intake• Limit food sources of cholesterol• Choose high fibre foods

To help lower LDL cholesterol, replace saturated and trans fats with small amounts of unsaturated fats, such as:

• Olive oil• Canola oil• Rice bran oil• Nuts and seeds such as peanuts, almonds and ground flaxseeds• Soft margarine

Make healthier choices from each of the food groups:

Rice & alternatives • Choose whole grains• Choose high-fibre grains, especially those with soluble fibre (such as barley, brown rice, multigrain pasta)• Choose low-glycaemic index foods

Fruits • Choose whole and unprocessed fruit for more fibre

Vegetables • Eat a rainbow and choose different coloured vegetables• Choose fresh vegetables

Meat & alternatives • Reduce red meat to not more than two times per week• Choose at least two meals per week of oily fish (such as salmon, sardines)• Choose plant protein more often (such as tofu, legumes, lentils)• Choose lean meats, trim visible fat, remove skin from poultry• Choose lower fat cheese • Choose low fat dairy (such as skim or low fat milk, low fat cheese and low fat yoghurt) • Choose low-fat milk alternatives such as soy- or rice-based products

Diabetes & Cholesterol

SPECIAL FEATURE

About the author: Michelle Hoi is the lead dietitian at CelliHealth, a digital corporate health and wellness startup. She is a registered dietitian nutritionist and accredited dietitian of Singapore, with eight years of experience in clinical nutrition and food development. She enjoys cooking, baking delicious allergy-friendly foods and travelling when she has the opportunity.

Michelle Hoi

Diabetes Singapore APR - JU

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Ingredients 1 medium head cauliflower, stem removed3 teaspoons canola oil2 large eggs, lightly beaten 3 cloves garlic, minced 1 one-inch piece fresh ginger, peeled and grated 1 cup carrots, peas and baby corn, diced 1/4 cup thinly sliced scallions1/4 cup & 2 tablespoons soy sauce2 tablespoons sesame oil 2 cooked chicken breasts, diced Optional: hot sauce for serving

Method of preparation1. Cut the cauliflower into chunks. In small batches, pulse the cauliflower in a food processor until coarse in texture, like

rice. This recipe uses about 4 cups of cauliflower rice. If you have any left over, save it for another use.2. Heat a wok or large skillet over medium-high heat.3. Add 1 teaspoon of canola oil. Add the eggs and quickly scramble. Transfer the eggs to a plate and set aside.4. Heat the remaining 2 teaspoons of canola oil. Add the garlic and ginger and cook, stirring constantly, for about 1 minute.5. Add the peas and carrots, scallions and cauliflower. Stir-fry until the vegetables are tender, for about 5 minutes.6. As the vegetables are cooking, whisk the soy sauce and sesame oil together in a small bowl. Stir the sauce and chicken

into the cauliflower mixture.7. Cook an additional 1 to 2 minutes.8. Stir the cooked eggs back into the mixture.9. Serve with hot sauce and additional soy sauce if desired.

Nutrition Information Per ServingEnergy 401kcalCarbohydrates 17gProtein 39gTotal fat 21g Saturated fat 4gCholesterol 175mgDietary fibre 4.4gSodium 930mgSugar 5gCarbohydrate exchange 1 exchange

SPECIAL FEATUREBonnie Lau

COOKOUT

SERVES 4

Cauliflower Fried Rice

Michelle Hoi

About the author: Michelle Hoi is the lead dietitian at CelliHealth, a digital corporate health and wellness startup. She is a registered dietitian nutritionist and accredited dietitian of Singapore, with eight years of experience in clinical nutrition and food development. She enjoys cooking, baking delicious allergy-friendly foods and travelling when she has the opportunity.

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Ingredients 6 ounces (170g) brown rice noodles 2 whole carrots, “ribboned” with a vegetable peeler or spiraliser2 green onions, finely chopped1/4 cup (15g) chopped cilantro (coriander)2-3 tablespoons (6g) chopped mint1 cup (30g) loosely packed spinach, chopped1 cup (75g) thinly sliced red cabbage1 red bell pepper, thinly slicedOptional: 1 batch marinated peanut tempeh

Dressing1/3 cup + 1 tablespoon (100g) salted creamy peanut butter, almond butter, or sunflower seed butter3 tablespoons (45ml) soy sauce3 tablespoons (45ml) maple syrup1 teaspoon chili garlic sauce, 1 red chilli minced, or 1/4 teaspoon red pepper flakes1 lime, juiced ~(3 tablespoons or 45ml)Water to thin (~1/4 cup or 60ml)

Method of preparation1. Cook rice noodles according to package instructions, rinse, drain, and set aside to cool.2. To a large serving bowl, add cooked and cooled noodles, carrots, green onions, cilantro, mint, spinach, cabbage, and

red bell pepper and toss loosely to combine. Set aside.3. Make dressing by adding peanut butter, soya sauce, maple syrup, chilli sauce (or chilli or red pepper), and lime juice

to a small mixing bowl and whisking to combine. Then add warm water a little at a time until a thick but pourable sauce is achieved.

4. Taste and adjust seasonings as needed, adding more maple syrup for sweetness, chilli sauce (chilli or red pepper) for heat, lime juice for acidity, or tamari for saltiness. Set aside.

5. Add half the tempeh (optional) and half the sauce to the salad and toss. Then top with remaining tempeh and sauce. Serve immediately. Leftovers store well in the refrigerator for up to 4 to 5 days, though best when fresh. If making this dish ahead of time, it is better to leave the salad undressed and store the tempeh separately.

COOKOUT

SERVES 4

Michelle Hoi

Vegan Tempeh Salad

Nutrition Information Per ServingEnergy 441kcalCarbohydrate 43.3gProtein 21.1gTotal fat 23.7g Saturated fat 4.7gCholesterol 0mgDietary fibre 4.8gSodium 887mgCarbohydrate exchange ~3 exchanges

Diabetes Singapore APR - JU

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SPECIAL FEATUREBonnie Lau

Nutrition Information Per Serving Energy 170 kcalCarbohydrates 19gProtein 6gTotal fat 10g Saturated fat 1gCholesterol 0mgDietary fibre 8gSodium 5mgPotassium 135mgCarbohydrate exchange ~1 exchange

COOKOUT

SERVES 2

Chayote with Peppery Mung Dal

Ingredients I cup (130g) chayote (1 piece) 50g mung dal, cooked I chopped green chilli 1 teaspoon mustard 1 teaspoon fennel seeds 1 teaspoon cumin seeds 1 teaspoon ground black pepper 1 tablespoon cilantro leaves (coriander) chopped 1 tablespoon sunflower oil 4 cloves garlic Salt to taste

Method of preparation1. Cook the chayote with the green chilli. Add cooked dal, black pepper and salt.2. Heat the oil in a pan and fry the mustard seeds until they sputter, then add the

fennel seeds. 3. Add the chayote and dal to the pan. Mix well.4. Pound garlic, cilantro leaves and cumin seeds and use this mixture as garnish.5. Sprinkle the green chilli and salt over the salad and serve.

Kohila Govindaraju

About the author: Kohila Govindaraju is an accredited nutritionist and director of THE BERRIES Nutrition Consulting, an avid blogger (kohilag.wordpress.com) and prolific author of magazine articles on food and nutrition, including a book titled How to Lose Weight Without Hunger published by PatientsEngage.

THE LIGHTER SIDEKohila Govindaraju

About the author: Kohila Govindaraju is an accredited nutritionist and director of THE BERRIES Nutrition Consulting, an avid blogger (kohilag.wordpress.com) and prolific author of magazine articles on food and nutrition, including a book titled How to Lose Weight Without Hunger published by PatientsEngage.

21

Kohila Govindaraju

Most fruits and vegetables are naturally low-calorie nutrient-dense foods that when consumed regularly contribute to good health. According to the United States Food and Drug Administration, a low-calorie food is any food that is 40 calories or less per serving.

LEAN GREENS

GETTING MUCH OUT OF ALMOST NOTHING

Romaine lettuce is high in fibre and low in calories, 16 calories per 100 grams. Though it is low in calories, it consists of minerals such as calcium, potassium, phosphorous and magnesium. It is also packed with vitamin C, vitamin K and folate. Romaine hearts, the middle leaves of the lettuce are smaller and sweeter.

Celery stalks make great snacks at only 14 calories per 100 grams. Celery stalks contain minerals such as calcium, sodium, potassium, magnesium, copper, iron, zinc that help detoxify the body. It contains all the fat soluble vitamins A,D,E,K and water soluble vitamins B and C. Butylphthalide compound, found in celery, stimulates the bile juices that lower cholesterol levels. Potassium, an essential electrolyte, is a vasodilator, and helps to regulate the blood pressure. Vitamin C in celery helps prevent free radical damage and reduces the risk of inflammatory conditions like asthma. Celery leaves make a great addition to soups. The darker the colour, the stronger the flavour! Tomato chicken soup with carrots and celery sounds delicious for lunch!

Chayote, a tender Mexican squash, is called the vegetable pear for its shape. It belongs to a gourd family with a mild sweet flavour. It is a good source of folate that helps in cell division and DNA synthesis. It is also a good source of fibre, phosphorus, potassium, vitamin B and vitamin C. Chayote is a low-calorie vegetable that provides 16 calories for 100 grams. This light green squash can be sauteed with garlic. Chayote and yellow bean stew goes great with rice. Chayote, with avocado, bell pepper, jalapenos and cilantro, also makes a great salad. (see recipe on Page 20)

Cucumbers belong to the family as squash and pumpkin. Like watermelon, cucumbers are made up of 95% water and yield only 12 calories per 100 grams. Water-rich, cucumber is hydrating and helps to suppress the appetite. Cucumbers are rich in vitamin B, vitamin C and vitamin K. They are also loaded with copper, potassium, and manganese. Polyphenols compounds, called lignans, in cucumber help to reduce the risk of chronic diseases. Lignan helps to lower the risk of breast, uterine, ovarian cancers. Quercetin, an antioxidant in cucumber, along with vitamin C and beta-carotene, helps to lower the risk of heart diseases.

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SHAPE UP

Exercise helps you to lose weight and improve balance, which is important because many people with type 2 diabetes are at risk for obesity and for falls. “I fully recommend that anyone over 40 with

diabetes include balance training as part of their weekly routine, at least two to three days per week,” says Dr Sheri Colberg-Ochs, founder of the Diabetes Motion Academy in Santa Barbara, Califorinia, and professor emerita of exercise science at Old Dominion University in Norfolk, Virginia. “It can be as simple as practising balancing on one leg at a time, or something more complex like tai chi. Lower body and core resistance exercises also double as balance training.” Here are five great workouts you can easily work into your daily routine.

1 Walking“Walking is easy for people to do,” Colberg-Ochs says. “All you need is a good pair of shoes and somewhere to

go. Walking is probably one of the most prescribed activities for people with type 2 diabetes.” Brisk walking done at a pace that raises the heart rate is an aerobic exercise, and studies show beneficial effects when people with diabetes participate in aerobic activities at least three days a week for a total of 150 minutes.

2Tai ChiTai chi is ideal for people with diabetes because it provides fitness and stress reduction in one. Tai chi also

improves balance and may reduce nerve damage, a common diabetic complication—though the latter benefit “remains unproven,” says Colberg-Ochs. Still, she emphasises that working on your balance daily is a critical component of staying on your feet as you age, and living well and independently throughout your lifetime. “If you don’t do tai chi, incorporate some other balance exercises into your weekly routine to reduce your risk of falling,” says Colberg-Ochs.

3 SwimmingSwimming is another aerobic exercise—and an ideal one for people with type 2 diabetes because it doesn’t

put pressure on your joints. “Being buoyed by the water is less stressful for you,” Colberg-Ochs says. Swimming also is easier on your feet than other forms of exercise, such as walking or jogging. Very often diabetes reduces blood flow to the small blood vessels of your extremities and you can lose sensation in your feet as a result. People with diabetes must avoid foot injuries, even minor cuts or blisters, because they can be slow to heal and are prone to infection.

4 Weight TrainingWeight training builds muscle mass, important for those with type 2 diabetes. “If you lose muscle mass, you have

a lot harder time maintaining your blood sugar,” Colberg-Ochs says. Plan for resistance exercise or weight training at least twice a week as part of your diabetic management plan— three is ideal, but always schedule a rest day between weight workouts (other exercise is fine on those days). Each session should include five to 10 different types of lifting involving the major muscle groups. For optimal strength gains, work your way up to doing three to four sets of each exercise, with each set comprising 10 to 15 repetitions.

5 Stationary BicyclingBicycling is another form of aerobic exercise, one that makes your heart stronger and your lungs function

better. A stationary bike is ideal for people with diabetes because you can do it inside, no matter the weather, and you do not have to worry about falling or getting a flat when you are a long way from home. Bicycling improves blood flow to your legs—a great benefit for people with diabetes—and burns lots of calories to keep your weight at healthy levels.

Source: https://www.everydayhealth.com/type-2-diabetes/living-with/great-

exercises-for-people-with-diabetes/#01(adapted)

Beth W. Orenstein

5Great Workouts for Type 2 Diabetes

An educational message from

Diabetes Singapore

It is very important to learn how to manage your illness when you are sick. Please consult your physician for further advice on diabetes and sick-day management.

When you are sick, your body reacts by releasing hormones to fight infection. Your body fights the disease through many mechanisms, including changes in hormone levels, which can raise or lower your blood sugar levels. However, as the hormones raise your blood sugar levels, they will also make it more difficult for insulin to lower blood sugar levels.

Here are some tips on how to manage your diabetes when you are ill:

1 When sick, continue taking your medicines for diabetes. Even if you are throwing up, do not stop taking your

medicines. You need them because your body makes extra glucose (sugar) when you are sick. Take your usual dose of insulin/oral medication. DO NOT OMIT YOUR INJECTION/ MEDICATION.

2 Eating and drinking can be a big problem when you are sick.But it is important to stick to your normal meal plan

if you can. Drink plenty of water to keep your body hydrated. This will help to prevent hyperglycaemia (high blood glucose). Avoid caffeinated and alcoholic drinks as these may interfere with your medication.

3 Check your blood glucose at least four to six hourly as some medication may increase your blood glucose, which

will require you to adjust your medication accordingly. (Please check with your doctor on how to adjust your medication during sick days.)

4 Call your doctor if: · you have a fever (temperature over 101°F or 38.3°C). · you have diarrhoea or are vomiting and are unable

to eat food, or drink fluids containing glucose or carbohydrates.

· you have persistent vomiting or diarrhoea. · your fever persists longer than 24 hours. · your blood sugar stays higher than 180 mg/dL or

lower than 70 mg/dL.

5 Rest. Do not exercise.

6 Test your urine or blood for ketones. If you have type 2 diabetes, you have a very low chance of developing

ketoacidosis. However, during severe illnesses, it is possible that ketoacidosis may develop. You should test your urine for ketones when:

· you feel severely sick (have a cold, the flu or other illness) and/or have unexplained nausea or vomiting.

· your blood glucose level is high (over 300 milligrams per deciliter or mg/dL) and continues to rise throughout the day.

7 Some suggestions for sick-day diet: · Small and frequent meals. · Nutrient-dense soft foods or liquids such as porridge

with other ingredients, milk, soy bean milk, and nutrition supplement formula.

· Adequate fluid intake.

What do you do WHEN YOU ARE SICK?

DIABETES SINGAPORE