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CONTENTS COVER STORY AND FEATURES
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Get Fit While Travelling!
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Jet Lag and Diabetes
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Traveling with Insulin
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Have Diabetes, Will Travel
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Vaccines for the Diabetic Traveller
Jose Martin Punzalan lists some of the fitness-buff-friendly travel destinations you can flock to this summer.
Is there really a connection between jet lag and diabetes? Dr. Yvette Rosales-Amante explains the link between the two.
Dr. Jimmy Aragon shares tips on how to manage a road trip or “globe trot” with insulin on board.
Packing the essentials is a must and that includes your medications. Emil Karlo dela Cruz shows you how to make sure that everything you need is ready.
regulars 4 | EDITOR’S EDICT 6 | WE’VE GOT MAIL 7 | SWEET NEWS ON THE COVER: Summer provides the perfect opportunity to travel. But if you have diabetes, does that mean giving up on your out-of-town plans? Not necessarily. Read on to find out how to enjoy a trip, diabetes and all.
Traveling this summer but wary of diseases you may catch? Dr. Salvador Abad Santos gives a lowdown on the various vaccinations you’ll need for traveling to different countries.
Cover photo by Jose Martin Punzalan
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columns 11
Educator’s Corner
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Fightin’ for Fitness
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Righteous Recipes
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Good Food Guide
How to avoid getting sick while traveling No one definitely wants to get sick while traveling. Dr. Jocelyn Isidro teaches you prevention tips on how to stay healthy during your ultimate getaway.
Water survival and swimming tips With the country surrounded by water, swimming is an essential survival tip. Coach Dang Amparo writes why swimming is a must for every Filipino.
Easy-to-pack dishes Going on a road trip? Planning a picnic? Chef Junjun presents three quick nutritious recipes tasted by Cristina Arayata.
Veggie good move for good health With the campaign for healthy meals, many have gone vegetarian. Nutritionist Joan Sumpio goes behind the phenomenon and presents the two sides to skipping meat.
sections 13
You Ask, We Answer
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Living Well
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Product Spotlight
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Dos and Don’ts
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Stress Busters
Is there a link between sun exposure and diabetes? The heat is definitely on and for those baking under the sun, be wary as Dr. Joy Fontanilla surprisingly discovers that while too much sunshine may cause skin cancer, too little may lead to diabetes.
Sugar-Free Treats Mylene C. Orillo scours the grocery aisle to check for quick treats for the health conscious hungry.
On vacation from/with diabetes Tired and weary as you may be, traveling with the family is a perfect time for bonding. Michaela Sarah De Leon guides you how.
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Dancing with Diabetes Just because one is diagnosed with the condition doesn’t mean the world stops. Alexa Villano sat down with Enrico Santos on how dancing kept him going despite his condition.
Angelica de Leon outlines a step-by-step process before even packing your bags.
Affairs to Remember Doodles & Dreams
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EDITOR’S EDICT
Sweet Voyages Travel is fatal to prejudice, bigotry, and narrow-mindedness, and many of our people need it sorely on these accounts. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one’s lifetime. - Mark Twain
There’s no place like home… I agree with Dorothy. Oz was a disconcerting place. A child away from the comforts of home would be terrified. But even though the wizard turned out to be a not-so-wonderful fraud, the trip to Oz was worth it. Dorothy helped the tin man get a heart, the scarecrow score a brain and the lion find its courage. And most of all, she was able to defeat the wicked witch of the west. It’s summer…’tis the season to get bitten by the travel bug! And we each have our own reasons for traveling. Maybe it’s to pursue the wonderful wizards of adventure, sightseeing, recreation, relaxation, pilgrimage, charity, exploration or trade.Whatever your motivation for travel may be, you need to stay healthy and keep safe. People with diabetes need to take extra precaution when traveling. Read on to know more about travel vaccines, packing essentials, insulin care, illness prevention, jet lag deterrents and more. As you traverse that yellow brick road, may you don a fresh pair of eyes. Rid yourself of the wicked witches of prejudice, bigotry and narrowmindedness, create precious memories with your loved ones, and leave the world a kinder, gentler place! Peace and thank you,
Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM, CCD
Editor-in-Chief
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MEDICAL ADVISORY BOARD Ramon F. Abarquez Jr., MD Professor Emeritus, University of the Philippines College of Medicine; Academician, National Academy of Science and Technology Mary Ann Lim-Abrahan, MD Past President, Philippine Lipid and Atherosclerosis Society; Professor, University of the Philippines College of Medicine–Endocrine Section Abdias V. Aquino, MD President, Philippine Society of Hypertension; Past President, Stroke Society of the Philippines; Past President, Philippine College of Physicians Corazon VC. Barba, PhD, RND Past President, Nutritionist-Dietitian’s Association of the Philippines Ricardo E. Fernando, MD Founder and President, Institute for Studies on Diabetes Foundation, Incorporated Ruby T. Go, MD Immediate Past President, Philippine Lipid and Atherosclerosis Society; Head, Endocrine Section, Chinese General Hospital Augusto D. Litonjua, MD President, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Society of Endocrinology and Metabolism; Philippine Association for the Study of Overweight and Obesity Roberto C. Mirasol, MD Past President, ASEAN Federation of Endocrine Societies; Past President, Philippine Society of Endocrinology and Metabolism Antonio R. Paraiso, MD Medical Specialist III, National Kidney and Transplant Institute; Assistant Professor, College of Medicine, University of the East Ramon Magsaysay Memorial Medical Center Ma. Teresa Plata-Que, MD Past President, Philippine Diabetes Association; Consultant, East Avenue Medical Center; National Kidney and Transplant Institute Tommy S. Ty-Willing, MD Immediate Past President, Diabetes Philippines; Trustee, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Lipid Society; Consultant, Metropolitan Hospital
CONTRIBUTORS Jocelyn Capuli-Isidro, MD, FPCP, FPSEM Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Emil Karlo dela Cruz Art Director: Editorial Coordinator: Senior Writer: Staff Writers:
Donna I. Pahignalo Alexa Villano Michaela Sarah de Leon Ma. Cristina Arayata Jose Martin Punzalan Aencille Santos
Graphics and Layout: Danie Paul Cisneros Executive Officer: Lisandro Q. Favila Overall Marketing Manager: Hudson Pelayo Marketing Assistant: Godfrey Santos Group Sales Manager: Ma. Elna P. Jagape Senior Account Managers: Noel A. Ongkingco Charlotte Aireen Punzalan Corporate Communications Specialist: Jacqueline Cates Flaviano Representatives: Girlie Joy D. Jovero Brent James D. Castro Angelica F. Monsod Jeyzel M. Sanchez Keizi Ann E. Agujo Angelo Aguilar Leonard Anthony D. Baluyot Florence Palapar Antonio Fajardo Jr.
Dr. Isidro is a Consultant Endocrinologist at Makati Medical Center and the St. Luke’s Medical Center, Global City. She is also a member of the medical bureau of Diabetes Center Philippines or the Philippine Center for Diabetes Education Foundation, Inc.
Marie Yvette Rosales-Amante, MD, FACE, FPCP, FPSEM A graduate of the University of the Philippines College of Medicine, Dr. Amante took up her residency in internal medicine at the University of Connecticut, and had her Fellowship in Endocrinology, Diabetes and Metabolism at the University of Massachusetts. She is a member of the board of the directors of the American Association of Clinical Endocrinologists-Philippine Chapter and Endocrinology Section Chief at the Asian Hospital and Medical Center.
Jimmy B. Aragon, MD, FPCP, FPSEM, FACE Dr. Aragon is a Fellow of the Philippine Society of Endocrinology and Metabolism, and a Fellow of the American College of Endocrinology. He is also an internal medicine and endocrinology consultant at the Makati Medical Center and a member of the board of directors of the American Association of Clinical Endocrinologists-Philippine Chapter.
Salvador Abad Santos, MD Dr. Santos is an infectious disease consultant at the Asian Hospital, Makati Medical Center, and St. Luke’s Global.
Advertising Assistant: Irina Mae Carampatana Officer-in-Charge, Circulation Department: Armando Sandajan Executive Assistants: Angeli M. Mamaril Zenaida R. Fortes Legal Counsel: Castillo, Laman, Tan, Pantaleon and San Jose Law Firm Diabetes is not a one-size-fits-all disease. The information in DiabetEASE, therefore, is not meant to substitute for a health professional’s advice and readers are cautioned to consult with their healthcare provider before putting any of its contents into practice.
DiabetEASE is published by Friendly Alliances and Media Expressions, Inc. (FAME, Inc.). No part of the magazine may be reproduced in any manner without the permission of the publisher. Unsolicited manuscripts, photographs, and artwork will not be returned unless accompanied by self-addressed stamped envelopes.
Erlinda “Dang” Amparo Coach Amparo is currently the swimming coach of Miriam College. She is also the head teacher for MAPEH (Music, Arts, PE, Health), at the Holy Spirit National High School, Quezon City. She is also a member of the Philippine Air Force Search and Rescue Auxiliary Group and former paddler for the Philippine Dragon Boat Rowing Team.
Joan Sumpio, RND
Ms. Sumpio is a registered nutritionist-dietitian, experienced nutrition counselor and academician and trained diabetes educator. She is also a board director of the Nutritionist-Dietitian’s Association of the Philippines.
Address all correspondence and subscription inquiries to FAME Inc., Suite 503 Narra Building, 2276 Pasong Tamo Extension, Makati City, Philippines. Tel. Nos. 892-0723 to 24; 894-0483; 813-5433 or 36; Fax No. 892-8514; E-mail: diabetEASE.famepublishing@gmail.com. All rights reserved. Copyright 2012 by FAME, Inc.
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we’vegotmail Dear DiabetEASE,
Dear DiabetEASE, First and foremost, I am glad that there is a magazine that caters to those who have the condition. I have friends whose families and relatives have been diagnosed with type 2 diabetes, and I told them to grab a copy of your magazine to manage their condition.
I am really a fan of yours, because my grandfather would always read your magazine, and so I was curious and I started to read it, too. I am learning new things about the diabetes - even kids nowadays can suffer this, so your magazine is really a big help. Hope you could give us more tips, products, healthy facts on how we are going to prevent this illness. More power to you and may the Lord bless you! Sincerely, A.K.A. POG
God bless. Dear DiabetEASE,
Sheila via e-mail Dear DiabetEASE, DiabetEASE welcomes feedback from readers. Please send your comments, questions and suggestions through any of the following: Snail mail: 503 Narra Building, 2276 Pasong Tamo Extension, Makati City 1232 Philippines Email address: diabetEASE.famepublishing@ gmail.com Fax number: (+632) 8928514 Telephone numbers: (+632) 8920723 to 24; 8940843; 8135433 or 36 DiabetEASE reserves the right to edit materials for publication.
I really loved the last issue. It was very enlightening to know that even with the disease, nothing stands in the way of my dreams of becoming a dancer. I’ve had DM for years so I thought I won’t ever be capable of doing something as strenuous as dance. Thank you so much.
I love your recent magazine volume. I’ve learned a lot and I shared it with my mom and lola because they’re diabetic. She doesn’t listen to me until I showed her some samples of what will happen if she does not lessen her food consumption. Now she is conscious of her diet, health, and figure. Thanks for your tips and advice! Yours truly, ESSIE
-Dindo via e-mail
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sweetnews
goodmenproject.com
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en are more exposed to type 2 diabetes when they are stressed, said a new study from the University of Gothenburg, Sweden. “Today, stress is not recognized as a preventable cause of diabetes. However, our study shows that there is an independent link between permanent stress and the risk of developing diabetes, which underlines the importance of preventive measure,” said Masuma Novak, lead author of the study published in the journal, Diabetic Medicine. The researchers identified a link between stress levels and metabolic conditions in a sample collected over the past 35 years from a total of 899 men who developed Type 2 Diabetes.
Stressed men more prone to Type 2 Diabetes By Michaela Sarah De Leon
The scientist examined close to 7,000 men who took part in the long-term population based health study. The respondents did not have histories of diabetes, stroke, or heart disease at the beginning of the research but 15.5 percent said they experienced permanent or chronic stress related to work or home conditions in the past one to five years. The men, who were stressed, were 45 percent more prone to developing type 2 diabetes compared to men who did not experience permanent or periodic stress. The connection between stress and diabetes remains statistically significant even with consideration of age, levels of physical activity, body mass index, blood pressure, and use of high blood pressure medication. D
Diabetic foot ulcers may not benefit from oxygen therapy By Aencille Santos
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espite previous studies showing that pure oxygen exposure aids wound healing among diabetes patients, a new large study debunks this notion, proving that severe foot ulcers receive no benefit – and might even be possibly harmed–from oxygen treatment. “We really thought we would see a replication of what occurred in the randomized trials. The data demonstrates that didn’t come to pass,” said Dr. Stephen Thom, professor at the Perelman School of Medicine in Philadelphia, to Reuters Health. Dr. Thom also worked in the said study. The study, which was published in the journal Diabetes Care, analyzed 6,259 patients with foot ulcers treated at wound care centers in the US between 2005 and 2011. From these patients, only 793 had oxygen therapy, which lasted for 45 minutes to two hours for once or twice a day over four to five times a week, on top of standard care. Of those patients, only 793 ended up having the oxygen
therapy on top of standard care. Their sessions lasted from 45 minutes to two hours in the pressurized chambers, and were done once or twice per day, 4-5 times a week. Results indicate that after 16 weeks, 43 percent of oxygen therapy patients had fully healed wounds, while 50 percent of patients who did not use oxygen therapy had healed as well. On the other hand, 7 percent of oxygen therapy patients had an amputation compared to 2 percent who did not get oxygen treatments. “It does not only say it’s not equal, it says it may be worse. You’re seeing a higher amputation rate and a longer healing of a foot wound,” said Dr. Nicholas Morrissey, a vascular surgeon at New York-Presbyterian Hospital and who was not involved in the study. However, authors note that further study is still needed to better understand the results and the effects of oxygen therapy. with a Reuters Health report D APRIL 2013-MAY 2013
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by Aencille Santos
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iets with lean meats and healthy fat (like olive oil) were seen to be the most effective in promoting weight loss and lowering blood sugar among people with diabetes, according to a recent study. Data reviewed from over 20 sources compare the effects of seven popular diets among adults with type 2 diabetes. Findings indicate that Mediterranean diets, low-carb diets, high protein diets, and low glycemic index diets – which rank foods by how quickly their carbs turn into glucose – all lowered the participants’ blood sugar. After six months, however, those under the Mediterranean diet plan also lost an average of 4 pounds, where no other diet had a significant impact on weight, according to the findings published in the American Journal of Clinical Nutrition.
womensheart.org
Mediterranean diet best for weight loss in diabetes patients
“We were quite surprised by the Mediterranean diet in particular,” Dr. Olubukola Ajala, a diabetes specialist at Western Sussex Hospitals in the UK, told Reuters Health. “I would have thought that low-carb would have been the best for losing weight, but Mediterranean seems to be better.” Low-carb, low-glycemic, and Mediterranean diets all led to a rise in “good” cholesterol by 4 percent to 10 percent, while triglycerides decreased by 9 percent. Even so, the Mediterranean diet is not the only way to achieve weight loss and improve heart health, said Katherine Zeratsky, a registered dietitian at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study. She adds that it’s more important to take a balanced approach, eating moderate portions and talking to a doctor before embarking on a plan. D
Diet softdrinks linked to type 2 diabetes by Alexa Villano
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f you think diet beverages are better than regular colas, think again. A new France-based study showed that diet or “light” versions of softdrinks may put drinkers at a considerably higher risk of type 2 diabetes. The American Journal of Clinical Nutrition reported that individuals who consume diet softdrinks regularly are more likely to develop the disease, compared to those who drink the regular version. Around 66,000 middle-aged French women were quizzed about their softdrink consumption habits. They were followed up by experts from the National Institute of Health and Medical Research in France for 14 years. The group discovered that women who either drank regular or diet colas had a higher chance of getting type 2 diabetes, compared to those who drank unsweetened fruit juice.
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The report also showed that the chances of developing type 2 diabetes was even greater in women who drank diet softdrinks. It was 15 percent higher for those consuming 500 mL/ week, and 59 percent higher for consumptions of 1.5 liters/week. Factors for the study include women’s age and body size. The researchers however said that the study was limited, because it did not take into proper account eating habits which may have changed. “We cannot rule out that factors other than ASB (artificially sweetened beverages) are responsible for the association with diabetes,” they said. Studies of sweet drinks especially those with regular sugar have been linked to high risk of diabetes over the years but this is the first study to be associated with diet drinks that contain artificial sweeteners. with a report from diabetes.co.uk D
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Firstborns more likely to have diabetes, high blood pressure
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New Zealand study recently found that firstborns have a reduced level of insulin effectiveness, compared to their counterparts who have older siblings. It is a known fact that insulin resistance is linked with the emergence of diabetes and high blood pressure, although further research is needed to determine how these findings relate to risks during adulthood. The study came out in the January issue of Journal of Clinical Endocrinology and Metabolism. “Although birth order alone is not a predictor of metabolic or cardiovascular disease, being the first-born child in a family can contribute to a person’s overall risk,” said Wayne Cutfield of the University of Auckland. Cutfield and colleagues found the 21 percent drop in insulin sensitivity among firstborns during their study, which could suggest that birth order may be associated with changes in our metabolism during childhood. For their study, Cutfield and team examined data on 85 children aged 4 to 11. A total of 32 kids were firstborns.
by Emil Karlo Dela Cruz
The researchers set out to compile the children’s lipid and hormone profiles, their height, weight, and body composition. Blood pressure was also monitored using a 24-hour ambulatory device, coupled with frequent blood tests for glucose. Data showed that the firstborns had a 21 percent lower insulin sensitivity, with a 4 mmHg higher blood pressure. However, the blood lipids generally remained the same. The researchers suggest that this change in insulin sensitivity could be due to the changes that took place in the uterus during the first pregnancy. Thus, subsequent pregnancies would result in the fetus receiving more nutrients. “Our results indicate first-born children have these risk factors, but more research is needed to determine how that translates into adult cases of diabetes, hypertension, and other conditions,” said Cutfield. The results could also have strong implications on countries like China, where the population mainly comprises of firstborns due to their one-child policy. D
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thediabetesweb.blogspot.com
Insulin resistance found in 53% of Filipinos with type 1 DM by Michaela Sarah De Leon
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ocal data on diabetes mellitus and the metabolic syndrome were presented at the recently concluded Philippine Society of Endocrinology and Metabolism (PSEM) Annual Convention. In a study entitled, “Insulin Resistance among Adults with Type 1 Diabetes Mellitus at the Philippine General Hospital” by Barrera, J. et. al., it was reported that the prevalence rate of insulin resistance was 53 percent among adults with established type 1 diabetes mellitus. In the study, insulin resistance was also found to be more prevalent in Filipinos with type 1 diabetes mellitus with features such as hypertension, older age, longer duration of disease, and a higher waist-to-hip ratio. Compared to patients without insulin resistance, type 1 diabetes mellitus subjects with insulin resistance were significantly older at 29.59 vs. 25.59 (p = 0.007), with longer duration of diabetes (59.7 percent vs. 40.3 percent with duration of diabetes at >5 years, p = 0.037). They also have a higher waist-to-hip ratio at 0.95 vs. 0.93 (p = 0.0005) and higher prevalence of hypertension (100 percent vs. 0 percent, p = 0.00) than those without insulin resistance. “Type 1 diabetes mellitus with insulin resistance tend to have higher insulin requirement per day, poor glycemic control and higher BMI than those type 1 diabetes mellitus patients with no insulin resistance though these were not significantly different,” said the researchers. The research used a cross sectional analytic study, which recruited 83 adult subjects, aged 19 years old
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and above with established type 1 diabetes mellitus in the Philippine General Hospital (PGH). Mixed meal stimulated C-peptide level was done to confirm the diagnosis of type 1 diabetes mellitus. “The main outcome measure, insulin resistance, was determined using the validated clinical scoring, estimated glucose disposal rate (eGDR), with the following formula: eGDR=24.31 – (12.22xWaist-to-Hip ratio) – (3.29 x 1 of with hypertension or on anti-hypertensive or x 0if with no hypertension) – (0.57 xHbA1c). Patients with eGDR of ≤ 7.5 mg/kg/min were considered to have insulin resistance,” said the researchers. Increase in risk for cardiovascular complications in type 2 diabetes mellitus is affected by insulin resistance. “Recently, insulin resistance has also been shown to play a bigger role in the natural history of type 1 diabetes mellitus disease process than is commonly recognized. Given the clear association of insulin resistance and cardiovascular complications in diabetes patients, detecting the prevalence of insulin resistance in type 1 diabetes mellitus population will probably clarify the well-documented gaps in the management of this type of diabetes. ” The study aimed to determine the prevalence of insulin resistance among Filipino adults with established type 1 diabetes mellitus at the PGH. It also aimed to describe the clinical features of type 1 diabetes patients with insulin resistance compared to patients with insulin resistance. D
educatorscorner worldinhabit.com
How To Avoid Getting Sick While Traveling By Maria Jocelyn Capuli-Isidro, MD, FPCP, FPSEM
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raveling makes a person wiser. It provides wonderful learning experiences that can last a lifetime. However, this becomes a great challenge to persons with diabetes. Some of them feel so deprived of this opportunity to enjoy life’s adventures. Can we allow diabetic individuals to travel abroad? The answer to this question is a big YES! Definitely, diabetes should not prevent you from traveling and exploring a new horizon. It only requires very intricate planning and preparation. Like any other traveller, diabetics are exposed to a number of illnesses during traveling. These include upper respiratory tract infection, diarrhea, headaches, allergies, sunburn, dizziness, and many more. The following are a few steps on how to prevent illness while traveling abroad. A. Plan ahead - If you’re going abroad, make your itinerary way ahead of time. Know the weather of the city or the country that you are visiting and make sure that you bring the appropriate attire. Check on the need to get a vaccination and if there’s a need for vaccination, get it at least one month before your scheduled departure in order to observe for possible unwanted effects. Before traveling, always get a travel insurance. It does not only protect you but it also protects your properties particularly your luggage. Make early arrangements with the airline regarding your specified diet onboard. Get an identification bracelet indicating that you have diabetes. It is also worth mentioning whether you are an insulin user or not. B. Visit your doctor - Ask permission from your healthcare provider before
proceeding with your trip. Show your timeline and itinerary. Inquire regarding medications, precautions for the “highs and lows “ of your blood sugar and how to carefully manage them if they go haywire. Request for a prescription for all your medicines that will last throughout your trip. A certification must be issued to allow you to carry your medications, glucose meter, lancets, and particularly insulin. If possible try to ask for the number of your doctor in cases of emergency. C. Pack your things properly- Pack your things days before your departure. Make a checklist of the things to be brought during your travel. Arrange your medicines in a pillbox and put labels on the medicines including their indications. Include in the list of medications some cold and fever remedies, pain reliever, anti-allergy, anti-diarrhea, anti-dizziness among others. Other things to be packed include comfortable walking shoes, sunblock, insect repellant, small umbrella, cookies or candies in cases of hypoglycemia. D. Control the “lows and highs” of blood sugars- If you’re not feeling well, check your sugars more frequently. If you are on insulin, make sure that you continue it even when you’re sick. Remember the guidelines given to you by your physician on insulin adjustment during illness. However, watch out for high blood sugars also. Control your “highs” using rapid and short acting insulin if you are familiar with its use and consult a physician right away.
time. Avoid eating in buffets where you cannot resist eating beyond your specified diet. To avoid having diarrhea, stay away from eating in food stands in the streets where sanitary requirements for food preparation are sometimes not properly met. Always bring along a bottle of mineral water wherever you go to prevent dehydration. F. How to carry and store insulin during travel- Insulin must be stored properly during travel. Extremes of temperatures can lose its potency. When traveling in a hot temperature, put your insulin in insulated bag with a bag of ice. Make sure that the insulin does not get in close contact with the ice. When traveling to a cold environment, put your insulin in an insulated bag or thermos. G. Avoid alcohol during travel- Alcohol intake should be limited in people with diabetes. This can predispose them to develop alcoholic fatty liver disease. During travel, diabetics are predisposed to hypoglycemia if they take excessive amounts of alcohol without eating carbohydrates while drinking. Alcohol drinking should be limited to just one to two glasses per day. These aformentioned tips allow diabetic patients to travel safely and enjoy the pleasures of traveling. These prove that even with diabetes, you can enjoy a normal life. “Diabetics! All your bags are packed, are you ready to go”? D
E. Your food selection during travelContact your travel agent or your trip organizer regarding your diet ahead of APRIL 2013-MAY 2013
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Q: &A:
Is there a link between su n exposure a nd diabetes?
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es, apparently so. Low sunlight exposure has been associated with higher risk of developing diabetes, whereas more sunlight seems to reduce diabetes risk. A 2010 Swedish study in 1000 women followed for an average of 11 years found that those who with active sun exposure habits had a 30 percent lower risk of having diabetes compared to those with non-active habits. What could possibly explain this? Two ways by which sun exposure may reduce diabetes risk are through the beneficial effects of: 1) adequate vitamin D levels; 2) limited ultraviolet radiation (UVR).
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youaskweanswer Vitamin D to defeat diabetes? Vitamin D is more known for its effects on calcium balance and bone health. However, several studies have suggested that either low vitamin D levels or low vitamin D intake may also predispose to the development of both type 1 and type 2 diabetes. Some studies even imply that vitamin D given to pregnant mothers and infants may protect against type 1 diabetes in childhood. It turns out vitamin D receptors are present all over the human body—even in the pancreas which produces insulin. The active form of vitamin D has also been shown to reduce inflammation by lowering lymphocyte proliferation and cytokine production, both implicated in the destruction of the insulin-producing cells of the pancreas in type 1 diabetes. In type 2 diabetes and prediabetes, vitamin D allows the body to release more insulin and may improve insulin effectivity. Sources of the sunshine vitamin The Institute of Medicine recommends a total daily intake of 600 IU of vitamin D from the age of one through 70 years and 800 IU for those over age 70. But how do we get vitamin D? We can get it in three ways through: 1) skin exposure to sunlight; 2) food; 3) vitamin D supplements. Since only a few foods naturally contain vitamin D, sunlight exposure becomes the primary source of vitamin D for many people. The amount of sun exposure needed to synthesize 1000 IU of vitamin D, however, varies with time of day, season, location in relation to the equator, cloud cover, smog, skin pigmentation, clothing and sunscreen application. Dietary sources of vitamin D include cod liver oil (1 tbsp = 1,360 IU), oily fish such as salmon (3 oz = 794 IU)
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blog.bestvacationsever.com
and mackerel (3 oz = 388 IU) as well as fortified milk or juice (8oz = 100 IU). People with diabetes also tend to have lower vitamin D levels, particularly those with chronic kidney disease. Low vitamin D levels have also been linked to heightened risk for clogged arteries and heart disease in those with diabetes. Ultraviolet radiation: Good or bad? Sun exposure is certainly a tricky issue. Over- and underexposure to UVR can cause problems. Too much sunlight or UVR can lead to sunburn, skin cancer, cataracts, eye tumors, skin wrinkling, skin aging and immune system suppression which can in turn cause reactivation of latent viral infections. However, UVR may also have beneficial effects beyond vitamin D involving several mechanisms in modulating immune function. Effects of too little UVR exposure are indeed less clear but may include predisposition to cancer, diabetes, autoimmune disorders (such as multiple sclerosis and rheumatoid arthritis), as well as bone diseases related to vitamin D insufficiency (rickets, osteomalacia and osteoporosis).
But how much UVR exposure is safe and adequate for disease prevention is still a matter of debate. Sun avoidance advocates promote generous sunscreen application, sunprotective clothing and accessories (e.g., sunglasses, hats), evading the sun between the hours of 10 a.m. and 3 p.m. as well as boycotting tanning beds.They recommend getting vitamin D from supplements instead of the sun. Others, on the other hand, wish to liberalize these policies and endorse five to 10 minutes of sunshine to the arms, legs or back at least twice a week around noon without sunscreen to get the non-vitamin-D-related benefits of UV rays. If you have tan skin by nature, you have some solar protection. Melanin skin pigment is great natural sunscreen, and dark skin can cut UV-mediated production of skin vitamin D by as much as 99 percent (much like putting on sunscreen with a sun protection factor of 15). People who don’t have the protection of melanin such as those with vitiligo or albinism should be cautious though about sun exposure. So, please live well. A healthy diet, exercise and a bit of sunshine everyday just might keep diabetes away. D
Joy Arabelle C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM Past President, American Association of Clinical Endocrinologists Philippine Chapter; Head, Nutrition Committee; Executive Officer, Diabetes Center and Weight Management Program, Asian Hospital; Active Consultant, St. Luke’s Medical Center-Global City; Training Co-Chair, Diabetes Center Philippines; Board Director, Diabetes Philippines; Diplomate, American Boards of Internal Medicine, Endocrinology, Diabetes and Metabolism
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fightin’forfitness
Water Survival & Swimming Tips By Coach Erlinda “Dang” Amparo
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ne way to survive during moments of natural calamities and disasters (such as floods and water accidents) is to know how to swim. I strongly believe that swimming should be taught to people of any age not only for survival but also for total body exercise and superior body conditioning. This water sport is a very rewarding activity and, at the same time, an enjoyable form of recreation and socialization. Many Filipino families enjoy going to beaches, resorts, and swimming pools during summer. This is one of the reasons why I want to give you tips on this kind of water sports activity to enable you to enjoy life and equip you
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with some survival skills that you can use. Water survival is the ability of a person to stay alive in or on water, in shallow or in deep water, in the bathtub at home or out in the open at sea. Here are some of the tips for water survival:
slip out of an oversized device, and an undersized one will not provide enough buoyant support for a big individual.
Presence of mind. Do not panic. It is easier to float in salt water than in a pool. All you have to do is to lie on your back as if you are lying down on a water bed.
Use of hand signals. In case you are out in the open and are immersed in water, and you feel like you can’t move or you’re about to drown, keep your body up and bring your hands up for help.
Personal floating device. Make sure that the device is appropriately sized for the person concerned. A child may
Disrobing. Clothes are, oftentimes, a hindrance for flotation. Removal of shoes and outer clothing may reduce the weight.
Breathing is essential for life. To enable you to stay longer in the water,
fightin’forfitness
reachforthewall.com
hold your breath a little longer. Try to bring yourself up to the surface of the water to get air and breathe. For those who want to know the basics in swimming, here they are: Survival floating The first phase of survival floating is a “resting position” face down. Allow your body to float in the water with your knees tucked into the chest. Relax and try to hold your breath while in this position. Next is “inhaling position”. Do a swimming motion with your arms. Your head should reach the surface of the water for you to inhale. For the third phase, after breathing comfortably for a few minutes, inhale deeply, and return to the resting position. Water treading Water treading is a skill that involves the swimmer staying in a vertical position in the water while keeping the head above the surface of the water. Treading water
provides the swimmer with the opportunity to keep the head from submerging while not providing sufficient directional thrust to overcome momentum and propel the swimmer in any specific direction. Dog paddle The dog paddle is like the combination of water treading and survival floating except the body is more in a horizontal position and should be moving forward. In simple words, it is swimming like a dog.
Back floating The back floating is performed by lying on your back with both feet relaxed, slightly apart, and both arms at the side. Slightly move the arms and hands alternately upward and downward while remaining under water as in sculling or the figure of eight (8). Swimming is fun! Learn it and live with it! D
Erlinda Garcia- Amparo Coach Amparo is currently the swimming coach of Miriam College. She is also the head teacher for MAPEH (Music, Arts, PE, Health), at the Holy Spirit National High School, Quezon City. She is also a member of the Philippine Air Force Search and Rescue Auxiliary Group and former paddler for the Philippine Dragon Boat Rowing Team.
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righteousrecipes
Easy-to-Pack
Dishes
Recipes by Chef Junjun De Guzman Text by Ma. Cristina Arayata Photos by Jose Martin Punzalan
Our resident chef, Chef Junjun shares with us three easy-to-pack dishes. Whether you are still on vacation mode or preparing to go back to school, these dishes are really a must-try.
Smoked Turkey Pita Pocket For 5-6 Persons Prep Time 20 Minutes Cooking Time 5 Minutes Ingredients: 6 pcs 250 gms 8–10 slices 1 pc 150 gms
Nutrition facts per serving: 236.33 calories 14.03g protein 41.55g carbohydrates 3.42g fat
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whole wheat pita bread, heated sliced smoked turkey salad tomatoes cucumber, cut into sticks salad greens, washed and spun dry
Procedure: After whole wheat pita bread is heated, it will puff up. Cool and cut into two. Insert sliced turkey, salad tomatoes, cucumber and lettuce into each pocket. Do this to the rest of the pita pockets. Wrap and keep chilled for later eating.
righteousrecipes Roasted Vegetable Pasta Salad For 3-4 Persons Prep Time 30 Minutes Cooking Time 12 Minutes Ingredients: 1 pc whole garlic, cloves removed 1 pc red bell peppers, sliced 2 pcs egg plant, sliced into rounds 1 pc zucchini, sliced into rounds Salt Freshly ground pepper Extra virgin olive oil 300 gms whole wheat penne pasta, cooked al dente 8 pcs basil leaves, chiffonade
Procedure: Lay all sliced vegetables and garlic on a tray. Season with salt and pepper. Drizzle with olive oil and bake for 15 minutes. When vegetables and garlic are cooked. Add this into the pasta and toss well. Add in basil leaves and serve.
Nutrition facts per serving: 319.87 calories 12.03g protein 64.27g carbohydrates 11.93g fat
Boiled Carrots with Calamansi Juice For 3-4 Persons Prep Time 10 Mins Cooking Time: 2 Minutes Ingredients: 3 pcs carrots, washed, peeled and cut into sticks 2 tbsps calamansi juice Pinch salt Pinch ground pepper
Procedure: Put carrot sticks in a bowl. Season with salt and pepper. Let stand for a few minutes. Toss in calamansi juice and mix well. Chill and pack. Best eaten when chilled.
Nutrition facts per serving: 14 calories 0g protein 3g carbohydrates 0g fat
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G
feature
travelling!
By Jose Martin Punzalan
I
ts summertime once again and many people are surely looking forward to their annual trip out of town. This is the season to partake in a little R&R, eat some sumptuous cuisine, and bask in the pleasure of being away from work. For people with diabetes, however, this moment of indulgence might come with a tinge of worry. With such a condition, taking a vacation becomes a little more complicated. There is always the nagging thought that too much of a good thing might lead to the next hyper- or hypoglycemic attack. That glass of mango juice, or sunbathing too long under the sun might aggravate their diabetes, putting a quick end to their trip. Not to worry though. There are several travel destinations where you can have fun and enjoy, while doing the recommended amount of physical activity and exercise to keep your condition at bay. Climb Mt. Pulag in Benguet
Mt. Pulag may be the highest peak in Luzon and the second highest in the whole Philippines, but that should not intimidate you from attempting to conquer it. It offers various trails leading up to its peak, with varying levels of difficulty that will challenge and excite anyone from novice to veteran mountaineers. Just remember to bring thick clothes and other things that’ll keep you warm (along with your diabetes essentials of course) as it can get awfully cold up there. Do get your doctor’s go signal though, before you start your trek. Pedal through Cebu Not only is biking healthy, it’s also environment-friendly. It could be the best way to explore the land as you won’t have to worry about parking,
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security, or gas. Moalboal in Cebu, in particular, is popular among biking newbies and enthusiasts alike for its endless trails and dirt roads that go along with a picturesque countryside view. Casual riders can do a family day trip to Olango Island Bird Sanctuary or through the long asphalted road called “Vegetable Highway,” which connects the towns Carcar, Barili, and Sibonga. More experienced trail biking enthusiasts will have a blast in the mountain barangay of Guba, or at the foot of Mt. Manunggal. Here, the steep incline of the mountain slope makes it a perfect challenge for four-wheel drive vehicles. Paddle and swim across Palawan No travel adventure in the Philippines is complete without experiencing its
majestic marine wonders, the most popular of which are in Palawan. One of the best ways for casual travelers to enjoy this is through kayaking or snorkeling in its pristine waters. Paddle your way to the coves of Coron Island, or to the shores of El Nido. Exhaustion would be the last thing on your mind as you’d be too busy being overwhelmed by the beauty of the place. Be one with the butanding in Donsol SCUBA diving with diabetes used to be a contested issue, but the activity is now allowed provided that the condition is well-controlled, the patient is aware of the risks, and has taken all necessary precautions for it. One good thing about diving for a person with diabetes is that it serves as motivation to manage the condition, in preparation for the actual dive.
feature
One unique diving attraction here in the Philippines is Donsol, Sorsogon where you can experience being in the presence of the gigantic whale sharks a.k.a. the butanding. Some other renowned dive spots in the country include: Anilao and Nasugbu, Batangas; Puerto Princesa, Palawan; Puerto Galera, Mindoro; and Boracay, Aklan. Note that there now are recreational diving tours that do not require a diving license or any prior training or experience in diving. Get wiped out by the waves of Baler, Aurora First, you paddle your way into the sea where you wait to catch some waves.
O n c e you do, you have to balance yourself on the surfboard and control it so that the waves won’t swallow you whole. This is what surfing is all about. It is an exhilarating and enjoyable activity that can also be a good way to get your muscles burning. For beginners who want to experience the adrenaline rush of riding a wave, Sabang Beach in Baler, Aurora offers itself as a great venue for casual and educational surfing. It’s waves are described as “beginner-friendly”.
Its sea bottom is composed of soft sand instead of scratchy rocks and coral reefs – perfect for newbies. No diabetic person should ever be left out from the fun of travelling. And with these travel destinations, one can enjoy oneself while making sure to stay in tiptop shape, too. D
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feature
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goodfoodguide bonsecoursweightloss.com
e v o M d o o h t l a eggie G e H d o o for G
V S
By Joan Sumpio
ome people embrace vegetarianism either for religious goals and commitments, or for health improvement purposes. Obviously, the latter reason raises more eyebrows in terms of how long one can maintain that dietary regimen and how far one can really enjoy eating. When labelled as a vegetarian, there can be a lot of differences in food restrictions: Those who totally forego all forms of animal food are called strict vegans; those who allow themselves to have fish are called pesco-vegetarians; people who take the liberty to add egg in their meat-free diet are called ovo-vegetarians; and those who gratify themselves with egg and milk are labelled as lacto-ovo-vegetarians. Up to now, not too many people have fully acknowledged that a vegetarian diet can still be quite dense in nutrients as the typical diet that includes animal meat. Below are examples of a vegetarian menu that can still help provide 21 nutrients per serving, without having (the-less-favored) meat.
Menu 1 Breakfast
Lunch
Dinner
Menu 2
• 2 slices of bread • 1 tablespoon of peanut butter • 1 medium slice of papaya
• 2 slices of bread • Coleslaw bread-fill (mix thinly sliced carrots, cabbage, raisins and ¼ cup yogurt) • 1 piece banana
• ½ cup of rice • Sautéed sayote with corn kernel and shiitake mushroom • 1 slice of ripe mango
• ½ cup rice • Crunchy eggplant salad (boil eggplant, mash and mix with onion, 1 tsp vinegar, 1 tsp sugar and top with ground peanuts) • 2 pieces peach halves
• ½ cup of rice • ½ cup steamed Japanese Tofu Steak with chopped boiled spinach • 10 pieces small grapes
• ½ cup rice • Sautéed monggo beans • Crispy breaded spinach omnivore-almostveg.blogspot.com
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indepth
JET LAG
Diabetes By Marie Yvette Rosales-Amante, MD
J
et lag refers to disturbed sleep patterns, weakness, and disorientation caused by traveling. It happens when our normal body clock is disrupted by traveling through several time zones. Our body clock is primed to respond to a regular rhythm of daylight and darkness. It is thrown out of sync when it experiences daylight at what it considers the wrong time, and it can take several days to readjust. When traveling across a number of time zones, the body clock will be out of synchronization with the destination time, as it experiences daylight and darkness contrary to the rhythms to which it has grown accustomed. The body’s natural pattern is upset, as the rhythms that dictate times for eating, sleeping, hormone regulation and body temperature variations no longer correspond to the environment nor to each other in some cases. To the degree that the body cannot immediately realign these rhythms, it is called jet lag. The condition is not linked to the length of flight, but to the trans-meridian (west–east) distance traveled. For example, a 10 hour flight from Europe to Southern Africa does not cause jet lag, as travel is primarily north–south. A five-hour flight from the east
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to the west coast of the United States may possibly result in jet lag. The symptoms of jet lag can be quite varied, depending on the amount of time zone alteration, time of day, and the susceptibility of individual differences. Sleep disturbance occurs, with poor sleep upon arrival, sleep disruption including trouble falling asleep (if flying east), early awakening (if flying west), and interrupted sleep with multiple awakenings and trouble remaining asleep. Cognitive effects include poorer performance on mental tasks and concentration, increased fatigue, headaches, and irritability, and problems with digestion including indigestion, changes in the frequency of defecation and consistency of feces and reduced interest in and enjoyment of food. Symptoms are caused by a circadian rhythm that is out of sync with the day-night cycle of the destination. The Sugar Connection Levels of both insulin and the counter-regulatory hormones (hormones which work against the action of insulin), are influenced by a circadian rhythm. The counter-regulatory hormones, which include glucagon, epinephrine (also known as adrenaline), growth hormone, and cortisol, raise blood glucose
indepth levels when needed. In the middle of the night, there is a surge in the amount of growth hormone the body releases, followed by a surge in cortisol, which increases blood glucose production by the liver. In people who don’t have diabetes, these processes are offset by increased insulin secretion by the pancreas, so blood glucose levels remain relatively stable. However, in people with type 1 diabetes, whose pancreases don’t make insulin, and in people with type 2 diabetes, whose livers may not respond to insulin well enough to stop glucose production, changes in blood glucose levels during sleep can have a powerful effect on morning blood glucose levels. Blood glucose levels typically rise between 4 a.m. and 8 a.m., an event dubbed the “dawn phenomenon.” Certain conditions called circadian rhythm disorders can disrupt a person’s wake-sleep cycle. Jet lag is one of these disorders, among others such as shift-work disorder and delayed sleep disorder (in which people sleep and wake up very late). Research findings suggest that not getting enough sleep or having poor quality of sleep can disrupt blood glucose control in people with diabetes. For patients with diabetes, it has been proven that circadian misalignment can significantly increase two-hour postmeal glucose and insulin levels. In other words, patients with diabetes may experience higher levels of blood sugar during episodes of time change or sleep disruption. On the other hand, hypoglycemia may pose a serious risk for those who tend to skip meals during and immediately after a long flight. Therefore, travelers who take medication according to a strict timetable (such as insulin or oral hypoglycemic medications) should seek medical advice and coordinate well with a health professional before their journey. Checking blood glucose more often or measures towards extra vigilance may eliminate these risks. Can jet lag cause diabetes? Yes, according to a new survey, constant jet lag may trigger obesity and diabetes. Twenty one men and women volunteered for a Harvard Medical School study, which controlled how and when they slept, ate, and exercised for five weeks. Participants first started with 10 hours of sleep each day, which was then gradually reduced. Over time, they were also asked to sleep and wake up later to mimic change in time zones. Eventually, the participants were sleeping during the day and awake at night. Researchers had effectively simulated both working in shifts and frequent time zone changes. Tests confirmed the worrying hypothesis. Over the five weeks, participants’ metabolic rates fell 8 percent. Over a year, this metabolic slowdown could mean a four kilo weight gain if diet and exercise habits remain the same. There was another fallout. The reversed sleep cycle (sleeping during the day) and reduced sleep time also hit insulin levels. After three weeks, participants produced about a third less insulin in response to meals. Blood glucose levels rose sufficiently to diagnose the participants to have
pre-diabetes. A study done in rats similarly confirmed that the disruption of the circadian rhythm may increase the risk of T2DM by accelerating the loss of beta-cell function and mass in the pancreas. Managing jet lag Light is the strongest stimulus for re-aligning a person’s sleep-wake schedule and the careful control over exposure and avoidance of bright lights can speed adjustment to a new time zone. Natural light may help in restoring routine. Timing of exercise and food consumption have also been suggested, though their applicability in humans and practicality for most travelers are not yet certain and no firm guidelines exist. There is very little data supporting the use of diet to adjust to jet lag. Proper hydration during travel, though, will always be beneficial. While there is data supporting the use of exercise, it is hard to determine if the exercise is responsible, or the accompanying exposure to sunlight, and that the intensity of exercise necessary is not yet certain. Use of these strategies can occur both before departure and after landing. Individuals may also differ in their susceptibility to jet lag and ability to quickly adjust to new sleepwake schedules. Short-acting sleep medications can be used to improve sleep quality and timing, and stimulants can be used to promote wakefulness. Among the stimulants, only caffeine may be readily available to the general public. For time changes of less than three hours, jet lag is unlikely to be a concern, and if travel is for short periods (three days or less) retaining a “home schedule” may be better for most people. Sleeping on the plane is only advised if it is the destination’s normal sleep time. Short naps, however, will always be helpful in restoring energy. Conclusion Frequent episodes of jet lag may worsen sugar control in those with diabetes, and trigger diabetes in those who do not have it yet. Jet lag is therefore best avoided, or at best its severity diminished through individualized measures that help re-align the sleep-wake routine. D
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indepth
Traveling with Insulin The World is a book, and those who do not travel read only a page. ~St. Augustine By Jimmy B. Aragon, M.D.
P
eople travel for various reasons. For diabetic patients, the challenge is to bring all the necessary medicines, take them on time and still have fun. But for people who need insulin shots, how does one go about it? Here are some tips: Preparing for travel Always tell your doctor that you will be travelling. Ideally, your blood glucose levels should be stable before embarking that plane ride. Your doctor may ask for lab tests to confirm this. Basic tests like FBS, HBA1c, CBC, BUN, and creatinine may be requested. Alert your doctor if you have complications like heart disease or stroke, especially if they are recent events. If your complications are stable, permission is usually granted. A lung problem like COPD may need a clearance from a pulmonologist to assess oxygen requirements. Flu or pneumonia vaccine may be recommended. Bring more than enough worth of medicines and insulin. Twice the expected amount needed is a good number, in case you need to extend your trip or if you get stranded. Bring a list of your medicines including generic and trade names, in case you need to buy extra. Carry your medicines with you, because checked-in baggage may get lost. Don’t forget your glucose meters and strips to check your sugars more often until you settle into a routine. Again, bring double the expected strip usage. Plan also for syringe and lancet disposal, this can be a small plastic cup or you can check out airport restrooms that may have sharps containers. DIET AND EXERCISE Unfortunately, diabetes doesn’t go on vacation even when you are on vacation, so plan for diet and exercise. Ask your airline if they can provide special meals. Ask your doctor if you need extra insulin, especially during long flights or when you
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www.shesugar.com
take extra food during stopovers. If you will sit for a long time, try to stand every hour to allow blood to circulate well. If you are expecting to walk a lot on your trip, bring the necessary things to keep hydrated. A handy container for fluids, proper clothing and a good pair of shoes are some of the necessary things. INSULIN HANDLING Travelling is no reason to stop insulin, but it should be handled properly. Room temperature is usually sufficient. If temperature will vary during travel, a storage container designed to keep insulin at room temperature (about 25°C) is needed. If you are using vials, use them within 28 days after opening whether refrigerated or not. Pre-filled pens do not need
indepth to be refrigerated and are used within 28 days after opening. Premixed analogues (like Humalog Mix 25 and Novomix) may need 14 days or less. Check the labels for this. Adjust insulin dose when travelling east across six or more time zones (usually to the USA). If you are on once daily insulin, inject the usual dose at the usual time on the day of departure. The first morning at the destination, just before breakfast of local time, inject 2/3 of the usual morning dose of NPH (Humulin N or Insulatard). This reduced dose is designed to prevent hypoglycaemia during the day. On the evening of the first day, inject the remaining 1/3 of the usual morning dose only if the blood glucose is elevated (arbitrary value of >240 mg percent). If there is regular (Humulin R, Actrapid) or rapid acting analogue (Humalog, Novorapid, Apidra), these are still taken together with meals. If you are on twice daily injection, follow the same instructions. Inject the usual evening dose on arrival, but if the blood glucose is > 240 mg percent, you should add to your evening dose the one-third of the morning dose of NPH that was omitted. If you are taking extra meals, additional regular or rapid analogue may be needed. If you are taking a basal analogue insulin (Lantus, Levemir) and a rapid acting analogue during meals (called basal-bolus regimen), you might need to add or subtract the basal insulin dose if the time change will add three or more hours of your day, respectively. Some doctors may opt to shift you to a basal bolus regimen during travel as well, as this is simpler to follow but might require three or more injections. Preventing hypoglycemia and hyperglycemia Hypoglycemia remains a problem during travel. Remember that extra activity or delayed meals can precipitate hypoglycaemia. Prepare for this by carrying medicines or food to counter hypoglycaemia. This can be glucose tablets, 4 ounces of regular soda or fruit juice or three to five pieces of hard candy. If you are travelling with a group, alert the other members in case of emergencies when you need to be brought to an emergency room. If you are travelling alone, a diabetes bracelet or a card in your wallet should be carried at all times. In case of hyperglycemia, ask your doctor in advance how much regular or rapid acting analogue you should inject. Check your blood glucose hourly until the results fall back into target range. Needless to say, avoid eating too much (especially eat– all- you-can restaurants!) and don’t miss your medication. If you get too sick, keep hydrated and know the area where you can seek professional help. A health insurance is a must if you are travelling abroad. With these tips in mind, I hope you will be able to make your next trip enjoyable and worthy without sacrificing the good control of your diabetes. Happy trip! D
Have Diabetes, Will Travel By Emil Dela Cruz Does having diabetes mean automatically giving up on your wanderlust? Not necessarily. Though diabetes can make travelling a bit difficult, it doesn’t mean you’ll have to forego the idea completely. With the right amount of preparation and vigilance, one can still enjoy the perks of travelling, without suffering from the consequences of their condition. DiabetEASE teaches you how. Preparing for the trip: Insulin Galore. If you are dependent on insulin treatment and you think you might need to use it during the trip, here are some things you’ll need to prepare in advance: • If you are travelling via air, check with the airlines regarding their security guidelines. Some airlines have specific rules on insulin usage • Ask for a doctor’s note which confirms your condition. You might need to present this to Customs. Make sure that the letter “clearly” states that you need the insulin with you at all times (print lots of copies of this letter) • Label all your insulin, just to be on the safe side • Don’t forget to but enough syringes, pen needles, test strips, and meters to supplement the insulin • Try to secure travel insurance for you and your belongings • Discuss your travel plans to a doctor or a certified Diabetes Educator. This will help you know what time zone adjustments to consider, or if there are other medicines you’ll need to take, apart from insulin Geared to Go. Apart from the insulin, you may also need to prepare other non-medical items that will keep hypo- or hyperglycaemia at bay: • Invest in a good pair of shoes that is comfortable on your feet. Chances are you will be walking a lot during your trip, which increases the risk of blisters and other foot injuries. If you are diabetic, then you know that won’t be a simple wound • Buy lots of health bars or other treats to stave off hypoglycaemia and keep your blood in the ideal level • Pack a lot of easy-to-seal ziplock bags for your insulin, to keep them dry and sealed • A first-aid kit will come in handy in case of minor cuts or blisters Travelling via Air Smart Packer. After making it through countless metal detectors and baggage checks, it’s now time to board the plane. The flight will be long, with plenty of opportunities for diabetes to strike. If you are well-prepared, then you’ve got nothing to worry about: • Carry your medication (insulin, testing equipment, etc.) in your carry-on luggage. Make sure to split it between your carry-on and your check-in luggage, so in case one is accidentally lost, you’ll still have enough supplies to last • If you have a copy of a medical note or a certification, keep it close to you (preferably in your carry-on) for easy access, in case someone needs to verify it • Wait until the in-flight meal is already in your table before taking your insulin. You may also administer it halfway through the meal, or immediately after eating • Drink lots of water to avoid dehydration. Pass the alcohol, for now • If your feet are getting too tired, you may opt to take them off. It is recommended that you take a walk in the cabin to improve blood circulation and keep your blood in the ideal level • You may also try feet and leg exercises • If you have a sever condition, it might be wise to tell the stewardess about your condition With enough planning, any individual with diabetes will be able to travel without suffering from any vacation-ending diabetic episodes. Just don’t forget your insulin, medical kits, tablets, and of course, the souvenirs.
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indepth
Vaccines for the Diabetic Traveller By Salvador Abad Santos, M.D.
D
iabetic patients are more at risk for acquiring vaccine preventable diseases when travelling to certain areas. The choice of vaccine for any traveller is based on the risk of exposure to certain diseases, the severity of the disease if acquired (more serious in diabetic patients); and risk/ side effects of the vaccine. Vaccines that one would need when travelling to a developing country (except developed countries like the USA, Canada, Japan, Australia, New Zealand, Scandinavian countries and some European countries) are the following: Hepatitis A vaccine. This vaccine is given to non-immune travellers to countries with moderate to high risk of infection. Transmission is usually through intake of contaminated food or water. One dose of hepatitis A vaccine given at any time will provide adequate protection. A second dose of vaccine should be given six months after. Booster doses after completing the vaccine series is not needed. Hepatitis B vaccine. This is indicated for longer staying travellers who will be visiting high risk areas. Transmission is usually through sexual contact, blood transfusions, contaminated medical equipments, body piercing, tattooing, acupuncture; sharing of cooking and bathroom facilities. Three doses of vaccine is given and the first dose should be given two weeks before travelling. The second dose is given after 1 month and the third dose after six months. Booster doses are not required if antibody response has been documented. Typhoid vaccine. This is indicated for travellers going to the Indian subcontinent and to all other endemic countries. Transmission is through ingestion of contaminated water and
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diabeticmediterraneandiet.com
food. In high risk areas, food and water precautions should still be followed strictly despite receiving the vaccine since the effectivity of the vaccine is only 50 to 70 percent. Booster doses are given every three years if continued exposure is present. Influenza vaccine. This is transmitted year round in the tropic countries. This may be the most vaccine-preventable disease in travellers. Vaccine should be given yearly at least two weeks before travel. Pneumonia vaccine. this is recommended for travellers with underlying chronic medical conditions (like diabetes) This is given to provide protection against streptococcus pneumoniae which is the most common pathogen that causes communityacquired pneumonia. Booster doses should be given every five years. There are specific vaccines needed for travelling to certain areas. These vaccines are as follows: Yellow fever vaccine. This is transmitted by mosquitoes in endemic areas like certain areas in South America, and
indepth African countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Congo, Cote d’Ivoire, Gabon, Ghana, Liberia, Mali, Niger, Rwanda, Sao Tome, Serra Leone, Togo). These countries would require proof of vaccination before entry is permitted. The vaccine is valid for 10 years. It is not recommended to receive the vaccine in persons who are not at risk for the disease due to its rare but serious side effects. Meningococcal vaccine. This is recommended for travellers to the African subcontinent “meningitis belt� during the dry season months of December to June. Muslims going to Saudi Arabia to attend the Hajj and Umrah pilgrimages are at higher risk. Transmission is through close contact of infected persons (droplet transmission). This is a single dose vaccine that is good for 10 years. Rabies vaccine. This is a series of three vaccines recommended for persons travelling to Asia, Latin America, and Africa, where the threat of rabies remains constant and the availability of post exposure rabies immunoglobulin and vaccines are limited. Booster doses after completing the series of vaccine is not routine, but two doses after exposure is employed.
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areas between April to October. Tick precautions should be employed. The vaccine is available in endemic areas. It is a series of 3 vaccine with boosters needed after three years. All of the above vaccines can be given all at the same time prior to travel. All of the above are killed or inactivated vaccines except for the yellow fever vaccine which is a live vaccine. Adverse events are rare for inactivated vaccines, more commonly fever and pain at the injection site. Adverse event are more likely for live vaccines (yellow fever) such as allergies, utricaria and angioedema. Vaccines are relatively safe, effective and would markedly decrease the risk of acquiring these potentially serious diseases. D
Japanese encephalitis vaccine. This is a mosquito borne viral infection that is endemic in rural farming areas of South East Asia and Indian sub continent. Two doses are given one month apart. It is not known at present if booster doses are required. Polio vaccine. Because of good eradication efforts, this disease remains to be seen in only a few countries. Persons travelling to endemic areas and who have completed their childhood series of vaccine should receive one booster dose if the last vaccine given was at least 10 years ago. Cholera vaccine. This is transmitted through contaminated food and water. Vaccine is only recommended in persons/ health care workers going to refugee or disaster areas where the risk of cholera outbreak is high. This is given by mouth for two doses one week apart. Booster is given after two years. Tick borne encephalitis vaccine. This is a serious emerging viral infection of the central nervous system. This is endemic in focal areas of Germany through Scandinavia and the Baltic to Siberia and Vladivostok. Risk to travellers is low unless patient engages in prolonged outdoor activities in forested areas. Immunization is recommended for adventure travel, camping in forest and extensive outdoor activities in endemic
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specialadvertisingfeature
Eat Diabetes Away H
ealth experts have said it: nothing beats the importance of a proper diet. But in a fast-paced world where fast food abound, and with the pull of a sedentary lifestyle, can a proper diet still be attained? Yes, it can.
Last October, seven key diabetes societies launched the Philippine Diabetes Algorithm (PhilDNA) together with Glucerna. The PhilDNA is a finite list of steps that can incorporate diabetes-specific nutrition. Through the algorithm, it will help health experts treat and advise diabetes patients on how to manage their condition. Medical nutritional therapy has been proven to prevent diabetes, delay the complications brought by diabetes, and prevent morbidity among those in the early stages. Diabetes has become one of the fast-rising diseases in the country with 4.5 million Filipinos reported to have the condition. The condition may lead to cardiovascular disease, kidney failure, leg amputation, and even death. In a 2008 survey conducted by the Food and Nutrition Institute, it showed that 40 percent of Filipinos are taking their meals and snacks outside of their home, with rice and sugar as the top three food items consumed. Prevent diabetes by eating right. Skipping meals is definitely a big no. Cut down on sweets and starch and
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increase your intake of vegetables and selected fruits. Eat lean meat and fish. Also, don’t forget to take eight glasses of water, which helps in digestion during meals. Always carry healthy snacks with you in case hunger strikes. Diabetes nutrition formula drinks that lower blood sugar is an example of something you can tuck in your bag or bring in a thermos. Clinically-proven Diabetes Nutrition Glucerna Triple Care may just be the one that can boost your system. It is the number one doctor-recommended diabetes nutrition formula. Glucerna Triple Care is a unique combination of key ingredients, which help patients manage blood sugar, support heart health, and control weight management. By drinking one to three glasses depending on your needs, you are assured that you get only the best results in managing your blood sugar, heart health, and weight. Don’t let diabetes control you. Fight back by eating right, and taking a glass of Glucerna Triple Care for healthy living.
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productspotlight
Sugar-Free Treats
healthkart.com
By Mylene C. Orillo
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hen we think of a person with diabetes, one thing comes to mind: someone who must limit sugar intake regularly. These days, however, a lot of supermarkets sell a variety of sugar-free cookies made for diabetic people,to satisfy their palates without jeopardizing their health. Sugar-free chocolates, biscuits, or cookies are welcome treats for people with diabetes. These may be healthier than regular cookies, instead of sugar they have substitute sweeteners that make them sugar-free. Some products are made with maltitol, a sugar alcohol, which is part of a family of sugar substitutes that includes mannitol, xylitol, isomalt, and sorbitol. Accordingly, it is good because only a part of maltitol is digested and absorbed into the system.
Murray Sugar Free® It is America’s #1 brand of sugar-free cookies. In 1994, its master bakers cleverly eliminated sugar from their recipes, which paved the way for their first sugarfree cookie. They make great tasting cookies that fit your desire for a sugar-free lifestyle.
Nutrition Facts
Serv. Size 3 Cookies (32g) Servings About 5 Calories 160 Calories form fat
80
Amount/Serving %DV*
Total Fat 9g 14% Saturated Fat 3.5g 18% Trans Fat 0g Cholesterol less than 5mg 1% Sodium 130mg 5% Total Carbohydrate 20g 7% Dietary fiber 1g 4% Sugar 0g Sugar Alcohol 7g Protein 2g Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 6%
Finding quality products can take a lot of effort with brands promising you the moon and more. Thus, we at DiabetEASE have come up with a list of these popular sugar-free products being sold in the Nutrition market today.(Have your doc/dietitian approve it Facts ycchocolate.com before partaking of it. Sugar-free does not mean Serv. Size (42g) Serv. Per Cont. 2 calorie-free or fat-free.– Ed.) Coco Polo/ Yamata Chocolatier (YC) Calories 220 Chocolate Calories form fat 160 For chocolate lovers, taste is everything. This is Amount/Serving %DV* an all natural sugar-free, gluten-free, trans fatsTotal Fat 18g 27% Saturated Fat 11g 54% free chocolate. These sugar-free confections Cholesterol 5mg 1% are created without artificial colorings, flavors, Sodium 0mg 1% Potassium 85mg 2% preservatives, or sweeteners to match (or even Total Carbohydrate 20g 7% exceed) the finest sugar-sweetened chocolates Fiber 2g 10% in taste and texture. Sugar 0g Maltitol 16g Protein 3g Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 6%
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productspotlight
Nutrition Facts
Serv. Size 5 pieces (40g) Calories 190 Calories form fat
140
Amount/Serving %DV* Total Fat 15g 23% Saturated Fat 9g 45% Trans Fat Cholesterol 5mg 2% Sodium Potassium Total Carbohydrate 23g 8% Dietary fiber 3g 12% Sugar 0g Sugar Alcohol Protein 2g Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 4%
ch oc op er fe cti on .co m
consmr.com
HERSHEY’S Sugar-Free Chocolate Chips These are sweetened with sugar alcohols. Sugar alcohols (or polyols), such as xylitol, mannitol, sorbitol, erythritol, and lactitol, contain some calories and increase blood sugar levels to varying degrees. On average, they provide half the calories of sugar and other carbohydrates. So these products are moderately lower in calories (by about 20 percent) and similar in fat content to the original versions. Take note that sugar alcohols are neither a sugar nor an alcohol. They are called “sugar alcohols” because part of its chemical structure resembles sugar and part resembles alcohol. Sugar alcohols occur naturally in foods and are found in plant products, such as fruits and berries.
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ChocoPerfection It is a gourmet European chocolate that has all the beneficial antioxidants of chocolate. It is all natural, 100 percent sugar-free. It has 14 grams of prebiotic fiber in every bar which reduces sugar craving. It has a saturated fat from stearic acid in the cocoa plant, which has been proven to either lower cholesterol or have no effect on cholesterol at all, and butter oil.
Nutrition Facts
Serv. Size 1 bar Servings Per Bar: Calories
(50g) 1 197
Amount/Serving %DV*
Total Fat 18g 28% Saturated Fat 11g 55% Trans Fat 0g 0% Cholesterol 0mg 0% Sodium 0mg Total Carbohydrate 16g 5% Dietary fiber 14g 56% Sugar 0g Protein 1g Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 17%
Amberlyn Sugar-Free Belgian Chocolate Its sugar-free chocolate candy is made with the finest ingredients and their products are all natural. It uses maltitol, a natural sweetener that is safe for people with diabetes and for those who wants to avoid gluten. They’re also developing a new sugar-free formula that will be better than their current maltitolbased chocolate.
Nutrition Facts
Serv. Size 1 bar Calories Calories form fat
(34g) 170 110
Amount/Serving %DV*
Total Fat 12g 18% Saturated Fat 8g 40% Trans Fat 0g Cholesterol 0mg 0% Sodium 25mg 1% Total Carbohydrate 19g 6% Dietary fiber 2g 8% Sugar 0g Maltitol 15g Protein 2g Vitamin A 0% • Vitamin C 0% Calcium 1% • Iron 5%
Still having a hard time choosing the best chocolate? Let your taste buds do the rest of the work! But remember, there’s still such a thing as “eating in moderation”. D
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stressbuster
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stressbuster
www.softpedia.com
On vacation from/with Diabetes A guide to a stress-free holiday with the family
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By Michaela Sarah De Leon
ired of the old rum-tum-tumble vacation? Play your cards right with this checklist for fun family time on vacation!
This guide is meant to create a hassle-free vacation. Read on to find out how:
Pre-Vacation
The Vacation
Post Vacation
1. Choose a destination and save. Months ahead of your family trip, choose a place you and your family want to go to. Is it within the country or outside? A family vacation costs money too. Make the destination a goal that you have to save up too. Remember that the memories of the trip may last a lifetime but it also costs tons of money.
1. Visit off-beaten roads. Now that you’re prepared for the road, drive off from the super highway and try off-beaten roads. It may take more time, but you’ll see more scenery and get more eccentric experiences.
1. Unpack right. Vacation is over and you and your family are sure to be too tired after the trip. It may be tempting to just dump your luggage wherever and go to bed directly but consider how much work will be done tomorrow if you neglect it today. Your meds could get stale and your souvenirs and pasalubongs could go bad.
2. Get a medical certificate. Before you go, make sure you’ve been cleared by your doctor, especially if you plan to do extreme activities like bungee jumping or skydiving.
2. Go for athletic activities. If you’re up to it, you can beef up your and your family’s healthy lifestyle by going for athletic activities on vacation. If you’re going to the beach, try wind surfing. If you’re going to the province, try mountain climbing.
2. Gather the memories. After your vacation, the memories you made will be a constant reminder of how much fun and exciting your vacation was. Gather the memories in a photo album or a scrapbook or post everything on Facebook or Twitter.
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stressbuster
Pre-Vacation
The Vacation
Post Vacation
3. Book in advance and check for deals. Be a smart traveler and look for deals and hotels that cater to you and your family’s condition. If one of you has diabetes, look for a place where food and accommodations are fit for your condition.
3. Pig out but watch out. A vacation can be a gastronomic explosion of unique experiences. Check out every place for a delicacy that will surely make for good stories to tell friends. Try the weird, the gross, the eccentric, the unusual, the odd, and the unexpected dishes but within limits, of course.
3. Tell your friends. Your friends will surely be asking how your vacation with your family went. For sure, they’ll be willing listeners to your adventures.
4. Pack right, pack light. Pack everything you need before you hit the road, but don’t overdo it. You wouldn’t want to pay more on luggage fare for things that you don’t even need. Make sure to leave room in your luggage as well for things that you could take home like souvenirs, photos and knick-knacks. Your meds should also be stored in its required temperature so it won’t get stale while you’re on the road.
4. Keep track of your funds. It may be tempting to throw money on that rare knickknack you found at the souvenir shop but you need to control your spending on the vacation. After all, you don’t want to run out of cash when something dire happens while you’re on vacation with your family.
4. Call the office. You’ve probably left work to go on vacation. It’s your responsibility to tell your superiors when you’ll be reporting to work after the ruckus of the family vacation.
5. Consider the time zone. If you’re traveling abroad, make sure you adjust your med schedule accordingly. Check how you should adjust your schedule with your doctor so you and your family won’t miss a schedule.
5. Go camera happy. Go wild with the camera. Gone are the days when you have only 24 shots to make memories. Grab your digicam and capture as many moments with your family as possible.
5. Retune your transpo. Your transportation may have suffered from the long drive. Give it a welldeserved rest and bring it to the autoshop for retuning and repairing. You wouldn’t want it to break down on a regular day, would you?
6. Prep your transportation. Tune your car if you have to. Bad things can happen on the road, especially if you’re going on a long trip, which can damage your car.
6. Stay safe/know the law. While family vacations usually know no limits, it would be wise to know the laws of the place you are going. Are traffic laws different? Is there a curfew where you’re going? Will you be safe from harm while on vacation? If you do get harmed, will you be protected by the law?
6. Plan the next trip. This vacation may be over but your time with your family can go beyond that. Start planning for your next vacation!
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stressbuster
The Vacation
Post Vacation
7. Plan your iternirary It’s smart to know what you and your family would like to do while you’re at your destination. You don’t have to follow it right down to the last punctuation but planning ahead will save you time and money while on vacation.
7. Go for public transpo. If you’re with your family, chances are you brought your family car with you – making it easier for your family to go around. But also consider riding public transportation like jeeps, pedicabs and even the ride-on-ride-off boat. This saves up on gas and maximizes your chances of discovering something new.
7. Settle loose ends. Did you use your credit cards while on the road? Did you forget to pay the bills before you left? Now is a good time to settle loose ends that you’ve incurred while you were away from everything. Don’t end your vacation stressing about the debt you’ve incurred.
8. Tell your endocrinologist. Your endocrinologist should be the first person to know that you’re going on a vacation. He can advise you on how you and your family can manage diabetes while having fun as well.
8. Be flexible. You may have a well-oiled plan prepared for the entire trip but try not to stick to it too strictly. If you see things that are not on the list but will surely be fun for the entire family, why not veer away a bit from your plan and have fun?
8. Go back to your endocrinologist. You and your family should be checked by your endocrinologist after vacation. Check for changes in your blood sugar levels or other vital signs that may affect or have affected your condition.
Illustration by: Danie Paul Cisneros
Pre-Vacation
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livingwell
ancing with iabetes By Alexa Villano Photos by Jose Martin Punzalan
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hen diabetes strikes, you either deny it or accept it. For Enrico Santos, a retired businessman, he took diabetes to the dance floor. Diagnosed with the condition 20 years ago, Enrico had to find a way to stay in shape. He chose to face his condition head-on. “I took it as a challenge. The doctor said it was better to prevent (complications) rather than to cure,” said Enrico. Together with his wife, he enrolled himself in a nearby gym but found it repetitive and that the exercises he was doing was not enough. He decided to switch to dancing when his son, who loves to dance, discovered the program offered by Studio 116 Manila. Since then, he found himself going to the studio two to three times in a week, learning step after step from the dancing instructors. His wife even joins him in his dancing sessions at the studio. “With dancing, I discovered a lot of things,” said Enrico.“I love music too. I get to express (that love) with dance.” Aside from improving his physical fitness, dancing also served as a good way to bolster his memory. He found it a pleasant challenge to try to remember the next step of a dance routine. It was also through his dancing at Studio 116 Manila that Enrico discovered the importance of conditioning the body before doing any dance steps. “We are encouraged to condition our bodies before the dance proper, which I normally don’t do. With this (dance) conditioning, particularly the stretching routines, I am able to execute parts that were very hard for me to do before.”
bellmorelibrary.org
On his condition Since dancing can take a toll on one’s feet (opening up wounds and causing calluses) one has to be extra careful, especially with a condition like diabetes. Here, Enrico makes sure to stick to age-appropriate dances and routines that are not so tedious on one’s feet. His wife also helps him deal with his condition by reminding him to take a step back from time to time to recover. He also makes sure to take his vitamins regularly, on top of the diet and exercise that he does. “You really have to give time for exercise. Diabetes will take a toll on your life unless you manage it well. Enjoy the regimen and the ensuing discipline of dancing. You get skills in dancing that stays with you. There are many exciting challenges that come along the way as you continue to dance regularly,” he said. For those who continue to cope with accepting their diabetes, Enrico has these words of wisdom to share: “Diabetes exists. For older people, (I advise them) not to be afraid or not to be intimidated to try dancing. In the studio there are dancers of all ages: Anyone can dance! The young ones will naturally tend to dance with more energy than the old ones. Do not be afraid to try dancing. No need to be ashamed or intimidated by the younger people,” he concluded. D APRIL 2013-MAY 2013
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Traveling with Diabetes
dosanddonts
By Angelica de Leon Reviewed by Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM (Reprint from April-June 2012 issue)
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iabetes should not hamper you from enjoying your vacation travel or from giving that top-level performance on an important business trip. Yet, there are many things about traveling that may affect your eating habits, compliance to medication, and physical condition, which could alter your blood sugar levels and complicate things further. Therefore, it is important to be prepared before and during a trip. DiabetEASE provides you some tips when traveling, to help stabilize your blood sugar and ensure an enjoyable and comfortable trip:
DOS See your doc. Inform your doctor about your travel plans. This is especially important if you are traveling by plane and on insulin treatment. He may have special instructions for you, like changing your injection schedules considering time zone differences. Present a medical certificate from your doctor, authorizing you to carry your medicines and paraphernalia in your luggage.
IIlustration by Michael A. Seludo
Bring extra meds. Packing an extra two-week supply of your medications will ensure continuous treatment during unforeseen cases like when you have to extend your trip and/or the medicines are out of supply in stores within the area. At your destination, keep some medicines inside your carry-on bag but leave some on your bedside table or the dresser inside your room. This will serve as a reminder for you to take your medicines in the morning or before you leave for the day’s tour activities. Pack snacks. Bring both low-fat snacks and sweet food items. Low-fat snacks like crackers will ensure you have something to eat while on the road. Sweet snacks, like candy, will come in handy in case
you experience hypoglycemia while on the road. If you’re traveling abroad, learn the statements “I have diabetes” or “I need juice or food, please” in the language of your destination. Check your blood sugar. Do it often especially when crossing time zones. Jet lag can make it hard to tell if your symptoms are from high or low blood sugar. Keep your blood sugar testing kit and medicines with you or store them well. Avoid packing them in your checkin luggage as they may get damaged or lost. Don’t put them where they can be exposed to the elements. Extreme temperatures in the cargo area of a plane, the glove compartment or trunk of a car can ruin your medications and glucose testing strips.
DON’TS Don’t leave your prescriptions. Besides your meds and glucose meter, don’t forget to bring your prescriptions, and your doctor’s contact details. You just might have to buy a few more medicines during the trip especially
Consult your doctor
if you have to extend your stay or if you lose them inadvertently. And for emergency cases, keep your doctor’s contact information handy. Wear a medic alert bracelet or keep a card in your wallet indicating that you have diabetes and what medications you’re on. Don’t be careless with food. Be picky with your food and water sources. Eat at reputable, clean establishments, and avoid drinking from the tap. Don’t skip meals either, and try to stick to your meal plan. When flying, request for low sugar, fat, and cholesterol food ahead of time. Don’t forget to exercise. If you can, climb the stairs instead of taking the elevator, and walk instead of riding the cab, tricycle, pedicab, etc. Pack your gym shoes and clothes, and sneak in a workout most days of the week. D
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dosanddonts
Paglalakbay Nang May Diyabetes Isinulat ni Angelica de Leon Pinamatnugutan ni Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM (Reprint mula sa April-June 2012 na issue)
A
ng diyabetes ay hindi dapat maging sagabal sa iyong pagbibiyahe maging sa bakasyon man o negosyo. Ngunit, ang paglalakbay ay maaaring maka-apekto sa iyong pamamaraan ng pagkain, pag-inom, o pagturok ng gamot na puwede ring makapagpababa o makapagpataas ng iyong antas ng asukal sa dugo o kaya’y makapagpalala sa iyong kalagayan. Samakatuwid, mahalaga na paghandaan mo ang iyong paglalakbay. Narito ang ilang payo mula sa DiabetEASE, ukol sa paglalakbay kapag may diyabetes. Makakatulong ito sa pangangalaga ng iyong asukal sa dugo at pagsisigurong masaya at maayos ang iyong paglalakbay.
DAPAT Magpatingin sa doktor. Ipaalam sa iyong doktor na ikaw ay may biyahe. Mahalaga ito lalo na kung ikaw ay may type 1 diabetes at sasakay sa eroplano. Maaari siyang magbilin sa iyo tungkol sa pagbago ng oras ng pagtuturok dahil sa pagkakaiba ng oras ng iba’t ibang bansa. Ipakita ang medical certificate mula sa doktor na pinapayagan ka magdala ng mga gamot at gamit para sa diyabetes.
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Magbaon ng pagkain. Magbitbit ng meryendang ‘di mamantikain at ilang matatamis na pagkain. Maaaring gawing panawid-gutom ang pagkain tulad ng crackers. Ang mga matatamis na pagkain naman tulad ng kendi ay makatutulong kung sakaling maranasan mo ang hypoglycemia o pagbaba ng asukal sa dugo. Kung ikaw ay nasa ibang bansa, aralin ang pagsabi ng “Mayroon akong diyabetes”, at “Kailangan ko ng juice o pagkain,” sa wika ng bansang iyong kinaroroonan. Alamin ang iyong blood sugar. Dalasan ang pagsukat ng asukal sa dugo lalo na kapag tumatawid ng time zones. Kung may jet lag, mahirap sabihin kung ang nararamdaman ay dulot ng mataas o mababang antas ng asukal sa dugo. Bitbitin palagi ang mga gamot at pangsukat ng asukal sa dugo. Huwag ilagay ang mga ito sa iyong check-in luggage sa eroplano dahil maaari itong mawala o masira. Huwag ilagay ang mga ito sa cargo area ng eroplano, sa glove compartment o trunk ng sasakyan kung saan ay baka masyadong mainitan o malamigan at ‘di na sila gumana.
HINDI DAPAT Huwag iwanan ang reseta. Bukod sa iyong mga gamot at glucose meter, huwag kalimutang dalhin ang iyong reseta at detalye kung paano makipagugnay sa iyong doktor. Ito ay sakaling magkaroon ng emergency, kailangan mong bumili ng gamot dahil nawala mo o kaya’y biglang kinailangang manatili sa biyahe ng ilan pang araw. Magsuot din ng medic alert bracelet o maglagay ng card sa iyong pitaka kung saan nakasulat na mayroon kang diyabetes at ang mga gamot na iyong iniinom. Huwag magpabaya sa pagkain. Piliin ang pagkain at inumin. Kumain lamang sa mga disente at malinis na lugar at iwasang uminom ng tubig na galing sa gripo. Kumain din sa tamang oras at sundin ang iyong meal plan. Kapag sasakay ng eroplano, hilingin ilang araw bago lumipad na ang ihaing pagkain sa iyo ay mababa sa asukal, taba at kolesterol. Huwag kalimutang mag-ehersisyo. Kung maaari, umakyat ng hagdan sa halip na sumakay ng elevator. Maglakad sa halip na sumakay ng taksi, tricycle, pedicab, at iba pa. Dalhin ang mga gamit na kakailanganin sa gym at isingit ang ehersisyo sa pang-araw-araw na gawain. D
IIlustration by Michael A. Seludo
Dagdagan ang dala-dalang gamot. Magdala ng karagdagang gamot na aabot sa dalawang linggong pananatili pa lampas sa nakatakdang petsa. Sa gayon, maipagpapatuloy mo ang gamot
sakaling magkaroon ng ‘di inaasahang pangyayari tulad ng pag-antala ng iyong pag-uwi o kawalan ng mabilhang gamot sa biyahe. Pagdating sa pinaroroonan, maglagay ng ilang gamot sa iyong bitbit na bag; mag-iwan din ng ilang gamot sa lamesa katabi ng iyong kama o sa tokador sa iyong silid. Ito ay magpapaalala sa iyong inumin ang iyong gamot sa umaga bago ka umalis.
affairstoremember
Diabetes experts participate in PLAS-PSH Convention By Alexa Villano
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xperts from the Philippine Society of Endocrinology and Metabolism and Diabetes Philippines (PSEM) were among the panelists in the 18th Annual Joint Convention of the Philippine Lipid and Atherosclerosis Society and Philippine Society of Hypertension on February 13-15 at the Crowne Plaza Galleria. Speaking on the first day of the convention for the symposium on “Evidence-based Practice for the Mitigation of Cardiovascular Risks in Diabetes and Pre-Diabetes” was Dr. Nemencio Nicodemus Jr. while discussed “Best Practices for Diabetes and Pre-Diabetes Prevention” saying that the country should be more prepared, especially with the
continuing rise of the disease and discussing best practices. “We should be worried about this increasing prevalence of diabetes in our country because if the trend continues, we will be putting our country on the map of the world as one of the top 10 countries with the highest prevalence of diabetes by the year 2030. And perhaps by then, it won’t be more fun in the Philippines,” he told the audience. PSEM President Dr. Sjoberg Kho tackled “Best Practices for Lipid Management in Diabetes and Prediabetes,” while Dr. Cecilia Jimeno ended the lecture series by discussing “Best Practices for Hypertension and CV Disease Prevention in Diabetes.” On the second day, during the
session on “The Interface between Diabetes and the Cardiovascular System (CVS),” Diabetes Philippines Immediate Past President Dr. Susan Yu-Gan tackled the “Insulin Resistant Heart.” She was followed by Diabetes Center Philippines Training CoChair and DiabetEASE editorin-Chief, Dr. Joy Fontanilla, who discussed “Effects of GLP 1 on Lipids and the CVS,” and Dr. Rima Tan who emphasized the importance of the body clock with the topic “Circadian Rhythm, Insulin Resistance, and CVD.” The theme for this year’s PLASPSH convention was “Enhancing Clinical Practice for Better Clinical Outcomes.” D
DiabetEASE editor-in-chief Dr. Joy Fontanilla and Diabetes Philippines Immediate Past President Dr. Susan Yu-Gan during the forum.
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affairstoremember
AACE Ph to hold annual convention in Cebu
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he American Association of Clinical Endocrinologists – Philippine Chapter is set to hold the 5th joint meeting with the American Association of Clinical Endocrinologists on August 1-3 2013 at the Radisson Blu Hotel, Cebu. With the theme “Advocacies, Advances, and Challenges in Clinical Endocrinology”, the gathering also includes the 7th Annual Meeting and Clinical Congress of the society. Speakers expected to attend the summit are Dr. Lewis Braverman, an expert on thyroid diseases; Dr. Harold Lebovitz, internationally recognized authority in the field of diabetes and currently serves on several editorial boards; and Dr. Pauline Camacho, director of the Loyola University Osteoporosis Metabolic Bone Disease Center. Dr. Camacho is also part of the editorial board of Endocrine Practice and Journal of Clinical Densitometry. Interested physicians and health professionals who would like to attend the event may log on to the AACE website at www.aacephil.com to register or may call the AACE Philippines secretariat at (632) 553-0188 or e-mail at aacephil@yahoo.com.
doodles&dreams
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GLICLAZIDE Scored Tablets
z z z z
Effective glycemic control 1, 2 Protection of the `-cells 3, 4 Protection of the kidneys and the heart 1, 5, 6, 7 Supported by evidence from ADVANCE, the largest morbidity-mortality trial in diabetes 1
1 to 2 tablets at breakfast
*
*In most patients
1. ADVANCE Collaborative Group; Patel A et al.N Engl J Med. 2008; 358: 2560-2570. 2. The GUIDE Study Eur J Clin Invest. 2004; 34: 535-542. 3. Sawada F et al. Metabolism. 2008; 57(8): 1038-1045. 4. Del Guerra S et al.Diabetes Metab. 2009; 35(4): 293-298. 5. The CONTROL Study. Diabetologia. 2009; 52: 2288-2298. 6. Khalangot M et al. Diabetes Res Clin Pract. 2009; 20(6): 611-615. 7. Katakami N et al.Diabetologia. 2004; 47: 1906-1913.