DiabetEASE April-May 2014 by Dan Cisneros

APRIL-MAY 2014

CONTENTS

behindthescenes

COVER STORY AND FEATURES

20 40

Helping Kids Cope with Diabetes Here is a summer camp that helps kids with diabetes realize that they are not alone nor different. Mylene C. Orillo sits down with Dr. Jimmy Aragon on the importance of the Diabetes Center Philippines’ annual camp for kids.

Mona Louise Rey’s Gambit Mona Louise Rey is a child with diabetes who chose to look past the disease and did what most never do in their entire lifetime: achieve her dreams. Alexa Villano talks about school, diabetes, playtime, and career with the child wonder and her mom.

in depth 23

Diabetes in the Young

Much Ado About Dietary Supplements

Summer Illnesses to Watch Out For

The editorial team with Mona and her family after wrapping up the shoot

regulars 6 | EDITOR’S EDICT 8 | WE’VE GOT MAIL 9 | SWEET NEWS ON THE COVER: Mona Louise Rey breaks her silence on how one child copes with a disease not many adults could handle. This is her story of hope.

Commonly accepted to be an illness among the elders, diabetes is now becoming a common disease among the young. Dr. Marsha Tolentino gives us an in-depth look at the issue, and offers ways on how to deal with it.

Your friendly neighborhood drugstores could be a treasure trove of affordable treatments and supplements. Dr. Ma. Leonora Capellan lists down the pros and cons of some familiar alternative remedies.

Just because the weather is a lot warmer in the summer doesn’t mean illnesses are not afoot. Dr. Rowena de Jesus explains how to take care of yourself in the hot months of the year.

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Photographs by Jose Martin Punzalan Hair & make-up by Anne Magadia Clothes from Moosegear Location Britespark International School, Libis, Quezon City Special thanks to Jeff Tan & GMA Artist Center

Diabetes in Children with Special Needs

Dr. Sioksoan Cua answers the pressing matter of how to deal with children with special needs due to learning and other disabilities who also have diabetes.

columns 13

Educator’s Corner

Fightin’ For Fitness

Good Food Guide

Righteous Recipes

Moms Who Care for Kids with Diabetes How do mothers of children with diabetes cope with the reality of their child’s condition? Dr. Jocelyn Isidro shares stories from some of the mothers she met.

The Beach Body Workout Trim the extra flab just in time for the swimsuit season. Cyrus Eleuterio teaches us a mean beach body workout for a healthier body this summer.

Healthy Snacks for People with Diabetes Learn from a snacking guide for people who are tired of the “healthy” and “low-sugar” options. Nutritionist Joy Rabbie Catungal hunts down other snacks that don’t fit in the two categories and are still healthy for everyone.

Diabetic Picnic-Ready A day at the park isn’t complete without food. If you have diabetes, you won’t struggle choosing food with Chef Junjun de Guzman’s picnic-ready recipes made especially for you.

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sections

You Ask, We Answer

Is Buko Juice Suitable For People With Diabetes? Coconut juice, the drink usually dubbed as the “Miracle Juice” isn’t all that it’s cut out to be. Nutritionist Encar Gigante gets to the bottom of how buko juice can affect people with diabetes.

Product Spotlight

A Piece on Sugar-Free Breads An alternative to rice, bread is the next staple food Filipinos love to consume. Gelyka Ruth R. Dumaraos compares five sugar-free breads available at grocery stores so you know how yours measure up.

Living Well

A Sweeter Slice of Life Over Diabetes Rosario realized that life with diabetes could still be a piece of cake. Candice Monique O. Brillon interviews a mother who chose to live positively despite her condition with the support of family and friends.

Stress Busters

6 Staycation Strategies

Staying at home can be as relaxing as a full-blown vacation. Michaela Sarah de Leon shows you how in six simple ways.

65 67

Dos and Don’ts

Beat the Heat Diabetes and heat is not a good combination, which can lead to problems that can be dealt with. These are dos and don’ts to follow when the temperature rises from the DiabetEASE staff.

Affairs to Remember

68 4

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Doodles & Dreams

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EDITOR’S EDICT

Sweet Child o’ Mine Children are one third of our population and all of our future. ~ Select Panel for the Promotion of Child Health, 1981 Type 1 diabetes, previously known as juvenile diabetes, is one of the most common childhood endocrine disorders. In many countries, new cases are increasingly diagnosed chiefly in kids under 15 years of age. Prevalence of type 2 diabetes, formerly a disease seen only in adults, is likewise rising in children and adolescents. The swelling numbers of young people getting type 2 diabetes parallels escalating levels of obesity and physical inactivity. Children with type 1 diabetes need insulin to survive. Those with type 2 diabetes may only need anti-diabetic pills initially. But all these children risk having complications such as eye, kidney, nerve and heart damage. Mothers and caregivers of kids with diabetes know only too well the struggles their precious wards face each day. The sting of insulin shots and frequent blood sugar monitoring, the fear of hypoglycemia (low blood sugar levels), the frustration of having to plan all meals, or just the annoyance of feeling “different” can already be taxing for an adult, how much more so for a child? In this issue, we focus on diabetes in the young and how to help them and their caregivers cope with their condition. And we are so delighted to have remarkable child actress/commercial model, Mona Louise Rey, gracing our cover. She can certainly win you over with her adorable smile and humongous heart. Plus, the heat is on! Be summer-ready, safe and have fun with our tips on how to beat the heat, get that swimsuit-body, ward off summer ailments, prepare a savory picnic, and more. Have a summerific time everyone! 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 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 Past President, Diabetes Philippines; Trustee, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Lipid Society; Consultant, Metropolitan Hospital

CONTRIBUTORS Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Michaela Sarah de Leon Art Director: Donna I. Pahignalo

Marsha C. Tolentino, MD, FACE

A UP College of Medicine graduate, Dr. Tolentino received her residency and fellowship training at the Albert Einstein College of Medicine in New York. She is currently an endocrinology consultant at the Perpetual Succour Hospital and the Cebu Doctors’ University Hospital and was also the past president of the American Association of Clinical Endocrinologists Philippines.

Editorial Coordinator: Alexa Villano Writers: Ma. Cristina C. Arayata Jose Martin Punzalan Gelyka Ruth R. Dumaraos Thea Loise Torres Graphics and Layout: Dan Cisneros Overall Marketing Manager: Hudson P. Pelayo Marketing Assistant: Godfrey Santos Group Sales Manager: Ma. Elna P. Jagape Senior Account Managers: Noel A. Ongkingco Charlotte Aireen Punzalan

Rowena E. De Jesus, MD, FPCP, FACE

Dr. De Jesus is a graduate of the UP-PGH Department of Medicine, Section of Endocrinology. She is a fellow of the Philippine College of Physicians, a diplomate of the Philippine Society of Endocrinology and Metabolism, and a member of the American Association of Clinical Endocrinologists. She currently holds clinics at the Asian Hospital and Medical Center and St. Luke’s Medical Center-Global City.

Representatives: Leonard Anthony D. Baluyot Arjay Yano Ian Paul Cabatay Advertising Assistant: Irina Mae Carampatana Officer-in-Charge, Circulation Department: Armando Sandajan Executive Assistant: Angeli M. Mamaril

Sioksoan C. Cua, MD, MSC

Dr.Cua is a pediatric endocrinologist. She is currently the chief of the section of Pediatric Endocrinology, College of Medicine, University of the Philippines, Manila and the Philippine General Hospital. She is a consultant in various hospitals, including Cardinal Santos Medical Center, Chinese General Hospital, Manila Doctors Hospital, Our Lady of Lourdes Hospital and the Medical City.

Legal Counsel: Castillo, Laman, Tan, Pantaleon and San Jose Law Firm

Joy Rabbie M. Catungal, RND, CDE

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.

Ms. Catungal is a nutritionist-dietitian who graduated with a degree in Nutrition and Dietetics at the University of Santo Tomas in 2007. She was a former nutritionist at the Makati Medical Center’s Diabetes Center and Viva Healthcare, Quezon City. She is also a member of the NutritionistDietitian’s Association of the Philippines and Philippine Society for Parenteral and Enteral Nutrition.

Cyrus Eleuterio

Cyrus is a certified TRX instructor and a personal trainer for five years. He currently works with Fitness First.

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 2014 by FAME, Inc.

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Via Email

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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.

Greetings,

Dear Mr. Green,

I am an American who has resided in the Philippines for 20 years. I am also a diabetic and a reader of your magazine since its first issue. My wife and I are living in San Pedro, Laguna. We often go to Asian Hospital and Medical Center. I am writing to inquire if your magazine knows of any dermatologist handling diabetic foot problems at Asian Hospital or in my area.

Thank you very much for your letter. Asian Hospital has a whole roster of excellent dermatologists. Your primary physician or endocrinologist can help you find one you can both trust. Your doc can also help figure out if the foot problem may also involve conditions that are not just skindeep. These may include problems with blood vessels, nerves, bones, or those due to infection for which other specialists may need to be consulted.

Your assistance is highly appreciated.

Best regards,

Respectfully yours,

JCF

Robert R. Green via email San Pedro, Laguna

Via Facebook Look whose cover got 7,994 likes on Facebook! Nikki Gil has such a supportive fan base and we love how much love Nikki Gilâ&#x20AC;&#x2122;s DiabetEASE cover is getting on the social networking site. Here are a few their comments:

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sweetnews

Cardiac drugs may WHO wants cuts in increase diabetes risk sugar intake to 5%

atients with impaired glucose tolerance could be more at risk of new-onset diabetes if they take cardiac drugs such as diuretics and statins, according to a reanalysis of a landmark trial. In the reanalysis of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial data, results revealed that the risk for new-onset diabetes rose higher in those who took diuretics or statins than those who did not. Meanwhile, risk for new-onset diabetes in patients exposed to β-blockers or calcium channel blockers did not change among patients. Investigators examined the close association of β-blocker, thiazide diuretic, statin, or calcium-channel with new-onset diabetes in a sample size of 9,306 participants enrolled in the NAVIGATOR trial. During the median five years of follow-up, β- blockers were started in 915 (16.2 percent) patients, diuretics in 1,316 (20.7 percent), statins in 1,353 (22.0 percent), and calcium channel blockers in 1,171 (18.6 percent). It is advised that proper monitoring of glycemia should be observed when diuretics and statins are instigated with patients. The usage of β-blockers, diuretics, and statins is for the reduction of cardiovascular morbidity and mortality due to an array of disease, but debates on the main role of statins to lower risk in key populations are still ongoing. More studies should be conducted to prove and confirm the effects of these drugs on patients with high diabetes risk, according to the researchers. Gelyka Ruth R. Dumaraos with a Medscape Report D

Free sugars increase risk of NCDs like dental diseases

he World Health Organization (WHO) wants to cut current worldwide sugar intake by half. WHO released new draft guidelines calling for a reduction of sugar in daily calorie intake to 5 percent. The organization’s 2002 guidelines recommended eating less than 10 percent of total calorie intake. “There is increasing concern that consumption of free sugars, particularly in the form of sugar-sweetened beverages, may result in both reduced intake of foods containing more nutritionally adequate calories and an increase in total caloric intake, leading to an unhealthy diet, weight gain and increased risk of non-communicable diseases (NCDs),” WHO said in a statement. Of particular concern, according to WHO, is the role that sugar plays in the cause of dental diseases, particularly dental caries or tooth decay. “Dental diseases are the most prevalent NCDs globally and though great improvements in prevention and treatment have occurred in the last decades, dental diseases continue to cause pain, anxiety, functional limitation, and social handicap through tooth loss for large numbers of people worldwide,” WHO said. The five percent reduction of sugar in the new proposed guidelines will be beneficial because it would be equivalent to 25 grams (around six teaspoons) of sugar intake per day for a normal adult’s body mass index or BMI. This is less than a single can of soda, which contains 40 grams of sugar, according to a CNN report. If the proposed guidelines are approved, this will be applied to sugars added to foods by manufacturers and those present in honey, syrups, fruit juices, and fruit concentrates. Fresh produces are not included. WHO conducted a public consultation for the guidelines, which will be finalized before publication. Alexa Villano D

unbconnect.com

tu.no.com

Diuretics, statins linked to new-onset diabetes in re-evaluated landmark trial study

APRIL-MAY 2014

sweetnews

Metro Manila T1DM patients reluctant to seek dental help

Financial insufficiency, fear, and dentist's refusal to treat cited as causes

news.bbcimg.co.uk

ype 1 Diabetes Mellitus patients in Metro Manila are reluctant to seek dental help due to financial insufficiency, fear, and the dentist’s refusal to treat them, according to a study from the University of the Philippines - National Institutes of Health (NIH) The patients’ fear and the dentists’ reasons come from the misconceptions regarding possible negative outcomes of dental treatment such as uncontrolled bleeding and delayed healing. At least 80 percent of the group have dental caries or cavities, 32.1 percent have periodontitis. Moreover, the study also found out that although 70 percent of them knew what dental floss is, only 15 percent used it daily. They also found that only 50 percent knew what gingivitis is, but only 12.8 percent knew what periodontitis is. Periodontitis is a disease that affects the bone and soft

he risk of death is not limited to obese people as underweight ups risk for both adults and fetuses, according to study published in the Journal of Epidemiology and Community Health. “We have an obligation to ensure that we avoid creating an epidemic of underweight adults and fetuses who are otherwise at the correct weight,” said lead researcher Dr. Joel Ray. They found that adults who are underweight with a BMI of 18.5 or less have a 1.8 times higher risk of dying than those with “normal” BMI of 18.5 to 24.9. Meanwhile, the study also found that the risk of dying was higher by 1.2 times in people who are obese with a body mass index of 30-34.9 and 1.3 times for those who are severely obese with a BMI of 35 or higher. The study also factors in smoking, alcohol use, lung disease, and occurrence of chronic or terminal illness in adults.

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tissue supporting the teeth, causing the teeth to become mobile and migrate from its original position. Meanwhile, another NIH study ascertained the prevalence of such dental diseases in T1DM patients in Metro Manila, specifically that of periodontitis and dental caries. A study in their periodontal health found that periodontitis begins early in T1DM patients and is accompanied by rapid progression. “With increasing age, the number of patients and teeth affected with periodontitis increases as well,” said the researchers. Periodontitis, however, was lower in patients who visited their dentists even without symptoms regularly twice a year and in patients with decayed, missing, and filled teeth index scores. On the other hand, another NIH study found that dental caries, or cavities, were most prevalent in patients aged 2125 years old, but the age group with the most number of tooth extractions was in the six-10 age group. It explained that high prevalence among T1DM patients was because of increased concentration of salivary glucose, acidity of the oral cavity, salivary viscosity, reduced salivary flow rate, and salivary gland dysfunction. Some studies, however, debunk this conclusion as dental caries were found to decrease because of decreased sucrose ingestion. Mica G. De Leon D

Underweight people also at risk of death Review of 51 studies on the relationship of the BMI and deaths from any cause and data on newborn weight and stillbirths in Ontario was done. The researchers followed people for five years or longer to remove study participants who were underweight because of cancer, chronic lung disease, or heart failure. The study determined that the common causes of being underweight were malnourishment, heavy alcohol or drug use, smoking, low-income status, mental health, and poor self-care. Dr. Ray also questioned why the focus is on the ills of excess body fat. “BMI reflects not only body fat, but also muscle mass. If we want to continue to use BMI in health care and public health initiatives, we must realize that a robust and healthy individual is someone who has a reasonable amount of body fat and also sufficient bone and muscle,” he said. “We are, therefore, obliged to use the right measurement tool.” Mica G. De Leon D

sweetnews

A third of obese kids 'metabolically healthy'

Obesity prevention programs lower kids' BP

“It’s not all about fat.” According to a study by researchers from the University of Alberta, a third of children who have obesity can be classified as ‘metabolically healthy’ – or are not imminently at risk of developing insulin resistance, high blood pressure, high cholesterol, or other obesityrelated diseases. Insulin resistance is a precursor to type 2 diabetes. The study explained that weight doesn’t determine a child’s overall health, which can be influenced by other factors such as physical activity, diet, and screen time “even for kids who meet the definition of obesity.” “Lifestyle behaviors – how physically active they are and what they eat – those things have an effect on their health, independent of fatness,” said lead researcher Geoff Ball, Associate Professor of Pediatrics in the university’s Faculty of Medicine & Dentistry and clinical director of Stollery Children’s Hospital’s Pediatric Center forWeight and Health. The study was composed of a sample size of 181 children with obesity aged eight to 17 years old. They examined five years of clinical data, tracking the age and body composition of obese children, lifestyle behaviors such as physical activity and diet. They also looked for clinical indicators associated with obesity such as insulin resistance and blood pressure, as well as fat and glucose levels in the blood. They also included traditional measures of obesity like body mass index. Aside from being “metabolically healthy,” children were shorter, lighter, and less overweight than their “metabolically unhealthy” counterparts. They also spent less time in front of the TV, computer, or video game consoles and ate fewer overall calories, including less fat and fewer servings of meat. “Obesity is often described as a complex disease with lots of causes and lots of consequences. Not everyone has the same consequences,” he said. He further explained that someone with type 2 diabetes could have less body fat than somebody who has quite a bit more body fat and doesn’t have type 2 diabetes. The researchers hope that the findings will help physicians in understanding and treating the complexity of obesity in children. The researchers are currently conducting a larger national study on what happens to children with obesity regardless if they are metabolically healthy or not over time and whether risks of obesity-related illness eventually catch-up. Mica G. De Leon with Diabetes Care report D

esearch shows that even if obesity prevention programs do not prevent obesity, many help reduce blood pressure (BP) in children and are effective in promoting healthy eating and physical activity. “It is important to identify obesity intervention programs that can help children develop healthy lifestyles and keep BP at an optimal level because these programs help them avoid many long-term health consequences,” said Dr. Youfa Wang, Ph.D., epidemiologist from the University at Buffalo in collaboration with researchers from the Johns Hopkins University, in a study that is considered the first of its kind. The researchers studied 28 obesity intervention programs with complete data and found that 13 (46 percent) of them had favorable effects on both adiposity and BP, while 11 interventions (39 percent) had a significant effect on BP, even if they did not affect adiposity. Earlier studies have found that one of the serious health consequences of obesity is elevated blood pressure and that children with high BP usually find themselves with high BP and with it a wide range of negative consequences. High BP amongst adolescents can pose cardiovascular problems later in life. D

newswise.com

Lifestyle behaviors, not fat, have an effect on health - study

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youaskweanswer

Is buko juice suitable for people with diabetes?

oconut or Cocos nucifera L. is a common tree found in tropical countries (eg. Thailand, Brazil, and the Philippines). It produces a peculiar round shelled fruit with a white kernel, which can be used as an ingredient for cooking Filipino dishes and a refreshing drink called coconut water or buko juice. Patients with diabetes should avoid juice because of the simple sugars it contains, which can lead to high blood sugar levels. It is most especially true if there are added sugars in it.

However, there are juices, which can be taken in moderation by diabetes patients. One of these is fresh buko juice. This “naturally-canned beverage” can be a fruit substitute. One serving of fruit is equivalent to ½ cup fresh buko juice with ¼ cup buko meat, or 1 cup fresh buko juice. This juice contains small amounts of sugar (6.26g per serving) and 600 mg potassium. Fresh buko juice is loaded with potassium, which plays a vital role in maintaining water and acid-base balance in the body. In spite of the importance of potassium in the body, there are special cases that should be taken into consideration, especially if the person has renal disease, wherein the function of the kidneys to filter and reabsorb electrolytes is impaired. Diabetes patients with renal disease should steer clear of fresh buko juice. D Bibliography: Prades, A., Dornier M., et al. (2011). Coconut Water Uses, Composition and Properties: A Review. Cambridge Journal, 67, 87-107. Doi: 10.1051/fruits/2012002.

Encar C. Gigante, RND

is a graduate of Bachelor of Science in Nutrition and Dietetics at the University of Santo Tomas. She works at the Makati Medical Center as a Clinical Dietitian. She is also an Associate Diabetes Educator.

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educators’corner

Moms who care for

kids with diabetes - how do they do it?

kidsarelovely.com

By Jocelyn Capuli-Isidro, MD

She walks down the hallway and time passes by, As she sits in dark silence and quietly cries. I have to stay strong, and for him I will fight, We'll battle this Diabetes "D" with all of our might. I'll teach him to master and conquer this foe, This 'D' will not stop him, I promised him so - A Mother's Promise (Kids with Diabetes Type 1 Support Group)

other is indeed the wind beneath our wings; the face that welcomes us to the world of the unknown, and the strength that makes us go through life and its wonders. As a mother starts to kindle her baby in her arms at birth, from that time on, she commits herself to the demands of motherhood. Mothers of diabetic children are extraordinary by far. They are faced with more challenges and difficulties as they raise children with special needs. On the day of diagnosis, mom is caught unprepared on how to cope with the fact that her child has an incurable disease. How can she smilingly and lovingly tell a type 1 diabetic child that from now on, she or he will inject insulin and that his/ her tiny little fingers will be pricked at least twice a day for the sugar monitoring? If only she could have her fingers pricked instead. How can she stop a child from binging on ice cream, chocolate, and cotton candy just like his other friends, when this activity seems everything to them? How can she stop a child from playing in the middle of a game just to check his blood sugar? How can she let go when it’s time for her child to go to school and meet new friends? This is a tough task indeed. A task our super moms do everyday–taking care of diabetic children. Hence, these great moms need all the support their family and friends can give them. How did the mom of “Mr. Pure Energy” Gary ValenciAPRIL-MAY 2014

ano, a type 1 diabetic multi-awarded performer, make it through all the years her child was growing? It must have been tough! Coping starts with the realization that one’s life and one’s family’s are about to change. It starts with the acceptance that diabetes, though dreadful, could be fought. How many moms would leave work and sacrifice their personal careers to take good care of their child with diabetes? How many would prioritize buying the anti-diabetic medications that may take a big chunk of the family’s budget? Mom’s the one who oversees all the needs of the family, especially those of the child with diabetes. She goes with her child to every clinic visit, understanding the intricacies of diabetes. With every visit to the doctor, she takes a crash course on “Diabetes 101.” She learns the pathophysiology of diabetes; recognizes the symptoms when her child’s blood sugar level is high, more so when it’s low, understanding the complications that may arise from poorly controlled disease. She has in her pocket an alarm

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clock that tick tocks when it’s time for her to check her child’s blood sugar. She has in her cabinet a complete volume of books and magazines about diabetes. These books have become her favorite novels, with every page turned and each chapter memorized. She has become a better cook, preparing a healthy and hearty meal each day for the entire family, mastering the glycemic indices of food (a measure of blood sugar level rise after eating a particular type of food). She has become a member of all types of support groups for moms of diabetic kids. Through these support groups, she is able to get inspiration from other mothers who have successfully gone through the same tough job. I have met some of these wonder moms (They are so incredible). When asked how they made it through? Most of them answered strong family support and faith in God. With these two amulets in hand, they were able to raise kids with diabetes who do not pity themselves, children full of self-confidence who don’t feel they are different from the rest, but rather

feel special and blessed to have them as their mothers. The smile on a mother’s face provides strength to the child and a frown makes the child feel so downhearted. It’s the attitude and disposition of the mothers that bring out the best in their children. It is through loving care that the child with diabetes feels loved, welcomed and accepted. The child feels that he is just like any other, unafraid to run and explore his surroundings. Motherhood in itself is a vocation. Mothering a child with diabetes is both a vocation and profession. No amount of success can compare to these simple words from ones’ children - “Thank you”, “I love you”, “You are a great mom.” A simple joy comes from seeing your children sleep in the night soundly. I am a mother myself and I salute all mothers of diabetic children. You have made your presence in this world felt and appreciated. You have devoted your lives to taking care of them and preparing them for the future battles in life. “There is an overwhelming feeling of love that fills a mother’s heart whenever she stops and thinks of what a miracle her children are to her life and how absolutely wonderful her life is because of them.” - Deanna Beisser D

v1.theglobeandmail.com

akronchildrens.org

educators’corner

educatorsâ&#x20AC;&#x2122;corner

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fightin’forfitness

The Beach Body Workout Plan By Cyrus Eleuterio

dmit it. Swimsuits and trunks look best with a toned and healthy body. Those “love handles” look more like “muffin tops” with a bikini or swimming trunks. But, what is the worth of a very difficult diet and workout plan if it drains the energy and vigor out of a person? Pair this workout plan with proper diet and achieve a toned beach body. Remember, exercising is only half way to fitness. A healthy and disciplined diet still makes all the difference. Do these exercises back-to-back until the prescribed reps per set are done and look and feel the part of a genuine beach bod.

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fightinâ&#x20AC;&#x2122;forfitness 1B

Feet Elevated Push-Ups

Reps/Set: 3 x as many reps as possible

> Get on the floor with your weight on your toes and hands, with your feet together elevated on the bench and your palms flat on the floor about shoulder width apart. Your body should form a straight line. Start with your arms straight and lower your chest to within an inch or two of the floor. Push yourself straight up to the starting position. Repeat as required.

jerseygirltalk.com

Bulgarian Split Squat

Reps/Set: 3 x 12

> Stand with your leg split, the top of your rear foot resting on a bench (Start with your weaker leg). Hold the dumbbells with straight arms, your palms facing your sides. Lower your body until your front knee is bent about 90 degrees while keeping your torso upright. Rise back to the starting position. Do all reps, then switch legs and repeat.

fitbie.com

2B C B

TRX Row

Reps/Set: 3 x 10-15

> Using a TRX, make sure to adjust the TRX straps to its shortest length. On a standing position, hold the TRX handles and place it on the side of your chest. Keeping tension to the straps, lower your body backwards to produce a vertical plank position. Extend the arms. Return to starting position.

cdnds.net

menshealth.co.uk

Dumbbell Thrusters

Reps/Set: 3 x 10-12

> Stand with your feet shoulder width apart while holding the dumbbells on your shoulders. Squat down making sure your hips go below your knees and your back is flat. Stand up through your heels and press the dumbbells up at the top of the squat. Use your legs to drive the dumbbells up and fully extend your arms at the top of the press.

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fightinâ&#x20AC;&#x2122;forfitness 3B A

Closed Grip Push-up

Reps/Set: 3 x as many reps as possible

> Get on the floor with your toes and hands supporting your weights. Keeping your elbows close to your side. Lower your chest to the floor while keeping your elbows tuck at your side. Push yourself back to the starting position.

tribesports.com

Romanian Deadlift

Reps/Set: 3 x 10-12

fitbie.com

blogspot.com

> Load a barbell and hold it with an overhand grip. Stand with your arms straight and the bar in front of your thighs; lower-back is in neutral arc and your shoulders are pulled back. Lower the bar along your thighs until itâ&#x20AC;&#x2122;s just below your knees. Push your hips forward as you straighten your torso and pull the bar straight up along your thighs.

Leg Raises

Reps/Set: 3 x 25

> Lie on your back. Keeping your lower back flat on the floor with your legs extended with your knees slightly bent. Lift your legs up and lower it slowly going to the starting position.

Crunches

Reps/Set: 3 x 25

> Lie on your back. Use your abs to pull your upper torso up as high as it will go. Slowly lower yourself to the starting position.

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menshealth.co.uk

fightinâ&#x20AC;&#x2122;forfitness Metabolic Finisher - 10 minutes as many rounds as possible 5B

Crossbody Mountain Climbers

Reps/Set: 15

womenshealthmag.com

l.yimg.com

> Start from a push up position, keeping your abs braced. Move your right leg towards your left elbow (twist from the hips) and then go back to the starting position. Do it on the opposite side.

Kettlebell Swing

Reps/Set: 10

> Hold a kettlebell (with a fairly light weight) with both arms. Let your arms hang loosely. Raise the weight with both hands over your head and inhale. Swing the weight with both hands between your legs towards your back while exhaling. Move the kettlebell using your hips, hamstrings, and glutes.

* Consult your doctor before engaging in any exercise. D

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feature

The campers in their field trip at the Paradizoo

Helping Kids Cope With Diabetes Text by Mylene C. Orillo Photo courtesy of Dr. Jimmy Aragon

any people think that diabetes is a disease of the old. What they don’t know is that diabetes affects everyone regardless of age or gender. And when children get it, parents do everything they can to help kids cope and fight for their survival. The Philippine Center for Diabetes Education Foundation, Inc. or the Diabetes Center Philippines was established by Dr. Augusto D. Litonjua, the “Father of Philippine Endocrinology” and a group of other dedicated Filipino endocrinologists in 1990 to help educate every diabetes patient the best way it can. As part of Diabetes Center Philippines’ program, Camp COPE (Children Overcoming Diabetes Problems Everywhere) was initiated in 1996 to enrich and reinforce

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the lives of children and young adults afflicted with type 1 diabetes (formerly known as juvenile diabetes). “Type 2 diabetes patients have diabetes maybe because the child is obese, has insulin resistance, meaning the insulin is there, but it’s not working very well so the blood sugar goes up. But they don’t need insulin yet, they can be treated by oral medication. For type 1, they really need insulin,” said Dr. Jimmy Aragon, Camp COPE’s administrator. In the U.S., once the child is diagnosed with type 1 diabetes, they can readily avail of insulin pumps. Here in the Philippines, insulin pumps are too expensive. That’s why they have to control their blood sugar by using insulin injections, which Camp COPE teaches kids how to do. “We teach them how. Many of

them know already, but we teach them the proper technique,” said Dr. Aragon.

Camp COPE Camp COPE helps type 1 diabetes patients develop a positive outlook in life despite their potentially debilitating affliction. It is designed to shape a mindset that reinforces the notion that there is, indeed, life after diabetes. The first camp was held in Makiling, Laguna on the Boy Scout grounds, and the second was held on the Girl Scout grounds. Succeeding camps were held at Forrest Camp in Laguna, before transferring to Tagaytay Haven. This year, Camp COPE will be held on April 27-30 at Tagaytay Haven. It is open to young people ages 8 to 18 with a registration fee of PhP 6,000 each inclusive of board and lodging, transfers (from

feature Makati Medical Center to camp site and back), and meals. Special arrangements can be made for indigent patients. Conducted once a year, camps usually last for four days and three nights and is limited to 24 to 28 type 1 diabetes patients. Kids can attend up to two consecutive camps, but after the second, priority is given to newcomers (unless slots are still available) and to indigent patients. “This is why we cannot afford to do it twice a year. If we have 28 kids and they don’t have money, we have to shoulder their expenses and it can be quite taxing. We’re not money-making. We rely on corporate partners who create activities or programs for the kids. Thru activities, kids learn something about skills, diabetes management, or just the attitude,” said Dr. Aragon.

Long-term plans Dr. Aragon noted that attitude is very important. They teach kids to be positive and not to let the burden of the disease pin them down. During the camp, kids also get to interact with other kids who have diabetes. However, Dr. Aragon looks forward to conducting a family camp involving the mother, father, sibling, and the child with diabetes. He believes that family support is one of the most important things a child should have. “If they have family support, it would be easier for the child to cope,” he said. He also said that sometimes, the family creates friction with other family members. For example, the child with diabetes is not allowed to eat ice cream; his siblings can’t eat ice cream, too so they may

Games are played to teach skills and knowledge about diabetes

resent him for that. But if the sibling understands what diabetes is, he will understand why his sister/ brother can’t eat ice cream. It will be easier for one sibling to support the other. The same goes for the parents; if they know which food to avoid, how to prepare the meals, then it would be easier for them to buy the right food and teach their kids the importance of exercise. But right now, the center cannot conduct family camps yet because it’s more expensive to house a whole family and would need a bigger venue. On why it is necessary to conduct camps when patients attend regular checkups, Dr. Aragon explained that checkups usually last for 15-30 minutes only

– not enough to discuss everything about type 1 diabetes. “When the family or parents participate in camps, they can interact with other parents who share the same situation. It’s very difficult for a parent to have a child with diabetes. They always wonder why their children got diabetes and why they are being punished. But when parents with the same situation gather together, it will be easier for them to cope with diabetes,” Dr. Aragon said.

Challenges Dr. Aragon admitted that the number one problem they have conducting camps is finding a suitable venue. The venue they went to before has become very pricey that they could not afford it APRIL-MAY 2014

feature anymore. This year, they’re conducting it in Tagaytay Haven in Tagaytay City for the fourth time because it answers all their camp requirements. “[The venue is] important because we prepare the food there as well. It’s a special menu. There also has to be an outdoor space, and sleeping quarters should be clean and safe.” Next challenge is creating useful activities. Dr. Aragon said they cannot just give lectures. They should incorporate fun games, song, and dance, so it’s more interesting and the kids will be able to remember the lesson from the songs. Last year, five training institutions helped Camp COPE conduct activities, namely University of Sto. Tomas, Philippine General Hospital, Makati Medical Center, St. Luke’s Hospital, and The Medical City. The staff includes a camp administrator, camp director, and a 24-hour healthcare team that includes fellows in endocrinology, physicians, nurses, and dietitians who specialize in diabetes care. A consultant in endocrinology trained here and abroad will also be around to cater to the individual needs of each camper. Dr. Aragon admitted that there is really lack of awareness on type 1 diabetes. Some people have this notion that diabetes is a disease of old. But in reality, it affects all people regardless of age and gender. It’s

even more difficult when kids have it because they love to eat chocolates and ice cream.

After the camp Although Dr. Aragon admitted that unless there’s an award, they have no way of assessing the kids’ situation after the camp, however he is looking forward to improve on that aspect later on. “We only assess during the end of the camp: kid’s feedback, what they learned and the good points. That’s how far we get.” Dr. Aragon said that some companies give free insulin meters and after six months, they will check on the patient’s HbA1c, a measure of how the blood sugar is doing in the previus three months. If the HbA1c is good that means the blood sugar is controlled. “We will be there for them and help them realize that they are not as alone and different as they once thought they were. They should not lose hope. They should keep on coping with the disease,” Dr. Aragon concluded. For more information and inquiries, contact Ms. Ella Respicio, Secretariat, at 0922-8080539, 8921064, or diabetes.center@yahoo.com. You can also visit Diabetes Center at 2nd Floor, Hall C, Makati Medical Center, #2 Amorosolo St., Legaspi Village, Makati City. D

Camp Cope coordinators Drs. Jimmy Aragon (leftmost) and Carol Narvacan-Montano (5th from left) with Diabetes Center Philippines Executive Director Ms. Erlinda Inocencio (3rd from left) and corporate partner reps.”

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g n u o y e h t n i es

t e b a Di

, FACE ntino, MD le To . C a By Marsh

however, y tl n e r r u C nts. osed with young andparein r n g g d ia n d a g ts en s in ett of our parnd young adults gra of diabete by s s s e e p ln ty il l e e d a th , e fined ve e ts e p b s n ty e e to c r d s a ir d le e e th o s r iabetes uber of children, ad older adults, the tes mellitus plus a be the num is increasing. As in and 2 dia 1 s e p s ty te f s. diabe These consist o ic diabete n e . g o le n p o o e p –m mutations e n e g le g sin

Type 1 diabetes Type 1 diabetes mellitus is the more common type of diabetes in children. It was previously called juvenile diabetes because of the young age of onset. It is an autoimmune disease - meaning the body’s immune system “attacks” the pancreas and the pancreas is thus unable to produce insulin. Most of these children do not have a family history of diabetes. The diagnosis is usually made when symptoms of weight loss, thirst, frequent urination, and fatigue develop over several weeks and high blood sugar is detected on testing. Sometimes abdominal pain, nausea, and vomiting occur in a condition called diabetic ketoacidosis (DKA). The treatment of type 1 diabetes is insulin replacement as these children cannot produce any or enough insulin to lower their blood sugar levels. Insulin may be given by frequent multiple-dose injections daily or by continuous insulin pumps. The type and dosage of insulin will be determined by a diabetic specialist working closely with the child’s parents as well as with the guidance of a dietitian and diabetes nurse educator. Balancing the meals with the amount of insulin given will require practice and lots of patience especially in the very young.

Type 2 diabetes timesulin.wpengine.netdna-cdn.com

Type 2 diabetes mellitus is getting increasingly common in adolescents and young adults. Although this is due to both genetic and environmental factors, the latter has been identified as the main course for this growing prevalence. Both the proliferation of

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indepth high-density, low-nutrient fast food and drink globally as well as the increasing sedentary lifestyle that industrialization and computerization has brought about, have resulted in the rising obesity epidemic that parallels the rise in diabetes. This type of diabetes is either due to one or both of the following: (1) a relative lack of insulin secretion by the pancreas; or (2) insulin resistance-the inability of the body to use insulin properly. Insulin resistance is commonly due to excess weight and fat together with physical inactivity. The diagnosis of type 2 diabetes in the young may be done by early blood sugar testing of those at risk, such as the overweight or obese child or those children of diabetic parents. Physical signs such as

acanthosis nigricans â&#x20AC;&#x201C; the darkening or thickening of the skin in the neck/nape or axillary areas â&#x20AC;&#x201C; may indicate insulin resistance. Waiting for the classic signs and symptoms of fatigue, polyuria and polydipsia (increased thirst and urination) may delay the diagnosis and treatment of these young patients. Furthermore, prevention may be initiated if the blood sugar levels are still in the prediabetic or borderline stage. Most children will be treated with a sulfonylurea and/or metformin to lower their blood sugar levels. These have to be coupled with proper diet and exercise. Some may need insulin therapy if the blood sugars are very high or if the diabetes is complicated by an infection. Although most of these type 2 children may not need lifelong

insulin treatment (unlike their type 1 counterparts), the possible side effects of chronic intake of oral antidiabetic medications have to be taken into consideration. The newer medications have not been approved for use in people below 18 years old. Hence, the importance of lifestyle modification, dietary changes, and a physically active daily routine cannot be over emphasized, these changes need to be instigated at the earliest age possible. Because of the premature onset, type 2 diabetes in the young should be considered a serious disease in children and adolescents. These young diabetics will be living longer with diabetes and its potential complications-complications that may involve the eyes, nerves, kidneys, heart, and brain.

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Monogenic diabetes

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Types 1 and 2 diabetes are polygenic, meaning multiple gene changes may be involved in increasing the risk of developing diabetes. There is another form of diabetes which results from a single gene mutation (where a transformation or alteration in only one gene results in the development of diabetes). This is classified as monogenic diabetes. Monogenic diabetes accounts for only one to two percent of all diabetes in the young, and this may be inherited or may develop even in the absence of a family history. Types of monogenic diabetes include Permanent or Transient Neonatal Diabetes (where the diabetes is diagnosed before six months of age); or Maturity-Onset Diabetes of the Young (MODY). Diagnosis and presentation may be very similar to types 1 or 2. Certain tests like antibody testing or C-peptide levels may help differentiate type 1 from monogenic diabetes. But in most case, genetic testing is the key to specific diagnosis. Because genetic testing is not easily available and affordable, your doctor will only consider doing additional tests if suspicion is high. Some

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indepth of these features are: (1) Diabetes diagnosed in the very young (< six months of age), (2) Familial diabetes with an affected parent, (3) Mild elevations in the fasting blood sugar levels, and (4) other features as part of a genetic syndrome (such as blindness, deafness, and certain movement disorders). Some forms of monogenic diabetes may not require insulin, or even milder forms may not require medication. A correct diagnosis with the proper management should lead to better glucose control and lesser complications, as well as to further testing of other family members at risk.

meals with two or three snacks depending on their insulin regimen and their activity levels. It is recommended that the whole family eats the same meals since a healthy diet is the same for everyone, whether or not they have diabetes. Sweets, in moderation and when accompanied by appropriate insulin dose, are not anymore taboo in these children. Exercise is important in all growing children. Since physical activity lowers the blood sugar, an extra snack of bread, juice or carbohydrates may be given before engaging in any sports activity. Good glucose control is important in order to avoid the complications that may develop as the length of time of diabetes increases. Hypoglycemia or low blood sugar levels also need to be avoided as these episodes can impact on the quality of life of the child. Having a child with diabetes at a young age can cause considerable strain on the parents as well as on the child himself. Access to multidisciplinary diabetes team can help in terms of proper diet and appropriate activity levels. Compliance with medications or insulin regimens and appropriate response to both the highs and lows (hyperglycemia and hypoglycemia) will require practice and patience. Monitoring blood sugar levels with a glucose meter and injecting insulin may need to be taught to the child himself as soon as he is at the appropriate age of understanding. Support from both the family, other caregivers, teachers and other staff in school and the diabetes medical team is essential for these children. D

Approach to all young patients with diabetes

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Although the specific type of diabetes is important for the proper medical management of all patients, certain key features apply to the treatment of all young people with diabetes. These include proper diet, exercise, and prevention of hypoglycemia. Frequent blood sugar monitoring with a glucose meter will greatly aid in better glycemic control and lessen complications and hospital admissions. Children should be eating three main

References: 1. International Diabetes Federation. Position Statement â&#x20AC;&#x201C;Type 2 diabetes in the young. Published online (www. idf.org) May 2008 2. Hattersley A. Multiple facets of diabetes in young people. Current Science 2002; Vol. 82, No. 3: 273-278. 3. Stoffel, M. Maturity-Onset Diabetes of the Young: Molecular genetics, Clinical Manifestations and Therapy. Principles of Diabetes Mellitus. Edited by Paretsky L. 2002. Kluwer Academic Publishers. 221-231 4. American Diabetes Association. Standards of Medical Care in Diabetes-2011. Diabetes Care 2011; Vol. 34: S11-61.

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s t n e m e l p p u s y r a

t e i d

n, M.D. . Capella .R D ra o n Leo By Maria

ore turning mility e r a le p o pe ilab betes andndition despite avaains ia d e v a h to co em , the fact artion of the diagnosed help manage this s s e e r n a e v le ti p c o ore pe ative therapies to ient data of effe he recent public the use of ore and m at altern . Despite insuffic supplements. T to e r o evidence ntht of diabetes”. m d s d e y r ie it an p ta m a li r ie “ e d d th use nts eme re is of standaprle will continue to014 stated that thessary in the managd dietary suppleme that peo etes Association 2pplements is neceost commonly use em Diab al su American, minerals and herband I listed down th vitamins se statements on hs about them. With the t the evidence say and wha

What are vitamins and other supplements? Complementary and Alternative Medicine (CAM) are products not considered part of conventional medicine and dietary supplements are among them . Dietary supplements are defined as “products taken by mouth that contain a dietary ingredient intended to supplement the diet.” These consist of vitamins, minerals, or herbs in the form of tablets, softgels and liquid. They are not considered drugs and fall under the category of food.

What are the commonly used vitamins, minerals and supplements? Hundreds are listed in nutrition and supplements books but I will choose the most commonly used suppelments:

motherandchild.co.uk

Aloe vera This tropical plant has been used in medicine for thousands of years. Aloe is taken by mouth either by APRIL-MAY 2014

indepth mixtures or tablets. It is believed that the gel’s active ingredients namely polysaccharide and glycoprotein can stimulate the body’s ability to transport excess glucose from the blood into the cells and tissues where it is needed. Some suspect it is because of its fiber content. Its effectivity has not been confirmed. There is no recommended dose. Side effects include low blood glucose level when taken together with medications for diabetes. Alpha lipoic acid is a vitamin-like substance called an antioxidant – a substance that protects cells from the damaging effects of oxidative stress. It’s produced in the liver and can be found in other foods like broccoli, potatoes, yeast, and animal liver. People with diabetes use alpha lipoic acid to treat nerve damage to the hands and feet. It has not been shown to prevent nerve damage as well as lower glucose levels. Typical doses are 600 to 1,200 mg daily. In numerous studies it has been found to decrease the symptoms of diabetic nerve damage when compared to placebo(dummy pill). No serious side effects have been reported but it may cause nausea, vomiting and vertigo. Banaba (Lagerstroemia speciosa) It is a type of crape myrtle that grows in the Philippines, Australia,

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India, and Malaysia. Its leaves are used to make an oral form of the supplement. Its active ingredients are thought to stimulate cells to take up glucose and work similarly to insulin. There are no large studies to prove its efficacy. No adverse reaction noted but it may lower blood glucose level if taken with diabetes medications. Benfotiamine (Vitamin B1) Vitamin B1, also called thiamine, is not absorbed by the body very well and high levels are needed for successful treatment. Benfotiamine provides a higher level of thiamine in the blood and tissue. This supplement may relieve the effects of certain diabetes-related complications such as neuropathy (nerve), retinopathy (eye) and nephropathy (kidney) diseases. This supplement enhances the activity of an important enzyme in the glucose metabolism called transketolase. This enhancing activity prevents glucose from being metabolized in a way that can cause damage. Numerous studies have been done in people with diabetes and neuropathy and noted minor improvements in nerve pains. It is a very safe dietary supplement. Bitter melon (Momordica charantia) Bitter melon (ampalaya) is a climbing plant with greenbumpy, cucumber-like fruits. It got its name from its signature bitter taste. Bitter melon contains several chemical

ingredients that are thought to lower blood sugar levels. Most clinical studies in bitter melon are small and inconclusive. Overall, bitter melon may be considered safe when eaten as vegetable, but is not consistently safe when used as a supplement form together with diabetes medication. Cinnamon is a trendy supplement for diabetes. Scientists claim that the active ingredients in cinnamon may increase insulin sensitivity. Though numerous studies did not consistently show cinnamon lowers blood sugar levels there were some which showed high cinnamon intake is effective in lowering glucose levels. Side effects are rare which include skin irritation. Cinnamon also may contain a blood thinning chemical; bleeding may occur if taken with blood-thinning agents. In theory, cinnamon may lower blood glucose if combined with diabetes medications. Fish oil (Omega-3-fatty acids) There are two sources of omega 3 fatty acids: plant oils and fish oils. Fish oils contain the fatty acids eicosapentoic acid (EPA) and docosahexanoic acid (DHA). Good sources are salmon, trout, halibut, mackerel, tuna and sardines. Fish oil has shown more cardiovascular benefits than plant oils. And they are well-known to treat cardiovascular disease and specifically high cholesterol and triglycerides. There were

indepth some claims of fish oil in preventing type 2 diabetes but studies are insufficient. Side effects of fish oil include fishy aftertaste, belching, bad breath, heartburn and loose stools. Stevia (Stevia rebaudinia Bertoni) This is a food sweetener which came from stevia plant – a small, shrubby perennial that bears small white flowers. It grows in Brazil, Central America, Southeast Asia and China. Of all the sweeteners, stevia is 200 to 300 times sweeter than sugar, while aspartame (Equal) is 200 times sweeter than sugar and sucralose (Splenda) is 600 times sweeter. Stevia does not have any calories. In some Asian countries, stevia is used in soy sauce, pickled products or dried seafood to diminish the salty taste. It is used as a sweetener and may lower blood glucose and have antihypertensive as well as antiinflammatory effects. Stevia was approved for use in Europe and in Russia. The US FDA did not approve the use of whole–leaf stevia because of some concerns on reproductive, cardiovascular and renal effects of these supplements. Our own FDA has no clear approval on its use, but I saw different foods approved by the FDA containing stevia. Side effects noted were nausea, bloating, dizziness, headache, weakness and muscle pains. Vitamin D (cholecalciferol) This is a fat- soluble vitamin that plays an important role in the body including maintaining the health of your bones, teeth

and joints and assisting immune system function. Signs of Vitamin D deficiency can range from bone pain and muscle weakness to depression and weakened immune system, while longer term deficiency can be seen in obese persons, psoriasis, osteoporosis, chronic fatigue syndrome, Alzheimer’s, diabetes mellitus types 1 and 2. Numerous readings claim that if corrected there is improvement of well-being but showed conflicting results as far as preventing diabetes or improving glucose control. Vitamin E is an essential nutrient that is found naturally in foods such as poultry, eggs, fruits, cereal grains. Vitamin E comes in different forms, and the primary form used for supplements is alpha-tocopherol. This vitamin is used as a supplement in the following conditions: aging, inflammatory skin conditions, Alzheimer’s and Parkinson’s diseases. Although vitamin E was originally thought to benefit diabetes, it has not consistently been shown to improve blood glucose levels or patients’ heart conditions. A recent study showed an increased rate of death with use of vitamin E doses of more than 150 IU daily. Side effects with this vitamin is rare but some include stomach upset, weakness, headaches, blurred vision, and rash. Higher dosage of vitamin E (more

than 400 IU) showed association with heart failure and bleeding. In summary, all these supplements came from natural food products and end results of taking them showed some promising but inconclusive results as to improving glucose control. Supplements should not be used as sole treatment for diabetes but may be used in conjunction with diabetes medicines. Precautions should be taken because some supplements might have untoward reactions with some medications you are taking. Take-off points for patients to ask their doctors before starting on a supplement: 1. Is there any evidence that this supplement can improve my diabetes control and my health? 2. Is there reliable research about the supplement’s benefits? 3. Is it known whether this supplement is safe for me? 4. Could this supplement interact with any other medicine I take or medical conditions I have? 5. How much should I take and how often? 6. Are there any known side effects that I should be aware of? 7. Are there situations when I should stop taking it? 8. How can I tell if the supplement is improving my health? D

Online Resources for Dietray Supplement Information: ConsumerLab.com: www.consumerlab.com. Natural standard: www.naturalstandard.com. National Center for Complementary and alternative medicine: www.nccam.nih.gov. Office of Dietary Supplements, National Institute of Health: http://ods.od.nih.gov. Food and Drug Administration, Department of Health: www. bfad.ph. American Diabetes Association Standards of Care.Diabetes Care vol.37, Supp 1, Jan. 2014 S5. Dietary Supplements Health and Education Act of 1994 of the United States. American Diabetes Association Guide to Herbs and Nutritional Supplements by Laura Shane- McWorter, 2009.

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s e s s e n l l i r e m m r o Su f t u o h c t a w o t D e Jesus, M Ejercito-D a n e w o R By

un? nder the spools or plan u n fu g in nd hav e nd it than d hit the beaches a e p s ded favortit to w o y r a c n w a in r s t e e u tt a attir t be e th ng o e and whuat on our swimminxgcursions, or just hartant for us to realizd. r e h is r e o e p hin umm before weutdoor picnics andment parks, it is imspmay not be far be r, e v e w o H r those o malls and amuse er-related illnesse potlucks fo laces like er, summ summer pst around the corn er ju with summ

For people with diabetes, the heat of summer can pose many challenges to good health. If you have diabetes, you need to take extra care. It is important to plan your vacation time and take special precautions to protect against the common illnesses that come with summer. Here, we will discuss the more common summer illnesses, namely dehydration including heat exhaustion and sunburns, food-borne illness, swimmer’s ear (otitis externa), and infectious conjunctivitis (sore or pink eyes) and how to keep them from ruining your perfectly planned vacation. Factors that can contribute to dehydration include:

Symptoms of dehydration are:

• Insufficient fluid intake • Hot weather • Strenuous exercise activity with excessive sweating • High blood glucose levels • Alcohol drinks • Diarrhea • Vomiting

• Thirst dry mouth and eyes • Dizziness tiredness • Reduced sweating concentrated and decreased urine

Dehydration and heat-related complications

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Summer time with its high temperatures and high humidity may affect control of blood sugars. Dehydration occurs when more body water is lost than replenished. Severe dehydration with loss of electrolytes may present with low blood pressure, sunken eyeballs, and weak rapid pulse. This can lead to organ damage and result in lethargy, confusion, coma, or death. This can affect any person, but APRIL-MAY 2014

indepth those with diabetes face more challenges in maintaining hydration during the hot weather especially for many who want to continue their outdoor activities, which play a vital role in managing diabetes. People with diabetes can become dehydrated quickly. Heat has been known to elevate blood glucose, which in turn, can increase the body’s excretion of urine resulting in further loss of body water. Sometimes, they do not know they are being overly exposed to heat because their

nerves for sensation may be impaired and the action of their sweat glands may be reduced. People with diabetes can suffer heat complications a lot faster than those without diabetes. Prevention of dehydration is crucial during the hot steamy months of summer. Staying well-hydrated can help prevent fluctuations in blood sugar levels and avoid serious complications such as heat exhaustion or heat stroke.

are not taken. • Keep hydrated. Take plenty of water. Don’t wait until you are thirsty. Always carry a bottle of water with you at all times. Avoid sugary drinks unless you have hypoglycemia. Limit caffeine and alcohol, which have diuretic effects. Keep in mind that with prolonged or excessive exercise, electrolytes such as sodium may also be lost and must be replaced as well. Popular flavored sports drinks may replace lost electrolytes but are also loaded with sugar and calories, which may not be advisable for hydration maintenance for people with diabetes. Try to go for zero calorie sports drink instead. If you have a condition that warrants limited fluid intake, consult your doctor on what to do during times of high temperatures to maintain hydration. • Exercise in a cool environment. Staying active is a pillar in the treatment of diabetes so plan your workout location and time of day. Use an air-conditioned gym or exercise in the water. You may also exercise early in the morning or later in the evening when the temperatures are cooler.

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• Check your blood sugars frequently. Monitor at least 4x/ day or more often if you are not feeling well. Remember that heat can cause erratic blood sugar levels. It can cause not only hyperglycemia but hypoglycemia as well since metabolism may be faster in hot and humid conditions. It may be difficult to identify hypoglycemic symptoms such as sweating and tiredness, which may be just be mistaken as due to hot weather. Serious complications can occur when hypoglycemic symptoms are disregarded. Carry fast-acting carbohydrates to treat hypoglycemia. • Know the signs of heat exhaustion especially if you are outdoors o Dizziness/fainting o Sweating excessively o Muscle cramps o Cold clammy skin o Headache o Rapid heart beat o Nausea If you experience any of these, move to a cooler environment, take plenty of fluids and seek medical attention. Heat stroke can cause death or permanent disability if emergency measures

• Limit sun or heat exposure. Use your air-conditioner or enter an air-conditioned building to stay cool. Discuss any plans of strenuous activity with your health care provider. • Protect your eyes, skin and lips. Sun’s UV rays can damage these organs. Stay in the shade between 10 am to 3 pm. Wear sunglasses that provide 100 percent UV protection. Use sunscreen with SPF of at least 15. Choose lip balm with SPF. Avoid sunburn because this may raise blood glucose levels. If with sunburn, get out of the sun and take a cool shower. Seek medical consult if burns blister. • Wear loose fitting lightweight, light-colored clothing and hat as protection. Use an umbrella if necessary. • Pay special attention to your feet. Do not walk barefoot especially on hot surfaces to avoid burns or blisters. Apply sunscreen to feet. Wear comfortable shoes. Stay out of polluted waters. Examine feet carefully for any signs of infection or injury everyday.

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• Wear or carry an ID stating you have diabetes. This may include other important

Food-borne illness As summer conjures up plans of outdoor picnics, and travel, exposure to variety of foods and food preparations subject people with diabetes not only to the temptations of unhealthy diet but also to higher risk of food poisoning and infectious gastroenteritis. Diabetes impairs the immune system, making the person susceptible to infection. The immune system in diabetes may not immediately recognize and respond to harmful bacteria. Diabetes affects the gut by damaging acid -producing cells in the stomach and by delaying food transit due to nerve damage along the gastrointestinal tract allowing longer contact with contaminated food. This can encourage growth of pathogens.

information such as your doctor’s information, emergency contact numbers, or list of medications. Dehydration can be treated by taking in more water. If it is severe, you will need medical help to replenish water and electrolytes lost. In people who are insulin-dependent, very high blood glucose levels result in dehydration and high levels of ketones (ketoacidosis), which may lead to diabetic coma.

High blood sugar levels can directly suppress the WBC function, thereby prolonging the recovery process. For a person with diabetes, contracting a food-borne illness may impact hugely on blood glucose levels due to infection, stress, and possible dehydration and to the kind of foods that the patient can and cannot eat at that time. Since food-borne illnesses can be serious or even fatal, it is important to pay close attention to food safety practices in handling, cooking, and cleaning food properly to avoid a summer disaster. Follow these basic practices for food safety: • Clean. Clean. Clean. Wash your hands frequently before preparing, handling, eating and storing foods. Keep surfaces (cutting boards and kitchen counters) clean and dry at all times. Ensure dishes and utensils are clean and dry. • Separate cooked or ready to eat foods apart from raw foods. Avoid cross contamination. • Cook animal products thoroughly to destroy germs. Pass on soft-boiled or over easy egg preparations because the yolk is not completely cooked.

• Keep cold foods cold and refrigerate and freeze leftovers right away. Never consume foods that have been sitting around. Heated foods should be served hot and chilled foods should be served cold. Don’t store leftovers for more than two-five days (depending on the food type). When in doubt, throw it out. • Rinse all fresh fruits and vegetables thoroughly. • Check the “sell-by” dates and expiry dates to make sure foods are safe to eat. • Be aware of symptoms of foodborne illness: fever, diarrhea, nausea, vomiting, abdominal cramps, headache, loss of appetite. Check your blood sugar levels frequently and get medical attention immediately.

Swimmer's ear If your summer plans involve swimming, beware of swimmer’s ear or otitis externa. This is an inflammation of the outer ear and ear canal, a common cause of earache. The ear canal skin swells and may become painful or tender to touch. The skin of the ear canal is closely attached to the bone and APRIL-MAY 2014

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• Store your glucometer, glucose strips and insulin in a cool dry place. Heat can damage your supplies. For those on the insulin pump, excess sweating may loosen the adhesive securing the infusion set. You may opt to apply antiperspirant over the adhesive area.

indepth can easily be abraded or torn by manipulation. The most common causes are excessive moisture and trauma. Prolonged water exposure as in swimming, and injury caused by attempts at self-cleaning or scratching with cotton swabs, finger nails, hair pins, keys and the like, can compromise the protective barrier of the ear canal allowing the bacteria to flourish. Symptoms of otitis externa include ear discharge, ear pain, hearing loss, and itching of the ear or canal. These symptoms can lead the patient to manipulate the ear canal with selfcleaning attempts, which can further lead to more damage and worsening of the condition. Immunocompromised patients, including those with diabetes, need to address this condition immediately and properly. If left untreated, this potentially life-threatening infection can spread to the surrounding tissues and skull bones and cause necrotizing or malignant otitis externa. Treatment is difficult and mortality rates are high. Strategies for prevention of swimmer’s ear include: • Avoid inserting anything into the ear canal, including cotton buds/swabs. Ear canals have their own natural way of cleaning and drying itself. • Keep ears clean and dry and do not let water enter the ears when bathing. • After prolonged swimming, you can dry your ears by using a small batteryoperated ear dryer or low flow hair dryer.

• When using earplugs during swimming, ensure proper fit and comfort to prevent injury. Used earplugs must be cleaned and dried properly before using again. Call your health care provider if you develop any symptoms of swimmer’s ear or if symptoms worsen or persist despite treatment or if new symptoms develop including pain and redness of the skull behind your ears.

Infectious conjunctivitis More commonly known as sore eyes or pink eye, conjunctivitis is an inflammation of the conjunctiva, the thin clear tissue that covers the white part of the eye and lines the inside of the eyelid. The three most common causes of this are infection (viral or bacterial), allergies, and irritants (e.g., eyelash, shampoo, dirt, smoke, pool chlorine). Infective conjunctivitis is highly contagious and can easily spread from person to person. Hanging out in crowded places can put anyone at risk to develop conjuctivitis, especially people afflicted with diabetes. Symptoms of pinkeye may differ based on the cause but may include redness of the eye or inner eyelid, increased amount of tears, thick yellow discharge that may crust over the eyelashes especially on waking up, eye itchiness, burning or foreign body sensation in the eye, blurred vision and increased sensitivity to light. Although conjunctivitis may not pose a serious health risk, people with diabetes are still urged to go see their eye doctor if they have any of the symptoms for proper treatment. To avoid spreading conjunctivitis:

• Avoid swimming in polluted waters. • Always wash your hands. • Avoid wetting or swimming if very mild symptoms of acute external otitis begin.

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• If you have the pink eye, do not touch the infected area with your hands.

• Do not share wash cloths, towels, pillows, or soap with anyone who may have the infection or if you yourself have it. Wash these towels and pillowcases frequently. • Do not touch the hands of, or any items that have been handled by a person with the infection. • Avoid using make-up which may be contaminated. Buy a fresh supply. • Take note of proper blowing of noses and cover your nose and mouth when coughing or sneezing. • For conjunctivitis caused by allergens or irritants, wear goggles when swimming and avoid smokefilled rooms With proper planning, good preparations and taking special precautions, there is no reason why anyone, including people with diabetes, cannot have fun in the sun. Have a good and healthy summer, everyone! D

1. Joslin Guide to Diabetes online 2. American Diabetes Association 3. www.diabetes.co.uk 4. www.fda.gov 5. www.foodsafety.gov 6. www.aafp.org 7. www.nlm.nih.gov 8. emedicine.medscape.com 9. www.nhs.uk

indepth

n e r d l i h c n i s e t e s Diab d e e n l a i c e p s h wit Sc a, MD, M an C. Cu o s k io S y B

1) Who are the children with special needs? The children with special needs include those with “syndromes” like Down syndrome, Prader- Willi syndrome, or those with developmental delay or mental retardation, autism and other learning disabilities.

2) How is diabetes diagnosed in children with special needs? Diagnosis of diabetes mellitus is based on blood glucose levels. The cut-off point of blood glucose is the same for all children, including those with special needs. Diabetes mellitus is diagnosed when a child has a fasting blood glucose value more than 7 mmol/L or 126 mg/dl, or after meals random blood glucose more than 11 mmol/L or 200 mg/dl. A blood HbA1c test result of more than 6.5 percent can also be used to diagnose diabetes mellitus.

3) What are the signs and symptoms of diabetes in children with special needs? Diabetic children with special needs, like any other diabetic children without special needs, generally present with frequent urination, bed-wetting after toilet-training, incessant thirst, excessive drinking and weight loss in non-emergency setting. In female adolescents, whitish vaginal discharge with itchiness may be noted. The children with high blood glucose may have recurrent skin infections. Another symptom is irritability; however, because they are “special,” it can be misinterpreted as a behavioral problem with delay or no immediate medical consultation. If high blood glucose persists APRIL-MAY 2014

indepth without timely treatment, the children may have vomiting, stomach ache, and severe dehydration. They can be found “sleepy” most of the time. They can also present with flushed cheeks, rapid breathing with a sighing quality and acetone smell. Difficulty of breathing will prompt the parents or caregiver to bring them to the hospital emergency room.

4) How can diabetes be better treated in them?

Children with Down Syndrome are at risk to have “autoimmune diseases” including type 1 diabetes and thyroid disorder like chronic lymphocytic thyroiditis. Children diagnosed to have type 1 diabetes mellitus, the type of diabetes with insulin deficiency, require insulin therapy. Some children with special needs are obese and can develop type 2 diabetes mellitus; in such cases, they do not have absolute deficiency of insulin but their insulin hormone is not working properly. The important cornerstone of treatment is “healthy lifestyle” - “eating right” and “moving more” in order to attain “healthy weight.” They need to eat a balanced diet including fiberrich food like vegetables. They should be taught and encouraged to have physical activity. Generally, they need oral medication to lower blood glucose.

5) What are the tips for coaxing these children to take their medications like insulin, check blood sugars, follow their meal plan, and visit the physician? A. Application of local anesthetic cream at the injection site about 30 to 60 minutes before insulin injection; B. Use of “Divert attention” technique – someone shows a favorite toy to get the child’s attention while another person gives the injection; C. Positive reinforcement for good behavior – hug, kiss, praise, or clap hands for compliance and “a job well done”; D. Use of “colors” and “flash cards” showing vegetables to make the children familiar with colorful vegetables which are introduced initially in small amounts and gradually increased after the tastes become more acceptable;

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E. Bringing along some favorite toys and books when visiting the physician and most importantly, never threatening the children at home by such remarks like “If you do not eat or do so, I will inject you or bring you to the doctor for……”

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We need to be more understanding and patient when dealing with children with special need. Adults should avoid making confusing and contradicting comments. What we say and do should be consistent.

indepth Here are some findings of medical studies and researches which may be useful or interesting to know.

A review of 1,105 children and adolescents (18 years or less) with Down syndrome in a hospital in Spain showed that thyroid problem is the most common endocrine pathology, followed by type 1 diabetes mellitus. Some of the children with Down Syndrome were overweight (28.2 percent) or obese (16.9 percent). The prevalence of endocrine comorbidities in children and adolescents with Down syndrome is higher than in the general population.2

The prevalence of Down Syndrome in Denmark population was 0.09 percent, whereas a prevalence of Down Syndrome in type 1 diabetes patients was 0.38 percent (95 percent CI 0.17-0.75), corresponding to a 4.2fold increased prevalence compared with the background population. A more than fourfold increased prevalence of Down’s Syndrome among type 1 diabetes patients supports the notion that genes on chromosome 21 may confer risk for type 1 diabetes, probably also in the general population.4

Increased risk of infantile autism was observed for children with a family history of type 1 diabetes. The observed associations between familial autoimmunity and autism spectrum disorder (ASD)/ infantile autism are probably attributable to a combination of a common genetic background and a possible prenatal antibody exposure or alteration in fetal environment during pregnancy.5

Several genetic syndromes are associated with diabetes mellitus. Longitudinal data for patients with diabetes onset at age younger than 20 years were collected from 309 treatment centers in Germany and Austria. The top three syndromes associated with diabetes were Down Syndrome, Turner Syndrome and Prader-Willi syndrome.1 Data for 159 Down Syndrome patients with diabetes (<20 years old) and 41,983 young type 1 diabetic patients without Down Syndrome were compared. The former used less insulin, but showed better glucose control (HbA1c). Diabetes onset during the first three years of life occurred in 18.9 percent of Down syndrome patients with diabetes and in 6.4 percent of young type 1 diabetic patients. The ageof-onset distribution showed a shift towards younger ages and was bimodal in the Down Syndrome group. The better metabolic control found in Down Syndrome children with diabetes, despite intellectual impairment, was likely due to a less complex lifestyle. The presence of beta cell autoantibodies supports an autoimmune cause of diabetes in some children with Down Syndrome.3

Over the last years, studies suggest an association

between type 1 diabetes mellitus and autism spectrum disorder (ASD). Doctors and children with diabetes and ASD have to face challenges. The key to effective treatment is its individualization connected with proper education of the patient and his caregivers.6

The metabolic effects of oral blood glucose lowering medication on glycemic control and eating behavior were investigated in type 2 diabetic subjects with mental retardation who were habitual overeaters and had difficulty in controlling their appetites. Metformin may have beneficial effects not only to control glycemia but also to correct eating behavior in obese type 2 diabetic patients with the difficulty in controlling their appetites. The improvement was related to the reduction of insulin resistance and serum leptin levels.8 D

The beneficial effects of Exenatide in weight reduction and appetite

suppression provide a promising strategy for the treatment of obesity and diabetes mellitus in Prader-Willi syndrome.7

Reference: 1 Schmidt F, et al. Diabetes mellitus in children and adolescents with genetic syndromes. Exp. Clin Endocrinol Diabetes. 2012. 2 Regueras L, et al. Endocrinological abnormalities in 1,105 children and adolescents with Down syndrome. Med Clin (Barc). 2011;136(9):376-81. 3 Rohrer TR, et al. Down’s syndrome in diabetic patients aged <20 years: an analysis of metabolic status, glycaemic control and autoimmunity in comparison with type 1 diabetes. Diabetologia. 2010;53(6):1070-5. 4 Bergholdt R, et al. Increased prevalence of Down’s syndrome in individuals with type 1 diabetes in Denmark: A nationwide populationbased study. Diabetologia. 2006; 49(6):1179-82. 5 Atladóttir HO, et al. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics. 2009;124(2):68794. 6 Kaminska H, et al. [Diabetes type 1 therapy individualization among children suffering from autism spectrum disorder]. Pediatr Endocrinol Diabetes Metab. 2011;17(2):113-6. 7 Seetho IW, et al. Treating diabetes mellitus in Prader-Willi syndrome with Exenatide. Diabetes Res Clin Pract. 2011; 92(1):e1-2. 8 Komori T, et al. Metformin ameliorates treatment of obese type 2 diabetic patients with mental retardation; its effects on eating behavior and serum leptin levels. Exp Clin Endocrinol Diabetes. 2004;112(8):422-8.

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orewa.org

goodfoodguide

Healthy Snacking with Diabetes Munch into healthy snacks in the right proportions that will still make any diabetes By Joy Rabbie Catungal patient feel full without shooting up their blood sugar levels

n diabetes nutrition, snacking is eating light and simple meals between main meals to bridge the gap, avoid hypoglycemia, or simply lower the blood sugar. The components of a snack mostly comprises of 100-200 calories, correlative of one serving of complex carbohydrates (bread, pasta, crackers, root crops, etc.) and healthy fats (olive oil or other healthy oils, some nuts, avocado, etc.). Snacks with vegetables helps in making food feel heavier, therefore convincingly making your stomach think itâ&#x20AC;&#x2122;s full. Good snacks can also help you hold off your big appetite until the next meal. Word to the wise, avoid fast food meals especially during snacks because these contain very high Portion

Snack

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levels of calories and bad fats that could add up to excess and unnecessary caloric intake. One fast-food meal may even have the total caloric intake a person consumes in a day! Sweet and salty snacks may tend to make us eat more than what we need, leading to excessive intake and weight problems. Portion control is recommended for healthy snacking. Divide food into smaller plates, which can really teach a person discipline over food. Healthy snacking means having a balanced appetite and well-controlled blood sugar. Below are some examples that kids and adults may enjoy eating during snack time. D Portion

Snack

goodfoodguide

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Mona Louise Rey is nine years old and she has diabetes [c

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Type 1 Diabetes Mellitus, in fact.

While most children, whom Hippocrates himself said are quick in

feeling but weak in judgement, almost carelessly taste everything the world has to offer, she takes things slower and carefully judges every step she takes.

This is Mona Louise Rey: young, bubbly, and responsible for herself. At nine years old, she injects insulin on her own, works several acting jobs, knows all the Victoria’s Secret models by name, cooks sinigang, and inspires other children with diabetes to fight back a disorder that not even doctors can pinpoint the beginnings.

Dr. Marsha Tolentino, past president of American Association of Clinical Endocrinologists Philippine Chapter, explained in an article published in DiabetEASE some time ago that type 1 diabetes is an autoimmune disease which attacks the pancreas rendering it unable to produce insulin and that most children with the condition do not have a family history of diabetes. Meanwhile, Dr. Patricia Borromeo in her DiabetEASE article entitled Sugar Babies: A Look at Type 1 Diabetes Mellitus explained that while diabetes can be inherited, it is not the usual case for type 1 diabetes. In fact, aside from genes, type 1 diabetes can be triggered by environmental stimuli. “Scientists do not know what all these triggers are. There is evidence that some kinds of viral infections can act as a trigger. As the body fights off the infection, it produces antibodies that end up attacking not only the virus but the beta cells of the pancreas as well,” Dr. Borromeo wrote. This is the case with Mona Louise Rey who wonders with her mother where her diabetes came from.

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“No one had it in my family. No one had it from my siblings or from my mother. I could not pinpoint where it came from,” said Mommy Fatima, Mona’s mother. They did not disclose whether there's diabetes in Mona's Father's side. What’s even more puzzling for Mommy Fatima was that diabetes never showed on the blood test that Mona took before she entered showbusiness when she had amoebiasis. Because of the pervading uncertainty that even Mona’s doctor had, Mommy Fatima came up with her own speculation of where it came from. It was the iced tea. “During the Munting Heredera taping, I only found out around October or November of that year that the one packet (of iced tea) that is supposed to be for one liter was mixed in only 250 mL,” she said. “There is a big difference because she drinks around seven glasses a day. What is supposed to be diluted for one liter is done in a small mineral water bottle. There are times she could not drink water.”

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When Mona was diagnosed with diabetes, her blood sugar level was at 658 mg/dL. She was only 7 ½. “They (mom and the doctor) just told me I had diabetes. Then they told me that I had to inject myself, but there are times I don’t have to do it anymore because of my maintenance. They told me I could die of it so I need to be prepared,” Mona said. Her blood sugar has since gone down to around 80 mg/dL as she has learned to constantly monitor herself. On hand at all times are chocolates and soft drinks to control her blood sugar. She’s allowed to eat anything but in moderation. “She eats the food we eat. But what I do is I make ampalaya juice for her. She can eat anything she wants provided it’s in small servings. In the morning she has a coke or chocolates because her blood sugar would go down and she would have to eat or drink something sweet,” her mom said. Mona is not a fan of white rice unlike regular Filipino kids who, according to the Food and Nutrition Research Institute, eat about a cup and a half of white rice. Her weakness though is lamb chop, which can make her eat more rice than usual. Mommy Fatima also gives Mona fruits except mangoes and grapes. On Mona’s cheat days, she asks for fast food. “She would request for Jollibee or McDonalds. I would help her extract ampalaya together with vegetables such as celery, carrots, and cucumber. And I would cook her vegetables. The good thing about her is that when it comes to vegetables, she eats them,” said her mom.

Mona Louise Rey is probably the most recognized Filipina young star living with type 1 diabetes as her celebrity seemingly came alongside the diagnosis. Born Mona Marbella Al-Alawi, she is the daughter of a Filipino mother and Bahraini father. The youngest of four siblings, the family moved back to Manila after her parents separated. With her fair skin and doll-like features, it was only a matter of time when the nine-year-old Mona would be discovered in commercials which led to a contract with GMA Artist Center, which has been managing her career for three years now. In three years, Mona has starred in five soap operas, including Munting Heredera, Luna Blanca, Aso ni San Roque, Bukod Kang Pinagpala, Carmela, and Villa Quintana, and worked with the likes of veteran actresses like Gloria Romero and Camille Prats. Of all her roles, her favorite is the role of a young Carmela. “I liked Carmela because it’s a very challenging role. The show teaches you how to be a fighter in life because Carmela is a very

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strong woman and does not give up easily,” she said. As a child actress, Mona has proven herself ready for the professional role as she is willing to do anything for her roles including being thrown into a well, crying on cue, and feigning fear. But for her role in the horror sleeper hit movie, Basement, she wasn’t feigning fear. She was actually scared. “What you saw was my natural reaction,” she said about her role in the movie. Like girls her age, Mona loves to play with dolls, dress-up with her sisters, and being with her family. She is close to her sister Maria and as seen on the numerous photos on her Instagram, they bond as much as they can. Unlike other stars who defer their education, Mona prioritizes her studies as a grade four student. Although it can be quite difficult, Mona tries to manage her time balancing work and school. “If I have taping, I don’t have any other choice but to be absent. If I miss an assignment or project, I just do it at the house,” Mona said.

"Siyempre may sakit ako, may sakit sila. It inspires me kasi po kahit may sakit sila hindi pa rin sila sumusuko. And nilalakasan ko po din ang loob nila." APRIL-MAY 2014

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ver story ] But having diabetes has not dampened Mona’s spirits. Like any child, Mona is hyperactive, energetic, bubbly, and charming. She looks at her condition in a positive way because for the past two years, she has been celebrating her birthday with kids with diabetes at the Institute for Studies on Diabetes in Marikina. She would join games, render song numbers, and take time talking with them about her struggles of having diabetes. Mona said that she is grateful to be an inspiration to kids like herself who are fighting the condition. “Siyempre may sakit ako, may sakit sila. It inspires me kasi po kahit may sakit sila hindi pa rin sila sumusuko. And nilalakasan ko po

din ang loob nila. (Of course I am sick and so are they. It inspires me that even if they have the condition, they don’t give up and I inspire them as well with my story).” She added: “Our condition should not hinder us from reaching our dreams and what we want in our lives. I always tell them never to lose hope.” Mommy Fatima recalled a time when Mona asked why she had to suffer the condition, she would remind her that she is still very lucky to be alive. “I would tell her ‘you are still lucky because you can control your diabetes because you have maintenance unlike cancer patients, who one day are alive then the following day are gone,’” she said.

Indeed, diabetes has not hindered Mona from achieving her dreams. In a span of three years, she has starred in several hit shows and has earned her star on GMA’s Walk of Fame along EDSA. She is aware that diabetes is a lifelong condition, but Mona’s gambit is to remain positive that the time will come when she can tell the world that she is diabetes-free. “Hindi pa rin ako nawawalan ng pag-asa, still praying, still hoping na sana one day gumaling po ako kasi with God naman po nothing is impossible. Di po natin alam na malay po natin one day pagalingin niya tayo. (I have not lost hope, still praying, still hoping that one day, I will get well because with God, nothing is impossible. We don’t know but maybe one day, he will make us well),” she said. Hippocrates also said that the youth are easy to deceive because they are quick to hope. Mona’s gambit is one where she can live life with positive optimism rather than die wretched and hopeless. Hippocrates should have applied his own lecture on disease to his belief on the youth as well: "Men believe only that it is a divine disease because of their ignorance and amazement." Too bad Hippocrates never knew Mona. He would have been amazed. D

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Cardigan by Bayo | Dress by Max Santos

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productspotlight

n o e c A Pie reads

B e e r F Sugarumaraos Ruth R. D By Gelyka

ary a Filipino table is left without a piece of bread waiting for breakfast and merienda. Coupled with a spread and hot coffee, breads of every variety â&#x20AC;&#x201C; be it bun, slice, sugar-free, wheat, or pandesal â&#x20AC;&#x201C; can certainly take a hungry stomach to bread nirvana. But breads have been quite a dilemma for people living with diabetes. On picking breads, Diabetes UK suggests avoiding white breads in favor of grainy kinds. White breads

are rich in starch, which acts like sugar in the body that slows down glucose control. On the other hand, grainy breads will contribute to the control on blood sugar levels because of its slower absorption aside from providing the essential energy and nutrients for the body. DiabetEASE slices through the bread aisle of your local grocery for sugar-free bread choices good for maintaining a healthy and balanced diet with or without diabetes.

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productspotlight Walter Sugar-Free Wheat Bread

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Walter uses isomalt as its natural sugar replacer for this bread, making it tastier than what other breads with artificial sugar content offer. This wheat bread is high in fiber and low in glycemic carbohydrate, suitable for people who want to reduce weight and keep fit.

Breakfast will always be perfect with a couple of hot pandesals. Walter’s sugar-free delicious offering is rich in calcium, iron, protein, and vitamin A, ideal for boosting your body’s energy as you start your day with work or school.

Nature's Own Whole Grain Sugar-Free Bread This bread gives you 100 percent whole grain in just a single slice and a definitive good source of fiber, providing you with the energy and nutrition that your body needs. It does not have any artificial preservatives or high levels of fructose corn syrup.

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Gardenia Sugar-Free 12-Grain Loaf

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Good for a hearty lunch or a light dinner, this contains an array of 12 high quality grains and seeds that protects the body against cancer, diabetes, and heart diseases. It also has protein, calcium, and iron that effectively provides the body with many nutrients sans the cholesterol and the sugar.

Health buffs consider this bread to be one staple food for alleviating the risk of diabetes and heart diseases as it is high in fiber and has no trans fatty acids and cholesterol. Marby’s Sugar-Free Bread is also rich in protein.

livingwell

Diabetes is a Piece of Cake Rosario de Leon shows the world that diabetes patients can have their cake and eat it, too - in moderation, of course.

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By Candice Monique O. Brillon

f life were cake, Rosario de Leon’s life would be flavored bittersweet and sprinkled with diabetes. A nurse by profession, Rosario never imagined that she would be diagnosed with type 2 diabetes. "I decided to take my annual check-up last year. I didn't notice any symptoms. I just found out about it after my annual check-up last year and after seeing the results of the lab exam," she said. Even if it was the most shocking news of her life, Rosario doesn’t feel bad about it. It was a struggle at first to comply with the medication and food intake. Eventually, she adjusted to her new lifestyle. "Having diabetes did not stop me from doing my daily activities. I can still do the things that I have been doing ever since. I can still clean the house, go to work, and exercise. Diabetes wasn't that much of an obstacle," she said.

Safe haven Lemery, Batangas was a safe haven for Rosario and her whole family. Growing up and living in a peaceful environment added a splash of serenity and peace to a patient’s life with diabetes.

Rosario obtained her Master of Arts in Nursing (2000) at Battings State University, and graduated with Bachelor of Arts in Nursing (1978) at Philippine College of Science and Health. A supportive husband like Marine Engineer Eusebio de Leon, 61, and her five children – Maria Toni, John Aldrin, Maria Isabel, Anthony Nash, Josephus Ton, and Angelo Roque – give Rosario a bite of strength every waking day of her life. "They eat whatever I eat and all of us do exercise. We're not always together so we exercise individually during our free time," Rosario said. Rosario finds slices of happiness on important family occasions and holidays were she spends special moments with her whole family. It lessens worries on living with diabetes.

Equal cuts Diabetes can be a piece of cake for Rosario through medication, proper nutrition and maintenance of sugar level. It’s a good thing diet was never a problem for 55 -year- old Rosario. Her secret is to maintain balance in anything she eats. "I always need to have vegetables and lean carbohydrates on my diet. I don't drink soft drinks, but APRIL-MAY 2014

livingwell I can still eat what I want. I just have to remember to not eat too much of it frequently," she said. Balancing work, maintaining a happy family, and having a good relationship with co-workers is important for Rosario. Time management is essential to keep her different roles smooth-sailing. Harmonious relationships with people create a fulfilling personal growth. Having diabetes can be managed easily through the positive people around her.

Bite-size fun Diabetes has taught Rosario how to infuse fun into her life's secret recipe. Reading romance novels while listening to pop songs gives her zest to overrule diabetes. It became an optimistic way of life despite her busy schedule as a nurse. An avid fan of Judy Ann Santos, Sandra Bullock, and Julia Roberts, she is mesmerized by films like “Notting Hill” and “Don't Give Up on Us.” Rosario's light approach to diabetes came from her colorful childhood memories, which she passes on to her family. "There was a time when I was a child…my parents and I would annually go to Baclaran to attend the mass. My parents and I would always eat puto bumbong for our breakfast and lechon for our lunch. Until now, I go to Baclaran with my whole family annually," she recalls.

Icing on the cake

Discipline during food intake and keeping a healthy and happy lifestyle is vital for a sumptuous

revenge against diabetes

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"I want to witness my children finish their studies, have their own successful careers and live a happy life," Rosario said. Rosario's selfless love for her family transcends to a devotion that only a mother can have. "I pray that I will always have good health so that I can take care of my family and see their future triumphs," she said. She believes that diabetes should not be a hindrance rather an opportunity for self-realizations and discovery. "Discipline during food intake and keeping a healthy and happy lifestyle is vital for a sumptuous revenge against diabetes," she said. Being diagnosed with a lifetime disease like diabetes is not the end of one's journey through life. Diabetes is a piece of cake for her. Rosario can have her cake…and eat it, too. D

righteousrecipes

Diabetic picnic-ready By Chef Junjun de Guzman Photos by Jose Martin Punzalan

iabetes is no picnic, but the food can certainly be as delicious. We round up three picnic-ready recipes to get anyone hungry for more.

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righteousrecipes Nutrition facts per serving: 224.5 calories 17.5 g fat 14.5 g carbohydrates 2.5 g protein

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righteousrecipes

Potato and vegetable salad Serves 4-5 persons

Ingredients 6 pcs 2 pcs 10 pcs 1 pc 2 tbsps 2 stems Âź cup 2 tbsps 2 tsps

Potatoes, washed and boiled until soft Carrots, peeled and cubed String beans, cleaned Onion, finely chopped Parsley, finely chopped Celery, deveined and sliced Extra virgin olive oil White wine vinegar Mustard

Procedure 1. Peel and cube potatoes. Set aside. 2. Boil carrots until soft. Boil string beans until soft and slice into 1- inch pieces. 3. Toss potatoes, carrots, and string beans. Add parsley and celery. 4. Mix extra virgin olive oil, vinegar, and mustard. Season with salt and pepper. 5. Toss vegetables with dressing. Refrigerate and serve cold.

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righteousrecipes Nutrition facts per serving: 251 calories 20.4 g fat 32 g carbohydrates 18.2 g protein

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righteousrecipes

Three-mushroom tortillas with tomato salsa Serves 4 persons

Ingredients Meat and Mushroom Base 4 pcs Whole wheat tortilla, warmed ¼ cup Extra virgin olive oil 2 tsps Garlic, finely chopped 2 pcs Onions, sliced 200 g Ground chicken breast 400-450 g Fresh mushrooms, sliced Salsa Dressing 2 pcs Native tomatoes, diced and finely cubed 1 pc Onions, finely chopped 1 tbsp Extra virgin olive oil 1 tsp White wine vinegar ¼ cup Cilantro, finely chopped

Procedure Meat and Mushroom Base 1. Sauté garlic and onions in oil. 2. Add in ground chicken breast and cook until brown. Season with salt and pepper. 3. Add in mushrooms and cook until juices are released. 4. Season with salt and pepper. Set aside. Meanwhile, make tomato salsa. Salsa dressing 1. Mix all ingredients in a bowl. 2. Let rest for a few minutes. 3. Serve with mushroom tortilla. APRIL-MAY 2014

righteousrecipes Nutrition facts per serving: 304.2 calories 12 g fat 44.26 g carbohydrates 2.52 g protein

APRIL-MAY 2014

righteousrecipes

Salmon fusilli Serves 5 persons

Ingredients Âź cup Extra virgin olive oil 1 tbsp Garlic, finely chopped 1 pc Onion, sliced 1 can Salmon in brine 3 tbsps Capers, rinsed and finely chopped 2 tsps Lemon zest, finely chopped 2 tsps Lemon juice 400 gms Fusilli, cooked al dente

Procedure 1. Heat extra virgin olive oil in a pan, add garlic and onions, and cook until onions are translucent. 2. Add salmon and spread out into flakes. Cook for two minutes. Add in lemon zest and lemon juice. 3. Toss into cooked fusilli. Add some water or stock to moisten the pasta. 4. Serve immediately.

APRIL-MAY 2014

righteousrecipes

APRIL-MAY 2014

stressbuster

Staycation strategies

Staying at home can be as relaxing as a full-blown vacation. You just need the right strategies to really get some R&R.

livingwellspendingless.com

By Mica G. de Leon

tress just throws blood glucose levels out of whack. In fact, the American Diabetes Association said that excessive stress can work against diabetes management by increasing blood glucose levels (quickly and substantially), inciting strong negative emotions, impairing sound thinking and decision-making, and tempting compulsive, poor eating. But for most yuppies with diabetes in the Metro, a day away from the office desk could mean a pile of work the next day. That makes tuning out on a vacation – and more so on a staycation – close to impossible! On a staycation, everything is just too accessible to ignore. Here are six tips to get you started:

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1. Finish loose ends. Before going on a staycation, make sure that everything you have to do at work or at home are done. If some tasks cannot be finished by the time you leave, delegate your tasks to your co-workers. Teach them how to do your task and make sure that whatever you’re leaving behind won’t be too much of a burden to them that their own tasks are hampered. Return the favor when it’s their turn to go on vacation. APRIL-MAY 2014

stressbuster

executiveair.aero.com

2. Go somewhere unfamiliar. The point of a vacation is to go very far away from everything that is familiar so your mind can rest from them. A staycation is sort of a mini-version where you can rest from the daily grind and still stay in the same city. Visit the new shop across the street, go for a long walk or a picnic at the park (we even have recipes for you to try in this issue!). Just make sure that wherever you go, it is new to you.

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3. Keep and lock away phones and gadgets. Set the out-of-office function of your email. Switch off your phones. Post a message on your social media accounts that you will be on hiatus from the world for a few days. And then lock your gadgets in a cabinet or drawer for the entire duration of your staycation. Whatever you do, don’t let yourself be tempted to peek.

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4. Staycation with people you are comfortable being with. If a staycation alone isn’t an attractive notion at all, be with people you are willing to see you let your hair down without fear of judgment or worry for their welfare. A common Filipino trait is to make guests feel comfortable on a vacation trip no matter how tired they get. You won’t get any R&R if your staycation turns into a hospitality fest for your acquaintances.

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5. Focus on the here and now. No news. No Facebook. No internet. No nothing. It should be just you getting some welldeserved R&R.

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6. Don't even look at your work files.

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Out of sight, out of mind, right? Don’t peek, touch, or even skim through work files or what seem like work files. The relaxed state that you got when your staycation began will be for naught if you stress yourself out with work again. D

dosanddon’ts

Beat the Heat By the DiabetEASE Staff Reviewed by Joy C. Fontanilla, MD

he heat can really get to diabetes patients. People with diabetes should take the time to prepare personal protective measures from the sun like staying indoors, drinking more water, applying sunscreen, and wearing protective clothing. The US Centers for Disease Control and Prevention say that diabetes patients have the most difficult time enduring high temperatures because of their condition. Folks with diabetes can beat the heat if they know what and what not to do. Here are a few tips:

DO’S Hydrate. Hydrate. Hydrate. Dehydration can happen whether you have diabetes or not. The situation is even worse when blood glucose is not under control. Drink plenty of caffeine-free fluids like water, seltzer, or sugar-free iced tea and lemonade. Drink even before you feel thirsty! If, however, your doctor limits your liquid intake, ask him or her how you can stay hydrated during times of day when the heat is just too much.

IIlustration by Donna I. Pahignalo

Plan ahead. Plan all your exercise and outdoor activities. Go outside or exercise during the coolest part of the day. Consider going to malls or any other air-conditioned place to exercise. Since natural calamities happen at erratic phases in the country, it is also smart to have an emergency plan designed specifically for diabetes patients. Prepare an adequate supply of medicine and supplies in your emergency kit and store them according to your pharmacist’s storing instructions. Keep copies of prescriptions and other medical information in your emergency kit.

Get sun protection. Because the Philippines is both a hot and humid country, sweat can’t evaporate as well. Wear clothes that will allow sweat to evaporate easily from your clothes. Likewise, apply sunblock and lip balm to protect skin for harmful UV rays. Help kids and the aged cope. If extreme heat is dangerous for regular diabetes patients, it is even more dangerous for kids younger than age four and the elderly aged 65 and older. As kids are prone to playing beyond their capacity, be aware of how their medication and treatment procedure happens and know what you can do in the event that the heat gets to them.

Leave meds exposed to heat. The heat can seriously affect the potency of meds and health devices like insulin, the insulin pump, the glucose meter and test strip packages. Store them at the required temperature indicated in the packet. Check as well on how to use them during times of high heat and humidity. Don’t leave them in the car’s glove compartment, by the pool, the beach, or any place where they can

directly absorb sunlight! Before taking insulin this season, check if there is clumping or frosting in the vial, because that means that it’s not good for use anymore. Insulin pumps meanwhile can suffer major damage from high heat. Store it somewhere cool, cover it with a small towel, or place it beside a gel pack. Disregard symptoms. With diabetes, patients are more at risk of heat exhaustion, which occurs when you’re exposed to high temperatures for long periods of time and don’t replace the fluids you lose. Symptoms include cool moist skin with goosebumps when in heat, heavy sweating, dizziness, fatigue, weak and, rapid pulse, low blood pressure upon standing, muscle cramps, nausea, and headache. On the other hand, the body’s metabolism is higher in hot and humid weather, which can lead to an increased chance of hypoglycemia. Watch out for signs of sweating or tiredness because of hot weather. Constantly monitor changes that happen in the body. Binge drink. Alcohol can affect the body’s ability to regulate body temperature. It can also worsen dehydration as it induces urination. D

APRIL-MAY 2014

dosanddonâ&#x20AC;&#x2122;ts

Tag-Init

Isinulat ng mga kawani ng DiabetEASE Pinamatnugutan ni Joy C. Fontanilla, MD

ng mainit na panahon ay maaaring makaapekto sa mga pasyenteng may diyabetes. Ang mga taong may diyabetes ay kailangang maghanda upang maprotektahan ang sarili mula sa init ng araw tulad ng pamamalagi sa loob ng bahay, pag-inom ng maraming tubig, pagpapahid ng sunscreen, at pagsusuot ng damit na pamprotekta sa katawan. Ani ng US Centers for Disease Control and Prevention, ang mga may diyabetes ay nahihirapang mamalagi sa init dahil na rin sa kanilang kondisyon. Kayang malagpasan ang init ng panahon kung alam ang mga dapat at di dapat gawin. Narito ang ilang payo:

Magplano nang maaga. Planuhin ang lahat ng ehersisyo at mga gawain sa labas. Lumabas lamang sa pinakamalamig na oras ng araw. Maaari ring pumunta sa mall o sa ibang lugar na air-conditioned upang doon mag-ehersisyo. Dahil ang mga natural na kalamidad ay pasumpung-sumpong, mainam ding magkaroon ng emergency plan na nakatuon sa mga may diyabetes. Maghanda ng sapat na gamot at iba pang gamit sa inyong emergency kit at itabi nang ayon sa bilin ng pharmacist. Magtabi rin ng kopya ng reseta at iba pang impormasyong medikal sa loob ng kit. Protektahan ang sarili sa araw. Ang Pilipinas ay mainit at maalinsangan kaya hindi agad

APRIL-MAY 2014

Alagaan ang mga bata at matatanda tuwing tag-init. Kung ang labis na init ay delikado na sa mga regular na taong may diyabetes, higit pang delikado ito sa mga batang may edad four pababa at sa matatandang nasa 65 taong gulang pataas. Ang mga bata ay maaaring mawili sa paglalaro kahit di na nila kaya kayaâ&#x20AC;&#x2122;t matiyagan sila at kanilang paggagamot. Kailangan ding maghanda sakaling mapinsala sila sa init.

Pabayaan ang mga gamot sa init. Ang init ay makaaapekto sa gamot at mga aparato ng mga may diyabetes tulad ng insulin, insulin pump, glucose meter, at test strips. Ilagay ang mga ito sa lugar na may sapat na temperatura. Suriin din kung paano ito gagamitin sa mga oras na mainit at maalinsangan ang panahon. Huwag itong iwan sa glove compartment ng kotse, sa pool, lalo na sa tabing dagat, o sa mga lugar na lantad sa sikat ng araw! Bago gamitin ang mga gamot,

lalo na ang insulin, tignan muna kung may pamumuo o hamog sa bote â&#x20AC;&#x201C; mga senyales na hindi na ito dapat gamitin pa. Ang insulin pumps naman ay maaaring masira rin. Ilagay ito sa lugar na malamig, balutin sa maliit na tuwalya, at ilagay sa tabi ng gel pack. Balewalain ang mga sintomas. Dahil sa diyabetes, mas mataas ang panganib sa heat exhaustion. Ito ay nagaganap kung nakabilad sa init nang matagal o kung hindi napunan ang tubig na nawala sa katawan. Mga sintomas nito ay ang panlalamig ng balat, pagtatayo ng balahibo, pagpapawis, pagkahilo, pagkapagod, panghihina, pagbilis ng pulso, pagbaba ng blood pressure kapag nakatayo, pulikat, panunuwal at pananakit ng ulo. Sa kabilang banda, ang metabolismo ng katawan ay bumibilis sa mainit at maalinsangang panahon na maaari namang magdulot ng hypoglycemia. Maging mapagmatiyag din sa mga sensyales ng pagpapawis o pagkapagod dulot ng mainit na panahon. Pansinin lahat ng pagbabago sa katawan. Labis na pag-inom ng alak. Ang alak ay maaaring makaapekto sa kakayanan ng katawang panatilihin ang tamang temperatura nito. Puwede ring magdulot ng panunuyo ang alak dahil sa labis na pag-ihi. D

IIlustration by Donna I. Pahignalo

Uminom ng sapat na tubig. Ang panunuyo ay maaaring maranasan, may diyabetes man o wala. Maaari rin itong lumala kung ang asukal sa dugo ay hindi kontrolado. Uminom ng inuming walang caffeine tulad ng tubig, seltzer, o iced tea at lemonada na walang asukal kahit hindi pa nararamdaman ang pagka-uhaw. Kung nililimitahan ng doktor ang tubig sa iyong katawan, magtanong ng ibang paraan para maiwasan ang panunuyo.

sumisingaw ang pawis sa katawan. Makabubuting magsuot ng damit na makatutulong sa agarang pagsingaw ng pawis, magpahid ng sunblock at lip balm upang maprotektahan ang balat laban sa UV rays.

affairstoremember

UPCM '93 slates "Diabetes Update 2014"

he First Postgraduate Course in Diabetes of the UP College of Medicine (UPCM) Class of ’93 in partnership with the UP Medical Alumni Society (UPMAS) dubbed Diabetes Update 2014: GPs and Specialists - Together We Can Do More was held at the De La Salle University Medical Center in Cavite on February 27, 2014. “Our main objective for organizing this course is to share our expertise,” said Dr. Jericho Thaddeus Luna, a diabetes patient himself and the president of the UPCM Class of ’93, adding that he has more than 50 classmates who are already well-known in their field of expertise. About 300 physicians and other health care professionals attended the course. Lecture and symposia topics included diabetic skin disorders, proper diabetic eye screening, strategies to prevent and detect cardiovascular disease, polycystic ovary syndrome in relation to diabetes and heart disease, facts and fallacies about fatty liver, diet and drug therapy for diabetic kidney disease, diabetic

neuropathy, urologic complications of diabetes, and diabetic foot must-knows to avert amputation. Meanwhile, Dr. Joy Arabelle Fontanilla, scientific program chair and editor-in-chief of DiabetEASE magazine, mentioned the possibility that the course may be conducted every year. Three industry-sponsored symposia were also held on the cardiovascular safety data of saxagliptin (Astra Zeneca); new treatment guidelines for type 2 diabetes and the role of vidagliptin: a case-based approach (Novartis); and innovations in SMBG accuracy (Bayer). Ma. Cristina C. Arayata D

Drs. Ricky Luna (front row 3rd from left) and Joy Fontanilla (2nd row, 3rd from left) with other UPCM Class ‘93 members

APRIL-MAY 2014

affairstoremember

MetaFit camp starts anew in 2014

he Metabolic Fitness (MetaFit) Camp is back in 2014 at the SM by the bay of SM Mall of Asia in Pasay City just in time for redefining fitness goals in the summer. “This year’s MetaFit Camp is the perfect venue for health and wellness advocates as we help provide them a more comprehensive fitness training,” said Corazon Garalde, general manager of Royal DSM Philippines, adding that this year’s camp will be done with four of the best motivational coaches in the country. This is the only camp that offers fitness, motivational, and nutritional coaching to help participants get fitter, slimmer, stronger, and healthier. This will also allow them to learn the importance of overall fitness, strength, endurance, balance, cardiovascular endurance, flexibility, and core training from certified MetaFit Coaches. “We at DSM feel that it has become our duty to continue the goal of promoting a healthy and fit lifestyle. Fitness is not about losing weight. Fitness is about improving the quality of life by being stronger, fitter, and healthier,” she said. DSM’s Metabolic Fitness Camp gives participants

a chance to challenge and motivate themselves in comprehensive trainings and high-intensity workouts, with proper supervision from coaches Jim and Toni Saret of the Biggest Loser Philippines and guidance from motivational coaches, Diane Obsina, Tin Obsina , Raffy Tan, and Hazel Chua. DSM’s Metabolic Fitness Camp runs from April 2 to April 30, 2014. D

IIlustration by Donna I. Pahignalo

doodles&dreams

APRIL-MAY 2014