DiabetEASE August-September 2013 by Dan Cisneros

AUGUST-SEPTEMBER 2013

CONTENTS

behindthescenes

COVER STORY AND FEATURES

The Anti-Obesity Drink?

OMG! (Oh My Gulay!)

Breakfast and Diabetes

Kuya Kim Remembers

On the heels of a campaign to reduce softdrinks in the United States, giant brand Coca Cola is rebranding itself as a fighter of obesity. But is this for real or merely a PR stunt? Aencille Santos investigates.

With more people recognizing the importance of greens, Cristina Arayata looks into Senator Edgardo Angara’s campaign for increasing vegetables on everyone’s plate.

Mylene C. Orillo discovers the importance of breakfast in preventing diabetes.

Three years after a stroke almost took his life, weatherman, marathoner, and TV host Kim Atienza sat down with Michaela Sarah de Leon and talks about the changes he made in his lifestyle including a low glycemic diet.

The DiabetEASE team together with Kuya Kim

regulars

6 | EDITOR’S EDICT 8 | WE’VE GOT MAIL 9 | SWEET NEWS ON THE COVER: Tagged as the Steve Irwin of the Philippines, Matanglawin and It’s Showtime’s Kim Atienza shows the madlang people the importance of a healthy lifestyle.

in depth 44

Diabetic Complications- What, Why and How to Screen Dr. Theresa Marie Valdez-Faller discusses the common diabetes complications and how to avoid them.

What is Good Blood Glucose Control?

Best Practices for Weight Loss in People with Diabetes

How do you define good blood glucose control? Dr. Marie Yvette Rosales-Amante elaborates.

In a society where thin is in, can you reduce weight in spite of diabetes? Dr. Patricia Maningat explains how you can shed the pounds without resorting to drastic measures.

AUGUST-SEPTEMBER 2013

Cover photo by Fritz Tentativa Styling by RJ Roque Grooming by Carlos Roque Shot at NYNP Studio, Tomas Morato, QC Special thanks to Ms. Liezel Gumia

columns 15

Educator’s Corner

Fightin’ For Fitness

Righteous Recipes

Good Food Guide

What is Prediabetes? So how do you detect diabetes in the early stages? Dr. Jocelyn Isidro gives advice on how to prevent and treat this condition.

Simple Exercises for Diabetes Patients Getting in shape is important but you can’t just lift weights nor do hardcore work-out. Cyrus Eleuterio lists down work-outs diabetes patients can try.

Soup and Salad Recipes Chef Junjun de Guzman is back and comes up with four recipes to enjoy for those wanting to eat healthy this rainy season.

10 Best Diet Practices for People with Diabetes One of the most common questions diabetes patients ask is what food they should eat and how to go about it. Nutritionist Sabrina Batac helps out through this basic list.

AUGUST-SEPTEMBER 2013

sections 12

You Ask, We Answer

Is Ashitaba safe and effective for treating diabetes? What is ashitaba, and how can this help diabetes patients? Dr. Lynn Bilar explains its benefits and risks.

Product Spotlight

Living Well

Got Soy Milk? Nicole Limlengco gives the low-down on three variants you’ll surely enjoy drinking.

It’s Never Too Late for Change Coming from a family who loves to eat, Aileen Garcia narrates her experience in coping with diabetes and the changes she made to keep herself in shape.

AUGUST-SEPTEMBER 2013

Stress Busters

Write Your Way Out of Depression! Emil Karlo dela Cruz outlines the power of writing one’s feelings to beat depression.

67 69 72

Dos and Don’ts

Gestational Diabetes Pregnant women are not exempted from diabetes and this could affect the baby. Alexa Villano gives a step-by-step guide in management and prevention.

Affairs to Remember Doodles & Dreams

AUGUST-SEPTEMBER 2013

EDITOR’S EDICT

Only the Best It is those who have this imperative demand for the best in their natures, and who will accept nothing short of it, that holds the banners of progress, that sets the standards, the ideals, for others. - Orison SwettMarden

What was it like to have diabetes in the era before insulin was discovered?

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

Life would have been terribly short. For those who developed diabetes before the age of 20 years, they were hardly expected to reach their 23rd birthday.

Ricardo E. Fernando, MD Founder and President, Institute for Studies on Diabetes Foundation, Incorporated

And how was diabetes treated in the pre-insulin age? People were prescribed starvation diets, periodic blood-letting, and even opium! Anyone routinely recommending these today could very well end up in jail.

Ruby T. Go, MD Past President, Philippine Lipid and Atherosclerosis Society; Head, Endocrine Section, Chinese General Hospital

We now live in an era not just with insulin in our arsenal but a whole host of medications to treat and prevent the many complications of diabetes. Medicines and other remedies to improve blood sugar, blood pressure, cholesterol, and heart health are all at our disposal.

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

We also live in an era of evidence-based medicine. Medical decision-making is increasingly based on best available scientific evidence rather than force of habit, anecdotes or unsystematic clinical experience. Health care professionals, caregivers, and patients alike are thus challenged to catch up on advances in diabetes care. In a very busy world, poring over mountains of medical literature and research to find out how best to manage each condition can be a daunting task. We have thus asked several experts to weigh in on the evidence and present the best practices in various aspects of diabetes care – diet, exercise, weight loss, blood sugar control, complication prevention and more. Allow us to help you sort through the noise and sieve the truth from gossip, the facts from the myths. Hope you enjoy this compilation of the recent guidelines based on the best available evidence. Would you settle for anything less? Peace and thank you,

Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM, CCD

Editor-in-Chief

MEDICAL ADVISORY BOARD

AUGUST-SEPTEMBER 2013

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 Marie Yvette Rosales-Amante, MD, FACE, FPCP, FPSEM Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Emil Karlo dela Cruz Michaela Sarah de Leon Art Directors: Donna I. Pahignalo Michael Patricio Editorial Coordinator: Alexa Villano Senior Writers: Ma. Cristina Arayata Jose Martin Punzalan Aencille Santos Graphics and Layout: Dan Cisneros Executive Officer: Lisandro Q. Favila Overall Marketing Manager: Hudson Pelayo Marketing Assistant: Godfrey Santos Group Sales Manager: Ma. Elna P. Jagape Senior Account Managers: Noel A. Ongkingco Charlotte Aireen Punzalan Representatives: Girlie Joy D. Jovero Chiro Dela Peña Abigail Lavadia Leonard Anthony D. Baluyot Florence Palapar Antonio Fajardo Jr. Advertising Assistant: Irina Mae Carampatana Officer-in-Charge, Circulation Department: Armando Sandajan Executive Assistants: Angeli M. Mamaril Zenaida R. Fortes Legal Counsel: Castillo, Laman, Tan, Pantaleon and San Jose Law Firm

A graduate of the University of the Philippines College of Medicine, Dr. Amante took up her residency in internal medicine at the University of Connecticut, and had her Fellowship in Endocrinology, Diabetes and Metabolism at the University of Massachusetts. She is Asst. Secretary of the American Association of Clinical Endocrinologists-Philippine Chapter and Endocrinology Section Chief at the Asian Hospital and Medical Center.

Theresa Marie Valdez-Faller, MD, FPCP, FPSEM, FACE Dr. Faller is an endocrinologist at St. Luke’s Medical Center Global City and World Citi Medical Center. She is a fellow of the American College of Endocrinology and the Philippine Society of Endocrinology and Metabolism.

Patricia D. Maningat, MD is an endocrinologist at St. Luke’s Medical Center-Global City, and the Philippine General Hospital. She is also a visiting consultant at Our Lady of Lourdes Hospital and Cardinal Santos. She is also a member of the Research Faculty of the University of the Philippines, National Institute of Health, and a visiting fellow at the Rockefeller University in New York.

Jocelyn Capuli-Isidro, MD, FPCP, FPSEM Dr. Isidro is a Consultant Endocrinologist at Makati Medical Center and the St. Luke’s Medical Center, Global City. She is also a member of the medical bureau of Diabetes Center Philippines or the Philippine Center for Diabetes Education Foundation, Inc.

Dr. Lynn W. Bilar, MD, FPCP, FPSEM Dr. Bilar is an endocrinologist at the Asian Hospital and Medical Center, Alabang.

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.

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 2013 by FAME, Inc.

AUGUST-SEPTEMBER 2013

we’vegotmail

Dear DiabetEASE, Gusto ko lang po malaman ano pa po ang puwedeng kainin kung wala pong gana at nag-therapy. Ang nanay ko po kasi ay mas gusto na lang uminom ng liquid kaysa sa kumain ng solid. (I would just like to know what else could be eaten if appetite is poor after therapy. My mother prefers to just take in liquids instead of solid food.)

You ask, we answer Can you please discuss how Lantus works? Coz I’m using it now, and I don’t know the peaks of this insulin. I inject it every morning, and I’m just worried that it might lower my blood sugar in the middle of night especially when I’m sleeping... thanks.

– Melba via e-mail

–Cristina via Facebook

find us on www.facebook.com/diabetEASE

DiabetEASE welcomes feedback from readers. Please send your comments, questions and suggestions through any of the following: Snail mail: 503 Narra Building, 2276 Pasong Tamo Extension, Makati City 1232 Philippines Email address: diabetEASE.famepublishing@ gmail.com Fax number: (+632) 8928514 Telephone numbers: (+632) 8920723 to 24; 8940843; 8135433 or 36 DiabetEASE reserves the right to edit materials for publication.

Dear Melba, It’s not clear which “therapy” is referred to in your letter. Nevertheless, liquid food supplements deemed nutritionally complete are available in the market. Some have formulas specific for various diseases like cancer, diabetes or kidney disease. Consult your doctor and/or clinical dietitian to help you choose the right formula. Also, your doc can teach you techniques and prescribe medications to help improve your mom’s appetite,as well as aid you in figuring out why she prefers liquids to solids as there may be an underlying problem with her digestive tract.

Dear Cristina, Insulin glargine or Lantus is a long-acting insulin. On the average, when injected into the fat layer under the skin, it starts to work in about an hour, does not have a clear peak,and then lasts from 20 to 26 hours. If you happen to inject it into the muscle layer, particularly if you are using long needles (8 mm and up), then it can peak in a few hours and may cause your blood sugar to drop.If you’re injecting in the morning, the insulin is unlikely to peak in the middle of the night. You will need to review your regimen with your doctor if you suspect low blood sugar attacks. Thanks, Dr. Joy

I would like to know the right food to eat by a diabetic person? - Lilibeth via Facebook Dear DiabetEASE, Sana po ay maglabas kayo ng listahan ng mga puwede para sa may diyabetes para makatulong sa amin sa pamimili ng mga dapat at hindi dapat bilhin.(I wish you would come out with a list of food ideal for people with diabetes to help us choose which food to buy.) - Rosemarie via e-mail

SUBSCRIBE NOW! Send me a one year subscription (6 issues) of DiabetEASE magazine within Metro Manila

only PhP 600

Send me a one year subscription (6 issues) of DiabetEASE magazine to a provincial address

only PhP 960

Best regards, Dr. Joy

Dear Lilibeth and Rosemarie, In every magazine issue, our “Good Food Guide” features various aspects of proper nutrition for people with diabetes. In this issue (August-September, 2013), you may find some of your questions answered in Ms. Sabrina Batac’s the“Ten Best Diet Practices for People with Diabetes”.We’ll surely keep your questions in mind, so watch out for specific food lists in our coming issues. You may want to consult a clinical dietitian or physician nutrition specialist to help with your meal plans. Thanks, Dr. Joy

Call 813-5433 Name: Date: Mailing address: Birthday: Contact No.: E-mail: Start of subscription:

Mode of payment: Cheque (Should be payable to FAME, Inc.) Please mail to: Circulation Department Friendly Alliances and Media Expressions, Inc. Suite 503 Narra bldg., 2276 Pasong Tamo Ext., Makati City, 1232 Philippines

DECEMBER-JANUARY 2013

Bank Payment Payment deposited to account of FAME, INC. at BDO bank with savings account no. 1450-024147 (please fax this form with your bank validated deposit slip to (63) 892-8514)

sweetnews

New hormone, potential target for diabetes treatment

new hormone discovered by researchers of the Harvard School of Public Health could help in treating type 2 diabetes and other metabolic diseases. The study which appeared in Cell Metabolism described an experiment by scientists wherein they used stateof-the-art technology to discover a hormone, which when switched off, improves control of glucose production from the liver. “Although it has long been recognized that a key event leading to development of type 2 diabetes is uncontrolled glucose production from the liver, underlying mechanisms

have been elusive,” said Gökhan S. Hotamisligil, one of the study authors and chair of the Department of Genetics and Complex Diseases and J.S. Simmons Professor of Genetics and Metabolism at HSPH. “We now have identified aP2 as a novel hormone released from fat cells that controls this critical function. We suspect this communication system between adipose tissue and liver may have evolved to help fat cells command the liver to supply the body with glucose in times of nutrient deprivation.” Hotamisligil added that “when the engorged fat cells lose control over this signal in obesity, the blood levels

of aP2 rise, glucose is poured into the bloodstream and cannot be cleared by other tissues. The result is high blood glucose levels and type 2 diabetes”. In the study, researchers first raised the levels of aP2 in normal, healthy mice to match the high blood aP2 levels seen in obese mice and humans. This led to impaired glucose metabolism. Next, they cut the blood aP2 levels in obese and diabetic mice to low levels found in lean healthy mice. This restored glucose metabolism to normal. Therefore, the investigators concluded that the level and action of aP2 in blood was critical for diabetes, opening up new doors for potential control or prevention of type 2 diabetes. The researchers also identified a possible treatment role for a novel a P2 antibody that neutralizes aP2 activity and corrects type 2 diabetes in mice. with Science Daily Report D

AUGUST-SEPTEMBER 2013

sweetnews

Infants eating solid foods early may be at risk of type 1 diabetes

Type 2 diabetes may lead to certain cancers

ecomama.eu

esearchers from the University of Colorado and the CU School of Medicine’s Barbara Davis Center for Diabetes recently stated that infants taking solid food before four months of age may have a higher risk of developing type 1 diabetes later. However, the same study noted that infants who are still being breastfed when starting on solids, meanwhile, have a lower risk of developing type 1 diabetes, especially among those taking foods with wheat or barley. The study was published in JAMA Pediatrics. Lead researcher Jill Norris, MPH, PhD, stated that the risk of diabetes is almost two times higher than normal for infants taking solids at the age of four to five months. Norris and team gathered data from Colorado children with a greater genetic risk of type 1 diabetes. They focused on when solid foods were introduced, what foods were taken, and whether the children developed type 1 diabetes soon after. “The data suggest parents should wait before introducing any solid foods until after the four-month birthday,” said Norris. He added that when the infant is ready, solid foods should be introduced on the six-month birthday or immediately after, preferably while the infant is still being breast-fed. Norris said that further studies need to be carried out on other food types to verify whether they might also affect Type 1 diabetes risk when feeding an infant. Of particular interest are fruits before four months old and rice and oats after six months old. Meanwhile, a Swedish study published in The Lancet said that the longer one breastfeeds, the more protection the infant gets from developing type 1 diabetes later on. D

AUGUST-SEPTEMBER 2013

hechart.blogs.cnn

By Cristina Arayata

new study showed that a certain genetic abnormality linked to cancer was common in people with type 2 diabetes. The study by scientists at Imperial College London and CNRS in France suggested that mutations called clonal mosaic events (CMEs) may have something to do with the potential development of cancers. Past studies have shown the connection of diabetes to blood cancers such as leukemia and lymphoma. CMEs are defects that result in some cells having extra copies or missing copies of large chunks of DNA. They are very rare in young people but become more common as we get older. The report, which was published in Nature Genetics had the researchers look into blood samples of 7,437 participants in Europe including 2,208 people with type 2 diabetes. They found that CMEs were four times more common in people with type 2 diabetes. Professor Philippe Froguel who led the study said: “Type 2 diabetes is a disease that accelerates aging, so we wondered if it would make people more likely to have these genetic defects that are associated with aging.” “This finding may partly explain why people with type 2 diabetes are more likely to get blood cancers. It may be useful for doctors to test for CMEs in patients with type 2 diabetes to identify those who have the highest risk of cancers. These patients would be followed up closely to watch for early signs of leukemia and could start having mild chemotherapy,” he added. They also discovered based from the report that diabetes patients with CMEs have high risks of developing kidney failure, eye disease, or heart disease. With Medical News Today report D

sweetnews

Metformin m ay Very low blood sugar reduce dementia risk ups risk of CVD in in Type 2 diabetes diabetes patients

visual-snow.info

new observational study showed that the use of metformin can reduce dementia for people with type 2 diabetes. The study, which was presented at the Alzheimer’s Association International Conference (AAIC) 2013, showed a cohort of 14,891 patients age 55 and above with type 2 diabetes who began their therapy on October 1999 and November 2001. In the “new user” cohort, patients who started with a single drug (metformin, sulfonylureas [SU], thiazolidinediones [TZDs], or insulin) were included. The five-year study showed that dementia was diagnosed at 1,487 patients or 9.9 percent. Compared to patients taking SU, those who used metformin were able to reduce dementia by 20 percent. This was reported by Dr. Rachel Whitmer, PhD, senior scientist at the Kaiser Permanente Northern California Division of Research, Oakland. For patients who took TZD, those who started metformin had a lower risk of 23 percent for dementia during follow-up. In contrast, starting SU (compared with metformin) was associated with a 24 percent increased risk for dementia; TZD, an 18 percent increased risk; and insulin, a 28 percent increased risk. Results were also the same after researchers took into consideration the age, diabetes duration, and glycemic index control. Dr. Whitmer said that the study provided “preliminary evidence that metformin may have benefits on brain health,” “These results provide preliminary evidence that the benefits of insulin sensitizers may extend beyond glycemic control to neurocognitive health,” Dr. Whitmer said. With Medscape report D

ype 2 diabetes patients, particularly those with severe hypoglycemia, are at risk of cardiovascular disease (CVD) according to a new study published in the BMJ. While many reports have come out linking CVD risk and severe hypoglycemia, it remains controversial, thus researchers from Japan, the United State and Netherlands did a systematic review to assess the association. The researchers analyzed results of six studies consisting of a population of 903,510 patients. Information included age, gender, duration of diabetes, CVD history, insulin use, BM Iand smoking status were taken to consideration. Results show that 0.6 - 5.8 percent of participants experienced severe hypoglycemia from one to five years follow-up. In total 1.56 percent was added to the total risk of developing CVD in the whole population. With this, the researchers believe that “less stringent glycemic targets may be considered for type 2 diabetic patients at high risk of hypoglycemia,” saying that avoiding severe hypoglycemia may prevent the risk of CVD. The researchers also believe that prevalence of serious illnesses would need to be “unrealistically high” among patients who experienced severe hypoglycemia and the association between serious illnesses and cardiovascular disease would need to be “extremely strong.” They concluded” that severe hypoglycemia is associated with a 2-fold increased risk of CVD”. They also suggest that to reduce the risk of CVD, choice of glucose lowering agents with a low propensity to induce hypoglycemia, patient education, and self-monitoring of blood glucose can be useful in preventing hypoglycemia. With Medical News Today report D

AUGUST-SEPTEMBER 2013

youaskweanswer

Is ashitaba safe a nd effective for treating diabetes?

namayasai.co.uk

modernfarmer.com

Ashitaba is the Japanese name of the herb Angelica Keiskei Koidzumi, also called “tomorrow’s leaf”, “king of vegetables”, &” Aeshe de la Longevite”. It grows mainly in Hachi Jo Island. It is said to prolong life and regenerate the human body. It has a “celery like” taste distinguishable from other plants because of its yellow sap. Ashitaba is thought to contain 11 vitamins and 13 different minerals. The nutritional components are fibers, proteins, saponins, coumarins, and germanium. Its nutritional data in edible parts per 100 g are as follows:

AUGUST-SEPTEMBER 2013

Potassium 540 mg Fiber 5.6 g Pantothenic acid 0.92 mg Niacin 1.4 mg Vit B2 0.24 mg Vit K 500 ug Vit E 2.8 mg Beta-carotene 5300 ug Manganese 1.05 mg Copper 0.16 mg (Source: Japan BioScience Lab Co.,LTD) The plant is claimed to be good for digestion, wound healing, even improvement in appetite. It is largely popular for its antiviral, antibacterial, and antiparasitic properties. It is claimed to reduce blood sugar levels in people with diabetes. The yellow sap of Ashitaba contains CHALCONES Chalcones are open chain flavanoids widely produced in plants. Flavanoids play an important role in defense against virus, bacteria, parasites, and insects. Ashitaba has 20 kinds of chalcones. The 2 major chalcones, XA (xanthoangelol) and 4HD (4 hydroxyderricin) have insulin-like activity, which was shown in rat experiments to decrease blood sugar in diabetic rats. The exact mechanism of action is still unknown. So far no similar studies have been done in humans. There may be anecdotal reports of its blood sugar lowering properties in patients with diabetes, but these stories are still not proven by scientific studies. These are simply testimonies. Web search only shares a short anecdote of one patient in Texas and 1 patient in Japan.

wordpress.com

youaskweanswer

Closer to home, some patients are sharing their own and others’ experience on ashitaba’s possible role in the improvement of their blood sugar control. The components of Ashitaba appear to work as antioxidant. The studies conducted on the chalcone derivatives show potential for use as anti-malarial, antiviral, antiparasitic, antifungal, anti-cancer, and anticonvulsant to name some. There is not enough information available on the benefits of human consumption. Most researches have been done on animals or in test tubes, not people. There are ongoing studies conducted in mice on the use of Chalcone derivatives as blood glucose lowering agent. No similar studies are being conducted in humans. Until there are enough human studies to prove its safety and effectiveness, this can’t be recommended as a treatment option for people with diabetes as of this time. Keep in mind that natural products do not necessarily equate to safety and dosing is very important. D

References: Batorska, DI. Trends in the utilization of the pharmacological potentail of chalcones. Abstract, source Pubmed.gov. Rahman, MA. Chalcone, A valuable insight into the recent advances and potential pharmacological activities. Clinical Science Journal volume 2011. Tatsuji, Enoliet,al Anti diabetic acivities of chalcones derived from Ashibata. Abstract. Source: Asian Science &Technology Portal. Ashitaba overview information. source, WebMd. Bove,Fred. Ashitaba: Tomorrow’s leaf Today. Modern Farmer

Dr. Lynn W. Bilar, MD, FPCP, FPSEM Dr. Bilar is an endocrinologist at the Asian Hospital and Medical Center, Alabang.

AUGUST-SEPTEMBER 2013

youaskweanswer

AUGUST-SEPTEMBER 2013

educatorsâ&#x20AC;&#x2122;corner

Wh at is Pre-diabetes? By Dr. Jocelyn C. Isidro

iabetes is a dreaded disease, which is increasing in prevalence worldwide. In the Philippines, it is a growing health problem affecting 9.7 percent of the adult Filipino population. This prevalence rate doubles if we include the 12.5 percent of Filipinos at risk of diabetes with impaired glucose tolerance or pre-diabetes. When combined, approximately one in every 5 Filipino adults has either pre-diabetes or diabetes. Such an alarming increase! Before succumbing to the dreadful disease called diabetes. Patients enter the phase, which is called pre-diabetes. It means that the blood sugars are not normal but they have not reached the cut-offs for the diagnosis of diabetes. By definition, pre-diabetes is characterized by a fasting blood sugar of 100-125mg/dL, or a blood sugar of 140-199mg/dL 2 hours after ingesting 75 g of glucose, or an A1C of 5.7 percent to 6.4 percent. The mechanism behind prediabetes is the presence of genes related to insulin resistance. This is a state wherein our body cannot utilize the sugars very well. As a result, the sugars stay in the blood instead of entering the cells of our body providing energy. The hormone responsible for the entry of sugars into the cells is called insulin. It is a hormone secreted by the pancreas that acts like a key, opening the doors of our cells to sugar. Prediabetes starts when there is a strong barrier to the entry of blood sugars into the cells. This is then followed by the compensatory response of the

pancreas producing markedly elevated insulin to combat the existing insulin resistance. While the body is capable of these compensatory responses, the blood sugar levels are kept normal or below the diabetic cut-offs. When these compensatory responses fail, blood sugars become elevated. Risk Factors: Genetic risk is one area that can account for the development of pre-diabetes. Persons with strong family history of diabetes are at risk for developing pre-diabetes. One important factor related to the development of pre-diabetes is the increasing prevalence of overweight and obesity. Excess fat depot particularly in the abdomen predisposes one to develop pre-diabetes. The thicker the intrabdominal fat content the higher the insulin resistance, the stronger the risk for the development of prediabetes. Another factor is sedentary lifestyle that goes with westernization. Filipinos mostly office-bound, laptop-bound or iPad-hooked rarely exercise and engage in physical activities. Physical activities

utilize the sugars and improve insulin sensitivity. Another common risk factor is polycystic ovarian syndrome or PCOS. This is a state of insulin resistance characterized by increased male hormone, impaired glucose control, obesity and irregular or absent menstruation. Patients with PCOS are evaluated for glycemic control to check for pre-diabetes or even diabetes. All these factors put together increase the risk for the development of pre-diabetes/diabetes. However, there are no telltale signs or symptoms of the disease. This is silent until discovered. That is why a high index of suspicion is encouraged to uncover the disease the soonest possible time. Diagnosis: Before the diagnosis of pre-diabetes is made. A confirmatory test is done; this is the 75g oral glucose tolerance test or OGTT. After an overnight fast for eight hours, fasting blood sugar is extracted then patients are asked to drink a sugar solution equivalent to 75 grams of glucose followed by another extraction of AUGUST-SEPTEMBER 2013

Significance Of The Disease: Pre-diabetes should not be ignored. It heralds the development of diabetes in ten years time or even less. It could signal the development of cardiovascular complications such as blocking of the arteries in the heart, brain, eyes and kidneys. Complications of diabetes begin at the pre-diabetic level.

diyhealth.com

Management: Pre-diabetes proceeding to diabetes is not inevitable. Active intervention with lifestyle modification and or early treatment can still reverse this pre-diabetic stage to normal blood sugars. However, intervention has to be early and consistent. Researches and landmark trials have shown that early intensive treatment of blood sugars is capable of preventing the occurrence of both microvascular and macrovascular complications and can delay or prevent the occurrence of full-blown diabetes. The first area to target is the attainment of ideal body weight or weight management. Most people who have prediabetes are overweight with a body mass index (BMI) of

AUGUST-SEPTEMBER 2013

fitpromag.com

healthcenter.uoregon.edu

blood after two hours. If the fasting blood sugar level falls anywhere from 100to 125mg/dL with a normal second hour blood glucose, a diagnosis of impaired fasting glucose is made. If the second hour blood glucose falls anywhere from 140to 199mg/dL with a normal fasting glucose, a diagnosis of impaired glucose tolerance is given. If both blood sugar determinations are high, both diagnoses are given. Elevated fasting, or second hour blood sugars, or both is/ are diagnostic of pre-diabetes. Another test that is being considered diagnostic if done by a certified laboratory (NGSP certified) is the glycosylated hemoglobin (Hba1c or A1c). This test reflects the average blood sugar for the past three months. Normal Hba1c is 5.6 percent or less, pre-diabetes is 5.7 percent to 6.4 percent and diabetes is 6.5 percent and above.

moderndiabete.com

educatorsâ&#x20AC;&#x2122;corner

25 or higher by World Health Organization (WHO) criteria. Weight loss of 5 percent to 10 percent in six months may help prevent or delay diabetes. Improvement of eating habits is the next step instead of fad dieting. Dieting is temporary; it prevents a person from eating his usual meal and this sometimes leads to the perception of deprivation. Hence, after sometime, persons revert back to their usual eating habits and weight is regained back. Development of healthy eating habits in a highly motivated person is the way to go. In this way, persons are encouraged and motivated to attain their desirable weight by not crash dieting or following some magic formula of weight loss. Proper diet is well-balanced and healthy. It does not promote starvation due to very low caloric intake. Effective exercise goes hand-in-hand with proper diet. Daily and sustained aerobic exercises of at least 30 minutes a day is effective in boosting resistance and affording slow but continuous weight control. If lifestyle changes are not enough, medical treatment maybe provided. In the latest American Association of Clinical Endocrinologists (AACE) Algorithm on Pre-diabetes 2013, patients who fall under the criteria of pre-diabetes with other co-morbid illnesses such as obesity, hypertension and/or dyslipidemia are treated accordingly. Antiobesity medications together with medications such as Metformin, Alpha-glucosidase inhibitors (Acarbose) and GLP-1 agonists maybe given to pre-diabetic patients upon proper evaluation of the physicians. Pre-diabetes is prelude to a dreaded disease: DIABETES. If one intervenes early, then progression to diabetes can be prevented. Physicians, health care providers, diabetes educators and patients are invited to work hand-in-hand in order to stop diabetes at its roots. If patients have any of the risk factors mentioned above, early consultation is worth a million cures. D

fightin’forfitness

Simple Exercises for Diabetes Patients By Cyrus Eleuterio

eing diagnosed with diabetes should not be a hindrance for a person to pursue a normal active life, participate in sports, or achieve a fit body. Doctors recommend patients with diabetes to engage in physical activity (walking, jogging, biking, swimming, resistance training, etc.) for as little as 30 minutes most days of the week in order for them to control their blood sugar levels, achieve a desirable weight, and increase their metabolism. Like any other physical regimen, it is imperative for them to consult their attending physician before plunging into any type of physical activity. Here are a few things that a person with diabetes should heed, before doing any physical activity: • Get a doctor’s clearance before you engage in any type of physical activity, especially if you have type1 diabetes; • Have a clear knowledge of the signs and

symptoms of hypoglycemia because exercise normally decreases blood glucose level; • Check your blood sugar level before, during, and after exercise; • Have your medicine on your side at all times; When you are sure that all of the above mentioned tips are present, you can now start your exercise. Always remember that all workouts start with warmup exercises followed by the main body workout, and cool-down exercises(stretching and breathing). Before you start, always have your bottle of water, towel and your medicine packs (with your blood sugar monitoring kit) beside you.

The phases of the exercise: 1. Warm-up - a series of body weight exercises done for specific time and repetitions. Do it for two rounds, non-stop, to elevate the heart rate. Exercise

Time

Jumping Jack

30 seconds

Repetition as many as you can in 30 seconds

Description Performed by jumping with your legs spread wide while your hands touch overhead with a clap and then return to the position with legs together and the hands on the side.

AUGUST-SEPTEMBER 2013

fightin’forfitness Exercise

Time

Spiderman Climb

Exercise

Time

Push-up

Exercise Prisoner’s Squat

Time

Repetition

Description

5 repetitions per side

Start with the push-up position. Step your right foot towards the outside of the right hand. Return to starting position. Do the same on your left leg.

Repetition

Description

5 repetitions

Lie face down your hands placed approximately shoulder width apart. Push yourself up with your legs and arms straight. Slowly lower your chest until it touches the floor, keeping your back flat all through out. Return to the starting position.

Repetition

Description

8 repetitions

Begin in a standing position with your hands clasped behind your head. Lower your torso until your legs are parallel to the floor. Quickly stand-up (starting position), then repeat lowering your body.

2. Main Workout – it is a circuit body workout consisting of five exercises, training the whole body. Do each exercise with a 15-20 seconds rest interval in between exercise. Rest for one to two minutes after completing the circuit exercises. Repeat the circuit for two to three times.

AUGUST-SEPTEMBER 2013

fightin’forfitness

A. Prisoner’s Squat – 10 repetitions; B. Push-up – Six to eight repetitions; C. Wall Sit – Lean back against the wall. Feet shoulder-width apart. Slowly slide down the hips until the thigh are parallel to the floor (the legs should look like a letter L).Hold it for 20 seconds; D. Lying Hip Extension – Lie down on your back. Legs are bent with your arms stretched out on the side. Lift the hips up and down ensuring that the buttocks are off the floor. Do it for 20 repetitions E. Plank – Lie face down with your forearms resting on the floor. Push off the floor, raising up onto your toes and resting on the elbows. Keep yourback flat, forming a straight line from head to heels. Hold for 20-30 seconds. F. Rest for one to two minutes and repeat the entire circuit two to three more times.

AUGUST-SEPTEMBER 2013

fightin’forfitness 3. Cool down – a physical activity that transitions the body from extreme exercise to the state of resting.

A. Cat Pose – Put your hands and knees on the floor, creating a “tabletop” pose. Make sure the knees are directly below the hips with your wrist, elbows, and shoulders in line and perpendicular to the floor. Push the back up forming a hump, tightening your abdomen and buttocks, with your head down. Hold for eight counts. Slowly return to the original position. Do it for 10 repetitions.

B. Standing Quad Stretch – Hold on to a chair or any sturdy wall. Stand on oneleg grabbing the other leg with one hand (Right leg for the right hand). Hold it for 15-20 seconds. Do it for the other side.

Always hydrate yourself when doing these exercises. Remember, diabetes is not a hindrance in the pursuit of fitness. D

AUGUST-SEPTEMBER 2013

fc00.deviantart.net

feature

The AntiObesity Drink? Coca-Cola Company joins fight against diabetes but motives questioned By Aencille Santos

oca-Cola, the world leader in the soft drinks industry, has been known to associate their drinks with happiness. But for the first time in the United States, it took a stance against one of the world’s largest health burden: obesity. In January this year, Coca-Cola launched “Coming Together”, a campaign which directly addresses the problem of obesity, through the improvement of the health content of its products. The campaign highlighted the wider array of beverage choices including regular, low-, and no-calorie options which would match the caloric need of every consumer.

“Across our portfolio of more than 650 beverages, we now offer over 180 low- and no-calorie choices,” the ad said. “Over the last 15 years, this helped reduce the average calories per serving across our industry’s products in the US by 22 percent.” Coca-Cola’s full calorie drinks are

not taken off the limelight. Itinitiated that physical activity plays a crucial role in combating obesity, especially when drinking a regular, full calorie Coke. “There is a place for all of our beverages in a healthy lifestyle,” said Muhtar Kent, chairman and chief executive officer (CEO) of Coca-Cola. AUGUST-SEPTEMBER 2013

kootation.com

feature

No nutrition, empty calories While the case to decrease the bulging waistline of Americans is good, this move did raise eyebrows, especially among the health practitioners. The Center for Science in the Public Interest, a US-based non-profit watchdog and consumer advocacy group fighting for safer and more nutritious food, is skeptical of the motives of Coca-Cola. While Coca-Cola showed a good side by being an active “health advocate” with low-calorie or caloriefree sodas, dietitians think otherwise. They said that soft drinks, in general, still promote poor health regardless of caloric count. Jeff Cronin, the director of communications at the US CSPI, said that sugary drinks are all the same: no nutritional value, while upping the risk of heart disease, diabetes, and obesity. “No matter how much water, juice or seltzer is in their portfolio,” Cronin said, “the core of their business is selling full-calorie Coke.” And even if a person chooses to eat healthier by having low-calorie or nocalorie sodas, it might give consumers the false hope of losing weight by drinking the beverage alone. “Even low-calorie sodas could contribute to weight gain and illness,” said Brenda Murray, a bariatric dietitian at the University of Illinois Hospital and Health Sciences System.

AUGUST-SEPTEMBER 2013

Soda functions in the same manner as eating a lot of white bread or rice, she explained. It is processed immediately into fat, thus leaving the consumer with empty calories and no nutritional value at all. The quality supersedes quantity in terms of consuming food beverages, said Murray. Bigger portions of high food quality are healthier than smaller portions of a low food quality. “They are saying a calorie is just a calorie. But it’s not the amount of calories you take in, it’s the kind of calories, too,” she added. In response to Coke In response to the suspicious campaign, the CSPI released a video entitled, “Coming Together: Translated,” which shows various excerpts from the original CocaCola ad with “translations” that interpret and expound the messages more bluntly. For example, the original video states, “If you eat and drink more calories than you burn off, you’ll gain weight,” wherein the tweaked version inserts a “translation” afterwards saying, “If you gain weight, remember it’s your fault and not ours.” “We thought the ad was laughable on its face,” Cronin said. “What we wanted to do was to translate what Coke was saying into

plain English.” Is it just a diversion strategy? Coca-Cola’s behavior can be compared to that of tobacco companies, said Professor Tim Calkins at Northwestern University’s Kellogg School of Management. “The executives at Coke have to be very concerned about the focus of soda on the risk of obesity,” he said. “Like the tobacco industry and other industries that have been scrutinized, they could be stigmatized as a bad product.” Soda companies, Calkins said, feel obliged to engage in the government’s action to impose strict regulations on soft drinks against obesity. He added that while it may be tempting for Coca-Cola to stay mum on the issue of obesity and diabetes, the soda company instead jumped in on the bandwagon to fight this health issue to avoid being identified as the main problem. “(And) I think we’re going to see more of this. As obesity comes to the fore, more and more companies will take action,” Calkins said. In May this year, this campaign which started in the US now moved unto a global scale to address the issues of increasing number of obese children and adults worldwide. Is it because Coca-Cola is sincere with their worries to address obesity? Or is Coke simply dodging the blame? D

feature

Students harvest the fruits of their hard work and patience

(Oh My Gulay!) By Ma. Cristina C. Arayata

t is so hard to feed children vegetables, isnâ&#x20AC;&#x2122;t it? It seems youâ&#x20AC;&#x2122;ve tried everything and nothing works. Thank God then, to former Senator Edgardo Angara for coming up with the OMG! (Oh My Gulay!) campaign. Launched last year, the OMG campaign is a brainchild of then Senator Ed, aiming to establish vegetable gardens in public elementary schools in the country, thus, eliminating hidden hunger that affects 26 of every 100 kids. Compared to short-term feeding programs, engaging children to plant vegetables provides them with the practical skills and healthy eating habits Students of Maria Aurora Central School display their cooking skillswill as they competeeven in the schoolâ&#x20AC;&#x2122;s that carry after finishing Cooking Contest. It was a very fun activity for the students as they develop patience, team work, and school. creativity.

Students of Maria Aurora Central School (MACS) together with Michelle Calica of East West Seed Company and foreign student Emma James showcase their harvest from the school vegetable garden.

Hands-on activities also play an essential part in the program. Through experiential learning, students easily acquire knowledge on the basics of vegetable production . Students of Reserva ES transplanting seedlings into the planting beds.

Students also develop patience and sense of responsibility as they tend to their gardens every day. The students allotted part of their free time to check on their crops.

Vegetables include sweet pepper, upo, eggplant, pechay, tomato, kangkong, okra, ampalaya. As of press time, OMG has had more than 80 participating schools. Last school year, OMG reached approximately 240 faculty members, 30, 000 students, and 100,000 family members. The OMG campaign also aims to create awareness on the nutritive value of vegetables, thus, encouraging parents and children to plant vegetables. A year after its launch, OMG continues to promote vegetable farming among elementary school children. Based on the FNRI 7th National Nutrition Survey 2008, 26 of 100 Filipino kids are

AUGUST-SEPTEMBER 2013

feature malnourished. Moreover, 26 percent of children 0-5 years old are underweight, while 28 percent were underheight. The survey added that 25 percent of children 6-10 years old are underweight and 33 percent are underheight. According to the said survey, common malnutrition problems are protein energy malnutrition, iron deficiency anemia, vitamin A deficiency and iron deficiency A series of classroom lectures is the first phase of the program. The school children are taught modern vegetable production technology as well the health benefits of vegetables. OMG-TSK Coordinator disorders, which can beasaverted by eating vegetables. Michelle Calica delivers her lecture to the students of Diteki ES.

Public-Private Partnership Various organizations collaborated for the OMG.

BDO Foundation adopted a total of 15 schools nationwide for the Oh My Gulay! Program which represent nine regions of their Branch Banking Group. The donor company organized their volunteer group to assist in monitoring the progress of the program.

Students harvest the fruits of their hard work and patience

One of the objectives of OMG! is to engage parents and the community. This way, OMG! believes that parents will be encouraged to plant vegetables in their own backyard. Members of the PTCA of Reserva Elementary School help prepare the beds for planting.

Private companies including BDO Foundation, Asian Terminals Inc., Aboitiz Foundation, Private companies including BDO Foundation, Asian Terminals Inc., Aboitiz Foundation, Sunwest Care Foundation and IPNAP signed up to formalize their sponsorship for the Sunwest CareofFoundation and IPNAP up to formalize their sponsorship for the establishment vegetable garden in 40signed public elementary schools around the country. establishment vegetable gardenOMG!’s in 40 public elementary schools aroundthe the country. East West Seed of Company (EWSC), implementing partner, provided technical assistance progress of theimplementing program in each of theprovided OMG! schools. East West and Seedmonitored Companythe (EWSC), OMG!’s partner, the technical assistance and monitored the progress of the program in each of the OMG! schools.

They are the Department of Education, FNRI, East West Seed, Aboitiz, Sunwest, Asian terminals, Nutrition Foundation of the Philippines, Nutrition Council of the Philippines, Viva Films, ABS-CBN, Knowledge Channel, Solar Entertainment, TV 5, Novartis, and individual volunteers. With the initial success of OMG, it is currently on its second phase of advocacy: bringing OMG to schools through gardening programs and teaching students, teachers and parents how to grow vegetables. Celebrities also posed for OMG for free, glad to help out in the campaign. D Under the OMG! Program, Sunwest Care Foundation, Inc. adopted five (5) public schools in Aurora province namely, Baler Central School, Maria Aurora Central School, Diarabasin Elementary School, Diteki Elementary School, and Reserva Elementary School.

School orientation marked the launch of the Oh My Gulay! Program. It was initiated by the OMG implementing team and joined by the school officials, barangay officials, an PTCA officers. It is very heartwarming to see the school’s commitment in promoting good nutrition and in improving the academic performance of their students. The produce from the vegetable gardens were used for a feeding program within the school.

CS) commitment in promoting good nutrition and in improving the academic e from the vegetable gardens were used for a feeding program within the eed owgar-

Celebrities for the OMG Campaign include (L-R) Cristine Reyes, Carlo Aquino, Anne Curtis, Sam Pinto, Mark Bautista, and Sarah Geronimo

AUGUST-SEPTEMBER 2013

feature

FOR YOUR PATIENTS WITH TYPE 2 DIABETES

Please review product information before prescribing

AUGUST-SEPTEMBER 2013

Breakfast a nd Diabetes The importance of breakfast and its relation to glucose maintenance for people with type 2 diabetes By Mylene C. Orillo

reakfast eaters tend to have lower BMI than breakfast skippers shared Dr. Roberto Mirasol during a roundtable discussion hosted by Abbott Nutrition Philippines. Dr. Mirasol, head of the Diabetes, Endocrine, and Thyroid Center at St. Luke’s Medical Center Quezon City, revealed that breakfast consumption has declined in all age groups over the past 25 years particularly among older females and female adolescents (15-18 years). “Consumption of breakfast is considered as one of the most

important health-related behaviors. Breakfasteating behaviors can affect behavioral, cognitive, and affective aspects of a person. Obese individuals are more likely to skip breakfast or consume less energy at breakfast,” said Dr. Mirasol, adding that stress, lack of time, lack of parental control, and living alone or individualization process are some of the reasons why people skip breakfast. Dr. Mirasol cited early studies where it said that breakfast skipping can lead to overeating later in the day. Eating cereals or breads for breakfast can

AUGUST-SEPTEMBER 2013

lower BMI versus people who skip breakfast or those who eat meat and/ or eggs for breakfast. “Metabolic changes associated with an overnight fast to maintain the availability of energy and nutrients to the CNS (central nervous system). Long-term beneficial effects that breakfast may have (is) an overall nutrient intake and nutritional status which could consequently affect cognition,” Dr. Mirasol added. He also cited a study conducted by The American Journal of Clinical Nutrition by Rania

blog.womenshealthmag.com

feature

A. Mekary, et al entitled “Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking”, which showed that men who skipped breakfast have slightly higher BMI, smoked more, exercised less, consumed more alcohol, ate less cereal fiber, and drank more coffee compared with breakfast consumers. “Men who skipped breakfast tended to have poorer diet quality reflected by a lower prudent dietary pattern score and higher Western dietary pattern score than breakfast consumers,” it

feature said on the study. The objective of the study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and type 2 diabetes mellitus (DM) risk in men. After adjusting for age, there’s a 50 percent higher risk of type 2 DM in men who skipped breakfast than in men who consumed breakfast. This direct association remained significant after adjustment for dietary and other risk factors for type 2 DM (multivariable RR: 1.27; 95 percent CI: 1.13,1.43). The association also remained significant after additional adjustment for BMI (21 percent increased risk), which was a potential mediator. “Compared with men who ate three times daily, the relationship between increased eating frequency and type 2 DM risk was direct for men who ate four times/

of breakfast, there’s a 5 percent decreased risk of developing type 2 DM (HR, 0.95; 95 percent confidence interval, 0.91-0.99). Compared with participants who ate breakfast between zero to three times per week, those who ate five times or more had 31 percent reduction in type 2 DM. Weight gain was also less. “Overall, findings showed an inverse relationship between increasing breakfast frequency and type 2 DM, probably mediated by BMI,” said Dr. Mirasol. With this, Dr. Mirasol recommends glycemiatargeted specialized-nutrition (GTSN) products, such as Glucerna Triple Care as it exerts a significantly lower rise in blood glucose levels compared to a typical breakfast. It could be helpful for meal planning as part of diabetes management. “Choosing the right food helps manage your glucose

Dr. Roberto Mirasol

day and non-significant for men who ate five to eight times/day before adjustment for BMI,” said Dr. Mirasol. These associations appeared to be mediated by an increased BMI because they became non-significant after additional adjustment for BMI, even though the P-trend was significant (P-trend = 0.04). When it comes to frequency of meals, men who ate one to two times daily also had a higher risk of type 2 DM than men who consumed three meals daily (multivariable RR:1.26; 95 percent CI: 1.09,1.46). The association appeared to not be mediated by BMI because it was not materially altered after additional adjustment for BMI. The study found that each additional day/week

response and is important to controlling your overall blood glucose levels,” said Dr. Mirasol. “GTSN can be a good choice, as part of a healthy meal plan, for many people with diabetes.” “Glucerna Triple Care improved glucose response and elevated GLP-1 levels which help your body to better use and release insulin, compared to a typical breakfast food without negatively impacting appetite,” said Dr. Jose Rodolfo Dimaano, Jr., medical director, Abbott Nutrition Philippines. “While more research is needed in this area, the results of this study are promising for people with type 2 DM as they show a way to help manage their glucose response through simple nutrition modifications.”D AUGUST-SEPTEMBER 2013

specialadvertisingfeature feature

Abbott introduces 3 steps in fighting diabetes

femside.com

ver 11 million Filipinos are diagnosed with pre-diabetes and diabetes. On its advocacy to fight diabetes in the Philippines, Abbott introduces The Glucerna® 1-2-3 Challenge, a free program designed to help people with diabetes implement new healthy habits and provide them with useful resources that can help make managing their diabetes with a healthy lifestyle easier. “Proper diabetes management can be overwhelming for people with diabetes, but is essential for them to maintain a healthy and active life,” said Dr. Jose Rodolfo Dimaano, Medical Director, Abbott Nutrition. “That’s why we developed the Glucerna 1-2-3 Challenge to provide people with diabetes an easy-to-use resource that helps them take charge of managing their condition and feel confident they can lead a healthier lifestyle.” This unique 12-week program provides online and mobile resources for people with diabetes to create a simple plan that incorporates 1) a healthy meal plan, 2) exercise, and 3) specialized nutrition such as Glucerna Triple Care. The three steps of the 1-2-3 Challenge help people with diabetes to address three important components of managing their condition – managing

AUGUST-SEPTEMBER 2013

blood sugar response, reducing weight and waistline, and supporting heart health. “Little steps, such as eating right, exercising and incorporating specialized nutrition, such as Glucerna Triple Care, as part of your diabetes management plan can help you live a healthy lifestyle,” said Nadine Tengco, a US certified fitness nutritionist chef. “Lifestyle intervention is important in overall diabetes management to help reduce the risks and complications of diabetes.” By visiting the website http://www.glucerna123challenge.com.ph or through mobile app downloadable via Iphone® or Android phones®*, the 1-2-3 Challenge offers a robust set of tools and tips to provide people with diabetes with: • easy, healthy meal plans and recipes based on caloric needs and personal preferences, • daily exercise plans and step-by-step instructional videos, • Glucerna serving recommendations,tracking tools and progress reports to monitor their progress that they can share with their doctors, and • a loyalty program that rewards members with points so they can redeem prizes depending on the number of points accumulated such as Freestyle® Glucometer, Freestyle® glucose strips, Mercury® Drugstore Gift Certificates, Robinson’s® Gift Certificates, and a lot more. The Role of Specialized Nutrition in Diabetes Management In addition to meal and exercise plans, the 1-2-3 Challenge provides Glucerna serving recommendations, a specialized nutrition product from Abbott Nutrition that leads the world in diabetes nutrition science. The new Glucerna Triple Care product provides a unique system of ingredients to help patients manage their blood sugar response and support heart health. Also, Glucerna Triple Care can support weight management when used as part of an overall diabetes management plan. It has been clinically proven to help manage weight and reduce A1C in conjunction with an overall diabetes management plan, including diet and exercise.

feature

AUGUST-SEPTEMBER 2013

feature

AUGUST-SEPTEMBER 2013

ver story ]

lejandro “Kim” Atienza or Kuya Kim remembers even the scientific names of animals. But three days after his high-profile stroke, he remembered only three: Cat. Dog. Bird.

It was assumed that every bit of trivia in the world was crammed inside the Safari Stetson Hat-donned head of Kuya Kim, who inherited the role from the late Ernie Baron – the man dubbed as the country’s “walking encyclopedia”. But one day, everything went away, like a switch turned off. “And I realized that life was like that. Life is like a switch. It can be taken away from you just like that,” he said with a snap of his fingers.

AUGUST-SEPTEMBER 2013

ver story ]

White Shirt by Team Manila

AUGUST-SEPTEMBER 2013

ver story ]

Dark Pants by Team Manila

Flash back to three days before the end of his memory – the day of his stroke. It was 8 in the morning. He was preparing for Showtime, which aired at 10 am. He was naked in the bathroom when it happened. “All of a sudden, like a switch, I lost my memory. I lost my cognition. I lost all senses. My mind went blank,” he says. Just like any human being in trouble, the first thing Kuya Kim wanted to do was to scream for help. He opened his mouth. Nothing. “I realized that I didn’t have a voice. I knew what to say but I couldn’t say it,” he says. Kuya Kim knew that something was wrong. He was running on raw instincts. His second instinct commanded him to run outside his bathroom so people could see and help him. His househelp knew something was wrong when they saw a naked and panicked Kuya Kim run outside the bathroom, trying to scream for help. “I couldn’t say it. I knew what to say but I couldn’t so I was running around the house for five minutes with my mind blank and not knowing what to do,” he says. “And because the stroke was still happening and there was still blood flowing, the next instinct was wear clothes and run outside my house.” His driver saw him, pulled him to his car, and drove Kuya Kim to the nearest hospital, which is the Philippine General Hospital where he said he almost died. “Naku, muntik na ako mamatay doon (I almost died there). Let me clarify. PGH has the best specialists, the best doctors in the Philippines, but don’t ever go to the emergency room. You will die. You will die,” he said. At PGH, he had to fall in line. His mind was still blank as he was still in the middle of the stroke. Worst still was that other patients in the PGH emergency room instinctively asked to have a picture with him, despite his condition. He was only wearing pants and no shirt. Photos of a shirtless Kuya Kim flooded the internet that day. After two hours, he was brought to the emergency room of Makati Medical Center. His wife, Felicia, called for an ambulance. He was given an anti-coagulant to dissolve the block lodged in the left side of his brain. “I was given the medicine and I was very lucky because the block in the left side of my brain dispersed into seven little pieces,” he says, adding that had the block not dispersed, the stroke would have escalated and would have left him permanently blank and totally devoid of emotion. Kuya Kim’s stroke was congenital rather than due to regular causes like hypertension. He had Patent Foramen Ovale (PFO) or a hole in his heart, which caused the stroke. Because he did not like being on Coumadin, which he describes as “rat poison”, he opted for angioplasty. Kuya Kim is the first one to go through this kind of operation for PFO.

AUGUST-SEPTEMBER 2013

ver story ] is the language you think with,” he explains.

Three days after the stroke, the proclaimed walking encyclopedia could talk again, but only in Tagalog. “Then the doctors explained it to me. There is a three-day window for a stroke. Within three days, whatever you recover, that’s what you live with. Whatever you don’t have within three days is what you work on,” Kuya Kim said. Within three days, Kuya Kim recovered 70 percent of his memory back but it was in shambles. “I couldn’t memorize. I couldn’t remember anything. Alam ko lang (All I know is that) there’s something wrong with me,” he says. His doctor came in three days after and tested his memory. She said to him “Kim, let me just test you. I know there’s something wrong with your memory and language, but it’s normal. We’ll work on it. Eventually, it will come back. Tell me, where are you?” Kuya Kim answered Makati. He forgot the word “Med”. The doctor explained that it is normal and that it is called aphasia. Another test. “Name five animals.” “Even the scientific names of animals, I know. I could only name cat, dog, and bird. I forgot all the rest,” he said. A third test. “What’s her name?” the doctor points to his wife. He answered, “Felicia”. More days passed and he realized that he was speaking only in Tagalog, whereas before the stroke he spoke English and Spanish fluently. “Aphasia pala is like that. You lose all your languages. The only language that stays in your brain

AUGUST-SEPTEMBER 2013

Kuya Kim stayed in the hospital for three weeks. He was able to speak albeit with difficulty, but he could not work yet. He was prescribed to walk everyday for 30 minutes to get the blood flowing. He was also required to monitor his blood pressure three to five times a day. This went on for months until he saw a group of runners running around the field led by Miguel “Ige” Lopez. “I saw how graceful they were, how nice it was to see runners running,” he says. “I was doing brisk walking while still dizzy from all my maintenance medicine.” It wasn’t long until Kuya Kim was running with Coach Ige’s group. The coach even admitted that he didn’t want to accept Kuya Kim because he and his stroke was too high- profile. “The slow walk became a slow run. I learned the basics of running. The slow run became a fast run. About six months from the stroke, I joined my first fun run*,” Kuya Kim said. Six months after his first fun-run, he trained for his first full marathon, which was the Bordeaux Marathon in France. He finished the race in five hours and 10 minutes. He was hooked on running. “I wanted to run every day after that but you can’t because as a runner, bawal araw-araw (it’s not allowed) unless you cross-train. I’m a runner. I guess it made sense to ride a bike so I learned how to ride a bike,” he said. Eventually, it also made sense to learn how to swim so he could

be a triathlete. This was ten months before the Cobra Half Iron Man 2012. He swam the length of two kilometers, biked 90 kilometers, and ran 21 kilometers, which Kuya Kim finished in six hours. The average beginner finishes at seven hours. He’ll be doing his first Cobra Full Iron Man in Australia in December. Full Iron Man is a 4-kilometer swim, 180-kilometer bike, and a 42kilometer run, which Kuya Kim aims to finish in just 14 hours.

“Since after the stroke and because I’m also training for ironman, people are saying I’ve lost a lot of weight,” he said. “The reason that I am very slim is because of my exercise and because I come from a family of diabetes patients.” His grandparents from both sides died of diabetes. “I’m very conscious of my diet also. I eat like a diabetic although I’m not. What does that mean? I watch my glycemic index,” he said. Kuya Kim explains that with high glycemic index food, consuming a little shoots up blood sugar levels considerably. “Take away anything that is white, meaning no white rice, no white bread, and no white sugar,” he said. Fruits are also classified. He recommends lanzones and saba but warns against bananas, lakatan, and grapes. “Choose low glycemic index and you can eat more, feel fuller, and not gain weight. Of course, if you want to stay healthy, and your blood sugar is low, walang problema (you have no problems). Your blood pressure stays low, too,” he said. “For about three years already,

AUGUST-SEPTEMBER 2013

ver story ]

I never eat white rice. If I have to, I eat very little. I eat brown rice. It’s not actually brown, it’s black but it has flavor. It tastes like vegetables. Ang sarap (it’s delicious),” he said. He also never eats white bread, which he describes as dessert, and sticks to rye bread or whole wheat bread.

“When you’re in your 40s, ibang-iba (it’s very different). Ngayon kasi bata pa tayo ‘kala natin invincible tayo (Because we’re young now, we think we’re invincible). By the time we reach 40, a lot of things happen to our bodies,” he said. When Kuya Kim was 43, he thought he had 20-20 vision. A test by the doctor found he was at 75/100 with Presbyopia. The doctor explained to an incredulous Kuya Kim that it was normal for his age. “What happens when you’re forty is that the incidence of stroke and heart attacks doubles,” he explains. “The best way is to prevent this early on.” Stress is not new to Kuya Kim who transitioned from the stress of politics to that of showbiz. He describes the transition as pleasurable. “The stress of showbiz is very manageable stress. Good stress. They say that showbiz is ma-politika

(politics-driven). That’s nothing compared to real politics,” Kuya Kim said. “It depends on how you carry yourself as well.”

It was a major dilemma explaining to his father that he was replacing Ernie Baron on television instead of him in politics. He was set to replace his father as mayor of Manila and he thought promoting himself on television by hosting a segment in ABS-CBN’s morning news program called Animalandia would help in his recall with the voters. Unfortunately, Maria Ressa, the station’s head of news and current affairs, was on to him and he was given a choice. “Atienza, I like you. I like you. I like what you do but I know what you’re doing,” Maria Ressa told Kuya Kim in that fateful meeting six months into his hosting gig. “You’re running for politics. You’re running for mayor and you are using news and current affairs for exposure. And I will not allow that.” “But since I like you, here’s a contract. I’d like for you to work for me and keep doing what you’re doing but you cannot be in politics.” Simply put, he was asked to choose between his dad and what he is happy doing. He prayed

AUGUST-SEPTEMBER 2013

and asked for two signs from God to help him decide. The first was plain and simple. Ernie Baron bequeathed his image as trivia-man to Kuya Kim on air. The second was Ernie Baron dying the day before Kuya Kim’s birthday. “Kuya Kim” was born that day. Even the problem of telling his dad passed by smoothly. His dad happily accepted Kuya Kim’s decision. From that day on Kuya Kim totally dropped off politics. “I’d rather be Kuya Kim than Senator Kim or Mayor Kim. After Kuya Kim, I’d like to retire as Kuya Kim. After that, I’d like to concentrate on family, triathlon, my garden, and my animals,” he said.

beautiful children. That makes me happy. All else is extra,” he said. At the height of his stroke, a time came when he wanted to pray or even say goodbye to his wife but couldn’t because his mind was blank. “You know what I realized after the stroke? When you’re on the verge of death, you realize that just to live is relevant. Just to be alive is good. All else is bonus,” he said. The ordeal is done. Kuya Kim ends the story for that day. He recounted every detail to the media as if it had happened yesterday. The stroke, aphasia, Patent Foramen Ovale, and the victory of every race and decision, Kuya Kim remembers. Kuya Kim remembers everything very well.

Twenty snakes, three Macaus, 36 minipinchers, a Labrador, a Jack Russell Terrier, a Welsh Corgi, turtles and tortoises, rare frogs, iguanas, and lizards all live with Kuya Kim and his family of animal lovers. His home is also where he draws happiness from – his Taiwanese wife, Felicia, and his three children. “My heart’s very happy. I’m married to a beautiful woman. It takes a lot of grace from God to find the right one. I’m very happy with my Fely and my three

*Kuya Kim’s first fun run was the 1st annual G.O.O.D. Run organized by the Philippine Chapter of the American Association of Clinical Endocrinologists (AACE) on April 3, 2011 to raise awareness for endocrine diseases such as Goiter, Obesity, Osteoporosis, and Diabetes. *Kuya Kim was interviewed at his launch as brand ambassador of Omron Blood Pressure Monitor held at the Makati Shangri - La in July. D

Quinoa

150

White rice, average

150

Quick cooking white basmati Brown rice, average

67 50

Converted, white rice (Uncle Ben's®)

150 150

150

Whole wheat kernels, average

Bulgur, average

150

Graham crackers

Vanilla wafers

Shortbread

Soda crackers

Ice cream, regular

Ice cream, premium

Milk, full fat

250mL

Milk, skim

250mL

Reduced-fat yogurt with fruit, average

200

Apple, average

120

Banana, ripe

120

Dates, dried

Grapefruit

120

Grapes, average

120

Orange, average

120

Peach, average

120

Peach, canned in light syrup

120

Pear, average

120

Pear, canned in pear juice

120

Prunes, pitted

Raisins

Watermelon

120

Baked beans, average

150

Blackeye peas, average

150

Black beans

150

Chickpeas, average

150

Chickpeas, canned in brine

150

Navy beans, average

150

Kidney beans, average

150

Lentils, average

150

Soy beans, average

150

Cashews, salted

Peanuts, average

Fettucini, average

180

Macaroni, average

180

ver story ] 16

COOKIES AND CRACKERS

Kuya Kim mentioned that he was on a diabetes patient’s diet despite not having the Here is 25 82 disease himself. Rice cakes, average 17 25 64 Rye crisps, average 11 a list of food with their glycemic indices. A Glycemic index below 55 is considered low. FOOD

Glycemic index (glucose = 100)

Serving size Glycemic load (grams) per serving

BAKERY PRODUCTS AND BREADS Banana cake, made with sugar

Banana cake, made without sugar

Sponge cake, plain

Vanilla cake made from packet mix with vanilla frosting (Betty Crocker)

111

Apple, made with sugar

Apple, made without sugar

Waffles, Aunt Jemima (Quaker Oats)

Bagel, white, frozen

Baguette, white, plain

Coarse barley bread, 75-80% kernels, average

Hamburger bun

Kaiser roll

Pumpernickel bread

50% cracked wheat kernel bread

White wheat flour bread

Wonder™ bread, average

Whole wheat bread, average

100% Whole Grain™ bread (Natural Ovens)

Pita bread, white

Corn tortilla

Wheat tortilla BEVERAGES

Coca Cola®, average

250 mL

Fanta®, orange soft drink

250 mL

95±10

250 mL

Apple juice, unsweetened, average

250 mL

Cranberry juice cocktail (Ocean Spray®)

250 mL

Gatorade

250 mL

Orange juice, unsweetened

250 mL

Tomato juice, canned

250 mL

Lucozade®, original (sparkling glucose drink)

BREAKFAST CEREALS AND RELATED PRODUCTS

DAIRY PRODUCTS AND ALTERNATIVES

FRUITS

BEANS AND NUTS

PASTA and NOODLES

All-Bran™, average

Macaroni and Cheese (Kraft)

180

Coco Pops™, average

Spaghetti, white, boiled, average

180

Cornflakes™, average

Spaghetti, white, boiled 20 min, average

180

Cream of Wheat™ (Nabisco)

250

Spaghetti, wholemeal, boiled, average

180

Cream of Wheat™, Instant (Nabisco)

250

Grapenuts™, average

Corn chips, plain, salted, average

Muesli, average

Fruit Roll-Ups®

Oatmeal, average

250

M & M's®, peanut

Instant oatmeal, average

250

Microwave popcorn, plain, average

Puffed wheat, average

Potato chips, average

Raisin Bran™ (Kellogg's)

Pretzels, oven-baked

Special K™ (Kellogg's)

Snickers Bar®

SNACK FOODS

VEGETABLES

GRAINS Pearled barley, average

150

Green peas, average

Sweet corn on the cob, average

150

Carrots, average

Couscous, average

150

Parsnips

Quinoa

150

Baked russet potato, average

111

150

White rice, average

150

Boiled white potato, average

150

Quick cooking white basmati Brown rice, average

67 50

150 150

Instant mashed potato, average

150

Sweet potato, average

150

Converted, white rice (Uncle Ben's®)

150

Yam, average

150

Whole wheat kernels, average

MISCELLANEOUS

Bulgur, average

150

Hummus (chickpea salad dip)

COOKIES AND CRACKERS

Chicken nuggets, frozen, reheated in microwave oven 5 min

100

7 22

Graham crackers

Vanilla wafers

Pizza, plain baked dough, served with parmesan cheese and tomato sauce

100

Shortbread

Pizza, Super Supreme (Pizza Hut)

100

Rice cakes, average

Honey, average

Rye crisps, average

Soda crackers

Ice cream, regular

Ice cream, premium

Milk, full fat

250mL

Milk, skim

250mL

DAIRY PRODUCTS AND ALTERNATIVES

Source: http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm

AUGUST-SEPTEMBER 2013

righteousrecipes

By Chef Junjun de Guzman Photos By Jose Martin Punzalan

A 40

soup or salad is always served before the main course. For those who are conscious about having any of the two, here are some recipes you can try without the added guilt.

AUGUST-SEPTEMBER 2013

righteousrecipes n Nutritio

ing: er serv facts p lories a c 0 6 1 0 g fat rates y rboh d 29 g ca g protein 1

Green Salad with Pomelo Bits Makes 6 servings Ingredients: 400 grams assorted lettuce leaves ½ piece pomelo, segmented and cubed ½ piece carrots, julienned ½ piece cucumber, sliced Procedure: 1) Toss all ingredients together. Decorate with some of the remaining ingredients for presentation. 2) Pour some vinaigrette dressing on top.

Balsa mic Vi n aigrette Makes ½ cup Ingredients: 1 tsp Dijon mustard cup extra virgin olive oil 1 tbsp balsamic vinaigrette 2 tbsp water

Procedure: 1) Put all the ingredients in a bottle. 2) Shake until well-combined. 3) Pour over salad.

Nutrition facts per serving: 677 calories 71 g fats 0 g carbohydrate 0 g protein

Carrot – Potato Soup Makes 6 serving Ingredients: ½ tsp minced garlic 3 pcs onions, quartered 4 pcs carrots, sliced into chunks 4 pcs potatoes, quartered 1 pc celery, chopped Procedure: 1) Mix all ingredients in a pan and sauté for 5-7 minutes or until aromatic. 2) Add enough water to cover the vegetables. 3) Boil and simmer for 20-30 minutes or until the vegetables are soft and tender. 4) Put all the ingredients in a blender and process until fine. 5) Return mixture into a casserole and simmer for 20-30 minutes. Serve while hot.

Nutrition fa

cts per serv ing: 156 calorie s 0 g fats 30 g carboh ydrates 3 g protein

AUGUST-SEPTEMBER 2013

righteousrecipes Nutrition

serving: facts per es 255 calori ts fa g .5 0 9 ydrates oh rb ca g 9.7 ein 27.5 g prot

Chicken a nd Grape Salad Makes 4-6 servings Ingredients: 2 pieces whole chicken breast, boiled, deboned and cubed 1 cup red seedless grapes, halved ½ – cup lite mayonnaise 3 tbsps non-fat milk 1 tbsp chopped onion chives or spring onions Pinch salt ½ tsp ground pepper Procedure: 1) Mix mayonnaise and milk together. Add spring onions, and season with salt and pepper. Set aside. 2) Toss chicken breast and grapes. Add in mayonnaise mixture. Keep in the refrigerator until ready to serve.

Crea mless Mushroom Soup Makes 5-6 servings Ingredients: ¼ cup butter 2 pcs onions, sliced 300-350 grams fresh mushrooms, sliced like brown, button, shitake, oyster 2-3 cups water or chicken stock Pinch dried thyme Procedure: 1) Sauté the onions in butter until it becomestranslucent. 2) Add in sliced fresh mushrooms and cook until juices are released. 3) Add pinch of dried thyme and season with salt and pepper. 4) Cover with enough water or chicken stock until mushrooms are submerged. Let boil and then simmer for 45 minutes to an hour, adding just enough water when needed. 5) Separate two cups of the fresh mushroom mixture, process the leftover in a blender and return this to the main mixture. 6) Let boil and simmer for 10 minutes. Serve warm.

AUGUST-SEPTEMBER 2013

Nutrition

facts per

serving (f

or 5 pers ons): 130 calo ries 15 g fats 4.2 g carb ohydrates 1.4 g pro tein

righteousrecipes

AUGUST-SEPTEMBER 2013

Best practices for prevention By Theresa Marie Valdez-Faller, MD, FPCP, FPSEM, FACE

veryone is familiar with the old adage â&#x20AC;&#x201C; nobody dies from diabetes, only from its complications. There is truth in these words since if it were not for these complications; diabetes may be regarded as an annoyance rather than an inherently dangerous condition. It is sad that when control of diabetic complications is mentioned, it is almost always said that its development is inevitable but can be delayed in onset and

AUGUST-SEPTEMBER 2013

progression if one has good sugar control as well as control of other risk factors. The effect of high blood sugar levels on blood vessels cause the long term complications of diabetes mellitus (DM). The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), both landmark trials in DM type 1 and type 2 respectively, have found that lower blood sugar levels brought fewer complications than those with

podiatrytoday.com

Diabetic Complications â&#x20AC;&#x201C; What, Why, and How to Screen

oregoneyes.net

neuro.com

drmikeli.com

news.bbcimg.co.uk

indepth

higher values or uncontrolled sugar. MICROVASCULAR COMPLICATIONS affect the small blood vessels, creating problems with the eyes (retinopathy), kidneys (nephropathy) and nerves (neuropathy). Diabetic retinopathy This eye complication is caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina) and can later lead to mild vision problems initially and eventually to

indepth blindness. The risk of development of this complication is dependent on the type of diabetes and the presence of other co-morbid illnesses. Regular eye examinations are essential to detect early stages of retinopathywhen this condition can be monitored and treated to preserve vision. The eye exam which includes dilating the pupil to completely view the retina, should be done by an eye specialist, the ophthalmologist. Type 1 diabetics should have their eyes examined beginning five years after diagnosis and yearly thereafter. If they have vision difficulties or wear glasses, they may need to be examined earlier. In type 2 diabetics, blood sugar levels have insidiously increased over a period of time before diagnosis such that it is not surprising for a newly diagnosed diabetic to already have retinopathy. It is recommended therefore that type 2 diabetics have their eyes examined upon diagnosis of DM. The results of the initial exam determine the frequency of subsequent assessments, usually every year there after. Diabetic nephropathy The normal function of the kidney can be altered by diabetes. The nephrons, which are small units that make up the kidney and filter the blood to help remove waste from the body, thicken and slowly become scarred over time. The kidneys then begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin. The amount of albumin in a simple urine test can determine if the filtering action of the kidneys are already affected. Small or microscopic amounts of protein in the urine (microalbuminuria) can be an early indicator of DM-related kidney disease. The health care provider maybe guided by the amount of albumin in the urine

as to the worsening of condition. In type 1 diabetics, urine screening should begin about five years after diagnosis. In people with type 2 DM, screening should begin at time of diagnosis of diabetes. If the exam shows presence of albumin in urine, it is a must to have tight blood sugar and cholesterol control. It is generally recommended that if albumin does not improve, to start with the anti-hypertensive medication (ACE inhibitor or angiotensin receptor blocker), even in normotensive diabetics. These medications act todecreasethe amount of protein in the urine and can prevent or slow progression of DM-related kidney disease. Diabetic neuropathy About half of the diabetic population have some form of nerve damage. It is found more commonly in those who had the illness for several years, and this can lead to many kinds of problems. Neuropathy occurs over time when the uncontrolled sugar injures the walls of the tiny blood vessels that nourish the nerves, especially in the lower extremities. Pain, temperature and touch sensations, as well as muscle movement then become impaired. So does the nerves that control digestion and urination. There are several types of neuropathy. Peripheral neuropathy, also known as sensorimotor neuropathy, causes tingling sensations (pins and needles), numbness, or weakness of hands and feet. Autonomic neuropathy affects the nerves that control the body systems like the digestive system (constipation, bloatedness), urinary tract (incontinence, overactive bladder), sex organs (erectile dysfunction), heart and blood vessels (orthostatic hypotension), and sweat glands (hyperhidrosis). Additional types neuropathyinclude the less common cranial neuropathy, Charcot’s joint, thoracic or lumbar

radiculopathy and unilateral foot drop. If blood sugar levels are kept on target, then nerve damage may be prevented or at least delayed in onset. If nerve damage is already present, good sugar control will help prevent further deterioration. Pharmacologic treatments are available – just ask your doctor about it. MACROVASCULAR COMPLICATIONS affects the larger blood vessels, taking its toll on the heart and brain. It is estimated that two-thirds of the diabetic population will die from either a heart attack or stroke. Coronary Artery Disease (CAD) This condition is also known as hardening of the arteries. It is caused by narrowing or blockage of the blood vessels that supply the heart. Through these vessels flow the blood that carries the oxygen and other materials needed by the heart to function properly. If these blood vessels become blocked, partially or totally, by the fatty deposits then the blood supply is compromised and a heart attack or myocardial infarction (MI) may result. Since diabetics may already have nerve damage, heart attacks may be silent or painless. The usual warning signs may not be felt – chest pain or discomfort in the chest or arms, back, jaw, neck or stomach, shortness of breath, sweating, nausea, tiredness and lightheadedness. Heart failure In this condition, the heart is having difficulty pumping blood. It may be caused by a variety of problems: CAD, MI and hypertension. In congestive heart failure, fluid builds up inside body tissues like the lungs which then results to difficulty in breathing. Warning signs can differ among patients but usually include shortness of breathing, weakness, nausea, fatigue, and swelling of feet and ankles (edema) from fluid retention. AUGUST-SEPTEMBER 2013

indepth Stroke This occurs when there is an interruption in the blood supply to a specific part of the brain leading to tissue damage. Most strokes are due to a blood clot that blocks a vessel in the neck or brain. This may manifest with weakness, pain, numbness, movement problems and problems with thinking, remembering or speech. Being diabetic raises the risk for stroke even higher if there is a family history of stroke, previous history of transient ischemic attack (TIA) or stroke, age >50 years, presence of heart disease, hypertension, high LDL, low HDL, overweight and smoking. Peripheral Arterial Disease (PAD) This condition happens when blood vessels in the legs become narrow due to blockage by fatty deposits resulting to decreased blood flow to feet and legs. This also increasesthe risk for heart attack and stroke. A third of diabetics >50 years old have this disorder yet is not aware of it and therefore do not seek treatment. A diabetic is at an even higher risk of acquiring PAD when they have the following conditions like smoking, hypertension, dyslipidemia, sedentary, overweight, elderly, history of heart condition or family history of cardiovascular disease. Most diabetics with PAD donâ&#x20AC;&#x2122;t have any symptoms. There may just be mild leg pain or trouble walking that is usually attributed to advancing age. Other symptoms include leg pains upon walking or exercise which disappear after a few minutes of rest, numbness, tingling or coldness of lower legs or feet, including infections or wounds that heal slowly. The Ankle Brachial Index (ABI) test is recommended by the American Diabetes Association (ADA) as a screening tool for PAD. It is used to diagnose the complication by comparing the blood pressure in the ankle to the blood pressure in the arm. A positive result is a lower value in the leg. To lower the risk of heart disease, stroke and PAD, it is imperative to control the sugar and manage the other cardiovascular risk factors like

AUGUST-SEPTEMBER 2013

blood pressure (<130/80mmHg), cholesterol (LDL <100mg/dL), and smoking cessation. It should be completed with healthy diet, physical activity and appropriate medications given by your doctor. FOOT PROBLEMS Many different foot problems may develop in diabetics. Ordinary problems may become worse and serious oftentimes. Multiple problems like neuropathy and poor circulation may make the foot more vulnerable to injury, infection and delayed healing. A foreign object inside a shoe worn all day may go unnoticed and produce a blister that may later ulcerate and infect. Calluses also often develop in diabetics and maybe due to the high pressure areas under the foot. These calluses may also later on ulcerate and infect. These are now ripe settings for amputations should the delayed healing and presence of uncontrolled infection come into play. Foot deformities may also arise. Dry, peeling and cracked skin in the legs and feet may be due to the impaired nerves that control the oil and moisture in this area. Proper foot wear and regular foot care and examination may prevent foot problems. See a health care provider right away if a blister or a callus develops since these may be harbingers of future trouble. A thin coat of moisturizer will help alleviate skin dryness. Use of oils and creams are discouraged sincethe extra moisture can lead to infection. Conclusion The best strategies to address all these diabetic complications would be to have early and proper screening, and prevent their onset. The importance of good sugar control is emphasized, along with control of the other cardiovascular risk factors like blood pressure, cholesterol, smoking cessation and weight control. Lifestyle changes that include a balanced diet and exercise are a must. Regular visits to your health care provider would complete the regimen. D

indepth

Wh at is good blood glucose control? By Marie Yvette Rosales-Amante, MD

he goal of diabetes treatment is to normalize the blood glucose levels with diet, exercise and medication. Your doctor will give you specific blood sugar goals based on your particular medical situation. There are different sets of recommendations coming from different diabetes organizations to guide your clinician. Your doctor may set higher levels goals in an attempt to “step down” your levels gradually, or to avoid hypoglycemia (very low sugar episodes). Be sure to know your goals so you can assess your progress in controlling your diabetes. HOW TO MEASURE BLOOD GLUCOSE CONTROL? Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glucose control: patient selfmonitoring of blood glucose (SMBG), and A1C. a. General recommendations on self-monitoring of blood glucose (SMBG): 1. Patients on multiple-dose insulin (MDI) or insulin pump therapy should do SMBG at least prior to meals and snacks, occasionally after meals, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until it returns to normal, and prior to critical tasks such as driving. 2. For those on less frequent insulin injections or oral medication, SMBG may be helpful to guide treatment decisions and/or patient self-management.

3.Patients should receive ongoing instruction and regular evaluation of SMBG technique and SMBG results, as well as their ability to use SMBG data to adjust therapy. Major clinical trials of insulin-treated patients that demonstrated the benefits of intensive glucose control on diabetes complications have included SMBG as part of the interventions, suggesting that SMBG is a component of effective therapy. SMBG allows patients to evaluate their individual response to therapy and assess whether glucose targets are being achieved. Results of SMBG can be useful in preventing hypoglycemia and adjusting medications (particularly premealinsulin doses), medical nutrition therapy (MNT), and physical activity. The evidence base for SMBG for patients with type 2 diabetes on non-insulin therapy is somewhat mixed. Several randomized trials have called into question the use and cost-effectiveness of routine SMBG in non– AUGUST-SEPTEMBER 2013

indepth insulin-treated patients. A recent meta-analysis suggested that SMBG reduced A1C by 0.25 percent at 6 months however another study concluded that this effect subsides after 12 months. Because the accuracy of SMBG is instrument- and user - dependent, it is important to evaluate each patient’s monitoring technique, both initially and at regular intervals thereafter. Optimal use of SMBG requires proper review and interpretation of the data, both by the patient and provider. Among patients who checked their blood glucose at least once daily, many reported taking no action when results were high or low. In one study of insulin-naïve patients with sub-optimal initial glucose control, use of structured SMBG (a paper tool to collect and interpret 7-point SMBG profiles over three days at least quarterly) reduced A1C by 0.3 percent more than in an active control group. Patients should be taught how to use SMBG data to adjust food intake, exercise, or medication to achieve specific goals, and the ongoing need for and frequency of SMBG should be re-evaluated at each routine visit. b. General recommendations for A1C 1. Your doctor should order the A1C (also known as HbA1c or glycosylated hemoglobin) test at least two times a year if you are meeting treatment goals (and who have stable glucose control). 2. Your doctor should order the A1C test quarterly if your therapy has changed or you are not meeting your glucose goals. Because A1C is thought to reflect average glucose levels over several months, and has strong predictive value for diabetes complications, A1C testing should be performed routinely in all patients with diabetes, at initial assessment and then as part of continuing care. Measurement approximately every three months determines whether a patient’s glucose targets have been reached and maintained. For any individual patient, the frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the judgment of the clinician. The A1C test is subject to certain limitations. Conditions that affect red blood cell turnover (hemolysis or blood cell breakdown, blood loss) and hemoglobin variants must be considered, particularly when the A1C result does not correlate with the patient’s situation. In addition, A1C does not provide a measure of the wide variations in glucose levels, or hypoglycemia. The A1C may also serve as a check on the accuracy of

AUGUST-SEPTEMBER 2013

the patient’s meter (or the patient’s reported SMBG results) and the adequacy of the SMBG testing schedule. WHAT ARE THE GOALS? Here are two sets of guidelines, one from the American Diabetes Association, and one from the American Association of Clinical Endocrinologists: American Diabetes Association - Blood glucose goals for people with diabetes: 1. Before eating (pre-prandial) 70-130mg/dL 2. 1-2 hours after eating (peak post-prandial) <180mg/dL 3. A1c blood glucose test (3 month blood glucose indicator) <7 percent Lowering A1C to below or around 7 percent has been shown to reduce microvascular (eyes, kidney, nerves) complications of diabetes and if implemented soon after the diagnosis of diabetes is associated with long-term reduction in macrovascular (heart, brain, peripheral vascular) disease. Therefore, a reasonable A1C goal for many nonpregnant adults is <7 percent. 4. Providers might reasonably suggest more stringent A1C goals (such as <6.5 percent) for selected individual patients, if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes, long life expectancy, and no significant cardiovascular disease. Less stringent A1C goals (such as <8 percent) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, and those with longstanding diabetes in whom the general goal is difficult to attain despite all efforts. American Association of Clinical Endocrinologists - Blood glucose goals for people with diabetes: 1. Before eating (pre-prandial) <110mg/dL 2. Two hours after eating (post-prandial) <140mg/ dL 3. A1c blood glucose test < 6.5 percent More recent AACE guidelines included a goal of A1c > 6.5 percent for patients with concurrent illness and at risk for hypoglycemia.

indepth WHAT ARE THE BENEFITS AND RISKS OF TIGHT BLOOD GLUCOSE CONTROL? Tight control means keeping glucose levels as low as possible, which actually has been proven to prevent or slow some complications: -Diabetic eye disease started in only one-quarter as many people. -Kidney disease started in only half as many people. -Nerve disease started in only one-third as many people. -Far fewer people who already had early forms of these three complications got worse. But the downside of tight control includes increased potential for hypoglycemia and weight gain. Hypoglycemia may be lifethreatening for the elderly and frail. Elderly people probably should not

go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years. Some people who already have complications should not be on tight control. For example, people with end-stage kidney disease or severe vision loss probably should not try it. Their complications are probably too far along to be helped. People who have hypoglycemia unawareness (no symptoms when the glucose levels drop to very low levels) probably should not go on tight control. People on tight control gained more weight than people on standard treatment. The average weight gain in the DCCT trial was 10 pounds. If you are concerned

about putting on pounds, work with your dietitian and doctor to devise a meal and exercise plan to prevent it. Tight control is not for everyone. Work closely with a diabetes team to set goals which may be different from person to person. IN CONCLUSION: Good glucose control in a person with diabetes is an effect of a healthy balance of diet, exercise, and medication. Goals of glucose levels are individualized. Regular supervision, evaluation, and management by a doctor or health care team is the key in meeting these goals. D References: ADA guidelines 2013 AACE algorithm 2013

AUGUST-SEPTEMBER 2013

indepth

Best Practices for Weight Loss in People with Diabetes By Patricia D. Maningat, MD

idealmagazine.co.uk

iabetes and obesity are closely linked conditions contributing to increased risk for heart disease. Obesity is a condition characterized by excess accumulation of body fat resulting from a mismatch between energy intake and expenditure and was recently classified as a disease by the American Medical Association. Both genetics and the environment play roles in the development of obesity. Although there are very rare cases of obesity attributed

to alterations in one gene, most commonly, several genes make small contributions to increase susceptibility to obesity. Consumption of foods high in calories combined with reduced physical activity result in a net gain in calories, and a chronically positive balance in a genetically susceptible person will lead to accumulation of excess fat. In the past, fat was an afterthought - just a storage site of fuel in the body. We now know that fat is an active endocrine organ secreting various

AUGUST-SEPTEMBER 2013

hormones that influence appetite control and enhance insulin sensitivity. It also secretes inflammatory substances associated with the development of insulin resistance and diabetes. How to measure obesity There are sophisticated machines that accurately measure lean muscle mass and fat content, but these are not readily available for home use or in doctors’ clinics. Weighing oneself is simple but does not measure body fat. Weight, however is important in

the calculation of the body mass index (BMI), the most common measure of obesity. The BMI is calculated by dividing weight (in kg) by height (in meters-squared). There are BMI apps available for easier calculations. In the US and other non-Asian countries, obesity corresponds to a BMI of ≥ 30 kg/m2. Asians have a lower cutoff, and a BMI ≥ 25 kg/ m2 is considered obese. The reason for this is because Asians tend to deposit more fat in the abdominal region, the socalled “apple-shaped”

indepth vs. “pear-shaped” figure where fat is deposited mainly on the hips. For a given BMI, Asians tend to have higher abdominal fat compared with matched white populations. People with more abdominal fat are at increased metabolic risk for insulin resistance, diabetes, high cholesterol, and heart disease. Effects of excess body fat Normally, carbohydrates from a meal are digested, broken down into glucose units, and enter the circulation. In response to blood glucose, insulin is secreted from the pancreas and works on the muscle and fat cells to take up glucose from circulation for use in energy production and storage. In obese individuals, excess fat also gets deposited in the liver and muscle. This results in insulin resistance or insensitivity of tissues to insulin, leading to disruption in glucose metabolism. Early in the course of diabetes, the pancreas compensates by increasing insulin secretion, but over time, there is a burnout and the insulin produced is insufficient, resulting in higher levels of blood glucose. Weight loss helps make the body more sensitive to insulin and helps in the control of blood sugar. Excess body fat may put a person at risk for various health issues. Obesity makes it more difficult for insulin to do its job of using the glucose in the circulation, and results in insulin resistance and diabetes. Excess body fat increases the volume of blood the heart must pump to supply tissues and increases pressure on the walls of arteries leading to hypertension. Elevated bad cholesterol (LDL) and low good cholesterol (HDL)

result in increased deposition of plaques in the arteries leading to heart disease. Shortness of breath and sleep apnea are more common in obese individuals. Joint disease, specifically osteoarthritis, is more common because of the greater stress on the joints. Infertility, pregnancy problems, gallstones, and depression are also more common. Finally, the risk of cancers is also increased, such as cancers of the colon, breast, uterus, and esophagus. Weight loss benefits We live in a weight-obsessed society. Reality TV actually follows people who try to lose weight and this has inspired many to lose weight as well. For people on these shows, losing weight is a full-time job and it’s not an easy one. However, getting back to better health does not entail losing half of your weight. In fact, studies show that losing just 5-10 percent of your weight results in improved health in terms of better blood sugar and blood pressure control, and may reduce the need for medications for diabetes, hypertension, and cholesterol. Somewhat disappointing, a recent weight loss study on intensive lifestyle interventions in obese diabetics failed to reduce cardiovascular illness compared with a group given standard diabetes support and education. This study did however show other benefits, such as better blood sugar control, sleep apnea, depression, mobility, and quality of life. Therefore, the benefits of weight loss still outweigh the risks of remaining obese. In terms of optimal rate of weight loss and the amount of

absolute weight loss per se that will result in long-term success, the jury is still out. Bottom-line, even a small percentage of weight loss results in improvement of metabolic health parameters. Achieving cosmetic goals may entail larger weight loss. Talk to your doctor if you plan on going on a diet, as your medications may need to be modified. Losing and maintaining weight are two challenges that must be faced. As one loses weight, the body tries to counter by bringing it back to the previous set point. Weight regain after an initial period of weight loss is the norm, therefore it takes a lifelong commitment to proper diet habits and physical activity to achieve and maintain weight loss. Diet tactics For people with diabetes, the American Diabetes Association recommends moderate weight loss of ~7 percent of body weight. A negative energy balance is key to losing weight and there is no shortage of diet plans available – including low fat, low carbohydrate, high protein, etc. What these diets for weight loss have in common is that they are low in calories. The optimal macronutrient distribution for diabetics has not yet been established and the mix of proteins, fat, and carbohydrates may be adjusted based on the metabolic goals and preferences of the individual. No specific diet has been shown to be superior to others for weight loss, control of blood sugars, and reduction of cardiac risk. Be wary of diets that cut out specific food groups entirely, a balanced diet with smaller portions are AUGUST-SEPTEMBER 2013

indepth preferable. People with diabetes are encouraged to count carbohydrates by checking food labels, exchanges, or experienced-based estimation in order to achieve blood-sugar goals. Consult your doctor or nutritionist if you are unfamiliar with these methods. Choose fiber-rich carbohydrates and vegetables and fruits over calorie-enriched snacks. Saturated fat should be <7 percent of total calories and trans fats should be avoided. Limit alcohol to one drink per/day for adult women and two drinks/day for adult men, with precautions for the development of low blood sugar, especially for those on diabetes medications. New apps for tracking calorie intake and expenditure from physical activity are helpful. Adherence to any diet has turned out to be the most important factor to any dietary approach, therefore the best diet for diabetics is one that works for them, and one that can be sustained.

images.idiva

Exercise recommendations In terms of physical activity, diabetics are encouraged to engage in moderate intensity physical activity at least 150 minutes/week, or 75 minutes/ week of more vigorous aerobic physical activity. If there are no contraindications, resistance training with free weights or weight machines is encouraged twice a week. For adults over 65 years, or those with

disabilities, try to be as physically active as possible. For patients with type 1 diabetes, vigorous exercise can worsen hyperglycemia and ketosis. Physical activity is encouraged if you are feeling well, have been injecting the right doses of insulin, and ketones are negative. For type 2 diabetic patients on insulin or medications that increase insulin secretion (glibenclamide, gliclazide, or similar medications), there is a risk for developing low blood sugar. Check your blood sugar levels before exercise. If it is <100 mg/dL, strategies include having a snack prior to exercise, and intermittent snacks during prolonged vigorous activity, or decreasing the insulin dose prior to exercise. For patients with type 2 diabetes not on insulin or medications that increase insulin secretion, there is a low chance of developing hypoglycemia. If you have eye complications or have decreased sensation or pain in your legs and feet, not all exercises may be right for you. Talk to your doctor about the appropriate steps for you, there is no one way of adjusting medications as our bodies respond to exercise differently. Losing weight and maintaining weight loss are challenges. It takes time, but it is not impossible. Solicit the help of your doctor, nutritionist, friends and family to help in the weight-loss journey. It will be a long journey, so the more people in your company enjoying a healthier lifestyle, the easier and merrier it will be. D

AUGUST-SEPTEMBER 2013

America n Eye Center brings the latest in eye care to Sh a ngri-La m all

indepth

By: Michael E. Dugenia Photos by: Rusdee Bolante

merican Eye Center, the country’s pioneer and leading mall-based ophthalmic clinic, recently reopened the doors of its branch at the Shangri-La Plaza mall in Mandaluyong City. The renovation is part of the clinic’s commitment to bringing world-class eye care to its many loyal customers in this part of the metropolis. The clinic features a smarter looking interior and a modern look and feel and brighter exterior and interior. However, its loyal customers can still expect the same kind of quality eye care they have come to expect all these years. Since opening in 2000, American Eye Center’s Shangri-La Plaza branch has evolved to become a full-service diagnostic, therapeutic, and surgical eye facility fully accredited with the Department of Health and the Philippine Health Insurance Corporation. It has since grown its customer base exponentially, as it developed a reputation for excellence. Like any trailblazer, the clinic started many firsts that have since become barometers in the industry. For example, it was the first clinic to practice globally accepted procedures that are now being widely used across the industry. “The renovation is just part of our expansion not just of our facilities but also of our services to our customers.” said Dr. Alnette L. Tan, clinic manager and a LASIK/refractive surgeon at American Eye Center. “We need to meet the growing needs of our customers in this part of town and given that this is first mall-based branch, it is high time we invested in a new and better clinic.” Investing in the latest eye-care technology American Eye Center also built a reputation for investing in the latest technology, which would become hallmarks of its excellent service. Setting aside more than PhP2 million in 2011, it brought in the all-laser or bladeless LASIK via the Wavelight Refractive Suite. The acquisition was significant for the clinic because only a handful of eye hospitals in the world had it at the time, thus putting American Eye Center on a par with the best abroad. The Wavelight Refractive Suite is the world’s fastest refractive platform, combining two of the most advanced technologies for performing LASIK surgery, namely, the

Wavelight EX500 excimer laser and the Wavelight FS200 femtosecond laser. This technology enables eye-care professionals to conduct the entire procedure in less than 10 minutes. The Wavelight EX500 and the Wavelight FS200 allows surgeons to ensure consistent results in laser vision correction because of their speed, versatility, safety, and precision. Also, in November 2011, the clinic introduced the latest in cataract surgery in Asia. Called the Alcon LenSx femtosecond laser surgery, this equipment brings an unprecedented level of safety, speed, and precision in treating cataracts, and enhances the host of options for surgical-based methods that American Eye Center offers its clients. This is the true bladeless cataract surgery. By using very short but intense bursts of near-infrared light, the Alcon LenSX femtosecond laser technology is able to create extremely precise subsurface cuts without manual intervention. The blades used to create the small incisions in the eye have been completely replaced by this laser, making the incisions more precise and predictable. In addition, the circular opening that is created in the human lens in order to access the cataract (called a capsulotomy), which was traditionally performed by human hands, has been perfected by the femtosecond laser, making the capsulotomies more architecturally round and centered. Cataract is the leading cause of blindness in the Philippines, with an estimated half a million Filipinos blind or having some degree of visual impairment. This disease, which hits almost everyone due to aging, involves the gradual formation of a cloudy film in the lens of the eye, varying in degree from slight to complete opacity, and obstructing the passage of light. Studies have shown that this is very important in intraocular lens (IOL) stability and refractive predictability of surgical outcomes. Finally, the actual cataract is also fragmented by the femtosecond laser, making it much easier and less traumatic for the surgeon to remove and clean it up prior to placement of the IOL. In short, the femtosecond laser has replaced many of the steps in the cataract surgery that were previously performed by human hands, resulting in less surgical error and better predictability of outcomes. Outcomes are more precise than any other previous or current

methods of cataract surgery. International expertise, continuing training, and Filipino compassion All of the clinic’s doctors are diplomates of the Philippine Board of Opthalmology and have trained extensively in prestigious learning institutions abroad. Doctors at American Eye Center are also noted for being leaders in their field of expertise and have trained or mentored today’s eye doctors. The clinic’s doctors are qualified in all subspecialties in eye care such as cataract surgery, lasik/refractive, cornea and external diseases, glaucoma, retina and vitreous, pediatric ophthalmology and strabismus, neuro-ophthalmology, oculoplastic, orbital, lacrimal and reconstructive surgery, and low vision and vision rehabilitation. “Doctors who practice in our clinics are selected from the best,” said Dr. Benjamin G. Cabrera, chief operating officer of American Eye Center. “Our doctors are selected not just for their expertise but for their character and, more importantly, for their compassion, so that patients are assured of the best in eye care.” Happy customers Over the years, American Eye Center has earned an unrivalled reputation in the field of eye care, making it the preferred eye care clinic among the discerning set. But more than just providing worldclass eye care, the level of dedication and professionalism has been one of many reasons why its list of satisfied customers keeps getting longer. Celebrity hosts Ceska Litton and Rovilson Fernandez, broadcaster Daphne Osena, 360 Fitness Club founder Kim Tanedo, and Bulacan State University Dean Nora Tan are just a few of the clinic’s happy customers. “Investing in the latest equipment and machines is just one part of the equation,” said Dr. Victor L. Caparas, chief financial officer of American Eye Center. “We believe that the way we take care of our customers sets us apart from our competition. Our sense of compassion is just as important as our professional abilities.” For inquiries and appointments, call 636-0762 (Shangri-La clinic) or 729EYES (3937) (Makati clinic). You may also visit www.american-eye-manila.com for more information.

AUGUST-SEPTEMBER 2013

goodfoodguide

Best Diet Practices for People with Diabetes

cloudfront.net

By Sabrina Batac, RND

id you know that there is really no such thing as a “diabetic diet”? The food and dietary guidelines given to people with diabetes are also good diet practices for the rest of the family. In fact, strictness in compliance and consistency in maintaining the right amount of carbohydrates, and the ideal portion sizes may be the only differences between a normal diet and a diet formulated for a person with diabetes. I would not say that these are the “best” diet practices but rather, the most common and easy to follow diet guidelines for people with diabetes. Some of them are adapted from the Nutritional Guidelines for Filipinos developed by the NutritionistDietitians’ Association of the Philippines (Revised Edition 2000 FNRI-DOST). Eat a variety of foods everyday. Just because you have diabetes doesn’t mean you have to deprive yourself of food. You are not supposed to go hungry, after all. Not one food item contains all the nutrients that you need, different food items provide different nutrients. Even with diabetes, there are a lot of food items you can choose from to compose your meal. Explore, experiment, and have fun.

Consume fish, lean meat, poultry, and dried beans. According to the Protein Controversies in Diabetes by Marion

AUGUST-SEPTEMBER 2013

Franz of Diabetes Spectrum Journal, insulin secretion to protein is greater in obese people with type 2 diabetes than those without diabetes. Both protein and carbohydrates are equal in stimulating insulin response, even more when they are combined, thus improving the post prandial response to carbohydrate. It also stated that “in well-controlled diabetes, large amounts of protein have the potential to contribute to glucose production, minimally increasing blood glucose levels, and requiring additional small amounts of insulin” with regards to people with type 1 diabetes. This does not mean that protein is better than carbohydrates for

people with diabetes. Just because carbohydrates affect blood sugar levels quickly does not mean that you should eat less of them and substitute more protein. Actually, too much protein may even lead to some complications. This is because some proteins may also be filled with saturated fat that can increase the risk of heart disease, which is why there is the word “lean” in the guideline. Protein should account for about 15-20 percent of the total calories you eat each day, depending on your daily needs.

Eat more vegetables, fruits, and root crops. It is recommended to eat

goodfoodguide 20-40 grams of dietary fiber everyday. Studies have shown that an increased intake of whole grains and dietary fiber help improve insulin sensitivity and reduces risk of complications. Fiber is known to not only lower levels of bad cholesterol but also to help achieve good control of blood sugar levels especially after meals.

you at a great risk of developing low blood sugar levels that can lead to complications and even, in extreme cases, diabetic coma. If you want to lose weight, work with your medical nutrition team — physician, diabetes educator and dietitian – to formulate a diet plan that considers your diabetes condition.

Limit saturated fat. This will not only help you maintain a healthy weight, it will aid in having a healthy heart and prevent the development of other health complications for people with diabetes. Overweight and obesity have been linked to many diseases including heart disease and high blood pressure, as well as atherosclerosis (hardening of the blood vessels, a condition, which many people with diabetes are prone to). Fatty foods have also been found to increase insulin resistance. Current recommendations of fat intake for people with diabetes should be 30 percent of total calorie intake per day, while substituting unsaturated fat (vegetable sources: sunflower oil, olive oil, sesame oil, soybean oil, corn oil; omega-3 oils from fish: salmon, sardines, fresh tuna, mackerel); for saturated fat (animal fat; tropical oils such as palm oil, coconut oil, cocoa butter). Saturated fat should be <7 percent of total calories, and intake of trans fat (processed foods; chips and crackers; foods made with shortening or hydrogenated oils; some margarines and dressings; etc.) should be minimized.

Practice reading labels carefully. It is inevitable that people go for “quick bites” or “easy-to-grab” food items in the grocery or convenience store. Those no-cook meals or snacks make it easier to meet one’s craving or hunger pangs,especially in this fastpaced world. Thus, there is a need for people to understand and be familiar with food labels. Food labels are not there as an ad but rather as a tool guide that can help individuals decide which foods are appropriate to use in meal planning and how to use them properly. Below are three general guidelines adapted from Diabetes is Bitter Sweet by Fernando-Lopez, et al (2008) that may be helpful in reading food labels:

Never skip meals. Missing meals is not uncommon, but it is not wise. The key to controlling diabetes is to control your blood sugar levels. Whatever you eat (or don’t eat) has a significant effect on your blood glucose levels. Skipping meals puts

a. Definition of terms • Sugar free – with less than or equal to 0.5 grams sugar per serving • Very low sodium – with less than or equal to 35 grams sodium per serving • Low sodium – with less than or equal to 140 gram sodium per serving • Sodium free – with less than or equal to 5 gram sodium per serving • Low cholesterol – with 20 mg or less of cholesterol and 2 gm or less of saturated fats per serving • Cholesterol free – with less than or equal to 2 mg cholesterol and 2 gm or less of saturated fats per

serving b. Ingredient listing • Ingredients in a product are listed on the label in descending order of predominance in weight • Words that end in –ose or –ol usually indicate some form of sugar (if most of these words are first on the ingredient list then this food item should be used minimally or not at all; but if it is found at the end of the list then sugar content may not be a major concern) c. Nutrition labelling Take note of the following information when reading food labels: • Number of servings in the container • Size of serving • Number of calories per serving • Amount of carbohydrates, protein, fat and sodium per serving

Control portions. Being able to know how much to eat helps with controlling blood sugar levels and even hunger pangs. If you train yourself to

AUGUST-SEPTEMBER 2013

goodfoodguide eat the right amount of food during a particular meal, you learn to satisfy yourself without having to overeat. Know the ideal portions or how big a serving should be for a particular food group. Ask your dietitian to educate you on portion sizes of food items during your diet consultation. Shop when youâ&#x20AC;&#x2122;re full, not hungry. Going grocery shopping with an empty stomach is a recipe for disaster! There is temptation everywhere you go, and with a grumbling stomach and a hungry mind, you will definitely grab whatever you see that looks good. Focus and selfcontrol will be tested. This also applies to those who are watching their weight, which is also a factor in controlling diabetes, more specifically type 2 Diabetes.

Make changes slowly. There is no magical diet pill that will cure diabetes or any other health condition in an instant. When applying dietary changes, it will take time and patience to make things a habit and to fully commit to a long-term goal. Donâ&#x20AC;&#x2122;t do things drastically like completely cutting down on food intake or eliminating carbohydrates completely from your diet just so you can bring down your blood sugar levels and eat more of other food items to compensate for the lack of calories. Talk to your doctor, diabetes educator, and dietitian to develop a diet plan that

For a healthy lifestyle and good nutrition, exercise regularly, do not smoke, and avoid drinking alcohol. Alcohol does not have nutrients but it does contribute calories to your meal. For people who are regular alcohol drinkers, consult with your doctor, diabetes educator, and dietitian on how to incorporate these into your meal. It is still best to avoid these drinks in general as it provides more bad effects, as compared to their alleged health benefits. For people with diabetes, exercise has additional benefits. It helps increase insulin sensitivity, which makes it possible for the body to use glucose more easily, thus lowering the blood glucose level and reducing the need for insulin in the body. It also helps lower levels of cholesterol and triglycerides in the blood. Other than that, exercise aids in weight reduction and weight maintenance which also helps in proper glucose control as well as reducing the risk of obesity-related diseases or diabetes complications. Take note though, nutrition recommendations should be individualized based on the treatment goals, current eating habits, and beneficial changes that the individual is willing to make. Those with diabetes need accurate and specific information of their dietary needs and medical nutrition therapy because ultimately, you will make the final decision as to what you will eat. D

AUGUST-SEPTEMBER 2013

stopdrinkings.com

wordpress.com

static.ddmcdn.com

works for you and your schedule.

goodfoodguide

AUGUST-SEPTEMBER 2013

productspotlight

Got Soy Milk? By Nicole Limlengco

ilk. The white (and sometimes chocolatey), creamy goodness that our parents and doctors tell us to drink to help us grow tall, strong and healthy. Milk has been touted as a super food, providing the body with vitamins, minerals and nutrients. So milk has to be good for every one, right? Not so, especially for the lactose intolerant (where oneâ&#x20AC;&#x2122;s body cannot easily digest lactose â&#x20AC;&#x201C; a natural sugar found in milk and dairy products). The good thing is that there are substitutes like soy milk, which is friendly towards the lactose intolerant. Here are some available in the market today.

AUGUST-SEPTEMBER 2013

productspotlight Soy Milk #1: Silk Very Vanilla (PhP 50.00)

Silk is an American brand, manufactured by the White Wave Foods Company. Silk soy milk comes in flavors such as original, chocolate, light chocolate, vanilla, light vanilla and very vanilla. Silk also has organic variants of the above mentioned flavors, as well as Unsweetened and with DHA Omega-3. Before taking a sip, I took a whiff of the product and it did smell like vanilla ice cream. It tasted like vanilla ice cream too --a very rich, delectable, vanilla ice cream! For a first-time soy milk drinker, this went down easily, all 130 calories per single serving.

A product of Thailand, Vitamilk comes in three variants – Regular, Choco Shake, and Energy1. Vitamilk also comes in 1-liter packs, single packs and 300ml bottles.Vitamilk also claims to have a lower sugar content compared to regular milk – 8 percent sugar for Vitamilk Regular and 5 percent sugar for Vitamilk Energy2. I chose the regular variant to taste. As with the previous one, I also took note of this brand’s “aroma”. This time, it smelled like how I would expect soy milk to smell like – an earthy aroma, you knew this didn’t come from ol’ Bessie the cow. It tasted like it came from beans. http://www.greenspot.co.th/interbus/default.asp?topic=product&dataid=106 https://www.facebook.com/pages/Vitamilk-Philippines/176557742393214

1 2

AUGUST-SEPTEMBER 2013

productspotlight

Canadian import Natura rounded off the choices for soy milk. For something that claimed to be organic, it was worth the price.Chocolate flavored, and it was packed with 160 calories per serving. Upon opening the carton, there was this mild chocolate scent that filled my nostrils. The taste reminded me so much of the favorite chocolate milk drink of my childhood – the one sold in glass bottles. It was downright delicious! There was no strange aftertaste, only chocolate that blanketed my tongue. I think this particular brand would go well with kids (and adults) who are lactose intolerant or who are tired of the taste of plain milk. Just like cow’s milk, soya milk also has a number of benefits3. Soy milk contains only vegetable, protein and causes less calcium loss. It contains no lactose but has prebiotic sugars stachyoseand raffinose that boost immunity. It also helps reduce cholesterol levels as the US FDA confirms that soy protein, as part of a diet low in saturated fat and cholesterol, may significantly reduce the risk of coronary heart disease. Aside from reducing the total serum cholesterol level, soy also raises “good cholesterol” (high density lipoprotein of HDL) levels4. Unlike cow’s milk that may have artificial hormones, soy milk does not and is rich in isoflavones – antioxidants which protect our cells and DNA against oxidation. The low-level estrogenic activity of the isoflavones in soybeans can help to offset the effects of reduced estrogen production by the ovaries that is associated with menopause. These isoflavones can thus reduce certain symptoms of menopause, such as night sweats and hot flashes – making it the ideal drink

of choice for the ladies entering that stage in life. You also need not worry about the gases often associated with beans. Soy milk contains very little of the sugars associated with increased flatulence in people who have a low tolerance for beans compared with whole beans. If you know that you have a low tolerance for beans or for other foods that cause gas, try easing soy into your diet gradually. Start first by drinking smaller portions of soy beverages, and then increase your consumption gradually until your body becomes accustomed to digesting this healthy whole food. But before jumping on the bandwagon, exercise caution. Always check with your doctor before making the switch from cow’s milk to soy milk, especially if part of a new diet, or if one has an underlying health condition. And remember; always combine the right eating habits with exercise to stay fit and healthy. With all that said, we raise our glass and drink up to better health. D

*All soy milk products are available in leading supermarkets and convenience stores. http://www.soya.be/benefits-soy-milk.php http://naturaplus.ca/faqSanteBienfaits.php

3 4

AUGUST-SEPTEMBER 2013

livingwell

It’s Never Too Late for Ch a nge By Aileen Garcia

come from a family of cooks. From the grandest occasion such as Christmas dinners and town fiestas to the most mundane (such as commemorating the pet dog’s birthday), my aunts would always find a reason to whip up something in the kitchen. Home cooking and eating together are hobbies that my family from the maternal side takes seriously. Gatherings and celebrations would simply call for lechon, caldereta, menudo, dinuguan, hamonado, or morcon – obviously we were a family of meat lovers. Then there were desserts from leche flan to buco salad to mais con yelo. Serving vegetables was rare, in fact, when I was younger, I even thought of vegetables as a mere side dish or garnish. Our family’s motto was “never a birthday without a cake, and it has to be chocolate-flavored.” Unfortunately, diabetes is another thing that we as a family share. I was still in high school when we learned that our oldest aunt had diabetes and soon after, the other aunts had

it, too. To date, seven of my mother’s 10 siblings have diabetes, including her. It was a complicated condition to manage while tending the kitchen and serving and partaking of hearty meals occasion after occasion. The younger members of the family, including myself took it upon ourselves to be the guardians of forbidden food for members with the condition in the house. And yet, there was never really an attempt to adjust our own preferences to make the meals that we share “diabetic-friendly.” Food for one is food for all. The non-diabetics knew what certain foods to avoid or cut back on, but we would prepare and partake of these nonetheless, we didn’t have diabetes anyway. Outside the home, my work brought me to lots of different places in the country. Naturally I would devour local delicacies and specialties – from bagnet in Ilocos to sisig in Pampanga to chili ice cream in Bicol. And of course, there was lechon in Cebu and ham in Cagayan de Oro. Those meals would be gulped down with either an ice cold

soda or beer. Exercising or any physical activity was very far from my mind. In fact, I had all the reasons – I was too busy at work. The genetic predisposition and the lifestyle I had took a toll on my health without me knowing it (or was I going through self-denial?). Four years ago, I felt something was not right with my body that I had to spend at least 24 hours in the hospital for routine checkups. That was when I learned that I too, had elevated glucose level in the blood. I started taking maintenance medicines and embarked on a modified diet, but sadly I did not take my condition seriously. “Ningas-kugon” took the better of me. After a few months, I got back to work and to the lifestyle I used to have. Changing my lifestyle Fast forward to 2013, and nothing has changed except that I had been avoiding seeing my doctor. The fact that I had diabetes has been tossed at the very back of my mind. But in April, at the peak of summer heat and AUGUST-SEPTEMBER 2013

livingwell before I knew it, I was doing the onehour workout every other day. I got hooked and at the same time, I made serious changes to my diet. I have cut back on carbohydrates, sweets, and fatty foods, and started eating more whole grains and protein. I’ve changed the way I prepared food at home and I’ve been conscious of my food choices and portions whenever dining out. Shortly after embracing these changes, I’ve started getting enough sleep, something that was very elusive to me in the past. When I got back to work, I signed up for the Zumba sessions being offered as part of our company’s fitness program. People started noticing the pounds I’ve been shedding off and I felt good about myself, too. The results also gave me more determination than ever that I could conquer diabetes. stresses at work, I suffered from severe chest pains while in the office. Lo and behold, at the emergency room, my blood pressure and glucose level were too high. I had to be admitted for a few days and advised to take a rest for a couple more weeks after being discharged from the hospital. Fortunately, I had the most considerate and supportive supervisors so I didn’t have to think about work while on vacation. During that time, I reflected on my condition and the need for me to make serious changes. I am raising two daughters and I told myself I had to do something about my diabetes; I have to conquer it for the sake of my children, and for myself. One morning, while scouring my collection for old movies to watch, I found an instructional DVD tucked away in my collection unopened since a relative sent it to me two years ago. I turned it on and started following the steps to the Latin cardio workout and

AUGUST-SEPTEMBER 2013

Working progress My journey to health and fitness is still a work in progress as I have yet to reach my ideal weight based on my BMI calculation. My blood glucose levels are still fluctuating. But I am very positive that I am on the right track because I am really determined to succeed more than ever. I’ve also influenced some of my relatives and close friends to embrace the healthy lifestyle and they tell me that seeing the new me has inspired them to do the same. I also get negative comments from people who knew me well. They didn’t think that I could sustain the changes I’ve made and they’ve been saying that I’ll be back to my old self when the “ningaskugon” kicks in. But I know I don’t have to listen to those negative comments, instead, I take them as a challenge to prove them wrong. I believe in peer support, and I have started surrounding myself with people who can inspire and help me reach my health goals, even if they are not aware that they’ve been helping

me. One of them is a college friend, whom I have not seen in a while but I’ve been following her Facebook updates on the fun runs she’s been into and her conquests in the gym; and she’s looking really fit and happy. I told myself I can do something like that, too. I have learned in this journey that it is never too late to make positive changes in one’s lifestyle. Most people, including myself, only realized this after being hospitalized. Diabetes is manageable, and it takes a lot of discipline and determination, perhaps also some amount of inspiration. I got mine from my little girls and from the people within my circle who have been eating healthily and exercising regularly; and they are the happiest lot I’ve seen! Having diabetes sure has been saddening and sometimes frustrating, but it also gave me a compelling reason for wanting to be healthy and fit, and I am working toward that goal. D

livingwell

AUGUST-SEPTEMBER 2013

Write Your Way Out of Depression! By Emil Karlo Dela Cruz

howto.drprem.com

stressbuster

here is no denying that diabetes can be a real downer sometimes. Just imagine: you have to cut back on your food intake.You have to regularly check if your blood sugar is at the right level, while contending with the side effects of hypo- or hyperglycemia. You also have to be extra careful with foot injuries, lest you risk an amputation. And let’s not even get started on eating desserts, as these may be “forbidden fruits” for one with a condition such as yours. No matter how much you might have your condition under control, there are times when having diabetes can leave one feeling blue. That’s just the way things are sometimes. But fear not. There a lot of ways to combat depression naturally, without having to resort to medications.In fact, it can even be as simple as picking up a pen and paper. The potential of the written word If you are feeling down in the dumps, perhaps a letter to yourself can help get you out. A 2010 York University study involving 200 individuals found that a feel-good letter to oneself can alleviate feelings of sadness or depression. In the study, a group of participants were asked to write either a letter of self-compassion (addressing the depressing

AUGUST-SEPTEMBER 2013

event and attempting to find a solution), or one of optimism (imagining a future in which the current issues are resolved). The researchers found that there are generally two types of personalities at high risk of depression: the dependent and the self-critical. Dependent individuals become anxious at the thought of abandonment or dissolution of personal relationships. Meanwhile, self-

stressbuster critical individuals get a feeling of worthlessness from not having achieved the standards they set for themselves. Data showed that dependent individuals alleviated their depression most from selfcompassionate letters, whereas the self-critical ones benefited the most from optimistic letters. “The idea was to try and be good to yourself, to realize your distress makes sense and provide the words you would need to hear to feel nurtured and soothed,” said study co-author Myriam Mongrain, an associate professor of psychology in York’s Faculty of Health. Getting started on the ‘positive note’ The next time you are feeling depressed, it might be a good idea to try this exercise out for yourself. All you need is a pen, a paper (or perhaps a computer if you are more comfortable with that medium), and an open mind. Here are some tips to get you started:

Think happy thoughts. Experts recommend that the best time to write a letter to yourself is when you are in a good mood. This is what you will then read on your rainy day, to boost self-esteem and lift up your spirits. Of course, this is easier said than done. You sometimes can’t fake being happy, especially if you’ve been depressed for a long time. In order to counter this, try adopting an optimistic mood - one where you are strong and wise enough to give advice to yourself. The trick is for the strong, stable you, to write a letter to the weak and vulnerable you. This is the first step to your rehabilitation.

Review past experiences that worked. Chances are that this isn’t the first time you’ve been depressed. In your letter, try to think up of past experiences where you’ve felt down, and list the things you did that helped you get over it. Make the small details count. Jot down what you need to do, what made you feel better, whatever you did that helped in the past. Also include things not to do. We don’t mean suicide alone – this also encompasses the things that pull you even deeper into depression (drinking alcohol, risky actions, etc). These are the things to avoid. By listing down anti-depression steps, you shift your focus to solutions, rather than to problems.

Recount the experience as if you were composing a tale. Our memories of events are often fragmented. In order to get a clear picture of what it is that made us depressed in the first place, it helps to write down these details, then stitch them together after. Take some time to do this and clear your mind from any distraction. The goal is to get to the root of your melancholy. Once you can grasp the details in your head, write it all down: what you saw, said, and felt. Who it is that made you feel depressed? What did they do that affected you? You may choose to do this in bullet points with a brief description. This exercise is particularly helpful because you get to see your depression in a new perspective. Seeing the actual details in chronological form will also pinpoint what exactly triggered your depression. At times, it may

also help you realize that there really is nothing to be sad about.

Write what you want to happen. Going back to the York experiment, one of the exercises mentioned was to make an optimistic letter citing what you want to happen in the future. Try to picture yourself being successful in your goals and achieving what you desire. This can particularly be useful if you have diabetes, especially if it is your new lifestyle that is making you depressed. Say you are limiting your food intake, or holding off on the dessert, and that’s what is making you depressed. Instead of focusing on how miserable you are with these changes, try to write about what you seek to accomplish instead. Write about your target weight, or your target blood sugar. Write about how, after all this is over, you will be a lot healthier and a lot fitter. Write about your end goal and focus on that. In doing so, you’ll be able to make things more bearable since you are setting yourself up for a reward in the end. If you are having a hard time following these steps, there’s no pressure. You can opt to write whatever comes to your head. Allot half an hour or even ten minutes for this exercise. Free your mind of those negative thoughts by writing it all down (no editing required). Before you know it, you’ll be back to your chipper old self, which goes to prove that at times, the pen can be mightier than a bad mood. D AUGUST-SEPTEMBER 2013

stressbuster

AUGUST-SEPTEMBER 2013

dosanddon’ts

Gestational Diabetes By Alexa Villano Reviewed By Joy Arabelle Castillo Fontanilla, MD

estational diabetes or gestational diabetes mellitus (GDM) occurs during pregnancy when sufficient insulin is not produced causing the blood glucose (sugar) level to become higher than normal.GDM can affect 2-10 percent of pregnancies and it’s important to detect it immediately to avoid complications to the baby.

DO’S Undergo screening. Screening is normally done between 24 to 28 weeks of pregnancy. But if you are obese, have had history of previous GDM, a family history of DM, or sugar in your urine, it can be done early. Procedure of the screening is done through blood sugar testing after fasting and a specific number of hours after taking a sweet drink. Monitor glucose levels. Check before and after eating breakfast, after lunch, and dinner or as often as specified by your physician. Be active. Exercise will help stabilize blood sugar level. Ask your doctor what exercises you can do so as not to strain your body.

IIlustration by Calvin Saquibal

Eat a well-balanced diet. Recommendations include increasing the amount of nonstarchy fruits and vegetables (at least five servings a day), lean cuts of meat, and whole grain products. Limit certain fruits that may raise blood sugar level (e.g., dried fruit, grapes, mangoes, etc.). Avoid high-calorie snacks and desserts, such as soda with sugar, juice, candy, chips, cookies, cakes, and full-fat ice cream. Choose low or fat free dairy products, and use liquid oils such as canola and olive oil instead of margarine, butter, and

shortening for cooking. Substitute sugar with sweeteners such as aspartame, sucralose, stevioside, or acesulfame potassium. Take your medications. According to experts, about 15 percent of women with gestational diabetes will need to inject themselves with insulin. When injecting insulin, log your doses and blood sugar levels then show these to your doctor. Keep daily records. Track your diet, medication, and physical activity. Writing everything down will help you and your doctor determine changes if needed. It will also serve as a reminder of what you need to do.

Exert during hot weather. Since pregnant women are very sensitive to hot climates, do activities in cooler areas to avoid dehydration and thirst. Getting hot might also lead to fainting spells or hypoglycemia. Skip meals. Avoid skipping meals especially when you have diabetes. You may not only feel weak, you may also deprive your baby of the nourishment he/she needs.

Drink alcohol. Studies have shown that alcohol has been linked to premature delivery, low birth weight and birth defects. The CDC, US Surgeon General, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics all advise against alcohol intake during pregnancy. Skip doctor visits. Aside from your obstetrician, don’t forget to check with your endocrinologist regarding your blood sugars. Gain excess weight. While you need to eat for your baby, the extra pounds can make it difficult for women who are pregnant. Make sure weight gain is between 25 and not more than 35 lbs for normal weight women. For overweight women (pre-pregnancy body mass index/BMI 25-29.9), you should not gain more than 15 to 25 lbs, and no more than 11-20 lbs for obese women (BMI >/= 30). (To know your BMI, divide your weight in lbs by your height in inches squared then multiply by 703.) Stress yourself. While pregnancy will change your life dramatically, learn to relax by meditating, reading a book or talking with friends. You can also listen to music so it would calm your body as you prepare to deliver a baby to the world. D AUGUST-SEPTEMBER 2013

dosanddonâ&#x20AC;&#x2122;ts

Diyabetes ng Pagbubuntis Isinulat ni Alexa Villano Pinamatnugutan ni Joy Arabelle Castillo Fontanilla, MD

ng gestational diabetes mellitus (GDM) ay puwedeng mangyari sa isang buntis kung hindi sapat ang insulin sa kanyang katawan. Itoâ&#x20AC;&#x2122;y puwedeng maging sanhi ng pagtaas ng asukal sa dugo. Mula 2-10 porsyentong ng mga buntis ay nagkakaroon ng GDM, at mahalagang masuri ito agad upang maiwasan ang komplikasyon sa sanggol.

Bantayan ang asukal sa dugo. Dapat mag-tsek bago at pagkatapos ng almusal, pagkatapos ng tanghalian at ng hapunan o ayon sa payo ng iyong doktor. Mag-ehersisyo. Ang pag-ehersisyo ay makatutulong na gawing normal ang antas ng asukal sa dugo. Ikonsulta sa doktor kung ano ang mga gawaing puwedeng gawin upang hindi mapinsala ang iyong katawan. Kumain nang wasto. Ugaliing kumain ng prutas at gulay na hindi mataas sa starch (limang serving o higit pa), mga pagkaing gawa sa buong butil at karne na walang taba. Bawasan ang mga prutas na makapagpapataas ng asukal sa dugo (tuyong prutas, ubas, mangga, atbp.). Iwasan ang matatamis tulad ng softdrinks, juice, kendi, chips, biskwit, cake, kakanin at regular na ice cream. Gumamit ng mga langis tulad ng canola at olive oil imbes na mantikilya o butter. Sa halip na asukal, maaaring gumamit ng ibang pampatamis tulad ng aspartame, sucralose, stevioside,

AUGUST-SEPTEMBER 2013

oracesulfame potassium. Gamitin ang gamot. Ayon sa mga eksperto, 15 porsyento ng mga may GDM ay mangangailangan ng insulin. Kung gagamit ng insulin, siguraduhin na itala ang dosis nito pati na rin ang antas ng asukal sa dugo para makita ng doktor. Magtala araw-araw. Siguraduhing isulat ang lahat ng ginawa mo, mula sa pagtusok ng gamot, dami at uri ng pagkain, tagal at tipong ehersisyo. Ang pagsulat nito ay makatutulong sa pagtiyak kung ano ang dapat mong baguhin o sa ipapayo ng doktor at magsisilbi ring ala-ala para sa iyo.

Magpagod pag mainit ang panahon. Tiyakin na ang mga gagawin ay nasa isang lugar na komportable ang lamig para hindi mahilo at matuyo dahil sa maselanang kondisyon. Ang sobrang init ay maaaring makahimatay o makapagbagsak sa antas ng asukal sa dugo . Kalimutang kumain. Huwag laktawan ang pagkain lalo na kung ikaw ay may diyabetes. Maaaring humina ang iyong katawan at magkulang sa nutrisyon ang iyong sanggol. Uminom ng alkohol. Ayon sa ilang pagaaral, ang pag-inom ng mga inuming may alkohol tulad ng alak o beer ay puwede humantong sa maagang panganganak,

mababang timbang ng bata o depekto sa katawan ng sanggol. Ang CDC, US Surgeon General, American College of Obstetricians and Gynecologists, at American Academy of Pediatrics ang nagpapayo na iwasan ang paginom ng alkohol habang buntis. Kalimutan magpatingin. Maliban sa inyong obstetrician, siguraduhin na pumunta din sa inyong endocrinologist para masuri iyong asukal sa dugo. Sumobra sa timbang. Kahit kailangan ng iyong sanggol ang pagkain, tiyakin na hindi lalabis ang iyong timbang. Dapat nasa 25 lbs at hindi hihigit sa 35 lbs ang timbang na idadagdag para sa mga normal ang timbang bago mabuntis. Para sa mga lagpas sa timbang, (pre-pregnancy body mass index/ BMI 25-29.9), tiyakin na hindi hihigit sa 15 to 25 lbs, at 11-20 lbs naman para sa mga babaeng ubod ng bigat (BMI >/= 30). (Para malaman ang iyong BMI, hatiin ang inyong timbang sa lbs sa iyong taas sa inches squared at pagkatapos ay i-multiply sa 703.) Mabahala. Maaaring malaki ang mga pagbabagong idudulot ngi yong pagbubuntis sa iyong buhay. Upang hindi mabagabag, mag-meditate, magbasa ng libro, o makinig ng musika para mapahinahon ka habang naghahanda sa pagsilang ng sanggol. D

IIlustration by Calvin Saquibal

Magpasuri. Ang pagpapasuri ay karaniwang ginagawa mula ika-24 hanggang 28 linggong pagbubuntis, ngunit kung mayroong diyabetes sa inyong pamilya, labis ang iyong timbang, o may asukal ang iyong ihi, mas mainam na magpatingin nang maaga. Karaniwaâ&#x20AC;&#x2122;y kailangan suriin ang dugo pagkalipas ng ilang oras na hindi kumain at pagkatapos ng pagpapainom ng matamis nainumin.

affairstoremember

Diabetes Philippines calls for diabetes prevention

iabetes Philippines (DP) together with the Philippine College of Physicians held a forum on Diabetes Prevention last July 23 at Annabel’s Restaurant as part of Diabetes Awareness Week. Dr. Grace delos Santos, board director of DP, said that many people are at risk of diabetes and the numbers continue to increase. In a 2008 report, the age-adjusted prevalence of diabetes was 6 percent, which today could be translated to mean 6 million Filipinos diagnosed with diabetes with another 6 million not knowing they have the disease. “If you don’t move, [if] you’re always on the computers, always sitting, delegating orders [these are the risk factors]. If you have first-degree relatives with diabetes even if you yourself don’t have it, you may still become a diabetic if you gain weight,” said de los Santos, adding that diabetes is also often associated with other conditions such as hypertension and gout. “Diabetes cannot be removed. Once a diabetic, always a diabetic. We don’t want to regard diabetes as a mild disease because our patients sometimes [get that impression] just because their blood sugar is not high,” said Dr. Agnes Cruz, a nephrologist and diabetologist from the Institute for Studies on Diabetes and DP treasurer. Blindness, stroke, cardiovascular disease and kidney problems are some of the leading causes of death from diabetes complications. Dr. Cruz said that diabetes can be detected very early through screening thus preventing it from complicating the body. Meanwhile, DiabetEASE editor-in-chief and DP board director Dr. Joy Fontanilla said that lifestyle intervention can help in fighting the risk of diabetes citing trials done in China, Finland and the United States. “When you hit the age of 40, you should be tested. But if you have the risk factors, you should be tested earlier,” said Dr. Fontanilla, citing other factors such as big waist circumference, family history, hypertension, abnormal cholesterol levels and schizophrenia as risk factors for diabetes. More risk factors to consider are

Chart showing the China study

L-R: Dr. Grace delos Santos, Dr. Rima Tan, Dr. Agnes Cruz, Dr. Joy Fontanilla and Dr. Elywn Fernando.

cigarette smoking, stress, depression and abnormal sleep patterns, she added. Diets rich in fiber and vegetables but low in fat and sugar, exercise and weight loss for the overweight/obese can prevent diabetes, she said. High-risk individuals may also benefit from taking metformin, a medicine for diabetes and maintaining it for years. Dr. Elwyn Fernando, President and Chairman of DP, Dr. Rima Tan, DP secretary, as well as other DP board directors Ms. Emy Cardino and Leyden Florido were present to answer questions at the forum. The two called on the media to help them spread information to fight the disease. Diabetes Awareness Week is held every 4th week of July, as per former president Fidel Ramos’ declaration. Many diabetes societies besides DP, such as the Diabetes Center Philippines (or Philippine Center for Diabetes Education Foundation), Philippine Association of Diabetes Educators, AACE Philippines, and the Philippine Society of Endocrinology and Metabolism among others, engage in a series of diabetes-geared activities targeting both laymen and health professionals. D

AUGUST-SEPTEMBER 2013

affairstoremember

Diabetes Awareness Week grooves with ‘I-Zumba Mo Sugar Mo’

he Diabetes Center Philippines (or Philippine Center for Diabetes Education Foundation) together with Diabetes Philippines, the American Association of Clinical Endocrinologists Philippine Chapter (AACE-PH), and the Philippine Society of Endocrinology and Metabolism (PSEM) gathered together last July 28 to celebrate the 21st Diabetes Awareness Week Celebration at the Pasig Sports Complex. The event kicked off with a zumba session, where attendees from different diabetes groups danced to songs such as “Cha-cha,” and PSY’s “Gentleman.” Even the doctors and physicians in attendance joined in on the fun. Zumba, the Latin dance currently making waves in the fitness industry has been regarded as one of the exercises that help diabetes patients keep fit, fight

obesity, and lower blood sugar especially for those with type 2 diabetes. This year’s battle cry is Diabetes Mo, I-Exercise Mo: I-Zumba Mo Sugar Mo. Patients, mostly senior citizens, were treated to free blood glucose checks, consultations and games from pharmaceutical companies present to support the event. “I am very delighted today because the presidents of the three associations are with us to combat diabetes,” said Dr. Augusto Litonjua, president of Diabetes Center Philippines. Addressing the lay, he advised that one should remember to avoid the 3 Ks katabaan (obesity), katamaran (laziness), and katakawan (overeating) in order to prevent diabetes. Dr. Richard Elwyn Fernando, president and chairman of Diabetes Philippines said that fighting diabetes entails doing it through action and words, and

The Annual Diabetes Awareness Week

Participants singing with the Kundirana

Awardees of Diabetes Awareness Week

Participants doing the zumba

AUGUST-SEPTEMBER 2013

affairstoremember

Diabetes Center President Dr. Augusto Litonjua

AACE President Dr. Florence Santos

PSEM President Dr. Cecilia Jimeno

DP President Dr. Richard Elywn Fernando

adopting a health-oriented mindset. Meanwhile, Dr. Cecilia Jimeno, president of PSEM told the audience that the organization aimsto help patients through a video they are distributing regarding diabetes awareness. On the other hand, Dr. Florence Amorado-Santos, AACE-PH president, commented that the number of people in attendance showed that they were one in the fight against the disease. “Your participation today is proof that we are together in fighting diabetes. Let us all work together in fighting diabetes in the Philippines,” said Dr. Santos. Entertainment was provided by the De La Salle Greenhills’ Kundirana who serenaded the audience, drawing smiles and laughterwith their repertoire of songs. The lead stars from the hit series My Husband’s Lover Dennis Trillo and Carla Abellana also appeared, to the delight of many. Alexa Villano D

Vitamin B12 for neuropathies Clinical trial proves HI-Eisai’s Methycobal effectively treats neuropathy in diabetics and elderly Vitamin B12, specifically methylcobalamin, significantly improved symptoms of diabetic neuropathy in a 24week clinical trial funded by HI-Eisai and discussed in a symposium held at the Crowne Plaza entitled “Methycobal Revisited! – The Nerve Symposium”. “This is a way to show us that methylcobalamin prevented the emergence of the presence of symptoms,” said lead author Dr. Jacqueline Dominguez of the Institute of Neurosciences-St. Luke’s Medical Center. “We know that over time neuropathy symptoms increase. But in this analysis, it is showing us that those who remained pain free at baseline remained pain-free at the end of treatment indicating that intervention prevented the emergence of new symptoms.” The open-label clinical trial involved administering oral Methycobal tablets at 1,500 µgm/day for six months to forty eight subjects. Thirty seven of the subjects completed treatment and twenty one agreed to have a repeat neurophysiologic study post treatment. Eleven were eventually excluded from the analysis because one had a previous stroke, two transferred residence out of Manila, four were lost to follow-up, four were not compliant, and one had an adverse event.

The trial had a sample of people with diabetes diagnosed with elevated blood sugar or elevated HbA1c as confirmed by a physician. Subjects were mostly senior citizens with a mean age of 62. There were more females than males; 57 percent have had diabetes for less than 10 years and 42 percent more than 10 years. “The trial is investigator-initiated. It passed institutional and ethics review board approval. HI-Eisai only provided

AUGUST-SEPTEMBER 2013

affairstoremember logistics for neurophysiologic testing and vitamin B12 pills but it did not have any influence at all in the design and the conduct of the trial, analysis, and publication of results,” clarified Dominguez who added that they used the Toronto

Clinical Scoring System (TCSS) as the primary measure and the Subjective Impression of Change, Clinician’s Impression of Change and neurophysiologic parameters to measure data. At the end of the trial, there was a significant decline in the TCSS score, indicating improvement. The symptoms that improved compared to baseline and that did not emerge over the course of 24 weeks were tingling, upper limb symptoms, ataxia, and signs of impaired position sense, vibration sense, pinprick sensation, and knee reflex. “We found that the decline in TCSS scores happened actually on the 6th week and beyond,” she said. “It means to say that we may not see the effect immediately but we can only see it after the 6th week with continuous and progressive decline up to the 24th week.” The test also showed that Methycobal was effective in different kinds of diabetes durations, whether less than or more than 10 years. Michaela Sarah de Leon D

doodles&dreams Oh Antganda, kamusta na ang daddy mo?

Eto. Sobrang busy. Todo trabaho sa pagiging mayor.

Naks! Ano naman ang pakiramdam ng pagiging first daughter?

Ang boring din kaya!

Well, anak ka ng pulitiko eh. That’s life!

AUGUST-SEPTEMBER 2013

IIlustration by Calvin Saquibal

Huh? Bakit mo nasabi iyon?

Kasi wala na lang akong ginawa kung hindi picture dito, at picture doon noh!

GLICLAZIDE Scored Tablets

z z z z

Effective glycemic control 1, 2 Protection of the `-cells 3, 4 Protection of the kidneys and the heart 1, 5, 6, 7 Supported by evidence from ADVANCE, the largest morbidity-mortality trial in diabetes 1

1 to 2 tablets at breakfast

*In most patients

1. ADVANCE Collaborative Group; Patel A et al.N Engl J Med. 2008; 358: 2560-2570. 2. The GUIDE Study Eur J Clin Invest. 2004; 34: 535-542. 3. Sawada F et al. Metabolism. 2008; 57(8): 1038-1045. 4. Del Guerra S et al.Diabetes Metab. 2009; 35(4): 293-298. 5. The CONTROL Study. Diabetologia. 2009; 52: 2288-2298. 6. Khalangot M et al. Diabetes Res Clin Pract. 2009; 20(6): 611-615. 7. Katakami N et al.Diabetologia. 2004; 47: 1906-1913.