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CONTENTS COVER STORY AND FEATURES
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Warriors United Against Diabetes
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Say Goodbye to Sodas
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AACE-PC: Champions Against Diabetes
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The battle against diabetes has gone beyond the doctorpatient relationship. Emil Karlo Dela Cruz talked with Philcare’s Jaeger Tanco on leading an advocacy to fight against the disease.
In what could be the start of an “anti-soda revolution,” Nicole Limlengco interviews Dr. Roberto Mirasol of the Philippine College of Physicians on plans to reduce softdrinks in schools.
Various organizations have come up with activities in promoting a healthier lifestyle. Alexa Villano gets to know more about the AACE-PC’s projects that have been active in reducing diabetes and obesity in the country.
Growing through Diabetes With a support group, patients with diabetes will understand more about their condition as Excel Dyquiangco discovers that you don’t have to suffer from diabetes alone.
Living With Type 1 Diabetes In a poignant piece written by Aretha Angcao, we learn about how author Catherine Price did not let her diabetes get in the way of her passion.
regulars 4 | EDITOR’S EDICT 6 | WE’VE GOT MAIL 7 | SWEET NEWS ON THE COVER: As diabetes continues to spread, various health organizations and private sectors unite in the fight against the disease.
in depth 30 33
Fat in Your Liver Can Be Bad Is fatty liver connected to diabetes? Dr. Eternity Labio explains what happens when the two are combined.
Diabetes & Dyslipidemia Sweet and fatty food may be delicious to some but apart from increasing our risk of diabetes, it also puts us at risk of dyslipidemia. Dr. Jose Carlos Miranda narrates how to avoid the deadly duo. Cover photo by Jose Martin Punzalan
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Hypertension and Diabetes One of the most common factors affecting people is hypertension. Dr. Yvette Rosales-Amante tells us how to treat it before it shoots up to a dangerous degree.
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Educator’s Corner
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Fightin’ for Fitness
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Righteous Recipes
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How to Prevent Diabetes Dr. Jocelyn C. Isidro gives tips on avoiding the condition.
Bike Your Way to Fitness Biking is not only for the adventurous, but also a form of cardiovascular exercise. Jacquiline Go Laruan gives the low-down on its benefits. Gourmet food made healthy Guest chef Carol Lavin whips up three savory and nutritious gourmet food made healthy.
Good Food Guide Follow that Plate The food pyramid has become passé and a new food format has been introduced. Nutritionist Luchie Callanta presents to you the Plate Method.
sections 10
You Ask, We Answer
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Product Spotlight
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How Do I Improve My Leg Circulation? As the most vulnerable part of the body when diagnosed with diabetes, the foot needs tender loving care. Dr. Jimmy Aragon teaches us how. Self Monitoring of Blood Glucose - a Question of Accuracy A new digital glucose meter is launched to help determine blood levels accurately.
Stress Busters
Be Retirement-Ready For people who have worked their whole life, preparing for retirement is the next step in their minds. Aencille Santos asks Financial Coach Jake Lingan some tips for those taking the next step.
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Dos and Don’ts
Turning Vegetarian Many have taken a 360-degree turn with their diet by turning vegetarian. Michaela Sarah de Leon tells us how to transition properly into this diet.
Living Well
Sweet Love Mylene C. Orillo gets to know a couple whose love shines through, diabetes and all.
Affairs to Remember Doodles & Dreams
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EDITOR’S EDICT
Advocates for a Diabetes-Free World How wonderful it is that nobody need wait a single moment before starting to improve the world. - Anne Frank
It’s a diabetogenic world. We live in an age so conducive for developing diabetes. Though diabetes is not spread by contagion, its breeding grounds are ubiquitous nonetheless. Sedentary lifestyles, obesity, unhealthy diets, and urbanization all contribute to the diabetes epidemic. The World Health Organization estimates that 347 million people worldwide have diabetes. In 2004, high blood sugar cost us 3.4 million lives with over 80 percent of diabetes-related deaths occurring in low- and middle-income countries. The good news is most diabetes cases can be prevented. With the right nutrition, regular physical activity, a healthy body weight and shunning tobacco use,onset of type 2 diabetes could be averted or delayed. In the Philippines, many well-meaning groups have advocated for diabetes prevention and care such as the Department of Health, Diabetes Philippines, Diabetes Center Philippines (or the Philippine Center for Diabetes Education Foundation), Philippine Society of Endocrinology and Metabolism, the Philippine Chapter of the American Association of Clinical Endocrinologists and many others. We have featured these organizations, various health programs and support groups in our past issues and do so again in this one. May the Good Lord guide and bless us as we all strive to change the world for the better one life at a time! Peace and thank you,
MEDICAL ADVISORY BOARD Ramon F. Abarquez Jr., MD Professor Emeritus, University of the Philippines College of Medicine; Academician, National Academy of Science and Technology Mary Ann Lim-Abrahan, MD Past President, Philippine Lipid and Atherosclerosis Society; Professor, University of the Philippines College of Medicine–Endocrine Section Abdias V. Aquino, MD President, Philippine Society of Hypertension; Past President, Stroke Society of the Philippines; Past President, Philippine College of Physicians Corazon VC. Barba, PhD, RND Past President, Nutritionist-Dietitian’s Association of the Philippines Ricardo E. Fernando, MD Founder and President, Institute for Studies on Diabetes Foundation, Incorporated Ruby T. Go, MD Past President, Philippine Lipid and Atherosclerosis Society; Head, Endocrine Section, Chinese General Hospital Augusto D. Litonjua, MD President, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Society of Endocrinology and Metabolism; Philippine Association for the Study of Overweight and Obesity Roberto C. Mirasol, MD Past President, ASEAN Federation of Endocrine Societies; Past President, Philippine Society of Endocrinology and Metabolism Antonio R. Paraiso, MD Medical Specialist III, National Kidney and Transplant Institute; Assistant Professor, College of Medicine, University of the East Ramon Magsaysay Memorial Medical Center Ma. Teresa Plata-Que, MD Past President, Philippine Diabetes Association; Consultant, East Avenue Medical Center; National Kidney and Transplant Institute Tommy S. Ty-Willing, MD Past President, Diabetes Philippines; Trustee, Philippine Center for Diabetes Education Foundation; Founding President, Philippine Lipid Society; Consultant, Metropolitan Hospital
Joy C. Fontanilla, MD, FACE, FPCP, FPCDE, FPSEM, CCD
Editor-in-Chief
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CONTRIBUTORS Jocelyn Capuli-Isidro, MD, FPCP, FPSEM Publisher: FAME Publishing, Inc. Editor-in-Chief: Joy Arabelle C. Fontanilla, MD Assistant Editors: Mylene C. Orillo Emil Karlo dela Cruz Art Directors: Donna I. Pahignalo Michael Patricio Editorial Coordinator: Alexa Villano Senior Writer: Michaela Sarah de Leon Staff Writers: Ma. Cristina Arayata Jose Martin Punzalan Aencille Santos Graphics and Layout: Danie Cisneros Contributing Graphic Artist: Kevin Paul Faustino 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
Dr. Isidro is a Consultant Endocrinologist at Makati Medical Center and the St. Luke’s Medical Center, Global City. She is also a member of the medical bureau of Diabetes Center Philippines or the Philippine Center for Diabetes Education Foundation, Inc.
Marie Yvette Rosales-Amante, MD, FACE, FPCP, FPSEM A graduate of the University of the Philippines College of Medicine, Dr. Amante took up her residency in internal medicine at the University of Connecticut, and had her Fellowship in Endocrinology, Diabetes and Metabolism at the University of Massachusetts. She is a member of the board of the directors of the American Association of Clinical Endocrinologists-Philippine Chapter and Endocrinology Section Chief at the Asian Hospital and Medical Center.
Jimmy B. Aragon, MD, FPCP, FPSEM, FACE Dr. Aragon is a Fellow of the Philippine Society of Endocrinology and Metabolism, and a Fellow of the American College of Endocrinology. He is also an internal medicine and endocrinology consultant at the Makati Medical Center and a member of the board of directors of the American Association of Clinical Endocrinologists-Philippine Chapter.
Jose Carlos S. Miranda, MD, FACE, FPCDE Dr. Miranda has been a doctor of endocrinology for 17 years. He graduated from De La Salle University and had his residency and fellowship training in Makati Medical Center. He is now practicing in Our Lady of the Pillar Medical Center and Crisostomo General Hospital. He is also a member of the medical bureau of Diabetes Center Philippines (or Philippine Center for Diabetes Education Foundation) and one of the camp directors of its sumer camp for children with type 1 diabetes - Camp COPE.
Eternity Labio 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.
Dr. Labio is a gastroenterologist and hepatologist at the Center for Liver Disease Management and Transplantation of the Medical City and Asian Hospital.
Jake Lingan Jake is a personal financial coach, a Certified Investment Solicitor, and the owner of FitForWealth.com.
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.
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we’vegotmail
Dear DiabetEASE, First of all, I am very happy that there is a publication for patients with diabetes. Despite the information campaign, there is still a long way to go for the public to fully understand the disease, but with a publication like yours, I hope it will bring them closer. More power.
Maraming salamat at may ganitong magazine para sa may mga dyabetes. Ako po ay isang 50-taong-gulang na ina na may type 2 dyabetes, at umaasa ako na ang inyong magasin ay magmumulat sa mata ng gobyerno na seryoso ang kundisyon na dyabetes.
Isabel via e-mail
Emmanuelle via e-mail
Dear DiabetEASE, DiabetEASE welcomes feedback from readers. Please send your comments, questions and suggestions through any of the following:
As a mother of a 16-year-old boy afflicted with type 2 diabetes, the magazine has been very helpful. I hope that you will have more articles that can help parents like me deal with children affected by the condition.
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.
Beth via email
find us on www.facebook.com/diabetEASE
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sweetnews
Is vitamin D supplementation effective for type 2 DM? May lower blood glucose level By Alexa Villano
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an Vitamin D help in decreasing blood glucose levels in type 2 diabetes patients? This is the question asked
ukbbcnews.com
in a study conducted by Dr. Kristian Punzalan and Dr. Romulo Ramos, presented in the recent Philippine College of Physicians’ Convention. “According to studies,
there are some evidences that gene polymorphisms of Vitamin D associated receptors may be associated with insulin resistance, insulin secretion and fasting glucose concentrations, suggesting that Vitamin D is related to abnormal glucose metabolism,“ the authors said. To come up with a valid answer, the study authors looked at candidate articles from PubMed and Medline. They conducted a metaanalysis using a combination of mean difference from individual studies with a fixed effect model. Based on the results, the authors noticed that the use of vitamin D supplementation showed significant benefit by decreasing FBS levels
(mean difference -29.24, CI- 43.06, -15.42) in the experimental group compared with the control (placebo) group. But vitamin D did not have any significant effect on the levels of HbA1C (mean difference -0.28, CI -0.73, 0.17), and insulin (mean difference 1.43, CI –1.26, 4.12) in both of the groups. The authors concluded that after 12 weeks of vitamin D supplementation, patients with type 2 DM showed significant decrease in fasting blood glucose levels, but no significant change in HbA1C and insulin levels. They also said that Vitamin D may be considered for diabetic care. D
One soda a day increases diabetes risk By Ma. Cristina C. Arayata
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onsuming at least one can of soda a day increases risk of diabetes by a fifth, a new study warned. According to researchers, drinking one can of soda daily increases the chance of developing diabetes by
22 percent, compared to consuming soda once a month. Moreover, when the body mass index (BMI) was taken into account, the findings only dropped slightly – still indicating that consuming soda a day increases the risk despite the Continued on next page BMI.
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sweetnews From previous page
In the said study led by Dr. Dora Romaguera of Imperial College London, researchers asked 350,000 people in UK and Europe about their diet, including their soda intake. Dr. Romaguera wrote in the journal, Diabetologia, that their study “corroborates the association between
increased incidence of Type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.” She further noted that with the increase in sweet beverage consumption in Europe, “clear messages on its deleterious effect on health should be given to the population.” D
Most people clueless of waist size and type 2 DM link
B sciencedaily.com
ased on a recent Ipsos MORI survey, most people (63 percent) are clueless that large waist circumference indicates risk for type 2 diabetes. The claim, commissioned by diabetes UK and Bupa, stated 37 percent were not aware of the link between the two despite, “strong evidence that this is the case”. Meanwhile, Diabetes UK describes a large waist
By Ma. Cristina C. Arayata
as 31.5 inches and above for women and 35 inches and above for men. The research highlighted that 72 percent were aware that being overweight and inactive were risk factors. However, Diabetes UK and Bupa notes that people who have a body mass index (BMI) in healthy weight range but with a large waist might assume they are not at risk. D
Fish oil supplement could help prevent type 2 DM By Alexa Villano
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part from being good for the heart, fish supplements can also do wonders for it. A new study showed that fish oil supplements can help prevent the risk of type 2 diabetes by increasing the levels that is
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associated with it. According to the research that came out from The Endocrine Society`s Journal of Clinical Endocrinology and Metabolism (JCEM), fish oil supplements or polyunsaturated omega 3 fatty acid capsules can boost the level of the hormone
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84daybodychallenge.com
sweetnews known as adiponectin which is in the blood. Adiponectin is known as a marker for insulin sensitivity, and high levels of the hormone have been linked in reducing type 2 diabetes and cardiovascular diseases in past studies. In the study, researchers led by Jason Wu from the Harvard School of Public Health looked into 14 randomized clinical trials, with 682 participants treated in fish oil supplement and 641 participants given placebo for eight weeks. Results showed that after eight weeks of treatment, fish oil supplement boosted adiponectin levels, which translates into a 3 percent reduced of diabetes incidence.
However, the authors noted that the rise of adiponectin is different from the various trials hence; fish oil may have higher levels in one group from the other. “Results from our study suggest that higher intake of fish oil may moderately increase blood level of adiponectin, and these results support potential benefits of fish oil consumption on glucose control and fat cell metabolism,” Wu said. Wu however clarified that more studies should be done on the effect of fish oil in other metabolic conditions such as inflammation, free fatty acids, and insulin resistance. With diabetes.co.uk D
Night shift may increase risk of type 2 diabetes
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ore than affecting one’s lifestyle and social habits, working the night shift may also increase an individual’s risk of Type 2 diabetes. Study author Christopher Morris, PhD, postdoctoral research fellow in the Medical Chronobiology Program of the Division of Sleep Medicine at Brigham & Women’s Hospital, and his team studied 13 healthy, non-obese adults who participated in two, eight-day, in-laboratory simulations in random order. One included day work, the other is night work. None of the participants had a significant shift work history. They were given a diet that was isocaloric and identical for both simulations. For the benefit of the study, subjects ate at 8 am or 8 pm and were required
By Emil Karlo Dela Cruz
to finish their meals in 20 minutes. Fasting blood samples were taken before the meal. Additional blood samples were drawn at 10-minute intervals for 90 minutes, then every 30 minutes for 90 minutes. Their results showed that peak glucose levels were 16 percent higher among subjects working a simulated night shift, compared to those engaged in simulated daytime work. In fact, the insulin levels of the night workers were 40 to 50 percent higher at 80 minutes and 90 minutes after a meal. “It is surprising that just a
single night shift can significantly impair glucose tolerance and increase insulin levels,” said Morris. “These findings are important because they demonstrate, under highly-controlled lab conditions, that acute exposure to night
work impairs glucose tolerance.” He added: “Chronic impaired glucose tolerance is likely to lead to Type 2 diabetes.” The research abstract can be seen in the online edition of the journal Sleep. D
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youaskweanswer
Q: &A:
How do I improve my leg circulation? Determine first the extent of the problem. If the circulation is critical, with the danger of the limb having ischemia (deficiency of blood flow), then one should consult a doctor who may need to do a surgical procedure, like a bypass, to improve the circulation. If the circulation is not critical, then regular exercise may help circulation. This can be as simple as regular walking or brisk walking for at least 30 minutes
or whatever length of time the patient can tolerate. Other factors like controlling blood pressure, sugar and cholesterol will avoid further deterioration of the Peripheral Arterial Disease (PAD), a term used in medicine to denote circulatory problems in the lower extremities. Your doctor may also prescribe antiplatelet agents like clopidogrel or cilostazol to help improve the circulation.
Jimmy B. Aragon, MD, FPCP, FPSEM, FACE Dr. Aragon is a Fellow of the Philippine Society of Endocrinology and Metabolism, and a Fellow of the American College of Endocrinology. He is also an internal medicine and endocrinology consultant at the Makati Medical Center and a member of the board of directors of the American Association of Clinical Endocrinologists-Philippine Chapter.
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educators’corner
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iabetes mellitus type 2, the most common form of diabetes, is a chronic disease that is increasing in prevalence worldwide. International Diabetes Federation (IDF) estimates that by year 2030, 552 million people will have diabetes. But why do we see this growing prevalence? What is the root cause of this significant increase in prevalence? What is the implication of this rapid growth? Can we prevent diabetes? The high-risk populations for the development of diabetes that we commonly see are those with family history of diabetes, and those who are obese or overweight. Similarly important are those who are taking medications that can increase blood sugar. An example of which is the abusive intake of steroids which sometimes may be taken without doctor’s prescription, because these have been quoted as “wonder drugs”. Another important risk for diabetes is a history of gestational diabetes which can lead to more than 40 percent increased risk for having diabetes in the future. But basically, the most common risk factors for diabetes type 2 are: obesity and family history of diabetes coupled with poor eating habits and sedentary lifestyle. Westernization plays a very important role in the increasing prevalence of diabetes. More white-collar jobs are made available, most of them encouraging sedentary lifestyle. In recent years, we noted the mushrooming of call center offices where the prevalence of obesity and even diabetes is increasing. Most people when at work are just sitting down and are hooked to their computers. Worse, they also eat junk food at work. Because of their busy schedules, they also resort to eating in fast-food chains, which provide high calorie diets like burgers, french fries, regular sodas and fruit juices. This increasing prevalence of obesity and diabetes is also noticeably evident among children and adolescents. Gone are the days when children would mostly play hide and seek, sack races, jump ropes, touch balls, where they run and other physical activities. Now children are confined to their bedrooms playing computer games using laptops and iPads. However, there are so many things that we can do to prevent this dreadful disease: diabetes, and yet enjoy the fruits of modernization. Here are some tips on how to prevent diabetes:
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educators’corner A.
ACTIVE LIFESTYLE: Physical activities allow us to burn the calories that we take everyday especially if we take more than what we need. Simple aerobic exercises daily such as bicycling, running swimming or even brisk walking, climbing up the stairs as we go to work are effective forms of exercise. Children are encouraged to limit their use of electronic gadgets or television viewing to one hour a day only and instead engage in sports such as basketball, volleyball, and swimming for boys or gymnastics for girls. Active muscles improve insulin sensitivity making the cells absorb more sugars.
B. PROPER DIET: High fiber, low calorie, low fat diets are advisable. Vegetables are healthy, as we have always been told since elementary. These are high in vitamins and minerals and high in fibers, which allow us to feel full right away preventing undue indulgences in food. The fiber in grains delays breakdown of complex sugars such as starches into simple sugar. This leads to slower increases in sugar and insulin after food intake. Steamed or roasted food are preferred over fried. Home cooked are preferred over foods that we buy from fast-food chains since these are less fatty. Red meat, in addition, can increase the risk for diabetes by 20 percent. It has been found that the high iron content of red meat decreases insulin activity leading to poor control of blood sugar.
C. MAINTAIN AN IDEAL BODY WEIGHT: Overweight and obesity increases the chance of having diabetes in the future.Maintainingideal body weight cuts this chance in half. If you are obese or overweight, 7 percent weight loss at a rate of 1 pound weekly is desirable.
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D. ENOUGH SLEEP EVERYDAY: Adequate sleep everyday consists of at least eight hours for adults and 12 hours for growing kids. Recent studies have shown that sleep deprivation or sleep interruption for prolonged periods of time can lead to obesity and diabetes.
E. KNOW YOUR FAMILY HISTORY: If one parent has diabetes, you have a 3.5fold higher chance of having it too, more so if both parents are afflicted causing as high as 7-fold higher risk of diabetes in the future compared to those without family history of diabetes. Because of this genetic predisposition, children of diabetic parents become high-risk for the development of the disease. Therefore, as early as childhood, they are encouraged to maintain their ideal body weight and they are educated on proper diet and exercise.
F. EARLY CONSULT WITH THE DOCTOR IF OBESE OR OVERWEIGHT: An ounce of prevention is worth a pound of cure. In cases of obese or overweight children or adults, having realized the risk for diabetes in them, early consultation with the specialist is very important. They can be given a dietary prescription and/or weight-reducing exercise program to follow. If warranted, they can also be prescribed safe and effective weightreducing medication that can work effectively with their diets and exercise. The above six simple tips are effective in the prevention of diabetes particularly in high-risk groups. Simply put, the cornerstone for this prevention is lifestyle change: proper diet and exercise. If we realize the importance of lifestyle change and we educate our patients early, then together we can prevent diabetes and its dreadful complications. Start now and start fast, time is ticking! D
fightin’forfitness
Bike Your Way to Fitness By Jacquiline Go Laruan
claimyourjourney.com
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iking takes you where you want to be in the shortest possible time on realistic ground. It gives you the thrill of the rush, and most importantly, gives a wide range of health benefits – making you visibly fitter and better. Biking on a regular basis is an effective and entertaining form of aerobic or cardiovascular exercise. This is the type of physical exercise that is relatively low intensity and primarily depends on the use of oxygen to adequately meet energy demands. It also gives you the opportunity to bond with biking buddies during rest stops, and to study your surroundings intimately (which makes the exercise entertaining). Specifically, if done at least one hour a day and four times a week, biking activity gives you the following:
Strengthened respiratory and circulatory organs Biking facilitates the flow of air in and out of the lungs. It also strengthens the heart muscle for improved pumping efficiency and reducing blood pressure. While it improves the efficiency of pumping and circulation, pedalling increases the total number of red blood cells in the body – therefore, facilitating the transport of oxygen in the blood. As such, experts confirm that cardiovascular exercises such as biking are good for people with diabetes, heart disease, and high blood pressure. Improved mental health and mood Regular biking reduces stress and lowers the occurrence of
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fightin’forfitness depression. For many bikers, the ride gives themthe feeling of happiness and freedom. Alan Andico, a 32-year old architect by profession, started riding his mountain bike 10 years ago. According to him, his job demands so much of his time during weekdays, so he has to bike every weekend to relieve stress. He usually rides at the Fort, Global City in Taguig, La Mesa Dam Eco Park, and Timberland in San Mateo, Rizal. If he still has to work on a weekend, he bikes to his workplace or around UP Diliman campus (which is very near his home) before going to the office. “If I stop biking, I might die of stress from work,” Alan said laughing. Improved posture and stamina Improvement in body posture from biking is excellent because of the repetitive movement of the legs which help work out the muscles in the lower back of the body. Through biking, the spine is strengthened and protected from external pressure. It stimulates the small muscles of the spinal column (which are usually hard to work on through other exercises). A strengthened spine through biking reduces slipped disc, back pains, and other hip problems. Regarding stamina, Mike Abanes, a 37-year-old mountaineer, shares that his endurance in outdoor sports lengthened. He said that biking made him physically stronger and leaner, and he seldom got leg cramps during the climb. Outside his hobby, he observed that he rarely got sick when he started biking three years ago. Manageable weight and toned body This is the most important for people with diabetes. A 15-minute bike activity every day, five times a week, in addition to healthy eating habits will definitely reduce additional pounds. Based on health experts, this biking pattern burns 300 calories per day and the percentage increases every day because the body still burns calories even after biking. This means body metabolism speeds up for several hours after a biking exercise. Longer and frequent rides will transform your body muscles to a lean or beautifully toned one.
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Getting started Biking can fit any lifestyle. How often you ride when and where you want to do it, may depend on your preference. The key is to start with short distances, like around the neighborhood. You may increase the distance and time, and aim for a more difficult terrain, once you’re confident enough to go outside the subdivision and ride along with public transportation. You may choose a mountain bike (MTB) or a road bike (roadie) to start with this fitness regime. MTB is originally created for offroad cycling or traversing dirt trails, gravel roads, steep declines, and other unpaved environments with wheels that are usually wide and knobby for good traction on uneven terrain and shock absorption, while a roadie is used on paved terrain and usually is for racing. MTB is usually preferred by newbies for diversity of use. Different bike shops such as Powerbike in Rockwell in Rockwell, Makati, All Terra Bike Shop in Libis, Bike Town Cyclery in Chino Roces, and Mt. Pro Bikes in Bangkal, Makati offer low-end to highend bikes and bike parts for those who want their bike customized or assembled. The price of a fully assembled high-end MTB ranges from PhP 130,000 to PhP 300,000, while a roadie is around PhP 100,000 to PhP 250,000. Apart from the bike, don’t forget to buy a quality helmet, which must be worn correctly and close-fitting (without being pushed to the back of the head) to serve its purpose. A pair of gloves, shades, or a clear eyewear, and a comfortable outfit of cycling jersey and shorts, and confidence will make you ready for a bike ride from home to the office. There are a lot of people who do this, and amazingly, they arrive faster than they do if they were driving a car. What’s more, you won’t be irritated about the traffic, and your mood for the day will start on a positive note. On flat ground, riding a bike will take you to at least 5-8 kilometres in 35 minutes, which is faster than the cars in EDSA and C5 during rush hours. Not only will biking save gas, it will also add years to your life. D
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here is a perpetual battle going on inside every diabetic person’s body. A constant struggle where every action counts as a step towards sweet victory, or stinging defeat. Here, the stakes are as high as amputation or death, and success means living another day without suffering from a potentially deadly glycemic attack. This is the internal battle that every individual with diabetes goes through every day. And there is no mistaking it: this is indeed war. At the frontline of this war (alongside the individuals themselves) are the doctors and healthcare workers who move heaven and earth to alleviate the condition of their wards. Behind them are the diabetic’s family and friend, ever supportive of their loved one’s endeavor. And finally, serving as the last line of defense are support groups who advocate awareness about the disease. They serve as the intelligence in this massive war against diabetes, providing information and support to the lay on how to combat this disease effectively.
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PROUD WARRIORS. Diabetes “warriors” pose with their photos at “I AM: The Many Faces of Diabetes” photo exhibit, marking the launch of the One Million Warriors Against Diabetes advocacy. From L to R: renowned writer Ms. Luna Inocian, journalist Mr. Edwin Sallan, retired judge Orlando Siapno and home-schooled student Kearny “Tutoy” Chico.
Warriors unite One support group, which has been feeding the public with a torrent of information for three years now is the One Million Warriors Against Diabetes. “We believe that diabetes is a disease that can be prevented beforehand. The biggest factor there is information” says Jaeger Tanco, executive vice president and chief operating officer of PhilCare, which thought up of the One Million Warriors Against Diabetes. “If we are able to inform the public immediately, that could really help eliminate this disease.” Established in 2011, the organizers of One Million Warriors Against Diabetes have made it their mission to educate at least 1 million individuals (which they call as “Warriors,” hence the name) about the dangers of diabetes and how to prevent or counter the disease. They do this through information drives, various partnerships, social media, and engaging programs that tug at the heartstrings of individuals, rallying them to their cause. Just last year, One Million Warriors Against Diabetes held a relaunch of a massive three-day photo exhibit, shot by renowned photographer Jun De Leon. The exhibit featured photos of famous personalities with diabetes, like media man Mike Enriquez, concert and theater director Freddie Santos, and theater director Luna GriñoInocian,among others. The goal was clear-cut and precise: diabetes does not discriminate; it affects individuals from all walks of life, male or female, young or old. Famous or not. “The exhibit was titled ‘The Many Faces of Diabetes’,” says Tanco. “It shows that
[c everyone can be affected by the disease. Hindi pumipili ang diabetes eh. (Diabetes doesn’t choose its victims). I think that is also one of the reasons why we picked those people and why we came up with the exhibit.” On pooling the people to be featured on the exhibits, Jaeger recalls how it wasn’t much of a hard sell at all. “When we explained what our advocacy was all about, they really wanted to support it. They were quite eager, in fact.” “[Maybe it’s because] diabetes isn’t that ‘supported’ in terms of the different foundations and programs available [to teach about the disease].” Unfortunately, not everyone is as lucky as Jaeger to find individuals so willing to share that they have the disease. The problem with diabetes is that there is still a stigma associated with the condition. In fact, you could say that it was this stigma that prevented some diabetic individuals from seeking help and support, or from getting the information they need to properly manage their disease. In a way, it was this same stigma – this fear of the unknown that Filipinos have toward diabetes – that led to the conception of One Million Warriors Against Diabetes. Apart from the stigma, there was also a general lack of urgency when it comes to treating the diabetes, unlike other diseases. “A lot of people don’t take the disease too seriously. Once you have diabetes, you don’t really do enough to try to stop it” says Jaeger. “Unlike if you have hypertension, you take up maintenance medicines. With dengue, you get checked up immediately. Diabetes, I feel, is being take up for granted. And because of this, it usually gets worst, leading to amputation.” “We also noticed that only when a family member has diabetes do individuals become more conscious,” adds Jaeger.
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We believe that diabetes is a disease that ca n be prevented beforeha nd. The biggest factor there is information.
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Jaeger Tantoco Executive Vice President and Chief Operating Officer of PhilCare Photo by: Jose Martin Punzalan
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One Million and counting Aside from the photo exhibit, One Million Warriors Against Diabetes also partnered with M Lhuillier branches in Divisoria to get closer to the people. Here, they had a representative talk to the customers, informing them about diabetes, and even holding blood testing. As for their original mission – to recruit at least 1 million individuals to take up their cause – Jaeger believes they haven’t yet reached that goal. However, he pledges that once they do in the near future, that won’t be the end. They plan to multiply their supporters by twice or thrice their target number, taking in millions of individuals who actively fight against diabetes. Of course, apart from traditional media, they plan to be more aggressive in social networking to truly influence the youth and help them prevent diabetes even at an early age. The group also has several activities slated for diabetes week this July, such as photography sessions, Zumba
classes, and other activities geared towards engaging the warriors more. On his part, Jaeger’s time with the advocacy group might have influenced his lifestyle a bit, as he has opted for a healthier life. He spends his free time playing tennis, and whenever possible, jogs after work. He admits that though he may not be able to adopt a truly healthy diet, he compensates by engaging in enough physical activity to burn those extra calories off. “It helped me become more aware as to what I had to do, what I needed to do (to stay healthy),” says Jaeger. “Sometimes, even if you can’t religiously follow a strict diet, you are at least conscious at the back of your mind to do something that balances it.” He adds: “You just have to strike a balance. [You have to be] aware about staying healthy, in whatever you do.” It is this awareness that they wish to inculcate in every diabetic person’s mindset, helping them manage their disease better and fully equipping them in the battle to come. D
PARTNERS IN THE FIGHT AGAINST DIABETES. Executives from the Agustin Tanco Foundation (ATF) and PhilCare pose during the launch of One Million Warriors Against Diabetes, including (middle) Mr. Monico Jacob, president and chief executive officer (CEO) for PhilCare; Ms. Regina Gonzales, director for ATF and Mr. Jaeger L. Tanco, executive vice-president and chief operating officer (COO) for PhilCare.
Exhibit and Event Photos Courtesy of Philcare
Photos by: Jun De Leon
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charlesayoub.com
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Say Goodbye to Sodas PCP beefs up anti-soda campaign By Nicole Limlengco
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uring summer, in a tropical country such as ours, water is the ideal thirst-quencher to get us through another hot day. The recommended number is eight to 10 glasses a day (or even 12 in this heat). But sometimes, we crave for something else; softdrinks, the fizzy, carbonated drinks that some individuals turn into their diet staples. Refreshing as they are, soft drinks or sodas now pose a bigger health risk than previously thought, leaving experts and health officials to find new ways for consumers to avoid these sugary drinks. Front of pack labeling According to experts, soft drinks should carry cigarette-style health warnings on their packaging. The label should explicitly show how much sugar they contain and should recommend limiting consumption as part of a healthy diet1. The reliable nutrition labeling of food products should be a top priority in the importance of accurate nutrition for the consumers. In line with this, the Food and Drug Administration (FDA) has already issued a circular for the proper labeling of energy or calorie content on food products, by allowing the use of “factbased” labeling to provide a simple and immediate way for consumers to make healthier choices2. Health risks A study conducted by Imperial College of London found that a 12 oz. serving of soft drink can increase the risk of type 2 diabetes by as much as 22 percent. Other research also shows that it can damage the liver and
kidneys, and can increase the risk of developing cancer or dementia3. Data showed that subjects who consumed soft drinks had lower bone mineral density, placing them at high risk of suffering not only from osteoporosis but from bone fractures as well. Soft drinks also contain caffeine, which could disrupt sleep and lead to anxiety, DNA damage and hyperactivity, especially among children4. And with statistics showing more and more Filipinos getting more obese and at risk for diabetes and other lifestyle diseases, the Philippine College of Physicians (PCP) renews its call for a ban on soda or soft drinks in schools5. Soda ban In what could be similar to the “Food Revolution” program of celebrity chef Jamie Oliver, the Philippine College of Physicians has launched a program to encourage schools to minimize or ban the consumption of soft drinks among children.
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feature Dr. Roberto Mirasol, lead convener for “Front of Pack Labeling” said that the program is to create awareness on the amount of sugar soft drinks really contain. “The advocacy or campaign is really to ban soft drink consumption among children and young adults. Soft drinks are sweetened carbonated beverages that are high in calories and contain a lot of other substances,” Dr. Mirasol said. Dr. Mirasol also believes that the Department of Education should strictly enforce the DepEd Memo No. 373 of 1996, known as “Encouraging the Sale and Consumption of Healthy and Nutritious Food” and DepEd Order No. 14 of 2005: “Instructions to Ensure Consumption of Nutritious and Safe Food in School”6. “I think that is what we want the administrators of the schools do. They should take a proactive stand and make sure that healthy foods are served in the school cafeteria and canteen. Students should be exposed to nutritious and healthy foods,” said the doctor. Dr. Mirasol cited a study published in Diabetologia said “consuming a 12 oz soft drink daily will increase risk of type 2 diabetes by 22 percent”. He also cited another study involving 350,000 individuals across countries in Europe. “Those who consumed soft drinks daily were 18 percent more likely to get a stroke. Those who consumed soft drinks or sodas also had increased weight and waist circumference.” Dr. Mirasol said that with the varieties of food available, information dissemination must continue. “We need to inform consumers on healthy food choices.” With the campaign, Dr. Mirasol hopes that it’s the start of a new food revolution especially in schools. “We hope to make the people aware of the need to choose healthy food choices. One of them is to really limit intake of soft drinks especially among the children. Long term goals – hopefully, soft drinks-free schools!” D http://www.dailymail.co.uk/health/article-2316123/Fizzy-drinks-carry-cigarettestyle-health-warnings-say-experts.html 2 http://newsinfo.inquirer.net/364805/fda-pushes-for-calorie-labels-on-foodproducts 3 http://www.dailymail.co.uk/health/article-2316123/Fizzy-drinks-carry-cigarettestyle-health-warnings-say-experts.html 4 http://newsinfo.inquirer.net/352245/should-soft-drinks-be-banned 5 http://www.abs-cbnnews.com/video/lifestyle/03/05/13/soft-drink-ban-schoolssought-prevent-obesity 6 http://business.inquirer.net/110163/mandatory-food-labeling-and-dental-health 1
Dr. Roberto Mirasol Dr. Mirasol is the chief of the Section of Endocrinology and Executive Director of the Weight and Management Center at the St. Luke’s Medical Center Quezon City.
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dietpsyche.com
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AACE-PC: Against Diabetes By Alexa Villano
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iabetes has become a global epidemic. In the latest report by the World Health Organization (WHO), 347 million people have been reported to have the condition. WHO has projected that by 2030, diabetes will become the seventh leading cause
of death. In a report by the Department of Health (DOH), diabetes mellitus in the Philippines is one of the top ten causes of death and a leading cause of mortality, according to a five year study (2001-2005) released in 2006. To change this trend, various organizations have stepped up the fight against diabetes. One of which is the American Association of Clinical Endocrinologists – Philippine Chapter (AACE-PC), which came up with several projects to combat diabetes and raise awareness among the lay. The ‘G.O.O.D’ in Diabetes One of these is the “G.O.O. D. Day (Goiter, Obesity, Osteoporosis and Diabetes)” project by the organization, which not only gives importance to the awareness of diabetes, but that of other endocrine diseases as well. “The G.O.O.D Day is a different program catering to adults, making them aware of the major [endocrine] diseases affecting millions of Filipinos. Aside from free blood screening and health checks, the day includes mini-lectures appropriate for patients and the lay, games, and fun activities (such as Zumba) to get the patients moving,” said AACE-PC president Dr. Marsha Tolentino. “[The project] started in 2008 and is held every year in different cities to disseminate the information. Laboratory services include blood sugar screening, cholesterol, and triglyceride tests, ECG, foot screening, and bone densitometry,” said Dr. Michael Gan, one of the head coordinators of the program. Nutrition counseling service is offered too. And since it is a “specialized” medical mission, medications are provided for free.
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Last year, with help from the Quezon City government, the project was able to educate 360 patients through 41 specialists and diabetes educators. This year, the brains behind the G.O.O.D. Day project decided to switch things up by holding a fun run-cum-medical mission at the Parkmall in Mandaue City, Cebu last March 24. “The G.O.O.D day evolved into the GOOD Run still with the same objective. [It was also meant] to raise funds for the benefit of the Power of Prevention Through Fitness and Nutrition program (POPTFN), which is also one of the major projects of AACE-Philippine Chapter,” said Dr. Gan. POPTFN: Health via Prevention Launched in November 2007, POPTFN (Power of Prevention Through Fitness and Nutrition) was initially participated in by schools from Luzon with the help of the office of Sen. Edgardo Angara. The project is one of the original programs of the chapter’s mother organization in the U.S.. “The advocacy aims to instill awareness among adolescent Grade 5 students on obesity and its complications such as heart disease, stroke, hypertension, and diabetes,” says AACE-PC president-elect Dr. Florence Amorado-Santos. “[Specifically], POPTFN aims for the prevention of diabetes by preventing obesity through healthy lifestyle,” she added. Five modules on proper nutrition and fitness were included in the participating schools chosen for the project, implemented via Science and Physical Education classes. “The students who have joined in this activity have learned the importance of good nutrition, how to choose healthy alternatives, how to interpret nutrition facts, and the importance of physical activity,” Dr. Santos said. AACE’s mission With diabetes continuing to be an alarming condition
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in the country, AACE-PC is beefing up its efforts not only to provide medical consultation, but also to inform the masses about the dangers of diabetes, using the G.O.O.D. Day program and POPTFN. “Because of the increasing prevalence of obesity and diabetes, the number of patients who are getting admitted for the complications of these two diseases is rising. As a result, the cost of health care in the country has gone up. In addition, the growing number of children who are overweight or obese is changing the face of affected people with diabetes,” Dr. Tolentino explained. “POPTFN will definitely try to reach out to the other provinces all over the Philippines involving both public and private schools. Through the students’ awareness on good nutrition and staying active everyday, we hope to help decrease the incidence of diabetes,” Dr. Santos said. She also emphasized that the group will continue to update its database among its members, which would give them an estimate of the prevalence of diabetes among the private clinics to get a picture of the national data.” “The goal of AACE-PC this year is to bring its flagship programs to the different regions of the country. For June 2013, POPTFN plans to go to Mindanao. In addition, there is a plan to hold a caravan starting from Northern Luzon and ending in Southern Luzon. The G.O.O.D day likewise will be launched in other areas. Rather than starting new programs, we are strengthening existing ones to truly reach many Filipinos especially those in the provinces,” Dr. Tolentino added. Plans of the organization include continuing their midyear activities, which according to Dr. Santos can strengthen knowledge among their members with regards to updated management of patients with diabetes.” “We also have advocacies which delivers assistance to indigent diabetic patients such as free insulin, free glucometers and free oral medications,” she said. In the end, it’s all up to the patient whether he or she wants to get well. “All of these things are a reflection of the patient’s willingness to accept responsibility for his health, which I believe, is the key. As physicians, there is only so much we can do if a patient is not willing to be a partner in managing his health,” said Dr. Tolentino. She added: “For patients, it is imperative that they find a physician with whom they can have an open line of communication. Patients cannot be simply passive participants. Better communication leads to education and a better understanding of the disease. This, in turn, helps motivate patients to carry out the lifestyle modifications necessary to maintain optimum health.” D
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How a support group can make all the difference
The Medical CIty’s various projects for its Diabetes Group includes glucose-checks and symposia
By Excel Dyquiangco
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oo many patients have fought the disease alone. While family members and friends are there by the bedside with them during their most turbulent times, there is always that yearning to “belong” with people who really understand the disease. Indeed, managing diabetes gets easier through the power of support groups. According to Marilyn Ritholz, PhD, licensed staff psychologist at Joslin Diabetes Center, a research and teaching affiliate of Harvard Medical School, “support groups are important and helpful to people with diabetes, because they provide a venue to meet others who share similar medical and psychosocial concerns.” The Medical City (TMC) in Pasig City knows this fact well. Their Diabetes Program is a multidisciplinary approach to diabetes management which includes a diabetes class, the Diabetes Support Group, and diabetes counseling by a diabetes educator. The Diabetes Support Group started three years ago and was initially called the Diabetes Club. It was made for the purpose of organizing people with diabetes and educating them about their illness.
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Facilitated by The Medical City Center for Patient Partnership (CPP) who organizes and coordinates the activities during the meetings and the Diabetes Class, the group has now blossomed to a little more than fifty members. “Here at TMC, we want the patient to be a partner in managing their illness,” says Dr. Ruben Kasala, head of the Section of Endocrinology and Metabolism, Department of Medicine from TMC. “[The first step] is to educate them and to make them responsible for their disease. No matter how good your doctor is, if you are not responsible enough, the treatment won’t be effective. [Patients] should be responsible for
their health.” He adds that the management of diabetes becomes successful once the patient is truly knowledgeable about the disease. “We just meet and talk about the disease until we come up with a program that will encompass all the things a person with diabetes needs to understand,” says Dr. Kasala. The Diabetes Program Aside from imparting specific and general knowledge about diabetes, the Diabetes Support Group also has a one-on-one program for people with diabetes who are starting their insulin treatment. Topics covered include how to check blood sugar,
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what kind of diet one should take, and other lessons beneficial to diabetics. After the lessons, the patient is then referred to the Diabetes Health Educator, for a briefing on how to administer insulin because according to Dr. Kasala: “there is knowledge that people with diabetes should learn that they can’t learn in a diabetes class.” The Diabetes Support Group also fielded a weight management program called “The Greatest Loser”. “To make the game fun, we had to make the doctors funny and enjoyable that’s why we invited funny guy Dr. Patch Adams here at TMC,” says Dr. Kasala. “When the situation is just too serious, the patients get depressed all the more. Diabetes complications are difficult to talk about already but if you discuss it lightly and make it a little bit funny, that makes the talk more effective.” “The result is that the patients can learn more – that it’s really not too bad to become a diabetic as long as you are able to control it.” Group members are also given a band or a bracelet with an inscription embedded on it: “Live well with diabetes”, which serves as an identification card whenever they are outside the center. Whoever comes across them would know that they indeed have diabetes whenever they collapse or have hypoglycemia on the streets. “The band also signifies that living with diabetes is not so depressing, after all,” says Dr. Kasala. He added that people respond better to a positive nature. They used to have a program called “Sweetness that Kills,” which didn’t bode well with the crowd. They later renamed it as “The Sweet Life”. A diary [carrying the same name] is also given to the members. All basic information such as the target goals, what they should know about the illness, etc. – can be found there. There are also exercise activities for people with diabetes. And with the participation of social and advocacy groups imparting knowledge about the
disease, things couldn’t get any easier. Living the Sweet Life Dennis Chua, who works at Unilab and is also part of the support group, claims that it has helped him a lot in his journey through the condition. “First was the education,” he says. “I am empowered to control and manage my condition because of that. Second, we also do screening so we’d know if our sugar levels are up or not.” “We also confer and talk with one another, share our experiences and what method works for some people. I am very thankful with the hospital for giving us the venue, expert advice and professionals who help us with our disease.” He added that with the experience, his lifestyle completely changed a hundred percent. But unlike Dennis and even with such a program, many patients still shy away from the hospital and are quite hesitant – or are in denial – to admit that they have diabetes. “Our thinking is that once they know their illness well, they learn to accept it and manage it better,” says Dr. Kasala. “They also need to know that it’s not a temporary thing. Education is important. If you are a diabetic and you know how to manage the illness, you’ll even be healthier than a non-diabetic.” In the near future, he hopes that people with diabetes from all over the metro can converge to form one huge group similar to Alcoholics Anonymous. “Hospitals have different goals, though,” says Dr. Kasala. “Ours are based on the patient partnership so I really don’t know the set up for the different hospitals.” “It’s really not the end of the world when you have diabetes,” says Dennis. “You become more aware of what you eat and what you do so you live longer and of course, support groups such as the Diabetes Support Group can help you in this field.” D
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Living
By Aretha Angcao
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ome people choose to become victims of their diseases, while others choose to fight the limitations that their bodies imposed on them. One of them is accomplished author and diabetes blogger Catherine Price. Despite having been diagnosed with type 1 diabetes when she was a senior in college, Catherine has found the will to live her life to the fullest. After her widely received parody travel book 101 Places Not To See Before You Die, Catherine is now working on her second book, another humorous creation about the history of vitamins. Both works show that this is one gal who chooses to see the brighter side of life despite the challenges that she faces. When asked if diabetes has ever stopped her from doing certain things, Catherine replied: “No. Diabetes has never stopped me from traveling or doing things that I love. The only exception is swimming. Diabetes itself doesn’t prevent me from swimming, but my insulin pump is attached to me with an adhesive patch and it starts to lose its stickiness if it’s submerged in water for too long.” “I decided that I would stubbornly refuse to let diabetes get in the way of anything else. I did a cross-country bicycle trip for a non-profit organization called Habitat for Humanity that required biking 60-100 miles nearly every day for 63 days. Surviving that gave me hope!” On travelling “I’ve since done lots of other travel, and have become very good at packing diabetes gear. For example, when my husband and I left California to move back to the east coast, we decided to take several months to travel the world going to some remote locations like Tibet along the way. I had an entire oversized backpack stuffed with diabetes supplies that I had to carry with me.” “Diabetes can be a big hassle and definitely adds stress to travel, but it’s doable. What’s more, I think it made me even more stubborn that I already
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am by which I mean more committed to living my life to the fullest, and not letting diabetes or anything else get in my way.” Refusing to give in to diabetes, Catherine has recently decided to participate in a clinical study for a possible cure for type 1 diabetes and she encourages people to do the same. Aside from this, Catherine writes for A Sweet Life, a web site for people with type 1 diabetes, sharing her experiences with the purpose of reaching out to people with the same condition as hers. When asked how diabetes shaped her as a writer, Catherine replied:
“As a writer, I guess the main thing is that it made me an involuntary expert in a disease that’s becoming increasingly prevalent (especially type 2 diabetes) so in an odd way, it gave me work opportunities! But it’s also given me a chance to write pieces that I feel provide emotional support to people and knowing that makes me feel emotionally supported too.” * To know more about Catherine and her battle with type 1 diabetes, read her most recent contribution for the New York Times’ Well Blog, “Thinking About Diabetes With Every Bite”. D
productspotlight
Self Monitoring of Blood Glucose - a question of
accuracy Self-monitoring of blood glucose has now become the standard of care for ensuring tight glucose control in patients with diabetes, especially those on insulin or tablets. It, therefore, follows that devices used for this purpose must be designed, and used, to ensure they are suitable for that intended purpose. This has led many people to the question, Which blood glucose meter will provide consistently accurate and precise readings?
The importance of accuracy
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o accurately monitor blood glucose levels and effectively manage their condition, people with diabetes need to be confident they have a reliable meter that is, above all, capable of continuosly producing accurate and precise results. Patients and their healthcare professionals need to know when they are reaching low or high levels of blood glucose, as this can lead to a variety of short and long term complications. Scientific discoveries have been driving developments in blood glucose meters and test strip chemistries in an effort to produce even more accurate and precise meters. Two independent Australian studies have concluded that the Accu-Chek Performa meters from Roche Diabetes Care give
accurate readings and the results from the Accu-Chek Performa meter are very similar to what one would expect from a test done at a good laboratory. The most recent study was carried out in September 2010 in Sydney². It was prompted by the availability of the new generation Accu-Chek Performa advanced chemistry test strips and the need to compare these with other different strip chemistries that are currently in the market. Samples were collected and analyzed by three meter brands as well as by the glucose reference method used in the hospital’s laboratory. All meters were used according to the manufacturer’s instructions. The study concluded that of the three meters, Accu-Chek Performa, and another brand met the current international standard requirements. However, only the Accu-Chek Performa met the proposed stricter accuracy requirements based on the study criteria. These findings reinforced previous results from a similar study¹ carried out during 2007. The objective of the study was to evaluate Accu-chek Performa of Roche Diabetes Care and another well-known brand versus a comparative laboratory method. The results based on
the criteria of the study¹ indicated that the meters of the other brand did not meet the current ISO 15197 international accuracy standards. On the other hand, the Accu-Chek Performa meter gave Accuract Results that could be compared closest to laboratory results. Together, these two studies demonstrate that Accu-Chek Performa has proven Accuracy1-4. • Especially Designed Canister Protects test strips from exposure to high temperature and humidity- characteristics of the Philippine weather • Allows Re-dosing Gives out a signal if blood sample is insufficient so re-dosing can be done on the same test strip • No Open-Vial Expiration Test strips can be used until expiration date on the vial to prevent strip wastage D 1. Evaluation of the Accu-Chek Performa, Medisense Optium® and Medisense Optium® point-of-care blood glucose meters against a laboratory comparative method. L. Kitchener, G. Freitas. Department of Clinical Chemistry, South West Sydney Area Pathology Service. Liverpool NSW 2170. Australasian Association of Clinical Biochemists ASC, September 2008, p28. 2. Evaluation of three blood glucose meters: Accu-Chek Performa®, One Touch Verio® and One Touch Vita® against a laboratory comparative method. L. Kitchener, S. Djordjijoska, Department of Biochemistry, Sydney South West Area Pathology Service, Liverpool Hospital, Sydney, Australia, September 2010. 3. Extended study report on Accu-Chek® Performa self-monitoring blood glucose system. MV. Lovrencic, B. Rocic. January 2008. Data on file. 4. Accu-Chek ® Performa User Study Australia and France. RJ. Koubek. Data on file. 2008. *American Diabetes Association. Standards of Medical Care in Diabetes – 2006. Diabetes Care 2006; 29 Suppl 1: S10, S11, S16, S31 +Roche Diagnostics, data on file. ACCU-CHEK, ACCU-CHEK PERFORMA and ACCU-CHEK PERFORMA NANO are trademarks of Roche © 2011 Roche. All other product names and trademarks are the property of their respective owners.
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righteousrecipes Chef Carol Lavin, CCE
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ho doesn’t love gourmet dishes? They taste so good. Good thing, they are available in local supermarkets nowadays in easy-toprepare recipes at an affordable price. But are they healthy? Try these recipes by Chef Carol Lanvin of the Center for Culinary Arts for DiabetEASE and see for yourself.
is a CCA, Manila graduate with a Diploma in Baking and Pastry Arts and Technology Management. Chef Carol attended many continuing education courses here in the Philippines, and in other countries such as Australia, New York, Thailand, and Atlantic City. She specialized in the field of Baking & Pastry Arts, which has been evident with her numerous medals and recognitions from various Baking and Pastry Arts competitions both and abroad.
Yield: 2 pieces 6” Tart/Pan Number of servings: 8
Yield: 2 pieces 6” Tart Pan Ingredients: 100g bread flour 100g cake flour 5ml salt 5ml Splenda 100g butter, cut into cubes 1 piece egg Procedure: 1. Combine flours, salt, and sugar in a bowl. 2. Cut in butter until pea-size. Add egg. Gather ingredients into a ball. Add water if too dry. Wrap in plastic and chill for one hour.
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Ingredients: Pate Brisee 180g low fat/ fat free bacon/ham cut into strips 250g lite cream 3 pieces eggs Pinch nutmeg To Taste salt To Taste pepper 80g Gruyere cheese, grated 80g spinach Procedure: 1. Roll out pastry into 1/8” thick. Place in a tart pan and pre-bake for 15 minutes at 375o F. Allow to cool. 2. Sweat bacon. Allow to cool. 3. Whisk together cream and eggs. Season with salt, pepper, and nutmeg. Pour over prepared crust. Top with bacon and Gruyere cheese. 4. Bake at 350o F until golden brown.
Nutrition facts per serving: 321.55 calories 21.88 g fat 21.19 g carbohydrate 13.5 g protein
righteousrecipes
Yield: 2 5 x 9 loaf pan Number of servings: 8
Nutrition facts per serving: 342.13 calories 17.96 g fat 64.74 g carbohydrates 8.85 g protein
Ingredients: 1/3 cup orange zest 255g lite butter 270g Swerve or Splenda 4 pieces eggs 2 pieces egg yolks 5ml vanilla 200ml milk 345g all purpose flour 15ml baking powder 60g maraschino cherries (optional)
Procedure: 1. Sift together flour and baking powder. 2. Cream butter and sugar until light and fluffy. 3. Add eggs one at a time. Add vanilla. 4. Add milk alternately with dry ingredients. 5. Pour in to a loaf pan that’s greased and floured. 6. Bake at 370o F for 20 to 30 minutes. 7. Garnish with maraschino cherries
Number of servings: 1 Procedure: Ingredients: 1. Heat the pan and add olive oil. 2 teaspoons olive oil 1 tablespoon ground black 2. Season chicken breast with 1/2 tablespoon of black pepper then pepper, divided 1 skinless, boneless chicken squeeze fresh lemon juice. Season with the rest of black pepper. breast half 1 tablespoon Fresh Lemon 3. Place the chicken on the pan. Turn until golden brown.
Nutrition facts per serving: 153.5 calories 11.5 g fat 0.3 g carbohydrates 11.6 g protein
Yield: 2 cups Ingredients: 1 packed fresh strawberry 6 tablespoons lemon juice 1/4 cups Splenda or Swerve 2 tablespoons cider vinegar 2 tablespoons olive oil 1tsp sesame seeds
Procedure: 1. Place the fresh strawberries in a blender, cover, and process until pureed. 2. Add lemon juice and sugar; cover and process until blended. 3. While processing, gradually add vinegar and oil in a steady stream; process until thickened. 4. Stir in sesame seeds. 5. Transfer to a large bowl or jar; cover and store in the refrigerator.
Nutrition facts per cup: 165.66 calories 14.85 g fat 17.35 g carbohydrates 1.365 g protein
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indepth
Fat in Your Liver Can Be Bad By Dr. Eternity Labio
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day in the clinic will not pass without seeing a handful of patients with fatty liver. It can be their main reason for seeking medical consult or an incidental finding they themselves are not aware of unless the doctor points it out.
What is fatty liver? Fatty liver is the accumulation of excess fat in the liver. It is also known as “hepatic steatosis” and is one of the most common liver diseases worldwide. Millions are afflicted who may or may not even know about it. Excess fat in the liver is associated with a certain lifestyle – a lifestyle of too much “good food and drinks”. There are two types of fatty liver disease – (1) Non-alcoholic fatty liver disease referred to as NAFLD and (2) Alcoholic fatty liver disease (AFLD). Fatty liver is not a disease attributed solely to alcohol drinkers. In the majority of cases, it is found among those who do
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not drink alcohol particularly those who are overweight, have diabetes, and with high cholesterol levels. Why is it common in people with diabetes? NAFLD is the expression of diabetes, high cholesterol and obesity in the liver. It is the hepatic manifestation of the metabolic syndrome. Being part of a syndrome, the typical patient with NAFLD is also diabetic, hypertensive, overweight and has high cholesterol. In the absence of the full-blown syndrome, the finding of fatty liver alone can be considered as an “early warning” suggesting the risk of
developing these associated conditions in the future if not reversed early. Alcoholic fatty liver disease on the other hand is a consequence of regular and habitual drinking of alcoholic beverages. Consuming alcohol in excess leads to fat accumulation in the liver similar to what happens in NAFLD. This condition can be prevented by limiting alcohol consumption to levels that are not harmful to the liver. Binge drinking or drinking huge amounts of alcohol only on special occasions is just as bad as having a few drinks too many on a regular or daily basis.
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How is it diagnosed? Attention to it is commonly a result of finding “hepatic steatosis” or “fatty liver” on ultrasound or abnormal “liver function tests” on annual check-up or testing for other reasons. Typically, it goes unnoticed without symptoms and is incidentally discovered. Pain or discomfort around the area of the liver or right side of the abdomen is usually not due to fatty liver and a search for other causes of pain should be investigated. The most common blood tests used to investigate the presence of liver disease are the serum ALT (SGPT) and serum AST (SGOT). These may be completely normal in the presence of fatty liver and should not be relied upon to confirm or exclude the diagnosis. The presence of certain “red flags” such as diabetes and being overweight should trigger a diagnostic work-up with a liver ultrasound to make the diagnosis with confidence. To know the extent of damage from excess fat accumulation in the liver, a new method using transient elastography (Fibroscan) is now available to determine the amount of scarring or fibrosis in the liver. It is a quick, painless, and reliable test which can give your doctor valuable information in assessing the degree of damage in your liver.
What are its complications? Many people, patients, and doctors alike have long been complacent when a diagnosis of fat in the liver is discovered. Many think that having fat in the liver is an innocuous finding not associated with any serious health risks. It has been shown that people with fatty liver have a shorter life span compared to those without fatty liver. The most common cause of death is cardiovascular disease, usually from heart attacks and strokes. This is the reason why people with fatty liver need to be screened for metabolic risk factors such as diabetes, heart disease, elevated cholesterol, and high blood pressure. In the same way that diabetes and high cholesterol lead to serious heart disease, fatty liver can also lead to serious liver damage. When fat is accompanied by inflammation with subsequent damage of liver cells in a condition called non-alcoholic steatohepatitis (NASH), this can progress to significant liver damage in the form of liver cirrhosis, liver failure, and, eventually, liver cancer. Fortunately, not everyone with fatty liver disease develop these complications in the liver. Only those with uncontrolled diabetes, cholesterol, and obesity are at highest risk in developing these complications.
therefore exert extra effort to prevent it. A healthy and active lifestyle is the first step to reduce your chances of developing these conditions. If discovered early, fatty liver can be reversible. Weight loss through a healthy diet and exercise coupled with good control of sugar and cholesterol levels and avoidance of too much alcohol are the most effective strategies known to prevent progression of fatty liver. There is no single drug known to be better than weight loss and lifestyle change in treating this condition. Supplements, popularly known as “liver vitamins” have not been proven by good scientific evidence to be effective in treating fatty liver disease. It only gives patients a false sense of security and distracts their attention from doing what matters. Until there is good evidence to support the use of these medications, the use of these liver vitamins is of no proven benefit. In fatty liver, the hardest thing to do is usually the one that works. Unfortunately, there are no easy short cuts but is definitely worth doing. D
How can it be prevented and treated? The risk of developing diabetes, fatty liver, and its complications is a product of bad genes and an environment characterized by a sedentary and inactive lifestyle. Some are genetically predisposed to have it and should
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Diabetes & Dyslipidemia By Jose Carlos Miranda, MD
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weet and fatty...what comes into your mind first? Yum yum, tasty, flavorful, mouthwatering? True, but it’s also high caloric, filling, heavy, and most of all, dangerous (especially when taken frequently or in excessive amounts). When we talk about diabetes mellitus we know it’s sugar excess in the blood. When we talk about dyslipidemia, then we know it’s abnormal levels of fat in the blood. “Dys” means abnormal, “ lipid” means fat, and “emia” from “hemia” means blood. Imagine these two substances in excess circulating in the blood. Inevitable damage will happen. How do we diagnose dyslipidemia? It is diagnosed by taking one’s lipid profile. The lipid profile includes total cholesterol, triglycerides, HDL, LDL, and VLDL. In diagnosing dyslipidemia, one has to use the NCEP ATP III guidelines. (www.nhlbi.nih.gov/guidelines/ cholesterol/atglance.pdf). If you might ask what is the good and the bad cholesterol then HDL is good and LDL is bad. Just think LDL as Lechon De Leche, therefore bad; it’s that easy to remember. Generally, total cholesterol should be less than 200 mg/dL, triglycerides as less than 150 mg/dL, HDL as more than 40 mg/ dL for men and 50mg/ dL for women, LDL must be less than 100 mg/dL for individuals with or presumed to have coronary heart disease; less that 130 mg/dL for
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those with two or more risk factors; and less than 160 mg/dL for those with 0-1 risk factor. For people with diabetes, they have a characteristic dyslipidemic profile. They have low HDL, high triglycerides, and high LDL. These three components compose the atherogenic triad. A deadly triad since it highly correlates with cardio- and cerebrovascular disease (heart disease and stroke). Diabetes mellitus alone puts an individual at risk for cardiovascular disease like having a heart attack. What more if that individual has dyslipidemia? Because of this, it is even recommended that the target LDL should be less that 70 mg/dL. What to do about it? First, follow a healthy lifestyle. Exercise and not “extra rice”. Walk, run, swim, dance, bike, do jumping jacks, and skip rope; there are many ways of doing it. Enroll in a gym. A structured form of exercise is very good. Thirty minutes a day, 5x a week is beneficial in lowering glucose and lipids. Minimize or avoid fatty and sugary foods. Try not to fill up your plate too much. Avoid second servings. Seek a nutritionist’s help. He/she can even recommend sample menus. Second, consult your doctor for appropriate pharmacologic treatment. Statins are the first-line recommended treatment for dyslipidemia. Statins have proven themselves not only in improving the lipid profile but also in lowering the risk for cardio- and cerebrovascular diseases. Other forms of drug therapy that your doctor may deem appropriate could be the use of fibrates, nicotinic acid, bile acid sequestrants, and EPA, DHA depending on the need. Don’t forget to follow up. Adjustments maybe needed. Reinforcements could be done. Diabetes and dyslipidemia- a deadly duo. This duo must be recognized early. These must be treated promptly and properly to avoid any complications that may arise. One must have discipline in resisting the temptation of the mouthwatering, yummy, but DEADLY sweet and fatty. D
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indepth
Hypertension and Diabetes By Marie Yvette Rosales-Amante, MD
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ypertension (defined as a blood pressure ≥140/90 mmHg) is an extremely common condition seen in people with diabetes, affecting 20–60 percent of patients with diabetes. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome, which includes central obesity and dyslipidemia (high cholesterol). In type 1 diabetes, hypertension may reflect the onset of diabetic nephropathy (kidney damage). Hypertension substantially increases the risk of both macrovascular and microvascular complications, such as stroke, coronary artery disease (heart attack), peripheral vascular disease, retinopathy (eye damage), nephropathy, and possibly neuropathy (nerve damage). In recent years, adequate data from well-designed trials have demonstrated the effectiveness of aggressive treatment of hypertension in reducing these complications.
Hypertension as a risk factor for complications of diabetes Diabetes increases the risk of heart attack events twofold in men and fourfold in women. Part of this increase is due to the frequency of associated cardiovascular risk factors such as hypertension, dyslipidemia, and clotting abnormalities. In observational studies, people with both diabetes and hypertension have approximately twice the risk of cardiovascular disease as non-diabetic people with hypertension. In the U.K. Prospective Diabetes Study (UKPDS) epidemiological study, each 10-mmHg decrease in mean systolic blood pressure was associated with reductions in risk of 12 percent for any complication related
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to diabetes, 15 percent for deaths related to diabetes, 11 percent for heart attacks, and 13 percent for microvascular complications (such as retinopathy and nephropathy). Screening and diagnosis • Blood pressure should be measured at every routine visit. Patients found to have elevated blood pressure should have blood pressure confirmed on a separate day. • Home blood pressure selfmonitoring and 24-hour ambulatory blood pressure monitoring may provide additional evidence of “white coat” and masked hypertension and other discrepancies between office
and “true” blood pressure. Goals Epidemiological analyses show that blood pressure >115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes, and that systolic blood pressure above 120 mmHg predicts long-term end-stage renal disease (ESRD). Randomized clinical trials have demonstrated the benefit (reduction of heart attack events, stroke, and nephropathy) of lowering blood pressure to <140 mmHg systolic and <80 mmHg diastolic in individuals with diabetes. • People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg.
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• Lower systolic targets, such as <130 mmHg, may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. • Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg.
systolic and/or ≥80 mmHg diastolic, pharmacological therapy should be initiated along with lifestyle therapy. Lowering of blood pressure with regimens based on a variety of antihypertensive drugs, including ACE inhibitors, ARBs, -blockers, diuretics, and calcium channel blockers, has been shown to be effective in reducing cardiovascular events. In people with diabetes, inhibitors of the renin-angiotensin system (RAS), such as the ACE inhibitors and ARBs, may have unique advantages for initial or early therapy of hypertension. In a nonhypertension trial of high-risk individuals, including a large subset with diabetes, an ACE inhibitor reduced cardiovascular disease (CVD) outcomes. In patients with congestive heart failure (CHF), including diabetic subgroups, ARBs have been shown to reduce major CVD outcomes, and in type 2 diabetic patients with significant nephropathy, ARBs were superior to calcium channel blockers for reducing heart failure. • Patients with a blood pressure >120/80 mmHg should be advised on lifestyle changes to reduce blood pressure. • Patients with confirmed blood pressure ≥140/80 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely subsequent titration of pharmacological therapy to achieve blood pressure goals. • Lifestyle therapy for elevated blood pressure consists of weight loss, if overweight; Dietary Approaches
to Stop Hypertension (DASH)-style dietary pattern including reducing sodium and increasing potassium intake; moderation of alcohol intake; and increased physical activity. • Pharmacological therapy for patients with diabetes and hypertension should be with a regimen that includes either an ACE inhibitor or an angiotensin receptor blocker (ARB). If one class is not tolerated, the other should be substituted. • Multiple-drug therapy (two or more agents at maximal doses) is generally required to achieve blood pressure targets.
Treatment strategies Although there are no wellcontrolled studies of diet and exercise in the treatment of elevated blood pressure or hypertension in individuals with diabetes, the DASH study in non-diabetic individuals has shown anti-hypertensive effects similar to pharmacological monotherapy. Lifestyle therapy consists of reducing sodium intake (to below 1,500 mg/day) and excess body weight; increasing consumption of fruits, vegetables (8–10 servings per day), and low-fat dairy products (2–3 servings per day); avoiding excessive alcohol consumption (no more than two servings per day for men and no more than one serving per day for women); and increasing activity levels. These nonpharmacological strategies may also positively affect sugar and lipid control and as a result should be encouraged in those with even mildly elevated blood pressure. Non-pharmacological therapy is reasonable in diabetic individuals with mildly elevated blood pressure (systolic blood pressure >120 mmHg or diastolic blood pressure >80 mmHg). If the blood pressure is confirmed to be ≥140 mmHg
Summary There is a strong connection between hypertension in diabetes and adverse outcomes of diabetes. Clinical trials demonstrate the efficacy of drug therapy in reducing these outcomes and in setting a blood pressure–lowering target of < 140/80 mmHg. A goal of <130/80 mmHg can be used for patients with long life expectancy, but this should be achieved with few drugs and without side effects of therapy. Achievement of the target blood pressure goal with a regimen that does not produce burdensome side effects and is at reasonable cost to the patient is a most practical and safe strategy. D
References: • Diabetes Care 2013 • New Dash- US Department of Health and Human Services
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specialadvertisingfeature indepth
New Glucerna® with Prediabetes and Diabetes in the Philippines Triple Care Specialized Nutrition for People
Abbott is responding to the growing worldwide diabetes epidemic by introducing Glucerna® Triple Care, a specialized nutrition product for people with prediabetes and diabetes, in the Philippines. The new Triple Care formula provides a unique combination of ingredients to help patients manage their blood sugar levels while supporting heart health and weight management, as part of an overall diabetes management plan. Globally, more doctors recommend Glucerna than any other diabetes-specific nutrition brand. Diabetes, a metabolic condition characterized by elevated glucose or blood sugar levels affects nearly 371 million people worldwide. The International Diabetes Federation (IDF) estimates that unless rapid action is taken, one person in ten will have diabetes by 2030. Type 2 diabetes, also known as “adult onset diabetes,” comprises 90 percent of total diabetes cases and is largely due to excess body weight, obesity and lack of physical activity. It is well established that Type-2 diabetes is a major risk factor for cardiovascular disease: those with Type-2 diabetes are twice as likely to suffer a heart attack or stroke, than people without diabetes. In addition, diabetes places people at greater risk for kidney failure, blindness, lower-limb amputations and death. Diabetes is a massive global economic burden with an estimated 465 billion (US dollars) spent worldwide last year treating diabetes and its related conditions.1,2,3 Advanced Specialized Nutrition for Prediabetes and Diabetes Lifestyle intervention, including specialized nutrition, can delay or prevent the onset of prediabetes in those at risk and
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may slow the progression for people with diabetes.4 Glucerna Triple Care has been clinically shown to help manage weight and reduce cardiovascular risk factors in conjunction with an overall diabetes management plan, including diet and exercise.5,6 Glucerna Triple Care is clinically proven and scientifically designed for people with prediabetes or diabetes to use in conjunction with an overall diabetes management plan. Specifically, Glucerna Triple Care provides: • an advanced, slowly digested, low-GI carbohydrate system to manage blood sugar response; • a unique heart-friendly lipid blend rich in MUFAs and omega-3 fatty acids to support heart health; • a combination of key ingredients including FOS to help reduce weight and waistline; • 225 calories per serving; • 32 vitamins and minerals; and • available in vanilla & chocolate flavors Glucerna Triple Care can be purchased in Mercury Drug outlets, key supermarkets and drugstores nationwide.
References: 1. IDF Diabetes Atlas, 5th Edition, 2012. http://www.idf.org/diabetesatlas/ 2. IDF: Diabetes and Cardiovascular Fact Sheet, Accessed 2 March 2012, www.idf.org/ fact-sheets/diabetes-cvd 3. IDF: Diabetes Atlas (Fifth Edition), Accessed 2 March 2012, www.idf.org/diabetesatlas/5e/ the-global-burden 4. Elia et al. Diabetes Care 2005;28:2267-2279 5. Look Ahead Research Group. Arch Intern Med. 2010;170(17):1566-1575 6. Wadden et al. Obesity. 2009;17:713-722
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goodfoodguide
ollow that
plate! Move over, Food Pyramid. There is a new food guide in town, one endorsed by no less than Michelle Obama herself. By Luchie Callanta, RND
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he days of the Food Guide Pyramid are long gone. It is out, obsolete, passĂŠ. These days, a better food model is the MyPlate, endorsed by no less than US First Lady Michelle Obama. An offshoot of the 2010 American Dietary Guidelines, MyPlate was officially launched in 2011. One look at the model and you can tell how easy it is to use. It is easy to visualize where everything should go: half of the plate should go to fruits and vegetables, a quarter should be for protein, and another quarter for grains. The other important food group is dairy, to round up a well-balanced meal.
Illustration of the plate division
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goodfoodguide If we were to translate this into actual food, it would look something like this:
(such as the ever popular bacon-egg-rice, or our very own tosilog). A better alternative would be to choose lean beef tapa, egg white, and a small serving of rice instead. But whatever meal you may choose, what is important is that you should concentrate more on fruits and vegetables. The protein section does not only mean meat but rather legumes, beans, and tofu. Some meats are also healthier than others. Go easy on the red meats! Choose fish and lean chicken instead. For the grain section, go whole grain. The model does not mention oils when in fact there are healthy oils, such as olive oil. Besides, not having oil or fat in a diet may lead to an extremely low fat, high carbohydrate diet, which makes it more difficult to control weight and blood cholesterol levels.
Following the model does not automatically mean lower calorie intake. Watch out for: Compare this now with the typical Filipino dinner plate and you will realize where we might have a problem:
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The model naturally increases fruit and vegetable intake, while lowering the amount of fatty protein. Both these steps are crucial to the health of people with diabetes. In fact, it is so healthy that many doctors and nutritionists endorse it. The only problem with this model is that it only applies to dinner. Experts still need to come up with a breakfast and lunch plate to complement the existing model. Breakfast is especially crucial as most people traditionally have a high carbohydrate, high fat breakfast
1. Salad dressings and heavy sauces on vegetables. Go for stir fried veggies, such as our guisadong gulay using healthy olive oil. 2. Full cream milk. Dairy can be low fat milk, skimmed milk, or yoghurt. You also do not need three servings of milk a day! Hydrate with water instead. Or, if your carbohydrate counter will allow it, fresh fruit smoothies. 3. In the same vein, avoid sugary drinks at all cost! 4. When shopping for food, check the food label and pay special attention to total calories, fat grams, and sodium levels
The MyPlate model can be accessed through its website (http://www.choosemyplate.gov) where you will find many recommendations for portion and serving size. However, it would be difficult to use the model for children and teenagers as their caloric needs are very different from adults. It also does not take into consideration special dietary restrictions such as lactose intolerance, allergy to gluten, and other conditions. For Filipinos who love sautĂŠed vegetables, soups, and other mixed foods, it is difficult to estimate the amounts consumed. It is certainly not a guarantee that you wonâ&#x20AC;&#x2122;t gain weight, as the model does not address overall consumption. You may be making healthier food choices but the amount you are eating may cause you to gain
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goodfoodguide weight. This is where portion sizes will come into play to help one achieve their weight goals, maintain good health, and avoid future health problems. Seek the help of a nutritionist to assist you in creating a customized meal plan.
The Other Plates There are other versions of the MyPlate. One of these was created by the Harvard School of Public Health and Harvard Medical School. It is called the “Healthy Eating Plate.” This model includes advice on healthy choices in the major food groups.
Then there is the “Eatwell Plate”, which is from the United Kingdom. It focuses more on the proportions of different food groups essential for a healthy and wellbalanced diet. Instead of the boring layout of the MyPlate model, it uses images of the food laid out in a pie chart. The suggested balanced intake is good for the whole day and suggests, among other things, eating plenty of fruit and vegetables, focusing on whole grains and restricting intake of fat, sugar and salt. Ultimately, your health is in your hands. The models merely serve as guides in your food choices and portion sizes. The final decision is still yours to take. D
Ms. Luchie Callanta Ms. Luchie is armed with a BS degree in Community Nutrition and a Master’s in Nutrition from the University of the Philippines, Diliman. She had been affiliated with various companies, attended numerous seminars and conferences, and conducted training programs and consultancies in the field of Nutrition, which makes her a resident expert on teaching Nutrition courses. Besides being a full-time instructor and resident nutritionist at CCA Manila, she is a lecturer at the Department of Food Science & Nutrition - UP College of Home Economics and a contributing writer for many publications as well. She also handles training and consultancy for Triple V Foods Corporation and educates people on First-Aid, Personal Safety, and Food Safety and Sanitation.
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stressbuster wordpress.com
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ilipinos are a universal epitome of a person hardat-work, but did you know they also tend to be the least prepared when it comes to retirement?
In a research conducted by AXA Retirement Scope, most of their Filipino respondents believe that the government should be the primary source of retirement fund, or that it should be provided by their employers. Only half of the respondents believed in preparing for their own retirement themselves. “This is one of the most alarming findings in the AXA Retirement Scope,” said AXA Philippines Andrew Alcid. “We have to help the average Filipino take personal control of their retirement future. We should realize that planning for a good tomorrow – a golden retirement – begins today.”
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The successful retirement Retirement means that a “person stops employment completely.” However, a successful retirement means something else. In personal finance terms, a successful retirement means a person is no longer actively working for income to maintain his/her own lifestyle. This means being sustained by investments or what we call as ‘passive income’,” says Jake Lingan, a certified investment solicitor and a financial planner. While taking it easy is a luxury at the youthful age of 30s or 40s, Lingan advises everyone to think decades ahead and start building up a retirement plan as early as when you receive your first income.
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stressbuster This is something that is easier said than done, especially when one is clueless on the twists and turns of financial management. Start early and be in the know, with help from Lingan’s list of factors to consider in preparing for one’s retirement: Desired Age to Retire. The biggest factor that contributes to retirement planning is time. Think up of the ideal age where you’ll be retired and work towards that goal. Desired Lifestyle. Imagine the type of lifestyle you want to have 50 years from now. Are you cozily resting by a beachfront house or are you dwelling in a peaceful village up north? This will tell you how much you’ll need to save every month, to make your dream scenario a reality. Inflation rate. Commodities change in price through time. To prepare for retirement, take into account the inflation rate and do the necessary adjustments. Life expectancy. “Although no one can predict the remaining years we will (have) after our retirement, life expectancy is still considered as an important element in computing your needed retirement fund,” says Lingan. He added that life expectancy of twenty more years after retirement is already considered as a safe estimate. Pre-retirement investment interest rate. This is the interest rate of your investment prior to your retirement. Lingan notes that most of the time, investment is placed on aggressive or growth oriented portfolios such as stocks or equities (Mutual Funds). Post-retirement investment interest rate. This is the interest rate of your investment during your retirement. Most invest on conservative portfolios such as bonds or bond fund (Mutual Funds). More than mere technicalities, these factors will help you formulate the ideal “saving pattern” for you. As an example, Jake cites the regular Juan dela Cruz who wishes to retire at the age of 60, with a life expectancy of twenty more years. If the retirement you imagined is worth PhP 28.4 million, then the monthly savings should not be less than 30K/month, with an average inflation rate of five percent annually and the post-retirement investment rate of six percent annually. The rule of thumb is to save as much as you can. In fact, even the rule of saving at least 10 percent of your earnings isn’t enough anymore if aiming for a comfortable retirement, says Lingan.
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“Make sure that your investments intended for retirement are also protected from short term uncertainties such as medical expenses, accidents, or disability,” he added. In the end, it is always prudent to seek the help of professionals, such as certified financial advisors. This way, you are given proper guidance on the finances of your future. D
Retirement Preparation FAQ: Q: I am clueless with the how-to’s of finances! What should I do? Lingan: Plan for your retirement as soon as possible. Building a retirement fund is very challenging. Save and invest your money in assets appreciating higher than the bank and inflation rate (i.e. stocks, mutual funds, etc.). While accumulating wealth, never neglect insurances and emergency funds to protect your long-term investment from short term uncertainties. Q: What are the things you need to watch out for during retirement? Lingan: Based on experience, medical expenses always drain retirement funds. Maintain a healthy lifestyle with exercise, proper diet, and food supplement. Even with good discipline, you should keep your medical and life insurance active. This is to ensure that your retirement fund is intact despite the shortterm uncertainties. Q: Does investing in insurance in the past affect one’s retirement? Lingan: If the life insurance has investment components such as guaranteed cash benefits, dividends or linked to mutual funds, it could help out on your retirement. However, take note that the primary objective of life insurance products is income/ asset protection. Wealth accumulation is just a secondary. If it is a term insurance, expect no investment return. Thus, it will not help out on your retirement. Jake Lingan is a personal financial coach, a Certified Investment Solicitor, and the owner of FitForWealth.com. For inquiries, feel free to email him at jakelingan@yahoo.com
dosanddon’ts
Turning Vegetarian Lessons from a former vegetarian who did it wrong the first time By Michaela Sarah De Leon
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was at the height of my bout against animal rights abuse when I decided to become a vegetarian. I hated the fact that animals suffer inhumane conditions in slaughterhouses before they die – just so we could have good meat on our plates. It was a compassionate cause that ended horribly because I did it wrong. I ended up on a hospital bed with gastroenteritis. Don’t do what I did. Here are lessons I learned from my brief stint as a vegetarian:
Know if your body can tolerate the lifestyle. Talk to your doctor. Your doctor will know if you can tolerate becoming a vegetarian. Your doctor can also give you advice on how to safely become vegetarian and even recommend diets to get you started.
food wasn’t vegetarian with one bite. Your sense of taste will change if you’ve been vegetarian for weeks. I usually taste blood when I eat non-vegetarian food. Read labels and know the ingredients of what you’re eating.
your suit. You should understand their predicaments because, if they really are your friends, they sure do understand yours. Starve yourself. I’m repeating myself but if you’re vegetarian, you won’t have
IIlustration by Kevin Paul Faustino
Go Out with your friends and family. Eating out was a constant problem. Back then, restaurants did not serve vegetarian alternatives. Whenever I went out with my friends, I was the most difficult to feed because we had to look for a place that served food that I could eat. Sometimes we just didn’t eat at all.
Give up meat right then and there. I admit that this was my biggest mistake. I was so caught up in the passion of fighting for animal rights that I decided to rid my life of meat immediately. You have to do it gradually to allow your body to get used to the diet.
Become vegetarian for a good cause. My decision to become vegetarian was motivated by my love for animals and my passion to protect them from abuse. The first few months of turning vegetarian were the most difficult but my passion kept me from giving up.
Settle for anything less. I came from a meat-loving, middle-income family. It had palengke meat and processed meat in abundance because it’s cheaper and more filling. Needless to say, we can’t afford to have a member become a vegetarian. Take it from me: become vegetarian when you can afford it.
Know what you’re eating. Here’s a deal breaker: not everything labeled vegetarian is actually vegetarian. I knew
Avoid your friends because they eat meat. Your friends eat meat and you don’t. Don’t judge them for not following
choices when you go out to eat. On many occasions, I went starving because there was nothing to eat but meat. I was weak, hungry, and moody. It was a very horrible experience. After my trip to the hospital, I went back to my old omnivorous diet. Meat tasted like blood in my mouth for months until my body got used to eating meat – not to mention the constant guilt hanging over my head every time I ate eat. I’m going to do it right next time. You have to be absolutely sure when you decide to become vegetarian because the consequences of doing it wrong are just bloody tormenting. D JUNE-JULY 2013
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Pagiging Vegetarian Isinulat ni Michaela Sarah de Leon
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ag-aaral pa ako sa kolehiyo noong una akong magdesisyong maging vegetarian. Noong mga panahon na iyon, ipinaglalaban ko mga karapatan ng mga hayop. Hindi ko gusto na pinahihirapan ang mga hayop lalo na ang mga pinapadala sa slaughterhouse. Hindi ko gusto ang ‘di makatuwirang trato sa mga hayop. Subalit ang aking mabuting layunin ay nagdulot ng sakit dahil sa maling paraan ng pagbago sa diyeta. Samakatuwid, na-ospital ako dahil sa gastroenteritis. Huwag po sana ito maranasan pa ng iba. Ito ang mga natutunan ko noon:
naging vegetarian ka. Kailangan mong suriin nang mabuti ang pagkain mo.
Huwag ihinto ang pagkain sa labas. Napakahirap kumain sa labas noon. Wala pang masyadong kainan na naghahain ng putaheng panay gulay lamang. Ipaglalaban ko pa rin ang karapatan ng mga hayop pero ayaw ko mawalan ng kaibigan.
Sumuko sa karne agadagad. Ang pinakamalaki kong pagkakamali noon ay ang pagsuko sa karne nang agad-agad. Sa aking pagsuporta sa karapatan ng mga hayop, nakalimutan kong isipin ang kaligtasan ng aking desisyon. Tinanggal ko agad-agad ang karne sa katawan ko. Mali iyon.
Maging vegetarian sa tamang dahilan. Ang pagkamahabagin ko sa mga hayop ang nagtulak sa akin upang hindi kumain ng karne. Sa mga unang buwan ng diyeta, nahirapan ako, pero ang layunin ko ang nagtulak sa akin upang hindi sumuko. Alamin ang nilalaman ng kinakain. Hindi lahat ng may label na vegetarian ay tunay. Alam kong hindi vegetarian ang kinakain ko sa isang kagat lamang. Magbabago ang panlasa mo kapag
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Piliin ang ‘di kaya ng bulsa. Lumaki ako sa middle-income na pamilyang mahilig kumain ng karne. Ang laman ng refrigerator namin ay laging karne dahil mas mura at mas nakakabusog. Magvegetarian pag kaya mo nang tustusan ito. Husgahan ang iba sa pagkain ng karne. ‘Di dahil kumakain
ang mga kapamilya’t kaibigan ng karne ay ibig sabihin na maaari mo na silang husgahang walang malasakit sa hayop. Intindihin mo sila tulad ng pag-intindi nila sa iyo. Gutumin ang sarili. Kung magiging vegetarian, ihanda ang sarili sa naparaming pagbabago. Sa Pilipinas, napakahirap kumain kung vegetarian ka. Maraming beses akong nagutom noon dahil wala akong makain. Noong makalabas na ako sa ospital, bumalik ako sa dating gawi. Lasang dugo ang lahat nang karneng dumaan sa mga labi hanggang masanay ulit ako sa karne. Nakonsiyensiya rin ako sa pagbitiw sa aking laban. Higit sa lahat, kailangang sigurado ka sa pagpigil sa pagkain ng karne dahil ang kahihinatnan ng maling pagbabago ng diyeta ay tunay na napakahirap sa damdamin. D
IIlustration by Kevin Paul Faustino
Alamin ang kaya ng katawan mo. Kausapin mo ang iyong doktor. Alamin mo kung kakayanin ng katawan mo ang pagbabago sa diyeta mo. Siya ang makakagabay sa iyo sa tamang paraan upang maging vegetarian.
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livingwell
Sweet Love Diabetes, marriage, and how one couple made things work By Mylene C. Orillo
“I take you to be my (husband/wife). I promise to be true to you in good times and in bad, in sickness and in health. I will love you and honor you all the days of my life.” This is the popular wedding vow. Over the years, couples getting married try to revise or write their own wedding vows but still, the essence of the vow simply put: the couple promises to stick together and love each other whatever happens – in good and bad times, in sickness and health. Roberto “Bert” and Mercita Fullente have been married for 39 years. Earlier in their marriage, Mercy revealed that she wanted a job but her husband asked her to stay at home and take care of the kids. Born in Bicol, Bert puts too much value in family ties. He wanted to make sure his family is intact and their kids are guided properly. So the couple agreed that Bert will be the sole breadwinner and Mercy will be left at home to take care of their three kids: Rommel, Romeo, and Maricel. Aside from close family ties, Bicolanos are noted for their “gastronomic appetite in fiery or chili-hot dishes”. Because the Fullentes are very sociable people, they regularly organize and celebrate parties and birthdays, often inviting people, friends, and families over to
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their house. But as they say, everything in excess is bad. In 1998 and 2001, Mercy and Bert, respectively found out they have type 2 diabetes during their annual physical examination. “Nagtataka ako kasi wala naman kaming history ng diabetes sa pamilya. Sabi nila sa lifestyle daw. Mahilig kasi ako sa matatamis at matataba (I was surprised because we have no family history of diabetes in the family. They say it’s in the lifestyle. I like to eat sweets and fatty food),” says Mercy. Although they admitted that there was no major lifestyle change, the couple had to maintain daily medications and vitamins to manage their illness. Mercy is taking insulin before breakfast; while Bert is taking Glibenclamide 5 mg and Metformin 500 mg thrice a day. They also remind each other to avoid getting scars, eating sweets and fatty food even if it pisses off the other sometimes. Mercy, on her part, gets on her treadmill for 30 minutes a day and does household chores a lot as forms of exercise. Bert, on the other hand, makes sure he takes daily walks and avoids too much sweet and fatty food,
and soft drinks. “Eat more fish and vegetables,” says Mercy, adding that they still eat everything but in moderation. Life with diabetes The couple admitted that they try to live a normal life despite having diabetes. They also go for a quarterly checkup at St. Luke’s Medical Center in Quezon City to keep track of their illness. But aside from diabetes, they’re grateful they don’t have any other illnesses. “Kahit naman may diabetes ka, pwede ka pa din namang makapagwork ‘di gaya ng ibang sakit na ‘di ka na makapag-work” (Even if you have diabetes, you can still work unlike other diseases where you couldn’t),” says Bert, who have just retired from the Intercontinental Broadcasting Company (IBC) 13. Aside from work, he and Mercy have been active members of the Lectors and Commentators’ Ministry for more than 10 years now. Also, he’s been the President of the Parish Pastoral Council for three years. “Always follow your doctor’s prescription and advice and exercise,” ad-
livingwell
vises Mercy, who is also an active member of the barangay Pastoral Council in San Jose, Rodriguez, Rizal. As they say, it’s hard to have a chronic illness like diabetes. But having the support of your husband or wife can help ease the feelings of fear or frustration that often go along with having diabetes. In an article published in Diabetes Self-Management, it stated that “research has clearly shown that people who have social support tend to do better managing their diabetes.” It continued: “Social support can mean different things to different people. You may feel supported when a family member offers to take you to a doctor visit. You may feel supported when a friend listens and lets you cry about how frustrated you feel. Or you may feel supported when your sister walks with you each morning so that you can stick with your exercise program.” “When one knows they have people who care about them, whom they can talk to about their deepest feelings, they are more likely to stick to their self-care
regimen, to have better blood glucose control, and to feel positive about their ability to cope with diabetes, which couples with diabetes benefit from the most,” the article adds. True enough, having diabetes is a challenge that can either help or hurt a relationship, but as they say, choose to focus on what you have and be grateful that there is someone in your life – your husband/wife who’s there to walk with you on this road in good and bad times, in sickness and in health. D
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affairstoremember
Incretins can help manage type 2 diabetes
Dr. Guillermo Manalo
PSEM President Dr. Cecilia Jimeno
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s part of her discussion on the “New Generation of Strategies to Optimize Blood Sugar Control,” Diabetes Philippines immediate past president Dr. Susan Yu-Gan said that incretins - a group of gastrointestinal hormones that causes the increase of insulin - can help in managing type 2 diabetes. “We’ve identified two major incretins – we have GLP1 and GIP. Both of them are produced in the intestines and they stimulate insulin release in glucose-dependent manner,” said Dr. Gan. She added: “When the sugar or glucose is high, then there will be more insulin release, but when the glucose is already low, then there will be less.” The doctor also mentioned the importance of new drugs and how incretins help in preventing hypoglycemia. GLP inhibits gastric emptying so the patients do not feel hungry, which contributes to weight loss in diabetic patients.
Dr. Nemencio Nicodemus
She also mentioned that the kidneys and the brain contribute to hypoglycemia in their own way. The kidney goes through a process called glucose reabsorption, wherein nutrients return to the organ, contributing to increased glucose levels. Likewise, the brain has neurotransmitter dysfunction, where obese patients have impaired appetite regulation. Dr. Yu-Gan’s talk was just one of the topics in the first Cardiometabolic Summit sponsored by the Philippine Heart Center last April 11-12 at the Dr. Avenilo P. Aventura Hall. Doctors who also presented studies were Philippine Society of Endocrinology and Metabolism (PSEM) president Dr. Cecilia Jimeno who spoke on “Prediabetes and CVD” Dr. Guillermo Manalo on the “Impact of Early Insulin Therapy on Macrovascular Outcomes in Patients with Dysglycemia,” and Dr. Nemencio Nicodemus on “Optimal Glucose Control for CVD Prevention.” Alexa Villano D
PSEM holds diabetes and metabolic syndrome congress
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revalence of diabetes is rising worldwide with Asia having the highest incidence in developing countries. Among Asian countries, India and China have the highest numbers of people with diabetes. This was according to Dr. Rosa Allyn G. Sy who talked about “Younger, Thinner, Sooner: The Changing Epidemiology of Diabetes in Asia” in the 2013 Philippine Society of Endocrinology Metabolism Diabetes & Metabolic Congress at the EDSA Shangri-
La Hotel, Manila last March 20, 2013. “The high prevalence of large population size contributes to the huge burden of diabetes on these countries. The poorest economic strata bear the highest cost burden of diabetes treatment,” said Dr. Sy. She noted that type 2 diabetes mellitus was once a disease of the West but now has spread to every country of the world and increasingly common among the poor, especially in the pediatric
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affairstoremember population due to the rising rates of childhood obesity. “The number of people with younger-onset diabetes (age < 44 y) in developing countries increase from 30 million in 2000 to 55 million by 2030,” she said, adding that contributing factors to increasing prevalence of DM in Asia are obesity, poor diet, exercise lack, smoking, and alcohol. Dr. Sy concluded that the economic cost increases many times with the development of vascular complications associated with diabetes. Developing countries need to increase national capacity for early diagnosis, encourage effective management, and improve primary prevention to combat the rising burden due to this chronic disease. With this year’s theme: “Best Practices in Diabetes and Metabolic Syndrome”, PSEM congress topics also include “Inherited or Acquired? Understanding the Gene-Environment Interactions in Obesity and Diabetes” [Epigenetics of Diabetes and Obesity Revisted] by Dr. Augusto D. Litonjua and “Best Practices in Sports for Diabetics: Gym, Marathons, Biking – Doing it Safely and Effectively for both Young and Old Diabetics” by Professor Hercules P. Callanta, BPE, MSPE. Mylene C. Orillo D
Professor Hercules P. Callanta receives a certificate of appreciation from the PSEM officers and secretariat
PhilDNA advises specialized nutrition for diabetics
Dr. Danilo F. Baldemor discusses the challenges of Filipino diet and its link to diabetes
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iabetes experts from the Philippines composed of healthcare professionals from seven societies and institutions developed the Philippine Diabetes Nutrition Algorithm (PhilDNA), which provides recommendations on diabetes-specific nutrition to support the goals of weight loss, lowering blood sugar, blood pressure,
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and cholesterol for prevention of complication and longevity. PhilDNA recommends the use of diabetes-specific formula like Glucerna Triple Care to benefit patients with low body mass index (BMI) and or insufficiency states, such as the elderly. According to PhilDNA, caloric supplementation is helpful for weight gain, amelioration of nutritional deficiencies, and prevention of diabetic complications. For patients with normal or elevated BMI, caloric replacement is helpful to achieve weight loss, greater metabolic control and avoidance of subtle deficits of vitamins or other nutrients that can accompany simple calorie restrictions. “Glucerna Triple Care offers an unparalleled combination with three key benefits – it’s clinically proven to manage blood sugar levels while supporting heart health and weight management – for those with prediabetes and diabetes,” said Dr. Jose Rodolfo Dimaano Jr., medical director of Abbott Nutrition, who was also present during the media forum. Glucerna Triple Care provides an advanced, slowly digested, low-glycemic index carbohydrate system to manage blood sugar response. It is a unique heart-friendly lipid blend
affairstoremember rich in monounsaturated fatty acids (MUFA), and omega-3 fatty acids to support heart health. It is also a combination of key ingredients including fructooligosaccharides (FOS) to help reduce weight and waistline. Glucerna is the number one doctor-recommended diabetes nutrition brand in the US. It has 225 calories per serving rich with 32 vitamins and minerals, clinically proven and scientifically designed for people with prediabetes or diabetes to use in conjunction with an overall diabetes management plan. Prevalence of diabetes According to Dr. Danilo F. Baldemor, internal medicine, diabetologist, and diabetes educator who talked about “The Challenges of Filipino Diet and its link to Diabetes” in a media forum at Fairmont Makati recently, one out of every five Filipino adults or approximately 11 million has either prediabetes or diabetes. An estimated 2.5 million Filipinos remain undiagnosed. Dr. Baldemor cited common risk factors for diabetes
include obesity, physical inactivity, family history, ethnicity/ race, age, and low birth weight. In 2012, diabetes in the Philippines is a growing health problem affecting the lives of 9.7 percent of the adult population and this number tends to double if we add the 12.5 percent of Filipinos at-risk with impaired glucose tolerance (IGT), according to Dr. Baldemor. In 2008, obesity has ballooned to 25 percent from 1987 statistics of only 13.5 percent. “The problem why Filipinos are becoming heavier can be linked to the changing Filipino dietary habits as revealed in the 2008 Food Consumption Survey done by the Food and Nutrition Research Institute,” said Dr. Baldemor. Based on the survey, 40 percent of Filipino households are taking their meals/snacks outside of home. Approximately 30 percent of the caloric intake the whole day is derived from animal sources in 2008 as compared to 20 percent in 1978. Rice, sugar, and cooking oil are top three food items commonly consumed by Filipinos and there was a significant increase on the intake of rice. Mylene C. Orillo D
More than a nerve supplement Hi-Eisai’s Methycobal effective in treating neuropathy in diabetics and elderly – clinical trial
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itamin B12, specifically methycobalamin, 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 on March 16 entitled “Methycobal Revisited! – the Nerve Symposium.” “This is a way to show us that methycobalamin 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 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 at the mean age of 62. There were more females than males. Close to half or 57 percent have had diabetes for less than 10 years and 42 percent more than ten years. “The trial is investigator initiated. It passed institutional and ethics review board approval. Hi-Eisai Japan, a sponsor, only
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affairstoremember provided logistics for neurophysiologic testing and vitamin B12 pills but they 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 (p<0.03)., upper limb symptoms (p<0.003), ataxia (p<0.004), and signs of impaired position (p<0.009) sense, vibration sense (p<0.0001), pinprick sensation (p<0.004), and knee reflex (p<0.004). “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
doodles&dreams
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different kinds of diabetes durations, whether less than or more than 10 years. “This is for me to emphasize the burden of diabetic neuropathy and the quality of life because eventually what matters for patients is quality of life. And quality of life is certainly affected by chronic pain from neuropathy and even from depressions,” said Dominguez who conducted the study with Drs. Arlene Ng and Ludwig Damian. They recommended conducting larger controlled trials to support their findings. The symposium also highlighted the history and latest studies on methylcobalamin, which is an active form of cobalamin. In his lecture, Hiroyuki Tanaka of the Osaku University Graduate School of Medicine elaborated on the studies made to update what we know about Vitamin B12, specifically methylcobalamin. He concluded that methylcobalamin promoted neurite outgrowth, inhibited apoptosis, promoted erk and akt activity, promotes histological regeneration of nerve after injury, and caused no hypervitaminosis. D
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.