Category: Healthy Living

“It’s all in the genes!” You may have heard your parents proudly say when you were complimented as a child on your physical attributes or on your academic achievements. But when it comes to heredity, it isn’t just about the genes. Chromosomes play a significant role too according to Pre-implantation Genetic Testing Scientist Mr Aaron Chen.

Genes vs chromosomes

Delving into the subject of genes and chromosomes, Aaron says, “Genes are basically the instructions for building and maintaining our bodies whereas chromosomes are chains which are formed from these genes during cell division. Each cell in our body contains 46 chromosomes with each chromosome consisting of thousands of genes. Hence, a normal person would have roughly 25,000 genes.”

“An individual may have a normal number of chromosomes but can still experience mutation on one or more genes on their chromosomes. In that case, they will have what is called a genetic disorder. Similarly, someone may have normal genes but can have an abnormality in one or more of their chromosomes. Should that happen, they have a chromosomal disorder,” Aaron explains when asked about the difference between chromosomal and genetic disorders. “Many people clump them under ‘genetic conditions’ but they are actually two different things.”

Here’s a rundown on some genetic and chromosomal disorders commonly found among Malaysian children.

Genetic disorders

Cystic fibrosis

This disorder is passed on in an autosomal recessive pattern, meaning both copies of the gene in the child’s every cell are mutated. For the child to be affected, both parents must be carriers. Every kid has a 25% risk of being affected. They usually suffer from reproduction and digestion complications, and recurring lung infections – a result of their bodies producing excessive thick, sticky mucus.

Blood disorders

Inherited blood disorders like thalassaemia prevent red blood cells (RBCs) from properly producing haemoglobin (an oxygen-transporting molecule). This subsequently causes anaemia which gives off symptoms like jaundice, diarrhoea, an enlarged spleen and heart, breathlessness and brittle bones.

Sickle cell anaemia, another blood disorder gives RBCs a crescent shape, instead of its normal disc shape. Kids with this condition are prone to infections, tissue damage and stroke.

Phenylketonuria

Delayed development, seizures, eczema, behavioural and motor complications are common among children with phenylketonuria as their livers are incapable of producing an enzyme to metabolise phenylalanine. High levels of this amino acid harm the brain.

Chromosomal disorders

Down syndrome

Caused by an additional gene copy on chromosome 21, this disorder produces symptoms normally noticeable at birth like diminished muscle tone, heart defects, protruding tongue, thick lips and flat nose. Symptom severity can vary among children.

Turner syndrome

A normal cell has two sex chromosomes (males have one X chromosome and Y chromosome while females have two X chromosomes) but people with Turner syndrome only have one normal X chromosome; the other is either structurally changed or absent. Therefore, Turner syndrome only strikes in females. Sexual development in these females is impaired; most are infertile and some don’t undergo puberty unless treated with hormone therapy.

Fragile X syndrome

Linked to the common forms of inherited mental retardation and developmental delays like autism, hyperactivity and attention deficit disorder (ADD), this condition arises when a portion of the X chromosome breaks apart – hence, its name ‘fragile X.’ The portion, which induces the fragility, may be repeated on the chromosome; the more repeated portions, the higher the fragility and the more severe the syndrome.

References:

1. Active Beat. Available at www.activebeat.com/your-health/children/the-10-most-common-genetics-disorders/6/

2. Education.com. Available at www.education.com/reference/article/chromosomal-genetic-disorders/

3. Genetics Home Reference. Available at http//ghr.nlm.nih.gov/condition/fragile-x-syndrome

4. Seattle PI. Available at http://education.seattlepi.com/difference-between-genetic-defect-chromosomal-abnormality-4617.html

5. Steady Health. Available at www.steadyhealth.com/articles/the-16-most-common-genetic-diseases

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Raising a child that suffers from an inheritable disorder (either a genetic or chromosomal disorder) can exert a severe emotional and financial toll on any couple, so some parents will appreciate knowing in advance the risk of their child inheriting such a disorder. This is why genetic screening is offered by fertility centres – it allows parents wishing to conceive a child to be aware of the risks and to prepare themselves to do what is best for themselves and their child. 

What kinds of genetic screening are there?

While technological developments have allowed these screening tests to achieve highly accurate results, accuracy is still not 100%. Hence, your fertility specialist may recommend screening at several stages of the IVF (in vitro fertilisation) and pregnancy process.

1. Pre-conception genetic screening. This is to check whether both parents are carrying genes that can put any child they conceive at risk of developing an inheritable disorder.
2. Pre-implantation genetic screening. A sample of cells is carefully extracted from the embryo to determine whether there is any genetic abnormality present.
3. Prenatal genetic screening. This is to test whether the baby one is carrying has inheritable disorders.

Do not worry if you are not well-versed in genetic matters. Many fertility clinics have a genetic counsellor that can advise you on the types of screening best suited for your needs. Once screening results are in, he or she will help you understand the results, as well as offer advice and information on how you can best manage any unexpected outcomes of the screening.   

Reference:

National Infertility Association (Canada). Available at www.resolve.org

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We have shared with you a close look into how genetic screening can be used to detect inheritable disorders that can be passed down to our children, and how these procedures can be incorporated in various stages of fertility treatments.

Technology and science have allowed us to conceive even when the odds seem impossible, and in the process, helped us detect and predict the possibilities of our children having disorders that can affect them for the rest of their lives. These developments give rise to concerns and even objections from certain quarters – that we are now playing God.

Perhaps it is worth remembering that, while our genes define a big part of us, how we live, whom we love and the choices we make for ourselves – these are just some things that we have full control over. If it was decided by our genes that we face a higher risk of heart disease, for example, then we can practise healthy diet and active lifestyle to minimise the risks. And if our children’s genes dictate that they have Down syndrome, it does not mean that we cannot love, nurture and cherish them to the best of our abilities as parents. We have our genes, but our genes do not have us.

At the end of the day, science and technology give us the options, and it is up to us to decide how these options can be best applied to our lives. The fact that these options exist so that we as parents-to-be can choose to screen or not to screen – this could very well be a blessing in itself.

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What exactly is Japanese encephalitis?

Encephalitis is a condition, in which the brain becomes inflamed due to an allergy reaction or infection. Japanese encephalitis (JE) is caused by a viral infection. This disease got its name from the fact that it was first documented in Japan in 1871.

Who is at risk of JE?

According to the World Health Organization (WHO), there are nearly 68,000 clinical cases of JE every year. It is said that more than 3 billion people in the 24 countries in the WHO South-East Asia and Western Pacific regions face the risk of JE transmission. Children are most affected when it comes to this disease.1

In Asia, there are 30,000 to 50,000 cases reported each year, and 25-30% of these cases are fatal, while half the survivors suffer from severe nerve and brain-related problems.

(Map taken from http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/japanese-encephalitis)

What are the symptoms of JE?

Infected people rarely show symptoms. However, 1-in-250 infections can lead to a severe form of the disease.1

This person would experience rapid onset of high fever along with seizures, headache, disorientation and neck stiffness. Coma, spastic paralysis and even death may occur. It is said that up to 30% of people who experience this severe form of disease would die, while of those who survive, 20-30% would suffer from permanent problems related to their intellect, behaviour and nerve function, such as paralysis, loss of speech and recurrent seizures.1

If you suspect that you or a loved one has JE, see a doctor immediately.

How does one catch JE?

The JE virus can be transferred from pigs and water birds (such as egrets and herons) to humans. The Culex mosquito would carry the JE virus when it feeds on an infected animal. When the mosquito feeds on a person, it can pass the virus to that person.1

Like many mosquito-borne diseases, JE may be more prevalent during or after rainy seasons, especially in rural areas where people live close to animals that can host the JE virus. 

Humans cannot pass the virus to one another.

Why are pigs such a matter of concern when it comes to JE?

This is because pigs can breed quickly and produce many offspring that are susceptible to JE. When infected, pigs also tend to develop high concentrations of the JE virus in their blood. This is why pig farms are set up as far away from towns and villages as possible, and pigs infected with JE have to be eliminated during an outbreak.

Will other animals be able to catch JE?

Various domestic animals can also catch JE. However, the World Organisation for Animal Health (OIE) published a technical card on JE which states that horses and donkeys are “dead end hosts” for the virus (they cannot spread the virus to people), while domestic animals such as dogs, cats and cattle “likely do not contribute to [the] spread [of JE]”.

How is JE treated?

To date, we have not found a cure for JE. Treatment revolves around providing relief and stabilizing the symptoms. When it comes to JE, prevention is definitely the more preferable option to cure!

References:

[1] World Health Organization. Japanese Encephalitis. Retrieved on Nov 3, 2015 from http://www.who.int/mediacentre/factsheets/fs386/en/

[2] See C Wong, et al. (2008). A decade of Japanese encephalitis surveillance in Sarawak, Malaysia: 1997–2006. Trop Med Int Health. Jan;13(1):52-5. doi: 10.1111/j.1365-3156.2007.01967.x.

[3] Erlanger TE, Weiss S, Keiser J, Utzinger J, Wiedenmayer K. (2009). Past, present, and future of Japanese encephalitis. Emerg Infect Dis Retrieved on Nov 3, 2015 from http://wwwnc.cdc.gov/eid/article/15/1/08-0311

[4] Centers for Disease Control and Prevention. (2010). Japanese encephalitis vaccines: recommendations of the Advisory Commitee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 59, 2.

[5] Vythilingam, I, et al. (1997). Abundance, parity, and Japanese encephalitis virus infection of mosquitoes (Diptera:Culicidae) in Sepang District, Malaysia. J Med Entomol. May;34(3):257-62.

[6] World Organisation for Animal Health. Japanese Encephalitis. Retrieved on Nov 4, 2015 from http://www.oie.int/fileadmin/Home/eng/Animal_Health_in_the_World/docs/pdf/Disease_cards/JAPANESE_ENCEPHALITIS.pdf

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Keep Mosquitoes Out!

When there is a reported outbreak of Japanese encephalitis (JE) in your neighbourhood, minimising your chances of being bitten by mosquitoes is one way to protect yourselves from the disease.

• Air conditioning can help reduce the chances of being bitten by mosquitoes.
• If you do not have air-conditioning, cover windows and gauze with close-fitting gauze screens to keep mosquitoes out.
• Use aerosol insecticide, electric mats or mosquito coil in the bedroom for added protection.
• If you are travelling outdoors (especially from dusk to dawn, when the Culex mosquito is the most active), wear long-sleeved clothing and socks.
• If possible, avoid going out after dusk. If you have to go out, wear long-sleeved clothing, trousers and socks. You can apply insect repellent on exposed skin.
• If your neighbourhood is infested with mosquitoes, make arrangements for neighbourhood mosquito control programmes (such as spraying) to take place as soon as possible.

Stop mosquitoes from breeding

Mosquitoes breed in areas of still or standing water, so removing these breeding areas would cut down the mosquito population around your home.

• Identify spots around the house that are potential mosquito breeding grounds (gully trap in sinks, air conditioner trays, flower pots, etc) and clean them regularly. Alternatively, you can pour some bleach or insecticide into the water.
• Containers, bowls, plates and other utensils that can collect water should either be covered or turned over when not in use.
• Discard all unwanted water-collecting containers, and always cover your dustbin.
• Keep your house and garden free from clutter and debris.

Get vaccinated

There are vaccinations to protect you from JE, and it is definitely worth giving this shot a shot!

Who should get vaccinated?

The JE vaccine is suitable for adults and children aged 2 months old or above. The following people are recommended by US Centres for Disease Control and Prevention (CDC) to get the vaccine:

Locals

• People who are living in areas known to be JE ‘hot spots’.
• Pig farmers and other people who come into frequent close contact with pigs.
• All laboratory workers.

Travellers

Travellers heading to JE ‘hot spots’ should be aware that certain activities can place them more at risk of catching JE. These activities include:

• Spending a significant amount of time outdoors in rural areas or plantations, especially during the evening or night.
• Taking part in outdoor activities such as camping, hiking, hunting, etc.
• Staying in accommodations that lack air conditioning, bed nets, screens and other means to reduce your chances of being bitten by mosquitoes.

The following travellers should get the JE vaccine:

• Those who intend to spend a month or longer in a destination where JE cases happen all year long.
• For travellers who intend to stay for less than a month, they should still get the vaccine if they plan to travel to rural areas or plantations, or if they intend to carry out the high-risk activities listed above.
• Those heading to a destination that currently experiences a JE outbreak.
• For travellers who are heading to a JE ‘hot spot’, but have not determined what their specific destination, activities or duration of stay, it is better safe than sorry to get the vaccine!

The JE vaccine is not necessary for short-term travellers whose destination is restricted to urban areas, or if there is no well-defined season of JE virus transmission during their visit.

Centers for Disease Control and Prevention. (2010). Japanese encephalitis vaccines: recommendations of the Advisory Commitee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 59, 17-18.

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What is this vaccine?

There are several types of JE vaccines, and just like most vaccines, they are developed either from live but weakened versions of JE virus (which will not cause the disease when injected into the body) or an inactive version of the virus grown and cultivated in a laboratory.

How does the vaccine work?

Like all vaccines, the JE vaccine triggers the body’s immune system to produce antibodies without actually causing the disease. Therefore, the next time the actual JE virus finds its way into the body, the immune system will produce the antibodies that will help protect the person from the disease.

Is the vaccine really useful?

Yes, it is. In a study conducted in Sibu between 1997 and 2006, it was found that the introduction of the JE vaccination reduced the incidence of JE from 9.8 per 100,000 population under 12 years old per year to 4.3 per 100,000.2

Can children receive the vaccine?

Depending on the specific type of vaccine, children after a certain age can safely receive it. Talk to a doctor for more information.

Who should not or cannot receive the vaccine?

The specific groups of people who should not receive the JE vaccine may differ slightly from one brand of vaccine to another. You should consult your doctor for more information. Generally, though, you should notify your doctor before receiving the vaccination if you are pregnant, breastfeeding, or suffering from a medical condition that weakens the immune system.

[1] Centers for Disease Control and Prevention. (2010). Japanese encephalitis vaccines: recommendations of the Advisory Commitee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 59, 7.

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Dr Hew Fen Lee

Consultant Endocrinologist

You have surely heard of diabetes in the past, but after being diagnosed with the condition, diabetes is no longer an issue that affects other people. It is now affects you.

Before you can take control of your health and life, you should know the facts about diabetes, such as why it is happening to you and what it can do to you. Such information may be harsh or frightening, but the more you know about diabetes, the more you will understand why you need to commit to the lifestyle changes that will help you control the condition.

You will understand that all is not lost, and there is no need to give up when the going gets tough. There are many diabetics out there who live healthy and fulfilling lives by making the necessary changes, and there is no reason why you cannot be one of them.

So let us take a better look at type 2 diabetes mellitus (T2DM).

An issue of insulin resistance

Many people believe that T2DM is a disease caused by eating too much sugar. This is not true.

“T2DM is a problem caused by insulin resistance,” explains Dr Hew. “Patients with T2DM are usually insulin resistant, which means they require more insulin to control their glucose level, more than their body can produce.”

First, let us start by taking a look at the pancreas. Our pancreas is an organ located behind the lower part of the stomach, and it produces insulin, the hormone responsible for regulating blood glucose levels.

Our body needs glucose for energy. Our digestive system breaks down the carbohydrates in our meals to glucose. Therefore, after each meal, the amount of glucose in the blood typically rises.

In a healthy person, the pancreas detects this rise in blood glucose level. It then releases insulin into the bloodstream, and insulin attaches itself to the appropriate cells in our body. The attachment of insulin alerts these cells to begin absorbing glucose from the blood stream. This action helps to remove excess glucose from the bloodstream, keeping the blood glucose level within a healthy range. The more glucose is present in the bloodstream, the more insulin would be released by the pancreas.

In someone with insulin resistance, the pancreas produces insulin each time it detects high blood glucose level in the bloodstream. However, the cells of the body do not respond normally to insulin.

We don’t know all the causes of insulin resistance, but researchers strongly believe that excessive weight and lack of physical activity are 2 important and significant causes. Most patients with T2DM are overweight and they lead sedentary (inactive) lives.

According to Dr Hew, because of insulin resistance, more insulin is required to control the blood glucose level. This exerts pressure on the pancreas to produce higher amounts of insulin than normal.

“Over time, the insulin resistance builds up to a level at which the pancreas can no longer keep up with,” says Dr Hew. “A shortfall of insulin occurs, and the blood glucose level in the blood is no longer controlled adequately, causing it to rise above the healthy limit.”

Insulin resistance slowly builds up over time, so many people may not know that they have T2DM until the condition has progressed to a later stage and controlling it becomes more difficult.

So what happens now?

If left unchecked, T2DM can lead to various health conditions (complications) that can severely affect the patient’s quality of life and can even possibly lead to early death.

According to Dr Hew, T2DM patients are at risk of the following:

• Eye problems (retinopathy).
• Kidney problems, including urine infection and kidney damage.
• Damage to blood vessels, which can lead to heart problems, stroke and poor blood circulation. The latter can give rise to poor sensation, especially in the feet, increasing the risk of nerve damage, infections, ulcers and tissue death and possibly requiring amputation.

Managing your diabetes

According to Dr Hew, there are 3 cornerstones in good management of diabetes, all of which should be practised.

All 3 work together to help control T2DM. We cannot just focus on 1 aspect alone, which is why it is important to work closely with our healthcare team to come up with a plan that helps coordinate all 3 aspects of T2DM management in our lives.

Why manage T2DM?

Managing the condition is important to slow its progression and reduce the risk of health problems that can arise over time. The principle of T2DM management is to adopt a healthy lifestyle which should apply to anybody with or without diabetes. Dr Hew points out that a good control of diabetes often allows the patient to lead a healthy and normal life while minimising the complications normally associated with T2DM.

Dr Hew believes that, when one is armed with the right knowledge and a bit of determination and discipline, achieving good diabetes control is not too difficult. “You should make health your No. 1 priority now,” he urges. “Once you keep this in mind, everything else becomes easier.”

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Prof Dr Norlaila Mustafa   Consultant Endocrinologist, Universiti Kebangsaan Malaysia Specialist Centre.

According to Prof Dr Norlaila Mustafa, a consultant endocrinologist who runs a diabetes clinic, oral diabetes medications are designed to help you manage your blood glucose level and currently, there are many types available. Your doctor will prescribe the types of medication that are appropriate for you, depending on your body’s response to insulin as well as other health conditions you may have alongside diabetes.

Diabetes medications do not cure diabetes. Dr Norlaila points out that it is just as important to follow a meal plan and exercise regularly to manage your weight to slow the progress of diabetes and reduce the risk of damage to your brain, kidney, liver, eyes, heart, nerves and more.

5 good medication habits

Dr Norlaila recommends the following:

1. Follow your doctor’s advice when it comes to monitoring your blood glucose level in order to check your response to the medications prescribed.
2. Refill your medications when they run out. Diabetes medications should be taken continuously, not just when you are feeling unwell, in order to slow the progression of the disease.
3. Too busy to take your medication? Download a smartphone app to help you schedule your time.
4. Do not share your medication with other people. Medicine is one of the few things in life that you should always keep to yourself!
5. Keep a list of all the medications you are on (write down the name displayed on the packaging) as well as any supplements or alternative medications. This list will be useful during medical emergencies.

Metformin: The frontline against diabetes

According to Dr Norlaila, most diabetes patients are on metformin, for good reasons.

• Along with proper diet and regular exercise, metformin is effective in helping the patient control his or her high blood sugar level.
• It can be taken by most type II diabetes patients without experiencing dangerous side effects.
• It is also affordable, and therefore, can be purchased by most patients without straining their finances.

“Because of its effectiveness on many patients with type II diabetes, doctors usually prescribe metformin as the first option when it comes to treating the disease,” adds Dr Norlaila.

Metformin is considered by many as a “wonder drug” due to how effective it is. In fact, its discovery changed the way we treat diabetes for the better, improving the quality of life and life expectancy of diabetes patients.

Dr Norlaila goes on to explain that metformin helps you manage your blood glucose level in several ways.

• Your liver produces glucose, which adds to the glucose you obtain from your meals. Then, metformin helps to decrease the amount of sugar produced by your liver.
• It also helps to reduce the amount of glucose absorbed by your body during the digestion of food.
• It helps to improve your body’s sensitivity to insulin, allowing your liver, muscle cells and fat cells to take in more glucose from your blood. This reduces the overall amount of glucose in the blood.

Taking metformin. Metformin is available in tablet and liquid forms. Depending on the severity of your disease, your doctor may recommend taking them 1 to 3 times a day after meals.  There are also extended release tablets in the market, which only requires you to take 1 tablet a day, usually during your evening meal. You should follow your doctor’s instructions, restock your metformin when it runs out and continue to take your metformin even when you are feeling healthy.

Side effects. Like many medications, metformin can potentially cause side effects in certain people. Milder side effects include: diarrhoea, indigestion, bloating and stomach pain, constipation, heartburn, headaches, muscle aches and an unpleasant metallic taste in the mouth. More severe side effects include chest pain and rashes. Dr Norlaila advises that you should alert your doctor if you experience any of these side effects over a prolonged period of time.

Very rarely, a patient with renal failure may develop a potentially fatal reaction to metformin called lactic acidosis. Such patients should take other forms of medication for their diabetes. Besides, metformin may not be suitable for patients with problems relating to the heart, kidneys and liver. Fortunately, Dr Norlaila mentions that there are other alternatives to metformin, termed the second line medications, which may be suitable for them.

Second line medications

Second line medications are those that are given to patients in order to support or complement the effects of metformin for better blood glucose management. They may also be given to patients for whom metformin is cannot be used (contraindicated), perhaps due to side effects, kidney problems and such.

Dapagliflozin: improving blood glucose control

Dapagliflozin is an interesting drug in that, unlike most diabetes drugs that target the pancreas or and liver, it works on the kidneys. “It helps to reduce blood sugar by increasing the amount of glucose excreted in the urine. It may also help with weight loss and improvement of blood pressure,” explains Dr Norlaila.

To help you gain a better understanding of how this drug works, let us first take a look at the link between glucose and our kidneys.

Your kidneys: it’s not just about urine

The kidneys are the main waste disposal factory in our body, so let us imagine a kidney as a big building. Inside the building are about a million little filtration machines called nephrons. The nephron is the key structure responsible for controlling the amount of substances present in the urine.

The glomerulus is the filtration structure – it makes sure that only the right substances that can fit through its pores will end up in the urine. Glucose is of the right size, so it can pass from a blood vessel through the glomerulus without any difficulty.

Normally, urine contains no glucose because the nephron has a system in check to reabsorb any glucose that passes through the glomerulus filter. What happens is that any glucose that strays into the nephron eventually makes its way to the proximal convoluted tubule.

Lying in wait there are special transporters called “sodium-glucose linked transporter (SGLT)” or “sodium-dependent glucose co-transporter”. Like their name suggests, they absorb glucose back into the blood along with sodium. Just like how there are different models of Proton cars, there are different types of SGLTs, such as SGLT-1 and SGLT-2. SGLT-2 is the main transporter in the proximal convoluted tubule.

“About 90% of the glucose filtered in the nephron is reabsorbed with the help of the SGLT-2,” Dr Norlaila points out. Any remaining glucose that manages to elude the SGLT-2 is “caught” by SGLT-1 in a later, straight part of the proximal tubule.

In the case of a type II diabetes patient, the blood glucose level can be high, so it is a good thing if the glucose that finds its way into the kidneys is not reabsorbed but instead, removed from the body via urine.

This is where dapagliflozin steps in. “The drug inhibits the action of SGLT-2, therefore drastically cutting down the amount of glucose that would be reabsorbed back into the blood stream,” says Dr Norlaila. For someone with diabetes, that is a good thing!

Indirectly, dapagliflozin may also help with weight loss as it reduces the amount of calories stored in the body after each meal as well as to reduce one’s overall sense of hunger. However, it should not be considered as a weight-loss drug. Studies suggest that the drug may also help in reducing high blood pressure.

Taking dapagliflozin. Dapagliflozin can be prescribed alongside metformin, or can also be prescribed on its own. In general, it can be prescribed to patients with any stage of diabetes. Ask your doctor for more information.

Who should not take it? This drug may not be suitable for patients who are pregnant or breastfeeding, having kidney problems, having low salt levels in their body, or those with history of dehydration and have been admitted to the hospital. Check with your doctor for more information.

More second line medications

Dr Norlaila mentions some other common medications for diabetes.

Combination pills are also available, often combining the effects of 2 different medications (for example, metformin and a second level medication) for the purpose of convenience and reducing the number of pills you need to take.

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“The typical response from people when I tell them I’m diabetic is, ‘Oh, I’m sorry to hear that.’ You know, I’m not. I’m a better athlete because of diabetes rather than despite it. I’m more aware of my training, my fitness and definitely more aware of nutrition. I’m more proactive about my health.” – Charlie Kimball

“What should I eat?” you may be wondering. Should you cut out carbohydrates from your diet? Should you adopt one of the many diets out there said to be designed just for diabetics?

Actually, the good “old-fashioned” healthy and balanced diet – advocated by nutritionists for everyone young and old, healthy or suffering from a chronic condition – is still an effective option for diabetics like you.

Your nutrition goals

You will be working with your dietitian to plan your meals. This may seem complicated at first, but don’t worry, you will soon get the hang of it.

• Practice carbohydrate counting. Basically, you would have to make sure that you are aware of how much carbohydrates you are having in each meal, and carbohydrate counting allows you to ensure that your meals do not contain too much of it. If you are on insulin, knowing how much carbohydrate is present in a meal is important to ensure that you get the right dosage.
• Eat food in appropriate portion sizes. A good way to start is to list down the usual portion sizes of the food you eat often and share them with the dietitian, who will advise you on how much to cut down. You will then be using measuring cups and a scale to make sure that your meals are all in the right portions.
• Think well-balanced. You will include a good mix of every food group to make sure that you get all the nutrients you need to stay healthy. For carbohydrates, you should choose fruits, vegetables and whole grains as they contain what we call complex carbohydrates (such as starch and fibre). Such foods can help keep your blood glucose level stable while still providing energy. Consult your dietitian on the types of food that would best suit you at your current state of health.
• Avoid food and drinks that contain added sugar. In addition to glucose, you should also avoid food and drinks that contain sucrose, high fructose corn syrup and other types of sugar. You can check the ingredient list on the bottle or package to be certain. Such drinks tend to be high in calories but low in nutritional value, and their sugar content can cause your blood glucose level to rise rapidly.

However, if you are experiencing the effects of low sugar level such as dizziness and sleepiness, such drinks can be used as a way to quickly raise your blood sugar.

Changing your eating habits for the better

It can be hard to change your diet, as it often requires discipline, willpower and the ability to unlearn bad eating habits – all of which can take time, and you may become frustrated and even feel tempted to give up along the way.

Here are some tips to help you stay on course despite the various challenges and frustrations you will encounter:

On your mark…

Don’t try to make many big changes at once, as you would only be setting yourself up for failure. Instead, start simple.

Sit yourself down, then, list all the possible eating habits you have. You can enlist the help of family members, as sometimes you may have habits that you are not aware of. Typical bad eating habits include: eating while watching the TV or computer, stress snacking, eating too-largefood portions, enjoying high-fat meals and so on.

Next, list all the good eating habits you would like to adopt. You can consult your dietitian for advice if you are unsure of what these habits are.

Now, pick 5 bad habits you would like to break, and 5 good habits you would like to adopt.

Get set…

To get ready for this new you, pick a “start date”. The weekend is always a good time, as you have more time to focus and there are fewer distractions. Also, set a realistic “end date” for you to evaluate your progress.

In the meantime, make sure that you are clear on what you need to do. Consult your healthcare team to share with them your plans, and make sure you have a good blood glucose monitor at hand.

Go!

On the start date, jump right in! Break 5 bad habits, adopt 5 good habits! Remember to detail your efforts and progress in your journal for you and your healthcare team to review after the end date.

At the end date, if you have achieved your goals, it is time to pick another 5 good habits to adopt as well as another 5 bad habits to break. Of course, you must also maintain your current progress. We will not lie; it will not be easy. However, there are ways to keep yourself motivated.

Don’t forget to move!

Regular physical activity is a good way to burn excess calories, keep your weight within healthy limits and strengthen your body. Not only does regular physical activity slow down or halt any damage caused by the progression of diabetes, it can also lift your mood or de-stress you.

The Malaysian Clinical Guidelines on Management of Type 2 Diabetes Mellitus (2009) recommends 150 minutes of physical activity a week. This boils down to about 20-30 minutes a day.

If you are not active before, or if you suffer from a condition that may make exercising difficult, share your plans with your healthcare team. They will advise you on the most appropriate types of physical activity you can adopt.

It can be hard to get the body moving, especially if you are used to a sedentary lifestyle. Give up your TV time to go jogging? You may instinctively balk at the thought. Still, with some determination and our tips, you will soon be moving and enjoying every minute of it!

Making it fun. If sports or hitting the gym is not your thing, pick an activity that you will enjoy, or one you can do in the company of people you like. Ballroom dancing, yoga, tai-chi and weekend walks to a picnic spot are some options worth considering.

Think outside the box. There are other forms of physical activity which are not the typical recreational ones. For example: take the stairs instead of the elevator, walk instead of driving, devote more time to gardening and house work. If you love window shopping, spend more time walking in your favourite malls, and park a little farther away from the entrance.

Use a pedometer to measure how many steps you take a day, and slowly build up your walking rate so that you will eventually walk about 10,000 steps a day.

Find and channel your motivation

The first few weeks of your new adventure will be the hardest, as you will be trying to replace habits you enjoy with habits that you may not enjoy doing as much, at the beginning. Going lunch with your colleagues can be a challenge in itself, as you would be tempted by all the delicious but unhealthy foods that you used to enjoy indiscriminately!

There may also be moments when you become frustrated at your slow progress, and you may even experience a degree of “withdrawal symptoms” of the favourite foods and old habits that you have enjoyed all this while.

During those moments, your resolve may waver, tempting you to give up because everything seems so impossible. Don’t succumb to it! Stay focused. You can do it.

Here are some tips to help you strengthen your resolve.

Know why you are doing this. It is not enough to say that you want to be healthy, as sometimes it can be hard to remember why this is important when you are craving for chocolate ice cream.

So, list down more specific reasons. Perhaps you want to stay healthy for your children and your partner as well as yourself? What are the dreams and goals you want to achieve, but will not be able to do so if your diabetes worsens? These reasons do not even have to be long-term in nature. Perhaps you want to lose weight to fit better in a bikini and impress everyone when you saunter down the beach later the year. There is no right or wrong motivation – so long as it matters to you, it’s worth listing down and remembering.

Paste your list in a prominent place where it can be spotted easily, especially when you are feeling vulnerable, such as at the door of your refrigerator, the monitor of your computer or even as a reminder on your mobile phone.

Don’t do this alone. Support from other people is a powerful motivator to keep you going. Therefore, enlist a family member, friend or co-worker for support. Support can come in many forms, such as a diet or exercise partner, but sometimes, even just having someone to confide your joys and frustrations in can be a great boost to your morale.

If you have problems finding someone close to you who is willing to support you, why not branch out? For example, you can:

• Organise a weight-loss or exercise group at your workplace or neighbourhood.
• Join a support group. If you cannot find one in your neighbourhood, you can search for an online support group.
• Connect with fellow diabetics via a blog, Facebook account or other social media platforms, and share your progress and frustrations with them.

Don’t be discouraged by lapses. Occasionally you will slip up. Do not let this bring you down. Review the possible causes for your lapse, and work to overcome them. If you find yourself lapsing often, consult your support group or healthcare team on how you can stay motivated.

“My mom passed away at 41 from diabetes. And I’m 42, thank you. I didn’t want to do that to my son. So any time I was at the gym, that thing that helped me do that last squat was my son calling some other woman mommy. And that would just give me that extra oomph to do that last squat. I want to be around for him.” – Sherri Shepherd

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