DiabetesSingapore

Issue 56 JAN - MAR 2016

Publication of Diabetic Society of

MC

I (P) 028/09/2015New Year GoodiesCOUNT YOUR CALORIESTOSS & TURN: Healthy Salads for the FamilyEXERCISING WITH DIABETES COMPLICATIONS

糖尿病对你身体的影响糖尿病并发症

Love Yourself For Good HealthEat Fruit: Load up on the Fibre

DSS m

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2014/2016

An educational message from the

Diabetic Society of Singapore

It is very important to learn how to manage your illness when you are sick. Please consult your physician for further advice on diabetes and sick-day management.

When you are sick, your body reacts by releasing hormones to fight infection. Your body fights the disease through many mechanisms, including changes in hormone levels, which can raise or lower your blood sugar levels. However, as the hormones raise your blood sugar levels, they will also make it more difficult for insulin to lower blood sugar levels.

Here are some tips on how to manage your diabetes when you are ill:

1 When sick, continue taking your medicines for diabetes. Even if you are throwing up, do not stop taking your

medicines. You need them because your body makes extra glucose (sugar) when you are sick. Take your usual dose of insulin/oral medication. DO NOT OMIT YOUR INJECTION/ MEDICATION.

2 Eating and drinking can be a big problem when you are sick.But it is important to stick to your normal meal plan

if you can. Drink plenty of water to keep your body hydrated. This will help to prevent hyperglycaemia (high blood glucose). Avoid caffeinated and alcoholic drinks as these may interfere with your medication.

3 Check your blood glucose at least four to six hourly as some medication may increase your blood glucose, which

will require you to adjust your medication accordingly. (Please check with your doctor on how to adjust your medication during sick days.)

4 Call your doctor if: · you have a fever (temperature over 101°F or 38.3°C). · you have diarrhoea or are vomiting and unable

to eat food, or drink fluids containing glucose or carbohydrates.

· you have persistent vomiting or diarrhoea. · your fever persists longer than 24 hours. · your blood sugar stays higher than 180 mg/dL or

lower than 70 mg/dL.

5 Rest. Do not exercise.

6 Test your urine or blood for ketones. If you have type 2 diabetes, you have a very low chance of developing

ketoacidosis. However, during severe illnesses, it is possible that ketoacidosis may develop. You should test your urine for ketones when:

· you feel severely sick (have a cold, the flu or other illness) and/or have unexplained nausea or vomiting.

· your blood glucose level is high (over 300 milligrams per deciliter or mg/dL) and continues to rise throughout the day.

7 Some suggestions for sick-day diet: · Small and frequent meals. · Nutrient-dense soft foods or liquids such as porridge

with other ingredients, milk, soy bean milk, and nutrition supplement formula.

· Adequate fluid intake.

What do you do WHEN YOU ARE SICK?

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CONTENTS

DSS m

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2014/2016

04 A WORD FROM THE PRESIDENT

GET ACTIVE!

06 DSS BUZZ

DIABETES SUPPORT GROUP MEET & SHARE

HEALTH TALK IN MALAY ‘SIHAT SEPANJANG HAYAT’

PAST OUTREACH PROGRAMS

WORLD DIABETES DAY 2015 BEAT THE BULGE

08 CARE CORNER

糖尿病对你身体的影响: 糖尿病并发症 DIABETES COMPLICATIONS

11 EYE SITE

THE OPTIC DISC

12 HEARTWARE

LOVE YOURSELF FOR

GOOD HEALTH

14 COOKOUT

NIAN NIAN YOU YUSHENG

ORIENTAL FOOD SALAD

BLUEBERRY & CHICKPEAS SALAD

17 THE LIGHTER SIDE

EAT FRUIT: LOAD UP ON THE FIBRE

18 FEATURE

COUNT YOUR BLESSINGS, COUNT YOUR CALORIES

20 SHAPE UP

EXERCISING WITH DIABETES COMPLICATIONS

FOUNDER Dr Frederick Tan Bock Yam

PATRONThe Honourable Minister for Health

ADVISORDr Warren Lee

PRESIDENTMr Yong Chiang Boon VICE-PRESIDENTSDr Kevin Tan Eng KiatDr Ben Ng

HON SECRETARYMs Esther Ng

ASST HON SECRETARYMr Stanley Lim

HON TREASURERMr Seah Peck Hwee

ASST TREASURER Ms Caroline Lim

COMMITTEE MEMBERSDr Yeo Kim TeckMdm Rohanah PagiMs Kalpana BhaskaranMs Juliana Lim

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DisclaimerThe views, opinions and recommendations given by the contributors of Diabetes Singapore or are merely for general reference. All materials in

this newsletter are for informational purposes only. The individual reader should consult his own doctor or specialist for his personal treatment or other medical advice. DSS and Diabetes Singapore Editorial Board disclaim all

responsibilities and liabilities for content expressed in this newsletter including advertisements herein. All contents of the newsletter are the copyright of the contributors and newsletter. Reproduction in any form is strictly prohibited

unless with written permission.

edito

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A WORD FROM THE PRESIDENT

Editor-in-chiefDr Yeo Kim Teck

Managing EditorCharlotte Lim

Editor (Dietetics)Janie Chua

Editorial ConsultantsDSS Management Committee

WritersHenry Lew (psychologist)

Kohila Govindaraju (nutritionist)Ray Loh (physiologist)

Rodiah Hashim (DSS)

ContributorsDr Yeo Kim Teck, Janie Chua,

Sharon Teoh So Suan, Noor Adzilah, Melvin Goh, 李淑君译

Concept & DesignCharlotte’s Web Communications

PhotographyDreamstime.com, Shutterstock & sxu.hu

Printing Stamford Press Pte Ltd

AdvertisingGeorge Neo

Esther Ng

Advertisement BookingsT: 6842 3382 or E: editor@diabetes.org.sg

Feedback editor@diabetes.org.sg

Back Issues www.diabetes.org.sg

Diabetic Society of Singapore HQBlk 141 Bedok Reservoir Road #01-1529

Singapore 470141 T: (65) 6842 6019 /3382

This year, we are raring to go with a greater emphasis on being active, beating the bulge and eating well to manage diabetes. Do not wait till it is too late!

We would like to share two pieces of good news with you.

Firstly, we are currently upgrading our South West Diabetes Education and Care Centre at Jurong West Street 52. The Centre should be full operational to serve our patients by early February 2016. The new facilities will include a training room to conduct workshops and talks. It will also serve as a meeting place for our DSS Support Group which has been very active in the last few years and we are encouraged by the energy of the leaders and the positive response of members.

Secondly, we welcome Ms Melissa Chan on board our team as General Manager of the Diabetic Society of Singapore (DSS). She will oversee the operations of our three Centres and the mobile clinic, improve services and foster partnerships to initiate new projects and programs. Melissa will also be responsible for staff training as well as the publicity of our outreach and education programs and the promotion of diabetes awareness. We look forward to fresh ideas and a more active year ahead!

During my recent trip to the World Diabetes Congress 2015 which was held in Vancouver, I had the opportunity to learn from many healthcare professionals who shared about three factors that are key in helping us manage diabetes:

1. The right type of foods to eat.2. Exercise and weight loss.3. Checking blood pressure and glucose level.

Our DSS activities and the articles in this issue of Diabetes Singapore are geared towards teaching our members and the public all about good nutrition, appropriate exercise, weight control, self-care, etc. Check out our website www.diabetes.org.sg for the latest information on our workshops, health screening and forums. We hope to see you soon.

Be active. Stay healthy. And warmest, best wishes for the New Year!

MR YONG CHIANG BOONPresidentDiabetic Society of Singapore

Diabetic Society of Singapore (DSS) was founded by Dr Frederick Tan Bock Yam on 25 September 1971 to help diabetes patients manage their condition.

DSS is a non-profit organisation affiliated to the International Diabetes Federation and the National Council of Social Service. DSS gratefully accepts donations of any amount to help fight diabetes. All donations are tax-deductible. Please make cash donations in person at any of our centres. Cheque donations should be made payable to ‘Diabetic Society of Singapore’. You may also make online donations via www. sggives.org/diabetes.

GET ACTIVE!

SAVE THIS DATE:45th Annual General MeetingDate: Saturday, 23 April 2016Venue: Drama Centre Level 3 Function Room 2 100 Victoria Street #05-01 National Library Building, Singapore 188064

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DSS Support Group Meet & Share Join us for our next support group event today! Call Juliana at 9278 2084 for more details or to register.

DSG CALENDAR 2016

23 January 2016DSG Walk (with guided tour)Time: 4pmMeeting point: Clarke Quay MRT Station - Station ControlTrail route (guided tour): River Valley Road-Read Bridge-Hill Street-Boat Quay-Market Street-Hong Lim Park.

27 February 2016DSG Walk Venue: Gardens By The Bay Time: 4pmMeeting Place: Bayfront MRT Station Passenger Service AreaDinner: Raffles City Food Court

19 March 2016 DSG Walk – ChangiVenue: Changi Moonlight/Boardwalk WalkTime: 4pmMeeting Place: Bedok MRT Station Passenger Service Area, Bus No. 2 to Changi VillageDinner: Changi Village

30 April 2016 DSG Walk – Coney IslandVenue: Coney IslandTime: 4pmMeeting Place: Punggol MRT Station Passenger Service Area, Bus No. 84 Dinner: Kovan MRT Food Centre

DSS BUZZ

Past Outreach Programs

Rodiah HashimHealth Talk in Malay ‘Sihat Sepanjang Hayat’

Health statistics do not bode well for the Malay community. Hence, the need for talks such as the one organised by Geylang Serai CCC as part of an ongoing health campaign aimed at encouraging healthy diets and lifestyle as well as health awareness within the Malay community.

Targeting the beneficiaries of Dr Fatimah Lateef’s Marine Parade GRC, the majority of the participants were women aged 50 and above. Dr Fatimah Lateef was also present to grace the event.

We hope that the talk on Diet and Nutrition by Sister Rohanah Pagi helped to give participants a greater understanding of the different aspects of health and well-being as well as nutritional knowledge.

17 Oct 2015 Diabetes Self Care Management Sharing Program for Support Group Leaders using Diabetes Conversational Map

25 Oct 2015 Sihat Sepanjang Hayat (Health Talk in Malay) organised by Geylang Serai CCC

28 Oct 2015 Fundraising and outreach booth at National Institute of Education by student volunteers from Group Endeavours and Service Learning

7 Nov 2015 Outreach Booth at IMMSA Blood Donation Drive

8 Nov 2015 Free Health Screening at Mt Elizabeth Novena Hospital organised by Nexus Surgical

12 Nov 2015 Sanofi Internal World Diabetes Day Screening for Staff

24 Nov 2015 Health Talk on Diabetes Prevention & Management at Takeda Pharmaceuticals International

4 Dec 2015 Health Talk on Diabetes Prevention & Managementfor NCS Active Day

12 Dec 2015 Health Screening at Food & Fun Fair for Seniors & Children organised by Lions Communication Foundation

For the latest on

DSS events, check out

www.diabetes.org.sgor call

6842 6019

1. Program subject to change due to weather conditions or unforeseen circumstances. Please look out for email updates.

2. Please wear good walking shoes.3. Check your feet for cuts/wounds, and alert

event coordinators if you have any. Please do not proceed with the activity if you have cuts or wounds on your feet.

4. Let’s cultivate great exercise habits! Bring along your own blood glucose metre!

5. Please bring along: umbrella, plain water as well as snacks (e.g. biscuits, in case of hypo).

6. Meals will be at your own expense, unless stated otherwise.

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DSS BUZZ

World Diabetes Day (WDD) 2015 was held on 15 November at Suntec Singapore Convention & Exhibition Centre, with Senior Minister of State for Health and Environment & Water Resources, Dr Amy Khor, as the Guest-of-Honour.

In her speech, Dr Amy Khor echoed the theme of this year’s WDD, “Beat the Bulge! Healthy Lifestyle the Way to Go! Act to change your life today”. She urged everyone to “act now and take charge of your health today” through regular exercise, a balanced diet and regular health screening for early detection of diabetes. Diabetes can be managed better with early detection.

World Diabetes Day first started in 1991 by the International Diabetes Federation and World Health Organisation (WHO), in response to great concerns about the escalating burden of diabetes. Two decades have passed and the burden has not been reduced.

According to WHO, there are 347 million people worldwide with diabetes and the disease is projected to become the seventh leading cause of death globally by the year 2030.

WDD 2015, as in previous years, provided a platform to raise awareness about diabetes, its complications and management.

Activities included complimentary eye, foot and health screenings, exercise and healthy cooking demonstration, educational talks, Q&A sessions with dietitians, nurse educators and physiotherapists. There was an array of exhibits and products on sale by pharmaceutical and industry partners as well as fun activities organised by the Diabetic Society Singapore (DSS).

This year, a group of student teachers from National Institute of Education (NIE) volunteered their services as part of their Group Endeavour Service Learning programme. Volunteering for different roles for WDD, they began their learning journey a few months before the event.

As ambassadors for WDD, they equipped themselves with knowledge about diabetes by visiting the DSS HQ and DSS Mobile Diabetes Education &Care Centre as well as attending educational talks.

To raise awareness about diabetes, the team had a fundraising and awareness booth on NIE campus on 28 October and 4 November 2015.

Beat the Bulge!Healthy Lifestyle the Way to Go!

WORLD DIABETES DAY 2015

Noor Adzilah and Melvin Goh

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PARTNERS AND SPONSORS

Abbott Laboratories (S) Pte Ltd (Diabetes Care) Abbott Laboratories (S) Pte Ltd (Nutrition) Aeras Medical Pte Ltd AstraZeneca Singapore Pte Ltd Bakels Singapore Pte Ltd Bayer (SEA) Pte Ltd Becton Dickinson Holdings Pte Ltd Boehringer Ingelheim Singapore Pte Ltd Eli Lilly (Singapore) Pte Ltd Equal Field Catering & Supplies Pte Ltd Gardenia Foods (S) Pte Ltd Giant Singapore Imexlink Trade Pte Ltd Johnson & Johnson Medical Singapore Kingston Medical Supplies (Pte) Ltd Lilly-NUS Centre for Clinical Pharmacology Pte Ltd LION Corporation Pte Ltd Medimex Singapore Pte Ltd Merck Pte Ltd MSD Pharma (Singapore) Pte Ltd Mundipharma Pte Ltd Nestle Singapore (Pte) Ltd Novartis (Singapore) Pte Ltd Novo Nordisk Pharma (Singapore) Pte Ltd

Pfizer Singapore Pte Ltd Pharmaforte Singapore Pte Ltd Roche Diagnostics Asia Pacific Pte LtdSanofi-Aventis Singapore Pte Ltd Servier Singapore Pte Ltd Siemens Diagnostics Singapore Pte Ltd Soyjoy Singapore Tat Hui Foods Pte Ltd Terumo Singapore Pte Ltd Topcon Singapore Medical Pte Ltd

ORGANISATIONS

Association of Diabetes Educators Singapore Health Promotion Board Lions Club of Singapore Lions Community Service Foundation Group Endeavours in Service Learning - National Institute of Education Obesity and Metabolic Surgery Society of Singapore Podiatry Association (Singapore) Singapore National Eye Centre Singapore Nutrition & Dietetics Association Singapore Physiotherapy Association Temasek Polytechnic

It’s an eye opener for all of us as we get to work and learn

alongside the volunteers and staff from the Diabetic Society

of Singapore. We are more than glad to be given the

opportunity.

Cyril Matthew Philix, NIE Volunteer

Before volunteering for the Diabetic Society of Singapore, I thought diabetes is a chronic disease which affects only blood sugar levels

but it is actually a metabolic dysfunction which causes other health conditions. The good news is that it is treatable if detected

early, by managing diet and having a healthy lifestyle, even with the option of bariatric

surgery. The old saying, ‘Prevention is better than cure’ still holds a whole lot of truth.

Rahayu Haris

DSS wishes to thank all partners, sponsors and organisations for their participation and support, and making WDD 2015 a great success:

8CARE CORNER

糖尿病对你身体的影响糖尿病并发症 Diabetes Complications

血糖如果不加以控制，糖尿病引起的并发症几乎可影响身体的每个器官。糖尿病并发症包括：

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心脏疾病心脏疾病是最常见的糖尿病的并发症之一。在看诊室里，你的医生可能会进行各种测试，以检查你是否有心脏疾病，并帮助你避免任何严重的，与心脏相关的问题。在每次复诊中，医护人员将检查你的血压。你的胆固醇水平和甘油三酯可能在你第一次看诊时就进行检查。取得基础心电图也应成为完整医疗记录的一部分。了解更多关于你个人心脏疾病的风险因素，如家族病史或是否吸烟，并制定出一套预防计划包括减重，经常运动和压力管理，以及保持你的血压，胆固醇和甘油三酯在正常水平内。

糖尿病肾病（肾脏疾病）如果你有糖尿病，每年应验尿以尽早发现糖尿病肾病 - 肾脏疾病。也应验血测量基础肌酐，以确定你的肾功能。医护人员也将定期检查你的血压，因为控制高血压对减缓肾脏疾病至关重要。血压应低于130/80。在这次健康话题中了解更多关于肾病的症状，如腿或双脚持续肿胀。知道什么时候应打电话给你的医生，以避免严重的问题。

中风中风的症状和体征包括面部或身体的一侧突感无力;脸，手臂或腿感到麻痹;说话困难;双眼视线障碍或眩晕。如果你出现任何这些症状，请立即就医。你可能会被转去看神经科医生或其他中风科的专家。了解更多关于中风的先觉征兆，也注意防范可能给你带来这一严重问题的方法。

糖尿病神经病变（神经损伤）随着时间的推移，糖尿病可导致神经损伤如麻痹，烧灼感或疼痛的症状。如果你的皮肤变得麻木，你可能注意不到有小伤口，由此而发展成为更大的健康威胁。每天检查你的脚和手，观察是否有发红，老茧，裂纹，或皮肤破损。如果在下一次复诊前发现这些症状，请立即通知你的医护人员。

李淑君译新加坡糖尿病协会教育护士

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糖尿病性视网膜病变为了保护你的视力，所有的糖尿病人应该每年至少看一次眼科医生。作为眼科检查的一部分，医生将你的眼睛扩张，这样他/她才能看到眼睛的后面（视网膜)，并确定是否受到糖尿病的损害。在1型糖尿病患者中，一旦年满10岁及以上，须在三到五年内开始这种常规检查。 2型糖尿病患者一旦被确诊就应该开始第一次眼部检查。那些有眼睛并发症的患者可能需要更频繁看眼科医生。女性糖尿病人怀孕的头三个月内应做一个全面的眼科检查及在随后的孕程中密切随访眼科医生。(此建议并不适用于妊娠糖尿病人）

皮肤问题多达三分之一的糖尿病患者将在一生中的某个时候出现与糖尿病相关的皮肤问题。血液中高浓度的葡萄糖给细菌和真菌提供优良的滋养基，从而降低人体的自愈能力。幸运的是，大部分的皮肤问题是可以预防及在早期发现时成功治疗的。2型糖尿病患者如果没有好好照顾皮肤，一个很小的皮肤问题可能导致潜在的严重后果。

胃轻瘫糖尿病会增加你的胃轻瘫的风险。胃轻瘫时，胃的神经被损坏而无法正常工作。这将导致胃花费很长的时间来清空其内容物，使得血糖水平难以受到控制。有时，改变你的饮食会有帮助。还有一些药物和治疗针对胃轻瘫。跟你的医生探讨如何预防糖尿病并发症的发生。询问有关先兆症状的信息，以便您可以寻求最有效的治疗。

8勃起功能障碍糖尿病会增加患勃起功能障碍或阳痿的几率。对于一些人，采取健康的生活方式，如戒烟，经常锻炼，减少压力，可能需要一起才能解决勃起功能障碍。在这次健康话题中，你还将了解跟你的医护人员谈勃起功能障碍的重要性，因为你的医生可以推荐其他的补救措施 - 包括药物治疗，真空缩窄装置(VCD)，以及其他勃起功能障碍的辅助工具 – 有所帮助。

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THE OPTIC DISCDr Yeo Kim Teck Apple Eye Centre Senior Consultant Ophthalmologist

The optic nerve, the second cranial nerve comprise approximately a million nerve fibres all in a diameter of 1.5 mm within the retina. The optic nerve in a retinal photograph is important in staging the severity of diabetic retinopathy. The appearance of the optic disc, its colour, the sharpness of the optic nerve margins, the presence of congested or abnormal fine blood vessels, the size of the optic cup, among other signs, can point to a host of eye conditions. Here are some common and not-so-uncommon optic disc pictures you might come across in your patients who come to you waving a set of retinal photographs.

The Normal Optic Disc Note the optic cup-disc ratio. This is the ratio of the diameter of the optic cup (the blue arrow ) divided by the longest diameter of the whole optic disc (black arrow). The ratio of the cup-disc or CD ratio and the difference in the CD ratio between the two eyes are important factors for the diagnosis of suspected chronic glaucoma.

Generally a CD ratio of 0.6 and above and a difference of 0.2 or more between the two eyes should trigger a full clinical examination. Bear in mind that retinal photography alone is insufficient to clinch a diagnosis or to rule out the presence of chronic glaucoma.

A pale disc is always a cause for concern. One should always compare the colour of the optic nerve with that of the fellow eye.

The diagnosis of optic atrophy can be collaborated by the accompanying poor vision. In early stages of optic atrophy however visual function may only be mildly affected.

If you are seeing the patient, check for relative afferent pupillary defect (RAPD) colour vision, contrast and possible causes of optic atrophy.

More commonly seen causes of optic atrophy include chronic glaucoma, trauma, optic neuritis, toxic neuropathy, and compressive lesions, among others.

Pituitary tumours or suprasellar meningioma are notoriously difficult to diagnose as the optic disc pallor is often minimal. Most are diagnosed from the loss of the outer visual fields (bitemporal hemianopia).

The Pale Disc

Left optic atrophy following a late presentation acute glaucoma attack.

Left enlarged optic cup-disc from advance chronic glaucoma on first consultation.

The normal right optic nerve of the same patient. The retina features are

blurred and obscured by cataract.

Fellow eye with a normal CD (optic cup/optic disc) ratio.

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HEARTWARE

Leading a healthy lifestyle is not easy. Watching our diet. Being physically active. Getting enough sleep. The list goes on. Cultivating a healthy lifestyle is even harder when we have diabetes. It gets even more overwhelming when we have to take our medications regularly, check our blood sugar periodically, arrange various medical appointments and get there on time, and the like.

Slip ups happen, at least for some, if not for most of us. There will be times when we forget an appointment, miss recording our blood sugars, or literally “slip in” that piece of high-sugar, high-caloric dessert. Inevitably, we feel guilty that we did something “bad”. We get angry with ourselves for not following guidelines. We begin to feel ashamed of ourselves. But guilt, shame and anger are far from healthy behaviours.

Behavioural change is made harder when we have been taught to value ourselves based on what we do. As a child, we get messages from adults and the wider society that we are “good” only when we achieve certain grades. As an adult, we also receive explicit or implicit messages from people around us, that we are worthy only if we work in certain jobs, hold particular positions or earn a certain amount of money. Naturally, when it comes to our health, we also evaluate ourselves based on what we are doing.

Fortunately, developing self-compassion not only enables individuals to manage these emotions and the associated self-criticism, it offers a gentler way of relating to ourselves and enhancing self-management in diabetes. Self-compassion means to extend compassion to one’s self in instances of perceived inadequacy, failure, or general suffering. In very simple terms, it involves being kinder to ourselves.

Egede and Osborn (2010) in a series of research, found that patients who reported higher levels of self- compassion have a higher motivation to engage in self-management of diabetes, quit smoking, maintain a healthy diet, and exercise.

The good news is that self-compassion can be learnt. When highly self-critical individuals in particular were taught self-compassion, they managed to achieved their health goals despite setbacks. Self-compassion might have helped these individuals tolerate distress when they experience setbacks, enabled them to motivate themselves instead and focus on taking actions to improve their health.

Henry Lew, Psychologist

Love YourselfFor Good Health

Here are some ways to cultivate self-compassion:

Recognise That You Are Not Alone

Failure can make us feel very alone, especially when you feel like the oddball who cannot make it. Part of self-compassion is recognising that everyone is flawed in some ways. Being imperfect is natural. It helps to remember that you are not alone in your struggles, that there are others who are also struggling to make behavioural changes.

Be Your Own Best Friend

When our best friend or loved ones make mistakes or fail to do something, we often console and soothe them. We do not criticise our best friends to motivate them, do we? But when it comes to ourselves, we have a tendency to beat ourselves up. Instead, talk to yourself and treat yourself as kindly as you would a best friend.

Feast Your Senses

Get a massage, sleep in, eat warm foods, have a warm shower, stare at the window panes when it is raining, look up at the clouds, etc. What are things that typically engage your senses and soothe them? Each of us has our own list, so start writing your inventory.

ME First!

Sometimes, we are so used to doing things for others that we neglect doing things for ourselves. Or, we may find it hard to say “no” to others. Or, we may find ourselves surrounded by people critical of our failure to make behavioural changes. During such moments, think about the in-flight message you hear when on board an passenger airplane, “Put on our own oxygen mask before attending to your children”. You need to look after yourself before you can look after others. Have some “me” time.

Build A Library

Collect phrases on self-compassion that speak to your heart. In times when you notice you are self-critical or feeling ashamed and guilty, take a look at these quotes to help soothe yourself.

Reference:Egede L, Osborn C: Role of motivation in the relationship between depression, self-care, and glycemic control in adults with Type 2 diabetes. Diabetes Education 8;36:276-283, 2010.

Making behavioural changes is a journey we may need to take at one point or another in our lives. Being kind to ourselves does not mean making excuses for ourselves.

Being kind to ourselves means cutting ourselves some slack, giving ourselves permission to move on, from the guilt, shame and anger, to better things.

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1. To make dressing, combine all ingredients in a bowl and set

aside.

2. Arrange raw salmon in the centre of a large platter.

3. Place each type of vegetable in sections around the platter.

4. Place peanut, sesame seeds and wholewheat cereal over the

vegetables.

5. Sprinkle five spice powder and pepper on top of the yusheng.

6. Just before serving, pour the dressing over.

7. Toss and serve immediately.

METHOD OF PREPARATION

NUTRITION INFORMATION per serving Energy 149 kcalProtein 5.9g*Carbohydrate 21gTotal Fat 4.7gSaturated Fat 0.7gDietary Fibre 3.1gCholesterol 5mgSodium 144mg

*Carbohydrate exchange: ~1.5 exchange

100g raw salmon, thinly sliced1 white radish, thinly shredded2 carrots, thinly sliced2 cucumber, thinly shredded½ purple cabbage, thinly shredded3 red capsicum, thinly sliced45g wholewheat cereal¼ cup chopped peanuts, roasted and unsalted1 tablespoon toasted sesame seeds2 pieces lime, cut into half1 teaspoon five spice powder1 teaspoon white pepper ground

Dressing½ cup plum sauce½ cup water2 tablespoons lemon juice4 teaspoons sesame oil

INGREDIENTS

Nian Nian You Yushengserves 10

by Janie Chua Senior Dietitian

National Health Group Polyclinics

COOKOUT D

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by Janie Chua Senior Dietitian

National Health Group Polyclinics

Oriental Fruit Saladserves 8

¼ cup wolfberry, washed5 kumquat, sliced thinly5 mandarin oranges, peeled and cut into segments1 pomelo, peeled and cut into segments1 can lychee, drained1 can cubed pineapple, drained

Spiced Syrup¼ cup orange juice¼ cup honey1 teaspoon cloves3 star anise2 2-inch cinnamon sticks

METHOD OF PREPARATION

INGREDIENTS

NUTRITION INFORMATION per serving Energy 150 kcalProtein 1.5g*Carbohydrate 36gTotal Fat 0.5gSaturated Fat 0.04gDietary Fibre 2.5gCholesterol 0mgSodium 17mg

*Carbohydrate exchange: ~2.5 exchanges

1. Combine the fruits in a medium serving bowl. Cover and chill in the fridge.

2. In a small pan over medium heat, combine ingredients for the spiced syrup. Remove from heat and leave to cool and let the

flavours infuse.

3. Just before serving, drizzle the cooled syrup over the fruit salad.

4. Toss to combine and serve immediately.

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Blueberry & Chickpeas Saladserves 4

1. Make the dressing by mixing all the ingredients in a small bowl.

2. Add 1 to 2 tablespoons of water to get the desired consistency.

3. Make the salad by tossing all the ingredients and topping with the dressing!

METHOD OF PREPARATION

NUTRITION INFORMATION per serving

Energy 84 kcalProtein 5g*Carbohydrate 15gTotal Fat 1gDietary Fibre 4gSodium 11mg

*Carbohydrate exchange ~ 1 exchange

120g blueberries, whole 120g chickpeas (half a cup, cooked) 100g cucumber, diced 2 tablespoons red bell pepper, chopped 140g Romaine lettuce, chopped

Dressing 3 tablespoons Greek yoghurt 1 tablespoon chopped mint 1 tablespoon lemon juice A pinch of pepper

INGREDIENTS

by Kohila GovindarajuNutritionist

The Berries Nutrition Counselling

COOKOUT

17THE LIGHTER SIDE

Kohila GovindarajuNutritionist The Berries Nutrition Consulting

It is a fallacy to think that fruit juice is any healthier than soft drinks. In fact, a greater intake of fruit juices is associated with a higher risk of type 2 diabetes. Although fruit juices may have antioxidant activity, they lack fibre, are less satiating and have

a higher sugar content. The danger lies in regular consumption of fruit juice which recently has been linked with an increase in type 2 diabetes risk.

However, people who eat a minimum of three servings of fruit are likely to have a reduced risk of type 2 diabetes, some types of cancers, hypertension and heart diseases when compared to those who do not take fruit every day. Even if you have diabetes, you should still eat two servings of fruit every day. Although fruits contain sugar, they are low in calories. Even berries, peaches and apricots are low in glycaemic loads even when they are fully ripe.

Now the other all too important question is which of the two, juice extraction or eating whole fruits, is more beneficial.

Juicing fruit seems like an easy way to squeeze more nutrients into your busy schedule but, watch out, they are loaded with natural sugars as well! A 250ml glass of unsweetened orange juice contains around 100 calories, compared to an orange that contains only 60 calories.

Fresh juice may be abundant in vitamins, minerals, phytonutrients, and antioxidants. Unfortunately, they lack fibre! Fruit juice that has been robbed of its fibre is merely a concentrated source of sugar. Higher amounts of sugar in the juice can also quickly cause a rise in blood sugar levels. If you are not careful, these extra calories can lead to unhealthy weight gain.

Eat the Fruit, Not Drink It

The glycaemic index (a measure of how rapidly carbohydrates in a food elevates blood sugar) of fruit is not significantly associated with type 2 diabetes risk when compared to the high glycaemic index of fruit juice. This is because fruit juice rolls through the

digestive system much faster than fibre-loaded whole fruit.

You can always blunt the blood sugar-raising effects by taking advantage of the fibre in fruit and vegetables. Fibre is the indigestible part of plant foods that, because the body does not break it down, has zero calories and therefore does not affect your blood sugar, making it pretty good for people with diabetes.

The main benefit of eating whole fruit is that the nutrients are intact and you get both the soluble and insoluble types of fibres. Soluble fibre can help lower your cholesterol levels and improve blood glucose control if eaten in large amounts. Apples, oranges, and pears all contain soluble fibre, but not when juiced.

Both soluble and insoluble fibres, along with other nutrients, have a synergistic action in reducing blood pressure, improving insulin sensitivity, keeping you full for longer periods so that it can naturally decrease the risk of obesity and heart diseases.

By grabbing a whole fruit you are less likely to experience a spike in your blood sugar, too. The fibre makes your body absorb the natural sugars more slowly. Combining fibre-rich fruits with protein and fats will also slow down the absorption of the carbohydrates that curtail the overall effect of the meal on your blood sugar levels.

So, instead of juicing, eat the whole fruit to get the best out of Nature’s goodness.

EAT FRUIT: Load up on the Fibre

References:http://www.webmd.comhttp://www.mayoclinic.orghttp://www.diabetes.co.ukhttp://www.diabetes.orghttp://www.mindbodygreen.com

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FEATURE

Count your BlessingsCount your Calories

Sharon Teoh Soh SuanDietitian, National Health Group Polyclinics

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There is no special diet for diabetes. To control your blood sugar, people with diabetes should eat small and regular meals with evenly spread carbohydrate throughout the day. They should also reduce sugar and fat intake and incorporate high fibre food into their daily diet.

Popular foods for Chinese New Year can be lower in calories, fats and sugar if we make some healthy changes to our recipes such as choosing healthier ingredients and using healthier cooking methods. If we dine out, we can order healthier dishes or consume less high-calorie foods.

Choose lean meat instead of fatty meat or pork belly.

Limit Chinese New Year high-calorie goodies

and replace them with healthier

snacks like baked nuts, mandarin

oranges or dried fruit.

Trim off poultry skin.

Instead of deep fried, choose

healthier cooking

method such as steaming,

boiling, grilling, stewing, braising and stir frying.

Choose plain water or sugar-free beverages instead of soft and sweetened

drinks.

Replace processed meat

(e.g. Chinese sausage, luncheon meat) with fresh

meat.

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Here are some useful tips:

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TO PREVENT OVEREATING:

• Do not skip meals or substitute meals with snacks.• Eat slowly and enjoy every bite.• Drink more water before and during each meal.• Have more vegetables for each meal and incorporate whole grains whenever possible. This will help to fill you up and

make you feel full.• Avoid visiting on an empty stomach. Have a portion of healthy snacks, e.g. fruits, sandwich, wholemeal biscuit before

you leave home.• Share festive treats with relatives and friends.

People with diabetes should practise caution when drinking. Do not drink on an empty stomach or when your blood glucose is low. If you choose to drink, follow the guidelines and have it with food. Extra caution should be taken for those who are on insulin or medication. According to Health Promotion Board Singapore, men should not drink more than two standard drinks a day and women should not drink more than one standard drink a day. A standard drink is equal to one can of beer (330ml), half a glass of wine (175ml) and one shot of spirit (35ml).

In conclusion, be mindful to eat in moderation and not to overindulge, just because Chinese New Year happens only once a year. For those who are on medication, remember to take your medication during this festive season. Put your medicines into a pill box and take them with you on all your outings.

Lastly, be physically active! Go for a walk or do any exercise that you enjoy. It will help control your blood sugar and burn some calories, too.

Niangao1/4 piece (105g) 244 calories (kcal) 56g carbohydrate (equivalent to 1 bowl of rice)

Pineapple Tarts3 pieces (60g) 280 calories (kcal) 42g carbohydrate (equivalent to 2/3 bowl of rice)

Kuih Bangkit3 pieces (12g) 45 calories (kcal) 8g carbohydrate (equivalent to less than 1/4 bowl of rice)

Bakwa1 piece (94g) 370 calories (kcal) 47g carbohydrate (equivalent to 3/4 bowl of rice)

Loveletters3 rolls (39g) 168 calories (kcal) 29g carbohydrate (equivalent to 1/2 bowl of rice)

Twisted Cookies3 pieces (36g) 202 calories (kcal) 18g carbohydrate (equivalent to 1/3 bowl of rice)

With so many delicious food and treats during the Chinese New Year festival, it may be a challenge for us to watch what we eat. Overindulging and excessive intake of the popular foods and treats may lead to increased blood sugar levels and weight gain.

Take a look at the calories and carbohydrate content of these favoruite Chinese New Year goodies:

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SHAPE UP

If you have had diabetes for a long time and have developed complications, you may have questions about whether you should be engaging in physical activity—and, if so, what kind of physical activity is best for your condition.

According to Jacqueline Shahar, MEd, RCEP, CDE, a clinical exercise physiologist and manager of Exercise Services in the Joslin Clinic at Joslin Diabetes Center, patients with diabetes complications should definitely continue to find appropriate opportunties for physical activity.

There is always some type of exercise people with complications can do. Not remaining active can lead to developing additional complications and loss of functional capacity (the ability to do the activities of daily living).

Here are some of the more common diabetes complications and exercise recommendations:

>> Peripheral NeuropathyPeripheral neuropathy is nerve damage in the extremities, causing tingling, pain or loss of sensation in your toes, feet and fingers. Peripheral neuropathy increases the risk of loss of balance—and subsequently the increased risk of falling. In addition, the pain and burning can make it difficult to walk.

Exercise prescription:Incorporate balance exercises and avoid weight-bearing activities such as walking or jogging. Good choices are the stationary bike and swimming.

>> Charcot FootCharcot Foot is a specific type of peripheral neuropathy in which there is destruction of the nerves on the bottom of the foot. The foot eventually becomes deformed and loses sensation. It is important to stay off your feet as much as possible.

Exercise prescription:Use a stationary or arm bike, or do chair exercises using free weights in a seated position.

>> NephropathyNephropathy is damaged to the kidneys, which eventually leads to complete kidney shutdown and the need for dialysis. With nephropathy, exercise capacity is decreased because of the buildup of waste products in the body.

Exercise prescription:Light to moderate exercise is encouraged.

>> Proliferative RetinopathyProliferative retinopathy is advanced diabetic eye disease in which new, fragile cells develop on the optic disc. These new cells are prone to leakage or hemorrhage into the eye resulting in loss of vision. You may also be at risk for retinal detachment.

Any exercise that increases blood pressure should be avoided. You need to avoid lifting heavy objects and any vigorous exercise. In addition, do not perform any exercise that requires forward bending such as yoga or the valsalva manoeuvre(The valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut.)

Variations of the manoeuvre can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to "clear" the ears and sinuses (that is, to equalize pressure between them) when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or aviation].

Exercise prescription:Stick to non-weight bearing exercise such as moderate intensity biking or walking in the pool. Or try slow, steady hiking, ballroom dancing or elliptical machines at low to moderate intensity.

Exercising with Diabetes Complications