December 10, 2016 61
Singaporeans love to be on top. we love to be the first. First in line to get that free gift or try out the new trendy café, that’s not a secret. But this thirst to be on top might not be good for us in some ways.
Did you know Singapore is second in the race to have the highest proportion of diabetics among developed nations. 3 in 10 Singaporeans have diabetes before turning 40 and estimated that in 2015 alone, there were 541, 600 cases of diabetes in Singapore. Not scary enough? Take a look at the person beside you, there’s a chance that one of you, is going to be a diabetic. Dr Abel Soh unravels the need-to-know on diabetes.
Unraveling Diabetes Mellitus:
What is diabetes mellitus?
Diabetes mellitus is a condition where the body is unable to properly use and store sugar (glucose), resulting in blood sugar level rising higher than normal.
What are the types of diabetes?
Type 1 diabetes (5 to 10% of all cases of diabetes) is due to no production of insulin (hormone) in the body and mainly occurs in children and adolescents.
Type 2 diabetes, which comprises 90% to 95% of all cases of diabetes, occurs because the body does not produce enough insulin and is also unable to use insulin properly (insulin resistance). This type of diabetes usually occurs in people who are over 40 years of age, overweight or obese, and have a family history of diabetes.
Gestational diabetes is a type of diabetes that occurs in the late second or third trimester of pregnancy. High blood sugar level in pregnancy can pose risks for both the mother and the unborn baby.
What symptoms does someone with diabetes have?
Symptoms of high blood sugar level include increased thirst and urination, tiredness or fatigue, blurred vision, unexplained weight loss, more frequent infections, and slow-healing cut and sores.
Why is treatment of diabetes so important?
Treatment of diabetes is very important as high blood sugar level over time can lead to a host of complications — heart attack, stroke, blindness, kidney failure, nerve damage and blood vessel disease that may require an amputation, and impotence in men. Controlling blood sugar will reduce the risk of development and/or slow down the progression of complications.
How does someone with type 2 diabetes control his or her blood sugar level?
Controlling blood sugar level in an individual with type 2 diabetes involves making changes to the diet, increasing the amount of exercise, and taking medications that help to lower blood sugar level.
There are many different medications (tablets as well as insulin injections) currently available to help control blood sugar level in an individual with diabetes. The different tablet medications lower blood sugar level by targeting the different reasons for high blood sugar level in someone with diabetes. As insulin production continues to decrease with increasing years of type 2 diabetes, 40 to 50% of individuals will need insulin injections by the time they have 10 years of diabetes.
Moderate-intensity exercise, such as brisk-walking and jogging, of at least 150 minutes per week is the level of physical activity recommended for people with type 2 diabetes. Gradual increase in exercise duration and intensity is advised for individuals who are not exercising or exercising little at baseline.
What should the diabetic dietary approach be?
One of the goals of diet treatment is to encourage the attainment and maintenance of a healthy body weight. With a healthy body weight, it helps delay or prevent the complications associated with diabetes and achieve the best blood sugar control without compromising the quality of life.
For individuals who are overweight (BMI > 25 kg/), a nutritionally balanced, calorie-reduced diet should be followed. Even a modest weight loss of 5 to 10% of original body weight will improve blood sugar levels, blood pressure as well as cholesterol levels.
Carbohydrates: 45 to 60%
Minimum carbohydrate intake should be at least 130 g per day. This is the amount needed for healthy brain function. Carbohydrate-containing foods with a low glycemic index and high fiber content should be consumed.
Added sugars like fruit juice, sodas, candy and even in condiments should consist of less than 10% of the total diet. Anything above 10% would increase the body’s blood glucose profile.
Other factors that affect the blood sugar response include: dietary fiber, other nutrients like protein and fat, being a fast/slow eater and digestibility. For individuals with diabetes or
prediabetes, a higher total intake of soluble fibers is recommended – around 25 to 50 g/day or 15-25 g/1000 kcal. Soluble fibers play an important role in slowing down the emptying of the stomach as well as sugar absorption.
Fats: 20 to 35%
Recommended fat intakes:
- Saturated fat less than 7% of total energy
- Avoiding trans fatty acids
- Monounsaturated fatty acids up to 20%
- Polyunsaturated fatty acids up to 10%
Omega 3 fatty acids have no effect on blood glucose levels but decrease blood triglyceride (oil) levels and clumping together of platelets (a type of blood cells) [i.e. lowering a person’s risk of cardiovascular disease]. It is recommended to consume 2 to 3 servings of fish each week to reduce heart disease.
Protein: 15 to 20%
(1.0 to 1.5 g/kg/day)
Protein plays a big role in the maintenance of lean body mass and is crucial in weight loss. Plant-based proteins should be the first choice of protein and can be found in quinoa, buckwheat, beans, peanut butter and chia seeds. Patients with established kidney disease should refrain from having too much protein, consuming up to 0.8 g/kg/day.
If you do not drink, it is not recommended that you start. If you do enjoy wine, it should be limited to 1 drink per day for women, and 2 drinks per day for men or no more than 10 drinks per week for women, and 12 per week for men. If you drink more than that, alcohol can have the opposite effect - it increases blood sugar levels, blood pressure and cholesterol levels and it can dehydrate you. The best approach is to drink in moderation – do not deprive yourself, but know your limits!
Tips for safe drinking—
- Drinking can lead to delayed occurrence of low blood sugar levels up to 24 hours after consumption
- Excess calories from alcohol may lead to weight gain
- Drink slowly and eat more carbohydrate-rich foods when you are drinking alcohol. This will counteract the slowing down of sugar release by the liver.
This article was written in conjunction with Dr Abel Soh, from Abel Soh Diabetes, Thyroid and Endocrine Clinic.
Dr Soh graduated with Bachelor of Medicine and Bachelor of Surgery (M.B.,B.S.) from the National University of Singapore (NUS) in 2000. He trained in Internal Medicine at the Singapore General Hospital (SGH) and attained the Membership of the Royal College of Physicians of the United Kingdom [MRCP (UK)] in 2006. He then pursued Advanced Specialist Training in Endocrinology at SGH and obtained his Specialist Accreditation in Endocrinology by the Ministry of Health (MOH) in 2010.
Certified nutritionist with sports and fitness in my blood. Basketball is my passion and I live by Ali’s saying “don’t count the days, make the days count” View all articles by Sara.