sunday Star, 8 november 2015

special

world diabetes day

SUNDAY STAR, 8 NOVEMBER 2015

2 world diabetes day

By THERESA BELLE
DESPITE the notorious reputation
diabetes has garnered over the
years, many remain unaware
of how dangerous it can be.
The idea that diabetes is not
dangerous as many people have
it could not be further from the
truth. This disease can lead to
serious complications and there
is no such thing as mild diabetes,
says Emeritus Prof Datuk Dr
Mustaffa Embong, executive
chairman of the National Diabetes
Institute (Nadi) and consultant
diabetologist/endocrinologist at
Nadis Diabetes Resource Centre
DCenters.
The disease is closely associated
with metabolic syndrome
increased blood pressure,
abnormal cholesterol level, high
blood sugar level and excess body
fat around the waist.
This cluster of conditions
increases ones risk of developing a
non-communicable disease such as
diabetes, which is caused by the
bodys inability to regulate blood
glucose levels due to insulin
insufficiency or resistance.

Warning signs
Diagnosis of the pre-diabetic
condition helps address the growth
in number of diabetics by
identifying the condition at the
earliest stage. Using simple blood
tests, doctors are able to determine
whether or not a patient is
borderline diabetic.
There is also the now popular
HbA1c (glycated haemoglobin) test,
which is able to provide an average
sugar level reading of the past
two to three months, as opposed to
the fasting plasma glucose test that
only measures glucose
concentration in the blood at
that point in time.
Those at the pre-diabetic stage
are still able to delay or prevent the
onset of diabetes with proper
management of lifestyle factors.
This is a crucial period in
INSULIN is a pancreatic hormone
that converts glucose into energy,
thus controlling the level of blood
sugar in the body.
When insulin, which is
produced by beta cells, is
insufficient or unable to function
optimally, this conversion process
is interrupted and the level of
sugar rises beyond the healthy
range. This is how diabetes
comes about.
Although the basic mechanism
is general, diabetes cases vary
from one individual to the next
due to different root causes and
degrees of environmental impact.
Hence, follow-up treatment and
control measures may also differ.
People react differently to
medication, which is why every
case is dealt with individually
some need to have insulin
introduced into the system while
others may need to reduce it.
A balance of lifestyle changes
and medication is needed for
diabetics to be in the best of
health and a very small
percentage of people can
depend on only one or the
other, says Dr Lim Siang Chin,
endocrinologist and physician
at Mahkota Medical Centre.

Risk-free living
diabetes management as there
is no way to cure the disease
pre-diabetes diagnosis can be
considered a final warning for
high-risk individuals to make
significant changes.
According to Siah Guan Jian,
senior diabetes educator at the
National Heart Institute (widely
known by its Bahasa Malaysia
acronym IJN), preventive measures
are vastly similar to diabetes
control methods.
Diabetes prevention and
management rely on blood sugar
management, so we generally
advise high-risk patients to
improve their diet by cutting down
on sweet, fatty and cholesterol-rich
foods, eat regular meals in small
portions, and exercise regularly,
she says.
Being obese places one at great

risk of developing diabetes, which

is why weight loss through healthy
methods is one of the prescribed
actions at the pre-diabetic stage.
Scientists and doctors say that
increased abdominal fat in
particular has been shown to
contribute to insulin resistance
because of the release of proinflammatory chemicals
(substances that attack cells, vessels
and tissues to slowly damage them)
by fat cells, which decreases cell
responsiveness to insulin.
Insulin resistance is the defining
characteristic of Type 2 diabetes.
Obesity further exacerbates the
condition by disrupting the bodys
metabolism, which causes the
release of more fat molecules, thus
keeping the cycle going.

> SEE ALSO PAGE 4

Education, guidance
AS the premier non-government
organisation dealing with diabetes
in the country, the National
Diabetes Institute (Nadi) is
dedicated to spreading the word
on and assisting with prevention
and optimal management of
diabetes, its complications and
associated diseases.
This non-profit organises
activities and sessions aimed
at promoting early detection
and elevating best diabetes
management practices through:
l Talks, road shows,
exhibitions and counselling
sessions
l Screening for diabetes
and risk factors

l Publishing booklets, posters

and the NADI Diabetes Magazine
l Two conferences held
annually for healthcare
professionals: Diabetes Asia
Conference and Diabetes
Complications Conference
l Diabetes Resource Centre
called DCenters, offering
specialist services and
consultation as well as affordable
diabetes tests
l Health and diabetes talks
open to the public
l T-1 Club to provide assistance
to children with Type 1 diabetes
l DEWI Project to empower
and support diabetic mothersto-be

Know the disease

Here is a brief overview of the
types of diabetes:
l Type 1 The less common of
the two, Type 1 diabetes shows its
symptoms earlier in life.
Many people do not
understand this type of diabetes
and assume that it develops due to
lifestyle factors, but it can be
genetic, says Dr Lim.
The bodys immune system
destroys insulin-releasing cells,
thus inhibiting its production and
curtailing glucose absorption in
the blood.
Patients can face low blood
sugar (hypoglycaemia) or diabetic
ketoacidosis, which is caused by
acid build-up due to excessive fat
breakdown. The body tries to
convert fat into energy in the
absence of insulin to properly
regulate glucose conversion.

l Type 2 Previously known to

affect older, inactive folks, Type 2
diabetes today affects people at an
earlier age due
to the prevalence of unhealthy
lifestyles in the past few decades.

In this condition, the body

is unable to properly manage
glucose due to insulin resistance,
in which there is less glucose
uptake than necessary for energy
production.
As Type 2 gradually worsens
without proper care, pancreatic
function is affected as the beta
cells become unable to secrete
required amounts of insulin.
Together, the insulin resistance
and insufficiency make it hard
to control sugar levels.

l Diabetes insipidus This

rare type of diabetes is not related
to blood sugar level or insulin
function instead, the body is
unable to properly manage and
regulate fluids.
This causes extreme thirst and
excessive excretion of diluted
urine. Depending on the method
of disruption, diabetes insipidus
can be central (stemming from
a dysfunction of the pituitary
gland), nephrogenic (related
to the kidney) or gestational.
For John (not his real name),

It is important to understand and get the right treatment for your type of
diabetes.

a tumour near his hypothalamus

gland affected his bodys
antidiuretic hormone (ADH, the
hormone that regulates fluid
excreted by the kidneys)
production when he was just a
teenager, causing central diabetes
insipidus.

It was difficult to cope with

unquenchable thirst followed
shortly after with urination,
leaving me thirsty again, he
shares.
Fortunately, today I am able to
control the symptoms with ADH
pills daily.

SUNDAY STAR, 8 NOVEMBER 2015

DIABETES brings about a host of

complications relating to other
parts of the body, one of which is
diabetic retinopathy. As the name
suggests, this condition affects
blood vessels in the retina
(light-sensitive tissue) of the eyes.
According to Dr Pall Singh,
consultant ophthalmologist at Tun
Hussein Onn National Eye Hospital,
more and more younger people
are being affected by this
condition, which is known to be
the leading cause of blindness
among adults.
Patients with diabetic
retinopathy may not immediately
notice their vision deteriorating,
but over time, the condition can
worsen to cause vision loss in both
eyes, he says.
As an ophthalmologist,

world diabetes day 3

Getting your eyes checked regularly will go a long way in preventing diabetes-related eye complications.

Keep a watchful eye

approximately 30% of Dr Palls
patients are afflicted with diabetic
retinopathy.

Exploring effects

Dr Pall Singh.

The condition arises because

excess sugar in the blood can cut
off blood supply by blocking small
retinal blood vessels.
As it progresses, patients may
begin to have blurred sight, see
spots or experience dark, empty
areas in their line of vision.
In some diabetic retinopathy
cases, blood vessels may swell, leak
fluid or abnormally grow on the

surface of the retina.

On top of that, Dr Pall explains
that diabetics tend to develop eye
complications such as cataracts
(clouding of eye lens) much earlier
than the general population.
Another common concern is
diabetic-induced glaucoma
(damaged optic nerve fibres).
While diabetics cannot directly
prevent diabetic retinopathy, good
control of blood sugar, blood
pressure and cholesterol can delay
its onset.
This is why diabetics must
remain vigilant about the potential
complications of the disease.

Diabetes patients are

encouraged to check their eyes
once a year, including a dilated
fundus examination to detect early
diabetic changes. Check-ups should
be regular and not delayed until
they begin to experience vision
impairment, says Dr Pall.
He also advises healthy members
of the public to not take their eyes
for granted and get them checked
every two years, and every year
after the age of 50.

Elevating treatment
As with almost all other diabetic

conditions, the key management

method is control. No specific
treatment is prescribed in the early
stages unless the patient has
macular oedema, which develops
when the central area of the retina
becomes swollen with fluid due to
blood vessel leakage.
Laser surgery is only used to
treat diabetic retinopathy in its
advanced stages. The scatter laser
treatment applied helps shrink
abnormal blood vessels in the eye
within two or more sessions.
Severe bleeding would call for a
different surgical procedure called
a vitrectomy, during which blood is
removed from the centre of the
eye.
These methods seek to cure
complex complications, but Dr Pall
says advancement in medical
research has brought new hope to
early-stage diabetic retinopathy
treatment.
We can now be proactive in
treating the retina by injecting the
eye with anti-VEGF (anti vascular
endothelial growth factor) drugs,
which are able to reduce fluid
leakage and interfere with growth
of new blood vessels in the retina,
says Dr Pall.
Studies and research findings
vouch for the potential efficacy of
this treatment, which could play a
greater part in visual improvement
compared to laser surgery.

n For more information, contact

Tun Hussein Onn National Eye
Hospital.

SUNDAY STAR, 8 NOVEMBER 2015

4 world diabetes day

> FROM PAGE 2

The National Health and
Morbidity Survey report from 2011
indicates that one in seven
Malaysian children are obese, an
alarming jump from one in 19
reported in 2006.
It is easy to dismiss childhood
obesity as a temporary phase, but
the host of conditions that are
caused by obesity can stunt overall
development of growing children.
This is a major reason doctors
and health experts stress the
importance of proper nutrition and
adequate physical activity from as
early in life as possible.
We see more 20- to 30-year-olds
developing diabetes, but we are
also increasingly seeing this among
children. This is linked to
increasing obesity among the
young, which causes them to
develop risk factors such as high
cholesterol and high blood
pressure much earlier in life, says
Dr Mustaffa.
The hereditary aspect is also at
play according to Dr Mustaffa,
one of the reasons diabetes is so
prevalent in Malaysia is that a
growing number of diabetics who
live longer have children who are
more prone to developing Type 1
and Type 2 diabetes.
But genes do not solely influence
the development of Type 2 diabetes
it is triggered by controllable
environmental factors, which is
why medical professionals say the
condition is preventable.

Unhealthy lifestyle
habits such as constant
overeating can increase
ones risk of developing
diabetes.

Protection and vigilance

Yet, Type 2 diabetes affects more
and more people each year.
Parents do not merely pass
down their genes. They influence
childrens lifestyle habits and diet
from the moment they are born,
thus designing the environment
that directly influences health.
Children pick up dietary and
exercise habits, meal portion
control and overall lifestyle
management from those around
them, so unhealthy parents are

likely to raise children that are in

even poorer health.

Clearing the air

In an effort to tackle the growing
national issue of childhood obesity,
the National Coordinating
Committee on Food and Nutrition
of the Health Ministry released the
Malaysian Dietary Guidelines for
Children and Adolescents in 2013.
This guide outlined 15 key

messages for healthy children and

adolescents, from breastfeeding
to the breakdown of nutritional
requirement for optimum growth.
Guides such as these are
commonplace as the Health
Ministry is on its toes when it
comes to managing obesity and
its associated non-communicable
diseases.
With the wealth of authoritative
information available, members of
the public have better resources to

depend on for information.

Coupled with the improving
level of medical expertise in the
country and increased access to
health screenings at public and
private facilities alike, individuals
are encouraged to take matters
into their own hands by initiating
proactive action to guard
themselves and their families
against diseases such as diabetes.
Even diabetics are able to better
manage their condition and lead
more fulfilling lives thanks to these
factors, as long they are disciplined
in adhering to set rules and
regimes for diet and exercise.
Here are three key steps towards
a better, risk-free life:
l Keep weight within healthy
body mass index range (19 to 24). If
you are obese, losing as little as 5%
of body fat can make a difference
and reduce your susceptibility to
developing diabetes.
l Move about and exercise for
at least 30 minutes every day.
Obese people who have had long
periods of physical inactivity can
begin with light, simple aerobic
exercises and move on to brisk
walking.
l Maintain a balanced diet
rich in fibre and protein and
low in carbohydrate and fat,
complemented with an abundance
of fruits and vegetables. Meals
should be small and low in sugar
yet nourishing.

> SEE PAGE 8 FOR INFORMATION

ON WORLD DIABETES DAY

SUNDAY STAR, 8 NOVEMBER 2015

SUNDAY STAR, 8 NOVEMBER 2015

6 world diabetes day

Managing neuropathy
MOST people take foot care for
granted. To the diabetic, however,
caring for the feet is a serious
matter with unfortunate
consequences if neglected.
In diabetics, prolonged high
blood sugar level damages nerve
cells and causes tingling, impaired
sensitivity, numbness or pain.
Most often, this affects the
nerves to the feet as they are the
longest in the body. Loss of
sensation in the feet means that
sores or injuries may go unnoticed
and become ulcerated or infected.
Eventually, amputation of the
toe, foot or even lower leg may be
necessary if treatment is no longer
possible.
According to the World Health
Organization, diabetic neuropathy
is the most common complication
of diabetes. It has been implicated
in 50% to 75% of non-traumatic
amputations.

Foot care tips

Keeping blood sugar in control
is just the first step in avoiding
amputations caused by diabetic
neuropathy. Proper foot care is
also necessary to prevent or
reduce the risk of amputations.
Good foot care involves the
following:
l Inspect your feet daily to

check for cuts, sores, blisters,

cracks, redness, swelling or
other problems.
l Wash your feet daily with
warm water and a mild soap.
Dry them with a soft towel
and dry carefully between
your toes.
l Moisturise your feet with
lotion but avoid getting lotion
between your toes.
l Cut your toenails regularly.
l Avoid walking barefoot to
prevent injuries on the feet.
l Wear shoes that fit well.
l Attend to foot injuries
promptly.
l Undergo regular foot
examinations with a doctor
who will be able to identify
problems sooner than you.
The American Diabetes
Association recommends that
adult diabetics have annual
health screenings to detect
diabetic neuropathy.
Such a check includes noting
down your history, physical foot
inspection, neurological tests and
screening for diabetic peripheral
neuropathy (nerve damage of the
legs and arms).
In conjunction with World
Diabetes Day, Merck Sdn Bhd
is providing nerve tests in
pharmacies and during various

health events nationwide using a

biothesiometer.
By taking the nerve test, you
will be able to understand the
condition of your nerves better and
seek further medical consultation
or treatment if needed.
To avoid amputations, it is
important to both keep blood sugar
in check and practise proper foot
care and control nerve damage
that can cause it to happen.

Treating or slowing
down neuropathy
Neuropathy can be treated or
slowed down by providing nerve
cells with the nutrients that they
need to function properly,
especially vitamins B1, B6 and B12.
While a healthy person usually
has a sufficient supply of these
vitamins in the body, diabetics
often experience deficiency. The
longer a person has diabetes, the
worse this is and the more severe
the nerve damage becomes.
Therefore, diabetics need to
ensure that they get sufficient
amounts of these vitamins in their
diet or via a health supplement.
Neurobion is a health
supplement brand that has been
trusted for more than 50 years
and offers diabetic patients the
synergistic benefits of vitamins B1,

B6 and B12.
It has been clinically proven to
help manage diabetic neuropathy.
It nourishes your nerve cells to
help improve nerve function and
relieve nerve pain.
On top of that, Neurobion can

help you slow down the progress

of diabetic neuropathy. If you have
diabetes, come for Mercks nerve
tests.

n This article is brought to you by

Merck Consumer Health.

SUNDAY STAR, 8 NOVEMBER 2015

IN-DEPTH education and

awareness are important aspects of
diabetes management and control.
This is why the National Heart
Institute (widely known by its
Bahasa Malaysia acronym IJN)
opened its Diabetes Education
Clinic back in 2007 to advise
people with diabetes on healthy
eating and lifestyle changes,
preventing complications and
monitoring blood sugar levels.
Since then, it has expanded to
also offer services by visiting
endocrinologists to better manage
all aspects of the disease.
With the expertise of specialist
doctors, we are able to properly
address diabetes-related issues and
treat them as soon as possible,
says senior diabetes educator Siah
Guan Jian.

world diabetes day 7

Discretion in management
importantly, minimising or
eliminating refined sugar in foods
and drinks.

Prevention, control

Lifelong monitoring
The majority of those who seek
consultation at IJNs Diabetes Care
Centre are existing patients with
some type of heart disease who
must address their risk of
developing diabetes complications.
According to Siah, diabetes
educators advise patients from
pre-diabetic stage onwards
because the aspects of diabetes
care are wide ranging and
all-encompassing.
Patients are prescribed oral,
subcutaneous insulin injection or
pump insulin replacement therapy
based on their bodys ability to
regulate and neutralise sugar

Consultation and guidance provided at IJNs Diabetes Care Centre ensure patients are aware of how the disease
works so they can better understand management measures.

levels, but beyond that, several

lifestyle components are taken into
account.
People with diabetes are made
aware that their condition is
manageable with proper blood
sugar levels, which involves
dietary changes and exercise on
top of the prescribed insulin
therapy, says Siah.
Patients can become
hyperglycaemic (high blood sugar
level) or hypoglycaemic (low blood
sugar level). To avoid this and

reduce the long-term damage of

diabetes, they must be cognizant of
their blood sugar levels.
These patients are encouraged to
perform regular self-monitoring of
blood glucose at home using testing
strips available at pharmacies and
undergo HbA1c testing so doctors
can assess their average blood
sugar control over the past three
months.
It is important to not only
monitor the readings, but respond
with appropriate controlling

measures. This is when patients

must exercise self-discretion and
discipline, says Siah.
Although it is a lifelong
condition, people with diabetes can
manage their lifestyle to control its
effects. As their health improves,
they can go on to live normal lives
with lower risks of complications.
Among other measures, this
involves maintaining a high-fibre
diet with appropriate carbohydrate
intake, eating regular meals in
small portions and, most

It can be hard to eat and live

healthy with sweet and savoury
foods available at all hours of the
day at Malaysian eateries and fast
food outlets.
When combined with the
generally sedentary lifestyles
of most citizens, it comes as no
surprise that the obesity rate
continues to rise.
Even those without family
history of diabetes can develop this
disease, and Siah says the centre
has even attended to teenage
patients with Type 2 diabetes.
Everyone should at least go for
yearly check-ups and go for blood
glucose testing to stay on top of
their health risks, she says.
The heart screening programmes
at IJNs Wellness Centre include
blood glucose testing. Besides
guidance and consultation, the
Diabetes Care Centre also offers
diabetes education, comprehensive
foot examination and
endocrinologist consultation.

n For more information,

contact IJN.

SUNDAY STAR, 8 NOVEMBER 2015

8 world diabetes day

THOUGH diabetes is a noncommunicable disease it is not

contagious its spread throughout
the world is accelerating at an
alarming rate.
According to the International
Diabetes Federation (IDF), the
number of people who have a form
of diabetes in the world is larger
than the population of the United
States.
To bring awareness to the
diabetes epidemic and growing
threats it poses, the IDF and the
World Health Organization (WHO)
created World Diabetes Day, which
falls on Nov 14, in 1991. It is now
the worlds largest diabetes
awareness campaign and draws
attention to the issues that are
of paramount importance in
preventing the disease.

A growing health threat

Navigating the disease

The IDF has gathered its
research and statistics into the IDF
Diabetes Atlas. First published in
2000, it is produced biannually in
collaboration with international
experts and contains data on
diabetes cases, prevalence and
expenditure on the national,
regional and national levels.
One of the key findings of the
sixth edition of the Diabetes Atlas,
published last year, is that 387
million people have diabetes and
the number will rise to 592 million
by 2035 in 20 years.
Of this, 75 million are in SouthEast Asia and this figure will rise to

The number of people living with diabetes is continually rising. Leading an active lifestyle as a family can prevent you
and your loved ones from developing this disease.

123 million by 2035.

Here are a few more important
statistics from the Diabetes Atlas:
l The greatest number of people
with diabetes are aged between 50
and 59

l More than 79,000 children

worldwide developed Type 1
diabetes in 2013
l More than 21 million live
births were affected by diabetes
during pregnancy in 2013

The research also found that the

number of people living with Type
2 diabetes is increasing in every
country and that the disease
caused 4.9 million deaths last year;
one person dies of diabetes every

seven seconds.
The Diabetes Atlas calculated
that diabetes caused about 1.19
million deaths in South-East Asia,
about 54% of which were of people
under the age of 60.
However, the region has the
lowest diabetes-related
expenditure per person with
diabetes, totalling only US$7bil
(RM30.15bil).
Compared to the US$310bil
(RM1.335 trillion) total expenditure
by countries in North America and
the Caribbean, which have a total
population that is about half that of
South-East Asia, this is a dismal
figure.
What is more worrying is that
in this region, almost half of
the people with diabetes are
undiagnosed. This means that the
overall figures of people living with
diabetes and those who die from it
are actually higher.
Also, it means that people who
remain undiagnosed do not get the
treatment and medication required
to manage the disease.
The latest IDF Diabetes Atlas
with new global figures will be
released on Nov 12 and will be
made available on www.idf.org/
diabetesatlas

> SEE NEXT PAGE

SUNDAY STAR, 8 NOVEMBER 2015

world diabetes day 9

Halting the diabetes epidemic

> FROM PREVIOUS PAGE
This year, the World Diabetes
Day campaign is a year-long
attempt to reflect the realities
faced by people living with
diabetes, focusing on healthy
eating as a key factor in fighting
the disease and as a cornerstone of
global health and sustainable
development.
Here is how you can be a part of
the World Diabetes Day campaign,
spread awareness of the disease
and prevent yourself and your
family from developing diabetes.

Act to change your life

today
IDF and WHO statistics show
that almost 600 million people may
be living with Type 2 diabetes by
2035. Delayed diagnosis means
that many people with Type 2
diabetes suffer from at least one
complication of the disease by the
time they are diagnosed.
A generally healthy lifestyle
can prevent up to 70% of Type 2
diabetes.
A healthy diet containing
leafy vegetables, fresh fruits,
wholegrains, lean meat,
unsweetened yoghurt and nuts
can help reduce a persons risk
of Type 2 diabetes and reduce
complications in people who

already have diabetes.

While Type 1 diabetes cannot
be prevented, a healthy lifestyle
is an important part of effective
management of the disease.
Encouraging healthy eating
habits in young children is key
to halting the rise of the diabetes
epidemic. Further, by ensuring
the health of future generations,
overall sustainable development
can be assured.

Act to change the world

tomorrow
Diabetes does not only affect
individuals suffering from the
disease and their families; it is a
growing burden on communities
and economies. According to IDF
statistics, global health spending
to treat diabetes and manage
complications was estimated to
cost US$612bil (RM263.6 trillion)
last year.
Up to 11% of total healthcare
expenditure in every country
across the globe can be saved
by tackling the preventable risk
factors of Type 2 diabetes, and
up to 70% of Type 2 diabetes cases
can be prevented or delayed by
adopting healthier lifestyles. This
is equivalent to up to 150 million
cases by 2035.

Access to affordable healthy food

is essential to reducing the global
burden of diabetes and ensuring
global sustainable development.
However, a healthy diet is more
expensive than an unhealthy one,
which means that the number of
people with diabetes in low- and
middle-income countries will
continue to grow, posing a threat
to sustainable development.
In Malaysia, the Health Ministry
is already working with state
governments and health
professionals to spread awareness
about the disease and the
importance of healthy lifestyles.
On the ground, ordinary people
can push for improvements in
lifestyle by engaging with
community leaders and creating
opportunities for activities and
exercise in the community,
especially among young people.
Large-scale improvements to
accessibility of healthy food will
take some time, but can be
achieved simply by people making
any healthy food they can afford as
their first choice. Economies of
scale dictate that prices go down
as demand goes up.

n For more information about

diabetes and the World Diabetes
Day campaign, visit www.idf.org

Make HEALTHY EATING

a RIGHT, not a privilege
CONSISTENTLY

HIGH blood

DIABETES

SUGAR LEVELS

If left unmanaged can result

in serious health complications

DIABETES

1. CHINA

Worlds

is the
rd most populous
country

2. INDIA

3. DIABETES
4. USA

Global healthcare
expenditure

US

in

IS SPENT ON
DIABETES CARE

HEALTHY EATING
and physical
activity

DIABETES poses
a THREAT to
GLOBAL
SUSTAINABLE
DEVELOPMENT

COULD
PREVENT

UP TO

70%

of type 2
DIABETES

IS AN
IMPORTANT

PART OF
EFFECTIVELY
M A N AG I N G

type 1
DIABETES

All figures from the IDF Diabetes Atlas Update 2014

HALT the diabetes EPIDEMIC

www.worlddiabetesday.org
#WDD

SUNDAY STAR, 8 NOVEMBER 2015

10 world diabetes day

Recognising the symptoms

WITHIN the last 10 years, the
percentage of diabetes cases
among Malaysian adults has not
only risen but doubled to 20.9%.
According to Dr Lim Siang Chin,
endocrinologist and physician at
Mahkota Medical Centre, part of
this high percentage is due to the
obesity rates in Malaysia.
In the past two decades,
Malaysians have begun to lead a
less healthy lifestyle, contributing
to the nation reporting the highest
obesity rates in South-East Asia.
Obesity is one of the causes of
insulin resistance, she says.
Insulin is the hormone produced
by the pancreas that helps glucose
(a type of sugar) to enter the bodys
cells for energy.
When the pancreas is damaged
or unable to produce sufficient
insulin (Type 1 diabetes) or if the
bodys cells begin to develop
insulin resistance (Type 2 diabetes),
the glucose levels in the blood will
rise and become abnormally high.
Unlike Type 2 diabetes, Type 1
diabetes is not caused by lifestyle
factors. The condition mainly
affects younger children but
adolescents and adults can also
develop it, says Dr Lim.

Early diagnosis
Symptoms of diabetes include

Regular check-ups and comprehensive screenings will keep diabetic

complications in check.

being constantly thirsty, needing to

frequently urinate, experiencing
weight loss and having blurred
vision.
However, many people
(especially those who have
developed Type 2 diabetes) only
recognise the need to seek medical
attention when their symptoms
significantly worsen and this may
only happen after a few years.
Many of our patients never get
checked for diabetes because they
still feel generally good.
It is only when they find

something amiss with their vision

or urine would they seek medical
treatment, says Dr Lim.
When patients come in after
realising something is wrong, it
usually means the condition has
worsened and requires additional
treatment and more expensive
medication.
But this may be too late. In
serious cases, patients could
experience kidney failure, while
others may require their feet to
be amputated as the condition
reduces blood supply to the

Dr Lim says that a full body

screening keeps individuals aware
of their diabetes risk and allows
early treatment.

feet, Dr Lim adds.

Specialised facility
The Mahkota Diabetes Centre
aims to provide diabetic care
services as a precautionary
measure to battle the condition.
It also strives to educate patients
on the common diabetic symptoms,
highlight the importance of a
regular full body screening and
inspire people to lead healthier
lifestyles.
A full body screening helps

patients be constantly aware of

their diabetes risk and to treat the
problems before the condition
causes further complications,
says Dr Lim.
The team at the centre, which
consists of consultants, a diabetic
educator and physiotherapist,
conducts a wide range of tests that
include a diabetic retinopathy
screening programme (to monitor
the health of the human eye), blood
tests (to monitor cholesterol), urine
tests (to monitor protein in the
urine) and foot checks.
After all the tests have been
completed and assessed by a
dietician, a physician will advise
patients on their health status.
All diabetes patients are advised
to have their comprehensive body
screening of possible complications
at least once yearly.
Besides screenings, at-risk adults
can take fasting plasma glucose
tests (finger pricking) to help detect
early diabetes or pre-diabetes.
HbA1c test is a tool to assess
average glucose control. This test is
very important as it can accurately
predict diabetes complications.
Diabetes patients are
recommended to undergo HbA1c
blood check every three months.

n For more information, contact

Mahkota Diabetes Centre.

Keep active
DIABETES is a lifelong disease with no
cure. However, daily care can help to control
blood sugar level and manage complications
arising from diabetes.
Diabetes has a negative impact on red
blood cells and causes thickening of the
blood. This increases the resistance of blood
flow and causes poor blood circulation that
lead to high blood pressure and high
cholesterol.
Diabetes sufferers are twice as likely to
suffer from heart attacks and stroke
compared to healthy adults and the average
life expectancy of diabetes sufferers may be
reduced by up to 12 years.
Due to poor blood circulation and low
body oxygen, diabetes can cause severe
damage in the nerves especially in the arms
and legs.
Diabetes can also affect vision when it
damages the tiny blood vessels in the retina,
which causes it to leak fluid or bleed, leading
to distorted vision and blindness.
Diet and lifestyle can help to minimise the
health complications associated with
diabetes. Keeping track of carbohydrate
consumption, increasing fibre intake and
maintaining a healthy balanced diet helps in
controlling blood sugar levels.
Regular exercise such as brisk walking
and swimming for about 30 minutes a day
helps to strengthen the heart and lungs and
help with weight loss.
As many of these health complications
occur due to poor blood circulation, it is
important to improve blood circulation and
body oxygen level.
Owell BIO-Ge Titanium Health Accessories
are specifically designed to improve blood
circulation and body oxygen levels using
Germanium (BIO-Ge) health minerals.
Each necklace, bracelet and timepiece
contains BIO-Ge health minerals that help
to minimise health complications associated
with diabetes through the positive hole effect
and far infrared rays.

Owells BIO-Ge
Titanium Heath
Accessories are
designed to improve
blood circulation,
minimising the
complications caused
by diabetes.

Owell will be bringing health check

facilities closer to you through its popular
3 Step Health Check in support of World
Diabetes Day.
Using proprietary diagnostic tools, the
approachable health consultants help to
check your body oxygen level and pulse
rate, vascular age, and blood capillary
shape and blood circulation.
The no-obligation, non-invasive health
check only requires minutes to complete
and provides you with a clearer picture of
your health.
Owell health consultants will also share
with you how you can further enhance and
maintain your health.
In support of World Diabetes Day and to
kick-start your journey towards greater
health, Owell is providing the 3 Step Health
Check and giving away a BIO-Ge Titanium
Health Pendant with any purchase of two
BIO-Ge Titanium Health Accessories.

n For more information, call 012-785 1368.

SUNDAY STAR, 8 NOVEMBER 2015

world diabetes day 11

Healthy
sweet life
IN the process of supporting
their loved ones to ensure that
they stay healthy and happy,
caregivers of diabetes patients
often end up doing the opposite.
Caregivers tend to want to
take charge of what patients
should or should not eat. For
instance, sweetened beverages
and sweet delights such as
cakes, cookies and desserts are
commonly banned from the
diabetics diet.
Often, it reaches the extent of
over-controlling what diabetes
patients eat. However, should
they be deprived entirely of
sweet delights?
Overwhelmed after learning
that they are sick, some patients
undergo stages of depression
before accepting the reality of
the disease.
Caregivers should help smooth
out the transition by making the
necessary changes, especially
diet modification, gradually.
Abrupt changes not only
frustrate patients but also make
them lose hope in managing
their blood sugar levels.

Sugar craving
Patients who have long been
taking sweet food habitually
will find it difficult to give up
muffins, puddings and cakes in
their diet.
As a result, they might eat
these forbidden foods behind
their caregivers back.
This has become the common
complaint of most caregivers
who think they have been taking
good care of the patients diet,
yet the sugar level of their
loved one does not respond
accordingly.
Preference for sweetness is
not acquired within a day or
two. Our body learns and
responds to sweet food from the
time we were first exposed to it.
The more we are exposed to
sweetness, the higher the dose of
sweetness required to satisfy our
taste buds the next time. This is
termed sugar addiction.
Sweetness from food sends a
signal to the body that food or
energy supply is en route. If we
decide to remove sweetness or
sugar totally from our diet, our
body would automatically think
that nothing is being fed to the
body, causing the body to fight
back by requesting for more
food.
Alas, food craving ensues
and the vicious cycle of
uncontrollable behaviour
towards sweet food and sugar
spike starts all over again.

Understanding calorie
Although sugar is often
accused of being the culprit of
diabetes, medical practitioners
can tell you that sugar is not the

reason for diabetes; the calorie

content is.
Every gramme of sugar
provides four calories and food
that is high in sugar is usually
packed with calories.
Diabetics need calories and
energy too, but not too much.
The energy needed is about
1,800 calories a day, depending
on body weight.
If one takes more calories
than recommended, blood
sugar level can easily go up.
To prevent sugar spike, it is
best to avoid sugar loading.
This can be done by spacing
out the calorie intake throughout
the day or simply by sparing
calories. A useful tip to achieve
this is to always opt for lowercalorie alternatives.
However, never attempt to
achieve zero calories. This is
made possible by adding
artificial sugar like aspartame
into coffee, which adds virtually
no calories to the drink.
As artificial sugar evokes the
sweet sensation, the body would
expect the delivery of calories.
But because artificial sugar only
provides a sweet stimulus with
no calories, the body will crave
for the calories it does not
receive, leading to binge eating
during the next meal.
Many scientific studies have
emerged with proof on the
negative effects (such as obesity)
of taking artificial sugar such as
aspartame.

Enjoy sweetness with

less calories
Many caregivers try their best
to look after their loved ones by
attempting different recipes to
satisfy their taste buds.
However, many find it
challenging to prepare a healthy
yet palatable meal.
With Kordels Sweetsant from
France, preparing your next
diabetic meal becomes easier.
Containing maltitol sourced
from cereals, it is as sweet as
sugar but with only half the
calories.
Moreover, Kordels Sweetsant
is a low glycaemic index (GI)
food. Unlike sugar, which has a
high GI of 68, Sweetsants GI is
only 29.
With Kordels Sweetsant, you
can now enjoy the previously
forbidden foods in moderation.
No special recipe is required as
you can replace sugar with
Kordels Sweetsant. This gives
you the same sweetness with no
worries.
This information is brought to
you by an in-house pharmacist
at Cambert (M) Sdn Bhd.

n For more information,

call 1300 881 712 or e-mail
ask-kordels@cambert.com.my

Containing maltitol from

cereals, Kordels Sweetsant
provides the same sweetness
as sugar but with only half the
calories.

SUNDAY STAR, 8 NOVEMBER 2015

12 world diabetes day

Life-saving knowledge
A MAJOR part of preventing diabetes is
knowing what to look out for.
At the current rate of diabetes prevalence,
the World Health Organization projects that
it will be the seventh leading cause of death
by 2030. In 2014, the worldwide statistic for
adult deaths caused by diabetes was 9%,
placing the disease in the top 10 leading
causes of death.

Understanding treatment
Diabetes may be gaining notoriety around
the world, but according to Siah Guan Jian,

senior diabetes educator at the National

Heart Institute (IJN), many remain unaware
of important details about the disease and
are misled by inaccurate information,
including on side effects from treatment.
This leads to many refusing their best
treatment options.
There have been patients who were
apprehensive about taking oral medication
because they heard that it causes kidney
failure. In actuality, it is poorly managed
diabetes that can cause kidney failure and
refusing medication will only exacerbate the
condition, says Siah.

Insulin replacement therapy is widely

applied to manage diabetes and plays a
crucial role in providing the glucoseconverting hormone to those who are
unable to produce it or can only produce
small, insufficient amounts.
The type of treatment prescribed depends
on individual requirements and reactions to
insulin replacement therapy with different
onset time (how quickly it starts to work),
peak time (period of time when it is most
effective in lowering blood sugar) and
duration (how long the insulin remains
working in the body).
You can start proactive action against this
lifelong condition by equipping yourself and
loved ones with vital information on the
disease. Consult a medical professional if
you have any serious qualms.
Remember these for diabetes prevention
and early detection:

Risk factors
l Family history of diabetes
l High blood pressure
l High cholesterol level
l High blood triglyceride and low HDL
(high-density lipoprotein) levels

l Pre-diabetes diagnosis
l Obesity, especially excessive fat in
abdominal area

l Antibody presence (Type 1 diabetes)

Symptoms
Frequent thirst and urination Kidneys
are forced to work harder in filtering excess
glucose, which exits the body in the form of
urine along with other liquids.
You urinate more because of this
increased nephrogenic action, which in turn

Go for a check-up and speak to a doctor if you

are concerned about developing diabetes.

deprives the body of essential liquids and

tissue moisture, leaving you thirsty.

l Weight loss Excessive urination also

forces calories out of the body and prevents
the sugar we eat from reaching the bodys
cells. This deprives cells of energy, which
alerts the brain that you are hungry.
In Type 1 diabetes where insulin is not
produced, the hunger-weight loss cycle goes
on due to constant urination caused by the
bodys inability to convert glucose. The body
is simply unable to use food for energy,
leaving you thin and malnourished despite
eating well.
l Blurred vision Optical tissues are also
affected by dehydration, causing eye lens to
lose moisture. This negatively influences the
ability to focus and can cause blood vessel
damage over the long term.
l Fatigue Major organs are affected as
they are dehydrated by constant removal of
fluids from their tissues while the kidneys
continue to remove excessive sugar through
urine.

The natural solution

ACCORDING to a news report from the
International Diabetes Federation, 387
million people have diabetes and the figure
is estimated to increase to 592 million by
2035.
There were 3.2 million cases of diabetes
in Malaysia, which were responsible for the
death of 34,422 people last year.
Prof Dr Mohd Ismail Noor, president of the
Malaysian Society for the Study of Obesity,
stated that Malaysia has the highest rates for
both obesity and diabetes in South-East Asia.
Diabetes is a health condition
characterised by high blood sugar levels in
the body. Type 2 diabetes is the most
common type of diabetes, accounting for at
least 90% of all cases.
Risk factors include physical inactivity
and bad diets or if someone in your family
has diabetes, you have a higher risk of
developing it.
The symptoms may not be obvious for
some individuals. It is therefore important to
get your blood sugar checked regularly and
monitored closely. If poorly managed,
diabetes can lead to several life-threatening
complications such as heart disease, stroke,
kidney failure, nerve damage, blindness and
lower-limb amputation.
The good news is you can prevent or delay
the onset of Type 2 diabetes with positive
lifestyle modifications. Maintaining a healthy
weight, exercising regularly, following a
healthy eating plan and quitting smoking
may help lower the risk of this deadly
disease and its complications.
Some herbs and spices such as fenugreek,
cinnamon and bittergourd offer natural
alternatives to help improve blood sugar
levels.

Certain herbs and spices can aid with blood

sugar management.

Fenugreek is effective in lowering blood

sugar as it helps increase feeling of satiety
and slows down the absorption of glucose
from food.
It also stimulates insulin production when
blood sugar levels are high. Cinnamon has
also gained much attention for its positive
effects on blood sugar levels.
It contains a water-soluble polyphenol
compound called methylhydroxychalcone
polymer (MHCP), which is able to mimic
insulin, increasing the uptake of blood sugar
by cells.
Bitter melon, turmeric and olive leaf are
among other herbs that are known to be
effective in managing blood sugar levels.
This informational article is brought to
you by VitaHealth.

n For more information, call VitaHealth at

03-7729 3873.

SUNDAY STAR, 8 NOVEMBER 2015

world diabetes day 13

Kick-start your workout

INACTIVITY promotes Type 2
diabetes and every hour you
spend watching television
instead of participating in
physical activities increases
your chances of developing
diabetes by 14% (source:
www.hsph.harvard.edu).
Working your muscles more
often and intensely improves
their ability to use insulin and
absorb glucose, which puts less
stress on your insulin-making
cells.
Findings from the Nurses
Health Study (source:
www.channing.harvard.edu/nhs/)
and Health Professionals Followup Study (source: www.hsph.
harvard.edu) suggest that
walking briskly for 30 minutes
every day can reduce the risk
of developing Type 2 diabetes
by 30%.

Begin your healthy

lifestyle today
Get started on your healthy
lifestyle today with the
NordicTrack T13 treadmill.
The treadmill is equipped
with impressive features
designed to make your workouts
more effective and enjoyable at
the comfort and convenience of
your own home.
This treadmill features a
smooth and powerful 2.75 CHP
DurX Commercial Plus Motor,
20-inch (50.8cm) x 60-inch
(152.4cm) tread belt.
Track your total calories
burned and your workout
progress with a six-inch
(15.2cm) large backlit display
and enjoy your workout with an
iPod-compatible music port and
the AutoBreeze workout fan that
automatically adjusts its speed
to match your workout speed.

Exercise is
made
convenient
with the
NordicTrack
T13 treadmill.

intensity and calorie burn. You

can choose to stay focused on
your current mode or easily
scroll through various settings.

l FlexSelect cushioning
The adjustable treadmill
cushioning offers two different
modes superior impact
reduction and joint comfort as
well as a surface that likens to
running on road.

l Convenient usage
Fold your treadmill up and
out of the way for convenient
cleaning and storage.
A hydraulic dampening spring
does the heavy lifting for you,
making it easy to fold your
treadmill and save precious
floor space.

Get a head start today

Performance features of the

NordicTrack T13 treadmill
include:
l 32 workout apps
Get the training you want
with built-in workouts designed
by a certified personal trainer
that target calorie-burning,
incline, speed or intensity goals.

The NordicTrack T13 treadmill

is now available exclusively at
all Fitness Concept outlets
nationwide.
Fitness Concept is Malaysias
Largest Fitness Specialist Chain
as certified by The Malaysia
Book of Records with 45 outlets
in leading shopping malls
nationwide.
Fitness Concept is running a
year-end sale promotion with
exciting deals on treadmills,
crosstrainers, exercise bikes,
gym stations and fitness
accessories.
Enjoy up to seven years
warranty for the NordicTrack
T13 (terms and conditions
apply).

l 1Touch speed and incline

controls
Take your speed up to 20kph
and incline up to 12% with the
touch of a button to increase

n For more information, call

03-7726 7787 or e-mail your
enquiries to enquiries@
fitnessconcept.com.my or visit
www.fitnessconcept.com.my

Impressive features

The FlexSelect cushioning allows you to switch modes to simulate

running on different surfaces.

The NordicTrack T13 treadmill

sports impressive performance
features a variety of workout
apps, one-touch controls and
cushioning, all to suit your various
exercise needs.

SUNDAY STAR, 8 NOVEMBER 2015

14 world diabetes day

KEEPING a diabetic diet involves controlling

blood sugar (glucose) level and managing
weight. An ideal diet for diabetics is
naturally rich in nutrients and low in fats
and calories with an emphasis on fruits,
vegetables and wholegrains.
Eating excess calories and fat causes the
body to respond by creating an undesirable
rise in blood glucose.
If not kept in check, this can lead to health
issues such as hyperglycaemia and chronic
complications such as nerve, kidney and
heart damage.

Getting your diet right

Complex carbohydrates and
fibre-rich foods such as fruits
and vegetables should make up
the main part of your meals.

What to include
Complex carbohydrates and fibre-rich
foods should make up the main part of your
meals. These are not so easily broken down
to blood glucose and will keep you fuller for
longer without causing a high glucose spike.
Examples are fruits, vegetables and
wholegrain products.
Since it is common for Malaysians to
include white rice and bread as well as foods
with high sugar content such as breakfast
cereals in their diet, diabetics should find
healthier alternatives such as brown rice,
wholewheat or wholegrain bread and rolled
oats.
A diabetic diet should also include good
fats that contain monounsaturated and
polyunsaturated fats as these can help lower
cholesterol levels if taken sparingly. Foods
with good fats include almonds, walnuts,
avocados and olive oil.

What to avoid
Diabetics should learn to avoid foods high
in saturated fats, trans fats and cholesterol as
these accelerate the development of clogged

important to control your sugar intake

and reduce or completely cut out refined
sugar, which is often found in packaged
and processed sweets or baked items, soft
drinks, and flavoured foods such as
flavoured yoghurts and milk.
You can make soft drinks at home using
sparkling water flavoured with lemon or
lime juice and you can use healthier
ingredients in your homemade sweets.
For example, instead of having ice
cream from the tub, blend up frozen
bananas to make a creamy frozen treat.
You can add cinnamon or coconut flakes
to give it extra flavour.
Try to buy natural-flavoured products
such as natural yoghurt and sweeten it
with fruits or honey.

Eat out wisely

and hardened arteries.

Saturated fats are found in high-fat dairy
products and animal protein such as beef,
sausages and bacon, trans fats in processed
snacks and baked goods, and cholesterol in
high-fat dairy products, egg yolks, shellfish,
liver and other organ meats.
As these foods often exist in the meals
cooked by food outlets, diabetics should

always be aware of the ingredients being

used in their dishes.
For example, fried noodles and rice often
contain a lot of oil and fast foods often use
processed meat.
The same goes for store-bought items,
which often contain high amounts of sugar,
sodium or preservatives.
Check the glycaemic index (GI) of food
items before buying or consuming. The GI
indicates how quickly a food turns into blood
glucose in your system.
Foods with high GI cause a greater spike
in blood sugar levels compared to those with
low GI, such as complex carbohydrates.
Try to consume more low-GI foods but
always be sure to check what they contain
before buying.

Sweet tooth satisfaction

While it may not be necessary for
diabetics to completely cut out sugar, it is

One of the biggest problems diabetics

face is how to manage their food intake
when they eat out.
Since Malaysian food outlets mostly
offer foods high in fats, sodium,
cholesterol and sugar, diabetics must be
particularly careful when it comes to
making choices when they dine out.
Here are some important things you
should consider when you dine out:
l Do you know whats in the dish? If
the menu does not say, be sure to clarify
with the waiter or cook. Avoid foods that
are breaded or fried too as these include
added fats and carbohydrates as well as a
high content of oil.
l Try to eat the same portion as you
would at home. If the serving size is
bigger than usual, ask if you can share it
with someone else or take away the
leftovers.
l Request toppings and flavourings
such as cream and gravy to be given on
the side so you can control how much to
add to your main meal.
l If you can substitute something with
a heathier option, go for it. For example,
instead of chips with your burger, get a
salad without a high-calorie dressing.

Healthy orange and poppy seed muffins

Ingredients:

l 3 tbsp chia seeds

l 2 large organic oranges, juiced and
zested

l 300g almond meal

l 2 tbsp honey
l 1/4 cup poppy seeds
l 3 eggs
l 1 tbsp lemon juice
Instructions:
Preheat the oven at 160C. Mix chia
seeds with six tablespoons of water in a
small bowl. Leave aside for chia gel to
form.
In a large mixing bowl, combine orange

juice and zest, almond meal, honey, poppy

seeds, eggs and lemon juice. Mix manually
or with a kitchen mixer until well
combined. Fold chia gel into the muffin
mixture.
Grease muffin tray with vegetable oil or
line individual muffin slots with baking
sheet. Spoon mixture into nine or 10 muffin
slots. Bake at 160C for 35 to 40 minutes or
until a skewer inserted in the middle of a
muffin comes out clean.
Serve and enjoy with tea or coffee.
Muffins can be refrigerated and kept for up
to five days.
Source: denisechewsnutrition.weebly.com

SUNDAY STAR, 8 NOVEMBER 2015

AT this years recent meeting of the

European Association for the Study
of Diabetes, researchers from the
University of Texas Health Science
Center presented a study of a
three-and-a-half-year-old girl with
Type 2 diabetes, one of the worlds
youngest sufferers of the chronic
disease.
They noted that the childs
diet provided evidence of poor
family nutritional habits with
uncontrolled consumption of
calories and fat.
According to the European
Society of Cardiology, carbohydrate
digestion and absorption can be
slowed down by choosing foods
with a low glycaemic index (GI).
The GI allows identification of
the absorption rate of glucose from
carbohydrate-rich foods into the
bloodstream.
Starchy foods such as white rice
and highly processed grains are
usually high in GI and low in fibre
content, which could raise blood
sugar level almost instantly. Hence,
daily intake of it should be limited.
Decreasing the GI in everyday
foods is most practical and best
obtained by increasing the fibre
content in your diet, particularly
the highly viscous soluble fibres
such as oat beta-glucans.
You can just add one to two
scoops/sachets of Oat BG22 oat
bran powder (9g to 18g) into a
bowl of rice porridge or into three
rounded tablespoons of cooked
oatmeal in a bowl.
This will add more fibre to your

world diabetes day 15

For a healthy heart

Oat BG22 oat bran powder.

One packet of Oat BG22 Crispy Cereal provides 3g of oat beta-glucan.

meal, especially the viscous oat

beta-glucan of 1.8g to 3.6g for
optimal health effect.
Healthy eating begins at home.
Sprinkle a teaspoonful of Oat BG22
oat bran powder into your
childrens favourite beverage or
start their mornings with a hearthealthy breakfast such as Oat BG22
Crispy Cereal with some fresh
fruits.
Dr Robert E. Steinert, clinical
trial manager and scientist for DSM
Nutritional Products based in
Switzerland, attested that recent GI

testing in collaboration with

Glycemic Index Laboratories,
Canada, confirmed Oat BG22
Crispy Cereal as a low-GI food (less
than 55) compared to dextrose
used as control in 10 healthy
subjects.
For people with diabetes,

Attention
to the feet
DIABETICS are highly prone to foot
complications due to diabetic neuropathy,
which is nerve damage that can cause
numbness of the feet.
According to Dr Harikrishna K. R. Nair,
head of the Wound Care Unit at the
Department of Medicine, Hospital Kuala
Lumpur, approximately 1.5 million diabetics
suffer from foot complications yearly, and in
many cases, their infected wounds are left
untreated. In fact, diabetic foot ulcers are
the most common foot wound among
Malaysians.
Dr Nair explains that there are three types
of nerve damage: sensory, autonomic and
motor neuropathy.
Sensory neuropathy is characterised by
numbness of the feet or insensate feet or
abnormal sensations such as pins and
needles, autonomic neuropathy is
characterised by dryness of skin, which can
lead to cracks, while motor neuropathy
involves the gradual weakening of muscles
that eventually waste away.
Muscle atrophy can increase pressure on
the skin, causing it to break and form a
wound, he says.
Besides that, the compromised immune
systems of diabetics can make them more
susceptible to infection and vascular
abnormalities can interrupt blood supply
to the feet as blood vessels are damaged.
These patients can be helped as long as
the infected wound does not develop into
gangrene, after which point not much can be
done to save the affected area the foot or
part of it has to be amputated. This calls for
greater caution and care among those living
with diabetes.
Diabetics must ensure their feet are
always clean, wear proper footwear, and
tend to any wound immediately to prevent
infection. Wounds must be thoroughly

Diabetics should perform regular foot checks

to quickly identify abnormalities.

assessed, cleaned and dressed, says Dr Nair.

Regularly checking the feet will also
allow diabetics to identify any cuts or
abnormalities as soon as possible, even
though they may not be able to feel those
injuries. Dr Nair recommends using a mirror
to check the bottom of the feet, too.
Diabetic wounds are easily infected,
especially if the patient is also experiencing
renal failure as it restricts blood supply to
the feet.
However, Dr Nair explains that this
situation can be managed with greater
vigilance and constant management of blood
sugar levels.
Eighty-five percent of all diabetic foot
wounds can be prevented with yearly foot
check-ups at the hospital or health centres as
well as regular monitoring by diabetics
themselves, he says.

n This article is brought to you by Soza.

monitoring and being mindful

about their total carbohydrate
intake is important for achieving
glycaemic control, he says.
Based on the data, Oat BG22
Crispy Cereal is a snack solution
with a low GI and a low glycaemic
load (GL) (less than 16g of total
carbohydrates) and, therefore, a
good alternative to commonly
consumed sugary snacks.
Containing only 102 calories, one
packet of Oat BG22 Crispy Cereal
provides 3g of oat beta-glucan,
more than 6g total fibre, 4g protein
and laboratory-tested low-GI and
low-GL cereal.

Healthy eating is important for

everyone, including people living
with diabetes.
Enjoying healthy foods and
staying active will help manage
blood glucose levels and body
weight.
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sunday Star, 8 november 2015

16 world diabetes day

The International Diabetes

Federation estimates 382 million
people have diabetes worldwide
and reported 3.2 million cases in
Malaysia last year.
But did you know that 85% of all
amputations caused by diabetes
are preventable with proper
management?
People with diabetes have an
increased risk of developing a
a number of serious health problems
that affect the heart and blood
vessels, eyes, kidneys and nerves.
One of the most feared
a complications of diabetes is losing
a limb. An amputation caused by
diabetes occurs every 20 seconds
a somewhere in the world. It is
? debilitating, causing reduced
quality of life and being a financial
burden to sufferers.

Save
a limb

What is diabetic foot?

People with diabetes have very
high blood sugar levels and over
time, this can damage the nerves,
decreasing a persons ability to
notice pain and pressure.
Losing these sensations can
increase the risk of developing
calluses on pressure spots and
getting injured.
Nerve damage can also weaken
foot muscles, which can result in
change of foot shape.
Elevated blood sugar levels can
also damage the blood vessels and
deprive the foot from getting
enough blood and oxygen, making
healing of tissues harder.
Consequently, minor foot
injuries such as cuts and blisters, if
not properly managed, can cause
ulcers, infections and, in serious
cases, may even lead to
amputation.

Managing diabetes

Control blood sugar

Healing and defence against
infections improve as blood sugar
returns to normal or near-normal
range. People with diabetes need
to work with their healthcare
providers to achieve the ideal
blood sugar and HbA1c range.
For people with diabetes, diet
is essential when it comes to

controlling their blood sugar level.

They need to be concerned of the
content, portion and timing of their
meals.
Carbohydrates have a huge
impact on blood sugar levels and
diabetics should learn about
carbohydrate counting as well.
They should also avoid
sweetened food or beverages as
these contain very high amounts
of sugar.

Physical activity
Being physically active usually
lowers blood glucose levels as the
muscles use more sugar as energy
and the body becomes more
sensitive to insulin.
People with diabetes should
accumulate 30 to 45 minutes a day,
three to five days a week exercises
such as walking, jogging,
swimming, skipping, bike riding
and brisk walking.

Source genuine medicines

Do you know where your
medicines come from? This is an
important question to ask when
obtaining medication.
There are many counterfeit
medicines in the market that are
substandard, spurious, falsely
labelled and falsified, all of
which can harm you.
Community pharmacies are
now playing an important role
in educating the public about the
medication that they are taking.
As access to medicines is getting
much easier, there is likelihood
that one may end up getting fake
medicines.
Since its inception 21 years
ago, Caring Pharmacy has
always emphasised integrity
in its pharmacist services to
the community.
It believes in delivering
medicines that are genuine, good
quality, safe and efficacious to
consumers.
As a leading pharmacy group

in Malaysia, Caring Pharmacy

has the responsibility to educate
the community to say no to
counterfeit or fake medicines
and to be aware of substandard
products of unverifiable sources.
Caring Pharmacy is planning
to launch its Choose Genuine
Medicines Campaign in the
fourth quarter of this year,
with the aim of educating the
community on the importance
of choosing genuine medicines
from genuine sources that
comply with regulatory
requirements right up to proper
storage prior to consumption.
This programme is supported
by the Health Ministry,
pharmaceutical companies and
the Malaysia Pharmaceutical
Society.
Visit any Caring Pharmacy
outlet today to find more
information about genuine
medicines from its in-house
pharmacists.

Medicines
If medicines are prescribed,
ensure compliance and proper
coordination of meals and
medicines.
Some medicines are meant to
be taken before meals and some
after meals. Always speak to a
pharmacist for any inquiry
regarding medicines.
Those who are on insulin
should learn the proper injection
technique and timing of injection
as well as ascertain the correct
dose of insulin.
Consult a healthcare provider if
your blood sugar level is too high
or too low.

Blood sugar monitoring
This is another important part
of the diabetes management plan.
Keeping track of the numbers will
guide people with diabetes on
making the proper choices in their
diet and lifestyle as well as
medicines.
The HbA1c test shows your
average blood sugar level over the
past two to three months.
Therefore, it is important to
routinely check with the
HbA1C test and discuss your
results with a healthcare
provider.

Care for the

feet
Inspect
your feet
every
day from
all sides,

Maintain
thorough foot
care to keep
diabetic
complications
at bay.

Eating healthy is an important aspect of blood sugar level control.

including the space between your

toes.
Look out for dry patches or
cracks, cuts, blisters, corns,
calluses, swelling, ingrown toenails
or places that are red or pale. Feel
for increased heat in the skin.
Seek early care for any foot
injury and ensure annual foot
checks at the diabetes foot
clinic. These clinics are
currently available at
Hospital Kuala Lumpur
(HKL), Hospital Tengku
Ampuan Rahimah
Klang (HTAR),
University Malaya
Medical Centre
(UMMC) and Institut
Jantung Negara (IJN).
There are many things
one can do to keep feet
healthy. Here are some
tips:
l Wash feet with mild
soap or body wash and
dry feet well, especially
the space in between toes
with a soft towel.
l Apply moisturising
lotion daily to prevent skin
dryness but avoid the

space between toes.

l Stop smoking.
l Avoid using heating pads or
hot water bottles. These can burn
the skin without warning if you
have nerve damage in the feet as a
cause of diabetes.
Never walk barefoot and choose
proper footwear with sufficiently
thick and flexible rubber soles,
closed toes and closed heels with
wide and deep toe boxes.
l Cut toenails after bathing or
cleaning. Trim toe nails straight
across and file sharp edges with an
emery board. Ask for assistance if
you have poor vision.
In conjunction with the World
Diabetes Day in November, Caring
Pharmacy has been organising
in-store activities every year for
the public, inclusive of health
screening, counselling on
medicines and lifestyle advice.
This year, apart from the usual
activities for diabetic patients,
additional emphasisis has been
given to foot care.

n For more information, contact

Caring Pharmacy.