Jul - Sep 2010 - Diabetic Society of Singapore

Transcription

Issue 34 July - September 2010
MICA (P) 100/10/2009
Newsletter of Diabetic Society of Singapore
The Truths Will
Set You Free
Stroke Rehabilitation
Eight Life-threatening
Myths
An Overview of the Journey
Sweet Surrender
Different Strokes
Resisting Unhealthy
Temptations
Managing Emotional
Difficulties
Striking The Right Balance
Hunger Pangs
Eating Healthy to Cut Stroke Risk
Satisfying Healthy Substitutes
More Than Able
with Limited
SpurringExercising
the World
OnMobility
Football Legend
Gary Mabbutt
工作压力
Bolehkah Pesakit Diabetis
Berpuasa di bulan Ramadan?
30-1113 DIABETES NEWSLETTER NO.indd 1
7/12/10 10:01 AM
15
contents
12
20
22
News Buzz
6
Map to Diabetes Care
7
Bready Bunch
8
Retreat for Adults with Type 2 Diabetes
10 Get Up and Go
Care Corner
11 Insulin therapy
12 Different Strokes: A Guide for Patients and Caregivers
14 工作压力
Healthy Makan
15 Lotus Seed & Gingko Sweet Dessert
16 Spinach & Tofu Soup
18 Strike the Right Balance
In Shape
20 More than Able
Insight
22 Stroke Rehabilitation – An Overview of the Journey
Special Feature
24 Bolehkah Pesakit Diabetis Berpuasa di bulan Ramadan?
Diablogue
26 Running the Race of Life
DSS MANAGEMENT COMMITTEE 2008/2010
PATRON:
Prof Arthur Lim
HONORARY SECRETARY:
Ms Esther Ng
ADVISOR:
Dr Warren Lee
HONORARY TREASURER:
Mr Stanley Lim
PRESIDENT:
Mr Yong Chiang Boon
ASST HONORARY TREASURER:
Ms Zann Lim
VICE-PRESIDENTS:
Dr Kevin Tan Eng Kiat
Hj P.M. Mohd Moideen
COMMITTEE MEMBERS:
Dr Yeo Kim Teck
Mr For Wei Chek
Mr GreIg Price
3
7/16/10 11:58 AM
editor’s message
diabetes singapore july - september 2010
Diabetes
Singapore
Editorial Team
Editor :
Dr Yeo Kim Teck
Managing Editor :
Charlotte Lim
AVOIDING A STROKE
IN TIME SAVES LIVES
The four-yearly contagion is on. For a month or so, the
world is at a virtual standstill. The shopping malls and
restaurants are deserted, come football time. Yes, it is the
FIFA World Cup Pandemic. Whether you are a fanatic
who breathes, lives and talks football for a month or you
think of the game as just “22 silly men running after a silly
ball”, there is no denying its impact. Yes, its aftermath
has included broken marriages, suicides, murders, heart
attacks and even strokes. So, if you have diabetes or are
at risk, you will do well to check out this “stroke” issue. The
ball is in your court.
On a sombre note, this “stroke” issue is an emotive one.
My own dad passed on from a stroke three years ago. I
remember all too well how he collapsed suddenly before
my eyes one night while my mum and I were with him.
I had to climb onto the hospital bed and resuscitate
him while the presumably overstretched on-call doctor
took a full 15 minutes before coming by. My dad lived
on for another year or so before another stroke fell him.
He remained alert but was robbed of his mobility and his
speech. I wonder sometimes if I should have done what I
did but that is another issue.
While we cannot help certain risks factors like age or/
and race, knowing and controlling these nine avoidable
and modifiable risk factors for strokes will help you or your
family members reduce the risk of a stroke. A stitch in time
saves nine indeed.
AVOIDABLE AND POTENTIALLY MODIFIABLE RISK FACTORS
FOR STROKES
1.
2.
3.
4.
5.
6.
7.
8.
9.
High blood pressure
Diabetes
High cholesterol
Smoking
Obesity
Certain heart disease (such as atrial fibrillation)
Intravenous drug abuse
Carotid or neck artery disease
Certain blood disorders
4
Dr Yeo Kim Teck
Senior Consultant
Apple Eye Centre
Editor (Medical) :
Dr Elaine Huang
Editor (Dietetics) :
Janie Chua
Editorial Consultants :
DSS Management Committee
Charlotte’s Web Communications
Contributors :
Dr Effie Chew, Henry Lew,
Janie Chua, Joan Choo,
Chionh Lay Keng, Kohila Govindaraju,
Rohanah Binte Pagi, Marco Aizawa
Production/Advertising Manager :
George Neo
Advertising Coordinator :
Esther Ng
Publishing Services :
Stamford Press Pte Ltd
Booking for Advertisements :
Tel: 6842 3382
Email: [email protected]
Address feedback to:
Managing Editor
Diabetes Singapore
Diabetic Society of Singapore
Blk 141 Bedok Reservoir Road
#01-1529 Singapore 470141
Fax: 68423118
Email: [email protected]
For past issues of Diabetes Singapore, log onto:
http://www.diabetes.org.sg/publication.html
Disclaimer
The 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. Diabetic Society of Singapore 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.
7/12/10 10:01 AM
Vice-president’s message
THE RIGHT TRACK
In the last issue of Diabetes Singapore, our
DSS president Mr Yong Chiang Boon gave
an uplifting illustration of our society’s
spirit. It is my pleasure now to focus on
our society’s community involvement in
raising diabetes awareness and other
related programmes. In Singapore alone,
it is estimated that there are about
300,000 diabetic patients. Many more
are still undiagnosed. The number of DSS
members hardly reflects the pervasiveness
of diabetes here, and we are stepping
up efforts to ensure that the word about
diabetes control and prevention gets out
as fast, and as wide, as possible.
We also hope that people will understand
that good health is in their own hands, that
they will overcome whatever indifference
they may have to start exercising and
eating healthy. Our three Diabetes
Education Care Centres have trained
diabetes nurse educators and a wealth of
resources to make it easier for you to get
on the right track – physically, emotionally
and psychologically. Early diagnosis can
prevent many complications such as
heart disease, blindness, kidney failure
and even amputation. Don’t wait till it is
too late.
Our mission to educate the masses runs
deep in our many programmes but our
means are limited. We currently depend
greatly on the generosity and active
support of a few religious organisations,
corporations and grassroots organisations.
Yet more can be done. Even shopping
centres can play their part and
disseminate our message, and enlighten
the public about diabetes by distributing
our newsletter, Diabetes Singapore, as
well as flyers about our talks, seminars
and support groups. We hope that such
collaborations, DSS will continue to prod
the masses make that all important move
to lead a healthy lifestyle.
Hj P.M. Mohd Moideen PBS
Vice-President, DSS
© Lane E
rickson
5
7/12/10 10:01 AM
news buzz
MAP TO DIABETES CARE
By Joan Choo
There were some
burning questions
at the DSS Public
Forum on 22
May - “What’s so
important about
diabetes
selfmanagement
education and
support?”,
“What should
I know about
managing my
diabetes?”
and “How can I adopt
appropriate nutritional management in my
lifestyle?” Thankfully, Rohanah Bte Pagi, CDE,
and Sarah Shamila Sinaram, Dietitian, National
Healthcare Group Polyclinics (NHGP), had all the
right answers to these hot topics.
as well as signs and symptoms of hypoglycaemia
and hyperglycaemia, foot care, etc.
Watch out for our next public forum in English on 17
July 2010 at KK Women’s and Children’s Hospital.
It will be on “Behavioural & Psycho-Social Issues
Related to Diabetes plus the Latest Developments
in Diabetes”.
*To find out more about the Diabetes Conversational
Map, please ring any of DSS centre to speak to our
Diabetes Nurse Educators.
Nurses from the Association of Diabetes Education
(Singapore) (ADES) also conducted an interactive
session using the Diabetes Conversational Map, a
tool to give diabetics many opportunities to clear
their doubts by asking any diabetes-related question
pertaining to diet, blood glucose monitoring and its
interpretation, insulin – its action and side effects –
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Online contribut
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Go to www.diabet
JOIN US FOR
6
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World Diabetes Da
14 November 2010
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(beside Yio Ch
7/12/10 10:02 AM
news buzz
BREADY BUNCH
By Joan Choo
Who can resist the sweet aroma and taste of freshly
baked bread, even with the scorching sun beating
down on you? Certainly not our members and their
families. They relished every bit of the DSS-organised
trip to the Gardenia Bakery on 5 May, including the
video presentation on bread making Gardenia style,
the tour of the production plant and an enlightening talk
by Mrs Kalpana Bhaskaran from Temasek Polytechnic
(Nutrition Department) on dietary management and
the effects of a low Glycaemic Index (GI) diet for
people with diabetes.
According to Mrs Bhaskaran, a low GI diet consists
mainly of low GI foods. GI stands for Glycaemic
Index and is a measure of the impact of food on your
blood sugar. Foods with a low GI tend to raise your
body’s blood sugar levels more
slowly and over a longer period. This helps to
improve the well being of people with diabetes by
lowering their blood sugar levels and even control
weight gain.
The day ended with members and their families buying
exclusive Gardenia premiums and products at special
prices and receiving a goodie bag comprising a Nutri
multigrain loaf. I hear that many of the members are
looking forward to another DSS outing. Well, wait no
longer. Our next excursion has been scheduled for
26 September. Watch this space to find out our next
destination!
7
7/12/10 10:02 AM
news buzz
Take Charge, Be In Control!
A Retreat for Adults with Type 2 Diabetes
Date
Retreat Begins
Retreat Ends
Venue
Cost
: 31 July – 1 August
: 1.30pm on 31 July 2010
: 5.00pm on 1 August 2010
: Changi Village Hotel, 1 Netheravon Road S 508502 Tel: 63797111
: $150 (Member) $170 (Non-Member)
Note: Registration is on a first-come, first-served basis, so register early! Please send registration
forms, as well as camp fees, no later than 10 July 2010.
Payment by cheque to “The Diabetic Society Of Singapore”.
Please send to:Diabetic Society of Singapore, Blk 141 Bedok Reservoir Road, #01-1529, Singapore
470141. Please write your name and contact number at the back on the cheque or you may proceed to
any of our centres to pay by cash. Please visit our website at www.diabetes.org.sg for the registration
form.
Call 6842 3382 / 9711 0132 to find out more.
Program Highlights
An interactive workshop titled “My Journey with Diabetes” by Ms Yang Su-Yin,
Senior Psychologist, Psychology Services, Tan Tock Seng Hospital
An Educational Talk by Dr Kevin Tan Eng Kiat Consultant Diabetologist and Endocrinologist
Mt Elizabeth Medical Centre
Work it out with Eric
Senior Physiotherapist
Singapore General Hospital
Understand the effects of diet on blood sugar and diabetes control. Realise how eating
healthy rather than dieting can help you better manage your weight and allow food to be
enjoyable again by
Mrs Kalpana Bhaskaran, Dietitian
An interactive session with the doctor, diabetes nurse educator, dietitian, psychologist and
physiotherapist
BBQ Dinner by the poolside with fun interactive games.
Prizes to be won!
Buffet Lunch at Salt Water Café
Big Walk by the Beach
8
Free goodie bag for all participants
7/12/10 10:02 AM
news buzz
Get Up and Go!
By Joan Choo
Johnson & Johnson (J&J) and DSS jointly organised a public forum
for One Touch users at Suntec City Exhibition and Convention
Centre on 20 March. DSS members enjoyed free pre-prandial blood
glucose testing and a scrumptious lunch, courtesy of J&J. DSS
Nurse Educator Praveen Gosal talked about “The Importance of
Self-Monitoring of Blood Glucose” while dietitian Lock Poh Leng
(KK Hospital) emphasised “The Importance of Diet and Exercise”
and physiotherapist Ms Katherin Huang (SGH LIFE Centre) waxed
lyrical about “Exercise in Prevention and Management of Diabetes”.
Poh Leng and Katherin conducted a food labelling and an exercise
workshop respectively to empower participants not only with
knowledge but also knowhow. Participants went home with a
goodie bag consisting of an exercise mat, a good reminder to put
into action the exercise tips they would have picked up.
10
7/12/10 10:02 AM
care corner
INSULIN THERAPY:
TO START OR NOT TO START?
It is a common perception that insulin represents the last therapeutic
measure and should be postponed for as long as possible. Chionh Lay
Keng, diabetes nurse educator, Diabetic Society of Singapore, sets the
record straight on the benefits of insulin therapy.
According to an article by Craig W Spellman, Assistant
Dean, Professor of Medicine, Head of Endocrinology,
and Director of the Diabetes Center, University of
North Texas Health Science Center, titled ‘Advancing
Beyond Basal Insulin Therapy in Patients with Type 2
Diabetes’, people with type 2 diabetes will eventually
need insulin therapy because oral agents fail over time.
Many patients, however, are needle-phobic and may
reject insulin therapy which requires multiple daily
injections. They would be pleased to know that
twenty-first century needles are now so fine that the
level of pain is tolerable, and hurts no more than an
ant bite.
So, what then is insulin and why do we need it in the first
place? In simple terms, the pancreas produces insulin
to convert the sugar from our food to generate as
energy. But for type 2 diabetes patients, the pancreas
does not secrete enough insulin or are insulin resistant.
They experience high blood sugar, which causes
damage to blood vessels. Uncontrolled diabetes can
lead to serious complications of the eye and kidneys
as well as amputations and nerve damage.
Most type 2 diabetes patients rely on oral hypoglycaemic
agents to control their blood sugar. As years pass,
the pancreas may decline with age and cannot cope
with the high sugar from the food consumed. When
oral hypoglycaemic agents are no longer effective on
their own, insulin therapy must then be initiated in
combination with oral diabetes medications to prevent
glucose toxicity.
What happens when your doctor suggests that you
need insulin therapy? For a start, it is a commitment,
not a mere guideline. Firstly, you must follow strict
eating and exercise plans. Secondly, you need more
frequent blood sugar tests than before so as to achieve
better blood sugar control. Thirdly, and this depends
on different individuals, some might need short-acting
insulin in combination with a long-acting insulin while
others may need just one long-acting insulin to last
the day.
Success stories among our DSS members who
had gone on insulin therapy after years of taking
oral medicines reveal marked improvements in their
HbA1C reading. A case in point is Sarah* who had
been taking oral medications for diabetes for 12 years.
After just one month on insulin, her HbA1C improved
from 9.1% to 7.6%! Another member, Elizabeth* was
equally delighted and more energetic when her HbA1C
dropped from 8.1% to 6.9%, after combining insulin
therapy with diet control and exercise.
Be aware that non-compliance to the insulin regime
will affect the outcome of blood sugar control, thus it
is very important to follow your insulin regimen closely
as directed by your doctor. Getting support from your
health care team, family and friends is crucial. Joining
a support group may also help motivate you to control
your diabetes better.
* Not their real names.
References:
http://www.touchendocrinology.com
http://www.webmd.com/
© Scott Rothstein
11
7/12/10 10:02 AM
care corner
DIFFERENT STROKES:
A GUIDE FOR
PATIENTS AND
CAREGIVERS
© Eduardo Jose Bernardino
Stroke can cause many physical effects such as speech problems and
memory loss. It can also trigger psychological changes. Henry Lew,
psychologist, National Healthcare Group Polyclinics, reports.
When stroke damages the brain cells, the sensations
and parts of the body controlled by these cells no
longer function properly. Along with the physical
damage to the brain, stroke can cause emotional,
psychological and behavioural changes. Each stroke
is different and, to a large extent, the psychological
problems that someone may experience will vary,
depending on the part of the brain affected and the
extent of the damage.
In addition, the person who has had a stroke may have
to come to terms with the loss of many of their hopes
and plans for the future, as well as having to adapt to
a changed role in the family, and possibly the loss of a
career. Some of them may feel anxious or depressed,
frustrated, angry or bewildered. All these feelings are
common and, although they usually fade with time,
they may persist in some people.
Treatment of psychological difficulties faced by patients
is often through medication by medical doctors and
psychiatrist, and referral to psychological interventions
by mental health professionals like psychologists,
medical social workers and counsellors.
12
Information
A lack of knowledge about stroke can lead to
uncertainty. Misunderstandings can arise and that
can add to your worries. Do not be afraid to ask your
doctor to explain.
Social Contact
Meeting people regularly, every day, if possible, is an
important source of well-being. Talking to others can
be a big help, too. If you are able to, keep talking to
family and friends, and try not to push people away or
assume you are a burden.
Support Groups
Many people find support groups useful. They provide
a chance to meet people who have been through a
similar experience, and many arrange social activities.
Hobbies and Interests
Returning to hobbies and interests after a stroke is an
important part of the rehabilitation process. You could
even look at trying new things. Try not to be put off by
thoughts that you are unable to do things as well as
you could before the stroke. Many activities can be
adapted to enable you to carry on enjoying them.
Emotional Difficulties:
What Stroke Patients Can Do
Exercise
In addition to seeking help from your doctors and
mental health professionals below are some points
you could consider. Not all of these suggestions will
suit everyone, but you may find some helpful. Do bear
in mind that these do not replace professional help.
Counselling
Recent research shows that regular physical activity
or exercise, however gentle, can help improve one’s
mood.
Acknowledging what has happened, and accepting
how life has changed is an important step in the
recovery process and talking treatments can help
with this. Psychological and counselling services aim
7/12/10 10:02 AM
care corner
to encourage you to talk about your thoughts and
feelings and help you to come to terms with what has
happened to you. You will gain a clearer picture of what
lies ahead and help you feel more in control of life by
working out and trying to find solutions to problems.
Many people benefit from talking through their
difficulties, but if your stroke has left you with problems
communicating or understanding others, it may not be
the best option, or you may require the specialist skills
of a speech and language therapist.
Managing Your Diabetes
Diabetes is progressive and, if left untreated or
uncontrolled, it increases the risk of developing and
complicating your stroke.
Take regular exercise, eat a healthy and balanced diet,
manage your weight and don’t smoke.
Emotional Difficulties:
What Family Members Can Do
Communication:
•
•
•
•
•
•
Slow down and speak in short, clear sentences.
Ask direct questions that can be answered with
“yes” or “no”. For example, “would you like a cup of tea?”
Give the person plenty of time to answer.
Don’t shout at the person – they’re not deaf!
When starting to speak, give the person time to
tune in. Touch the person and pause. Say their
name first.
Place the key word at the end of a sentence, such as “What do you want for dinner?” and “It’s time for your bath.”.
Managing emotional difficulties
•
•
•
Don’t tell the patient not to cry; this will not help
him or her. People often feel upset or embarrassed
about being too emotional or helpless.
Distract the patients by changing the subject of
conversation, or try some deep breathing to help
them relax.
Don’t ignore the person. Do not leave them,
unless they say they want to be alone, when they are emotional.
Managing personality changes
Family and friends of stroke survivors often find
changes to personality in the stroke patients hard
to deal with. Some people find that the challenging
behaviour, e.g. aggressiveness is aimed only at them
and that the person affected by the stroke is reasonable
with other people. This kind of situation is harder to
manage so it is important to try and get support from
other members of your family. You should also avoid
confrontational situations and walk away if a situation
is becoming too hot to handle.
Each patient and family is affected by stroke differently,
hence it is important to seek professional help to
assess and help you and your family cope with these
new challenges.
References:
http://www.strokensw.org.au
http://www.strokesurvivors.org
http://www.stroke.org.uk.
13
© Philip Lange
7/12/10 10:02 AM
care corner
工作压力
妥善处理每日承受的工作压力，不仅能帮您改进糖尿病的
病情，也能预防和延缓病发症。国立保健集团综合诊所的
心理学家, Henry Lew, 教您如何放松减压。
工作压力有短暂的，如发表工作报告到超时工作。它
也有长时期累积的，如面对诸多要求的上司或工作时
间长。
压力与糖尿病
面临工作压力时，我们的身体会以增加体内的葡萄糖
(glucose)和脂肪(fats)来控制压力。对糖尿病患者
来说，却没有这么好的反应效果。这是因为体内常常
没有足够的胰岛素(insulin)来应付因压力而增加的
葡萄糖，因此糖分就累积在血液中。
研究显示精神和肉体上的压力往往会导致血糖上升，
尤其对属于2型糖尿病患者。肉体上的压力，如病痛
或受伤，都会使糖尿病患者的血糖增加。
况且，受压力的人可能不会好好的照顾自己。他们很
有可能借酒消愁，多喝酒少运动。他们也可能健忘
或没时间，忘了检查血糖或好好的计划他们饮食起
居。因此，学会如何应付压力和改进血糖的控制是很
重要的。
学习放松
© mayangsar
深呼吸
以坐下或躺着，手脚放松伸直，慢而深地呼吸，再透
过嘴巴慢慢地把气呼出来。
重复吸气吐气，在吐气时尽量放松肌肉。
每次连续的深呼吸及放松5到20分钟，每天至少做一
次。
运动
另一种放松身心的方式是让身体活动。放松的三种动
作有：旋转，伸展，及摇摆身体的部分。要使这项活
动更有趣，去找个朋友配合音乐一起活动。
无论您选择哪种放松方式，一定要纳入日常的生活
里，就如学新的运动项目要经常长期的锻炼，才能把
它炼好, 学放松也是要练的。
减低精神压力的良方
支持小组
改善日常生活
有些压力来源，不管您怎么做，都不会消失。尽管如
此，仍有些办法来减轻这些压力。支持小组和朋友们
都能帮助您。去认识和您处在类似状况的人不仅能让
您感到少些寂寞，也能让您从他人的经验中学习如何
应付困境。
压力无法根除，但却能让我们把它控制到自己能应付
的水平。如果上下班的繁忙交通使您烦躁，不妨找另
一条顺畅的路走或早点出门，以避免交通阻塞。如果
工作使您觉得快发疯了，试试申请换个部门，或和上
司商量如何改善工作上的程序。以下还有一些对抗压
力的方法：
•
•
•
•
参加一些体育活动或参加体育队
学舞蹈或参加舞蹈俱乐部
培养一项嗜好或学习一门新手艺
到医院或慈善机构做义工
14
辅导
有时候，您可能被巨大的压力压倒。在这种情况，辅
导或心理治疗都有可能会有帮助。和治疗师倾诉烦恼
也许能找到解决的办法，学习新的应付方法或改善对
事情的看法。
参考
American Diabetes Association
7/12/10 10:02 AM
healthy makan
Spinach &
Tofu Soup
Serves 4
by Janie Chua, dietitian,
National Healthcare Group Polyclinics
Ingredients
Method
2 bunches of spinach, chopped
½ tsp salt
¼ tsp ground pepper
1 block soft tofu, drained, cubed
3 cups chicken stock
1 tsp light soy sauce
1 tsp sesame oil
12 prawns, shelled, deveined and diced
½ carrot, sliced thinly
1 tbsp cornstarch, dissolved in 2 tbsp water
1. Combine stock, soy sauce and sesame oil
in a pot. Bring to boil over high heat.
2. Add carrots and cook for 1 to 2 minutes.
3. Add prawns, spinach and tofu, mix well for
another 1 to 2 minutes until all ingredients
are cooked.
4. Add cornstarch solution and stir until
slightly thickened.
5. Serve hot.
Nutrition Information
Energy
134 Kcal
Carbohydrate
8g
*Carbohydrate Exchanges =
~ 0.5
Protein
13 g
Fat
6g
Saturated Fat
0.7 g
Cholesterol
29 mg
Dietary Fibre
1.2 g
Sodium
613 mg
16
7/12/10 10:02 AM
healthy makan
Lotus Seed
& Gingko
Sweet
Dessert
Serves 10
by Janie Chua, dietitian,
National Healthcare Group Polyclinics
Ingredients
Method
15 red dates
50g dried longan
200g lotus seed, soaked in hot water, drained
100g lily bulb, soaked in hot water, drained
30 ginkgo nuts, canned, drained
8 cups water
100g sugar
3 pandan leaves
1. Put red dates, dried longan and pandan
leaves in a pot of water.
2. Boil under medium heat for 30 minutes.
3. Add lotus seed and lily bulb. Add sugar to
sweeten.
4. Once cooked, turn off flame and add
gingko nuts.
5. Serve hot.
Nutrition Information
Energy
165 Kcal
Carbohydrate
33 g
*Carbohydrate Exchanges =
~2
Protein
6g
Fat
1g
Saturated Fat
0.2 g
Cholesterol
0 mg
Dietary Fibre
1.6 g
Sodium
57 mg
17
7/12/10 10:03 AM
healthy makan
STRIKE THE RIGHT BALANCE
Stroke prevention involves minimising risk factors, such as controlling high
blood pressure, elevated cholesterol and tobacco abuse. Kohila Govindaraju,
a nutritionist in private practice, shows you how to keep stroke at bay with
a balanced diet.
The brain needs oxygen and nutrients, the life
sustaining products delivered via blood, in order to
function properly. A stroke occurs when there is a
lack of blood proportionate to the brain that results in
loss of brain function. The stroke can be caused by
a ruptured blood vessel (aneurysms) or by a floating
clot that interrupts or blocks the blood flow to the
brain. Depending on which area the brain is affected,
the stroke can cause speech impairment, paralysis,
unconsciousness or even death.
18
Narrowing, furring, hardening or weakening of blood
vessels or thickening of the blood flow will end up in
stroke. Haemorrhagic strokes occur when a blood
vessel in the brain breaks or ruptures. Ischaemic stroke
can occur when too much plaque (fatty deposits and
cholesterol) clogs the brain’s blood vessels.
The most common causes of haemorrhagic stroke are
high blood pressure and brain aneurysms. Older people
and those with strong family histories of hypertension,
heart disease, and strokes have a higher risk of stroke
than people without these histories. These risk factors,
however, can be controlled.
Risk factors to watch for and control:
- High blood pressure: If there is a high blood
pressure, we need to keep it under control.
High blood pressure increases the risk of a
haemorrhagic stroke.
- Heart disease: The causes of heart attacks are
the causes for strokes too. Strokes are called
brain attacks.
- Smoking: Smoking doubles the risk of
having a stroke because it causes the arteries
7/12/10 10:03 AM
healthy makan
to fur up and makes the blood more likely to clot against heart disease and diabetes by lowering
that increases the risk of stroke.
blood cholesterol and glucose level.
- Diabetes: Diabetes has an adverse affect on our • Foods rich in calcium. Milk and milk products,
arteries that reduces or blocks blood flow to the almonds, oysters, small fish with bones such as
brain.
sardines, mustard greens, bok choy, watercress,
- Alcohol: Drinking too much alcohol can raise
broccoli are good sources of calcium.
blood pressure and lead to heart failure or
• Soy products – tofu, tempeh, soymilk, reduces
stroke [American Heart Association].
Low Density Lipoprotein (LDL) cholesterol and
raises HDL cholesterol level.
It is wise to institute good, healthier practices early in
life. Eating and exercise habits need to be improved • Fish (grilled or baked) three times or more per
at younger age. Sitting for hours before the television
week. Omega-3 fatty acids in fish are good for
and chowing down fat-foods like hamburgers, fries,
heart . Eating one to two servings of fish a week,
and sugary soft drinks will increase the likelihood of
reduces the risk of heart attack. Omega-3, a type
premature heart attack or stroke.
of unsaturated fatty acid reduces the inflammation
Healthy tips to stay stroke-free
The food we eat influences our risk of having a stroke.
Consuming different food groups, such as fruits,
vegetables, and whole grains cereals, protects us
against stroke. High cholesterol and too much of salt
in the diet will increase our risk of getting stroke early
in life.
“PREVENTING LITTLE THINGS
FROM BECOMING BIG THINGS,
KEEPS US ENJOYING LIFE AND
STAYING HEALTHY.”
throughout the body. Salmon, herring and tuna
are good sources of omega-3 fatty acids. Those
who eat fish high in omega-3 fatty acids, three
times or more per week, have a lower risk of silent
brain lesions that can cause dementia and stroke.
Flaxseed and oil, walnuts, canola oil, soybeans
and soybean oil are the non-fish food options that
are good sources of omega-3 fatty acids. Soy
products – tofu, tempeh, soymilk, reduces LDL
cholesterol and raises HDL cholesterol level.
• Limit the amount of fat you eat. Too much of fat
can clog the arteries and add to weight problems.
Choose vegetable, seed and nut oils rather
than margarine and butter. Snack on fruit and
vegetables.
Make healthier choices:
• Two servings each of fruits and vegetables
daily will provide sufficient potassium, folate,
and antioxidants that protect against stroke.
One serving is equivalent to:
1 small apple, orange, pear or mango (130g)
1 wedge papaya, pineapple or watermelon (130g)
10 grapes or longans(50g)
Raw leafy vegetables (150g)
¾ mug cooked vegetables (100g)
[ABCs of Healthy Eating, HPB]
• Reduce salt intake: Avoid processed foods as they
can be high in salt. Excess salt raises the blood
pressure. Always check the sodium content in the
food label. Go for low salt foods that contain less
than 120mg/100g of sodium.
• Food rich in soluble fibre, such as whole grain
products (barley, oats, rye), fruits (apples, citrus)
and legumes are associated with protecting
Be flexible: Balance what you eat
with physical activity. Research
has shown that 30 minutes of
physical activity every day will
help to lower the blood pressure,
lower cholesterol and to maintain
a healthy weight. Obesity leads
you to a risk of high cholesterol,
high blood pressure and insulin
resistance. People under stress
may overeat. Having a regular
physical activity will reduce the
stress.
19
7/12/10 10:03 AM
in shape
© arekmalang tai chi
MORE THAN ABLE
Having limited mobility does not have to mean exercise is out of the question. For the person with
diabetes, able-bodied or not, exercise is essential.
Exercise has many benefits. It can help keep weight down and build muscle. It can strengthen bones
and improve circulation. Exercise can also help:
• Lower blood pressure
• Stabilise blood sugar levels
• Increase insulin sensitivity
• Slow the progression of neuropathy (nerve disease)
ADA Exercise Recommendations
For a person with limited mobility caused by neuropathy, the
the following activities:
• Swimming
•
• Bicycling
•
• Rowing
•
American Diabetes Association (ADA) recommends
Chair exercises
Arm exercises
Other non-weight-bearing exercise, such as yoga
or tai chi
Remember to practise proper foot care during exercise. An air or silica gel midsole inside shoes will provide
protection. Polyester or cotton-polyester socks will help keep feet dry.
Warming Up Before Exercise
No matter the exercises or level of ability, a warm-up period is essential. Even those with extremely limited mobility
can do slow and gentle range-of-motion exercises with their unrestricted body parts. Their doctors can demonstrate
these exercises.
Here’s an example of a good warm-up routine. Each of the following exercises should be repeated six to 10 times.
Those who are unable to stand should talk to their doctors about accommodations.
• Neck rolls: Tuck chin into chest and roll chin from side to side by trying to touch ear to shoulder. Can be done
standing or sitting.
• Shoulder circles: Stand with feet apart. Raise right shoulder toward right ear; lower shoulder back down in a
smooth motion. Repeat on the other side.
• Overhead arm swings: Stand with feet slightly wider than shoulder-width apart. Keep back straight and knees
slightly bent. Swing both arms up overhead, then back down past hips.
• Crossover arm swings: Stand as for overhead arm swings. Swing both arms out to side at about shoulder
height and then across chest.
• Side bends: Stand as in overhead arm swings. Rest hands on hips. Lift torso up and bend smoothly to left,
then back up straight, then to the right. Try to keep a smooth slow rhythm and spread out while bending to the
side. Inhale while returning to the upright position.
Sources:
“Having Limited Mobility Does Not Mean You Can’t Exercise.” Lehigh
Valley Hospital and Health Network. Lehigh Valley Hospital and Health
Network. 27 Sep 2007 <http://www.lvh.org/lvh/Your_LVH|1196>.
Rowett, D. “Exercise Concerns for People with Diabetic Neuropathy.”
Yahoo! Health. 29 Sep 2004. Yahoo! Health. 27 Sep 2007 <http://
health.yahoo.com/ency/healthwise/tf4724>.
20
“Physical Activity/Exercise and Diabetes.” Diabetes.org. 2004.
American Diabetes Association. 9 Sep 2007. <http://care.
diabetesjournals.org/cgi/content/full/diacare;27/suppl_1/s58>.
Balducci, S., G. Iacobellis, L. Parisi, N. Di Biase, E. Calandriello, F.
Leonetti, and F. Fallucca. “Exercise Training Can Modify the Natural
History of Diabetic Peripheral Neuropathy.” (2006). Journal of Diabetes
Complications 20:216-223.
“Warm Up Exercises.” Tansun. (2006) Kinetix. 9 Sep 2007 < http://www.
exercisechairs.com/warm-up.htm >.
This article was written by Jennifer Hicks of LifeWire (www.LifeWire.com)
http://diabetes.about.com/od/benefitsofexercise/a/mobility.htm
7/12/10 10:03 AM
insight
Stroke Rehabilitation –
An Overview of the Journey
Time is of the greatest essence when a stroke strikes. It hits you like a bolt of lightning
out of the blue but you can limit its damage and any subsequent disability by getting
immediate help. Dr Effie Chew, consultant, Rehabilitation Medicine, National University
Health System, tells you why, and walks you through the process of stroke recovery.
I THINK I HAVE A STROKE
Occasionally, over dinner, someone will casually ask me, “I have
this numbness in my arm on and off for years. Do you think it
is a stroke?”
There are a few things wrong with this scenario:
1. Stroke is a medical emergency. If you think you are having
a stroke, it is not the topic of casual dinner conversation. You
should rush to the hospital immediately.
Strokes are also known as ‘brain attacks’. The blood supply to
part of the brain is cut off abruptly. Other strokes are caused by
burst blood vessels bleeding into the brain.
The sooner you get to a hospital equipped to manage your
stroke, the higher your chances of limiting the damage that is
done to your brain and, consequently, the disability that you will
suffer from your stroke.
2. The symptoms of stroke come on suddenly. If the symptoms
are gradually getting worse over months to years, chances are
it is some other problem, not a stroke.
When symptoms of a stroke resolve within an hour, it is called
a ‘mini-stroke’ (transient ischaemic attack). These episodes
should not be ignored as they indicate an increased risk to
having another stroke.
The most common warning sign of a stroke is sudden weakness
of the face, arm or leg on one side. Stroke can also manifest as
sudden numbness on one side of the body, sudden confusion,
sudden trouble speaking or understanding speech, sudden
trouble seeing, sudden trouble with balance or coordination.
Once you arrive at the hospital, the doctors will administer
treatment according to the type of stroke you had. They will
investigate the likely causes of the stroke and look for underlying
risk factors. Treatment will be targeted at the results of these
investigations. We will not go into detail on these treatments
here.
REHABILITATION – THE ROAD TO
RECOVERY AFTER A STROKE
The process of rehabilitation usually starts in the hospital as
soon as possible, oftentimes, the very next day after diagnosis.
The goal of rehabilitation is to achieve the highest functional
abilities possible, given each person’s individual disabilities and
environment. There are those who would rather be assisted
and waited upon, but by and large, most people want to be
as independent as possible. Through rehabilitation, the stroke
survivor relearns the skills of everyday living to regain as much
independence as possible.
The earlier stroke rehabilitation is started, the better the
outcomes will be. Rehabilitation is the only way to help in the
recovery of function after the stroke has occurred. Brain cells
damaged by stroke, or other injuries, do not replace themselves
easily, particularly in adults. It is through rehabilitative training
22
7/12/10 10:03 AM
insight
that the brain is able to reorganise its connections, a process
termed neuroplasticity, so that some of the lost function may
be regained.
Early rehabilitation also decreases complications that can
happen after a stroke, such as infections of the lung and urinary
tract, pressure sores and development of fixed stiffness in the
limbs (contractures).
A number of options for continuation of rehabilitation after the
acute phase are available, depending on the severity of the
disabilities and individual factors
1. Inpatient rehabilitation is appropriate for those who have
significant disabilities and can engage in one to two hours
of therapy a day at the rehabilitation unit of a hospital, or a
community hospital.
2. Home rehabilitation or early supported discharge may be
appropriate for those who can be cared for at home.
3. Outpatient rehabilitation at a hospital or day rehab centre
may be appropriate for those with milder deficits, or for
maintenance of function.
WHAT HAPPENS DURING STROKE
REHABILITATION?
Stroke rehabilitation is an interdisciplinary team effort. The
team usually involves the stroke survivor, his or her family,
the physiotherapist, the occupational therapist, the speech
therapist, nurses and the doctor, often a rehabilitation physician.
The stroke survivor is at the centre of this team.
A number of body functions may be affected by the stroke, apart
from those listed above - awareness of one side of the body,
language, memory and thinking abilities, swallowing, bladder
and bowel control and mood problems such as depression.
An inpatient rehab programme starts with a formal assessment
of the functional deficits resulting from the stroke and how
these affect the patient given his particular environment and
personal factors. Other medical problems and how they impact
on the rehabilitation process will also be assessed. The team,
including the patient, then comes to an agreement on the goals
for rehabilitation. There will also be screening for early medical
and rehabilitation complications, and measures will be taken to
prevent and treat these complications.
Therapy will be targeted towards the functional deficits
identified during the assessment. Some examples of common
daily tasks that are worked on include retraining of balance,
walking, toileting, dressing and bathing.
Nutrition and
swallowing abilities are also looked into, as are cognitive and
communication abilities, and bladder and bowel function.
Prior to discharge, an assessment of the stroke survivor’s home
environment will be made and the equipment necessary to
assist the stroke survivor in daily activities will be prescribed.
Some equipment that may be needed include wheelchairs or
walking aids, grab bars, orthotics to assist with activities of daily
living or walking. If necessary, caregivers will be trained in the
appropriate skills to assist the stroke survivor.
WHAT HAPPENS AFTER GETTING HOME?
For those with residual disabilities, rehabilitation often continues
into the outpatient phase. This may take place at a hospital,
a day rehab centre or in a home therapy programme. Some
challenges only become apparent when the stroke survivor
returns home and faces the actual demands of daily life. Which
is why an outpatient review is important. For others, return to
work issues, driving, and other higher-level activities, need to be
addressed as an outpatient.
WHAT ELSE CAN BE DONE?
Having had a stroke puts a person at an increased risk of
having another stroke. So it is very important to work with the
doctors to control the risk factors that can be controlled, as
much as possible. This may be through lifestyle changes, diet,
exercise and medications. Some important risk factors to work
on include:
1.
2.
3.
4.
Diabetes
High cholesterol
High blood pressure
Heart disease - irregular heart beat, heart valve disease
and heart failure.
5. Smoking
6. Obesity
Technology has been advancing in
the area of stroke rehabilitation.
Recent advances include the
use of robotics to assist
in rehabilitation training
and noninvasive brain
stimulation to improve
responses
to
rehabilitation. You
can learn more
about participating
in ongoing trials
from rehabilitation
physicians in any
of the restructured
hospitals.
23
7/12/10 10:03 AM
special feature
Bolehkah Pesakit Diabetis
Berpuasa di bulan Ramadan ?
By Rohanah Binte Pagi, Certified Diabetes Nurse Educator (Singapore), Association of Diabetes Educators Singapore (ADES)
PENGAWALAN Diabetis, terutama pada bulan Ramadan sememangnya paling mencabar
untuk mereka yang menghidap Diabetes. Malah dengan nasihat dokter, pesakit yang
bijak pengawalan pemakanan dan pengambilan ubat ubatan yang teratur mampu
meneruskan ibadah puasa.
Mengikut Perangkaan Tahun 2004 Kementerian Kesihatan
Singapura (MOH), 8.2% penduduk Singapura yg berumur 1869 tahun menghidap Diabetis. Daripada jumlah itu, kira-kira
11% terdiri daripada kaum Melayu dimana 8% terdiri dari lelaki
dan 10% wanita.
Diabetis atau penyakit kencing manis adalah penyakit kronik di
mana terdapat kadar gula (glukos) berlebihan di dalam darah.
Ini disebabkan gangguan peranan hormon insulin secara
kuantiti (insulin berkurangan) atau kualiti (insulin tidak berkesan).
Secara umumnya, mereka boleh menjalani ibadat berpuasa
dengan baik, dengan syarat mereka mematuhi jadual
pengambilan ubat, mengawal pemakanan dan yang penting
sekali, nasihat dari dokter.
Siapa yang di larang berpuasa berdasarkan
pandangan dokter?
•
•
•
Secara khusus dari pandangan agama dan perubatan, orang
yang sakit dikecualikan dari berpuasa, namun banyak dari
mereka yang dikecualikan mungkin ingin mengamati bulan
Ramadan ini. Pesakit diabetis jatuh dalam kategori ini dan
ini boleh meletakkan mereka pada risiko tinggi serta boleh
mengakibatkan pelbagai komplikasi. Pesakit diabetis Jenis 1,
Jenis 2 dan wanita yang hamil dengan diabetis (gestational)
harus mendapatkan nasihat dokter sekiranya ingin berpuasa.
Persoalannya, bolehkah pesakit diabetes berpuasa sedangkan
mereka terpaksa begantung kepada ubat-ubatan atau suntikan
insulin setiap hari untuk mengawal penyakit? Boleh atau tidak
seseorang pesakit itu berpuasa, telah banyak di bincang oleh
sekumpulan ahli endokrin dan diabetologis dari negara negara
muslim dan non-muslim. Kajian menunjukkan bahwa puasa
dibulan ramadan memang cukup umum di kalangan umat Islam
dengan diabetes. Ianya telah meningkatkan kesedaran bahwa
berpuasa dibulan ramadan berdasarkan menepati ajaran
agama serta penyakit diabetis adalah masaalah kesihatan
global.
Berpuasa bagi mereka ada lah suatu cabaran yang besar.
Pertimbangan dan pengurusan berpuasa terserah pada
pesakit yang terus memutuskan untuk
berpuasa.
•
•
•
•
•
Pesakit yang diabetis nya tidak terkawal.
Pesakit diabetis yang tidak mematuhi nasihat pengawalan
permakanan, pengambilan ubat dan insulin.
Pesakit diabetis yang mengalami komplikasi serius seperti
kerosakkan buah pinggang, penyakit jantung yang tidak
stabil, dan tekanan darah tinggi yang tidak terkawal.
Pesakit diabetis yang mempunyai sejarah atau sering
mengalami hipoglisemia (kekurangan glukos dalam darah)
dan hiperglisemia (berlebihan glukos dalam darah)
Pesakit diabetes yang sedang mengalami jangkitan
kuman.
Pesakit diabetes yang lanjut usia, tinggal bersendirian dan
tiada keluarga untuk membantu
Pesakit diabetes yang mengandung dan memerlukan
insulin.
Pesakit diabetes kanak-kanak berumur di bawah 12 tahun.
Di bulan ramadan, pesakit perlu memberi lebih perhatian
dengan keadaan perut yang kosong selama lebih dari 14 jam.
Mereka mungkin mengalami komplikasi buruk saperti masalah
dihidrasi (kekurangan cairan), hipoglisemia (kekurangan glukos
dalam darah) jika kurang makan diwaktu sahur atau melakukan
aktiviti yang berat ketika berpuasa. Hiperglisemia (berlebihan
glukos dalam darah) juga boleh berlaku jika keadaan diabetis
menjadi tidak terkawal.
Kekeliruan mengenai penjagaan di bulan ramadan saperti
penukaran waktu di masa pengambilan ubat2an, salah tanggap
mengenai keperluan permakanan dan nafsu ketika berbuka
puasa menjadi fakta utama menyebabkan sesetengah pesakit
diabetis mengalami masalah sepanjang waktu tersebut.
Tanda hipoglisemia
•
•
•
•
•
•
•
Rasa gelisah dan binggung
Lemah
Teramat lapar
Berpeluh
Menggeletar
Denyutan nadi terlalu laju – berdebar debar
Tidak sedarkan diri (pada peringkat serius)-Koma
24
© Wynter1969
7/12/10 10:03 AM
special feature
Tanda hiperglisemia
•
•
•
Sangat letih
Terlalu dahaga
Kerap buang air kecil
Tanda dihidrasi
•
•
•
Teramat dahaga
Kekeringan kulit dan lidah
Fikiran terganggu
Jika mengalami hipoglisemia, anda
lin
© Adina Chiriliuc insu
harus:
-Segera berbuka
-Minum minuman yang manis sampai tanda2 hipoglisemia
hilang, dilanjutkan dengan makan
-Berjumpa doktor jika tanda2 tidak hilang dan semakin lemah
•
•
Diet
Ianya harus ringkas mengikut panduan pemakanan yang
menitikberatkan pelbagai jenis makanan secara sederhana
dan seimbang. Pemakanan di bulan ramadan sepatutnya tidak
jauh berbeza daripada makanan seharian biasa. Buat temu
janji dengan pakar pemakanan (dietitian) untuk merancang
pemakanan di bulan ramadan.
Pemakanan harus dibahagi dan diatur mengikut keperluan
individu bersama ubat-ubatan yang di perlukan. Kuantiti
makanan harus dipertimbangkan sewaktu berbuka seperti,
berbuka dengan meminum air untuk mengelakkan kekurangan
air di dalam badan, makan 1-2 biji kurma untuk cepat memberi
pesakit tenaga yang diperlukan dan makan ubat-ubatan yang
telah disyorkan sebelum solat magrib.
Sejurus lepas solat magrib, makan makanan utama secara
sederhana saja sebelum tarawih. Setelah tarawih, boleh
menambah tenaga dengan memakan makanan yang agak
ringan saja. Waktu Sahur perlu di perlambatkan. Makan dengan
secukupnya kerana jika makan terlalu awal atau sedikit boleh
mengakibatkan masaalah hipoglisemia.
Ubat
Ubat ubatan yang selalu dimakan pada sebelah pagi pada
hari tidak berpuasa ditukar masa pengambilan nya ke waktu
berbuka puasa dan dos malam yang di ambil sewaktu tidak
berpuasa diambil sebelum sahur. Berbincang dengan dokter
tentang pengambilan ubat ubatan dan dos insulin untuk bulan
ramadan kerana ianya dapat mengelakkan tahap kadar darah
glukos dari terlalu turun atau naik.
Senaman
Senaman
yang
ringan
boleh
di
lakukan
asal
permakanan,pengambilan ubat ubatan serta pemantauan
darah glukos dapat di lakukan dengan baik.
Panduan:
•
•
•
Jangan makan berlebihan ketika berbuka. Pilih makanan
yang kurang kandungan gula, lemak dan garam.
Percepatkan berbuka puasa dan lambatkan bersahur.
Mematuhi jadual pengambilan ubat-ubatan dan waktu
suntikkan insulin yang disyorkan dokter.
•
•
•
Berusaha mengawal diabetis secara berterusan
dengan memantau darah glukos yang lebih ketat iaitu
di rekomendasi pada dua jam selepas waktu sahur, 1
petang dan 4 petang.
Mengenali tanda tanda hiperglisemai (berlebihan glukos
dalam darah), hipoglisemia (kekurangan glukos dalam
darah) dan dihidrasi (kekurangan cairan).
Berbuka jika terdapat tanda2 yang boleh memudaratkan.
Selain mengawal diabetis, berusaha mengawal penyakit
sampingan lain saperti tekanan darah tinggi
serta
mengawasi berat badan di sepanjang bulan ramadan.
Pembelajaran
pengawalan diri sebelum ramadan
mustahak. Belajar dari doktor, pakar pemakanan
dan jururawat. Catat secara terperinci pemakanan,
pemantauan diabetis, tekanan darah tinggi dan berat
badan sepanjang ramadan dan hari hari seterusnya
selepas ramadan. Ini memudahkan dokter menganalisa
kawalan penyakit diabetis, darah tinggi dan sampingan
lain.
Kesimpulan
Keputusan pesakit untuk berpuasa harus dibincangkan
dengan dokter. Pengawasan , pendidikan penjagaan diri
serta penyesuaian perubahan jadual pemakanan dan ubat
ubatan dapat membantu pesakit mengawal diabetes di bulan
ramadan. Jika panduan dan syarat dapat di patuhi, ibadah
puasa dapat dilaksanakan dengan selamat dan ianya tidak
menjadi halangan besar bagi pesakit diabetis.
Selamat Menyambut Bulan Ramadan
Sumber Referensi:
1. Fereidoun Azizi and Behnam Siahkolah; Ramadan Fasting
and Diabetes Mellitus: Int J Ramadan Fasting Res. 1998:
Endocrine Research Centre, Teheran.
2. Recommendations for Management of Diabetes during
Ramadan - Diabetes Care September 2005
3. Website: Article from Assoc Prof Dr Nor Azmi Kamaruddin,
Malaysia, for Novo Nordisk Pharma (M) Sdn Berhad
4. Website: Penjagaan Diabetes Musim Ramadan, Dr
Norasyikin Wahab, Malaysia, August 2009
5. International Meeting on Diabetes and Ramadan, Edition
of the Hassan II Foundation for Scientific and Medical
Research on Ramadan, Casablanca, Morocco, 1995
25
7/12/10 10:03 AM
diablogue
RUNNING
THE RACE OF LIFE
A Singaporean born to a Japanese father, Marco Aizawa
has actually scaled mountains to overcome diabetes. The
staff nurse talks about his love for endurance sports and its
impact on his health in this new column for diabetes patients
who want to share their experiences with others.
Luck, said Aristotle, is
when an arrow hits the
guy standing next to you.
But what happens when
that arrow hits you right
between the eyes?
Fifteen years ago, I was hit by a bout of breathlessness.
It sent me straight to the East Shore Accident and
Emergency. I thought I had asthma. But when the doctor
broke the real diagnosis to me, I could hardly believe my
ears.
It was D-day for me – I found out I had type 1 diabetes,
also known as Insulin Dependent Diabetes Mellitus.
Clueless, I began poring over brochures to find out more
about this disease. The information about the ill effects
of poor diabetes control, for example, hypertension,
heart disease, leg amputation and kidney failure, really
frightened me. I was determined not to suffer from its
complications.
Growing up with diabetes is not a bed of roses. There are
ups and downs, like stress, and the way people look at
you when they give you insulin jabs and test your blood
sugars. Keeping blood sugars in control is not easy either.
26
However, I look upon my condition as a test of my strength
and never as an obstacle. Now 26, I have completed
five Project Discoveries with Touch Diabetes Support. I
have scaled Mount Kinabalu twice, reaching the summit
on the second attempt; cycled 500km to Kuantan and
also Cherating; and participated in a 100km trekking
expedition in Singapore.
After these projects, I started on endurance sports,
inspired by Lance Armstrong, Phil Southerland of Team
Type 1 and Dr William Tan. They have either cancer or
diabetes and are living testimonies of people who are
able to live life to its fullest despite their conditions. I hope
to be able to give hope to others and encourage them in
the same way with my running and cycling.
Both running and cycling allow me to know my body better
and help me control my blood sugars and my HbA1c.
Hyperglycaemia (high blood sugar) and Hypoglycaemia
(low blood sugar) are conditions I have to take note of
when I exercise.
When I experience a hyperglycaemia, I drink more water
and have plenty of rest. I never exercise when I have a
sugar reading of more than 14 mmol/L as it will increase
my blood sugar level further. When I have hypoglycemia,
I rescue it by drinking something sweet and eating
(depending on my sugar level). With my experience
over the years, I will make it a point to reduce my insulin
dosage by 2-4 units to prevent hypoglycaemia.
There are times when my blood sugar reading will be a
little low, even after I have trained harder. I am still in the
process of understanding what works for me and how
much insulin to reduce when I exercise. I know I still have
lots to discover about myself as I run this race of life.
What’s next for me? Ironman, perhaps!
7/12/10 10:03 AM

Jul - Sep 2010 - Diabetic Society of Singapore

Transcription

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