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JUL TO SEP 2018 ISSUE 66 Singapore

MCI (P) 033/09/2017

DIABETES

GLUTEN-FREE DIET Who is it for?

Journalling How it can help with emotional health

HYPOGLYCAEMIAON THE ROAD Dangers of driving with low blood sugar

WARM-UP RESISTANCE EXERCISES to prevent hypoglycaemia

FLAG DAY

SAVE THIS DATE

SAT, 29 SEP 2018

CONTENTS

DS management committee 2018/2020FOUNDER Dr Frederick Tan Bock Yam

PATRONThe Honourable Minister for Health

ADVISORDr Warren Lee

PRESIDENTDr Kevin Tan Eng Kiat VICE-PRESIDENTSDr Kalpana BhaskaranDr Bee Yong Mong

HON SECRETARYMs Esther Ng

ASST HON SECRETARYDr Daphne Gardner Su-Lyn

HON TREASURERMs Evelyn Hah

ASST HON TREASURERMs Juliana Lim Bee Yoke

COMMITTEE MEMBERSMr Yong Chiang BoonDr Gabriel YeeMs Maurine LamMs Aslena Hussain

04DS MESSAGEA TIME FOR GROWTH & RENEWAL

05DS BUZZ TAMPINES ECO GREEN WALKSAF MANDAI HILL CAMP TALKRAMADAN TALKTALKS AT LION BEFRIENDERS SENIOR ACTIVITY CENTRESDIABETES CARE & MANAGEMENT TALKS AT RIVERVALE GROVE RC AND JURONG SPRING RCDSG CALENDAR 2018SECOND QUARTER DS-DSG GATHERINGPROJECT VITALIZE: CITI-YMCA YOUTH FOR CAUSES

10 HEARTWAREOPENING DOORS: REFLECTION, EXPRESSION & SELF-DISCOVERY

12 SPECIAL FEATURE HYPOGLYCAEMIA AT THE WHEEL

14 COOKOUT CREAMY ACAI BOWLCHICKEN ZOODLE SOUP

16THE LIGHTER SIDEDO I NEED TO GO GLUTEN-FREE?PUMPED WITH GOODNESS

20SHAPE UP WARMING UP WITH RESISTANCE EXERCISES: REDUCING SEVERITY & DURATION OF HYPOGLYCAEMIA

12 1610055-bevel needle tip formore comfort.2‡

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References: 1. Aronson R, et al. Effects of extra thin-wall needle technology on preference, confidence, and other patient ratings. Clinical Therapeutics. 2013; 35(7)b: 923–933. 2. Hirsch LJ, et al. Impact of a Modified Needle Tip Geometry on Penetration Force as well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes. J Diabetes Science & Technology 2012;6(2):328-335.

BD Medical – Diabetes Care 30 Tuas Avenue 2, Singapore 639461© 2016 BD. BD, BD Logo and all other trademarks are the property of Becton, Dickinson and Company.BD-1717 Printed in Singapore

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Diabetes Singapore JU

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editorial team

On 25 September 1971, Dr Frederick Tan Bock Yam founded the Diabetic Society of Singapore (DSS) to help diabetes patients manage their condition. On 1 January 2018, DSS officially changed its name to Diabetes Singapore (DS).

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

DisclaimerThe views, opinions and recommendations given by the contributors of Diabetes Singapore or are merely for general reference. All materials in this newsletter are for informational purposes only. The individual reader should consult his own doctor or specialist for his personal treatment or other medical advice. DSS and Diabetes Singapore Editorial Board disclaim all responsibilities and liabilities for content expressed in this newsletter including advertisements herein. All contents of the newsletter are the copyright of the contributors and newsletter. Reproduction in any form is strictly prohibited unless with written permission.

Editor-in-chiefDr Yeo Kim Teck

Managing EditorCharlotte Lim

Editor (Dietetics)Abbie Sim

Editorial ConsultantsDS Management Committee

WritersHenry Lew (psychologist)Kohila Govindaraju (nutritionist)Ray Loh (physiologist)Clare Tan (DS)Juliana Lim (DSG)

ContributorsBonnie LauColby, Jia Kang, Mason & Kong Yao

Concept & DesignCharlotte’s Web Communications

Printing Stamford Press Pte Ltd

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

Back Issues www.diabetes.org.sg

DS HQ @ Hong KahBlk 528 Jurong West St 52#01-353 Singapore 640528Tel : (65) 6564 9818Fax: (65) 6564 9861

Central Singapore Diabetes Education & Care CentreBlk 22 Boon Keng Road#01-15 Singapore 330022 Tel : (65) 6398 0282Fax : (65) 6398 0275

DS MESSAGE

DR KEVIN TAN

PresidentDIABETES SINGAPORE

It is with great honour that I take the baton from Mr Yong Chiang Boon, assuming the role of President of Diabetes Singapore. Despite having served on the DS board of committee for many years, the responsibility of serving as President of

DS is monumental, and I ask of everyone’s guidance and assistance as I embark on this new journey of growth and renewal. This key change happens to coincide directly with a similar period of growth and renewal in Diabetes Singapore. Apart from a change of some members in Diabetes Singapore’s management committee, Diabetes Singapore has had its IPC status renewed for another two years, laying testimony to DS’ meticulous governance. DS is also in the midst of finalising its request for a long-awaited additional mobile bus, which will definitely help meet the increasing demand for our services from the Primary Care Networks (PCNs), as well as the upgrading of our current medical equipment. Furthermore, we have seen notable growth and renewal in outreach efforts. Apart from harnessing our current collaborations with Health Promotion Board, YTL Seraya, Lions Befrienders and Gardenia, we have now made headway into new projects with two People’s Association Residents’ Committee Centres, and even had our first talk with Singapore Armed Forces. This trend will only accelerate in the next quarter, as we conduct Flag Day on 29 September 2018, and start publicising our Diabetes Preventive Care and Management workshops, which are supported by Council for Third Age’s National Silver Academy funding. In this upcoming period of growth and renewal in Diabetes Singapore, our team remains committed to serving the community by providing support for diabetes care and management through empowering patients, caregivers and the public!

A Time for Growth & Renewal

Our third walk for the year was held at the Tampines Eco Green Park. This “one of a kind” park has neither lights nor pavements while at the same time hidden away between the expressway and Tampines Ave 12. Thirty-

nine enthusiastic participants, including experienced and volunteer Diabetes Nurse Educators (DNEs) Mdm Lai Yee Khim and Ms Rose Tan, gathered in the Tampines MRT (East West Line) from as early as 3pm. We left the Tampines MRT station at 3.45pm heading to Sun Plaza Park where the pre-blood glucose tests were taken in a sheltered multi-purpose hall, by Rose Tan (DNE) and Christine, with recordings by Michael.

Mr Kwan Hun (wildlife researcher) who joined us for the walk, introduced to us the various wildlife spots, trees and different plants in the park. We exited the park when the weather changed and took shelter at a void deck nearby.

Jenniser and Kean, two trainers from “Happy Fit”, led us in a 20-minute exercise session. All the participants had a lot of fun, gamely joining in the various workouts with much verve and laughter. Many sought advice from the duo for their various concerns. Next up was a 10-minute sharing from the Vitalize project group of four students from Hwa Chong Institution. They have organised a “walkathon” and intend to invite us to their event.

The walk ended with the post-blood test readings taken by Rose and Mdm Lai and recordings by Michael. With a slight drizzle in the air, we all walked back along the Tampines Park Connector. Finally, we reached Tampines MRT Station at 6.45pm. Most participants adjourned for dinner in the 40-stall Kopitiam at Tampines Hub while the rest returned home. Join us for our next walk in July!

28 APR 2018TAMPINES ECO GREEN WALK

DS BUZZJuliana Lim

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18 MAY 2018SAF MANDAI HILL CAMP TALK

Diabetes Singapore held her inaugural talk for almost 350 participants from Singapore Armed Forces (SAF) at Mandai

Hill Camp. Our speaker Mdm Lai Yee Khim was warmly received by her first military audience. After the success

of the earlier Ramadan Talk (article below), DS corporate partner Gardenia continued to generously sponsor free

samples of their latest low GI bread products. Mdm Lai also made some references to the benefits of eating low GI foods

for those with diabetes. At the end of the talk, Diabetes Singapore was delighted to be presented a certificate of appreciation

from SAF.

With less than two weeks to the month of fasting, Diabetes

Singapore held its annual Ramadan Talk to assist and

guide the Muslim community in managing their health

during puasa, especially if they have diabetes or pre-diabetes.

We were privileged to have many esteemed Muslim professionals

getting involved in our event. Dr Shakoor of Tan Tock Seng Hospital

brought up numerous case studies to get the audience to think about

applying the various situations during fasting. This was followed by

National Heart Centre Ms Dahliana Idris’ explanation of how one’s

glycaemia would be prone to drastic changes without food and water.

Finally, Ms Filzah Abdul Rahim of Ng Teng Fong Hospital gave practical

advice on management of food intake between fasts. Renowned artiste

and comedian Alias Kadir, who hosted the talk, also shared his personal

life experiences.

DS was honoured this year to be supported by Health Promotion

Board who provided the venue, healthy refreshments for the

participants, as well as their team of health ambassadors who

interacted well with our attendees. Our corporate partner Gardenia

contributed free samples of their latest low GI breads, which was a hit

with the participants. DS would like to thank our speakers and all the

organisations for their partnership.

DS BUZZClare Tan

5 MAY 2018RAMADAN TALK

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DS BUZZClare Tan

APRIL 2018TALKS AT LIONS BEFRIENDERS’ SENIOR ACTIVITY CENTRES

Hot on the heels of the successful Mandarin Diabetes Management Talk with Lions Befrienders held on 31 March 2018,

Diabetes Singapore decided to take the message of diabetes care and management to seven Lions Befrienders Senior

Activity Centres (SACs) in April.

For the 25 to 30 elderly participants at each SAC, our talk provided them with knowledge and information on the practical

application of diabetes management in daily life. Examples of these include learning how to plan the portion of food types

according to the healthy plate recommendation, learning to read nutrient labels on food packaging, and even examining the

suitability of their footwear.

Our speaker Mdm Lai Yee Khim was able to build rapport with the audience, educating and amusing them at the same time

with anecdotal examples. Members of the Lions Befrienders SACs were so impressed that they asked if they could send DS

additional “frequently asked questions” to Mdm Lai. Diabetes Singapore is heartened by the positive outcome of these talks,

and hopes to initiate more of such programs.

Diabetes Singapore (DS) was approached by the residents’

committees of Rivervale Grove and Jurong Spring to conduct

outreach talks in April and June.

For the 60 and 30 residents at Rivervale Grove and Jurong Spring

respectively, these events presented the perfect opportunity for them to

learn about diabetes care and management during festive celebrations.

While the residents were being treated to the healthy yet sumptuous

feast provided by their zone representatives, speakers Mdm Lai Yee Khim

and Ms Nursyafiqah demonstrated to them how they can all still enjoy a

good meal without compromising their health.

Our speakers were able to connect with the audience and DS is

confident such relatable talks on the ground will eventually raise public

awareness to prevent diabetes and promote action towards better

diabetes management in daily life.

29 APR & 3 JUN 2018 DIABETES CARE & MANAGEMENT TALKS RIVERVALE GROVE RC AND JURONG SPRING RC

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#02-11, SynapseSingapore 138623

Clare TanDS BUZZ

28 July 2018 (Sat)Walk @ Changi Beach ParkTime: 3.30pm – 6.30pmMaximum number of pax: 40

18 August 2018 (Sat)Walk along Civil District TrailTime: 3.30pm – 6.30pmMeeting Point: To be confirmedMaximum number of pax: 40

1 September 2018 (Sat)DSG 3rd Quarterly Gathering with DS MembersTime: 2.00pm – 5.30pmVenue: To be confirmedMaximum number of pax: 100

15 September 2018 (Sat)Visit to NKFTime: 3.30pm – 6.30pmMaximum number of pax: 40

29 September 2018 (Sat)Diabetes Singapore Flag Day Time: 3.30pm – 6.30pmMeeting Point: 4 collection centres islandwide Hong Kah & Boon Keng office;Toa Payoh Hub & Tampines Mall Maximum number of pax: 100

27 October 2018 (Sat)Walk in Sungei BulohTime: 3.30pm – 6.30pmMaximum number of pax: 40

DSG CALENDAR 2018MEET & SHARE

This year’s second DS-DSG Gathering was held on 2

June 2018 at Singapore General Hospital. The program

consisted of a talk by a nerve care specialist invited by

pharmaceutical company Merck. Merck also provided a booth

for foot nerve health screening for participants that day.

Unlike previous screening tests, this event was especially

informative with two staff from Merck patiently explaining

to the participants the implications of the figures recorded

during the foot nerve screenings. The invited speaker further

elaborated on nerve health and diabetes neuropathy. Our

DSG members deeply appreciate Merck’s efforts in raising

awareness about nerve care and hope that more members and

participants can benefit from these talks and screenings in the

future.

18 MAY 2018Second QuarterDS-DSG Members’ Gathering

Join us for our next support group event! Call Juliana at 9278 2084 for more information.

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PROJECT VITALIZE CITI-YMCA YOUTH FOR CAUSES

Lilly Centre for Clinical Pharmacology Pte Ltd3 Biopolis Drive

#02-11, SynapseSingapore 138623

DS BUZZ

18 MAY 2018Second QuarterDS-DSG Members’ Gathering

Hi, we are Project Vitalize, a group of Secondary Four

students from Hwa Chong Institution! We signed up

for the Citi-YMCA Youth for Causes, choosing to raise

funds and conduct outreach projects for Diabetes Singapore

(DS). With the national War on Diabetes now at the

forefront, we felt galvanised to chip in and help fight the war

together with DS.

The project has been an eye opener for the four of us.

Conceptualising and implementing have taught us empathy,

deliberation and foresight, life skills which we cherish

and hope will help us face future challenges in life. In our

interactions with the DS Support Group members, they

have imparted precious knowledge to manage our health

well, whether we have diabetes or not. We realise we

should never take our health for granted.

We held the finale fundraising concert, with the aim of

bringing patients and the public together, believing that

other like-minded youths can enjoy the concert and at the

same time learn from our experience and be moved to take

up worthy causes. The success of the concert has indeed

proven that!

Thank you, Diabetes Singapore!

Colby, Jia Kang, Mason & Kong Yao

Hwa Chong Institution

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HEARTWAREHenry Lew

OPENING DOORS Reflection, expression & self-discovery

Health is sought after by everyone. Some of us may exercise, while some others may change their diet. And some of us may change some of our habits to be healthier, for example, having more hours of sleep. We search for information

online, we consult professionals, or we may purchase products and services to enhance our health. But there is an important tool readily available that can help us in our journey to better health. Yet, we often forget about this important tool...journalling.

Journalling may sound archaic and alien to some. Wasn’t it what our grandparents used to do, you may ask. Or something we were forced to do in school. Some may also contend that they are already journalling since they blog, vlog, tweet or post on social media. There are two points that differentiate journalling from public posts and sharing. Firstly, journalling is timeless and relevant to all. Secondly, journalling has its own unique features.

Broadly speaking, journalling has certain features that differentiate it from a social media post. It is reflective and personal,

while posting on social media is generally what we like others to know about us. Generally, journalling can be done in two

ways:

Free flowing expression. This type of journalling allows whatever that comes to mind to be expressed without

censorship. There is no need to worry about grammar, sentence structure or the content.

Reflective. This kind of journalling usually involves monitoring ourselves, taking note and narrating about a specific area

that is of interest to us. For example, some people keep track of their diet, some their exercise, while others keep track of

their mood or interpersonal relationships. It also involves reflecting on what helped them or what did not help them to stay

on track, so that they can adjust their actions in pursuit of their goals.

OPENING DOORS Reflection, expression & self-discovery

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HEARTWARE

About the author: Henry Lew works as a psychologist and enjoys coming up with creative ways to engage his patients and readers.

Journalling is relevant to everyone because it offers many benefits:

1It helps us to identify and express our feelings and

thoughts. In writing without censorship, we allow

our innermost thoughts and feelings to surface. By

gaining access to these feelings and thoughts, which

we often chuck aside or suppress, we are getting in touch

with what we really need and want. In doing so, we can then

take action to fulfill our needs and wants.

Some of these thoughts and feelings may be too personal and

difficult to share with others. Expressing these feelings and

thoughts in a “safer” medium can help us be more honest

with ourselves and reduce stress as there is no ‘audience’.

2 It helps us to identify behavioural patterns.

Journalling gives us room to take a step back from

our daily events and activities. We are in a better

position to reflect and think about our next step of

actions, rather than go with the flow or our usual response

to situations or other people. It helps us to gain insight into

any patterns of behaviours that we are not aware of. For

example, we may find ourselves unknowingly joining our

colleagues to snack when they offer us food, even when we

feel full.

3 It helps us to identify environmental cues that

assist or hinder us. Besides gaining insights into

our behavioural patterns, journalling also helps

us to be aware of possible environmental factors

that influence us. For instance, we may find ourselves

buying more food than we need or planned due to sales or

discounts and then end up feeling tempted or pressured to

finish the extra amount of food we bought.

4 It reinforces our learning and progress. Journalling

also makes us aware of the success and progress

we have made. Sometimes, we may think that a tiny

action that we have taken may not have any huge

impact. On the contrary, these small actions may be the

building blocks to better habits and health.

I recall a lady who once told me that she was surprised

her blood sugar and pressure had improved. She said

she had only cut sugar from her breakfast. I invited

her to journal for two weeks. She discovered while

journalling that she had also just started to drink plain

water for the other meals even though she did not

do it deliberately. You may discover much more about

yourself than you know!

5 It helps us to develop other aspects of our

identity. Changing our old habits and adopting

new habits can be very challenging. Most of the

time we may not be able to sustain them for

long. Furthermore, from our past experiences when we

were not able to keep up with lifestyle changes, we may

end up thinking that it is impossible to succeed. Or we

may lose confidence in trying to change.

In journalling, we may be made aware of some of the

situations when we succeed. We may become aware of

our inherent skills and abilities that we can harness to

build our confidence. There was a gentleman whom I

worked with who felt demoralised while trying to make

lifestyle changes. After journalling, he became aware

that since he was young, he actually had a preference

for healthier food options. Instead of seeing it as a

major change, journalling helped him to see that it was

merely a return to his preference. This made it easier

for him mentally and emotionally to chose healthier

foods whenever he was tempted to consume more high

caloric food!

Journalling has many benefits. How often and how you

do it would depend on your goal. Generally, it would be

helpful to journal at a regular frequency. For example,

daily, every other day, or weekly. Or you could decide to

only journal for a duration if journalling regularly seems

daunting to you. For example, you could decide to journal

every other day for two weeks if you want to gain insight

into your behavioural patterns or environmental cues.

Journalling is free and can be done anytime and anywhere.

Just reach for the pen and paper or the notes APP on your

digital device. It’s that easy and definitely opens doors to

your heart and mind. Surprise yourself!

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SPECIAL FEATUREVeronica Koh

Low blood sugar or hypoglycaemia can put vehicle drivers with diabetes and other road users at risk of an accident

on the road. This happens when blood glucose levels fall below normal levels. It can happen to anyone with diabetes, but is more common with those taking insulin and certain types of oral glucose-lowering medication such as sulphonylureas.

The problem is compounded if they have been physically active, such as shopping or exercising; have missed a meal or eaten a smaller than usual meal; have other medical problems such as renal impairment, which can increase the risk of hypoglycaemia from medication; and have been on medication that can cause drowsiness.

On the road, these would reduce your alertness and the ability to notice signs and symptoms of low blood glucose, which could, in turn, lead to potentially tragic outcomes.

“Drivers with diabetes should always have glucose tablets handy. And until all symptoms of hypoglycaemia— including trembling, excessive sweating and nausea—are gone, the driver should not resume driving.

HYPOGLYCAEMIA AT THE WHEEL

SPECIAL FEATURE

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WHEN GLUCOSE LEVELS DROPA blood glucose level of less than 4.0 mmol/L is considered

hypoglycaemia, and could make the person dizzy or

agitated, impairing concentration and reaction times.

Other symptoms include trembling, excessive sweating,

accelerated heartbeat, headaches, a tingling sensation in

the fingers, lips or tongue, and feeling hungry or nauseous.

If left untreated, hypoglycaemia could become more

severe, leading to weakness and difficulty walking, blurred

vision, confusion and abnormal behaviour, unclear speech,

seizures, and even loss of consciousness.

If you are experiencing any of these symptoms you should

call for an ambulance or find someone nearby to do so

immediately.

If you are on the road, find a safe place to stop and park

the car. Turn off the engine and shift to the passenger seat.

Drink 15g of fast-acting carbohydrates such as fruit juices

or glucose tablets, which should be kept handy.

Wait 15 minutes before testing the blood glucose level.

If it has reached above 4.0 mmol/L (but is less than 5.0

mmol/L), take another 15g of carbohydrates.

The driver should not resume driving until all the

symptoms are gone and he is able to perform tasks such

as mental arithmetic. This could take as long as 30 to 45

minutes.

STAYING SAFEMost people with diabetes are able to maintain stable blood glucose levels, and can drive without incident. However, because of the dangers posed by hypoglycaemia, it is important to monitor blood glucose levels before and along the journey. This is especially so on long or extended journeys. Ensure that your blood glucose level is above 5.0mmol/L before driving.

Here are some helpful tips to stay safe while driving, from the SingHealth Duke-NUS Diabetes Centre:

DO • Bring a glucometer to monitor blood glucose readings.

• Protect your glucometer from extreme temperatures

by not leaving it in the car on a hot day, or under direct

sunlight, to ensure it gives accurate readings at all times.

• Carry quick and long-acting carbohydrates to treat

hypoglycaemia.

• Always test blood glucose levels before driving, and every

two hours into driving. If the blood glucose reading is

below 5.0 mmol/L, take 15g of carbohydrates (such as

three biscuits or one slice of bread) before starting to

drive.

• Carry a Medik Awas card to identify yourself as a person

with diabetes in case of an emergency. If you have a

hypoglycaemia episode, treat the hypoglycaemia and do

not drive until you have recovered fully.

DON’T • Drive with blood glucose levels below 5.0 mmol/L.

• Drive when tired or are on medication that may cause

drowsiness.

• Drink and drive.

APPY FOR THE MEDIK AWAS CARDApply for and carry a Medik Awas card at all times. The card,

issued by the Singapore Medical Association, will have your

personal details, medical conditions, drugs, allergies, medication,

as well as your doctor’s name and contact number.The card

will be very helpful if you are unable to communicate vital

information to people around you, or to medical or dental

personnel during a medical emergency. To find out how to apply

for a Medik Awas card, visit www.sma.org.sg/medikawas.

Article from Singapore Health (Mar to Apr 2018 issue), a publication of the THE SINGHEALTH DUKE-NUS ACADEMIC MEDICAL CENTRE. Reproduced with permission.

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SPECIAL FEATUREBonnie Lau

COOKOUT

SERVES 2

Creamy Acai Bowl

Nutrition Information Per BowlEnergy 426kcalCarbohydrate 67gProtein 10.4gTotal fat 12.4g Saturated fat 3.6gCholesterol 8mgDietary fibre 12.2gSodium 58mg

About the author: Bonnie Lau is an accredited practising dietitian, with over five years’ working experience. She has worked in SGH and TTSH, and is currently at Holmusk with its flagship product GlycoLeap (https://glycoleap.com). Bonnie loves food and is passionate about chronic disease management. Check out her blog at https://blog.glycoleap.com.

Bonnie Lau

Ingredients 1/2 large banana (cut into slices, frozen)3/4 whole mango (cut into cubes, frozen)3/4 cup frozen berries (blackberries, strawberries, raspberries or blueberries) 1 100g frozen acai packet (unsweetened)2 tsp honey2 tsp avocado (frozen)1/4 cup fresh milk

Toppings:Berries: strawberries, blueberries, raspberries, cranberriesFigs, longans, or any fruit you like!Mango cubes; coconut chips (unsweetened)Pomegranate seedsChia seeds, dried flowers3 Tbsp unsweetened granolaPumpkin seeds

Method of Preparation 1. Put 2 tablespoons of granola into a large bowl.2. Put the bowl and the blender jug in the freezer to make cold (important in Singapore weather!).3. Add all acai bowl ingredients into a blender and blend for around 1.5 minutes until smooth and creamy. 4. Pour this mixture into the bowl over the granola, and top with your favourite toppings. Serve immediately.

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Source: https://www.allrecipes.com/recipe

COOKOUT

SERVES 6

Chicken Zoodle Soup

Nutrition Information Per ServingEnergy 208kcalCarbohydrate 8.9gProtein 21.6gTotal fat 9.5g Saturated fat 2gCholesterol 48mgDietary fibre 2.1gSodium 257mg

Ingredients 3 zucchini squash, cut into ‘noodles’ using a vegetable peeler2 tablespoons olive oil1 cup diced onions1 cup diced celery3 cloves garlic, minced5 (14.5 ounce) cans low-sodium chicken broth1 cup sliced carrots3/4 pound cooked chicken breast, cut into bite sized pieces1/2 teaspoon dried basil1/2 teaspoon dried oregano1 pinch dried thyme (optional)salt and ground black pepper to taste

Method of preparation1. Heat olive oil in a large pot over medium-high heat. 2. Saute onion, celery, and garlic in hot oil until just tender, about

5 minutes.3. Pour chicken broth into the pot; add carrots, chicken, basil,

oregano, thyme, salt, and pepper. 4. Bring the broth to a boil, reduce heat to medium-low, and

simmer mixture until the vegetables are tender, about 20 minutes.

5. Divide zucchini ‘noodles’ among 6 soup bowls; pour broth mixture over the ‘noodles.’

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What is Gluten?

Gluten is a type of protein found in various grains including wheat, barley, rye, triticale, malt and oats. People with

coeliac disease have an immune system that attacks their own body after eating gluten. This causes inflammation in

the small intestine, which can cause problems like diarrhoea, abdominal pain, anaemia and ultimately an increased

risk of colorectal cancer and infertility. If you have coeliac disease, you need to follow a gluten-free diet for the rest of your

life to prevent these complications.

Is There Any Connection Between Diabetes and Gluten? In Western countries, about 1% of the population has coaelic disease (in Asians, it is only 0.5%1). Compare this with people

with type 1 diabetes, with about 10%2 having coeliac disease as well. This could be due to a genetic link between type 1

diabetes and coeliac disease. Both conditions have an inflammatory response that can make our immune system damage

the body’s organs, like the intestines or pancreas. However, there does not seem to be any link between type 2 diabetes and

coeliac disease.

SPECIAL FEATURE

Gluten-free has been a craze in the ‘diet world’ for many years. You may have noticed gluten-free labels on food packaging in the supermarket and wondered if you need to avoid gluten if you have diabetes. The simple answer is no, unless you have coeliac disease or non-coeliac gluten sensitivity (NCGS).

THE LIGHTER SIDEBonnie Lau

DO I NEED TO GO

?

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Non-Coeliac Gluten Sensitivity (NCGS)Some people have NCGS, but still suffer from symptoms

similar to coeliac disease after eating gluten, although there

is no damage or injury to the gut itself. It could also be mere

intolerance to other components of gluten-containing food

(e.g. FODMAPs; a group of fermentable carbohydrates) that

could cause symptoms. If you suspect you have either coeliac

disease or NCGS, it is important to talk to your doctor for a

diagnosis before going on a gluten-free diet (as it is essential

to be eating gluten for an accurate diagnosis).

If your diagnosis shows you need go on a gluten-free diet, it

can seem difficult to juggle this with diabetes as well. Thus,

it is important to speak to a dietitian to ensure you are

getting the right nutrition while watching out for all potential

sources of gluten.

What if I have Coeliac Disease or NCGS? Gluten is found in many carb-containing foods because

they are grain-based. Other than watching out for the

carbohydrate quantity you are eating for your blood sugars,

you will have to avoid gluten.

Some tips on following a gluten-free diet include:

• Assume all breads, bakery products, cereals, beer, pastas,

wheat noodles, and snack foods, contain gluten unless it

states “gluten-free” on the label. Many processed food

products may contain traces of gluten including soy

sauce, commercial sauces, canned foods containing

thickeners, battered or marinated foods, and ice cream.

Label reading is paramount!

Healthy starchy foods that are naturally gluten-free which you can include in your meal plan:

• brown, red glutinous and wild rice; and rice noodles like red rice beehoon

• fresh root vegetables, e.g. lotus root, tapioca, yam, white or sweet potatoes (with skin)

• corn/polenta • buckwheat • amaranth • millet • soy • quinoa • sorghum • teff • legumes, dhall and besan flour

• Do not be tricked: having a gluten-free label does not

automatically make a product ‘healthy’! Gluten-free

products often have more added sugar or salt to enhance

the flavour, so read the labels to choose a healthier

choice. Gluten-free alternatives may also have different

carbohydrate counts compared to the ‘regular’ version

than what you are used to. Count these carbohydrate

products as you would in your regular

carbohydrate allowance in the day!

Many gluten-free products

tend to be lower in fibre

(e.g. noodles or biscuits

made with tapioca flour,

which is lower in fibre

than typical wheat-

based products).

This may spike your

blood sugars, so it is

important to try to

choose high-fibre gluten-

free products to help regulate

your blood sugars.

Should I go Gluten-Free? If you do not have diagnosed coeliac disease or NCGS, you

should not be following a gluten-free diet. There are no

health benefits to a gluten-free diet compared with other

diets optimal for diabetes. In fact, it could put you at risk of

certain nutrient deficiencies and unnecessary expenditure

on your wallet. However, if you do have coeliac disease

or NCGS, then going gluten-free is an essential aspect to

managing your condition and symptoms.

For more information on the gluten-free diet, you can visit

http://www.singaporecoeliacs.com/gluten-free-diet/ for tips

on living in Singapore with a gluten-free diet, and https://

www.health.qld.gov.au/__data/assets/pdf_file/0026/149930/

gastro_coeliac.pdf for a comprehensive leaflet on foods to

avoid and foods you can eat.

THE LIGHTER SIDE

About the author: Bonnie Lau is an accredited practising dietitian, with over five years’ working experience. She has worked in SGH and TTSH, and is currently at Holmusk with its flagship product GlycoLeap (https://glycoleap.com).

References:

1. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgh.13270

2. http://www.diabetes.org/food-and-fitness/food/planning-meals/gluten-free-diets/

Diabetes Singapore JU

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THE LIGHTER SIDEKohila Govindaraju

PUMPED WITH

GOODNESS When we think of pumpkins, we tend to think

of Halloween and Jack-o-lanterns. But did

you know that pumpkins are one of the most

misunderstood fruit (yes, it is a fruit!) and has been ignored

and avoided by diabetes patients for all the wrong reasons?

When I give talks at various locations, people are often

surprised to learn that this beautiful orange and plump fruit is

mistakenly classified under starchy vegetables.

Pumpkin once boiled has the high score of GI value at 75.

But its total carbohydrate value is only 6 to 8%. Surprised?

Compare that with a baked potato that has a total

carbohydrate of 17%. It is obvious that the total carbohydrate

(sugars and starch) in pumpkin will not have much effect on

your blood glucose levels. Portion size matters, of course, so

only take pumpkin in moderate amounts.

Pumpkin is also loaded with betacarotene, the precursor to

vitamin A. Betacarotene is an antioxidant that protects cells

from damage caused by free radicals. The principal function

of vitamin A is in the visual process where it promotes good

vision. It also helps form and maintain healthy skin, teeth,

skeletal and soft tissue, mucus membranes and skin. Retinol

is another name for vitamin A, as it produces the pigments in

the retina of the eyes! The best source of vitamin A are the

carotenoids from fruits and vegetables.

Pumpkin is a good source of potassium. Along with calcium,

the bone mineral and magnesium, potassium plays a major

role in cardiovascular health. Potassium helps the body to

excrete excess sodium and at the same time helps increase

the calcium retention which prevents magnesium loss!

This intimate relationship between calcium, potassium and

magnesium is important for many of our vital bodily functions.

You may be tempted to buy canned pumpkin off the supermarket

shelf but the canned product is high in carbohydrate which may

elevate your blood sugars. It is still always better to buy fresh.

It is also important to note that the iron in pumpkin is

non-heme (iron found in vegetables) and therefore requires

a sufficient amount of vitamin C to get absorbed. So, enjoy

pumpkin with vitamin C rich fruits to enhance the absorption

of iron.

QUICK FACTS ABOUT PUMPKINS

The potassium contained within pumpkins can have a positive effect on blood pressure.

The antioxidants in pumpkin could help prevent degenerative damage to the eyes.

Uncut pumpkins should be stored in a cool, dark place for up to two months.

Pumpkin puree can be used as a replacement for butter or oil in baking recipes.

adapted from www.medicalnewstoday.com

About the author: Kohila Govindaraju is an accredited nutritionist and director of THE BERRIES Nutrition Consulting, an avid blogger (kohilag.wordpress.com) and prolific author of magazine articles on food and nutrition, including a book titled How to Lose Weight Without Hunger published by PatientsEngage.

SHAPE UPRay Loh

WARMING UP WITH RESISTANCE EXERCISES Reducing severity and duration of hypoglycaemia

Hypog lycaemia refers to the c o n d i t i o n when our

blood glucose level drops below 3.9mmol/l (70mg/dl). It occurs commonly in people with type I and advanced type 2 diabetes mellitus, and especially those treated with insulin and oral medications such as sulfonylureas. It is the most feared complication of diabetes treatment, with a reported figure of 2% to 4% deaths attributed to hypoglycaemia.

Hypoglycaemia is often related to

the treatment of diabetes. However,

a variety of conditions, although

rare, can cause low blood sugar in

people without diabetes. Like fever,

hypoglycaemia is not a disease but an

indicator of a health problem.

Hypoglycaemia symptoms are signs

triggered by our body’s physiological

defence when our blood glucose level

falls below the glycaemic threshold.

Hence, understanding the signs of

hypoglycaemia for early treatment is

important.

The two categories of hypoglycaemia

symptoms are the Neurogenic

symptoms and the Cholinergic-

mediated symptoms. Neurogenic

hypoglycaemia is activated by the

autonomic nervous system (ANS).

It causes a person to feel shakiness,

anxiety, nervousness, palpitations,

sweating, dry mouth, pallor, and

pupil dilation. Cholinergic-mediated

symptoms can be identified from

profuse perspiration and itch or tingling

feelings of the body.

Over a period of time, repeated

episodes of hypoglycaemia can lead

to hypoglycaemia unawareness. The

body and brain does not produce

signs and symptoms that warn of

low blood sugar, such as shakiness or

irregular heartbeats. This can prove

rather dangerous because it increases

the risk of severe, life-threatening

hypoglycaemia.

The glycaemic threshold that triggers

the hypoglycaemia response differs

individually. It depends on the types of

treatments and occurrence frequency.

19

Diabetes Singapore JU

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20

Patients with higher HbA1c were

observed to perceive hypoglycaemia

symptoms at a higher blood glucose

level which may be above the normal

range. In the opposite manner, patients

with intensive medical treatment to

control their blood glucose level may

recognise the symptoms at a lower

than the normal physiological glycaemic

thresholds.

Antecedent and persistent

hypoglycaemia also blunt or reduce the

sensitivity to subsequent hypoglycaemia

responses at a lower glycaemic

threshold. In fact, early research from

Segel and colleagues (2002) already

reported a shift of glycaemic threshold

to a lower concentrations in recent

antecedent hypoglycaemia and the

counter-regulatory response was

virtually absent in advanced insulin-

treated type 2 diabetes. In other

words, our body may not respond to

hypoglycaemia with any symptoms

until we reach the critical stage as the

number of episodes of hypoglycaemia

increases.

Exercise has been advocated as the

best medicine and treatment for people

with diabetes especially type 2 diabetes.

The physiological benefits even at

cellular level are not seen in dietary and

medication interventions.

The improvements such as increasing

Mitochondria (powerhouses of the

cell) content, glucose transporter type

4 (Glut4) content, pancreatic insulin

secretion, and reducing endoplasmic

reticulum (ER) stress and inflammation

through proper structured training

are well documented. However,

prolonged physical activity

without sugar compensation and

medication adjustment may also

lead to hypoglycaemia and dull our

physiological defences.

The effect of a single bout of exercise

may last up to 17 hours. Thus,

hypoglycaemia symptoms may occur

even hours after exercise. Patients with

previous episodes of hypoglycaemia are

also at a higher risk of hypoglycaemia

during or post-exercise. During a bout

of moderate intensity exercise, insulin

secretion is reduced by 40 to 60% with

the compensation of an increase in

Glut4 connectors for glucose uptake. In

other words, the rate of glucose uptake

is increased with just a small amount of

insulin.

Depending on intensity and duration

of activity, supplements of 10g to 20g

of carbohydrates for every 30 to 60

minutes of physical activity may be

needed to maintain healthy blood

glucose level. With improved

insulin sensitivity, medication doses

such as insulins and sulfonylureas

may need to be reduced in a 24-

hour period to prevent post-exercise

hypoglycaemia.

Interestingly, exercise order may

also help in preventing exercise-

induced hypoglycaemia. Yardley and

colleagues (2012) did the interesting

study with type 1 diabetes and

found that performing resistance

exercise first before continuing with

aerobic exercises improves glycaemic

stability throughout the exercise and

reduces the duration and severity of

hypoglycaemia. It sounds like it may

be a good practice to integrate some

simple resistance exercises into your

warm-up routine before going for your

big walk.

SHAPE UPRay Loh

Exercise has been advocated as the best medicine and treatment for people with diabetes especially type 2 diabetes. The physiological benefits even at cellular level are not seen in dietary and medication interventions.

“

21

Leg Swings

• Stand with hand support if needed, swing

leg to reach opposite hand.

• Perform 20 repetitions for each leg.

Half Squats

• Stand with feet shoulder width apart,

keeping body upright, lift arms and

lower the body through the hips till

arms and thigh is parallel to the floor.

Hold for 2 seconds and return to

standing position.

• Repeat 10 to 20 times.

Hip Circles

• Stand with feet shoulder width apart.

Place hand by your waist and circle your

hips clockwise and anti-clockwise.

• Repeat 20 repetitions or as needed for

each direction.

Forward Lunges

• Stand with feet shoulder width apart, place hand

by your waist and take a step forward, keep

body upright and lower the body till the front

and back knees are almost 90 degrees. Hold for

2 seconds and return. Repeat with the other leg.

• Repeat 10-20 repetitions.

SHAPE UP

A warm-up routine that requires only about 10 minutes is illustrated below and on the next page. For those with lower limb conditions, please consult your health care professionals for alternative exercises.

Diabetes Singapore JU

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References Briscoe VJ, & Davis SN. (2006). Hypoglycemia in type 1 and type 2 diabetes: Physiology, pathophysiology, and management. Clinical Diabetes, 24(3):115-121.

Yardley et at. (2012). Effects of performing resistance exercise before versus after aerobic exercise on glycemia in type 1 diabetes. Clinical care 35(1):669-675.

About the author: Ray Loh is an exercise physiologist at the Sports Medicine and Surgery Clinic, Tan Tock Seng Hospital. He has been an active volunteer with Diabetes Singapore, giving talks and demonstrations on exercise and workouts.

SHAPE UP

Calf Stretch (perform a then b)

• Stand with both hands against the wall, place

one foot back. Holding heel on the ground,

while keeping the back knee straight, bend

the front knee till you feel a stretch in the

calf. Hold for 20 seconds before returning.

Repeat 3-4 times for each leg.

• Stand with both hands against the wall, place

one foot back. Holding heel on the ground,

bend the back and front knee at the same

time until you feel a stretch on the lower

calf. Hold for 20 seconds before returning.

Repeat 3-4 times for each leg.

Knee Circles

• Stand with feet together. Place hand by

your waist, bend knee and rotate clockwise

and then anti-clockwise.

• Repeat 20 repetitions each or as needed.

Single Leg Curl

• Stand on a single leg with support.

Lift heel as high as possible quickly

and return slowly.

• Repeat 20 repetitions for each leg.

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