One family's war on diabetes

Mr Kumara used to think exercise was good enough, but changed his mind after attending a Let's Beat Diabetes talk for tertiary students. His family members now choose healthier choice options like brown rice or basmati rice, rather than refined carbo
Mr Kumara used to think exercise was good enough, but changed his mind after attending a Let's Beat Diabetes talk for tertiary students. His family members now choose healthier choice options like brown rice or basmati rice, rather than refined carbohydrates. ST PHOTO: JONATHAN CHOO
Mr Kumara used to think exercise was good enough, but changed his mind after attending a Let's Beat Diabetes talk for tertiary students. His family members now choose healthier choice options like brown rice or basmati rice, rather than refined carbo
If you want to have a low-GI pasta dish, make sure it is cooked al dente.ST FILE PHOTO

HPB campaign reaches out to different groups to make the change to a healthier lifestyle

These days, the family of Mr Kumara Karthik, 31, including his diabetic parents, eat basmati and brown rice, instead of plain white rice.

The full-time polytechnic student - he went back to school after almost 10 years - urged his family to make the switch after attending a Let's Beat Diabetes dialogue session in November last year.

Basmati and brown rice have a lower glycemic index (GI), compared to white rice, which leads to healthier blood sugar levels.

It was one of the tips he picked up during the dialogue, one of 17 sessions held by the Health Promotion Board (HPB) to tap people for ideas to beat the chronic ailment. Five roadshows were also held from September to December last year.

The HPB said there were about 2,000 responses from the dialogues and roadshows.

  • 1 in 3
    People who are expected to be diagnosed with diabetes in their lifetime.

    60%
    Percentage of Singaporeans who eat out at last four times a week.

    40%
    Percentage of adults who do not have sufficient exercise.

This was the first phase of a six-month exercise to identify issues that prevent people from adopting a healthy lifestyle. The HPB is going through the responses before starting the next phase, where the public can comment on measures and initiatives.

The "war on diabetes" was declared by Health Minister Gan Kim Yong in April last year. He said that about 400,000 Singaporeans have diabetes and, by 2050, about one million "will have diabetes if nothing is done".

WISHFUL THINKING

Most people know about diabetes and the risks, but they think it will not happen to them.

MR KUMARA KARTHIK, on the importance of making a mindset change.

The exercise, launched in September last year by Mr Gan and Education Minister Ng Chee Meng, reached out to different segments of society.

Working adults, women, young people and various ethnic communities were targeted in the sessions.

Each group had different reasons to be concerned about diabetes. For example, Indians have the highest prevalence of diabetes, while Malays have the highest percentage of poorly-controlled diabetes.

While advice such as exercising or eating well was dished out, the discussions sought to find out how to get Singaporeans to act on what they know to be the healthy choice.

For Mr Kumara, the key is in a mindset change. "Most people know about diabetes and the risks, but they think it will not happen to them," he said.

He does not have diabetes but knows a lot about health issues. This is because he graduated from a fitness training course in ITE and, in 2015, started a diploma course in health management and promotion at Republic Polytechnic.

After attending the dialogue session last year, he changed his diet and encouraged his parents to adopt habits to keep their diabetes in check. They now buy grocery products that carry the Healthier Choice Symbol, he said.

CHANGES START AT HOME

One common refrain across the target groups was to replace refined carbohydrates with healthier options. This is particularly important in Asia, where white rice and noodles feature prominently.

And as 68 per cent of Singaporeans eat at least one meal at home every day, the sessions included tips on preparing healthy dishes.

In a dialogue session for women, Senior Minister of State for Health Amy Khor demonstrated how to prepare dishes like laksa fried rice using 20 per cent brown rice, while Malay participants were taught how to make mee goreng using wholegrain yellow noodles and healthier ingredients.

Tertiary students tried their hand at making healthy sandwiches during their dialogue session.

Madam Salmabee, a 61-year-old housewife, attended a session in December last year. Since then, she has been using less sugar and salt in her cooking. "My family members asked me about the change. After I explained it to them, they agreed that it was important for us to change our diet," she said.

She had been worried about the disease ever since her niece fainted and was in a diabetic coma.

She said the information shared by participants at the session convinced her to take action. Now, when she buys groceries, she reminds her daughter to look out for products with the Healthier Choice Symbol.

Beyond the home, participants also suggested increasing the availability of healthier food choices in hawker centres.

With 60 per cent of Singaporeans eating out at least four times a week, dishes like yong tau foo or fish soup can be healthier options.

At the sessions, working people were also encouraged to take breaks to do simple stretches at their desks. About 40 per cent of adults here do not have sufficient exercise.

One in three people is expected to be diagnosed with diabetes in their lifetime. Poor control can lead to heart disease, stroke, amputation or other complications.

Mr Kumara said his 62-year-old mother was lucky to get her condition under control early. She was diagnosed with gestational diabetes in her early 30s.

He said: "When she was warded, I saw other patients who were not so lucky. Diabetes can really affect the whole family."


Portion control can help diabetics manage their blood sugar better

People with diabetes may often choose foods with a low glycaemic index (GI) to prevent their blood sugar levels from spiking after a meal.

However, chief dietitian Lim Su Lin from the National University Hospital does not recommend using GI in isolation.

This is because GI does not take into account the nutritional content or overall health quality of the food. For example, chocolate has a low GI but is high in fat. Eating too much of such foods can, therefore, cause weight gain and high cholesterol.

Diabetics should choose foods with a GI of 55 or lower. The index indicates the food's effect on one's blood sugar levels.

A higher number suggests that eating that particular food will cause one's blood sugar to rise rapidly, which is dangerous for patients with diabetes and puts a strain on the heart.

Meanwhile, low-GI foods result in glucose being released more slowly. Some examples are rolled oats, pasta and carrots. Besides keeping GI and the quality of food in mind, diabetics should also watch their food portions.

Ms Anna Jacob, director of nutrition at Abbott Singapore, advised diabetic patients to exercise portion control and meal spacing. The total amount of carbohydrates consumed over a day also impacts a person's blood sugar levels.

"Nutrient-dense, low-GI food, when selected as part of portion- controlled meal plans, can help diabetics manage their blood sugar levels better," she said.

While it may be daunting to figure out what adjustments to make, simple substitutions can convert common dishes into low- GI versions.

One innovative recipe is cauliflower fried rice, where the finely chopped vegetable replaces rice.

As it contains mostly cauliflower, the dish has very little carbohydrate and a low GI.

Other tips on converting dishes into low-GI meals include:

  • Substituting high-GI staples like white rice with carbohydrate alternatives like tang hoon, basmati rice and al dente pasta. Overcooked pasta, on the other hand, has a high GI.
  • Eating meat together with rice. This can lower the GI of a meal, as protein and fibre slow the breakdown of carbohydrates and, subsequently, the release of sugar into the bloodstream. An example is to add chicken or fish to porridge.
  • Avoid overcooking, mashing or pureeing food, as this leads to the sugars in the food being released into the bloodstream more quickly.
  • Combine high-GI foods with low-GI foods to help moderate the release of sugars during digestion.

Dr Lim suggests that diabetic patients read food labels and make changes that can be sustained over the long term.

She said: "The key is to make small changes gradually, in a way that your body and mind can adjust to them. Lifestyle changes do not happen in a single bite or a single meal."


Exercise, but take safety precautions

Creating a new habit of regular exercise is often difficult. This may be even harder for diabetes patients who have not done any exercises in a while.

Physical activity can improve insulin sensitivity and blood sugar control.

This is important for people with diabetes, said physiotherapist Tay Hung Yong, a manager at Singapore Heart Foundation.

For a start, patients can take short walks after meals and aim for 6,000 to 8,000 steps every day. This can then be increased to more than 10,000 steps a day.

Ms Serene Lim, senior physiotherapist at National University Hospital's Rehabilitation Centre, suggested doing zumba, dance, yoga or taiji to kickstart a more active lifestyle.

But safety precautions should be taken, as exercise often causes blood sugar levels to fall, which can be dangerous for diabetes patients.

Mr Tay recommends that patients check their blood sugar levels before exercise.

If the levels are below 5.6 mmol/L, have a snack before starting any physical activity.

Blood sugar levels should also be measured after exercise.

The levels should not be below 4 mmol/L. If so, taking a snack like a piece of bread or a Milo drink can help to raise the blood sugar levels quickly.

If the weather is hot and humid, diabetic patients should avoid exercising outdoors as they are vulnerable to heat- related illness.

As with all physical activity, those who are just starting to exercise should give their bodies time to adapt to prevent overexertion.

Both Mr Tay and Ms Lim said setting "smart" goals will help patients keep up their routines.

These goals are specific, measureable and achievable, and can be done within a time frame.

The two physiotherapists also gave tips on how to keep up with an exercise routine:

  • Try different forms of exercise in order to find one that you enjoy. This will help you stay motivated.
  • Have a contingency plan, such as exercising indoors when it rains.
  • Place visual reminders like a note on the refrigerator or running shoes near the door.
  • Exercise with a partner. This makes you less likely to skip the workout.
  • Join a class at the gym. An instructor can guide you and provide help in emergencies.

Ms Lim said: "Having a regular exercise routine is important for sustained health benefit."

Mr Tay agreed that the benefits are worth working for.

He said: "Maintaining control over your blood sugar levels helps you obtain a longer runway in your diabetes journey.

"There is a lower risk of complications and you will also feel more energetic."

A version of this article appeared in the print edition of The Straits Times on February 07, 2017, with the headline 'One family's war on diabetes '. Print Edition | Subscribe