MHTMAY15_pg26-40_Special Report_Diabetes

Taking Control
of DiabetesSo you have diabetes. What happens now?
Being diagnosed with Type 2 diabetes mellitus is not the end of the world. True, making
the necessary changes in order to control this condition may seem daunting at first, but
with planning and determination, you will still be able to remain in pretty good health
despite having diabetes.
In this Special Report, HealthToday presents information and tips from specialists to help
you take control of your health and make those changes. So, hop into the driver’s seat
and don’t worry – if you are lost, we can help you get back on track!
Words by Lim Teck Choon
Special Report
Taking Control of Diabetes
26 HEALTHTODAY•May 2015
MHTMAY15_pg26-40_Special Report_Diabetes.indd 26 4/15/15 4:56 PM

Y
ou have surely heard of
diabetes in the past, but
after being diagnosed with
the condition, diabetes is
no longer an issue that affects other
people. It now affects you.
Before you can take control of your
health and life, you should know the
facts about diabetes, such as why it is
happening to you and what it can do
to you. Such information may be harsh
Dr Hew Fen Lee
Consultant
Endocrinologist
Understanding type 2
diabetes mellitus is the
first step in empowering
you to take real actions in
controlling the condition.
or frightening, but the more you know
about diabetes, the more you will
understand why you need to commit to
the lifestyle changes that will help you
control the condition.
You will understand that all is not
lost, and there is no need to give up
when the going gets tough. There are
many diabetics out there who live
healthy and fulfilling lives by making
the necessary changes, and there is
T2DM
&You
no reason why you cannot be one of
them.
So let us take a better look at type 2
diabetes mellitus (T2DM).
An issue of insulin resistance
Many people believe that T2DM is
a disease caused by eating too
much sugar. This is not true.
“T2DM is a problem caused by
insulin resistance,” explains
Dr Hew. “Patients with T2DM
are usually insulin resistant,
which means they require
more insulin to control their
glucose level, more than their
body can produce.”
First, let us start by taking a look
at the pancreas. Our pancreas is an
organ located behind the lower part
of the stomach, and it produces
insulin, the hormone responsible
for regulating blood glucose levels.
Our body needs glucose for energy.
Our digestive system breaks down
the carbohydrates in our meals to
glucose. Therefore, after each meal,
the amount of glucose in the blood
typically rises.
In a healthy person, the pancreas
detects this rise in blood glucose
level. It then releases insulin into the
bloodstream, and insulin attaches
itself to the appropriate cells in our
body. The attachment of insulin alerts
these cells to begin absorbing glucose
from the blood stream. This action
helps to remove excess glucose from
the bloodstream, keeping the blood
glucose level within a healthy range.
The more glucose is present in the
bloodstream, the more insulin would
be released by the pancreas.
In someone with insulin resistance,
the pancreas produces insulin each
time it detects high blood glucose
level in the bloodstream. However,
the cells of the body do not respond
normally to insulin.
Special Report
This special report is made possible with an education fund from

Make every meal
well-balanced
Exercise
regularly
Take your
medications
correctly
GOOD DIABETES
MANAGEMENT
According to Dr Hew, because of insulin resistance, more insulin is required to control the blood glucose level. This exerts
pressure on the pancreas to produce higher amounts of insulin than normal.
“Over time, the insulin resistance builds to a level at which the pancreas can no longer keep up with,” says Dr Hew. “A
shortfall of insulin occurs, and the blood glucose level in the blood is no longer controlled adequately, causing it to rise
above the healthy limit.”
Insulin resistance slowly builds up over time, so many people may not know that they have T2DM until the condition has
progressed to a later stage and controlling it becomes more difficult.
So what happens now?
If left unchecked, T2DM can lead to various health
conditions (complications) that can severely affect
the patient’s quality of life and can even possibly
lead to early death.
According to Dr Hew, T2DM patients are at risk of
the following:
♥ Eye problems (retinopathy).
♥ Kidney problems, including urine infection and
kidney damage.
♥ Damage to blood vessels, which can lead
to heart problems, stroke and poor blood
circulation. The latter can give rise to poor
sensation, especially in the feet, increasing the
risk of nerve damage, infections, ulcers and
tissue death and possibly requiring amputation.
Managing your diabetes
According to Dr Hew, there are 3 cornerstones in good management of diabetes,
all of which should be practised.
All 3 work together to help control T2DM. We cannot just focus on 1 aspect alone,
which is why it is important to work closely with our healthcare team to come up
with a plan that helps coordinate all 3 aspects of T2DM management in our lives.
Dr Hew believes that, when one is
armed with the right knowledge and
a bit of determination and discipline,
achieving good diabetes control is
not too difficult. “You should make health your No. 1 priority now,” he urges. “Once you keep this in mind, everything else
becomes easier.” HT
We don’t know all the causes of insulin resistance, but researchers strongly believe that excessive weight and
lack of physical activity are 2 important and significant causes. Most patients with T2DM are overweight and
they lead sedentary (inactive) lives.
Why manage T2DM?
Managing the condition is important to slow its progression and
reduce the risk of health problems that can arise over time. The
principle of T2DM management is to adopt a healthy lifestyle which
should apply to anybody with or without diabetes. Dr Hew points out
that a good control of diabetes often allows the patient to lead a
healthy and normal life while minimising the complications normally
associated with T2DM.
Special Report

Coping with
changes can
be hard, but
nothing is
impossible
with the right
attitude and
perspective.
Y
our mind may be reeling
from the diagnosis that
you have diabetes. The
changes you need to make
in your life may be overwhelming at
first. Don’t worry; take your time to let
the diagnosis sink in and, once you are
feeling calmer, reassess your situation.
What are we aiming for?
In diabetic management, the goals
are:
► To keep your blood glucose levels
as normal as possible, and as
stable as possible (without going
too high or too low)
► To prevent high blood glucose
levels from causing damage to the
organs in your body.
To ensure that you are on the right
track, you will need to constantly
monitor your condition through a
series of tests. Some tests can be
conducted on your own, such as
monitoring your blood glucose, while
others involve your healthcare team
extracting a sample of your blood to be
analysed in the laboratory.
While the above figures may not mean
much to you now, they represent the
goals of your diabetes management.
By comparing your results to those in
the table, you will know whether you
are on the right track. We will discuss
more about this in the later pages.
For now, you should understand that
there is a purpose for keeping to these
goals. For example, research has
found that even a small reduction in
HbA1c has great positive impact on
your health.
Therefore, do not wait until you are
feeling ill before taking action. Take
steps to manage your diabetes as
soon as possible. After all, every little
improvement can go a long way in
ensuring that you have a healthy and
fulfilling life despite your diabetes!
Types of tests Target values
Blood glucose (glycaemic) control
•Fasting
•Non-fasting
•HbA1c
4.4 – 6.1 mmol/L
4.4 – 8.0 mmol/L
< 6.5%
Lipid control
•Triglycerides
•HDL cholesterol
•LDL cholesterol
≤1.7 mmol/L
≥1.1 mmol/L
≤2.6 mmol/L
Blood pressure
•When kidney function is normal
•When there is a kidney problem
≤130/80 mmHg
≤125/75 mmHg
Source: Ministry of Health Malaysia. (2009). Clinical practice guidelines
(CPG) on management of type 2 diabetes mellitus (T2DM) (4th ed.).
Putrajaya: Health Technology Assessment Section.
You Can Do It!
JUST 1% REDUCTION IN
HbA1c GIVES
• 21% reduction in risk of death
related to diabetes
• 37% reduction in risk of
complications from damage
to small blood vessels
(microvascular complications)
• 14% reduction in risk of heart
attack (myocardial infarction)
Special Report

Take charge of your health
When it comes to T2DM, you
are primarily responsible for its
management.
Yes, you read that correctly. It may
be tempting to rely solely on your
healthcare team to guide you,
but a big part of good diabetes
management relies on your own
determination to stay healthy. You
will be the one responsible for taking
your medications and making the
necessary changes in your lifestyle.
So, it is important that you know what
you are doing. Don’t let the changes in
life overwhelm you – that is the fastest
route to giving up and letting T2DM
get the better of you.
You can stay healthy, for yourself and
your loved ones. You can do it. Stay
focused, and you will be fine.
Planning your next steps
1
Educate yourself. Read up
on T2DM from authoritative
sources, such as books and
websites. However, there is much
misinformation on T2DM out there, so
discuss with your healthcare team on
what you have found to ensure that
your sources are accurate.
2
Be proactive. Your healthcare
team will work with you to come
up with medication and lifestyle
plans to help you manage your T2DM
better. Ask questions when you have
doubts. Do not worry about being seen
as “fussy” or “problematic”, as most
healthcare teams will be happy to
answer your questions. Make sure you
know exactly what you need to do.
3
Start your own journal, as it
would be good to record your
medication, food and self-
monitoring values. Your records would
be useful during consultations with
your healthcare teams as well as
during medical emergencies.
4
Share with your family the
lifestyle changes you need to
make. It is greatly recommended
that the entire family make the
changes associated with diet and
physical activity together, as this only
contributes to the success of your
T2DM management as well as the
overall health and wellness of the
entire family. If you have difficulties
convincing your family to make these
changes, share your concerns with
your healthcare team. They would be
happy to help facilitate discussions
with your family members. HT
Special Report

Understanding Your
Oral Medications
So you are
diabetic, but do
you know what
you are putting
into your mouth?
Prof Dr Norlaila Mustafa
Consultant Endocrinologist
Universiti Kebangsaan
Malaysia Specialist Centre
Special Report

A
ccording to Prof Dr Norlaila
Mustafa, a consultant
endocrinologist who runs
a diabetes clinic, oral
diabetes medications are designed to
help you manage your blood glucose
level and currently, there are many
types available. Your doctor will
prescribe the types of medication that
are appropriate for you, depending on
your body’s response to insulin as well
as other health conditions you may
have alongside diabetes.
5 good medication habits
Dr Norlaila recommends the following:
1 Follow your doctor’s advice when
it comes to monitoring your blood
glucose level in order to check
your response to the medications
prescribed.
2 Refill your medications when they
run out. Diabetes medications
should be taken continuously, not
just when you are feeling unwell, in
order to slow the progression of the
disease.
3 Too busy to take your medication?
Download a smartphone app to
help you schedule your time.
4 Do not share your medication with
other people. Medicine is one
of the few things in life that you
should always keep to yourself!
5 Keep a list of all the medications
you are on (write down the name
displayed on the packaging) as well
as any supplements or alternative
medications. This list will be useful
during medical emergencies.
METFORMIN: THE FRONTLINE AGAINST DIABETES
According to Dr Norlaila, most diabetes patients are on metformin, for good
reasons.
♦ Along with proper diet and regular exercise, metformin is effective in helping
the patient control his or her high blood sugar level.
♦ It can be taken by most type 2 diabetes patients without experiencing
dangerous side effects.
♦ It is also affordable, and therefore, can be purchased by most patients
without straining their finances.
“Because of its effectiveness on many patients with type 2 diabetes, doctors
usually prescribe metformin as the first option when it comes to treating the
disease,” adds Dr Norlaila.
Dr Norlaila goes on to explain that metformin helps you manage your blood
glucose level in several ways.
♦ Your liver produces glucose, which adds to the glucose you obtain from your
meals. Metformin helps to decrease the amount of sugar produced by your
liver.
♦ It also helps to reduce the amount of glucose absorbed by your body during
the digestion of food.
♦ It helps to improve your body’s sensitivity to insulin, allowing your liver, muscle
cells and fat cells to take in more glucose from your blood. This reduces the
overall amount of glucose in the blood.
Diabetes medications do not
cure diabetes. Dr Norlaila
points out that it is just as
important to follow a meal
plan and exercise regularly
to manage weight, slow the
progress of diabetes and
reduce the risk of damage to
your brain, kidney, liver, eyes,
heart, nerves and more.
Metformin is considered by many as a “wonder drug” due to how
effective it is. In fact, its discovery changed the way we treat diabetes
for the better, improving the quality of life and life expectancy of
diabetes patients.
Special Report

Taking metformin. Metformin is
available in tablet and liquid forms.
Depending on the severity of your
disease, your doctor may recommend
taking them 1 to 3 times a day after
meals. There are also extended
release tablets in the market, which
only requires you to take 1 tablet
a day, usually during your evening
meal. You should follow your doctor’s
instructions, restock your metformin
when it runs out and continue to take
your metformin even when you are
feeling healthy.
Side effects. Like many medications,
metformin can potentially cause side
effects in certain people. Milder side
effects include: diarrhoea, indigestion,
bloating and stomach pain,
constipation, heartburn, headaches,
muscle aches and an unpleasant
metallic taste in the mouth. More
severe side effects include chest pain
and rashes. Dr Norlaila advises that
you should alert your doctor if you
experience any of these side effects
over a prolonged period of time.
Very rarely, a patient with kidney
(renal) failure may develop a
potentially fatal reaction to metformin
called lactic acidosis. Such patients
should take other forms of medication
for their diabetes. Furthermore,
metformin may not be suitable for
patients with problems relating to the
heart, kidneys and liver. Fortunately,
Dr Norlaila mentions that there are
other alternatives to metformin,
termed the second line medications,
which may be suitable for them.
SECOND LINE
MEDICATIONS
Second line medications are those
that are given to patients in order to
support or complement the effects
of metformin for better blood glucose
management. They may also be given
to patients for whom metformin is
cannot be used (contraindicated),
perhaps due to side effects, kidney
problems and such.
Dapagliflozin: improving blood glucose control
Dapagliflozin is an interesting drug in that, unlike most diabetes drugs that target
the pancreas or the liver, it works on the kidneys. “It helps to reduce blood sugar
by increasing the amount of glucose excreted in the urine. It may also help with
weight loss and improvement of blood pressure,” explains Dr Norlaila.
To help you gain a better understanding of how this drug works, let us first take a
look at the link between glucose and our kidneys.
The kidneys are the main waste disposal factory in our body, so let us imagine
a kidney as a big building. Inside the building are about a million little filtration
machines called nephrons. The nephron is the key structure responsible for
controlling the amount of substances present in the urine.
Special Report

The glomerulus is the filtration
structure – it makes sure that only the
right substances that can fit through
its pores will end up in the urine.
Glucose is of the right size, so it can
pass from a blood vessel through the
glomerulus without any difficulty.
Normally, urine contains no glucose
because the nephron has a system
in check to reabsorb any glucose that
passes through the glomerulus filter.
What happens is that any glucose that
strays into the nephron eventually
makes its way to the proximal
convoluted tubule.
Lying in wait there are special
transporters called “sodium-glucose
linked transporter (SGLT)” or “sodium-
dependent glucose co-transporter”.
Like their name suggests, they absorb
glucose back into the blood along
with sodium. Just like how there are
different models of Proton cars, there
are different types of SGLTs, such as
SGLT-1 and SGLT-2. SGLT-2 is the main
transporter in the proximal convoluted
tubule.
“About 90% of the glucose filtered
in the nephron is reabsorbed with
the help of the SGLT-2,” Dr Norlaila
points out. Any remaining glucose
that manages to elude the SGLT-2 is
“caught” by SGLT-1 in a later, straight
part of the proximal tubule.
In the case of a type 2 diabetes
patient, the blood glucose level can
be high, so it is a good thing if the
glucose that finds its way into the
kidneys is not reabsorbed but instead,
removed from the body via urine.
This is where dapagliflozin steps
in. “The drug inhibits the action of
SGLT-2, therefore drastically cutting
down the amount of glucose that
would be reabsorbed back into the
blood stream,” says Dr Norlaila. For
someone with diabetes, that is a
good thing!
Indirectly, dapagliflozin may also
help with weight loss as it reduces
the amount of calories stored in the body after each meal as well as to reduce
one’s overall sense of hunger. However, it should not be considered as a weight-
loss drug. Studies suggest that the drug may also help in reducing high blood
pressure.
Taking dapagliflozin. Dapagliflozin can be prescribed alongside metformin, or
can also be prescribed on its own. In general, it can be prescribed to patients
with any stage of diabetes. Ask your doctor for more information.
Who should not take it? This drug may not be suitable for patients who are
pregnant or breastfeeding, having kidney problems, having low salt levels in
their body, or those with history of dehydration and have been admitted to the
hospital. Check with your doctor for more information.
More second line medications
Dr Norlaila mentions some other common medications for diabetes. HT
Combination pills are also available, often combining the effects of 2
different medications (for example, metformin and a second
level medication) for the purpose of convenience and reducing the
number of pills you need to take.
Drug group Examples How they work
Sulfonylurea
•Glimepiride
•Glyburide
•Glipizide
•Micronized
glyburide
Increases the amount of insulin
released by the pancreas over a
few hours after a meal.
Meglitinides Repaglinide
released after each meal.
D-Phenylalanine
derivatives
Nateglinide
released after each meal.
Thiazolidinediones
(TZDs)
Pioglitazone
Increases the sensitivity of the
body towards insulin.
DPP-4 inhibitors
•Sitagliptin
•Saxagliptin
•Linagliptin
Increases insulin level after a meal
while decreasing the amount of
glucose produced.
Alpha-glucosidase
inhibitors
•Acarbose
•Miglitol
Lowers the rate of carbohydrate
absorption into the body after a
meal.
Bile acid
sequestrants
Colesevelam Helps lower glucose level.
Special Report

Eat, Move,
Stay Healthy
There are many diets
out there which are
designed for diabetics,
but the tried-and-true
regime of healthy and
balanced diet along
with regular exercise
is never out of style.
Special Report

W
hat should I eat? you
may be wondering.
Should you cut out
carbohydrates from
your diet? Should you adopt one of
the many diets out there said to be
designed just for diabetics?
Actually, the good “old-fashioned”
healthy and balanced diet – advocated
by nutritionists for everyone young and
old, healthy or suffering from a chronic
condition – is still an effective option
for diabetics like you.
“The typical response from
people when I tell them I'm
diabetic is, 'Oh, I'm sorry to
hear that.' You know, I'm not.
I'm a better athlete because
of diabetes rather than
despite it. I'm more aware
of my training, my fitness
and definitely more aware of
nutrition. I'm more proactive
about my health.”
– Charlie Kimball
Your nutrition goals
You will be working with your dietitian to plan your meals. This may seem
complicated at first, but don’t worry, you will soon get the hang of it.
♥ Practice carbohydrate counting. Basically, you would have to make sure that
you are aware of how much carbohydrates you are having in each meal, and
carbohydrate counting allows you to ensure that your meals do not contain
too much of it. If you are on insulin, knowing how much carbohydrate is
present in a meal is important to ensure that you get the right dosage.
♥ Eat food in appropriate portion sizes. A good way to start is to list down
the usual portion sizes of the food you eat often and share them with the
dietitian, who will advise you on how much to cut down. You will then be using
measuring cups and a scale to make sure that your meals are all in the right
portions.
♥ Think well-balanced. You will include a good mix of every food group to make
sure that you get all the nutrients you need to stay healthy. For carbohydrates,
you should choose fruits, vegetables and whole grains as they contain what
we call complex carbohydrates (such as starch and fibre). Such foods can
help keep your blood glucose level stable while still providing energy. Consult
your dietitian on the types of food that would best suit you at your current
state of health.
♥ Avoid food and drinks that contain added sugar. In addition to glucose, you
should also avoid food and drinks that contain sucrose, high fructose corn
syrup and other types of sugary. You can check the ingredient list on the
bottle or package to be certain. Sugary drinks tend to be high in calories but
low in nutritional value, and their sugar content can cause your blood glucose
level to rise rapidly.However, if you are experiencing the effects of low sugar
level such as dizziness and sleepiness, such drinks can be used as a way to
quickly raise your blood sugar.
Special Report

Changing your eating habits for the better
It may be challenging to change your diet, as it often
requires discipline, willpower and the ability to unlearn bad
eating habits – all of which can take time, and you may
become frustrated and even feel tempted to give up along
the way.
Here are some tips to help you stay on course despite the
various challenges and frustrations you will encounter:
Don’t try to make many big
changes at once, as you would
only be setting yourself up for
failure. Instead, start simple.
Sit yourself down, then, list all the possible bad eating
habits you have. You can enlist the help of family members,
as sometimes you may have habits that you are not aware
of. Typical bad eating habits include: eating while watching
the TV or computer, stress snacking, eating too-large food
portions, enjoying high-fat meals and so on.
Next, list all the good eating habits you would like to adopt.
You can consult your dietitian for advice if you are unsure of
what these habits are.
Now, pick 5 bad habits you would like to break, and 5 good
habits you would like to adopt.
To get ready for this new you, pick a "start
date". The weekend is always a good time,
as you have more time to focus and there
are fewer distractions. Also, set a realistic "end date" for you
to evaluate your progress.
In the meantime, make sure that you are clear on what
you need to do. Consult your healthcare team to share with
them your plans, and make sure you have a good blood
glucose monitor at hand.
On the start date, jump right in! Break 5 bad
habits, adopt 5 good habits! Remember to detail
your efforts and progress in your journal for you
and your healthcare team to review after the end date.
At the end date, if you have achieved your goals, it is time
to pick another 5 good habits to adopt as well as another 5
bad habits to break. Of course, you must also maintain your
current progress. We will not lie; it will not be easy. However,
there are ways to keep
yourself motivated.
1.On your mark...
2.Get Set...
3.Go!
Find and channel your motivation
The first few weeks of your new adventure will be the
hardest, as you will be trying to replace habits you enjoy
with habits that you may not enjoy doing as much, at
the beginning. Going lunch with your colleagues can be
a challenge in itself, as you would be tempted by all the
delicious but unhealthy foods that you used to enjoy
indiscriminately!
There may also be moments when you become
frustrated at your slow progress, and you may even
experience a degree of “withdrawal symptoms” of the
favourite foods and old habits that you have enjoyed all
this while.
During those moments, your resolve may waver,
tempting you to give up because everything seems so
impossible. Don’t succumb to it! Stay focused. You can
do it.
Here are some tips to help you strengthen your resolve.
1
Know why you are doing this. It is not enough to
say that you want to be healthy, as sometimes it
can be hard to remember why this is important
when you are craving for chocolate ice cream.
So, list down more specific reasons. Perhaps you
want to stay healthy for your children and your partner
as well as yourself? What are the dreams and goals
you want to achieve, but will not be able to do so if your
diabetes worsens? These reasons do not even have to
Special Report

DIET
appropriate types of physical activity you can adopt.
It can be hard to get the body moving, especially if you are
used to a sedentary lifestyle. Give up your TV time to go
jogging? You may instinctively balk at the thought. Still, with
some determination and our tips, you will soon be moving
and enjoying every minute of it!
♥ Making it fun. If sports or hitting the gym is not your
thing, pick an activity that you will enjoy, or one you can
do in the company of people you like. Ballroom dancing,
yoga, tai-chi and weekend walks to a picnic spot are
some options worth considering.
♥ Think outside the box. There are other forms of physical
activity which are not the typical recreational ones. For
example: take the stairs instead of the elevator, walk
instead of driving, devote more time to gardening and
house work. If you love window shopping, spend more
time walking in your favourite malls, and park a little
farther away from the entrance.
♥ Use a pedometer to measure how many steps you take
a day, and slowly build up your walking rate so that you
will eventually walk about 10,000 steps a day. HT
“My mom passed away at 41 from diabetes. And
I'm 42, thank you. I didn't want to do that to my
son. So any time I was at the gym, that thing that
helped me do that last squat was my son calling
some other woman mommy. And that would just
give me that extra oomph to do that last squat. I
want to be around for him.”
– Sherri Shepherd
be long-term in nature. Perhaps you want to lose weight
to fit better in a bikini and impress everyone when you
saunter down the beach later the year. There is no right
or wrong motivation - so long as it matters to you, it’s
worth listing down and remembering.
Paste your list in a prominent place where it can
be spotted easily, especially when you are feeling
vulnerable, such as at the door of your refrigerator, the
monitor of your computer or even as a reminder on your
mobile phone.
2
Don’t do this alone. Support from other people is
a powerful motivator to keep you going. Therefore,
enlist a family member, friend or co-worker for
support. Support can come in many forms, such as
a diet or exercise partner, but sometimes, even just
having someone to confide your joys and frustrations in
can be a great boost to your morale.
If you have problems finding someone close to you
who is willing to support you, why not branch out? For
example, you can:
a. Organise a weight-loss or exercise group at your
workplace or neighbourhood.
b. Join a support group. If you cannot find one in
your neighbourhood, you can search for an online
support group.
c. Connect with fellow diabetics via a blog, Facebook
account or other social media platforms, and share
your progress and frustrations with them.
3
Don’t be discouraged by lapses. Occasionally you
will slip up. Do not let this bring you down. Review
the possible causes for your lapse, and work
to overcome them. If you find yourself lapsing often,
consult your support group or healthcare team on how
you can stay motivated.
Don’t forget to move!
Regular physical activity is a good way to burn excess
calories, keep your weight within healthy limits and
strengthen your body. Not only does regular physical activity
slow down or halt any damage caused by the progression of
diabetes, it can also lift your mood or de-stress you.
The Malaysian Clinical Guidelines on Management of Type
2 Diabetes Mellitus (2009) recommends 150 minutes of
physical activity a week. This boils down to about 20-30
minutes a day.
If you are not active before, or if you suffer from a condition
that may make exercising difficult, share your plans with
your healthcare team. They will advise you on the most
Special Report

The Right CheckSelf-monitoring is a good way to make sure that
you are on the right track.
Y
ou may be eating and exercising according to
your healthcare team’s recommendations while
faithfully taking your medications.
But how do you know if you are doing the right thing when it
comes to managing your diabetes?
The answer is pretty simple: regularly monitor your blood
glucose level and keep a record of your progress.
SELF-MONITORING
Self-monitoring alerts you to the possibility of whether you
are hyperglycaemic or hypoglycaemic after a meal. Knowing
the results early will allow you to take quick actions in
restoring your blood glucose level to within a healthy range.
Also, self-monitoring allows your healthcare team to
measure the progression of your diabetes and adjust your
medications accordingly. This is why you should self-
monitor even when you show no signs of illness, and keep a
record of the results.
When should you monitor your blood
glucose?
According to the Malaysian Clinical Guidelines on
Management of Type 2 Diabetes Mellitus (2009), the
following practice is recommended.
MONITORING BY YOUR HEALTHCARE
TEAM
Your healthcare team monitors the progress of your
diabetes management efforts by measuring the following:
■ Blood glucose level. Check with your healthcare
professional whether you need to fast before they
measure your blood glucose level.
■ Urine testing. This is to determine whether your kidneys
are functioning properly.
■ HbA1c. HbA1c refers to the protein in your red blood
cells, haemoglobin, which bonds to glucose to give what
we call “glycated haemoglobin”. By determining your
HbA1c value (measured in %), your healthcare team
will get a good idea of your blood glucose level over the
last 2 or 3 months. (This is why you cannot fool your
healthcare team by starting to manage your diet only a
few weeks before your medical appointment!)
■ Blood pressure. This is to gauge whether your
cardiovascular system is in good order.
■ Blood lipid level. By measuring the amount of
cholesterol and triglycerides in your blood, your
healthcare team would have a good gauge of your risk
of heart disease, which is usually increased in diabetics,
especially those with weight problems. HT
Your blood glucose target
•Fasting
•Non-fasting
•HbA1c
4.4 – 6.1 mmol/L
4.4 – 8.0 mmol/L
< 6.5%
Breakfast Lunch Dinner
On oral
medication
only
Check
before
and after
Check
after
Check
after
On insulin
Check
before
Check
before
Check
before
and after
Special Report

W
e have come to the end of our Special
Report, and we hope that you find the
information here a useful guide in the days
ahead.
These days, there are many options when it comes to
managing diabetes, so having diabetes is not the end of the
world. You can still lead a healthy life despite your diabetes,
so long as you practise the 3 cornerstones of diabetes
management: eating right, staying active and taking your
medications.
For example, gone are the days when healthy eating is
associated with tasteless food. There are many tasty
recipes online that you can use to create nutritious meals
which taste great. These recipes tend to be simple enough
even for novices, so if you do not cook for yourself, it is a
great time to start. If you can prepare your own delicious
Here’s to You & Your
Health
“Life is not over
because you have
diabetes. Make the
most of what you
have, be grateful.”
– Dale Evans
diabetic-friendly meals, you will miss your old unhealthy
favourites less as time goes by.
Compliance regarding your treatment is equally easy. If you
are too busy to remember when to take your medications,
complying with your treatment plan is as simple as
downloading an app into your mobile device. There
are also many apps designed to remind you of medical
appointments and even track the progress of your exercise
plan.
So many options, so many ways to make diabetes
management not only simpler but fun and fulfilling to do –
so, what are you waiting for?
Act now, take control of your diabetes – a healthy future
awaits! HT
Special Report

MHTMAY15_pg26-40_Special Report_Diabetes

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (19)

Destaque

Destaque (14)

Semelhante a MHTMAY15_pg26-40_Special Report_Diabetes

Semelhante a MHTMAY15_pg26-40_Special Report_Diabetes (20)

Mais de Lim Teck Choon

Mais de Lim Teck Choon (11)

MHTMAY15_pg26-40_Special Report_Diabetes