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Oct - Dec 2012 - Diabetic Society of Singapore

SPECIAL REPORT: The Diabetes Pandemic SPECIAL FEATURE: Healthier Hawker Guide


D iabetes Issue 43 OCT-DEC 2012


Publication of Diabetic Society of

MICA (P) 148/09/2012


World Diabetes Day

11 November 2012






Diabetes Singapore Oct - Dec 2012

DSS management committee



Prof Arthur Lim


Dr Warren Lee


Mr Yong Chiang Boon


Dr Kevin Tan Eng Kiat

Hj P.M. Mohd Moideen


Ms Esther Ng


Ms Rohanah Bte Pagi


Mr Stanley Lim


Dr Yeo Kim Teck

Ms Kalpana Bhaskaran

Mr Greig Price

Ms Juliana Lim






ECG (Electrocardiogram)



Protect Our Future

editorial team

Chief Editor

Dr Yeo Kim Teck

Managing Editor

Charlotte Lim

World Diabetes Day is upon us again. 14 November marks the occasion when

the whole world unites against diabetes the condition, to heighten awareness

about what diabetes is all about, how it can be prevented and how it should

be controlled; so as to reduce the suffering that diabetes complications can


The International Diabetes Federation has a theme each year. The focus is on Diabetes

Prevention and Education. This year, the aim is to Educate, Engage and Empower

youth and young persons, as well as the general public on diabetes. One of the key

messages is relevant to us in Singapore, that “the way we live is putting our health at

risk” for diabetes.

The slogan for the campaign – “Diabetes: Protect Our Future” – hopes to

disseminate education and prevention messages to communities and make children

and young people aware of the warning signs and risk factors for diabetes. In many

cases, type 2 diabetes can be prevented through healthy eating, physical activity

and the prevention of obesity. The plan is to galvanise action for the protection of

the health of our future generations.

Our World Diabetes Day commemorative event in Singapore will be held on

Sunday, 11 November, at the NUSS-The Graduate Club at Kent Ridge Drive

from 9am to 3pm. The Minister for Health, Mr Gan Kim Yong, will be our Guestof-Honour.

Our partners in this cause are NUSS, who will also be raising funds

for Diabetic Society of Singapore, and Singapore National Eye Centre for its

combined National Eye Care Day!

We need your help to make this year’s World Diabetes Day a success, especially

since the venue is not in a high-visibility location. Please come, bring your

friends, spread the word around from now till November 11. Persons with or

without diabetes can come to learn more, as well as have their regular checks

and to buy diabetes-related products and enjoy the special offers on that day.

Let’s protect our future.


See all of you at

World Diabetes Day!

Dr Kevin Tan


Diabetic Society of Singapore

Diabetic Society of Singapore is a non-profit organisation affiliated

to the International Diabetes Federation and the National

Council of Social Service. DSS gratefully accepts donations of any

amount to help fight diabetes. All donations are tax exempt. Cash

donations must be made in person at our HQ. Cheque donations

should be made payable to Diabetic Society of Singapore. You may

also make online donations via www.sggives.org/diabetes.

Editor (Dietetics)

Janie Chua

Editorial Consultants

DSS Mgmt Committee


Henry Lew (psychologist)

Kohila Govindaraju (nutritionist)

Cindy Ng (physiotherapist)

Chionh Lay Keng

(diabetes nurse educator)

Rodiah Hashim


Dr Ang Chee Wan; Dennis Oh;

Eric Teo; Milind Sovani; Yen Koh;

Pravin Rajwani; Delcie Lam;

Hj P M Moideen.


Charlotte’s Web Communications


Dreamstime.com & sxu.hu


Stamford Press Pte Ltd


George Neo

Esther Ng

Advertisement Bookings

T: 6842 3382 or E: editor@diabetes.org.sg

Feedback editor@diabetes.org.sg

Back Issues www.diabetes.org.sg

Diabetic Society of Singapore HQ

Blk 141 Bedok Reservoir Road #01-1529

Singapore 470141 T: (65) 6842 6019 /3382


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. 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.


by Rodiah Hashim

Manage Your Diabetes,

Successfully! by Rodiah Hashim

A Retreat for Adults with Type 2 Diabetes

Diabetes Singapore Oct - Dec 2012

Cooking Demonstration

y Kohila Govindaraju


by Rodiah Hashim

Bulan Ramadan, telah datang dan

pergi dengan perayaan Hari Raya

Aidilfitri pada 19 August. Bagi 35

orang pesakit kencing manis dan

perawat mereka, persiapan untuk bulan

Ramadan dimulai pada 7 Julai ketika

mereka menghadiri sebuah forum bertajuk

‘Fakta-fakta mengenai berpuasa di bulan

Ramadan’ yang di adakan di bilik activiti di

Pusat Pendidikan Kencing Manis Bedok.

Di anjurkan oleh Persatuan Kencing Manis

Singapura (Diabetic Society of Singapore

– DSS) dengan penaja utama MSD, forum

itu di harap dapat membantu pesakit

kencing manis mengurus dan memahami

risiko yang berkaitan dengan berpuasa.

Hal ini tegas di ulangi oleh pembicara

utama Puan Rohanah Bte Pagi, Jururawat

Kanan dari SingHealth Poliklinik dalam

tajuk ceramahnya ‘Kencing Manis dan

Ramadan’. Beliau begitu prihatin sekali

mengemukakan langkah – langkah dan

nasihat yang dapat di praktikan oleh

pesakit kencing manis.

Selain penjagaan tahap darah glukosa

(gula dalam darah), pemakanan dan

diet juga penting. Demikian di tegaskan

pembicara seterusnya Saudari Siti Hussain,

pensyarah dan Pakar Pemakanan dari

School of Applied Science Temasek

Polytechnic dalam tajuk ceramahnya

“Pengawalan Kencing Manis dan berat

badan melalui pemakanan’. Menurutnya,

makanan yang seimbang, terutama sekali

pemilihan makanan karbohidrat yang

bijak, dapat mengimbangi kandungan

darah glukosa. Semasa berpuasa, kita

di galakkan memakan makanan yang

mengandungi zat serat yang tinggi

dan rendah glisemik. Makanan yang

sedemikian baik untuk pesakit kencing

manis dan juga ahli keluarga mereka.

Kami berharap bahwa dengan

pengetahuan yang diperoleh semasa

forum dan dengan buku pegangan

berguna yang didistribusikan oleh MSD,

semua peserta kami berhasil menguruskan

kencing manis mereka di bulan Ramadan.

DSS ingin mengucapkan terima kasih

kepada MSD dan pembicara terkemuka

kami yang sama-sama telah menjayakan

forum ini.


Diabetes Singapore Oct - Dec 2012

Diabetes Singapore Oct - Dec 2012



How to manage your diabetes successfully







ECG (Electrocardiogram)






HQ @ Bedok

Hong Kah Diabetes Education Central Singapore Diabetes

Blk 141 Bedok Reservoir Road #01-1529 & Care Centre

Education & Care Centre



Blk 528 Jurong West St 52 #01-353 Blk 22 Boon Keng Road #01-15

Tel: (65) 6842 6019 /3382

Singapore 640528

Singapore 330022

Fax: (65)

6842 3118

Tel : (65) 6564 9818, (65) 6564 9819 Tel : (65) 6398 0282

Opening Hours:

Fax: (65) 6564 9861

Fax : (65) 6398 0275

Monday-Friday ECG 8.30am - 5.00pm (Electrocardiogram)

Opening Hours:

Opening Hours:

Saturday 8.30am - 12.30pm

Monday-Friday 8.30am - 5.00pm

Monday-Friday 8.30am - 5.00pm

Saturday 8.30am - 12.30pm

Saturday 8.30am - 12.30pm

Translated by Hj P M Moideen, DSS VP



如 何 应 付 低 血 糖

Prevention and Treatment of Hypoglycaemia

by Chionh Lay Keng, diabetic nurse educator, Diabetic Society of Singapore

低 血 糖 是 :



Menstruation gingivitis

& pregnancy gingivitis



by Dr Ang Chee Wan, dental specialist in periodontics,

clinical director, T32 Specialist Division

Physiological conditions that can lead to oral health problems

There are no accurate data on the prevalence of

menstruation gingivitis and most females do not

notice any changes in their gum condition. This

is because when menstruation gingivitis occurs,

it is usually mild in 75% of females.

However, some female patients have complained of more

severe gum bleeding during menstruation or pregnancy.

In fact, some patients can even experience gum swellings

that bleed easily to brushing or eating.

Female patients with more “dramatic” gum reactions

during menstruation and pregnancy tend to have

pre-existing gum disease to start with. Hence, most of

these patients can resolve menstruation gingivitis and

pregnancy gingivitis with effective gum treatment by a

gum specialist.


As a woman goes through menopause, her

oestrogen levels decline. Since oestrogen

is important for absorption of calcium and

bone formation, a decrease in oestrogen

levels in menopausal women can lead to osteoporosis.

This effect of poor calcium absorption and bone

formation can sometimes be seen on jawbones.

Osteoporotic patients have more severe gum disease

that often leads to teeth loss. Other effects of declining

oestrogen levels include more severe gum bleeding

and dry mouth.

There are ways to prevent or limit the effect of

menopause on oral health. Hormone replacement

therapy (HRT) might be able to slow down the effect

of menopause on the oral cavity. Regular dental

visits and cleaning can also keep gum disease in

check. The dentist or gum specialist will formulate a

comprehensive plan to keep the gums healthy and

hence prevent the negative effects of menopause on

the oral cavity.

Medical conditions that may cause oral health problems


Lupus Erythematosus

Osteoporosis is commonly seen in postmenopausal

women and osteoporosis may be

linked to more severe gum disease and tooth

loss. The loss of bone mass can sometimes

be seen in the jawbone and this can lead to loosening of

teeth and ultimately tooth loss.


Diabetes is another common medical condition

that can lead to more severe gum disease.

Usually patients with diabetes have more gum

bleeding, receding gums, shaky teeth and

tooth loss. Interestingly, when a patient has her diabetes

treated well, her gum condition can also improve.

Another medical condition commonly

affecting women is Lupus Erythematosus,

commonly called lupus. Lupus is an

autoimmune condition with unknown

causes but it can appear as ulcers or swellings in the


Many medical conditions or even physiological ones

can show up in the oral cavity. Hence, your dentist can

help in picking up signs of possible underlying medical


Due to the possible link between gum disease and

women’s health status, it is advisable for women to see

a gum specialist on a regular basis.

Diabetes Singapore Oct - Dec 2012





by Henry Lew, psychologist

Have you ever wondered why it is so hard to change and maintain your diet? Why you just cannot bring yourself

to exercise regularly even though you know that it is good for you? Well, perhaps because even though you

“know what to do”, something else could be getting in the way. It is called environmental influences.

Consider the following three statements. Are they myth or fact?

1. I know how much I eat. 2. I control how much I eat 3. I just need discipline to exercise.

As much as the statements appear to be facts, they are actually myths. These myths minimise, discount and disregard

environmental influences on our behaviours pertaining to exercise and diet.

Myth #1

I know how much I eat.

Our environment may actually determine how

much we eat instead!

Myth #2

I control how much I eat.

Environmental cues that suggest what kind of meal we

are having may instead determine how much we eat!

Diabetes Singapore Oct - Dec 2012

In a landmark study by Dr Brian Wansink, individuals

were given either medium or large size popcorn.

Those with the large size portion ate 50% more than

those who ate from the medium portion. In another

instance, individuals drank soup from a bowl that

was either bottomless (i.e. it kept replenishing itself)

or a normal bowl (soup supply was limited). Those

who drank from the ‘bottomless’ bowl drank more.!

In both studies, all were unaware of the portion size

and simply ate what was given.

The arrangement of food seems to influence our

eating habits as well. Individuals tend to eat more

when food is arranged neatly, and also when the

dish looks like it has some variety of ingredients,

compared to the same dish that is all mixed up!

What you can do:

• Limit your patronage of ‘high-risk ‘ places that

offer bigger or upsized portions, top-ups, free

flow of soft drinks, etc.

• When preparing healthy meals, arrange the

dishes/ingredients neatly so that the food

appears more appetising.

Two groups of people were provided with the same

food but different environmental cues. One group had

disposable utensils (paper/plastic) normally associated

with snack time or tea, etc. Another group was given

ceramic utensils normally associated with a proper

meal. These individuals actually ate more than those

using disposable utensils, highlighting how subtle

environmental cues can prompt us to eat more and

circumvent our best efforts to eat less.

What you can do:

• Plan and decide what you want to eat before you

go out to eat or prepare your own meals to avoid


• The size of your plate or bowl should be based

on the amount of food you want to eat till you

are comfortably full, and not beyond the point of


• If you need to have a snack, limit the size to a

snack’s portion and keep the rest away. Out of sight,

out of mind and out of your autopilot hands that

feed your mouth when you are multi-tasking.

Myth #3

I just need the discipline to exercise.

You may think that exercise is just about getting down

to it. It appears that reminders make quite a difference.

Individuals who saw cues about exercise along their way

home from work were more likely to hit the gym compared

to those who did not encounter such cues. Individuals who

received SMS reminders to exercise were also more likely to

initiate regular exercise.

Habits could well be a result of “automacity” rather than

“frequency”. In other words, habits like regular exercise are

usually formed because there are cues in the environment

that regularly prompt and support one to exercise, e.g.

Mdm Sulaiman walks regularly after dinner, mainly

because her grandchildren will remind and encourage her

to join them for walks.

What you can do:

Build cues into your physical or social environment to

help you to exercise regularly since good habits are better

formed if we engineer our environment. This may include:

• Physical reminders to exercise, e.g. timetable to

exercise, mobile alerts that are programmed into your

phone to go to the gym or take a brisk walk, etc.

• Social reminders, e.g. a workout buddy, exercising with

your family and friends, etc.

In our journey to achieve a healthier lifestyle, we may

meet with obstacles and difficulties. In some situations

we cannot change much, but there are bound to be areas

in our environment we can modify, even if it is the tiniest

thing. Remember small drops of water make up an ocean.


Social Environmental Pressure to Eat

Here is a quiz to help you determine how well you cope with social influences on your eating habits.

Rate yourself on each of the statements then refer to the scoring for some guidelines on how to

manage these environmental social cues.

1= Never 2 = Sometimes 3 = Usually 4 = Almost Always 5= Always



01 It's not right to say "no” when someone is just trying to be nice to me.

02 It’s often hard for me to speak up for what I need or want.

03 I’d rather put my own needs second than hurt someone else’s feelings.

04 It isn’t fair to want others to help me in my weight-management efforts.

05 I shouldn’t not involve others in my problems.

06 I need to drink or eat a lot at a restaurant in order to make others feel comfortable.

07 When someone else is paying for it, I feel I may as well take advantage of it.

08 Guests who are invited to dinner expect to be treated to fancy (i.e., high calorie) meals.

09 A good host prepares special meals for invited guests, and this involves a heavy meal and a sweet dessert.

10 When invited to dinner, I should show my appreciation by eating well.

11 Calling ahead to inquire about the menu or making special requests of a host is making a nuisance of myself.

12 Other people depend on me, and their needs must come first.

13 When someone tries to pressure me, I resist, even if what they want me to do is a good idea.

14 When someone I care about does not want me to change, I feel I should do as they ask.

15 I like the attention and sympathy I get from having a weight problem.

16 I can't resist food at parties or celebrations.

17 When I see others eating, I just cannot resist getting something to eat too.

18 It isn't polite to refuse food when someone has prepared it especially for me.


18-36: Low Pressure Quotient

Your beliefs are strong enough to help

you resist social influences.

37-53: Moderate Pressure Quotient

Some of your beliefs make it difficult for

you to cope with social pressures. Identify

which beliefs are a hindrance and try to

change them.


54-90: High Pressure Quotient

Much of your belief system makes it harder

for you to cope with social influences. You

need to challenge your beliefs and change

the way you think about them.

Diabetes Singapore Oct - Dec 2012

Diabetes Singapore Oct - Dec 2012


method of preparation





• 25g whole green moong dal

• 25g split channa dal

• 25g tur dal (arhan dal)

• 1 tsp turmeric

• 2 1/4 cups water

• 80g drumsticks, medium-sized

• 2 green chillies

serves 4

by Chef Milind Sovani


• 1 tbsp FairPrice rice bran oil

• 1 tsp cumin seeds

• 4 garlic, chopped

• 50g red onions, chopped

• 10g ginger, chopped

• 50g tomatoes, chopped

• 1 tsp red chilli powder

• 1 tbsp asafoetida (hing)

• 1 tbsp green coriander, chopped

• 1/4 tsp salt

1. Wash and soak all the dal (lentils) in water for 2 hours.

2. Drain the lentils and boil them in a thick bottom pan in 600ml water.

3. Add in the turmeric and slit green chillies when water starts to boil. Cook for 15 minutes.

4. Cut the drumsticks into 2-inch pieces, and add to the lentil mixture. Cook the entire mixture till done (approx.

30 minutes). Set aside.

5. In a separate frying pan, heat oil and add in the cumin seeds until they crackle.

6. Add in the garlic and saute for few seconds. Add the onions and saute till translucent. Add the ginger and

saute for another 15 seconds.

7. Add in the hing (asafoetida) and then the tomatoes. Saute till they are well cooked and mashed.

8. Add in the red chilli powder and saute. Add the boiled dal and chicken mixture into frying pan. Stir to mix

well for 2 to 3 minutes.

9. Add in the salt, bring the mixture to a boil, add in the green coriander. Mix well and remove from heat.

10. Serve hot.

Heat oil till hot before stir-frying, as this will shorten cooking time and reduce the amount of oil absorbed

by the ingredients.

Use unsaturated oils (e.g. sunflower oil, canola oil, olive oil) instead of saturated oils (e.g. ghee, butter,

blended vegetable oil) to reduce your risk of heart disease.

Beancurd, pulses, lentils, peas and beans are good sources of protein and low in saturated fat. They can

be used to replace meat in some dishes.


Energy (1 kcal = 4.2kJ)




Total fat (g and % of total calories) 4.3g (30.4%)

Saturated fat 0.7g



Carbohydrate 16.4g

Dietary Fibre 4.5g



To shorten cooking

period, use a pressure

cooker for step 4.

Chef Milind Sovani

Recipes courtesy of Health Promotion Board Singapore



grandma's famous sliced fish

with beehoon soup

by Chef Eric Teo

serves 4


200g Toman fillet, sliced and blanched

200g brown rice spaghetti, soaked and drained

2 tomatoes, cut into wedges

2 spring onion, cut into 2-inch lengths

5g ginger, sliced and blanched

1 tsp sesame oil

6 tbsp low-fat evaporated milk

6 cups hot water

25ml concentrated chicken stock

1 tbsp corn oil

Salt & pepper to taste

Diabetes Singapore Oct - Dec 2012

method of preparation


1. Heat up 1 tablespoon of oil in wok. Stir-fry sliced ginger untiI fragrant.

2. Pour in 6 cups of hot water. Add in concentrated chicken stock to boil for 2 minutes.

3. Add brown rice spaghetti, Toman fillet slices, tomato wedges, spring

onion, sesame oil and low fat evaporated milk. Cook for 2 minutes.

4. Add salt and pepper to taste.

5. Ready to serve.

For soup-based dishes, skim away visible fat or oil after cooking to maximise

the healthfulness of the dish.

Use more water when cooking whole grains, as whole grains absorb more

water than refined grains.

Select low-salt soup stocks or prepare at home.


Energy (1 kcal = 4.2kJ)


Protein 14.3g

Total fat (g and % of total calories) 5.8g (18.5%)

Saturated fat 0.9g





Dietary Fibre 3.2g



Try substituting

beehoon with brown

rice spaghetti for a

healthier alternative.

Chef Eric Teo

Recipes Diabetes courtesy Singapore of Health Promotion Oct - Dec Board 2012 Singapore




by Chef Yen Koh

serves 4

Diabetes Singapore Oct - Dec 2012

method of preparation



180g FairPrice White Rice

70g FairPrice Brown Rice

1 tbsp canola oil

1 tbsp turmeric powder

2 tbsp coriander powder

1 tbsp garlic

1 tbsp peppercom

1 pandan leaf

3/4 cup low-fat evaporated milk

salt to taste

2 cups water

200g canned tuna flakes, unsalted

50g tomatoes, diced

50g green peas

1 tbsp raisin/sultanas

1 tbsp almond flakes

3 lime leaves, finely chopped

2 tbsp lemon grass, chopped

1. Wash the rice and drain.

2. Heat the oil in a non-stick wok. Stir-fry rice, turmeric, coriander, garlic, lemon grass and lime leaves.

3. Transfer to rice cooker. Add peppercorns, pandan leaf, salt, low-fat evaporated milk and water. Then bring to

boil with the lid uncovered.

4. Stir to mix. Cover rice cooker and let it simmer till cooked.

5. Fold in the tuna, diced tomatoes and green peas while the rice is hot.

6. Garnish with raisins, almond flakes, lime leaves and lemon grass.

7. Serve hot.

Use more water when cooking wholegrains, as wholegrains absorb more water than refined


Use fresh ingredients, herbs and spices or low sodium seasonings as flavour enhancers.

Vegetables such as tomatoes, corn, peas and mushrooms are good sources of glutamate and act

as natural flavour enhancers.


Energy (1 kcal = 4.2kJ)


Protein 20.1g

Total fat (g and % of total calories) 6.2g (14.6%)

Saturated fat 1.1g





Dietary Fibre 3.0g



A simple way of creating

this recipe

is to cook the rice

first and mix the

other solid ingredients

while the rice is still warm.

Chef Yen Koh

Recipes Diabetes courtesy Singapore of Health Promotion Oct - Dec 2012 Board Singapore

things you should not store in your fridge

{ the LIGHTER side }

By Hilary Meyer, EatingWell.com


Tomatoes: Technically a fruit, but taste-wise, it is closer to a

vegetable. If you have ever grown tomatoes, then you know that they love

the heat and hate the cold. It turns out even after they are plucked from

the vine, they still dislike cold. The refrigerator is not the ideal place to store

tomatoes. Store them there and your perfect tomatoes turn into a great

disappointment. They will still be good for cooking, but not the best for

eating fresh. Store them on your counter instead (but not in direct sunlight)

and enjoy them when they are ripe.

Basil: Tomatoes and basil go well together on your plate and they have

similar needs in the storage department too. Like tomatoes, basil loves the

heat, so extended periods of time in a cold environment like a refrigerator

causes it to wilt prematurely. Basil will do best if it is stored on your counter

and treated as you would fresh cut-flowers. A fresh bunch of basil can be

stored for in a cup of water (change it every day or two) away from direct

sunlight. Covering it loosely with a plastic bag will help keep it moist (but

make sure the bag has an opening to allow for some fresh air in).

Potatoes: Potatoes like cool, not cold temperatures. They do best

at around 7 degrees celsius, which is about 10 degrees warmer than the

average refrigerator. Most of us do not have a cool, dark place to store root

vegetables like potatoes, so keeping them in a paper bag in a coolish spot

is best. Why paper? It is more breathable then plastic so potatoes will not

succumb to rot as easily. And why not the refrigerator? Storing potatoes at

cold temperatures converts their starch to sugar more quickly, which can

affect the flavour, texture and the way they cook.

Onions: Onions do not come out of the ground with that protective

papery skin. To develop and keep that dry outer layer, they need to be

“cured” and kept in a dry environment like a pantry, which is not as damp as

the refrigerator. Also, a lack of air circulation will cause onions to spoil, as will

storing them near potatoes, which give off moisture and gas that can cause

onions to spoil quickly. Store onions in a cool, dry, dark, well-ventilated place

as light can cause the onions to become bitter. Scallions and chives, however,

have a higher water content, bruise more easily and have a shorter shelf life,

so store them in the refrigerator.

Avocados: Avocados do not start to ripen until after they are

picked from the tree. If you are buying a rock-hard avocado, do not store it

in your refrigerator, as it slows the ripening process. On the other hand, if

you have a perfectly ripe avocado that you are not ready to use, storing it in

the refrigerator may work to your advantage by prolonging your window

of opportunity to use it before it becomes overripe. So the bottom line on

storing avocados is store hard, unripe avocados on your counter and store

ripe avocados in your refrigerator if you are not going to eat them right away.

Diabetes Singapore Oct - Dec 2012

22 { the LIGHTER side }

The Plate

An Alternative Way to Portion Control

for Diabetes? by Derrick Ong, Eat Right Nutrition Consultancy



Fill ½ of your plate with

Non-starchy vegetables

include carrots, broccoli,


green beans, peppers

and asparagus.

Pack pre-cut vegetables

for a quick snack.

Grains/Starchy Vegetables

Fill ¼ of your plate with whole grains or

starchy vegetables.

Whole grains include brown rice, whole wheat

pasta, whole-grain breads and cereals.

Starchy vegetables include potatoes,

corn, peas and legumes.

Diabetes Singapore Oct - Dec 2012

Make at least half of your choices

per day whole grain and/or

unprocessed grains.




non-starchy vegetables.

Aim for a variety of


Veggies are low in

calories and full of

fibre, vitamins,

minerals and



Fill ¼ of your plate with

lean protein sources.

Choose protein sources such as non-fried

chicken, fish or lean cuts of beef and pork.

No more than three eggs per week.

Meatless protein choices include

soy (tempeh, tofu) and legumes.

Source: michigantoday.umich.


Diabetes Singapore Oct - Dec 2012

24 { the LIGHTER side }




Diabetes Singapore Oct - Dec 2012

by Kohila Govindaraju, freelance nutritionist

Your stomach is

growling, but lunch is

hours away. You might

just grit your teeth,

thinking that waiting

for lunch is the best. But why? You

could always indulge in a snack!.

Isn’t snacking the same as

eating junk food?

We are talking about healthy snacking,

of course! Healthy snacks reduce the

risk of developing type 2 diabetes,

obesity, and heart disease. Snacking

helps people with diabetes better

control their blood sugar and decrease

the risk for hypoglycaemia as well.

My friend packs snacks such as mixed

nuts, banana, wholemeal crackers,

an apple and baby carrots for her

daughter every day.

They are so easy to pack, lightweight,

low in calories, and high in vitamins

and minerals to boost her child’s

energy in school.

It is the variety that makes the snack

more appealing. The wider the range

of foods we eat, the more nutrients

we get.


The Complete Diabetes Prevention Plan: A

Guide to Understanding the Emerging By

Sandra Woodruff, Christopher D. Saudek

Knack Healthy Snacks for Kids: Recipes for

Nutritious Bites at Home Or On the Go By Amy

Wilensky, Peter Ardito, Susan Byrne

Diabetes Snacks, Treats and Easy Eats ,for Kids

By Barbara Grunes, Linda R. Yoakam R D, M S

But aren’t snacks fattening?

Well, not really. Snacks help manage

hunger and reduce binge eating.

Moderation and balance is the key

while incorporating the snacks in our

daily diet. Remember to opt for snacks

of 100 calories or less to stay within

our daily calorie goal.

The nutrient-poor, sugar-laden snacks

like candy bars give us a quick jolt of

energy that is followed by a crash that

can leave us hungry, cranky, sleepy,

and unable to concentrate.

Healthy snacks are like slow-burners

that help us keep going all day.

Eggs, tofu snacks help to regulate

concentration and alertness for

they increase the production of

neurotransmitters or chemical

messengers that can affect mood,

appetite, anxiety, sleep, heart rate,

temperature, aggression, fear and

many other psychological and physical


A piece of a fruit or some raw veggies

as a snack can tame our hunger

without ruining our appetite for the

next meal. In the afternoon, a snack

would stave off the overwhelming

fatigue and sleepiness. Having two

to three snacks a day may just banish

the postmeal sleepiness that usually

results with engulfing too many

calories at one sitting.

To get all the essential nutrients our

body needs in a day, snacking can be

very beneficial!

Healthy snacks are

like slow-burners

that help us keep

going all day.


Fruits & Vegetables

Small number of calories, good

amount of vitamins, minerals

and fibre. Try celery sticks, cherry

tomatoes, grapes and cucumber.

Nuts & Seeds

High in calories, high in fat,

thankfully the good fat, but still,

a handful is just about enough.


High in complex carbohydrates

that give energy with staying


Low-Fat Dairy Products

Cheese and yoghurt are good

sources of calcium and protein.



Photos courtesy of Health Promotion Board

Diabetes Singapore Oct - Dec 2012

Healthier Chicken Rice and Shredded Chicken Noodle/Hor Fun at Yuhua Hawker Centre


Preliminary results from the Health

Promotion Board”’'’s 2010 National

Nutrition Survey (NNS) showed that seven

in 10 exceed their recommended calorie

requirements. Among them, about 15% consume

at least twice the recommended allowance.

Source: Health Promotion Board Singapore

Diabetes Singapore Oct - Dec 2012



Malay Community Health Figures

The 2010 National Health

Survey (NHS) found that 24% of

the Malay community are obese,

a figure which is double the

national average.

The 2010 National Nutrition Survey

showed that the Malay community

consumes more calories, total and

saturated fat, and less whole-grains than

other Singapore residents.

28% of the Malay community have high

blood pressure and 23% have high blood

cholesterol, which are also the highest

percentages across all races.

The incidences for stroke and heart

attack in the Malay community are about

240 and 404 respectively per 100,000,

compared to about 155 and 207 per

100,000 across all races.

The Malay community consumes about

a third more salt than the

recommended amount.

Deep-fried snacks and fast

foods, fried rice and stir-fried

vegetables, coconut dishes and

flavoured dishes such as nasi

briyani, nasi lemak and chicken

rice, contribute up to 50% of

saturated fat intake by the Malay


Diabetes Singapore Oct - Dec 2012







Have your kueh and eat it!

Selected hawker centres at Geylang

Serai now offer healthier versions

of their famously delectable local

delights - without compromising on

price, taste or enjoyment.

Participating stalls use whole-grain

noodles, brown rice bee hoon,

healthier oil and salt, and sell

drinks with lower sugar content.

Source: Health Promotion Board Singapore

These stalls serving traditional Malay

dishes such as mee siam, mee rebus,

nasi lemak and nasi padang are

located at:

• Eunos Crescent Block 4A

Market and Food Centre

• Haig Road Market and

Cooked Food Centre

• Geylang Serai Market

and Food Centre



The Diabetes Pandemic by Dennis Oh

Without urgent action, the World Health Organization has warned that the death toll

will increase by 17% over the next 10 years … across the world diabetes

now kills 4.6 million people annually, higher than the combined death toll

from HIV/AIDS, tuberculosis and malaria, the three most deadly infectious diseases.

Kofi Annan, former Secretary-General, United Nations, at the European Diabetes Leadership Forum 2012

Dire warnings for a dire global situation. The world’s

population has surpassed seven billion, and people

are moving from rural settings into cities around

the globe at a speed that is creating alarming

challenges for diabetes and diabetic care.


Current statistics from the World Diabetes Foundation (WDF)

reveal that in 2011, China and India led the pack in diabetes

– a staggering 90 million and 61.3 million diabetic patients

respectively; and numbers are rising. The next largest nation,

the United States, stands at 23.7 million.

Leaders in health care have no qualms calling this trend

a diabetes pandemic. Look at the statistics and you will

understand why. Estimates show that 366 million people

currently live with diabetes and additionally 280 million are

at identifiably high risk of developing diabetes. During 2011,

diabetes killed more than 12,600 people a day. Of these

deaths, nearly half (48%) occurred in people under the age

of 60.


The WDF projects that 9.9% of the world’s population will

have diabetes by 2030. Statistics from the International

Diabetes Federation (IDF) reveal that 552 million people are

expected to live with the disease and 398 million are at high

risk of developing diabetes.

Perhaps one of the scariest things about diabetes is that

more than 50% of people with diabetes are unaware

of their condition, which is costing society

millions of dollars in treating the many

serious complications that arise from

undiagnosed or poorly treated

diabetes (blindness, kidney failure,

nerve diseases, limb amputations

and cardiovascular diseases). In

some countries, this figure may

reach 80%.

Because of its nature and the

multiple risk factors and comorbid

conditions connected

with this chronic illness, diabetes tops the World Health

Organization’s priority list for the prevention and care of

non-communicable chronic diseases (NCDs). In other words,

controlling diabetes minimises the risk and complications of

other long-term illnesses.


According to Jesper Høiland, Senior Vice President of Novo

Nordisk and head of international relations, “another place

where diabetes is exploding is Southeast Asia.” IDF predicts

that the number of people with diabetes in the region will

increase to 120.9 million by 2030; that is 10.2% of the adult

population. A further 23.8 million people have impaired

glucose tolerance (IGT) in 2011, and this will increase to 38.6

million by 2030.

Approximately 95% of people with diabetes struggle with

obesity, and as waves of people in Southeast Asia flow into

cities and enjoy the finer things in life with less physical

effort, blood sugar levels go up and so does the average

weight. This spells nothing but trouble for Asians who,

because of their generally weaker pancreatic beta cells,

already have a higher prevalence of insulin resistance than



Singapore functions as a major rallying point for many

nations of various socio-economic levels and serves as a

prime example of urbanisation that has led to an improved

quality of life. Recent national health survey results done

in 2010 reveal that the rate of diabetes in Singapore

has risen to a 12-year high. 11.3% of adults

aged between 18 and 69 years are diabetic,

compared to 8.2% in 2004 and 9% in 1998.

The obesity rate has ballooned to 11%, up

from 6.9% in 2004.

With those figures growing on our

own shores, we cannot ignore the fact

that the world diabetes burden is

Singapore’s burden as well. We are

in this fight together with the rest

of the world.

Source: Novo Nordisk Headquarters, Copenhagen, Denmark




Novo Nordisk, a global leader in diabetes care, insulin production, and insulin

delivery devices, is putting a new face to diabetes care, which one might call an

“integrated approach.” At their Steno Health Promotion Centre, two initiatives are

underway to take diabetes care to the next level.


First is in the area of patient


It appears that physicians in general

do not view diabetes seriously

enough to improve their usual

patient education procedure.

Given the facts about diabetes

and its connection to many other

factors, researchers at Steno are

challenging the paradigm of the

top-down monologue that merely

centres on the problem and the

solution and are proposing a more

“democratic” approach of patientcentered,

participatory education.

As coaches working with

participants, physicians should

come alongside patients and

help them balance their complex

condition and its effects on their

lives socially and psychologically.


A second notable initiative

involves community-level

diabetes prevention. At a Danish

town called Bornholm, Steno

researchers are bringing

diabetes prevention into

schools, day care institutions,

the media, and even into


Spheres of influence,

ranging from teachers,

advertisements, and the reorganisation

of food products

in a grocery store are working

in tandem to send the urgent

message of diabetes prevention to

the consumer.

This project involves some 220

families and the cooperation of

municipal leaders and businesses

with the main aim being local

ownership by the community.


Diabetes in a Connected Age

Diabetes is a highly “connected” condition. On the

physiological level, it is a problem involving many

chemicals, organs, and systems. Psychologically,

it affects emotions and feelings of self-worth, pride, and

hope. Socially, it alters our relationships and aspirations.

Globally, it is one of the greatest health and economic

threats in society.

As our generation also becomes increasingly

connected with each other and our

environments, new challenges

and opportunities face us in

how we deal with diabetes.

At the end of the day, it is

the individual struggling with

diabetes, or the at-risk, prediabetic

with high blood glucose

that will face the challenge of

controlling his or her incurable condition in this everchanging


Even so, connectivity with one’s environment and social

network will have a profound effect on how diabetes is


The main path to increased connectivity is communication.

Does everyone around you know about your condition?

Tell them! There’s nothing to be ashamed about, and

their understanding of your daily needs and routine may

become very helpful, or even save your life, one day.

Unveil the condition which has been hidden behind closed

doors and let people understand, remind, and support you

with your dietary restrictions, medications, and exercise

routine. You are not alone in the fight against diabetes.

by Dennis Oh

Diabetes Singapore Oct - Dec 2012



Diabetes Singapore Oct - Dec 2012



It is quite common to hear

complaints of pain in the

knees with activities such

as climbing stairs, jogging

or even walking.

The causes of knee pain are

plenty, ranging from overuse to

an injury or a traumatic incident

that happened years ago.

Having a sedentary lifestyle,

being overweight or being

involved in high impact sports

or activities are all risk factors of

knee pain.

Being sedentary can weaken

your knee muscles and any

additional weight may put

pressure on the knee joints, thus

increasing the rate of wear and


Regular aerobic exercises such

as walking and cycling are

recommended as these can help to

improve your fitness, plus reduce or

maintain weight.

The knee joint is like a hinge,

allowing one to bend (flex) and

straighten (extend) it with very slight

medial and lateral rotation. As it is

one of the major joints supporting

your weight, it is easily injured and

prone to wear and tear with time.

by Cindy Ng, principal physiotherapist,

Singapore General Hospital

Having a


lifestyle, being

overweight or

being involved in

high impact

sports or

activities are all

risk factors

of knee pain.

The knee joint also consists of a

group of muscles and ligaments as

well cartilages to help support and

protect it.

Regular exercises are important

for health including healthy

joints. A combination of flexibility,

strengthening and aerobic exercises

are essential to ensure that.

Exercises are usually prescribed to

provide flexibility to the joint and

ensure the muscles around the knee

are strengthened.


of the




are essential to

ensure the muscles

around the knee are

not tight such that it affects

function. For example, someone

with very tight quadriceps may

not be able to squat down.

These stretches can be done

every day – three repetitions with

10 seconds hold for each repetition.

If you exercise regularly, you should

carry out these stretches before, and

especially, after you exercise.

It is also important to strengthen the

muscles around the knees and hips

as they help to provide stability and

support. Leg exercises can be carried

out at home at least twice a week

with minimum equipment.

These include wall squats, leg raises

and knee extension in sitting, as well

as hip abduction, adduction and

extension exercises.

However, it is recommended that

exercises for knee pain should be

individualised, taking into account

age, overall mobility and function

as well as other existing medical



Thomas KS, Muir KR, Doherty M, Jones AC, O’Reilly SC & Bassey EJ on behalf of the Community Osteoarthritis Research Group. Home based exercise

program for knee pain and knee osteoarthritis: a randomised controlled trial. BMJ 2002; 325:752

Roddy E, Zhang W, Doherty M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—

the MOVE consensus. Rheumatology 2005; 44:67-73

Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM, Bradley JD, et al. Glucosamine, chrondroitin sulfate, and the two in combination for

painful knee osteoarthritis. The New England Journal of Medicine 2006; 354:795-808


Leg strengthening stretches

Leg raises

© PhysioTools Ltd

© PhysioTools Ltd

© PhysioTools Ltd



Wall Squats

© PhysioTools Ltd

© PhysioTools Ltd

Knee Extension

© PhysioTools Ltd


Illustrations reproduced with permission from PhysioTools Ltd.


Hamstring stretches


There are advertisements promising

a relief of pain with supplements

such as glucosamine. Studies have

produced inconsistent results from

the effect of glucosamine sulfate on

the treatment of osteoarthritis of the


© PhysioTools Ltd



© PhysioTools Ltd

© PhysioTools Ltd

A recent study in The New England

Journal of Medicine found that

the combination of glucosamine

hydrochloride and chondroitin

sulfate may have some efficacy in

people with moderate to severe knee

pain, but not in those with mild

pain. The same study did have a high

placebo rate and most of the patients

had only mild pain.

However, these supplements are safe

to take with minimal side effects

compared with steroids and pain


NOTE: These are general exercises and if the pain persists or if you experience pain during these exercises,

do consult a physiotherapist to assess your knees and individualise your exercise programme.

Diabetes Singapore Oct - Dec 2012




by Pravin Rajwani


fall under category of a young working single adult,

hitting the big 3-0 this year. The only difference - and

a huge one - is that I have been living with type 1

diabetes since I was seven. Well, I guess you can’t really

escape the condition when it runs so deep in the family

- mum has type 2 diabetes, so do all my grandparents and a

host of other relatives.

The fateful day we discovered I was diabetic was quite traumatic

for mum. She had just returned from a trip to India. I greeted

her at the door with a ‘hi’ , and collapsed. I was rushed to the

hospital where the specialist confirmed that I was diabetic.

Pravin with his younger sisters Nisha (left) and Neeta who

was diagnosed with diabetes when she was three.

I missed the majority of classes when I was in Primary 1 because

I was in hospital. On my first day back in school, the form

teacher explained my condition to the class. Some were nice.

Some plain mean and ate ice cream in front of me. In retrospect,

the teachers, principal and most students were very supportive.

It helps to tell people what you are instead of trying to hide.

Acceptance is the only way forward. When I was in secondary

school and junior college, I was exempted from doing the

NAFTA tests but I did them anyway. I don’t like being told I can’t

do something. I even earned the gold award a couple of times.

Then came the oranges. That was how the nurse educator

taught us the fundamentals of injections. I would like to say

I was a tough kid, but I cursed like a sailor every time they

injected me. My dad, a medic during his NS days, took it upon

himself to inject me and used to joke that it was like playing

darts. Well, this dart board was not laughing. After a couple of

days, I told him not to quit his day job and tried to master the

skill myself.

When I was five, I wanted to be a fighter pilot. You can’t even get

a private pilot’s license (PPL) if you are medically unfit, let alone

a commercial pilot’s license. But when life gives you lemons, you

make lemonade. I decided to become an aerospace engineer

instead. That is what I am today. My dream of flying is still very

much alive though. Perhaps one day.

Diabetes Singapore Oct - Dec 2012


When I decided to start my cake business in

September 2008, my mother who was a

businesswoman herself objected. She said, “I put

you through studies of your own interest (design

and advertising), you had a great career as an

art director in a good company that paid you well, why do you

want to give that all up?”.

I told her, “I want to be like you!”

I remembered her look of

disappointment. “Perhaps you should

learn it the hard way”, was her last word of

advice to me before she passed away six

months later.

In 2006, mum was diagnosed with stage three

breast cancer and needed surgery. She suffered

chemotherapy and radiation over the next six months, to be

declared cancer free in 2007. After that, she went on an organic

and hi-fibre diet influencing me to do likewise. I did not follow

her strictly organic diet and still had my hawker indulgences

when I was not with her.

I immersed myself in my cakery, 12 hours a day tending the

shop and running around meeting people. Three months into

my business, mum complained of stomach bloating; she looked

as if she was four months pregnant. We rushed her to the

doctor and she was immediately diagnosed with stomach and

intestinal cancer.

Everyone was devastated. We thought she might beat the

cancer again, but her condition worsened. I watched her scream

by Delcie Lam

in agony for more morphine shots every

day. On 31 September 2009, mum

passed away, quietly, while everyone

was outside the hospital ward.

Mum had a heart of gold, doing charity

work and always giving to people who

needed money. What did she do to

deserve such sickness? I grieved for a

whole year, searching for the reasons.

Then one day my fiancé opened my


Yes, it was mum’s food, lifestyle and stress

that cumulatively caused her cancers! The

organic diet after her breast cancer could not prevent another

cancer because she had fallen back into the old unhealthy

pattern of irregular meals and long working hours.

I had the answer right in front of me all along - vegetarianism.

I then made a life choice for myself. No, I do not want to be like

my mother. I want to live my life differently. Food can either be

your medicine or your poison.

Because of this, I transformed my entire bakery’s menu in 2010

and pioneered the technique in baking organic, egg free, dairy

free, gluten free and diabetic friendly cakes in Singapore and

in 2011 my bakery became the proud recipient of the Healthier

Bakery Award by Health Promotion Board.

I am sure mum is smiling right now. Everything that I am now, I

owe it all to her. She is and will always be my inspiration.

photos courtesy of www.delciesdesserts.com

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