Diabetic Hero

Foot and Eye screening today

noreply@blogger.com (Bun) — Mon, 01 Jun 2009 07:09:00 +0000

Went to the medical centre to get my hypertension pills but the doctor suggested a foot and eye screening for my diabetes. These parts are vulnerable to complications that diabetic nephropathy will lead to, because of the lack of blood flow.

Got my Height and Weight measured. 70.6kg, 177cm. Lost some weight, been having poor appetite for awhile.
My blood pressure was way high!! I have white coat syndrome, that's probably why.

My leg was good, but the staffs were quite shocked when I entered the room, because of how young I was. They even asked for verification, just in case! Check was done first visually for any rots/spots that can indicate poor diabetic control. The staff advises me dry my foot thoroughly after bathing and avoid wearing slippers and flip flop that exposes the foot.

Next she uses a little pricking device just to test the sensitivity of my foot, it dosen't hurt or tickle, just a little sensation. Simple test, just say 'ahhhh' or something when you feel the prick touching you.

And then comes the vibrating machine, I have no idea what is this for, apparently for sensitivity check as well. She places it at different spots on my foot and I'll say 'ahhh' when I feel it. And then she'll adjust the vibrations lower to guage the sensitivity of my foot.

The eye test was pretty quick, first was just some reading test, the one you do when visiting an optician. After the test, a really powerful camera is used to take images of my eye. My iris was large enough, so I didn't have to apply a solution to artifically enlarge it temporarily. This machine is powerful! Felt like a flashbang when she took a shot of my eyes.

1,2,3 and then a huge flash goes off, blurring my vision for a few minutes. This was done to both my eyes and I really hope my precious rod and cones are not damage in this process!

Should you be getting out of your Comfort Zone?

noreply@blogger.com (Bun) — Sat, 30 May 2009 17:39:00 +0000

For people who have problems with weight, the real issue here is not about losing weight. It's about how to maintain your weight after you've manage to lose it.

I know many people love to try new diets, eating foods that they have never eaten in their life(grapefruit, cabbage) or even try to play with nutrient composition [low carbs, low fat, low (you name it)]. I'd admit that these diets really spice up your life a little, making your diet a little more exciting. When people go, 'hey, why are you eating all these nasty stuff?!', you reply proudly 'I'm on low carb!'.

But very often than not, these diets requires you to get out of your comfort zone, you're simply not comfortable doing it. Maintaining your weight is a lifelong issue, can you sustain eating these foods for the rest of your life? The first time I've tried extra virgin olive oil, I puked. The whole bottle was eventually neglected.

Have you ever failed in your diet, only to realise you've gone back to your old dietary habits? The ones you are more comforatable with? Well, here's the issue. You are trying to change too much, trying to adapt too much.

What I suggest is to really change your diet without affecting much of your comfort zone. Analyze what you're eating and see what's wrong. Cut down or replace these food with ones that you like but are much healthier.

29/5/09 HBA1c

noreply@blogger.com (Bun) — Fri, 29 May 2009 18:10:00 +0000

5.3%! It was great relief for me considering I have been having less physical activity. Will post pictures of the reading up soon!

After some calculations, the average blood glucose level that I have is 6.2mmol/l or 111mg/dl.

Calculation is based on this formula - Mean Blood Glucose level(mmol/l) = (1.98 x HbA_1c) - 4.29

My previous reading in December was 5.8%, that made me a little disappointed, but all is good now! I'm currently aiming for a 5% HBA1c level, ambitious, but I'll do it.

Weight Loss is Easy

noreply@blogger.com (Bun) — Fri, 29 May 2009 06:38:00 +0000

I've always been telling people that weight loss is easy, but maintaining your weight is not easy! The challenge of weight loss does not come during the process, it comes after it. This is the reason why 95% of people eventually fail and gain back all the weight that they've lost.

Many people revert back to their old lifestyle after their weight loss, not instantly but gradually. This is the wrong perception that weight loss is just a one time issue.

In actual fact, it's very much like starting a business. It may be hard coming out with ideas but once you have one, it's fairly simple to start a business. When the business is successful, maintaining success becomes the hardest part. With the perception of weight loss is over when weight is lost, it's like walking out of the company one fine day, never coming back again, assuming that everything will be in order.

So remember! What we're fighting is not weight loss, it's weight maintenance. This is a constant struggle between your body and your brain, known as the bodyfat setpoint theory. I'll cover about this issue someday.

Almonds can Lower Glycemic index of Food

noreply@blogger.com (Bun) — Thu, 28 May 2009 14:53:00 +0000

Studies have shown that eating Almonds before meals will be able to lower the Glycemic response of the meal. Subjects fed with 30g, 60g and 90g of almonds together with 50g of white bread were tested to have lower Blood Glucose level and glycemia response as compared to those who ate just the white bread alone. The more the almond consume, the lower the glycemic index of the food(1).

This does not come suprising as fats are known to slow down the glycemic response of food, effectively lowering the glycemic index. The classic example of this phenomenom would be the GI of fresh potatoes against potato chips.

Fresh potatoes at a GI of 70 is considered a High GI food
White Potato chips at a GI of 54 is considered a Low GI food

Almond however, unlike potato chips, is a very healthy snack. They're packed with anti-oxidants and monounsaturated fats that are able to fight cardiovascular diseases. What's more, you've now also learnt that they can reduce the glycemic index of food. It's about time you incoporate these gems into your diet! Have a handful of them before meals and you'll get all the benefits you deserve.

However, please do note that although I may have made almond sound like a magical nut, they're relatively high in calories. Reduce the amount of food that you're gonna eat together with the almonds and all will be perfect.

Do also note that roasted almonds are as addictive, literally. It's really hard to resist them! So please do take note of the amount that you're taking in. Raw almonds are fine, I eat raw almonds regularly, they don't taste as great, which is a good thing!

Reference
1. Almonds and postprandial glycemia—a dose-response study
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WN4-4N0X4FN-P&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=722803eccf6de73e5162cca462728189 Cited 28/5/2009

Weight loss through Appetite Control

noreply@blogger.com (Bun) — Thu, 28 May 2009 03:30:00 +0000

Permanent weight loss is not easy, infact 95% of people who lost weight eventually gained them back. I'm proud to say I'm one of the 5% group, it's been 4 years and counting. Want to know my secret? Read on!

Appetite is not the same as hunger, it's a psychological process that demands more food. And more often that not, your body does not need this extra food.

One of the single and most effective means of weight loss is through manipulating your appetite, or rather suppressing it down. Just think about it, the last time you felt very sad, did you ate much? Chances are you didn't, you were hungry but you didn't feel like eating, that was when you have defeated your appetite, temporarily.

Imagine if you can control your appetite daily, knowing when to stop eating, wouldn't that be great? The good news is you are able to achieve that! Without having to feel sad everyday. Appetite can be controlled by some simple changes, many of these changes should be practiced together in order to be effective.

Methods to Suppress Appetite

Satiety index
The satiety index is a gauge to measure how much and how long a particular food makes a person feel full, in other words satisfied from the food. The higher the food is in the satiety index, the more and the longer a person will feel full after eating the food.

The major food nutrients affects this index
Fats - Highest satiety
Protein - Medium satiety
Carbohydrate - Low satiety

Higher fibre content will also increase the satiety index.

I'm not advocating on a low carbohydrate diet, although many advocates love to use this index as basis of their argument. The satiety index is not an excuse to eat high fats and high protein food while avoiding carbohydrates.

As I've mentioned, Fibre affects the satiety index as well, and fibre are found mainly in Carbohydate foods.

This is the plan

1. Avoid low-fat diets

2. Eat Carbohydrate foods that are high in fibre - eg. Wholemeal pasta, fruits, vegetables, oats, barley

3. Eat moderate amount of protein, there's no reason to avoid protein unless your kidneys are not functioning well

4. Always include healthy oils in your diet. Oils derived from nuts, olives, avocados, fish are all good sources of oil.

Nutrition data has recently launch a new method of measuring satiety, which is known as the Fullness factor. This is better gauge because it take notes of both the calorie contribution and satiety factor at the same time. Visit the link to read up on it.

Exercise
Did you know that exercise affects your appetite as well? Exercise regulates some of the hormones in your body that suppresses appetite. Two of which are Ghrelin and Peptide YY.

But which kind of exercise? Studies have shown that Aerobic exercises(jogging, cycling, walking) are more effective in suppressing appetite than Anaerobic exercises(weight lifting, sprinting).
There, another point to pick up your shoe and start exercising.

Habits
Keep nice food out of sight - Hide them, avoid them, give them away. Nice foods and smells are known to stimulate appetite. Even the sight or smell alone can be strong enough to evoke such senses!

Keep an eye on yourself during Celebrations - A very likely situation, you'll lose track of yourself from all the joy and merry making. This is also the time where many people binge and where many diets fail. Don't notice the food, don't anticipate about what you should eat next! Socialise and shift your focus elsewhere.

Avoid buffet or all you can eat events - Self-explainatory. If you're on a diet but you persists on going to such events, please pray before you do. That's all you can do because even I fall victim to this.

Dish food out on a plate - If you're having a humongous plate or bowl of something, dish it out into a smaller plate or bowl. You'll eat less than you are going to, this is physchological doing but it really does helps.

Hot Tea
This is my personal experience. I've realised that my appetite is much easier to control after some cup of green tea. I have no idea why, but i'll look up for it soon.

How does weight loss help overweight diabetics? Will write up on this soon!

Reference
1. Broom et al. The influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin and peptide YY in healthy males. AJP Regulatory Integrative and Comparative Physiology, 2008; DOI: 10.1152/ajpregu.90706.2008

Staple food - A Blessing or a Disaster?

noreply@blogger.com (Bun) — Tue, 26 May 2009 17:45:00 +0000

Some Food for my thoughts.

Throughout Human civilization, food is a problem, it was never easy to obtain. It's difficult to find food that lasts for prolonged storage. That was the problem, until several vital crops species were discovered. These species not only gives plenty of energy, they're easy to grow and also can be stored for much longer periods of time.

Rice cultivation. Picture from Tree Hugger

Throughout different nations and cultures, certain food are grown in huge quantity and are eaten as the main energy source. These foods are sure to be present in every meal and are known as Staple food.

Staple or Stapled?
In my culture, Rice is our staple, elsewhere in the world you'd find people eating Bread, Potatoes and all kinds of products made from these staple crops. I'm respectful for these food because without them, we would never have enough food to support the enormous population that we have now(about 7 billion).

These very same food that supported our large population have also seemed to been stapled and embedded into our diet. Here in my country, the older generations thinks that one would die without eating Rice. Staple food are excellent sources of energy but many of these foods are sadly, very poor in nutrients, especially after processing. Let's take a look at rice processing.

Milling is the removal of husk and bran of the rice. The husks are not pleasant to be eaten while the bran have oil that can turn bad easily. These two parts of the rice are removed for economic reasons and yet in truth, they're provide the gist of Micro-nutrients in rice, just like the skin of the Apple is.

On the list we can only see Calcium and the rest below it are Vitamin B's. I believe there are much more nutrient loss than that but from here you can already see the impact that processing does. And don't forget the loss of Micro-nutrients from our processing such as storage, washing and cooking!

Glycemic Index of various Staple food
Now let's take a look at the GI of several major staple food.

White rice, boiled - 73±4 (High)
White wheat bread - 75±2 (High)
Whole wheat/whole meal bread - 74±2 (High)
Potato, boiled - 78±4 (High)
Potato, Baked - 98 (Everest High)
Corn tortilla - 46±4 (low)
Spaghetti, white - 49±2 (low)
*taken from mendosa.com, please visit him, great dude!

High GI foods are those with value 70 and above
Medium GI foods are those between 56~69
Low GI foods are those below 55
(Notice the difference in GI difference that 'wholemeal' bread makes! Not much.)

Not as bad as you expected?
Take a look at the GI of Table Sugar, the ones found in sweets, cakes, coke and everywhere.
Sucrose(Table Sugar) - 65±4

So much for the Complex Carbohydrate. These staples are the culprits that are spiking our blood sugars. It's good if you're not eating them but if you are, please be aware. Not all staples are bad, you just have to pick the right one, like spaghetti, I eat spaghetti often.

What's the plan?
Remember, it's not only about the GI factor but also lack of Vitamins and Mineral contents of many of these foods.I'm not against staple food, I've grown up eating them until recently. What I propose is not to eliminate but rather, replace some of these energy source with nutrient dense ones, such as fruits and vegetables. Eat a little less rice, take in a little more vegetables or skip that potato, eat a fruit afterwards.

Every little step counts to a healthy living.

Ignorance is not Bliss

noreply@blogger.com (Bun) — Tue, 26 May 2009 09:08:00 +0000

Not at least for us diabetics! In fact, it's the number 1 killer of diabetics.

How many times have you seen someone desperately seeking for help only when complications occur? Blindness, Amputation, Kidney problems, Cardiovascular diseases, you name it, diabetes delivers it. Google for Diabetes complication and you'll find yourself pictures from nightmares.

That being said, this can only happen when someone is ignorant enough. Diabetes to me, has two faces, it's a condition that is merciful but also cruel at the same time.

Merciful

Diabetes does not show any physical signs when it is well controlled, unlike many other diseases. Well, it's good in a way that there will not be any embarrassment or social stigmatism. Many people are shocked to know I'm a diabetic and I'm pretty sure there are many around that we can't tell either.

As long as you keep everything well controlled and regulate your Blood Glucose levels, there's no reason why you can't live life normally and free of complications.

Are you aware that these famous people listed below are diabetics?

Elliot Yamin (type 1 diabetic)
Halle Berry (type 1 diabetic)
Elvis presley(type 2 diabetic)
Thomas Edison (type 2 diabetic)

And many more other here

Cruel

What if you don't control your diabetes? Your body will be living like a time bomb. Everything will seem pretty calm, but deep inside, the counters are ticking. You will not show much obvious signs of being in a dangerous state, not unless you do a clinical test.

Every time your blood sugar levels are up, a little damage is done. And Wham! it just hits you hard on the face some day, when you discover that your wounds don't heal, when you wake up to find that all you see is darkness, when your kidney gives up on you, when doctors tell you that your legs have to go. This is kind of cruelty we're talking about here.

It just kills to be ignorant about diabetes, the damage done are very often irreversible. Please take control if you are currently this stage of ignorance! If you need help, please give me a mail, I will assure you my full support and assistance. It's just painful to see people suffering from regrets that can are preventable.

It's not difficult at all
It just requires consistency in your lifestyle. Once the change is made, maintain it and stick with it. Whether you're doing it with insulin and medicine or just diet and exercise alone, it's the same. Just keep your blood glucose levels down.

For type 1 diabetics, do not ever forget to monitor your blood glucose levels as well as taking your jabs, whether its the rapid acting or the long acting ones. But to keep your HBA1c levels down, you will have to do more than that. Keep a close check on your lifestyle habits and maintain an active lifestyle. Every little thing you do counts, do practise some of the lifestyle habits I listed below. Monitor your blood glucose levels daily and HBA1c once every 3 months.

For type 2 diabetics
Exercise regularly
Eat foods that are lower in the Glycemic index
Eat more fruits and vegetables
Eat more lean meat and healthy oils
Practice some habits that will help with blood sugar control(eg. drinking tea)
Monitor your blood glucose level regularly and HBA1c once every 3 months.

Green Tea can lower your Blood Glucose Level

noreply@blogger.com (Bun) — Mon, 25 May 2009 11:35:00 +0000

Being a frequent Green Tea drinker, this news definitely made me a happy man! Ever since I've known the health benefits of Green Tea, I've developed a habit of drinking 3~5 cups of Green Tea daily.

I happened to stumble across this article a few years after my drinking habit has developed, tea drinking habit that is.

Studies have shown that Green tea enhances glucose metabolism in human subjects when given 1.5g of green tea powder. Not only that, it also lowers blood glucose levels in mice. However it seems like larger doses of green tea is required to achieve the latter effect.

This anti-hyperglycemic effect is speculated to have been caused by a decreased in a serum protein, 4211(4212) Da(yes this is a protein name)(1).

I strongly recommend diabetics to drink Green tea regularly, if you haven't done so. The health benefits and glycemic benefits is far too much to be missed.

Green tea powder is just green tea that has been grinded up into fine powder, it's not the same as green tea extract. Green tea extract would have been more potent. One thing to note that if you're using tea bag, you're only taking in the soluble compound that leaks out to the water from tea bags. Usually the tea bags come in 2grams forms, so I would probably recommend 2 tea bags at the very least to reap the benefits.

Reference
1. Effect of green tea on blood glucose levels and serum proteomic patterns in diabetic (db/db) mice and on glucose metabolism in healthy humans
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=517497 Retrieved 25/5/09

Glycemic Index - Simplified

noreply@blogger.com (Bun) — Mon, 25 May 2009 08:54:00 +0000

After much thought, I've decided to simplify my explanation further, the original post is right below.

Glycemic Index is a measurement index, just like how metres are used for lengths. However in this case, the Glycemic index is used to compare how fast the sugars in food are absorbed into out body. You see, many of the food we eat contains carbohydrate, a source of energy that is eventually broken down into sugars. These sugars are not the same as table sugar, they're in much simpler chemical forms.

Different kind of foods have different carbohydrates as well as different nutritional contents, these accounts for the difference in the glycemic index of different food.(try saying that quickly!)

The higher the glycemic index of a food = the faster the blood sugar level rises
- This is what we want to avoid! High blood sugar is what diabetics are suffering from, it's the mechanism that tears down our body.

Low glycemic index food are food that gradually releases carbohydrate into our blood stream, it dosen't release less, it just releases slowly. Therefore it has much less impact to the blood sugar level. This is what we want to acheive.

Much lengthier but detailed explaination
Carbohydates are a source of energy for our bodies, and they come mainly from plant products such as grains, fruits or roots. Most vegetables do contain carbohydrate, but only some of it can be broken down by our body, therefore not a great source of carbohydrate.

When ingested, these carbohydrates will eventually be broken down to simpler forms that our body can use. Processing these carbohydrates into simpler forms and transporting it into our blood stream takes time. Eventually these carbohydrates are taken up by our blood stream which causes an increase in our Blood glucose level. A curve would be plotted to determine the changes that different carbohydrate causes.

Based on this curve, the Carbohydrates are given a ranking and this is known as the Glycemic Index. Low glycemic index foods are those that cause a gradual increase in blood glucose level while high glycemic index foods are those that causes sharp increase.

High GI foods are those with value 70 and above
Medium GI foods are those between 56~69
Low GI foods are those below 55

Lower glycemic index foods are generally better because they do not cause a sharp increase in blood glucose level. Which in turn will also cause an uproar of insulin into the blood stream.

Increased insulin levels are known to cause
- Weight gain due to promotion of lipid storage
- Increased sodium retention in the body, which causes hypertension
- Increased Inflammatory compounds in the blood stream(This causes irritation)
- Reduction in the Good Cholesterol in blood(HDL), this cholesterol is essential for keeping down cholesterol levels.

There are plenty of issues to discuss regarding the glycemic index, this post is meant to explain the glycemic index system. Future posts will cover other topics such as what affects the glycemic index and how it is helpful to diabetics.

Diabetic Management

noreply@blogger.com (Bun) — Sun, 24 May 2009 16:52:00 +0000

Here's a chart I've created to simplify the big picture on diabetic management.

Weight Management
Obesity is the number cause for Type 2 Diabetes. All that extra weight damages you twice. Why do I say that?

Number 1: Glucose transporter in your cells become less resistance to insulin. This means that the glucose will stay in your blood stream.

Number 2: This resistance to insulin causes the cells which secretes insulin(Beta cells) to work harder and pump out more insulin. In time, these cells are exhausted and so secretes less and less insulin.

This causes a cycle that would trap any obese person. There is limited insulin supply for the very insulin-resistant cells, glucose uptake would be close to impossible. It's like trying to fight a battalion of army with a pair of chopsticks.

Most diabetic weight management studies are only done on obese persons. However, I'm a strong believer that even an overweight person will experience this cycle of insulin resistance. For type I diabetics, there would be no beta cell secretions but the risk of insulin resistance from cells still exists. Just in case you are wondering, yes, it is possible to have 'double diabetes', being insulin resistant and having no insulin secretions at the same time(1).

Frequent Physical Activity
Studies have shown the benefits of exercise on carbohydrate metabolism and insulin sensitivity. With exercise done 3 or 4 times a week, HBA1c levels can be lowered by as much as 20%(2). It is recommended that type 2 diabetics practise resistance training(weight lifting) up to 3 times a week, together with some aerobic exercises. (3) I'll touch on this further in my future entries.

Good dietary habits**
I cannot emphasize more on how important this part is! So I engaged in the help of the asterisks. Please don't miss this point.

Some good dietary habits for diabetic includes:

Low glycemic foods
Consuming more fruits and vegetable
Eating more healthy oils and lean protein
Frequent but small meals
Regular timing for meals

I'll update this page as I go, I'll post articles on these habits.

Insulin and Medications
I'm currently not under Insulin Jabs and any form of medication. It's not that I'm skipping them! But I'm keeping my diabetic under control with cautious eating habits and doing my exercises. I used to take metformin but not anymore. I'm not a medical student, neither do I have experience with usage of Insulin, so please listen to your doctors on this part!

Monitoring is a must, whether it's the HBA1c or the Blood glucose tests. Both tests does not come cheap but it's the only way to find out whether you've passed your diabetic test. For type I diabetics, it's advisable to do the blood glucose test every so often. I didn't include monitoring in my chart because it does not help with glucose control, what it does is to simply put you in check. If you're confident managing your diabetes, monitoring can even be done less frequently.

Reference
1. University Of Pittsburgh Medical Center. "Type 1 Diabetics Can Get 'Double Diabetes' From Insulin Resistance, Says University Of Pittsburgh." ScienceDaily 25 April 2003. 25 May 2009 http://www.sciencedaily.com /releases/2003/04/030425071101.htm>.

2.Diabetes Mellitus and Exercise — Diabetes Care
http://care.diabetesjournals.org/content/25/suppl_1/s64.full retrieved 25 May 2009

3.
New Recommendations Regarding Exercise and Type 2 Diabetes
http://cme.medscape.com/viewarticle/533929 retrieved 25 May 2009