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Transcript
PERSATUAN DIABETES MALAYSIA
(MALAYSIAN DIABETES ASSOCIATION)
No . 2, Lorong 11/4E, 46200 Petaling Jaya, Selangor
Tel : 03 - 7957 4062
Fax : 03 – 7960 4514
Email : [email protected]
Website : www.diabetes.org.my
PDM Newsletter
. KDN No. PP4556/08/2012(31341)
Jan - Dec 2011
Persatuan Diabetes Malaysia (PDM) celebrated the World Diabetes Day (WDD) 2011 on 13th November 2011 by
organizing the event at Mydin Mall, Ayer Keroh, Melaka. The WDD 2011 was jointly organized by kerajaan Negeri Melaka,
Jabatan Kesihatan Negeri Melaka and PDM Cawangan Negeri Melaka. The WDD event was officially launched and the
speech read by Y.Bhg Datuk Seet Har Cheow, Pengerusi Jawatankuasa Negeri Kesihatan, Pemulihan Projek, Pembangunan
Pekan kecil dan NGO on behalf of the Ketua Menteri Melaka. The activities included the 10,000 Steps walkathon which
attracted about 1,600 participants and ten Companies/Organizations took part in the Exhibition booths and Health
Screenings, besides other events.
The PDM State and District Branches organized the WDD 2011 events in their respective cities and towns, with such
activities, as talks and health screenings. PDM, through the activites, hope to raise awareness of diabetes and its
complications and to improve diabetes care and prevention.
In the pictures above, the V.I.P.s are getting ready to take part in the 10,000 steps walkathon.
CONTENTS HIGHLIGHTS
PAGES
Editor’s Message
4
President’s Message
5
Pemantauan sendiri glukosa dalam darah (SMBG)
7
Diabetes dan penyakit saraf (Neuropathy)
8
Apakah itu Karbohidrat dan kesannya pada badan?
9
Apakah maksud makan secara Sihat?
11-12
Bagaimanakah saya mengawal diabetes?
13
Memahami bagaimana insulin mempengaruhi gula dalam darah
14
Apa jenis insulin yang sesuai untuk penyakit diabetes saya ?
16
IDF World Diabetes Congress, Dubai UAE 1-8 Dec 2011
17
PDM HQ ACTIVITIES 1
19
PDM HQ ACTIVITIES 2
20
PDM HQ ACTIVITIES 3
21
PDM HQ ACTIVITIES 4
22
PDM HQ ACTIVITIES 5
23
PDM HQ ACTIVITIES 6
24
Diabetes – Self-Monitoring Of Blood Glucose (SMBG)
26
Diabetes and Nerve Disease (Neuropathy)
27
What Are Carbohydrates & What Do They Do For The Body?
28
What Does Healthy Eating Mean?
30 & 32
How Can I Take Care Of My Diabetes?
33
Understanding How Insulin Affects Your Blood Sugar
34
What Type Of Insulin Is Best For My Diabetes?
36
Community-based healthy lifestyle intervention among adults at risk of type 2 diabetes
37- 38
PERSATUAN DIABETES MALAYSIA
Member of International Diabetes Federation
Editor’s Message
Patron
DYTM Raja Muda Perak Darul Ridzuan
Raja Nazrin Shah
Everyone in Malaysia needs to understand the
seriousness of this disease because all of us are
susceptible to diabetes and its resultant impact on
health.
Advisors
Prof. Dato’ Dr. Anuar Zaini B. Md. Zain
Dato’ Dr. Shafie B. Ooyub
President
Prof. Dato’ Dr. Ikram Shah B. Ismail
Vice President
Jong Koi Chong
General Secretary
Dato’ Hajah Rahimah Bt. Dato’ Haji Ahmad
Assistant General Secretary
K. S. Maniam
General Treasurer
M. Tirunavukarasu
Editorial Board
Prof. Dato’ Dr. Ikram Shah B. Ismail – Chief Editor
Jong Koi Chong - Editor
Dato’ Hajah Rahimah Bt. Dato’ Haji Ahmad
Dr. Vijay Ananda
Dr. S . Elangovan
Dr. Nizam Malik B. Bali Mohamad
Dr. Noraryana Hassan
Nor Hayati Bt. Mohd Nawi
K. S. Maniam
Disclaimer
The views, opinions and recommendations contained in
Berita Kontrol are those of the authors and not
necessarily endorsed by the Persatuan Diabetes Malaysia
and the Editiorial Board. The reader should consult his
own doctor for his personal treatment or other medical
advice. The acceptance of advertisements in the Berita
Kontrol does not imply endorsement by Persatuan
Diabetes Malaysia.
Printed by :
Neptune Press
No. 113, Jalan Sultan Abdul Samad,
Off Jalan Tun Sambathan,
50470 Kuala Lumpur .
Tel : 03- 2273 2707 Fax: 03- 2274 7509
Message From Editor Of Berita Kontrol
The prevalence of diabetes is alarmingly high and is
expected to increase over the next century. In Malaysia,
over 200,000 people have been diagnosed with diabetes;
at least another 300,000 people don't know they have it.
Four out of 10 people with diabetes will develop
debilitating and long-term complications.
Diabetes is a major cause of premature death, blindness,
kidney disease, heart disease, stroke, limb amputation
and other significant health problems. With diabetes, life
expectancy is significantly reduced. One of the hidden
impacts of diabetes is the loss of productivity from
disability, sickness, premature retirement and premature
death. Diabetes is estimated to cost the country health
system just under one billion dollars annually.
PDM always working closely with Ministry Of Health
Malaysia in highlighting the growing public health
problem of diabetes and recommending preventive
strategies for reducing the incidence of diabetes and its
complications. The special concerns will be focus on type
2 diabetes which accounts for 90 per cent of all diabetes
and is the most preventable. Although we have no
control over our family history and age, which are two
important risk factors for diabetes, we can practice
healthy behaviors. Even slight changes in physical activity
and diet can provide long-term benefits for the
individual, the community, and the province.
By promoting the importance of lifestyle changes and
creating the social and environmental supports needed
for these changes, we can promote health, save lives,
and reduce the burden of diabetes in our country.
Jong Koi Chong
Editor, Berita Kontrol
President’s Message
Message From The Chief Editor Desk
Thank You.
In Malaysia today, about 18 per cent of the population - have
been diagnosed with diabetes. In fact, one Malaysian is newly
diagnosed with diabetes every 20 minutes! Diabetes was the
cause of death for more than 2,200 people in 1996. Forty per
cent of people with diabetes will develop debilitating
complications such as blindness, kidney failure, or heart
disease. In addition, some people will undergo foot, toe or leg
amputations. All these complications from diabetes are
devastating for the individual, the family, and the province's
health system.
Besides physical problems, people with diabetes can
experience anxiety and depression from living a restricted
lifestyle. They may lose productivity due to work or school
absences. They may see a decrease in their earning potential
because of the development of complications. As well,
changing personal routines can affect other family members.
Because the physical, social, economic and emotional burden
of diabetes is substantial, diabetes is a major public health
concern.
Diabetes is a disease that can affect anyone. A projected rise in
the incidence of type 2 diabetes in Malaysia is related to the
aging of the population and increasing obesity and physical
inactivity. This report will focus on type 2 diabetes because it
represents 90 per cent of all cases and is the most preventable
by changes to lifestyles.
It is very disturbing that 35 to 44 per cent of people with
diabetes don't know they have it. As a long-lasting disease with
serious consequences if left untreated, diabetes requires
appropriate and timely intervention. Symptoms of diabetes
often do not show up until several years after the onset of the
disease. In fact, someone may have had diabetes for up to 12
years before diagnosis.
Since people with diabetes generally feel well during the initial
stages of the disease, many people are only diagnosed once
they develop complications. For example, 21 per cent of
people with diabetes have eye disease before being diagnosed.
Late diagnosis results in delayed treatment, which can be less
effective in preventing or decreasing further complications.
Even though diabetes is a serious problem, this disease is
manageable if individuals, communities, health care providers,
and policy-makers are given and use the information and tools
to motivate and support behavioural change.
Currently, PDM has planned a lot of health programs educate
the public about preventing diabetes. Despite educational
programs for preventing complications, the proven
effectiveness of lifestyle changes, and advances in treatment,
some people remain unaware, or unconvinced, of the
seriousness of this disease. Research advances in diabetes,
including new drug therapies, are often not communicated
effectively. Type 2 diabetes is often not managed aggressively.
The result: many people with diabetes are not motivated when
diagnosed to change their lifestyles.
Prof. Dato’ Dr. Ikram Shah Ismail
President, PDM
3rd NATIONAL DIABETES CONFERENCE 2012
Dear Participants,
We are pleased to announce that Persatuan Diabetes Malaysia
rd
(Malaysian Diabetes Association) is organizing the 3 National
nd
rd
Diabetes Conference 2012 on 22 -23 June 2012 at the
rd
Crowne Plaza Mutiara Kuala Lumpur. The theme of the 3 NDC
2012 is “Towards Better Diabetes Prevention and Control”. The
NDC 2012 aims to provide a platform to discuss recent
scientific advances and innovations to improve the
management of diabetes.
Persatuan Diabetes Malaysia is inviting all levels of healthcare
professionals involved in treating diabetes to the Conference
with the view to improve the standard of care for people with
diabetes.
Highlights of the Conference
•
•
•
•
•
•
•
•
•
•
•
•
Epidemiology of Obesity and Diabetes
Cholesterol and Blood Pressure
Diabetic Foot Disease
Kidney Disease
HbA1c
Dietary Therapy
Pharmacological Therapy
Cardiovascular Risk
Psychological Aspects
Gestational Diabetes
Hypoglycemia
Neuropathy
Who should attend
Healthcare professionals responsible for managing
people with diabetes, including medical and family
medicine specialists, general practitioners, medical and
health officers, diabetes educators, dieticians and
nutritionist, pharmacists, nurses, medical assistants,
clinical psychologists, physiotherapist and other allied
healthcare professionals.
For more information and updates regarding the
Conference, please contact PDM Staff:
Ms Parameaswari/Ms Penny Peh/Ms Nurbazlin
Tel : (6) 03-7957 4062/63
Fax: (6) 03-7960 4514
DIABETES – PEMANTAUAN SENDIRI GLUKOSA DALAM
DARAH
Beberapa kajian menjelaskan bahawa memantau sendiri
glukosa dalam darah secara kerap dan konsisten
sepatutnya menjadi sebahagian daripada program
pengurusan diabetes. Kawalan ketat glukosa dalam
darah akan mengurangkan risiko dan melambatkan
bermulanya komplikasi berkaitan dengan diabetes
seperti retinopathy (penyakit mata), neuropathy
(penyakit saraf), serangan jantung dan nephropathy
(penyakit buah pinggang) di samping memberikan
banyak manfaat kepada pesakit.
Kebanyakan pesakit diabetes beranggapan bahawa
apabila doktor mengubah suai ubat, tahap glukosa dalam
darah akan stabil beberapa bulan. Sebenarnya terdapat
beberapa kemungkinan yang mengubah tahap glukosa
dalam darah secara mendadak. Namun, fisiologi badan
yang normal akan menjamin perubahan yang berlaku
tidak terlalu banyak. Faktor-faktor yang menyebabkan
perubahan adalah seperti yang berikut:
Makanan: Tidak mungkin seseorang mengambil
makanan yang sama jenis dan sama banyak sepanjang
masa. Makanan mempunyai beberapa komponen dan
karbohidrat terutamanya yang menentukan turun naik
glukosa dalam darah. Karbohidrat dalam makanan akan
bertukar menjadi glukosa. Kadar pertukaran bergantung
kepada saiz makanan dan juga kehadiran/ketiadaan
bahan-bahan lain, seperti jus buah yang menaikkan
glukosa dalam darah lebih cepat daripada memakan
buah itu sendiri. Ini adalah kerana jus tiada serat, bahan
yang menurunkan tahap glukosa dalam darah. Demikian
juga dengan kehadiran protein bersama karbohidrat
dalam diet melambatkan kenaikan tahap glukosa
berbanding dengan kehadiran karbohidrat sahaja.
Insulin: Bagi orang tanpa diabetes, insulin dihasilkan
dalam badan apabila terdapat makanan, seperti
karbohidrat. Insulin akan mengawal tahap glukosa. Bagi
pesakit diabetes, sama ada yang kekurangan insulin atau
sel-sel tidak menerima insulin, suntikan diperlukan. Masa
dan kuantiti yang disuntik hendaklah diubah supaya pada
bila-bila masa tahap glukosa dalam darah tidak terlalu
tinggi atau terlalu rendah. Amaun insulin yang
diserapkan oleh badan manusia setelah disuntik boleh
berbeza sebanyak 25% dari hari ke hari. Ini disebabkan
oleh beberapa perkara :Bahagian badan yang disuntik insulin – Jika insulin
disuntik pada bahagian yang sama setiap hari, kadar
serapan akan jadi berkurangan.
Jika insulin disuntik pada perut, kadar serapan lebih
cepat berbanding dengan jika disuntik di paha.
Sebanyak mana insulin diserap bergantung juga kepada
aktiviti fizikal yang melibatkan bahagian badan yang
disuntik. Misalnya, jika insulin disuntik di lengan selepas
senaman lasak yang melibatkan lengan – kadar
penggunaan insulin agak tinggi.
Senaman: Semasa senaman, otot-otot yang bekerja,
akan menggunakan glukosa sebagai bahan bakar dan ini
akan menurunkan kadar glukosa dalam badan. Senaman
juga akan meningkatkan sensitiviti insulin terutamanya
dalam otot-otot, yakni kurang insulin diperlukan untuk
menolak glukosa ke dalam sel-sel. Pada hari apabila
kurang atau tiada senaman, keperluan insulin akan
bertambah, dan akan terdapat perbezaan pada tahap
glukosa dalam darah.
Tekanan: Dalam jangka masa yang panjang tekanan
mungkin menjadi salah satu faktor utama yang
menyebabkan peningkatan kes-kes diabetes dan
penyakit jantung di dunia. Bagi mengawal tekanan secara
berkesan,
hormone
tertentu
dihasilkan
yang
menyebabkan tahap glukosa dalam darah meningkat.
Gaya hidup sekarang ini sentiasa berubah, demikian juga
dengan tekanan. Seseorang bertindak secara berlainan
terhadap tekanan, bergantung kepada personaliti
masing-masing. Sesetengah orang lebih mudah
dipengaruhi bahaya tekanan daripada yang lain. Sebagai
contoh, ada orang makan lebih dan ada yang makan
kurang apabila menghadapi tekanan. Kita tidak boleh
mengkuantitikan tekanan dan menentukan sebanyak
mana ia boleh meningkatkan glukosa; bagaimanapun,
adalah jelas mereka yang hidup dalam tekanan adalah
lebih terdedah kepada diabetes dan sakit jantung.
Penyakit dan Jangkitan: Keadaan ini boleh membawa
kepada perbezaan yang ketara pada tahap glukosa dalam
darah. Oleh kerana badan mengalami tekanan semasa
sakit, hormon tertentu akan dihasilkan yang berlawanan
dengan tindakan insulin. Ini boleh meningkatkan tahap
glukosa dalam darah. Ubat-ubatan pasaran gelap juga
diambil oleh sesetengah orang. Ubat-ubatan ini,
terutama yang mengandungi alkohol atau gula, boleh
menaikkan tahap glukosa dalam darah.
Ramai di kalangan kita yang makan terlalu banyak,
minum terlalu banyak, merokok terlalu banyak,
memandu terlalu laju, tetapi berjalan terlalu sedikit.
Sumber: Medindia Health Network
DIABETES AND PENYAKIT SARAF (NEUROPATHY)
Tahap glukosa yang tinggi boleh menyerang saraf dalam
badan, menjejaskan fungsinya. Bagaimana saraf rosak
tidak jelas, tetapi ada beberapa kemungkinan.
Apabila glukosa menyerap ke dalam saraf dengan
banyaknya (kerana tahap gula dalam darah tinggi), ia
boleh bercantum dengan protein dan enzim dan
menjejaskan fungsinya. Kepekatan glukosa dalam saraf
akan menarik air ke dalam sel, menjadinya bengkak dan
mengubah kepekatan kimia-kimia utama. Pengedaran
darah dan oksigen kepada saraf mungkin penting. Apa
pun sebabnya, kesannya saraf jadi rosak. Kesan kepada
individu bergantung pada saraf mana yang terjejas.
Peripheral Neuropathy
Sering dikatakan neuropathy (iaitu ada yang tidak kena
pada saraf) ialah "peripheral neuropathy", yang bererti
masalah pinggiran badan, seperti di hujung kaki atau
tangan. Tanda-tandanya ialah rasa kebas seperti
"dicucuk jarum peniti" (atau kaki sedang “tidur”), hangat,
dan rasa kejutan elektrik. Walau bagaimanapun,
seseorang itu biasanya tidak mempunyai apa-apa tanda.
Peripheral neuropathy amat berbahaya. Pesakit boleh
cedera di kaki tanpa sedar, yang membawa kepada
jangkitan kaki, dan seterusnya kepada satu komplikasi
diabetes yang ditakuti oleh pesakit diabetes iaitu
amputasi. Orang yang sedar dirinya akan kehilangan
deria rasa boleh mengambil langkah berjaga-jaga bagi
mengelakkan kakinya daripada kecederaan. Individu
patut memeriksa kakinya setiap hari jikalau ada
kecederaan, dan menjaga kaki supaya sentiasa bersih
dan lembap bagi mengurangkan risiko masalah kaki.
Mereka yang tidak tahu masalah ini hendaklah
diberitahu oleh doktor supaya sentiasa berjaga-jaga.
Namun demikian, tidak salah jika kita menganggap deria
rasa di kaki kita tidak normal dan menjaga kaki dengan
sebaik-baiknya.
Satu lagi kesan peripheral neuropathy ialah kesakitan,
yang boleh jadi teruk, biasanya pada waktu senja atau
malam, dan boleh mengganggu tidur, mendorong
seseorang mengambil narkotik untuk kelegaan. Tabiat ini
mungkin menjadi ketagihan. Oleh itu, jangan ambil
narkotik untuk menghilangkan kesakitan; ada cara lain
untuk melegakan kesakitan, iaitu dengan ubat yang
diberikan oleh doktor. Ubat bertindak mengubahkan
kimia dalam saraf, terutama yang menyebabkan
kesakitan. Antara ubat-ubatan termasuk antidepressants (dalam dos kecil), anti-seizure, dan ubat
yang kadangkala digunakan untuk mengubat masalah
denyutan jantung. Krim yang mengandungi capsaicin
juga membantu sesetengah orang. Semua rawatan
mengambil masa berminggu-minggu untuk mendapat
kesan awal. Terdapat masalah lain neuropathies. Jika
sudah teruk, seseorang tidak dapat merasa lantai pada
kaki, hingga menyebabkan berjalan pun sukar. Ada orang
menganggap sebagai hilang imbangan. Apabila jari-jari
hilang rasa, tugas harian menjadi susah atau mustahil.
Tugas biasa seperti memasang butang baju, mengenakan
zip, memakai tali leher, bergantung kepada deria rasa di
jari. Memegang sesuatu juga boleh menjadi sukar.
Kelemahan dan ketidakstabilan tangan dan kaki boleh
menjadi masalah. Apabila keadaan sudah menjadi serius,
otot-otot tangan akan reput dan kemampuan untuk
menggunakan tangan akan terjejas. Dengan ketiadaan
saraf, otot-otot di kaki akan hilang, membawa kepada
kecacatan, kalus (calluses) dan ulser, dan kadang-kadang
amputasi.
Bolehkah Kumpulan Saraf Lain Terjejas oleh Diabetes?
Apa jua saraf boleh terjejas dengan tahap gula yang
tinggi dalam darah. Apa jua kemampatan (compression)
pada saraf, seperti carpal tunnel, sciatica, dan lain-lain,
biasanya kerap berlaku kepada pesakit-pesakit diabetes,
mungkin kerana saraf yang ada banyak glukosa lebih
cenderung mendapat kecederaan disebabkan oleh
kemampatan.
Adakalanya saraf pada otot-otot besar di kaki akan
terjejas dengan teruknya dan boleh menyebabkan
kesakitan dan kelembutan saraf.
Autonomic Neuropathy
Diabetes juga boleh menggangu saraf secara tidak sedar,
termasuk organ-organ dalaman kita dari berfungsi
dengan baik. Keadaan ini menyebabkan berbagai-bagai
masalah seperti:
Diabetes dan Perut: Diabetic Gastroparesis
"Diabetic Gastroparesis" terjadi apabila diabetes
bertindak ke atas saraf pada perut, menyebabkan otototot dalam perut tidak berfungsi, perut menjadi kendur
dan tidak mampu mengalirkan makanan dengan baik.
Makanan akan berada dalam perut berjam-jam tanpa
dihadam. Lambat-laun, individu rasa mual dan muntah.
Gastroparesis juga menyukarkan untuk mengawal gula
dalam darah kerana anda tidak tahu bilakah makanan
anda akan diserap — menyebabkan gula dalam darah
terlalu tinggi atau rendah dan jarang berlaku di
pertengahan. Ubat boleh membantu, jika penyakit tidak
begitu teruk.
Diabetes dan Usus
Diabetes dan Seks
Jika saraf pada usus besar terjejas, seseorang akan
mengalami cirit-birit.
Diabetes boleh menyebabkan mati pucuk, tetapi kerap
diabaikan. Keadaan ini juga disebabkan saraf terjejas,
dalam kes ini saraf pada alat kelamin. Terdapat beberapa
pilihan kepada masalah ini — tanya doktor atau pendidik
untuk maklumat tambahan. Diabetes boleh mengganggu
perlakuan dan kenikmatan seks wanita, dengan
menjejaskan kelembapan dan masalah lain. Penyelidikan
dalam bidang ini kurang dijalankan.
Sumber: Diabetes Home
Ini boleh menyusahkan kerana ia biasanya berlaku pada
waktu malam, dan boleh dikaitkan dengan
ketidakmampuan mengawal diri. Seseorang mungkin
tidak merasa seperti hendak membuang air sehingga
sudah terlewat. Ini kerana rektum sudah hilang rasa;
kerana tidak merasa hendak membuang air, seseorang
tidak pergi ke bilik air. Keadaan ini boleh diubati.
Diabetes dan Pundi Kencing
Apabila saraf pada pundi kencing terjejas, pundi kencing
hilang sebahagian otot-otot, dan bertindak sebagai beg
kendur, tidak mampu mengecut atau mengembang. Ini
menyebabkan pembuangan air yang tidak sempurna,
mendedahkan individu kepada jangkitan dan masalahmasalah lain. Kencing cuma merupakan limpahan air dari
pundi kencing, bukan dengan pergerakan otot-otot pundi
kencing. Ubat juga boleh membantu keadaan ini,
walaupun dalam kes-kes teruk memerlukan intermittent
catheterization of the bladder (meletakkan tiub dalam
pundi kencing untuk menyalurkan air kencing keluar).
Saraf pada Jantung dan Saluran Darah
Saraf pada jantung memberi kesan terhadap denyutan
jantung, dan penyakit saraf umumnya menjejaskan
kebolehan jantung untuk mengawal denyutan. Mereka
yang menghidap neuropathy jenis ini amnya mengalami
denyutan jantung yang lebih pantas daripada biasa.
Apabila diabetes menyerang saraf jantung, jantung akan
hilang deria rasa. Keadaan ini berbahaya bagi orang yang
menghidap penyakit arteri jantung (pengerasan arteri).
Dengan kekurangan oksigen, jantung berasa sakit,
keadaan dikenali sebagai angina.
Pesakit diabetes mungkin tidak berasa apa-apa, dan tidak
sedar masalah ini. Tindakannya tidak berubah, dan ini
boleh membawa kepada serangan jantung atau lebih
buruk.
Saraf pada saluran darah dan jantung memberi kesan
kepada penyelenggaraan tekanan darah yang cukup bila
kita beralih kedudukan, seperti berdiri daripada baring.
Jika saraf ini terjejas, individu mungkin berasa pening
apabila ia berdiri, atau mungkin pitam.
APA ITU KARBOHIDRAT & KESANNYA PADA BADAN?
Mengambil karbohidrat memberi tambahan tenaga
secara mendadak atau perlahan-lahan, bergantung
kepada jenis karbohidrat yang diambil. Karbohidrat,
protein dan lemak digolongkan dalam macronutrients,
yang membekalkan bahan bakar untuk badan semasa
berehat atau melakukan aktiviti fizikal. Molekul glukosa
dalam karbohidrat lebih baik sebagai sumber tenaga
untuk otak dan sel saraf, dan untuk sel otot semasa
senaman yang cergas.
Faedah
Karbohidrat daripada bijirin penuh, buah-buahan, sayursayuran, kekacang dan dal memberi tenaga kepada otak
supaya kita boleh menumpukan perhatian kepada kerja
yang dilakukan. Jika anda pernah mengambil diet rendah
karbohidrat, anda akan tahu betapa susahnya untuk
berfikir, mengira, menganalisa dan menumpukan
perhatian dengan tenaga yang sedikit. Mengambil
karbohidrat yang sihat untuk sarapan bukan karbohidrat
yang tidak sihat akan mengurangkan keinginan untuk
mengambil bahan makanan yang berlemak, bergula dan
yang masin di kemudian hari.
Mudah atau Kompleks
Karbohidrat mudah ialah gula mudah. Glukosa, fruktosa,
sukrosa, laktosa dan maltosa semuanya gula mudah atau
karbohidrat mudah. Fruktosa, sukrosa, laktosa dan maltosa
akhirnya bertukar menjadi glukosa dalam badan anda.
Sementara buah-buahan dan produk tenusu kaya dengan
gula mudah fruktosa dan laktosa, gula-gula ini diterima
dalam badan sebagai karbohidrat kompleks kerana
kandungan serat dalam buah-buahan dan kandungan
protein dalam susu. Karbohidrat kompleks ialah makanan
kanji yang terdapat dalam bijirin, kacang pea, kentang,
kekacang, jagung dan sayur jenis akar. Karbohidrat
kompleks mempunyai lebih glukosa atau tenaga daripada
karbohidrat mudah. Diet yang kaya dengan buah-buahan
segar, sayur-sayuran berserat dan produk tenusu rendah
lemak akan memberikan banyak vitamin, zat galian dan
serat. Karbohidrat jenis ini mengurangkan risiko
osteoporosis, kolesterol tinggi dan meningkatkan kesihatan
atau kekuatan fizikal.
Bijirin Penuh lwn. Bijirin Diproses
Karbohidrat yang diproses daripada bijirin penuh untuk
mengasingkan bahagian luar dan lapisan germa,
meninggalkan endosperm atau lapisan kanji di dalam.
Karbohidrat bijirin penuh mengandungi banyak serat;
serat bijirin juga mengandungi lemak sihat dan protein.
Bijirin penuh memberi kesan yang sedikit terhadap tahap
gula dalam darah berbanding dengan bijirin yang
diproses. Beras perang, steel-cut oats dan pasta gandum
penuh memberi tenaga di samping mengurangkan risiko
diabetes dan obesiti berbanding dengan beras putih yang
diproses dan roti putih. Mengambil bijirin yang diproses
dengan kerap akan menjejaskan kesihatan kerana ia
boleh menambahkan gula dalam darah anda, diikuti
dengan penghasilan insulin segera.
Penghadaman Yang Cepat lwn. Yang Perlahan
Karbohidrat mudah atau kompleks, penuh atau yang
diproses boleh dibahagikan kepada yang cepat dihadam
atau yang perlahan. Karbohidrat yang cepat bergerak
melalui trek laluan penghadaman ke dalam saluran darah
anda dengan cepat. Karbohidrat yang perlahan
mengambil masa panjang untuk hadam dan untuk
menyerap ke dalam saluran darah. Karbohidrat yang
cepat dihadam seperti nasi putih, kentang, nanas,
tembikai, kacang jeli dan pretzel, menaikkan tahap gula
dalam darah dengan kadar yang cepat dan
mempengaruhi penentangan insulin dan diabetes.
Peningkatan gula diikuti dengan penurunan gula dalam
darah, bahkan lebih rendah daripada sebelum makan,
membuat anda lebih berselera. Karbohidrat yang
perlahan seperti roti gandum penuh, spageti, mi, epal,
oren, susu skim, aprikot kering memberi kesan minimum
kepada gula dalam darah mengekalkan tahap tenaga
anda teguh sepanjang hari.
Sumber: Live Strong
APAKAH MAKSUD MAKAN SECARA SIHAT?
Makan secara sihat bermaksud makan pelbagai jenis
makanan yang memberi khasiat yang diperlukan untuk
menjaga kesihatan anda, rasa ceria dan bertenaga.
Makanan berkhasiat termasuk protein, karbohidrat,
lemak, air, vitamin dan zat galian.
Pemakanan sihat penting untuk semua. Apabila
diamalkan bersama dengan gaya hidup sihat, kawalan
berat badan dan makanan sihat adalah cara paling baik
untuk kesihatan dan kekuatan badan. Jika anda ada
sejarah barah payudara atau sedang menjalani rawatan,
penjagaan makanan yang rapi adalah amat penting. Apa
yang anda makan akan memberi kesan kepada sistem
imun, perasaan dan tahap tenaga anda.
Tiada makanan yang dapat mencegah daripada barah
payudara. Penyelidik masih mengkaji kesan makanan
yang tidak sihat ke atas barah payudara dan risiko
ulangan, tetapi kita tahu bahawa berat badan berlebihan
juga faktor risiko bagi kes mula atau ulangan barah
payudara. Di sini diterangkan cara makan yang boleh
menjaga kesihatan anda sebaik-baiknya.Seterusnya baca
tentang kumpulan makanan, khasiatnya, bagaimana
merangka pelan makanan sihat, sebesar mana setiap
bahagian, dan bagaimana hendak menikmati makanan
tanpa makan berlebihan.Makan pelbagai jenis makanan
yang mengandungi khasiat adalah cara yang paling
mudah untuk menjaga kesihatan. Di muka surat ini, anda
akan belajar kenapa badan anda memerlukan makanan
berkhasiat daripada:
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Protein
Karbohidrat
Lemak
Vitamin dan zat galian
Air
Protein membekalkan asid amino — sebagai blok binaan
yang membantu sel-sel badan menjalani aktiviti harian.
Protein membantu badan anda membina sel-sel baru,
membaiki sel-sel lama, membina hormon dan enzim, dan
menjaga sistem imun yang sihat. Jika anda kekurangan
protein, badan anda mengambil lebih masa untuk pulih
daripada penyakit dan anda lebih mudah jatuh sakit dari
awal lagi.
Semasa rawatan barah payudara, sesetengah orang
mungkin memerlukan lebih protein daripada biasa.
Sumber protein yang baik ialah daging tak berlemak,
ikan, ayam itik, produk tenusu rendah lemak, juga
kekacang termasuk yang kering, kacang pea dan dal.
Karbohidrat memberi lebih separuh keperluan kalori
yang diperlukan oleh badan untuk berfungsi setiap hari.
Karbohidrat membekalkan tenaga segera— sebab itu
kenapa atlet “carbo loading" sebelum acara bermula.
Mereka mengisi tenaga untuk menghadapi cabaran.
Buah-buahan, sayur-sayuran, roti, pasta, bijirin, produk
bijirin, biskut, kacang kering, pea, dan dal semuanya
sumber karbohidrat yang baik. Kebanyakannya juga
sumber serat, yang baik untuk sistem penghadaman
untuk kekal sihat.
Gula (putih atau perang), madu, dan molasses adalah
juga karbohidrat. Tetapi karbohidrat jenis ini tinggi dalam
kalori dan tidak mempunyai faedah lain (seperti vitamin
dan zat galian). Bijirin penuh serta buah-buahan dan
sayur-sayuran adalah sumber karbohidrat yang lebih
sihat daripada bijirin dan gula yang diproses.
Lemak membekalkan badan asid lemak yang diperlukan
untuk pertumbuhan dan menghasilkan sel-sel baru dan
hormon. Lemak juga membantu sesetengah vitamin
bergerak melalui badan anda. Vitamin A, D, E, dan K ialah
jenis vitamin yang larut dalam lemak, dan ini bermakna
ia perlu kepada lemak untuk diserap. Lemak juga
tersimpan dalam tisu lemak dalam tubuh dan hati anda.
Lemak juga melindungi organ anda daripada trauma.
Badan anda menyimpan kalori berlebihan sebagai lemak
untuk tenaga rizab.
Lemak memberi anda lebih kalori padat daripada
karbohidrat atau protein. Atau dengan kata lain, sesudu
lemak mempunyai lebih kalori daripada sesudu
karbohidrat atau sesudu protein.
Ada tiga jenis lemak yang penting:
Lemak tepu, yang biasanya terdapat dalam daging dan
produk tenusu penuh, hanya terdapat dalam makanan
daripada binatang, bukan daripada tumbuhan. Lemak
tepu menambahkan kolesterol dalam darah. Lemak
trans (atau trans-saturated fats atau trans fatty acids)
terbentuk apabila cecair minyak sayur melalui proses
dikenali hydrogenation, di mana hidrogen dicampurkan
untuk menjadikan minyak lebih pejal. Minyak sayur yang
hydrogenated digunakan dalam pemprosesan makanan
kerana ia membuat makanan lebih tahan lama, lebih baik
dari segi kelazatan, bentuk dan tekstur. Kebanyakan
lemak trans terdapat dalam shortening, marjerin yang
kental, biskut, makanan ringan, makanan yang digoreng
(termasuk makanan segera), donat, pastri, kuih bakar,
dan yang diperbuat daripadanya atau yang digoreng
dengan campuran minyak hydrogenated. Lemak trans
juga menambah kolesterol “jahat” dalam darah, (lowdensity lipoprotein - LDL), mengurangkan kolesterol
“baik” dalam darah (high-density lipoprotein - HDL).
Lemak Monounsaturated dan Polyunsaturated terdapat
dalam makanan daripada tumbuhan seperti sayuran,
kekacang, dan bijirin, juga minyak daripadanya (kanola,
jagung, soya). Asid lemak omega-3 and omega-6 adalah
polyunsaturated. Di samping sayuran, kekacang dan
bijirin, Lemak asid omega-3 dan omega-6 terdapat dalam
ikan air sejuk seperti tuna, salmon, dan sardin. Beberapa
kajian menunjukkan pengambilan makanan berlemak
mono atau polyunsaturated boleh mengurangkan
kolesterol
“jahat”
(LDL).
Lemak
mono dan
polyunsaturated juga boleh menurunkan tahap
triglyceride. Triglycerides ialah jenis lemak dalam saluran
darah. Orang yang tahap triglyceride-nya tinggi biasanya
mempunyai kolesterol “jahat” yang tinggi (LDL) dan
kolesterol “baik” (HLD) yang rendah. Kajian juga
menunjukkan ada kaitan tahap triglyceride yang tinggi
dan lebih berisiko diserang angin ahmar (strok) dan sakit
jantung.
Vitamin dan zat galian: Vitamin membuat tulang jadi
keras, penglihatan yang jelas dan tajam, dan kulit, kuku,
dan rambut sihat dan bersinar. Vitamin juga membantu
badan anda menggunakan tenaga daripada makanan
yang anda makan.
Zat Mineral ialah bahan kimia yang membantu
mengawal proses dalam badan anda. Potassium, sebagai
contoh, membantu saraf dan otot berfungsi. Kalsium
membantu gigi dan tulang kuat. Zat besi membawa
oksigen kepada sel-sel.
Jika anda mengambil diet yang seimbang, kalori dan
protein yang cukup, anda mungkin beroleh vitamin dan
zat galian yang cukup. Tetapi jika anda dirawat kerana
barah payudara, mungkin menjadi cabaran. Kerana
sesetengah rawatan mungkin menggunakan sebahagian
daripada bekalan vitamin atau zat galian.
Perlu diingat terdapat perbezaan besar antara
mendapat zat makanan melalui makanan dan mengambil
zat tambahan (vitamin, zat galian, herba/botani). Vitamin
dan zat galian bekerjasama dalam badan anda secara
kompleks, mempengaruhi penyerapan dan pemprosesan
dan mempengaruhi bagaimana fungsi badan bertindak.
Apabila anda mendapat vitamin dan zat galian melalui
makanan, lebih mudah bagi badan anda mengekalkan
imbangan zat makanan. Apabila anda mengambil zat
tambahan, seperti pil vitamin C atau E, anda mendapat
dos dalam kepekatan tinggi yang tidak terdapat daripada
makanan. Sementara sesetengah zat tambahan
berfaedah, yang lain mungkin mengurangkan
keberkesanan sesetengah rawatan bagi barah payudara.
Air diperlukan untuk hidup, dan penting bagi kesihatan.
Air merupakan 50% - 66% berat badan. Air mengawal
suhu, memindahkan khasiat makanan melalui badan,
dan membuang kotoran. Rawatan barah payudara
kadangkala boleh menyebabkan cirit-birit atau muntah.
Kehilangan banyak cecair termasuk kimia dan zat mineral
di dalamnya membawa kepada penyahhidratan. Pada
amnya, meminum 6 hingga 8 gelas air sehari adalah
suatu amalan yang baik. Jika anda kehilangan banyak
cecair kerana cirit-birit atau muntah, anda perlu
menggantikan kedua-dua cecair dan bahan-bahan
penting di dalamnya. Bubur ayam atau sayuran, jus
tomato, jus buah-buahan, dan minuman sukan seperti
Gatorade sebagai contoh cecair yang dapat membantu
menggantikan vitamin dan zat mineral yang hilang.
Sumber: Breastcancer.org
BAGAIMANAKAH SAYA MENGAWAL DIABETES?
Diabetes bermakna glukosa atau gula dalam darah
terlalu tinggi. Badan anda menggunakan glukosa untuk
tenaga. Tetapi terlalu banyak glukosa dalam darah boleh
memudaratkan anda.
Apabila anda mengawal diabetes anda, anda akan
merasa lebih sihat. Anda akan mengurangkan risiko
masalah berkaitan buah pinggang, mata, saraf, kaki, dan
gigi. Anda juga akan mengurangkan risiko serangan
jantung dan strok. Anda boleh mengawalnya dengan
sentiasa aktif secara fizikal
mengikuti pelan pemakanan sihat
mengambil ubat yang ditetapkan oleh doktor
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Jenis aktiviti fizikal apakah yang boleh membantu
saya?
Ada empat jenis aktiviti yang boleh membantu:
•
lebih aktif setiap hari
•
buat senamrobik
•
buat latihan kekuatan
•
regangan
Lebih aktif Setiap Hari
Lebih aktif setiap hari boleh membakar lebih banyak
kalori. Cuba cara-cara ini untuk lebih aktif, atau
fikirkan sendiri cara-caranya.
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Berlegar-legar semasa menggunakan telefon
Bermain dengan kanak-kanak
Bawa anjing berjalan
Bangun untuk menukar saluran TV sebagai ganti
menggunakan alat kawalan jauh
Buat kerja kebun atau bersihkan laman rumah
Bersihkan dalam rumah
Basuh motokar
Tambahkan tugas. Contoh, buat dua kali turun
naik tangga untuk menghantar kain kotor di
tingkat bukannya sekali
•
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Letak kereta jauh sedikit dari kedai dan berjalan
ke sana.
Di pasar, berjalan di setiap lorong.
Di tempat kerja, pergi ke tempat pekerja lain
sebagai ganti menggunakan fon atau email.
Naik tangga sebagai ganti naik lif.
Regang atau berjalan-jalan semasa rehat sebagai
ganti duduk minum di kedai kopi.
Semasa rehat tengah hari, berjalan ke pejabat
pos atau lakukan tugas-tugas lain.
Buat Senamrobik
Aktiviti senamrobik menggunakan otot-otot dan
mempercepatkan degupan jantung. Pernafasan jadi lebih
kuat. Melakukan senamrobik selama 30 minit setiap hari
sekurang-kurangnya 5 hari seminggu memberi banyak
faedah. Tempoh 30 minit itu boleh dipecahkan. Sebagai
contoh, lakukan berjalan cepat 10 minit selepas setiap
kali makan.
Jika anda sudah lama tidak bersenam, sila jumpa doktor
dahulu untuk memastikan sama ada boleh atau tidak.
Minta nasihat doktor cara memanaskan badan, cara
meregang dan cara menyejukkan badan selepas
bersenam. Mula perlahan-lahan dengan 5 - 10 minit
sehari. Tambah sedikit demi sedikit setiap minggu,
dengan matlamat sekurang-kurangnya 150 minit
seminggu. Selamat mencuba.
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Berjalan cepat
Hiking
Naik tangga
Berenang atau bersenam dalam air
Berdansa
Kayuh basikal di luar atau basikal tak
bergerak di dalam rumah
Hadir kelas aerobik
Bermain bola jaring, bola tampar, dll
Sukan luncur atau skating
Bermain tenis
Rentas desa
Buat Latihan Kekuatan
Lakukan senaman angkat berat menggunakan tangan,
lingkaran elastik, atau mesin angkat berat tiga kali
seminggu untuk membina otot-otot. Apabila banyak otot
dan kurang lemak, anda akan membakar lebih banyak
kalori kerana otot membakar lebih kalori berbanding
dengan lemak, walaupun antara sesi senaman. Latihan
kekuatan membantu meringankan kerja-kerja harian,
membaiki imbangan dan koordinasi, termasuk kesihatan
tulang. Anda boleh lakukan latihan kekuatan di rumah,
di pusat kesihatan, atau dalam kelas. Jurulatih kesihatan
anda boleh menjelaskan lagi tentang latihan kekuatan
yang sesuai untuk anda.
pankreas bertindak balas menghasilkan
membolehkan gula memasuki tisu badan.
insulin,
Simpanan glukosa berlebihan untuk tenaga. Selepas
makan - apabila tahap insulin tinggi - glukosa berlebihan
disimpan dalam hati dalam bentuk glycogen. Antara
waktu makan - apabila tahap insulin rendah - hati
melepaskan glycogen ke dalam saluran darah dalam
bentuk gula, dan mengekalkan gula pada tahap biasa.
Jika pankreas anda mengeluarkan insulin sedikit sahaja
atau tiada langsung (diabetes jenis 1) atau badan anda
menghasilkan terlalu sedikit insulin atau menentang
kesan insulin (diabetes jenis 2), tahap gula dalam darah
anda akan meningkat. Ini adalah kerana ia tidak dapat
meresap ke dalam sel. Tanpa rawatan, tahap gula yang
tinggi dalam darah membawa kepada komplikasi seperti
buta, rosak saraf (neuropathy) dan rosak buah pinggang.
Matlamat terapi insulin
Jika anda menghidap diabetes jenis 1, terapi insulin
menggantikan insulin yang gagal dihasilkan oleh tubuh
anda. Terapi insulin adakalanya diperlukan bagi diabetes
jenis 2 dan gestational diabetes (mengandung) apabila
terapi lain gagal mengekalkan glukosa dalam darah pada
tahap
yang
dikehendaki.
Jika
doktor
anda
memperakukan terapi insulin, timbang secara serius.
Terapi insulin boleh menghindar komplikasi diabetes
dengan mengawal gula dalam darah pada tahap baik.
Regangan
Regangan menambah kelenturan anda, mengurangkan
stres, dan mengelak otot-otot daripada rasa sakit selepas
senaman jenis lain. Jurulatih kesihatan anda boleh
menentukan jenis regangan yang baik untuk anda.
Sumber : National Institute of Diabetes Disease
MEMAHAMI BAGAIMANA INSULIN MEMPENGARUHI
GULA DALAM DARAH BAGI MEMBANTU ANDA
MENGAWAL KEADAAN DENGAN LEBIH BAIK
Terapi Insulin ialah bahagian penting dalam pengawalan
diabetes. Memahami peranan insulin penting bagi
mengawal gula dalam darah, dan tujuan terapi insulin.
Pengetahuan menghindar komplikasi diabetes.
Peranan insulin dalam badan
Mungkin lebih senang memahami kepentingan terapi
insulin jika anda faham bagaimana insulin bertindak
dalam badan dan apa yang berlaku jika ada diabetes.
Mengawal gula dalam saluran darah
Peranan utama insulin adalah untuk mengawal tahap
gula dalam saluran darah berada pada tahap normal.
Selepas makan, karbohidrat berubah jadi gula dan masuk
ke dalam saluran darah sebagai glukosa, iaitu gula yang
bertindak sebagai sumber utama tenaga. Biasanya
Pelan rawatan anda
Jenis dan amaun insulin. Terdapat beberapa jenis insulin
yang berbeza dari segi cepat lambat ia dapat mengawal
gula dalam darah. Biasanya doktor anda akan
memperakukan lebih daripada satu jenis insulin. Untuk
menentukan jenis insulin dan sebanyak mana yang anda
perlu, doktor anda akan mengambil kira beberapa faktor,
iaitu termasuklah jenis diabetes, tahap glukosa, sebanyak
mana turun naik tahap gula dalam darah sepanjang hari
dan gaya hidup anda.
Pilihan cara memberi insulin. Insulin disuntik ke bawah
kulit anda, biasanya beberapa kali sehari. Anda boleh
pilih jenis alat suntikan, sama ada pena atau pam insulin
yang dapat membekalkan insulin secara berterusan
melalui tiub saluran (catheter) di bawah kulit anda.
Terapi insulin amat mencabar, tetapi tidak semestinya
mengongkong hidup anda. Pilih program yang sesuai
dengan keperluan dan gaya hidup anda, elakkan
komplikasi diabetes, dan hidup secara aktif dan sihat.
Sumber : Mayo Clinic
APA JENIS INSULIN YANG SESUAI UNTUK DIABETES
SAYA?
Doktor anda akan bersama anda untuk menentukan
jenis insulin yang paling baik untuk anda dan diabetes
anda. Menentukan jenis insulin yang paling sesuai
dengan anda bergantung kepada banyak faktor,
termasuk:
• Tindak balas badan anda terhadap insulin (lama
masa yang diambil oleh insulin untuk meresap ke
dalam badan dan tinggal aktif dalam badan berbeza
antara seseorang dengan orang yang lain).
Bertindak secara Pendek (Short-Acting)
Regular (R)
humulin
30 min.
atau
-1 jam
novolin
2-5 jam
5-8 jam
Velosulin
(digunakan 30 min.2-3 jam
dalam pam 1 jam
insulin)
2-3 jam
Bertindak secara Pertengahan (Intermediate-Acting)
NPH (N)
1-2 jam
4-12
jam
18-24 jam
Lente (L)
1-2½
jam
3-10
jam
18-24 jam
• Pilihan gaya hidup anda – seperti, jenis makanan
diambil, banyak mana alkohol diminum, banyak
mana senaman dilakukan – semua ini mempengaruhi
bagaimana badan anda memproses insulin.
• Kesanggupan
anda untuk menerima beberapa
suntikan setiap hari.
• Berapa kerap anda sanggup untuk memeriksa tahap
gula dalam darah anda.
30 min 10-20
-3 jam jam
Carta berikut menyenaraikan jenis-jenis insulin yang
disuntik bersama dengan butir-butir tentang permulaan
(tempoh masa sebelum insulin sampai pada saluran
darah dan mula menurunkan gula dalam darah), puncak
(tempoh masa apabila insulin paling berkesan
menurunkan gula dalam darah) dan tempoh (selama
mana insulin mampu merendahkan gula dalam darah).
Tiga faktor ini mungkin berubah, bergantung pada
tindak balas badan anda. Kolum akhir menunjukkan
pemahaman tentang "liputan" yang diberi oleh setiap
jenis insulin dalam hubungannya dengan waktu makan.
Lantus
1-1½
jam
Jenis
PermuInsulin &
laan
Jenamanya
• Matlamat anda dalam pengurusan gula dalam darah.
Puncak
Tempoh
Peranan dalam
Pengurusan Gula
dalam Darah
Bertindak Cepat (Rapid-Acting)
Humalog
atau lispro
15-30
min.
30-90
min
3-5 jam
Novolog
10-20
atau aspart min.
40-50
min.
3-5 jam
Apidra atau 20-30
glulisine
min.
30-90
min.
1-2½ jam
Insulin bertindak
cepat termasuk
yang perlu disuntik
semasa makan.
Insulin jenis ini
digunakan dengan
insulin yang
kesannya lama.
Insulin yang
bertindak secara
pertengahan
meliputi insulin
yang diperlukan
kira-kira setengah
hari atau semalam.
Insulin jenis ini
biasanya dicampur
dgn yg bertindak
cepat atau secara
pendek
Bertindak secara Lama (Long-Acting)
Ultralente
(U)
• Umur anda.
Insulin yang
bertindak secara
pendek meliputi
insulin yang
diperlukan bagi
makanan yang
diambil antara
30-60 minit
Levemir atau 1-2
detemir
jam
Insulin yang
bertindak secara
lama perlukan kiraTiada
kira sehari suntuk.
waktu
Insulin jenis ini
puncak:
kerap dicampurkan
20-24 jam
insulin
apabila diperlukan,
diberi pd
dengan insulin
tahap
yang bertindak
tetap
cepat atau secara
Hingga 24 pendek.
6-8 jam
jam
20-36 jam
Dicampur terlebih dahulu (Pre-Mixed)*
Humulin
70/30
30 min.
2-4
jam
14-24 jam
Novolin
70/30
30 min.
2-12
hours
Hingga 24
jam
Novolog
70/30
10-20
min.
1-4
jam
Hingga 24
jam
Humulin
50/50
30 min.
2-5
jam
18-24 jam
Humalog
campuran
75/25
15 min.
30
min.- 16-20 jam
2½ jam
Produk ini biasanya
diambil dua kali
sehari sebelum
waktu makan.
*Insulin dicampur terlebih dahulu merupakan kombinasi
bahagian tertentu iaitu yang bertindak secara pertengahan dan
secara pendek dalam bottle atau pena insulin (angka mengikuti
jenama menandakan peratusan bagi setiap jenis insulin).
Penjadualan Dos Insulin untuk Diabetes
Patuhi panduan oleh penyelia kesihatan tentang bila
insulin patut diambil bagi merawat diabetes anda. Masa
antara suntikan insulin dengan masa makan bergantung
kepada jenis insulin yang anda ambil.
Pada umumnya, anda patut selaraskan suntikan insulin
dengan waktu makan anda. Daripada carta di atas,
dalam kolum "permulaan" memberi maklumat penting.
"Permulaan" juga merujuk kepada bila insulin mula
bertindak dalam badan anda. Anda inginkan supaya
insulin mula melaksanakan tugasnya dalam badan pada
masa yang sama apabila makanan mulai diserap.
Penjadualan yang tepat mengelak daripada tahap gula
dalam darah menjadi rendah.
• Insulin bertindak cepat (Rapid-Acting).
Jika anda mengambil Novolog atau insulin lain yang
bertindak cepat dan boleh disuntik, anda sepatutnya
menyuntik sendiri kira-kira 10 minit sebelum waktu
makan.
IDF World Diabetes Congress, Dubai UAE 1-8 Dec 2011
attended by Diabetes Educator SN Hamiza Had
Working as a diabetic educator at the Diabetes
Resource Centre, Kangar Health Clinic and as a
Treasurer of the Malaysian Diabetes Association State
Branch in Perlis, I was honoured to have been selected
as part of the MDA team to attend the World Diabetes
Congress in Dubai, UAE. I was assigned to be in the
Global Village and was responsible for the Malaysian
Diabetes Association booth which provided information
regarding the MDA and its’ role.
There were many booths from various associations
around the world also show casing their activities to
develop, implement and evaluating a computer-based
self management programme for adults with Type 2
diabetes. Other highlights include the poster
presentation and interesting topics which were
presented.
• Insulin bertindak secara pendek (Short-Acting).
Seperti insulin biasa, patut diambil 30 - 60 minit
sebelum waktu makan. Insulin pertengahan patut
diambil sejam sebelum waktu makan.
• Insulin dicampur
terlebih dahulu (Pre-mixed).
Bergantung pada produk yang digunakan, insulin
jenis ini patut diambil 10 minit atau 30 - 45 minit
sebelum waktu makan.
Sumber : WebMD News home
I had the opportunity to attend a topic on ‘IDF
Education activities : Centre Of Education’ where it was
acknowledged that “Diabetes Education is best
provided by an integrated interdisciplinary team skilled
in diabetes prevention and management as well as
educational, behavioral and psychosocial strategies”
and that lack of qualified health care professionals
makes it difficult to meet these requirements. It was
also stressed that the primary health care providers are
on the frontline in the treatment of diabetes and there
is a need to develop the required competencies to meet
the needs of the people with diabetes. The International
Diabetes Federation has several programmes to
promote and provide diabetes education to health
professionals. One such programme is the IDF Network
of Centres of Education.
IDF Centre of Education form a voluntary network to
improve access to interdiscisplinary diabetes education
for health professionals and strengthen regional
capacity to respond to the diabetes epidemic. IDF
centres of education will prepare health care providers
to assume new roles, develop their expertise in diabetes
management and advocate for improved access to care.
DIABETES – SELF-MONITORING OF BLOOD GLUCOSE
(SMBG)
A number of studies have emphasized that regular and
consistent self-monitoring of blood glucose (SMBG)
should be a part of all diabetes management programs.
Tight blood glucose control reduces the risk and delays
the onset of diabetes-related complications like
retinopathy, neuropathy, heart attack, and nephropathy
besides benefiting the patient immensely.
Most people with diabetes are under the impression
that once the doctor has adjusted the medication, the
blood glucose levels remains unaltered for few months.
This, however, is not the case as there are many
variables that affect the blood glucose levels by the
minute. However, the normal physiology of the body
keeps these fluctuations within a narrow band. The
various factors that cause these fluctuations are as
follows:
Food: It is not possible for one to eat the same type and
amount of food all the time. Food has various
components and carbohydrates are primarily
responsible for the variation in the blood glucose levels.
Carbohydrates present in the food get converted to
glucose. The rate at which this conversion takes place
depends on the particle size as well as the
presence/absence of other components, i.e., fruit juice
raises the blood glucose much faster than eating a fruit.
This is because the former is devoid of fiber - the
component that keeps blood glucose down. Similarly
the presence of protein with a carbohydrate in diet
raises the blood glucose level slower than only when
carbohydrates are present.
Insulin: In a non-diabetic person, insulin is released in
the body in the presence of food i.e carbohydrate. This
keeps the blood glucose level under control. In a person
with diabetes where there is either less insulin secreted
or the cells are resistant to insulin, injections are
required. The timing and quantity of the insulin
injections must be adjusted in a way that at any given
time the blood glucose is neither too high nor too low.
The amount of insulin absorbed by the human body
after it is injected can vary as much as 25% from day to
day. This has been attributed to various reasons like –
Site of insulin injection - if the same site is used for
daily injections the rate of absorption is less.
If insulin is injected in the abdomen, the rate of
absorption is faster than if injected in the thigh.
The amount of insulin absorbed is also dependent
upon the physical activity performed by that part of the
body where the insulin is injected. For example, if
insulin is injected in the arm after strenuous exercise
involving the arm - the rate of utilization of insulin will
be quite high.
Exercise: During exercise, the muscles, which are
working, have to use the glucose as fuel and this brings
down the glucose levels in the body. Exercise also
increases the insulin sensitivity especially in the
muscles, i.e., less insulin is required to push glucose into
the cell. On a day when there is less or no exercise there
may be an increased requirement of insulin and hence
there is variation in the blood glucose levels.
Stress: Over time this is perhaps one of the most
important factors and may have been responsible for
recent increase in the incidence of diabetes and heart
diseases in the world. To effectively cope with stress
certain hormones are released that keep the blood
glucose levels high. The dynamics of current lifestyle
changes constantly and so it is with stress. People react
differently to stress depending on their personality
types. Some people may be more susceptible to the
physical harms of stress than others. There are also
examples of people who eat more and some who eat
less when faced with a stressful situation. One cannot
quantify stress and proportionate it in terms of knowing
how much of it can raise the blood glucose; however,
people who lead a stressful life are known to be more
prone to diabetes and heart disease.
Illness or Infections: These can bring about
tremendous variation in the blood glucose levels. Since
the body is under stress during an illness, certain
hormones are produced which are counterproductive to
the action of insulin. This can raise the blood glucose
levels. Over-the-counter medications are also taken
during illness by some individuals. Some of these
medicines especially those containing alcohol or sugars
can raise the blood glucose levels.
We eat too much, drink too much, smoke too much,
drive too fast but walk too little.
Source : Medindia Health Network
DIABETES AND NERVE DISEASE (NEUROPATHY)
High levels of glucose can attack any nerve in the body,
impairing its function. The exact way that the nerve gets
damage is unclear, but several possibilities may be
important. Once glucose gets into the nerve in high
concentrations (because the blood level of glucose is
high), it can bind to important proteins and enzymes
affecting their function. Also, high concentrations of
glucose in the nerve may draw water into the cell,
swelling it and affecting concentrations of other key
chemicals. Blood and oxygen supply to the nerve may
be improtant. Whatever the cause, the end result is that
the nerve gets damaged. How this affects the individual
depends on what nerves are affected.
There are other problems with these neuropathies. As
they get severe, one cannot sense the floor against the
foot, making even walking difficult. People usually
interpret this as having lost their balance. When
sensation of the fingers is poor, everyday tasks become
difficult or impossible. Things we normally take for
granted — fastening a button, pulling up a zipper, tying
a tie — depend upon our being able to feel with our
fingers. Even holding objects may be difficult.
Peripheral Neuropathy
Weakness and unsteadiness of the arms or legs can be a
problem. When severe, the muscles of the hands waste
away and the ability to use the fingers is impaired.
Without nerves to supply it, muscle is lost from the foot,
leading to certain deformities, calluses and ulcers, and
sometimes even amputation.
The most common neuropathy (i.e. something wrong
with the nerve) is "peripheral neuropathy", meaning a
problem at the periphery of the body, such as the ends
of the feet and hands. Common symptoms are
numbness, a "pins-and-needles" feeling (as if the feet
have fallen "asleep"), burning, and a feeling like an
electric shock. However, a person will usually not feel
any symptoms at all.
Peripheral neuropathy is dangerous. Individuals with it
can injure their foot and not know it. This leads to foot
infections, a dreaded complication of diabetics as it
often leads to amputation. People who realize they
have something wrong with their sensation can use this
knowledge, and guard themselves by protecting their
feet from injury. Individuals should examine their feet
daily for any unnoticed injury, and keep the feet clean
and moisturized. This will reduce the risk of significant
problems. People who aren’t aware of any problem
must be informed by their doctor so they can be on
guard. Nevertheless, it never hurts to assume that
sensation of the feet is not normal, and take especially
good care of the feet.
Another problem with a peripheral neuropathy is pain,
which can be severe. It is usually worse in the evening
or night, and can be particularly bothersome because it
interferes with sleep. It drives some people to take
narcotics for relief, to which they inevitably become
addicted. Never try narcotics for this pain; many options
for pain relief are available, but all are medications that
must be prescribed by your doctor. They work by
altering the chemistry within the nerve, particularly that
which causes pain. These drugs include some of the
older anti-depressants (in small doses), anti-seizure
medications, and drugs that are sometimes used for
rhythm disturbances of the heart. Creams containing
capsaicin also help certain individuals. Any of these
treatments take weeks to have an initial effect.
Can Other Nerve Groups be Affected by Diabetes?
Any nerve can be affected adversely by high blood
sugars. Any kind of nerve compression, such as carpal
tunnel, sciatica, and others, is more common in people
with diabetes, probably because a nerve that has too
much glucose is more susceptible to injury by
compression.
There are instances where nerves to the large muscles
of the legs can be predominantly affected. This can
cause pain and severe tenderness.
Autonomic Neuropathy
Diabetes can also affect nerves that we are normally
unaware of, including those which keep our internal
organs functioning correctly. This causes a large variety
of problems, such as:
Diabetes and the Stomach: Diabetic Gastroparesis
"Diabetic Gastroparesis" occurs when diabetes affects
the nerves that supply the stomach. This causes the
muscles in the stomach to stop working, resulting in a
very flaccid stomach that doesn’t move food very well.
Food sits in the stomach for many hours, undigested.
Sooner or later, the individual gets nauseated and
vomits.
Gastroparesis also makes it harder to control blood
sugars because you never know when the food you eat
is going to be absorbed — resulting in blood sugars that
are either too high or too low, and rarely in between.
Medications may help, if the disease is mild enough.
Diabetes and the Bowels
If the nerves to the large intestine are affected,
individuals will usually experience diarrhoea. This is
especially bothersome because it typically occurs during
the night, and can be associated with incontinence.
Indeed, the individual can have a bowel movement in
bed and not realize until it is too late. This is because
the rectum has lost sensation; without being able to
sense when there is stool present, the individual does
not know to go to the toilet. Again, medications may
help this symptom.
Diabetes and the Bladder
When the nerves to the bladder are affected, the
bladder loses some of its muscle tone, and acts more
like a flaccid bag, unable to contract or push. This
results in incomplete emptying of the bladder,
predisposing the individual to infections and other
problems. Urination may consist merely of spill-over
from the bladder, rather than proper contraction of the
bladder muscle. This too can be helped somewhat by
medication, although the most severe cases require
intermittent catheterization of the bladder (putting a
soft tube in the bladder to help it drain).
Nerves to the Heart and Blood Vessels
Nerves to the heart affect heart rate, and disease of
these nerves generally affects the ability of the heart to
control its heart rate. People with this kind of
neuropathy generally have heart rates that are faster
than normal.
When diabetes afflicts the heart nerves, the sensation
of what is going on in the heart is blunted. This is
dangerous for someone with some degree of coronary
artery disease (hardening of the arteries to the heart).
Lacking oxygen, the heart feels pained, a condition
called angina. But a diabetic may not feel anything, or
realize anything is wrong. His actions at the time will not
be changed, and this could precipitate a heart attack, or
worse.
Nerves to the blood vessels and heart affect the
maintenance of adequate blood pressure when we
change positions, such as getting up from a lying
position to a standing position. If these nerves are
affected, the individual may become dizzy anytime he
stands up, and may even black out.
Diabetes and Sexual Function
Diabetes is a common cause of impotence, though it is
typically overlooked. This, too, is a manifestation of the
nerves being affected, in this case, the nerves to the
penis. There are a number of options to help this
symptom — please ask your doctor or educator for
more information. Diabetes can interfere with a
woman’s sexual performance and pleasure as well, by
impairing lubrication and other problems. Research is
quite lacking in this area.
Source : Diabetes Home
WHAT ARE CARBOHYDRATES & WHAT DO THEY DO
FOR THE BODY?
Eating carbohydrates can give you a high jolt of energy
or a slow stream of energy, depending on the type of
carbohydrate you eat. Carbohydrates, proteins and fats
are collectively called macronutrients, providing fuel for
your body at rest and during physical activity. The
glucose molecule in carbohydrates is the preferred
source of energy for your brain and nerve cells, and
for your muscle cells during intense exercise.
Benefits
Carbohydrates from whole grains, fruits, vegetables,
beans and lentils fuel your brain cells so you can
concentrate on matters at hand. If you have ever been
on a low-carb diet, you know you had little energy and it
was difficult to think, analyze and concentrate while you
were on the diet. Including healthy carbohydrates for
breakfast instead of unhealthy carbs reduces the
likelihood you will binge on fatty, sugary and salty foods
later in the day.
Simple vs. Complex
Simple carbohydrates are really simple sugars. Glucose,
fructose, sucrose, lactose and maltose are all simple
sugars or simple carbs. Fructose, sucrose, lactose and
maltose eventually convert to glucose in your body.
While fruits and dairy products are rich in the simple
sugars fructose and lactose, these sugars are treated in
the body as if they were complex carbohydrates due to
the fiber content of fruits and the protein content of
milk. Complex carbohydrate is the dietary starch found
in grains, peas, potatoes, beans, corn and root
vegetables. Complex carbs have more glucose or energy
than simple carbs.
A diet rich in fresh fruits, high-fiber vegetables and
nonfat or low-fat dairy products gives you plenty of
vitamins, minerals and fiber. These carbs reduce your
risk of osteoporosis, high blood cholesterol and enhance
your fitness or athletic performance.
Certificate of attendance for all
participants and CME points are
available for Malaysian Doctors,
Medical Assistants, Dieticians,
Nurses and Pharmacists.
ORGANIZED BY
Malaysian Diabetes Association
2, Lorong 11/4E, 46200 Petaling Jaya
Selangor Darul Ehsan, Malaysia
Tel: (6) 03-7957 4062 / 3
Fax: (6) 03-7960 4514
Email: [email protected]
Conference Venue :
The Summit Hotel, Subang USJ,
Selangor Darul Ehsan, Malaysia
For further information and update regarding the Conference,
Please contact the Secretariat: Ms. Parameasvari / Ms. Penny Peh / Ms. Nurbazlin
Whole Grain vs. Refined Grain
Refined carbohydrates are whole-grain kernels that
have been processed to remove the outer bran and
germ layer, leaving the endosperm or the inner starch
layer. Whole-grain carbohydrates pack plenty of fiber;
the fibrous part of the grain also contains healthy fats
and protein. These grains have a small effect on your
blood sugar level compared to refined grains. Brown
rice, steel-cut oats and whole-wheat pasta give you
energy while reducing your risk of diabetes and obesity
compared to refined white rice and white bread. Eating
refined grains regularly is disastrous for your health
because these grains cause a rapid spike in your blood
sugar, followed by a rapid release of insulin.
Fast-Digesting vs. Slow-Digesting
Simple, complex, whole and refined carbohydrates may
be further labeled as fast-digesting or slow-digesting.
Fast-digesting carbohydrates move quickly through your
digestive tract and enter into your bloodstream rapidly.
Slow-digesting carbohydrates take a while to break
down in your digestive tract and are absorbed into your
bloodstream slowly. Fast-digesting carbs, such as white
rice, baked potatoes, fresh pineapple, fresh
watermelon, jelly beans and pretzels, raise your blood
sugar level really fast and predispose you to insulin
resistance and diabetes. Followed by this quick rise in
your blood sugar is a dip in your blood sugar, even
lower than before your meal or snack, making you more
ravenous. Slow-digesting carbs like whole-wheat bread,
cooked spaghetti noodles, apples, oranges, skim milk
and dried apricots have a minimal effect on your blood
sugar which keeps your energy levels steady throughout
the day.
Source : Live Strong
WHAT DOES HEALTHY EATING MEAN?
Healthy eating means eating a variety of foods that give
you the nutrients you need to maintain your health, feel
good, and have energy. These nutrients include protein,
carbohydrates, fat, water, vitamins, and minerals.
Nutrition is important for everyone. When combined
with being physically active and maintaining a healthy
weight, eating well is an excellent way to help your
body stay strong and healthy. If you have a history of
breast cancer or are currently undergoing treatment,
eating well is especially important for you. What you eat
can affect your immune system, your mood, and your
energy level.
No food or diet can prevent you from getting breast
cancer. While researchers are still studying the effects
of eating unhealthy food on breast cancer and
recurrence risk, we do know that being overweight is a
risk factor for both first-time and recurrent breast
cancer. In this section, you can learn how to eat in a way
that keeps your body as healthy as it can be. Read on
for information about food groups, nutrients, how to
create a healthy eating plan, how to figure out portions,
and how to enjoy your food without overeating.
Eating a wide range of foods that include a variety of
nutrients is the easiest way to have a healthy diet.
On this page, you'll learn why your body needs each of
the following nutrients, and which foods you'll find
them in:
•
•
•
•
•
Proteins
Carbohydrates
Fats
Vitamins and minerals
Water
Proteins give your body amino acids — the building
blocks that help your body's cells do all of their
everyday activities. Proteins help your body build new
cells, repair old cells, create hormones and enzymes,
and keep your immune system healthy. If you don't
have enough protein, your body takes longer to recover
from illness and you're more likely to get sick in the first
place.
During treatment for breast cancer, some people may
need more protein than usual. Good sources of protein
are lean meat, fish, poultry, and low-fat dairy products,
as well as nuts, dried beans, peas, and lentils.
Carbohydrates give your body a little more than half of
the calories it needs to function each day.
Carbohydrates give you quick energy — which is why
you hear about athletes "carbo loading" before a big
event. They're fueling their bodies for the challenge to
come.
Fruits, vegetables, bread, pasta, grains, cereal products,
crackers, dried beans, peas, and lentils are all good
sources of carbohydrates. Many of them are also good
sources of fiber, which your digestive system needs to
stay healthy.
Sugar (white and brown), honey, and molasses are also
carbohydrates. But these types of carbohydrates are
high in calories and don't offer any other benefits (like
vitamins and minerals). Whole grains and fruits and
vegetables are healthier sources of carbohydrates than
refined grains and sugars.
Fats give your body the fatty acids it needs to grow and
to produce new cells and hormones. Fat also helps
some vitamins move through your body. Vitamins A, D,
E, and K are fat-soluble vitamins, which means they
need some fat to be absorbed. They are also stored in
the fatty tissues in your body and the liver. Fat also
helps protect your organs against trauma. Your body
stores excess calories as fat, which is saved up as
reserve energy.
Fats give you more concentrated calories than
carbohydrates or proteins. In other words, a teaspoon
of fat will have more calories than a teaspoon of
carbohydrate or a teaspoon of protein.
There are three basic types of fats:
Saturated fats, found mainly in meat and whole-milk
products, are only found in foods that come from
animals, not those that come from plants. Saturated fat
is the type that raises your blood cholesterol level.
Trans fats (also called trans-saturated fats or trans fatty
acids) are formed when liquid vegetable oils go through
a process called hydrogenation, in which hydrogen is
added to make the oils more solid. Hydrogenated
vegetable fats are used in food processing because they
give foods a longer shelf-life and a desirable taste,
shape, and texture. The majority of trans fat is found in
shortening, stick (or hard) margarine, cookies, crackers,
snack foods, fried foods (including fried fast food),
doughnuts, pastries, baked goods, and other processed
foods made with or fried in partially hydrogenated oils.
Trans fat also raises your blood's level of "bad"
cholesterol (low-density lipoprotein, or LDL), and lowers
your level of "good" cholesterol (high-density
lipoprotein, or HDL).
Monounsaturated and Polyunsaturated fats are found
in plant foods such as vegetables, nuts, and grains, as
well as oils made from these nuts and grains (canola,
corn, soybean). Omega-3 and omega-6 fatty acids are
polyunsaturated. Besides vegetables, nuts, and grains,
omega-3 and omega-6 fatty acids are found in
coldwater fish such as tuna, salmon, and mackerel.
Some studies have shown that eating foods that have
mono or polyunsaturated fats can help reduce your
levels of "bad" (LDL) cholesterol. Mono and
polyunsaturated fats also may keep your triglyceride
levels low. Triglycerides are a form of fat in your
bloodstream. People with high triglyceride levels often
have high total cholesterol, high LDL cholesterol, and
low HDL ("good") cholesterol. Studies have linked high
triglyceride levels to increased risk of stroke and heart
disease.
Vitamins and minerals: Vitamins keep your bones
strong, your vision clear and sharp, and your skin, nails,
and hair healthy and glowing. Vitamins also help your
body use energy from the food you eat.
Minerals are chemical elements that help regulate your
body's processes. Potassium, for example, helps your
nerves and muscles function. Calcium helps your teeth
and bones stay strong. Iron carries oxygen to your cells.
If you eat a balanced diet with enough calories and
protein, you're probably getting enough vitamins and
minerals. But if you're receiving treatment for breast
cancer, this may be a challenge. And certain treatments
may sap your body's supplies of some vitamins or
minerals.
It's also important to remember that there is a big
difference between getting your nutrients through food
and taking supplements (vitamins, minerals, and
herbals/botanicals). Vitamins and minerals work
together in your body in very complex ways, affecting
each other's absorption and processing and influencing
how your body functions. When you get your vitamins
and minerals through eating foods, it is often easier for
your body to maintain a balance of these nutrients.
When you take a supplement, such as a vitamin C or E
tablet, you're getting a highly concentrated dose that
you would probably never get from food. While some
supplements may be beneficial, others may reduce the
effectiveness of certain breast cancer treatments.
Water is necessary for life, which makes it vital for good
health. Water makes up about 50% to 66% of your total
body weight. It regulates your temperature, moves
nutrients through your body, and gets rid of waste.
Breast cancer treatment can sometimes cause
diarrhoea or vomiting. Losing a lot of fluids plus the
chemicals and minerals they contain can lead to
dehydration. In general, it's a good idea to drink 6 to 8
glasses of water a day. If you've lost fluids because of
diarrhea or vomiting, you need to replace both the
fluids and the essential ingredients in them. Chicken or
vegetable broth, tomato juice, fruit juices, and sports
drinks such as Gatorade are examples of fluids that can
help you replace the vitamins and minerals your body
has lost.
Source : Breastcancer.org
HOW CAN I TAKE CARE OF MY DIABETES?
Diabetes means your blood glucose, also called blood
sugar, is too high. Your body uses glucose for energy.
But having too much glucose in your blood can hurt
you.
When you take care of your diabetes, you’ll feel better.
You’ll reduce your risk for problems with your kidneys,
eyes, nerves, feet and legs, and teeth. You’ll also lower
your risk for a heart attack or a stroke. You can take
care of your diabetes by
being physically active
following a healthy meal plan
taking medicines,if prescribed by your doctor
•
•
•
What kinds of physical activity can help me?
Four kinds of activity can help. You can
•
be extra active every day
•
do aerobic exercise
•
do strength training
•
stretch
Be Extra Active Every Day
Being extra active can increase the number of
calories you burn. Try these ways to be extra
active, or think of other things you can do.
•
•
•
•
•
•
•
•
•
Walk around while you talk on the phone.
Play with the kids.
Take the dog for a walk.
Get up to change the TV channel instead of
using the remote control.
Work in the garden or rake leaves.
Clean the house.
Wash the car.
Stretch out your chores. For example, make two
trips to take the laundry downstairs instead of
one.
Park at the far end of the shopping center
parking lot and walk to the store.
•
•
•
•
•
At the grocery store, walk down every aisle.
At work, walk over to see a co-worker instead of
calling or emailing.
Take the stairs instead of the elevator.
Stretch or walk around instead of taking a
coffee break and eating.
During your lunch break, walk to the post office
or do other errands.
Do Aerobic Exercise
Aerobic exercise is activity that requires the use of large
muscles and makes your heart beat faster. You will also
breathe harder during aerobic exercise. Doing aerobic
exercise for 30 minutes a day at least 5 days a week
provides many benefits. You can even split up those 30
minutes into several parts. For example, you can take
three brisk 10-minute walks, one after each meal.
If you haven't exercised lately, see your doctor first to
make sure it's OK for you to increase your level of
physical activity. Talk with your doctor about how to
warm up and stretch before you exercise and how to
cool down after you exercise. Then start slowly with 5
to 10 minutes a day. Add a little more time each week,
aiming for at least 150 minutes per week. Try
•
•
•
•
•
•
•
•
•
•
•
walking briskly
hiking
climbing stairs
swimming or taking a water-aerobics class
dancing
riding a bicycle outdoors or a stationary
bicycle indoors
taking an aerobics class
playing basketball, volleyball, or other sport
in-line skating, ice skating, or skate boarding
playing tennis
cross-country skiing
Do Strength Training
Doing exercises with hand weights, elastic bands, or
weight machines three times a week builds muscle.
When you have more muscle and less fat, you’ll burn
more calories because muscle burns more calories than
fat, even between exercise sessions. Strength training
can help make daily chores easier, improving your
balance and coordination, as well as your bones’ health.
You can do strength training at home, at a fitness
center, or in a class. Your health care team can tell you
more about strength training and what kind is best for
you.
of energy. Normally the pancreas responds by
producing insulin, which allows sugar to enter the body
tissues.
Storage of excess glucose for energy. After you eat —
when insulin levels are high — excess glucose is stored
in the liver in the form of glycogen. Between meals —
when insulin levels are low — the liver releases
glycogen into the bloodstream in the form of sugar. This
keeps blood sugar levels within a normal range.
If your pancreas secretes little or no insulin (type 1
diabetes) or your body produces too little insulin or has
become resistant to insulin's action (type 2 diabetes),
the level of sugar in your bloodstream increases. This is
because it's unable to enter cells. Left untreated, high
blood sugar can lead to complications such as blindness,
nerve damage (neuropathy) and kidney failure.
The goals of insulin therapy
Stretch
Stretching increases your flexibility, lowers stress, and
helps prevent muscle soreness after other types of
exercise. Your health care team can tell you what kind
of stretching is best for you.
Source : National Institute of Diabetes Disease
UNDERSTANDING HOW INSULIN AFFECTS YOUR
BLOOD SUGAR CAN HELP YOU BETTER MANAGE YOUR
CONDITION.
Insulin therapy is often an important part of diabetes
treatment. Understand the key role insulin plays in
managing your blood sugar, and the goals of insulin
therapy. What you learn can help you prevent diabetes
complications.
The role of insulin in the body
It may be easier to understand the importance of insulin
therapy if you understand how insulin normally works in
the body and what happens when you have diabetes.
Regulate sugar in your bloodstream. The main job of
insulin is to keep the level of sugar in the bloodstream
within a normal range. After you eat, carbohydrates
break down into sugar and enter the bloodstream in the
form of glucose, a sugar that serves as a primary source
If you have type 1 diabetes, insulin therapy replaces the
insulin that your body is unable to produce. Insulin
therapy is sometimes needed for type 2 diabetes and
gestational diabetes when other therapies have failed
to keep blood glucose levels within the desired range. If
your doctor says that you need insulin therapy, take the
recommendation seriously. Insulin therapy can help
prevent diabetes complications by helping to keep your
blood sugar within your target range.
Your treatment plan
Type and amount of insulin. There are several types of
insulin available that vary in how quickly and how long
they can control blood sugar. Frequently your doctor
may recommend more than one type of insulin. To
determine which types of insulin you need and how
much you need, your doctor will consider several
factors. These include the type of diabetes you have,
your glucose levels, how much your blood sugar
fluctuates throughout the day and your lifestyle.
Insulin delivery options. Insulin is injected underneath
your skin, often several times a day. You may choose
among syringes, injection pens or an insulin pump that
provides a continuous infusion of insulin through a
catheter underneath your skin.
Insulin therapy can be demanding, but it doesn't have
to dictate your life. By choosing a program that best fits
your needs and lifestyle, you can prevent diabetes
complications and lead an active, healthy life.
Source : Mayo Clinic
WHAT TYPE OF INSULIN IS BEST FOR MY DIABETES?
Your doctor will work with you to prescribe the type of
insulin that is best for you and your diabetes. Deciding
what type of insulin might be best for you will depend
on many factors, including:
• Your body's individualized response to insulin (how
long it takes insulin to be absorbed in the body and
remain active in the body varies slightly from person
to person).
Regular (R)
30 min.
humulin or
-1 hour
novolin
Velosulin
(for use in
the insulin
pump)
2-5
hours
5-8 hours
30 min.- 2-3
1 hour hours
2-3 hours
Intermediate-Acting
NPH (N)
1-2
hours
4-12
hours
Lente (L)
1-2½
hours
3-10
hours
• Your own lifestyle choices -- for instance, the type of
food you eat, if/how much alcohol you drink, or how
much exercise you get -- are all factors that influence
your body's processing of insulin.
• How willing you are to give yourself multiple
injections per day.
• How frequently you are willing to check your blood
sugar level.
30
10-20
min.-3
hours
hours
Type of
Insulin &
Brand
Names
Onset
Peak
Duration
Role in Blood
Sugar
Management
Rapid-Acting
Humalog or 15-30
lispro
min.
30-90
min
3-5 hours
Novolog or 10-20
aspart
min.
40-50
min.
3-5 hours
Apidra or
glulisine
30-90
min.
1-2½
hours
Short-Acting
20-30
min.
Rapid-acting
insulin covers
insulin needs for
meals eaten at the
same time as the
injection. This type
of insulin is used
with longer-acting
insulin.
20-36
hours
Lantus
1-1½
hour
No peak
time;
insulin is
20-24
delivere
hours
d at a
steady
level
Levemir or
detemir
1-2
hours
6-8
hours
Up to 24
hours
Humulin
70/30
30 min.
2-4
hours
14-24 hours
Novolin
70/30
30 min.
2-12
hours
Up to 24
hours
Novolog
70/30
10-20
min.
1-4
hours
Up to 24
hours
Humulin
50/50
30 min.
2-5
hours
18-24 hours
15 min.
30
min.2½
hours
16-20 hours
• Your blood sugar management goals.
The following chart lists the types of injectable insulin
with details about onset (the length of time before
insulin reaches the bloodstream and begins to lower
blood sugar), peak (the time period when the insulin is
the most effective in lowering blood sugar) and
duration (how long insulin continues to lower blood
sugar). These three factors may vary, depending on your
body's response. The final column provides some insight
into the "coverage" provided by the different insulin
types in relation to mealtime.
Intermediateacting insulin
covers insulin
needs for about
half the day or
overnight. This
18-24 hours type of insulin is
often combined
with rapid- or
short-acting
insulin.
18-24 hours
Long-Acting
Ultralente
(U)
• Your age.
Short-acting insulin
covers insulin
needs for meals
eaten within 30-60
minutes
Long-acting insulin
covers insulin
needs for about
one full day. This
type of insulin is
often combined,
when needed, with
rapid- or shortacting insulin.
Pre-Mixed*
Humalog
mix 75/25
These products are
generally taken
twice a day before
mealtime.
*Premixed insulins are a combination of specific proportions of
intermediate-acting and short-acting insulin in one bottle or
insulin pen (the numbers following the brand name indicate the
percentage of each type of insulin).
Insulin Dosing Schedule for Diabetes
Follow your health care provider's guidelines on
when to take your insulin for your diabetes. The
time span between your insulin shot and meals
may vary depending on the type of insulin you are
taking.
In general, however, you should coordinate your
insulin injection with when you want to eat. From
the chart above, the "onset" column provides
useful information. Again, the "onset" refers to
when the insulin will begin to work in your body.
You want the insulin to begin working in your body
at the same time your food is being absorbed. This
timing will help avoid low blood sugar levels.
•
•
Rapid acting insulins. If you take Novolog or
another rapid-acting injectable insulin, you
should self inject about 10 minutes before
mealtime.
Short-acting insulins. Such as regular insulin,
should be taken 30 to 60 minutes before a meal.
Intermediate-acting insulins should be taken up
to 1 hour prior to a meal.
• Pre-mixed insulins. Depending on the product used,
premixed solutions should be taken 10 minutes or 30
to 45 minutes before mealtime.
Source : WebMD News home
Community-based healthy lifestyle intervention
among adults at risk of type 2 diabetes (Co-HELP)
project
By: Dr Norliza binti Ibrahim and Dr Moy Foong Ming
Introduction
Community-based interventions have increasingly
received attention as many have come to acknowledge
the importance of an intervention that makes healthy
choice the easy choice. Therefore, the current study
could be used as a pilot study for diabetes prevention
program in the community. Evidence from large scale
clinical trials has demonstrated a 40-58% reduction of
diabetes incidence through lifestyle modification.
Although compelling evidence exists, it has yet to be
widely adopted at the community level.
The diabetes prevalence rate in the country has risen
much faster than expected as shown by National Health
and Morbidity Survey (NHMS); 6.3% (NHMS I-1986),
8.3% (NHMS II-1996) and later was found to be 11.6%
(NHMS III-2006) and 15.2 in 2011. Based on this
prevalence, the projected number of people age 18
years old and above affected by diabetes in Malaysia is
estimated at 3 million. One in five adults in Malaysia is a
diabetic. What is even more worrying is the fact that
almost half of our population with diabetes is unaware
that they have the disease. Translating the evidence to
public health is a challenge, and there is a clear need to
balance effectiveness and feasibility to fit the
community settings . Evidence from DEPLOY pilot study
has proved that collaboration with strong community
partner such as YMCA may become a promising channel
for wide-scale dissemination of a low-cost approach to
lifestyle diabetes prevention at community level .
Successfulness of translating the diabetes prevention
program in non-health facility is a promising finding that
can be exampled and tested in Malaysia. The
community-based lifestyle modification approach
seems to be a promising method to fill the unmet gaps.
Purpose of this study
The main purpose of this study is to determine the
effectiveness of a community-based lifestyle
intervention program in reducing the modifiable risk
factors for type 2 diabetes. The lifestyle interventions
will incorporate healthy eating, physical activity and
weight reduction practices.
Methods
This is quasi-experimental study, collaboration between
Malaysia Diabetes Association, Social and Preventive
Medicine department of University Malaya and
Seremban Health Office of Negeri Sembilan. This project
is also supported by the community organization of
Taman Ampangan, Seremban. The study populations
are the high risk adults with pre-diabetes condition (IFG
or IGT) residing within Ampangan and Senawang
localities. The strategy of intervention is by using groupbased approach conducted in community setting such
as the community hall with the help of health
professionals in the initial stage but later on carried out
by the trained facilitator from local volunteers from the
Malaysia Diabetes Association and community. The
primary outcomes are changes in the blood glucose and
diabetes incident. The secondary outcomes include
change in cardiovascular risk factors, dietary intake,
physical activity, social behaviour and health related
quality of life. The measurements will be collected at 3,
6 and 9 months. This study is funded by the Malaysian
Health Promotion Board (project reference number (4)
LPKM/04/061/06/07) from July 2011 until September
2012.
Recruitment
Recruitment of high risk adults are identified through
various strategies. The strategies involved an open
recruitment strategy such as distribution of fliers to
targeted areas either via mail or by hand, advertisement
through local radio stations, local newspapers and the
Malaysia Diabetes Association (MDA) official websites.
We also conducted few community health screening
affairs in the targeted areas including in person
presentations to community organizations and
community leaders. Screening of the high risk adults are
done in cooperation with health team from the primary
health centres and the MDA staffs. The other strategy
involves recruitment through opportunistic and
selective screenings as well as provider referral in the
primary health centres. The guiding principles for
selection of inclusion and exclusion criteria are to enroll
participants that meet major criteria such as high risk
for type 2 diabetes and no medical contraindications to
participate in a lifestyle intervention including
unsupervised physical activities and weight reduction.
Project phases
The project is being divided into 3 main phases. Phase 1:
setting up collaborations between study partners and
training of community facilitators. Phase 2 involves the
implementation of the lifestyle modification
intervention in the community and Phase 3 is the
maintenance phase. Currently this project has entered
the second phase of the study and in the consolidate
stage. The goal setting is for the participants to achieve
5-10% reduction of their initial weight, 150
minutes/week of physical activity, 20-25 kcal/kg
reduction of calorie diet and smoking cessation.
Table 1: Community-based healthy lifestyle intervention session schedule
Stages
Sessions
Session title
Intensive stage
1
Welcome to Co-HELP program
Overview of Diabetes and Cardiovascular Diseases
2
Healthy eating and Co-HELP diary
3
Guide to exercise and physical activity
4
Keys to healthy eating out and groceries shopping
5
Guide to lose weight and advice on healthy cooking
6
10,000 steps with walking groups
Consolidate stage
7
Dietary interactive session
8
Exercise for indoor and during leisure time
9
Cooking demonstration and creating a healthy recipe
Maintenance stage
10
Strengthen you exercise programs
11
Motivational talk and sharing of experience
12
Looking back and looking forward
Conclusion
The finding from this study will perhaps demonstrate that a community-based lifestyle intervention administered
through a local Non-Governmental Organization such as Malaysia Diabetes Association may become a promising
strategy for widespread dissemination of interventions at preventing type 2 diabetes in high risk individuals.