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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: • • • • • 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 • • • 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. • • • • • • • • 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 • • • • • • 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. • • • • • • • • • • • 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.
