DiabetesSingapore

Issue 46 JUL-SEP 2013

Publication of Diabetic Society of

MIC

A (P) 148/09/2012

DISPELLING MYTHS ABOUT INSULIN

WHEN BLINDNESSCLOSES IN

SWEETENERSECRETS

OFFICE PAININ THE NECK MUSHROOMS

FOR WEIGHT

LOSS

04 NOTE FROM THE EDITOR

PAYS TO BE PREPARED

06 DSS BUZZ

42ND DSS ANNUAL GENERAL MEETING

COOKING TO MANAGE DIABETES

EDUCATIONAL TOUR

GET FIT!

DSG DIARY - MARCH EVENING WALK

HEALTH SCREENING

DSS RETREAT

09 CARE CORNER

DIABETIC RETINOPATHY

糖尿病视网膜病, 你对它了解吗

DISPELLING MYTHS ABOUT INSULIN

14 HEARTWARE

WHEN THE DARKNESS CLOSES IN

16 COOKOUT!

MUSHROOM OMELETTE

MUSHROOM FRIED RICE

MUSHROOM-STUFFED PARATHA

18 THE LIGHTER SIDE

Q&A

THE MAGIC OF MUSHROOMS

SWEET SECRETS

24 SHAPE UP

OFFICE WOES: PAIN IN THE NECK

26 EYESITE

RETINAL PHOTOGRAPH QUIZ

CONTENTS

DSS m

anagement com

mittee

2012/2014

PATRONProf Arthur Lim

ADVISORDr Warren Lee

PRESIDENTMr Yong Chiang Boon

VICE-PRESIDENTSDr Kevin Tan Eng KiatHj P.M. Mohd Moideen

HON SECRETARYMs Esther Ng

ASST HON SECRETARYMs Rohanah Bte Pagi

HON TREASURERMr Stanley Lim

COMMITTEE MEMBERSDr Yeo Kim TeckMs Kalpana BhaskaranMr Greig PriceMs Juliana Lim

COVER PHOTO: © Cleo | Dreamstime.com

What do you do WHEN YOU ARE SICK?

When you are sick, your body reacts by releasing hormones to fight infection. Your body fights the disease through many mechanisms, including changes in hormone levels, which can raise or lower your blood sugar levels. However, as the hormones raise your blood sugar levels, they will also make it more difficult for insulin to lower blood sugar levels.

Here are some tips on how to manage your diabetes when you are ill:

1. When sick, continue taking your medicines for diabetes. Even if you are throwing up, do not stop taking your medicines. You need them because your body makes extra glucose (sugar) when you are sick. Take your usual dose of insulin/oral medication. DO NOT OMIT YOUR INJECTION/ MEDICATION.

2. Eating and drinking can be a big problem when you are sick.But it is important to stick to your normal meal plan if you can. Drink plenty of water to keep your body hydrated. This will help to prevent hyperglycaemia (high blood glucose). Avoid caffeinated and alcoholic drinks as these may interfere with your medications.

3. Check your blood glucose at least four to six hourly as some medication may increase your blood glucose, which will require you to adjust your medication accordingly. (Please check with your doctor on how to adjust your medication during sick days.)

4. Call your doctor if: · you have a fever (temperature over 101°F or 38.3°C). · you have diarrhoea or are vomiting and are unable

to eat food, or drink fluids containing glucose or carbohydrates.

· you have persistent vomiting or diarrhoea. · your fever persists longer than 24 hours. · your blood sugar stays higher than 180 mg/dL

orlower than 70 mg/dL.

5. Rest. Do not exercise.

6. Test your urine or blood for ketones. If you have type 2 diabetes, you have a very low chance of developing ketoacidosis. However, during severe illnesses, it is possible that ketoacidosis may develop. You should test your urine for ketones when:

· you feel severely sick (have a cold, the flu or other illness) and/or have unexplained nausea or vomiting.

· your blood glucose level is high (over 300 milligrams per deciliter or mg/dL) and continues to rise throughout the day.

7. Some suggestions for sick day diet: · Small and frequent meals. · Nutrient-dense soft foods or liquids such as porridge

with other ingredients, milk, soy bean milk, and nutrition supplement formula.

· Adequate fluid intake.

An educational

message from Diabetic

Society of Singapore

It is very important to learn how to manage your illness when you are sick. Please consult your physician for further advice on diabetes and sick day management.

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edito

rial

teamA WORD FROM THE EDITOR

Editor-in-chiefDr Yeo Kim Teck

Managing EditorCharlotte Lim

Editor (Dietetics)Janie Chua

Editorial ConsultantsDSS Mgmt Committee

WritersHenry Lew (psychologist)

Kohila Govindaraju (nutritionist)Cindy Ng (physiotherapist)

Rodiah Hashim

ContributorsDr Yeo Kim Teck, Dr Ben Ng Jen Min,

Ong Li Jiuen, Tan Ling Ying

DesignCharlotte’s Web Communications

PhotographyDreamstime.com & sxu.hu

Printing Stamford Press Pte Ltd

AdvertisingGeorge Neo

Esther Ng

Advertisement BookingsT: 6842 3382 or E: editor@diabetes.org.sg

Feedback editor@diabetes.org.sg

Back Issues www.diabetes.org.sg

Diabetic Society of Singapore HQBlk 141 Bedok Reservoir Road #01-1529

Singapore 470141 T: (65) 6842 6019 /3382

DisclaimerThe views, opinions and recommendations given by

the contributors of Diabetes Singapore or are merely for general reference. All materials in this newsletter are

for informational purposes only. The individual reader should consult his own doctor or specialist for his personal

treatment or other medical advice. DSS and Diabetes Singapore Editorial Board disclaim all responsibilities and

liabilities for content expressed in this newsletter including advertisements herein. All contents of the newsletter are the

copyright of the contributors and newsletter. Reproduction in any form is strictly prohibited unless with written permission.

Diabetic Society of Singapore is a non-profit organisation affiliated to the International Diabetes Federation and the National Council of Social Service. DSS gratefully accepts donations of any amount to help fight diabetes. All donations are tax exempt. Cash donations must be made in person at our HQ. Cheque donations should be made payable to Diabetic Society of Singapore. You may also make online donations via www.sggives.org/diabetes.

I’ve been pretty ‘flabbygusted’ since the haze descended upon us. I had to give up my outdoor runs because I couldn’t step out of the house without tearing in the eyes and feeling an itch crawl up my face. I’d never bothered about the haze, mainly because it never bothered me in any way. Until now. Needless to say, I was one of many scrambling to buy N95 masks and to book an air purifier which might just arrive after everything has blown over. But one thing is clear, I’d be well equipped for the worst next year when the haze hits again, come hail or shine.

It pays to be prepared, not just for the haze. When you suffer from a disease like diabetes, you need to arm yourself with knowledge. There is no dearth of information and research about insulin. Yet many still continue to be foggy about it and hold fast to age-old myths surrounding its use. We hope endocrinologist Dr Ben Ng’s article (p.10-12) will clear the air and help you make an informed decision should the need for insulin arise.

In psychologist Henry Lew’s article (p.14-15) which traces a man’s denial then acceptance of his gradual loss of vision due to diabetic retinopathy, we are reminded that change is never easy but there are ways to prepare us for what lies ahead. Having said this, if we can prevent blindness and do what is necessary to keep other diabetic complications at bay, we wouldn’t have to deal with such painful issues. As our DSS nurse Tan Ling Ying writes (p. 8), life-long checks are most essential; don’t wait for symptoms to show!

On a more ‘magical’ note, nutritionist Kohila Govindaraju’s article (p.18-19) about mushrooms will have you smiling and eager to turn to these fungi to lose weight. With the haze still looming over our heads, those mushrooms surely look like a great substitute for my night runs. Speaking of substitutes, Ong Li Jiuen goes all saccharine on artificial sweeteners (p. 22-23) so do read her article before your next cuppa. And if, like me, you work at the desk for long hours at a stretch, don’t forget to sit up and stretch those tight as a fist muscles. Office work need not be such a pain if you follow the exercises recommended by physiotherapist Cindy Ng (p. 24-25).

Should you have a topic you would like us to cover or a story to share, drop us an email at editor@diabetes.org.sg.

Stay safe and healthy.

Charlotte LimManaging Editor

PAYS TO BE

PREPARED

AC_DSS Ad_2013Q3.indd 1 01 . 07 . 2013 9:31 AM

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By Rodiah Hashim

By Rodiah Hashim

{ NEWSbuzz }

Cooking to Manage Diabetes‘Please hold more of these cooking sessions!’ urged one participant who attended the Healthy Cooking Workshop held at the Food Production Laboratory of Temasek Polytechnic on 4 May 2013.

For the first time, we were allowed into the inner sanctum where Miss Kalpana Bhaskaran, Miss Siti Saifa and their team of student dietitians patiently demonstrated how to cook healthier versions of four recipes—Chicken Briyani with Raita, Stir Fried Tung Hoon, Szechuan Mixed Vegetables and Honeydew Sago Dessert.

Watch this space for news about upcoming cooking workshops! And I am sure those who joined us before can’t wait to pick up more ktichen tips!

This year’s Annual General Meeting was held on 21 April 2013. Forty four members spent their Sunday afternoon at the Victoria Room of SAFRA Toa Payoh going through the Society’s annual report. DSS President Mr Yong Chiang Boon and his committee members took members through the events, activities and financial statement of 2012.

DSS would like to thank Gardenia Foods (S) Pte Ltd for their kind sponsorship of multi-grain loaves.

Fun, budget-friendly and lots to learn…what more can you say about educational tours? Yummy, too!

On 30 April, DSS members set out to uncover the secrets of making beancurd and Yakult. We made a stop at Unicurd, a tofu factory at Senoko, Woodlands. There was an enlightening lecture by the staff on different types of beancurd and how to check the quality and even how to cut them. From the second floor, we had a good view of the beancurd manufacturing machines; we could also smell the fragrance of the soy milk which we later got to taste as well! Just perfect.

After lunch, we headed for the Yakult Factory, also at Senoko. Made from fermented skimmed milk, Yakult also contains the lactobacillus casei shirota strain, which is named after the Founder of Yakult, Dr Shirota. Is Yakult good for diabetics? We were assured that a single serving of Yakult will not raise the blood glucose level and we enjoyed the light Yakult with much relish!

We learnt something else that was new: Only in Singapore is this delicious drink in different flavours! Yakult manufactures only the original flavour in other countries! Aren’t we fortunate to be able to enjoy such variety?

March Evening Walk Three Hwa Chong Institution students joined us for our evening walk to learn more from participants about managing diabetes. Instead of a brisk walk through the crowded ground floor shopping area, Eddie led us to the rooftop walkway on the fourth level, where we caught a lovely glimpse of our cityscape and the Singapore Flyer. Before long, we reached Gardens By the Bay. Just before it turned dark, we took shots of the the OCBC Super Saver Tree after crossing the overhead bridge. At the ticketing booth, the group had half an hour to explore on their own and Rose, our nurse educator, measured our blood sugars.

We continued our walk towards the Marina Bay Sand Expo Hall and managed a very satisfying 2.7km walk before we parted ways at 8.50pm. The exercise was great, and the company even greater!

42nd DSS ANNUAL GENERAL MEETING

FOR THE LATEST ON

DSS EVENTS, LOG ONTO

www.diabetes.org.sg

DSS EDUCATIONAL TOUR

For enquiries, please contact

6842 6019.

By Rodiah Hashim

DSS recently completed the second course of its three-month Exercise Program, which is run in conjunction with Sports Medicine & Surgery Clinic at Tan Tock Seng Hospital. Miss Jo-an Loh, a DSS member, attended the sessions led by Mr Ray Loh, a Physiologist with the Sports Medicine & Surgery Clinic. She said, “It’s a good program for us to get together, to learn, to encourage and to look out for one another. And it was fun!”

If you have been trying to get into an exercise routine but cannot find the support or motivation, join us for the next course. Each session consists of warm-ups, exercises, cool down and education on exercise precautions & motivation, exercises and stretching techniques and correct exercise intensity, to name just a few. Places get snapped up fast so check our website www.diabetes.org.sg for the latest news.

Get Fit!

DSG DIARY

For enquiries, please contact

6842 6019.

Care to join us for our next DSG outing/meeting? Ring Juliana at 9278 2084 for information. DSG CALENDAR 2013OUT NOW ON www.diabetes.org.sg

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DSS conducted three outreach health screening programs during the months of April and May. The Sikh Welfare Council had their yearly Vesakhi Mela at Khalsa Association on 28 April 2013 and invited DSS to participate by providing free health screening.

Thomson Shunfu RC carried out their second health screening exercise by DSS for their constituency on 19 May, the same day that Cheng San CC held their Healthy Lifestyle Fair 2013. DSS deployed a working team to each event.

DSS wishes to thank all our volunteers and the nurse volunteers from Singhealth polyclinics for spending their precious weekends helping to administer the screenings. We are deeply grateful for your partnership!

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对于许多糖尿病患者来说， 最普遍的并发症莫过于失

明或截肢。 是否真是如此？你又了解多少？又要如何

预防呢?

糖尿病视网膜病是导致糖尿病患者失明的主要原因。 由

于长期患有糖尿病， 患者的视网膜微血管会出现损坏。

液体和脂肪会从受损的血管溢出，流到视网膜上。如果

溢出情况发生在视网膜中央窝， 便会形成黄斑性水肿。

这也是成年发病型糖尿病患者失明的主要原因。除此之

外， 微血管也会变得窄小， 这也会造成流向视网膜的

血液减少，而导致视网膜血管异常增生。 血液流向眼球

中央窝的玻璃体， 使眼球产生异常的纤维组织，也因此

造成视网膜脱离眼球。最终形成青光眼。 青光眼是由于

异常微血管的增生， 阻碍了正常体液的排放系统， 造

成眼球内的压力足见升高，当眼内压过高时就会损害视

神经。

血糖控制不佳 （导致高血糖），高血压和吸烟都属于视

网膜病的危险成因。

由于患者早期没有任何不适症状， 所以一年一次的眼睛

检查就显得格外重要。让专业人士或医生用特别仪器检

查网膜和眼球内部。唯有定期检查才能在病情恶化前及

时发现， 并进行适当的治疗 （例如激光或手术， 因个

人情况而定。

许多患者都不以为然， 眼睛和视线没出现异状或不适，

就忽略了对眼睛的照顾。眼睛是我们的灵魂之窗， 透过

它看到了这美丽的世界，何不让它继续的指引我们， 让

我们更有信心的迎接未来的每一天？

预防胜于治疗。现在就到新加坡糖尿病协会进行眼睛检

查， 同时也可预约了解如何更妥善的控制你的糖尿病。

糖尿病视网膜病，你对它了解吗？by Tan Ling Ying, Diabetic Nurse Educator, Diabetic Society of Singapore

以下是新加坡糖尿病协会的联络地址与电话号码：

DSS HQ @ Bedok Blk 141 Bedok Reservoir Road #01-1529 Singapore 470141.电话号码：6842 3382 / 6842 6019

Hong Kah Diabetes Education and Care CentreBlk 528 Jurong West Street 52 #01-353 Singapore 640528.电话号码: 6564 9818 / 6564 9819

Central Singapore Diabetes Education and Care CentreBlk 22 Boon Keng Road #01-15 Singapore 330022.电话号码: 6398 0282

Diabetic retinopathy is the most common diabetic eye disease and the leading cause of blindness. Most diabetic patients ultimately develop abnormal changes of the blood vessel in the retina.

In some people with diabetic retinopathy, the damaged blood vessels may leak the fluid and fat onto the retina. When the leaks occur in the central part of the retina, macular edema develops. This leads to blindness. Besides that, there might be narrowing of blood vessels which can restrict the blood flow to the retina. Eventually, this leads to abnormal blood vessels growth and bleeding into the clear jelly in the centre of the eyeball and cause abnormal fibrous tissues to grow in the eye. The retina becomes separated from its attachment to the eyeball. Ultimately, glaucoma can develop. (Glaucoma occurs when there is increased pressure in the eyeball; fluid cannot normally flow out of the eye and builds up in the eye causing increased pressure.)

There are three main leading causes to diabetic retinopathy: smoking, poor control of blood sugar levels and high blood pressure. Often, there are no signs and symptoms in the early stages of the disease. Do not wait for symptoms to show or it will be too late. Life-long checks are therefore most essential! Make an effort to have your eye check once a year.

Diabetic Retinopathy

{ NEWSbuzz }Health Screening

{ CAREcorner }

For more information, visit www.bddiabetes.com BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company. © 2011 BD, SEAPM112011-184.

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‘I need insulin because I

have failed.’

Just as the body ages, diabetes will progress as well. This does not mean that your diabetes has become more ‘serious’ but that you may need stronger medications to control your blood sugar. Diabetes is only ‘serious’ if you

develop complications when the sugar levels are not well controlled.

I’m afraid at times some of the public including healthcare professionals are equally to blame for instilling this feeling of failure. In order to urge or warn people to manage their diabetes better, insulin treatment is often referred to as a ‘punishment’ for ‘bad lifestyle choices’.

All too often we hear doomsday statements not dissimilar to ‘If you don’t start exercising or eating better, you are going to need insulin…’

All this puts insulin in a very poor light; but let’s be clear that moving on to insulin treatment is not necessarily a sign of failure on a diabetic’s part but it should be seen as a natural progression of diabetes.

‘Insulin is hard to take. It is complicated.’

Modern insulin regimes have actually become very simple now. Most doctors will start patients on one injection of insulin a day making it easier than many other oral

medications for diabetes.

Many insulin devices come in pen devices where delivery and storage are pretty straightforward. Many people in the beginning are daunted by the thought of insulin and injectable treatments but the reality is almost all of them learn to cope well.

‘Insulin is dangerous.’

Just like many other different forms of medications and treatments, insulin can be dangerous if given incorrectly. However, part of the reason why it can be dangerous is simply because it is a

very powerful blood sugar reducing agent.

If given too much, a person can develop hypoglycaemia (a situation where the sugars fall too low).

It is important that you and your family familiarise yourselves with the way your insulin works and also to recognise signs and symptoms of hypoglycaemia and the steps you can take to avert such an event.

by Dr Ng Jen Min, Ben, consultant endocrinologist, Changi General Hospital

DISPELLING MYTHS ABOUT INSULIN

Modern insulin regimes have actually become very simple now. Many insulin devices come

in pen devices where delivery and storage are pretty straightforward.

‘Insulin causes the kidney and eyes to fail.’

This is one of the most common misconceptions and very unfortunate. Insulin has been blamed for contributing to organ failure. While people with diabetes can develop complications, this is inevitably a result of high blood sugars. Many people who do not want to be on insulin have very high blood sugars which have been left untreated for years.

Once complications develop, due to a variety of factors (pressure from healthcare providers, family or the individual) many people start insulin with the hope that it will improve their blood sugars and their complications. However, starting blood sugar reducing treatments too late often does not work as organ damage has already occurred and insulin cannot reverse the complications.

As a result of this delay, some people find that their diabetic complication(s) appear to have started not long after their insulin treatment began. The truth of the matter is that they probably started their insulin treatments too late and were therefore unsuccessful in preventing or reversing the diabetic complication.

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The treatment of diabetes and insulin treatment has evolved by leaps and bounds since its discovery in the 1920s. Now, there are numerous

different insulin therapies available in varying forms and methods of action.

Despite the fact that insulin has been used in many people with diabetes since its discovery, significant barriers and fear towards this treatment remain.

A recent study in Singapore shows that the majority of people with diabetes are opposed to or have significant reservations about insulin treatment.

Part of the problem lies in common misconceptions which ultimately lead to fear of insulin therapy. Here are some common ‘myths’ that I often come across in my clinical practice.

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‘It is better to take tablets than go on insulin.’

The most important step in the treatment of diabetes is the individualisation of treatment. Each person is different. With the numerous types of medicines available for diabetes today, it is essential that the treatment of blood sugars is tailored to the individual patient.

It is therefore important to speak with your healthcare providers if insulin treatment (or any treatment for that matter) is contemplated.

Some people may do better on tablet treatment, but an equal number of people who will also benefit from insulin treatment.

‘I am all alone.’You are not alone. People with diabetes commonly need insulin

treatment and there are many people in Singapore on insulin treatment. People with diabetes now live very long and fruitful

lives and, because of that, as the disease progresses many of them will eventually need insulin.

This becomes more and more common the longer you have diabetes. If you are looking for support, do contact the Diabetic Society of Singapore to join their support group activities.

The most important step in the

treatment of diabetes is the

individualisation of treatment.

With the numerous types

of medicines available

for diabetes today, it is

essential that the treatment

of blood sugars is tailored to the individual

patient.

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Insulin treatment is a powerful treatment for diabetes. While it is true that not everyone will benefit from insulin treatment, insulin is still effective and commonly used to treat diabetes. Embarking on insulin treatment does require motivation and education and it is

encouraging to know that most people cope with the treatment well.

Finally, it is essential that all therapy in any illness is tailored to the needs of the individual patient. No one is the same and it important that patients and healthcare providers work closely together to find the best and most effective treatment to suit the patient.

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{ HEARTware }July 2007 I finally decided to tell my family doctor that my eyesight has been blurred for a while. They sent me to the specialist for rounds of tests over the next few weeks. The doctor sat me down and in low, serious tones, broke the news to me. I never expected it—how could I have retinopathy? I think they must be mistaken.

January 2008It wasn’t easy accepting the fact that I have retinopathy. Over the past few months, my eyesight has been getting worse, especially my left eye. I find it hard to read even in the day; I need bright light. When night falls, it is even harder. I realise that it is not going to go away by itself. I feel down from time to time thinking about how I will lose the ability to do even the most mundane things in life. I distract myself by occupying myself with tasks and have to keep reminding myself to treasure the time I still have my sight and make full use of it while I can.

August 2008My eyesight has deteriorated even more. I now need to read with a magnifying glass. I’ve stopped driving as well. Sometimes, I get angry with myself. Why did I not take better care of my health before? Sometimes, I get angry with life; why is it so unfair to me? My heart aches when I think about the awful burden I will become to my family. But no matter

what, I will still continue to go for regular treatments and do the best I can to manage this condition.

February 2009Thankfully, my faith and prayers have been helpful , especially when my mind swirls with negative thoughts and my emotions brew a storm. I have come to realise that as much as I am losing vision gradually, the memories are keeping me sane and strong. I hang on to them to help me through this ordeal.

April 2009I ‘ve started attending sessions with a support group. It’s comforting to know that I am not alone. It was valuable to hear from others how they maintain their quality of life. They struggled too but they also overcame. If others can stand up again, so can I. I found the fighting spirit I used to have when I was younger; it is not like me to be taken down so easily. I still want to live a fruitful life, as meaningful as it can be. I don’t want to be helpless and feel useless.

March 2010 I have lost all vision in my left eye. Something inside me kind of died. But I am grateful my family and friends have been very encouraging towards me, especially in my darkest moments. It took some getting used to at first, as my vision is restricted. Initially, it was so awkward socially too; I don’t notice people on my left. The

radio has now become my best friend. I listen to the local and international news to keep in touch with what’s happening in the community and the world. At least I can still converse with people when they visit or when we attend family gatherings.

June 2013Looking back, it has been three years since I lost all vision in my left eye. My right eye now suffers from blurred vision. It is a surprise and I am thankful that my right eye still works, for now. In some ways, life remains pretty much the same. I still enjoy happy moments with my family and friends. I am slower and do need help in moving around. At the same time, I have cultivated the habit of savouring each moment in the present. This has helped me be at peace with the occasional negative moods I experience from time to time.

The journey has been tough for Muhammad. But his openness and willingness to receive help from others made it less painful. Family, friends, professionals, support groups and religion are important avenues of support. Muhammad also coped in a variety of ways—distraction, substituting one activity (reading) with another (radio), positive self-talk, scaling down his expectations, and, most importantly, giving himself the gift of the moment.

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Ever played blindfold games as a child? Though it is only a game, to grope in darkness can cause much distress, even helplessness and confusion. The thought of losing our eyesight permanently is a hundred times more terrifying. Mr Muhammad*, a diabetic patient, lost his eyesight due to retinopathy**. As darkness descends on his world, he sheds some light on how he faces the situation.

WHEN THE DARKNESS CLOSES IN…

by Henry Lew, psychologist

“They took away what should have been my eyes (but I remembered Milton’s Paradise). They took away what should have been my ears, (Beethoven came and wiped away my tears) They took away what should have been my tongue, (but I had talked with God when I was young) He would not let them take away my soul, possessing that I still possess the whole.” Helen Keller, The Story of My Life

* Not his real name** Complications of diabetes that cause serious damage to our retina (eyes), which can then lead to blindness.

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INGREDIENTS

METHOD OF PREPARATION

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INGREDIENTS

1. Whisk eggs and 2 tablespoons of water together, set aside2. Heat the pan over medium heat. Add 2 teaspoons of olive oil.3. Saute mushrooms, green onions, and bell pepper for 3 minutes. Transfer to a bowl with cheese.4. Add 1 teaspoon of oil to the pan and slowly add the egg mixture.5. As the mixture starts to cook, gently lift edges and tilt pan, for the uncooked portions to flow underneath.6. Top half of the omelette with cheese and the cooked mushroom, green onions and bell pepper mixture. 7. Fold over and cook for 1 minute.8. Transfer to a serving plate, garnish with cilantro and serve immediately.

METHOD OF PREPARATION

Eggs 3 mediumChopped crimini mushrooms 140g (5oz)Chopped scallion (green onions) 2 tablespoonsChopped cilantro (coriander leaves) 1 tablespoonChopped red bell pepper 2 tablespoonsGround black pepper 1 teaspoonShredded cheddar cheese, reduced fat 3 tablespoonsOlive oil 1 tablespoon

Paratha DoughWhole wheat flour 1cupSalt 1/2 teaspoonPlain yoghurt, low fat 1 tablespoon

FillingFinely chopped button mushrooms 1 cupCoriander powder 1 teaspoonChilli powder 1 teaspoonCumin seed powder 1 teaspoonOlive oil 3 tablespoons

{ COOKout! }

Paratha Dough1. Combine all the ingredients in a bowl, mix well and knead into a soft dough, with water2. Cover and set aside for 20 to 30 minutes.3. Divide the dough into 8 equal portions.

Filling4. Heat the pan over medium heat, add 2 tablespoons of olive oil, saute mushroom for 2 minutes.5. Add coriander, chilli, cumin seed powder and salt, mix well and cook for 3 minutes. Set aside to cool.6. Divide the filling into 8 equal portions.

Stuffed Paratha7. Roll out a portion of the dough into a circle with a 5” diameter.8. Spoon one portion of the mushroom filling over one half of the paratha, flip the other half over to cover the

mushrooms and gently press the edge of the paratha.9. Heat the pan and cook each paratha using little oil, till golden brown spots appear on both sides. 10. Repeat to make 7 more paratha.

NUTRITION INFORMATION per serving: Energy 190 KcalCarbohydrate 3gProtein 13gFat 14gSaturated fat 4.7gCholesterol 188mgDietary fibre 1.7gSodium 172mgCarbohydrate Exchanges = ~ 0.25 exchange

NUTRITION INFORMATION per serving: Energy 109 KcalCarbohydrate 12gProtein 2gFat 6gSaturated fat 0.9gCholesterol 0mgDietary fibre 2.1gSodium 130mgCarbohydrate Exchanges = ~ 1 exchange

Mushroom Omeletteserves 3

Mushroom-Stuffed Paratha serves 8

Recipe and photo by Kohila Govindaraju, freelance nutritionistRecipe and photo by Kohila Govindaraju, freelance nutritionist

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by Kohila Govindaraju, freelance nutritionist

Are watermelons good for diabetics?

Watermelon is not only delicious but healthy as well.

It is a good source of vitamin C and carotenoids called, “provitamin A” that is converted to retinol, an active form of vitamin A, a powerful antioxidant, in the body.

Leaving the uncut watermelon on the counter at room temperature will increase the carotenoids that naturally increase the vitamin A, so don’t go rolling it into the refrigerator too soon.

The lycopene in red/pink watermelon has been associated with a lower risk of developing prostate cancer!

This juicy fruit is also high in L-citrulline and L-arginine which keep the arteries healthy to maintain a healthy blood pressure.

It is a wonderful fruit for weight loss. Many think that watermelon increases the glucose level because it is high in GI. While it is high in GI (78), the watermelon is also 92% water. For its size, most of the weight is water! That is good news indeed!

It is easy to overeat when snacking on watermelon. So, stick to the recommended portion size. People with diabetes, can have a slice/wedge (130g). That should be good enough to quench your thirst! Enjoy!

Thankfully, no! Not all the carbohydrates have the same effect in your body. Some carbohydrates will give a quick rise in blood sugar levels and some will have a slower

effect. For example, oatmeal, white rice, white bread, more cooked or processed food, more ripen fruit are generally high in GI. They break down in the body faster and quickly raise the blood sugar levels! Soft-cooked pasta, mashed potato, are high in GI. So, avoid over cooking any food!

Juice has a higher GI compared to a whole fruit. The fibre and acids in fruit tend to lower the GI. The more acidic the food, the lower the GI. Sourdough bread is low in GI compared to other varieties of bread. Dried beans & legumes, most fruits, non-starchy vegetables, some starchy vegetables like sweet potato, jicama (mang kuang) whole wheat grain breads and cereals like barley, brown rice, whole wheat bread are considered low GI foods.

We eat foods in combination with other foods.When you combine High GI with low GI food, the final is a medium GI, balanced meal. A diabetes meal plan involves choosing foods that have a low or medium GI and low in saturated/trans fats. A teaspoon of peanut butter is high in GI and wholemeal bread is low in GI. Combining these to food will give you a medium GI! A bowl of white rice is naturally high in GI. Reducing it to a medium GI will not only prevent the insulin spike, it also keeps you feel full for a longer time. But how? The answer is very simple. Replace half the bowl of rice with red kidney beans and vegetables. You will get a low GI dish and a pretty decent amount of protein, too!

It is not only the low calories or GI that we need to take note of, but also the serving size when planning a meal because serving size has a great impact on blood glucose level. Popcorn that is air popped has a high GI (72) but low in carbohydrate 6 to 8g per cup. Thus popcorn (plain with little salt) would have an overall lower impact based on the serving size. If you consume more than the serving size, the blood glucose shoots up and it will take longer time to go back to normal. Puffed millet, like popcorn, is low in calories ( half a cup or 20g of puffed millet gives only 70 kcal) and high in GI. Half a cup of puffed millet with milk, plus a teaspoon of honey and nuts or fruits to enrich the protein and vitamin value, make a quick, healthy and satisfying breakfast meal.

Do I have to give up high GI foods completely?

{ the LIGHTER side }18 19

INGREDIENTS

METHOD OF PREPARATION

Shitake mushrooms, sliced 150gEggs 2 mediumGinger, minced 1 tablespoonGarlic, minced 1 tablespoon Green bell pepper, diced 2 tablespoonsCarrots, chopped 2 tablespoonsSesame oil 1/2 teaspoonOlive oil 2 tablespoonsCooked brown rice 1 cupSalt 1/4 teaspoon

Mushroom Fried Riceserves 3

NUTRITION INFORMATION per serving: Energy 398 KcalCarbohydrate 39gProtein 11gFat 22gSaturated fat 3.9gCholesterol 178mgDietary fibre 2.7gSodium 269mgCarbohydrate Exchanges = ~ 2.5 exchange

1. Heat the pan over medium heat. Add one tablespoon of

olive oil and the eggs, keep stirring until eggs are fluffy

and cooked. Set aside.

2. Add 1 tablespoon of olive oil to the pan. Saute garlic and

ginger for 30 seconds.

3. Add bell pepper, carrot and salt. Saute for 3 to 4 minutes.

4. Add sliced mushrooms, and saute for 2 minutes.

5. Add the cooked eggs, and mix in. Gradually add cooked

brown rice, sprinkle sesame oil and mix well.

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Recipe and photo by Kohila Govindaraju, freelance nutritionist

{ COOKout! }

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References:Boston University Medical Center (2013, April 22). Mushrooms can provide as much vitamin D as supplements. ScienceDaily. Retrieved April 25, 2013, from http://www.sciencedaily.com/releases/2013/04/130422132801.htm Leslie M Klevay, MD, SD in Hyg: “Lack of a Recommended Dietary Allowance for Copper may be Hazardous to Your Health,” J Am Coll Nutr August 1998 vol. 17 no. 4 322-326D. Craig Willcox, PhD, Bradley J. Willcox, MD, Hidemi Todoriki, PhD, Makoto Suzuki, MD, PhD: “The Okinawan Diet: Health Implications of a Low-Calorie,Nutrient-Dense, Antioxidant-Rich Dietary Pattern Low in Glycemic Index,” Journal of the American College of Nutrition, Vol. 28, No. 4, 500S–516S (2009)www.medicalnewstoday.comwww.eatright.orgwww.foodlve.com

by Kohila Govindaraju, freelance nutritionist

THE MAGIC OF MUSHROOMS

Mushrooms have been used for thousands of years as food as well as for curative purposes. Over 14,000 kinds of mushrooms exist yet only about 3,000 are edible. In fact, about 700 have known medicinal properties, and less than one

percent is actually toxic.

ROOM FOR WEIGHT LOSSThese fungi, not vegetables or herbs, contain about 80 to 90 percent water, and are very low in calories. For example, 100g of mushrooms have only 25 calories compared to grilled lean beef that provides 175 calories! Oyster mushrooms are a good source or iron. Plus, they’re low in calories: Six medium white, for example, have just 22.

Mushrooms have very little sodium and fat, and eight to 10 per cent of the dry weight is fibre. High in vitamins, they are also fat- and cholesterol-free. With their meat-like heft and texture, it is no wonder that they are so popular around the world!

And the best news ever is that in the game of weight loss, the pretty & tiny sponge like mushroom is one of nature’s powerful players. They are ideal for people who are following a weight management program and also a good dietary substitute for hypertensives.

A one-year randomised clinical trial by researchers at the Weight Management Center at Johns Hopkins Bloomberg School of Public Health found that substituting white button mushrooms for red meat can be a useful strategy for enhancing and maintaining weight loss.

Replacing low-energy density foods like mushrooms for high-energy density foods such as lean ground meat makes you feel full for longer and satiated after a meal; it is also an

effective method for reducing daily energy and fat intake. The glutamic acid found in mushroom, is an amino acid, a natural flavour enhancer that may entice even the fussiest of eaters to enjoy this low-energy density food. Glutamic acid, along with glucose, is one of the principle fuels for the brain.

MORE GOODNESS!Mushrooms not only aid in weight loss as a super food but they also help prevent cancer and heal infection, too. It is a good source of selenium, a powerful anti-oxidant that neutralises free radicals and protects the body from chronic diseases. Selenium, along with vitamin E, prevents skin damage. It is also a good source of copper, an anti-oxidant nutrient for cardiovascular health.

Crimini and shitake mushrooms are also good sources of zinc which supports our metabolic rate, the rate at which the body creates and uses up the energy. Mushrooms are low in protein though and should not entirely replace meat; they have only three to four percent protein compared to beans which are eight to 13 percent protein and 25 to 35 percent for 100g of meat. However, this is easy to compensate, such as with a combination of mushroom with beans (e.g. red kidney beans, black beans, soybeans) will provide one of the best tasting protein meals.

Whatever your favourite—crimini, enoki, oyster, portobello, shiitake or white button—all mushrooms are loaded with essential nutrients.

Exercise is equal to diet when it comes to losing weight. Aerobic exercise has important cardiovascular and metabolic implications. The age-old advice, “Eat less and move more to lose weight”, still holds true!

' Mushrooms are considered fresh when their caps are clean, bright and have no bruises all over. ' Mushrooms--whether wild or domestic--should be moist but not wet. They shouldn’t be dry enough to crack;

they should be moist enough to flex when you bend them. ' Pale pink gills indicate that the mushrooms are fresh. Avoid those with dark gills. ' Do not wash mushroom. Instead, wipe them with a wet cloth or kitchen paper

towel. ' If you must rinse them, do it lightly, then dry them immediately – and gently –

with paper towels. Never soak fresh mushrooms in water, which will cause them to become soggy.

' Refrigerate mushrooms in a tightly sealed plastic bag, but slip in a paper towel to absorb any excess moisture.

' Avoid placing mushrooms near foods with strong odours or flavours – they will absorb them like a sponge.

' Mushrooms have a natural flavour, and require very few condiments. Use garlic and pepper to season the dish.

' Mushrooms are rich in water and shrink while cooking. They also soak up fat much faster so use less oil to avoid a greasy dish.

Mushrooms have very little sodium and fat, and eight to 10

per cent of the dry weight is fibre.

High in vitamins, they are also fat- and cholesterol-

free.

MAKE ROOM FOR MUSHROOMSMany varieties of mushrooms contain good-for-your-bladder selenium and, like us, they produce vitamin D when exposed to sunlight.

Increase your vitamin DMushrooms are the only fruit or vegetable source of this critical vitamin. Like humans, mushrooms produce vitamin D when in sunlight. Exposing them to high levels of ultraviolet B just before going to market converts more of the plant sterol ergosterol into the so-called sunshine vitamin.

Kick up your metabolismB vitamins are vital for turning food (carbohydrates) into fuel (glucose), which the body burns to produce energy. They also help the body metabolise fats and protein. Mushrooms contain loads of vitamin B2 (riboflavin) and vitamin B3 (niacin): 100 grams (31/2 ounces) of crimini have 44 percent and 30 percent of your daily recommended amount, respectively, white button have 36 and 30 percent, and oyster mushrooms have 32 and 39 percent.

Adapted from an article by Margaret Nearing, Best Health Magazine, March/April 2011

www.besthealthmag.ca

How to choose, store and cook mushrooms

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Types of Sweeteners

Nutritive Sweeteners Non-nutritive Sweeteners� Includes sugars and sugar alcohols.

� Contribute carbohydrates and calories to the diet.

� Contains few vitamins and minerals, hence they are often referred to as sugar with ‘empty’ calories.

� Known as artificial sweeteners.

� Key ingredient in ‘diet’ products as they provide a significant sweetening effect without adding carbohydrates or calories.

� Many times sweeter than sucrose.

Sweetening power compared to sucrose:

Examples - Sugars: Sucrose, Fructose, Dextrose, Corn sugar, High fructose corn syrup, Maltose, Honey, etc.

- Sugar alcohols: Malitol, Xylitol, Isomalt, Sorbitol, Mannitol, etc.

Saccharin 200-700 times Aspartame 160-220 times Acesulfame K 200 times Sucralose 600 times

{ the LIGHTER side }

These days, artificial sweeteners (also known as intense sweeteners) and other sugar substitutes are pretty prevalent and can be found in a wide range of food and beverages including soft drinks,

chewing gum, fruit juice, ice cream and yoghurt. These are often marketed as “sugar-free” or “diet”.

Many patients with diabetes use artificial sweeteners as sugar substitutes as they provide sweetening effects without affecting blood sugar levels. Another reason people use artificial sweeteners is to cut calories, mainly to prevent weight gain. Artificial sweeteners are many times sweeter than sucrose (table sugar) and only minute amounts are necessary for food or drink to taste sweet (refer to table below for sweetening powder compared to sucrose).

However, people may rely so much on artificial sweeteners that they end up craving for more sugary foods that

contain carbohydrates, thus raising the blood sugar level when they overeat.

Be warned that artificial sweeteners are not magic bullets for diabetes or weight management and should be used only in moderation. If you eat too many sugar-free foods, you can still gain weight if they consist of other ingredients that contain calories. While the use of sugar need not be outlawed for people who have diabetes, keeping sugar intake low is certainly recommended. A balanced diet and healthy eating are still key in diabetes management.

The term ‘sweetener’ does not mean that it is artificial or sugar-free. So, what is the difference between sugars and artificial sweeteners? Basically, there are two types of sweeteners—those which have calories (nutritive) and those that are calorie-free (non-nutritive). Refer to the table below:

Saccharin (brand ‘Sweet N Low’) is one of the first sugar substitutes to receive U.S. Food and Drug Administration (FDA) approval and it continues to be popular despite initial concerns over its carcinogenic effect and safety. It works well in cooking and baking as it is heat-stable.

Aspartame (brand Equal or Nutrasweet) was approved by FDA since 1981. There is no evidence of any harmful effects from its use. However, aspartame does contain phenylalanine and individuals with the metabolic disorder ‘phenylketonuria’ (known as PKU, an inherited disease in which the body cannot dispose of excess phenylalanine) should consult their physicians before using this sweetener. It is not recommended for use in baking as it is not heat-stable and loses its sweetness when heated. It should also be added to recipes only after heating the ingredients to avoid a bitter taste.

Sucralose (brand Splenda) is exceptionally stable and will not affected by heat and generally retains its sweetness. Thus, it is suitable for use in cooking or baking. Furthermore, sucralose received FDA approval in April 1998 for use in 15 food and beverage categories, the broadest initial approval ever given to a calorie-free sweetener.

Acesulfame Potassium or Acesulfame K is a calorie-free sweetener used in more than 5,000 food, beverage and pharmaceutical products in over 100 countries around the world. In the past 30 to 40 years, it has been consistently shown in over a hundred studies that it is safe and suitable for human consumption.

The FDA has established Acceptable Daily Intake (ADI) levels for artificial sweetener intake. The acceptable amount of milligrams (mg) you should consume is based on kilogram of body weight per day (mg/kg bw/day). See table below:

References:• Position of the Academy of Nutrition and Dietetics: Use of nutritive and non-nutritive sweeteners. Journal of the Academy of Nutrition and

Dietetics. 2012;112:739• Is stevia an FDA-approved sweetener? U.S. Food and Drug Administration. http://www.fda.gov/AboutFDA/Transparency/Basics/

ucm214864.htm. Accessed June 01, 2013.

Sweetener Acceptable Daily IntakeADI Equivalent in Packets of

Table Sweetener Per Day(based on a 68kg body weight)

Saccharin 5mg/kg bw 9

Aspartame 50mg/kg bw 97

Acesulfame-K 15mg/kg bw 20

Sucralose 5mg/kg bw 68

Monitoring the amount of artificial sweeteners that are being consumed is especially important for small children as children have smaller body size and their ADI should be lower in relation to adults. Artificial sweeteners are generally safe for human consumption and it is rare that the ADI will be exceeded. To help you make an informed decision, always read the food labels of the item you are considering to calculate the amount of artificial sweeteners.

Novel sweetenersSome sweeteners do not quite fit into any particular category because of what they are made from and how they are made.

Stevia is one of them. This South American shrub, whose leaves have been used as a sweetener for centuries by native people in Paraguay and Brazil, has been gaining popularity in Singapore. Stevioside, the main ingredient, is virtually calorie-free and hundreds of times sweeter than table sugar. FDA has approved highly refined stevia preparations as a novel sweetener but not for whole-leaf stevia or crude stevia extracts. There are concerns about the effects whole-leaf or crude stevia have on blood sugar control, the kidneys, and the cardiovascular and reproductive systems.

BACKGROUND FACTS

by Ong Li Jiuen, senior dietitian, Changi General Hospital

SWEET SECRETS

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With fingers interlaced and palms out, straighten arms in front of you until the stretch is felt. Hold for 10 seconds.

While tilting the head to the left, pull the right arm down with the left hand until the stretch is felt. Hold for 10 seconds. Repeat for the other side.

Lift up the right arm and reach up as far as possible until the stretch is felt on the side of the trunk. Hold for 10 seconds. Repeat for the other side.

With left leg over the right leg, bring the right arm over the left leg. Push your left leg across the body until the stretch is felt. Turn the head over to the left shoulder. Hold for 10 seconds. Repeat for the other side.

With hands in the small of the back, arch your back until the stretch is felt. Hold for 10 seconds.

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by Cindy Ng, principal physiotherapist, Singapore General Hospital

{ SHAPEup}

OFFICE WOES:PAIN IN THE NECKIf your work requires you to

sit for prolonged periods of time, it can be a pain the

neck. Literally. It can also be a strain on your back.

We spend far too many hours in front of the computers. Sitting for eight straight hours can cause stiffness and soreness that resonates from your lower back all the way up through your neck and shoulders. Many of us are also guilty of some nasty habits that leave us pretty sore in mere minutes!

A neck or back pain can not only ruin your work day, but it can also cause long-term complications if you don’t take any action now. And I mean this literally, too!

There are a number of exercises you can do in the office to strengthen your back, loosen your muscles and minimise your pain.

These exercises can easily be completed while sitting in your office chair, so you don’t even actually have to get up to do them. It is still advisable to walk around once in a while, though.

1 Always choose a chair that has a high and firm back rest; it is a

good habit to sit upright, resting the back against the back rest.

2 Keep the shoulders relaxed and elbows close to the body

when using the keyboard or mouse. Your wrists should be relaxed and straightened when typing.

3 Ensure that your feet rest flat on the floor and the computer

screen is at eye level.

4Organise your workplace in such a way that you need

not bend, slouch or twist your posture frequently.

5Take frequent breaks to stretch your muscles. Do neck and

back stretches to increase blood flow to surrounding muscles and tissues, reduce muscle tension and stiffness and reduce stress.

TIPS TO PREVENT NECK & BACK ACHES

Do these neck and back stretching exercises two to three times in a day.

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Detection of diabetic retinopathy (diabetes eye disease affecting the nerve tissue at the back of the eye) by retinal photography is a common and accepted practice in Singapore. The Diabetic Retinal Photography Programme (DRP Programme) which started in the Polyclinics has been in existence since 1991.

A fairly common ‘incidental’ finding is what you would see in the photographs below. They belong to a mother and son.

RIGHT LEFT

RIGHT LEFT

{ EYEsite}1. The white round portion (optic nerve cup) is larger than the norm in both eyes in both sets of photographs. These are so-called glaucoma optic disc cupping. Both mother and son have open angle glaucoma. 2. Risk factors and associations of glaucoma include increasing age, family history, diabetes, heart disease, high blood pressure, hypothyroidism and use of steroids . 3. Chronic glaucoma is the leading irreversible cause of blindness. You are not expected to ‘read’ the above photographs yourself. However if your primary care doctor or optometrist find that you have suspicions of having enlarged optic nerve ‘cup’ you need to be assessed further by your own Ophthalmologist or Eye Specialist. Not all eyes with enlarged optic disc cup are caused by glaucoma, however.

PHOTOGRAPH OF MR B’S EYES

PHOTOGRAPH OF MADAM A’S EYES

ANSWERS

by Dr Yeo Kim Teck, Senior Consultant, Apple Eye Centre

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