Sports and Exercise Medicine - diabetes.org.sg · Issue 37 Newsletter of Diabetic Society of...

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Sports and Exercise MedicineDr Jason Chia Enlightens

All In The MindPsych Yourself Up to Exercise

Look Before You EatDon’t Bite Off More Than You Can Burn

Pets Get Diabetes TooHow to Spot the Signs

31-0664 DIABETES NEWSLETTER NO37.indd 1 3/29/11 5:43 PM

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editor’s message

DiabetesSingapore

Editorial Team

Editor : Dr Yeo Kim Teck

Managing Editor : Charlotte Lim

Editor (Medical) : Dr Elaine Huang

Editor (Dietetics) : Janie Chua

Editorial Consultants : DSS Management Committee

Charlotte’s Web Communications

Contributors : Dr Jason Chia, Henry Lew, Marco Aizawa,

Chong Hui Hsien, Wong Yuefen, Rodiah Hashim, Chionh Lay Keng, Angie Lee

Production/Advertising Manager :

George Neo

Advertising Coordinator : Esther Ng

Publishing Services : Stamford Press Pte Ltd

Booking for Advertisements : Tel: 6842 3382

Email: [email protected]

Address feedback to:Managing Editor

Diabetes SingaporeEmail: [email protected]

For past issues of Diabetes Singapore, log onto:http://www.diabetes.org.sg/publication.html

Diabetic Society of Singapore HQBlk 141 Bedok Reservoir Road #01-1529 Singapore 470141

Tel: (65) 6842 6019 /3382 DSS website: www.diabetes.org.sg

Disclaimer

The views, opinions and recommendations given by the contributors of Diabetes Singapore or are merely for general reference. All materials in this newsletter are for informational purposes only. The individual reader should consult his own doctor or specialist for his personal treatment or other medical advice. Diabetic Society of Singapore 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.

editor’s message diabetes singapore april - june 2011

It is well known that exercising has great benefits for those with diabetes. For one thing, your blood sugar control would be better. For those on Insulin treatment, exercise also makes the insulin more sensitive and therefore more effective. On the other hand, those who have weight issues will find their blood sugar control more diffiicult. Given that the health benefits of exercising is a given, why do we all struggle to maintain or even start to do something we all know is good ? For our convenience, perhaps I could summarise the top five excuses and the top five reasons for exercising or not exercising.

Top 5 excuses for not exercising:1. I cannot get up early in the morning and am too tired at

the end of the day to exercise.2. I have no time and no mood to exercise.3. I cannot afford the gym fees and, besides, I don’t look

good in sports attire.4. I developed health problems from lack of exercise in the

past. Now i think I cannot exercise because I have these health problems.

5. I think it is too far to travel to the park to exercise. The exercise machine at home is also not working properly because It is rarely used.

Top 5 reasons for exercising:1. I will be more alert and sleep better.2. I will feel better about myself and my mood will improve. 3. I will feel less stressed. 4. I have diabetes and my weight and blood sugar control

will be better now.5. I will have a lower risk of high blood pressure, heart

problems and stroke. It has been reported that 30 minutes of walking a day lengthens your life by between 1.3 years ( moderate level of physical activity ) and 3.7 years (higher level of physical activity). Our health is in our hands! PS: Do pace yourself when exercising and consult a professional before engaging in a higher level of physical activities. This is particularly important for those with heart conditions and/or high blood pressure.

An Exercise in Health

Dr Yeo Kim TeckSenior ConsultantApple Eye Centre


diabetes singapore april - june 2011

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President’s message

Warmgreetingstoall!Thisyear,DiabeticSocietyofSingaporeturns40!Overthehillalready?Notatall!Infact,aswecelebrate40yearsofunwaveringservicetoourmembersandthegeneralpublic,wewanttomakeatoasttoabrightfutureahead.

Today,wecansay,inhumilityandwithgratitudeto our dedicated staff and volunteers, that ourvoice is more audible and our services morevisible. Moving ahead, we need more funds,more volunteers andmore resources to run thesociety inorder tomeet thenewchallengesweface, suchaseffectivelycarryingout screeningandclinicaltestsandadoptingnewtechnologies.Wehavebeenexploringgreatercooperationwithagencies,institutions,associationsandspeakerstoraiseourprofileaswellastoeducatethemassesby offering consultation, organising public talksandworkshops,andconductingresearch.

DSS is also very proud to announce anothermajor milestone in DSS’ history: we have wonthebid tohost the IDF-WPRCongress in2014.Weshallbeexpectingmorethan2000delegatesfrom20countriestoattendthescientificprogramas well as to visit the exhibition of the latesttechnologiesinmedicalequipmentandservices.

Not So Over The HillTheproposed4-dayeventwillincludeafunwalkfrom Esplanade Drive through Helix Bridge toGardensby theBay, followedbya samplingoflocal hawker food. We want our distinguishedguests tosavour theSingaporeexperienceandbringhomebeautifulmemoriesoftheirtimehere.

Thisyear,wearealsoplanningtocelebrateWorldDiabetesDayonalargerscaleinNovember.Theorganisingcommitteewill kick-start themeetingsoonso lookout fordetails in thenext issueofDiabetesSingapore.Betterstill,comejoinusasmembers and volunteers and be a part of thisverysignificantevent,onethatcanhelpmanylivehealthylivesandevensavelives!

On16April2011,thesocietywillholditsAnnualGeneralMeetingandelectthenextManagementCommitteeforatwo-yearterm.Iurgealltoattend.Weneedallthehelpwecanget.Seeyouthere.

Thank you very much and here’s wishing yougoodhealth!

Yong Chiang BoonPresident,DiabeticSocietyofSingapore


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news buzz diabetes singapore april - june 2011

TheDiabeticSocietyofSingapore’sMobileCentrerolledintotheheartlandson 7 March 2011. In partnership with the Tung Ling COPE and DakotaCrescentResidents’Committee,themobilecentreprovidedhealthscreeningfortheresidentsandvolunteersoftheCare&FriendsCentreatBlock10,DakotaCrescent.

TLCSmanagestheElderlyActivityCentreunderTungLingCOPE(CommunityOutreachProgramfortheElderly)aninitiativeprogramestablishedbySouthEastCommunityDevelopmentCouncil.

WithcentremanagerMrRogerNeo’shelp, themobilebus founda lotatthe carpark right where the centre is. Between 9.30am and 4.30pm, 27pre-registered participants were screened that day forbloodsugarlevel,bloodpressureandtotalcholesterolchecks.

Inanemail toDSS,MrNeosaid, “Iamsogladthings are working out well and we are havingvery positive response.” The feeling is mutual.Hence,asecondvisitby theMobilebus to theCentreon21March.Andwehope itwillnotbethelast!

Health Screening in the Heartland

7 & 21 MARCH 2011By Rodiah Hashim


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news buzz diabetes singapore april - june 2011

Some50participantsarmedthemselveswithagoodknowledgeofwhatnot toeatorprepareduring theLunarNewYearwhentheyattendedapublicforumtitled“ManagingMyDiabetes:WhatisMyScore?”.HeldatSuntecCityExhibitionandConventionCentre,incollaborationwithJohnson& Johnson Medical Singapore on 15 January2011,theeventbeganwithafreeglucosetestforregisteredparticipants.

After a sumptuous but healthy lunch, MissAngie Lee, a Diabetes Nurse Educator with theDiabetic Society of Singapore, discussed “WaystoKeepDiabetesMellitus (DM) inControl”. In thesegment that followed, Dr Kevin Tan, ConsultantEndocrinologist, reiterated the importance ofmedicationinthemanagementofDM.

WiththeChineseNewYearfestivitiesapproaching,participantsweregiventipstohealthyeatingbyMrForWeiChek,DieteticsManageratMtAlverniaHospital,andhisteamofdietitians.Hegavethelowdownonthecontentsandnutritionalvalueofourlocalfestivegoodies.

Theeveningclosedwithparticipantsgettingtheirpostglucosechecksbeforeteabreak.All inall, itwasafruitfulsessionforourOneTouchUserswhowenthomesatiatedandmuchthewiser.

Scoring Points

Health Screening in the Heartland

7 & 21 MARCH 2011

By Rodiah Hashim


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Psych Yourself Up To Exercise

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care corner

Can’t get yourself to start that workout? Henry Lew, psychologist, offers some tried and tested ways to motivate you.



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We all know about thebenefits of exercise andthe need to do it, oneway oranother. Exercise helps us tostay healthy, lose weight, relax,etc,etc.Yetweprocrastinateandcook up excuses not to budge.However,thosewhohaveovercomethis inertiawill testifytothefactthatwhenthemotivationandbenefitsarereallyclosetoourhearts,thegoingisnotsotough.

Think BenefitsOneofmypreviouspatients,MrRanjit*,once shared with me: “I had known allalongwhy it is important to exercise.Butit was only when I realised that I wantedto seemygrandchildrenenter school andwatchthemgrowupdidIseriouslystart toexercisetostayhealthy.”

Another patient, Mdm Siti*, commented:“I did not want to be seriously ill and be aburdentomylovedones...that’swhyIstartedto exercise.” Love is a very strongmotivatorindeed!

Think Double BenefitsPerhapsanothermotivatorforexercisingcouldbethatitmayimproveyourdietingattempts!Inresearchstudies,participantswereseparatedinto twogroups.GroupAwasencouragedtoexercisewhileGroupB just receivedgeneralinformation about exercise. It turnedout thatGroupA not only exercisedmore, lostmoreweightbuttheywerealsomoremotivatedtowatch their diet andmake changes to theirdiet.GroupAwaslesslikelytoeatwhentheywere feelingsad,stressorbored.GroupAwasalsomoreabletotalkthemselvesoutofgivingintotemptationsofeating!Inmyownencounterswithpatients, Ihaveobservedthatmanypatientswhobeganexercisingalsobeganrestrainingthemselveswhenitcametoeatingunhealthily.Theyjustdidnotwanttolettheireffortsgotowaste.They opted for sandwiches instead.Thenexttimethatyouhesitateaboutexercising, think about the potentialpositive effect exercising will haveonyourdietaswell!

Think and Start SmallWewillhavemanyreasons(realormadeup)fornotexercisingorpostponingit.Andtobehonest,themainandrealreasonisusually justbecausewe feel tired, lazy,uncomfortable (i.e.,sweating,panting, muscle soreness) about exercising.So, think and plan small, so that it seemsmoremanageableandwearemorelikelytostartonit.Andwhenwe start small, it will be at a level ofintensityandfrequencyweareabletocopewith.Don’tsabotageyourselveswithsoresandachessothatyouwillnotwanttoexerciseforthenexttwoweeks!Consultadoctorormedicalprofessionalbefore starting any exercise programme; theywouldbeabletoadvisehowsmallorslowtostartandhowtoincreaseexerciseovertheweeks.

Think FunAnyactivitycanonlybesustainedifitisfunandinteresting.Chooseanexerciseyoulikeorenjoydoing. How about revisiting an activity or sportyouusedtolike?Peter,apatientinhis70soncetoldme:“Iactuallywentswimmingaftersomanyyearsoflayingoff.Ican’tswimasfastoraslongasIwanttobutIstillderivealotofpleasurefromit.”

Share the good timesSometimes we may be only restricted to a fewexercisebecauseofmanyreasonsandthesefewexercisesmay seemboring.During these timesyoumaywanttogatheragroupordoanexerciseactivity that others have invited you to join. Youwillbedelightedtoseewhatcompanycandotolivenupamundaneactivity.MdmHabibah*,whostarted climbing the stairs with her colleagues,said:“We’dheadtothenearbyblockofflatsandstartingwalking up anddown.Whowould havethoughtthatclimbingthestairscouldbesomuchfun?”Exercise itself releasesendorphinsandmakeusfeelgood.Nowonderwhypeopletendtocontinueto exercise and like to exercise once they getstarted.Youcanstart feelinggood too.Toenjoytheseendorphinsweneedtostartexercisingfirst.Think benefits, think small, start small and thinkfun.Now,justwhatareyouwaitingfor?

*Nameshavebeenchanged

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care corner diabetes singapore april - june 2011


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care corner

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When do you need insulin? Chionh Lay Keng and Angie Lee, diabetes nurse educators from Diabetic Society of Singapore, guide you through the process.

Starting Insulin

Discovering A New Lease Of Life


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care corner

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Achieving good blood sugar levels is a dailychallengeforthosewithtype2diabetes.Highblood sugar is damaging to the cells andtissues in thebodyand leadtocomplicationssuchasblindness,lossofalimb,kidneyfailure,heartattackandstroke.Assuch,manypeopledreadalifewithdiabetes.

Most personswith type 2 diabetes need oralmedication to lower their blood sugars andmaintainatacceptablelevels.Somemayneedinsulin injectionsandmayevenchoose tobeoninsulinforbettercontrol.

When Medications FailIt ispossible tocontrolbloodsugar levels foryears with a good diet and exercise regime.Different oral medications (one ormore)mayadditionally be needed. However, there aremanysituationsormedicalconditionsthatmayrendertheseoraltabletsineffectiveornolongerusableforthepatient.Theseinclude:

• Acuteinfectionsorotherseriousillnesses• Pregnancy• Majorsurgery• Congestiveheartfailure• Kidneydisease• Liverdisease• Useofotherdrugs(prednisoneandsome

psychiatricmedications)thatraisebloodsugar

• Overeatingorexcessiveweightgain• Antibodies that destroy beta cells

(inpeoplewith type-1,misdiagnosedastype2)

• Progressivelossofbetacellfunctionovermanyyears

There are many with type 2 diabetes whoexperienceprogressivelossofpancreaticbetacell (insulin-producing cells) function. Theiroverworkedbetacellsseemto‘burnout’,anddrugs thatwereonceeffectivecanno longerholdtheirbloodsugarsareacceptablelevels.The fact is that when type 2 diabetes is firstfound out in a person, only 50% of his betacell functionremains.AccordingtotheUnited

References:Intensiveblood-glucosecontrolwithsulphonylureasorinsulincomparedwithconventionaltreatmentandriskofcomplicationsinpatientswithtype2diabetes(UKPDS33)[publishedcorrectionappearsinLancet1999;354:602]. Lancet.1998;352:837-53.

KingdomProspectiveDiabetesStudy(UKPDS,alandmarkstudyabouttype2diabetespatientspublished in 1998), the function will continuetodeteriorateovertimedespitetreatmentwithdiet,exerciseandoralmedication.

Some indicators that suggest that insulin hasbecomenecessaryare:

1.Oral diabetes medications have beenincreased to the maximum dosage andyetbloodsugarlevelsarestillhigh.

2.No improvement in blood sugar levelseven after switching between differentoraldiabetesmedications

3.Blood sugar levels remain high andsymptoms appear (excessive thirst,frequent urination, weight loss despitegood appetite) despite oral medication,dietandexercise.

There is nodoubt thatmany fear the thoughtof insulin injections. Some of these fears likethefearofneedles;hypoglycaemia(lowbloodglucose episodes) and weight gain can beovercome with the help of a diabetes nurseeducatoror yourown familyphysicianwho isspecialisedindiabetes.

Research clearly shows that achieving goodcontrolearlyonandmaintaining it foras longas possible helps prevent or delay diabeticcomplications,includingnerve,kidney,eyeandheart disease, from happening up to twentyyearslater.

Looking forward to a life of good diabetescontrol is not unachievable nor a far-fetcheddream…if you are motivated to do so. Withdiscipline and support from your family andhealthcareproviders,youcandiscoveranewleaseoflifewithwell-controlleddiabetes!


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healthy makan

A healthy balanced diet and a healthy lifestyleare the key ingredients in the managementof diabetes. Diabetes does not stop you fromexercising.Infact,combiningdiet,exercise,andmedicine(asprescribed)willhelptocontrolyourweightandyourbloodsugarlevel.

People with diabetes can exercise safely aslong as certain precautions are taken. Regularexercisehelpsto:• Promoteweightloss• Optimisebloodglucosecontrol• Optimiseyourbloodpressure• Improveinsulinsensitivity• Reduceriskofheartdiseaseandstroke• Keepyourjointflexible• Increasemusclestrengthandtone• Improvewell-being• Reduceyourstresslevel,promoterelaxation, releasetensionandanxiety

So, what happens if you cannot resist the temptation of a curry puff or banana fritter? Chong Hui Hsien, Dietitian from Changi General Hospital shows you how much exercise you need on a daily basis and how much to burn off those extra calories.

Don’t bite off more than you can burn…


How much exercise is enough? Aimforatleast30minutesofmoderate-intensity, three tofivedaysaweek. Ifyouareabeginner, it is important tobuildupthedurationand intensityof theexercisegradually.Youcansplitupthe30minutesexerciseintoseveralparts.Forexample,youcantakea10-minutebriskwalkthreetimesaday.

It is important to choose an exercise that youenjoy.Findinganexercisebuddymayhelpyoutobemorecommittedtoyourexerciseregimen.Running, jogging, swimming and cycling aresomeexamplesofaerobicexercise thatare funandcaneasilyfitintoyourlifestyle.

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healthy makan diabetes singapore april - june 2011

10,000 steps a day:Always keep in mind your goal to increasephysicalactivitywhenevertheopportunityarises.Forexample:• Parkyourcarfurtherawayandwalktherest ofthewaytoreachyourdestination• Usestairsinsteadofelevators• Walk,run,playactivelywithyourchildrenor grandchildren• Walkthekidstoschool• Dailyhousecleaningorgardening• Takeawalkingbreakinsteadofcoffeebreak atwork• Hidetheremoteandchangechannelsinthe old-fashionedway• Wearapedometerandaimfor10,000steps aday.

If you enjoy sports: If you enjoy dancing: If you enjoy walking:

Paintball Ballroomdancing Hiking

Tennis Salsa Briskwalking

Volleyball Ballet Mallwalking

Basketball Aerobicdance Dogwalking

References: 1. AinsworthBE,HaskellWL,WhittMCetal.Compendiumofphysicalactivities:anupdateofactivitycodesandMETintensities.Med.Sci.SportsExerc. 2000;32:S498-504

Exercise Precautions:• Ensureproperfootwear• Donotexerciseifyouareill• Donotexerciseinthepresenceofketosis. Forpeoplewithtype1diabeteswhoare deprivedofinsulinandareketotic,exercise canworsenhyperglycaemia.Therefore, vigorousexerciseshouldbeavoided.• Hypoglycaemiamayoccurduringexercise forapersononinsulinorcertaintypesoforal hypoglycaemicagents.Hypoglycaemia ismorecommonafterexercisethanduring exercisebecauseoftheneedtore-plete liverandmuscleglycogen.Checkwithyour physicianbeforecommencingyourexercise programme.

Inadditiontoexercise,youshouldalsowatchyourfoodintakeinordertoachieveoptimalweightloss.YouwouldbesurprisedtolearnjusthowmuchexerciseisrequiredtoburnofftheEXTRAcaloriesfromyourdiet!



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healthy makan

So,beforeyousinkyourteethintothattantalisingapplestrudelorfriedyamcake,bepreparedtoworkitoff!Exerciseisnotonlyimportanttohelpmaintainyourbloodsugarlevelbutitisalsoessentialaspartofahealthyliving.Eatinghealthilyandchoosingtherightfoodsisjustasimportantforgoodbloodsugarcontrol.Thesetwolifestylechangeswillhelpyoutostayfitandhealthy.

*based on a 60kg adult. This serves as a guideline only as energy expenditure level will alter according to your age, skill and fitness level.

If you eat...Nutrient Content

You need to do*:Calories (kcal) Carbohydrate (g)

Applestrudel,1piece(97g) 220 28 40minsofaerobic

Chickennugget,6pieces(108g) 303 22 50minsofdancing

Currypuffwithpotatoesandmuttonfilling,1piece(138g) 401 42 50minsofrunning@8km/hr

Frenchfries,1mediumpack(117g) 370 45 85minsofbriskwalking@

6km/hr

Fruitcake,1piece(60g) 223 28 45minsofswimming

Ngohhiangmeatroll,1roll(59g) 228 16 70minsofwalkingthedog

Murtabakmutton,1piece(211g) 371 39 50minsofsoccer

Pisanggoreng,1piece(65g) 197 35 40minsofbadminton

Popiah,1roll(140g) 191 15 25minsoftennis

Waffle,peanutbutter,1piece(113g) 460 46 45minsofrunning@10km/

hrYamcakefried,2pieces(170g) 210 40 65minsofbowling

2. AmericanDiabeticAssociation.PositionStatement:StandardsofMedicalCareinDiabetes–2011.DiabetesCare2011;34(1):S11-S613. HealthPromotionBoard.FoodCompositionGuideSingapore.


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diabetes singapore april - june 2011healthy makan

Ingredients

2breakfastwheatbiscuits2largebananas500mllow-fatmilk60glow-fatplainyoghurt

Method

1. Blendallingredientsinablenderuntilsmooth.

2. Pourintoservingglasses.

Wheaty Starterby Wong Yuefen, Dietitian, National Healthcare Group Polyclinics

Nutrition Information (Per Serving)

Energy 105kcal

Protein 6.8g

TotalFat 3.6g

SaturatedFat 0.8g

Cholesterol 0mg

Carbohydrate 3.1g

*Carbohydrateexchange 0.2exchange

Dietaryfibre 3.0g

Makes 4 x 200ml glasses

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healthy makan

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Nutrition Information (Per Serving)

Energy 105kcal

Protein 3.6g

TotalFat 2.5g

SaturatedFat 0.8g

Cholesterol 0mg

Carbohydrate 3.1g

*Carbohydrateexchange 0.2exchange

Dietaryfibre 3.0g

Serves 2

Ingredients

150gyoungasparagus,trimmed100gFrenchbeans2teaspoonssoftmargarine30gtoastedalmondflakesFreshlygroundblackpepper&salttotaste

Method

1. AddasparagusandFrenchbeanstoalargesaucepanofboilingwater.Cookfor1minute,oruntiljusttender.

2. Drainandtosswithmargarineandalmondflakes.

3. Seasonwithpepperandsalttotaste.4. Serveimmediately.

Asparagus & Green Beans with Almonds

by Wong Yuefen, Dietitian, National Healthcare Group Polyclinics



The Rise of Sports and Exercise MedicineDr Jason Chia, Consultant, Sports Physician and Head, Sports Medicine and Surgery Clinic at Tan Tock Seng Hospital, talks to Charlotte Lim about the growing awareness of Sports and Exercise Medicine in Singapore.

medical conversation

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diabetes singapore april - june 2011medical conversation

Q&AWhat is Sports and Exercise Medicine?

Sports and exercise medicine is a medicalspecialistfield thatmanagesmedicalproblemsrelatedtosportsandexercise.Thescopeiswideandattheclinicallevelrangesfrommanagementandpreventionofsports injuries toprescriptionofexerciseformanagingmedicalproblemssuchasdiabetesandobesity.

Theimagethatimmediatelycomestomindwhensportsmedicineismentionedisthatoftheeliteathleteswheresportsmedicineplaysabigroleinsportsperformance.However,fromthepublichealth perspective, the “exercise medicine”portionalsoplaysanimportantrole,forinstance,in itsuseofexercise toprevent theonsetofortreatmentofchronicdiseasesorlookingatsafetyissuesinsportsparticipationandexercise.

While I have at times used the analogy ofcomparingtheservicingofaFerraritoaToyotatohighlightthedifferenceswhencaringforaneliteathleteversusarecreationalathlete, inpracticethesetwoaspectsarenotdiametric.Forinstance,the sports enthusiasts whom we take care ofin the schools and sports clubs in the generalpopulation have very similar requirements asthe elite athletes andwill eventually be part ofthe talentpool fromwhich theeliteathletesareselected.

Why is Sports and Exercise Medicine becoming more popular among healthcare professionals and patients?

Increasingly, medical students and youngdoctorshavebeenexpressinginterestintraininginSportsMedicine.This isprobablya resultofthe establishment of sports medicine clinics

in the public healthcare institutions and in theformalizationoftrainingandcareerpathways.

For the latter, thepopularity is probablydue inpart to the risingnumber in thepopulation thatexercisesregularlyandalsocompetesinsportsrecreationally. There is a better understandingthat they can manage their health not justthrough regular screening but also proactivelybydecreasing their risk factors through regularexercise.Thisleadstoariseindemandforsportsmedicineservices.

Who are the key professionals in the Sports and Exercise Medicine consultation team?

The team at the Sports Medicine and SurgeryClinic consists of sports physicians, sportsorthopaedic surgeon, sports physiotherapists,podiatrists and exercise physiologist. Eachone is a specialist with a special skill set butin combination, the team provides the mostappropriatetreatment(s)foraparticularproblem.Intheelitearena,theteammaybesetupdifferentlywithagreater representationofsportsscientiste.g. exercise physiologist, sports nutritionist,sports biomechanist, sports psychologist andstrengthandconditioningcoach.

What are some of the sports injuries you treat these days?

The list is pretty long but they can range fromcommonconditionssuchas runner’s kneewithultramarathonerstotendonrupturesinsurferstoplantarfasciitisfrombriskwalking.

There have been many recent studies in the area of sports medicine. Could you share one with our readers and what impact it might have on the way we view exercise?

The more recent studies reveal that regularexercise probably exerts its protective effecton the heart in terms of preventing coronary


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diabetes singapore april - june 2011medical conversation

heart disease through its effect on inflammation. Working out the mechanism helps in refining the way we prescribe exercise for different conditions.

How does exercise help one with diabetes or help prevent diabetes?

Exercise helps by increasing the body’s sensitivity to insulin, increasing the muscle uptake on glucose in circulation, and decreasing body fat.

Can people with diabetes engage in the same sports and exercise regimens as those without diabetes?

Yes and no. People with diabetes are not a uniform group of patients. On one end of the spectrum would be Olympians like Steve Redgrave who has won five gold medals despite being diagnosed with diabetes at 35. On the other hand, there are those who have developed complications from long standing diabetes and, for them, the type and intensity of exercise need to be tailored to their fitness and medical conditions.

You were involved in the writing and publication of a handbook for exercise prescription for general practitioners. What is the key point in the book?

I think the key point is that exercise is like medicine and should be prescribed according to the patient’s fitness and medical condition.

You have completed the Ironman triathlon in Langkawi. What were some of the hardest moments you had to overcome while preparing for the race and running in it?

It was difficult juggling the huge volumes of training from three different disciplines with the rigours of medical training and working as a medical officer. There were a few times riding

in the evening of the day after a busy call and a day’s work when I had been on the verge of dozing off while cycling. And the race itself was no easier. There were occasions on the run leg that I had wanted to give up. What really stopped me was the sight of a paraplegic athlete passing me by on a uphill slope (it turned out that he had a spinal cord injury from a riding accident two years ago) where he would stop intermittently and pivot this wheelchair 90 degrees to catch his breath. When it dawned on me that he had to do that so that he would not roll backwards (all I had to do when I needed to catch my breath was stop and stand) and that he had covered the distance with just his two arms… well, in the presence of such true grit, there was no excuse not to finish, was there?

What area of research are you currently involved in?

Currently, I am looking at how to use non-invasive methods to monitor the mechanical properties of tendons as they respond to treatment.

What’s next for you, professionally and personally?

Professionally, in terms of clinical development I would like contribute to the development of sports medicine towards refining exercise testing and prescription for medical conditions while administratively, towards how I can develop sports medicine in Tan Tock Seng Hospital to support wider national agendas.

Personally, I started learning golf two years ago. I get strange looks when I mention this to my old friends from the triathlon days but golf has taught me innumerable things (concentration, relaxation, self-awareness to name but a few) which I had not learnt from swimming, biking and running. It’s also a great way to meet and learn from people from all walks of life.


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Diabetes and Pets

special feature diabetes singapore april - june 2011

• Seizure• Wobbliness• Weakness• Dullness• Sleepiness• Restlessness• ComaWhenpetsarehypoglycaemic theyshouldneverbeleft alone overnight. The complications of untreateddiabetes can be awful. These include cataractformation and loss of sight in dogs, andboth nervedamageandhind-endweaknessincats.

Diabetes treatment for petsInsulin is generally regarded as the benchmarktreatmentforbothtype1andtype2diabetes.Your vet can prescribe special insulin. Owners ofdiabeticpetsshoulddiscusshowbesttopreparetheinsulin,andhowmuchinsulinisneededforpets,withtheirvet.

Insulin tips for diabetic animals• Insulin should be stored in a refrigerator. Insulin

shouldbemixedbeforebeingused.• Mixing should be carried out using gentle rolling

andnoshaking.• Wheninsulinreachesitsexpirydatedonotuseit.• Clip the hair of the petwhere you need to inject

insulin–thiscanmaketheinjectionprocesseasierforbothpetandowner.

• Monitoryourpet’sbloodglucose.• Remember–petscanbetreatedwithgoodresults!

Pets can suffer from diabetes too. Knowing whether or not your dog or cat is healthy could save their lives. Here’s some information about diabetes in animals, and how best to manage the condition.

What are the causes of diabetes in animals?Justlikeinhumans,petswithdiabetesmaynotbeabletoproduceenoughinsulin,orpossiblytheirbodiesdonotallowthemtouseinsulinproperly.Insulin is produced by the pancreas, and allowsglucoseinthebloodtoentercells,allowingthebodytoproperlyfunction.Justlikepeople,petscansufferfrombothtype1andtype2diabetes.

What are the symptoms of diabetes in animals?Diabetes symptoms and the complications of thedisease are also similar to humans. The followingsymptoms could indicate that your animal hasdiabetes.

Diabetes symptoms• Weightloss,oftendespiteanincreasedappetite• Excessivethirstandurination• Breakdown of body fat and development of

ketacidosis• Lowerappetite• Pungentbreathwithachemicalsmell• Complicationsassociatedwithdiabetes

My animal looks very sick, could this be pet diabetes?Yourpetmaybeinthethroesofhypoglycaemiaorlowbloodsugar.Hypoglycaemiacanoccurinanimalsduetoinsulinoverdose.Thesymptomsofhypoglycaemiaincludethefollowing:


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Managing pet diabetesLikediabetes in humans, diabetes amongst animalsneedstobecloselymanagedinorderforyourpettolive a longer, healthier life.Whenapet’s diabetes isunder control, they have normal thirst and urinationtimes,anormalappetite,astableweight,goodvisionandalertnessandagood levelofactivity.Therearethreemajorpartsofcontrollingbloodsugaramongstanimals.Thesearediet,bloodglucosemonitoringandexercise.• Diet.Whenadogorcatdevelopsdiabetes, they

shouldbe fedondriedorcanned foods,but it isimportant to avoid semi-moist foods because ofpossible sugar content. Vets should be able toprovidemoreinformation,andalsoadviseonwhentofeedpetsinrelationtoinsulin.

• Blood Glucose Monitoring.Keepinganaccuratemonitor of your pet’s bloodglucose levels allowsavettoworkoutchangestotheinsulinregimeortype.Somepetownermaybetaughttodothisathome.

• Exercise. Diabetes often occurs amongstoverweight or obese animals, when excess fatleadstoinsulinresistance.Dailywalkswillbegoodforboththepetandtheowner.

Dogs with DiabetesHow Common is it?Diabetesisoneofthemostcommonhormonaldiseasesindogs.Itcanoccurindogsasyoungas18monthsofage.Mostdogsarebetweensevenandtenwhencanine diabetes diagnosis is made. Approximately70% of dogs with diabetes are female. Any breedcanbeaffected,butdachshunds,poodles,miniatureschnauzers,cairn terriers,andspringerspanielsareat increasedrisk. Interestingly,diabetes isseenveryinfrequently in Cocker Spaniels, shepherds, collies,andboxers.

Canine Diabetes SignsWhatsignsmightyourdogbeexhibiting ifhe/she isdiabetic?Thereare 3 clinical signstolookfor:• Diabeticpatientsusuallyshowamarkedincrease

intheirwaterintake,alongwithanaccompanyingincreaseinurination.Theyfrequentlyhaveexcellentappetites,yetarelosingweight.Finally,thesuddenappearanceofcataractsintheeyessuggeststhepossibilityofunderlyingdiabetes.

• Aswithmostconditions,itisimportanttodiagnosediabetesearlyinthedisease.Ifyouobserveanyoftheabovesigns inyourdog,don’thesitatetogether to your family veterinarian. Left undiagnosedand untreated, diabetic dogs can develop life-threatening secondary complications due to themetabolicderangementsintheirbody.

• The diagnosis of diabetes is generally fairlysimple.Thepresenceofahighbloodsugar level

(hyperglycaemia)andsugarintheurine(glucosuria)alongwith theappropriateclinical signsconfirmsthediagnosis.Indogs,normalbloodsugarlevelsare 80 to 120, I have seendiabeticpatientswithvaluesashighas600.

TreatmentAlthough diagnosing diabetes is not demanding,treating it certainly is. That said, it is a treatabledisease in dogs and most diabetic dogs can leadveryhigh-qualitylives.Virtuallyalldogswithdiabetesrequireinsulintherapy.Justasinhumans,theinsulinisadministeredbyinjection.Mostdogsrequireinsulintwicedailytoadequatelycontroltheirdisease.

Beforeyouthrowupyourhandsandthinkyoucouldnevergiveyourdogshots,thatalmostallownersarecapableofproperlyadministeringinsulintotheirdogs.Theneedlesusedareverysmall,makingtheinjectionsquitecomfortable.

Insulin therapyA complete discussion of insulin therapy is beyondscope here, but there are a few key points youshouldknow.Therearemanydifferenttypesofinsulinavailable,besureyoudiscusswhattypeisappropriateforyourdogwithyourveterinarian.Insulinshouldberefrigerated,andmixedgentlybeforeadministration.Thisisdonebycarefullyrollingthevialbackandforthbetweenthepalms.Anotherimportantconsiderationisproperdisposalofusedinsulinsyringesandneedles.Don’t throw them in the trash!Your veterinarianmaybeabletotakecareofdisposingofthemedicalwasteforyou.

Complexities of DiabetesDiabetes is a serious and complex disease. Until a“cure” is discovered, diabetic dogs and people willcontinue to require insulin therapy. This treatmentdemands close collaboration and communicationbetweenownerandveterinariantomakeitasuccess.Treatingdiabetescanbeveryrewardingforpatientandowneralike,and thesedogscananddo livenormallives.Ifyouobserveanyofthesignsofdiabetesinyourdog,don’tdelay-takehimorherintoyourveterinarianforanexamination.

Cats with DiabetesFrequencyDiabetesoccurslessfrequentlyincatsthanindogs.However,when itdoesoccur, felinediabetescanbemoredifficulttoregulate.

Whenadiabeticcatingestsglucoseandcan’tprocessit properly, it leads to the build up of sugars in thebloodstream.Eventually,thebloodsugargetssohighthatsugarbeginstobespilledinthecat’surine.Boththehighbloodsugarandthelossofsugarthroughtheurinecanhavesevere,andsometimeslifethreatening,consequences.


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Source: www.diabetes.co.uk

Common ProfilesDiabetescanoccur incatsofanyage, thoughmostare over six-years-old. Some cats can be insulindependent and can be helped by life-long insulintherapy.Othercatscanbenon-insulindependentandonly require insulin when stressed. Typically, thesecats regain their balanceonce the stressful event isover.

History and Physical ExaminationThecommonsignsofdiabetesareincreasedthirstandurination, along with increased appetite and weightloss.However,thesesignscanbemaskedincatsthathaveotherillnesses.Youmayseesignsofillness,suchas:

• Vomiting• Diarrhea• Lossofappetite• Breathingdifficulties• Weakness• Strainingtourinate

These symptoms can appear suddenly, over a fewdays,oroverseveralmonths.

DiagnosisInmanycases,catsthathavediabetescanbedifficultto diagnose because they also have a concurrentillnessordiseasethatcanmimicdiabetes.Some of these diseases are hyperthyroidism,kidney disease or failure, adrenal gland disease,gastrointestinal disease, cancer, liver disease orfailure,andsometypesofdrugtreatment.To diagnose feline diabetes, veterinarians use thefollowingtests:• Fasting blood-sugar level: Testresultsthatshowa

blood-sugarlevelover200indicatethepossibilityof diabetes. However, stress alone can resulthigherblood-sugarlevels(upto300to400)incatswithoutdiabetes,attributedtoasurgeofreleasedadrenaline.

• Urine glucose: Diabetic cats have sugar intheir urine. They can also have ketones in theirurine, which results from a defective fatty acidmetabolism.Catswithoutdiabetes thatareunderstressmayalsohavesomeglucoseintheurine,butitistemporary.

• Blood chemistries:Lipemia,whichisincreasedfatinthebloodcanbeevidenceofliverdysfunctions.

• Urinalysis: In addition to sugar and possibleketones,theremaybesignsofbladderinfections.

TreatmentInsulin injections are still the most accepted meansof treating insulin-dependentdiabeticcats. Initially,adiabeticcatishospitalizedandregulatedforthreetofourdays.Duringthattime,multiplebloodsugartestsaregiventoestablishaproperscheduleforthecat.Thegoaloftreatmentistomaintainablood-sugarlevel

between100and200duringeach24-hourperiodandtoimproveoreliminateanysymptoms.Often, numerous hospitalizations for serial bloodsugars are required for monitoring and makingadjustmentsininsulindosages.

The nature of cats canmakediabetesmanagementdifficult.Ascatshaveastrongstressresponse,itcanbe hard to interpret blood-sugar tests. Some otherdifficulties inmanagement difficulties are causedbythefollowingconditions• Variabilityininsulinactivityanddosagerequirements• Feline eating habits. Ideally, diabetic cats should

befedtwotofourtimesperday.Sincemostcatsare fedby freechoice, it canbehard tochangethemto interval feeding.Also,somecatswillonlyeatonetypeoffood,makingithardtochangetoanewdiet.

• Transient diabetes. Some diabetic cats mayspontaneouslylosetheneedforinsulinafteryearsoftreatment.

• Failure to perform serial glucose tests. Basingtreatmentononerandomglucosetestisconsidereda hit-or-miss approach, and is usually more timeconsumingandexpensivethandoingserialtests.Itcanalsocausewidefluctuationsinbloodsugarlevels.

• Failuretoproperlyeducatethediabeticcatowner• Failuretogivetheproperdoseofinsulin• Improperstorageandhandlingofinsulin• Impropercatdiet• Improper blood-sugar monitoring Prolonged or

frequentboardingofthecatHormonalinfluences.Blood sugar can be controlled more easily in aspayedorneuteredcat.

• Concurrentdiseases• Concurrentdrugtherapy

AC_TDS Ad.indd 1 3/25/11 5:33 PM31-0664 DIABETES NEWSLETTER NO37.indd 24 3/29/11 5:45 PM

diablogue diabetes singapore april - june 2011

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I’ve never let my diabetes get in the way of mypassionforcycling.OnthedaysIexerciseortakepartinanysportingevent,Itrytoanalysemybloodsugarstounderstandmybloodsugarprofile.Andeven though I understand pretty well now afteryearsofpracticehowmybodyrespondstodifferentfoodsandphysical activity, eachday still offers anewlearningexperience.

On6March2011,ItookpartinaneventcalledtheOCBC Cycle Singapore with my friend, who alsohas type 1 diabetes, and who shares the samepassionasI.

Iroseveryearlythatmorningatfiveanddidmybloodglucosecheck. Itwas4.5mmol/L. Igavemyself4unitsofNovorapid(Insulin),halfofwhatInormallyrequiretopreventhypoglycaemiaduringexercise,thenateachocolatemuffin,alargebananaandhalfapacketofmango juice.By5.30am, IwasoutofthehouseheadingfortheF1Pitbuildingwheretheeventwasheld.

I arrived at 6.35am after cycling 12km, and didanotherbloodglucosecheckwhichgaveareadingof 7.5mmol/L.Whenmy blood sugar level is lessthen10.0mmol/L,Iwillnormallyeatasnackbeforeexercising,soIateapacketofOreocookies.Afterwhich,myfriendandItookourplacesatthestartingpoint.

Theeventkickedoffat7.15am.Wetookourtimeasthereweremanycyclistsontheroad.IwaschieflyconcernedaboutcontrollingmybloodsugarsandensuringthatIdidnotfalloverduetotheheavybiketraffic.

The Adjustment BureauDuringtheride,Idrankwatertopreventdehydrationand cramps. However, after cycling about 25 to28 km, the cramps inmy leg forcedme to downPowerGel, a sports supplement, tomake it to thefinishingline.Iclockedatimeof1hour25minutes,oneofmypersonalbests.After theride, IguessIdecidedtocongratulatemyselfwithacanofisotonicdrinkbeforemeetingmyfriendforbreakfast.

Atthebreakfasttable,Itestedmybloodglucose.Ithadgoneupto12.6mmol/L.Iknewinstantlythattheculprit responsible for this blood sugar spikewasthatisotonicdrinkbutthegreaterculpritwasme!Irealised that Ishouldhave testedmybloodsugarafterreachingtheendpointinsteadofindulginginthatdrink!

Sobefore I tucked intomybowlofmeesiamandcupoficecoffee,Ihadtodosomedamagecontrol.Igavemyself8unitsofNovorapid.Afterbreakfast,Imademywayhomeridinganother13km,which brought my blood glucosedownto5.3mmol/L.So,Iateanotherbananaforrecovery.

Every person living with diabeteshasadifferentbloodsugarprofileandyouneedsometimetogetto know it better and adjustaccordingly. It’s kind of likeyourownpersonaladjustmentbureau. If you have anyissueswithunderstandingthebloodsugarprofile, Iamsureyourdoctorandnurseeducatorcanhelpyou!


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