Outsmarting Diabetes Complications -...

Outsmarting Diabetes Complications Ang Puso at ang Utak sa Diabetes

Pangingimay, Pangangapal at iba pang

problema sa Nerves ng isang Diabetic

Diabetic Eye Complications

Myths & Facts of Kidney Complications

Bukang Bibig: Mga katanungan ng Diabetic sa Dentista

Plus: Mandirigmang Salat sa Sandata: Isang Mukha ng Type 1 Diabetes Mellitus

DISASTER PREPAREDNESS

Foot Care In Diabetes

Non-NutritiveSweeteners

Hotspot July.indd 1 18/07/2019 7:41 AM

2 HORMONE HOTSPOTS JULY 2019

Sa aming mga mambabasa…ISA sa labing-apat na Pilipino ay kasalukuyang may diyabetis. Ito ay inaasahang tataas pa sa susunod na mga taon.

DALAWANG mga mata, DALAWANG mga bato o “kidneys”, at ang mga ugat o “nerves” ang kadalasang napipinsala kung hindi kontrolado ang diyabetis.

TATLONG karaniwang kondisyong sanhi ng pagkamatay o pagkabaldado ng isang pasyenteng may diyabetis: atake sa puso, atake sa utak o “stroke”, pagkaputol ng isang paa o binti.

APAT DAPAT ang gawin upang maiwasan ang komplikasyon: pagkain ng wasto, palagiang ehersisyo, pagsunod sa gamot, pagkonsulta sa doktor.

ANG AMING MINIMITHI: maging malaya sa komplikasyon ang bawat Pilipinong may diyabetis.

Nawa’y makatulong ang nilalaman ng mga pahinang ito tungo sa aming minimithi.

Elaine C. Cunanan, MD Editor-in-Chief

Editorial Board Editor-in-chief

ELAINE C. CUNANAN, MD

Managing EditorsAURORA G. MACABALLUG, MDLORA MAY C. TAN-TIN HAY, MD

Scientific EditorMA. CECILE ANONUEVO-CRUZ, MD

Features EditorHANNAH C. URBANOZO-CORPUZ, MD

Lay-out EditorNESTOR ERIC R. LAPLANO, MD

The Philippine Society of Endocrinology, Diabetes and MetabolismUnits 2005-2006, 20/F, Medical Plaza Ortigas

San Miguel Avenue, Pasig City, PhilippinesTel. No. 632-6336420

Email address: [email protected] Website: www.endo-society.org.ph

The Philippine Society of Endocrinology, Diabetes & Metabolism is a sub-specialty society of the Philippine College of Physicians and Philippine Medical Association. Its members are board-certified physicians involved in the management of diseases of the glands such as diabetes, thyroid, obesity and other hormone diseases.

We are Filipino endocrinologists serving the Filipino patients.

*The complete list of board-certified endocrinologists can be found at www.endo-society.org.ph

From the President's desk

Dear readers,

Warm greetings from the Philippine Society of Endocrinology, Diabetes and Metabolism (PSEDM). The Endocrine Hotspots was created specifically with you in mind. We gathered our expert colleagues from PSEDM to discuss important issues about specific endocrine conditions for your better understanding. In this issue, we feature the complications associated with diabetes. We hope that you will take time to read through the articles so you can discuss this with your doctor on your next visit.

We highlight four components of diabetes management which we promote as part of our diabetes advocacy, the "Apat Dapat" phrase stands for adherence to doctor visits, proper diet, anti-diabetes medication compliance and guided physical exercises. Keep this in mind and always remember that controlling your blood sugar and preventing complications are key goals in managing your diabetes.

Stay tuned for future issues by logging on to our website: www.endo-society.org.ph. The site contains everything you need to know about our society.

Till the next issue. Keep healthy.

Sincerely,

Jeremy F. Robles, MDPresident, PSEDM

ANO ANG ENDOCRINOLOGIST?• Ang ENDOCRINOLOGIST ay isang espesyalistang doktor

na nakapagtapos ng dalawang taon na masinsinang pag-aaral sa mga kinikilalang institusyon.

• Ang ENDOCRINOLOGIST ay sertipikado sa paggamot ng DIYABETIS (DIABETES), BOSYO (GOITER), OBESITY, ABNORMAL NA CHOLESTEROL, OSTEOPOROSIS at iba pang sakit na may kaugnayan sa sobra o kulang na “hormones” ng katawan.

INFOGRAPHICS



3HORMONE HOTSPOTS JULY 2019

Ang PUSO Ang UTAKPaano nga ba naapektuhan ng diyabetis?

Ang taong may diyabetis ay...

Ano ang koneksyon?• Ang mataas na asukal sa dugo ay maaring makapinsala

sa daluyan ng dugo o “blood vessels” na nagdadala ng oxygen papuntang puso at utak.

• Ang taong may diyabetis ay madalas ding may:

Alamin ang ABCs ng iyong diyabetis.

A ay para sa A1C testIpinapakita nito kung ano ang bilang ng iyong blood glucose sa loob ng nakaraang tatlong buwan. Ang A1C target para sa karamihan ng mga tao ay < 7%.

B ay para sa Blood pressureAng target para sa karamihan ay 130/80.

C ay para sa CholesterolAng LDL o “bad cholesterol” target para sa karamihan ay <100mg/dl. Ang HDL o “good cholesterol” target para sa karamihan ay >40mg/dl.

s ay para sa Sigarilyong dapat itigil

Atake sa puso

Atake sa utak

High Blood Pressure High Blood

LDL (bad cholesterol)

Tanungin ang iyong Doktor: 3kung ano ang bilang ng iyong A1C, Blood pressure,

at Cholesterol

3kung ano ang dapat na target ng iyong ABC

3kung ano ang kailangang gawin upang maabot ang iyong targets

Adapted from www.ndep.nih.gov

Suriin ang mga paa araw-araw.I-check kung may paltos, sugat, pamumula o pamamaga. Kung hirap tingnan ang talampakan, gumamit ng salamin o patingnan sa iba. Isangguni agad sa doktor kung may problema.

Panatilihing malinis ang mga paa.Hugasan ang paa araw-araw. Gumamit ng maligamgam na tubig. Huwag gumamit ng mainit na tubig. Patuyuin ang paa pagkahugas, lalo na sa pagitan

ng mga daliri upang makaiwas sa alipunga.

Pahiran ng manipis na “moisturizer/cream” ang mga paa.Pahiran ng “moisturizer/cream” ang paa araw-araw upang mapanatiling malambot at makinis ang balat at hindi magka-crack o mangati. Huwag lagyan ng “moisturizer” o

“cream” ang pagitan ng mga daliri.

Huwag maglakad ng walang sapin sa paa.Kahit nasa loob ng bahay, laging magsuot ng tsinelas o sapatos upang maiwasang magkasugat.

Magsuot ng angkop at komportableng sapatosTingnan at siguraduhing walang matulis na bagay sa loob ng sapatos bago suotin. Magsuot ng malinis at tuyong medyas pag-magsasapatos.

Maingat na gupitin ang mga kuko. Gupitin ang mga kuko ng tuwid at hindi pakurba. Gumamit ng nail file upang pumantay ang mga gilid. Huwag din masyadong maiksi ang paggupit upang maiwasan ang “ingrown”

Huwag piliting tanggalin ang kalyo. Isangguni ito sa doktor.

Hango sa…https://www.foothealthfacts.org (American College of Foot and Ankle Surgeons)http://www.diabetes.org/(American Diabeteds Association)

Elaine Cunanan, MD



Nagtapos si Dr. Alvin Rae Cenina ng kanyang Doctor of Medicine sa University of the Philippines College of Medicine at ng kaniyang Residency training sa Adult Neurology sa UP-Philippine General Hospital. Siya ay sumailalim at nagtapos ng Fellowship training sa Cognitive Neurology and Dementia sa National Neuroscience Institute sa Singapore. Si Dr. Cenina ay kasalukuyang Clinical Associate Professor at Consultant ng Department of Neurosciences sa UP-PGH at nagsisilbing head ng Brain Wellness & Memory Center ng Asian Hospital & Medical Center at Vice Chair ng Dementia Council ng Philippine Neurological Association. Siya ay administrator ng isang health education webpage: @pinoyBrainMD na nagbibigay ng impormasyon ukol sa brain health. Sa kanyang labis na pagmamahal sa neurology, siya ay nakipag-isang dibdib sa isa ring neurologist, si Dra. Dale Moll-Cenina.

Maaring sumangguni kay Dr. Cenina sa:• Asian Hospital & Medical Center. (Alabang Muntinlupa) Room 703. Phone. 8359019 • Brain Wellness & Memory Center. Phone. 9000-771 loc. 8444 • Manila East Medical Center. (Taytay Rizal) Room 508. Phone. 0000-660 loc. 7508 • Binangonan Lakeview Hospital (Binangonan Rizal) Phone. 9612-836

TANONG: Bakit nagkakaroon ng nerve damage ang mga diabetic?

SAGOT: Maraming posibleng komplikasyon ang pagkakaroon ng diabetes lalo na kung ang blood sugar ay hindi nakokontrol, at isa na dito ang nerve damage. Ayon sa pag-aaral, ang pagkakaroon ng nerve damage sa mga taong may diabetes ay sanhi ng metabolic changes at toxic na epekto na dulot ng hyperglycemia o mataas na blood sugar na nagdudulot ng oxidative stress na siyang nakakasira sa nerves. Nagkakaroon din ng pagkapal ng mga maliliit na blood vessel wall kaya kumokonti at pumapangit ang supply ng dugo at nutrients na nagdudulot ng perwisyo at unti- unting pagkasira sa iba’t ibang bahagi ng katawan kabilang na ang mga nerves. TANONG: Ano ang mga madalas na sintomas ng nerve damage sa diabetes?

SAGOT: Pamamanhid, malamig o mainit na pakiramdam, may tumutusok-tusok, o parang may dumadaloy na kuryente ang ilan sa mga madalas na inerereklamo ng mga pasyenteng may nerve problems. Minsan may kasamang sakit ang mga pakiramdam na ito na tinatawag nating nerve pain. Ang nerve pain ay naiiba sa katangian ng muscle / joint pain na karaniwang inilalarawan na mabigat o makirot at nakikita sa mga taong may arthritis, may mga pasa o sugat mula sa aksidente at iba pa.

Ang karaniwang unang naaapektuhan ng nerve damage sa diabetes ay ang mga talampakan ng paa at palad ng kamay. Kaya mainam na routine na nasusuri ang mga paa upang makita kung ito may mga sugat na hindi namamalayan ng pasyente sapagkat, kapag napabayaan, ito ay maaaring lumala at hindi na makakayanan ng antibiotiko. Ito ay maaaring mauwi sa pagputol ng paa o binti.

Minsan naaapektuhan din ang lakas ng muscle kapag nasira na din ang nerves para sa pagkilos. Maaaring lumiit at manghina ang mga muscle sa pagkakataong ito.

Hannah C. Urbanozo-Corpuz, MD

PANGINGIMAY, PANGANGAPAL, AT IBA PANG PROBLEMA SA NERVES NG

ISANG DIABETICPanayam kay Neurologist Dr. Alvin Rae Cenina


TANONG: Nagagamot pa ba ang nerve damage sa diabetes?

SAGOT: Kapag nadiagnose na ang isang tao ng “diabetic

neuropathy” matapos ang sapat na pagsusuri, ang damage sa nerves ay malabo nang ma-reverse. Habang ang katawan ay nagtatangkang i-repair ang na-damage na nerves, ang prosesong ito ay

mabagal at hindi sapat upang maibalik ang nerves sa dati nitong normal na estado.

TANONG: Paano ginagamot ang nerve damage sa diabetes? Maiiwasan ba ito?

SAGOT: Priority ang sugar control ng pasyente. Kung patuloy na mataas ang sugar, magpapatuloy pa rin ang damage sa nerves. Mapapababa ang tsansa ng nerve damage kung mananatiling maganda ang sugar sa tulong ng mga gamot pang diabetes, healthy na diet at exercise.

Para naman mabawasan ang nerve pain, may ilang gamot na maibibigay ang inyong doktor tulad ng Pregabalin at Gabapentin. Makatutulong ito sa mga nerve pain na may kasamang kuryente o tusok-tusok. Sa kasamaang palad, wala pang gamot na makatutulong para sa manhid o numbness.

TANONG: "Pre-diabetic palang ako - maari ba akong magkaroon ng nerve damage mula sa borderline high na blood sugars?"

SAGOT: Yes. Ang mga pasyenteng pre-diabetic pa lamang o may impaired glucose tolerance ay posible nang makaranas ng nerve damage dahil sa mas mataas na blood sugar kumpara sa normal. Ayon pa din sa mga pag- aaral, habang mas napapalapit sa normal na level ang blood sugar ay maaari pang makontrol ang sintomas ng pre-diabetic patients na may nerve damage. Kaya mahalaga na madiagnose ng maaga ang diabetes upang agarang magamot at maiwasan ang mga komplikasyon nito katulad ng nerve damage.



Jerico B. Guttierez, MD

1. Tama ang sukat Ang sapatos ay dapat mas mahaba ng 1-2cm kesa sa paa. Laging magsuot ng medyas.

2. Komportable isuot Ang espasyo sa loob ng sapatos ay kasing lapad ng pinakamalapad na parte ng paa.

3. Kayang protektahan ang paa Natatakluban ang paa. Hindi nasusugatan kung mabagsakan o makatapak ng anumang bagay.

Gabay sa pagpili ng tamang sapatos para sa may diabetes

Source: International Working Group on the Diabetic Foot (IWGDF), 2015.Isip et al. JAFES, May 2016. DOI:https://doi.org/10.15605/jafes.031.01.07

Wastong Paggupit ng Kuko para sa may DiabetesNapakahalaga ang pangangalaga sa paa upang maiwasan ang pagkaputol nito.

Isang paraan nito ay ang tamang paggupit ng mga kuko

Deretso ang gupit ng kuko. Huwag gupitin ang mga

sulok upang hindi maging pabilog o patusok ang kuko.

Masyadong maiksi Pabilog Patusok

Tama Mali

Paalala: agad na kumunsulta sa doktor kung may sugat sa paa, lalo na kung ito ay hindi gumagaling.


Ang info graphic na ito ay likha ni Dr. Jerico B. GutierrezAng mga larawan ng mga daliri ay binago mula sa orihinal na larawan ni Renne Cannon. Ito ay hango sa artikulong akda nila Heidelbaugh, Joel J.

and Hobart Lee, mula sa "Management of the ingrown toenail." American family physician 79 4 (2009): 303-8



Sarael S. Brobo Jr., M.D

DIABETIC EYE:Complications and Care

Out of the five senses, our vision seems to be of highest importance. Our eyes are the portals through which our brain sees the world, appreciates what is in it and makes

wonderful memories. Loss of vision not only negatively impacts the person with diabetes but his family as well. It leads to reduced quality of life and poses a high financial burden.

Eye diseases that may affect a person with diabetes are as follows: diabetic retinopathy, glaucoma and cataracts.

Glaucoma Glaucoma occurs when pressure builds up in the eye. The pressure causes drainage of the liquid inside the eyeball known as the aqueous humor to slow down so that it builds up in the anterior chamber of the eye increasing the pressure further. The increased pressure constricts the blood vessels supplying nutrients to the retina and optic nerve leading to gradual vision loss. There are drugs that can be used to reduce pressure in the eye, however, if pressure is not relieved, surgery may be required.

Cataract People with diabetes more likely to develop this eye condition than those without. People with diabetes also tend to get cataracts at a younger age and have them progress faster. With cataracts, the eye's clear lens clouds, blocking light.For cataracts that interfere greatly with vision, doctors usually remove the lens of the eye.

Sometimes the patient gets a new transplanted lens. In people with diabetes, retinopathy can get worse after removal of the lens, and glaucoma may start to develop.

Diabetic Retinopathy One of the conditions that may affect the eyes of a person with diabetes

is termed “diabetic retinopathy”. It is is categorized into two stages, the

nonproliferative and proliferative. Nonproliferative retinopathy is

the early stage in which small blood vessels at the back of the eye balloon and form

pouches and may lose their ability to control the passage of substances between the blood and the retina. Fluid then may leak into the macula, the part of the eye where focusing occurs. When the macula swells with fluid, vision blurs and can be lost entirely, this condition is called macular edema. In some people, retinopathy progresses to a more serious form after several years, this is called the proliferative stage. The blood vessels become blocked because of further damage. Consequently, new blood vessels start to grow in the retina. These blood vessels are weak and can bleed. If bleeding occurs in the macula, vision is blocked leading to

blindness. Eventually scar tissues form. The scarring can pull the retina out of position, a condition called retinal detachment.

Who are prone to develop these diabetic eye diseases? Factors that can lead to development of these diabetic eye diseases include uncontrolled blood sugar, hypertension, and high cholesterol. The longer you've had uncontrolled diabetes, the more likely you are to have these conditions as well. Intensive diabetes management achieving near-normal sugar level will prevent or delay the onset and progression of diabetic retinopathy and potentially improve visual function.

How should I be screened if I have diabetes? In its early stage, diabetic retinopathy may not have any symptoms, thus screening is advocated. An ophthalmologist who is knowledgeable and experienced in diagnosing diabetic retinopathy should perform the examinations. A person with diabetes should have an initial eye screening at the time of diagnosis and at least yearly thereafter. Since pregnancy is associated with a rapid progression of diabetic retinopathy, eye checkup should be done before conception, once in each trimester and one examination 2 months after delivery in pregnant diabetics.

How do I prevent diabetic eye disease? It has been proven that optimum blood sugar, blood pressure and cholesterol control lowers the risk or slows the progression of diabetic retinopathy. Therefore, compliance to medications, regular check up and a healthy lifestyle are of utmost importance. Once diabetic retinopathy is confirmed, treatments such as laser photocoagulation, vitrectomy and anti-vascular endothelial growth factor (anti-VEGF) eye injection can be offered as it may prevent blindness in most patients. In photocoagulation, the ophthalmologist makes tiny burns on the retina with a special laser. These burns seal the blood vessels and stop them from growing and leaking. In cases where the retina has already detached or a lot of blood has leaked into the eye, surgical vitrectomy is needed. This procedure

involves removal of scar tissue and cloudy fluid from inside the eye.

Vascular endothelial growth factor (VEGF) is a hormone that promotes the growth of weak, leaky blood vessels in the retina. A newer treatment which involves injection of an anti-VEGF drug directly into the eye can stop the growth of these weak blood vessels thereby improving vision. In many cases, these treatments may need to be repeated every few months. The earlier retinopathy is detected, the more likely these treatments will be successful and the best results occur when sight is still normal.

Common misconceptionsand facts

1. "I can still see clearly, I don't need eye consult." Visual clarity does not necessarily mean that you do not have the disease. Retinopathy may have already set in before you notice any change in your vision. Most patients with nonproliferative retinopathy have no symptoms. Even with proliferative retinopathy, the more advanced form, patients sometimes have no symptoms until it is too late to treat them. Because of this, diabetic patients need regular eye check up as recommended.

2. "Once treated, you are already healed." Once diabetic retinopathy sets in, it cannot be reversed to normal. However if proper treatment measures are taken, these may delay progression and prevent complications. Once complications are detected, these can be managed by photocoagulation, vitrectomy or anti-VGEF injection. It must be clear that the condition is lifelong thus repeated treatments should be expected.

3. "I cannot take aspirin anymore." Aspirin is an antiplatelet medicine which is commonly used for cardioprotection. While one of its side effects is bleeding, current data showed no increase in the risk of retinal hemorrhage. Therefore, aspirin can be safely taken if prescribed by your physician.

4. "Cataract surgery will improve my vision if I have diabetic retinopathy." Cataract is a clouding of the lens in the eye leading to poor vision, while diabetic retinopathy involves the retina. Thus, implanting a lens inside the eye will not solve all problems but only the affected lens and not the diseased retina. In fact in some cases after cataract surgery, diabetic retinopathy worsened. Blindness greatly affects a person's quality of life together with his family. Diabetic eye disease is the most common cause of blindness and it can be prevented and treated. Persons with diabetes should comply with their medications and have regular check ups in order to achieve optimum control of blood sugar, blood pressure and cholesterol. Regular screening should be done and if retinopathy is detected, different treatment modalities may be undertaken. Prevention is always the key, but if damage transpires, it can still be managed with proper consultation with an expert.

ReferencesStandards of Medical Care in Diabetes (2019, Jan). Diabetes Care. Volume 42, Supplement 1.Harshey, K (2019, Feb 1). Diabetic Retinopathy: Myths and Facts. Retrieved from https://www.practo.comEye Complications (2018, Nov 19). Retrieved from http://www.diabetes.org.Lee, et al (2015). Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision. 2:17Community Eye Health Online Course. Retrieved from http://www.uniteforsight.org




Ria Mari Sebastian Siao, MD

Myth: Kidney disease in diabetes is rare.Fact: Diabetes is the #1 cause of kidney disease.

About one third of adults with diabetes will develop diabetic kidney disease.

How does diabetes cause kidney disease? High blood sugar levels can damage the blood vessels in the kidneys. Over time, they start to leak small amounts of protein (albumin) into the urine, affecting the kidneys’ job of removing waste products and extra fluid from the body. This is known as Diabetic Kidney Disease (DKD), Diabetic Nephropathy, or Chronic Kidney Disease (CKD). This progressive damage can lead to renal failure or end-stage renal disease (ESRD).

Myth: You’d know if you have kidney disease.Fact: Most people with diabetic kidney disease do not have symptoms. Kidney damage can begin 5 to 10 years before

symptoms start.

How can I tell if I have diabetic kidney disease? The kidneys try to compensate for the defective capillaries, so no symptoms are felt until almost all function is gone. For those with diabetes, regular screening should be done. Two key markers for kidney disease are urine albumin and estimated glomerular filtration rate (eGFR).

Urine albumin. The earliest sign of diabetic kidney disease is an increased excretion of albumin in the urine, measured by comparing the ratio of albumin to creatinine in a single urine sample. Kidney disease is present when urine contains more than 30 milligrams of albumin per gram of creatinine.

eGFR. This is calculated based on creatinine, a waste product. As creatinine levels in blood goes up, the eGFR goes down. Kidney disease is present when eGFR is less than 60 mL/min/1.73 m2.

The American Diabetes Association (ADA 2019) recommends:At least once a year, assess urinary albumin and eGFR in patients with type 1 diabetes with duration of >5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension.

In later stages of kidney disease, signs and symptoms may be present. Though the symptoms of kidney disease are not specific, these may include (but are not limited to): weight gain, swelling of feet, ankles, hands or eyes, increased need to urinate, worsening blood pressure control, difficulty concentrating, loss of appetite, nausea and vomiting, persistent itching, and fatigue.

Myth: There’s nothing you can do about getting kidney disease.

Fact: Most cases of kidney disease could be prevented.

Who Gets Kidney Disease? Not everyone with diabetes develops kidney disease. Risk factors include family history, poor blood glucose control, high blood pressure, smoking, and obesity.

Myths and Facts of Kidney Complications of Diabetes:

How to prevent it? The best way to prevent diabetic kidney disease is to keep blood glucose and blood pressure under control. Lifestyle habits like maintaining a healthy weight, keeping active, limiting salt and sodium in the diet, taking medicines as prescribed, and stopping smoking also can help to reach blood glucose and blood pressure goals.

Myth: Oral medications such as metformin destroy the kidneys.

Fact: Oral medicines for diabetes can keep your sugar level at a target range.

Antidiabetic medicines should be started as soon as a doctor advises, in order to prevent kidney damage and complications in the other organs.

How to treat Diabetic Kidney Disease? Early treatment by maintaining a healthy lifestyle and managing the diabetes and high blood pressure may prevent or slow disease progression and reduce the chance of complications.


A Primer for Patients

The American Diabetes Association (ADA 2019) recommends:

At least once a year, assess urinary albumin and eGFR in patients with type 1 diabetes with duration of >5 years, in all patients with type 2 diabetes, and in all patients

with comorbid hypertension.

Some of the treatment recommendations of the ADA

2019 for diabetic kidney disease include:

Blood pressure levels <140/90 mmHg are generally

recommended. Lower blood pressure targets (e.g.,

<130/80 mmHg) may be considered for patients based

on individual anticipated benefits and risks.

For those not on dialysis, dietary protein intake should

be approximately 0.8 g/kg body weight per day (the

recommended daily allowance). For patients on dialysis,

consider higher levels of dietary protein intake.

In nonpregnant patients with diabetes and hypertension,

either an ACE inhibitor or an angiotensin receptor blocker

is recommended for those with modestly elevated urinary

albumin-to-creatinine ratio (30–299 mg/g creatinine)

and is strongly recommended for those with urinary

albumin-to-creatinine ratio >300 mg/g creatinine and/

or estimated glomerular filtration rate <60 mL/min/1.73

m2.

Patients should be referred for evaluation for renal

replacement treatment if they have an estimated

glomerular filtration rate <30 mL/min/1.73 m2.



Sheryl N. Tugna, MD

Sa Pagkontrol ng Diabetes...

Ako ay nagsimula ng aking practice bilang isang Endocrinologist nung 2014. Ang bawat pasyente na may diabetes na nakikita ko

ay nagtatanong kung ano ba ang mabisang paraan para gumanda ang kanilang blood sugar. Dahil dyan, nakaisip ako ng apat na simple ngunit epektibong paraan upang makatulong na bumuti ang blood sugar. Parati ko din sinasabi na upang maging successful ang pag kontrol ng blood sugar, hindi maaaring alisin ang alin man sa apat na ito. Upang mas madaling tandaan , ito ay tinawag ko na APAT DAPAT. Ito ay binubuo ng pagkain ng wasto, ehersisyo, regular na paggagamot at regular check-up sa isang doktor na eksperto sa diabetes.

Karaniwan ng sinasabi ng mga pasyente na kaysa uminon ng gamot sa Diabetes, sila daw ay mag “diet and exercise” muna. Karaniwan din sinasabi kapag mataas ang kanilang blood sugar ay “napakain” lang daw sila. Totoo na importante ang wastong pagkain at ehersisyo sa pagpapababa ng blood sugar ngunit ito ay hindi sapat upang makontrol ang blood sugar.

1 2Pagkain ng Wasto EhersisyoAng masustansya at nasa oras na pagkain ay makakatulong upang maging normal ang blood sugar. Importante din na ang dami ng kain ay naaayon sa level ng activity ng isang tao. Ang isang taong parating kumikilos o naglalakad ay mangangailangan ng mas madaming enerhiya mula sa pagkain kaysa sa isang taong maghapon na nakaupo.

Piliin ang gulay, prutas, isda at mga pagkaing mataas ang “fiber”. Iwasan ang alak at beer, mga inuming matatamis gaya ng fruit juice , iced-tea, milk-tea at energy drink. Mas makakabuti ang pag-inom ng tubig.

Ang minsan na pagkonsulta sa isang nutritionist o dietitian ay makakatulong upang malaman ang bilang or portion ng pagkain na maaring makonsumo.

Ang ehersisyo ay napatunayang nakakapagpababa ng blood sugar dahil ito ay nakakatulong laban sa “insulin resistance.” Hindi kailangan gumastos upang makapag ehersisyo. Maaring magbisikleta, jogging o kaya ay mabilis na maglakad sa loob ng 30 minuto o higit pa araw-araw. Kung umuulan naman, maaring gawin ito sa loob ng bahay. Madaming exercise at dance videos sa youtube na maaring sundan. Siguraduhin din na ligtas ang pag-eehersisyo at hindi magkakasugat dahil dito.




Sa panahon ngayon, madami tayong nababasa tungkol sa gamot na mabisa o kaya paraan ng pagpapayat upang ma-kontrol ang Diabetes lalo na sa social media. Minsan ang mga payo

ay nanggagaling sa ating kamag-anak, kapitbahay, katrabaho o kaya sa ating paboritong artista. May mga kung ano-anong dahon, herbal, prutas at juice at iba pang supplement na

sinasabing mabisa daw na pampababa ng blood sugar. Ngunit lahat ba ito ay tama at dapat natin paniwalaan?

3 4Araw-araw na paggagamot Regular na pagkonsulta sa Diabetes doctor o endocrinologist

Ang araw-araw na paginom ng gamot o pagineksyon ng insulin ay napakaimportante sa pagpapanatili ng normal na blood sugar. Hindi madaling gawin ito ngunit lagi nating tandaan na ito ay makakatulong upang makaiwas sa komplikasyon dulot ng uncontrolled blood sugar. Kung sa tingin ay magastos ang pagbili ng gamot, ito ay mas maliit pa din kumpara sa perang

uubusin kung magka komplikasyon na. Maari namang kausapin ang inyong doktor para sa alternatibong gamot na mas mura.

Karaniwan kong nadidinig sa aking mga pasyente ang ilang mga haka-haka tungkol sa mga gamot sa diabetes gaya ng:

Ang regular na pagbisita sa doktor ay mahalagang bahagi ng “Apat Dapat.” Ang inyong doktor ay inyong gabay sa gamutan sa diabetes. Ang ilan sa mga sinisigurado ng doktor ay ang mga sumusunod :

- Pagkaroon ng normal na blood sugar, blood pressure at ch o lestero l .

- Ang pagkain ng wasto, regular na ehersisyo at pag-inom ng gamot. Kasama din dito ang paghihikayat na iwasan ang pag-inom ng alak at pan in igari lyo.

- Regular na pagcheck ng blood sugar

“Nakakasira ng bato o “kidney” ang Metformin”

Ang nakakasira ng bato o “kidney” ay ang mataas na blood sugar at

blood pressure. Ang side effect ng Metformin ay pagsakit ng tiyan o

kaya ay diarrhea.

“Kapag naka-insulin na ay malala na ang Diabetes”

Ang insulin ay isang uri ng gamot sa diabetes na iniineksyon sa

kadahilanang hindi ito maaring inumin. Sa taba ng katawan ito

nilalagay upang maging epektibo.

“Iniiwasan ko uminom ng gamot dahil may epekto ito sa atay”

Karamihan ng gamot ay hindi masama sa atay. Kung ito ay nireseta ng iyong doktor, ito ay tiyak na safe

sa iyo.

Ang pagkakaroon ng Diabetes ay hindi madali. Nandyan ang gastos sa pagbili ng gamot at blood tests. Kasama din dito ang pangamba ng pagkakaroon ng komplikasyon. Sa panahon na laganap ang social media ay madami tayong impormasyon na nababasa o nadidinig ngunit hindi lahat ay maaring paniwalaan lalo na kung ito ay may mga produktong binebenta o tinitinda. Madaming “Diabetes supplement” sa tindahan na hindi dumaan sa masusing pag-aaral kung tunay nga bang nakakapag-pababa ng blood sugar at kung ito ay safe na inumin.

Wala namang magic formula upang maging normal ang blood sugar. Talagang kailangan ang disiplina at tamang pag-gabay at desisyon upang maiwasan ang komplikasyon. Ang pagsunod sa apat na simpleng paraan ay malaki ang maitutulong upang manatiling aktibo at malakas sa kabila ng pagkakaroon ng Diabetes.




Paano kung isang araw, bigla nalang nagbago ang buhay mo sa

paraang hindi mo inaakala, dahil sa mga bagay na hindi mo naman pinili?

Simple lang naman ang gusto mo sa buhay. Hindi mo naman hinangad na sumikat o makamit ang labis na kayamanan. Gusto mo lang na makatapos ng kolehiyo sa suportang bigay ng ama mong namamasada ng tricycle at nanay mong namamasukan sa bahay ng ibang tao. Para isang araw, hindi na nila kailangan gawin yun para lang makakain ng tatlong beses sa isang araw.

Pero – bakit kaya ikaw pa ang napili ng tadhana, na pumasan ng ganitong karamdaman? Type 1 Diabetes Mellitus…sa edad na 16 years old. Kung kailan ang inaatupag ng mga kaibigan mo ay mga pimple nila, crush at GF nila, mga damit nilang ipapakita sa FB, mga grades nila…ikaw naman ilang beses nang itinakbo sa ER na pinaglalaban mo na ang buhay mo…

Na-iisip mo ba ang sarili mo sa ganitong sitwasyon? Imagine mo ngayon ang sarili mo noong ikaw ay 16 y/o, anong ginagawa mo noon? Tayo, sa imahinasyon lang natin mararanasan ang ganitong buhay. Pero para kay John Henry delos Santos, na ngayon ay 27 anyos na – ito ang katotohanan ng kanyang buhay.

Nakilala ko si John Henry sa isang charity hospital kung saan siya nagpapagamot. Pumayag siya na bisitahin namin siya sa kanilang tahanan sa isang barangay sa La Union. Payak ngunit malinis ang kanilang bahay. Sinalubong kami ng kanyang ina, si nanay Florida. Magayak sila sa pakikipag-usap pero may mga luha rin sa pagsagot ng ilang mga katanungan mula kay nanay Florida.

Nalaman namin na noong una, sinikap pa ng mag-anak na ipagamot si John


Henry sa pribadong institusyon. Subalit sa dami ng gastusin sa gamot at gamit sa pang-gagamot ng type 1 diabetes, nagpasya ang pamilya na magpatuloy ng pagpapagamot sa charity hospital na malapit sa kanila.

Nang tanungin si John Henry kung ano ang mga hilig niya, agad niyang sagot: “Basketball! Si Lebron James!” Dati palang mahilig sa basketball ang binata, bilang ang kanilang tahanan ay halos katabi lang ng isang basketball

pagkahilo at pagkawala ng malay. Ngunit hindi lamang ito ang naranasan ni John Henry – sapagkat minsang nag-agaw buhay na siya nang dahil sa hypoglycemia.

Ika ni Nanay Florida: “Biglaan nalang po (na mawawalan ng malay) – hindi na po niya mararamdaman yung mga gutom o hilo. Minsan kakakain lang niya bigla nalang syang walang malay, tapos pag chineck ko yung blood sugar niya, nasa 40 nalang pala, itatakbo ko na siya sa ospital pag ganoon.”

Hindi naman natakot si John Henry sa kanyang karamdaman, paano? “Alam ko naman na andiyan lang sina mama at papa, naaalagaan nila ako.” At ipinakita niya ang kabuuan ang loob sa pamamagitan ng pagtatapos sa kolehiyo noong 2013 bilang Bachelor of Science in Industrial Education sa Don Mariano Marcos Memorial State University.

“Teacher ka pala John Henry!” ika ko. “Opo.” Sagot niyang may hiya pa sa kaniyang pagngiti.

Ang Mandirigmang Salat sa Sandata:ISANG MUKHA NG TYPE 1 DIABETES

“Si John Henry, hindi iyan gaya ng ibang mga lalaki, yung ano, hindi ma-ano sa bahay…siya kasi, minsan, pag-uwi ko,

nagugulat ako na nalabhan na ang mga damit namin, hindi ko naman inutos. Mabait na anak si John, wala akong

pinroblema sa kanya.”

court. Ngayong mga araw na ito, mahirap na magbasketball para kay John Henry dala ng komplikasyon ng diabetes.

Dagdag ng kaniyang ina: “Si John Henry, hindi iyan gaya ng ibang mga lalaki, yung ano, hindi ma-ano sa bahay…siya kasi, minsan, pag-uwi ko, nagugulat ako na nalabhan na ang mga damit namin, hindi ko naman inutos. Mabait na anak si John, wala akong pinroblema sa kanya.”

Lumipas ang ilang taon at maraming karanasan sa sakit niya, nakasanayan na ni John Henry ang pagmomonitor ng kanyang blood sugars ng pito hanggang walong beses sa isang araw – kada bago kumain at matapos kumain, at tuwing may mararanasan siyang sintomas ng “hypoglycemia” – ang lubos na pagbaba ng blood sugar ng higit sa inaasahan. Ilan sa mga sintomas nito ay ang matinding gutom, pagpapawis ng malamig,

Photos: Allan D. Corpuz

Litrato ng pagtatapos sa BS in Industrial Education




Noong naging madalas ang pag-hahypoglycemia ni John Henry, napagtanto na mataas na pala rin ang kanyang creatinine, at bago pa roon ay napansin niyang mabula ang kanyang ihi at may kaunting pagmanas na sa kanyang mukha sa pag-gising palang sa umaga. Ipinaliwanag sa kanila noon na kakailanganin na ni John Henry mag dialysis. Subalit dahil sa lubos na kapos ang mag-anak, ipinagpasa-Diyos muna nila ang desisyon at umasang hindi pa mauuwi sa ganoon si John Henry.

Kasabay ng madalas na atake ng hypoglycemia, kinailangan ni Nanay Florida na tumigil sa pamamasukan bilang stay-in na kasambahay at tumanggap na lamang ng mga trabaho gaya ng labahin at paminsang stay-out na gawaing bahay para mas matutukan si John Henry.

Ngunit, nagkataon na isang gabi noong 2018, inatake ng matinding hypoglycemic episode si John Henry, nawalan ng malay sa bahay at tila ba tumigil sa paghinga pa. Hindi gaya ng dati na alam ni Nanay Florida na magigising pa ang kanyang anak. Mag-isa niya at dali-daling binuhat ang kanyang anak, isinakay sa tricycle at dinala sa regional hospital, kung saan siya ay napag-alamang “coded” – walang kusang hininga, walang BP, walang tibok ang puso – sa madaling salita, namatay si John Henry.

“Noong mga panahong iyon – sabi ko sa doktora sa ER – dok, kung wala na ang anak ko wag na natin pilitin. Iyak ako nang iyak, Diyos ko, hindi ko na alam ang desisyon ko. Mabuti nalang kilala ako nung doktor – isa sya sa mga dating doktor ni John Henry. Sabi niya noon sa akin – ‘Nanay, ako

ito, si Dra Mae, nanay, tubuhan natin si John Henry, gawin natin lahat!’ At heto doktora, alam naman natin ang nangyari - nabuhay siya, na-survive niya yun! Laking pasalamat ko na si Dra Mae ang nandoon nung gabing iyon.”

Matapos ang karanasang iyon, napagdesisyunan ng mag-anak na ituloy na ang pagpapadialysis. Dito lalong nabaon sa pinansyal na kahirapan ang mag-anak. Sa puntong ito lalong lumuha ang ina

nang kaniyang isalalay ang karanasan ng pangungutang kahit sa 5-6 na malaki ang interes at pagbebenta ng kung ano-ano para lang maitawid ang mga pangangailangan ng anak na may sakit.

Makikitang naghahalo ang awa at sakit sa mga mata ng binata habang pinakikinggan ang ina. Lahat ng damdamin, nakakubli sa ilalim ng tibay ng kanyang panlabas na anyo.

Matapos ang aming panayam, pinabaunan pa kami ng mag-anak ng kakanin, isa sa mga luto nilang binebenta. Naghanda pa rin sila, kahit na paulit-ulit ko nang sinabi na wag nang mag-abala. Binili nalang namin ang isang bilao.

Nang ako’y makabalik sa sasakyan kong komportable, hinayaan ko nang madurog ang puso ko ng tuluyan at di ko na napigilan ang pagluha, at tila naging napakababaw ng kung ano man ang pinoproblema ko noong mga panahong iyon.

Paano pa, paano pa kami m a k a k a t u l o n g ?

Siguro, isang paraan na ang paghayad ng kwento niya dito.

Siguro, tingnan natin si John Henry at ang kanyang magulang – mga mandirigmang salat sa sandata, na patuloy na lumalaban para mabuhay.

Bakit? Dahil para sa kanila, napakabuti ang mabuhay – sa kabila ng matinding kakulangan, nakikita nilang mabuti ang Diyos sa kabila ng lahat at sa kanilang mga mata, sapat na na

magkakasama silang mag-anak, ke maiksi o mahaba pang panahon ang ibigay sa kanila na sila ay buo pa. Sa kanilang isipan – hindi sila salat, basta kumpleto silang mag-anak.

Si John Henry ay isang tao na nasa sitwayson na maiintindihan ko kung nagkaroon na ng depresyon o gumawa man ng hindi kanaisnais dala ng galit o desperasyon. Subalit hindi siya ganito. Wala siyang bahid ng pagka-awa sa sarili o galit sa mundo. Wala siyang pinupulaan, o nirereklamo. Hindi niya nakikita ang katiwalian ng mundo, hindi siya naiinggit sa kung anong meron ang iba. Masyadong maiksi ang buhay para pag-isipan pa ang mga bagay na ganoon.

Marami tayong matututunan sa pagtingin kay John Henry at pagkilatis ng kung paano niya tinutugunan ang mga problema sa buhay – isang tunay na mandirigma.


Pag-anyaya ng mag-ina sa kanilang tahanan

Ang kakaning binebenta kapalit ng pambili ng gamot ni John Henry – “Hindi ko kinakain yan doktora.”

Pabirong sabi ni John Henry.



Melissa Claire K. Uy, MD

SweetenersNatural & Artificial

Sugar comes in many different forms. The one that is most commonly

used is table sugar, which is made by processing sugarcane. Another form of sugar is the high-fructose corn syrup, which is cheaper than table sugar and is commonly used in processed foods.

Non-caloric or low-calorie sweeteners are those that can be used instead of table sugar to help prevent or control weight gain. They do this by decreasing the total amount of calories that are being taken in.

Non-caloric high intensity sweeteners are regulated as food additives and are

free” candies, cookies, and chewing gums. They do not promote tooth decay since they are not fermentable by oral bacteria.

All of these artificial sweeteners may seem to provide a quick solution for people who crave sweets to help them lose weight and prevent diabetes, but

ReferencesStandards of Medical Care in Diabetes (2019, Jan). Diabetes Care. Volume 42, Supplement 1.Harshey, K (2019, Feb 1). Diabetic Retinopathy: Myths and Facts. Retrieved from https://www.practo.comEye Complications (2018, Nov 19). Retrieved from http://www.diabetes.org.Lee, et al (2015). Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision. 2:17Community Eye Health Online Course. Retrieved from http://www.uniteforsight.org

High-intensity Artificial Sweetener

Common Brand Name

Sweetness compared to table sugar

Acceptable daily intake (mg/kg/d)

Aspartame Equal 200x 50

Sucralose Splenda 600x 5

Acesulfame K Sweet One 200x 15

Neotame Newtame 7000-13,000x 0.3

Saccharin Sweet and Low 200-700x 15

Stevia Sweet Leaf 200-400x 4

Luo Han Guo Monk Fruit 100-250x Not Specified

approved for use by the Food and Drug Administration (FDA). These include aspartame, sucralose, acesulfame-k, neotame, saccharin and advantame. Other non-caloric sweeteners are Stevia and Luo Han Guo or monk fruit, which are designated as “Generally Recognized As Safe” (GRAS) by the FDA. These sweeteners are sweeter than table sugar but have zero calories. They are used to make diet drinks, baked goods, frozen desserts, candy and chewing gum. They can also be added to coffee or tea, or sprinkled on top of food.

Sugar alcohols such as sorbitol, xylitol, maltitol, lactitol, erythritol and glycerol, have lower calories than table sugar and are used primarily to sweeten “sugar

Unfortunately, since added sugar means extra calories and weight gain, it can lead to diabetes and increased levels of triglycerides in the blood.

One of the means by which diabetes can be prevented or delayed is by decreasing the intake of added sugars. The World Health Organization (WHO) recommends that people have to keep their sugar intake below 10% of their total energy needs per day and reduce it to 5% for even greater benefits. This amount is equivalent to less than a serving (250 mL) of commonly consumed sugary drinks like iced tea or sodas.

Natural Sweeteners are those that are produced by nature from fruits, vegetables, nuts, seeds and roots without added chemicals. Examples are raw honey, maple syrup and molasses. Raw honey is made by bees from the nectar of a flower and it contains antioxidants, one of which is Vitamin C. On the other hand, maple syrup comes from the sap of maple trees and contains fewer calories and a higher concentration of minerals than honey. Blackstrap molasses contain substantial amounts of calcium, magnesium, potassium and iron. Foods containing natural sugar, such as fruits, tend to be more nutritious compared to just plain table sugar – they may contain vitamins and fiber that helps in digestion and they may have a lower glycemic load. These are healthier alternatives and have less calories than table sugar, but be cautious! They can still lead to increases in blood sugar and promote weight gain if taken in large amounts.

caution should be exercised because sweetness that is not accompanied by other caloric content may only offer partial, but incomplete activation of the body’s food reward pathways. This leaves them still feeling hungry and looking for other food to eat. This may then lead to a heightened motivation to eat.

A miniscule amount of artificial sweetener produces a sweet taste comparable to table sugar, and people who routinely use artificial sweeteners may start to find less intensely sweet foods, such as fruits and vegetables, less appealing and unpalatable. Also, frequent intake of sweet food, even those that use artificial sweeteners, may actually encourage sweet cravings by activating pleasure centers in the brain and this may ultimately lead to addiction to sweets and sugar dependence from other foods.

Finally, we should always keep in mind that processed foods, which may contain sugar substitutes, generally don’t offer the same health benefits as fruits and vegetables. Also, taken in large quantities, sugar alcohol can actually increase blood sugar levels and cause abdominal discomfort, like flatulence, bloating and even diarrhea. In the end, limiting the consumption of any sweetener is still the best healthful move we can all make.

SweetenerSweetness

compared to table sugar

Kcal/g

Sorbitol 60% 2.5Xylitol 100% 2.5Maltitol 75% 2.7Lactitol 35% 2

Erythritol 70% 0.2Glycerol 40% 4





BUKANG BIBIG:

Mga Katanungan ng Diabetic sa Isang DentistaQuestions from Diabetic Patients answered by

Dentist Dr. Artemio R. Licos, Jr.

Si Dr. Artemio “Jhun” R. Licos, Jr. ay nagtapos ng Doctor of Dentistry sa University of Baguio at nagpatuloy sa pagaaral ng Master of Public Health at Doctor of Public Health sa Wako City, Japan. Siya ay kasalukuyang nagsisilbing Department Head ng Dental Medicine ng Ilocos Training and Regional Medical Center sa La Union. Siya ay nakapagtamo ng mga awards gaya ng Most Outstanding Public Health Dentist na ipinagkaloob ng Philippine Dental Association noong 2013 at ng National Gawad ng Pagkilala na ipinagkaloob ng Department of Health Central Office para sa kanyang public health service achievements at good job performance.

TANONG:Ano ang madalas na problema

ng ngipin o bibig ng isangtaong diabetic?

TANONG:Bakit bawal magpabunot ng

ngipin kapag mataas ang blood sugar ng pasyente?

SAGOT:Ang taong may diabetes ay mahina sa paglaban sa mga mikrobyong nagdudulot ng impeksyon sa bibig. Ang kadalasang resulta nito ay pagkakaroon ng impekyon sa gilagid, na kung hindi maagapan at mabigyan ng lunas, ay nagdudulot ng pag-uga o galaw ng ngipin sanhi ng pagkasira ng parte ng ngipin na sumusuporta sa ugat nito. Ito ang nagiging sanhi ng pagkawala ng ngipin. Isa pang nakikitang problema ay ang pagkakaroon ng nanunuyong bibig na nakakatulong din sa paglala ng impeksyon sa gilagid. Ang paghina ng daloy ng laway sa bibig, sanhi ng matataas na blood sugar ay maaaring maging dahilan rin ng pagkasira ng ngipin, dahil sa di matanggal na plaque at bacteria na nakakapit sa ngipin.

TANONG:May mga sintomas ba ang sakit

sa gilagid o ngipin ng isangmay diabetes?

SAGOT:Oo meron. Ito ay ang mga sumusunod: Una ay ang madalas na pananakit at pagdurugo ng gilagid kahit sa oras ng pagsisipilyo. Pangalawa, madalas na impeksyon sa gilagid na may kasamang nana o abcess. Pangatlo, pagkakaroon ng mabahong hininga dahil sa pagkakaroon ng impeksyon, sirang ngipin at paghina ng daloy ng laway sa bibig.

TANONG:Gaano ba dapat kadalas ang

check up sa dentista kung ako ay diabetic?

SAGOT:Ang rekomendasyon namin bilang dentists ay regular na pagpapacheck ng di bababa sa dalawang beses kada taon. Ito ay depende sa personal hygiene at diet ng pasyente.

TANONG:Paano maiiwasan ang

pagkakaroon ng komplikasyon ng ngipin o gilagid sa

pasyenteng may diabetes?

SAGOT:Ang regular na pagbisita at pagkonsulta sa dentista ay isang importanteng paraan upang makaiwas at mapigilan ang pagkaroon ng problema sa bibig na mauuwi sa komplikasyon kung ito ay napabayaan. Isa pa, ang pagsunod sa mga payo ng mga espesyalista ay kailangang sundin upang ang “treatment plan” sa paggamot sa problema sa bibig ng isang pasyente ay maging matagumpay.

SAGOT:Hangga’t maaari, iniiwasan ang pagbubunot ng ngipin sa pasyenteng may mataas na blood sugar sa kadahilanang maari itong magdulot ng komplikasyon pagkatapos ng pagbunot ng ngipin tulad ng pagkaantala sa paggaling ng nabunutan, pagkaroon ng “dry socket” o impeksyon sa buto kung saan nabunutan. Kadalasan kapag mataas ang blood sugar ng isang pasyente at gustong magpabunot ay pinapayuhang sumangguni sa kanilang doktor para sa medical clearance o pahintulot medikal.



Sweet Garllie Albert R. Tappan, MD

JUICING JUICES

and

Over the past few years, the cases of type 2 diabetes mellitus have significantly increased not just worldwide, but also within our country. It is considered as one of the top causes of death and

disabling complications such as blindness, kidney failure and amputations. That’s why it is very important for us to lower our risk of developing type 2 diabetes as well as the obesity associated with it. One way to do this is by reducing the consumption of sugar-sweetened beverages.

Many think that drinking fruit juices is a healthier option compared to drinking other sweetened drinks like softdrinks. But is this really true? Here we will try to debunk some of the myths and bring to light the real facts about fruit juice intake.

First, let us define some terms.1-6

Sugar-sweetened beverages (SSBs) – include any beverage with added sugar or other sweeteners, such as carbonated and non-carbonated softdrinks, fruitpunch, fruit juice concentrates, powdered drink mixes, and energy drinks. Sugar-sweetened beverages typically contain 140 to 150 kcal (around 35 to 37.5g of sugar) per 12-oz. (360mL) serving, and they are the largest sources of added sugars in a typical Westernized diet.

Fruit juice – can legally describe a product which is 100% fruit juice both in the UK and the USA. However, a juice made by reconstituting concentrate can still be called juice. Pure (100 %) fruit juices can be nutrient-dense foods providing potassium, magnesium, folate, calcium, vitamins A and C, and soluble fiber as well as an array of bioactive substances including carotenoids and flavonoids. Depending on regulations and trends, beverages listed as 100% juice may actually contain unlisted additives (eg. ethyl butyrate, ascorbic acid, and water).

Juice cocktail or juice drink (USA) – a blend of fruit juices with other ingredients, example, high-fructose corn syrup, also known as sugar-sweetened fruit juice. Fruit nectar (UK) – must contain at least 25 to 50% juice, depending on the fruit.

Juice concentrate – pasteurized juice that is juiced from the fruit then filtered through a processor that extracts water. With this process, the juice takes up less space when transported. Before packaging and marketing, water is added back into the concentrated juice and subsequently pasteurized. Pasteurization involves quickly heating the juice to kill any harmful bacteria.

What is the difference between juicing and blending? 74

increased risk of type 2 diabetes. It is still recommended that individuals should limit their intake of sugar-sweetened fruit juice to prevent the development of type 2 diabetes.

Myth: A juice with “no added sugar” means it is sugar-free. Fact: Juice containers may have commonly-printed labels stating that there is “no added sugar”, but it doesn’t mean that it is free of calories. The products may actually contain large amounts of naturally occurring sugars.10,11 Added sugars can be listed in the form of different ingredients such as corn syrup, high-fructose corn syrup, dextrose, and malt. Be sure to check the calorie content as well as the ingredients listed in the juice containers you are buying, especially if you are at risk for obesity or diabetes.

Myth: Juicing leads to a permanent, wholesome weight loss.Fact: Weight loss occurs if you burn more and consume lesser number of calories. For example, if your recommended total caloric intake in a day is 1800 calories, but you only consume 1500 calories of juice each day as part of your juicing regimen, then it is likely that you will lose weight because of the calorie deficit. However, once you resume your usual “normal diet,” you will probably regain part or all of the weight that you had lost. Sadly, a juice diet is also nutritionally unbalanced and may cause loss of muscle mass instead of fat mass. This can also lead to food cravings which could actually encourage you to eat more instaed of less, thus eventually leading to higher blood sugar levels.12 The Food and Nutrition Research Institute (FNRI) even reminds us that there is no single food that contains all the nutrients that our body needs so eating a variety of food ensures that daily nutritional needs are met. It is still best to consume the recommended daily serving of fruits and vegetables as part of a balanced diet and reduce overall calorie intake to lose weight healthily. When in doubt, consult your doctor and dietitian so they can plan with you a safe and healthy weight loss program that would best suit you.

Juicing Blending

Essentially removes all fibrous materials, leaving only the liquid of the fruits or vegetables; therefore these lack fiber

Blended fruits and vegetables retain all their FIBER

Provides a high glycemic index (GI) Leads to a lower insulin response

Highly concentrated; has more amounts of vitamins and nutrientsMay lead to faster absorption of sugar

Better for the general population since it may lead to healthy digestion and the fibrous parts also contain beneficial antioxidants

JUICING VERSUS BLENDING

In juicing, one may get more concentrated and easily-absorbed nutrients. However, it contains little to no fiber, and this is actually not good, since fiber is important for health and proper digestion. Soluble fiber dissolves in water and slows digestion, and this helps manage blood sugar levels. One study has also compared the presence of phytochemicals (antioxidant compounds with potential anti-cancer properties) in grapefruit juice vs. blended grapefruits and found that the blended fruit had higher concentration of this beneficial compound since it is primarily found in the fibrous membranes of the fruit.8

Myth: Juice has less sugar than sodas and does not raise sugar levels significantly. Fact: Sugar consumption is a major downside of both juicing and blending, says dietitian Kimberly Gomer, MS, RD, LDN. Both juices and smoothies can raise blood sugar – but the effects are more rapid and dramatic with juice. The pulp, skin, and fiber in blended fruits and veggies help increase the volume of the drink, so it is more filling, and this then limits your total calorie consumption. On the other hand, with juicing, you can consume the same amount of fruits and vegetables and still not feel satisfied. Also, some commercial fresh juices contain as much, or even more, sugar than sodas. It has been found that on average, fruit juices contain 45.5 grams of fructose per liter, not far off from the average of 50 grams per liter in sodas. Minute Maid apple juice was found to contain 66 grams of fructose per liter, higher than both Coca-Cola (62.5 grams per liter) and Dr. Pepper (61 grams per liter). Although smoothies may have less than these amounts, they still have significant levels that may lead to increased overall total caloric intake.7

Myth: Taking sugar-sweetened fruit juice is a healthier option, leading to a lower risk of developing type 2 diabetes, as compared to 100% fruit juice.Fact: In a study done reviewing intake of fruit juice and incidence of type 2 diabetes mellitus9, they found that a higher intake of sugar sweetened fruit juice was significantly associated with an

Drink/Brand Serving size

Calories Carbo-hydrates

Fat Protein

Activity Needed to Burn

Minutes of Cycling

Minutes of Running

Min./Hours of Cleaning

Fruit Juice Drink Concentrate, Mango

100 g 75 cal 100% 18 g 0% 0% 11 7 27 min.

Zesto Big 250 ml – Mango Drink 250 ml 100 cal 100% 25 g 0% 0% 15 10 36 min.

Fruit Juice Drink Concentrate, Calamansi

100 g 239 cal 100% 58 g 0% 0% 36 24 1.4 hours

WHAT IS IN YOUR JUICE?

Below are some common fruit juices that can be found in your nearby grocery store. Learn more about their contents.

Drink/Brand Caloriesper serving

Dietary Fibre per serving

Sugars per serving

Del Monte Quality Four Seasons Juice Drink, 1L; Serving size: 240 mL; Servings per container: 4

70 0 g 18 g

Del Monte 100% Pineapple Juice, Fiber-enriched, No Sugar Added, 240 mL can, Servings per container: 1

120 0 g 23 g

Minute Maid Pulpy Orange, 330 mL bottle; Servings per container: 1 143 - -

Tropicana Twister Juicy Pulp, 355 mL bottle; Serving per pack: 1 150 0 g 36 g

Oishi Smart C+ Lemon Squeeze Juice Drink, 350 mL bottle; Servings per container: 1 100 0 g 24 g

Harvey Fresh Apple Juice No Added Sugar, 2L

Servings per pack: 8; Serving Size 250 mL 500 - 27.5 g

Welch’s 100% Grape Juice, Concord Grape, No sugar added, 1.89L, Serving Size 237 mL, Servings per container: 8

140 0 g 36 g

Apple & Eve 100% Juice Cranberry juice & more, No Sugar Added, 1.89L, Serving size: 240 mL; Servings per container: 8

130 - 30 g

Zesto Mango Juice Drink, 200 mL, Servings per container: 1 80 0 g 20 g

**Based on 2002 Philippine RENI; Male 19 to 29 years old; ***Based on RDA 10th Edition, Food and Nutrition Board, National Research Council, Washington, DC for Adults Percent Daily Values on a 2,000 calorie diet.

You can visit http://www.myfitnesspal.com and type a specific juice or brand to determine its nutritional information, the number of calories it contains, and the duration of activity needed to burn those calories. Here are a few examples:

Myth: Juicing reduces the risk for type 2 diabetes as much as does whole fruit consumption. Fact: In 2013, a study was published in the British Medical Journal.13 In this study, the researchers looked at overall fruit consumption, consumption of individual fruits (grapes or raisins; peaches, plums, or apricots; prunes; bananas; cantaloupe; apples or pears; oranges; grapefruit; strawberries; and blueberries), as well as consumption of apple, orange, grapefruit, and “other” fruit juices. Their findings revealed that those who ate at least 2 servings each week of certain whole fruits – particularly blueberries, grapes, and apples – reduced their risk for type 2 diabetes mellitus by as much as 23% compared to those who ate less (<1 serving/month). On the contrary, those who consumed one or more servings of fruit juice each day increased their risk of developing type 2 diabetes by as much as 21%. They also found that taking 3 servings of whole fruits per week instead of juice resulted in a 7% reduction in diabetes risk. The fruits’ glycemic index (measure of how rapidly carbohydrates in a food raise blood sugar) did not prove to be a significant factor in determining a fruit’s association with type 2 diabetes risk. However, the high glycemic index of fruit juice – which passes through the digestive system more rapidly than fiber-rich fruit – may explain the positive link between juice consumption and increased diabetes risk.

When all is said and done, for a healthier and fitter YOU, the better choice is still to eat the fruit instead of drinking it’s juice, and to make sure that this is taken in the context of a balanced, calorie-appropriate diet supplemented with the proper amount of exercise.




Edelissa F. Payumo MD

P R E P A R I N G F O R

What is disaster preparedness?

Disaster preparedness refers to measures that we do to lessen or even prevent the ill effects of a disaster. For this topic, we will focus on two natural disasters that we periodically experience, earthquakes and floods.

Why do we need to prepare for these disasters?

First, these are events that we have no control. We can predict them but we cannot hold them off. The Philippines lies along the Pacific Rim of Fire, which is an area in the Pacific Ocean where a lot of earthquakes and volcanic eruptions occur. This causes our country to have frequent seismic and volcanic activities. There is also the threat of “The Big One”, a 7.2 or higher magnitude earthquake from the West Valley Fault that the Philippine Institute of Volcanology and Seismology (PHILVOCS) expects to occur anytime. On the other hand, the Philippines is also situated in a typhoon belt and welcomes more than 20 typhoons each year. Along with the rainy season because of the monsoons, our country has recurring problems of flooding.

Second, these calamities may cause severe damages to a community. The 7.8-magnitude earthquake that shook the cities of Baguio, Cabanatuan and Dagupan in 1990 killed more than 1600 people and caused 10 billion pesos in damages. The “Big One”, likewise, is predicted to result in the collapse of more than a 100,000 residential houses and the death of approximately 30,000 individuals. Recall also in 2009, Tropical Storm “Ondoy” caused vast floodings in Metro Manila and nearby provinces. This killed more than 500 people and caused 11 billion pesos in damages. Being prepared for such disasters can lead to

a reduction in casualties and damages.

How do we prepare for a possible disaster?

I have enumerated below some important things that will help us be prepared for earthquakes and floods alike.

• Keep yourself informed. Monitor the news for weather updates, warnings, and

advisories. Familiarize yourself with terms such as earthquake magnitude scale and rainfall warning system. These will give you a heads up for early evacuation before or immediately after the disaster.

• Evaluate and secure your residence or workplace.

Check the safety of your house against earthquake and floods. Secure heavy furniture and hanging objects and move essential items to the upper floor. Educate yourself on how to turn off main electrical switch and operate fire extinguishers. Fire most commonly happens after an earthquake while submerged electrical outlets and appliances may cause electrocution. Familiarize yourself with the floor plan or at least the emergency exits of your building.

• Prepare an emergency supply kit.

Your kit should include the following:• First aid kit• Food• Bottled water• Flashlight and spare

batteries• Battery-operated

r a d i o• Candles and matches

or lighter• Whistle• Blankets, spare clothes

and shoes• Toiletries

• Marker, pen and paper• Cash

Food should be ready to eat and stocks

should last for at least three days. Your emergency kit should be placed in an area where you can easily grab it in case of an emergency. Check the contents periodically for expiration.

• Secure important documents and have an emergency fund.

Important documents should be kept in a water-proof and fire-proof container. You can include here land titles, certificates, or even your priceless collection. You should also have enough savings that should at least cover three months’ worth of your household expenses. This will cover repairs and other expenses to help you get back after the disaster.

• Participate in emergency drills. This will allow you to know the

emergency evacuation plans of your workplace or your community. Familiarize yourself with the things you need to do during earthquake like “duck, cover and hold” and during floods like staying indoors.

Being prepared for any disaster will

give you more chances of surviving. It will also help you not to panic when it happens. They say that preparedness is the calm before, during and after the storm.

Source: pinoytekkie.wordpress.com

https://panahon.tv/



PHILIPPINE RED CROSS HOTLINE: 143OPERATIONS CENTER: (02) 790-2344 TO 45 0917-8068513

BFP MMDA PNP

DIRECT LINE

(02) 426-0219(02) 426-3812(02) 426-0246

HOTLINE

171HOTLINE136;(02) 882-4154 to 74METROBASE255PUBLIC SAFETY255FLOOD CONTROL(02) 882-0925

SEND

TXT PNP to 2920

ROAD SAFETY319ROAD EMERGENCY320

Bago BUMAHA

ü Alamin ang mga babala tungkol sa pagbaha at tiyaking alam ito ng buong pamilya. Makinig araw-araw sa ulat ng panahon (weather news update).ü Mag-imbak ng malinis na tubig.ü Maglaan ng pagkaing delata o mga hindi madaling mapanis.ü Magtabi ng flashlight at ekstrang baterya. Ilagay sa lugar na madaling hanapin kahit madilim.ü Isaayos ang mga mahalagang kagamitan upang hindi abutin ng baha.ü Maglaan ng lugar na malilipatan kung kailangang lisanin ang bahay.

Kung may BAHA

ü Isara o “turn OFF” ang “main switch” ng kuryente.ü Kung kinakailangang lumikas, isara ang lahat ng pinto at bintana.ü Kumain lamang ng pagkaing niluto nang mabuti. Takpan ang mga tirang pagkain.ü Iwasang lumusong o maligo sa tubig-baha upang maiwasan ang mga sakit na dulot nito

(tulad ng alipunga, galis, leptospirosis), at mga aksidente tulad ng pagkakuryente, paghulog sa imburnal, o pagkalunod.ü Magsuot ng botas kung kinakailangang lumusong sa tubig-baha.

Pagkatapos ng BAHA

ü Pagbalik sa tahanan, gumamit ng flashlight pagwalang-ilaw. Iwasan ang paggamit ng gasera o kandila dahil maaaring magdulot ito ng sunog.ü Ipagbigay alam ang mga putol na kawad ng kuryente sa tamang ahensya.ü Huwag buksan ang main switch ng kuryente o gamit na de-kuryente kung ito ay nabasa.

Paghanda saBAHA

P R E P A R I N G F O R

Infographic by Elaine Cunanan MD


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