All You Need To Know About Diabetes

WWW.INFOMED.COM.MY

ALL YOU NEED “Know
Diabetes,
TDOIKANBOWEATBEOUST No Diabetes”

“A Collaborative Project
with Taylor’s University
School of Pharmacy
Annual Public Health
Campaign”

- Risk Factors
- Sign & Symptoms
- Diagnosing Diabetes
- Complications
- Prevention
- Living with Diabetes
- Future Developments
- Tables & Charts for Keeping

Your Records

KDN PP 17588/12/2012(031493) SPECIAL EDITION

THE EDITORIAL TEAM

EDITOR
Mohan Manthiry

CONTRIBUTORS
Students, School of Pharmacy, Taylor’s University

Eileen Yeo Kong Hie Law Sok Ching, Loke Ren
Fong Caroline Zhang

Ong Yi Xian Tan Hui Peng, Tan Li Ying, Nisha Parveen
Chloe Canly Kaur

STUDENT ADVISOR
Dr. Jason Loo Siau Ee, School of Pharmacy, Taylor’s University Malaysia

CONSULTING EDITOR
Dr. Shalini Sandra Mohan, Consultant Endocrinologist, Western Australia

DESIGN
Racheal Lenita Pricilla

PRINTED BY
Percetakan Okid Sdn Bhd

KDN PP 17588/12/2012(031493)
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CONTENTS

4 7 25

TAYLOR’S SCHOOL OF THE SIGNS & LIVING WITH
PHARMACY ANNUAL SYMPTOMS DIABETES
PUBLIC HEALTH • Maintaining a Healthy
CAMPAIGN 8
• Public Health Campaign Diet: Keeping a Food
• TuPSS DIAGNOSING Journal, “Simple
DIABETES Food? Simply Good!”
5 • Exercise: Start Small
9 (Your under-10-
INTRODUCTION TO minutes Remedy)
DIABETES COMPLICATIONS OF • Treatment for Diabetic
• Background DIABETES Patients
• Statistics in the World • Diabetic Nephropathy • Self-monitoring:
• Diabetic Neuropathy Tracking your Blood
vs Malaysia • Diabetic Ulcer Sugar Level
• Diabetic Retinopathy • Regular Health
6 • Diabetic Heart Disease Checks
• PHARMACISTS
TYPE OF DIABETES 12 ROLES in helping
• Type I you/your loved ones
• Type II PREVENTING manage diabetes:
• Gestational diabetes DIABETES
• Myths Debunked 31
(Diabetes during • Maintaining a Healthy
Pregnancy) A GLIMPSE INTO
Diet: Knowing the THE FUTURE
7 Food Pyramid, DEVELOPMENTS
Glycemic Index FOR MANAGING
RISK FACTORS FOR Chart, Be a Smart DIABETES
GETTING DIABETES Shopper
• Type I • Exercise: BMI 33
• Type II Calculation, No Pain,
• Gestational diabetes No Gain (Your under- HEALTH GOAL
10-minutes Remedy)
(Diabetes during
Pregnancy)

TAYLOR’S SCHOOL OF
PHARMACY ANNUAL PUBLIC
HEALTH CAMPAIGN

THEME: KNOW DIABETES, NO DIABETES

The Public Health Campaign (PHC) proactive, one can protect themselves
is an annual project by the Malaysian and their loved ones from diabetes and
Pharmaceutical Student Association its consequences. For instance, knowing
(MyPSA) to all universities nationwide how to read nutritional labels, to cook
offering pharmacy courses. MyPSA is a healthier food, as well as equipping
non-profit association for students which themselves with the ability to recognise
consolidates the various local pharmacy the signs and symptoms of diabetes.
students’ society under one organization.
For those who have already been
This year, Taylor’s University will hold diagnosed with diabetes, proper
their Public Health Campaign with the management of diabetes will go a long
theme “Know Diabetes, No Diabetes,” way in ensuring a healthy life, and
focusing on diabetes awareness through diabetes-free complications. We are
prevention and management. We aim to convinced that the knowledge of diabetes
reduce health disparities in communities management is as equally important. Our
which are disproportionately burdened collaborators and we aim to impart this
by diabetes, to increase awareness of knowledge to the diabetic community
diabetes particularly among Malaysians and their families, teaching them how to
who may have undiagnosed diabetes, manage their medicines, monitor their
and to help those with diabetes to have blood sugar, making sure they have
an improved quality of life. We also aim proper foot care, and educate them on
to focus on young children as diabetes how to recognize symptoms that may
is seen to be affecting the younger warrant medical attention.
generation as well.
We hope and pray that our Public Health
Through our event, we aim to educate Campaign will make a lasting impression
the community on HOW to prevent and impact to the community. It is not a
diabetes. We believe that it is crucial for touch-and-go business when it comes
all to know and understand that by being to diabetes, as sustainability is always

4

important when dealing with chronic health. Most importantly, we want to thank
diseases. We believe that we can make YOU for being a part of our journey and
a change for the benefit of all Malaysians’ making all this possible!

TAYLOR’S UNIVERSITY PHARMACY STUDENTS’ SOCIETY (TUPSS)
TUPSS is a student society that is led by dedicated pharmacy students from Taylor’s
University to reach out to the community passionately. Hence our motto is to be
‘Inspired by Need, Driven by Passion.’ Through our very own student initiatives
such as “The Extra Mile Programme,” we aim to encourage students to be active in
uplifting local communities by going an extra mile to empower and aid others.

INTRODUCTION TO DIABETES

Background

Diabetes is a disease that occurs when pancreas. Insulin helps to transport

the blood sugar (also known as blood glucose into the cells. People with

glucose) is too high. Glucose diabetes produce little or no

comes from the food that insulin, or their bodies may

we eat and acts as our have become insensitive to

main source of energy. In the effects of insulin. As a

healthy people, their Although result, the glucose level

blood glucose level there is no cure in their blood remains

is controlled by a for diabetes, there are high and uncontrolled,

hormone called many ways to manage leading to long-term

insulin, which is diabetes effectively, health complications.

produced by the making it possible for

people with diabetes

to lead a perfectly

normal life.

5

Statistics: World vs. Malaysia decades. The unhealthy lifestyle has
widely practiced among the society and
According to World Health Organisation resulted in a significant rise in diabetes
(WHO), the global prevalence of diabetes rates, contributing to 37% of all diabetes
among adults aged 18 years old and cases in the world.
above has increased from 4.7% in 1980
to 8.5% in 2014. There are 422 million Very often we hear in the news that
people with diabetes around the world almost 1 in 5 Malaysian adults has
in 2014, and more than 60% of them are diabetes. Official statistics from Ministry
living in Asia. of Health has revealed that out of 32
million Malaysians, 657,839 people have
The Western Pacific region, which also diabetes, which includes both type 1 and
includes Malaysia, has experienced type 2 diabetes. The prevalence of type
industrialization and rapid socio- 2 diabetes reported in 2015 was 17.5%, a
economic growth over the past few figure which has doubled since 1996.

MORE THAN 253 MILLION PEOPLE WITH DIABETES
ARE LIVING IN ASIA….WHO 2014

TYPE OF DIABETES

Type 1 Diabetes Type 2 Diabetes

Type 1 diabetes is usually diagnosed in Type 2 diabetes is the most common type
children and young adults, although it of diabetes. Although it can develop at
can appear at any age. People with type any age, it is more commonly diagnosed
1 diabetes do not make enough insulin among older people who are overweight
on their own. This can happen when the and who have bad eating habits. In type
body’s immune system (which normally 2 diabetes, the body either becomes
fights infection) attacks and destroys their resistant to the effects of insulin or it
own pancreas cells that makes insulin. As does not produce enough insulin, which
a result, no insulin is produced. Hence, results in high blood glucose levels.
people with type 1 diabetes need to inject Hence, people with type 2 diabetes may
insulin every day as insulin helps to lower be treated with medications and may also
the amount of glucose in the blood. need to take insulin jab on their own if
their condition is severe.

6

Diabetes during pregnancy (Gestational diabetes)

Gestational diabetes is a type of diabetes that develops in
some women during pregnancy. It is usually diagnosed in the
24th to 28th week of pregnancy. In most cases, gestational
diabetes will resolve after the baby is born. However, there is a
higher chance for the mother to develop type 2 diabetes if they
have had gestational diabetes during pregnancy.

THE RISK THE SIGNS & SYMPTOMS
FACTORS FOR For early detection of diabetes,
GETTING DIABETES do take note if you experience
any of the following symptoms:
Type 1 Diabetes
• Increased frequency of
1. Family history of type 1 diabetes urination, particularly at night
2. High body weight (> 4kg) at birth
3. Rapid growth within first two years • Feel thirsty all the time
• Feel very tired easily
of life • Unexplained weight loss
4. High energy food intake especially • Blurred vision
• Wounds that take a long
disaccharides and sucrose
time to heal
Type 2 Diabetes
7
1. Age 45 or older
2. Family history of type 2 diabetes
3. Overweight or obese
4. High blood pressure
5. Low level of HDL (“good”)

cholesterol
6. Not physically active

Gestational Diabetes
(Diabetes during Pregnancy)

1. Body mass index >27 kg/m2
2. Previous history of Gestational

Diabetes Mellitus
3. History of high birth weight (>4 kg)
4. High blood pressure

DIAGNOSING DIABETES

If diabetes is suspected based on the are commonly used for diagnosis of

presence of the symptoms stated diabetes, one is oral glucose tolerance

above, you can seek advice from a test and another is Haemoglobin

pharmacist or consult a doctor A1c test.

regarding the tests to determine

your blood sugar level. To undergo oral glucose tolerance

test, you may need to fast for at least

One of the easiest and quickest way to 8 hours, and venous blood sample will

know your current blood glucose reading be taken for testing. The fasting blood

is by measuring your random blood glucose level of a normal individual will

glucose (after a meal) or fasting blood be below 6.1mmol/l, whereas patients

glucose level (before a meal) using a with diabetes will have fasting blood

glucose meter (finger- prick test). This glucose more than 7mmol/l. You will be

simple test takes merely 5 seconds. given 75g glucose to be taken orally

Fasting blood glucose greater than 6.1 and a second blood sample will be

mmol/L or random blood glucose greater taken after two hours (random blood

than 5.6 mmol/L may indicate glucose). The random

that the person might have blood glucose of patients

underlying diabetes and with diabetes will be more

requires more detailed tests than 11.1mmol/l while the

for diagnosis. Two tests HbA1c test normal target will be
is more specific below 7.8mmol/l.

and precise….is Haemoglobin A1c
(HbA1c) test is more
an overall picture of specific and precise
blood glucose control as it provides an

over the past three overall picture of blood
months.

glucose control over

the past three months.

A patient will be

diagnosed with Type 2

diabetes, if the HbA1c

result is more than or

equal to 6. 5%.

8

COMPLICATIONS OF DIABETES

The long-term effects of diabetes Symptoms of kidney damage are general
and may include:
Having diabetes is not a death sentence. • Changes in the amount and number of
In fact, with proper medical management,
weight loss and a healthy diet, symptoms times urine is passed
of the disease can be controlled • Blood in the urine
effectively. However, on the flip side, • Tiredness and loss of appetite
poorly managed diabetes may lead to
certain complications. It is important to detect diabetic kidney
disease early as early treatment can
Kidney Damage (Diabetic assist to increase the life of the kidneys. If
Nephropathy) you have diabetes, it is advisable that you
visit your doctor regularly so you can do
Each of your kidneys has millions of the proper tests. This may include:
functioning units called nephrons, which • A urine test to detect the presence
act as the filter for the kidneys. Diabetes
can damage these kidney filters and of protein in your urine. When your
cause a build-up of waste and fluids kidneys are damaged by diabetes, a
in the body, leading to diabetic kidney protein called albumin may leak into
disease or also known as diabetic your urine. This condition is known
nephropathy. as microalbuminuria and may lead to
fluid accumulation in the body causing
IF LEFT UNCHECKED, swelling in the legs and hands
PATIENTS • Blood test to estimate your kidney
WITH DIABETIC function
NEPHROPATHY MAY
END UP WITH KIDNEY Your kidney function is commonly
FAILURE AND EVEN measured using the Estimated
REQUIRE DIALYSIS. Glomerular Filtration Rate (eGFR), which
can be calculated by measuring the
level of a waste product called creatinine
in your blood. When your kidneys are
functioning well, they can remove
creatinine from the blood effectively. As
kidney function is damaged by diabetes,
the creatinine level in the blood may rise
and this usually would be an important
red flag for the doctor’s diagnosis.

9

Nerve Damage
(Diabetic Neuropathy)

Over a period, diabetes can damage your
nerves, which may lead to a condition
known as diabetic neuropathy. Depending
on the affected nerves, the symptoms of
diabetic neuropathy range from pain and
numbness in the extremities (commonly
the feet) to issues in the digestive system,
blood vessels and the heart.

The nerve damage caused by Foot Ulcers
diabetes commonly affects the
feet and legs first, followed by Another serious complication of advanced
the hands and arms. This form of diabetes is diabetic foot ulcers, which is a
nerve damage is found in nearly one-half consequence due to the loss of protective
of diabetic patients. sensation of the nerve. This is because
nerve damage can cause a lack of feeling
THE SIGNS OF SYMPTOMS in the feet resulting in cuts and sores
OF DIABETIC NEUROPATHY going unnoticed and eventually become
ARE NORMALLY: infected. The risk of infection is high as
• Numbness or reduced ability diabetes reduces blood flow to the feet and
slows down the wound healing process.
to sense pain or temperature Infections may spread to the bone and
changes cause tissue death known as gangrene. If
• A tingling or burning sensation left untreated, amputation of the foot, toe
(described to be felt like “pins or lower leg may need to be carried out to
and needles”) stop the infection from spreading.
• Sharp pains or cramps
• Increased sensitivity to touch PROPER FOOT CARE
– even the weight of bed sheet IS EXTREMELY
can be agonizing CRUCIAL FOR
• Muscle weakness DIABETIC PATIENTS.
• Serious foot problems such as
ulcers, infections and bone pain

10

Eye Damage
(Diabetic Retinopathy)

Diabetic retinopathy is another
complication of diabetes which
affects the eyes. It is caused
by damaged blood vessels of
the retina at the back of the
eyes, and usually it affects
both eyes. As a result of
diabetes, the tiny blood vessels
that nourish the retina may be
blocked, leading to damage to
the eye.

While it may be symptomless or only mild Diabetic Heart Disease
vision problem at first, the condition would
progress gradually and leads to diabetic According to the American Heart
retinopathy. Association, there is a strong
association between diabetes and
DIABETIC RETINOPATHY risk of heart disease.
SYMPTOMS INCLUDE:
• Spots or dark strings RELATIONSHIP BETWEEN
DIABETES AND RISK OF
floating in your vision HEART DISEASE:
(floaters) • Adults with diabetes are two
• Blurred vision
• Impaired colour vision to four times more likely to
• Dark or empty areas in the die from heart disease than
vision adults without diabetes.
• Vision loss • At least 68 percent of
people age 65 or older with
Regular eye examination, good control of diabetes die from some form
blood sugar and blood pressure, as well of heart disease, and 16% die
as early intervention for vision problem, of stroke.
can help to prevent severe vision loss.

11

High levels of blood glucose causes the changes to the structure and function of

formation of fatty deposits in the blood the heart. This increases the risk of heart

vessel walls and hence can reduce the diseases such as coronary heart disease,

blood flow and cause the blood vessels heart attacks, heart failure and stroke.

to harden over time. This condition

decreases the ability of the blood PREVENTING
vessels to stretch, increases DIABETES
the amount of fluids in the

body and causes an increase The most important way

in the blood pressure. someone can prevent

The combined factors of “Preventing diabetes is by living an active
high blood pressure and diabetes = lifestyle and eating a healthy
diabetes can change the Healthy diet + diet. However, there are
way the body responds to Active lifestyle” many misconceptions and
insulin and cause harmful myths about healthy food.

12

Myths Debunked There are several types of carbohydrates
such as sugar, sugar alcohol, starch and
The Truth about ‘No Sugar’ = dietary fibres.
‘No Carbohydrate’
Where Is It Found?
Do you know that some carbohydrates • Sugars are found naturally in food like
are a source of sugar?? This means that
just because something isn’t sweet, that fruits, vegetables and dairy products.
doesn’t mean it can’t lead to diabetes if • Sugar alcohols are found naturally in
not eaten in the right proportions.
small amount in a variety of fruits and
vegetables.
• Starches are found naturally in grains
(barley, brown rice, oats, wheat and
corn), vegetables (potatoes and
carrots), beans and peas (garbanzo
beans, kidney beans, lentils, and split
peas).
• Dietary fibres are found in whole
grain food (such as brown rice and
whole grain bread, cereals, pasta),
beans and peas, fruits, nuts and
seeds, vegetables.

13

CARBOHYDRATES

WHY DO WE NEED For energy!
CARBOHYDRATE IN

OUR DIET?

HOW ARE Carbohydrates are broken down into sugar
CARBOHYDRATES (glucose) before being absorbed into our body,
RELATED TO OUR providing about 4kcal per gram energy.
BLOOD GLUCOSE LEVEL?

HOW IS INSULIN Sugar (glucose) enters our body’s cells with the
RELATED TO OUR release of insulin from our pancreas. Glucose is used
BLOOD GLUCOSE as fuel energy for us to accomplish daily activities,
may it be a run or simple tasks such as breathing.
LEVEL?

LESS SUGAR? As we need glucose in our daily activities,
insufficient carbohydrate intake will result in low
blood glucose level, low energy and may lead to
low blood sugar (hypoglycaemia). Symptoms of
low blood sugar include dizziness, weakness, and
cold sweats.

MORE SUGAR? Unused glucose is converted to glycogen, which
stored in the liver and muscles. If more glucose is
consumed rather than being stored as glycogen, it
would be converted into fats, for long-term storage
of energy. (National Health Service, 2016)

HOW CAN WE BALANCE High fibre, starchy carbohydrates releases sugar into
THE CARBOHYDRATES the blood more slowly than sugary food and drinks.
WE EAT? Foods that are high in fibre also make you feel full
faster, ensuring you don’t eat too much!

14

Use the Nutrition Facts Label to monitor We often hear how people rave about
your consumption of total carbohydrates. brown rice is much more nutritional than
The Nutrition Facts Label on food white rice, but how true is this? Well, let’s
and beverage packages shows the find out today!
total carbohydrate in grams (g) and
the Percent Daily Value (%DV) of total Let’s get a little scientific. What is
carbohydrates per serving. rice? We all know that rice is a grain
that comes in a few different colours,
The Truth about Brown rice vs. normally seen as either white or brown.
White rice What makes rice its colour comes
down to the processing part which is
IF WHITE RICE WERE also known as milling. Brown rice is a
TO BE A CONTESTANT whole grain whereby it is made up of
ON “LET’S GET THESE three separate parts: the fibrous bran,
BLOOD SUGARS carb-rich endosperm and nutritious
SOARING” IT WOULD germ. Meanwhile, white rice is said to be
RECEIVE A STANDING ‘whitened’ as a result of brown rice being
OVATION.” subjected to heat and pressure causing
it to lose its precious germ and bran.
White rice has nothing but endosperm,
which puts it at a disadvantage when we
compare the nutritional values between
brown rice and white rice.

BROWN RICE IS
A WHOLE GRAIN
MADE UP OF THREE
SEPARATE PARTS:
THE FIBROUS
BRAN, CARB-RICH
ENDOSPERM AND
NUTRITIOUS GERM.

15

Now, we know why brown rice fibr
is so precious… but how can it holesterol
help my body???
eight
Here are some QUICK anti xidants
FACTS that you should know dia etes
about BROWN RICE! BROWN RICE

BROWN RICE

BROWN RICE CAN One of the reasons why people get diabetes is due
HELP DIA-BEAT-ES! to their high glycemic index (GI) diet. Glycemic
index indicates the relative ability of food to cause
a spike in our blood glucose level. Brown rice has
a lower GI of 10 to 20 percent less than white rice,
and that is good news!

BROWN RICE IS It is essential that we keep our body balanced in
A POWERFUL free radicals and antioxidants level.When free
NATURAL radicals overrule the antioxidants level in our

ANTIOXIDANT. body, we are more likely to fall sick as our immune
system guard is weak.

BROWN RICE Brown rice can help one to lose some weight
CAN HELP YOU TO to look “wow!”.This is because high fibre foods
like brown rice tend to be more filling, so you’re
LOOK “WOW!” likely to eat lesser. In a way, it helps to satisfy your
growling tummy with just a simple and small
portion of food!

16

The Truth About ‘Sugar-Free’ or alternatives in food and beverages
‘Zero Sugar’ marketed as “sugar-free’ or “diet”, including
soft drinks, baked goods, powdered
Artificial Sweeteners/ High-intensity drink mixes, candy, puddings, canned
sweeteners food, jams and jellies, dairy products, and
scores of other food and beverages in
What are artificial sweeteners? lower quantity because they are many
times sweeter than table sugar (sucrose)
Artificial sweeteners are commonly but contribute only a few to no calories.
used as sugar substitutes or sugar (U.S. Food and Drug Administration, 2017)

BROWN RICE IS rown rice contains a nutrient called niacin which
GOING TO GETYOUR can increase our “good” cholesterol, and at the
same time, bringing down our “bad” cholesterol.
CHOLESTEROL
DOWN.

BROWN RICE IS Wow, that is a lot of ‘e’ in the word fibre… but that
is to emphasize how rich brown rice is in fibre! Fibre
FIBREEEEE-RICH. can help to slow down the absorption of sugar and

therefore, it helps to improve our blood sugar levels.

17

How can I identify artificial sweeteners?

You can identify artificial sweeteners by reading the nutritional labels for additives.

Artificial Acceptable Daily Intake (ADI) Calorie
Sweeteners milligrams per body weight (kg) per day (kcal/g)

Aspartame (mg/kg bw/d) 4
Sucralose 0
50 0
Stevia*
5

4

Table 1: Artificial sweeteners available in Malaysia
*Inadequately tested (Malaysia Dietitians’ Association, n.d.)

(U.S. Food and Drug Administration, 2018)

Knowing the Food Pyramid

In a
nutshell, sugar-
free and zero-
sugar does not
mean there is no

sugar at all.

A balanced diet with controlled Maintaining a Healthy Diet: Knowing the
intake of carbohydrates and Food Pyramid, Glycemic Index Chart,
sugar can help to keep your Be a Smart Shopper
blood glucose level under
control and maintain a
good weight. It is rather
tough to follow a strict sugar-free
diet, what more to say living life without
any ‘sweetness,’ but it’s our body and
is our choice on how we choose to
live with it.

18

FOOD PYRAMID SIX GROUPS

GROUP 1 (Smallest) Fats, sweets, alcohol, potato chips Special occasions only

GROUP 2 (Meat & Chicken, beef, turkey, eggs, tofu, 4-6 oz per day in
Meat Substitutes) cheese, peanut butter divided portions

GROUP 3 (Milk) Dairy products 2-3 servings per day

GROUP 4 (Fruits) Apples, bananas, strawberries, oranges 2-4 servings per day

GROUP 5 (Vegetables) Cabbage, broccoli, cauliflower, carrots 3-5 servings per day

GROUP 6 (Largest) Grains, beans, starchy vegetables 6-11 servings per day

What is Glycaemic Index or GI? a low GI value (<55) are more slowly
digested, absorbed and metabolised
The Glycaemic index (GI) measures thus promote a lower and slower rise in
how quick or slow a carbohydrate- blood glucose.
containing food raises blood glucose
after consumption. Carbohydrates with

GLYCAEMIC INDEX CHART

Starch Vegetables Fruits Dairy Snack

Barley Low GI (55 or below)
Yam
Oat bran, raw Green peas Apple Milk, full fat Chocolate milk

Cabbage Watermelon Milk, skimmed Chocolate bar

Broccoli Pisang berangan Yoghurt Pizza
Tomatoes Curry puff
Pear Soy milk, drinks

Durian Custard Ice cream

19

Starch Vegetables Fruits Dairy Snack
Doughnut
Basmati Moderate GI (56 to 69)
Tosai with Waffles
chutney Boiled potato Papaya Sago porridge
Nasi lemak
Sultanas Hummus
Digestive biscuit
Raisins
Fried meehoon/ (Canada)
macaroni
High GI (70 and above)
Roti canai and Dates, dries
dhal curry
Pineapple
Glutinous and
white rice Lychee, canned
in syrup
Sweet potato

MyHEALTH Portal. (2018). Glycaemic Index & Glycaemic Load.
Retrieved from: http://pendidikanpesakit.myhealth.gov.my/en/glycaemic-index-and-glycaemic-load/

Be a smart shopper total of two cups in the container. If you
consume the whole container, you are
1. Serving size eating two servings.

“Serving Size” is the amount of the food 2. Calories (and Calories from Fat)
product, such as cups or pieces, that is
considered to be one portion. Calories is how much energy you get
E.g:  If the label says the serving size from a serving of the food product. For
is one cup and there are two servings example, if you consume the whole
per container, this means that there is a packet, then you are eating two servings

20

1
2

6
3

4

5

or 500 calories, and 220 calories will be Total Carbohydrate
coming from fat.
It is important to use total grams when
3. Limit these nutrients counting carbs rather just the grams of
sugar. If you are only looking at the sugar
Limiting the intake of total fat, saturated number, you may end up overeating
fat, trans fat, cholesterol and sodium can food such as grains that have no natural
help reduce the risk of certain diseases, or added sugar but do contain a lot of
such as heart disease, cancer, and high carbohydrates.
blood pressure.
• Dietary fibre: It is recommended to
4. Get enough of these nutrients consume about 25 grams per day for
women and 38 grams per day for men.
Take adequate amount of dietary fibres,
vitamin A, vitamin C, calcium, and iron in • Sugar alcohol (also known as
your diet! polyols) includes sorbitol, xylitol and
mannitol, have fewer calories than

21

sugars and starches. If a certain food U.S. Food and Drug Administration
contains these, it would be listed on (FDA) to help consumers determine the
the label as well. E.g.: The use of level of various nutrients in a standard
sugar alcohols in a product does not serving of food in relation to their
necessarily mean that the product is approximate requirement for it. The label
low in carbohydrate or calories. Same actually provides the %DV so that you
goes if a package says “sugar-free” on can see how much (what percentage)
the outside, it does not mean that it is a serving of the product contributes to
calorie or carbohydrate-free. reaching the DV.

Always remember to check the label for 6. Percent (%) Daily Value
the grams of carbohydrate and calories!
Each %DV tells us how much of the
5. Understand the footnote on the recommended daily intake for that
bottom particular nutrient is met by one serving
of the food.
There is an asterisk (*) after “% Daily
Value” that refers you to this footnote. For example, the DV for total fat based
It gives the Daily Values (DVs) for each on a 2,000 calorie diet is 65 grams. A
nutrient for diets of 2,000 and 2,500 food that has 12 grams of fat per serving
calories. The DV is the recommended would state the %DV is 18%. Thus, one
amount of that nutrient to be consumed serving of this food gives you 18% of the
each day. DVs were developed by the fat you should consume in one day.

1 serving % fat % fat allowance remaining
allowance
2 serving 82%
utilized
22 100%
0% 18%
total fat
allowance

% fat 36% % fat allowance remaining
allowance
64%
utilized 100%

0% total fat
allowance

Exercise: BMI Calculation,
No Pain, No Gain (Your under-
10-minutes Remedy)

Body Mass Index (BMI) Calculation:

• The Healthy BMI range: 18.5 to 24.9
• BMI applies to most adults between

18-65 years old.

BMI is NOT applied to: REASON
CATEGORIES
BMI doesn’t differentiate the weight from muscle
Bodybuilders/ mass or fat; so their BMI will be higher than usual.
Athletes

Elderly ( > 65 years old ) Muscle mass is lost while aging.
Children
& < 18 year-olds Growth isn’t complete yet.

Pregnant women Body composition changes during pregnancy and
lactation.Therefore, BMI is inaccurate.

BMI Formula: Body Weight (Kilograms)

Body Mass Index (BMI) = Height (Meters) x Height (Meters)

EXAMPLE OF BMI CALCULATION:
Simon is 172 cm and 65kg.
Simon’s height = 172 centimeters (cm) = 1.72 meters (m)
Simon’s weight = 65 kilograms (kg)
Simon’s BMI = 1.72m6 5xkg1.72m = 21.97

(Therefore, Simon’s BMI is within the healthy range!)

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No Pain, No Gain per day for at least four days in a week
is recommended. The magic behind this
Regular physical activity along with approach is that there is no need for the
proper meal planning, adherence to recommended 30 minutes of exercise to
medications, and a balanced stress be in one block of time.
level are crucial in the management of
diabetes. 30 minutes of physical activity

Your under-10-minutes Remedy:

1. Rock that Body!
(a) 12 exercises; 30 seconds each with up to 5 seconds between each exercise
(b) Gradually increase the number of sets of this series of 12 exercises; work up to

3 sets

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2. Get Low footed, then lift your toes off the
(a) Chair squats (1 minute): Sit in your ground several times
(k) Repeat (i) and (j)
no-wheels chair, then stand up using
just the lower body’s power. Squat 3. Get High
down until you just touch the seat, (a) Circle your arms at your sides in
then stand up again. Repeat. If that
doesn’t feel challenging, do the a big, controlled motion - forward
squats one leg at a time. (30 seconds) then backward
(b) Interlace fingers with arms extended (30 seconds)
behind your back to stretch your (b) Keep your back flat. With the right
chest (30 seconds) arm reached out forward, reach your
(c) Interlace fingers with arms extended left leg back. Alternate opposite arms
in front of you to stretch your and legs (1 minute)
shoulders and upper back (c) Push up (30 seconds)
(30 seconds) (d) Repeat (a), (b) and (c)
(d) Repeat (b) and (c) (e) Bridge pose (1 minute): Lie on your
(e) Step onto a sturdy, no-wheels chair or back, bend your knees so that your
do knee raises while standing on the feet remain flat on the floor, and raise
floor (1 minute) your hips off the ground. If that is too
(f) Reach above your head with your left easy, straighten one leg and hold it in
arm and lean to the right to stretch the air
your side (30 seconds) (f) Plank pose (1 minute)
(g) Reach above your head with your (g) Repeat (e) and (f)
right arm and lean to the left to (h) Superman’s pose (30 seconds): Lie
stretch your other side (30 seconds) flat on the stomach but lift your arms,
(h) Repeat (e), (f) and (g) legs and chest off the ground
(i) Calf raises (30 seconds): stand flat- (i) Child’s pose (30 seconds): Kneel
footed, then lift to your tiptoes several with forehead on the ground and
times. arms outstretched
(j) Heel rocks (30 seconds): stand flat- (j) Repeat (h) and (i)

LIVING WITH DIABETES

If you are already diagnosed with
diabetes, there are many things you can
do to keep your diabetes in check as
eating healthy, exercising regularly, taking
your medicines consistently, and going to
your doctor for check-ups regularly.

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Maintaining a Healthy Diet Keeping a Food Journal -
“Simple Food? Simply Good!”
THE AVERAGE
PERSON NEEDS Food journaling has been demonstrated
ABOUT 1600 - 2800 to be beneficial for diabetic patients. In
CALORIES PER DAY* our daily practices, chances are, we tend
to forget what we have eaten and how
*Women = Lower end of the calorie; much exactly we have eaten. It has been
Men = Middle to high end of the calorie shown that the more food records that
range; the more active, the higher the you keep, the more weight you can lose.
calorie intake needed. Similarly, this practice also helps with
better blood glucose control.

STEP 1 STEPS TO FOOD JOURNALING
STEP 2
Choose a journal that suits you

Record as you eat rather than at the end of the day;
make sure to include the snacks and light-bites.

STEP 3 Include a record of your emotions before and after the
meal; this helps to describe your eating habits accurately
and to prevent overeating.

STEP 4 Review trends; not just for the food but also how it affects
STEP 5 the blood glucose level.
STEP 6
React.

Always be truthful in your food journal; if you’re lying to your
food journal, you are only lying to yourself.

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SAMPLE FOOD JOURNAL

DATE TIME MEAL/INGREDIENTS QUANTITY NUTRITIONAL CONTENT MEDICATION BLOOD GLUCOSE
Carbs(g) Cals Fat Sugar Protein Fibre Pre meal 1 hr post 2 hr post

TOTAL AVERAGES

Exercise: Start Small (Your under-10-minutes Remedy)
Calories in, Calories out

10 minutes of walk after every meal; 3 meals per day = 30 minutes of exercise per day

Treatment for Type 2 Diabetes

The major goal in the treatment of Type 2 (b) Oral medications are prescribed
Diabetes is to control the blood glucose when these measures fail to control
levels within the normal range, with the high blood glucose levels in Type
minimal excursions to high or low levels. 2 diabetes patients.

In general, Type 2 Diabetes is treated (c) If and when oral medication
with: becomes ineffective in achieving
(a) Weight reduction, healthy diet targeted blood glucose levels,
treatment with insulin is initiated.
suitable for Type 2 diabetes patient
and exercise.

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Self-monitoring: Tracking your
Blood Glucose Level

If you have diabetes, it is important that Glucose monitoring kits can be
you monitor your blood glucose levels at purchased at pharmacies and are easy
home. By keeping your record, you can to use.
get a better idea of how effective your
diet and medications are in controlling Make sure to bring your records with your
your diabetes. when you visit your doctor!

SAMPLE BLOOD GLUCOSE MONITORING CHART

Diabetes Log (Week of )

BREAKFAST LUNCH DINNER BEDTIME
PRE POST PRE POST PRE
PRE POST

Date Blood Glucose
Date Carb Eaten
Date Insulin/Med
Date Exercise
Date Blood Glucose
Date Carb Eaten
Date Insulin/Med
Date Exercise
Date Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise
Blood Glucose
Carb Eaten
Insulin/Med
Exercise

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SAMPLE FOOD & BLOOD GLUCOSE DIARY

EVERYDAY REGULAR HEALTH CHECKS

Blood glucose test:
• 4.4- 7.0 mmol/L (Before meal)*
• 4.4- 8.5 mmol/L (After meal)*

ONE WEEK TO • Blood pressure: ≤135/75 mm Hg *
THREE MONTHS • HbA1c test: ≤6.5%*
CHECK-UPS

ANNUALLY Lipids Test:
• Triglycerides: ≤ 1.7 mmol/L*
• HDL- cholesterol (Good Cholesterol): >1.0mmol/L*
• LDL- cholesterol (Bad Cholesterol): >1.2 mmol/L*

*The target should be individualized for each patient, please consult the healthcare professionals.
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PHARMACISTS ROLE in helping QUICK FACT!
you and your loved ones to HbA1c (glycated
manage Diabetes haemoglobin) test
measures how well your

FACT: EVERY 1 IN 5 diabetes is being controlled.
MALAYSIANS HAVE It measures the average
DIABETES, IT IS level of blood glucose
over the past 2 to 3
months.

IMPORTANT TO GET CHECKED

1. We identify high-risk patients. 2. We provide pharmaceutical care.
• We’re the most accessible • You are our priority; we will
healthcare provider for patients. ensure the medications that you
• We carry out simple tests like take are safe and effective!
blood glucose testing, and it does • Feel free to ask us about
not cost a lot! complications and issues about
• If you are potentially diabetic, your medications, we will explain
we will direct you to appropriate it to you.
medical attention. • We will make sure you take your

30

medication as prescribed, no A GLIMPSE INTO THE
cheating! ;) FUTURE DEVELOPMENTS
• We are your one-stop information FOR MANAGING DIABETES
centre for side/adverse events,
do approach us if you think What now?
something is wrong after taking
your medication. We believe that the strongest voice
to share and spread the awareness
3. We provide patient-specific of diabetes lies greatly among the
tailored services, just for you! diabetic community, which includes
• We provide adherence strategies diabetic patients themselves as well as
• We teach you the right way to their families and friends. They are the
administer your Insulin, provide people who have walked through their
home glucose meter training journey in overcoming and managing
and monitor your diabetes diabetes, so in a way, they are much
treatment goals! more experienced than most of us who
• We perform a physical are not diabetic, nor have we experience
assessment of your feet, skin, it among our beloved. Therefore, how and
blood pressure, and weight; where the future trend of diabetes goes
and even diabetes and lipid should be empowered and driven by
management education. these group of people.
• We could guide you in planning a
diabetes-friendly diet for you
or your loved ones.

4. We provide blood glucose
management strategies
• We will advise you on monitoring
glucose levels and solutions on
how to manage out-of-range
levels. If blood sugar levels go
too low, fret not! We will help to
develop an action plan for you too!
• We select the most appropriate
hypoglycemic management
strategy on an individual basis.

“Your health will always be our number
one concern.”

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What are their thoughts? What do Malaysian diabetic
patients or friends and families
Let’s take a look at the voices of UK need?
diabetic patients! They think that diabetic
patients need: Potentially available treatment options
• More support for emotional and in the future!
Think positive! Our healthcare
psychological health. technology is advancing day by day.
• Better access to healthcare One breakthrough innovation which
has been approved by FDA US is the
professionals who understand
diabetes.
• Better access to technology and
treatments.
• Widely available information and
education
• More support and understanding at
work and school
• Hope for the future

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‘artificial pancreas.’ This medical device level of blood glucose from tears, a
closely mimics a ‘healthy pancreas’ by collaboration between Google and
continuously monitoring blood glucose Novartis.
level and works on subcutaneous delivery
of both rapid-acting insulin and glucagon Then we have ‘nutrigenomics,’ which
as directed by a computer algorithm, thus is based on the understanding that
is able to keep the blood sugar at the our genome gives information about
normal healthy levels. our individual needs, and it combines
genetics with nutritional science to
Another development is the digital deliver personalised meals for
contact lens that can measure the healthy living.

HEALTH GOALS

Your Plan of Action in the next 6 months

What do you want to achieve in the next 6 months?
Plan it and do it step by step!

Before After

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EDUCATE
ENABLE
EMBRACE
EMPOWER
INDIVIDUALS

For a sustainable and affordable
healthcare for ALL

Your
health

your
choice

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