Diabetes screening and Pre-Diabetes Ms Chan: Good morning, Doctor Doctor: Good morning, Ms ChanYou’re back for your annual check up today Your record shows that you are 50 years old Your body mass index, or BMI, is over 23 which means you’re overweight And your waist circumference is over 80 cm which means you’re centrally obese
Your age and obesity increase your risk of Diabetes I recommend that you have a blood test to check for Diabetes Ms Chan: You mean I may have Diabetes?Who may be at risk of this disease? Doctor: Diabetes is a common metabolic disease People at risk include those who are over 45 years old and are overweight or obese those who lead a sedentary lifestyle those with a family history of Diabetes for example, those with a parent or sibling who has Diabetes women with a history of Gestational Diabetes or who have given birth to a baby over 4 kg and women with a history of heart disease,stroke hypertension or poly cystic ovarian syndrome I would recommend that people with these risk factors have a blood test to check for Diabetes Ms Chan: I don’t feel sick,so I should be healthy, right? Doctor: Many Diabetes patients may show no symptoms at all Blood tests can help us diagnose and control this disease as early as possible Diabetes is a common chronic disease Persistently elevated blood sugar levels may lead to serious complications which may damage our eyes, kidneys,nerves, heart or blood vessels Ms Chan: I’m afraid of blood tests.
Can I just do a urine test? Doctor: The urine of Diabetes patients may not contain sugar so having only a urine test is not reliable We’ll first arrange a fasting blood test for you In the case of any abnormal readings,we’ll arrange a second blood test which is an oral glucose tolerance test Hence, a blood test is necessary to check if you have Diabetes or not The nurse will explain the details to you later Ms Chan: OK, then.
Please arrange the blood test Pre-Diabetes Ms Chan: Hi, Doctor Doctor: Hello, Ms Chan Let’s go over the report of your blood tests Neither the fasting blood test nor the oral glucose tolerance test shows that you have Diabetes However your blood sugar level is higher than normal which means you have Pre-Diabetes Pre-Diabetes patients can delay or prevent Diabetes by improving their diet and increasing their level of physical activity Otherwise, 15 to 30 percent of Pre-Diabetes patients will progress to Diabetes within 5 years Ms Chan: I don’t even eat that much sugar Why is my blood sugar level so high? Doctor: Usually our endocrine system can keep our blood sugar level stable The pancreas secretes insulin, which controls our blood sugar level and prevents drastic fluctuations caused by our diet However, if insulin secretion is insufficient or if sensitivity of the body’s cells to insulin decreases our blood sugar level may increase and even remain at a high level Being overweight or obese will decrease the sensitivity of the body’s cells to insulin so eating too much sugar is not the only cause of elevated blood sugar levels Ms Chan: I see So are there many people like me? Doctor: According to the Department of Health Population Health Survey 2014/2015 8 out of 100 Hong Kong people over 15 had Diabetes In a mainland survey about the prevalence rate of Diabetes it was found that 36 out of 100 people were Pre-Diabetic These show that Pre-Diabetes and Diabetes are very prevalent Ms Chan: My blood sugar level is just slightly higher than normal It hasn’t reached Diabetes-level yet So it should not affect my health a lot, right? Doctor: Not really! Persistently elevated blood sugar levels can gradually cause damage to small blood vessels and are particularly harmful to the eyes,kidneys, nerves, heart and blood vessels In severe cases, it can lead to hypertension,kidney impairment, neuropathy and retinopathy If you don’t manage your condition properly you may develop Diabetes which in turn increases the risks of heart disease, stroke and even death Ms Chan: Then how can I prevent Pre-Diabetes from becoming Diabetes? Doctor: There are ways to do that You can lose weight, increase your level of physical activity and improve your diet Research shows that,with an improved lifestyle the number of Pre-Diabetes patients who develop Diabetes can be reduced by more than 50%after 2 years Ms Chan: Then what should I do in my daily life Doctor: Start by improving your diet Control the size and timing of your meals Having small but frequent meals can prevent blood sugar levels from becoming drastically elevated When you feel thirsty, you should drink water, tea or sugar-free beverages Avoid sugary and soft drinks To maintain a balanced diet you should eat at regular hours and abide by the proportions indicated on the Healthy Eating Food Pyramid You should also control your intake of carbohydrates such as rice, noodles and bread at each meal Your diet should be low in fat,salt and sugar Ms Chan: Can I drink fruit juice? Doctor: No, please avoid fruit juice because it contains lots of fructose It’s better to eat fruit directly because fruits are rich in vitamins and fiber But avoid eating too much fruit in one go Ms Chan: Must I eat very little rice from now on? Doctor: If you restrict your rice or grain intake too severely you may feel dizzy as your blood sugar drops too low You should limit your intake to an appropriate amount Blood sugar levels can be stabilised by a high-fiber diet With the help of fiber your body will take a longer time to absorb carbohydrates, decreasing the demand for insulin You should eat more whole-grain food such as wheat bread, oatmeal,brown rice and red rice Include at least one bowl of vegetables squashes or mushrooms at lunch and at dinner Ms Chan: Do I need to lose weight? Doctor: Yes Weight loss can help improve control of your blood sugar levels and increase sensitivity of the body to insulin It allows the body to use insulin more effectively lowering the pancreas’s workload and the risk of Diabetes Since you’re overweight, losing weight is your prime task right now! A weight loss of 5 to 10 percent can prevent Pre-Diabetes from developing into Diabetes and even help you return toa normal blood sugar level Ms Chan: Then how can I lose weight? Doctor: In addition to maintaining a good diet, you should exercise more For at least 5 days a week you should take part in no less than 30 minutes of moderate-intensity physical activities These are activities during which you can speak but not sing such as speed walking and stair climbing You should also exercise for at least 10 consecutive minutes at different times during the day Don’t remain sedentary all day long Once you’ve adapted toa lifestyle of regular exercise you can then increase the frequency and duration of exercise in order to lose weight It is also a good idea to exercise with oneor two family members or friends and turn it into a habit Exercising is helpful for maintaining blood pressure blood lipids and cholesterol at normal levels thus lowering the risk of ischaemicheart disease and stroke Ms Chan: I see.
Doing exercise has lots of health benefits! Doctor: You’re right.
You must also remember to come back regularly for blood tests and follow-ups.
We need to monitor your blood sugar level and health condition to see if there is any improvement or if there’s progression to Diabetes Ms Chan: OK, I’ve got it Doctor: One more thing.
Avoid smoking or drinking in order to decrease the risk of developing cardiovascular diseases including ischaemic heart disease and stroke Doctor: I also encourage you to join a weight management workshop,which we hold regularly You should also see a dietitian in your community for individual consultations based on your diet and lifestyle I have a list of dietitians here for your reference Ms Chan: I will.
Thanks, Doctor Key points about how Pre-Diabetes patients should eat Narrator: Following the doctor’s advice Ms Chan met with a dietitian who reviewed her diet The dietitian also gave her some dietary tips for Pre-Diabetes patients Let’s check out their conversation Ms Chan: My doctor said my blood sugar level is too high which means I have Pre-Diabetes How should I adjust my diet? Dietitian: Pre-Diabetes patients must have regular meals and control how much they eat in each meal Having breakfast, lunch and dinner at regular hours every day is important for maintaining stable blood sugar levels This not only helps you control portion sizes but also helps you to avoid feeling hungry We tend to overeat when we are hungry which may lead to drastic fluctuations in blood sugar levels Dietitian: Apart from eating regularly, you must also control your carbohydrate intake Carbohydrates are found in several types of food including grains, dried beans,and starchy vegetables.
It also includes fructose found in fruits lactose found in milk and any sugars added to food All of them directly affect blood sugar levels Dietitian: So we suggest thatPre-Diabetes patients should evenly distribute their carbohydrate intake among their three main meals and snacks They should also avoid foods anddrinks with lots of added sugar and choose high-fibre foods to stabilise their blood sugar levels Ms Chan: Should I stop eating rice? Dietitian: No.
Having a moderate amount of grains at each meal can stabilise blood sugar levels You can choose grains that are high in fibre such as brown rice and oatmeal,to help you feel full longer Dietitian: On average, a woman needs about 1500 kilo calories per day You can have 5 Carbohydrate Exchanges at each main meal and 1 Carbohydrate Exchange at each between-meal snack.
Dietitian: 1 Carbohydrate Exchange is approximately 1 full tablespoon of cooked rice, which contains about 10 g of carbohydrates 5 Carbohydrate Exchanges are approximately 5 full tablespoons of cooked rice,or 1 level bowl of rice We are talking about a bowl of about 300 ml here Dietitian: If you don’t want rice ata main meal you can have 1 level bowlof rice noodles or 1 full bowl of egg noodles instead For an 8-slice–per-pound loaf of bread you can eat two and a half slices of bread without the crust Dietitian: Remember to avoid mixing gravies or sauce in rice or pasta dishes Gravies and sauces are madewith sugar or corn starch so they’ll increase our carbohydrate intake and affect blood sugar control Baked rice, fried rice or noodlesalso contain lots of oil so you’ll gain weight if youhave them frequently! Ms Chan: Can I eat fruits?My favourite fruit is grapes Dietitian: Fruits are rich in nutrients Pre-Diabetes patients can have fruitsevery day, but in moderate amount Since fruits contain fructose eating too much in one go willaffect your blood sugar level You should also avoid fruit juice Dietitian: You can eat whole fruitsas a between-meal snack Each portion should equal1 Carbohydrate Exchange which is about 10 g of carbohydrates Dietitian: For example, 1 small orange, either half a medium apple or pear,1 kiwifruit either 1 finger banana orhalf a small banana, or 10 small grapes Ms Chan: So I can eat10 small grapes as a snack and I should remember notto eat too much fruit in one go.
Dietitian: That’s right! Ms Chan: What other snacks can I eat? Dietitian: You can choose a snack thatcontains 1 Carbohydrate Exchange which is 10 g of carbohydrates.
Apart from fruits, you can also havehalf a slice of bread without crust 2 pieces of soda crackers,or one-third of a corn cob Dietitian: Having milk or dairy products assnacks can increase your calcium intake For example, you can have either 1 cupof 240 ml low-fat or skimmed milk or 1 tub of 150 ml low-fat low-sugar plain yoghurt Ms Chan: What about meat? What do I have to keep inmind when having meat? Dietitian: You can have 5–6 taels of meat,fish, eggs or their alternatives per day which is the same amount recommended for an average adult One tael of meat is about3 to 4 slices of meat Apart from blood sugar control Pre-Diabetes patients mustalso maintain a healthy weight This will keep your blood pressure normaland your heart and blood vessels healthy reducing the risk of cardiovascular disease Dietitian: When you cook meat,remember to trim off the skin and fat You should also avoid offals Dietitian: Choose fresh meat,fish or seafood and avoid those that are processed or preserved,so that you don’t consume too much salt Ms Chan: You don’t have toworry about that.
I seldom cook with sausage,luncheon meat or salted fish Dietitian: That’s great.
You should keep it up! Dietitian: Talking about fish remember that fish and seafoodshould also be included in your daily quota of 5–6 taels of meat You should choose more fish,especially oily fish which contains more omega-3 fattyacids and is good for your heart Ms Chan: I usually steam orstew my meat and fish Can I keep on doing that? Dietitian: Absolutely! You can also stew and boil your food moreoften because these are low-fatcooking methods Whether you are cooking your ownfood or dining out you should avoid high-fat andhigh-sugar cooking methods which include pan-frying, deep-frying frying with sauce, cooking in sweetand sour sauce, and braising in oil Ms Chan: What should I drink when I dine out?Is water my only choice? Dietitian: Plain water is naturallythe best choice For other drinks, you shouldopt for ‘no sugar’ Suitable drinks also included plain tea,lemon water or tea without sugar lime soda without sugar,and sparkling mineral water Ms Chan: What about packaged drinks? Dietitian: Pay attention to the food ingredients liston the package before you buy drinks Don’t buy drinks that contain sugar for example granulated or cane sugar or syrup because such high-sugar drinks willaffect your blood sugar levels! Also, don’t overdrink even if the products claimto be ‘low-sugar’, ‘sugar-free’ or ‘artificially sweetened’ It is because those drinks still contain carbohydrates Absorbing a lot of carbohydrates willincrease your blood sugar levels! Ms Chan: I see.
So, I shouldavoid any drinks with sugar Dietitian: That’s right Ms Chan: I have soup with my family every night.
What should I keep in mind regarding soup? Dietitian: Generally speaking, squashes, and leafyvegetables don’t increase the soup’s carbohydrate content so you can prepare soup with hairy gourd, loofah,spinach, tomato, or winter melon, for example Dietitian: Ingredients with higher sugar content such as dried dates preserved dates, figs and longans increasethe soup’s carbohydrate content so you should use them sparingly Ms Chan: Can I eat the soup ingredients? Dietitian: For soup ingredients like rootvegetables, starchy vegetables, dried beans and fruits you should exchange their carbohydratecontent with that of rice to control and limit your carbohydrateintake at each meal Let me show you some examples of food that should be exchanged with1 full tablespoon of rice These include: 1 piece of potatoequivalent to the size of an egg 2 pieces of carrots, lotus roots orpumpkin equivalent to the size of 2 eggs one-third piece of corn cob;2 chestnuts 4 level tablespoons of cooked dried beans one-third bowl of soaked vermicelli or mung bean threads Another thing: you should preparesoup with low-fat ingredients such as tofu, dried scallops, dried octopus,chicken without skin lean meat and fish tails Avoid high-fat ingredients like pork bone, chicken feet,chicken with skin and fish heads They affect your weight control Ms Chan: My daughter sometimes takesme out for dessert What should I do then? Sweet soups and desserts are usually made with lots of sugar and syrup so you should reduce the amount and frequency of eating them Try to discuss with your daughter and maybe sharing a dessert together in order to reduce your sugar intake Or you can enjoy some fresh fruits with your daughter as an alternative! Ms Chan: Sometimes I ask her to take a walk with me after dinner We have a chat and then go home to enjoy some fruits That is even better than having sweet soup! Dietitian: Good thinking!One more thing Chinese sweet soups often contain high-carbohydrate ingredients such as root vegetables fruits and dried beans When eating, you have to exchange them with other sources of carbohydrates Ms Chan: I know I can’t eattoo much sweet foods How about artificial sweeteners? Dietitian: Artificial sweeteners make food taste sweeter Using a small amount of them wouldn’t affect blood sugar levels under normal circumstances However, just because you are using artificial sweetener doesn’t mean you can forget about the existing carbohydrates in the food Overconsuming such food will still increase your blood sugar levels Ms Chan: Your detailed explanation has taught me a lot about dietary management Thank you! Narrator: Let’s recap how to delay or prevent Pre-Diabetes from developing into Diabetes The most important rules are lose weight, exercise more and improve your diet Here are the key points about how Pre-Diabetes patients should eat Have your meals: breakfast, lunch and dinnerat regular hours Have between-meal snacks in moderate amounts Control the carbohydrate content in meals and snacks Opt for high-fibre whole grains Eat more vegetables When eating soup ingredients like root vegetables starchy vegetables and dried beans exchange their carbohydrate content with that of rice to control your carbohydrate intake at that meal Avoid mixing gravies or sauce in rice or pasta dishes Avoid food and drinks with added sugar Have fruits, dairy products or their alternatives daily but control portion sizes properly and avoid fruit juice Have 5–6 taels of meat fish, eggs or their alternatives daily If possible, opt for fish more often and avoid fatty meat Pre-Diabetes patients can live a healthy and joyous life! All you need is an improved lifestyle and a good diet.