All About Diabetes

Exubera, manufactured by Pfizer, Inc., became the first inhaled insulin to get approval from the United States Food and Drug Administration (US FDA). The FDA approval came late January this year, giving the makers of Exubera license to market the product for the treatment of adults with type I and type 2 diabetes. It has been found in clinical trials that Exubera is as effective as short-acting insulin injections, and that it significantly improves blood sugar control when added to diabetes pills. (more…)

Pregnancy is generally perceived as the consummation of womanhood, an experience wherein the “RESULT” is excitedly anticipated despite morning sickness, altered food preferences and tolerance, the modification of daily routine and so many more. A few, even have to contend with balancing their blood sugars as well! In the US, approximately 7 percent of all pregnancies are complicated by gestational diabetes (GDM). Unfortunately, there are no figures locally.

A pregnant woman with elevated glucose levels has to check her blood sugar several times a day. Along with the daily testing is the dietary modification in order to sufficiently control the blood sugar. If she needs medication, insulin is the safest choice. Whether or not the woman is on insulin, regularity of food intake is of utmost importance. Contrary to the belief of many, dieting is not equated with hunger. How can you allow a pregnant woman starve? There is just the additional care in terms of food selection and choices until the baby is delivered. Weight gain should be similar to an “ordinary” pregnancy.

The diet for the pregnant woman has the usual everyday food except that foods with significant sugar content and excessive fat are omitted. Some basic dietary guidelines follow:

• Mealtimes must be regular, that is, taken at about the same time daily whether the woman is on insulin or not.
• The amount of food must be consistent, hence the reason for prescribing a calorie-computed diet. Both the average/usual pregestational weight and the actual weight are important in calculating the calorie target. Other factors also have to be considered (blood sugar level, food preferences, other medical concerns, etc.) in order to come up with the individual requirement. Hence, professional dietary consultation is necessary.
• Meals are divided into three major meals and snacks of which the most important is the bed time. It is recommended that the distance between the last meal and the next one must not be too far (longer than six to eight hours). Hence, the bed time snack is prescribed to shorten the distance between supper of the night before and breakfast the next morning.
• Fruits, which are simple carbohydrates, are more rapidly digested to form glucose compared to rice. When taken, they are best eaten WITH a major meal and are NOT suitable snacks. Moreover, the higher the fiber content, the better. This further means that juices, even if they are unsweetened or freshly squeezed are poor choices. Besides, one will need to extract from at least two or three pieces of fruit to get around ’1/4 to 1/2 standard cup undiluted juice. This number is already equivalent to the total maximum amount recommended in one day.
• Complex carbohydrates such as (whole grain) cereals, steamed (unpolished or brown/red) rice, noodles and pasta, root crops, whole kernel corn and others must be served in all meals, including snacks. However, since energy requirements are individual, no “recommended” amount may be mentioned. Meals must always contain a complex carbohydrate in order to prevent hypoglycemia or less than normal blood sugar level.
• Aside from plain water, fresh calamansi or lemon juice in dilute form may be served as tolerated. Definitely these beverages must be served unsweetened or sugar-free.
• Aspartame, a protein form of an artificial sweetener, is safe for pregnant women. However, it is best that one asks her attending physician for guidance.
• Vegetables may be taken as “fillers”, especially if they are green and leafy. Not only will these provide vitamins and minerals, they will also contribute fiber. Fiber helps significantly in keeping the after-meal blood sugar within normal limits.
• Meals may be made varied and appetizing by using spices and herbs as tolerated. Add them to anything to come up with exciting dishes: soups, salads, main courses, and side dishes. Mold the allowed fruit in unsweetened agaragar/gelatin and use food colors to make a visually attractive dessert with good fiber content.
• If the after-meal blood sugar is to be tested, please consume the food completely within 15 minutes. This is to “standardize” the distance between the start of the meal and the time the blood sample is to be drawn. Time starts when the first morsel of food is taken.
• “Visible” fat has to be removed: chicken skin, fatty portions of beef and pork, aligue and others. The portions of added fat in the form of cooking oil, mayonnaise, margarine/butter depend on the calorie allowance.

Diabetes educators from all over the country and their counterparts from the ASEAN region convened at the Grand Ballroom of Century Park Hotel, Manila last December 7, 2005 for a whole-day affair that served as a kick-off event for the 2005 ASEAN Federation of Endocrine Societies (AFES) Congress.

The whole-day convention dubbed Pearls of Wisdom (On Which Diabetes Educators Can Live By) illustrated the basics of diabetes management for both adults and children. The continuous sessions were dedicated to promoting the expertise of diabetes educators, ensuring the delivery of quality diabetes self-management training to diabetic patients and influencing them to live a healthy lifestyle through self management of diabetes and related conditions.

The sessions covered fundamental areas on the understanding of the importance of diet management, obesity and diabetes mellitus, behavior changes among diabetics, diabetes complications and therapeutic innovations in diabetes management. Renowned speakers from the Philippines as well as from other countries in the ASEAN region graced the convention.

Do you regularly have headaches? Does your heart race? Are you irritable before meals? Do you feel confused or unable to make a decision? Are you constantly hungry? Are you always tired? Like Hollywood celebrities Burt Reynolds and Merv Griffin, you may be suffering from hypoglycemia, popularly known as “low blood sugar.” (more…)

For the third time, the Philippines played host to the ASEAN Federation of Endocrine Societies (AFES) Congress, bringing together endocrinologists in the ASEAN region as well as from other parts of the world. With the theme “Linking Molecular and Clinical Endocrinology”, the 2005 AFES Congress took place at the Philippine International Convention Center from December 7 to 10, 2005.

Organized by the Philippine Society of Endocrinology and Metabolism (PSEM) and the Philippine Diabetic Association (PDA), the congress delivered a first-rate interdisciplinary program which helped in increasing the knowledge of researchers and clinicians in the field of endocrinology.

The convention was graced by some of the most respected physicians of the country who gave lectures on various topics relating to the care of diabetic patients and the management of diabetes. Some of the event’s speakers were Dr. Augusto Litonjua, President, Diabetes Center Philippines and Philippine Association for the Study of Overweight and Obesity; Dr. Ricardo Fernando, Founder and President of the Institute for Studies on Diabetes Foundation Incorporated; Dr. Mary Anne LimAbrahan, President, Philippine Lipid Society; Dr. Eva Cutiongco; Dr. Dante Morales; Dr. Leonardo Almeda; and Dr. Antonio Dans.

Pinky, 49, a type-2 diabetic and a doting mother of three has been complaining that she could not function well sexually. She is unable to reach orgasm, feels pain during intercourse and has dwindling interest in having a sexual experience. All along, she has thought of these as just menopausal symptoms, ignoring them although they have been causing her distress. But what she does not know is that she could be experiencing female sexual dysfunction.

Female Sexual Dysfunction
Among other dysfunctions, Female Sexual Dysfunction can be difficult to recognize. “There is no empirical standard by which to assess female sexual dysfunction,” says endocrinologist Dr. Mary Anne Lim-Abrahan during the 2005 ASEAN Federation of Endocrine Society Congress. Female Sexual Dysfunction (FSD) has no definite meaning until a urology group got together, looked at the physical, emotional and psychological factors that affect sexual responses.After studying these factors, the group came up with a definition that FSD is a disturbance or pain during sexual activity.

Although poorly defined, FSD is caused by many factors. Sexual dysfunction in women can be caused by changes in a woman’s sexual behavior that can occur after childbirth or menopause. Other factors that can impede sexual responses are dissatisfaction with any emotional, relational or physical facet of life, sexual inhibitions, stress, decreased levels of sex hormones and medical complications such as diabetes and atherosclerosis (hardening of the arteries).

The symptoms of FSD can be easily detected. It includes the lack of sexual desire, inability to achieve orgasm, difficulty in becoming aroused, and apprehension about sexual performance. Other symptoms are pain during intercourse or faiiure to derive pleasure from sex. The doctor may recommend a physical and psychosocial examination to diagnose FSD. They may also perform an extensive evaluation that may include the measurement of hormones, vaginal pH and genital vibratory perception thresholds in order to monitor responses to sexual stimulation. They may also use ultrasonography to measure blood flow to the reproductive organs.

Classification of Female Sexual Dysfunction
Female Sexual Dysfunctions, in general, can be classified as Lifelong (it has always been present), Acquired (at some point the woman was able to function normally), Situational (it occurs in some situations), and Generalized (it occurs regardless of the situation). Hypoactive Sexual Dysfunction happens when a female lacks sexual fantasies and thoughts that can trigger sexual activity. There is also a pervasive inhibition of sexual desire. This may be caused by chronic physical disease, depression due to hormone deficiency, and stress. It can also be caused by psychological impacts of life’s events.

A woman suffering from Sexual Arousal Disorder does not feel any erotic sensations and may even find physical contact offensive, or may find it pleasurable only to a certain point. Her vagina does not lubricate nor expand and she does not reach orgasm, which is the third stage in human sexual responses. But if she does reach it, there is an inability to achieve or maintain recurrence of the sexual excitement. “In our local dialect, we call it manhid,” adds Dr. Lim-Abrahan. On the other hand, women with Orgasmic Disorder may be very sexually aroused but fail to reach orgasm. Women may also have Sexual Pain Disorder and experience dyspareunia or pain in the genital area before, during or after intercourse. They may also experience vaginismus or the severe tightening of the vaginal muscles during attempted penetration.

Female Sexual Dysfunction and Diabetes

Aside from stress and depression brought about by diabetes, diabetic neuropathy* also causes female sexual dysfunction. Diabetes can damage sensitive nerve endings via the excess of glucose or sugar in the blood. Damaged nerves in the female genital area can reduce or interfere with the ability to feel sensation thus leading to a difficulty of achieving arousal and orgasm. Poor control of blood sugar can lead to tiredness and a lack of interest in sex. Also, women who suffer from poor blood glucose control are more prone to vaginal yeast infection, which can cause painful sex, as the yeasts thrive in high sugar environments.Thus, glucose management plays an important role in preventing nerve damage, and once a nerve has been destroyed, sensation can be rarely recovered.

Proper diet and exercise can help alleviate and prevent female sexual dysfunction. Having a diet that is low in saturated and trans-fats and high in good quality carbohydrates plus following a rigorous exercise plan can help improve circulation.With these measures,the blood flow to sexual organs may improve.

Make everyone’s favorite dessert with less of the sugar and more of the flavor.  We added a bit of brown sugar (use muscovado if you can find it) but the chocolate itself is a dark sweet sugar-free chocolate version.

Yield: 10 portions

Ingredients:

• 2 pieces eggs, beaten
• 1/4 cup brown sugar
• 1 teaspoon powdered gelatin
• 45 ml water, heated
• 100 grams sugar free dark sweet chocolate, chopped and melted over hot water
• 1 teaspoon coffee
• 3/4 cup heavy cream, frozen and whipped

Procedures:

1. Beat eggs with sugar over a double boiler.
2. Let gelatin bloom in 1/2 cup of hot water then add to rest of water.
3. Stir in gelatin mixture to eggs.
4. Carefully fold in melted chocolate and coffee. Stir to mix in chocolate.
5. Add cream and fold everything together.
6. Pour into ramekin molds and chill.

Nutrition Facts Per Serving:

• Calories (kcal) 129
• Carbohydrates (g) 9
• Protein (g) 3
• Fat (g) 9

Tomatoes are know as pomme l’amour or the fruit of love.  In this season of hearts, we put a twist to the classic tomata pasta lasagna by adding other “heart”-full of ingredients such as tuna and shrimps.  It’s an easy dish to make for two or two dozen.

Yield: 10 portions

Ingredients:

Tomato Sauce

• 1 tablespoon olive oil
• 5 pieces garlic cloves, minced
• 1/2 pc Onion, chopped
• 1/2 teaspoon oregano, dried
• 1/2 teaspoon thyme, dried
• 1/2 teaspoon tarragon, dried
• pepper
• 1 cup tomato sauce
• 1 cup water
• 1 can tuna chunks in water, drained
• 300 grams shrimps, skinned, deveined, cut into 1/2 inch slices

White Sauce

• 1 cup cottage cheese, low fat
• 1 cup mozzarella, grated
• 9 pieces no cook lasagna noodles
• 1/2 cup parmesan cheese

Procedures:

Tomato Sauce

1. Heat oil and saute garlic and onion.
2. Add dried herbs and saute.
3. Season with a pinch of pepper.
4. Add shrimps and cook until slightly cooked.
5. Add drained tuna.
6. Add tomato sauce and 1 cup water and let boil.
7. Set aside

White Sauce: combine two cheese and set aside.

Assembly:

1. Preheat oven to 375F.
2. Layer lasagna in a 9″ x 9″ square pyrex.
3. Pour tomato sauce in base about 2 tablespoons.
4. Place 3 layers of lasagna noodles.
5. Add tomato sauce (1/3 of remaining mixture).
6. Add white sauce mix (1/3).
7. Top with 3 layers of lasagna.
8. Continue until final layer.
9. Finish top with parmesan.
10. Bake in oven for 45 minutes

Nutrition Facts Per Serving:

• Calories (kcal) 305
• Carbohydrates (g) 34
• Protein (g) 22
• Fat (g) 9

Give your classic soup a twist by preparing it without the cream that everyone is accustomed to.  Instead, add more mushrooms that will increase the flavor.  Play around with other mushrooms that are available for the season.  The secret to this great-tasting soup is a good vegetable stock base.  It may take some time to make but can be used for a long time in the freezer.

Yield: 2 portions

Ingredients: Vegetable Stock (Base)

• 1 tablespoon olive oil
• 1 piece Onion, peeled and sliced
• 1 stalk celery, cut into 1″ segments
• 1 piece carrot, peeled and sliced
• 2 teaspoons thme, dried
• 1 teaspoon sage
• 1 bunch flat leaf parsley
• Freshly ground black pepper
• 1 1/2 liters water

Procedures:

1. Heat olive oil in a casserole.
2. Saute onions, celery and carrots for 5 minutes.
3. Add in thyme, sage and parsley.  Mix into vegetables and cook for another 2 minutes.
4. Add water and bring mixture to a boil.
5. Lower heat to a simmer and cook for 30 minutes.
6. Taste and adjust seasoning. Season with freshly ground black pepper only
7. Strain stock and set aside vegetable stock for future use.

Ingredients: Mushroom Soup

• 1 tablespoon unsalted butter
• 1/2 piece onion, chopped
• 1/4 cup fresh button mushrooms, sliced
• 1/4 cup fresh shiitake mushroom, sliced
• 1 tablespoon all purpose flour
• 2 cups vegetable stock, heated
• 1 tablespoon plain low fat yogurt

Procedures:

1. Saute butter over low fire and add onions.
2. Add mushrooms and saute.
3. Add flour on top and stir until mixture dries up.
4. Add vegetable stock and let mixture thicken.
5. Season with pepper if needed.
6. Transfer to blender/food processor and puree.
7. Pour mixture into 2 bowls and top with yogurt.

Nutrition Facts Per Serving:

• Calories (kcal) 249
• Carbohydrates (g) 43
• Protein (g) 8
• Fat (g) 5

Nothing will beat the “king” of salads when it comes to taste.  Invented by Caesar Cardini, an immigrant from Tijuana, Mexico in the 1920s for a group of Hollywood stars, its lasting flavors may have undergone some innovation, but this recipe still remains as close to the original as it was then.

Ingredients:

• 1 head Romaine Lettuce
• 1 pc egg yolk
• 1 anchovy fillet
• 1 teaspoon garlic, minced or pressed
• 1/2 teaspoon mustard (preferably Dijon or Dijon style)
• 3/4 cup olive oil
• 3/4 tablespoon fresh calamansi juice
• 1/2 teaspoon pepper

Procedures:

1. Wash and separate leaves for salad
2. Prepare dressing
3. Bring water to a boil and add egg to boiling water
4. Cook for one minute.  Remove pan and transfer to sink.  Run water over egg to let cool.
5. Break egg and separate yolk.  Discard white.
6. Whisk egg and add in anchovy, garlic and mustard.  Whisk until incorporated.
7. Add oil slowly and half of calamansi juice.
8. Whisk and add pepper to taste.
9. Taste and add more calamansi juice if needed.
10. Serve with lettuce

Nutrition Facts Per Serving:

• Calories (kcal) 371
• Carbohydrates (g) 2
• Protein (g) 3
• Fat (g) 39