Marissa Sanchez, a singer/ actress/comedian, has type 2 diabetes and admitted indulging in food before. She shares that she used to eat anything and everything she wanted and craved for, and most especially, she loved rice. But then, symptoms started appearing: blurry vision, constant and unusual thirst, and going on constant bathroom trips. That was the time it was confirmed that she was diabetic and was asked by her endocrinologist, Dr. Augusto Litonjua, to change her eating habits. Although she wasn’t able to kick her usual eating habits all at once, she says that once she was able to control her food intake, she began experiencing miracles in her diabetes management.

So is good eating habit the key to managing both type 1 and type 2 diabetes and prevent the onslaught of the disease’s dreaded complications? And could this be the answer to put off diabetes in pre-diabetics?

The “Right” Diet for Diabetic Patients
It is given that when one suffers from diabetes, that person must adhere to some changes in his or her lifestyle, especially when it comes to food. If in the past, you could satisfy your cravings with anything, having diabetes may mean that you’ll have to start looking for other means to fill those needs. Moderation is the key and may not always be easy to do. And although it is important to tweak eating habits, experts say that there is no one definite diet for every diabetic patient.

For Ms. Imelda Cardino, Life Member of the Nutritionist-Dietician’s Association of the Philippines (NDAP), every case of diabetes differs from others.”First, there is no such thing as a right diet since every individual’s needs have to be addressed. You should look into the medical condition first,” she explains.

There are also other factors that experts use as basis for meal plans for people with diabetes. Namely, medications, height, weight, physical activity, socioeconomic status, blood sugar levels (both fasting and post-meal) and usual meal patterns — these factors help pinpoint what is right for that individual.

According to Dr. Editha Arceo-Dalisay, chairman of the Nutrition Council of the Philippine Diabetes Association (PDA), individualization of every meal plan for diabetics is crucial. “The first rule in medical nutrition therapy in diabetes is to individualize, so it will depend. Like one, your height because we compute your total caloric requirement based on your height, based on your body build, based on your physical activity,” she shares.

And not only do those factors come into play, it also depends on what type of diabetes a person has. Ms. Cardino has something to say about this,”Una ang type 2 diabetics kailangan nito ang regularity ng meal intake. Ang type 1 diabetes kasi iba-iba ang age bracket, mahirap itong mag-develop ng specific meal pattern (First type 2 diabetics need regularity of meal intake. Type 1 diabetics differ in age bracket, so it is harder to develop a specific meal pattern),” she relates.

But she also clarifies that you cannot classify the type of diabetes a person has just because of age because there are kids as young as three years old who have type 2 diabetes.”Kaya kapag may bata, Pero he has type 2 diabetes ibang pattern na yan. Pero ang magiging major concern ay yung mga type 1 since nakadepende sa insulin yan. (If a kid therefore has type 2 diabetes, that requires a different meal pattern. The major concern is for type 1 diabetics because of their dependence on insulin.) That is a very important factor to consider in the timing and distribution of meals:’ she says.

Definitely sticking to a healthy diet could lead to good diabetes management, as the proper diet could help keep blood sugar levels at bay and prevent complications. Getting started on a healthy diet could also benefit pre-diabetics, as Dr. Dalisay says,”these are patients who are not yet diabetic but who in the future are likely to become diabetic.”

She says that pre-diabetes is a common problem nowadays and must be addressed the same way as diabetes. Dr. Dalisay assures that if a pre-diabetic eats right as early as now, it would greatly help in preventing diabetes.

It Takes Three to Tango
For managing diabetes, three is definitely not a crowd.The patient,the endocrinologist or diabetologist, and the nutritionist-dietician should form a cohesive circle to make everything work out. Ms. Cardino says that her role as nutritionist-dietician is to help motivate these patients in getting into the habit of eating right. “Even if whoever comes up with a very good ‘pattern’, that is, addressed all of the medical concerns, it is still up to the person to make that decision to follow the pattern:’ she shares.

Dr. Dalisay shares Ms. Cardino’s enthusiasm in motivating patients and also says that there should be no boundaries for a doctor and a nutritionist-dietician when working up a meal pattern for a patient. “I cannot say that the nutritionist can only do this much, or I can only do this much. If we cooperate, if we talk to each other, then there will be no boundaries between what we’re doing:’ she narrates.

Since both parties have agreed that they could work as a team, both have also established that patients and their caregivers or a family member should be there during the whole process of making a meal plan. “The success of the treatment will actually depend on the person and the people around him no supportive:’ says Ms. Cardino.

However, Ms. Cardino adds that not only is it hard to make patients comply with the meal plan, it is also hard to motivate them to exercise.”We encourage them to change their habits for the better. But one factor they really find it difficult to adhere to is exercise:’ she says. She adds that not all people could exercise, but it is the little things you do within the day that helps.”In fact, experts say that any kind of activity you do within the 24-hour period helps:’ she adds.

“Medical nutrition therapy is very easy to say but it’s the hardest thing for the patient to do:” describes Dr. Dalisay of the whole process. She emphasizes that making the patient understand the importance of what he or she is undergoing is important in making everything work out well. She also says that once patients see a positive outcome in their work, compliance will come naturally. “I think what we doctors should realize is that in the management of patients, one of our main goal is to improve quality of life. That is very important. If you improve their quality of life, they will comply,” she shares.

Therefore, it is highly important that a dialogue be done between the patient, the family and caregivers and between the nutritionist-dietician and the doctors to make it easier for the patients to understand. It is true that if one has full understanding of his or her situation,then he or she will follow everything there is to be followed. And if that person sees good results, it will not be hard for the person to continue with the habit.

Experts’ Advice
Following moderate eating habits can help patients with diabetes cope with the disease. Dr. Dalisay emphasizes that patients should not be afraid to talk to their doctors. “I think this is going to be a lifelong management. They [the patients] should tell their doctors what they like, what they don’t like and come to an understanding:’ she relates. She shares that there are some patients who just nod during consultation, but in reality don’t understand a word the doctor has said. And this should be highly avoided.

On the other hand, Ms. Cardino takes on the nutritionist-dietician’s point-of-view, by recommending what is healthy for the patients to eat. “Eat a high fiber diet, eat mostly polysaccharides (complex carbohydrates), make sure you eat fruits with a meal, avoid juices because they do not contain fiber, use alternative sweeteners instead of sugar whether white or brown,” she states.

Ms. Cardino also says that it is very important for these patients to read nutrition labels of the things they buy at the grocery. “It may be low in calorie but they have to look at the composition of the product or, it may be low in sugar but the fat or sodium content may not have been reduced,” she says.

Taking that Bold Step
To promote the importance of being aware that changing one’s lifestyle may mean a lot, especially for diabetics and pre-diabetics, different organizations have taken measures to get that message across. The Philippine Diabetes Association (PDA) has been giving lay fora and lay workshops to educate patients about their situation. “The PDA is very active in advocacy programs, programs which will improve the knowledge of patients about diabetes. Because a patient who is well-learned about diabetes is the patient who will comply and will have very little complications:’ shares Dr. Dalisay. She also adds that the publication of the PDA, Diabetes Watch,helps disseminate information, as doctors who are PDA members get it for free. “Meron kaming mga columns doon, you can ask something about diabetes and we regularly have recipes for diabetics,” she says.

Ms. Cardino adds that the Department of Health (DOH) has spearheaded a coalition called, Coalition for the Prevention of Non-Communicable Diseases. “There are 40 organizations that belong to that coalition and kasama yung PDA and NDAP. One of the things we are doing right now is we have opened dialogue with fast food chains:’ she says of the coalition.The coalition has been responsible for fast-foods now offering healthier food options like salads with low calorie dressings.

She also says that Diabetes Center Philippines, headed by Dr.Augusto D. Litonjua, has been training teams (of diabetes educators) for free. “What he does is he trains a diabetes teaching team for free na ang kondisyon ay they will put up a diabetes educational clinic in their own area. So dapat lahat ng members ng team, iisa long ang kanilang sinasabi,” she relates.

Seeing how much efforts these diabetes organizations go through just to be able to educate people is a bold move.With proper education and information dissemination, persons with diabetes could fully understand everything there is to know about diabetes, and will make it easier for them to follow all procedures given to him either by his endocrinologist/diabetologist and nutritionist.

A healthy diet is just one of the many things a diabetic should pay attention to, and as the experts say, proper diet could help prevent complications and make living with diabetes easier.

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