Diabetes screening and Pre-Diabetes
Transcript
Title：Diabetes screening and Pre-Diabetes
Sub-heading: Diabetes screening and Pre-diabetes
Ms Chan: Good morning, Doctor.
Doctor: Good morning, Ms Chan. You're back for your annual check up today. Your record shows that you're 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 polycystic 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.
Sub-heading: 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 two 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 fibre. 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-fibre diet. With the help of fibre, 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 to a 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 to a lifestyle of regular exercise, you can then increase the frequency and duration of exercise in order to lose weight. It's also a good idea to exercise with one or 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 ischaemic heart 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's 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.
Sub-heading: 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.
Dietitian: 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 that Pre-Diabetes patients should evenly distribute their carbohydrate intake among their three main meals and snacks. They should also avoid foods and drinks 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 kilocalories per day. You can have 5 Carbohydrate Exchanges at each main meal and 1 Carbohydrate Exchange at each between-meal snack.
Dietitian: One 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're talking about a bowl of about 300 ml here.
Dietitian: If you don't want rice at a main meal, you can have 1 level bowl of 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 made with sugar or corn starch, so they'll increase our carbohydrate intake and affect blood sugar control. Baked rice, fried rice or noodles also contain lots of oil, so you'll gain weight if you have them frequently!
Ms Chan: Can I eat fruits? My favourite fruit is grapes.
Dietitian: Fruits are rich in nutrients. Pre-Diabetes patients can have fruits every day, but in moderate amount. Since fruits contain fructose, eating too much in one go will affect your blood sugar level. You should also avoid fruit juice.
Dietitian: You can eat whole fruits as a between-meal snack. Each portion should equal 1 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 or half a small banana, or 10 small grapes.
Ms Chan: So I can eat 10 small grapes as a snack and I should remember not to 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 that contains 1 Carbohydrate Exchange, which is 10 g of carbohydrates. Apart from fruits, you can also have half a slice of bread without crust, 2 pieces of soda crackers, or one-third of a corn cob.
Dietitian: Having milk or dairy products as snacks can increase your calcium intake. For example, you can have either 1 cup of 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 in mind 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 about 3 to 4 slices of meat.Apart from blood sugar control, Pre-Diabetes patients must also maintain a healthy weight. This will keep your blood pressure normal and 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 to worry 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 seafood should 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 fatty acids and is good for your heart.
Ms Chan: I usually steam or stew my meat and fish. Can I keep on doing that?
Dietitian: Absolutely! You can also stew and boil your food more often because these are low-fat cooking methods. Whether you're cooking your own food or dining out, you should avoid high-fat and high-sugar cooking methods, which include pan-frying, deep-frying, frying with sauce, cooking in sweet and 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 naturally the best choice. For other drinks, you should opt 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 list on 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 will affect your blood sugar levels!
Dietitian: Also, don't overdrink even if the products claim to be ‘low-sugar', ‘sugar-free' or ‘artificially sweetened'.
Dietitian: It is because those drinks still contain carbohydrates. Absorbing a lot of carbohydrates will increase your blood sugar levels!
Ms Chan: I see. So, I should avoid 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 leafy vegetables 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 increase the soup's carbohydrate content, so you should use them sparingly.
Ms Chan: Can I eat the soup ingredients?
Dietitian: For soup ingredients like root vegetables, starchy vegetables, dried beans and fruits, you should exchange their carbohydrate content with that of rice to control and limit your carbohydrate intake at each meal. Let me show you some examples of food that should be exchanged with 1 full tablespoon of rice. These include: 1 piece of potato equivalent to the size of an egg; 2 pieces of carrots, lotus roots or pumpkin 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.
Dietitian: Another thing: you should prepare soup with low-fat ingredients, such as tofu, dried scallops, dried octopus, chicken without skin, lean meat and fish tails.
Dietitian: 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 takes me out for dessert. What should I do then?
Dietitian: 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's even better than having sweet soup!
Dietitian: Good thinking!
Dietitian: 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 eat too much sweet foods. How about artificial sweeteners?
Dietitian: Artificial sweeteners make food taste sweeter. Using a small amount of them won't affect blood sugar levels under normal circumstances.
Dietitian: 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 dinner at 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!