Diabetics can take control of lives

Maria Endah Hulupi, The Jakarta Post, Jakarta

For people with diabetes, the disorder is not the end of the world -- they have the power to help prevent the onset of possible health complications.

These include hypertension and heart disease, and even blindness, gangrene or kidney problems, nerve damage or impotence.

According to experts, people with diabetes can help prevent the complications by adopting four preventive pillars -- exercise, proper diet, education and medication.

"It is important to prevent the health complications of diabetes by adopting the four preventive pillars. However, before they adopt an adjusted lifestyle, diabetics should obtain comprehensive information on the disease from their physician," said Aris Wibudi, an internist from the Gatot Subroto Army hospital.

Most Indonesians with the disorder, Aries explained, suffer from type II diabetes, an inherited non-insulin dependency that is the most common form of the condition.

Type I diabetes, he added, is an insulin-dependent disease that usually develops from childhood or teenage years.

Some people, he said, develop diabetes after taking certain medication or steroids, while women may develop gestational diabetes during pregnancy.

"Gestational diabetes only occurs during pregnancy. However, studies show that 30 percent of women who develop it become real diabetics within six to 12 years," Aris said.

Diabetes is characterized by a chronic hyperglycemic condition (excess sugar in the blood) due to the body's failure to produce sufficient insulin or the body's resistance to it.

A proper and balanced diet plan, with a percentage of 60:20:20 carbohydrate, protein and fat respectively, needs to be introduced immediately.

"It is also advisable to ensure an adequate fiber intake, with a fiber-to-starch ratio of 3 to 1," Aris explained.

To avoid a sudden increase in blood-sugar level, he advised diabetics to focus on slow and sustainable released sugar like brown rice or corn, instead of white rice or white bread, for example.

The fat, he added, can best be obtained from mono-unsaturated fat sources like olive oil, sesame seed and certain types of bean. Protein can be supplied from lean meat, fish, eggs and tofu, for example.

Maintaining normal body weight is important and men especially need to avoid fat accumulation in the stomach.

"A big stomach may indicate insulinemia (abnormally high levels of insulin in the blood) and people with a big stomach are liable to develop diabetes in the next 10 to 20 years, because the body grows resistant to insulin," he warned.

A diet high in carbohydrates can also induce fat accumulation in the stomach and such a diet will also put an extra burden on the body to produce higher levels of insulin to balance the glucose level; this may lead to pancreas fatigue and/or insulin resistance.

Exercise is important to maintain or attain normal body weight and stave off possible complications such as cardiovascular diseases. Other sources have also said that exercise improves the utilization of insulin.

As part of efforts to maintain normal glucose levels and normal body weight, diabetics need to reduce their sugar intake and reduce consumption of sugar-loaded food and drink, like carbonated drinks.

Food expert from the Bogor Institute of Agriculture (IPB) Made Astawan explained that low-calorie synthetic sweeteners like saccharine, acesulfame potassium or aspartame can be used to enhance a sweet taste.

"Aspartame can be used to provide a sweet taste; it is about 200 times sweeter than sugar, but only 4 calories per gram," he said.

He also dismissed reports that aspartame poses health risks like lupus or blindness and affects brain function.

Aspartame, he added, has secured approvals from the U.S. Food and Drug Administration (FDA), the Joint Expert Committee on Food Additives (JECFA), the American Medical Association (AMA) and the American Diabetes Association (ADA) and has been added to various diet food and drinks, bread spreads, dairy products and multivitamins, several items in the long list of aspartame containing food.

He said that aspartame is safe except for people with a very rare inherited disease, phenylketonuria. According to Webster's Medical Desk Dictionary, this is an inherited metabolic disease in man that is characterized by inability to oxidize a metabolic product of phenylalanine and by severe mental deficiency.

"People with the disease need to avoid phenylalanine not only from aspartame-containing food but also from other sources, such as milk, eggs and salmon, for example," said the expert from the institute's department of food technology and human nutrition.