Having a strong family history of DM, I knew I have 67% risk of getting DM. So I always try my best to maintain a healthy lifestyle. On the odd day, I will still have a few cheat days. But I did not expect the bad news to come so early. During my second pregnancy, I was diagnosed with Gestational DM. Read more about GDM here.
I felt really depressed and started with calorie counting and carbohydrate restriction. I also tried to become more physically active by increasing my level of incidental activity such as walking up the stairs instead of taking the lift. However my sugar control was still going downhill and never recovered even after delivery-- I was confirmed to have prediabetes. Being a doctor, I probably have too much exposure about how detrimental even prediabetes can be. It practically makes the immune system weak and raises the risk of kidney problem, stroke and heart attack much higher than normal healthy population. Good sugar control is essential at all times, especially when a person is first diagnosed as our body develops memory and makes maladaptation to persistently high blood sugar levels. Sometimes it gets really frustrating, not able to enjoy my food as much, especially during festivities.
Prediabetes usually does not require medications but the risk of becoming overtly diabetic is at about 30% each year. I was aware that meal replacement can be useful in achieving better sugar control and can help weight management. I do recommend my patients to try meal replacement especially if they are overweight/obese. And now I am also giving it a go!
Glucerna® by Abbott is a diabetes-specific formula (DSF), which is a complete and balanced nutritional supplement formulated for people with diabetes or prediabetes. If you read more about diabetic diet, you will soon realise that carbohydrate counting and restriction is one of the keys. Choosing the correct carbohydrate-- ie those with low glycemic index (GI) which only release carbohydrate slowly into the bloodstream. The concept of suku suku separuh (fill your plate with a quarter of carbo, a quarter of lean protein and half of vegetables/fruits). Portion control is therefore also important. Gaining enough nutrition can be tricky for diabetics but it can be done easily when we are empowered by the knowledge to have a balanced diet with the help of DSF.
Wondering about the science behind Glucerna® ? The keywords are myo-inositol and slow release carbohydrate system which makes the body more sensitive to insulin by increasing GLP-1 levels (an important hormone lacking in DM), hence lowering blood glucose. The new Glucerna contains 4 times higher myo-inositol! Other active ingredients like Omega 3, 6 and 9 are vital for heart's health, as well as dual fiber blend of soluble fibers which relieves constipation and indigestion. Besides that 28 vitamins and minerals are also found in Glucerna with 35% higher folate and 56% higher iron levels which are essential for ladies with gestational diabetes.
Even if you don't like milk, Glucerna® is still an excellent choice because it comes in many flavours like vanilla, chocolate and the newest flavour, wheat and if you like, add some coffee powder/espresso shot and voila, it becomes so palatable. As Glucerna® is lactose free, us Asians do not have to worry about bloating and diarrhoea as many of us are lactose intolerant.
Glucerna® can also be used in cooking-- I sometimes substitute it instead of using coconut milk in puddings and curries. Combining it with oats also works well. If you like cold food, freeze Glucerna® with cut fruits into icicles! Remember to always combine meal replacement with healthy diet and exercises!
How is meal replacement done? This is the recommended guideline:
UNDERWEIGHT: BMI <18kg/m2
● 2 SERVINGS A DAY TO SUPPLEMENT DIET
Eg. morning snack and supper supplement
NORMAL WEIGHT: BMI 18 — 23kg/m2 ( I am in this category)
● 1 SERVING A DAY AS PARTIAL MEAL REPLACEMENT
Eg. breakfast supplement
OVERWEIGHT: BMI >23kg/m2
● 2 SERVINGS A DAY AS MEAL REPLACEMENT
Eg. breakfast and snack replacement
What does Dr Yingzangel think?
I felt discouraged at times in my journey of getting good sugar control. After 4 weeks of Glucerna® meal replacement program, the fluctuation of blood sugar level has fortunately plateaued so I feel so much more empowered and in control now. The main problem I face was a rise in blood sugar level after meals as my body cannot respond adequately to secrete enough insulin. Meal replacement also works well by reducing the total amount of calories consumed in a meal. Remember to cut down other food intake especially carbohydrates when you are on meal replacement therapy or else there can be weight gain (total caloric intake exceeds total energy expenditure). As a Doctor myself, I will still ensure I do my regular check-up because this is where I can review my medication and nutritional intake and evaluate if it is working. One must always be aware of what we put in our body.
To understand how other fellow Malaysians are living with diabetes:
Abbott conducted an online survey from 2-12 October 2020 to find out more about people with diabetes in Malaysia and how they are managing their condition, including how they are making daily decisions about their food and nutrition. The survey aimed to identify areas that people with diabetes struggled with the most, with a focus on understanding areas that can be better supported.
● A total of 158 Malaysian residents with diabetes participated in the survey, comprising a mix of genders and ethnicity. Among the respondents, 24.7% provided feedback with the help of a caregiver, which was allowed to enable less tech-savvy people with diabetes to also participate.
● The respondents mainly indicated that they had been diagnosed with diabetes for:
o 3-5 years (34.8%)
o Less than 3 years (19%)
o 6-8 years (17.7%)
● The respondents were mainly aged:
o 50-59 years (28.6%)
o 40-49 years (22.9%)
o 30-39 years (22.3%)
● Most respondents reported going for follow-ups at a frequency of:
o Every 4-6 months (48.7%),
o Every 3 months (25.3%)
o Do not go for follow-ups (12%)
● Most respondents has recorded a latest HbA1c reading of:
o Within 6.5-7.0% (51.3%)
o Within 7.1-8.0% (26.6%)
o Below 6.5% (12.7%)
● The HbA1c readings were mainly steady, with respondents reporting that they were:
o Showing no change in trend (55.1%)
o Trending upwards (17.1%)
o Trending downwards (13.9%)
● When asked about how diabetes impacted their lives, the respondents indicated that they were struggling, agreeing (strongly agree, agree or somewhat agree) to the following statements in the indicated percentages.
o I feel that diabetes controls my life (96.2%)
o I feel that managing diabetes is taking up too much of my mental and physical energy every day (95.6%)
o I feel overwhelmed by the demands of living with diabetes (94.3%)
o I feel that I am often failing with my diabetes routine (92.4%)
o I do not feel confident in my day-to-day ability to manage diabetes (91.8%)
o I feel angry, scared and/or depressed when I think about living with diabetes (90.5%)
o I feel that I am not sticking closely enough to a good meal plan (90.5%)
● Nevertheless, 58.2% of respondents still felt they were managing diabetes very well or quite well.
● The respondents indicated that fitness and diet management factors were among the key stressors in their diabetes management, saying that the following activities were stressful (very or slightly stressful):
o Achieving or maintaining a healthy weight (74.7%)
o Daily carbohydrate or calorie counting (73.4%)
o Management of emotions (72.2%)
o Reducing or giving up favourite foods and drinks due to unsuitability (72.2%)
o Following a diet suitable for people with diabetes (71.5%)
o Regular exercise (70.9%)