18 Feb 2011
A sprightly octogenarian poked his silver-haired head round the door of my consultation room and whispered: “Doctor, I sneaked in two pineapple tarts.”
“Here, for you,” Mr L continued in his conspiratorial tone.
“My daughter makes so many, but she doesn’t let me have any. You tell her later, OK, that my diabetes is good, otherwise she won’t let me eat any this year.”
Now I know how the Kitchen God, Zao Jun, must feel.
It is believed that on the 23rd day of the 12th lunar month, the Kitchen God returns to heaven to report what happened in every household over the past year.
The Jade Emperor either rewards or punishes a family based on the Kitchen God’s yearly report.
On this day, the lips of Zao Jun's paper effigy are often smeared with honey or nian gao (glutinuous rice cake) to sweeten his words to the Jade Emperor or to keep his lips stuck together.
Unlike the Kitchen God, the test we use to judge diabetes control cannot be bribed with luscious pineapple tarts or nian gao.
The haemoglobin A1c (HbA1c) test gives a picture of the overall glucose control over the past two to three months.
It measures the percentage of glycated haemoglobin – or red blood cells with glucose attached to them – in the blood.
When diabetes is uncontrolled, too much glucose is present in the bloodstream and more haemoglobin gets glycated.
The amount of HbA1c reflects blood sugar control for the past 120 days, which is the usual lifespan of a red blood cell. For example, a HbA1c reading of 6.5 to 7 per cent reflects good diabetes control whereas a reading of more than 9 per cent indicates poor control.
Mr L’s HbA1c was 7.2 per cent, which was pretty good, considering that he was 82 years old.
He had just been diagnosed a few months ago and we wanted to avoid undue hypoglycemia (low sugar) events in a patient like him. We were not aiming for very tight diabetes control.
I explained the result to him, only to be met by a dismayed groan.
“Past 120 days? That means cannot hide lah, even what I ate at Christmas is also counted,” he sighed.
His ever-vigilant daughter said: “Anyway, he shouldn’t eat any bak kwa and pineapple tarts right?”
Well, fortunately for Mr L, it is “yes” and “no”.
People with diabetes used to be told that all sugary foods were off-limits.
Our current thinking is that you can substitute small amounts of sugar for other foods containing carbohydrates and still keep your diabetes under control.
We also know that while the type of carbohydrate can affect how quickly blood glucose levels rise, the total amount of carbohydrate you eat affects blood glucose levels more.
It helps too if you check your blood sugar levels with a glucometer to monitor your condition.
Some traditional and delectable Chinese New Year goodies have large amounts of carbohydrates and sugar in a very small serving.
One slice of bak kwa has about 200 to 230 calories. One pineapple tart contains about 30g carbohydrate and 70 to 80 calories. And who can stop at one?
With the dietitian, we worked out some common meals and food choices for Mr L.
Saving sweets for a special occasion is a healthy way to eat so that the patient can focus his meal plan on the most nutrient-dense foods such as vegetables, beans, wholegrains, fruit, non-fat dairy, fish and lean meats.
Even so, after we calculated the contents of a bowl of his favourite dessert, orh nee (Teochew yam and pumpkin paste), Mr L remarked: “I think I’ll reserve that for my 85th birthday, in three years’ time.”
Most of us are familiar with the concept of informed consent: When patients are scheduled for an operation, doctors explain the procedure, the risks and the benefits.
Perhaps it is time to consider “informed consumption” – something that even the Kitchen God should think about, before his next dose of nian gao.
gsodia@sgh.com.sg
Dr Goh Su-Yen is the director of diabetes clinical services and a consultant in the department of endocrinology at the Singapore General Hospital.
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Dept of Endocrinology
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