Eyeing diabetes

What say you on the issue below?

This week, our new column on eye health and food looks at diabetes and eye health.

Dr Fong: I’m feeling depressed. Post-raya holiday blues and overwork is part of it, but the main reason is because one of my young adult diabetic patients has gone blind in one of his eyes.

I have been treating his diabetic retinopathy for the past year, and despite all my best efforts, his vision has continued to get worse.

Diabetes is probably the most serious medical issue facing Malaysians today. The figures are frightening. More than 20% of our population has diabetes, and this figure is projected to increase by another 50% in the next 20 years.

One of the more serious complications of diabetes is diabetic retinopathy. This is bleeding from small blood vessels at the back of the eye, and occurs in one out of three diabetic patients.

Further growth and bleeding from the retinal vessels can be prevented by early laser treatment and this is needed for 10% of diabetic patients with retinopathy.

Diabetic patients can also get macular oedema or swelling of the centre of the retina.

The macula is the most sensitive part of our eye and is used for seeing sharp images. Macular oedema causes more blindness in the working diabetic population than retinopathy itself. This is treated with gentle laser and drug injections into the eye. About 10% of diabetic patients can get macular oedema, and often, also have concurrent diabetic retinopathy. Retinal detachment and glaucoma are two other serious eye complications of diabetes that requires surgery to treat them.

A national screening programme for diabetic retinopathy is the most cost-effective to prevent blindness in our diabetic population. These patients essentially have digital photographs of their retina taken in the local hospital or clinic and the images are sent remotely for grading by an eye doctor or trained grader.

Patients with signs of proliferative diabetic retinopathy or macula oedema seen on their photos can then be sent to their local eye department for prompt treatment.

Many stakeholders were consulted about the guidelines for diabetic eye screening and I am very excited about this new proposal. This would be money well spent by our government.

Prevention is better than cure and diabetic retinopathy is one disease that illustrates this. I hope that our government will focus on developing a viable national screening programme for diabetic retinopathy. This will save much more money in the long term as we will allow active working diabetic patients to continue working and contributing to our economy.

To prevent blindness from diabetes, we need good and consistent control of the blood sugar levels. Blood pressure and lipid level control are also very important.

We all know the obvious steps that must be taken to prevent complications from diabetes, but the barriers are many. These barriers include cultural and social issues that prevent good diabetic control like stigma associated with needles, excess sugar in our diet, lack of access to regular exercise, and lack of a national eye screening programme.

Chui Hoong: How do you take charge of your diet? Carbohydrates are our main source of energy. Too much carbohydrate in the diet can raise your blood sugar levels too high. Current studies have shown that consistency in day-to-day carbohydrate intake improves blood sugar levels. This means, having two bowls of nasi lemak for lunch today and cutting back to ½ bowl of white rice the next day to make up is not advisable.

It is best to spread your carbohydrate intake evenly throughout the day. Do not skip meals. This prevents high and low blood sugar levels.

Eating at regular intervals helps control hunger and prevents overeating at the next meal. If you monitor your blood sugar levels regularly, you will be able to identify patterns in your diet – what triggers high sugar levels – and avoid it.

Enjoy a variety of fruit, vegetables and wholegrains. These foods are good sources of fibre which helps to lower total cholesterol levels.

Fat does not raise blood sugar levels, but can lead to being overweight. Excess body weight can raise blood sugar levels.

A high-fat diet also increases your risk of heart disease.

Assoc Prof Dr Fong Choong Sian is a consultant opthalmologist, while Goo Chui Hoong is a consultant dietitian. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice.

Here’s a recipe you can try at home:

Green peas, tuna and wolfberry rice

Peas are a good source of vitamin C, fibre, beta-carotene and contain some amount of omega-3. This is an excellent one-pot meal which is complete on its own and easy to prepare.

Serves five

Preparation and cooking time: 35 minutes

Ingredients:

180 g (1 cup) uncooked white rice

180 g (1 cup) uncooked brown rice

1 tbsp cooking oil

20g (2 cloves) garlic, chopped

50g dried shrimp, soaked in 200ml water, pounded, retain soaking liquid

10g (6) dried Chinese mushroom, soaked in 200 ml water, sliced, retain soaking liquid

1 tin (185g) canned tuna in water, drained and flaked

3 tbsp dried wolfberries

325ml (1½ cup) water

320g (2 cups) frozen green peas, thaw in a bowl of water, drained

Garnish:

2 tbsp chopped spring onions

40g (4) shallots, sliced and fried

Method:

Rinse the rice in a large bowl and drain. Heat the oil in the rice cooker. Add in the garlic, dried shrimp and fry till aromatic.

Stir in the sliced mushroom, tuna flakes and dried wolfberries. Finally, stir in the washed rice. Add all the soaking liquid and water into the rice cooker.

Cook the rice until all the liquid is absorbed or vaporised. This will take about 25 minutes. Switch off the rice cooker and stir in the green peas until it is well mixed. Leave the rice to sit for at least two minutes. Garnish with spring onions and fried shallots.