Diabetes Self-Management: A Matter Of Self-Discipline

Mr Nagutha Mohamed Eusoof first felt that something was amiss with his health in 1997 — the then-39-year-old started having severe headaches for which paracetamol did little to relieve the pain. Acting on the advice of a pharmacist friend, he went to Toa Payoh Polyclinic where he was diagnosed with hypertension. 

“From then on, I was put on a diabetes tracking programme,” says Mr Nagutha. He tried ways to control his diet, including reducing food portion sizes, but found out he had Type 2 Diabetes Mellitus in 1998, just a year after he was diagnosed with hypertension. 

Diabetes and Family History

“There was no history of diabetes in my family; I was predisposed to it due to my high blood pressure.” 

Family history is just one of the risk factors for prediabetes and type 2 diabetes. Other factors that increase the risks include: being overweight or obese, high blood pressure, and a lack of physical activity, among others.

Mr Nagutha would later also develop high blood cholesterol, which is not uncommon for people with diabetes. But rather than be defeated by his condition, he started making the much needed dietary changes and put more effort into his meal planning.

Diabetes Self-Management

Processed red meats, oily foods and white rice were out, and Mr Nagutha stopped adding salt and extra sugar to his food and beverages. In their place were lean white meats such as chicken, generous servings of a variety of vegetables, brown rice or chapati (Indian flatbread made with whole-wheat flour), and teh si siu dai (tea with evaporated milk and less sugar). Almost 20 years on, he is still sticking to this diet.

Mr Nagutha, now 58, holds two jobs as an accountant and a part-time accounting lecturer, which doesn’t leave much time for regular workouts. But he still manages to fit in some form of exercise while going about his usual activities.

“I don’t like sitting still,” he explains. “I enjoy walking from one location to another, and prefer to stand and walk when teaching classes.” With stable HbA1c or blood sugar level readings of 6.1 to 6.3 per cent, he has successfully kept his diabetes in check over the years.

The grandfather of two credits much of this to family support. “My wife and two adult children are not at risk for diabetes, yet they willingly adjusted their diet at home to suit mine,” he says. His wife also makes sure he takes his medication as prescribed.

Earlier this year, Mr Nagutha found himself advising his mother-in-law, who is in her 70s, after she was diagnosed with diabetes. “She wanted to share my medication, but I said it wasn’t safe because different patients require different dosages. I told her to see a doctor to sort out her medication, which she did,” he recounts.

Related: Diabetes - Are You at Risk?

Continuity of Care for Diabetes Management

In 2005, Mr Nagutha switched from Toa Payoh Polyclinic to Hougang Polyclinic for his routine checkups. He was seen by various doctors until March 2016, when he met Senior Staff Nurse Ms Wang Qingli, who is an Advanced Practice Nurse (APN) at Hougang Polyclinic.

APNs are registered nurses with postgraduate education and clinical training in the diagnosis and management of medical conditions. Many APNs, like Ms Wang, conduct clinical sessions in an outpatient setting, where they perform physical examinations, take patients’ medical histories and order basic laboratory tests. 

Based on their assessment, they will draw up personalised treatment plans that include realistic, achievable goals for patients. In some cases, patients’ caregivers are also involved. “Patients under the care of APNs will be followed up by the same APN each time,” says Ms Wang, 36, who specialises in chronic disease management.

“This allows us to build rapport and trust with our patients so they will be more willing to accept our advice and take action to meet their health needs.”

Mr Nagutha was initially hesitant to meet Ms Wang, having consulted with doctors only in the past. But he was quickly won over by her clear explanation and patience. “She reminded me about what I needed to know, and told me to stick to the same foods I have been eating,” says Mr Nagutha, who is looking forward to his next quarterly check-up with her.

Ms Wang is impressed with Mr Nagutha’s determination to take charge of his own health. “He practises a healthy lifestyle as recommended by healthcare professionals, and also demonstrates enthusiasm to learn how to interpret various parameters in his blood test report,” she says. “His enthusiasm in self-care is something we can all be inspired and learn from.”

Related: Diabetes: Diet and Lifestyle

Tips to Manage Diabetes

Ms Wang offers seven self-care tips to keep the condition under control.

Eat healthily
Make sure the food you consume provides essential nutrients.
Be physically active
Exercise to control blood glucose levels and manage weight.
Improve problem-solving skills
These skills will come in handy when you need to modify daily routines such as food intake and physical activities.
Remember your check-ups
Engage in preventive care measures, including eye and foot screenings to avoid further complications.
Know your medicines
Understand how they work and the possible side effects. If your doctor increases the prescribed dosage, ask why.
Check your blood sugar levels
Take a home blood glucose (finger-prick) test regularly, as recommended by your healthcare provider.
Stay optimistic
Diabetes often affects patients physically and psychologically, so you need to deal with these challenges positively.

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• Diabetes (Pocket Guide)
• Guide to Managing Diabetes
• Losing Weight When You Have Diabetes
• If You Think Thin People Don't Get Diabetes, Think Again!
• Desserts, Durian, Diet: Busting Diabetes Myths