#AskTheExpert: Diabetes, Cardiovascular Health, and COVID-19

Diabetes was already an epidemic even before COVID-19. Now that we are in the midst of the pandemic and battling mutations of the coronavirus, the safest way to avoid getting infected is by staying home. Does this mean we are also staying healthy? Not always.

If we work or study from home and take care of family or loved ones, we are exposed to new types of stress or experiencing stress at a different level. We may be coping by eating more (or stress eating), sleeping more (and not exercising) — putting ourselves at greater risk of developing diabetes which can affect our cardiovascular health.

For diabetes patients, this could also mean less opportunities to exercise which could lead to complications. How do we avoid this? How do we live with diabetes and COVID-19? Watch our interview with Dr. Ayi Faller, president of Alliance of Clinical Endocrinologists Philippines, where she shares helpful tips we can follow at home.

Welcome to #AskTheExpert

Kai Magsanoc: Hi, everyone! Welcome to #AskTheExpert here on Hello Doctor PH.

My name is Kai Magsanoc, and I’m the Editor-In-Chief of Hello Doctor here in the Philippines.

With us today is someone who’s going to talk to us about the relationship between diabetes and cardiovascular disorders. I know for certain that diabetes is one of the top searches on Hello Doctor Philippines.

So doktora, I’m pretty sure we have quite an audience watching our interview today.

To introduce our guest: We have someone who is the chief of the World City Medical Center Section for Endocrinology. She’s a member of the core trainers’ group. She’s the treasurer of the Osteoporosis Society Philippines Foundation, Incorporated.

She’s a diplomate and fellow of the Philippine College of Physicians. She is a diplomate and fellow of the Philippine Society of Endocrinology, Diabetes, and Metabolism. She is a fellow of the American College of Endocrinology, and she is the president of the Alliance of Clinical Endocrinologists Philippines.

Welcome Dr. Theresa Marie Valdez-Faller also known as Dr. Ayi Faller.

Hi, Doc Ayi!

Dr. Ayi Faller: Hi, and good afternoon. Hello, Kai. Thank you for inviting me to talk today.

KM: Of course! Thank you for being our first ever guest on our #AskTheExpert video series. Our goal really in Hello Health, Hello Doctor, is to democratize healthcare information to everyone.

So, I’m sure we’re coming together because we know a lot of people — I don’t know the data on diabetes; we’ll get to that pretty quickly.

The relationship of diabetes and cardiovascular health

Doktora, my first question: Why do you think it’s important for us to have this conversation? Why do we need to talk about the relationship of diabetes and cardiovascular health?

Dr. Ayi Faller: Well, first and foremost, diabetes is a fast-rising public health problem, not only in the Philippines but worldwide. And it’s brought about, usually being sedentary and obese, which is what we’re having nowadays. Like during this COVID-19 pandemic, a lot of us are staying at home and not doing much, not having any physical exercise, and all of that.

So, diabetes has been on the rise lately. And in my private practice, I have actually seen a lot of newly-diagnosed diabetics who a year ago, or two years ago, have not been diabetic, yet right now they are.

And the thing about it is, diabetes can lead to a lot of complications. One of which is — the most important — severe cardiovascular diseases. It’s really very important to be talking about diabetes and its complications nowadays.

KM: I completely agree with you, Doc. My father passed away to complications brought about by diabetes.

Dr. Ayi Faller: I am sorry to hear that.

KM: It’s okay; because you know, he left us a very good lesson to really take care of our health and be mindful because it runs in the family, sa mga Magsanoc. So, that’s an opportunity for us to be more mindful of our diets and our lifestyles.

The state of diabetes in the Philippines

Okay so, Doc, tingnan natin yung lay of the land, the state of diabetes in the Philippines. How many Filipinos are currently suffering from diabetes?

Dr. Ayi Faller: Well, as of the year 2019, there were about 4.9 million diagnosed diabetics in the Philippines. Our prevalence rate is about 6.1% so I guess that’s almost 5 million. It has exponentially increased during COVID times. But of course, we want to do our best to prevent those numbers from rising.

KM: Yes, that’s why we’re having this conversation. Doctora, what kind of diabetes is most prevalent? Let’s go to the basics. Diabetes for dummies muna tayo. ‘Yung information na pwede nilang kunin kay Dr. Google, dito na lang nila kay Dr. Ayi tanungin.

Different types of diabetes

Dr. Ayi Faller: So, first let me talk about the different types of diabetes. We actually have 4 different types of diabetes.

The first one is Type I Diabetes or what we used to know as “Insulin Dependent Diabetes Mellitus” or your “Juvenile Onset Diabetes.” It’s brought about by a patient’s pancreas unable to produce insulin.

So, for these patients, the onset of diabetes is during the younger days though we still see this type 1 diabetes in adults. Their main problem is they don’t have any insulin; they have to inject insulin for them to be able to control their sugar. This Type I Diabetes accounts for less than ten percent (10%) of diabetics worldwide.

Now, the most prevalent type of diabetes is the one that we know, the type 2 diabetes. It used to be known as “Non-Insulin-Dependent Diabetes Mellitus.” So, from its name, it does not really need insulin for it to be controlled.

The main problem with it is that the pancreas — or the body’s factory for insulin — is not able to produce enough to supply the demand of the body, so the sugar levels just keep on rising.

Now the second problem in type 2 diabetes is insulin resistance. It’s when the body is not sensitive to the effect of insulin. So, insulin is very important because it’s the one that regulates the sugar levels inside of our liver, muscles, and fatty tissues. So, if these tissues do not respond to the insulin, the sugar gets left out, and they’re just in your blood.

So that is the reason why when you check your sugar — your blood — the sugar levels are really very high. So that’s the most prevalent type of diabetes, type 2.

Now, the other two types of diabetes would be: diabetes ng buntis or your gestational diabetes — it’s secondary to the pregnancy hormones. Usually, this gestational diabetes may become type 2 diabetes in later life.

And then the 4th type of diabetes is diabetes secondary to other illnesses, like for example there are some patients who have an excess of growth hormones, so they can develop diabetes, or those who have an excess of steroids in their body. Either their body produces too much steroids or they’re taking steroids for other causes.

So, because of this, their sugar levels go up, and sometimes they are having diabetes already. So these are the types that are reversible, but the others, we have to live with it.

Sugary foods make you unhealthy and sick

KM: Oh no. Oh gosh. The human body is so complicated. So, you already explained the causes noh, doktora. Pero magpaka-ano tayo, ‘yung usual na naririnig natin ‘di ba, habang lumalaki. Huwag ka kakain ng matamis. Magkaka-jabetis ka. ‘Di ba? Matamis, jabetis, ganyan. So, is that really it? Ito ba ang puno? Sweets?

Dr. Ayi Faller: Yes. Well, the diet actually has a lot to do with your sugar levels going up because some of the patients, or some of the people really just get to eat a lot and not exercise, and then especially when you get to eat those sugary foods that really don’t give you any healthy calories, these are the ones that will really make you unhealthy and sick.

So regarding the one that you’re saying earlier na, “Huwag kang kain nang kain nang matamis,” well, in a way, it really does make your sugar levels go up if you’re not exercising, you’re not taking enough water, and if you have a predisposition to diabetes, then it’s really good for you not to be eating too much sweets.

But you have to remember that it’s not like if you’re diabetic, you cannot eat any of the sweet foods anymore. You can still eat, as long as it’s in moderation. So moderation is the key. Yes.

Moderation, balance, and exercise

KM: Moderation, balance, and exercise, noh, doktora?

Dr. Ayi Faller: Yes, correct.

Causes of diabetes

KM: Pati exercise. Okay, so let’s deep dive into the causes. Among all the causes of diabetes, which is the most prevalent, and why do you think this is so?

Dr. Ayi Faller: So, as I’ve said, the most prevalent type of diabetes is type 2 diabetes, noh. It’s found in about 70 to 80% among the diabetics worldwide, and probably it’s because of the rapid urbanization of our lives.

So when everything is westernized, everything is automatic — it’s not like before in the good old days when people would really get to walk around and do things for themselves. Unlike now, it’s the machines that do everything for us.

So, I think it’s because of this sedentary lifestyle and the access to too much food noh, so it brings about obesity. And obesity is one of those factors that brings about insulin resistance, and later on diabetes mellitus, type 2.

Diet, lifestyle, and guidance of your doctor

KM: Gosh. So, actually we’re having this conversation I think, for a lot of people, even for diabetics, noh, doktora. It’s not too late. Diet and lifestyle — diet and of course the guidance of your doctor — your medical physician — and then your lifestyle.

I do have friends who, after getting diagnosed with diabetes, that’s when they embraced the healthier lifestyle. They look better, they look younger, they’re even fitter. So it’s not necessarily a “death sentence.”

Dr. Ayi Faller: Correct. Yes, Kai. I would always tell that to my patients because sometimes they just discover that they’re diabetics based on the annual exam. And then, they get so sad whenever I tell them that “you really are diabetic already,” and some even cry, noh.

But I tell them it’s not like cancer that you just have several days or years to live, noh. It’s really easy to live with diabetes.

The first step is to accept it because, you see, there are a lot of people nowadays, who you don’t know are diabetic because they’re very active, they can do whatever they like, noh. So it’s just, it all boils down to acceptance and being disciplined, because it’s not really difficult to live with diabetes, you just have to live in moderation.

KM: Yeah.

Dr. Ayi Faller: Yes.

KM: Consistent with your healthy habits noh, doktora?

Dr. Ayi Faller: Correct. Yes. Yes. That’s true.

Diabetes runs in the family

KM: So, doktora, meron akong mga naririnig din. Diabetes runs in my family, noh, so tanggapin ko na lang, or can I say like, me, kami, sa mga Magsanoc, it runs in the family. Do I have a chance to make it stop with me?

‘Cause I have a son, and sometimes when my kid eats a lot of rice, it really affects me, but you know, he’s 19. You know, but should I go with it ba, or do I encourage him na to exercise, noh.

Anyway, the generational curse you know, of diabetes, can it be stopped? Can a generation stop it?

Dr. Ayi Faller: Well, you know, Kai, I have some patients who tell me that, actually, their grandparents are diabetic, but their parents are not and now they are diabetic. So, they say, “Doktora, is it true that it skips a generation?”

Well, I think the reason behind that is because the children of the diabetics already saw how they were suffering, so that’s why they took it upon themselves to discipline themselves, have a good diet and exercise, and all of those good things so they don’t become diabetic.

But now, the children of those people didn’t see the sufferings or hardships of a diabetic person. So now they don’t know about it, so they’re the ones now who get to live an abusive lifestyle. So they are the ones who develop diabetes.

So the long and short of it, Kai, is that if you know that diabetes runs in your family, you can always just be careful, live in moderation, and practice a good lifestyle.

It’s like when diabetes runs in your family, it’s like you’re a loaded gun, but the trigger has to be clicked for the gun to fire off. So it’s the same with you people who have diabetes in their genes: there should be something that would click the diabetes to go into existence. And it’s up to you on what you should do to not let it happen.

So with regards to your question, can it just simply stop with you? Yes. If you’re going to teach the future generation to take care of themselves, then diabetes will stop in the family.

There is hope

KM: Yes, so there is hope. There is hope for those with diabetes that runs in their families. Our generation, we have the power to teach the next generations how to stop it, so that hindi maclick yung trigger.

Dr. Ayi Faller: Correct.

KM: And that we start new generations of healthy members of the family. Okay, so let’s go into diet, doktora. Let’s go into more practical ways that we can apply what you’ve been teaching us since the start of this conversation.

So, when we go to the gym, any fitness person we meet, they say that more than 70% is actually what we eat. It’s not what you do in the gym, right? It’s what you eat and what you’re eating when you’re not in the gym.

So, doktora, a concrete example of a daily diet for someone who is trying to avoid diabetes. Can you give us an example of how the daily diet looks like?

How the daily diet looks like

Dr. Ayi Faller: Well, in the Philippines, we have what you call the Pinggang Pinoy. The Pinggang Pinoy is the ideal or healthy plate for every Filipino. The half of the plate would comprise your vegetables and of the fiber and a little [portion] of the fruits. And then half of that would be your proteins which would be your fish and meat kumbaga your ulam. And then the other half of that would be your carbs.

So, it’s like ¼ of your plate would be your carbs, ¼ would be your proteins and fats, and the rest would be your fiber. And then outside of your plate, there will be a glass of water. So that’s how the Pinggang Pinoy looks like.

But if you want to have a more detailed way of how to go about it, we have the Mediterranean Diet, which is actually the diet recommended by the American Diabetes Association for people with diabetes. It’s really a healthy type of diet, in which there will be more fiber that would be fruits and vegetables and proteins, and the good oil which is olive oil, and a little of the carbs.

So remember, there’s still carbs in every good diet. You cannot take out the carbs because the carbs will still be the primary source of your sugar. And sugar, remember, is like your gasolina. It’s the energy provider for your body so you still need a little of the carbs, but not too much. So, that’s the Mediterranean Diet. It’s one of those diets that we advocate for all also.

KM: Great. Yeah, I think we have a story on the Mediterranean Diet kasi nga diabetes is really a top search here in the Philippines.

Dr. Ayi Faller: Yeah.

Daily diet for those managing diabetes

KM: So doktora, how about a daily diet that will help one who is already managing diabetes. Is it the same?

Dr. Ayi Faller: This is the one that I always advise my patients because they’re always saying, “Doktora, what is bawal ba? What should I not eat? What should I just be eating?”

In the Filipino household, especially in the FIlipino patients with diabetes, I find it funny whenever I say, “Wala pong bawal sa inyo. You just have to eat everything in moderation.” They always say, “What?! Walang bawal?” Para bang kailangan may bawal when you’re diabetic.

So, the good news for people with diabetes: actually there is no bawal as long as you’re going to eat everything in moderation. So, I don’t like patients with diabetes who are sad. They’re like, “Doktora, I really want to eat leche flan. Can I not even have two tablespoons of it?”

Of course you can! But you cannot have the whole lanera. Can I eat halo-halo? Of course you can, but you cannot have the whole halo-halo. Can I eat ice cream? Yes, you can have half a cup. But the thing is, you have to eat all these sweet foods in moderation at the right time with the right amount.

So Kai, if you’re asking me, can you give me an example of what are the things that I need to be eating on an everyday basis? You eat all the food groups — carbs, proteins and fats, and your fiber.

So, what is there in your table right now doesn’t have to be specially made for that diabetic. You can eat whatever the rest of the family is eating, but you have to be mindful of how much you are eating. So, sometimes it boils down to the quantity.

For example, just a solid example, people always ask me, which is better to eat? Is it the white rice? Or the red rice? The black rice? Or whatever color of rice is available? And then they say, “because doktora the red is more fibrous so it has lesser sugar content,” which is true. However, the difference between the white rice and the red rice is not that much.

So that means, if you’ll have one cup of white rice now, that is equivalent to 2 cups of red rice. So, you get it, Kai? It’s like magre-red rice ka nga but you’re eating too much red rice. So, the sumatutal is the same. Rice and blood sugar is still very high.

KM: Right.

Eat the right amount and at the right time

Dr. Ayi Faller: So that just goes to show that when you’re eating, even if it’s the right food, you still have to be eating it in moderation.

KM: The right amount.

Dr. Ayi Faller: Yes, the right amount.

KM: Pero doktora, you mentioned that you have to eat it at the right time, okay. When I was a lifestyle journalist, lifestyle editor, I would attend events alam mo yung mga slimming clinics, doktora. Tapos doktora, ililibre ka ng consultation tapos sige, the last, I remember this: pwede ka mag-rice hanggang 2PM lang, mga ganun.

Pero I am asking doktora, my question is basically: mayroon bang time of the day when our bodies also slow down, alam mo yun? And breaking down? So, is there a certain cut-off? Sige, I’m gonna have rice for dinner but at what time should I have eaten my dinner, for example?

Dr. Ayi Faller: Actually, have you heard about the saying that the breakfast should be eaten like you’re a king because it’s the largest meal of the day, and the lunch is like two-thirds or one-thirds of your breakfast, and then your dinner should be just a third or one-fourth of your breakfast.

So the reason for this is because when you eat breakfast, you’re going to have a lot of activities for the rest of the day. So, you should pack in energy but if you expect that you would not be moving around for the rest of the day, so you don’t eat a lot. It works like that.

During dinner time, we tell the patients: don’t eat a lot of carbs anymore because you’ll be sleeping in a while and then, you won’t be using up all these carbs that are turned into sugar and are supposed to be used up. They will just be stored. These are the ones that will be stored as fats. That’s the reason why you don’t want patients to be eating a lot of rice or carbs during the night.

With regards to what should be the appropriate stop time that we should be not eating anymore any of these rice, actually, it would depend on your activity levels. If you have activities until the middle of the night then you can have it as late as about 9PM or 10PM.

But the thing is, what we really notice about diabetics is that when they eat past 9PM or 10PM, that’s the time that their sugar levels are really quite high and these are the people who really pack up a lot of bilbil or subcutaneous fats. So, they’re the ones who really get to be obese or overweight later on. It’s because they have a lot of extra eating at bedtime. So no more carbs after like 8PM.

Kai, you’ve heard of intermittent fasting, right?

KM: Yeah.

Dr. Ayi Faller: It’s like a nicer version of your “After-6 Diet” wherein after 6PM, before nauso ‘yan eh, you don’t get to eat anything anymore. Intermittent fasting is like that. There’s like this time period when you don’t eat, and then there’s this hour window period wherein you’re going to eat.

Parang ganun din yung principle doon. During the night, you don’t get to eat much, you don’t get to eat anymore because you don’t have any activity. You’re just going to be sleeping.

KM: Yes.

Dr. Ayi Faller: If you’re just like the ordinary person but there are a lot of people nowadays who are awake during the night, especially the people from the BPO communities.

KM: Right.

Dr. Ayi Faller: They are the ones awake during the night, so wala silang choice. Kumbaga, they just get to eat a lot to keep awake and all of that, and this really makes them unhealthy.

KM: Yeah, it’s a challenge noh, doktora? Lalo na ngayon the gig economy because of the uncertainty, a lot of Filipinos are working more than one or 2 jobs at the same time.

Dr. Ayi Faller: Correct.

KM: So, let’s talk about activities and exercises in relation to diabetes. Mayroon bang ideal exercise we should be doing that will help us breakdown the insulin?

Dr. Ayi Faller: The sugar. Breakdown the sugar.

KM: Sorry.

Is it the aerobic exercise or gayahin ba namin ang workout ni Hidilyn Diaz for example? Hidilyn literally lifts and squats, that’s part of her daily fitness routine. Pero tayong mga — okay, ayaw kong magka-diabetes sa generation ko. Gusto ko maging healthy para hindi rin ako magka problem sa heart — ano ang exercises na dapat ginagawa ko araw-araw, doktora?

Dr. Ayi Faller: Well, usually we ask the patients what exercise they can do. Something that they can be doing every day at least 30 minutes or 2-and-a-half hours in a week on separate days. That’s the time requirement for you to be exercising.

So what kind of exercise? Preferably cardiovascular exercises, like walking. Walking is one of those most important and one of the best exercises you can do. Especially during this COVID season, all of the patients are saying, “I was not able to exercise because I can’t go to the gym” diba it’s ECQ, the gyms are closed and all that.

And then when it’s the rainy season, they’re saying, “I cannot go out because it’s raining and all of that.” But walking is something that you can do in the confines of your house, in your room, or even in your very small space, you can still be walking.

So, I keep on telling the patients: do an exercise that will let you move all parts of your body. One that you love, like dancing, either Zumba or aerobics.

Do something that you think you will be able to sustain, something that you enjoy. Because that’s the most important thing – that you enjoy doing that, so that you get to be doing that every day. That’s important.

So, if it’s walking they find – they enjoy walking, go about that. Every day, go 30 minutes, and then if they say na, “Doktora, I’m so busy to spend 30 minutes of walking everyday, is there anything else that I can do?” So, I tell the patient, “Well, after each meal, you can do like a 10-minute walk around your table, or inside your office.” And so if you do like three 10-minute walks after each meal, you now have 30 minutes of walking every day.

Or they say, “I’m really so busy, I can’t spare those 10 minutes, those 30 minutes three times a day.” So, I tell them, “Then you have to incorporate it into your daily life.” For example, they always drive a car, so they park at the farthest point in the parking space, and before they get into the office, they go around the building first, or instead of taking the lift or the elevator, then they just take the stairs.

And then they tell me, “Doc, my office is on the ground floor.” Okay, so, well, you can still walk around the building, or you can take the stairs, take two flights of stairs, twice a day, before you go into your office. So, we just have to be more creative about it. Let’s try to look for a way to exercise because I always tell them, “Your health comes first.”

Hindi pu-pwede na work ka nang work, and then napapabayaan mo ‘yung health mo.

So, exercise is one of those very important things. It’s a pillar in the management of diabetes.

KM: It should take priority alongside your work, if not higher, noh, doktora? You can jog in place, ‘di ba, doktora, or pretend to skip rope, ‘yung mga ganon, many things.

Dr. Ayi Faller: Okay. So just a word of caution for that. We actually do not recommend jumping, or even jogging because this may injure your knees later on. So, if ever, walking — brisk walking — is really gonna be the best if you would like to do some jogging.

KM: Okay. So walking, or brisk walking? Okay. Sige, thank you po. Noted po ‘yan.  Iha-highlight natin ‘yan dito sa ating video.

So how bad is the diabetes situation now with COVID, and now we’re going back to another lockdown?

Dr. Ayi Faller: Yeah. So, it’s quite sad because what we really realized during the first COVID surge was that people with diabetes were like left out. They’re the ones who are regulars in the clinic, eh. So like, again in my practice, I tell my patients, “You have to see me regularly every 3 to 4 months,” like that.

And if the sugar levels are really uncontrolled, I have to see them more often. So, when the COVID pandemic occurred, these were the people who were not able to really see their healthcare providers, and so a lot of the diabetes went haywire.

But we have to remember that people with diabetes are the ones at high risk for severe complications of COVID, if they get infected. So, it’s really a very bad time for the people with diabetes and their healthcare providers during this COVID pandemic. We’re really very affected by it.

KM: Diabetes is a comorbidity, correct?

Dr. Ayi Faller: Yes. It’s a comorbidity, just like hypertension and cardiovascular disease that, if they are present in a patient, the chance, or the risk for a serious complication is there. So, I always tell my patients with diabetes, “You really still have to take care of yourselves even if you are just staying at home, working from home.” Yes.

KM: And even if you are vaccinated, follow the protocols still, noh, doktora?

Dr. Ayi Faller: Correct. That’s very important.

KM: I don’t even mind the face mask, to be honest. I mean, the face shield.

Dr. Ayi Faller: Well, actually, Kai, the face shield kasi is for you not to keep on touching your mask. Kaya ka pinag-feface shield. Kasi ‘di ba, a lot of people, hindi kasi talaga sanay eh, na naka-face mask. So ang nangyayari, hawak nang hawak sa mask, and all of that. So, I think the face shield is there to protect us from keep on touching your face, so you don’t get infected.

KM: Yes. Ayun, doktora. Okay. So, doktora, let’s go to diabetes management. What should one do when he or she is found to be borderline, dun muna tayo sa borderline diabetic? ‘Pag ganyan ba, ginagamot na, doktora? Tapos diba may mga matitigas ang ulo na, “Di bale, may gamot naman, eh.”

Dr. Ayi Faller: Yes. Actually, Kai, that’s a very Filipino remark. “I’ll eat all of these matamis kasi I have gamot naman, given by Doktora Faller.” So, it’s really funny that way.

But, with regards to your question, “What happens if a patient is diagnosed to be prediabetic?” Well, first and foremost, we have to assess, “Is this patient really at high risk to become diabetic later on?” There are some studies that show that it’s just a play of numbers, kumbaga.

So a lot of research has gone into prediabetics developing macrovascular or big vessel disease, the same as that of a diabetic. So, kapag ang pasyente, if a patient is at high risk, really, meaning the patient’s also hypertensive, has high cholesterol levels, and they’re found to be borderline diabetics, then it’s a must. They should be treated already.

Because it’s passé when you say, when the doctor says, “Ay naku, you’ll just spread diabetes. Borderline pa lang, mag-diet, exercise ka lang, and then it will go away.” Pero the thing is, it really does not go away. The diet and exercise, unless the patient is really motivated, the numbers don’t go down, the sugar levels just pile up. And before you know it, the patient has crossed the border, and is now a full-blown diabetic.

So, nowadays, what we want to do is give already — aside from the lifestyle intervention — we already give medication. Some patients would say, “Doc, I’m just prediabetic, why do I have to take medications already?”

So, it’s just a simple matter of explaining to them that because the longer time that you stay prediabetic, you’re still going to be developing the complications of diabetes for big vessels, as I have said earlier. So, if you explain it to them that way, then they would understand, and then they will follow you.

KM: Yeah. They would take it more seriously, noh, doktora?

Dr. Ayi Faller: Correct. So, with regards to the, “I have gamot naman” or “I have this medicine,” especially those patients who are already on insulin, they will say, “I’m on insulin, so that means I can eat anything already because I can just simply adjust my insulin doses every time I’m going to eat more, I’m going to add more,” like that. But that’s just not the way it should be. We should still be disciplined.

Sometimes, a patient who is Type II diabetic is placed on insulin for a faster control of their glucose levels. So, if these patients are still undisciplined, then it’s all for naughtt. So, sayang. Sayang ‘yung panahon, sayang ‘yung perang pambili ng insulin, and all of that.

And furthermore, the longer time that they are uncontrolled, the greater the risk that they’re going to develop all of the complications. And it’s the complications that we’re really scared of. Because once the complications are there, they cannot be reversed.

And that’s what I keep on telling the patients: “You cannot cry anymore when the complications are there because I cannot help you.” So, the thing is let us prevent these complications from coming in. So now that I can still help you, we don’t have complications, so help yourself also. Be more controlled.

KM: Pero, doktora, sige let’s inject some fear factor ano. Kasi may mga tao na kahinaan ‘yun, e. Let’s talk about the complications. And again, going back to the cardiovascular, for example. What are the complications that may arise from diabetes?

Dr. Ayi Faller: Well, first and foremost, the most important thing is that this one, it’s actually not the fear factor thing. I tell the patients, “Kinukwento ko po ito sa inyo kasi ito po ‘yung mga facts.” Okay.

So, fact number one, it’s like 80% to 90% of diabetics, they eventually die of a cardiovascular disease. Cardiovascular disease encompasses all those diseases of the heart, like chronic heart disease, cerebrovascular disease or stroke, and peripheral vascular disease, or all blood vessel diseases that supply your heart, your brain, your upper and lower extremities.

So, with that in mind, that means that if you’re a poorly controlled diabetic, you have a great risk to develop a heart attack, a stroke, or a lower extremity amputation. So that means ‘yung mga non-traumatic amputations o pagkaputol po ng mga paa o daliri, sa paa. Sometimes, the majority of them, like 60% to 80% of them, are secondary to diabetes. So that’s one.

The second complication that we’re really scared of is the renal failure. So, diabetes accounts for a little, about half, of all new cases of patients who have to have renal replacement treatment. That means either hemodialysis, or peritoneal dialysis, and diabetes is the number one cause of end-stage renal disease, or renal failure in the Philippines and worldwide.

And if you combine diabetes with hypertension, they account for 80% percent of all patients on dialysis. So, it’s really a very bad thing to be diabetic and have another comorbidity like hypertension.

Not only that, but diabetes also accounts for blindness. These are other complications that we’re really scared of, aside from the neuropathy. Neuropathy is when your nerves are, or your “ugat pandamdam,” they’re all going crazy.

So, when you touch something, and it’s supposed to be hot, the patient with diabetes will feel it to be just warm, so they keep their hand on it, and then before they know it, they’re already having burns. I have a lot of patients like that.

Neuropathy is also one of those complications of diabetes that decreases the quality of life of a diabetic. So that’s the reason why we always tell the patients, “Please, help us help you in preventing these complications from setting in by having better sugar control.”

KM: Right. And we’ve been talking to the patients so far, doktora, but I think we also need to address the carer, or the other members of the family, noh? Kasi minsan, it’s the support. So, the patient doesn’t feel, I guess, alone, or singled-out, ‘di ba?

So, what is your advice to the carers, or the family members of a diabetic patient?

Dr. Ayi Faller: Usually, when a patient with diabetes would seek consultation in the clinic, I always tell them, “Bring a family member along.” These family members are now aware of the condition of their relatives, so they would be more supportive.

And sometimes, I really talk to the relatives because sometimes they get to be too strict, and the patient now doesn’t get to eat anything, and they get to be sad, and then ‘yan, panget na. So, I just tell them, “You just encourage mommy or daddy to be eating the better foods, and then encourage them to be working, like walking around, moving.”

So, I tell the relatives, “You should be a part of the treatment regimen of your relatives.” And I also tell them, “Since you are relatives, you also may develop this later on. So, it’s good for you to be learning about this now.” So that’s the role of the family. They should be part of the support group of the patient.

KM: Okay, wow. We’ve covered everything, doktora, from the kinds of diabetes to the causes, exercises, diet, okay. Even the family, or carers, support. And complications, most importantly. Oh my gosh, parang, una muna po, wala po sa atin can afford to be sick, ‘di po ba? Lagi nating sinasabi ‘yun.

Dr. Ayi Faller: Especially now.

KM: Especially now. So part of avoiding that, pati ‘yung gastos, kung ganon po tayo mag-isip, is to really stay healthy and to follow our doctor’s advice.

And ako, para sa akin, hindi ko na po hihintayin ang diagnosis na diabetic ako bago ko pa i-adopt ‘yung mga tips na shinare ni Doc Ayi just now.

So, we’re going to the last stretch of our interview, Doc Ayi. Let’s just talk about two myths, ‘no. Let’s debunk two myths na may kinalaman sa diabetes. Una muna, ang mga payat, hindi nagkaka-diabetes. Diba ‘pag sinabing diabetes, ‘yun ‘yung mga morbidly obese. Is that a myth, this is true or false, and why? What is the fact?

Dr. Ayi Faller: Well, it is a myth. Even the thin people get diabetes. And actually, nowadays, they say na, “You’re diabetic, but you’re fat.” So that’s one. Actually, obesity really leads to a lot of metabolic abnormalities including sugar, increase in blood pressure, increase in cholesterol levels, so it’s accepted. It’s a proven fact that being overweight and obesity will lead to diabetes.

But what about the thin people? So sometimes, they are thin because they are already diabetic and they are poorly controlled, so that’s why they are thin. And if it runs in the family, then even having a thin frame, body frame, but you’re having a very bad lifestyle, then you can still be diabetic.

So regardless of what your body frame is, if you’re small, medium, large, extra large, triple large, it doesn’t matter. We all have to live healthily so we will not be diabetic. So even if it runs in your genes, as I’ve said earlier, we can put a stop to it. Just keep a healthy lifestyle.

KM: Okay, Doktora. Loud and clear. Hindi lang po ang overweight o obese ang pwede maging diabetic, pwedeng ‘yung mga skinny din, kasi nga, baka may diabetes na. Ganito ka-importante ‘yung annual exam, ‘no Doktora? ‘Yung annual check.

Dr. Ayi Faller: Yes, correct. That’s very important ‘cause sometimes, we actually find a lot of newly-diagnosed diabetics just on the annual exam.

KM: Yeah. Oh my gosh, that reminds me, I have to have mine soon. Okay, second myth, Doktora. I know a lot of, mga 20-somethings noh, “Parang mabilis pa naman metabolism ko eh, so okay lang. Tsaka na ako mage-exercise ‘pag when I’m in my mid-30s to my 40s,” ‘di ba, ‘yung parang nandun na sa age na may onset na. Is that fact, is that a myth, or is that wrong? What are the facts?

Dr. Ayi Faller: That’s a very, very bad myth. Very very wrong. It’s quite saddening that the youth nowadays or the young adults, they just want to work, work, work, and not take care of their health because just like what you’re saying, ‘cause they think they’re still very young and eventually they can catch up later on with exercise, and sleep, and no stress, and all of that.

But actually, the fact is, nowadays, we see a lot of very young adults who have diabetes. And you know, Kai, sometimes it’s so scary because a 28-year-old diabetic will have a stroke, or will have a heart attack. And it’s so sad because they’re not even in their 30s yet; they’re not even at the height of their careers, or chosen paths in life, and yet they already have these complications primarily because they’re really very big, they have this “panget na lifestyle,” just eating anything in sight, not exercising, drinking a lot of the sugar beverages, and all of that.

So, it’s really sad that we have a lot of young adults who are already diabetics, and a lot of them, aside from having all these cardiovascular diseases, have renal failure. So, we also have a lot of young diabetics who are on dialysis. So, it’s very sad. It’s really very sad, so please, don’t do that.

When you’re diagnosed to be diabetic, then you really have to follow a good lifestyle, take your medications, and see your doctor. And if you’re not yet diabetic, don’t wait. Just like what Kai had said, don’t wait to be diabetic. Practice a healthy lifestyle so you don’t get to be diabetic later on.

KM: Okay. Yeah. And then we are repeating this like a broken record because it is a very important message that we really want to para, may plan po sa inyo. And please spread the word. Share po ninyo ‘tong interview natin with doktora para mas marami pang makaintindi kung ano ba talaga ‘yung causes, anong komplikasyon ng diabetes, and, how will it affect talaga our life and our family?

But at the same time, even after getting diagnosed, it’s not a life sentence. ‘Wag pong mawalan ng pag-asa, makinig sa doktor, at sundin ang doktor, okay. So, Doc Ayi, for my last question, pwede rin siyang repeat e. Pero ulitin natin para sa mga nanonood na, kasi ang viewers namin dito sa Hello Doctor, madami ang meron nang suspetsa, noh.

They’re looking up symptoms, or either that or na-diagnose na sila, or they’re caring for a patient. So ano ang inyong mensahe sa kanila? What is your message to them, as far as diabetes is concerned?

Dr. Ayi Faller: Okay. So actually, for those people who already have diabetes, you don’t have to be living a lonely life. You don’t have to be sad. All you have to do is discipline yourselves, accept that you are diabetic. You can live with it, be happy with it, you just have to make sure that you have a good diet, and enough exercise. Basically, a good lifestyle: no smoking, no intake of alcohol, less stress. All of these can make you have a good quality of life even if you are diabetic.

Of course, you have to know what your other risk factors are because diabetes – they have a gang of friends. May barkada ‘yan, eh. Hypertension, hypercholesterolemia meaning increased cholesterol levels, increased blood pressure, so you also have to look into this because if you are not able to control the blood pressure or the cholesterol, and you’re just controlling the blood sugar, then you can still get the other complications like cardiovascular diseases, renal failure and all of that.

So, it would be best for you to know what your risk factors are, go visit your doctor, and there are a lot of websites also that can help you for this one. There’s like the For Your Sweetheart website and in this, you will be taught all about diabetes and its complications.

There’s also the Framingham Risk Assessment test there, so you would know if you have the risk to develop all of the cardiovascular diseases also that may be present in diabetes. So, again, it’s easy to live with diabetes, you just have to live healthy and be disciplined. Visit your doctor regularly.

KM: Okay. Thank you for that Doc Ayi. So ‘yung website po is for-your-sweetheart-dot-PH (foryoursweetheart.ph). Okay. Bisitahin niyo po ‘yun right after watching this interview.

So, there you have it, Doc Ayi Faller, president of the Alliance of Clinical Endocrinologists in the Philippines. I learned so much in this one hour, I mean, we publish a lot of stories on diabetes, but you know, it’s always good to keep learning, to keep re-learning.

And I appreciate message being repeated over and over again because like, today, ang excuse ko, doktora, nag-memedicate pa ako e, ‘di comfortable earbuds ko e, pero ‘yung bike ko naghihintay oh. Parang, “Ay, buong araw ka na namang nakaupo.” Alam mo ‘yun, doktora? I think we can never get enough reminders to take care of our health.

Yes. And especially, Kai, I just want to say, because a lot of our people are just working from home and the majority are just sitting down and all of that. We have to remember that now, sitting is the new smoking. If smoking kills, sitting kills as well.

So, I always tell the patients who are working from home, “Every now and then you have to get up and walk around. Try to exercise while you’re working from home. Take advantage of this COVID pandemic when we’re just at home.”

I think it would be nice because you get to really have time for yourself so you can exercise, look into the food that you’re eating, unlike before when we’re still working outside, we have to hurry because of the traffic and all of that so you have to make more time for work.

But now, since you’re working from home, then I guess, now we can take care of our family, and ourselves. So that’s I think the plus point of having the quarantine.

KM: Yeah. I agree, Doc Ayi. Sometimes, I miss — I used to work in a building that was 40 to 45 minutes away from my condo, and I really walk. I walk going home.

Uy, wow. Really? That’s nice.

KM: Yeah, and it was also kind of, you decompress, so by the time you get home, you’ve let go of your work mode, and you’re ready to be in the home mode. And I miss that.

Yeah, that’s true.

KM: I had friends who would say, “Wow, kawawa ka naman, mag-grab ka na lang.” Parang, ba’t pa ako naging kawawa, naglalakad nga ako e.

Yeah, but you know, walking really relieves you of stress. It clears your mind. That’s what I tell the patients, “Walking is really a very very good exercise. Not just for your body, but for your mind as well.”

KM: For the creative mind, people like us, we have to think of ideas. You look around randomly, and just by looking at people, new ideas go into your head. So, yeah.

Walking. Brisk walking, right?

KM: Yes. So, thank you, Doc Ayi. Thank you for spending an hour with us talking about diabetes and cardiovascular health.

My pleasure.

KM: And for your sweetheart dot PH (foryoursweetheart.ph). Everyone, please visit that website right after watching this.

So, this has been Kai Magsanoc of Hello Doctor Philippines, for our very first #AskTheExpert video interview. Please join us again for the next one, as we talk to another medical expert about another pressing medical issue whose conversation needs to happen now. Until then, stay well and be safe.

Learn more about diabetes, here.