While nearly 70% of diabetics are overweight and obese, 60% of them have not implemented any weight control. 
Statistics of the Ministry of Health and Welfare show that diabetes had taken 9,845 lives in 2014, meaning an average of 1 death per hour! According to the 2013-2014 Nutrition and Health Survey in Taiwan conducted by the Health Promotion Administration (HPA), the prevalence rate of diabetes among Taiwanese aged above 18 is 12.4% (14.4% for male; 10.3% for female). If patients suffering from diabetes do not control the disease well, they may develop irreversible constitutional lesions in major and minor blood vessels, nerves, etc., resulting in complications such as strokes, heart diseases, kidney diseases, retinopathy, and foot necrosis, which may lead to amputation. The 2015 Standards of Medical Care in Diabetes issued by the American Diabetes Association (ADA) stated that obesity may increase the risk of Type 2 diabetes. Most Type 2 diabetes patients are obese, and obesity increases the level of insulin resistance. Diabetes patients who are not obese according to the conventional standard may have a significant increase in body fat percentage, especially in the abdomen. It is advised that overweight and obese diabetes patients should lose weight appropriately, in order to effectively reduce their insulin resistance level. 

As pointed out by Director-general Chiou, Shu-Ti of HPA, the result of the 2013 National Health Interview Survey showed that in terms of BMI, the overweight and obesity rate among people aged above 40 was 49.0% (male: 55.6%, female: 42.7%) (Table 1), but the BMI overweight and obesity rate among diabetics aged above 40 was even higher! Almost 70% of them were overweight and obese according to BMI (male: 66.5%, female: 66.1%) (Table 2). The survey result also showed that about 60% of the diabetics that were overweight and obese according to BMI did not take any weight control measures; among them, there were more female patients (58.9%) than male patients (51.3%) (Table 3). Weight control helps to keep in check blood sugar, blood lipid and blood pressure. Director-general Chiou reminded diabetics that fighting obesity is the first step of diabetes prevention! 

Female diabetics have normal BMI, but the excess waistline rate approximates 50%. 
Director-general Chiou added that a noteworthy fact from the abovementioned survey is that among diabetics aged above 40, 49.8% of female patients have normal BMI (18.5≦BMI<24) but excessive waist circumference (WC≧90cm for male, and WC≧80cm for female), much higher than the 13.2% among male patients (Table 4). The figure for female patients is more than 3.5 times that for male patients! Waist circumference reflects the extent of abdominal obesity, which in turn reflects internal fat deposits, and serves as a measure for diagnosing metabolic syndrome and determining the risk of cardiovascular diseases. Body mass index (BMI) is an internationally adopted index for obesity, but may not fully reflect the level of internal fat deposits. Therefore, apart from body weight and BMI, attention should also be paid to the waist circumference. If the waist circumference exceeds the optimal size, the fat tissues accumulated in the abdomen will affect the metabolism, causing increased concentration of triglycerides in the blood and heightened blood sugar level, hence raising the risk of cardiovascular diseases and diabetes. Female diabetics are reminded to guard particularly against becoming belly ladies! Director-general Chiou of HPA explained that both general obesity and internal obesity are among the major risk factors leading to the incidence of hyperglycemia. People are reminded that weight management is the only proper way to prevent diabetes. 

Five ways for diabetics to control sugar intake and stay healthy! 
How do patients already suffering from diabetes keep their blood sugar level well under control, and hence avoid or minimize the incidence of various chronic complications thereafter? According to the result of the abovementioned survey, nearly 50% of diabetics aged above 40 that are overweight and obese according to BMI have not exercised in the past one month (45.6% for female patients, 44.5% for male patients) (Table 5). It shows that these patients’ habit of regular exercise has yet to be improved. Patients are encouraged to develop the habit of regular exercise, and integrate it into their daily life. Don’t let obesity rob you of your health! Director-general Chiou of HPA provided the “Five Ways to Control Sugar” to ensure health. Develop a responsible attitude to life, and start over again! 
* Weight Control: Undertake weight control under a dietitian’s guidance, or join a patients group for weight loss, or make use of the HPA weight management hotline 0800-367-100 (367-100 is pronounced as san-loh-khi, iau-tong-tong in the Taiwanese dialect; meaning literally “exercise to slim down”). Free telephone inquiry service in Mandarin and Taiwanese dialect is provided daily from 9:00 a.m. to 9:00 p.m. by professional dietitians and sport experts. Patients are welcome to use the service, putting the quest for a healthy life into practice and avoiding the threat of obesity and diabetes. 

* Regular Exercise: Minimize the time of sitting without activity, such as watching TV, surfing the Internet, etc. It is suggested that commuting time can be used for exercise, e.g., getting off the bus one or two stops in advance when going to and from work, or climbing stairs instead of taking the escalator or elevator, and incorporating these habits into daily life. At least 150 minutes of physical activities per week is recommended, but caution has to be taken against potential dangers such as falling, dehydration, etc. Also, foot care is another focus; it is advised that blood sugar self-examination should be done before exercise to avoid hypoglycemia. 

* Disciplined Medication: Adjustment to diabetic medication has to be made based on the blood sugar level and depending on personal response (presence of discomfort or not). Overdose may lead to hypoglycemia, while discretionary reduction of medication may cause hyperglycemia. Therefore, medication has to be taken as per doctor’s prescription. If a different doctor is consulted during the period of treatment, the new doctor must be informed of the existing medication in order to avoid the cross effect of different medicines or interference with blood sugar control. 

* Healthy Diet: Consult a doctor or a dietitian, and work out a suitable personal diet plan depending on your height, weight, gender, age and medical condition. Also, based on the principle of “balanced diet”, take in a fixed amount of carbohydrate and high fiber, and a proper amount of fat, for the goal of controlling blood sugar and maintaining your health. 

* Blood Sugar Self-examination: Blood sugar level varies with diet and lifestyle. Therefore, patients should not only revisit their doctor for consultation and inspection, but also monitor blood sugar level in the way suggested by medical personnel, so as to understand the interrelations among different foods, physical activities and anti-diabetic medication. Patients may also discuss the examination results with their caretakers to help work out an effective blood sugar control method for themselves. 


Exercising Tips for Diabetics! 
Ask – Ask for your doctor’s advice: Patients are suggested to first discuss with their doctor regarding an exercise prescription suitable for their condition. Type of exercise, time, occasion and intensity should be taken into consideration, and an appropriate exercise, to be executed progressively, should be identified considering one’s lifestyle and habit. 

Protection – Proper protection: Wear suitable clothing, footwear and other protective gear. No bare-foot exercise is allowed. 

Bring – Bring handy supplies: Always bring glucose tablets, sweetened juice, biscuits, etc., with you, so you may consume them immediately in case of hypoglycemia. 

Companion – Invite someone: Always bring your “diabetes booklet” or diabetes identification document with you, and avoid exercising alone. 

Warm-up – Sufficient warm-up: Proper warm-up and cool-down activities should be done before and after exercise, and the exercise intensity should be increased gradually. 

Let’s get together and exercise on the 2015 UN World Diabetes Day in Taiwan! 

This year’s World Diabetes Day (November 14th) theme is “healthy eating and diabetes”, urging diabetics to improve their dietary habit and daily routine to enhance their quality of life and create their beautiful life. It is also encouraged that comprehensive diabetes prevention education should be launched to disseminate the message about developing proper dietary and exercise habits, so that obesity and diabetes, as well as other chronic diseases can be prevented. To emphasize the importance of the prevention and control of diabetes, the HPA has joined hands with The Diabetes Association of the R.O.C., Taiwanese Association of Diabetes Educators, Formosan Diabetes Care Foundation, Taiwanese Association of Persons with Diabetes, and the Public Health Bureau of Nantou County Government to organize a series of activities in response to the international resonance of World Diabetes Day. 

* Fun Fair and Walk: Fun fair, walk, and other activities will be carried out at 3:00 p.m. to 6:30 p.m. on October 31st (Sat) at Wen Wu Temple of Sun Moon Lake, promoting correct messages about diabetes prevention and control through interactive games, and encouraging the development of good exercise habits such as walking. 

* Lantern Lighting: Lantern lighting activity will be carried out daily at 5:30 p.m. to 9:00 p.m. from October 31st (Sat) to November 6th (Fri) at Wen Wu Temple of Sun Moon Lake, as a sign of working hand in hand with other countries around the world against diabetes, jointly preventing the spread of diabetes. 

* In addition, other activities, such as a photography competition, Cycling 4 Hope diabetic bike team, etc., are also planned. Relevant information is available in the appendix; please refer to The Diabetes Association of the R.O.C. for details: 
http://www.endo-dm.org.tw/dia/news/content.asp?id=595, or consult Ms. Gu, Feng-Ying of The Diabetes Association of the R.O.C. at 02-23753352. 
You are welcome to join the series of diabetes education activities, and everyone is encouraged to take sugar control seriously in your daily life. Work on health first, and then your wallet. Avoid diabetes and make your life healthy and colorful!