Commentary: Here’s how people with diabetes can still enjoy hawker food without fear

Contrary to what some people might think, no food is off-limits to people living with diabetes. 

In Singapore, where decadent food is a part of our family and social lives, the challenge of managing the condition through diet can sometimes lead to conflict.

But there are some surprisingly easy ways to make sure those with diabetes are getting the balanced diet they need, even at that most Singaporean indulgence: Hawker centres.

Being a dietitian, I’ve seen my share of family stress over the management of diabetes.

In one recent consultation, an elderly diabetic patient came into my office with his daughter.

At home, the daughter nagged him for having an extra teaspoon of sugar in his coffee, not knowing that he had been sneaking out regularly to meet his friends for unhealthy snacks at the hawker centre.

This story is all too common: To avoid conflict and the loss of their favourite foods, patients hide their indulgences from caregivers. 

What they don’t realise is that this pattern of behaviour can be more harmful than the occasional teaspoon of sugar.

Whether for yourself or for someone in your care, knowing how to live with diabetes is crucial.

After all, diabetes is not exclusive to the elderly.

According to the International Diabetes Foundation, approximately 13.3 per cent of adults in Singapore aged 20 to 79 will be living with diabetes by 2030.

While the Government ramps up its war against diabetes with the "Let’s BEAT Diabetes" programme and increasing access to free screening through HealthierSG, we can do more to help patients, loved ones and even ourselves who may be living with diabetes to better navigate everyday life.

EASY HACKS

Dining at a hawker stall is quintessentially Singaporean.

This treasured experience brings friends and families closer as we share a meal. It’s no wonder my elderly patient couldn’t forego his regular meetups.

Living with diabetes doesn’t mean you have to forsake your favourite bowl of noodles or share food with loved ones.

These easy tips can help you keep your blood glucose in check while still enjoying your local favourites.

• Use the plate format. Plan out your meal using the plate format. Draw an imaginary line through the centre of your average-sized plate, then divide one of the halves into quarters. Half of the plate should be filled with vegetables, and the remaining quarters are for protein and carbohydrates. You can go about your usual order following this rudimentary format to ensure that you eat a variety of food groups even when you are having hawker fare.
• Ask for less. Everything comes down to portion control. How much you eat matters more than what you eat at a hawker stall, so ask for half a serving of rice or noodles. This helps to satisfy your cravings without going over your daily limit. Ask for less gravy and sauce as well. They might seem negligible but they can contribute to your daily carbohydrate consumption.
• Eat in order. The sequence of what you eat can affect your blood glucose levels even without a change to portions. Preloading on protein, fat, and fibre slows down the digestion of carbohydrates, thereby improving the blood glucose levels following a meal. So, start with your vegetables or meat before eating carbs. It’s a simple modification of practice that can go a long way in managing diabetes.

THE CHEAT SHEET

Instead of telling off our loved ones with diabetes for eating at hawker stalls, we must help them navigate these realistically and healthfully. Each person will probably need some trial and error to see what works for them, but here are a few examples of what you can get:

• At a caifan stall, ask for half a serving of economic rice, one serving of lean protein like tofu or chicken and two servings of vegetables. Fish soup is a good choice to increase satiety and pack in nutrients. If you’re getting nasi padang, apply the same combination.
• At a biryani stall, get chicken biryani with half the usual portion of rice. Add a serving of vegetables like lady fingers or cabbage — these are usually available if you ask. Alternatively, you can order one chapati or naan with dhal and add two vegetables to make a complete set.
• If you are looking for one-dish meals, you can get mee siam or soto ayam as they tend to be less oily. Ask for less mee or "ketupat" and more bean sprouts for extra fibre. 
• Skip the sugarcane juice stall and make water your drink of choice. But if you really crave a sweet drink, choose a sugar-free option, save it for last and limit your intake.

No two people are the same, and different people will have different blood glucose responses to the same food. The same slice of bread could cause one person’s blood glucose levels to spike but not another person’s.

The only way to truly understand the effect of different foods on the system of someone living with diabetes is to monitor their glucose levels. 

My patients have found continuous glucose monitoring to be useful for this: A wearable sensor automatically measures, captures and stores glucose data every minute for 14 days at a time, giving them real-time feedback on glucose levels using their smartphones and saving them having to prick their fingers to measure blood glucose.

LIVING WITH DIABETES

These hawker hacks are not fix-all solutions for managing diabetes, but they can lead to real results for those living with the condition and the people around them. 

Along with regular exercise, this kind of strategic dining makes it easier for people living with diabetes to enjoy the things many of us take for granted.

Diabetes is a lifelong condition that requires lifestyle modifications. However, we should be realistic about the changes we wish to adopt, especially when it comes to diet. 

We must understand that the best one to follow is the one we can adhere to every day. 

Through reasonable adjustments, we can ensure nutritional needs are met without feeling like diabetes is a life sentence to dietary misery.

When someone living with diabetes or their caregiver is equipped with the proper tools and knowledge, they become empowered to manage the condition better, thus improving their overall quality of life. 

This is what we should aim for. Apart from intensifying efforts for disease prevention, learning to live with diabetes in the best way possible could very well be the key to mitigating its impact on Singaporeans.

ABOUT THE AUTHOR:

Jaclyn Reutens is a clinical and sports dietitian at Aptima Nutrition.