Author: Editor

To snack or not to snack?

Ask the dietician: Genevieve Jardine

From our community: “My average blood sugar over the past few months was higher than it should have been, so I’m trying really hard not to eat the wrong foods. Any tips for healthy snacks?” Lynnae Daniel

Getting creative with your snacks can really help make your daily meal plan more exciting. We all get into a rut with our meal choices, and adding different (healthy) snacks can improve variety, colour, flavour and even add valuable nutrients to your daily intake.

Not every person with diabetes needs to snack. Some people are happy with three square meals a day, while others prefer small snacks throughout the day. Your unique eating style largely depends on your own natural eating patterns, medication, blood sugar control, and how active you are.

Remember: If you go for more than 4 or 5 hours between meals you may need to snack in order to prevent your blood sugar from dropping too low. But snacking on the wrong kind of food can cause blood sugar levels to rise and also cause unwanted weight gain.

So what does a healthy snack look like?

  • A snack should be between 300 to 600 kilojoules otherwise it is more like a meal.
  • Snacking is a good chance to increase your vegetable or fruit intake (remember, the aim is 5 servings of vegetables a day).
  • Plate your snack to help control portion size: don’t eat straight out of a bag, box or packet – or straight from the fridge!
  • Portion your snacks into snack-size packets, or buy suitable snack portions.

Ask yourself: are you actually hungry? Don’t snack because you’re bored, stressed or worried.

Healthy snack ideas:

  • One piece of fruit (carb 15g, fat 0g, 300kj)
  • 100ml low-fat flavoured yogurt (carb 16g, fat 2g, 400kj)
  • 2 cups popped popcorn sprinkled with fat-free parmesan cheese (carb 15g, fat 7g, 636kj)
  • 30g lean biltong (carb 0.7 g, fat 2g, 346kj)
  • 3 Provitas or 2 Ryvitas with cottage cheese, tomato and gherkin (carb 20g, fat 2g, 382kj)
  • ½ an apple with 20g sliced low-fat cheese (carb 8g, fat 5g, 430kj)
  • Raw veggies (carrot sticks, cucumber, baby tomatoes, gherkins, baby corn, snap peas) with cottage cheese, hummus or avocado dip (carb 8g, fat 7g, 540kj)
  • 30g nuts/seeds (carb 3g, fat 14g, 735kj)
    Tip: Nuts and seeds are high in fat and kilojoules. However, the type of fat is much healthier than that found in a chocolate bar.

Unhealthy snack choices:

  • 50g bar of chocolate (carb 30g, fat 12g and 1120kj)
  • 30g packet of potato crisps (carb 24g, fat 12g, 766kj)
  • 300ml bottle of drinking yoghurt (carb 45g, fat 5.6g, 1140kj)
  • 25g packet of sweets (carb 18g, fat 0g, 316kj)
    Tip: It might seem like this snack is within the recommended carb, fat and kilojoule allowance, but they are empty kilojoules with no fibre and very little vitamins and minerals.

Snacking for exercise:

Remember that exercise can also cause low blood glucose. It is important to check blood glucose before and after you exercise. People react differently to exercise depending on the type, duration and intensity: some people see a rapid drop and others an increase in blood sugar levels, so it is important to test and see what your individual response is.

As always, you should see a dietician to help you plan suitable snacks for different situations. Fresh snack ideas can bring a sense of fun into your daily eating plan.

What does this food label mean?

Ask the dietician: Genevieve Jardine

From the community: “I would like to understand the nutritional information printed on food labels – I’m new to it all and don’t know what I should and shouldn’t be looking for.” Lynnette Hitchcock.

Food labels are certainly not the simple list of ingredients they used to be – they’ve evolved into complicated beasts that don’t make sense to most people. So what information is actually useful? What makes you decide to put a product into your trolley?

Let’s take a look at an example: Jungle Energy Bar (Yoghurt)

At the top of the label is the nutritional breakdown for 100g/ml and the breakdown per serving size. Make sure that you read the label clearly and understand the difference – this example is clear because it gives the nutrients for 100g and for the 40g bar.

There should also be a list of ingredients with the highest ingredient by weight listed first. You can then check the nutritional value of a particular ingredient by referring to the nutrition information panel.

Energy

When it comes to Energy, look at the serving size. This energy bar contains 760kj per bar. People with diabetes who are trying to manage their weight should compare total energy of a few products to get perspective. For example, this energy bar is a snack, but when you compare it to the energy content of an apple (273Kj) or low-fat yoghurt (425Kj) you will notice that it contains twice the amount of kilojoules. There is no reference for energy content because you have to take into account your total energy intake across the day.

Protein

The Protein content per serving may come with a percentage next to it (not found on this example). This is merely to indicate how much of the product contributes to the recommended daily allowance of the average individual: about 55g protein per day.

Carbohydrate

This is important for diabetics, especially those who are carbohydrate counting or watching their carbohydrate intake. On most labels you will see two categories “Total Carbohydrates” and “of which are sugar”. This information can be tricky to interpret: the total amount of carb is more important than how much sugar and starch there is, as all sugar and starch eventually ends up as glucose in your blood stream. The “sugar” indicated on the food label could mean added sugar or natural sugars found in the food. If we look at the list of ingredients, we see that oats appear first (highest in weight) followed by sugar and golden syrup. This would indicate that oats make up most of the carbohydrate amount, with a smaller contribution made from sugar and golden syrup. The sugar is therefore added sugar.

If you look at the label, there are 25g of total carbohydrate in the energy bar. 15g of carb is one portion, so this energy bar is closer to two servings (30g) of carbohydrate. The bar therefore has a much higher carb content than an apple, 3 Provitas or 100ml low-fat flavoured yoghurt – all 1 carb.

Fat

When looking at the fat content, take a look at the values per 100g/ml. Take note of the total fat content and then the saturated fat and trans fatty acid.

For a product to be labeled “low-fat” there needs to be less than 3g of total fat per 100g (solids) or 1,5g per 100ml (liquids). Fat-free means less than 0,5 g total fat per 100 g/ml.

Saturated fat is part of total fat and is a key player in raising cholesterol. Low saturated fat is less than 1.5g per 100g (solids) or 0.75g per 100ml (liquids). This energy bar is not low in fat or saturated fat.

Trans fatty acids have a similarly harmful affect and also lower your HDL (good) cholesterol. For a product to be called “trans fat free” there should be less than 0,1g per 100g/ml.

Fibre

Fibre is very important to help improve gastro-intestinal health, prevent cancers, help lower cholesterol and delay the release of glucose into the blood stream. It also helps you feel fuller for longer. These are all very positive benefits which make a high fibre product very desirable. The recommended daily intake for fibre is 25g per day (for women) and 30 to 45g per day (for men). As a general estimate, a high fibre product would be more than 5g of fibre per 100g. This energy bar just makes the grade.

Sodium

Sodium comes from salt: a high salt intake has been linked to raised blood pressure in some people. The recommended daily intake of salt is 240 to 300mg per day. A low sodium product should contain less than 120mg per 100g. A sodium free product should contain less than 5mg per 100g. This energy bar is not too bad.

Results:

So overall how does the energy bar fair? The energy and total carbohydrate content of the energy bar are similar to that of a Bar One chocolate, with slightly less total fat. On the plus side the fibre content is good and the sodium content is low. I would suggest this energy bar as a treat.

Durban Diabetes Fundraiser

We got sent this invitation this morning – doesn’t it sound fabulous? If you’re in Durban, check it out!

We are very excited to be organising our first event to raise funds for Diabetes SA.

Diabetes is a growing concern in SA and rising in terms of mortality.

Diabetes SA rely a great deal on fundraising so please help us to raise funds for this worthy cause and spread the word to family, friends & clients to support this fabulous event.

There will be a Decadent Morning Tea, Goodie Bags for everyone, Informative talks and Lucky Draw Prizes.  Please see below details and note that the invite is extended to LADIES & GENTS.

The speakers at this event will be :

1)      Dr Silvana Nienaber (Type 1 Diabetic)

2)      Julie Peacock (Dietitian & T1D)

3)     Doody Adams ( Editor of The Ridge Magazine ) : A mom giving her perspective on dealing with a child who has Type 1 diabetes.

Obesity study in SA

We just got sent this information that we thought you – the South African diabetes community – would like to know about… What do you think? Want to get involved?

Healthy Living Alliance (HEALA) is an alliance of like-minded organisations with a mission to improve the health of an increasingly obese South Africa, compelled by the constitutional right that says that everyone  should have access to clean drinking water and sufficient healthy food.

For our obesity prevention campaign, we are looking for people who have suffered severe complications from diseases like diabetes, heart disease and stroke who are willing to share their stories with us.

The sort of complications we have identified are; blindness, amputation, stroke or being on dialysis.

The purpose of this is to create awareness about the seriousness of non-communicable diseases, and the importance of making lifestyle changes to prevent complications. We’re hoping to find individuals who would like to share their stories in order to help others.

We would like to hear from YOU!

Check out our website at www.heala.org or write to us at info@heala.org

Diabetic Q&A

Have a question about healthy living and nutrition? Ask us here and we’ll get an answer for you!

How does exercise impact my blood sugar?

Regular activity is as key a part of managing diabetes as proper meal planning, regular monitoring and taking medication as prescribed. When you are active, your cells become more sensitive to insulin, which means that your body can work more efficiently. During exercise your cells also remove glucose from the blood using a mechanism totally separate from insulin. So, not only does exercising consistently lower blood glucose, it also improves your blood glucose control overall.

Top tip:

Get moving and get the most out of your exercise routine by incorporating strength training (to build muscle and body structure), cardiovascular training (to improve heart health) and flexibility training (to ensure supple limbs and range of movement).

How often can I eat eggs?

Eggs are relatively high in cholesterol, yet there is now enough evidence to suggest that we can eat an egg a day without a detrimental effect on our blood cholesterol levels

The South African food-based dietary guidelines allow for 4 eggs per week and here’s why:

  • Eggs are a source of protein and several essential nutrients.
  • Although eggs are relatively high in cholesterol – 210mg per large egg (50g) – they have a low saturated fat content.
  • Many of the studies linking eggs to high blood cholesterol levels and poor heart health are now criticized and considered to be weak.
  • New evidence suggests that eating eggs is associated with satiety (feeling fuller for longer), good weight management and better diet quality.

So, if you enjoy eggs, go ahead, include them in your diet.

Just remember:

  • Prepare your eggs with no extra fat by boiling, poaching or scrambling them.
  • Limit your egg intake to 1 egg per day. And, if you have raised blood cholesterol levels, limit your intake of animal fats and increase your vegetable, fruit and fibre intake.
  • Egg whites contain no cholesterol. So, if a recipe calls for a few eggs, moderate your cholesterol intake by using two egg whites in place of one whole egg.

This information was brought to you by www.picknpay.co.za

Pick n Pay is committed to promoting health and wellbeing among South Africans and employs the services of a registered dietician to provide food and nutrition related advice to the public. For your nutrition and health related queries, contact healthhotline@pnp.co.za or toll free on 0800 11 22 88

For more fantastic information on diabetes and nutrition, visit Pick n Pay’s Health Corner.

Diabetes Performance for National Diabetes Month

Good day,

We are the Blood Sugars project from the University of the Witwatersrand and the Chris Hani Baragwanath Academic Hospital.

November is National Diabetes Month.

We have created a performance that takes people through a reflective journey through the use of storytelling and metaphor.

The aim of the performance is to explore the complexities of living and working with Diabetes from the perspective of clinicians, patients and families with the ultimate aim of improving treatment outcomes through changed behaviour.

We would like to bring the performance to hospitals, clinics, schools and theatres as a way of reaching the general public.

We aim to perform in the month of October and November 2016.

Please email me if you are in Johannesburg and interested in hosting a performance.

Looking forward to hearing from you.

– Tshegofatso Seabi
– Health Communication Research Unit
– University of the Witwatersrand

Diabetes and Alcohol

Do you drink alcohol? Do you know how it affects your blood sugar? Here’s some fantastic advice from community member Ane on how to deal with drinking and diabetes:

I’m a second year student in Stellenbosch, which is not very helpful with all the beautiful wineries etc here for a type 1. I do, however, prefer to either drink nothing or drink something I know will not have an impact on my sugars too much. The problem with alcohol is it makes your sugar drop rapidly when too much alcohol is in the blood without sufficient carbs to keep levels stable. This is a confusing concept since 275ml of beer = 5 slices of white bread = carb overload!
Do not drink cocktails. Nor shots. Ever. Try to avoid cloudy drinks as well.
I would recommend not drinking and drinking Coke Light or water (much much cheaper) or if you have to drink and want to, have some whiskey or champ. (Whiskey is your best option, and champagne is regarded the best type of drink for ladies with Type 1 diabetes.)
Always always have a friend with you that will not get drunk. In the (hopefully) unlikely event of a hypo, people will think you are drunk since it looks 100% the same in a club at 02:00..
Keep carbs with you at all times, and never drink on a empty stomach.
Set alarms in the morning to make sure that you don’t get a hypo. Rather little higher than too low.
Wear something to say that you have type 1 diabetes..
Remember, we are all curious at some point in time about alcohol (and a lot of other things that have an influence on our levels) We try things, make mistakes, learn and educate others. Everyone is different, this is my opinion since I have experience.. Hope it helps!

drinking and diabetes

Humans of South Africa

Hi there,

I am a writer, copywriter and journalist; I have been running Humans of SA for 2 years – we also have a Facebook page. I wanted to create a space where I could share South African stories. My aim has always been to open windows into worlds we might know nothing about. I interviewed a lady recently who lost her father to diabetes.

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She speaks about a lack of understanding in terms of care and treatment. I feel it is important to bring attention and help create more awareness by telling stories of people who are diabetic, of professions who can advice and help.

If you have a story you are happy to share, please get in touch by emailing me.

Thank you!

Sandy

Type 1 Diabetes and Breastfeeding

To all the diabetic mommies out there:

Being diabetic did you breastfeed your baby? I have found that my sugar dips from the breastfeeding.   think I should stop as I nearly went into a coma, when I came to my sugar was 0.5, but I don’t want to stress my baby out. She does not like taking a bottle from me at all.

The doctors and councilors all seem to have different opinions. I have been feeding my baby less and have now got spiking sugars, I assume from my body adjusting  again. I am very torn because my baby needs me more than my milk.

Has anyone else out there had the same situation?

Thanks,

Candace

Managing Diabetes During Ramadaan

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Ramadaan can be a difficult time for those Muslim diabetics who want to fast and don’t know how to incorporate fasting into their diabetes diet.

We asked Pietermaritzburg-based dietician Sumaya Sooliman for some advice on managing diabetes during Ramadaan and she gave us this fantastic information… Read on!

——-

Ramadaan is the ninth month of the Islamic calendar and is known as the month of believers. It is an opportunity for muslims to purify their minds, bodies, heart and soul. The important aim of Ramadaan is also to experience what the poor feel and what it is like to be hungry so that we appreciate what our creator has given us. Fasting is compulsory for muslims who have reached the age of puberty, are healthy and able to fast. Those who have conditions where fasting is seen as detrimental to health are exempt from fasting; however, this is entirely the individual’s decision. Diabetics fall under this category. There are however, many well controlled otherwise healthy diabetics who wish to fast. The following are guidelines to help those with diabetes to safely fast during Ramadaan.

What is diabetes?

Diabetes is a condition where the body is unable to make enough insulin (Type 1 diabetes) or it is unable to use the insulin it makes effectively (Type 2 diabetes). This affects the way the food we eat is absorbed into the body to provide us with energy. These result in a build-up of glucose in the bloodstream called hyperglycaemia.

The symptoms of diabetes include excessive thirst, excessive urination, excessive hunger, unexplained weight loss or weight gain, fatigue, blurred vision and frequent infections that take long to heal.

Diabetes and the above symptoms can be controlled with medication, diet and exercise. Type 1 diabetics are treated with insulin injections, whilst type 2 diabetics are treated with oral tablets and sometimes insulin. A person with diabetes can live a perfectly, normal, good quality, healthy life if they are compliant with medication, diet and exercise.

Which diabetics can fast?

It must be mentioned that only those diabetics whose blood glucose levels are well controlled, compliant with medication and otherwise healthy can safely fast.

Type 1 diabetics on insulin are at a higher risk for fasting as compared to type 2 diabetics. Type 2 diabetics on insulin are at a higher risk for fasting as compared to type 2 diabetics on oral hypoglycaemic agents. Poorly controlled type 1 or type 2 diabetics as well as diabetics with heart or kidney disease are very high risk patients and should consider not fasting. Fasting increases the risk of hypoglycaemia, diabetic ketoacidosis and dehydration and patients may require hospitalisation.

However, currently in South Africa, with the fasts being just about 12 hours, well controlled diabetics can safely fast. Furthermore, if they follow the guidelines correctly and use the fast as a means of detox and putting the right foods into the body, it can also be very beneficial. Fasting can improve weight management, result in weight loss and can be beneficial to improve insulin resistance and therefore improve the condition.

Before deciding to fast

It is important that the diabetic individual deciding to fast be aware of the risks associated with fasting and has had a thorough check up with the doctor to establish if it is safe for them to fast. Family support is imperative at this stage and it is important that the family understand the journey the patient will be undertaking. The family should also form part of the pre-Ramadaan education sessions in order to guide and support the patient.

It is crucial that they are educated on blood glucose control, adapting medication, exercise, what to do if experiencing hyper or hypoglycaemia or dehydration and the appropriate diet to be followed in order to reduce the risks associated with fasting. Furthermore, it is vital that they are informed as to when it is necessary to break the fast to prevent further complications.

The individual can decide if they will be fasting the whole month or if they will be fasting on alternate days. It is also beneficial if the individual practices a few fasts prior to the start of Ramadaan to establish if he/she will cope during Ramadaan. Furthermore, the fasting diabetic must inform those around him/her that he/she is fasting.

A diabetic who is planning to fast must not have a fear of fasting. The same diet can be followed during Ramadaan as during the rest of the year, the only difference is that meal times have changed and medication will have to be adjusted accordingly. Simply put, for a diabetic, in Ramadaan; the day and night are reversed. Hypothetically speaking, the iftar or sunset meal is like breakfast (breaking the fast); the meal from supper to after the evening prayers will be considered lunch and snacking and the sehri (pre-dawn) meal is considered as supper; so the fasting hours can be equivalent to the time when one is usually asleep at night and not eating.

Types of foods to eat during Ramadaan

  • Foods that are high in energy, yet nutritious such as nuts and dates
  • Foods that keep one full for a longer time ie. high in fibre such as whole gains and cereals eg. brown bread, oats
  • Fruits and vegetables to provide enough vitamins and minerals
  • Meat, fish, chicken, lentils, milk, eggs and yoghurt as these are good sources of protein and also keep one full for longer
  • Drink lots of water to prevent dehydration

Types of foods to limit during Ramadaan

  • Foods high in fat and sugar as these make you full very quickly and then hungry again soon after. They can result in hyperglycaemia immediately after eating and then hypoglycaemia later. They also make you sluggish so you get tired quickly and are low in vitamins and minerals eg. pies, samoosas,burgers , donuts and cakes.
  • Drinks high in caffeine such as tea, coffee, fizzy drinks as this may cause dehydration

 

Suhoor/Sehri: The pre-dawn meal

At sehri it is important to eat foods that keep one fuller for longer. These foods include complex carbohydrates rather than refined starches and foods that are high in energy and protein. It is also important to drink water to keep you hydrated during the fasting day.

Example of a nutritious sehri

It is a good idea to start sehri with an energy dense fruit such as a banana. Thereafter, a bowl of wholegrain porridge such as oats or semolina, whole-wheat or bran cereals is suitable with low fat milk and a teaspoon of sugar or honey. It is a good idea to add a tablespoon of seeds (pumpkin, sunflower, sesame and linseeds) or nuts and muesli to the porridge to increase the energy and fibre content which will keep you fuller for a longer period of time. Thereafter 1 to 2 slices of brown or wholewheat/low GI bread with peanut butter or cheese is advised. Egg bread/French toast made with brown or wholewheat/low GI bread is also a good option.

If you are someone who does not enjoy porridge or cereal, an egg is a good source of protein and is very complex with vitamins and minerals. A fried, scrambled, boiled egg or omelette with brown roti or brown bread is a good option. Also, a toasted chicken and mayonnaise sandwich with low fat mayonnaise and some salad in the sandwich is nutritious or a bowl of haleem or soup with 2 slices of brown or wholewheat/low GI bread. One can also enjoy a bran muffin or brown flour scone with margarine and cheese.

One can drink water or fruit juice at sehri. Since mornings are going to be cold, a warm drink may be preferred. It is better to drink rooibos tea or Milo, Horlicks, Nesquik or hot chocolate rather than tea or coffee. If a powdered drink is desired, 3 level teaspoons of powder in a cup of low fat milk with no sugar is the recommendation.

It is advisable to end the sehri with a handful of unsalted nuts or almonds and up to 3 dates. The prophet Muhammad (peace be upon him (pbuh)) advised us on the excellent properties of dates and recommended dried dates for sehri as these are full of slow releasing energy that will sustain one during the day. Dates have a low GI between 35 – 55 and are therefore safe and ideal for diabetics. Drink a little bit of water at sehri. It is crucial that a diabetic does not skip this meal as it could result in hypoglycaemia later in the day.

Habits to avoid at sehri

Whilst there are foods to avoid, there are also certain bad habits that should be avoided at sehri. One should not stuff themselves for fear of feeling hungry during the fasting day. The above mentioned foods will not prevent hunger as this is the essence of fasting; but it will maintain energy levels so that we are able to function optimally. Avoid jumping into bed or lying down immediately after eating. This can make one nauseas, cause constipation and increase acid reflux and cause heartburn. It is advisable to wait 45 minutes to an hour after sehri before lying down. If you are someone who specifically battles with heartburn, sleep with the pillows elevated so you are not lying flat.

Iftar: The sunset meal (opening the fast)

It is important to open the fast with foods that are pure, whole and natural. After fasting the whole day and cleansing the body, it is advisable to continue with this process and consume good foods. It is prophetic teaching to open the fast with fresh dates as these are high in natural sugar and provide a burst of energy after going without food for the day. The prophet (pbuh) used to eat dates and cucumbers or dates and almonds together as they neutralise each other. Date is heat and cucumber is cool. It is advisable to open with dates and water.

Example of a nutritious iftar

The iftar table should be laid with dates, salad, fresh fruit and water. One can open the fast with up to 3 dates or half a cup of cut fruit and water and thereafter a soup with a slice of brown/whole-wheat or low GI bread. The traditional bowl of haleem (barley broth) or soup is beneficial as this warms the body after fasting.

Thereafter, one should break for the sunset prayer and return for supper. A traditional curry and rice meal cooked with minimal oil and served with a side salad or a vegetable is acceptable. Also grilled meals such as chicken, chops, steak or fish with roasted vegetables and salad or oven baked or air fried chips or baked or mashed potato is a good option. It’s important to ensure that vegetables or salad is served with the meal. Rice, whole-wheat pasta, brown roti and brown or whole-wheat breads or rolls are good options. It is also advisable to have a good variety of foods every day and alternate proteins ie. meat, chicken, fish as well as have meat free days eg. fish counts as meat free as well as lentils such as mung dhal. By having a good variety and combining starches, proteins and vegetables at meals, one is able to get all the nutrients they require in a short space of time. It is beneficial to drink water or ½ cup 100% fruit juice with supper.

Avoid foods that are high in fat and sugar and avoid overeating as this can result in hyperglycaemia. These include high fat, deep fried foods such as samoosas, bhajias, pies, donuts and cakes. Tea, coffee and fizzy drinks should also be limited at iftar time. Processed meats such a patties, polonies, sausages etc.should also be avoided. These foods are not only refined, high in fat and have low nutritional value; they cause constipation, bloating, stomach discomfort and heartburn. They also result in one filling up on these at the time of breaking fast and then not having space for more nutritious foods, therefore losing out on replenishing your nutrients after fasting. Furthermore, eating incorrectly at iftar and supper will affect you from performing the evening prayer optimally.

Habits to avoid at iftar

Avoid overeating and eating very fast. This is a sign of greed as well as will make you feel uncomfortable and sick. It is important that we thank the Almighty for blessing us with an abundance of food and a huge spread at our tables and remember those who don’t even break their fast because they have no food and bear in mind that for them, Ramadaan does not end. It must be mentioned here that our prophet (pbuh) has mentioned: the stomach is the home of disease and abstinence from gluttony is the head of every remedy.

The prophet (pbuh) has also guided us to eat just to sustain ourselves: The son of Adam never fills a vessel worse than his stomach. The son of Adam only needs a few bites that would sustain him, but if he insists, one third should be reserved for his food, another third for his drink and the last third for his breathing.

The evening prayer (Taraweeh)

Try to catch up on water intake and hydrate yourself during evening prayers. Keep a bottle of water with you and drink as you take breaks between your prayers. It is more important as well as more achievable to catch up on water intake during the evening non-fasting hours as opposed to the pre-dawn meal.

After taraweeh, healthy desserts such as ½ a cup of fruit salad and ice cream, custard and jelly, strawberries and cream or the milk falooda is acceptable. Use low fat milk in preparation. A cup of almond milk (homemade badam milk or kheer), or rooibos tea with whole-wheat crackers and cheese or 2 rusks or 2 small biscuits is also acceptable. If one is not feeling for the above, then one or two medium sized fruit is also a good option and an excellent way to still get sufficient fruit intake.

Exercise

Normal daily activity that the diabetic individual usually engages in is sufficient and safe. However, excessive physical activity during fasting hours may lead to hypoglycaemia and dehydration. It is therefore safer to exercise two hours after the sunset meal. The taraweeh prayer is quite intense and can be considered a form of physical activity. Remember to drink lots of water during prayer intervals (rakaats).

Medication

It is crucial that you discuss your medication with your doctor before deciding to fast. Those on oral hypoglycaemic agents are at less risk than those taking insulin. However, since the evening involves greater food intake, the medication dosage would be altered where the ratio is greater at night as compared to the morning. Please ensure that you are aware of the correct dose and time of the medication during Ramadaan as this determines your overall well-being during the month and your ability to fast. Medication is individualised; there is no one size fits all so it is therefore of utmost importance that this be discussed with your doctor and both the doctor and family are aware that you will be fasting. This cannot be stressed enough as mismanagement can be detrimental and even fatal.

Blood glucose monitoring and breaking the fast

Blood glucose levels should be monitored frequently, at least 2-4 times daily ie. before, during and after the fast. Checking blood glucose levels does not break the fast. If the blood glucose is less than 3.3 mmol/l or greater than 16.7 mmol/l; the fast has to be broken to prevent further complications.

What to do if hypoglycaemia occurs during the fast

Break the fast with 2-4 teaspoons of sugar in water (sugar water); ½ cup of regular soda (cooldrink) or ½ cup of fruit juice. Check the blood glucose levels again after 15 minutes and then have a wholesome snack such as a slice of brown bread with peanut butter/cheese or ½ cup of yoghurt with muesli or 1 cup of milk with a teaspoon of sugar or honey as these will restore and stabilise the blood glucose levels. Monitor the blood glucose levels every 15 to 30 minutes thereafter until it restores to normal.

As a rule, diabetics should always carry sweets in their handbags, pockets or in the car in the case of hypoglycaemia. Diabetics should take a break from fasting for a few days to recuperate if they have had a hyperglycaemic or hypoglycaemic episode.

Conclusion

I would like to take this opportunity to wish all Muslims a blessed, prosperous and spiritually uplifting Ramadaan. I would also like to commend those diabetics taking on the challenge of fasting during this month. May the Almighty grant you strength and reward you for your efforts.

Healthy Bran muffin recipe for sehri

Beat together:

2 cups milk
2 eggs
1t vanilla essence
½ cup oil, 1 ½ cup sugar

Mix together:

2 cups bran
2 ½ cup nutty wheat
1t bicarb
1 cup (carrots/apple/dates/pecans/mixed fruit/cranberries/muesli/almonds – your choice) *rub this into the dry mixture

*Add dry ingredients into beaten mixture. Beat well until everything is well mixed and evenly spread. Scoop into greased muffin pan and bake on 180 for about 20 minutes.

Healthy vegetable soup for iftar

½ cup 4 in 1 soup mix (1/4 cup pea dholl, ¼ cup pink lentils, ¼ cup barley, ¼ cup crushed wheat)
2 medium potatoes
2 medium tomatoes
2 large carrots
1 small onion
2 medium turnips
2t salt
½t black pepper

*Soak dholls overnight. Boil all ingredients together and liquidise. Garnish with greens.

**Save Time Tip: Make a big amount on a weekend and freeze in smaller containers, and then take out, thaw and simply heat on the day you want to serve it.

 

References

  • Al-Arouj M (2010). Recommendations for Management of diabetes during Ramadan. URL: care.diabetesjournals.org
  • Managing diabetes during Ramadaan – Diabetes UK. URL: https://www.diabetes.org.uk>ramadan
  • Joslin Diabetes Center (2016). Ramadan and Diabetes. joslin.org
  • Ibrahim M (2015). Recommendations for management of diabetes during Ramadaan: update 2015. British Medical Journal. URL: drc.bmj.com
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