No matter the season exercising outdoors beats running on a treadmill in the gym. If you want to keep fit and have a social life, then soccer, touch rugby or rounders is the answer. Nicole McCreedy tells us how to get started.
The beauty of ball sports is that they’re so easy to learn. All you need to do is find an open space to play, organize some equipment and two teams, and learn a few basic rules. While your focus is on winning, you’ll be walking, running and laughing your way to better health.
The basics of touch rugby are similar to the traditional version of the game – the ball is passed backwards during play. However, in touch rugby you don’t tackle your opponent but rather touch the person running with the ball on any part of their body, clothing or the ball itself using your hand. Because touch rugby is less physical, women can also play without fear of injury. Once touched, the player in possession of the ball is required to stop, return to the mark where the touch occurred and perform a ‘rollball’ without delay. Facing the defending try-line the player rolls the ball between his/her legs. After six touches the ball is handed over from the attacking team to the defending team and the game starts again from the halfway line in the centre of the field. The aim is to score a touchdown over the defending team’s try-line. Five to six players are on one team at a time, and a game lasts for about forty minutes per side.
A game of soccer can be as simple as kicking the ball around with a few friends. Players dribble the ball on the ground, kicking it to pass to each other. For most games, there are eleven players per team – the goalkeeper is the only player allowed to use his/her hands. Teams are made up of defenders, midfielders and forwards. Two defenders patrol the left and right area while the two central defenders play in the middle. The midfielders play both defence and attack, and the forward positions focus on scoring the goals. The centre forwards play in the middle flanked on each side by a wing. In soccer be aware of the offside rule. If you are behind the other team’s defenders without the ball, you are offside. But if the ball is kicked past the defenders, you can pass them. Laduuuuuuuma!
To play rounders you need a small ball (a tennis ball will do) and some kind of bat. There must be a minimum of six players per team. A match consists of two innings, giving each team a chance to bat and bowl. An innings is over when the last batter is caught out, and each person on the team gets a chance to bat. When bowling, the ball must not bounce and it must be above the batter’s knee, below the batter’s head, and not at the batter’s body. The batter hits the ball and then runs in a circle, passing a series of markers on the way. A ‘rounder’ is when the batter makes it all the way around the circuit in one hit of the ball. The team with the most rounders wins. A batter is out if the ball is caught before it hits the ground or if the ball is fielded before the batter reaches a marker. A batter who has missed the ball can run to the first marker and then continue to the next three when the next batsman strikes the ball. Only one person can stand at a base at a time.
Team ball sports are a great cardiovascular workout because they increase your heart rate. They are particularly good for people with diabetes because the body uses up extra glucose and decreases resistance to insulin. Muscle strength, endurance and eye-coordination also improve. Best of all? You lose weight while having a ball!
Ask the expert: Anette Thompson, Podiatrist shoes or barefoot?
SEMDSA, the Society for Endocrinology, Metabolism and Diabetes of South Africa, recently released 2012 guidelines which state that a person living with diabetes should not walk or run barefoot. There are a number of reasons for this – even well controlled, highly active people who have not developed any complications will experience a delay in healing if their skin punctures or cracks. Any break in the skin is a potential entry point for infection: bacterial, viral or fungal.
The goal is to wear footwear that most closely approaches the benefits of being barefoot. ‘Barefoot-like’ sports shoes allow maximum flexibility and give the feet the most natural workout. The benefits are improved blood flow to the feet and lower limbs, which feeds nerves and muscles during exercise. Ensure that the shoes are wide enough, as well as being the correct size. It’s a good idea to invest in good quality socks as well.
You only get one pair of feet – take good care of them.
Sport tips Sarah Hall, Biokeniticist
When playing outdoor sports, especially those you’re not used to, keep these tips in mind:
- A sport specific warm up is essential. Try and focus on the muscle groups you’re about to use and make sure that you pay particular attention to those during your warm up. If you’re about to play soccer, try to loosen up the ankle joints with some ankle circle exercises. Stretch the groin muscles with some lunges and do a couple of lengths of sideways shuffle running along the field.
- Wear supportive footgear to support your feet and cushion the rest of your body as you run.
- Be as prepared as possible. Make sure you have enough water for the extended length of time of play. You must also keep some fast acting snacks handy as the game, although fun, may use up more energy than you think.
We chat to Bongi Ngema-Zuma, First Lady and founder of the Bongi Ngema-Zuma Foundation.
Why did you start the Bongi Ngema-Zuma Foundation?
It has always been my ambition to do something like that – I never came across anybody who told me about diabetes as a child, even when I was at school. But when you speak about it you find that each and every family is affected by diabetes in some way.
How did your mother find out she was diabetic?
My mother was not an educated woman, she was a housewife and only went to school up to Std 4. First she was told she had hypertension and received treatment for that. And then they investigated further and found out she had diabetes. Many people have had this happen – the underlying factor is diabetes. That’s why I encourage people to actively check their blood sugar. Whenever you go to the clinic you should get tested. What I learned from my mother is that changing her lifestyle made her live healthier and longer. She took every little lesson she could from the clinic – you eat like this, you don’t eat like that, you take your tablets, you eat so many times a day. What made it easier for her is that she made the whole family eat like that.
What makes your life sweet?
What makes me happy is chatting to people. I like getting people’s opinions on things, I like listening to people’s stories and visiting new places where I can learn new things.
Find out more about the Bongi Ngema-Zuma Foundation here.
Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.
Who did you skate for?
I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.
How long have you been diabetic?
I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.
Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?
I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.
What do you love about ice skating?
I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.
What do you think the biggest challenge of living with diabetes is?
The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.
What advice would you offer to diabetics who are struggling?
Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.
What makes your life sweet?
Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.
Get in touch with Rachel: email@example.com
There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.
“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”
For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.
“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”
Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”
Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”
Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.
Are there any benefits to starting insulin sooner?
“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”
Ask the dietician: Genevieve Jardine
From our community: “My favourite food isn’t very good for me… I love braais and chips, hamburgers and hot dogs. Is there any way to make these delicious foods better for me? Help!” Thabo Duma.
All of us like a bit of pleasure in life, and nothing beats a treat now and again. The attraction of junk food lies in its “quick fix” ability to satisfy food cravings. Unfortunately, what makes junk food so delicious is also what makes it unhealthy. Junk food tends to be high in kilojoules, bad fats and refined carbohydrates. Because it tastes so good, it’s also hard to stop eating. You may get away with one biscuit, but 4 or 5 will cause a significant increase in blood sugar.
When relaxing with family and friends, you want to be able to enjoy holiday food: take-outs, braais and easy meals. There are definitely ways to enjoy these times without feeling left out – and without packing on the extra kilograms!
For take-out options, choose grilled chicken breast or beef hamburgers with salad (no chips!) Or try grilled chicken breast, spicy rice, coleslaw and green salad. Choose water or a diet fizzy drink to go with your meal, and obviously skip the dessert. Try to avoid food that’s high in fat and refined starch and sugar – pizza, deep fried chips and sugary drinks are all a bad idea.
Who said a braai couldn’t be healthy? Bring chicken or beef kebabs and braaied corn on the cob, with carrot salad and green salad on the side. These are a much better choice, and much lower in fat and carbs than boerewors and chops, garlic bread, pap and gravy or white bread rolls. And they’re delicious!
If you’re looking for delicious snacks, here are some yummy diabetic-friendly options:
|Snack||Portion||Energy||Carbohydrate (including sugar)||Fat|
|Popcorn (lite)||2 cups popped||636kj||15g*||7g|
|Dried fruit||2-4 pieces||381kj||21g||0g|
|Low GI biscuit||1 biscuit (30g)||440kj||15.3g||5.8g|
|Lean biltong||Handful (30g)||346kj||1g||2g|
* Remember that one carbohydrate portion = 15g.
Compare those to regular snacks and you’ll see the difference:
|Snack||Portion||Energy||Carbohydrate (including sugar)||Fat|
|Chocolate||1 bar (50g)||1120kj||30g||15g|
|Energy bar||1 bar (40g)||739kj||22g||7g|
|Biscuits (with icing)||2 biscuits (33g)||676kj||30g||7g|
|Sweets (boiled)||125g packet||316kj||18g||0g|
|Potato crisps||1 packet (30g)||766kj||24g||12g|
Newly diagnosed with diabetes? We get to grips with what your medical scheme can do for you, and what you might have to budget for yourself.
- Join a medical scheme
Diabetes is a chronic condition that’s on the Medical Scheme Act’s Prescribed Minimum Benefits (PMB) List. All registered medical schemes in SA have to provide basic funding for your diagnosis, treatment and care.
- Register your condition
Make sure your condition is registered with your scheme, and be sure to do this again each time you switch. Find out how the registration process works: you’re likely to have to complete a form with the help of your doctor.
- Stay on a scheme
If you leave your current scheme, or join a scheme for the first time, the new scheme may impose a waiting period of 3 to 12 months. During this time, your costs may not be fully covered. Do your research before you join a new scheme and avoid breaks where you don’t belong to a medical scheme at all.
- Use a healthcare broker
Understanding what’s covered by all the schemes out there can be complicated. Do your research with the help of a healthcare broker. Their services are free of charge.
- Reassess your plan
Once a year, you can shift from a basic to a more comprehensive plan, and vice versa. Ask your scheme for your medical records and check what you’ve had to pay out of your own pocket during the year. Do the math to see if it makes sense to upgrade or downgrade your plan.
- Check which meds are covered
Even the most basic plans cover diabetes medication, as long as you choose from the formulary (the list of approved medication). Ask for this list before you choose a plan. Your prescribed medicine might not be available on the scheme’s most basic plan, but it could be on another, more comprehensive plan, or on another scheme’s formulary list.
- Stick to Designated Service Providers (DSPs)
These healthcare providers (doctors, pharmacists and hospitals) have an agreement with your scheme, which means their rates are usually fully covered. Get hold of your scheme’s DSP list and use them. Expect a co-payment if you use a doctor outside of this network.
- Go for your consultations
This will depend on your plan, but some of your doctor’s visits will be covered up to an agreed rate. Some schemes, for example, cover annual visits to the GP, dietician, podiatrist, ophthalmologist and other specialists in full.
- Check up on tests and equipment
Diagnostic tests are usually covered in full, as well as annual HBA1c, creatinine microalbumin and lipid tests. Insulin pumps and other specialised equipment might only be covered by top-tier plans, or not at all.
- Use those additional benefits
Many of SA’s schemes offer free coaching, education and reward programmes. Make use of these benefits – they’ll help you to manage your condition better, saving you money in the long run.
Staying young at heart is easy with these great activities. Charis Le Riche gives us some ideas…
Though you might not be able to turn back the clock, you can always feel – and act – young at heart. Here’s how to lighten up and be more youthful.
Nothing makes you feel younger than having a good laugh. Laughter also helps you feel less anxious, less tense, boosts your immune system, protects your heart and can even make you look younger. Be sure to surround yourself with cheerful, happy people and seek out opportunities to have a good giggle together.
Sing out loud
You don’t have to be pitch perfect to belt out a tune, and children definitely don’t let being in tune stand in the way of their performance! Even doctors recommend singing out loud, as a means to release endorphins which make you feel good.
Build a fort
Dismantle the couches and build yourself a fort right in the lounge. There is nothing better to cheer you up on a rainy day than putting together a fort made out of couch pillows and sheets for you and the kids to play in – or maybe for a romantic candlelit evening with your partner.
Play board games
We seem to have forgotten that there are better things to do with our time than sit in front of the computer or TV screen. So switch off all your devices and get a little competitive with board games. Whether it’s 30 Seconds, Pictionary or good old Monopoly, you’ll be amazed what fun a board game can be.
Not just for kids, colouring in (and painting!) for adults is all the rage at the moment. Colouring in is a stress-free activity that will help put your mind at ease. Choose from one of the many adult colouring in books and whatever crayons or kokis you need to get your creative juices flowing and make you feel young again.
“My son is a Type 1 diabetic, but I don’t want to be overly protective and make him feel he can’t do anything. Do you have any tips for parents of diabetic children, and how to make life normal?’ Sam Shongwe.
The first thing you must realise is that a child with diabetes is still a child. He should not be treated differently than a child who does not have diabetes. Granted, you have more issues to cope with – like good food choices, insulin and testing – but these things shouldn’t stop him from having a normal, happy childhood.
The first thing to do is make sure he is safe at school. Let a responsible person know what his diabetes involves so that they can keep an eye on him. By doing this you won’t have to keep phoning him or the school to make sure he is okay: this will only embarrass him and make him withdraw from friends and fun.
Remember, he can also play sports and take part in physical activities just like any other child: you just need to plan – first talk with his doctor, and then help him with the routine of glucose testing, planned eating, and insulin. Work out a plan that he’s happy and comfortable with.
Encourage your child and allow him to socialise. Let him do parties, sports, sleepovers and camps if he wants to. Discuss a back-up plan with him when he does, but try to let him do his thing.
Most importantly, help your child to become more independent by getting him to take an active part in his diabetes care while he’s still young. Encourage him to solve problems and make choices with you about adjusting insulin doses, for example. Help him create a good lifestyle so that his diabetes doesn’t become too difficult to manage and hijack his life. Self-care is the key to developing any child’s independence and self-esteem: it’s important to get your child involved in self-care as soon as he is able to – with your supervision, of course.
Finally, recognise your limit of control. Accept that you cannot watch over him all the time, stand back and allow him more independence as he becomes more confident and responsible. It’s the same with any child: if they prove their responsibility, they get more independence.
– Jeannie Berg, Diabetes Educator
Want to have a more flexible body and improve your circulation? Nicole McCreedy tells us why stretching should be part of everyone’s day.
When we’re young, it’s easy to imagine that our bodies will always do what they’re told. But as we age, our muscles tighten and all of a sudden something as easy as bending over to pick up your keys might be a struggle. Stretching is important because it keeps the body flexible and allows your joints to move through their full range of motion. Here’s all you need to know to keep flexible.
For people with diabetes, improving circulation is essential for maintaining good health. Because stretching increases blood flow to the muscles, specifically the legs, it is great for circulation, but that’s not all. Regular stretching will increase nutrients to the muscles, improve your co-ordination, lengthen your muscles, reduce lower back pain, and even increase your energy levels.
How to stretch
While you can stretch anytime, anywhere – in your home or at work – you want to be sure to do it safely. Each stretch should be done in a slow and controlled manner till you feel ‘mild discomfort’. If it feels painful, you’ve stretched too far. Do not bounce or force the stretch.
Ideally, you should stretch before you start exercising. To avoid injury, first warm up your muscles. Run on the spot for a few minutes or do some jumping jacks to get your blood flowing and increase your heart rate. Stretch again at the end of your training sessions to help your muscles recover.
Types of stretching
What kind of stretching you choose to do will depend on your fitness and flexibility.
Static stretching is the most common form and is safe for beginners. Give this a try: to stretch the back of your upper thigh lie down on your back. Lift your right leg up in the air, heel facing the ceiling. Make sure that your lower back stays in contact with the floor and the left leg remains straight on the floor. Grip your raised leg with both hands. You may be comfortable holding your thigh, or you may be able to clasp your knee. Do what feels best for you. Keep your head and neck relaxed. Hold for 30 seconds or less. Change legs.
Passive stretching means you are using something outside yourself to help you stretch. Here’s a passive stretch to try: Relax the muscle you are trying to stretch and rely on a strap, gravity, another person, or your own body weight to stretch the muscle gently. Make sure you are well balanced before you start stretching!
Passive stretching is useful for those who have been injured or are frail. A recent study has found that passive stretching can help regulate blood glucose and is beneficial in treating people who are less physically able.
Dynamic stretching is moving through a challenging but comfortable range of motion repeatedly. Take shoulder circles for instance: stand tall, feet slightly wider than shoulder-width apart, knees slightly bent. Lift your right shoulder towards your right ear, take it backwards, down and then up again to the ear in a smooth action. Repeat six to ten times. Do the same with the left shoulder. What you are doing is actively contracting the muscle in the opposition position to the one that you are stretching.
Love stretching and want to take it further? Try yoga or pilates – both involve active stretching. With yoga, the postures are timed with the breath and are designed to put pressure on the glandular system. In pilates, the sequence of movements focuses on strengthening your core muscles – the deep, internal muscles of the abdomen and back.
What to keep in mind while stretching – Sarah Hall, Biokineticist
Remember that – just like people – each muscle group and joint is individual.
- Make sure that you warm up before you do any activity, and stretch afterwards as well. A quick rule of thumb is to stretch a muscle only if it is tight.
- Do not stretch in such a way that you put another joint or muscle at risk of injury.
- Try to isolate a muscle when stretching. If you are working the hamstring, do not put weight on that leg. Breathe into the stretch to allow the benefits of the stretch to move through that muscle.
- Decide on a reason for stretching a particular muscle: is it to relax, release tightness or restore length to the muscle? Aim to stretch each muscle for between 10 and 30 seconds.
Ask the expert: Dr. Zaheer Bayat, Endocrinologist
Exercise is good for everybody. But for those with diabetes, there are added benefits:
- Exercise lowers glucose levels as muscles require more glucose for fuel.
- Exercise helps in losing weight, which in turn improves morale. Not only will you feel better, you will also look good.
- Exercise improves insulin sensitivity. This can go a long way to stabilizing blood sugar levels
When starting any exercise program, it is important to spend a few minutes stretching, which will help lessen the risk of doing damage to yourself.
Ask the expert: Prof. Wayne Derman, Professor of Sports and Exercise Medicine
“Flexibility is an important part of fitness, so stretching should be included in any exercise programme. It’s also a great way to manage and prevent muscle cramps. Not sure what to do? Get a physio, biokineticist or trainer to assist you with the right stretches for the muscle groups in which you are particularly tight.”
The day that you are diagnosed with diabetes is a day that is hard to describe. The world stops but at the same time a neverending rollercoaster ride starts: one you never asked to get on in the first place.
I remember sitting in the doctor’s office and a funny thing happened: he said the test results came back and you’re a Type 1 diabetic. After that I was in shock. The funny thing is I knew that he was talking because his lips were moving, but honestly I have no idea what he said. It was all a blur to me. All I remember thinking is: how can this happen? I never ate much sugar and now I’m going to die. But at least I have an answer to why I’ve been feeling so sick the last few months.
After the shock set in, I remember going to the book shop to basically buy any book that had been printed that mentioned the word diabetes, and then reading them all and being more confused than ever as they all contradicted each other. After the initial diagnosis, the doctor suggested that I go and see an endocrinologist.
Well, I saw a few of them and what they were all good at was sitting me down and telling me the negative side of the disease. How you can lose your eyesight and your feet and how if you get wounds there is a good chance they won’t heal well. Then in the next breath, they explain that now you will need to go on a strict diet and inject for everything you eat ever. They seem to wonder why you look so depressed and have an attitude of, what’s the point to life any more?
At some point during the initial diagnosis, it seems we all go on a sort of autopilot. We inject when needed and ask every question we can think of, and blindly trust what our doctors say, because they’re the professionals and know what they’re talking about, right?
What we don’t realise then is that diabetes is a common condition but it’s also very individually based. What makes my levels go up can have no effect on a friend’s levels. The other thing we learn on our journey is that at some point all diabetics and carers become doctors, dietitians and endocrinologists. The only difference between us and the real doctors is that they have diplomas and we don’t, but we have the life experience and they don’t.
What I have learned the most in my love-hate relationship with diabetes is that while I hate the constant management and daily injections, being diabetic has made me a stronger person and taught me to stand up for myself. In a weird way, it has given my life a kind of warped purpose. So I guess I will always love to hate being diabetic. You know what? That’s actually okay and totally healthy.
From our community blog:
I wonder if anyone can advise me. I’m 27 (soon to be 28) and was diagnosed as a Type 2 diabetic in 2010. When I lived in South Africa, my average blood glucose would read between 5-7 and I would have occasional episodes of hypoglycemia.
Since I moved to South Korea, I have had the opposite problem. My reading first thing in the morning before breakfast is 10-14! I eat special K cereal with skimmed milk diluted with water for breakfast, a garden salad with no dressing for lunch and an average meal for dinner. I take Metformin 500 twice a day (I’ve been on that dose since I was diagnosed) and exercise regularly but I can’t seem to drop my blood glucose to within healthy levels.
I can’t really seek medical help because with my job, I can be deported if they find out I’m diabetic.
How can I get my blood sugar down?
Hi Kerissa, Just wondering if you eat snacks in between your meals as well? My dietician has me eat 7 times a day. Here are my thoughts:
- Find a doctor that specialises in diabetes, you might need your medication changed. I was been diagnosed in August 2012 with diabetes, my medicine has changed since and now I’m on both metformin and insulin.
- As far as I know, special K is a no-no for cereal. Rather eat oats with an apple.
Make a change in your breakfast and see if that helps. Then test 7 times through the day for 2 days and take that to your doctor’s appointment.
Hope you can get it under control. I battle sometimes too, you are not alone!
I’ve been a Type 1 diabetic for 11 years now, so I can give you some input. Good carbs as far as I know (low GI) are: oats not Oats So Easy, brown rice, sweet potato, rye bread, brown rice cakes. Healthy fats are good for your joints and lowering the GI of a meal or snack (fish oil/omega 3 oil, 30g of almonds, quarter avocado). Good proteins are handy for maintaining muscles. Don’t forget to drink sufficient amounts of water daily to stay hydrated.
We ask Dr. Tracey Naledi, the Chief Director of Health Programmes for the Western Cape Department of Health, to share her personal health tips and what the Department of Health has to offer diabetics who want to live a healthy, happy life with diabetes.
What does the Department of Health offer those with diabetes?
We focus a lot on prevention: diabetes prevention is so important. People need to be aware of the risk factors that lead to diabetes before we even start talking about the condition, so we highlight the dangers of a poor diet and being overweight, lack of physical activity, drinking too much and smoking. But this isn’t only the role of the Department of Health – it’s also important for individuals to understand what the risk factors are and to prevent them from happening in the first place.
We also screen people so that we can pick up those with early signs of diabetes, and provide proper diagnosis and treatment. If a doctor suspects you might be diabetic, it kicks in a whole process within our health facilities. But we also proactively do campaigns in community-based settings like malls, where we go out and invite people to test for hypertension, diabetes, cholesterol and HIV, and give them information on these conditions.
Do you believe community is important when living with a chronic condition?
Absolutely – I think community is important when you’re dealing with anything that government does. Government is something that works for the people: it is put there by the people to do things on behalf of the people, but at all times we need to be consulting with the people to be sure the things we’re coming up with are what they want. We have to make sure the way we’re doing things is what the community needs. That’s why we have processes to consult with community members, health facility boards and health committees, so that any problems can be discussed. Being close to the community is very important to us.
Why is diabetes a priority in South Africa?
Chronic diseases in general are a priority, because they affect so many people and are such a huge burden of disease. You also can’t just pop a pill for a chronic condition to go away: you need to treat it for the rest of your life. We have to make sure we have the capacity to deal with all these chronic diseases for a very long time. It’s a long term, lifelong thing. And the consequences of uncontrolled diabetes are actually quite serious.
What makes your life sweet?
God and my family. At the end of the day, when all is said and done, the most important thing to me is my family. My work one day will end, all the money in the world will disappear, all the material things will be gone, but there’s nothing I love more than coming home.
We all know that a healthy diet is key to managing your diabetes. But should you also be taking a diabetic supplement? Andrea Kirk asks the experts.
Living with diabetes can be challenging, so when you hear about a natural supplement that works wonders, it’s easy to get excited. “A number of supplements have been said to play a role in improving insulin sensitivity, blood sugar control, and helping to prevent complications of diabetes,” says endocrinologist Dr Joel Dave. “Although there is some observational evidence to suggest that some of these may be beneficial, unfortunately there are no large, long-term, placebo-controlled studies that prove any supplement is effective when it comes to diabetes.”
Dietician Cheryl Meyer agrees: “In some cases benefits have been shown, but at this stage there is just not enough scientific evidence.” Both experts believe that a well balanced diet should provide all the essential minerals and vitamins you need.
“I don’t recommend routine supplementation,” says Dr Dave, “but if someone is deficient in a specific vitamin or mineral, then I would recommend they take a supplement of that particular vitamin or mineral.”
When a supplement may be necessary
If you are experiencing specific symptoms and suspect you are deficient in a vitamin or mineral, speak to your doctor about having a blood test. Your doctor will make a recommendation based on the test results and may prescribe a supplement. Keep in mind that the type and dosage your doctor prescribes may be different from what is found on the shelf. Stick to your prescription rather than self-medicating.
Be careful of drug interactions
Dietary supplements can have adverse interactions with prescription drugs, other herbal products or over-the-counter medications, warns Meyer. The effects range from mild to potentially life-threatening, so it is important to disclose everything you are taking to your doctor.
Never replace your conventional prescription
“Don’t replace a proven conventional medical treatment for diabetes with an unproven health product or practice. The consequences can be very serious,” says Meyer.
“I generally advise my patients to steer clear of supplements unless we know for sure that it’s necessary,” says Dr Dave. “Rather focus on sticking to a healthy diet and lifestyle, monitoring your blood glucose and taking the medication your doctor has prescribed.”
Supplements and their claimed benefits
Alpha-lipoic acid (ALA) is an antioxidant made by the body. It is found in every cell, where it helps turn glucose into energy. Several studies suggest ALA helps lower blood sugar levels. Its ability to kill free radicals may also help people with nerve damage, which is a common diabetes complication. For years, ALA has been used to treat diabetes-related nerve damange in Germany. However, most of the studies that found it helps were based on using intravenous ALA. It is not clear whether taking it orally will have the same effect.
Source: University of Maryland Medical Centre
Chromium is an essential mineral that plays a role in how insulin helps the body regulate blood sugar levels. For many years, researchers have studied the effects of chromium supplements on those with Type 2 diabetes. While some clinical studies found no benefit, others reported that chromium supplements may reduce blood sugar levels, as well as the amount of insulin people with diabetes need. Good food sources of chromium include whole grain breads and cereals, lean meats, cheese, some spices (like black pepper and thyme), and brewer’s yeast.
Source: University of Maryland Medical Centre
Fenugreek seeds may be helpful to people with diabetes because they contain fibre and other chemicals that are thought to slow digestion and the body’s absorption of carbohydrates and sugar. The seeds may also improve the way the body uses sugar and increase the amount of insulin released. An Iranian study found that a daily dose of fenugreek seeds soaked in hot water may be helpful in controlling Type 2 diabetes. Another study from the US suggests that eating baked goods, such as bread, made with fenugreek flour may help to reduce insulin resistance in people with Type 2 diabetes.
Several studies have shown that American ginseng lowered blood sugar levels in people with Type 2 diabetes. The effect was seen both on fasting blood sugar and on glucose levels after eating. One study found that people with Type 2 diabetes who took American ginseng before or together with a high sugar drink experienced less of an increase in blood glucose levels.
Source: Penn State Milton S. Hershey Medical Center
Magnesium deficiency has been associated with increased risk of Type 2 diabetes. Some studies suggest that supplementing may be beneficial, but other studies have shown no benefit. A healthy diet should provide all the magnesium you need, so have your doctor check for deficiency before you consider supplementing. Good food sources of magnesium include legumes, whole grains, broccoli, green leafy vegetables, dairy products, seeds and nuts.
Source: Oregan State University and WebMD
Ask the dietician: Genevieve Jardine
From our community: “My daughter is on insulin injections and can’t inject for every cold drink she wants. Everybody says aspartame is bad for you, so what can she drink except water?” Di-ann Reid.
A lot of the excess sugar in our diet comes from drinks that are high in sucrose and fructose: regular fizzy drinks, energy drinks and also fruit juices. These not only have an effect on blood sugar, but also increase overall energy intake, which can lead to weight gain. That’s why these drinks aren’t a good idea for diabetics.
So what else can you drink?
Artificially sweetened diet drinks
These are pretty much kilojoule free and don’t raise blood sugar levels, but most of them contain aspartame – the topic of a lot of debate for many years. Although aspartame has been linked to increased risk of cancer, mood disorders and even diabetes, nothing has been proven and the FDA (Food and Drug Administration) has approved diet drinks with aspartame, with a limited daily intake. So it’s a good idea to reduce the number of artificially sweetened drinks you have, especially if you’re using other sweeteners in tea and coffee.
These often confuse people with diabetes, because they say “no sugar added” on the label. Although there is no added sugar, fruit juices are high in fructose sugar that can push up blood glucose levels. They are a concentrated form of natural sugar from the fruit – you get all the sugar, but none of the fibre that’s good for you. A small glass of fruit juice can have twice as much sugar as a piece of fruit!
Tip: When looking at food labels, always check the total carbohydrate content (per serving size) and not just the sugar content.
Here are some ideas for drinks with and without artificial sweeteners:
One-a-day drinks – low carb, with artificial sweeteners
- Diet fizzy drinks (Tab, Coke Light, Coke Zero, Sprite Zero, Fanta Zero etc.)
- Diet cordials (Brookes Low-Cal etc.)
- Light iced teas (Lipton Iced Tea Lite etc.)
- Light flavoured mineral water (aQuelle Lite etc.)
Everyday drinks – low carb, no artificial sweeteners
- Freshly squeezed lemon juice in ice-cold water.
- Hot or cold flavoured herbal teas (no sugar added).
- All unflavoured sparkling water.
- Chopped up fruit pieces (like strawberries, lemon or orange) soaked in water for the fruity flavour without the sugar.
Treat drinks – medium carb
These drinks have 6 to 8g of carbohydrate per serving – half the amount of normal drinks!
- 200ml tomato juice (low GI).
- 150ml Lamberti’s low GI juice.
- 100ml Energade Champ (low GI).
Managing everyday life challenges can be hard for the strongest and most emotionally balanced people. But having diabetes changes the game and adds extra curve balls we need to deal with. Depression is a very common problem, but studies show that people with chronic illnesses such as diabetes are three time more likely to suffer from depression and anxiety. With the constant management plan we have to follow, it’s no surprise that we are at greater risk for depression and anxiety.
Anxiety and depression can overlap with symptoms of diabetes, which make it harder to diagnose whether it is simply anxiety or rather depression that you are feeling. Anxiety can lead to depression if not treated correctly, but depression rarely leads to anxiety. Depression also has fewer symptoms, making it harder to diagnose.
Depression is a chemical imbalance in the brain which affects how you think and feel, and it can manifest in both emotional and physical symptoms. The thing to remember about depression is that you can suffer from depression without fully feeling depressed, and if you are depressed it’s not easy to simply snap out of it.
There are six main symptoms to look out for when dealing with depression:
- A loss of appetite or any change in eating habits
- Feeling down all the time
- Any change in sleeping pattern
- Lack of energy
- Loss of interest in daily tasks that you used to enjoy
- Feeling irritable all the time.
These symptoms are very similar to anxiety, however the main difference is that when you are anxious you worry more about the future and current things that have either happened or could happen. When you feel depressed, you simply have no drive to do anything and can only see things from a negative space.
To understand more about depression, it’s helpful to know what’s happening in your body. Your mood is determined by neurotransmitters such as serotonin and dopamine, which are released into the brain. When these levels are low, we start to experience feelings of anxiety and depression. Depression can feel a bit like anxiety and that is why it is often overlooked. A constant state of anxiety can show up in ways that make you feel physically sick, such as constant headaches, dry mouth, upset stomach and nausea.
To suffer from depression or to feel depressed does not mean that you are weak. Many people suffer from depression: it is an ancient disease that affects thousands of people, even famous people such as Winston Churchill. He used to call it his “black dog”.
As diabetics, we often have weaker metabolic and glycaemic control. This in turn can intensify depression symptoms: if not treated correctly, it can lead to diabetes burnout. We need to remember that when we experience depression or anxiety, the body reacts the same way it does to stress. The fight, flight, fright response is activated which releases adrenalin and cortisol into the blood stream, which in turn increases our sugar levels. There are many levels of depression ranging from mild to major: the levels don’t get worse, it’s simply the consequences and symptoms that change.
Depression affects everyone and people suffering from chronic conditions are at a higher risk of suffering from depression and anxiety. One of the most important things to remember about depression is that you can suffer from depression and not look depressed. The symptoms for depression do not always manifest in the known ways: it is also linked to aches and pains in muscles or constant headaches.
So what’s the answer? We need to find ways to relax as much as we can and remember to listen to our bodies. You are not alone in this.