carb counting for diabetics
Not sure what to make for dinner? Let us help! Check out our delicious free diabetes-friendly recipes to get ideas for dinner that are tasty, healthy and good for people with diabetes (and all those without diabetes!)
You’ll find recipes for:
- Spinach and Leek Pie
- Grilled Boerie, Cauli Mash and Relish
- Korean Beef Lettuce Wraps
- Baba Ganoush with Tortilla Crisps
- Guilt-free Baked Chicken
- Hearty Beef and Bean Soup
- Delicious Chicken Barley Salad
All with nutritional information to ensure you know the carbohydrate count, protein and fibre in each dish.
Looking for a specific diabetes recipe? Let us know!
And don’t forget to check out our free diabetes cookbook, which you can read online or download and print out.
Here’s to healthy, delicious, diabetes-friendly meals!
Ask the dietician: Genevieve Jardine
From the community: “I don’t understand the whole ‘low carbs high fat or high protein’ idea – how do carbs, fat and protein work together? Is there a happy middle ground, or does it need to be all or nothing?” Wessel Jones
To understand what all the fuss is about, we need to look at the history of diabetes treatment. Treating diabetes (both Type 1 and Type 2) by lowering carbohydrates (carbs) has come and gone out of fashion over the last century. This debate is not a new one and it is probably not going to go away.
Before the invention of insulin, the only way for a diabetic to survive was to cut out the foods (carbs) affecting blood glucose. With the advent of insulin, the focus switched from lowering carbs to lowering fat to help reduce heart disease. Fast forward a couple of decades and we can see that we have failed in reducing obesity, diabetes or heart disease. It’s not as simple as just diet: it’s about physical activity, stress, diet and environment.
How do carbs work in the body?
What is quite simple is that carbs cause blood sugar to rise and the more carbs you eat, the higher the blood sugar goes. If a person wants to control their blood sugar, it’s a very good idea to reduce carbs. The big question is: how low do you go? A “low carbohydrate diet” can have anything from 20g to 130g of carbohydrate per day.
Remember: One portion of carb (a medium apple, a slice of bread) = 15g carb
The amount of carbs depends on the individual, their control, their medication and their weight. There is a growing amount of scientific evidence that low carb diets improve glucose control and help with weight loss.
Where do fat and protein fit in?
When carbs are cut, the amount of protein or fat (or both) go up. And this is where the debate heats up. The concern is not the low carb, but the increase in saturated fat or fat in general. Remember that not all fat is the enemy and there are good fats that play a very important role in the body.
A benefit of protein and fat is that in the immediate, they do not cause the same spikes in blood sugar. When you lower carb intake you have an immediate blood sugar lowering effect. When this happens, and you have fewer spikes and dips in blood sugar, your appetite is better controlled. The fuller you feel, the less likely you are to snack and the fewer kilojoules you consume. The fewer kilojoules you consume, the more likely you are to lose weight.
The problem with the low carb approach is that, like everything else, it needs to be a lifestyle. When you add carbs back into your diet you will put on weight, especially if you have increased your fat and/or protein. You can’t have it all: full fat products and also carbs. The most important goal is to increase your vegetable intake and try to eat as close to nature as possible. Eat foods in their most original form.
When it comes to deciding on the right ratio of carbs : fat : protein, work with a dietician. It may take time to find your correct balance and you need to be monitored properly with blood tests and possible medication adjustments.
Ask the dietician: Cheryl Meyer
From our community: “I get invited to lots of business meetings and workshops that are catered… Needless to say, none of the catering is healthy! What do I choose or how do I deal with this situation?” Rene Prinsloo.
Many of us consume at least half of our meals and snacks during work hours, which makes our food choices in catered meetings and workshops very important. Here are three steps to consider:
Step 1: Build your plate
- Aim to fill half your plate with vegetables or salad. Look out for vegetable skewers, veggie sides, crudités (chopped raw veg), soup or salads.
- Next, add a healthy carbohydrate: either a wholegrain/high fibre starch or a piece of fruit.
Look out for:
- Wholewheat bread
- A seeded roll
- Wholewheat pita
- Wholewheat pasta/noodles
- Wholewheat wrap
- Brown or basmati rice
- Fresh fruit
- For long-lasting brain and body power, add a source of protein.
Some good protein choices:
- Lean cold meats
- Grilled chicken
- Mini meatballs
- Legumes like beans or lentils
- Fish like tuna, sardines or pilchards
- Cottage cheese
- Boiled eggs
Sauces like low-fat mayonnaise, sweet chilli sauce, hummus or guacamole are optional but not essential.
- Deep-fried foods (like samoosas, spring rolls or vetkoek)
- Sausage rolls and pies
- Croissants, muffins or other pastries
Step 2: Choose portions with caution
- Be sure to start the day with a balanced breakfast and keep healthy snacks or a packed lunch on hand to avoid arriving at a meeting hungry.
- Use smaller plates and serving utensils to help manage how much you dish up.
- Sit far away from the food to avoid “picking”.
- Use the size of your hand to determine sensible and healthy portion sizes and curb overeating:
- A fistful is equal to one cup and can be used to estimate the portion size for carbohydrates (starches and fruits).
- The size of the palm of your hand can be used to estimate the portion size for protein. For a stew, curry or casserole this would be about half a cup.
- The tip of the thumb is equivalent to one teaspoon and can be used to estimate the portion size for all oils, butter or mayonnaise.
- The thumb can also be used to estimate the portion size for peanut butter or hard cheese.
Step 3: Carefully consider your choice of drink:
Some good choices are:
- Still or sparkling water
- Tea or coffee
- Vegetable juice
- Low-fat milk
- Sugar-free fizzy drinks
Sometimes the biggest challenge to eating a healthy diet is finding the right ingredients: here’s how Annora Mostert, the founder and group owner of Anja’s Pantry, and Alliyah Geldenhuys, who just opened Anja’s Pantry Plumstead, did just that.
Do you have a special interest in diabetes?
“It soon became clear that people with diabetes have the biggest need for healthy low carbohydrate and sugar-free food,” explains Annora. “So we involved trained nutritionists to guide us in what the right type of products should be for diabetics, and started to change the content of our pantry.” The result? All the products in Anja’s Pantry stores are now diabetic friendly. Some of the store owners also have close family members with diabetes, so as a team they work together to stock the right kind of products.
Do you think awareness is growing around healthy food alternatives?
“Absolutely! Social media is the biggest contributor creating awareness, but the awareness is now affecting policies. The research is so clear and the problem is so great that the South African government has followed the UK government in introducing a sugar tax next year on foods to try to curb the high sugar content in processed foods,” says Annora. As a result, all their stores offer a wide range of food products that are sugar-free and low carb so that those who want to avoid sugar can still have a variety of foods to choose from. “Our range of food products is now over 200 items with more being added all the time. This becomes a mini grocery store for the large percentage of the population that are either diabetic or pre-diabetic, those who have allergies or those who just want to lose weight while enjoying their food.”
How did you choose the location of Anja’s Pantry Plumstead?
Anja’s Pantry in Plumstead is right next door to a number of fast food restaurants. “We chose the location on purpose,” explains Alliyah, the owner of the store. “We want to provide healthier options to those in Plumstead and surrounds. It’s often difficult to prepare home cooked meals and so called ‘proper food’ with the fast paced lifestyles that many of us lead today. We end up simply settling for the quickest and easiest option available, but often these are unhealthy food choices. With our easy to prepare premixes and pre-prepared items such as pizza bases and meals, we are hoping to make it much easier for those wanting to enjoy a more nutritionally sound meal.”
Do you think there’s a particular need for healthy alternatives in the Muslim community?
“Yes! Traditional Muslim food is well known for being loaded with unhealthy fats, excessive carbohydrates and sugars. Diseases such as diabetes, high blood pressure and cholesterol are rife within the Muslim community and have sadly become a way of life for many within the community. I think it’s possible to ‘eat yourself healthy’, and that if we can share this vision and all that it stands for it will change the lives of many and allow Muslims to re-think their food choices.”
Do you have any advice for those who are struggling with their diabetes?
“Living a sugar-free and low carb life shouldn’t be that difficult,” says Annora. “We know that it is more expensive since real food items aren’t mass produced and made with lots of chemicals, but it saves so much on unnecessary medical bills.” Alliyah agrees. “An important part of managing your condition is to eat healthy meals and steer clear of certain items. Always read labels and check the ingredients of items that you purchase, as product packaging can often be misleading!”
What makes your life sweet?
For Annora, it’s feeling healthy and eating without feeling guilty. For Alliyah: “My amazing family, who made the opening of this shop a reality. It would never have happened without their help, guidance and support.”
When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.
Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?
That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.
What inspired you to write The Low Carb Solution for Diabetics?
We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.
The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.
I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.
A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.
Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?
Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!
What advice would you offer to people living with diabetes who are struggling?
Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!
What makes your life sweet?
Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.
Get in touch with Vickie: @Vickiefantastic on Twitter
Ask the dietician: Cheryl Meyer
From the community: “Being both diabetic and pregnant makes it difficult to know what to eat – there are so many things I have to avoid! And I’ve been craving sweet things. Any advice?” Sameshnie Naidoo.
The diet for pregnant women with diabetes should be a healthy, well-balanced eating plan aimed at supporting the pregnancy and promoting blood sugar control. This is essential for the wellbeing of both mom and baby.
Of course, pregnancy and diabetes means that there are more foods on the “Do Not Eat” list, as your normal diabetic diet has a new list of things to avoid. But bear in mind that it’s only for nine months, and that it’s for the best possible cause: your healthy child.
Foods to avoid:
Here’s a list of foods that you shouldn’t eat when you’re pregnant because they pose a potential food safety risk and might make you ill or harm your baby.
- Soft cheeses e.g. brie, camembert, and blue-veined cheeses unless the label says they are made with pasteurised milk.
- Processed cold meats or deli meats unless they are reheated until steaming hot.
- Refrigerated paté or meat spreads (canned options can be eaten).
- Refrigerated smoked seafood unless as an ingredient in a cooked dish e.g. a casserole.
- Raw or partially cooked eggs and dishes that contain these e.g. homemade mayonnaise.
- Raw or undercooked meat and poultry
- Unpasteurised juice
- Raw sprouts
- Raw or undercooked fish or shellfish
- The American Academy of Nutrition and Dietetics (AND) recommends pregnant women avoid fish high in mercury e.g. shark, swordfish, marlin. And limit intake of fish and shellfish lower in mercury e.g. prawns, canned light tuna and salmon, to 360g or less per week.
The good news? You don’t need to give up caffeine entirely. The AND recommends keeping your intake below 300mg/day, which is about one or two servings of coffee or tea. And of course rooibos is naturally caffeine free, so you can have as much as you like!
Being both diabetic and pregnant can feel restrictive from a diet point of view… When you’re lacking motivation, just remember that everything you eat your baby is eating too: so put down the junk food and pick up a carrot!
A note on cravings:
Whether it’s pickles and ice cream or other odd combinations, both cravings and food aversions are common during pregnancy. Although the exact cause is unknown, taste perceptions may change with hormonal changes. Cravings are generally harmless*, unless foods you crave replace more nutritious foods, or all you want is junk food. If broccoli loses its appeal, for example, substitute another vegetable that you enjoy and tolerate.
*Cravings for non-food substances like sand or chalk (a condition called pica) can be dangerous as they contain lead or other toxic substances. If you’re craving non-food items, consult your doctor.
Ask the dietician: Cheryl Meyer
From our community: “I’ve just been diagnosed and have no idea what to eat. Please help me! I just need some basic ideas of what to keep in my cupboard so I can make easy healthy meals…” John Tabenga.
Stocking your pantry is a fantastic place to start – healthy eating isn’t only about your kitchen, it begins when you wheel your trolley down the aisles of your local supermarket. Arming yourself with a well-planned grocery list will not only get you in and out of the shops quickly, it will also keep your healthy eating plan on track.
To help get you started I have put together a basic list to help you stock your fridge, freezer and pantry with healthy options:
- Oat bran
- Rolled oats
- Low GI muesli
- Baby potatoes
- Sweet potatoes
- Wholewheat pasta
- Brown rice
- Corn: frozen, canned or fresh
Breads & crackers
- Rye, wholewheat or low GI bread
- Wholegrain crackers: Provitas, Ryvitas, Finn Crisp
- Multigrain melba toast
- Wholewheat wraps
- Wholewheat pita bread
- Canned beans, lentils and chickpeas (drain and rinse well)
- Dried beans, lentils and chickpeas
- Low-fat milk
- Low-fat yoghurt
- Low-fat cottage cheese
- Ricotta cheese
- Hard cheeses: mozzarella or reduced fat cheddar
Tip: When choosing hard cheese, aim for less that 25g fat per 100g.
Meat, poultry, fish & eggs
- Lean beef and pork, trimmed of fat
- Chicken, trimmed of skin
- Lean cold meats
- Fish rich in omega 3s: Fresh, frozen or tinned salmon, trout, tuna, pilchards, sardines, mackerel
- Hake or kingklip fillets
Fats and oils
- Olive / canola / avocado oil
- Unsalted nuts
- Peanut butter
- Low oil dressings and mayonnaise (less than 5g fat per 100g)
- Frozen vegetables: green beans, peas, carrots, cauliflower, broccoli.
- Fresh vegetables
- Tinned tomato
- Tinned asparagus
- A variety of fresh fruit
- Pre-cut frozen fruit
- Canned fruit (in juice) for treats
- Olive oil
- Unsalted nuts
- Lean or game biltong
- Popcorn kernels to prepare homemade popcorn with a dash of oil and salt
Store cupboard basics
- Non-stick cooking spray: Spray n Cook
- Beef, chicken and vegetable stock powder
- Lots of herbs and spices
Tip: Read food labels and compare different brands within each food category.
With these pantry essentials, you should be able to whip up all kinds of delicious diabetic-friendly meals… Check out our recipes here if you’re looking for inspiration!
Ajita Ratanjee is a registered dietician on the Sweet Life Panel of Experts. She shares some of her diabetes dietary tips with us today.
Blood sugar control is of the utmost importance for a diabetic. To date, many diabetics have a challenge keeping their glucose levels controlled. A combination of the following 3 factors ensure good glucose control:
- Use of medication (oral meds or insulin injections)
Foods to avoid
Most diabetics I meet are familiar with the “AVOID” list of foods. These are the obvious sugars e.g. Sugar, sweets and chocolates, sugary cooldrinks, cakes, pastries, biscuits, ice-cream, puddings etc. If you’re a diabetic and continue consuming the above list, then you are literally accelerating the chances of complications of diabetes: nerve damage, blurred vision, kidney failure, sores on feet etc.
However there are many who are compliant with the “AVOID” list yet may still find that their blood sugar levels remain elevated. Many years of clinical experience working with diabetics has allowed me to create a shortlist of other foods that are most likely spiking your blood sugar and you’re not even aware they are the cause. They are “healthy” food choices; however they tend to spike blood sugar and are not the best choice for a diabetic.
Other foods that spike blood sugar
These foods should also be avoided:
- any 100% fruit juice,
- dried fruit,
- energy drinks,
- flavoured bottle water,
- energy bars,
- muesli (containing nuts and dried fruit),
- popcorn, and
100% Juices and dried fruits are a concentrated source of natural sugar resulting in blood sugar elevation. Most energy drinks are loaded with sugar and are not suitable for diabetics. Energy bars tend to be marketed as low-fat, however that is not the same as sugar free (at all!)
The important thing to remember is that a diabetic should be aware of all foods that elevate bloods sugar levels. Grains, fruit and vegetables are all healthy but they need to be eaten in the correct portions to keep sugar controlled. Protein helps to stabilize sugar and thus an extra serving of meat / fish / chicken / egg etc. will not elevate glucose as much as an additional slice of bread / rice / potato.
The magic diabetes diet lies in the correct proportion of carb to protein at meals and snacks, and the correct portions at every meal and snack.
Choosing the right food
Fatty fish are high in omega 3 – tuna, sardine, salmon and mackerel are high in essential fatty acid. These are protective towards cardiovascular health and have anti-inflammatory properties. Diabetics are at high risk of heart disease thus omega 3 supplements are highly recommended. Make sure that you use good quality omega 3 that is heavy metal free.
Alcohol is metabolized as a sugar so plan in your glass of wine (preferable red and dry) or whiskey.
My key message in a nutshell would be – it’s not just about “no sugar” but rather getting the carbohydrate and protein balance. Test your glucose regularly; at different times of the day. This enables you to monitor your control throughout the day. Test your sugar before a meal or 2 hours after a main meal. Keep a record of your blood sugar readings.
At Easy Health Wellness we assist our clients by teaching them how to exchange carbs and how to count carbs to ensure that they always are in balance at each meal and snack, and they can enjoy variety in their eating plans. We also stock a fabulous range of sugar-free products to support our diabetic’s client needs.
The diabetic way of eating is a very healthy way of eating. We can all do with avoiding the refined carbs and eating regularly.
Find out more at www.easyhealthwellness.com or call 012 997 2783.
From our community: “I know that as a diabetic I should always try and be good, but sometimes it’s hard… What can I snack on without feeling too guilty about it (but that will also be a treat)?” Charne Smith.
A treat is something that tastes great, is normally high in fat and refined carbohydrate, and is eaten to either celebrate or make you feel better… But how do you have your treat and prevent it from totally messing up your blood sugar levels for the day?
Treats are not forbidden, but they should not be too often or too big. It all comes down to self-control and portion control. The occasional block or two of chocolate should not mean disaster for your blood sugar: it’s when you eat the whole slab that things spiral out of control. Everything in moderation is the key.
If you battle with cravings, you need to understand that the last bite never tastes as good as the first bite. The feel good rush you get from the first bite of a treat starts to fade as you continue eating, but your blood sugar levels start to increase.
What does this mean? You only need a small amount to feel like you’ve had a treat. You don’t need the whole slab, packet, bowl or slice…
How to cheat:
- Split a dessert with your partner. It might drive them nuts, but it will keep your blood sugar and weight down. Better yet, plan ahead and choose a light main course so that you can have a small dessert on those special evenings out.
- Choose biscuits and cakes that don’t have icing, or remove the icing and jam from cakes. Icing has twice the amount of sugar as the cake or biscuit.
- Choose a dessert like apple crumble (without the ice-cream or cream) or two small scoops of ice-cream. Just remember to keep portions small.
- Spoil yourself with some good diabetic-friendly ice-cream (low fat/low sugar), lite custard and diabetic friendly puddings.
- Opt for small “bite” sized chocolates or chocolates with wafer inside (e.g. Kit Kat Fingers).
- Dark chocolate with a high percentage of cocoa is better for you as it is higher in antioxidants. Dark chocolate is also bitter so people tend to eat less of it: usually a block or two is enough.
- Salt and vinegar popcorn instead of crisps will keep your fat content low and help with salt cravings. When going to the movies, choose a small popcorn and a diet drink.
Remember: Spoiling yourself on the odd occasion is allowed. Always test your blood sugar levels to see how they react and you will learn to better control these situations.
If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.
Meet the expert
Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years
What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.
What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.
What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.
When should someone consider getting an insulin pump?
- If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
- If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
- If they have irregular eating, working and resting times.
Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.
A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.
FAQ about the insulin pump from our community:
What is an insulin pump?
- Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
- The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
- It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
- Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
Where do you buy an insulin pump and how much does it cost?
You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.
What are the advantages and disadvantages of using an insulin pump?
Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.
- Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
- You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
- You can participate in sports whenever you feel like it — without having to plan in advance
Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.
Will my blood sugar control be better if I use an insulin pump?
It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.
Will I still have to test my blood sugar as much?
A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.
Are there insulin pumps that have a Continuous Glucose Meter attached?
Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs
How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?
You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.
At what age can you put a child on the insulin pump and how easy is it for them to adapt?
I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.
What is the risk of infection?
If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.
How much is an insulin pump with and without medical aid?
That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.
Ask the expert: Dr Claudine Lee, GP
“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”
Ask the dietician: Cheryl Meyer
We asked our community what they most wanted to know about diabetes and food – here are 10 frequently asked questions, answered by our expert dietician.
- Must I cut sugar out of my diet completely?
Small amounts of sugar can be included in your diet, but too much sugar or sweet food is not recommended as part of a healthy eating pattern.
- What can I eat when I feel like chocolate?
Treats like chocolate can fit into a healthy diet, as long as you keep these points in mind:
- Try to have treats with a meal, e.g. as a dessert.
- Watch your portion size: choose a small portion or share.
- Put a healthy twist on treats – check out these great recipes for ideas
- Do I have to buy special sugar replacements, or can I just use less sugar?
Small amounts of sugar, jam, and honey have little effect on blood glucose levels, so small amounts of sugar can be included in your diet, e.g. a scrape of jam on wholewheat bread.
- How important is fibre in a diabetic’s diet?
Fibre keeps your digestive tract working well, can help lower your cholesterol level and can improve blood glucose control if eaten in large amounts. Another benefit of fibre is that it adds bulk to help make you feel full. Given these benefits, fibre is important to include in a diabetic’s daily diet – and in the diets of those who don’t have diabetes!
- How many vegetables should I be eating in a day?
The amount of vegetables you need depends on your age, gender and level of physical activity. On average, an adult woman will need 2½ cups a day, while an adult man will need 3 cups, and children will need between 1 to 2 cups a day.
- How much protein do I need to balance out carbohydrate?
Protein should account for about 15 to 20% of the total calories you eat each day – roughly a fist-sized portion at each meal.
- Is too much fruit bad for diabetics? And grapefruit?
Fruit (any kind, grapefruit included) can be included as part of your diet, but controlling portion size is vital. Limit your portions to a fist-sized or tennis-ball sized portion at a time.
- How do I manage food for my diabetic child?
Provide structured, nutritious meals and snacks for your child and make healthy eating and lifestyle changes as a family (don’t single out one family member). Remember that they are a child first and a diabetic second. Work with your child’s diabetes health care team to help your little one grow up healthy and happy!
- My sugar is always high – am I eating wrong?
Diabetes is managed with diet, exercise, tablets and/or injections. Check in with your doctor to make sure your food choices, exercise levels and medication are on track to keep your sugar within your target range.
- How can a diabetic lose weight in a healthy way?
The best way to lose weight for good is to find an approach to eating that makes sense, doesn’t cut out whole food groups and has you eating regularly and feeling well.
Ask the dietician: Cheryl Meyer
From our community: “Can anyone tell me about madumbis for diabetics – good or bad for us, and how much can we eat?” Lynette Hitchcock.
Madumbis, amadumbe, African potato or taro – call them what you will, they are delicious! They have a rich, nutty, earthy flavour and a stickier texture than potatoes. Like potatoes, they fall into the carbohydrate group of foods and can be roasted, mashed or boiled.
The key to eating proudly South African carbohydrates like madumbis, roti, pap or samp in a healthy diabetic diet is portion control! Counting the carbs in your meals and being aware of the carbs you eat can help you match your medication or activity to the food you eat. This can lead to better blood sugar control.
Remember: Everyone needs a different amount of carbohydrate at each meal and/or snack – the amount that is best for you depends on your:
- physical activity
- current blood sugar
- blood sugar targets
Not sure how many carbs you should be eating? Ask your doctor or dietician for help.
|A general guide:|
|Carb limits for women||Carb limits for men|
|Meal||30 – 60g||45 – 75g|
|Snack||15 – 30g||15 – 30g|
What does this mean? A food that has 15g carbohydrate is called “one carb serving”. One slice of bread or a small piece of fruit each have around 15g carbohydrate, so they are equal to one carb serving.
One carb portions of Proudly South African foods:
|1 carb serving||50g madumbi|
|1 small roti (35g)|
|⅓ cup pap (60g)|
|⅓ cup samp (75g)|
|½ cup sweet potato (100g)|
|1 medium mielie (140g )|
|½ cup rice (50g)|
|1 x 15cm tortilla or wrap (35g)|
|½ cup pasta (100g)|
|1 slice bread (30g)|
|1 small apple (115g)|
As much as possible, try to stick to this portion size, with a serving of protein (meat, fish, chicken, eggs, beans) and half a plate of vegetables or salad.
How to cook amadumbe: Scrub them clean and steam or boil until soft. Drain and cool slightly before removing the skins. Serve dusted with black pepper, a dash of salt and a drizzle of olive oil. Yum!
Amadumbe in numbers:
100g portion boiled amadumbe has: *
- 600 kJ
- 5g plant protein
- 1g fat
- 5g of carbohydrate
- 1g fibre
* According to The SA Food Tables
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|
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.
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).
Whether you battle to lose weight, or struggle to gain it, maintaining a healthy weight is a constant battle for many people with diabetes. Joanne Lillie explains how to make lasting changes.
Putting on weight
Controlling blood sugar levels is the starting place for achieving your target weight with Type 1 diabetes, as high blood sugar levels will cause glucose to be lost in the urine and result in weight loss, says dietician Genevieve Jardine. Many people find that once their glucose levels are under control, weight management becomes much easier.
Top tips to build mass:
- Go for low GI: To balance your glucose levels, lower-GI carbs such as wholegrains, beans, sweet potatoes and some fruit (like plums and apricots) are great choices, as they are less likely to spike your blood glucose. Milk and yoghurt also have a low GI. Just remember that low GI food still has to be eaten in the right portion.
- Eat more often: Rather than three meals a day, eat six smaller meals a day. Check your blood sugar more often and inject accordingly if you decide to try eating this way. Don’t skip meals as you will miss opportunities to increase your calorie intake.
- Fat has more calories than carbohydrates or protein: fat contains 9 calories per gram, while carbs and proteins contain 4 calories. So it makes sense to eat more fat when you’re aiming to put on a few pounds. Just be aware that you need to choose healthy fats. Cook with more olive or canola oil, get plenty of nuts and seeds, and add avocado and olives to salads.
- As long as your kidneys are in good shape, you can add protein powder to yoghurt or smoothies. This helps you gain weight as lean muscle mass rather than fat.
A normal body mass index (BMI) is vital for people with diabetes. “As the BMI increases, the amount of insulin required to maintain a normal glucose level also increases because patients become more insulin resistant,” explains endocrinologist Dr Joel Dave. An elevated BMI is also associated with high blood pressure (hypertension) and high cholesterol (dyslipidemia).
Healthy eating, regular physical activity, and medicine (if prescribed), are the key elements of Type 2 diabetes management. For many people with diabetes, the most challenging part of the treatment plan is working out what to eat.
Top tips to lose mass:
- Aim to reduce your energy intake while sticking to a healthy eating pattern. This means getting all the nutrients you need, in as few calories as possible. How? By focusing on nutrient-dense foods such as green vegetables, some fruits (especially berries) and beans.
- Carbohydrates from vegetables, fruits, wholegrains, legumes and dairy products are better than from other sources, especially those with added fats, salt and sugar. The most carb-dense foods include those with refined white flour: breads, biscuits, pastries, cakes, as well as white rice and potatoes. Limit these as much as possible!
- A Mediterranean-style diet may boost weight loss and benefit blood sugar control and cardiovascular risk factors. This means:
- Eating mostly plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Keeping carbohydrate levels as low as possible
- Using healthy fats, such as olive oil
- Using herbs and spices instead of salt to flavour foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
Ask the expert: Genevieve Jardine, dietician
“Learn to respond to hunger and not appetite. Often a high carbohydrate diet makes people hungry whereas enough protein and healthy fats helps make people feel fuller for longer.”
I don’t know about you, but I love the idea of eating only what’s in season. Fresh fruit and vegetables are obviously at their most abundant when they’re in season, and I like to only eat what’s local and fresh (don’t we all?!) It’s not always that easy to know what’s in season, though, and what to look out for. That’s why I love this seasonality calendar we were sent – take a look below and download a PDF if you’d like to keep it.
Happy cooking – and eating!
Seasons change, and so should the fruits and veggies you put onto your plate. Eating seasonally is tastier, more cost effective and sustainable. Chef James Diack, one of South Africa’s pioneers of provenance, has taken the concept of seasonality even further by producing a Seasonality Calendar for South Africans as a guide on what to eat each season, and what they can expect to see on his plates during the months and weeks of the year based on the produce from Brightside Farm.
“Seasonality and sustainability are all about protection – protection of the environment, protection of our diners’ health and not least of all protection of animal health. All of our practices are geared toward these goals,” James says.
Download the calendar to keep on your fridge!
It might seem as though being a restaurant chef would be too tempting a job for a Type 1 diabetic, but 30-year-old Vanessa Marx has made an art out of making healthy food delicious – and accessible.
When did you find out you were diabetic?
I was about sixteen and in high school – seriously bad timing! I had all the usual symptoms. I was drinking about four litres of water a day and falling asleep during class because I was so exhausted. My mom eventually suspected diabetes and I had to be hospitalised. It was a traumatic experience. I’ve always loved food, and I remember lying in my hospital bed naming all the foods I could never eat again… It was a long list!
How has diabetes changed your daily life?
That’s a hard question, because it’s so much a part of my daily life. It can be difficult, sometimes, explaining to people who don’t have diabetes how you’re feeling. If I wake up with low blood sugar, for example, I’m exhausted before the day begins. People understand a throat infection, but they often don’t understand what waking up low feels like. As a head chef, I need to be alert every day, taking charge of the kitchen. There’s no room in a busy kitchen for feeling tired or unwell because of high blood sugar or needing time out to have something sweet because of low blood sugar.
Isn’t it difficult to be around food all day? How do you resist sweet treats?
It is quite tricky! Often just the act of making sweet treats for someone else satisfies the urge for me but other times I’m pretty tempted: what puts me off is that I know how I’ll feel later. I do believe in “everything in moderation”, so I allow myself a treat now and then. As long as it’s a once-off, and I’m not doing it every five minutes!
What advice would you offer to other diabetics?
Be disciplined! Pay attention to your diet: what you eat plays a huge role in how you feel. Also don’t feel like you’re on your own, don’t be afraid to ask for help – talk about your diabetes, and explain to those around you what it feels like. There’s still a stigma around diabetes, that it’s only people with weight problems who are diabetic. But the only way we’re going to change that is by talking about it.
What makes your life sweet?
My family and friends, and my work.
Get in touch with Vanessa: @vanessajaynem on Twitter and Instagram