diabetes and diet

Natural supplements for diabetics

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
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
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
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.
Source: Healthline

American ginseng
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
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

The best diabetes-friendly drinks

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.

Fruit juices
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).

How to avoid dehydration caused by diabetes

When you think of your diet as it relates to your diabetes, you probably think mostly about the foods you consume. However, did you know that staying hydrated is also a big concern if you have diabetes? In fact, polydipsia is the term given to excessive thirst that is a symptom of diabetes. According to the Mayo Clinic, dehydration occurs when the kidneys have trouble filtering and absorbing excess sugar. Those who suffer with diabetes insipidus are also at an increased risk for dehydration.

To ensure that you stay hydrated and reduce the risk of dehydration caused by diabetes, follow these three top strategies.

Keep a water bottle with you at all times
One of the easiest ways to stay hydrated is to keep a full water bottle with you at all times. This removes the need to purchase water outside of the home, makes it simple to have a constant supply of water, and serves as a constant reminder to drink water throughout your day. Since many public places are equipped with filtered water, you can prevent the onset of dehydration caused by diabetes with little effort and no expense.

Set reminders to get enough water
The importance of staying hydrated while managing your diabetes symptoms should not be overlooked. Dehydration is a serious condition which shouldn’t be treated lightly. If you are having a tough time remembering to drink water during the day (even while carrying a water bottle with you), set daily reminders for yourself on your phone or computer to make it a habit. Treat regular water drinking as if it were as essential as taking a medication on schedule.

Replace other beverages with water
Do you tend to drink beverages other than water throughout the day? Skip beverages that don’t provide adequate hydration. Instead, replace some of your carbonated beverages, coffee, and other drinks with a glass of water. Aim to drink at least eight 250ml glasses of water every day. Consuming a sufficient amount of water (rather than beverages that simply contain water) will help combat the risk of dehydration. 

Make it simple to stay hydrated
Making it a habit to stay hydrated doesn’t have to disrupt your life. Begin working these simple steps into your life to limit your chances of developing dehydration as a result of diabetes. While it may take a few weeks (or more) to be sure that you are consuming the proper amount of water, you’ll eventually see how simple it is to stay hydrated throughout the day.

Using laughter as medicine

You would never guess that Trevor Davids, a business consultant, film and TV producer and biker filled with the joys of life, has Type 2 diabetes. That’s because he’s managed to take diabetes in his stride.

When did you find out you were diabetic?

Six years ago, in November 2010. I had all the usual symptoms – constantly thirsty, needing to urinate a lot – and I looked them up on the internet. Up came: diabetes. I read up on the condition before going to the doctor, and then announced, “I have diabetes.” We took the necessary tests and my blood sugar was really high (18mmol/l), so I was put onto insulin tablets immediately. Diabetes doesn’t run in my family, I’m not overweight and I do a lot of exercise, so I’m not a typical Type 2 case. I do have high blood pressure that runs in the family. When I was diagnosed with diabetes I had already given up alcohol ten years before, but I was smoking 40 cigarettes a day, so I had to give that up too. After 31 years of smoking, I quit on the first try. Once I make up my mind about something, there’s not much that can move me.

How has diabetes changed your daily life?

I’m a lot more conscious of my eating patterns now. I never used to eat breakfast – I’d grab something on the run, snack in the afternoon, and then eat a big plate of food in the evening. I had to learn to be less flexible about food. Eat a regimented breakfast, lunch and dinner, look at my intakes and learn about low GI. I couldn’t have done it without my family – my wife Norma and son Danté have been the most amazing support.

How do you manage to focus on the lighter side of living with a chronic condition?

I never focussed on the darker side of diabetes! I’m a very positive person, I like being focussed on doing something well. In challenging times, I just take it in my stride and deal with life’s knocks as they come.

Is there anything diabetes has stopped you from doing?

No. Only smoking! I’ve actually been able to take on more daily life challenges since being diagnosed, because I restructured and reorganised my life, so I now have more time.

What advice would you offer to other diabetics?

If you’ve just been diagnosed, don’t worry – it’s not as daunting as you think. It can become a lifestyle condition, you just need to adapt your lifestyle. Diabetes is part of who you are now, and denying it doesn’t make it go away.

What makes your life sweet?

Life itself! And my family, of course. And laughter: the ability to laugh and create a laugh. I believe that people can live a long time if they can learn to laugh in the face of adversity. I like to use laughter as part of my medication.

Maintaining a healthy weight with diabetes

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.


Losing weight

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.”

Fun festive food

Ask the dietician: Genevieve Jardine

From our community: “With Christmas coming up I know I’m going to want to eat what I shouldn’t… What are the ‘safe’ foods to snack on at parties?” Jabu Hlazo

The festive season is a great time of year when the hard work is over and it’s time for fun and feasting. The question is, how do you celebrate with everyone else, but still maintain healthy blood glucose levels? Here are some holiday points to ponder.

Watch your weight

Most people tend to gain about 2 to 5kg over the festive season only to make a New Year’s Resolution to lose it again. Prevention is better than cure, so make it your goal not to gain any weight this festive season.

Treat yourself

Using your bonus money to buy special treats is tempting – nothing says Christmas like mince pies or brandy pudding. This year, why not use your money to buy healthy treat alternatives: exotic fruit, nuts or delicious lean biltong. Better yet, spoil yourself with non-edible treats like a magazine, a new recipe book or a pair of running shoes.

Get active

Use your free time and the sunny weather to try a new activity. Play a game of tennis, hire a bike, do that hike you’ve always wanted to do. Take the focus off food and get adventurous. Touring a new city on foot or playing with the kids on the beach allows you to burn off kilojoules and improves your body’s ability to use insulin more affectively. The result? Better blood sugar control.

Re-gift the chocolates

It’s the season of giving and granny’s homemade biscuits or that box of chocolates can become very tempting. The truth is that you don’t have to eat the whole box in order to celebrate or appreciate the gift. This year, rather re-gift the biscuits and spoil someone else.

Plan ahead

During the festive season the social calendar fills up. Be wise and plan around your daily ‘eating commitments’. It is still important to eat regular meals (even while on holiday) and you may need to adjust meal sizes and snacks around social engagements. For example, if you know that you have a family braai in the afternoon, you may want to plan a light lunch with a healthy snack just before you leave to help stabilize blood sugar levels and avoid binging on snacks. When invited out, offer to contribute to the meal and bring your own healthy alternative. You will be amazed how grateful people are when you arrive with an extra plate of fresh veggies and dip, or a fresh green salad or diabetic-friendly dessert.

Watch the alcohol

Holiday celebrations often involve excessive drinking, which can send blood glucose levels soaring with an inevitable crash in the early hours of the morning. Be sensible and opt for alternatives like light beer or light wine, and watch how much you drink: the recommended amount is two alcoholic drinks per day for men and one per day for women. Never drink on an empty stomach and don’t drink and drive. There is more at stake than just your blood glucose levels.

Party tricks

If the festive season means endless office parties and end of year functions, don’t hesitate to find out more about the food. Chat to the person in charge of catering the office party to ensure there will be snacks like chicken pieces, fruit kebabs, diced vegetables and sandwiches, as well as diet drinks and light alcohol. For restaurant dining, phone ahead for the menu and decide what to order so you’re not tempted when you get there. If you choose wisely and stick to reasonable portions, you’ll get through the festive season just fine.

 

Photo by Brooke Lark on Unsplash

How to eat seasonally

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!

Download (PDF, 1.08MB)

Tackling the Challenges of Diabetes and Obesity in Africa

I was lucky enough to be invited to the most fascinating diabetes conference in Cape Town recently: Tackling the Challenges of Diabetes and Obesity in Africa.

The line-up was truly impressive (more on that below) but what really struck me was how engaged and passionate all the attendees were about the issues of diabetes and obesity, and what we – as individuals, researchers and caregivers – can do about it.

But first! The amazing speakers and their topics.

The first day was chaired by Professor Naomi Levitt, the Head of Diabetic Medicine and Endocrinology at the University of Cape Town. Prof Levitt gave an overview of the issues of diabetes and obesity in Africa, and led the discussions after each talk. Her passion for diabetes research in South Africa is palpable.

Professor Justine Davies is a Professor of Global Health from Kings College London and started us off with a talk on Health systems challenges of deadling with diabetes in sub-Saharan Africa. She’s the previous editor of The Lancet journal and gave insights from The Lancet Diabetes and Endocrinology Commission. A fascinating look at just how severe the problem is in sub-Saharan Africa.

Then it was Dr Ankia Coetzee‘s turn. She’s a Clinical Endocrinologist at Stellenbosch University, with a special interest in gestational diabetes. Her talk – Gestational Diabetes Mellitus: The Alchemy of Diabetes Prevention? – suggested that treating those with gestational diabetes holistically can be a key to unlock future Type 2 diabetes.

After a short tea break to let the information digest, Salaamah Solomon, a Dietician from Tygerberg Hospital, spoke about Challenges in Nutrition Education – specifically, how essential it is to make nutritional information as simple as possible so that it can be easily adopted.

Then Professor Julia Goedecke, a Researcher at the South African Medical Research Council, spoke about her research into Mechanisms underlying insulin resistance in black South African women, which sparked a whole debate around exercise and diet as two critical components in Type 2 diabetes management (along with medication, of course).

After a fascinating lunch spent absorbing more diabetes information, Professor Tandi Matsha, the Head of the Department of Biomedical Sciences at Cape Peninsula University of Technology spoke about Epigenetics and Type 2 Diabetes. I didn’t know much (if anything) about epigenetics, so this was a real eye-opener for me.

And then Dr Sundeep Ruder, an Endocrinology Consultant and Lecturer at the University of the Witwatersrand, took things in an entirely new direction with his presentation about Philosophy in Diabetes – how it is our goal as humans to be peaceful, blissful and happy, and too often we use food as a cheap trick to get us there. (Among many other fascinating points!)

I had to get home to my young children, so sadly I missed Professor Carel Le Roux‘s talk: Can we approach obesity as a subcortical brain disease to address prediabetes and diabetes? I also missed Professor Andre Kengne‘s talk on Diabetes and BMI trends in Africa – both of which were discussed a lot the next day.

The next day was World Diabetes Day, and Dr Rufaro Chatora from the World Health Organisation gave some opening remarks about World Diabetes Day.

Then it was time for the keynote presentation, by Professor Jean Claude Mbanya, Honorary President of the International Diabetes Federation (Africa Region and Global), and Professor of Medicine and Endocrinology at the University of Yaounde, Cameroon. He gave a fascinating presentation on Global and Africa’s Burden of Diabetes, releasing the latest research from the 8th IDF Diabetes Atlas.

Then it was Dr Eva Njenga‘s turn to tell us about diabetes in Kenya. She’s the Chair of the NCD Kenya Alliance and the Director of the Kenya Diabetes Management and Information Centre, which she co-founded. They get funding from the WDF and partner with the Minister of Health to make a tangible difference to people with diabetes in Kenya. She spoke about Changing lifestyles to combat Diabetes, Obesity and other NCDs.

It was really the most extraordinary two days of diabetes discussions, talks, information sharing and inspiration. I left feeling so motivated to make a difference to people with diabetes in South Africa, and so inspired by all the doctors, researchers and healthcare workers who are so involved in diabetes in our country.

I can’t wait for the next one!

Type 1 diabetic going through puberty

From our community blog:

Hi,

My son was diagnosed with Type 1 Diabetes about a year and a half ago.  His HbA1c hasn’t been great for the last few months – sitting on about 8. We seem to do everything “right” but for reasons we cannot understand we go through days with sugar levels that just won’t come down.

I now think that he is often injecting into scar tissue… He uses pretty much the same area to inject. I think he is finding it hard to inject anywhere else as it is a bit painful (he had a slight phobia of needles before being diagnosed). He is now 12 years old and is going through puberty so his body is changing and will need more insulin.

Any advice?? I’m feeling a little helpless at the moment.

We see his doctor every 3 months, but does anyone know of a nurse in the Fourways Johannesburg area who deals with Type 1 diabetics who we can perhaps see monthly to check his readings and perhaps guide us on eating, etc.

Thank you so much.
Warm Regards
– Candice
Comments:

Jen Whittall is in Bryanston
Kimberley

Hi Candice
You are quite spot-on with your own findings concerning your son. If he is currently injecting into the stomach, challenge him in injecting into the upper outer thigh. He should try to do this fast (like throwing a dart – playful challenging). When I changed my technique from a slow approach to the dart action, I never looked back. Just take note that the legs are active and blood glucose levels might drop faster than expected, especially if you are correct with your diagnosis of him injecting into scarred tissue.
Kindest regards
Marelize

Making diabetes delicious

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

Quick diabetes-friendly food

Ask the dietician: Genevieve Jardine

From our community: “I find myself worrying about food a lot, as a diabetic… What are the essentials I should always have on hand for healthy lunches or quick food on the go?” Kriveshen Moodley.

Life is busy, with many demands that distract us from healthy eating. So how do we make good food choices? It starts with the right attitude and being prepared. As a diabetic, it’s important to remember that food is part of your treatment, so it needs to be a priority – but it doesn’t need to be hard.

Some helpful tips for simplifying food choices:

  • Plan meals for the week and do a big weekly shop.
  • Take a bag full of fresh food to work on Monday morning to use as lunch for the week.
  • Keep healthy snacks stashed in your car.
  • Have a back-up meal replacement drink for those times you don’t have time to eat.

Breakfast ideas:

Great tip: Wake up earlier so that you have time for breakfast at home – always a good idea!

  • Bake some diabetic-friendly muffins as a breakfast option.
  • A poached egg in the microwave (even at work) on a slice of low GI toast with a piece of fruit is a healthy choice.
  • Microwave oats (they’re low GI!) with a chopped apple or ¼ cup (30g) raw nuts and seeds to make a quick nutritious breakfast.

Lunch ideas:

  • A sandwich made with low GI bread filled with lean protein (cottage cheese / low-fat meat / tinned fish). Stuff with lettuce, tomato, cucumber and other salad.
  • Vegetable soup with 1 to 2 slices of low GI bread or a small wholewheat roll.
  • A picnic lunch with wholewheat crackers, hummus for a dip and cucumber chunks, carrots sticks, baby tomatoes or snap peas instead of a salad.
  • A salad made with lean protein (chicken or tuna) with very little dressing and no high fat toppings (croutons, bacon bits, cheese etc).

Dinner ideas:

Great tip: Cook meals for the week or cook double portions and freeze the food so that you have meals ready when you don’t have time to cook.

  • Make simple meals that don’t need lots of attention: roast chicken or baked fish with roasted vegetables. A steaming net is a handy tool that fits into any pot and steams all your vegetables at one time.
  • Always have a stash of frozen vegetables in the freezer for when you run out of fresh vegetables. When life gets busy, the first food groups to suffer are vegetables and fruit.
  • Always have salad ingredients handy. Salad is a quick side dish that takes up room on the plate so you can’t fill it with more carbs!
  • An omelette filled with vegetables like tomatoes, onion, mushrooms and peppers is a quick and healthy meal.

Get more fantastic meal ideas here.

Free Diabetes Cookbook!

Together with Pick n Pay, we’ve designed a cookbook specifically for people with diabetes who want ideas for every meal of the day. Breakfast, lunch, dinner, snacks and treats – there’s something for everyone!

Get nutritional advice on how to build balanced meals, and delicious recipes the whole family will enjoy – whether or not they have diabetes.

Download your free copy or read it online here.

Diabetic pregnancy and the pump?

From our community blog:

I am a Type 1 diabetic since 1991. I have had two children and desperately want a third, but cannot face another pregnancy like the second due to severe hypoglycaemia that kept occurring.

I want to get a pump – my doctor did initially suggest it and I have asked for a referral to a centre that deals with pumps. I also would like to know what the chance of getting a pump on medical aid is if it is recommended by a doctor and if the medical aid is paying for CDE at the moment?

I am trying to control my sugars now but even tracking them 6-8 times a day, taking multiple extra shots when needed and tracking my diet closely is not helping.

– Bronwyn

Comments:

Hi Bronwyn,

The CDE has 5 pump centers in Johannesburg. 011 7126000. They also have an amazing 5 day course called DINE. Speak to Michelle Daniels.
Kimberley

Hi Bronwyn,
I hope this may be of some help in resolving your control problems. I used a pump for 10 years and found it to be helpful particularly as you can control the long acting (basal) insulin for your individual requirements. You programme the pump to dispense whatever you need for each hour of the 24 hour day which will be exclusive to your needs.
A phone call to your medical aid should be able to tell you if they will support the purchase fully or partially. I stopped using mine because my levy on the consumables was increasing beyond reason.

It needs time and expertise to learn how to use the pump. I know we are all different but I believe that with the proper advise and treatment you should be able to get control before getting a pump. It will help your new doctor (it seems you need one) if you keep a record of insulin taken, food consumed, and exercise taken.

I’m a chairman of a support group, find one of these as they can also be very helpful.

Mervyn

What is the ‘right’ kind of food for diabetics?

Ask the dietician: Genevieve Jardine

From our community: “Being newly diagnosed, I am learning about foods that I can and can’t use. I cannot find an article explaining what to look for. It’s all a bit confusing. Help would be greatly appreciated.” David Staff.

“Eat the right type of food, in the right amount, at the right time of the day”

It’s important to make dietary changes that are simple and progressive. First you need to learn what foods should be in your trolley, fridge and kitchen cupboards: that will make good eating decisions easier to choose.

I have one simple rule: eat food that is as close to its natural form as possible! This helps to reduce the amount of processed, high sugar, high-fat foods that cause problems with weight and blood sugar control. Try not to focus on what you can’t have (it is very depressing) and rather be adventurous in experimenting with healthy nutritious meals.

Once you know which foods are suitable, you need to get specific and work out how much to eat. Portion control is very important. The good news is that almost all foods are allowed in correct portions.

Here are some general rules:

Starch: Use low GI, high fibre starches. Reduce foods made with lots of white flour and sugar (doughnuts, biscuits, cakes ). For your main meal, the portion size of starch should be the size of your fist (approximately 2 portions of starch).

Protein: Opt for low-fat protein. Remove visible fat from meat and skin from chicken. For your main meal, the portion of protein should be the size of the palm of your hand and the same thickness as your baby finger (less at other meals)

Dairy: Choose low-fat or fat-free dairy. Try for 2 portions of dairy a day.

Vegetables: Choose a variety of colours and serve raw, steamed and roasted. Eat lots – double portions where possible!

Fruit: Try to eat a variety of fruits. The size should be that of a tennis ball and you should aim for 2 servings of fruit a day.

Fat: Try to reduce the use of fats in your cooking. Rather grill, bake, boil, steam, microwave or stir-fry your food. The portion of fat should equal the size of the tip of your thumb.

Specific portion sizes:

Starch:

  • ½ cup wholewheat cereal / muesli
  • ½ cup cooked, cooled and reheated mealie meal / oats porridge
  • 1 slice seed loaf
  • ½ wholegrain seed roll / low GI bread roll
  • 3 Provita / 2 Ryvita
  • ½ cup (2 Tbs) beans or whole corn
  • 1 small mealie on the cob
  • ½ cup cooked, cooled & then reheated samp
  • ½ cup pasta / long grain rice / wild rice
  • ⅓ cup white rice
  • ½ cup brown rice with added lentils
  • ½ medium sweet potato
  • 2 – 3 baby potatoes
  • ½ cup cooked lentils

Protein:

  • 1 egg
  • 30g grilled chicken / ostrich / extra lean mince / grilled beef or pork
  • ¼ cup tuna
  • 30g steamed / poached / grilled / baked fish
  • 2 tbs peanut butter
  • 50g raw soya
  • 90g tofu
  • ½ cup cooked lentils / beans

Dairy:

  • 1 cup low-fat / fat-free milk
  • 100ml low-fat / fat-free sweetened yoghurt
  • 30g low-fat cheese (Lichten Blanc, Dairybelle InShape, Elite Edam, Woolworths, Mozzarella)
  • 50g low-fat feta cheese (Pick n Pay Choice Danish Style / Traditional, Simonsberg)
  • 50g low-fat cottage cheese (Dairybelle, Lancewood, Parmalat, In Shape, Clover)

Vegetables:

  • Asparagus
  • Green pepper
  • Baby marrow
  • Lettuce
  • Bean sprouts
  • Mushrooms
  • Broccoli
  • Mixed vegetables
  • Butternut
  • Onion
  • Cabbage
  • Pumpkin
  • Carrots
  • Peas
  • Cauliflower
  • Radish
  • Celery
  • Spinach
  • Cucumber
  • Tomato
  • Green beans
  • Watercress

Fruit:

  • 1 medium apple / peach / pear / grapefruit / orange
  • 1 large naartjie
  • 3 small apricots
  • 10 – 12 grapes (only!)
  • 1 small to medium nectarine
  • 1 tablespoon dried fruit
  • ½ cup fruit salad

Fat:

  • 2 teaspoons low-fat margarine / mayonnaise / dressing
  • 4 olives
  • ¼ avocado
  • 80ml low-fat gravy / sauce
  • 1 teaspoon olive / canola oil

Diabetes breakthroughs

From the artificial pancreas to new ways of testing blood sugar and more, we take a look at the future for those with diabetes.

Diabetes is a rollercoaster ride of blood sugar ups and downs, and tight control can be hard work. But there’s good news: while some researchers are working on a cure, others are making life easier for those with diabetes right now, through technology.

Carine Visagie brings you a roundup of the top new technologies out there.

Glucose-monitoring devices

 

Continuous glucose monitoring (CGM) devices are soon going to take blood sugar control to another level.

With the help of tiny electrodes stuck beneath the skin, CGM devices allow for real-time glucose readings throughout the day. The results are sent wirelessly to a monitor you can clip onto your belt and access on the go, and some devices can even send results to your doctor. Normal finger prick testing is still required (for a double check and to calibrate the CGM sensor), but you can rest assured that a CGM device will alert you if your sugar spikes or drops below your limits.

Examples include the Flash Glucose Monitoring System (Abbott) and the Guardian REAL-Time Continuous Glucose Monitoring System (Medtronic).

Ask the expert: Dr Joel Dave, endocrinologist
“24-hour glucose monitoring is going to be very helpful in patients that have difficulty controlling their blood glucose levels, as it will provide a 24-hour 360-degree view of their diabetes control.”

Ask the expert: Dr Wayne May, endocrinologist
“I’m looking forward to the Abbotts Flash Monitor, as it will stay on for 14 days and doesn’t require calibrating with a second machine.”


Insulin pumps

Insulin pumps keep getting smarter: some of the latest ones sync with CGM devices, while others are incredibly accurate at giving just the right insulin dose at the right time.

One example is the touch-screen Tandem t:slim insulin pump, which shows the date, time, how much insulin is ‘on board’ (seeing this before you bolus can help you avoid stacking your insulin*), duration of insulin action, and the amount of insulin in the reservoir. It looks like a smartphone and data is easily transferrable via a USB port. Plus, it can deliver insulin in very small doses.
*Insulin stacking is injecting a second dose too soon after a first, without taking into account the insulin already in your system. This can result in low blood sugar.

Another insulin pump to watch is the MiniMed530G by Medtronic – the first pump to shut off when blood sugar goes below a predetermined level.

Ask the expert: Dr Joel Dave, endocrinologist
“Although an insulin pump isn’t the ideal way of administering insulin for everyone, many diabetics find a pump improves their diabetes control and quality of life. Since the addition of CGM, the use of this technology has improved even more, especially in children and patients with very erratic blood sugar.”


Bionic pancreas


Bionic (artificial) pancreas systems are the next big thing in diabetes management. These systems, the first of which is still being tested, combine the latest CGM tech with the most advanced insulin pump tech and add a sophisticated computer programme to simulate the function of the pancreas.

The system constantly checks blood sugar levels by means of a CGM, and responds automatically by administering either insulin (to lower blood sugar) or glucagon (to raise blood sugar levels quickly) via two separate pumps. The system hooks up to a programme on your smartphone that makes decisions every few minutes, telling the pumps via Bluetooth how much hormone to deliver.

The bionic pancreas should be available in the next 5 years.

Ask the expert: Dr Joel Dave, endocrinologist
“The artificial pancreas has been the ‘holy grail’ for diabetes care for many years. The system has been vastly improved and early studies are showing great promise. Although not for routine clinical use at the moment, in the near future it will be a life-changing addition to the diabetes care of many patients.”

What about now? Smartphone apps for diabetes

If the future of diabetes tech seems too far away, keep an eye out for apps that can help you deal with diabetes right now, on your smartphone. We like:
Glucose Buddy: to track blood sugar readings, insulin doses, carb intake, exercise, blood pressure and weight, and
Diabetic Connect:
helping you tap into trusted advice, friends, support and tips.

But be warned: many international apps use mg/dL, the US blood glucose standard, instead of mmol/l, the South African standard.

South Africa’s most (and least) obese city

Last week I was lucky enough to spend a morning at Discovery learning about The Vitality ObeCity Index 2017 (check out #VitalityObeCity to read all about it.)

It was a fascinating morning. The Vitality ObeCity Index analysed data from Discovery Vitality members in six cities in South Africa (Bloemfontein, Cape Town, Durban, Johannesburg, Port Elizabeth and Pretoria) to see which city is the most obese and how their buying habits influence that.

A few interesting (and terrifying) facts:

  • Half of South African adults are overweight or obese. What that means is increased risk of heart disease, Type 2 diabetes, certain cancers and premature death.
  • Our eating habits have changed so much that South Africans now spend more money on beer than on vegetables and fruit combined. What?!
  • 45% of South African women are obese, as opposed to only 15% men. In 2013, South African women were the most obese in sub-Saharan Africa. So South African women are the most at risk for obesity.

I asked why that was and apparently there are three reasons:

  1. Women who were nutritionally deprived as children are more likely to be obese as adults (men who were deprived as children are not).
  2. Women of higher adult socioeconomic status (which is income, education and occupation) are more likely to be obese, which is not true for men.
  3. And possibly: in South Africa, women’s perceptions of an ‘ideal’ female body are larger than men’s perceptions of the ‘ideal’ male body – it’s seen as a status symbol to be a heavier woman.

Are you a South African woman? I am… Let’s make sure we’re informed and don’t let obesity happen to us and our sisters, mothers, daughters, friends.

The results

Vitality gathered data from half a million Discovery members to give us these results:

  1. Their weight status (BMI and waist circumference)
  2. Their food purchasing score (healthy vs unhealthy items)
  3. How many fruit and vegetable portions they purchased
  4. How many teaspoons of sugar and salt in the food they purchased

Weight status

Cape Town scores highest, with 53.5% of Capetonians in a normal weight range. Cape Town also topped the healthy purchasing score (which shows a positive relation between what you buy and whether your weight is in range or not.)

Fruit and vegetables

Cape Town purchased the most portions of fruit and vegetables compared to other cities – see the ranking above. In general, though, South Africans are only eating 3 servings of fruit and vegetables a day, as opposed to the 5 servings we should be eating.

Salt

Durban purchased the least amount of salt in SA, with Cape Town purchasing the most. We are eating twice as much salt as we should be in a day: it should only be 5g (1 teaspoon).

Sugar

Durban came out top of this test too, with the lowest average number of teaspoons of sugar purchased – Bloemfontein purchased the most sugar. And again, we’re eating twice as much sugar as we should be – a staggering 100g a day! (That’s 24 teaspoons – in the food and drink we consume.)

There are a number of factors that play into this, of course. The way we buy our food – the impulse buys, the treats, emotional eating. Fast food is also a huge problem, because it’s loaded with salt, sugar and bad fats. Cooking at home with whole foods (not convenience foods or ready-made meals) has been proven to have an enormous impact on health and weight.

So what should we be eating? Here are some excellent guidelines.

What do you think? This information made me take a closer look at how I shop and what we eat… Not even because I’m diabetic, but just because I want my family to be as healthy as we possibly can.

Living well with diabetes

From Facebook (Diabetic South Africans):

What does living well with diabetes look like for you?


Tried changing my way of eating, lost weight and still had to go on tablets. My levels are stable though – between 5.3 and 6.1 – enjoying my new way of life.
Sharon

Well… Sharon, that’s living well with diabetes, the rest is history! Well done.
Clint

I am Type 2 and lost 40kg from 110kg, gained muscle, full of energy and feeling 10 years younger! What I eat is part of living well with diabetes.
Phillip

It sucks big time. But taking it day by day. Some days are cool, but some are just hell.
Phumzile

Totally sucks. Got neuropathy from my ankles to my toes! Sugar down from mid 16s to between 8 and 12. Doc wants to put me on insulin but I don’t want to. Staying positive and fighting hard!
Anton

After taking control of my diabetes myself, i.e. testing throughout the day and increasing my insulin to where I needed it, I’m happy to report I tend to stay between 4 and 8 with a couple of hiccups here and there when I hit 12 or 9 – but nowhere close to 16 as before… Anton, I fought insulin injections too. But it works and I feel so much better. The fight against insulin is not worth it if you are damaging your body…
Elrica

Do or Don’t: Diabetic dietary supplements

Are dietary supplements really necessary if you have diabetes? Nicole McCreedy asks the experts.

Like many other people with diabetes, you may be wondering whether you need to take supplements to help manage your condition. Dietary supplements can be vitamins, minerals, herbs or other plants, amino acids (the building blocks of protein) or a combination of the above. They can be in pill, capsule, powder or liquid form.

Despite some of the claims being made, there is not enough scientific evidence to suggest that any dietary supplements can help prevent or manage Type 2 diabetes. That said, dietary supplements may provide extra nutritional benefit to people with special health problems, including diabetes. In such cases, they are usually recommended when there is a specific lack of something in the body.

Do: Eat correctly

It’s important to try and get the nutrition your body needs from a balanced diet. Making healthy food choices and choosing fruit, vegetables and whole grains over carbohydrates, refined sugars and foods high in saturated fats can make a big difference. Compared with supplements, whole foods provide a variety of different nutrients for health in one package, whereas single vitamin supplements are most often for a single purpose. An apple, for example, contains vitamin C, fibre, and antioxidants – all in one crunchy package!

Dr Claudine Lee, a GP from Hilton, says that following a balanced and healthy diet is essential. “If you think you’re not getting the vitamins and minerals you need from your diet, consult with your GP whether it is necessary to take a supplement,” she advises. Eating correctly, being physically active and taking your prescribed medication is vital for maintaining good control of blood sugar levels to avoid serious complications like strokes, heart and kidney disease, limb amputation and blindness.

Don’t: Go it alone

Talk with your doctor. That is the first step in deciding whether or not to use a dietary supplement. He or she can discuss the possible benefits of dietary supplements, and check that any supplements you take will not interact dangerously with your medications.

Be sure to list any dietary supplements you take whenever you tell your doctor or any other healthcare professional about your medications. Most importantly, keep in mind that a dietary supplement is not a replacement for the diabetes treatment and care advised by your doctor.

So who could benefit from a vitamin supplement?

  • Those on low calorie diets, who do not eat a variety of foods.
  • Those following vegan diets.
  • Those with certain food allergies, kidney disease or diseases of the gastrointestinal tract that interfere with nutrient digestion or absorption.
  • Pregnant women.

An A to Z of supplements and their benefits

 

Ask the expert: Andrea Jenkins, nutritionist.

“The following supplements have been shown to improve blood sugar control or limit diabetic damage.”

Amino Acids/Protein

Carnitine (L-carnitine), a nutrient made from amino acids that helps the body turn fat into energy, has been found to be deficient in people with diabetes. Almonds, egg and cottage cheese are rich in this nutrient.

Antioxidants

Antioxidants can help reduce oxidative stress and lower the risk of diabetic complications. Choose brightly coloured fruits and vegetables in smoothies, salads and soups to ensure a variety of antioxidants.

Enzymes

Digestive enzymes help ensure that mineral uptake is strong and can aid the management of diabetes. Pre- and probiotics are also helpful to maintain digestion and immunity.

Lipids and essential fatty acids

Omega-3 fatty acids lower blood pressure and triglyceride levels, and can help to relieve many of the complications associated with diabetes.

Minerals

Magnesium, common in leafy green vegetables, is frequently lacking in people with Type 2 diabetes, as is chromium. Brewers yeast, mushrooms and non-refined grains all contain chromium. Zinc improves insulin function, and potassium (found in all fruits and vegetables), can improve insulin sensitivity.

Vitamins

A vitamin B complex improves the metabolism of glucose, and vitamins C and E can improve eye health.

Remember that dietary changes are important to treat diabetes successfully. Many foods can have a positive impact on blood sugar, for example artichokes, garlic, nuts, onions, olives, cinnamon, blueberries, avocado and fenugreek. Try to include some (or all!) of these in your next meal…

Ask the expert: Faaiza Paruk, dietician
“Some people believe that by taking a supplement they won’t need to exercise or take any medication. 
This is untrue. You need a balanced diet as well as exercise to help control your sugar levels. 
A balanced diet includes five servings of fruit and vegetables a day, a low intake of salt and fat, lean meat and complex carbohydrates found in foods such as brown rice, potatoes, beans and lentils.”