Links to other sites that have diabetes information.
Did you know that if you have diabetes and you’re a member of a medical aid, they have to – by law – give you certain benefits for free? Nicole McCreedy explains all you need to know about PMBs.
If you’re a Type 1 or a Type 2 diabetic and you belong to a medical aid, you have the right to certain health services, known as Prescribed Minimum Benefits (PMBs). There are about 300 medical conditions where PMBs apply, and 26 of those are chronic conditions like Type 1 and Type 2 diabetes.
Your health is important
PMBs were introduced to the Medical Schemes Act to protect members. It doesn’t matter how old you are, how healthy you are, or which medical aid option you are on (yes – even hospital plan counts!) Your medical aid has to provide minimum healthcare if you have a chronic condition – at no extra cost. You shouldn’t have to pay extra (over and above your monthly medical aid contribution) for certain medical services for diabetes. Because the government has made this law, it is also impossible for medical aids to charge you more or force you to lose your medical aid cover because you have a serious medical condition.
When you can (and can’t) use PMBs
What does this mean? A medical aid must pay in full, without any co-payment from you, for the diagnosis, treatment and care costs of the PMB condition (your diabetes). The medical aid cannot use your medical savings account or day-to-day benefit to pay for PMBs. Remember, though, that PMBs are subject to pre-authorisation (you have to register your PMB with the medical aid first), protocols (specific treatment and medication guidelines), and making use of designated service providers (hospitals, pharmacies and doctors that they have chosen). So you can’t expect your medical aid to cover the costs of your diabetes care unless you play by their rules, and you may not be able to get the same doctors and medicine as you had before.
Sometimes, members will not have cover for PMBs from their medical aid. This can happen if you join a medical aid for the first time (without switching from another medical aid) or if you join a new medical aid more than 90 days after leaving the previous one. If this is the case, there is a waiting period, during which you won’t have access to the PMBs for any pre-existing condition for 12 months.
Diabetes treatment and PMBs
The treatment of diabetes focuses on the control of blood sugar levels. Treatment involves all aspects of your lifestyle, especially nutrition and exercise, but most people with diabetes also use medicine (usually insulin) at some point. Treatment of other risk factors, like blood pressure and high cholesterol, is also very important.
Both Type 1 and Type 2 diabetes qualify as PMBs and must be treated according to PMB regulations for diagnosis, medical management and medication. You can ask your medical aid about the following treatments that should be covered:
- Visits to your doctor (GP or specialist – if authorised).
- Dietary and disease education.
- Annual eye exam for retinopathy.
- Annual comprehensive foot exam.
- Blood tests every 3 to 6 months.
- Disease identification card or disc.
- Home blood sugar testing.
How to get your Prescribed Minimum Benefits:
Step 1: Register
Phone your medical aid and tell them you want pre-authorisation for diabetes PMBs. They will ask for a code that your doctor will be able to give you. It is very important that you have the right ICD-10 code – this gives the right information about your condition and helps the medical aid to know what benefits you are allowed. A PMB condition can only be identified by the correct ICD-10 codes. If you give the wrong ICD-10 code, your PMB services might be paid from the wrong benefit (like your medical savings account), or it might not be paid at all if your day-to-day or hospital benefit limits have run out.
Step 2: Your service will be pre-authorised
After you have registered your chronic condition for PMB, your benefits will be authorised and you can ask for your PMB schedule, which tells you exactly what you get for free.
The A to Z of PMBs
Chronic Diseases List (CDL)
A list of the 26 conditions (including diabetes) that qualify for PMBs.
Medicine used for the long-term treatment (three months or longer) of a chronic condition. The chronic medicine must be used to prevent or treat a serious medical condition, to sustain life and to delay the progress of a disease. It must also be the accepted treatment according to treatment guidelines (protocols).
The difference between the cover provided by the medical aid and the cost of the medical service – payable directly to the service provider.
Designated Service Provider (DSP)
Doctors and other health care providers who have been chosen by the aid to “provide its members diagnosis, treatment and care” for PMB conditions.
Emergency Medical Condition
A medical condition that needs immediate medical or surgical treatment.
An official list of the medication that can be prescribed for the treatment of the 26 conditions on the Chronic Diseases List (CDL).
An international clinical code that describes a disease diagnosis. If you want to qualify for PMBs, you must be sure your doctor puts the correct ICD-10 code on all your forms.
Medicine for the treatment of the 26 conditions on the Chronic Diseases List (CDL) qualifies for PMBs, as long as you provide all the necessary information. This can be anything from a diagnosis by a specialist to results of certain tests – your medical aid will tell you what you need.
Prescribed Minimum Benefits (PMBs)
The minimum benefits that must be provided to all medical aid members. These include diagnosis, treatment and care costs for a number of conditions, including diabetes.
Protocols (Treatment Guidelines)
There is a minimum standard treatment for each PMB condition. Medical aids use these guidelines to come up with protocols (treatment guidelines) and formularies (lists of approved medication) to manage PMBs.
This article was reviewed by:
- Alain Peddle, Discovery Health
- Herman van Zyl, Principal financial advisor, HVZ Financial Consultants
- Rossouw van Zyl, Brokers, t/a Medinet, Authorised Financial Service Provider
- Michael A.J. Brown, Accredited Diabetes Educator, Centre for Diabetes and Endocrinology, Houghton
Recent research suggests that a certain kind of surgery may “cure” Type 2 diabetes. We find out more, and give you the facts.
One of the experts in the field of gastric bypass surgery is Professor Tess van der Merwe, the president of the South African Society for Obesity and Metabolism, who have been sharing information about the surgery. We found out what it could mean for Type 2 diabetes, then asked our experts to weigh in on the topic.
Is this surgery a cure for Type 2 diabetes?
Gastric bypass surgery has been used to help obese people lose weight since it was first performed 20 years ago. But now there is new research that this same surgery (specifically a type called “laparoscopic Roux–en–Y gastric bypass”) could cause Type 2 diabetes to go into long-term remission. What does this mean? Type 2 diabetes could be “paused” for a number of years. An international study shows that about 90% of obese patients with Type 2 diabetes who go for this surgery have normal blood sugar and no evidence of diabetes for three to fifteen years.
Is it a cure? No. But it is possibly a very long break from a chronic condition.
Some might say that any surgery that causes very overweight people to lose weight will have a good effect on blood sugar, but experts say the difference can be seen before the weight is lost. Professor Francesco Rubino (a leader in surgery for Type 2 diabetes) was in Johannesburg for the 3rd Centres for Metabolic Medicine and Surgery Workshop. He said that a few days after a gastric bypass, patients with Type 2 diabetes show normal blood sugar levels, even before any weight has been lost.
Ask the expert: Dr. Joel Dave, endocrinologist
“Bariatric surgery is becoming an important part of the treatment of diabetic patients with a BMI over 35. But although the results with this surgery are very good, it is still an invasive procedure with potential complications. It should not be considered a shortcut to weight loss and diabetes improvement, but a last resort after a low calorie diet and structured exercise programme has failed.”
What if the Type 2 diabetic ate badly and didn’t exercise, and returns to this same lifestyle – will the surgery still work?
The surgery doesn’t just help the patient by making their stomach smaller. It also triggers changes to the hormones, the appetite and the metabolism, so that long-term change is possible. But it is not a magical cure – the patient has to be ready to make changes to their diet and exercise. As Prof. van der Merwe points out, “There is not a single treatment in medicine that will be immune to an uncooperative patient.” In other words, if the patient goes back to a diet of fast food and no exercise, the same problems will return. One of the ways they guard against this in the Centres of Excellence (where they do the surgery) is by coaching the patient to start new, positive habits. They have a team of experts to help with this.
Ask the expert: Genevieve Jardine, dietician
“It is my opinion that gastric bypass surgery may be a good option for those who have a high BMI (above 35) and have tried for many years to lose weight. If they are managed well after surgery and take this opportunity to start over, it could mean a second chance at health. It is important to remember, though, that it still comes down to diet and exercise. Lifelong lifestyle changes are still the foundation of good diabetes management.”
How extreme is the surgery?
The surgery is minimally invasive. It is also known as laparoscopic surgery, keyhole surgery or bandaid surgery because the cuts made are so small – on average 0.5 to 1.5 cm. The doctor uses images on TV screens to magnify the surgery so they can see what they need to do.
Ask the expert: Dr. Joel Dave, endocrinologist
“Although the procedure is minimally invasive there are still some potentially serious complications. The patient’s decision to have this surgery must not be taken lightly.”
Is the surgery covered by medical aids?
That depends on how urgently you need it. In order to work that out, doctors look at your BMI (Body Mass Index), which outlines whether you are underweight, at a healthy weight, or overweight (see the box on this page). Diabetic patients with a BMI over 35 may be able to get the surgery covered if they have a motivation letter from a Metabolic Centre for Excellence, and if they are on the right medical aid option. There is usually a 20 to 30% co-payment that the patient would have to pay.
Have there been any local studies?
A South African study based at Netcare Waterfall City Hospital tracked 820 patients who had not been able to lose weight for up to 18 years before they had surgery. Three years later, 88.5% of the patients who had diabetes at the time of the surgery still had normal blood sugar levels.
Is there anyone it won’t work on?
This surgery is only an option for Type 2 diabetics who are very overweight – with a BMI greater than 35. They are doing research on lower BMI’s as well.
Want to find out more?
How to work out your BMI
There are many websites (http://www.smartbmicalculator.com/) that calculate BMI for you, but if you want to do it yourself, here’s what you need:
- Your weight.
- Your height in metres.
- A piece of paper and a calculator!
First, find out the square of your height in metres (your height times your height, i.e. 1,5m x 1,5m).
Then do this sum: (Weight in kg) divided by (square of height in metres)
You should get a number between 18.5 and 40.
- Less than 18.5 means you are underweight.
- 18.5 to 25 means you are at a healthy weight.
- 25 to 30 means you are slightly overweight.
- More than 30 means you are very overweight (obese).
From Facebook (Diabetic South Africans):
Belinda wants to know if there are any parents of Type 1 diabetic kids out there… Want to share advice?
Some advice: the treatment of diabetes is not a perfect science. What works for one person may not work for the next. You need to make notes of what works for your child. This will take much of the guess work out of controlling your child’s blood sugar.
Allow your kids to have a say and let them see the effects. Never wrap them in cottonwool! Let them live, learn and experiment!
Hi. I’m also new to this. My little girl was diagnosed in May. She’s 2 and a half. Very scary and completely heart breaking often.
Hi Belinda – join Kids Powered by Insulin if you haven’t yet. You’ll get good advice and support there. My son is 15 – diagnosed when he was 13. A good endo and educator, healthy diet and an understanding of how much insulin is needed and how each insulin works has helped us a lot so far. Take care x
Hi there my daughter is 3 years old and Type 1 diabetic, she was diagnosed last year two weeks before her 2nd birthday.
Belinda there are LOTS of us – join the Facebook group Kids Powered by Insulin.
Never tell them they can’t do something because of diabetes. As a child, I was told that I can’t do many things because of my diabetes – I missed out on a lot.
My daughter is 9 years old now and was diagnosed when she was 4. I would love to help anyone who has had to endure diagnosis – it was 3 months of pure hell and would have loved a shoulder to cry on or some tips to help.
Thank you everybody for the reply. I am feeling much better that there are so many parents that are prepared to give me advice!
Ask the dietician: Genevieve Jardine
From the community: “Every year I hold a National Heritage Day feast for my friends and serve up all the South African classics: boerewors rolls, koeksisters, samoosas, shisa nyama and curry. This year I have a diabetic friend coming and don’t want him to feel left out. How do I make the feast more diabetes-friendly?” Nashikta Singh
National Heritage Day is about celebrating the mixed flavours of South Africa, and there’s no better way to do this than by showing off our traditional dishes. Coming together around the braai or dining room table lets us share our past and create our future.
Traditional South African dishes have a lot of flavour and nutrition. Many of the classic dishes are naturally diabetes-friendly, while others may require some simple changes.
Made with onions, tomatoes, carrots, chillis, garlic, cabbage and cauliflower. It is packed with nutrients, fibre and flavour.
Tip: Don’t use too much oil while making chakalaka.
Mielie meal is a starch, so it will affect blood sugar. For better blood glucose control, you can cook it the night before and then reheat it on the day. This lowers the GI (glycemic index) of the pap.
Tip: Mix pap with cooked beans to further reduce the GI.
Use lean cuts of meat and fill the pot with a wide variety of vegetables. This method of cooking keeps the nutrients locked in the sauce.
Tip: Add plenty of non-starchy vegetables like baby marrows and green beans.
Curry and bobotie
The beauty of Indian cooking is all the herbs and spices. Garlic, onion, fresh chilli, turmeric, coriander and clove are all great for your health. Try to use lean cuts of meat (extra lean mince) and serve with small portions of brown basmati rice and vegetables.
Tip: Bean or lentil curry make an excellent starch alternative.
Shisa nyama or braai
Traditionally, braai meat is fatty (brisket, boerewors, chicken wings) and served chargrilled. Try to use leaner cuts of meat like skinless chicken or sirloin, with different marinades to keep the meat tender. Don’t only think meat when it comes to a braai: mielies, butternut, sweet potatoes and madumbes are also delicious.
Some traditional foods, like lean biltong or air-fried samoosas, can be altered to make them healthier. But when it comes to things like vetkoek and koeksisters, there’s not much you can do!
Ask the dietician: Cheryl Meyer
From our community: “Sometimes it feels like I’m constantly trying to juggle what I want to eat and what I should be eating. Are there certain foods I must include in my diet because I’m diabetic?” Gracie Monaheng
The term “superfood” has become very popular in the language of food and health. We know that Mother Nature offers a wonderful selection of healthy foods, but research has yet to prove any of them magical. No single food, no matter how “super,” can take the place of the important combination of nutrients from a diet based on a variety of nutritious foods, including plenty of fruits and vegetables.
Some tests to help you decide whether a certain food is worth trying:
- How does it taste? No food is worth eating if it doesn’t taste good. There are plenty of options to choose from that offer both health benefits and flavour.
- Where was it grown? Has it had to travel long distances from where it was grown to where it was sold?
- How much does it cost? Has its “super” title brought with it a “super” price tag?
- Has it been researched? Check with your healthcare team.
- What value does it add to my overall diet? Variety is an important measure of diet quality, but bear in mind that adding variety doesn’t necessarily mean trying wildly new things: even just a slight change can wake up your taste buds.
Think positive when planning your diet — focusing on foods to add, rather than avoid. Aim to include*:
- Omega-3 rich foods: like salmon, mackerel, pilchards, tuna, canola oil, flaxseed oil, flaxseeds and walnuts.
- Leafy green vegetables: like spinach, kale, lettuce and bok choi. These powerhouse foods are low in kilojoules and total carbohydrate.
- Wholegrains: easily trump their paler, refined counterparts. Choose brown or wholewheat options for a source of protein, fibre and B vitamins.
- Berries: sweet, yet low in calories and packed with antioxidants, vitamins and fibre.
- Nuts: plenty of flavour, very versatile and with a good dose of fibre and selenium. Although they are high in fat and calories, a few nuts go a long way to adding taste to all kinds of meals.
- Legumes: delicious, low in fat, high in fibre and rich in protein.
*As with all foods, you need to work these into your individual meal plan in appropriate portions.
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
Ask the dietician: Genevieve Jardine
From our community: “As the mom of a diabetic child, I’m constantly wondering what to make her that is delicious but won’t spike her blood sugar. Could you give me some basic guidelines please?” Bernadette Simons.
As a mother of three (constantly hungry) young boys I am kept on my toes when it comes to healthy eating. Although my children are not diabetic, I practice “diabetes-friendly” eating in my household. The bottom line is that you want your children to eat real, whole foods. This means no foods that are manufactured, processed and refined: time for a cupboard clear-out!
For children with diabetes, you need to make meals novel, colourful and exciting, while reducing refined carbohydrates and harmful fats. It’s important to break away from the rut of cereal for breakfast, sandwich for lunch and one-pot meal for dinner. Parents need to constantly focus on increasing fresh foods and not wait for dinner to try and make up the daily vegetable intake…
Here are some menu options:
- Bring back eggs for breakfast! Make eggs more interesting and nutritious by adding vegetables and baking in a muffin tray as mini crustless quiches. Serve with chopped strawberries or other brightly coloured fruit.
- Try making your own cereal out of nuts and seeds, coconut shavings and some rolled oats. This can be eaten with plain yoghurt or milk. Use vanilla, cinnamon and half a grated apple to sweeten it naturally.
- Move away from a daily sandwich for lunch. Try choosing other low GI starch like baby potatoes or corn on the cob.
- Add some protein – chicken drumsticks, hard-boiled eggs, meatballs, homemade fish cakes or cheese. Remember protein makes you feel fuller for longer and doesn’t spike blood sugar levels.
- Add a small amount of colourful fruit like a fruit kebab or fruit salad.
- All lunchboxes should have vegetables! If your child doesn’t like salad, give some cucumber and carrot sticks, baby tomato kebabs or cucumber sandwiches (two slices of cucumber with cheese or cream cheese in the middle).
- Most traditional South African dinners are one-pot meals like curry, stew, cottage pie or spaghetti bolognaise that are high in starch and low in vegetables. Try adding more vegetables to stew, curries and mince. Make the mashed potatoes with added cauliflower, add lentils to brown rice, and use baby marrow or aubergine instead of pasta.
- Always serve dinner with vegetables on the side. Raw carrot sticks, sliced cucumber or snap peas are kid-friendly. Children need to get used to eating vegetables that are not hidden in food but out in plain sight!
Remember: Children learn eating habits from their parents so you need to set the example. Tastebuds are influenced early on by processed foods with hidden sugars and fats, so it’s up to you to encourage your kids to eat – and love – real food.
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!