Diabetics ask others with diabetes for advice.
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
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
When someone is newly diagnosed with diabetes, it’s helpful to start with very simple dietary advice as they come to terms with the necessary lifestyle changes. The spectrum of food choices for diabetics involves “good choices” on one end and “bad choices” on the other. In the middle lies ‘moderation’, which can be adapted to the individual depending on personal factors and other conditions like blood pressure or cholesterol.
Here, we’ll break down what good and bad choices look like in each of the food groups – proteins, starches and sugars, vegetables, fruit, fats and oils, and drinks.
Proteins: meat, chicken, fish, eggs and dairy
- Fish more frequently (especially fatty fish like salmon, trout and mackerel)
- Eggs, especially boiled eggs
- Plain yoghurts, milk and cottage cheese
- Plant-based protein options like beans, lentils and chickpeas, instead of meat
- Using chicken that has skin removed (preferably grass-fed)
- Game meat that is very low in fat
- Deep fried meat, chicken and fish
- Very fatty red meats and processed meats
- Diary that has been sweetened, like ice cream
- Imitation cheese and coffee creamers
Starches and sugars
- Unprocessed, high fibre starches like sweet potatoes, rolled oats, brown rice, wild rice, quinoa, buckwheat and barley.
- Items made with wholegrain flour with little or no added sugar such as wholegrain bread, crackers and cereals.
- Any food item that has a lot of sugar added, like sweets, chocolates and biscuits.
- Refined flours that have been processed and bleached white such as white flour, white breads, white crackers, white rice and refined cereals (especially if the cereals have sugar added).
- Deep fried starches such as doughnuts, koeksisters, vetkoek, fried potato chips and crisps.
- Homegrown, fresh or even frozen vegetables with emphasis on lots of different colours. Try to eat a rainbow of vegetables. Eat them raw, juice them, steam them or bake the root vegetables for maximum nutrient retention.
- Fresh herbs and spices like garlic, ginger, turmeric, cinnamon, mint, rosemary and coriander.
- Vegetables that have been boiled
- Vegetables with thick sauces
- Canned vegetables which are higher in salt (for those people who need to watch their salt intake)
- Fresh fruit in season
- Fruits with a naturally lower sugar content, such as berries, apples and citrus
- Fruit juices
- Dried fruit with sugar coating
- Fruit canned in a thick syrup
Fats and oils
- Foods that are naturally high in fats like olives, avocado, nuts and seeds
- Good quality oils such as extra virgin cold pressed olive oil
- Foods that are high in trans fatty acids and hydrogenated vegetable oils (read the food labels to spot these words).
- High quantities of plant seed oils like sunflower and canola oil (usually deep fried products).
- Filtered water flavoured naturally with lemon or mint
- Herbal teas
- Sugary drinks such as sports drinks, fizzy drinks, iced tea, flavoured water.
- Alcoholic beverages that are high in sugar, such as cocktails, dessert wines and fruity mixed drinks.
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: 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: Genevieve Jardine
From the community: “My wife and I love having friends over for sundowners but never know what drinks to offer and what snacks to serve so that I can actually enjoy myself too. Any advice?” Riyaaz Benjamin.
Luckily, there is a way to enjoy (guilt-free) sundowners… It just takes a little planning. Let’s take a look at the when, what and where of it.
The main problem with sundowners lies with the timing. As the name suggests, they usually occur long after lunch and just before supper. This means that you may arrive hungry and tired with low blood sugar levels: a recipe for overeating, drinking (sugary) alcohol on an empty stomach, and filling up on unhealthy snack food. After sundowners, you may then go for supper, which means even more food and alcohol.
The key? Sundowners are best handled when prepared. Make sure you have an afternoon snack just before arriving (preferably one that contains protein to help stabilise blood sugar levels). Upfront, decide to either have the snacks as a replacement dinner (only a good idea if there are healthy snack options) or hold back and leave room for a light supper.
What is being dished up? The good news is that sundowner snacks are usually savoury and not sweet. The bad news is that savoury snacks – like chips and cream dip, sausage rolls and salty peanuts – are often high in starch and fat. Try to choose the healthiest options on the table, and don’t forget to dish up a plate rather than snacking so that you know exactly how much you’re eating.
Sundowners are also synonymous with cocktails (not the right choice of drink for anyone with diabetes!) When it comes to alcohol, good options are light beer, a wine spritzer made with Sprite Zero or soda water, or single spirit tots with diet mixers. Sparkling water with ice, lemon and cucumber is a refreshing drink if you’re not in the mood for alcohol.
Healthy snack ideas:
- Lean proteins like nuts, lean biltong and grilled strips of chicken or beef.
- Fresh vegetables like cucumber strips, baby carrots, baby tomatoes and celery sticks, served with a low-fat cottage cheese, avo or salsa dip.
The last thing to consider is where the sundowners are being held. If you’re hosting or going to a friend’s house, you can simply bring along what you would prefer to eat and drink. Restaurants can be more challenging, but easily overcome with a bit of forward planning. Call the restaurant beforehand and make sure that there are snacks or drinks on hand that you can enjoy. Most restaurants are more than willing to help – if not, at least you know and can plan for the evening.
Having diabetes doesn’t mean you can’t enjoy a cold drink and a delicious snack as the sun goes down, it just means you need to forward plan a little to enjoy it!
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.
I am a diabetic and live in Pretoria.
I have problems controlling my sugar and have to use Metformin 850. My problem is I have no idea when it is high or low.
Where in Pretoria can I find a government diabetic clinic? Currently I am unemployed and every time I go to the government hospital my sugar is 37,5 or around there.
I got a glucose meter from Sister Louise Pywell, but can not afford sticks. I know nothing in life is free. Can you please point me in the right direction? I’m having bad headaches and my left foot starts dragging as the muscle went numb.