diabetic questions

Questions by diabetics, for diabetics.

The secret to a happy life with diabetes?

From Facebook (Diabetic South Africans):

What’s the secret to a happy life with diabetes?

To not make it an issue. Treat it and forget it. Life is too short.
Louis

Most people suffer some type of illness, but we all have to just deal with it and get on with our lives.
Erika

Sorry to all those optimistic people out there… but there is no happy life with diabetes 🙁
Lisa

Finding the right balance… While diabetes is not a good thing to have, one certainly does still have a happy life. Be informed… and that goes for your spouse and family members too.
Lynnae

Support and understanding from the people closest to you makes it easier to live with.
Adele

Top tips for a pregnancy diet

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.

How to help a poorly controlled diabetic

My dad is a poorly controlled Type 2 diabetic, and he doesn’t seem to care. I keep telling him how serious his condition is and that he has to take care of himself, but he continues eating whatever he likes and says he’s too old to change. What can I do?” Celeste Damen.

Dear Celeste,

It isn’t easy for people to hear that they have diabetes. Diabetes is a condition that cannot be cured: it has to be taken care of every day. People who have diabetes have to make some important changes in their lives, but if the change is forced on them, they may not want to do it.

This is what is probably happening with your dad. He most likely knows exactly how important it is to look after his diabetes, but might still be in denial or angry that this inconvenience has been brought into his life.

The fear you feel for your dad’s condition also projects to him, and he is probably trying to reassure you by giving you excuses that he is too old to change or that the situation is not that serious.

Instead of telling Dad what to do and being cross with him when he doesn’t do the right thing, you need to ask him what changes he is willing and able to make. Then encourage him to follow through on what the two of you have decided.

Diabetes has not only happened to him: it has happened to your whole family. This is something all of you have to accept. It’s a good idea to get the whole family to adopt healthy habits, so that there will be less temptation… Offer your dad help, but try not to be the Diabetes Police.

Good luck!

– Jeannie Berg, Diabetes Educator

 

Yoga and diabetes

Yoga is not only a fantastic form of strengthening exercise, it’s also great for calming the mind – something most of us with diabetes need to do! Bridget McNulty finds out more.

As a diabetic, the one thing I hear over and over is that exercise is good for me. And it is! But sometimes exercise feels a bit too much like… well… hard work. Not so with yoga. I started doing yoga a few months ago and I’m totally hooked – it has just the right balance of strengthening, balancing and heart-racing poses, and I love that we get to meditate after each class. I asked yoga teacher Tasha Saha why she thinks yoga is particularly good for diabetics.

“As well as better fitness and cardiovascular health, yoga massages and stimulates the function of the internal organs, balances the endocrine system and has measurable effects on the release of stress hormones,” she says. “All of these are factors that affect blood sugar, so it’s no surprise that several major studies have shown that regularly doing yoga can significantly reduce blood sugar levels.” Another aspect of yoga that sets it apart from other exercise is that it increases body awareness, which makes it easier to maintain a healthy weight and to make wiser food choices.

But which yoga to choose? In general, hot yoga (Bikram) and flow yoga (Ashtanga) are more demanding, so it’s better to begin with a slower practice like Hatha or Iyengar. Some poses (especially those that are active in the abdominal area and lower back) are particularly good for diabetics because they target the pancreas, promoting better function and helping to lower blood sugar levels. “But a balanced yoga session will work holistically on every system in the body,” says Tasha, “as well as the mind and emotions too – lowering stress levels and helping the whole person towards balance.”

I can honestly say that my yoga practice has helped me feel not only stronger and fitter, but calmer and more able to take on the daily challenges of diabetes.

Want to give it a try? Many yoga studios offer free trial periods or classes to beginners. Most gyms also offer yoga classes at a fraction of the price of private classes.

Find a yoga teacher in your area
Or visit Tasha Saha

Sundowner snacks

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.

When?

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?

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.

Where?

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!

Exercise classes for diabetics

Are you looking for a fun way to get fit? Here are a few exercise classes specifically for people with diabetes – we’ll add to this list as we find more! Please email us with details of other fun fitness classes for diabetics.


Latha Singh: Chatsworth, Durban

I’ve been an exercise instructor for the past 28 years. I teach exercise classes for women and senior citizen groups in and around Chatsworth.

I would love to spread my knowledge and literally hold exercise classes at hospitals (like Chatsmed Garden Life Hospital) and other venues to make people aware of the importance of exercise, especially people with diabetes.

My classes are currently at:

  • Malvern Library (Queensburgh): Monday and Wednesday from 8am to 9am
  • Shallcross Heidi School Hall: Tuesday and Thursday mornings from 8am to 9am
  • Woodhurst Library, Chatsworth: Tuesday and Thursday from 6pm to 7pm
  • Mobeni Heights Temple Hall: Wednesdays from 10am to 11am
  • Woodhurst Library: Thursdays from 11am to 11.30am

Email Latha to find out more.

 

Kayla Murphy: Randburg, Johannesburg

We are a private biokinetics practice in Randburg, Johannesburg. We specialise in youth and adult diabetic exercise classes: Fit for Diabetes (see below PDF for more info).

We are happy to do any free classes or participate in educational talks to get more involved and contribute to the diabetic community of South Africa.

Email Kayla to find out more.

Download (PDF, 1.05MB)

Lessons learnt from a diabetic pregnancy

Sweet Life editor and Type 1 diabetic Bridget McNulty shares her pregnancy story – and what she wishes she’d known before she fell pregnant.

How long have you been diabetic?

I was diagnosed in October 2007… It was a very dramatic diagnosis: I was admitted to ICU for five days and was apparently only three days away from a diabetic coma because my blood sugar was so high.

Did you have to prepare to fall pregnant?

I told my endocrinologist ahead of time that my husband Mark and I were thinking of having a baby, and he gave me the go-ahead because my blood sugar was already well-controlled: my HbA1c results were 7.0 and below for the year before I fell pregnant. I also mentally prepared for the pregnancy, because I knew it would require a lot of discipline and that my diabetes would become even more of a full-time job than it already was!

How did having diabetes affect your pregnancy?

I had to be in extremely tight control throughout – HbA1c results of 6 and below (which I didn’t think was possible before I fell pregnant!) and blood glucose results of 7.8mmol/l or below an hour after eating… Where possible. I also had to test even more frequently than usual (up to 8 times a day). I had HbA1c tests every month and saw my endocrinologist every month, and I couldn’t indulge in pregnancy cravings like eating a whole tub of ice-cream! I had to be very strict with my diet. But it’s amazing how much easier it is to do when your motivation is the health of your baby.

How was the birth experience?

As smooth as I could have hoped for. I chose to have an elective C-section: it was either that or an induction, as all babies born to diabetic moms have to be born at 38 weeks. In the week before the birth my blood pressure started creeping up, and I was retaining a lot of water. Because diabetics are at greater risk of pre-eclampsia, my gynecologist decided to bring the birth forward two days, from the Monday to the Saturday. It was hugely exciting, and hugely nerve-wracking. Arthur, my baby boy, was born totally healthy and weighed in at a (very) healthy 4.5kg. We fell in love with him instantly.

What was it like having a young baby, with diabetes?

It was a real challenge in the early days. Breastfeeding plays havoc with blood sugar control, and causes really persistent lows. Sleep deprivation is tough to deal with, and it’s so overwhelming having a new baby and trying to learn how to be a parent that my diabetes kind of took a back seat for a while. I remembered to inject and test, but that was about it.

What do you think the biggest challenge of a diabetic pregnancy is?

Although 9 months doesn’t seem like that long at first, it feels like a really long time to be non-stop super-disciplined.

What advice would you offer to diabetics who are struggling?

You will feel so much better if you get your blood sugar under control. It is so worth it in terms of health and energy and general happiness to do what it takes to get good control. I know how hard it can be, but the reward is a healthy, happy life with diabetes – and that’s about as good as it gets.

What makes your life sweet?

My two sweet children, my wonderful husband, my awesome family and friends and the sweet life I’m living!

 

Get in touch with Bridget: @sweet_life_mag on Twitter or hello@sweetlifemag.co.za

Reiki and diabetes

Bridget McNulty goes for a reiki session to see what it can do for diabetics.

At first glance, reiki seems a little odd. How can it possibly help to have someone wave their hands over your body? What could this do for diabetes, really? But if you put your doubts aside for a minute, the effects of reiki can be quite profound.

To understand what reiki is, think back to the last time you stood in line at the bank, and someone came up behind you. Even though you couldn’t see the person, you could sense that they were in your space. This space is your energy field, and just like your body, the energy field becomes blocked from physical, emotional and mental experiences. These blockages can cause you to feel ill, or tired, or depressed – they literally block the flow of energy in your body. Reiki helps to unblock the energy field, which in turn unblocks the body.

So what does it feel like? Deeply relaxing. A reiki session generally begins with a conversation about whatever is bothering you, and then moves to the treatment, where you lie down and the healer moves their hands over your body. You’re fully clothed at all times, and while there may be some light pressing of the hands, it’s not a massage. Some people feel heat coming from the healer’s hands, others just feel relaxed and sometimes even sleepy. It is completely non-intrusive and actually very pleasant.

But what can it do for diabetes? That’s what I asked Debbie Caknis, the reiki healer I visited. “Reiki can help people with diabetes as historically it has been known to heal on the physical, emotional and mental levels of the personality,” she explained. “Therefore disease (or dis-ease, because the body is not at ease) is addressed on many different levels.” It’s not only a physical healing – emotionally you can begin healing stuck energy, and mentally you can learn how to cope with the management of the condition in a more positive way. “Reiki helps people to get to know their bodies and be able to respond to ailments in a conscious manner,” says Debbie.

What’s interesting here is the focus not just on the physical side of the condition, but also on the emotional and mental side. As all diabetics know, there’s a lot more to managing diabetes than just taking your medication, eating right and exercise. Reiki helped me to see my emotions around diabetes in a clearer way, and understand why I react the way I do to high and low blood sugar. It also took away a lot of stress, and we all know how badly stress affects blood sugar.

I left the session feeling calmer, more on top of my condition, and with a burst of fresh energy. In short, I was quite amazed what healing hands can do.

Want to give it a try? Go for a reiki session, or do a once-off course that enables you to do your own treatments at home.

Ask the expert: Ruth Scott, psychologist

“While it is easy to feel overwhelmed by all the treatment options out there claiming to ‘heal’ you, many forms of alternative therapy can really help to calm the mind and therefore relax the body. How you feel about your treatment is almost as important as the treatment itself.”

Find a Reiki healer in your area: www.reikihealing.co.za
Or visit Debbie Caknis in Cape Town: www.zeropointhealing.co.za

Climbing Kilimanjaro – with diabetes

It’s the highest mountain in Africa, but that didn’t stop Neil Rae – a Type 1 diabetic for 50 years – from wanting to climb it. We chat to Neil, 63, about his preparation, the climb itself, and life with diabetes.

How long have you been diabetic?

I was diagnosed on the 13th December 1964: over 50 years. I’ve seen a lot of changes for diabetics in my time – there’s a lot more we can eat, the technology to monitor blood sugar levels is a lot more advanced and the insulin pen sets are much more convenient. We’ve come a long way since the gas cylinder with a tin cup that I used to sterilise my glass syringes when I was at university!

What made you decide to climb Kilimanjaro?

I grew up in Lesotho and I’ve always had a love for mountains. I don’t know how many decades ago, I said to myself I wanted to set a goal for my diabetes: to climb Kilimanjaro when I’d lived with it for 50 years. About 18 months ago I contacted Novo Nordisk, the people who manufacture my insulin, to ask if they’d like to partner with me. They were very excited to join the challenge. As you can see it’s been a long-term goal of mine…

What did you do to prepare?

I’ve always been a relatively fit person, and I do a lot of walking with my wife Shaye, in and around the streets of Johannesburg and in the Drakensberg. I was walking between 30 and 40km a week and over weekends doing long walks in Westcliff – they have a flight of 222 stairs built into the rock face, and with a heavy rucksack on your back it’s good training! I did the climb with my doctor, Dr Bruce Ilsely and David Broomfield from Novo Nordisk so as a team we were well prepared.

How did you know what to eat and drink while climbing, and how to balance your blood sugar?

Balancing blood sugar was obviously going to be a challenge – spending between 7 and 8 hours a day climbing up and up and up all the time. It was tricky to balance that amount of exercise with the food supplied by the people who organised the walk – we didn’t take any food with us. Normally my sugar is very well controlled, so the plan was to do very regular checks of my blood sugar levels, see what we were going to be given to eat and then decide how much insulin to take. It turned out that I didn’t eat very much – I became nauseous quite early on, once we were over 3500m.

What was the hardest part of the climb?

The hardest part for me were the ascents and descents because you had to climb up mountains and then down into valleys, and there was a lot of very rocky pathways – walking from rock to rock. Some days we went up and down two or three times in a day. We left Moshi on the Monday and we summited on the Thursday night/Friday morning. Unfortunately I wasn’t able to make the summit – I got up to about 5000m and my altitude sickness was so bad that Dr Bruce said to me, “If you carry on, you’re going to die”. Once I got back down to the base camp at 4600m, then I was fine: it wasn’t diabetes related at all.

What advice would you offer to diabetics who are struggling?

In my opinion, every diabetic who’s struggling has got to develop a lifestyle routine: get up in the morning, check your blood sugar, decide how much insulin you need and what you’re going to eat for the day. You have to have a definite lifestyle routine, and stick to it every day. Discipline is so important to a diabetic. If you don’t have the routine and don’t have the discipline, you’re not going to live with it for 50 years!

What makes your life sweet?

I’m very fortunate: I’m married to a lovely lady and I have two daughters and four grandchildren now. My family, my life and everything in it makes my life very sweet.

Your insulin pump questions, answered

If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.

Meet the expert

Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years

What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.

What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.

What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.

When should someone consider getting an insulin pump?

  • If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
  • If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
  • If they have irregular eating, working and resting times.

Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.

A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.

 

FAQ about the insulin pump from our community:

 

  1. What is an insulin pump?

  • Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
  • The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
  • It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
  • Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
  1. Where do you buy an insulin pump and how much does it cost?

You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.

  1. What are the advantages and disadvantages of using an insulin pump?

Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.

  • Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
  • You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
  • You can participate in sports whenever you feel like it — without having to plan in advance

Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.

Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.

  1. Will my blood sugar control be better if I use an insulin pump?

It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.

  1. Will I still have to test my blood sugar as much?

A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.

  1. Are there insulin pumps that have a Continuous Glucose Meter attached?

Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs

  1. How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?

You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.

  1. At what age can you put a child on the insulin pump and how easy is it for them to adapt?

I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.

  1. What is the risk of infection?

If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.

  1. How much is an insulin pump with and without medical aid?

That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.

Ask the expert: Dr Claudine Lee, GP

“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”

 

10 FAQ about the diabetic diet

Ask the dietician: Cheryl Meyer

We asked our community what they most wanted to know about diabetes and food – here are 10 frequently asked questions, answered by our expert dietician.

  1. Must I cut sugar out of my diet completely?

Small amounts of sugar can be included in your diet, but too much sugar or sweet food is not recommended as part of a healthy eating pattern.

  1. What can I eat when I feel like chocolate?

Treats like chocolate can fit into a healthy diet, as long as you keep these points in mind:

  • Try to have treats with a meal, e.g. as a dessert.
  • Watch your portion size: choose a small portion or share.
  • Put a healthy twist on treats – check out these great recipes for ideas
  1. Do I have to buy special sugar replacements, or can I just use less sugar?

Small amounts of sugar, jam, and honey have little effect on blood glucose levels, so small amounts of sugar can be included in your diet, e.g. a scrape of jam on wholewheat bread.

  1. How important is fibre in a diabetic’s diet?

Fibre keeps your digestive tract working well, can help lower your cholesterol level and can improve blood glucose control if eaten in large amounts. Another benefit of fibre is that it adds bulk to help make you feel full. Given these benefits, fibre is important to include in a diabetic’s daily diet – and in the diets of those who don’t have diabetes!

  1. How many vegetables should I be eating in a day?

The amount of vegetables you need depends on your age, gender and level of physical activity. On average, an adult woman will need 2½ cups a day, while an adult man will need 3 cups, and children will need between 1 to 2 cups a day.

  1. How much protein do I need to balance out carbohydrate?

Protein should account for about 15 to 20% of the total calories you eat each day – roughly a fist-sized portion at each meal.

  1. Is too much fruit bad for diabetics? And grapefruit?

Fruit (any kind, grapefruit included) can be included as part of your diet, but controlling portion size is vital. Limit your portions to a fist-sized or tennis-ball sized portion at a time.

  1. How do I manage food for my diabetic child?

Provide structured, nutritious meals and snacks for your child and make healthy eating and lifestyle changes as a family (don’t single out one family member). Remember that they are a child first and a diabetic second. Work with your child’s diabetes health care team to help your little one grow up healthy and happy!

  1. My sugar is always high – am I eating wrong?

Diabetes is managed with diet, exercise, tablets and/or injections. Check in with your doctor to make sure your food choices, exercise levels and medication are on track to keep your sugar within your target range.

  1. How can a diabetic lose weight in a healthy way?

The best way to lose weight for good is to find an approach to eating that makes sense, doesn’t cut out whole food groups and has you eating regularly and feeling well.

 

Keeping diabetics inspired

We chatted to community inspiration Veronica Vember about how she changes lives, one step at a time.

What got you interested in diabetes at first?

It all started whilst working in the vascular unit at Kingsbury Hospital. I realised that most people are not informed about managing diabetes after being diagnosed. So I became passionate in the control of potential complications, and Kingsbury management identified my passion and allowed me to do the vascular course in London as it’s not offered here. On my return, I did two presentations at the doctors academic meetings. At the time my husband had a myocardial infarction and had been diagnosed with hypertension and diabetes. The entire experience stimulated me to get involved with my community. Now my husband is one of the volunteers. I then started doing motivational talks at schools, groups, on radio and at our nursing college.

How did you start your community group?

I joined the Strandfontein Health Forum and offered to do the diabetes awareness events as there was no project as such. With the awareness held at the Strandfontein Clinic I handed out questionnaires and a suggestion box. The community asked for a diabetic support group: that’s what started it.

What keeps you inspired?

The positive attitude and enthusiasm of the volunteers, and noticing the excitement of the attendees. When we take a break, people want to know when we’ll be starting again. The continuous support of ‘diabetes life’ (a diabetic clinic at Kingsbury hospital) under the management of endocrinologist Dr May, Dr Tracy van Rensburg and nurse educator Sr. Dee Ferguson (my mentor). Positive feedback from the doctors at the day hospitals where the clients attend also keeps me going.

You were voted one of the Western Cape’s Lead SA heroes – how did this make you feel?

Surprised, shocked, emotional, confused and thankful towards the responsible person for the recognition. I’m very proud of the team of dedicated volunteer attendees as I can’t do this alone. It’s a team effort – unity is strength.

What advice do you offer your support group members when they are struggling?

To persevere, not to give up, not to give in, to be compliant, to attend the support group regularly. We do individual counselling and have a communication box available for constructive comments and replies.

How do you make diabetes inspiring?

We create a harmonious atmosphere: a safe environment with easy accessibility, clean, functional equipment and competent staff. We vary programs, presentations, literature, topics and menus (soup in winter and tea and a snack in summer). We also combine our decision making with the volunteers.

What makes your life sweet?

Carrying out our mission, vision and outcome.

S – be sensitive towards all

W – warn people about the consequences of not being compliant

E – educate people regarding a healthy lifestyle and change of mindset

E – be empathetic and empower people with knowledge

T – to be trained, to train others

Outcome:

To ensure that all community members are well informed, and reach and maintain normal glucose levels.

Get in touch with Veronica: Strandfontein Diabetic Support Group on Facebook

Proudly South African portion sizes

Ask the dietician: Cheryl Meyer

From our community: “Can anyone tell me about madumbis for diabetics – good or bad for us, and how much can we eat?” Lynette Hitchcock.

Madumbis, amadumbe, African potato or taro – call them what you will, they are delicious! They have a rich, nutty, earthy flavour and a stickier texture than potatoes. Like potatoes, they fall into the carbohydrate group of foods and can be roasted, mashed or boiled.

The key to eating proudly South African carbohydrates like madumbis, roti, pap or samp in a healthy diabetic diet is portion control! Counting the carbs in your meals and being aware of the carbs you eat can help you match your medication or activity to the food you eat. This can lead to better blood sugar control.

Remember: Everyone needs a different amount of carbohydrate at each meal and/or snack – the amount that is best for you depends on your:

  • age
  • height
  • weight
  • physical activity
  • current blood sugar
  • blood sugar targets

Not sure how many carbs you should be eating? Ask your doctor or dietician for help.

A general guide:
  Carb limits for women Carb limits for men
Meal 30 – 60g 45 – 75g
Snack 15 – 30g 15 – 30g

What does this mean? A food that has 15g carbohydrate is called “one carb serving”. One slice of bread or a small piece of fruit each have around 15g carbohydrate, so they are equal to one carb serving.

One carb portions of Proudly South African foods:

1 carb serving 50g madumbi
1 small roti (35g)
⅓ cup pap (60g)
⅓ cup samp (75g)
½ cup sweet potato (100g)
1 medium mielie (140g )
½ cup rice (50g)
1 x 15cm tortilla or wrap (35g)
½ cup pasta (100g)
1 slice bread (30g)
1 small apple (115g)

As much as possible, try to stick to this portion size, with a serving of protein (meat, fish, chicken, eggs, beans) and half a plate of vegetables or salad.

How to cook amadumbe: Scrub them clean and steam or boil until soft. Drain and cool slightly before removing the skins. Serve dusted with black pepper, a dash of salt and a drizzle of olive oil. Yum!

Amadumbe in numbers:
100g portion boiled amadumbe has: *

  • 600 kJ
  • 5g plant protein
  • 1g fat
  • 5g of carbohydrate
  • 1g fibre

* According to The SA Food Tables

All about insulin

There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.

“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”

For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.

“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”

Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”

Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”

Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.

Are there any benefits to starting insulin sooner?

 

“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”

“Junk” food for diabetics

Ask the dietician: Genevieve Jardine

From our community: “My favourite food isn’t very good for me… I love braais and chips, hamburgers and hot dogs. Is there any way to make these delicious foods better for me? Help!” Thabo Duma.

All of us like a bit of pleasure in life, and nothing beats a treat now and again. The attraction of junk food lies in its “quick fix” ability to satisfy food cravings. Unfortunately, what makes junk food so delicious is also what makes it unhealthy. Junk food tends to be high in kilojoules, bad fats and refined carbohydrates. Because it tastes so good, it’s also hard to stop eating. You may get away with one biscuit, but 4 or 5 will cause a significant increase in blood sugar.

When relaxing with family and friends, you want to be able to enjoy holiday food: take-outs, braais and easy meals. There are definitely ways to enjoy these times without feeling left out – and without packing on the extra kilograms!

Healthy take-out

For take-out options, choose grilled chicken breast or beef hamburgers with salad (no chips!) Or try grilled chicken breast, spicy rice, coleslaw and green salad. Choose water or a diet fizzy drink to go with your meal, and obviously skip the dessert. Try to avoid food that’s high in fat and refined starch and sugar – pizza, deep fried chips and sugary drinks are all a bad idea.

Braai menu

Who said a braai couldn’t be healthy? Bring chicken or beef kebabs and braaied corn on the cob, with carrot salad and green salad on the side. These are a much better choice, and much lower in fat and carbs than boerewors and chops, garlic bread, pap and gravy or white bread rolls. And they’re delicious!

If you’re looking for delicious snacks, here are some yummy diabetic-friendly options:

Snack Portion Energy Carbohydrate (including sugar) Fat
Popcorn (lite) 2 cups popped 636kj 15g* 7g
Dried fruit 2-4 pieces 381kj 21g 0g
Low GI biscuit 1 biscuit (30g) 440kj 15.3g 5.8g
Lean biltong Handful (30g) 346kj 1g 2g

* Remember that one carbohydrate portion = 15g.

Compare those to regular snacks and you’ll see the difference:

Snack Portion Energy Carbohydrate (including sugar) Fat
Chocolate 1 bar (50g) 1120kj 30g 15g
Energy bar 1 bar (40g) 739kj 22g 7g
Biscuits (with icing) 2 biscuits (33g) 676kj 30g 7g
Sweets (boiled) 125g packet 316kj 18g 0g
Potato crisps 1 packet (30g) 766kj 24g 12g