Sweet Life magazine

Posts about Sweet Life, a South African diabetes lifestyle magazine.

Ice skating with diabetes

Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.

Who did you skate for?

I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.

How long have you been diabetic?

I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.

Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?

I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.

What do you love about ice skating?

I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.

What do you think the biggest challenge of living with diabetes is?

The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.

What advice would you offer to diabetics who are struggling?

Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.

What makes your life sweet?

Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.

Get in touch with Rachel: ray.durban@gmail.com  

Diabetes in the community

We ask Dr. Tracey Naledi, the Chief Director of Health Programmes for the Western Cape Department of Health, to share her personal health tips and what the Department of Health has to offer diabetics who want to live a healthy, happy life with diabetes.

What does the Department of Health offer those with diabetes?

We focus a lot on prevention: diabetes prevention is so important. People need to be aware of the risk factors that lead to diabetes before we even start talking about the condition, so we highlight the dangers of a poor diet and being overweight, lack of physical activity, drinking too much and smoking. But this isn’t only the role of the Department of Health – it’s also important for individuals to understand what the risk factors are and to prevent them from happening in the first place.

We also screen people so that we can pick up those with early signs of diabetes, and provide proper diagnosis and treatment. If a doctor suspects you might be diabetic, it kicks in a whole process within our health facilities. But we also proactively do campaigns in community-based settings like malls, where we go out and invite people to test for hypertension, diabetes, cholesterol and HIV, and give them information on these conditions.

Do you believe community is important when living with a chronic condition?

Absolutely – I think community is important when you’re dealing with anything that government does. Government is something that works for the people: it is put there by the people to do things on behalf of the people, but at all times we need to be consulting with the people to be sure the things we’re coming up with are what they want. We have to make sure the way we’re doing things is what the community needs. That’s why we have processes to consult with community members, health facility boards and health committees, so that any problems can be discussed. Being close to the community is very important to us.

Why is diabetes a priority in South Africa?

Chronic diseases in general are a priority, because they affect so many people and are such a huge burden of disease. You also can’t just pop a pill for a chronic condition to go away: you need to treat it for the rest of your life. We have to make sure we have the capacity to deal with all these chronic diseases for a very long time. It’s a long term, lifelong thing. And the consequences of uncontrolled diabetes are actually quite serious.

What makes your life sweet?

God and my family. At the end of the day, when all is said and done, the most important thing to me is my family. My work one day will end, all the money in the world will disappear, all the material things will be gone, but there’s nothing I love more than coming home.

Fun festive food

Ask the dietician: Genevieve Jardine

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

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

Watch your weight

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

Treat yourself

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

Get active

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

Re-gift the chocolates

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

Plan ahead

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

Watch the alcohol

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

Party tricks

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

 

Photo by Brooke Lark on Unsplash

Making diabetes delicious

It might seem as though being a restaurant chef would be too tempting a job for a Type 1 diabetic, but 30-year-old Vanessa Marx has made an art out of making healthy food delicious – and accessible.

When did you find out you were diabetic?

I was about sixteen and in high school – seriously bad timing! I had all the usual symptoms. I was drinking about four litres of water a day and falling asleep during class because I was so exhausted. My mom eventually suspected diabetes and I had to be hospitalised. It was a traumatic experience. I’ve always loved food, and I remember lying in my hospital bed naming all the foods I could never eat again… It was a long list!

How has diabetes changed your daily life?

That’s a hard question, because it’s so much a part of my daily life. It can be difficult, sometimes, explaining to people who don’t have diabetes how you’re feeling. If I wake up with low blood sugar, for example, I’m exhausted before the day begins. People understand a throat infection, but they often don’t understand what waking up low feels like. As a head chef, I need to be alert every day, taking charge of the kitchen. There’s no room in a busy kitchen for feeling tired or unwell because of high blood sugar or needing time out to have something sweet because of low blood sugar.

Isn’t it difficult to be around food all day? How do you resist sweet treats?

It is quite tricky! Often just the act of making sweet treats for someone else satisfies the urge for me but other times I’m pretty tempted: what puts me off is that I know how I’ll feel later. I do believe in “everything in moderation”, so I allow myself a treat now and then. As long as it’s a once-off, and I’m not doing it every five minutes!

What advice would you offer to other diabetics?

Be disciplined! Pay attention to your diet: what you eat plays a huge role in how you feel. Also don’t feel like you’re on your own, don’t be afraid to ask for help – talk about your diabetes, and explain to those around you what it feels like. There’s still a stigma around diabetes, that it’s only people with weight problems who are diabetic. But the only way we’re going to change that is by talking about it.

What makes your life sweet?

My family and friends, and my work.

Get in touch with Vanessa: @vanessajaynem on Twitter and Instagram

The stigma of diabetes

Children with diabetes often experience stigma. Carine Visagie explains how to make life easier for your child.

When Njabulo Dlamini was diagnosed with diabetes at the age of 16, he didn’t reveal his diagnosis to his friends. Fear of being called a drug addict, and standing out from the crowd, made him keep it a secret until the age of 19.

After he met Jenny Russell from Diabetes South Africa’s Durban branch, this young man (also an Idols star) started using his experience to break down some of the myths about the condition. But many other children with diabetes still have to deal with rejection and ridicule – so much so that their mental and physical health suffers.

Is there something that can be done to eliminate this social side effect of diabetes? We asked the experts.

Don’t make a fuss

When parents, teachers and other role models make a diabetes diagnosis and the day-to-day management a simple part of life, other children are more likely to accept this model as the norm. “Children don’t usually have preconceived prejudices, and they tend to follow models of behaviour set out for them,” says paediatric endocrinologist Dr Michelle Carrihill. “There’s no reason for children with diabetes to feel stigmatised if everyone is shown the right way to behave.”

Parents have a special role to play in this process, which starts with giving school staff and classmates the correct info. The more informed others are, the less likely it is that they’ll treat the child with diabetes differently.

Not sure where to start? Here are some guidelines*.

How you can help:

  1. Learn as much as possible about your child’s condition and do a simple presentation to teachers and classmates explaining what diabetes is, and what blood glucose testing and insulin injections involve. This moves the kids’ response away from fear and suspicion towards acceptance.
  2. Provide teachers with written information about your child’s needs. Include:
  • A care plan for your child’s routine school day.
  • A plan for days when the routine isn’t followed (for example, during outings).
  • Signs and symptoms that could indicate a problem.
  • What to do in an emergency, including all necessary contact information.

Make these plans with the teachers’ input, so that their roles are clear and accepted. A diabetes educator, dietician or diabetes specialist nurse can assist.

  1. Explain to teachers that blood glucose testing, additional trips to the bathroom and eating extra carbohydrates may sometimes be necessary. No big deal should be made of this.
  2. Explain that your child can exercise and also take part in outings, just like the other kids: there’s no need to treat them differently.
  3. Some kids are okay to inject in front of friends, while others are not. Ask the school to provide an area where your child will feel comfortable to test and inject. This could be the corner of a classroom or the nurse’s office, as long as the space is clean and quiet. They shouldn’t have to resort to the school bathroom.
  4. Ask teachers to provide positive support and encouragement, especially if your child seems anxious. Also ensure that a staff member is always available to them, so that they know who to ask for help.

* From Dr Carrihill, Jenny Russell and diabetes educator Kate Bristow.

Remember:
Your child should always have their medical info and emergency contact details on hand: an ICE band or MedicAlert bracelet will do the trick. Find out more at www.medicalert.co.za

Backpack checklist:
Make sure your child’s backpack always has:
– Testing equipment (a glucose monitor, lancets and strips).
– Insulin in a small cooler bag.
– A quick-acting sugary food or drink (like Super Cs).
– A glucagon emergency kit for severely low blood sugar emergencies: be sure to show teachers and older friends how to use it!

Join the community: Does your child have diabetes? Come and talk to us about it at www.facebook.com/DiabeticSouthAfricans

 

New IDF Diabetes Atlas

Every two years, the International Diabetes Federation (IDF) publishes a Diabetes Atlas, with estimates of diabetes facts and figures from around the world. The 8th Diabetes Atlas is now live – take a look! Here’s more information about it.

To mark World Diabetes Day, the International Diabetes Federation (IDF) released new estimates on the prevalence of diabetes around the world, indicating that 1 in 11 adults are currently living with diabetes, 10 million more than in 2015.

Data published in the 8th edition of the IDF Diabetes Atlas confirms that diabetes is one of the largest global health emergencies. More action is required at the national level to reduce the economic and social burden that it causes.

Type 2 diabetes
Diabetes, which is associated with a number of debilitating complications affecting the eyes, heart, kidneys, nerves and feet, is set to affect almost 700 million people by 2045. Over 350 million adults are currently at high risk of developing type 2 diabetes, the most prevalent form of the disease. One in two adults with diabetes remain undiagnosed, emphasizing the importance of screening and early diagnosis.  Two-thirds of adults with diabetes are of working age and 8 million more adults living with diabetes are over 65 years old.

“Diabetes causes devastating personal suffering and drives families into poverty,” said Dr. Nam Cho, IDF President-Elect and Chair of the IDF Diabetes Atlas committee. “There is urgency for more collective, multi-sectoral action to improve diabetes outcomes and reduce the global burden of diabetes. If we do not act in time to prevent type 2 diabetes and improve management of all types of diabetes, we place the livelihood of future generations at risk.”

Diabetes and women
Diabetes has a disproportionate impact on women, the focus of IDF and its affiliated members in over 160 countries this World Diabetes Day.  Over 200 million women are currently living with diabetes and many face multiple barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care, particularly in developing countries. Women with diabetes are more likely to be poor and have less resources, face discrimination and have to survive in hostile social environments. Diabetes is also a serious and neglected threat to the health of mother and child, affecting one in six births and linked to complications during and after delivery.

“Women and girls are key agents in the adoption of healthy lifestyles to prevent the further rise of diabetes and so it is important that they are given affordable and equitable access to the medicines, technologies, education and information they require to achieve optimal diabetes outcomes and strengthen their capacity to promote healthy behaviours,” said Dr. Shaukat Sadikot, IDF President.

Urgent action needed
IDF welcomes all the international commitments on diabetes that have been made over the last few years and acknowledges that some advances have taken place. However, it is clear that urgent action is still required to achieve the targets agreed by UN member states in 2013 and 2015. These include a 0% increase in diabetes and obesity prevalence; 80% access to essential medicines and devices by 2025; and a 30% reduction in premature mortality from NCDs by 2030. To this end, IDF has launched a call to action for the 2018 High Level Meeting on NCDs, calling on governments to renew their commitments and increase their efforts towards achieving the agreed targets.

“IDF is calling for all nations affected by the diabetes pandemic to work towards the full implementation of the commitments that have been made. We have both the knowledge and the expertise to create a brighter future for generations to come,” said Dr Sadikot.

Candy Tsamandebele: living with Type 2 diabetes

Indigenous Afro-Soul artist Candy Tsamandebele talks to us about living with Type 2 diabetes.

When did you find out you had Type 2 diabetes?

After the death of my son through an accident. It was unexpected to say the least.

Was it a shock?

Yes it was.

How did you have to adapt your lifestyle?

I started with what I ate and drank. It was difficult at first, but with time I got used to it.  Secondly, my lifestyle all together.

How do you balance a busy lifestyle with eating well and exercise?

Sticking to a strict diet. Also understanding the consequences of ignoring that diet.

What advice would you offer to those living with diabetes?

Just take it one step at a time. Take your medications on time and eat healthy.

What makes your life sweet?

Music. It really does.

Some background on Candy and her outreach work:

August 2, 2011 was one of Candy Tsamandebele’s most trying times in her life when she lost her son in a car accident. Six months later she was diagnosed with Type 2 diabetes. Not one to be kept down, two years after the trauma, Candy garnered strength to launch CANDY TSAMANDEBELE FOUNDATION. She uses the foundation to teach young women and the youth in general about values and it is her vehicle to drive and leave behind a legacy as she continues to grow in the music industry.

The main aim of the Candy Tsamandebele Foundation was to teach kids about music, the importance of culture, significance of language, youth development, medical assistance, helping with school uniforms to needy, and several other initiatives that are close to her heart.

Every year Candy Tsamandebele dedicates her time to carry out community building initiatives such as visiting schools and donating school uniforms, as well as motivating the youth both in and out of school. She encourages young people to use their natural abilities and talents to make it through life. During her motivations, she always talks about the importance of getting tested for diabetes and other chronic conditions and adhering to taking treatment once diagnosed.

Since she was diagnosed with diabetes, Candy Tsamandebele has made it her mission to be a national diabetes warrior. She is a force to be reckoned with and she will stop at nothing for as long as she is needed to make a difference.

Find out more at www.candytsamandebelesa.com

A happy life with diabetes

If you met Shiara Pillay, a happy, healthy and confident 21-year-old who loves Art and is studying International Relations and Diplomacy, you wouldn’t guess that she had a chronic condition. But Shiara is a Type 1 diabetic. She just doesn’t let it get her down.

When did you find out you were diabetic?

When I was in Grade 4 and just about to turn 10. It wasn’t too horrible a diagnosis in comparison to some – my parents noticed that I was losing an extreme amount of weight, I was very dehydrated and waking up in the night to pee – all the classic symptoms.

Then one morning I threw up and they took me to the doctor. I was in hospital for a week and since then I’ve figured out how to live as normal a life as possible with diabetes. The hardest thing to get used to was not being able to eat sweets!

How has diabetes changed your daily life?

I think I’m obviously way more healthy than I would have been because I have to watch what I eat. I have a great diabetes team, and they’ve helped me to adjust my medication and my meals whenever I need to. I like the idea of being able to eat everything in moderation.

How does it help to have a community of fellow diabetics?

It helps to know that there are others in the same situation, it reminds you that you’re not alone. Youth With Diabetes really helped me to meet other people who have to think about the same things every day. I also think diabetes education is so important – new diabetics especially need to know what helps and what doesn’t, what you can eat, how you should exercise, how you feel when you’re low or high. It’s nice for me to share my experiences too. I do have bad days, it’s annoying to have to inject every day, but it’s just something you have to make the best of.

What advice would you offer to other diabetics?

Just do it – you can’t get out of it. If you look after yourself, it’ll be better for you in the long run, it’s for your benefit. And it makes you healthier too!

What makes your life sweet?

Just being happy – when things are going well and the sun is shining!

Get in touch with Shiara: shiaraismyname@gmail.com or join the YWD Facebook page: www.facebook.com/YouthWithDiabetes

 

Extreme sport and diabetes

Richard English has Type 1 diabetes – but that hasn’t stopped him from embarking on all kinds of adventures, including a seven day, 1000km cycle across England and Scotland. We ask him for his secrets to a healthy life with diabetes.

When did you find out you were diabetic?

Eight years ago, when I was 25. I had been feeling incredibly under the weather and stressed, but I blamed work and too much partying – I just thought I was run down. Then I started getting all the symptoms: extreme thirst, dramatic weight loss, drinking 2 litres of water a night and needing to pee every hour.

How has diabetes changed your daily life?

Obviously I have to inject insulin before I eat anything, and I test my blood sugar more or less before every meal. Exercise is also more of a need than a want – I always used to exercise, but now I can see the effect on my blood sugar results, immediately. That’s very motivating.

I went cold turkey on a lot of things when I was diagnosed, and I haven’t kept any bad habits. I’m 20kg lighter than I used to be, and I don’t over-indulge any more. I suppose, in my case, diabetes could be seen as a positive thing. I wasn’t living a healthy life before I was diagnosed, and I have a better quality of life now.

I don’t think I could have adapted so well to life with diabetes if it weren’t for my wife, Casey. She never left my side, and all the dietary changes I adopted she did too. She also helped a lot in the early stages, when there was just too much information for me to absorb. She got behind the science of it and now knows more about low GI and its effect on blood sugar than I do!

Have you always been a cyclist?

I got my first bike when I was 5 years old, and I’ve almost always had a bike. Cycling is a big part of my life, and I really love it. I stopped exercising for about 6 months after my diagnosis, because I was uncertain about what it would do to my blood sugar, and every so often I have to cut a ride short because I’m going low. But most of the time diabetes doesn’t get in the way of my cycling at all.

Can you tell us about the Ubunye Challenge?

The Ubunye Challenge is a triathlon event organised by an old Rhodes friend of mine, Cameron Bellamy in 2012. He decided to raise funds for the Angus Gillis Foundation by doing an extreme cycle, swim and rowing challenge. I joined him for the cycle – I rode for seven consecutive days and covered 1000km through howling gales, rain, sleet and snow. It was in April, which was supposed to be spring, but it was shockingly cold. By the third day, we outran the weather and I saw my shadow for the first time. That was a good moment! 1000km seems like an unbelievable distance, but if you do it in 120km chunks it’s not that bad.

What advice would you offer to other diabetics?

To me, the most important thing is that you have to stay positive and optimistic, because diabetes is not going to go away. As soon as you can smile at it and look it in the eye, you’re on your way to living a happy life with diabetes. The sooner you can get positive about it, the better.

What makes your life sweet?

My wife Casey, my wonderful son Robbie, weekends with friends, good food, my bike, and exploring my new home city of London.

Get in touch with Richard: molorich@gmail.com

Diabetes breakthroughs

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

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

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

Glucose-monitoring devices

 

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

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

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

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

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


Insulin pumps

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

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

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

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


Bionic pancreas


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

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

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

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

What about now? Smartphone apps for diabetes

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

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

South Africa’s most (and least) obese city

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

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

A few interesting (and terrifying) facts:

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

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

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

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

The results

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

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

Weight status

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

Fruit and vegetables

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

Salt

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

Sugar

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

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

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

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

The challenge of gestational diabetes

Celeste Smith is no stranger to gestational diabetes: she’s had it twice, including during her pregnancy with now-five-year-old twins Connor and Adam. We find out what she wishes she’d known before she fell pregnant.

Is there a reason you’re so happy to share this very personal story?

I want to educate, encourage and motivate women with gestational diabetes, and prevent other women from having to go through what I and many others had to endure.

How did you find out you had gestational diabetes?

My first pregnancy was stillborn: Noah was born at 38 weeks. I didn’t know I had gestational diabetes until after Noah was born. We suspected with my family having diabetes that I could get it, but my doctor at the time never picked it up. When I wanted to fall pregnant again, my new doctor Dr Jansen immediately tested for glucose tolerance before I fell pregnant, and then again after I fell pregnant. That’s how we found out I had gestational diabetes again.

What were your symptoms?

What’s tricky about gestational diabetes is that it goes from nothing to full-blown diabetes very quickly. It’s only when you’re pregnant, so there’s no warning beforehand. The symptoms I had were swollen hands and feet, bad circulation, pins and needles in the hands, and constant thirst – I was drinking a lot of water.

Does diabetes run in the family?

Yes – my late mother had Type 2 diabetes, and three of my sisters and my brother have diabetes (half of my eight siblings, in fact!) None of my family recognised my symptoms, but none of us were looking for them: you put your faith in the doctor, that’s what doctors are there for.

What did you do to manage your gestational diabetes?

During my pregnancy with the twins, I was put on Metformin and later insulin. I also had to have monthly HbA1c tests and test my blood sugar seven times a day: when I woke up, before each meal, after each meal and before I went to bed. My fingers had so many holes in them; I didn’t know where to prick myself! I went to a dietician, which was helpful, we discussed good eating habits and made a lot of changes – we started eating more steamed foods and not so much starch (like potatoes, bread and pasta). And I started exercising. My diabetes doctor, Dr Dave, told me I had to exercise every day, even when I was tired after working all day.

What advice would you offer to women with gestational diabetes?

Listen to your doctors, stick to your eating plan and exercise a little bit every day. Stay focused: this is for the health of your babies. It helps that you just have to stay focused for nine months, and then the reward at the end is breathtaking. My boys were big for twins (2.8kg/each at 35 weeks) and healthy. I’ll never forget how relieved I was to hear both babies crying in the delivery room. They were both crying at the same time, and the doctor said: “Wow, they sound like a choir!”

What makes your life sweet?

I could say sunsets and sunrises, I could say my religion or even cupcakes and chocolates. But my husband and three boys are the light of my life, and sharing everything with them makes my life so sweet.

Finding flavour in diabetes-friendly food

We chat to Ishay Govender, acclaimed foodie writer, about her love of cooking and how to make Indian food just as tasty – but a little healthier.

You have a family history of diabetes – have you been tested yourself?

I get my blood sugar and cholesterol tested once a year – every year. Because I’m aware that Type 2 diabetes is often a hereditary condition, I’m very conscious of my health and how food contributes to my wellbeing. In traditional homes there’s an emphasis on food and family as a way of expressing love, and I know I’ve inherited that from my mother and grandmother – sharing food with people is my way of expressing that love.

Have you made any changes to your diet because you know Type 2 diabetes runs in the family?

I’ve learnt to alter things slightly so that they’re healthier but still have lots of flavour. When we first found out that my mom was diabetic I did a lot of research, and made sure she went to a dietician and found out specifics of how to change her cooking style. That said, we grew up in a very healthy household so the changes weren’t too difficult.

What advice would you offer to people who are struggling to eat a healthy diet?

I think the most important thing is to accept and make peace with the fact that you have diabetes – it doesn’t make sense to fight it. Also, food should never be about restriction, it’s about enjoyment. Change the spotlight from focusing on what you can’t have to what you can enjoy. It’s a great time to explore flavours, textures and a sense of fun in the kitchen.

Have you learnt any ‘tricks’ to make traditional Indian food a little healthier?

A few! Here are the main ones:

  • Cook with less oil – it is possible, especially if you use olive oil cooking spray.
  • Don’t eat double starch (i.e. rice and potato curry, or curry and roti)
  • Cook vegetables for a shorter period of time so that they keep some of their goodness – things like okra and butternut don’t have to be cooked to mush.
  • Rethink vegetables – they don’t only have to be pickled or curried, they can be fresh with interesting dressings. I try to include half a salad in a meal, with a yoghurt dressing (plain low fat yoghurt with toasted cumin seeds, mint and lemon zest – delicious!)
  • I only use baby potatoes with their skins on – they’re low GI and the skin has fibre.
  • Brown rice is so much healthier than white rice – it’s full of fibre and has a lovely nutty flavour. You also need less rice because it fills you up more.
  • Spices and herbs are a diabetic’s best friends! They add such flavour and zest, and you can experiment with different combinations to make a dish more interesting.

What makes your life sweet?
The pleasure of enjoying food and food travel with my husband. Cotton pyjamas and fresh linen. The knowledge that even someone with a ‘soft’ voice like mine, can make a difference using it.

Get in touch with Ishay: @IshayGovender on Twitter / Instagram / Vin

Need to know: what are PMBs?

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.

Chronic Medicine
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).

Co-payments
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.

Formulary
An official list of the medication that can be prescribed for the treatment of the 26 conditions on the Chronic Diseases List (CDL).

ICD-10 Codes
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.

PMB Medicine
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

 

Photo by Olu Eletu on Unsplash

The best diabetic advice?

From Facebook (Diabetic South Africans):

What’s the best diabetic advice you’ve ever been given?

Lower your carbs.
Paula

Use insulin.
Bonnie

Exercise and drink lots of water.
Masego

No diabetic is the same… Individuals react differently!
Isabella

Go Paleo.
Anton

Daily cardio and eggs for breakfast!
Jenna

Eat the same time everyday.
Elmarie

Take your insulin even if you are ill, and always eat regular small meals
Thabiet

Kid first, diabetes second.
Ellen

Gastric bypass surgery to “cure” diabetes

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?
Visit www.sasomonline.co.za

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:

  1. Your weight.
  2. Your height in metres.
  3. 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.

Results:

  • 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).

 

A Sweet Life update

Hello friends!

For those of you who’ve been here for a while, you’ll know that we started this online community (both here on the blog and on Facebook – Diabetic South Africans) at the same time as we started Sweet Life magazine. It’s been over 5 years, and 20 issues of our free quarterly diabetes lifestyle magazine, and the response from you – our readers – has been amazing. We are constantly told what a relief it is to find a safe space to be able to talk about diabetes, and learn from each other and our amazing Panel of Experts.

We’ve been able to print and distribute Sweet Life for free for all these years because of the generous support of our advertisers – diabetes brands who saw the worth in the information we were sharing, and wanted to be part of it. But the times are changing, as we all know, and at the beginning of this year all our major advertisers told us that their marketing budget had been removed from print and so they wouldn’t be able to advertise in Sweet Life any more. The world has turned digital!

It’s taken us a few months to decide what to do next – we knew that without the print publication every 3 months you would still need a space to be able to get information and inspiration on how to live a happy, healthy life with diabetes, so we’ve been revamping our website and social media presence. You’ll notice that we have a lot of new sections on the site, and over the next few weeks we’ll keep adding more and more articles: we want this to be a database of helpful diabetes information, with all the features from the last 20 issues of Sweet Life right here in one place. And if you prefer the magazine format, you can also read all our past issues here.

So it’s a new start for Sweet Life: an online home that draws together all the best of the past magazines and lets us move forward in a way that everyone will be able to contribute to. We’re excited to have you on this journey with us!