Victoria wrote to me last week with this glimpse of life with a Type 1 diabetic husband…
Meet Michael Marnewick, a Type 1 diabetic and active member of the Diabetic South Africans community. Michael has an inspiring take on living with diabetes, and shares some of his advice here. He’s also the author of a new book: “Coach: The life and soccer times of Clive Barker.”
“Although diabetes has the potential to be life threatening if not managed well, it also has the potential to create better awareness about our bodies and our health. I accept that I have a condition but I do (almost) everything I can to live a life free from fear. But ultimately a combination of diet (first and foremost), regular physical activity, a wonderful endocrinologist and my awesome diabetic nurse (Fiona Prins), the fear of the consequences of not managing it properly and the willpower to follow a lifestyle that works for me is what keeps me positive.”
What was your diabetes diagnosis like?
I was quite unaware of my so-called ill-health when I went for a routine test and my blood sugar was in the mid-teens. I put it down to the coke and chocolate I had enjoyed earlier. The frequent night visits to the loo were explained away with advancing age (early 40s). In short, I was in complete denial.
Do you know many other people with diabetes?
I don’t know many, but my brother was diagnosed Type 1 diabetic some years ago following a massive trauma (shrapnel through the brain while on active service duty for the SADF in 1986). So, while there might be a genetic link, both of us had trauma that may have had a hand in this. For me, it was a sedentary lifestyle, bad eating habits and the stress of divorce that led to the diagnosis in 2012 – six years ago.
When (and why) did you change your diet?
When I posted something on Facebook about it, my GP called me up and suggested I look into the low carb, high fat lifestyle. I don’t call it a diet, because it isn’t a short-term intervention. So I’ve been living the low carb lifestyle for about six years. Initially I lost about 8kgs and dropped to a low of 55kgs (I am 1.7m tall). A year ago I went for a health check and with persistently high and uncontrolled BG ranging from 6 – 18 (and a high of 27), was hospitalised. My initial diagnosis in 2012 proved to be incorrect, I was not Type II but Type 1 (Actually, Type 1.5 – LADA which is Latent autoimmune diabetes of adults). My endocrinologist gave me the diagnosis and since working with her and my diabetic nurse, my HBA1C has improved every four months since then.
Could you tell us a typical day’s food?
Typically I wake up at 5am for work and eat breakfast at 9am. Generally I’ll eat some bacon, two eggs, half an avo, cream cheese or other cheese, and some leftover cheesy roasted veg. Lunch is a smoothie at about 2pm. Double cream Greek yoghurt with added cream, chia seeds (soaked in water first), frozen strawberries, almond nut butter, cinnaon and ice. Dinner at about 6.30pm will be roast / pork rashers / chicken dish / curry / zoodles (zuccini noodles or konjac root noodles) with a creamy sauce and bacon or salami / generally with veg. If I eat out, it will be mostly chicken with veg or salad.
What exercise do you do?
I do a lot of physical exercise – when time affords. Some parkrun or else a jog, mountain biking action cricket in season, swimming, badminton, tennis, gym. I am also outside and on my feet most days, often 12-18 000 steps worth.
How is your health?
My health, despite the diabetes, is probably the best since I was an active teenager. I eat zero sugar, I exercise 3-5 times a week, and I am rarely sick with colds, etc. My TomTom sports watch gives my physical age as 25 (I am currently 49).
What advice do you have for diabetics who are struggling?
My advice is to find a reason to stay healthy. I live an active lifetsyle that I want to continue. I want to walk my daughters down the aisle one day, not from a wheel-chair. My brother has no control because he is in denial and has ended up in comas and in hospital numerous times. My inspiration is not to be like him.
What makes your life sweet?
I try to avoid sweet things as much as possible – as far as substitutes go. Sugar addiction (and it was), is what I believe made me diabetic. But I feel like diabetes has given me a new lease on life. I want to be setting sporting world records in my 80s and I feel strongly that I am in the kind of good health now that will realise that.
Any final advice?
We are all led to believe that the food pyramid is the bible on nutrition when vast numbers of studies are proving the opposite. We’re told to eat carbs for energy, when fat is a much denser fuel but isn’t stored as fat in the cells like glucose is. We’re told to “Eat “healthy” things like fruits, but when fruit juice contains more sugar than coke, something is very wrong. I’ve read the testemonies of sick people who no longer suffer from PCOS, high blood pressure, high blood glucose, and they’re winning the war on obesity.
Hippocrates wrote: “Let food be thy medicine and medicine be thy food” – how true!
Jane Sandwood, one of our regular contributors, tackles the issue of diabetes diagnosis in the elderly.
In a recent study of South Africans over the age of 50, 9% reported having diabetes and this percentage rose with age. With the proportion of elderly people over 60 growing fast in South Africa, having reached 4.6 million in 2017, this means that a chronic disease like Type 2 diabetes is on the rise too. As an older person, dealing with a new diagnosis can be challenging and as well as changes in diet and lifestyle, support from family and friends can be very helpful in managing the disease.
Changing habits to be diabetes-friendly
In a country where the demands of other health challenges take precedent, the needs of older people can be overlooked. Even with the best health care, a diagnosis of diabetes can be difficult for older patients. They need to change deep-rooted habits when they may already be facing symptoms and illnesses associated with the condition.
Nearly a third of people with diabetes have diabetic retinopathy which causes gradual deterioration to sight, and yet with early and regular treatment, the risk of blindness is reduced by 90%. This highlights how, by attending routine regular check-ups and creating new healthy habits, many of the symptoms of diabetes can be controlled.
Managing sugar levels
Older people are particularly vulnerable to hyperglycemia caused by very high blood sugar levels. Complications from a hyperglycemic crisis are dangerous. This is a very real risk in the elderly who may have trouble getting used to a new diagnosis and forget to follow health and diet guidelines strictly. Daily reminders about diet, keeping hydrated, careful monitoring of blood sugar levels and, in case of collapse, a system to ensure treatment is provided promptly can all help the patient feel more in control and less vulnerable.
Coping with stress – and diabetes
Adjusting to a new regime can be very demanding but it’s important to learn to relax (easier said than done!) Stress affects metabolic control and can lead to increased HbA1c, a term for glucose in the blood. HbA1c levels are almost double in diabetics experiencing extreme stress, increasing the risk of long-term complications. Tempting as it might be, it’s crucial not to rely on habits like smoking to relieve stress. One of the many consequences of smoking is hardening of the arteries, leading to an increase in cardiovascular complications. In a recent study of adult South Africans with diabetes, 73% were dealing with other cardiovascular illnesses such as angina or hypertension. In order to alleviate stress and improve circulation, an increase in exercise can be very helpful
A diagnosis of diabetes in later life can be a lot to cope with. However, small changes in lifestyle and regular check-ups and treatment can make a big difference.
We would like to ask your support for a very important initiative: the IDF campaign on the occasion of the UN High Level Meeting (HLM) on NCDs.
As we have explained previously, the HLM will take place on September 27, and will be the most important political meeting for the diabetes community of the last four years. During this meeting, global and national progress on diabetes and NCDs will be assessed, and the countries will decide which actions they will develop over the next four years.
We would like to ask you for the following diabetes selfie:
1. Write your HLM message on a piece of paper:
o On the first line, write: #HLM2018
o On the second line, write what you think is more important for people with diabetes in the coming 4 years, choosing one of the following options:
- Improve prevention of diabetes complications
- Conduct T2D prevention initiatives
- Improve diabetes education and awareness
- Ensure access to affordable essential diabetes medicines and supplies
- Improve access to quality diabetes care
- Guarantee Universal Health Coverage
- End discrimination against people with diabetes
- Defend the rights of people with diabetes
- Increase investment in diabetes care
- Increase budget for diabetes care and medicines
- Develop new funding mechanisms for diabetes care
- Engage and empower people with diabetes
2. Take a nice picture of yourself with the paper.
3. Send it to Blue Circle Voices as soon as possible.
We will use your pictures in the coming months on the IDF social media channels.
As much as possible, please share this action with your networks. The more support we can gather, the more likely governments are to listen and take action!
It’s one of the questions we get asked at Sweet Life all the time. Do I have to change my lifestyle – and my diet – to manage Type 2 diabetes?
Well, that depends. Most of the time, Type 2 diabetes is caused directly or indirectly by issues of diet and lifestyle – it’s sometimes called a ‘lifestyle disease’. That said, there is a strong genetic component, so it’s not helpful to think that you ‘gave yourself diabetes’. That kind of attitude isn’t going to help you live a healthy, happy life with diabetes.
Take a close look at your lifestyle. Do you think it’s one of the reasons you were diagnosed with Type 2 diabetes? Do you eat a lot of fried, fatty food? Is there enough fresh fruit and vegetables in your diet? Do you eat a lot of processed food or refined carbohydrates? Do you eat large portions, even if you’re no longer hungry? If so, it might be time for a lifestyle revamp. Take a look at Sweet Life’s Ask the Dietician articles for advice on a healthy diabetes diet.
Family with diabetes
One of the hardest things for newly diagnosed diabetics is making the changes necessary for their health, while still being part of the family. For many people, family meals are an important part of the day, and having to either eat a different variety of a meal or eat at different times or in a different way (a plate of food instead of sharing from communal plates, for example) is a difficult adjustment. Some families are fantastic at supporting the newly diagnosed, others find it too much of a challenge. Sweet Life has written about the challenges of family life with diabetes in our Partner’s Corner articles – you can find out more about families with diabetes here.
Remember that it’s important to sit down and explain to your family why you need to make certain changes, and how they can benefit from them too. Those who have adopted a healthier lifestyle – one that’s rich in fresh food and regular exercise – not only see the effects in their blood sugar results, but in their overall wellbeing.
Have you had to change your lifestyle because of diabetes?
There are some questions that only diabetics know how to ask – and answer… This is your space to ask any diabetes questions you like – and give answers to the rest of the community. After all, we’re all in this diabetes journey together!
Share your experience, your tips and advice, and your challenges with diabetes on this page.
Please bear in mind that any information shared here is from the diabetic community, and has not been supplied by a medical doctor. Don’t make any changes to your medication without first consulting a medical professional. That said, diabetes is a social condition, and we can all learn from each other as we strive towards better control.
Have a question?
Write an email, attach a photo (if you want to) and we’ll publish it here! Give as much information as you can about the issue and we’ll work through it together!
Diabetes question (an example!)
Subject: Eating curry sends my blood sugar up
Email: Every time I eat curry my blood sugar goes through the roof… Has anyone else experienced this? I’m eating chicken curry with naan and taking what I think is the right amount of insulin. By Joe Blog (www.yourwebsite.com)
Pics: If you want to add photos to your post, simply add them as an attachment in the email and we’ll put them up as part of your blog post.
Once your blog post is live, we’ll invite the rest of the community (particularly from Facebook) to join us in sharing advice.
Have a diabetes question? Let’s answer it!
Ask the dietician: Genevieve Jardine
From the community: “I don’t understand the whole ‘low carbs high fat or high protein’ idea – how do carbs, fat and protein work together? Is there a happy middle ground, or does it need to be all or nothing?” Wessel Jones
To understand what all the fuss is about, we need to look at the history of diabetes treatment. Treating diabetes (both Type 1 and Type 2) by lowering carbohydrates (carbs) has come and gone out of fashion over the last century. This debate is not a new one and it is probably not going to go away.
Before the invention of insulin, the only way for a diabetic to survive was to cut out the foods (carbs) affecting blood glucose. With the advent of insulin, the focus switched from lowering carbs to lowering fat to help reduce heart disease. Fast forward a couple of decades and we can see that we have failed in reducing obesity, diabetes or heart disease. It’s not as simple as just diet: it’s about physical activity, stress, diet and environment.
How do carbs work in the body?
What is quite simple is that carbs cause blood sugar to rise and the more carbs you eat, the higher the blood sugar goes. If a person wants to control their blood sugar, it’s a very good idea to reduce carbs. The big question is: how low do you go? A “low carbohydrate diet” can have anything from 20g to 130g of carbohydrate per day.
Remember: One portion of carb (a medium apple, a slice of bread) = 15g carb
The amount of carbs depends on the individual, their control, their medication and their weight. There is a growing amount of scientific evidence that low carb diets improve glucose control and help with weight loss.
Where do fat and protein fit in?
When carbs are cut, the amount of protein or fat (or both) go up. And this is where the debate heats up. The concern is not the low carb, but the increase in saturated fat or fat in general. Remember that not all fat is the enemy and there are good fats that play a very important role in the body.
A benefit of protein and fat is that in the immediate, they do not cause the same spikes in blood sugar. When you lower carb intake you have an immediate blood sugar lowering effect. When this happens, and you have fewer spikes and dips in blood sugar, your appetite is better controlled. The fuller you feel, the less likely you are to snack and the fewer kilojoules you consume. The fewer kilojoules you consume, the more likely you are to lose weight.
The problem with the low carb approach is that, like everything else, it needs to be a lifestyle. When you add carbs back into your diet you will put on weight, especially if you have increased your fat and/or protein. You can’t have it all: full fat products and also carbs. The most important goal is to increase your vegetable intake and try to eat as close to nature as possible. Eat foods in their most original form.
When it comes to deciding on the right ratio of carbs : fat : protein, work with a dietician. It may take time to find your correct balance and you need to be monitored properly with blood tests and possible medication adjustments.
What’s the one piece of advice all diabetics should listen to?
We asked our Panel of Experts… Here’s what they had to say:
“Focus on the good-for-you foods you want to include in your diet, rather than the things you want to limit.”
Cheryl Meyer, Dietician.
“Make small changes to your diet that could bring about a bigger change in your health. Swap white bread for low GI bread, for example, and leave off the butter.”
Faaiza Paruk, Dietician.
“Exercising, keeping to the right BMI and eating a good diabetic diet are all essential because these factors determine the amount of medication you need. It’s also important not to smoke, to take your medication properly and to visit your doctor regularly.”
Dr. Joel Dave, Endocrinologist.
“Ask yourself: ‘Have I got diabetic retinopathy: Yes or No?’ The only way you can know that answer is if someone competent and trained has looked at your retina and given you the answer. So visit an ophthalmologist every year!”
Dr. Dale Harrison, Ophthalmologist.
“Always use a good diabetic foot cream. Examine your feet every day, especially if you have neuropathy. Check your shoes with your hands before you put them on to be sure there isn’t anything in them. Ensure your shoes fit properly and have enough space so that there are no pressure areas that could cause blisters or wounds.”
Andy Blecher, Podiatrist.
“Go to a qualified podiatrist for a thorough Diabetic Foot Assessment at least once a year. Ask questions and be informed.”
Anette Thompson, Podiatrist.
Any advice to add?
Ask the dietician: Cheryl Meyer
From our community: “I get invited to lots of business meetings and workshops that are catered… Needless to say, none of the catering is healthy! What do I choose or how do I deal with this situation?” Rene Prinsloo.
Many of us consume at least half of our meals and snacks during work hours, which makes our food choices in catered meetings and workshops very important. Here are three steps to consider:
Step 1: Build your plate
- Aim to fill half your plate with vegetables or salad. Look out for vegetable skewers, veggie sides, crudités (chopped raw veg), soup or salads.
- Next, add a healthy carbohydrate: either a wholegrain/high fibre starch or a piece of fruit.
Look out for:
- Wholewheat bread
- A seeded roll
- Wholewheat pita
- Wholewheat pasta/noodles
- Wholewheat wrap
- Brown or basmati rice
- Fresh fruit
- For long-lasting brain and body power, add a source of protein.
Some good protein choices:
- Lean cold meats
- Grilled chicken
- Mini meatballs
- Legumes like beans or lentils
- Fish like tuna, sardines or pilchards
- Cottage cheese
- Boiled eggs
Sauces like low-fat mayonnaise, sweet chilli sauce, hummus or guacamole are optional but not essential.
- Deep-fried foods (like samoosas, spring rolls or vetkoek)
- Sausage rolls and pies
- Croissants, muffins or other pastries
Step 2: Choose portions with caution
- Be sure to start the day with a balanced breakfast and keep healthy snacks or a packed lunch on hand to avoid arriving at a meeting hungry.
- Use smaller plates and serving utensils to help manage how much you dish up.
- Sit far away from the food to avoid “picking”.
- Use the size of your hand to determine sensible and healthy portion sizes and curb overeating:
- A fistful is equal to one cup and can be used to estimate the portion size for carbohydrates (starches and fruits).
- The size of the palm of your hand can be used to estimate the portion size for protein. For a stew, curry or casserole this would be about half a cup.
- The tip of the thumb is equivalent to one teaspoon and can be used to estimate the portion size for all oils, butter or mayonnaise.
- The thumb can also be used to estimate the portion size for peanut butter or hard cheese.
Step 3: Carefully consider your choice of drink:
Some good choices are:
- Still or sparkling water
- Tea or coffee
- Vegetable juice
- Low-fat milk
- Sugar-free fizzy drinks
We’ve got a dose of winter workout motivation that will ensure the only layers you’ll be adding this chilly season are layers of clothing! Lee-Anne Spurdens gives us the ideas.
While it’s tempting to stay under a blanket all winter long, hibernating isn’t good for your body or mind. Exercise is essential to manage your diabetes well, keep away the winter blues and build a healthy body – which also means you’ll be able to battle the winter germs better. Need some ideas to get you started? Here are seven of our favourites.
- Skipping Mobile, inexpensive and effective, this might be the most winter-friendly workout around. If it’s too cold or wet to skip outdoors, any indoor non-slippery surface will do (even in front of the TV). Skipping ups the heart rate, burns calories and strengthens muscles and bones. Start with five to 10 minutes a day.
- Boot camp If a little authority is what you need to get moving, you could be a winter warrior in the making! Boot Camp Academy SA (bcasa.co.za) offers “military” style boot camp classes across the country for all fitness levels.
- Exercise videos If you prefer to be drilled from the comfort (and warmth) of your living room, an exercise DVD is a good option. And who better to whip you into shape than martial arts guru, Billy Blanks? His legendary Tae Bo workouts are a mix of taekwondo and boxing, and available from takealot.com.
- Fit radio Sometimes all you need to get you moving is the right music. The Fit Radio app delivers a fresh new workout soundtrack whenever you need it and is guaranteed to get you off the couch, even if all you do is dance around your living room. Which brings us to…
- Dancing A tonic for body and soul, the ultimate stress buster and a fun way to warm up a cold body! From ballet and ballroom to hip hop and salsa, there are adult classes available for just about every type of dance. Check out dancedirectory.co.za to find a class in your area – soon you’ll be walking taller, sitting straighter and bending down more easily.
- Walking A brisk, daily 30-minute walk can help maintain a healthy weight, strengthen bones and muscles, manage high blood pressure and heart disease, improve balance and lift your spirits.
- Running If you’re ready (and willing) to take your walking up a notch, why not try a local park run? These free, timed 5km runs take place every week all over the world, are open to all levels and are a great way to get the whole family moving and make new workout buddies. Visit parkrun.com to find a run near you.
Morning movers and shakers
Generate some heat on chilly winter mornings with this 3-minute blood-pumping routine:
- Jumping Jacks: Jump your feet out and sweep your arms up over your head, then jump feet together and bring arms to your side. Repeat for 60 seconds.
- Side squats: Squat as low as you can, stand up and take a step to the side. Squat down again. Repeat on the other side. Keep going for 60 seconds.
- Plank: Get into a push-up position. Bend your arms to the floor, and rest your body weight on your forearms. Your elbows should be directly beneath your shoulders, your body in a straight line from head to feet. Hold for 60 seconds.
How to motivate yourself to get off the couch
Ask the expert: Ilona Padayachee, Biokineticist
Enjoyment: This is the key to staying motivated, so make sure you enjoy whatever exercise you choose.
Goal setting: This reaffirms a sense of mission, purpose and direction. Set goals during winter to keep you motivated, and reward yourself for sticking to your exercise routine.
Variety: Change up your workout routine to prevent it from becoming boring – try different activities, train outdoors as well as in, and work out with a partner to keep things interesting.
Your toes might be in hiding over winter, but that doesn’t mean you should neglect them. Podiatrist Anette Thompson has this advice for healthy winter feet:
- Treat dry, flaky skin with an exfoliating foot scrub and a good foot and heel balm.
- Warm feet up by soaking them in warm (not hot) water for five to 10 minutes. Follow with foot balm and thick socks for extra snugness.
- Shoes with inflexible soles prevent natural bending at the ball of the foot, which can cause circulation problems. Tight shoes and a toe shape that does not match your foot shape can also limit circulation. Wear low-heeled shoes with flexible soles that don’t squeeze the front of your foot (this can cause inflammation of the big toes or ingrown toenails). Buy a larger size if you wear thick socks, and choose shoes with built-in cushioning – this promotes circulation under the ball of the foot.
“One of my children has diabetes, the other doesn’t. How do I make changes that the whole family can adopt so that my daughter doesn’t feel like she’s making our lives more difficult because of diabetes?” Fatima Richards.
The emotions that parents deal with when a child is diagnosed with diabetes are the same as any serious medical condition. Confusion, shock, denial, sadness, anger, fear and guilt are some of these emotions.
Unfortunately, guilt is a feeling common to many family members, the patient as well as the parents. I believe that guilt is one of the most destructive negative emotions – it drains you so that you can’t focus on more important things.
Getting the whole family to deal with these feelings openly at the time of diagnosis helps with long term adjustment. As you all learn to live with diabetes, you will become more used to it and find ways to fit it into your life more naturally. Fitting diabetes care into as normal a life as possible is the major goal.
Remember, too, that if all family members have a positive attitude, life with diabetes will be much easier. One day at a time is a good option!
How to help the whole family adjust to diabetes:
- Keep your family routine as close to the previous ‘normal’ as possible.
- Whenever possible, fit diabetes care around your child’s lifestyle, rather than her life revolving around diabetes.
- Remember, children with diabetes are children first. Their diabetes should not define who they are.
- Explain any changes that are made because of diabetes to everyone in the family.
- Remember that nobody is being punished because of the diabetes. Everyone is just going to follow a healthier lifestyle. And this is a good thing.
– Jeannie Berg, Diabetes Educator
“My husband is a diabetic, and I would like to know how long it takes before diabetes affects your liver? Should I be worrying about him?” Alicia Greenway.
You’re wise to think about steps to protect your husband’s liver – diabetes is a lifelong condition that affects the liver and vice versa. Being informed is the first step towards ensuring good liver health. Those with diabetes are at higher risk of non-alcoholic fatty liver disease, a condition in which extra fat builds up in the liver even if you drink little or no alcohol. Other medical conditions related to diabetes — including obesity, high cholesterol and high blood pressure — also raise the risk of non-alcoholic fatty liver disease. Diabetes does not cause fatty liver disease, but the two tend to occur in the same people because the same conditions cause both problems.
Diabetic-related liver disease can be largely prevented. Good control of blood sugar, maintaining a healthy weight, and having regular check-ups to monitor the effects of medication can help reduce the risk of liver problems.
Strategies for protection against fatty liver disease include:
- Working with your health care team towards good control of your blood sugar.
- Losing weight if necessary, and trying to maintain a healthy weight.
- Taking steps to reduce high blood pressure.
- Keeping your cholesterol within recommended limits.
- Not drinking too much alcohol.
Then, let’s talk about worry. “Worry never robs tomorrow of its sorrow, it only saps today of its joy.” Leo Buscaglia.
Having a partner with diabetes puts unique strains on a relationship, but it can also bring you closer together if you learn how to work together. Here are some golden rules for rising to the challenge of managing a chronic disease like diabetes:
- Get educated
- Set shared goals
- Make room for negative emotions
- Get support from others
- Commit to nurturing your relationship.
You can do it if you work together.
– Jeannie Berg, Diabetes Educator
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.
“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.
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.
– Jeannie Berg, Diabetes Educator
As a parent, you obviously want what’s best for your child – but what is really best when it comes to exercise and children with diabetes? Riekie Human tells us what you need to know (adults can learn a little something, too!).
Although experts agree that it’s crucial for kids with diabetes to exercise, you need to make sure they’re doing it safely. Thankfully, it’s easier than you think… We got all the answers from experts in the field.
What kind of exercise should my child do?
“The most helpful exercises encourage muscle contraction and increase the effect of insulin.” What does that mean? The exercise helps more glucose to be transported out of the blood stream and into the cells to be used: body weight exercise and resistance training are particularly good at this. However, young children should take part in all kinds of exercise, particularly cardiovascular for the development and health of the heart, lungs and lipid profiles (cholesterol), and team sports to encourage skills and develop confidence. Sarah Hall, Biokineticist at Wellness in Motion, Morningside
Ball sports are especially good for children with diabetes. “They involve a combination of exercises like jogging and sprinting, and research has found that this is best for stability in blood sugar levels.” Contact sports like karate can be tricky, especially for children with insulin pumps, as the pump could get damaged – and the same applies to horse riding. Andrew Heilbrunn, Head Biokineticist at the Centre for Diabetes and Endocrinology (CDE) in Houghton
What time of day should my child exercise?
The best time for kids with diabetes to exercise is before breakfast and before supper. “They’re less likely to hit lows at those times. Before breakfast, they’ll be quite insulin-resistant and are unlikely to experience a drop in blood sugar.” The worst time to exercise? An hour or two after meals, when insulin in the system can cause more frequent lows.
How long should my child exercise for?
That depends on the child: what they’re capable of and how fit they are. “The general recommendation is 1 to 2 hours, but take into account the type of exercise, your child’s age and their fitness level. And remember to limit exercise to 30 to 45 minutes if it’s a new sport or type of exercise – and then closely monitor their blood sugar levels, before and after exercising.”
What else do I need to know about exercise and diabetes?
It’s important to give the coach a list of symptoms of high and low blood sugar, as well as detailed instructions of what to do if your child goes low. “A child with low blood sugar will be irritable, have a headache and blurry vision, and generally feel horrible.” If your child’s blood sugar is too high, they will feel tired and thirsty.
Dr Claudine Lee, GP
If your child exercises for more than one hour, any time of the day, they should have a protein snack, like full-cream yoghurt or small yoghurt-coated rice cakes, before going to bed. “Sustained energy overnight is crucial, as it prevents hypos between 2 and 4am. “Also, always have a quick-acting sugar snack on hand (fruit juice, sweets or honey) to treat low blood sugar, and make sure the coach knows how to use a glucagon pen in case of emergency.
Ask the expert: Sarah Hall, Biokineticist Studies have shown that children with Type 1 or Type 2 diabetes are generally less physically active than those without: the exact opposite of what the situation should be!
Some advantages of increased physical activity for children with diabetes:
- Better health
- More confidence
- An improved response to insulin and blood sugar control
- A greater awareness of diabetes and their bodies
- The prevention of conditions associated with diabetes, like obesity and heart disease
- Improved weight management
- Don’t let your child exercise if their blood sugar is too high: over 16mmol/l or too low: under 4mmol/l, or if ketones are present.
- Make sure your child’s blood sugar is in the target range before exercise, in order to avoid low blood sugar.
- Talk with your doctor about lowering your child’s insulin dose before exercise, if necessary.
- Inject insulin before exercise in a site other than the body parts about to be used. For example, if your child will be running, don’t inject in the legs.
- Watch for symptoms of low blood sugar for 12 hours after exercise, especially if it’s a new kind of exercise.
- Make sure your child drinks water so they don’t get dehydrated.
- Choose something fun for you and your child to do together and they’ll learn that getting active is just as enjoyable as relaxing. You could go to dance classes, swim, learn to surf, take up yoga, go on hikes, play tennis or even join a soccer team. There’s even something called laughter yoga if you really want to have a good time.
“I’m looking for some tips or advice on how to communicate better with my diabetic wife. She has Type 1 diabetes and when she goes low it’s sometimes hard for me to know what to do, and hard for her to explain how she’s feeling. Also when she goes high, but low is more of a problem, because it can get dangerous. Any tips?” Luke Jacobs.
I think it’s really great that you are involved in helping your wife cope with her diabetes. The challenges faced by those who care about someone with diabetes are rarely discussed, and very real.
Diabetes is riddled with valleys and waves, otherwise known as lows and highs, and this can be totally frustrating – as well as scary – both for the diabetic and their spouse. Good diabetes management limits the frequency of lows and highs, but there is no guarantee. And there are so many factors that can influence blood sugar that there’s no such thing as a ‘perfect’ diabetic.
So what now?
First of all it’s important for you to be able to identify when your wife is going low. Sometimes, people who have had diabetes for a long time lose the ability to feel their lows – this is where you come in. Learn how to treat a low. Keep some glucose sweets or jelly beans with you so that you can help her if her blood sugar suddenly drops. Don’t be afraid to suggest she checks her blood sugar if you think she’s acting funny.
The trick is to be diplomatic about this. The last thing a wife with diabetes wants is pity – and what woman can be responsible for being snippy when her blood sugar is at 3mmol/L?
– Jeannie Berg, Diabetes Educator
Keeping your diabetes in check as you get older is not only possible, but important. Here’s what you need to remember.
- Diet is vital: be sure to eat as balanced a diet as possible. Not eating the right kind of food or often enough can result in low blood sugar. Drinking plenty of water is also important.
- The average HbA1c in the elderly population in SA is within national guidelines at around 7.3. What’s yours?
- Be prepared and always have at least 3 days of supplies on hand for testing and treating your diabetes.
- Hypos (low blood sugar) are a risk, especially in Type 2 diabetics who are on SUs (sulphonylureas). Severe hypos can result in comas, so it’s important to know how to treat them.
- Always keep a glucagon pen on hand for hypo emergencies (and make sure you’ve told someone close to you how to use it).
- Controlling Type 2 diabetes with Glucophage or Galvus can have a life-changing effect.
- It’s important to have regular blood pressure and cholesterol tests, and annual kidney, eye, teeth and feet check-ups.
- It’s a good idea for any diabetics over 65 years old to have a pneumonia vaccine shot. An annual flu shot is also beneficial.
- Keep active as it helps with mobility, balance, strength, mental wellbeing and insulin sensitivity.
- Studies show that older diabetics are more compliant than teenagers, the newly diagnosed, and even pregnant diabetics.
Staying active during pregnancy is the best thing for you – and your baby, Cindy Tilney tells us.
While exercise may not be what you feel like doing when you’re expecting, experts agree that it has a host of benefits – besides being a natural mood-lifter, there’s no denying how good it is for you. “In pregnancy, it’s always better to exercise than not – even with a chronic disease such as diabetes,” says personal trainer Shelley Lewin, who offers specialised pre- and postnatal exercises in Cape Town. “Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active. Unless you have a specific medical condition that puts you and your unborn child at high risk during pregnancy, it can only work to your advantage,” she says. “And in people with diabetes, it can help the body to process glucose more effectively.”
What can exercise do for pregnant diabetics?*
- Lower blood sugar
- Improve insulin sensitivity
- Control blood pressure
- Increase energy
- Reduce after-meal blood sugar spikes
- Encourage restful sleep
- Lower gestational weight gain.
According to the American College of Obstetricians and Gynecologists (ACOG).
*Type 1, Type 2 and gestational diabetes
Remember: If you have diabetes, it is essential to get the all-clear from your doctor before starting an exercise programme, particularly if you are pregnant.
“Exercise in any form may require a reduced amount of insulin because exercise increases glucose uptake in the cells,” explains biokineticist Sarah Hall. “The intensity of the exercise you are doing will determine this: lower-intensity exercise can lead to a recommended insulin reduction of roughly 20%, as opposed to a possible 50% with higher intensity exercise.” This is further complicated by insulin needs often doubling during pregnancy, so consulting a doctor is a must.
Healthy exercise tips during pregnancy:
- Check your blood sugar before and after exercise (Type 1 diabetics).
- Always take a ‘quick-fix’ snack, such as a banana, along with you when you exercise, so that you have a sugar source on hand in case of hypoglycaemia (low blood sugar).
- Stay away from forms of exercise that carry a high risk of falling, and avoid lying on your back with the head below the level of the heart, as this can restrict the blood flow to your baby.
- Wear a heart rate monitor during cardiovascular exercise, and keep your heart rate to 140bpm or below. In the past, there was a widely held belief that pregnant women should stay away from all cardiovascular exercise – but modern research has shown that this does not hold true.
The good news? If you’ve been exercising regularly, you can carry on very much as normal, agree Hall and Lewin – provided the activities are not extremely high impact, do not involve fast or sharp changes in direction, or cause surges in blood pressure or adrenalin.
Ideal pregnancy exercise
Both experts recommend 30 minutes of moderate physical activity three times a week, such as walking, swimming, aqua aerobics and light weight lifting under the guidance of a certified ante-natal instructor. The ligaments tend to naturally relax during the second and third trimesters of pregnancy, so be careful not to overstretch during warm-ups – and if you are weight training, use machines rather than free weights to avoid any hyperextension injuries.
“Building up core strength is important in pregnancy,” says Lewin, “but as your tummy grows, you should stay away from certain intense core exercises, such as tummy crunches – instead opt for opposite leg and arm lifts, or practice stability work on a Pilates ball.” Kegel exercises are also important during pregnancy, as they strengthen the pelvic floor muscles.
Be gentle with yourself during pregnancy: stay away from contact sports and aggressive forms of exercise. And be aware of your body and how hard you are pushing yourself during workouts. “The ‘talk test’ is always a good marker of whether you are pushing yourself too hard,” says Lewin. “If you are exercising at the right level, you should be able to talk at the same time – but if you’re struggling to take in breath and unable to hold a conversation, it means you are pushing yourself too hard.”
Find out more about pregnancy exercise at www.homefit.co.za
“Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active.”
Ask the expert: Sarah Hall, Biokineticist
Don’t exercise if you have:
- Pregnancy-induced hypertension
- Ruptured membranes
- Placenta praevia
- Vaginal bleeding of any kind
- Incompetent cervix (when the cervix is weak and opens too early)
- Or if you are expecting twins or more
If you experience any of the following during exercise, stop immediately and seek medical help:
- Sudden calf swelling
- Decreased foetal movement
- Chest pains
- Any amniotic leakage
- Excessive overheating