“Diabetes…. Uugh.” That feeling pretty much sums up what diabetes burnout is all about: the feeling that it’s too exhausting / frustrating / unpredictable / impossible to manage your diabetes, so why even try? Diabetes burnout is common in people with diabetes (both Type 1 and Type 2) and for good reason – it’s a chronic condition. Chronic as in forever, never giving you a break, never giving you a holiday, never giving you a moment’s rest. Add to that the fact that diabetes is an ever-changing condition, with blood sugar fluctuating depending on everything from your diet and exercise to hormones, weather, sickness and more, and it’s no surprise that people with diabetes sometimes feel exhausted by it all.
When you need to worry about diabetes burnout
“Diabetes burnout is a normal emotion for diabetics to feel at any given time,” explains Gabi Richter, a Type 1 diabetic and counsellor in Cape Town. “It occurs when you are fed up with the routine and lifestyle that being diabetic entails, and you just want to forget it all. This is fine to feel once in a while – and can even be healthy to some point. But it needs attention when the feeling stays for a long time and your routine diabetes care stops.”
This, of course, is the warning sign. If it feels like there’s no point taking care of your diabetes because you have no control any more, that’s when you stop paying attention to food and medication and self-care. And that’s when blood sugar levels can get wildly out of control. Extended periods of high blood sugar (hyperglycemia) lead to diabetes complications, and in Type 1 diabetics, low blood sugar (hypoglycemia) can be extremely dangerous.
So what do you do if you’re experiencing diabetes burnout? Reach out. Connect. Realise you’re not alone. “Diabetes burnout is a very real issue for all the people I am privileged to educate and spend time with,” explains Kate Bristow, a diabetes specialist nurse in Pietermaritzburg, KZN. It’s a combination of the frustration of things: Never having a day off from diabetes. The guilt of not sticking to the right eating plan or forgetting to take medication or check blood sugar. The relentlessness of never being able to take time off from managing diabetes. “Burnout is often accompanied by stress and anxiety and sometimes depression or guilt – all negative emotions,” says Kate.
5 tips for diabetes burnout
Here are 5 pieces of advice Kate Bristow offers her patients.
Share your frustrations with someone – a family member, or diabetes nurse or educator. See if there are ways to decrease your burden for a while.
Try new diabetic-friendly recipes – a change is as good as a holiday.
Try practicing mindfulness – a practice based on learning to become aware of how you are feeling emotionally in a non-judgemental way. It has been found to be effective in supporting diabetes management and the general stress of everyday life. Eating mindfully has been shown to improve diabetes control.
Life is busy – stress is a way of life – defined as a state of emotional tension elicited by the pressure of everyday life. Diabetes is probably only one of those stresses. Exercise has been shown to reduce stress levels and alleviate depression as much as some medications used for the same purpose. Exercise is also good for our physical health – blood pressure, weight, cholesterol, and diabetes. So perhaps another way of dealing with burnout is to get an accountability exercise partner and start getting physical at least 3 times a week (even if it’s only for 20 minutes at a go, or at work).
If you really feel like you are not coping – ask for help. This is why you have a health care team and a diabetes community. Ask your doctor, your diabetes educator, your diabetic community. You’re not alone in this.
Diabetes burnout is a reality for many of us with diabetes, but it doesn’t have to be a long-term reality. With the right help and care, it can be a phase we move through – just another part of living with this chronic condition. How do you cope with diabetes burnout? Do you have any tips to share?
Diabetes changes oral microbiome that promotes gum disease
In a fascinating study on the relationship between diabetes and periodontal (or gum) disease, Janet Southerland and colleagues note that hyperglycemia leads to the formation of specific proteins and fats that promote inflammatory responses in the mouth. “Diabetes is an important risk factor for more severe and progressive periodontitis, infection or lesions resulting in the destruction of tissues and supporting bone that form the attachment around the tooth.” A new study, however, has discovered the reason why. It’s all got to do with the way that diabetes changes the oral microbiome – the community of microbial residents that lives in the mouth. Therefore, regular brushing and flossing, attention to one’s diet, and dental visits are key.
Shifting oral biomes
The study, published in the journal Cell Host & Microbe, compared the gum health of mice with and without diabetes, finding that the microbiome of hyperglycemic mice changed. Bacteria diversity became lower, and the result was gum disease, including a loss of bone supporting the teeth. These mice also had higher levels of IL-17, a molecule involved in the immune response and inflammation. The researchers were able to reduce bone loss in affected mice through the use of an IL-17 antibody. Currently, however, this treatment is not likely to be useful for humans. Researchers therefore insisted on blood sugar control and good oral hygiene for human beings with diabetes.
Your dentist can save your oral health
An interesting study involving 2.5 million people found that adults with diabetes are less likely to visit the dentist than those with pre-diabetes or those who don’t have diabetes. Why is that? Part of the problem is undoubtedly cost, as unlike countries like the USA, where those with lower earnings can rely on Medicaid to cover emergency and preventive oral health care, few medical aid schemes in South Africa cover dental health. The report also found ethnic disparities and concluded that single people and men were less likely to visit dentists than those in relationships and women, respectively.
How often should diabetics visit their dentist?
Diabetics are advised to visit their dentist at least once a year Preventive care ensure that teeth are clean and plaque does not cause gum tissue to separate, form pockets, and eventually lead to tooth and bone loss. It’s a good idea to see your dentist right away if you have any signs of gum disease or dry mouth… Be on the alert if your gums are inflamed and bleed, which happens with gingivitus.
Because microbiomes are different for people with diabetes, inflammation and gum disease can be more likely. It is important to take proactive measures to battle gum disease and tooth decay through daily hygiene and regular dental visits. Also be on the lookout for signs and symptoms of the beginning stages of gum disease.
When last did you go to the dentist?
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.
I got this amazing email from one of our community members last week and had to share it. Would you like to share your story with the Sweet Life community? Email me – we’d love to hear it.
What an absolute treat to read your magazine and continually refer to it.
I have been Type 1 diabetic for 14 years. As much of a roller coaster ride as it has been, I would not swop being diabetic for anything in the world.
The people you meet along this journey, the knowledge you gain about how your body functions and responds, the prior knowledge you get from high glucose readings before you get ill and a complete understanding of the people I meet who possibly battle with elevated glucose levels or hypoglycemia.
Being Type 1 diabetic makes you aware on every level – spirit, body, mind, soul, feelings, thoughts, allows for wise choices (although if not wise then the consequences that accompany these – you have actually just got to smile, knowing that this is within your control), tolerant and respectful of others.
It is without a doubt, a gift.
The International Diabetes Federation reports an average of three and a half million people in South Africa are living with diabetes. Three and a half million of us struggling with the insufficient production of insulin by our bodies – and many more undiagnosed. There is no question that diabetes is one of the most common healthcare concerns of South Africa and its citizens. So what diabetes treatment updates are there?
Well, there are reasons to hope and possibly celebrate. Recent years have seen great advancements in the diagnosis and treatment of diabetes globally. Scientists and medical professionals alike continue to work tirelessly in pursuit of a clinically tested and dependable way to improve the lives of those living with diabetes and possibly prevent the diagnosis of further cases. That work is beginning to show with some great breakthroughs in the treatment of diabetes. Here are some treatment advancements coming to the forefront and what it may mean for diabetes patients across South Africa.
Diabetes treatment options are changing
In 2016, the world received word of the first artificial pancreas being brought to the market for the first time. Although distribution and availability of the system remain fully explored, it is certainly garnering attention for its ability to help patients living with Type 1 diabetes by reducing the chances of hypoglycemia. The development has been cited by many studies as having the ability to transform diabetes by offering improved glycemic control. It responds to either low or high glucose levels and automatically adjusts the insulin levels accordingly.
With overwhelming success rates, South Africans saw the first version launch in 2009 along with Europe before later being expanded upon and eventually approved by the FDA in the United States of America. New drugs such as empagliflozin have also shown a great deal of promise in reducing cardiovascular risk. South Africa’s senior population has one of the highest cardiovascular risks in the world and this is directly linked to diabetes. The most common causes of death in diabetic patients have been shown to be either stroke or heart disease.
New development in insulin treatment for diabetes
For those living with diabetes, insulin is a key part of their daily lives. Diabetes means the body is unable to process glucose which in turn affects blood sugar. This is caused by the body either producing too little insulin or the insulin produced not working properly. Another exciting development in recent years is the development of longer lasting and more efficient medication for those having to do regular injections of insulin. Technological inventions such as the insulin pen by Timesulin are especially aimed at the senior population. The pen tells you when you last took an insulin dose. The device is now widely available from distributors in South Africa and has been largely welcomed.
Diabetes awareness is shifting
Public awareness around South Africa and amongst South Africans about diabetes is changing. Organisations such as SEMDSA (the Society for Endocrinology, Metabolism and Diabetes of South Africa) have released updated guidelines alluding to dietary guidelines for those with diabetes. The government is playing its part as well with an announced sugar tax taking effect in April 2018.
The Sugar Beverage Levy dictates that for beverages with sugar content exceeding 4g per 100ml is taxed at 2.1 cents per gram of sugar content. The tax is apart of the Healthy Living initiative being pursued by the government and saw information roadshows being held across South Africa to educate the public about the tax. Introduction of a sugar tax is hoped to deter the consumption of sugary beverages, a large trigger for patients and also a contributing factor for being diagnosed with diabetes in the first place.
Diabetes awareness in the workplace
Corporate wellness programs are now being offered by employers and more food establishments and canteens across South Africa are offering healthier options. More and more online resources and publications are promoting the need and tips for healthy eating on a budget. With over 37 percent of the population not being able to afford an adequate healthy diet thanks to food prices, the timing of these promotions is perfect.
Although these steps are certainly in the right direction, there remains a long way to go in fighting the spread of diabetes in South Africa. Better education along with an increased priority on healthcare lists are among some of the pressing options. By preventing and treating diabetes early, it is not only the country’s population that stands to benefit greatly, but also its economic standing.
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
Ketones and ketoacidosis are often mentioned in relation to diabetes, but what are they exactly?
- Ketones result when your body burns fat for energy.
- They are formed when the body doesn’t have enough insulin to use glucose for fuel.
- A urine test is traditionally used to test for ketones: some blood glucose meters can also test for ketones.
- Ketones make the blood more acidic.
- Ketones in the urine combined with high blood sugar are a warning sign that your diabetes isn’t under control.
- Diabetic ketoacidosis (DKA) is caused by a combination of high blood sugar that causes a rise in ketones. The ketones are an indication of how acidotic the patient is, and the acidosis can be fatal.
- DKA is serious and can lead to diabetic coma.
- DKA is rare in Type 2 diabetics and more common in Type 1 diabetics with uncontrolled blood sugar.
- Symptoms of DKA are thirst, frequent urination, high blood glucose, constant tiredness, nausea, vomiting, abdominal pain, dry/flushed skin, breathing difficulty and confusion.
- If these symptoms ring a bell, see a doctor as soon as possible to get your blood sugar under control.
Ask the dietician: Genevieve Jardine
From our community: “As the mom of a diabetic child, I’m constantly wondering what to make her that is delicious but won’t spike her blood sugar. Could you give me some basic guidelines please?” Bernadette Simons.
As a mother of three (constantly hungry) young boys I am kept on my toes when it comes to healthy eating. Although my children are not diabetic, I practice “diabetes-friendly” eating in my household. The bottom line is that you want your children to eat real, whole foods. This means no foods that are manufactured, processed and refined: time for a cupboard clear-out!
For children with diabetes, you need to make meals novel, colourful and exciting, while reducing refined carbohydrates and harmful fats. It’s important to break away from the rut of cereal for breakfast, sandwich for lunch and one-pot meal for dinner. Parents need to constantly focus on increasing fresh foods and not wait for dinner to try and make up the daily vegetable intake…
Here are some menu options:
- Bring back eggs for breakfast! Make eggs more interesting and nutritious by adding vegetables and baking in a muffin tray as mini crustless quiches. Serve with chopped strawberries or other brightly coloured fruit.
- Try making your own cereal out of nuts and seeds, coconut shavings and some rolled oats. This can be eaten with plain yoghurt or milk. Use vanilla, cinnamon and half a grated apple to sweeten it naturally.
- Move away from a daily sandwich for lunch. Try choosing other low GI starch like baby potatoes or corn on the cob.
- Add some protein – chicken drumsticks, hard-boiled eggs, meatballs, homemade fish cakes or cheese. Remember protein makes you feel fuller for longer and doesn’t spike blood sugar levels.
- Add a small amount of colourful fruit like a fruit kebab or fruit salad.
- All lunchboxes should have vegetables! If your child doesn’t like salad, give some cucumber and carrot sticks, baby tomato kebabs or cucumber sandwiches (two slices of cucumber with cheese or cream cheese in the middle).
- Most traditional South African dinners are one-pot meals like curry, stew, cottage pie or spaghetti bolognaise that are high in starch and low in vegetables. Try adding more vegetables to stew, curries and mince. Make the mashed potatoes with added cauliflower, add lentils to brown rice, and use baby marrow or aubergine instead of pasta.
- Always serve dinner with vegetables on the side. Raw carrot sticks, sliced cucumber or snap peas are kid-friendly. Children need to get used to eating vegetables that are not hidden in food but out in plain sight!
Remember: Children learn eating habits from their parents so you need to set the example. Tastebuds are influenced early on by processed foods with hidden sugars and fats, so it’s up to you to encourage your kids to eat – and love – real food.
Hypoglycemic episodes (hypos) can be a scary experience for all involved: here’s what you need to know to deal with one.
- A hypo is a sudden low blood sugar episode.
- The optimal blood glucose range is 4 to 7mmol/l. With a hypo, blood glucose levels are usually lower than 3mmol/l.
- Initial symptoms are nervousness, sweating, intense hunger, trembling, weakness, palpitations, or trouble speaking (depending on the person).
- The best thing to treat a hypo is fast-acting carbohydrates: 15-20g of sugary carb (a few sweets, 2 tablespoons of raisins, a tablespoon of honey or half a cup of fruit juice).
- The key is to catch low blood sugar early – as soon as it starts dropping – and treat it with a small dose of something sweet.
- If blood glucose drops too low it can get to the stage where the brain is not getting enough glucose.
- Symptoms of this are confusion, drowsiness, changes in behaviour, seizure and eventually coma.
- In case of a severe hypo, a glucagon emergency kit may be necessary. This once-off injection instantly raises the blood sugar, and is particularly useful when the person with diabetes is unconscious or unable to swallow.
- Notify all those close to you what to do in an emergency and how to use a glucagon injection.
- Test often to keep your levels as well controlled as possible.
“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
When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.
Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?
That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.
What inspired you to write The Low Carb Solution for Diabetics?
We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.
The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.
I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.
A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.
Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?
Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!
What advice would you offer to people living with diabetes who are struggling?
Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!
What makes your life sweet?
Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.
Get in touch with Vickie: @Vickiefantastic on Twitter
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
“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
Ask the dietician: Genevieve Jardine
From the community: “My wife and I love having friends over for sundowners but never know what drinks to offer and what snacks to serve so that I can actually enjoy myself too. Any advice?” Riyaaz Benjamin.
Luckily, there is a way to enjoy (guilt-free) sundowners… It just takes a little planning. Let’s take a look at the when, what and where of it.
The main problem with sundowners lies with the timing. As the name suggests, they usually occur long after lunch and just before supper. This means that you may arrive hungry and tired with low blood sugar levels: a recipe for overeating, drinking (sugary) alcohol on an empty stomach, and filling up on unhealthy snack food. After sundowners, you may then go for supper, which means even more food and alcohol.
The key? Sundowners are best handled when prepared. Make sure you have an afternoon snack just before arriving (preferably one that contains protein to help stabilise blood sugar levels). Upfront, decide to either have the snacks as a replacement dinner (only a good idea if there are healthy snack options) or hold back and leave room for a light supper.
What is being dished up? The good news is that sundowner snacks are usually savoury and not sweet. The bad news is that savoury snacks – like chips and cream dip, sausage rolls and salty peanuts – are often high in starch and fat. Try to choose the healthiest options on the table, and don’t forget to dish up a plate rather than snacking so that you know exactly how much you’re eating.
Sundowners are also synonymous with cocktails (not the right choice of drink for anyone with diabetes!) When it comes to alcohol, good options are light beer, a wine spritzer made with Sprite Zero or soda water, or single spirit tots with diet mixers. Sparkling water with ice, lemon and cucumber is a refreshing drink if you’re not in the mood for alcohol.
Healthy snack ideas:
- Lean proteins like nuts, lean biltong and grilled strips of chicken or beef.
- Fresh vegetables like cucumber strips, baby carrots, baby tomatoes and celery sticks, served with a low-fat cottage cheese, avo or salsa dip.
The last thing to consider is where the sundowners are being held. If you’re hosting or going to a friend’s house, you can simply bring along what you would prefer to eat and drink. Restaurants can be more challenging, but easily overcome with a bit of forward planning. Call the restaurant beforehand and make sure that there are snacks or drinks on hand that you can enjoy. Most restaurants are more than willing to help – if not, at least you know and can plan for the evening.
Having diabetes doesn’t mean you can’t enjoy a cold drink and a delicious snack as the sun goes down, it just means you need to forward plan a little to enjoy it!
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.