Category: 2017 Autumn – Diabetes Focus eMag

What it takes to have that ‘perfect’ smile…for you

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There is something rather special about a big bright smile. There is a certain warmth that we feel when greeted by someone who is smiling broadly. What is it about a full smile that makes it so attractive? Is there such a thing as a perfect smile? Marc Sher touches on some of the fundamentals of aesthetics in dentistry.

When the human eye sees things in proportion, we immediately find this attractive. This concept is known as the golden proportion or golden ratio, and is mentioned countless times in literature pertaining to cosmetic surgery and dental aesthetics. The golden proportion is an ancient concept, dating back to the times of the ancient Greeks. It has helped us understand why the relationship of adjacent shapes/objects makes it appeal to the human eye. The golden ratio is 1:0.618 or Pi, and is consistent in nature. The ratio between the front eight teeth, when looking directly at the central incisors, is one of these natural concepts that follows the golden proportion.

When the eight front teeth (smile line) of the top jaw follow the golden proportion, they will immediately look attractive; this is what we aim to achieve in dental aesthetics. It will always be a dentist and dental specialist’s greatest challenge when trying to recreate a smile.

The concept of the golden ratio is also seen in the relationship between the lips and teeth, the smile and teeth, and even the eyes and teeth. For any dentist to achieve that perfect smile for their patient, they must understand the golden ratio.

Just to clarify, the perfect smile does not exist in isolation and cannot be copied from person to person. To have a perfect smile is to have the right smile for you. Yes, we follow the principles that can help create that perfect ratio which may lead to a more attractive smile, but to try and achieve ‘perfection’ is only in the eye of the beholder.

Many dentists who specialise in aesthetic dentistry will understand the concept of a smile design. This is a process that we use to analyse a specific patient’s smile that helps guide the dental team in achieving their desired result; it involves using digital photography and videography to evaluate a patient’s smile line, lip line and central line, amongst other important features. We can use this information to digitally design a smile. It allows us (the dentist/specialist) to communicate the needs to the dental laboratory, in order, to create the ceramic/porcelain crowns or veneers which are to be bonded onto the front six to eight teeth (sometimes more) in the smile line. We then communicate this back to the patient. The use of a specialised dental laboratory is essential in this process as the dental technician is the one creating the ceramic/porcelain teeth.

The process of crowning/veneering teeth can be incredibly invasive as the tooth is usually irreversibly cut down to allow the ceramic prosthesis to fit. I, personally, do not advocate the cutting of healthy teeth to change their appearance. Once a tooth is cut/drilled on, there is no turning back. In cases where all other non-invasive options have been investigated and a tooth is already compromised, filled, broken, or missing, only then should the use of ceramics/porcelains be used.

I usually urge a patient to follow a less invasive route if they’re looking at changing their smile line. Orthodontics is my preferred method of moving teeth into their ideal proportion/relationship as orthodontists are incredibly skilled in creating the correct relationship between teeth. I always encourage my patients seeking an ‘aesthetic makeover’ to investigate the orthodontic process. This specific process does involve a sacrifice of sorts; wearing braces or retainers to move the teeth can be uncomfortable, cumbersome and obviously less attractive. However, it is important to understand that it is only a short-term sacrifice in the grand scheme of things, and the benefit is that you do not land up cutting healthy tooth structure.

“We shall never know all the good that a simple smile can do” – Mother Teresa

Tooth whitening

Tooth whitening plays a massive roll in the realm of aesthetic dentistry. I am often bombarded with requests to make my patients teeth whiter. What is important to understand, is the concept of tooth colour and staining. A natural tooth can have a variety of different levels of whites, yellows, blues and, even, greys. Therefore, we classify tooth colour in shades. This can be seen quite easily if you look at your canines; the neck of a canine has more of a yellow shade then the adjacent incisor.

Tooth whitening or bleaching changes the intrinsic (natural) shade of a tooth by penetrating the enamel layer and ‘bleaching’ the layer below, the dentine. The process involves the use of a peroxide-based bleaching agent, and a heated exchange reaction takes place. Tooth sensitivity is a very common side effect. However, it is not long-lasting.

Staining of teeth involves the extrinsic surface of the tooth. This is the after-effect caused by many of the wonderful things we love to eat and drink, such as coffee, tea, red wine, fruits, some vegetables and more. Smoking is also a major factor in extrinsic tooth staining. Fortunately, extrinsic stains can be quite easily removed by an oral hygienist or a dentist with specialised cleaning instruments. I always recommend a professional cleaning before any bleaching procedure is commenced.

All the concepts I have mentioned play a pivotal role in aesthetic dentistry. In today’s times, we can easily become obsessed with our appearance and be incredibly self-conscious of our smile. We may feel pressured to achieve perfection in our smile, and that obsession can alter the very essence of why we smile in first place. The act of smiling is far more important than the way it looks!

It is vital to protect what nature has given you by following a strict protocol of maintenance and prevention. You must also never compromise your dental health and function to achieve an aesthetic outcome. It is however comforting to know that with the help of modern technology in dentistry and with the skilled hands of a dentist, specialist and dental technician, we’re able to create beautiful bespoke smiles if needed.  

MEET OUR EXPERT - Dr Marc Sher

Dr Marc Sher (B.Ch.D) practices at The Dental Practice in Sea Point, Cape Town, and can be reached via email: marc@drmarcsher.co.za

The low down on South Africa’s sugar tax

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The Minister of Finance announced in the February 2016 National Budget a decision to introduce a tax on sugar-sweetened beverages (SSBs), with effect from 1 April 2017, to help reduce excessive sugar intake by South Africans. A revision of the proposed tax was discussed in the February 2017 Budget Speech, where it was announced that the tax will be implemented later in 2017 once further consultations have taken place. The Association for Dietetics in South Africa (ADSA) welcomes this step as one part of the solution to address the obesity problem and improve the health of South Africans.

How much sugar do South Africans really consume?

When you think of sugar-sweetened beverages, the first thing that comes to mind is the regular fizzy drink, but the term encompasses far more than that. SSBs are beverages containing added sweeteners that provide energy (calories or kilojoules) such as sucrose, high-fructose corn syrup or fruit-juice concentrates. This includes carbonated drinks (fizzy soft drinks and energy drinks), non-carbonated drinks (sports drinks, iced teas, vitamin water drinks and juice concentrates), sweetened milk drinks and sweetened fruit juices. And, many of us do not realise just how much sugar is found in these drinks. For example, a 330ml bottle of iced tea has a little over six teaspoons of sugar.

ADSA is concerned that the intake of added sugars (sugars added to foods and drinks during processing by the food manufacturing companies, cook or consumer) is increasing in South Africa, both in adults and children. Some estimate that children typically consume approximately 40-60g/day of added sugar, possibly rising to as much as 100g/day in adolescents. High intakes of added sugar, particularly as SSBs, has been shown to lead to weight gain and cause dental caries. The added sugar in these drinks makes them high in energy (kilojoules). Because these drinks don’t make us feel full in the same way that eating food does, most of us don’t reduce our food intake to compensate, making it easy to consume too many kilojoules. Over time, these extra kilojoules can cause one to become overweight, putting us at risk for diabetes, heart disease and certain cancers. Obesity is already a massive problem in South Africa, with two in three women and one in three men being overweight or obese, as well as almost one in four children.

What is ADSA’s recommendation for sugar intake?

ADSA supports the recommendations by the World Health Organisation (WHO) and the South African Food-Based Dietary Guidelines that we need to reduce the intake of beverages and foods that contain added sugars, such as sugar-sweetened beverages, sweetened yoghurts, frozen desserts, some breakfast cereals, ready-to-use sauces, cereal bars, health, savoury and sweet biscuits, baked products, canned or packaged fruit products, sweets and chocolates. The WHO advises reducing the intake of free sugars found in foods and beverages (including added sugars, but excluding sugars naturally present in fresh fruits, vegetables and milk) to less than 10% of total energy (kilojoule) intake for the day (i.e. 50g of sugar, which is approximately 12 teaspoons per day), with a conditional recommendation to further reduce intake to 5% of total energy (approximately six teaspoons per day) for additional health benefits. The South African Food-Based Dietary Guidelines also advise to ‘use sugar and foods and drinks high in sugar sparingly’. To put this into perspective, a 500ml bottle of a carbonated drink will provide your maximum sugar allowance for an entire day!

The sugar tax – is it a good idea?

The proposed tax on SSBs will mean an additional tax will be added on to the purchase price of sugary drinks, which is intended to decrease the purchase and consumption of SSBs. Encouragingly, in Mexico, a sugar tax has reduced sugary drink sales by 12% in the first year. The sugar tax is likely to affect shelf prices, but will also motivate manufacturers to reduce the amount of sugar added to their products. Initially, the proposal was for a tax rate of 20% on the added sugar content of a beverage. But in the February 2017 Budget Speech, it was announced that the proposed tax rate has been reduced to about 11%. ADSA is concerned that the lower tax rate might not be sufficiently high enough to have a significant impact on purchasing behaviour, and has submitted comments to National Treasury to motivate to strengthening the tax. ADSA welcomes the proposed tax on SSBs, but acknowledges that the sugar tax is only part of the solution to address the growing obesity problem. Just as taxing tobacco does not reduce or stop smoking by all people, taxing SSBs will not reduce or stop all purchasing and consumption of SSBs and reduce obesity on its own. Obesity is a complex condition, and sugar is not the only cause. There is a need for multiple interventions across a variety of different sectors to address unhealthy diets and lifestyles and have an impact on the obesity epidemic. ADSA recommends that revenue generated from the tax should go towards health promoting interventions, such as subsidies to reduce the costs of fruits and vegetables, education around healthy choices, and creating an enabling environment to make those healthier choices easier.

In addition to reducing the consumption of SSBs to prevent obesity and promote long-term health, ADSA continues to recommend a healthy diet which includes whole grains, fruit, vegetables, nuts, legumes, healthy oils, proteins such as lean meats and seafood, and a reduced intake of processed meats and salt, accompanied by regular physical activity.

To find a registered dietitian in your area, visit http://www.adsa.org.za/

ADSA’s detailed Position Statement on the Proposed Taxation of Sugar-Sweetened Beverages, with references, can be accessed here: http://www.adsa.org.za/Portals/14/Documents/2017/March/ADSA%20Position%20Statement%20on%20Sugar%20Tax_Updated%20post%20budget%20speech_2%20Mar%202017.pdf

This article was written by The Association for Dietetics in South Africa (ADSA).

Family ties

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Research has shown that families play a key role in how well people with diabetes adjust to the disease, integrate it into their lives, and manage it well. This suggests that good diabetes control depends on a healthy psychological environment. Rosemary Flynn advises on how to achieve this.  

You have diabetes, but in a way your family has diabetes too because you are one part of a whole family, whatever the family looks like: a partnership, married parents with children, grandparents or extended family. Each member of the family has an influence on all the others. On the one hand, how you deal with your diabetes will have an impact on your partner and family, and on the other hand how your partner and family supports you will impact you and how you handle your diabetes.

 

Creating a healthy psychological environment

If you manage your diabetes well and show that you can cope with the daily demands of diabetes, and get it right, your partner will relax and leave you to it and only be involved when you need it.

If you don’t take responsibility for your diabetes and either ignore it or defy it, your partner will become very anxious and will possibly try to persuade you to do the ‘right thing’ whether it is to do with what you eat or how you exercise or taking medications. They may do it in an annoying way and perhaps will need to learn how to do it more gently, but when you think about it, they have to deal with the stresses that diabetes brings too, particularly if you have Type 1 diabetes.

When your partner has these worries, he or she is not paranoid or unreasonable; they are natural responses because they love you. You may want to be totally independent and cope with your diabetes on your own, but if you are not being responsible about managing your diabetes, your partner will want to help. The more responsible you are, the less they will feel they need to nag you. Some of your partner’s worries would be the following:

  • Partners worry a lot about your lows when you have Type 1 diabetes. They’re afraid that you’ll have a low in the night and not wake up, or you’ll become unconscious, or have a seizure, and that they will not wake up to help you. So they often have disturbed nights, because they want to check on you at some time during the night.
  • They worry that you’ll ignore the symptoms of a low or not have the glucose you need to address the symptoms.
  • Since diabetes is not curable, they fear for your future. They really worry about complications developing, especially when your control is poor.
  • They often feel very sad that you have diabetes. They feel it as a loss as much as you do. They may fear that you will die and they will lose you. They also need to be reassured that you can overcome your diabetes.
  • When they’re being bossy, it may be because they’re afraid that you’ll get it wrong and they’ll lose you.
  • They may feel that the good relationship you had before the diabetes has been lost, and they miss what you had before.

Striking a balance is not easy. How much does your partner play a part, and how much do they leave you to get on with it? This needs to be negotiated between the two of you, until you find a way to work together without conflict. And then there are life stressors that complicate your relationship. Things like:

  • family arguments.
  • the loss of a loved member of the family or a friend.
  • the loss of a job.
  • financial strain.
  • a traumatic incident such as a car accident.
  • a violent crime that touches you.
  • excess alcohol consumption.

All of these stressors will have an impact on your relationship while you’re dealing with the difficult circumstances. Both of you will be more anxious and your responses to the anxiety can create uneasiness in the relationship. Add to that, the fact that the stress is pushing your blood glucose levels up and the situation can become quite volatile.

If the difficulty in your relationship with your partner is not resolved in a satisfactory way, conflict and reactions to the dispute can become ongoing. It is so important for you to find a way to normalise your relationship. This is vitally important to your family and to your diabetes! If you need outside help and support to do this, find the help you need.

What can families do to cope with these feelings?

  • Talk to each other about diabetes and things that have happened. Talking can help to strengthen the family bond. The idea is to communicate about the issues that are of concern to each other and the way everyone feels about it. Everyone should have a turn to speak, and each person should feel understood and supported so that the issue can be addressed constructively. Respecting each person’s individuality and situation helps to create an atmosphere of acceptance and allows for creative solutions to problems. Any diabetes information or issues can be discussed in this way.
  • Talk to other families who also have a member with diabetes. Attend family events organised by diabetes organisations or interested parties. This offers you support and helps you feel less isolated as you deal with the day-to-day care of diabetes. Sometimes other families, especially those who have many years of experience, can share good ideas on how to deal with family issues that arise because of diabetes.
  • Be committed to the decisions that are made in the family, but carry these out in a flexible way.
  • Be respectful and kind to each other.
  • Solve problems together.

This way, feelings are valued and the connection between partners and between all family members is restored and maintained.

Also remember that diabetes is in the family genetics, so each member of your family could also be at risk of developing diabetes.  It is helpful to educate your family members on leading healthy lifestyles in order to prevent another member of your family having a diabetes diagnosis.

MEET OUR EXPERT - Rosemary Flynn

Rosemary Flynn
Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Toenails – mirrors of your health

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Just as they say, ‘your eyes are the mirror of the soul’, so too are your toenails mirrors of your health – revealing information about nutritional status, general health and even an undiagnosed systemic disease.

Discolouration

The primary cause may be from trauma – either from an object dropped onto the toenail or from constant bumping inside a shoe, as suffered by runners and athletes. This discolouration is due to micro-bleeding under the nail, and will grow out with the nail over a period of months (it can take eight to 10 months for the big toenail to grow out completely). If severe bleeding occurs under the nail, the nail may detach while a new nail grows out, provided there is no damage to the nail matrix or the nail bed.

In some instances, in women who have dark skins, it may be perfectly normal for aging to bring about brown or black streaks in the toenails. These are due to changes in melanin (the natural pigment that causes skin and nail darkening).

Changes in consistency, curvature, surface texture, growth and even colour can be signs of a systemic process. For example, blue half-moons or lunulae on your toenails can indicate Wilson’s disease of the liver or silver salts deposition in argyria. In rare instances, discolouration can indicate the presence of a benign glomus tumour beneath the nail, or, even more rarely, malignant melanoma.

Extremely thick toenails (onychogryphosis)

Poor circulation in the feet affects blood supply to the nail matrix and nail bed. It is thought that the stop-start nature of poor circulation (intermittent hyperaemia) triggers the cell replication that can result in thickened toenails. Poor circulation can be present in cardiac conditions as well as in people who have high or low blood pressure, diabetes mellitus, or visible broken and/or varicose veins.

Onychocryptosis with paronychial inflammation

Onychocryptosis with paronychial inflammation

Ingrown toenails (onychocryptosis)

  • Excessive moisture can cause toenails to bend and penetrate the skin.
  • Pressure from shoes or from adjoining toes can shape or mould the toenail into the surrounding skin.
  • Growth spurts in childhood and adolescence can result in a toenail that is wider than the growing toe for a period.
  • Incorrect cutting of toenails can cause ingrown toenails.
  • Fungal infection under the toenail causes weakening of the nail plate and thus structural change in the curvature of the nail, and discolouration. People living with diabetes have an increased risk of fungal infections in the foot.
  • Trauma, such as accidentally dropping heavy objects onto the nail bed and/or the nail matrix at the source of the nail, causes a shape change in the resultant nail growth.

Footwear knowledge to prevent discoloured, thick or ingrown toenails

  • Avoid shoes that are too narrow in the front of the foot as these can restrict blood circulation to your toes.
  • Shoes that are too tight in the toe area may promote ingrown toenails.
  • Avoid shoes that have a shallow tapering toe box as these will constantly rub against the tops of your toenails. Toe muscle action is essential in preventing bunions and corns, hence why you should have enough toe room to be able to wiggle your toes inside your shoes.
  • Choose styles that do not require gripping friction from your toes, such as those that grip around the heel (either closed heel or strap), plus a strap or some form of fastening or closure across the instep of the foot.
  • Heeled shoes tilt body weight onto the ball of the foot. This can lead to toes curling inside the shoe, possibly resulting in hammer toes. Choose flats or lower heels for everyday use and reserve high heels for short one- to two-hour functions or events.

Find a podiatrist:

Podiatry Association of South Africa Toll-free number 0861 100 249

MEET OUR EXPERT - Anette Thompson

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.

Diabetes and pregnancy

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A question that many women ask is, “Can I have a baby if I have diabetes?” This is a very important question. If the pregnancy is not planned and managed correctly, the pregnancy outcome can be harmful to both mother and baby. Dr Louise Johnson explains further.

There are two types of situations that can occur: healthy pregnant women that develop diabetes during pregnancy or diabetes patients (women) that wish to fall pregnant. It is best to look at these topics separately.

Healthy women that develop diabetes

This type of diabetes is called gestational diabetes mellitus (GDM), and the risk factors for developing GDM are:

  • Being older than 35 years.
  • Having a close family member, such as a mother or father, with Type 2 diabetes.
  • Having had GDM in a previous pregnancy.
  • Being overweight with a BMI (body mass index) of over 30kg/m2.
  • Having polycystic ovarian syndrome (PCOS).
  • Having complications in a previous pregnancy with a baby larger than 4,5kg, a still born baby, or a baby with malformations.
  • Women who are of South Asian descent.

GDM has an incidence of 4% in all pregnancies. It usually develops during the second trimester; in this time, the body changes due to the adjustment in hormones and begins to be more insulin resistant. This is like the insulin resistant state of Type 2 diabetes.

As the pregnancy advances, the insulin resistance becomes worse and patients may need insulin temporarily during the last few weeks before delivery. This need will go away after the birth of the baby. The problem with insulin resistance during the last part of the pregnancy is that the body cannot produce enough insulin to manage the higher glucose levels. This glucose gets transferred to the baby and causes the baby to gain too much weight.

There are recommendations from the American Diabetes Association (ADA) that all pregnant women should be screened for GDM at week 24 with an oral glucose tolerance test (OGTT). This test is where the mother fasts from 10pm at night then at 8am the next morning, blood is drawn, she then consumes 75g of glucose and blood is collected again after an hour and then after two hours. This helps the doctor to pick up GDM early, preventing a big baby.

You will be diagnosed with GMD, if your OGTT test results are as follows:

  • Fasting glucose is more than 5,1mmol/L.
  • First hour value is more than 10mmol/L.
  • Second hour value is more than 8,5mmol/L.

The dangers of GDM are twofold: the mother can develop Type 2 diabetes about six to ten years after the pregnancy. It is important for the mother that had GDM to stay on a diabetic diet and get yearly check-ups to diagnose diabetes early, if she does develop it.

The baby will also have a higher risk to become obese, especially if it was born weighing more than 4,5kg. This baby has a risk of developing diabetes a lot earlier, even in childhood. Again, living a healthy lifestyle is important.

The risk of complications during pregnancy is the same as a mother with Type 1 or Type 2 diabetes, except there is no increased risk of organ malformations in these babies since the organs formed when the glucose levels were still normal. In the healthy female population, the risk of birth defects is 1-4%.

Patients with GDM should have a OGTT six weeks after delivery to determine if the raised glucose levels have returned to normal. Remember, the risk of developing Type 2 diabetes is more than 50%.

The diabetes patient (Type 1 or 2) that wishes to fall pregnant

The most important factor in this pregnancy is planning. Both Type 1 and Type 2 diabetes patients should only become pregnant once they have a HbA1c test result of 6,5% for three continuous months. This is important for healthy eggs and conception.

The first seven weeks are extremely important to have normal glucose control as this is the time that the baby’s organs are formed. Abnormal glucose control during this period increases the risk of birth defects and miscarriages.

More than 50% of women who have diabetes become pregnant without planning. It is vital to use effective family planning to prevent this and to plan for a healthy pregnancy.

Pre-pregnancy examinations:

  • Do the HbA1c test to determine if your result is at the correct target – 6.5% or lower.
  • Test your blood pressure, kidneys and the nerves of the feet.
  • It is important that an eye specialist does a thorough eye examination before the pregnancy and every trimester to prevent eye damage. Laser treatment may be necessary.
  • Check the functionality of the thyroid, especially in Type 1 diabetes. An underactive thyroid can cause a floppy baby.
  • Review all the current medication and stop medication that can be harmful to the baby such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and statins. This should be substituted with ‘baby friendly’ drugs as recommended by your physician.
  • Type 1 diabetes with difficult control will usually be switched to an insulin pump for the period of three months before and during the pregnancy. Type 2 diabetes will usually be started on insulin first, as a baseline, once a day and as time progresses a short-acting insulin will be introduced before each meal. Most oral medications are not safe in pregnancy, except for metformin.

It is important to be vigilant in checking blood glucose often (before each meal and 90 minutes after each meal). There are also devices available, such as Dexcom continuous glucose monitoring, that can help with this.

Type 1 diabetes with difficult control will usually be switch to an insulin pump for the period of three months before and during the pregnancy. Type 2 diabetes will usually be started on insulin first, as a baseline, once a day and as time progresses a short-acting insulin will be introduced before each meal. Most oral medications are not safe in pregnancy, except for metformin.

Blood glucose control is essential because of the risk of complications to the mother and the baby that increases dramatically with poor control.

Risk for mother:

  • Worsening of diabetic eye problems.
  • Worsening of diabetic kidney problems.
  • Increase in infections in the bladder and vaginal area, which can cause early labour.
  • Preeclampsia (a condition in pregnancy characterised by high blood pressure, sometimes with fluid retention and proteinuria).
  • Difficult delivery or caesarean section.

Risks for the baby:

  • Premature delivery.
  • Birth defects (not an increased risk for the GDM mother).
  • Macrosomia (big baby).
  • Possible damage to the nerve of the arms if the baby is big and delivered vaginally.
  • Low blood glucose at birth.
  • Prolonged jaundice.
  • Respiratory distress syndrome (difficulty in breathing).
  • Twitching of the hands and feet due to low calcium and magnesium, which is a direct effect of uncontrolled glucose.

What should the glucose target be during pregnancy?

• HbA1c result below 6%. • Fasting glucose 3,5-5,9 mmol/L. • One hour post eating <7.8 mmol/L.

After the pregnancy

Patients with Type 1 and Type 2 diabetes can breastfeed if there is no sight-threatening bleeding or the possibility thereof in the eyes.

Advice for women with diabetes who breastfeed:

  • Breastfeeding will make the glucose a bit more difficult to predict because there are carbohydrates that are going to the baby through breastmilk.
  • Check the glucose before breastfeeding and if below 5mmol/L, eat a 15g snack.
  • Keep a snack ready to eat, to prevent having to interrupt the breastfeeding.
  • Drink enough liquids, especially water or caffeine-free tea, while nursing.
  • Low blood sugars are much more common during night-time nursing. Add a snack or reduce night-time medication. Discuss this with a doctor.

Insulin needs fall dramatically after delivery and medication should be adjusted to prevent hypoglycaemia (low blood glucose). Contraception should also be discussed for future planning.

Another question that is normally asked, “What is my child’s risk of getting diabetes?”

If the father has Type 1 diabetes, the risk is 8-9%.

If the mother has Type 1 diabetes, the risk is 2-3%.

If the father has Type 2 diabetes, the risk is 15%.

If the mother has Type 2 diabetes, the risk is 15%.

If both parents have Type 1 diabetes, the risk is less than 30%.

If both parents have Type 2 diabetes, the risk is 75%.

Final thought

My advice to the diabetic mother and her partner is to follow the rules and consult with the healthcare providers regularly and the beautiful reward for the perseverance will be a healthy baby. I know this is a lot of hard work but there is a silver lining. After this pregnancy, you will have learned how to take control of your health and have had the opportunity to develop healthy habits, which you can take with into your future for you and your family.

References:

  • Amod A, Motala A, Levitt N et. al. (2012) ‘The 2012 SEMDSA guideline for the management of type 2 diabetes.’ JEMDSA, 17 S1-94.
  • Dornhorst A, Banerjee A (2010) ‘Diabetes in pregnancy. Textbook of diabetes 4th edition, Oxford Wiley Blackwell.
  • Metzger BE, Gabbe SG, Persson B et. al. (2010) ‘International association of diabetes and pregnancy study group consensus panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycaemia in pregnancy.’ Diabetes Care, 33 p676-82.
  • Sacks D. (2011) ‘Diabetes and pregnancy: a guide to a healthy pregnancy for women with type1, type 2 and gestational diabetes.’ 1st edition, American Diabetes Association Virginia.

MEET OUR EXPERT - Dr Louise Johnson

Dr Louise Johnson
Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

When food stands still

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Dr Angela Murphy shares one of her patient’s stories to explain the connection between diabetes and gastroparesis.

Ms DL is a 28-year-old lady, who was diagnosed with Type 1 diabetes at the age of 15. She had poor control from the start due to not being able to accept the diagnosis. She was admitted regularly with diabetic ketoacidosis, with extreme dehydration. During these episodes, she would go into renal failure. Closer questioning revealed that symptoms would begin with nausea and vomiting. She had been experiencing bloating after meals for over a year.   A gastric emptying study was done, which showed significant gastroparesis.

What is gastroparesis?

It is a condition where the stomach does not empty properly, resulting in food not moving into the small intestine. Normally, the muscles of the entire gastrointestinal tract contract and release rhythmically to move food along, which is necessary for the digestive process. This muscle action is controlled by the vagus nerve. However, damage to the vagus nerve results in weaker, poorly contracting muscles and slows the movement of food out of the stomach.

Causes

Unfortunately, there are many causes – it can occur as a complication of surgery to the gastrointestinal tract; as part of neurological disorders; infective and inflammatory conditions; or in underactive thyroid disease. Over a third of cases are due to diabetes, and in some cases no specific cause can be found.

Poorly controlled diabetes can result in damage to the vagus nerve, and is the most common known cause of gastroparesis. Patients classically present with stomach pain, bloating, indigestion, nausea and vomiting. In an insulin-dependent diabetic patient, vomiting will lead to ketones, and the presentation may look like an episode of ketoacidosis. In addition, patients may have documented reflux disease or irritable bowel syndrome (IBS), and the symptoms may be attributed to these conditions. A careful examination and history is needed to work out the sequence of events.

Diagnostic tests

Ms DL had a variety of tests to diagnose her problem, such as:

  • Upper gastrointestinal gastroscopy is performed by either a gastroenterologist or a surgeon, and can be carried out as an outpatient. The patient fasts for six hours, then a flexible camera is used to look inside the oesophagus, stomach and the duodenum (the first part of the small intestine).
  • Barium meal and follow-through is when a patient must fast for eight hours and then drinks barium – a chalky type liquid – that is used as the contrast agent. A series of X-rays are then taken. Barium lines the gastrointestinal tract so will show any obstruction, such as food in the stomach, quite clearly on the X-ray.
  • Ultrasound allows the radiologist to exclude any disease of the gallbladder or pancreas.
  • Gastric emptying scintigraphy is usually the gold standard for diagnosis. The patient fasts from the night before and is then required to eat a bland meal which is radiolabelled with technetium. A camera then scans the abdomen to follow the progress of the radiolabelled food hourly for four hours after a meal. If more than 10% of the meal is in the stomach after four hours, the diagnosis of gastroparesis is made.

Treatment

Ms DL was started on domperidone (prokinetics) and erythromycin (antibiotic). After 10 months, the episodes returned despite medical treatment. She then had a gastric pacemaker inserted, which only seemed to give benefit for six months. Ms DL recently spent weeks in hospital being treated with anti-nausea medication and intravenous fluids. Unfortunately, there was no way to improve the result with the pacemaker so she was given the option of Botox injections; however, the relief in symptoms after this was very short. After almost two years of suffering, Ms DL underwent a sleeve gastrectomy. (See medical explanations below).

  • Prokinetics are drugs that improve the contraction of the stomach muscles, and move food through to the small intestine more effectively.
    • Metoclopromide is the active ingredient in Maxalon and Clopamom. This should be taken 20-30 minutes before meals. It helps reduce nausea and vomiting. Although it is approved for gastroparesis, it may have side effects, such as tardive dyskinesia – a movement disorder which causes shaking.
    • Domperidone
  • Erythromycin is an antibiotic. When it is prescribed chronically at low doses, it improves stomach muscle contractions. Unfortunately, it can also cause nausea and stomach cramps which limits its use in the gastroparesis patient.
  • Anti-emetics are anti-nausea drugs.
    • Prochlorperazine (Stemetil) is useful when the patient is acutely ill, however, it has even more side effects with chronic use than metoclopramide.
  • Antipsychotic drugs
    • Chlorpromazine (Largactil) has frequently been used in patients with severe, persistent hiccups. Its actions on muscle have also worked in the patient with gastroparesis with some degree of success.
  • Botulinum toxin is used when a gastroenterologist injects Botox directly into the pylorus (the valve between the stomach and duodenum involved in the rate of gastric emptying) using an endoscope. This relaxes the valve, keeping it open for longer periods allowing food to pass through. The results of Botox are quite variable; some patients have relief of their symptoms for months, while others find no improvement.
  • Gastric pacemaker is a neurostimulator device which can be surgically implanted. This is normally done in patients with symptoms not responding to medication and diet changes. The battery-operated device has electrodes that are inserted into the stomach muscle wall. This then sends signals at regular intervals to stimulate the stomach muscle.   Studies have found that sending pulses that have a higher frequency than normal gastric contraction improves nausea and vomiting more effectively. However, more work needs to be done to refine this treatment for patients.
  • Jejenostomy is a feeding tube which is placed through the abdominal wall directly into the jejunum (the second section of the small intestine). Special, balanced liquid food can then be given to the patient. It is commonly used in a malnourished, dehydrated patient.
  • Surgery
    • Sleeve gastrectomy is a near total gastrectomy performed via keyhole surgery.
    • Roux-en-Y gastric bypass is when a small pouch is made from the top of the stomach and is attached to a loop of jejunum.

In both these surgeries, by removing most of the functional stomach it is possible to relieve symptoms of nausea and vomiting. Patients must be well-prepared, even though the dietary changes required are essentially the same as they should be following: small regular meals (see info on diet below).

Surgery is the treatment of last resort, but in my patient, this was life-changing. In the months post-surgery, she has had fewer and fewer episodes of vomiting. Generally, her symptoms have declined and her quality of life has improved incredibly.

Diet

There are several useful measures patients can take to improve symptoms:

  • Eat six small meals a day; this gives the stomach a chance to empty.
  • Limit the amount of fatty foods.
  • Limit fibre as it also takes longer to digest.
  • Eat in an upright position.
  • Avoid late evening meals.
  • Avoid carbonated drinks.
  • If the patient is very symptomatic then a liquid diet is the best choice until improvement.

Gastroparesis and diabetes

There is no doubt a vicious cycle exists when diabetes and gastroparesis occur together; high blood glucose directly slows down gastric emptying. Poor diabetes control for more than 10 years increases the risk of damage to the autonomic nervous system. The autonomic nerves control the automatic functions of the body, such as heart beat, blood pressure and gastric emptying.   The erratic emptying of food into the small intestine makes timing of insulin doses very difficult, and patients often swing from high to low blood glucose levels. It may be necessary to change the insulin regimen to get better control, and frequent blood glucose testing is vital.

Gastroparesis severely impacts a patient’s quality of life. Most patients with gastroparesis will respond to dietary changes, prokinetics and erythromycin.   However, for those that don’t, it is important to pursue more invasive treatment until relief of symptoms is achieved.

MEET OUR EXPERT - Dr Angela Murphy

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She is part of the Netcare Sunward Park Bariatric Centre of Excellence and has a busy diabetes practice.

Are we only knocking on social media doors?

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When last did you call a friend or have a friend call you? Or are your relationships dependent on digital technology?

It is tough to experience the heart-wrenching loneliness in a connected world. The sad reality is that many people are experiencing loneliness while they are seemingly having so much fun in the social media world.

When we experience hard times, it can become apparent that people don’t visit. Yes, they check-in via Facebook, WhatsApp, and the rest of the myriad of social media applications, either by sharing inspirational messages, jokes or virtual hugs to brighten your day. However, deep down we all long for someone to knock on our front door. Someone who has taken the time to see if what you’re posting online is the reality at home. Someone who cares enough to put their busy schedule aside to look you in the eyes and find out how you’re really doing.

This is the friend who wouldn’t mind that you’re still in your pyjamas, even though it’s early afternoon. This is the friend who understands that the selfie you posted earlier today, doesn’t really reflect what you actually look like at present, because you just didn’t have the strength to get dressed. This is the friend who not only wants to reach out to you, but who needs you too. Remember, while your life changes, friends and family do their utmost best to support you and adjust, but they might not know how to.

We, as a society, give so many  detailed updates about what we are going through, where we are, what we are eating, how we feel, and what we’re experiencing that friends start thinking that they don’t need to call to find out how we are doing, as they already know thanks to social media – they have ‘checked-in’ via Facebook by clicking  on the ‘Like’ button.

The reality is while one person is fighting a physical health battle, someone else is struggling through depression. Another person is experiencing the loss of a loved one, while another is dealing with the heartache of a friend who has been diagnosed with a life-threatening disease. The point is we all need each other! And, don’t forget about the friend who has finally hit their ‘lucky break’ after three years of hard work and perseverance. Friends also need us to celebrate with them.

When I was a little girl, I remember watching my mom as she was having a phone conversation. It was so different from the mobile device conversations my son observes me having. She would hold the phone, while sitting still next to the receiver, which was connected to the source. She was attentive, really involved and so focused on the conversation. She memorised phone numbers and had a handwritten phonebook. Having a telephone conversation was an occasion to look forward to and a moment to connect.

These days, we rarely call. We depend on social media and electronic messages to keep our relationships alive. We take phone calls while driving or cooking dinner, with the phone clinched between a squashed cheek and stressed out shoulder. 

Are we having quality conversations? 

Are we aware of the tone of voice, the heavy pauses and real intention of the call? 

Having a long list of Facebook ‘friends’, hundreds of WhatsApp messages and Instagram followers may create the sense that we matter, that we belong, and that we’re needed and cared for. Yet, the feeling of loneliness doesn’t go away, no matter how many messages we receive.

The digital knock on the door just cannot feed this hunger. We all long for a real personal connection and a voice that shares empathy and compassion. Better yet, we crave eye contact and a hug from a human being. The increase in compassion deficit syndrome, especially amongst the youth, is alarming. We have to be aware of this side effect of an overdose of social media and being bombarded with messages from all platforms.

Digital communication does offer various benefits, and it certainly has made positive impacts on many levels. That said, it seems that it is quite difficult to keep a balance and to  guard against the fear of missing out (FOMO).

We’re expected to be available every minute of the day, however, perhaps it’s time to put on a new pair of glasses to get a better perspective, and to nurture those relationships that matter.

All we are actually doing is going back to basics. It will take some effort, time and, possibly, cost you money to enjoy that coffee together or to make the phone call. However, when it comes to extraordinary relationships, the ones that fulfill your needs and purpose, the value far outweighs the investment you make – bit by bit.

How to stay connected by disconnecting:

  • Call people on their birthdays. You can still wish them blessings on their Facebook profiles, however, they’ll appreciate hearing your voice, and, if possible, seeing you on their special day. 
  • If friends are going through difficult times, call them with the intention to listen or, better yet, go visit. You then can share motivational cell phone messages as extra encouragement once you have better context. 
  • When a friend is experiencing trauma, it can be hard to find the right words to say. In fact, most of the time, we really have to be very careful with the words we use, because even though it is meant well, it could hurt. How about a visit? Yes, actually going to your friend’s house and knocking on the door. Then just sit with them, be there in the stillness by lending your ears and hugs as they process what they’re going through in the safety of your comfort.
  • Schedule face-to-face visits ahead of time (even if it’s once every three months) to ensure it happens and you don’t get to the end of the year, wishing you had a chance to share time together.
  • Be there for each other. A message is not going to help feed your friend’s family if she has just had surgery and can’t prepare dinner. She’ll appreciate it if you run to the shops for her or bring over a cooked meal.
  • Ask for help. By dropping the ‘all is ok’ mask and asking for help, you can receive blessings and solutions. If you prefer to act the role of the perfect Pinterest woman with everything balanced and perfect, you might have to cry alone, and miss the opportunity to learn from others who have gone through the same dark valley. 
  • Accept help from friends. It might be their love language and a way for them to support you. If you don’t accept the help offered, you could be rejecting the blessing sent to you, and miss the opportunity to allow a friend to be there for you in a tangible way.
  • Oh, and those wonderful unexpected calls. Is it not lovely when a friend calls just say hello and reminds you that he/she cares? Take a moment every day to call a friend and thank them for their friendship, and remind them how magnificent they are. 
  • Time to collect mail from your postbox. Can you imagine the surprise and joy when you receive a handwritten letter from a friend? The time that is used to put pen to paper shows that you treasure that extraordinary friend even more.

MEET OUR EXPERT - Rianette Leibowitz

Rianette Leibowitz (@Rianette) is a cyber safety activist for SaveTNet Cyber Safety (@SaveTNet), which aims to save lives by creating awareness of responsible online engagement. Her upcoming book Not For Sale – Relationships of Influence talks about the power of extraordinary relationships of influence.
Rianette Leibowitz (@Rianette) is a cyber safety activist for SaveTNet Cyber Safety (@SaveTNet), which aims to save lives by creating awareness of responsible online engagement. Her upcoming book Not For Sale – Relationships of Influence talks about the power of extraordinary relationships of influence.

Agents for Change by Noy Pullen

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African traditional medicine and Western medicine:

how, when and where can we meet?

The significance of the traditional healer in contemporary society

The World Health Organisation (WHO) estimates that 80% of people in Africa regularly consult traditional healers, and advocates incorporating safe and effective traditional medicine into primary healthcare systems1.

South Africa was one of the first countries to recognise the significance of collaboration. In 2005, parliament approved a law to recognise the country’s estimated 200 000 healers as healthcare providers in an attempt to bring traditional healers into a legal framework2. Recent meetings, held in Pretoria, have strengthened relationships and possibilities for collaboration between the Department of Health and the recognised traditional medicine organisations.

Credo Mutwa – renowned Zulu sangoma and author – experienced both Western Christianity and traditional African folklore as a child. In his view, traditional and modern medicine both serve the well-being of their patients and contribute to a healthy community. However, traditional healing encompasses body, spirit, the personality and ancestors of a patient, and the prescription of traditional medicine, whereas the formal health sector tends to focus on specific symptoms, treating the disease rather than the individual situation3.

Dr Velaphi Mkhize, an initiate regarded as an authority on African traditions, culture, ancestral wisdom and African healing, pleads for recognition of both disciplines in his comprehensive article: ‘Africa’s two worlds of healing: their challenges’. As the origin of both is Ancient Egypt, Western medicine should acknowledge the African uniqueness of being able to heal both the physical body and the soul, which allopathic medicine does not claim to do. Some conditions cannot be cured by Western medicine and others cannot be cured by African medicine so the two systems need each other in service of all South Africans. He posed the question: How can we marry the two for the betterment of our communities and for humanity?4

Can training in diabetes management emulate the success of the HIV/AIDS model in KwaZulu-Natal?

The South Africa prevalence (> 7%), increasing and risk factors (BMI, obesity and cholesterol levels) for diabetes make a case for urgent intervention and cooperation of health practitioners in all our communities5. Dr James Hartzell, a professor at South Africa’s University of KwaZulu/Natal medical school, initiated a project to improve collaboration between doctors and 350 healers trained in caring for people with HIV/AIDS.

In his experience, people take their traditional healers seriously, and when the healers are willing to be trained, they recognise symptoms and refer to the health facilities. When referring patients to the clinics, they wish to be regarded as part of the team. According to Dr Hartzell, “They are just asking for at least basic information back from the biomedical team, which is often hostile to them, such as what were patients given in terms of treatment.”

The training of 350 healers included prevention, voluntary counselling and testing, home-based care and antiretroviral therapy. The healers are empowered to make an impact on patient compliance and management when there is collaboration with the biomedical team. Traditional healers can assist with advice on good nutrition, lifestyle changes, a positive attitude, and many good herbal remedies strengthen the immune system6. Together with the formal healthcare sector, they could ensure improvement in diabetes awareness, prevention and management.

Why are they sidelined?

For the most part, healers, according to Itai Madamombe, a United Nations staffer, are not officially recognised by governments. Not including them in the formal structures could have serious consequences. Patients, putting their trust in the healer, may disregard their medical doctor’s advice or take herbal medicines without regard for possible dangerous interactions with pharmaceuticals. By working with these healers, doctors would find colleagues in the patient’s own community7.

Collaboration with all stakeholders

As an outreach project of Diabetes South Africa (DSA) – Agents for Change – seeks to empower all those living with (i.e. patients and families) and working with (i.e. health providers) diabetes-related conditions with knowledge and skills, so they can collaborate as a team.

Traditional doctor and community leader, Joseph Makhubu, recently heard about the project and, with great enthusiasm, booked 30 traditional healers and invited us to Duduza Township in Ekurhuleni to offer the first module of the Agents for Change training. This module focuses on the pathophysiology of diabetes, signs and symptoms, risk factors, and the significance of lifestyle changes of the participants themselves.

He explained that the formal health sector has shown continued interest in the role of sangomas and the efficacy of their herbal remedies. Some of which are being researched include buchu, aloe and Sutherlandia frutescens. On the other hand, traditional healers were most willing to be a part of the diabetes team and to learn more about diabetes and how the two disciplines can collaborate for the benefit and health in the communities.

Dr Henning Morr – a medical doctor supporting departmental programmes, training and research, including community health and community development – works with traditional doctor Joseph Makhubu. Their research found that traditional healers empowered with basic medical knowledge feel safer in their decisions and have more patients. ‘Co-educational’ training is requested, role plays, dialogues, not aiming at shifting traditional healers to the modern system, but rather to understand and find ways of collaboration8.

A role play between Dr Ethel Ndlovo Phillips and traditional doctor Joseph Makhubu during the Agents for Change project.

A role play between Dr Ethel Ndlovo Phillips and traditional doctor Joseph Makhubu during the Agents for Change project.

How, when and where can we meet?  

In the South African medical Journal, J P de V van Niekerk, posed the question: how is it possible for such a diverse and often conflicting range of systems and views to be accommodated sensibly, peacefully and to the benefit of South Africa’s people? He concludes in his editorial, that establishing a council for traditional healers could face insurmountable problems. However, acceptance and respect for their respective domains of truth has enabled health professionals to collaborate successfully with traditional healers to address some of South Africa’s major health challenges9.

References:

  1. Traditional healers boost primary health care – Reaching patients missed by modern medicine Itai Madamombe <http://www.un.org/africarenewal/taxonomy/term/290> : Africa Renewal: January 2006 <http://www.un.org/africarenewal/taxonomy/term/322>  www.un.org/…/traditional-healers-boost-primary-health-care
  2. Ibid
  3. http://credomutwa.com/books/zulu-shaman/
  4. http://soaha.org.za/wpp/africas-two-worlds-of-healing-their-challenges
  5. http://www.idf.org/membership/afr/south-Africa
  6. http://soaha.org.za/wpp/africas-two-worlds-of-healing-their-challenges  (Footnote 1)
  7. Ibid
  8. 2010: Morr H., Makhubu, J., McKay V.: “Primary health care and traditional health practitioners (THP): lessons learned from a comprehensive health and life skills pilot project in Duduza, South Africa” Oral presentation, Traditional Medicine Conference, Durban, July 2010.
  9. South African Medical Journal March 2012, Vol. 102, No. 3 SAMJ editorial www.samj.org.za/index.php/samj/issue/view/123/showToc

Agents for Change is sponsored by:

Healthy eating – a family affair

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A healthy meal plan isn’t just for people with diabetes. In fact, the dietary guidelines recommended for people with diabetes are the same as those recommended for the rest of the population. That means your family doesn’t need to prepare separate meals for you at home – they can simply adopt your healthy habits. Follow these 10 tips to build a balanced and healthy meal plan for your whole family.

  1. Enjoy a variety of foods.

Not one food can deliver all the necessary nutrients for you and your family, so you should make sure that your family eats different types of food.

  1. Make starchy foods part of most meals.

A small portion of good quality carbohydrates helps to give the body energy. Choose high-fibre starchy foods – like high-fibre breakfast cereals, whole grain bread and wholewheat pasta – over more refined versions for sustained energy to help your family through the work or school day.

  1. Eat dried beans, split peas, lentils and soya regularly.

Beans and legumes are good sources of protein, fibre and B vitamins, and they also help to improve blood glucose control. Aim to include beans and legumes in your family’s menu at least twice a week.

  1. Eat plenty of vegetables and fruit every day.

Vegetables and fruit contain loads of different nutrients, like fibre, vitamins and minerals. Your family should eat at least five portions of vegetables and fruit daily to make sure they get a variety of nutrients needed for health.

  1. Have milk, maas or yoghurt every day.

Encourage your family to enjoy at least three servings of dairy foods per day to ensure they develop strong, healthy teeth and bones. Aim to choose versions with less added sugar where possible.

  1. Drink lots of clean safe water.

Water is the best way for your family to stay hydrated and should be their first choice when choosing a beverage. It is the cheapest yet best drink of all. Start your children on water when they are young and it will remain a good habit for the rest of their lives.

  1. Use salt and food high in salt sparingly.

Eating too much salt increases your risk of high blood pressure (hypertension) and health conditions in the long term. Let your family enjoy the natural taste of foods by not adding salt to meals and avoiding salty ingredients in your cooking, such as stock cubes and soup powders.

  1. Use sugar and food and drinks high in sugar sparingly.

Limit foods with added sugar, like cookies, sweets, chocolates and sugar-sweetened drinks. Keep sugary foods as ‘special occasion’ treats, and practice portion control when you do enjoy them.

  1. Fish, chicken, lean meat and eggs can be eaten daily.

Protein helps to provide the body with strength and structure, while repairing damage and promoting growth. Including protein in your meals also helps to improve blood glucose control. Oily fish is also a great source of omega-3 fatty acids which helps to protect against heart disease.

  1. Choose good quality fats.

Beware of eating excess saturated and trans fats. When you and your family use fats, choose unsaturated sources like olive and canola oil, oily fish, tub margarines, avocado, peanut butter and nuts.

Pick n Pay Health Hotline

Did you know that Pick n Pay employs a registered dietitian to provide free food and nutrition-related advice to the public? Whether looking for guidelines on managing your condition, weight loss tips, healthy eating tips for kids, how to manage food allergies, how to interpret food labels or any other food-related query you have always wanted answered, our registered dietitian is just a phone call away.

Contact the Pick n Pay Health Hotline on 0800 11 22 88 or email healthhotline@pnp.co.za to start your nutrition conversation.

Click here for delicious recipes

MEET OUR EXPERT - Leanne Kiezer

Registered Dietitian BSc Diet, PgD Diet UKZN, MSc Nutrition NWU. Leanne joined Pick n Pay as the resident dietitian in May 2014. She is the voice behind the Pick n Pay Health Hotline, providing advice to customers on a range of nutrition and health-related topics. She also provides nutrition input as part of the Pick n Pay food development team, and ensures that all communication is in line with the most recent advances in nutrition science and research.

Recipes by Pick n Pay

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People with diabetes can still enjoy pasta! Just remember to choose the whole wheat, higher fibre version, and keep your pasta servings controlled, eating no more than one cup of pasta at a meal.

These pasta dishes, as cooked by Justine Drake on Just Cooking, bring you healthy, heart-warming and easy-to-prepare meal solutions as things begin to cool down towards autumn – brought to you by Pick n Pay! See more of what Justine and the Fresh Living team have been preparing by visiting www.picknpay.co.za

Ingredients

  • 300g whole wheat fusilli, cooked and cooled
  • 4 baby marrows, sliced lengthways and chargrilled
  • 1 red pepper, chargrilled, peeled and sliced
  • 250ml leftover chicken, shredded
  • 500ml baby spinach

Hummus dressing

  • 125ml plain low-fat yoghurt
  • 60ml hummus
  • 60ml freshly squeezed lemon juice
  • 5ml ground cumin
  • 5ml ground coriander
  • 1 dash milled pepper

Method

  • Toss salad ingredients together.
  • Whisk dressing ingredients together, pour over salad and mix well.

Ingredients

  • 500g whole wheat spaghetti
  • 400g pilchards in tomato sauce
  • 1 glug olive oil
  • 4 garlic cloves, sliced
  • 1 pinch dried chilli flakes
  • 1 handful Calamata olives, pitted
  • 30ml capers
  • 1 handful flat-leaf or curly parsley, chopped
  • 1 dash salt and milled pepper
  • 1 squeeze lemon juice

Method

  • Cook the spaghetti according to the packet instructions.
  • Drain the pilchards, reserving the sauce.
  • Break the pilchards into chunks.
  • Heat the oil and fry the garlic and chilli flakes until fragrant.
  • Add the reserved tomato sauce and heat. Add a splash of water if needed.
  • Stir in the pilchards, olives and capers and cook for a minute or two.
  • Add the parsley, and gently toss the mixture through the cooked spaghetti.
  • Season and drizzle with a little lemon juice.

Ingredients

  • 1 glug olive oil
  • 1 bunch spring onions
  • 1 garlic clove
  • 2 x 170g cans tuna in brine, drained
  • Finely sliced peel of ½ fresh lemon
  • 1 fresh lemon, juiced
  • 125ml chicken or vegetable stock
  • 1 cup cherry tomatoes (optional)
  • 80g rocket leaves
  • 1 handful basil
  • 1 handful fresh parsley
  • 1 dash salt and milled pepper
  • 500g whole wheat spaghetti, cooked

Method

  • Heat the olive oil.
  • Fry the spring onions and garlic for a second or two.
  • Add the tuna and lemon and stir-fry for two minutes.
  • Add the stock and tomatoes and cook for a minute.
  • Add all the herbs and season.
  • Toss into the hot spaghetti.

Great things to add:

Shaved baby marrows, fresh chilli, broccoli florets, olives and/or capers.

Spicy Tomato and Brinjal Penne

Tomatoes are a great source of the antioxidant lycopene. Serves 4

Ingredients

  • 1 packet of whole wheat penne
  • 1Tbsp. olive oil
  • 1 red onion, chopped
  • 2 cloves of garlic, chopped
  • 2 medium-sized brinjals, sliced
  • 3ml dried chilli flakes
  • 1 can of tinned tomato
  • 250g cherry tomatoes
  • 45ml tomato paste
  • 80g reduced-fat feta

Method

  • Cook the pasta according to packet instructions. Drain and set aside.
  • Heat that oil in a pan and fry the onion until soft.
  • Add the garlic and fry for another minute.
  • Add the brinjal, and sauté for a further 10 minutes.
  • Add the chilli, tinned tomato, cherry tomatoes and tomato paste, and simmer covered over a low heat for 10 minutes.
  • Dollop sauce over the pasta and serve sprinkled with feta.

Shopping List

The ingredients referred to in the recipes above are available from Pick n Pay:

Vegetables
Baby marrows
Red pepper
Baby spinach
Spring onion
Tinned tomato
Brinjal
Cherry tomatoes
Red onion

Condiments
Chicken or vegetable stock
Tomato paste

Fruit
Lemon

Protein
Chicken breasts
Plain low-fat yoghurt
Pilchards in tomato sauce
Tuna in brine
Fat-reduced feta

Starch
Whole wheat fusilli
Whole wheat spaghetti
Whole wheat penne

Fats and oils
Hummus
Olive oil
Calamata olives

Herbs and spices
Ground cumin
Ground coriander
Milled pepper
Fresh garlic
Dried chilli flakes
Salt
Fresh parsley
Rocket
Basil

Other
Capers

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Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs the services of a registered dietitian to provide food and nutrition-related advice to the public. For all your nutrition and health-related queries, email healthhotline@pnp.co.za or call 0800 11 22 88.