Category: 2022 Autumn – Diabetes Focus Online

Peanut Buttery Biscuits

Suganon Peanut Buttery Biscuits

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These delicious Peanut Buttery Biscuits are made with sugar-free Suganon Xylitol and are so simple to make.

Ingredients

  • ½ cup almond flour
  • ¼ cup Suganon Xylitol
  • ½ t baking soda
  • ½ t Himalayan rock salt
  • 1 egg
  • ¼ tsp cinnamon
  • ¼ tsp ground cloves
  • 1/3 cup unsweetened peanut butter
  • 1 tsp vanilla extract

Method

  1. Preheat the oven to 180°C.
  2. In a large mixing bowl, combine almond flour, Xylitol, baking soda and salt together.
  3. In a separate bowl, beat the egg, peanut butter and vanilla together.
  4. Combine the wet and dry ingredients until thoroughly mixed then roll into balls, approximately 8-10.
  5. Lay the balls out on a baking sheet lined with parchment paper, lightly flattening each one down with a fork.
  6. Bake for 10-12 minutes, then allow biscuits to cool and harden.

Suganon is a range of great tasting sugar alternatives to help you maintain a healthier lifestyle.

Visit shapesuganon.co.za

Adcock Ingram Healthcare (Pty) Ltd. Reg. no. 2007/019928/07. Private Bag X69, Bryanston, 2021, 1 New Road, Erand Gardens, Midrand. www.adcock.com
Customer Care: 0860ADCOCK/232625

five elements

How to balance the five elements through reflexology

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Reflexologist, Veronica Tift, elaborates on how, if unbalanced, the five elements can cause ailments and pain.

Take a moment to think about how completely and totally unique you are. Everything about you is like no one else on this planet of 7,5 billion. Your fingerprints, personality, genomes and cellular operating instruction are all unique to you. How incredible!

This is where many ancient healing practices had it right, looking at us as the unique humans we are and our deep connection with earth and its elements. Observing the changes in nature and the changing cycle of us humans: birth, adulthood, maturity, aging and dying.

Using five essential features of nature: fire, earth, wood, metal (or air) and water, ancients explained the complex traits of our bodies and minds. These are not literally the elements that make up our bodies, but more metaphorically.

One of these elements is produced by one element and then produces another, this creates a cycle of the five elements within each of us that require balance.

The five elements

The five elements, fire, earth, wood, metal (or air) and water, are broken down into different categories. These include seasons, physical traits, body type, taste, colour, emotion and sound.

While a person is made up of all five elements, there will always be one or two more dominant. So, for example, if we look at the different emotions, you might be quicker to anger or feel frustrated easily (a trait of people with a dominant wood element), or you are incredibly well-organised (like metal element types). Maybe you are more introspective (like those with a strong water element), or possibly you struggle with depression or are passionate (a dominant fire element).

When we experience extremes in our mood, tastes, sense of smell or even over doing it on a colour, this can indicate that there is an imbalance in that related element.

Each person’s element requires different ways of bringing their individual element into balance. A fire dominant will need lively, energetic people with fun activities to help balance emotions, while an earth dominant will look to supportive friends and family, or metal dominant will detach for a while when under stress.

Imbalance in elements causes illness

Ever wondered why you seem to struggle more at different times of the year? The elements correspond with a season: water with winter; wood is with spring; fire with summer; metal with autumn; and earth with late summer.

Extreme imbalances in nature produce forest fires that rage out of control, and flooding and massive storms. When we think of extremes and imbalance in the body, we see illness, fevers, indigestion, high blood pressure and pain. Balancing the five elements within us help generate well-being and enable us to cope better with stressors.

Find balance with reflexology

Reflexology is a very well-rounded complementary therapy. When a client comes into my practice for the first time, I ask a couple of questions. For example, what emotion seems to come up when stressed and the time of the day when they feel extremely tired.

I notice the quality of a person’s hair and the colour of the clothes they might wear often when coming to see me, even what tone of voice a person speaks in: if they have a slight way of singing (earth) or speak in a shouty way (wood). All this tells me what element might be out of balance.

Then when I begin working on the feet, I have a better understanding of what the client’s needs are based on which element might be out of balance.

The body is mirrored on the feet through points called reflexes. Looking at the element out of balance, I can stimulate the reflex that best allows balance to be restored through the body’s own healing ability.

Help yourself

There are many online resources to find out which element might be your dominant and the best ways to balance it.

Visit your local reflexologist. Make sure they are trained in the elements and meridian therapies. This will help you delve deeper into the incredible world of the five elements, giving you specific insight on how to take care of yourself.

Note, as reflexologists, we should never claim to cure a specific disease or diagnose. If you have experienced this with a reflexologist, they might not be qualified to practice.

References:

Dougans, Inge. 2005 Reflexology- the 5 elements and their 12 meridians a unique approach

Axe, Dr Josh. 2021, Ancient Remedies for modern Life

Haas. Dr Elson M. 1981, Staying healthy with the seasons

Wills Pauline. 1995, The reflexology manual

MEET THE EXPERT

Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.

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prediabetes

Prediabetes: what you need to know

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Dr Angela Murphy goes into detail about prediabetes and highlights that healthcare providers need to provide specific, useful information to stop the progression.

Mrs T, a 65-year-old lady, has just been told she has prediabetes. She relays this information to her daughter describing it as ‘a touch’ of diabetes. She has been told that she must just avoid sugar and she will be fine. Her daughter, however, wants to know more and asks the following questions:

What is prediabetes?

Prediabetes includes the conditions: impaired fasting glucose and impaired glucose tolerance. These describe levels of blood glucose that are higher than normal but not yet in the diabetic range. These higher glucose levels are associated with a significantly higher risk of developing cardiovascular disease as well as progression to diabetes.

How is prediabetes diagnosed?

There are international guidelines set out to diagnose diabetes and prediabetes. Over the last decades, the goal posts have been moved several times in the diagnosis of prediabetes.

Blood glucose levels are measured fasting after eight hours of no food or drink, or two hours after a glucose challenge. This is given as a drink containing 75g of glucose. Your healthcare provider will ask the laboratory to do an oral glucose tolerance test (OGTT). This is the only test that can diagnose impaired glucose tolerance and is considered a sensitive test to diagnose prediabetes.

To definitively diagnose prediabetes, two tests should be done on separate days.

Table 1 shows the glucose levels for normal, prediabetes and diabetes.

TABLE 1: DIAGNOSIS OF PREDIABETES

NORMAL PREDIABETES DIABETES
FASTING GLUCOSE (mmol/L) ≤ 6,0 6,1-6,9 ≥ 7,0
2-HOUR GLUCOSE*(mmol/L) <7,8 7,8-11,0 ≥ 11,1
HBA1C % ** ≥ 6,5

*2-hour glucose level after a 75g glucose challenge

**HbA1c is not used in the categorization of prediabetes

Where: Fasting is defined as no caloric intake for 8 hours

2-hour glucose is measured after a 75g glucose load given in 250ml of water over five minutes.

What are the symptoms of prediabetes?

It’s unlikely that a person will have any specific symptoms of prediabetes. As glucose rises, thirst and loss of weight may occur. It’s concerning that in many instances prediabetes is detected when tests are done to investigate another complaint, particularly ones that may be a complication of diabetes such as the following:

 Peripheral neuropathy – damage to the small nerves of the feet cause pain and discomfort which may be described as burning, pins and needles, or sensitive. This may eventually lead to complete loss of sensation.

Cardiovascular disease – cardiac disease such as angina, heart attack or heart failure; peripheral vascular disease resulting in decreased blood flow in the legs causing pain on walking; stroke or transient ischaemic attack.

Kidney disease – this would be detected with blood and/or urine tests.

Other described complications of diabetes may be a presenting feature of prediabetes, but these are infrequent, e.g. retinopathy, autonomic nervous dysfunction (including impotence in men) and poor wound healing or recurrent infections.

Who should be tested for prediabetes?

Increased body weight is the greatest risk for developing prediabetes. It’s also more frequent in older populations and those with a family history of diabetes. Certain ethnicities have a higher incidence and in South Africa, our Indian community has a particular increased risk. Women with a history of gestational diabetes (diabetes developed during pregnancy) and polycystic ovarian syndrome may develop prediabetes or diabetes as well.

When should people be tested for prediabetes?

The US Preventative Task Force recommends screening for prediabetes every three years in adults with normal blood glucose, especially if they have risk factors.

Our South African guidelines suggest that all adults be screened for high glucose from the age of 45 years but an adult who is overweight can be screened at any age. The frequency of repeat screening will depend on the presence of the risk factors mentioned above.

Can prediabetes be treated?

Several large studies have shown conclusively that it’s possible to prevent the progression of prediabetes to diabetes. In the Finnish Diabetes Prevention Study (DPS) and the Chinese Da Qing Study, weight loss and physical exercise showed significant benefit.

The DPS demonstrated a 58% relative risk reduction in the progression to Type 2 diabetes in participants with impaired glucose tolerance who were treated with intensive lifestyle modification. The Da Qing study showed a similar 51% lower incidence of progression to Type 2 diabetes in a similar population of prediabetes.

Most importantly, there was still a 43% lower incidence seen over a 20-year follow-up period and this was associated with overall lower mortality. It’s incredible to think that a six-year lifestyle intervention showed such long-term benefits.

Other trials have shown benefit with pharmacological treatment. The most quoted of these is the Diabetes Prevention Programme undertaken in the US. Lifestyle intervention alone was compared to metformin, a medication that is the cornerstone of Type 2 diabetes management. The group following lifestyle alone showed a 58% decrease in the incidence of Type 2 diabetes compared with 31% in the metformin group.

The Diabetes Prevention Programme Outcomes Study followed up these subjects for a mean of 15 years offering twice yearly lifestyle reinforcement to the lifestyle group and ongoing metformin to the second group. Type 2 diabetes incidence was further reduced by 27%.

Other studies have looked at the role of diabetic medications to treat prediabetes and, thus, prevent progression to diabetes, e.g. pioglitazone, acarbose (no longer available in SA) and orlistat (a weight loss agent).

Should medications be used to treat prediabetes?

There is a role for medications, but several factors must be considered. All of these medications, including metformin, can have side effects. In addition, medical funders don’t recognise any prediabetes condition as a primary medical benefit so the medications can’t be put on to chronic reimbursement.

For there to be ongoing benefit from the medications, they do need to be continued. It’s recommended that medications be considered in people who haven’t reversed their prediabetes diagnosis with lifestyle alone or in individuals who are considered very high risk of progressing to diabetes.

According to our local South African guidelines these would include people with the following:

  • Age < 60 years old
  • A history of gestational diabetes
  • A BMI > 35 kg/m2
  • Presence of both impaired fasting glucose and impaired glucose tolerance
  • The metabolic syndrome (hypertension, high cholesterol, obesity)

The treatment of choice is metformin starting at a dose of 500mg twice daily, but this can be adjusted if glucose levels don’t improve.  Repeat blood tests can be done every three to six months. The person will need to be advised that this medication is being used off-label.

Orlistat is an option for those people struggling to lose weight as it has shown benefit for both weight reduction and glucose lowering.  However, it has significant gastrointestinal side effects requiring an almost fat-free diet which is not suitable for everyone.

What lifestyle intervention is best for prediabetes?

Weight loss

The key elements of lifestyle intervention are a reduction in body weight and an improvement in physical activity. Data from the DPP showed that for every 1kg of weight lost, there was a 16% decrease in the risk of developing Type 2 diabetes. Referring patients to a registered dietitian to embark on this journey is best. Weight loss requires significant calorie reduction, and it’s essential for a balance of nutrients to be included in the diet.

For patients who struggle to achieve significant weight loss, it’s reasonable to discuss weight loss medications, such as orlistat mentioned above, or liraglutide, now available in SA.As a rule of thumb there should be 5% weight loss in three months. If that isn’t attained, then the method of weight loss has to be discussed with the dietitian or the doctor.

Exercise

Physical activity needs to be of a moderate intensity, such as brisk walking, and it needs to be regular. A daily 30-minute session five days a week is ideal. The aim is usually to be active for 150 minutes per week which burns around 700 kilocalories.

Where possible, it’s best to have a mixed exercise programme that includes resistance training, stretching and cardiovascular. Light weight training improves insulin resistance and, thus, blood glucose levels.

It’s important to be active during the day, choose the stairs and not the lift, park far from the shop entrance but these types of activities can’t be counted as part of the 150 minutes.

Support system

If it was easy, we would all be losing weight and exercising regularly.  The reality is that for many people, achieving these goals is a struggle so a support system must be in place. It can be difficult to motivate yourself to go for a walk at the end of a busy workday, but if you have a friend or family member to motivate you and get you walking, it will help.

It’s encouraged to follow some structured programme, preferable with supervision. The COVID pandemic has presented a huge challenge with the closing of exercise classes, gyms and even the popular parkrun. Now that we are able to return to these activities, try and have a specific programme.

Seeing the dietitian regularly helps keep up the motivation to follow the eating plan. It’s important to set goals and to troubleshoot when the goals aren’t being met.

Conclusion

The importance of identifying prediabetes isn’t to diagnosis a stand-alone condition but rather to highlight the continuum of risk of increasing blood glucose levels to cardiovascular diseases and diabetes itself.

At the point of prediabetes, there is a definite window of opportunity to change lifestyle and improve blood glucose, to reverse the prediabetes and prevent the development of Type 2 diabetes.

Healthcare providers should provide specific, useful information for people to be able to make these changes and guidelines on the follow-up of blood glucose testing.

References

  1. US Preventive Services Task Force. Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. 2021;326(8):736–743. doi:10.1001/jama.2021.1253
  2. Guideline Committee. The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes. JEMSDA 2017; 22:1(Supplementary pgS1-S192)
  3. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care. 1999 Apr; 22(4):623-34.
  4. Table Adapted from The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes. JEMSDA 2017; 22:1(Supplementary pgS1-S192)

MEET THE EXPERT

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She has a busy diabetes practice.

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Diabetes Centre

Diabetes Centre opened at Groote Schuur Hospital

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Groote Schuur Hospital (GSH) launched its Diabetes Centre to promote a culture of excellence in diabetes-related primary healthcare in the Western Cape. This is the first public healthcare centre of its kind in Africa.

Diabetes on the increase

The number of people living with diabetes (PLWD) continues to escalate globally, outpacing all predictions. According to the International Diabetes Federation (IDF):

  • Over the next two decades, the number of PLWD in Africa is projected to increase by 143%, the greatest increase among all continents.
  • In SA, we continue to see a rise in the numbers of PLWD, with current estimates suggesting there are 4,6 million South Africans with diabetes.
  • Roughly 52% of PLWD are undiagnosed. At least 50% of those that are diagnosed don’t have access to adequate care.
  • Approximately 70% of all PLWD remain poorly controlled.

Professor Joel Dave, Head of the Department of Endocrinology at GSH, said,“Overall, diabetes was the second most common cause of mortality in SA, just behind tuberculosis. The vulnerability of PLWD to infectious diseases has been highlighted during the recent COVID-19 pandemic with diabetes being a significant risk factor for hospitalisation and death from COVID-19. Data from the Western Cape shows that 43% of all those with COVID-19 requiring admission to hospital were PLWD and 23% of all deaths from COVID-19 were PLWD.”

About the Diabetes Centre

Since the Diabetes Centre is a tertiary clinic, the more complicated cases of diabetes will be dealt with. The centre will only accept referrals from the Community Healthcare Centres and secondary level hospitals. However, some referrals will be accepted from private doctors. Referrals to the centre are made via the Vula E-Referral App.

Offerings:

This centre will be used as a fulcrum on which an extensive and expanded diabetes service will be built providing the following services:

  1. Diabetes Clinic: Specifically focusing on complicated diabetes, such as Type 1 diabetes, gestational diabetes, diabetes in special situations (patients with organs transplants, cystic fibrosis, steroid-induced, atypical), preoperative optimisation of diabetes. A specialised Diabetes Foot Clinic encompassing a multi-disciplinary team, including a podiatrist, endocrinologist, vascular surgeon, plastic surgeon, will be part of the centre.
  2. Patient Education: A dedicated patient education centre will form part of the GSH Diabetes Centre where patients will be encouraged to attend group sessions and one-on-one education sessions with trained diabetes educators.
  3. Nurse Education: A state-of-the-art Conference Room will form part of the GSH Diabetes Centre and will be used to conduct Basic and Advanced Diabetes Education Courses for all nurses within the public and private sectors.
  4. Doctor Education: The Conference Room will also be used to conduct Masterclasses in diabetes for doctors within the public and private sectors.
  5. Training of endocrinologists/physicians: The expertise and technology in the GSH Diabetes Centre will be used to train the next generation of endocrinologists and physicians for SA and Africa.
  6. Teaching of medical students: The GSH Diabetes Centre will provide an environment in which the next generation of medical students and general practitioners will be empowered to develop a foundation of knowledge for the optimal management of PLWD.
  7. Research: The GSH Diabetes Centre will focus on generating local data that will allow for the optimal management of PLWD in SA and will be used to inform local and national guidelines.
  8. Outreach: The GSH Diabetes Centre will house the expertise and technology to conduct outreach clinics and training regionally, nationally and internationally within Africa.

On the right track

The Provincial Minister of Health, Dr Nomafrench Mbombo, said, “Having worked as a nurse in the public healthcare system, I have seen first-hand how PLWD struggle with their illness. It also places enormous pressure on our healthcare system. However, we must do more in providing affordable and uninterrupted access to diabetes care for everyone. We know that early diagnosis and access to appropriate care for all types of diabetes can avoid or delay complications in people living with the condition. That is why I am so encouraged by the establishment of the Diabetes Centre. It shows that we are on the right track in the fight against diabetes.”

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work-life balance

Check your work-life balance to prevent burnout

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A shift in working habits affecting work-life balance since the start of the pandemic could be contributing to greater risk of burnout. But, reassessing how we manage demands in our daily routines can make a significant difference.

Sticking to a fixed schedule has become more difficult than ever, perhaps even more so for working parents and people working from home. A 24-hour weekday should ideally be made up of roughly eight hours each for working, sleeping and private time, which would include family responsibilities, rest, and leisure. This ideal balance isn’t always possible, and at times we need to be flexible with a few hours of overtime for urgent work priorities. This should be the exception, however, not the rule.

High expectations

In the last two years a pattern has emerged where productivity expectations seem to be higher than ever, and this shows no sign of abating. While work demands may be intense, it’s very often the pressure employees put on themselves that may alter work-life balance.

This has given rise to an ‘always on’ trend, which is persisting in many workplaces even among those not working from home. The technology and online platforms many people use for work can be convenient for keeping in touch with colleagues and cutting down on travel time, allowing us to pack more meetings into the day, but this can be intrusive after working hours and set a pace that is unrealistic and unsustainable.

Setting boundaries

Work demands are intense, and often we place further pressure on ourselves by trying to meet every expectation. If you feel you can’t even find time for a quick tea break, bear in mind that it’s simply not humanly possible to maintain good concentration solidly for eight or nine hours without a rest. Taking a short mental health break will help to keep you more productive throughout the day.

When the workday has ended, people often tend to take their work home both physically and emotionally. Actively working overtime, as well as time spent processing the demands of the day, worrying about tomorrow, and anxieties about our work can intrude on personal time.

Set boundaries for yourself on how you manage your time, and define a cut off point for work because there will always be priorities no matter how much extra time you put in. If a healthy work-life balance is not restored in time and a person is unable to replenish themselves sufficiently, it can have consequences for mental and physical health.

The need to decompress

Although working from home has allowed employees some flexibility and has squeezed a little extra time into our schedules, one advantage of commuting is that it offers a clear divide between work and home, and the time to decompress and evaluate the day.

After a full day’s work, it’s common to experience depleted emotional energy levels. After logging off work, we would all like to start relaxing but usually there are domestic tasks to be attended to first, such as preparing meals.

Taking a little time, if possible after work when you aren’t expected to be busy with anything else, to refresh your mind before transitioning into domestic life. Taking a breather to shrug off the stress of the workday can be helpful for fulfilling the need to put some distance between our work and home lives and help us transition into private family time.

Parents face extra demands

Parents often face additional demands, as parenting is a full-time job in itself. Working parents may feel worn out by the time they get home, but this is often when parenting time begins. There may be homework to oversee, preparations for school the next day, and bath time, and while you might be physically present for your family, it’s just as important to be emotionally present too.

By the time there is a chance to relax, parents may be so exhausted that they have no resources left for nurturing their personal lives and making the most of any spare time left before going to bed.

We are not meant to only work and sleep

When a person is approaching burnout, often the first thing to fall away is a sense of enjoyment. As human beings, we aren’t meant to only work and sleep. Don’t forget, we need to enjoy ourselves and invest time in our relationships.

Couples may sit together watching a series or scrolling through their phones but lead very separate lives. Spending time together should be about sharing and relating to each other, but often people at risk of burnout feel too exhausted to be fully present, and this could be a sign that it’s time to reassess your work-life balance.

Leisure time is vital for recharging our emotional energy and is therefore necessary to be at our best for both work and family. All too often, it’s only when people are burnt out to the point where they are no longer able to function in their working or home lives, that they reach out for professional support.

Often, we place so much value on the time we spend being productive, but not nearly as much as we should on replenishing our own mental and physical health. If you find you are starting to feel overwhelmed or demotivated, reach out for professional mental health support.

For information about mental health and services, and accessing care, or for help in an emotional crisis, Netcare Akeso is here to help. In the event of a psychological crisis, individuals can phone the Netcare Akeso crisis helpline on 0861 435 787, 24 hours a day, to talk to an experienced counsellor. 

MEET THE EXPERT

Lauren Leyman is an occupational therapist practising at Akeso Crescent Clinic. She has a passion for assisting individuals in their return to a fulfilling and meaningful life. Her experience includes working in general psychiatry, with adolescents, and with addiction. Her approach focuses on the person’s leisure pursuits, hobbies and interests, which are often pushed to the side when work demands, family commitments and life’s responsibilities take priority.

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IDF Young Leaders in Diabetes Programme

Chosen for IDF Young Leaders in Diabetes Programme

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DSA Port Elizabeth management board member, Ernest Groenewald, was recently selected as the only South African to be part of the International Diabetes Federation (IDF) Young Leaders in Diabetes Programme (YLD) 2022-2024. We chat to him about this.

Ernest Groenewald (27) lives in the Eastern Cape and is currently studying a Bachelor of Education in intermediate phase teaching.

Ernest is a member of the management board of DSA, Port Elizabeth. His portfolio is camp director; he oversees the Type 1 camps in the PE region. He had planned Camp Diabetable which was supposed to take place last year August. But due to COVID, it had to be postponed. When asked how he dealt with the delay, he explains, “It hasn’t been easy. As I have had a lot of personal problems that I had to deal with. Grief of a loved one has never been easy especially someone so close. Also having COVID 19 in the glooming background made matters more severe. Postponing the camp was the only option.” Though he is very eager kick the year off with the long-awaited DSA Camp Diabetable.

Plus, with the fantastic opportunity of being selected as South Africa’s only representative for the IDF YLD programme, he is set to make the most of this year.

Selection process

Ernest explains the selection process, “There was an application process where candidates around the world had to fill in and submit. All criteria needed to be fulfilled and the person applying had to be part of an NPO and be in good standing with them. I was lucky enough to have been approached and nominated by Margot McCumisky, National manager of DSA, as well as Martin and Elizabeth Prinsloo who run the Port Elizabeth branch.

New challenge and opportunities

The 27-year-old was thrilled when he was chosen. “The opportunity entails learning as well as travelling possibilities where I will interact with other people living with diabetes around the world. I also get the opportunity to get more in-depth education on managing diabetes as well as being able to use that knowledge to help others.”

The scholarship will also see Ernest having to raise awareness and be an active activist for diabetes. This excites Ernest and he has great plans ahead. “I want to work towards a better education system for newly diagnosed diabetes patients at government hospitals and clinics and work towards continuous glucose monitor (CGM) to be freely available for people with diabetes.

We wish Ernest all the best and can’t wait to see the success of this excellent opportunity.

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

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meal planning

How meal planning fits into diabetes management

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Diabetes educator, Tammy Jardine, offers 12 guidelines for healthy meal planning and explains why meal planning is important for diabetes management.

Diabetes is a condition where your body can’t properly use and store food for energy. The fuel that your body uses for energy is called glucose. Glucose is made in the blood from different types of carbohydrates, a nutrient found in food.

A high amount of this carbohydrate nutrient is found in foods, such as fruit, milk, some vegetables, starchy foods, and sugar. To control your blood glucose (blood sugar) you’ll need to choose healthy foods and limit the amount of the foods mentioned that are high in carbohydrate.

There is no perfect diet for people living with diabetes and you’ll find many contradictions as to which diet is best for diabetes. Instead of taking costly supplements and restricting food groups in your daily diet, it’s recommended that you eat foods that are high in nutrients and that you eat a variety of different foods. It’s always best to seek out a dietitian who has a special interest in diabetes to help you identify what foods are best for you as an individual.

Try these general guidelines for healthy meal planning:

  1. Monitor blood glucose

Always monitor your blood glucose to help determine whether you need fewer meals or whether you do better on smaller more frequent meals. Every person is individual and depending on how diabetes affects you will help to identify what type of eating routine is best for you.

  1. Eat vegetables

Although there is a lot of different information about what is the best diet for diabetes, the one consistent factor is that vegetables are important. Vegetables are high in fibre and high in vitamins and minerals. A variety of vegetables should make up 50% of your daily intake.

In addition to veggies like cauliflower, carrots, beans, and salad veg, be sure to include dark green leafy vegetables like spinach, kale, and broccoli. These are high in magnesium. You may need to limit these if you are on warfarin; check with your dietitian. Vegetables don’t have to be raw but if you cook them, steam or stir-fry until still crispy as soggy veggies are never appetising.

Try to add at least ½ cup of beans into your weekly meals about three times a week. Beans are high in fibre which helps to control blood glucose. These can be canned but be sure to drain them and rinse them to get rid of most of the salt. Beans include kidney, pinto, black beans, butter beans, cannellini beans and chickpeas.

  1. Avoid processed foods

They are usually crammed with preservatives and additives. Clean, whole foods are a much better choice and if they are closer to the way they come from the earth, the better. For example, choose a mealie (corn on the cob) rather than mealie meal. Also, if you choose starches that are whole grain instead of the more processed versions (white versions), you’ll get more fibre, vitamin B, magnesium, omega 3 fatty acids and folate.

  1. Identify your tolerance for carbohydrates

You can do this by testing your blood glucose before (pre-meal) and two hours after (post meal) eating a meal of carbohydrates. Use an app like FatSecret or MyFitnessPal to determine the amount of carbohydrates you’re going to eat. If your blood glucose post meal is more than 2 above the pre-meal reading, then you know you need to eat less carbohydrate.

Once you’ve identified your individual tolerance level then use the apps to calculate the portion of meals you usually enjoy and help with meal planning.

  1. Eat berries

Berries are the best fruit to eat as they contain very little sugar and are high in antioxidants which help protect your body from everyday damage. Fruits are generally high in a sugar, called fructose, so watch the amount that you eat at a time and never have more than three portions a day.

  1. Palm size protein

Protein foods like meat, eggs, chicken and fish can be eaten daily. Try to keep your portion to the size of your palm at a meal. It doesn’t really matter how much is red meat but do try to have three portions of fish a week (about 180-270g per week). Fish that is naturally oily like mackerel, pilchards, salmon and trout are excellent choices as they are high in omega 3 which is heart healthy and good for your immune system.

Stay away from the breaded and deep fat fried variety. They don’t count in your goal of 60-90gportions three times a week and the crumb will add to your carbohydrate limit.

  1. Avoid non-nutritious foods like sugar and sweeteners

Sugar will increase blood glucose. This includes sucrose sugar (the one we use in beverages and cereal) as well as honey. Although sweeteners are generally safe for people with diabetes, they still don’t add value to your diet and water is still the number one recommended beverage. If your urine is dark, you need more water, and try to replace fluid if you have been to the loo.

  1. Calcium is important especially if you are on metformin

Calcium is found in green leafy veg, as well as the bones of fish (like pilchards and canned salmon), in nuts, and also in dairy products. Milk does contain its own carbohydrate, called lactose, so be sure to consider it in your individual tolerated carbohydrate limit. Limit cheese to three times a week as it’s high in salt.

  1. Limit salt

Try to use less salt added to foods and use more herbs, garlic, ginger, cinnamon, and chilli to flavour your foods. 

  1. Avoid processed and packaged snacks like crisps, sweets and chocolate

This is a guideline that everyone wanting to be healthier should follow and not only people with diabetes. Like the guideline number 3 and 7, they are packed with preservatives and additives and add no real nutritious value to a healthy diet. Also, they do seem to have an addictive quality and the less you eat of them, the less you will crave them.

  1. When eating out, remember your carbohydrate tolerance limit

If you know you can only tolerate a small amount of carbs then choose a meal with a protein and veg or salad and avoid the carb loaded pasta.

  1. Avoid alcohol

People tolerate alcohol differently but in general limit alcohol to one to two drinks since low blood glucose can often be mistaken for drunkenness. Also, avoid sweet drinks like mixers and the sweeter wines and spirits, like brandy and rum. Rather choose the dry wine and white spirits, like gin, vodka and cane. Avoid tonic as it has even more sugar than coke. Mix drinks with water, soda water or sugar-free sodas.

MEET THE EXPERT

Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com

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endocrine system

What is the endocrine system?

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Sister Lynette Lacock explains what the endocrine system is and how this systems fails when the pancreas malfunctions.

Unless you took biology in high school or work as a health professional, you’re probably not aware of all the different functions in the body that rely on the endocrine system to work properly. So, let’s start off with the basics.

What is the endocrine system?

The endocrine system is a complicated group of glands that produce hormones and regulate different functions in the body. These include:

  • Pancreas – produces insulin that regulates blood glucose levels.
  • Adrenal gland – produces hormones that help regulate metabolism, immune system, blood pressure and response to stress.
  • Thyroid gland – controls metabolism by regulating thyroid hormones.
  • Pituitary gland – referred to as the master gland because it controls other glands in the body and is responsible for well-being.
  • Pineal gland – regulates circadian rhythm by regulating melatonin.
  • Ovaries – regulates hormones responsible for female characteristics and reproduction.
  • Testes – regulates hormones responsible for male characteristics and sperm production.

Pancreas malfunction

Many people are blissfully unaware of how hard their pancreas is working to regulate their blood glucose all the time. Unfortunately, many of us have some form of diabetes and our blood glucose is unregulated, causing us to be symptomatic.

The more stable our blood glucose is, the less likely we’ll experience the negative side effects of diabetes. So, if you’ve diabetes you must be knowledgeable about various treatments and work at keeping your blood glucose in check. 

Types of diabetes

Pre-diabetes and insulin resistance

You may be more prone to getting pre-diabetes if you’re overweight, have a family history of diabetes, lead a sedentary lifestyle, have an elevated cholesterol level or had gestational diabetes.

Be aware of some warning signs, such as constant thirst, frequent urination, urinary tract infections, fatigue, blurry vision and itchy skin. If you’re experiencing any of these symptoms go have your blood glucose checked by a healthcare professional. If you blood glucose is slightly elevated, see your doctor for an evaluation and advice.

Warning bell

You can think of pre-diabetes as a warning bell telling you to change your lifestyle and diet to prevent yourself from getting full-blown diabetes.

When you’re pre-diabetic, your pancreas is still producing insulin but your cells don’t respond normally and glucose builds up in the blood. You’ll have slightly elevated blood glucose levels that aren’t high enough to be diagnosed with diabetes.

Reverse the progression

However, your body will be suffering the negative side effects of elevated blood glucose and you may not even be aware it’s happening. Luckily there are ways to reverse this progression. These following three changes may seem hard at first but if you stick with them you’re on the road to a healthier life.

  • Exercise/walk five days a week
  • Eat less processed, high glycaemic index and fatty foods
  • Drink more water

Start small and progress at your own pace. At first you may just be able to walk short distances but over time you’ll be able to increase that distance. If you’re not the one that cooks at home, speak to whom ever does so you can come up with healthier alternatives that the whole family can enjoy.

Type 1 diabetes

Unfortunately there isn’t anything you can do to prevent Type 1 diabetes. It’s an autoimmune disease thought to be the result of genetics or a viral infection which causes the body to attack and destroy the cells in the pancreas, making them unable to produce insulin.

If you’ve Type 1 diabetes, you’ll need to use insulin to regulate your blood glucose on a daily basis. Your doctor will explain how to control your blood glucose with insulin. You will need to check your blood glucose several times a day to make sure the insulin dose is effective. It’s still very important to exercise and eat healthy foods if you have Type 1 diabetes.

Type 2 diabetes

This type of diabetes occurs when you develop insulin resistance and the pancreas can no longer produce enough insulin to regulate your blood glucose.  If your pancreas is still producing some insulin it may be possible to go on oral medication to regulate you blood glucose. However, if there isn’t enough insulin being produced, you’ll need to go on insulin to regulate your blood glucose.

People living with Type 2 diabetes can help control their blood glucose by losing weight, exercising and following a healthy diet. This will help lower blood sugar glucose levels and possibly prevent you needing insulin in the future.

Why is it important to keep my blood glucose levels normal?

To maintain your health and well-being you must keep your blood glucose levels stable and within the normal range. The best way to do this is to have your blood glucose tested regularly and work closely with your doctor to decide the best course of treatment.

Elevated or uncontrolled blood glucose over a period of time can have negative effects. Though, most of these problems can be prevented. Although you may not feel sick with slightly elevated blood glucose, it may already be affecting your organs.

Uncontrolled diabetes can damage small blood vessels causing problems with your heart, kidneys, eyes, peripheral nerves and capillaries causing neuropathies and delayed wound healing. Remember, prevention is easier than cure.

Keep track of your pancreas

It’s important to get your blood glucose tested regularly, particularly if you have a family history of diabetes, or have been diagnosed as pre-diabetic.

If you’re already on treatment, it’s still important to monitor your blood glucose so you and your doctor can make sure you’re on the best treatment for your type of diabetes. For example, if you’re prescribed tablets, you need to monitor your blood glucose to make sure that they are controlling it. If they are not, you can be suffering from the negative side effects of high blood glucose because the treatment isn’t working.

So, please take charge of your health and learn the best ways to stay healthy and prevent complications. Get your doctor or healthcare professional to explain your medications and anything you don’t understand about your condition. Remember, we only get one body so look after yourself.

References

https://kidshealth.org/en/teens/endocrine.html

https://www.carenewengland.org/blog/endocrine-system-and-diabetes

Sr Lynette Lacock

MEET THE EXPERT

Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.

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hormones

The four hormones in glucose control

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Bongiwe Nkondo expands on the four hormones needed for glucose control: insulin, amylin, incretins and glucagon.

Glucose, also known as blood sugar, is the preferred source of energy by the body cells. It’s transported from the liver or intestines to the cells of the body through the bloodstream. The body has a system that regulates the glucose level so that it doesn’t rise too high or drop too low, as this has detrimental health complications.

The regulation of glucose is done through an intricate system, involving various hormones insulin, amylin, incretins and glucagon.

Blood glucose regulation 101

When glucose levels are higher than normal (hyperglycaemia), the hormone, insulin, is released from the pancreas and this allows the glucose circulating in the blood to be taken up by the body cells and also to be used to create fat cells. This restores the blood glucose to a normal level (euglycaemia).

When the glucose levels are lower than normal (hypoglycaemia), the hormone, glucagon, is released and then the glycogen in the liver is broken down and converted into glucose, restoring euglycaemia.

The four hormones

Insulin

Insulin is a hormone secreted by the beta cells of the pancreas. It’s carefully regulated in response to circulating blood glucose levels. It allows body cells to access glucose for energy and it’s also involved in the creation and storage of fat.

Insulin isn’t secreted if the blood glucose level is less than or equal 3,3mmol/L, but is released if the amount is higher and increases as blood glucose levels increase.

After eating, insulin is released in two phases: an initial rapid release of preformed insulin, followed by an increased secretion by the pancreas and subsequent release in response to the blood glucose levels. There is a long-term release of insulin if the blood glucose levels remain high.

While glucose is the most potent stimulus of insulin release, there are other factors that also stimulate the creation and release of insulin, like certain amino acids, such as arginine, leucine, lysine, and glucagon-like peptide 1 (GLP-1) after a meal, to name a few.

So, how does it regulate blood glucose? When your glucose levels are increased, insulin is released. The insulin allows glucose entry into the muscles and liver, converting glucose to glycogen for storage and the remainder of the glucose is converted into fat cells. Hence, glucose is removed from the blood, restoring the glucose level to normal.

Amylin

Amylin is also a hormone which regulates blood glucose levels and is secreted by the pancreas alongside insulin. It complements the effects of insulin by reducing the blood glucose level after meals and by suppressing the creation of glucagon (which would work to increase blood glucose levels).

In Type 1 diabetes, the secretion of amylin is also deficient. Amylin also helps to slow down gastric emptying, the process by which the contents of the stomach are moved or emptied into the small intestine, and therefore slowing the rate of absorption of nutrients by the small intestine.

Incretins

These are hormones made by the digestive tract and includes GLP-1. They increase the amount of insulin released by the pancreas after eating, even before blood glucose levels become elevated. They also slow down the rate of absorption of glucose in the blood by reducing the rate of gastric emptying/digestion and may directly reduce food intake. Incretins also inhibit the release of glucagon from the alpha cells of the pancreas.

Glucagon

Glucagon is a hormone released by the alpha cells of the pancreas. It’s released in different circumstances: when the blood glucose level is low (hypoglycaemia), or when there are increases in adrenaline and epinephrine when you feel threatened or your body is under stress (fight or flight mode), and due to other factors.

When glucagon is released, the liver converts glycogen (sugar previously assimilated and stored) into glucose, thus raising the blood glucose level and restoring a balance.

Work with a multi-disciplinary team

The body is so intricate and complex. Each organ, hormone and substance play such a crucial role in maintaining balance. Glucose control is reached through the harmonious work of the different elements. When one element is off balance, it has an effect on the balance of the overall system, as seen in diabetes. Therefore, it’s best to work with a multi-disciplinary team to ensure you have the necessary tools to create balance in your body.

References

  1. Holst JJ et al. (2021). The Role of Incretins on Insulin Function and Glucose Homeostasis. Endocrinology 162(7): 1 – 10.
  2. Dong XL et al. (2018). Influence of blood glucose level on the prognosis of patients with diabetes mellitus complicated with ischemic stroke. Journal of Research in Medical Sciences23:10
  3. Mayan KL, Raymond JL. (2017). Krause’s Food and the Nutrition Care Process.14th Elsevier: Missouri.
  4. Stephen LA et al (2004). Glucose Metabolism and Regulation: Beyond Insulin and Glucagon. Diabetes Spectrum 17(3): 183 – 190.
Bongiwe Nkondo is a registered dietitian and has worked in both public and private practise. She is currently the vice chair and CPD portfolio holder of the ADSA Gauteng South Branch Committee. Her areas of interest are optimum nutrition, nutrition throughout the life cycle and non-communicable diseases. She is passionate about empowering people to make better health choices.

MEET THE EXPERT

Bongiwe Nkondo is a registered dietitian and has worked in both public and private practise. She is currently the vice chair and CPD portfolio holder of the ADSA Gauteng South Branch Committee. Her areas of interest are optimum nutrition, nutrition throughout the life cycle and non-communicable diseases. She is passionate about empowering people to make better health choices.
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