Category: 2023 Spring – Diabetes Focus Online

feelings

Is there a link between food and feelings?

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Kate Bristow expands on food and feelings: what food improves mood and knowing the difference between emotional eating and real hunger.

Happiness is something that we are all looking for. Generally, things like exercise, meditation and therapy are top of the list of recommendations. But did you know that the food you eat can play a role in your feelings?

There have been studies done on food and mental well-being and certain foods can be linked to increased serotonin levels in the brain. Serotonin is a chemical, also known as the happy hormone, which plays a big role in regulating your mood. Serotonin levels which are low can cause low mood.

Which foods lift mood and how to manage in diabetes

  1. Dark chocolate – There are components in dark chocolate which have been shown to produce serotonin and have anti-depressant properties. Dark chocolate isn’t a complete no in diabetes; in moderation it can be used to take away that craving for something sweet, and now to bring on a better mood.
  2. Bananas – Although not recommended in large quantities in diabetes, bananas contain vitamin B6 and the body needs vitamin B6 to create serotonin.
  3. Coconut – More research is needed here, but animal studies have found that coconut milk can possibly reduce anxiety.
  4. Coffee – Research shows that coffee consumption has been significantly associated with a decreased risk of depression, including the decaffeinated version.
  5. Avocado – This fruit is packed with good stuff, including choline which the body uses to regulate the nervous system and mood. Studies have shown decreased anxiety in women when they eat avocados. Avos are also rich in vitamin B which is good to decrease stress levels.
  6. Berries – Higher fruit and vegetable intake has been linked to better mental health. Berries are rich in antioxidants, which may reduce symptoms of depression.
  7. Foods which are fermented – Sauerkraut, kimchi, kefir, kombucha and yoghurt help with a healthy gut and may improve your mood. Up to 90% of serotonin is made in the gut, so eating these products will promote the production of serotonin.
  8. Mushrooms – These are packed with vitamin D which has been linked to antidepressant properties and mood enhancement. It’s also easily absorbed in this form by the body. For the best benefit, expose your mushrooms to the sun for a couple of hours before you cook them.

The good news is that the above, eaten in the right proportions are healthy choices and can be included as part of an eating plan in diabetes.

Emotional and comfort eating

We all have a relationship with food, just as we have a relationship with family and friends. And without even thinking about it, you could be an emotional or mindless eater. Add diabetes into the mix with a whole lot of strangers, as in the healthcare team and your family and friends taking extra interest in what you are eating, and it can get complicated.

Food is not just fuel for the body; it can be soothing and nurturing as in a baby receiving breast milk to settle and sooth. It’s not surprising then that you reach for food to help you cope with feelings (stress, conflict, anxiety, relationship challenges), we all need comforting from time to time.

However, even though eating does make you feel better and help settle emotions of distress, it may be beneficial to recognise the cause of the emotion and manage this rather than dull everything with food.

Diabetes itself can be a cause of stress and depression. Having to pay close attention to what you eat and learning on the job can be tough and possibly a cause of emotional eating.

Express your emotions in a safe way

Here’s one example of a conversation with yourself, “I’m eating because I’m frustrated for not being as productive as I would have liked today.”

It’s important to recognise behaviours like this and figure out your triggers and ways to express your emotions in a safe way. For example:

  • Talk to a friend or family member
  • Allow yourself to show emotion e.g. cry
  • Journal
  • Exercise
  • Do something fun to distract yourself

What can you do differently next time?

Dr Jen Nash, a psychologist who is living with diabetes, says that food challenges are real. But she also says that food should be pleasurable and a diagnosis of diabetes shouldn’t mean the end of this. Hunger is only one of 30+ reasons why you eat.

She suggests setting goals which are achievable. Strive to do the right thing 90% of the time and don’t feel guilty when things don’t go according to plan. She suggests an Oh-well attitude and to use the experience as a learning tool – What can I do differently next time?

  • Try not to feel that you’re being watched by everyone and equip yourself to face the challenges that food may give you in the journey ahead.
  • Try practical ideas such as experimenting with new recipes but planning a weekly shopping list and menu is a good idea.
  • Phone a friend who is there to support you and that you can be accountable to. This isn’t stalking, but rather support for choices that you make. Keep in touch with family and friends and reach out if you’re struggling. You are not alone.
  • Look after your body – make healthy choices with regards to food, get enough sleep and exercise regularly.

Mindful eating and how it helps in your meal plan choices

As a person with diabetes, you’re required to pay attention to what you’re eating constantly. Feeling stressed or depressed can be a cause of emotional eating. If you find yourself eating as a form of comfort, substitute this behaviour with an alternative treat: have your nails done, go to a movie or visit a friend.

You should enjoy food but eating mindlessly for the sake of eating means that you’re not taking time out to really savour what you’re eating. Before reaching out for a tasty treat, ask yourself “Why am I eating, am I actually hungry?” This is a more mindful approach.

Mindful eating means that you use all your emotional and physical senses to enjoy the food you’re eating. It encourages better choices for food, which are satisfying and nourishing.

Mindless eating or distracted eating can be associated with anxiety and stress, overeating and the associated weight gain.

How unhealthy eating patterns cause mayhem

Unhealthy eating patterns have been known to lead to mood swings, fluctuations in blood glucose levels and nutritional imbalances. With this lack of stability, your mind and body doesn’t function well.

Examples include:

  • Skipping meals leads to low blood glucose levels which can leave you feeling weak and tired.
  • Cutting out food groups can lead to not getting all the essential nutrients in your diet, which can also lead to mood swings and decreased energy.
  • Too many refined carbohydrates can cause erratic blood glucose levels, low energy and irritability.

Health eating habits

Evidence suggests that a healthy eating plan is both physically and mentally protective. Some general guidelines include:

  • Eat at regular set intervals during the day.
  • Choose less refined sugars and eat more whole grains.
  • Make sure you have protein at every meal.
  • Keep a variety of food in your eating plan.
  • Try to reach and maintain a healthy weight.
  • Drink enough fluid, particularly water.
  • Exercise regularly.

Pause mindfully

Pause mindfully when you eat, intentionally create time between each bite.

P    Present – Stop multi-tasking when you eat, and just eat.

A   Awareness – Be aware of the feeling of hunger, how does it make you feel physically?

U   Understand – Your feelings and how they may influence the food choices you make.

S    Savour – Take a mindful bite – smell, taste, touch, listen.

E    Enjoy – How much are you enjoying this bite?

Mindful eating becomes a strategy to encourage meals with fewer distractions, as well as better eating habits. Taking the time to enjoy the flavour of your food, atmosphere and company has been shown to lead to better psychological well-being, increased pleasure when eating and satisfaction.

So, go out there and enjoy mindful meals with your loved ones and in doing so create better health for yourself and fewer emotional eating habits.

Physical hunger vs. emotional hunger

PHYSICAL

Stomach growling

Thinking/considering choices

Low energy levels

Hunger grows slowly

How much time since the last meal?

Is food satisfying?

EMOTIONAL

What am I feeling? (anger, bored, stress)

How strong were the emotions?

When did you start feeling like this?

How did you hope food may help? (soothe or help you escape feelings)

References

https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/food-psychology/the-eating-journey

https://www.cnet.com/health/mental/8-mood-foods-that-will-make-you-happy/

www.eatingmindfully.com

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

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Kate Bristow is a qualified nursing sister and certified diabetes educator.

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fitness

Making fitness fun

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Monique Marais explains how you can make fitness fun and shares tips on where to start depending on your fitness personality profile.

Fitness means different things to different people. For some, it means taking the dog for a walk while others train for marathons and extreme challenges. Fitness programmes are followed for various reasons, ranging from health-related benefits to weight loss management.

Fitness is not a one-size-fits-all concept and you need to know what your personal goals are to achieve your desired fitness level, and you need to find the motivation to stick to the plan.

Finding that motivation can be difficult, especially when you’re trying to balance a busy work schedule and raising children. The main reason reported for irregular exercise regimes is the lack of time. When you enjoy what you’re doing, you are, however, more likely to stick to it in the long run. The key is to make exercise fun.

F – focused

U – unique 

N – new normal

Focused fitness

Have a clear goal of what you want to achieve. This will help you to stay motivated and identify exercises that will help you achieve these goals. Sometimes you may need some external motivation, so find a fitness buddy that has similar goals to you and motivate each other. Look for group classes or activities in your area that suits your time schedule, pocket, and goals.

Also make sure your goals are achievable. If you continuously miss the target, you’ll become demotivated with the process. Having someone to exercise with gives accountability, which reduces your chance of cancelling at the last minute.

Unique fitness

Find a form of exercise that is unique to your needs. Just because everyone jumps on the latest bandwagon, doesn’t mean it will be suitable for your needs, or enable you to meet your goals.

There is a wide variety of exercises available that cater for different levels of fitness. If you’re a beginner, identify a form of exercise that matches your level of experience and goals. If you’re more experienced, find a new challenge and commit to it. There are also various online fitness programmes and challenges which you can tailor to your needs and schedule.

If the conventional ways of exercising don’t motivate you to get moving, consider options such as trampoline fitness, pole fitness, rock climbing, trapeze, or aerial skills or even horse riding.

New-normal fitness

To achieve sustainability, you need to identify a form of exercise that can fit into your routine and that you will stick to. This might mean exploring different options before settling on something specific. For others, variety is the key, and they want to do different activities.

Know yourself and know your goals. A mind-shift is, however, required; this needs to become part of your routine, your new-normal, a lifestyle change. If you have children, remember that you’re modelling healthy lifestyle choices when you’re choosing to exercise regularly. Include your children when you do physical activities, this way you get to spend quality time with them while working out.

Exercises for all levels of fitness and ages

Benefits of physical activity

 What fitness personality profile are you?

Dr James Gavin (Ph.D.) formulated the following fitness personality profile to help you identify the best fit for you that will be fun and sustainable.

Remember to follow a healthy balanced diet when you exercise to further contribute to your health and weight loss goals. By eating healthy and regular physical activity, you’ll reduce your risk of heart attacks and strokes, and manage symptoms of hypertension and diabetes more effectively.

You need to provide your body with the necessary fuel to continue in this fitness journey to prevent injuries and complications. Also check with your healthcare provider if you have any chronic conditions before starting a rigorous exercise regime.

Go out, get fit, get healthy, and have some fun while doing it!

References

6 Ways to Put Fun Back in Your Workout | MyFitnessPal

Fun Ways to Exercise: 23 Unconventional Workout Ideas | Bulletproof

Starowicz, J., Pratt, K., McMorris, C. & Brunton, L. 2022. Mental health benefits of physical activity in youth with cerebral palsy: a scoping review. Physical & Occupational Therapy in Paediatrics, 42(4):434-450.

Ntwanano, A.K. & Pule, E. 2016. Psychosocial and psychical benefits of exercise among rural secondary school students. European Review of Applied Sociology, 8(11):14-18.

Hosseini, S.A., Salehi, O., Keikhosravi, F., Hassanpour, G., Ardakani, H.D., Farkhaie, F., Shadmehri, S. & Azarbayjani, M.A.  2021. Mental health benefits of exercise and genistein in elderly rats. Experimental Aging Research: An international journal devoted to the scientific study of the aging process, 48(1):42-57.

Monique Marias is a registered social worker at the ClaytonCare Group which provides in-patient care to medically complex patients on a sub-acute level. She has specialised in physical rehabilitation for in-patients for 13 years, and has a passion to assist people to understand and manage their diagnoses and the impact on their biopsychosocial well-being.

MEET THE EXPERT

Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

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Polycystic ovarian syndrome

Polycystic ovarian syndrome

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Dr Louise Johnson expands on polycystic ovarian syndrome and the risk of it leading to Type 2 diabetes.

Polycystic ovarian syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. It was described in 1935 by Stein and Leventhal.

Systematic screening of women according to the National Institute of Health diagnostic criteria estimate that 4 to 10% of women of reproductive age suffer from PCOS.1

Understanding PCOS

PCOS is a hormonal imbalance when the ovaries create excess androgen hormones.

The diagnosis of PCOS can follow one of three guidelines:

National Institute of Health criteria:

  1. Hyperandrogenism (high male hormone)
  2. Menstrual irregularity

Androgen Excess PCOS Society criteria:

  1. Hyperandrogenism
  2. Menstrual irregularity or polycystic ovaries on ultrasound

Rotterdam criteria (2 of 3):

  1. Hyperandrogenism
  2. Menstrual irregularity
  3. Polycystic ovaries on ultrasound

In polycystic ovaries there are small follicle cysts (fluid filled sacs with immature eggs) visible on your ovaries on ultrasound due to lack of ovulation (anovulation). This is one of the most common causes of infertility in women.

Signs of PCOS

  • Irregular periods which include missing menstruation or heavy bleeding.
  • Abnormal hair growth on arms, chest and abdomen. This is called hirsutism and affects up to 70% of women with PCOS.
  • Acne especially on face, chest and back. This may continue past teenage years and is difficult to treat.
  • Obesity is common in 40 to 80% of women with PCOS and they have trouble maintaining a healthy weight.
  • Darkening of skin in the folds of the neck, armpits and groin and under breasts. This is called acanthosis nigricans.
  • Cysts on ovaries that appear larger or with many follicles (egg sac cysts) on ultrasound.
  • Skin tags in armpits or on the neck.
  • Thinning hair or patches of hair loss.
  • Infertility is caused by PCOS.

What are the main causes of PCOS?

The exact cause is unknown. Genetics may play a role. Several other factors, most importantly obesity, also play a role. Other factors that play a role are:

  1. Higher levels of androgens (male hormones)
  2. Insulin resistance
  3. Low grade inflammation

How is PCOS diagnosed?

Clinical history of abnormal menstrual cycle.

Signs and symptoms as discussed above.

High levels of testosterone and luteinizing hormone (LH).

On ultrasound more than 12 follicles in each ovary.

Follicle size between 2 and 9mm.

Morbidities associated with PCOS

Obesity

This is one of the most common features of PCOS and varies between 61 and 76%. Childhood obesity is a well-documented risk factor for PCOS.

Insulin resistance

This is considered the main pathogenic factor in the background of increased metabolic disturbances in women with PCOS which can explain high androgen levels, menstrual irregularity and abnormal blood lipid levels.3

Type 2 diabetes

PCOS confers a substantially increased risk for Type 2 diabetes and gestational diabetes from early ages. About 1 in 5 women with PCOS will develop Type 2 diabetes.

Cardiovascular disease

In 1992 Dalhgren et al2 identified a 7 times higher risk of heart attack in women with PCOS compared to healthy people. More recent data shows higher burden of atherosclerosis and early onset cardiovascular dysfunction and heart vessel calcifications.

Infertility

In a 2015 study it was shown that infertility is 10-times more common in women with PCOS than in healthy controls. Women who conceive with PCOS might suffer from pregnancy-related complications, such as gestational diabetes and pregnancy-induced hypertension. Concerning the effects of the foetus, women with PCOS are 2.5 times at a higher risk of giving birth to a small for gestational age child.

Cancer

Females suffering from PCOS are at risk for endometrial cancer. Studies show a three-fold increase risk to develop endometrial cancer.

Psychological well-being

Women with PCOS are more prone to suffer from depression, anxiety, disordered eating and psychosexual dysfunction. It’s worth noting that obesity, acne, hirsutism and irregular menstrual cycles, all associated with PCOS, are major contributors to the psychological stress that the patients experience due to the challenging of the female identity and her body image.

Treatment

The management of PCOS targets the symptomatology for which patients usually present: anovulation, infertility, hirsutism and acne.

Lifestyle

Lifestyle modifications, such as exercise and a calorie-restricted diet, are considered as a cost-effective first-line treatment. Excessive weight is associated with adverse metabolic and reproductive health outcome. For instance, female fertility significantly decreases with body mass index (BMI) more than 30.

Multiple studies show that weight decrease as little as 5% regulates menstrual cycle, improves fertility, reduces insulin and testosterone levels, decreases acne and hirsutism and benefits psychological well-being.

Medical treatment

  1. Oral contraceptive pills

Oral contraceptive pills are the most used medication for the long-term treatment of women with PCOS. It’s recommended for regulating of menstrual cycle and decrease of testosterone levels as first-line treatment. A minimum of six months on oral contraceptives is usually required to obtain satisfactory results against acne and hirsutism.

  1. Metformin

Metformin is an oral antidiabetic biguanide drug that acts on suppressing glucose production from the liver and increasing peripheral insulin sensitivity. The use of metformin in women with PCOS decreases insulin resistance, reduces testosterone levels and improves glucose managing in the body.4

Screening recommendations

Screening for Type 2 diabetes

Women with PCOS should be routinely screened for Type 2 diabetes. Studies have shown that measuring only fasting glucose in patients with PCOS miss up to 80% of prediabetics and 50% of diabetics.

Current guidelines suggest screening women with PCOS using an oral glucose tolerance test every three years. Risk factors that require screening more often are:

  • Family history of diabetes
  • Hypertension medication use
  • Smoking
  • Increased waist circumference more than 80cm in females
  • Physical inactivity

Screening for cardiovascular disease

Women with PCOS should be screened regularly for risk factors such as:

  • Increased waist circumference
  • Smoking
  • Blood pressure
  • Abnormal cholesterol profile (increase triglycerides and low HDL)

 Screening for psychological well-being

Screening women with PCOS for depression, anxiety, negative body image and eating disorders is important.

PCOS is a complex disease and should be managed by a team of medical practitioners from a dietitian, psychologist, gynaecologist, dermatologist and specialist physician. Team work can lead to a successful outcome.

References

  1. Azzizz R, Woods K et.al. (2004)’The prevalence and features of the polycystic ovary syndrome in an unselected population.’ J Clin Endocrinol Metab. 89,2745-2749
  2. Dahlgren E, Janson P et.al. (1992) ‘Polycystic ovary syndrome and risk for myocardial infarction.’ Acta Obstet Gynecol Scand. 71,599-604
  3. Diamanti -Kandarakis E, Dunaif A (2012) ‘Insulin resistance and the polycystic ovarian syndrome revisited: an update on mechanisms and implications.’ Endocr Rev, 33 981-1030
  4. Hayek S.E., Bitar L et. al. (2015) ‘Polycystic ovarian syndrome: an updated overview’ Physiol, 7:124
Dr Louise Johnson

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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.

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hypoglycaemic anxiety

Managing hypoglycaemic anxiety

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Dr Paula Diab discusses hypoglycaemic anxiety, its impact on diabetes management and provides practical strategies to help take control and reduce it.

Living with diabetes can present numerous challenges, including daily glucose monitoring; paying careful attention to what you eat and when you eat; and compensating for normal, everyday lifestyle challenges such as stress, exercise and hormonal changes. Added to these challenges is the ever-present danger of low blood glucose levels (hypoglycaemia). While hypoglycaemia can be concerning in itself, it can also trigger hypoglycaemic anxiety and stress which may even exacerbate glucose levels further.

Understanding hypoglycaemic anxiety

Hypoglycaemic anxiety refers to the fear or worry experienced by people living with diabetes regarding the possibility of experiencing low blood glucose levels. This anxiety can stem from concerns about the physical symptoms as well as potential complications associated with hypoglycaemia.

Symptoms associated with hypoglycaemia include dizziness, confusion, and even loss of consciousness. These may often be misinterpreted as an anxiety attack or exacerbated by associated anxiety.

A previous experience of hypoglycaemia will also have a significant impact on future decision-making. Additionally, the fear of not being able to manage or control these episodes can contribute to heightened anxiety levels.

This is particularly true for the elderly; people who live alone and those who have poor or unstable support systems. Even an adult living with a spouse at home may feel unsupported and anxious if the spouse’s work demands irregular working hours or shift work. Children who have unpredictable daily routines where one day involves a two-hour sport practise after school and the next day is more sedentary or when sports practise is suddenly cancelled, or the time moved, or some aspect of the exercise changed.

Even those who rely on served meals (old age homes, hospitals, boarding schools, work conferences, travel, etc.) may experience anxiety at not being in control of what food they have access to at any time.

Impact on diabetes management

Hypoglycaemic anxiety can have a significant impact on diabetes management. Anxiety and stress can lead to hormonal changes that affect blood glucose levels, potentially triggering a vicious cycle of unstable glucose control.

Fear of hypoglycaemia may also result in intentionally maintaining higher blood glucose levels to avoid low episodes, which can lead to long-term health complications. It’s crucial to address hypoglycaemic anxiety to maintain a balanced and healthy approach to diabetes management.

Strategies to prevent hypoglycaemia

As with most challenges in diabetes, awareness and education are key to gaining control. Understand the signs and symptoms of low glucose levels and discuss them with your healthcare team.

Learn to recognise your individual triggers and identify the steps to prevent and treat low blood glucose effectively. This may differ for each and every individual.

Insulin

The most common culprit is short-acting insulin as this is exactly what it’s designed to do. Long-acting basal insulins don’t generally have a high risk of hypoglycaemia. Particularly the newer basal analogue insulins are very stable and don’t have a high risk for hypoglycaemia.

Pre-mixed insulins may also cause hypoglycaemia as they have a short-acting component in them and if you haven’t eaten enough to compensate for the insulin, your glucose levels will drop. Try to opt for newer insulins that have a lower risk profile.

Delayed food intake

Skipping meals, delaying meals, or inadequate carbohydrate intake can cause a drop in blood glucose levels. It’s important to maintain a regular eating schedule and include balanced meals and snacks to provide a steady supply of glucose to your body. When planning and scheduling isn’t in your control (boarding schools, catered meetings, travel), make sure that you speak to your healthcare team and mitigate this risk as best you can.

Physical activity

Engaging in physical activity or exercise can lower blood glucose levels, particularly if you aren’t properly fuelling your body before and after exercise or if the activity level is more intense than usual.

Once again, a change in scheduling of exercise, may enhance your risk of hypoglycaemia so try to mitigate the risk as best you can and understand what changes can be made if necessary.

The combined anxiety of a change in routine added to the risk of hypoglycaemia with exercise may well be a perfect storm so try to plan your exercise and stick to the regime as best you can.

Alcohol

Alcohol can interfere with the liver’s ability to release stored glucose, leading to hypoglycaemia. It’s important to consume alcohol in moderation and with food to help prevent low blood glucose.

Again, an honest discussion with your healthcare team can prepare you for this risk and help you to make the necessary adjustments rather than being afraid of a potential glucose low and making incorrect decisions around your medication.

Illness

Factors such as illness, hormonal changes (during menstruation), and stress can affect insulin sensitivity. These changes can result in increased insulin activity, potentially leading to hypoglycaemia. Education and awareness are the key ways to understand how these events will impact you and what you need to do to avoid hypoglycaemia.

Mistakes

You are human. You make mistakes. Sometimes you may confuse your long and short-acting insulins or miscalculate a carbohydrate intake. Such errors often result in glucose lows. Know how to correct your mistakes and have emergency plans in place.

Insulin pump malfunctions

If you use an insulin pump for diabetes management, a malfunction or infusion site issue can lead to improper insulin delivery. This usually results in glucose levels to rise but the corrective action may be a bit too severe and you may end up with a rebound hypoglycaemia. Many of the newer pumps have cut-off alarms and suspend functions that can now predict hypoglycaemia and switch off insulin delivery to prevent the event occurring.

However, a past experience of hypoglycaemia may tempt the user to override the pump actions and this generates artificial machine learning. Disconnecting your pump and allowing it to deliver insulin outside of your body or manually overriding settings aren’t encouraged as this will result in incorrect decision-making in the future. Speak to your pump specialist about individualising these settings and ensuring they work best for you. Too many alarms and alerts can also result in alarm fatigue where users ignore warning signs and don’t act appropriately.

Medications

Certain medications, such as those used to treat other health conditions like beta-blockers or some antibiotics, can mask the symptoms of hypoglycaemia or affect blood glucose regulation, increasing the risk of low blood glucose. If you’re taking other medications, make sure that they aren’t compounding the problem and be aware of additional signs and symptoms to look out for.

Test, test and test again

Regular monitoring of blood glucose levels empowers you to detect and address potential fluctuations promptly. There is unfortunately no easy and cheap way around this. Regular finger-pricking and interpretation of the numbers can give you important information as to how various lifestyle events, medications and situations affect your blood glucose levels. The more often you test, the more you can predict future patterns.

As an example, if you test regularly before going to bed and know that you’re generally safe if your levels are around 7 – 8mmol/L, then you can be assured that your levels will remain at that level overnight and not drop low.

Not testing leads to too many unknowns and consequent anxiety that a potential hypo will occur which, in turn, leads to false decision-making. By keeping a close eye on your glucose levels, you can gain confidence in managing your diabetes and reduce anxiety associated with hypoglycaemia.

Managing anxiety

Once you’re aware of the nuances of diabetes management and have educated yourself on the effects of daily food intake, activity and hormonal changes, then you can start to plan and make the necessary adjustments that are required.

Try to build a strong support network which can provide a valuable source of encouragement and assistance. Identify one (maybe even two) person/s that you trust (and who you have educated on diabetes) who can call you out and alert you to signs of potential danger.

One of the many downsides of hypoglycaemia is that it affects your executive brain function and decision-making abilities. It can also make you irrational, irritable and angry. Very often, people who are experiencing a severe low glucose level will make decisions that they would not normally make simply due to the physiological changes in their body as a result of the low glucose. Have a trusted friend who can very directly comment on your behaviour and enforce correct decision-making.

Try to find your tribe. Connect with other people living with diabetes through support groups or online communities. Sharing experiences and seeking advice from peers who understand your challenges can help alleviate anxiety. Very often these community groups can provide sound advice and understanding when healthcare professionals are unable to. It’s difficult to empathise with the fear associated with a severe hypoglycaemic episode if you have never experienced it yourself.

Mitigate stress

We are all far too stressed. At this time of year, we’re usually mentally exhausted. Having navigated the cold winter months, the onslaught of public holidays in the first half of the year that wreak havoc with business practices and still just too many months left until the end of the year. Medical aid funds are often depleted at this time and people are unwilling to invest time and money into healthcare.

Although the end of the year may rehabilitate your medical aid benefits, it will do no more than that. There will be more breaks in business function, more stress, more curveballs. Try to incorporate stress management techniques into your daily routine, such as regular exercise, meditation, deep breathing exercises, or engaging in hobbies you enjoy.

Reducing overall stress levels can positively impact both your mental well-being and your blood glucose control and will go a long way to improved diabetes management in the long run.

If hypoglycaemic anxiety significantly impacts your quality of life and ability to manage diabetes, don’t hesitate to seek professional help. Mental health professionals with expertise in diabetes care can provide guidance and support to address anxiety-related challenges effectively.

Questions to ask yourself are:

  1. How confident are you that you can stay safe from hypoglycaemia when:
  • Exercising
  • Sleeping
  • Driving
  • Social situations
  • Alone

If you feel that you lack confidence in any of these situations, then seek professional assistance from your diabetes team before you encounter the problem. Ensure that you know how to avoid and respond to hypoglycaemia and this will greatly diminish your anxiety. Involve your family and friends and ensure that those close to you are also well-equipped to support you.

Conclusion

Hypoglycaemic anxiety is a common concern among people living with diabetes. However, by understanding the condition, implementing effective strategies, and seeking support when needed, you can regain control over your diabetes management and reduce anxiety surrounding hypoglycaemia. Remember, managing diabetes is a journey, and with time, patience, and support, you can overcome hypoglycaemic anxiety and live a fulfilling life while effectively managing your condition.

Dr Paula Diab

MEET THE EXPERT

Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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nutritional supplements

The use of nutritional supplements in diabetes

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Dietitian, Esteé van Lingen, educates us on nutritional supplements, what ingredients to look for and highlights the benefits of using Lifegain® Advanced Nutritional Supplement.

Before we can get into why nutritional supplements could be beneficial for people living with diabetes or not, we need to first understand the difference between meal replacements and nutritional supplements.

We also need to understand the ingredients nutritional supplements may contain and why each one is important. This will assist you in making an informed choice before buying a nutritional supplement.

Nutritional supplement vs meal replacement

A nutritional supplement is an extra supplement that you can take on top of your meals to add extra nutrients your body may be lacking. This can be taken with meals or in between meals to add extra nutrition where needed. Lifegain® is an example of a nutritional supplement.

Meal replacements, on the other hand, are as the words say, a replacement option instead of having a meal. You will have this instead of a meal. An example of this is a Meal Replace Shake like Replace® Diabetic.

Ingredients in nutritional supplements

When looking at the different ingredients that nutritional supplements contain, we start with protein then carbohydrates and lastly fats.

Protein

Protein is one of the most important macronutrients needed for the body to function. The word protein comes from a Greek word meaning primary or holding the first place and that’s why they say protein is seen as the building blocks of the body. Because it is an essential nutrient, you need to consume it daily whether it’s from an animal or plant source.

Protein helps stabilise blood glucose levels when eaten together with a carbohydrate so that the impact isn’t as high on blood glucose compared to eating carbohydrates alone.

As you get older, you quickly start to lose muscle and since most people cut their protein intake (due to various reasons), there is nothing to help sustain muscle mass. To then try and rebuild muscle when you are older is much harder compared to when you were young.

The average person needs at least 0,8g protein per kg of bodyweight per day to sustain basic functions. For example, a person who weighs 50kg will need at least 40g of protein per day.

If you are training a lot or want to build muscle, you would need at least 1,2 – 2g of protein per kg of bodyweight per day. For example, a person who weighs 50kg will need 60 – 100g of protein per day.

It’s interesting to know that many people don’t even reach 1g of protein per kg of their bodyweight per day through meals alone.

Note: This doesn’t mean 120g meat is equal to 120g protein. For example, 1 chicken breast of 120g contains 28g of protein. 

Carbohydrates

Out of the three macronutrient types, carbohydrates have the most marked effect on postprandial blood glucose response (blood glucose level after a meal).

Carbohydrates provide the body with energy and can be found in various foods, including bread, pasta, cereals, rice, potatoes, sweet potato, butternut, fruits and dairy products.

You should also then distinguish between healthy (unrefined) and unhealthy (refined) carbohydrates. Unrefined carbohydrates are minimally processed and eaten as close to their natural state with the grain and germ still intact.

Refined carbohydrates are processed to get a softer, more available carbohydrate. The end results: quicker absorption and release into the bloodstream, causing a spike in blood glucose levels.

One starch portion is equal to 15 grams of carbohydrates. So, depending on how well-controlled your glucose levels are, your gender and other chronic conditions, you don’t want to consume more than two starches in one meal.

The lower the carbohydrate content of a certain meal is and the less processed it is, the lower impact it will have on blood glucose levels. Therefore, it’s encouraged to rather eat a lower amount of carbohydrates in a meal and when consumed, choose the unrefined options instead.

You should also rather spread it out evenly throughout the day instead of eating no carbohydrates the whole day and then eating three servings at night.

Fats

Fat is the final macronutrient. It is also a source of energy but more importantly it assists in keeping the cell walls healthy as well as assists the body in making healthy hormones.

When consuming fats, you want to consume more healthy fats (omega-3) versus unhealthy fats (saturated fats, trans fats, and cholesterol).

Omega-3 helps reduce and prevent inflammation in the body as well as keep the cell walls healthy for the body to properly absorb nutrients and medication into the cells making blood glucose control more effective.

Lifegain® Advanced Nutritional Supplement

When looking at Lifegain®, it contains 4g of carbohydrates per serving and 15,3g of protein which makes it low in carbohydrates and higher in protein.

Furthermore, Lifegain® has a protein blend that contains three sources of protein (soy protein, whey protein isolate and milk protein isolate) that helps with muscle recovery. This is very helpful in the case of an active person living with diabetes or in the elderly to assist in maintaining muscle mass.

This makes it a good substitute for a person with diabetes that needs to consume a small amount of carbohydrates and still keep blood glucose levels stable without it dropping too low or going too high. Provided it fits within your nutrient requirements and/or consulting with your healthcare provider or dietitian first before starting on anything.

Glutamine

Lifegain® also contains glutamine that assists with immune function and gut health which is important. Uncontrolled blood glucose levels reduce immune function and makes a person with diabetes more susceptible to infections. If your gut health is not great, you can’t absorb the nutrients that you do consume properly.

Glutamine improves gut health to assist with digestion and absorption of nutrients. With the improvement in absorption, it may then in the long run assist with weight loss when combined with a balanced lifestyle and consumption of the correct amounts of healthy foods.

Vitamins and minerals

Vitamins and minerals are essential to assist with muscle functions as well as boost your immune system and provide you with energy. The combination of the vitamins and minerals found in Lifegain® includes calcium, magnesium, vitamin D3, zinc, iron and vitamin C. Again, these help protect your muscles, bones and boost immunity.

Free from intolerant ingredients

Lifegain® is free of gluten, lactose, cholesterol, trans fat and preservatives which makes it ideal for someone suffering from gluten or lactose intolerance or anyone with sensitivities to preservatives. This also means that there is no added sugar and no refined carbohydrates.

How to make a nutritional supplement part of a healthy balanced diet

If you are a very busy individual (especially someone living with diabetes) that tends to miss meals as you don’t have time to eat a proper cooked meal, have certain food preferences, or you don’t have a big appetite to eat a large meal, a nutritional supplement will then be an ideal option for you.

Lifegain® only has 507kJ per serving so it will work well as a snack in between meals or used as a base of a light meal. If you want to increase the nutrients, you can do so by mixing it with low-fat milk instead of water or eating a fruit and/or raw vegetables on the side. Or you can make a smoothie out of it with unsweetened plain yoghurt or low-fat milk, one fruit serving, raw vegetables and a fat, such as almonds and chia seeds.

Since Lifegain® has 15g of protein per serving, it has about the protein content of half a chicken breast making it an ideal nutritional supplement even for someone that has kidney issues. This only counts as long as it is made with water and the protein intake for the rest of the day is restricted. Any additions or changes should of course only be made under the guidance of your healthcare professional.

A nutritional supplement is recommended for the elderly who might have a poor nutritional status due to not cooking nutritious meals as often and especially for the elderly who also have diabetes. For example, instead of eating two slices of bread, they can have one serving of Lifegain® once or twice per day and then add fresh vegetables and protein as needed. Thus, making it more balanced and sustainable in the long term.

Kidney problems and protein

A low protein diet is recommended for people with kidney problems and renal disease. The protein requirements for people with renal disease is 0,6 – 0,8g per kilogram of bodyweight but this depends on the stage of kidney disease.

Protein increases the pressure in the kidney tubes by attracting more water as it passes through them, thus leading to increased strain on the kidneys and increased loss of renal function. People on dialysis have higher protein requirements due to the protein loss during the dialysis process.

The function of the kidneys includes: removing waste products from the blood, maintaining fluid balance in the body as well as controlling blood pressure. When the kidneys are failing, damaged or only one of them is functioning, they can’t perform these essential tasks.

Seek professional guidance

Before taking any nutritional supplement or meal replacement, please consult your dietitian first to see if it would be suitable for you and how it can be worked in as part of a healthy balanced diet and lifestyle.

For people with kidney problems (a complication of diabetes), protein does need to be restricted depending on kidney function and you should contact your dietitian to calculate your specific needs and work it into a balanced and sustainable diet.

 

Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

MEET THE EXPERT

Estée van Lingen is a registered dietitian and has been in private practice since 2014. She is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

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