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Roast veg chicken wrap

Roast veg and chicken wrap with harissa yoghurt dressing

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Serves 4

Ingredients

  • 1 packet of roasting vegetables
  • 100 ml plain yoghurt
  • 2 Tbsp. harissa paste
  • 30 ml lemon juice
  • 2 cups rotisserie chicken, shredded
  • 1 disc fat-reduced feta, crumbled
  • 4 whole-wheat wraps
  • 1 bunch fresh coriander

Method

  1. Roast the vegetables according to the packet instructions and set aside.
  2. Mix the yoghurt, harissa and lemon juice together and set aside.
  3. Divide the vegetables, chicken and feta equally between the wraps.
  4. Drizzle with yoghurt, scatter with coriander, roll up and pack for lunch.

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

relationship ophthalmologist diabetes

How is your relationship with your ophthalmologist?

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Dr Gareth Fernandes explains why a good relationship with your ophthalmologist will stand you in good stead.

We are often looking for a quick fix, when it comes to medical problems. We have become accustomed to near instantaneous results regarding ophthalmic treatments; vision is often excellent within a few hours of cataract or refractive eye surgery. Many diabetes patients would have had cataract surgery as they tend to get cataracts at a younger age than non-diabetes patients. However, many of the other ophthalmic problems, which are associated with diabetes patients, are chronic and persistent and require long-term treatment. For this reason – a good, steady long-standing relationship with your ophthalmologist is essential. This relationship would ideally go through a number of stages as discussed below.

Ideally, you should see an ophthalmologist (or optometrist) after five years of diagnosis of Type 1 diabetes and within a year of diagnosis of Type 2 diabetes. We, as medical practitioners, need to detect problems before your vision is affected.

Even if your vision is affected, the deterioration may be very slow, and can be compensated for by the other eye so that you don’t notice the decline. Though, you should not wait for your vision to deteriorate before coming to see us. The reason for this is, many of the effects of diabetes on the retina do not cause symptoms, and when diabetes does start to affect your vision – causing symptoms, some of the damage (to the retina) may already be irreversible. This means that even with ideal treatment, we may be able to improve your vision, however, we may not be able to restore it to normal.

Screening can be frustrating. You may see your ophthalmologist annually, only to be told that everything is okay. Many diabetes patients don’t need any treatment until five, 10 or even 20 years after diagnosis. After a few annual visits, it is easy to become blasĂ© about the health of your eyes and lose motivation to continue your annual visits. You may only return when your vision is reduced and the damage is irreversible, and we may not be able restore your vision to normal again. Hence, why during this screening period it is so important to build a good and lasting relationship with your ophthalmologist.

Reduced vision in the diabetic population has many diverse causes. You may simply need glasses. As mentioned, conditions like cataracts can be easily and permanently cured with surgery, producing good results and a return of normal vision.

The most important and worrying cause of loss of vision in diabetes patients is from chronic damage to the small blood vessels in the retina (the membrane at the back of your eye which detects light and forms an image, much like the film of a camera).

One of the most common causes of retinal visual loss in diabetes patients is macula oedema. This is when the blood vessels of the retina become leaky, allowing too much fluid to seep out into the retina, causing the retinal tissues to swell. Macula oedema can be satisfactorily treated by monthly injections into the eye. The injections make the retina blood vessels less leaky, reducing the seepage of fluid into the retina. As the eye absorbs the excess fluid in the retina, the vision improves. Diabetic patients with macula oedema really need a solid, ongoing relationship with their ophthalmologist because it may take a few months for the fluid to be absorbed and little improvement may be seen initially, despite the monthly injections. But, if you persist with the treatment, you’ll usually be rewarded with improved vision. Once the fluid is gone, your vision is as good as we can get it. Your injections unfortunately do not end there; the injections will still be required to maintain your vision. We can usually increase the interval between injections at this point. The good news is that over the years you will require fewer and fewer injections to maintain control of the macula oedema.

The retina can also be affected by the formation of new blood vessels on the retina. These may bleed into the eye, causing reduced vision, or they may cause scar tissue to form on the retina. The scar tissue can cause permanent damage to the retina. Hopefully, if you have been seeing your ophthalmologist regularly, they would have been able to detect the new blood vessels before they form the scar tissue. We can laser the retina to stop the new vessels from progressing. This will prevent formation of scar tissue and allow you to maintain good vision.

All is not lost if scar tissue has damaged the retina. We then can remove the scar tissue surgically. This should prevent further deterioration in vision and can result in significant visual improvement.

Diabetic eye disease has multiple effective treatment options, and it is critical that patients have a good relationship with their ophthalmologist in order to benefit from these treatments. It is important to have a good understanding of your specific problem; the limitations and side effects of your treatment; and a realistic expectation what the treatment can do for you. This understanding is essential because the treatment is long-term and you need to persist with treatment to get the most benefit.

MEET OUR EXPERT - Dr Gareth Fernandes

relationship ophthalmologist diabetes
Dr Gareth Fernandes is an ophthalmologist in private practice at Visiomed Eye Laser Centre in Northcliff, Johannesburg. He completed his ophthalmology training at Wits University in 2014. He performs a range of treatments for diabetes patients, including diabetic screening, intra-ocular injections, laser treatments and cataract surgery.
Communicating confidence

Communicating with confidence

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Many people with diabetes worry about whether they should say anything to others, such as their work colleagues, boss and friends, about their diabetes. Clinical psychologist, Rosemary Flynn, offers advice on how to communicate with confidence.

Some of the questions that diabetes patients will ask are:

  • Should I tell my boss and colleagues about this? I’d rather not. They’ll think I am a freak!
  • If I say anything about my diabetes, they may accuse me of looking for sympathy but sometimes I need to attend to my diabetes at work.
  • How do I tell people about this?
  • Do I test and inject in front of others or do I have to go to the bathroom when I am at work?
  • I don’t want anyone to feel sorry for me all the time.
  • What if no-one helps me if I pass out from a hypo?

Before you, the diabetes patient, can start communicating with others about your condition, you need to ask yourself these questions:

  • Do you have enough knowledge about your diabetes and treatment?
  • Do you have the skills to know what is going wrong and work out a solution?
  • Do you believe the treatment works?
  • Do you have confidence that you can do this?

The answers to these questions will influence how you talk to others about your diabetes. If you can answer yes to all the questions, you have a good understanding of your diabetes and can communicate accurately with confidence. If you have said no to any of the questions, make an effort to improve in that area.

Taking emotions into consideration

It is also helpful to recognise how you react to things emotionally. Do you push people away? Do you get angry with people who are trying to help? Are you too embarrassed to say anything?

Telling people you have diabetes and then being able to discuss it, can be a real challenge. Sometimes you may feel comfortable talking about it, but sometimes you may prefer not to say anything. Figure out a starting point that would be suitable for the people you’re addressing. Then you can explain what you do and why. When you feel comfortable, others will tend to be more comfortable about talking to you about your diabetes. Your confidence gives them the impression that you have mastered a serious challenge and they need not worry.

Do you tell everyone you meet?

Not necessarily. If they need to know because you interact with them often, or if they are important people in your life, tell them. In the big picture, it is best to tell those who need to know about your diabetes in case they need to help you. There is always a chance that you could have a low blood glucose level unexpectedly, where you need help and cannot think straight in the moment, and you will need others to help you. You don’t want to give others too much of a fright by suddenly falling over. If at least one colleague knows what is going on, they’ll be able to do the right thing to help you. That is being fair to them and being fair to yourself. Most of the time they won’t need to help you, but just in case.

18-year-old Brad said, “I have had diabetes since I was two years old and I find it’s a breeze now – there’s no need to think you stand out. You can still be the same as everyone else and do the same things. There is no need to feel different.”

If you explain what diabetes means to you and what you must do, usually others let you get on with it, without a fuss. Some people may try to help, and as well meaning as they are, they can get it wrong. They can be irritating when they think they “know it all” and they can also be insensitive.

Jenna talked to those in her office about her diabetes. She mentioned she may need help if her blood glucose went too low, but she reassured them that she could manage on her own most of the time. The first time she actually needed help for a low, her friend brought the insulin pen. The friend thought there was glucose in the pen!

Friends don’t always get it right, but with a bit of experience and coaching from you, they’ll learn to know the right thing to do.

How do you handle criticism?

Dealing with criticism, whether it is justified or not, is an important life skill.

If others make negative comments about your diabetes, it is usually for one of two reasons:

  1. Because they are looking for someone to pick on, who they think is ‘weak’ or ‘different’, and they want to feel superior.
  2. Because they are afraid of the condition as they don’t know enough about it.

When your colleagues are informed, they will often be the ones who stop those who are criticising. Keeping your diabetes a secret will be very difficult to maintain all your working life and it can have consequences, especially if something goes wrong and you cannot fend for yourself.

Destructive criticism is often just thoughtlessness, but it can be malicious and hurtful. As Dale Carnegie said, “Any fool can criticise, condemn and complain, but it takes character and self-control to be understanding and forgiving.” Usually, people don’t react as badly as you think they will, if you appear confident about your diabetes management. Most of them will understand once they know more. You have nothing to be ashamed of; you are doing what is necessary to stay alive and well.

MEET OUR EXPERT - Rosemary Flynn

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

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

Communicating confidence

Rosemary Flynn’s new book “The Emotions of Teenagers with Diabetes” is now available. To order your copy contact Rosemary at rosemaryf@cdediabetes.co.za

How is your relationship with your heart?

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Our hearts serve us dutifully, sustaining us from our first to our very last breath. In view of this, the Heart and Stroke Foundation South Africa (HSFSA) have come up with six practical tips to treat your heart with the respect and care it deserves.

Get active!

A strong heart is a happy heart. Regular exercise provides profound long-term health benefits including benefits which protect your heart’s health, such as:

  • Improves ‘good’ cholesterol levels
  • Helps lower high blood pressure
  • Helps reduce and control body weight
  • Helps control blood sugar levels and reduces the risk of developing diabetes
  • Helps to manage stress and releases tension
  • Reduces the risk of heart disease and stroke

Aim for a minimum of 150 minutes of moderate activity a week, such as 30 minutes 5 days a week, or 75 minutes of vigorous activity per week, such as 20 minutes 4 times a week.

healthy-heart

Know your numbers

All strong relationships are built on good communication. Blood pressure, cholesterol and blood glucose values shouldn’t be a secret than can ruin the relationship with your heart. If these hidden numbers are out in the open, a broken heart could be saved before it’s too late! So go for regular health checks to make sure you know what your numbers are.

heart-healthy-meal-plan

Eat well

How we eat and it’s impact on our daily blood glucose control has an accumulating effect on our heart health. Which means that our daily choices which stretch over months and years have a far larger impact on our heart’s health than the odd chocolate. So, care for your heart by nourishing your body daily with a balanced, healthy diet. Eat more healthy foods such as fruits, vegetables, beans, low-fat dairy, whole grains, and healthy fats like olive oil and avocados. Watch your portion sizes to avoid over-eating and eat less food with excess sugar, salt and bad fats such as take-aways, sugary drinks, cakes and pies. For individualised dietary advice and support, find a dietitian at www.adsa.org.za.

Build healthy relationships

Could love improve heart health? Satisfying relationships and social support don’t only make us feel happy and loved, but may also provide health benefits. One reason for this is that it may lower harmful levels of stress and stress hormones. Many behaviours, such as human touch or showing affection; affirming our love for one another; caring behaviours or offering help, could elicit this calming effect, sense of security and support. Loved-ones may also provide encouragement for us to take better care of ourselves by preparing and enjoying healthy meals together and supporting us to go for regular health check-ups.

Avoid smoking

Even though most people associate smoking with lung health, more smokers will in fact suffer heart disease. Smoking almost triples the risk of heart disease and more than doubles the risk of having a stroke. Therefore, you can’t have a good relationship with your heart if you light up a cigarette daily. It’s like saying ‘I love you, but I don’t want to be with you’. Quitting however, is not easy, it’s like getting out of a bad relationship. So don’t do it alone, ask for help or get in touch with any of the following support programmes:

Mind your mental health

Stress and depression have both been linked to an increased risk of heart disease. While we can’t always escape day-to-day stress, we can manage it effectively. Instead of reaching for a cigarette or a donut, try to relieve your stress with something healthier like going for a brisk walk, speak to a friend or take time to do something you enjoy.

Depression is a common mental disorder characterized by lowered mood, negative thoughts, low energy levels and a change in appetite. It increases the risk of heart disease by 50% compared to someone without depression. If you think you may suffer from depression, then speak to someone you trust and seek professional help from a psychologist or psychiatrist. Depression can be effectively treated but the first step is recognising it.

One-on-one with Dr Cliff Allwood

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Dr Cliff Allwood, specialist psychiatrist – Akeso Clinic Pietermaritzburg, explains how diabetes and depression are linked.

What comes first – depression or diabetes?

As far as we know, there is not a causative link between the two conditions and they may occur at different times. However both conditions may be linked to a significant physical, medical or emotional stressor. The onset may have occurred at a similar time.

Is there a link between the two? And how does this work?

There does not seem to be a direct link, however, we do know that clinically the two conditions do affect each other. Each makes the other worse. Both conditions need to be adequately treated.

How do you break this vicious cycle?

Both conditions have to be taken seriously. Diabetes and any other medical conditions must be treated. Ongoing monitoring and control is essential. Depression must be treated with whatever biological, psychological, social or spiritual interventions are appropriate and effective. Lifestyle changes may have to be made in both conditions, and exercise is essential for both conditions.

How does depression in a diabetic patient differ to any other form of depression?

In the diabetic patient, mood can be affected by blood sugar changes. The patient has to be aware of the effects of both ‘highs’ and ‘lows’. Sometimes the medications used for diabetic control may have an effect on mood. Diet and lifestyle changes may also affect mood. The patient is encouraged to be observant about the effects of changes. A partner or close friend can be helpful in observing changes. On the other hand, depression may affect the manner in which the patient is managing his/her diabetes. Depression may have a negative effect on motivation and compliance with treatment.

In advanced stages of diabetes sufferers may lose sight, limbs, or have other medical conditions. These profound disabilities will commonly result in depression. The depression requires full treatment. Untreated depression may have severely negative effects on later compliance and efforts towards treatment and rehabilitation.

Is there an increase in this?

There is a worldwide increase in the incidence of depression.

What are the signs of depression in the diabetic patient? Do these differ from other forms of depression?

Depression in a diabetic patient is no different from depression in people who don’t have diabetes, except as mentioned in question four. However, any signs of ‘confusion’ in the patient must be taken very seriously since this indicates that either the blood-sugar is out of control, or there is some reaction to the medication. This requires a full medical examination and appropriate treatment.

How is depression beaten?

Treatment for depression varies dependent on the specific history and symptoms of each sufferer. Research does however indicate that treatment with medication and psychotherapy is generally most effective. Substantial lifestyle changes may be required and the recruitment of social support is also necessary, as self-isolation makes depression worse. If the depression is severe the sufferer can be treated with the assistance of an inpatient treatment programme, such as the programmes offered by Akeso.

When should partners or family members worry?

When the depression is preventing the sufferer from functioning as they wish to.

Are there tips and tools to reducing your levels of depression if you have diabetes?

Self-care is an important practice as is increasing self-awareness. The establishment of good habits like journaling (a food and mood diary); moderate and consistent cardiovascular exercise (brisk walking etc.); dealing proactively with negative thoughts; sustaining healthy friendships; ensuring compliance with medication; supplementation with Omega 3s; getting 20 minutes of sunshine every day; developing resilience; practicing self-acceptance and being kind to oneself – are just a few ways to limit the destructive impact of depression.

Read more on depression
Grilled tuna steaks pineapple citrus salsa

Grilled tuna steaks with pineapple and citrus salsa

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Serves 4

Ingredients

  • 4 tuna steaks, (150 g each)
  • 10 ml olive oil
  • 10 ml fish rub

Salsa

  • 1 pineapple cubed
  • 1 grated lemon peel
  • 2 ruby grapefruits or large oranges, peeled and segmented
  • 125 ml freshly squeezed orange juice
  • 15 grams fresh mint, roughly chopped

METHOD

  1. Heat a griddle pan. Roll tuna steaks in oil.
  2. Season tuna well with fish rub.
  3. Sear for 2 minutes on each side or until cooked to your liking.
  4. Toss together salsa ingredients and serve with the tuna.

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

Seared beef carpaccio wasabi dressing

Seared beef carpaccio with wasabi dressing

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Serves 4

Ingredients

  • 400 gram beef fillet
  • 3 Tbs olive oil
  • 1 Tbs sesame oil
  • 1 Tbs grated ginger
  • 45 ml wasabi paste
  • 2 tsp sugar
  • 75 ml lime juice, and grated peel of 5 limes
  • 3 Tbs fresh coriander
  • 2 Tbs fresh mint
  • 1 cup cabbage, finely shredded
  • 250 g mangetout,finely sliced
  • 2 carrots, peeled and shredded
  • 4 bunches spring onions, finely shredded
  • 6 radishes, finely sliced

METHOD

  1. Season fillet.
  2. Heat olive oil in a large saucepan until hot.
  3. Sear fillet for a few minutes on both sides until rare (or about 10 minutes for medium rare).
  4. Remove from pan and set aside to cool.
  5. Blitz sesame oil and remaining olive oil with ginger, wasabi paste, sugar, lime juice and peel, coriander and mint.
  6. Mix three quarters of dressing with cabbage, mangetout, carrots, spring onions and radishes.
  7. Place finely sliced fillet on a bed of salad. Drizzle over dressing, sprinkle with sesame seeds and serve.

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