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

*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)

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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.”

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

Header image by Adobe Stock

Type 2 diabetes, high cholesterol and high blood pressure can be silent killers. How often do you get screened for these chronic conditions?

Many people are unaware that chronic health conditions, such as Type 2 diabetes, high cholesterol and high blood pressure (hypertension), can cause damage to the body, often without the person experiencing noticeable symptoms.Although these conditions can occur individually, these three are often interlinked and can significantly increase the chances of stroke, heart attack and premature death.

NB! Routine health screenings

At the beginning of a new year, many of us think about improving our health through taking up a fitness regimen or eating more healthily. A crucial but often overlooked aspect of taking care of our well-being is having routine health screenings.

Even if you feel healthy and well, be aware that you could be living with one or more of these underlying conditionswithout knowing it. With non-communicable diseases on the rise in SA, it really is advisable for adults to screen for these common health threats each year so that any risks can be detected and managed early to ward off more serious complications from developing in future.

Three silent killers 

Diabetes – chronic high blood glucose

Diabetes is a chronic long-term condition that affects how your body breaks down glucose from the food that you eat. While Type 1 diabetes is usually diagnosed in childhood, Type 2 diabetes develops over time and is more often diagnosed in adulthood.

Insulin is a hormone that helps control your body’s blood glucose levels. If your body doesn’t produce enough insulin or cells stop responding to insulin, too much glucose remains in your bloodstream and this can lead to serious health problems over time, including potentially irreversible damage to the eyes, kidneys and other organ systems. It’s therefore critical to be aware of your blood glucose levels and get tested regularly to know if you are at risk of developing Type 2 diabetes.

With the medicines available these days, along with regular exercise and a healthy diet as advised by your treating doctor, diabetes can be well-controlled with many new oral or injectable medicines to help keep blood glucose levels stable.

Hyperlipidaemia – high cholesterol

High cholesterol, or elevated levels of fat in the bloodstream, is another common non-communicable disease that is all too common in SA. Although people with high cholesterol usually don’t have any symptoms, if it remains undiagnosed and therefore untreated it significantly increases the risk of heart disease, heart attack and stroke.

A simple blood test reveals cholesterol levels, and if these are outside of the healthy range your treating doctor will prescribe the right kind of chronic medicine to help maintain cholesterol at healthier levels. A diet that is low in saturated fat and regular cardio exercise are generally recommended as part of the treatment plan.

Hypertension – high blood pressure

The World Health Organisation estimates that almost half of people living with high blood pressure globally remain undiagnosed and therefore untreated, and only one in five have their hypertension under control.

When hypertension isn’t well-controlled, it places additional pressure on the cardiovascular system, potentially leading to heart attack, heart failure and stroke, as well as kidney damage among other risks.

Unmanaged, these conditions are associated with significantly higher risk of hospitalisation and premature death, but these outcomes can be avoided with the right treatment. Once a person has been tested, they have the power to improve their long-term health and can often avoid complications with the necessary treatment and lifestyle adjustments.

When your doctor has prescribed the right medication specifically for you, this is only the first step to effective treatment, and it’s of critical importance that you continue to take your medicine exactly as prescribed, even when you feel better.

Supporting better health outcomes

Being diagnosed with a chronic condition and starting new medication can be daunting, and to help make it as easy as possible to adhere to prescribed treatment, Medipost Pharmacy offers telephonic assistance from the pharmacy team in all official languages, as well as free delivery of chronic medicines to any address in SA. If you have any questions or concerns about your treatment, reach out to your pharmacist who can give you advice, such as how to overcome potential side effects.

To be effective, chronic medicine must be taken at the right dosage continuously, even when you’re on holiday or out of your usual routine.

As part of its free delivery service for chronic medicines, with advanced notice those registered with the courier pharmacy can have their confidential medicine parcels delivered to another address while they are away from their usual delivery address.

As well as dispensing medicines to individuals privately, the service also includes assistance with registering PMB conditions, including diabetes, hypertension and hyperlipidaemia, to help conserve medical scheme members’ day-to-day benefits.

Medipost Pharmacy aims to improve access to quality and affordable medicines for all South Africans, making it simple and convenient to adhere to chronic treatment and improve your health and quality of life.

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We get to know the two new DSA National Board Members, Salih Hendricks and Wesley Mc Aslin,who were elected at the DSA National AGM held on 14 December 2021.

Salih Hendricks

Salih Henricks (55) lives in Crawford, Cape Town. He is separated and has five children. He has had Type 1 diabetes for 40 years and been a diabetic amputee for two years.

How do you feel about this appointment?

I’m happy to be part of this organisation and hope to be of value for DSA and the diabetes community.

What do you aim to achieve?

What I want to get into action is raising awareness on the less costly medications that are given to diabetes patients in the public sector. These medications aren’t working for many patients. Treatment needs to be put together as a package deal with extra management and added components to make these meds work.

No matter what type of medication you take, a good mindset and exercise help the medication work better. I want to ensure all people with diabetes don’t give up.

What are your responsibilities?

The community

In your opinion, how does the care for diabetes need to change or improve in SA?

There is no need for improvement but more involvement from communities and sharing their experience. We learn from each other better than from any book.

What does balance mean to you?

Nothing is perfect in this world therefore giving, caring, supporting , mental health and many more positives could help us balance our lives better. Just by trying, we can balance everything.

Wesley Mc Aslin

Wesley Mc Aslin (43) lives in Kempton Park, Gauteng. He is married and has two children. He has Type 1 diabetes.

How do you feel about this appointment?

I’m excited in that I believe I can make a difference to someone’s life by hopefully inspiring people with diabetes to push themselves and their limits and not to let diabetes rule their lives.

What do you aim to achieve?

Enlighten people about diabetes and eliminate any misconceptions

What are your responsibilities?

My responsibilities have not been completely defined as yet but I want people living with diabetes to know that they need to look after their health and they shouldn’t cheat as in the end it only does harm.

In your opinion, how does the care for diabetes need to change or improve in SA?

Better understanding and better education in all sectors about living with diabetes and the emotional toll it takes on people living with diabetes and their immediate family members.

What does balance mean to you?

Healthy living and been able to manage your diabetes efficiently without it encumbering your ambitions and goals in life.

Western Cape Camp Diabetable

With the kind sponsorship of EPT recovery, DSA is holding Camp Diabeteable on 22 to 24 April 2022.

Benefits of diabetes camps

Diabetes South Africa has been holding camps for children with diabetes for well over 40 years. These camps are designed to facilitate a camp experience in a medically safe environment, while fostering opportunities for children to develop basic diabetes self-management skills.

These type of camps also provides opportunities for children with diabetes to forge sustainable relationships, overcome feelings of isolation, and gain self-confidence and a positive attitude to living with a lifelong chronic disease which has to be managed hour by hour.

IMPACT 

According to three years of pre and post surveys, diabetes camps positively impact a wide-range of camper outcomes, including knowledge of diabetes management, management behaviours, and emotional well-being.

Doctors have reported to us that the positive benefits of our camps for children with diabetes are seen in their young patients for many months post camp. Newly diagnosed campers appear to benefit the most from their camp experience.  The encouragement and support the children receive often leads to them giving themselves their first insulin injection on their own. Campers usually ask on leaving the camp when the next one will be.

Some our past campers have joined our DSA Camp Management Team as young adults to pay forward the positive experience they had when attending our camps as children.

The theme of the camp is: The elements – earth, wind, fire, water.

To join the camp email margot@diabetessa.org.za

Wellness Day

As we are well aware, last year (2021) was not the best time in most lives. It was also not a good time for DSA Pretoria. Due to lock down we were unable to meet together for most of the year. We were also unable to do what we need to do and that is to inform people about diabetes, by means of holding wellness days at companies and doing testing, as well as free testing ay shopping malls.

So, we are thrilled to have hosted our first Wellness Day at x on 26 February.

DSA members interviewed on TV show

In December, DSA Pretoria was approached by SABC 2 asking for people with Type 1 and Type 2  diabetes to be interviewed their TV program, Vital Signs.

Frans Steenkamp (Type 1) and Brian Midlane (Type 2) were the two representatives chosen from the Pretoria branch. They shared their experience of living with diabetes. Both men had very interesting stories to tell.

At the end of the broadcast, National Chairman, Martin Prinsloo, was able to publicise the purpose of Diabetes SA. All in all a good experience was had by all and we are hoping that the message went out loud and clear.

Dietitian, Retha Harmse, educates us on the different flours and what they are used for.

At a couple’s conference, the speaker mentioned that many husbands and wives are so disconnected that 85% of husbands didn’t know their wives’ favourite flower. One husband turned to his wife next to him and whispered,”It’s self-rising, isn’t it?”

All jokes aside; I laughed at the irony of the wordplay until I realised that these two words were actually derived from one another. The English word flour is originally a variant of the word flower, and both words derive from the Old French fleur or flour, which had the literal meaning blossom, and a figurative meaning the finest. The phrase fleur de farine meant the finest part of the meal since flour resulted from the elimination of coarse and undesirable matter from the grain during crushing until it resembled a fine powder.

There are many flours on the market these days, some we know very well and others with very distinct characteristics and purposes.

The protein content 

Protein content is the primary factor that varies in flours.

• High-protein wheat varieties (10-14% protein) are classed as hard wheat.
• Low-protein wheat (5-10%) are known as soft wheat.

Simply put: More protein equates to more gluten which results in more strength. More strength results in more volume and a chewier texture. High-protein flours lead to doughs that are both more elastic (stretch further) and more extensible (hold their shape better), which are desirable qualities in bread and other yeasted products where a firm structure is required, but undesirable in pastries and cakes, where the objective is flakiness or tenderness.

Types of flours

All-purpose flour 

When recipes call for flour, it’s referring to all-purpose flour. This type of flour is made from a mixture of soft and hard wheat, with moderate protein content in the 10-12% range. All-purpose flour is a pantry staple; it’s the most versatile of flours, capable of making flaky pie crusts, fluffy cookies and chewy bread.

Cake flour 

This type has the lowest protein content (5-8%). The low amount of gluten-forming proteins makes it ideal for tender baked goods, such as cakes but also muffins or scones. It’s commonly chlorinated, a bleaching process that further weakens the gluten proteins and modifies the starch content, increasing its capacity to absorb more liquid and sugar (guaranteeing a moist cake).

Pastry flour 

An unbleached flour made from soft wheat with protein levels between cake and all-purpose flour (8-9%). This type achieves the ideal balance between flakiness and tenderness, making it perfect for pies, tarts and many cookies.

Make your own pastry flour by mixing 1 ⅓ cups of all-purpose flour and ⅔ cup of cake flour together.

Bread flour 

With a protein content of 12-14%, bread flour is the strongest of all flours, delivering the most structural support. This is especially crucial in yeasted bread, where a strong gluten network is needed to contain the CO₂ gases formed during fermentation. The extra protein also results in more browning in the crust (in a process called the Maillard reaction).

Self-rising flour 

This is flour that has baking powder and salt added during the milling process. Self-rising flour is best stored tightly wrapped in its original box and used within six months of purchase. After that the baking powder in it begins to lose its strength.

Make your own self-rising flour: Mix 1 cup of pastry flour with 1 ½ teaspoons of baking powder and ¼ teaspoon of salt.

Whole wheat flour 

During grinding, the wheat kernel is separated into its three components: the endosperm, the germ and the bran. Fluctuating quantities of the germ and bran are combined back into whole wheat flour.

It’s usually high in protein, but its gluten-forming ability is altered by the bran and germ therefore tends to produce heavier, denser baked goods.

Whole wheat flour is far more perishable than white because the germ is high in oils that are prone to rancidity. For ultimate freshness: store it at cool room temperature for up to three months, then transfer it to a freezer.

Gluten-free flour 

There are numerous gluten-free flours available today, made from all sorts of grains, nuts and starches. A small proportion of xanthan gum is sometimes added to recreate or mimic the chewiness typically associated with gluten.

• Almond flour: Ground almonds. It’s low in carbohydrates, high in healthy fats and fibre. When replacing flour with almond flour, substitute it 1:1 and add more of a rising agent (like baking powder or baking soda) as needed to contain the heavier weight of the almonds.
• Bean flour: Ground dried or ripe beans. Garbanzo and fava bean flour is a combination with a high nutritional value but a strong aftertaste.
• Brown rice flour: Great significance in Southeast Asian cuisine. Edible rice paper is made from it.
• Buckwheat flour: Commonly used for pancakes all over the world (United States, Russia, Brittany in France). On Hindu fasting days (Navaratri and Maha Shivaratri), people eat cuisine made with buckwheat flour.
• Coconut flour: Made from ground coconut, it has the greatest fibre content of any flour and has a very low concentration of digestible carbohydrates therefore making an excellent choice for those who are restricting their carbohydrate intake.
• Hemp flour: Made by pressing the oil from the hemp seed and milling the residue. Hemp seed is approximately 30% oil and 70% residue. This type of flour doesn’t rise and is best mixed with other flours. Added to any flour by about 15-20%, it gives a spongy nutty texture and flavour with a green hue.
• Tapioca flour: Obtained from the root of the cassava plant (commonly used for bread, pancakes, tapioca pudding, etc).

Remember, adapting recipes is both a science and an art. Bake it till you make it!

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