Ask the dietitian expert

Meet Tammy Jardine


Get to know more about Tammy Jardine – why she became a dietitian, her ongoing passion to help people living with diabetes and partnering with Diabetes Focus.

Tammy Jardine (42) lives in Roodepoort, Gauteng with her husband.

 Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits.

She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively.

With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital.

Becoming a dietitian

When Tammy was in grade two, her parents took her to see a dietitian as she was a chubby child. It was this visit that initiated Tammy’s career path. “I was inspired by the dietitian I saw and developed in interest in nutrition and helping others eat better,” she explains.

Tammy completed the standard dietitian degree and post graduate diploma. She then did a masters in dietetics and her thesis was on nutrition and diabetes.

Type 1 diabetes diagnosis

In 2005, at the age of 26, Tammy was diagnosed with Type 1 diabetes. “I pretended it didn’t exist and collapsed in 2007 then started on insulin.”

Currently Tammy is on a basal-bolus insulin regimen where she takes a standard night time dose of insulin. She then takes rapid-acting insulin up to three times a day, depending on her blood glucose and what she eats. “I also make use of a modified carb counting strategy to manage my blood glucose and control my insulin usage.”

Diabetes nurse educator

“In South Africa, dietitians are not able to specialise in a certain area of medicine like doctors can, but we can take a special interest in an area. With a history of diabetes in my own life, I wanted as much knowledge as I could get to help other people in the same position as a diabetes nurse educator,” Tammy explains.

Since there is no qualification to become a diabetes nurse educator, only the need of additional knowledge, Tammy completed a diabetes management course in 2010 which allowed her to add diabetes nurse educator to her resume.

Loving her job 

Tammy loves her job as she says it is never boring. “Every patient is an individual and how diabetes affects people is different. As much as the medical fraternity tries to give one solution to a condition like diabetes, the truth is that every person with diabetes needs individualised advice for how diabetes is affecting them,” she says.

Partnering with Diabetes Focus

“My aim with partnering with Diabetes Focus is to help people with diabetes to learn more about the condition and understand how it is affecting them and to identify what works for them and what doesn’t. So, please ask as many questions as you need to!”

Ask Tammy


Do you have a question for Tammy?

Email your question to tamjdiet@gmail.com

PLEASE NOTE: Not all questions can be answered, check back here to read our Q&A 

Questions & Answers

Hi Tammy,

I am hoping you can give me some advice.

My boyfriend is diabetic, he injects insulin at 18 units 2-3 times a day. Today and the past couple of weeks his blood glucose has been quite high (between 20-25). I am vegetarian so I normally feed him what I eat unless I find something else for him to eat at the shop.

His diet is normally coffee with sweetner in the morning, sometimes with oats and sugar-free peanut butter. I make him cheese sandwiches for lunch on brown bread, with some kind of soup from the shop (either butter chicken curry soup or potato and leak soup are his faves).

I make a lot of bean curries and lentil curries during the week that we’ll have for dinner. And once a week we will have pasta (I normally get the whole-wheat kind). He will snack on chips or starchy snacks sometimes during the day.

He is very stressed a lot of the time due to his job, I don’t know if this could be something that could be affecting his blood glucose levels.

Please could you give me some advice? I am feeling very worried and helpless at this point.


Hi Leila,

Being vegetarian often means a higher intake of carbohydrate which is the macronutrient that requires insulin in the body.
What insulin is your boyfriend on so that I can help more specifically on the dosing, if necessary.
In the meantime, I recommend using an app like myfitnesspal or FatSecret to look at the amount of carbohydrates being eaten at one time. This is important to know since insulin dosing can be fluctuated according to the meal for optimal blood glucose control.
Stress plays a huge role in blood glucose control. Hormones like adrenalin and cortisol are released in stress and they usually block insulin, therefore increasing blood glucose levels. It is obviously impossible to stop stressing but there are insulin regimens that may be better and de-stressing techniques like exercise, meditation, and doing something relaxing at the beginning or end of the day is very important too.
Let me know the insulin he is on, as well as some valuable information like what the blood gluocose levels are at different times of the day and also how many carbohydrates he eats at meals and snacks and I can help further.

Hi Tammy,

Please may I request your assistance. I went through the list of Diabetes SA-approved products on the website and came across the Simple Truth High Protein Wholegrain Chocolate Flavoured Cereal at Checkers.

I just wanted to get clarification on this as I am keen to try the product, but the idea of a chocolate-flavoured but diabetic-friendly cereal seems a contradiction in terms.

If you could provide some background as to what makes the product diabetic-friendly, or how they have managed to restrict the sugar content, I would be most grateful.

Mr Govender.


Good day Mr Govender,

Thank you for your query. DSA uses the Heart and Stroke Foundation South Africa to endorse products. The products need to meet strict criteria in order to be endorsed as safe for people with diabetes.

I’m not on the endorsement panel, but can give an educated guess as to why the Simple Truth High Protein Wholegrain Chocolate Flavoured Cereal is on the safe product list.

Low-GI

Firstly, the cereal is low-GI. Glycaemic Index (GI) is a score of how fast a food moves into your bloodstream compared to pure glucose. The higher the score, the faster the food moves into the bloodstream. When a food moves very quickly into the bloodstream, it spikes the blood glucose requiring a big amount of insulin to respond to the blood glucose.

If it moves slowly into the bloodstream over a longer period, it will require a slower response by the insulin as the blood glucose will rise more gradually over a longer period.

The bonus of this strategy in diabetes is that it gives the slower-than-usual insulin time to work more effectively and efficiently over a longer time rather than requiring a quick response.

An optimal GI score is any score below 50 in a 100g serving of the product. Although, the actual score is not stated on the packaging of the Simple Truth High Protein Wholegrain Chocolate Flavoured Cereal, the GI of the product is listed as low.

Ingredients

Secondly, the product contains carbohydrates from brown sugar, glucose syrup as well as the starches: maize and sorghum. It’s not sugar-free but rather reduced sugar, compared to other cereals.

It contains 14g of total sugar in 100g and 23g per 50g portion. It contains 46g of carbohydrates in 100g and 23g per 50g portion. As a matter of interest, comparatively Weet-Bix has 63g carbohydrates per 100g and 25g of carbohydrates per two biscuit serving but only 2,9g of sugar in 100g and 1,2g of sugar in the 40g serving.

Although Weet-Bix is lower in sugar, it’s not actually low-GI which means it potentially spikes blood glucose. This is because it has a lower protein content, (Simple Truth has 19g per 100g and Weet-Bix has 12,4g per 100g), as well as a lower fat content (Simple Truth has 9,5g in 100g and Weet-Bix has 2,9g per 100g). Protein, fat and fibre reduce the GI of food.

A food is endorsed based on the ingredients as well as the nutrient profile per 100g and more importantly per serving size. Just because it’s considered safe. it can’t be eaten in unlimited amounts. Portion control is paramount to good blood glucose control.

Carbohydrate toleration

People with diabetes tolerate different amounts of carbohydrates at a meal. To identify how much carbohydrate you can tolerate at a meal:

  1. Test your blood glucose before you eat.
  2. Measure the carbs of the meal you are eating by using the food label per serving or by using an app, like MyFitnessPal or FatSecret.
  3. Test your blood glucose two hours after eating the meal without any snacks or beverages from the time you finished the meal to the two hours post meal test.
  4. If your post meal blood glucose levels are within 2mmol/L above your initial pre meal blood glucose reading then you were able to tolerate that amount of carbohydrate in the meal you tested.

If your post meal reading was higher than 2mmol/L above the initial reading then you will need to reduce the amount of carbohydrate in that meal the next time you eat it.

As a side note, the chocolate flavour in Simple Truth High Protein Wholegrain Chocolate Flavoured Cereal is from cocoa. The taste is not overwhelming chocolatey and the texture reminds me of other maize cereals like Pronutro and FutureLife. So if you like those you may like the Simple Truth one too.

Regards

Tammy

I have had been on insulin for two years now and treated at a state hospital. I’m 39 years old. I’m on metformin 500mg in morning and 500mg in the evening. Morning dose of Actraphane is 15u, lunch 15u, and 8u before supper. My glucose levels is between 7 and 8 when I wake up in the morning. Is that good? I don’t have much energy?

Werner.


Hi Werner,

That is good. The fasting blood glucose of 7-8 is good. I would definitely recommend that you check one day before lunch and two hours after lunch and then before supper so that you can get an idea of whether your blood glucose levels are bouncing. Often feeling tired in the day can be because your blood glucose levels are bouncing.

If this is the case then we can look at your medications and eating in more detail, to optimise your blood glucose throughout the day and hopefully improve your energy levels.

Regards

Tammy

My 89-year-old mother stays in the frail care at a retirement home in Bellville, Western Cape. They know she is had diabetes. She injects 18/20 units of insulin nightly. She also takes medication for her diabetes.

Yesterday morning the sister took a blood glucose reading and it was 20. I am very worried.

They give her porridge in the morning as well as yoghurt (sweetened I think) and two slices of brown bread with either peanut butter, marmite or cheese. I personally think that she should only have the porridge and yoghurt. She puts sweetener on the porridge.

Lunch is standard, one portion protein but she says they give her too much starch with it. She has macular degeneration and can’t see what is on the plate. Yesterday she said there was chicken, sweet potato, peas and carrots. She wasn’t hungry so she left all the food and just ate her dessert which is not sugar-free! Dessert served twice a week. 

The day before was spaghetti and two veg. There must have been meat in the spaghetti but because she can’t see she said there was no meat in. Sometimes it’s stew with very little meat. She doesn’t eat the rice at all, sends it back. 

Supper is soup and bread with a fishcake or vienna (no food value in my eyes) or cheese and a banana or a few grapes. 

Saturdays they get an egg with evening soup. 

I make sure she has fruit handy, like naartjies and nectarines, of which she has one or two a day. I take little packets of biltong and nuts for her to snack on. 

She drinks lots of diet coke, 3-4 cups of coffee or tea per day with milk and sweetener. 

They sometimes get salad. 

I think she should have five fruits a day, or am I wrong? I know a banana is classified as two fruits and grapes should only be about half a cup for one serving. 

She is otherwise healthy but lays in bed all day, refusing to do any exercise whatsoever. She only gets up to go to the loo. She is very stubborn and refuses to dress every day or walk around with her walker to get exercise. Her tummy is very big. So she basically stays in bed every single day and has her meals brought to her, which she eats in bed. 

Once a month she comes to me for a few days and when I say let’s go for a walk around my complex, she doesn’t want to. 

What do you suggest I do to lower her blood sugar? 

Leona.


Good day Leona,

I can understand that you are worried about your mom, as a blood glucose reading of 20 is definitely not good.

I agree that porridge, yoghurt and bread is too much for a meal. Ideally, this should be divided into a breakfast and snack.

Being on only a long-acting insulin once a day (like her nightly 18/20 units) means that she should eat small meals, with carb-food like porridge, bread, rice, yoghurt, and fruit being no more than a fist size.

Sweeteners are fine but if she chooses to have dessert then she should ideally leave out the carb at that meal (pasta, rice, potato). It’s not ideal but luckily the temptation of dessert is not daily.

Fruits are a nutritious snack but also have carbs in which can spike blood glucose. I would recommend a maximum of two fruits a day. Small amounts of cheese, biltong, and nuts are good snacks.

Lots of water and exercise are key to lowering blood glucose but you can’t force her to do those things.

I would see if you can influence the kitchen to adjust her meals, otherwise the only other choice is to speak to her doctor about relooking her insulin, possibly changing her to a twice a day mix insulin.

Regards

Tammy

Good morning,

My husband has Type 2 diabetes. Please advise what bread he can eat that is safe and also affordable. 

Celia.


Good day Celia,

Good blood glucose control in diabetes is the aim in managing the disease because when blood glucose sits in the bloodstream for too long, it damages the blood vessels causing multiple complications.

Blood glucose is ultimately influenced by the amount of carbohydrate in a food or meal eaten. However, not all carbohydrates are equal. How quickly they rise the blood glucose will determine the response of the insulin and if the insulin is at all ineffective or inefficient in responding (which is what happens in diabetes and insulin resistance), the glucose will sit in the bloodstream for too long and cause damage to the blood vessels.

How much carbohydrates the body can tolerate is dependent on how efficient the insulin in the body is. This makes the tolerated amount of carbohydrates variable in individuals as the response of insulin is not the same in everyone.

In general foods that contain carbohydrates, they are better tolerated when they are low-GI. When a food label states that a product is low-GI, it means that the product should not spike the blood glucose as the carbohydrate takes longer to get into the bloodstream giving the low or resistant insulin a better chance of responding to the blood glucose.

The product company usually tests the GI of a food. Also, the GI foundation in South Africa (www.gifoundation.com) tests multiple products in South Africa and lists them on their website.

With regards to bread, you should choose a low-GI bread, the lower the better.

However, portion control is extremely important and just because a food is low-GI doesn’t mean that it can be eaten unlimited amounts.

Carbohydrate toleration

People with diabetes tolerate different amounts of carbohydrates at a meal. To identify how much carbohydrate you can tolerate at a meal:

  1. Test your blood glucose before you eat.
  2. Measure the carbs of the meal you are eating by using the food label per serving or by using an app, like MyFitnessPal or FatSecret.
  3. Test your blood glucose two hours after eating the meal without any snacks or beverages from the time you finished the meal to the two hours post meal test.
  4. If your post meal blood glucose levels are within 2mmol/L above your initial pre meal blood glucose reading then you were able to tolerate that amount of carbohydrate in the meal you tested.

If your post meal reading was higher than 2mmol/L above the initial reading then you will need to reduce the amount of carbohydrate in that meal the next time you eat it.

Regards

Tammy

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