Fabulite™ Vegetable Curry

A vegetable curry that’s quick and easy.


Ingredients

  • 1 cup cooked basmati rice
  • 2 cups cooked chickpeas
  • 2 cups vegetable stock
  • 1 tspn curry powder
  • ¼ cup Fabulite™ plain yoghurt
  • 2 tspn fresh parsley for garnish

Method

  1. Add the vegetable stock and curry powder to the pot of chickpeas.
  2. Let it simmer for 10 mins and add your Fabulite plain yoghurt.
  3. Dish rice and chickpea curry on a plate and enjoy.

For more information please visits www.lactalis.co.za


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Back to school (with Type 1 diabetes)

Going back to school can be a stressful time for anyone. For people with Type 1 diabetes (T1D) this can be even more so, especially returning to school after a new diagnosis. It’s important that teachers are aware of T1D so they can ensure the wellbeing of their students.


Education

It’s so important that your school teachers are aware of your T1D and know what to do when you need assistance. If they are educated, they will be better prepared to help you.

It’s also advisable to keep a Glucagon kit at the school office, therefore it’s best to educate the school secretaries or the school nurse.

If you feel comfortable, it’s also great to make your friends aware. That way you can ask them for help too.

Educate your teachers on the symptoms of high and low blood glucose so that they can keep an eye out for you.

If you play sports, educate your coaches on how you may need to take breaks if your blood glucose drop and eat and rest until your blood glucose returns to a good level.

Know your rights

It’s important to educate your teachers that you need to eat during class. No excused from your teachers, you are the exception. If you write exams, make sure the teachers are aware of your T1D!

Be as open about your T1D as possible

The more open you are about your diabetes, the better. People are often very inquisitive and unfortunately T1D carries a lot of misconceptions so try to be as patient as possible

If you wear a medical device, wear it with pride

NEVER be ashamed of a CGM or pump being visible. People are more likely to ask you questions but use it as an opportunity to educate people and create a positive conversation about T1D.

Be prepared

Make sure you ALWAYS have glucose sweets or a juice box with you. Lows can happen at the most unexpected times. It’s also important if you leave the classroom to carry your ‘low’ treatments with you.

Drink plenty of water at school too. Pack your bag the night before; that way you are less likely to forget important things at home. Be prepared for more than one low a day and pack enough supplies.

Remember that your T1D doesn’t define you

Know that diabetes doesn’t make you different from everyone else 🙂

Click on the image to make use of a printable PDF from the JDRF which is a great resource to give to your teachers.

T1D

MEET OUR YOUTH WARRIOR


Sarah Gomm (16) has been living with Type 1 diabetes for nearly 13 years; diagnosed at age four.


Sarah’s story

My family knew something was wrong with me due to my symptoms of thirst and weight loss, etc. They took me to the doctor and I was immediately sent to the hospital where I was diagnosed with T1D. I spent a few nights in hospital where my family and I learnt all the ins and outs of T1D.

For the next eight years, I did insulin injections and finger pricks. My mom would come to my school during break to do my injections until I was able to do them myself.

The past five years, I’ve been fortunate enough to use a CGM and insulin pump, which I’ve found to assist in lowering my HbA1c and improve my overall control.

As I get older, I’m becoming a lot more responsible managing my diabetes and it’s made me a very independent person.

However challenging T1D can be, I still count it as a blessing. I have experienced so many amazing things I never would have, it’s made me mature and, most importantly, I’ve met so many amazing people.

T1D does not define me, though, it has made me the person I am today, and for that I am grateful!

Albany boiled egg sriracha mayonnaise sarmie

INGREDIENTS

  • 2 slices Albany Low GI Wholewheat Bread
  • ¼ Small Avo (30g)
  • 2 Large boiled eggs (100g)
  • 10ml sriracha
  • 15ml mayonnaise
  • 45ml Low Fat Plain Yoghurt
  • Juice of ½ a Fresh Lemon
  • 15g Parsley
  • Black pepper
  • Handful of fresh rocket leaves (25g)

METHOD

  1. Spread mashed avo on both slices of bread
  2. Chop one boiled egg (keeping the other aside for the sarmie), stir together with the sriracha, yogurt, lemon juice, parsley and mayonnaise, season with black pepper
  3. Slice the remaining egg in quarters, place the quarters of boiled egg on the mashed avo
  4. Then fill with the sriracha egg mayo mix and scatter with fresh rocket leaves
  5. Top with the remaining slice of bread spread with mashed avo.

Nutritional Information for the recipe (per serving):

Energy (kJ) Protein (g) Carbohydrates (g) Added Sugars (g) Dietary Fibre (g)
2440 26.6 47.7 0.9 9.5
Total Fat (g) Saturated Fat (g) Monounsaturated Fat (g) Polyunsaturated Fat (g) Sodium (mg)
30 7.5 11.5 8.4 814

When losing is winning – Tash Minto

Natasha Minto, who does not have diabetes, openly speaks about her struggle with her weight, weighing 155kg at the age of 23, and how she came to lose 70kg and how her weight loss has positively affected her relationship.


Natasha Minto (30), better known as Tash, originally comes from Boksburg, South Africa but moved to Hampshire, England in 2012. She lives with her partner of six and half years, Tony Waterhouse (35).

I didn’t feel like I had to lose weight for Tony but it was because he loved me at my worst that I felt he deserved me at my best.”

When did you start battling with your weight?

I started getting a bit chubbier than my friends in my last year of primary school. I was always a bit bigger than most of the people I knew. Though, it really escalated when I finished school. When I was younger, my grandad would spend the afternoons with us and treated us to sweets. I think I associated this with feeling safe.

As a child, I was was the fussiest eater. I never ate cooked vegetables, onion, and no food could touch on my plate and don’t even think of giving me a salad.

Unfortunately, I made my parents life very difficult and since we had a lot of other stuff going on at home, my mom let it slide most of the time. I was so fussy that I would eat crisps and slap chips but not roast potatoes or jacket potatoes. This also applied to fruit. I never used to eat mango or kiwi fruit.

Only at the age of 23, did I stop picking onions out of my food. I also now eat tomatoes because I enjoy them rather than I must.

Did your weight bother you? If so, how did you deal with it?

My weight bothered me more and more as I got older. Older kids would pick on me and then when I went to high school, other people would too.

I always had a good group of friends, though, who made me feel welcome and comfortable. So, for the most part it was never a constant thing. Only on occasion. Shopping for clothes, especially for parties, was tough.

Sometimes if my friends and I went out for the night, my friends would get attention from boys and get asked out. But, I very rarely did and this is when it hurt the most. I knew and still maintain that people (guys) wouldn’t give me the time of day because I wasn’t slim and pretty. It was a harsh lesson to learn but made me tougher.

I learnt very early on that if I wasn’t going to be the prettiest, I had to be the funniest or the nicest, or something else for people to like me. So, I worked very hard on that.

I did try dieting and have possibly done every single diet you can think of. Banting, high-carb, low-carb, cabbage soup, popcorn diet, Gummy Berry juice, juicing, shakes only, fruit only, meat only, appetite suppressants, hypnosis. Everything!

This unfortunately has resulted in disordered eating on my part and my relationship with food is still quite damaged. I work on it every day.

What was your heaviest?

I weighed in at 155kg when I was about 23 years old. I tried to avoid the scales when I could.

When did your weight loss journey start and why?

In 2012 my father passed away suddenly three days before Christmas. Then the following year, I developed alopecia (hair loss) and was diagnosed with an autoimmune disease, Hashimoto’s and hypothyroidism (thyroid gland doesn’t produce enough thyroid hormone). The Hashimoto’s was the cause of the alopecia and hypothyroidism.

This was a real wake up call for me and after losing my dad, it really hit home how important it was to stay healthy and for weight loss.

I started really trying in November 2014. Tony and I used to eat out a lot and we were very much in the honeymoon phases of our relationship so we didn’t really try to be healthy. This is when the light came on. Something was working and for the very first time in a long time, I stuck with it. When the weight came off, it was easier to be active and I had more energy so I enjoyed it for the first time ever.

Plus, Tony is a vegetarian so I started exploring vegetables for the first time and my pallet started to change. I enjoy broccoli now!

When did you meet Tony?

We met in 2013. I had just come back from my dad’s funeral in South Africa and was vulnerable. My friend said I should try online dating. By this point, I was probably about 135kg so felt a lot better about myself and gave it a go.

After six months of going on a few unsuccessful dates, I decided to cancel my account. The day I went on to do so, I saw a message from Tony. We got talking and chatted for about four weeks before we met in person and have been together ever since.

Was your weight an insecurity in your relationship with Tony?

My weight was and probably always will be an insecurity of mine. Though, Tony has a way of making me feel like nothing in the world matters other than us. He has never treated me any differently and never even commented on my weight until one day I did.

We did lots of activities and he never once said, “We can’t do this because of your weight or we can’t do that.” And so, we did so much more than I have ever done and this was a huge eye opener.

Tony’s family also treated me like gold. They made me feel very welcome and it was comfortable to talk openly about my feelings with them.

I didn’t feel like I had to lose weight for Tony but it was because he loved me at my worst that I felt he deserved me at my best.

How much do you weigh now?

Since my heaviest of 155kg, I have lost 70kg and now weigh somewhere between 85/90kg depending on the day.

What does your exercise regime consist of?

I developed a real love for exercise and it’s constantly changing. As it stands now, I run three times per week (about 5km), go to Bootcamp three times per week and sometimes add in a boxing class or fit club of some sort.

I tend to have one or two days off a week but even then, I make sure to walk every single day and try to at least hit 10k steps.

Outside of this, Tony and I try to be as active as possible. We go hiking, do outdoors sports, water sports, etc. and I really enjoy it.

What does your diet entail?

Again it depends on the day and I don’t proclaim to be a saint. But, for the most part I stick to a low carbohydrate diet. Very little bread, rice, pasta and potatoes. Low sugar where I can and moderate fat/protein.

For the most part, my weight came off when I reduced my calorie intake. It’s that simple and honestly, I feel the only sustainable way to lose weight is eat less and move more.

I have completely curbed my crisp addiction and went from having a packet a day to almost one per year. Though, I still enjoy chocolate but try to keep it low sugar where I can, and I will almost always have a piece of cake on someone’s birthday.

I really try to live an 80/20 balanced lifestyle so that it doesn’t feel like such hard work.

Have you reach your goal weight?

I haven’t really got a goal. This is very much my life now so if weight loss is a by-product then great but I will keep going regardless. I have always had 80kg in my head as a goal number but as long as I am active and healthy I am happy. I’m trying not to get hung up on a number.

How has your confidence changed?

I’ve always been a fairly confident person, as I explained before. I’ve never battled for friends or jobs, etc. but being able to shop for clothes in normal shops (my mom used to have to make clothes for me at my biggest) and being able to take part in so many adventure activities has completely changed my outlook on life. I have so much to live for.

With extreme weight loss comes the battle of the excess skin. Do you have plans to get it removed?

I have no immediate plans but it’s on the wish list. It’s very heavy and weighs me down and pulls a lot when I exercise. So, I must wear compression gear to stop it from hurting.

Does the excess skin interfere with intimacy with Tony?

The excess skin is a constant battle. I will be honest as it has moments of affecting our intimate moments. But, I am quickly reminded to be proud of my hard work and to enjoy my new body, thanks to the weight loss, as I never would have before.

Tony loved me when I was much bigger and has never been bothered by it. So, why should I be? He truly does love me for what is inside and for that I can’t dare to bring myself down when all he does is lift me up.

If I had the money I would have it removed tomorrow but until then I make peace and enjoy this new lease on life. I won’t let my old body hold me back any longer. How can I let excess skin hold me back when I’ve come so far?

How do you feel being 70kg lighter?

I feel like for the first time in my life, the inside matches the outside. For so long I felt trapped inside a body that didn’t belong to me. Like I was a prisoner. But now, I have a freedom and a future I could only once imagine.

I wouldn’t say I feel sexy but there are moments when I am so proud that I could burst. It’s not always like that and I often must remind myself of how far I’ve come.

I think as women, we naturally will always find something wrong but for the most part I feel like I am the prettiest, healthiest and definitely happiest I’ve ever been.

We chat to Tony

When you first met Tash, what attracted you to her?

We initially met online so it was mostly her personality. She only had a couple of pictures to view. While I was attracted to her physically, I needed a lot more than that to be truly interested in her and didn’t trust online pictures completely.

When we got chatting, we found that we both had a love of music, travel and shared a real interest in different cultures. It was really easy conversation between us that flowed well with just the right amount of laughter. It was only when we first met face to face that I knew I was physically attracted to her.

Did her weight ever bother you and did you want her to lose weight?

I certainly didn’t need her to lose weight. But, I was aware that she wasn’t happy with her size. Wanting her to feel good about herself led me to want her to lose weight.

I was never bothered about her size but did notice her getting a bit out of breath when we would go on walks and stuff, although this never stopped her.

How has Tash changed since she her weight loss?

Tash has found a real love of exercise, which wasn’t apparent at all in the first couple of years together.

She has also started eating a much wider variety of foods but I’m not sure that’s due to the weight loss. Could just be changing taste buds through time.

She has also started to experiment with fashion and is getting more confident wearing brighter colours.

How do you motivate her?

I don’t need to motivate her much as she has great personal motivation. On the odd occasion when she has a down day or a moment where her confidence isn’t great, we might have a little conversation about being proud of what she has achieved and how far she has come with her weight loss.   

I believe there is diabetes in your family. Please explain.

My Nan had Type 2 diabetes in her eighties, and my uncle and father have been diagnosed in the last couple of years with Type 2. So, I’m very aware that I may be genetically prone to the disease, albeit later in life.

We have a rule in our house that anything with over a 10% sugar content we avoid but that doesn’t always stick. A bar of chocolate or a couple of beers isn’t uncommon once a week. 

With Tash’s weigh loss, did you ever get insecure?

No, I don’t mind other men looking or chatting with Tash because I’m confident in our relationship and trust her completely. It makes me happy that she feels more confident in herself. I would never want her to be miserable just because I was insecure. 

Have you ever battled with your weight or health?

I’ve been lucky that I have never had weight or health issues. Although, I did consider myself too skinny in my early 20s. As I get into my late 30s though I’m more aware of healthy eating and keeping fit.

MEET OUR EDITOR


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


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A toast to bread and all its benefits

Dietitian, Nicola Walters, tells us all the good things about bread and why we should eat it.


Bread is a staple food that has been around for more than 10 000 years. It’s delicious, convenient, and satisfying, sure, but what if I told you it was healthy too?

With advancements in recipe development, the composition of bread has been perfected over many years. What has evolved has created a selection of bread choices that, when eaten as part of a healthy, balanced diet, can add valuable nutrition elements.

A loaf affair

When choosing the perfect bread to suit your needs, look for the nutrition information label and be sure to size up the competition. Not all breads are created equal.

If it’s weight management and weight loss you desire, focus on the overall kilojoule value of the bread.

To lose weight, daily energy intake (measured in kilojoules) from food and fluids should be less than total energy expenditure (energy spent on daily activities, exercise and normal body functions).

A lower total kilojoule content per slice means a lower contribution to total daily energy which means more wiggle room for calorie deficits.

But that’s not all that matters; the quality of the kilojoules is equally important. Quality kilojoules come from foods that offer additional nutrition related benefits over and above the energy they provide.

Fibre is one such nutrition factor that offers huge health benefits, such as controlled blood glucose levels for sustained energy. Fibre also improves gut health; keeping the tummy bloat-free and regular.

Any bread that has more than 6g of fibre per 100 g serving is considered high in fibre and will increase daily fibre intakes and boost health. Well, isn’t that the best thing since sliced bread?

Low GI options

Sustained energy you say, but do we still have your attention? For this, it might be worthwhile to focus on low GI bread options. No, this isn’t a new Wi-Fi speed to rival 5G; the glycaemic index (GI) is referred to as the GI.

The GI of a food indicates how quickly that particular food (normally a food that contains carbohydrates) will raise the amount of glucose in the bloodstream.

A croissant for example, will be considered a high GI food because it increases blood glucose levels as fast as lightening, after being eaten.

A slice of low GI, high-fibre bread on the other hand, is considered a low GI food because it steadily releases glucose into the bloodstream, over a period. This means no more concentration rollercoasters and more stable energy cycles throughout the day.

If it’s health you’re after, you can have your high-fibre, wholegrain bread and eat it too. But when you do, remember the whole truth: no one food or diet can be “best” for health. The true effect of bread, like any other food eaten, must be considered in the context of the diet as a whole.

MEET OUR EXPERT


Nicola Walters is a registered dietitian and has workedas an associate Dietitian at Nutritional Solutions in Johannesburg since 2013. Nicola is an accredited DNAlysis practitioner and enjoys optimising her patient’s health outcomes through the individualised interpretation of genetic results.


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Using diabetes guidelines: the right medicine for the right person

Dr Angela Murphy helps us understand the recent changes in the guidelines for treating diabetes.


The purpose of treating diabetes is to improve the symptoms which result from high glucose levels and to prevent other complications in the future. Diabetes is a risk for heart disease, stroke, kidney failure, amputations and loss of vision. In fact, heart disease is the most common complication of diabetes, encompassing angina, heart attack and heart failure.

With good control, these conditions can be avoided. Achieving good control is the challenge for both patient and healthcare provider (HCP). We must never under estimate the benefit of a healthy lifestyle and this is always the building block in any treatment algorithm.

Controlled portions, choice of unrefined carbohydrates and good fats, as well as regular exercise are essential to have a holistic approach to managing diabetes.

When insulin was first discovered in 1922, it seemed the only feasible treatment for diabetes. It remains the cornerstone of treatment for Type 1 diabetes to this day. Although, there have been advances in types of insulin and ways to deliver it.

The initiation of treatment for Type 2 diabetes is generally straightforward in that most patients will be counselled regarding a healthy lifestyle and given metformin. Metformin reduces levels of blood glucose by decreasing the amount of glucose produced by the liver. It also improves the action of insulin, secreted by the pancreas, at the level of the muscle cell.

Many people, particularly those eating and exercising correctly, may control their blood glucose levels on metformin indefinitely. However, if the glucose levels and HbA1c start to rise, further treatment will need to be added.

At this point, the choice of medication becomes quite extensive. The critical question the HCP must now ask is: what is the right medication for the patient in front of me?

What is the right medication for the patient?

There are eight groups of diabetic medications with various types within each group. This means that the possible combinations of drug types and dosages can count into the hundreds. HCPs have for many years looked to clinical practice guidelines to assist in their choice.

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) are sentinel voices in the world of diabetes. Many experts over many years have come together to work out diabetes management guidelines.

Most countries, including South Africa, will consult the content of these guidelines when drawing up local recommendations. In recent years, the experts from ADA and EASD have come together on several occasions to issue a Combined Consensus Statement on the management of Type 2 diabetes. The latest one, published at the end of 2018, suggested some basic changes to our approach of diabetes management.

2018 guidelines

The reason for the new guidelines is that it recognises the excess risk of cardiovascular disease in diabetic patients and takes into consideration the evolution of diabetes drugs, particularly with the advent of the sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.

SGLT2 inhibitors

SGLT2 inhibitors (Forxiga; Jardiance), also known as the gliflozins, act by blocking the re-uptake of glucose that has been filtered through the kidney. This results in excess glucose being excreted in the urine. The advantage of this glucose loss from the body is that this translates into a calorie loss as well which helps with some weight loss in the patient.

As the name of the medication suggests, not only excess glucose but sodium is excreted. The lowering of sodium helps reduce blood pressure and has beneficial effects on the heart.

Jardiance is registered in America for the indication of cardiovascular death reduction in the patient with Type 2 diabetes and previous cardiovascular disease (angina, heart attack, need for stents).

Forxiga has recently been shown to improve heart function in patients with heart failure; in both diabetic and non-diabetic subjects.

GLP-1 receptor agonists

GLP-1 (Byetta; Victoza) is a hormone secreted by the cells in the wall of the small intestine in response to food. The GLP-1 then stimulates the pancreas to secrete insulin and, thus, lowers post-meal glucose levels. The GPL-1 receptor agonist drugs also delay the emptying of the stomach and increase the sense of fullness which results in weight loss.

In addition, Victoza has proven to reduce the risk of a heart attack, stroke or death from these causes in Type 2 diabetic patients who have already had an event. The Federal Drug Agency (FDA) in America have added this benefit to the indications for the use of Victoza.

Cardiac protection changes how Type 2 diabetes patients are managed

The incredible cardiac protection these new medications offer in addition to diabetes control is so important that it has initiated a change in how we mange Type 2 diabetes.

It is crucial that HCPs identify the patients who would benefit from these medications as soon as possible. For this reason, the 2018 guidelines now advise that after initiation of metformin, patients should be divided into two groups.

The first group is those patients with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD); i.e. patients who have already suffered from a heart attack or angina, had coronary stents, a stroke or have chronic decrease in kidney function.

The second big group is the patients who have not had heart or kidney disease to date. The latter group then gets subdivided into three main groups aiming for treatment that addresses a patient’s most pressing concern.

The groups identify those patients struggling with hypoglycaemia (low blood glucose), obesity, and those patients who need to keep costs of treatment down.

It makes sense that those patients with established ASCVD and CKD be given one of the classes of medication which have been proven to protect the heart from further events or a deterioration in heart function. As one would expect with a ‘designer drug’, the cost is significant and reimbursement from medical aids is not guaranteed.

SGLT2 inhibitors and GLP-1 receptor agonists do not cause hypoglycaemia. So, they would be possible choices in patients who need to avoid hypoglycaemia.

Dipeptidyl peptidase-4 inhibitors

Another group of medications, called dipeptidyl peptidase-4 inhibitors, also increase the natural GLP-1 levels and do not cause hypoglycaemia. The class of drugs most effective with weight loss is the GLP-1 receptor agonists, especially Victoza. However, much higher doses need to be used for weight loss management than just for diabetes management. A higher dose pushes up the cost.

South African setting

In South Africa, where most of the diabetes patients receive healthcare from the state and, in the current climate of escalating costs in the private healthcare system, cost effective medicine is essential.

The oldest group of oral medications used in Type 2 diabetes are the sulphonylureas (SUs) which increase insulin secretion from the pancreas.

The South African diabetes guidelines, drawn up by Society of Endocrinology and Metabolism of South Africa (SEMDSA), advocate the use of the newer generation SUs, such as gliclazide MR (Diamicron MR, Diaglucide MR and other generic formulations), as acceptable second-line treatment for Type 2 diabetes.

More than two million South Africans are living with diabetes. To improve their present and future health aiming for good glucose control is important. However, with increasing types of medication available to manage Type 2 diabetes, choosing the right drug for the right patient is becoming ever more important.

The newer agents have made it possible to improve long-term complications from the outset, by mechanisms other than just glucose lowering. It may not be necessary, or possible, for everyone to access these medications at present but the guidelines from both local and international societies will continue to guide the diabetes community to make the correct choice.

MEET OUR EXPERT


Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She is part of the Netcare Sunward Park Bariatric Centre of Excellence and has a busy diabetes practice.


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DSA News Summer 2019

DSA Port Elizabeth news

Diabetes Awareness in Happy Valley, Port Elizabeth on 30 September 2019


Martin and Elizabeth Prinsloo were invited to attend  a gathering of more than 100 senior citizens who were treated by the South African National Zakah Fund to an outing in our beautiful Happy Valley to enjoy the fresh air and the beauty of nature and, at the same, be encouraged and informed about living a healthy and happy lifestyle. Many of those who attended either had diabetes or had a friend or family member with diabetes. Some refreshing Spring showers greeted us early the morning, but the sun soon appeared to brighten the day. Soraya Boomgaard, a fitness coach, who is associated with our Springdale Diabetes Wellness Group demonstrated easy exercises everyone can do and then invited the more active people present to join her on the lawns for some fun exercises.

People listening to the talk about Diabetes.
Some of the people there.
Soraya Boomgaard leading the fun exercises.
The DSA and the SANZF banners.

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