Don’t let the cold win: exercise

Posted on June 3, 2024 by Diabetes Focus eMag

Retha Harmse explores safe outdoor exercise activities to keep you active in the colder months.

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Physical activity plays a critical role in maintaining optimal health, particularly during the winter season.

For those managing diabetes, staying active isn’t merely a suggestion, it’s a fundamental aspect of effective diabetes care. However, the colder weather brings its own set of challenges, impacting blood glucose levels and overall well-being.

During winter, the shorter daylight hours and cooler temperatures can deter even the most dedicated individuals from engaging in regular physical activity. Additionally, fluctuations in blood glucose levels due to the cold weather pose additional hurdles for those with diabetes. Therefore, it’s essential to explore a variety of indoor and outdoor exercise options tailored to various preferences and fitness levels.

Whether you prefer indoor workouts or outdoor adventures, there’s something for everyone to stay active and healthy throughout the winter season. Let’s delve into these options to help you maintain your physical fitness and blood glucose control during the colder months.

Outdoor exercise ideas

Benefits of outdoor exercise in winter

While South Africa’s winter may not have the concern of snow-covered landscapes, it may still be really hard to continue the exercise habit, but exercise remains crucial for people managing diabetes.

Venturing outdoors during winter allows you to benefit from exposure to natural light, which can regulate your sleep-wake cycle and improve mood. Breathing in fresh air can also boost your energy levels and overall sense of well-being, making outdoor exercise an excellent choice for maintaining physical and mental health during the cooler months.

Walking

Walking outdoors in winter offers numerous health benefits. It provides an opportunity for physical activity while allowing you to enjoy the beauty of nature. To ensure a safe and enjoyable walking experience in cooler weather, dress warmly in layers, wear appropriate footwear and consider walking during daylight hours for maximum exposure to sunlight.

Hiking

Winter hiking allows you to explore scenic trails and connect with nature while reaping the health benefits of physical activity. Choose trails suitable for your fitness level and take precautions, such as wearing sturdy hiking boots, packing adequate water and snacks, and checking weather conditions beforehand.

Sports

Consider activities such as trail running, mountain biking, or beach volleyball, depending on your location and preferences. These outdoor sports provide opportunities for cardiovascular exercise, muscle strengthening, and co-ordination improvement while enjoying the beauty of the South African landscape.

Tips for safe and effective winter exercise

Blood glucose management

Maintaining stable blood glucose levels is crucial during winter exercise. Before physical activity, check your blood glucose levels to ensure they are within a safe range. Monitor regularly during exercise, as cold weather can affect insulin sensitivity and glucose utilisation. Have fast-acting carbohydrates on hand for hypoglycaemia and be ready to adjust insulin dosage as needed. After exercise, monitor again for post-exercise fluctuations and take appropriate action.

Dress appropriately

Proper attire is essential for comfort and safety during outdoor exercise in winter. Dress in layers to trap heat and regulate temperature effectively. Start with moisture-wicking base layers, insulating layers for warmth, and finish with a waterproof and wind-resistant outer layer. Wear thermal socks, gloves, and a hat to keep extremities warm and choose breathable fabrics to prevent overheating.

Hydration and nutrition

Stay hydrated by drinking water regularly before, during, and after exercise, even in cooler temperatures. Fuel your body with healthy snacks containing carbohydrates and protein before and after winter exercise sessions to replenish energy stores and support muscle recovery. Choose nutrient-dense options, such as fruit and nut butter, yoghurt with granola, or a small handful of biltong and cheese sandwich.

Safety precautions

Exercise safely by checking weather forecasts and avoiding extreme conditions. Dress appropriately, use reflective gear and lights in low-light conditions, and inform someone of your exercise plans. Consider exercising with a buddy or group for safety and motivation and be prepared to modify or postpone your workout if conditions become unsafe.

Insulin storage

During the winter months, proper insulin storage becomes even more crucial for people managing diabetes. Fluctuating temperatures can affect the efficacy of insulin, potentially leading to inadequate blood glucose control. It’s essential to store insulin at the recommended temperature range of 2°C to 8°C (36°F to 46°F) to maintain its potency.

However, extreme cold temperatures, such as those experienced during winter, can cause insulin to freeze, rendering it ineffective. To prevent this, store insulin in a cool but not freezing environment, away from direct sunlight and sources of heat. Insulated bags or containers can help protect insulin when travelling outdoors in colder weather.

Additionally, be cautious when storing insulin in vehicles or other unheated spaces during winter, as temperatures can drop significantly, compromising insulin quality. By following these guidelines, people with diabetes can ensure that their insulin remains effective, enabling them to manage their condition successfully throughout the winter season.

Support, share and care

In conclusion, prioritising physical activity during the winter months is essential for people managing diabetes. Through a variety of indoor and outdoor exercise options, you can maintain physical fitness and blood glucose control during the colder months. Remember to prioritise safety, monitor blood glucose levels, dress appropriately, stay hydrated, and take necessary precautions when exercising outdoors.

As you embark on your winter exercise journey, share your favourite activities and tips. Your insights may inspire others in your community to discover new ways to stay active and thrive with diabetes during the winter season. Let’s support each other through our wellness journeys and enjoy the benefits of a healthy, active lifestyle year-round.

MEET THE EXPERT

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

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Marilyn Nicolaisen – If you still breathe, there is hope

Posted on June 3, 2024 by Diabetes Focus eMag

After a series of major health complications, Marilyn Nicolaisen chooses to focus on the positive with her life motto of: if you still breathe, there is hope.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Marilyn Nicolaisen (48) lives in Pretoria, Gauteng with her husband and two children, aged 14 and nine.

Diabetes diagnosis

Twenty-four years ago, in 2000, Marilyn was diagnosed with Type 2 diabetes after having the symptom of drinking an extreme amount of water but still staying thirsty. After being admitted to hospital, the diagnosis was made.

She was immediately put on insulin and was given guidance on how to change her diet. Currently, she uses insulin glargine and insulin glulisine.

Multiple sclerosis diagnosis

In 2017, Marilyn was diagnosed with multiple sclerosis (MS), a chronic disease of the central nervous system which is thought to be an autoimmune disorder.

This came about after her pen constantly fell out of her hand as well as her coffee mug, like she had no control over her hands. Her right leg also became weak.

After consulting a neurologist, a lumbar puncture and MRI of the brain and spine were ordered. “A few lesions were seen on the MRI and I can’t remember the results of lumbar puncture but I was diagnosed with MS.

After her diagnosis, several medications were used as management (as there is no cure). Currently, she undergoes an IV infusion of ocrelizumab every sixth months. The cost per infusion is expensive but thankfully her medical aid covers it in full.

Marilyn says this diagnosis was much harder to accept than the diabetes diagnosis as there is no cure. “It was a huge shock for me and my family; I was extremely disappointed and very emotional,” she says.

Recent health scares

In April 2021, Marilyn’s whole life changed. “First I had a heart attack then two weeks later a stroke. My right side was mostly affected but with three months of rehab and a lot of exercise I have improved. While in rehab I had a MS relapse and then got COVID. My husband was out of country and no one was allowed to visit me. Thankfully, my mom took care of our children. It was the most difficult three months of my life. I tried to be positive for my husband and children but cried silently every night. We were obligated to get rails in the house, shower, etc. and a caretaker to help me. My new mode of transport, a wheelchair, was delivered to my house and a whole new life was awaiting the whole family,” Marliyn says.

She goes on to say that the heart attack and stroke were due to uncontrolled diabetes and high blood pressure. Since having the stroke and heart attack, she has tried to change her diet but says it isn’t easy; she eats mostly from the green list and low-carb foods.

Adapting to life in a wheelchair

Marliyn admits that accepting she needs a wheelchair has been beyond difficult. “I don’t think anyone will easily accept the fact that they are in a wheelchair. It’s three years now and every day is a challenge. However, my eight-year-old son makes it fun and drifts me,” she explains.

Grateful to be alive

Despite a life filled with health challenges, Marilyn is grateful to still be alive. “Every day is a challenge but I say thank you to the Lord for another day with my hubby and kids. When I think of them, I know the reason why I’m still here. I insist on making the lunchboxes myself in the morning; this makes me feel useful and needed. I sell online goods to keep me busy and motivated during the day as I was a busy bee before the wheelchair. Every evening I help prepare dinner with my caretaker and ensure I do my fair share. To help me mentally and emotionally, I consult a psychiatrist (via Zoom) and have to take medication,” Marilyn says.

Seeing the bright side

Marilyn’s children are the sole source of her motivation and positivity. “My 14-year-old daughter takes over the personal tasks from my caretaker in the evenings and over the weekends; she is my diamond. My husband and son help with other tasks, like getting me into bed or whatever I need help with. Without them I would surely not manage. My motto now in life is: if you still breathe, there is hope.

MEET THE 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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Unlocking the hidden healing potential of the human body

Posted on June 3, 2024 by Diabetes Focus eMag

Veronica Tift enlightens us on the hidden healing potential of the human body and how you can tap into it.

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Have you ever stopped and actually thought about the marvel that is your body? What it is capable of and the amount of regeneration and healing potential that occurs every day without you even being aware of it happening?

Your body is constantly trying to find balance, its working hard to fight off infection, maybe as you read this it’s digesting lunch or eliminating the waste from breakfast. Your heart is pumping blood around your body as your lung’s breathe in the air, all while cells regenerate and repair. There is function of the human body that science is still discovering, and the full capabilities of the body is underestimated and unexplored.

For me, this is the most apparent when thinking of the placebo effect and the nocebo effect. Never heard of the nocebo effect? Well, it’s the phenomenon were when you are told you might have a symptom from a treatment or intervention and you actually manifest those symptoms, even if that treatment was harmless. It’s kind of the opposite to the placebo effect, instead of having a positive effect from a belief you have a negative one.

In the book Mind Over Medicine, author Lissa Rankin writes about patients who were mistakenly informed that they had only a few months to live and died within that time frame, even when an autopsy found no physiological explanation for their death.

If the mind has been proven time and time again to have such a vital role in the ability to heal and even in how humans experience illness, then why are we not practicing more in-depth body-mind connection?

The power of regeneration of the body

One of the most powerful healings is the body’s ability to regenerate tissues and organs. You don’t need to ask the minor cut or bruises to heal, your body knows what to do and gets to it. More complex regeneration processes in the liver and stem cells are crucial without us even being aware of it.

The immune system became a hot topic during lock down. What I found fascinating is how little we actually understand what is considered the first-line of defence against harmful pathogens and foreign invaders. This protection function plays a key role in health and recovery from injury or infection.

We have hundreds of different immune cells at work within us. Making this system even more complex to study is the fact that every person’s immune system is unique. What is similar about the immune system in most people is that stress or exhaustion will have an effect on how we fight infection.

Nutrition and lifestyle, we know, has an important role to play in the body’s ability to heal. However, when looking at people who had experienced spontaneous remissions, Dr Joe Dispenza, a physician and scientist, found in years of interviews, that nutrition isn’t the major factor. He believes that while these can play a role in healing, changing the inner state of the mind will have a deeper impact on the body’s ability to heal.

While we can say “you are what you eat” and that proper nutrition, good quality sleep and physical exercise are the building blocks for healing and regeneration, it’s not the only factor. I would even argue that when humans have an inner state that is healing and processing emotions, rather than suppressing feelings and without anxiety taking over, humans are more capable of making better choices around nutrition and sleep habits, leading to better health overall.

The mind-body connection

The field of psychoneuroimmunology is a field of study that explores the complex connection between the brain, nervous system and immune system. Factors like stress, emotions and social structure all influence the immune function and healing. There are many factors that have been shown to help the body, like meditation, yoga and a variety of body work.

When stress is reduced, inflammation lowers, enhanced immune function is seen and these all help the healing processes. These all complement conventional medical treatment and support overall health and well-being. Please note: while I absolutely believe in the body’s ability to repair itself, I’m in no way suggesting that you should not seek medical advice of modern medicine.

Reflexology

Reflexology is an ancient healing practice which can help unlock the hidden healing potential of the human body. This gentle art of applying pressure to the reflex points on the feet can stimulate the body’s natural healing mechanism, aid in relaxation and help to restore balance to the body.

Part of my education as a coach, we learn the importance that self-care has on our mental well-being and while things like body work, coaching, or even time to journal might seem like luxuries, its actually self-love and caring for your body and mind, and in turn give yourself the space and time to heal.

Harnessing the healing potential

There is little doubt that the body is able of remarkable healing and I’m sure we can all think of an instance when someone was given little chance of healing and made a miraculous recovery.

Unlocking the body’s full potential while still not fully understood, we know where to start. A holistic approach to physical, emotional and environmental factors is needed. Conventional medicine with complementary approaches, optimising nutrition, managing stress, positive relationships and emotional support can all help the body heal and thrive.

The body really is resilient and has a range of sophisticated mechanism for healing and regeneration that we are still trying to understand. We can tap into this healing potential of our bodies and support it with the right tools, tools that you can discover for yourself through exploration of supportive modalities, like reflexology.

References

The Four Pillars of Healing (drjoedispenza.com)

Adding Nutrition to Balance the Body (drjoedispenza.com)

Rankin, Lissa. Mind Over Medicine. Hay House. Kindle Edition.

MEET THE EXPERT

Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.

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The tell-tale signs of the skin

Posted on June 3, 2024 by Diabetes Focus eMag

Dr Rakesh Newaj shares the tell-tale signs of the skin that can be indicative of underlying diabetes.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Diabetes, a multi-faceted condition marked by the body’s inability to regulate blood glucose levels effectively, can exert profound effects on various organs.

Most of the time, it’s discovered fairly late, when other organ complications, prompts the medical practitioner to do a blood glucose test. At this stage, some of the damage caused by unregulated blood glucose is usually irreversible. Fortunately, the skin, serving as a visible interface with the external environment, often reflects internal metabolic disturbances, offering valuable insights for diagnosis and management.

Acanthosis nigricans

One prominent cutaneous manifestation indicative of insulin resistance and impending diabetes is acanthosis nigricans. This condition manifests as velvety, hyperpigmented patches of skin, typically observed in areas such as the neck, axillae, and facial regions.

Despite rigorous hygiene practices, the distinct texture persists, prompting individuals to seek evaluation for underlying insulin resistance and diabetes. Treatment strategies encompass a holistic approach, including meticulous blood glucose control, regular physical activity, weight management interventions, and, in some cases, adjunctive therapies like chemical peels to address cosmetic concerns.

Dry skin

Individuals grappling with poorly-controlled diabetes often contend with troublesome dermatological issues, such as dry skin, particularly prevalent on the shins, accompanied by intense itching. This tends to be very persistent with bouts of scratching that leads to injuries on the skin.

Effective management entails meticulous blood glucose regulation alongside targeted interventions, such as the application of specialised moisturising creams, to alleviate discomfort and prevent complications. Sometimes the use of antihistamines and steroid creams can be very helpful in easing symptoms.

Skin tags

Moreover, the presence of multiple skin tags in regions like the neck, face, axillae, or groin may signal an underlying association with diabetes, often also linked to obesity. These tags can appear over a short period of time and can be very unsightly.

Treatment modalities typically involve the removal of these skin tags through cautery procedures, aiming to alleviate discomfort or improve the cosmetic look.

Skin infections

Diabetic individuals, owing to compromised immunity and metabolic dysregulation, frequently encounter recurrent skin infections. Bacterial infections commonly present as multiple sores scattered across the body, necessitating prompt medical attention and targeted antimicrobial therapy.

Conversely, rashes in skin folds should raise suspicion of fungal infections, such as candida. Another very common fungus infection in people with diabetes is called pityriasis versicolor. It appears as hypo or hyperpigmented patches mainly on the back and chest regions.

Addressing these infections may involve antifungal medications and meticulous hygiene practices to prevent recurrence. Additionally, diabetic individuals may contend with recurring vaginal yeast infections and oral thrush, warranting comprehensive management strategies tailored to individual needs.

Delayed wound healing

Prolonged hyperglycaemia can culminate in systemic complications, including impaired circulation and nerve damage, precipitating delayed wound healing and the development of diabetic ulcers.

In severe cases, chronic poor glycaemic control may precipitate toe gangrene, necessitating aggressive interventions, including amputations, to forestall further complications.

Diabetic dermopathy

Diabetic dermopathy is characterised by brownish skin discoloration on the shin. This type of skin lesion is fairly common and starts as pale macules which become darker in colour with time.

Many patients are unaware of its implications and try to ignore it at first till it becomes a cosmetic disturbance. The brown patches pose a therapeutic challenge to doctors due to their stubborn nature.

Diabetic blister

Sometimes patients present with a single blister on the lower leg, without a history of trauma. The blister appears overnight and can be fairly big. This is called a diabetic blister and warrants a full investigation to exclude the disease.

Necrobiosis lipoidica

Necrobiosis lipoidica can be considered as one of the cutaneous markers of diabetes. It presents as yellow atrophic patches, most often on the shins. Sometimes a red-brown rim may indicate activity at the border. Ulceration may also occur and is very slow to heal. There can be reduced sensation to fine touch in the affected area. The affected person needs to see a dermatologist to confirm the diagnosis and treat this condition.

Comprehensive management

While various other rare cutaneous signs may serve as harbingers of underlying diabetes, consultation with healthcare professionals is paramount for accurate diagnosis and comprehensive management. By adopting a multi-disciplinary approach encompassing lifestyle modifications, pharmacotherapy, and preventive measures, individuals can mitigate the impact of diabetes on skin health and overall well-being.

Dry skin and fungal infection in a diabetic

MEET THE EXPERT

Dr Rakesh Newaj is a specialist dermatologist with special interest in skin surgeries. Since qualifying in 2010, he practices in Waterkloof, Benoni, Kempton Park as well as Mauritius. His special interests lie in skin cancers, hidradenitis suppurativa and stem cell and fat grafting.

Visit dermsa.co.za

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Five ways to track your food using the mySugr app

Posted on June 3, 2024 by Diabetes Focus eMag

Do you want to know how to make the most out of food tracking using the mySugr app? We have got you sorted.

Listen to this article below or wherever you get your podcasts or visit our playlist.

The mySugr app is full of handy features to help you track your food, learn from your data and identify patterns. Tools like the Photo Function and Notes allow you to add valuable details about what you’re eating. Plus, Tags and the Smart Search Function means you can easily find what you’re looking for in just a few taps.

1. Photo Function

A picture speaks a thousand words, and photos of your food provide you with valuable information and details, so you can look back and learn from your data. Plus, you’ll become a carb-calculating connoisseur as the Photo Function trains your eye to judge a food’s carb content.

To make the most out of the Photo Function:

Make sure you photograph your entire meal. This will help you more in the long run and allow you to judge whether your carb estimation was correct.
Add contextual information to each photo, including location, estimated exchange quantity, and a precise description of the meal. This way, the next time you visit your favourite restaurant, you can find it in your past entries, see exactly what you ate, how much you dosed, and whether your estimations were on target. Check your blood glucose trends in the graph to see if you hit the bullseye.
Use the same photos so you don’t need to take a new photo every time (as long as the portions remain about the same). Just make sure you turn on the Save photos to Photos app setting, so you can quickly select pictures from your library without having to take new ones each time.
Add the picture after eating. Log entries can be backdated, meaning you can snap a quick photo of your food and then dig right in. Add the photo from your photo library and describe your meal afterwards.

2. Tags

The mySugr diabetes tracker app lets you create a new food log entry with handy Tags. You can select between almost 50 small icons that describe different situations and emotions. These Tags are there to help you understand the context of each entry better. Using the Tags regularly can help you to discover patterns when using the Smart Search Function.

3. Food type

Vegetable, fruit, dairy. If you want to keep an eye on what type of food you eat, you can easily track it with the Food Type Function. Just tap on the little icon with the plate on it in the mySugr App and you get a selection of different food types to choose from.

These food labels can help you understand the context of each entry better. You can easily search for food type tags and identify patterns using the Smart Search Function.

4. Meal descriptions notes

Add contextual information to your data by entering descriptions of meals in the text field. So, you can easily find out what, where, when and why? Every log entry tells a story, and when it comes to your diabetes, the more detail, the better. Find out all you need to know about each log entry by adding descriptions of meals and referring back to them in the future.

5. Save meals

Save meals and find out how your blood glucose is affected. It’s super handy to have your favourite meals on file so you know exactly how they affect your blood glucose. Log your meals in the mySugr app and refer back to them anytime to easily learn from your data.

Top tip: The Smart Search Function

The Smart Search Function in the mySugr app helps you find important data faster. Remember those handy Tags we discussed above? You can find food you have previously tagged using the Search Function. Easily locate things like food types and specific meals by searching for specific tags.

So, there you have it. Logging your food in the mySugr app means that you can say goodbye to confusion at meal times and a big hello to deliciousness.

Download the mySugr app now!

You can download the mySugr app in the Google Play store or the App Store.

Please contact our customer support team to check if your mobile device is compatible with the mySugr app.

For more information, contact your healthcare professional.

For any questions related to your diabetes management, kindly reach out to your healthcare provider.

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Join the conversation @RocheDiabetesCareSSA

Visit the website www.rochediabetescaremea.com for more information on our products and diabetes management tips.

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Time to understand time in range

Posted on June 3, 2024 by Diabetes Focus eMag

Dr Angela Murphy expands on time in range and why it may become the most important of all glucose measurements in the future.

Listen to this article below or wherever you get your podcasts or visit our playlist.

It’s estimated that about a half a billion people are living with diabetes worldwide. Most of them will have Type 2 diabetes, with about 10% living with Type 1 diabetes.

Large scale studies have proven that good glucose control reduces the complications associated with diabetes: cardiovascular disease, such as heart attack and stroke, kidney disease, vision loss and amputations.

At the heart of this statement are the words ‘good glucose control’. Until now, two main parameters have been used to determine diabetes control:

Home glucose levels
HbA1c

Blood glucose measurement

Initial testing of blood glucose levels in the 20^th century was done using urine test kits. These were difficult to interpret and had no real correlation with complications of diabetes. The introduction of the Ames dextrostix, in the 1960s, paved the way for home glucose testing as we know it today.

We now have a choice of efficient, accurate glucometers. It’s possible to get a glucose reading from capillary blood in mere seconds, allowing the person living with diabetes (PWD) to act timeously.

In 1999, the first continuous glucose monitoring (CGM) device was approved. For the first time, blood glucose levels were measured continuously over a 24-hour period. A sensor is worn by the PWD which transmits readings to a reader, insulin pump or a smartphone. The real time sensors will alarm if the glucose level becomes too high or drops too low. This can assist the PWD to take more accurate and frequent actions to improve glucose control.

Figure 1: CGM device showing current blood glucose level, arrow with direction of blood glucose rise and graph of previous 8 hour readings. (https://www.freestylelibre.com.au/getting-started-with-freestyle-libre-2)

HbA1c (glycated haemoglobin)

Researchers, Samuel Rahbar and Helen Rannay, found that haemoglobin (Hb) from blood samples of PWD had a specific pattern and this was named HbA1c.

HbA1c is formed when excess glucose in the blood attaches to the haemoglobin molecule, a process called glycation. Red blood cells are renewed on average every three months, so HbA1c is regarded as an average of blood glucose control over a three-month period.

Every PWD should be aware of their most recent HbA1c reading. Two landmark trials have proven that HbA1c correlates with complications.

The Diabetes Control and Complications Trial (DCCT), which involved people living with Type 1 diabetes released its results in 1990. It conclusively showed that improved glucose control, defined as a HbA1c < 6.5%, reduced the risk of microvascular (small blood vessel) complications of the eyes, kidneys, and nerves.
The United Kingdom Prospective Diabetes Study (UKPDS) confirmed these reductions in microvascular complications with good diabetes control in people living with Type 2 diabetes. Longer follow-up studies eventually showed the benefit in cardiovascular disease too.

Without HbA1c, this would have been nearly impossible to demonstrate.

Figure 2: Demonstrates the concept of a lower HbA1c: <7.0% being good, so it is green, whereas a higher HbA1c is dangerous and thus, is in red. HbA1c can be affected by several conditions that may make it less reliable, such as kidney failure, pregnancy, smoking and ethnicity (Quora.com).

Time to understand measuring glucose readings

Testing blood glucose regularly is an onerous task. It’s important therefore, to test with purpose.

Guidelines suggest that PWD treated with oral medications can measure blood glucose levels two to three times weekly. The timing of the test can vary from a fasting blood glucose to two-hour post-meal.

PWD using insulin will have to check their glucose readings more frequently. As a rule, the minimum tests should equal the number of injections per day. For PWD on four to five injections daily, this is taxing. However, we know that more frequent glucose testing does improve diabetes control.

How to understand continuous glucose monitoring

CGM devices are the machines of many a PWD’s dreams: a way of always seeing the blood glucose without having to open a conventional glucometer and prick a finger.

As the CGM devices became more advanced, they not only showed the current glucose reading, and of course the tracing of where the glucose had been but could predict where the glucose would go. In this way, PWD can be forewarned of hypoglycaemia or hyperglycaemia and take appropriate action to avoid these.

When this type of CGM technology works in tandem with insulin pumps, we see the makings of an artificial pancreas.

A CGM tracing can look like a rollercoaster. So where do we start to assess what the overall picture means?

Figure 3: CGM download showing blood glucose readings over a 24-hour period (Supplied by author).

Time in range

What data from CGM shows is that we cannot always rely on average blood glucose levels, even HbA1c, to fully assess overall diabetic control. Averages do not show the extent of the high and low glucose readings.

Let me explain: if there are three blood glucose values of 6.0mmol/L, then obviously the average blood glucose is 6.0mmol/L. However, three readings of 12mmol/L, 2mmol/L and 5mmol/L will also give an average of 6.0mmol/L and yet only one reading is in the target range. This variation in glucose levels is called glucose variability.

CGM demonstrates patterns of glucose over a 24-hour period in detail so the swings in blood glucose levels are easily seen. The more frequently the blood glucose levels swing from highs to lows, the higher the glucose variability. There is concern that this variability can damage blood vessels and thus, may be implicated in diabetic complications.

Glucose targets

Based on data from all the large diabetes trials over the years, you can set targets for good diabetes control. This is not a one-size-fits-all range. Age, duration of diabetes, presence of complications, risk of hypoglycaemia and pregnancy all affect the target blood glucose levels.

In older PWD who have diabetic complications, particularly of the heart and kidneys, glucose levels are slightly higher than a young, newly diagnosed PWD.

Table 1: Glucose Targets set out by SEMDSA 2017 (Society of Endocrinology, Metabolism and Diabetes of South Africa).

In 2019, the International Consensus in Time in Range (TIR) defined the desired targets for CGM readings. If blood glucose levels remain between the values of 4.0mmol/L and 10mmol/L 70% of the time (Time in Range – TIR), the corresponding HbA1c is around 6.5%. That equates to excellent diabetes control. Time below range (TBR) refers to readings < 4mmol/L and time above range (TAR) gives the percentage of time glucose readings are above 10mmol/L.

Figure 4: International Consensus of Time in Range (Battelino T et al., Diabetes Care 2019; https://doi.org/10.2337/dci19-0028)

Figure 4 illustrates the ideal range for patients with Type 1 and Type 2 diabetes and in pregnancy. Several medical aids will now consider reimbursement (with various levels of co-payment) for people living Type 1 diabetes who wish to use CGM devices.

Summary

To achieve good diabetes control, you try to get as close to physiological glucose levels as is safe. This has been proven to decrease both microvascular and macrovascular complications. Good control is not only a good average glucose, but also stability of glucose levels over time. Time in range gives us insight into glucose stability and may become the most important of all glucose measurements in the future.

References

ParkinG, Zhihong Jelsovsky, Bettina Petersen, Matthias Schweitzer, Robin S. Wagner. Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes. Diabetes Care Feb 2011, 34 (2) 262-267; DOI:2337/dc10-1732
Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, Bosi E, Buckingham BA, Cefalu WT, Close KL, Cobelli C. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diab Care. 2019;1(42):1593–603.
Gabbay, M.A.L., Rodacki, M., Calliari, L.E. et al.Time in range: a new parameter to evaluate blood glucose control in patients with diabetes. Diabetol Metab Syndr 12, 22 (2020)
Hirsch IB, Welsh JB, Calhoun P, Puhr S, Walker TC, Price DA. Associations between HbA1c and continuous glucose monitoring-derived glycaemic variables. Diabet Med. 2019;36:1637–42.

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 17 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.

MEET THE EXPERT

Dr Angela Murphy is a specialist physician. Currently she sees patients at Sunward Park Medical Centre and she retains a special interest in endocrinology with a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education.

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Know your sweeteners

Posted on March 1, 2024 by Diabetes Focus eMag

In a world where sweeteners have become a focus for people living with diabetes or wanting to lose weight, the Huletts EquiSweet range provides sweetness without the drawbacks of traditional sugar.

Listen to this article below or wherever you get your podcasts.
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What are sweeteners?

There are various alternatives to sucrose and other carbohydrate sweeteners such as fructose and glucose. There are two different categories of sweeteners and each have a different effect on blood glucose levels and weight.

1. Non-nutritive or intense sweeteners

The first category are products with very intense sweetening properties that are used solely to replace the sweetening effect of sugar. They have sweetness levels that vary from around 20 times to around 600 or more times the sweetness of sugar. Therefore, they only need to be used in very small quantities and accordingly contribute minimal kilojoules to the products in which they are incorporated. They also have minimal impact on blood glucose levels. Examples: aspartame, sucralose, saccharin, acesulfame potassium and stevia.

2. Polyols (sugar substitutes)

The second category is polyols which are sugar substitutes that provide sweetness at a lower level than that of non-nutritive sweeteners but still usually lower than that of sugars.

They are used to replace sugar in those applications where the functional properties of sugar are still required but removal of sugar is desirable for health reasons; the best examples are sugar-free chocolate and other confectionery.

Polyols have a similar structure to sugars but are not as well absorbed by the body. Hence, they have lower kilojoule contents than sugars (although contribute more kilojoules than non-nutritive sweeteners) and a lower effect on blood glucose, making them more suitable for people with diabetes. Although, it would be advisable to discuss this with your doctor before making them part of your regular diet.

Some polyols, such as sorbitol and xylitol, play an important role in dental cavity prevention as they are unable to produce the acids that can cause dental decay. The downside is that, if consumed in large quantities, they can have a laxative effect and cause bloating, wind and diarrhoea. Examples: sorbitol, mannitol, xylitol, maltitol and erythritol.

How does the taste of sweeteners compare to sugar?

The taste and sweetness can vary based on the type of sweetener and the blend used. Some may closely mimic the taste of sugar with a similar sweetness level, while others may have a slight aftertaste or different sweetness intensity. It often comes down to personal preference and the specific application in which it is used.

How does the Huletts EquiSweet range differ from regular sugar?

Huletts EquiSweet comprises a range of sugar substitutes from both the non-nutritive and polyol categories.

The EquiSweet non-nutritive sweeteners, known as the EquiSweet Sweetener range, are mainly intended to replace sugar in beverages and products where they only provide sweetness without any other function. The products include EquiSweet Classic and EquiSweet Sucralose which is an aspartame-free variant.

The EquiSweet polyols, known as the EquiSweet Sugar Substitute range, are designed for use in cooking applications where sugar removal is desired, but the physical properties of sugar are still needed, for example baking. The products include EquiSweet Erythritol and EquiSweet Xylitol. These are lower in kilojoules than sugar but not as low as those in the EquiSweet Sweetener range.

Huletts EquiSweet Erythritol is derived from starch and is a low-GI and low-kilojoule sugar substitute. Among the sugar substitutes, it has a higher digestive tolerance because about 90% of the ingested erythritol is readily absorbed and excreted in urine. This is why it’s called a low-kilojoule sugar substitute as opposed to xylitol where it’s kilojoule levels aren’t low enough to be called a low-kilojoule sugar substitute.

Huletts EquiSweet Xylitol is also a low-GI sugar substitute derived from plant sources. It’s slowly and partially absorbed and metabolised which results in very insignificant changes in blood glucose levels. It can assist in weight management as well as managing diabetes. High consumption of xylitol can cause digestive symptoms, such as diarrhoea, due to it only being partially absorbed.

Huletts EquiSweet range

EquiSweet Product	Usage	Sweetness Measure & Energy Values Comparison
Classic and Sucralose Sachets (low kJ)	Hot or cold beverages Cereals and porridge Cooking and baking Sprinkle over yoghurt	1g EquiSweet Sachet = 2 level teaspoons of sugar 1 EquiSweet Sachet = 16 kJ 2 teaspoons of sugar = 136 kJ
Classic and Sucralose Tablets (low kJ)	Hot beverages:tea and coffee	1 EquiSweet Tablet = 1 level teaspoon of sugar 1 EquiSweet Tablet = 1 kJ 1 teaspoon of sugar = 68 kJ
Erythritol (low kJ and low glycaemic response)	Cooking and baking Beverages	60% – 80% as sweet as sugar Erythritol = 100 kJ/100g Sugar = 1700 kJ/100g
Xylitol (low-GI)	Cooking and baking Beverages	1 teaspoon Xylitol = 1 teaspoon of sugar Xyltitol = 1400 kJ/100g Sugar = 1700 kJ/100g

Can the Huletts EquiSweet range be used in cooking and baking?

EquiSweet products can generally be used in cooking and baking as substitutes for sugar. However, it’s essential to note that they may behave differently from sugar when heated or mixed with other ingredients. For best results, follow specific guidelines or recipes designed for the particular sweetener you’re using.

Visit EquiSweet Archives – Huletts Sugar for recipes using their sweetener range.

Can people living with diabetes use the Huletts EquiSweet range?

Yes, Huletts EquiSweet is a suitable option if you have diabetes as the range generally doesn’t significantly impact blood glucose levels. However, it’s crucial to monitor your responses and consult a healthcare provider for personalised guidance.

Are sweeteners safe for consumption?

Sweeteners have to undergo country-specific safety assessments and evaluation processes prior to approval for use. Post-approval evaluation and monitoring of sweeteners are also conducted by regulatory agencies.

All the sweeteners in the Huletts EquiSweet range have undergone rigorous testing and are considered safe when consumed within recommended limits.

Regulatory bodies like the Food and Drug Administration (FDA) and European Food Safety Authority (EFSA) have approved the ingredients used in Huletts EquiSweet Sweeteners for consumption.

In South Africa, there are comprehensive regulations on sweeteners and the Huletts EquiSweet products are fully compliant with these regulations.

At global level, considerable research has gone into determining the maximum desirable quantity of each sweetener that should be consumed on a daily basis. This is known as the Acceptable Daily Intake (ADI) and has been determined in such a way that it’s an extremely safe level of consumption.

Are there side effects associated with sweeteners?

While generally safe for consumption, some people may experience digestive issues like bloating or diarrhoea when consuming large amounts of polyols found in the Huletts EquiSweet Erythritol and Xylitol products.

It’s advisable to have a moderate intake and to be mindful of your tolerance levels. Additionally, if you have specific health conditions or allergies, please consult your healthcare professional before using sweeteners.

Sweeteners for children

Few studies have examined how non-nutritive sweeteners may affect health outcomes in children. The World Health Organization (WHO) suggests not to use non-nutritive sweeteners as a strategy to reduce non-communicable disease risk in children.

Though harmful effects from the consumption of sweeteners under the Acceptable Daily Intake (ADI) by children or adolescents have not been reported, guidance generally remains that diet beverages should be limited, and unsweetened water and milk should be the preferred fluid source.

For children with diabetes, who follow a balanced diet and routinely monitor their blood glucose levels, substituting sugar-sweetened beverages with alternative beverages sweetened with a sweetener is an option in moderation.

Given the smaller body sizes of children and adolescents, careful planning should be given to ensure the consumption of non-nutritive sweeteners is not excessive. The consumption of sweeteners by children of less than two years of age is not recommended.

It’s a safe yes to Huletts EquiSweet range

In conclusion, Huletts EquiSweet range offers a viable alternative to sugar for anyone seeking sweetness without the added energy. While generally safe for consumption, its essential to use in moderation and consider your tolerances and health conditions.

Whether in beverages, baking or everyday cooking, understanding the nuances of these sweeteners can help you make informed choices towards a healthier lifestyle. Always consult your healthcare professional for personalised advice regarding dietary changes or concerns.

MEET THE EXPERT

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

This article is sponsored by Huletts in the interest of education, awareness and support. The content and opinions expressed are entirely the health professional’s own work and not influenced by Huletts in any way.

TRY THESE DELICIOUS RECIPES BY HULETTS EQUISWEET!

Roasted Spiced Butternut Soup

Huletts Xylitol Cheesecake

Huletts Peach & Berry Breakfast Slice

Sleep and screen time: what you should know

Posted on February 29, 2024 by Diabetes Focus eMag

Kate Bristow, a diabetes nurse educator, gives a rundown of all you need to know about sleep and screen time.

Listen to this article below or wherever you get your podcasts.
Visit our channel mypod.zone/diabetessa

World Sleep Day is 15^th March.

As children we are told that we need to sleep because sleep is good for us. That’s not just parents trying to get peace and quiet, it’s for real.

Getting less than seven hours of sleep at night on a regular basis can be risky to your health. So, when talking about how screen time affects sleep patterns, it’s best to understand why sleep is important, just like a good diet and exercise is also a priority.

Why do we need to sleep?

Please note for reference purposes, we are talking about less than seven hours of sleep per night.

Weight management

Studies have shown that adults who don’t sleep enough have a higher risk of weight gain and obesity.
Lack of sleep increases the levels of ghrelin, which is the hormone that makes you hungry, and decreases the levels of leptin which is the hormone which makes you feel fuller.
People who are sleep deprived tend to be hungrier and eat more, and to compensate for the lack of energy they may crave foods higher in sugar and fat.
If you are feeling tired, you are less likely to hit the gym or do any physical activity which you may normally enjoy.

Brain function

Research into sleep has shown that getting enough sleep improved academic performance, problem-solving skills and memory in both adolescents and young adults, possibly also in older folk, but there seems to be less research done here.

Athletic performance

Better sleep enhances athletic performance, fine motor skills and endurance as well as reaction time.
Lack of sleep decreases your motivation to actually get out there and exercise, which is beneficial to glucose levels and your mental well-being.

Your health

Poor quality sleep and less duration of sleep has been shown to increase the risk of developing heart disease and high blood pressure.
Shorter sleep duration is also associated with a risk of developing insulin resistance and diabetes, which along with the risk of obesity and heart disease also associated with lack of sleep leads to metabolic syndrome.
Poor sleep is strongly associated with depression. This includes poor quality sleep and sleep apnoea as well as insomnia.
Your general immunity is reduced by poor sleep patterns. Getting at least seven hours of sleep has been shown to improve immune function to fight the common cold and flu.
Sleep disturbance has been associated with higher levels of general inflammation.
Chronic inflammation can cause development of many chronic conditions such as obesity, heart disease, some cancers, Alzheimer’s disease, depression and Type 2 diabetes.

Emotions

Lack of sleep affects your ability to interact socially, resulting in emotional outbursts and behaviours such as social withdrawal.

Danger to yourself and others

When you are tired, your ability to focus on tasks, your reflexes and your reaction times are affected, in a similar way to having consumed large amounts of alcohol.
Less than six hours of sleep increases the risk of falling asleep at the wheel exponentially.
Errors at work are also a risk with poor sleep habits.

To sum all this up: sleep along with a good eating plan and exercise is one of the pillars of good health.

Managing screen time

Along with getting enough sleep, with the increased use of technology nowadays, you also need to take into account the amount of screen time you have before you settle in for the night.

How does watching TV or playing on phones, computers or Ipads before bed actually affect health and sleep quality?

These issues arise with the use of technology and screens:

You spend more time in front of screens, giving you less available time for sleep.
What you watch/play causes psychological and physical stimulation of your senses as well as social interaction which interferes with the ability to sleep or stay asleep.
The light from screens affects your circadian rhythms and your alertness.

What are circadian rhythms?

Defined as the natural cycle of physical, mental and behaviour changes that the body goes through in a 24-hour cycle.
Light and dark have the biggest influence on circadian rhythms, but your food intake, stress levels, physical activity, social interactions and temperature can also have an effect.

In a nutshell, circadian rhythms are a series of body functions that control cycles such as sleep, being awake, your body temperature, your hormones and a whole lot more. It’s important to maintain your circadian rhythms consistently by having stable bedtimes and wake-up times, aiming for a healthy seven to nine hours of sleep a night.

How is the circadian rhythm affected by screen use?

This is how it works: when it’s time to sleep your body produces a hormone called melatonin. Melatonin is produced in the pineal gland, a tiny organ in the middle of your brain which helps control your body’s sleep cycle. It’s also an antioxidant.
The bright light from screens supresses the production of this hormone, which affects the quality of your sleep.
It’s also estimated that most of us spend at least seven hours a day in front of a screen. The effects of this on general health, physical activity, cognitive function and social interactions are continually being researched, and there is still need for further research.
Consistent findings from a number of studies associate screen time with decreased duration of sleep and sleep problems.
Also to be noted in the research was the fact that in the advancement of technology, there may be stacking of screen time. What this means is that a single person may be using more than one screen at any one time. For example, as I write this article, I have the television on in the background, my cell phone at my side – and yes, I’m checking it regularly, and my computer on my lap. Three screens – not unusual anymore.

Youth and screen use

The harm of the use of screens, particularly on our young people and the consequences of this in sleep patterns is still under research, and as technology advances and changes, this will be an ongoing field of study. Research thus far is showing that the use of screens of all types is linked to delayed bedtime and not enough sleep in our young people. This includes preschoolers, children of school-going age and adolescents.

Insufficient sleep has been associated with a risk of obesity in children, mental health issues as well as impaired cognitive and academic abilities.
You may have put a TV in your bedrooms to help you fall asleep. Parents use TV to help children wind down in the evening, and people use calming apps now to help them fall asleep. There has also been suggestion that people who leave an electronic device on in their bedroom after bedtime also have less total sleep as well as poorer quality of sleep as well as daytime tiredness.
The brightness of the screen over a long period of time has also been shown to increase alertness before sleep. Screen brightness increases arousal and decreases sleepiness at bedtime and delays the onset of the circadian rhythm, which in turn delays the onset of sleep. If the same wake time is set, the total duration of sleep is therefore shorter.
Light-emitting screens have also been shown to suppress the blood levels of sleep-inducing melatonin, which is supposed to increase in the hours prior to bedtime, blue light screens are the ones which suppress the production of melatonin the most. This means less sleepiness at bedtime and interference in the sleep cycle.
Delayed bedtimes, and things like violent video games, also increase stimulation before bed, as do TV shows which excite and stimulate your senses.

AAP guidelines

The American Association of Paediatrics (AAP) has issued guidelines which recommend that any screen-based activities be stopped 30 minutes before bedtime, and that screens are not allowed in bedrooms, to try to reduce exposure in preschool children.

The link to diabetes

So, if you understand what screen time does to your health in general, how do you tie this up to your diabetes health? There are so many reasons to get a decent night’s sleep and for some of us this may feel like a luxury. Stats in America show that 1 in 3 adults don’t get enough sleep and this increases the risk for developing Type 2 diabetes, heart diseases, obesity or depression.

When you have diabetes, lack of sleep can affect every aspect of how you manage it: your food choices, the amount you eat, how you respond to insulin as well as your mental health. Good sleep puts you in a better mood and gives you more energy.

Too little sleep can:

Increase insulin resistance
Make you hungrier
You may be more likely to reach for comfort food – high in carbs and sugar
Make weight management more difficult
Increase blood pressure and increase the risk of heart disease
Decrease your general immunity
Increase your levels of depression and anxiety

Tips to improve the quality of your sleep

Your bedroom should be dark, quiet and cool (a relaxing space).
Remove all electronic devices from the bedroom. This includes TVs, computers and smartphones.
Get some exercise in the day.
Do some relaxation exercises before you go to bed.
Have a regular bedtime routine – take a shower, read or write in a journal.
Get into bed when you are tired.

Things you can change

Caffeine can affect you for up to eight hours. Avoid it in the afternoon and the evening.
Alcohol can affect how you breathe when you sleep and it affects your sleep quality.
Avoid large meals in the evening. Late meals can cause indigestion and raise blood glucose levels.
Try not to nap after 3pm so you are tired at bedtime.
Avoid nicotine; it has the same effect as caffeine.

To sum things up, all the evidence points to the fact that as humans in general we all need better sleep practices and avoid screen time at night. We need to have routine and discipline in our sleep routines just like we do in our dietary choices and our exercise. By doing this we will lead to better long-term health and better quality of life.

References

MEET THE EXPERT

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.

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Does apple cider vinegar help with diabetes management?

Posted on February 29, 2024 by Diabetes Focus eMag

Estée van Lingen, a registered dietitian, explores the potential advantages of apple cider vinegar for diabetes management.

Listen to this article below or wherever you get your podcasts.
Visit our channel mypod.zone/diabetessa

What is apple cider vinegar?

Apple cider vinegar is fermented juice from crushed apple. It has all the nutrients of apple preserved in vinegar liquid.

Raw unfiltered organic apple cider vinegar is usually the best choice. It may be cloudy, but this means it’s higher in beneficial bacteria.

Complementary therapy for diabetes

Apple cider vinegar has various health benefits and one of those benefits is regulation of blood glucose levels. Diabetes, which is characterised by high blood glucose levels, is managed by medication and dietary and lifestyle changes. However, many people with diabetes also incorporate natural remedies, such as apple cider vinegar, to complement their primary treatment and overall management of their diabetes.

Health benefits

Regulating blood glucose levels – It has been shown to improve insulin sensitivity and lower blood glucose levels after meals, especially in people with insulin resistance or Type 2 diabetes. It occurs due to its effect of reducing a glucose spike after a meal through acetic acid that helps to inhibit the digestion of refined carbohydrates, slowing down the conversion of starches into sugars.

Enhancing insulin sensitivity – Insulin resistance is a key factor in Type 2 diabetes, where the body’s cells become less responsive to insulin’s action. Studies suggest that it may help enhance insulin sensitivity, allowing cells to better utilise glucose from the bloodstream. This can lead to improved glycaemic control and reduced reliance on insulin.

Weight management – Obesity is a significant risk factor for Type 2 diabetes; maintaining a healthy weight is essential for managing the condition. It has been suggested that apple cider vinegar helps with appetite suppression and increased feelings of fullness. This may help to consume less calories and achieve weight loss goals since it only has three calories per tablespoon which is way less than standard salad dressings or marinades.

Supporting heart health – People with diabetes are also at increased risk for cardiovascular complications, such as heart disease and stroke. Apple cider vinegar consumption has been linked to improvements in various cardiovascular risk factors, including lower blood pressure, reduced LDL (bad cholesterol) and improved cholesterol levels. By supporting heart health, it can contribute to overall diabetic management.

Anti-inflammatory effects – Chronic inflammation plays a significant role in development and progression of diabetes and its complications. Apple cider vinegar possesses anti-inflammatory properties attributed to its bioactive compounds like phenols and antioxidants. By reducing inflammation, it may help minimise the complications experienced in diabetes and also improve overall health.

Gut health and digestive benefits – Maintaining a healthy gut microbiota is essential for optimal metabolic function. Apple cider vinegar promotes gut health by acting as a prebiotic (food) for probiotics which is the good bacteria in the gut. Additionally, it may assist in alleviating symptoms such as bloating and indigestion.

Easy and versatile – Apple cider vinegar is a versatile ingredient that can be easily incorporated into various foods. From salad dressings and marinades to beverages and condiments, there are numerous creative ways to add it into your diet. However, it’s essential to dilute it properly and not over consume it due to the potential side effects like tooth enamel erosion and throat irritation.

How to take apple cider vinegar effectively:

Dilute it in water (20ml in 40ml of water).
Consider taking it before meals to help control blood glucose.
Make your own salad dressing or marinade by mixing it with olive oil, fresh or dried herbs.
Remember that individual responses vary, so it’s essential to monitor your blood glucose levels closely.

Always consult your healthcare provider

While apple cider vinegar shows promise as a complementary approach to diabetes management, it’s essential to use it cautiously and in conjunction with medical advice and conventional treatment methods.

Incorporating apple cider vinegar (about two teaspoons per day) into a balanced diet and healthy lifestyle may offer several potential benefits. These include improved blood glucose control, enhanced insulin sensitivity, and better overall health for people living with diabetes.

As with any natural remedy, it’s advisable to consult with your healthcare professional before making significant changes to your diabetes management regimen.

MEET THE EXPERT

This article is sponsored by Safari Vinegar in the interest of education, awareness and support. The content and opinions expressed are entirely the contributor’s own work and not influenced by Safari Vinegar in any way.

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DSA News Autumn 2024

Posted on February 29, 2024 by Diabetes Focus eMag

– DSA National Office News –

Assisting Bergville Diabetes Support Group

DSA National Office assisted a diabetes support group in Bergville, KwaZulu-Natal run by Mrs Dorcas Mabizela. This group has already had two meetings. The recent one was on 21^st February with 15 attendees (four male, 11 female) and six members who sent apologies for not being able to attend. Six new members were given a warm welcome and given more information about the programme.

Reinforcement of following a diabetes- and hypertension-friendly diet was explained using the booklets issued by DSA.

Members were impressed by what DSA had to offer and found it easy to know the difference between high and low blood glucose because of the pamphlets that were handed out.

Mrs Dorcus Mabizela has been invited to do a programme presentation at the local task team meeting at a municipality level on 13 of March 2024. The local government consists of 15 wards.

Assisting Bergville diabetes support group

– DSA Western Cape News –

Silver Stars Group

DSA sponsored The Seniors Club (NPO) namely ECM Silver Stars Seniors club groups members with free diabetes membership for the next year.

Norma and Alvin White are the co-ordinators of the club and based in Malibu Eersteriver, Western Cape. Since so many of the members have diabetes, they approached DSA to educate them on how to manage this chronic condition. With the little income/pension they receive, it makes it difficult to focus on their health as well as what foods to avoid.

There are currently 42 members and they meet once a week on a Thursday morning.

Each member was so grateful to be able to check their own blood glucose level instead of waiting until they have to see a doctor at their clinic.

– DSA Pretoria News –

February Wellness Meeting

Pieter Roos, a leading podiatrist in Centurion, gave an informative talk on feet, how to taking care of them and the correct footwear needed. The video shown was excellent. It was very interactive and we all came away having learned something new.

– DSA Port Elizabeth News –

Department of Recreation, Sports, Arts and Culture

Martin and Elizabeth were invited to give a talk about Diabetes Awareness at the Department of Recreation, Sports, Arts and Culture situated in the Fairview Office Park, Greenacres. A few of those present there have diabetes and most knew somebody who has diabetes. They appreciated the pamphlets.

Dept of Sport, Recreation, Arts & Culture

Trident Steel Wellness Day

Martin and Elizabeth attended the Wellness Day at Trident Steel on Friday 1 December 2023. Each stall holder had a chance to address the people and explain what their table had to offer.

Malabar Diabetes Wellness Meeting

The Malabar Diabetes Wellness Group had their first meeting for 2024 on 13 February at the Malabar Community Centre. Dr Tyrone Moodaley spoke about General Diabetes – Questions And Answers. He ably answered the many interesting questions that were asked.

Springdale Diabetes Wellness Meeting

On 13 February 2024, the people who attended the Springdale Diabetes Wellness Meeting had loads of fun as Soraya Boomgaard, a fitness coach, led them through a variety of exercises. She explained that Exercise should be part of our daily life.

Newton Park Diabetes Wellness Meeting

The Newton Park Diabetes Wellness Meeting was held on Wednesday evening, 14 February 2024 in the hall at the Caritas Centre. The guest speaker, a registered dietitian, Carli Rauch, delivered a most informative presentation titled Carbohydrate Counting 101 and then answered many questions.

Rest in peace Xabiso Mbetshe

We met Xabiso on 7 August 2021 after his brother contacted Paula Thom from our DSA Young Guns, asking for advice and help about diabetes.

Martin, Elizabeth and Pamela, who speaks their home language, took gifts that had been donated to Xabiso. The gifts included a brand-new glucometer, testing strips, needles, sweeteners, breakfast cereals, milk, fresh vegetables, booklets explaining diabetes care and clothing to name a few items. He and his Aunt Nomonde were so happy and grateful.

Xabiso attend our first Campdiabetable and learnt much from the other children living with Type 1.

Sadly, on 21 February 2024, he passed away during the night due to a hypoglycemic coma.