Author: Diabetes Focus eMag

apple cider vinegar

Seven ways to get the most out of apple cider vinegar

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Apple cider vinegar is a kitchen staple that has several benefits including health, beauty, household, and cooking uses. Estée van Lingen tells us how to get the most out of it.

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

What is apple cider vinegar?

It’s a vinegar made from cider; it’s made by crushing apples, then squeezing out the juice. The apple juice is then fermented to yield apple cider vinegar. Acetic acid and malic acid combine to give this vinegar its sour taste.

Note: Organic, raw and unfiltered apple cider vinegar is usually the best choice. It may be cloudy and will be higher in beneficial bacteria.

Seven ways to get the most out of apple cider vinegar

Did you know that you can wash your hair with apple cider vinegar and even use it as a skin toner? Yes, you can. 

However, let’s focus on the different ways to use apple cider vinegar with food and to benefit your health.

1. Preserve food

Just like other types of vinegar, apple cider vinegar is an effective preservative. People have used vinegar as a pickling agent to preserve foods for thousands of years.

Apple cider vinegar deactivates the enzymes and creates an acidic environment that inhibits the growth of harmful bacteria, yeast, and mould. You can pickle various vegetables like cucumbers, onions, and olives; the tangy flavour of apple cider vinegar adds a delightful twist to pickled veggies.

It can also be used to preserve sauces, marinades, and chutneys. Its acidity helps extend the shelf life of these flavourful condiments.

There are many recipes online to preserve or pickle food using apple cider vinegar. Just make sure that you follow the instructions and that you use the correct cookware. Most importantly, don’t dilute the vinegar as the acidity will be lowered and might not be enough to kill harmful bacteria.

2. Make salad dressings, vinaigrette or marinades

Homemade dressings can be much less processed than store-bought and are often tastier too. They also don’t contain added sugars which is ideal for people living with diabetes.

Apple cider vinegar is a very popular ingredient in steak marinades because it gives a nice sweet-and-sour flavour. This can then be combined with olive oil, garlic, soya sauce, onion, cayenne pepper and fresh or dried herbs to give your meat a delicious flavour.

3. Add a burst of flavour to your food

If you are looking for a tangy sauce for your food, try adding apple cider vinegar to tomato-based sauces to give a fuller flavour.

You can also add to your favourite soup at the end if it tastes bland. Add it gradually and taste as you go, until you reach a flavour you enjoy.

4. Wash fruits and vegetables

Pesticide residue on fruits and vegetables can be a concern for many people. That’s why some people like to wash theirs in apple cider vinegar before consuming.

Although it’s not entirely clear whether it will remove more pesticides than simply washing with water, it may help kill any dangerous bacteria.

5. Ease a sore throat

Gargling with apple cider vinegar diluted in water is a popular home remedy for sore throats. The thought is that its antibacterial properties could help kill off the bacteria that is causing the sore throat. However, there is no evidence to support its use in this way.

If you try this at home, make sure you mix the vinegar with water before gargling (about 1-2 Tbsp. per half a glass of water). This is because of the acidity which can cause throat burns when consumed undiluted.

6. Increase satiety

Obesity is a significant risk factor for Type 2 diabetes, and 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 you consume less kilojoules and achieve weight loss goals since it only has 12,6 kilojoules per tablespoon which is way less than standard salad dressings or marinades.

7. Regulating blood glucose levels

Apple cider vinegar has been shown to improve insulin sensitivity and lower blood glucose levels after meals, especially if you have insulin resistance or Type 2 diabetes.

This is 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.

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 apple cider vinegar 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.

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.

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 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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Nathan Hendricks

Nathan Hendricks – Hard work pays off

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Nathan Hendricks will be competing in the Paris 2024 Paralympic Games. We catch up with the young swimmer to find out what this great achievement means to him.

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

Nathan Hendricks (18) lives in Middelburg, Mpumalanga with his parents, Darryl and Jennifer. He has five siblings.

Despite not having the easiest start to life – being diagnosed with diabetes as a baby and then diagnosed with Stargardt disease – macular dystrophy at the age of 12 – Nathan depicts joy. He answers every question with the most mature mindset and is very humble. A playful relationship with his father is evident while admiring respect is given to his mother.

“I never had self-pity, I grew up with diabetes and made the decision that I wouldn’t allow it to limit me. Then when I lost my eye sight, I never saw it as a bad thing, it actually helped me get closer to my family as my mother had to read for me and my dad had to help me with a lot of other things. I also believe God gave it to me for a reason so I’m going to find that reason,” Nathan says.

Type 1 diagnosis

At just eight months old, Nathan was diagnosed with Type 1 diabetes. This came after he was urinating a lot; a GP treated him with antibiotics for a bladder infection. Though, it didn’t help so his mother, Jennifer, took him to a hospital where a paediatrician diagnosed him with diabetes. He was treated with insulin and his parents took him to Johannesburg for a consultation with a paediatric endocrinologist.

“For the first six months, we injected him mainly in the buttocks but then the endocrinologist suggested that he start insulin pump therapy. Nathan was actually one of the first babies to be on an insulin pump. Up until the age of 16 or 17, he was using the insulin pump,” Jennifer explains.

Nathan stopped using the pump due to swimming. “Because I was in the water for a long periods of time (two and a half hours) without the pump, I wasn’t getting a good flow of insulin. So, I started injecting long-acting insulin to sustain me while swimming but now I inject both long- and short-acting insulin as I find it’s the best way for me to have good management,” Nathan says.

Stargardt disease – macular dystrophy

Then at the age of 12, Nathan was diagnosed Stargardt disease – macular dystrophy, a genetic eye disorder that causes progressive vision loss, mainly affecting central vision loss.

“We discovered that I was struggling to see when we sat at the dinner table. Instead of looking straight at a person, I would either look just above their head or to the side, so I could picture their face better. I went to an optometrist and was given the strongest lenses but still couldn’t see. We then consulted an ophthalmologist and he then diagnosed me with Stargardt disease – macular dystrophy,” Nathan says.

“Stargardt has nothing to do with my diabetes, it’s genetic. However, uncontrolled glucose levels can cause further damage but I’m proud to say that my ophthalmologist says there is no sign of diabetic damage.”

Unfortunately, there is no cure or current treatment for Stargardt disease. However, various gene and drug research trials are underway. To slow the vision loss down, Nathan reduces his vitamin A intake.

“There is a possibility that as I get older, I may become completely blind but it’s not a definite,” Nathan says.

Education

Nathan attended primary school and his parents would explain his diabetes to every new teacher he got, educating them on highs and lows and what to do in those instances. “At first the teachers were scared of the responsibility but as the years went by, it became a non-issue,” Darryl says.

Nathan then started high school but in Grade 9, his parents made the decision that home-schooling would be better for him due to him struggling to see the white board. It has been a good move as Nathan is doing extremely well academically and hopes to further his studies in particle physics.

A love for swimming

When asked when his skill for swimming was discovered, Nathan humbly says that he doesn’t see himself as being talented but rather that he has a love for swimming.

“When I joined my swimming club, I would lose to girls who were three years younger than me. But I kept on training, putting in the work in for my stroke correction and eventually I became good at it and was invited to Senior Nationals and competitions overseas,” Nathan says.

Darryl adds that when Nathan was in primary school he encouraged his son to keep on practising and eventually he would win races. “And that happened, even though his first swimming teacher said he would never be a swimmer. Nathan is disciplined; he doesn’t miss any training and as the years went by, the more races he won. In 2020, Nathan qualified to swim in a Level 2 competition, but it was cancelled due to COVID.”

Darryl continues, “When Nathan joined the swimming club, I told his coach that our goal is for him to compete in the Paralympics as he qualifies as a S13 swimmer due to having Stargardt disease. The coach looked at me incredulously but a few months later, Nathan was invited to swim in a Level 3 competition and he made the final of the 100m backstroke and from then, he just kept on going, and now he is one of the top swimmers in the club.”

Nathan is an all-rounder and is good at all four strokes but his top two strokes are 400m freestyle and 100m backstroke. “Surprisingly, I have an African record for breaststroke, which is my least favourite.”

Breathing techniques to regulate emotions

If Nathan has low blood glucose levels while training, he can feel it as he gets very tired; he then immediately gets out of the pool. Though, he says if his levels are high, he can continue to swim for a while.

He admits that emotions during galas play a huge factor in his management and extreme highs and lows. “We noticed my glucose levels were very high before a race. No matter if we increased the insulin dosage, it stayed high. Then after a race, I would go into an extreme low and had to pull out of races that were straight after. After consulting with my endocrinologist, he confirmed that adrenalin was the cause of these rollercoaster glucose levels,” Nathan explains.

Nathan consulted a sports psychologist who taught him breathing techniques to do before a race which helps him stay more calm. He also follows a daily six-meal plan to help curb these highs and lows during races and has to take a certain amount of carbs just before races and thereafter.

Keeping colds and flu at bay

With preparations for the upcoming Paralympics underway, Nathan’s schedule is jammed-pack with 10 training sessions a week, which includes two gym sessions and a total of four hours in the pool a day and 60km+ of swimming a week, as well as home-schooling.

To keep the colds and flu at bay in winter, Nathan’s coach keeps him in his own swimming lane during training. Jennifer adds that their family become hermits in winter and stay indoors to keep all the germs away.

Nathan adds that he does test more during winter to just keep an eye on his glucose levels; this is to ensure his body isn’t put through unnecessary strain.

Road to Paralympics

Nathan says he is very excited to take part in the 2024 Paris Paralympic Games as it has always been one of his goals. “I’m so honoured to represent my country and it’s a beautiful flag to hold up. There are many people that are looking up to me now, especially in my province, so I’m going to do well not only for myself but for everyone who is supporting me.”

We wish Nathan all best and look forward to seeing him make more of his goals come true.

Nathan Hendricks
Nathan Hendricks

“I also believe God gave it to me for a reason so I’m going to find that reason.”

Nathan Hendricks
Nathan Hendricks
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

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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moods

Are moods and blood glucose in children related?

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Daniel Sher explores the mechanisms behind the relationship of moods and blood glucose and offers practical advice for parents and caregivers to better support their children.

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

The interplay between mood and blood glucose in children with diabetes involves a complex relationship where physical health significantly influences emotional well-being and vice versa. This connection reminds us that we need to focus on more than just blood glucose management when it comes to diabetes, we also need to pay attention to the emotional side of this condition. 

Understanding blood glucose dynamics

Blood glucose is essential for the body’s cells and critical for brain function. In children with diabetes, the body’s inability to effectively regulate blood glucose can lead to significant mood and behavioural effects. Hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose) can manifest various psychological symptoms that impact a child’s daily life.

For example, hyperglycaemia can cause symptoms such as fatigue, irritability, and difficulty concentrating. These can disrupt a child’s ability to engage in academic and social activities, potentially leading to frustration and lowered self-esteem.

Hypoglycaemia on the other hand, can lead to symptoms such as confusion, dizziness, irritability, and even severe outcomes like seizures. The acute nature of hypoglycaemia can induce significant anxiety and mood swings, affecting not only the child but also those around them.

Psychological impacts

Managing diabetes demands ongoing attention and adjustment, which can put a substantial mental burden on a child. The stress of constant monitoring and treatment can lead to psychological issues such as anxiety and depression, which can further complicate mood regulation. Diabetes distress, or burnout, can also hold a child and their family back when it comes to living a happy and healthy life with this condition.

Social challenges may also become evident. The visible aspects of diabetes management (such as technology, testing and taking insulin) can make children feel self-conscious and different, which can impact their social interactions and emotional well-being.

The bidirectional relationship

Mood and blood glucose levels influence each other in a bidirectional manner. Stress and emotional distress can lead to hormonal imbalances that may disrupt diabetes management, while unstable blood glucose levels can cause mood swings. Understanding this reciprocal relationship is crucial for effective management of diabetes in children.

How can we help kids cope?

Educational and supportive strategies

Education is crucial. Parents and children need to understand how diabetes can affect emotional health. Recognising the signs of blood glucose fluctuations and their emotional effects is the first step toward effective management. 

Holistic care approach

Management strategies should incorporate both medical and psychological support. Regular consultations with healthcare providers who understand the dual nature of diabetes care are essential. 

Establishing routine

Consistency in daily routines helps stabilise blood glucose and mood. Regular monitoring and timely adjustments in diet and medication are key to maintaining balance.

Open communication

Encouraging children to express their feelings about diabetes and its challenges is so important. Support from counsellors or participation in support groups can provide children with coping mechanisms and a sense of community. 

Inclusive and active lifestyle

Activities that integrate children with diabetes into wider social groups can enhance their self-esteem and emotional health. Physical activity not only helps in regulating blood glucose but also boosts mood through the release of endorphins.

Family engagement

Involving the entire family in diabetes care helps normalise the condition and reduces the emotional burden on the child. Shared meal planning and group activities can foster a supportive environment.

Comprehensive care

The relationship between mood and blood glucose in children with diabetes is central to overall health. By addressing both the emotional and physical aspects, caregivers can provide more effective support, enhancing both the child’s quality of life and their diabetes management.

Understanding and intervening in this bidirectional relationship is key to helping children manage their condition while maintaining a positive outlook on life. Comprehensive care not only stabilises blood glucose but also significantly improves mental health, offering a brighter and healthier future for children with diabetes.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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post-meal rollercoaster

Navigating the post-meal rollercoaster

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Dr Paula Diab shares valuable tips for keeping blood glucose spikes in-check to avoid the post-meal rollercoaster.

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

Over nearly 20 years of assisting people managing their diabetes, I’m always humbled by how much there is to know about the disease. Not too long ago, I thought that if you could master the art of counting carbohydrates, then dosing insulin would be simple. 1 unit of insulin for every 15g of carbohydrates. 1 slice of toast = 15g of carbohydrates. What could be easier?

But if practicing medicine has taught me nothing else, it is that medicine is an art as much as it is a science. Seemingly simple maths does not always add up.

In listening to patients, I began to realise that they too were finding that this simple maths didn’t always work and that eating a burger with a side salad as a starter would sometimes work out better than eating just the burger alone. And then I had the opportunity to attend an international conference where I attended a lecture on macro-sequencing and the puzzle pieces slowly started to fit together.

One of the latest buzzwords or phrases in diabetes management is Time in Range (TIR). This refers to the overall time during the day that you spend within a particular target range. This range can depend upon your circumstances but is generally between 3.9 – 10.0mmol/L (70-180mg/dL).

If you are able to spend 70% or more of your time within this range, your risk of complications and overall prognosis in diabetes will be greatly improved. Studies have shown that kidney and eye disease are accelerated with greater post-meal peaks as well as these rises being an independent risk factor for developing cardiovascular disease.

Matching the action of insulin

Short-term glucose control is also negatively affected by these post-meal peaks which manifests in a decrease of energy, cognition (thinking) difficulties, mood swings and other physical and emotional abilities are affected.

As we then struggle to get the readings back into range, a common problem is that of overcompensating and causing what clinicians refer to as a rebound-low. A key component of remaining in range is therefore being able to manage your glucose levels after meal times and not just monitoring your fasting glucose levels early in the morning.

Keeping your glucose levels to remain in the target range with as little fluctuation as possible. In fact, if you are trying to get your glucose levels closer to that magic number of an HbA1c of 7%, managing your after-meal peaks is going to be all the more important.

It is normal to have fluctuations in glucose levels throughout the day even for people who don’t have diabetes. However, if the peak of the rise is too high or lasts too long, this may have adverse effects on your health. The idea in diabetes is to match the action of insulin with the consumption and digestion of carbohydrates.

Measuring and targets

Medicine is an art as well as a science. So, whilst most people will experience a peak about 60 – 90 minutes after starting their meal, this may vary from person to person and depending upon the meal eaten.

The next conundrum occurs when looking at what your targets should be. General guidelines suggest a post-meal peak of <10mmol/L (180mg/dL); however, this may also vary. Elderly patients or those with multiple co-morbidities may be encouraged to set their targets slightly higher to avoid the disastrous consequences of hypoglycaemia whilst pregnant women will be encouraged to have a much tighter range and not allow their post-meal peak to rise above 7.8mmol/L (140mg/dL) in order to prevent unnecessary damage to the foetus.

Peak management

  1. Selecting the correct insulin

Very often people think that all rapid-acting insulins are the same. The reality is that whilst most people (particularly with Type 2 diabetes) don’t notice a significant difference between insulin aspart or glulisine, for example, other people do react very differently.

There are also newer ultra-rapid insulins that will act even quicker as well as different formulations of insulin (inhaled insulin, not yet available in South Africa) that also work much quicker.

  1. Injection technique

The manner in which you inject insulin can also affect the way it’s absorbed and how quickly and efficiently it acts. Injected insulin works much faster when the injection site is warmed. This can be done by rubbing the site before injecting, exercising the muscle near the site or immersing the site in warm water.

In practical terms, your insulin may be absorbed quicker after a warm bath, after a run or on a warm summer’s day. Injecting directly into the muscle (anterior thigh or arm) is not usually indicated but if you are wanting insulin to work very quickly in the case of diabetic ketoacidosis (DKA) or treating a very high glucose level, this will certainly make a difference.

Remember that working quicker or faster doesn’t mean working for a longer time which will be discussed later.

  1. Pre-bolusing

Some people may have heard about the concept of pre-bolusing or injecting insulin prior to a meal. This can have a significant impact on squashing the peak that occurs after a meal, but you do need to be careful.

The aim is to get the insulin into your body and working at its maximum at the same time as your meal peaks. The exact timing of this will depend on multiple factors as medicine is an art, as well as a science.

High glycaemic index (GI) foods will peak quicker and therefore may require a bolus 15 – 30 minutes before the meal whilst lower GI foods may digest better when the insulin is given at the start of the meal. Higher pre-meal glucose values may respond better when mealtime boluses are more pronounced whereas lower glucose levels may benefit from insulin taken during or even after the meal.

  1. Other medications

The effect of insulin may be enhanced by other hormones, such as GLP-1 receptor agonists. These delay gastric emptying and keep carbohydrates from raising the blood glucose levels too quickly after meals.

Another drug, pramlintide (not available in South Africa) also helps to reduce appetite and squash the post-meal secretion of anti-insulin hormones in the body. Both of these medications will result in much more stable glucose levels and smaller peaks.

These are the pharmaceutical ways in which you can squash that post-meal peak but there are also quite smart manoeuvres you can try with simple lifestyle adjustments that will also have a significant impact.

Lifestyle adjustments

  1. Glycaemic index

As mentioned previously, lower-GI foods (pasta, beans, legumes) will digest slower and therefore have a flatter peak if you measure the glucose response.

Higher-GI foods (bread, cereal, potatoes, rice) are converted into glucose more quickly and therefore will tend to give a higher and more pronounced peak.

In addition to balancing the timing of your insulin, try to balance your meals with a combination of carbohydrates so that you do not only get a quick peak and then feel hungry again soon afterwards.

  1. Acidity

The addition of acidity to food has also been shown to reduce the post-meal spike. In practical terms, this can be in the form of sourdough bread as opposed to regular flour bread; adding vinegar or even tomato sauce as a condiment.

  1. Food sequencing

The order in which you eat your food has also been shown to be important in maintaining stable glucose levels. Having a salad or vegetables prior to your main meal will allow time for your digestive enzymes to be secreted so that when you eat your carbohydrates, your body is optimally-primed to digest these foods.

Fats will slow down the absorption of carbohydrates in the body. The most typical example is that of a cheesy pizza – very often insulin is given in split doses in this case to match the peak of the carbohydrate as well as the delayed peak of the fat in the cheese.

Proteins will also slow down the absorption of food in the body and contribute to satiety (fullness) therefore reducing the overall glucose load.

As always, a healthy balanced meal is recommended so experiment with your favourite meals and see what the impact can be on your post-meal peaks.

  1. Splitting meals

Other suggestions are to split the meal and have a portion of the meal 30 – 60 minutes after the initial meal. This is particularly useful if you are to embark on a large gourmet feast. The longer you take to eat the food, the more time your body has to digest it.

Even smaller meals can be broken down in this way by having a cup of coffee prior to breakfast and then eating the bowl of cereal and milk a while later.

Those who like to have a mid-morning or mid-afternoon snack may consider removing a serving of fruit from breakfast or lunch and having it between meals. In this way, the body is presented with smaller loads of carbohydrates more consistently which will certainly assist in more regular blood glucose levels. Please speak to your clinician about how to dose insulin if you are going to split your meals in this way.

  1. Exercise

If ever there was a solution to almost all problems, it is that of physical activity. Being active after eating will reduce post-meal peaks by slowing down absorption of glucose into the bloodstream. The body also uses the glucose consumed and actually becomes more sensitive to insulin as well. Ten to twenty minutes of mild activity (walk, household chores, etc.) is usually adequate.  

  1. Prevent hypoglycaemia

We’ve spoken often about the dangers of hypoglycaemia but one of the most overlooked problems is the vicious cycle that it creates. The body responds to low glucose levels by doing everything it can to counteract this potentially lethal situation. It empties the stomach quicker, food is digested quicker and blood glucose levels rise more rapidly. In addition, counter-regulatory hormones are released that stimulate glucose production in the liver. The end result – blood glucose levels peak and it becomes difficult to lower them again.

Take-home lessons

Its highly possible that by now your blood glucose levels have dropped, due to all the mental agility, or sky-rocketed, due to the stress response elicited by the body by reading all this information. Perhaps, they’re perfectly stable with no change at all.

If you take away one thing, remember that medicine is an art as well as a science. Sometimes, what looks like simple maths is actually a complex interplay of numerous different factors with even more unexpected outcomes.

Another good point to remember is to be alert to new ideas and thinking and constantly try to improve your knowledge and understanding of diabetes. What worked for the last 20 years, may not be the most ideal way to manage your diabetes and sometimes change is necessary and even helpful.

Experiment with your medication and food and find out what works best for you. Read through this article slowly and carefully and try one strategy at a time and get a good idea of the impact it has on your diabetes.

Obviously, all these strategies are much easier when using a continuous glucose monitor but you can get a very good idea by testing before and two hours after each meal and then discussing your findings with your diabetes educator or diabetologist.

Treat it as an interesting puzzle and try to solve the conundrums. Even experienced clinicians are sometimes forced to go back to the drawing board and ask for assistance. Managing the post-meal rollercoaster very often requires time, lots of trials and testing and a great team-effort.

Dr Paula Diab

MEET THE EXPERT

Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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The ‘Can you eat that’ shame

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Monique Marais addresses the shame that people with diabetes can experience when loved ones question or misunderstand their food choices.

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

There are several common misconceptions regarding what a person with diabetes should eat and what needs to be avoided at all costs. It is, however, important to note that dietary needs can differ among individuals, and people with diabetes should work closely with health professionals who understand the condition and can give relevant and practical guidance to create a meal plan that is appropriate for them.

It’s also recommended to approach conversations about dietary choices with sensitivity and empathy, especially when discussing restrictions. It may be counterproductive to point out what people are allowed to eat and what not and can affect the person living with diabetes on an emotional level. People living with diabetes often face enough challenges in managing their conditions without the added stress of feeling ashamed about their food choices.

It’s therefore more constructive to focus on positive and supportive communication and understanding their dietary needs. Encourage them to make healthier choices, provide information on balanced nutrition and highlight a variety of foods that are beneficial for their well-being. Educating yourself as a family member is vital to effectively support them in their journey, and this means eliminating inaccuracies.

Common misconceptions

  • Sugar must be avoided completely

While it’s true that managing sugar intake is crucial for people with diabetes, it doesn’t’ mean they must eliminate sugar completely. The focus should be on monitoring carbohydrate intake, as carbohydrates directly impact blood glucose levels. The type and amount of carbohydrates, along with proper portion control, are important considerations.

  • People with diabetes can only eat diabetic foods

Specialised diabetic foods are helpful, however, are not a must or an only and can be expensive. These products often still contain carbohydrates and kilojoules, and they may have sugar alcohols or artificial sweeteners that can have laxative effects if consumed in excess. A balanced and varied diet is more beneficial.

  • Starchy foods are off-limits

Starchy foods like bread, rice and pasta can affect blood glucose levels, but when they are part of a balanced diet and consumed in moderation, the effect on the blood glucose levels is reduced. Whole grains are also a better option to include in your meal plan.

  • Fruit is forbidden

Fruits contain natural sugars, but they also provide essential nutrients and fibre. Moderation is key, and it’s advisable for people with diabetes to choose fresh, whole fruits over fruit juices or dried fruits, which can be more concentrated in sugars.

  • Skipping meals controls blood glucose

Skipping meals can lead to irregular blood glucose levels and overeating later. Regular, well-balanced meals and snacks are essential for managing stable glucose levels.

A family disease

Diabetes is known as a family disease, as it can affect many people within one family in various ways. It’s important for people with diabetes – and their family members and support system – to understand how different foods affect an individua’s body.

By understanding the condition, and specific red flags, you can avoid spikes in blood glucose levels, and will be able to have a more consistent average.

Approaching conversations with empathy and understanding can help create a supportive environment for people with diabetes to make informed and positive choices regarding their diet and overall health. This is important for family members and friends, but also for healthcare professionals. Have patience with your patients, work from where they are and support them in their journey. Take the time to understand where they are in the process and how you, as the healthcare professional, can support them to make effective and sustainable lifestyle changes.

As a loved one, you can support your family member by:

  1. Understanding the impact that a chronic illness has on their emotional well-being. This is a long-term condition, and some days may be easier to deal with than other days.
  2. Avoid blaming. Do not constantly nag your loved one about what they are eating and add more pressure, as it often leads to conflict in the relationship.
  3. Ask your loved one what they need from you; support them in their journey.
  4. Attend appointments with your loved one. This way you also get the feedback from the doctor and will be able to support them more effectively.

Learn to identify symptoms of high or low blood glucose levels so that you can intervene quickly and effectively.

How best to support someone with diabetes
Monique Marias is a registered social worker at the ClaytonCare Group which provides in-patient care to medically complex patients on a sub-acute level. She has specialised in physical rehabilitation for in-patients for 13 years, and has a passion to assist people to understand and manage their diagnoses and the impact on their biopsychosocial well-being.

MEET THE EXPERT

Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

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diabetic amyotrophy

What is diabetic amyotrophy?

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Christine Manga, a diabetes nurse educator, clarifies what diabetic amyotrophy is and the necessary information you need to know.

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

Diabetic amyotrophy is also known as proximal diabetic neuropathy, ischaemic mononeuropathy, diabetic lumbosacral plexopathy, Bruns-Garland syndrome, to name but a few.

In 1890, neurologist Ludwig Bruns first described the condition in people with diabetes, usually poorly controlled. In 1955, another neurologist, Hugh Garland coined the term amyotrophy. For this article I will refer to it as diabetic amyotrophy.

What is diabetic amyotrophy?

Diabetic amyotrophy is a rare episodic and progressive form of diabetic neuropathy. It’s characterised by loss of unilateral (sometimes bilateral) proximal motor function, atrophy (wasting, shrinking) of muscles in the front upper legs, sensation of severe burning, weakness, and pain.

An extreme aching pain in the hips, thighs and buttocks are almost always present. This is often followed by weakness. Anywhere between 35 – 50% of affected people will report unintended weight loss. Getting up from a sitting position becomes difficult. This condition can be disabling with some people requiring wheelchair assistance for a time. Progression of diabetic amyotrophy is quick, taking a few months.

Causes

The causes are not fully understood. Possible causes include but are not limited to:

  • A sudden reduction in blood glucose levels of a person with chronically raised blood glucose levels
  • Initiation of anti-hyperglycaemic treatment
  • An immune mediated vasculitis causing ischaemic (insufficient blood supply) damage to the nerves, and it has also been referred to as idiopathic.

Who is at risk?

Almost 50% of people with diabetes will experience diabetic neuropathy. However, diabetic amyotrophy only affects approximately 0.8 – 1% of people with diabetes. It affects more people with Type 2 diabetes compared to Type 1.

Onset is usually during middle age but can be seen in younger individuals. Males over the age of 50 with Type 2 diabetes are the most frequently affected. Duration and severity of diabetes are not predisposing factors. People with good glucose control can also experience diabetic amyotrophy.

How is diabetic amyotrophy diagnosed?

Diagnosis usually consists of a thorough history taking and physical examination especially of the lower limbs as well as reflex testing. To exclude other conditions with similar symptoms, such as nerve compression, a process of elimination is used.

A lumbar puncture, nerve conduction studies, and MRI scans may be performed. A blood workup will be done to assess diabetes control, vitamin deficiencies and inflammation markers.

Treatment

Treatment is pain management. However, it does not respond to conventional pain medication, rather anti-epileptic, antidepressants, such as amitriptyline, and nerve pain treatments. Recently steroidal medication has been used. It appears to increase recovery time but also causes an increase in blood glucose levels. There is still not enough evidence for its use. Good glucose control is to be strived for.

An improvement in diet, physical exercise, such as physio, and stopping smoking and alcohol aid in recovery. The physiotherapy can aid in nerve restoration.

Diabetic amyotrophy can lead to anxiety and depression. Education is of utmost importance, hence explaining the progression to possible severe disability, paraplegia, and extreme pain. Although, it will not reverse diabetic amyotrophy, regular foot examinations for injury, wounds and infection will prevent further complications. The goal of treatment is to improve quality of life.

Prognosis

Diabetic amyotrophy is self-limiting and the likelihood of full recovery is probable. The entire process takes a few months up to about two years. Sometimes, but not often up to three years. Reassurance and encouragement that it will resolve is vital.

Prevention

There is no precise way to prevent diabetic amyotrophy. The principles used to prevent general diabetes complications should be adhered to, including smoking cessation, good glucose control, limit alcohol intake, maintain a healthy BMI and regular check-ups with your doctor, dietitian, and educator.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

MEET THE EXPERT

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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roasted spiced butternut soup

Roasted Spiced Butternut Soup

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Who doesn’t love a roasted spiced butternut soup in winter?

The added plus is this recipe is approved by the GI Foundation of SA and Diabetes SA.

Serving: 6 | Cooking time: 3 hours | Difficulty level: Easy

INGREDIENTS

Soup

  • 1 ½ kg butternut, peeled, seeded, and cut into ½cm cubes (2 large butternuts)
  • 1 large carrot, peeled and cut into ½cm chunks
  • 30ml (2 Tbsp.) olive oil
  • 3 sachets Huletts EquiSweet
  • 5ml (1 tsp.) ground cinnamon
  • 5ml butter, cut into cubes
  • 1 large onion, thinly sliced
  • 4 cloves garlic, chopped
  • 20ml (4 tsp.) vegetable or chicken stock powder prepared with
    • 1 litre (4 cups) boiling water
    • 2 sprigs thyme
    • 1 bay leaf
    • Freshly ground black pepper

Topping

  • 250ml (1 cup) low-fat yoghurt
  • 1ml (pinch) ground cinnamon
  • 1ml (pinch) nutmeg
  • 1ml (pinch) salt
  • 1ml (pinch) garlic/onion powder
  • Chives, chopped to garnish

METHOD

  1. Preheat oven to 230°C.
  2. Toss the butternut and carrot together with 25ml of olive oil (keeping 5ml aside). Sprinkle with Huletts Equisweet and cinnamon and divide and spread onto two baking trays.
  3. Roast until the butternut and carrot have browned (about 40 minutes). Turn two- or three-times during cooking. Set aside.
  4. Place 5ml butter and remaining 5ml of olive oil, onion and garlic into a large saucepan over medium heat and sauté until soft and lightly brown.
  5. Add the roasted butternut and carrot to the saucepan and add the prepared stock, thyme sprigs, and bay leaf. Bring to a boil, lower heat and simmer until vegetables are soft (about 10 minutes). Remove the thyme sprigs and bay leaf.
  6. Blend soup with a blender until completely smooth. Season with black pepper.
  7. Return soup to saucepan and keep warm.

Topping

  1. Mix the low-fat yoghurt, cinnamon, nutmeg, garlic powder and salt. Set aside.
  2. Serve soup with a dollop of the spiced yoghurt, chopped chives and a slice of low-GI bread, if desired.

Tip: Freezes well for up to three months.

NUTRITIONAL INFO (per serving)

Nutrients per serving: One serving is equivalent to three portions vegetables and one portion low-fat protein.

GI (calculated) = 44 (low-GI). GL per serving = 17.

Energy Protein Carbohydrates Fat Fibre
Per serving   1046 kJ  6.8 g 38 g 5.5 g 5.5 g
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DSA news

DSA News Winter 2024

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– DSA National Office News –

Chery Middelburg Diabetes Awareness Event

Eastvaal Chery Middelburg hosted a Diabetes Awareness Event at Eastdene Pharmacy last year in honour of World Diabetes Day. The event was spearheaded by Eastvaal Chery Brand Manager Derick Truter, who has Type 1 diabetes.  DSA National Office supported the event with literature and contacts.

The public also had the opportunity to test drive one of the Chery vehicles on display and win prizes throughout the day.

Chery Middelburg and Eastdene Pharmacy, alongside the Witbank Diabetes Centre, HomeMed, Pharmoco, Contour, Rubicon Medical Centre and more made this day possible.

 It was a great privilege to be able to host the event in Middelburg and see so many smiling faces. It was fantastic to bring a positive vibe and energy to the community.

The following tests were administered to anyone wanting to evaluate their health: (FREE)

  • Haemoglobin A1C test
  • Lipogram blood test
  • Glucose test
  • PSA test

– DSA Western Cape News –

Parents’ Breakfast

DSA Western Cape held a breakfast for moms and dads with children with Type 1 diabetes in April at the beautiful Chart Rose Farm in Wynberg, Cape Town. One family drove all the way from Kleinmond to attend the breakfast.

Speakers that presented to the parents were: Dr Adnaan Mia who has a daughter with Type 1 and Sr Lyn Starke who was in charge of the Diabetic Paediatric Clinic at Red Cross Hospital for 45 years.

It was a beautiful sunny day with the smell of roses wafting over the meeting.

Milnerton Diabetes Support Group

Nurse Onyinye Nwaulu of DSA Milnerton Support Group presented a talk for pastors in the Western Cape and also the Cameroon Community in March and May 2023.

She educated women on the importance of taking good care of their health, most importantly covering diabetes, hypertension, kidney health and general well-being of women.

She extends her thanks to DSA for always supporting the Milnerton Diabetes Support Group.”

– DSA Pretoria News –

March Wellness Meeting

On 2 March 2024, DSA Pretoria hosted an interesting discussion on proper planning of meals and the importance of moderation. The speaker was Bernadine Blom, a dietitian. The meeting was well-attended.

May Wellness Meeting

On 4th May 2024, DSA Pretoria held their monthly diabetes meeting in Pierre Van Ryneveld Park. The speaker was Welma Geldenhuys from The Association for Dementia and Alzheimer’s of South Africa (ADASA). She spoke in general on dementia and how the different types of Alzheimer’s fit under the dementia umbrella.

She also mentioned that dementia is a brain disease and not a mental disorder, and made the connection of dementia with other chronic conditions like diabetes.

It was so great finding out about the signs and symptoms that family members can look out for in their ailing loved ones. The talk was very interesting, interactive and everyone learned such a great deal about a disease that is so debilitating for the person that has it. DSA thanks Welma for giving up her valuable family time to be with the group. So appreciated.

Medical Personnel Wellness Event

DSA Pretoria was invited to participate in a wellness event run by medical personnel in Centurion. There were seven stations altogether. It was aimed mainly at people who need services but do not have medical aid. The medical personnel want to make it a monthly event. Bravo to this health outreach to the community.

– DSA Port Elizabeth News –

DSA Young Guns

The DSA Young Guns enjoyed a fun day outing that included a 5km walk through the forest. The cherry on the top was that there was no entrance fee. 

Health Awareness Morning

On 17 May, Pamela Molefe, Elizabeth and Martin Prinsloo attended a Health Awareness Morning for the employees of PnP Hypermarket, Moffet Retail Park, which was held in their board room. We had a PowerPoint presentation on diabetes that they could watch while waiting to have their blood glucose tested.

– DSA Pietermaritzburg News –

Diabetes Symposium

In March, DSA PMB branch hosted a diabetes symposium with 70 attendees. There were several talks given:

  • The importance of taking their medication on time by pharmacist, Mr Moodley.
  • The diabetic journey by Dr Naidoo
  • Diabetes in the Pead by Dr Naidu
  • Understanding food labels by dietitian, Pranisha Deonarain
  • Diabetes in your pet by veterinarian, Dr Singh
  • The role of herbs and spices in your diabetic diet by Dr Mohan
  • Diabetes and menopause by gynaecologist Dr Pephra
  • The vegan way of eating by Mrs Lubbe

Fig and Olive, a local company focusing on healthy homemade juices and shots, also presented products at the symposium. Sensors from Libra and Medtronic were on display. Attendees could also purchase nuts and healthy snacks from Chrissy’s table. B.braun also displayed supplements. There were plenty of lucky draw prizes up for grabs. Attendees also revived goodie bags.

podiatrist

The role of the podiatrist

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Lynette Lacock, an occupational health sister, highlights the role of the podiatrist in the healthcare team for those living with diabetes.

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

You may not be aware of how important it is as a person with diabetes to take care of your feet. Since diabetes can cause poor circulation and neuropathy, it’s essential to have your feet and lower extremities examined by a podiatrist regularly.

Podiatrists are doctors who treat conditions of the lower limbs, including feet and ankles. Therefore, they are the best healthcare professional to see routinely to prevent any future problems relating to feet and diabetes.

The saying prevention is better than cure rings true in this case.  Wounds are often difficult to treat when you have diabetes due to poor blood flow. You need to be vigilant when it comes to preventing sores and infections and you also need to be on the lookout for blisters or sores caused by ill-fitting shoes. If you have even a mild neuropathy in your feet, your shoes may not feel tight even though they are damaging your skin.

What can podiatrists assist you with?

  • Routine foot exams

It’s crucial for all people with diabetes to have a professional exam of their feet and lower extremities on an annual basis. A trained podiatrist will be able to see things that you may have not noticed.

  • Early detection and prevention

Detecting a blister or treating an open wound when it first happens is the key to preventing the problem from getting worse. Most people with diabetes have problems with poor circulation and neuropathy. Neuropathy is caused by nerve damage due to uncontrolled blood glucose. It causes you to have less feeling or sensation in an extremity. If you can’t feel that your shoe is too tight or rubbing in an area, then you can develop a blister or wound without even knowing about it.

  • Mechanical assessment

A podiatrist can watch your gait or the way you walk to see if there is anything out of the ordinary. If there is, they can recommend a specialised shoe or orthotic to help prevent any damage from happening.  

  • Foot wound and ulcer care

If you do get a wound or ulcer, the podiatrist is the best person to treat it. You may also need a course of antibiotics which they can also prescribe. Don’t ignore a blister, wound or open ulcer.  These are difficult to treat in people with diabetes and you want to take care of it immediately to prevent it from getting any worse. 

  • Surgical procedures

Podiatrist can also perform any surgical procedures necessary to treat lower extremity deformities or to debride dead tissue to allow an existing wound to heal.

Multi-disciplinary care

Although podiatrists are the foot specialists, they are part of a team that works together treating diabetic foot and lower extremity problems. They collaborate with vascular surgeons if they feel you need to be referred because of poor circulation. And if they are aware that you are having problems controlling your blood glucose, they may refer you to an endocrinologist. They all form a team that play a part in keeping you healthy.

Now that you understand the role of the podiatrist, make an appointment to see one. Don’t put it off until something is seriously wrong. Rather try to prevent complications before they happen by having routine check-ups and keeping your blood glucose under control.

References

Sr Lynette Lacock

MEET THE EXPERT

Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.

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Sign Up Here
Chimichurri pork meatballs

Chimichurri Pork Meatballs

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These delicious Chimichurri Pork Meatballs are an easy, high-protein midweek hit that will satisfy even the hungriest family members. The lean pork mince and almond flour are more nutritious alternatives.

Servings: 12 | Prep time: 20 minutes | Cooking time: 15 minutes | Cut: pork leg

Ingredients

Meatballs

  • 500g lean pork mince
  • 1/2 cup almond flour
  • 1/2 cup fine bread crumbs
  • 1 egg
  • Salt and pepper
  • Olive oil to fry

Chimichurri sauce

  • 1 small shallot, cut into wedges
  • 3/4 cup flat-leaf parsley leaves
  • 1 fresh oregano leaves
  • 2 garlic cloves
  • 1 1/2 tsp. kosher salt
  • 1 tsp. freshly cracked black pepper
  • 1/2 tsp. red pepper flakes
  • 3/4 cup extra virgin olive oil
  • 1/4 cup red wine vinegar, plus more to taste

Method

Meatballs

  1. Combine the lean pork mince, almond flour, bread crumbs, egg, salt and pepper in a bowl.
  2. Mix well and roll into balls.
  3. Fry in olive oil until crispy.
  4. Serve with Chimichurri sauce.

Chimichurri sauce

  1. In the base of a food processor, combine the shallot, parsley, oregano, garlic cloves, salt, and pepper. Pulse until well combined but still slightly chunky.
  2. Transfer the mixture to a small bowl. Add the olive oil, vinegar, and red pepper flakes. Stir to combine. Store refrigerated in an airtight container for up to two weeks.

Note: makes 1 1/4 cup 

Visit sapork.co.za for more info on pork.