Author: Diabetes Focus eMag

Type 1

New guidelines for managing early Type 1 diabetes

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Dr Louise Johnson explains the new guidelines for managing early Type 1 diabetes.

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

Type 1 diabetes 101

Type 1 diabetes is an autoimmune condition that occurs as a result of destruction of the beta cells of the pancreas. The beta cells produce insulin in normal healthy people. This destruction leads to sever insulin deficiency. Without insulin treatment, this will lead to diabetic ketoacidosis and death. Thus, lifelong insulin therapy is needed for survival. Type 1 diabetes represent 5–10% of all diabetes. The diagnosis classically occurs in children and adolescents but can also occur in adulthood.

Classically Type 1 diabetes present over the course of days or weeks in children and adolescents with drinking a large amount of water and passing a large amount of urine. This is associated with weight loss, dry mouth, and blurred vision. These are all symptoms of high blood glucose and is associated with or without ketones.

Four antibodies that cause Type 1 diabetes

In Type 1 diabetes, there are autoantibodies present in the blood that can be measured to confirm Type 1 diabetes. There are four types of antibodies that can cause Type 1 diabetes. They can all be measured in the blood and are usually present at diagnosis. They are:

  • Glutamic acid decarboxylase (GAD) antibody

This antibody is specific against GAD. It’s common as the first detected autoantibody in childhood up to 15 years of age. Adult-onset cases most often present with this antibody. It’s associated with slower progression to Type 1 diabetes and is often found as a single-positive antibody, especially in adults.

  • Insulin autoantibody (IAA)

This antibody is specific against insulin. It’s common as a first detected autoantibody in young children. Its frequency declines with age but is of little information in people already injecting insulin as antibodies can develop in response to injected insulin.

  • Insulin antigen 2 auto antibody (IA-2A)

Also known as ICA512, this antibody is against tyrosine phosphatase islet antigen-2. Its presence is associated with more advanced islet auto-immunity and a faster progression to Stage 3 Type 1 diabetes.

  • Zinc transporter 8 auto antibody (ZnT8A)

This antibody is against transmembrane zinc transporter type 8 protein in the beta cell granule. The presence of this antibody can improve risk stratification in individuals with a single other autoantibody.

Usually more than one antibody is present at diagnosis.

Diagnosis

Type 1 diabetes can de classified in three stages. These stages are determined by the presence of antibodies and the amount of abnormal glucose measurements.

Stage 1

The person’s blood tests positive for two or more antibodies but the person is without symptoms and the oral glucose tolerance test (OGTT) is normal.

An oral glucose tolerance test is a blood test where a person consume 75 gram of glucose and blood is tested at fasting, 30-, 60-, 90-, and 120 minutes.

The fasting plasma glucose is below 5.6 mmol\L and the two-hour OGTT is below 7.8 mmol\L. HbA1c below 5.7%. The person is asymptomatic.

Stage 2

The blood tests positive for two or more antibodies, and the oral glucose tolerance test is impaired but not yet in the diabetes range. This mean the fasting plasma glucose value is below 5.6 and 6.9 mmol/L and the two-hour OGTT is more than 11.1 mmol/L at 30-, 60-, and 90 min. The HbA1c is between 5.7 and 6.4%.

Stage 3

Antibodies are positive, the person is symptomatic, and glucose is in the diabetes range. Fasting glucose more than 7 mmol/L and two hours after meals more than 11.1 mmol\L. HbA1c more than 6.5%. The treatment for Stage 3 diabetes is insulin.

Advice for stages

Stage 1 Type 1 diabetes

  1. Confirm the autoantibody three months later with a second sample.
  2. Metabolic monitoring with glucose testing for the first two years after testing positive. Monitor the glucose thereafter every six months or if symptomatic.

Stage 2 Type 1 diabetes

  1. Use HbA1c every six months to monitor glucose.
  2. Combine with diabetes diet and exercise.
  3. The question when to start early insulin to preserve beta cells of the pancreas will be decided by a specialist.

Latent auto immune diabetes of adults

Half of all the new cases of Type 1 diabetes is now occurring in adults. Misclassification due to misdiagnosis (commonly as Type 2 diabetes) occurs in nearly 40% of people.

The term latent autoimmune diabetes of adults (LADA) was introduced 30 years ago to identify adults that developed immune-mediated diabetes. The criteria for the diagnosis of LADA consists of:

  • Age older than 30 years
  • Lack of the need for insulin for at least six months
  • Present of autoantibodies

However, there is a debate whether the term LADA should still be used. The American Diabetes Association standard of care notes that for classification purposes all forms of diabetes mediated by autoimmune destruction are included in the classification of Type 1 diabetes.

The investigation of adults with suspected Type 1 diabetes isn’t always straightforward. The first step is to suspect this in a non-obese patient with high glucose (more than 16.7 mmol/L and can present with mild acidosis). An antibody test should be done to confirm the presence of autoimmunity.

This will mark the progression to severe insulin deficiency. It’s important to remember to only check GAD antibodies in clinically suspected Type 1 diabetes since a low concentration of GAD antibodies can be seen in Type 2 diabetes and thus false positivity is a concern.

Just to make the scenario more interesting, there is 5–10% of Type 1 diabetes that may occur without antibodies and the autoantibodies disappear over time.

Genetic risk scoring (GRS) for Type 1 diabetes has received attention to differentiate people whose classification is unclear. This was developed in 2019 and uses 67 single nucleotide polymorphisms from known autoimmune loci and can predict Type 1 diabetes in children of European and African ancestry. It’s not routinely available yet for clinical use.

Investigating adults with suspected Type 1 diabetes

Step 1

Test for autoantibodies; if this is positive the diagnosis is confirmed.

Step 2

If the autoantibody test is negative, check the age (since 5–10% of Type 1 can test negative). If older than 35 years, the classification is unclear. A trial of non-insulin therapy can be started.

Do a C-peptide blood test to determine the amount of insulin from the pancreas. C-peptide with a value of more than 600 pmol/L confirms the diagnosis of Type 2 diabetes. A value between 200 and 600 makes the diagnosis indeterminate and the C peptide should be followed up in five years. Keep a good eye on glucose management.

A C-peptide value of less than 200 pmol/L moves the scale over to Type 1 diabetes.

Psychosocial care

The testing and positive screening of an autoantibody that predicts Type 1 diabetes can be very stressful to both the patient and their families. Shock, grief, guilt, anger and depression can all be emotions that may be encountered. The TEDDY study and the Autoimmunity Screening for Kids (ASK) study showed these emotions in children testing positive.

Psychosocial care should be integrated into these patients’ routine medical visits. Unfortunately, the medications tested to preserve beta cells of the pancreas in Stage 1 and 2 haven’t shown any results yet.

The quest for insulin beta cell replacement and autoantibody suppression is ongoing. As our understanding of the immunology of Type 1 diabetes expands, development of the next generation of immunotherapy is under active pursuit.

References

  1. Fourlanos S, Dotta F et al. “Latent autoimmune diabetes in adults (LADA) should be less latent.” Diabetologia 2005; 48:2206-12
  2. Lynam A, McDonald T et. al.” Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults age 18-50 years.” BMJ 2019;9
  3. Holt RIG et.al. Investigating suspected type 1 diabetes. Diabetes care 2021;44:2589-625
  4. Philip M, Achenbach P et al. “Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes.” diabetology, 2024;67:1731-1759

MEET THE EXPERT

Dr Louise Johnson

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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DSA news

DSA News Autumn 2025

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– DSA Head Office News –

IDF President visits DSA main branch

Prof Peter E. H. Schwarz is current President of the International Diabetes Federation (IDF) and is based at the University of Dresden in Germany.

He paid a visit to Diabetes South Africa National and Western Cape Offices in January. During his visit he asked about the challenges DSA experienced and congratulated us on 55 years of service to the people with diabetes in South Africa.

We informed him of the various projects and programmes we run and explained the ideas we have to reach more people with diabetes.

One of our biggest challenges is funding, which is a common problem for many non-profit Organisations, but especially Diabetes South Africa as it’s not well understood.

It was a great honour for us to meet Professor Schwarz and have him visit our new offices with his wife and young daughter whilst he was in Cape Town. He showed a lot of interest and gave us much encouragement to continue with our outreach to patients with diabetes in South Africa.

Prof Swartz

– DSA Western Cape News –

Macassar Support Group Visit 

Margot McCumisky and Gail Pasqualle visited the Macassar Diabetes Support Group in February.

They were warmly welcomed by the Support Group Leader, Michelle Turner, and all the other members.

Margot gave a talk about how DSA was established, and how the members could manage their blood glucose, showing them a picture of food portions.

Michelle Turner, the group facilitator, spoke about exercise, showing them that you don’t always have to go outside of the home to exercise.

The group also participated in laughter therapy.

Vitals were taken; those with high blood glucose levels and high blood pressure were taught how to bring these readings down, with moderate exercise and medication.

Margot and Gail also met with the principal of False Bay Primary School, where the group meets regularly. He was very welcoming, inviting the to have a Denim 4 Diabetes day. He also proposed to have an event where the community of Macassar could come and learn about diabetes.

Michelle Turner, group facilitator, and Margot Mc Cumisky DSA National Manager.
DSA visit to Macassar Group.

Silver Stars Diabetes Wellness Group visit 

Margot McCumisky and Gail Pasqualle from DSA went to visit the Silver Stars Diabetes Wellness group in Blue Downs near Cape Town recently.

We were warmly welcomed by the group eaders, Alvin and Norma White, and all the many members who attended.

Margot spoke on what DSA does, footcare and how the members could manage their blood glucose levels. She also spoke about food portions and medication. A few of the members asked questions about symptoms and what to do when their blood glucose is too high or too low.

Gail gave out booklets, samples, and also introduced a product for open wounds that isn’t healing, or for nappy rash or eczema. We handed out several bottles to people for them to see if the product helps with healing.

It was a lovely meeting the group. Alvin and Norma White do a wonderful job of assisting people in the community with their health. DSA is always available to assist in whatever way we can and hope to visit again before too long.

– DSA Pretoria News –

First meeting of the year

The DSA Pretoria Wellness Support Group kick-started its first meeting of 2025 on 1 February with an insightful information session led by Sister Louise Pywell and her guest, Annette van Ginkel, a highly-experienced ICU and paediatric nurse.

It was back to basics as Sr Louise welcomed attendees and introduced the group’s objectives. While the group primarily focuses on Type 2 diabetes in older individuals, it’s open to all members, regardless of age or diabetes type. She provided key statistics on diabetes in South Africa, highlighting that 6% of the population is affected, and it remains the second leading cause of death after tuberculosis.

Diabetes overview

Type 2 diabetes accounts for 90% of global cases, often linked to poor diet, obesity, aging, and genetics.

Type 1 diabetes is less common (10% of cases) and has no known cause.

Gestational diabetes affects some pregnant women.

Diabetes Management Insights from Sister Annette 

Medication & medical check-ups

We were cautioned to avoid adjusting medications without consulting doctors. For optimal effectiveness, medication should be taken at regular time each day. Additionally, be informed about the potential side effects of prescribed medications. Attend regular check-ups at least twice a year.

Diet and nutrition

Consume smaller portions and uphold a balanced diet. Encouraged to eat fibre-rich foods, nuts, olive oil, and fermented items for optimal gut health. Restrict sugar, fried items, and alcohol, particularly beer. Drink enough water daily.

Lifestyle and holistic care

  • Exercise helps lower blood glucose levels. Technology devices like glucose monitors linked to phones aids diabetes management.
  • Foot care is critical; check for cuts and blisters, visit a podiatrist yearly, and avoid walking barefoot.
  • Eye health matters; schedule annual eye exams and consider Optive Omega UD Eye Drops for dry eyes.
  • Skin health; keep skin moisturised and treat rashes or dark spots immediately.
  • Manage stress as it raises cortisol levels, impacting on blood glucose spikes.
  • Get quality sleep and maintain social connections for better well-being.

Children and diabetes

There is a great need for young volunteers to assist in running diabetes awareness camps. Many children diagnosed with Type 1 diabetes initially experience abdominal pain. DSA Pretoria used to host these camps, and by the end of the camp, children would have learnt to inject themselves with confidence.

The session emphasised education, self-care, and a proactive approach to diabetes management. The DSA Pretoria Wellness Support Group looks forward to a year of support, awareness, and healthier living.

The next support group meeting will be on 1 March.

– DSA Durban News –

IDF President visits DSA Durban Branch

International Diabetes Federation President, Professor Peter Schwartz, visited Diabetes South Africa Durban Branch Manager, Sean Gunn, and Chairlady, Pillile Dlaminin, on 2 February 2025. They discussed DSA’s plans and what they would like to achieve for the next year and described to Prof Schwartz their activities in the KZN region.

(Left to right) Prof Peter Schwarz, President of International Diabetes Foundation; Sr Pilile Dlamini, Chairlady Diabetes South Africa Durban Branch; and Sean Gunn, Branch Manager of DSA Durban Branch.

– DSA Port Elizabeth News –

DSA Port Elizabeth branch had a variety of Diabetes Wellness Meetings in February to start the new year; four venues and four different guest speakers and topics.

S’Khona Diabetes Wellness Group

Exciting news is that on 1 February 2025, Sr Pamela Molefe, the nursing advisor on our Branch Management Board, started a new support group: S’Khona Diabetes Wellness Group. They will be meeting once a month on Saturday afternoons. The main speaker was Dr Ntombekhaya Mtyobo, who also happens to have diabetes.  
S’Khona Diabetes Wellness Group

Malabar and Springdale Meetings

Two Diabetes Wellness Meetings that were held on Tuesday evening, 11 February 2025, one in Malabar and the other in Springdale.

MalabarMeetings
Springdale Meetings

Newton Park Meeting

On Wednesday evening, 12 February 2025, the Diabetes Wellness Meeting was held in Newton Park.

Newton Park Meeting

2024 Diabetes Awareness Events

Towards the end of last year, we had three diabetes awareness events.

Clive and Pamela at CRH-Africa Automotive.
Pamela at Seventh Day Adventist Church.
Martin and Elizabeth at Trident Steel.
health goals

Setting realistic fitness and health goals

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Here are eight essential fitness tips to help you stay on track with your health goals.

A new year stirs most people to feel inspired to change their fitness and health routines positively.

But while motivation runs high, it’s easy to set too ambitious goals, which can lead to burnout and frustration. Every year, millions set out to improve their health—whether to lose weight, build muscle, eat better, or boost mental wellness.

Unfortunately, goals might be abandoned very soon after starting, often because the targets weren’t realistic.

Starting with small, manageable steps can make a huge difference. Instead of aiming for quick fixes, setting achievable goals can help build a long-lasting commitment to health, reducing the chances of burnout, injuries, and disappointment.

Start with daily movement

Starting with daily movement is a great, manageable way to boost your health and energy. Instead of diving into intense workouts right away, aim for 20 to 30 minutes of activity each day. This could be a brisk walk or a run around the block, anything that gets you moving and your heart rate up. By committing to a small, achievable amount of movement, you’ll build a habit without feeling overwhelmed.

Focus on nutritional balance

 Focus on balanced nutrition by including foods that offer essential nutrients, vitamins, and minerals. Instead of following strict rules or eliminating food groups, aim to enjoy a mix of veggies, fruits, lean proteins, and whole grains, with room for occasional treats.

Sleep schedule

Having a regular sleep schedule is key to recovery and feeling your best. Quality sleep helps your body repair muscles, restore energy, and balance essential hormones, supporting physical and mental health. Try going to bed and waking up simultaneously every day to create a healthy routine.

Prioritise daily hydration

Prioritising drinking water throughout the day is vital for your overall health and energy levels. Water supports nearly every function in the body, from maintaining healthy skin to aiding digestion, regulating body temperature, and keeping joints lubricated. Even mild dehydration can cause fatigue, headaches, and difficulty concentrating, impacting productivity and mood. Aim to drink water consistently rather than trying to catch up all at once.

Break down goals

Big goals become more achievable when broken into smaller, manageable steps. For instance, if you aim to lose 10 kilos or build muscle, try setting monthly or weekly milestones instead. This approach helps keep you motivated and on track.

Track progress

Tracking your progress is a great way to stay motivated and accountable. Simple tools, such as a fitness app or a journal, can help you spot patterns, celebrate small wins, and see where you can improve.

Support 

Having support from friends or family can make a big difference. Whether it’s a workout friend or a nutrition coach, sharing goals and progress with someone adds motivation and keeps you on track. 

Practise patience 

Achieving fitness and health goals is a marathon, not a sprint. Embracing patience allows you to enjoy the journey and focus on gradual improvements.

Go achieve your health goals 

Setting realistic health goals helps build lasting habits. Taking it step by step prevents burnout and ensures real progress. Remember, even small changes count and deserve celebration!

Focus on goals that fit your lifestyle and support your body and mind. Proper fitness is about steady progress, not quick fixes—embrace a patient approach.

This article is attributed to Affinity Health. 

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Self-monitoring

FAQs: Self-monitoring of blood glucose

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Living with diabetes means staying on top of your blood glucose levels, and self-monitoring is a key part of that. Here are common questions and answers to help you out.

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

Why is self-monitoring of blood glucose important?

Blood glucose monitoring shows you the effect of the food you eat, how exercise affects you, and how your medication works. Self-monitoring is essential for anyone with diabetes and can help you:

  • Keep your blood glucose within a healthy range.
  • Fine-tune your meals, medication, or activities.
  • Provide helpful information to your healthcare team.
  • Reduce your risk of other health problems associated with diabetes.

How often should you test my blood glucose?

Your healthcare team will tell you how often and when to check your blood glucose. The frequency needed depends on several factors, such as the type of diabetes you have, the type of medication you are on, your current blood glucose control, etc.

Typically:

Type 1 diabetes: Check before meals, occasionally after meals, before and after exercise, before critical tasks (such as driving), and at bedtime.

Type 2 diabetes: Varies from several times a day to a few times a week, depending on your management plan. Structured blood glucose monitoring is recommended.

Always ask your healthcare provider for personalised advice.

What equipment do I need for self-monitoring?

You’ll need:

  • A blood glucose meter (e.g. Accu-Chek Instant)
  • Test strips
  • A lancing device (e.g. Accu-Chek Softclix) and lancets
  • A logbook or an app (e.g. mySugr) to track your results

What are the target blood glucose ranges?

The general target ranges, as recommended by the American Diabetes Association (ADA), are as follows:

  • Before meals: 4.4 – 7.2 mmol/L
  • Two hours after meals: <10.0 mmol/L

Target ranges, however, differ from person to person and depend on several factors, such as age, duration of diabetes, other comorbid conditions, hypoglycaemia awareness, and the presence of diabetes complications. Your ideal target range is specific to you and will be agreed upon with your healthcare team.

How can you ensure accurate readings?

Here’s how to get the best readings:

  • Store your meter and strips properly.
  • Use test strips before they expire.
  • Make sure that your hands are clean and dry before checking your blood glucose.
  • Follow the instructions for your meter and lancing device.

What are essential tips when checking your blood glucose?

  • Wash and dry your hands. Using warm water may help increase blood flow to your fingertips.
  • You can minimise pain by using a fresh lancet for each test. Today’s lancets are so tiny that even a single use can bend or dull the tips. This can cause them to hurt more when reused. Alternate fingers daily so that each one has a chance to rest.
  • Lance on the side of the fingertip rather than the pad. The pad of your fingertip (where your fingerprints are most visible) is one of the most sensitive parts of your body.
  • Record the results in a logbook or use a diabetes management app like mySugr to review and analyse them later.
  • Based on your healthcare professional’s recommendations, take the appropriate steps if your blood glucose is high or low.

Self-monitoring your blood glucose is vital for managing diabetes. By understanding and integrating it into your daily routine, you can take control of your health and improve your life. If you have any questions, don’t hesitate to reach out to your healthcare provider.

Remember, you don’t have to manage diabetes on your own. There are plenty of resources available to help you stay on track.

References

  1. Bailey TS, Grunberger G, Bode BW, Hirsch IB, Roberts VL, Rodbard D. American Association of Clinical Endocrinologists and American College of Endocrinology 2016 Outpatient Glucose Monitoring Consensus Statement. Endocrine practice. 2016;22(2):231-261.
  2. American Diabetes Association Professional Practice Committee; 7. Diabetes Technology: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S146–S166.
  3. American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025. Diabetes Care 1 January 2025; 48 (Supplement_1): S128–S145.

Download the mySugr app now!

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

 

 

To check if your mobile device is compatible with the mySugr app, please contact our customer support team.

For any questions related to your diabetes management, kindly reach out to your healthcare provider. Should you have any queries about our products, please get in touch with our customer support centre at info@accu-chek.co.za. Country-specific contact numbers can also be found in the information below.

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Join the conversation @RocheDiabetesCareSSA

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

Email: info@accu-chek.co.za | Toll Free: 080-34-22-38-37 (South Africa only) | +254 20 523 0560 (Kenya only) | +234-1227-8889 (Nigeria only) | +27 (11) 504 4677 (Other countries)

ACCU-CHEK, ACCU-CHEK INSTANT and MYSUGR are trademarks of Roche. All other product names and trademarks are property of their respective owners. | © 2025 Roche Diabetes Care | Roche Diabetes Care South Africa (Pty) Ltd. | Hertford Office Park, Building E | No 90 Bekker Road | Midrand, 1686, South Africa. ZA-534

Information provided is void of any representation and warranty as to the reliability, accuracy, usefulness, adequacy, or suitability of the information provided and is not a substitute for professional medical expertise or treatment for medical conditions, applications of medication. For personalised medical advice, consult an appropriate medical professional for queries regarding any medical conditions.

Green therapy

Green therapy

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We learn how green therapy boosts mental health.

Exploring the healing power of green therapy (nature), whether through the tranquillity of a garden or the presence of plants in your home has many benefits. Whether you’re gardening or tending to indoor plants, caring for living things can serve as a powerful reminder of the care you need to show yourself.

A time for personal growth and mental clarity

Green therapy provides a direct link between your environment and your mental health, offering both peace and purpose.

“Spring is an ideal time to reflect on your mental health,” says Kgomotso Sebeela, Mental Health Professional and Specialist Wellness Counsellor at Kena Health. “Whether it’s by working in a garden or nurturing plants indoors, plants play a crucial role in creating environments that nurture mental resilience, encourage mindfulness, and an appreciation for slow, steady growth—all qualities that are essential for mental well-being.”

Outdoor gardening offers an opportunity to engage with the earth, physically grounding you while reducing anxiety. “Digging into soil, planting seeds, and watching them grow can be incredibly therapeutic,” says Kgomotso.

She adds that spending time outdoors also increases exposure to sunlight, boosting mood and improving overall mental health. On the other hand, the care of bonsais and succulents indoors brings nature into your personal spaces, encouraging mindfulness with every watering or trimming.

Green therapy benefits: indoors and outdoors

In 2023, the University of Reading conducted a study with the Royal Horticultural Society to investigate the psychological responses to house plants. The study concluded that plants with lush green leaves, high leaf areas and dense canopies are likely to give the biggest boost to your well-being. In addition, research from Japan also found that the presence of leafy plants can enhance creativity in workplace tasks.

The act of nurturing a plant, big or small, can create a sense of routine and purpose, offering a meaningful connection to nature. “Caring for plants gives you a much-needed break from the pressures of modern life,” explains Kgomotso. “Tending to them helps you slow down and centre your thoughts.”

The outdoors also helps engage all your senses. The sound of birds, the smell of flowers, the feeling of soil—each sensory experience promoting mindfulness. Being indoors also offers a similar sense of tranquillity, providing a rewarding routine that fosters a sense of achievement and purpose.

The mindful practice of gardening

Gardening, whether outdoors or indoors, encourages you to slow down, focus on the moment, and immerse yourself in the simple act of nurturing life.

“The process of caring for plants encourages you to be present, to pay attention to details, and to appreciate small moments of progress,” says Kgomosto. “Our team of therapists and mental health counsellors at Kena Health often advise patients to incorporate greenery and plant life into their homes as a way to boost mental wellness – it makes a world of difference.”

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foot ready?

Are you foot ready?

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Here are six essential tips to love your feet and always be foot ready. 

If you have diabetes, you know that your feet can be severely affected by it. The two biggest foot concerns for people with diabetes are peripheral vascular disease and neuropathy.

Peripheral vascular disease (PAD) can constrict the arteries that transport blood to the legs and feet. This lack of blood flow increases the risk of developing ulcers (open sores) and infections.

Neuropathy occurs when high blood glucose harms your nerves and blood vessels, making your feet and legs less able to feel temperature changes or pain. You might not notice if you get a small cut or sore. With reduced blood flow, these injuries can also heal much more slowly. If they go untreated, they can become infected, which could lead to further complications.

Those with diabetes also experience an increased risk of athlete’s foot, toenail fungus, blisters, bunions, ingrown toenails, and plantar warts.

Foot ready tips 

Wash and dry your feet daily

Practise good foot care by keeping your feet clean, using mild soap and warm water. Pat your skin dry; do not rub, and ensure your feet are thoroughly dried. After washing, apply lotion or petroleum jelly to the soles of your feet to prevent cracking. 

Check your feet every day

Take a good look at the tops and bottoms of your feet every day. Check your toes, heels, and in between your toes for any blisters, corns, calluses, ingrown nails, cuts, scratches, bruises, or sores. Don’t forget to watch for any signs of fungus between your toes.

Take care of your toenails

Trim your toenails carefully with stainless steel toe clippers or sharp nail scissors. Cut them straight across and smooth the edges with a nail file. Never cut the cuticles (the thin layer of skin that forms at the base of the toenail, where the nail meets the skin), and don’t use sharp objects to clean under your nails. To soften rough heels, use a pumice stone, but avoid scrubbing too hard.

Protect your feet while exercising

Exercise regularly to keep your blood flow healthy. Aim to move your body for at least 30 minutes a day. Walk and work out in comfortable shoes. While aerobic and resistance training are typically suggested for diabetes, ask your doctor which activity is best for you.

Always wear shoes 

Even though warm weather might make you want to go barefoot, your feet need the protection shoes provide. Avoid wearing shoes with high heels or pointed toes, and steer clear of styles that expose your toes or heels, like open-toed shoes, flip-flops, or sandals.

Follow your doctor’s advice if they recommend special footwear, and replace shoes when they show wear, such as uneven heels or damaged lining.

Try diabetes-friendly socks

Switching up your socks every day is a must. Choose natural fabrics like cotton, wool, or blends of the two. These materials let your feet breathe and keep things comfy. Avoid socks with rough seams that could rub and cause blisters and anything too tight that might restrict your circulation.

If you want to go the extra mile to be foot ready, try diabetes-friendly socks. They’re specially made to boost blood flow and keep your feet feeling their best.

This article is attributed to Affinity Health. 

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Custard

Huletts EquiSweet Low-Fat Custard

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Craving the comforting taste of custard? Now you can have the best of both worlds with a delicious custard made with the perfectly sweet taste of Huletts EquiSweet low-kilojoule sweetener.

Servings:

4

Prep time:

5 minutes

Cooking time:

10 minutes

Ingredients

Method

  1. Bring 400ml of the milk to boil.

  2. While the milk is heating up, place the reserved 100ml of the milk, EquiSweet, and the custard powder into a small bowl and mix well to combine, making sure it’s lump-free.

  3. Just as the milk begins to bubble, pour half of it onto the custard powder mix and stir.

  4. Pour this back into the saucepan of hot milk and bring to a boil, stirring.

  5. Cook until thickened.

  6. Add 1 tsp. vanilla essence if desired.

  7. Serve warm or cold with any low-GI puddings.

Tips

Both EquiSweet Classic and Sucralose variants are suitable for this recipe.

One serving of 125ml each (made with low-fat milk) is equivalent to ½ portion of low-fat dairy.

  • GI (calculated) = 39 (low GI). GL per serving = 4

NUTRITIONAL INFO (per serving of 125ml low-fat milk)

Energy 312kJ  |  Protein 4,4g  |  Carbs 9,4g  |  Fat 1,8g  |  Fibre 0,6g

This recipe is approved by GI Foundation of SA and Diabetes SA. It was created by registered dietitians Liesbet Delport and Gabi Steenkamp and adapted by Tongaat Hulett with the consent of the authors.

The merits of good diabetic nutrition

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We learn about the six must-have foods for good diabetic nutrition and when to add a nutritional supplement to fill any nutrient gaps.

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

Defining good diabetic nutrition

As a person living with diabetes, you may feel overwhelmed with all the things you need to do to manage your health. Good nutrition can assist to manage symptoms of diabetes that you may experience, such as weight loss, feeling very hungry and tired, sores that heal slowly, and having more infections than usual.1

Nutrition is also an important part of a healthy lifestyle to help keep your blood glucose level in your target range. Nutrient requirements for people living with diabetes are likely to be higher than those set for people who don’t have diabetes. This is due to the following:

  • People with diabetes are prone to deficiencies in magnesium and zinc.2,3.
  • Some medications used to treat diabetes can result in increased nutrient requirements.2,3.
  • Nutrition therapy is critical in the management of diabetes to ensure the maintenance of correct blood glucose levels.2,3.

Eating healthy foods in the right amounts at the right times so your blood glucose stays in your target range as much as possible is key. It’s also important to eat foods that helps prevent diabetes complications like heart disease.

Figuring out the best foods to eat when you have diabetes doesn’t have to be tough and you can also include a nutritional supplement to make sure you’re filling any nutrient gaps.

Some of the best foods for people with diabetes are high in protein and low in sugar like avocados (consume in moderation) and grilled fatty fish.

The must-have super six

The following foods can help manage your blood glucose levels:

  1. Fatty fish like salmon and sardines are great sources of omega-3 fatty acids, which have major benefits for heart health.
  2. Leafy greens are low in digestible carbs.
  3. Avocados have less than a gram of sugar, few carbohydrates, a high fibre content and healthy fats.
  4. Chai seeds are extremely high in fibre which reduces hunger. They are also low in digestible carbs.
  5. Beans are rich in B vitamins, beneficial minerals (calcium, magnesium, potassium) and fibre.
  6. Broccoli contains only 3g of digestible carbs.4

Adding a nutritional supplement

If you’re considering using any supplements if you have diabetes, it’s important to get nutritional advice from your healthcare professional prior to using anything.

More than likely, once you have gotten the go-ahead from your healthcare professional, you may choose a nutritional supplement on the merit of the scientific facts of the product as well as what others have to say about it.

For this reason, here are all the beneficial facts of adding LIFEGAIN® Advanced Nutritional Supplement to your diet as well as patient testimonials.

LIFEGAIN® Advanced Nutritional Supplement is scientifically formulated to offer beyond everyday nutrition that can support chronic illness. The Triple Protein Formula in LIFEGAIN® can help you to feel fuller for longer and assist with recovery of muscle tissue and a healthy weight.

The Lifegain® formula:

  • High in energy, protein, and omega-3 fatty acids.
  • 24 minerals and vitamins, several being key for immune support.
  • High in iron and zinc.
  • Contains fibre.
  • Trans fat-, gluten-, lactose-, and cholesterol-free.
  • Low in carbs (no refined carbs).
  • No added sugar.

Patient testimonials

Monique Mentoor

(On behalf of her dad)

My dad’s health was deteriorating fast in October 2019. He is a diabetic and hypertension sufferer and has had two transient ischaemic attacks due to not managing these illnesses. He was constantly tired, and his quality of life was so poor as he was sleeping all the time. I insisted he come live with me and offered only nutritious meals and added LIFEGAIN® Advanced Nutrition Supplement to his diet – and I believe this was the perfect compliment.

Within weeks there was a noticeable difference in his health and the lethargy was improving too. Throughout the lockdown my dad continued taking his LIFEGAIN® Advanced Nutrition Supplement and he has not looked or felt better in years. ​

Tebogo Maesela

(Caregiver of his father who has diabetes)

I love Lifegain® Advanced Nutrition Supplement vanilla flavour. I currently use Lifegain® to boost my body and support my immune system.

My father is a diabetic patient, and he uses Lifegain® to boost his immune system. My journey with Lifegain® started two years back when my father was very sick, he was losing weight and he couldn’t eat anything. At that moment we thought that we were losing him. His body was small and frail. Then a family friend suggested that we buy Lifegain® supplement for my father. We did, and he started to eat again, and regained energy. Since that day Lifegain® has been our supplement.

References

  1. Diabetes Symptoms.2022 Dec 30. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/diabetes/basics/symptoms.html
  2. Walker, A.F., 2007. Potential micronutrient deficiency lacks recognition in diabetes.
  3. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity. Accessed: 05/08/2020.
  4. Kelly E. Diet for People Living with Diabetes: The Best Foods to Choose and More. 2023 Feb 23. Healthline.com Available from: https://www.healthline.com/nutrition/16-best-foods-for-diabetics      
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Tirzepatide

Tirzepatide available in SA

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Aspen Pharmacare Holdings Limited announced last year the local availability of Eli Lilly’s tirzepatide.

Tirzepatide is a once-weekly glucose-dependent insulinotropic polypeptide (GIP)receptor and glucagon-like peptide-1 (GLP-1) receptor agonist, used as an adjunct to diet and exercise to treat adults with insufficiently controlled Type 2 diabetes, which has been approved by the South African Health ProductsRegulatory Authority (SAHPRA).

On 30 August 2023, Aspen announced that it had entered into a distribution and promotion agreement with Lilly to extend access to Lilly’s innovative portfolio of medicines to patients in South Africa and the rest of Sub-Saharan Africa.

Stephen Saad, Aspen Group Chief Executive said, “Aspen values our relationship with Lilly and its recognition of Aspen as its chosen partner inSouthern Africa to assist in contributing towards arresting non-communicable diseases (NCDs) which include cardiovascular diseases, cancer and diabetes.”

“Tirzepatide is one of the therapeutic options available to physicians for the treatment of Type 2 diabetes, which has doubled in recent times1, with one in two diabetic patients in South Africa being undiagnosed.2 A strong link is evident between diabetes, heart disease, and obesity which triggers the metabolic-cardio-renal complex3 and which poses a significant financial and public health threat to an already over-burdened healthcare system, impacting lives and livelihoods. Tirzepatide represents an added therapeutic option to address the rising tide of NCDs. It will increase access and can significantly improve related health outcomes.”

Tirzepatide has been available in SA during since December 2024 in single-dose vials, with a KwikPen® presentation currently under evaluation at SAHPRA.

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salad

Is your salad even healthy?

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Estée van Lingen explores the hidden truths behind your greens and what can make a healthy salad become a dietary disaster.

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

Salads are often considered the epitome of healthy eating. Whether you’re trying to lose weight, boost your nutrient intake, or adopt a more plant-based diet, salads seem like the perfect choice.

However, not all salads are as healthy as they seem. Despite being packed with leafy greens, they can quickly become energy dense or nutrient-deficient due to common add-ons and poor ingredient choices. So, is your salad really as healthy as you think?

  1. The base: Choose your greens wisely

The foundation of any salad is the greens. Leafy greens are rich in vitamins, minerals, and fibre. However, the type of green you choose makes a difference in your salad’s nutritional value.

Dark leafy greens like spinach, baby spinach or kale are packed with nutrients like vitamin C, vitamin K, and iron. On the other hand, iceberg lettuce, while low in kilojoules, offers little nutritional value compared to these nutrient-dense options.

Many pre-made salad kits may use iceberg lettuce as a base, which can lead to a false sense of nutritional security. For a truly healthy salad, opt for a variety of dark, leafy greens.

Mixing different types of greens, such as romaine, Swiss chard, and baby spinach, can enhance both flavour and nutritional diversity.

  1. Protein add-ons

Adding protein to your salad is a great way to make it more filling and balanced, but the type and preparation of protein matters. Grilled chicken, hard-boiled eggs, beans, and tofu are healthy protein options that provide necessary nutrients without excessive kilojoules or unhealthy fats.

However, many people opt for processed meats like bacon bits, fried chicken strips, or deli meats, which can increase sodium, fat, and preservatives in your salad. Additionally, adding high-fat cheeses like cheddar or blue cheese may add unnecessary saturated fats and kilojoules.

If you’re looking for a plant-based protein, chickpeas, lentils, and quinoa are excellent choices that bring both protein and fibre to the table.

When choosing proteins for your salad, focus on whole, minimally processed options, and avoid those that are breaded, fried, or heavily processed.

  1. Watch out for dressings

One of the biggest culprits in turning a healthy salad into an energy bomb is the dressing. Creamy dressings, such as Ranch, Caesar, and Blue cheese are typically high in fat, kilojoules, and added sugars. A seemingly small portion can add hundreds of kilojoules to your salad.

Even vinaigrettes, which are often perceived as healthier, can contain added sugars and preservatives.

The best approach is to make your own dressing using simple ingredients like olive oil, vinegar, lemon juice, and herbs. Olive oil provides healthy fats, while vinegar and lemon juice add flavour without the extra kilojoules.

If you prefer store-bought options, look for dressings with simple ingredients, minimal sugar, and healthy fats. Be mindful of portion sizes (especially when using oils e.g. olive oil); a little dressing can go a long way.

  1. Be cautious with toppings

Toppings can take your salad from healthy to indulgent quickly. Croutons, fried onions, candied nuts, and tortilla strips may add crunch and flavour, but they also come with unhealthy fats, refined carbs, and sugar. These additions can significantly increase your salad’s kilojoule count without providing much nutritional value.

Instead, opt for nutrient-dense toppings that still provide texture and flavour. Seeds like sunflower or pumpkin seeds add healthy fats, protein, and a satisfying crunch. Nuts like almonds and walnuts are also great but stick to raw or dry-roasted varieties to avoid added oils or sugars. Fresh fruits, such as berries or apple slices, can also add natural sweetness without the sugar spike of dried fruits or sweetened toppings.

While avocado can also be a healthy topping, it still remains a fat and the portion needs to be controlled.

  1. Portion control: Bigger isn’t always better

Salads are often viewed as free foods because of their low-kilojoule content. However, this perception can lead to overeating. If you’re adding energy-dense ingredients like cheese, nuts, and dressing, even a salad can surpass your daily kilojoule needs.

Healthy options can also include adding butternut, corn, baby potatoes, or grains into the salad and in these cases, portions need to be monitored even more so.

Being mindful of portion sizes is crucial. Stick to moderate amounts of high-kilojoule ingredients and make your salad filling by focusing on vegetables, lean proteins, and fibre-rich grains. A well-proportioned salad should leave you satisfied but not stuffed.

  1. Nutrient balance: More than just greens

A healthy salad is more than just a bowl of greens. To create a balanced meal, make sure your salad includes a good mix of macronutrients (protein, fats, and carbohydrates) and micronutrients (vitamins and minerals).

Vegetables like bell peppers, carrots, cucumbers, beetroot and tomatoes add colour, crunch, and vitamins, while whole grains like quinoa or barley provide fibre and energy-sustaining carbohydrates.

Pasta and potato salads are not real salads but just another form of a starch-based dish. So, don’t eat a whole plate of potato salad and say you had your salad for the day.

Healthy fats from sources like avocado, nuts, or olive oil help with nutrient absorption and provide satiety. By including a variety of colours and food groups, you can ensure your salad is both nutritious and satisfying.

Not all salads are created equal

While the idea of eating a salad may sound inherently healthy, it’s essential to be mindful of the ingredients and portions you choose. Rather make your own salads compared to buying ready-made salads. Start with a base of nutrient-dense greens, opt for lean proteins and healthy fats, and be cautious with dressings and toppings.

With thoughtful ingredient choices, your salad can be the nutrient-packed, wholesome meal it’s meant to be—without hidden kilojoules and unhealthy surprises. Remember, a healthy salad is all about balance and moderation. By making smart choices, you can ensure that your salad truly supports your health goals.

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.

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