FUTURELIFE® Smart food™ with Strawberries and a yoghurt topping


  • 50 g or ½ cup FUTURELIFE® Smart food™
  • 125ml of warm water or low fat milk (or more to get your preferred consistency)
  • 1 – 2 tbsp. low fat plain yoghurt
  • 1 – 2 sliced strawberries
  • 1 tsp of shaved coconut flakes (optional)


  1. Add your FUTURELIFE® Smart food™ and milk to a bowl and mix well.
  2. Top with yoghurt, sliced strawberries and coconut shavings.

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-high-energy-smart-food/



  • 2 passion fruit (granadilla)
  • 125ml skim milk
  • 125ml water
  • 3 tablespoons FUTURELIFE®Zero Smart food™
  • 4 ice cubes


  1. Add all the ingredients to your blender and blend together on full power until smooth. Serve and enjoy.

Serves 1 – meal
Serves 2 – snack

For more information on the product used in this recipe visit: http://futurelife.co.za/product/futurelife-zero-smart-food/

FUTURELIFE® Smart Fibre™ 2in1 goes nuts

Makes: 1 serving


  • ½ cup FUTURELIFE® Smart Fibre™ 2in1
  • 1 cup low-fat milk or ½ cup low fat plain unsweetened yoghurt
  • 3 pecan nuts
  • 1 tablespoon almond flakes
  • 1 teaspoon sunflower seeds
  • 1 teaspoon pumpkin seeds (or any seeds of your choice)
  • 1 sachet HOWARU® Premium Probiotics


  1. Add all the ingredients into one bowl, sprinkle over the nuts and seeds.
  2. Enjoy a bowl filled with, prebiotics, probiotics and omegas. The perfect way to start your day!

For more information on the product used in this recipe visit: http://futurelife.co.za/product/smart-fibre/

A mother’s motivation

Single mother, Francinah Monyamane, shares her motivation for managing her daughter’s Type 1 diabetes with the utmost dedication: unconditional love and her own supportive mother.

Francinah Monyamane (28) and her daughter Tshimologo (3) live in Lawley, Lenasia in Gauteng. They stay with Francinah’s parents Grace (57) and Arnold. Tshimologo has Type 1 diabetes. 

Misdiagnosed three times

Even though Francinah knew the father of her child had Type 1 diabetes and that there was a chance her child could have it as well, it was far from a concern in her mind. It was only when Tshimologo was 1 year and nine months old that reality revealed itself.

The crèche, that Tshimologo attended, informed Francinah that the toddler was not active anymore, frequently sleepy, continually thirsty, and urinating more than usual. Francinah asked her mother, Grace – who looked after Tshimologo after she returned from crèche every day – to take her to the Lawley Clinic to check her glucose levels. The grandmother was told that it was not diabetes as a child could not get diabetes; antibiotics were prescribed.

The symptoms persisted and with the added aggravation of ringworm, Francinah requested her mom to take Tshimologo back to the clinic and insist on a urine test. Once again, the toddler was sent back with only ointment for ringworm.

Another week past and the toddler was not showing any signs of improvement; it was Gogo Grace who insisted they take her to Lenasia South Clinic. The doctor said they shouldn’t worry, it was only tonsillitis. “As I was walking out the consulting room, I thought I can’t leave here with my daughter like this. I knew something was wrong and insisted on a urine test,” Francinah says.

Progress made

After much frustration and lack of assistance from the nurse, the urine test was done by Francinah. “I saw the dipstick – her glucose levels were high and she had ketones. I showed it to the doctor and said, ‘You see she does have diabetes!’” The doctor was stunned. All the necessary tests were completed; the toddler was put on a drip and rushed to Chris Hani Baragwanath Hospital.

After two days in ICU and back in a normal ward, treatment commenced: two units of Protaphane and one unit of an ultra-rapid-acting insulin. But within five days, little Tshimologo was back in ICU as the ultra-rapid-acting insulin was causing her to have low blood sugar.

Currently, Tshimologo only takes Protaphane twice a day, and goes for check-ups every three months. Her doctor is very impressed with her management, and she hasn’t had to be admitted to hospital again.

A mother’s and grandmother’s love

What motivates this mother to keep her daughter’s glucose levels under control? “I want to keep her alive. I want to see her grow up, go to school, matriculate, go to university. I want to see her getting married. I can’t lose my baby,” Francinah explains. “With my mother’s assistance, the stress is alleviated. We have gotten used to the routine. The only time we stress, is when she has a low; we always carry food with us.”

The young mother adds, “Honestly, I wouldn’t be able to cope without my mother. While I am working, my mom cares for her. And, by witnessing what a supportive mother I have, I want to set the same example to Tshimologo, and hopefully by me being an example of a good daughter, Tshimologo will see that and be one as well.”

Gogo Grace’s explains her reasoning for helping her granddaughter, “Francinah is my only daughter, whatever she goes through, I go through as well. I need to help her and my granddaughter.” And the love is definitely mutual as Tshimologo only sleeps with Gogo Grace.

The plan for self-care

Francinah and Gogo Grace are already trying to get Tshimologo to understand her condition. If you ask the little girl what food she eats, she replies ‘special food’ and if you ask what food she doesn’t eat, she answers ‘chips’. During, the interview she even asked her mother to buy ‘diabetic food’ for her at Southgate Shopping Centre.

At first, the toddler was fearful of the insulin pen but has gotten used to it now. When her glucose levels are being checked, she will ask, “Mommy, is it up or down?” and if Francinah says “Up”, Tshimologo says, “Aaahhh, now I have to drink water”, and if the response is “Down”, the baby girl will jump up and down, clapping her hands, saying “I’m getting food. Yay!”

Ideally, the single mother and Gogo would like Tshimologo to be injecting herself by the age of 10.

mothers motivationMessage to other mothers with diabetic children

“There are a lot of children with diabetes. When we go for Tshimologo’s check-ups, I see numerous children being admitted due to poorly-managed control. I urge other mothers to take care of their children, good control is attainable. Diabetes is treatable. Even if you don’t have a lot of money – all you must do is make your child eat more vegetables and less starch. Constant monitoring is essential, and ensure that their child understands at an early age,” Francinah says.

Daily care plan

7am: Check glucose levels.

  • If it is lower than four, breakfast (All Bran Flakes or Weet-Bix with low-fat milk/ProVita with low-fat cheese) is given, then she is injected. Check glucose levels again. If it stays on 5, more ProVitas are given.
  • If it is higher than 4, they inject her first before she eats (limited breakfast). Check glucose levels again. if it is 7,5, she can go to crèche.

7am – 2pm: At crèche

  • Francinah informed the crèche not to feed her anything starchy (pap or rice). Tshimologo mainly eats vegetables.
  • Her glucose levels are not tested while she is at crèche.

2pm: Gogo Grace fetches her from crèche. Once at home, her glucose levels are checked.

  • If it is lower than 3, food is given.
  • If is higher than 5, no food is given.

6pm: Gogo Grace checks her glucose levels again.

  • Food is given despite the levels.

9pm: Glucose levels are checked again.

  • If it is lower than 3, a snack is given then they inject her.
  • If is high like 7 or above, she is injected.

MEET OUR EDITOR - Laurelle Williams

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 [email protected]

DSA News

dsa news spring 2017DSA Port Elizabeth branch news

The Diabetes SA Port Elizabeth branch’s library was started in 1991, when the Port Elizabeth Lions Club donated the first books.

Pat Rhodes was the first librarian. She carried the books in a box to the monthly meetings. Over the years, many more books were obtained and a cupboard was purchased.

Currently, there are 148 books, several DVDs and a variety of magazines, not only back copies of Diabetes Focus but also magazine from overseas countries.

The library is based in Newton Park, where the branch’s main Wellness Group meeting is held. Books are loaned to the Malabar and Springdale Wellness Groups.

The present librarian is Lofaine van Niekerk, who enthusiastically encourages members to expand their knowledge of diabetes by reading. She also keeps strict control of the books and gently reminds those whose books are overdue.

Books may be borrowed, at no cost by all paid-up members, and can be kept for one month. There are books on meal planning ideas, healthy eating, diabetes management as well as recipe books. There are a range of books suited for men, parents of young diabetics, teenagers and children of all ages.      

‘Reading is to the mind what exercise is to the body.’

– Joseph Addison

Dates to diarise



Wellness Festival and Run Walk – Sat 11 November, Durban Beach Front Ampitheatre, 1 – 6 pm. 5km Run/Walk; live music, beach hockey, yoga, aerobics and kids’ area. Exhibitors and sponsors welcome. Enquiries at [email protected] or 084 717 7443.



Diabetes Outdoor Family Day for families with children with diabetes – Sat 18 Nov. Speakers and activities for children, sponsors and exhibitors welcome. Enquiries [email protected] or 072 345 0086.


Port Elizabeth Global Diabetes Run/Walk –  Date to be confirmed. R20, 000 sponsorship is needed.


Diabetes Children’s Camp weekend of 20th to 22nd October 2017. Donors and sponsors welcome. Enquiries louise.pywell@gmail.com or 082 451 0706.




Corporate Casual Day “Denim for Diabetes” Awareness Campaign November 2017. Wear an item of denim in exchange for a small donation to support Diabetes SA’s outreach projects i.e. camps and children’s activities for children with diabetes. Community outreach groups into underprivileged communities. Enquiries: [email protected] or 072 345 0086.

Meet your inner king, hero and court jester

Noy Pullen explains how you can access your inner king, hero and jester when tackling the management of your diabetes.

Motivation can be defined as one’s direction to behaviour, or what causes a person to want to repeat a behaviour and vice versa1. Motivation is a buzzword bombarding the modern individual. Back in the day, our parents and, certainly our grandparents, would never have been exposed to this idea of ‘being motivated’.

Words have their own magic living within them, so exploring a few of these words in popular culture reveal their own wisdom.

Motivation – has to do with ‘move’ and ‘motive’.

Change – would have been what was left over from a purchase.

Coach – in the past, a coach was a conveyance that took people to their chosen destination.

Creative – using an adjective as a noun adds to its power. Juggling these letters around to form the word reactive, gives you the opposite of what a creative implies.

Influencer – tries to get ‘in’ to you from the outside.

Looking throughout history

Whenever we hear the words ‘Once upon a time…’, we know we can settle down to hear a story – a story of heroism, wisdom and adventure.

The king

The regal king or ukumnkani led his people through times of plenty and famine, through war and peace, and solved problems brought to his throne by his subjects. People relied on his wisdom and knowledge of the inner and outer world.

The heroes

Then, there were the heroes (amaqhawe) doing the bidding for the king, bravely facing monsters and other enemies to bring peace and well-being to the kingdom.

The king (or head) knew about everything, but did not do anything; the hero (or limbs) fought for the king and for the stability and health of the whole country. But without the heart man in the centre, neither of these characters could function.

The jester

The fool (jester), wizard or iphakathi (the creative centre of the people) not only played jokes on the king but was his closest advisor. “The fool had the right to sit at table with his master and say whatever came into his head. He could be juggler, confidant, scapegoat, prophet, and counsellor all in one. Entertaining, but also offering criticism and advice couched in with…Laughter frequently turns the scale in matters of great importance. The jester’s detached stance allows him to also take the side of the victim, to curb the excesses of the system without ever trying to overthrow it. His purpose is not to replace one system with another, but to free us from the fetters of all systems2.”

What has this got to do with diabetes?

The good news is that we now each have access to our inner king, hero and jester. Look at any self-help category in a bookstore for irrefutable evidence that we have discovered these beings within us in this modern time. It is called identity.

A manual called The Diabetes Toolkit7, written by Buyelwa Majikela-Dlangamandla, is filled with simple but good information of all aspects of diabetes, for your inner king to come to terms with diabetes.

Two other books come to mind: The Obstacle is the Way3 is one where Ryan Holiday using techniques of the jester explores the ancient art of turning your tragedy into a strategy. Then, the charming book Be a Hero- Lessons for Living a Heroic Life4, by Alan Knott-Craig and Craig Rivett, uses delightful playful visuals, in the form of rules, guides, cartoons, quotes, powerful daily exercises, and useful lists to help you become creative, rather than reactive (by knocking yourself against the same old brick wall). Both these books can be read in an afternoon but their effects will last a lifetime.

Thanks to Friedrich Nietzsche, you will also find various comics which call forth the hero, such as Clark Kent becoming Superman (Übermensch). Superman knows everything, can do anything, even recognising his own vulnerabilities and, more importantly, senses through his heart when a fellow being is in difficulty and does only what is needed in that situation. He does not blame or question, or judge. He has pulled his own inner kingdom together. He, like the jester, helps his community out of the danger and seeks to free us ‘from the fetters of all systems’2.

Music of healing

Unfortunately, people – diabetes educators and many others – who want to assist those living with diabetes, out of the noblest of intentions and prior official training, treat the patient as though he/she needs to listen to an outer king, who gives him orders. Then, they expect him/her to act like a hero, vanquishing the dragon.

If only the diabetes healthcare provider or loved one could play their own court jester, and, in finding the patient’s own court jester, then their combined creative energy would create the wisest and most effective ways of meeting the immediate situation.

No wonder the fate of the entire nation was put in the hand of the jester. Everyones’ lives depended on it. The sense of humour can make the most desperate situation bearable, where wisdom and action meet in the heart.

Creative people know they are all jesters. What they do with paint, or music, or on the stage is not called ‘play’ for nothing. If the diabetes team players could find their way into an orchestra of ‘harmonious instruments’, they, together with the patient, would create the music of healing.

Identity is a journey 

In a recent interview, Glen Phillips, a musician, who recently suffered personal tragedy, characterised his own journey by saying, “I’m not sure if I’m entirely post-sabotage yet. It’s a process and old habits are hard to break…Part of getting out of self-sabotage is just avoiding the territory where I know I’m conflicted, so the more I concentrate on service and art, the better life gets. I can tour enough to make a living, and the less I stress about the business side of things, the more things seem to open up creatively…I think we could benefit more if there was some better encouragement for just being a citizen, a helper and healer, a good friend, a member of a community. I realise, there’s a power to money and success that can make things move in the world, but for most of us the work is less abstract, more about the people we touch and the love we give…If you feel entitled to some kind of immortality, it kind of sucks the passion out of making the most of the few days you have. The living days are where the gold is.6

Soweto-born, Elo Zar, another creative says one of her biggest struggles was, “Getting over myself. Self does not play a role when serving people and I’d like to do that – serve. Self-love is a struggle for all of us. I believe we ought to be reminded and supported to be different and to stay different… Identity is, after all, a journey5.

Tim Pullen, another creative in the musical and artistic realm, has this message for heroes like himself, who carry out the task of living with diabetes day to day: “It’s your diabetes. It’s your life. it’s your freedom. Enjoy it7.”

Track your progress each day 

Remember an artist, musician and sportsperson improves by playing often and by practising their chosen discipline regularly. They form new habits towards excellence.

To liberate your inner king, train your thinking

  • Think of a very simple object, like a matchstick, every day for five minutes. Just building up a logical picture of the object for a few minutes.
  • Keep a daily journal and review what has happened on that day, jotting down patterns and rhythms you noticed about yourself. Mark it with a blue dot.
  • Read biographies.

To liberate your inner hero, enliven your will

  • Do something no one has asked you to do, at the same time every day e.g. moving your keys from one pocket to another at noon.
  • Keep a diary of the main obstacle of the day, where you felt unfairly attacked, or given bad news, or accused of something which you had to defend, etc., and write it down. Mark with a red dot.
  • Watch biographies.

To liberate your inner jester, warm your heart

  • Keep a diary each day of extreme emotional outbursts from either yourself or others. Look for the trigger and write it down.
  • Keep a diary of your obstacle of the day (see above). Try to find what triggered your reaction – fear, hatred, doubt, jealousy, pain, boredom – and mark it with a yellow dot.
  • Get into a habit of asking people about their life stories in casual conversation. You will be fascinated no matter how difficult your relationship might be.

Reflect, assess and share

  • Compare what you wrote in your diary next to the blue, red and yellow dots over a period of a week. Look for clues of how to make some changes that you feel would help you find a new creative step. Let your inner king and hero know what you have discovered and have a conversation with them.
  • Write down what the king thinks. Add to this, what the hero wants to do about the situation and write down how you, the jester, feel. Come to some agreement and try it out.
  • Repeat this as a life-long practice in various creative ways.
  • Have fun and let people know how your journey is progressing. You never know you may be the hatching your own best-seller.


  1. Maehr, Martin L; Mayer, Heather (1997). ‘Understanding Motivation and Schooling: Where We’ve Been, Where We Are, and Where We Need to Go’. Educational Psychology Review. 9 (44
  2. http://www.press.uchicago.edu/Misc/Chicago/640914.html
  3. Holiday Ryan (2015) ‘The Obstacle is the Way -The ancient art of turning adversity into advantage’.  Profile Books
  4. Knott-Craig Alan; Craig Rivett (2015). ‘Be a Hero – lessons for living a heroic life.’ Fevertree Publications
  5. City Press13 August 2017 Phumlani S Langa
  6. http://www.brucedennill.co.za/music-interview-glen-phillips-appetite-empathy-fillip-integrity/
  7. Majikela-Dlangamandla Buyelwa (2016). ‘The Diabetes Toolkit’ manual. P22

Please contact Noy Pullen if you would like more information on her resources: [email protected] or 072 258 7132.

Metal fillings’ place in modern-day dentistry

Metal fillings (amalgam) has had its place in dentistry for decades. Dr Marc Sher educates us on the facts and the myths.

Patients frequently ask what should they do with their metal (amalgam) fillings. Mostly, it’s because they’ve read an article that says metal fillings are poisonous and can cause cancer, dementia, Alzheimer’s, and a host of other deadly diseases.

There are also patients, whom have visited a ‘holistic’ health practitioner, and have been advised to remove all their metal fillings. Then, there are patients that simply don’t like the dark shadow they see when they smile or open their mouth.

Whatever the reason, amalgam has had its place in dentistry for decades. It’s important to separate the facts from the myths, and for you to understand the facts to be able to choose the best course of treatment.

What you need to know about metal fillings

Amalgam, a metal alloy, made up of mainly mercury, silver, zinc and copper was the filling of choice for many dentists across the globe for decades. It’s been clinically proven to withstand all the complexities that the oral environment can deliver as well as been shown to last for many years, without wearing down, breaking, or changing its shape.

Amalgam is not moister sensitive (a big issue in the mouth) and it’s condensed into a cavity using the tooth undercuts for mechanical retention. It has a low-cost output for the dentist and a short working time. Which means many dentists have chosen this as a filling of choice to increase production and turnover. There is no wonder that many government dental clinics only offer amalgam as the filling of choice.

Patients more aesthetically demanding

In my 10 years in the dental industry, my personal journey with amalgam has been short. We were taught, and instructed, to place a certain number of amalgam fillings in dental school and had to be fully competent in its application.

We were also taught about resin (white) fillings, but to a much lesser extent. When I left dental school, and entered private practice, naturally I did what I was taught in the beginning. So yes, I was placing amalgam fillings.

As I grew in my role as a private practitioner, I developed a passion for aesthetic dentistry, leading me into the world of tooth-coloured/white fillings. I’ve done research, tried different resin, ceramic and glass ionomer filling materials, and attended courses and workshops learning about their application and function.

As my patients became more aesthetically demanding, I had to make a choice on filling material, and what it basically boiled down to was a simple question, “Why place a metal filling in a white tooth?” The last time I recall placing an amalgam filling was in 2010.

Advances in filling material

As technology and innovation drives the growth and changes in every industry, dentistry has seen a paradigm shift in filling materials. The dental material companies, manufacturing tooth-coloured fillings, have pushed each other to create filling materials that can truly withstand all that the mouth can throw at them.

It’s been a long road, but the science has shown that composite resin, glass ionomers, ceramics and other tooth-coloured materials are a superior choice. There is no reason, other than increased productivity and low-costs, that dentists should turn to an amalgam filling in this day and age.

Technique sensitive

Placing a tooth-coloured filling is extremely technique sensitive; all the steps need to be followed to ensure the correct bonding of the filling to the tooth. There will still be instances where these tooth-coloured fillings will fail, but this is mostly due to poor technique or incorrect material selection. Every other aspect of the tooth-coloured materials we are using nowadays is superior to amalgam.

The difference between amalgam and tooth-coloured fillings

The fundamental difference between amalgam and tooth-coloured fillings is that tooth-coloured materials are ‘bonded’ onto the tooth surface, and metal is not. Metal is held in place mechanically.

What now?

Do you rush to your dentist and have he/she replace all your amalgam fillings? My advice, definitely not! If you have sound, functional metal fillings that do not give you a moments trouble then let sleeping dogs lie.

Unless your dentist has pointed out that there is a health issue (secondary decay), functional issue (broken or chipped), or an aesthetic issue with your amalgam filling, I do not recommend removing them.

Is there scientific proof that metal fillings are poisoning the body?

The short answer is no. Nothing has been clinically proven, and the literature on the topic states that they cannot conclusively prove that amalgams are the cause of said illness. What is known, is that the ‘feel-good factor’ and ‘placebo effect’ have been shown to reign true when it comes to removing metal fillings.

Another important fact is when a dentist picks up his/her drill to remove the amalgam filling, that process completely vaporises the filling into millions of tiny particles. At which time, the patient is at the greatest risk of swallowing and inhaling the harmful metal alloys that the filling contains. Basically, it’s safer in then out.

Removing metal fillings

If you need to have an amalgam filling removed, please request that the dentist places a rubber dam (isolation device) and uses a high-powered suction. This will greatly limit your exposure to debris caused when having an amalgam filling removed.

It is also expected that a tooth will experience some post-operative sensitivity after amalgam has been removed. Most often, the sensitivity is short-lasting and will settle. However, there are exceptions, and removal can lead to further treatment needed on the tooth, such as root canal and a ceramic crown or overlay.


Dr Marc Sher (B.Ch.D) practices at The Dental Practice in Sea Point, Cape Town, and can be reached via email: [email protected]

Quinoa Loaf

Suganon is a range of great tasting sugar alternatives to help you maintain a healthier lifestyle.

Range endorsed by:
• Diabetes SA
• GI Foundation   



  • 300g whole uncooked quinoa (soaked in plenty of cold water overnight in the fridge)
  • 60g chia seeds (soaked in ½ cup water until gel-like overnight, stirring a few times in the beginning)
  • ½ cup water
  • 60ml olive oil
  • ½ t bicarbonate of soda
  • ½ t Himalayan rock salt
  • ½ T Suganon Xylitol
  • Juice from ½ lemon


  1. Preheat oven to 160° Celsius.
  2. Drain quinoa and rinse thoroughly.
  3. Place the quinoa into a food processor followed by chia gel, water, olive oil, bicarb soda, salt, Suganon Xylitol and lemon juice. Mix for 3 minutes.
  4. The batter should be fairly thick with some whole quinoa still left in the mix.
  5. Spoon mixture into a loaf tin lined with baking paper.
  6. Bake for 1 ½ hours or until bread is firm to touch and bounces back when pressed with your fingers.
  7. Remove from the oven and cool for 30 minutes in the tin, then remove it and cool completely before eating.

Popular sugar substitute in cooking and baking

Click here to read more about Suganon.

Suganon is a product of: Adcock Ingram Limited. Reg. No. 1949/034385/06. Private Bag X69, Bryanston, 2021, South Africa. Tel. +27 11 635 0000

Don’t let glucose levels scare you this Halloween

If your family is planning to go trick-or-treating, Donna van Zyl shares ways to enjoy Halloween without fussing over glucose levels.

Halloween need not only be about the trick-or-treating. Encourage your child to partake in non-food activities, such as carving a pumpkin; make decorations; having fun with friends and family whilst watching a scary movie; dressing up or visiting a ‘haunted’ house. It is, however, important to know what your child is looking forward to on this day, so that you can help meet their diabetes management in the middle.

Plan ahead

Sit down with your family and make Halloween plans in advance so your child knows what to expect. Create boundaries and general rules with your family. Your child will be more likely to be on board with a plan they helped create.

The rules of the plan may include:

  • Make sure your child does not go alone.
  • Ensure your child eats well and smart throughout the day, prior to the trick-or-treating so he/she can start off the evening with normal blood sugar level.
  • Then, make a deal with your child to avoid snacking until you’re both home from trick-or-treating.
  • Your child should take his/her own water or non-sugary drinks along, as they may get thirsty.
  • Your child should keep track of his/her sugar levels throughout the evening. Trick-or-treating may include a lot of excitement, running around or even having a treat out of the extraordinary.
  • Be prepared – test and ensure your child has something appropriate to treat a hypo. It is likely that he/she will have something in their bag to treat a hypo, however, the chocolate containing sweets do not necessarily act rapidly. Ideally, they should choose the sugary option and may need a follow-on snack, like a half of a peanut butter sandwich.
  • Friends and family can be very supportive and have healthy snacks waiting for your child. These options may include nuts, dark chocolate and fruit (strawberries dipped into dark chocolate). If they do have chocolate, encourage them to make sure they’re the snack-size versions.

Returning home

Once both of you have returned home, allow your child to choose his/ her favourite treat and administer an insulin dose accordingly.

The non-chocolate treats could be sorted into 15g carb packets and kept to treat a hypo. Those chocolate coated treats can be exchanged for a desired gift i.e. a toy, TV game, movie ticket, or a trip to the zoo etc. The exchange of sweets for a desired toy or game could apply to all the children of the house. The exchanged treats can also be donated to the less fortunate community groups as a treat they often do not receive.

Diabetic-friendly Halloween recipes

You can also make great Halloween diabetic-friendly recipes that will allow your children with diabetes to enjoy the day, without missing out treats.

Suitable Halloween treats:


Donna van Zyl is a private practicing dietitian for Nutritional Solutions, Bloemfontein. She is growing in the field of paediatrics and plays a key role in individualising nutritional therapy for Type 1 diabetics. She has a special interest in optimising health, managing chronic lifestyle related diseases, and sports nutrition. She lectures part-time at the University of the Free State, which she enjoys thoroughly.

Irritable bowel syndrome – do you have it?

It seems every second person you talk to nowadays has irritable bowel syndrome (IBS), but what exactly is it? Dr Trevlyn Burger sheds insight.

Irritable bowel syndrome is synonymous with ‘leaky gut’ or ‘spastic colon’. It is a condition that affects the function and behaviour of the intestine. It is the most commonly diagnosed gastrointestinal condition and thus has a large impact on healthcare costs. An estimated 10 to 20% of the general population experience symptoms of IBS. Many people experience only mild symptoms, but for some, symptoms can be severe and impact on quality of life and work productivity.

The primary symptoms are abdominal cramping and bloating, a feeling of incomplete evacuation, and altered bowel movements. Some people have frequent, watery bowel movements while others are constipated, and some switch back and forth between diarrhoea and constipation.

Despite intensive research, the cause of irritable bowel syndrome remains incompletely understood. IBS is a heterogeneous disorder and no single abnormality accounts for IBS symptoms in all patients. Postulated causes include:

  • Post infectious – Some people develop IBS after a severe gastrointestinal infection (e.g. salmonella or campylobacter jejuni). It is not, however, clear how infections trigger IBS.
  • Food intolerancesThis raises the possibility that it is caused by food sensitivity or allergy. The best way to detect an association between symptoms and food sensitivity is to eliminate certain food groups systematically (an elimination diet). Note: eliminating foods without assistance from a nutritionist can lead to omission of important sources of nutrition. Several foods known to cause symptoms include gluten, dairy, legumes, and cruciferous vegetables amongst others.
  • Heightened sensitivity of the intestines to normal sensations (visceral hyperalgesia)The theory proposes that nerves in the bowels are overactive in people with IBS, thus normal amounts of gas or movement are perceived as excessive and painful.
  • Anxiety and stressThese are known to affect the intestine. A strong association exists in patients who have experienced significant early-life emotional trauma.
  • Abnormal contractions of the intestines – There may be an intense prolonged, spastic contraction due to an abnormal electrical system. When two parts of the colon contract simultaneously, the colon between stretches like a balloon resulting in bloating and distension.
  • Alteration in faecal microfloraEmerging data suggests that the faecal microbiota (normal bacterial load in the intestine) in individuals with IBS differs from that of healthy controls.
  • GeneticsStudies suggest a genetic susceptibility in some patients with IBS.
  • Bile acid malabsorptionIn some patients, excess bile in the colon may result in diarrhoea-predominant IBS.

Diagnostic approach

Many disorders present with symptoms similar to irritable bowel syndrome, thus it is important to exclude other causes. ‘Alarm’ or atypical symptoms that are not compatible with IBS include:

  • Rectal bleeding.
  • Nocturnal waking with pain and bowel movements.
  • Weight loss.
  • Laboratory abnormalities, such as anaemia, elevated inflammatory markers or electrolyte disturbances.
  • Family history of colorectal cancer, inflammatory bowel disease or celiac disease.

The diagnostic evaluation depends on whether the predominant symptoms are diarrhoea or constipation. The most common conditions that need to be excluded are inflammatory bowel syndrome, hormonal disturbances, infections, diverticular disease and colorectal cancer.

In diarrhoea-predominant, a stool sample is sent for testing and celiac disease needs to be excluded. In constipation-predominant, other causes of constipation, e.g. an underactive thyroid or high calcium need to be excluded.

All persons over the age of 50 years should have a colonoscopy at least once a year.


  • Education and reassurance – It is important to establish a therapeutic clinician-patient relationship to validate the patient’s symptoms, and to understand that IBS does not increase the risk of cancer, but that it is a chronic (long-standing) disease. In patients with mild and intermittent symptoms that do not impair quality of life, we initially recommend lifestyle and dietary modification alone. In those with more significant symptoms, we suggest adjunctive pharmacological therapy.
  • Dietary modificationA careful dietary history may reveal patterns of symptoms related to specific foods. More than half of patients’ symptoms are improved by eating smaller meals, avoiding milk products, avoiding fatty foods and gluten.

Patients with IBS may benefit from exclusion of gas-producing foods; a diet low in fermentable oligo-, di- and monosaccharide’s and polyols (FODMAPS), as it is thought that there are bacteria in the colon that ‘feed off’ these foods changing bowel function and behaviour.

There is insufficient evidence to support routine food allergy testing in patients with IBS. The role of fibre is controversial, but given the absence of serious side effects and potential benefits, psyllium and ispagulla should be considered in those constipated.

  • Psychological interventionCognitive behavioural therapy may be of benefit.
  • Physical activity – This is advised to be of benefit.
  • Pharmacological therapy
    • Constipation-predominant:
      Loperamide (Imodium) is usually the first line of treatment. Lubiprostone (Amitiza) and linaclotide as second line (not freely available in South Africa).
    • Diarrhoea-predominant:
      Antidiarrheal agents, such as loperamide, as first line treatment. Bile acid sequestrants, such as cholestyramine (Questran and Questran Lite), are used as second line treatment.
    • Abdominal pain and bloating:
      • Antispasmodics as needed.
      • Iberogast
      • Colpermin
      • Simethicone
    • AntidepressantsTricyclic antidepressants (TCAs) are considered in patients in whom laxatives, loperamide or antispasmodics have not helped. Selective serotonin reuptake inhibitors can also be considered.
    • AntibioticsNot routinely recommended. A two-week trial of rifaximin may give long-lasting symptom relief, emphasising the role of the gut bacteria. (Microbiome)
    • ProbioticsNot routinely recommended. Although, they have been associated with an improvement in symptoms. The magnitude of benefit and the most effective species and strain are uncertain. Faecal microbiota transplants (stool transplants) are being evaluated in clinical trial.
    • Other therapiesHerbs, acupuncture, enzyme supplements and mast cell stabilisers have been evaluated, but their role in irritable bowel syndrome remains uncertain.

Patients with refractory symptoms should be carefully reassessed, paying specific attention to the type of ongoing symptoms, the degree to which symptoms have changed, compliance with medications, and the presence of any alarm symptoms.

Reassurance that there is no sinister underlying illness is of great importance with these patients as their pain and bowel habits are often abnormal and real, and this can cause anxiety.

MEET OUR EXPERT - Dr Trevlyn Burger

Dr Trevlyn Burger is a consultant gastroenterologist at Morningside Mediclinic, with an interest in inflammatory bowel disease, functional disease and liver pathology.