Fabulite, simply fab for diabetics

Being diabetic definitely does not mean that you have to miss out on deliciously refreshing and filling treats. As the world focuses on Diabetes Awareness during the month of November it’s a good time to remember the nutritious and delicious options Parmalat’s range of no added sugar Fabulite yoghurt offers, and to include it in your diet as one of the suggested three servings of dairy a day adults should consume.

Fabulite eating yoghurt, Parmalat’s healthy alternative, is 100% no added sugar and fat-free, and offers a variety of great-tasting Fruit and Smooth flavours.

With fewer kilojoules than regular yoghurt, Fabulite is a guilt-free and delightful snack that can be enjoyed by health-conscious consumers.

The Fabulite Smooth range consists of Plain, Vanilla, Strawberry and Black Cherry flavours.

Fabulite has been part of the Parmalat family, known for its focus on quality, since its launch almost ten years ago (in 2008) when it was endorsed by the GI Foundation of South Africa (GIFSA) and Diabetes SA.

* The Parmalat Fabulite range is available in 175g and 1kg packs (Plain, Vanilla, Strawberry and Black Cherry flavours). The 6x100g variety pack is available in the following varients: Strawberry, Black Cherry and Vanilla.

Smooth(ie) sailing

ParmalatSmoothies made of healthy ingredients are a great way to boost your nutritional intake in a quick, all-in-one meal, snack or treat. But it’s important to make sure that the ingredients you use for a diabetic-friendly smoothie are healthy and not too high in sugar, fats or calories.

Enter Parmalat Fabulite… the perfect NO ADDED SUGAR, FAT-FREE dairy and fruit combo to use when you’re craving a deliciously healthy smoothie for a good start to the day or an anytime treat. Fabulite is of course also perfect for enjoying on its own as an on-the-go and healthy breakfast, snack or treat.

People living with diabetes who want to enjoy yoghurt should avoid yoghurts with packaged toppings and not buy yoghurt without checking the on-pack nutritional information.

Whole grains could be a great addition to a smoothie to make it crunchier and up the nutrition stakes. Just ensure that what you add contains no hidden sugars that will contribute to increased blood sugar. And always remember to control the serving size! You can consider using oats or bran when making a smoothie, but keep an eye on the product’s nutritional info, sugar and carbohydrate content; when the added up it should all still be within your daily allowed totals.

Another option for a fabulous Fabulite smoothie is adding some fresh blueberries and sliced almonds to a tub of Fabulite yoghurt of your choice.

GOOD ADVICE

The Nutrition Information Centre at Stellenbosch University (NICUS) provides a few diet tips to help prevent and treat type-2 diabetes:

  • Losing as little as five to 10% of your body weight improves insulin resistance;
  • Try to have at least two cups of dairy (milk, cottage cheese or yoghurt, or a plant milk alternative) per day, preferably low-fat products, because these products contain all the necessary protein and calcium, but with less fat.
  • Eat at least three balanced meals a day;
  • Drink at least six to eight glasses of water a day;
  • Increase your fibre intake by including foods such as wholewheat bread and pasta, whole grains, brown rice, legumes, fruit and veg, and oats in your daily diet;
  • Limit your fat intake, especially that of foods containing saturated and transfats. Rather opt for mono-unsaturated fats in limited amounts (for example use canola or olive oil instead of sunflower oil, or use avocado or peanut butter instead of margarine on bread);
  • Eat at least five portions of fruits and vegetables every day and include as much variety as possible;
  • Use healthy cooking methods (eat food raw, or boil, steam, bake, grill or braai it and use as little fat as possible when preparing your food);
  • If you consume alcohol (beer and wine), do so moderately (one to two glasses a day, and always with a meal), and
  • Manage your sugar intake and limit or avoid food that is very high in energy, but low in nutrients.

DID YOU KNOW?

2016 statistics from the International Diabetes Federation, the World Health Organisation and the Centre for Disease Control paint a gloomy picture.

Worldwide, 415 million people were diagnosed as diabetic as opposed to 35 million patients with HIV and 14 million with cancer. Every six seconds a person dies from diabetes-related causes. Every 10 seconds two people develop diabetes and every 30 seconds, a lower limb is amputated due to diabetes-related complications.

Two auto-immune diseases, two healthy children


Not even two auto-immune disease – Type 1 diabetes and Graves’ disease – stopped Tara-Lee De Wit from starting her family. She shares this journey with us.


Tara-Lee De Wit (28) lives in Hopefield, Western Cape with her husband and two children, Madison (6) and Kayden (4 months).


Auto-immune disease 1: Type 1 diabetes

In October 2007, at the age of 18, Tara-Lee would walk in to work with two bottles of juice, a bottle of water, a whole-wheat sandwich and fruit. However, the contents of this lunchbox would never sate her appetite. The scale shocked her with the fact that she had lost 6kg. “Considering how my calorie intake had increased over the past two weeks, I knew something was wrong,” she says.

What followed was a five-day stay in hospital and a diagnosis of Type 1 diabetes. Here, she was taught how to inject her stomach and thighs with insulin, and the importance of drinking water to flush ketones out of her system if she experienced a hyperglycaemic episode. “I was dreadfully shocked. No one in my family had diabetes. Let alone Type 1. But as I learnt, it is not hereditary. Thinking about it now, it seems scary, but in the moment, you do what you must do. You have no choice,” explains Tara-Lee.

Obviously, the teenager was overwhelmed but took her diagnosis in her stride due to her being a naturally disciplined person. “I learnt and researched as much as I could about my condition. Diabetes would not own me; I was adamant about that,” she adds.

Auto-immune disease 2: Graves’ disease

At 25-years-old, then a mother of one, was plagued with an abundance of symptoms: heart palpitations, heart rate constantly above 100bpm, constantly anxious, slight tremors in her hands, and then a goitre (swelling in the neck due to the enlargement of the thyroid gland). It was diagnosed as Graves’ disease, where the thyroid gland produces too much thyroid hormone (hyperthyroidism).

“During my research after my diabetes diagnosis, I read that when you’re diagnosed with an auto-immune condition, it is likely you can have more than one. However, I was still quite stunned. Once again, I read up as much about Graves’ disease and the thyroid as I could. Interestingly enough, both diseases I have are the rare ones. Hyperthyroidism affects up to 5% of people between the ages of 20 – 40 years old. Whereas hypothyroidism – where the body operates at a much slower rate, slow heartbeat, lacklustre, no energy, more prone to depression – is much more prevalent. Just like Type 1 only accounts for 10% of all diabetes, and is diagnosed mostly in children and young adults.”

Treatment

Currently, the 28-year-old takes Actrapid and Protaphane, injecting four times a day (Basal-bolus regime). The amount of insulin she takes is dependent on whether she is exercising, sick, and what she eats. “It allows me to change it accordingly to my lifestyle which is great. I am in control,” Tara-Lee says. For her thyroid, she takes 2,5mg of Carbimazole. Her thyroid is at optimal levels now.

Conflict of auto-immune diseases

If Tara-Lee’s thyroid hormone levels are high, then it interferes with her blood glucose control. But during this time, if it occurs, she takes extra insulin, until the thyroid medication starts working. “It takes about two weeks until you see a difference in thyroid levels,” she explains.

Pregnancy 1

Despite being a scared 22-year-old with Type 1 diabetes, the young mother had a very good pregnancy. “I knew I was doing everything I had to, to ensure the health of my baby remains at optimal levels. I had a consistent 6% HbA1c, and when Madison was born, my HbA1c was 5,4%. Madison was a bit bigger than normal, but babies born to diabetic mothers are known to be bigger when born. After a five-day hospital stay, Madison and I could go home,” she says.

Pregnancy 2

Tara-Lee had her second child, Kayden, this year July. The pregnancy was planned. Before conception, she worked with the endocrine unit at Tygerberg Hospital to ensure her HbA1c and thyroid levels were exactly where they should be. This took six months, then the married couple got the go ahead. Two months later, Tara-Lee was pregnant.

Describing this pregnancy, Tara-Lee says, “Despite a high blood pressure scare, all went well thankfully. Kayden was just growing exponentially and a decision was made to take him out via C-section at 37-weeks’ gestation. My big boy shocked all the doctors when he came out at a whopping 5,1kg! I was told he would have some lung immaturity (wet lungs), but we had no choice. He was on oxygen for a couple of days, and after all checks were done we went home after 11 days in hospital.”

You do what you have to do

With both pregnancies, Tara-Lee had to travel 300km every two weeks to the hospital. She did this for nine months, sometimes every week. She had much more foetal monitoring scans than someone who doesn’t have a high-risk pregnancy, and her HbA1c and thyroid levels were checked every 4-6 weeks. Commenting on this, Tara-Lee says, “You push through… you do what you have to. The team at the hospital was amazing; they helped me complete my family: two healthy babies even though I have two auto-immune conditions.”

10 years of being a diabetic

When Tara-Lee was asked how she feels looking back at her diagnosis 10 years ago, she responds, “I do not give much thought to the fact that I am diabetic. It is part of who I am. I always have my glucose meter with me, a roll of sweets in my bag, in the car, in my pocket…for that emergency hypo. I constantly carry my small bag with my insulin pens around with me.”

“But, in the beginning…in all honestly, the first thing I was concerned about was pregnancy. I knew it would probably be a huge undertaking, but was aware that pregnancy and diabetes can happen. Dr Google gives numerous horror stories. I remember searching online and in book stores for a story of a young South African woman with Type 1 diabetes, and her successful pregnancies. But I didn’t find any. This is what motivated me to share my story…for women in the same position I was…they need to hear the positive stories.”

Knowledge is power

“I am fully aware of what my body is susceptible to due to these two conditions I have: possible deteriorating eyesight, more prone to infections, take longer to recover when sick, kidney function must remain optimal etc. However, I take care of my body. This is what everyone should be doing anyway though.”

She goes on to say, “Diabetes is nothing to be afraid of. Knowledge is power. To this day, if someone finds out I have diabetes, they immediately say, ‘Oh, you are so thin, so which one do you have then?’, or ‘You don’t look sick!’ I hate hearing this. Yes, I do not look sick at all. I can do anything and be anything I want to be. Diabetes does not restrict me in any way.”

Exercise

The mother of two walks as much as she can, teaches hip-hop dancing to toddlers. She started cycling off-road, which she hopes to intensify soon. “I look for any excuse to remain active, even though I have an office job. Exercise releases the good endorphins. It is so important!”

Diet

“I eat whole wheat low-GI bread and the low-fat version of everything. Twice a day I drink a green smoothie, and make salads in summer. Three fruits a day is my goal, and I supplement with Provitas and cheese or peanut butter. However, I am not a saint –  I enjoy my father-in-law’s lovely Sunday roasts! I just remove the skin from the chicken,” Tara-lee explains.

MEET OUR EDITOR

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

Breastfeeding and the diabetic mother


Many diabetic mothers are concerned that their diabetes may be transmitted to their baby via their breastmilk, but this is a myth. Clinic sisters, Lara Kaplan and Timor Lifschitz, talk us through breastfeeding if you are a diabetic mother.


Breastfeeding is best

Breastmilk is the most beneficial source of nutrition for infants. It provides the perfect amount of nutrients, antibodies and immune protecting components for your growing baby.

For women, it is important to remember that having diabetes comes with increased risks of having a caesarean section; delayed milk production onset; a lower breastmilk supply; and risk for candida (thrush) or mastitis infections. All of which can impact breastfeeding.


Health benefits of breastfeeding

For diabetic mothers

  • It can assist to lose weight gained during pregnancy. Remember, it is important for diabetic women to maintain a healthy weight and still get the correct amounts of nutrients while breastfeeding. You may need to develop an eating plan with your healthcare provider.
  • Bonding with baby is enhanced due to oxytocin release. This can help improve how you feel physically and emotionally. In addition, it can help to decrease stress, which can aggravate diabetes.
  • Some mothers may need less insulin post-partum because breastfeeding helps to lower blood sugar levels.
  • Breastfeeding assists in keeping glucose levels more constant. Mothers may have a remission of symptoms during this time.

For babies

  • They are less likely to get ear and respiratory infections, allergies, eczema, asthma, and, more importantly, diabetes later in life.
  • Being diabetic, your baby’s genetic predisposition may be increased but by breastfeeding you can help to mitigate and prevent that risk.
  • A child of a mother who has gestational diabetes during pregnancy has an increased risk of becoming obese during childhood and therefore a risk of diabetes later in life. However, studies found that breastfeeding a baby for at least six months neutralises this risk.

Will your diabetic medication affect baby?

Most medications used to manage diabetes can be safely used while breastfeeding, but you should confirm this with your doctor or lactation consultant. Medications, such as insulin and oral treatments, often must be adjusted in the period following birth under the guidance of a doctor.

Breast milk production

Breast milk production is controlled by a delicate balance of hormones, and any metabolic imbalances, such as diabetes, can interfere with this balance.

Having diabetes – and the increased risk of having a caesarean section – may delay the onset of the milk ‘coming in’, or lactogenesis II.

There is also a risk of baby being hypoglycaemic because of having higher insulin levels in utero of the diabetic mother, due to her higher blood glucose levels. When baby is born, baby gets glucose through breast milk but it is often lower than that in utero.

Colostrum

Colostrum – the very first milk – produced in small amounts and densely packed with nutrients, helps to stabilise blood glucose levels in new-borns.

Pregnant mothers can gently hand express colostrum from 37 weeks under the care of an obstetrician or midwife. The expressed colostrum can be collected on a spoon and then placed into a container. This should be labelled with the date and time of collection, and then placed in the freezer. Expressing colostrum can cause contractions, and it is recommended to stop as soon as you start to experience them.

Once baby is born, mom must remember that breast milk production is all about supply and demand. You need to make sure to feed regularly and on demand. Feeding 8 – 12 times a day will help to empty the breasts and tells the brain to produce more milk.

Skin-to-skin contact

Once baby is born, skin-to-skin contact is important. It keeps baby warm and stimulates hormones to produce breast milk. Feed your baby as soon as possible after birth. The baby needs to be positioned and latched on correctly, if you have any difficulties please contact a lactation consultant.You can ask the lactation consultant to come immediately after birth.

Regular feeds help to stabilise and maintain baby’s blood sugar levels. These can drop after birth due to the higher levels of insulin that your baby’s body generally produces while in utero.

Should baby struggle or be unable to feed, baby can be fed expressed breast milk by syringe or cup. The hospital staff will assist you. If expressed breast milk is not available, mom can look in to donor milk or formula.

24-hour monitoring

The blood sugar levels of babies born to diabetic mothers are monitored for the first 24 hours to check for hypoglycaemia. If the levels drop too low, baby will be fed via other temporary measures so as not to burn more energy trying to feed.

If this is the case, you should continue to express regularly to stimulate milk production. Once baby’s blood sugar levels have stabilised, the staff will stop measuring them. The baby should continue to feed on demand. If the blood sugar levels do not stabilise, baby may need to be admitted to the neonatal unit for monitoring. Here baby will be fed your expressed breast milk.

Jaundice

Jaundice is a yellow discolouration of the skin and sclera (whites of eyes) due to a build-up of bilirubin, which occurs when red blood cells are destroyed and haemoglobin is broken down. A breastfeeding baby of a diabetic mother has an increased risk for jaundice.

These babies are often born bigger and thus have more haemoglobin to be broken down. Fortunately, this problem is treated easily with light treatment (phototherapy).

Lack of insulin in the body can cause ketosis, the presence of ketones. This can pass directly into breast milk, which increases the workload on the baby’s liver and can contribute to jaundice. It is thus important to continue taking your insulin doses and be in contact with your physician. The more baby feeds, the more baby will pass stool, which helps to eliminate the bilirubin out the baby’s system.

Thrush

Diabetes increases the risk of developing thrush and/or mastitis during breastfeeding. This is more likely to happen when your blood sugar levels are poorly controlled.

It is also important to treat breast infections quickly, as they can otherwise increase blood sugar levels. The main symptoms of thrush are: pain in the nipples or breasts – usually a sharp stabbing/shooting pain and itching, burning and sensitive nipples. Sometimes there may be no symptoms at all.

Baby can also have thrush in the mouth – creamy white patches. Baby may be fussy and pull away from the breast while feeding, and have a nappy rash. Both mom and baby do need to be treated together, but you do continue breastfeeding during treatment.

Mastitis

Mastitis is an infection diagnosed following hard, tender, red areas on the breast that may be painful when touched, coupled with flu-like symptoms, such as fever and aching. If left untreated, it can cause a breast abscess.

You should continue feeding on the affected breast and call a lactation consultant to assist you. Ensure the latch is deep, and massage the affected area before and after feeds. You can use paracetamol to relieve pain and reduce temperature, and ibuprofen to reduce inflammation and pain. Try to rest as much as possible to allow for healing. If it does not get better, please contact a lactation consultant to assist you together with your doctor.

Tips to ensure a successful breastfeeding relationship with diabetic control:

  • Remember that during a breastfeeding session, the body uses up large amounts of sugar to produce milk. This can cause a modest drop in blood glucose levels, resulting in a hypoglycaemic episode.
  • Eat before you feed baby to stop your blood sugar levels from dropping. Especially if you are alone when you feed baby. Alternatively keep a snack handy when you are breastfeeding so that you do not have to stop the feed.
  • Mothers who breastfeed will need to increase their calorie intake by an extra 500 calories spread throughout the day, as breastfeeding burns calories. Avoid dieting while you are breastfeeding as your body needs calories for energy.
  • You are more likely to have hypoglycaemic episodes if you start breastfeeding when you already have low blood sugar levels, or if the feeding session goes on for a prolonged period. New-borns usually feed for 45 minutes to an hour, but may be exacerbated if baby is not latching well. If you are concerned, contact a lactation consultant.
  • It is normal to feel thirsty when breastfeeding, and is not necessarily a sign of high blood sugar levels. By monitoring your blood sugar levels, you will be able to tell whether it is due to natural thirst, or if it is caused by a hypoglycaemic attack.
  • Weight loss will almost always result in decreased insulin requirements. As maternal weight drops, medication doses will need to be reduced.
  • It is important to avoid hypoglycaemic episodes while nursing as they trigger the production of adrenaline, which reduces milk production and milk let-down reflex.
  • Rooming-in with baby improves breastfeeding outcomes as you can feed baby on demand and practiSe skin-to-skin to enhance milk production.
  • Avoid taking supplements, such as fenugreek, as it can have a dangerous effect on blood glucose levels. Always discuss medications and galactogogues with your lactation consultant for safety measures.
  • Try to sleep when baby sleeps. Lack of sleep can result in blood sugar level problems related to basal insulin doses.
  • Avoid stress as it can cause blood sugars to rise and stay high.
  • There is a significant association between diabetes and post-partum depression; this risk is exacerbated when blood sugar levels are not well-controlled. If you experience any feelings of inadequacy, major sleep/appetite changes, lack of bonding with baby and thoughts of harm to baby or yourself, contact your physician.
  • Babies often feed more frequently (cluster-feeding) during a growth spurt. Continue monitoring your blood sugar levels regularly and seek advice from your healthcare professional if your insulin/medication regime needs adjusting.
  • Allow your partner, family and friends to assist with caring for baby. Check if there are any ‘Mother and Baby groups’ in your area to connect with other mothers.
  • Always have a snack on hand when you are out with baby. To be prepared, make a special place in baby’s nappy bag for your key diabetes equipment, such as your blood glucose meter; strips; lancets; insulin; and medication.

Team effort

When managed, diabetes and breastfeeding can work but you will most likely need support from healthcare professionals, family and friends.

Your lactation consultant can assist you with any challenges related to breastfeeding. Your multi-disciplinary team must work together to give you and your baby the best start in your breastfeeding journey. It really does become a team effort, and you and baby are the stars!

MEET OUR EXPERT

Timor Lifschitz a qualified nurse and lactation consultant. She comes from a midwifery background and is passionate and knowledgeable about the antenatal, birth and post-partum period as well as child growth and development.

MEET OUR EXPERT

Lara Kaplan is a registered nurse/midwife and certified lactation consultant with a passion for working with moms and babies. She has worked in both government and private sector clinics. She is dedicated to helping moms according to their own needs through the journey of early motherhood.

Reflections of a Type 1 diabetic: diagnosed during WW2


Nadine Lang says living with Type 1 diabetes for 74 years has not been problematic. She reflects back to the time she was diagnosed and tells her tale.


Nadine Lang (79) – a widow – lives in Summerstrand, Port Elizabeth and has two daughters and a granddaughter. She moved to South Africa from Britain in 1964.


1944

I was diagnosed one week before my 6th birthday. The onset was very quick; I was constantly drinking, tripping off to the toilet and bed wetting. I landed up in the local children’s hospital and a few days later, all the children, except me, were enjoying my birthday cake. Naturally, my parents were in shock but quickly recovered with the wonderful help and encouragement they received from the hospital staff.

Insulin options

It was only 22 years after the discovery of insulin and there was little choice: only the long-acting Protamine Zinc and short-acting insulin, I think called Soluble. Because I was so young, it was thought better (and kinder) to only have one injection a day, so I was put on Protamine Zinc.

After I left hospital, I used to go every fortnight as an outpatient. The Protamine Zinc-alone regimen proved ineffective, so it was complemented with Soluble. Eventually, the Protamine Zinc was discontinued and thereafter I was only on Soluble twice a day.

Waiting game

I had to wait 20 minutes to half an hour in those days after having my injection before I could eat. This was to allow the insulin to start to work before the food had chance to raise my sugar level. As I became more stable and my mother more confident in coping, my outpatient visits occurred less frequently. They became monthly, then every six weeks and finally every six months, unless a problem cropped up.

I continued to use Soluble twice a day with occasional adjustments of dosage as I grew up until the mid 80s. In fact, I must have been almost the last person to use Soluble as I refused to change until it ceased to be manufactured. I considered myself quite stable on it and had no wish to bother to change.

Changing insulin

From the mid 80s, I still had two injections a day for a long while with my doctors trying different alternatives and dosages. Eventually, around the turn of the century, I changed to Levemir twice a day and NovoRapid three times a day, until recently when my diabetes began to give problems. My sugar readings have always yo-yoed but were getting out of hand. Currently, my doctor and I are trying Ryzodeg twice a day and NovoRapid at lunchtime.

Diabetes old syringe.

Glass syringes

Initially, injections were a hassle. How much easier it is today! Back then, there were no pumps, pens or even disposable syringes. Only glass syringes, which had to be sterilised by boiling in water and/or be kept in spirits. Needles were longer and thicker by today’s standards. Mine were often re-sharpened when they got blunt as we were too poor to buy new ones.

Sugar test by urine sample

Another problem was testing sugar levels. We had no blood testing with a glucometer. It was urine testing with a test tube, a spirit lamp and Fehling’s or Benedict’s solution. Once mixed together and heated, the results merely showed whether there was no sugar (no colour change); green (a little or 1+); yellow (more or 2+); or red (far too much or 3+).

Later, it was easier by dropping a pill in the test tube which contained a sample of my urine. Then it became a paper strip which just had to be held in the urine flow. Urine testing was never very accurate but we managed.

If one was feeling hypoglycaemic (having a low), it was useless to test to ‘prove’ one was indeed having a low as the urine could be ‘stale’. Comparing those urine test readings with today’s blood tests with glucometer readings, one realises just how inaccurate they were.

I must admit, because testing was such a hassle, from my early teens I never tested unless I was going to the doctor or if I was pregnant. I relied on how I felt. This was until glucometers and the new insulins arrived.

Weighing what you eat

Because testing results were so limited, diets were rigid. Everything had to be weighed. It was 1944, in wartime Britain with food rationing which persisted for several years afterwards. Though, diabetes patients were allowed extra meat, cheese and butter in place of sugar and sweets.

There was little choice and apart from diabetic apricot jam, which came in a jar not unlike the old small anchovette jars. There were no alternatives for many years, such as tins of ‘lite’ or sugar-free versions of fruit, custard, biscuits, soup, sweets and cool drinks, etc.

Finding a good paediatrician

When I went to kiddies parties, I was not allowed any sweet things the other children had. Instead my mother would make me blue jelly made with gelatine and colouring. When I was about nine, I was lucky to get a new paediatrician. He explained as he had four children himself, he knew all too well that children broke rules, and it was better to break the rules of rigid dieting and times of eating and learn how to avoid problems that could ensue. Which I did.

His reasoning has stood me in good stead and I have enjoyed everything that life has offered me. My diabetes has not prevented me from doing anything. At school I was treated like everyone else. Only once, in primary school, was it a problem when teachers were hesitant to take responsibility for me on a day trip out of town. Thankfully, my mother came so I enjoyed the outing.

No diabetologists

In the early days, there was no such speciality as a diabetologist. You either saw a GP or specialist physician. I was under the care of a diabetologist for several years.

Over the years, I have seen several other medical experts, such as podiatrists and dietitians, etc. There is always something new to be learned. For instance, I find it fascinating that there always seems to be a newer insulin on the market, which is ‘better’ than the others. I must admit, I do not always follow the changes, particularly if I am stable. It is both wasteful and expensive if the new is ineffective, since insulin usually comes in batches of 5 pens. At times I was left with some I couldn’t use.

.

Diabetic pen pal

At 16, I stayed with my diabetic pen pal in Holland for five weeks. I also went on the first three overseas trips, organised by the British Diabetic Association; twice to Switzerland then to Austria. At varsity, I participated in several extramural activities, where I met my husband, Cyril – a South African. We both became dental surgeons and spent many years together in private practice. I have been fortunate to have travelled extensively, enjoyed a variety of hobbies, been involved in several community and charitable organisations and studied further.

Starting a family as a Type 1 diabetic

After finishing varisty, Cyril and I migrated to South Africa, finding I was pregnant with our first child. When I was pregnant, urine testing and Soluble insulin were still common practise. I would test meticulously and watched my diet, though I had given up weighing my food years before. There were no dietitians in town and I relied on past diets, experience and my specialist physician and gynaecologist. My daughters have not inherited diabetes, and as far as can ascertain, I am the only one of my many cousins who has it (I am an only child).

Type 2 diabetic husband

However, I am ashamed to admit that I failed to recognise the symptoms when my husband developed Type 2 in his seventies. Though he complained of a dry mouth, I was more concerned with his sudden and dramatic loss of weight. When we were given the diagnosis by the doctor, I burst out laughing both with the relief that it was not cancer and at my stupidity. My husband was on insulin for a couple of weeks, then moved to tablets for the rest of his life. He only retired at 83 when he had a successful quadruple bypass heart operation. He lived very well afterwards until his sudden death of natural causes, a month short of 88.

Can’t picture a life not as a Type 1 diabetic

I really cannot imagine my life without diabetes. Starting so young, I have little recollection of life before it arrived. My experiences, when things were more difficult, taught me to be more self-reliant; to be pro-active and not reactive; and not to take risks.

I am well aware of how infections and relatively minor illnesses can upset my diabetes control. Thus, I always seek medical advice sooner than later and have flu vaccinations and the like. But, with that said, I don’t worry about all the other diseases that diabetes may lead to because they can affect the normal population too.

Fear of an amputation

However, I am petrified of having an amputation. I only buy shoes that I have fitted properly in the shop. Though, I once bought a pair of shoes with had a label inside, just over the toes, which I could neither feel nor see. The next day, my big toes, on both feet, were septic. I sought a doctor immediately. I lost the toenails a couple of days later. The doctor and my podiatrist admitted how lucky I was not to have needed surgery which they had both anticipated.

Personal records

Since the mid 80s, I have kept a record of my tests, insulin taken and food eaten. I find it useful when things go haywire to see why, by turning a few pages back to find similar circumstances and compare. Also, I am never without sweets, chocolate or biscuits within reach, in case of a low.

Past vs Present

I read the labelling on foods in supermarkets these days and know the contents are listed in order from highest percentage to least. These labels weren’t always listed in the past. Also, one must be wary of ‘lite’ now that our government is promoting less consumption of sugar. Some cool drinks are ‘lite’ with no sugar, but others are ‘lite’ in the sense they that they contain less than the normal product but far more than a diabetic should have.

There is definitely an element of luck with my surviving so long. When you get to my age, you’ve lost many friends along the way. I’m lucky. My only handicap at the moment is that I am very hard of hearing and getting slower with age.

Article written by Nadine Lang.

Diabetes burnout


Do you feel that you have been working so hard at trying to manage your diabetes, but are not getting better results and your frustration is mounting? You more than likely have diabetes burnout.


Not a sign of weakness

If your glucose readings are not improving and you start getting exasperated, this is the first subtle sign of diabetes burnout1. Diabetes is, by analogy, “a full-time job you didn’t want, and can’t quit.”

Author, Joan Williams Hoover, developed the term diabetes burnout. She says, “Few things generate burnout like the awful frustration of having followed instructions and done everything just right and still be failing to get diabetes under control. At those times, it seems no use to continue to try2.” 

Diabetes burnout is not a sign of weakness, it is about being strong for too long.

How common is diabetes burnout?

A national survey in the USA showed that 21% of Type 1 diabetes and 41% of Type 2 diabetes using insulin reported that they never checked their blood glucose outside of hospital or healthcare settings due to burnout and denial3.

Recognising diabetes burnout

The more positive answers (yes) to the list of the underlying feelings you have, the greater the chance of diabetes burnout:

  • Are you feeling overwhelmed and defeated by diabetes?
  • Are you feeling angry about your diabetes?
  • Do you feel diabetes controls your life?
  • Do you feel alone and that nobody understands?
  • Do you feel ashamed and keep your diabetes a secret?
  • Do you worry about not taking care of your glucose levels well enough but also feel hopeless and unable to change them?
  • Do you feel guilty and frightened by poor control?
  • Do you feel exhausted with decreased capacity of action?
  • Do you feel proper self-management is not worth the effort?
  • Do you admit to chronically poor glucose control and self-care?
  • Do you avoid glucose control or doctor appointments?
  • Do you think about diabetes as little as possible?

Relational diabetes burnout

Diabetes burnout occurs not only in diabetic patients but also in their partners and families, especially parents with young diabetic children.

Sometimes the concept of diabetes burnout is also seen in the healthcare provider responsible for caring for these patients. They are usually people that need everything to be perfect in every situation. They also like to be absolutely certain of all circumstances. With diabetes, this is not always possible.

Preventing diabetes burnout

There are numerous ways but here are seven steps to try:

  1. Accept and name how you feel. “I am tired of being a diabetic.” Allow yourself to feel this way. State how you are feeling without trying to change it. Once you accept how you are feeling, you will feel better.
  2. Take care of yourself. Do something every day that does not involve diabetes. This will allow you to feel cared for. Do some yoga, or walk in your garden, have a cup of tea and read, or connect with a friend. Do whatever works for you.
  3. Practise self-compassion. Tell yourself, “Today, I am going to believe that doing my best is enough.”
  4. Be kind to yourself. Do not judge or be critical of yourself.
  5. View your diabetes as part of being human. See it as your shadow and not a full-time job.
  6. Live in the moment. Focus on the present. Do not think bad thoughts. Notice when your thoughts turn into worries and box them and focus on the present.
  7. Remind yourself that you are not the only person with diabetes. Worldwide the diabetes population in 2016 was 415 million with up to 50% still undiagnosed.

It is important to talk to your healthcare professional about these feelings.

Take a diabetes vacation

I often suggest to my patients to take a diabetes vacation. This can be anything from testing only twice a day instead of six times per day to taking a pump vacation and go back to syringes, or stop using your continuous glucose monitor (CGM) for a while. This should be well structured, safe and not too long as to be detrimental to your health. It should, however, give you some relief from the stress that can be caused by too many alarms, numbers and electronics. This method is usually highly successful. It will help you to realise what you thought was bad is very convenient.

I also suggest that you have a ‘cheat day’ once every two weeks, where you indulge in whatever food you like but give insulin accordingly. Know that small changes lead to big differences.

The question ‘why can’t we eat everything we like every day and only carb count’ usually pops up. The reason is quite simple: insulin is an anabolic hormone and will cause huge amounts of weight gain if you overindulge in carbohydrates daily.

How do people on insulin in diabetes trials stay motivated?

Probably, the best example is the Diabetes Control and Complications Trial (DCCT) that was conducted from 1982 to 1993. The trial was designed to test the glucose hypothesis of Type 1 diabetes and determine whether the complications could be prevented or delayed with glucose control.

It was a controlled clinical trial with 1441 participants with Type 1 diabetes. The investigators developed two arms in the study. In the first arm, called the intensive arm, the subjects had normal to near-normal glucose control. In the second arm, glucose control was according to conventional therapy at the time, aimed to achieve asymptomatic glucose control.

The participants in the intensive arm were recently asked how they managed to maintain near-normal blood glucose levels for this period and stay motivated. The factor that helped them the most was ‘nondirective support’. The staff worked with the participants in a friendly, respectful manner with frequent contacts, helping them to make their own decisions rather than telling them what to do3.

This is the core of good diabetes management. Teamwork is important with the diabetic in the role as captain of the ship. The role of the healthcare professional should be to supply new information and help with analysis of diabetes data. The discussion should be continuous and be positive.

The 3 R approach of diabetes burnout

  • Recognise – watching out for the warning signs of burnout.
  • Reverse – undo the damage by managing stress and seeking support.
  • Resilience – build flexibility to stress by taking care of physical and emotional health4.

Understand that diabetes is a way of life. It is not life. Acknowledge it as part of you in the same way you would acknowledge your shadow. Follow the rules of the game as close as possible. We all make mistakes and sooner or later you’ll receive a yellow card during the game. Try and avoid it as far as possible. Recognise it as a metabolic disturbance and not a disease but also realise that it can become a disease when good glucose control and lifestyle is not followed.

If the burden seems too heavy to carry seek help. Take into consideration that the association between diabetes and depression is high. Talk to a psychologist, this may help alleviate the symptoms and lessen the burden.

Appreciate that you are unique and can do this with the help of your support team of family, friends and healthcare professionals.


References:

  1. Guzman, S. ‘Tools to face the psychological demands of diabetes.’ http://www.behavioraldiabetesinstitute.org
  2. http://tde.sagepub.com/context/9/3/41.abstract
  3. Polonski, W; Diabetes burnout. What to do when you can’t take it anymore.’ American diabetes Association
  4. Culman M, Guja C ‘Diabetes burnout –review’ Proc Rom Acad, Series B, 2016,18 (1) p25-30

MEET OUR EXPERT

Dr Louise Loot
Dr Louise Loot 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.

Thorns and blisters: unexpected summer holiday hazards

Warm weather tempts us to wear sandals or even go barefoot. This increases the risk of exposing part of your foot to injury, such as thorns and blisters. How you deal with the injury if you have diabetes could be the difference between ending up with a successful outcome and having to seek emergency care because the situation has complicated.


Many people are all too quick to self-diagnose and self-prescribe treatment, especially with thorns and blisters. The media and the internet constantly bombard us with information and a variety of products in convincing campaigns. Packaging instructions often leave much to be desired – since warnings for people with diabetes or peripheral vascular disease are often in tiny-sized type, unable to be read by people with less than perfect vision.

Annual diabetic foot assessment

Before summer arrives, if you haven’t already done so this year, make an appointment to visit your podiatrist to have your annual diabetic foot assessment done.

The thorough assessment should cover musculoskeletal examination of your joint function, flexibility, range of motion, and loss of shape/bony protuberances. It should also assess your skin texture, hydration/lack of hydration, presence of infection in skin or nails, presence of callus or corns indicating high-pressure areas.

The podiatrist will also carry out a comprehensive vascular examination of your feet to establish whether you have good blood flow. The assessment also includes a full neurological sensory exam to pick up any warning signs of loss of sensation (neuropathy). These measurements are tiny yet vital to knowing what risk your feet may be at. Feet are classified into risk categories after an assessment.

Risk categories

LOW-RISK classification is given to those people living with diabetes who have no risk factors. For example, there is no loss of sensation, no sign of peripheral vascular disease, no history of foot ulceration (breaks in the skin that are difficult to heal), no foot deformity, no foot infections, no high-pressure areas, and normal vision.

People with diabetes in the low-risk classification have low chances of developing foot complications and foot ulcers. They may not need regular podiatry treatment since their feet are in good condition. They must, however, have an annual full screening to compare year to year.

MODERATE-RISK people with diabetes are those with one risk factor (neuropathy,
or peripheral arterial disease, or foot deformity) and no previous history of foot ulcer/amputation. Risk factors are:

  • Loss of feeling/altered feeling in their feet.
  • Reduced circulation in the feet.
  • Hard thick skin, corns or callus on the feet.
  • Vision has been affected.
  • Shape of foot is altered/there are bony protuberances present.
  • Signs of redness on the feet after taking off shoes.
  • Person who cannot look after their feet themselves.
  • Infections present on the skin or in the toenails.

HIGH-RISK people with diabetes have two or more risk factors (neuropathy, peripheral arterial disease, or foot deformity) and/or a previous history of foot ulcer/ amputation. High risk factors to develop foot ulceration are:

  • Loss of feeling/altered feeling in the feet.
  • Reduced circulation in the feet (verified by Doppler or ABPI test).
  • Hard thick skin, corns or callus.
  • Vision impairment.
  • Shape of foot is altered/there are bony protuberances.
  • Signs of redness on feet after taking off shoes.
  • You are unable to take care of your own feet.
  • Infections on the skin or in the toenails.
  • Previous ulceration.
  • Previous amputation.
  • On renal dialysis treatment.

Actions to take

If your feet are moderate or high-risk, you should:

  • Wear protective versions of footwear and skip the strappy sandals that can expose you to harm.
  • Use a SPF30 sunblock on exposed areas of ankle or feet to prevent sunburn.
  • Wear flip flops to protect the soles of your feet from hidden germs and fungi in public showers or swimming pool areas.
  • All injuries to the foot in a moderate- or high-risk foot should be reported to your podiatrist or doctor.
  • Products and actions that are perfectly fine on non-diabetic feet (that have good working pain sensation and good blood supply) can be dangerous if used on moderate-risk or high-risk diabetic feet with nerve damage (neuropathy), or a combination of nerve damage and poor blood circulation (neuroischaemia). It may not be that the product itself is ‘bad’ but the fact that it may cause a problem if used in the wrong way. It may also mask a problem in a foot with less than perfect sensation, or prevent you from getting professional care.

Always carry an emergency kit

Whether you’re going to the beach, or if you’re going to be away on holiday at a location that is far from medical assistance, be sure to pack a basic emergency kit. This should consist of a pair of scissors; a fine tweezer; a sewing needle and a flick lighter to sterilise it; a small bottle of a liquid disinfectant soap, such as Bioscrub or Savlon; a small bottle of surgical spirits or surgical alcohol; cotton wool; a pack of gauze; a tube of disinfectant cream, such as Betadine or Germolene; plasters; a miniature magnifying glass; and two crepe bandages plus two safety pins. Always carry a spare bottle of water. All these items are available from a pharmacy.


How to get a thorn out of your foot

Please note: this should only be done if you are far from medical assistance.

  1. Do not put your weight on the affected foot as it may drive the thorn/splinter/prickle deeper.
  2. Before you start trying to get the thorn out, it is a good idea to wash your hands and the area of the injured area with soapy water. Then pat dry with a square of gauze.
  3. Use the tweezer to grab the end of the thorn and pull out slowly and gently. Pull in the same line of entry that the thorn went in otherwise you risk breaking it if you pull against it.
  4. If this doesn’t work, sterilise the pointy end of the sewing needle for a few seconds with the end of the flame from the lighter. Wait a second or two for the needle to cool down, then gently push against the end of the thorn and work it back out enough to use the tweezer to pull it out.
  5. If this doesn’t work, soak a wad of cotton wool with the disinfectant and water and hold it up against the part of the foot with the thorn in it for at least 3 minutes so that it can soak and soften the skin. Then try again to loosen the skin around the end of it so that it can be pulled out.
  6. If this doesn’t work, apply antiseptic cream and a plaster to cover it so it doesn’t catch on anything until such a time as you can get to medical help.
  7. Thorns and prickles can be difficult to get out, and are more likely to become infected.

DO NOT: squeeze a thorn. This makes it more likely to split apart and break, increasing risk of infection.

NB! If you have moderate- or high-risk feet, do not attempt to remove the thorn without a trained medical person. Loss of protective sensation will mean that you won’t feel pain while probing for the thorn and you may inadvertently cause more harm.


When to seek medical help urgently

You should definitely seek medical help if the thorn/splinter is under your toenail and you can’t get it out, and if the area is red, oozing, swelling or warm to the touch as this may indicate an infection and medical extraction and care is needed.


Glass

Slivers of glass can usually be taken out fairly easily. Staining the skin with Betadine liquid can highlight a hidden piece of glass since the glass will show up clear against the stained skin background.


How to treat a blister

Blisters develop because of friction or rubbing, warmth and moisture, such as sweat. You should plan on changing socks during the day if you know that your feet will sweat. Always ensure you have the correct fit of shoes or sandals. Remember, feet normally swell by as much as 7% within 4 hours of getting up in the morning.

Small blister

If a blister is smaller than a 10c coin, wash the overlying skin gently with disinfectant, gently pat dry and apply a plaster to cover and protect it. The blister should re-absorb once the cause of friction has been removed and you are wearing sufficient protective padding.

Large blister

If the blister is larger than a 10c coin, it is more prone to split open and become infected so you should release the pressure in a controlled, sterile way. See below:

  1. Pour surgical spirits over the blister to disinfect the overlying skin.
  2. Disinfect the pointy tip of a sewing needle by passing it under the end of a flame for a few seconds.
  3. Then gently puncture the edge of the blister. Never puncture the centre of the blister.
  4. Mop up the blister liquid with cotton wool and disinfectant.
  5. Using a fresh piece of gauze moistened with disinfectant, gently press down on the top of the blister to release all the blister liquid.
  6. Pat dry with more gauze and cover with an adhesive plaster.
  7. Avoid submersing the blister site in water for the next 4 days but change the dressing daily and keep the rest of the foot clean. The roof of the blister will act as a protective layer while the new skin repairs itself underneath.

Keep the area dry, padded and protected until complete healing takes place.

MEET OUR EXPERT

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.

Travelling with a child with diabetes


Travelling, whether it’s on a train, plane or by car, with children always takes planning and preparation. The more so when travelling with your child who has Type 1 diabetes. Consider these factors when travelling.


Travelling must:medical alert bracelet

Firstly, when travelling, your child should be wearing some form of indication that he or she has Type 1 diabetes. A medic alert bracelet, or even a letter from the doctor may suffice.

General travelling tips

  • Before departure, it is important to make sure that the country or region to which you are travelling has medical services nearby. Find out where the closest hospital is and if they treat paediatric diabetic cases.

  • Keep contact information for emergencies (e.g. pump helpline) as well as a prescription of supplies or a copy thereof on hand.

  • Ensure your travel insurance covers the emergency treatment of diabetic-related issues.

  • It is essential to keep a travel (cooler) bag with your child’s diabetic supplies handy. Ensure you pack more than enough insulin to cover the days of your trip and possible fluctuating glucose levels; a glucose meter and extra batteries for both the meter and pump; capped lancets; appropriate snacks; and glucagon.

  • Always carry easy meals or snacks for unforeseen delays and unanticipated glucose levels.

  • Remember heat and excitement can cause fluctuating blood glucose levels. Carry plenty of water and suitable snacks to address these fluctuating levels.

  • If your child is on a pump, consider taking a spare pump along, or if this is unavailable ensure you have a spare prescription or supply of insulin pens, including short-acting and long-acting insulin.

  • Glucose control may be affected due to changes in your child’s normal routine. Therefore check glucose levels more frequently. As a result, more strips will be used – make provision for this. Don’t forget to make provision for ketone testing strips.

  • Ideally, split the supplies into two bags. If possible, give one bag to a travelling companion in case some luggage gets lost.

Flying and diabetes

These days airline security measures are very strict regarding the possession of diabetes supplies. The regulations require that all diabetic supplies are transported in original pharmacy packaging with prescription labels preferably intact.

In addition, you may need to prove that the syringes and lancing devices are specifically for your child’s diabetes care. The brand of the lancets and blood glucose meter must also match each other. It’s important that the strips have not expired.

When travelling within the country, enquire prior to the flight whether a meal is provided or not. Provision can therefore be made when this information is obtained. Taking your own meal may, however, be better accepted by your child.

When flying outside of your home country, it is recommended that you find out that specific country’s requirements when travelling with diabetes supplies. Also, learn phrases in the local language that may help address a crisis situation e.g. ‘Please help, my son/daughter has diabetes’; ‘Please give me something sweet’; and ‘Please call a doctor’.

For those children wearing an insulin pump, inform the screener that your child is wearing a pump. The pump should not be scanned by the X-ray machine along with all the other items. Therefore request a hand wand screen.

If you’re flying, don’t put any of your supplies in your checked-in luggage as the temperature in the hold can drop to freezing. Instead, keep everything with you in your hand luggage.

Altitudes and temperature

Check your child’s glucose meter manufacturing information regarding the altitude and temperature ranges that the meter may have altered accuracy. Keep meters close to the body for optimum temperature operation.

It is important to keep your child’s insulin supplies at the correct temperature. In a hot climate, it is a good idea to request a room with a fridge, or to bring your cold bag or Frio bag. Frio bags are activated by cold water and are reusable every 48 hours; but are only available online.

In cold climates, insulin should not freeze. In freezing conditions, keep your child’s insulin or pen injector in an inner pocket of your clothing or bag.  Examine the insulin for crystals and discard the insulin if any are found.

Adjusting insulin doses

You may find you need to vary insulin doses for very active holidays or holidays in unfamiliar climates. If your child is swimming for extended periods, test his/her blood glucose level regularly. Especially in the evening due to the occurrence of low blood glucose level after periods of prolonged exercise.

Insulin absorption is more rapid in hot climates so be careful for post-meal lows, which may be followed by a spike. If you’re on a pump, the dual or square wave function may be very useful in these situations.

Don’t allow the fluctuating glucose levels to get your child or family down. Do what you know and manage each situation best you can.

Avoid holiday tummy bugs

  • Ensure to avoid tap water. Ideally, your child should not swallow the water even when brushing teeth.
  • Avoid ice cubes in unclean environments because they’re generally made from tap water.
  • Be cautious of milky, creamy and mayonnaise products or produce.
  • Be cautious of diluted juices e.g. a concentrate mixed with water as this water may be from a tap. Rather choose water from a bottle.
  • Be vigilant when feeding your child from buffet tables – food items have probably been washed using tap water.
  • Avoid shellfish, for example sushi, salads and raw food.
  • Carry plenty of bottled water, especially during hot weather, or if high blood sugars are being experiences and if your child is doing extra activities, to ensure they stay hydrated.

In summary, check your child’s blood sugar often, make smart adjustments based on their levels, and keep a positive attitude in the face of challenges when travelling with diabetes.

MEET OUR EXPERT

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.

Holiday fitness exercises


Tone up and torch some fat this festive season by doing these holiday fitness exercises. You can do them while at home or even if you are away on holiday. Perform four sets with a minute rest after each round of five fitness exercises.


Forward Lunge

holiday fitness exercises

  • Keep your upper body straight, with your shoulders back and relaxed, and chin up (pick a point to stare at in front of you so you don’t keep looking down).
  • Always engage your core.
  • Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle. Make sure your front knee is directly above your ankle, not pushed out too far, and make sure your other knee doesn’t touch the floor.
  • Perform 10 repetitions alternating on each leg.

Jump Squats

holiday fitness exercises

  • Stand with your feet shoulder-width apart.
  • Start by doing a regular squat, then engage your core and jump up explosively.
  • When you land, lower your body back into the squat position to complete one rep. Land as quietly as possible, which requires control.
  • Perform 12 repetitions.

Tricep Dips

holiday fitness exercises

  • Position your hands shoulder-width apart on a secured bench or stable chair.
  • Slide your butt off the front of the bench with your legs extended out in front of you.
  • Straighten your arms, keeping a little bend in your elbows to keep tension on your triceps and off your elbow joints.
  • Slowly bend your elbows to lower your body toward the floor until your elbows are at about a 90-degree angle. Be sure to keep your back close to the bench.
  • Once you reach the bottom of the movement, press down into the bench to straighten your elbows, returning to the starting position.
  • Keep your shoulders down as you lower and raise your body. You can bend your legs to modify this exercise.
  • Perform 12 repetitions.

Mountain Climbers

holiday fitness exercises

  • Start in a plank position with arms and legs long. Beginning in a solid plank is the key to proper form and good results in the Mountain Climber. At its heart, the Mountain Climber is a form of plank.
  • Keep your abs pulled in and your body straight. Squeeze your glutes and pull your shoulders away from your ears.
  • Pull your right knee into your chest. As the knee draws to the chest, pull your abs in even tighter to be sure your body doesn’t sag or come out of its plank position.
  • Quickly switch and pull the left knee in. At the same time you push your right leg back, pull your left knee in to the chest using the same form.
  • Continue to switch knees. Pull the knees in right, left, right, left. Always switching simultaneously so that you are using a ‘running’ motion.
  • As you begin to move more quickly be in constant awareness of your body position and be sure to keep a straight line in your spine and don’t let your head droop. Core body stability is crucial.
  • Perform 15 repetitions on each leg alternating.

Wall Sit

holiday fitness exercises

  • Stand with your back pressing against a wall.
  • Slide downward into a squat position by moving your feet forward until your knees make a 90-degree angle and your hamstrings are parallel to the floor.
  • Hold this move as long as you can. For beginners, aim for a 30 second hold.

MEET OUR EXPERT

holiday fitness exercises
Richard Wood is a personal trainer. Visit his Facebook page Richard Wood Personal Training.

Rethink your drink; choose water


The Heart and Stroke Foundation South Africa, together with the National Department of Health, Diabetes SA and other stakeholders, remind you to rethink your drink and choose water.


Why you need to rethink your drink?

Sugary drinks, such as fizzy drinks, flavoured waters, iced teas and even fruit juice, are the main source of added sugar in the diets of most South Africans. This excessive intake of sugar stacks up the kilojoules and often leads to weight gain.

A typical 500ml fizzy drink contains roughly 885 kJ, which would require walking for 5,5km or running for 30 minutes to burn it off. Drinking just one sugary drink a day increases the likelihood of being overweight by 27% in adults and 55% in children.

Despite the impact on your waistline, drinking just one sugary drink per day has also been found to increase the risk of developing diabetes by 26%, and having a heart attack by 29%.

Diabetes is an independent risk factor for cardiovascular disease, the leading killer worldwide, increasing its risk by 200% to 400%. With a country already heavily burdened by obesity, heart diseases, and strokes, please rethink your drink and make water your beverage of choice!

How much sugar is okay?

The American Heart Association recommends no more than 6 to 9 teaspoons of added sugar per day from all food and drinks. This is based on the World Health Organisation’s recommendation to limit added sugar to less than 5% of total daily energy intake for added health benefits. This includes any sugar in a food or drink that was added by the manufacturer or sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

How much sugar is in your drink?

The best way to see how much sugar is in your drink is to read the label. Look out for ‘total sugar’ on the nutrition information table then calculate the number of teaspoons by dividing the sugar in grams by 4.

Use the ‘100g’ column to easily compare sugar content between different products, or use the ‘per serving’ column to see how much sugar you’ll have in that serving size.

On average, commercially produced sugary drinks available in South Africa contain the following amounts of sugar per 500ml serving:

  • Fizzy drink: 15 teaspoons
  • Energy drink: 14 teaspoons
  • Sports drink: 7 teaspoons
  • Fruit juice: 13 teaspoons
  • Sweetened dairy drinks: 10 teaspoons (includes naturally occurring milk sugar).
  • Iced tea: 9 teaspoons
  • Flavoured or vitamin-enriched water: 6 teaspoons

So, let’s choose water

Water – still, sparkling or flavoured with fruit – is the best beverage to choose. It serves so many essential purposes in the body:

  • Keeps you hydrated
  • Lubricates joints
  • Prevents headaches
  • Helps with digestions
  • Prevents constipation

Water is far cheaper than other drinks and contains zero sugar or kilojoules and will therefore help to maintain a healthy weight and lower the risk of developing diabetes or heart disease.


Tasty twists

Add a twist to your water with exciting flavours by using any of these ingredients:

  • Fresh slices of lemon, lime, grapefruit or other citrus fruits.
  • Fresh slices of cucumber.
  • Mint leaves.
  • Other fresh fruit, including strawberries, pineapple, or watermelon.
  • Unsweetened rooibos or fruity herbal teas.
  • Add sparkling or soda water if you’re craving some fizz.
  • If you really want to add a bit of sweetness, add a small splash of 100% fruit juice.

Not in the mood for water

Then swap your sugary drink for any of these healthier alternatives:

  • Tea or coffee without added sugar or honey.
  • Sugar-free iced tea, fizzy drinks, energy or sports drinks and cordials.
  • Try our Homemade iced tea recipe.
  • 100% fruit juice diluted with plain, soda or sparkling water.
  • A glass of milk.