Protecting your eyes in summer


Eye Care Awareness Month has passed and with summer fast-approaching, it is a good idea to relook at ways to protect your biggest gift of all – eyesight.


Annual eye examination

Firstly, it’s important to get an eye examination annually. A lot of underlying health issues can put your eyes at risk, with diabetes being one of them.

At the annual eye exam, your optometrist will look at the general retinal health. Diabetic retinopathy can be picked up and a treatment plan can be put in place.

Avoid prolonged UV exposure

Another area to look at is prolonged ultraviolet (UV) exposure during the summer months. UV can cause conditions like cataracts and macular degeneration. If you think sunglasses alone is enough to protect your eyes, think again.

Certain medications may make your body and eyes more sensitive to sun, so take the necessary precautions to protect them.

Buy 100% UV protective sunglasses

Always make sure the sunglasses you buy is 100% UV protective, and also covers your whole eye area. The bigger the better.

A great piece of advice we all know but seem to forget is to rather stay out of the direct sunlight between 10am and 3pm.

Things to remember

  • Eye protection is very important all year long.
  • Early detection can save your vision.
  • Prevention is always better than a cure.

MEET OUR EXPERT

Werner Fourie (B.Optom UVS) believes optometry enables him to help people in unique ways, and The Eyewear Boutique gives him the ability to stay passionate and to be his creative self.
Werner Fourie (B.Optom UVS) believes optometry enables him to help people in unique ways, and The Eyewear Boutique gives him the ability to stay passionate and to be his creative self.

What have you gained this year through your diabetes?

As you reflect on the management of your diabetes in the year 2017, what are the first thoughts that come to mind? Has it been a difficult year where things have gone wrong? Has it been a better year than last year? Have you benefitted from your diabetes in any way?


Hopefully there have not been too many difficulties for you, but if there were, why not try to reframe those difficulties. What have you gained from them? If you don’t believe that you could gain from having diabetes, let me share some ideas of what you probably did gain, over and above all the knowledge you learned as you managed your diabetes.

What you might have gained

  • You developed a greater appreciation of life itself. Diabetes is one chronic condition where you can continue living a healthy life if you follow your treatment well.
  • Your sense of self-worth increased as you realised you really want to live and will do what you have to do to keep living.
  • You developed more resilience – the courage to come back – as you tackled your diabetes each day, even if you did not always succeed.
  • You strengthened your resistance to the tough times and that allowed you to cope better when the tough times came.
  • You learned more perseverance because diabetes is ongoing and requires your input daily.
  • You gained confidence as you coped with the ups and downs and gained experience of what was happening.
  • You developed the capacity to be adaptable and flexible since diabetes is never an exact science and often does the unexpected.
  • You developed the ability to learn from your experiences.
  • You increased your level of tolerance of negative emotions and failures.
  • You have greater compassion and empathy for others who have struggles, especially those who have diabetes.
  • You have developed the ability to maintain courage, hope and informed optimism in the face of diabetes.

Personal growth

So, although negative consequences are usually associated with diabetes, there is positive personal growth too. How many of these qualities do you think you have gained? I am sure if you think about it, there will be at least a little of each. If it is just a little, keep working at your diabetes in the best way you can and you will come to the end of next year with more days of adjustment, inner peace and positive self-worth. At best you will be a stronger person, who is well able to continue managing your diabetes effectively for now and in the future. May 2018 be a year like that for you.

MEET OUR EXPERT

Rosemary Flynn
Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Frequently asked questions when diagnosed with diabetes


When diagnosed with diabetes, you will have a plethora of questions. Diabetic Nurse Educator, Christine Manga, shares the top 10 frequently asked questions.


A whirlwind of emotions is dealt with when receiving a diabetes diagnosis. Because of this, the first consultation post diagnosis barely touches on treatment per se. This is due to the fact that patients have an overwhelming need to get answers that are pertinent to them. There is definitely a trend to the questions that are asked regularly. I consider the following questions to be frequently asked questions (FAQs).

1. Is my diagnosis correct?

For a diabetes diagnosis to be made, a minimum of two blood glucose tests need to be done. It is recommended that the same test is used, but on two separate days. A fasting blood glucose reading of ≥7 mmol/l, a random blood glucose level of ≥11 mmol/l, or a two hour post glucose ingestion reading of ≥ 11 mmol/l is required for diabetes to be confirmed. One HbA1c level of ≥6,5% would also be sufficient to make the diagnosis of diabetes. If these tests have been done, then the diagnosis is most likely correct.

2. Is Type 2 diabetes reversible or is there a cure?

No and no. It can, however, be managed that it goes into ‘remission’ or gets significantly better. This is more likely to happen in the early stages of the disease. This can be achieved by being physically active and losing excessive amounts of weight by dietary means or bariatric surgery. Even with this weight loss, some people will not go into remission. Unfortunately, aging, the natural progression of Type 2 diabetes, and weight regain will cause the diabetes to return in most people.

3. Did I get diabetes from eating too much sugar?

No. However, a high consumption of fatty and sugary foods can cause weight gain. This extra weight could lead to insulin resistance which usually precedes Type 2 diabetes.

There are some people who do not carry extra weight and yet go on to develop diabetes. In these individuals, genetics may play a significant role. If you have a parent or sibling with Type 2 diabetes, you have an increased risk of developing diabetes yourself.

4. What do I do now that I have been diagnosed with diabetes?

It is important to make positive lifestyle changes. Being active is important. The World Health Organisation recommends 150 minutes of activity a week. Following a balanced, nutritional eating plan is imperative in managing your diabetes. A dietitian can assist you with this, as it is best if it is individualised.

Adhering to the medication regimen, prescribed by your medical practitioner, will also form part of the lifestyle changes. An annual screening by a podiatrist and ophthalmologist are also advised.

5. What should my glucose readings be?

There are international guidelines set out for glucose targets. These targets may need to be adjusted according to your individual needs. Your practitioner would assist you with deciding on a target. By achieving these targets, it may delay the onset of diabetes complications.

The targets set out for the general population with diabetes are:

  • fasting blood glucose 4,0-7,0mmol/l
  • post prandial (MEAL) blood glucose of <10,0mmol/l

Avoiding hypoglycaemia whilst reaching these targets may be challenging.

6. I don’t want to inject, but do I need to take insulin?

Some patients may live for many years using only oral medication to manage their condition. Research indicates that the earlier diabetes is diagnosed and treated, it may delay the need to use insulin.

On the other hand, some patients experience a much quicker progression of their diabetes. This could result in the need to use insulin early on in the condition. Most people living in excess of fifteen years with diabetes will require insulin.

An indication that you may need insulin is when your glucose readings and HbA1c start to increase. Your medical practitioner will discuss with you – if and when it is necessary to commence insulin.

Once on insulin, you will usually use it for the rest of your life. If the correct injection technique, site rotation and needle replacement is practised, injecting of insulin will not be too uncomfortable.

7. Now that I take insulin, do I have Type 1 diabetes?

No. Type 2 diabetes can’t turn into Type 1 diabetes. They have different causes. Type 1 diabetes is an autoimmune disease – the body completely destroys the insulin producing cells so that no insulin can be produced. People with Type 1 diabetes need to start taking insulin at diagnosis. Type 1 usually occurs in childhood and is much less common than Type 2 diabetes.

With Type 2 diabetes, the body does still produce insulin, however, the body can be resistant to it. Over time the body will produce less insulin, at this stage you will need to start to replace insulin by means of injections. You will still have Type 2 diabetes.

8. Will I gain weight with insulin?

Possibly yes. When you are not using insulin, your levels of glucose in the blood stream are high. Some of this glucose is lost in the urine. Once you commence insulin, the cells in the body absorb this glucose from the blood, to be used as energy. If you are consuming extra glucose, the body will now store it as fat. Portion control and being active are important ways to combat the potential weight gain.

9. Can I share a glucometer with my family/partner?

Preferably not. Firstly, for infection control, it is important that each person who is pricking their finger should use their own needle. This will prevent blood borne diseases spreading.

Secondly, when your practitioner downloads the glucometer to evaluate your control, it will not be a true reflection. Your averages will be skewed and the profile of your readings will be inaccurate. This could lead to incorrect management choices. If you do have to share a meter with someone, let your practitioner know.

10. Can I drink alcohol?

Yes. Taken in moderation it is okay to consume alcohol. One drink a day for women and two drinks a day for men. Taking alcohol with certain medication and/or insulin can increase your risk of hypoglycaemia. Discuss this with your diabetes practitioner.

No doubt, there will be many other questions; direct them to your healthcare provider who will give you the correct information.

MEET OUR EXPERT

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

Diabetes and cancer – is there a link?


An estimated up to 4,6 million people are living with diabetes in South Africa and an alarming 60 000 new cases of cancers are reported annually, according to the South African National Cancer Registry. Dr Jay Narainsamy says it is important to delve into the link between these two prevalent conditions in the hope that this understanding may lead to better lifestyle choices and positive changes in clinical management.


The link between diabetes and cancer was considered as early as 1959. A report in the New England Journal of Medicine, in March 2011, looked at causes of deaths in patients with diabetes. The article estimated cancer-related deaths at 7 per 1000 person-years and 4 per 1000 person-years among men and women respectively. Diabetes was associated with an increase in cancer-related deaths involving the pancreas, ovaries, liver, colorectum, breasts, lungs and bladder.

Common risk factors

Diabetes and cancer have common risk factors, some of which are modifiable and some not. Non-modifiable risk factors include: age, gender and ethnicity, with increased risk in older people, men and in the African American population in the United States. Modifiable risk factors include: obesity, diet, physical activity, smoking and alcohol.

Obesity is linked to the development of insulin resistance and Type 2 diabetes. It is thought that the high levels of insulin produced by the body to compensate for insulin resistance and obesity-associated inflammation may precipitate cancer development. In addition, diabetes itself (especially if not controlled) may cause vascular damage and an inflammatory state, which may create an environment for tumour development.

Diets low in processed and red meats, with a high content of vegetables, fruits and whole grains aid in lowering the risk of developing certain cancers. A healthy diet may also lead to weight loss and reduce the risk of developing insulin resistance and diabetes. Increased physical activity has shown to reduce the risk of certain types of cancer as well as improving overall health. Smoking and alcohol are both associated with the development of cancer as well as diabetes.

Metformin and cancer

On a further positive note, the oral diabetes medication metformin – the first-line drug of choice for patients with Type 2 diabetes – has been shown to inhibit abnormal cell growth, and has potential anti-cancer properties. Further studies are currently underway to assess the interaction between metformin and cancer.

The link between diabetes and cancer in other classes of oral diabetes agents are, however, less conclusive.

Injectable insulin and cancer

On the opposite spectrum, injectable insulin was thought to be associated with an increased risk of cancer development. However, this has not been conclusively proven and risk is probably better evaluated in the context of duration of diabetes, other oral diabetes agents already on board, and poor glycaemic control.

The link between diabetes and cancer

There is undoubtedly a link between diabetes and the development of certain types of cancer. With this in mind, doctors must ensure routine screenings for at-risk patients are completed timeously. They also need to be vigilant for ‘red flag’ complaints and act promptly to investigate these problems.

Reduce your risk

While further research needs to be done on the link between diabetes and cancer, the positive message is foundational lifestyle therapies for diabetes – healthy eating, increased physical activity, weight loss, not smoking, and first line pharmacological therapy, metformin – may have the additional benefit of reducing your cancer risk.

MEET OUR EXPERT

Dr Jay Narainsamy is a specialist physician and endocrinologist.

Type 2 diabetes and HIV


Considering World Aids Day, Dr Alessandra Prioreschi examines the connection between Type 2 diabetes and HIV.


Increase of lifestyle diseases in HIV patients

Advances in treatment of HIV have resulted in HIV patients being able to live longer lives, largely due to controlling their disease using combination antiretroviral therapies (cARTs). This has resulted in people with HIV experiencing increases of lifestyle diseases. These include hypertension, cancers, metabolic disease and Type 2 diabetes.

These non-communicable diseases (NCDs) occur due to the normal aging process. However, the presence of HIV and drug therapy used to treat HIV are associated with increased risk of developing NCDs. Thereby, resulting in people with HIV having multiple risk factors for developing an NCD, such as Type 2 diabetes1.

Increase of Type 2 diabetes in Africa

Type 2 diabetes is becoming increasingly common in Africa. This is due to the rapid transition to a ‘Westernised lifestyle’ that has occurred over the last few years. Although the reasons are not fully clear, recent studies internationally have associated diabetes with HIV infection and with cART1-3.

Systematic review

The Developmental Pathways for Health Research Unit (University of the Witwatersrand, Faculty of Health Science) therefore conducted a systematic review and meta-analysis of the literature. This is the most rigorous scientific method to review published literature to determine the overall effects found from multiple studies.

The aim was to determine whether HIV infected patients in Africa were more likely to have Type 2 diabetes than non-infected individuals. We also wanted to determine whether cART treated patients were more likely to have Type 2 diabetes than non-treated patients.

After screening for eligibility, 21 articles were found to meet the search criteria and were included in the analysis.

Findings

The results showed no statistically significant association between HIV infection or cART treatment with Type 2 diabetes prevalence. These findings are contrary to international studies in Europe and North America, which showed a higher prevalence of diabetes in HIV infected compared to uninfected participants4,particularly when treated with cART1-3.

Therefore, from the limited data available in Africa, it does not seem as if the risk of Type 2 diabetes is higher in populations infected with HIV than in a normal healthy ageing African population.

However, we did find that the number of new cases of Type 2 diabetes that occur in HIV infected cART treated African patients was higher than what has been shown internationally. Therefore, it does not seem that patients with HIV in Africa are presenting with Type 2 diabetes more frequently than a normal aging population in Africa. However, the number of cases of Type 2 diabetes is higher than rates reported internationally for HIV infected patients.

Possible reasoning

It is possible that this finding is in part due to African populations being more susceptible to diabetes, regardless of HIV status. This could be due to ‘Westernisation’, which is happening rapidly in many African countries, resulting in changes in lifestyle and metabolism. In Africa, there is an added risk for infants born during periods of Westernisation to develop metabolic disorders later in life, due to metabolic changes occurring during pregnancy.

In fact, in this systematic review, a substantial proportion of participants infected with HIV were overweight or obese and thereby predisposed to diabetes. This presents a different picture to the undernourished HIV infected individual previously associated with Africa.

Importance of screening

In this new context, higher diabetes risk may just be an effect of lifestyle rather than due to HIV disease or treatment. Therefore, although this review did not show a higher risk of Type 2 diabetes in HIV infected individuals compared to uninfected individuals, it does support the importance of screening for diabetes in African populations infected with HIV, where diabetes incidence appears to be high in general.

Furthermore, these findings reinforce the importance of managing and screening for metabolic diseases, such as diabetes, as part of routine clinical care of patients infected with HIV to support continuity of care5.

Limitations of review

It is important to note that there were some limitations; namely the small number of studies available to analyse and the small number of participants included in these studies.

Over and above that, all the studies available for this analysis were observational. So, we were unable to determine how things may change over time. However, this meta-analysis shows that currently HIV infection and cART do not seem to predispose patients in Africa to Type 2 diabetes. However, high rates of Type 2 diabetes warrant focus on screening and preventative programmes for HIV infected people living in Africa.

MEET OUR EXPERT

HIV
Dr Prioreschi is a researcher with a background in exercise physiology. She has a special interest in lifestyle behaviours, particularly physical activity and sedentary behaviours, which can be used to decrease obesity and metabolic disease; as well as treat some chronic diseases. She has a keen interest in examining these behaviours throughout the life course, but particularly in the first two years of life.

References:

  1. Samaras K. The burden of diabetes and hyperlipidemia in treated HIV infection and approaches for cardiometabolic care. Curr HIV/AIDS Rep. 2012;9(3):206-17.
  2. Hadigan C, Kattakuzhy S. Diabetes mellitus type 2 and abnormal glucose metabolism in the setting of human immunodeficiency virus. Endocrinol Metab Clin North Am. 2014;43(3):685-96.
  3. Paik IJ, Kotler DP. The prevalence and pathogenesis of diabetes mellitus in treated HIV-infection. Best Pract Res Clin Endocrinol Metab. 2011;25(3):469-78.
  4. Galli L, Salpietro S, Pellicciotta G, Galliani A, Piatti P, Hasson H, et al. Risk of type 2 diabetes among HIV-infected and healthy subjects in Italy. Eur J Epidemiol. 2012;27(8):657-65.
  5. Rabkin M, Melaku Z, Bruce K, Reja A, Koler A, Tadesse Y, et al. Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland. J Trop Med. 2012;2012:137460.

Healthiest city in South Africa revealed


Cape Town is the healthiest city in South Africa. The city has the highest number of people who are a healthy weight. Plus, they purchase the most vegetables and fruit when compared with South Africa’s other major cities. 


Finding the healthiest city

Discovery Vitality ObeCity Index 2017 presented the latest insights on weight status (measured by Body Mass Index and waist circumference) and food purchasing behaviour of nearly half a million Vitality members in Johannesburg, Pretoria, Cape Town, Durban, Bloemfontein and Port Elizabeth.

“Insights from the Vitality ObeCity Index 2017 allow us to better understand the amount of sugar and salt in the foods we are actually buying, as well as fruit and vegetable consumption,” says Dr Craig Nossel, Head of Vitality Wellness.

Impact of obesity

The impact of obesity on individual health, globally, is significant. The number of people who die each year because of being overweight or obese (4,5 million) is now more than the number of worldwide deaths linked to being underweight.

In addition to health concerns, obesity impacts the global economy. R16,4 trillion is lost each year, which is roughly equivalent to the impact from smoking or wars globally. The economic impact of obesity in South Africa is estimated to be R701 billion each year.

Processed foods

One of the most important factors contributing to the obesity epidemic are changes in dietary patterns, characterised by the increased consumption of sugar, salt, fat and animal products. Ultra-processed food contains high percentages of most of these products.

In South Africa, sales of ready-made meals, snack bars and instant noodles increased by 40% between 2005 and 2010. Fast food consumption continues to grow, negatively impacting our weight.

Healthcare costs

Dr Craig Nossel says, “We see a direct correlation between weight status and health outcomes. People with an unhealthy bodyweight incur a direct increase in healthcare costs of approximately R4 400 per person per year. We also know that the purchase of healthy foods has a positive impact on BMI and the associated risks of developing chronic diseases of lifestyle.”

Discovery data shows that members who purchase healthy foods have a 10% lower BMI compared to those who purchase unhealthy foods. The same purchasing behaviour is associated with up to R2 500 lower health costs per year.

Conclusion in a nutshell

In reviewing the results, Distinguished Professor of Nutrition at the University of North Carolina, Barry Popkin, says, “The analysis underlying this report shows that by reducing purchasing of unhealthy confectionary and convenience meals and processed meats, a half unit of BMI would be decreased and similarly reducing sugary drinks and salty snacks would produce a similar impact. Both changes were linked with replacement by healthier foods and healthier beverages. These reductions in BMI were in both cases associated with lower healthcare costs per year. But more importantly, these create longer-term healthier eating trajectories which promise to have even greater effects.”

Dr Craig Nossel concludes, “While tackling obesity is complex, it is critical that we all do our bit. As individuals, we need to move more and consciously make healthier food choices. As businesses – manufacturers, retailers, or restaurant owners – we need to actively contribute to creating a society where the healthy choice is the easier choice.”

A summary of the results of the healthiest city:

Category  Description  Rank 
Weight status A combined score using Body Mass Index (BMI) with waist circumference. 1. CT

2. JHB

3. DBN

4. PTA

5.BLM

6.PE

Food purchasing score The ratio of healthy to healthy-plus-unhealthy products purchased at Pick n Pay and Woolworths through the HealthyFood benefit. The higher the score, the healthier the basket of food.  

1. CT

2. BLM

3. PE

4. Pretoria

5. JHB

6. DBN

Fruit and vegetable intake The average number of fruit and vegetable portions purchased per member. 1. CT

2. JHB

3. BLM

4. PTA

5. PE

6. DBN

Salt intake The average number of teaspoons of salt purchased per member – determined by taking into account purchases of salt as well as of high-salt foods. 1. DBN

2. PE

3. PTA

4. BLM

5. CT

6. JHB

Sugar intake The average number of teaspoons of sugar purchased per member – determined by taking into account purchases of sugar as well as sugary snacks and drinks. 1. DBN

2. PE

3. PTA

4. JHB

5. CT

6. BLM

Mindful eating


Ria Catsicas encourages you to reflect on your relationship with food and to practise mindful eating.


Reflection

Part of living well as a person with diabetes requires that you sometimes need to take time to reflect on the choices you make and how they impact on how healthy you live your life. 

The types of food you should eat is well documented in the media. What we often neglect to recognise and fail to communicate is the how, when and why we eat. These are equally crucial factors that need to be considered. They impact on the quantity of food you consume which affects your weight, blood sugar and blood fat levels.

Research has demonstrated that when mindful eating is practised, less food is consumed at a meal, satisfaction is experienced earlier during the eating process and as a result there is a feeling of content after the meal. Mindful eating assists you to change from being an impulsive eater to become an intuitive eater.

Observation 1: Control where and when you consume your food

It is essential that you ask yourself: where you eat and when you eat. You will identify eating patterns which may be as follows: eating too fast; eating second portions; sneaking food; and eating in places other than your dining room, such as in your car, in the supermarket, in front of the TV and in the kitchen while cooking. All these locations are inappropriate and impact your weight negatively.

Observation 2: After identifying the habits, identify the rewards you receive

You must ask why you keep practising these poor eating habits if you intuitively know they result in weight gain. The logical answer to the question, is that they benefit you in some way. In other words, you feel rewarded by practising the behaviour. As you cannot change what you don’t acknowledge, it is important to identify the reward.

What rewards do you receive? 

  • Pleasure of food: You place value on the pleasure the taste of unhealthy foods provides and get instant gratification. The challenge is to control the frequency and quantity of consumption of instant gratification foods. You need to gain control of this – the ‘pleasure seeking taste’ as it contributes to the deterioration of your health and life.
  • Physiological calm: Consuming pleasurable food releases a ‘high’ in our brain. This triggers a desire to consume more and this desire is difficult to control.
  • Emotional relief: The act of eating can provide us with relief of emotions we do not want to face or resolve, such as fear, anxiety, anger, aggravation, frustration or sadness. The problem is that eating provides only temporarily relief. Ultimately, the weight gain causes feelings of guilt and disappointment that can erode your self-esteem.
  • Irrational rewards: You use food as a reward of enduring a stressful day. A typical scenario is coming home after a stressful day and you start consuming salty snacks with your glass of wine, or rusks with your cup of coffee.
  • Being sociable: You might find yourself part of a circle of friends and family that often get together and enjoy large lavish meals. It is easy to start to copy their behaviour as you want to belong and be accepted in the group.
  • Safety: Being overweight becomes a convenient excuse of not acting to change your life. It can serve as an excuse to do the difficult risky things in life that need courage. How many times have you told yourself – as soon as I lose weight I will start socialising, or resign from a low-paying job and seek a better job?

The bottom line

There is nothing wrong with the rewards we receive from consuming food. We all want to belong, be accepted or need emotional relief and have some pleasures in life. The problem is when we use food to reward. Excessive consumptions of all types of food causes weight gain, which will result in both physiological and physical illness that will impact on the quality of your life.

Strategy of eating better

You need to start a process of replacing bad unhealthy eating habits with good healthy eating habits. Practising the following steps will assist in doing so:

STEP 1: Replace the unhealthy habits with competing activities

Identify the triggers that result in eating outside your normal meal times or snacking consistently. This can be the time of day (after dinner) and the environment (coming home).

Make a list of activities you can do to replace the act of eating. They need to be incompatible with eating. Example, you cannot eat a packet of crisps whilst you are walking the dogs.

Choose activities that can be done with little effort. Keep these activities on your phone, or at a place where you can access it easily. Example, when you feel aggravated or upset; instead of eating, phone a friend, browse Facebook, read, or watch a movie on TV, or play a game on your computer. This is an everyday exercise consistently replacing the act of eating with a competing activity. Soon you will have changed the habit of inappropriate eating.

STEP 2: Resolve impulsive eating

Luckily the impulse or urge to eat does not happen all the time. It happens at certain times of the day. Resolving impulse eating requires two strategies:

  1. Identify the triggers (internal and external) that create the desire to eat impulsively. The urge to eat can be triggered by external triggers, such as the sight or smell of food as you are shopping, walking past the nuts and dried fruit section. The trigger might also be internal, like coming home and you become stressed by your children, who turned the house upside down.
  2. Create a defence strategy to combat the urge to eat. It starts by changing your thoughts, then soon the urge to eat at that time disappears. Change the buying nuts action by buying water as you enter the shop; this will help you to be more disciplined towards what you add to your trolley. When coming home, you can decide to make yourself a cup of tea and quickly create a game for your children, such as whoever picks up most of the toys will win a price.

STEP 3: Change your eating style to mindful eating

How you eat plays a key role towards gaining unnecessary weight. The eating styles that need change are the following:

  • Gulping down your food.
  • Consuming excessive portions, or second portions, or your child’s leftovers.
  • Eating while standing, on the move, or in the car.
  • Cooking and eating at the same time.
  • Snacking while watching television, or eating in other rooms in your house other than the dining room.
  • Overeating at parties or social events.

Mindful eating is about becoming aware and obeying sensations, such as hunger, fullness, taste and satiety cues. To change your style to mindful eating, you need to practise the following skills:

  • Slowing down the pace of eating by chewing slowly. An effective way is to start a conversation that will force you to slow down.
  • Eating your main meal away from distracting activities, such as eating in front of the TV or whilst working on your computer. Mindful eating should take place at a beautifully laid table.
  • Becoming aware of your body’s hunger and fullness cues and using them to guide the decision to start and end the meal.
  • Choosing to eat food that is both pleasurable and nourishing, using all senses while enjoying the experiencing of eating.

STEP 4: Create rewards that work for you – see yourself where you want to be

The objective is that the behaviours you have chosen to replace eating should let you feel so good that you will find them more attractive than eating food.

Stop using the excuse ‘I love food.’ Most of us love food. The question is how do you manage food in your life to optimise your health and your life. Mismanaging food causes you to become overweight and depressed.

Ultimately, to make these new behaviours or rewards, you need to practise them for at least a month. Be patient, you might not feel immediately that they will work but just persevere. Soon you will feel more in control and happier.

Example 1: Instead of going straight home rather change your route home and go to the gym. This will eliminate the urge to snack, which normally occurs when you sit in front of the TV.

Example 2: You have the habit of eating leftover food, especially the food your children have left on their plates. You should rather keep these leftovers and pack them in your lunchbox for the next day.

Example 3: To get out of the office, you and your colleague use the excuse to visit the cafeteria, which normally results in purchasing a chocolate. You should now convinced her that you two should take a walk outside the building and spend 10 minutes a day in the garden, next to the fountain. You should now decide it is a 10-min break to soak up some sun for vitamin D, and maybe even develop a game of identifying images in the clouds.

The rewards need to leave you with a feeling of having fun, a sense of accomplishment, feeling of calm, relaxed and in control. So, you are no longer driven by the instant gratification, self-destructive habits impulses or urges.

STEP 5: Visualise yourself, and create concrete reminders to stay on track

Visualisation of yourself – where you ultimately want to be and how this will feel – will strengthen your motivation. Create an image of yourself looking and feeling extremely good. Be specific in terms of place, time, the clothes you’re wearing and the remarks of the people. It can also be an image or photo of you doing something exciting, such as competing in a cycling race or dancing at a party. Look at this image daily.

Because tempting food is everywhere around you and part of your daily lives, it helps to create concrete reminders to stay on track. This can be a photo of yourself on the fridge, or your dress or pair of jeans that you would like to fit in that you now hang outside your cupboard, as a reminder that you will fit into. It is only a matter of time.

The key to reducing unhealthy food consumption is to develop strategies that allows for the replacement of food as a reward. They should be new positive constructive habits that let you feel good about yourself and your appearance.

MEET OUR EXPERT

Ria Catsicas
Ria Catsicas is a dietitian in private practice and completed a master’s degree in nutrition. She has a special interest in the nutritional management of chronic diseases of lifestyle and authored a book The Nutritional Solution to Diabetes.

DSA News

Western Cape branch news

Justice Dikgang Moseneke supports DSA

Diabetes South Africa (DSA) was invited to the Golf Challenge and Dinner held in honour of the retired Deputy Chief Justice of South Africa, Justice Dikgang Moseneke. Earl Bell, from East London DSA branch, and Margot McCumisky, DSA’s national manager, attended the event.

At the event, Margot and Earl presented the work DSA does. The South African judge then donated the proceeds raised at the Golf Challenge and Dinner to DSA. He kindly matched the donation raised with the same amount, donated by himself and his wife.

In his speech, Justice Dikgang Moseneke gave explained why he chose DSA as his beneficiary. His son, Reabetswe Botshelo ‘Bo’ Moseneke – who was a Super Sports presenter, succumbed to the complications of diabetes in 2005.

What was profound about his speech was that he stressed the fact that people in South Africa should learn to give more and not just take.

The attendance was littered with who’s who from judges, advocates, lawyers, retired army generals and businessmen. It was certainly a glittering occasion and many items from one of Madiba’s painting (limited edition no.84 of a 100 copies that are produced), wines and holiday vouchers were put under the hammer.

From left to right: Earl Bell, Kabonina Moseneke, Justice Dikgang Moseneke and Margot McCumisky.

Diabetes SA Seminar for Diabetes Wellness/Support Group

The facilitators held this seminar on 2 September 2017. It was kindly sponsored by The South African Sugar Association (SASA) and Fountains Hotel in Cape Town.

The programme included: depression and diabetes; diabetes nutrition, diabetes emergencies; CPR and first aid for heart attacks and stroke.

Children’s Camp

Diabetes South Africa Children’s Camp was held in April 2017 at Soetwater Environmental Centre in Kommetjie, Western Cape. Fifty-one children with diabetes attended.

Port Elizabeth branch news

The DSA young guns meet-and-greet

This newly established group for Type 1 children, teens and young adults, named The DSA Young Guns had a meet-and-greet picnic in Victoria Park, Port Elizabeth on 7 October.

The aim of the meet-and-greet was so the youngsters and their families could get to know each other.

Coach Kux (Nkululeko Kwinana) from PowerPlay Cricket Academy entertained the young fellows by playing soccer and cricket with them.

Zillah, the Rottweiler with diabetes, gave cart rides to the little ones and demonstrated that having diabetes does not prevent her from still enjoying life.

Casey Roche, our special photographer, took all the photographs.

Paula Thom is the enthusiastic convener of this group, and is already, with the help of some of the parents, planning another fun event.

For more information, contact Paula on 073 895 0707.

Remembering the old days of insulin

The discovery of insulin is one of the most enthralling detective stories filled with drama, intrigue and competition. Noy Pullen introduces us to two of the first insulin patients and how the discovery changed their lives.


First people treated with insulin

Imagine the medical world before insulin was discovered in 1921. This was what Leonard Thompson and Elizabeth Hughes had to face when they were diagnosed with diabetes mellitus some years prior to this.

Leonard Thompson. Photo courtesy of Eli Lilly and Company Archives. Copyright Eli Lilly and Company. All Rights Reserved.

Leonard Thompson

Leonard Thompson was the first patient treated with insulin by Dr Fred Banting, one of the four researchers credited with the discovery of insulin.

When Leonard was taken, by his father, to the Toronto General Hospital, Leonard weighed 65 pounds (22,6kg), and was drifting in and out of a diabetic coma.

As a result, Leonard’s father agreed to let the doctors inject Leonard with this new fluid, called insulin, made from bovine pancreas. Within days, a miracle had taken place as the 14-year-old regained his strength. He went on to enjoy another 13 years of life, dying from pneumonia. When told of the news, Banting’s comment was, “I hope he had a good life,”

Elizabeth Hughes

Elizabeth Hughes, daughter of a prominent politician, was one of the first Americans to receive insulin. She had been a sporty child with great dreams when, aged 11, she was diagnosed with diabetes.

Diagnosed in 1919, she struggled through three years of the only treatment used then: starvation therapy. She hoped she would live until insulin was past the experimental stage.

She found solace in reading, which did not tax her strength and ignited her dreams to travel to all the wonderful places she had read about.

Not her mother’s pleading nor her father’s position and influence could help at this stage. She took in less than 300 calories a day and exercised conscientiously.

Elizabeth Hughes

Starvation therapy

Before 1921, Dr Frederick Allen, ‘father’ of the starvation therapy method, ran a successful clinic in America for those living with diabetes Type 1.

A starvation diet was worked out for patients; keeping them alive yet free from blood sugar in the urine. It has been reported that Dr Allen ran his clinic like a military operation and patients were locked away for up to five months.

One British patient, Rene Mason, recalled, “Before I was put on to insulin I was starved. My mother would lock the larder. I would steal the dog biscuits.” Another patient on starvation therapy, John Johnson, recalled being forced to live on boiled cabbage water from Friday to Monday.

While on the diet, one of Dr Allen’s young patients kept having high sugar levels. After interrogation, the patient admitted that he secretly ate toothpaste and the bird seed meant for his canary, which he had cunningly asked for as a pet.

Another enterprising patient, on the third floor, made a deal with the newspaper boy to tie sweets onto the end of a long piece of string every day.

Breakthrough

Margaret Kienast, a nurse who worked with Dr Allen recalled, “The hope of insulin cajoled the patients into new life. Diabetics, who had not been out of bed for weeks, began to trail about, clinging to walls and furniture.”

When Dr Allen appeared in the doorway, after visiting Dr Fred Banting on the patients’ behalf, he caught the beseeching gaze of hundreds of pairs of eye. “I think I may have something for you,” he said softly.

Consequently, Elizabeth Hughes – who was in Dr Allen’s clinic – became Banting’s prize patient. In hand-written notes, he described what he saw: weight 45lbs (20kg); height 5ft (1,5m); extremely emaciated; slight oedema of the ankles; skin scaly and dry; hair brittle and thin; muscles extremely wasted; subcutaneous tissue almost completely absorbed; and scarcely able to walk due to weakness.

The change in Elizabeth was described as dramatic – almost magical. Furthermore, it has been reported that she said, “Oh, it’s simply too unspeakably wonderful for words, this stuff…To think I’ll be leading a normal healthy existence is beyond all comprehension!”

Samples of insulin from the early days of the drug’s development. Photo by SSPL/Getty Images.

A good life on insulin

As a result, Elizabeth went on to graduate from college, got married, and had three children. None of whom ever knew of her secret regime. They would see their mother disappear into her room each day at 5:30, in the evenings, but never knew what she was doing there.

She was always strict with her diet and exercise while travelling widely. She lived a healthy life to the age of 74, with no complications.

So, Elizabeth Hughes demonstrated that it was her attitude to life, her ‘inner conductor’ of her choices, that guided the rhythm of her life. No one else directed her.

Probably, many people with diabetes feel the oppressiveness of the cage of chronic illness, the diet and insulin dependence. Yet, Elizabeth found insulin liberating. Most of all, she found it to be a miracle substance which transformed her life.

Therefore, much can be learnt from reflecting on the history of people living with diabetes, and how current individual reflection influences the possibility for leading a healthy life with diabetes.

Accounts of this marvellous discovery can be found in two highly recommended books by the renowned Canadian historian, Michael Bliss – ‘The Discovery of Insulin’ and ‘Banting – A Biography’. Anyone who reads these will never see insulin in the same light again.

References:

Please contact Noy Pullen if you would like more information on her resources: linoia@web.co.za or 072 258 7132.

AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT

MANAGED BY NOY PULLEN


Avoid holiday season weight gain


In a recent study, it was found that half the annual weight gain in South Africans occurred over the holiday season. Paula Pienaar informs us how not to become a part of this statistic.


The next three months’ weight gain

End-of-year functions, the holiday season and ‘back-to-school/work’ jingles are key events on the horizon over the next three months, and sadly unwanted weight gain.

During this time, we find ourselves taking a break from our usual daily routine, which on the one hand is great because it allows us to engage more with our loved ones and let our hair down, but on the other hand, also coaxes us into less healthier habits. Diet and physical activity are often the first lifestyle habits to be neglected.

You need not give up quality time with your loves ones to hit the gym, but it is essential to maintain a healthy physical activity pattern during the holiday season to avoid weight gain.

Seasonal food purchases and weight gain

In a recent study,1 investigating the relationship between seasonal food purchases and weight gain, it was found that half the annual weight gain in South Africans occurred over the holiday season.

Interestingly, the research showed that the least nutritionally desirable foods were purchased in November and December, and the most fruit and vegetables in January – possibly due to optimistic New Year’s resolutions. These findings support the need for an increased focus on lifestyle interventions to address health habits during holidays.

In a country where obesity is at its highest level, it is pertinent that we maintain a healthy, conscious lifestyle throughout the year, and especially during these upcoming months.

Weight gain associations

Weight gain is associated with raised blood pressure, cholesterol and blood glucose. When unmanaged, these conditions may culminate to Type 2 diabetes, which may often co-exist with hypertension (high blood pressure) and dyslipidaemia (high cholesterol).

For the first time, researchers have shown a strong link between diabetes and obesity in all regions of Africa. This first of its kind obesity and diabetes trend analysis, conducted between 1980 and 2014, showed that the prevalence of diabetes continued to increase rapidly and that it was triggered by the high incidence of obesity2.

Take responsibility of your health

To prevent the progression of this diabesity epidemic, it is up to us to take responsibility of our own health. When combined with dietary changes, physical activity has the potential to delay the progression of full-blown diabetes,3 by playing a key role in managing the intermediary risk factors, such as obesity, high blood pressure and a poor lipid profile.

Let’s optimise the beautiful summer days and take care of our heart and blood vessels by being mindful of our food choices, and maintaining a healthy active holiday season.

Benefits of regular physical activity

The table below provides information on the physiological benefits of regular physical activity. The exercise prescription is based on international guidelines aimed at using physical activity as a potent treatment of health conditions. These guidelines complement prescribed medication in those with diagnosed chronic disease.

  Physiological benefits Exercise prescription:

Type, duration and frequency of activity

Pre-cautions
Diabetes4,5 Promotes adaptations in the muscle, fat tissue, and liver associated with enhanced glucose uptake. A: 30 minutes, at least 3 days/week with no more than 2 consecutive days without exercising. Preferably at the same time in relation to meals and insulin injections in patients treated with insulin.

RT: 1–4 sets of 8–15 repetitions, 2 days/week on non-consecutive days. Aim for 5–10 exercises per session.

Taking care of your feet:

  • Always inspect your feet for any changes before and after exercise.
  • Avoid exercise that causes stress to the feet. Exercise which poses minimal weight or stress on the feet is ideal, such as riding an exercise bike, or brisk walking in good footwear.
  • Wear comfortable and well-fitting shoes.
Hypertension6,7 Helps to ‘relax’ the blood vessels, facilitating blood flow and may lower high blood pressure by and average of 11mm Hg (systolic) and 5mmHg (diastolic). A: 30-60 minutes continuous or accumulated in bouts ≥10 minutes each. Most, preferably all, days of the week.

RT: 1 set of 8-12 per muscle group (using light weights) 2-3 times a week.

Please note the precaution for RT with high blood pressure.

You should not do the following, as they can raise your blood pressure to dangerous levels for a short period of time:

  • Lift heavy weights without supervision of a qualified biokineticist or personal trainer.
  • Vigorous short bursts of exercise like boxing or squash.
Dyslipidemia (high cholesterol and triglycerides)8,9 Increases the enzymes responsible for raising HDL ‘good’ cholesterol. A: 40-60 minute sessions at least 5 days a week.

RT: 1 set of 8-12 repetitions, 2-3 days a week. Best when including 8-10 different exercises.

Certain medications used for the treatment of dyslipidaemia may have a negative impact on exercise, such as:

  • Muscle weakness or pain.
  • Muscle cramps.
  • Fatigue (feeling tired).

You may need to increase rest periods or reduce intensities to accommodate these adverse side effects.

A: Aerobic (cardiovascular) exercise; RT: Resistance (strength) training

MEET OUR EXPERT

Paula R. Pienaar
Paula R. Pienaar (BSc (Med)(Hons) Exercise Science (Biokinetics)), MSc (Med) Exercise Science) is the scientific advisor to EOH Workplace Health and Wellness, and a PhD candidate at the University of Cape Town. Her scientific research relates to sleep health and managing daytime fatigue to improve workplace productivity and lower the risk of chronic disease. Her thesis will identify the link between sleep and cardiometabolic diseases (Type 2 diabetes and cardiovascular disease) in South African employees. She aims to design a tailored sleep and fatigue management workplace health intervention to improve employee health risk profiles and enhance work productivity. Contact her at paula.pienaar@eoh.co.za

References:

  1. Sturm, R., Patel, D., Alexander, E., & Paramanund, J. (2016). Seasonal cycles in food purchases and changes in BMI among South Africans participating in a health promotion programme. Public Health Nutrition, 19(15), 2838-2843. doi:10.1017/S1368980016000902
  2. Kengne, Andre Pascal, et al. “Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies.” International Journal of Epidemiology (2017).
  3. The Society for Endocrinology, Metabolism and Diabetes of South Africa Type 2 Diabetes Guidelines Expert Committee. “Physical activity and type 2 diabetes” in 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. JEMDSA 2017; 21(1) (Supplement 1): S1-S196.
  4. Mendes R, Sousa N, Almeida A, et al Exercise prescription for patients with type 2 diabetes—a synthesis of international recommendations: narrative review Br J Sports Med 2016;50:1379-1381
  5. Colberg, Sheri R., et al. “Physical activity/exercise and diabetes: a position statement of the American Diabetes Association.” Diabetes Care 39.11 (2016): 2065-2079.
  6. Börjesson M, Onerup A, Lundqvist S, et al Physical activity and exercise lower blood pressure in individuals with hypertension: narrative review of 27 RCTs Br J Sports Med 2016;50:356-361.
  7. Pescatello, Linda S., et al. “Exercise for hypertension: a prescription update integrating existing recommendations with emerging research.” Current hypertension reports 17.11 (2015): 87.
  8. Jacobson, Terry A., et al. “National Lipid Association recommendations for patient-centered management of dyslipidemia: part 2.” Journal of clinical lipidology 9.6 (2015): S1-S122.
  9. Pescatello LS, Arena R, Riebe D, Thompson PD. (eds.) ACSM’s guidelines for exercise testing and prescription. 9th ed. Baltimore, MD: Wolters Kluwer-Lippincott Williams & Wilkins; 2014: 165