Agents for Change by Noy Pullen

Happier healthier lunch boxes for children

Why does a 30-second video called Japanese school lunches puts the rest of the world to shame have more than 42 million likes in a few days? What is the project The Grab 5 doing right when they can claim: ‘There definitely has been an improvement in behaviour and children are healthier now than they were a year ago’? Lunch boxes are changing. Lunch time is seen as part of education, not a break from it. Will South African schools join in happier healthier lunch boxes?


The World Health Organisation and the Basic Dietary Guidelines recommends that at least five portions of rainbow coloured food are consumed every day as part of a balanced diet. This advice is easy to understand and remember in theory, and psychologically strengthening, because it does not ask us to give something up. But, sadly, this is not happening.

The Diabetes South Africa (DSA) Agents for Change team knows that in the rural areas, most meals consist of brown and white (very little colour). According to a British project, The Grab 51, some children do not even have one coloured piece of fruit or vegetable per day.

Agents for Change model

We, at Agents for Change, target health providers, patients and families living with and working with diabetes and share creative ideas for changing habits. At a recent site visit with our international funders, World Diabetes Foundation, their project manager, Hanne Strandgaard, accompanied us to the Red Cross War Memorial Children’s Hospital in Rondebosch, Cape Town. We interacted with parents and children at the diabetes clinic and demonstrated simple effective ways of presenting healthy, economical and enticing food options.

Dr Steve Delport, the consulting endocrinologist, told us that his little patients kept darting in and out of his rooms to fetch another snack. The snacks definitely passed the taste test, especially the green grapes which Hanne placed on tooth picks and called green balloons. Her ‘boiled egg mice’ were also popular.

Happier healthier lunch boxes
‘Boiled egg mice’ with Vienna or ham slices for ears and chive tails prepared by Hanne Strandgaard from World Diabetes Foundation, Denmark.
Happier healthier lunch boxes
Noy Pullen replenishing a platter for the food demonstration of healthier snacks at the Diabetes Clinic at Red Cross War Memorial Children’s Hospital in Cape Town.

The fathers were most interested in tasting all snacks and finding out how to make them. Those who took part in this demonstration also had fun choosing from the available variety of tomatoes, cheese blocks, Vienna rounds, grapes, pawpaw, apple slices, and building their own ‘toothpick towers’. They were overjoyed at being given a copy of the booklet Rainbow in my kitchen14, which contains ideas of how to shop for a basic pantry, and recipes using whatever you have.

Self-feeding vs spoon-feeding

According to recent studies on eating habits of babies, nutritional ‘schooling’ starts long before schoolgoing age. Early healthy nutrition develops healthy balanced thinking processes and develops the subtle sense of knowing when you have had enough to eat.

Recent UK studies show that spoon-fed babies are more likely to become obese children6. If someone else shovels in the food (with the best motives), this bypasses this subtle sense. Let the children guide the way to what and how much they want to eat. The study shows that the self-feeders had a lower obesity rate than the spoon-fed children. Allowing them to choose from a selection of finger foods means they learn to regulate the amount they eat and are less likely to become overweight. They are also more likely to opt for healthier options than spoon-fed babies, who tend to favour sweet things.

The study suggests infants weaned through the baby-led approach learn to regulate their food, resulting in lower body mass index and a preference for healthy foods. This has implications for combating the well-documented rise in obesity in society. Tam Fry, from the National Obesity Forum, said, “Babies have this wonderful rapport with their mother when breastfeeding and indicate how much milk they want and when they are ready to go on to solids.” Adding, “It is important they experience all five food groups and experiment with variety as much as possible. If half of it finishes on the floor, so be it – the value of experimentation in the early months of nutrition is incalculable and babies won’t willingly starve themselves.”

The study comprised 92 children who had been weaned on finger foods and 63 who were traditionally spoon-fed. Parents filled in questionnaires on how their children had been weaned, including how often they ate certain foods when they were aged six months and six years.

The Grab 5 project research

Aiming for a holistic approach to school lunches and healthy tuck shop, they found:

  • Well-fed pupils are calmer and concentrate better.
  • Well-fed pupils have fewer days off due to illness.
  • School food activities, such as tasting events and playground markets, are good ways to involve parents and community groups in school life.
  • School food activities, such as cooking, growing and tasting, are often good ways to engage children that are otherwise reluctant to get involved in school life.
  • Serving meals and snacks increases school revenue and children develop a positive attitude towards what they eat.
  • Curriculum links with food projects and events bring subjects alive and are responsible for healthier more socialised children1.

How can we change the school food environment?

  • Free fresh fruit and vegetable food tasting tables offered to pupils at the tuckshop. This would be a gradual means of finding out what they like and introducing them to new foods textures, colours and combinations.
  • Integrating talks on nutrition about all food groups and their service to the body – energy foods (carbohydrates), protection foods (vegetables and fruit), nutrients (milk products), building foods (meat and other protein) and food that protects our nerves (fats)4. Tasting tables prepared by children in the classroom.
  • A visit to a fruit and veg shop or food farmer.
  • Introducing practical demonstrations of how to put food together in balanced, fun healthy and economical combinations. This could be done in the form of fund raising projects, and help to wean children off the unhealthy options offered in tuck shops.

  • Introducing all aspects of food into the curriculum in each age group. This would involve maths – budgeting, ordering and invoicing, being able to apply the concept of a planned balanced meal; science – cooking, processes of heating and freezing; biology – learning the various components of hygiene, digesting and nutrition, portion sizes etc.; life-skills – co-operation through supervised preparation of and cooking of simple dishes and clearing up; geography – cultural differences in serving and eating; horticulture – encouraging children to ‘grow their own’ simple bean or spinach plants and to demonstrate sprouting of various pulses and seeds for immediate micro-nutrients.
  • Developing new standards for the tuck shop stock e.g. practical fruit and vegetables options, bread sticks, plain popcorn or sprinkled with healthy herb salts, crumpets with honey, natural yoghurt with chopped fruit and toasted snacks5,6,7,8,9,10..
  • The more children taste different kinds of fruit and vegetables, prepared in different kinds of ways, the more they will learn to like them. It is a learning curve for children to try new foods. Exploring new tastes is an educational adventure in itself.

A working model for schools

In Japan, children’s lunch time is part of the curriculum, where fresh simple meals are made from scratch by pupils in rotation for less than $2,50 (roughly R35) per day. They study the menu and cultural history, and assess the nutritional value. The children prepare, cook and serve the meal and then clear up. This teaches cooperation and manners. They harvest from their own gardens where possible. It is no wonder that they have one of the lowest obesity rates in the world.

As the first verse of the song The Greatest Love of All says:

I believe the children are our future
Teach them well and let them lead the way
Show them all the beauty they possess inside
Give them a sense of pride to make it easier
Let the children’s laughter remind us how we used to be

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

How to plan your workday lunch box

The 1st to the 7th of July is Corporate Wellness Week, and Pick n Pay encourages you to pick up healthy eating habits at work.

The foods you eat at work are important to your overall health, productivity and well-being. Planning appropriate meals and snacks helps to maintain normal blood glucose levels, helps you meet your nutrient requirements each day, prevents you from snacking on more energy dense foods, which could cause weight gain in the long term, and helps you sustain your energy levels throughout the work day.

Choose 1 to 2 foods from each of the food groups below to build your balanced lunch box for work:

Lean protein
Roast chicken breast cut into strips
Chicken drum sticks
Boiled egg
Smoked chicken breast
Lean shaved turkey, chicken, ham (whole muscle)
Lean biltong
Toasted, flavoured chickpeas
Meat leftovers from previous night’s dinner
Carrot sticks / baby carrots
Cherry tomatoes
Mange tout
Cucumber sticks
Celery sticks
Bell pepper strips
Green beans
Vegetable kebabs
Snap peas
Lettuce (for wraps and sandwich fillings)
Vegetable chips
Mini fruit kebabs
Apple pieces
Banana chips
Pear sticks
Melon cubes
Any whole fruit chopped into bite-sized serving
Mozzarella cheese
Cottage cheese
Milk carton
Drinking yoghurt without added sugar
Plain yoghurt
Homemade dairy smoothie
High fibre starchy food
Beans, chickpeas or legumes (in a salad)
Mini whole-wheat wrap
Whole-wheat roll
Whole-wheat pita
Whole-wheat pasta
Pearl Barley
Brown rice
Baby potato
Potato wedges
Sweet potato wedges
Popcorn (unsalted)
High fibre crackers
Mini corn
Sweet corn
Mini oat/bran/apple muffins
Plain instant oats
Healthy fat
Reduced oil salad cream
Peanut butter without added sugar
Peanuts and raisins (unsalted)
Raw nuts
Low-fat dressings and dips
Bean dip

Other tips:

  • Remember to drink water throughout the workday – keep a jug or bottle on your desk for frequent sipping.
  • Keep your lunch safe in a clean insulated lunch box or bag. If possible, store the perishable foods in your lunch box in a fridge, or use a small re-freezable ice pack to help keep your food cold.

MEET OUR EXPERT - Leanne Kiezer

Registered Dietitian BSc Diet, PgD Diet UKZN, MSc Nutrition NWU. Leanne joined Pick n Pay as the resident dietitian in May 2014. She is the voice behind the Pick n Pay Health Hotline, providing advice to customers on a range of nutrition and health-related topics. She also provides nutrition input as part of the Pick n Pay food development team, and ensures that all communication is in line with the most recent advances in nutrition science and research.

Need some ideas of healthy lunch box snacks to pack for work?

Pick n Pay provides you with a few nutritious, easy-to-prepare and convenient to pack lunch box solutions here!

Roast veg chicken wrap
Vegetable crisps
Chicken kebabs peanut sauce
Veggie sandwich

Shopping List

The ingredients referred to in the recipes above are available from Pick n Pay:
Vegetables and fruit
Roasting vegetables
Baby marrow
Sweet potato
Red cabbage
Harissa paste
Lemon juice
Coconut milk
Red curry paste
Soy sauce
Plain yoghurt
Fat-reduced feta
Legumes and lentils
Tinned chickpeas
Wooden skewers
Rotisserie chicken
Chicken breasts
Whole wheat fusilli
Whole wheat spaghetti
Whole wheat penne
Fats and oils
Canola oil
Sugar-free peanut butter
Herbs and spices
Fresh coriander
Black pepper
Starchy foods
Whole-wheat wraps
Dumpy, low-GI, wholegrain, seeded bread

Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs the services of a registered dietitian to provide food and nutrition-related advice to the public. For all your nutrition and health-related queries, email [email protected] or call 0800 11 22 88.

Lunch options at the workplace

Lunch is the second most important meal of the day. However, this is the meal that is often neglected because of poor planning, poor shopping practices, work constrains and most often lack of allocating some time to sit down and enjoy the meal. Ria Catsicas offers lunch options at the workplace to avoid skipping this meal.

Lunch should be planned to take all lifestyle practices, environment as well as practical facilities available to you in consideration. Lunch ideally should be consumed no later than 15h00 in the afternoon.

Work cafeteria or make use of the kitchen at the workplace

The best lunch meal to consume in summer is a salad bowl. The challenge is to keep it interesting and varied.

A nutritionally balanced salad bowl should consist of a healthy source of protein, carbohydrate, vegetables and fat. This balanced combination will provide you with the sustained energy required to perform throughout the afternoon. By combining the following menu items shown below, you can achieve this objective:

One portion of lean protein: boiled egg or chicken (use leftovers from supper) or canned fish (tuna chunks, mackerel, salmon, tomato pilchards, sardines (oil/water drained)) or low-fat cheese (ricotta/cottage) or sliced lean cold meats (ham/pastrami). (Ideal for their low saturated fat content and the fish for their high omega-3 fatty acid content).


One portion of starch: corn kernels (canned/frozen), brown/wild rice (leftovers) or chickpeas or lentils or all types of beans (canned). (Ideal for their high fibre content, low-glycaemic index).


A variety of vegetables: beetroot, tomatoes, broccoli florets, green beans, gherkins, cabbage, carrots, mange tout, variety of lettuce, cucumber, leftover vegetables e.g. peas, roasted butternut etc. (Ideal for their content of fibre, vitamins, minerals and phyto chemicals).


One portion of fat: “Lite” mayonnaise or avocado pear, olive oil and lemon juice or vinegar or commercial low oil vinaigrette dressing. (Ideal for their high content of mono unsaturated fats). 

In winter, the salad bowl can be swapped for a bowl of chunky vegetable soup. Once again keep it interesting and varied by creating different combos, combining a variety of lean proteins (cut up chicken breast or canned lentils or beans or lean beef and marrow bones) and whole grains (canned corn wild brown rice or barley).

For those of us who love cooking, there is nothing better than cooking a delicious beef barley vegetable soup on the weekend, ready to bring to work during the week. Alternatively, buying a pre -prepared vegetable soup and creating combos at work, easy to mix and to warm in the microwave oven is recommended. Examples are a Lentil corn vegetable soup or Bean brown rice vegetable soup.

Lunch on the road or no kitchen available at the workplace

The lunch box menu shown below will provide you with the necessary carbohydrates, protein, fats, fibre, vitamins and minerals your body requires. Eating a well-balanced lunch box daily will ensure that you achieve optimal blood glucose control throughout the afternoon. In addition, packing your own lunch box is more economical.

A balanced lunch box consists of the following: starch, protein, fruit and a portion of vegetables.

FRUIT Strawberries


Sliced pear Fruit kebabs Sliced pawpaw Orange
STARCH Health bread filled with Wholegrain crackers spread with peanut butter Whole wheat pita bread filled with Pasta tuna salad Durum wheat pasta (penne) mix with Carrot and bran muffin served with
PROTEIN Egg, boiled and sliced 1 x 175ml low-fat fruit/plain yoghurt Chicken breast-sliced and mixed with Canned tuna chunks (oil drained) Low-fat grated cheese
VEGETABLE Sugar-snap peas, baby corn, baby carrots Cucumber sticks, baby tomatoes chopped tomato and lettuce Mix with a variety of vegetables Baby carrots and gherkins
FAT Lite mayonnaise Peanut butter Lite mayo Low-oil honey-mustard dressing Lite margarine
TREATS (optional) Handful cranberries 6 Dry apricots 1 handful of biltong (fat removed) Dry fruit bar 1 handful of nuts

Emergency ‘back-up’ lunch

It is recommended to always keep a few items in the cupboard at work as a back-up in case you don’t have time to pack your lunch box. Easy nutritious foods are canned fish, or John West tuna packs, chunky flavoured low-fat cottage cheese or lean cold meats (pastrami or turkey) served on whole grain low-fat crackers, such as Provita or Ryvita. Enjoy the fish/cheese and crackers with a mug of vegetable soup (canned) in winter. In summer, the soup can be replaced with one portion of fresh fruit.

Healthy fast foods

If you are spending your lunch time on the road and you forgot your lunch box at home, you should choose a healthy fast food meal. The following fast food choices are lower in fat and have lower glycaemic load than the unhealthy options:

Something Fishy, Fishaways – order a portion of grilled fish, ½ portion of rice and a double portion of coleslaw.                                                        

Nandos: order a small portion ¼ chicken (remove skin) combined with spicy rice, Portuguese salad, vegetables and coleslaw or the Vitality meal that consists of ¼ chicken portion, corn on the cob and a green salad.                                                                                    

Sushi bars: limit the rice portion of sushi by ordering Miso soup or edamame beans combined with sashimi and sushi pieces (limit sushi portions to 3 to 4 per meal).                                  

Chinese: order healthy choices such as beef or chicken chow main. Ask for ½ portion steamed rice and double portion vegetables.

Indian: order a bean or chicken curry as well as a vegetable curry with a ¼ portion rice (avoid the Naan bread and Roti).    

Note: larger portion of starch can be enjoyed if you are doing carb-counting and adjust your insulin accordingly.

Unhealthy fast foods include burgers and chips, pizzas, wraps, shawarmas, vetkoek, boerewors rolls, pap and meat, Bunny chows, fish and chips, Russian and chips and Prego rolls.

MEET OUR EXPERT - Ria Catsicas

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.

Five winter-warming soup ideas to boost your immune system

The winter months are here – the days are shorter, the nights colder but nothing can be quite as soothing than mouthfuls of a delicious, warming soup. In your quest to make it through cold- and flu-season without a sneeze, the Heart and Stroke Foundation South Africa (HSFSA) gives you some soup ideas with food combos, packed with nutrients and flavour, to give your immune system a boost.

Creamy roasted red pepper & tomato soup

Red peppers are packed with vitamin C, which is important for cells of the immune system to work properly, helping them to detect and destroy invading germs. Half a cup of chopped red pepper has nearly double the recommended daily intake of vitamin C – double that of the famous orange. Tomatoes are also excellent sources of antioxidants, specifically lycopene and vitamin E, which protect immune cells from damage. Add a creamy texture with a punch of protein by stirring in some low-fat plain yoghurt.

Carrot, orange & ginger soup

All citrus fruit, including oranges, are high in vitamin C which is well-known for its immune-boosting effect. Vitamin C is also known to help maintain the integrity of your skin, which is the body’s first line of defence against microbes and viruses. Vitamin A-rich carrots pair well with citrus fruits to make a vibrant sniffle-fighting soup.

Ginger contains potent anti-inflammatory compounds, called gingerols. It has also been thought to promote healthy sweating which is helpful for fighting colds and flu’s since sweat contains a potent germ-fighting agent, called dermicidin. Ginger has also been seen to improve symptoms of nausea, which is often experienced with the flu.

Practical tip: add the orange towards the end to minimise the amount of vitamin C lost from the heat.

Chicken soup made with bone broth

Granny was right to give you chicken soup when you were sick. Chicken is a valuable source of protein and iron, both of which support a healthy immune system. Too little iron could lead to anaemia and weaken the immune system. Combining iron-rich foods with a source of vitamin C, such as broccoli, red pepper and sweet potato, can help boost your absorption even further.

Chicken soup made with real bone broth will also work wonders on your digestive and immune health. The gelatine in the bone broth contains a vital nutrient, called glutamine, which is the primary fuel for the cells lining your gut, keeping it healthy and able to block out pesky bugs.

Butternut, sweet potato & cinnamon soup

Butternut and sweet potato are both rich in vitamin A. Vitamin A has long been known for its role in supporting the immune system, as it was called ‘the anti-infective vitamin’ from as early as the 1920s. Vitamin A is needed to maintain the surfaces of the respiratory and digestive systems, which is important to make sure they block harmful bacteria from entering the bloodstream.

Cinnamon’s essential oils have antimicrobial properties; these help to stop the growth of harmful bugs. It’s so effective that research has shown that it can be used as an alternative to traditional food preservatives. Besides these benefits, what can provide as much relief from the cold or flu as a warm cup of tea with cinnamon and ginger?

Click here to view the recipe!

Super seed & nut soup toppers

Add some crunch and texture to your soup by sprinkling a mixture of your favourite roasted nuts and seeds over it. They’re great sources of many nutrients needed for a strong immune system, including selenium, copper, zinc and vitamin E. Almonds and sunflower seeds are particularly high in the antioxidant vitamin E, with a 30g serving giving you a whopping 50% of your daily requirements. If you’re looking for more affordable options, seeds and unsalted peanuts are the way to go.

Remember that most of the immune-benefits seen from the nutrients mentioned above, are largely only obtained from eating foods rich in these nutrients. The same benefit is not always seen when using supplements. In fact, using mega-doses of some nutrients could actually harm your immune system. So, make sure to maintain a healthy, balanced diet this winter, and get cooking.

The HSFSA plays a leading role in the fight against preventable heart disease and stroke, with the aim of seeing fewer people in SA suffer premature deaths and disabilities, and to reduce the cardiovascular disease (CVD) burden in SA and ultimately on the SA health care system. Their mission is to empower South Africans to adopt healthy lifestyles, make healthy choices easier, seek appropriate care and encourage prevention

How is your relationship with your ophthalmologist?

Dr Gareth Fernandes explains why a good relationship with your ophthalmologist will stand you in good stead.

We are often looking for a quick fix, when it comes to medical problems. We have become accustomed to near instantaneous results regarding ophthalmic treatments; vision is often excellent within a few hours of cataract or refractive eye surgery. Many diabetes patients would have had cataract surgery as they tend to get cataracts at a younger age than non-diabetes patients. However, many of the other ophthalmic problems, which are associated with diabetes patients, are chronic and persistent and require long-term treatment. For this reason – a good, steady long-standing relationship with your ophthalmologist is essential. This relationship would ideally go through a number of stages as discussed below.

Ideally, you should see an ophthalmologist (or optometrist) after five years of diagnosis of Type 1 diabetes and within a year of diagnosis of Type 2 diabetes. We, as medical practitioners, need to detect problems before your vision is affected.

Even if your vision is affected, the deterioration may be very slow, and can be compensated for by the other eye so that you don’t notice the decline. Though, you should not wait for your vision to deteriorate before coming to see us. The reason for this is, many of the effects of diabetes on the retina do not cause symptoms, and when diabetes does start to affect your vision – causing symptoms, some of the damage (to the retina) may already be irreversible. This means that even with ideal treatment, we may be able to improve your vision, however, we may not be able to restore it to normal.

Screening can be frustrating. You may see your ophthalmologist annually, only to be told that everything is okay. Many diabetes patients don’t need any treatment until five, 10 or even 20 years after diagnosis. After a few annual visits, it is easy to become blasé about the health of your eyes and lose motivation to continue your annual visits. You may only return when your vision is reduced and the damage is irreversible, and we may not be able restore your vision to normal again. Hence, why during this screening period it is so important to build a good and lasting relationship with your ophthalmologist.

Reduced vision in the diabetic population has many diverse causes. You may simply need glasses. As mentioned, conditions like cataracts can be easily and permanently cured with surgery, producing good results and a return of normal vision.

The most important and worrying cause of loss of vision in diabetes patients is from chronic damage to the small blood vessels in the retina (the membrane at the back of your eye which detects light and forms an image, much like the film of a camera).

One of the most common causes of retinal visual loss in diabetes patients is macula oedema. This is when the blood vessels of the retina become leaky, allowing too much fluid to seep out into the retina, causing the retinal tissues to swell. Macula oedema can be satisfactorily treated by monthly injections into the eye. The injections make the retina blood vessels less leaky, reducing the seepage of fluid into the retina. As the eye absorbs the excess fluid in the retina, the vision improves. Diabetic patients with macula oedema really need a solid, ongoing relationship with their ophthalmologist because it may take a few months for the fluid to be absorbed and little improvement may be seen initially, despite the monthly injections. But, if you persist with the treatment, you’ll usually be rewarded with improved vision. Once the fluid is gone, your vision is as good as we can get it. Your injections unfortunately do not end there; the injections will still be required to maintain your vision. We can usually increase the interval between injections at this point. The good news is that over the years you will require fewer and fewer injections to maintain control of the macula oedema.

The retina can also be affected by the formation of new blood vessels on the retina. These may bleed into the eye, causing reduced vision, or they may cause scar tissue to form on the retina. The scar tissue can cause permanent damage to the retina. Hopefully, if you have been seeing your ophthalmologist regularly, they would have been able to detect the new blood vessels before they form the scar tissue. We can laser the retina to stop the new vessels from progressing. This will prevent formation of scar tissue and allow you to maintain good vision.

All is not lost if scar tissue has damaged the retina. We then can remove the scar tissue surgically. This should prevent further deterioration in vision and can result in significant visual improvement.

Diabetic eye disease has multiple effective treatment options, and it is critical that patients have a good relationship with their ophthalmologist in order to benefit from these treatments. It is important to have a good understanding of your specific problem; the limitations and side effects of your treatment; and a realistic expectation what the treatment can do for you. This understanding is essential because the treatment is long-term and you need to persist with treatment to get the most benefit.

MEET OUR EXPERT - Dr Gareth Fernandes

relationship ophthalmologist diabetes
Dr Gareth Fernandes is an ophthalmologist in private practice at Visiomed Eye Laser Centre in Northcliff, Johannesburg. He completed his ophthalmology training at Wits University in 2014. He performs a range of treatments for diabetes patients, including diabetic screening, intra-ocular injections, laser treatments and cataract surgery.

Eating on a time budget

We all need to eat, but sometimes our busy schedules don’t allow us to. Christine Manga shares tips on how to eat on a time budgetit all comes down to preparation.

Louis E Boone said, “I am definitely going to take a course in time management…just as soon as I can work it into my schedule.” Does this sound like something you might also say? We live in rushed times: sticking to work schedules and deadlines; chasing after children; and road travel as part of work. All of these factors impact what, when and, if at all, we are able to eat during the day. Then add diabetes to the mix.

Having diabetes is challenging, there are things which need to be managed: taking medication, exercising and eating properly. Adhering to these will help keep your diabetes under control. Eating a balanced diet throughout the day is vital, as it assists to stabilise blood glucose levels. This may prevent hunger pangs and cravings which can lead to binge eating in the evenings.

A regular complaint that I hear from people with diabetes is insufficient time to eat during the day. So how do you overcome this? Preparation!

Why prep?

Knowing what to eat will simplify this task. It is important that you get food from all the food groups; carbohydrates, protein, vegetables and fat. Low-GI (glycaemic index of <55) and intermediate-GI (56-69) foods are a good option. Low-GI foods are more slowly digested, metabolised and absorbed. They result in a slower and lower glucose rise than higher GI foods. This allows you to feel full for longer.

How to prep

Take time to prepare food that will be easy and convenient to eat between meetings, sitting at your desk and even on the road (subject to safety). This should help you from feeling the need to rush off to the vending machine or stopping for takeaways. Be aware when buying ‘diabetic’ products; even though these products may be sugar-free, they often contain more calories and/or fat than ‘regular’ food. They also often have a laxative effect and tend to be expensive.

Here are some simple foods that can be easily prepared and packed. They can be eaten separately or combined.

  • Cook extra dinner in the evening, leftovers can be used in salads or sandwiches for lunch.
  • Wash, cut and peel fruit and/or raw vegetables into bite size pieces/crudités.
  • Cut or grate a small amount of low-fat cheese. Alternatively, pack small individually wrapped cheese wedges, rounds or sticks that don’t need refrigeration.
  • Keep ‘Lite’ varieties of packet soup on hand, these are quick to prepare.
  • Pop your own popcorn at home, add spices or cinnamon. This is low-GI and high in fibre.
  • Buy or roast your own seed mix. Sunflower, pumpkin, flax and sesame seed. Keep handy in small amounts. These contain healthy fats.
  • Small pots of low-fat or fat-free yoghurt. Add fresh berries, some peanut butter, nuts or seeds.
  • Lean biltong, pre sliced for easy eating.
  • Pack a peeled boiled egg.
  • Make whole grain sandwiches or wraps with any of the following fillings (cut into small manageable portion sizes):
    • Cheese and tomato.
    • Cottage cheese and peppadew.
    • Egg and mayonnaise with peppers.
    • Grated carrot and sweetcorn.
    • Guacamole and beans.
    • Tuna mayonnaise, cucumber and diced tomato.
    • Leftover meat, chicken or fish.
  • These fillings could also be enjoyed with Provita biscuits.

All of the above options will be easy to eat if you’re rushed and not able to take a dedicated lunch break. Pack water that you have flavoured yourself by adding fruit or cucumber. If you prefer flavoured drinks, stick to the Lite, Light or Zero options. Avoid fruit juice as it is usually high in carbohydrates and has a high-GI.

The preparation time will be worth it. Put very aptly by Benjamin Franklin, “By failing to prepare, you are preparing to fail.”

MEET OUR EXPERT - Christine Manga

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.
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.

The risks of alcohol use and diabetes

The South African National Council on Alcoholism and Drug Dependence (SANCA) educates us on the effect alcohol use has on diabetes patients, substance dependency in South Africa, and their latest campaign #KICK-YOUR-HABIT.

Alcoholism and diabetes

SANCA warns that alcohol can have negative effects on any person but especially if the person suffers with diabetes. Alcohol affects the liver by interfering with its job to regulate the blood sugar in the body.

The liver needs to work harder to change the proteins into glucose from the alcohol, especially when the person has consumed large amounts of alcohol. Alcohol can cause blood sugar changes as it has high calories and increases blood pressure. It could either increase or reduce the blood glucose levels, depending on the number of units consumed by the person.

People with Type 1 diabetes may experience dangerously low blood sugar levels when drinking alcohol in large quantities.

Alcohol will reduce the person’s ability to recognise the normal symptoms of a low blood sugar. A person with diabetes could therefore have a serious hypoglycaemic episode and fall into a coma. The people around the person may assume that they have fallen down due to being drunk and leave the person to sleep off the excess alcohol consumption. If the person is alone and becomes confused, aggressive or disorderly because of the low blood sugar, they may even end up being arrested and spend the night in jail. In either event, failure to treat the low blood sugar it could be fatal.

Beverages, such as beer and sweet wines, have carbohydrates that increase blood sugar. Other risks involved are that one’s judgement is impaired and could cause a person to forget to take their medication or double dose. which could also lead to a serious situation.

The person can also experience an increase in their appetite and then one tends to tends to make unhealthy  eating choices, leading to weight gain. Alcohol further tends to interfere with the medications or insulin used to control diabetes and could lead to low blood sugar.

Note: a person with low blood sugar seems ‘drunk’ as they display similar symptoms, such as disorientation, flushes, nausea, increased heart rate, slurred speech and dizziness. It can become a medical emergency and the person would need medical care when going into ‘insulin shock’.

Does this mean that a diabetic patient can never drink alcohol?

The answer is no. They can drink alcohol, if they stick to the following guidelines:

  • Always consult your general practitioner about drinking alcohol.
  • Always have a medical alert notice on you, stating that you have diabetes.
  • Test your blood sugar levels before taking a drink and don’t drink when your blood glucose is low.
  • Make sure you don’t drink on an empty stomach; food slows down the rate of how alcohol is absorbed into the blood stream.
  • Know your limits; women can only drink one unit per day and men two units per day. One unit is 330ml beer or one medium glass of wine or one tot.
  • Avoid binge drinking.
  • Avoid sweet sugary drinks.
  • Mix alcohol with water, club soda or diet soft drinks.
  • Drink slowly; it takes two to four hours for the liver to break the alcohol down.
  • Don’t mix alcohol and exercise as both increase the risk of lowering the blood sugar levels.
  • Always carry around glucose tablets or another sugar source.

#Kick-Your-Habit by giving up one habit for one week!

International Day against Drug Abuse and Illicit Drug Trafficking is celebrated on 26 June. SANCA celebrated this over the week of 24 to 30 of June 2017, with their annual campaign #Kick-Your-Habit.

Substance dependency in SA

Substance dependency statistics show that drug consumption (cannabis, cocaine, and Tik) in South Africa is twice the global average and second to none in Africa1.The average age of drug dependency in South Africa is 12 years and decreasing. South Africa is among the top 10 narcotics and alcohol abusers in the world.

For every 100 people, 15 have a drug problem and for every R100 in circulation, R25 is linked to the substance abuse problem2. Drug and alcohol dependency is destabilising the fabric of South African society and is often linked to other social ills, such as violent crime, gender-based violence, child abuse, and the ever increasing HIV/AIDS incidence rates.

The South African youth are particularly vulnerable to the experimentation and long-term use of substances, whether it be alcohol, illicit drugs, or even over-the-counter and prescription medication.

The cost to the country is measured not merely in rands, but also in loss of creativity, innovation, artistry, talent, to name a few. As endemic as the problem of substance abuse within the country is, many South Africans know very little about the problem and how it might be affecting them personally. Secondly, many people are unaware of the difficulties faced by substance dependents when first entering treatment and the long-term fight that is faced over the years after treatment.

Years of believing that the addict has a choice every time they use, has led to the idea that active addiction is fuelled by the irrational and selfish behaviours of the individual themselves. However, addiction is far more complex that this simple explanation. The drive to continue using is more often fuelled by the psychological and physical needs of the dependent individual and treatment is often more complex that just stopping.

Aims of #KICK-YOUR-HABIT campaign

The purpose is to raise awareness of the complexities related to addiction and dependence. It seeks to build awareness through experience; by challenging individuals within our communities and country to stop using one ‘thing’ for a week and experience, albeit briefly, to see what a substance dependent might go through in treatment.

With experience comes education and this is the ultimate aim of the campaign. Whether this ‘thing’ is caffeine, tobacco, chocolate, or even shopping; it is entirely up to the supporter’s discretion. However, it is important to consider the choice and select the habit that is used on regular basis.

Keeping a daily log, or even an online blog of your progress is encouraged, as this will create awareness for the difficulties faced by dependents on a daily basis. Whether this daily log is posted online or is private is your decision, as long as you engage with the challenge. It is our responsibility as citizens of this country to work together to build a brighter future for the next generation.

Please contact SANCA on 011 892 3829 or on WhatsApp 076 535 1701, if you want to refer someone for help with an alcohol problem. Visit or their Facebook page SANCA National or Tweet them @sancanational


1-UN World Drug Report, 2014.

2 -Christian Addiction Support, 2016.

Workplace wellness – making the workplace a healthy, happy space

Corporate Wellness Week is observed in the first week of July (1-7). With this in mind, Paula Pienaar explains why workplace wellness is of vital importance.

What is corporate wellness?

Corporate, employee or workplace wellness refers to the physical and mental well-being and health of employees, their work environment and workplace culture. Understanding the significance of this concept begins by addressing the health needs of our working population.

State of the nation’s health

Recent data from Statistics SA show that 56% of all deaths annually are attributed to chronic diseases, such as heart disease, cancer, diabetes and stroke. In fact, Type 2 diabetes mellitus is now the second most common cause of death in South Africa (5,4%), after tuberculosis (7,2%)1. The prevention and management of such chronic diseases can be largely accomplished by managing associated health risk factors which include hypertension, high blood sugar levels, high cholesterol, excess body weight and lifestyle behaviours, such as smoking, physical inactivity, poor dietary habits and poor sleep health. One estimate is that eliminating these health risk behaviours would make it possible to prevent 80% of heart disease, stroke, and Type 2 diabetes mellitus, and even 40% of cancers2.

Using the workplace to improve the nation’s health

Recent economic statistics show that 44% of South Africans are employed3 and on average, South Africans who work full-time spend more than one-third of their day, five days a week, at their workplace. It is therefore not surprising that the workplace provides an opportune setting through which a large part of the population can be helped through workplace wellness programmes. Employers have a responsibility to provide a safe, hazard-free workplace for their employees and also the opportunity to foster a happy, productive working environment by promoting a healthy lifestyle.

Workplace Wellness programmes (WWPs)

Healthy employees are more productive and have the lowest cost to organisations. WWPs therefore aim to prevent the development of chronic diseases and support employees with existing chronic medical conditions. Another way in which employees can be supported is by creating a work environment that encourages healthy lifestyle behaviours, such as having quality short breaks away from the desk, physical activity, good nutrition and no smoking. Successful, effective WWPs therefore have significant benefits to the organisation and to employees.

Workplace wellness is beneficial to:

The Organisation

The Employee

Reduces productivity loss. Reduces risk for premature death.
Reduces risk for short-term disability. Reduces risk for cardiovascular disease, diabetes, cancers, back pain, and high cholesterol.
Enhances mood and job satisfaction. Results in greater job satisfaction.
Enhances work performance. May increase annual income.
Reduces healthcare spending. Lowers debt.
Lowers employee turnover rates. Lowers long-term unemployment.

Workplace wellness – the key to a healthy, happy and productive workforce

Workplace wellness is among the most vital investments that a company can make. Businesses that start WWPs aren’t only investing in the physical wellness, safety, and mental health of their employees, but are also taking preventive measures by creating a healthier environment. A recent scientific review concluded that well-designed, comprehensive WWPs have the potential to improve heart health and to reduce mortality and disability resulting from cardiovascular disease and stroke4.

5 evidence-based strategies that have shown to work in successful WWPs:

  1. Wellness screening days (height, weight, waist circumference and finger prick blood tests).
  2. Healthy lifestyle programmes (e.g. smoking cessation, weight loss, fatigue management, and diabetes programmes).
  3. Covering or minimising co-payment of lifestyle-related health programmes.
  4. Onsite exercise facilities and informative health talks.
  5. Fully covered flu vaccinations.

Making workplace wellness enjoyable

Participation in workplace wellness initiatives may often be poor. However, research has shown that by involving employees in the roll-out of such programmes through interest-based surveys and good communication strategies, companies can play a significant role in changing employees’ attitudes to work from a dreary obligation to an exciting health-enhancing part of their day.

Strategies that organisations can take to improve 3 pillars of performance – nutrition, physical activity and adequate rest:

  1. Nutrition
    1. Review the catering menu and vending machines to gently introduce healthier options.
    2. Coordinate a ‘healthy snack of the month’ club.
  2. Physical activity
    1. Arrange for bicycle racks and provide ‘bike to work’ promotional materials.
    2. Make the area around the office building conducive to walks and try to move your meetings from the boardroom to walking paths (walking meetings).
  3. Sleep and fatigue
    1. Invite a sleep health professional to a ‘lunch and learn’ session.
    2. Create a workplace with adequate natural lighting and low noise levels.

For more information, please visit

MEET OUR EXPERT - Paula R. Pienaar

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 [email protected]


  1. Statistics South Africa, Mortality and causes of death in South Africa, 2015: Findings from death notification. 2017: Pretoria:SSA.
  2. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4): 586-613
  4. Fonarow GC, Calitz C, Arena R, et al. Workplace wellness recognition for optimizing workplace health: a presidential advisory from the American Heart Association. Circulation. 2015;131(20): e480-e497.

No chilblains this winter

With winter gracing us with his chilly presence, Anette Thompson speaks about chilblains – what they are and what causes them?

Chilblains are small, itchy, painful bumps on the skin caused from an abnormal response to cold temperatures. They usually go away after a week or two if further exposure to cold is avoided, but can be very dangerous to people living with diabetes.

What are chilblains and what causes them?

Chilblains (also called pernio) are small, itchy, painful, red swellings on the skin caused by an abnormal reaction to cold weather. They most frequently occur on exposed toes, fingers, ears and nose; and are usually red in colour but may change to purple. Other areas of skin can also develop painful and tender chilblains if exposed to cold, e.g. heels, lower legs and thighs.

Chilblains are quite common. Small blood vessels, called capillaries, become narrow (constrict) when the skin becomes cold. In addition, the cooled blood will flow slower. When the skin is re-warmed, there is leakage of fluid from the blood vessels into the tissues. This is thought to cause the inflammation, swelling and itching associated with chilblains.

The speed (rate) of temperature change may play a part. Some people develop chilblains if they warm up cold skin too quickly. For example, with a hot water bottle or by sitting very close to a fire, stove or heater. Natural ways of warming the skin better are with warm water (not hot!), real wool or mohair socks and gloves.

People are more at risk of developing chilblains, if they:

  • have poor circulation and other problems associated with their blood vessels.
  • have a condition called systemic lupus erythematosus (SLE).
  • smoke because nicotine constricts blood vessels.
  • have a family history of chilblains.
  • have frequent exposure to cold, draughty or damp weather.
  • have a poor diet or low body weight.
  • wear shoes that create pressure points, e.g. over a bunion or squeezing the toes so that blood flow is constricted.
  • suffer from Raynaud’s phenomenon – a condition that affects blood circulation to the extremities.
  • take medications that have the side effect of constricting their blood vessels, e.g. beta blockers.
  • suffer from microangiopathy (damage to small blood vessels) e.g. due to diabetic complications.
  • suffer from peripheral neuropathy (unable to feel their feet) e.g. due to diabetic complications.

How do you prevent chilblains?

  • Keep your hands and feet warm when out in cold weather by using warm gloves and socks. Consider special polar gloves and socks, if chilblains are a recurring problem. Look for real wool, angora or mohair socks as their fibres trap more heat than acrylic wool.
  • Keep your head and ears warm by wearing a hat and scarf or a beanie. Remember that 40% of the heat of your body can be lost through the top of your head if it is exposed to cold.
  • You should keep as warm as possible in the cold. Wearing several loose layers is ideal to trap body heat. You should also keep as dry as possible.
  • Insulate your feet and legs by wearing long johns, long boots, tights, leg warmers or long socks. It’s a good idea to wear a clean pair of warm socks if you get cold feet in bed. 
  • If your skin gets cold, it’s important to warm it up gradually. Heating the skin too quickly, for example, by placing your feet in hot water or near a heater, is one of the main causes of chilblains.
  • Side effects from some medicines may narrow (constrict) tiny blood vessels. This may be enough to make you prone to recurring chilblains. For example, beta-blockers can have this effect. Tell your doctor if you become prone to chilblains following starting any medication.
  • Look after your feet, examine them carefully every day, especially if you have diabetes as people with diabetes may not be able to feel their feet and could have infected chilblains without realising it. Moisturise them regularly – this stops them drying out and the skin from cracking.
  • Take steps to improve your circulation; keep active – this helps improve your circulation.
  • Stop smoking – nicotine causes the blood vessels to constrict, which can make chilblains worse.
  • Avoid tight shoes and boots – these can restrict the circulation to your toes and feet.
  • Eat at least one hot meal during the day – this will help warm your whole body, particularly in cold weather.
  • Warm your shoes in front of a heater before you put them on. Make sure damp shoes are completely dry before you wear them; if your feet are already cold, make sure your shoes aren’t too hot. 
  • Warm your hands before going outdoors; place them in warm water (not hot water) for a few minutes and dry thoroughly, and wear cotton-lined waterproof gloves, if necessary. If your hands are already cold, make sure not to warm them up too quickly.
  • Keep your house well heated – try to keep one room in the house warm and avoid drafts.
  • A range of creams and lotions, claiming to be beneficial for chilblains,can be bought from a pharmacy. However, there is no evidence that any of these OTC creams ease chilblains, so therefore not recommended.
  • It may help to use a soothing lotion, such as calamine or witch hazel, to relieve itching.
  • Steroid creams are no longer recommended for the treatment (or prevention) of chilblains as they thin the skin and can be implicated in the breakdown of the skin.
  • Medicines are not usually needed. However, nifedipine can open (dilate) the small blood vessels and may help to treat chilblains, which are not settling within the normal time. Occasionally, it may also be used to prevent chilblains in the winter months in people who have recurring symptoms. A doctor will have to prescribe it.

Complication of chilblains for people living with diabetes

  • Occasionally, the skin breaks down to leave a small ulcer, which is prone to infection.
  • Permanent discolouration of the skin.
  • Scarring of the skin.
  • In some cases, the skin over a chilblain may blister, which may delay healing.
  • It’s important not to scratch the skin as it can break easily and become infected. You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing.  The dressing should be changed every day until the skin heals.

 Signs of infection may include:

  • Redness and heat.
  • Swelling and pus forming in the affected area.
  • Feeling generally unwell.
  • Blood glucose levels rise.
  • A high temperature (fever) of 38C (100.4F) or above.
  • Swollen glands.

If the skin does break down and become infected, see your podiatrist or doctor immediately. Diabetic ulcer wound treatment will need to be initiated and antibiotics are likely to be prescribed to treat the infection.

MEET OUR EXPERT - Anette Thompson

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.

Communicating with confidence

Many people with diabetes worry about whether they should say anything to others, such as their work colleagues, boss and friends, about their diabetes. Clinical psychologist, Rosemary Flynn, offers advice on how to communicate with confidence.

Some of the questions that diabetes patients will ask are:

  • Should I tell my boss and colleagues about this? I’d rather not. They’ll think I am a freak!
  • If I say anything about my diabetes, they may accuse me of looking for sympathy but sometimes I need to attend to my diabetes at work.
  • How do I tell people about this?
  • Do I test and inject in front of others or do I have to go to the bathroom when I am at work?
  • I don’t want anyone to feel sorry for me all the time.
  • What if no-one helps me if I pass out from a hypo?

Before you, the diabetes patient, can start communicating with others about your condition, you need to ask yourself these questions:

  • Do you have enough knowledge about your diabetes and treatment?
  • Do you have the skills to know what is going wrong and work out a solution?
  • Do you believe the treatment works?
  • Do you have confidence that you can do this?

The answers to these questions will influence how you talk to others about your diabetes. If you can answer yes to all the questions, you have a good understanding of your diabetes and can communicate accurately with confidence. If you have said no to any of the questions, make an effort to improve in that area.

Taking emotions into consideration

It is also helpful to recognise how you react to things emotionally. Do you push people away? Do you get angry with people who are trying to help? Are you too embarrassed to say anything?

Telling people you have diabetes and then being able to discuss it, can be a real challenge. Sometimes you may feel comfortable talking about it, but sometimes you may prefer not to say anything. Figure out a starting point that would be suitable for the people you’re addressing. Then you can explain what you do and why. When you feel comfortable, others will tend to be more comfortable about talking to you about your diabetes. Your confidence gives them the impression that you have mastered a serious challenge and they need not worry.

Do you tell everyone you meet?

Not necessarily. If they need to know because you interact with them often, or if they are important people in your life, tell them. In the big picture, it is best to tell those who need to know about your diabetes in case they need to help you. There is always a chance that you could have a low blood glucose level unexpectedly, where you need help and cannot think straight in the moment, and you will need others to help you. You don’t want to give others too much of a fright by suddenly falling over. If at least one colleague knows what is going on, they’ll be able to do the right thing to help you. That is being fair to them and being fair to yourself. Most of the time they won’t need to help you, but just in case.

18-year-old Brad said, “I have had diabetes since I was two years old and I find it’s a breeze now – there’s no need to think you stand out. You can still be the same as everyone else and do the same things. There is no need to feel different.”

If you explain what diabetes means to you and what you must do, usually others let you get on with it, without a fuss. Some people may try to help, and as well meaning as they are, they can get it wrong. They can be irritating when they think they “know it all” and they can also be insensitive.

Jenna talked to those in her office about her diabetes. She mentioned she may need help if her blood glucose went too low, but she reassured them that she could manage on her own most of the time. The first time she actually needed help for a low, her friend brought the insulin pen. The friend thought there was glucose in the pen!

Friends don’t always get it right, but with a bit of experience and coaching from you, they’ll learn to know the right thing to do.

How do you handle criticism?

Dealing with criticism, whether it is justified or not, is an important life skill.

If others make negative comments about your diabetes, it is usually for one of two reasons:

  1. Because they are looking for someone to pick on, who they think is ‘weak’ or ‘different’, and they want to feel superior.
  2. Because they are afraid of the condition as they don’t know enough about it.

When your colleagues are informed, they will often be the ones who stop those who are criticising. Keeping your diabetes a secret will be very difficult to maintain all your working life and it can have consequences, especially if something goes wrong and you cannot fend for yourself.

Destructive criticism is often just thoughtlessness, but it can be malicious and hurtful. As Dale Carnegie said, “Any fool can criticise, condemn and complain, but it takes character and self-control to be understanding and forgiving.” Usually, people don’t react as badly as you think they will, if you appear confident about your diabetes management. Most of them will understand once they know more. You have nothing to be ashamed of; you are doing what is necessary to stay alive and well.

MEET OUR EXPERT - Rosemary Flynn

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.

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

Communicating confidence

Rosemary Flynn’s new book “The Emotions of Teenagers with Diabetes” is now available. To order your copy contact Rosemary at [email protected]