Understanding the steps to diabetes self-management

We explore ways to help you learn and implement self-management practices.

The diagnosis of diabetes

If you or a loved one have just been diagnosed with diabetes, you may be feeling an overwhelming amount of mixed emotions. Diabetes is a complex and serious condition, and living with it every day can be challenging1. Part of that challenge is due to the fact that the management of diabetes will largely rest in your hands. This can be daunting. Be kind to yourself and remember that small positive steps every day will make a difference in the long run.

Getting started with self-management

Ideally, on diagnosis, you should have access to a team of healthcare professionals. This may include the treating doctor, a diabetes educator or coach, and possibly a dietitian.

However, in many cases you might only have access to a doctor and your time spent with him or her in consultation will be limited.

In the beginning, you may feel overloaded with information about what to eat, how much to exercise, when to take your medicine, how to test as well as confusing terminology, such as HbA1c, hyperglycaemia, hypoglycaemia, glycaemic control etc.

To help make sense of it all, diabetes educators have developed some key areas to focus on1:

  1. Healthy eating

Having diabetes does not mean you must give up your favourite foods. Over time and through experience, you’ll learn how the foods you eat affect your blood sugar. You should eat regular meals and make food choices that will help control your diabetes better1.

Work with a dietitian or diabetes educator to develop a healthy, balanced eating plan that suits your lifestyle. Remember that it is okay to treat yourself once in a while. You can also visit the Accu-Chek website and download the Accu-Chek portion plate which will give you some practical tips on healthy eating.

  1. Being active

Guidelines for the management of Type 2 diabetes refer to studies that have proven that regular physical activity significantly improves blood sugar control, reduces cardiovascular risk factors, and may reduce chronic medication dosages2. Regular physical activity may also improve symptoms of depression and improve health-related quality of life2. Try to include a combination of cardio and resistance training into your weekly exercise routine.

  1. Self-monitoring of blood glucose (SMBG)

The International Diabetes Federation (IDF) recommends SMBG as an effective means for patients with diabetes to understand more about their condition and the influence of events – such as exercise, stress, food and medication – on blood sugar levels3.

However, for SMBG to be effective, it’s recommended that you practice structured testing using a tool, such as the Accu-Chek 360 3-Day Profile Tool3 which can be found on www.accu-chek.co.za

Structured testing is testing at the right times, in the right situations, and frequently enough to generate useful information3. Always agree with your doctor or diabetes educator what your individual structured SMBG testing plan is.

Another aspect you should discuss with your doctor will be your target range for your blood sugar levels. In the beginning, understanding this range and what is considered out of range may be confusing, so you may want to make use of a meter such as the Accu-Chek Instant Meter which offers a support tool called the target range indicator (TRI)4.

A study done on the TRI showed that 94% of study participants were able to easily interpret their blood sugar values through the use of the target range indicator4. Furthermore, 94% felt that the support tool will help them discuss their blood sugar values with their doctor4.

  1. Taking medication

You may need to take medication to help keep your blood sugar (glucose) level steady. Diabetes can increase your risk for other health conditions, such as heart or kidney related problems, so you may need to take medicine to help with those too1.

  1. Problem solving

When you have diabetes, you learn to plan ahead to be sure you maintain blood sugar levels as much as possible within your target range goals – not too high, not too low.

As we know, things don’t always go according to plan and a stressful day at the office or an unexpected illness can send your blood sugar in the wrong direction. Days like this will happen from time to time. Here are some tips to cope1:

  • Don’t beat yourself up – managing your diabetes doesn’t mean being perfect.
  • Analyse your day and think about what was different and learn from it.
  • Discuss possible solutions. This can be with your doctor, your diabetes educator or even a face-to-face or online diabetes support group. Try joining some of the online diabetes communities out there, such as the Accu-Chek Facebook page which has over 148 000 members. You can join the conversation at AccuChekSubSahara.

Technology, teenagers and diabetes distress

Dr Louise Johnson explains the difficulties experienced by teenagers with diabetes, including diabetes distress, and how sharing on social media helps them.

Diabetes is currently still a chronic disease with continuous treatment and lifestyle adjustments. The good news though is that rapid technology improvements will power a paradigm shift. For this reason, in the future our views should change. But until such time, we must still regard diabetes as a chronic metabolic disturbance.

19-year peak

Adolescent years are the most challenging time in life. Not only are there physical changes but also emotional changes. In a teenager with diabetes this will be the most difficult time to control glucose. The reason is due to the interaction of all the hormones that are also affecting diabetes. These hormones are growth hormones, oestrogen, testosterone and cortisol. On a positive note, it’s worth mentioning this difficult period peaks at 19 years; thereafter it should be a lot easier.

Study results

In a study (Tanenbaum ML et. al) on diabetes and technology (social media); an analysis of teenage patients in a certain population was used.  Looking at the amount of participants that posted on social media and the reasons behind it, it was found that 105 participants (51,5%) posted on their health in the previous six months. Of these, 80 (76,2%) posted about mood and 62 (57,1%) posted on wellness and prevention, while 44 (41,9%) posted on acute complications and only 13 (12,4%) posted on chronic medical conditions. Only 10 (9,5%) posted about their sexual health.

The reasons teenagers were posting were:
• To connect with others with similar conditions (43,8%),
• Seeking advice (41%),
• Looking for support (31.4%),
• Share their health issues (26,7%),
• Thought it was fun (22.9%),
• Wanted to search for additional treatment (13.3%).

The social media apps that the groups of teenagers used most were:

  • YouTube
  • Instagram
  • Snapchat
  • Facebook
  • Twitter

This interaction (in this case by sharing about their health) was shown to improve their awareness about their disease. The teenagers reacted to social media comments by testing more, eating correctly, taking insulin more regularly and exercising more, etc. Overall, the use of these social media platforms by teens with Type 1 diabetes helped their HbA1c decrease by 0,4% .The important point is interaction with someone (even unknown persons) improves health.

The study identified four types of people:

  • The D-embracer endorses barriers and overcomes them. They have a high uptake on devices and have low diabetes distress. The target for this group is only maintenance on information.
  • The Wary Wearer has numerous barriers and is resistant against technologies (insulin pumps, continuous glucose monitoring (CGMs), etc). They also suffer from a high amount of diabetes distress. To target this person, education and problem-solving is important.
  • The Data Minimalist has an average tech attitude and doesn’t want more info. They have an aversion against CGMs and have low diabetes distress. To target this group, education and specifically technology problem-solving is needed.
  • The Free Ranger endorses few barriers. They have a negative attitude against technology and do not like new devices. They also have above average diabetes distress and worry about low blood sugar. The target treatment would be to provide a pump or CGM device as a temporary solution and teach them problem-solving.

Change in treatment for adolescence years is needed

One of the points that was raised in this study was the fact that change in treatment is needed in adolescence years. Most teens feel that they want to take control of their diabetes. It is important for parents to realise this and thus hand over the care to them. This can be done in different ways. One example is a family meeting, once or twice a week, to discuss difficulties surrounding diabetes.

DiabetesWise.org is a good website to help you determine if your device is still compatible for your unique lifestyle. This information will be available soon. In the meantime, patients can register.

Essential points for teenager with diabetes to remember:

  • Blood glucose is just a number.
  • Any number is a good number because it is data and data is good. There is no such thing as a bad number.
  • It is not you that isn’t compliant. It’s your pancreas that isn’t producing insulin. Therefore, your pancreas is not compliant.
  • Your blood sugar numbers are not bad because you are bad but rather because your pancreas is lazy and not performing.
  • You can make a difference by substituting insulin to help your lazy pancreas.
  • Keep trying until you own it. For example, eat the same pizza (once a week) and adjust insulin until the two-hour after pizza glucose value is on target. Pizza does count as ‘wrong food’  but can be eaten if you inject accordingly (with insulin) to counteract the rising glucose.
  • It is essential that you have a good partnership with a friend, parent, or even your doctor. A partner is there to support you. A great partner will take time to learn about diabetes, buy healthy food, and even exercise with you. Moreover, they will gently remind you of your medication, they will understand and support your emotions. They will also respect your autonomy. What any partner should not do is: nag, argue, shame you when your glucose levels are high and they should never undermine your autonomy.

What is diabetes distress (DD)?

DD refers to the worries, concerns, fears, and threats that are associated with struggling with the demanding and progressive chronic disease – diabetes. In addition, the management, threats of complications and lack of leading a normal lifestyle are included in this mix.

DD is an expected response to having diabetes. It does not fall under psychopathology, nor is it viewed as a co-morbid disorder or condition. It is simply the emotional side of having diabetes.

Signs of DD

  • Feelings of weakness and hopelessness.
  • Excessive fear of hypos or complications.
  • Avoidance – Who me? Everything is fine!
  • Burnout because of all the management tasks.
  • Even those with excellent or good management can present with high DD. Not just those with poor management.
  • Anger and frustration with providers, distrust, hostility, and even no-show for appointments.

It is noteworthy to realise that DD has a high prevalence among both Type 1 and Type 2 diabetes. The values range from 35% to 42%. It does not disappear on its own and can become chronic, and needs treatment. DD is highly responsive to treatment.

One must bear in mind that it should be distinguished from depression.

Addressing DD

  • Focus on the change of medication or complications that may have appeared.
  • Talk to the patient about the new treatment.
  • Use of interactive groups led by an expert or psychologist.
  • Concentrate on the patient more than on the glucose numbers. It is important to be an active listener.
  • www.diabetesdistress.org is a useful website for additional information and assistance with diagnosis.


Tanenbaum ML, Hanes SJ et. al. ‘Diabetes Device use in Adults with type 1 diabetes: Barrier to uptake and potential intervention targets.’ Diabetes Care 2017; 40: 1-7


Dr Louise Johnson


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

TEDDY study

Some of the results of The Environmental Determinants of Diabetes in the Young (TEDDY) study were revealed at the American Diabetes Association Congress, in Orlando, this past month. Dr Louise Johnson tells us more.

Aim of TEDDY

TEDDY study is looking for the causes of Type 1 diabetes mellitus (T1DM).

About T1DM

T1DM used to be called childhood diabetes or insulin-dependent diabetes. It occurs when special cells in the body, called the beta cells of the pancreas, are destroyed by the body’s infection fighting cells, called immune cells. When these beta cells are destroyed, the body cannot produce the hormone – insulin.

Insulin is needed for the body to effectively use food as an energy source. Insulin helps keep the sugar level in the blood normal. If there is no insulin in the body, the sugar in the blood becomes high and this makes someone sick. Children with Type 1 diabetes must take insulin shots and monitor their blood sugar levels several times a day to stay alive and healthy.

What does research say?

Research tells us that children who are diagnosed with diabetes have certain kinds of genes. Other children who have these genes are at higher risk for getting diabetes. However, not all children who are at a higher risk get diabetes.

It has been suggested that something happens that ‘triggers’ or causes a child with higher-risk genes to develop diabetes. It is the purpose of TEDDY study is to find out what the triggers are that cause children to develop diabetes.

The long-term goal of TEDDY study is the identification of infectious agents, dietary factors, or other environmental agents, including psychosocial factors that trigger T1DM in genetically susceptible individuals or which protect against the disease. Identification of such factors will lead to a better understanding of disease pathogenesis and result in new strategies to prevent, delay, or reverse T1DM.

TEDDY results

The study enrolled all American, Germany, Sweden and Finland babies from birth up to four months of age with a specific HLA gene in that population, or babies with a first degree relative with Type 1 diabetes. This would be a baby with a sibling or mother or father with Type 1 diabetes. These babies were followed up for 15 years.

TEDDY study showed:

  • Different gut organisms (microbiome) in different countries.
  • Diet (high in fat and high in gluten in the first six months of life when solid foods are introduced.) This diet alters the bacteria in the gut and can increase the risk of auto-antibodies.
  • Probiotics early in life might reduce auto-antibodies to those at risk.
  • It is vital to feed your children (from early) a healthy low-fat, low-gluten diet, and to only use antibiotics if really necessary.

The new millennium diabetics

The new millennium diabetics (from 2000) all have the value of new technology on their side. The improvement of newer insulin, better glucose meters and continuous glucose monitors (CGM). These are all currently available in South Africa.

The availability of tablets, as an add-on to background insulin in Type 1 diabetes, showed promising results at the ADA congress. These new tablets will soon be available. Taking the facts into consideration, it suffices to conclude the treatment of diabetes will take a diverse approach in both the physical and mental realm.

Dr Louise Johnson


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

Albany Bread-A-Betix Tasty Tzatziki Roll Ups


  • 3 slices Albany Bread-A-Betix Low G.I. White
  • 60ml yogurt
  • 1/8 grated cucumber
  • Mint leaves, chopped
  • 5ml lemon juice
  • 2.5ml chopped garlic
  • 1 large zucchini, sliced lengthways and grilled
  • Fresh chopped Italian parsley
  • Shredded crisp lettuce
  • Drizzle of olive oil
  • 5ml lemon zest
  • Seasoning to taste


  1. Thinly slice zucchini lengthwise.
  2. Grill zucchini ribbons on a medium heat and drizzle with a little olive oil.
  3. To make the tzatziki – mix the yogurt, cucumber, garlic, chopped mint leaves, and lemon juice together.
  4. Place lettuce on each slice of bread, top with tzatziki and then the zucchini.
  5. Roll up each slice of bread into a cone and wrap with greaseproof paper.
  6. Drizzle with olive oil and lemon zest.

Albany Bread-A-Betix Smashing Good Chickpea Chow


  • 2 slices Albany Bread-A-Betix Low GI Seeded Brown Bread
  • Butter lettuce
  • 80ml chickpeas, smashed with a fork
  • 30ml tahini
  • ½ avocado, sliced 


  1. Lay the lettuce on top of 1 slice of bread.
  2. Top with smashed chickpeas, and drizzle with tahini.
  3. Lay the sliced avo on top of the chickpeas.
  4. Top with the second slice of bread and chow down!

Albany Bread-A-Betix Soy Much Energy Steak Sarm


  • 2 slices Albany Bread-A-Betix Low GI Wholewheat Brown Bread
  • Beef strips
  • 30ml light Soy sauce
  • 10ml oil
  • 4-6 slices tomato
  • 15ml Dijon mustard
  • Handful of baby spinach leaves


  1. Fry the beef strips in oil over a high heat. Once cooked, pour the light Soy sauce into the pan and cook for a further minute.
  2. Spread the Dijon mustard onto both slices of bread.
  3. Lay four of the tomato slices on one of the slices of bread.
  4. Top with beef strips and cover with second slice of bread.
  5. Pop the sarm on a heated pan and toast until outside of bread is golden. Remove from heat and fill with fresh baby spinach.
  6. Slice and skewer to serve.

Medical schemes, healthcare cover and patients

Elsabė Klinck aims to empower patients on their rights in the funding of healthcare with a series of articles. This first article covers the basics of medical schemes, healthcare cover and patients.

A complex environment

Funding for healthcare is a controversial issue. It can lead to friction between healthcare funding companies (medical schemes or healthcare insurers), providers (doctors, hospitals) and patients.

Because no person chooses to be ill, the buying of healthcare services is rarely done on a purely voluntary basis. It is mostly begrudgingly. Add to this the aspect that some healthcare interventions are life-saving, the moral arguments on equal access to healthcare and a conflict-free discussion appears virtually out of the question.

With the Minister of Health’s recent announcements on changes to the healthcare system and to medical schemes, debates on co-payments have also been added to the above complexity.

The Health Market Inquiry has also found that patients find medical scheme options, benefits and the limitations thereto, daunting. Fighting for cover is also a difficult undertaking. Many patients simply give up, even if they feel they should have better cover.

The law as a patient’s guide

The legal frameworks do, however, protect patients, and the fund from which healthcare is paid. Understanding these frameworks will help patients, providers and funders to better communicate. They can then use the same reference points when discussing access to, or denial, of care.

Funding for healthcare services (doctors’ fees, hospitalisation, etc.) and goods (medicines, etc.) can be provided by:
  • Persons out of their own pocket (often these patients are called private patients);
  • Their medical scheme, subject to the provisions of the medical schemes law and the scheme rules;
  • Third party insurers, which sometimes provide lump sum cover for “dread disease” and/or “hospitalisation” or “gap cover”. These pay the difference between what another funder pays and what is owed.

Where third party funders (i.e. medical schemes or health insurers) pay healthcare services in part, co-payments may have to be paid by patients, to ensure that the full event, medicine or care is covered. In some cases, schemes call this levy a “penalty co-payments”. We will look at co-payments in the next articles of this series.

Knowing about the care you require

Whether funders would fund care or not, your healthcare journey must start with your healthcare professional (doctor, pharmacist, nursing professional, etc.) discussing your healthcare status with you. This includes how you feel, what they observe, and what the test results or physical examinations show them about your health.

Based on your healthcare status, your healthcare professional will discuss with you what your treatment options are, and what the benefits, risks and costs of each option will be. Regarding this, you must consider the arrangement of your funder.  Remember your funder makes rules for the general patient population under their cover. So, what they may fund, may not be what is appropriate for you.

Discuss the alternatives that your scheme will fund with your healthcare professional. Ask them to explain why you may require something your funder may not fund in full, or may not fund at all.

The same applies when you present a prescription at a pharmacy. Pharmacists must substitute products with generic alternatives. Ask the pharmacist if the product is substituted with another product. If you are uncertain, call your prescribing healthcare professional.

PMB conditions

For prescribed minimum benefit (PMB) conditions (we will address PMB in detail later), you are entitled to decline a product that would have been appropriate for you, in favour of something you choose voluntarily. But then there may be a co-payment levied. Some patients prefer to stick to treatment they know, or products they choose. Because of this choice, they will then only be reimbursed by the funder up to the price of the funder’s preferred product.

Right to decline care

You always have the right to decline care. For example, some patients do not want to co-pay, or they agree to swop treatment to what the funder is willing to reimburse. If a patient does this, she/he must understand what the implications (health and cost) of the refusal of care their healthcare professional advised is.

Ask your healthcare professional to explain why they would prefer or recommend a treatment that your funder does not pay for at all, or only pays for in part.

The medical schemes law states that a healthcare professional may never be incentivised to provide you with care that is inappropriate for you. It is therefore unlawful. For example, if your healthcare professional prescribes or dispenses a product because if they do so, they will get paid better by the funder, and such change is not in your interest.

Consumer legislation also prohibits any consumer (patient in this case) from being pressurised into accepting any service or goods. Therefore, take time when deciding on the right care for you, and consider the funding implications of the care you choose.

Paying for care

Medical schemes should, by law, pay for all conditions that are listed in the law as PMB conditions. There are 271 conditions listed in the law, and 25 chronic conditions.

Diabetes, its diagnoses, monitoring (e.g. through glucometers), and all treatment of (for example, diabetes-associated events, such as diabetic ‘highs’ or ‘lows’ where one lands in hospital) are included in the PMB.

The law says that this treatment must be funded “in full and without co-payment” (regulation 8, Medical Schemes Act). This, in short, means that the scheme must pay for all the care associated with living with diabetes.

Where a medical scheme limits the various aspects of healthcare, such as where you receive in-hospital care, or the medicine it would pay for, these limitations should take place within what the law allows. (We will go into the details of these circumstances on managed care, PMB, designated providers (DSP), etc. in future articles.)

 Medical scheme options or plans

Irrespective of your medical scheme plan or option, you are always entitled to appropriate care. Some scheme options do, however, limit the number of visits to healthcare professionals, limit your choice of hospital, or restrict the list of medicines from which your doctor may prescribe.

Normally, if you want more choices, you would have to belong to a higher option with a higher monthly contribution.

One should keep in mind that even if one is on a lower option, there may be circumstances where the law requires the full funding of care, not generally included in that option. For instance, circumstances that are outside of the control of the patient, such as a negative reaction to a medicine, or an emergency.

Where to seek help

Most medical schemes do have internal complaints and appeals systems. If you, as the patient and scheme beneficiary, do not come right at the scheme, you are entitled to lodge a complaint at the Council for Medical Schemes (CMS) – [email protected].

You should receive a case number within 48 hours. You will use that case number when communicating with the CMS. It’s important to include all information and dates, as well as any reports from your doctor, test results, how you were feeling or what you experienced, etc.

Do not forget to add that you have a PMB condition if that is the case. Also explain any instances where treatment was not successful, or where you had to switch treatments, and why that was the case.

Attach any reports or evidence of negative reactions or implications you have experienced to the complaint. Number all the attachments to your complaint and refer to each attachment by that number in your complaint letter.

If a ruling on a complaint is not in your favour, you can appeal that ruling. The details of this right, and the correct email address is always provided on the letter containing the ruling on your complaint.

Final thought

Patients should be aware of their entitlements in terms of the law. These entitlements override the medical scheme rules, if there is a conflict between the rules and the law.

The process starts with informed consent at your healthcare professional where your condition and the treatment options must be discussed.

You must consider the financial implications of your chosen care, or of the care that is necessary for you. Plan for your interaction with your funder, if you know they may not pay in full, or may not pay at all.

Ask your doctor for assistance to understand why you need a particular treatment, or why it may be good for you to choose a particular treatment freely.


Elsabė Klinck (B.Iuris, LLB, BA Hons (German), BA Applied Psychology) specialises in health law, -policy and -ethics. She owns a successful healthcare consulting firm, serving various clients in the pharmaceutical, medical device, healthcare professional and health facility markets.

Physical activity for life

Janine Paladin tells us why physical activity is needed in all stages of life, especially in the beginning stages of youth.

Children have extremely high energy levels and have an innate sense to move; this should be nurtured. Children need to be encourage to partake in a variety of sports and movement as it helps to increase brain stimulation as well as enhance gross and fine motor control.

But what if your child has diabetes?

As a parent your first thought is to protect your child and pull them from all sporting activities. You want to hold them and protect them. More than likely, you feel that nobody else can take care of them like you can – which is true. However, exercise is one of the best things for a child with diabetes. Though, understanding diabetes and the effects exercise has on it is key.

Type 1

The onset of Type 1 diabetes is most common among young children. Type 1 diabetes is defined as a chronic medical condition whereby the pancreas produces little or no insulin. Insulin is the hormone needed to transport sugars (glucose) across the cell membranes to be used for energy. Without this hormone (insulin), sugar builds up in the bloodstream which can become toxic to the body.

Type 2

Type 2 diabetes was originally known as adult-onset diabetes as it mainly occurred in the sedentary adult population. However, the prevalence of Type 2 diabetes has risen dramatically over the last few years, especially in young children and adolescents.

Type 2 diabetes is also a chronic condition. The body either resists the effects of insulin or doesn’t produce enough insulin to metabolise the amount of sugars in the bloodstream and thereby cannot maintain a normal sugar level. The cause is mainly due to poor lifestyle choice and inactivity.

The increased use of technology at a young age promotes a sedentary lifestyle and thereby increases the risk of Type 2 diabetes. Technology is like a drug for the younger generations. It filters negatively through all aspects of their lives, affecting their health and mental well-being.

How will physical activity help?

Exercise has so many benefits; the biggest one is that it makes it easier to control blood glucose levels.

It increases the insulin sensitivity for Type 1 diabetics. So, basically after exercise, the body doesn’t need as much insulin to process complex sugars (carbohydrates).

Type 2 diabetics have too much sugar (glucose) but muscles can use glucose without insulin when exercising. So, it doesn’t really matter if you are insulin resistant (Type 2) or if you don’t produce enough insulin (Type 1) as when you exercise your muscles gets the sugar they need. Therefore, blood glucose levels go down.

So, what does this mean for your child?

To go wild and do as much activity as they possibly can. No. Obviously, there are precautions to take as diabetes is a serious condition and if not managed correctly can be extremely dangerous.

Managing diabetes holistically is important. A combination of a healthy meal plan, utilising prescribed medications or insulin with regular exercise will help maintain your child’s blood glucose levels.

Try pick an activity that your child enjoys. Consistent regular exercise is the best and your child is more likely to stick to it if he/she enjoys it.

It’s important for them to test their blood sugar levels before and after exercise to prevent their sugar levels spiking (hyperglycaemia) or dropping too much (hypoglycaemia).

Blood glucose response to exercise will vary depending on:

  • Blood glucose level before starting activity.
  • The intensity of the activity.
  • The length of time you are active.
  • Changes made to insulin doses (Type 1).

Remember to always keep snacks, juice, water, and glucose tabs nearby to assist in keeping those sugar levels normal. If you manage the sugar levels consistently throughout the day, it’s easier to manage it during and after exercise.

Added benefits of physical activity

Everyone wants their kids to be happy and the more active children are, the happier they are.

Plus, promoting exercise into their lifestyle will have other benefits including, weight loss (Type 2), emotional well-being, stress management and acceptance from their peers.

Also, introducing exercise at a young age will help children maintain it as a part of their lifestyle. It makes it easier to continue it throughout their lives as a positive habit.

As parents, we must remember that our child who has diabetes is just like any other kid. They have the same dreams, goals and aspirations and can pretty much do anything that the other kids can. All they need to do is understand their condition and learn to manage it through positive steps and have a great support system through their family and friends.


Janine Paladin currently runs a Biokinetics practice and Pilates studio in Green Point, Cape Town. She completed an internationally recognised STOTT Pilates Course.  She completed a Human Movement Sciences Degree at the University of Port Elizabeth (Nelson Mandela Metropolotan University) obtaining her Cum Laude for her degree.She then continued her studies at the University of Cape Town completing her Honours degree in Biokinetics.

Obesity in children

Obesity in children can lead to Type 2 diabetes. Diabetes nurse educator, Christine Manga, shares how parents can prevent obesity.

Obesity stats

Africa is ranked as having the highest rate of obesity in preschool children in the world. South Africa was also listed as one of the top countries that have obesity issues. These stats were presented in  October 2016 at a World Obesity Day presentation.

If the current rate of increase continues, by 2025, there will be approximately 3,91 million overweight (BMI 25-29,9) and obese (BMI > 30) school children. This would result in 120 000 children with impaired glucose tolerance (pre diabetes) and 68 000 with overt diabetes.

Childhood obesity also carries other health risks:

  • Breathing problems, such as sleep apnoea and asthma.
  • Joint and musculoskeletal discomfort.
  • High blood pressure and high cholesterol which are cardiovascular risk factors on their own.
  • Fatty liver disease and heartburn.
  • Psychological and social problems, including discrimination and poor self-esteem.

Birth to Twenty

A study, Birth to Twenty (BT20), conducted in Soweto, showed that obese children between the ages of four and six were 42 times more likely to be obese in their teens, compared to their peers of normal weight. Childhood obesity is also a strong predictor of adult obesity. Once obesity in childhood is established, it is very difficult to treat. But it is not impossible.

Cause of childhood obesity

The causes of childhood obesity are complex. The most obvious causes are overeating and under exercising. Other reasons obesity may occur include: sleep deprivation, poverty, and genetic predisposition as well as social and environmental components.

As much as psychological issues can be caused by obesity, they too can lead to obesity. Kids who are stressed, bored or depressed may become emotional eaters. Certain cultural beliefs about body shape may further exacerbate the obesity pandemic.

Exercise and dietary recommendations

With under activity being one of the major contributory factors, it is worth noting the WHO exercise recommendations. Children in the five to 17 year age band should be getting a minimum of 60 minutes of exercise a day. This can be incorporated into play and sport.

The other main contributor of obesity is over eating. An average calorie intake for a child of the following ages should be:

  • 2 – 3 years = 1000 per day.
  • 4 – 8 years = 1200 per day.
  • 9 – 13 years = 1600 per day.
  • 14 – 18 years = 1800 per day.

These calories should include no more than 100 calories from added sugars. This equates to 25 grams of sugar or less than six teaspoons a day.

It is very easy to overshoot these numbers, considering that a 330ml can of Coke contains seven teaspoons of added sugar and contains 139 calories (already more than the daily quota for added sugar). While a medium chocolate muffin contains 364 calories.


Poverty also plays a huge role as energy dense food (often high in unhealthy fats) cost less than the healthier, low energy dense options, such as fruit, vegetables and protein.

Energy dense food contains high levels of calories per serving. These foods tend to fill you up, but often have poor nutritional value. They will usually contain hidden sugars, fats and salt.

For more information on the nutritional value of food, read the food labels on the packaging. Fatsecret South Africa is a very helpful website and can be downloaded as an app.

Sleep deprivation

Sleep deprivation is associated with poor eating habits and significantly increases the risk of becoming obese. The National Sleep Foundation recommends that three to five year olds should get between 11 to 13 hours of sleep a night, while six to 13 year olds should get nine to 11 hours.

So, how do parents prevent children from becoming obese?

Firstly, we need to lead by example. Parents are the single biggest influence on their children. We need to make healthy food choices as often as possible. Don’t keep high sugar and fat foods at home. Let your children learn that there are healthy everyday foods. These should be readily available where possible.

Then, there are ‘sometimes’ foods; these should not be kept at home or readily available. Be aware of the foods that are being advertised on TV and social media. Children are susceptible to this conditioning.

Packing lunch boxes

When packing a lunch box, make one swap a week to replace the unhealthy options until eventually you have a nutritious box packed. For example:

  • Swap dried fruit, which is high in calories and sugar and easy to over consume, for a fresh fruit.
  • Add a crunchy vegetable; they add colour and are high in nutrients.
  • Replace a cold drink with water. Flavour it by putting in a few berries or cucumber and mint.
  • Let your child experiment. Shift from white bread to whole grain.
  • To keep your child interested, try to vary between rolls, pita and regular bread.
  • Change the filling from jam or chocolate spread to a protein, such as cheese, egg or a nut spread.
  • If you are unable to make school lunches at home, get involved with the school tuck shop. Even if you are physically unable to help out, make suggestions of foods that should be offered and those that should not be.

Do not use food as a reward

Praise your child when making healthy food choices. Do not use food as a tool to bribe, punish or reward behaviour. It can cause an unhealthy relationship with food.

Eat as a family at a table

Where possible, sit together as a family to eat. Avoid eating in front of the TV or computer as this leads to mindless eating and often over eating.

Encourage activity

Encourage your child to take part in sport. Activity is of paramount importance in preventing obesity.

Obesity is preventable and it is a parent’s responsibility to assist in preventing it.

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.