Category: 2020 Summer – Diabetes Focus eMag

What’s in Shape Diet Meal Replacement Shakes?

Posted on by
Share

There were many comments from our readers after we shared the article on Shape Diet Meal Replacement Shakes. We share the relevant ones with feedback by registered dietitian and diabetes nurse educator, Tammy Jardine.

The carbs in Shape is high. How can it be diabetic friendly?

Diabetes management is tricky since every person is affected differently by this disease and the amount of carbs that one person can tolerate is not the same as somebody else.

A basic rule is to have no more than 45g carbs per meal which is about equal to a meat and salad sandwich. Every person is different and to determine your individual limit it is advisable to see a dietitian who specialises in diabetes. 

I currently use a meal replacement shake with high nutrition and am happy with my choice. Must I change it?

There are many meal replacement options on the market. Always seek the advice of a qualified dietitian to ensure you are getting the best option that works for you.

Is there sucrose in Shape?

No, there is no sucrose but sucralose (an artificial sweetener).

The non-nutritive sweeteners, sucralose (in the shakes), and sugar alcohols (xylitol) are safe to use for people living with diabetes. They don’t cause a rise in blood glucose levels.

There will always be controversy about sugar substitutes since they require processing to achieve final product. The debate is not whether it’s natural (since sucrose sugar is natural), but rather about the process and the chemicals required to process the product. In studies, there is no scientific reason to avoid sugar substitutes in diabetes.

What is the carbohydrate source in Shape?

The first three ingredients listed on the label are: skim milk powder, maltodextrin, whey protein concentrate and does not include sugar at all. The carbohydrate source of this product is maltodextrin.

MEET THE EXPERT

Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: [email protected]

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy for diabetic neuropathy

Posted on by
Share

Dom Van Loggerenberg shares how hyperbaric oxygen therapy (HBOT) not only healed his wound but helped with diabetic neuropathy.

People tend to think of diabetes as a silent, painless condition. Don’t tell that to the millions of folks with diabetes-induced tingling toes or painful feet. This problem, called diabetic neuropathy, can range from merely aggravating to disabling or even life-threatening. It’s something I have first-hand (or, more appropriately, first-foot)  knowledge about.

If you ask medical professionals what the biggest concerns around diabetes are, at the top of most of the list will be microvascular complications. Uncontrolled blood glucose damages nerves and capillaries (the smallest blood vessels). Starting with those furthest from the spinal cord, the toes and feet.

The start of neuropathy

I have been a Type 1 diabetic for the better part of the last 15 years. Being diagnosed as a young adult forced a lifestyle change on me that I was slow to adopt, and probably caused small medical complications that I will be dealing with for the rest of my life.

I am just over 1.9m tall and a rather large person and have had issues with peripheral circulation since I was a teenager. I have always had cold feet. This rapidly became a problem when I developed diabetes, turning into minor neuropathy that became increasingly severe. What started as a loss of sensation and occasional tingling became complete numbness.

This complication was manageable. Under doctor’s orders I needed to check my feet weekly (yay Sunday night foot rubs) and monthly pedicures. I’m serious, the doctor prescribed pedicures. It was a nice excuse for that end-of-the-month-treat-yourself-time. I also had to be extremely careful of hurting myself because I could very easily stub my toe or stand on a thorn and not even notice.

Small scratch, big problem

Now fast forward to 2020, life is changing for all of us. I don’t need to explain, the pandemic has affected everyone and we’ve all had to experience change as a result.

This is where the latest chapter of my diabetic journey took a turn for the worse. It’s early August and I’m having my first pedicure since lockdown started. It’s not the usual place I go to but a professional who was willing to visit my residence. While not being completely sure the chain of events they probably unfolded as follows: a small scratch on the side of my minimus (little toe). I don’t even react to this because it’s completely numb – so the pedicurist assumes no harm, no foul.

Wrong! Two days after this, I wake with my leg being a little stiff around the ankle. Due to me working from home I only walk maybe five minutes that day: kitchen, bathroom, desk (yes, not the most active). Next thing I know the sun is setting and I stand up from my desk. A sharp intense pain shoots up my leg and I panic. I haven’t felt pain in my foot for the better part of a decade. I start to examine my foot and it’s hot to the touch and very swollen. It’s infected and my toe is a deep purple. I swear it didn’t look like this when I woke up.

I contact my father, who is an emergency medicine specialist, and when I hear him say this is urgent I know I’m in trouble. He arranges a course of antibiotics to get to me that evening and examines my foot personally. I’m take four pills, three times of hospital grade antibiotics and my dad sends me into hospital first thing in the morning.

Diabetic foot

Arriving at the hospital, I have an emergency visit, the diagnosis is immediate: diabetic foot.

The truly scary thing about diabetic neuropathy is a 10-letter word we usually associate with horrific accidents or war veterans: amputation. When sensory nerves in the feet become damaged, a blister, cut, or sore can go unnoticed, allowing time for the wound to become infected. Infections that cause the tissue to die (gangrene) and that spread to the bone may be impossible to treat with cleansing and antibiotics.

Then I hear a sentence that shocks me to the core, one of the best doctors says, “I don’t think I can treat this, I am not comfortable in my ability as a doctor, the risks are too great.”

My mother, who is also a doctor, tells me will have a colleague look at me in the next hour. In the meantime, I have a Doppler ultrasound scan of my foot; it maps the blood flow, veins and arteries. Thankfully finding mine in my foot aren’t completely closed off. It has about 30% of a normal person circulation.

Hyperbaric oxygen therapy (HBOT)

Thankfully this medical horror story takes a turn for the better. About 45 minutes later, I have surgery on my foot and most of the dead and infected tissue is either drained or surgically removed. It’s now up to fate and my ability to heal.

I could completely recover with no permanent damage, and to promote this healing treatment it is suggested that I undergo Hyperbaric oxygen therapy (HBOT). Something that I had only heard of in movies (to treat divers from the bends).

Hyperbaric oxygen therapy is conducted within a pressurised chamber. It involves the type of treatment used to speed up healing of carbon monoxide poisoning, gangrene, stubborn wounds, and infections in which tissues are starved for oxygen.

If you undergo this therapy, you will enter a special chamber to breathe in pure oxygen in air pressure levels 1,5 to three times higher than average. The goal is to fill  the blood with enough oxygen to repair tissues and restore normal body function.

I was placed in a chamber for one hour for five days. This would help increase my healing and the wound would have a greater chance of successfully recovering back to normal.

Excellent results

And, yes, the wound healed well. But that’s not all, after my second treatment, getting out of the chamber and stepping off the bed, to my complete surprise I had tingling in my other foot, a sensation missing since I was first diagnosed. By the end of the week I could feel a touch on my foot and had a visible change in the tissue blood supply.

This was confirmed to still be the case six weeks later, when I went for my quarterly check-up at a diabetic centre. I hadn’t mentioned to my doctor that I went for HBOT yet she noticed the changes in my feet. My wounded one obviously had remnants of the procedure but my other foot had returned blood flow and sensation.

She recommended immediately to continue HBOT to see what changes further sessions could do. If 5 hours for one week could make a noticeable difference. Going for a maximum full six-week course of 30 sessions might do more. Normally five and 10 session sets are recommended. I am seeing what the maximum allowed would do.

Further benefits of hyperbaric oxygen therapy1

  • Many of patients mention that before they started HBOT, they had trouble sleeping. After the first session, their sleeping habits improved as did their attention to their diets.
  • HBOT is currently being tested in several antidepressants studies as the oxygenation of the brain seems to help.
  • It has long been known to help speed up wound healing and, in particular, wounds that have a poor recovery rate, like burns and skin flaps (it’s used post-surgery at the breast centre).

Reference:

  1. Milpark Hyperbaric Medicine Centre

MEET THE AUTHOR

Dom Van Loggerenberg (29) lives in Bryanston, Gauteng.

OVERDOSING

Insulin: overdosing and underdosing

Posted on by
Share

Diabetes nurse educator, Tammy Jardine, explains the various reasons for overdosing and underdosing of insulin.

There are serious consequences of insulin-related medication errors. The first is overdosing which results in severe hypoglycaemia, causing seizures, coma and even death. The second is underdosing which results in hyperglycaemia and sometimes diabetic ketoacidosis and long-term diabetes complications.

Overdosing

Giving too much insulin will result in hypoglycaemia. A hypo is when your blood glucose level is too low, usually below 4mmol/L.

Low blood glucose can occur if the insulin, the food you eat, and the physical activity you do are not balanced correctly and it can happen very quickly.

Overdosing may happen for various reasons

  • You give too much insulin for the meal that you have eaten. This is common if you give a standard dose of rapid-acting insulin with meals. Often the amount of carbohydrate in the meals you eat is not the same, and giving a standard dose of rapid insulin with all meals when you do not need it will cause your blood glucose to drop. For example, if you give a standard dose of 8 units of rapid insulin with breakfast. It may be a suitable amount when you have oats for breakfast but too much if you have an omelette instead.Also, if you overestimate the amount of carbohydrates in a meal you may overestimate the amount of insulin needed and cause a hypo if you are carb-counting.
  • Giving insulin to correct high blood glucose can also cause a hypo if you give too much insulin. This can often happen when you correct a high blood glucose after exercise. Some types of exercise can increase your blood glucose straight after performing the exercise and then drop rapidly over the next few hours as the muscles absorb the glucose from the bloodstream. It is advised to not correct high blood glucose in the six hours after exercise.
  • It may happen if you give your rapid-acting insulin instead of your basal (long-acting insulin) by mistake. Since the basal insulin is usually a higher dose than the rapid-acting insulin, it could be that you give a large amount of rapid-acting insulin which will drop your blood glucose quickly.
  • You can also overdose on insulin on a pump if your basal and bolus pump settings are incorrect.

Notice the symptoms

Everyone has different symptoms of a hypo, but the most common signs are trembling and shaking, feeling disorientated, sweating, being anxious or irritable, going pale, palpitation and a fast pulse, lips tingling, blurred vision, feeling hungry, tiredness, losing concentration, headache, and a fogginess in your head.

Sometimes you may already feel these symptoms when your blood glucose is falling quickly but are not yet below 4mmol/L. Testing your blood glucose regularly can help you to identify a hypo before you get any symptoms and prevent it from dropping too low.

If you are unable to tell when your blood glucose is low, you will only know by checking your level.

How to treat a hypo

You must act as soon as you notice symptoms of a hypo or if your blood glucose level is too low. If you don’t act quickly, it could get worse and you could start feeling confused and drowsy, and you could even become unconscious or have a fit. This is called a severe hypo.

To treat a hypo, immediately eat or drink something that has 15-20g of fast-acting carbohydrate. For example, three Super C sweets or five jelly babies or 200ml coke less sugar (new original taste) or 120ml litchi juice. Choose whatever you have on hand, or is preferable to your taste, or is easy to store.

If you are not sure how much carbohydrates are in a product, check the nutrition label on the product but be sure to look for the amount of carbs in the portion that you will be consuming. Wait 15 minutes and re-test your blood glucose. If they are not increasing at all then repeat the process.

Once you see your blood glucose rising, to prevent them from dropping again, eat 15-20g of slow-acting carbohydrate. For example, a slice of wholegrain bread with cheese or peanut butter, or a fruit and some nuts, or a glass of milk.

When help is needed

If you are feeling too confused or drowsy to eat or drink then ask someone to help you. It is important that your family, friends and colleagues know what to do if you have a severe hypo or become unconscious. If you are unconscious, they should put you on your side and call an ambulance.

Always keep hypo treatments by your bed in case you have a hypo at night. If a hypo doesn’t wake you up, you may realise that you had one if you feel very tired or have a headache the next morning.

Do a blood test before you go to sleep and during the night, If you think you may be having a hypo at night. If the one during the night is much lower, you may need to change your insulin dose. Speak to your healthcare provider about this.

Underdosing

Giving too little insulin will cause your blood glucose to rise above acceptable levels. This is called hyperglycaemia. A hyper is when your blood glucose levels are above 7mmol/L before a meal, or above 8,5mmol/L two hours after a meal.

If your blood glucose level is slightly higher than normal, you will not usually experience any symptoms but as they rise you may need to urinate more often especially at night, feel thirsty, have headaches, or feel lethargic and sleepy.

Underdosing may happen for various reasons

  • If you do not give enough insulin for the amount of food that you have eaten. Make sure you are aware of the amount of carbohydrate foods you are eating and how they affect your blood glucose after you eat them. Testing regularly will help you to identify foods that push your blood glucose up and need more insulin to prevent a hyper.
  • Not giving insulin or missing doses dose of insulin. Don’t skip insulin doses, specifically the long-acting bolus amount. You may occasionally fluctuate your rapid-acting insulin doses according to your blood glucose and what you are eating, but keep your long-acting insulin stable.
  • Your blood glucose levels could be higher than normal when you are unwell. You may need to drink more fluids, take more insulin and check your blood glucose more than you would usually. The amount of extra insulin needed will vary from person to person. Your diabetes team will help you to work out the correct dose for you.
  • Blood glucose levels may also spike because of a growth spurt or puberty, high stress period like exams, surgery or injury, and sometimes menstruation can increase blood glucose as well.

Diabetic ketoacidosis (DKA)

One of the risks of a rising blood glucose is DKA. If you blood glucose is more than 15mmol/L, you should check for ketones. If ketones are present, it is likely that you do not have enough insulin in your body.

DKA happens when there is severe lack of insulin in the body. Since glucose needs insulin to be able to make energy, this means the body can’t use glucose for energy and starts to use fat instead. When this happens, chemicals called ketones are released.

The difference between ketones when your blood glucose is high and you need more insulin, and the ketones that are produced on a (low carbohydrate diet) is the presence of excess blood glucose. Together with the ketones, the excess blood glucose will cause an acid build-up in your body, hence the name acidosis. If left unchecked, this can cause serious damage to your organs.

Warning signs

The warning signs for DKA are the same as for a hyper except that often there will be stomach pain, with or without vomiting. Sometimes there may also be a sweet smell on the breath that will smell like nail polish remover or boiled sweets.

Check your blood glucose straight away if you have any of the signs of a DKA. If your blood glucose is above 15mmol/L, check for ketones using urine sticks or a blood ketone meter. A blood test will show your ketone levels in real time but a urine test will show what they were a few hours ago.

If your blood glucose are high and you have ketones present in your blood or urine, you should get medical help straight away especially if you have abdominal pain or are vomiting. DKA is serious and must be treated in hospital quickly with insulin and fluids to prevent dehydration. Left untreated, it could lead to a life-threatening situation.

Avoiding DKA

You can avoid DKA by monitoring your blood glucose levels regularly and altering your insulin dose in response to your blood glucose levels and what you eat. Speak to your healthcare provider on how you can individualise this.

It is still a good idea to contact your GP or diabetes team if you feel fine but are getting higher than usual readings for blood glucose and ketones, or if you feel unwell but your blood glucose and ketones are only slightly higher than normal.

Besides the risk of DKA, having high blood glucose levels regularly can increase your long-term risk in developing complications, including problem with your eyes, feet, and kidneys, erectile dysfunction if you are male, and an increased risk of stroke and heart attack.

If you notice that your blood glucose levels are often high, you should contact your diabetes healthcare team. They will review your treatment and provide you with advice on how to get your blood glucose levels back within your target range.

MEET THE EXPERT

Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: [email protected]

Header image by FreePik
intermittent fasting

Why all the fuss about intermittent fasting?

Posted on by
Share

Dietitian, Chantal Walsh, explain the how intermittent fasting works and how it is an eating pattern rather than eating plan.

Intermittent fasting (IF) has become quite a buzzword and there is no shortage of freely available information about it. With its many promises to assist with weight loss, especially around the belly, control insulin levels and help brain function, it’s no wonder that we are all intrigued by this new pattern of eating.

What is intermittent fasting?

It’s an eating pattern that cycles between periods of fasting and feeding. During the fasting phase, there is a significant restriction of calories. On feeding days, there is no specific calorie requirements or certain types of foods recommended but rather focuses on when you should be eating them. It’s therefore not an eating plan but rather an eating pattern.

Patterns of intermittent fasting

There are numerous patterns of intermittent fasting that can be used.

  • 16/8 fast

In this pattern, you will fast for 16 hours and then eat for eight. This is often the pattern where we skip breakfast and only start eating about 16 hours after your last evening meal. This is followed for seven days a week.

  • 5/2 fast

With this pattern, you will restrict your calorie intake to 500 – 600 calories for two non-consecutive days, while the other five days you have your normal consumption.

  • Eat stop eat

This involves a 24-hour fast one to two times per week, where no calories are consumed on those days.

  • Alternate days

In this pattern, there is a restriction of calorie intake every second day (to around 500 calories), while on the feed days you continue your normal intake.

  • Warrior fast

This fast focuses on a 20-hour fasting period followed by a 4-hour feasting period. This is normally for the dinner meal that is a large portion of unrestricted foods.

  • Spontaneous fast

The last of the fasting patterns is where you choose a meal or two to skip as and when you feel it necessary.

Possible benefits

What does science say? Firstly, let’s look at reduction in adipose tissue and weight loss. It’s suggested that due to the limited time that you get to ‘feed’ that there is a reduction in calories and therefore results in weight loss.

In a review1, it was found that intermittent fasting reduced body weight by 3–8% over a period of 3–24 weeks. This was on condition that the food items that were chosen during the ‘feeding’ times where healthy food choices. Ensuring that the meals were balanced, incorporating loads of vegetables, lean vegetables and complex carbohydrates.

It’s therefore important to consider the nutrient density of the food choices, ensuring an intake of a variety of vitamins, minerals and other essential elements.

An observational study2 of overweight and obese men during the religious fast of Ramadan reported that since obesity is accompanied by increases in adiposity and changes in appetite-regulating hormones, if we decrease weight it alters the abnormal release of these hormones, which might be useful in managing obesity. Ramadan IF improved body composition and produced some positive changes in these hormones, these changes in hormone levels persisted for three weeks after the end of Ramadan.

With the possible weight loss that is experienced with calorie conscious IF, glucose (sugar) and lipid (blood fat) can also be improved. A 2017 review3 on intermittent energy restriction (IER) and time-restricted feeding (TRF) found that there are possible benefits of these styles of eating on weight loss and metabolic health. However, most of the studies are on animals and there is very little evidence currently in human studies.

In comparison to a calorie-controlled, nutrient density diet, it was found that long-term the effects on weight loss and lifestyle health benefits are similar to that of IF.

Yay or nay?

If you are considering intermittent fasting, consider the type of IF programme that suits you and ensures that you don’t get too hungry or that it affects your mood stability. Ensure that the types of foods that you choose are nutrient dense and full of vitamins and minerals. Monitor the calorie intake; you still want to stay within your specific daily requirements. It will take time to adjust to the new style of eating and for the body to adjust, be patient.

It’s important to remember that IF is one of the tools in your nutrition toolbox, it will need to be combined with basic nutrition guidelines, sufficient water intake and exercise. To help with the success of this style pattern, please contact a registered dietitian.

References

  1. Barnosky et al., 2014
  2. Zouhal et al., 2020
  3. Antoni et al., in 2017

MEET THE EXPERT

Chantal Walsh RD (SA) is a practicing dietician in Gauteng. She has a special interest in lifestyle illness (weight loss, cholesterol, hypertension) and sports nutrition and encourages clients to make small changes to reap the great health rewards. She is also a trained and practicing Pilates instructor.
De Villiers Chocolate

De Villiers Chocolate no added sugar range

Posted on by
Share

De Villiers Chocolate’s new no added sugar offering is now available. We get the lowdown on this new product.

Research indicates that indulgent purchases in comfort food, like chocolate, have increased during lockdown, and now De Villiers Chocolate, one of Africa’s first bean-to-bar chocolate brands, is making it even easier to find comfort.

At a time when consumers can all do with some guilt-free pleasure in their lives, this proudly South African chocolate brand has made one of the world’s most craved foods more accessible, by not adding sugar, dairy or gluten.

Years of experimentation

After years of experimentation on no added sugar options, De Villiers Chocolate is now officially the first South African chocolate brand to develop a wholly plant-based, keto, and Internationally Vegan Certified chocolate bar. The most unconventional bar in the De Villiers Chocolate range to date.

“We have been trying to perfect a no added sugar De Villiers Chocolate option for several years, but we couldn’t get it quite right. While there are many no added sugar chocolates on the market catering to health-conscious consumers, people with diabetes and those following the ketogenic and low-carb diets, most of the available options are a cheerless substitute for the real deal.  The most common downsides one usually associates with these products is the unpleasant aftertaste left by many of the sugar replacers, as well as unwanted gastrointestinal side effects. Then there is also the undesirable spiking of blood glucose levels,” says Master Chocolate Maker and owner, Pieter de Villiers.

Giving the consumers what they want

De Villiers Chocolate makes all its chocolate and inclusions in its factory just outside Paarl, near Cape Town. Their chocolate is made using cocoa beans sourced sustainably from farmers in Western Uganda. The bars are recognised by their colourful labels and loved by consumers for their moreish taste. Though many have been hoping for an option that is equally indulgent, but less ‘sinful’.

De Villiers Chocolate no added sugar range

Having worked tirelessly during South Africa’s lockdown period to perfect a no added sugar chocolate range, this chocolate brand is now ready to spill the (cocoa) beans, and share the joy.

“In our mission to develop a wholesome chocolate range, we refused to compromise on the flavour and texture of our bars,” says Pieter. “After extensive research, we finally landed on the right combination of ingredients to use in our no added sugar range, without compromising on flavour or wholesomeness.”

The secret? A curated blend of erythritol, monk fruit and soluble corn fibre; ingredients which have been carefully selected for their unique ability to mimic the sensory profile of sugar without causing any unwanted side effects. Without any milk or grain content, these bars are also suitable for lactose and gluten intolerant chocolate lovers.

To ensure that consumers can rely on these bars to be as good as they taste, De Villiers Chocolate worked with research consultant, Dr Lindie Schloms, who performed research on sugar alternatives to help the brand develop this diabetic- and keto- friendly chocolate range.

For Dr Lindie Schloms, it’s all about the development of healthier products by including antioxidant-rich superfoods, botanicals and adaptogens and reducing harmful ingredients, such as gluten and sugar.

Consumers will also appreciate that these bars carry International Vegan Certification, are Keto Certified and registered with the Rainforest Alliance in support of a mandate to do no harm and to ensure a better future for the planet and its people.

Spoilt for choice

Further cause for celebration is that consumers are spoilt for choice too, with Dark Chocolate and Nut Butter options. Chocolate enthusiasts can take their pick from 70% Dark Chocolate or Salt and Seed Dark Chocolate, as well as a range of nut-butter chocolate bars made entirely from scratch, using ingredients prepared and made in the De Villiers Chocolate kitchen. These include Sea Salt and Caramel Nut Butter, Chocolate Cookie Nut Butter (yes, also gluten free!), Almond Pieces Nut Butter, Cashew Nut Butter, Hazelnut Nut Butter and Coconut Nut Butter.

FAQs

What makes De Villiers Chocolate’s no added sugar options different than other brands?

While there are several no added sugar chocolates on the market to cater for health-conscious consumers, people with diabetes and those following the ketogenic diet, most of the available options are not nearly as palatable as one would like. They often leave a bitter aftertaste, include ingredients other than sugar that still cause blood glucose levels to spike, or cause unwanted gastrointestinal side effects.

Since De Villiers Chocolate didn’t want to settle for any of that, extensive research was done to find the right combination of ingredients to use in the no added suagr range, to tick all the boxes without compromising on taste.

The brand-new range is not only keto certified, but also vegan and sweetened with a curated blend of erythritol, monk fruit and soluble corn fibre. What is erythritol?

Erythritol is a sugar alcohol (polyol) that occurs naturally in fruits, such as melons, grapes and pears. It’s 70% as sweet as sugar, contains almost no calories (0 to 0,24 kcal/g) and has a zero glycaemic index.

Erythritol is considered to be one of the best sugar substitutes for people with diabetes and those on the ketogenic diet since it doesn’t increase blood glucose levels at doses of 20-64g. De Villiers chocolates contain only 16g erythritol per 80g bar.

How does erythritol differ from other sugar alcohols?

Erythritol is well-tolerated. It has the highest digestive tolerance of all the sugar alcohols, and long-term consumption of high amounts of erythritol hasn’t been associated with any serious side effects.

Unlike other sugar alcohols, which are fermented by bacteria in the colon and produce gas as a by-product, ± 90% of ingested erythritol is absorbed into the bloodstream before it reaches the colon. Since humans don’t have the enzymes required to break it down, erythritol can’t be metabolised and is excreted completely unchanged in the urine. The remaining 10% of erythritol, which is not absorbed into the bloodstream, travels undigested and unfermented through the colon.

The new range contains a variety of nuts, all boasting major health benefits. In other words, guilt-free chocolate?

Nuts are great for people with diabetes since they are low in carbohydrates and rich in healthy fats, fibre, protein, antioxidants, vitamins and minerals. Nuts, such as almonds, have also been shown to increase insulin sensitivity and reduce the rise in blood glucose levels after meals.

Almonds are one of the best dietary sources of vitamin E, a powerful antioxidant which helps to support immune-, heart- and skin health, while cashews have been linked to benefits like weight loss, improved blood glucose control and heart health.

Did you know that hazelnuts, for example, provide significant amounts of antioxidants protecting the body from oxidative stress?

To purchase this no added sugar chocolate, visit the De Villers Chocolate online store

summer 2023

DSA News Summer 2020

Posted on by
Share

DSA Port Elizabeth news

This year, with a multitude of challenges, is nearing the end. Most of us are survivors of the COVID-19 pandemic. We do send our sincere condolences to the families and friends of those with diabetes who sadly did not survive being infected with COVID-19. Please still practise social distancing, mask wearing and hand sanitising.

 DSA PE Annual General Meeting

Our normal monthly Diabetes Wellness Meeting are still not on the go. We are planning to meet again in February 2021.

We were challenged to arrange a virtual DSA, PE Annual General Meeting. This was held on 21 September 2020 via a Google meeting, combined with email responses from those unable to attend the Google Meeting.

This worked out well and we managed to receive the reports that had been circulated to all via email, and complete all the other official business.

The following Management Board Members were elected; Martin Prinsloo (Chairperson), Darren Badenhuizen (Secretary), Surendra Daya (Treasurer), Elizabeth Prinsloo (Branch Manager), Pamela Molefe (Nursing Advisor), Clive Burke (Springdale Wellness Group), Paula Thom (Young Guns) and Surendra Daya (Malabar Diabetes Wellness Group).

A screen shot of the Virtual AGM. Sadly, we forgot to take photos at the beginning so a couple of those present had already signed off. Those on the photo from left to right: Top row: Paula Thom and Coleen O’Brien. Bottom row: Elizabeth and Martin Prinsloo.

Virtual street collection

We could not hold our main fundraiser, our annual street collection, this year because of lockdown. So, we are currently hosting a virtual street collection and appealing to all to donate to help the Port Elizabeth branch. Contact us at 082 579 9059 for bank details.

Jessica, the dog who assists our regular volunteers to collect, posing with a huge collection tin in the cart to help promote the virtual tin collection.

DSA Pietermaritzburg news

DSA pays tribute to Ruby Skinner (1932 – 2020)

Ruby Skinner, supported by her husband Viv, served the local diabetes community in Pietermaritzburg wholeheartedly for two decades.

Ruby moved to Pietermaritzburg, in 1986, where she and Viv became involved in the Diabetes South Africa Pietermaritzburg Branch. The couple became widely known and loved in the area. Their efforts grew the Pietermaritzburg branch into a place where anyone with diabetes could come for advice and help.

Type 1 diabetes

Ruby developed Type 1 diabetes at the age of 29. Her daughter, Linda explains, “Not much was known about diabetes in the early 1960s and treatment was a hit-and-miss affair. Despite the medical risks at the time, she went on to have three healthy children and managed her diabetes without fuss or fanfare, giving herself insulin injections every day for the rest of her life.”

DSA Pietermaritzburg

Ruby became passionately committed to supporting others with diabetes. Working with their Pietermaritzburg branch committee, Ruby and Viv organised monthly meetings with expert speakers and carried out blood glucose screenings. To generate income for branch activities and to raise awareness, they organised street collections and other fundraisers.

Together with Felicity and the late Robin Giles, they organised regular camps for children with Type 1 diabetes, with the aim of educating and supporting children and parents about diabetes management, in a way that was fun and child-friendly.

Fellow diabetic and camp dietitian, Julie Peacock remembers, “Ruby was always present with a gentle, reassuring word and often a little chuckle, ever encouraging and loving.”

Ruby ran the DSA office at Hayfields Mall and counselled people from all walks of life about the importance of careful blood glucose management and making healthy lifestyle choices. Here she helped many people living with diabetes. Her nursing background and own extensive research meant she gave sound advice and monitored progress with genuine interest, kindness, and concern.

Her daughter, Norma reflects that “Ruby’s vision was to empower people with diabetes to live full, productive and meaningful lives by carefully managing their condition. She practised what she preached, her 88-rich years bearing testimony to her vision.”

Ruby will be remembered with great fondness, and for being a wonderful ambassador for Diabetes S. and its work in communities throughout South Africa.

(Acknowledgement: Kathy Johnson; “Obituary: Ruby Skinner (formerly Sharratt, nee Rowles) 26/07/1932 – 04/09/2020”; Published in The Witness 22/9/2020).

DSA Pretoria news

On 21 November 2020, we shook off the lethargy which had overtaken us during the long lockdown and joined forces with The Lions Club of Alberton for a Wellness Day.

We met at the Bracken City Mall and had a wonderful morning doing our community service. Encouraging passers-by to come for free diabetes tests.

Sister Liz de Lange did the diabetes testing on our behalf, while Brian and Liz Midlane assisted her.

The Lions were collecting food for animals who are in distress and handing out diabetes literature.

Between the two groups we both managed to get a lot of exposure for Diabetes SA Pretoria and the Lions Alberton.

A very beneficial joining of forces!

peace

Making peace with your diabetes

Posted on by
Share

Noy Pullen shares how she made peace with a life-threatening illness and offers guidance on how to make peace with your diabetes.

Have you ever looked back in your past at those people who made your life a misery? During the nineties, I was in England as part of a self-schooling course at the Centre for Social Development. Most of us were there because we wanted to make sense of the difficulties and hindrances that life had thrown at us. We did lots of biographic exercises to try to ‘read’ and write the real story of our lives

When you look back at your life whether it be the last 70 or the last 20 years, you can trace a thread that belongs uniquely to you. No one else has had the experiences you have had, all in service of your own development.

During the past months while everyone has had the opportunity of reassessing their lives, I joined an online creative writing group. Our writing prompt, Sally, offered the theme Memoirs. Every week she gives us a written topic to compose during the week about our lives which she reads and gives valuable feedback on how individual each one is when writing about a common topic. She shares our stories with the others in the group.

On Wednesday mornings when we ‘meet’, she gives us an impromptu speaking prompt to share. We have another opportunity to see and hear just how unique each one is, how differently we respond to a common theme.

When I share these written stories with my sister and brother we are often shocked by the difference our experience was of the times and events we shared.

Life-threatening condition

During the past year, I was diagnosed with a life-threatening condition. The doctors give a catalogue of symptoms, treatments and lifestyle modifications. It’s all so overwhelming. You can be pulled this way and that by the experts who have different opinions on how the condition should be managed. It’s rather like going to buy a coat. We know that the coat has a certain design. Yet each of us needs to find out what suits our unique body; the texture, colour and cost. Just so when faced with a diagnosis, like diabetes for example, how does one tailor-make the avalanche of information to accommodate individual needs?

Looking back to the schooling course in England, I found one of the exercises was helpful, in coming to terms with my condition. We were asked to recall someone, whether it be a teacher, parent, bully at school, sibling or employer, who made life miserable.

Even though we might have hated or feared them at the time, when looking back at this person all of us, without exception, found that the difficulties made us stronger. Perhaps more courageous, more tolerant, enabling us to grow. Let’s face it, we don’t grow when we’re sitting in our comfort zones, lazing about in the sun, visiting with friends. That’s where we recharge our energy.

Recall this person in the greatest detail; replay the experiences exactly as possible, but with the eyes of a stranger. Look at the consequences of the encounters. You’ll find you developed in some way. Looking at this person with hindsight, you can only think of them with gratitude for the lesson learnt. You’ll be surprised at what you discover if you think of this person objectively without bitterness. What has this to do with a life-threatening condition?

Making peace

The theme of this issue of Diabetes Focus is Making peace with my diabetes. Making peace implies that a war had been going on. Fear, pain, dread and an enemy. What started the war? Who is the enemy? What are they fighting about? What does the winner get?

Having learnt so much from my so-called enemies of the past, I tried this same exercise on my new situation on the battleground of health. There was no escape. I was wounded and scared. I needed an arsenal of ammunition to fight this monster. Perhaps you can look at these questions and write down your own experience on what your war is with diabetes. What are you afraid of? What do you dread? Who is the enemy, what the fight is about, who is the winner? And is there a loser? You may be surprised by what you discover about you and your diabetes. You may get to know each other better.

Are you ready to die?

Then I met with a priest who had had the same diagnosis as I had been given. Her first question was “Are you ready to die?” This was not what I wanted to hear. She said that this was a wake-up call for me to face my own mortality and then to embrace life fully.

As I went through the dreadful first stages of physical medical aspects of my condition, I realised that what she said could free me. I got my will and the list of all my personal papers in order. Quite an ordeal considering one of the items was my elaborating my funeral arrangements! I placed them all in a drawer and felt totally liberated as I had conquered a fear and could get on with living.

I may or may not have a long time. None of us knows how long, yet we can choose how to live these years our best way under the circumstances. This included listening to my own inner voice for clues. My life has led me to this point, living the only way I knew how until I got the wake-up call. The battle had begun. Now many options opened-up. What do I need to do differently so that I can change the trajectory of my life path which has led me to this situation?

Choosing the path where peace reigns

I chose a medical path that I trust and agree to follow. Not being told what to do, but choosing what to do. I embraced singing lessons, writing and drawing to widen my horizons.

Many people I had not seen for a long time contacted me. My family started a family chat group which has connected us all over the world; each member has said it is a true gift.

Is it easy living with a chronic condition? No, but in this battle, we are both the victor; it has changed me for the better. I am grateful; my opponent has become my teacher. My eating habits have benefited my body. The lifestyle changes have been brought joy and pleasure, despite the health challenges. There is a new bond between my community and me. Suddenly it does not feel necessary to sweat the petty stuff. The war is over; peace reigns in the newly acquired self-knowledge and gratitude for what has happened to me and why.

Enjoy your own voyage of self-discovery and appreciation for who you can become.

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

AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT

MANAGED BY NOY PULLEN

SPONSORED BY:

Header image by FreePik
family fitness

Make family fitness fun this festive season

Posted on by
Share

Whether there is one person or a few in a family who have diabetes, this may affect lifestyle habits and choices of the family. Wendy Vermaak informs us how to make family fitness fun.

Now that we are nearing a time of holiday or rest and recuperation from a tough 2020, the lifestyle habits of a family (as opposed to just those of each individual) become more evident. This is because when everyone in the family spends so much concentrated time together without the usual commitments of work and school, the choice of meals, leisure and activity times and family fitness must take the whole family into account.

Each generation teaches and guides the younger generations of which lifestyle choices are healthy and important. This follows through from where you decide to go on holiday, what meals you eat, how you plan your leisure or relaxation time and budget, and what physical activity you engage in, and so on.

Children learn from example

Research shows that children learn lifestyle habits from an early age, and that by a mere nine years old, they already have an established idea of what lifestyle habits are perceived to be the ‘norm’.

This is based mostly on their limited exposure to what their own family has taught them, as opposed to have experienced what other family’s lifestyles are like. Children learn by example from their parents and grandparents’ behaviour. Modelling a good example of healthy lifestyle habits entails regularly engaging in:

  • Regular exercise
  • Eating a healthy diet
  • Refraining from alcohol, drugs and smoking
  • Drinking enough water
  • Good hygiene
  • Getting enough quality sleep

Children learn from what they see, and parents choosing healthy lifestyle habits as a regular and continual choice day by day, as opposed to merely lecturing your children, has a much bigger impact on their learning response to healthy lifestyle habits.

What type of family is yours?

Choices that affect our families are whether you are the type of family who always goes away over holidays to rest, or decides to stay home.

Is your family avid campers? Adventure holiday seekers? Hotel or resort guests, or rather road trippers? Often your choices of where you go on holiday also affects what food choices you make and the physical activity level you choose to engage in.  

Whatever the choice, families have an opportunity to be physically active anywhere or anytime. Exercising should not be a mere chore to get through, or something to try to fit in when one finds the time.

As early as 1819, Edward Stanley wrote: “He who has not time for exercise, must create time for illness.” This lifestyle choice stands for every person of every age, and what better way to institute this healthy standard in your family than over the festive season break when families are often all together?

Use movement to develop relationships

Exercising together as a family is a great way to use movement to develop relationships and spend quality time together. Movement is an essential part of everyday life, for people of all ages. Movement affects development, learning, communicating, work capacity, health, and quality of life. Exercising together promotes open communication, and the feel-good endorphins promote good family relations as well. Encourage less screen time and more physical outings or games or sports as a family.

Exercise – the most underutilised medicine

Research shows that for those who are sedentary more than seven hours a day are 47% more at risk of developing depression than those who sit for four or fewer hours a day.

Women who don’t exercise at all have a 99% increased risk of experiencing depressive symptoms compared with those who exercise regularly.

Physical activity helps beat stress and prevents or treats many other health concerns and diseases. It is considered the most underutilised medicine and has the least amount of side effects as opposed to most medication.

Physical activity, whilst being fun, can have positive impacts on health, such as decrease dementia risk by 30% which is a specific concern for the elderly, and physical fitness levels improve cognitive performance (e.g. concentration, memory) for children and adults alike.

Exercise reduces the risk of certain cancers, such as breast cancer by 20% and colon cancer by 35%. It can decrease cardiovascular disease risk by 35% and Type 2 diabetes risk by up to 40%. More than 150 minutes of exercise each week is associated with a 0,89% drop in HbA1c.

One of the major benefits of having family as exercise buddies is that they are excellent accountability partners.

How to make family fitness fun

  • Put music on and have a dance contest.
  • Walk the dogs as a family.
  • Go on a hike in your area.
  • Turn a board game into an active game.
  • Play a game of cricket, touch rugby, or any sport in your back yard.
  • Complete an exercise routine in the garden/on the beach.
  • Build a sandcastle.
  • Ride your bike (or hire one for a cycle outing).
  • Participate in an online challenge.
  • Try a new skill that’s physically demanding, such as rock-climbing, or a dance class, or an aqua class.
  • Work as a team to complete physical tasks in and around the house, such as mowing the lawn, washing the car, cleaning the windows, mopping the floors, etc.
  • Incorporate exercise into your outings, such as visiting a zoo or street market where you can walk around a lot.

Before you start your family fitness, it’s always best to:

  1. Get the go-ahead from your doctor and to discuss possible medication changes.
  2. Consult with a biokineticist to discuss a suitable exercise programme to minimise any complications. Biokineticists are trained in monitoring blood glucose levels and effects of exercise on insulin, required nutrition, and specific exercise prescription for each patient noting their level of fitness, medication, and disease profile. Find a biokineticist near you www.biokineticsSA.org.za
  3. Use the right gear. Wear well-fitting, cool clothing and the right footwear to look after your feet. Also inspect your feet often to check for blisters, cuts and injuries. If you suffer from foot problems, avoid weight-bearing exercises and opt for cycling or swimming.
  4. Wear your medical alert bracelet or other identification when you exercise. The info should include your name, address, doctor’s details and phone number. If possible it should also include your medicine details.
  5. Inform the person you are exercising with that you have diabetes or any other major health conditions, whether it be a coach of any organised sports team, team players, friends or family. Explain to them how to respond if you should have a hypoglycaemic episode.
  6. Monitor your blood glucose before and after exercising and refrain from exercise if you are feeling ill.

Be aware of symptoms of hyperglycaemia (extreme thirst, hunger and urinations, blurred vision, fatigue) and hypoglycaemia (hunger, shaking, dizziness, confusion, sleepiness and weakness)

Written by Wendy Vermaak on behalf of the Biokinetics Association of South Africa.

Wendy Vermaak is a biokineticist in private practice in Johannesburg, Gauteng. She has a keen interest in falls prevention and balance rehabilitation, and is also the marketing director for Biokinetics Association of South Africa (BASA).

Header image by FreePik