Category: 2020 Winter – Diabetes Focus eMagazine

Dry skin conditions

The science behind caring for dry skin

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Dr Alexander Filbry, Head of Product Development for Body Care at Eucerin, looks at the causes of dry skin and the science behind Eucerin’s UreaRepair PLUS range.

What causes dry skin?

Dry skin is a very common condition and often results in visits to dermatologists. Symptoms vary according to the severity of dryness, but skin can be tight and rough and/or prone to itching, scaling, flakiness and redness. In extreme cases, skin is pathologically dry.

The main reason for skin dryness is an impaired skin barrier function which results from:

  • A lack of lipids that help to protect skin from moisture loss.
  • A deficit of urea and natural moisturising factors (NMFs) which bind moisture into the skin.

The story behind Eucerin UreaRepair PLUS

In the 1990s, Eucerin skin scientists were the first to discover how to include a natural moisturising factor in a dermo-cosmetic product. The NMF they used was urea and it has gone on to become one of the most respected and widely used ingredients in the treatment of dry skin symptoms. (Xanax)

People who suffer from dry skin need more than just immediate relief. They need a long-term solution which will prevent symptoms, such as roughness, itchiness and flakiness from returning.

The Eucerin team set out to create an effective range of products that would deliver both immediate and long-lasting relief for dry, very dry and extremely dry skin.

What are the active ingredients in the formula?

Urea is the key ingredient in Eucerin UreaRepair PLUS and, as part of our formulas, it improves natural skin exfoliation and soothes and smooths the surface of dry skin.

As an NMF, urea helps skin to regulate its moisture content and, being a natural skin compound, it is well-tolerated even by dry and sensitive skin.

Urea more effective when combined with other moisturisers

Our formulas are enriched with additional NMFs too. These include amino acids, inorganic salts and lactate, and they work alongside the urea to improve skin’s water-binding capacity and increase its moisture content.

Another key active in the range is ceramide. Ceramides prevent moisture loss from evaporation, and help to keep out the irritants that cause itching and inflammation. It has also been proven to help repair and regenerate skin’s natural barrier, lock in moisture and prevent and treat dryness.

These ingredients work together in the Eucerin UreaRepair PLUS formulas to repair the skin barrier, reduce moisture loss and bind water into the skin and many of the products deliver immediate + 48h dry skin relief.

 

dry skinChoosing the right product for dry skin conditions

Eucerin UreaRepair PLUS offers a comprehensive range of products which includes a cleanser, body lotions and creams.

These products are available with different concentrations of the water-binding active urea: 5%, and 10%. The concentration of urea needed, depends on the dryness of the skin. Those with dry skin may want to use a body product with 5% urea whereas very dry skin will benefit from a 10% urea product.

Clinically and dermatologically proven products

All the 5% and 10% urea Eucerin UreaRepair PLUS moisturisers are clinically and dermatologically proven to replenish both lipids and moisture, delivering immediate + 48h dry skin relief. They leave skin looking and feeling smooth, soft and supple.

Research on Eucerin UreaRepair PLUS 5% Urea Body Cream indicates:

  • A significant improvement in moisturisation, both immediately and 48 hours after a single application.1
  • 95,9% of patients scored the cream as “very good” and “good” in terms of tolerability.2

Research on Eucerin UreaRepair PLUS 5% Urea Body Lotion and Eucerin UreaRepair PLUS 10% Urea Body Lotion indicates a significant reduction of dry symptoms with daily use.3

Eucerin’s UreaRepair PLUS 5% Urea Hand Cream scored equally well in research with the sample reporting:

  • An immediate and significant decrease in skin dryness and roughness after a single product application.1
  • 97,2% of patients scored the hand cream as “very good” and “good” in terms of tolerability.2

Research proves the effectiveness of Eucerin UreaRepair PLUS products. Clinical and dermatological studies have also shown that UreaRepair PLUS products are suitable for mature skin and for those with psoriasis, keratosis pilaris and diabetes.4

References:

  1. Clinical grading and Corneometer measurements – Data on file BDF
  2. In vivo efficacy and tolerability study ¬– Data on file BDF
  3. Treatment of Xerosis with a topical formulation containing Gluco Glycerol, Natural Moisturising Factors and Ceramide; Weber et al., JCAD 2012
  4. Not all products are suitable for all conditions. Please refer to the information on pack.

MEET THE EXPERT

Dr Alexander Filbry is the Head of Product Development for Body Care at Eucerin and leads an outstanding team of skin scientists. He has a PhD from the University of Hamburg and over two decades of experience in derma cosmetic research.

For more information please visit www.eucerin.co.za

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PEAD-SA

PEAD-SA – Should children with diabetes go back to school?

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The Paediatric & Adolescent Endocrinology & Diabetes Society – South Africa (PEAD-SA) share their position statement on children with Type 1 diabetes mellitus returning to school.

All children should return to school in accordance with government guidelines. Type 1 diabetes mellitus (T1DM) does not seem to increase the risk of acquiring infection or of having COVID-19 severe disease in children and adolescents. Our position as PEAD-SA is that children and adolescents with T1DM should not be prevented from returning to school.

Background

The pandemic of infection with coronavirus (SARS-Cov-2), which has caused corona virus disease since 2019 (COVID-19) has affected all aspects of life throughout the world.

South Africa has not been spared and we are now in the early stages of this epidemic. The carefully considered and courageous decision by government to call for a lockdown was timely and necessary as is the easing to the different levels.

As part of this change, it has been recommended that children and adolescents begin returning to school. Considering concerns raised by numerous people, PAEDS-SA is presenting our position on this aspect of the epidemic.

What does PEAD-SA know about children and infection with SARS-Cov-2?

What we do know comes from very limited information from other countries and from limited local experience.

  1. Children (under 20 years) do get infection with SARS-Cov-2. In most countries, children make up a small fraction of all the people with infection. Thus, it seems that children and young people don’t contract COVID-19 at the same rate as adults. In China and Italy, children less than 10 years were only 1% of all cases, and those between 10 and 19 years were 1,2% of all cases. In the USA, children and adolescents (under 18 years of age) were 1,7% of all cases reported1,2,3.
  2. Children do not seem to get severe infection very commonly. This may be the reason why children make up such a small fraction of people with infection, because in most countries, people are only tested when they are ill. It is thought that most children get infected but do not have symptoms. Children rarely require hospitalisation or have severe disease4. (1,1% of cases are critical, 2,2% of cases are severe)5(5,7% of children hospitalised US)3
  3. Very few children have been seriously ill or have died from this condition. To date, it is thought that 30 children have died from COVID-19.
  4. Children do not seem to be responsible for the major spread of infection to others. Most children are infected by adults rather than from each other.
  5. It is not clear that children have the same risk factors as adults for serious illness e.g. hypertension, lung disease, Type 2 diabetes, etc. Reports from colleagues suggest that children with T1DM do not contract Corona virus infection more frequently than other children2 and do not have more severe forms of COVID-19 disease than other children. In China and Italy, no-one under 25 with T1DM landed up in hospital or with severe disease (needing ICU).2
  6. In South Africa, we are starting to see a few children with COVID-19 disease and the pattern does not seem to have changed from the rest of the world.
  7. We are seeing increasing numbers of children with stress, anxiety and other psychological, social and emotional issues because of the lockdown.

Conclusion

PEAD-SA, therefore, have taken the position that children and adolescents with T1DM should not be treated any differently from other children in terms of going back to school.

All usual advice for the care of children and young people with T1DM remains valid:

  • Better control means better health, particularly in winter when everyone gets sick.
  • Children with T1DM should have a flu vaccine.
  • Any illness will affect glucose control, which then needs extra attention.
  • If children are ill, they or their caregivers should not delay in contacting their healthcare provider because they are afraid of COVID; unmanaged DKA is far more dangerous.
  • Hypoglycaemia remains the most urgent problem that must be treated immediately, including at school.

PEAD-SA will continue to monitor reports from international organizations (WHO, ISPAD, ADA), colleagues and from across the world and update this statement promptly as new information becomes available.

Click on the video below to hear The International Society for Paediatric and Adolescent Diabetes (ISPAD)  statement on COVID-19 and children with diabetes.

REFERENCES: 

  1. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaSummary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Zunyou Wu, MD, PhD; Jennifer M. McGoogan, PhD JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
  2. Summary of recommendations regarding COVID‐19 in children with diabetes: Keep Calm and Mind your Diabetes Care and Public Health Advice | International Society of Pediatric and Adolescent Diabetes (ISPAD) | Ped diab 2020;21(3):413-414 doi.org/10.1111/pedi.13013
  3. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. 422 MMWR / April 10, 2020 / Vol. 69 / No. 14. CDC COVID-19 Response Team 
  4. SARS-CoV-2 Infection in Children Xiaoxia Lu, Liqiong Zhang, Hui Duet alNEJM 18 Mar 2020
  5. Clinical Manifestations of Children with COVID-19: a Systematic Review Tiago H. de Souzaa, MD, PhD; José A. Nadala, MD, MSc; Roberto J. N. Nogueiraa et al
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Biokinetics

Motivation, management and movement

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How do you find your winter mojo? The Biokinetics Association of South Africa (BASA) says it is all about motivation, management and movement.

We are now in July; this means shorter days and longer nights, thus affecting our general energy and motivation. These effects to the body and behaviour play a vital role in those with chronic diseases and their management, specifically those with diabetes.

The importance of these effects is extended to an ever-growing healthcare and economic burden of 1 in 11 adults (20-79 years old), presenting with diabetes and resulting in 10% of the global health expenditure (760 billion USD). These numbers are likely to double by 2030 without sustainable intervention.1

The needs of these individuals shouldn’t only emphasise blood glucose control, but more attention should be directed to preventing secondary complications, such as disability limitation and rehabilitation.

Thus, individuals with diabetes have been shown to have a substantial impact on the progression and reducing the development of their condition by participating in their own well-being.

Motivation

Physical activity isn’t only done by breaking a sweat at the gym. Any physical activity counts towards improving your health and managing your diabetes.4 Activities of daily living, such as walking, cleaning, gardening and shopping aid in lowering blood glucose and increasing insulin sensitivity.

Therefore, waking up to a daily routine of sweeping, washing dishes or trimming the lawn is some sort of physical activity. The objective is to find an activity you enjoy doing during leisure time and take that as an incentive to generate the habit of exercising.

In most situations, it’s enjoyable to do things as a family. Family activity could further be an education process to learn about the physical response to movement in diabetes. Plus, it can serve as an opportunity to establish risks, special considerations and ways to monitor blood glucose, in the event of an emergency.

A good foundation is limiting sedentary activities, such as computer time and using an elevator. Preferably do stretching exercises/leg lifts while watching TV, park your car at the far side of the parking lot, take an after dinner walk with family or friends, and schedule family time to do leisure activities.

The benefits of physical activity include a reduction in body fat, improvement in muscle strength and an increased sensitivity of the muscle to the uptake of glucose, improved blood circulation, bone mass preservation to prevent injury and falls, and an enhanced quality of life.

Moreover, it’s vital to have goals to achieve during exercising. This could be the ability to walk for long-distances or losing five kilograms of fat mass. Achieving these serves as motivation to most people and once you’ve accomplish your objective, you tend to achieve a balance between physical, mental and social well-being.

Management

As a person living with diabetes, you have both the right and the responsibility to manage your condition. There are several risk-reduction behaviours which predict good outcomes. These include healthy eating, being physically active, maintenance of adequate sleep, monitoring of blood glucose levels and medication compliance.

Self-management begins with understanding your base. This would include your current status, with regards to which self-care behaviours (as mentioned above) you’re implementing and which of them are deficit.

It isn’t only the adherence of these self-care measures but, more importantly, the inter-relationship between them. For example, how inadequate sleep patterns results in increased unhealthy dietary consumption and ultimately a skewed blood glucose profile.

Acknowledging how these factors might impact the nature of diabetes, it’s advisable to gain a better understanding through obtaining more information from trusted and reliable resources such as your healthcare providers.

A greater understanding of your condition is expected to have a more profound impact on your disease and complications.2 Thus, it’s imperative to monitor dietary intake and practice at least 150 min of guided physical activity per week, to promote sustained energy all-day.

Furthermore, monitoring sleep schedule with an average aim of eight hours per night, regularly recording blood glucose measurements throughout the day, and adhering to the correct medication dosages and regulations ought to be daily, thoroughly and consistently.

Holistic management of risk-reduction behaviour, specifically in combination with physical activity has proven to help achieve a variety of goals. These goals include increasing cardio-respiratory fitness and glycaemic control; decrease insulin resistance and blood pressure, and maintain weight loss in both Type 1 and Type 2 diabetes, of which all are associated reduced mortality.3

Movement

Biokinetics is the profession that has practically contributed toward addressing the general public’s attention that ‘exercise is medicine’. Previous studies have shown that a combination of diet, exercise and medication aid towards a healthy lifestyle and well-being.

All physical movement has the potential to improve physical and mental health. Similarly, the World Health Organisation explained health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity.5

Diabetes is a complex chronic ailment that can be managed through exercise to avoid secondary complications, progress of the condition, and exposure to cardiovascular disease (CVD) risk factors.

Some of the CVD risk factors include obesity, hypertension and dyslipidaemia (abnormal amount of lipids in blood) with complications that could result in excessive production of glucose and blood acids, leading to possible heart attack, coma and death.

Training components that are advised to treat/manage the condition are aerobic, resistance, flexibility and balance exercises. These exercises have shown to lower blood glucose, diminish risk for heart disease, reduction of stress and improves insulin sensitivity which means your body’s insulin works better.

Since blood glucose management varies with several environmental and medical factors, it’s critical for recommendations to be tailored for activity type and specific health complications to be effective.

How to move

Recommendations for exercise prescription are at least 150 min or more of moderate- to vigorous-intensity activity weekly. It’s also suggested that these activities occur at least three or more days during the week and individuals shouldn’t allow more than two days to lapse between activity sessions. This is so they can maintain higher levels of insulin sensitivity.6,7

Training sessions may be initiated by walking the dog, cycling, swimming and/or sit-to-stands. Thereafter, you can include body weight exercises, such as hip bridges, plank, push-ups, arm raises, sit-ups, curl-ups and crunches to build endurance and strength.

Lastly, you can end the session with static stretching exercises to increase range of motion around joints and flexibility. Moreover, balance exercises are advised for older adults with diabetes since they are prone to instability and falls. These movements comprise of standing on one leg, straight-line walking and wall lunges.

When we exercise, the body needs extra energy from blood glucose. The muscles take up much more glucose when you exercise which helps lower blood glucose levels. Likewise, the insulin resistance goes down and your cells can use the glucose more effectively.

Finding your winter mojo

During the winter months, with increased comfort-seeking behaviour, plus demotivation there is more than meets the eye to all physiological adaptations that take place due to inactivity, in combination with other risk-promoting behaviours.

However, finding your winter mojo and considering ‘exercise as medicine’ will have a positive impact on your lifestyle. The benefits are the release of the ‘feel-good’ chemicals (serotonin and dopamine) to reduce anxiety and/or depression; strengthening of your immune system to fight off bacterial and viral infections (colds and flu); and avoiding winter gain as inactivity and comfort may become more familiar.

Fortunately, we can manage controllable risk-reduction behaviour through lifestyle changes, including making better dietary choices and participating in regular exercise and physical activity. To reduce global healthcare costs and the prevalence of this devastating condition, we encourage you all to make the first step to a healthier lifestyle and visit a biokineticist near you.

Where to find a biokineticist?

For more information on where to find a biokineticist or on the profession itself, visit Biokinetics Association of South Africa (BASA)

For neurological rehabilitation or biokinetics services, visit Therapy & Beyond Centre: Walking with Brandon or contact 021 879 2280.

References

  1. IDF Diabetes Atlas 9th edition 2019 [Internet]. [cited 2020 Jun 24]. Available from: https://www.diabetesatlas.org/en/
  2. Shrivastava SRBL, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus [Internet]. Vol. 12, Journal of Diabetes and Metabolic Disorders. Springer; 2013 [cited 2020 Jun 24]. p. 1–5. Available from: https://link.springer.com/article/10.1186/2251-6581-12-14
  3. Sigal RJ, Cep MJA, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, et al. Physical Activity and Diabetes Diabetes Canada Clinical Practice Guidelines Expert Committee. 2018;42:54–63.
  4. American Diabetes Association. (2018). Standards of Medical Care In Diabetes. Diabetes Care, 33 (Supplement 1) S62-S69.
  5. Hall, J. E., & Guyton, A. C. (2016). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Elsevier.
  6. Mcmillian, D., Moore, Josef., Hatler, Brian & Taylor, Dean. (2006). Dynamic vs. Static Stretching Warm Up: The Effect on Power and Agility Performance. Journal of strength and conditioning research/National Strength & Conditioning Association.
  7. Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2018). ACSM’s guidelines for exercise testing and prescription. American College of Sports Medicine

MEET THE EXPERTS

This article was written by Simamkele Vena (BA Sport Science (UWC), Hons-Biokinetics (UWC) Intern Biokineticist) and Thulfieq Berhardien (Bsc (Med)(Hons), MPhil-Biokinetics (UCT) Registered Biokineticist) on behalf of Biokinetics Association of South Africa (BASA).  

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Peter Zangerle

Peter Zangerle – lockdown has helped improve my management of diabetes

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With no stressful job to go to and more time to exercise, Peter Zangerle tells us how lockdown has helped him manage his Type 2 diabetes.  

Peter Zangerle (70) lives in Sea Point, Cape Town. He is married and has an adult daughter. He has Type 2 diabetes.

Diagnosis

After a medical check-up in 2013, due to Peter feeling constantly tired, he was diagnosed with Type 2 diabetes at the age of 63. The doctor prescribed Janumet, Januvia, Metformin 500 and Forxiga.

Weighing 125kg, Peter lost 14kg due to the Forxiga which reduces blood glucose levels by helping the kidneys to excrete it, and supports weight loss. “But, I had to stop the medication as I formed skin rashes,” Peter explains. In 2016, he started using a Byetta injection.

Life as a tour guide

Being a tour guide for over 20 years, Peter says it has been impossible to manage his diabetes well. Firstly, he sits most of the day and then to top that, his finds his job stressful and he says he has always been a ‘stress eater’. “I get little sleep and the irregular eating times don’t help,” he adds.

The biggest positive of lockdown is that Peter has been able to walk every day for 30 minutes. “Without a job to go to every day, I have no stress, and I have time to walk. I eat properly and regularly, so much so that my Hba1C level is 6,5%. It has never been so low in the last two years; while I was working, it was 9,5%! The best thing is I feel wonderful!”

Knowledge is power

Currently, Peter uses Metformin 1000 XR, Jalra 50 and Ryzodeg 30/70 insulin. He says he started to gain weight again once he started Ryzodeg in November last year.

“Until January 2019, I managed my diabetes relatively well but afterwards it went bad. I didn’t get the right support from my doctor. I didn’t get any information about diabetes, when to measure my blood glucose, or any explanations as to what causes spikes. He also did not consider my extreme stress situation and the influence of my tour guide job. So, I studied diabetes through reading the websites of Mayo Clinic and Diabetes South Africa. I installed various apps, such mySugr app and a calorie and carb counter, and changed my diet to low carb and avoided anything with a high sugar content. Within two weeks, I was doing better. I also now test three times daily.”

Thankfully, Peter had an open conversation with his endocrinologist and Peter explained the support he needed and all was sorted out. “He had a more scientific approach and sadly no human approach. I need a doctor to work with me due to my working schedule. His nurse convinced me that he isn’t a ‘people person’. But, fortunately, his approach changed. Plus, to get a new doctor, I had to wait seven months.”

Time for retirement

Peter’s winter menu consists of vegetables, soups, fish, and meat once a week. With the added support of his family, he says he gets through the temptations of winter comfort food.

As for work, he says there will be no work until the middle of next year but is at peace that he needs to retire.

MEET OUR EDITOR

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

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summer 2023

DSA News Winter 2020

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DSA Port Elizabeth news

So far 2020 has been an interesting and strange year, first with power outages and then the COVID-19 lockdown. We have learnt how to persevere and to cope with various challenging situations.

Our last monthly Diabetes Wellness meeting this year was held in March in the Caritas Hall, Newton Park. As there was a sudden unscheduled load shedding, we used eighteen candles and three torches to provide light.

Our guest speaker was Lisa Luckman, a biokineticist, who explained, through a talk (without the help of a PowerPoint presentation), much about Bio+Kinetics = Life Through Movement.

Lisa demonstrated various exercises that most of us could do. We learnt that, irrespective of our age and physical fitness, scientifically-based exercise programmes will improve our health and general physical abilities.

The vibe was great and didn’t need modern technology to make it happen, just an enthusiastic speaker and our loyal people who attended and who, so eagerly, participated. So, we enjoyed a ‘romantic’ and educational evening filled with much fellowship and fun.

Currently, we are not allowed to hold public meetings but any one is most welcome to contact us at any time on 082 579 9059.

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lunch

Lunch ideas for home or school during lockdown

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Mommy, what are we eating for lunch? A question that most mommies have heard a lot during the lockdown period. Donna Van Zyl, a dietitian, shares a few lunch ideas for the family

School-going children generally have a routine and other activities that makes diabetes management a bit easier than children at home during lockdown. They may be sleeping late at night, waking late morning, and eating at irregular times. The lack of routine may contribute to irregular blood glucose levels.

In addition, we find ourselves walking far more to the cupboard or refrigerator due to boredom and we catch ourselves snacking slightly more. Boredom eating is one of the bigger challenges in lockdown and therefore routine should also be established like the school day at home with breakfast; school work; snack and lunch time. However, eating at home or school; a diabetic lunch is no different to a healthy lunch that every child should eat.

A healthy balanced lunch will ensure that your child gets the right amount of nutrients and energy they need to concentrate or perform optimally. A balanced lunch consists of a wholegrain/unrefined low-GI carbs, protein, fats, fruit, salads and vegetables.

 Tips for lunch or lunch boxes

  • For those who are carb-counting, a good tip is to write down the total amount of carbohydrates on a sticky note, paste inside the lunch box so that it is easier for your child, or the school nurse, to count carbs at school. Preparing portioned foods can also aid your child at school, or at home, when carb counting.
  • Prepare or pack a healthy lunch you know your child will eat. Otherwise your child may enjoy swopping his or her food with friends or end up not eating. It is important to switch up the foods regularly. Let your children try new foods over the weekend or at night, so that you know whether you can prepare or pack the food in for them.
  • Allow your child to help you prepare the lunch or pack the lunch box. At the same time, you can teach your child how to do the carb counting or even some culinary skills. Often children who take responsibility for preparing the meal establish healthy and good eating habits.
  • Always provide a low-carb option, such as a protein or fat snack. See options listed below.
  • Always have a snack available to pick up a low blood glucose level; longer life options, such as a packet of raisins, can be kept close by just in case.
  • Prepare food in advance and freeze or prepare more portions the evening before so that leftovers can be used for lunch the next day

Use leftovers

How to use leftovers the next day; and if there are no leftovers what can you serve for lunch tomorrow?

When leftovers are available:
Chicken Chicken mayonnaise whole-wheat wraps, whole-wheat rolls with added salad preserves

Pesto quinoa/durum wheat pasta chicken salad with added rosa tomatoes and feta

Pineapple and pineapple mixed salad

Chicken, feta and bean salad including salad preserves

For the lower carb: Chicken salad with a honey mustard dressing
Steak Steak Prego whole-wheat roll with added salad preserves

Stir-fry and steak vegetable wrap

Steak strips served with baby potato salad and salad/veg on the side

For the lower carb: Steak salad with a balsamic & olive oil or Blue Cheese dressing
Mince Mince and cheese toasted whole-wheat or rye sandwich (can even be topped with a fried egg)

Cheese, mince and corn whole-wheat wrap (Toasted)

Mince, guacamole, corn and diced tomato tacos
Prepared Soup Chicken and noodle soup

Hearty beef and barley soup

Vegetable and lentil soup

When no leftovers are available:
Eggs Lean bacon, cheese and egg toasted whole-wheat sandwich

Scrambled egg muffins/omelette (bacon, mushroom and cheese or spinach and feta) served with a whole-wheat or rye toast
Tuna Apple and tuna salad mixed with salad preserves and mayonnaise

Tuna pasta salad

Salmon and tuna fishcakes (prepared) served with roasted vegetables or mixed assorted salad

For the lower carb: Tuna, cucumber, tomato and chickpea salad dressed with mayonnaise

 

Snack items

For those children heading off to school, a lunch box can include a few more snacky items; especially when lunch is generally served at home. You can include the following:

  • Proteins

Scrambled egg muffins; or lean meat, such as beef strips, chicken breasts strips, sosaties (mini), biltong, salami slices/sticks, meatballs (chicken or beef), cheese: wedges, blocks of cheddar cheese, cottage cheese or cream cheese, yoghurt, smoothies.

  • Starchy food

Whole-wheat/rye bread, whole-grain Provitas, wraps, brown rice, quinoa, barley, baby boiled potatoes/sweet potato with the skin, and durum wheat pasta.

  • A good helping of salad, vegetables and fruit

Fresh fruit is easy to pack; or chopped fresh strawberries, pineapple fingers, apple slices, orange or naartjie wedges. Remember to count the fruit towards your carbs.

Raw veggies, such as carrot sticks, cherry/Rosa tomatoes, mini cucumber or sliced, gherkins, mini corn, corn on the cob, capsicum strips are all popular to add colour to the lunch box and can always be served with a dip: sour cream/hummus or guacamole.

Nuts and seeds or unsweetened nut butters can also be added as an additional treat.

The actual lunch box

  • Ensure it is a strong container that will protect the food from being squashed.
  • Have smaller containers available for dips, sauces or cut-up fruit.
  • When choosing a water bottle, make sure that it will be easy to clean. Some juice containers have a removable ice pack that you can use to keep the water cold. This is also great for milk or smoothies.
  • You can use a soft cooler bag for food that needs to be kept cool.
  • And remember to wash out the lunch box daily.

MEET THE EXPERT

Donna van Zyl is a private practicing dietitian for Nutritional Solutions, Bloemfontein. She is growing in the field of paediatrics and plays a key role in individualising nutritional therapy for Type 1 diabetics. Her special interests are optimising health, managing chronic lifestyle related diseases, and sports nutrition. She lectures part-time at the University of the Free State, which she enjoys thoroughly.

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Youth with diabetes

Youth with Diabetes – How to decide if your child should go back to school

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We hear Youth with Diabetes’ position statement on whether sending your child with diabetes back to school is a good idea.

Two large studies from England have just been released on COVID19 and diabetes. Because of this new information, Youth with Diabetes is adjusting our recommendations about going back to school. Please use this new advice to help you decide if you will be sending your child back to school.

The studies show that people with Type 1 diabetes are more at risk of dying from COVID-19 than those with Type 2 diabetes.

After taking into account age, sex, heart disease, socioeconomic status and race, people with Type 1 diabetes are almost three times more likely to die from COVID-19 than those without diabetes. (Hazard ratio of 2,86).

If your HbA1c is more than 10,0%, you are twice more likely to die than if your HbA1c was less than 7,5%. (Hazard ratio of 2,19).

It is important to note that age is the most important risk factor, even if you have diabetes. In these studies, no one with Type 1 diabetes under the age of 50 has died. Most of the COVID-19 deaths in Type 1 diabetes have been in the age group of over 70 years.

Other risk factors that contribute to increased risk of death for people with Type 1 diabetes are obesity and chronic kidney disease.

All this information means that you can reduce your risk by getting your blood glucose level under control and losing weight if you are obese.

Here are the links to read the full research articles:

https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf

https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf

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good exercise

Keep up good exercise during winter

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Nick Caracandas from Diabetic Athletic shares an action plan to keep up good exercise during the colder months.

As people living with diabetes, we know that our condition is a full-time job. We also know that with any full-time job, it helps to create a happy and healthy working environment.

If we make enemies and cause difficulty in the workplace, we can expect our time at work to be less desirable and more challenging than it needs to be.

The same goes for our job while being the CEO of our diabetes. Granted, we didn’t ask for this position, however, it’s here and most likely here to stay.

Be the CEO of your diabetes

The environment we create each day is the largest contributing factor to how we manage and maintain our physical, mental and emotional well-being with diabetes. All three are important for our workplace but also for us as healthy and happy diabetes patients.

Being the CEO, we need to manage our diabetes as we would manage any employee or aspect of our business. We need to have respect, understanding, patience, and put effort in; and only after that can we expect the same in return.

One of the best ways to make sure that you can maintain a more proactive winter season is to implement an action plan that can keep you on track.

I say proactive because most of us are handling our glucose levels, our exercise and our diets in a reactive manner. How often do you fix high glucose only after its sitting in undesirable ranges?

This is an example of reacting to our diabetes, rather than getting to know our patterns and proactively avoiding the high by acting before it happens.

Being reactive to weight gain or our glucose levels can get tiring and can cause potential diabetic burnout, that so many of us experience.

For you to increase your sensitivity to insulin, to tolerate carbs better and to maintain tighter control over your diabetes, you’ll need to create a daily lifestyle that helps achieve this.

Diabetes management 101

As people living with diabetes, we need a mind-set and understanding of the fact that diabetes is managed with exercise, nutrition and medication. This is how it is meant to be. No other way.

Regular exercise helps your body lower blood glucose levels, reduces insulin resistance and promotes weight loss, reduces stress and enhances physical fitness and enjoyment of life. Therefore, exercise is not a suggestion but is medicine and is considered one of the main tools to manage diabetes.

Planned and unplanned activity

First, I’m going to talk about activity. There are two kinds:

  1. Planned exercise, such as gym, workouts, cycling, and sports matches.
  2. Unplanned exercise, such as gardening, walking the dog, walking to the shops, or on the beach.

As any diabetes patient or individual wanting to maintain the best possible health, we need to make use of both these types of activity. Most of us will prioritise gym (planned activity) over unplanned activity which ultimately creates far less overall activity.

To explain: 

There are 10 080 minutes in one week. If we plan to go to gym three to five days a week, this only equals 180-300 minutes of activity out of a 10 080-minute week. This, unfortunately, will never be enough to make the change we’re after. The amount of activity versus the rest of the time we sit, sleep, work and eat are just not in favour of getting a positive outcome.

It must be said that going to gym three to five days a week isn’t easy to do, and you get an A+ for it! The issue here is that although you get an A+ for gym attendance, it’s still only 180-300 minutes of activity out of your 10 080-minute week. This means that your overall activity is still far too low for a good working environment for your diabetes.

So, what’s the fix?

We use gym sessions, or planned activity to provide us with a solid exercise base and strength within the body, and to maintain integrity within our joints and skeletal muscle. Planned activity is also good for making time for yourself, this is vital.

This kind of activity is best paired with non-exercise activity. This is where your daily steps come into play. By setting a challenge to achieve 10 000 daily steps, you’re going to increase the amount of time you spend being active throughout the entire day, not just the 45-60 minutes at the gym or walking from 6am -7am.

By increasing the unplanned activity, you’re going to cause your overall activity to be where it needs to be to have better glucose control and get better results.

Now that your overall activity is higher, you can start putting more effort into your exercise programme. I always tell my clients that the 10 000 daily steps will help improve heart health and will allow you to be able to ‘afford’ food.

Three types of exercise

For the best exercise plan as a patient living with diabetes, it’s recommended you first understand that there are three types of exercise:

  1. Aerobic – swimming, running, cycling, etc. These are generally long and steady-state in nature.
  2. Anaerobic – weight training, bodyweight, resistance training, etc. These are usually weighted workouts with resistance.
  3. Stop-start training – high-intensity interval training, or workouts that are both aerobic and anaerobic in nature.

Each of these will have different effects on your glucose levels. Aerobic activity will likely cause a low glucose event (hypo), while anaerobic activity will cause an initial spike before a potential glucose low.

Knowing how to exercise while staying in the range is the ultimate key to diabetic success. Having new workouts to do at home with no equipment is exactly what most of us need this winter to keep glucose levels in range and to keep the winter blues at bay.

Something to remember whenever you’re completing any kind of training or gym activity is that the higher the intensity, the more potential your glucose will have to spike.

Generally higher intensity exercises are completed over shorter durations due to the increased intensity (think about a sprinter running a 100m race, that pace can only be held for short periods of time).

Lower intensity workouts are more likely to cause a hypo and are often longer workouts due to the low intensity and increased duration of the activity (think about a long steady-state or slow-paced run).

Plan your workouts

  • Avoid a blood glucose low when doing an aerobic activity. This means eating carbs prior to training. Usually about 10-20g for most.
  • Avoid a blood glucose spike when doing weighted exercises or high-intensity classes or sessions, etc. This means giving insulin 10-15 minutes into your workout.
  • Find out how to create and complete workouts that serve a purpose towards your strength and fitness while causing the least disturbance to your glucose ranges.

Use these three points as a mini checklist to create the proactive mind-set, rather than training with random workouts and reacting to your diabetes.

Search for patterns and learn the rules

Diabetes control isn’t as random and as hard as most people believe. It hard for those that don’t yet understand certain diabetic guidelines and foundations.

Accounting is a good example. I struggled with accounting in matric. Was I the only one? No! The ones that excelled at accounting took the time to find patterns and learnt how the rules of accounting worked. Granted I never did this, and so, it led me to a place of overwhelming struggle.

If you can take the time to learn about exercise and diabetes, you’ll start to enjoy how easy increased activity can make your diabetic control. Just like any skill, it takes initial practice and a lot of repetition in the beginning.

I know this is all very easy to read and is often not as easy to act on and to apply. For this reason, I have included my Diabetic Athletic Custom Toolkit of guides to help you with everything you need.

These guides are free and for you to use as resources in your diabetic toolbox so you can master the diabetic skills to exercising with diabetes while staying in range and enjoying the process.

Download your FREE Diabetic Toolkit here.

Here is a home workout for beginners:

(These warm-ups and exercises have been taken out of my home workout guide for diabetics)

Get your free workout here: https://bit.ly/2WTGzO8

Read more about the frequently asked questions regarding glucose levels and exercise.

MEET THE EXPERT

Nick Caracandas is a strength and conditioning coach with a passion for helping fellow diabetes patients learn more about how to live life with more diabetic impact, freedom and control. With over 15 years as a fitness professional and gym owner, he has developed an online programme that takes diabetes patients from a place of struggle and guides them to a place of empowerment and confidence through exercise and nutrition. As a Type 1 diabetes patient for over 24 years, he has created multiple online programs that merge his experience with being a diabetic and being a reliable option for other diabetics worldwide. 

Header image by FreePik

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