Category: 2022 Spring – Diabetes Focus Online

kidney disease

Prevent the silent onset of chronic kidney disease

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This National Kidney Awareness Week (5 to 9 September 2022), let’s really appreciate these vital organs and make sure we’re living in a way that promotes our kidney health.

“By the time most people become aware that their kidneys are failing, they will already have lost 50% of their kidney function.”

Kidney disease is an irreversible illness that affects 10% of people across the world, and up to one in eight people in South Africa.

Function of the kidneys

The kidneys are a pair of bean-shaped organs found at the back of the body at about the level of the waist. Each kidney holds thousands of filtering units. As our blood moves through them, they filter waste products and extra water out and these are released in our urine.

Paediatric nephrologist, Professor Errol Gottlich, says, “Kidney disease is silent, meaning it often develops without any noticeable symptoms. By the time most people become aware that their kidneys are failing, they will already have lost 50% of their kidney function.”

“Kidneys also balance our fluid levels ensuring we don’t become over-hydrated or dehydrated. They normalise electrolytes and blood pressure, assist in calcium metabolism and prevent anaemia.”

“Our kidneys are essential for a normal, healthy lifestyle. The kidneys fulfil many roles, the most important of which is excreting toxins out of the body in the urine.”

Prof Gottlich also heads up Discovery Health Medical Scheme’s Kidney Care Programme, which is designed to ensure the best quality of care and life for medical scheme members on chronic dialysis.

Paediatrician, Dr Nokukhanya Ngubane-Mwandla, adds, “The kidneys have multiple important functions in the body, including controlling acid-base homeostasis, water and electrolyte balance and blood pressure. They also produce certain hormones important for production of red blood cells and bone mineralisation.”

Dr Ngubane-Mwandla is the recipient of a 2020 Discovery Foundation Sub-Specialist Award and is using this support to work towards improving the lives of children with congenital and acquired renal pathology.

How to look after your kidneys

Taking care of your kidneys is as simple as leading a healthy lifestyle. Professor Gottlich recommends that people do the following:

  • Ensure regular exercise. Exercise for 30 minutes, five days a week. Even a brisk walk is an excellent form of exercise.
  • Adopt a balanced, healthy diet of unprocessed, fresh foods with no more than a teaspoon of added salt per day.
  • Regularly check and control your blood glucose.
  • Regularly check and control your blood pressure.
  • Drink an appropriate amount of fluids. Your doctor will explain how to adjust your fluid intake if you have kidney, heart or liver disease.
  • Don’t smoke as smoking slows the flow of blood to the kidneys.
  • Don’t take over-the-counter pain or anti-inflammatory pills regularly.Long term, frequent use of medicine, like Ibuprofen, can harm your kidneys.
  • Get your kidney function checked regularly if you have any of the high-risk factors, such as diabetes, high blood pressure, a family history of kidney disease, and being overweight or obese.

A silent disease: What damages kidneys and how?

Discovery Health’s data show that around 75% of renal (kidney) failure is a result of diabetes or hypertension (high blood pressure). Data from the National Kidney Foundation mirrors this with up to 65% of kidney failure in South African adults being attributed to hypertension and up to 25% due to Type 2 diabetes.”

“Uncontrolled diabetes can damage the blood vessels in your kidneys and can gradually decrease the functionality of this vital organ. And untreated high blood pressure experience damage to their kidney tissue as a result of blood vessels being exposed to a higher than normal blood pressure,” adds Professor Gottlich.

Other causes of kidney disease include living with HIV and other infectious diseases, auto-immune diseases, and structural abnormalities.

Dr Ngubane-Mwandla adds, “There is also a relatively high incidence of kidney problems among South African children. Some of these problems are congenital, which means that children are born with them, but several conditions are caused by malnourishment and gastric issues.”

This passionate doctor adds, “It would be great to implement screening programmes at schools or at primary healthcare facilities, in particular to ensure blood pressure and urine screening, to detect the early onset of kidney disease, especially those born prematurely, at a low birth weight or who have a family history of kidney disease.”

The National Kidney Foundation notes that up to 80% of chronic kidney failure may be preventable, making it vital to keep up regular screening checks that will identify signs of chronic diseases like kidney disease and others, as early as possible, in adults and children alike.

Catch the onset of kidney disease early on – simply screen

The good news is that, for most people, screening for kidney disease can be done as part of regular health check-ups.

“It’s really as simple as going to your primary healthcare provider and doing a screening test for high blood pressure, blood glucose levels and kidney functionality,” says Professor Gottlich.

“Essentially, your urine is an easily accessed window to your kidney health. A dipstick into the urine sample will show markers of possible kidney health issues.”

Treating chronic kidney disease

Once a person has chronic kidney disease, they will need to undergo chronic dialysis (an average of three sessions per week), explains Professor Gottlich. Patients may either undergo:

  • Peritoneal dialysis, which uses the lining of their abdomen to filter the blood inside their body.
  • Haemodialysis, which uses a dialysis machine and a special filter, called an artificial kidney or dialyser, to clean the patient’s blood.

“In addition to dialysis treatment, it is critical that patients live a healthier lifestyle and take prescribed medicine to control blood pressure, improve anaemia and bone health,” adds Professor Gottlich.

Complex illness and expensive to treat

Chronic kidney disease is a complex illness that is expensive to treat.

  • In 2021, Discovery Health paid out R1.5 billion in kidney treatment related claims for about 3,000 members – of which 0.6% was for members under the age of 18, reflecting the way in which kidney disease affects children too.
  • Interestingly in 2020 Discovery Health paid out a slightly higher R1.6 billion in claims from about 3,500 medical scheme members for kidney treatment. The 14% drop in members claiming between 2020 and 2021, shows the decrease in screening and treatment for kidney disease and other chronic treatment over the course of the COVID-19 pandemic. This is due to the fact that people have stayed away from healthcare facilities out of fear of exposure to COVID-19, due to stay-at-home measures imposed to curb the spread of infection, and also due to the redirection of resources in healthcare towards COVID-19 care, especially during peaks of infection.

Organ donation a lifesaver for people who live with kidney disease

“The most ideal therapy for chronic kidney disease is a kidney transplant,” says Professor Gottlich.

“However, there’s been a significant decrease in organ donors over the past two years because of COVID-19 and very few kidney transplants have been done during this time.”

Dr Ngubane-Mwandla adds, “There is a great need for organ donation and transplantation for kids too, particularly for those children treated in the state sector. Until transplanted, these children must stay on a chronic dialysis programme. Some, we transition to haemodialysis which is both costly and needs regular visits to the hospital so really affects and defines a child’s life. The sooner a child in need receives a kidney transplant, the better for the child and their family.”

One organ donor can save seven other lives. Your heart, liver and pancreas can save three lives and your kidneys and lungs can help up to four people. And, one tissue donor can help up to 50 people by donating their corneas, skin, bones, tendons and heart valves.

Sign up to be an organ donor – Organ Donor Foundation of South Africa.

All medical information in this article including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to empower diabetes patients and their families by promoting a better understanding of kidney disease.

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Resistance bands

Resistance bands to manage your insulin resistance

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Biokineticist, Vishaan Makan, explains the benefits of using resistance bands in your exercise routine to manage your insulin resistance.

Looking to manage your diabetes? Improve your health and well-being? Maybe even lose a few kilos before summer? Do all this, through exercise

Exercise has proven to be an effective strategy to manage your diabetes. Colberg et al (2010) explains that regular participation in exercise improves blood glucose levels, prevents and delays the onset of Type 2 diabetes and maintains numerous cardiovascular improvements.

Research shows that many exercises are appropriate for the management and prevention of diabetes which can be done at home.

Biokineticists have found that walking, running, swimming, dancing and strength training are amongst the most effective and appropriate exercises to perform. We recommend daily participation of approximately 30 minutes of exercise at a prescribed intensity from your health professional.

Benefits of consistent exercise

  • Lowered risk of cardiovascular accidents (stroke or even death)
  • Improved blood glucose control
  • Improved utilisation of insulin
  • Improved blood pressure
  • Decreased risk of obesity
  • Improved levels of cholesterol
  • Improved quality of life

Strength and resistance training

While exercise can be performed in many ways and settings; strength and resistance training will be the primary area of focus. Strength training is known to be the most challenging and daunting amongst our population, due to its intensity and assumed adverse effects. Strength training is not limited to heavy weights and clanging dumbbells in the gym. In fact, there are multiple ways to employ strength training in your lifestyle and reap all the benefits. One highly effective and popular method is through resistance bands, which are affordable, easy to use and can be adapted to target the full body.

Resistance bands are flexible, elastic rubber hoops, which are extremely versatile and useful to target multiple outcomes, namely strength, endurance, balance, cardiovascular health and even weight loss. These are only some of the crucial aspects that exercise targets to better manage your diabetes.

Using resistance bands are simple and can be used to either make basic movements easier or even harder. These adaptations allow for an individual to get stronger and progress in their exercises, thus achieving greater benefits.

Ways to include resistance bands in your exercise routines

To add to their versatility, resistance bands come in varying resistance levels, to accommodate for all strengths and abilities. The varying resistances allow for beginners to utilise them and progress while still accommodating for those who are more advance.

These resistance bands are a well-known and popular items used by all biokineticists. They are known to produce the same results as the hard iron plates in your local gym. In addition to the strength gains, they assist in improving joint stability, thus reducing our risk of injury, in addition to assisting us in improving the quality of our exercises.

Your biokineticist will use these bands in a session to complete prescribed exercises, based on set goals, function and ability; several aspects as observed in your initial assessment.

Your initial biokinetics assessment will be individualised to you and will comprise of multiple tests to assess aspects of your physical function, namely strength, BMI, endurance, cardiovascular fitness, balance, gross motor skills, flexibility and various physiological screenings (blood pressure or glucose).

The impact of exercise on diabetes

As we know, diabetes needs to be well-managed to avoid detrimental incidents, such as hypoglycaemic or hyperglycaemic episodes, which could lead to further life-threatening states. Management of diabetes is prominently done through diet, however, exercise can have just as great of an effect.

Exercise directly affects the body and its blood glucose levels, through increasing insulin sensitivity and lowers fasting blood glucose levels for a 24-hour period, following exercise.

Research has shown that moderate exercise after your meals, will decrease the spike in blood glucose levels and allow for a more neutral reading, specifically in Type 2 diabetes. Hence, we emphasise the importance and necessity for regular physical activity, to reap these benefits and help yourself in managing your diabetes.

Daily is best

Exercise in any form should be performed daily to lead a balanced lifestyle and ensure improved management of diabetes and other illnesses or injuries.

Once again, we recommend you perform any of your favourite exercises for at least 30 minutes daily, to improve your strength, endurance and your quality of life. You should consult a biokineticist to facilitate and guide your exercises to ensure proper form and intensities, thus allow for maximal improvements and benefits.

Biokineticists are registered healthcare practitioners that treat injury and disease through individualised, evidence-based exercise prescription. They are specifically educated to prescribe and supervise exercise to individuals for the management and prevention of non-communicable diseases, such as diabetes. To find out more about biokinetics, or to find a biokineticist near you, visit biokineticssa.org.za

Article written by Vishaan Makan on behalf of Biokinetics Association of South Africa

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References

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B; American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010 Dec;33(12):e147-67. doi: 10.2337/dc10-9990. PMID: 21115758; PMCID: PMC2992225.

Lopes JSS, Machado AF, Micheletti JK, de Almeida AC, Cavina AP, Pastre CM. Effects of training with elastic resistance versus conventional resistance on muscular strength: A systematic review and meta-analysis. SAGE Open Med. 2019 Feb 19;7:2050312119831116. doi: 10.1177/2050312119831116. Erratum in: SAGE Open Med. 2020 Sep 9;8:2050312120961220. PMID: 30815258; PMCID: PMC6383082.

Ruegsegger GN, Booth FW. Health Benefits of Exercise. Cold Spring Harb Perspect Med. 2018 Jul 2;8(7):a029694. doi: 10.1101/cshperspect.a029694. PMID: 28507196; PMCID: PMC6027933.

Zieff, G., Borror, A., Battaglini, C., & Stoner, L. (2019). Postprandial Exercise and Glucose Regulation for Type II Diabetics: Considerations for ACSM Guidelines. Acsm.org. https://www.acsm.org/blog-detail/acsm-certified-blog/2018/06/29/postprandial-exercise-and-glucose-regulation-for-type-ii-diabetics-considerations-for-acsm-guidelines

summer 2023

DSA News Spring 2022

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– DSA Western Cape News –

Onyinye receives award by Nigerian community

Onyinye Nwokeji, a nurse and who has been running a Diabetes Wellness Group in Brooklyn/Milnerton in Western Cape for a number of years was given an award in June by the Nigerian community in the area and all the Igbo Nigerian Pastors in the Western Cape. Well done.

Mitchells Plain Wellness Workshop Week

From 22 till 30 July, a Wellness Workshop Week was held at Strand chalets in conjunction with the Mitchells Plain DSA support group.

Blood pressure and blood glucose testing took place every morning and a walking and light exercise programme combined with a fancy dress competition took place.

– DSA Port Elizabeth News –

World Diabetes Day Walk for Diabetes

The Port Elizabeth branch of Diabetes SA held annual Global Walks for Diabetes from 2010 till 2016. Sadly, we have not had Diabetes Walks since 2018 due to the lack of sponsorship and the arrival of COVID. So, we are most excited to announce that on 19 November 2022, the first Saturday after World Diabetes Day, we shall have a Walk for Diabetes in Port Elizabeth.

Our fundraiser manager, Megan Soanes, will be organising this in conjunction with Michael Zoetmulder from Zsports. Michael has done amazing work organising all our previous walks. Young and old are welcome to join this fun walk and to invite their friends and family to also participate. 

The start of our first Diabetes Walk in 2010.
The start of our first Diabetes Walk in 2010.
The start of our last Diabetes Walk in 2016.
The start of our last Diabetes Walk in 2016.

Camp Diabetable

This December, the second Camp Diabetable (Eastern Province) will be held from 15 to 17 December 2022 at Hobbiton-on-Hogsback. Ernest Groenewald, our Camp Director, will be organising this fun-filled and educational event. More information will be available closer to the time.

Gravity Jump for Diabetes

On 2 October 2022, our branch will again be having a Gravity Jump for Diabetes. Our first one was held in November 2017. Paula Thom and Darren Badenhuizen, the DSA Young Guns leaders, will be organising this fun event.

Youngsters attending our first event in 2017.
Youngsters attending our first event in 2017.

– DSA Pretoria News –

Passing of Mariaan Marias

Mariaan Marais served DSA for many years and was an active volunteer. Louise Pywell, a member of DSA Pretoria Wellness Support Group, attended the funeral service on 30 June and wrote, Mariaan Marais’ memorial service on Thursday, 30/6/22 at the Oosterlig NG church in Waterkloof Glen was a beautiful farewell to our dear friend! Her niece Dominee Nadia Marais gave a very touching and heartfelt service which was absolutely befitting of such a special lady! There were photographs and messages from friends screened above the pulpit, which were so personal and emotional! It truly was amazing! A tribute of note! May she RIP …she will forever be in our hearts.

Ethel Magidela

Ethel Magidela – Eight years living with Type 2 diabetes

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Ethel Magidela recalls the day she was diagnosed with Type 2 diabetes and how far she has come since then.

Ethel Nonkosi Magidela (50) lives in Pretoria, Gauteng. She has three adult children.

One evening in 2014, I was watching a movie and my eyes started getting blurry. I thought perhaps there was something wrong with the picture and decided to move closer to the television but there was no change. At the same time, I became so thirsty like an unusual thirst, with my mouth so dry as if I had run a marathon and needed to drink lots and lots of water. I remember I finished a 2-litre jug of water and could not understand what was happening. Added to that, I started feeling extremely tired so went to bed. In the middle of the night, I went to the bathroom back and forth to urinate.

Having lost my late brother and niece from Type 1 diabetes, I thought to myself those could be the signs, but I was in so much denial and told myself it can’t be, not me. So, I ignored the signs, got up the next morning, got into my car and drove my kids to school thinking everything was going to be fine. Boy, was I wrong!

After dropping my kids at school, I started feeling more fatigued. Around 11am I experienced extreme thirst and hunger. I decided to Google, and the symptoms were exactly spot on. Still refusing to accept it, I got ready to pick up my kids from school and afterwards decided to take a nap but was not able too. Finally, I decided to go see a doctor that same afternoon.

Admitted to hospital

When I got to the doctor and told him what I experienced, he did a blood and urine test, and told me my blood glucose was 28.9 and that I definitely had Type 2 diabetes due to the blood test results.

I was admitted into hospital immediately. In fact, the doctor was even surprised that I was still aware of my surroundings and had to ask me twice if I was aware that I’m in his consultation room because of how high my blood glucose was.

The next day I was discharged the following day with medication (metformin 500mg) and had to embark on this new unknown journey of diabetes. I now needed to change my lifestyle and get used to living with it. I started reading every article about diabetes to know what I’m living with. Knowledge is power.

My medication was only changed once in March 2019; I was put on Glucophage 500mg twice a day with a 1.8mg Victoza insulin injection once a day.

The hardest part

I found the following extremely hard when I was first diagnosed:

  • To learn how and when to prick and test on my own.
  • What would be a high or low number for my blood glucose during testing.
  • How many times to test per day and how to stick to the same testing time.
  • To watch my diet, as to what to eat to avoid hyperglycaemia (high blood glucose) or hypoglycaemia (low blood glucose).

Thankfully today I can say I have my daily routine down and have gained knowledge on the tasks I found hard due to constant education about diabetes.

My advice to fellow people with diabetes

  • First accept the diagnosis. Don’t be in denial, take it as a transition to a living a healthy lifestyle.
  • Get as much as possible knowledge about diabetes, by reading articles.
  • Educate your family and close friends so they understand what you are dealing with daily. In that way you’ll have their support, so you don’t feel alone, because you are never alone.
  • Join support groups both on social media and attend in person in your area

Making the best of it

To me the saying Bloom where you are planted means to take advantage of the opportunities in my life (like starting my own support group for diabetes) and be grateful for my current situation and make the best of it.

Currently, I’m eating healthy as possible and watching my starch intake and have lots of veggies in my diet. Soon I will start with Banting. Unfortunately, I don’t exercise as much as I want to, but I do take long walks thrice a week.

World Diabetes Day

This World Diabetes Day, I plan to participate in a local Diabetes Awareness Walk, light up my home in blue, make my friends and colleagues aware about the importance of World Diabetes Day.

 

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Darren Badenhuizen – wake up and try again

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Darren Badenhuizen, DSA PE management board secretary and joint co-ordinator of the DSA Young Guns, tells us more about his journey of managing Type 1 diabetes.

Darren Badenhuizen (39) stays in Port Elizabeth. He is in a relationship with Paula Thom and has a 11-year-old daughter.

Diagnosed in the UK

I was living in London, UK, in 2007, when I got sick. I was ill for a while and thought I would get better eventually. I thought I had flu, not knowing anything about diabetes. I lost a lot of weight and was weak. I struggled to climb up stairs and urinated a lot. Luckily at that time my mother came to visit friends in the UK. I fetched her from the airport. She was shocked to see what state I was in and dragged me to the hospital. At age 24, I was diagnosed with Type 1 diabetes and remained in hospital for three days. They called me a medical miracle as I wasn’t in a coma with a glucose reading of 36.  The doctor prescribed me Lantus and NovoRapid insulin which I still currently take.

A week later, I came back to South Africa. I was upset as it wasn’t on the cards to come back yet. It was only my fourth year living and working as a carpenter in London. But I suppose life obviously had other plans.

Took a while to accept

Honestly, I didn’t handle my diagnosis well. I was 24 and was only living on my long-acting insulin for a while. I don’t think I was educated enough in the UK with the five minute session with a diabetic nurse educator. It took me a long time to accept and understand that I had diabetes as I was set in my ways.

I struggle to think of a positive of living with diabetes and wouldn’t wish this on anyone. The reality is that a person with diabetes always has to consider their diabetes in whatever they do. Diabetes is hard but all you can do is wake up in the morning and try again.

DSA Port Elizabeth

In 2018, a friend was diagnosed with Type 1 diabetes when she fell pregnant and wanted to get involved with DSA. She invited me to go with her to meet up with Paula Thom, who is the co-ordinator of DSA Young Guns. I learnt that there is a group for youngsters living with diabetes. This was very interesting; I wish I had been part of a group like this when I was diagnosed. So, I started attending these get-togethers and that’s how I got involved in DSA Young Guns.

I like to joke that my role is the muscle but I assist Paula with organising the events. I have also been co-opted onto the DSA management board as the secretary.

Being part of this group has enriched my life as I have met many other people living with Type 1 diabetes.

Dating another Type 1

Being in a relationship with someone who also has Type 1 diabetes has its benefits like being able to speak to someone at any time about anything and they understand what you’re going through and where you’re coming from without even having to say that much as they have had something similar at some point or just yesterday.

It also helps with small things, like getting your injection for a meal and then getting theirs too, or doing your long-acting shot and checking if they have done theirs.

Those little things all add up and make it easier which some non-diabetic might not get. Though, I don’t think both having diabetes automatically makes the relationship easier, you still have to work at it but it definitely doesn’t hurt.

Ready for spring

I’m looking forward to spring as it’s a season closer to summer and then I don’t stand out so much for always wearing shorts. I prefer to wear shorts as it’s easier to inject in my thighs.

World Diabetes Day

Megan Soanes, the DSA Port Elizabeth fundraising manager, is organising a walk in and around Port Elizabeth. I’m hoping to spend it with many other Type 1s.

Darren Badenhuizen

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Best snack options for hiking and picnics

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Dietitian, Estée van Lingen, offer ideas for snacks when hiking or going on a picnic.

Most newly diagnosed diabetes patients think they won’t be able to do any activities like hiking or enjoying a picnic. Luckily that’s not the case. As long as you manage and plan your outings and snacks, you can still continue as normal as possible. Exercise can also be great to help manage blood glucose levels but being mindful is key in all cases.

Hiking

In the case of a hike/exercise, the most important thing to remember is to start off slowly and train your body to get used to the exercise and not just jump into a 10km hike after no exercise for the last few years. You have to slowly increase the intensity and duration. By doing this you will also learn how your body works and what works best for you.

First thing to remember, is to test your glucose levels before you leave for your hike to determine if and what you should be eating beforehand.

You should also take your blood glucose monitoring kit with you to ensure blood glucose levels remain steady. If your blood glucose levels are low, it’s definitely good to consume a breakfast before you leave that includes a protein, healthy fat and fibre. For example, oats with low-fat milk and sugar-free peanut butter; a boiled egg and avocado; scrambled eggs with chickpeas; or a slice of low-GI bread and sugar-free peanut butter. The starch or fibre will help to increase blood glucose levels slightly and the protein and fats will help to stabilise it, so it does not drop too quickly.

Hydration is essential

Water is vital to pack and depending on how long you will be away, how far you will be walking and the weather, you need to bring extra water. This will keep you hydrated and also prevent you from being hungry all the time that you snack the whole way through (that’s also not ideal).

Food should only be used to nourish us to have enough energy and keep blood glucose levels stable. Hiking (or exercise) in general is not an excuse to eat more or bigger portions of food.

Snack options to pack for a hike

  • Trail mix of cranberries, nuts and seeds but be aware of portion size.
  • Lean biltong
  • Unsalted nuts and seeds
  • Sugar-free protein bar
  • Fruits (preferably fresh, and only eat 1 to 2 (max) during the whole hike)
  • Brown rice cakes
  • Take a few jelly sweeties with in case your blood glucose drops too low and you need a quick pick-up, then ONLY HAVE ONE and then follow that with balanced snack and or protein.

Snack options to pack for a picnic

  • Lean biltong
  • Unsalted nuts and seeds
  • Sugar-free protein bar
  • Boiled eggs
  • Low-GI sandwiches with protein filling/sugar-free peanut butter
  • Low-GI, sugar-free muffins
  • Vegetable sticks with hummus or low-fat cottage cheese
  • Low-fat plain/unsweetened yoghurt
  • Fresh fruits
  • Brown rice cakes with avocado, hummus or low-fat cottage cheese

Things to remember

Please take note of the following when planning and packing snacks:

  1. Drink lots of water throughout the hike, picnic or exercise.
  2. Make sure the snack is low in sugar and carbohydrates (15g carbs = 1 starch portion). Only consume 1 starch or fruit portion at a time (in 2 hours space).
  3. Do not continuously eat throughout. Try to eat a good breakfast before (especially before a picnic so you don’t overeat). Have a snack about 2 hours later and then another 2-3 hours later, or as you feel blood glucose levels might be dropping. Only eat when hungry or low blood glucose and not just because the food is there.
  4. Make sure the snack contains protein (biltong, chicken, low-fat cottage cheese, eggs, nuts), fibre (low-GI starches, fruit and vegetables) and/or healthy fats (sugar-free nut butter, avocado, olives, nuts and seeds) to help regulate blood glucose.
  5. Monitor portion sizes. Even if you eat healthy snacks but the portions are too big, it can still affect your blood glucose levels, and an increased calorie consumption can lead to weight gain or prevent weight loss.
  6. Avoid foods too high in fats especially saturated fats and trans fats (mainly found in processed foods).
  7. Avoid salty snacks as this can dehydrate you and increase your blood pressure.

Now you can use these guidelines to plan your next hike or picnic and adjust it to meet your individual requirements as each person is different and reacts differently to foods. Do try to play around with ideas when you are at home or taking shorter walks to see which snacks works best for you.

If you are still not certain or need more assistance with your individual dietary needs, book an appointment with your nearest dietitian.

MEET THE EXPERT

Estée van Lingen is a registered dietitian and has been in private practice since 2014. She is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

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How to become an expert meal planner

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Lynette Lacock shares the basics of becoming an expert meal planner.

You have just found out you or a family member has diabetes. There are so many thoughts going through your mind about medication and checking blood glucose levels that you almost forgot you were also told to follow a diabetic diet. What is a diabetic diet anyway? Do you need to buy special food? What will the rest of the family eat? How am I going to find the time to plan a special diet?

You can stop worrying because it’s easier than it sounds. A diabetic diet is simply eating healthy foods in moderation and eating three meals a day at more or less the same time every day. My rule of thumb when determining if a food is healthy is asking: how close is this food to its natural state? For example, whole oats as opposed to a processed cereal with oat flour, or a skinless chicken breast as opposed to chicken nuggets mixed with breading and fillers. You get the picture.

So, you don’t need to purchase special foods, just food in its more natural state and in the correct portion size. The whole family will benefit from eating healthier so there is no need to make separate meals.

Honestly speaking, you’ll have to put in some extra effort to plan your meals but after a couple weeks it will become routine. The trick is to be more organised when you make your shopping list then stick to it. Before we talk about meal planning, we first have to go back to the basics.

Back to basics

Most will remember learning about the five basic food groups in school and will only need a little refresher. It’s a good idea to have a list of your family’s preferences for each food group when planning your meals for the week. You don’t want to make tasty meals with ingredients that no one will eat.

Food group Types of foods
Grains Wholegrains: Brown rice, buckwheat, bulgur wheat, oatmeal, popcorn, wholegrain barley, wholegrain cornmeal, whole rye, whole-wheat bread, whole-wheat crackers, whole-wheat pasta, whole-wheat cereal flakes, whole-wheat tortillas, wild rice.

Other products: Mostly made from refined grains, however, some may be made from wholegrains, such as cornbread, corn tortillas, couscous, crackers, flour tortillas, pasta, pitas, pretzels, ready-to-eat cereals.
Vegetables Carrots, broccoli, kale, spinach, acorn squash, carrots, pumpkin, red peppers, sweet potatoes, tomatoes, artichokes, asparagus, avocado, bean sprouts, beets, Brussel sprouts, cabbage, cauliflower, celery, cucumbers, eggplant, green and red peppers, mushrooms, onions, snow peas, string beans, tomatoes, vegetable juices, zucchini.

Starchy vegetables: corn, green peas, potatoes, sweet potatoes, butternut.
Fruit Apples, applesauce, apricots, bananas, berries, figs, unsweetened fruit juices, grapefruit, grapes, kiwi fruit, mangoes, melons, nectarines, oranges, papayas, peaches, pears, plums, pineapple, raisins, prunes, starfruit, tangerines.
Protein Meats: Lean cuts of beef, veal, pork, ham, minced beef and lamb; reduced-fat deli meats.

Poultry: Skinless chicken and turkey, ground chicken and turkey.

Fish: Snoek, salmon, hake, yellowtail, clams, crab, lobster, mussels, octopus, oysters, scallops, calamari, tuna fish.

Beans: Cooked beans, refried beans, tofu.

Nuts and seeds: Peanut butter; sunflower seeds, almonds, and hazelnuts.

Eggs: Chicken eggs, duck eggs.
Dairy Low-fat milk, yoghurt, cheeses: cheddar, mozzarella, Swiss, parmesan, string cheese, cottage cheese. Frozen yoghurt and soya milks.

Putting it all together

Now that you’re familiar with the different food groups we can put it all together to make your diabetic meal. There are different ways to keep track of your food intake. You can count carbohydrates, or you can use the plate method.

The plate method

This makes it easy to get used to looking at a plate of food and knowing if it’s the right foods in the right amounts for you. Your plate should be half non-starchy vegetables, quarter protein and a quarter carbohydrates as in the figure below.

 

With some practice, you’ll be able to quickly measure the food on your plate at a glance. See the explanation below to get an idea of how large or small your portions should be. This method is helpful when you want to make sure you’re eating the right portion size. It’s also a good idea to get a kitchen scale and measure the portions until you get used to the sizes.

  1. 84g of meat, fish, or poultry – Palm of hand (no fingers)
  2. 28g of meat or cheese – Thumb (tip to base)
  3. 250ml or 1 medium fruit – Fist
  4. 28-56g of nuts or pretzels – Cupped hand
  5. 15ml – Thumb tip (tip to 1st joint)
  6. 5ml – Fingertip (tip to 1st joint)

Staying organised is the key to successful meal planning

It’s best to start planning meals weekly so it doesn’t seem so overwhelming. Make a list of favourite family foods from each group.  Now that you have an idea of portion sizes, you can measure how much various proteins you’ll need for the week.

Then it’s a matter of buying fresh fruits, vegetables and carbohydrates. Be careful not to have starchy vegetables with every meal since they are high in carbohydrates and a quarter of your plate will already contain your carbohydrate intake. Substitute this with a whole-wheat rolls or bread sometimes.

Try to introduce these new changes over a couple weeks, especially with children.

Prep and freezing

Preparing some things ahead of time can help keep you and your meals more organised. The freezer will soon be your best friend because it will allow you to get a jump start on the week by cooking ahead of time. Once you make something to freeze, remember add the number of portions per bag to the label.

  • Dice, spice and cook chicken fillets and freeze (or leave whole).
  • Spice and fry ground mince beef, chicken or turkey and freeze.
  • Cook brown rice and store in refrigerator or freezer.
  • Buy or make whole-wheat bread/rolls and freeze.
  • Roast vegetables, refrigerate and use for meals over a couple days.
  • Peel and chop carrots and freeze cooked or uncooked.
  • Cook and freeze green beans or any other vegetable (Note: potatoes don’t freeze well unless cooked first due to their high water content).

Try new recipes

Once you’ve tackled basic meal planning, it’s time to start researching new diabetic recipes. You can find so many sites online with great recipes for healthy meals that also take into account the portion sizes required.

Give yourself time to get used to this new way of eating. It’s not easy but you can do it. In the long-run, it will all be worth it because you and your family will be eating a healthier diet.

References:

https://www.diabetes.org/healthy-living/recipes-nutrition/eating-well/diabetes-superstar-foods

https://www.cdc.gov/healthyweight/healthy_eating/meals.html

https://www.eatingwell.com/article/2059371/how-to-become-an-expert-meal-planner-when-you-have-diabetes/

Sr Lynette Lacock

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Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.

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Foot pain

Foot pain and reflexology treatment

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How delightful would it be to dance into spring with pretty painted toes, soft heels and, more importantly, no foot pain? It’s possible.

“The job of feet is walking, but their hobby is dancing.” Amit Kalantri

First, a little bit more about these two important, yet sadly often neglected parts of your body. The feet really do have a rotten deal. They carry us throughout our lives, get shoved into ill-fitting shoes and are seldom given the praise and recognition they deeply deserve.

As a Pilates instructor and therapeutic reflexologist, I’ve seen 100s of pairs of feet in my studio; all of which tell a tale. Hardly ever have I heard anyone say, “I love my feet.” They are always berated and presented to me with embarrassment and copious apologies for how ugly they are.

The magnificent structures of feet

Each foot consists of 26 bones, 33 joints, over 30 ligaments, 19 muscles and tendons. Don’t forget the 250 000 or so sweat glands in both, or the 7 000 nerves in each.

The feet are the most superb shock absorbers. They cushion up to approximately 454kg of pressure during one hour of strenuous exercise. They provide support of up to 1,2 times our body weight while walking and 2 to 3 times that while running.

The feet are our foundation and keep us balanced. Since 25% of the body’s bones are in our feet, when they are misaligned the implications for our posture are enormous.

What your feet say about you

From a reflexology perspective, the feet can tell a tremendous amount about the state of our mental, emotional, and physical health.

A therapeutic reflexologist can look for signs of disease and pain in the different regions of the foot which have reflexes corresponding to the various organs and systems of the body.  Seldom are these wrong. So, while a reflexologist may not diagnose, they can assuredly suggest where you need to pay attention in your health concerns.

Problems which feet present are many and varied. The most common are:

  • Neuropathy – common in diabetes
  • Hammertoes
  • Bunions
  • Cracked, painful heels
  • Morton’s neuroma
  • Dropped arches
  • Plantar fasciitis

These are the tip of the iceberg and all play a significant role in the rest of your body’s health and posture as when your feet are painful, we compensate when we walk, and the quality of life is seriously impacted.

Identifying the culprits

Unfortunately, it’s neglect, lack of awareness, poorly-fitting shoes (the biggest culprit), high heels, cold temperatures and in particular never walking barefoot that contribute to foot pain. Do your feet a favour, take those shoes off and go and walk on the grass. They will love you for it and the health benefits are far-reaching. Watch Earthing Movie for more information on this powerful yet free health supplement right under your toes. (Please note if you have lost sensation in your feet due to neuropathy, it’s advisable to not walk bare feet).

Addressing foot problems

Apart from visiting a podiatrist and taking up Pilates which will teach correct foot placement and how to walk properly, reflexology is a brilliant modality to assist with foot problems.

Remember that reflexology is not simply a foot massage. A properly qualified therapeutic reflexologist has tremendous knowledge of the feet, the reflexes and what they reveal and how to work these reflexes correctly and effectively.

Many health issues can be noted and assisted with reflexology. For example, bunions (those painful bumps that develop on the side of the foot under the big toe) aren’t only due to incorrect foot placement and poorly-fitting shoes but may also indicate blood glucose imbalances or thyroid pathologies.

Constant and painful, deeply cracked heels aren’t only dryness but more often than not a sign of poor gait, as well as lower back problems or issues in the reproductive organs because the heel reflex corresponds to the pelvic and lumbar area of the back. You can go for as many pedis as you like. Until your address the underlying issues, the cracked heels will persist.

Plantar fasciitis which is that horrendous pain in the sole of the foot could relate not only to badly-fitting shoes, but also to tight calf muscles or even a tight lower back. And, from a reflexology perspective, kidney issues.

Neuropathy, the diabetic patient’s nightmare is a numbness of the feet which can be lethal as often pain and injuries can’t be felt and can often lead to more serious symptoms. Reflexology will bring unnoticed injuries to your attention and will also stimulate feeling in the feet.

Awaken the reflexes

Reflexology will awaken these reflexes, bringing energy to the relevant areas encouraging healing to occur. Of course, a session is usually wrapped up with a relaxing foot and calf massage which will loosen tight calves, mobilise immobile ankles, and bring much needed love and relief to sore, tired feet. Reflexology is a many faceted bonus for the body and feet.

Let’s start spring with not only a step but a dance in our feet. Look at your feet with new eyes and thank them for how well they carry you through every moment of your life.

References

MEET THE EXPERT

Fiona Hardie has recently relocated to the Western Cape and is teaching Pilates online and looking to further her offerings with Rebounding. She is also studying yoga and new modalities that will facilitate the healing that is so necessary today. She is focusing on growing her online presence and when she finds the right space she will open a Pilates and therapy studio.

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interrupted sleep

Dealing with interrupted sleep patterns for parents of kids with T1D

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Diabetes nurse educator, Christine Manga, offers valuable advice for parents of children with T1D experiencing interrupted sleep patterns.

A diagnosis of Type 1 diabetes in a child comes with many physical, mental and emotional challenges for both the child and parent. As parents assume most of the responsibility for managing the diabetes, it’s no surprise that parental burnout is real.

Of the plethora of feelings parents experience, fear and guilt appear to be common threads in literature. Chronically disrupted sleep resulting in chronic sleep deprivation is another standout topic. Parents who are sleep deprived have an increased risk for depression, anxiety and potential weight gain. It can have a detrimental impact on relationships, work and day-to-day functioning.

How to deal with 2AM testing

2AM testing of blood glucose is a part of the deal. If the glucose level is in range, that is great. If not, it probably means not much sleep for the rest of the night. How do you deal with this?

Good overall blood glucose management is key to a better night’s sleep. If there are regular night-time hypos, the treatment regimen that the child is on will need reviewing. Reassessing the basal doses, carb ratio as well as correction factor and carb counting skills will aid in achieving good stable glucose levels. A pre-bedtime low-GI snack may be recommended. Even with all of these parameters met there is still a chance of night time hypos. Remember, diabetes does not sleep.

Rotation basis

If there is more than one parent at home, working on a rotation basis for testing will allow for better sleep. This could be split up for day to day, week to week or even half evening shifts.

If you are a night owl, staying up until 1am and then your partner being responsible from then until the morning will guarantee a few hours of quality sleep.

If you are a single parent, ask for help. You could teach a relative or friend how to test and what to do depending on the outcome. A solid night of sleep once a week will do wonders.

Minimise the fuss

Be prepared for evening testing and treating, the less fuss involved, the quicker you can get back to sleep. Have the tester and strips out, have a sweet or juice on hand in case of a hypo. Use dim lighting and make sure the passage and room is free of obstacles. Don’t engage in conversation unless necessary.

Good sleep hygiene

Good sleep hygiene will make falling asleep easier for you when initially going to bed or after testing. This includes no use of electronics an hour before bed; a cool, quiet environment if possible, and avoid caffeinated drinks. Try sticking to a routine. Same bedtime every evening, make it early even if it means missing out on some adult time. The extra sleep will help you.

CGM

Using continuous glucose monitoring (CGM) technology to track blood glucose levels that give predictive warnings of an impending high or low reading will provide peace of mind and negate the need to physically get up and test your child. Sensor augmented insulin pump therapy plays a huge role in reducing overnight hypos.

Unfortunately, this technology is expensive and not financially feasible for most of the population. If you are fortunate enough to use any of these, do not do sensor changes or infusion site changes before bed. Calibrations may be required or there may be a site failure that goes unnoticed until intervention is required that will take extra time.

Be kind to yourself

When there has been a rough sleepless night, be kind to yourself. If you are unable to complete all the home chores, park some for the next day. Try to get in a 10-minute power nap. Type 1 diabetes stretches the boundaries of what we believe is possible and what we are capable of.

It is important to know that if blood glucose levels are stable then there is no need to test at 2AM every night. Once or twice a week is sufficient.

Seek counselling for you and your child

Children with T1DM can experience feelings of guilt and believe they are a burden. They may also show anger or resentment towards the parent or caregiver who does their testing. An over-tired parent may struggle to show compassion thereby aggravating the child’s ability to accept their condition. Seek counselling for both you and your child if necessary, reach out to your diabetes team, join support groups and learn how other families cope. Sharing your experience and insight may just be what another parent needs to survive.

Remember, this 2AM testing ritual will not be forever.

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

MEET THE EXPERT

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

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Suganon Banana Crumpets

Suganon Banana Crumpets

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Ingredients

  • 2 large eggs
  • 2 ripe bananas
  • 4 tbsp self-raising flour
  • 1 tbsp Suganon Xylitol
  • ½ tsp Vanilla Essence
  • Splash of coconut oil for frying

Method

  1. Mash ripe banana in a bowl and mix thoroughly with the remaining ingredients.
  2. Heat coconut oil in a frying pan on high heat. Spoon the remaining ingredients batter onto the pan, cook until bubbles form then flip and cook until browned and fresh berries.
  3. Serve with your choice of toppings, like cinnamon or honey.

Suganon is a range of great tasting sugar alternatives to help you maintain a healthier lifestyle.

Visit shapesuganon.co.za

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