Category: 2023 Summer – Diabetes Focus Online

Hydrate and get H2Glo

Hydrate and get that H2Glo

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Dietitian, Estée van Lingen, expands on the importance of hydration, especially in summer. Plus, she shares the benefits of H2Glo for people living with diabetes

Summer is here and being well-hydrated is important for everyone, and who doesn’t want that H2Glo?

Benefits of hydration

Water is essential for life as the body consists of about 50 – 60% fluid (about 75% when born, gradually decreasing as you age). It’s a major part of the body and has many functions including transporting nutrients and compounds in blood as well as removing waste products through urine. Water also helps to regulate body temperature through sweating and acts as a lubricant and shock absorber in joints.

Drinking enough water is vital to maintain good health in the short as well as the long-term. In order for your brain (which also mainly consists of water) to function properly, you need to be well-hydrated to be alert and be able to concentrate properly.

Water also prevents constipation as it needs to bind with fibre to make the stools soft. Since the kidneys assist in filtering out waste through water, drinking enough can also reduce the risk of developing urinary tract infections, kidney stones and damage to kidneys which could lead to chronic kidney disease. Frequent dehydration, even if its mild, can lead to damage to the kidneys.

How much do you need to drink?

Drinks provide around 70 – 80% of your water needs. The remaining 20 – 30% comes from foods, such as soup, stews, fruit and vegetables.

Infants need to consume between 640 – 800ml water from fluids per day. Smaller children need to drink between 800 – 1600ml per day depending on their age, gender and activity levels. Adults need to consume between 1500 – 2000ml per day and pregnant and lactating women need to drink even more than that of an adult.

These are average amounts and your individual need will depend on factors like: temperature and humidity, medication consumed and exercise.

Warm and dry environments, such as hot sunny days and air-conditioned offices or strenuous physical exercise, can increase the need for water as they speed up the evaporation of sweat on the skin.

How much water is enough?

Thirst is one way you regulate hydration in the body. But when you drink, you stop feeling thirsty before your body is completely rehydrated. Some people also never feel thirsty as they haven’t been drinking enough water throughout their life.

So, observing the colour of your urine and the smell is a useful way to determine hydration status. Your urine should be a pale straw colour which shows you are well-hydrated. Dark yellow urine as well as strong odour urine means that your urine is very concentrated, and this is often a sign of dehydration, but in a few cases may have other causes. If you are concerned, contact your GP.

Signs of dehydration

  • Headaches
  • Tiredness
  • Confusion
  • Lack of concentration
  • Constipation
  • Urinary tract infection (UTI)

It can be hard to spot dehydration. The first thing you’ll notice is increased thirst and a dry sticky mouth. Darker coloured urine is also a good indicator.

Dehydration is a common problem in older people. It can be particularly difficult to detect as signs such as urine colour, thirst and a dry mouth aren’t reliable indicators in older adults.

What types of drinks will help with hydration?

Drinking water is one of the best ways to hydrate as its energy and sugar-free. Other choices, such as unsweetened caffeine-free tea and milk (as well as milk alternatives) also provide fluid to maintain hydration. Any drinks that contain caffeine (coffee and normal tea) as well as alcohol, can’t be counted towards fluid intake as these drinks also have a dehydrating effect on the body.

Some drinks contain added sugar, such as regular, fizzy and still drinks. These should especially be avoided in people living with diabetes as it can cause a rise in blood glucose levels.

Pure vegetable or fruit juices and smoothies also provide fluid and other nutrients but should again be limited in people with diabetes and also assessed before drinking.

H2Glo

H2Glo is a great alternative sparkling water drink to rehydrate with for people living with diabetes as it doesn’t contain any sugar and is also aspartame-free. It’s a nice refreshing drink in these hot South African summers. With a burst of flavour from the edible jelly balls inside, you can have a great-tasting drink without the guilt.

H2Glo comes in seven flavours (Blueberry, Strawberry, Pineapple, Passion fruit, Lemon, Naartjie and Energy) and is also gluten-free and enriched with ozone that can also provide the body with extra oxygen molecules.

Fluid intake in active people

Active people need to drink more water as they lose more in the form of sweat. It’s important that this is replaced to maintain performance and health. Water is the best choice during and after most activities, but those who participate in regular strenuous physical activity may need to consume sports drinks or drinks containing electrolytes.

Top tips for staying hydrated this summer

  • Keep hydrated by drinking small amounts frequently.
  • Find the best way to motivate you to consume more water. For example, keep a bottle or jug of water on your desk as a reminder, or drink a glass of water at specific times: when you wake up, with each meal and before every cup of coffee.
  • Remind children and older adults to drink regularly and also keep a bottle of water close by for them.
  • Increase water intake during hot weather or when you are exercising.
  • Fluid is particularly important if you’re unwell (especially with vomiting, diarrhoea or fever) as all of these conditions can also lead to dehydration especially in children.
  • Foods high in water, such as fruit and vegetables, can also contribute to hydration but fruit and starchy vegetables, should be taken with caution in people with diabetes.
Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

MEET THE EXPERT

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

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Fabulite

Exploring the delicious world of Fabulite

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Dietitian, Esteé van Lingen, explores the added benefits of including the tasty Fabulite range of yoghurts into your eating plan.

In the realm of dairy products, the Fabulite range stands out as a brand that truly understands the art of combining health and indulgence. Fabulite is a range of yoghurts, which is South Africa’s number one fat-free yoghurt.

With a wide range of products that cater for the diverse taste and dietary preferences of people living with diabetes, Fabulite has established itself as a beloved choice for those seeking both flavour and nutrition.

Nutritional information

Benefits

  • Rich in calcium: Fabulite yoghurts are good sources of calcium, a vital mineral that supports healthy bones and teeth. Since a lot of people have started reducing milk intake for various reasons, consuming these products can contribute to your daily calcium intake, promoting strong and sturdy bone health.
  • High-quality protein: Protein is an essential component of a balanced diet, and Fabulite yoghurt contains between 3,2 – 3,8g per 100g. These dairy delights offer a convenient and delicious way to incorporate protein into your diet, which is essential for muscle development and overall health.
  • Fat-free and no sugar added: Making it the ideal snack or addition to a diabetic meal. The sugar that is in the product is the lactose (milk sugar) that is found naturally in milk.
  • Halaal approved

Fabulite yoghurts are versatile and can be consumed with any meal or snack. It can even be used as a dessert alternative or added to dressings or sauces, without compromising on the taste.

Nutritional value

Nutritional info (per 100g)

Yoghurt Plain fat free Fat free fruited Fat free vanilla
Energy (kJ) 200 210 210
Protein (g) 3,8 3,2 3,4
Glycaemic carbohydrates (g) 6 8 6
Of which total sugar (g) 3,1 3,1 3,1
Total fat (g) 0,2 0,1 0,2
Calcium (mg) 110,9 102,9 100,2

What does the range consist of?

Whether you prefer the classic taste of plain yoghurt or the sweetness of fruit-infused yoghurts, you’re sure to find a Fabulite yoghurt that tantalises your taste buds. With its creamy texture, sweet taste and added benefits, this yoghurt makes for a perfect snack, breakfast option or even an addition to main meals or sauces.

You can choose from:

  • Fat free plain
  • Fat free strawberry
  • Fat free blueberry and pomegranate
  • Fat free black cherry
  • Fat free vanilla flavour

Each flavour is available in 1kg, also a select flavour range in 175g for single portion convenience, as well as a 6 x 100g multi-pack if you’re looking to indulge in more than one flavour.

Fabulite has won the hearts of consumers by offering a wide range of yummy yoghurts that also provides numerous health benefits. From plain to various flavours of yoghurts, Fabulite has something for everyone. So, next time you’re in the yoghurt aisle, consider Fabulite for a delightful and nutritious addition to your daily diet. Enjoy the best of both worlds with the exceptional yoghurts from Fabulite.

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

MEET THE EXPERT

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

This article is sponsored by Parmalat in the interest of education, awareness and support. The content and opinions expressed are entirely the health professional’s own work and not influenced by Parmalat in any way.

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Hormone balance

Hormonal balance

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Veronica Tift explains the importance of striving for hormonal balance and adds how body work and reflexology can aid in achieving this.

“Wow, this is a really cool song, who sings it?” I ask my teenage daughter innocently one afternoon on the car drive home. “I don’t know who sings it Mom. Why do you have to ask me questions about my music? Can you please just stop!” She then bursts into tears.

I sense this was not about the music and dropped the subject. When we got home, I quickly fed the teenager. I had heard that hunger can be a contributing factor to the madness that is puberty, and soon enough she emerged from her room a completely different human.

Later that day we had a conversation about the sudden shift in mood; she said she honestly just felt emotional and couldn’t actually figure out why. She felt she needed justification to cry in the moment. My question just gave her the excuse to burst into tears randomly, which is what she felt like doing.

Understanding puberty and these hormonal shifts has gone a long way in helping her understand that these are all normal and healthy ways in which her body communicates to her.

Hormones

Our hormones are doing a daily dance with our bodies; they control so many vital aspects of our everyday life. I like to think of them as spies, silently on a mission, passing messages to target cells in the body. We only really notice the spies if they start to go rogue, miss the target cell or disappear from their assigned mission all together.

To understand how to balance hormones, you first need to know what hormones are. They are chemicals that are produced in the body, they are like chemical messengers, that are released by the endocrine system. Hormones travel throughout the bloodstream to the cells and other organs not considered part of the endocrine system, such as the small intestine, and the stomach also release hormones.

Hormones control and influence fertility, growth, development, metabolism, immune system, gut health and mood. The human body is made up of more than 20 major hormones, with each one having a specific purpose and only effecting its own target cell.

Hormonal balance with body work

Reflexology and body work can help with hormonal balance, however, it all depends on the hormone that is out of balance.

In my practice, I see a lot of thyroid hormone imbalance; the two main thyroid hormones are T3 and T4. The thyroid, among other things, regulates metabolism and can have an effect on overall energy levels. Too much thyroid hormone, you have hyperthyroidism or too little called hypothyroidism. There are a number of different thyroid disorders.

In Malvina Bartmanski’s book, Autoimmune Survival Guide, she invites people who have thyroid issues to ask some real questions about how you speak up for yourself and express your thoughts and how you show up for your own needs. She encourages reflexology in her book, speaking to the ability to lower stress hormones and the healing effect it has on the body. The thyroid gland reflex is worked on the feet during a reflexology treatment as well as all endocrine glands, relaxation techniques are also used help with the improvement of circulation of hormones.

The hormone insulin

Insulin is the hormone necessary for the cells in your body to use glucose properly in your bloodstream. The reflexes that a reflexologist would work on the feet would be the pancreas as this is the endocrine gland responsible for the production of insulin. All endocrine glands are included in a treatment; the liver reflex and relaxation techniques to improve circulation of the hormones are also included.

Sweet balance of life

From a reflexology point of view, the pancreas injects mind, body and soul with sweet thoughts, the sweetness of life could be missing or the joy.

We also notice an imbalance in the reflex when someone is too sweet for their own good, or maybe they struggle to accept the sweeter things in life. Related to confidence, self-esteem and creativity, shock can negatively impact all of these and pancreas issues have been linked to trauma. Digesting life and creating a sweet balance of life can emotionally support the pancreas.

Most people only ever start paying attention to their hormones when they start going on their own unsanctioned missions in the body.

Releasing the kindness hormones

In David R. Hamilton’s book, Why the Woo Woo Works, he writes about what he calls kindness hormones, oxytocin being one of them, also called the hugging hormone it plays a role in social bonding. This amazing hormone protects the cardiovascular system and can have a counter effect on stress. Stress or even just thinking about stress makes your hormones respond, same goes for the kindness hormones. Reflexology and supportive body work help release kindness hormones.

Taking this brief look at hormones, you can see how hormone health has a significant impact on overall well-being. We need to care more about our hormone health, supporting them through eating a healthy diet, getting regular exercise and ensuring mental health is supported, helping the overall quality of life to be improved.

Check your hormones regularly

Maintenance is key; don’t wait for your hormones to be MIA before you pay attention to them. Take care of your body and it will take care of you. Being kind to yourself and understanding what is happening with life changes that influence hormones, like puberty and menopause, can also help. Speak to a healthcare professional if you need extra support.

If you suspect you might have any imbalance in your hormones, please have them checked regularly.

Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.

MEET THE EXPERT

Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.

References

https://www.drneilspiegel.com/blog/6-important-hormones-and-their-roles-in-your-body

E-motion, energy in motion messages of the body; Sue Ricks – Barney Books 2016

Why the Woo-Woo Works; David Hamilton PH.D – Hay House 2021

The language of the feet; Chris Stormer – Hodder Education 1995, 2007

The Autoimmune Survival Guide; Malvina Bartmanski – Bookstorm 2023

Ruth Hull the complete guide to reflexology second edition Lotus publishing.

https://www.hubermanlab.com/topics/hormone-health

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fat and protein

Insulin dosing for fat and protein

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Christine Manga, a diabetes nurse educator, explains the calculation of insulin dosing for fat and protein.

We are social creatures and food plays an enormous role in our lives. Many gatherings and celebrations revolve around food, promoting socialisation and fostering a sense of belonging. These events should be fun and exciting but instead they often present as daunting and challenging if you have diabetes, especially if you need to inject insulin.

Who needs to inject insulin?

Type 1 diabetes is the absolute absence of insulin. Insulin is required to facilitate the movement of glucose from the bloodstream into the cells for energy use and storage. People with long-standing Type 2 diabetes may also have less or no insulin reserves. This will necessitate the need to inject a rapid-acting insulin before eating a meal as well as a long-acting insulin at least once a day.

Carb counting is a commonly taught skill that involves calculating the amount of insulin required to match the amount of carbohydrates eaten at a meal. Your healthcare provider will assist you in working out a carb ratio and insulin sensitivity factor (ISF). This will be used at each meal.

Meals are more than just carbs

Fats and proteins also impact blood glucose levels by delaying the digestion and absorption of carbohydrates, often causing a delayed and prolonged hyperglycaemia (high blood glucose). It can be drawn out for as long as three to five hours post-meal.

Fat causes and worsens insulin resistance which would mean more insulin would be required. A meal that contains 35% or more of it’s total calories is considered a high fat meal. This amount varies in the literature.

There are vast differences in interpersonal and intrapersonal blood glucose responses to fat and protein. There is no uniform response to a meal. These differences can be caused by, but are most definitely not limited to carb ratio, ISF, exercise, weather, duration of diabetes, order in which food is eaten as well as overall health.

To establish how fat or protein affect your glucose, it’s imperative to monitor yourself for patterns. Measurements should be taken three- and five-hours post-meal. It’s possible to monitor with manual finger pricks, but continuous glucose monitoring (CGM) is really helpful in these situations. Pattern detection is far easier.

High fat and protein meals

Examples of high fat and protein meals could include bacon and eggs, burger with avo and chips, salmon with olive oil drizzled on roast vegetables, pizza, creamy sauce pasta, pastries. The list goes on.

It’s often the case that even when carb counting is accurate, a high fat and protein content in the meal will result in under dosing of insulin and a delayed hyperglycaemia. A study using a 50g protein example: 200g cooked steak and 30g carb meal received an extra 30% insulin delivered in a combination bolus. This amount improved post-meal glucose levels without any additional risk of hypoglycaemia. When the amount of insulin was increased to 45%, there was increased hypoglycaemia whereas a 15% increased dose still resulted in post-meal hyperglycaemia.

Whittington Health, followed on the NHS guidelines, suggest counting carbs for the high fat or protein meal and adding 20% extra insulin along with a correction, if necessary. If the meal contains no carbs and more than 50g of protein, count it as 10g of “carbs” and dose according to your carb ratio. If you’re consuming alcohol with the meal, make no adjustments.

Calculating is hard work

In my practice, I tend not to teach insulin bolusing for fat and protein. Carb counting is already an additional step someone with diabetes must contend with pre-meal. Working out the carb content of food can already be challenging. Add in trying to establish the fat or protein content of the meal too and then calculate the extra insulin required. That is hard work and adds to the diabetes burden, possibly causing distress and eventual burnout.

With saying that, there are carb counting apps that make provision for fat and protein. If you choose to follow a low-carb, high-protein, with or without high-fat diet, you will need to work out with your HCP the best insulin ratios to use. There will be a lot of trial and error, but a certain amount of insulin will almost definitely be required, albeit a small amount.

If you’re fortunate enough to be on a sensor-augmented insulin pump, you’ll be better able to negate the effects of fat and protein in the meals. Depending on the pump, there are different features that will accommodate for the extra insulin requirements. Insulin can be given as a dual or square wave bolus which is a bolus given over an extended period. Auto correction from the pump will assist in compensating for the delayed rise in glucose. These are very small bolus amounts delivered by the pump without the user needing to initiate them. The pumps are also able to modulate the basal rate to regulate the blood glucose levels. If you’re manually injecting, you may need to give two boluses to compensate for high fat or protein meals.

Your choice

The choice is entirely up to you, if you would like to take your diabetes management to this level. Many people who don’t bolus for high fat or protein are still extremely well-controlled with an excellent Hba1c only counting for carbs.

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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Russell Smith

Russell Smith – Big in Japan

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Russell Smith, a professional photographer, shares his food experience while travelling in Japan and how he had to adjust his insulin dosages.

Russell Smith (52) lives in Cape Town with his wife and two young sons.

Type 1 diagnosis

I was diagnosed with Type 1 diabetes when I was 13 years old and currently inject four times a day, using a combination of rapid-acting insulin (insulin lispro and insulin aspart) as well as long-acting insulin glargine.

When I was newly diagnosed, I started off injecting only twice a day but have found using this current method, I have more control and flexibility around my meals and their times of day.

Professional photographer

For the past 21 years I have been a professional photographer. I discovered that I preferred photography while working as an art director with photographers which I did for several years both in South Africa and abroad.

I love playing with light and have delved into almost all of the genres of photography over my career but have finally stuck to portraiture, lifestyle, still life and food, both in studio and on location.

As part of my non-commercial passion for taking pictures I love to travel with my camera. Every few years I have been fortunate enough to visit places on my own or accompanied by a friend without the responsibilities of family life and free to wake early for sunrise or make long trips on a whim. Things I could never do with young kids in tow.

I’m extremely grateful to my wife who lets me explore and gives me this time to shoot travel.

I love that travel photography is a combination of everything. It’s a little reportage of street photography, interiors, food and portraiture as well as landscape and still life. Being in new environments wakes the senses and makes me see what I sadly probably take for granted at home where I live.

Cherry blossom season in Japan

In late March, early April this year I went to see and photograph Japan during the cherry blossom season. I had done extensive research beforehand by reading what photographers’ rate as worthy of precious time and even the time of day to be there.

The blossoms are magical and make for great subjects to shoot. The weather was a little overcast and even rainy during this period, so I had a little time to shoot with blue skies. The time of the blossoms is also fleeting and moves up and down the country. When I left Tokyo to visit Kyoto and Osaka, the blossoms had already disappeared in Tokyo on my return a week later.

Travelling with diabetes

Having diabetes when travelling, I’m constantly aware that routine is my friend and that regular meal times and correspondingly injections are helpful in keeping my blood glucose in check. I can predict the meals and times, and with the familiarity of that I know how much to inject every day.

However, this is also made more complicated by the different food and ingredients in different countries. I also tend to walk a lot more so there is a lot more exercise, and sometimes I am not even aware of it.

Low glucose levels in Japan

My experience in Japan as a person with diabetes was pretty interesting and unique.

I carry a lot of sweets with me when I go abroad so that when I experience hypoglycaemia (low blood glucose), I have them on hand where ever I may be, up a mountain or in a remote village. I thought I had enough for my whole trip. Side note: I find Mentos easy to carry and don’t melt in hot weather.

After a few days in Japan, I found my glucose levels dropping all the time and I was having to dip into my sweets supply and constantly lower my insulin intake. But this didn’t help, it kept dropping until after a week of being in Japan, I needed to buy a new supply of sweets to see me through. It was very confusing at the time and I only managed to gauge the correct dose of insulin near the end of my trip. I had significantly reduced the amount of insulin I was taking by this time.

It was only when I returned to South Africa and decided to share my new passion for Japanese cuisine with my wife at a local restaurant that I realised what was different.

No added sugar was the difference

Due to having diabetes for so long, I’m very sensitive to the taste of sugar in food and drink and immediately could taste the sugar in the Japanese ingredients in Cape Town. Almost as if our western palates needed the sugar to enjoy the food. Or perhaps masking something else?

What I became to realise is that in Japan they put emphasis on quality ingredients and don’t sweeten or add much else to their food. This goes across the board in Japan, even street food. I’m talking about savoury dishes but marvelled how subtle yet tasty the flavours were. Texture is also important in Japan and this can be experienced usually in small tasting bowls, again a substitute for strong flavour.

I wear a sensor patch now as well to test my glucose levels which has been an absolute game changer. This allowed me to not only read the rising glucose levels after the Cape Town Ramen (Japanese dish) but also to give me early clues to my lowering levels in Japan.

Low-carb dishes

The other big dietary interest in Japan was the low-carb food. It’s mainly seafood rice and noodles. I may be wrong and in parts of Japan it may be different, but I was cutting out on a lot of bread and heavy starch which I think added to the change of diet.

It made me really think about South African food and how it’s modified according to different palates. With so many people living with Type 1 and 2 diabetes in South Africa, why are we being exposed to high sugar foods constantly? Especially when we go to a restaurant and place responsibility on a kitchen to keep sugar as low as possible.

It took a trip to Japan and a big change in my levels to realise that it could be different and yes, we may be used to sweeter or more flavoured foods. Maybe this needs to change, and we will learn to change with it?

PLEASE NOTE: THIS WAS RUSSELL’S PERSONAL EXPERIENCE WITH EATING JAPANESE CUISINE AND THIS WILL NOT NECESSARILY BE THE CASE FOR ALL PEOPLE WITH TYPE 1 DIABETES.

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

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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Brookes Low-Cal Passionquilla

Brookes Low-Cal Passionquilla

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Enjoy the flavours of summer with this refreshing Brookes Low-Cal Passionquilla recipe.

Perfect for those hot summer days, Brookes Low-Cal is the perfect beverage partner this season for those seeking a healthier alternative without compromising on flavour. The 6% fruit juice content guarantees the deliciously fruit flavour you all love in your favourite squash drinks and with 95% less sugar in a bottle and low-kilojoules, it’s the healthier choice for anyone who is living with diabetes.

Finding healthier alternatives can be difficult when options are few and you are craving something sweet and refreshing. That’s why Brookes Low-Cal crafted a fruit squash drink, specifically geared to help make healthy choices easier.

Taste more out of life and let’s get living and loving life even more.

Try this excitingly, zesty Passionquilla recipe for a refreshing twist to your summer delights.

INGREDIENTS (per serving)

  • 2 shots of Brookes Low-Cal Passionfruit
  • 1 passionfruit, cut into wedges
  • 1 rosemary sprig
  • 1 can (200ml) soda water
  • Crushed or blended ice

METHOD

  1. Crush ice in a blender and pour into a highball glass or jam jar.
  2. Add the two shots of Brookes Low-Cal Passionfruit.
  3. Top up with soda water and stir.
  4. Add 1 passionfruit wedge.
  5. Add fresh rosemary sprigs to garnish.

BROOKES Low-Cal is a low kilojoule squash drink that comes in a variety of fruity flavours. It’s proudly endorsed by Diabetes South Africa and the Heart and Stroke Foundation. It can be enjoyed by making mocktails or refreshing juice drinks, as part of a diabetic-friendly diet.

Read about how this low-kilojoule drink is perfect for a diabetic-friendly eating plan.

Brookes Low-Cal is available at all leading supermarkets.

Follow us on IG for more exciting recipes and updates: @lowcal_sa

NUTRITIONAL INFO (per serving)

Energy Sugars Fat Salt Saturates
Per  100ml serving <14 kJ <0.2  g <0.1 g <0.1 g <0.1 g
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postprandial blood glucose levels

Reducing postprandial blood glucose levels

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Here are simple ways to lower postprandial blood glucose levels as well as the benefits that comes along with it.

What are postprandial blood glucose levels?

Postprandial means after a meal so postprandial blood glucose levels is your glucose level after eating a meal.

Glucose is the primary source of energy for your body and the cells in your body rely on this energy to function. Balancing your blood glucose levels can contribute to manage cravings, fatigue, hormonal and fertility issues, skin conditions, ageing/wrinkles, poor sleep, menopause and mental health symptoms.

Glucose control isn’t only necessary for people living with diabetes. Everyone needs to improve their knowledge and implement skills to ensure optimal blood glucose control and prevent spiking glucose levels that contribute to oxidative stress and inflammation, which have a magnitude of negative implications on human health. 

How is glucose metabolised?

When you eat a meal, the carbohydrate gets broken down into simple sugars (glucose). The glucose is absorbed into the bloodstream which can either result in a stable release or a spike (often referred to as hyperglycaemia or high blood glucose) of glucose, depending on the type and quantity of carbohydrate you consumed.

As the blood glucose level rises, so does the level of insulin. Insulin is a hormone that carries glucose from the blood into the cells so that it can be used where it’s needed for energy.

Why should blood glucose spikes be avoided?

Hyperglycaemic spikes can impact inflammation by contributing to an increase in inflammatory cytokine concentrations more significantly than continuous high blood glucose levels. These up and down, roller-coaster blood glucose levels may lead to cravings, fatigue, poor sleep and low mood which can affect you on a daily basis.

The consequences of increase in inflammation are being highlighted as a key concern when assessing overall health because the associated inflammatory response and oxidative stress are root causes of lifestyle diseases that develop when there is a constant state of chronic inflammation.

Moreover, prolonged high blood glucose levels after meals is usually the first indicator of a defect in glucose tolerance which may pose as a contributing risk factor in the development and progression of non-alcoholic fatty liver disease, Type 2 diabetes and cardiometabolic diseases.

With persistently high blood glucose levels, protein glycation occurs which further contributes to complications, such as vascular dysfunction (damage to retina, kidneys, nerves) and the generation of free radicals which cause further harm to the cells, fibrosis and skin aging.

The effect of carbohydrates on blood glucose levels

Carbohydrate-rich meals are the main drivers of glycaemic spikes throughout the day. The quality and quantity of carbohydrates can be categorised according to their effect on blood glucose. This measurement of how a certain carbohydrate will impact blood glucose levels is known as the glycaemic index (GI).

Carbohydrate food items are compared to glucose and can be categorised into the following groups: high-, medium- and low-GI; with high-GI foods (white bread roll) exerting a higher effect or spike on the blood glucose level when compared to eating a low-GI food (rolled oats).

The portion of carbohydrate consumed is just as important as the quality of the carbohydrate, as the quantity ingested will contribute to the amount of glucose available for absorption.

Tips to reduce postprandial blood glucose levels

  1. Carbohydrates: quantity and quality

Be mindful of the type of carbohydrate and portion eaten at a sitting. A portion of starch is normally about ½ cup of cooked starch. Give preference to low-GI foods over high-GI foods. For example, unprocessed high fibre carbohydrates (more than 6g of fibre per 100g) will generally have a lower effect on blood glucose levels.

Aim to eat foods in their natural, unprocessed form. Give preference to eating fresh fruit as opposed to having fruit juice or uncontrolled portions of dried fruit. Be cautious with dried fruit; all the fluid has been removed, and the portion size equivalent to 1 fresh fruit is a whole lot smaller.

  1. Adding natural food adjuvants

Mulberry leaf (ML) and mulberry leaf extract (MLE) have numerous biological properties, such as regulating glucose and lipid metabolism, reducing blood glucose, and increasing insulin secretion. These benefits may be attributed to the phytochemicals they contain. Mulberry leaf extract is best taken with a meal as you want the MLE to reach your small intestine at the same time as the carbohydrate so that it can compete for glucose absorption. MLE has been shown to reduce fasting blood glucose and HbA1c in a recent systemic review. Taking mulberry leaf extract preparations pre-meal appear to be safe and tolerable solutions in preliminary studies, longer term research is required.

  1. Apple cider vinegar

Add to your meals or salads as a dressing, or consume apple cider vinegar (diluted with water) prior to meals. This may aid in stabilising the glucose and insulin response. However, evidence supporting the long-term use is lacking; one of the concerns is the demineralisation of teeth and therefore it’s recommended to avoid taking in large amounts.

  1. Whey protein

Eating this 30 minutes before a meal lowers the glucose peak by delaying gastric emptying without stimulating insulin secretion whereas eating whey protein with a meal leads to a lower postprandial glucose level by increasing the insulin secretion. Therefore, more insulin is available to carry glucose from the bloodstream into the cells.

  1. Cinnamon

Adding to your meals may lower the postprandial blood glucose response by increasing the insulin sensitivity.

Leveraging food combinations

Adding slow-release carbohydrates, more fibre, protein or fat to a higher GI carbohydrate slows the absorption of the glucose from the carbohydrate and leads to a lower postprandial blood glucose level.

  • If you do eat a high-GI carbohydrate, combine it with a low-GI carbohydrate to slow the glycaemic response of the meal. For example: add milk and berries to instant oats porridge and other high-GI cereals.
  • Pair carbohydrates with proteins or fats. For example: serve an egg or avocado with a slice of wholemeal toast instead of with butter and jam or serve meat/chicken/fish/eggs/plant protein with grains/pastas/potato mash and prepare the meal with olive oil.
  • Add more fibre to your meal by adding a salad or vegetables (colour) to the plate; topping breakfast cereals with oat bran, nuts or seeds; or adding lentils, beans or pulses to soups and stews, or all in one dish.

Food order

Eating foods in a particular order, for example, eating the vegetable/salad/protein/fat portion before the carbohydrate portion on the plate appears to reduce the postprandial glucose release when compared with other meal patterns by stimulating a lower insulin and higher glucagon-like peptide 1 (GLP-1) response which plays an important role in maintaining glucose homeostasis.

Physical activity

A non-dietary way that is known to help reduce the postprandial blood glucose rise includes exercising after eating. Only 10 minutes of activity: walking; bench stepping; taking the stairs or clearing the table and cleaning the dirty plates instead of being sedentary is an effective way to burn the glucose that has been absorbed into the bloodstream. The exercise duration and intensity will no doubt impact the glucose response, however, it’s evident from research that moderate exercise is sufficient to improve the glucose response to a meal.

The benefits

The overall benefits of keeping blood glucose levels more stable include less cravings, improved energy and sleep, slower ageing due to reduction in inflammation, improved gut and mental health, improved glucose tolerance, reduced risk for disease and promoting remission from Type 2 diabetes.

In summary

Eat for more fibre, protein and fats with all meals. Give preference to unprocessed carbohydrates in sensible quantities. Pre-load with add-ons (apple cider vinegar, cinnamon, whey or mulberry leaf extract). Eat the carbohydrates last, start with vegetables and protein and opt for a walk after your meal.

References

  1. Alpana P Shukla et al., “Effect of food order on ghrelin suppression,” Diabetes Care 41, no. 5 (2018): e76-e77,https://care.diabetesjournals.org/content/41/5/e76.
  2. “Impact of nutrient type and sequence on glucose tolerance: Physiological insights and therapeutic implications,” Frontiers in endocrinology 10 (2019): 144,https://www.frontiersin.org/articles/10.3389/fendo.2019.00144/full#B58.
  3. Bellini, Alessio, et al. “Walking attenuates postprandial glycemic response: What else can we do without leaving home or the office?” International journal of environmental research and public health, vol. 20, no. 1, (2022): 253, https://pubmed.ncbi.nlm.nih.gov/36612575/.
  4. Patrick Wyatt et al., “Postprandial glycaemic dips predict appetite and energy intake in healthy individuals,” Nature metabolism 3, no. 4 (2021): 523-529,https://www.nature.com/articles/s42255-021-00383-x.
  5. Biplab Giri et al., “Chronic hyperglycemia mediated physiological alteration and metabolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: an update on glucose toxicity,” Biomedicine & pharmacotherapy, no. 107 (2018): 306-328,https://www.sciencedirect.com/science/article/pii/S0753332218322406#fig0005.
  6. Zheng Zhou et al., “Glycemic variability: adverse clinical outcomes and how to improve it?,” Cardiovascular diabetology 19, no.1 (2020): 1-14,https://link.springer.com/article/10.1186/s12933-020-01085-6
  7. Chezem, J., Fernandes N., et al “Effects of Ground Cinnamon and Apple Cider Vinegar on Post prandial Blood glucose levels in healthy adults.Journal of the Academy of Nutrition and Dietetics, vol 112, issue 9, suppl: A43, https://doi.org/10.1016/j.jand.2012.06.148
  8. Singh VP, Bali A, Singh N, Jaggi AS. Advanced glycation end products and diabetic complications. Korean J Physiol Pharmacol. 2014 Feb;18(1):1-14. doi: 10.4196/kjpp.2014.18.1.1. Epub 2014 Feb 13. PMID: 24634591; PMCID: PMC3951818.
  9. Gheldof, N.; Francey, C.; Rytz, A.; Egli, L.; Delodder, F.; Bovetto, L.; Piccardi, N.; Darimont, C. Effect of Different Nutritional Supplements on Glucose Response of Complete Meals in Two Crossover Studies. Nutrients 2022, 14, 2674. https://doi.org/10.3390/nu14132674
  10. Mohamed M, Zagury RL, Bhaskaran K, Neutel J, Mohd Yusof BN, Mooney L, Yeo L, Kirwan BA, Aprikian O, von Eynatten M, Johansen OE. A Randomized, Placebo-Controlled Crossover Study to Evaluate Postprandial Glucometabolic Effects of Mulberry Leaf Extract, Vitamin D, Chromium, and Fiber in People with Type 2 Diabetes. Diabetes Ther. 2023 Apr;14(4):749-766. doi: 10.1007/s13300-023-01379-4. Epub 2023 Mar 1. PMID: 36855010; PMCID: PMC10064401.
  11. Lown M, Fuller R, Lightowler H, Fraser A, Gallagher A, Stuart B, et al. (2017) Mulberry-extract improves glucose tolerance and decreases insulin concentrations in normoglycaemic adults: Results of a randomised double-blind placebo-controlled study. PLoS ONE 12(2): e0172239. doi:10.1371/ journal.pone.0172239
  12. Takahashi M, Mineshita Y, Yamagami J, Wang C, Fujihira K, Tahara Y, Kim HK, Nakaoka T, Shibata S. Effects of the timing of acute mulberry leaf extract intake on postprandial glucose metabolism in healthy adults: a randomised, placebo-controlled, double-blind study. Eur J Clin Nutr. 2023 Apr;77(4):468-473. doi: 10.1038/s41430-023-01259-x. Epub 2023 Jan 17. PMID: 36650279; PMCID: PMC10115625.
  13. Phimarn, W., Wichaiyo, K., Silpsavikul, K. et al. A meta-analysis of efficacy of Morus alba Linn. to improve blood glucose and lipid profile. Eur J Nutr 56, 1509–1521 (2017). https://doi.org/10.1007/s00394-016-1197-x
  14. Kamruzzaman M, Horowitz M, Jones KL and Marathe CS (2021). Gut based Strategies to Reduce Postprandial Glycemia in Type 2 Diabetes. Front. Endocrinol. 12:661877. Doi:10.3389/fendo. 2021.661877.
tired

Tired of feeling tired

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Dr Paula Diab breaks down the various reasons that people living with Type 2 diabetes may constantly feel tired.

Living with Type 2 diabetes

Living with Type 2 diabetes (T2D) is indeed a challenge. Daily life can also present quite a few challenges. Put them together and you often end up with the perfect storm. Just recently I had a patient come to see me about her diabetes that was out of control by her own admission. She went into great detail about how she wasn’t sleeping well, was constantly tired and all the problems that she was dealing with. Not five minutes into the consultation and I was already exhausted as well!

I heard about the ladies at her work who order cake on a Friday that she is unable to enjoy with them. I heard about her washing machine that had packed up and how she had to hand wash all her clothes until she was able to get the repair company to collect the machine and fix it. Then, I heard about her cat that needed to go to the vet; her brother who was out of work who she was sending daily meals to; her car that needed new tyres and the new pharmacist that wouldn’t give her the correct needles on her script. I was exhausted listening to all these problems and initially wondered what on earth they had to do with her diabetes management.

Her stories had everything to do with her diabetes

Her fatigue was not only a physical fatigue from working hard and not sleeping well coupled with financial stressors, but it was a symptom of a far deeper problem.

Diabetes distress is commonly expressed by people as fatigue and it’s estimated that almost half of people with diabetes will experience it at some stage of their life. Usually, this occurs at the diagnosis of diabetes but can also become a problem at various crossroads on the journey of diabetes or when the stress of life and the stress of diabetes intersect to cause havoc.

Diabetes is a complex condition to manage and requires a high level of patient involvement, affecting all aspects of daily life and including complicated treatment regimens and frequent healthcare visits, not to mention the financial burden of a chronic disease.

Life too, comes with many curve-balls and unexpected challenges and if the correct support isn’t available, the results can be overwhelming. As tired as I was feeling halfway through the consultation, I can only imagine the mental and physical fatigue all these challenges must have been causing the patient.

Understanding fatigue in Type 2 diabetes

This case highlights some of the struggles experienced by people living with diabetes but there is often good reason for fatigue in diabetes that does require further medical investigation and management.

Remembering that T2D is a chronic condition characterised by insulin resistance, where the body’s cells don’t respond effectively to insulin. This leads to elevated blood glucose levels and eventually a decrease in the production of insulin from the pancreas. Multiple, interconnected problems may be the cause of fatigue in someone with diabetes.

Fluctuating blood glucose levels

One of the main factors contributing to fatigue in T2D is the fluctuation of blood glucose levels. When blood glucose levels are too high, the body struggles to efficiently transport glucose into cells for energy production. Conversely, when levels drop too low, the brain and muscles may not receive adequate energy, leading to fatigue.

In addition, the body becomes used to certain blood glucose levels and a significant change (either drop or rise) in these levels can have a significant adverse effect. For example, a person who is used to glucose levels around 10mmol/L may start feeling symptoms of hypoglycaemia at a level of 5mmol/L. They may feel hungry, thirsty, tired and even start shaking. However, someone who is used to levels of 5 – 7mmol/L on a regular basis, may not feel these same symptoms until they reach levels <3.0mmol/L.

Recent research is promoting the maintenance of stable blood glucose levels as being as important as average readings. Whereas we used to aim for an HbA1c < 7%, we are now looking at spending 70% of the day in range and having a co-efficient of variation <36%. What this means is that instead of aiming for a specific target and having varying glucose levels to get you there, rather aim to spend most of the day in range and have as little variation as possible.

Insulin resistance

Insulin resistance, the main underlying pathological cause of T2D, means that the body’s cells don’t respond as effectively to insulin. This can reduce the uptake of glucose by cells, depriving them of a crucial energy source. As a result, you may experience persistent tiredness. If your muscles, don’t receive energy, your body becomes weak. If your brain cells lack energy, they too become slow and fatigued.

Chronic inflammation

Exciting new data has shown the association of T2D with chronic low-grade inflammation and immune dysregulation. The constant activation of the immune system and inflammation are certainly factors which can contribute to feelings of tiredness.

Compromised sleep quality

Sleep and diabetes often form a proverbial vicious cycle of problems. Uncontrolled glucose levels can keep you from a sound night’s sleep, which in turn can raise cortisol levels and further increase glucose levels. Associated conditions, such as sleep apnoea and restless leg syndrome, can also cause sleep interruption.

Poor sleep can contribute to daytime fatigue, creating a cycle that perpetuates tiredness.

Sleeping tablets can assist in the short-term to induce a good pattern of sleep but generally, the underlying cause should be addressed rather than relying on long-term sedative medications.

Co-existing conditions

Some people with T2D often have other health conditions, such as hypertension and cardiovascular disease, which can independently contribute to fatigue. The cumulative burden of managing multiple health conditions can take a toll on energy levels. These need to be actively managed and optimised so as to reduce the burden of complications.

Mental health factors

The emotional and psychological impact of living with a chronic condition like T2D can’t be overlooked. Stress, anxiety, and depression are common companions of diabetes and can contribute to feelings of fatigue. These conditions need careful and sensitive management and shouldn’t be tagged as an add-on to an already complicated diabetes consult. Chronic medication may be indicated but usually works best in conjunction with regular psychotherapy and lifestyle intervention.

Managing fatigue in Type 2 diabetes

As with most aspects of diabetes, addressing fatigue requires a holistic approach that considers both lifestyle modifications and medical interventions:

  • Blood glucose management

Regular monitoring and management of blood glucose levels are fundamental. Unfortunately, these behaviours form the cornerstone of any management plan in diabetes and can’t be avoided. Incorporating a well-balanced diet, regular physical activity and remaining adherent to medication is vitally important. Monitoring of blood glucose levels and ensuring levels remain as stable as possible will contribute greatly to lessening feelings of fatigue.

  • Physical activity

Not only does regular exercise release hormones in the brain that combat fatigue, but it also provides a physical release of energy and improves insulin sensitivity. Blood glucose levels become more regulated, energy levels are enhanced, and a more restful sleep occurs when the body is physically tired.

  • Healthy diet

The importance of a well-balanced diet is crucial. Choose foods that are rich in fibre, organic nutrients and low-GI carbohydrates where possible. Lower GI carbohydrates (oat/bran cereals, pasta, sourdough bread) will release energy over a longer period of time and prevent the spikes in glucose levels that occur with higher GI foods (processed cereals, white rice, white bread, etc).

The addition of fat and protein in the correct quantities as well as a good serving of fresh vegetables can also have an extremely beneficial effect on drawing out metabolism and keeping glucose levels more stable.

Opt for fresh, home-grown and unprocessed foods. Get rid of junk food completely; just throw it out. Reduce snacks as much as possible and sit down and enjoy your meals if possible.

Regular, planned meals rather than a daily binge and snack-attack as soon as you return home in the evenings go a long way to improving glycaemic control and preventing the glucose surges that cause fatigue.

  • Adequate sleep

Prioritising good sleep hygiene is essential for managing fatigue. Establish a consistent sleep routine, create a comfortable sleep environment, and address sleep disorders with the guidance of healthcare professionals who are specifically trained.

Don’t rely on sleeping tablets in the long-term unless absolutely necessary. Treat the underlying cause, whether it’s getting the correct device to combat sleep apnoea, finding the right medication for neuropathic pains or simply gaining better glucose control.

  • Stress management

This is probably the most difficult factor to manage. Life is stressful and there is no getting away from it. Chronic stress can exacerbate fatigue and impact blood glucose levels. But try to find the time to investigate a suitable technique that works for you; it may be mindfulness, meditation or relaxation exercises. Perhaps it’s just connecting with friends, spending time nurturing your spiritual self or dedicating time each day to unwind and disconnect.

Conclusion

Fatigue in Type 2 diabetes is a multi-faceted issue involving physiological and psychological factors. Perhaps in understanding the mechanisms behind this single symptom, people with T2D will feel empowered to start addressing some of the concerns and seek adequate help.

It’s impossible for a diabetologist to pay the vet bill, fix the washing machine, repair the car tyres and argue with the pharmacist about which needles are required and why. However, it’s completely possible to lend a listening ear.

Breaking down some of the stressors, identifying which need urgent attention and which can be side-lined can be very helpful strategies. If fatigue is due to any of the diabetes-related scenarios discussed above, then treating the root cause of the problem is going to give the best outcome.

However, if fatigue is more related to be a symptom of diabetes distress, then compounding the problem with additional demands of tight glycaemic control is not going to help.

Sometimes, these curveballs do all arrive at the same time. I often use the analogy of a juggler with too many balls in the air. A good suggestion is to concentrate on just a few important balls, allow some to drop and pick them up when you can. Concentrate on self-care first and get the basics right. Utilise the skills of the entire diabetes team and seek appropriate help where needed.

Diabetes isn’t a disease that can be treated with a bi-annual 15-minute visit to renew a script. A comprehensive approach that includes blood glucose management, lifestyle modifications, and emotional well-being is essential for improving overall quality of life. And if digesting all of that does make you feel tired…at least you know you’re not alone.

Dr Paula Diab

MEET THE EXPERT

Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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