Category: Treatment AtoZ 2022

Bariatric surgery

Bariatric surgery

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Bariatric surgery is a treatment option for obesity and diabetes in patients whose body mass index (BMI) is ≥ 35 kg/m2 and glucose levels aren’t controlled despite the best efforts with medications and lifestyle modification.

BMI is calculated as follows: BMI = weight (kg) ÷ height (m²).     

Bariatric surgery has been a major advancement in treatment of people living with obesity and diabetes in recent years. Between 70 and 90% of these people will still be in diabetes remission two years post-surgery. Remission is defined as normal blood glucose on no diabetes medication for at least a year. Even 15 years after bariatric surgery, a third of people will still be in remission. Of those that need diabetes treatment again, simpler regimens achieve glucose control. 

There are a variety of procedures available, and this should be individualised by the bariatric centre which will be staffed by a full multi-disciplinary team: surgeon, specialist physician, dietitian, psychologist, and exercise therapist.

The benefits extend beyond improving glycaemic control, as multiple other comorbidities (hypertension, sleep apnoea, high cholesterol) are also positively affected. 

Bariatric surgery has few complications, but regular structured follow-up is essential. Particular attention must be paid to those complications relating to nutritional deficiencies since the stomach and intestines are responsible for absorbing nutrients from food eaten.

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Insulin pump therapy

Insulin pump therapy

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Insulin pump therapy, also known as continuous subcutaneous insulin infusion, uses a small, computerised device to deliver insulin continuously in the way a functioning pancreas would. Only short-acting insulin is used for both the background and mealtime requirements.  

Insulin is administered via a plastic tubing connected to the pump on one side and a small cannula inserted through the skin. The subcutaneous site can be on the abdomen, outer thigh, outer arm, or top of buttock. The abdomen is usually the preferred site. The site needs to be changed every three to four days to prevent infection or inflammation.

A background basal rate is set up to give insulin continuously. This rate will vary over the 24 hours of a day depending on the requirements. 

For mealtimes, you will need to give a bolus insulin dose. To do this, the blood glucose value and amount of carbohydrates (in grams) is entered into the pump. The amount of insulin needed to cover the carbohydrates is pre-programmed. In the same way the on-board computer will calculate how much insulin is needed to correct a high blood glucose reading.

Some pumps can communicate with continuous glucose monitoring devices which has brought a new level of accuracy. The most sophisticated of these systems allows the pump to adjust basal insulin according to requirements, switch off insulin delivery if glucose levels drop to low and give small boluses of insulin to correct glucose levels starting to rise. This system has been dubbed the artificial pancreas. 

People with Type 1 diabetes are ideal candidates. However, people with Type 2 diabetes who inject insulin four times a day can also benefit. Unfortunately, pumps are expensive and only worth considering if you have medical aid that will cover the costs.

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Oral Medication

Oral medication

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All patients with diabetes are initiated on medication at diagnosis. People with Type 1 diabetes will require insulin replacement due to the damage to the pancreas. People with Type 2 diabetes are prescribed oral medication according to international and national guidelines. In addition, lifestyle measures including a balanced diet and exercise are recommended for both types of diabetes.

The first medication prescribed to people diagnosed with Type 2 diabetes is metformin. This can be given as a daily extended-release pill, or twice daily normal formulation. The dose is increased according to average glucose levels. Metformin improves the action of insulin in the liver and thus, decreases the production of glucose from the liver. Similarly, it helps the work of insulin at the level of the muscle to absorb glucose from the bloodstream. 

Metformin benefits and side effects

Metformin also has benefit in protecting the body against the abnormal, complication-inducing complexes that form when glucose levels are high. For this reason, metformin is continued life-long for benefits beyond just lowering of glucose. 

The side effects of concern are gastrointestinal, especially diarrhoea, bloating and nausea. Some patients can’t tolerate metformin at all but for many who develop side effects, a lower dose allows them to continue treatment. (softlay.com) The daily extended-release formulation also seems better tolerated.

Other classes of agents

If diabetes isn’t controlled, as measured by HbA1c, three months after initiating metformin, then a second agent needs to be added. There are four classes of agents: sulphonylureas (increases insulin secretion); dipeptidyl peptidase inhibitors; thiazolidinediones; and sodium-glucose like transporter-2 inhibitors (results in sugar being flushed out of the body via the kidneys). 

A non-insulin injectable can also be used; these are the glucagon-like peptide receptor agonists. These latter agents help with weight loss as well as HbA1c control.

Type 2 diabetes is a progressive condition. This implies that periodically there will be further deterioration in control and at some point, the pancreas may not produce enough insulin. This may require one to four injections of insulin daily to supplement what the body needs. There is no doubt that a healthy diet, weight control and regular physical activity will slow this progression.

Side effects

It’s possible that you may have some side effects when taking oral medications but it’s important that you don’t stop taking your medicine without speaking to your doctor first. Side effects usually settle down once your body gets used to the medicine. Check the patient information leaflet that comes with your medicine for more info. 

The most common side effects include a metallic taste in the mouth, nausea, vomiting, or diarrhoea. Some of the medications may cause hypoglycaemia and you should report this to your doctor immediately. The medications which work through the kidney can increase the risk of urinary and genital infections which need to be speedily treated. Again, you need to alert your healthcare team.

Management of diabetes in the modern age includes maintaining a balanced lifestyle and appropriate medications so that you may be assured to decreased risk of complications.

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Insulin

Insulin

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Insulin lowers blood glucose by stimulating the uptake of glucose into your muscles and fat and stops the liver from producing and releasing more glucose into the bloodstream.

Insulin is the first-line treatment for people diagnosed with Type 1 diabetes as pancreatic destruction means they don’t produce their own insulin. 

People with Type 2 diabetes or gestational diabetes who don’t achieve good glucose control on oral agents will also need to be initiated on insulin. Often people starting insulin feel that they’ve failed in their efforts to manage their diabetes with exercise and diet. Starting insulin isn’t a reflection on discipline or perseverance. Often insulin is the only therapy that can control blood glucose and improve management. It shouldn’t be seen as a last resort or as a punishment.

Types of insulin:

  • Basal or long-acting insulin is usually taken once a day and provides insulin coverage over 18 to 24 hours.
  • Bolus or rapid-acting insulin is taken before meals to prevent a spike in blood glucose from food. An additional amount (correction dose) may be added to lower an already high blood glucose. This usually reduces high blood glucose quickly and will remain in your body for three to five hours.
  • Mixed insulin is a mix of long-acting and rapid-acting insulin. It’s usually taken twice a day before breakfast and dinner and has eight to 12 hours of coverage in your body. The initial amount of insulin will be faster-acting with smaller amounts in your body after five hours. 

Your doctor will discuss which option would be preferable depending on the features of your diabetes. It’s ideal to also see a diabetes educator and dietitian when you start insulin. The diabetes educator will provide education about how to use insulin and help to make any necessary adjustments. The dietitian will discuss the best strategies for eating.

Side effects

The most common side effect is hypoglycaemia (blood glucose level < 4mmol/L). People using insulin should always carry a fast-acting carbohydrate with them, such as sweets or juice, as well as a blood glucose kit. Patients requiring high doses of insulin can also experience weight gain. Adjusting carbohydrate intake can assist with this.

Tips for effective use

  1. The insulin pen in current use can be kept at room temperature while all spare insulin is stored in the fridge. Using a cooler box or gel pack is useful if insulin has to be kept in the car.
  2. Speak to your doctor about using insulin cartridges instead of disposable pens as these are often cheaper and fully reimbursed by medical aids.
  3. Looking after injections sites is vital which involves changing the needle after every third injection and using different sites each time.
  4. When initiating insulin, your dose may need several changes so keep in close touch with your doctor or diabetes nurse. One dosage change every few months isn’t adequate.

Optimal control with insulin is dependent on your individual requirements which is assessed by checking your blood glucose regularly. 

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Diabetic skincare

Urea, the gold standard for dry skin treatment

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Eucerin® UreaRepair PLUS provides immediate relief and 48 hours of protection for the family.

Urea is the gold standard in the treatment of dry skin conditions.  Eucerin® UreaRepair PLUS offers a comprehensive and clinically proven range to treat dry skin.

Suffering from dry skin is not only uncomfortable, itchy and sore, but the effects go beyond the physical symptoms, often leaving people feeling frustrated, helpless, emotionally drained and tired from lack of sleep.

Dermatologist-recommended Eucerin® provides a comprehensive and effective solution for people suffering from extremely dry skin. The Eucerin® UreaRepair PLUS complete range of cleansers, moisturisers and acute care products contain Urea which, according to research and a published paper, is the best active ingredient for the treatment of dry skin.**

The Eucerin® UreaRepair PLUS offers the immediate and long-lasting relief of dry skin signs, like roughness, scaliness and flakiness, providing moisture and strengthening the skin barrier.  This makes skin more resilient and impedes the recurrence of dry skin.

Why skin becomes dry

Dry skin can be caused by internal factors, such as a genetic predisposition, hormonal influences, biological skin ageing, as well as diseases such as eczema, psoriasis, diabetes or ichthyosis.

External causes can include heat, cold or humidity; UV-induced skin ageing; frequent washing; insufficient fluid intake and extreme medical treatments such as radiation therapy, chemotherapy, or dialysis.

Balancing skin and soul

The skin we live in is our natural protective sheath with a complete balance of water, fat and moisture binding substances, protecting us from weather and dryness. If this substance relation is disrupted, the skin becomes rough, scaly, red, itchy and sensitive. Extremely dry skin needs care that balances both lipids and moisture as these strengthen the skin’s resilience.

The formulation combines the following active ingredients:

To BIND moisture into skin

  • Urea is significantly reduced in dry skin, so the supplementation of Urea actively improves the moisture binding capacity of skin and replenishes its moisture deficit. Urea is established in dermatology as the “gold standard” in the treatment of dry and very dry skin.
  • A Natural Moisturising Function Complex (NMF-complex) made up of Urea, Amino Acids, Lactate and PCA, ensures a balanced moisture level, thus supporting the barrier function of the skin. Supplementing the NMF-complex promotes skin regeneration and Filaggrin breakdown.
  • Filaggrin is a type of protein found in the skin that is formed during the process of keratinisation (when cells move to the horny layer). A mutation of the filaggrin gene can interfere with the skin’s ability to act as a barrier. When this happens, water is lost from the skin and bacteria and other substances can enter, possibly leading to allergies, irritation and infection.

To LOCK moisture into skin

  • Ceramide 3 assists with barrier repair and reduces moisture loss.

Improves MOISTURE DISTRIBUTION in the skin

  • Gluco-Glycerol activates the skin’s natural moisturising network (Aquaporins), ensuring moisturisation in the deeper epidermal layers.

Noticeable improvements can be seen even after six days of application. Those who suffer from dry skin can finally feel comfortable in their own skin.

References:

*Eucerin clinical studies incl. measurements and self-evaluation, Winter 2015; Lotions: PIU 2012

**“Diagnosis and treatment of xerosis cutis – a position paper” German Society of Dermatology (JDDG) in November 2019, the original German version appeared in 2018.

The Eucerin® UreaRepair PLUS products are available in-store and online from Clicks, Dis-Chem, Takealot and Foschini.

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Physical activity

Physical activity

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Studies have shown that physical activity can delay the progression of prediabetes to Type 2 diabetes, when combined with dietary changes. Regular physical activity significantly improves glycaemic control. In addition, it improves cardiovascular risk factors (cholesterol and blood pressure) and may reduce medication dosages, including insulin.

Regular physical activity may also improve symptoms of depression and improve health-related quality of life.

A recommendation of 150 minutes per week of moderate-intensity aerobic physical activity is given, with the aim of achieving and maintaining a heart rate that is 50 – 70% of the maximum heart rate. To determine your maximum heart rate, minus your age from 220.

Resistance training

In the absence of contraindications (back or neck problems), you should aim to do resistance training three times per week. Resistance exercise increases strength and vigour, reduces body fat, and increases resting metabolic rate. 

The studies reporting the greatest impact of resistance exercise on HbA1C had subjects progress to three sets (with approximately eight repetitions per set) of resistance type exercises at moderate to high intensity (the maximum weight that can be lifted eight times while maintaining proper form).

If you wish to begin resistance exercise, you should seek initial instruction and periodic supervision by a qualified exercise specialist (biokineticist) where possible, to maximise benefits while minimising risk of injury. Not unexpectedly, studies have shown that resistance exercise with less supervision reported less beneficial impact on glycaemic control, insulin resistance and body composition than with greater supervision.

Walking

Walking is often the most popular and feasible type of aerobic exercise. For those who struggle with pain upon walking for any reason, semi-recumbent cycling may provide an alternative. Moderate brisk walking on level ground or semi-recumbent cycling would be an example of moderate aerobic exercise, while brisk walking up an incline or jogging would be vigorous aerobic exercise. 

Also try to increase the number of activities of daily living, such as housework, gardening and walking around shopping centres. Ideally reduce sedentary time, particularly in the workday, by breaking up extended amounts of time spent sitting. Every hour or hour and a half move around for a few minutes.

Hypoglycaemia during exercise

Physical activity can cause hypoglycaemia in some individuals. 

If your blood glucose tends to drop with exercise, consume some carbohydrates before starting to exercise. The exact amount needed will vary widely between people and can vary depending on the type of exercise, time of day and even the ambient temperature. Work with your doctor or DE to calculate what amount of carbohydrate works for you. 

A useful rule of thumb is to add 250ml fruit juice to 250ml water and sip frequently during the training session. This is for a session of longer than 45 minutes. However, an individualised approach is usually needed. You shouldn’t exercise vigorously if the blood glucose level is > 15mmol/L as this can cause damage to your muscles. 

Having social support (exercising with a friend, partner or in group classes) facilitates and aids in motivating regular physical activity.

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Chicken, Chilli and White Bean Soup

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Makes 6 servings
Preparation time: 10 – 15minutes 
Cooking time: 40 minutes

Ingredients

  • 1 Tbs extra virgin olive oil
  • 1 SPAR Freshline onion, medium, chopped
  • 1 SPAR Freshline jalapeño chilli pepper (seeded and chopped)
  • 1 SPAR Freshline red bell pepper (chopped)
  • 2 SPAR Freshline garlic cloves, minced
  • 1 ½ tsp cumin
  • 1 Tbs chilli flakes (medium spicy) (adjust to your sensitivity to spicy foods)
  • ½ tsp Sea salt
  • 3 cups prepared Ina Paarman Chicken Stock (divided) (1 tsp powder to 1 cup boiling water)
  • 3 cups white kidney beans (SPAR canned Cannellini Beans, drained and rinsed)
  • 600g SPAR Select Chicken Thighs – remove skin before cooking (The bones can be removed during the cooking process when shredding the chicken)
  • 1 cup chopped SPAR Freshline broccoli (fresh or frozen)
  • ½ cup SPAR Freshline coriander (chopped)
  • Additional water
  • 1 SPAR Freshline lime, sliced in wedges 

Method

  1. Heat oil in a large pot with a lid over medium-high heat. Add onion, jalapeño and bell pepper and cook for about 5 minutes or until onion is soft. Add garlic, cumin, chilli flakes and salt and cook for another minute until fragrant. If it starts to turn brown or burn, add a little water. 
  2. While vegetables are cooking, add a third of the stock and half of the beans to a food processor, or blend using a hand blender to puree the beans. 
  3. Add the remaining stock and pureed beans to the pot and stir to combine. Place the chicken pieces in the pot, cover with lid and reduce heat to medium-low. Cook at a gentle boil for 20 – 25 minutes, or until chicken is cooked through. 
  4. Remove the cooked chicken thighs from the pot and carefully shred the chicken with two forks or chop it finely. Return the chicken and any juices back to the pot with the remaining beans, broccoli, and coriander. 
  5. Stir to combine and season with additional salt if needed. 
  6. Allow soup to cook for an additional 5 – 10 minutes. 
  7. Add additional water if needed. 
  8. Divide the soup into bowls and serve with a lime wedge. 
  9. Enjoy!

Additional notes:

  • Leftovers – Refrigerate in airtight container for up to 3 days. Freeze for up to 3 months. 
  • No chicken thighs – Use chicken breasts instead.
  • Vegetarian – Omit the chicken and use extra beans (this will increase the carbohydrate). 
  • 1 serving is equal to approximately one cup of chilli soup.

This recipe is brought to you by:

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Lancewood yoghurt

What is yoghurt?

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What is yoghurt?

Yoghurt is a popular dairy product made through the fermentation of milk with the use of yoghurt cultures. These cultures ferment the natural sugar in milk, called lactose. 

Yoghurt is both delicious and nutritious, offering both high-quality protein and aids in meeting your daily calcium requirements, meaning it isn’t just good, but good for you too. 

Benefits of yoghurt

It contains protein and nutrients, such as calcium and B-vitamins, and is also known to be a good source of potassium. It can aid digestive health, may strengthen the immune system and assist in weight management.

How to choose the best yoghurt for you

While taste might be a big deciding factor in what type of yoghurt you prefer, other health factors should be considered when choosing the best option for you.

Three of LANCEWOOD’s Low Fat Yoghurts are recommended for people living with diabetes or who may be lactose sensitive.

The nutritional table (below) of these yoghurts can be consumed as part of a balanced diet. They contain less than 6 grams of sugar per 100g serving, which is less than 1 teaspoon. They also contain protein, which could aid in reducing the GI of the yoghurt, potentially resulting in lower blood glucose levels.

LANCEWOOD® No Sugar Added Low Fat Blackberry & Cherry Yoghurt – the goodness of fruit yoghurt without compromising on taste, the perfect guilt-free snack without the added sugar.

LANCEWOOD® Lactose Free Low Fat Plain Yoghurt – a lactase enzyme is added to breakdown the sugar (lactose), naturally found in milk. The addition of the enzyme aids the digestive process for lactose sensitive people, so they too can still enjoy LANCEWOOD’s quality yoghurt. 

Delicious and versatile, LANCEWOOD® Low Fat Plain Yoghurt is lower in fat and higher in protein, ideal for adding a healthy and tasty twist to any meal.

Lancewood yoghurt

NUTRITIONAL INFORMATION

Nutritional Information comparison per 100g

AVERAGE VALUES No Sugar Added LF Blackberry & Cherry Lactose Free LF Plain Yoghurt Low Fat Plain Yoghurt
Energy 196 kJ 189 kJ 196 kJ
Protein 2,8 g 3,0 g 3,5 g
Glycaemic carbohydrate 5 g 5 g 6 g
of which total sugar 2,6 g 1,3 g 3,8g
Of which total lactose / <0,1 g /
Total fat 1,5g 1,3g 1,0g
 of which saturated fat 0,9 g 0,8 g 0,7g
Cholesterol 5 mg 4 mg 3 mg
Dietary fibre# 0,9 g <0,5 g <0,5 g
Total sodium 34 mg 38 mg 41mg
Calcium 90,1 mg 101 mg 113 mg
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