Understanding the DSA Endorsement Logo

We are sure many have wondered exactly how certain food products get the DSA Endorsement Logo. With that, we explain the procedure and specifications needed.


Any food product which has the DSA Endorsement Logo on it, is deemed diabetic friendly and is safe for people living with diabetes (Type 1 and Type 2) to consume in the recommended serving size.


The DSA Endorsement Logo is a third-party verification that the endorsed product does meet the strict specifications to carry the logo.

The purpose is to assist people with diabetes, hypertension, cholesterol, or those who wish to follow a healthy eating plan. The diabetes endorsement has been running for 20 years. The endorsement page  supplies a list of products which have been approved to assist anyone when doing their shopping.


GIFSA

The Glycemic Foundation of South Africa (GIFSA) is the dedicated service provider that handles this procedure, from application, nutritional evaluation, testing of the products’ Glycaemic Index when applicable and finally conclude an Endorsement Agreement. Both DSA and GIFSA are official government-approved endorsement entities in terms of Regulation 146. GIFSA have had good success in managing their own GIFSA Endorsement Logo programme for 25 years.

The DSA Endorsement Logo process is done in tandem with the GIFSA Frequent Foods (very low GI) and GIFSA Often Foods (low GI) logos.

DSA Endorsement Logo
FREQUENT FOODS are very low fat, low GI products. The mark means that the product has been tested and found to have minimal effects on blood glucose, blood cholesterol and/or blood pressure levels. In addition, the product is virtually fat free, is manufactured from ingredients considered to be free of health risks and so may be eaten freely. What distinguishes this product from the ‘green group’ is the fact that it is aimed at the health-conscious and those who follow a fat-free or extremely low-fat diet. The Diabetes South Africa endorsement is done in tandem with the Frequent Foods logo.
DSA Endorsement Logo
OFTEN FOODS are low fat, low GI products. The ‘green’ mark certifies that the product has a minimal effect on blood glucose, cholesterol and/or blood pressure levels. The product contains ingredients considered to be healthy when eaten in normal amounts. These products pose no risk to health even to those suffering from diseases of lifestyle. The Diabetes South Africa endorsement is done in tandem with the Frequent Foods and Often Foods logos.

How do these classifications work?

There are specifications for types of foods and they are evaluated according to how suitable they are for use by people living with diabetes and other lifestyle diseases. Foods are rated according to their effect on overall health in respect of blood glucose response (GI and GL), total fat, saturated fat, sodium, fibre, and sugar content.

The evaluation and grading specifications have been developed through consultation with nutritional experts and is approved by the Department of Health and Welfare.

View or download the nutritional specifications for endorsed foodstuffs.

GI Testing and Endorsement Procedure

The DSA Endorsement Logo is available at a reasonable cost to any food and drink manufacturer who wishes to have a product labelled, provided the product complies with the specifications. The DSA specifications also include a specification for sugar content.

The process to obtain DSA endorsement typically takes place in four steps.

  1. Evaluation and Assessment

The product is evaluated against the specifications. Note, there are different specifications for all the different food categories.

GIFSA would need the product formulation which they use to do an evaluation and theoretical GI and nutritional calculation. All information is strictly confidential, and a non-disclosure  agreement is signed. The initial evaluation cost is R1 380 (excluding VAT). Follow-up calculations, after changes to the formula may be necessary, is R690 (excluding VAT), but is often not needed. 

  1. Nutritional Analyses

After the initial assessment, nutritional analyses are needed and can be done by The Council for Scientific and Industrial Research (CSIR), Microchem, Société Générale de Surveillance (SGS), or another laboratory. Specifically, important is to get the glycaemic carbohydrate value for the product. The cost would be about R7 500 (once-off). 

  1. GI Testing

GIFSA would then do a Glycaemic Index test on human subjects after receiving samples of the product if applicable. GIFSA’s once-off fee for testing is R14 200 (excluding VAT). There is usually a waiting period of a couple of weeks or months depending upon their testing schedule. 

Testing for the GI of a given food is done on real people, eating real food and taking actual blood glucose readings. A GI test team typically consists of at least 10 people. Only healthy individuals are allowed in a test team, in accordance with ISO 26642:2010 . 

You can read more on the testing.

  1. Endorsement Agreement

If the product meets all the specifications, the manufacturer may opt to participate in the endorsement programme. The fee is R9 700 (excluding VAT) per product annually for the DSA logo. Discounts are given for product ranges.

A contract is signed which fixes the fee for three years and allows GIFSA to hold the manufacturer accountable for the formula of the product.

DSA Endorsement Logo

Find out more about more about GIFSA.


Did you know that all flavours of Futurelife© Zero Smart Food™ are endorsed by Diabetes South Africa?

To help you understand how it got the DSA Endorsement Logo, we have outlined the criteria for you using Futurelife© Zero Smart Food™ as an example.

Learning about glucagon

Estée van Lingen tells you everything that you need to know about glucagon, the hormone that raises blood glucose to treat a low in diabetes.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Most of you have heard about insulin and know what its function is in the body. But how many know what glucagon is and what it does?

What is glucagon?

Your body normally has a complex system to make sure your blood glucose is at optimum levels. If you have too much or too little glucose in the blood, it can cause certain symptoms and complications and in cases of people with diabetes, it can also be life-threatening.

Glucagon is a natural hormone that your pancreas makes that works with other hormones (like insulin) and bodily functions to help regulate your blood glucose levels.

Why is this important and how does it work?

Hormones are chemicals that co-ordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.

Your pancreas is a glandular organ in your abdomen that secretes several enzymes to help with digestion and several hormones, including glucagon and insulin. It’s surrounded by your stomach, intestines and other organs.

Glucose is the main sugar found in the blood. You get glucose from carbohydrates in the food you eat. This sugar is an important source of energy and provides nutrients to your body’s organs, muscles and nervous system. Glucose is essential because it’s the primary source of energy for the brain.

Glucagon increases your blood glucose to prevent it from dropping too low (hypoglycaemia), whereas insulin, another hormone produced by the pancreas, decreases blood glucose levels. The alpha cells in your pancreas make glucagon and release it in response to a drop-in blood glucose, prolonged fasting, exercise and protein-rich meals.

How does it do this?

Glucagon helps blood glucose levels rise back up in multiple ways, including:

  • Glucagon triggers the liver to convert stored glucose (glycogen) into a usable form and then release it into the bloodstream. This process is called glycogenolysis
  • Glucagon can also prevent your liver from taking in and storing glucose so that more glucose stays in the blood.
  • Glucagon helps your body make glucose from other sources, such as amino acids (protein building blocks).

If your blood glucose levels trend higher, your pancreas releases insulin to bring it back into range.

What is the difference between glucagon and insulin?

Glucagon and insulin are both important hormones that play essential roles in regulating your blood glucose. Both hormones come from your pancreas: alpha cells in your pancreas make and release glucagon and beta cells in your pancreas make and release insulin.

The difference is in how these hormones contribute to blood glucose regulation. Glucagon increases blood glucose levels, whereas insulin decreases blood glucose levels. If your pancreas doesn’t make enough insulin or your body doesn’t use it properly, you can have high blood glucose (hyperglycaemia) which can then lead to diabetes, if left untreated.

What tests check glucagon levels and what are normal levels?

Healthcare providers don’t typically order glucagon level tests for people with diabetes, but they may order tests to help diagnose some rare endocrine conditions.

Your healthcare provider may order glucagon blood tests to measure your glucagon levels if you’re having certain symptoms. During the test, a provider will draw a blood sample and send it to the lab for testing.

Normal value ranges can vary from lab to lab and depending on the duration of fasting and blood glucose levels. Always compare your results to the reference given on your blood lab report and talk to your healthcare provider if you have questions.

What conditions are related to glucagon function?

People with diabetes can develop an inability to release enough glucagon in response to decreasing blood glucose levels. Because of this, they’re more likely to develop frequently low or severely low blood glucose if they take medication that could cause low blood glucose, especially synthetic insulin and certain medications.

People with Type 2 diabetes may have glucagon levels that are relatively higher than what would be considered normal, based on blood glucose levels. This can contribute to higher blood glucose.

What are the symptoms of glucagon-related conditions?

Depending on the situation and condition, you can experience low and/or high blood glucose from abnormal glucagon levels.

Symptoms of low blood glucose (hypoglycaemia)

  • Shaking or trembling
  • Sweating or chills
  • Dizziness and light-headedness
  • Faster heart rate
  • Hunger
  • Confusion or trouble concentrating
  • Nervousness or irritability
  • Pale skin
  • Weakness
  • Tingling or numbness in your face/ mouth

If you experience these symptoms, it’s important to eat food with carbohydrates/sugar to treat it and bring your glucose levels up, and after that make sure you consume a healthy balanced meal. If this happens often, contact your healthcare provider.

Symptoms of high blood glucose (hyperglycaemia)

Not necessarily always caused by glucagon problems but more by not enough insulin or the body not being sensitive to insulin.

  • Increased thirst and/or hunger
  • Blurred vision
  • Frequent urination
  • Headaches
  • Fatigue (feeling weak and tired)
  • Unexplained weight loss
  • Slow healing cuts and wounds

If you experience these symptoms, it’s important to see your healthcare provider.

When should you see your healthcare provider about glucagon levels?

If you have diabetes and are experiencing frequent episodes of low or high blood glucose, it’s important to contact your healthcare provider. Glucagon levels are not normally tested in people living with diabetes, but your provider might need to adjust medications.

While other glucagon issues are rare, if you are having symptoms, its essential to figure out the cause by talking to your healthcare provider.

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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Seven ways to get the most out of apple cider vinegar

Apple cider vinegar is a kitchen staple that has several benefits including health, beauty, household, and cooking uses. Estée van Lingen tells us how to get the most out of it.


Listen to this article below or wherever you get your podcasts or visit our playlist.

What is apple cider vinegar?

It’s a vinegar made from cider; it’s made by crushing apples, then squeezing out the juice. The apple juice is then fermented to yield apple cider vinegar. Acetic acid and malic acid combine to give this vinegar its sour taste.

Note: Organic, raw and unfiltered apple cider vinegar is usually the best choice. It may be cloudy and will be higher in beneficial bacteria.

Seven ways to get the most out of apple cider vinegar

Did you know that you can wash your hair with apple cider vinegar and even use it as a skin toner? Yes, you can. 


However, let’s focus on the different ways to use apple cider vinegar with food and to benefit your health.

1. Preserve food

Just like other types of vinegar, apple cider vinegar is an effective preservative. People have used vinegar as a pickling agent to preserve foods for thousands of years.

Apple cider vinegar deactivates the enzymes and creates an acidic environment that inhibits the growth of harmful bacteria, yeast, and mould. You can pickle various vegetables like cucumbers, onions, and olives; the tangy flavour of apple cider vinegar adds a delightful twist to pickled veggies.

It can also be used to preserve sauces, marinades, and chutneys. Its acidity helps extend the shelf life of these flavourful condiments.

There are many recipes online to preserve or pickle food using apple cider vinegar. Just make sure that you follow the instructions and that you use the correct cookware. Most importantly, don’t dilute the vinegar as the acidity will be lowered and might not be enough to kill harmful bacteria.

2. Make salad dressings, vinaigrette or marinades

Homemade dressings can be much less processed than store-bought and are often tastier too. They also don’t contain added sugars which is ideal for people living with diabetes.

Apple cider vinegar is a very popular ingredient in steak marinades because it gives a nice sweet-and-sour flavour. This can then be combined with olive oil, garlic, soya sauce, onion, cayenne pepper and fresh or dried herbs to give your meat a delicious flavour.

3. Add a burst of flavour to your food

If you are looking for a tangy sauce for your food, try adding apple cider vinegar to tomato-based sauces to give a fuller flavour.

You can also add to your favourite soup at the end if it tastes bland. Add it gradually and taste as you go, until you reach a flavour you enjoy.

4. Wash fruits and vegetables

Pesticide residue on fruits and vegetables can be a concern for many people. That’s why some people like to wash theirs in apple cider vinegar before consuming.

Although it’s not entirely clear whether it will remove more pesticides than simply washing with water, it may help kill any dangerous bacteria.

5. Ease a sore throat

Gargling with apple cider vinegar diluted in water is a popular home remedy for sore throats. The thought is that its antibacterial properties could help kill off the bacteria that is causing the sore throat. However, there is no evidence to support its use in this way.

If you try this at home, make sure you mix the vinegar with water before gargling (about 1-2 Tbsp. per half a glass of water). This is because of the acidity which can cause throat burns when consumed undiluted.

6. Increase satiety

Obesity is a significant risk factor for Type 2 diabetes, and maintaining a healthy weight is essential for managing the condition. It has been suggested that apple cider vinegar helps with appetite suppression and increased feelings of fullness. This may help you consume less kilojoules and achieve weight loss goals since it only has 12,6 kilojoules per tablespoon which is way less than standard salad dressings or marinades.

7. Regulating blood glucose levels

Apple cider vinegar has been shown to improve insulin sensitivity and lower blood glucose levels after meals, especially if you have insulin resistance or Type 2 diabetes.

This is due to its effect of reducing a glucose spike after a meal through acetic acid that helps to inhibit the digestion of refined carbohydrates, slowing down the conversion of starches into sugars.

Insulin resistance is a key factor in Type 2 diabetes, where the body’s cells become less responsive to insulin’s action. Studies suggest that apple cider vinegar may help enhance insulin sensitivity, allowing cells to better utilise glucose from the bloodstream. This can lead to improved glycaemic control and reduced reliance on insulin.

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 Safari Vinegar in the interest of education, awareness and support. The content and opinions expressed are entirely the contributor’s own work and not influenced by Safari Vinegar in any way.

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Are moods and blood glucose in children related?

Daniel Sher explores the mechanisms behind the relationship of moods and blood glucose and offers practical advice for parents and caregivers to better support their children.


Listen to this article below or wherever you get your podcasts or visit our playlist.

The interplay between mood and blood glucose in children with diabetes involves a complex relationship where physical health significantly influences emotional well-being and vice versa. This connection reminds us that we need to focus on more than just blood glucose management when it comes to diabetes, we also need to pay attention to the emotional side of this condition. 

Understanding blood glucose dynamics

Blood glucose is essential for the body’s cells and critical for brain function. In children with diabetes, the body’s inability to effectively regulate blood glucose can lead to significant mood and behavioural effects. Hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose) can manifest various psychological symptoms that impact a child’s daily life.

For example, hyperglycaemia can cause symptoms such as fatigue, irritability, and difficulty concentrating. These can disrupt a child’s ability to engage in academic and social activities, potentially leading to frustration and lowered self-esteem.

Hypoglycaemia on the other hand, can lead to symptoms such as confusion, dizziness, irritability, and even severe outcomes like seizures. The acute nature of hypoglycaemia can induce significant anxiety and mood swings, affecting not only the child but also those around them.

Psychological impacts

Managing diabetes demands ongoing attention and adjustment, which can put a substantial mental burden on a child. The stress of constant monitoring and treatment can lead to psychological issues such as anxiety and depression, which can further complicate mood regulation. Diabetes distress, or burnout, can also hold a child and their family back when it comes to living a happy and healthy life with this condition.

Social challenges may also become evident. The visible aspects of diabetes management (such as technology, testing and taking insulin) can make children feel self-conscious and different, which can impact their social interactions and emotional well-being.

The bidirectional relationship

Mood and blood glucose levels influence each other in a bidirectional manner. Stress and emotional distress can lead to hormonal imbalances that may disrupt diabetes management, while unstable blood glucose levels can cause mood swings. Understanding this reciprocal relationship is crucial for effective management of diabetes in children.

How can we help kids cope?

Educational and supportive strategies

Education is crucial. Parents and children need to understand how diabetes can affect emotional health. Recognising the signs of blood glucose fluctuations and their emotional effects is the first step toward effective management. 

Holistic care approach

Management strategies should incorporate both medical and psychological support. Regular consultations with healthcare providers who understand the dual nature of diabetes care are essential. 

Establishing routine

Consistency in daily routines helps stabilise blood glucose and mood. Regular monitoring and timely adjustments in diet and medication are key to maintaining balance.

Open communication

Encouraging children to express their feelings about diabetes and its challenges is so important. Support from counsellors or participation in support groups can provide children with coping mechanisms and a sense of community. 

Inclusive and active lifestyle

Activities that integrate children with diabetes into wider social groups can enhance their self-esteem and emotional health. Physical activity not only helps in regulating blood glucose but also boosts mood through the release of endorphins.

Family engagement

Involving the entire family in diabetes care helps normalise the condition and reduces the emotional burden on the child. Shared meal planning and group activities can foster a supportive environment.

Comprehensive care

The relationship between mood and blood glucose in children with diabetes is central to overall health. By addressing both the emotional and physical aspects, caregivers can provide more effective support, enhancing both the child’s quality of life and their diabetes management.

Understanding and intervening in this bidirectional relationship is key to helping children manage their condition while maintaining a positive outlook on life. Comprehensive care not only stabilises blood glucose but also significantly improves mental health, offering a brighter and healthier future for children with diabetes.

MEET THE EXPERT


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com


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The ‘Can you eat that’ shame

Monique Marais addresses the shame that people with diabetes can experience when loved ones question or misunderstand their food choices.


Listen to this article below or wherever you get your podcasts or visit our playlist.

There are several common misconceptions regarding what a person with diabetes should eat and what needs to be avoided at all costs. It is, however, important to note that dietary needs can differ among individuals, and people with diabetes should work closely with health professionals who understand the condition and can give relevant and practical guidance to create a meal plan that is appropriate for them.

It’s also recommended to approach conversations about dietary choices with sensitivity and empathy, especially when discussing restrictions. It may be counterproductive to point out what people are allowed to eat and what not and can affect the person living with diabetes on an emotional level. People living with diabetes often face enough challenges in managing their conditions without the added stress of feeling ashamed about their food choices.

It’s therefore more constructive to focus on positive and supportive communication and understanding their dietary needs. Encourage them to make healthier choices, provide information on balanced nutrition and highlight a variety of foods that are beneficial for their well-being. Educating yourself as a family member is vital to effectively support them in their journey, and this means eliminating inaccuracies.

Common misconceptions

  • Sugar must be avoided completely

While it’s true that managing sugar intake is crucial for people with diabetes, it doesn’t’ mean they must eliminate sugar completely. The focus should be on monitoring carbohydrate intake, as carbohydrates directly impact blood glucose levels. The type and amount of carbohydrates, along with proper portion control, are important considerations.

  • People with diabetes can only eat diabetic foods

Specialised diabetic foods are helpful, however, are not a must or an only and can be expensive. These products often still contain carbohydrates and kilojoules, and they may have sugar alcohols or artificial sweeteners that can have laxative effects if consumed in excess. A balanced and varied diet is more beneficial.

  • Starchy foods are off-limits

Starchy foods like bread, rice and pasta can affect blood glucose levels, but when they are part of a balanced diet and consumed in moderation, the effect on the blood glucose levels is reduced. Whole grains are also a better option to include in your meal plan.

  • Fruit is forbidden

Fruits contain natural sugars, but they also provide essential nutrients and fibre. Moderation is key, and it’s advisable for people with diabetes to choose fresh, whole fruits over fruit juices or dried fruits, which can be more concentrated in sugars.

  • Skipping meals controls blood glucose

Skipping meals can lead to irregular blood glucose levels and overeating later. Regular, well-balanced meals and snacks are essential for managing stable glucose levels.

A family disease

Diabetes is known as a family disease, as it can affect many people within one family in various ways. It’s important for people with diabetes – and their family members and support system – to understand how different foods affect an individua’s body.

By understanding the condition, and specific red flags, you can avoid spikes in blood glucose levels, and will be able to have a more consistent average.

Approaching conversations with empathy and understanding can help create a supportive environment for people with diabetes to make informed and positive choices regarding their diet and overall health. This is important for family members and friends, but also for healthcare professionals. Have patience with your patients, work from where they are and support them in their journey. Take the time to understand where they are in the process and how you, as the healthcare professional, can support them to make effective and sustainable lifestyle changes.

As a loved one, you can support your family member by:

  1. Understanding the impact that a chronic illness has on their emotional well-being. This is a long-term condition, and some days may be easier to deal with than other days.
  2. Avoid blaming. Do not constantly nag your loved one about what they are eating and add more pressure, as it often leads to conflict in the relationship.
  3. Ask your loved one what they need from you; support them in their journey.
  4. Attend appointments with your loved one. This way you also get the feedback from the doctor and will be able to support them more effectively.

Learn to identify symptoms of high or low blood glucose levels so that you can intervene quickly and effectively.

How best to support someone with diabetes
Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

MEET THE EXPERT


Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.


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JOIN THE DSA FAMILY!

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What is diabetic amyotrophy?

Christine Manga, a diabetes nurse educator, clarifies what diabetic amyotrophy is and the necessary information you need to know.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Diabetic amyotrophy is also known as proximal diabetic neuropathy, ischaemic mononeuropathy, diabetic lumbosacral plexopathy, Bruns-Garland syndrome, to name but a few.

In 1890, neurologist Ludwig Bruns first described the condition in people with diabetes, usually poorly controlled. In 1955, another neurologist, Hugh Garland coined the term amyotrophy. For this article I will refer to it as diabetic amyotrophy.

What is diabetic amyotrophy?

Diabetic amyotrophy is a rare episodic and progressive form of diabetic neuropathy. It’s characterised by loss of unilateral (sometimes bilateral) proximal motor function, atrophy (wasting, shrinking) of muscles in the front upper legs, sensation of severe burning, weakness, and pain.

An extreme aching pain in the hips, thighs and buttocks are almost always present. This is often followed by weakness. Anywhere between 35 – 50% of affected people will report unintended weight loss. Getting up from a sitting position becomes difficult. This condition can be disabling with some people requiring wheelchair assistance for a time. Progression of diabetic amyotrophy is quick, taking a few months.

Causes

The causes are not fully understood. Possible causes include but are not limited to:

  • A sudden reduction in blood glucose levels of a person with chronically raised blood glucose levels
  • Initiation of anti-hyperglycaemic treatment
  • An immune mediated vasculitis causing ischaemic (insufficient blood supply) damage to the nerves, and it has also been referred to as idiopathic.

Who is at risk?

Almost 50% of people with diabetes will experience diabetic neuropathy. However, diabetic amyotrophy only affects approximately 0.8 – 1% of people with diabetes. It affects more people with Type 2 diabetes compared to Type 1.

Onset is usually during middle age but can be seen in younger individuals. Males over the age of 50 with Type 2 diabetes are the most frequently affected. Duration and severity of diabetes are not predisposing factors. People with good glucose control can also experience diabetic amyotrophy.

How is diabetic amyotrophy diagnosed?

Diagnosis usually consists of a thorough history taking and physical examination especially of the lower limbs as well as reflex testing. To exclude other conditions with similar symptoms, such as nerve compression, a process of elimination is used.

A lumbar puncture, nerve conduction studies, and MRI scans may be performed. A blood workup will be done to assess diabetes control, vitamin deficiencies and inflammation markers.

Treatment

Treatment is pain management. However, it does not respond to conventional pain medication, rather anti-epileptic, antidepressants, such as amitriptyline, and nerve pain treatments. Recently steroidal medication has been used. It appears to increase recovery time but also causes an increase in blood glucose levels. There is still not enough evidence for its use. Good glucose control is to be strived for.

An improvement in diet, physical exercise, such as physio, and stopping smoking and alcohol aid in recovery. The physiotherapy can aid in nerve restoration.

Diabetic amyotrophy can lead to anxiety and depression. Education is of utmost importance, hence explaining the progression to possible severe disability, paraplegia, and extreme pain. Although, it will not reverse diabetic amyotrophy, regular foot examinations for injury, wounds and infection will prevent further complications. The goal of treatment is to improve quality of life.

Prognosis

Diabetic amyotrophy is self-limiting and the likelihood of full recovery is probable. The entire process takes a few months up to about two years. Sometimes, but not often up to three years. Reassurance and encouragement that it will resolve is vital.

Prevention

There is no precise way to prevent diabetic amyotrophy. The principles used to prevent general diabetes complications should be adhered to, including smoking cessation, good glucose control, limit alcohol intake, maintain a healthy BMI and regular check-ups with your doctor, dietitian, and educator.

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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DSA News Winter 2024

– DSA National Office News –

Chery Middelburg Diabetes Awareness Event

Eastvaal Chery Middelburg hosted a Diabetes Awareness Event at Eastdene Pharmacy last year in honour of World Diabetes Day. The event was spearheaded by Eastvaal Chery Brand Manager Derick Truter, who has Type 1 diabetes.  DSA National Office supported the event with literature and contacts.

The public also had the opportunity to test drive one of the Chery vehicles on display and win prizes throughout the day.

Chery Middelburg and Eastdene Pharmacy, alongside the Witbank Diabetes Centre, HomeMed, Pharmoco, Contour, Rubicon Medical Centre and more made this day possible.

 It was a great privilege to be able to host the event in Middelburg and see so many smiling faces. It was fantastic to bring a positive vibe and energy to the community.

The following tests were administered to anyone wanting to evaluate their health: (FREE)

  • Haemoglobin A1C test
  • Lipogram blood test
  • Glucose test
  • PSA test

– DSA Western Cape News –

Parents’ Breakfast

DSA Western Cape held a breakfast for moms and dads with children with Type 1 diabetes in April at the beautiful Chart Rose Farm in Wynberg, Cape Town. One family drove all the way from Kleinmond to attend the breakfast.

Speakers that presented to the parents were: Dr Adnaan Mia who has a daughter with Type 1 and Sr Lyn Starke who was in charge of the Diabetic Paediatric Clinic at Red Cross Hospital for 45 years.

It was a beautiful sunny day with the smell of roses wafting over the meeting.

Milnerton Diabetes Support Group

Nurse Onyinye Nwaulu of DSA Milnerton Support Group presented a talk for pastors in the Western Cape and also the Cameroon Community in March and May 2023.

She educated women on the importance of taking good care of their health, most importantly covering diabetes, hypertension, kidney health and general well-being of women.

She extends her thanks to DSA for always supporting the Milnerton Diabetes Support Group.”

– DSA Pretoria News –

March Wellness Meeting

On 2 March 2024, DSA Pretoria hosted an interesting discussion on proper planning of meals and the importance of moderation. The speaker was Bernadine Blom, a dietitian. The meeting was well-attended.

May Wellness Meeting

On 4th May 2024, DSA Pretoria held their monthly diabetes meeting in Pierre Van Ryneveld Park. The speaker was Welma Geldenhuys from The Association for Dementia and Alzheimer’s of South Africa (ADASA). She spoke in general on dementia and how the different types of Alzheimer’s fit under the dementia umbrella.

She also mentioned that dementia is a brain disease and not a mental disorder, and made the connection of dementia with other chronic conditions like diabetes.

It was so great finding out about the signs and symptoms that family members can look out for in their ailing loved ones. The talk was very interesting, interactive and everyone learned such a great deal about a disease that is so debilitating for the person that has it. DSA thanks Welma for giving up her valuable family time to be with the group. So appreciated.

Medical Personnel Wellness Event

DSA Pretoria was invited to participate in a wellness event run by medical personnel in Centurion. There were seven stations altogether. It was aimed mainly at people who need services but do not have medical aid. The medical personnel want to make it a monthly event. Bravo to this health outreach to the community.

– DSA Port Elizabeth News –

DSA Young Guns

The DSA Young Guns enjoyed a fun day outing that included a 5km walk through the forest. The cherry on the top was that there was no entrance fee. 

Health Awareness Morning

On 17 May, Pamela Molefe, Elizabeth and Martin Prinsloo attended a Health Awareness Morning for the employees of PnP Hypermarket, Moffet Retail Park, which was held in their board room. We had a PowerPoint presentation on diabetes that they could watch while waiting to have their blood glucose tested.

– DSA Pietermaritzburg News

Diabetes Symposium

In March, DSA PMB branch hosted a diabetes symposium with 70 attendees. There were several talks given:

  • The importance of taking their medication on time by pharmacist, Mr Moodley.
  • The diabetic journey by Dr Naidoo
  • Diabetes in the Pead by Dr Naidu
  • Understanding food labels by dietitian, Pranisha Deonarain
  • Diabetes in your pet by veterinarian, Dr Singh
  • The role of herbs and spices in your diabetic diet by Dr Mohan
  • Diabetes and menopause by gynaecologist Dr Pephra
  • The vegan way of eating by Mrs Lubbe

Fig and Olive, a local company focusing on healthy homemade juices and shots, also presented products at the symposium. Sensors from Libra and Medtronic were on display. Attendees could also purchase nuts and healthy snacks from Chrissy’s table. B.braun also displayed supplements. There were plenty of lucky draw prizes up for grabs. Attendees also revived goodie bags.

The role of the podiatrist

Lynette Lacock, an occupational health sister, highlights the role of the podiatrist in the healthcare team for those living with diabetes.


Listen to this article below or wherever you get your podcasts or visit our playlist.

You may not be aware of how important it is as a person with diabetes to take care of your feet. Since diabetes can cause poor circulation and neuropathy, it’s essential to have your feet and lower extremities examined by a podiatrist regularly.

Podiatrists are doctors who treat conditions of the lower limbs, including feet and ankles. Therefore, they are the best healthcare professional to see routinely to prevent any future problems relating to feet and diabetes.

The saying prevention is better than cure rings true in this case.  Wounds are often difficult to treat when you have diabetes due to poor blood flow. You need to be vigilant when it comes to preventing sores and infections and you also need to be on the lookout for blisters or sores caused by ill-fitting shoes. If you have even a mild neuropathy in your feet, your shoes may not feel tight even though they are damaging your skin.

What can podiatrists assist you with?

  • Routine foot exams

It’s crucial for all people with diabetes to have a professional exam of their feet and lower extremities on an annual basis. A trained podiatrist will be able to see things that you may have not noticed.

  • Early detection and prevention

Detecting a blister or treating an open wound when it first happens is the key to preventing the problem from getting worse. Most people with diabetes have problems with poor circulation and neuropathy. Neuropathy is caused by nerve damage due to uncontrolled blood glucose. It causes you to have less feeling or sensation in an extremity. If you can’t feel that your shoe is too tight or rubbing in an area, then you can develop a blister or wound without even knowing about it.

  • Mechanical assessment

A podiatrist can watch your gait or the way you walk to see if there is anything out of the ordinary. If there is, they can recommend a specialised shoe or orthotic to help prevent any damage from happening.  

  • Foot wound and ulcer care

If you do get a wound or ulcer, the podiatrist is the best person to treat it. You may also need a course of antibiotics which they can also prescribe. Don’t ignore a blister, wound or open ulcer.  These are difficult to treat in people with diabetes and you want to take care of it immediately to prevent it from getting any worse. 

  • Surgical procedures

Podiatrist can also perform any surgical procedures necessary to treat lower extremity deformities or to debride dead tissue to allow an existing wound to heal.

Multi-disciplinary care

Although podiatrists are the foot specialists, they are part of a team that works together treating diabetic foot and lower extremity problems. They collaborate with vascular surgeons if they feel you need to be referred because of poor circulation. And if they are aware that you are having problems controlling your blood glucose, they may refer you to an endocrinologist. They all form a team that play a part in keeping you healthy.

Now that you understand the role of the podiatrist, make an appointment to see one. Don’t put it off until something is seriously wrong. Rather try to prevent complications before they happen by having routine check-ups and keeping your blood glucose under control.


References

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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The tell-tale signs of the skin

Dr Rakesh Newaj shares the tell-tale signs of the skin that can be indicative of underlying diabetes.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Diabetes, a multi-faceted condition marked by the body’s inability to regulate blood glucose levels effectively, can exert profound effects on various organs.

Most of the time, it’s discovered fairly late, when other organ complications, prompts the medical practitioner to do a blood glucose test. At this stage, some of the damage caused by unregulated blood glucose is usually irreversible. Fortunately, the skin, serving as a visible interface with the external environment, often reflects internal metabolic disturbances, offering valuable insights for diagnosis and management.

Acanthosis nigricans

One prominent cutaneous manifestation indicative of insulin resistance and impending diabetes is acanthosis nigricans. This condition manifests as velvety, hyperpigmented patches of skin, typically observed in areas such as the neck, axillae, and facial regions.

Despite rigorous hygiene practices, the distinct texture persists, prompting individuals to seek evaluation for underlying insulin resistance and diabetes. Treatment strategies encompass a holistic approach, including meticulous blood glucose control, regular physical activity, weight management interventions, and, in some cases, adjunctive therapies like chemical peels to address cosmetic concerns.

Dry skin

Individuals grappling with poorly-controlled diabetes often contend with troublesome dermatological issues, such as dry skin, particularly prevalent on the shins, accompanied by intense itching. This tends to be very persistent with bouts of scratching that leads to injuries on the skin.

Effective management entails meticulous blood glucose regulation alongside targeted interventions, such as the application of specialised moisturising creams, to alleviate discomfort and prevent complications. Sometimes the use of antihistamines and steroid creams can be very helpful in easing symptoms.

Skin tags

Moreover, the presence of multiple skin tags in regions like the neck, face, axillae, or groin may signal an underlying association with diabetes, often also linked to obesity. These tags can appear over a short period of time and can be very unsightly.

Treatment modalities typically involve the removal of these skin tags through cautery procedures, aiming to alleviate discomfort or improve the cosmetic look.

Skin infections

Diabetic individuals, owing to compromised immunity and metabolic dysregulation, frequently encounter recurrent skin infections. Bacterial infections commonly present as multiple sores scattered across the body, necessitating prompt medical attention and targeted antimicrobial therapy.

Conversely, rashes in skin folds should raise suspicion of fungal infections, such as candida. Another very common fungus infection in people with diabetes is called pityriasis versicolor. It appears as hypo or hyperpigmented patches mainly on the back and chest regions.

Addressing these infections may involve antifungal medications and meticulous hygiene practices to prevent recurrence. Additionally, diabetic individuals may contend with recurring vaginal yeast infections and oral thrush, warranting comprehensive management strategies tailored to individual needs.

Delayed wound healing

Prolonged hyperglycaemia can culminate in systemic complications, including impaired circulation and nerve damage, precipitating delayed wound healing and the development of diabetic ulcers.

In severe cases, chronic poor glycaemic control may precipitate toe gangrene, necessitating aggressive interventions, including amputations, to forestall further complications.

Diabetic dermopathy

Diabetic dermopathy is characterised by brownish skin discoloration on the shin. This type of skin lesion is fairly common and starts as pale macules which become darker in colour with time.

Many patients are unaware of its implications and try to ignore it at first till it becomes a cosmetic disturbance. The brown patches pose a therapeutic challenge to doctors due to their stubborn nature.

Diabetic blister

Sometimes patients present with a single blister on the lower leg, without a history of trauma. The blister appears overnight and can be fairly big. This is called a diabetic blister and warrants a full investigation to exclude the disease.

Necrobiosis lipoidica

Necrobiosis lipoidica can be considered as one of the cutaneous markers of diabetes. It presents as yellow atrophic patches, most often on the shins. Sometimes a red-brown rim may indicate activity at the border. Ulceration may also occur and is very slow to heal. There can be reduced sensation to fine touch in the affected area. The affected person needs to see a dermatologist to confirm the diagnosis and treat this condition.

Comprehensive management

While various other rare cutaneous signs may serve as harbingers of underlying diabetes, consultation with healthcare professionals is paramount for accurate diagnosis and comprehensive management. By adopting a multi-disciplinary approach encompassing lifestyle modifications, pharmacotherapy, and preventive measures, individuals can mitigate the impact of diabetes on skin health and overall well-being.

Dry skin and fungal infection in a diabetic
Dry skin and fungal infection in a diabetic
Acanthosis nigricans and skin tags
Acanthosis nigricans and skin tags
Diabetic dermopathy
Diabetic dermopathy
Dr Rakesh Newaj is a specialist dermatologist with special interest in skin surgeries. Since qualifying in 2010, he practices in Waterkloof, Benoni, Kempton Park as well as Mauritius. His special interests lie in skin cancers, hidradenitis suppurativa and stem cell and fat grafting.

MEET THE EXPERT


Dr Rakesh Newaj is a specialist dermatologist with special interest in skin surgeries. Since qualifying in 2010, he practices in Waterkloof, Benoni, Kempton Park as well as Mauritius. His special interests lie in skin cancers, hidradenitis suppurativa and stem cell and fat grafting.

Visit dermsa.co.za


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Sleep and screen time: what you should know

Kate Bristow, a diabetes nurse educator, gives a rundown of all you need to know about sleep and screen time.


Listen to this article below or wherever you get your podcasts.
Visit our channel mypod.zone/diabetessa

World Sleep Day is 15th March.

As children we are told that we need to sleep because sleep is good for us. That’s not just parents trying to get peace and quiet, it’s for real.

Getting less than seven hours of sleep at night on a regular basis can be risky to your health. So, when talking about how screen time affects sleep patterns, it’s best to understand why sleep is important, just like a good diet and exercise is also a priority. 

Why do we need to sleep?

Please note for reference purposes, we are talking about less than seven hours of sleep per night.

Weight management 

  • Studies have shown that adults who don’t sleep enough have a higher risk of weight gain and obesity.
  • Lack of sleep increases the levels of ghrelin, which is the hormone that makes you hungry, and decreases the levels of leptin which is the hormone which makes you feel fuller.
  • People who are sleep deprived tend to be hungrier and eat more, and to compensate for the lack of energy they may crave foods higher in sugar and fat.
  • If you are feeling tired, you are less likely to hit the gym or do any physical activity which you may normally enjoy.

Brain function 

  • Research into sleep has shown that getting enough sleep improved academic performance, problem-solving skills and memory in both adolescents and young adults, possibly also in older folk, but there seems to be less research done here.

Athletic performance 

  • Better sleep enhances athletic performance, fine motor skills and endurance as well as reaction time.
  • Lack of sleep decreases your motivation to actually get out there and exercise, which is beneficial to glucose levels and your mental well-being.

Your health

  • Poor quality sleep and less duration of sleep has been shown to increase the risk of developing heart disease and high blood pressure.
  • Shorter sleep duration is also associated with a risk of developing insulin resistance and diabetes, which along with the risk of obesity and heart disease also associated with lack of sleep leads to metabolic syndrome.
  • Poor sleep is strongly associated with depression. This includes poor quality sleep and sleep apnoea as well as insomnia.
  • Your general immunity is reduced by poor sleep patterns. Getting at least seven hours of sleep has been shown to improve immune function to fight the common cold and flu.
  • Sleep disturbance has been associated with higher levels of general inflammation.
  • Chronic inflammation can cause development of many chronic conditions such as obesity, heart disease, some cancers, Alzheimer’s disease, depression and Type 2 diabetes.

Emotions 

  • Lack of sleep affects your ability to interact socially, resulting in emotional outbursts and behaviours such as social withdrawal. 

Danger to yourself and others 

  • When you are tired, your ability to focus on tasks, your reflexes and your reaction times are affected, in a similar way to having consumed large amounts of alcohol.
  • Less than six hours of sleep increases the risk of falling asleep at the wheel exponentially.
  • Errors at work are also a risk with poor sleep habits.

To sum all this up: sleep along with a good eating plan and exercise is one of the pillars of good health.

Managing screen time

Along with getting enough sleep, with the increased use of technology nowadays, you also need to take into account the amount of screen time you have before you settle in for the night.

How does watching TV or playing on phones, computers or Ipads before bed actually affect health and sleep quality?

These issues arise with the use of technology and screens:

  • You spend more time in front of screens, giving you less available time for sleep.
  • What you watch/play causes psychological and physical stimulation of your senses as well as social interaction which interferes with the ability to sleep or stay asleep.
  • The light from screens affects your circadian rhythms and your alertness.

 What are circadian rhythms?

  • Defined as the natural cycle of physical, mental and behaviour changes that the body goes through in a 24-hour cycle.
  • Light and dark have the biggest influence on circadian rhythms, but your food intake, stress levels, physical activity, social interactions and temperature can also have an effect.

In a nutshell, circadian rhythms are a series of body functions that control cycles such as sleep, being awake, your body temperature, your hormones and a whole lot more.  It’s important to maintain your circadian rhythms consistently by having stable bedtimes and wake-up times, aiming for a healthy seven to nine hours of sleep a night.

 How is the circadian rhythm affected by screen use?  

  • This is how it works: when it’s time to sleep your body produces a hormone called melatonin. Melatonin is produced in the pineal gland, a tiny organ in the middle of your brain which helps control your body’s sleep cycle. It’s also an antioxidant.
  • The bright light from screens supresses the production of this hormone, which affects the quality of your sleep.
  • It’s also estimated that most of us spend at least seven hours a day in front of a screen. The effects of this on general health, physical activity, cognitive function and social interactions are continually being researched, and there is still need for further research.
  • Consistent findings from a number of studies associate screen time with decreased duration of sleep and sleep problems.
  • Also to be noted in the research was the fact that in the advancement of technology, there may be stacking of screen time. What this means is that a single person may be using more than one screen at any one time. For example, as I write this article, I have the television on in the background, my cell phone at my side – and yes, I’m checking it regularly, and my computer on my lap. Three screens – not unusual anymore.

 Youth and screen use

The harm of the use of screens, particularly on our young people and the consequences of this in sleep patterns is still under research, and as technology advances and changes, this will be an ongoing field of study. Research thus far is showing that the use of screens of all types is linked to delayed bedtime and not enough sleep in our young people. This includes preschoolers, children of school-going age and adolescents.

  • Insufficient sleep has been associated with a risk of obesity in children, mental health issues as well as impaired cognitive and academic abilities.
  • You may have put a TV in your bedrooms to help you fall asleep. Parents use TV to help children wind down in the evening, and people use calming apps now to help them fall asleep. There has also been suggestion that people who leave an electronic device on in their bedroom after bedtime also have less total sleep as well as poorer quality of sleep as well as daytime tiredness.
  • The brightness of the screen over a long period of time has also been shown to increase alertness before sleep. Screen brightness increases arousal and decreases sleepiness at bedtime and delays the onset of the circadian rhythm, which in turn delays the onset of sleep. If the same wake time is set, the total duration of sleep is therefore shorter.
  • Light-emitting screens have also been shown to suppress the blood levels of sleep-inducing melatonin, which is supposed to increase in the hours prior to bedtime, blue light screens are the ones which suppress the production of melatonin the most. This means less sleepiness at bedtime and interference in the sleep cycle.
  • Delayed bedtimes, and things like violent video games, also increase stimulation before bed, as do TV shows which excite and stimulate your senses.

 AAP guidelines

The American Association of Paediatrics (AAP) has issued guidelines which recommend that any screen-based activities be stopped 30 minutes before bedtime, and that screens are not allowed in bedrooms, to try to reduce exposure in preschool children.

 The link to diabetes

So, if you understand what screen time does to your health in general, how do you tie this up to your diabetes health? There are so many reasons to get a decent night’s sleep and for some of us this may feel like a luxury. Stats in America show that 1 in 3 adults don’t get enough sleep and this increases the risk for developing Type 2 diabetes, heart diseases, obesity or depression.

When you have diabetes, lack of sleep can affect every aspect of how you manage it: your food choices, the amount you eat, how you respond to insulin as well as your mental health. Good sleep puts you in a better mood and gives you more energy.

 Too little sleep can:

  • Increase insulin resistance
  • Make you hungrier
  • You may be more likely to reach for comfort food – high in carbs and sugar
  • Make weight management more difficult
  • Increase blood pressure and increase the risk of heart disease
  • Decrease your general immunity
  • Increase your levels of depression and anxiety

 Tips to improve the quality of your sleep

  • Your bedroom should be dark, quiet and cool (a relaxing space).
  • Remove all electronic devices from the bedroom. This includes TVs, computers and smartphones.
  • Get some exercise in the day.
  • Do some relaxation exercises before you go to bed.
  • Have a regular bedtime routine – take a shower, read or write in a journal.
  • Get into bed when you are tired.

Things you can change

  • Caffeine can affect you for up to eight hours. Avoid it in the afternoon and the evening.
  • Alcohol can affect how you breathe when you sleep and it affects your sleep quality.
  • Avoid large meals in the evening. Late meals can cause indigestion and raise blood glucose levels.
  • Try not to nap after 3pm so you are tired at bedtime.
  • Avoid nicotine; it has the same effect as caffeine.

To sum things up, all the evidence points to the fact that as humans in general we all need better sleep practices and avoid screen time at night. We need to have routine and discipline in our sleep routines just like we do in our dietary choices and our exercise. By doing this we will lead to better long-term health and better quality of life.

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

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Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.


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