Fighting fit: exercising with diabetes

Prof Martin Schwellnus gives us a rundown of how to form a safe exercise regime when living with diabetes.


Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. Before you start exercising, the first, and most important, step is having a full medical check-up. The main reason for this is to make sure that the prescribed exercise “dose” is safe.

Types of diabetes

Diabetes mellitus is a group of chronic diseases classified into four broad clinical classes:

  • Type 1 diabetes is characterised by the destruction of pancreatic β-cells, leading to insulin deficiency.
  • Type 2 diabetes is characterised by insulin resistance and a relative insulin deficiency.
  • Gestational diabetes is diagnosed during pregnancy.
  • Other types of diabetes may be caused by genetic defects, disease of the exocrine pancreas, and drug- or chemical-induced causes.

Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. But it also includes nutrition, psychosocial support, smoking cessation and education. So, don’t forget the other important elements of your strategy for managing diabetes.

Benefits of exercise in diabetes patients

Exercise improves many factors important in the prevention and management of diabetes. These include improved glucose control, muscle and liver insulin sensitivity and muscle glucose uptake; reductions in HbA1c; improved weight management, blood pressure, and overall cardiovascular health.

Before you start exercising, the first, and most important, step is having a full medical check-up. The main reason for this is to make sure that the prescribed exercise “dose” is safe Any treatment plan should be patient-centred, not disease-centred, which means you should be assessed and treated holistically.

Identifying any other health concerns is important. Since these may influence how you manage your overall health, and your ability to exercise safely and effectively. Once you have the full picture, a plan can be created that suits your specific needs.

This lifestyle intervention programme is usually directed by a physician trained in sport and exercise medicine and a physician specialising in diabetes management, together with a multi-disciplinary team. This team includes dietitians, biokineticists, endocrinologists, physiotherapists and others.

Your exercise/activity plan

Structured exercise is an important part of your lifestyle, and the FIT principles below give you an idea of the type of exercise you could include in your regime.

Having said that, your activity/exercise plan needs to take various things into account, including type of diabetes, age, activity done, medication use and the presence of any complications.

As such, your plan needs to be tailored to your specific needs. So, speak to a sport and exercise physician about the strategies you will need to adopt. You may be advised to participate in an out-patient setting, or you may be able to train by yourself. In most instances training is initially conducted in small groups, where sessions (usually three per week) are supervised by members of the lifestyle intervention team.

In addition, try to increase the amount of unstructured activity you do. This is the activity you typically do during your day, such as shopping, errands, household tasks, walking your dog and gardening.

If you feel you are not ready for a structured exercise programme, start by increasing your daily activity, and then start including short bouts of structured exercise. Since any activity will increase energy expenditure and improve glycaemic control, this is a great step in the right direction.

Recently, more attention has been paid to prolonged sitting as this has a negative effect on health, irrespective of how active you are. So, be aware of how long you sit during the day, and try to stand up and do some light activity for a few minutes every 30 minutes.

General exercise guidelines for adults with diabetes and pre-diabetes: 

F

I

T

Type of exercise Frequency Intensity Time

Progression

Aerobic

(cardio – walking, swimming, cycling)

3-7 days per week, with no more than 2 days without exercise.

Moderate (your breathing and heart rate is increased slightly) to vigorous (only do if already active, your breathing is heavy and heart rate increased). Build up to at least 150 minutes per week of moderate-intensity. For those already active, 75 minutes per week of vigorous intensity.

If you are starting an exercise regime, start with bouts of 10 minutes at moderate intensity. Increase intensity, frequency and durations slowly over time to at least 150 minutes per week of moderate intensity.

Resistance 

(body weight exercises, free weights, resistance machines or bands)

At least 2 (preferably 3) non-consecutive days per week.

Moderate (using weights that allow you to do up to 15 repetitions) to vigorous (using heavier weights allowing you to do up to 6-8 repetitions). At least 8-10 different exercises, doing 1-3 sets of 10-15 reps, to near fatigue.

Start with weights that allow you to do 10-15 reps per set. Increase weight only once you can do 15 reps consistently. When you increase the weight, reduce the reps to 8-10, then increase reps again over time.

Flexibility & balance

(stretching, yoga, tai chi, balance exercises)

2-3 days per week.

Stretch to point of slight discomfort, not pain. Balance exercises of easy to moderate difficulty. Hold static stretch, or do dynamic stretch for 10-30 seconds, 2-4 reps per stretch.

Increase duration and/or frequency slowly over time

Exercise guidelines during pregnancy with gestational diabetes:

 

Aerobic exercise:

Resistance Exercise:

During pregnancy with gestational diabetes: check with your doctor Up to 30min of moderate-intensity (if sedentary before pregnancy, start at a lower intensity). No more than 2 consecutive days without exercising.

 

5-10 different exercises, 1-2 sets of 8 -15 reps, up to 60 minutes. At least 2 but ideally 3 times a week, at moderate-intensity.

Monitoring and follow-up

All patients participating in a lifestyle intervention should be assessed regularly during exercise training sessions by a member of the healthcare team. Before each exercise session symptoms of diabetes mellitus (polyuria, polydipsia), other symptoms (cardiac, infectious disease), resting heart rate, resting blood pressure and blood glucose concentrations should be taken.

During the training session, rating of perceived exertion, peak heart rate, and peak blood pressure should be monitored.

After exercise, a blood glucose measure may also be taken.

All the measurements that were recorded during the initial assessment, before starting the lifestyle programme, should be repeated two to three months later. These results should be discussed and a revised strategy created for the subsequent few months. All patients with diabetes should be re-assessed at least once a year.

Cautions to keep in mind when exercising

  • Blood glucose responses are influenced not only by the type, timing, intensity, and duration of exercise, but also by many other factors. This variation in the way blood glucose responds to exercise makes it difficult to give generalised recommendations for the management of food (carbohydrate) intake and insulin dosing during and after exercise. Speak to your sport and exercise physician, doctor and/or dietitian about the strategies you will need to adopt.
  • Adults with diabetes are frequently treated with multiple medications for other conditions. Some medications may have a negative interaction with exercise and therefore dosage may need to be adjusted.
  • Older adults or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary disease should avoid exercising outside on very hot and/or humid days to prevent heat-related illnesses.
  • Patients with autonomic neuropathy should undergo cardiac screening before starting exercise, and be monitored for hypoglycaemia and abnormal thermoregulatory responses during training.
  • High-intensity endurance and resistance training, jumping, jarring, head-down activities and breath-holding are not recommended for patients with proliferative diabetic retinopathy or severe non-proliferative diabetic retinopathy, due to the increased risk of triggering vitreous haemorrhage or retinal detachment.
  • Patients with peripheral neuropathy should practise proper foot care during activity. Non-weight bearing exercise is recommended, to decrease the risk of skin breakdown, infections and joint destruction.
  • During pregnancy, avoid sports with a risk of forceful contact or falling (basketball, rugby, horseback riding, gymnastics), exercising in a supine position after the first trimester, scuba diving, and prolonged intensity workouts that increase body temperature and perspiration. Stop exercising immediately if your experience vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain or swelling and dyspnea without exertion.

What does the Sport, Exercise Medicine and Lifestyle Institute (SEMLI) offer?

SEMLI at the University of Pretoria has a team of specialist sport and exercise physicians, qualified to assess your current health status and advise you on an activity programme that will suit you.

The multi-disciplinary approach of SEMLI means you have access to a variety of healthcare professionals, including biokineticists, physiotherapists, dietitians and psychologists, as well as sport scientists who can assist you along your journey to good health.

For more information contact us at:  info@semli.co.zaor 012 484 1749.  www.up.ac.za/sport-exercise-medicine-and-lifestyle-institute/


References:

  • Schwellnus MP, Patel DN, Nossel C et al. Healthy lifestyle interventions in general practice
  • Part 4: Lifestyle and diabetes mellitus. SA Fam Pract 2009; 51(1): 19-25
  • Colberg SR, Sigal RJ, Yardley JE et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39: 2065–2079
  • Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6(8): 1033-1044

MEET OUR EXPERT


Prof Martin Schwellnus is the director of SEMLI. He is a specialist sport and exercise medicine physician who regularly consults with athletes of all levels. He is passionate about promoting safe physical activity for all, as part of a healthy lifestyle.


What fruit is best for you?

Dietitian, Donna Van Zyl, explains the considerations for diabetes patients when eating fruit.


There is often concern as to eating ‘sweet fruit’ if you have diabetes. However, this does not mean that you should avoid eating fruit completely.

Fruit can be classified under the macronutrient, known as carbohydrates. Carbohydrates, or fruit, are digested and converted by the body into glucose and therefore should be counted as part of a carb-counting regimen.

What needs to be considered when eating fruit is: the type of fruit and the quantity consumed as both these influence blood glucose control.

If we look at the type, fruits are classified according to their glycaemic index, which will further have an impact on the spike of the blood glucose level.

Type of fruit: The glycaemic index

What is the glycaemic index (GI)?

It is a numerical measure of the rate i.e. how fast and to what extent the intake of carbohydrate rich foods may affect your blood glucose levels. An item of food with a high GI raises blood glucose levels more than an item of food with a medium or low GI.

Glucose has been given a numerical value of 100, because it is absorbed immediately into the bloodstream. All carbohydrate-containing food, such as fruit, are compared to the reference of glucose.

The low-GI index food items fall below the reference range of 40 (<40) and are given the green to go. Whereas intermediate-GI food items falls within the reference range of 56 – 69; the orange for slow down and proceed with caution. The high-GI food items, with a reference range of above 70 (70+), gets the red for halt.

Though, high-GI fruits can be consumed with exercise, depending on blood glucose levels, and in combination with other foods products, especially protein or fat, or even to correct a hypoglycaemic event.

The GI Foundation uses the following icons to indicate the GI of foods:

Absorption and digestion factors

Factors affecting the absorption and digestion of fruit, which in turn may influence the GI of foods include:

  • The amount of cooking (cooked apple versus raw apple).
  • Processing (fruit versus fruit juice).
  • Ripeness and storage time: the riper a fruit, the higher the GI.
  • The type of fibre (soluble – citrus fruits).
  • The more acidic a food is, the lower the GI value. e.g. lemon juice lowers the GI of the food or meal.
  • The presence of fat, protein or low-GI foods consumed with the GI carbohydrate.

When eating a higher GI fruit, you can combine it with other low GI foods, or protein and fat to balance out the effect on blood glucose levels. For example, eating a fruit salad and yoghurt (plain).

The GI of fruit commonly eaten

Fruit GLYCEMIC INDEX (glucose=100)  Serving size in gram
Apple, average 39 120
Banana, ripe 62 120
Grapefruit 25 120
Grapes, average 59 120
Orange, average 40 120
Peach, average 42 120
Peach, canned in light syrup 40 120
Pear, average 38 120
Prunes, pitted 29 60
Raisins 64 60
Strawberries/Berries 40 120/125
Watermelon 72 120

When looking at the GI of specific fruits above, a variety of low GI fruit should form part of a balanced dietary intake. Fruits are not only delicious, but a good source of fibre which helps aid in regulating blood glucose levels. Fruits are also a good source vitamins, minerals or phytochemicals which aid bodily functions and help fight against disease.

Give preference to apples, berries, peaches or citrus throughout the day and consume with meals to ensure that the rise in blood glucose is covered by the insulin injected i.e. part of carb-counting.

Whereas your high-GI fruit, such as watermelon or grapes, can be used to prevent hypoglycaemia, especially after exercise, or to correct a hypoglycaemic event.

Quantity

Be mindful of your portions too. You will see the above-mentioned GI of fruit is indicated per quantity. Remember, the more fruit you eat at once, the more fruit sugar is also consumed which will affect blood glucose control.

One small apple provides approximately 15g of glycaemic carbohydrates. So, eating two apples in one go will naturally provide you with up to 30g of glycaemic carbohydrates, which will lead to a spike in blood glucose levels due to quantity consumed.

Take home message

Fruits form part of a healthy balanced intake. A variety of low-GI fruit should ideally be consumed and distributed throughout the day. Be cautious with high-GI fruits, however. they can be useful especially in picking up blood glucose levels.

MEET OUR EXPERT


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


My art of living with diabetes

When you think of art, what comes to mind? Creative art, colourful art, abstract art, black and white art? Art is different to every person, therefore, the art of living with diabetes is different to every person living with diabetes.


There are many different arts (ways) of living with diabetes. My art of living with diabetes include lifestyle, foodstuff and sports. I ensure my sugar readings stay under control so that I can be healthy and live a long and happy life.

I keep my blood glucose levels under control by making sure that I eat the correct foods. I include a large amount of fresh vegetables and fruit and, of course, protein. My favourite proteins are chicken and pork.

By doing this, my sugar readings do not get too high. By eating correctly, I don’t need to inject myself with insulin too many times a day.

In our household, we only drink sugar-free cool drinks and water, which means less sugar and less insulin injections for me. We also eat mostly home-cooked meals, which is healthier and better for my blood glucose readings.

I play a lot of sport which keeps me active and keeps me healthy and in shape, both physically and mentally. I’m a cricketer and a golfer. It takes at least four to six hours to complete a cricket game or a round of golf. So, I always keep healthy snacks and water with me to ensure my sugar level remains stable. However, I enjoy any sport as I enjoy being out in the fresh air.

My lifestyle also includes not watching too much TV, etc. and trying not to stress too much about school and exams. Stress can affect my sugar readings too.

I realise that different people have their own art of living with diabetes. It is your choice what art you use and how you use that art.

MEET OUR EXPERT


Aiden Nel lives in Port Elizabeth. He is 15 years old and has Type 1 diabetes.


Getting to know me

Noy Pullen shares the positive revelations she encountered when she started the journey of ‘getting to know me’.


“Getting to know you
Getting to know all about you
Getting to like you
Getting to hope you like me”

The King and I by Rodgers and Hammerstein


My father had high cholesterol and high blood pressure. My older brother and sister use blood pressure tablets and statins. In our Agents for Change courses, we always invite the participants (all of whom work in the health sectors in the rural regions of SA) to go for regular check-ups.

As someone who should be walking the talk, I decided, a year ago, to go for the various basic health tests: blood glucose, blood pressure, cholesterol and body mass index (BMI). It has been a good journey of getting to know me a lot better, as well as a scary journey where decisions that need commitment and courage were made. I have gotten to know my body and I think it has gotten to like me.

Writing on the wall

Every year medical aids send out SMSes to their members to have their readings checked. So, I went to the local pharmacy clinic for the first time in years. I had to cross the threshold of fear, to pluck up the courage to go. I hate needles. My heart beat faster as I sat on the clinic chair.

The Sister was kind, yet professional, guiding me through the various finger pricks, weighing and measuring techniques. The results were all available in a matter of five minutes. I was in for a shock and had to face some uncomfortable moments. My blood glucose was within the ‘green’ of the medical aid constraints. My BMI was just in the orange and my blood pressure and cholesterol were high.

I went to check my blood pressure later that morning at another clinic. It had come down by 10 points on both systolic and diastolic beats. The first lesson I learnt, was to not to chop and change facilities and for future checks I would stick to one facility.

Patient choice

The advice I got was to take medication to reduce the readings. This seems to be the easiest way. But I remembered that my brother developed a chronic cough after going on to his blood pressure tablets. I also knew the side effects of statins; there has been controversy about them. I considered these facts. This was not the route I wanted to take, even though these medications have added many health benefits to patients. What were my other options? Pamphlets were pressed into my hand by the Sister. My medical aid sent an email and an SMS with a large red alert warning which made my blood pressure rise; I could feel it!

Starting point – trusting my own attitude to life

I have spent my whole life trusting in a natural way of living. Natural childbirth, natural remedies, herbal teas and using doctors’ prescriptions only when the natural method was not serving me. So, I used this as my point of departure. I also knew that my thoughts, the way I feel, and how I do things affect my well-being. I had three paths to walk down at the same time.

A description of my prescription

  1. Thoughts

Can I change my mind-set? One of the pamphlets the Sister gave me spoke about ‘waking up softly’. Not to hit the ground running as I was used to doing. I’ve never been a ‘quiet time’ morning person, but as it would have no bad side effects and it’s free, I decided to look in to it.

If one were so inclined, one could choose a prayer or aphorism (an observation which contains a general truth), or to simply write a few pages about how one was feeling. In Julia Cameron’s excellent book, The Artist’s Way, she writes about this morning discipline which has changed many people’s lives for the better. She says, “The bedrock tool of a creative recovery is a daily practice called Morning Pages. Morning Pages are three pages of handwriting, done first thing in the morning. They are about anything and everything that crosses your mind – and they are for your eyes only. Morning Pages provoke, clarify, comfort, cajole, prioritise and synchronise the day at hand.”1

As I have done this in the past, I decided to try something new and chose a special verse that strengthens me. I say it aloud every morning and then spend a few moments thinking of who I would meet that day, as well as my loved ones.

In the evening, I go through the day backwards, looking for a miracle in the day. For example, an event which delayed me, possibly saving me from an accident, or helping me meet someone I otherwise would not have met, or a surprise telephone call that changed the course of my day. For those who battle to get to sleep, this practice is an excellent sleeping agent. One can hardly finish it before one has fallen asleep.

  1. Feelings

Can I control my anger, pain or fear that sets my heart pounding? I decided to do some observations to find out what the warning signs are of these feelings.

As soon as I felt the tell-tale symptoms, I pictured myself at a crossroad and asked (if I caught it in time): do I want to go down the same old road of rage and frustration or can I do something different?

Two techniques emerged from this: I have chosen to change the way I speak about difficult issues, and to breathe before reacting. I realised that I can calm myself down if I get there in time.

In Byron Katie’s book, Loving what is, she offers a technique called ‘The Work’. This consists of four questions that, when applied to a specific problem, enables you to see what is troubling you in an entirely different light.

  1. Is it true? 
  2. Can I absolutely know it’s true in this moment now? (If the answer is a definite yes then move onto another question/belief you have).
  3. How do I react when I believe this thought?
  4. Who would I be without this thought? 

“Contrary to popular belief, trying to let go of a painful thought never works; instead, once we have done The Work, the thought lets go of us.”At that point, we can truly love what is, just as it is. I do this technique any time anywhere in less than two minutes, even on a napkin in a coffee shop.

  1. My physical body

Loving nature

Every morning, for 20 minutes, I practise eurythmy (an art-form of movement and imagination initiated by Rudolf Steiner). It’s gentle, enlivening and brings a positive attitude. When we do this in the Agents for Change courses, the participants become joyful and express their appreciation for its effects.

Nature can bring joy and serenity. So, I’ve prescribed a half an hour walk every day. I walk along Zandvlei’s embankment, amused by the dogs playing with their owners. Conversations happen. Suddenly I am more connected with my neighbours. And I have lost two centimetres around my waist. I notice how valuable this is for my mood as well as the body.

Staying with nature I have spent this year living closer to nature’s rhythms. My logic is that it could change my blood pressure. Call me crazy but my readings have come down substantially.

I go to bed earlier and wake earlier to enable me to have quiet time. I also increased my sleep time by one hour and my partner reads an extract of a story each night aloud. We do not use any screens after 9pm.

A surprising discovery is the joy of growing plants. Recently, I collected some potatoes from my kitchen that had started sprouting and I planted them in my garden. I sowed some bean and chilies seeds into pots. Watching them come up is a mood-lifter and connects me to nature in a very immediate way. It’s good physical activity – bending and stretching – in a meaningful way. And, I get to eat them!

Herbal supplements

For the past year, I chose to take daily herbal supplements which help lower the effects of high blood pressure and stress levels.

I cut my meat consumption by half and increased my oily fish consumption. Every day I eat a handful of tree nuts to supplement this. I added a daily herbal remedy to lower cholesterol. The cholesterol pamphlet suggested a daily dose of omega oil in various forms which I started taking. Raw salads with fruit nuts and some cheese have become my regular choice for lunch.

I drink at least four large glasses of pure water with infused lemon and cucumber slices, or mint. I have a glass dispenser with a tap and every time I pass it I’m reminded of this delicious refreshing drink.

Results

  • Blood pressure is 130/70; a vast change (one of the readings in the past year was 160/101).
  • Blood glucose remains in the 5,5 range.
  • BMI has decreased by 1 point due to losing  2cm around my waist and the scale tells me I am 2kg lighter.
  • Cholesterol is down from 7,4 to 6,3. It’s still in the orange.

The only disappointment I had was that my medical aid sent a red alert message via SMS and email after the huge effort of my experiment, with absolutely no encouragement or reference to the improvement, and although there is not one measurement in the red range on their scale.

Be that as it may, the important thing is that I feel empowered and have managed to change every aspect of my health, and I thoroughly enjoy these new habits I have prescribed. By using salutogenesis (origins of health) as a model for my health rather than pathogenesis (origins of disease), I’m getting to know me, getting to like me, loving my new life, and focusing on factors that support and increase well-being rather than on factors that merely prevent disease.3

The power of this way of working is that: you find out what makes you joyful, and you think about how you got into this state, and how you may overcome these aspects that aren’t having a positive effect. The results take time and a change of attitude to life. You free yourself and your health practitioner as you take responsibility for your own health. It is worth a try and is fun, this, ‘getting to know me’.

Keeping a regular check on my readings will enable me to monitor how effective my own method of maintaining my health is and when intervention is needed.

PLEASE CONSULT WITH YOUR DOCTOR BEFORE YOU CHOOSE YOUR PREFERRED WAY OF TREATMENT.


References:

  1. https://juliacameronlive.com/basic-tools/morning-pages/
  2. https://fourminutebooks.com/loving-what-is-summary/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955424/  


Please contact Noy Pullen if you would like more information: linoia@web.co.za or 072 258 7132.


AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT

MANAGED BY NOY PULLEN

Afro-soul artist, Candy Tsamandebele, speaks about her diabetes

Candy Tsamandebele, South African award-winning afro-soul artist and songwriter, tells us how she lives with Type 2 diabetes.


Sekedi Candy Mokwena (48), better known as Candy Tsamandebele, lives in Kempton Park. She is a mother of two sons and is a grandmother to a beautiful eight-year-old girl, Sehlora.

Shortly after Candy’s first-born son, Phetole, passed away, in 2011, in a car accident and due to the trauma and stress of his passing, Candy was diagnosed with Type 2 diabetes. At the time, she didn’t know what the symptoms of diabetes were but rather just knew of the disease itself. She was prescribed diaglucide, gliclazide, and metformin.

Since being diagnosed Candy has changed her lifestyle. “I had to have a fulfilling life. I eat healthily and exercise a lot – off and on stage. My mother has made it her mission to remind me all the time to eat healthy food, like morogo (African spinach). We grew up eating this. When my youngest son cooks, he prepares food that he knows is healthy. In fact, the entire family has adopted my way of eating,” she says.

When asked how she manages her career and diabetes, she responds, “It takes some doing. However, I have employed some good mechanisms to help me. The people I work with know of my situation. They have made it their business to make sure I eat on time and take my meds when on the road. I have a personal support group, and have numerous reminders in the house to notify me of my doctor’s appointment amongst other things.

Candy believes that South Africans are not aware of the dangers of diabetes. “Not like they know the dangers of diseases like HIV/AIDS. They fear HIV/AIDS far more than diabetes as they believe it more deadly and life-threatening. This is caused by the general information and awareness as far as these diseases are concerned. Diabetes has generally not received as much attention, and information around it has not yet reached the person on the ground fully. People only hear or care about it when its directly or indirectly affecting them.

Candy will be releasing her third studio album later this month. Catch her performing at Metro FM Heatwave, in Polokwane, on the 24th November; Mapungubwe Music Festival, in Polokwane, on the 15th December; the Nubian Music Festival on the 16th December; and the 7th BGT Bolobedu Get Together, in Limpopo, on the 26th December.

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


In sickness and in health – Graham and Yolandi

We speak to married couple, Graham and Yolandi Chamberlain, about how diabetes works in their relationship and why they chose a cheese wheel as their wedding cake.


Graham (33) and Yolandi (36) live in Pretoria, Gauteng. Graham and Yolandi have been dating since 2016 and got married in August 2018.


Graham Chamberlain

How did your family support you once you were diagnosed?

I was diagnosed with Type 1 diabetes in October 2001, at the age of 16. My mother is a qualified nurse and took my diagnosis very serious. She cooked every meal with my illness in mind. It was a learning experience for my whole family and together as time went by, we learnt what my body required and how we would accommodate and adapt to my specific needs.

I consider myself very fortunate to have had the privilege of such an amazing and supportive family, who has been there for me day and night in this challenging journey as a Type 1 diabetic. Diabetes can have a serious impact on your emotions. Being diagnosed in my teenage years while enduring puberty must have played some role in my parents’ grey hair.

Ilze, my sister, has been practising karate with me since I was six. After my diagnosis, she always made sure that I had some sort of sugar with me in case of a hypoglycaemic incident.

Do you agree with the International Diabetes Federation Word Diabetes Day Theme “Diabetes concerns every family”?

Yes, most definitely! Diabetes is on such an incline and according to global diabetes statistics, 415 million adults have diabetes. That means 1 in every 11 adults has diabetes. Therefore, creating awareness and support groups for families who are affected by this illness is essential. I would love to get involved with such programmes which educate families on diabetes. Because without my family’s support, my diabetic journey would have been a lot more challenging.

How has Yolandi supported you?

From day one Yolandi has been by my side, supporting me in this daily and ever-changing illness. Her ability to understand my actions and reactions due to my blood glucose either being high or low is what really impresses me.

I know how difficult I can become if my blood glucose is high or low and this obviously has an influence on our relationship. But the fact that she can recognise and distinguish between me being irrational and me just being difficult and argumentative, keeps our relationship in balance.

Prior to me being on the insulin pump, I struggled a lot with hypoglycaemia in the evening or early morning hours, especially after karate. Yolandi insisted that I wake her up when my blood glucose level dropped, no matter what the time might be. She would get out of bed, fetch the closest form of glucose and would stay awake until my glucose level recovered.

Does Yolandi’s support help the management of your diabetes?

I often joke with Yolandi and tell her that she is the diabetes police, because she questions my decisions in a firm, yet caring and subtle way. Whenever I attempt an extra helping of potatoes or garlic bread, she would ask, “What is your blood glucose level and did you inject for that extra helping?” All this aids me in being more mindful of what I consume and helps me manage my blood glucose level that much better.

You recently changed to a Medtronic MiniMed 640G insulin pump and use Humalog insulin. Has this change been a positive one?

The change to my Medtronic 640G insulin pump has been a life-changing experience for me and my family. For years, I have been reluctant and very hesitant in the thought of having an insulin pump constantly attached to my body. Purely because I did not want to feel like a robot. I finally decided to follow Yolandi and my mother’s request to give this option a chance.

I really struggled to manage my blood glucose levels throughout the day. Work stress, karate training and daily challenges really got to me, which caused my HBA1C count to be at 12,7.

The 15th February this year, marked my first day of being on the insulin pump. It was not even a week later, when I started to feel and see the difference in my energy levels, my mood and overall well-being. In July, just six months later my HBA1C level dropped to 7,6. This is remarkable because for the first time in 17 years my count was below 8.

Tell us more about your hobbies – karate and skateboarding.

I have been skateboarding for the past 19 years but it’s purely just for fun. My talent, however, lies in karate. I started at the age of 6. I’m an instructor at the Griffins Karate Club, in Pretoria, which is affiliated to the South African Shotokan Karate Academy.

I have competed in four World Championships and recently was selected after competing in the trials for the World Championship in Slovakia next year. Karate is my passion and I take pride in having diabetes and competing on an international level.

Yolandi Chamberlain

When you started dating Graham and heard he had diabetes, were you scared?

Yes, of course I was scared. My knowledge then of any type of diabetes was none. In fact, all I knew was that Graham wasn’t allowed to eat any sugar. I had no idea that there was so much more to diabetes. I had to learn a lot as it is not just about sugar. All food and beverages had to be considered before consuming it.

I was scared that I would lose focus and start to panic or I would forget to take his blood glucose levels beforehand and inject the wrong quantity into him. Then I would be the one killing him and not diabetes.

As a partner, do you feel a responsibility to ensure Graham is managing his diabetes well?

No, I don’t feel responsible for it at all. Graham has been a diabetic for so long and he knows exactly what to do. I feel my responsibility is to help him when he can’t help himself. As his partner, I feel that I must know all about diabetes. Just in case he needs my help, I must know what to do.

You decided to have a cheese wheel rather than a traditional cake at your wedding. Explain the thinking behind this.

I felt it was unreasonable to have a traditional sweet cake when Graham is not allowed to eat it. After all it was his wedding as well. So, I came up with the idea and made the ‘cake-cutting’ part of the canapés at the reception.

What is your worst fear with Graham having diabetes?

I am afraid that the day will come when he loses his vision or some of his organs. I am afraid of losing him in at an early age.

How has Graham’s diabetes changed your life? 

In the beginning of our relationship, there was much to learn. Not only about food and beverages. I had to learn to have patience when Graham’s blood glucose was high and he felt irritated. I had to learn to give him some time for the insulin to take effect. I had to learn that when we go out, or go camping, it’s not as easy as packing and jumping into the car. Preparation for Graham needs to be done. We must keep his insulin cold all the time and it is essential for him to have enough Coke or any type of glucose.

But as you start knowing diabetes and your partner, it starts getting easier each day. Diabetes doesn’t have to come between people in a relationship. It made me a better person and brought me a lot closer to Graham.

Have you seen a change in Graham since he is using the pump?

From the time Graham got his insulin pump, our life has changed drastically and all for the best. He is feeling more constant and happier than before and I could see the difference in him almost immediately. I am so very grateful for the insulin pump and the change it brought to his health.

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


Potatoes – good for heart health

We look at the nutritional facts and health benefits of potatoes, especially for heart health, and why the Heart and Stroke Foundation has endorsed boiled potatoes with the skin on.


“You are what you eat” – this old saying is something to reflect on, especially when heart health is concerned. It is well-recognised that making informed choices about what we eat has a profound impact on our general physical and mental well-being, including the health of our cardiovascular system. What’s less well-known is the contribution that potatoes can make to a heart-friendly diet. 

South African statistics

At the outset, it’s worth reminding ourselves just how serious the problem is in our country. The sad fact is that South Africa has one of the highest rates of hypertension and strokes in the world. 

The Heart and Stroke Foundation of South Africa’s website provides these sobering statistics: 225 South Africans are killed by heart disease every day, 45% of adults in South Africa have high blood pressure, and 10 South Africans suffer a stroke every hour. 

But the good news is that 80% of heart disease and strokes can be prevented, which takes us back to the importance of a heart-healthy diet. 

Endorsement of boiled potatoes

The Heart and Stroke Foundation has endorsed boiled potatoes as a heart-healthy food, provided it’s boiled and served with its skin on. This is an important qualification because one of the characteristics of the potato is that it is so versatile; it can be cooked in many ways, and the cooking method has a huge impact on its healthiness. 

Health benefits of potatoes

One of the main reasons a potato a day keeps your heart happy is its high potassium content. A 150-gram serving of boiled potato will provide 20% of the recommended daily allowance of potassium. Potassium helps maintain a proper fluid balance, regulate blood pressure, transmit nerve impulses and support muscle function, including the heart muscle. 

Aside from its role in regulating blood pressure, and thus in reducing the risk of hypertension, potassium also blunts the effect of sodium on blood pressure. High sodium consumption—and that’s a South African fault—is a major contributor to hypertension. 

Potatoes are also rich in vitamins C and B6, copper and insoluble fibre. Insoluble fibre is another secret weapon in the fight against heart disease. It binds with blood cholesterol, so it is excreted safely, and doesn’t build up in the blood, thus descrease the risk of heart attack. 

Because potatoes are a source of fibre, they are bulkier than many other foods. This is important because a bulky meal is more satisfying than a light meal, even if they have the same calorific value. That’s because the more bulk there is in your stomach, the more stimulated the vagus nerve is. This nerve is responsible for transmitting the full feeling to the brain. And the fuller you feel for longer, the less likely you are to be overweight. And as we all know; extra weight is a major strain on the heart. 

Claire Jusling Strydom, a registered dietitian, says that the potato’s high potassium content, its fibre and its other important minerals make it an important part of a healthy, balanced diet. “Potatoes are cheap, they make you feel full and they promote a healthy body, including a healthy heart. That makes them a healthy and cost-effective alternative for other forms of refined starch,” she says. “But everything depends on how you cook them, and what else you put on the plate.”

Five ways potatoes improve heart health

  1. The potato’s fibre, potassium, vitamin C, and vitamin B6 content, coupled with its lack of cholesterol, all support heart health.
  2. Potatoes contain more potassium than any other vegetables. Potassium plays a crucial role in normal heartbeat rhythm, smooth muscle contraction, blood pressure control, and nervous system and heart function.
  3. Potatoes contain significant amounts of fibre. Fibre helps lower the total amount of cholesterol in the blood, thereby decreasing the risk of heart disease.
  4. Some evidence suggests that potatoes might help reduce inflammation and constipation. Although it is not proven that inflammation causes cardiovascular disease, inflammation is common for heart disease and stroke patients and is thought to be a sign or atherogenic response.
  5. Potatoes contain several minerals and plant compounds that may help lower blood pressure. Low blood pressure that causes an inadequate flow of blood to the body’s organs can cause strokes, heart attacks, and kidney failure.

“The shocking statistics that can be decreased if we are mindful of our health are a testament that something needs to be done. We work towards the prevention of heart disease on the one hand and suggesting health and nutritious food options on the other, further driving conversation around the role potatoes play in heart health.” – says, Dr Bianca van der Westhuizen, Nutrition Science Manager at the Heart and Stroke Foundation South Africa. “Further to this, we have started a drive through which we are aiming to achieve a 25% Rheumatic Heart Disease reduction in those under the age of 25 years by 2025.”

About Potatoes South Africa
Potatoes South Africa is a non-profit company (NPC) that was established to serve, protect and promote the interest of all potato producers in South Africa. The vision of Potatoes South Africa is to play a leadership role in sustainable potato production in South Africa. Potatoes South Africa is an industry organisation that supports the potato producers (ware, seed potatoes and processing) within each region in South Africa to continuously perform optimally by: Continuously striving towards free market principles, Managing user-orientated research, Providing all role players with strategic industry information, Ensuring that all consumers have continuous access to quality products, Developing and expanding the local and foreign potato markets, and Investing in transformation in the industry through providing support to black potato producers to become commercial, providing support to communities to produce potatoes for food security purposes and educational initiatives.

Managing your diabetes at your matric dance

One of the biggest highlights of the Grade 12 year is the matric dance. Finding the perfect dress and splurging out on nails, hair and make-up and celebrating the last year of high school. Shelly Schutte, a Type 1 diabetes patient, tells us how she made the most of hers.


Shelly Schutte (28) lives in Fish Hoek and has had Type 1 diabetes for 18 years.

My matric dance

Whether you have diabetes or not, your matric dance is the perfect opportunity to treat yo-self. I matriculated almost 10 years ago now and overall, my matric dance is a night I remember with a great deal of fondness.

It took place at the Kelvin Grove Ballroom, in Cape Town, which is a stunning location. During the run-up to the event, we went to ballroom dance classes in the school sports hall. We had great fun attempting the Boogie to the dulcet tones of Katy Perry.

After the dance, we headed out to the club Velvet, where the “official after-party” was being held. It was honestly such a palaver at first. The club was too full and we ended up waiting on the pavement for almost half an hour. Not the glamorous night of dancing and partying we had been imagining!

Luckily, but somewhat embarrassingly, a friend’s dad, who had been our transport eventually came to the rescue. He had some words with the bouncer and got us in.

Although the after-party has much hype in the run-up to the event, it paled in comparison to the brilliant fun that was the dance itself. We happily headed home a little after 3am.

Six am saw us at the local beach for the traditional matric breakfast, with many pale-skinned, dark-eyed students wandering into the restaurant at various times. Some of whom had apparently slept on the beach itself.

How to enjoy your matric dance

As a Type 1 diabetic, events like a matric dance can often come with an extra layer of stress. I often wish I could just have a diabetes timeout every now and then. A chance to a have an evening completely free from the responsibility that is being your own pancreas.

Alas, science has yet to gift us with a cure or a timeout card. However, it is completely possible for you, as a diabetic, to have a matric dance experience that is as wonderful and carefree as every other person in the grade. To this end, I offer a few pieces of advice:

  1. Be safe: face your number

We have a wonderful saying at the DSA diabetes camps: face your number. No matter how high or low your glucose level is. Once you know, you can fix it. This is especially the case on nights like the matric dance when it’s tempting to ignore the fact that you have diabetes. Test regularly throughout the evening.

Whenever I go out and know I will be moving from place to place or drinking alcohol, I set alarms on my phone to check my blood glucose or scan my Freestyle Libre every hour. Time flies by when you’re having fun and especially if you are dancing a lot, but remember dancing can make your blood glucose drop very rapidly.

Nothing is more of a mood-killer than crying in the bathroom because you’re recovering from a low. Test yourself so you can prevent extreme highs and lows throughout the evening and the associated complications.

  1. Appoint a dia-buddy

This is especially important if you are planning to drink alcohol. It is essential that you have a ‘dia-buddy’ – a close friend who knows exactly what to do if you experience a low or high. This person should also have your ICE details, in case you need medical help.

  1. Maintain your normal eating patterns on the night

Keeping diabetes under control is all about routine and predictability. Although the temptation to let loose for a night is probably strong, you will enjoy yourself way more if your blood glucose is not yo-yoing. Keep to your normal eating patterns, count your carbs and be careful with your insulin doses.

  1. Maintain healthy exercise and eating routines in the months before the dance

I have always struggled to keep my BMI in the normal range. Whereas my non-diabetic friends and family members seem to be able to be able to eat whatever they want. I simply was not gifted with a similar metabolism.

In the months before my dance, I was constantly fighting the urge to crash diet to lose those extra 3kg. If there’s anything I’ve learned since then, it’s that a steady routine of exercise and a predictable diet is the biggest gift you can give yourself as a T1 diabetic.

The incredible, stabilising after-effects of a workout at the gym can last for more than 24 hours, which can really transform my whole day into a calmer experience. Also, somehow, a salad always tastes better when I’m eating it after a workout. Exercise at least three times a week, adopt a carb-controlled diet and your body will look after itself in so many ways.

  1. Enjoy yourself

Most of all, you must enjoy yourself! Make beautiful memories and always remember that your diabetes does not define you…but you are braver, stronger and more brilliant because of it.

MEET OUR EXPERT


Shelly Schutte is the youth representative on the board of Diabetes South Africa. She loves spreading awareness and showing the world that she lives an amazing life with diabetes She is currently the Head of Department at a school for children with learning barriers.


My family support

Aiden Nel, a teenager with Type 1 diabetes, tells us the highlights and challenges of the support from his family concerning his diabetes.


My family tries to support me with my diabetes as much as possible. Most of the time their support is good, but to be honest there are times that the way they go about supporting me does upset me.

The positives

One of the positive ways that my mother supports me is when she cooks; she tries to cook with the least amount of sugar, and as a family, they try their best to not have more carbohydrates than necessary.

As a family, we also only drink sugar-free cold drinks. It’s very rare that we will have a sugar cold drink, like Coke or Cream Soda, in the fridge.

My sister likes sweets, but she is very considerate and won’t eat them in front of me. I still do eat sweets, but not as much as other non-diabetic children. I just need to have my insulin immediately.

The negatives

One thing that does upset me though, is that we don’t often eat dessert. I sometimes feel that this is because of my diabetes and what child wouldn’t be upset if they could not have pudding?

The biggest bugbear is the constant asking of what my reading is. Every night, before I go to bed, they ask me what my reading is. Before I leave for school, in the morning, they ask me what my reading is. Sometimes I do get irritated by all the asking and checking of my readings. However, I do know that it is for the best and they are asking out of concern and love for me. So, I do not stay upset for long. I just go and test myself, and then everyone is happy again.

Even if my family sometimes upsets me, they still do their best to help me, and I am very grateful for their support and love.


Aiden Nel lives in Port Elizabeth. He is 14 years old and has Type 1 diabetes.