Denim for Diabetes

Cara Verster

Cara Verster, a Grade 6 learner, is thrilled that the Denim for Diabetes Day she organised at her school, Leeuwenhof Akademie, was such a success.

On 14th October, Leeuwenhof Akademie scholars swopped their school uniform for denims. They raised R3858 and donated the proceeds to Diabetes South Africa.

Cara Verster, a young diabetic, decided in the beginning of the year she wanted to get her school involved with the DSA Denim for Diabetes initiative. Leeuwenhof Akademie has been super supportive during Cara’s six years at the school.

The teachers and headmaster are always willing to help and very understanding when it comes to Cara’s diabetes management. Cara’s parents have peace of mind every single day sending Cara to school.

There isn’t a school activity or sport that Cara doesn’t try at school. She is an avid public speaker at the school, she is in the theatre group, she runs long distance, plays hockey and the drums. She is in the Top 10 academically and always full of beans. If you ask anybody at the school they will tell you Cara has never let diabetes stop her in any way. She always finds the strength to persevere and endure in spite of overwhelming circumstances.

Cara is looking forward to the Grade 7 trip to Cape Town next year.

Hannes Labuschagne

Hannes Labuschagne, a young boy with Type 1 diabetes, held a Denim for Diabetes Day at his primary school, Laerskool Mariepskop (Hoedspruit, Limpopo) in November. He raised R1500 for Diabetes South Africa from the proceeds of the day. His success was published in the local newspaper.

Olivia Smargiasso – Walking the road to success

Olivia Smargiasso is the perfect example of living her best life with diabetes. This young lady has achieved so much already and her future is bright.


Olivia Smargiasso (18) lives in Brakpan with her parents and two younger siblings.

Diagnosis

I was diagnosed with Type 1 diabetes at the age of two and a half, in November 2005. My mom had noticed the classic symptoms of thirst and excessive urination. She tested my blood glucose at home, and it was 16,6. By the end of that day, I had seen an endocrinologist and started using insulin.

I think at about five years old, I understood that I had something extra I always had to think about. It was then that I realised I needed to test my glucose and bolus for food (I had gone on to an insulin pump six months after I was diagnosed). This was also the time I became aware that other people in the class did not tell the teacher they were feeling low. A low usually left me feeling sweaty, irritable and very emotional. These mood swings were definitely difficult to regulate.

Aim for a dart board rather than the bullseye

I think because I was diagnosed at such a young age, living with diabetes is all I’ve ever known. Whenever I feel that I don’t want to have to deal with my diabetes anymore, I remind myself that I don’t need to be perfect, only aim for perfection. Living with the challenge of diabetes is more about aiming for a dart board rather than the bullseye, and it’s more than okay to miss here and there.

I’m currently on a Medtronic 670 pump. Before this I used the Medtronic Veo and before that injections. I have used Novorapid short-acting insulin for the last 15 years. My treatment hasn’t changed much in that time, only the carb ratios and other settings on my pumps.

As a child, I saw an endocrinologist, and a diabetes nurse educator, who also has a son (now grown up) with diabetes. Thus, she could empathise with my family, especially my mom. In more recent years, however, my mom, Dr Angela Murphy, has become my doctor; she is a specialist physician

Olivia Smargiasso: Walking the road of success

Dr Mom

I always joke that I couldn’t get away with anything because my mom knew when I wasn’t telling the truth. It was definitely challenging at times, having a doctor as a mom, because I knew she expected me to manage my diabetes with accuracy and precision.

I have also been very fortunate, though. My mom will often tell me about the launch of a new diabetic drug, or an advancement in research. She also sees how well I manage the many challenges of diabetes compared to patients or colleagues’ patients. I feel encouraged that perhaps I do manage my diabetes reasonably well.

Achieving in abundance

I was always encouraged not to let diabetes hold me back. I have Protea colours for karate after competing in Zimbabwe, Botswana and at the Commonwealth Karate Games. I’m a keen runner and Running Captain at school. I used to be an avid waterpolo and netball player too.

When I went onto continuous glucose monitoring (CGM), I found that playing sport became much easier as I was always aware of any change in my glucose levels. Before sensors, however, I would aim for a glucose level of 7,5-9 before playing sport in the afternoon and below 6,5 when swimming in the morning. This way I avoided experiencing a high after morning training and a low during netball or waterpolo practices after school.

I also make sure I always have something sugary close by. Game or Powerade have worked best for me; small sips throughout the training or match to replace any energy I’ve used while exercising. I also eat something with slow-releasing energy, like a banana, before training sessions or matches.

I don’t find that my diabetes affects my academic performance too much. If I go low or high in class, my teachers are always happy to let me eat something or bolus to correct my glucose. I am currently 4th in my grade, I was recently awarded the Best All Round Matric trophy and I’m the top senior public speaker too.

Next year, I’m moving to Stellenbosch to study environmental sciences. I’m really looking forward to this.

Diabetes camps

I have attended three diabetes camps; one as a camper and two as a leader. I absolutely love these camps and encourage every child with diabetes I meet to attend at least one. These camps not only equip kids with the practical and medical skills they need to live a full life with diabetes, but also instil a sense of belonging, showing kids that they are not alone in this very difficult journey.

Children get the chance to meet others with similar and different experiences, exchange stories and come up with new ideas and different approaches to the most common obstacles. These camps also show children that they can have a normal life and enjoy normal activities, they do not have to stop eating sweets or give up their favourite sports because of diabetes. I hope post COVID, camps will be able to happen again.

Supportive teachers 

My teachers were always patient, caring, and compassionate when it came to handling my diabetes. My Grade 00 teacher was particularly loving in helping me add up the amount of carbs I was planning on eating at lunchtime. I was always allowed to have a quick snack or go fill up my water bottle. Some teachers went as far as giving me nuts or fruit instead of cupcakes and biscuits when it was a birthday.

My Grade 2 teacher also has a child with diabetes and was involved in the diabetes support group my mom helped establish when I was a child. At the start of every year until I reached Grade 9, my mom met with the new teachers and chatted about my diabetes management. This was never a burden for them and they were always supportive. There have been other girls in my school with diabetes over the years, currently there are four of us in different grades. I’m always happy to chat to them if I can help them in any way.

I have heard stories of children being treated badly at school, by teachers and peers, because of their diabetes. I think more awareness is needed so that phrases like “you can’t eat that” and stigmas of diabetes being a result of an unhealthy lifestyle, are abolished.

Understanding friends

Most of my friends have been with me since preschool and have grown up knowing I have diabetes. When I explain the condition to people I have just met, I often use an analogy: the good soldiers in my body (my immune system) got confused and attacked their own castle (my pancreas) and destroyed it. Now it doesn’t work so I have to get insulin from this pump.

I also explain that it’s a genetic disease and there is nothing I could have done to avoid getting it. Nobody did anything wrong, my parents did not give me too many sweets when I was little. The condition was always in my DNA, it was only a matter of time before it activated.

I also say that I can live a completely normal life and do everyday activities like any other person. All I have do is simply be careful that my insulin covers my carbs, the correct amount and given in time. I need to be aware of the different effects of food and activity on my life.

Love of fruit

I absolutely love fruit, watermelon, pears, and oranges in particular. Whenever I have a sweet craving, I try to go for a fruit rather than a sugary snack. While sticking to a healthy diet is important, treats like KitKats or ice lollies are my go-to when I need something slightly less nutritious.

Good advice

For anyone that has just been diagnosed with diabetes, I would say the most important thing to remember is that life with this condition is a balancing act. It’s impossible to be perfect all the time and constantly have a blood glucose reading of 5,6 but luckily CGM has taught us if most of our readings are in the range of 4 to 10, overall control will be good.

But it’s normal and perfectly okay to miss the target range sometimes. The important thing is that we focus on the positives more than the negatives because that way we will see how well we are doing. Something I live by is, “Today I will do what others won’t do that tomorrow I can do what others can’t”.

Ryan Pasqualle – overcoming depression

Ryan Pasqualle tells us how having diabetes led to depression and a suicide letter but thankfully with the support of his family he pushes on every day.


My story starts when I was 7 years old. Wherever we went, I needed to use the toilet less than five minutes after leaving the house. My parents we very concerned, because it would happen anywhere, no matter if I drank water or not. I was eating loads and was losing weight!

One Thursday evening, my dad went to our local pharmacy to find out what was wrong. The pharmacist gave him a urine container and told him to bring back a sample of my urine to have it tested. After my father got the urine and returned it to the pharmacist, he told him to take me to the doctor.

We went to the doctor on Friday and the following day the doctor phoned to say that I had diabetes and we had to go immediately to hospital.

Minutes after we got the news, my mom and sister rushed me to the hospital to get treated. The doctors gave me amazing treatment and got my blood glucose levels down to a decent level.

Life turned upside down

Finding out that I had to take insulin every day for the rest of my life was a massive shock. I had no way of knowing how to cope with it. It wasn’t only the fact that I have diabetes, it was the fact that I had no idea what diabetes was. I’d never heard of it before. Thankfully, the doctor was very helpful; he took a lot of his time to explain what diabetes was. After he explained it, I had somewhat of a grasp on my illness.

It took me round about two weeks to be discharged from hospital. I had no idea how I would go through my day-to-day life with my newly found illness, but my family and doctors supported me every step of the way.

It took me years to really get a hang of my diabetes, it was about three to four years to get my blood glucose levels semi under control.

Depression and suicidal thoughts

Having diabetes really took its toll on me; it led to me being depressed and writing a suicide letter. However, my dad found the letter and rushed to fetch me from school and took me to hospital to get help for my depression.

I wasn’t happy about being in a psychiatric ward, it made me feel like I was put in a jail, but I couldn’t be mad at my family because they were only looking out for me.

I stayed in that hospital for more than three months. It was tiring to have your every move watched, you weren’t allowed to do anything, not even have your phone on you. But after I was discharged, I was so happy, because I came home to loving family, and I was extremely happy to see my dog.

We are only trying to survive

Every day is a challenge for a person living with diabetes. We must live our lives watching what we do and eat. There are days where we can’t even eat an ice cream in warm weather, because the heat from the sun pushes our readings up.

It’s tough living like this. Our lives are in constant danger, and it’s our duty to control it, but it’s difficult to control it when all you want is to be like a normal child. All you want to do is eat what other kids eat, drink what they drink, and live how they live. People will call us sick, weird, different, but we’re normal, our lives just have extra tasks to do daily. We aren’t weird, we are only trying to survive.

Ryan with other camp leaders at 2019 Diabetes Children’s Camp in Kommetjie, Western Cape.
Ryan with other camp leaders at 2019 Diabetes Children’s Camp in Kommetjie, Western Cape.
Ryan and family celebrating his sister's graduation.
Ryan and family celebrating his sister's graduation.

Cara ten Cate – Reflections of a TD1 teenage girl

Cara ten Cate, a Type 1 diabetes patient, shares a creative piece of writing she penned in regard with having diabetes.


Cara ten Cate (15) lives in Durban, Kwa-Zulu Natal with her parents.

I have an illness called diabetes, Type 1 to be exact. As it’s a part of my routine to inform my peers about this illness, it’s not the diabetes that sparks curiosity. The automatic facial reaction to my statement is towards the simple but deadly word ‘disease’. This word causes reactions so intriguingly cringy, it almost forces a feeling within you to jump behind a bush and hide.

Just one reminder though, don’t give me your sympathy. You may ask why I don’t want your sympathy but I’ll get to that in a moment.

This monologue will be far from grammatically correct, or might even sound like it’s been rushed. However, I have recently accepted my newly-found courage to openly share my story, because after all I am defined by this invisible force. The power it has held over me, the consumption of emotion it’s caused, the fearful depth, the capacity within has led me to finally say that this illness has unrepeatable beauty.

We are living in a society entirely hypnotised by the idea of outer beauty, normality, time and pity. We live in a world where positive outcomes are the expectation of all living species, but listen. I am a failure and I am proud.

I was diagnosed at the age of 5. I am 15 now and I still can’t count my amount of insulin dosages. I rely on people’s care, taking more than I care for myself. I barely inject myself anymore. I still don’t read labels on foods or drinks. So, ya I’ve been failing for 10 years and I’m proud. It is the failure that has gotten me here today.

I continue to refer to my failures in the present tense because it’s not my past. It will never be. It’s the continuation of my future and my now. If I can admit that my failure continues to define me and spark growth within my maturity, then you may call me a failure for the next few years because without that I wouldn’t have the emotional and physical awareness I hold onto to this day.

Diabetes defines me, and don’t tell me otherwise. I grew up listening to social platforms, family members, friends, etc. telling me that this disease shouldn’t hold severe control over me. Guess what, it did and still does because I’m living with it.

Growing up with diabetes I was saddened by a feeling of no control over myself, and yes that is still partially true but I now know it’s my body’s way of expressing a compromise between that five-year-old little girl and my 15-year-old self. Compromise is key. I’m not saying to continue a path of lacking self-growth within managing an illness, but use the failure as a way of identifying the problem, planning a solution and kicking its ass. Don’t expect structure.

The backwards law states that expecting positive will lead to negative outcomes. However, it’s the acceptance of negative that will prove to be a positive experience. Diabetes isn’t easy, it never was. I am living proof of a negative and positive outcome. It’s through this half and half lifestyle that I have learnt sympathy is the worst thing given.

As someone who has diabetes, sympathy has the power to make me feel as if I’m a walking disease. This may have a dramatic tone, though I bet you will find plenty of other people with diabetes who will strongly agree.

Why are you sorry? You as a human who may never endure a physical illness will never get to realise the hardships of having the jealousy we feel towards peoples’ functioning pancreases, all for the reason being that they produce insulin. For that I say sorry to you.

This piece of writing will never be one to be used as a piece for school. My story does not deserve to be graded. This is my life, the span of my 10-year journey with an illness that changed a five-year-old tiny life into a whirlwind roller coaster of ups, down and mediums within a flash of a second. As humans, we all have our low moments, but just like a roller coaster we find ourselves soaring again.

The day of that diagnosis, you are immediately classified as a different personality, “The diabetic.” Hi, I’m that diabetic and I think that’s pretty cool. Don’t grow up with a label you regret, especially with one that was not a choice and was given by a group of societal members that have no understanding of this illness.

I spent years trying to hide the fact that I was diabetic. I was ashamed and embarrassed, but oh do I wish I didn’t. Wishing for the past to change won’t do anything, so as I continue entering my nows, know that I am no longer embarrassed and you shouldn’t be either.

This is my story, it wasn’t chosen but it’s there and I’m happy to say that I had a story. I wasn’t able to choose my storyline but I was able to choose my purpose for it. My purpose is spreading my acceptance to the people who are struggling to cope with this newly found

illness. Even if you don’t have diabetes, please know that you and I aren’t so different. We have individual stories, different storylines, evidence and even characters. Though our words and emotions will forever be conjoined. I am diabetic and that’s who am meant to be.

Isabella Rocha – online schooling during COVID

Isabella Rocha, a Type 1 diabetes patient, and her parents, Ashleigh and Carlos, share their experience and reasoning for opting for online schooling and how they decided when the right time was to go back to school.


Isabella Rocha (15) lives in Johannesburg, Gauteng with her parents and sister. She is in grade 9 at Assumption Convent.

Isabella was diagnosed with Type 1 diabetes in October 2018. She was put on Apidra and Optusilin. The teenager explains, “At first, it was a bit of a blow as it was extremely unexpected. I was scared and had no idea what to expect. However, through the unconditional love and support from my wonderful friends and family, I’m as strong as I’ll ever be and grateful for where I am and where I started.”

Before the COVID pandemic, Isabella managed her diabetes well. “For the most part. Of course, there were ups and downs,” she explains.

As the news hit that people living with diabetes were high-risk, fear started to set in. “I was so scared to even go out to the shops, but things have thankfully died down and returned to some form of normal.”

Online schooling

Due to the outbreak of COVID last year, all lessons were moved online. Ashleigh explains, “It was a bit of an adjustment at first. However, with time it did get easier. The schools were eventually allowed to return mid-June 2020. Though my husband and I were still unsure and a bit uncomfortable with sending her back during such a peak period in the virus. So, we sat down with her and discussed the option of continuing online and she was totally on board and aware of the risks involved of contracting the virus and having Type 1 diabetes. Her school was also super supportive.”

Ashleigh says that they got through online schooling by sticking together as a family. Fortunately, I could stay at home with our children and support them during the lockdown periods and online schooling. It’s been tough at times, especially with no social interaction with friends and teachers.”

When asked what the pros and cons of online schooling is, Isabella says, “The freedom I had at home. I didn’t need to wear a uniform or raise my hand to speak. It was also a bonus that I could stay in bed and sleep in. However, nothing can make up for not seeing anyone or going outside for recreational purposes.”

Back to school

In September 2020, when the positive cases started dropping my husband and I discussed Isabella going back to school with her endocrinologist and he agreed that if her blood glucose was in good control he saw no reason why she couldn’t go back to school.

Isabella was so excited to go back and see her friends. “I was dying to see my friends at school. Unfortunately, I couldn’t hug anyone or come in close contact, but it was better than not being able to see them at all.”

Constant worry as parents

Isabella’s parents say they worried tremendously during the first lockdown about their daughter, and still do. “In the beginning, we were quite paranoid about going anywhere and would sanitise absolutely everything and everyone. We questioned going back to school a million times. Through online research and speaking to her doctor, we realised that she was perfectly healthy and had good control of her blood glucose which put our minds at ease. Her school has also been fantastic in the sense of maintaining strict COVID protocols so we know she would be safe.

Growth and reflection

Isabella sees the year 2020 as a weird one. “There was always something going on in the world: good and bad. Of course, COVID added to this. Many times, I wished that we could return to the normal ways of life and go outside without masks, but I believe everything happens for a reason, including this.”

Ashleigh and Carlos can only be proud of how their daughter handled such a tricky school year. They say, “Isabella has such a positive attitude to life and always tries to see the good in everything so doing school online came with few obstacles and difficulties. She managed the process beautifully. There were days when frustration would rear its ugly head with technology difficulties and load shedding.”

“Isabella couldn’t wait to get back to school and we also noticed a slight increase in her blood glucose readings due to stress and lack of activity, being home in front of the computer all day. But we tried our best to manage it and would walk as much as we could and just kept an extra close eye on her numbers and would treat as needed.”

Isabella with her parents, Ashleigh and Carlos and sister, Sienna.
Isabella with her parents, Ashleigh and Carlos, and sister, Sienna.
Isabella showing her Continuous Glucose Monitoring patch.
Isabella showing her Continuous Glucose Monitoring patch.

MEET THE 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


Tips to get your kids eating healthy

The Heart and Stroke Foundation suggests five ways to get your kids eating healthy to support their growth and development, all while building healthy eating habits.


The COVID-19 outbreak is upending life for families around the world. To make things even harder, panic buying and disruptions to food supply systems mean some foods can now be difficult to find. And for many people, unemployment and lost income are making food shopping an additional financial challenge.

While many parents are understandably looking to ready meals and processed foods as a quick and low-cost way to feed the family, there are convenient, affordable and healthy alternatives to get your kids eating healthy.

Five healthy eating tips

  1. Keep up fruit and vegetable intake

Purchasing, storing and cooking fresh vegetables can be challenging. But it’s important to ensure children are getting plenty of fruit and vegetables in their diet. Whenever it’s possible to get hold of fresh produce, do so.

As well as being eaten fresh, vegetables can be frozen where possible and will retain most of their nutrients and flavour.

Using fresh vegetables to cook large batches of soups, stews or other dishes will make them last longer and provide meal options for a few days. These can also be frozen where possible and then quickly reheated.

  1. Use healthy dried or canned alternatives when fresh produce isn’t available

Fresh produce is almost always the best option, but when it’s not available there are plenty of healthy alternatives that are easy to store and prepare.

Canned beans and chickpeas, which are high in protein and fibre, can be stored for months and can be included in meals in many ways. Canned oily fish, such as sardines, pilchards and tuna, are rich in essential omega 3 fatty acids and a range of vitamins and minerals. These can be used cold in sandwiches, salads or pasta dishes, or cooked as part of a warm meal.

Dried goods like dried beans, pulses and grains, such as lentils, split peas, rice, couscous or quinoa, are nutritious, long-lasting options that are tasty, affordable and filling. Rolled oats cooked with milk or water can serve as an excellent breakfast option.

  1. Build up a stock of healthy snacks

Children often need to eat a snack or two during the day to keep them going. Rather than giving kids sweets or salty snacks, opt for healthier options like unsalted nuts, low-fat plain yoghurt, chopped fruit and boiled eggs. These foods are nutritious, more filling, and help build healthy eating habits that last a lifetime.

  1. Limit highly processed foods 

While using fresh produce may not always be possible, try to limit the amount of highly processed foods in your shopping basket. Ready-to-eat meals, packaged snacks and desserts are often high in saturated fat, sugars and salt.

Remember when shopping, always look out for the Heart Mark and DSA logos to help you choose healthier food options for you and your family.

  1. Make cooking and eating a fun and meaningful part of your family routine

Cooking and eating together is a great way to create healthy routines, strengthen family bonds and have fun. Wherever you can, involve your children in food preparation.


Five lunchbox menus to get you started

1. Quick and easy

  • Cheddar cheese cubes
  • Mini whole-wheat rice crackers
  • Apple slices

2. Sandwich option

  • Hard boiled eggs
  • Whole-wheat bread
  • Baby carrots

3. Salad option

  • Tuna pasta salad
  • Sliced orange

4. Vegetarian option

  • Hummus
  • Whole-wheat pita
  • Tomatoes
  • Cucumbers
  •  

5. Funky Friday option

  • Peanut butter (no added sugar)
  • ½ banana
  • Sliced apple
  • Low-fat plain white yoghurt

For more healthy, tasty recipes, download our Cooking from the Heart recipe books onetwo, and three from our website.

 

Header image by FreePik

Shiara Pillay – Diabetes community helps keep you accountable

Shiara Pillay tells us how her diabetes community, formed at DSA youth camps, has helped her be accountable for managing her diabetes.


Shiara Pillay (25) lives in Muizenberg, Cape Town. She has Type 1 diabetes.

About Shiara

Shiara has attended the Diabetes South Africa youth camps for many years. First as a child and then as a teenager and young adult. She progressed from being a camp attendee to becoming a camp leader.  Presently, she is a dedicated member of the YT1 team that helps to organise and manage the Diabetes SA YT1 Children’s and Youth Outreach.

She is currently working in the social development and capacity building industry, and studying towards completing her Honours in Development Studies.

Consistent focus and attention

Life with Type 1 diabetes seems like the most normal thing in my life right now. Especially during the COVID-19 pandemic! It hasn’t always been that way though. It has required consistent focus and attention since I was diagnosed 15 years ago.

The last decade and a half has seen me experience things not a lot of other people I know have. I have advocated for diabetes awareness in school and social environments. Experienced an unexpected DKA admission to hospital. Held the space for countless conversations with friends and family about diabetes management support. All the while I am studying and pursuing a career path.

Community holds you accountable

One of my favourite triumphs of this journey is being a part of the gathering of young diabetic children at the DSA educational camps. Experiencing the connection between the diabetes community (young, old, family and friends) through shared and individual struggles and triumphs is so rewarding.

Being able to accept, grow and take control of the role that diabetes plays in my life is an ongoing commitment that this community has helped me stick to.

I work constantly to maintain my glucose levels through diet, exercise and regular testing. Supplemented by as much information as possible and a healthy balance of finding pleasure in all these things.

Shiara in Amsterdam, the Netherlands.
Shiara in Visakhapatnam, India.
Shiara Pillay
Shiara with her group of campers dressed for their Saturday camp concert evening at Diabetes SA April 2017 Diabetes Childrens Camp in Kommetjie, Cape Town.

PEAD-SA – Should children with diabetes go back to school?

The Paediatric & Adolescent Endocrinology & Diabetes Society – South Africa (PEAD-SA) share their position statement on children with Type 1 diabetes mellitus returning to school.


All children should return to school in accordance with government guidelines. Type 1 diabetes mellitus (T1DM) does not seem to increase the risk of acquiring infection or of having COVID-19 severe disease in children and adolescents. Our position as PEAD-SA is that children and adolescents with T1DM should not be prevented from returning to school.

Background

The pandemic of infection with coronavirus (SARS-Cov-2), which has caused corona virus disease since 2019 (COVID-19) has affected all aspects of life throughout the world.

South Africa has not been spared and we are now in the early stages of this epidemic. The carefully considered and courageous decision by government to call for a lockdown was timely and necessary as is the easing to the different levels.

As part of this change, it has been recommended that children and adolescents begin returning to school. Considering concerns raised by numerous people, PAEDS-SA is presenting our position on this aspect of the epidemic.

What does PEAD-SA know about children and infection with SARS-Cov-2?

What we do know comes from very limited information from other countries and from limited local experience.

  1. Children (under 20 years) do get infection with SARS-Cov-2. In most countries, children make up a small fraction of all the people with infection. Thus, it seems that children and young people don’t contract COVID-19 at the same rate as adults. In China and Italy, children less than 10 years were only 1% of all cases, and those between 10 and 19 years were 1,2% of all cases. In the USA, children and adolescents (under 18 years of age) were 1,7% of all cases reported1,2,3.
  2. Children do not seem to get severe infection very commonly. This may be the reason why children make up such a small fraction of people with infection, because in most countries, people are only tested when they are ill. It is thought that most children get infected but do not have symptoms. Children rarely require hospitalisation or have severe disease4. (1,1% of cases are critical, 2,2% of cases are severe)5(5,7% of children hospitalised US)3
  3. Very few children have been seriously ill or have died from this condition. To date, it is thought that 30 children have died from COVID-19.
  4. Children do not seem to be responsible for the major spread of infection to others. Most children are infected by adults rather than from each other.
  5. It is not clear that children have the same risk factors as adults for serious illness e.g. hypertension, lung disease, Type 2 diabetes, etc. Reports from colleagues suggest that children with T1DM do not contract Corona virus infection more frequently than other children2 and do not have more severe forms of COVID-19 disease than other children. In China and Italy, no-one under 25 with T1DM landed up in hospital or with severe disease (needing ICU).2
  6. In South Africa, we are starting to see a few children with COVID-19 disease and the pattern does not seem to have changed from the rest of the world.
  7. We are seeing increasing numbers of children with stress, anxiety and other psychological, social and emotional issues because of the lockdown.

Conclusion

PEAD-SA, therefore, have taken the position that children and adolescents with T1DM should not be treated any differently from other children in terms of going back to school.

All usual advice for the care of children and young people with T1DM remains valid:

  • Better control means better health, particularly in winter when everyone gets sick.
  • Children with T1DM should have a flu vaccine.
  • Any illness will affect glucose control, which then needs extra attention.
  • If children are ill, they or their caregivers should not delay in contacting their healthcare provider because they are afraid of COVID; unmanaged DKA is far more dangerous.
  • Hypoglycaemia remains the most urgent problem that must be treated immediately, including at school.

PEAD-SA will continue to monitor reports from international organizations (WHO, ISPAD, ADA), colleagues and from across the world and update this statement promptly as new information becomes available.

Click on the video below to hear The International Society for Paediatric and Adolescent Diabetes (ISPAD)  statement on COVID-19 and children with diabetes.

REFERENCES: 

  1. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaSummary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Zunyou Wu, MD, PhD; Jennifer M. McGoogan, PhD JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
  2. Summary of recommendations regarding COVID‐19 in children with diabetes: Keep Calm and Mind your Diabetes Care and Public Health Advice | International Society of Pediatric and Adolescent Diabetes (ISPAD) | Ped diab 2020;21(3):413-414 doi.org/10.1111/pedi.13013
  3. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. 422 MMWR / April 10, 2020 / Vol. 69 / No. 14. CDC COVID-19 Response Team 
  4. SARS-CoV-2 Infection in Children Xiaoxia LuLiqiong ZhangHui Duet alNEJM 18 Mar 2020
  5. Clinical Manifestations of Children with COVID-19: a Systematic Review Tiago H. de Souzaa, MD, PhD; José A. Nadala, MD, MSc; Roberto J. N. Nogueiraa et al
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Lunch ideas for home or school during lockdown

Mommy, what are we eating for lunch? A question that most mommies have heard a lot during the lockdown period. Donna Van Zyl, a dietitian, shares a few lunch ideas for the family


School-going children generally have a routine and other activities that makes diabetes management a bit easier than children at home during lockdown. They may be sleeping late at night, waking late morning, and eating at irregular times. The lack of routine may contribute to irregular blood glucose levels.

In addition, we find ourselves walking far more to the cupboard or refrigerator due to boredom and we catch ourselves snacking slightly more. Boredom eating is one of the bigger challenges in lockdown and therefore routine should also be established like the school day at home with breakfast; school work; snack and lunch time. However, eating at home or school; a diabetic lunch is no different to a healthy lunch that every child should eat.

A healthy balanced lunch will ensure that your child gets the right amount of nutrients and energy they need to concentrate or perform optimally. A balanced lunch consists of a wholegrain/unrefined low-GI carbs, protein, fats, fruit, salads and vegetables.

 Tips for lunch or lunch boxes

  • For those who are carb-counting, a good tip is to write down the total amount of carbohydrates on a sticky note, paste inside the lunch box so that it is easier for your child, or the school nurse, to count carbs at school. Preparing portioned foods can also aid your child at school, or at home, when carb counting.
  • Prepare or pack a healthy lunch you know your child will eat. Otherwise your child may enjoy swopping his or her food with friends or end up not eating. It is important to switch up the foods regularly. Let your children try new foods over the weekend or at night, so that you know whether you can prepare or pack the food in for them.
  • Allow your child to help you prepare the lunch or pack the lunch box. At the same time, you can teach your child how to do the carb counting or even some culinary skills. Often children who take responsibility for preparing the meal establish healthy and good eating habits.
  • Always provide a low-carb option, such as a protein or fat snack. See options listed below.
  • Always have a snack available to pick up a low blood glucose level; longer life options, such as a packet of raisins, can be kept close by just in case.
  • Prepare food in advance and freeze or prepare more portions the evening before so that leftovers can be used for lunch the next day

Use leftovers

How to use leftovers the next day; and if there are no leftovers what can you serve for lunch tomorrow?

When leftovers are available:

Chicken Chicken mayonnaise whole-wheat wraps, whole-wheat rolls with added salad preserves

Pesto quinoa/durum wheat pasta chicken salad with added rosa tomatoes and feta

Pineapple and pineapple mixed salad

Chicken, feta and bean salad including salad preserves

For the lower carb: Chicken salad with a honey mustard dressing

Steak Steak Prego whole-wheat roll with added salad preserves

Stir-fry and steak vegetable wrap

Steak strips served with baby potato salad and salad/veg on the side

For the lower carb: Steak salad with a balsamic & olive oil or Blue Cheese dressing

Mince Mince and cheese toasted whole-wheat or rye sandwich (can even be topped with a fried egg)

Cheese, mince and corn whole-wheat wrap (Toasted)

Mince, guacamole, corn and diced tomato tacos

Prepared Soup Chicken and noodle soup

Hearty beef and barley soup

Vegetable and lentil soup

When no leftovers are available:

Eggs Lean bacon, cheese and egg toasted whole-wheat sandwich

Scrambled egg muffins/omelette (bacon, mushroom and cheese or spinach and feta) served with a whole-wheat or rye toast

Tuna Apple and tuna salad mixed with salad preserves and mayonnaise

Tuna pasta salad

Salmon and tuna fishcakes (prepared) served with roasted vegetables or mixed assorted salad

For the lower carb: Tuna, cucumber, tomato and chickpea salad dressed with mayonnaise

 

Snack items

For those children heading off to school, a lunch box can include a few more snacky items; especially when lunch is generally served at home. You can include the following:

  • Proteins

Scrambled egg muffins; or lean meat, such as beef strips, chicken breasts strips, sosaties (mini), biltong, salami slices/sticks, meatballs (chicken or beef), cheese: wedges, blocks of cheddar cheese, cottage cheese or cream cheese, yoghurt, smoothies.

  • Starchy food

Whole-wheat/rye bread, whole-grain Provitas, wraps, brown rice, quinoa, barley, baby boiled potatoes/sweet potato with the skin, and durum wheat pasta.

  • A good helping of salad, vegetables and fruit

Fresh fruit is easy to pack; or chopped fresh strawberries, pineapple fingers, apple slices, orange or naartjie wedges. Remember to count the fruit towards your carbs.

Raw veggies, such as carrot sticks, cherry/Rosa tomatoes, mini cucumber or sliced, gherkins, mini corn, corn on the cob, capsicum strips are all popular to add colour to the lunch box and can always be served with a dip: sour cream/hummus or guacamole.

Nuts and seeds or unsweetened nut butters can also be added as an additional treat.

The actual lunch box

  • Ensure it is a strong container that will protect the food from being squashed.
  • Have smaller containers available for dips, sauces or cut-up fruit.
  • When choosing a water bottle, make sure that it will be easy to clean. Some juice containers have a removable ice pack that you can use to keep the water cold. This is also great for milk or smoothies.
  • You can use a soft cooler bag for food that needs to be kept cool.
  • And remember to wash out the lunch box daily.

MEET THE 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 interests are 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.


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