Motivation, management and movement

How do you find your winter mojo? The Biokinetics Association of South Africa (BASA) says it is all about motivation, management and movement.

We are now in July; this means shorter days and longer nights, thus affecting our general energy and motivation. These effects to the body and behaviour play a vital role in those with chronic diseases and their management, specifically those with diabetes.

The importance of these effects is extended to an ever-growing healthcare and economic burden of 1 in 11 adults (20-79 years old), presenting with diabetes and resulting in 10% of the global health expenditure (760 billion USD). These numbers are likely to double by 2030 without sustainable intervention.1

The needs of these individuals shouldn’t only emphasise blood glucose control, but more attention should be directed to preventing secondary complications, such as disability limitation and rehabilitation.

Thus, individuals with diabetes have been shown to have a substantial impact on the progression and reducing the development of their condition by participating in their own well-being.


Physical activity isn’t only done by breaking a sweat at the gym. Any physical activity counts towards improving your health and managing your diabetes.4 Activities of daily living, such as walking, cleaning, gardening and shopping aid in lowering blood glucose and increasing insulin sensitivity.

Therefore, waking up to a daily routine of sweeping, washing dishes or trimming the lawn is some sort of physical activity. The objective is to find an activity you enjoy doing during leisure time and take that as an incentive to generate the habit of exercising.

In most situations, it’s enjoyable to do things as a family. Family activity could further be an education process to learn about the physical response to movement in diabetes. Plus, it can serve as an opportunity to establish risks, special considerations and ways to monitor blood glucose, in the event of an emergency.

A good foundation is limiting sedentary activities, such as computer time and using an elevator. Preferably do stretching exercises/leg lifts while watching TV, park your car at the far side of the parking lot, take an after dinner walk with family or friends, and schedule family time to do leisure activities.

The benefits of physical activity include a reduction in body fat, improvement in muscle strength and an increased sensitivity of the muscle to the uptake of glucose, improved blood circulation, bone mass preservation to prevent injury and falls, and an enhanced quality of life.

Moreover, it’s vital to have goals to achieve during exercising. This could be the ability to walk for long-distances or losing five kilograms of fat mass. Achieving these serves as motivation to most people and once you’ve accomplish your objective, you tend to achieve a balance between physical, mental and social well-being.


As a person living with diabetes, you have both the right and the responsibility to manage your condition. There are several risk-reduction behaviours which predict good outcomes. These include healthy eating, being physically active, maintenance of adequate sleep, monitoring of blood glucose levels and medication compliance.

Self-management begins with understanding your base. This would include your current status, with regards to which self-care behaviours (as mentioned above) you’re implementing and which of them are deficit.

It isn’t only the adherence of these self-care measures but, more importantly, the inter-relationship between them. For example, how inadequate sleep patterns results in increased unhealthy dietary consumption and ultimately a skewed blood glucose profile.

Acknowledging how these factors might impact the nature of diabetes, it’s advisable to gain a better understanding through obtaining more information from trusted and reliable resources such as your healthcare providers.

A greater understanding of your condition is expected to have a more profound impact on your disease and complications.2 Thus, it’s imperative to monitor dietary intake and practice at least 150 min of guided physical activity per week, to promote sustained energy all-day.

Furthermore, monitoring sleep schedule with an average aim of eight hours per night, regularly recording blood glucose measurements throughout the day, and adhering to the correct medication dosages and regulations ought to be daily, thoroughly and consistently.

Holistic management of risk-reduction behaviour, specifically in combination with physical activity has proven to help achieve a variety of goals. These goals include increasing cardio-respiratory fitness and glycaemic control; decrease insulin resistance and blood pressure, and maintain weight loss in both Type 1 and Type 2 diabetes, of which all are associated reduced mortality.3


Biokinetics is the profession that has practically contributed toward addressing the general public’s attention that ‘exercise is medicine’. Previous studies have shown that a combination of diet, exercise and medication aid towards a healthy lifestyle and well-being.

All physical movement has the potential to improve physical and mental health. Similarly, the World Health Organisation explained health as a state of physical, mental and social well-being and not merely the absence of disease or infirmity.5

Diabetes is a complex chronic ailment that can be managed through exercise to avoid secondary complications, progress of the condition, and exposure to cardiovascular disease (CVD) risk factors.

Some of the CVD risk factors include obesity, hypertension and dyslipidaemia (abnormal amount of lipids in blood) with complications that could result in excessive production of glucose and blood acids, leading to possible heart attack, coma and death.

Training components that are advised to treat/manage the condition are aerobic, resistance, flexibility and balance exercises. These exercises have shown to lower blood glucose, diminish risk for heart disease, reduction of stress and improves insulin sensitivity which means your body’s insulin works better.

Since blood glucose management varies with several environmental and medical factors, it’s critical for recommendations to be tailored for activity type and specific health complications to be effective.

How to move

Recommendations for exercise prescription are at least 150 min or more of moderate- to vigorous-intensity activity weekly. It’s also suggested that these activities occur at least three or more days during the week and individuals shouldn’t allow more than two days to lapse between activity sessions. This is so they can maintain higher levels of insulin sensitivity.6,7

Training sessions may be initiated by walking the dog, cycling, swimming and/or sit-to-stands. Thereafter, you can include body weight exercises, such as hip bridges, plank, push-ups, arm raises, sit-ups, curl-ups and crunches to build endurance and strength.

Lastly, you can end the session with static stretching exercises to increase range of motion around joints and flexibility. Moreover, balance exercises are advised for older adults with diabetes since they are prone to instability and falls. These movements comprise of standing on one leg, straight-line walking and wall lunges.

When we exercise, the body needs extra energy from blood glucose. The muscles take up much more glucose when you exercise which helps lower blood glucose levels. Likewise, the insulin resistance goes down and your cells can use the glucose more effectively.

Finding your winter mojo

During the winter months, with increased comfort-seeking behaviour, plus demotivation there is more than meets the eye to all physiological adaptations that take place due to inactivity, in combination with other risk-promoting behaviours.

However, finding your winter mojo and considering ‘exercise as medicine’ will have a positive impact on your lifestyle. The benefits are the release of the ‘feel-good’ chemicals (serotonin and dopamine) to reduce anxiety and/or depression; strengthening of your immune system to fight off bacterial and viral infections (colds and flu); and avoiding winter gain as inactivity and comfort may become more familiar.

Fortunately, we can manage controllable risk-reduction behaviour through lifestyle changes, including making better dietary choices and participating in regular exercise and physical activity. To reduce global healthcare costs and the prevalence of this devastating condition, we encourage you all to make the first step to a healthier lifestyle and visit a biokineticist near you.

Where to find a biokineticist?

For more information on where to find a biokineticist or on the profession itself, visit Biokinetics Association of South Africa (BASA)

For neurological rehabilitation or biokinetics services, visit Therapy & Beyond Centre: Walking with Brandon or contact 021 879 2280.


  1. IDF Diabetes Atlas 9th edition 2019 [Internet]. [cited 2020 Jun 24]. Available from:
  2. Shrivastava SRBL, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus [Internet]. Vol. 12, Journal of Diabetes and Metabolic Disorders. Springer; 2013 [cited 2020 Jun 24]. p. 1–5. Available from:
  3. Sigal RJ, Cep MJA, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, et al. Physical Activity and Diabetes Diabetes Canada Clinical Practice Guidelines Expert Committee. 2018;42:54–63.
  4. American Diabetes Association. (2018). Standards of Medical Care In Diabetes. Diabetes Care, 33 (Supplement 1) S62-S69.
  5. Hall, J. E., & Guyton, A. C. (2016). Guyton and Hall textbook of medical physiology. Philadelphia, PA: Elsevier.
  6. Mcmillian, D., Moore, Josef., Hatler, Brian & Taylor, Dean. (2006). Dynamic vs. Static Stretching Warm Up: The Effect on Power and Agility Performance. Journal of strength and conditioning research/National Strength & Conditioning Association.
  7. Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2018). ACSM’s guidelines for exercise testing and prescription. American College of Sports Medicine


This article was written by Simamkele Vena (BA Sport Science (UWC), Hons-Biokinetics (UWC) Intern Biokineticist) and Thulfieq Berhardien (Bsc (Med)(Hons), MPhil-Biokinetics (UCT) Registered Biokineticist) on behalf of Biokinetics Association of South Africa (BASA).  

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Keep up good exercise during winter

Nick Caracandas from Diabetic Athletic shares an action plan to keep up good exercise during the colder months.

As people living with diabetes, we know that our condition is a full-time job. We also know that with any full-time job, it helps to create a happy and healthy working environment.

If we make enemies and cause difficulty in the workplace, we can expect our time at work to be less desirable and more challenging than it needs to be.

The same goes for our job while being the CEO of our diabetes. Granted, we didn’t ask for this position, however, it’s here and most likely here to stay.

Be the CEO of your diabetes

The environment we create each day is the largest contributing factor to how we manage and maintain our physical, mental and emotional well-being with diabetes. All three are important for our workplace but also for us as healthy and happy diabetes patients.

Being the CEO, we need to manage our diabetes as we would manage any employee or aspect of our business. We need to have respect, understanding, patience, and put effort in; and only after that can we expect the same in return.

One of the best ways to make sure that you can maintain a more proactive winter season is to implement an action plan that can keep you on track.

I say proactive because most of us are handling our glucose levels, our exercise and our diets in a reactive manner. How often do you fix high glucose only after its sitting in undesirable ranges?

This is an example of reacting to our diabetes, rather than getting to know our patterns and proactively avoiding the high by acting before it happens.

Being reactive to weight gain or our glucose levels can get tiring and can cause potential diabetic burnout, that so many of us experience.

For you to increase your sensitivity to insulin, to tolerate carbs better and to maintain tighter control over your diabetes, you’ll need to create a daily lifestyle that helps achieve this.

Diabetes management 101

As people living with diabetes, we need a mind-set and understanding of the fact that diabetes is managed with exercise, nutrition and medication. This is how it is meant to be. No other way.

Regular exercise helps your body lower blood glucose levels, reduces insulin resistance and promotes weight loss, reduces stress and enhances physical fitness and enjoyment of life. Therefore, exercise is not a suggestion but is medicine and is considered one of the main tools to manage diabetes.

Planned and unplanned activity

First, I’m going to talk about activity. There are two kinds:

  1. Planned exercise, such as gym, workouts, cycling, and sports matches.
  2. Unplanned exercise, such as gardening, walking the dog, walking to the shops, or on the beach.

As any diabetes patient or individual wanting to maintain the best possible health, we need to make use of both these types of activity. Most of us will prioritise gym (planned activity) over unplanned activity which ultimately creates far less overall activity.

To explain: 

There are 10 080 minutes in one week. If we plan to go to gym three to five days a week, this only equals 180-300 minutes of activity out of a 10 080-minute week. This, unfortunately, will never be enough to make the change we’re after. The amount of activity versus the rest of the time we sit, sleep, work and eat are just not in favour of getting a positive outcome.

It must be said that going to gym three to five days a week isn’t easy to do, and you get an A+ for it! The issue here is that although you get an A+ for gym attendance, it’s still only 180-300 minutes of activity out of your 10 080-minute week. This means that your overall activity is still far too low for a good working environment for your diabetes.

So, what’s the fix?

We use gym sessions, or planned activity to provide us with a solid exercise base and strength within the body, and to maintain integrity within our joints and skeletal muscle. Planned activity is also good for making time for yourself, this is vital.

This kind of activity is best paired with non-exercise activity. This is where your daily steps come into play. By setting a challenge to achieve 10 000 daily steps, you’re going to increase the amount of time you spend being active throughout the entire day, not just the 45-60 minutes at the gym or walking from 6am -7am.

By increasing the unplanned activity, you’re going to cause your overall activity to be where it needs to be to have better glucose control and get better results.

Now that your overall activity is higher, you can start putting more effort into your exercise programme. I always tell my clients that the 10 000 daily steps will help improve heart health and will allow you to be able to ‘afford’ food.

Three types of exercise

For the best exercise plan as a patient living with diabetes, it’s recommended you first understand that there are three types of exercise:

  1. Aerobic – swimming, running, cycling, etc. These are generally long and steady-state in nature.
  2. Anaerobic – weight training, bodyweight, resistance training, etc. These are usually weighted workouts with resistance.
  3. Stop-start training – high-intensity interval training, or workouts that are both aerobic and anaerobic in nature.

Each of these will have different effects on your glucose levels. Aerobic activity will likely cause a low glucose event (hypo), while anaerobic activity will cause an initial spike before a potential glucose low.

Knowing how to exercise while staying in the range is the ultimate key to diabetic success. Having new workouts to do at home with no equipment is exactly what most of us need this winter to keep glucose levels in range and to keep the winter blues at bay.

Something to remember whenever you’re completing any kind of training or gym activity is that the higher the intensity, the more potential your glucose will have to spike.

Generally higher intensity exercises are completed over shorter durations due to the increased intensity (think about a sprinter running a 100m race, that pace can only be held for short periods of time).

Lower intensity workouts are more likely to cause a hypo and are often longer workouts due to the low intensity and increased duration of the activity (think about a long steady-state or slow-paced run).

Plan your workouts

  • Avoid a blood glucose low when doing an aerobic activity. This means eating carbs prior to training. Usually about 10-20g for most.
  • Avoid a blood glucose spike when doing weighted exercises or high-intensity classes or sessions, etc. This means giving insulin 10-15 minutes into your workout.
  • Find out how to create and complete workouts that serve a purpose towards your strength and fitness while causing the least disturbance to your glucose ranges.

Use these three points as a mini checklist to create the proactive mind-set, rather than training with random workouts and reacting to your diabetes.

Search for patterns and learn the rules

Diabetes control isn’t as random and as hard as most people believe. It hard for those that don’t yet understand certain diabetic guidelines and foundations.

Accounting is a good example. I struggled with accounting in matric. Was I the only one? No! The ones that excelled at accounting took the time to find patterns and learnt how the rules of accounting worked. Granted I never did this, and so, it led me to a place of overwhelming struggle.

If you can take the time to learn about exercise and diabetes, you’ll start to enjoy how easy increased activity can make your diabetic control. Just like any skill, it takes initial practice and a lot of repetition in the beginning.

I know this is all very easy to read and is often not as easy to act on and to apply. For this reason, I have included my Diabetic Athletic Custom Toolkit of guides to help you with everything you need.

These guides are free and for you to use as resources in your diabetic toolbox so you can master the diabetic skills to exercising with diabetes while staying in range and enjoying the process.

Download your FREE Diabetic Toolkit here.

Here is a home workout for beginners:

(These warm-ups and exercises have been taken out of my home workout guide for diabetics)

Get your free workout here:

Read more about the frequently asked questions regarding glucose levels and exercise.


Nick Caracandas is a strength and conditioning coach with a passion for helping fellow diabetes patients learn more about how to live life with more diabetic impact, freedom and control. With over 15 years as a fitness professional and gym owner, he has developed an online programme that takes diabetes patients from a place of struggle and guides them to a place of empowerment and confidence through exercise and nutrition. As a Type 1 diabetes patient for over 24 years, he has created multiple online programs that merge his experience with being a diabetic and being a reliable option for other diabetics worldwide. 

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Glucose levels and exercise – frequently asked questions

Nick Caracandas from Diabetic Athletic answers frequently answered questions regarding glucose levels and exercise.


Q: What should I do if my blood glucose is high before I do cardio?

If your blood glucose is high pre-cardio, consider taking half (or less) of your usual correction dose and assess 25 minutes into training. A full correction dose might stimulate a hypo.

Q: What should I do if my blood glucose is low before I do cardio?

Consume an adequate amount of carbohydrates to bring blood glucose back into range. Cardiovascular exercise has the tendency to lower blood glucose, thereby having the potential to amplify the hypo. Short bouts of High-Intensity Interval Cardio can increase blood glucose levels. But the nature of the cardio after may lower blood glucose back down again, defeating the purpose.

Weight training

Q: What should I do if my blood glucose is high before I weight train?

If your blood glucose is high pre-weight training, consider taking your usual correction dose and assess 25 minutes into training. Strength training has the potential to increase blood glucose levels. Taking less than your normal correction dose may not account for the blood glucose rise that often accompanies this form of stressful training.

Q: What should I do if my blood glucose is low before I weight train?

Consume a liquid carbohydrate sports drink. This acts fast and won’t bloat you like a solid food meal. The number of carbs to consume will largely depend on the severity of your hypo. Weight training can increase your blood glucose levels. Accommodate this when eating and avoid over-treating your hypo with too many carbs, which will inescapably drive you into hyperglycaemia. Short bouts of High-Intensity Interval Cardio can increase blood glucose levels. The strength training that follows may increase blood glucose further and get you back into a safe range: 15-30 secs on with 45-60 sec active recovery. I personally use the bike and row sprints. The severity of your hypo will largely be down to how much insulin is circulating in your system. The more insulin, the more severe the hypo. Subsequently, carbohydrates may be needed.


Q: As a female, will I get big and bulky like a bodybuilder if I lift weights?

No. You are not set up hormonally for rapid muscle gain compared to a male.

Q: What is the best form of cardio to burn fat?

A format you prefer and can consistently do on a regular basis.

Q: Can I train abs every day?

If you wish. Just make sure you hit them from different angles. Lateral, flexion, rotation, and extension.

Q:What if I am sore after a workout? is this a bad sign? Am I injured?

Not always.Soreness after a training session indicates you’ve pushed your body more than it’s normally exposed to. This dull pain is termed as Direct Onset of Muscle Soreness (DOMS). Don’t panic. It usually subsides after a few day recoveries. To recover well, you must have appropriate rest and food. You also need to manage your diabetes extremely well. Hyperglycaemia will jeopardise training recovery and prolong muscle soreness. The better the control in conjunction with good quality food and rest, the quicker DOMS will subside.

Q: Do you have to be sore and have a good workout?


Q: Do I have to push myself to complete exhaustion every training session?

No. Never leave the gym feeling damaged, vile or lifeless. Stimulate don’t obliterate.

Q: When is the best time to weigh myself?

First thing in the morning after your bowel movement, without clothes on. Use the same scale every time to keep things accurate. If you do weigh later in the day, keep the time of weighing consistent over a number of weeks.


Nick Caracandas is a strength and conditioning coach with a passion for helping fellow diabetes patients learn more about how to live life with more diabetic impact, freedom and control. With over 15 years as a fitness professional and gym owner, he has developed an online programme that takes diabetes patients from a place of struggle and guides them to a place of empowerment and confidence through exercise and nutrition. As a Type 1 diabetes patient for over 24 years, he has created multiple online programs that merge his experience with being a diabetic and being a reliable option for other diabetics worldwide. 

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Healthy herbs and spices for cooking

Dietitian, Retha Harmse, informs us on how to make low sodium meals by using healthy herbs and spices.

Wintertime calls for more comforting stews, soups and curries and suddenly cold salads seem much less appealing. But with that comes another risk that people living with diabetes need to steer clear of: falling in the high salt trap.

We run the risk of wanting quick and easy convenience during winter, using pre-packaged sauces or stock cubes to limit the time spent cooking in the cold kitchen and increase the time under a warm blanket or close to the heater.

These convenient alternatives unfortunately often have a very high sodium (salt) content, and with the risk of comorbidities already being increased in diabetes patients and needing to keep blood pressures in check, the convenient way is not the healthiest way.

Avoiding the high salt trap

Choose food and beverages that are lower in salt and prepare food with little or no added salt:

  • Choose fresh, simply prepared food as often as possible.
  • Limit packaged, processed, and ready-to-serve food, such as snack food, processed meats, regular canned and dried soups, frozen meals, cheese, gravies, dressings and sauces.
  • Use no added salt or reduced-sodium ingredients whenever possible.
  • Read labels – if the sodium content in the nutrition facts table is 5% or less of the DV (daily value), then the product is considered low in salt.

Practical tips to reduce salt in cooking

This may seem easier said than done, but remember breaking a habit does take time. Herewith a few step-by-step tips.

How to add less salt to food:

  1. One small step at a time
  • If you are used to adding salt at the table, try to break this habit first. Remove the saltshaker from the dinner table (often this already makes a huge difference – out of sight, out of mind).
  • Start using less salt and sodium rich spices (like stock cubes other salts, etc.) when you are cooking.
  • Reduce your salt intake gradually.
  1. Tips to cook with less salt
  • During the cooking process, taste your food as it may not need added salt.
  • Remember: if you’ve already added salty spices or a stock cube, you do not need to add salt too.

Healthy herbs and spices

But now you might ask: what should I use to flavour my food if I don’t use salt? To make your food tasty try these herbs and unsalted spices instead of salt:

  • Lemon juice or vinegar.
  • Herbs like Italian herbs mix, parsley or rosemary.
  • Spices like curry powder, paprika or pepper.
  • Garlic, ginger, chilli and onions.

Which foods to eat more often, only sometimes or eat less often

Foods low in salt
(eat more often)
Moderate salt foods
(eat sometimes)
Foods high in salt
(eat less often)
  • Foods prepared at home from fresh ingredients
  • Fruits and vegetables (Fresh, frozen and dried)
  • Unsalted nuts and seeds
  • Beans, lentils and peas
  • Mealie meal
  • Pasta and rice
  • Plain popcorn
  • Oats
  • Fresh fish
  • Fresh chicken and meat
  • Eggs
  • Yoghurt and Maas
  • Plain cottage cheese
  • Vinegar or lemon juice
  • Spices and herbs (dried and fresh)
  • Salted nuts
  • Cakes, pastries and biscuits/ cookies
  • Table sauces (tomato sauce and mustard)
  • Salad dressings
  • Mayonnaise
  • Convenience meals
  • Burgers and pies
  • Soft tub margarine
  • Pate and hummus

Look for lower salt options for these foods:

  • Bread and bread products
  • Breakfast cereals
  • Baked beans
  • Peanut butter
  • Tinned fish
  • All types of salt (yes Himalayan salt too)
  • Seasoning salts like barbeque or chicken spice
  • Stock cubes, gravy and soup powders
  • Take-away foods, pizza, crumbed meat or chicken
  • Potato chips
  • Salty spreads
  • Worcestershire and soya sauce
  • Processed meats like polony, viennas, salami, ham, sausages and boerewors
  • Cured meat and fish like biltong, bokkoms, anchovies, corned beef and pickled tongue
  • Cheese, butter and hard margarine
  • Instant noodles
  • Olives and pickles

Nutritional Information Table

Per 100g Low eat more often Moderate eat sometimes High avoid or limit
Sodium 120 mg or less 120 mg – 600 mg 600 mg or more

Popular herbs and how to use them

Here is the exciting and creative part, experimenting in the kitchen to find combinations you love. Certain herbs and certain combinations can elevate your meals to the next level. In the next table find staple herbs and ingredients they work well with.

Herb Complements Complementary herbs, spices or flavours Recipe ideas/ tips
Basil White meats



Roast beef




Thyme and oregano

Fennel and oregano

Stir fries

Italian dishes



Tomato sauces

Dill Salmon

Carrots Cucumber





Bay leaves






Borscht and other stews

Cream and cottage cheese

Vegetable salads


Mint Pork













Oregano Beef


Fried fish


Roast beef



Bay leaves

Marjoram and Thyme

Fennel and Basil

Tomato sauces


Rosemary Tomatoes


Roast meats



Grilled fish


Roast beef







Add to sauce for subtler taste

Poultry stuffing

Sage Sweet fruit and veg e.g. squash or apple




Fried fish




Winter savoury

Flavour holds well when cooked for long periods



Pork roast


Tarragon Chicken

Fried fish

Pickles tomatoes

Parsley, chervil, chives

Parsley + tarragon = fines herbs

Sauces for meats and vegetables

Eggs and cheese dishes

Green salads

Thyme Egg


Grilled fish

Roast beef






Sweet Marjoram




Vegetarian dishes


Coriander Beef


Grilled fish









Apple pie



Green salads


Parsley Fish





Basil and chives


Pasta dishes


 Be salt aware

  1. Use little or no salt in cooking – try using extra herbs and spices instead such as black pepper.
  2. Leave the saltshaker off the table.
  3. Cut down on salty processed foods and ready meals and try and make your own if you can.
  4. Check out food labels for salt and go for lower salt choices. There can be a really big difference between different types and brands.
  5. Compare salt levels among similar products and try to choose those lower in salt.
  6. Ask in restaurants and take-aways for no added salt.
  7. Be wary of fancy gourmet salts and salt substitutes claiming to be better for your health than table salt. These product ranges are still likely to add some form of salt to your diet.


  • How to match food with herbs and spices (
  • A Beginner’s guide to herbs and spices (
  • Spice and Herb Chart (
Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


Retha Harmse is a registered dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

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Eat for energy this winter

Dietitian, Mignon Jordaan, advises us how to eat for energy this winter so the winter-blues will be a thing of the past.

Cold weather can be dreadful but the food that warms you up is often so delightful. If the desperate need for comfort food or the so-called winter-blues binge eating happens, there is a perfect explanation for this, and you’re not alone.

Research1 has shown that people with diabetes tend to have a higher average fasting glucose level and HbA1c value during the winter months. The findings in this study was mainly related to less physical activity and low immunity leading to seasonal infections (less sunlight exposure equals low vitamin D levels equals low immunity).


Seasonal affective disorder (SAD) is defined in the 2017 Journal of Global Diabetes and Clinical Metabolism as a seasonal depression and a mood disorder subset in which people that have normal mental health throughout most of the year experience depressive symptoms in the winter.

The typical symptoms to expect when you suffer from SAD are increased appetite, weight gain, declined energy levels, increased sleep desire, loss of interest in usually pleasurable or fulfilling activities, cravings for food items, irritability, and as ruminations of guilt and suicide.

The incidence of SAD in people living with diabetes was found to be high, especially those with diabetic retinopathy. Since diabetic patients may experience similar symptoms of depression, like when blood glucose levels are out of range, it’s important to be aware of symptoms of low mood, cravings and irritability. If symptoms don’t resolve after blood glucose levels normalise, it’s most likely SAD.

The happy hormone (serotonin) is released after a good carbohydrate-rich meal, and tends to be lower during the winter month which leads to more cravings for refined carbohydrates. You would crave a nice warm pizza or warm Malva pudding rather than a whole-wheat chicken wrap.

Avoid rebound hyperglycaemic effect

Many know that a simple carbohydrate, like pizza, will rise your blood glucose levels quickly and lead to a quick drop soon after, making you feel so low in energy and even more hungry for sugar (rebound hyperglycaemic effect).

By changing your mind-set about the type of food and the appropriate portion to keep you satisfied and warm during winter can have a positive impact on your food choices.

Overeating and binge-eating refined carbohydrates can easily be activated by environmental cues, like social gatherings, work functions or habitual hot chocolate every night after dinner, or even just because you’ve been misinformed about a food item that isn’t as nutritious as you might think.

10 ways to be beat low energy winter-blues

The effect of winter blues can be very frustrating and exhausting if you don’t know how to control it. Here are easy tips to minimise low energy.

1. Eat five to six small regular meals

This should be done every two to three hours and should contain a balanced amount of wholegrain starch, lean protein and unsaturated fat to ensure your blood glucose level stay stable for longer. Examples of meals and snacks:

  • Chicken stir fry with brown rice
  • Whole-wheat chicken vegetable pasta
  • Fruit and nuts
  • Whole-wheat crackers with unsweetened peanut butter

2. Make sure you are good to yourself

Have a treat once a week; this needs to be controlled very strictly. Keep it small and have it with a meal to prevent high blood sugar levels.

Recommended snack Teaspoons of sugar Non-recommended snack Teaspoons of sugar
Dark chocolate

(70% or higher)

2 Blocks

½ teaspoon 50g chocolate bar 6 teaspoons
NOMU Skinny hot chocolate

1 Heaped teaspoon with 200ml low-fat milk

3 teaspoons




4 teaspoons original hot chocolate with 200ml low-fat milk 6 ½ teaspoons
Homemade S’mores

2 Gullón Sugar Free Maria biscuits with

1 marshmallow

1 teaspoon 4 Marie Biscuits2 Marshmallows 3 teaspoons
Chickpea chips

½ cup roasted spicy chickpeas tinned in brine/dried with added chilli spices of choice and roasted in oven

0 teaspoons 75g packet jelly babies 7 teaspoons

Comparison of the total teaspoons of sugar in healthy recommended snacks with the total teaspoons of sugar in typical sugary snacks

3. Increase your intake of vitamin D-rich food

Or Buy a vitamin D supplement to prevent vitamin D deficiency and increase your immunity.

Recommended daily allowance (RDA) for vitamin D

Age Male Female
1-13y years 600 IU (15mcg) 600 IU (15mcg)
14-18 years 600 IU (15mcg) 600 IU (15mcg)
19-50 years 600 IU (15mcg) 600 IU (15mcg)
51-70 years 600 IU (15mcg) 600 IU (15mcg)
>70 years

800 IU (20mcg)

800 IU (20mcg)

Food sources rich in vitamin D:

  • Fatty fish like salmon, tuna and mackerel
  • Beef liver, egg yolks and cheese
  • Fortified food like margarine, bread and cereals

4. Be physically active

Moderate physical activity, like brisk walking three to four times a week, will improve energy levels by more sunlight exposure and the release of the ‘good-feeling’ hormone, called dopamine.

5. Increase your fibre intake

Fibre improves the feeling of satiety and improves blood glucose control. Have five fruits and vegetables a day. Include a wide range of vegetables in a warm soup and add fruit to your snacks. This will help you to achieve the fibre recommendation.

6. Make a low-GI carbohydrate part of each meal.

Low-GI food ensures a steady release of sugar in the blood, leading to longer satiety and sustained energy throughout the day. Food sources include:

    • Low-GI seeded or whole-wheat bread
    • Cooled down and re-heated oats, maize meal, Maltabella porridge, potatoes or sweet potatoes
    • Fresh fruit, like apples, pears, strawberries, blueberries and cherries (and many more)
    • Legumes, like sugar or brown beans, hummus, chickpeas and lentils
    • Durum wheat pasta, sorghum, barley, brown rice or quinoa
    • Crackers, like Provita multigrain or whole-wheat

Have a look on for more examples of low-GI food.

7. Boost the 5 HTP-precursor

The 5 HTP-precursor is responsible to convert serotonin in the body. You can boost your dietary intake of L-tryptophan, which the body converts to 5-HTP. Food sources include turkey, chicken, pumpkin seeds, spinach, milk, and bananas. There are minimal human studies to ensure the success for using a 5-HTP dietary supplement and dietary intake will be sufficient.

8. Make sure that vitamin B-rich food is part of your daily intake

This ensures the successful activation of serotonin. Food sources include wholegrain bread and pasta, lean meat and chicken, seeds and nuts, dark leafy vegetables, eggs and legumes.

9. Have a planned cooking-routine

Make sure you make cooking enjoyable during the winter time and include the whole family. Compile your own recipe book, loaded with delicious soups, stews and casseroles with nutritious ingredients. Have a look on Diabetes South Africa’s website at for their amazing diabetic-friendly recipes.

10. Drink six to eight glasses of clean safe water a day

This prevents dehydration and fatigue. During winter, cold water can be difficult to consume so try a warm Rooibos or herbal tea topped with a slice of lemon or mint.

Stay energised this winter by making these 10 steps part of your daily routine and the winter-blues will be a thing of the past.


  1. Gikas, et al


Mignon Jordaan is a registered dietitian. Her heart’s desire is to make a difference in people’s lives with her knowledge of nutrition. Being a Type 1 diabetes patient herself, she can walk the journey of “mindful eating” with her clients.

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Supporting an elderly parent with diabetes

It’s no secret that diabetes is hard to handle. This is true for those who have the condition themselves, but also for their friends, family and loved ones. Daniel Sher covers some pointers for supporting an elderly parent with their diabetes. 

Problem solve around their needs

Ask what you can do to support your elderly parent and use their response to start a conversation. Acknowledge that you might not fully understand how best to help. Remind them that they don’t need to walk this path alone.

What if they don’t know what sort of help they need? If this is the case, you can brainstorm the following questions:

  • Can I help you plan and prepare healthy and delicious meal options?
  • Do you need any help with scheduling and remembering medical appointments?
  • Doctors’ visits can be stressful, would you like it if I accompanied you?
  • Would it be useful if we set up a system to help you remember to take your meds and check your glucose at the right time?
  • Is there anything about diabetes that you don’t understand? How would you feel about us researching it together?

Try to phrase your questions in an open-ended manner, to encourage conversations aimed at helping you learn how best to assist. Your most valuable tool in this regard, is an attitude of caring curiosity.

Ask your elderly parent how he/she feels

Check in with your loved one by asking how he/she is coping emotionally. Have they had any patches of feeling down, irritable, hopeless or depressed? Having this sort of a conversation with your parent can provide valuable emotional support.

Also keep in mind that people with diabetes are at risk of developing diabetes burnout and/or clinical depression. If your parent is suffering from a mental health condition in addition to their diabetes, they should ideally get treatment from a diabetes-specialised mental health professional.

Keep thinking about their thinking

Elderly people with diabetes are at a greater risk of developing cognitive difficulties, including vascular dementia. Look out for marked memory difficulties, trouble with concentration, planning problems and generally slowed thinking, as well as changes in mood or personality.

If you notice these sorts of changes, it’s important to get your parent screened by their physician. Catching these sorts of symptoms early, gives you valuable time to make changes that will keep their brain as healthy as possible going forward.

Also, keep in mind that the better your parent manages their diabetes and physical health, the lower their risk of developing cognitive difficulties later down the line.

Know when to back off

It’s natural to want to help your elderly parent be as healthy as possible. However, it’s important to allow them their space. If you find yourself giving lectures, getting irritable or giving advice that ends in arguments and avoidance, these are signs that you need to take a step back. At the end of the day, your role is to support your parent in a way that helps rather than hinders their health.

Help yourself

What if your parent refuses to take your advice? It can be so hard to watch a loved one do medical damage to themselves. This can leave you feeling frustrated and hopeless, at times leading to what psychologists called caregiver burnout.

The emotional toll of caring for someone with a chronic condition is no joking matter. If you feel like you’re taking strain, it’s a good idea to find your own psychologist or counsellor who can provide you with some support.

Overall message

Diabetes is a tough condition to manage alone. As the child of someone with diabetes, you are in a valuable position to provide practical and emotional support.

Your own insight, care and compassion can go a long way when it comes to keeping your parent as happy and healthy as possible. Though, sometimes they just need you to be there for them in the capacity as a son or a daughter, not as another helper.


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

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