How is diabetes a family affair?

There is a saying, “When one person feels better, the whole family situation improves”, Noy Pullen explains why this is true.

Some years ago, I interviewed Credo Mutwa, the renowned traditional practitioner. He told me that when he was newly qualified, diabetes was hardly ever diagnosed among his patients. He said with the continuing growth of what he called American cold drinks and the American lifestyle, he noticed a marked increase in diagnosis of diabetes. 

When I first started writing for Diabetes Focus, in 1996, I would ask any random group of people in any social setting how many of them had diabetes in the family. If two people put up their hands, it was unusual. During the many years we have run Diabetes South Africa’s Agents for Change courses with healthcare providers and patients, I continued to ask this question. Presently there is always more than 80% of the group raising their hands.

How does diabetes affect you?

Type 3 diabetes is a term that has been used colloquially (even though there is a medical definition for it) in the diabetes community to include all those who do not have diabetes themselves, but are living with someone who has diabetes and are affected by the condition. It has become clear that diabetes affects more than 80% of our population. Everyone’s diabetes affects family, friends, colleagues, in fact the whole community. Diabetes affects us all. 

Challenges to lifestyle changes 

Participants who attend the first Agents for Change module become motivated to change something in their life. Most of them have families to consider. Many of them would also like their families to change. For example, habits that have led to obesity amongst family members, or perhaps an inactive lifestyle. Questions are asked – How does one change the habits of others? Is it possible? 

When the participants return for the follow-up module three months later, they fill in questionnaires which indicate a mixture of success stories and challenges. Some of them managed their goals, others found it difficult to change their own habits. While others met with resistance from the family, who, for example, did not want to eat more vegetables, or give up unhealthy options. Some participants’ lives are dependent on their families who are not prepared to make special dishes for them.  

Some risk factors to developing diabetes (which affects all family members eventually):

Age – over forty

Central obesity – waist circumference of over 88 for women and over 102 for men 

Family history – heredity factors

Alcohol consumption


Side effects of certain medication e.g. steroids, statins and others

Inactive lifestyle

Consumption of high carbohydrates meals and fast foods

Stress levels

High blood pressure and cholesterol levels

Lifestyle changes will alter this picture. Yet this knowledge is clearly not enough to facilitate these changes. None of this information is new. We hear it on the radio, we see it on screen. How can we help change come about? Do we have to get diabetes before we make changes? 

The 5 As

These are based on a counselling style called Brief Behaviour Change Counselling1.

  • Ask about individual risk situations in the family; for a family chat and request permission to speak about your concerns.

  • Alert the person to what your concerns are, and add any information that you have agreed to talk about. Ask for support for any change that comes from the discussion.

  • Assess the relevance of the situation to others in the family – risk factors, possible outcomes. Determine the readiness of each member of the family to change.

  • Assist in making plans for agreed changes, behavioural skills and confidence to succeed e.g. graphs, charts, incentives.

  • Arrange for agreed appointments e.g. with the gym or dietitian, etc.; follow-up family check-ins, community based resources.



Please contact Noy Pullen if you would like more information: [email protected] or 072 258 7132.



Healthy eating – a family affair

A healthy meal plan isn’t just for people with diabetes. In fact, the dietary guidelines recommended for people with diabetes are the same as those recommended for the rest of the population. That means your family doesn’t need to prepare separate meals for you at home – they can simply adopt your healthy habits. Follow these 10 tips to build a balanced and healthy meal plan for your whole family.

  1. Enjoy a variety of foods.

Not one food can deliver all the necessary nutrients for you and your family, so you should make sure that your family eats different types of food.

  1. Make starchy foods part of most meals.

A small portion of good quality carbohydrates helps to give the body energy. Choose high-fibre starchy foods – like high-fibre breakfast cereals, whole grain bread and wholewheat pasta – over more refined versions for sustained energy to help your family through the work or school day.

  1. Eat dried beans, split peas, lentils and soya regularly.

Beans and legumes are good sources of protein, fibre and B vitamins, and they also help to improve blood glucose control. Aim to include beans and legumes in your family’s menu at least twice a week.

  1. Eat plenty of vegetables and fruit every day.

Vegetables and fruit contain loads of different nutrients, like fibre, vitamins and minerals. Your family should eat at least five portions of vegetables and fruit daily to make sure they get a variety of nutrients needed for health.

  1. Have milk, maas or yoghurt every day.

Encourage your family to enjoy at least three servings of dairy foods per day to ensure they develop strong, healthy teeth and bones. Aim to choose versions with less added sugar where possible.

  1. Drink lots of clean safe water.

Water is the best way for your family to stay hydrated and should be their first choice when choosing a beverage. It is the cheapest yet best drink of all. Start your children on water when they are young and it will remain a good habit for the rest of their lives.

  1. Use salt and food high in salt sparingly.

Eating too much salt increases your risk of high blood pressure (hypertension) and health conditions in the long term. Let your family enjoy the natural taste of foods by not adding salt to meals and avoiding salty ingredients in your cooking, such as stock cubes and soup powders.

  1. Use sugar and food and drinks high in sugar sparingly.

Limit foods with added sugar, like cookies, sweets, chocolates and sugar-sweetened drinks. Keep sugary foods as ‘special occasion’ treats, and practice portion control when you do enjoy them.

  1. Fish, chicken, lean meat and eggs can be eaten daily.

Protein helps to provide the body with strength and structure, while repairing damage and promoting growth. Including protein in your meals also helps to improve blood glucose control. Oily fish is also a great source of omega-3 fatty acids which helps to protect against heart disease.

  1. Choose good quality fats.

Beware of eating excess saturated and trans fats. When you and your family use fats, choose unsaturated sources like olive and canola oil, oily fish, tub margarines, avocado, peanut butter and nuts.

Pick n Pay Health Hotline

Did you know that Pick n Pay employs a registered dietitian to provide free food and nutrition-related advice to the public? Whether looking for guidelines on managing your condition, weight loss tips, healthy eating tips for kids, how to manage food allergies, how to interpret food labels or any other food-related query you have always wanted answered, our registered dietitian is just a phone call away.

Contact the Pick n Pay Health Hotline on 0800 11 22 88 or email [email protected] to start your nutrition conversation.

MEET OUR EXPERT - Leanne Kiezer

Registered Dietitian BSc Diet, PgD Diet UKZN, MSc Nutrition NWU. Leanne joined Pick n Pay as the resident dietitian in May 2014. She is the voice behind the Pick n Pay Health Hotline, providing advice to customers on a range of nutrition and health-related topics. She also provides nutrition input as part of the Pick n Pay food development team, and ensures that all communication is in line with the most recent advances in nutrition science and research.