Can people living with diabetes donate blood?

National Blood Donor Month was in June; with that we chat to Dr Nolubabalo Makiwane, from the South African National Blood Services (SANBS) about whether people living with diabetes can donate blood.


  1. Can diabetes patients using insulin (injection or pump) donate blood?

Yes, we accept donors who are using insulin to control their diabetes. Both those using injections or pumps. The most important factor is that their diabetes must be controlled and they must be well on the day they present to donate.

Insulin users should also not have any skin complications associated with using injections/pumps. We won’t allow a donor to donate blood, if they have a skin infection at the injection site, for example.

  1. Can diabetes patients using oral diabetes medication donate blood?

Yes, persons using oral medications and diet to control their diabetes are welcome to donate. Again, their diabetes must be well-controlled and they must be well when presenting to donate blood.

Most medication used to treat diabetes are classed as category B drugs. Therefore, are considered safe if one should opt to become a blood donor.

  • Understanding the categories of medication

Medications are assigned to five letter categories based on their level of risk to foetal outcomes in pregnancy. It can give one a good idea on the level of safety of a drug at a glance. This is of importance in transfusion as a fair percentage of SANBS blood products are used by pregnant women, women in labour or who are post-partum, and, of course, we also supply blood products for use in babies and children.

So, category A is the safest category of drugs to take. Category B medications are medications that are used routinely and safely during pregnancy. The C and D category drugs have shown positive evidence of human foetal risk but potential benefits of the drug may warrant use in pregnant women. Category X is never to be used in pregnancy. This is a classification based on the safety of a drug in pregnancy and lactation.

Pregnancy Category

Description

A No risk in controlled human studies: Adequate and well-controlled human studies have failed to demonstrate a risk to the foetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
B No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the foetus in any trimester.
C Risk not ruled out: Animal reproduction studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
D Positive evidence of risk: There is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
X Contraindicated in pregnancy: Studies in animals or humans have demonstrated foetal abnormalities and/or there is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
N FDA has not yet classified the drug into a specified pregnancy category.
  1. What are the medications that if taken, a person can’t donate blood?

Generally, SANBS doesn’t accept donors who are using medication that is classified as teratogenic. These drugs would fall into category X. These medications are known to cause malformations in unborn babies, or miscarriages. These include a lot of dermatological agents, like Roaccutane, Neotigason and etretinate.

Some anticonvulsant medication has been found to have teratogenic effects, such as valproic acid, phenytoin and phenobarbitone.

Some antibiotics and male hormonal medications are also classed as teratogenic. The list of teratogenics is, of course, much longer than this. However, what is of note is that there are no hypoglycaemic agents listed as teratogenic.

  1. Diabetes, unfortunately, has many side effects, such as heart problems, neuropathy, slow-healing, etc. Will any of these side effects stop people living with diabetes from donating blood?

Most definitely. If donors are people living with diabetes and they develop a complication due to their diabetes, we defer them until the complications are resolved, and until good control of the donors’ blood glucose level is re-established.

Persons who suffer from a hypoglycaemic coma (due to low blood glucose levels) are deferred for four months from the time of the episode. This is to ensure that their glucose control is adequate.

SANBS also doesn’t accept donors who develop diabetes as a complication of another disease process. For example, a donor who develops diabetes as a complication of acromegaly (a disorder caused by excessive production of growth hormone by the pituitary gland and marked especially by progressive enlargement of hands, feet, and face) would not be accepted for the procedure.

  1. Does SANBS encourage people living with diabetes to donate blood?

We encourage people living with diabetes to donate blood only if they are well enough to tolerate the procedures. At SANBS, the health of our donors is of very high importance. We do not collect blood from a donor if it would be detrimental to the health of the donor at all. This applies to our diabetic donors, even more so as they are at a slightly increased risk of developing infections and other complications.

MEET OUR EXPERT


Dr Nolubabalo Makiwane is a registered medical practitioner working in the transfusion medicine field. She is part of the medical team at the SANBS where she works to ensure that donor care is at its best.


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What are the best sweeteners for people living with diabetes?

There is a lot of controversy regarding  sweeteners (sugar substitutes) and which is better for people living with diabetes. Retha Harmse simplifies the facts.


Sugar consumption

The dangers of excessive consumption of sugar is well-documented. Including how it negatively affects the health status of individuals but even more so for people living with diabetes.

The typical South African consumes 24 teaspoons of sugar daily. More than double of the World Health Organization guidelines for daily intake. Added to that, 7% of the South African population has diabetes (3,85 million people, aged between 21 – 79 years old).

In 1985, 30 million people had diabetes. Its prevalence has increased six-fold and today  425 million people worldwide are currently. If nothing is done now to prevent this, this number will continue to increase to 629 million people by 2045.

Sugars that increase blood glucose levels

Some foods will be labelled “no added sugar” but will still be high in natural sugar (e.g. fruit sugars). These natural sugars also raise blood glucose levels and should be monitored for people with insulin resistance and diabetes.

Sugar Forms & uses Other things you should know
  • Brown sugar
  • Maltodextrins
  • Icing sugar
  • Agave syrup
  • Invert sugar
  • Brown rice syrup
  • White sugar
  • Corn syrup
  • Dextrose
  • High fructose corn syrup
  • Fructose
  • Maple syrup
  • Glucose
  • Fruit juice concentrates
  • Lactose
  • Honey
  •  Maltose
  • Molasses
  • Sucrose
  • Barley malt
  • Used to sweeten foods and beverages.
  • May be found in certain medications.
  • There is no advantage to those with diabetes in using one type of sugar over another (in other words, one teaspoon of sugar has the equal effect of one teaspoon of honey).
  • Sugars may be eaten in moderation. Up to 5% of the daily caloric requirement can come from added sugar.
  • High-sugar diets are not recommended, since such foods could replace more nutritious foods and lead to deficiencies.

Sugars that don’t affect blood glucose levels

Non-nutritive sweeteners, such as aspartame, sucralose, saccharine, stevia, xylitol, and neotame, are so popular due to it being approximately 300 to 13 000 times sweeter than sugar. Though, they don’t have any nutritional value (meaning no or low kilojoules).

Although artificial sweeteners may help to reduce total energy intake, the effectiveness in weight loss or diabetes management has not yet been established. We think fewer calories consumed equals less weight gained or more weight lost, right?

However, according to a recent review, regular consumption of non-nutritive sweeteners is related to an increase in BMI. This might be explained by sweeteners being associated with an amplifying of general cravings and appetite.

Despite this, and this is imperative: sweeteners are not all the same. They have different biochemical structures, with different routes of metabolisation and absorption. Certain sweeteners metabolise differently and are therefore better than others in maintaining blood glucose and weight management. Let’s look at a few different sweeteners and how they weigh up.

Sucralose

Sucralose (sold as Splenda) is 600 times sweeter than normal sugar. It’s mostly secreted which means it does not get absorbed in the body.

Although this might sound great, don’t be so quick to jump on the bandwagon. Sucralose has been associated with inflammation, and there is still ongoing research on whether it increases blood glucose level. The data is leaning towards a ‘no’ for people living with diabetes, as long-term use can cause insulin resistance.

It’s also worth mentioning that added table sugar, if consumed in excess, also causes inflammation and has also been associated with insulin resistance.

Conclusion: Consuming sucralose (or normal sugar) in excess over a long period of time has been linked to inflammation. Sucralose should rather be avoided if you’re diagnosed with any inflammatory diseases such, as rheumatoid arthritis or Crohn’s disease, as it can worsen the inflammatory state.

Aspartame

Aspartame is mostly used in sugar-free or low-sugar drinks and Iced Tea lite.

After the big media frenzy of aspartame causing cancer, recent human studies proved aspartame had no carcinogenic effect. However, it’s worthwhile to note that it’s still not beneficial for your health. More specifically gut health, as aspartame increases certain bacteria in your gut that are directly associated with weight gain.

Furthermore, the long-term (more than 10 years) use of aspartame has been negatively associated with cardiac health. Lastly, aspartame also leads to an increase in carbohydrate cravings, which can lead to increased appetite.

Conclusion: Although aspartame was set-free from being cancer causing, it still increases carbohydrate cravings and the effect it has on gut- and cardiac health shouldn’t be neglected.

Remember that moderation is key. Try to replace diet drinks with infused water or homemade iced teas (rooibos is such a good option). But if you still plan to consume aspartame, be sure to include extra fibrous vegetables, or even a probiotic, to keep the microbiota in balance.

Stevia, erythritol and xylitol

These three sweeteners have been categorised as natural sweeteners. The benefits of these sweeteners are that they don’t need insulin to be metabolised. Therefore, improves glucose tolerance and reduces insulin levels.

Stevia does have an undesirable bitter aftertaste, and erythritol and xylitol are quite expensive (roughly R150-160p/kg). But it seems worth it, because when consuming these natural sweeteners, the rewards system is activated leaving you feeling satisfied. And, in contrast to the previous mentioned sweeteners, they do not increase cravings.

Conclusion: Stevia, erythritol, and xylitol are superior. They can improve glucose levels and aid in weight management, in comparison to the other artificial sweeteners.

Still, moderation remains a key factor in any healthy diet. Therefore, using it sparingly will benefit your health as well as your wallet.

MEET OUR EXPERT


Retha Harmse (née Booyens) is a registered dietitian and the ADSA public relations portfolio holder. She has a passion for informing and equipping 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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Healthy and easy ways to make smoothies for people living with diabetes

Brought to you by: FUTURELIFE®


Smoothies are one of those foods that have stayed popular and remained on the food trend list for the last few years. Everywhere you look; restaurants, recipe books, food blogs and Pinterest are filled with the most delicious smoothie recipes and a simple google search on smoothies can pull through pages and pages of articles and recipes, but needless to say, looking through all this information can be a pretty daunting task. For those of you who don’t know anything about smoothies…you are in luck, here is all the information you need to know about making a nutritious smoothie.


WHAT ARE SMOOTHIES?

A smoothie is a blended drink made from a combination of fruits and/or vegetables; a liquid such as milk, a milk alternative, yogurt or juice and ice.1 Smoothies can vary in thickness depending on the ratio of solid to liquid ingredients used.

WHY ARE SMOOTHIES A GREAT ADDITION TO YOUR DAY?

As smoothies contain a combination of foods and are a great way to boost your nutrition in one meal. They often contain beneficial vitamins, minerals, antioxidants, fibre as well as healthy fats and protein. Smoothies are versatile, and if made correctly they can be had as a meal, snack or healthy treat.

There are endless combinations of ingredients that you can use to make smoothies, therefore it’s difficult to get bored. Smoothies are also quick and easy to prepare. Just put all the ingredients into a blender and ‘voila’ you have a nutrient dense meal.

ARE SMOOTHIES SAFE FOR INDIVIDUALS LIVING WITH DIABETES?

Living with diabetes doesn’t mean you need to deny yourself all the foods you love, but it is still important to ensure that you make healthier food choices. As smoothies contain many ingredients, they can often be high in sugar, carbohydrates and calories which can cause havoc on blood sugar levels. Therefore, it’s important to choose your ingredients carefully and keep an eye on how much you drink at a time.

HOW TO MAKE A ‘DIABETIC-FRIENDLY’ SMOOTHIE

1. Choose your produce

Most smoothie recipes call for the addition of a selection of fruits. Fruits are high in vitamins, minerals, fibre, antioxidants and natural sugars. Any seasonal fruit of your choice can be used but make sure include fruits of different colours. Examples include all berries, apples, pear, melon, nectarine, citrus, kiwi and plums etc. Watch your portion of the following fruits as they contain more sugar per portion e.g. banana’s, grapes, figs, paw paw, melon and dried fruit.

If you are going to include other carbohydrate sources in your smoothie, such as dairy or a cereal product e.g. FUTURELIFE® or oats, it is suggested you only include 1/2 – 1 fruit portion per smoothie.

One fruit portion = 1 tennis ball size fruit OR 2 golf ball size fruit OR ½ cup
People often forget about adding vegetables to smoothies. Vegetables also contain fewer carbohydrates than fruit therefore are helpful in keeping the total carbohydrate of the smoothie down. Including vegetables in your smoothie is a quick and convenient way to include more vegetables into your day. Any of the green vegetables such as kale, spinach, broccoli, cucumber and avocado are great additions to any smoothie as they contain little carbohydrates. Be careful of starchy vegetables such as carrots or beetroot. Some recipes also call for cooked vegetables like sweet potato or legumes that contribute to fibre content, texture and taste.

One vegetable portion = 1 cup raw vegetables OR ½ cup cooked
Natural sugars, found in fruits and starchy vegetables, also cause spikes in your blood sugar levels if too much is eaten at once. Remember to count the fruit and starchy vegetables you blend into your smoothies as part of your daily fruit allowance. This will ensure you don’t overdo it on carbohydrates.

2. Add your liquid

There are many choices when it comes to liquids, many people just add water or ice. Including plain, unsweetened dairy such yoghurt or milk not only contributes calcium and vitamin D which is important for bone health but also increases the protein content. This helps to lower the Glycaemic index (GI) of the whole smoothie (refer to article on GI & GL),2 which helps to prevent spikes in blood sugar levels.2,3 Bear in mind that dairy also contains carbohydrates, therefore contributing to the total carbohydrate content of the smoothie.

For dairy free options include a non-sweetened milk alternative such as soy, almond, rice, hemp, or a little bit of coconut milk. Other recipes also call for fruit juice, however for people living with diabetes, fruit juice isn’t recommended as it contains natural sugars but no fibre. Remember these smoothies contain multiple ingredients that contain carbohydrates, fruit juice will push the carbohydrate content up quickly.

3. Boost nutrition
Protein & Fat
Including a source of protein and fat in your smoothie is helpful as they both slow the rate at which the meal leaves the stomach. This slows down the absorption of the sugars into your blood which prevents spikes in blood sugar levels.

  • Ways to boost the protein content would be to add a protein powder such as whey and /or casein which is milk based or a plant based protein powder include hemp, soy, brown rice, and pea.
  • Include the following healthy fats in your smoothie: 1 small handful of nuts, 1 – 2 Tablespoons of seeds, ½ small avocado (gives your smoothie a creamy texture), 1 tablespoon of sugar free nut butter and 1 teaspoon of seed oils e.g. coconut, flaxseed, macadamia or olive.

Other tips:

  • Whole grains can also be a useful addition to the smoothie as they contribute texture and boost the nutritionals by adding vitamins, minerals, fibre, and protein and are low GI. Oats or oat bran are a great option. Remember to watch portions as they will contribute to the carbohydrate content
  • Don’t add extra sweeteners; remember fruits and dairy contain natural sugars already.
  • Remember to consider the carbohydrate content of the total smoothie. This should be no more than 1 – 3 carbohydrate exchanges depending on if it’s a meal or snack.

WHERE DOES FUTURELIFE® FIT IN?
FUTURELIFE® products are a great addition to any smoothie as they contain nutrients that are useful when looking at the steps for making diabetic friendly recipes above. They are high in protein, fibre, healthy fats and omega-3. Many of our products are also enriched with vitamins and minerals; contain the prebiotic inulin and MODUCARE® which supports the immune system. Our products are also quick and easy to prepare, just add water or milk.

FUTURELIFE® Smart food™, FUTURELIFE® HIGH PROTEIN Smart food™ and ZERO Smart food™ are the recommended products to add to any smoothie. While all are high in protein and fibre, low GI and nutrient dense, FUTURELIFE® HIGH PROTEIN Smart food™ has the highest protein content of 30 g per 100g. It contains SmartProtein3D which is a combination of soy, casein and whey protein, and has the lowest carbohydrate content and GI of all our products. FUTURELIFE® ZERO Smart food™ is free of cane sugar and contains Smart Sweetness, a combination of Stevia, Erythritol and Sucralose. All 3 offering great benefits despite your preferences.


How to make a diabetic friendly smoothie:

ONE

Choose your produce. Include both fruit and vegetables and stick to portions

One fruit portion = 1 tennis ball size fruit OR 2 golf ball size fruit OR ½ cup

One vegetable portion = 1 cup raw vegetables OR ½ cup cooked

TWO

Add your liquid e.g. water, milk, yoghurt or dairy free option such as unsweetened soy, almond or coconut milk

THREE

Boost the nutritionals with a source of protein and fat

FOUR

Consider the carbohydrate content of the total smoothie


There you have it, see how simple it is to make your own smoothie. Remember by following these principles above you can adapt any smoothie recipe into one that is suitable for people living with diabetes. Included below are some easy recipes containing FUTURELIFE® products for those living with diabetes. Consult with your dietitian or diabetic nurse educator if you have any questions. For more delicious smoothie recipes, nutritional advice, health tips, Diabetes meal plans and more, visit www.futurelife.co.za


Try our healthy and easy recipes!

FUTURELIFE® Mixed Berries and Mint Crush

Ingredients 1/3 cup mixed frozen berries 125 ml plain fat free / low fat yoghurt 125 ml water 40 g or 4 Tbsp. FUTURELIFE® Smart

FUTURELIFE® HIGH PROTEIN Mocha Smoothie

Ingredients ½ cup of coffee, already prepared ½ cup low-fat or fat-free yoghurt (vanilla) 1 handful of ice 50 g (5 heaped Tbsp.) of FUTURELIFE®