For a person with diabetes, the thought of dining out or ordering meals can be challenging and quite daunting when trying to control blood glucose levels. Annica Rust shares strategies to follow when deciding what to order.

What to drink

When dining out, the first confrontation is what to drink. Sparkling water, flavoured water and sugar-free soft drinks would be the preferred choices.

If it is a special occasion, moderate amounts (one or two drinks/units not more than twice a week) of alcohol may be consumed, only in combination with a well-balanced meal to prevent delayed hypoglycaemia.² This happens because drinking alcohol on an empty stomach can interfere with the ability of the liver to release stored glucose. A low kilojoule white wine with lots of ice is an example of a smart choice.

What to eat

Plate method

When deciding what to eat, it may be helpful to take the plate example in consideration. (See Figure 1.) The plate example will in most cases have a low glycaemic load (GL), even though some of the individual items have a high glycaemic index (GI). Choose a meal as close to the example or construct a meal to achieve a well-balanced meal. Try sharing, if possible, to be able to construct a more balanced meal.

Figure 1: Plate method¹

Let’s look at a few examples when ordering:

1. Pizza

2. Burger

3. Chicken

Take note of the carbohydrates

It is crucial for people with diabetes to control their carbohydrate intake. Carbohydrate containing items used in recipes can sometimes be hidden and may add to the total carbohydrate count for the meal. It is therefore important to be on the lookout for them whilst ordering.

Items that contain carbohydrates¹

• Grains: bread, baked goods, cereal, crackers, pancakes, rice, tortillas and pasta
• Starchy vegetables and legumes (beans): white potatoes, sweet potatoes, corn, peas and lentils
• Fruit and fruit juice
• Milk, milk substitutes and yoghurt
• Some condiments: jelly, braai sauce, tomato sauce and many salads dressings
• Sweeteners: sugar, honey, concentrated fruit juice, maple syrup and corn syrup
• Sweets: ice cream, cake and candy

Dessert is not a must

Lastly, remember that dessert is not a must. If you are satisfied with your meal, rather drink a coffee. Always remember that a flat white, cappuccino or a latte has a large milk basis which makes them high in carbohydrates.

Honour hunger and know when to stop

Lastly never forget about your intuition. Unfortunately, a person with diabetes cannot solely rely on intuitive eating, but a nutritional approach that combines key diabetic dietary strategies in combination with intuitive eating can only reap good results. Honour hunger but know when to stop when you are satisfied and rather ask for a “doggie bag.”

Try not to label certain food items as forbidden but try to incorporate them into your meal plan. Remember with portion control there is a time and place for all food items. Always try to see the bigger picture. For example, if dining out is part of your daily routine, stricter portion control is necessary, however, if you rarely dine out, you can be more lenient whilst still staying within boundaries.

There is no one size fits all approach. Please contact a registered dietitian for individualised advice on strategies for dining out at restaurants.

References:

1. https://www.nutritionletter.tufts.edu/general-nutrition/diabetes-diet-what-to-eat/
2. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.

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We learn more about the role of biokineticists in exercise and Type 1 diabetes.

What is a biokineticist?

Biokinetics is a profession that focuses on promoting health and well-being by means of scientifically-based exercise prescription.¹ It involves many areas, including: orthopaedic and neurological rehabilitation, health promotion, chronic disease management and sporting performance. As biokineticists, we promote an active lifestyle to prevent non-communicable diseases, such as diabetes, by enhancing muscle strength, endurance, cardiorespiratory fitness, and flexibility.  A biokineticist will improve your physical functioning and educate you on how you can live your life through movement.²

Understanding diabetes

Diabetes is characterised by a sustained elevation in blood glucose. Type 1 diabetes specifically is caused by an autoimmune dysfunction which disrupts the pancreas and its ability to produce insulin.³ Insulin is a key hormone which acts as a gatekeeper between your blood vessels and muscles. Insulin is required for muscles to absorb the glucose circulating in your bloodstream.

Without insulin, blood glucose levels elevate beyond normal levels, which has negative effects on our biology, particularly the cardiovascular system. Type 1 diabetics supplement their insulin levels with injections administered at strategic times throughout the day.

Function of exercise in diabetes

The primary reason for exercise in the management of diabetes is to improve glycaemic control. In conjunction with diet and medication, exercise can reduce the risk of diabetes-related health complications.³

A biokineticist will perform a personalised evaluation and assign an exercise prescription that will help improve your glycaemic control, in turn aiding cardiovascular health and increasing life expectancy.³ Your biokineticist will ensure that you are exercising safely and meeting your personal goals.

Principles for exercise

There are various principles that biokineticists use to ensure that exercise is prescribed correctly. These include frequency, intensity, time, and type.¹

1. Frequency: This is how often you exercise during the week. Studies show that 3-7 days of aerobic exercise and 2/3 days of resistance exercise is recommended.
2. Intensity: This is either how moderately or vigorously you exercise. It is calculated using a rating of perceived exertion (RPE) scale. This scale ranges from 1-20. 1 being no discomfort to 20 being unbearable. Aerobic exercise can be performed moderately (11-12 RPE) to vigorously (14-17 RPE). Resistance exercise can be performed moderately and vigorously using a percentage of your 1 repetition maximum, which your biokineticist will calculate.
3. Time: This is how long you exercise for. Your biokineticist will recommend at least 150 minutes a week for moderate exercise to 75 minutes of vigorous aerobic exercise. Resistance training uses repetitions and sets. It is encouraged to do 8-10 exercises with 10-15 repetitions and 1-3 sets.
4. Type: The type of exercise is important. Your biokineticist will give you aerobic exercises, like swimming and cycling, and resistance exercises, such as lifting weights or using resistance bands.

Where to find a biokineticist?

Biokineticists are found in private practice, gyms, or wellness centres. Head over to the BASA website to find a biokineticist near you.

References

1.Biokinetics Association of South Africa. (2021). What is a Biokineticist? Retrieved from Biokinetics SA – Life through Movement : biokineticssa.org.za/public-information/

2.Ellapen, T. J., Strydom, G. L., Swanepoel, M., & Hammill, H. V. (2018). Biokinetics: A South African Health Profession Evolving from Physical Education and Sport. Sport and Exercise Science, 15-27.

3.Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2016). ACSM’s Guidelines for Exercise Testing and Prescription. Tenth Edition. Philadelphia, PA: Wolters Kluwer.

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How our bodies fight off diseases has gained more attention recently since the unprecedented global pandemic hit. The immune system is the intricate mechanism your body uses to fight off diseases and foreign invaders. Your diet and lifestyle can greatly affect your immune system, Jessica Pieterse tells us how.

Vitamin D

Vitamin D has always been a large role player in immune health. Receptors of vitamin D have been identified on several immune cells; in addition, they regulate the immune system by suppressing the pro-inflammatory molecules.

To improve your vitamin D levels, spend 15-20 minutes daily in the sun with as much skin exposed as possible. It must be from direct sun exposure and not through any windows. To get as much vitamin D, avoid applying sun cream, however, being sun smart is just as important. Eat more foods that contain vitamin D, such as liver, mushrooms, whole eggs, salmon, mackerel, and cod liver oil. Take a supplement if you know you are deficient. It is best if your health practitioner monitors your vitamin D levels annually and regulates your supplementation.

Gut bacteria

We have billions of bacteria making their home in our gut. Gut bacteria can be helpful or harmful depending on the type of bacteria. If a person has a healthy balance of the good bacteria, it can be vital in supporting immune health. Good bacteria fight harmful foreign substances that enter the body by detoxifying them and easing their elimination. Bacteria can also stimulate immune cells and affect gut lining integrity.

Ways to improve your gut bacteria balance is to take a good quality probiotic supplement, increasing prebiotic fibres, adopting a balanced healthy diet, reducing stress and improving sleep.

Good quality probiotic supplements contain several different strains of bacteria, have high doses of bacteria (at least 1 billion CFUs) and are stored in the refrigerator to keep bacteria alive. Take probiotics on an empty stomach so the bacteria are released further down the gut system and not in the stomach.

Most fruit, vegetables and wholegrains (barley, brown rice, oats) are sources of prebiotic fibres. Eating more of these foods will improve your gut bacteria balance. People suffering with IBS, be cautious. Some prebiotic fibres can worsen IBS symptoms so it’s best to seek individualised advice from your health practitioner.

Antioxidants, vitamins and minerals

Many supplements marketed to improve your immune system will contain a variety of vitamins, minerals and antioxidants. Antioxidants help by reducing oxidative stress. Eat more cocoa, red grapes, berries, herbal teas, turmeric, olive oil and pomegranates to boost your antioxidant intake.

The main vitamins and minerals that support your immune system are vitamin A, C, E, D, selenium and zinc. They each play a unique role. One vitamin or mineral is not a magic pill for avoiding getting sick. To clean your house, you can’t just use a broom; you also need a mop, cloth, water, and a bucket to do a good thorough job. Your immune system is the same. Many different vitamins, minerals and substances are needed to protect your body. They all play a part in the big picture.

Eat more beans, chickpeas, lentils, salmon, pilchards, fish, oysters, nuts, seeds, sweet peppers, strawberries and orange fruit and vegetables to improve your intake of these key nutrients.

Exercise

Being active can improve your immune system. It is interesting to note that very high amounts of exercise can potentially strain your immune system and have the opposite effect. That is why it is common to hear of many Comrades runners getting sick right before the race as they are extensively exercising at that point.

Aim for 30-45 minutes of exercise 3-4 times a week of varying intensities as a gauge. Exercise that lowers stress levels will have further beneficial impacts.

Sleep

Most people are told when they are sick to sleep more. This is not just an old wife’s tale but is correct. While you sleep, your body releases certain immune and inflammation molecules which affect your immune health.

Aim to improve how long you sleep and the quality of your sleep. Make these changes to improve your sleep.

• Avoid digital devices an hour before sleeping.
• Make your room dark and cool enough.
• Avoid drinking liquids too late at night.
• Reduce your caffeine intake.
• Be more active.

Do a relaxing activity before sleep like reading, deep breathing, prayer or mediation.

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Daniel Sher explains how meditation can improve the mental and physical well-being of people with Type 1 and Type 2 diabetes.

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Omy Naidoo, a registered dietitian, shares four immune-boosting nutrition tips for people with diabetes and obesity when recovering from COVID-19.

People with diabetes and who are obese are part of the vulnerable group whose immune system is easily compromised, making them vulnerable to contracting COVID-19. If someone has been exposed to or contracted the virus, healthy nutrition is essential for recovery in boosting their immune system.

The impact of COVID-19 is greater for people with diabetes and are obese. People who have diabetes and are obese, are more likely to have serious complications from COVID-19. In general, people with diabetes are more likely to have more severe symptoms and complications when infected with any virus. On the other hand, obesity has emerged as a strong and independent risk factor for severe infection and death due to COVID-19.

According to the World Health Organisation, obesity significantly increases the chances of severe outcomes for COVID-19 patients. Likewise, extra healthy nutritional measures need to be taken for people with diabetes.

Those recovering from the coronavirus should eat a variety of fresh and unprocessed foods every day to get the vitamins, minerals, dietary fibre, protein and antioxidants their body needs. They should also drink enough water, avoid sugar, fat and salt to significantly lower their risk of diabetes and obesity.

Four immune-boosting nutrition tips for people with diabetes and obesity when recovering from COVID-19:

Proteins

Protein is an important nutrient for cell growth and regeneration. It is the building block of life and is required by our body for faster recovery. When suffering from COVID-19 it is recommended to eat a high protein diet.

Eating 75-100 grams of protein is essential every day. Add more foods like lentils, legumes, milk and milk products, soya, nuts, seeds, meat, chicken, fish and eggs.

Vitamins and minerals

• Fresh fruits and vegetables are loaded with immune-boosting, antioxidants, vitamins and minerals. These can be an excellent addition to your diet for faster recovery and strengthening your immune system.
• Aim for five portions of fruits and vegetables a day.
• Citrus fruits are packed with vitamin C, which helps in the formation of antibodies and fights infection, while green and root vegetables help to strengthen the immune system.
• Also, spend some time outdoors to get a sufficient amount of vitamin D.

Less sugar and salt

• When cooking and preparing food, limit the amount of salt and high-sodium condiments (e.g. soya sauce and fish sauce).
• Limit your daily salt intake to less than 5g (approximately 1 teaspoon), and use iodized salt.
• Avoid foods (e.g. snacks) that are high in salt and sugar.
• Limit your intake of soft drinks or sodas and other drinks that are high in sugar (e.g. fruit juices, fruit juice concentrates and syrups, flavoured milk and yoghurt drinks). Choose fresh fruits instead of sweet snacks, such as cookies, cakes and chocolate.

Fluids

• Water is an essential element for life as it carries nutrients in the blood, regulates body temperature, and flushes out toxins from the body. Besides, an infection can dehydrate the body.
• Try to drink at least two to three litres of water every day. You can also consume herbal concoctions, coconut water, milk and fresh juice.
• Avoid packed juice, caffeine and fizzy drinks.

MEET THE EXPERT

Omy Naidoo is a registered dietitian and founder of Newtricion Wellness Dieticians. He has been in practice for 13 years. He worked within the government sector and then moved into the pharmaceutical industry. His key focus is on diabetes products. This enabled him to further his knowledge and skills in diabetes management. Thereafter he went into private practice.

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Type 1 diabetic, Gabrielle Mixon, shares the pitfalls and peaks of managing her condition in a new workplace.

Managing diabetes at your workplace can be daunting or you can use it as an opportunity to share more about your condition. I’ve always chosen the easy, take-it-in-your-stride-approach and in all honesty, that hasn’t led to outcomes that really benefited me. Sharing that I have diabetes at a new job is something I’ve battled with, however, I have become bolder over the last couple of years and with certainty I can now say the best advice is to develop these simple habits: speak, prepare, feel (SPF).

Speak

My mistake was that I did not like speaking about the fact that I am  a Type 1 diabetic. This was for a number of reasons that don’t make sense to me anymore. One reason was that I just wanted to be as normal as the next person and not draw any special attention to myself by referring to myself as a diabetic.

My lesson learnt was to speak about the chronic condition openly. Seeing as I have to live with it, I ought to live with it more openly, even in the workplace.

One of the first things is to let the HR team or person know that you have a chronic condition. Should anything happen to you while at work that information is vital to know and for the purposes of office etiquette and catering to your health requirements, conditions should be made known to HR. It also saves you a great deal of pressure if you are in a meeting and need to excuse yourself because you have a low sugar and need to treat it.

You become a floodlight into the life of a person with diabetes who makes several hundred more decisions everyday than the average person, according to research. One decision you can make to manage your diabetes in a new work environment is to speak openly about having it. Tell your team or colleagues your story and how it has impacted your lifestyle and how you got diagnosed. The only way to overcome the nerves you are feeling is to open up about it. You’ll be astounded by the support and ease that comes with opening up.

A large portion of our population are undiagnosed diabetics. So, in speaking about it you can simultaneously raise awareness and perhaps help another colleague who is undiagnosed.

Prepare

One of my mistakes: taking the previous night’s dinner for lunch. Usually I enjoy higher carb content meals at night because it sustains my blood glucose level through the night and prevents me waking up with a low blood glucose at early hours of the morning. The problem with this easy lunch is that my blood glucose and energy level suffer because of it.

My lesson: Prepare lunches that are proven to not affect my blood glucose and energy level negatively. Your well-being is of the utmost importance, as the saying goes ‘’health is your wealth’’ and you can’t be a productive worker without first taking care of yourself, diabetic or not.

A little extra time used to prepare your lunch will result in great energy and productivity at work. Plus, your successful health management will be to your benefit in adjusting to your new job more efficiently.

Feel

My mistake was that in a previous job, I got used to eating cake on every birthday and whenever there was a reason to celebrate in the office. The pressure and natural desire to belong and fit in socially was more important than the guilt I felt for having a high glucose after eating the cake.

Not only did I feel terrible physically which resulted in lower productivity but I’d emotionally beat myself up for having failed at controlling my blood glucose level. Double trouble.

My lesson is to simply get used to feeling comfortable with having the conversation with yourself about how low glucose makes you feel or how high glucose makes you feel. When you can honestly say something makes you feel bad and come to terms with the empowering belief that only you are responsible for making yourself feel otherwise, you change your behaviour, which changes everything.

No one knows the impact of the condition if they do not have it or have not experienced it before through people close to them. Still, nothing compares to actually going through it yourself. As people with diabetes we go through highs and lows, literally and figuratively.

Over the last two years, speak, prepare and feel are habits that I’ve picked up and have really begun to work for me greatly. I urge you to take what you need from this and begin applying or share it with someone.

I believe in the below affirmations more now than ever:

• It’s normal for you to feel nervous
• It’s okay to snack in meetings
• It’s okay to take time away from your work to test your glucose
• It’s okay to drink a lot of water and use the restroom. Some people need smoke breaks, others need bathroom breaks. As a person with diabetes I need the latter.
• It’s okay to take a break when you have low blood glucose and to use the time to readjust to normalcy.
• It’s okay to take a bit of time preparing a considered lunch whether at home or in the work kitchen.
• It’s okay to be different to your co-workers and have different needs.
• It’s okay to say no.
• It’s okay to say yes

With affirmations that empower you to prioritise your diabetes in your new work environment, you can thrive in your occupational spaces despite having to deal with the unexpected and unique experience that comes with being diabetic.

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Intermittent fasting has become one of the world’s most popular health and fitness trends. People are using it to lose weight, improve their health and simplify their lifestyles. But is it for everyone?