LIFE CAN BE SWEET, WITH DIABETES
Issue 17
Autumn 2016
Living (and eating!)
Low Carb (all the details)
Also - Holiday ideas that don’t cost a cent - Relaxing ways to exercise - Healthy ideas - And more!
PLUS: Understanding all about insulin
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Hello, and welcome to 2016! Here at Sweet Life, we’re very excited about the year ahead... We’re going to be focusing on the four aspects of diabetes this year: medication, diet, motivation and exercise. This issue is all about medication, so it’s full of interesting facts, the latest news and all you need to know about insulin and other diabetes medications. We want to make diabetes as understandable as possible, so that it isn’t something big and scary, but is rather a part of your everyday life...
Welcome
That’s why we interviewed Vickie de Beer, the author of “The Low Carb Solution for Diabetics” about how changing her family’s diet changed their everyday lives, and why we’ve offered you some fantastic low carb recipes - and an explanation of what exactly low carb is, with all the information and advice you need to make an informed choice. We’re also introducing a new feature this year: Just Diagnosed explains an aspect of diabetes in an easy, simple-to-understand way. This issue it’s all about how insulin works in the body. Please let me know if you have any questions or suggestions, or if you just want to chat about everyday life with diabetes... That’s what I’m here for!
EDITOR Bridget McNulty
ART DIRECTOR Mark Peddle
PUBLISHER Claire Barnardo
ADVERTISING SALES TFWcc: Tessa Fenton-Wells
CONTRIBUTORS Andrea Kirk, Carine Visagie, Charis Le Riche, Genevieve Jardine, Jeanne Berg, Joel Dave, Leanne Kiezer, Nadine Van Driel, Nicole McCreedy, Sarah Hall, Vickie de Beer, Whitney Green ADVERTISING ENQUIRIES Box 52301, Kenilworth 7745. Tel: 021 761 2840. Fax: 021 761 0442. Cell: 082 320 0014. Email: tessa@tfwcc.net
EDITORIAL ENQUIRIES PO Box 12651, Mill St, 8010. Email: info@sweetlifemag.co.za
COPYRIGHT Published by The Editors Publishing House CC. Copyright The Editors Publishing House CC. All rights reserved. Reproduction in whole or part is prohibited without prior permission of the Editor.
Chat soon,
Bridget McNulty, Editor
PS: Want to make sure you get your free copy of Sweet Life? Check out page 4 for details. The views and opinions expressed in this magazine are those of the contributors and not necessarily those of Sweet Life. Always consult a specialist before making any changes to your diet or medicine.
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Whether you want to ask and answer questions about diabetes on our blog, connect with other diabetics on Facebook, or keep in touch on Twitter, make sure you’re part of Sweet Life’s community… online. Diabetic South Africans sweet_life_mag
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Sweet Life is available at all DisChem stores nationwide! Pick up your FREE copy of Sweet Life from any Dis-Chem store in South Africa, or from your local support group or pharmacy. Find your nearest Dis-Chem store:
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Community
You can also read Sweet Life online at: www.sweetlifemag.co.za/magazine
Meet our diabetic experts: Sweet Life has a fantastic Panel of Experts who are all leaders in the field of diabetes. They give us advice on everything we publish so that you can be sure you’re only getting the very best information to help you live a happy, healthy life with diabetes. Here are the wonderful experts on our panel: ENDOCRINOLOGISTS:
Dr. Zaheer Bayat
MBBCh (Wits), FCP(SA), Cert Endo is a specialist physician and specialist endocrinologist working in Gauteng. He is the chairman of SEMDSA: the Society for Endocrinology, Metabolism and Diabetes of South Africa.
Dr. Joel Dave
MBChB PhD FCP Cert Endocrinology is a Senior Specialist in the Division of Diabetic Medicine and Endocrinology at the University of Cape Town and Groote Schuur Hospital and in private practice in Cape Town.
PROFESSORS
Timothy Noakes
MBChB, MD, DSc, FACSM, (hon) FFSEM (UK) is a Professor in the Discovery Health Chair of Exercise and Sports Science at the University of Cape Town. He is also cofounder with Morné du Plessis of the Sports Science Institute SA.
Wayne Derman
MBChB BSc (Med) (Hons) PhD is the Director of the Chronic Disease Lifestyle Rehabilitation Programme based at the UCT Sports Science Institute of SA, where he is also Professor of Sport Science and Sports Medicine.
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Ajita Ratanjee is
a registered dietician and the founder of Easy Health Wellness in Moreleta Park. Her special interest is ICU nutrition and diabetes.
Cheryl Meyer is a
registered dietician and member of the ADSA* who is passionate about diabetes and works in private practice in Bryanston.
Genevieve Jardine
is a dietician based in Durban who is registered with ADSA* and specialises in diseases of lifestyle, including diabetes.
DOCTOR
DIABETES EDUCATORS
Dr. Claudine Lee
Jeannie Berg is
is a family doctor (GP) with a passion for diabetes. She is based in Hilton, KwaZulu/ Natal and also runs an insulin pump centre.
the Chairperson of DESSA: the Diabetes Education Society of South Africa, and a registered pharmacist and diabetic educator.
SUPPORT GROUP EXPERT Jenny Russell is
Branch Manager of DSA Durban and is passionate about educating diabetics on how to lead a healthy lifestyle. She also holds the Community portfolio on the DESSA KZN committee.
PODIATRISTS
Andy Blecher is a podiatrist in Cape Town and currently runs the Western Cape Diabetic Foot Clinic with a team of other specialists.
Faaiza Paruk holds
a Bsc Dietetics (Hons) from the University of the Western Cape and is a member of ADSA*. She specialises in diseases of lifestyle. *ADSA = Association for Dietetics South Africa.
Kate Bristow is
a qualified nursing sister and certified diabetes educator who runs a Centre for Diabetes in Pietermaritzburg, KwaZulu/Natal.
Community
DIETICIANS:
OPHTHALMOLOGIST: Dr. Dale Harrison is an ophthalmologist in private practice in Cape Town, and a sessional consultant at Groote Schuur Hospital. His motto is simple: Get your eyes checked annually.
BIOKINETICISTS
Anette Thompson
M Tech Podiatry (UJ) and B Tech Podiatry (SA) is currently Chairperson of the Footwear Committee of the SA Podiatry Assoc.
Sarah Hall is a registered biokineticist BSc (Med)(HONS) in Exercise Science (Biokinetics) UCT who works for Wellness in Motion in Parkmore.
Ilona Padayachee
is a biokineticist in private practice in Port Elizabeth. She studied HMS (Human Movement Science) Hons Biokinetics at NMMU.
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Living the
Inspiring
WORDS: BRIDGET MCNULTY PHOTOS: MARK PEDDLE
When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics. We chatted to Vickie and Lucca about their journey.
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Can you tell us about Lucca’s diagnosis? When Lucca was in Grade 3, Joe took the boys on a camping trip and when they came back Lucca was really tired and didn’t feel well. His breath smelt sickly sweet, which was odd. That evening I read an article in Your Family magazine about Type 1 diabetes. In a little tip box the symptoms were jotted down: • Constant thirst • Frequent urination • Unexplained weight loss Something clicked in my brain and when Lucca took a bath that evening I saw for the first time how much weight he had lost. I suddenly knew something was seriously wrong. The next day Lucca was diagnosed with Type 1 diabetes, with a blood sugar of 23, and admitted to ICU. Right there your life changes. What inspired you to write The Low Carb Solution for Diabetics? We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We only ate low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health. The doctor always said that the next step would be to control the fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. As a result, we reduced our carb intake, but didn’t remove carbs completely from our diet. I didn’t understand how we could remove all the carbs from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbs for energy, growth and brain function and I also knew that Lucca needed
to get insulin. If we took away the carbs how would he get the insulin he needed? I still gave the children small amounts of low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar didn’t improve significantly. Looking back, I would say that we were on a moderate carb diet. A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type 1 diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has
been a Type 1 diabetic for 69 years. After reading his book, we decided to change the way we eat. How difficult was it to change the whole family to low carb? Our process was gradual: we began reducing carbs after my initial meeting with Prof Noakes so when we went “cold turkey” it wasn’t such a big change. I sat everyone down and shared everything that I learnt from my research and why these 09
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foods were making us all sick – not just Lucca. How do you suggest eating low carb on a budget? We don’t buy any cereal, biscuits, cookies, crisps, pasta, rice and juices anymore. We spend that money on vegetables and dairy! So it’s not really more expensive. I started making many of the recipes with ground sunflower seeds instead of almonds and that really helps. A big part of this diet is cooking food from scratch and knowing what goes into the food that you serve to your family. No take-away food or ready-made meals, which saves a lot of money! How does Lucca feel about being the Low Carb Superhero? Haha! I don’t think he thinks of himself like that but when I asked him this question he said, “awesome!”
breakfast (the boys love bacon!) and then did dinners – lunch was last. What advice would you offer to diabetics who are struggling? Diabetes is in the details: the best tool is to test constantly. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs! What makes your life sweet? Hugs from my boys! The fact that Lucca’s blood sugar is under control has changed our lives. Although we still test and inject diligently, the anxiety is gone. We have finally taken control of diabetes, and diabetes has lost its control over us.
Inspiring
Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating? Do it gradually. We started with
“A big part of this diet is cooking food from scratch and knowing what goes into the food that you serve to your family.”
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All you need to know about your medication – and how to store it.
Insulin is a hormone that controls the amount of glucose in the blood. It acts as the “key” that lets glucose (from food) leave the blood and enter the cells of the body.
Learning how to inject properly will make the injections as pain-free as possible
People with diabetes either do not make enough of their own insulin (Type 1 diabetes), or the insulin their body makes is not as effective as it should be (Type 2 diabetes). As a result, most people with diabetes need to take medication, in tablet form
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Long-acting insulin has a slow release and works as a basal (background) insulin for a number of hours – it is usually taken once or twice a day in addition to short-acting insulin.
There are three different kinds of insulin: short-acting, long-acting and combination.
Insulin must only be taken on prescription from a doctor, as it is essential to take the right dose (prescribed for you) at the right time.
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Storing insulin correctly is important: it should not get too hot (over 30°C) or freeze. Spare insulin should be kept in the fridge, and the pen you are using can be kept at room temperature for 1 month. Always keep insulin out of direct sunlight.
Combination insulin is a mixture of long-acting and short-acting insulin, often prescribed to Type 2 diabetics.
Short-acting insulin is taken at mealtimes to cover the glucose released from the food that is being eaten.
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Healthy Living
10 Fast Facts About Insulin
While it is often possible to control Type 2 diabetes with diet and exercise at first, eventually insulin will be necessary for most people with Type 2, as diabetes is a progressive condition.
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Ask the expert: Dr Claudine Lee, GP “Insulin is a life-saving but dangerous hormone that deserves respect and should be dosed with precaution and precision. Testing is critical to make
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What if diabetes took less space in your life? MyStarCare® is a diabetes support service that offers individualized support to assist you on your diabetes journey. This enables you to better selfmanage your diabetes.
How does the programme work? The MyStarCare® Support Journey is simple, and effective: Week 1: You’ll meet your team leader for a chat about your diabetes and your insulin use. We give you a starter pack and talk about any concerns or worries you might have. Week 4/ 8 / 16 / 24: Your team leader phones you to ask how you are – how you’re adapting to your insulin and if you have any questions or anything you want to discuss. Your team leader can then report back to
your doctor with any relevant details, so that you’re all working together for the best possible care. Who are the team leaders? Our team leaders are here to support you. Plain and simple. The Sanofi MyStarCare® patient support programme is here to support patients on Sanofi insulins with all aspects relating to diabetes and diabetes management. Whether you need help with medication doses, testing or motivation, we’re here to help.
Ask your doctor about joining the Sanofi MyStarCare® programme today if you are on a Sanofi insulin
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ADVERTORIAL
Meet
We’ll introduce the other team leaders in each issue of Sweet Life this year!
Leonie Kruger
Diabetes Nurse Educator and Team Leader
>
What is the My Star programme? The My Star programme is a patient support program. Doctors refer patients to us when they decide it is time for the patient to start with one of our insulins. The patient then receives a personailised, face-to-face educational session along with a starter pack, and after this the doctor is sent a feedback report. After that, we follow up with the patient telephonically for 6 months. What is your favourite part of the programme? I love staying in contact with my patients and keeping track of their progress. What advice would you give someone who is nervous about starting insulin for the first time? I think the one-on-one education session is very important here: an informed patient will be more comfortable with insulin because they understand the importance of insulin in their diabetes management, and more knowledge brings acceptance and confidence to use insulin.
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If you live in Gauteng North, Nelspruit, Polokwane, Secunda or Ermelo, Leonie Kruger is the person who’ll be helping you with your diabetes management. Are there any practical insulin tips you can share? • It is so important to follow your insulin regimen: do not miss any doses of insulin. • Understand your insulin and how it works. Know the purpose and know how to take it, including the best time to take it. • Make sure you store your insulin correctly. • Change the needle regularly. • Monitor your blood sugar regularly. • Know what to do when your blood sugar is not at your goal. • Understand what to do in an emergency. How would you motivate a diabetic who is struggling with blood sugar control? Diabetes is never just smooth sailing: let’s go back to basics, then knowledge is power! The more you know, the better you can control your diabetes. If you test regularly you will know what you are dealing with and can fix it before it is totally out of control.
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All About Insulin
Special Feature
There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. WORDS: ANDREA KIRK
“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.” For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity. “There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.” Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is
a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.” Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blamefilled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.” The approach is now much more positive. Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.
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Are there any benefits to starting insulin sooner? “In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”
“Diabetes is a progressive condition and insulin therapy is inevitable.” 15
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“Insulin is a biological medication, also known as a biologic. Biologics are made from living organisms. Insulin is made using human DNA injected into a bacteria cell.�
New insulin medications available If you are already on insulin, you can expect to see some changes in the medications available this year. The patent on insulin glargine (Lantus) has expired, which means other pharmaceutical companies are now able to produce similar drugs.
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In the case of insulin, however, things work a little differently. This is because insulin is a biological medication, also known as a biologic. Biologics are made from living organisms, such as bacteria, yeast, fungi, and cells of plants and animals. Insulin was one of the first biologics available and was originally made from cow and pig pancreases. Today, it is made using human DNA that is injected into a bacteria cell. Biologics differ from other medicines in that their molecular structure is large and highly complex. This makes it difficult for other companies to produce perfectly identical copies (i.e. generics) of the original drug. Instead, when the patent for a biologic expires, other companies can produce new medications that are very similar, but not identical to the original. These are called biosimilars. According to Dr Dave, we can expect to see a biosimilar of Lantus on the market in 2016. Unlike generics, biologics and
biosimilars are not considered interchangeable (by law). This means your pharmacist will not be able to offer you the biosimilar version of the medication your doctor prescribed – even if it is almost identical, and cheaper. Be sure to talk to your doctor about the options available to you and get the right prescription. According to Dr Dave, we can also expect to see a clone of Lantus on the market in 2016. A clone is a biologic medication made by the same company that made the original and it is chemically identical. It is essentially the same product that gets registered under a different brand name when the patent on the original expires.
“Unlike generics, biologics and biosimilars are not considered interchangeable (by law). Biologics and clones are.” In time, other insulin patents will expire and more biosimilars and clones will become available. It may well be best for you to stay on exactly the medication you’re on right now, but talk to your doctor about the options available. There could be a new product that’s better suited to your needs, or a cheaper one that works just as well.
Special Feature
Usually, when a patent expires on a medication, other companies are able to produce generics, which are chemically identical to the original product. If your doctor prescribes Voltaren, for example, your pharmacist can offer you Panamor instead, which is a chemically identical, generic form of Voltaren. The generic is usually cheaper than the original brand and equally effective.
It’s also possible that your medical aid scheme may make some changes to which medications they cover if cheaper alternatives become available. Speak to your doctor about the best option for you. 17
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Relaxing Body and Mind Workouts Most of us have some stress in our lives. In the hustle and bustle of daily life, stress is hard to avoid... Especially when you add diabetes to the mix! Here’s how to use exercise to unwind.
Work It Out
WORDS: NICOLE MCCREEDY
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Yoga
Stress is your body’s way of coping with short-term danger – it’s your “fight or flight” response to what you see as a threat. When you’re stressed, your blood sugar levels rise. Stress hormones like epinephrine and cortisol kick in since one of their major functions is to raise blood sugar to help boost energy when it’s needed most. Exercise has been proven to lower stress and blood sugar levels. But if the thought of gym stresses you out, why not try one of these gentle ways to restore your energy levels?
Tai Chi This form of exercise uses slow, smooth body movements to relax the mind and body. Originally developed in 13th-century China, Tai Chi is practised today by many people worldwide. Studies have found that regular practice of Tai Chi is linked to improved blood sugar control. In older people, benefits also include reduced stress, improved balance and general mobility, and increased muscle strength in the legs.
Qi Gong Qi Gong is also an ancient Chinese art form. “Qi” refers to life energy, and the purpose of Qi Gong is to enrich the spirit and promote healing, health, and awareness through visualisation, breathing techniques, and repetition of specific energy flowing movements. Unlike Tai Chi, where there is series of movements, in Qi Gong the focus is on the repetition of one movement at a time.
Yoga is an ancient practice that originated in India, and includes a series of postures that help to build flexibility, balance, and strength, and promote wellbeing. Yoga improves muscle mass, which improves blood sugar levels. There are different styles of yoga, including hatha, ashtanga, iyengar, and many more: find the one that suits you best.
NIA The NIA technique blends martial arts, dance, and healing arts. This workout has a flowing blend of movement that combines deep breathing exercises with moves like kicks and turns to keep your heart rate elevated, your mind relaxed, and your body moving.
Pilates In Pilates, the emphasis is on spinal and pelvic alignment. By focusing on the breath during each fluid, gentle movement using your own body weight, Pilates encourages oxygen flow to the muscles to help develop a strong core or centre, and improve co-ordination and balance. No muscle group is under or over trained. Pilates’ flexible system allows for exercises to be modified from beginning to advanced levels of fitness.
Each of these forms of exercise are usually led by a trained instructor in group classes. Try to include a weekly class where possible, to keep your body – and mind! – in good shape. 19
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Ask the expert: Sarah Hall, Biokineticist
Work It Out
Positive benefits for your health The definition of exercise is, “an activity requiring physical effort carried out to sustain health”. Therefore any continuous movement that takes on an art form such as yoga, tai chi and NIA can be counted as exactly that: good quality exercise. Not only are these exercises relaxing in that they are a great way to centre the body and mind, but they will also improve your flexibility, endurance, strength, and cardiovascular health. Each one of these exercise types increases the heart rate, and – through movement – increases body temperature, circulation, muscle endurance and muscle strength.
If you have diabetes, you should 1.Monitor your blood sugar (test with a glucose monitor) before exercise, during exercise (if it’s for a long time) and after exercise. 2.Carry a source of glucose (something sweet) with you during exercise. 3.Start slowly. 4.Stop exercising if your blood sugar drops below 4mmol/L (again test with a glucose monitor) or if you develop any symptoms such as pain, dizziness and shortness of breath. - Dr Joel Dave, Endocrinologist
Ask the expert: Dr Joel Dave, Endocrinologist Regular exercise is an important part of the management of Type 1 and Type 2 diabetes. Unfortunately, there is not a single exercise “prescription” that fits all, and each person should discuss their individual exercise programme with their healthcare provider. This is important as exercise can affect the absorption of insulin, the metabolism of medications, and blood sugar levels. In addition, certain exercises should be avoided if you have specific diabetes complications.
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“Having diabetes doesn’t make me different. But having my Dis-Chem Clinic on my side makes all the difference.” Diabetes Type 2 sufferer
When I was diagnosed with diabetes,
I thought my whole life would change for
the worst, and I’d never be ‘normal’ again!
However, thanks to my Dis-Chem
Clinic Sister, I realised that with the
right diet and lifestyle changes,
a suitable exercise programme,
regular blood glucose monitoring and medication management, diabetes doesn’t rule my life. I do. If you suffer from diabetes,
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Clinic Call Centre 0861 117 427 Customer Careline 0860 347 243 careline@dischem.co.za www.dischem.co.za GO Advertsing 74654
“Remember, having diabetes doesn’t make you any different.”
“You’re not alone with diabetes. Dis-Chem supports you all the way.” Dis-Chem’s commitment to specific diabetes care goes beyond vitamins, supplements, monitoring aids, prescribed medication and specialised foodstuffs at our legendary low prices. In every Dis-Chem countrywide, our clinics are run by nursing practitioners with specialised diabetes training. Professional, qualified people who care, who’ll assist you with every aspect of diabetes and help make living with it easier. Including: 1. Lifestyle guidance and advice 2. Nutrition advice 3. Medicine management 4. Exercise programmes 5. Blood glucose measurement and management 6. Glycated haemoglobin (HbA1c) testing which reveals your average blood sugar level over weeks/months 7. Easy, convenient access to all your medication, devices, supplements and special foodstuffs under one roof 8. Free chronic medication and prescription delivery 9. Earn Benefit points on every purchase to redeem as cash on future visits 10. Only at Dis-Chem
Dis-Chem is a partner of the Centre for Diabetes and Endocrinology
Ask the expert:
Ask the Dietician
Genevieve Jardine
The Carbs-Fat-Protein Debate “I don’t understand the whole ‘low carbs high fat or high protein’ idea – how do carbs, fat and protein work together? Is there a happy middle ground, or does it need to be all or nothing?”
Wessel Jones
To understand what all the fuss is about, we need to look at the history of diabetes treatment. Treating diabetes (both Type 1 and Type 2) by lowering carbohydrates (carbs) has come and gone out of fashion over the last century. This debate is not a new one and it is probably not going to go away. Before the invention of insulin, the only way for a diabetic to survive was to cut out the foods (carbs) affecting blood glucose. With the advent of insulin, the focus switched from lowering carbs to lowering fat to help reduce heart disease. Fast forward a couple of decades and we can see that we have failed in reducing obesity, diabetes or heart disease. It’s not as simple as just diet: it’s about physical activity, stress, diet and environment.
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What is quite simple is that carbs cause blood sugar to rise and the more carbs you eat, the higher the blood sugar goes. If a person wants to control their blood sugar, it’s a very good idea to reduce carbs. The big question is: how low do you go? A “low carbohydrate diet” can have anything from 20g to 130g of carbohydrate per day. The amount of carbs depends on the individual, their control, their medication and their weight. There is a growing amount of scientific evidence that low carb diets improve glucose control and help with weight loss.
Where do fat and protein fit in?
When carbs are cut, the amount of protein or fat (or both) go up. And this is where the debate heats up. The concern is not the low carb, but the increase in saturated fat or fat in general. Remember that not all fat is the enemy and there are good fats that play a very important role in the body.
Remember! One portion of carb (a medium apple, a slice of bread) = 15g carb
“The most important goal is to increase your vegetable intake and try to eat as close to nature as possible. Eat foods in their most original form.”
A benefit of protein and fat is that in the immediate, they do not cause the same spikes in blood sugar. When you lower carb intake you have an immediate blood sugar lowering effect. When this happens, and you have fewer spikes and dips in blood sugar, your appetite is better controlled. The fuller you feel, the less likely you are to snack and the fewer kilojoules you consume. The fewer kilojoules you consume, the more likely you are to lose weight. The problem with the low carb approach is that, like everything else, it needs to be a lifestyle. When you add carbs back into your diet you will put on weight, especially if you have increased your fat and/or protein. You can’t have it all: full fat products and also carbs. The most important goal is to increase your vegetable intake and try to eat as close to nature as possible. Eat foods in their most original form.
Ask the Dietician
How do carbs work in the body?
When it comes to deciding on the right ratio of carbs : fat : protein, work with a dietician. It may take time to find your correct balance and you need to be monitored properly with blood tests and possible medication adjustments. 25
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Low Carb Inspiration If there’s one issue that diabetics want to understand better, it’s low carb. RECIPES: VICKIE DE BEER / PnP PHOTOS: SUPPLIED / iSTOCK
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We also asked for some helpful advice and great recipes from Pick n Pay’s dietician, Leanne Kiezer, who believes in a balanced approach to carb, fat and protein intake.
Food
That’s why we’ve interviewed Vickie de Beer, author of “The Low Carb Solution for Diabetics” in this issue, and why we’re sharing two of her delicious recipes with you.
As with anything in life, it’s up to you to decide – with the help of your medical team – what works best for you. Enjoy!
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Food 28
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Original recipe as found in "The Low Carb Solution For Diabetics"
Almond & Yoghurt Flapjacks energy
protein
fat
carb
350kJ
13g
31g
5g
Serves: 4 (as a snack)
2 cups ground almonds Pinch of salt ½t baking powder ½t ground cinnamon 4 eggs 2t xylitol ½ cup plain yoghurt Butter for frying
Method: Mix all the dry ingredients together in a large bowl. Combine the eggs, xylitol and yoghurt in the bowl of an electric mixer and beat together. Add the dry ingredients to the wet ingredients and mix through. Melt butter in a non-stick frying pan over a medium heat and drop large tablespoons of the batter in the pan. Fry until bubbles appear on the surface and turn over. Fry for another few minutes until golden and cooked. Serve with extra yoghurt and fresh berries.
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Joe’s Best Beef Braai Burgers We make double the quantity and keep the surplus for school lunches. Joe braais the patties on the Weber – they are really delicious and the kids will not eat them any other way. We eat the burgers on big grilled black mushrooms or slices of pan-fried aubergine. The kids love the low carb buns. energy
protein
fat
carb
187kJ
18g
12g
1g
For the patties: 2 eggs
½ cup full cream yoghurt with a dash of full cream milk 2t mustard powder 2t chopped garlic Grated zest of 1 lemon 1T ground psyllium husks 2kg topside beef mince 1 disk of feta cheese, crumbled finely Salt and freshly ground black pepper 4T olive oil
Method: Prepare medium-hot coals in a Weber or in a normal braai. In a small bowl, mix the eggs, yoghurt and milk with a fork until completely soft. Add the mustard powder, garlic, lemon zest and psyllium husks. In a big mixing bowl, combine the mince and yoghurt mixture. Add the feta cheese, season with salt and pepper and mix through thoroughly with your hands. Shape the mince into tennis ball-sized balls and press flat with the palm of your hand to form a patty. Rub each patty all over with olive oil before placing it over the fire. Grill for 8 minutes on one side before carefully turning with a spatula. If they stick to the grill, wait a bit longer before turning. Serve the patties as is with salad, or as a burger on grilled mushrooms or the Most Amazing Low Carb Buns with fresh tomatoes, red onion, baby spinach leaves and dollops of Chunky Guacamole.
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Food
Original recipe as found in "The Low Carb Solution For Diabetics"
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Baked Fish with Tomato and Olive Sauce and Baby Marrow “Spaghetti”
Serves: 4 3T olive oil cooking spray 3 cloves garlic, crushed 10 calamata olives, depipped 1 cup cocktail tomatoes 1 can chopped tomatoes 1T white balsamic vinegar 1 pinch salt 4 sustainable white fish fillets (like hake) 5 baby marrows 60ml basil leaves, torn
Method: Preheat oven to 200ºC. Mix olive oil, garlic, olives, tomatoes and vinegar in a roasting pan. Season and roast for 10 minutes. Add fish and bake for another 8 to 12 minutes, depending on thickness of fish, until cooked through. Grate baby marrows into “spaghetti” using va fine grater. Add basil and a dash of your favourite vinaigrette, toss together and serve with fish.
Top tip:
Baby marrow spaghetti encourages your intake of an extra veggie serving! This meal could also be paired with some brown or wild rice.
Health hotline
0800 11 22 88 healthhotline@pnp.co.za
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Serves: 4 1 dash celery salt and milled pepper 800g lamb goulash 1t canola oil 1 onion, finely chopped 1 knob ginger, finely chopped 90g rogan josh curry paste 4 tomatoes, chopped 1 cup water 1 cup low-fat Greek yoghurt 1 squeeze lime juice 1 handful coriander, chopped
ROTIS: 500g cauliflower florets 2 large eggs, beaten 60ml psyllium husks 40ml coconut flour 1 pinch salt 1t dried mint
Food
Lamb Curry with Cauliflower Rotis
Method: Season lamb and brown in oil. Remove and set aside. Cook onion, garlic and ginger until soft. Add curry paste and return meat to pan. Mix to coat. Toss in tomatoes and cook until they begin to break up. Add water, cover and simmer until tender (adding a little more water if necessary) – about 45 minutes to 1 hour. Stir through yoghurt, lime juice and coriander before serving. ROTIS: Purée cauliflower until smooth. Mix with eggs, psyllium husks, coconut flour, salt and mint. Cut into 8 pieces and roll out into rotis about 3mm thick. Shallow fry in a hot pan until golden. Serve with curry
Top tip:
Using cauliflower as a base ingredient for your rotis provides a high fibre, nutrient dense alternative to regular flour 33 39
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Fishcakes with Butternut Chips and Salad
Serves: 4 500g hake, uncooked 100g smoked salmon, finely chopped ½ bunch spring onions, finely chopped 50g ground almonds 1 dash salt and milled pepper 1 large butternut, peeled and cut into strips 1 glug olive oil 1 bowl salad, for serving 1 handful lemon wedges, for serving COATING ½ cup coconut flour 2 eggs, beaten 500g fine desiccated coconut
SAUCE ½ cup crème fraiche 3T freshly grated horseradish 1 squeeze lemon juice 2T baby capers
Method: Preheat oven to 200°C. Place fishcake ingredients into food processor and pulse until roughly chopped. Season with salt and pepper. Using wet hands, shape into patties, then dust in coconut flour. Dip in egg and coat in coconut. Toss butternut in a glug of oil and season. Roast for 15-20 minutes until golden. Shallow fry fishcakes in a glug of oil until golden, then roast until cooked through. Drain on kitchen paper. Mix sauce ingredients together and serve with fish, butternut chips, salad and lemon wedges.
Top tip:
Butternut chips provide a colourful alternative to potatoes – and they’re rich in vitamin A.
Health hotline
0800 11 22 88 healthhotline@pnp.co.za
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At Pick n Pay, we ensure that our advice and communication to the public is consistent with the latest nutrition and health research. Dietary recommendations for health have been published and are regularly updated by the World Health Organization, USA and Canada (Institute of Medicine, Food and Nutrition Board), Europe (the European Food Safety Authority), the Nordic countries (National Food Safety Agency) and Australia and New Zealand (Australian and New Zealand Ministries of Health), as well as the accredited Dietetic and Nutrition associations from each of these countries. These bodies consider the totality of available evidence to make conclusions about dietary guidelines for public health, and our communication and advice is consistent with their opinion.
Within the South African context, these recommendations have been translated to the Food- The Food-Based Dietary Guidelines for South Africa are: Based Dietary Guidelines • Enjoy a variety of foods. published by our National • Make starchy foods part of Department of Health. These guidelines are designed to promote health among the general public, but it is best for you to consult with a private practicing dietician to get individualised advice specific to your needs. To find a dietician practicing in your area, look on www.adsa.org.za Pick n Pay offers a wide range of products to suit a variety of people and their individual needs. Our gluten-free, lactose-free, vegetarian and low-fat product ranges are examples of how we cater for specific needs. Pick n Pay also sells products which can be included as part of a typical carb-controlled eating plan for customers who choose to follow these diets: free-range meat, fish, eggs, vegetables and nuts, as well as nut butter, nut oil, and a wide range of organic products.
most meals.
• Eat plenty of vegetables and fruit every day. • Eat dry beans, split peas, lentils and soya regularly. • Have milk, maas or yoghurt every day. • Fish, chicken, lean meat or eggs can be eaten daily. • Use fats sparingly. Choose vegetable oils, rather than hard fats. • Use sugar and foods and drinks high in sugar sparingly.
Nutrition Advice
Pick n Pay’s Nutrition Advice for Health
• Use salt and food high in salt sparingly. • Drink lots of clean, safe water. • Be active!
Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs the services of a registered dietician, Leanne Kiezer, to provide food and nutrition-related advice to the public. For your nutrition and health-related queries, contact >> healthhotline@pnp.co.za >> Toll free on 0800 11 22 88
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Budget Beaters You don’t have to pay a fortune to entertain the family this Easter holiday. Enjoy the long Easter weekend (25th to 28th March) with this list of freebies around SA. WORDS: CHARIS LE RICHE
Cape Town
March is probably the best time to be in the Mother City, as it’s not too hot and the infamous Cape Doctor wind has eased up. Here are some great things to do in Cape Town for free. STORY TIME It might not be an older child’s cup of tea, but every Saturday at 11am Cape Town’s favourite bookshop – the Book Lounge on Roeland Street – hosts story time for the kids. There’s also a fabulous upstairs room for adults to browse while the kids are entertained. Roeland St, Cape Town City Centre GLEN BEACH Just north of the über popular Camps Bay Beach lies the family-friendly Glen Beach. This lovely spot is usually free from crowds which makes it excellent for families who want to let their little ones run around. Camps Bay, Cape Town BAY HARBOUR MARKET Open Friday nights, Saturdays and Sundays, the Bay Harbour Market in Hout Bay offers a wealth of entertainment with live music and activities for the kids. 31 Harbour Road, Hout Bay
Joburg
In the city of gold, you might expect to pay a pretty penny to do anything… Here are some fabulous things to do for free. FEED THE DUCKS AT ZOO LAKE With plenty of picnic spots and paved trails for bikes (especially ones with training wheels), it’s no wonder this is a regular spot for locals. Zoo Lake Park, 1 Prince of Wales Drive, Parkview TAKE IN THE VIEW The second-highest point in Johannesburg, Northcliff Hill – or Aasvoëls Kop as it is also known – is the perfect spot to enjoy the sunset with some
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EXPERIENCE HISTORY AT WALTER SISULU SQUARE The spot where the freedom charter was signed, Walter Sisulu Square in the heart of Soweto is home to stunning stores, restaurants and plenty of events, all year long. Corner of Klipspruit Valley Road and Union Road, Kliptown, Soweto.
Durban
With its year-round tropical weather and glorious beaches, Durban is a popular holiday destination for locals and tourists alike and has plenty to do that won’t cost you. BROADEN YOUR MIND Chatsworth is known not only for its rich heritage but also as home to the Sri Sri Radha Radhanath Temple of Understanding – a stunning piece of architecture surrounded by tranquil gardens and with a superb vegetarian
restaurant that no one should miss. 50 Bhaktivedanta Swami Circle, Chatsworth
Lifestyle
bubbly for adults and apple juice for the kids. Don’t forget your camera to catch the amazing 360° view… Off Lucky Ave, Northcliff
EMBRACE THE ORIENTAL One of the must-see places in Durban (and there are many!) has to be the Japanese Gardens on Tinsley Road in Durban North. This is a lovely spot for a family picnic as you enjoy the fresh air, flower blossoms and bamboo reeds. Tinsley Road, Durban North A PARK FOR THE PEOPLE No trip to Durban is complete without a visit to the People’s Park at Moses Mabhida Stadium. Not only is it equipped with a kids’ play area and some amazing views of the actual stadium, but on the first Saturday of the month it plays host to the proudly local I Heart Market. 44 Isaiah Ntshangase Rd, Durban
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Partner’s Corner This is your space…
“M
y teenage son doesn’t want to take his insulin. He rebels against it as if it’s something only I want him to do, not something he needs to keep him alive. What can I do?”
Partners
Jesca Ncube
Dear Jesca, Even the brightest and smartest teens have a hard time dealing with the day-to-day demands of diabetes. Having diabetes is often the one thing that trips them up. Their freedom feels compromised. They are constantly asked about their blood sugar and as a result some lie about testing and taking shots: they suddenly experience a sort of “freedom” by lying and getting away with it. A wake-up call is usually when they land up in hospital. Most diabetics are prepared to do something to prevent that from happening again. Because we live in a fast-moving world, today’s teens have little time for themselves. Many teens are stressed, tired, and often have difficulty keeping up with the things they want to do, never mind the
things they don’t want to do. Teens are risk-takers and struggling for independence – within this struggle, taking care of their diabetes is definitely not a priority. So to answer your question: The most important thing is to stay involved. Try and coach your teen into some kind of “contract” regarding his insulin. Encourage him and make him accountable. Ask him what is helpful for you to do and what is not. Listen carefully. Find a healthcare provider he likes and let him be educated about the optimal treatment and the latest technology. Get him to meet up with other teens with diabetes. This is the difficult part: you as a parent know the importance of insulin in your teen’s life. Try to explain it to him and ask him to work with you.
Ask the expert: Jeanne Berg, Diabetes Educator “Most teens who have periods of giving up on their diabetes care eventually mature and start to do better again.”
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Each issue, we introduce you to one of the inspiring organisations we’ve partnered with to give back to the community. Here’s how you can get involved! What is Ithemba Labantwana Children’s Home?
Ithemba Labantwana is a home for orphans and vulnerable children in Khayelitsha. Ntombi, an ambitious and resourceful foster-care mother, decided that if the state kept bringing her more children than they were willing to help her with financially, she wouldn’t turn them away and would do all she could to equip her home to look after so many.
What do they do?
Aside from fostering the children, Ithemba Labantwana organises field trips and events for the kids. We believe these trips are a great way to show the kids a good time and see the city they live in. Modern technology allows me (Whitney) to be anywhere. Ntombi, however,
Charity
Sweet Life Gives Back
is day in and day out at the shack in Khayelitsha: feeding, bathing and loving the 13 children that are currently in her care. Deciding to invest time and energy into her and her kids was easy after spending time with the children and seeing the loving family unit that has been created there.
How can you get involved?
We are currently saving up to build Ntombi a container home. We run a few fundraising events throughout the year: details can be found on our Facebook group. We also want to source an after-school tutor to help the kids with their English. Get in touch with Ithemba Labantwana by emailing Whitney Green on whitneyanngreen@gmail.com or search for Ithemba Labantwana Children’s Home on Facebook. 39
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How Insulin Works in the Body Insulin is a hormone that helps to regulate glucose (sugar) levels in your blood. It does this by stimulating your body’s cells to use glucose for energy. Without insulin, you won’t be able to survive. Here’s how insulin works in the body.
Just Diagnosed
WORDS: CARINE VISAGIE
1 When you eat, food travels through your digestive system where it gets broken down into nutrients. In the stomach and small intestines, the protein, fat and carbohydrates in food are transformed into glucose. This is then released into your bloodstream.
2 For most people, this increase in blood glucose levels immediately triggers a response in a large gland called the pancreas. Just enough insulin is produced to stimulate your body’s cells, helping them to use the glucose from the meal. In other words, insulin acts as a “key” to unlock your cells, allowing the glucose to enter.
3 When glucose successfully enters
your cells, it’s either used immediately as energy to help the cells function, or stored for later use. Your liver and fat cells store excess glucose to use when your blood sugar levels are low (for example, when you’re sleeping, fasting or working out).
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4
5
If you have diabetes, your
pancreas either produces too little insulin to clear your bloodstream of excess glucose after a meal, or the insulin it produces doesn’t work as well as it should: it fails to properly unlock your cells to allow glucose to enter (this is called “insulin resistance”). Type 2 diabetics can have either or both of these problems.
By helping your cells take up glucose, insulin lowers
the glucose levels in your blood. This is important, as too much glucose in your blood can lead to organ damage. If you have Type 1 diabetes, your pancreas produces very little or no insulin – so you have to regularly inject insulin, or else glucose will build up and eventually cause severe damage.
6 If you have diabetes, it’s
7
important to tightly control your blood glucose levels by eating small, healthy, regular meals, exercising, and taking your insulin exactly as prescribed. Remember to check your blood sugar regularly and to keep consulting with your medical team.
Ketoacidosis is a dangerous condition that can lead to a coma
if left untreated. If your body can’t get the energy it needs from glucose (because it isn’t getting insulin), it will start breaking down fat. This process releases ketones into your bloodstream, making it acidic and leading to ketoacidosis. 41
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“A good laugh and a long sleep are the best cures in the doctor’s book.”
Last Word
Irish Proverb
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