Diabetes
 

Many South Africans have diabetes, but a large number remain undiagnosed. World Diabetes Awareness Day, which is the 14^th November, was created as an effort to educate the public about this disease and to inform those with diabetes about the resources available to them.

What is Diabetes:

Diabetes (or sugar sickness) is a condition of the body, where sugar is not used correctly to provide energy for living and growing. You develop diabetes when your body doesn’t produce enough insulin. Without insulin your body cannot get the energy it needs from your food. Normally, a gland called the pancreas makes insulin which carries the sugar in the blood into the cells. In diabetes, the pancreas fails to supply enough insulin, or the insulin doesn't work properly.

There are two major types of diabetes: Type I, commonly called juvenile diabetes, and Type II, commonly called adult on-set diabetes. Both have similar symptoms but very different causes.

 Type I diabetes, usually diagnosed in childhood, is a disease whereby the body's own immune system attacks and kills the cells in the pancreas which produce insulin, leaving a person's body without insulin, and unable to regulate its blood sugar levels.

Type II diabetes is a disease that results when the body's cells become resistant to insulin. In Type II diabetes, unlike in Type I, insulin is still produced by the body; it just isn't used correctly.

How would I feel or know if I have Diabetes?

Although there may be no obvious symptoms and some people have no symptoms, the following are common:

• Always thirsty
• Always tired
• Frequent urination
• Unexplained weight loss
• Itching
• Changes of vision (blurry)
• Slow healing cuts and bruises
• Numbness in hands and feet

These are all results of the body's inability to transport sugar (energy) from the bloodstream to the body cells.

Who is at risk?

Anyone, anywhere, at any age can get diabetes. Being overweight and having a family history of diabetes increase the risk. ive

How is diabetes treated?

Depending on the type and severity of the diabetes, either:

• with diet plus exercise,
• or diet, exercise and medication.

Medication may be insulin or tablets, or both.

The good news is that having diabetes does not mean the end of a normal healthy life. You need to accept that you have the condition and then learn how to manage it.

Management and control of blood sugar is very important as it prevents or reduces the risk of developing the complications of the disease. The abnormally high blood sugar levels (hyperglycemia), can cause kidney, eye, heart, blood vessel, and other diseases. Without proper management it can lead to heart and kidney disease, blindness and amputation

The Role of Food:

A healthy diet is the foundation for good blood sugar control in any type of diabetes. Whether you are being treated with insulin or tablets, you still need to follow a sensible diet.

The so-called "diabetic diet" is not in fact a diet, but rather a healthy eating plan which can, and should be followed by the whole family.

Keeping to a healthy food intake not only controls blood glucose levels (and so delays the onset of diabetic complications) but also helps to maintain body weight and prevent heart disease.

Ten important points to remember:

1. Eat regular meals (breakfast, lunch and supper), which contain different kinds of foods. Your diet doesn’t have to be boring by only including boiled foods – use herbs & spices, try different ways of cooking and different kinds of foods.

2. Make starchy foods the basis of your meals.
3. Eat less fat.
4. Chicken, fish, lean meat, and low fat dairy foods could be eaten daily.
5. Eat more fibre such as vegetables & fruit with skin and wholegrain foods.
6. Eat dry or tinned beans, peas, lentils and soya (pulses) at least twice a week.
7. Be active and control your weight.
8. Eat less salt and salty foods.
9. Drink as much safe water as you can throughout the day (6-8 glasses).
10. If you drink alcohol, drink sensibly.
11. Make Strachy Foods the Basis of your meals

There are two types of carbohydrate:

• Starchy foods
• Sweet foods

The best starchy foods to choose are those high in fibre as they are digested slowly making it easier for your body to control your blood glucose. Try to choose high fibre foods more often e.g. high bran cereals, porridge, brown or wholegrain bread, rice, dried or baked beans, samp and beans, potatoes, roti made with brown or wholegrain flour, phutu, lentils, oats and mealie meal, vegetables and fruit with skin.

• Include a starchy food with each meal
   
• Starches by themselves do not make you gain weight or worsen your diabetes especially those rich in fibre.
   
• However, be careful of having large amounts of starches in one meal (e.g. potato curry and rice).

Sweet foods
Sweet foods are quickly taken up by your body and cause blood glucose to rise very quickly. The best food choices of sweetened foods are those which have lots of fibre in them such as bran muffins.

However, if you are going to eat sweet foods, try to eat them seldomly and in small amounts, then have them with a high fibre meal rather than alone. E.g. plain cake following a meal rather than as a snack.

Use less fat and salt

Too many high fat foods can result in weight gain and make your diabetes more difficult to control. They can also increase your risk of heart disease. Fats are in your food as:

Visible fat (fats you can see) such as:
Cooking oil, dripping, ghee, butter, margarine, fat on meat, skin on chicken.

Hidden fat (fats you cannot see) such as:

Full cream milk/ maas, coffee creamer, full cream yoghurt, ice-cream, potato crisps, hot chips, pastry, sweets, chocolate and cream filled biscuits, chocolate, samoosas, sweetmeats, bhajias, pies, rich sauces, meat and meat products (wors, burgers, polony, processed meats, fried foods such as chicken, eggs and fish).

Having too much salt in the diet is linked with high blood pressure. Salt is commonly used to add flavour to foods and can come in the form of table salt, soup and gravy powders, stock cubes and seasoning. Many people use too much of these foods when they are cooking.

To use less salt but still keep a great taste make use of herbs, curry powder, ginger, garlic, onions, peppers and tomatoes. Some foods are also high in salt such as biltong, snoek, pickled fish, salted nuts, salted popcorn and chips. These foods can still be part of a healthy diet if they are eaten in small amounts and not too often.

Eat plenty of fruit and vegetables everyday
• All types of fruit and vegetables are good for you and can be eaten in a healthy diet (preferably with their skin on).
• Try to eat a variety of fruit and vegetables every day.
• 3 pieces of fresh fruit can be eaten every day (each the size of a tennis ball). Spread fruit intake throughout the day in different meals/ snacks.
• Frozen vegetables are as good as fresh vegetables.
• Add extra vegetables to recipes such as stews, curries or pasta dishes.
• Do not overcook your vegetables otherwise the vitamins will be lost.
• Fruit tinned in syrup, dried fruits and dried fruit roll may be eaten in small amounts as part of a high fibre meal.

The motto is to " strive for five" – 3 vegetables and 2 fruits a day. This can be managed by for example having a banana as a snack, salad and an apple with your lunch and 2 vegetables with your supper.

Eat Beans, Lentils, Peas and Soya Regularly

• Eat dry or tinned beans, lentils, peas and soya regularly (at least once a week) as they are high in protein and fibre and low in fat.
• Replace or stretch meat dishes with beans, lentils, peas and soya.
• Cut down on the cooking time needed for dried beans, lentils and peas by soaking them in water overnight.

Chicken, Fish, Lean Meat and Low Fat Milk/Maas could be eaten daily

• Lean meat/ skinless chicken/ fresh or tinned fish/ egg (max. 4 per week) and low fat milk/ maas may be eaten every day.
• Cut off the fat you can see on the meat and take the skin off the chicken before cooking.
• Eat fish at least once a week, either tinned in tomatoes or water, or fresh/ frozen (plain) fish if available. Try not to have fried fish or fish tinned in oil.

Cooking Methods and the best food choices

• If you need to have a snack choose raw vegetables, fruit, or high fibre biscuits. Try not to have high fat snacks such those mentioned in the hidden fat section.
• Choose other methods of cooking like baking, steaming, microwaving, grilling, stewing, braaing or boiling instead of frying food.
• Use less oil for cooking by measuring out the oil needed for a stew or curry. Use 1 teaspoon of oil per person in the family. E.g. curry/ stew for 6 people will need 6 teaspoons of oil.
• Use skimmed/fat free/ diet or low fat milk/ maas plain or fruit yoghurt, low fat cheese.
• Use tub margarine instead of brick margarine. Spread less margarine on your bread (you should still be able to see the bread).
• When making sandwiches you may use a fat reduced mayonnaise or salad cream instead or margarine

What can I drink?

• Hot and cold drinks
• Water is the best drink for health. Don’t wait until you are thirsty. Drink at least 6-8 cups of water a day.
• "Diet" or "sugar free" drinks are good choices for the whole family and may be drunk in moderation.
• Fresh fruit juice and sweetened juice are good when then are diluted with water as otherwise they are a very concentrated form of sugar.
• Sugar free tea and coffee may be whitened with fresh low fat milk or low fat milk powder as these are a better choice than coffee whiteners.
• If you drink alcohol, do so in moderation i.e. try to have at least 2 days free of alcohol per week. If you have been advised not to drink by your doctor then it should be avoided.
• All alcohol is high in calories and some drinks are high in sugar e.g. sweet sherry. Use sugar free or diet mixers with spirits e.g. diet lemonade & whiskey.
• Try not to drink more than the following amounts per day: 2 small cans or 1 pint ordinary beer, lager or cider or 2 glasses of dry wine or 2 glasses dry sherry or 2 spirit measures
• Avoid sweet wine, sweet sherry, liqueurs, homemade beer
• Alcohol lowers blood glucose, which can become dangerously low. Always have alcohol with a meal and your usual snack afterwards. Never drink on an empty stomach.

A guide to healthy snacks

It may be important for some people to have a snack at mid-morning and at bedtime. Try to choose a high fibre snack -the following are some examples:

Best snack choices

• Fresh fruit 
• Wholegrain cereal with low fat milk
• Brown or wholegrain bread with thinly spread peanut butter
• High fibre biscuits
• A bran muffin
• Low fat yoghurt

Not so good snack choices

• Meat pies, sausage rolls, fried samoosas
• Potato crisps and hot chips
• Chocolate/ cream biscuits/ chocolate bars/ ice-cream
• Sponge cake, sweet pastries/ cream cakes/ sweetmeats

Tips for healthy shopping

• Check labels on foods, which say "reduced sugar" or "no added sugar" – as glucose, fructose, sucrose and dextrose all mean sugar. Choose foods where sugar is not listed in the first 3 ingredients.
• Use skimmed/ fat free/ diet or low fat milk/ maas, fruit & plain yoghurt and low fat cheese as they contain less fat.
• Eat high fat take-aways or fast food such as deep fried chicken, burgers, chips, and pizza seldomly.

Exercise

It is important to do some form of exercise 3-4 times per week for 10-20 minutes. This may take the form of :

• Walking up and down a flight of stairs instead of taking the lift.
• Walking to the shops instead of taking a car/taxi/bus or getting off a bus/ taxi a couple of stops early.
• 50 –100 skips with a skipping rope.