By Mbali Thlani

November is World Diabetes Month. Dietician Mbali Tlhapi explains the disease and how sufferers can change their lifestyle and eating habits to help. 

Covid-19 opened our eyes about the risk of being a poorly controlled diabetic. The number of deaths during the pandemic changed the topic to how diabetes affects covid-19 positive cases. The truth is, having high sugar levels has always put diabetics at risk. Risk for illnesses such as glaucoma, kidney disease and in severe cases it can lead to amputations. It needs to be understood that even when the pandemic is over, whatever new disease emerges, taking care of our health is imperative. 

The high levels of sugar in your blood weaken your immune system and the body no longer works at optimum levels. Sugar (glucose) travels up and down the blood stream on a normal day, insulin removes this sugar into the body making us able to wake up, work and carry on with our daily lives, and also even store energy. 

In pre-diabetes, insulin no longer functions as before and therefore causes sugar to remain in our blood stream. The body adjusts and starts making ways to remove the amount of sugar in the blood stream but over time the body gets tired and we start seeing symptoms of fatigue, dizziness, constant urination, being thirsty and some have a fruity breathe smell. 

What is essentially happening in the body is the slow erosion of the blood vessels, slow injuries to the liver, build-up of glucose around the eyes and nerve damage usually around the hands and feet. Therefore if sugar levels are constantly high, your body is at a disadvantage when it comes to fighting illness and disease, as we have seen in this pandemic. Hospitalised diabetics have poor wound healing and the hyperglycaemia significantly reduces recovery being more susceptible to infections.

This is simply because of the food we eat. The amount of sugar we consume needs to reduce drastically. The South African government has even placed a sugar tax to help everyday citizens keep healthy, they even have a fortification program to put essential vitamins and minerals into our staple foods such as bread and flour. These efforts make a huge difference in our eating habits but it lies with the person. 

Managing diabetes is a socio-economic problem that cannot simply be fixed with medication. The pandemic has exasperated the country, which already had a declining economy; some people cannot afford what they used to anymore. The food choices made (food availability in certain areas is unfavourable), the budget, cooking methods, work schedules (some work shifts and odd hours) and number of mouths to feed inevitably determine how to keep healthy and manage diabetes. Each household is different but if one is willing to learn and be consistent, diabetes can be managed.  

Early education about the disease can offset some of the complications mentioned. It needs a change in lifestyle, which can be a struggle for some. Eating healthy is not cheap and some areas do not have diabetic friendly foods. A change in mind-set, food changes, exercise and medication leads to a longer, healthier life. 

Steps in changing your lifestyle:

  1. Portion control: on a plate the biggest portion should be vegetables. Half of the plate should be vegetables (not potatoes, butternut or mealies – these fall under starch), quarter of the plate should be starch (rice, pap or samp) and the other quarter of the plate should be protein (chicken, beef, fish or beans). 

Starch, when broken down in the body, is glucose. When eating a slice of bread or porridge in the morning, you are consuming sugar. This does not mean stop eating starch, it simply means reduce the amount consumed on each meal for the day. Starch must not be the main component of the plate. 

  1. Increase the amount of meals: diabetics can eat up to 6-8 times a day (depending on their circumstance at home). The common narrative is to eat three times a day but when decreasing starch it will mean you may need more food to keep energy levels up throughout the day. It needs to be emphasised that being hungry for a diabetic also affects health – low sugars levels are just as dangerous as high sugar levels. 
  2. Include snacks: by adding foods such as fruits, low fat yoghurt, vegetables or meat (foods that are not starch) you make up the increase in meals. An example – 7:00 breakfast (cereal or porridge) 10:00 snack (peanuts or dried fruit) 13:00 lunch (sandwich with tea) 16:00 snack (fruit or yoghurt) 19:00 supper (Rice and chicken) 21:00 snack (fruit or yoghurt). This is a simple way of keeping the body fed throughout the day and keeping sugar levels controlled. 
  3. Add fibre to the diet: adults should have at least 25g of fibre per day. Fibre makes you fuller for longer, making you less hungry. It also facilitates the slow release of glucose into the blood stream, this makes it possible to maintain optimum blood sugar levels. Examples of fibre – brown or wholegrain bread, brown rice or pasta, lentils, oats, bran flakes, beans, broccoli, nuts and seeds. 
  4.  Change cooking methods: use less oil when cooking. This means grilling, steaming, baking or boiling foods more than frying foods. Avoid eating deep fried foods such slap chips, fat cakes, and deep fried fish with batter. Eating high fat meals also affects diabetes and makes you at risk for heart disease and high blood pressure. 
  5. Eat a variety of foods: try to have the five food groups in each meal. Starch, protein, fruit or vegetable, fats and dairy. This ensures that you get all the energy (starch and fats), vitamins and minerals (fruits and vegetables) and muscle and bones building blocks (protein and dairy) in your daily diet. 
  6.  Choose good fats: reducing saturated fats (especially fat from meat) and increasing omega3 in your diet (fat usually found in fish). This is not only for people with diabetes but for adults that are getting older. Omega3 is an anti-inflammatory which helps with joint pain and body stiffness. 
  7. Exercise: weight has played a huge role in managing diabetes and exercising to maintain or lose weight has shown great improvement in the management of the disease. Central obesity is one of the risk factors for developing Type 2 diabetes and therefore adding exercise to your weekly routine can make a huge difference. 

There are diabetic supplements available in-store and in hospital settings. A dietitian can prescribe this medication but it should be used as a last resort. When medication, food changes and exercise no longer maintain blood sugar levels, one can look into using supplements. 

There are many dietitians, doctors and nurses available to aid in the step-by-step maintenance of this disease. There are those in private and public sectors who have been trained to educate and assist you on the journey. 

Please check the nearest hospital to see if dietetic services are available. Unfortunately there is no cure but it is a manageable disease and it can be reversed. It will take time but these are the small steps to a healthier you. 

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