'The Family and Diabetes' is the theme for World Diabetes Day, which is commemorated on 14 November 2018.
Three-and-a-half million South Africans – about 6% of the population – suffer from diabetes, and five million more are estimated to have pre-diabetes – when blood sugar levels are higher than normal, but not high enough to be considered as diabetes. Most cases of pre-diabetes in South Africa are undiagnosed.
Diabetes is the second most common cause of death in the country, according to the latest (2016) Statistics South Africa report on mortality and causes of death in South Africa.
The majority of people with diabetes have type 2 diabetes – where the body becomes resistant to insulin, resulting in dangerously high blood sugar levels. Type 2 diabetes is often caused by lifestyle or genetic factors.
On average it takes seven years for a person to be diagnosed with type 2 diabetes, as symptoms can be mild and may develop gradually. As a result, about 30% of people with type 2 diabetes will already have developed complications by the time they are diagnosed. Diabetes complications are serious and include heart disease, stroke, blindness, amputations and kidney failure. These complications can largely be avoided by early diagnosis and proper treatment.
Type 2 diabetes is placing a large burden on the South African healthcare system. Managing diabetes effectively requires daily treatment, regular monitoring, a healthy diet and lifestyle and ongoing education.
The costs associated with diabetes are alarming. There are direct costs of the disease, including hospital and medication costs and disability grants, as well as indirect costs, such as work absenteeism, time spent caring for sick relatives and reduced productivity. Around 76% of diabetes-related deaths in South Africa occur in people younger than 60 years – the most economically active age group of the population. Health expenditure for diabetes for adults in South Africa is projected to increase by 50% between 2010 and 2030.
Understanding diabetes
All South Africans can potentially be affected by diabetes, and awareness of the signs, symptoms and risk factors are vital for early detection.
Diabetes is a condition whereby the body is unable to maintain the blood sugar levels within the normal range. The four most important factors in diabetes management are:
Healthy eating habits – no special products are required.
Regular exercise – 20- to 30-minute exercise sessions, three times a week. People with a heart condition or people who have not exercised for a long time, should consult a doctor before starting an exercise routine.
The use of medication/insulin injections, as prescribed by a healthcare worker.
Regular testing of blood sugar levels.
It is important to be able to distinguish between the symptoms of high- and low blood sugar levels.
General symptoms of high blood sugar levels:
Unquenchable thirst
Urinating more than usual
Hunger, despite regular eating
Weight loss
Feeling tired and listless
Blurred vision
Nausea and vomiting
A short attention span and poor memory
Recurrent skin infections
Coma
General symptoms of low blood sugar levels
First signs – paleness, feeling jittery, sweating, nausea and headache
Moderate signs – Heart palpitations, feeling confused, anxious and irritated, speech is affected, constant yawning, personality changes e.g. moodiness
Severe signs – Aggression or fits of laughter, fainting, convulsions in children, coma
15 Dietary recommendations to prevent and treat diabetes
The dietary guidelines for people with diabetes are based on the same dietary principles as for healthy people without diabetes.
People with diabetes who are overweight or obese are advised to lose weight. You can improve insulin resistance by losing as little as 5% to 10% percent of your body weight.
Eat a variety of different foods at every meal, and vary the preparation techniques you use to make healthy food. This ensures that your diet contains sufficient nutrients and that it is more enjoyable.
Eat at least three balanced meals per day.
Avoid sugar-sweetened beverages and drink at least six to eight glasses of water per day.
Increase your fibre intake by:
Eating whole wheat bread instead of white bread;
Having oats, oat bran, or whole wheat cereals e.g. high-fibre cereal for breakfast;
Including a lot of vegetables and fruit in your diet;
Regularly eating legumes (peas, lentils, beans and soya), and including barley, samp, brown rice and whole wheat pasta to your diet.
People with diabetes may benefit from foods with a low GI/GL (food that slowly/gradually releases glucose into the blood thereby keeping blood sugar levels balanced), as long as it are incorporated into a balanced diet.
Limit your fat intake, especially saturated- and trans fats, such as animal fats, full cream dairy products, coconut, hard margarine, full cream products, confectionary (e.g. chocolate, pies and cookies), and palm oils (e.g. coffee creamers and artificial cream). Rather use mono-unsaturated fats in limited amounts (e.g. use canola oil or olive oil instead of sunflower oil, spread avocado or peanut butter instead of margarine on bread).
Eat fish two to three times per week, and chicken more regularly than red meat.
Small portions of red meat are allowed, but it is advised that you frequently replace red meat with fish, chicken, legumes (e.g. peas, beans, lentils and soy) and eggs. Processed meat products such as polonies, viennas and sausages are unhealthy, rather eat beans, eggs, nuts, peanut butter or lentils.
Eat at least five portions of fruit and vegetables every day. Buy vegetables and fruit that are in season and include as much variety as possible. Fruit contain sugar, therefore you should eat only one fruit at a time to avoid a spikes in blood sugar levels. Don't consume more than 125ml fruit juice per day.
Aim to eat or drink at least two cups of milk, cottage cheese or yoghurt per day. It is recommended that you consume low fat products, as it contain the same amount of protein and calcium, but has less fat than full cream products.
Follow the correct cooking methods: boil, steam, bake/grill in the oven and "braai" over coals, thus limiting the addition of any form of fat (e.g. margarine, oil, mayonnaise, cream and cheese) during food preparation.
Use small amounts of salt in food preparation and avoid the use of extra salt at the table. Rather use herbs, salt-free spices and flavouring instead of salt. Avoid processed foods with a high salt content.
Consume alcohol, such as beer and wine, in moderation (one to two glasses a day) and always with a meal.
Manage your carbohydrate and sugar intake by limiting or avoiding cake, cold drinks, sweets, cookies, and sugar-sweetened desserts and drinks (including alcohol), which are very high in energy, but low in nutrients.
Access the South African Food Based Dietary Guidelines and recommendations for healthy eating and weight loss at: http://www.sun.ac.za/english/faculty/healthsciences/nicus/how-to-eat-correctly.
Information supplied by NICUS: The information explosion in the science of nutrition very often creates the impression that available information is contradictory. Consequently, it is no longer easy to distinguish between fact, misinformation and fiction. The Nutrition Information Centre of Stellenbosch University (NICUS) was established to act as a reliable and independent source of nutrition information.
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