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The costs of diabetes to our country are astronomical. It is estimated that around 96,000 South Africans died of diabetes-related causes last year. The suffering and loss that patients and their families endure is incalculable, while in 2018, the country’s healthcare costs for diabetes were approximately R21.8 billion. The tragedy is that it doesn’t have to be this way. While diabetes cannot be cured at this time, it can be effectively managed through treatment and lifestyle habits so that people living with diabetes can avoid diabetes-related health complications and live long, healthy and fulfilling lives.
With the 2022 theme, ‘education to protect tomorrow’, World Diabetes Day is celebrated on 14 November, and for South Africans, November is Diabetes Awareness Month. The South African Government and health organisations such as ([[https://www.adsa.org.za/ADSA Association for Dietetics in South Africa) are urging South Africans to get tested for diabetes and raising awareness about the importance of diabetes education. Maria van der Merwe, the president of ADSA, says, “There’s a lot of confusion and misinformation around diabetes and about how this diagnosis can change one’s life – especially when it comes to making dietary changes. This can be a significant barrier to being tested for diabetes, and therefore it is important for South Africans to understand that managing diabetes through medical treatment, healthy eating and physical activity is achievable. Furthermore, a diabetes diagnosis has impacts on the family, so it’s important that loved ones have a solid understanding of the condition so that they can support a person who is either pre-diabetic or living with diabetes.”
For Diabetes Awareness Month, ADSA put 10 myth-busting questions about diabetes and food to a panel of registered dietitians:
Ria Catsicas: People with diabetes need to prioritise the intake of foods that are part of a healthy diet. There is no need to buy special foods or expensive foods labelled for people living with diabetes. Foods that form part of a healthy diet are available at any grocery store and include wholegrains; fresh vegetables and fruits; dried beans, legumes and pulses; fish, chicken, lean red meat; low fat dairy products; seeds and nuts; and plant-based oils such as olive, canola, sunflower and other seed or nut oils. This means that people living with diabetes have as wide a choice of foods as anyone else. A challenge is that people may know what they should eat but find it difficult to change eating habits. People who are diagnosed with diabetes or as pre-diabetic will benefit from seeking guidance from a registered dietitian. Each person requires individual dietary guidance, with consideration of several factors, including your health status, medication, lifestyle and food preferences. Having a dietitian on your team gives you the support that everyone needs when they need to change their habits.
Ria Catsicas: No, people with diabetes do not have to avoid fruit. All types of fruit contain fibre and have a low glycaemic load, a term that refers to the type and quantity of carbohydrate that is eaten. A low glycaemic load means that if you eat any fruit in moderation you will not experience a high blood sugar response. It is the amount of fruit you eat that matters and it is best to get your dietitian to check how much fruit you can consume as this is an individual recommendation.
Ria Catsicas: No, carbohydrates, also known as ‘starches’ or ‘starchy foods’, are not ‘the enemy’ for people with diabetes. Although carbohydrates are the foods that affect blood sugar most significantly, robust evidence has shown that starchy foods do not have to be avoided in order to attain blood sugar control. The type and quantity of carbohydrates consumed affect blood sugar levels. Refined, ultra-processed carbohydrates should be avoided including white and brown breads; white maize meal, and rice; fast foods such as slap chips, pizzas, vetkoek, bunny chows; baked goods such as pies, pastries, cakes and biscuits; high sugar foods such as ice cream, sweets and chocolates; sugary drinks including fizzy drinks, fruit juices, ice teas and cordials, refined and sugary breakfast cereals as well as snack foods such as white rice cakes, crackers and potato chips. There are a lot of tasty, high-fibre carbohydrate foods that should be included such as dense seed and health breads; unsweetened, high-fibre breakfast cereals; rolled oats; wild brown rice; baby potatoes and sweet potatoes with skins on, legumes such as beans, lentils and chickpeas; corn on the cob; grains such as barley, quinoa and bulgur wheat; high-fibre crackers, and all fresh fruit and vegetables. When it comes to quantity a dietitian can help you determine the optimal portions of carbohydrates for you based on your weight, age, gender, activity level, levels of blood sugar control and types of medication you use.
Nasreen Jaffer: It is not true that a person living with diabetes can never enjoy a sweet treat ever again. What is of greater importance is how much and how often these foods are eaten and making sure that there’s a balance of the food groups in a meal or snack. A dietitian is able to guide people living with diabetes on how to incorporate some treats, in moderation of course, while still managing their blood sugar levels. They can also help to identify healthier alternatives that may well become favourite go-to treats.
Ria Catsicas: No, it is a myth that Type 1 is a worse type of diabetes than Type 2. The differences between the types of diabetes are how they develop. Type 1 normally develops in people of a younger age in a short space of time due to an auto immune disorder and people living with Type 1 diabetes are 100% dependent on injecting insulin. Type 2 develops in older people over a longer period of time due to genetic predisposition, abdominal obesity, poor diet, inactivity and stress. Insulin resistance and fatty infiltration of the pancreas cause the pancreas to produce too little insulin to control blood sugar levels within normal range. Some people with Type 2 diabetes also use insulin while others use alternative medication. Both types are treated using a variety of medications including injections to control blood sugar levels most optimally. In truth, the worst type of diabetes is diabetes that is untested, undiagnosed or uncontrolled because this leads to dramatic health complications including blindness, loss of limbs and death.
Nasreen Jaffer: Type 2 diabetes does not only affect overweight people. However, overweight and obesity are the major risk factors for developing Type 2 diabetes because they lead to insulin resistance. Therefore, maintaining a healthy weight can prevent the onset of diabetes, and is an important cornerstone of managing diabetes.
Nasreen Jaffer: No, not all people with diabetes will experience these complications of poorly managed or undiagnosed and unmanaged diabetes. These complications set in when the blood sugar levels are not maintained within the targeted levels over an extended period of time. This is why it is so important to be tested, and if diagnosed, to follow recommended treatment. The onset of complications can be delayed or avoided by maintaining optimal blood glucose control through medical treatment, diet and physical activity.
Kgadi Moabelo: People with diabetes should definitely not avoid physical activity unless they are specifically advised to do so by their doctors. Physical activity offers significant benefits for people with diabetes as it improves insulin sensitivity and supports the control of blood sugar levels. Physical activity also helps control weight, protect nerve damage and can delay the progression of diabetes complications. Each individual living with diabetes should be aware of their unique glucose response to exercise, and tailor their activities accordingly. The general guideline is 150 minutes of moderate-intensity exercise weekly, such as walking, jogging, cycling and swimming; or 75 minutes of vigorous intensity activity per week.
Kgadi Moabelo: There are no plants or medicine that can cure diabetes. Amongst the many plant species used over time to treat diseases, there are reports that over 800 of them may have beneficial effects on blood sugar levels. However, there is a significant lack of research that is needed to determine important factors such as safe dosage and administration. It’s important to note that ‘natural’ does not mean ‘safe’, and that while there may be medicinal plants that can help at the right dose, administered in the right way, the same plants can be toxic at the wrong dose or taken in another form. Therefore, it is important to first discuss any supplementary or alternative treatments you may want to try with your doctor.
Kgadi Moabelo: It is crucial for any person living with diabetes to eat a healthy diet even when their blood sugar level is controlled. Moreover, maintaining healthy body weight is of great importance when managing diabetes. Therefore, focussing on high-fibre carbohydrate foods instead of highly refined carbohydrates, plenty of vegetables, low fat foods and limited salt intake are essential for the proper management of diabetes.