COVER STORY LiVing wiTh diabETES · 2015. 10. 14. · Michael Brown - CDE Houghton S ... Chantelle Olivier and her two young daughters and their ability to see blessings in the midst

COVER STORY

LiVing wiTh

diabETES

NEWNEWNEW

1 Freckmann G, Schmid C, Baumstark A, Pleus S, Link M, Haug C. System accuracy evaluation of 43 blood glucose monitoring systems for self-monitoring of blood glucose according to DIN EN ISO 15197. J Diabetes Sci Technol. 2012;6(5):1060-1075.

2 Data on fi le. ISO 15197:2013, in vitro diagnostic test systems requirements for blood glucose monitoring systems for self-testing in managing diabetes mellitus include tighter requirements for accuracy and new criteria for hematocrit and other interferences.

The Accu-Chek® Performa meter fi ts into your every day life with accuracy you can trust1. 47% of blood glucose meters failed a recent international accuracy study that the Accu-Chek Performa meter passed1. The enhanced Accu-Chek Performa meter meets the newest global accuracy standard with even stricter requirements2.

Get yours in-store now!

ACCU-CHEK and ACCU-CHEK PERFORMA are trademarks of Roche. © 2013 Roche Diagnostics.

Experience what’s possible.

every day easy, every day accurate.

Roche Products (Pty) LTDDiagnostic DivisionPO Box 1927, RandburgToll free: 080-Diabetes (Dial 080-34-22-38-37)www.accu-chek.co.za / www.diabetes.co.zaRef: ARET 131108

For more information contact your Healthcare Professional

1

Editor

Michael Brown - CDE Houghton

Sub-Editor

Rosemary Flynn

Advertising Enquiries

Angela Bell

082 451-0193

[email protected]

Editorial Advisors

Prof Larry Distiller

Dr David Segal

Dr Stan Landau

Vanessa Brown

Gerda Janse van Rensburg

Andrew Heilbrunn

Hester Davel

Paul Baker

Michelle Daniels

Project Manager

Peter Black - Chief Executive Officer CDE

Published for the Centre for Diabetes

and Endocrinology by

Homestead Publishing (Pty) Ltd

P O Box 1261 Rivonia 2128

Telephone: 011 787-9366

Fax : 088 011 787-9366

[email protected]

Design and layout

Adéle Gouws

Output Reproductions

Printing

Business Print

Centre for Diabetes and Endocrinology

011 712-6000

www.cdecentre.co.za

Copyright

Material published in Diabetes Lifestyle

including all artwork, may not be copied,

reproduced or published without the

permission of the Publishers.

We are weeks away from the 2014 National and Provincial Elections to be held on7 May 2014. I urge everyone of voting age to support this very importantinstitution of our young democracy and vote. Think carefully about your needs andthe needs of your community and South Africa as a whole. Listen carefully to theelection manifestos of the parties vying for election. Examine their pastmanifestos and delivery records. Does a thread of congruency tie all together? Tryto see beyond the smoke and mirrors, the ‘red herrings’, the divisiveness, the hypeand promises that may never materialize. As a person with diabetes, an importantissue you may want to consider is that of health care in general and of diabetescare specifically. With the prevalence of diabetes in the voting age populationapproaching 10 %, people with diabetes, as a group, could exert significant politicalpower... should they organise themselves... Remember the tumultuous days of theTreatment Action Campaign (TAC) and how people of passion changed Governmentpolicy on HIV/AIDs? So, make your marks on 7 May wisely – citizens in a democracytend to not only get the Government they choose but also that they deserve...

A criticism I heard last year about this publication was that we only feature ‘superhero’stories. Whilst this may be unapologetically true of many (but not all) of our Coverfeatures, the careful reader will note that we almost always also carry stories frompeople who have to deal with daily burdens such obesity, eating disorders, blindnessand other severe health problems. This issue is no different. Our Cover Story featuresFlo Simba, an amazing young Johannesburg resident, who in being brave enough tobelieve in and live out his dreams, has won the International Boxing Organization (IBO)Youth Heavyweight Title of the World. I had the privilege to hold his Championship Belt aswe did his incredible photo shoot – that belt is also a ‘heavyweight’! In people like Flo, allpeople with diabetes, no matter their state of health have a role model of what can beachieved, should we put our mind to it. Sure, you may never win a world sporting orother title... you may have difficulty in walking one block or even in getting up out ofa chair, but people like Flo can inspire you to live your life to the best of yourpotential! On the other end of the scale, you can only marvel at the bravery shown byChantelle Olivier and her two young daughters and their ability to see blessings in themidst of adversity... Read their story and be touched and inspired!

I would like to remind all our readers that again it is that time to seek out yourannual flu vaccination. International recommendations consider the level ofvaccination coverage among people with diabetes and their health careprofessionals (HCPs) to be one measure of patient safety and quality of care inhealth facilities. Do not put this task off until next week!

We trust that you will enjoy the fine smörgåsbord of other articles we have for youthis Issue, again, made possible by our willing contributors and our valuableadvertisers. Finally, I would like to thank our gem of a Publisher, Angela Bell and ourvery competent and creative Design and Layout Professional, Adèle Gouws. I feelprivileged to work with this amazing duo and would like to express my heartfeltappreciation to them both for all that they do!

Yours in diabetes care

Michael [email protected]

EDITOR’SNOTE

Diabetes Lifestyle...Real People, Real Stories, Real Answers

2

CONTRIBUTORS

COMMENTARY

• What really drives innovation in diabetes? Peter Black 4

• Paul’s side of the fence - Cycling – a healthy lifestyle choice Paul Baker 50

LIVING WITH DIABETES

• Back to the Basics of Diabetes – Hypoglycaemia Prof Larry Distiller 18

• Gluten Intolerance/Coeliac Disease Ria Catsicas 24

• And so began 2013... Chantelle Olivier 30

• A Brighter Future on the Horizon for Diabetes Madam Bongi Ngema 32

• The Sweet story of an Ice Cream maker Stuart Graham 36

• The Road to Self-discovery Hendrien van Zyl 42

COVER STORY 8Believe in your dreams!

Kingumba Florent Simba

INSIDE

Paul BakerCommunity Columnist

Peter Black Chief Executive Officer, CDE

Ria CatsicasRegistered Dietician - Nutritional Solutions

Stuart GrahamGelato Master

Prashant Narotam Madam Bongi NgemaPatron of the Bongi Ngema-ZumaFoundation

3

HEALTHY CHOICES

• Cooking from the heart - Introduced by Michelle Daniels 34

SNIPPETS FROM THE IDF WORLD DIABETES CONGRESS

MELBOURNE - DECEMBER 2013 Rosemary Flynn 46

DID YOU KNOW? 48

DIABETES LIFESTYLE SUBSCRIPTION FORM 52

ACCREDITED CDE SERVICE PROVIDER CLASSIFIEDS 52

DISCLAIMER

Views expressed in editorial are notnecessarily those of the CDE, thePublishers, or Editors. While every effort ismade to ensure the accuracy of thecontent of this journal, the CDE, thePublishers, and Editors do not acceptresponsibility for omissions or errors ortheir consequences. Any general advicecontained within cannot and is notintended to be a substitute forprofessional medical advice, diagnosis ortreatment and is not purporting to be thepractice of medicine. Never disregardprofessional medical advice, or delay inseeking it, because of something youhave read here, or rely on this informationin place of seeking professional medicaladvice. Always discuss any newinformation with your Diabetes Teambefore acting on any aspect of it. Use ofthe information contained within thispublication is thus with the understandingthat it is at the readers own risk.Acceptance of advertising does not implythat the products and services advertisedare recommended by the CDE, the Editorsor Publishers.

Michelle DanielsRegistered Dietician, CDE Houghton

Prof Larry DistillerSpecialist Physician / Endocrinologist, CDE, Houghton

Rosemary FlynnClinical Psychologist, CDE, Houghton

Chantelle Olivier Kingumba Florent Simba Hendrien van ZylLearning Solutions Specialist

What really drives innovation

in diabetes?

4

The pharmaceutical industry is, along

with the electronics industry, one of the

most innovative spaces in the global

economy. Companies spend billions of

Rands in Research and Development (R&D),

hoping to develop the next best therapy. Sceptics

point to the fact that this is purely driven by

profit motives. To a large degree, this is correct.

R&D costs a fortune, and before any new

therapy, medicine or new medical technology

reaches any patient, many expensive years are

spent getting a product to market.

The recent ATTD (Advanced Technologies and

Treatments for Diabetes) Conference held in

Vienna, Austria, showcased a number of mind-

boggling advancements in diabetes technologies.

More detail on these developments will be

discussed in future issues of this Journal – don’t

miss out! However, one of the unspoken and

underlying realities was rather interesting.

Real innovation is often personal innature

At the Conference, quite a number of

groundbreaking studies were presented and

discussed. One that truly stood out was a study

using human subjects to test technologies that

will form the backbone of the so-called ‘artificial

pancreas’. In other words, a wearable

computerised machine worn by a subject to

control that person’s blood glucose levels

automatically, thereby mimicking the action of a

healthy pancreas. The preliminary results of such

studies are amazing, and there is no doubt that

in the near future, such devices will be available

to people with diabetes.

However, one thing has become clear. Diabetes

personally touches many of the people

involved in these kinds of groundbreaking

innovation. Many have type 1 diabetes

themselves. A number have children with

diabetes. In many of the presentations,

scientists explicitly mentioned these personal

influences, as driving factors in their work.

One scientist mentioned that his goal is to

develop an artificial pancreas system so that

his son will be able to use it by the time he

goes to college. That is 5 years away, and the

work presented by this scientist demonstrates

that he may very well achieve his goal.

With these personal and passionate crusades,

scientists are busy creating fantastic future

opportunities for people with diabetes. What

is clear is that there is much more at play than

a mere profit motive.

Personal motives often drive real passion...

Editor: How does diabetes affect you? Maybe

you have the condition... Maybe you love

someone with diabetes... Maybe you facilitate

self-management for people with diabetes...

Do you have passion for diabetes? What would

you like to see changed for people and

families so affected?

We need innovation in many areas of diabetes

apart from searches for better treatments and

technologies. We need better awareness of the

condition, better healthcare provider and

patient education, better political advocacy

and less personal and structural apathy. How

will you use your passion to improve the status

of and approaches to diabetes in South Africa?

COMMENTARY

By Peter BlackChief Executive Officer, CDE

Fully Audible Meter

Code Free TestingMore Reliable Results

Fast Test TimeResults in 6 Seconds

Small Sample SizeLess Blood, No Mess

After Sales Support:• Solus V2 Helpline with dedicated nurse, 0800-499-994• Solus V2 Website, www.solusmeters.co.za• In-house diabetes nurse educatorAPPROVEDAPPROVED

Cipla Medpro (Pty) Ltd. Reg. No. 1995/004182/07, Building 9, Parc du Cap, Mispel Street, Bellville, 7530, RSA. Tel (021) 943 4200, Fax (021) 914 4699.E-mail: [email protected] Website: www.cipla.co.za Customer Care: 080 222 6662

CENTRES FOR DIABETES

Are you concerned about your diabetes?

Currently, we are witnessing an

alarming increase in diabetes in

South Africa, both in the young and

in adults, regardless of background,

ethnicity or age

Many people with diabetes are not

aware of the best approach for their

diabetes care

www.cdecentre.co.za

Helping you to live well with diabetes

... life can still be sweet!

To find out more, or for the location of your nearest CDE Branch, please contact the DMP Membership Department on 011 712-6000 or e-mail [email protected]

What is the CDE Diabetes Management Programme (DMP)?The DMP is a multi-specialist approach to the management of diabetes. The CDE, in partnership with many medical aidschemes, provides a comprehensive and holistic approach to the care of the person with diabetes, according tointernationally accepted standards of care. The CDE also trains, mentors and accredits many healthcare professionals inthe principles of good diabetes care.

What can I, as a person with diabetes, receive from the CDE Diabetes Management Programme?• Consultations with a specialist or accredited diabetes doctor.• Comprehensive diabetes education with a registered nurse, diabetes educator.• Foot screening by a podiatrist.• Eye screening by an ophthalmologist.• Dietary advice from a registered dietician.• 24-hour emergency hotline.• All evidence-based, CDE-prescribed diabetes medications, a blood glucose meter and test strips.

With all these benefits and support and your active participation, you should never require hospital admission for anacute complication of uncontrolled diabetes (E.g. hypoglycaemia, diabetic ketoacidosis). As part of our guarantee of good care, we assume the risk for the costs of any acute diabetes-related admissions.This comprehensive Programme is provided at no added cost to you, as long as you are a member of one of our contracted medical aid scheme partners.

In Grade 9, The Hill started playingbasketball. I had never played thegame, but one day in the schoolholidays I met a guy from schooland he showed me somebasketball tricks. I was soamazed that two days later Iwent and got my ownbasketball. I loved the sportand spent the duration of myholidays training so I couldjoin the team.

School started and I went tothe basketball trials. At theend of the trials, I wasselected for the

8

Iwas born on the 29 of September 1989 in Kinshasa inthe Congo and named after my grandfather,Kingumba Florent Simba. In 1991, we moved to SouthAfrica. After a short stay in Hillbrow, we moved into

our first house in South Hills, fronted by a little field – itwas here that I spent most of my youth. At the time, myfamily consisted of my two brothers, my sister, my mother,father, and me. My dad was a medical doctor and thebreadwinner, as well as the disciplinarian in the house.

My teachers had a problem communicating with mebecause we mostly spoke French at home. Eventuallymy parents had a meeting with the teachers, whosuggested we speak more English at home. We did, andafter a while, we could speak English fluently. But, inlife, it’s often give or take - as our English improved, ourFrench declined. Growing up we became so used tospeaking English we hardly ever spoke French. Funnily,though, French always came out when we were introuble or we were sent to do something...

Our home was disciplined - being naughty wasunacceptable. Amusingly, at the time we went toschool, the film The Lion King was very popular -everyone knew the name ‘Simba’ from the lion. Later Iwas the guy with the name ‘Florent’ while we werelearning about Florence Nightingale; so I got picked onfor that. But, I got over that quickly and was actuallyhonoured by having my grandfather’s names. It couldhave been worse and I could have been named after apronoun! Growing up I tended to be very shy. I reallyonly got into my element on the sports field...

We spent most of our time training after school orplaying on the field. My dad played soccer with us - hewas good, having captained his soccer team growingup. All the kids from our street played on that fieldwhere I met my best friend Jarred Anderson.

I played a multitude of sports, but for some reason Iexcelled at badminton. In Grade 6, the school beganconstructing a pool for us, so we started going to thelocal pool to get used to water. The first time we wentthere, I was excited, but also ignorant because I didn’tknow that a pool had a deep or a shallow end. So, I sawall the kids playing at the one end and decided to go tothe other side and jump in. Not knowing how to swim, Istarted drowning. Fortunately, the lifeguard saved me,but I got into a lot of trouble for that. However, itdidn’t stop me from learning how to swim. In only afew months, I could swim and compete.


In Grade 7, I became a prefect. My dad always toldme, “You go to school to study, not to play sports”.For him, there was no reason why I could not achieveacademically and on the sports field. So, mymentality was to dominate everything I got into.Ironically, Kingumba means ‘King of your domain’.

Back then, The Hill High school was the school to getinto. The Hill accepted only two of us out of ourgrade seven group. With a new school came a newenvironment and I had to start from scratch.

I didn’t know many people, so I did my best to fit in. Iplayed all the sports except for swimming (18 laps justas a warm up didn’t seem feasible to me). After havingmultiple nicknames, Flo seemed to stick. Around thattime, I remember asking my dad if I could start boxingat the local gym. I will never forget his response, “Noson of mine will become a boxer!”

By Kingumba Florent Simba

team and so was the guy that showed me the tricks.Even though I thought he was the better player, Iwas elected as captain. I was very proud of thatbasketball team because in every training session,the guys gave everything.

We did well, and in Grade 11, I was selected for thedistrict team. I knew I wasn’t just representing myself,but also my fellow teammates, my school and myfamily. Unfortunately, I didn’t make it to Provinciallevel, but it was an achievement from never havingplayed, to excelling at that level.

The teachers and fellowstudents then electedme prefect and I hadto attend prefectcamp after theschool holidays...


During the school holidays, I had constant fatigue,uncontrollable thirst and unstoppable urination. On topof that, even though I was a relatively athletic person, Ilost about 10 kg. The guys from the field in front of myhouse kept asking if I was OK - I had no idea what wasgoing on. All my energy on the sports grounds wasdepleted and I couldn’t do much. I actually thought Iwas dying. My mom was worried and one day decidedto call my dad. I explained the symptoms to my dad andhe said, “it sounds like you have diabetes”.

I had no idea what that was, but it was a relief to findout I wasn’t dying. Unfortunately, I had no one todiscuss my diabetes with and I felt very alone. I thenwent with my dad to his offices and a lady at thediabetes clinic checked my blood glucose level. Myfasting reading was 22.1 mmol/l, apparently very high. Iwas given a crash course on diabetes and insulin... Istarted a basic insulin regimen of 2 injections a day -one in the morning and one at night. A number ofpeople asked if I didn’t get tired of injecting myself. Iwould have lied if I said no, but I believed I was better

than people with or withoutdiabetes were. It was not my

handicap, but an obstacle Ihad to conquer!

Pho

tog

rap

hy

by

Mic

hae

l Bro

wn

10

Interestingly, my dad was angry on my behalf. Hedidn’t think I deserved to have diabetes at my age, buthe still made me check my blood glucose and take mytreatment accordingly. When I pulled out the insulinpen the first time, he asked if I knew how to use it. Ididn’t have a choice - I had to know how to use it andI remembered everything I had learnt in the crashcourse. So, I pulled up some skin on my abdomen andinserted the needle as my dad watched. The moment Iinserted the needle, I noticed his face scrunch up. Thissurprised me. My dad had always given me ‘toughlove’. He is usually focussed and never shows muchcompassion. This was the first time I really saw himshow emotion. I found it reassuring because I thenknew I had more than just support.

My dad worked hard, but he didn’t want to let me outof his sight. We went home, got achange of clothes and my brotherand I went with him to hisnightshift at another hospital. Wesat in the doctor’s room where Iwas hooked up to a drip for theduration of the night to rehydrateme. Even though my dad wasworking, at regular intervals hewould come and check on us. Forthe next few days, I learnt moreabout diabetes. I had a hard timewith the ‘diet’ because I had toreduce my sugar and carbohydrate intake. But, my dadsaid, “Don’t deprive yourself of nutrients. You’re agrowing boy, so eat what you want. Just make sure youtake enough medication for the food”.

School started and I had to go to prefect camp. It wasa bit weird at first as the other guys didn’t believe mewhen I told them I had to give myself injections everyday. I was also a bit worried about something goingwrong, as it was the first time I had left the house forany length of time since I had diabetes.

Fortunately, one of the teachers on the camp alsohad diabetes and she helped me as much as shecould. I had a great camp even though I had thoughtit would be awful. I hate being pitied, but, ratherthan pitying me, the guys admired my will toovercome my problem.

When we returned from camp, life went back tonormal, with a diabetes ‘twist’. Sport seemed to

regulate my blood glucose, but the constant highs andthe muscle cramps were very annoying. I remembertelling my team we have everything... two arms, twolegs and two eyes… there was no reason we couldn’tsucceed and win our matches. Many people had a lotless than us, but they still pushed through. I had realrespect for these people.

My Grade 12 year (Matric) was pressurised. I not onlywanted to do well on the sports field, but alsoacademically. However, I had to sort out my bloodglucose levels so I would have enough energy to tackleeverything. My dream was to be a medical doctor likemy dad and to be a professional sportsman.

My dad got the best marks in his province back in theCongo, so I had a lot to live up to - the pressure was

on! But, like everyother kid, I liked toparty with my friendsand have a good time.We called it ‘Living’.

I also met a girl thatyear that I really likedand we started dating.But, there was muchdrama with her and myfamily. My brother andmy girlfriend disliked

each other so much I hardly ever saw my brother, and,her mom didn’t like me either.

My younger brother Glen’s goal was to be better thanme in everything he did. I admired that. He achievedthings that I wanted, but although I didn’t get them Iwas never envious of him. The Matric exams came andsome papers seemed easy. My dad cautioned me, “Apaper should never by easy. Look again at youranswers and check”.

I recall the coffee buzz I often had and I didn’t know ifI was tired or if it was my diabetes acting up. I foundout that sleep is important to a successful lifestyle withdiabetes. My thoughts contradicted that because I hadalways told myself when I was tired, “I’ll sleep whenI’m dead” and I carried that thought through toeverything I did in life.

The following year I received my results. I didn’tqualify for medicine, so I went back to the drawing


I had a hard time with the ‘diet’because I had to reduce my sugarand carbohydrate intake. But, mydad said, “Don’t deprive yourselfof nutrients. You’re a growing boy,so eat what you want. Just makesure you take enough medicationfor the food”

board to rewrite some ofmy subjects. It was toughfeeling like a failure and told tostudy every day. In-between, Ihelped at my high school as anassistant coach. A few months later, Iwrote again and did better, but it stillwasn’t good enough to qualify to studymedicine. Then I had half a year withnothing to do. I couldn’t really work and mydad said “Enjoy being a teenager this year andleave the other stuff to me”.

My brother suggested I try boxing since I had somuch free time. He had been to a few sessions byhimself and he loved it. So, I went to the South Sideboxing gym, in Regents Park. It grabbed me from theminute I got in there. That’s how I met battle-hardenedboxer Jarred Lovett and his father Aubrey. I got into thehabit of training with The Hill basketball team and straightafter that quickly jogging to the boxing gym for a workoutevery Tuesday and Thursday. I didn’t want to mention my medicalcondition because I didn’t want to be treated differently; I justwanted to be treated like a normal fighter. I applied at theUniversity of Johannesburg to do Civil Engineering and I wasaccepted to start in 2009.

When I started university, my life consisted of classes, basketball andboxing. At that stage at South Side, we had an assistant trainer calledBilly. I had a few amateur fights, but it was tough to get fights becausethere weren’t a lot of guys in the heavier divisions. Then Billy opened uphis own gym in South Hills a few blocks from where I was staying. The gymwas open on Mondays and Wednesdays.

So, I started training Monday to Thursday at South Side and South Hillsrespectively and I was given the chance to go to the JohannesburgChampionships. I walked through them because there weren’t any opponents.Then I had to join the Johannesburg team for their Saturday training sessionsfor the Gauteng Championships. It was hard to get the respect of the guysbecause I walked through the Johannesburg Championships to get to theGauteng’s. I had two fights. The first fight was tough, but I won. I went to bedand woke for round two of the tournament the next day. I thought if I wonthat fight I would become the Gauteng Champion.

I found out that sleep is important to a successfullifestyle with diabetes. My thoughts contradictedthat because I had always told myself when I wastired, “I’ll sleep when I’m dead” and I carriedthat thought through to everything I did in life

11

I warmed up as I did for every fight. When it was myturn, the coach decided not to tell me until the lastminute that the well-built guy I was facing was thethree-time South African Champion. To make mattersworse, we needed one more win to take the teamtrophy. Again, the pressure was on. That statement,“three-time South AfricanChampion” kept goingthrough my head, but I hadwarmed up already and hadmade sacrifices to be in thatring. Round one washorrible... I felt like I waslosing, but I was actuallyahead by a point...

At the end of the second round, I sat down on thecorner stool. I felt close to defeat. My mind waswandering and I was not listening to the instructionsfrom the coach. He eventually slapped me andsaid “Focus! You can win this!”Suddenly, all the doubt vanished. Iwas determined to get back inthere and win. As the roundstarted, I felt full of energyas if it was the

first round. Eventually I stopped my opponent. I wonthe Gauteng Championship and Gauteng bought backthe team trophy.

After all the fights, they call up those who will be in theteam to represent the Province, but they did not call my

name. I was amazed and wantedto know why. The officials toldme I needed SA citizenship to bein the team. Some officials triedtheir best to help me to get mycitizenship quickly so I couldcompete at the South AfricanChampionships. The problemwas I was ignorant in filling out

my Identity Document form. I made a mistake at thecitizen part, so everyone in my family had citizenshipexcept for me because of that blunder.

I remember coming home from that fight hurt andbruised. My dad, sitting in the lounge and looking deadat my black eye asked, “Did you win?”

“Yes I did.”

Then I told him that I would hold the Gauteng titlefor a year. With an astonished look and sigh, herepeated, “You won?” I nodded my head andwalked to my room.

At the time, I also started playing basketball for theUniversity of Johannesburg at night. The coach took aliking to a few of us and put us in the first team. Iwas struggling to juggle my schedule without avehicle. But, my mind-set was, ‘If I don’t do it,no-one will do it for me’. I used publictransport to get home from basketballtraining, but I was carrying too muchluggage to be in town at that time ofnight. A schoolbag, drawing bag and kitbag was my regular load. It was all toomuch and it came to a point where thebasketball coach asked me to make achoice between boxing and basketball. Ichose boxing because I felt it was all onme to succeed and not others.

I started training harder and focused moreon boxing. Jarred Lovett needed someoneto spar with and I was happy to oblige. Afew months went by and the guys from the


My mind was wandering and I was not listening to theinstructions from the coach. He eventually slapped me andsaid “Focus! You can win this!”

12

13

gym started telling me I should turn professional. After awhile, I decided to do this. But, I would have one lastamateur fight at a South Hills Tournament under CoachBilly Hurford. Through Jarred and Aubrey, I wasfortunate to meet South African boxing legends whowould change my life. I met Brian Mitchell and ‘TheHammer’, Harold Volbrecht. Brian took me to GoldenGloves, the Promoter of Champions, where I metRodney Berman. My professional career was under way!

I was given a contract a few days later. Although I wasvery ambitious, I was doubtful. It took a few days andnegotiations with my dad before I signed and my dadsigned on my behalf. During the occasional trainingsession at Pulse, boxing great, Jeff Ellis and the lateboxing personality and historian, Terry Pettifer wouldpop in to check on the fighters. Terry gave me mynickname, ‘The Demolition Man’.

I had three months of solid training before I had myfirst Professional fight. I was anxious, but I didn’t knowif it was my diabetes or my nerves. Harold told me Ishould be happy because there’s no way anyonetrained more than I had. And, I was happy when theofficials gave me my gloves. I was so used to trainingwith heavy gloves that thethought of the lighterfighting gloves wasliberating for a moment.Then it sunk in that myopponent would also havelight gloves. So I was backto worrying...

I remember being the firstfight of the night, steppinginto the ring, looking at myopponent and looking at thecanvas full of old blood stains that couldn’t be washedout. That is when I realised it was really happening.Luckily, I stopped my opponent in the first round.Before and after a fight, the mixed feelings would playfunny games with my blood glucose levels. After everyfight, I struggled to sleep, which was ironic because myblood glucose levels were so high I should have beenvery tired and just slept. People would tell me howproud my brother was of me, but he would never tellme that.

Then my family moved from the South of Johannesburgto Pretoria. It was so far, it interfered with boxing and

varsity and I couldn’t train properly. I didn’t haveenough time to study as I was driving back and forth. Istarted looking for a place in Johannesburg.Fortunately, my sponsor at that time, Warren Laird,owned a block of apartments and he gave me a place tostay in Germiston. I had just received the ‘Prospect ofthe Year’ for 2009 from Boxing South Africa (BSA).

My brother and I still didn’t see eye to eye because ofmy girlfriend, who was living with me. However, heneeded to come to Johannesburg to write an exam.That night my dad brought him over. It was the firsttime I had seen him since moving into the apartment. Iwas happy, but also worried about playing refereebetween my girlfriend and him. My brother stepped outthe car complaining he was struggling to breathe. Sowe waited for him to catch his breath. When herecovered, we went upstairs talking as we always did,and into the apartment. I didn’t have to play refereethat night...

We caught up on old times and he gave me the ‘lowdown’ on what was going on at home. The nextmorning I dropped him off at the exam venue and wentto varsity to spend a normal day attending classes and

talking with my friends. Later,I received an unexpectedphone call from my brother’sfriend saying, “Glen hascollapsed”. I droppedeverything and rushed offimmediately. Going throughmy head was that he hadstruggled to breathe thenight before. My dad calledme on the way. He told me tobe calm, drive safely, andwait for him there. He still

had to fetch my other brothers and my sister fromschool. I arrived where my brother had collapsed andfound he had been declared dead on the scene.

I was shattered and broken when I saw him lying therein the shopping centre. Some very helpful andconsiderate people were at the scene. I sat with mybrother for hours. I didn’t want anybody to touch himor move him. I told the morgue people not to move mybrother until my dad got there. My dad arrived and Icould see he already knew. We picked up my brotherand put him in the mortuary van. It was 10 days beforemy third professional fight...


Before and after a fight, the mixedfeelings would play funny gameswith my blood glucose levels.After every fight, I struggled tosleep, which was ironic becausemy blood glucose levels were sohigh I should have been very tiredand just slept

14

My dad was worried and asked if I wanted to cancel thefight. I told him I didn’t as Glen would have wanted meto fight. My dad agreed. We spent the next few dayssorting out funeral arrangements and I trained.

That weekend we had the funeral. It was a dramaticday, but also a day for praising a life well lived. Aweek later, I stepped into the ring and won by afourth-round knockout. That fight changed my wholecareer as BSA ranked me as a contender for the SouthAfrican Title. Suddenly I had fight offers coming left,right and centre.

Harold gave me a great piece of advice, which was, “Ifyou want a luxury car or house it’s already yours. Youjust have to go out there and take it from every manthat will try to take it from you”. It certainly made memore determined. I also started working for AlbertoFogolin at Alminic Construction in Bedfordview for myin-service training. Alminic is a family business and I wasblessed to become part of that family. They gave metime off so I could attend training. BSA awarded mewith the ‘Knockout of the Year’ in 2010.

However, my diabetes was still an issue. Rodney Bermantook me to a specialist and he explained I was using thewrong medicine for my levelof sporting endeavour. So, Iwas put on a combination oflong and rapid acting insulinanalogues, which was betterthan the regimen I had beentaking. Previously, I had toeat at regular intervals toavoid a ‘hypo’, so I felt like Iwas playing ‘Russianroulette’ with myself. I nowhad more control of foodintake and my blood glucoselevels, but it still took a while to get the dosages right.Rodney and Brian took me for the all the health testsand they came back clear. Having diabetes and being aprofessional sportsman is tough. But, so are many otherthings in life...

Then, for my tenth fight, I had the opportunity to fightfor the IBO Youth Heavyweight Title of the World. I wasready for the fight mentally and physically, and my newinsulin regimen was exactly what I needed. I rememberarriving at the gym and checking my sugar. It wasslightly high so I took some insulin to get it to an

optimal level of between 4 and 7 mmol/l. The trainingsession went well like every other session and we wentto shower like every other day. But, this day, we had togo to the pre-medical. I was running a little late, so Igot into the car and rushed off. Just as I was about totake an off ramp from the highway, my blood glucosewent low and I blacked out.

I hit a concrete barricade and rolled my vehicle, whichwas sponsored by Deton Financial Services, owned byRichard Olfsen. The car was a write off, but fortunately,for me, I only had minor injuries. I arrived at the pre-medical an hour late but the doctor checked me anddeclared me fit to fight. A few days later AlbertoFogolin took me to Linksfield Medical Centre to see achiropractor to attend to the whiplash from theaccident - this was amazing, as all my pain disappeared.Days later, I stepped into the ring with an undefeatedBrazilian opponent. I saw an opportunity first roundand I went for it, winning by knockout and taking theIBO Youth Heavyweight Title of the World.

Some weeks later, I received a call from my managerBrian Mitchell to fight Francois Botha. I had no ideawho he was. I did my research on Francois’s professionalcareer and learnt he had fought big names like Mike

Tyson, Michael Moorer,Wladimir Klitschko, LennoxLewis and Evander Holyfield.I knew I was in for a fight,but at the end of the day, weare all just human... webreathe and bleed the same.A hard three-month trainingregimen had prepared mefor the fight. I was eager towin every round, which I diduntil the sixth round.Francois had a lot of

experience and he got under my skin with his illegaltactics, but at the end of the day in boxing, there has tobe a winner and loser. He is a legend in his own rightand it was an honour to fight him. I was devastatedwhen I lost the fight by TKO; I checked my sugar when Igot back to the changing rooms and it was slightly low.

But, I didn’t complain because I as a person withdiabetes, I had fought hard to be in the position I wasin, to compete with fully able-bodied athletes. At thispoint, I had to leave work and go back to varsity tocomplete the rest of my modules.


Previously, I had to eat at regularintervals to avoid a ‘hypo’, so I feltlike I was playing ‘Russianroulette’ with myself. I now hadmore control of food intake andmy blood glucose levels, but itstill took a while to get thedosages right

15

I know I have a fighter’s spirit at heart. I returned to thering to redeem my loss against Thamsanqa Dube. Hewas a hard-hitting fighter, but I won by third roundknockout. A month later, I had another fight with DanieVenter. I was over confident that I would prevail as thewinner and he caught me with a lovely right hand thatdropped me. I got back up and wanted to carry onfighting, but Harold threw in the towel. He told mehe’d rather have me fightanother day than let me takeunnecessary punishment.

At this point in my career, itwas suggested I drop a weightclass. It was the hardest thingfor me as I had spent mycareer building up myweight... now I had to take itoff. I made many changes to my diet and my runningpatterns, but it was still hard taking off the weight. Ihonestly wish I had a little more fat that I could get rid of,but I didn’t, so I had to start eating into my muscles. Thesmall amount of carbohydrates allowed went well withmy diabetes, but the energy was not there. I fought


Daniel Bruwer six months later in the cruiserweightdivision in preparation for the Nashua Super EightsTournament. My sugar remained slightly high before andafter the fight. I pulled off a victory over ten rounds.

Three months later, I had my first fight againstThabiso Mchunu, a hard-hitting southpaw boxer. Inthe first round, he caught me with a good, straight

left and a flurry of punches.The referee stopped the fight.My camp protested the lossand so I was awarded arematch. Three months later, Istepped into the ring andsuffered a first round defeat.

At this point, I was told toretire, but I decided to just take

a break from boxing. I took my break, but knew theBoxing Board wanted me to go for a brain scan andmedical check-ups before I returned to the ring. A fewmonths later, I started working at Alminic Construction.All the Fogolins helped me in different ways, for which Iam very grateful. Alberto took me to CDE to see a

At this point in my career, it wassuggested I drop a weight class.It was the hardest thing for meas I had spent my careerbuilding up my weight... now Ihad to take it off

biokineticist specialising in diabetes, Andrew Heilbrunn. He hasbeen helping me manage my diabetes.

He explained to me that for the training I was doing, I neededmy blood glucose level to be slightly high at the start, so atthe end of a session it would be normal instead of low. AtThe CDE, I met endocrinologist Dr Debbie Gordon whoadvised me to learn more about carb counting andinsulin correction factors. Diabetes Specialist Nurse,Sanet de Jager helped me to understand these things.She guided me to download electronic apps that helpyou with the carb counting. Sanet advised me to seeMichelle Daniels, a registered dietician for moreinformation on the nutritional management of diabetes.The guys at CDE are a helpful bunch and have helped meto understand and manage my diabetes. They alsofacilitated a great sponsor for me with Abbott DiabetesCare, where I met the lovely Linda Thompson.

So, that is my story... so far... I don’t really know how I achievedall that I have from never boxing to succeeding at a high level.I give praise to the Lord our Father for giving me the life Ihave. I have never seen diabetes as a disability; to meit is simply another of life’s challenges. Throughhaving diabetes, I have met some amazing peopleand I know I will meet many more. I have proved Ican live a normal, healthy and productive life and Ican do anything I want to. In many instances, Ihave done a lot more than many people who donot have diabetes have. This confirms to me thatdiabetes is not a handicap; it is just a manageablesituation.

I intend getting back in the ring. To do that I needa HbA1c of 6.5 %, which will be difficult. But, if itwill get me back to boxing, then I will make ithappen. I am excited about my future. I intendfinishing my course in civil engineering andeventually I would like to open my own company.I am also engaged to Leandra Beyers and I amlooking forward to our journey together!

Lastly, believe in your dreams, even if they don’talways work out quite the way you expect. Mydream was to be a professional basketballplayer and a doctor. Although I have diabetes, Iam happy as a professional boxer studying CivilEngineering. The Lord granted me my dream,not in the way I expected it, but that’s life.Guys, keep your hunger alive and succeed!God Bless.

16


18

The symptoms

Any person with

diabetes who is on

insulin therapy, and some

on tablets, will be well aware of the symptoms of

hypoglycaemia. Early on, one experiences early

warning symptoms including a sensation of acute

hunger, associated with a tremor, sweating and a fast

pulse rate (The release of the ‘fright-flight or fight hormone’

called adrenalin causes these ‘adrenergic’ symptoms).

If no action is taken, this state can then worsen progressively

until there is a loss of control, aggression, confusion and eventually

coma. This late ‘neuroglycopaenic’ (brain-starved-of-glucose) state is then


Back to the Basics of Diabetes –

Hypo (= low) glycaemia (= glucose in blood)

is the term used for a low blood glucose value

Any blood glucose level below 3,9 mmol/l,

in the context of treated diabetes, is

considered to be hypoglycaemia.

This said, many people with diabetes

feel symptoms of low blood glucose at

higher levels and some do not feel

symptoms at all even at very low levels

(called ‘hypoglycaemic unawareness’),

but more about that later...

By Prof Larry DistillerManaging Director, CDE

Hypoglycaemia

19

described as ‘severe hypoglycaemia’

and does not usually occur

unless the blood glucose

drops below 2.5 mmol/l.

Loss of consciousness

(coma) occurs only when the

glucose drops below

1.8 mmol/l –

very low

indeed. At this

point, you will

need external assistance.

A balancing act

People with diabetes who are on insulin therapy

have a difficult path to tread. If blood glucose levels

are maintained too high, the long-term risk of

chronic complications involving

the eyes (retinopathy), the

kidneys (nephropathy) and the

nervous system (neuropathy)

are increased. Consistently high

blood glucose levels may

also play a role in

the development

of heart disease

and increase the risk

of heart attacks. If the blood

glucose is kept too low,

however, then the risk of

hypoglycaemia is

increased. The problem

is that the

complications induced

by constant high glucose

levels take many years to

develop, whereas the fear

of the acute consequences of

low blood glucose is a daily

concern. Many people choose to run blood glucose

levels higher than recommended to avoid

hypoglycaemia. However, in reality this path is wider

than most of us realise, and it is indeed possible to

keep your blood glucose in the range of about 4 to

10 mmol/l provided you follow certain basic rules.

Insulin works! Too much insulin works too well!

It is therefore important to take enough

insulin for ones food and activity

requirements, not more and not less.

Skills for balancingdiabetestherapyand life

It requires certain skills to do this correctly, such as

being aware of one’s own responses to exercise, as

well as the carbohydrate (starch) content of each

meal and adjusting the pre-meal insulin dose

appropriately. A good Diabetes Educator or

dietician should be able to help you work out your

own individual ‘insulin-carb ratio’ to deal with this.

A major cause of hypoglycaemia is taking too

much insulin for the proposed meal, usually when

there is little or no carbohydrate in the meal. We

see this often in people who put themselves on a

‘diet’ without the help of a dietician, and cut out

carbohydrate or cut down their food quantity

without making the necessary downward

adjustments in insulin dosing.

Another very common problem is trying to correct

for the past - In other words, taking more insulin

for a meal if your blood glucose is too high before

that meal. This kind of ‘corrective dosing’ is

possible, but only if you use the correct formula to

calculate how much extra insulin you need to give

over and above the calculated dose for that meal.

Too often people just guess at how much extra

insulin to take and then end up overcompensating.

An even bigger problem is those who test between

meals, find their sugar is a bit high, and then take

extra insulin without realising that the previous

dose of insulin is still in the bloodstream. This

results in ‘stacking’ of insulin and a low before the

next meal. Of course, once your blood glucose

drops too low, the release of adrenalin results in

panic eating. This, plus the body’s additional

hormonal responses to the low, results in a rebound

high and the whole cycle starts again!


You can avoid all of these situations by

understanding the overall action profile of

your insulin/s, including the time to onset

after injection, the timing of the peaks of

insulin activity and the duration of action of your

particular insulin/s. Which insulin type/s do you

use? Speak to your diabetes educator about this

to help you improve your insight.

Treatment of hypoglycaemia

It is always difficult to know how much

carbohydrate you need to take in to combat a

low blood glucose level. This is made more

difficult by the fact that any sugar taken by

mouth will take up to 10 minutes to really raise

the blood glucose level significantly. If your blood

glucose level is ‘a little low’ – say between

3.5 and 4 mmol/l, you can usually counter this by

eating a fruit or by taking a few sips of fruit juice.

Once your blood glucose goes lower than that,

you will need a readily available source of

glucose. 15 g of glucose provided by a few

glucose sweets (e.g. 4-5 Dex4® tablets or


Figure 1: The various insulins used in the treatment of diabetes and their action profilesAdapted from Hirsch IB. N Engl J Med 2005; 352: 177

20

Super C Gums) or by a

glucose gel sachet works

really well and is easy to carry. A sugary

cool drink usually also does the job. Many people

use some form of chocolate but this is probably the

21

worst thing to use to treat a hypo. Chocolate has a

very high fat content - this delays the absorption

of the glucose, so that chocolate can take

over 20 minutes to have an effect

on the blood glucose.

If you do not treat a

hypo in time and

you become

confused,

uncooperative or

unconscious, the best

treatment is an injection

of the natural hormone

antagonist to insulin, glucagon

(Available in a convenient kit on

prescription by a doctor). This is really easy to use, but

there has to be someone else (a spouse, parent,

sibling, child, carer or friend) who knows how to

administer it. Anyone and everyone who is on insulin

should have a glucagon kit at home and other

household members must know where it is and how

to use it. Like a fire extinguisher, you may never need

it, but it should always be at hand, just in case.

Remember to monitor the expiry date and replace it

as needed.

A frequently

encountered

problem is

nighttime low

glucose levels

(nocturnal

hypoglycaemia).

This is much

more likely to

occur with the

use of the ‘older’

insulins but is still sometimes a problem even with

the newer long-acting insulin analogues. In fact,

nocturnal hypoglycaemia is far more common

than we realise, and often one sleeps through it.

Waking with a dull headache, feeling unrested or

experiencing nightmares or night sweats may

suggest an unidentified ‘low’ during your sleep. It

is said that if your blood sugar is below 5 mmol/l

when you wake in the morning, you were

probably too low during the night.

Hypos are preventable -Always find the culprit!

Insanity: doing the same thing

over and over again and

expecting different results -

Albert Einstein

Einstein’s quote could have been about

hypoglycaemia! Successfully detecting and

treating hypoglycaemia is only half the job. The

hypo you have just experienced is a strong predictor

of a future hypo unless you find and deal with the

cause. Whenever you experience hypoglycaemia,

interrogate all the possible reasons and change all

that is in your power to change! Your diabetes team

can be invaluable here and help you to become aware

of reasons that you may not have thought of.

Hypoglycaemic Unawareness

Hypoglycaemic unawareness is something that occurs

when you have had too many hypoglycaemic

episodes, or if you are tending to run your blood

glucose levels too low for too long. Your body then

gets used to low glucose levels and ‘resets its rheostat’

so that you no longer get the symptoms of a low

glucose. In this very dangerous situation, you can go

from feeling perfect to confusion and even a coma

without any warning. The correct treatment of this

condition is to run glucose levels consistently above

8 mmol/l, far higher than usually recommended and

strenuously avoiding any low glucose levels, for about

4-6 weeks. This allows your body to regain its

recognition of lower glucose levels again and you

usually will regain awareness of falling glucose levels.

The opposite occurs when someone has high,

uncontrolled glucose levels for a prolonged period.

Since now the body’s ‘rheostat’ is set higher and you

are used to constant high glucose levels, a drop

down to even 8-10 mmol/l can cause symptoms of

hypoglycaemia even though your blood glucose is

still higher than is healthy. We call this ‘relative

hypoglycaemia’ and treat it by bringing your

glucose levels down very slowly, over several weeks.


22

Alcohol and Hypoglycaemia

Alcohol is metabolised (broken down) by

your liver. While your liver is

performing this process, which can take

many hours to complete, it cannot

release glucose into the bloodstream

to compensate for falling blood

glucose levels. Thus, it is common

for people on insulin to

experience a severe hypo, even a

coma, 6-10 hours after

an alcohol binge.

Other than

avoiding alcohol,

there are ways to

cope with this, and

allow someone on insulin to

drink moderately and safely –

but we will deal with this in

detail in a future article.

Driving and hypoglycaemia

Driving whilst hypoglycaemic is no different from

driving whilst drunk. Regard driving with diabetes

as a privilege and not a right. Your ability to drive

safely will depend on your ongoing, active efforts.

You also need to be open to the possibility that

your fitness to drive may change temporarily, or

permanently, based on your risk profile.

Hypoglycaemia unawareness certainly would be a

legal impediment to driving.

• Maintain full insight into your blood glucose

trends by monitoring your

blood glucose

regularly, at least

twice daily and

before and whilst

driving;

• Check your

blood glucose

and ensure that it

is in a safe range

before getting

behind the wheel.

You shouldn’t drive if your blood glucose is less

than 4 mmol/l or if you are aware that your

blood glucose is on a rapidly descending trend;

• Test your blood glucose at least every four hours

during long drives and more frequently if the

trend isn’t stable;

• Stop driving, test and treat yourself

immediately if you suspect hypoglycaemia

and/or impaired driving.

• A very tough, but vital point, is that you must

not drive for 45-60 minutes after effective hypo

treatment (i.e. blood glucose back in your

target range) of non-severe (i.e. not requiring

assistance) hypoglycaemia. A blood glucose

value in the normal range doesn’t mean that

your brain glucose and brain function are back

to normal...

Maintaining reasonable glucose control while

avoiding hypoglycaemia is much like crossing a

bridge. You do not need to fall off the left side of

the bridge to avoid falling off the right side. The

trick is to learn to walk down the middle of the

bridge - it is wider and safer than you think...


Novo Nordisk (Pty) Ltd. Reg. No.: 1959/000833/07. 345 Rivonia Boulevard, 2nd Floor, Building A, Rivonia, 2128. Tel: (011) 202 0500 Fax: (011) 807 7989 www.novonordisk.co.za NDG/P56334/04/2014/ver1.

Visit glucagon.co.za for more information

Gluten is a protein consisting of a mixture of glutelin and gliadin, found in

many staple foods in the Western diet. It is found in wheat and other cereal

grains, including barley and rye and in processed foods made from these grains.

Gluten gives elasticity to dough helping it to rise and to keep its shape.

Some individuals can be gluten sensitive or

gluten intolerant. After ingesting gluten,

these individuals can experience nausea,

abdominal cramps, chronic constipation

and diarrhoea, failure to thrive (in children),

anaemia and fatigue. Coeliac disease or gluten

intolerance is caused by both genetic factors and

environmental stimuli. It is an autoimmune

24


By Ria Catsicas - Registered Dietician, Nutritional Solutions

condition (where your disease-fighting white

blood cells attack your own tissues), that causes

an immune reaction to the protein fractions in

certain grains including:

• glutenin and gliadin found in wheat,

• secalin found in rye,

• hordein found in barley, and

• avenin found in oats

Gluten Intolerance/ Coeliac DiseaseGluten Intolerance/ Coeliac DiseaseGluten Intolerance/ Coeliac Disease

In coeliac disease,

eating gluten and

other similar protein

fractions also triggers

your white blood cells to

attack the lining of your small

intestine, causing inflammation. This

damages the lining of the small intestine and

flattens out the villi (tiny, finger-like

protrusions on the internal walls of the

intestines), which absorb nutrients from the

food we eat. Damage to the villi results in

digested food not being absorbed properly,

which in turn leads to symptoms of malabsorption

of a wide variety of nutrients. Long-term, this

inflammation can result in ulceration, narrowing or

increased risk of certain cancers of the small bowel.

People with type 1 diabetes are at increased risk for

coeliac disease, with prevalence rates ranging from

5 to 10 %. In some people, it may be asymptomatic.

Screenings for coeliac disease at the diagnosis of

type 1 diabetes and again every 2-3 years, or if

bowel symptoms develop, is thus recommended.

We often hear people saying that they are ‘gluten

intolerant’ when they experience indigestion, a

bloated feeling or constipation. While it is

very important to diagnose the condition

in those who have it, diagnosis cannot

be taken lightly. Following a

lifelong gluten free diet is

expensive and restrictive and

needs full adherence for the

healing of the villi to take place

and for maintenance of bowel

health. If you experience any of the

troublesome symptoms described, do not

‘self-diagnose’. Once you have started

the gluten free diet, all diagnostic

tests for the condition lose their

usefulness. Importantly, other

medical conditions can also cause

these symptoms. Bloating can

often be the result of a lack of

fibre and too many refined

carbohydrates (I.e. sugar and

white-flour products) such as

breads, Prego rolls, Shawarmas,

pizzas, or wraps in your diet

So, to confirm if you are truly gluten

intolerant and require a gluten free diet, you

need to be tested by a medical doctor. Because of

the major implications of a diagnosis of coeliac

disease, professional guidelines recommend that

a positive antibody blood test be followed by an

endoscopy. This is a minimally invasive procedure

using a long, thin, flexible tube with a light and a

video camera to examine the interior surfaces of

the gut. During the procedure, biopsies (samples)

of the bowel wall are taken for microscopic

examination – this remains the gold standard in

the diagnosis of coeliac disease.

25


wheat, gluten, gliadin, couscous, pasta,

macaroni, spaghetti, wheat sorghum,

muesli, pretzels and bread crumbs (See the

list of foods allowed and what to avoid in

Table 1).

3. You can use corn, rice, soybean, millet and

buckwheat flours as alternatives in cooking

and baking.

The following are suggested substitutions

for 1 cup of wheat flour in recipes:

• 1 cup corn flour

• 5/8 cup potato flour

• 7/8 cup rice flour

Consult a registered dietician, who can help

you create a gluten-free eating plan that will

meet your requirements for energy as well as

for all macro- and micronutrients. The

dietician can also assist with sample menus

and a shopping list to assist with this major

lifestyle adjustment. It is advisable that during

the first few weeks of gluten omission, you

should take a vitamin and mineral

supplement to replenish nutrient stores that

were lost before you started the gluten-free

way of eating. It is also important to

remember that fluid and electrolyte

replacement is essential when you experience

severe diarrhoea.

The following local gluten-free products can

be obtained from selected

pharmacies and health shops:

Nature’s Choice

• Gluten-free raw muesli

• Gluten-free cereals and grains

• Gluten-free oats

• Gluten-free bread mixes

• Gluten- free flours

• Gluten-free pasta

• Buckwheat Flour

Health Connection Wholefoods

• Gluten-free muesli

• Organic buckwheat flour

• Stone-ground buckwheat flour

• Potato flour

Figure 1: Biopsy specimens of normal villi (above) andflattened villi in coeliac disease (below)

Nutritional Treatment

Treatment of coeliac disease requires removal of all

gluten and related protein fractions from your diet.

1. Replace all oats, wheat, barley

and rye with alternative grains

such as corn, corn flakes, corn

flour, maize, maize flour, rice,

rice flour, rice cakes, puffed rice,

wild rice, potatoes, potato flour,

sweet potato, sago, polenta,

lentils, pea flour, sorghum flour,

popcorn, unprocessed soy

beans, dried peas and

beans, millet and

buckwheat.

2. Read the labels of

all food products

carefully and

avoid foods and

products that

contain wheat,

wheat flour,

wheat germ, rye,

barley, semolina,

couscous, spelt, durum

26

27


Milk Fresh, powder, evaporated or condensed milk, cream, Malted milk, some commercial chocolate drinks, some

sour cream, whipping cream, unflavoured yoghurt, non-dairy creamers, yoghurts with added ‘crunchies’

buttermilk or toppings

Meat, Fish, Poultry All kinds of fresh meats, fish, other seafood, poultry, fish Prepared meats that contain wheat, rye, oats, or barley such

canned in oil or brine and some meat products prepared as some sausages, luncheon meats, chilli con carne,

without flour e.g. lean ham, silverside roast beef sandwich spreads, bread containing products such as

crumbed schnitzels, croquets, meat loaf, polony, Vienna’s,

battered crumbed fish and chicken portions

Eggs Plain or in cooking Eggs in sauce made from gluten containing flours

Cheeses All pure unprocessed cheeses All processed cheeses containing any of the forbidden flours

Potato , Rice, Other Starch Potatoes and sweet potatoes, all types of rice, corn on the All grains such as oats, wheat, pearl wheat, barley, rye, spelt,

cob, corn and gluten free pastas, polenta, corn tortillas, bulgur wheat, couscous and products made from these flours,

parsnips and turnips. Legumes such as lentils, all types of such as pasta, breads etc.

dry beans [not canned] as well as chickpeas, dry peas,

millet, and buckwheat

Vegetables All fresh, frozen and canned vegetables Vegetables in gluten containing sauce or gravy

Fruit All fresh, frozen, canned and dried fruit, all fruit juices and Pie fillings (often thickened with gluten containing flour),

some canned fruit dried fruit dusted with flour

Breads Specially prepared breads using allowed flours e.g. gluten All others containing wheat, rye, oat or barley flour

free bread, potato flour bread and corn bread

Cereals Hot porridge made from mielie meal and cereals made All other cereals containing wheat, rye, oats and barley e.g.

from rice or corn e.g. Cornflakes, Rice Crispies All Bran, Muesli, ProNutro etc.

Flours & Thickening Agents Corn starch, tapioca starch, corn flour, potato flour, All flours containing wheat, rye, oats and barley

potato starch, rice flour, soy flour

Crackers and Snack Food Rice cakes, rice wafers, popcorn and potato chips, All others containing wheat, rye, oat or barley flour

corn crackers and multi-grain corn thins e.g. matzo, croutons

Grains Buckwheat, Corn (maize), millet, quinoa, sorghum, Wheat (bulgur, couscous, durum, semolina, spelt,

soybean (soya) wheat germ), rye, barley, oats

Beans & Legumes Fresh, dried, or canned (no flavourings or sauces added), Check the labels for added ingredients - sauces have gluten

all types of beans, chick peas, lentils, edamame beans

Food Group Foods Allowed Foods To Avoid

This diet is designed to provide adequate nutrition while eliminating wheat, rye, oats and barley from the diet. Gluten may be present

in foods either as a basic ingredient [listed as wheat, rye, oats or barley] or added as a derivative when food is processed or prepared.

Thus reading labels carefully is vital. Since flour and cereal products are quite often used in preparing foods it is important to be

aware of the methods of preparation as well as of the foods themselves. This is especially true when dining out.

Table 1: Gluten / Gliadin Restricted Diet [Wheat, Rye, Oats, And Barley Free]

28

Ihave had type 1 diabetes since I was 18 months old.My parents and I went through all the ups anddowns that happen when there is someone in thefamily with diabetes. We weathered it well and got

it right most of the time. I survived my school yearsand then went to ’varsity to study a B Sc in FinancialMaths with the intention of someday working in aFinancial institution.

I am from Rustenburg, so starting at University meantI had to move into ‘digs’. Now I had to watch my owneating and manage my diabetes without the goodfood my mother used to prepare for me (although shedid send pre-prepared food back with me after I hadbeen home for a visit). In my first year, I noticed that Idid not gain any weight although I would haveexpected to. I thought it was just that I was in adifferent environment and not eating the same way Iused to. On top of that, I was just so tired all the time.The course I had chosen to study was a difficult one,and the tiredness was affecting my studies andmaking it more difficult. I wasn’t doing as well asusual. I wondered if my diabetes caused it, yet thishad not happened before, and my blood glucoselevels and HbA1c were reasonable. My stomachhowever gave me many problems – it was alwaysuncomfortable in some way. I saw my doctor inRustenburg. He was concerned and sent me to see aSpecialist Gastroenterologist. He did some blood testsand found that I had an almost zero white blood cellcount. He did a gastroscopy and could see what theproblem was immediately.

So in the February of my second year at ‘varsity, whenI was 22 years old, I was diagnosed with coeliacdisease. My journey with two chronic conditions hadbegun. It was a real shock and I resented that I shouldhave another condition to take care of. As if it wasn’tenough that I had diabetes! At first, I didn’t reallyunderstand what coeliac disease was. I was given abasic explanation and told I couldn’t eat gluten...

I didn’t know what gluten was, so how was I supposedto not eat it! I went home and ‘Googled’ it tounderstand it better. I went to see a dietician and she

gave me all the things I couldn’t eat. I felt even worsethen, even angry! It was bad enough that I wasrestricted in what I could eat with diabetes and now Iwas restricted a whole lot more. It felt like there wasnothing I could eat. I became sad and was emotionalabout everything. I felt like everything was goingagainst me! I think I gave my family and my girlfrienda hard time as I took out my frustrations on them.But, they were worried too and they were reallysupportive. They had to learn what foods and snacks Icould have as well.

I started to eat the gluten-free foods and gradually, Istarted to realise that my stomach felt a lot betterwhen I ate correctly. If I ate the wrong foods, I wouldsuffer the consequences. For example, I once ordereda gluten-free pizza at a restaurant, and the waiterforgot to order gluten-free – so I ate a regular pizza. Ifelt really sick for the next 2 days. Now I always checkwith the waiter when the food arrives – “Is thisdefinitely gluten-free?” I went to Ocean Basket onceand thought I would be safe to order a piece ofgrilled fish. I discovered that they put flour on theirgrilled fish so it wasn’t as safe as I thought. Now Ispecifically ask them not to put flour on my fish andcheck that they have done as I asked when the foodarrives. So, I can still enjoy a meal out, as long as Ichoose what I eat carefully. I can still eat all thehealthy vegetables and enjoy those. Now that I amused to this new way of eating, I enjoy it. Quite a lotof gluten-free products are available these days andthat helps a lot when deciding what to eat.

I have just started my 2nd year with this condition andI am doing a lot better. I have gained two or threekilograms in weight and my last HbA1c was 7 %. Mymother has taught me to cook gluten-free food andto use spices for flavour. I can make a chicken curry,pasta, rice and potatoes and some other vegetablestoo. Every now and then, a family member will findsomething new that is gluten-free and they will pass iton to me.

I would like to thank my parents, brother, grandmotherand girlfriend for the endless support they have givenand for not giving up on me. Without them, I doubt Iwould have been able to get through it as I did. I alsorealized that with time and confidence, things alwaysturn for the better, so I just needed to hang in there...

All this and Coeliac disease too...


By Prashant Narotam

Dry beans: The nutritional powerhouse3 cups of goodnessAccording to the Dry Bean Producers’Organisation, research has found that eatingdry beans on a regular basis (nearly three cupsa week) can prevent many illnesses such asheart diseases (cardiovascular) and certaintypes of cancer. Consuming dry beans oftencan also help to reduce high blood cholesteroland the risk of developing diabetes mellitus.

Stay lean with beansIntroduce dry beans to your diet if you wantto beat the bulge or maintain your desiredweight. An added benefit is that dry beanshelp to slow down the ageing process as theyare rich in antioxidants.

10 reasons to love beansDry beans …1. offer excellent value for money.2. contain essential minerals and vitamins.3. are low in salt and fat content.4. are high in dietary fibre.5. are rich in antioxidants and protein.6. are cholesterol-free 7. control blood sugar.8. are versatile and delicious.9. have a long shelf live.10. store easily.

Bake with dry beansBean Renaissance: The Intelligent Food Choice is abook that offers an array of healthy and easyto make recipes. This A5 full colour publica-tion sells for a mere R35 and can be obtainedby calling Lena du Toit on 012 819 8100 or bysending an e-mail to [email protected]. Therecipe book is also available in Afrikaans.

WIN!! Five lucky readers can each win a copy of BeanRenaissance: The Intelligent Food Choice. Simply tell us howoften you consume dry beans: Monthly, weekly, daily ornever. E-mail your answer to [email protected].

Didyou know that drybeans have disease

preventative propertiesand can thus reduce the

risk of developingmany modern-day

diseases?

30


By Chantelle Olivier

In April 2013, my 8-year-old

daughter Danielle was diagnosed

with both type 1 diabetes and

immune dysregulation syndrome

(IDS). When her blood was tested for

GAD65 antibodies, her score came

back as a high 51. This confirmed the

diagnosis of type 1 diabetes.

Fortunately, we had a good

This is the short story of three family members with diabetes.

I, Chantelle (age 34), was diagnosed with diabetes in January

2013. I also have a genetic disorder called cystic fibrosis, an

inherited condition characterized by the build-up of thick,

sticky mucous that can progressively damage many organs

including the respiratory and digestive systems. Difficulty

with breathing, worsened by frequent lung infections, is the

most distressing symptom. Cystic fibrosis can also cause

scarring and cyst formation in the pancreas, which often

leads to diabetes in adulthood, which is what happened in

my case. Most people with this condition only live up to the

age of 35 years although some have lived up to 60 years.

31


paediatrician who knew what to do next for both the diabetes and the IDS.

Danielle has to have insulin for the diabetes and receive intravenous blood

plasma transfusions every 3 weeks for the IDS.

And then in May, my 6-year-old daughter Danika was also diagnosed

with both type 1 diabetes and immune dysregulation Syndrome.

Her GAD65 antibody level was 106. Both the girls will probably

need bone marrow transplants later in their lives.

So, in a very short space of time, all 3 of us developed

diabetes. My first thought was “How are we supposed to

cope now?” We have to face each day and deal with the

high and low blood glucose levels that we encounter. We

are all in the ‘honeymoon phase’, the temporary period

that may follow initiation of insulin treatment for

diabetes following diagnosis. The few remaining insulin-

producing beta-cells in the pancreas that have not yet

been destroyed produce unpredictable amounts of insulin

for a short time. This can make things complicated. On

one day or for even a week at a time, we get good

readings of our blood glucose levels and on other days it is

like a horror show with readings of 29 mmol/l.

With all of this to take in to consideration, we still have a

positive outlook in life. Although it’s not always easy for us,

we still make jokes and still smile at one another. My husband

and I taught the girls from the first day they were diagnosed to

test and inject themselves. This was an important step, as I am

often hospitalized for days to get treatment for cystic fibrosis and

they have to manage it themselves for that time.

My message to them is always to live “in spite of” and not “because of” our

condition. On the other hand, I can be very hard on them. They cannot say, “But

Mommy, but you don’t know or don’t understand how I feel!” I know exactly!

We play games such as ‘match the sugar’ or ‘guess your number’. It creates big

giggles in our house if they guess the blood glucose results right, as if they told the meter

shortly before testing what the results should be.

Sometimes it is really hard because of the Immune Dysregulation Syndrome - the girls pick up infections

very quickly. Just a sneeze from someone and they can get pneumonia from the bacteria released into the

air. And, when they have these frequent infections, they get high blood glucose levels.

You might say that all this is difficult. We look for ways to see it as a blessing too. Can you imagine all of

this going on with only one child - who would get all the attention and treatment? The other would be sure

to feel it. This way, we are all treated the same! Our girls are a real blessing to us. Life is not easy, but we

have made it possible!

32

The beginning of the year is always a time to reflect onachievements of yester years, but it also presents us with anopportunity to start afresh and chart the road ahead.

For the Bongi Ngema-Zuma Foundation, 2014 leads us into ourthird year of operation since our launch. In this period, we havetouched millions of South Africans through media andcommunity outreach programmes that directlytouch citizens.

From inception, we were veryclear that our focus would be onthe Black population, whereinformation about diabetesremains scant. We have beentouched by how ordinarypeople in South Africa havereacted, indicating thatindeed information ondiabetes was sorely missed.Also, the attention wereceive from internationaland multi-lateral institutionssuch as the InternationalDiabetes Federation (IDF) hasonly proved that the world family isunited on the fight against diabetes.

We however still face manychallenges of diabetes in South Africa.The context for understanding thechallenges we face in our country, inrelation to diabetes, should be seen inthe broader socio-economic context.

South Africa: an unequal society

South Africa is populated by close to 52 million inhabitants,51.3 % of which are female. Black Africans make up 79.2 %(more than 41 million) of the population; coloured (mixed race)and white people each make up 8.9 % of the total; and the

Indian / Asian population accounts for 2.5 %. ‘Other’population groups make up 0.5 % of the total.

Among the greatest socio-economic challengeswe currently face as a nation are the triple

challenges of inequality, unemployment andpoverty. South Africa is also a country of the

haves and the have-nots, counting as theworld’s most unequal society. Manybefore me have called South Africa acountry of two nations – one living in thedeveloped world and another stuck in theThird World. Many of the Black majoritylive below the poverty line. Land

ownership and virtually the rest of thedevelopment and growth indices and access

to education and information naturally followthe same pattern. We believe this forms the crux

of the challenges we face even when it comes tothe diabetes pandemic.

HIV and AIDS

Add to these the fact that, as much as we are steadilyturning the tide, South Africa remains the country with thehighest prevalence of HIV and AIDS. But, thanks to our

A Brighter Future on theHorizon for DiabetesBy Madam Bongi Ngema, Patron of the Bongi Ngema-Zuma Foundation

33

government, we are also now the world’s beacon when itcomes to the rollout of antiretroviral treatment, with theworld’s largest and most comprehensive treatmentprogramme. However, because our nation dedicated the bulkof our attention and resources to addressing HIV and AIDS,non-communicable diseases (NCDs) such as diabetes took theback seat.

It took a while for diabetes to feature in the country’s topfive health risks or killers – including HIV and AIDS, TB, aswell unnatural causes (murders and road accidents). Becauseof this reality, one might say that the urgency of diabetes wasnot seen.

Let’s win the war against diabetes

Of the world’s estimated 382 million people living withdiabetes, about 20 million are in Sub-Saharan Africa.

Of these, roughly 4.5 million people in South Africa livewith diabetes and four million people are at risk ofdevelopment of complications from this condition. The biggestchallenge is lack of awareness and information about thecondition, its treatment, positive lifestyle and exercise as wellas management and care. These are exactly what myFoundation seeks to tackle head-on.

South African academics, Prof Bongani Mayosi, et al, in aLancet series article on “The burden of non-communicablediseases in South Africa” (Vol. 374 September 12, 2009),point to a disturbing trend. “Cardiovascular disease, type-2diabetes, cancer, chronic lung disease, and depression arethe major non-communicable diseases now reaching epidemicproportions in the former socialist states and low-incomeregions of the world.”

They identify low quality of healthcare, an uneven access toservices, poverty and insufficient quality education as amongthe contributing factors. The skewed focus, albeit criticallynecessary, on HIV and AIDS as well as tuberculosis hasmarginalised prevention and treatment of NCDs in South Africa.

More worrying is the assertion in the paper that, “Theburden of disease related to non-communicable diseases ispredicted to increase substantially in South Africa over thenext decade if measures are not taken to combat the trend.”

Estimates by the World Health Organisation place the

burden from NCDs in South Africa at two to three times higherthan that in developed countries and on par with countries thatfall into the highest quintile of burden.

Of course, the poor are the hardest hit. As the authors find,these diseases are on the increase in rural communities in SouthAfrica. They affect poor people living in urban settingsdisproportionately and are driving rising demand for chronicdisease care. “non-communicable disease is rising for poorpeople, and child mortality is twice as high in the rural EasternCape province compared with the more urban Western Cape,and four times higher for black than for white individuals,” theauthors write.

It is clear that the individual, societal, financial, and politicalcosts of South Africa’s huge burden of disease are overwhelmingthe country’s resources.

While at it, it seems to me we need a new revolution onhealth awareness in general. For this is not simply a problem forthe poor. Mayosi, et al, also indicate that analysis of data fromSouth Africa has shown an increase in the prevalence ofhypertension and obesity with increasing wealth.

As the Proposed Outcomes for the United Nations High-LevelSummit on NCDs indicate, leadership is as important asprevention, management and treatment in the fight againstNCDs. This calls on us all to take a holistic approach in dealingwith NCDs and to address social determinants, includingpoverty, as we scale up our public health systems.

Failure of stewardship in health, which will undermine thecountry’s ambitions to ensure economic prosperity and socialcohesion, is not an option. Together let us win the war againstNCDs generally and diabetes in particular. Let us work togetherto turn the tide of this silent mass killer, and refocus our resourcesand energy to build prosperous nations.

Extracts adapted from Madam Bongi Ngema-Zuma’ s speech atthe IDF Melbourne World Diabetes Congress 2-6 December 2013

BONGI NGEMA-ZUMA FOUNDATIONTelephone: 011 056-4182Email: [email protected]: www.bnzfoundation.org.zaFacebook: www.facebook.com/BNZFoundationTwitter: @BNZFoundation

HEALTHY CHOICES

Introduced by Michelle Daniels

Registered Dietician, CDE Houghton

With the year in full swing, you may have

many good intentions of eating healthily

along with improving your exercise

frequency. But, the demands of work and

school are already taking their tolls and

thus begins the juggling act of time and

food preparation.

Healthy eating should be simple. Try to

incorporate a food item from each of the

food groups at each meal to ensure it is

balanced. The two meals presented here

would constitute balanced fare.

34

Ingredients• 8 medium potatoes in the skin

• 3 tbsp (45 ml) sunflower oil

• Black pepper to taste

• ½ tsp (2,5 ml) salt

• 1 tsp (5 ml) dried thyme or rosemary

• 6-8 cloves of garlic, peeled

Method1. Preheat oven to 180 °C.

2. Cut potatoes into wedges and place in a bowl.

3. Mix the rest of the ingredients and pour over the

potatoes. Mix well to coat the potatoes with the oil.

4. Place in a single layer on an oven tray. Bake for

30-45 minutes or until golden brown and crispy.

Oven Baked ChipsRecipe from Keneoe Moroa

Serves 8

HEALTHY CHOICES

Ingredients

• 2 tbsp (30 ml) lemon juice

• 2 tbsp (30 ml) sunflower oil

• 2 tbsp (30 ml) chopped Fresh origanum

• ½ tsp (2, 5 ml) salt

• Black pepper to taste

• 500 g leg or shoulder of Pork, all fat removed and cut into cubes

• 1 onion, cut in pieces

• 1 green or red pepper, seeds removed and cut into pieces

• ½ a pineapple cut into pieces

Method

1. Mix lemon juice, oil, origanum, salt and pepper.

2. Place meat in a shallow dish and pour marinade over. Stir through to coat

the meat.

3. Marinate for 30 to 60 minutes.

4. Thread meat with onion, pepper and pineapple onto sosatie sticks.

5. Braai over medium coals for 8-10 minutes on each side or until the meat is

cooked, but still juicy.

35

Recipe from Ria van WykServes 4-6

Pork Sosaties

This healthy alternative to

deep-fried chips will make a

suitable accompaniment to

the sosaties. You could replace

the potatoes with sweet

potatoes, butternut or even a

mix of the two. When time is

short, you can boil or

microwave the potatoes until

almost tender and then cut into

wedges. They will then require

baking for only 20 minutes.

Experiment with replacing the

herbs with paprika, curry

powder or turmeric.

*Remember to keep your

portion size small to prevent

sending your blood glucose

levels too high.

Tips

1. Fry the sosaties over a medium

heat in a frying pan using the

marinade. The marinade can

be used to make chicken or

fish sosaties.

2. If available, dried prunes or

apricots are delicious on these

sosaties.

3. Add 1 tsp curry powder to the

marinade, if preferred.

This is a quick and easy recipe,

easily prepared on a braai

outside or done over a grill

indoors. You could omit the

pineapple and replace it with a

larger variety of vegetables such

as button mushrooms, cherry

tomatoes, celery, and even

baby corn.

Five years ago, I had this crazy idea to quit my

job and make ice cream for a living. I had

learned the craft from Gelato masters while I

was living in Sicily and then later in Buenos

Aires, which has an ice cream parlour or

“heladeria” on virtually every block.

I loved the ice cream, and the culture of ice cream

in these two countries. In Sicily, I used to see men

in suits stopping to buy an ice cream for breakfast

while on their way to work. In Buenos Aires,

families would gather at “heladerias” enjoying

artisan ice cream until well after midnight. I

wanted to see that in South Africa, so I came

home and started up a small ice cream

business here.

The ice cream was good. I made

ultra high-calorie, double

cream chocolate, caramel,

pistachio and peanut butter

flavours. But, one day I came

home and found out that my

eleven-year-old nephew had

been diagnosed with type I diabetes. It made me

rethink what I was doing with ice cream.

I called my nephew to talk about this turn of

events. He said that what worried him most about

having diabetes was that he would have to quit all

his favourite foods like burgers, fried chicken and

chips. Worst of all, he wouldn't be able to eat my

ice cream any more.


By Stuart Graham


I said “Listen man, don't worry. I'm going to make

an ice cream that'll be approved for anyone with

diabetes and it will be so good that everyone else

will want to eat it too.”

I didn't realise what I was getting myself into...

I called Diabetes SA, who put me in touch with

their nutrition tester at the Glycaemic Index

Foundation of South Africa (GIFSA).

I chatted to GIFSA's chief nutritionist Liesbet

Delport, who told me that for the ice cream to be

approved as suitable for people with diabetes, it

would have to meet a number of strict parameters.

It could have no more than three percent of

saturated fat, the cholesterol and sodium content

would have to fall within a certain range

and I could add only a certain

amount of a sugar. I could add no fructose to the

ice cream. It would have to be sent to the GIFSA in

Nelspruit for a glycaemic index (GI) test.

The Glycaemic Index (GI) is simply a ranking of

foods based on their immediate effect on blood

glucose levels. It is a physiological measure of

the rate at which carbohydrate-rich-foods affect

blood glucose levels, after they have been

eaten. Adapted from the GIFSA Website and

The South African Glycemic Index & Load Guide,

by Gabi Steenkamp & Liesbet Delport

(Registered Dieticians)

37


Once I had a recipe I was happy with, the ice

cream would also have to be Nutri-tested by a

laboratory like the Council for Scientific and

Industrial Research (CSIR).

In my research, I found out from GIFSA and other

nutritionists that diabetes is on the increase at a

rate of around 11 percent per annum. There is

talk of it being an epidemic, mainly due to a high

GI, high fat diets, increasingly sedentary

lifestyles, and increased stress and smoking. High

salt, high fat, high sugar foods contribute to

obesity, attention problems in children, high

blood pressure, strokes, high cholesterol, heart

diseases, asthma, depression and sleep disorders.

I read a recent report, published by the Centre of

Metabolic Medicine and Surgery (CMMS), which

found that 66 percent of women and 33 percent

of men in South Africa are overweight.

Another frightening fact is the high level of

obesity among children. It is estimated that one

in five South African children is either

overweight or obese, due mainly to poor diet

and lack of exercise.

The more I read and spoke to the experts, the

more I realised how a portion-controlled, low GI

way of eating (with some help from your dietician

and diabetes educator) could be an effective tool

to help lower and control blood glucose. And, low

GI eating wasn't just good for people with

diabetes. It was a better way of life, for everyone.

I worked through hundreds of kilograms of ice

cream mixtures trying to get my recipe right. I

had used all the low GI ingredients I could find

like whey powder, fruit fibre, carrageen seaweed

extract and carob powder from the carob tree. I

blended it into milk with a splash of cream for

taste. I still wanted the ice cream to taste like

authentic ice cream. I had also discovered an

innovative low GI sugar called isomaltulose,

derived from sugar beets. Research has found

that isomaltulose does not cause blood glucose

spikes like sucrose (table sugar) and provides

sustained energy.

After about two years, I finally had something

with which I was happy. And so, Wilfredo's ice

cream was born.

I sent it to GIFSA for GI testing. The Foundation

measured how fast and to what extent Wilfredo's

ice cream would affect a person's blood glucose

levels. Glucose (GI of 100) is used as the reference

standard. Foods that score below 55 on the index

are rated as low GI.

38

5 sec

0.5 µL

No limit in memory

LED indicator

Application in APP Store

No Coding

Power Display & Interface from iPhoneCurrently under development for Andriod Smart phone.

Smart review

Smart management

Smart testing

I was astounded by the results. The GI of

Wilfredo's ice cream was 24. Additionally, GIFSA

recommends that people keep their glycaemic

load (GL) below 100 per day. The glycaemic load

of the ice cream was 3 per 100 g portion.

“The glycaemic load (GL) of a specific food

portion is an expression of how much impact

(“oomph”), or power the food will have in

affecting blood glucose levels. It is calculated by

taking the percentage of the food’s

carbohydrate content per portion and

multiplying it by its Glycaemic Index value

GL = CHO content per portion x GI

100

It is thus a measure that incorporates both the

quantity and quality of the dietary

carbohydrates consumed” (GIFSA).

Both GIFSA and Diabetes South Africa approved

Wilfredo's ice cream!

I called my nephew and said,

“It's time for you to eat some

ice cream!”

I launched the ice cream in Cape

Town at the start of 2013, and the

response was incredible. Wilfredo's

sales were higher than their

regular ice creams in a number of

stores. We received fan mail from

mothers of children with attention

deficit hyperactivity disorder

(ADHD), those on slimming diets,

people with diabetes, athletes and

grandmothers who were so happy

with the ice cream.

Now, not only was my nephew

happy, but we had succeeded in

rolling out an ice cream that

everyone could enjoy.

Wilfredo's ice cream is available in eight flavours

(Vanilla, strawberry, cinnamon, mint, coffee mocha,

passion fruit, toffee and lemon) and is packaged in

175 ml tubs. Currently, it is available in Durban and

Cape Town. From September, it will be available in

Johannesburg.


Table 1: Typical Nutritional Information per 100 g

Energy 429 kJ

Protein 4.9 g

Glycaemic carbohydrate 11 g

• of which total sugar 11.4 g

Total fat 4.1 g

• of which saturated fatty acids 3.0 g

• of which monounsaturated fatty acids 1.0 g

• of which polyunsaturated fatty acids 0.1 g

Cholesterol 12 mg

Dietary fibre 0.1 g

Total sodium 48 mg

40

42

43

In previous articles, we investigated the steps we

could take to ‘open up’ the ‘Public Self’ pane of your

Johari window by asking for and receiving feedback

(making the ‘Blind Self’ smaller) and through self-

disclosure (making the ‘Private Self’ smaller). This

article will challenge you to work on making the

‘Unknown Self’ pane of your Johari window smaller.

The Unknown Self: Neither you nor

others in your life can see this part of

you which may include feelings,

behaviours, attitudes or capabilities. It

may also include deeply hidden aspects

of personality or talents that may be

useful if uncovered.

“Who in the world am I? Ah, that's the great puzzle.”

Lewis Carroll, Alice in Wonderland

Self-discoveryTHE ROAD TO

By Hendrien van Zyl, Learning Solutions Specialist

44

2. Dream about the future – it can

fuel your inspiration and give

direction to your discovery and

personal growth.

• What do you want more of:

money, recognition, or free time?

• What do you wish to avoid

the most?

• For what are you craving?

• If you could have coffee with a

famous person, real or fictional,

who would it be? What will you

ask them?

• If you won the Lotto and became

a millionaire overnight, how

would your life change?

• Do you think you are operating

at 100 % capacity?

• What is the one dream that you

have hidden away, for the

moment? How come?

• Describe this dream to someone

close to you.


So how do we access those potentially useful

parts of ourselves?

1. Reflect on the past - have the courage to be

totally honest.

• What gives you joy?

• What in your life, do you find utterly boring?

• What are you really good at?

• What are the qualities that empower you

to achieve?

• What are the qualities that help you to

deal with challenges and emergencies?

• What is the best compliment you have

ever received?

• What is one thing you’re deeply proud of,

but would never put on your CV?

• What is the most out-of-character choice

you’ve ever made?

• Is there something on which that people

consistently ask for your advice? What

is it?

• If you could sit down with your 18-year-old

self, what would you tell him or her?

• If you were to die today, what would you

regret most?

• What will people be saying during the

eulogy at you funeral?

• How do you celebrate your

achievements?

• What is one mistake you keep repeating?

• What’s the hardest thing you ever had to

do - and why?

• When was the last time you amazed yourself?

45

3. Practice gratitude.

Grateful people radiate

positivity and

appreciation. Their

words and voices sound

different and they

attract positive people

and experiences. You

will start to care less

about what is missing

and learn to appreciate

the value of your

personal gifts and

talents. Gratitude makes

you listen with an open

heart to others. This is a

prerequisite to

enrolling the

support of other

people in your

journey of self-

discovery.

4. Enrol the support of an accountability

partner. If you are conditioned to be a

self-sufficient perfectionist, ashamed to

admit that problems exist, you are

stifling your ability to discover yourself

and grow. Allow yourself to receive

emotional support and to learn

from a mentor, family member or

friend. Even if they do not have

diabetes, they have faced their own challenges

and conquered their own demons. Learn from

their experiences and extract what you can apply

in your own life and unique

circumstances. We need lots of support

when we are reflecting on the past and

start changing attitudes, beliefs and

resultant behaviours.

5. Spend time with yourself each day – in

reflection, dreaming, gratitude and in

planning your positive future. This aim of

this time alone is to raise your awareness,

integrate past experiences, get to know your true

self and commit to live a life of abundance. It may be

“Knowing yourself is the beginning of all

wisdom.” Aristotle

10 minutes dedicated quiet time at

the start of the day or 30 minutes before

you go to bed at night. Maybe switch off

the radio while you are driving to or from

work to enable focused reflection or jot down

your ideas, plans and achievements in a

journal. Commit to a realistic daily practice that

suits your personality, style and time schedule –

and stick to it.

In a future article, we will discuss how to

integrate the skills of feedback, self-disclosure

and self-discovery in managing personal change

and live the life of which you dream.


If you can’t be teachable, having talent won’t help you

If you can’t be flexible, having a goal won’t help you.

If you can’t be grateful, having abundance won’t help you.

If you can’t be mentorable, having a future won’t help you.

If you can’t be durable, having a plan won’t help you.

If you can’t be reachable, having success won’t help you.

J. Konrad Hole

Snippets from the IDF Melbourne - December 2013

46

By Rosemary Flynn

Dr E Davis from Western Australiasaid that even though hypoglycaemianeeds to be managed duringexercise, the benefits of exercise for adolescents who have type 1 diabetes include• Physiological and metabolic health

which will improve their HbA1cand give them aerobic fitness

• Psychological and emotionalhealth because of the endorphins released

• Improvement in functionality• Involvement with peers• Recognition for participating

in any form of sport• Weight control counteracting

the possibility of weight gain with insulin

• Good developmental health

Dr Natalie Piana from Italy encouragesher adolescent patients to tell or writea story about their situation. Shebelieves it gives them a voice andallows them to come to termswith their diabetes. Some of thewords the adolescents use todescribe their diabetes includesacrifice, obsession, a sentence(like a jail sentence), demanding, a

curse, a drag and an intrusion. Theyalso experience fears including fear of

not being able to manage on their own,fear of disappointing their parents and

doctors, fear of not being able to stopeating when they are ‘hypo’ and fear oftelling others about their condition.

The President of the International Diabetes Foundation,

Sir Michael Hirst, gave some interesting figures about the state of diabetes worldwide.

By the end of 2013, an estimated 382 million people had diabetes and it is predicted that this figure will riseto 592 million by the year 2035. More people have

diabetes than have TB, malaria and HIV put together. The prevalence of diabetes in South Africa has risen to 8.27 %, 8.3 % have ‘impaired glucose tolerance’ (a high-risk state

for future diabetes) and about 50 % of South Africans who have diabetes

are undiagnosed.

The kNOw Diabetes Projectin South West India, where the

prevalence of type 2 diabetes is high, used Grade 5 to 12 schoolchildren in 850 schools,

to encourage their communities to change their lifestyles to prevent diabetes or at least control it better.

By the end of 2013, 7 ‘Centres of Health’ wereestablished, 100 ‘Walk to Health’ annual events werestarted, diabetes exhibitions were put in 7 schools,

children from 100 schools distributed seeds and plantsto promote eating of healthy vegetables, and manythroughout the province participated in a global

diabetes walk. Why Children? Because they are ourfuture. They are the best agents who can influence the community, and childhood is the best time for making changes and adopting a healthy

lifestyle for a better tomorrow.

Prof Frank Snoek from theNetherlands stated that mental

health is a state of psychological,social and biological well-being.

If the person’s well-being isreduced, it would mean that he or

she would be less able to cope withstress. He said that managementgoals for people with diabetesshould increase mental health

and take care of diabetescontrol rather than just

maintaining diabetes control.He believes that there is

no health without mental health.

Prof. Tom Sanders from London stated that there are many fad diets, which lead people tobelieve that they will lose weight. These include ‘magical combinations’ of food said to promoteweight loss or the arguments for and against eating butter. He said that 65 % of these diets haveinsufficient evidence to support them, 4 % are possible, 16 % are probable and only 12 % are

convincing. His dietary advice was that we should change our overall dietary pattern rather thanfocussing on individual foods. Importantly, pay attention to portion size, and don’t expect to lose

a large amount of weight in a short time... that is, don’t expect miracles.

World Diabetes Congress

47

Our Youth with Diabetes Chairperson in South Africa, Kerry Kalwiet, presented results of a study she had done about the perceptions of South African children with type 1 diabetes regarding their condition. She analysed how theymanaged their diabetes and what effect it had on their quality of life. She found that children whohad a stable two-parent home did better thanthose did who had lost a parent to divorce ordeath, or who were from single parent homes. These children tended to worry more about their diabetes and their health.

A talk on care of diabetes in the elderly ended with the quote

from an elderly woman: “The older I get, the older old is.” When people with

diabetes pursue a healthy lifestyle with social activities and

exercise, eat healthy foods and take advantage of innovations that keep

them mobile and able to see and hear, they will remain able to manage their

diabetes well and live a healthy life for longer.

For people who eat a lot of rice, Dr Mohan from India found thateating brown rice instead of white rice, helped to reduce

glucose levels throughout the day. It also helps to reduce seruminsulin levels. He concluded that eating brown rice might helpprevent the onset of diabetes as well as control diabetes.

Dr Jean-Phillipe Assal from Switzerland said that if you find yourself resistant to managing your

diabetes at any stage of your life journey, it helps to use your creative skills to get you back on track. You may need toaccept your diabetes first. Sometimes painting a picture ofhow you perceive your diabetes can help you express yourresistance. Writing your story, including how you feel about

your diabetes, can help you deal with the areas that are troubling to you.

48

• Being physically active and eating in a

healthy way are cornerstones of managing

both type 1 and type 2 diabetes. But, did

you know that these cornerstones are

equally as important in preserving your

bone health and strength, whether you

are male or female?

• At the recent International Diabetes

Federation World Diabetes Congress in

Melbourne, it was reported that globally, the majority of

people with diabetes are between 40 and 59 years of age

and that 46 % of people with diabetes don’t even know they

have the condition.

Liana Grobbelaar, Registered Dietician

You should not exercise when you have ketones. A build

up of ketones in the body can result in ketoacidosis, a

medical emergency. In essence, the presence of ketones

in someone with type 1 diabetes shows a severe lack of

insulin and an immediate need for more insulin. Exercise,

at this time, will only burn more fat and produce more

ketones, thus aggravating the situation.

Lauren Williamson Moloi, Biokineticist

Seeing a psychologist is not because you are crazy or because you have a mental illness. Psychologists

focus more on mental health and helping you to cope with your emotional difficulties. Whether

your difficulties are about diabetes or not, a psychologist can help you to work through

them to make sure they do not have an impact on managing your diabetes.

Rosemary Flynn, Clinical Psychologist

Why do you need a healthy

breakfast? When you wake up

in the morning after going

8-12 hours without food,

your energy reserves are low

and your body and brain need

fuel. Besides, your body has lost

up to 1 litre of water during the

night through breathing, sweating and

visits to the bathroom. What you decide to eat for breakfast

will partly determine what will happen to your blood glucose

level for the rest of the day.

Riette van der Westhuizen, Manager of

‘Kids Powered with Insulin’ Facebook Group

PO Box 39, De Rust, 6650, Western Cape l Cell: 076-667-3182 l E-Mail: [email protected]

49

I have made good use of most of

the services available to people with

diabetes from the CDE Diabetes

Management Programme (DMP).

They have kept me alive, despite having

type 2 diabetes for more than 25 years.

The availability, at no further cost, of a team

of leading diabetes specialists, educators, a psychologist

(with diabetes herself), dieticians, podiatrists,

ophthalmologists, biokineticists (for exercise advice) as

well as a diabetes friendly pharmacy at the Houghton

CDE, is fantastic, in all respects.

During the past three years, the DMP team have

encouraged me to lose more than 30 kg in weight.

That has reduced my insulin requirements, assisted in

reducing the severe neuropathic pain in my feet and

has lead to a better lifestyle for me.

If you are not yet a DMP member, and you are a

member of a participating medical aid, you need to

enrol now. Go for it!

Graham Beadle, CDE DMP Patient

You should not exercise if you have flu. This can lead to inflammation

of the heart muscle, which is dangerous to your

health. You should rest for at least 7 days when

you are recovering from flu. Gradually return to

exercise only once you have fully recovered.

Nicole Sakinofski, Biokineticist

When you are having a stress electrocardiogram

(ECG), bring walking shoes, as it is

uncomfortable walking or running in socks or

barefoot. You will also feel more comfortable if your

wear gym clothes or clothes that are loose

fitting and allow good movement.

Estelle Ghirelli, Clinical Procedures

Nurse, CDE Houghton

When you are going on holiday, long journeys can make your feet

swell. If possible, try to walk about every half hour you are on an

aeroplane. Even a short distance helps.

Once you are at your destination, it is best to wear

shoes or sandals, even if you are on the beach, to

avoid blisters, breaks in the skin or infections. You

may burn your feet severely on hot sand without

realising it. Protect your feet with sun block

cream (Factor 30 or above) or keep them covered

to avoid sunburn on the feet. Avoid wearing flip-flops

as they may cause blisters between your toes.

If you have been supplied with therapeutic shoes, do not wear

other shoes while on holiday (except when you are swimming).

Be sure to treat any cuts or grazes on your feet with an antiseptic

and a clean, dry dressing.

Joanne Crawford, Podiatrist

The time to have your flu injection is NOW, to be sure that

you have protection against the influenza viruses that can

compromise your health this winter. Make sure you get the

latest flu vaccine approved for 2014, as this will include

cover for the major strains of flu expected this flu season.

Mervyn Gomer, Pharmacist

Iam on my bicycle on the highway on the M1 South and it isa cool 6:50 am. I am not alone. I am deep within thepeloton of about 150 road cyclists. We are cruising at

55 km/hour. My heart rate is in the 80 %’s but it feels like it isin the 70 %’s. This is because of race day adrenalin. It is theMomentum 94.7 Cycle Challenge and I raise my hand atthe spectators cheering as we pass under a bridge.Normally I am nervous of cycling inside a groupthis large, but these guys know what they aredoing. I confidently breathe in the quietatmosphere that is broken only by thehum of the bikes. Someoneunexpectedly clips what I can onlyassume is a small Energade plastic lid,and it ricochets like a pinball at anincredible speed between 10different bikes and is gone. Nobodyreacts. We approach an incline andthe group slows, but not by much.The warm up is over; it’s time to dosome work. I change down a gear. Ilove this race!

Last year I completed my twelfth 94.7Cycle Challenge. This also happened tobe my sixth time racing with diabetes.For those who don’t know, the 94.7 CycleChallenge is a 94.7 km long road bicyclerace. It is also the second largest cycle race inthe world and has full road closure, includingtwo highways. Last year there were over 25 000participants. Amazing!

Looking back over the last twelve years, each race hasbeen different; each had its own story. I did my first race on amountain bike, broke my derailleur in an accident, walked for twokm and cycled the second half of the race in one gear. I didn’t trainenough for my third race - It was the year my oldest son was born.My fourth race was the first time I broke three hours just hanging on

to the back of a group. My seventh race was my first race cyclingwith diabetes and it happened to be my quickest. I completed therace in 2 hours and 32 minutes! You cannot say that diabetes slowsyou down! I hope to beat that time one day but I haven’t yet.

Just after coming off the highway, there is a steep climbending at the top of the Ponte hill. This completely

splits the peloton up into single file with gaps inbetween. If you can ignore the mini waterfallof sweat coming off your eyebrows as youtackle the climb, the morning light seemsalmost romantic as the route takes usaround the Jo’burg landmarks. Thedescent down Ponte hill is quick. Weare back on the highway; off again;passing though the city centre andthen back on the highway. Goingover the Nelson Mandela Bridge isalways a favourite. This is thehardest part of the race because thegroups haven’t quite reformed yet -there is quite a bit of cycling on yourown and riders are jostling forposition. My heart rate has been over90% for the last 10 minutes. Thereare two small, tough hills and then thequick decent down Jan Smuts past theZoo and into Rosebank.

Cycling with diabetes is not only possible but,in my opinion, a good idea. Personally, I find that

the exercise helps with my blood glucose control aslong as I exercise at least three times a week. A tired

body is more predictable. Because I have diabetes, I needto be more organised than most. I always have breakfast before theride and I carry my test kit with me. I carry more than 200 g ofquick acting carb, over and above the food that I am planning toeat on during the ride, for emergencies. ‘That much?’ you ask. Yesthat much! And, once or twice a year I actually use it.

50

COMMENTARY

By Paul Baker

Cycling – a healthylifestyle choice

PAUL’S SIDE OF THE FENCE By Paul Baker

51

The scenery changes as the race moves through Dunkeld andinto Randburg. Lines of enthusiastic supporters now cheer uson. The timing could not be better as the energy of the crowdseems to diffuse into the legs and bolster the adrenalindepleted and fatigued legs. It is really quite incredible.

Preparation for a race is more than just what you need to carry onthe ride. As a person with diabetes, there are four other things ofwhich to be mindful, namely pre-race nutrition, pre-race adrenalin,nutrition during the race, and what to do after the race. If you aredeciding to do this race or one like it, it is a good idea to ask oneof the CDE Biokineticists to help you build a plan.

I have worked out my plan through a combination of lots ofreading and trial and error. I wake up 3 hours before the starttime and have breakfast. This is to try to reduce the amount ofactive insulin at the start of the race. I go back to sleep. When Iawake again I will give myself a small bolus (4 u) to counter theblood glucose spike that I know will come because of the race-day adrenalin release. If I am not careful, my blood glucose willgo above 10 mmol/l and that would mean that I will crampduring the race. I test a lot and make corrections before the race.My nutrition during the race is a mix of high-GI and medium-GIfoods; not very different to that of a typical cyclist. During acycle, I no longer think of myself as having diabetes. I can eatanything my heart desires as long as it is in moderation. I use aninsulin pump, so managing what happens after the race is easy.

I set a 30 % temporary basal rate for 8 hours to preventhypoglycaemia, as my liver replenishes its stores of glycogen(stored glucose) by drawing glucose from my bloodstream.

Last year, my cycle along the Krugersdorp road was theeasiest yet. The peloton re-formed and I found myselfback in a group of more than 200 cyclists. It was quickand exhilarating and I found myself feeling fresh comingoff the highway. I was ready for the last 20 km to thefinish. On the last hill before the finish, I felt inspired bya 20-year-old cyclist passing me. I stood on my peddlesand sprinted to the finish with him. What a race!

My 2013 race was the first that I have cycled for a Diabetescharity. Sponsored by Liberty Life, I cycled wearing ‘YouthWith Diabetes’ gear. I hope that this initiative grows sincethe funds go to less privileged children with diabetes toenable them to go on educational and life-changingDiabetes Camps.

Once cycling is in your blood it is hard to stop. Now I havestarted a new adventure. I have entered the Joburg2C raceas my next challenge. This is a 9-day staged, mountainbike race that promises over 900 km of the best mountainbiking in South Africa. I am nervous and excited. You canread more about it on my blog athttp://thethirstthatchangedmylife.blogspot.com/.

COMMENTARY

Water Point 1 - St Andrews and Victoria RdWater Point 2 - 197 Jan Smuts Ave (M27)Water Point 3 - 78 Homestead Ave (M75)Water Point 4 - Witkoppen Rd (R564)Water Point 5 - Malibongwe Dr (R512)

Water Point 6 - N14Water Point 7 - N14Water Point 8 - 22 Summit Rd (R562)Water Point 9 - 22 Summit Rd (R562)Water Point 10 - 1 Pitts (R55)

52

Dr MS AsvatMBChB, MRCP, FRCP, Dip Diabetes, MScSpecialist PhysicianSuite E, Milpark Hospital, Guild Road, ParktownMultidisciplinary team includingOphthalmologist, Podiatrist, Dietician, etc.Telephone: 011 482-3020/1E-mail: [email protected]

Sr Kate BristowDiabetes Specialist NurseCDE Diabetes Centre of Excellence331 Burger Street, PietermaritzburgTelephone: 033 345-2157Cell: 082 406-8707E-mail: [email protected]

Dr Neil Isaacs (MBBCh) General PractitionerBallito Medical CentreAllied services: Dietician, Podiatrist,Psychologist, Occupational Therapist,Biokineticist, Physiotherapy, MassageTherapist, Diabetic Nurse Educator.Corner of Albertina and Kirsty Way, Ballito.Opposite Alberlito Hospital.Hours: Monday-Friday 08h00 - 18h00Saturdays 08h00 - 13h00Sundays 09h00 - 11h00 for emergencies onlyTelephone: 032 946-1311E-mail: [email protected]

ACCREDITED CDE SERVICEPROVIDER CLASSIFIEDS

For a comprehensive list of the over 260 CDE Centres nationwide, please see the CDE Website, www.cdecentre.co.za

Dr Martine Joffe and Sr. Henrieke FaganManor Medical Diabetes CentreGeneral Practitioner and Certified DiabetesNurse Educator. An award winning Centre;passionate about comprehensive diabetes care.Hours: 08h00 to 15h30 Monday to Friday189 Kelvin Drive, Morningside Manor, SandtonTelephone: 011 804-6661E-mail: [email protected]

Dr Betsie H KloppersMBChB; MPharmMed; DOH; BSc (Hons)Aerospace Med; PG Dip Diabetes (Cardiff)CDE Diabetes Centre of Excellence, Accredited Insulin Pump Centre.1251 Burnett Str, Hatfield, PretoriaTelephone: 012 362-8828Cell: 082 920-2484E-mail: [email protected]

Dr Hemant MakanMBBCh (Wits) (SA) PG Dip Diab (Cardiff)80 Gemsbok Ave, Seva Sedan, LenasiaTelephone: 011 852-4741E-mail: [email protected]

Dr Heidi MalanCaredoc Medical CentreOther services offered at the centre:Biokineticist, Diabetes Specialist Nurse,Dietician, General Practitioners, Opthalmologist(Visiting), Podiatrist (Visiting), Pharmacy,Physiotherapist, The National Renal UnitNo. 3 Lira Link, Richards BayTelephone: 035 789-7137 Monday-Friday

Dr. Everard S Polakow and Sr. Lynne Kruger CDE Centres of Excellence at:• Linksfield and Edenvale - 34 Meyer Street,Linksfield

• Kempton Park - Unit 1, 40 Monument Road• Boksburg - B Albrecht Street (behind Sunward Park Hospital)

Contact: Sr. Lynne KrugerCell: 082 330-2031

Dr J TrokisDiabetes Care CentreTelephone: 021 987-6635E-mail: [email protected]

Laurie van der MerweEmpangeni Diabetes CentreCDE Diabetes Centre of Excellence Ukula Street, EmpangeniComprehensive Diabetes Care with DiabetesSpecialist Nurse, dietician and podiatristTelephone: 035 772-4528E-mail: [email protected]

• Proven Accuracy• Second-Chance™ sampling allows patients

to apply more blood to the same test strip if the � rst sample was not enough

• No set-up requirements—ready to test right out of the box

• No Coding™ technology eliminates errors due to miscoding

Innovative features help patients test with ease

••

•

•

• Simple & Advanced features to improve patient self-management

Ask your healthcare professional about the CONTOUR™PLUS meter from Bayer today.

Bayer (Pty) Ltd, Diabetes Care Reg. No.: 1968/011192/07 27 Wrench Road ISANDO, 1609 PO Box 143 lsando 1600. Tel (011) 921 5055 Fax (011) 921 5188 All numbers illustrated apply to South Africa only. Bayer (reg’d), the Bayer Cross (reg’d), CONTOUR, Second-Chance, No Coding, and the No Coding logo are trademarks of Bayer.

© 2013 Bayer HealthCare. All rights reserved.

Reference: 1. Data on fi le, Bayer HealthCare Diabetes Care.

NEW CONTOUR™PLUS

Specifi cally designed with the Insulin Patient in mind

www.bayerdiabetes.co.za

Dis-Chem’s commitment to speci�c diabetes care now goes beyond offering vitamins and supplements, monitoring aids, prescribed medication and specialised foodstuffs at our legendary low prices:the nursing practitioners who run our Clinics have now all received training in this highly specialised field.

This means that in every one of our 72 stores nationwide, you’ll �nd someone who can offer professional guidance and advice on every aspect of diabetes, including:• Lifestyle • Medication management• Nutrition • Overall management of your condition• HbA1c screening

Questions about diabetes? You can get all the answersat your Dis-Chem Clinic!

Dis-Chem is a partner of the Centre for Diabetes and EndocrinologyGO Advertsing 69510

Customer Careline 0860 347 243www.dischem.co.za | [email protected]

“Go on, ask usabout diabetes.”

“Go on, ask usabout diabetes.”

Documents

COVER STORY LiVing wiTh diabETES · 2015. 10. 14. · Michael Brown - CDE Houghton S ... Chantelle Olivier and her two young daughters and their ability to see blessings in the midst