cover story living with diabetes · 2015. 10. 14. · michael brown - cde houghton s ... chantelle...
TRANSCRIPT
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.
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For more information contact your Healthcare Professional
1
Editor
Michael Brown - CDE Houghton
Sub-Editor
Rosemary Flynn
Advertising Enquiries
Angela Bell
082 451-0193
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
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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
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CENTRES FOR DIABETES
Are you concerned about your diabetes?
Currently, we are witnessing an
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in adults, regardless of background,
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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
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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.
LIVING WITH DIABETES
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...
LIVING WITH DIABETES
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
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by
Mic
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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
LIVING WITH DIABETES
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
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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
LIVING WITH DIABETES
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...
LIVING WITH DIABETES
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.
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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!
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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.
LIVING WITH DIABETES
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...
LIVING WITH DIABETES
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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
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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...
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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.
LIVING WITH DIABETES
By Stuart Graham
LIVING WITH DIABETES
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
LIVING WITH DIABETES
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
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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.
LIVING WITH DIABETES
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.
LIVING WITH DIABETES
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.
LIVING WITH DIABETES
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]
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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.
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“Go on, ask usabout diabetes.”
“Go on, ask usabout diabetes.”