Читать книгу South African Cookbook for Diabetes - Hilda Lategan - Страница 5
INTRODUCTION
ОглавлениеIt is estimated that approximately 366 million people throughout the world have diabetes and according to the International Diabetes Federation (IDF) it is predicted that about 552 million people will suffer from diabetes by 2030. These figures are frightening and higher than previous predictions.
In South Africa it is estimated that by 2015, 3,5 million people (approximately 6% of the population) had been diagnosed with diabetes. In addition, it is estimated that about 5 million South Africans are pre-diabetic because of insulin resistance, which contributes to increased blood sugar levels, although these levels are not high enough for such individuals to be diagnosed with type 2 diabetes. On average, it takes seven years before a person with diabetes is diagnosed, by which stage complications of diabetes may already be present due to the disease. Most South Africans with diabetes have type 2.
Despite these scary figures, it is encouraging to know that diabetes is not an isolated, unknown illness that affects only you and your family, and that medical science, nutrition information and medication are available to help control it.
Early diagnosis of diabetes together with proactive treatment is important to prevent long-term complications and to ensure a better quality of life and life expectancy. A person with diabetes whose condition is controlled, is not ill and he or she is able to live an active and happy life without complications. Like any other person, someone with diabetes should aim to maintain a healthy lifestyle and should exercise regularly, eat a balanced diet, consume alcohol in moderation and have adequate rest and relaxation.
How does diabetes originate?
Insulin is the hormone which transports glucose into body cells and helps to transform it into energy. Insulin is also involved in the conversion and storage of unused glucose and energy in the form of body fat.
Diabetes is a condition where the body cannot control its blood sugar levels efficiently because the pancreas (the gland which produces insulin) produces too little or no insulin. There are also cases where the pancreas does produce insulin, but it is not used efficiently, and such cases will be discussed under type 2 diabetes below.
In cases where too little or no insulin is present, glucose cannot be properly taken up into the cells. Blood glucose levels consequently rise and the blood becomes thick and “syrupy”, while some of the excess glucose is excreted in the urine. A high blood glucose level is dangerous and can cause serious complications if it is not treated.
What are the symptoms of diabetes?
The symptoms of an uncontrolled high blood glucose concentration include:
1.Overwhelming thirst because the body tries to dilute the glucose in the blood so that it can be excreted by the kidneys. This process leads to excessive excretion of urine and can eventually cause dehydration and loss of electrolytes.
2.Tiredness and weakness because too little glucose reaches the cells where energy is produced.
3.Body pains and flu symptoms as a result of metabolic malfunction and inflammation.
4.Blurred vision because the changes in blood sugar levels increase the pressure in the eyeball, while the position and shape of the lens in the eyeball also change.
5.Pins and needles sensation in the feet and hands because of damage to the terminal nerve endings.
6.Ravenous hunger, a need to eat all the time and loss of weight because glucose is not being taken up efficiently into the body cells and transformed into energy. The body then breaks down its own fat and protein (muscles) to meet its own energy requirements.
7.Itchy skin, infection and delayed wound healing because of the advantageous growth medium for bacteria and other organisms that is created by the presence of sugar.
8.Coma: loss of consciousness, which is a dangerous condition.
An unhealthily high blood glucose level and diabetes mellitus are diagnosed when the capillary blood glucose concentration equals 7,1 mmol/litre (fasting) and 11,1 mmol/litre (2 hours after a meal or at random) and when the measurement of the HbAlc > 6,5% over a three-month period.
The blood glucose concentration can also drop to levels that are too low (lower than 3,5 mmol/litre) if too much insulin is injected or if medications, such as diabetic tablets, are not taken according to prescription, when the prescribed meal plan is not followed, if meals are skipped, if unplanned physical activity demands more energy than has been provided for in the meal plan, or if alcohol is consumed without a snack or subsequent meal.
The symptoms of hypoglycaemia or a low blood glucose concentration include:
•Hunger, tiredness
•Shakiness, dizziness, pallor, palpitations
•Blurred vision, reduced concentration, pounding headache
•Nausea, sweating
•Mood swings (feeling irritated, confused, aggressive)
•Coma
Different types of diabetes
The following types are differentiated:
•Type 1 diabetes
•Type 2 diabetes
•Gestational diabetes
•Impaired glucose tolerance
Type 1 diabetes
Type 1 diabetes occurs less frequently than type 2 diabetes. Type 1 diabetes is caused by an absolute deficiency of insulin as a result of damage to the Islets of Langerhans in the pancreas where insulin is produced. This condition is irreversible and type 1 diabetics are often not overweight. Injections of insulin, together with a balanced diet, are important components of the treatment. Uncontrolled high blood glucose levels can in the long term contribute to damage of the blood vessels, with subsequent cardiovascular disease, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the terminal nerve endings) and amputation of the lower limbs as a result of poor blood supply and gangrene. In children with poorly controlled type 1 diabetes, ketoacidosis, growth failure and delayed puberty also occur.
Type 2 diabetes
Type 2 diabetes is the most common form of the disease and there is a genetic association, which means that this condition can occur in families.
The symptoms and diagnosis of type 2 diabetes are often missed for up to seven years, during which time the malfunctioning of the beta cells in the pancreas is already present. This means that long before individuals are aware of their condition, chronically raised blood glucose levels may already contribute to damage to the blood vessels, with subsequent cardiovascular disease, stroke, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the terminal nerve endings) and amputation of the lower limbs as a result of poor blood supply and gangrene in later years.
Type 2 diabetes is often associated with obesity and an inactive lifestyle, but older patients are not always obese. Type 2 diabetes often originates as the metabolic result of excess fat in the abdomen, muscle tissue and liver. This excess fat in combination with high blood glucose levels contributes to beta-cell malfunction, increased blood pressure, a typical fat profile (low HDL, increased triglycerides and LDL) and insulin resistance. HDL, which is also known as high-density lipoprotein, is the “good” cholesterol carrier, which helps to keep the arteries clean. LDL, otherwise known as low-density lipoprotein, is the “bad” cholesterol carrier, which causes fat to be deposited in the arteries.
With insulin resistance the insulin-producing beta cells of the pancreas are overstimulated to excrete too much insulin in an attempt to try to reduce the blood glucose to within normal limits. Despite the increased circulating insulin it seems the body cells react as if they have developed resistance to the normal function of insulin.
Emotional and physical stress can also be a contributing factor to type 2 diabetes. The body is exposed to increased physical stress when long working hours lead to severe exhaustion. If meals are skipped during this period, this can result in a lack of nutrients required to maintain body tissue and can also cause inflammation.
Weight loss, a healthy lifestyle, healthy eating habits and regular exercise are regarded as important aspects in the treatment of type 2 diabetes. Medications are often added depending on the patient’s blood values. Depending on the nature of beta-cell malfunction, type 2 diabetics tend to start with insulin therapy much earlier these days to prevent long-term deterioration caused by diabetes.
Whereas type 2 diabetes was previously regarded as an illness of “the aged”, nowadays the condition is increasingly being observed in children. Such children should preferably be referred to a specialist.
Gestational diabetes
Gestational diabetes originates as a result of hormone changes during pregnancy. Although the condition usually improves spontaneously after the birth of the baby, there is the possibility that a woman who had gestational diabetes will over time develop type 2 diabetes. It is important to control blood glucose during pregnancy with a balanced diet and to continue to maintain healthy eating habits after the baby is born.
Impaired glucose tolerance or pre-diabetes
People with impaired glucose tolerance have increased blood glucose values, but not to such an extent that they can be diagnosed with diabetes. This disease is also referred to as pre-diabetes. Treatment of the condition includes healthy eating habits, regular exercise and long-term weight control. Impaired glucose tolerance can be improved, remain constant or develop into type 2 diabetes.
Sugar sensitivity
During consultations I often meet people with allergies who suffer from discomfort caused by sugar or sucrose and refined carbohydrates. This discomfort can range from sudden tiredness, headache, migraine, abdominal discomfort, abdominal distension and flatulence to loose stools.
In a case of true sucrose intolerance there is a deficiency of the enzyme sucrase which is required to break down sucrose into glucose and fructose. The symptoms of this condition include diarrhoea and distension of the abdomen, which is caused by fermentation and gas production in the digestive tract. This sensitivity to sugar is not related to diabetes, but those who suffer from this condition do benefit from a sugar-free diet.
What is regarded as well-controlled diabetes?
As mentioned, blood glucose values that fluctuate or remain high over a long period can damage the blood vessels which supply blood to the heart, kidneys, eyes and nerve endings.
Although fasting blood glucose values are important, increasing emphasis is being placed on the blood glucose values two hours after a meal.
SEMDSA* provided the following ideal finger prick values for blood glucose in their 2012 guidelines:
| Younger diabetics without complications | Majority of diabetics | Older diabetics with complications | |
| Fasting | 4,0-7,0 mmol/l | 4,0-7,0 mmol/l | 5,0-8,0 mmol/l |
| Two hours after a meal | 4,4-7,8 mmol/l | 5,0-10,0 mmol/l | < 12,0 mmol/l |
A part of the red blood cell known as haemoglobin is influenced by the amount of glucose that is present in the bloodstream. It is advisable to have an HbA1c test done regularly. HbA1c is a marker which indicates how efficiently your blood glucose has been controlled during the previous three months and it should be tested every six months. It is ideal to keep the HbA1c as low as possible without causing hypoglycaemia.
SEMDSA* provided the following HbA1c values in their 2012 guidelines:
| Younger diabetics without complications | Majority of diabetics | Older diabetics with complications |
| ≤ 6,5% | ≤ 7,0% | ≤ 7,5-8% |
*SEMDSA: Society for Endocrinology, Metabolism and Diabetes in South Africa
Golden rules for controlling diabetes
•Accept and make peace with the fact that you have been diagnosed with diabetes.
•Understand what diabetes is and what its treatment entails.
•Use your medication as prescribed and talk to the members of your diabetic care team if you feel unsure.
•Know and understand the principles of good nutrition and apply them every day.
•Keep your blood glucose under control by:
–following a balanced diet according to your needs, or
–following a balanced diet and using insulin injections and/or diabetes tablets as prescribed, and
–doing regular exercise as part of your treatment.
•Keep an accurate record of your blood glucose readings, particularly if they fluctuate a lot.
•Be honest if you overstep the mark with the wrong food and don’t use the medications properly.
•Keep your body weight within 10% of your ideal weight for your height or maintain a body mass index (BMI) – an indication of healthy weight – of less than 25 kg/m2.
•Care for your feet regularly. Tell your caregivers at once if sores or grazes do not heal and only allow a responsible person to cut your toenails.
•Have your blood pressure measured regularly if you have a problem with high blood pressure.
•Be as active as possible.
•Pay regular visits to your care team, which should include your medical doctor, dietitian, optometrist and podiatrist, among others.
Healthy eating habits
Food forms an important part of everyone’s life – including those with diabetes – and it should always be pleasurable. The food we eat should also have a high nutritional value. When you have been diagnosed with diabetes, you will be forced to review and adapt your eating habits, which will also have advantages for the maintenance of your body.
Guidelines for good nutrition
The South African Food-Based Dietary Guidelines were revised in 2012 and published in 2013. They are easy to follow and include the following:
•Eat a variety of foods every day and distribute the food evenly in meals that are spaced over the entire day.
•Make starchy food part of most of your meals. Eat more low-GI starchy foods.
•Have at least five portions of vegetables and fruit every day.
•Have cooked dry beans, split peas, lentils and soya regularly.
•Have low-fat milk, maas, yoghurt or cottage cheese every day.
•Fish, chicken, lean red meat or eggs can be eaten daily depending on your budget.
•Use fats sparingly. Choose vegetable oils rather than hard fats. Choose mono- and polyunsaturated fats more often.
•Get into the habit of drinking plenty of clean, safe water every day.
•Use salt and foods high in salt sparingly.
•Use sugar and foods and drinks high in sugar sparingly and in consultation with your medical doctor and dietitian.
•Be more active and keep your body weight under control.
•In addition, if you drink alcohol, drink sparingly and in consultation with your medical doctor and dietitian.
The use of food exchange lists
To make it easier to choose suitable foods for balanced meals and to control blood sugar effectively, food exchange lists are recommended. There are six exchange lists and each one lists foods in specific quantities. All these food items – in defined portions – supply more or less the same amount of energy, fat, carbohydrate and protein and can therefore be used interchangeably in the meal plan. The items in each list have a specific function and no single food group can supply all your nutritional needs. This means you need to consume foods from all six exchange lists to meet your nutritional needs. The food exchange lists are a useful aid when you need to adjust your insulin dose based on the calculated amount of carbohydrates in one of your meals.
The glycaemic index (GI) can also be used very effectively in combination with the food exchange lists.
The carbohydrate (CHO), protein, fat and energy contents of the food items in each exchange list are as follows:
| Food exchanges | CHO (g) | Protein (g) | Fat (g) | Energy (kJ) |
| Milk– 1 full-cream milk– 1 low-fat milk– 1 fat-free milk | 121212 | 889 | 85- | 640525340 |
| Protein– 1 medium-fat protein– 1 low-fat protein– 1 plant protein | --8 | 774 | 531 | 310230230 |
| Starch | 15 | 2 | - | 275 |
| 1 free vegetable1 medium vegetable | Minimal7 | Minimal2 | -- | Minimal150 |
| 1 fruit | 15 | - | - | 250 |
| 1 fat | - | - | 5 | 190 |
Carbohydrates and diabetes
Carbohydrates are included in a balanced diet in the form of different sugar-containing foods and sugar products, such as jam, as well as starchy food like bread, grains, legumes, vegetables, fruit and milk. Carbohydrates are digested by the body into single sugar molecules such as glucose, fructose (fruit sugar) and lactose (milk sugar). The part that is not digested is called fibre. Fibre promotes peristalsis (gut movements) and combats constipation. If no carbohydrates are eaten, proteins (which are actually a building material) and fats are used as sources of energy. Carbohydrates therefore ensure that the proteins in your diet are used primarily for repair and maintenance of the body.
Carbohydrates are not just an important source of energy for your muscles – in the form of glucose they are the only source of energy for the brain. This is why it is important for diabetics to include carbohydrate foods at each meal.
When proteins and fat are eaten together with carbohydrates, the time required to digest the food combination is increased and the release of glucose into the bloodstream is consequently delayed.
To ensure good blood glucose control, it is important to understand that different carbohydrate-rich foods do not have the same effect on blood glucose levels, because they have different glycaemic indexes.
What is the glycaemic index (GI)?
The glycaemic indexes of different carbohydrate-rich foods are calculated values which indicate how rapidly and to what extent blood glucose is influenced by the intake of a specific type of food.
Carbohydrate-rich foods which are digested and absorbed slowly have a low GI and contribute to a more gradual release of glucose into the bloodstream, resulting in a lower insulin reaction and better blood glucose control. Because this is a gradual process the digestive tract is not emptied so rapidly, delaying the sensation of hunger.
Carbohydrate-rich foods which are digested and absorbed rapidly have a high GI and cause a rapid increase in glucose in the bloodstream, resulting in an increased insulin reaction and/or insulin requirement because of the rapid increase in the blood glucose levels.
The digestive tract is emptied relatively rapidly, which causes hunger sensations to occur again soon after eating. If this large quantity of glucose in the blood is not effectively transformed into energy in the body cells, the circulating blood glucose levels remain high because of the absence of insulin or, as in the case of insulin resistance, this glucose is stored as fat in the body.
Carbohydrate-rich foods are divided into items with a low GI (55 or less), an intermediate GI (56 to 70) or a high GI (more than 70). From a practical point of view, carbohydrate-rich foods with a GI of up to 62 are regarded as foods with an acceptably “low GI”, based on the assumption that when they are combined with the other foods in a meal, they will be digested and absorbed at a slower rate.
In addition to better blood glucose control, a low GI diet also has other advantages. It protects against the development of obesity, and colon, prostate, ovarian and breast cancer.
Factors that influence the GI of foods
The following factors influence the digestion and absorption of carbohydrates, as well as the blood glucose level:
Cooking and gelatinisation of starch
When starch is cooked in the presence of water and heat, it causes swelling and gelatinisation of the starch granules (grains). This gelatinised starch contributes to faster and easier digestion by the enzymes in the digestive tract and this can then result in a higher GI.
Cooling and retrogradation of starch
Starchy foods that are cooked with moist heat, such as potatoes and maize (mealie) meal porridge, are more difficult to digest after they have cooled down, as a result of retrogradation of the starch. This starch resists rapid digestion and therefore contributes to a lower GI.
Types of fibre and fibre content
Water-soluble fibre (as in cooked dry beans, lentils, chickpeas, soya, etc.) lowers the GI because it delays the emptying of the stomach, while water-insoluble fibre (such as digestive bran) only lowers the GI when the food contains large quantities of this fibre.
Sugars
Not all sugars are absorbed at the same rate. Glucose is absorbed very rapidly and has a high GI (100), while fructose (fruit sugar) is absorbed more slowly and consequently has a low GI (23). Sucrose (cane or table sugar) is a mixture of glucose and fructose and has an intermediate GI (65). The addition of these sugars to starches with a higher GI can contribute to lowering the GI of the dish.(As a matter of interest, the GI of wheat flour is 70.)
Organic acids and fermented foods
Organic acids such as lemon juice and vinegar, as well as fermented foods like traditional fermented porridge (suurpap), lower the GI. By adding an acidic salad dressing and/or vinegar to salads, you can lower the GI of not only the dish, but the entire meal.
Where does sugar fit into the diabetic diet?
Cane/table sugar (sucrose) has an intermediate GI, which means that a diabetic does not need to totally avoid sugar, because a small amount will not cause the blood sugar to rise drastically. However, the concept of “less sugar” can be very misleading. From a more scientific point of view, it is recommended that not more than 10% of the total carbohydrates in your diet should be derived from sugar and sugar products.
A more practical guideline is that you should not consume more than 10 ml sugar per meal, that it must be part of a mixed meal and that it must be eaten with fibre. It is important to keep in mind that each teaspoon of sugar contributes both to your carbohydrate and kilojoule intakes of the day, but that it does not make any other contribution to your nutrient intake – such as fibre, minerals or vitamins.
Tips to reduce your sugar intake
•Learn to gradually use less sugar so that you lose your craving for sweet foods.
•Read the labels of products. Food legislation determines that the ingredients in a product must appear in descending order on the ingredients list. If an ingredient such as sugar appears at the end of the list, this probably means that the product contains only an insignificant amount of sugar.
•Avoid sugar in drinks such as tea, coffee and cold drinks.
•Avoid fruit that has been canned in sugar syrup. Rather choose fruit canned in fruit juice or artificially sweetened canned fruit.
•Clean, safe water should be your first choice to quench your thirst. You can also drink soda water and artificially sweetened cold drinks.
•Use low-kilojoule jelly.
•Enjoy a scraping of jam or honey on wholewheat or rye bread. There are a variety of jams on the market that are artificially sweetened or sweetened with fructose or which contain less sugar. Always keep your portion size small and rather store this type of jam in the fridge after opening it, to increase its shelf life. Also refer to the notes about fructose.
•Choose recipes with the least sugar, fructose or honey. In some recipes sugar can be replaced with fresh fruit, dried fruit, fruit purée, fruit juice or vegetables such as carrots, beetroot or pumpkin.
•Be aware of the sugar content of yoghurt and choose low-fat or fat-free, artificially sweetened yoghurt.
•Replace sugar in dishes with artificial sweetener or sugar substitutes in limited quantities.
Artificial sweeteners and sugar substitutes
Artificial sweeteners
Every so often a story does the rounds about how dangerous the prolonged use of certain artificial sweeteners can be. These findings are usually based on single cases and they are often not thoroughly investigated by means of additional research. In general, the consequences of obesity are regarded as a greater health risk than the possible negative effects of artificial sweeteners. It is, however, important to keep the use of these products to a minimum.
In my practice we use the guideline of not using more than eight to ten pills of artificial sweetener (which equals eight to ten teaspoons of sugar) a day. Heat (such as the boiling water you add to instant coffee), reduces the sweetness of sweetener pills. Test the sweetness of your tea or coffee by only adding the artificial sweetener when the beverage has reached drinking temperature. Artificially sweetened cold drink is also limited to not more than 500 ml per day.
Some artificial sweeteners consist of a combination of sweeteners, while others contain a filler, such as lactose or dextrose, which does provide some kilojoules and can have an effect on the blood glucose level. Read the labels of the products to obtain the necessary information. The brand names, contents of the products and combination of sweeteners change from time to time and new research results will appear in the lifetime of this cookbook. Where possible, I have indicated the amount of cane or table sugar in a recipe to enable you to work out a ratio to the sweetener of your choice.
Non-nutritive or artificial sweeteners include acesulfame-K, aspartame, sucralose, saccharin and cyclamate. These sweeteners do not contain any energy (kilojoules) and are very sweet even in small quantities. In pill form they often lose their taste when heated and in some cases they can cause a bitter taste in baked goods and cooked dishes. Sucralose is one of the sweeteners that is heat stable in any form.
Liquid sweeteners and some of the newer types of powder sweeteners are recommended for baking because they do not undergo taste chances during heating.
The safety of saccharin and cyclamate during pregnancy has not yet been determined and these sweeteners should preferably be avoided.
Stevia is a natural sweetener made from the leaves of the stevia plant. Like the artificial sweeteners, it does not provide any energy (kilojoules) and is currently being marketed in pill, liquid and powder form.
Sweeteners which provide energy (kilojoules)
Sugar alcohols such as lactitol, maltitol, mannitol and xylitol are more difficult to digest and are absorbed into the bloodstream more slowly than sugar, and therefore have a lower GI. In excessive quantities sugar alcohols sometimes cause abdominal discomfort and diarrhoea and should preferably be avoided by those suffering from irritable bowel syndrome. A limited intake of 20 g per day is recommended. Food containing xylitol should not be fed to dogs.
Fructose
Fructose occurs naturally in fruit and honey, but it is also available in powder form and as high-fructose corn syrup (HFCS). Fructose is slightly sweeter than cane/table sugar (6 ml fructose = 10 ml sugar), but it provides just as many kilojoules per ml/g as cane/table sugar. Fructose is absorbed slowly from the digestive tract into the bloodstream, it is metabolised in the liver and has a low GI. Research in the past indicated that fructose is possibly associated with the incidence of retinopathy (eye damage) in diabetics. More recent studies also indicate that excessive use of added fructose and particularly of high-fructose corn syrup can contribute to an increase in blood fats (cholesterol, LDL cholesterol, triglycerides), that it can result in an increase in blood clotting and because of its kilojoule content, also contribute to obesity. In the same way that diabetics are allowed to include cane/table sugar and artificial sweeteners in their diet in controlled quantities, depending on personal circumstances, limited use of fructose (not more than 20 g or 25 ml powder per day) is recommended as an aid in food preparation. This limited amount, however, does not allow diabetics to add teaspoonfuls of fructose to beverages or porridge. As a responsible dietitian I must warn against the excessive use of fructose powder and high-fructose corn syrup in particular, which is often used in commercial products such as flavoured water, sports drinks, jam and cordial syrup for making cold drinks. This warning does not apply to natural fructose as found in fruit.
Oligosaccharides
Oligosaccharides are not digested and are regarded as fibre. They ferment in the colon and form short-chain fatty acids. When ingested in excessive amounts, they can cause abdominal discomfort, including flatulence, stomach cramps and diarrhoea. People suffering from irritable bowel syndrome and spastic colon are advised not to use them. Oligosaccharides, which include inulin and FOS (fructo-oligosaccharides), are also known as prebiotics (food for gut-friendly probiotics or micro-organisms) and are increasingly being used in food preparation.
Honey
Honey is a natural product, it is nearly twice as sweet as sugar and contributes to the softness and moisture content of baked goods. Commercial honey often contains glucose syrup, which increases its GI. Make sure that the honey you use is pure, unprocessed raw honey. Honey should be used in the same limited quantities as sugar.
Replacement of sugar in recipes
Read the information on the container of the specific sweetener. The label should also state whether the sweetener is heat resistant and is suitable for baking and cooking. How much of the sweetener should be used to replace the equivalent amount of sugar is usually indicated in millilitres or grams.
Where possible I have indicated in the recipes in this book how much sugar each specific sweetener represents, so that you can replace it with another sweetener according to your circumstances and preference.
The fat content of your diet
Too much body fat and the excessive use of fat in the diet can stimulate insulin resistance because it suppresses insulin activity and can cause an increase in blood glucose.
Hyperlipidaemia
Diabetics have an increased risk of narrowing of the arteries and of developing cardiovascular diseases because of an increase in blood fat values in relation to total cholesterol, triglycerides and LDL cholesterol (which are deposited on the artery walls). This condition is called hyperlipidaemia. A fat intake of 20% to 30% (and in some cases even as high as 35%) of the total energy of the diet, is regarded as desirable. The body requires essential fatty acids because it cannot manufacture them. Fats are also important carriers of fat-soluble vitamins A, D, E and K. Research indicates that the high monounsaturated fatty acid content of olive oil, canola oil, nut oil, carotino oil (palm fruit oil), avocado and avocado oil, is advantageous for diabetics, particularly for the treatment of raised triglyceride levels. Despite claims to the contrary that do the rounds from time to time, reliable research studies continue to show that the intake of saturated fats and trans-fatty acids should be limited and that they should be replaced with mono- and polyunsaturated fats. It is a good idea to talk to your dietitian about this when she designs your meal plan.
Tips to reduce your fat intake
Make the following part of your lifestyle:
•Select small portions of lean red meat, chicken and fish. Remove the skin from poultry and cut all the visible fat off all meat. Steam, stew or grill food with a small quantity of oil at a lower temperature. When you stir-fry, add a few drops of boiling water as necessary to complete the stir-fry process with less oil.
•Oven roast meat on a grid in a roasting pan to collect the fat and meat juices.
•Make low-fat meat gravy from the meat juices in the pan by adding ice cubes to the juices to coagulate the fat. You can then remove the coagulated fat and ice cubes from the meat juices.
•Use minimal fat or oil when preparing food and, where possible, avoid using any fat at all.
•Use a spray bottle containing oil or lightly brush the pan with oil to prevent sticking, or use cooking utensils with a non-stick lining.
•Use soft butter or margarine sparingly and avoid whenever possible.
•Rather spread low-fat cottage cheese, low-fat dipping sauce, chutney, tomato sauce or low-oil mayonnaise on bread instead of margarine.
•Use “lite” or low-oil salad cream, lemon juice, balsamic vinegar and a few drops of olive oil instead of rich, fatty salad dressings.
•Replace cream in recipes with plain low-fat yoghurt, low-fat evaporated milk or soft tofu (soya curds).
•Replace cream cheese in recipes with ricotta or smooth fat-free cottage cheese.
•Replace a melted cheese topping with grated cheese that has been mixed with dry breadcrumbs, or mix some sesame seeds with the cheese and scatter over the dish.
•Replace rich puff or short-crust pastry with phyllo pastry. Brush the phyllo sheets lightly with milk or spray them with non-stick food spray.
•Use low-fat milk, yoghurt, cheese and ice cream.
•Read the labels of food products carefully to find out what fats they contain – including “hidden” fats.
•Restrict your intake of trans-fatty acids, which are formed when oil used for deep frying is heated. Hard margarine also contains trans-fatty acids, which are often indicated as “partially hydrogenated fat” on food labels.
High blood pressure
High blood pressure (hypertension) can in many cases be lowered by restricting salt intake and by losing weight if you are overweight. Try to limit your daily salt intake to not more than 5 ml (1 teaspoon).
Also keep the following in mind:
•Use minimal salt during food preparation.
•Do not use salt at the table.
•Avoid salted, processed foods such as sausages, polonies, ham, smoked and pickled fish and meat, droëwors and biltong.
•Limit your intake of foods such as ready-to-eat pizzas, pies, chips, salted nuts and salty biscuits.
•Limit your intake of sauces and pickles with a high salt content.
•Limit your intake of hard cheeses.
•Use herbs and spices to flavour food and to compensate for a low salt content.
•Be careful of flavour enhancers such as MSG (monosodium glutamate). Also look out for words such as “sodium” and “salt” on food labels.
•Instead of sprinkling salt on your food before eating, squeeze a few drops of lemon juice over it instead.
The use of alcohol
Despite research showing that the phytochemicals in red wine in particular are beneficial to health in relation to the prevention of cardiovascular disease, strokes, diabetes and Alzheimer’s disease, the negative effects of excessive alcohol intake should not be underestimated. Alcohol is often consumed “to relieve stress”. Although alcohol initially has a calming or sedative effect, it is in reality a depressant and damages the nerve cells. Excessive alcohol use also increases the load on the liver because it is the liver that has to break down the alcohol, which acts as a poison in the body.
Alcohol provides concentrated empty kilojoules, is metabolised rapidly and stored as fat, and it is therefore not a good idea for anyone trying to lose weight. Satisfy your thirst by first having a glass of water, so that you can enjoy your alcoholic drink slowly.
Diabetics must always remember that alcohol suppresses the production of glucose (from glycogen) in the body. If you therefore drink alcohol on an empty stomach, it can lead to hypoglycaemia and in extreme cases cause a coma. Alcohol also increases the effect of certain oral diabetic medications. Always have alcoholic drinks with a dry biscuit, fruit juice, milk or a meal. Because of their high sugar content, it is not a good idea to drink sweet wine, sweet sherry, vermouth or liqueurs. Also be careful with the cold drinks or mixers you add to alcoholic drinks.
It is recommended that alcohol intake should be limited to a maximum of two units per day for men and one unit per day for women. Recent research indicates that women should not drink alcohol every day because of the risk of developing breast cancer.
A unit is regarded as:
•25 ml spirits such as whisky, brandy, cane or vodka
•60 ml dry sherry, vermouth or port
•120 ml dry red or white wine
•200 ml low-kilojoule beer
Menu and meal planning
Like everyone else, the nutrient requirements of people with diabetes are influenced by a variety of factors, such as:
•Gender – male or female.
•Life stage – pregnant or breastfeeding women and children who are still growing require more nutrients.
•Age – children have higher nutrient needs than the elderly.
•Level of activity – active working people, those who regularly participate in sport, and children who play and run around a lot, have much greater nutrient requirements than inactive or passive people.
•Ratio of body weight to height – if a person is underweight or overweight and if he/she would like to gain or lose weight.
•Blood glucose, medication – blood glucose readings and medications such as insulin and diabetic tablets can determine the distribution of meals during the day and the choice of food types.
•Financial circumstances – cheaper substitutes for certain types of food may have to be chosen.
•Personal circumstances – having a family, the size of the family or limited cooking and cooling facilities can influence meal planning.
It is clear from the above that it is impossible to provide meal plans, menus and portion sizes that will accommodate all circumstances and meet the needs of everyone, within the scope of a book like this. Even if you use this cookbook it is still important to consult a registered dietitian for a suitable menu plan and portion sizes for you and/or your family. If you have a good meal plan at your disposal you can choose recipes from the book and make meals (and their consequences) a pleasant experience.
Guidelines for adapting your meal plan and menus
Read this section together with the information about healthy eating habits and the guidelines for good nutrition provided.
To control your blood sugar effectively, having “regular meals” means spreading three meals – consisting of a variety of foods – of more or less the same size, throughout the day and having snacks as required between breakfast and lunch, again between lunch and supper, and then once again before going to bed (when necessary).
Sometimes it may be necessary to have a more substantial breakfast to help you get through a very busy morning and to eat less food later in the day because your level of activity tends to decrease then and your energy requirements are therefore lower. In such a case the energy value of your breakfast would possibly be closer to 40% or 50% of your total daily intake.
An adequate volume of liquid must be included in the form of water, rooibos tea, green tea, Ceylon tea and, less frequently, coffee. Drink a limited amount of artificially sweetened cold drink (not more than 500 ml per day) and always try to first quench your thirst with water. Fruit juice should preferably be diluted with water and also consumed in limited quantities because the carbohydrates in the juice are absorbed rapidly and can therefore lead to a rapid rise in blood glucose. Avoid fruit juice if your blood glucose is not well controlled.
Make fruit lollies for children by diluting unsweetened fruit juice with the same amount of water (this helps it to freeze harder) and freeze the juice in suitable lolly containers. Alternatively, put 200 ml cartons of juice (like Ceres) in the freezer and cut off the top seam of the carton of frozen juice before serving. A lolly like this will keep a child busy for ages, whereas the juice would have been gulped down in a flash!
Some of the rapidly-acting types of insulin which are injected before each meal are available in the bloodstream within minutes, but the half-life or period during which the insulin is active in the bloodstream is also much shorter, which means that it will no longer be effective when the between-meal snack is eaten. In such a case it is not necessary to have a snack between meals. A liquid such as a cup of tea or a diet cold drink is regarded as adequate, and this contributes to a lower energy intake, which is an advantage for healthy slimming. People who use this kind of insulin are also inclined to be less hungry between meals and find a between-meal snack unnecessary.
When longer-acting insulin is injected at bedtime, it is important to have a snack before going to bed to prevent low blood sugar in the early hours of the morning. If you regularly wake up in the morning with high blood glucose values, it is important to take a blood glucose reading in the early hours of the morning, in other words three to five hours after injecting the late-night insulin, because in such a case the body makes its own glucose from stored glycogen to prevent low blood glucose levels. It is also important to pay attention to the amount of fat and the type of starch you eat at night, as this can contribute to the high blood glucose before breakfast. If the problem persists, discuss it with your dietitian and doctor so you can find a solution together.
The value of a cycle menu in busy lives
It is a general complaint that there is just not enough time to prepare proper meals.
Fast foods and high-fat dishes are often chosen as quick solutions.
I work full time in my career as a dietitian, which is why I understand this dilemma associated with having to cook at the end of a long working day. The best way to solve this problem is to sit down and plan your family’s meals and menus according to your unique needs and circumstances for a specific period of time, ranging from one to four weeks or one calendar month. When you know what you are going to eat, the next step is to compile a shopping list so that the necessary fresh produce and groceries are available when you start preparing meals.
There are many ways to plan your family’s meals. The example of a seven-day menu cycle is shown below, and is just one method you can use. Once you have planned the basic cycle menu, you can work out another three to four variations for each menu day.
Start by changing the page layout on your computer screen to “landscape” and create a table with seven columns and seven rows for the menu.
EXAMPLE OF A CYCLE MENU FOR 7 DAYS
| Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 |
| BreakfastMuesliYoghurtFruit | →Seed loafEggTomato | →PorridgeMilkFruit | →Brown breadFishCucumber | →CerealMilkFruit | →ProvitasCheese /eggFruit | →PorridgeMilkFruit |
| In between | → | → | → | → | → | → |
| Light mealProvitasCheeseCucumberCherry tomatoes | →PastaCold meatFruit | →Seed loafRed meatSalad | →ProvitasCottage cheeseFruit | →Pasta salad with legumesLettuceFruit | →PotatoesFishSalad or vegetables | →Rye breadCold chickenGreen salad |
| In between | → | → | → | → | → | → |
| Main mealRed meatBrown riceGreen vegetables | →FishPotatoesBeetroot/carrots | →ChickenBarley/ riceMixed vegetables | →Soup (winter)Quiche /pasta(summer)Green salad | →Red meatSweet potato/potatoGreen vegetables | →ChickenRiceGreen/ yellow vegetables | →Free choice |
| Late evening | → | → | → | → | → | → |
•Choose vegetables and fruit according to the season and availability.
•Plan between-meal and bedtime snacks according to your personal meal plan.
•Provitas can be replaced with any other low-fat, wholegrain crisp biscuit or cracker.
•Sauces, spreads and drinks are not indicated.
EXAMPLE:
VARIATION FOR DAY 3 IN THE CYCLE MENU
| Day 3 | Day 3 Variation 1 | Day 3 Variation 2 | Day 3 Variation 3 |
| BreakfastCooked porridgeMilkFruit | Oats porridgewith oat branLow-fat milkOrange slices | Maize porridge with oat branLow-fat milkStewed prunes | Maltabella porridgewith oat branLow-fat milkFresh apple |
| Light mealSeed loafRed meatSalad | Seed loafHam slicesMustard sauceLettuce | Toasted sandwich with savoury minceSliced tomato | Pita breadMinced meat pattyLettuceSliced tomato |
| Main mealChickenBarley/riceMixed vegetables | Apricot chickenBarley or crushed wheatMixed vegetables with broccoli, cauliflower, carrots, baby marrows | Chicken stir-fryBrown riceVegetables in stir-fry | Chicken curryBrown riceGreen beans or peasBeetroot salad |
Shopping list
A detailed shopping list makes food shopping much easier, reduces unnecessary purchases and ensures that the correct ingredients are available for each day’s menu. It also helps to stick a copy of the shopping list on the inside of your grocery cupboard or pantry door so that the supplies can be marked off or listed as they are used up. The shopping list shown below is only a guide and can be adapted according to your circumstances.
INGREDIENTS
Starch
Instant cereals
All-Bran flakes
Bokomo Fibre Plus
Kellogg’s Hi-Fibre Bran
ProNutro Wholewheat
Weet-Bix
Cooked porridges
Maize meal – unsifted
Maltabella – unsifted
Oat bran
Oats – rolled
Grain/starchy dishes
Baking powder
Baking soda
Cocoa powder
Cream of tartar
Crushed wheat
Custard powder
Flour – cake, Sasko bran-rich self-raising, soya, wholewheat
Instant yeast, dry
Maizena (cornflour)
Pasta/noodles – durum flour
Pearl barley
Rice – basmati, brown, maize, white
Bread, crackers
Bakers Digestive Wholewheat Biscuits
Bread – brown, rye, seed, wholewheat
Crackermates Lites
Provitas
Rice cakes
Ryvitas
Dairy group
Buttermilk
Cheese – hard, low-fat (mozzarella, edam, parmesan, In Shape,
Lichten Blanc)
Cheese spread – low-fat
Cheese wedges – low-fat
Cottage cheese – low-fat, fat-free
Evaporated milk – low-fat
Milk – fat-free, low-fat, fresh/carton
Milk powder – fat-free
Ricotta
Yoghurt – low-fat, fat-free,
plain or flavoured
Seasoning
Salt
Pepper – white, black, finely ground, whole peppercorns
Herbs
Capers
Marjoram
Mint/peppermint
Nutmeg
Origanum
Paprika
Parsley
Peppermint/mint
Rosemary
Spices
Aniseed
Cinnamon, ground
Cloves – whole, ground
Cumin
Curry powder – mild, hot
Garam masala
Ginger, ground
Mixed spice
Mustard – seed, powder
Turmeric
Other
Gelatine
Diabetic chocolate
Dark chocolate
Vanilla essence
Almond essence
INGREDIENTS
Protein
Eggs
Red meat
Bacon, lean or reduced fat products
Cold meat (ham, corned beef)
Lamb, lean
Mince, lean
Picnic ham (Enterprise)
Pork
Venison
Poultry
Chicken
Ostrich
Turkey
Fish – fresh/frozen/smoked
Cape whiting
Hake
Kingklip
Mackerel
Salmon
Shrimps
Sole
Trout
Tuna
Canned fish
Mackerel
Pilchards
Salmon
Sardines
Tuna
Beans in tomato sauce
Butterbeans, canned
Chickpeas
Dry beans – small white, butter, sugar
Lentils – brown, red, split
Textured soya protein –
soya mince, soya cubes
Fats
Coconut, dried
Low-oil/lite salad dressing
Margarine – soft, lite
Nuts – almonds, peanuts, cashews, pecans
Oil – olive, canola, sunflower
Olives
Peanut butter
Seeds – linseed, poppy,
sesame, sunflower
Sauces and spreads
Bovril
Chutney
Honey – raw, pure
Jam
Marmite
Soup powder
Soya sauce
Stock cubes or powder – beef, chicken, vegetable
Tomato sauce
Vinegar
Worcestershire sauce
Drinks
Coffee
Ensure powder
Red wine
Tea – green, rooibos, Ceylon
Sweeteners
Artificial sweeteners
Fructose
Sugalite
Sugar – brown, white
Xylitol
INGREDIENTS
Vegetables and fruit
Fresh vegetables
Aubergine/eggplant
Avocado
Baby marrows
Beetroot
Broccoli
Butternut
Cabbage
Carrots
Cauliflower
Celery
Chilli pepper
Chives
Cucumber
Eggplant/aubergine
Garlic
Gem squash
Ginger, fresh
Green beans
Leeks
Lettuce
Mange tout
Mushrooms
Onions
Parsley
Peas
Peppermint
Potato
Red cabbage
Spinach
Sweet peppers – green,
yellow, red
Sweet potato
Tomatoes – standard, cherry, rosa, romanita
Frozen vegetables
Green beans
Mixed vegetables
Peas
Gherkins
Mixed vegetables
Mushroom pieces
Piquanté chillies
Sweetcorn, creamed
Tomato and onion mix
Tomatoes in juice, whole,
canned
Tomato purée, tomato paste
Whole kernel corn
Fresh fruit
Apples
Apricots
Banana
Berries
Citrus fruit – orange, naartjie, grapefruit
Lemon and lemon juice
Mango
Pawpaw
Peaches
Pears
Pineapple
Strawberries
Canned fruit
Apple (pie apples)
Apple sauce
Apricots in fruit juice
Fruit salad in fruit juice
Peaches in fruit juice
Pears in fruit juice
Fruit juice
Apple juice
Orange juice
Dried fruit
Apple rings
Apricots
Currants
Dates
Glacé cherries
Prunes
Raisins, sultanas
Mixed dried fruit
Eating out, takeaways and packed meals
Eating out and takeaways
•Whenever possible, choose dishes that contain little fat, such as grilled or steamed lean meat or fish. If the skin has not been removed, the roast chicken served in restaurants can be very fatty. The marinade and basting sauces used can also contain a lot of fat and sugar, so be careful when ordering roast chicken.
•Stews and potjiekos must be prepared with minimal fat and lean meat or skinless chicken. Vegetables, particularly potatoes and sweet potatoes, are inclined to absorb the fat in a stew. Dish up carefully when you eat stews and potjiekos dishes away from home.
•Limit the use of sauces on meat, fish and chicken – they can contain large amounts of hidden fat and sugar.
•Choose steamed or cooked fresh vegetables and salad which consists of fresh, raw vegetables or fruit.
•Eat plain cooked rice, pasta, jacket potatoes or wholewheat bread instead of greasy chips, fried onion rings, fritters or vetkoek.
•Keep moderation in mind when you consume alcoholic drinks. Also read the paragraph about the consumption of alcohol.
•Decide if it is really necessary to eat dessert, and perhaps rather order unsweetened fruit salad, according to the guidelines of your meal plan.
Packed meals, lunch boxes and picnics
•It is a good idea to buy a suitable food container and a cooler for this purpose. Nowadays you can buy useful insulated flasks that can be used to store hot or cold liquids and soups. Whenever possible try to keep foods cool, particularly in the hot summer months.
•To prevent food poisoning, choose foods that will keep well even when it is difficult to control the temperature.
•Try to stick to your dietary prescriptions for the specific meal. Choose food items from the following for your lunch box or picnic:
| Protein dish | Starchy dish | Vegetables | Fruit |
| Beans, lentils – cookedBeef slicesBiltong, without fatChickenDairy products – cheese: low-fat, hard, cottage cheese, ricotta;low-fat or fat-free milk; low-fat or fat-free yoghurtEggFish fingers, fish ballsFish pâtéHamHummusMackerel or snoek – dried or smokedMinced meat –meatballsNuts, peanutsPeanut butterSalmon, tuna – canned or smokedTarts and quiches | Bread and rolls – rye, brown, seed, wholewheatBrown riceCrumpetsFruit loafFruit muffinsPancakesPastaPita breadPopcorn with little or no oilPotatoes – boiled, saladPretzelsTortillas for wrapsWholewheat crackers – RyvitasProvitas, Cracker-mates Lites | AsparagusBaby marrows – sticks or chunksBean sproutsBeetroot cubesCabbage salad or coleslawCarrot sticksCelery sticksCucumber sticks or slicesLettuceOnion, onion saladPeppersTomatoVegetable kebabsVegetable soup | ApplesApricotsBananaCherriesCranberriesDatesFigs – fresh/driedFruit kebabsFruit saladGooseberriesGrapefruitKiwi fruitMangoNaartjieNectarinesOrangesPapayaPeachesPineapplePrunesRaisins, sultanas, currantsSpanspekStrawberriesWatermelon |
Parties for children and teenagers
A child with diabetes does not have to miss out on the fun of a party.
Consider the following when you plan the party:
•Think creatively and make an effort with the theme and décor. Select suitable tablecloths and colourful containers for the food. Emphasise the festive atmosphere with balloons and music to suit the party theme.
•Devise meaningful ways of keeping the children busy, as the emphasis should be on a group of children, who do not necessarily know each very well, getting together and having a good time.
•Avoid the usual sugar-laden party foods such as cake, biscuits, sweets and cold drinks, which are not good for any child. Think of an event where sugar does not play such a prominent role, such as at a picnic – lay out the picnic blankets and brightly coloured tablecloths, and pack a picnic meal into a festive container for each child. Then you can conjure up other treats and surprises like ideas for games, balls or small gifts from the picnic basket.
•A light lunch of mini pizzas, hotdogs, hamburgers, vegetable and fruit kebabs, filled pancakes and wraps, open sandwiches with colourful fillings and toppings and waffles with ice cream, can also work well.
•For older children you could have a do-it-yourself party where the children make and bake their own pizzas, make their own hamburgers or fill their pancakes.
•Place large bowls of popcorn on the table and choose low-oil or lite
potato crisps.
•When sugary cold drinks are served, it is important to mark your child’s glass of sugar-free cold drink. If you don’t serve cold drinks in their original containers, it is advisable to choose sugar-containing and sugar-free drinks in different colours and to explain the difference to all the children.
•For many people a birthday party is synonymous with a large cake with candles that have to be blown out with a single puff. Consider using one of the cakes or fruit loaves in this book as the basis of the birthday cake. You can also deviate from the traditional birthday cake by using a two-litre container of suitable ice cream, such as Country Fresh Lite sorbet, or choose a savoury tart or cheese cake. Decorate the cake with ribbons, birthday candles and flowers or small toys.
•Bake some of the muffins in this cookbook in smaller muffin trays. Decorate with a small amount of melted dark chocolate or apricot jam and coconut. For children who are not diabetic, the muffins can be decorated with a small amount of butter icing and hundreds and thousands.
•Make jelly boats by letting jelly set in scooped-out orange halves and then cut through the orange halves containing the set jelly to form two wedges. Make a paper flag with a toothpick and decorate the jelly boat with the
little flag.
•If your child is invited to a friend’s party, it is advisable to inform the hostess about your child’s diabetes before the time and to offer to send along suitable eats and drinks.
Tips for hikers and backpackers
Healthy outdoor activities hold more advantages than disadvantages for people with diabetes.
•The type of route, the length of the route, the weight you have to carry and facilities for preparing food will of course determine your choice of food items.
•Use your prescribed meal plan as a guideline when planning the food supply for your hike. You should generally be able to work according to your normal diet prescription for the meal plan plus 25% to 30% extra (approximately equal to your normal breakfast or a light lunch) in the form of snacks.
•Because you will probably be more physically active than on a normal day, there is a risk of developing hypoglycaemia. Always take along glucose sweets that you can suck (e.g. Sparkles or Super C), a packet of raisins, a packet of nuts/seeds and raisins and/or a packet of cool drink powder (e.g. Game or Clifton) as snacks. Sugar-containing jelly powder also works well, but it should be eaten with a few sips of water.
•Pack the following:
Breakfast
Starchy dishes:
•Weet-Bix or Oat-Bix with 10 ml oat bran per portion to lower the GI, All-Bran, Futurelife Smart Food, wholewheat ProNutro, sugar-free muesli, or a mixture of cereals to obtain a kind of “muesli”.
•Oatso-Easy – natural flavour or with raisins; add oat bran to lower the GI.
Milk products:
•Pack milk powder in 60 ml portions per 250 ml water as required throughout the day and mix before use. Milk powder can also be added to the breakfast cereals and mixed with water just before serving.
•Low-fat/lite evaporated milk, long-life milk and low-fat yoghurt will remain fresh for 6-8 hours under cool conditions.
•Sugar-free custard in 250 ml packets (e.g. Ultra Mel Lite) can be used to replace milk.
Between-meal snacks
Starchy dishes:
•Dry crackers such as Provitas, Crackermates Lites, rice cakes, Ryvitas and bran-rich health muffins.
•Instant soup powder (e.g. Cup-a-Soup), especially in cold weather and when you sweat a lot.
•A wide variety of energy or “breakfast” bars are available, but it is important to check their sugar and fat content. A bar should be comparable with no more than a two-slice sandwich with a protein filling, therefore about 1 000 kJ energy; 20-30 g carbohydrate; 7-10 g protein; 5-10 g fat.
Fruit:
•Fresh and dried fruit. Fruit slices and dried fruit such as dried peaches, apricots, apple rings, prunes, raisins and sultanas can be mixed with nuts, peanuts and/or seeds.
•Fruit bars which provide about 350 kJ or 15-25 g carbohydrate.
Proteins:
•Cheese wedges, sliced biltong, nuts.
Light and main meals
Starchy dishes:
Most of these starchy dishes, which have been suggested from a practical point of view, have a higher GI which will cause a more rapid increase in blood glucose. However, in view of your increased physical activity, this can be an advantage.
•Instant or two-minute noodles, spicy instant pasta dishes which can be mixed with boiling water, standard pasta such as spaghetti, instant rice, instant mashed potatoes (e.g. Smash), instant maize meal porridge, canned sweetcorn, spaghetti in tomato sauce, beans in tomato sauce, canned potatoes.
Protein dishes:
•Frozen meat (wrapped in newspaper) for the first day, vacuum-packed meat for the following day, smoked, salted meat or snoek, soya mince or cubes, and soya products such as Knorrox or Imana, which have been seasoned and are ready for use.
•Biltong, hardboiled eggs in the shell (eat within 2-3 days of boiling).
•Tuna and salmon in foil packaging (looks like packets of soup powder), canned fish in small tins for single servings (e.g. tuna, sardines in oil or tomato sauce).
•Instant cheese sauce, instant gravy (e.g. Royco, Knorr).
Vegetables and fruit:
•Canned vegetables, canned/vacuum-packed salads.
Remember!
•A water bottle with clean water and water purification tablets.
•Scissors and/or a pocket knife to open packets.
•A can opener and bottle opener.
•A bag or container for all waste such as empty cans, bottles, etc.
•Leave only your footprints behind!
Sick days
Your blood glucose may rise when you are ill and/or have an infection. It is therefore important to always take your prescribed insulin and/or diabetic tablets. Even if your appetite is poor, you still need to eat the necessary amount of carbohydrates. If you feel nauseous or vomit, it sometimes helps to slowly sip ice-cold ginger lemonade or Lucozade. When you start feeling better, you can have some dry crackers, grated apple, ice-cold pawpaw or vegetable or meat extract dissolved in hot water. Try to eat or drink something light at least once an hour. Vomiting and diarrhoea can lead to dehydration and uncontrolled diabetes. Consult your doctor in good time, but immediately if your symptoms last for longer than 24 hours or if your blood glucose remains higher than 15 mmol/litre.
Suitable carbohydrates when you are ill
•Ice-cold apple or grape juice.
•Ice-cold lemonade or ginger lemonade.
•Sugar-containing jelly, which has been dissolved and allowed to set.
•Ice-cold pawpaw, grated apple, stewed apple or canned pears.
•Boiled rice or pasta without any sauce.
•Toast – dry, add Marmite or Bovril later.
•Dry crackers such as Provitas or water biscuits.
•Plain sweet biscuits such as Marie biscuits.
•Weak black Ceylon or rooibos tea with honey and/or a slice of lemon.
•Soup with toast – strain the soup initially.
•Low-fat fruit yoghurt, custard or milk when you feel better.
Sport, exercise and diabetes
Regular exercise is an important part of a balanced lifestyle for everyone. Choose a physical activity that you enjoy, can afford and that you can do regularly (five times a week for 30 minutes). Going for a fast walk, a swim or cycling, exercising in the gym or attending aerobic classes are all good forms of exercise.
In the case of type 2 diabetes, insulin resistance and blood glucose control can sometimes be improved to such an extent through exercise that the use of medication can be reduced or even stopped. It has also been shown that regular exercise can lower blood pressure and triglycerides.
In type 1 diabetes, regular exercise is also important but it is only advisable if you have already achieved good blood glucose control. People with type 1 (insulin-dependent) diabetes should not exercise if their blood glucose values are higher than 15 mmol/litre because exercise can increase these values even further due to the release of glucose by the liver. The production of ketones can also be increased if insufficient glucose is released into the body cells where energy is produced. If your blood glucose levels are too low, carbohydrates with a high GI should be eaten before, during and after exercise.
Consult a dietitian to compile a suitable diet plan for you.
Pregnancy and diabetes
It is important that your diabetes should be well controlled before you fall pregnant. Because of changes in hormone levels during pregnancy, your nutritional and insulin needs will also change from time to time. Consult your dietitian regularly so that your diet can be adjusted in good time to benefit your own and your baby’s health. During this period it is particularly important to eat regularly, especially breakfast and the late-night snack. Starving yourself and skipping meals increase the risk of ketoacidosis, which can be life threatening for you and your baby. Use artificial sweeteners sparingly during pregnancy and avoid sweeteners that contain saccharine or cyclamates, because their safety during pregnancy has not been established.
Children and teenagers
The general guidelines for balanced nutrition for the growth and development of children and teenagers without diabetes also apply to those who have diabetes.
Visit the dietitian at least once a year so that the diet prescription and meal plan can be adjusted in good time to meet your child’s changing needs. Also take your child for a medical check-up at least once a year.
It is important that your child understands that a diabetic meal plan is a balanced eating pattern which has many advantages for a healthy body. Get the entire family to buy into this eating pattern and try to make meals pleasant occasions.
Put some effort into snacks and keep surprises in the freezer or cake tin. Older children can be taught how to make their own dishes and snacks. Children aged ten years and older should easily be able to prepare the recipes in this book. Children who are encouraged to prepare their own meals and snacks are being taught to take responsibility for controlling their own diabetes.
Can these dishes be stored?
Each recipe in this book has an indication of approximately how long the dish can be stored, if it needs to be stored in the fridge and if it can be frozen. The purpose of this information is to help you always have a meal or a snack available for emergencies and to plan your meals ahead of time for when life becomes hectic.
Measuring ingredients and the use of household and metric measures
If you measure ingredients accurately, you should not have problems with preparing the dishes in this cookbook. Accurate measuring cups, measuring spoons and kitchen scales are available commercially. A medicine spoon or baby bottle also works well when you need to measure small quantities such as a small amount of vinegar or oil. Shakers with volume indicators and lids that seal tightly are also readily available in most shops. The lid seals tightly and all you need do is to shake the mixture instead of having to beat it with a whisk, which also means fewer dirty dishes to clean.
You should find the following conversion table useful:
| Metric measure | Household measure | Metric measure | Household measure |
| 1,25 ml2,5 ml5 ml10 ml12,5 ml15 ml | ¼ teaspoon½ teaspoon1 teaspoon2 teaspoon1 dessertspoon3 teaspoons | 15 ml60 ml80 ml125 ml190 ml250 ml | 1 tablespoon¼ cup⅓ cup½ cup¾ cup1 cup |
Abbreviations
| ADSA | Association for Dietetics in South Africa |
| °C | degrees Celsius (metric unit of temperature) |
| CHO | carbohydrate |
| Chol | cholesterol |
| g | gram (metric unit of mass) |
| GI | glycaemic index |
| HDL | high-density lipoprotein (the “good” cholesterol carrier, which keeps blood vessels clean) |
| kg | kilogram (metric unit of weight) |
| kJ | kilojoule (metric unit of energy) |
| LDL | low-density lipoprotein (the “bad” cholesterol carrier, which clogs blood vessels) |
| med | medium |
| mg | milligram (metric unit of weight) |
| ml | millilitre (metric unit of volume) |
| mm | millimetre (metric unit of length) |
| MUFA | monounsaturated fatty acid |
| PUFA | polyunsaturated fatty acid |
| SEMDSA | Society for Endocrinology, Metabolism and Diabetes in South Africa |
| SF | saturated fats |
