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Diabetes in Adolescence

We always tend to associate type 1 diabetes with childhood and type 2 diabetes with late adulthood but the reality is both can occur at any age. Furthermore, we are now seeing an increased number of teenagers being diagnosed with both types of diabetes. It may co-incide with the peak of physiological pubertal insulin resistance towards the end of puberty. Often these teenagers are asymptomatic or may present with vague symptoms of weight loss / weight gain, excessive thirst, frequent urination or ketosis.

The reason for diabetes developing in adolescence may be related to various genetic factors, behavioural factors (unhealthy eating habits, lack of physical exercise) or even follow a traumatic event or severe illness. Diagnosing diabetes at this stage may be quite complex as the expected normal values clinicians are accustomed to, do not always apply. It may even require ongoing testing of blood glucose levels over a period of time to detect subtle changes in glucose levels.

fat teenThe international obesity epidemic has not escaped teenagers and type 2 diabetes is fast becoming a serious threat to this age group. Those at high risk of developing diabetes (family history, obese, sedentary lifestyle) should be screened from age 10 or the start of puberty and repeated every 3 years throughout adolescence. Other criteria that may encourage diabetes screening are signs of insulin resistance including polycystic ovarian syndrome, menorrhagia, hirsuitism, abnormal cholesterol profile or a maternal history of diabetes / gestational diabetes.

Very little published evidence is available to give accurate information about the risk of diabetes in adolescents and the potential to develop complications such as eye or kidney disease, heart complications etc. It’s probably best to follow the usual common sense advice of controlling blood glucose levels as strictly as possible and pro-actively screening for potential complications on a regular basis.

Huge strides still need to be made in preventing diabetes in adolescents but the good news is we do have good medication to offer and many tools to make blood glucose control much simpler and more effective. If you know someone at risk, encourage them to get tested and repeat the screening on a regular basis; seek good medical care and make the lifestyle adaptations that will reduce the risk of diabetes complications.

Older and wiser in diabetes

elderly testingWe all know an older person who has diabetes. Many people think that advancing age and diabetes are almost synonymous. But did you know that the way we treat diabetes in the elderly is often very different to how we treat it in a younger person. This is partially due to the other co-mobidities and illnesses that older people may suffer from but it is mainly due to altered physiology, different living environments and a need to focus on different priorities.

Individualised care. This is probably the single most important aspect of treating diabetes in the elderly. Some 70 year olds are still working a full day in an office or running their own, highly successful business, whilst others may already be a familiar face in a retirement home. The days of classing all people over the age of 60 or 65 in one basket are long gone!

Preventing hypoglycaemia. As we age, our body metabolism and physiology changes. One important change is in the kidney’s filtration function. the nett result of this is that the risk of glucose levels going low is much higher as we get older. This may necessitate a change in medication, different glucose targets and lifestyle adaptations to prevent lower than normal values. Hypoglycaemia can become a serious threat especially if it occurs unannounced at night.

cognitionScreening for cognitive impairment. No one likes to admit that there is a decline in the way we function. However, both advancing age and diabetes itself can cause mental decline and both are also strongly associated with illnesses such depression and dementia. The latest SEMDSA Guidelines published in 2017, recommend annual screening for these conditions and cognitive function in general in order to inform optimal diabetes management. At The Atrium Lifestyle Centre we are privileged to have a multi-disciplinary team available and as such this specialised screening can be done by out team members. Follow this link to read more about it.

A change in medication. As mentioned previously, various medications are metabolised differently in the body as we get older. Those drugs that promote insulin secretion may be contra-indicated in the elderly. If you haven’t changed your medications since you were on the other side of 60, now is a good time to seek specialised, professional help. Re-writing the same script year after year is hardly a useful task!

elderly walkingA change in lifestyle. Older people may change their eating habits and activity levels and this may lead to a change in medication requirements. Our bodies also become naturally more insulin resistant as we get older and therefore careful manipulation of therapeutic options may need to be considered.

Support and care. Often older people change their living environments – some may need assisted care, others no longer do their own cooking, some live alone whilst others continue to drive. All these circumstances may require special consideration when managing diabetes. We may also need to take into account more regular hospital and doctor visits, multiple specialists becomming involved in care and the impact of multiple medications on the body.

The bottom line is there is no one-size-fits-all. Diabetes in the elderly is NOT “easy to treat” and cannot be managed in combination with a list of other illnesses in a 15 minute consultation. It requires specialised care and careful planning to ensure that the individual is able to continue living to their fullest potential.

The Lunch Box

Packing a lunch box for you child can be a daunting task. There’s lack of
time, lack of inspiration, fussy children to name a few of the barriers to happy
lunch boxing.


The lunch box is an important part of ones eating. For children its often most
of their meals for the day. My little boy will sometimes have 5 of his 6 meals at
nursery school. We should therefore try to plan the lunch box to ensure it
contains foods from all the food groups.

In 24 hours I would like my child to eat:
• 2 servings of meat/meat alternatives
• 5 servings of vegetables and fruits
• Cereals and grains with each main meal
• 2-3 servings of milk/milk alternatives

Plan the lunch box so the between breakfast and dinner these are covered!
Here are some ideas…

outside the box Cereals and grains:
Hot-cross buns
Pasta salad
Potato salad
Cous cous salads
Rice cake
Vegetables and Fruit:
Add tomato, cucumber, lettuce etc to sandwiches if you are allowed
Add roasted veg to salads
A salad
Veggie sticks – these are often better accepted with a dip like hummus or
Fresh fruit
Dried fruit
Canned fruit
Meat and Meat alternatives:
Add chicken, tuna, egg, peanutbutter, roast beef, ham
Sliced chicken or other cold meats
Boiled egg – watch the smell!
Milk and Milk alternatives:
Add cheese to a sandwich or grated cheese to a muffin/scones – this can be
cream cheese or a harder cheese like cheddar/gouda
Serve cheese muffins/scones
Add feta to salads
Blocks of cheddar cheese or wedges of cream cheese like Kiri/Melrose
Drinking Yoghurt.
Trouble shooting
Soggy sandwiches? Wrap the sandwich in some paper towel.
Soggy cheese and tomato sandwiches? – Wrap the sandwich in some paper
towel and salt the bread not the tomato.
Warm lunch? – Pack an ice brick into the lunch cooler bag
No time? – Prepare lunch boxes the night before

Let me know what works for you, and please share your own ideas. We can
never get enough inspiration for the lunch box.

– Megan Marshall, Registered Dietitian

Diabetes and the Family – World Diabetes Day 2018

Diabetes concerns every family

Over 425 million people are currently living with diabetes. Most of these cases are type 2 diabetes, which is largely preventable through regular physical activity, a healthy and balanced diet, and the promotion of healthy living environments. Families have a key role to play in addressing the modifiable risk factors for type 2 diabetes and must be provided with the education, resources and environments to live a healthy lifestyle.

1 in 2 people currently living with diabetes is undiagnosed. Most cases are type 2 diabetes. Early diagnosis and treatment are key to prevent the complications of diabetes and achieve healthy outcomes. All families are potentially affected by diabetes and so awareness of the signs, symptoms and risk factors for all types of diabetes are vital to help detect it early.

Diabetes can be expensive for the individual and family. In many countries, the cost of insulin injection and daily monitoring alone can consume half of a family’s average disposable income, and regular and affordable access to essential diabetes medicines are out of reach for too many. Improving access to affordable diabetes medicines and care is therefore urgent to avoid increased costs for the individual and family, which impact on health outcomes.

Less than 1 in 4 family members have access to diabetes education programmes. Family support in diabetes care has been shown to have a substantial effect in improving health outcomes for people with diabetes. It is therefore important that ongoing diabetes self-management education and support be accessible to all people with diabetes and their families to reduce the emotional impact of the disease that can result in a negative quality of life.


Cardiovascular disease and diabetes

Heart disease is any disorder that makes the heart function differently than it should. Heart heartdisease is one of the most common complications of diabetes. If the vessels leading to the heart become clogged, this can lead to a heart attack. If vessels leading to the legs become clogged, peripheral vascular disease (PVD) can result.

Why Heart Disease Is Common in People With Diabetes

People with diabetes tend to have more “bad” (LDL) cholesterol and less “good” (HDL) cholesterol. HDL cholesterol helps move bad cholesterol from the bloodstream to the liver. Over time, excess LDL cholesterol in the bloodstream is deposited inside blood vessels, where it sticks to the walls of the vessels and interferes with blood flow.

In addition to cholesterol levels, diabetes itself can bring about significant cardiac health risk, due in part to changes in the blood vessels produced by hyperglycemia, changes in blood coagulation properties, and changes in the plaques that form in the blood vessels of diabetics.

How to minimise your risk for heart disease

  • Eating a healthy diet (rich in fruits, vegetables, whole grains, lower-fat proteins and monounsaturated fats)
  • Limit sodium (salt) intake to less than 2,400mg/day
  • Achieving an optimal weight (calorie control)
  • Daily exercise routine (30-40mins 5 x week brisk walk or equivalent)
  • Stop smoking
  • Keeping blood sugar levels to target
  • Controlling blood pressure (< 130/80 for people with hypertension & diabetes)
  • Cholesterol control (LDL < 2.6mml/l, HDL >1.2mmol/l, triglycerides <4.5mmol/l ,)

What are the symptoms of heart disease

  • Chest pain (sometimes not felt “silent” in persons with diabetes due to neurological damage)
  • Discomfort or pain in the back, arms, neck or stomach
  • Shortness of breath
  • Sweating or light-headedness
  • Nausea or indigestion
  • Extreme weakness or anxiety

If you have experienced any of these symptoms, contact your healthcare provider immediately.

What are the symptoms of vessel disease

  • Painful cramps in the thigh, calves or hips during such exercise as walking or stair climbing
  • Persistent leg pain that continues even after exercise is stopped
  • Wounds on feet that are slow to heal or don’t heal
  • Gangrene
  • A much lower temperature in the affected foot or leg compared to rest of body

Because heart disease can be without symptoms until something major occurs, it’s essential to minimise the risk factors.

If you are experiencing any of these symptoms or feel you may be at risk to due other concominant illnesses or family history, please make a dedicated appointment to address these issues with your doctor. Various different modalities of therapy may be suggested depending upon your individual risk factors and symptoms.

Building Strong Bones


Calcium is essential for building and maintaining strong bones and teeth. It is also important for the functioning of the muscles, including the heart. The amount of calcium a person needs depends on their age. strong bones

You are more at risk of calcium deficiency if you:

  • are on a cow’s milk or lactose free diet
  • have coeliac disease
  • have osteoporosis
  • are breastfeeding
  • are past the menopause

Recommended Daily Calcium Requirements

Age Calcium Requirement   (mg/day)
0-12 months 525
1-3 years 350
4-6 years 450
7-10 years 550
11-18 years 1000 – Male,                   800 – Female
Adults 19+ 700
Pregnant women 700
Breastfeeding mums 1250


Calcium content of average portions of common foodsdairy

Dairy products Portion size Mg of Calcium
Full cream milk (glass) 200mls (approx 7oz) 248
Semi skimmed milk 200mls (approx 7oz) 256
Skimmed milk 200mls (approx 7oz) 258
Cheese-cheddar type 30g 240
Cheese-camembert type 40g 152
Cheese – cottage 50g 30
Cheese spread 25g 150
Butter 10g 1.5
Yoghurt 125g 225
Egg 1 (60g) 30


Dairy alternatives Portion size Mg of Calcium
Calcium fortified soya milk 200mls 260
Calcium fortified  nut milk



200mls 240
Calcium fortified rice milk  *rice milk should not be given to children under5* 200mls 240
Calcium fortified soya yoghurt 125g 150


Cereal foods Portion size Mg of Calcium
Cornflakes 30g 1
Museli  ** 55g 110
Chapattis 50g 33
Bread-white/brown I medium slice 40
Bread- wholemeal I medium slice 20
Bread-future life I medium slice 93


Fish Portion size Mg of Calcium
Canned sardines with bones

Pilchards, canned in tomato sauce

2 fish 275
Canned pilchards with bones 2 fish 260
Salmon canned with bones 100g 213
Shelled prawns 60g (20 prawns) 100




Fruit, vegetables and pulses Portion size Mg of Calcium
Broccoli 85g 34
Spring greens 2 tablespoons 70
Spinach 90g 144
Baked Beans Small can (150g) 80
Boiled lentils 3 tablespoons 25
Kidney beans I tablespoon 25
Hummus I tablespoon 12
Peanuts Small bag (50g) 30
Almonds 13g (6 nuts) 31
Tahini  (sesame seed paste) 1 tablespoon 130
Figs- dried 1 fig (20g) 56
Apricots-dried 7 52


1 large (210g) 70

 Meals and snack ideas to help you get your calcium …

  • Start the day with cereal (calcium-fortified) with milk or a milk substitute (calcium-fortified).
  • Use tinned sardines or pilchards (with the bones) instead of tuna in a sandwich or on toast.
  • Have a stir fry including tofu, broccoli spears and chopped nuts for lunch or dinner.
  • Add yoghurt/soya yoghurt to fruit as a pudding or use milk or a milk substitute (calcium-fortified) to make custard and milk puddings.
  • Try a glass of low-fat milk as a snack or to help rehydrate after exercising.
  • Don’t forget that low-fat dairy products have as much and often more calcium than the full-fat versions.
  • Remember to check non-dairy sources have added or are ‘fortified’ with calcium.

 strong bones2Vitamin D

Vitamin D helps the absorption of calcium from foods. Foods rich in vitamin D include: oily fish, margarine and fortified breakfast cereals but you cannot get enough vitamin D from food alone. Most of our vitamin D is made by the action of sunlight on the skin so make sure to take advantage of this by going out of doors regularly. Young babies should take a vitamin D supplement providing 8.5-10mcg Vitamin D unless they are drinking more than 500ml formula.

 Are calcium supplements necessary?

If you think you or your child are not meeting your calcium requiements, discuss the need for supplements with your dietitian.

Megan Marshall, Registered Dietitian

Mental Health Awareness Month: “In Pursuit of Happyness”

Many of us routinely have annual check-ups with our general practitioners, medical specialists and dentists, but what about our mental health?  October is mental health awareness month so perhaps it’s a good time to check in and think about our mental wellness.Image result for happyness

Sociologist, Aaron Antonovsky was surprised when research he conducted on concentration camp survivors showed that a significant number of them were well-adjusted, despite what they had endured. What had given these people the strength, despite their experiences, to be “well adapted and to maintain what would seem to be the capacity not only to function well, but even to be happy”?

Antonovsky concluded that we have been asking the wrong questions. Instead of focusing only on what causes disease, we should be asking what enables us to keep well, both physically and mentally?

For my PhD, I researched what it is that predicts psychological-wellbeing in children with life threatening long-term illnesses. My research confirmed that even children with diseases like cancer are able to maintain psychological well-being. Children that cope well psychologically when dealing with life threatening long-term illnesses are more likely to:

  • Have social support from family, peers and their community
  • Be able to make sense and understand their experiences through the way that they think about them
  • Have a belief system (religious or spiritual)
  • Have hope
  • Think that their experiences are helpful to others.

How we respond to our circumstances, and the environment in which we experience them, directly influences how we cope and the lasting impact that it has on our mental wellness.

So how do you create a life space that enhances your mental wellness?  Ask yourself these questions:

  • Do you have people in your life that make you feel supported and connected? The value of positive social relationships and support cannot be underestimated, including those that involve spiritual or religious activities.
  • Do you have interests that you can do on your own and with others outside of your work? Groups of interest could include creative activities, physical activities and educational or hobby courses.
  • Have you thought about goals and wishes for things you would want to do even if you can’t do them now…things that would make you excited for the future?
  • When you experience ongoing symptoms like insomnia, irritability, low mood, anxiety or loss of motivation, consider that this may be a warning that all is not well in your internal world. Rather than ignoring these symptoms, use them as an opportunity for growth and change.
  • Do you engage in small acts of kindness? Doing things for others can make a big difference to your mental well-being. Taking it one step further, being involved in a group that helps others can also be uplifting.
  • Do you spend too much time on social media? Social media can be educational and fun but it can also have the opposite effect. We can even end up neglecting our “real” lives and relationships for our on-line worlds. Consider a social media detox if you are spending too much time on-line.

Image result for happynessMental illness is as important as physical wellness. Just as you would visit the gym and eat well to keep your body healthy, think about how you can create a life that nurtures your mental wellness.

We acknowledge the daily struggle of those that suffer from serious mental illness, and their families.

Dr Brenda Talbot (PhD)
Educational Psychologist

National Nutrition and Obesity Week – Breakfast: The best way to start your day!

alarm clockMorning rush

Of course, our mornings are more urgent than our evenings. It is harder to relax and enjoy a meal when you’re anticipating everything that needs to be done in the day ahead and you have time pressures. However, it just takes a bit of planning and preparation to fit breakfast in. It helps to do as much breakfast preparation as you can the night before. Before you go to bed, set up your kitchen for breakfast. Soak the oats and slice the fruit so you don’t have to do it in the morning. Cook extra maize meal porridge for the next day’s breakfast when making supper, or boil some eggs the night before. Planning can make breakfast quick and easy.

health food

I don’t like typical breakfast foods!

Most people do find something they like amongst the range of foods we generally eat for breakfast, but it is important to remember there are no hard and fast rules. It doesn’t matter whether you eat the same things as others for breakfast – it just matters that you have a healthy start to the day. This means having a minimally processed starchy food, fruit or vegetable and combining it with at least one other food group. For example, maize meal porridge with maas, brown bread with pilchards, fruit and unsweetened low-fat yoghurt. Last night’s leftover beans can be used as a sandwich filling on brown bread for a great breakfast.

happy family

yawnIt takes my system a while to wake up, I don’t feel like eating in the early morning

Although breakfast is ‘breaking the fast’ between our longest sleep and lunch, there are many people who question the advice to eat when they don’t feel hunger. What’s important to consider is that breakfast can take place within 3 hours after waking.

avo & egg breakfast

Breakfast is easiest to ignore and I’m skipping meals to lose weight

It is important for those who are overweight and obese to follow a sensible, results-driven weight loss programme guided by registered dietitians and nutritionists. There are an abundance of studies that show that children, adolescents and adults who eat breakfast have better weight outcomes and lower risk of overweight and obesity.

making breakfast


As parents and caregivers, we are role models for the healthy lifestyles we hope our children will adopt for their lifetimes. Studies have shown that children who eat breakfast perform better at school than those who skip it. Eating breakfast has an immediate, positive impact on cognitive function, especially memory and concentration. Parents are the major influence on whether children make eating breakfast a habit, and studies have shown that 1 in 5 of South African children skip breakfast. It helps to make breakfast a family activity and involve children in preparing breakfast and eating together. Parents also need to ensure that healthy breakfast options that their children like to eat are available in the house.

Eye spy with my little eye










Why is it important to look after your eyes in diabetes?
People with diabetes are at a much higher risk of developing a number of complications related to their eyes and vision. High blood glucose levels or poor control will increase the risk. Trials have shown that good glycaemic control and regular eye screening can prevent or delay many complications related to diabetic eye disease. Your eyes can be badly damaged before you notice any change in vision therefore screening should occur at least once a year or more frequently if problems are detected.

Risk factors

In addition to poor glucose control, elevated blood pressure and/or cholesterol as well as kidney disease may place a person at a greater risk of developing eye disease. The longer the duration of diabetes, the greater the risk also. Pregnancy can also be a tricky time so if you are planning a pregnancy, please seek medical advice and have your eyes screened prior to conception.

What sort of changes occur with diabetes?

Doctors tend to categorise diabetic eye disease into diabetic retinopathy and maculopathy.

  • “Retinopathy” is a general term for all disorders of the retina (the back of the eye where all the blood vessels are located) caused by diabetes. Changes often occur in the retina PRIOR to any effect on vision taking place therefore regular screening becomes extremely important in preventing further damage.
  • “Maculopathy” refers to a leak into the centre of the macula (the area of the eye where colourful, sharp, straight-ahead vision occurs). The fluid makes the macula swell and blurs the vision. This can occur independantly of retinopathy.

Checking your visual acuity (near and far distance vision) and whether you require glasses or not is also important but often these changes are more age-related than they are to diabetes. Just because the lens of your eye are intact and reflecting light adequately (the windows are clear), t doesn’t mean that more complex changes in the back of the eye are not present.

What screening is necessary?

The Ophthalmology Society of South Africa (OSSA) recommends that those with diabetes are screened at least once a year. They require some background information on your diabetes from your doctor and will then provide a comprehensive report on your risk level and current clinical status. The screening test will also be able to indicate how often further follow-up is recommended.

Please don’t put off these tests because you can “see okay” or “just got new glasses last month”! Diabetic eye disease is preventable and treatable if detected early. There is no need to lose your vision in diabetes!!!