Ketones and ketoacidosis are often mentioned in relation to diabetes, but what are they exactly?
- Ketones result when your body burns fat for energy.
- They are formed when the body doesn’t have enough insulin to use glucose for fuel.
- A urine test is traditionally used to test for ketones: some blood glucose meters can also test for ketones.
- Ketones make the blood more acidic.
- Ketones in the urine combined with high blood sugar are a warning sign that your diabetes isn’t under control.
- Diabetic ketoacidosis (DKA) is caused by a combination of high blood sugar that causes a rise in ketones. The ketones are an indication of how acidotic the patient is, and the acidosis can be fatal.
- DKA is serious and can lead to diabetic coma.
- DKA is rare in Type 2 diabetics and more common in Type 1 diabetics with uncontrolled blood sugar.
- Symptoms of DKA are thirst, frequent urination, high blood glucose, constant tiredness, nausea, vomiting, abdominal pain, dry/flushed skin, breathing difficulty and confusion.
- If these symptoms ring a bell, see a doctor as soon as possible to get your blood sugar under control.
Hypoglycemic episodes (hypos) can be a scary experience for all involved: here’s what you need to know to deal with one.
- A hypo is a sudden low blood sugar episode.
- The optimal blood glucose range is 4 to 7mmol/l. With a hypo, blood glucose levels are usually lower than 3mmol/l.
- Initial symptoms are nervousness, sweating, intense hunger, trembling, weakness, palpitations, or trouble speaking (depending on the person).
- The best thing to treat a hypo is fast-acting carbohydrates: 15-20g of sugary carb (a few sweets, 2 tablespoons of raisins, a tablespoon of honey or half a cup of fruit juice).
- The key is to catch low blood sugar early – as soon as it starts dropping – and treat it with a small dose of something sweet.
- If blood glucose drops too low it can get to the stage where the brain is not getting enough glucose.
- Symptoms of this are confusion, drowsiness, changes in behaviour, seizure and eventually coma.
- In case of a severe hypo, a glucagon emergency kit may be necessary. This once-off injection instantly raises the blood sugar, and is particularly useful when the person with diabetes is unconscious or unable to swallow.
- Notify all those close to you what to do in an emergency and how to use a glucagon injection.
- Test often to keep your levels as well controlled as possible.
Ask the dietician: Keri Strachan
We recently published an article called The basic diabetic pantry, which focuses on a dietary pattern rich in wholegrains / high fibre grains and starches, fruits, vegetables, legumes and nuts; moderate in alcohol consumption; and lower in refined grains, red/processed meats and sugar-sweetened beverages.
Some of our readers asked if we could provide the low carb alternative to the diabetic pantry, so here it is!
Low carb pantry guidelines
When you start a low carb lifestyle, you’ll be struck by how you no longer visit certain parts of the supermarket, only the areas of fresh produce, and limited packaged items. When buying real food there is no need for a label, but there are some that are still worth checking: this will help you to identify which brands are better than others to suit your needs.
Buy basic food ingredients and cook from scratch and you are unlikely to be fooled into hidden carbs sneaking in. Here’s a basic list of what to eat:
- Meat (beef, pork, lamb)
- Fish (especially omega-3 rich such as sardines, pilchards, salmon, fresh tuna, salmon, trout)
- Free-range eggs
Vegetables and fruit
- Low carb veggies, excluding butternut, all potatoes, peas and corn
- Low carb nutrient dense fruit such as berries
- Full-cream milk
- Full or double-cream plain yoghurt (but in limited amount due to natural carb content)
Nuts and seeds
- Macadamia nuts
- Sunflower seeds
- Pumpkin seeds
- Sesame seeds
- Olive oil (not for cooking)
- Macadamia nut oil
- Coconut oil and cream
- Lard (no vegetable oils)
- Canned tomatoes
- Tomato paste
- Almond flour and coconut flour (but avoid replica foods too often, they are not as low carb as you think)
- Stevia, erythritol (but try to avoid sweetness)
- Coconut flakes/ desiccated coconut
- Pure herbs and spices e.g. paprika, turmeric, cayenne pepper, cumin, rosemary, basil, thyme, parsley
- Mayonnaise made from non-vegetable oil e.g. macadamia, avocado
- Fresh herbs (rocket, basil, origanum)
Remember a few tips:
- Do not snack!
- Get enough fat to replace your carbs, and ensure that you last between meals without snacking
- Avoid over-eating protein
- Bulk meals with boldly colourful vegetables, herbs and spices
- Drink mostly water, limit milk through hot drinks
Not sure exactly what pre-eclampsia is or how to spot it? Here’s what to watch out for.
- Pre-eclampsia is high blood pressure during pregnancy that causes hypertension.
- It is picked up by elevated proteins in the urine (which leak from the kidneys).
- Women with diabetes are at higher risk of pre-eclampsia.
- It usually starts after the 20th week of pregnancy and improves 6 weeks after birth.
- It must be closely monitored as it can result in an early delivery.
- If your blood pressure is above 120/80 you need to see a doctor.
- Type 1 diabetics are 2 to 4 times more likely to develop pre-eclampsia than those without diabetes.
- Your risk of developing pre-eclampsia is higher if you are obese or have a maternal history of high blood pressure.
- Symptoms include: severe headaches, problems with vision, abdominal pain, vomiting, swelling, not feeling your baby’s movement, and feeling ill. Treatment is medication or early delivery.
- Pre-eclampsia, gestational diabetes and hypertension during pregnancy can increase a woman’s risk of developing Type 2 diabetes up to 18 times.
Keeping your diabetes in check as you get older is not only possible, but important. Here’s what you need to remember.
- Diet is vital: be sure to eat as balanced a diet as possible. Not eating the right kind of food or often enough can result in low blood sugar. Drinking plenty of water is also important.
- The average HbA1c in the elderly population in SA is within national guidelines at around 7.3. What’s yours?
- Be prepared and always have at least 3 days of supplies on hand for testing and treating your diabetes.
- Hypos (low blood sugar) are a risk, especially in Type 2 diabetics who are on SUs (sulphonylureas). Severe hypos can result in comas, so it’s important to know how to treat them.
- Always keep a glucagon pen on hand for hypo emergencies (and make sure you’ve told someone close to you how to use it).
- Controlling Type 2 diabetes with Glucophage or Galvus can have a life-changing effect.
- It’s important to have regular blood pressure and cholesterol tests, and annual kidney, eye, teeth and feet check-ups.
- It’s a good idea for any diabetics over 65 years old to have a pneumonia vaccine shot. An annual flu shot is also beneficial.
- Keep active as it helps with mobility, balance, strength, mental wellbeing and insulin sensitivity.
- Studies show that older diabetics are more compliant than teenagers, the newly diagnosed, and even pregnant diabetics.
Did you know that diabetics are more at risk of developing heart disease? Here are the facts and what you can do about it.
- Both Type 1 and Type 2 diabetics are at risk of cardiovascular disease (CVD). CVD includes both heart disease and problems with the circulatory system, including strokes.
- What can you do? Get tested! A risk assessment will check your blood pressure, lipids and lipoproteins and see if you need to be concerned.
- Quit smoking! If you are a diabetic smoker, your risk of developing CVD doubles.
- Other risk factors also play a part: obesity, physical inactivity and a family history of CVD.
- Eat a heart-healthy diet. Cut down on saturated fats and avoid trans fats that raise cholesterol. Eat lean meat and choose a low fat diet as much as possible.
- If you have any feelings of numbness, confusion, impaired vision, severe headache or difficulty speaking, go to a hospital immediately. This could be signs of a TIA (Transient Ischemic Attack) – a warning sign for a stroke.
- Type 2 diabetics are twice as likely to have a heart attack or stroke.
- Eat plenty of fibre to help lower cholesterol. Wholegrain breads, cereals, fruit, veggies, oatmeal, beans and pulses are all full of fibre.
- Changing your lifestyle can decrease your risk of heart disease (and improve your blood sugar!) Time to get active…
- Hypertension is an important risk factor for diabetics and CVD. Your blood pressure should not be over 130/80 – the ideal is 120/80. The secrets to good blood pressure are to drink less alcohol, don’t eat too much salt, keep at a healthy weight, exercise, stop smoking and visit your doctor regularly. You can do it!
If you’re diabetic, you probably know all about testing your blood sugar… But are you doing it the right way? Here are some top tips.
- The goal is always to keep your blood sugar in a healthy range: not too high and not too low.
- Checking your blood sugar often makes it easier to understand the relationship between blood sugar levels and exercise, food, medication and things like travel, stress and illness.
- Blood sugar readings also give your doctor, diabetes nurse educator or clinic sister information to help you adjust medication and food, if your numbers are often too high or too low.
- Modern blood sugar meters only take 5 seconds and need just a tiny drop of blood.
- Pricking the tip of the finger is the easiest place to get the drop of blood.
- Before you test, it’s important to wash your hands with soap and water and dry them properly.
- Type 1 diabetics should test before every meal, to decide how much insulin to take.
- Before a meal, blood sugar readings should be 4 to 7mmol/l*.
- Two hours after a meal, blood sugar readings should be 5 to 10 mmol/l*.
- Keeping a blood sugar log is a very helpful tool for all diabetics. Write down your blood sugar test results, along with the date, time and what food you ate. This can make it easier to see if there are patterns in your blood sugar readings.
One of the most common complications of uncontrolled diabetes is diabetic neuropathy – but do you know what it is? Here are the basics of what it is, how to avoid it, and how to treat it if necessary.
- Diabetic neuropathy is the most common complication of diabetes.
- Neuropathy is short for “peripheral neuropathy” which means nerve damage in the peripheral nervous system.
- The peripheral nervous system includes all the nerves outside the brain and spinal cord, and connects the central nervous system to the hands, legs and organs.
- Diabetic neuropathy is caused from damage to the small blood vessels that supply the nerves.
- Blood vessels are damaged by high blood glucose levels, having diabetes for many years and abnormal blood fat levels.
- Smoking and excessive alcohol use can also cause diabetic neuropathy, as can mechanical injury to the nerves (like carpal tunnel syndrome).
- Symptoms can include numbness and tingling in the hands and feet, erectile dysfunction, dizziness, muscle weakness and changes in vision.
- Some common signs of peripheral neuropathy are sharp, jabbing pain that may get worse at night, and pain when walking.
- Diabetic neuropathy can’t be cured, but there are treatments to help the symptoms.
- The best treatment for neuropathy is good blood sugar control, which will prevent the condition from getting any worse.
All diabetics know that foot care is really important, but do you know why? Preventing foot ulcers is an essential part of keeping your feet healthy. Here are some great tips.
- Foot ulcers are skin ulcers where the skin has broken down under the foot and you can see the tissue underneath it.
- Diabetics are at greater risk of foot ulcers because high blood sugar for a long period of time can damage the nerves in the feet, which means you won’t be able to feel pain and might not notice a foot injury.
- A diabetic foot ulcer can develop after even the smallest injury, like stepping on a little stone with bare feet. Ulcers are easily infected and can take weeks or even months to heal.
- 15% of people with diabetes may develop a foot ulcer.
- More than half of all diabetic foot ulcers become infected.
- Foot ulcers are the most common reason for diabetics needing to go to hospital.
- Luckily, they are also easily prevented: by carefully controlling blood sugar levels to prevent nerve damage.
- It is very important to check the feet, including the areas between the toes, for cuts and sores – every day.
- Keeping the feet clean and dry is essential – but do not soak them.
- Be sure to have your feet checked once a year by a doctor or podiatrist.
Newly diagnosed with diabetes? We get to grips with what your medical scheme can do for you, and what you might have to budget for yourself.
- Join a medical scheme
Diabetes is a chronic condition that’s on the Medical Scheme Act’s Prescribed Minimum Benefits (PMB) List. All registered medical schemes in SA have to provide basic funding for your diagnosis, treatment and care.
- Register your condition
Make sure your condition is registered with your scheme, and be sure to do this again each time you switch. Find out how the registration process works: you’re likely to have to complete a form with the help of your doctor.
- Stay on a scheme
If you leave your current scheme, or join a scheme for the first time, the new scheme may impose a waiting period of 3 to 12 months. During this time, your costs may not be fully covered. Do your research before you join a new scheme and avoid breaks where you don’t belong to a medical scheme at all.
- Use a healthcare broker
Understanding what’s covered by all the schemes out there can be complicated. Do your research with the help of a healthcare broker. Their services are free of charge.
- Reassess your plan
Once a year, you can shift from a basic to a more comprehensive plan, and vice versa. Ask your scheme for your medical records and check what you’ve had to pay out of your own pocket during the year. Do the math to see if it makes sense to upgrade or downgrade your plan.
- Check which meds are covered
Even the most basic plans cover diabetes medication, as long as you choose from the formulary (the list of approved medication). Ask for this list before you choose a plan. Your prescribed medicine might not be available on the scheme’s most basic plan, but it could be on another, more comprehensive plan, or on another scheme’s formulary list.
- Stick to Designated Service Providers (DSPs)
These healthcare providers (doctors, pharmacists and hospitals) have an agreement with your scheme, which means their rates are usually fully covered. Get hold of your scheme’s DSP list and use them. Expect a co-payment if you use a doctor outside of this network.
- Go for your consultations
This will depend on your plan, but some of your doctor’s visits will be covered up to an agreed rate. Some schemes, for example, cover annual visits to the GP, dietician, podiatrist, ophthalmologist and other specialists in full.
- Check up on tests and equipment
Diagnostic tests are usually covered in full, as well as annual HBA1c, creatinine microalbumin and lipid tests. Insulin pumps and other specialised equipment might only be covered by top-tier plans, or not at all.
- Use those additional benefits
Many of SA’s schemes offer free coaching, education and reward programmes. Make use of these benefits – they’ll help you to manage your condition better, saving you money in the long run.
Want to keep healthy all-year round? Try these smart immune boosters to keep in the best possible health.
- Did you know that if your blood sugar remains high, you’re more likely to get infections? Balanced blood sugar is the key to good health.
- Getting an annual flu vaccination can help to build your winter immunity.
- Don’t overdo it! Chronic stress can run your immune system down.
- Drink up! Increase your intake of healthy drinks like water and rooibos. Hot water with a slice of lemon is a delicious variant.
- Eat a healthy and balanced diet, with plenty of fruit and veg. Try foods high in vitamin C (oranges, naartjies, kiwi fruit and berries), vitamin B (cheese and eggs), beta and mixed carotenes (carrots and sweet potato), vitamin E (sunflower seeds and almonds) and selenium (fish and bran). Don’t forget those leafy greens like spinach, kale and broccoli.
- Get off the couch! Whether you go for a walk or do an indoor class, keep up your exercise regime to boost your immune system.
- Rest more and get more sleep (if you can!)
- Get a vitamin B injection to give you an energy boost.
- Try pre- and probiotics to balance the bacteria in the gut and boost immunity.
- Eat more of these immune-boosting foods: cabbage, garlic, chicken soup, ginger, honey, lemon, mushrooms, oats, salmon, and oysters.
All you need to know about going on holiday with diabetes – Type 1 or Type 2.
- Make sure you have enough medication to last your whole holiday – including insulin injections or tablets, testing strips, needles and lancets. Take a little extra if you can, and don’t forget things like batteries for your glucometer.
- If you are on insulin, take a copy of your prescription and a letter from your doctor that says you need to carry your injections with you at all times. Some security checkpoints will ask for this, so it’s best to be prepared.
- Insulin needs to be kept at a constant, cool temperature – never above 30°C and never below freezing. Be sure to take a cooler bag to keep it at the right temperature wherever you travel.
- Never leave your medicine in direct sunlight! Check that if you’re on a long bus trip, it’s kept close to you and out of the sun.
- Always carry some sugary snacks with you in case of hypoglycemia. A roll of Super Cs or some sugar packets will do the trick.
- Be aware of the effects of exercise on your blood sugar. If you’re exploring a new city, you may be walking more than usual so your blood sugar could go lower than it normally does.
- If you’re going overseas, sign up for medical insurance or ask your South African medical aid what their overseas policy is. You want to know exactly what to do in case of emergency.
- If you’re travelling across time zones, adjust the time you take your long-acting insulin slowly (over a few days) so your body has time to adjust to the new time zone.
- Try to stick to somewhat-recognisable food so that you can accurately guess the carb content and know what it will do to your blood sugar.
- Have fun! Don’t let diabetes stand in the way of you experiencing everything you can while you’re on holiday.
All you need to know about what cholesterol is – and how to deal with high cholesterol.
- Cholesterol is a fatty substance that is naturally present in your blood and cells.
- It is measured in four parts: total cholesterol; LDL (low-density lipoprotein) which is the “bad cholesterol”; HDL (high-density lipoprotein) which is the “good cholesterol”; and triglycerides (a form of fat that the body makes from food sources, such as sugar and alcohol).
- Your body needs some cholesterol for healthy functioning. But many people have too much of the “bad” type and too little of the “good” type.
- In some cases, high cholesterol is inherited, but more often it is the result of an unhealthy lifestyle and too much saturated fat in your diet.
- Having high cholesterol does not cause any physical symptoms that you would be aware of. That’s why it’s often called a silent killer.
- Doctors advise that you have your cholesterol tested at least once a year. If you have diabetes, you’re aiming for an LDL reading of less than 2.8mmol/l.
- People with Type 1 or Type 2 diabetes are at higher risk for cardiovascular diseases such as heart attack and stroke. This risk increases if your LDL cholesterol is high.
- Many of the things that help to control your diabetes will also help to lower your cholesterol. Four lifestyle changes that can make a huge difference: lose weight; exercise more; avoid saturated fat; quit smoking.
- “Good” HDL cholesterol helps your body get rid of the “bad” LDL cholesterol. Include more healthy monounsaturated fats in your diet to assist this process. These include avocado oil, olive oil, peanut oil, avocados and most kinds of nuts.
- Keep in mind that these lifestyle changes aren’t always enough. Some people may need cholesterol-lowering medication too.
All you need to know about your medication – and how to store it.
- Insulin is a hormone that controls the amount of glucose in the blood. It acts as the “key” that lets glucose (from food) leave the blood and enter the cells of the body.
- People with diabetes either do not make enough of their own insulin (Type 1 diabetes), or the insulin their body makes is not as effective as it should be (Type 2 diabetes). As a result, most people with diabetes need to take medication, in tablet form or insulin injections.
- While it is often possible to control Type 2 diabetes with diet and exercise at first, eventually insulin will be necessary for most people with Type 2, as diabetes is a progressive condition.
- There are three different kinds of insulin: short-acting, long-acting and combination.
- Short-acting insulin is taken at mealtimes to cover the glucose released from the food that is being eaten.
- Long-acting insulin has a slow release and works as a basal (background) insulin for a number of hours – it is usually taken once or twice a day in addition to short-acting insulin.
- Combination insulin is a mixture of long-acting and short-acting insulin, often prescribed to Type 2 diabetics.
- Insulin must only be taken on prescription from a doctor, as it is essential to take the right dose (prescribed for you) at the right time.
- Storing insulin correctly is important: it should not get too hot (over 30°C) or freeze. Spare insulin should be kept in the fridge, and the pen you are using can be kept at room temperature for 1 month. Always keep insulin out of direct sunlight.
- Learning how to inject properly will make the injections as pain-free as possible.
Foot problems are one of the things that those of us with diabetes need to watch out for. We’ve got some top tips to keep a healthy spring in your step.
- People with diabetes should have their feet examined by their doctor or podiatrist at least once a year, with thorough washing and daily inspections a part of everyone’s diabetes management plan. Be careful to wash and dry properly between the toes, and at the first sign of any sores, blisters and cracks see a podiatrist immediately.
- When cutting your toenails, be sure to cut straight across, without following the curve, and file the edges to smooth them. Be careful not to cut your nails too short. This will prevent ingrown toenails.
- Avoid walking barefoot and have any corns or calluses cut by a medical professional – don’t do it yourself.
- Don’t use hot water bottles or heaters near your feet.
- Moisturize daily to avoid any dryness. Even mild cracking can lead to ulceration. Avoid putting cream between the toes, as this encourages fungal infections.
- Nerve damage caused by high blood sugar levels can cause numbness in the feet. Together with lower production of sweat and oils that lubricate the feet, this can cause increased pressure on the skin, joints and bones of the feet, which in turn causes pain, redness, swelling, sores and ulcers to develop.
- Foot ulcers are reported to affect 1 in 4 people with diabetes in their lifetime. Constant foot care is vital in preventing and treating complications like these.
- Foot ulcers can be stubborn to heal and, in the worst cases, lead to serious lower body infection, disability and even amputation. Contact your podiatrist at the first sign of any problem.
- How do you recognize a foot ulcer? They are often not very painful, and can occur just about anywhere on the foot. When calluses are not removed correctly and often enough, it causes bleeding under the callus, which is how the ulcer begins.
- When it comes to footwear, choose comfort above all else. A good pair of shoes will go miles towards keeping your feet in their best condition.