diabetes 1

‘Being diabetic is a gift’

I got this amazing email from one of our community members last week and had to share it. Would you like to share your story with the Sweet Life community? Email me – we’d love to hear it.

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What an absolute treat to read your magazine and continually refer to it.

I have been Type 1 diabetic for 14 years. As much of a roller coaster ride as it has been, I would not swop being diabetic for anything in the world.

The people you meet along this journey, the knowledge you gain about how your body functions and responds, the prior knowledge you get from high glucose readings before you get ill and a complete understanding of the people I meet who possibly battle with elevated glucose levels or hypoglycemia.

Being Type 1 diabetic makes you aware on every level – spirit, body, mind, soul, feelings, thoughts, allows for wise choices (although if not wise then the consequences that accompany these – you have actually just got to smile, knowing that this is within your control), tolerant and respectful of others.

It is without a doubt, a gift.

It is amazing how when you change your mindset and adopt an attitude of gratitude, how life truly shines in its full form.
Make no error, there are days when I sit on my kitchen floor and weep in frustration – as ‘for no reason’ my sugar levels are astronomically high (21.0) or scarily low (1.8) and then I do adopt the ‘oh woe is me’ and sob. Then when I’m done I get up and reconsider things with fresh eyes and chances are good I know what I have done wrong, or that my insulin pens are not working as they should or my change in hormones as I get older has added a new spin.
I have a diabetic friend who is wise, a mind blowingly phenomenal psychologist who practices the Demartini approach. At one of my ‘I can’t do this’ moments, she told me to get myself a journal and write down 200 reasons why I am grateful for the gift of having diabetes. Initially I balked at the mere thought – then when you get started you just keep going and smile as you write or nod like a lunatic. I am on 150 reasons and it’s been a couple of months – but I look back and reread these and then put one foot in front of the other again, with purpose.
– Lara

10 Fast facts about ketoacidosis

Ketones and ketoacidosis are often mentioned in relation to diabetes, but what are they exactly?

  1. Ketones result when your body burns fat for energy.
  2. They are formed when the body doesn’t have enough insulin to use glucose for fuel.
  3. A urine test is traditionally used to test for ketones: some blood glucose meters can also test for ketones.
  4. Ketones make the blood more acidic.
  5. Ketones in the urine combined with high blood sugar are a warning sign that your diabetes isn’t under control.
  6. 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.
  7. DKA is serious and can lead to diabetic coma.
  8. DKA is rare in Type 2 diabetics and more common in Type 1 diabetics with uncontrolled blood sugar.
  9. Symptoms of DKA are thirst, frequent urination, high blood glucose, constant tiredness, nausea, vomiting, abdominal pain, dry/flushed skin, breathing difficulty and confusion.
  10. If these symptoms ring a bell, see a doctor as soon as possible to get your blood sugar under control.

10 Fast facts about hypoglycemia (low blood sugar)

Hypoglycemic episodes (hypos) can be a scary experience for all involved: here’s what you need to know to deal with one.

  1. A hypo is a sudden low blood sugar episode.
  2. The optimal blood glucose range is 4 to 7mmol/l. With a hypo, blood glucose levels are usually lower than 3mmol/l.
  3. Initial symptoms are nervousness, sweating, intense hunger, trembling, weakness, palpitations, or trouble speaking (depending on the person).
  4. 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).
  5. 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.
  6. If blood glucose drops too low it can get to the stage where the brain is not getting enough glucose.
  7. Symptoms of this are confusion, drowsiness, changes in behaviour, seizure and eventually coma.
  8. 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.
  9. Notify all those close to you what to do in an emergency and how to use a glucagon injection.
  10. Test often to keep your levels as well controlled as possible.

Living the low carb life

When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.

Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?

That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.

What inspired you to write The Low Carb Solution for Diabetics?

We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.

The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.

I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.

A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.

Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?

Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!

What advice would you offer to people living with diabetes who are struggling?

Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!

What makes your life sweet?

Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.

Get in touch with Vickie: @Vickiefantastic on Twitter

Taking diabetes education to schools

When Roxanne and Derick de Villiers wanted to enroll their son Noah in pre-school, they didn’t think diabetes would be an issue. When it turned out it was, they turned the situation around.

Can you tell us about Noah’s diagnosis?

It was just before his 3rd birthday. When Noah got really sick and then diagnosed with Type 1 diabetes, we were really emotional. Here was our little boy who had this huge change in his young life: nurses and needles – that’s a picture we will never forget. But we can promise you this: in the midst of those overwhelming emotions, your parental instinct to protect your child immediately kicks in and your mind opens up so much to take in all that you need to. There is an urgency to get on top of the changes and adapt as quickly as possible.

Has it become any easier with time?

It has, it really has. You know that old saying that time is a healer? We believe time is a teacher. Diabetes is now second nature and so much a part of life. Having other family members also educated about Type 1 diabetes has made it easier as well because they can also test and inject when necessary.

When did Noah start pre-school?

Noah actually started pre-school the January before he was diagnosed with Type 1. When the pre-school was informed about him being diagnosed, the principal and his class teacher were at the hospital and were really supportive about this change in his life. What really impacted our lives positively was that they were prepared to learn and take part in this process too.

Could you tell us about the school application process?

At Noah’s first pre-school in 2012, he was already enrolled ahead of being diagnosed. We then made a home move and Noah needed to move pre-schools too. The school we enquired at for enrolment was amazing. Applying for Grade R was a little bit different and more involved. They had never had an application that included full disclosure of the child having Type 1 diabetes. We had a few meetings with the Executive Head and we pressed on for the understanding that we (the school and parents) could put a fair process in place that would protect both the child and the school without discarding school laws.

We needed to be a voice for Noah, for other diabetic children to follow and especially for the parents of diabetic children who go through this worry and want to enroll their precious children at the schools of their choice. The Executive Head and Regional Head of Noah’s grade school were true blessings because they agreed to put the suggested process in place and were on board to becoming the forward thinking, proactive and progressive school that they are. A beautiful school/parent relationship exists now.

What advice would you offer to other parents about diabetes education in schools?

The education is ongoing. It is never a once-off. Urge the school to have more teacher / parent sessions to talk openly about Type 1 diabetes. Whether your medical support is private or public, involve the nurse, the pediatrician, or the professor looking after your child. There is a big need, a big want and a big drive for education in this area. Minds need to be changed about diabetes and its management within the school system.

What makes your life sweet?

For Noah, having control of the DSTV remote and the Smart Tab and for us, his parents, seeing him so confident and secure even though he lives with diabetes.

Photos taken at Noah’s current school, Curro Century City.

Communication tips for hypoglycemic episodes

I’m looking for some tips or advice on how to communicate better with my diabetic wife. She has Type 1 diabetes and when she goes low it’s sometimes hard for me to know what to do, and hard for her to explain how she’s feeling. Also when she goes high, but low is more of a problem, because it can get dangerous. Any tips?” Luke Jacobs.

Dear Luke,

I think it’s really great that you are involved in helping your wife cope with her diabetes. The challenges faced by those who care about someone with diabetes are rarely discussed, and very real.

Diabetes is riddled with valleys and waves, otherwise known as lows and highs, and this can be totally frustrating – as well as scary – both for the diabetic and their spouse. Good diabetes management limits the frequency of lows and highs, but there is no guarantee. And there are so many factors that can influence blood sugar that there’s no such thing as a ‘perfect’ diabetic.

So what now?

First of all it’s important for you to be able to identify when your wife is going low. Sometimes, people who have had diabetes for a long time lose the ability to feel their lows – this is where you come in. Learn how to treat a low. Keep some glucose sweets or jelly beans with you so that you can help her if her blood sugar suddenly drops. Don’t be afraid to suggest she checks her blood sugar if you think she’s acting funny.

The trick is to be diplomatic about this. The last thing a wife with diabetes wants is pity – and what woman can be responsible for being snippy when her blood sugar is at 3mmol/L?

– Jeannie Berg, Diabetes Educator

 

Climbing Kilimanjaro – with diabetes

It’s the highest mountain in Africa, but that didn’t stop Neil Rae – a Type 1 diabetic for 50 years – from wanting to climb it. We chat to Neil, 63, about his preparation, the climb itself, and life with diabetes.

How long have you been diabetic?

I was diagnosed on the 13th December 1964: over 50 years. I’ve seen a lot of changes for diabetics in my time – there’s a lot more we can eat, the technology to monitor blood sugar levels is a lot more advanced and the insulin pen sets are much more convenient. We’ve come a long way since the gas cylinder with a tin cup that I used to sterilise my glass syringes when I was at university!

What made you decide to climb Kilimanjaro?

I grew up in Lesotho and I’ve always had a love for mountains. I don’t know how many decades ago, I said to myself I wanted to set a goal for my diabetes: to climb Kilimanjaro when I’d lived with it for 50 years. About 18 months ago I contacted Novo Nordisk, the people who manufacture my insulin, to ask if they’d like to partner with me. They were very excited to join the challenge. As you can see it’s been a long-term goal of mine…

What did you do to prepare?

I’ve always been a relatively fit person, and I do a lot of walking with my wife Shaye, in and around the streets of Johannesburg and in the Drakensberg. I was walking between 30 and 40km a week and over weekends doing long walks in Westcliff – they have a flight of 222 stairs built into the rock face, and with a heavy rucksack on your back it’s good training! I did the climb with my doctor, Dr Bruce Ilsely and David Broomfield from Novo Nordisk so as a team we were well prepared.

How did you know what to eat and drink while climbing, and how to balance your blood sugar?

Balancing blood sugar was obviously going to be a challenge – spending between 7 and 8 hours a day climbing up and up and up all the time. It was tricky to balance that amount of exercise with the food supplied by the people who organised the walk – we didn’t take any food with us. Normally my sugar is very well controlled, so the plan was to do very regular checks of my blood sugar levels, see what we were going to be given to eat and then decide how much insulin to take. It turned out that I didn’t eat very much – I became nauseous quite early on, once we were over 3500m.

What was the hardest part of the climb?

The hardest part for me were the ascents and descents because you had to climb up mountains and then down into valleys, and there was a lot of very rocky pathways – walking from rock to rock. Some days we went up and down two or three times in a day. We left Moshi on the Monday and we summited on the Thursday night/Friday morning. Unfortunately I wasn’t able to make the summit – I got up to about 5000m and my altitude sickness was so bad that Dr Bruce said to me, “If you carry on, you’re going to die”. Once I got back down to the base camp at 4600m, then I was fine: it wasn’t diabetes related at all.

What advice would you offer to diabetics who are struggling?

In my opinion, every diabetic who’s struggling has got to develop a lifestyle routine: get up in the morning, check your blood sugar, decide how much insulin you need and what you’re going to eat for the day. You have to have a definite lifestyle routine, and stick to it every day. Discipline is so important to a diabetic. If you don’t have the routine and don’t have the discipline, you’re not going to live with it for 50 years!

What makes your life sweet?

I’m very fortunate: I’m married to a lovely lady and I have two daughters and four grandchildren now. My family, my life and everything in it makes my life very sweet.

5 minutes with Bongi Ngema-Zuma

We chat to Bongi Ngema-Zuma, First Lady and founder of the Bongi Ngema-Zuma Foundation.

  1. Why did you start the Bongi Ngema-Zuma Foundation?

    It has always been my ambition to do something like that – I never came across anybody who told me about diabetes as a child, even when I was at school. But when you speak about it you find that each and every family is affected by diabetes in some way.

  2. How did your mother find out she was diabetic?

    My mother was not an educated woman, she was a housewife and only went to school up to Std 4. First she was told she had hypertension and received treatment for that. And then they investigated further and found out she had diabetes. Many people have had this happen – the underlying factor is diabetes. That’s why I encourage people to actively check their blood sugar. Whenever you go to the clinic you should get tested. What I learned from my mother is that changing her lifestyle made her live healthier and longer. She took every little lesson she could from the clinic – you eat like this, you don’t eat like that, you take your tablets, you eat so many times a day. What made it easier for her is that she made the whole family eat like that.

  3. What makes your life sweet?

    What makes me happy is chatting to people. I like getting people’s opinions on things, I like listening to people’s stories and visiting new places where I can learn new things.

Find out more about the Bongi Ngema-Zuma Foundation here.

 

Ice skating with diabetes

Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.

Who did you skate for?

I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.

How long have you been diabetic?

I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.

Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?

I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.

What do you love about ice skating?

I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.

What do you think the biggest challenge of living with diabetes is?

The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.

What advice would you offer to diabetics who are struggling?

Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.

What makes your life sweet?

Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.

Get in touch with Rachel: ray.durban@gmail.com  

All about insulin

There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.

“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”

For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.

“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”

Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”

Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”

Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.

Are there any benefits to starting insulin sooner?

 

“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”

Natural supplements for diabetics

We all know that a healthy diet is key to managing your diabetes. But should you also be taking a diabetic supplement? Andrea Kirk asks the experts.

Living with diabetes can be challenging, so when you hear about a natural supplement that works wonders, it’s easy to get excited. “A number of supplements have been said to play a role in improving insulin sensitivity, blood sugar control, and helping to prevent complications of diabetes,” says endocrinologist Dr Joel Dave. “Although there is some observational evidence to suggest that some of these may be beneficial, unfortunately there are no large, long-term, placebo-controlled studies that prove any supplement is effective when it comes to diabetes.”

Dietician Cheryl Meyer agrees: “In some cases benefits have been shown, but at this stage there is just not enough scientific evidence.” Both experts believe that a well balanced diet should provide all the essential minerals and vitamins you need.

“I don’t recommend routine supplementation,” says Dr Dave, “but if someone is deficient in a specific vitamin or mineral, then I would recommend they take a supplement of that particular vitamin or mineral.”

When a supplement may be necessary

If you are experiencing specific symptoms and suspect you are deficient in a vitamin or mineral, speak to your doctor about having a blood test. Your doctor will make a recommendation based on the test results and may prescribe a supplement. Keep in mind that the type and dosage your doctor prescribes may be different from what is found on the shelf. Stick to your prescription rather than self-medicating.

Be careful of drug interactions

Dietary supplements can have adverse interactions with prescription drugs, other herbal products or over-the-counter medications, warns Meyer. The effects range from mild to potentially life-threatening, so it is important to disclose everything you are taking to your doctor.

Never replace your conventional prescription

“Don’t replace a proven conventional medical treatment for diabetes with an unproven health product or practice. The consequences can be very serious,” says Meyer.

“I generally advise my patients to steer clear of supplements unless we know for sure that it’s necessary,” says Dr Dave. “Rather focus on sticking to a healthy diet and lifestyle, monitoring your blood glucose and taking the medication your doctor has prescribed.”

 

Supplements and their claimed benefits

 

Alpha-lipoic acid
Alpha-lipoic acid (ALA) is an antioxidant made by the body. It is found in every cell, where it helps turn glucose into energy. Several studies suggest ALA helps lower blood sugar levels. Its ability to kill free radicals may also help people with nerve damage, which is a common diabetes complication. For years, ALA has been used to treat diabetes-related nerve damange in Germany. However, most of the studies that found it helps were based on using intravenous ALA. It is not clear whether taking it orally will have the same effect.
Source: University of Maryland Medical Centre

Chromium
Chromium is an essential mineral that plays a role in how insulin helps the body regulate blood sugar levels. For many years, researchers have studied the effects of chromium supplements on those with Type 2 diabetes. While some clinical studies found no benefit, others reported that chromium supplements may reduce blood sugar levels, as well as the amount of insulin people with diabetes need. Good food sources of chromium include whole grain breads and cereals, lean meats, cheese, some spices (like black pepper and thyme), and brewer’s yeast.
Source: University of Maryland Medical Centre

Fenugreek
Fenugreek seeds may be helpful to people with diabetes because they contain fibre and other chemicals that are thought to slow digestion and the body’s absorption of carbohydrates and sugar. The seeds may also improve the way the body uses sugar and increase the amount of insulin released. An Iranian study found that a daily dose of fenugreek seeds soaked in hot water may be helpful in controlling Type 2 diabetes. Another study from the US suggests that eating baked goods, such as bread, made with fenugreek flour may help to reduce insulin resistance in people with Type 2 diabetes.
Source: Healthline

American ginseng
Several studies have shown that American ginseng lowered blood sugar levels in people with Type 2 diabetes. The effect was seen both on fasting blood sugar and on glucose levels after eating. One study found that people with Type 2 diabetes who took American ginseng before or together with a high sugar drink experienced less of an increase in blood glucose levels.
Source: Penn State Milton S. Hershey Medical Center

Magnesium
Magnesium deficiency has been associated with increased risk of Type 2 diabetes. Some studies suggest that supplementing may be beneficial, but other studies have shown no benefit. A healthy diet should provide all the magnesium you need, so have your doctor check for deficiency before you consider supplementing. Good food sources of magnesium include legumes, whole grains, broccoli, green leafy vegetables, dairy products, seeds and nuts.
Source: Oregan State University and WebMD

10 Fast facts about travelling with diabetes

All you need to know about going on holiday with diabetes – Type 1 or Type 2.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Always carry some sugary snacks with you in case of hypoglycemia. A roll of Super Cs or some sugar packets will do the trick.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Have fun! Don’t let diabetes stand in the way of you experiencing everything you can while you’re on holiday.

10 Fast facts about insulin

All you need to know about your medication – and how to store it.

  1. 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.
  2. 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.
  3. 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.
  4. There are three different kinds of insulin: short-acting, long-acting and combination.
  5. Short-acting insulin is taken at mealtimes to cover the glucose released from the food that is being eaten.
  6. 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.
  7. Combination insulin is a mixture of long-acting and short-acting insulin, often prescribed to Type 2 diabetics.
  8. 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.
  9. 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.
  10. Learning how to inject properly will make the injections as pain-free as possible.

All about LifeinaBox

Have you heard about LifeinaBox?
I’ve been hearing a lot about it lately – it’s a “device that will revolutionize the transport of medication worldwide.”

Here’s what they say about it…

LifeinaBox is the world’s smallest fridge, and the culmination of many years of research to produce a universal solution that will allow users to travel any place, any time, knowing that their medication is kept at exactly the right temperature. Suitable for any heat-sensitive medication such as insulin, growth hormones, arthritis or multiple sclerosis medications, it allows users the freedom to travel anywhere, anytime, knowing that their medication is kept at exactly the right temperature.

This state-of-the-art device uses a combination of thermoelectric energy and batteries that will allow the user to be mobile with his medications under any conditions for up to 24 hours without the need to recharge his device. Operating on 110V or 220V or with a car cigarette lighter, LifeinaBox is totally environmentally friendly and contains no hazardous gases, tubes, coils or compressors.

The greatest inventions are often born out of simple necessity. Who would have an idea as absurd as making a fridge just to carry medication? We asked Uwe Diegel, co-founder of LifeinaBox, to tell us a little more about his idea…

How did you come up with the idea for LifeinaBox?

My brother, Dr Olaf Diegel, visited me in France in the infamous heatwave of summer 2003. Olaf is a well-versed traveler and is used to travelling with his insulin and keeping it cool using iceboxes and cooler bags (insulin, like many other medications, is sensitive to heat and should be stored at a temperature between 2 and 8°C).

Olaf booked himself into a small hotel near Auxerres in France. When he arrived at the hotel, he noticed that there was no fridge in his hotel room (even though he had particularly insisted on this when making his booking). He needed a fridge to store his insulin. So he arranged with the clerk at the entrance desk to keep his insulin in the fridge in the kitchen.

Olaf does not speak French, coming from New Zealand. A few hours later, Olaf needed his insulin and went down to reception to ask for it, only to discover that it was placed in the freezer by accident by someone in the kitchen. He is thus obliged to have the night pharmacy opened just to get some fresh insulin.

We decided to design the idea of a portable fridge and our prototype actually worked quite well, so we sent it to an industrial design contest run by NASA in the USA. The product became a winner at the contest, received unexpected publicity and became the subject of an international story on the CNBC TV network.

When and where will Lifeinabox be available to South Africans?

We just launched LifeinaBox on the 12th of September on the Indiegogo crowdfunding platform. Crowdfunding platforms are places where people can pay for a product in advance at a preferential rate, paying in advance, so that their money can be used to accelerate production. We are already on our 9th generation of working samples and are nearly ready to go into mass production at the beginning of 2018. So the physical delivery of LifeinaBox should be by the April/May 2018. LifeinaBox is by definition a product that is born global and that will be launched in all countries at the same time. But the quickest way for people to get their hands on a LifeinaBox is to order on the crowdfunding campaign, as the first waves of production will be dedicated to people who have already placed an order.


How much will it cost?

LifeinaBox is quite an expensive device to produce, because we need it to basically last forever. The expected price in South Africa would be somewhere between R2800 and R3000. Next year we will launch LifeinaTube, which is a much cheaper device because it will only hold a single insulin pen.

Where can it be used – must it be plugged in? Can it be taken on planes?

It can be plugged in just about anywhere, from 110 to 240V, in a car’s cigarette lighter, or with a battery pack. We are still developing the battery packs and will be able to have 3, 6, 12 or maybe even 24 hours of battery life. We are really working quite hard on the batteries to give it more mobility. Right now I am already at 12 hours, but I am sure that by launch time I will already have a 24 hour battery. It is for people to take to work (so they don’t need to put their medication in the work fridge), in the car for long car trips, at home (so that the children don’t have access to medication in the kitchen fridge) and it can also be used on a plane.

What’s your LifeinaBox elevator pitch?

Nearly 4% of the worldwide population is prisoners of its medication that has to stay in the fridge at all times. LifeinaBox is the world’s smallest fridge for the safe transport and storage of fragile medication. LifeinaBox gives millions of people worldwide the freedom to travel anywhere, any time, knowing that their medication is at exactly the right temperature.


What makes your life sweet?

I still, 30 years later, wake up in the morning and can’t wait to get to work. My work is wonderful, because I always strive for perfection. I never think of my products as medical devices, but more as tools for the heart. And if you can touch the hearts of people the possibilities are infinite.
My first career was as a concert pianist, so I still spend a lot of time behind the piano, especially with my children who are also musicians and artists.

Raising a diabetic child

We were just sent this advice about raising children with diabetes… It takes a family to raise a diabetic child, as we all know! Do you have anything to add?

Hearing the diagnosis for the first time can be overwhelming and will leave any parent and child with mixed emotions – it’s unfair, it’s exhausting, it’s stressful, it’s scary and it’s tough to manage.  Yet there is nothing on earth that any parent could have done better to prevent their child from living with Type 1 diabetes. It is estimated that there are now more than half a million children aged 14 and younger living with Type 1 diabetes according to the 7th IDF Diabetes Atlas.

According to Dr Ntsiki Molefe-Osman, Diabetes Medical Advisor at Lilly South Africa, Type 1 diabetes is a disorder of metabolism caused by the body’s immune system which attacks the cells in the pancreas that produce insulin.  “Children are not born with it, rather it develops over time and there is usually a genetic predisposition.  In children, Type 1 diabetes presents commonly at around 14 years of age and younger.  This means that Type 1 diabetes is a lifelong condition, it is serious, and managing it needs to be done diligently as poor control of the condition today will have lifelong repercussions.  When a child is diagnosed with Type 1 diabetes, so is the entire family who all need to adapt to a new lifestyle.”

“The importance of good glycaemic control can’t be emphasized enough,” says Dr Ntsiki Molefe-Osman.  The basic 101 of managing and preventing the complications of Type 1 diabetes is careful daily management of blood glucose and sustaining tight glucose control as close to normal levels as possible.”

“Diabetes is a progressive disease, which left unchecked will cause organ damage. This has significant health repercussions for later on in life – from kidney failure, heart failure, blindness, nerve damage (diabetic neuropathy) and as a result loss of limbs. What you do for your diabetic child today and the responsibilities you teach your teen in managing Type 1 diabetes, will influence the quality of life they can expect to live later in life,” explains Dr Molefe-Osman.

Why do Type 1 diabetics need insulin?

People living with Type 1 diabetes do not produce any insulin at all, so it needs to be replaced with insulin injections.  Insulin moves blood sugar into body tissues where it is used for energy. When there is no insulin, sugar builds up in the bloodstream. This is commonly referred to as high blood sugar, or hyperglycaemia – it is dangerous and has many side effects. Fortunately when the blood sugar is stabilised with insulin treatment, these symptoms go away.

It can be managed

While a diabetes diagnosis for your child may come as a shock and will mean that lifestyle adjustments will have to be made, it is important to remember that with consistent control and the support of a healthcare provider, people living with Type 1 diabetes can live full, active lives.

Family support is vital

Managing Type 1 diabetes in your child takes a lot of courage and determination.  Imagine the mountain that a child faces knowing that injections will be part of their daily routine.  They may also worry that their condition will preclude them from enjoying all the things that other children get to experience, or lead to them being treated as ‘different’ in their school and peer environment.

It all comes down to how you work together as family to support and guide your child in helping them see their daily treatment regime as a positive step towards a healthy and normal life, rather than as a punishment or burden.  It is important to help your child believe wholeheartedly that with the right control and responsible approach, they can do whatever they want to do.

Managing chronic illness

“Coping with and learning to manage a chronic illness like diabetes is a big job for a child or teen.  It may also cause emotional and behavioral challenges and talking to a diabetes educator or psychologist can help immensely. It’s also important that family, friends, teachers and other people in your child’s network know of and understand the condition so they are alert to any symptoms or signs that their blood sugar is out of control and what to do to help them in an emergency situation,” adds Dr.  Molefe-Osman.

It takes a huge amount of discipline on the part of the parent and child in managing the demanding diet, lifestyle and treatment regimen, so it’s essential to establish a routine that works for everyone concerned.  Establishing good habits early, providing a support structure and ensuring that your child understands why good control is important are vital.  It’s the difference between your child managing their diabetes, or diabetes managing them,” she concludes.

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