diabetes

Dance your way to better health

Who said exercise had to be at the gym? Here are some fun ways to get active without even noticing it.

The joy of dancing is that it’s good exercise, but so much fun that you won’t even notice you’re getting fit… Much better than trying to jog around the block! Dancing is, at heart, both art and sport. If you’ve been tempted to pull some moves like you’ve seen on TV’s Strictly Come Dancing and So You Think You Can Dance, but haven’t managed to make the move from the couch to the dance floor, this is the year to do it!

Why dancing is good for you

What many people don’t realise is that dancing has a number of health benefits. Dance is a full mind and body workout that burns calories and lowers your heart rate, blood pressure and cholesterol. As with all kinds of exercise, dancing makes the body more sensitive to insulin, which means the insulin works better in your system. Because dancing is a weight-bearing activity, where the body works against gravity, it can also help strengthen bones, improve balance, posture and coordination. Dancing offers the opportunity to socialise and make friends, and moving your feet to a good tune can be a real pick-me-up. Apart from reducing stress, the biggest benefit of dancing is that it is fun (lots of fun!)

How to get involved

Whether you like to jive, tap, or tango, shake your belly or let yourself go to the beat, there’s a style of dancing that’s right for you. Different types of dance include ballroom, ballet, nia, afro-fusion, hip-hop and free dance, among others. The first step is to have a plan. Ask yourself what style of dance you think you might enjoy – do you like something more formal, or free? Then, consider how much time you can spare in your week, how fit you are and if you have any pre-existing injuries.

Once you know what you want, it’s time to find it! Check community noticeboards and local gyms to find out when and where classes or events are being held, and invite a friend to go with you if you feel too shy to go to the first class on your own. Convinced you have two left feet? Take lessons. Most dance studios hold beginners’ courses and welcome people with disabilities. Learning a new skill can be a real confidence booster and if you start now, you’ll definitely have new skills to show off at your end-of-year Christmas party!

What to wear

Wear comfortable clothing that gives you freedom of movement and shoes that fit the dance form. Some classes, like ballet, tap or jazz, might need special footwear depending on your level. Avoid wearing jewellery, as earrings, rings and necklaces can scratch you or get caught in clothing. Most importantly? Wear a smile.

How to warm up

Remember that because dancing isn’t the same movements that you do in daily life, you need to warm the body up and treat the dance hour like an exercise session, with a warm-up, movement preparation, dance, and cool down. Once you’ve done your warm-up and you understand the main demands of the type of dance you’re doing, you can let your body go and enjoy.

Ask the expert: Sarah Hall, Biokineticist

Here’s how to warm up for each of these dance styles:

Ballroom: A large focus of ballroom is technique and posture, so you need to ensure that in your warm-up you help lengthen your spine. The goal is to engage your neck, shoulder blades and core muscles, so that you reduce strain and tension from this form of dancing.

Nia: This dance is about moving with balance, without too much effort. It is a combination of yoga, modern dance, jazz and tai chi. A whole body warm-up with deep breathing would be best here.

Ballet: Although rhythmic and seemingly calm, ballet is one of the most demanding kinds of dance. Muscle endurance, power and strength, as well as flexibility of joints, are all required. Before starting ballet classes, it’s a good idea to try a few one-on-one classes or test out the poses so you know how far you can move.

Hip-Hop: This is an extremely physical but hugely enjoyable dance form. Hip-hop uses movements that require strength and balance to control your body weight. Body weight exercises that prepare the body for this challenge, like dips, push-ups, sit-ups, lunges and squats, would be great to include in your warm-up. It’s also a good idea to strengthen and protect the spine because it’s such a high impact form of dance.

Free dance: Spontaneous and with no choreography, free dance has no rules and boundaries. So it’s important to combine the tips of all the types of dance above and ensure that you follow the structure from the warm-up to the cool down.

Ask the expert: Fiona Prins, Diabetes Educator

“Being active helps control blood sugar levels, so when you have diabetes it’s really important to exercise. As a rule, aim for 30 minutes a day, five days a week. Regular physical activity will help keep your weight down, reduce blood pressure, raise good cholesterol (HDL) and lower bad cholesterol (LDL) in the bloodstream. Other benefits of exercise include being able to sleep better and better health in general.”

Candy Tsamandebele: living with Type 2 diabetes

Indigenous Afro-Soul artist Candy Tsamandebele talks to us about living with Type 2 diabetes.

When did you find out you had Type 2 diabetes?

After the death of my son through an accident. It was unexpected to say the least.

Was it a shock?

Yes it was.

How did you have to adapt your lifestyle?

I started with what I ate and drank. It was difficult at first, but with time I got used to it.  Secondly, my lifestyle all together.

How do you balance a busy lifestyle with eating well and exercise?

Sticking to a strict diet. Also understanding the consequences of ignoring that diet.

What advice would you offer to those living with diabetes?

Just take it one step at a time. Take your medications on time and eat healthy.

What makes your life sweet?

Music. It really does.

Some background on Candy and her outreach work:

August 2, 2011 was one of Candy Tsamandebele’s most trying times in her life when she lost her son in a car accident. Six months later she was diagnosed with Type 2 diabetes. Not one to be kept down, two years after the trauma, Candy garnered strength to launch CANDY TSAMANDEBELE FOUNDATION. She uses the foundation to teach young women and the youth in general about values and it is her vehicle to drive and leave behind a legacy as she continues to grow in the music industry.

The main aim of the Candy Tsamandebele Foundation was to teach kids about music, the importance of culture, significance of language, youth development, medical assistance, helping with school uniforms to needy, and several other initiatives that are close to her heart.

Every year Candy Tsamandebele dedicates her time to carry out community building initiatives such as visiting schools and donating school uniforms, as well as motivating the youth both in and out of school. She encourages young people to use their natural abilities and talents to make it through life. During her motivations, she always talks about the importance of getting tested for diabetes and other chronic conditions and adhering to taking treatment once diagnosed.

Since she was diagnosed with diabetes, Candy Tsamandebele has made it her mission to be a national diabetes warrior. She is a force to be reckoned with and she will stop at nothing for as long as she is needed to make a difference.

Find out more at www.candytsamandebelesa.com

Diabetic pregnancy and the pump?

From our community blog:

I am a Type 1 diabetic since 1991. I have had two children and desperately want a third, but cannot face another pregnancy like the second due to severe hypoglycaemia that kept occurring.

I want to get a pump – my doctor did initially suggest it and I have asked for a referral to a centre that deals with pumps. I also would like to know what the chance of getting a pump on medical aid is if it is recommended by a doctor and if the medical aid is paying for CDE at the moment?

I am trying to control my sugars now but even tracking them 6-8 times a day, taking multiple extra shots when needed and tracking my diet closely is not helping.

– Bronwyn

Comments:

Hi Bronwyn,

The CDE has 5 pump centers in Johannesburg. 011 7126000. They also have an amazing 5 day course called DINE. Speak to Michelle Daniels.
Kimberley

Hi Bronwyn,
I hope this may be of some help in resolving your control problems. I used a pump for 10 years and found it to be helpful particularly as you can control the long acting (basal) insulin for your individual requirements. You programme the pump to dispense whatever you need for each hour of the 24 hour day which will be exclusive to your needs.
A phone call to your medical aid should be able to tell you if they will support the purchase fully or partially. I stopped using mine because my levy on the consumables was increasing beyond reason.

It needs time and expertise to learn how to use the pump. I know we are all different but I believe that with the proper advise and treatment you should be able to get control before getting a pump. It will help your new doctor (it seems you need one) if you keep a record of insulin taken, food consumed, and exercise taken.

I’m a chairman of a support group, find one of these as they can also be very helpful.

Mervyn

The daily sweat

Getting active every day can feel like a bit too much to ask for… Which is why Cindy Tilney’s asked the experts to give us easy ways to keep fit – no matter how old you are!

We all know exercise is good for us, but exercising to the max – especially in later life – can be too much of a good thing. It’s essential not to stress the body by exercising too hard, says Professor Wayne Derman, the Director of the U-Turn Chronic Disease Lifestyle Rehabilitation Programme based at the UCT Sports Science Institute of South Africa. “When planning an exercise routine, it’s important to consider any medical condition you might have, as well as any medication you’re taking and how it may affect you while exercising,” says Prof. Derman.

Older age also comes with a bigger chance of aches and pains because of problems like osteoarthritis and rheumatoid arthritis – if these names ring a bell, it’s a good idea to be more careful about the kind of exercise you choose, and to consult a medical professional (a biokineticist, physiotherapist or sports physician) when planning an exercise routine. Be sure to check if any medications you are on will interfere with this routine, reminds Prof. Derman.

Be informed

“It’s essential to go for a health check and orthopaedic assessment before starting any exercise programme,” says biokineticist, Sarah Hall.

Get checked for:

  • Cardiac weakness
  • Any existing injuries
  • High blood pressure
  • Ischaemia (restriction in blood supply)
  • Uncontrolled diabetes

Also be aware that falls are more likely if your balance isn’t what it used to be.

Warning signs:

The right kind of exercise has benefits for every chronic condition, says Prof. Derman.  But watch out for:

  • Feeling breathless to the point that you can’t talk when exercising
  • Any pain.

“The saying ‘no pain no gain’ is not true,” he says. “Your body should be in a state of relative comfort while exercising.”

So what should you do?

It’s important to include all of these steps in an optimal exercise programme, as they all have different functions, say Derman and Hall. These include:

  1. The warm up: This involves stretching and preparing your body for exercise.
  2. Flexibility training/stretching: This focuses on increasing the range of motion of the joints and stretching the body to release tension in the major muscle groups – calves, quads, glutes, hamstrings, back, chest and arms.
  3. The aerobic phase: Involves movement of the large muscle groups to increase the heart rate. It can be walking, jogging, cycling, aqua aerobics or rowing, for example.
  4. Muscle strength resistance training: Using elastic bands or circuit training to make muscles stronger. This is particularly important for people with diabetes, as it can help the muscles involved in the absorption of insulin to become more sensitive, which helps blood sugar control.
  5. Stability training: Exercises like plank position that help balance and core stability.
  6. The cool down: This involves stretching and relaxation to allow the heart rate to go back to normal and the body to return to a resting state.

Remember: The goal is to exercise 20 to 30 minutes on most days of the week.

3 Top tips for people with diabetes:

  1. Don’t begin exercising if your blood sugar is either too high or too low (over 16 or below 4.8).
  2. If you are using insulin, always take something sweet with you when you exercise, in case of hypoglycaemia (low blood sugar).
  3. Avoid injecting into large muscle groups just before exercising.

What kind of exercise is best for older people with diabetes?

We asked biokineticist Sarah Hall to give us a sample exercise routine. Here’s what she said:

Warm up: 5-10 minute brisk walk

Stretch: Standing calf and quad stretch, chest, shoulder and bicep stretch, lying down hamstring stretch and cat stretch for the back

Aerobic: Step for 2 minutes

Muscle strength: Like bicep curls, wall push-ups and abdominal crunches (sit-ups)

Aerobic: Walk or jog on the spot for 2 minutes

Stability: Plank position

Cool down: Repeat stretches

Puppies, baby goats, hedgehogs and pre-diabetes

You might not think puppies, baby goats, hedgehogs and pre-diabetes have anything in common… But you’d be mistaken! This brilliant campaign highlights the risks of pre-diabetes, a condition that indicates a person is on the path to developing Type 2 diabetes.

Here’s the explanation:

More than one in three adults have pre-diabetes and are at a high risk of developing Type 2 diabetes. Of those individuals, 90% don’t even know they have pre-diabetes.

A first-of-its-kind PSA campaign from the Ad Council brings together the American Diabetes Association, American Medical Association and the Centers for Disease Control and Prevention with the ultimate goal of reducing the incidence of Type 2 diabetes. Anyone can find out where they stand with pre-diabetes in just one minute by taking a quick pre-diabetes risk test.

The spots offer viewers a “perfect way to spend a minute” where they can learn where they stand by taking the one-minute pre-diabetes risk test while also doing something everyone loves — watching adorable animal videos.

So here are those videos… They are amazing.

Puppies:

Baby goats:

Hedgehogs:

10 Fast facts about foot care

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.

  1. 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.
  2. 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.
  3. Avoid walking barefoot and have any corns or calluses cut by a medical professional – don’t do it yourself.
  4. Don’t use hot water bottles or heaters near your feet.
  5. Moisturize daily to avoid any dryness. Even mild cracking can lead to ulceration. Avoid putting cream between the toes, as this encourages fungal infections.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.

How to deal with a diabetes diagnosis

“My son has just been diagnosed with Type 1 diabetes and we all feel like our world has been turned upside down. But he’s really struggling to talk to us (and his extended family) about his diagnosis. Any tips on how to begin?” Razan Naransamy

Dear Razan,

When a child is diagnosed with diabetes, both parent and child feel different emotions. In the beginning, parents are inclined to spend time worrying about the physical effects and the day to day management of a condition they don’t yet know anything about. The child goes through different feelings, like sadness and hopelessness, even anger and frustration.

It might help to find someone your son will confide in – even if it’s just to find out why he doesn’t want to talk about his diagnosis. It could be a diabetes nurse he trusts or a psychologist or even a family member or friend. Don’t feel bad about getting help. There are many reasons he might not want to share: he might feel isolated, depressed, afraid or even angry at you. Because you are the one in charge of the tests and shots and the policeman of what he eats or does, it might be easier to blame you. He could even be feeling embarrassed because of the sudden overload of attention.

Helping your child involves acknowledging his feelings and listening to what he says. This communication does not always have to be verbal. Writing or drawing or even making music can get your child to share his feelings.

Encourage him to actively participate in his health care management. Help him to be independent. Once he starts feeling more confident and independent, he will be more likely to share his feelings of living with diabetes. Encourage him to have fun with friends and if he starts going on outings and camps with friends and other children with diabetes he will learn from them that it is okay to talk about it.

  • Tell your son that he did nothing to deserve diabetes – it just happens. If he feels that the condition is troublesome for you or your family, reassure him that there’s no reason to feel guilty.
  • Remember that children are likely to copy the way that their parents cope with something.   Also remember that expecting a child to deal with things quickly and practically isn’t helpful to you or him. You need to set the example.
  • Build a support network that you and your family can fall back on. Be informed parents.
  • Make the most out of every day.

You and your son are on a lifelong journey with diabetes.

A good journey requires lots of planning, flexibility, curiosity, frequent course corrections, and an occasional attitude adjustment.

Make it a good one.

– Jeannie Berg, Diabetes Educator

 

Exercise made easy

Who said getting fit has to be a big project? With these five 20-minute workouts, you’ll be on your way to getting active in minutes! Daniel Sher shows us how. 

Let’s be honest: most of us have a lot of things on our To Do Lists, and exercising is not the one we want to do most! Our busy lifestyles often get in the way of our health, but how hard is it, really, to get active? Exercising can be easier than you think – there’s no need to run marathons or spend hours at the gym. In fact, a recent study* showed that just twenty minutes of daily exercise is enough to lose weight and control your diabetes better. Here are five simple ways to get active that only take twenty minutes to complete. We all have twenty minutes every day… Why not use them to feel great?

  1. Before (or after!) work

It might be a part of everyday life, but walking is also a great way to exercise. Taking a walk is a simple and relaxing way to get your heart rate up. Beaches, forests, parks and rivers are all great for a refreshing twenty minute walk, but a quick stroll through your neighbourhood can be just as enjoyable. Choose a time for your daily walk – twenty minutes before work, for example – and try to do this every day. Walk quickly and keep things interesting by changing which way you go from time to time. Join up with a few friends and it will make your walk even more fun.

Ask the expert: Sarah Hall, Biokineticist

“It’s important to practise correct posture when you walk. Follow these tips: walk tall, imagine a piece of string pulling you from the top of your head, lengthening your spine, and use your arms so that you have more power.”

  1. On your way to work

Most people sit in a taxi, bus or car to get to work. Believe it or not, this is a great opportunity to get some exercise! If you live close to your workplace, choose to walk, jog or cycle instead. And if your home is too far away, get out of the taxi a few stops early, or park further away than usual. Using your morning commute to exercise can help you save time, and also make you feel refreshed for the day ahead. Choosing to walk home (or part of the way home) after work can help to burn away the day’s stress and clear your mind.

Ask the expert: Sarah Hall, Biokineticist

“Buy a pedometer and track how many steps you take and the time it takes you to get from home to work. This is a great way to figure out how active you are during the day, and to encourage you to work on beating your own time and setting your own goals.”

  1. In the office

Quiet times at work are ideal for a quick workout: you can do an easy muscle-toning routine while sitting at your desk. Start by tightening your three main muscle groups, one at a time (legs, stomach and arms). Begin with a deep breath and clench your legs for five seconds; then take a breather for ten seconds before tightening up your stomach muscles for five seconds. Take another breather, and finish by clenching your arms and chest, which you tighten by pressing your palms together as if you’re praying. Repeat this routine until twenty minutes are up for a quick and easy muscle workout!

Ask the expert: Sarah Hall, Biokineticist

“Add a few arm and neck stretches as well! Hold your drawer, roll your shoulders back and down, and lengthen your spine whilst you sit.”

  1. At home

We all make excuses to stay inside: it might be raining, you might have a lot of chores to do, or the TV might be calling your name. Don’t let this stop you from getting your twenty minutes of exercise – you can easily transform your household routines into a workout. When you’re talking on the phone, pace around the house or climb up and down stairs, rather than sitting down. What about your errands? Sweeping, mopping, scrubbing and washing can give you a great workout and a clean house at the same time. Feel like watching your favourite TV show? No problem – use this time to jog lightly on the spot, whilst gently punching your arms in front of you like you’re boxing. Just be sure to pull the curtains so your neighbours don’t think you’re crazy!

Ask the expert: Sarah Hall, Biokineticist

“Treat this just like any other exercise session. Start with the easy tasks first, then stretch. Follow this with the activities that get your heart rate up, and then end with the chores that involve lifting things. Remember: if you are treating it as a workout, don’t forget to cool down and stretch at the end.”

  1. On the weekend

If you’re looking for a simple way to exercise and to have fun at the same time, dancing might be the answer. And what better time to dance than on the weekend? Listen to your favourite playlist, focus on letting loose and try to enjoy yourself – before you know it you’ll have worked up a sweat. If you know any ballroom steps ask a partner to join you for twenty minutes – fast-paced dances like the swing, salsa or tango are all great for increasing your heart rate. If you don’t know any dance moves, make up your own! Nobody’s watching…

Ask the expert: Sarah Hall, Biokineticist

“Dancing can be a great way to challenge your balance and a useful way to become aware of any imbalances between the left and right side of the body.”

How does exercise help diabetes? Exercise is recommended for most people, but an active lifestyle is especially helpful for diabetics. Why? Exercise can:

–       Help your body to use insulin better.

–       Prevent cardiovascular (heart) disease and other diabetes-related complications.

–       Reduce stress and anxiety, which makes it easier to manage your condition.

–       Improve your blood sugar control.

* In the September 2012 issue of The Journal of the American Medical Association.

Living well with diabetes

From Facebook (Diabetic South Africans):

What does living well with diabetes look like for you?


Tried changing my way of eating, lost weight and still had to go on tablets. My levels are stable though – between 5.3 and 6.1 – enjoying my new way of life.
Sharon

Well… Sharon, that’s living well with diabetes, the rest is history! Well done.
Clint

I am Type 2 and lost 40kg from 110kg, gained muscle, full of energy and feeling 10 years younger! What I eat is part of living well with diabetes.
Phillip

It sucks big time. But taking it day by day. Some days are cool, but some are just hell.
Phumzile

Totally sucks. Got neuropathy from my ankles to my toes! Sugar down from mid 16s to between 8 and 12. Doc wants to put me on insulin but I don’t want to. Staying positive and fighting hard!
Anton

After taking control of my diabetes myself, i.e. testing throughout the day and increasing my insulin to where I needed it, I’m happy to report I tend to stay between 4 and 8 with a couple of hiccups here and there when I hit 12 or 9 – but nowhere close to 16 as before… Anton, I fought insulin injections too. But it works and I feel so much better. The fight against insulin is not worth it if you are damaging your body…
Elrica

The challenge of gestational diabetes

Celeste Smith is no stranger to gestational diabetes: she’s had it twice, including during her pregnancy with now-five-year-old twins Connor and Adam. We find out what she wishes she’d known before she fell pregnant.

Is there a reason you’re so happy to share this very personal story?

I want to educate, encourage and motivate women with gestational diabetes, and prevent other women from having to go through what I and many others had to endure.

How did you find out you had gestational diabetes?

My first pregnancy was stillborn: Noah was born at 38 weeks. I didn’t know I had gestational diabetes until after Noah was born. We suspected with my family having diabetes that I could get it, but my doctor at the time never picked it up. When I wanted to fall pregnant again, my new doctor Dr Jansen immediately tested for glucose tolerance before I fell pregnant, and then again after I fell pregnant. That’s how we found out I had gestational diabetes again.

What were your symptoms?

What’s tricky about gestational diabetes is that it goes from nothing to full-blown diabetes very quickly. It’s only when you’re pregnant, so there’s no warning beforehand. The symptoms I had were swollen hands and feet, bad circulation, pins and needles in the hands, and constant thirst – I was drinking a lot of water.

Does diabetes run in the family?

Yes – my late mother had Type 2 diabetes, and three of my sisters and my brother have diabetes (half of my eight siblings, in fact!) None of my family recognised my symptoms, but none of us were looking for them: you put your faith in the doctor, that’s what doctors are there for.

What did you do to manage your gestational diabetes?

During my pregnancy with the twins, I was put on Metformin and later insulin. I also had to have monthly HbA1c tests and test my blood sugar seven times a day: when I woke up, before each meal, after each meal and before I went to bed. My fingers had so many holes in them; I didn’t know where to prick myself! I went to a dietician, which was helpful, we discussed good eating habits and made a lot of changes – we started eating more steamed foods and not so much starch (like potatoes, bread and pasta). And I started exercising. My diabetes doctor, Dr Dave, told me I had to exercise every day, even when I was tired after working all day.

What advice would you offer to women with gestational diabetes?

Listen to your doctors, stick to your eating plan and exercise a little bit every day. Stay focused: this is for the health of your babies. It helps that you just have to stay focused for nine months, and then the reward at the end is breathtaking. My boys were big for twins (2.8kg/each at 35 weeks) and healthy. I’ll never forget how relieved I was to hear both babies crying in the delivery room. They were both crying at the same time, and the doctor said: “Wow, they sound like a choir!”

What makes your life sweet?

I could say sunsets and sunrises, I could say my religion or even cupcakes and chocolates. But my husband and three boys are the light of my life, and sharing everything with them makes my life so sweet.

Do or Don’t: Diabetic dietary supplements

Are dietary supplements really necessary if you have diabetes? Nicole McCreedy asks the experts.

Like many other people with diabetes, you may be wondering whether you need to take supplements to help manage your condition. Dietary supplements can be vitamins, minerals, herbs or other plants, amino acids (the building blocks of protein) or a combination of the above. They can be in pill, capsule, powder or liquid form.

Despite some of the claims being made, there is not enough scientific evidence to suggest that any dietary supplements can help prevent or manage Type 2 diabetes. That said, dietary supplements may provide extra nutritional benefit to people with special health problems, including diabetes. In such cases, they are usually recommended when there is a specific lack of something in the body.

Do: Eat correctly

It’s important to try and get the nutrition your body needs from a balanced diet. Making healthy food choices and choosing fruit, vegetables and whole grains over carbohydrates, refined sugars and foods high in saturated fats can make a big difference. Compared with supplements, whole foods provide a variety of different nutrients for health in one package, whereas single vitamin supplements are most often for a single purpose. An apple, for example, contains vitamin C, fibre, and antioxidants – all in one crunchy package!

Dr Claudine Lee, a GP from Hilton, says that following a balanced and healthy diet is essential. “If you think you’re not getting the vitamins and minerals you need from your diet, consult with your GP whether it is necessary to take a supplement,” she advises. Eating correctly, being physically active and taking your prescribed medication is vital for maintaining good control of blood sugar levels to avoid serious complications like strokes, heart and kidney disease, limb amputation and blindness.

Don’t: Go it alone

Talk with your doctor. That is the first step in deciding whether or not to use a dietary supplement. He or she can discuss the possible benefits of dietary supplements, and check that any supplements you take will not interact dangerously with your medications.

Be sure to list any dietary supplements you take whenever you tell your doctor or any other healthcare professional about your medications. Most importantly, keep in mind that a dietary supplement is not a replacement for the diabetes treatment and care advised by your doctor.

So who could benefit from a vitamin supplement?

  • Those on low calorie diets, who do not eat a variety of foods.
  • Those following vegan diets.
  • Those with certain food allergies, kidney disease or diseases of the gastrointestinal tract that interfere with nutrient digestion or absorption.
  • Pregnant women.

An A to Z of supplements and their benefits

 

Ask the expert: Andrea Jenkins, nutritionist.

“The following supplements have been shown to improve blood sugar control or limit diabetic damage.”

Amino Acids/Protein

Carnitine (L-carnitine), a nutrient made from amino acids that helps the body turn fat into energy, has been found to be deficient in people with diabetes. Almonds, egg and cottage cheese are rich in this nutrient.

Antioxidants

Antioxidants can help reduce oxidative stress and lower the risk of diabetic complications. Choose brightly coloured fruits and vegetables in smoothies, salads and soups to ensure a variety of antioxidants.

Enzymes

Digestive enzymes help ensure that mineral uptake is strong and can aid the management of diabetes. Pre- and probiotics are also helpful to maintain digestion and immunity.

Lipids and essential fatty acids

Omega-3 fatty acids lower blood pressure and triglyceride levels, and can help to relieve many of the complications associated with diabetes.

Minerals

Magnesium, common in leafy green vegetables, is frequently lacking in people with Type 2 diabetes, as is chromium. Brewers yeast, mushrooms and non-refined grains all contain chromium. Zinc improves insulin function, and potassium (found in all fruits and vegetables), can improve insulin sensitivity.

Vitamins

A vitamin B complex improves the metabolism of glucose, and vitamins C and E can improve eye health.

Remember that dietary changes are important to treat diabetes successfully. Many foods can have a positive impact on blood sugar, for example artichokes, garlic, nuts, onions, olives, cinnamon, blueberries, avocado and fenugreek. Try to include some (or all!) of these in your next meal…

Ask the expert: Faaiza Paruk, dietician
“Some people believe that by taking a supplement they won’t need to exercise or take any medication. 
This is untrue. You need a balanced diet as well as exercise to help control your sugar levels. 
A balanced diet includes five servings of fruit and vegetables a day, a low intake of salt and fat, lean meat and complex carbohydrates found in foods such as brown rice, potatoes, beans and lentils.”

10 Fast facts about the HbA1c

The HbA1c blood test is something that all diabetics should have every few months. But do you know what it is? Here are all the basics so you can be informed.

  1. HbA1c stands for haemoglobin A1c, also known as glycated haemoglobin.
  2. What does this mean? HbA1c is formed when glucose sticks to the haemoglobin found in red blood cells.
  3. The longer the glucose in the blood is elevated (i.e. the longer you have high blood sugar), the higher the HbA1c will be, as more glucose is available to attach to haemoglobin.
  4. Red blood cells live for 100 to 120 days (3 to 4 months) before they are replaced: therefore, the HbA1c can give a rough estimate of your average blood glucose for the past 3 months.
  5. The HbA1c can be done without fasting overnight: the test results do not change even if you’ve just eaten.
  6. The HbA1c is measured as a percentage: 7% or below is the magic number to aim for.
  7. 7% HbA1c = an average blood sugar of 8.6mmol/l.
  8. Both Type 1 and Type 2 diabetics should check their HbA1c every 3 to 6 months depending on the level – every 3 months if your last test was above 7%, every 6 months if you are at 7% or below.
  9. The higher the HbA1c, the greater the risk of developing diabetes complications.
  10. All those with diabetes should know their latest HbA1c result and have an HbA1c every few months at their local clinic or hospital. It is a simple blood sample test.

New Type 2 medication could provide weeks of control

We just heard about new studies at Duke University in the USA that may lead to an injection for Type 2 diabetes that could provide weeks of good blood glucose control… Doesn’t that sound wonderful, and hopeful?

Biomedical engineers at Duke University have created a technology that might provide weeks of glucose control for diabetes with a single injection, which would be a dramatic improvement over current therapies. In primates, the treatment has been shown to last for weeks, rather than days.

By creating a controlled-release mechanism for a drug and optimizing its circulation time in the body, this new biopolymer injection has the potential to replace daily or weekly insulin shots with a once-a-month or twice-a-month treatments for Type 2 diabetes.

The new therapy is described June 5 in Nature Biomedical Engineering.

Many current treatments for Type 2 diabetes use a signaling molecule called glucagon-like peptide-1 (GLP1) to cause the pancreas to release insulin to control blood sugar. However, this peptide has a short half-life and is cleared from the body quickly.

To make treatments last longer, researchers have previously fused GLP1 with synthetic microspheres and biomolecules like antibodies, making them active for two to three days in mice and up to a week in humans. Despite this improvement, many of these treatments don’t include a mechanism to control the rate of the peptide’s release, causing the treatment’s effectiveness to plateau after prolonged use.

Now researchers at Duke have created a technology that fuses GLP1 to a heat-sensitive elastin-like polypeptide (ELP) in a solution that can be injected into the skin through a standard needle. Once injected, the solution reacts with body heat to form a biodegradable gel-like “depot” that slowly releases the drug as it dissolves. In animal experiments, the resulting therapy provided glucose control up to three times longer than treatments currently on the market.

“Although we’ve pursued this method in the past, Kelli Luginbuhl, a grad student in my lab, systematically worked to vary the design of the delivery biopolymer at the molecular level and found a sweet spot that maximized the duration of the drug’s delivery from a single injection,” says Ashutosh Chilkoti, chair of the Department of Biomedical Engineering (BME) at Duke University and a senior author of the paper. “By doing so, we managed to triple the duration of this short-acting drug for Type 2 diabetes, outperforming other competing designs.”

Building upon their previous work with the drug and delivery system, researchers in the Chilkoti lab optimized their solution to regulate glucose levels in mice for 10 days after a single injection, up from the previous standard of 2-3 days.

In further tests, the team found that the optimized formulation improved glucose control in rhesus monkeys for more than 14 days after a single injection, while also releasing the drug at a constant rate for the duration of the trial.

“What’s exciting about this work was our ability to demonstrate that the drug could last over two weeks in non-human primates,” says Kelli Luginbuhl, a PhD student in the Chilkoti lab and co-author of the study. “Because our metabolism is slower than monkeys and mice, the treatment should theoretically last even longer in humans, so our hope is that this will be the first bi-weekly or once-a-month formulation for people with Type 2 diabetes.”

Currently, the longest-acting glucose control treatment on the market, dulaglutide, requires a once-weekly injection, while standard insulin therapies often have to be injected twice or more every day.

Despite a variety of treatment options, managing Type 2 diabetes still poses a problem. Patients don’t always reach their glycemic targets, and adherence to a treatment plan that relies on frequent, meal-specific dosing leaves room for human error. By limiting the number of injections a person will need to control their glucose levels, the researchers hope this new tool will improve treatment options for the disease.

The researchers now plan to study the immune response to repeated injections and test the material with other animal models. Chilkoti and Luginbuhl are also considering additional applications for the controlled-release system, such as delivering pain medication.

Chilkoti also said that because the drug is synthesized inside E. coli bacterial cultures instead of mammalian cells, it is cheaper and faster to produce, making it a potential target for use in developing countries once it’s commercialized.

The research was funded by the National Institutes of Health (R01-DK091789). Chilkoti is a scientific advisor for PhaseBio Pharmaceuticals, which has licensed this technology from Duke.

CITATION: “An Injectable Depot of Glucagon-Like Peptide-1 Fused to a Thermosensitive Polypeptide With Zero-Order Release Kinetics Provides One Week of Glucose Control,” Kelli M Luginbuhl, Jeffrey L Schaal, Bret Umstead, Eric Mastria, Xinghai Li, Samagya Banskota, Susan Arnold, Mark Feinglos, David D’Alessio, Ashutosh Chilkoti. Nature Biomedical Engineering, June 5, 2017. DOI: 10.1038/s41551-017-0078

Photo by Mark Olsen on Unsplash

Need to know: what are PMBs?

Did you know that if you have diabetes and you’re a member of a medical aid, they have to – by law – give you certain benefits for free? Nicole McCreedy explains all you need to know about PMBs.

If you’re a Type 1 or a Type 2 diabetic and you belong to a medical aid, you have the right to certain health services, known as Prescribed Minimum Benefits (PMBs). There are about 300 medical conditions where PMBs apply, and 26 of those are chronic conditions like Type 1 and Type 2 diabetes.

Your health is important

PMBs were introduced to the Medical Schemes Act to protect members. It doesn’t matter how old you are, how healthy you are, or which medical aid option you are on (yes – even hospital plan counts!) Your medical aid has to provide minimum healthcare if you have a chronic condition – at no extra cost. You shouldn’t have to pay extra (over and above your monthly medical aid contribution) for certain medical services for diabetes. Because the government has made this law, it is also impossible for medical aids to charge you more or force you to lose your medical aid cover because you have a serious medical condition.

When you can (and can’t) use PMBs

What does this mean? A medical aid must pay in full, without any co-payment from you, for the diagnosis, treatment and care costs of the PMB condition (your diabetes). The medical aid cannot use your medical savings account or day-to-day benefit to pay for PMBs. Remember, though, that PMBs are subject to pre-authorisation (you have to register your PMB with the medical aid first), protocols (specific treatment and medication guidelines), and making use of designated service providers (hospitals, pharmacies and doctors that they have chosen). So you can’t expect your medical aid to cover the costs of your diabetes care unless you play by their rules, and you may not be able to get the same doctors and medicine as you had before.

Sometimes, members will not have cover for PMBs from their medical aid. This can happen if you join a medical aid for the first time (without switching from another medical aid) or if you join a new medical aid more than 90 days after leaving the previous one. If this is the case, there is a waiting period, during which you won’t have access to the PMBs for any pre-existing condition for 12 months.

Diabetes treatment and PMBs

The treatment of diabetes focuses on the control of blood sugar levels. Treatment involves all aspects of your lifestyle, especially nutrition and exercise, but most people with diabetes also use medicine (usually insulin) at some point. Treatment of other risk factors, like blood pressure and high cholesterol, is also very important.

Both Type 1 and Type 2 diabetes qualify as PMBs and must be treated according to PMB regulations for diagnosis, medical management and medication. You can ask your medical aid about the following treatments that should be covered:

  • Visits to your doctor (GP or specialist – if authorised).
  • Dietary and disease education.
  • Annual eye exam for retinopathy.
  • Annual comprehensive foot exam.
  • Blood tests every 3 to 6 months.
  • Disease identification card or disc.
  • Home blood sugar testing.

How to get your Prescribed Minimum Benefits:

Step 1: Register

Phone your medical aid and tell them you want pre-authorisation for diabetes PMBs. They will ask for a code that your doctor will be able to give you. It is very important that you have the right ICD-10 code – this gives the right information about your condition and helps the medical aid to know what benefits you are allowed. A PMB condition can only be identified by the correct ICD-10 codes. If you give the wrong ICD-10 code, your PMB services might be paid from the wrong benefit (like your medical savings account), or it might not be paid at all if your day-to-day or hospital benefit limits have run out.

Step 2: Your service will be pre-authorised

After you have registered your chronic condition for PMB, your benefits will be authorised and you can ask for your PMB schedule, which tells you exactly what you get for free.

 

The A to Z of PMBs

Chronic Diseases List (CDL)
A list of the 26 conditions (including diabetes) that qualify for PMBs.

Chronic Medicine
Medicine used for the long-term treatment (three months or longer) of a chronic condition. The chronic medicine must be used to prevent or treat a serious medical condition, to sustain life and to delay the progress of a disease. It must also be the accepted treatment according to treatment guidelines (protocols).

Co-payments
The difference between the cover provided by the medical aid and the cost of the medical service – payable directly to the service provider.

Designated Service Provider (DSP)
Doctors and other health care providers who have been chosen by the aid to “provide its members diagnosis, treatment and care” for PMB conditions.

Emergency Medical Condition
A medical condition that needs immediate medical or surgical treatment.

Formulary
An official list of the medication that can be prescribed for the treatment of the 26 conditions on the Chronic Diseases List (CDL).

ICD-10 Codes
An international clinical code that describes a disease diagnosis. If you want to qualify for PMBs, you must be sure your doctor puts the correct ICD-10 code on all your forms.

PMB Medicine
Medicine for the treatment of the 26 conditions on the Chronic Diseases List (CDL) qualifies for PMBs, as long as you provide all the necessary information. This can be anything from a diagnosis by a specialist to results of certain tests – your medical aid will tell you what you need.

Prescribed Minimum Benefits (PMBs)
The minimum benefits that must be provided to all medical aid members. These include diagnosis, treatment and care costs for a number of conditions, including diabetes.

Protocols (Treatment Guidelines)
There is a minimum standard treatment for each PMB condition. Medical aids use these guidelines to come up with protocols (treatment guidelines) and formularies (lists of approved medication) to manage PMBs.

This article was reviewed by:

  • Alain Peddle, Discovery Health
  • Herman van Zyl, Principal financial advisor, HVZ Financial Consultants
  • Rossouw van Zyl, Brokers, t/a Medinet, Authorised Financial Service Provider
  • Michael A.J. Brown, Accredited Diabetes Educator,
Centre for Diabetes and Endocrinology, Houghton

 

Photo by Olu Eletu on Unsplash

Diabetic superfoods

Ask the dietician: Cheryl Meyer

From our community: “Sometimes it feels like I’m constantly trying to juggle what I want to eat and what I should be eating. Are there certain foods I must include in my diet because I’m diabetic?” Gracie Monaheng

The term “superfood” has become very popular in the language of food and health. We know that Mother Nature offers a wonderful selection of healthy foods, but research has yet to prove any of them magical. No single food, no matter how “super,” can take the place of the important combination of nutrients from a diet based on a variety of nutritious foods, including plenty of fruits and vegetables.

Some tests to help you decide whether a certain food is worth trying:

 

  • How does it taste? No food is worth eating if it doesn’t taste good. There are plenty of options to choose from that offer both health benefits and flavour.
  • Where was it grown? Has it had to travel long distances from where it was grown to where it was sold?
  • How much does it cost? Has its “super” title brought with it a “super” price tag?
  • Has it been researched? Check with your healthcare team.
  • What value does it add to my overall diet? Variety is an important measure of diet quality, but bear in mind that adding variety doesn’t necessarily mean trying wildly new things: even just a slight change can wake up your taste buds.

Think positive when planning your diet — focusing on foods to add, rather than avoid. Aim to include*:

 

  1. Omega-3 rich foods: like salmon, mackerel, pilchards, tuna, canola oil, flaxseed oil, flaxseeds and walnuts.
  2. Leafy green vegetables: like spinach, kale, lettuce and bok choi. These powerhouse foods are low in kilojoules and total carbohydrate.
  3. Wholegrains: easily trump their paler, refined counterparts. Choose brown or wholewheat options for a source of protein, fibre and B vitamins.
  4. Berries: sweet, yet low in calories and packed with antioxidants, vitamins and fibre.
  5. Nuts: plenty of flavour, very versatile and with a good dose of fibre and selenium. Although they are high in fat and calories, a few nuts go a long way to adding taste to all kinds of meals.
  6. Legumes: delicious, low in fat, high in fibre and rich in protein.

*As with all foods, you need to work these into your individual meal plan in appropriate portions.