diabetes

Your insulin pump questions, answered

If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.

Meet the expert

Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years

What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.

What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.

What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.

When should someone consider getting an insulin pump?

  • If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
  • If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
  • If they have irregular eating, working and resting times.

Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.

A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.

 

FAQ about the insulin pump from our community:

 

  1. What is an insulin pump?

  • Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
  • The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
  • It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
  • Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
  1. Where do you buy an insulin pump and how much does it cost?

You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.

  1. What are the advantages and disadvantages of using an insulin pump?

Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.

  • Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
  • You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
  • You can participate in sports whenever you feel like it — without having to plan in advance

Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.

Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.

  1. Will my blood sugar control be better if I use an insulin pump?

It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.

  1. Will I still have to test my blood sugar as much?

A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.

  1. Are there insulin pumps that have a Continuous Glucose Meter attached?

Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs

  1. How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?

You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.

  1. At what age can you put a child on the insulin pump and how easy is it for them to adapt?

I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.

  1. What is the risk of infection?

If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.

  1. How much is an insulin pump with and without medical aid?

That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.

Ask the expert: Dr Claudine Lee, GP

“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”

 

Telling a new partner about diabetes

Hi. This may seem like a silly question, but I want to know how do you tell a new partner that you have diabetes? Or should I say nothing and see how things go between us (I’ve been dating this guy for 6 weeks).” Bongani Nobuhle

Dear Bongani,

It can be a real challenge to tell someone you have diabetes. Sometimes people who do not understand diabetes have bizarre ideas about the condition and may react in an unwanted or hurtful way. Of course, some people will be more open-minded than others.

It’s normal for people with diabetes to worry about what their date will make of their diabetes. So when is the right time to talk about it?

Telling a new partner about your diabetes will be influenced by your personal preference and also by your medication. It’s a good idea to let your partner know about your diabetes early on in your relationship if you are on insulin, or at risk for hypoglycaemia. It will make the first episode of going low or having to inject less of a surprise to him. It is also a good idea to explain your need to inject at a convenient time as some people may feel funny about needles. If you are on oral medication, you could wait longer and see how you go.

When you do decide to tell him, be your brave and bold self. I do believe he has a right to know. If it scares him away, then he wasn’t the one for you. If he doesn’t know what it is about, all your secret long trips to the bathroom to check your sugar and inject insulin might alarm him. What if you can’t get up to go somewhere private to check your blood sugar? You don’t want to sacrifice your health just to keep a secret.

When you do tell him, don’t be a drama queen: just state the facts. Give your partner a chance to take in the news and be patient. Everyone reacts differently and at different speeds. But remember: if he doesn’t support you or take your diabetes seriously, don’t waste your time or his.

– Jeannie Berg, Diabetes Educator

 

 

Take to the trail

Tired of pounding the pavement or looking for a fun way to get active? Trail running may be the sport for you. More and more people are heading to the mountains, the veld and the forests to get away from the city, spend time in nature and run free.

More than just a work-out

Trail running is good for the body, mind and soul. It’s also good for the wallet – except for the price of running shoes, it doesn’t cost a thing. Trail running is different to road running because the ground you’re running on changes all the time and isn’t flat and hard like a road. It helps “proprioception”, our sense of balance and body awareness. It also develops strength in muscles and joints, and gives you stronger ankles and hip joints. Softer surfaces like grass, sand, and gravel are easier on the joints than tar. Trail running will help you burn more calories and shed fat faster as your body uses a greater amount of energy to use more muscles to move on the uneven surface. Paying attention to each step you take will also distract your mind from your everyday To Do list (always a good thing!) Don’t forget to stop for a moment, breathe in the fresh air, and give thanks for where you are.

Heading off-road

Although there is less risk of injury with trail running than road running, it’s a good idea in the beginning to include some exercises in your routine to strengthen your core, pelvic muscles, legs, knees and ankles to cope with the impact to these parts of the body. Follow a careful training programme where you can gradually build up your distance and speed. It’s important to be aware of your diabetic needs while you’re trail running, too. Don’t push yourself too hard in the beginning, and make sure you snack before you start running so that your blood sugar doesn’t go low while you’re on the trail.

When you’re trail running, it’s important to look where you’re going – vehicle tracks, puddles, logs and rocks are all obstacles that can trip you up, and low-hanging tree branches need to be ducked in time.

Here are some tips for different types of terrain:

Sand is difficult to run on, especially when it’s loose. Don’t run in a straight line, rather search for the firmest footing. The harder sand can usually be found on the very edge of the trail.

Muddy surfaces can be slippery, be careful!

Rocky trails mean you need to lift your legs higher to avoid tripping. Try to step lightly with a flat foot, so that if it’s not stable or you slip, you can quickly move your foot.

Forest paths can hide rocks and roots. Be on the lookout and avoid stepping on them if you you can.

Looking for runs in you area? Take a look at www.nightjartravel.com/trail-running

Want to see more of our favourite trails? Visit www.sweetlifemag.co.za/community

Expert tip: Get the right shoes.

Ask the expert: Nelfrie Kemp, Podiatry Association of South Africa

The most important tip when taking up any running is to buy the right shoes and make sure they fit properly. Foot care is vital if you have diabetes. When fitting a running shoe, choose a pair one size larger than your normal shoe size as your feet swell when you exercise. It’s a good idea to use sport socks that are thick from toe to heel and fit you perfectly. This will help prevent pins and needles or a burning sensation in the feet. Preferably wear ankle-height socks as secret socks can move and curl up under your foot, which can cause blisters. Always tie your laces, but make sure that it they are not tied too loosely or tightly.

Get more diabetic foot tips at www.podiatrist.co.za

Expert tip: Be aware

Ask the expert: Sarah Hall, Biokineticist

  • As well as the trail running, do some balance training either at home or in the gym by doing single leg exercises or balancing on wobble boards.
  • Use your whole body while you are trail running: your arms for balance and support, your core to help draw your legs up for climbing the rocky parts, and a mid-foot to front-of-foot strike with shorter, quicker strides for more control and adjustment.
  • Pay close attention to what you eat and drink before and during the run, especially on longer runs. Always have something sweet on you in case your blood sugar goes low, and never run alone.
  • Know the route you are running by mapping the route on GPS. It will give you a good idea of the height you may be climbing and the exact distance you will be covering. Remember to start with shorter routes and slowly build up distance.

Diabetic tips for teachers

“This year I have a diabetic child in my class and I don’t really know what to do. I want to make him feel supported but I also don’t want to make a big fuss about the fact that he’s diabetic – he seems to be managing it very well… What do you suggest?” Linda Nkosi.

Dear Linda,

I think it’s great that you want to lend support to your learner who has diabetes. However, being in charge of children with diabetes can be a challenge unless you know about the condition – it’s a good start for you to get more information on diabetes.

Children with diabetes often feel isolated and alone. Having to test your blood sugar several times a day, keep tabs on what you eat, and give yourself insulin shots or other medicine is enough to make anyone feel self-conscious and different.

If he is willing to do an awareness project with you, it could be very helpful for the whole class. It’s very important to first talk this idea through with him and his parents, though – some people prefer to hide their diabetes and pretend that it doesn’t exist. If you tackle this project in an exciting way, the child will feel involved and the other children in his class will enjoy the topic and then, like children do, just move on to something else. Children are like that. They soon move on, but the message of hypos, testing and shots will be stored in their memory banks.

Remember that this child must always be treated like his classmates. Don’t make exceptions. Always remember, he is a child first. He has diabetes, but that doesn’t give him more or less rights than the child next to him.

Like everyone else, kids with diabetes get along better with a little help from their friends. What a lucky person he is to have a supportive teacher like you!

– Jeannie Berg, Diabetes Educator

 

Have a ball

No matter the season exercising outdoors beats running on a treadmill in the gym. If you want to keep fit and have a social life, then soccer, touch rugby or rounders is the answer. Nicole McCreedy tells us how to get started.

The beauty of ball sports is that they’re so easy to learn. All you need to do is find an open space to play, organize some equipment and two teams, and learn a few basic rules. While your focus is on winning, you’ll be walking, running and laughing your way to better health.

Touch Rugby

The basics of touch rugby are similar to the traditional version of the game – the ball is passed backwards during play. However, in touch rugby you don’t tackle your opponent but rather touch the person running with the ball on any part of their body, clothing or the ball itself using your hand. Because touch rugby is less physical, women can also play without fear of injury.  Once touched, the player in possession of the ball is required to stop, return to the mark where the touch occurred and perform a ‘rollball’ without delay. Facing the defending try-line the player rolls the ball between his/her legs. After six touches the ball is handed over from the attacking team to the defending team and the game starts again from the halfway line in the centre of the field. The aim is to score a touchdown over the defending team’s try-line. Five to six players are on one team at a time, and a game lasts for about forty minutes per side.

Soccer

A game of soccer can be as simple as kicking the ball around with a few friends. Players dribble the ball on the ground, kicking it to pass to each other. For most games, there are eleven players per team – the goalkeeper is the only player allowed to use his/her hands. Teams are made up of defenders, midfielders and forwards. Two defenders patrol the left and right area while the two central defenders play in the middle. The midfielders play both defence and attack, and the forward positions focus on scoring the goals. The centre forwards play in the middle flanked on each side by a wing. In soccer be aware of the offside rule. If you are behind the other team’s defenders without the ball, you are offside. But if the ball is kicked past the defenders, you can pass them. Laduuuuuuuma!

Rounders

To play rounders you need a small ball (a tennis ball will do) and some kind of bat. There must be a minimum of six players per team. A match consists of two innings, giving each team a chance to bat and bowl. An innings is over when the last batter is caught out, and each person on the team gets a chance to bat. When bowling, the ball must not bounce and it must be above the batter’s knee, below the batter’s head, and not at the batter’s body. The batter hits the ball and then runs in a circle, passing a series of markers on the way. A ‘rounder’ is when the batter makes it all the way around the circuit in one hit of the ball. The team with the most rounders wins. A batter is out if the ball is caught before it hits the ground or if the ball is fielded before the batter reaches a marker. A batter who has missed the ball can run to the first marker and then continue to the next three when the next batsman strikes the ball. Only one person can stand at a base at a time.

Team ball sports are a great cardiovascular workout because they increase your heart rate. They are particularly good for people with diabetes because the body uses up extra glucose and decreases resistance to insulin. Muscle strength, endurance and eye-coordination also improve. Best of all? You lose weight while having a ball!

Ask the expert: Anette Thompson, Podiatrist shoes or barefoot?

SEMDSA, the Society for Endocrinology, Metabolism and Diabetes of South Africa, recently released 2012 guidelines which state that a person living with diabetes should not walk or run barefoot. There are a number of reasons for this – even well controlled, highly active people who have not developed any complications will experience a delay in healing if their skin punctures or cracks. Any break in the skin is a potential entry point for infection: bacterial, viral or fungal.

The goal is to wear footwear that most closely approaches the benefits of being barefoot. ‘Barefoot-like’ sports shoes allow maximum flexibility and give the feet the most natural workout. The benefits are improved blood flow to the feet and lower limbs, which feeds nerves and muscles during exercise. Ensure that the shoes are wide enough, as well as being the correct size. It’s a good idea to invest in good quality socks as well.

You only get one pair of feet – take good care of them.

Sport tips Sarah Hall, Biokeniticist

When playing outdoor sports, especially those you’re not used to, keep these tips in mind:

  • A sport specific warm up is essential. Try and focus on the muscle groups you’re about to use and make sure that you pay particular attention to those during your warm up. If you’re about to play soccer, try to loosen up the ankle joints with some ankle circle exercises. Stretch the groin muscles with some lunges and do a couple of lengths of sideways shuffle running along the field.
  • Wear supportive footgear to support your feet and cushion the rest of your body as you run.
  • Be as prepared as possible. Make sure you have enough water for the extended length of time of play. You must also keep some fast acting snacks handy as the game, although fun, may use up more energy than you think.

 

 

 

 

 

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.

 

10 Fast facts about planning financially with diabetes

Newly diagnosed with diabetes? We get to grips with what your medical scheme can do for you, and what you might have to budget for yourself.

  1. Join a medical scheme
    Diabetes is a chronic condition that’s on the Medical Scheme Act’s Prescribed Minimum Benefits (PMB) List. All registered medical schemes in SA have to provide basic funding for your diagnosis, treatment and care.
  2. Register your condition
    Make sure your condition is registered with your scheme, and be sure to do this again each time you switch. Find out how the registration process works: you’re likely to have to complete a form with the help of your doctor.
  3. Stay on a scheme
    If you leave your current scheme, or join a scheme for the first time, the new scheme may impose a waiting period of 3 to 12 months. During this time, your costs may not be fully covered. Do your research before you join a new scheme and avoid breaks where you don’t belong to a medical scheme at all.
  4. Use a healthcare broker
    Understanding what’s covered by all the schemes out there can be complicated. Do your research with the help of a healthcare broker. Their services are free of charge.
  5. Reassess your plan
    Once a year, you can shift from a basic to a more comprehensive plan, and vice versa. Ask your scheme for your medical records and check what you’ve had to pay out of your own pocket during the year. Do the math to see if it makes sense to upgrade or downgrade your plan.
  6. Check which meds are covered
    Even the most basic plans cover diabetes medication, as long as you choose from the formulary (the list of approved medication). Ask for this list before you choose a plan. Your prescribed medicine might not be available on the scheme’s most basic plan, but it could be on another, more comprehensive plan, or on another scheme’s formulary list.
  7. Stick to Designated Service Providers (DSPs)
    These healthcare providers (doctors, pharmacists and hospitals) have an agreement with your scheme, which means their rates are usually fully covered. Get hold of your scheme’s DSP list and use them. Expect a co-payment if you use a doctor outside of this network.
  8. Go for your consultations
    This will depend on your plan, but some of your doctor’s visits will be covered up to an agreed rate. Some schemes, for example, cover annual visits to the GP, dietician, podiatrist, ophthalmologist and other specialists in full.
  9. Check up on tests and equipment
    Diagnostic tests are usually covered in full, as well as annual HBA1c, creatinine microalbumin and lipid tests. Insulin pumps and other specialised equipment might only be covered by top-tier plans, or not at all.
  10. Use those additional benefits
    Many of SA’s schemes offer free coaching, education and reward programmes. Make use of these benefits – they’ll help you to manage your condition better, saving you money in the long run.

Tips for parents of diabetic children

“My son is a Type 1 diabetic, but I don’t want to be overly protective and make him feel he can’t do anything. Do you have any tips for parents of diabetic children, and how to make life normal?’ Sam Shongwe.

Dear Sam,

The first thing you must realise is that a child with diabetes is still a child. He should not be treated differently than a child who does not have diabetes. Granted, you have more issues to cope with – like good food choices, insulin and testing – but these things shouldn’t stop him from having a normal, happy childhood.

The first thing to do is make sure he is safe at school. Let a responsible person know what his diabetes involves so that they can keep an eye on him. By doing this you won’t have to keep phoning him or the school to make sure he is okay: this will only embarrass him and make him withdraw from friends and fun.

Remember, he can also play sports and take part in physical activities just like any other child: you just need to plan – first talk with his doctor, and then help him with the routine of glucose testing, planned eating, and insulin. Work out a plan that he’s happy and comfortable with.

Encourage your child and allow him to socialise. Let him do parties, sports, sleepovers and camps if he wants to. Discuss a back-up plan with him when he does, but try to let him do his thing.

Most importantly, help your child to become more independent by getting him to take an active part in his diabetes care while he’s still young. Encourage him to solve problems and make choices with you about adjusting insulin doses, for example. Help him create a good lifestyle so that his diabetes doesn’t become too difficult to manage and hijack his life. Self-care is the key to developing any child’s independence and self-esteem: it’s important to get your child involved in self-care as soon as he is able to – with your supervision, of course.

Finally, recognise your limit of control. Accept that you cannot watch over him all the time, stand back and allow him more independence as he becomes more confident and responsible. It’s the same with any child: if they prove their responsibility, they get more independence.

– Jeannie Berg, Diabetes Educator

 

Stretch it out

Want to have a more flexible body and improve your circulation? Nicole McCreedy tells us why stretching should be part of everyone’s day.

When we’re young, it’s easy to imagine that our bodies will always do what they’re told. But as we age, our muscles tighten and all of a sudden something as easy as bending over to pick up your keys might be a struggle. Stretching is important because it keeps the body flexible and allows your joints to move through their full range of motion. Here’s all you need to know to keep flexible.

Why stretch?

For people with diabetes, improving circulation is essential for maintaining good health. Because stretching increases blood flow to the muscles, specifically the legs, it is great for circulation, but that’s not all. Regular stretching will increase nutrients to the muscles, improve your co-ordination, lengthen your muscles, reduce lower back pain, and even increase your energy levels.

How to stretch

While you can stretch anytime, anywhere – in your home or at work – you want to be sure to do it safely. Each stretch should be done in a slow and controlled manner till you feel ‘mild discomfort’. If it feels painful, you’ve stretched too far. Do not bounce or force the stretch.

Ideally, you should stretch before you start exercising. To avoid injury, first warm up your muscles. Run on the spot for a few minutes or do some jumping jacks to get your blood flowing and increase your heart rate. Stretch again at the end of your training sessions to help your muscles recover.

Types of stretching

What kind of stretching you choose to do will depend on your fitness and flexibility.

Static stretching is the most common form and is safe for beginners. Give this a try: to stretch the back of your upper thigh lie down on your back. Lift your right leg up in the air, heel facing the ceiling. Make sure that your lower back stays in contact with the floor and the left leg remains straight on the floor. Grip your raised leg with both hands. You may be comfortable holding your thigh, or you may be able to clasp your knee. Do what feels best for you. Keep your head and neck relaxed. Hold for 30 seconds or less. Change legs.

Passive stretching means you are using something outside yourself to help you stretch. Here’s a passive stretch to try: Relax the muscle you are trying to stretch and rely on a strap, gravity, another person, or your own body weight to stretch the muscle gently. Make sure you are well balanced before you start stretching!

Passive stretching is useful for those who have been injured or are frail. A recent study has found that passive stretching can help regulate blood glucose and is beneficial in treating people who are less physically able.

Dynamic stretching is moving through a challenging but comfortable range of motion repeatedly. Take shoulder circles for instance: stand tall, feet slightly wider than shoulder-width apart, knees slightly bent. Lift your right shoulder towards your right ear, take it backwards, down and then up again to the ear in a smooth action. Repeat six to ten times. Do the same with the left shoulder. What you are doing is actively contracting the muscle in the opposition position to the one that you are stretching.

Love stretching and want to take it further? Try yoga or pilates – both involve active stretching. With yoga, the postures are timed with the breath and are designed to put pressure on the glandular system. In pilates, the sequence of movements focuses on strengthening your core muscles – the deep, internal muscles of the abdomen and back.

What to keep in mind while stretching – Sarah Hall, Biokineticist

Remember that – just like people – each muscle group and joint is individual.

  • Make sure that you warm up before you do any activity, and stretch afterwards as well. A quick rule of thumb is to stretch a muscle only if it is tight.
  • Do not stretch in such a way that you put another joint or muscle at risk of injury.
  • Try to isolate a muscle when stretching. If you are working the hamstring, do not put weight on that leg. Breathe into the stretch to allow the benefits of the stretch to move through that muscle.
  • Decide on a reason for stretching a particular muscle: is it to relax, release tightness or restore length to the muscle? Aim to stretch each muscle for between 10 and 30 seconds.

Ask the expert: Dr. Zaheer Bayat, Endocrinologist

Exercise is good for everybody. But for those with diabetes, there are added benefits:

  • Exercise lowers glucose levels as muscles require more glucose for fuel.
  • Exercise helps in losing weight, which in turn improves morale. Not only will you feel better, you will also look good.
  • Exercise improves insulin sensitivity. This can go a long way to stabilizing blood sugar levels

When starting any exercise program, it is important to spend a few minutes stretching, which will help lessen the risk of doing damage to yourself.

Ask the expert: Prof. Wayne Derman, Professor of Sports and Exercise Medicine

“Flexibility is an important part of fitness, so stretching should be included in any exercise programme. It’s also a great way to manage and prevent muscle cramps. Not sure what to do? Get a physio, biokineticist or trainer to assist you with the right stretches for the muscle groups in which you are particularly tight.”

The day you’re diagnosed with diabetes

Gabi Richter is a diabetic counsellor on our Panel of Experts. Today, she speaks to us about the day you’re diagnosed with diabetes.


The day that you are diagnosed with diabetes is a day that is hard to describe. The world stops but at the same time a neverending rollercoaster ride starts: one you never asked to get on in the first place.

I remember sitting in the doctor’s office and a funny thing happened: he said the test results came back and you’re a Type 1 diabetic. After that I was in shock. The funny thing is I knew that he was talking because his lips were moving, but honestly I have no idea what he said. It was all a blur to me. All I remember thinking is: how can this happen? I never ate much sugar and now I’m going to die. But at least I have an answer to why I’ve been feeling so sick the last few months.

After the shock set in, I remember going to the book shop to basically buy any book that had been printed that mentioned the word diabetes, and then reading them all and being more confused than ever as they all contradicted each other. After the initial diagnosis, the doctor suggested that I go and see an endocrinologist.

Well, I saw a few of them and what they were all good at was sitting me down and telling me the negative side of the disease. How you can lose your eyesight and your feet and how if you get wounds there is a good chance they won’t heal well. Then in the next breath, they explain that now you will need to go on a strict diet and inject for everything you eat ever. They seem to wonder why you look so depressed and have an attitude of, what’s the point to life any more?

At some point during the initial diagnosis, it seems we all go on a sort of autopilot. We inject when needed and ask every question we can think of, and blindly trust what our doctors say, because they’re the professionals and know what they’re talking about, right?

What we don’t realise then is that diabetes is a common condition but it’s also very individually based. What makes my levels go up can have no effect on a friend’s levels. The other thing we learn on our journey is that at some point all diabetics and carers become doctors, dietitians and endocrinologists. The only difference between us and the real doctors is that they have diplomas and we don’t, but we have the life experience and they don’t.

What I have learned the most in my love-hate relationship with diabetes is that while I hate the constant management and daily injections, being diabetic has made me a stronger person and taught me to stand up for myself. In a weird way, it has given my life a kind of warped purpose. So I guess I will always love to hate being diabetic. You know what? That’s actually okay and totally healthy.

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

Diabetes and depression

Gabi Richter is a diabetic counsellor on our Panel of Experts. Today, she speaks to us about depression and diabetes.


Managing everyday life challenges can be hard for the strongest and most emotionally balanced people. But having diabetes changes the game and adds extra curve balls we need to deal with. Depression is a very common problem, but studies show that people with chronic illnesses such as diabetes are three time more likely to suffer from depression and anxiety. With the constant management plan we have to follow, it’s no surprise that we are at greater risk for depression and anxiety.

Anxiety and depression can overlap with symptoms of diabetes, which make it harder to diagnose whether it is simply anxiety or rather depression that you are feeling. Anxiety can lead to depression if not treated correctly, but depression rarely leads to anxiety. Depression also has fewer symptoms, making it harder to diagnose.

Depression is a chemical imbalance in the brain which affects how you think and feel, and it can manifest in both emotional and physical symptoms. The thing to remember about depression is that you can suffer from depression without fully feeling depressed, and if you are depressed it’s not easy to simply snap out of it.

There are six main symptoms to look out for when dealing with depression:

  • A loss of appetite or any change in eating habits
  • Feeling down all the time
  • Any change in sleeping pattern
  • Lack of energy
  • Loss of interest in daily tasks that you used to enjoy
  • Feeling irritable all the time.

These symptoms are very similar to anxiety, however the main difference is that when you are anxious you worry more about the future and current things that have either happened or could happen. When you feel depressed, you simply have no drive to do anything and can only see things from a negative space.

To understand more about depression, it’s helpful to know what’s happening in your body. Your mood is determined by neurotransmitters such as serotonin and dopamine, which are released into the brain. When these levels are low, we start to experience feelings of anxiety and depression. Depression can feel a bit like anxiety and that is why it is often overlooked. A constant state of anxiety can show up in ways that make you feel physically sick, such as constant headaches, dry mouth, upset stomach and nausea.

To suffer from depression or to feel depressed does not mean that you are weak. Many people suffer from depression: it is an ancient disease that affects thousands of people, even famous people such as Winston Churchill. He used to call it his “black dog”.

As diabetics, we often have weaker metabolic and glycaemic control. This in turn can intensify depression symptoms: if not treated correctly, it can lead to diabetes burnout. We need to remember that when we experience depression or anxiety, the body reacts the same way it does to stress. The fight, flight, fright response is activated which releases adrenalin and cortisol into the blood stream, which in turn increases our sugar levels. There are many levels of depression ranging from mild to major: the levels don’t get worse, it’s simply the consequences and symptoms that change.

Depression affects everyone and people suffering from chronic conditions are at a higher risk of suffering from depression and anxiety. One of the most important things to remember about depression is that you can suffer from depression and not look depressed. The symptoms for depression do not always manifest in the known ways: it is also linked to aches and pains in muscles or constant headaches.

So what’s the answer? We need to find ways to relax as much as we can and remember to listen to our bodies. You are not alone in this.

How to handle a diabetes emergency

“A friend at work is diabetic, and I’ve never really thought about it before because he seems to handle it really well. But last month he had a scary episode where he started shaking and we had to put sugar on his tongue. How can I help him to feel okay about it?” Sini Webster

Dear Sini,

The word “diabetes” can lead to (unnecessary) concerns in the workplace about productivity and reliability. Co-workers who don’t have much information about the condition often feel unsure how to treat colleagues who are testing blood sugar, taking medication and possibly having hypoglycaemic (low blood sugar) episodes during work time.

The person with diabetes may feel insecure, embarrassed and afraid of being seen as different: it can be difficult to know how to support or assist them.

The most important thing is to develop trust so that the person with diabetes knows that they will not be made fun of or penalised for having diabetes. Everyone involved needs accurate information about diabetes and how to manage it: good communication and co-operation lead to a healthier, more productive workplace.

The shaking was probably caused by an episode of low blood sugar. Other symptoms include sweating, heart palpitations, anxiety and – if the blood sugar is very low – disorientation.

It is important for those with diabetes to choose a few colleagues who know how to quietly assist and not panic:

  1. Encourage the person with diabetes to have either a few sweets, 2 to 4 teaspoons of sugar in a little water or half a glass of Coke or juice. If they are unable to swallow, place the sugar or some jam on their tongue.
  2. Once their blood sugar has been raised by the sugary food, they should have something healthy to eat to stabilise it: a piece of fruit or a slice of health bread and peanut butter.
  3. If possible, they should test their blood sugar at this point.
  4. If they are disorientated or unconscious, call an ambulance: it’s always better to be safe than sorry.

– Jeannie Berg, Diabetes Educator

Using laughter as medicine

You would never guess that Trevor Davids, a business consultant, film and TV producer and biker filled with the joys of life, has Type 2 diabetes. That’s because he’s managed to take diabetes in his stride.

When did you find out you were diabetic?

Six years ago, in November 2010. I had all the usual symptoms – constantly thirsty, needing to urinate a lot – and I looked them up on the internet. Up came: diabetes. I read up on the condition before going to the doctor, and then announced, “I have diabetes.” We took the necessary tests and my blood sugar was really high (18mmol/l), so I was put onto insulin tablets immediately. Diabetes doesn’t run in my family, I’m not overweight and I do a lot of exercise, so I’m not a typical Type 2 case. I do have high blood pressure that runs in the family. When I was diagnosed with diabetes I had already given up alcohol ten years before, but I was smoking 40 cigarettes a day, so I had to give that up too. After 31 years of smoking, I quit on the first try. Once I make up my mind about something, there’s not much that can move me.

How has diabetes changed your daily life?

I’m a lot more conscious of my eating patterns now. I never used to eat breakfast – I’d grab something on the run, snack in the afternoon, and then eat a big plate of food in the evening. I had to learn to be less flexible about food. Eat a regimented breakfast, lunch and dinner, look at my intakes and learn about low GI. I couldn’t have done it without my family – my wife Norma and son Danté have been the most amazing support.

How do you manage to focus on the lighter side of living with a chronic condition?

I never focussed on the darker side of diabetes! I’m a very positive person, I like being focussed on doing something well. In challenging times, I just take it in my stride and deal with life’s knocks as they come.

Is there anything diabetes has stopped you from doing?

No. Only smoking! I’ve actually been able to take on more daily life challenges since being diagnosed, because I restructured and reorganised my life, so I now have more time.

What advice would you offer to other diabetics?

If you’ve just been diagnosed, don’t worry – it’s not as daunting as you think. It can become a lifestyle condition, you just need to adapt your lifestyle. Diabetes is part of who you are now, and denying it doesn’t make it go away.

What makes your life sweet?

Life itself! And my family, of course. And laughter: the ability to laugh and create a laugh. I believe that people can live a long time if they can learn to laugh in the face of adversity. I like to use laughter as part of my medication.

How to eat seasonally

I don’t know about you, but I love the idea of eating only what’s in season. Fresh fruit and vegetables are obviously at their most abundant when they’re in season, and I like to only eat what’s local and fresh (don’t we all?!) It’s not always that easy to know what’s in season, though, and what to look out for. That’s why I love this seasonality calendar we were sent – take a look below and download a PDF if you’d like to keep it.

Happy cooking – and eating!

Seasons change, and so should the fruits and veggies you put onto your plate. Eating seasonally is tastier, more cost effective and sustainable. Chef James Diack, one of South Africa’s pioneers of provenance, has taken the concept of seasonality even further by producing a Seasonality Calendar for South Africans as a guide on what to eat each season, and what they can expect to see on his plates during the months and weeks of the year based on the produce from Brightside Farm.

“Seasonality and sustainability are all about protection – protection of the environment, protection of our diners’ health and not least of all protection of animal health. All of our practices are geared toward these goals,” James says.

Download the calendar to keep on your fridge!

Download (PDF, 1.08MB)