diabetes

Dealing with diabetes complications

My husband is a diabetic, and I would like to know how long it takes before diabetes affects your liver? Should I be worrying about him?” Alicia Greenway.

Dear Alicia,

You’re wise to think about steps to protect your husband’s liver – diabetes is a lifelong condition that affects the liver and vice versa. Being informed is the first step towards ensuring good liver health. Those with diabetes are at higher risk of non-alcoholic fatty liver disease, a condition in which extra fat builds up in the liver even if you drink little or no alcohol. Other medical conditions related to diabetes — including obesity, high cholesterol and high blood pressure — also raise the risk of non-alcoholic fatty liver disease. Diabetes does not cause fatty liver disease, but the two tend to occur in the same people because the same conditions cause both problems.

Diabetic-related liver disease can be largely prevented. Good control of blood sugar, maintaining a healthy weight, and having regular check-ups to monitor the effects of medication can help reduce the risk of liver problems.

Strategies for protection against fatty liver disease include:

  • Working with your health care team towards good control of your blood sugar.
  • Losing weight if necessary, and trying to maintain a healthy weight.
  • Taking steps to reduce high blood pressure.
  • Keeping your cholesterol within recommended limits.
  • Not drinking too much alcohol.

Then, let’s talk about worry. “Worry never robs tomorrow of its sorrow, it only saps today of its joy.” Leo Buscaglia.

Having a partner with diabetes puts unique strains on a relationship, but it can also bring you closer together if you learn how to work together. Here are some golden rules for rising to the challenge of managing a chronic disease like diabetes:

  • Get educated
  • Communicate
  • Listen
  • Set shared goals
  • Make room for negative emotions
  • Get support from others
  • Commit to nurturing your relationship.

You can do it if you work together.

– Jeannie Berg, Diabetes Educator

 

Top tips for a pregnancy diet

Ask the dietician: Cheryl Meyer

From the community: “Being both diabetic and pregnant makes it difficult to know what to eat – there are so many things I have to avoid! And I’ve been craving sweet things. Any advice?” Sameshnie Naidoo.

The diet for pregnant women with diabetes should be a healthy, well-balanced eating plan aimed at supporting the pregnancy and promoting blood sugar control. This is essential for the wellbeing of both mom and baby.

Of course, pregnancy and diabetes means that there are more foods on the “Do Not Eat” list, as your normal diabetic diet has a new list of things to avoid. But bear in mind that it’s only for nine months, and that it’s for the best possible cause: your healthy child.

Foods to avoid:

Here’s a list of foods that you shouldn’t eat when you’re pregnant because they pose a potential food safety risk and might make you ill or harm your baby.

  • Soft cheeses e.g. brie, camembert, and blue-veined cheeses unless the label says they are made with pasteurised milk.
  • Processed cold meats or deli meats unless they are reheated until steaming hot.
  • Refrigerated paté or meat spreads (canned options can be eaten).
  • Refrigerated smoked seafood unless as an ingredient in a cooked dish e.g. a casserole.
  • Raw or partially cooked eggs and dishes that contain these e.g. homemade mayonnaise.
  • Raw or undercooked meat and poultry
  • Unpasteurised juice
  • Raw sprouts
  • Raw or undercooked fish or shellfish
  • The American Academy of Nutrition and Dietetics (AND) recommends pregnant women avoid fish high in mercury e.g. shark, swordfish, marlin. And limit intake of fish and shellfish lower in mercury e.g. prawns, canned light tuna and salmon, to 360g or less per week.

The good news? You don’t need to give up caffeine entirely. The AND recommends keeping your intake below 300mg/day, which is about one or two servings of coffee or tea. And of course rooibos is naturally caffeine free, so you can have as much as you like!

Being both diabetic and pregnant can feel restrictive from a diet point of view… When you’re lacking motivation, just remember that everything you eat your baby is eating too: so put down the junk food and pick up a carrot!

A note on cravings:

Whether it’s pickles and ice cream or other odd combinations, both cravings and food aversions are common during pregnancy. Although the exact cause is unknown, taste perceptions may change with hormonal changes. Cravings are generally harmless*, unless foods you crave replace more nutritious foods, or all you want is junk food. If broccoli loses its appeal, for example, substitute another vegetable that you enjoy and tolerate.

*Cravings for non-food substances like sand or chalk (a condition called pica) can be dangerous as they contain lead or other toxic substances. If you’re craving non-food items, consult your doctor.

How to help a poorly controlled diabetic

My dad is a poorly controlled Type 2 diabetic, and he doesn’t seem to care. I keep telling him how serious his condition is and that he has to take care of himself, but he continues eating whatever he likes and says he’s too old to change. What can I do?” Celeste Damen.

Dear Celeste,

It isn’t easy for people to hear that they have diabetes. Diabetes is a condition that cannot be cured: it has to be taken care of every day. People who have diabetes have to make some important changes in their lives, but if the change is forced on them, they may not want to do it.

This is what is probably happening with your dad. He most likely knows exactly how important it is to look after his diabetes, but might still be in denial or angry that this inconvenience has been brought into his life.

The fear you feel for your dad’s condition also projects to him, and he is probably trying to reassure you by giving you excuses that he is too old to change or that the situation is not that serious.

Instead of telling Dad what to do and being cross with him when he doesn’t do the right thing, you need to ask him what changes he is willing and able to make. Then encourage him to follow through on what the two of you have decided.

Diabetes has not only happened to him: it has happened to your whole family. This is something all of you have to accept. It’s a good idea to get the whole family to adopt healthy habits, so that there will be less temptation… Offer your dad help, but try not to be the Diabetes Police.

Good luck!

– Jeannie Berg, Diabetes Educator

 

FAQ: Exercising with diabetes

As a parent, you obviously want what’s best for your child – but what is really best when it comes to exercise and children with diabetes? Riekie Human tells us what you need to know (adults can learn a little something, too!).

Although experts agree that it’s crucial for kids with diabetes to exercise, you need to make sure they’re doing it safely. Thankfully, it’s easier than you think… We got all the answers from experts in the field.

What kind of exercise should my child do?

“The most helpful exercises encourage muscle contraction and increase the effect of insulin.” What does that mean? The exercise helps more glucose to be transported out of the blood stream and into the cells to be used: body weight exercise and resistance training are particularly good at this. However, young children should take part in all kinds of exercise, particularly cardiovascular for the development and health of the heart, lungs and lipid profiles (cholesterol), and team sports to encourage skills and develop confidence. Sarah Hall, Biokineticist at Wellness in Motion, Morningside

Ball sports are especially good for children with diabetes. “They involve a combination of exercises like jogging and sprinting, and research has found that this is best for stability in blood sugar levels.” Contact sports like karate can be tricky, especially for children with insulin pumps, as the pump could get damaged – and the same applies to horse riding. Andrew Heilbrunn, Head Biokineticist at the Centre for Diabetes and Endocrinology (CDE) in Houghton

What time of day should my child exercise?

The best time for kids with diabetes to exercise is before breakfast and before supper. “They’re less likely to hit lows at those times. Before breakfast, they’ll be quite insulin-resistant and are unlikely to experience a drop in blood sugar.” The worst time to exercise? An hour or two after meals, when insulin in the system can cause more frequent lows.

Andrew Heilbrunn

How long should my child exercise for?

That depends on the child: what they’re capable of and how fit they are. “The general recommendation is 1 to 2 hours, but take into account the type of exercise, your child’s age and their fitness level. And remember to limit exercise to 30 to 45 minutes if it’s a new sport or type of exercise – and then closely monitor their blood sugar levels, before and after exercising.”

Sarah Hall

What else do I need to know about exercise and diabetes?

It’s important to give the coach a list of symptoms of high and low blood sugar, as well as detailed instructions of what to do if your child goes low. “A child with low blood sugar will be irritable, have a headache and blurry vision, and generally feel horrible.” If your child’s blood sugar is too high, they will feel tired and thirsty.

Dr Claudine Lee, GP

If your child exercises for more than one hour, any time of the day, they should have a protein snack, like full-cream yoghurt or small yoghurt-coated rice cakes, before going to bed. “Sustained energy overnight is crucial, as it prevents hypos between 2 and 4am. “Also, always have a quick-acting sugar snack on hand (fruit juice, sweets or honey) to treat low blood sugar, and make sure the coach knows how to use a glucagon pen in case of emergency.

Andrew Heilbrunn 

Ask the expert: Sarah Hall, Biokineticist Studies have shown that children with Type 1 or Type 2 diabetes are generally less physically active than those without: the exact opposite of what the situation should be!

Some advantages of increased physical activity for children with diabetes:

  • Better health
  • More confidence
  • An improved response to insulin and blood sugar control
  • A greater awareness of diabetes and their bodies
  • The prevention of conditions associated with diabetes, like obesity and heart disease
  • Improved weight management

Top Tips

  • Don’t let your child exercise if their blood sugar is too high: over 16mmol/l or too low: under 4mmol/l, or if ketones are present.
  • Make sure your child’s blood sugar is in the target range before exercise, in order to avoid low blood sugar.
  • Talk with your doctor about lowering your child’s insulin dose before exercise, if necessary.
  • Inject insulin before exercise in a site other than the body parts about to be used. For example, if your child will be running, don’t inject in the legs.
  • Watch for symptoms of low blood sugar for 12 hours after exercise, especially if it’s a new kind of exercise.
  • Make sure your child drinks water so they don’t get dehydrated.
  • Choose something fun for you and your child to do together and they’ll learn that getting active is just as enjoyable as relaxing. You could go to dance classes, swim, learn to surf, take up yoga, go on hikes, play tennis or even join a soccer team. There’s even something called laughter yoga if you really want to have a good time.

Communication tips for hypoglycemic episodes

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

Dear Luke,

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

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

So what now?

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

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

– Jeannie Berg, Diabetes Educator

 

10 Fast facts about diabetes as you get older

Keeping your diabetes in check as you get older is not only possible, but important. Here’s what you need to remember.

  1. Diet is vital: be sure to eat as balanced a diet as possible. Not eating the right kind of food or often enough can result in low blood sugar. Drinking plenty of water is also important.
  2. The average HbA1c in the elderly population in SA is within national guidelines at around 7.3. What’s yours?
  3. Be prepared and always have at least 3 days of supplies on hand for testing and treating your diabetes.
  4. Hypos (low blood sugar) are a risk, especially in Type 2 diabetics who are on SUs (sulphonylureas). Severe hypos can result in comas, so it’s important to know how to treat them.
  5. Always keep a glucagon pen on hand for hypo emergencies (and make sure you’ve told someone close to you how to use it).
  6. Controlling Type 2 diabetes with Glucophage or Galvus can have a life-changing effect.
  7. It’s important to have regular blood pressure and cholesterol tests, and annual kidney, eye, teeth and feet check-ups.
  8. It’s a good idea for any diabetics over 65 years old to have a pneumonia vaccine shot. An annual flu shot is also beneficial.
  9. Keep active as it helps with mobility, balance, strength, mental wellbeing and insulin sensitivity.
  10. Studies show that older diabetics are more compliant than teenagers, the newly diagnosed, and even pregnant diabetics.

A fit pregnancy

Staying active during pregnancy is the best thing for you – and your baby, Cindy Tilney tells us.

While exercise may not be what you feel like doing when you’re expecting, experts agree that it has a host of benefits – besides being a natural mood-lifter, there’s no denying how good it is for you. “In pregnancy, it’s always better to exercise than not – even with a chronic disease such as diabetes,” says personal trainer Shelley Lewin, who offers specialised pre- and postnatal exercises in Cape Town. “Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active. Unless you have a specific medical condition that puts you and your unborn child at high risk during pregnancy, it can only work to your advantage,” she says. “And in people with diabetes, it can help the body to process glucose more effectively.”

What can exercise do for pregnant diabetics?*

  • Lower blood sugar
  • Improve insulin sensitivity
  • Control blood pressure
  • Increase energy
  • Reduce after-meal blood sugar spikes
  • Encourage restful sleep
  • Lower gestational weight gain.

According to the American College of Obstetricians and Gynecologists (ACOG).

*Type 1, Type 2 and gestational diabetes

Remember: If you have diabetes, it is essential to get the all-clear from your doctor before starting an exercise programme, particularly if you are pregnant.

“Exercise in any form may require a reduced amount of insulin because exercise increases glucose uptake in the cells,” explains biokineticist Sarah Hall. “The intensity of the exercise you are doing will determine this: lower-intensity exercise can lead to a recommended insulin reduction of roughly 20%, as opposed to a possible 50% with higher intensity exercise.” This is further complicated by insulin needs often doubling during pregnancy, so consulting a doctor is a must.

Healthy exercise tips during pregnancy:

  • Check your blood sugar before and after exercise (Type 1 diabetics).
  • Always take a ‘quick-fix’ snack, such as a banana, along with you when you exercise, so that you have a sugar source on hand in case of hypoglycaemia (low blood sugar).
  • Stay away from forms of exercise that carry a high risk of falling, and avoid lying on your back with the head below the level of the heart, as this can restrict the blood flow to your baby.
  • Wear a heart rate monitor during cardiovascular exercise, and keep your heart rate to 140bpm or below. In the past, there was a widely held belief that pregnant women should stay away from all cardiovascular exercise – but modern research has shown that this does not hold true.

The good news? If you’ve been exercising regularly, you can carry on very much as normal, agree Hall and Lewin – provided the activities are not extremely high impact, do not involve fast or sharp changes in direction, or cause surges in blood pressure or adrenalin.

Ideal pregnancy exercise

Both experts recommend 30 minutes of moderate physical activity three times a week, such as walking, swimming, aqua aerobics and light weight lifting under the guidance of a certified ante-natal instructor. The ligaments tend to naturally relax during the second and third trimesters of pregnancy, so be careful not to overstretch during warm-ups – and if you are weight training, use machines rather than free weights to avoid any hyperextension injuries.

“Building up core strength is important in pregnancy,” says Lewin, “but as your tummy grows, you should stay away from certain intense core exercises, such as tummy crunches – instead opt for opposite leg and arm lifts, or practice stability work on a Pilates ball.” Kegel exercises are also important during pregnancy, as they strengthen the pelvic floor muscles.

Be gentle with yourself during pregnancy: stay away from contact sports and aggressive forms of exercise. And be aware of your body and how hard you are pushing yourself during workouts. “The ‘talk test’ is always a good marker of whether you are pushing yourself too hard,” says Lewin. “If you are exercising at the right level, you should be able to talk at the same time – but if you’re struggling to take in breath and unable to hold a conversation, it means you are pushing yourself too hard.”

Find out more about pregnancy exercise at www.homefit.co.za

“Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active.”

Ask the expert: Sarah Hall, Biokineticist

Warning Signs

Don’t exercise if you have:

  • Pregnancy-induced hypertension
  • Ruptured membranes
  • Placenta praevia
  • Vaginal bleeding of any kind
  • Incompetent cervix (when the cervix is weak and opens too early)
  • Or if you are expecting twins or more

If you experience any of the following during exercise, stop immediately and seek medical help:

  • Sudden calf swelling
  • Headaches
  • Decreased foetal movement
  • Chest pains
  • Any amniotic leakage
  • Excessive overheating

Yoga may help reduce heart disease risk

The millenary practice of yoga is fast gaining ground on a worldwide scale; known as an efficient stress buster that brings practitioners greater vitality and a better mood, it also helps prevent heart disease, which is good news for people with diabetes.

Heart disease a risk for people with diabetes

Adults with diabetes have a higher likelihood of heart disease for various reasons. Those with Type 2 diabetes, in particular, may have conditions that can increase this risk, including high blood pressure, high cholesterol and triglyceride levels, and obesity. Leading a sedentary lifestyle is another modifiable major risk factor for both cardiovascular disease and insulin resistance, so one way to reduce the risk for heart attack or stroke is to keep physically active through aerobic activity and, new studies indicate, yoga.

Yoga as a means to reduce cardiovascular disease risk

In a review of 37 randomized controlled trials, researchers from the Netherlands and the USA found that yoga can provide the same benefits in risk factor reduction as commonly recommended activities such as cycling or fast walking. These two forms of exercise could have comparable working mechanisms; that is, yoga could have more physiological benefits, and exercise more relaxing effects than was originally thought.

As a deeply spiritual practice affecting physical and mental health positively, yoga is being embraced in a plethora of mental health settings, including rehabilitation centres for substance abuse. Science is more accepting than in the past of so-called ‘alternative therapies’ like yoga since numerous studies have shown that spirituality is linked to greater happiness and reduced anxiety and depression – key factors in managing diabetes from an integrated perspective.

In the studies, yoga practice was associated with significant improvement in Body Mass Index (BMI), blood pressure, and lipid levels, particularly when patients also took medication.

Yoga and aerobic activity a winning combination

Another, more recent study, presented at the American College of Cardiology in 2017, found that those who already have heart disease but practiced yoga in addition to aerobics, saw twice the reduction in BMI, blood pressure, and cholesterol levels, as those who practiced either of these activities exclusively. Combining these activities could also increase exercise capacity and improve heart function.

Of course, even if you only have time for yoga, you will still be doing yourself plenty of good, since heart rate variability (an indicator of optimal heart health) is higher in yoga practitioners. Yet another study showed that yoga can reduce atrial fibrillation (‘heart quivering’) while improving heart rate, blood pressure, and general quality of life.

If you have diabetes, it is important to lower your likelihood of heart disease by staying active, keeping to a healthy weight, and tapping into the potential of combining yoga and aerobic activities, making time for each throughout the week. By boosting physiological changes and lower stress levels, you can kill two birds with one stone, finding greater enjoyment and vitality as an added bonus.

Reflexology and diabetes

Bridget McNulty finds out what reflexology is all about, and if there’s any chance it can help those with diabetes.

Before I went for a reflexology session, I didn’t know much about it. I knew it was more than a foot massage, but didn’t really see how pressing a few points on my feet could affect my health and wellness.

Reflexology, it turns out, is a therapy that uses specific finger, thumb and hand pressure techniques on the different reflex areas, or zones of the feet, to correlate with different organs of the body. A reflexologist can tell you a lot about your body by feeling for congestion and imbalances in the feet, which show up as tightness, sensitivity or grainy areas. They can also ‘read’ the feet: the shape of the feet, the valleys and peaks, and how they respond to pressure.

The South African Reflexology Society has been recognized by the medical profession, and all reflexologists have to register with the Allied Health Professions Council. But what does a reflexology session actually feel like? Well, at first it is a little uncomfortable. The therapist looks for areas of tension or imbalance, and these are rubbed or pressed until they loosen. It’s like having a really firm massage: not painful, but not necessarily soothing. It is deeply relaxing, though, an hour of having your feet worked on feels like a few hours of sleep, and Lulu Beyers, the therapist I went to, says she has a lot of insomniacs as patients!

Reflexology, like most alternative therapies, has to be given on a regular basis to really see the results and changes in the body – the changes are slow but can be very positive, especially when it comes to treating complications of diabetes, like numbness in the feet. There have been a number of studies done on diabetes and reflexology (including self-reflexology, like the example below). The studies are mainly in Korea and China, as reflexology is an accepted form of healing in the East. (It began in 2330BC in Egypt, then spread to India, and from there to China and Japan.) Many of these studies show that reflexology is helpful in improving peripheral neuropathy, especially tingling sensation and pain, as well as slightly lowering blood sugar – perhaps due to a reduction in stress from the relaxing nature of the treatments – and an improvement in fatigue and mood.

Whether this is because of the nurturing nature of the treatments, an improvement in blood circulation from the massaging movements of reflexology or because of the endocrine system (especially the pancreas) being activated through pressure points is still to be discovered. But there is certainly no harm in having reflexology as part of your diabetes programme. Think of it as putting your feet up on the diabetic table, made up of the right medication, a healthy diet and regular exercise.

Try out this simple self-reflexology at home:

Press on each of these glands of the endocrine system (pictured below) with the base of a ball point pen for a few minutes at least once a week.

Ask the expert: Andy Blecher, podiatrist

“In my opinion, having time out to put your feet up and have them massaged can be good for your overall wellbeing – and if there’s some evidence that it helps with circulation and peripheral neuropathy in diabetics then patients should give it a try.”

Find a reflexologist in your area: www.sareflexology.org.za
Or visit Lulu Beyers in Cape Town: www.white-lotus.co.za

Support during a diabetic pregnancy

“I’m sure all husbands worry about their pregnant wives, but it’s extra worrying because my wife is diabetic and has to be in such strict control – or it could really harm our baby. I’m trying to be supportive, but sometimes it’s difficult… Especially because she’s so emotional!” Mark Roberts.

Dear Mark,

You have my sympathy!

Women who are pregnant can be on a real rollercoaster ride of emotions – highs and lows and everything in between. While some women seem to ‘bloom’ during pregnancy and are full of life, happiness and vitality, other women are tearful and apprehensive.

Pregnancy is a powerful experience: huge hormonal changes and a life-changing event are a lot to deal with. A woman who has diabetes has even more on her plate.

It is wonderful that you are supportive. Part of the support that you give should be helping your wife eat the right kind of diet, check her blood sugar regularly and do the right exercise.

The fear you have about the health of your baby is real, but this is also relevant for any pregnancy. Hopefully you have planned the pregnancy and worked out an action plan with your health care team. If your wife is keeping to her programme, the risk of anything going wrong is minimal. Contact her gynae or endocrinologist if you feel that something is not right: it is natural to worry, but one of the best solutions is not to nag her.

Mood swings tend to happen most frequently in the first 12 weeks of pregnancy. The mood swings usually decline between 3 to 6 months because the levels of the hormones become more constant. Here your wife will start to feel better and have more energy and hopefully be less emotional.

The emotions are difficult to cope with, I agree. It can be very helpful to allow yourself time out if the going gets tough! Remember that a pregnancy affects both partners: the golden rule is to talk about how you are feeling. You must voice your worries, concerns and anxieties. This goes a long way to relieving them.

Most importantly, don’t forget to take time for you and your wife to relax together and enjoy this wonderful, intimate and very exciting time.

Sometimes just being supportive and loving is the best thing you can do.

Enjoy your baby!

– Jeannie Berg, Diabetes Educator

 

Explore the outdoors

A weekend hike is not just a fun, affordable activity for the whole family, it’s also one of the best ways to enjoy South Africa’s natural beauty. And a great way to get fit! What more could you ask for? Nicole McCreedy leads the way.

Hiking is good for the heart and the soul. Being in nature can help you to de-stress and reduce anxiety levels after a busy week, and when you hike you get all the same benefits of walking – and a few more. Hiking is a powerful cardiovascular workout that is known to reduce cholesterol, which means less risk of heart disease, and it can improve blood pressure. Keeping your heart fit and healthy is important for all diabetics.

So what’s in a hike? The following ingredients:

1 x beautiful trail

1 x pair of shoes

1 x backpack to carry all the essentials

1 x spirit of adventure

What to bring on your hike:

Luckily, you don’t need much equipment to hike. It’s important to research the route beforehand, though, especially if you’re going seriously off-road. Make sure you always hike with other people and pack these essentials:

  • A cellphone in case you need to make an emergency call
  • A GPS or map so that you don’t get lost.
  • Enough water. It’s easy to become dehydrated, especially in warm weather.
  • A low blood sugar snack (like dried fruit or juice).
  • A mid-hike snack (like fresh fruit, crackers or nuts) to help you maintain your blood sugar levels.
  • Your glucometer, strips and insulin, if necessary.
  • A hat and sunblock to shield you from the sun.
  • Rain gear if it looks like rain!

How to prepare for a hike

Ask the expert: Sarah Hall, Biokineticist

The nature of hiking means that your terrain is unstable and unpredictable. Each step is different from the one before and requires a combination of balance, strength and stability, using one leg at a time. Here’s how to prepare for a hike:

  • Start by doing exercises with one leg at a time to isolate muscle groups and encourage improved balance and joint stability. This is called unilateral training.
  • Strengthen your glutes and calves to help with climbing and hiking for a longer period of time. Choose exercises like step-ups, standing side leg raises, static lunges and single leg balancing. Try to do 3 sets of 20 of each.
  • Alignment is key. Your spine will be taking the load with each step, so be sure to keep your hip, knee and ankle in one straight line for all exercises.
  • Always include core exercises that strengthen your abdominals and try to keep your posture upright during the hike.
  • To prevent injury during the hike, ensure that you take regular breaks and stretch. 

Taking care of your feet

Ask the expert: Anette Thompson, Podiatrist

Here are 5 tips to take care of your feet while out and about hiking:

  1. Condition your feet It is important to train the muscles, tendons, and ligaments of your ankles and feet for hiking with a backpack.
  2. Get good footwear
and socks Shoes that fit correctly are the most important way to keep your feet happy. When choosing socks, avoid moisture-retaining cotton: instead choose wool or synthetic socks.
  3. 3.  Manage your toenails and skin
 Socks will catch on nails that are too long or that have rough edges, putting pressure on the nail bed. Take special care of the skin on your heels.
  4. Learn how to prevent blisters
 Experiment with different blister patching products and different taping techniques. Find what works for your feet and then perfect the method.
  5. Carry a small foot care kit
 A small foot care kit carried in a ziplock bag is easy to carry with your backpack. Include either Vaseline or talcum powder, a few alcohol wipes to clean the skin, some blister plasters and a safety pin to drain blisters (if necessary!).

10 Fast facts about blood sugar testing

If you’re diabetic, you probably know all about testing your blood sugar… But are you doing it the right way? Here are some top tips.

  1. The goal is always to keep your blood sugar in a healthy range: not too high and not too low.
  2. Checking your blood sugar often makes it easier to understand the relationship between blood sugar levels and exercise, food, medication and things like travel, stress and illness.
  3. Blood sugar readings also give your doctor, diabetes nurse educator or clinic sister information to help you adjust medication and food, if your numbers are often too high or too low.
  4. Modern blood sugar meters only take 5 seconds and need just a tiny drop of blood.
  5. Pricking the tip of the finger is the easiest place to get the drop of blood.
  6. Before you test, it’s important to wash your hands with soap and water and dry them properly.
  7. Type 1 diabetics should test before every meal, to decide how much insulin to take.
  8. Before a meal, blood sugar readings should be 4 to 7mmol/l*.
  9. Two hours after a meal, blood sugar readings should be 5 to 10 mmol/l*.
  10. Keeping a blood sugar log is a very helpful tool for all diabetics. Write down your blood sugar test results, along with the date, time and what food you ate. This can make it easier to see if there are patterns in your blood sugar readings.

Gather the group

Struggling to get started on a fitness routine? Maybe you need to try exercising in a group. It’s far more fun, and just as good for you!

There’s something about pounding the pavement on your own that is just no fun. Swimming lengths can also be lonely, and so can going to the gym. But who said getting fit had to be a solo exercise? Here are some of our favourite ways to get active with your friends and family members.

Walking group

All you need is a pair of walking shoes and an adventurous spirit and you can start a walking group. Decide on a route that you want to follow, and start slowly – just a kilometre or two will do. It’s a good idea to have a goal in mind so that you can work up to longer distances. How about 10km by the end of the year?

5-a-side soccer

Finding enough people for a full soccer team might be a challenge, but 5-a-side soccer only needs ten people to play the whole game, and ensures that everyone gets a real work-out. You can play on any field or in a garden (because there are fewer players, you need less space) and the game doesn’t last as long – generally an hour in total. 

Boot camp

While you can pay a lot to attend official boot camp classes, you can also set up your own boot camp with a few friends. Decide what areas of the body you specifically want to work and set out a four-week exercise programme. You might want to include things like sit-ups, push-ups, jogging around a track or on the spot, doing star jumps, short sprints, skipping and lifting weights. Just make sure everyone is in agreement with what the session looks like – and don’t leave anyone behind!

Ask the expert: Ilona Padayachee, Biokineticist

The FITT principle is very helpful to keep in mind with walking.

F – Frequency

I – Intensity

T – Time

T – Type

Frequency: Aim to exercise for 3 to 5 days a week.

If you are a beginner try not to overdo it, start off slowly and progress to longer and faster walks.

Intensity: This is very important in any exercise programme.

Walking at the correct speed can make a huge difference to how effective the exercise is.

Time: Start slow and build up your time.

A beginner walker should start out at 10 to 12 minutes, including 5 minutes warm-up. Then increase it to 20 minutes by adding 2 minutes to the walk every week.

Type: Choose the type or kind of activity that you enjoy.

It’s always easier to stick to something you like doing!

Diabetic foot care tips:

No matter how much fun you’re having getting fit, don’t forget to look after your feet! As a diabetic, foot care is really important. Bad circulation in the feet and legs, often noticed as leg pain and leg cramps, is one of the problems facing diabetics, and can lead to chronic ulcers, numbness and even gangrene. Daily care for the feet is essential.

Here are some great tips:

  • Exercise and regular movement is good for circulation.
  • If possible, raise your feet when you’re sitting down.
  • Check your feet every day for swelling, marks and red spots.
  • Check your feet for ‘cold areas’ (a sign of poor circulation).
  • Check your feet for ‘hot areas’ (a sign of infection).
  • Dry your feet well after bathing, showering or swimming.
  • Apply a good natural cream to the feet every day.
  • Wear comfortable shoes that do not pinch the feet or toes.
  • Keep toenails trimmed and file sharp edges.

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