“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.
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
Keeping your diabetes in check as you get older is not only possible, but important. Here’s what you need to remember.
- Diet is vital: be sure to eat as balanced a diet as possible. Not eating the right kind of food or often enough can result in low blood sugar. Drinking plenty of water is also important.
- The average HbA1c in the elderly population in SA is within national guidelines at around 7.3. What’s yours?
- Be prepared and always have at least 3 days of supplies on hand for testing and treating your diabetes.
- Hypos (low blood sugar) are a risk, especially in Type 2 diabetics who are on SUs (sulphonylureas). Severe hypos can result in comas, so it’s important to know how to treat them.
- Always keep a glucagon pen on hand for hypo emergencies (and make sure you’ve told someone close to you how to use it).
- Controlling Type 2 diabetes with Glucophage or Galvus can have a life-changing effect.
- It’s important to have regular blood pressure and cholesterol tests, and annual kidney, eye, teeth and feet check-ups.
- It’s a good idea for any diabetics over 65 years old to have a pneumonia vaccine shot. An annual flu shot is also beneficial.
- Keep active as it helps with mobility, balance, strength, mental wellbeing and insulin sensitivity.
- Studies show that older diabetics are more compliant than teenagers, the newly diagnosed, and even pregnant diabetics.
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
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
- Decreased foetal movement
- Chest pains
- Any amniotic leakage
- Excessive overheating
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.
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.”
“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.
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
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:
- Condition your feet It is important to train the muscles, tendons, and ligaments of your ankles and feet for hiking with a backpack.
- 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. 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.
- 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.
- 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!).
If you’re diabetic, you probably know all about testing your blood sugar… But are you doing it the right way? Here are some top tips.
- The goal is always to keep your blood sugar in a healthy range: not too high and not too low.
- Checking your blood sugar often makes it easier to understand the relationship between blood sugar levels and exercise, food, medication and things like travel, stress and illness.
- Blood sugar readings also give your doctor, diabetes nurse educator or clinic sister information to help you adjust medication and food, if your numbers are often too high or too low.
- Modern blood sugar meters only take 5 seconds and need just a tiny drop of blood.
- Pricking the tip of the finger is the easiest place to get the drop of blood.
- Before you test, it’s important to wash your hands with soap and water and dry them properly.
- Type 1 diabetics should test before every meal, to decide how much insulin to take.
- Before a meal, blood sugar readings should be 4 to 7mmol/l*.
- Two hours after a meal, blood sugar readings should be 5 to 10 mmol/l*.
- Keeping a blood sugar log is a very helpful tool for all diabetics. Write down your blood sugar test results, along with the date, time and what food you ate. This can make it easier to see if there are patterns in your blood sugar readings.
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.
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?
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.
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.
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:
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.
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.
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.
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.
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.
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
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.
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.
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.
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.”
“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
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
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.
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.
“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.
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
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.
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.
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!
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.
We chat to Bongi Ngema-Zuma, First Lady and founder of the Bongi Ngema-Zuma Foundation.
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.
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.
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.
Newly diagnosed with diabetes? We get to grips with what your medical scheme can do for you, and what you might have to budget for yourself.
- Join a medical scheme
Diabetes is a chronic condition that’s on the Medical Scheme Act’s Prescribed Minimum Benefits (PMB) List. All registered medical schemes in SA have to provide basic funding for your diagnosis, treatment and care.
- Register your condition
Make sure your condition is registered with your scheme, and be sure to do this again each time you switch. Find out how the registration process works: you’re likely to have to complete a form with the help of your doctor.
- Stay on a scheme
If you leave your current scheme, or join a scheme for the first time, the new scheme may impose a waiting period of 3 to 12 months. During this time, your costs may not be fully covered. Do your research before you join a new scheme and avoid breaks where you don’t belong to a medical scheme at all.
- Use a healthcare broker
Understanding what’s covered by all the schemes out there can be complicated. Do your research with the help of a healthcare broker. Their services are free of charge.
- Reassess your plan
Once a year, you can shift from a basic to a more comprehensive plan, and vice versa. Ask your scheme for your medical records and check what you’ve had to pay out of your own pocket during the year. Do the math to see if it makes sense to upgrade or downgrade your plan.
- Check which meds are covered
Even the most basic plans cover diabetes medication, as long as you choose from the formulary (the list of approved medication). Ask for this list before you choose a plan. Your prescribed medicine might not be available on the scheme’s most basic plan, but it could be on another, more comprehensive plan, or on another scheme’s formulary list.
- Stick to Designated Service Providers (DSPs)
These healthcare providers (doctors, pharmacists and hospitals) have an agreement with your scheme, which means their rates are usually fully covered. Get hold of your scheme’s DSP list and use them. Expect a co-payment if you use a doctor outside of this network.
- Go for your consultations
This will depend on your plan, but some of your doctor’s visits will be covered up to an agreed rate. Some schemes, for example, cover annual visits to the GP, dietician, podiatrist, ophthalmologist and other specialists in full.
- Check up on tests and equipment
Diagnostic tests are usually covered in full, as well as annual HBA1c, creatinine microalbumin and lipid tests. Insulin pumps and other specialised equipment might only be covered by top-tier plans, or not at all.
- Use those additional benefits
Many of SA’s schemes offer free coaching, education and reward programmes. Make use of these benefits – they’ll help you to manage your condition better, saving you money in the long run.
“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.
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
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.
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.”