diabetes and exercise
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.
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.”
Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.
Who did you skate for?
I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.
How long have you been diabetic?
I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.
Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?
I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.
What do you love about ice skating?
I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.
What do you think the biggest challenge of living with diabetes is?
The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.
What advice would you offer to diabetics who are struggling?
Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.
What makes your life sweet?
Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.
Get in touch with Rachel: firstname.lastname@example.org
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.
You would never guess that Trevor Davids, a business consultant, film and TV producer and biker filled with the joys of life, has Type 2 diabetes. That’s because he’s managed to take diabetes in his stride.
When did you find out you were diabetic?
Six years ago, in November 2010. I had all the usual symptoms – constantly thirsty, needing to urinate a lot – and I looked them up on the internet. Up came: diabetes. I read up on the condition before going to the doctor, and then announced, “I have diabetes.” We took the necessary tests and my blood sugar was really high (18mmol/l), so I was put onto insulin tablets immediately. Diabetes doesn’t run in my family, I’m not overweight and I do a lot of exercise, so I’m not a typical Type 2 case. I do have high blood pressure that runs in the family. When I was diagnosed with diabetes I had already given up alcohol ten years before, but I was smoking 40 cigarettes a day, so I had to give that up too. After 31 years of smoking, I quit on the first try. Once I make up my mind about something, there’s not much that can move me.
How has diabetes changed your daily life?
I’m a lot more conscious of my eating patterns now. I never used to eat breakfast – I’d grab something on the run, snack in the afternoon, and then eat a big plate of food in the evening. I had to learn to be less flexible about food. Eat a regimented breakfast, lunch and dinner, look at my intakes and learn about low GI. I couldn’t have done it without my family – my wife Norma and son Danté have been the most amazing support.
How do you manage to focus on the lighter side of living with a chronic condition?
I never focussed on the darker side of diabetes! I’m a very positive person, I like being focussed on doing something well. In challenging times, I just take it in my stride and deal with life’s knocks as they come.
Is there anything diabetes has stopped you from doing?
No. Only smoking! I’ve actually been able to take on more daily life challenges since being diagnosed, because I restructured and reorganised my life, so I now have more time.
What advice would you offer to other diabetics?
If you’ve just been diagnosed, don’t worry – it’s not as daunting as you think. It can become a lifestyle condition, you just need to adapt your lifestyle. Diabetes is part of who you are now, and denying it doesn’t make it go away.
What makes your life sweet?
Life itself! And my family, of course. And laughter: the ability to laugh and create a laugh. I believe that people can live a long time if they can learn to laugh in the face of adversity. I like to use laughter as part of my medication.
All you need to know about going on holiday with diabetes – Type 1 or Type 2.
- Make sure you have enough medication to last your whole holiday – including insulin injections or tablets, testing strips, needles and lancets. Take a little extra if you can, and don’t forget things like batteries for your glucometer.
- If you are on insulin, take a copy of your prescription and a letter from your doctor that says you need to carry your injections with you at all times. Some security checkpoints will ask for this, so it’s best to be prepared.
- Insulin needs to be kept at a constant, cool temperature – never above 30°C and never below freezing. Be sure to take a cooler bag to keep it at the right temperature wherever you travel.
- Never leave your medicine in direct sunlight! Check that if you’re on a long bus trip, it’s kept close to you and out of the sun.
- Always carry some sugary snacks with you in case of hypoglycemia. A roll of Super Cs or some sugar packets will do the trick.
- Be aware of the effects of exercise on your blood sugar. If you’re exploring a new city, you may be walking more than usual so your blood sugar could go lower than it normally does.
- If you’re going overseas, sign up for medical insurance or ask your South African medical aid what their overseas policy is. You want to know exactly what to do in case of emergency.
- If you’re travelling across time zones, adjust the time you take your long-acting insulin slowly (over a few days) so your body has time to adjust to the new time zone.
- Try to stick to somewhat-recognisable food so that you can accurately guess the carb content and know what it will do to your blood sugar.
- Have fun! Don’t let diabetes stand in the way of you experiencing everything you can while you’re on holiday.
I was lucky enough to be invited to the most fascinating diabetes conference in Cape Town recently: Tackling the Challenges of Diabetes and Obesity in Africa.
The line-up was truly impressive (more on that below) but what really struck me was how engaged and passionate all the attendees were about the issues of diabetes and obesity, and what we – as individuals, researchers and caregivers – can do about it.
But first! The amazing speakers and their topics.
The first day was chaired by Professor Naomi Levitt, the Head of Diabetic Medicine and Endocrinology at the University of Cape Town. Prof Levitt gave an overview of the issues of diabetes and obesity in Africa, and led the discussions after each talk. Her passion for diabetes research in South Africa is palpable.
Professor Justine Davies is a Professor of Global Health from Kings College London and started us off with a talk on Health systems challenges of deadling with diabetes in sub-Saharan Africa. She’s the previous editor of The Lancet journal and gave insights from The Lancet Diabetes and Endocrinology Commission. A fascinating look at just how severe the problem is in sub-Saharan Africa.
Then it was Dr Ankia Coetzee‘s turn. She’s a Clinical Endocrinologist at Stellenbosch University, with a special interest in gestational diabetes. Her talk – Gestational Diabetes Mellitus: The Alchemy of Diabetes Prevention? – suggested that treating those with gestational diabetes holistically can be a key to unlock future Type 2 diabetes.
After a short tea break to let the information digest, Salaamah Solomon, a Dietician from Tygerberg Hospital, spoke about Challenges in Nutrition Education – specifically, how essential it is to make nutritional information as simple as possible so that it can be easily adopted.
Then Professor Julia Goedecke, a Researcher at the South African Medical Research Council, spoke about her research into Mechanisms underlying insulin resistance in black South African women, which sparked a whole debate around exercise and diet as two critical components in Type 2 diabetes management (along with medication, of course).
After a fascinating lunch spent absorbing more diabetes information, Professor Tandi Matsha, the Head of the Department of Biomedical Sciences at Cape Peninsula University of Technology spoke about Epigenetics and Type 2 Diabetes. I didn’t know much (if anything) about epigenetics, so this was a real eye-opener for me.
And then Dr Sundeep Ruder, an Endocrinology Consultant and Lecturer at the University of the Witwatersrand, took things in an entirely new direction with his presentation about Philosophy in Diabetes – how it is our goal as humans to be peaceful, blissful and happy, and too often we use food as a cheap trick to get us there. (Among many other fascinating points!)
I had to get home to my young children, so sadly I missed Professor Carel Le Roux‘s talk: Can we approach obesity as a subcortical brain disease to address prediabetes and diabetes? I also missed Professor Andre Kengne‘s talk on Diabetes and BMI trends in Africa – both of which were discussed a lot the next day.
The next day was World Diabetes Day, and Dr Rufaro Chatora from the World Health Organisation gave some opening remarks about World Diabetes Day.
Then it was time for the keynote presentation, by Professor Jean Claude Mbanya, Honorary President of the International Diabetes Federation (Africa Region and Global), and Professor of Medicine and Endocrinology at the University of Yaounde, Cameroon. He gave a fascinating presentation on Global and Africa’s Burden of Diabetes, releasing the latest research from the 8th IDF Diabetes Atlas.
Then it was Dr Eva Njenga‘s turn to tell us about diabetes in Kenya. She’s the Chair of the NCD Kenya Alliance and the Director of the Kenya Diabetes Management and Information Centre, which she co-founded. They get funding from the WDF and partner with the Minister of Health to make a tangible difference to people with diabetes in Kenya. She spoke about Changing lifestyles to combat Diabetes, Obesity and other NCDs.
It was really the most extraordinary two days of diabetes discussions, talks, information sharing and inspiration. I left feeling so motivated to make a difference to people with diabetes in South Africa, and so inspired by all the doctors, researchers and healthcare workers who are so involved in diabetes in our country.
I can’t wait for the next one!
Children with diabetes often experience stigma. Carine Visagie explains how to make life easier for your child.
When Njabulo Dlamini was diagnosed with diabetes at the age of 16, he didn’t reveal his diagnosis to his friends. Fear of being called a drug addict, and standing out from the crowd, made him keep it a secret until the age of 19.
After he met Jenny Russell from Diabetes South Africa’s Durban branch, this young man (also an Idols star) started using his experience to break down some of the myths about the condition. But many other children with diabetes still have to deal with rejection and ridicule – so much so that their mental and physical health suffers.
Is there something that can be done to eliminate this social side effect of diabetes? We asked the experts.
Don’t make a fuss
When parents, teachers and other role models make a diabetes diagnosis and the day-to-day management a simple part of life, other children are more likely to accept this model as the norm. “Children don’t usually have preconceived prejudices, and they tend to follow models of behaviour set out for them,” says paediatric endocrinologist Dr Michelle Carrihill. “There’s no reason for children with diabetes to feel stigmatised if everyone is shown the right way to behave.”
Parents have a special role to play in this process, which starts with giving school staff and classmates the correct info. The more informed others are, the less likely it is that they’ll treat the child with diabetes differently.
Not sure where to start? Here are some guidelines*.
How you can help:
- Learn as much as possible about your child’s condition and do a simple presentation to teachers and classmates explaining what diabetes is, and what blood glucose testing and insulin injections involve. This moves the kids’ response away from fear and suspicion towards acceptance.
- Provide teachers with written information about your child’s needs. Include:
- A care plan for your child’s routine school day.
- A plan for days when the routine isn’t followed (for example, during outings).
- Signs and symptoms that could indicate a problem.
- What to do in an emergency, including all necessary contact information.
Make these plans with the teachers’ input, so that their roles are clear and accepted. A diabetes educator, dietician or diabetes specialist nurse can assist.
- Explain to teachers that blood glucose testing, additional trips to the bathroom and eating extra carbohydrates may sometimes be necessary. No big deal should be made of this.
- Explain that your child can exercise and also take part in outings, just like the other kids: there’s no need to treat them differently.
- Some kids are okay to inject in front of friends, while others are not. Ask the school to provide an area where your child will feel comfortable to test and inject. This could be the corner of a classroom or the nurse’s office, as long as the space is clean and quiet. They shouldn’t have to resort to the school bathroom.
- Ask teachers to provide positive support and encouragement, especially if your child seems anxious. Also ensure that a staff member is always available to them, so that they know who to ask for help.
* From Dr Carrihill, Jenny Russell and diabetes educator Kate Bristow.
Remember: Your child should always have their medical info and emergency contact details on hand: an ICE band or MedicAlert bracelet will do the trick. Find out more at www.medicalert.co.za
Make sure your child’s backpack always has:
– Testing equipment (a glucose monitor, lancets and strips).
– Insulin in a small cooler bag.
– A quick-acting sugary food or drink (like Super Cs).
– A glucagon emergency kit for severely low blood sugar emergencies: be sure to show teachers and older friends how to use it!
Join the community: Does your child have diabetes? Come and talk to us about it at www.facebook.com/DiabeticSouthAfricans
Richard English has Type 1 diabetes – but that hasn’t stopped him from embarking on all kinds of adventures, including a seven day, 1000km cycle across England and Scotland. We ask him for his secrets to a healthy life with diabetes.
When did you find out you were diabetic?
Eight years ago, when I was 25. I had been feeling incredibly under the weather and stressed, but I blamed work and too much partying – I just thought I was run down. Then I started getting all the symptoms: extreme thirst, dramatic weight loss, drinking 2 litres of water a night and needing to pee every hour.
How has diabetes changed your daily life?
Obviously I have to inject insulin before I eat anything, and I test my blood sugar more or less before every meal. Exercise is also more of a need than a want – I always used to exercise, but now I can see the effect on my blood sugar results, immediately. That’s very motivating.
I went cold turkey on a lot of things when I was diagnosed, and I haven’t kept any bad habits. I’m 20kg lighter than I used to be, and I don’t over-indulge any more. I suppose, in my case, diabetes could be seen as a positive thing. I wasn’t living a healthy life before I was diagnosed, and I have a better quality of life now.
I don’t think I could have adapted so well to life with diabetes if it weren’t for my wife, Casey. She never left my side, and all the dietary changes I adopted she did too. She also helped a lot in the early stages, when there was just too much information for me to absorb. She got behind the science of it and now knows more about low GI and its effect on blood sugar than I do!
Have you always been a cyclist?
I got my first bike when I was 5 years old, and I’ve almost always had a bike. Cycling is a big part of my life, and I really love it. I stopped exercising for about 6 months after my diagnosis, because I was uncertain about what it would do to my blood sugar, and every so often I have to cut a ride short because I’m going low. But most of the time diabetes doesn’t get in the way of my cycling at all.
Can you tell us about the Ubunye Challenge?
The Ubunye Challenge is a triathlon event organised by an old Rhodes friend of mine, Cameron Bellamy in 2012. He decided to raise funds for the Angus Gillis Foundation by doing an extreme cycle, swim and rowing challenge. I joined him for the cycle – I rode for seven consecutive days and covered 1000km through howling gales, rain, sleet and snow. It was in April, which was supposed to be spring, but it was shockingly cold. By the third day, we outran the weather and I saw my shadow for the first time. That was a good moment! 1000km seems like an unbelievable distance, but if you do it in 120km chunks it’s not that bad.
What advice would you offer to other diabetics?
To me, the most important thing is that you have to stay positive and optimistic, because diabetes is not going to go away. As soon as you can smile at it and look it in the eye, you’re on your way to living a happy life with diabetes. The sooner you can get positive about it, the better.
What makes your life sweet?
My wife Casey, my wonderful son Robbie, weekends with friends, good food, my bike, and exploring my new home city of London.
Get in touch with Richard: email@example.com
From Facebook (Diabetic South Africans):
What does living well with diabetes look like for you?
Tried changing my way of eating, lost weight and still had to go on tablets. My levels are stable though – between 5.3 and 6.1 – enjoying my new way of life.
Well… Sharon, that’s living well with diabetes, the rest is history! Well done.
I am Type 2 and lost 40kg from 110kg, gained muscle, full of energy and feeling 10 years younger! What I eat is part of living well with diabetes.
It sucks big time. But taking it day by day. Some days are cool, but some are just hell.
Totally sucks. Got neuropathy from my ankles to my toes! Sugar down from mid 16s to between 8 and 12. Doc wants to put me on insulin but I don’t want to. Staying positive and fighting hard!
After taking control of my diabetes myself, i.e. testing throughout the day and increasing my insulin to where I needed it, I’m happy to report I tend to stay between 4 and 8 with a couple of hiccups here and there when I hit 12 or 9 – but nowhere close to 16 as before… Anton, I fought insulin injections too. But it works and I feel so much better. The fight against insulin is not worth it if you are damaging your body…
Celeste Smith is no stranger to gestational diabetes: she’s had it twice, including during her pregnancy with now-five-year-old twins Connor and Adam. We find out what she wishes she’d known before she fell pregnant.
Is there a reason you’re so happy to share this very personal story?
I want to educate, encourage and motivate women with gestational diabetes, and prevent other women from having to go through what I and many others had to endure.
How did you find out you had gestational diabetes?
My first pregnancy was stillborn: Noah was born at 38 weeks. I didn’t know I had gestational diabetes until after Noah was born. We suspected with my family having diabetes that I could get it, but my doctor at the time never picked it up. When I wanted to fall pregnant again, my new doctor Dr Jansen immediately tested for glucose tolerance before I fell pregnant, and then again after I fell pregnant. That’s how we found out I had gestational diabetes again.
What were your symptoms?
What’s tricky about gestational diabetes is that it goes from nothing to full-blown diabetes very quickly. It’s only when you’re pregnant, so there’s no warning beforehand. The symptoms I had were swollen hands and feet, bad circulation, pins and needles in the hands, and constant thirst – I was drinking a lot of water.
Does diabetes run in the family?
Yes – my late mother had Type 2 diabetes, and three of my sisters and my brother have diabetes (half of my eight siblings, in fact!) None of my family recognised my symptoms, but none of us were looking for them: you put your faith in the doctor, that’s what doctors are there for.
What did you do to manage your gestational diabetes?
During my pregnancy with the twins, I was put on Metformin and later insulin. I also had to have monthly HbA1c tests and test my blood sugar seven times a day: when I woke up, before each meal, after each meal and before I went to bed. My fingers had so many holes in them; I didn’t know where to prick myself! I went to a dietician, which was helpful, we discussed good eating habits and made a lot of changes – we started eating more steamed foods and not so much starch (like potatoes, bread and pasta). And I started exercising. My diabetes doctor, Dr Dave, told me I had to exercise every day, even when I was tired after working all day.
What advice would you offer to women with gestational diabetes?
Listen to your doctors, stick to your eating plan and exercise a little bit every day. Stay focused: this is for the health of your babies. It helps that you just have to stay focused for nine months, and then the reward at the end is breathtaking. My boys were big for twins (2.8kg/each at 35 weeks) and healthy. I’ll never forget how relieved I was to hear both babies crying in the delivery room. They were both crying at the same time, and the doctor said: “Wow, they sound like a choir!”
What makes your life sweet?
I could say sunsets and sunrises, I could say my religion or even cupcakes and chocolates. But my husband and three boys are the light of my life, and sharing everything with them makes my life so sweet.
Looking for a sport that’s relaxing and good for you? Yoga is not only a fantastic form of strengthening exercise, it’s also great for calming the mind – something most diabetics need! Here are some simple poses to try at home.
As a diabetic, the one thing you’re told over and over is that exercise is good for you. And it is! But sometimes exercise feels a bit too much like hard work. Now that the weather is colder it’s hard to get out for a walk or a run, and gym is not for everyone. That doesn’t mean you can sit back and wait for the weather to warm up, though! Yoga has just the right mix of strengthening, balancing and heart-racing poses, and you should take a few quiet minutes to lie down at the end of each class. Yes, that’s right! Exercise that makes you lie down!
There are specific reasons why yoga is good for people with diabetes, too. Yoga teacher Tasha Saha explains: “As well as better fitness and cardiovascular (heart and vein) health, yoga massages and increases the function of the internal organs, balances the endocrine system and has great effects on the release of stress hormones,” she says. “All of these are factors that affect blood sugar, so it’s no surprise that a number of big studies have shown that regular yoga can reduce blood sugar levels.” Another part of yoga that sets it apart from other exercise is that it increases body awareness – understanding how your body feels – which makes it easier to stay at a healthy weight and to make better food choices.
But which yoga to choose? In general, hot yoga (Bikram) and flow yoga (Ashtanga) are more difficult, so it’s better to begin with a slower practice like Hatha or Iyengar. Some poses (especially those that are active in the belly and lower back) are particularly good for diabetics because they target the pancreas, which can help to lower blood sugar levels. “But a balanced yoga session will work on every system in the body,” says Tasha, “as well as the mind and emotions too – lowering stress levels and helping you towards balance.” As every diabetic knows, balance is the magic word!
Here are a few yoga poses to try at home – these are very good for lowering blood sugar. If you can’t get to the full pose, go as far as you can. As you become more flexible, you will be able to stretch more. If something is sore, stop! Yoga should never be painful.
Seated twisting poses and forward bends
These stimulate the digestive organs and help the insulin work better in the system.
Seated forward bend
First: Sit on the floor with your legs out in front of you. Flex your feet and press down through your heels. Place your hands on the floor next to your hips and sit up straight, opening your chest.
Then: Take a deep breath in, and without curving your back, lean forward from the hips, not the waist. Either hold on to your feet or use a strap around the soles of your feet. Make sure your elbows are straight, not bent. Be careful not to pull yourself down – you want to lengthen the spine, not force it. Keep your head raised and aim to get your belly touching your thighs, and then your ribs. This might take a few months!
Finally: When you’re ready to come up, lift the body away from the thighs, take a deep breath in and slowly straighten up. Stay in this pose for: 1 to 3 minutes.
Half Lord of the fishes
First: Sit on the floor with your knees bent and your feet on the floor. Slide your left foot under your right leg to the outside of your right hip, with your left leg on the floor. Step your right foot over your left leg and place it on the floor outside your left hip. The right knee will point up to the ceiling.
Then: Exhale and twist your body towards the inside of your right thigh. Press your right hand against the floor behind you, and your left upper arm on the outside of your right thigh near the knee. Stay in this position, breathing deeply, then exhale and release.
Finally: Return to the position you started with, and repeat on the other side for the same length of time.
Stay in this pose for: 30 seconds to 1 minute.
Standing poses and flow poses
Any pose where you have to stand or flow from one pose to another is excellent for the blood and heart systems.
First: Stand up straight, with your feet together and your hands at your side. Breathe out, and step your feet apart, as wide as you can while still feeling balanced. Turn your left foot in 45 degrees, and your right foot out 90 degrees. Make sure the right heel and the left heel are in line with each other.
Then: Breathe out, and rotate your body till you are facing over the front foot. Raise your arms over your head, and reach towards the ceiling. Drop your shoulders and arch your upper back a little. With your back heel firmly pressing into the floor, breathe out and bend your front knee over your front ankle.
Finally: Reach through your arms and, if possible, bring the palms together. Keep your head looking forward or looking up at your thumbs.
Stay in this pose for: 30 seconds to 1 minute.
Poses which ground the body
These help to refresh the pancreas, liver and other abdominal organs.
First: Lie on your belly with your arms on either side, palms facing up, and your forehead resting on the floor. Turn your big toes towards each other and clench your butt.
Then: Exhale and lift your head, upper body, arms, and legs off the floor (this may take some practice!) Firm your butt and strengthen your legs. Raise your arms and stretch back through your fingers. Look ahead, but be careful not to stick your chin out. Keep the back of your neck long.
Finally: Breathe out and release. Take a few breaths and repeat (if you want to!)
Stay in this pose for: 30 seconds to 1 minute.
Poses where the feet are higher than the head.
These direct the flow of blood towards the pancreas and relieve pressure in the feet.
First: Lie with your back on the floor, in as straight a line as possible, with your legs up against the wall in a 90 degree angle (your body should form half of a square). Rest your shoulders on the floor and allow a small gap between your hips and the wall.
Then: Rest in this pose.
Finally: When you’re ready to come out of it, turn to the side for a few breaths and then come up into a sitting position.
Stay in this pose for: 5 to 15 minutes.
Want to give it a try? Many yoga studios offer free classes to beginners. Most gyms also offer yoga classes at a fraction of the price of private classes.
“Remember that everyone is different, so the range you will be able to work into will be different in each pose. It’s a good idea to start with a one-on-one yoga session so that you learn how your joints and muscles work within a safe range of motion. That way, you’ll be in control of the intensity and can adjust it for your fitness levels.”
– Sarah Hall, Biokineticist
Looking for an update on how many people have diabetes? Try to wrap your head around these numbers!
415 million people currently live with diabetes, with this figure expected to grow to 642 million people by 2040 according to the International Diabetes Federation (IDF). More distressingly, for the first time it is estimated there are now more than half a million children aged 14 and younger living with Type 1 diabetes, according to the 7th IDF Diabetes Atlas.
A further 318 million adults are estimated to have impaired glucose tolerance which puts them at high risk of progressing to diabetes, a disease that has already killed more people than HIV/Aids, TB and Malaria combined.
“Of concern is that of the 415 million people living with diabetes, an estimated 193 million – almost half – are undiagnosed. In support of this year’s IDF campaign themed “Eyes on Diabetes”, Lilly South Africa is encouraging South Africans to educate themselves about the risk factors for diabetes, and to proactively screen for Type 2 diabetes in a bid to modify its course and reduce the risk of complications.
A person with Type 2 diabetes can live for several years without showing any symptoms of this chronic disease, during which time high and uncontrolled blood glucose can cause significant damage in the body. There is an urgent need to screen, diagnose and provide appropriate treatment to people with diabetes, as well as screen for complications as an essential part of managing both Type 1 and Type 2 diabetes,” explains Dr Ntsiki Molefe-Osman, Diabetes Medical Advisor at Lilly South Africa.
Diabetes is a leading cause of cardiovascular disease, blindness, renal failure and lower-limb amputation. More than a third of Type 1 and Type 2 diabetics will also develop some form of damage to their eyes that can lead to blindness.
“Fundamental to managing and preventing the complications of diabetes is diligent management of blood glucose, blood pressure and cholesterol levels to as close to normal levels as possible. While diabetes can present with many complications, these can be picked up early through proactive screening so that they can be treated and managed, preventing them from becoming more severe and impacting health and quality of life. Whilst a diagnosis of diabetes may come as a shock and does require significant lifestyle adjustments, it’s important to remember that with consistent and good control, millions of people living with diabetes live full, active lives,” adds Dr Molefe Osman.
What is the difference between Type 1 and Type 2 diabetes?
Diabetes is a complex disorder of carbohydrate, fat and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the pancreas, or resistance to insulin.
- Type 1 diabetes – usually begins in childhood or adolescence and is caused by a faulty autoimmune response that causes the body to destroy the pancreatic cells that produce insulin, which in turn leads to an insulin deficiency.
- Type 2 diabetes – approximately 90% of all cases of diabetes are type 2. In the case of type 2 diabetes, insulin is produced, but the body’s cells do not respond to it correctly. Instead, the body becomes resistant to insulin. It is most often but not always associated with obesity, poor diet, physical inactivity, advancing age, family history of diabetes, ethnicity and high blood glucose during pregnancy. It can go undiagnosed for years. Due to the progressive nature of the disease, a majority will eventually need insulin to be added to their treatment.
- Read more here.
Symptoms of Type 2 diabetes:
- Excessive thirst
- Frequent urination
- Persistently dry skin
- Always feeling hunger
- Blurred vision
There is no cure for diabetes – prevention is crucial
There’s no cure for Type 1 diabetes although researchers are working on preventing the disease as well as the further destructive progression of the disease in people who are newly diagnosed. However, up to 80% of Type 2 diabetes can be prevented by making simple changes in our everyday lives and knowing the risks. The huge emphasis on prevention, or if you’re already living with diabetes, on strict control, is with good reason. Diabetes is an exceptionally challenging disease to live with and manage, requiring the support of specialist doctors, and a huge amount of discipline on the part of the patient in managing the demanding diet, lifestyle and treatment regimen.
Potential health challenges
- Diabetic retinopathy – diabetes can lead to eye disease (retinopathy), which can damage vision and even cause blindness.
- Nerve damage – poorly controlled blood glucose and high blood pressure can lead to damage of the nerves throughout the body (neuropathy). This damage can lead to problems with digestion, urination, erectile dysfunction in men and other complications. Among the most commonly affected areas are the extremities, in particular the feet, where nerve damage can lead to pain, tingling, and loss of feeling. Loss of feeling is particularly important because it can allow injuries to go unnoticed, leading to serious infections and possible amputations.
- Kidney failure – Kidney disease (nephropathy) is far more common in people with diabetes, a leading cause of chronic kidney disease.
- Heart Disease – 50% of people with diabetes die of cardiovascular disease – angina, heart attack, stroke, peripheral artery disease, and congestive heart failure.
- Depression – Diabetes can cause complications and health problems that worsen symptoms of depression, leading to poor lifestyle decisions, such as unhealthy eating, less exercise, smoking and weight gain.
- Mortality risk – the risk of dying prematurely among people with diabetes is at least double the risk of people without diabetes.
How to reduce your risk
While some risk factors for diabetes such as age, ethnicity and family history can’t be changed, many other risk factors such as managing your weight, eating healthy foods in the right quantities and exercising regularly can be managed. According to Diabetes South Africa, there are various aspects to good diabetes management including:
- Education – Knowing about diabetes is an essential first step. All people with diabetes need to understand their condition in order to make healthy lifestyle choices and manage their diabetes well.
- Healthy eating – There is no such thing as a ‘diabetic diet’, only a healthy way of eating, which is recommended for everyone. However, what, when and how much you eat plays an important role in regulating how well your body manages blood glucose levels. It’s a good idea to visit a registered dietician who can help you work out a meal plan that is suitable for your lifestyle.
- Exercise – Regular exercise helps your body lower blood glucose levels, promotes weight loss, reduces stress and enhances overall fitness.
- Weight management – Maintaining a healthy weight is especially important in the control of type 2 diabetes.
- Medication – People with type 1 diabetes require daily insulin injections to survive. There are various types of insulin available in South Africa. Type 2 diabetes is controlled through exercise and meal planning and may require diabetes tablets and\or insulin to assist the body in making or using insulin more effectively. Talk to your doctor about the best treatment option for you, as well as the all-important cost considerations of different treatments.
- Lifestyle management – Learning to reduce stress levels in daily living can help people manage their blood glucose levels. Smoking is particularly dangerous for people with diabetes.
“As a major contributor towards diabetes care for over 93 years, Lilly works with healthcare providers that can help people overcome the daily challenges of living with this chronic condition. Your doctor is your best resource for information about living with diabetes. However, while your healthcare team will advise and support you, how well your diabetes is managed depends on you. Use the resources available to empower yourself to improve your metabolic control, increase fitness levels and manage weight loss and other cardiovascular disease risk factors, which in turn will improve your sense of well-being and quality of life,” concludes Dr Molefe-Osman.
If you have been newly diagnosed with diabetes, you may be struggling to cope with the news of your diagnosis. This is absolutely understandable, as diabetes is a life-altering condition. As you begin to work through establishing your new daily norm, it is incredibly important to know that there is hope. Even though you are in the process of learning how to manage this stressful condition, and learning how this condition will fit into your life, there are steps that you can take to make the transition easier. To get you started, here are four strategies to help you stay positive when you have recently been diagnosed with diabetes.
1. Create a support system
Whether you reach out to friends, family, or a support group, having others to talk with is of great value. Build a support system of individuals that you trust and who will be there when you need someone to listen. People who have diabetes (including diabetes support groups and online groups like ours) can be the most supportive, as they have first-hand insight into what you are going through. Even if your support system consists of only two people, it is crucial to establish who you can go to when you are struggling and need to talk.
2. Keep your whole body healthy
Maintaining a holistic perspective on health (rather than just focusing on diabetic health) can also help you adjust. Focus on practicing habits that will keep both your body and mind healthy. Eat meals that are not only designed for controlling diabetes, but that are also delicious and loaded with nutrients. Exercise regularly with a workout or sport that you enjoy. Seek counselling from a mental health professional to manage depression and anxiety symptoms. By treating your whole body well, you will begin to look at managing your health and condition in a new way.
3. Education is power
You’ve likely heard this sentiment as it applies to other areas of life. However, it is also 100% applicable to a diabetes diagnosis. Learn as much as you can about the condition from day one. Empower yourself with the tools to overcome your condition, and to live life as uninterrupted as possible.
4. Stay realistic and give yourself time to adjust
As with any change or diagnosis, there is an adjustment period. How long that period will last is determined by numerous variables, including your mindset. Expect from the start that you will have setbacks. You will have days that are more of a struggle than others. This realistic perspective will help you be far more gentle on yourself when those days arrive. Additionally, when you do experience challenges, you will have prepared yourself in advance rather than be taken by surprise.
Staying positive as you enter this new chapter of your life:
While nothing can quite take away the full impact of your diabetes diagnosis, the four tips listed above can be a start to helping you transition to this new chapter of your life. Over time, you will have gained the strength and tools needed to manage your diabetes on a daily basis. Until then, reach out to others when you need it, stay realistic about your progress, keep your body and mind healthy, and stay positive.
Words: Jane Sandwood
A few weeks ago, I got a message from Jane Sandwood, a nutritionist who believes in intermittent fasting. I asked her to explain it for all of us – and to explain how it might be beneficial to those of us with diabetes.
Disclaimer: This is not dietary advice and you should not make any changes to your diet without consulting your doctor.
I’ve been a nutritionist for ten years, and I’ve learned two things. Firstly, dieting is not the solution to being out of shape or overweight, and secondly, everyone’s bodies are different. For example, a well-balanced, but restricted diet and exercise works for me, but my husband has found a fasting regime mixed with exercising on an empty stomach to be better for him.
I wanted to cover the topic of intermittent fasting and how it can help some people lose weight and actually boost their workouts, so I wrote a Guide to Intermittent Fasting. The guide covers what fasting is, how it compares to diets, who should not do it, and also the different kinds of fasting people can undertake.
Does intermittent fasting work for diabetics?
While genetics play a significant role in whether or not someone will become diabetic, for a lot of people, lifestyle choices and diet are the main contributing factors, especially in cases of Type 2 diabetes. The American Diabetes Association has stated that due to our increasingly sedentary lifestyles, we’re raising our risks of becoming diabetic even further.
Way back in 1916, Dr Eliot Joslin, working at Harvard University, wrote about the benefits of using intermittent fasting techniques to aid control of diabetes. The main health benefits are as follows:
- Lower blood sugar: Your body will use up the glucose in your system more effectively because you are fasting for between 12 and 16 hours.
- Increase in metabolism: This will then increase the number of calories you burn, resulting in a better metabolic rate.
- Increase in receptivity to insulin: As the glucose in your system is being used in a better, more efficient way, the insulin you do create will work better and do the job it’s supposed to, which is moving the sugar out of your body properly.
- Healthy weight loss: You may find that intermittent fasting results in slower, healthier weight loss of 1-2lbs per week, which is ideal.
If you’re planning to try intermittent fasting, please speak to your healthcare practitioner first. Read this guide to find out more about how intermittent fasting can aid your health.