diabetes community blog
From our community blog:
My son was diagnosed with Type 1 Diabetes about a year and a half ago. His HbA1c hasn’t been great for the last few months – sitting on about 8. We seem to do everything “right” but for reasons we cannot understand we go through days with sugar levels that just won’t come down.
I now think that he is often injecting into scar tissue… He uses pretty much the same area to inject. I think he is finding it hard to inject anywhere else as it is a bit painful (he had a slight phobia of needles before being diagnosed). He is now 12 years old and is going through puberty so his body is changing and will need more insulin.
Any advice?? I’m feeling a little helpless at the moment.
We see his doctor every 3 months, but does anyone know of a nurse in the Fourways Johannesburg area who deals with Type 1 diabetics who we can perhaps see monthly to check his readings and perhaps guide us on eating, etc.
Thank you so much.
Jen Whittall is in Bryanston
You are quite spot-on with your own findings concerning your son. If he is currently injecting into the stomach, challenge him in injecting into the upper outer thigh. He should try to do this fast (like throwing a dart – playful challenging). When I changed my technique from a slow approach to the dart action, I never looked back. Just take note that the legs are active and blood glucose levels might drop faster than expected, especially if you are correct with your diagnosis of him injecting into scarred tissue.
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
Every two years, the International Diabetes Federation (IDF) publishes a Diabetes Atlas, with estimates of diabetes facts and figures from around the world. The 8th Diabetes Atlas is now live – take a look! Here’s more information about it.
To mark World Diabetes Day, the International Diabetes Federation (IDF) released new estimates on the prevalence of diabetes around the world, indicating that 1 in 11 adults are currently living with diabetes, 10 million more than in 2015.
Data published in the 8th edition of the IDF Diabetes Atlas confirms that diabetes is one of the largest global health emergencies. More action is required at the national level to reduce the economic and social burden that it causes.
Type 2 diabetes
Diabetes, which is associated with a number of debilitating complications affecting the eyes, heart, kidneys, nerves and feet, is set to affect almost 700 million people by 2045. Over 350 million adults are currently at high risk of developing type 2 diabetes, the most prevalent form of the disease. One in two adults with diabetes remain undiagnosed, emphasizing the importance of screening and early diagnosis. Two-thirds of adults with diabetes are of working age and 8 million more adults living with diabetes are over 65 years old.
“Diabetes causes devastating personal suffering and drives families into poverty,” said Dr. Nam Cho, IDF President-Elect and Chair of the IDF Diabetes Atlas committee. “There is urgency for more collective, multi-sectoral action to improve diabetes outcomes and reduce the global burden of diabetes. If we do not act in time to prevent type 2 diabetes and improve management of all types of diabetes, we place the livelihood of future generations at risk.”
Diabetes and women
Diabetes has a disproportionate impact on women, the focus of IDF and its affiliated members in over 160 countries this World Diabetes Day. Over 200 million women are currently living with diabetes and many face multiple barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care, particularly in developing countries. Women with diabetes are more likely to be poor and have less resources, face discrimination and have to survive in hostile social environments. Diabetes is also a serious and neglected threat to the health of mother and child, affecting one in six births and linked to complications during and after delivery.
“Women and girls are key agents in the adoption of healthy lifestyles to prevent the further rise of diabetes and so it is important that they are given affordable and equitable access to the medicines, technologies, education and information they require to achieve optimal diabetes outcomes and strengthen their capacity to promote healthy behaviours,” said Dr. Shaukat Sadikot, IDF President.
Urgent action needed
IDF welcomes all the international commitments on diabetes that have been made over the last few years and acknowledges that some advances have taken place. However, it is clear that urgent action is still required to achieve the targets agreed by UN member states in 2013 and 2015. These include a 0% increase in diabetes and obesity prevalence; 80% access to essential medicines and devices by 2025; and a 30% reduction in premature mortality from NCDs by 2030. To this end, IDF has launched a call to action for the 2018 High Level Meeting on NCDs, calling on governments to renew their commitments and increase their efforts towards achieving the agreed targets.
“IDF is calling for all nations affected by the diabetes pandemic to work towards the full implementation of the commitments that have been made. We have both the knowledge and the expertise to create a brighter future for generations to come,” said Dr Sadikot.
From our community blog:
I am a Type 1 diabetic since 1991. I have had two children and desperately want a third, but cannot face another pregnancy like the second due to severe hypoglycaemia that kept occurring.
I want to get a pump – my doctor did initially suggest it and I have asked for a referral to a centre that deals with pumps. I also would like to know what the chance of getting a pump on medical aid is if it is recommended by a doctor and if the medical aid is paying for CDE at the moment?
I am trying to control my sugars now but even tracking them 6-8 times a day, taking multiple extra shots when needed and tracking my diet closely is not helping.
The CDE has 5 pump centers in Johannesburg. 011 7126000. They also have an amazing 5 day course called DINE. Speak to Michelle Daniels.
I hope this may be of some help in resolving your control problems. I used a pump for 10 years and found it to be helpful particularly as you can control the long acting (basal) insulin for your individual requirements. You programme the pump to dispense whatever you need for each hour of the 24 hour day which will be exclusive to your needs.
A phone call to your medical aid should be able to tell you if they will support the purchase fully or partially. I stopped using mine because my levy on the consumables was increasing beyond reason.
It needs time and expertise to learn how to use the pump. I know we are all different but I believe that with the proper advise and treatment you should be able to get control before getting a pump. It will help your new doctor (it seems you need one) if you keep a record of insulin taken, food consumed, and exercise taken.
I’m a chairman of a support group, find one of these as they can also be very helpful.
Motherhood is a great adventure and (morning sickness aside!) being pregnant is magical. Inside of you, a perfect little baby is growing… Carine Visagie explains what you need to know to ensure everything goes smoothly.
If you have diabetes, or get diabetes during pregnancy, you’ll naturally want to know what you can do to stay healthy. We spoke to endocrinologist Dr Veronique Nicolaou, obstetricians Dr Veronique Eeckhout and Dr Manasri Naiker, and registered dietician Emily Innes to learn more about diabetes and pregnancy.
Get this right before pregnancy
Keen to start a family? Don’t ditch the contraceptives yet. To prevent miscarriage, stillbirth, birth defects and other complications, our experts say you first need to:
1. Tightly control your blood sugar levels. This means keeping your HbA1c below 6.1% for three months.
2. Lose excess weight. Being overweight ups your risk of complications during pregnancy.
3. Take a 5mg folic acid supplement (three months before pregnancy up until the 2nd trimester).
4. Stop smoking.
Stay healthy during pregnancy
If all goes according to plan, you’ll soon be pregnant. Congratulations! Now is the time to focus on your baby’s growth and development, which (still) means managing your blood sugar levels as well as you can.
Poorly controlled blood sugar spells trouble for pregnant moms. Apart from a higher risk of infections, hypoglycaemia (low blood sugar), pre-eclampsia (high blood pressure) and ketoacidosis, excess amniotic fluid is an increased risk, which could lead to premature delivery. Existing diabetes-related problems (like nephropathy) may also worsen during pregnancy. Additionally, your baby may grow too big, which increases the risk of stillbirth, birth trauma and respiratory distress. But this is all if your blood sugar is uncontrolled: stay in good control and you’re likely to have a perfectly normal, healthy pregnancy.
Five steps to stay in good control:
Step 1: Eat well.
- Choose high-quality, nutritious foods.
- Steer clear of refined carbohydrates.
- Include healthy fats and lean protein at each meal.
- Eat plenty of vegetables (and some fruit) every day.
- Don’t be tempted to eat for two!
Step 2: Exercise.
Talk to your medical team about physical activity. Exercise is a key part of diabetes management, but can sometimes be risky (for example, if you have high blood pressure). Keep your pulse rate below 140 beats per minute at all times.
Step 3: Get your treatment plan right.
If you have Type 1 diabetes, talk about your insulin dosage with an endocrinologist: the amount of insulin you need may double or possibly triple during pregnancy. Women with Type 2 diabetes who use only oral medication (like metformin) before pregnancy may require insulin at some point. The good news is that metformin is safe to take during pregnancy.
Step 4: Monitor your blood sugar frequently.
As many as six times a day (before meals and snacks, and one hour after). Find out from your medical team if you should be doing any other checks (like ketone testing).
Step 5: Visit your obstetrician regularly.
Your doctor will tell you how often to come: some recommend very two weeks until 32 weeks of pregnancy. After this, schedule a weekly visit until your baby is born.
Natural birth or C-section?
If all goes well, it’s possible to deliver your baby naturally. The timing is more important than the method of delivery. Your doctor will most probably induce to deliver naturally at 38 weeks, or do a C-section if there are other problems (for example, if you have a large baby). To control your blood sugar during labour, an insulin pump and a dextrose drip will be used, and your sugar and ketone levels will be checked every 2 to 4 hours.
Gestational diabetes explained
Gestational diabetes occurs for the first time during pregnancy and goes away again after birth. Uncontrolled blood sugar levels in gestational diabetes can be as dangerous as in Type 1 and Type 2 diabetes. It may be possible to control your blood sugar with diet and exercise, or medication may be necessary. The medication will most likely be stopped after pregnancy, but it’s important to get your blood sugar tested again six weeks after delivery to rule out Type 2 diabetes.
- Dr Veronique Nicolaou, specialist physician and consultant endocrinologist, Chris Hani Baragwanath Academic Hospital
- Dr Veronique Eeckhout, gynaecologist and obstetrician, Medi-Clinic: Cape Town
- Dr Manasri Naiker, gynaecologist and obstetrician, theWomanSpace: Cape Town
- Emily Innes , registered dietician: Cape Town
Have you heard about LifeinaBox?
I’ve been hearing a lot about it lately – it’s a “device that will revolutionize the transport of medication worldwide.”
Here’s what they say about it…
LifeinaBox is the world’s smallest fridge, and the culmination of many years of research to produce a universal solution that will allow users to travel any place, any time, knowing that their medication is kept at exactly the right temperature. Suitable for any heat-sensitive medication such as insulin, growth hormones, arthritis or multiple sclerosis medications, it allows users the freedom to travel anywhere, anytime, knowing that their medication is kept at exactly the right temperature.
This state-of-the-art device uses a combination of thermoelectric energy and batteries that will allow the user to be mobile with his medications under any conditions for up to 24 hours without the need to recharge his device. Operating on 110V or 220V or with a car cigarette lighter, LifeinaBox is totally environmentally friendly and contains no hazardous gases, tubes, coils or compressors.
The greatest inventions are often born out of simple necessity. Who would have an idea as absurd as making a fridge just to carry medication? We asked Uwe Diegel, co-founder of LifeinaBox, to tell us a little more about his idea…
My brother, Dr Olaf Diegel, visited me in France in the infamous heatwave of summer 2003. Olaf is a well-versed traveler and is used to travelling with his insulin and keeping it cool using iceboxes and cooler bags (insulin, like many other medications, is sensitive to heat and should be stored at a temperature between 2 and 8°C).
Olaf booked himself into a small hotel near Auxerres in France. When he arrived at the hotel, he noticed that there was no fridge in his hotel room (even though he had particularly insisted on this when making his booking). He needed a fridge to store his insulin. So he arranged with the clerk at the entrance desk to keep his insulin in the fridge in the kitchen.
Olaf does not speak French, coming from New Zealand. A few hours later, Olaf needed his insulin and went down to reception to ask for it, only to discover that it was placed in the freezer by accident by someone in the kitchen. He is thus obliged to have the night pharmacy opened just to get some fresh insulin.
We decided to design the idea of a portable fridge and our prototype actually worked quite well, so we sent it to an industrial design contest run by NASA in the USA. The product became a winner at the contest, received unexpected publicity and became the subject of an international story on the CNBC TV network.
When and where will Lifeinabox be available to South Africans?
We just launched LifeinaBox on the 12th of September on the Indiegogo crowdfunding platform. Crowdfunding platforms are places where people can pay for a product in advance at a preferential rate, paying in advance, so that their money can be used to accelerate production. We are already on our 9th generation of working samples and are nearly ready to go into mass production at the beginning of 2018. So the physical delivery of LifeinaBox should be by the April/May 2018. LifeinaBox is by definition a product that is born global and that will be launched in all countries at the same time. But the quickest way for people to get their hands on a LifeinaBox is to order on the crowdfunding campaign, as the first waves of production will be dedicated to people who have already placed an order.
How much will it cost?
LifeinaBox is quite an expensive device to produce, because we need it to basically last forever. The expected price in South Africa would be somewhere between R2800 and R3000. Next year we will launch LifeinaTube, which is a much cheaper device because it will only hold a single insulin pen.
Where can it be used – must it be plugged in? Can it be taken on planes?
It can be plugged in just about anywhere, from 110 to 240V, in a car’s cigarette lighter, or with a battery pack. We are still developing the battery packs and will be able to have 3, 6, 12 or maybe even 24 hours of battery life. We are really working quite hard on the batteries to give it more mobility. Right now I am already at 12 hours, but I am sure that by launch time I will already have a 24 hour battery. It is for people to take to work (so they don’t need to put their medication in the work fridge), in the car for long car trips, at home (so that the children don’t have access to medication in the kitchen fridge) and it can also be used on a plane.
What’s your LifeinaBox elevator pitch?
Nearly 4% of the worldwide population is prisoners of its medication that has to stay in the fridge at all times. LifeinaBox is the world’s smallest fridge for the safe transport and storage of fragile medication. LifeinaBox gives millions of people worldwide the freedom to travel anywhere, any time, knowing that their medication is at exactly the right temperature.
What makes your life sweet?
I still, 30 years later, wake up in the morning and can’t wait to get to work. My work is wonderful, because I always strive for perfection. I never think of my products as medical devices, but more as tools for the heart. And if you can touch the hearts of people the possibilities are infinite.
My first career was as a concert pianist, so I still spend a lot of time behind the piano, especially with my children who are also musicians and artists.
- Half of South African adults are overweight or obese. What that means is increased risk of heart disease, Type 2 diabetes, certain cancers and premature death.
- Our eating habits have changed so much that South Africans now spend more money on beer than on vegetables and fruit combined. What?!
- 45% of South African women are obese, as opposed to only 15% men. In 2013, South African women were the most obese in sub-Saharan Africa. So South African women are the most at risk for obesity.
I asked why that was and apparently there are three reasons:
- Women who were nutritionally deprived as children are more likely to be obese as adults (men who were deprived as children are not).
- Women of higher adult socioeconomic status (which is income, education and occupation) are more likely to be obese, which is not true for men.
- And possibly: in South Africa, women’s perceptions of an ‘ideal’ female body are larger than men’s perceptions of the ‘ideal’ male body – it’s seen as a status symbol to be a heavier woman.
Are you a South African woman? I am… Let’s make sure we’re informed and don’t let obesity happen to us and our sisters, mothers, daughters, friends.
Vitality gathered data from half a million Discovery members to give us these results:
- Their weight status (BMI and waist circumference)
Cape Town scores highest, with 53.5% of Capetonians in a normal weight range. Cape Town also topped the healthy purchasing score (which shows a positive relation between what you buy and whether your weight is in range or not.)
Fruit and vegetables
Cape Town purchased the most portions of fruit and vegetables compared to other cities – see the ranking above. In general, though, South Africans are only eating 3 servings of fruit and vegetables a day, as opposed to the 5 servings we should be eating.
Durban purchased the least amount of salt in SA, with Cape Town purchasing the most. We are eating twice as much salt as we should be in a day: it should only be 5g (1 teaspoon).
Durban came out top of this test too, with the lowest average number of teaspoons of sugar purchased – Bloemfontein purchased the most sugar. And again, we’re eating twice as much sugar as we should be – a staggering 100g a day! (That’s 24 teaspoons – in the food and drink we consume.)
There are a number of factors that play into this, of course. The way we buy our food – the impulse buys, the treats, emotional eating. Fast food is also a huge problem, because it’s loaded with salt, sugar and bad fats. Cooking at home with whole foods (not convenience foods or ready-made meals) has been proven to have an enormous impact on health and weight.
So what should we be eating? Here are some excellent guidelines.
What do you think? This information made me take a closer look at how I shop and what we eat… Not even because I’m diabetic, but just because I want my family to be as healthy as we possibly can.
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…
Are dietary supplements really necessary if you have diabetes? Nicole McCreedy asks the experts.
Like many other people with diabetes, you may be wondering whether you need to take supplements to help manage your condition. Dietary supplements can be vitamins, minerals, herbs or other plants, amino acids (the building blocks of protein) or a combination of the above. They can be in pill, capsule, powder or liquid form.
Despite some of the claims being made, there is not enough scientific evidence to suggest that any dietary supplements can help prevent or manage Type 2 diabetes. That said, dietary supplements may provide extra nutritional benefit to people with special health problems, including diabetes. In such cases, they are usually recommended when there is a specific lack of something in the body.
Do: Eat correctly
It’s important to try and get the nutrition your body needs from a balanced diet. Making healthy food choices and choosing fruit, vegetables and whole grains over carbohydrates, refined sugars and foods high in saturated fats can make a big difference. Compared with supplements, whole foods provide a variety of different nutrients for health in one package, whereas single vitamin supplements are most often for a single purpose. An apple, for example, contains vitamin C, fibre, and antioxidants – all in one crunchy package!
Dr Claudine Lee, a GP from Hilton, says that following a balanced and healthy diet is essential. “If you think you’re not getting the vitamins and minerals you need from your diet, consult with your GP whether it is necessary to take a supplement,” she advises. Eating correctly, being physically active and taking your prescribed medication is vital for maintaining good control of blood sugar levels to avoid serious complications like strokes, heart and kidney disease, limb amputation and blindness.
Don’t: Go it alone
Talk with your doctor. That is the first step in deciding whether or not to use a dietary supplement. He or she can discuss the possible benefits of dietary supplements, and check that any supplements you take will not interact dangerously with your medications.
Be sure to list any dietary supplements you take whenever you tell your doctor or any other healthcare professional about your medications. Most importantly, keep in mind that a dietary supplement is not a replacement for the diabetes treatment and care advised by your doctor.
So who could benefit from a vitamin supplement?
- Those on low calorie diets, who do not eat a variety of foods.
- Those following vegan diets.
- Those with certain food allergies, kidney disease or diseases of the gastrointestinal tract that interfere with nutrient digestion or absorption.
- Pregnant women.
An A to Z of supplements and their benefits
Ask the expert: Andrea Jenkins, nutritionist.
“The following supplements have been shown to improve blood sugar control or limit diabetic damage.”
Carnitine (L-carnitine), a nutrient made from amino acids that helps the body turn fat into energy, has been found to be deficient in people with diabetes. Almonds, egg and cottage cheese are rich in this nutrient.
Antioxidants can help reduce oxidative stress and lower the risk of diabetic complications. Choose brightly coloured fruits and vegetables in smoothies, salads and soups to ensure a variety of antioxidants.
Digestive enzymes help ensure that mineral uptake is strong and can aid the management of diabetes. Pre- and probiotics are also helpful to maintain digestion and immunity.
Lipids and essential fatty acids
Omega-3 fatty acids lower blood pressure and triglyceride levels, and can help to relieve many of the complications associated with diabetes.
Magnesium, common in leafy green vegetables, is frequently lacking in people with Type 2 diabetes, as is chromium. Brewers yeast, mushrooms and non-refined grains all contain chromium. Zinc improves insulin function, and potassium (found in all fruits and vegetables), can improve insulin sensitivity.
A vitamin B complex improves the metabolism of glucose, and vitamins C and E can improve eye health.
Remember that dietary changes are important to treat diabetes successfully. Many foods can have a positive impact on blood sugar, for example artichokes, garlic, nuts, onions, olives, cinnamon, blueberries, avocado and fenugreek. Try to include some (or all!) of these in your next meal…
Ask the expert: Faaiza Paruk, dietician
“Some people believe that by taking a supplement they won’t need to exercise or take any medication. This is untrue. You need a balanced diet as well as exercise to help control your sugar levels. A balanced diet includes five servings of fruit and vegetables a day, a low intake of salt and fat, lean meat and complex carbohydrates found in foods such as brown rice, potatoes, beans and lentils.”
We were just sent this advice about raising children with diabetes… It takes a family to raise a diabetic child, as we all know! Do you have anything to add?
Hearing the diagnosis for the first time can be overwhelming and will leave any parent and child with mixed emotions – it’s unfair, it’s exhausting, it’s stressful, it’s scary and it’s tough to manage. Yet there is nothing on earth that any parent could have done better to prevent their child from living with Type 1 diabetes. It is estimated that 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.
According to Dr Ntsiki Molefe-Osman, Diabetes Medical Advisor at Lilly South Africa, Type 1 diabetes is a disorder of metabolism caused by the body’s immune system which attacks the cells in the pancreas that produce insulin. “Children are not born with it, rather it develops over time and there is usually a genetic predisposition. In children, Type 1 diabetes presents commonly at around 14 years of age and younger. This means that Type 1 diabetes is a lifelong condition, it is serious, and managing it needs to be done diligently as poor control of the condition today will have lifelong repercussions. When a child is diagnosed with Type 1 diabetes, so is the entire family who all need to adapt to a new lifestyle.”
“The importance of good glycaemic control can’t be emphasized enough,” says Dr Ntsiki Molefe-Osman. The basic 101 of managing and preventing the complications of Type 1 diabetes is careful daily management of blood glucose and sustaining tight glucose control as close to normal levels as possible.”
“Diabetes is a progressive disease, which left unchecked will cause organ damage. This has significant health repercussions for later on in life – from kidney failure, heart failure, blindness, nerve damage (diabetic neuropathy) and as a result loss of limbs. What you do for your diabetic child today and the responsibilities you teach your teen in managing Type 1 diabetes, will influence the quality of life they can expect to live later in life,” explains Dr Molefe-Osman.
Why do Type 1 diabetics need insulin?
People living with Type 1 diabetes do not produce any insulin at all, so it needs to be replaced with insulin injections. Insulin moves blood sugar into body tissues where it is used for energy. When there is no insulin, sugar builds up in the bloodstream. This is commonly referred to as high blood sugar, or hyperglycaemia – it is dangerous and has many side effects. Fortunately when the blood sugar is stabilised with insulin treatment, these symptoms go away.
It can be managed
While a diabetes diagnosis for your child may come as a shock and will mean that lifestyle adjustments will have to be made, it is important to remember that with consistent control and the support of a healthcare provider, people living with Type 1 diabetes can live full, active lives.
Family support is vital
Managing Type 1 diabetes in your child takes a lot of courage and determination. Imagine the mountain that a child faces knowing that injections will be part of their daily routine. They may also worry that their condition will preclude them from enjoying all the things that other children get to experience, or lead to them being treated as ‘different’ in their school and peer environment.
It all comes down to how you work together as family to support and guide your child in helping them see their daily treatment regime as a positive step towards a healthy and normal life, rather than as a punishment or burden. It is important to help your child believe wholeheartedly that with the right control and responsible approach, they can do whatever they want to do.
Managing chronic illness
“Coping with and learning to manage a chronic illness like diabetes is a big job for a child or teen. It may also cause emotional and behavioral challenges and talking to a diabetes educator or psychologist can help immensely. It’s also important that family, friends, teachers and other people in your child’s network know of and understand the condition so they are alert to any symptoms or signs that their blood sugar is out of control and what to do to help them in an emergency situation,” adds Dr. Molefe-Osman.
It takes a huge amount of discipline on the part of the parent and child in managing the demanding diet, lifestyle and treatment regimen, so it’s essential to establish a routine that works for everyone concerned. Establishing good habits early, providing a support structure and ensuring that your child understands why good control is important are vital. It’s the difference between your child managing their diabetes, or diabetes managing them,” she concludes.
- The 7th Edition of the International Diabetes Federation Atlas, World Health Organisation (WHO)
- http://www.who.int/mediacentre/factsheets/fs310/en/), Statistics SA
We just heard about new studies at Duke University in the USA that may lead to an injection for Type 2 diabetes that could provide weeks of good blood glucose control… Doesn’t that sound wonderful, and hopeful?
Biomedical engineers at Duke University have created a technology that might provide weeks of glucose control for diabetes with a single injection, which would be a dramatic improvement over current therapies. In primates, the treatment has been shown to last for weeks, rather than days.
By creating a controlled-release mechanism for a drug and optimizing its circulation time in the body, this new biopolymer injection has the potential to replace daily or weekly insulin shots with a once-a-month or twice-a-month treatments for Type 2 diabetes.
The new therapy is described June 5 in Nature Biomedical Engineering.
Many current treatments for Type 2 diabetes use a signaling molecule called glucagon-like peptide-1 (GLP1) to cause the pancreas to release insulin to control blood sugar. However, this peptide has a short half-life and is cleared from the body quickly.
To make treatments last longer, researchers have previously fused GLP1 with synthetic microspheres and biomolecules like antibodies, making them active for two to three days in mice and up to a week in humans. Despite this improvement, many of these treatments don’t include a mechanism to control the rate of the peptide’s release, causing the treatment’s effectiveness to plateau after prolonged use.
Now researchers at Duke have created a technology that fuses GLP1 to a heat-sensitive elastin-like polypeptide (ELP) in a solution that can be injected into the skin through a standard needle. Once injected, the solution reacts with body heat to form a biodegradable gel-like “depot” that slowly releases the drug as it dissolves. In animal experiments, the resulting therapy provided glucose control up to three times longer than treatments currently on the market.
“Although we’ve pursued this method in the past, Kelli Luginbuhl, a grad student in my lab, systematically worked to vary the design of the delivery biopolymer at the molecular level and found a sweet spot that maximized the duration of the drug’s delivery from a single injection,” says Ashutosh Chilkoti, chair of the Department of Biomedical Engineering (BME) at Duke University and a senior author of the paper. “By doing so, we managed to triple the duration of this short-acting drug for Type 2 diabetes, outperforming other competing designs.”
Building upon their previous work with the drug and delivery system, researchers in the Chilkoti lab optimized their solution to regulate glucose levels in mice for 10 days after a single injection, up from the previous standard of 2-3 days.
In further tests, the team found that the optimized formulation improved glucose control in rhesus monkeys for more than 14 days after a single injection, while also releasing the drug at a constant rate for the duration of the trial.
“What’s exciting about this work was our ability to demonstrate that the drug could last over two weeks in non-human primates,” says Kelli Luginbuhl, a PhD student in the Chilkoti lab and co-author of the study. “Because our metabolism is slower than monkeys and mice, the treatment should theoretically last even longer in humans, so our hope is that this will be the first bi-weekly or once-a-month formulation for people with Type 2 diabetes.”
Currently, the longest-acting glucose control treatment on the market, dulaglutide, requires a once-weekly injection, while standard insulin therapies often have to be injected twice or more every day.
Despite a variety of treatment options, managing Type 2 diabetes still poses a problem. Patients don’t always reach their glycemic targets, and adherence to a treatment plan that relies on frequent, meal-specific dosing leaves room for human error. By limiting the number of injections a person will need to control their glucose levels, the researchers hope this new tool will improve treatment options for the disease.
The researchers now plan to study the immune response to repeated injections and test the material with other animal models. Chilkoti and Luginbuhl are also considering additional applications for the controlled-release system, such as delivering pain medication.
Chilkoti also said that because the drug is synthesized inside E. coli bacterial cultures instead of mammalian cells, it is cheaper and faster to produce, making it a potential target for use in developing countries once it’s commercialized.
The research was funded by the National Institutes of Health (R01-DK091789). Chilkoti is a scientific advisor for PhaseBio Pharmaceuticals, which has licensed this technology from Duke.
CITATION: “An Injectable Depot of Glucagon-Like Peptide-1 Fused to a Thermosensitive Polypeptide With Zero-Order Release Kinetics Provides One Week of Glucose Control,” Kelli M Luginbuhl, Jeffrey L Schaal, Bret Umstead, Eric Mastria, Xinghai Li, Samagya Banskota, Susan Arnold, Mark Feinglos, David D’Alessio, Ashutosh Chilkoti. Nature Biomedical Engineering, June 5, 2017. DOI: 10.1038/s41551-017-0078
From Facebook (Diabetic South Africans):
How do you treat yourself when you feel like something sweet?
I only have a tiny taste, seems to work for me, but then I don’t really have a sweet tooth.
Very difficult question 🙁
Jungle Oats Light snack bar or Canderel sweets… Sweet enough and good.
Any sweet fruit that is in season! For now grapes and mangoes work for me.
Lehuma, fruits do contain a lot of sugar – especially grapes and mango. Remember to have small portions.
Yes I know, Sharon, hence I only eat them as a treat when I feel like something sweet!
Two blocks of Lindt 70% dark chocolate.
Wow! I thought I was the only one who had this craving for sweet things. I eat ice-cream once in a while. I was really feeling bad about it.
Stages of Diabetic Grief:
Dealing with life can be tough enough for emotionally strong people, but being diagnosed with diabetes changes the ball game completely, and sends you on a never-ending emotional rollercoaster ride.
Most people think that grief only applies to losing a person. But when you are diagnosed with diabetes, your world stops and the person you were before ‘dies’. The same stages of grief that apply to losing a person, mainly anger; denial; bargaining; depression and acceptance, apply to diabetic grief, but we have a few extra for good measure. The stages begin at the moment of diagnosis and never quite end, thus the diabetes loop begins and we continue to cycle through the stages on our new journey.
The first stage: Shock
First, there is denial and shock. You hear the doctor say that you have diabetes, and your mind stops.
‘It’s not possible. I don’t even eat that much sugar.’
That’s the shock part.
The second stage: Denial
Then you think, ‘Well, I will just inject for a bit till I feel better and it will be okay.’
This is denial. But unfortunately diabetes and the need for good control leave little room for denial to live.
The third stage: Anger
Anger quickly follows the denial, but this stage is hard to overcome, and you never fully let go of the anger. You get angry at yourself for not going to the doctor sooner and getting checked. You get angry when your blood sugar levels are high or low, and this leads to stress which will increase your levels. Of course in the anger phase, we all ask ‘why me?’ and ‘what did I do to deserve this?’ So we open the door to the bargaining and depression stages.
The fourth stage: Bargaining
As diabetics, we become expert bargainers, even though all our bargains are one sided. We bargain with our medical team that if we do things a little differently, our results will change, but mostly we bargain with ourselves. This is dangerous. We bargain that since our levels are good, we will eat now and skip a dose, and it will be fine. But each bargain we make can lead us closer to the depression stage. When our bargains fail, and they do, we get depressed and loop back to anger.
The fifth stage: Depression
Depression is something that most diabetics battle with. We get depressed when our blood sugar levels are bad, and we have not done anything wrong. Mostly, we get depressed when our routine and bargains fail us. For example, when we think we have everything under control and our levels are good, that bad day hits and we have to start all over again.
The sixth stage: Anxiety and fear
With the normal stages of grief, the next one would be acceptance. With diabetes, however, there are two extra stages. After depression come anxiety and fear. As diabetics, we tend to become very anxious and fearful people. Since diabetes is an unrelenting disease with constant management and a constant cycle of injecting, carb counting and weighing of food and reading of labels, it does not allow for any days off. It’s no wonder we have anxiety and fear! We never know what will happen from one day to the next, therefore it also makes it harder to move to the acceptance stage.
The seventh stage: Acceptance
Acceptance is something that even the most veteran diabetic struggles with. It’s the one thing we all want, and yet we rarely achieve. We all live in hope of a cure that will end our rollercoaster ride, and stop our management routine. There is a difference between acceptance and compliance. What can look like acceptance is in fact compliance. We need to acknowledge that compliance is good and normal, but we also need to acknowledge the fact that we will possibly never gain full acceptance of our condition. That is why we always live with a bit of hope.
The daily rollercoaster
Grief is something very common in everyday life, but in the diabetic life, it’s harder to overcome. We are on a constant rollercoaster ride that we have no control over, and never asked to get on. We are always wishing for a cure.
Even nine years after my diagnosis, I still find myself replaying these steps in no certain order. Unfortunately, there is no diabetic nirvana. It is a daily rollercoaster ride of emotions. The trick is to try not to get stuck in a specific stage, and realise that with diabetes, it is an ever-evolving process through the stages of grief.
We need to be ready for whatever comes our way. We need to keep in mind that the body reacts to emotional trauma and excitement by triggering a chemical reaction that will make the blood sugar rise, and also remember that with grief and life, it is normal to have bad days and we must try and enjoy the good days and not linger on the bad days.
“I would like to know to help and support a friend who has diabetes. My friend is a Type 1 diabetic and I’m not always sure how to help him in the tough times.” Markus Vorster
You have not said how old your friend is, but much of the basics stay the same. Here are 7 ways to support your friend with diabetes.
- First of all, treat your friend like anyone else. It is important for him to realise that his diabetes makes absolutely no difference to your friendship. If your friend is having trouble accepting his condition, be supportive and understanding.
- Try not to ‘mother’ him, but do encourage him to look after himself.
- Understand that people with diabetes are more prone to mood swings and depression than those who do not have diabetes.
- Learn to be able to recognise when his blood sugar goes too low, and know what to do in case he needs help.
- Remember, really tough times for diabetics are when they are sick. Blood glucose levels bounce up and down and this makes them feel more ill.
- Give him all your support by understanding his condition to the best of your ability.
- Get the facts and go beyond the myths and misinformation by talking to your friend, your doctor, or relatives who have diabetes.
As a friend, your understanding and acceptance are very important. The more you understand his circumstances, the less alone your friend is likely to feel.
Empathise, but never sympathise.
– Jeannie Berg, Diabetes Educator
Teens with Type 1
Teenagers with Type 1 diabetes feel especially isolated and alone. It’s bad enough dealing with body changes and hormonal issues, but add to that testing blood sugar, keeping tabs on what you eat and injecting yourself, as well as mood swings, and you can see why teens with Type 1 have a lot to deal with. Understanding what goes into diabetes means you can help your teen feel less self-conscious and different from everyone else.
So what’s on the plate of a diabetic?
Many diabetics have a challenge keeping their glucose levels controlled. Remember that a combination of the following 3 factors ensures good glucose control:
- Use of medication (oral meds or insulin injections)
When it comes to diet, most diabetics are familiar with the “AVOID” list of foods. Sugar, sweets and chocolates, sugary cooldrinks, cakes, pastries, biscuits, ice cream and puddings are the most popular. If you’re a diabetic and continue consuming the above list then you are literally accelerating the chances of complications of diabetes – blurred vision, kidney failure, sores on feet etc.
However there are many who are compliant to the “AVOID” list yet may still find elevated sugar levels. Many years of clinical experience of working with diabetics has allowed me to create a shortlist of other foods that are most likely spiking sugar and you are not even aware they are the cause.
These are 100% fruit juice, dried fruit, energy drinks, energy bars, muesli (containing nuts and dried fruit), popcorn and rusks.
Juices and dried fruits are a concentrated source of natural sugar resulting in blood sugar elevation. Most energy drinks are loaded with sugar and are not suitable for diabetics. Energy bars tend to be marketed as low fat however that is not sugar free.
The key to remember is that a diabetic should be aware of all foods that elevate bloods sugar levels. Grains, fruit and vegetables are all healthy but they need to be eaten in the correct portions to keep sugar controlled. Protein helps to stabilise sugar and thus an extra serving of meat / fish / chicken / egg / cold meat etc. will not elevate glucose as much as an additional slice of bread / rice / potato.
The magic to a diabetic’s diet lies in the correct proportion of carb to protein at meals and snacks and to ensure correct portions at every meal and snack.
Omega 3 available from tuna, sardine, salmon and mackerel is an essential fatty acid that is protective towards cardiovascular health and is anti-inflammatory. Due to diabetics being at high risk of heart disease omega 3 supplements are highly recommended. Make sure that you use good quality omega 3 that is heavy metal free.
So my message in a nutshell would be – it’s not just about “no sugar”
Rather, it’s about getting the carb – protein balance. Remember to test your glucose regularly and at different times of day. This enables you to monitor your control throughout the day. Test your sugar before a meal or 2 hours after a main meal. Keep a record of your glucose values.
At Easy Health Wellness we assist our clients by teaching them how to exchange carbs and to count carbs to ensure that they always are in balance at each meal and snack, and they can enjoy variety in their eating plans.
Remember: The diabetic way of eating is a very healthy way of eating, for all of us!
From Facebook (Diabetic South Africans):
What’s the best diabetic advice you’ve ever been given?
Lower your carbs.
Exercise and drink lots of water.
No diabetic is the same… Individuals react differently!
Daily cardio and eggs for breakfast!
Eat the same time everyday.
Take your insulin even if you are ill, and always eat regular small meals
Kid first, diabetes second.
We chat to Buyelwa Majikela-Dlangamandla, a diabetes educator who trains local healthcare workers in a programme called Agents for Change, about diabetes in the workplace.
Can you tell us about Agents for Change?
Agents for Change is a diabetes training outreach programme, supported by the World Diabetes Foundation, that aims to improve diabetes care in rural and semi-urban areas of South Africa. The goal is to empower healthcare providers and people living with diabetes to manage their diabetes to prevent diabetes-related complications.
The first part is two days of intensive and interactive training that provides participants with a sound knowledge of diabetes. Practical skills in preventing and managing lifestyle conditions are demonstrated, like how to prepare affordable healthy food. Participants set their own goals of what they wish to change in their lifestyle habits and workplace.
Six months later, the same participants come back for the second phase where they share their experiences, successes and challenges in carrying out their planned changes. We focus on behaviour counselling and the stages of change. People with diabetes are invited and they volunteer to share their real life experiences to be discussed as case studies for learning. Agents for Change has trained more than 1,500 healthcare workers and reached thousands of South Africans since 2008.
How are you involved?
I run the workshops with Noy Pullen, the project manager.
How did you become interested in diabetes?
My father had diabetes and so did all of his siblings, so there’s a family connection. I have also been working as a diabetes educator since 1995 at Groote Schuur Hospital and am currently working as a clinical educator at the University of Cape Town.
What is the most important message you share in your training?
- Choosing a healthy lifestyle can prevent and/or delay the onset of diabetes.
- People living with diabetes can enjoy a healthy, normal life.
- A positive attitude leads to a meaningful life.
What is the most surprising lesson for the participants?
That the effect of physical activity on blood sugar levels is similar to that of blood glucose lowering medicines and insulin.
Once they have finished their training, what happens?
They are encouraged to start support groups and vegetable gardens. Those groups are called “Khula Groups”. They get continued support from the project – reading material and gifts – and they are always linked to the project manager on SMS or email.
How many people has Agents for Change helped?
Agents for Change has trained more than 1,500 healthcare workers and through them reached thousands of South Africans since 2008.
What advice would you offer to people living with diabetes who are struggling?
I can never fully understand how diabetes affects people who live with it, so it wouldn’t be right for me to offer advice. Because diabetes affects people differently, the approach should be personalised. However, I do notice that those who have accepted diabetes as part of their lives and taken charge of their own health find it easier.
What makes your life sweet?
Living in the moment, love and smiles from people around me.
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.