Our regular contributor Jane Sandwood tackles the topic of how to quit smoking if you have diabetes. Have you managed to quit smoking? Do you have any advice to share? Tell us your experiences, here or on Facebook, and it might help the rest of the South African diabetes community.
The health risks of smoking with diabetes
The health risks of smoking with diabetes are well documented; however, curbing nicotine addiction while managing your diabetes adds another layer of complexity to a notoriously difficult task. In South Africa, the prevalence of diabetes is increasingly rapidly, which in turn raises the stakes for smokers with diabetes to quit while controlling glucose levels. Because standard nicotine replacement options such as patches and e-cigarettes aren’t safe for diabetics, either, many are left with the daunting prospect of going cold turkey without a tangible removal plan. Fortunately, a range of treatment options exists for diabetics looking to quit smoking while managing their disease.
Early stages and treatment plans
Before quitting, smokers should consult their doctors to determine the best course of action. Because smoking suppresses appetite, some research suggests that diabetics who quit smoking struggle to control their blood sugar levels. As a result, individual diets may need adjustment to prepare for withdrawal from nicotine. Doctors can work with patients to devise a schedule or pattern that best suits their needs.
Most smokers will attempt to quit dozens of times before they are successful. While some attempt to gradually wean themselves off cigarettes, others go “cold turkey” and quit all at once. Although individual results vary, some research suggests that smokers who quit “cold turkey” were more successful than those who quit gradually. At any rate, it’s important to remember that quitting smoking is a continual process, and not something that happens ‘all at once’–even if you can pinpoint your last cigarette to a specific day. It’s normal to have setbacks, and plenty of ex-smokers can attest to the efficacy of quitting cigarettes, even it takes more than one attempt.
Moving forward with quitting smoking
Normally, diabetics will be able to quickly observe improvements and results in their own health within weeks of quitting smoking, which can encourage efforts to absolve from nicotine. It is also a good idea to consult medically supported research on the trajectory of nicotine withdrawal to give you a broader sense of what’s happening to your body as you continue the process of nicotine withdrawal. It may also be a good plan to keep a journal logging changes in mood, diet, blood sugar level, and other related factors to track individual growth throughout the process.
Quitting smoking is a frightening prospect for anyone addicted to nicotine, least of all diabetics. However, many viable treatment plans exist to help curb nicotine in a manner that is effective and safe. It won’t take much time to benefit from the wide range of advantages to quitting smoking as you continue the ongoing process of diabetic care.
Ketones and ketoacidosis are often mentioned in relation to diabetes, but what are they exactly?
- Ketones result when your body burns fat for energy.
- They are formed when the body doesn’t have enough insulin to use glucose for fuel.
- A urine test is traditionally used to test for ketones: some blood glucose meters can also test for ketones.
- Ketones make the blood more acidic.
- Ketones in the urine combined with high blood sugar are a warning sign that your diabetes isn’t under control.
- Diabetic ketoacidosis (DKA) is caused by a combination of high blood sugar that causes a rise in ketones. The ketones are an indication of how acidotic the patient is, and the acidosis can be fatal.
- DKA is serious and can lead to diabetic coma.
- DKA is rare in Type 2 diabetics and more common in Type 1 diabetics with uncontrolled blood sugar.
- Symptoms of DKA are thirst, frequent urination, high blood glucose, constant tiredness, nausea, vomiting, abdominal pain, dry/flushed skin, breathing difficulty and confusion.
- If these symptoms ring a bell, see a doctor as soon as possible to get your blood sugar under control.
Sometimes the biggest challenge to eating a healthy diet is finding the right ingredients: here’s how Annora Mostert, the founder and group owner of Anja’s Pantry, and Alliyah Geldenhuys, who just opened Anja’s Pantry Plumstead, did just that.
Do you have a special interest in diabetes?
“It soon became clear that people with diabetes have the biggest need for healthy low carbohydrate and sugar-free food,” explains Annora. “So we involved trained nutritionists to guide us in what the right type of products should be for diabetics, and started to change the content of our pantry.” The result? All the products in Anja’s Pantry stores are now diabetic friendly. Some of the store owners also have close family members with diabetes, so as a team they work together to stock the right kind of products.
Do you think awareness is growing around healthy food alternatives?
“Absolutely! Social media is the biggest contributor creating awareness, but the awareness is now affecting policies. The research is so clear and the problem is so great that the South African government has followed the UK government in introducing a sugar tax next year on foods to try to curb the high sugar content in processed foods,” says Annora. As a result, all their stores offer a wide range of food products that are sugar-free and low carb so that those who want to avoid sugar can still have a variety of foods to choose from. “Our range of food products is now over 200 items with more being added all the time. This becomes a mini grocery store for the large percentage of the population that are either diabetic or pre-diabetic, those who have allergies or those who just want to lose weight while enjoying their food.”
How did you choose the location of Anja’s Pantry Plumstead?
Anja’s Pantry in Plumstead is right next door to a number of fast food restaurants. “We chose the location on purpose,” explains Alliyah, the owner of the store. “We want to provide healthier options to those in Plumstead and surrounds. It’s often difficult to prepare home cooked meals and so called ‘proper food’ with the fast paced lifestyles that many of us lead today. We end up simply settling for the quickest and easiest option available, but often these are unhealthy food choices. With our easy to prepare premixes and pre-prepared items such as pizza bases and meals, we are hoping to make it much easier for those wanting to enjoy a more nutritionally sound meal.”
Do you think there’s a particular need for healthy alternatives in the Muslim community?
“Yes! Traditional Muslim food is well known for being loaded with unhealthy fats, excessive carbohydrates and sugars. Diseases such as diabetes, high blood pressure and cholesterol are rife within the Muslim community and have sadly become a way of life for many within the community. I think it’s possible to ‘eat yourself healthy’, and that if we can share this vision and all that it stands for it will change the lives of many and allow Muslims to re-think their food choices.”
Do you have any advice for those who are struggling with their diabetes?
“Living a sugar-free and low carb life shouldn’t be that difficult,” says Annora. “We know that it is more expensive since real food items aren’t mass produced and made with lots of chemicals, but it saves so much on unnecessary medical bills.” Alliyah agrees. “An important part of managing your condition is to eat healthy meals and steer clear of certain items. Always read labels and check the ingredients of items that you purchase, as product packaging can often be misleading!”
What makes your life sweet?
For Annora, it’s feeling healthy and eating without feeling guilty. For Alliyah: “My amazing family, who made the opening of this shop a reality. It would never have happened without their help, guidance and support.”
When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.
Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?
That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.
What inspired you to write The Low Carb Solution for Diabetics?
We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.
The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.
I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.
A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.
Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?
Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!
What advice would you offer to people living with diabetes who are struggling?
Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!
What makes your life sweet?
Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.
Get in touch with Vickie: @Vickiefantastic on Twitter
Ask the dietician: Cheryl Meyer
From the community: “Being both diabetic and pregnant makes it difficult to know what to eat – there are so many things I have to avoid! And I’ve been craving sweet things. Any advice?” Sameshnie Naidoo.
The diet for pregnant women with diabetes should be a healthy, well-balanced eating plan aimed at supporting the pregnancy and promoting blood sugar control. This is essential for the wellbeing of both mom and baby.
Of course, pregnancy and diabetes means that there are more foods on the “Do Not Eat” list, as your normal diabetic diet has a new list of things to avoid. But bear in mind that it’s only for nine months, and that it’s for the best possible cause: your healthy child.
Foods to avoid:
Here’s a list of foods that you shouldn’t eat when you’re pregnant because they pose a potential food safety risk and might make you ill or harm your baby.
- Soft cheeses e.g. brie, camembert, and blue-veined cheeses unless the label says they are made with pasteurised milk.
- Processed cold meats or deli meats unless they are reheated until steaming hot.
- Refrigerated paté or meat spreads (canned options can be eaten).
- Refrigerated smoked seafood unless as an ingredient in a cooked dish e.g. a casserole.
- Raw or partially cooked eggs and dishes that contain these e.g. homemade mayonnaise.
- Raw or undercooked meat and poultry
- Unpasteurised juice
- Raw sprouts
- Raw or undercooked fish or shellfish
- The American Academy of Nutrition and Dietetics (AND) recommends pregnant women avoid fish high in mercury e.g. shark, swordfish, marlin. And limit intake of fish and shellfish lower in mercury e.g. prawns, canned light tuna and salmon, to 360g or less per week.
The good news? You don’t need to give up caffeine entirely. The AND recommends keeping your intake below 300mg/day, which is about one or two servings of coffee or tea. And of course rooibos is naturally caffeine free, so you can have as much as you like!
Being both diabetic and pregnant can feel restrictive from a diet point of view… When you’re lacking motivation, just remember that everything you eat your baby is eating too: so put down the junk food and pick up a carrot!
A note on cravings:
Whether it’s pickles and ice cream or other odd combinations, both cravings and food aversions are common during pregnancy. Although the exact cause is unknown, taste perceptions may change with hormonal changes. Cravings are generally harmless*, unless foods you crave replace more nutritious foods, or all you want is junk food. If broccoli loses its appeal, for example, substitute another vegetable that you enjoy and tolerate.
*Cravings for non-food substances like sand or chalk (a condition called pica) can be dangerous as they contain lead or other toxic substances. If you’re craving non-food items, consult your doctor.
“My dad is a poorly controlled Type 2 diabetic, and he doesn’t seem to care. I keep telling him how serious his condition is and that he has to take care of himself, but he continues eating whatever he likes and says he’s too old to change. What can I do?” Celeste Damen.
It isn’t easy for people to hear that they have diabetes. Diabetes is a condition that cannot be cured: it has to be taken care of every day. People who have diabetes have to make some important changes in their lives, but if the change is forced on them, they may not want to do it.
This is what is probably happening with your dad. He most likely knows exactly how important it is to look after his diabetes, but might still be in denial or angry that this inconvenience has been brought into his life.
The fear you feel for your dad’s condition also projects to him, and he is probably trying to reassure you by giving you excuses that he is too old to change or that the situation is not that serious.
Instead of telling Dad what to do and being cross with him when he doesn’t do the right thing, you need to ask him what changes he is willing and able to make. Then encourage him to follow through on what the two of you have decided.
Diabetes has not only happened to him: it has happened to your whole family. This is something all of you have to accept. It’s a good idea to get the whole family to adopt healthy habits, so that there will be less temptation… Offer your dad help, but try not to be the Diabetes Police.
– Jeannie Berg, Diabetes Educator
“I’m looking for some tips or advice on how to communicate better with my diabetic wife. She has Type 1 diabetes and when she goes low it’s sometimes hard for me to know what to do, and hard for her to explain how she’s feeling. Also when she goes high, but low is more of a problem, because it can get dangerous. Any tips?” Luke Jacobs.
I think it’s really great that you are involved in helping your wife cope with her diabetes. The challenges faced by those who care about someone with diabetes are rarely discussed, and very real.
Diabetes is riddled with valleys and waves, otherwise known as lows and highs, and this can be totally frustrating – as well as scary – both for the diabetic and their spouse. Good diabetes management limits the frequency of lows and highs, but there is no guarantee. And there are so many factors that can influence blood sugar that there’s no such thing as a ‘perfect’ diabetic.
So what now?
First of all it’s important for you to be able to identify when your wife is going low. Sometimes, people who have had diabetes for a long time lose the ability to feel their lows – this is where you come in. Learn how to treat a low. Keep some glucose sweets or jelly beans with you so that you can help her if her blood sugar suddenly drops. Don’t be afraid to suggest she checks her blood sugar if you think she’s acting funny.
The trick is to be diplomatic about this. The last thing a wife with diabetes wants is pity – and what woman can be responsible for being snippy when her blood sugar is at 3mmol/L?
– Jeannie Berg, Diabetes Educator
Sweet Life editor and Type 1 diabetic Bridget McNulty shares her pregnancy story – and what she wishes she’d known before she fell pregnant.
How long have you been diabetic?
I was diagnosed in October 2007… It was a very dramatic diagnosis: I was admitted to ICU for five days and was apparently only three days away from a diabetic coma because my blood sugar was so high.
Did you have to prepare to fall pregnant?
I told my endocrinologist ahead of time that my husband Mark and I were thinking of having a baby, and he gave me the go-ahead because my blood sugar was already well-controlled: my HbA1c results were 7.0 and below for the year before I fell pregnant. I also mentally prepared for the pregnancy, because I knew it would require a lot of discipline and that my diabetes would become even more of a full-time job than it already was!
How did having diabetes affect your pregnancy?
I had to be in extremely tight control throughout – HbA1c results of 6 and below (which I didn’t think was possible before I fell pregnant!) and blood glucose results of 7.8mmol/l or below an hour after eating… Where possible. I also had to test even more frequently than usual (up to 8 times a day). I had HbA1c tests every month and saw my endocrinologist every month, and I couldn’t indulge in pregnancy cravings like eating a whole tub of ice-cream! I had to be very strict with my diet. But it’s amazing how much easier it is to do when your motivation is the health of your baby.
How was the birth experience?
As smooth as I could have hoped for. I chose to have an elective C-section: it was either that or an induction, as all babies born to diabetic moms have to be born at 38 weeks. In the week before the birth my blood pressure started creeping up, and I was retaining a lot of water. Because diabetics are at greater risk of pre-eclampsia, my gynecologist decided to bring the birth forward two days, from the Monday to the Saturday. It was hugely exciting, and hugely nerve-wracking. Arthur, my baby boy, was born totally healthy and weighed in at a (very) healthy 4.5kg. We fell in love with him instantly.
What was it like having a young baby, with diabetes?
It was a real challenge in the early days. Breastfeeding plays havoc with blood sugar control, and causes really persistent lows. Sleep deprivation is tough to deal with, and it’s so overwhelming having a new baby and trying to learn how to be a parent that my diabetes kind of took a back seat for a while. I remembered to inject and test, but that was about it.
What do you think the biggest challenge of a diabetic pregnancy is?
Although 9 months doesn’t seem like that long at first, it feels like a really long time to be non-stop super-disciplined.
What advice would you offer to diabetics who are struggling?
You will feel so much better if you get your blood sugar under control. It is so worth it in terms of health and energy and general happiness to do what it takes to get good control. I know how hard it can be, but the reward is a healthy, happy life with diabetes – and that’s about as good as it gets.
What makes your life sweet?
My two sweet children, my wonderful husband, my awesome family and friends and the sweet life I’m living!
Did you know that diabetics are more at risk of developing heart disease? Here are the facts and what you can do about it.
- Both Type 1 and Type 2 diabetics are at risk of cardiovascular disease (CVD). CVD includes both heart disease and problems with the circulatory system, including strokes.
- What can you do? Get tested! A risk assessment will check your blood pressure, lipids and lipoproteins and see if you need to be concerned.
- Quit smoking! If you are a diabetic smoker, your risk of developing CVD doubles.
- Other risk factors also play a part: obesity, physical inactivity and a family history of CVD.
- Eat a heart-healthy diet. Cut down on saturated fats and avoid trans fats that raise cholesterol. Eat lean meat and choose a low fat diet as much as possible.
- If you have any feelings of numbness, confusion, impaired vision, severe headache or difficulty speaking, go to a hospital immediately. This could be signs of a TIA (Transient Ischemic Attack) – a warning sign for a stroke.
- Type 2 diabetics are twice as likely to have a heart attack or stroke.
- Eat plenty of fibre to help lower cholesterol. Wholegrain breads, cereals, fruit, veggies, oatmeal, beans and pulses are all full of fibre.
- Changing your lifestyle can decrease your risk of heart disease (and improve your blood sugar!) Time to get active…
- Hypertension is an important risk factor for diabetics and CVD. Your blood pressure should not be over 130/80 – the ideal is 120/80. The secrets to good blood pressure are to drink less alcohol, don’t eat too much salt, keep at a healthy weight, exercise, stop smoking and visit your doctor regularly. You can do it!
Neville Pillay is one of Durban’s favourite DJs and comedians… Who just happens to be a Type 2 diabetic. We speak to him about keeping up with the Morning Rush on Lotus FM, with diabetes.
How long have you been diabetic?
I was diagnosed well over 12 years ago, when I was 28 years old. But I remember my doctor telling me at 24 that I was at higher risk for diabetes because of my family history, and that I should change my diet… If only I had listened then!
Was your diagnosis a surprise?
To be perfectly honest, I knew all the symptoms – frequent urination, constant thirst, itchy skin, the sweats – but I chose to ignore them. By the time I was diagnosed I wasn’t surprised at all.
Are any of your family members diabetic?
My dad was and my mom is – she’s a Type 1 diabetic. You would think that would have made me more aware of diabetes, but the way we were brought up, we were ignorant about it – it was just something that my mom had. Type 2, or adult-onset diabetes, is also a very different condition to Type 1.
Do you ever talk about diabetes on air?
Absolutely: every chance I get to relate my story, I do. Many of my listeners on Lotus FM are affected by diabetes in one way or another, so it helps to be able to share our stories.
Do you ever tell jokes about diabetes in your comedy shows?
Oh yes, for sure. My comedy is based on my life, so of course I do! For example, I’ve got a lot of friends whose dads have passed away and left them things: cars and houses, even a Jaguar – all kinds of things. What did my dad leave me? Diabetes. I also like pointing out the irony of the fact that Indians came to South Africa as indentured labourers to cut sugar cane… And what disease do we all get? The sugars! Diabetes.
How do you balance a busy lifestyle with eating right and exercise?
It’s so difficult to do, so difficult. I’m not a pro at it and yes, I lapse every now and then. But for the most part I’m on point with eating well, staying away from sugary drinks and sweets and taking my medication. I’ve been a DJ since 1997 and I love it, but if you want any kind of stability or comfort zone, radio isn’t it. Every day is different and the landscape is constantly changing. So that’s an added challenge.
What do you think the biggest challenge of living with diabetes is?
To constantly monitor your blood sugar and make the right choices. The difficulty is in making those daily healthy choices, even when you’re around other people who can eat anything they like. That said, I know that there are terrible side effects, so it’s well worth making the effort. I was diabetic for a long time before I was diagnosed, and I know there have been some debilitating effects on my body, so I’m very careful to take good care now.
What advice would you offer to diabetics who are struggling?
Make one small change at a time and eventually you will have changed your lifestyle to effectively manage your condition.
What makes your life sweet
My girls, Jordan and Skylar, and my job. I love to entertain and it drives me daily.
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.”
One of the most common complications of uncontrolled diabetes is diabetic neuropathy – but do you know what it is? Here are the basics of what it is, how to avoid it, and how to treat it if necessary.
- Diabetic neuropathy is the most common complication of diabetes.
- Neuropathy is short for “peripheral neuropathy” which means nerve damage in the peripheral nervous system.
- The peripheral nervous system includes all the nerves outside the brain and spinal cord, and connects the central nervous system to the hands, legs and organs.
- Diabetic neuropathy is caused from damage to the small blood vessels that supply the nerves.
- Blood vessels are damaged by high blood glucose levels, having diabetes for many years and abnormal blood fat levels.
- Smoking and excessive alcohol use can also cause diabetic neuropathy, as can mechanical injury to the nerves (like carpal tunnel syndrome).
- Symptoms can include numbness and tingling in the hands and feet, erectile dysfunction, dizziness, muscle weakness and changes in vision.
- Some common signs of peripheral neuropathy are sharp, jabbing pain that may get worse at night, and pain when walking.
- Diabetic neuropathy can’t be cured, but there are treatments to help the symptoms.
- The best treatment for neuropathy is good blood sugar control, which will prevent the condition from getting any worse.
From Facebook (Diabetic South Africans):
What advice would you give a newly diagnosed diabetic?
Get as much info as you can. Prepare to make lifestyle change. Respect the illness and it won’t control you
Don’t think you are any different from any other human. Carry on and enjoy yourself: everything in moderation. Exercise a lot and eat well – no problem!
Vat een dag op ‘n slag. eet gesond en doen oefeninge. en als wat ‘n nie-diabeet doen kan diabete ook doen!
Cut out anything white (sugar, flour, bread, chips, etc) and start an exercise program.
Don’t dwell on it too much. My Type 1 diabetic son of 8 understands his illness yet just gets on with life. He is a happy child and a true inspiration to the people around him.
Relax – it’s not the end of the world. It can be so overwhelming at first, but remember you have a manageable condition (note, not disease) God bless you!
We chatted to community inspiration Veronica Vember about how she changes lives, one step at a time.
What got you interested in diabetes at first?
It all started whilst working in the vascular unit at Kingsbury Hospital. I realised that most people are not informed about managing diabetes after being diagnosed. So I became passionate in the control of potential complications, and Kingsbury management identified my passion and allowed me to do the vascular course in London as it’s not offered here. On my return, I did two presentations at the doctors academic meetings. At the time my husband had a myocardial infarction and had been diagnosed with hypertension and diabetes. The entire experience stimulated me to get involved with my community. Now my husband is one of the volunteers. I then started doing motivational talks at schools, groups, on radio and at our nursing college.
How did you start your community group?
I joined the Strandfontein Health Forum and offered to do the diabetes awareness events as there was no project as such. With the awareness held at the Strandfontein Clinic I handed out questionnaires and a suggestion box. The community asked for a diabetic support group: that’s what started it.
What keeps you inspired?
The positive attitude and enthusiasm of the volunteers, and noticing the excitement of the attendees. When we take a break, people want to know when we’ll be starting again. The continuous support of ‘diabetes life’ (a diabetic clinic at Kingsbury hospital) under the management of endocrinologist Dr May, Dr Tracy van Rensburg and nurse educator Sr. Dee Ferguson (my mentor). Positive feedback from the doctors at the day hospitals where the clients attend also keeps me going.
You were voted one of the Western Cape’s Lead SA heroes – how did this make you feel?
Surprised, shocked, emotional, confused and thankful towards the responsible person for the recognition. I’m very proud of the team of dedicated volunteer attendees as I can’t do this alone. It’s a team effort – unity is strength.
What advice do you offer your support group members when they are struggling?
To persevere, not to give up, not to give in, to be compliant, to attend the support group regularly. We do individual counselling and have a communication box available for constructive comments and replies.
How do you make diabetes inspiring?
We create a harmonious atmosphere: a safe environment with easy accessibility, clean, functional equipment and competent staff. We vary programs, presentations, literature, topics and menus (soup in winter and tea and a snack in summer). We also combine our decision making with the volunteers.
What makes your life sweet?
Carrying out our mission, vision and outcome.
S – be sensitive towards all
W – warn people about the consequences of not being compliant
E – educate people regarding a healthy lifestyle and change of mindset
E – be empathetic and empower people with knowledge
T – to be trained, to train others
To ensure that all community members are well informed, and reach and maintain normal glucose levels.
Get in touch with Veronica: Strandfontein Diabetic Support Group on Facebook
Ask the dietician: Cheryl Meyer
From our community: “Can anyone tell me about madumbis for diabetics – good or bad for us, and how much can we eat?” Lynette Hitchcock.
Madumbis, amadumbe, African potato or taro – call them what you will, they are delicious! They have a rich, nutty, earthy flavour and a stickier texture than potatoes. Like potatoes, they fall into the carbohydrate group of foods and can be roasted, mashed or boiled.
The key to eating proudly South African carbohydrates like madumbis, roti, pap or samp in a healthy diabetic diet is portion control! Counting the carbs in your meals and being aware of the carbs you eat can help you match your medication or activity to the food you eat. This can lead to better blood sugar control.
Remember: Everyone needs a different amount of carbohydrate at each meal and/or snack – the amount that is best for you depends on your:
- physical activity
- current blood sugar
- blood sugar targets
Not sure how many carbs you should be eating? Ask your doctor or dietician for help.
|A general guide:|
|Carb limits for women||Carb limits for men|
|Meal||30 – 60g||45 – 75g|
|Snack||15 – 30g||15 – 30g|
What does this mean? A food that has 15g carbohydrate is called “one carb serving”. One slice of bread or a small piece of fruit each have around 15g carbohydrate, so they are equal to one carb serving.
One carb portions of Proudly South African foods:
|1 carb serving||50g madumbi|
|1 small roti (35g)|
|⅓ cup pap (60g)|
|⅓ cup samp (75g)|
|½ cup sweet potato (100g)|
|1 medium mielie (140g )|
|½ cup rice (50g)|
|1 x 15cm tortilla or wrap (35g)|
|½ cup pasta (100g)|
|1 slice bread (30g)|
|1 small apple (115g)|
As much as possible, try to stick to this portion size, with a serving of protein (meat, fish, chicken, eggs, beans) and half a plate of vegetables or salad.
How to cook amadumbe: Scrub them clean and steam or boil until soft. Drain and cool slightly before removing the skins. Serve dusted with black pepper, a dash of salt and a drizzle of olive oil. Yum!
Amadumbe in numbers:
100g portion boiled amadumbe has: *
- 600 kJ
- 5g plant protein
- 1g fat
- 5g of carbohydrate
- 1g fibre
* According to The SA Food Tables
All diabetics know that foot care is really important, but do you know why? Preventing foot ulcers is an essential part of keeping your feet healthy. Here are some great tips.
- Foot ulcers are skin ulcers where the skin has broken down under the foot and you can see the tissue underneath it.
- Diabetics are at greater risk of foot ulcers because high blood sugar for a long period of time can damage the nerves in the feet, which means you won’t be able to feel pain and might not notice a foot injury.
- A diabetic foot ulcer can develop after even the smallest injury, like stepping on a little stone with bare feet. Ulcers are easily infected and can take weeks or even months to heal.
- 15% of people with diabetes may develop a foot ulcer.
- More than half of all diabetic foot ulcers become infected.
- Foot ulcers are the most common reason for diabetics needing to go to hospital.
- Luckily, they are also easily prevented: by carefully controlling blood sugar levels to prevent nerve damage.
- It is very important to check the feet, including the areas between the toes, for cuts and sores – every day.
- Keeping the feet clean and dry is essential – but do not soak them.
- Be sure to have your feet checked once a year by a doctor or podiatrist.
We chat to Bongi Ngema-Zuma, First Lady and founder of the Bongi Ngema-Zuma Foundation.
Why did you start the Bongi Ngema-Zuma Foundation?
It has always been my ambition to do something like that – I never came across anybody who told me about diabetes as a child, even when I was at school. But when you speak about it you find that each and every family is affected by diabetes in some way.
How did your mother find out she was diabetic?
My mother was not an educated woman, she was a housewife and only went to school up to Std 4. First she was told she had hypertension and received treatment for that. And then they investigated further and found out she had diabetes. Many people have had this happen – the underlying factor is diabetes. That’s why I encourage people to actively check their blood sugar. Whenever you go to the clinic you should get tested. What I learned from my mother is that changing her lifestyle made her live healthier and longer. She took every little lesson she could from the clinic – you eat like this, you don’t eat like that, you take your tablets, you eat so many times a day. What made it easier for her is that she made the whole family eat like that.
What makes your life sweet?
What makes me happy is chatting to people. I like getting people’s opinions on things, I like listening to people’s stories and visiting new places where I can learn new things.
Find out more about the Bongi Ngema-Zuma Foundation here.
There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.
“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”
For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.
“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”
Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”
Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”
Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.
Are there any benefits to starting insulin sooner?
“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”