Newly diagnosed with diabetes? We get to grips with what your medical scheme can do for you, and what you might have to budget for yourself.
- Join a medical scheme
Diabetes is a chronic condition that’s on the Medical Scheme Act’s Prescribed Minimum Benefits (PMB) List. All registered medical schemes in SA have to provide basic funding for your diagnosis, treatment and care.
- Register your condition
Make sure your condition is registered with your scheme, and be sure to do this again each time you switch. Find out how the registration process works: you’re likely to have to complete a form with the help of your doctor.
- Stay on a scheme
If you leave your current scheme, or join a scheme for the first time, the new scheme may impose a waiting period of 3 to 12 months. During this time, your costs may not be fully covered. Do your research before you join a new scheme and avoid breaks where you don’t belong to a medical scheme at all.
- Use a healthcare broker
Understanding what’s covered by all the schemes out there can be complicated. Do your research with the help of a healthcare broker. Their services are free of charge.
- Reassess your plan
Once a year, you can shift from a basic to a more comprehensive plan, and vice versa. Ask your scheme for your medical records and check what you’ve had to pay out of your own pocket during the year. Do the math to see if it makes sense to upgrade or downgrade your plan.
- Check which meds are covered
Even the most basic plans cover diabetes medication, as long as you choose from the formulary (the list of approved medication). Ask for this list before you choose a plan. Your prescribed medicine might not be available on the scheme’s most basic plan, but it could be on another, more comprehensive plan, or on another scheme’s formulary list.
- Stick to Designated Service Providers (DSPs)
These healthcare providers (doctors, pharmacists and hospitals) have an agreement with your scheme, which means their rates are usually fully covered. Get hold of your scheme’s DSP list and use them. Expect a co-payment if you use a doctor outside of this network.
- Go for your consultations
This will depend on your plan, but some of your doctor’s visits will be covered up to an agreed rate. Some schemes, for example, cover annual visits to the GP, dietician, podiatrist, ophthalmologist and other specialists in full.
- Check up on tests and equipment
Diagnostic tests are usually covered in full, as well as annual HBA1c, creatinine microalbumin and lipid tests. Insulin pumps and other specialised equipment might only be covered by top-tier plans, or not at all.
- Use those additional benefits
Many of SA’s schemes offer free coaching, education and reward programmes. Make use of these benefits – they’ll help you to manage your condition better, saving you money in the long run.
The day that you are diagnosed with diabetes is a day that is hard to describe. The world stops but at the same time a neverending rollercoaster ride starts: one you never asked to get on in the first place.
I remember sitting in the doctor’s office and a funny thing happened: he said the test results came back and you’re a Type 1 diabetic. After that I was in shock. The funny thing is I knew that he was talking because his lips were moving, but honestly I have no idea what he said. It was all a blur to me. All I remember thinking is: how can this happen? I never ate much sugar and now I’m going to die. But at least I have an answer to why I’ve been feeling so sick the last few months.
After the shock set in, I remember going to the book shop to basically buy any book that had been printed that mentioned the word diabetes, and then reading them all and being more confused than ever as they all contradicted each other. After the initial diagnosis, the doctor suggested that I go and see an endocrinologist.
Well, I saw a few of them and what they were all good at was sitting me down and telling me the negative side of the disease. How you can lose your eyesight and your feet and how if you get wounds there is a good chance they won’t heal well. Then in the next breath, they explain that now you will need to go on a strict diet and inject for everything you eat ever. They seem to wonder why you look so depressed and have an attitude of, what’s the point to life any more?
At some point during the initial diagnosis, it seems we all go on a sort of autopilot. We inject when needed and ask every question we can think of, and blindly trust what our doctors say, because they’re the professionals and know what they’re talking about, right?
What we don’t realise then is that diabetes is a common condition but it’s also very individually based. What makes my levels go up can have no effect on a friend’s levels. The other thing we learn on our journey is that at some point all diabetics and carers become doctors, dietitians and endocrinologists. The only difference between us and the real doctors is that they have diplomas and we don’t, but we have the life experience and they don’t.
What I have learned the most in my love-hate relationship with diabetes is that while I hate the constant management and daily injections, being diabetic has made me a stronger person and taught me to stand up for myself. In a weird way, it has given my life a kind of warped purpose. So I guess I will always love to hate being diabetic. You know what? That’s actually okay and totally healthy.
We ask Dr. Tracey Naledi, the Chief Director of Health Programmes for the Western Cape Department of Health, to share her personal health tips and what the Department of Health has to offer diabetics who want to live a healthy, happy life with diabetes.
What does the Department of Health offer those with diabetes?
We focus a lot on prevention: diabetes prevention is so important. People need to be aware of the risk factors that lead to diabetes before we even start talking about the condition, so we highlight the dangers of a poor diet and being overweight, lack of physical activity, drinking too much and smoking. But this isn’t only the role of the Department of Health – it’s also important for individuals to understand what the risk factors are and to prevent them from happening in the first place.
We also screen people so that we can pick up those with early signs of diabetes, and provide proper diagnosis and treatment. If a doctor suspects you might be diabetic, it kicks in a whole process within our health facilities. But we also proactively do campaigns in community-based settings like malls, where we go out and invite people to test for hypertension, diabetes, cholesterol and HIV, and give them information on these conditions.
Do you believe community is important when living with a chronic condition?
Absolutely – I think community is important when you’re dealing with anything that government does. Government is something that works for the people: it is put there by the people to do things on behalf of the people, but at all times we need to be consulting with the people to be sure the things we’re coming up with are what they want. We have to make sure the way we’re doing things is what the community needs. That’s why we have processes to consult with community members, health facility boards and health committees, so that any problems can be discussed. Being close to the community is very important to us.
Why is diabetes a priority in South Africa?
Chronic diseases in general are a priority, because they affect so many people and are such a huge burden of disease. You also can’t just pop a pill for a chronic condition to go away: you need to treat it for the rest of your life. We have to make sure we have the capacity to deal with all these chronic diseases for a very long time. It’s a long term, lifelong thing. And the consequences of uncontrolled diabetes are actually quite serious.
What makes your life sweet?
God and my family. At the end of the day, when all is said and done, the most important thing to me is my family. My work one day will end, all the money in the world will disappear, all the material things will be gone, but there’s nothing I love more than coming home.
Managing everyday life challenges can be hard for the strongest and most emotionally balanced people. But having diabetes changes the game and adds extra curve balls we need to deal with. Depression is a very common problem, but studies show that people with chronic illnesses such as diabetes are three time more likely to suffer from depression and anxiety. With the constant management plan we have to follow, it’s no surprise that we are at greater risk for depression and anxiety.
Anxiety and depression can overlap with symptoms of diabetes, which make it harder to diagnose whether it is simply anxiety or rather depression that you are feeling. Anxiety can lead to depression if not treated correctly, but depression rarely leads to anxiety. Depression also has fewer symptoms, making it harder to diagnose.
Depression is a chemical imbalance in the brain which affects how you think and feel, and it can manifest in both emotional and physical symptoms. The thing to remember about depression is that you can suffer from depression without fully feeling depressed, and if you are depressed it’s not easy to simply snap out of it.
There are six main symptoms to look out for when dealing with depression:
- A loss of appetite or any change in eating habits
- Feeling down all the time
- Any change in sleeping pattern
- Lack of energy
- Loss of interest in daily tasks that you used to enjoy
- Feeling irritable all the time.
These symptoms are very similar to anxiety, however the main difference is that when you are anxious you worry more about the future and current things that have either happened or could happen. When you feel depressed, you simply have no drive to do anything and can only see things from a negative space.
To understand more about depression, it’s helpful to know what’s happening in your body. Your mood is determined by neurotransmitters such as serotonin and dopamine, which are released into the brain. When these levels are low, we start to experience feelings of anxiety and depression. Depression can feel a bit like anxiety and that is why it is often overlooked. A constant state of anxiety can show up in ways that make you feel physically sick, such as constant headaches, dry mouth, upset stomach and nausea.
To suffer from depression or to feel depressed does not mean that you are weak. Many people suffer from depression: it is an ancient disease that affects thousands of people, even famous people such as Winston Churchill. He used to call it his “black dog”.
As diabetics, we often have weaker metabolic and glycaemic control. This in turn can intensify depression symptoms: if not treated correctly, it can lead to diabetes burnout. We need to remember that when we experience depression or anxiety, the body reacts the same way it does to stress. The fight, flight, fright response is activated which releases adrenalin and cortisol into the blood stream, which in turn increases our sugar levels. There are many levels of depression ranging from mild to major: the levels don’t get worse, it’s simply the consequences and symptoms that change.
Depression affects everyone and people suffering from chronic conditions are at a higher risk of suffering from depression and anxiety. One of the most important things to remember about depression is that you can suffer from depression and not look depressed. The symptoms for depression do not always manifest in the known ways: it is also linked to aches and pains in muscles or constant headaches.
So what’s the answer? We need to find ways to relax as much as we can and remember to listen to our bodies. You are not alone in this.
Do you know what brittle diabetes is? We asked one of our readers, Rencia, to share her story of living with brittle diabetes with us.
I was diagnosed as a juvenile diabetic at the tender age of 5 and a half. This was in 1987, when medicine was not as advanced as it is today.
Upon diagnosis, my parents were told that I would have to take insulin twice a day for the rest of my life and refrain from eating sweets, cakes and all the good things. At that point in my life I couldn’t grasp the enormity of being diabetic. I adhered to the diets and adapted quickly to the injections and glucose testing methods. I would often hear my parents discussing how doctors had advised them that I needed to be told that due to my diabetes I would never conceive children.
The strict control became non-existent when my parents got divorced. I guess as a teenager I didn’t understand the repercussions my teenage years would have on my life.
At the age of 19, I began to notice that my vision was being halved. I went to an ophthalmologist who had me undergo all kinds of tests to determine what the problem was. I was suffering from diabetes retinopathy: when the retina detaches from the back of the eye. If not treated as soon as possible, this leads to permanent blindness. I underwent my first eye operation to reattach the retina in my right eye and had to wait four months with sight only in my left eye. During the 4 months, I lost the vision in my left eye too and for the remainder of those months I had no proper vision, just distorted images in my right eye.
After the operation to my left eye, I became critically ill with hyperglycaemia (high blood glucose levels). I was in a coma for a few days. At this point I was being treated by my current specialist. He changed my insulin and put me on four insulin injections a day, as well as four blood tests a day. I had a new lease on life it seemed and I would take hold of it with both hands. I began to keep away from all forbidden items and all seemed well.
In mid 2007, I began having frequent lows and highs. Maintaining my blood sugar levels became more and more difficult, and it was worrying as I started losing chunks of my memory when I had a hypoglycaemic episode. I saw my specialist who diagnosed my diabetes as brittle diabetes. He explained that brittle diabetes is when you have hyperglycaemia and hypoglycaemia without much warning. There is no treatment for this, except frequent blood sugar checks.
I am often ill with mostly low sugar levels, ranging from 1.6 to 2.2. I’m seldom able to determine when these episodes occur which leads me into very dangerous ground. Brittle diabetes is a sub-type of Type 1 diabetes, a term used to describe particularly hard to control Type 1 diabetes. Those people who have brittle diabetes will experience frequent, extreme swings in blood glucose levels, causing hyperglycaemia or hypoglycaemia.
At the end of 2007, I was experiencing severe tenderness in my left eye and I visited my ophthalmologist who suggested I have my left eye removed as it was shrinking and becoming noticeable that there was no vision in the eye. I had the eye removed and 6 weeks later was fitted with a prosthetic eye.
Against all odds, I conceived my first child in 2010. It was a petrifying experience for me because I was so afraid of something going wrong. On the 4th of October 2010, I gave birth via C-section to my son Tyler. It was a very trying time keeping my levels down. I have successfully had two children – my second pregnancy was easier, though I was hospitalized three times in my first trimester. Once that was over, I maintained constant contact with my specialist and tried my utmost to keep my levels between 4 and 8mmol/l, so that I didn’t have to deal with the effects of my brittle diabetes.
Living with Type 1 diabetes is not as easy as most people thank. It’s a constant challenge and mine is slightly more difficult. However, I do try to rise to each of the challenges to the best of my ability. It’s my great desire to one day receive sponsorship in order to obtain a DAD (diabetic alert dog) – a dog trained to pick up if your blood sugar is high or low by the scent your body omits. Having one of these dogs as a brittle diabetic would be such a great help. It could be a lifesaver.
I urge parents, teenagers and even older individuals to take extra care of their diabetes from day one of diagnosis in order to prevent the challenges I face daily. See your doctors regularly and you could lead a fairly normal life. Diabetes is a life-altering illness, but with the correct care from day one you can lead a fairly normal life.
– Rencia Gabriel-Phillip
Would you like to share your story of living with diabetes with the Sweet Life community? Email us – we’d love to hear from you.
From our community blog:
I am in urgent need of assistance to help me get my diabetes / blood sugar levels in control and I’m actually almost on the brink of losing it… I’m struggling with sky high sugar levels and very low sugar levels, but it’s never between 4 and 6, it’s either lower, very low, or very-very high! I don’t know what to do anymore…
Please give me some advice. I am 28 years old, and have been diabetic since I was 9 years old.
Do not give up. If you are in a position to visit a Provincial Hospital do so. I want you to see a doctor please, for expert advice, as you need to undergo tests.
Sorry to hear that you are struggling with your diabetes. It is difficult to know how to help unless I have some information about types, doses and frequency of injections as well as some glucose values. You need to test and establish a pattern as to when the problems occur and in relation to what. Blood sugars that swing up and down cause more problems than those that are more stable. I suggest you establish a testing profile and then post again.
I have been a diabetic for 9 years as well and I am also 28 years old. You need to take a look at your diet and your lifestyle. From your email you sound like you are under a lot of stress and that is not helping your diabetes. With your sugar levels being so out of control your moods get affected badly. So strange how sugar levels have this effect on us but very true. You need to eliminate as much stress from your life as you can. You can get back to where you need to be as long as you take the day by day steps.
Your eating is very very very important and if you can try to exercise you must. When I was first diagnosed mine used to sit in the 30′s NOT GOOD! But now I am between 5-8 most days. I know that there are days when it is hard to keep your sugar levels under control but YOU CAN DO IT!
Please let me know if I can help with anything!
You would never guess that Trevor Davids, a business consultant, film and TV producer and biker filled with the joys of life, has Type 2 diabetes. That’s because he’s managed to take diabetes in his stride.
When did you find out you were diabetic?
Six years ago, in November 2010. I had all the usual symptoms – constantly thirsty, needing to urinate a lot – and I looked them up on the internet. Up came: diabetes. I read up on the condition before going to the doctor, and then announced, “I have diabetes.” We took the necessary tests and my blood sugar was really high (18mmol/l), so I was put onto insulin tablets immediately. Diabetes doesn’t run in my family, I’m not overweight and I do a lot of exercise, so I’m not a typical Type 2 case. I do have high blood pressure that runs in the family. When I was diagnosed with diabetes I had already given up alcohol ten years before, but I was smoking 40 cigarettes a day, so I had to give that up too. After 31 years of smoking, I quit on the first try. Once I make up my mind about something, there’s not much that can move me.
How has diabetes changed your daily life?
I’m a lot more conscious of my eating patterns now. I never used to eat breakfast – I’d grab something on the run, snack in the afternoon, and then eat a big plate of food in the evening. I had to learn to be less flexible about food. Eat a regimented breakfast, lunch and dinner, look at my intakes and learn about low GI. I couldn’t have done it without my family – my wife Norma and son Danté have been the most amazing support.
How do you manage to focus on the lighter side of living with a chronic condition?
I never focussed on the darker side of diabetes! I’m a very positive person, I like being focussed on doing something well. In challenging times, I just take it in my stride and deal with life’s knocks as they come.
Is there anything diabetes has stopped you from doing?
No. Only smoking! I’ve actually been able to take on more daily life challenges since being diagnosed, because I restructured and reorganised my life, so I now have more time.
What advice would you offer to other diabetics?
If you’ve just been diagnosed, don’t worry – it’s not as daunting as you think. It can become a lifestyle condition, you just need to adapt your lifestyle. Diabetes is part of who you are now, and denying it doesn’t make it go away.
What makes your life sweet?
Life itself! And my family, of course. And laughter: the ability to laugh and create a laugh. I believe that people can live a long time if they can learn to laugh in the face of adversity. I like to use laughter as part of my medication.
I was lucky enough to be invited to the most fascinating diabetes conference in Cape Town recently: Tackling the Challenges of Diabetes and Obesity in Africa.
The line-up was truly impressive (more on that below) but what really struck me was how engaged and passionate all the attendees were about the issues of diabetes and obesity, and what we – as individuals, researchers and caregivers – can do about it.
But first! The amazing speakers and their topics.
The first day was chaired by Professor Naomi Levitt, the Head of Diabetic Medicine and Endocrinology at the University of Cape Town. Prof Levitt gave an overview of the issues of diabetes and obesity in Africa, and led the discussions after each talk. Her passion for diabetes research in South Africa is palpable.
Professor Justine Davies is a Professor of Global Health from Kings College London and started us off with a talk on Health systems challenges of deadling with diabetes in sub-Saharan Africa. She’s the previous editor of The Lancet journal and gave insights from The Lancet Diabetes and Endocrinology Commission. A fascinating look at just how severe the problem is in sub-Saharan Africa.
Then it was Dr Ankia Coetzee‘s turn. She’s a Clinical Endocrinologist at Stellenbosch University, with a special interest in gestational diabetes. Her talk – Gestational Diabetes Mellitus: The Alchemy of Diabetes Prevention? – suggested that treating those with gestational diabetes holistically can be a key to unlock future Type 2 diabetes.
After a short tea break to let the information digest, Salaamah Solomon, a Dietician from Tygerberg Hospital, spoke about Challenges in Nutrition Education – specifically, how essential it is to make nutritional information as simple as possible so that it can be easily adopted.
Then Professor Julia Goedecke, a Researcher at the South African Medical Research Council, spoke about her research into Mechanisms underlying insulin resistance in black South African women, which sparked a whole debate around exercise and diet as two critical components in Type 2 diabetes management (along with medication, of course).
After a fascinating lunch spent absorbing more diabetes information, Professor Tandi Matsha, the Head of the Department of Biomedical Sciences at Cape Peninsula University of Technology spoke about Epigenetics and Type 2 Diabetes. I didn’t know much (if anything) about epigenetics, so this was a real eye-opener for me.
And then Dr Sundeep Ruder, an Endocrinology Consultant and Lecturer at the University of the Witwatersrand, took things in an entirely new direction with his presentation about Philosophy in Diabetes – how it is our goal as humans to be peaceful, blissful and happy, and too often we use food as a cheap trick to get us there. (Among many other fascinating points!)
I had to get home to my young children, so sadly I missed Professor Carel Le Roux‘s talk: Can we approach obesity as a subcortical brain disease to address prediabetes and diabetes? I also missed Professor Andre Kengne‘s talk on Diabetes and BMI trends in Africa – both of which were discussed a lot the next day.
The next day was World Diabetes Day, and Dr Rufaro Chatora from the World Health Organisation gave some opening remarks about World Diabetes Day.
Then it was time for the keynote presentation, by Professor Jean Claude Mbanya, Honorary President of the International Diabetes Federation (Africa Region and Global), and Professor of Medicine and Endocrinology at the University of Yaounde, Cameroon. He gave a fascinating presentation on Global and Africa’s Burden of Diabetes, releasing the latest research from the 8th IDF Diabetes Atlas.
Then it was Dr Eva Njenga‘s turn to tell us about diabetes in Kenya. She’s the Chair of the NCD Kenya Alliance and the Director of the Kenya Diabetes Management and Information Centre, which she co-founded. They get funding from the WDF and partner with the Minister of Health to make a tangible difference to people with diabetes in Kenya. She spoke about Changing lifestyles to combat Diabetes, Obesity and other NCDs.
It was really the most extraordinary two days of diabetes discussions, talks, information sharing and inspiration. I left feeling so motivated to make a difference to people with diabetes in South Africa, and so inspired by all the doctors, researchers and healthcare workers who are so involved in diabetes in our country.
I can’t wait for the next one!
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.
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.
From our community blog:
Petunia has a question for us about lowering high blood sugar:
“I would like to know what can I do to bring down my sugar. I have Type 2 diabetes, I’m on Actraphane 30/70 and I don’t have a proper diabetes diet.”
What do you suggest?
The obvious ones that spring to mind are:
- Eat lots of fresh vegetables, wholegrains, lean protein and no refined carbohydrates.
- Steer clear of sweet treats.
- Drink lots of water.
- Exercise a little every day – even if it’s just a walk around the block.
- Lose weight if necessary.
What do you have to add? Let’s help Petunia out!
I am also Type 2 – I find the best thing is exercise. Sometimes you can’t avoid the carbs, but if you walk, run or cycle 30 min per day – you can reduce your sugar levels significantly.
Diabetes is not an easy quick fix ever. It is important to manage this condition in the best way always and this means getting a lot of HELP! I suggest you find a dietician or a diabetes educator in your area and schedule an appointment a soon as possible. In order to understand this condition it’s important to understand how food and your medication impact on your glucose levels. It becomes so easy with this help!
From the artificial pancreas to new ways of testing blood sugar and more, we take a look at the future for those with diabetes.
Diabetes is a rollercoaster ride of blood sugar ups and downs, and tight control can be hard work. But there’s good news: while some researchers are working on a cure, others are making life easier for those with diabetes right now, through technology.
Carine Visagie brings you a roundup of the top new technologies out there.
Continuous glucose monitoring (CGM) devices are soon going to take blood sugar control to another level.
With the help of tiny electrodes stuck beneath the skin, CGM devices allow for real-time glucose readings throughout the day. The results are sent wirelessly to a monitor you can clip onto your belt and access on the go, and some devices can even send results to your doctor. Normal finger prick testing is still required (for a double check and to calibrate the CGM sensor), but you can rest assured that a CGM device will alert you if your sugar spikes or drops below your limits.
Examples include the Flash Glucose Monitoring System (Abbott) and the Guardian REAL-Time Continuous Glucose Monitoring System (Medtronic).
Ask the expert: Dr Joel Dave, endocrinologist
“24-hour glucose monitoring is going to be very helpful in patients that have difficulty controlling their blood glucose levels, as it will provide a 24-hour 360-degree view of their diabetes control.”
Ask the expert: Dr Wayne May, endocrinologist
“I’m looking forward to the Abbotts Flash Monitor, as it will stay on for 14 days and doesn’t require calibrating with a second machine.”
Insulin pumps keep getting smarter: some of the latest ones sync with CGM devices, while others are incredibly accurate at giving just the right insulin dose at the right time.
One example is the touch-screen Tandem t:slim insulin pump, which shows the date, time, how much insulin is ‘on board’ (seeing this before you bolus can help you avoid stacking your insulin*), duration of insulin action, and the amount of insulin in the reservoir. It looks like a smartphone and data is easily transferrable via a USB port. Plus, it can deliver insulin in very small doses.
*Insulin stacking is injecting a second dose too soon after a first, without taking into account the insulin already in your system. This can result in low blood sugar.
Another insulin pump to watch is the MiniMed530G by Medtronic – the first pump to shut off when blood sugar goes below a predetermined level.
Ask the expert: Dr Joel Dave, endocrinologist
“Although an insulin pump isn’t the ideal way of administering insulin for everyone, many diabetics find a pump improves their diabetes control and quality of life. Since the addition of CGM, the use of this technology has improved even more, especially in children and patients with very erratic blood sugar.”
Bionic (artificial) pancreas systems are the next big thing in diabetes management. These systems, the first of which is still being tested, combine the latest CGM tech with the most advanced insulin pump tech and add a sophisticated computer programme to simulate the function of the pancreas.
The system constantly checks blood sugar levels by means of a CGM, and responds automatically by administering either insulin (to lower blood sugar) or glucagon (to raise blood sugar levels quickly) via two separate pumps. The system hooks up to a programme on your smartphone that makes decisions every few minutes, telling the pumps via Bluetooth how much hormone to deliver.
The bionic pancreas should be available in the next 5 years.
Ask the expert: Dr Joel Dave, endocrinologist
“The artificial pancreas has been the ‘holy grail’ for diabetes care for many years. The system has been vastly improved and early studies are showing great promise. Although not for routine clinical use at the moment, in the near future it will be a life-changing addition to the diabetes care of many patients.”
What about now? Smartphone apps for diabetes
If the future of diabetes tech seems too far away, keep an eye out for apps that can help you deal with diabetes right now, on your smartphone. We like:
Glucose Buddy: to track blood sugar readings, insulin doses, carb intake, exercise, blood pressure and weight, and
Diabetic Connect: helping you tap into trusted advice, friends, support and tips.
But be warned: many international apps use mg/dL, the US blood glucose standard, instead of mmol/l, the South African standard.
- 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.
Celeste Smith is no stranger to gestational diabetes: she’s had it twice, including during her pregnancy with now-five-year-old twins Connor and Adam. We find out what she wishes she’d known before she fell pregnant.
Is there a reason you’re so happy to share this very personal story?
I want to educate, encourage and motivate women with gestational diabetes, and prevent other women from having to go through what I and many others had to endure.
How did you find out you had gestational diabetes?
My first pregnancy was stillborn: Noah was born at 38 weeks. I didn’t know I had gestational diabetes until after Noah was born. We suspected with my family having diabetes that I could get it, but my doctor at the time never picked it up. When I wanted to fall pregnant again, my new doctor Dr Jansen immediately tested for glucose tolerance before I fell pregnant, and then again after I fell pregnant. That’s how we found out I had gestational diabetes again.
What were your symptoms?
What’s tricky about gestational diabetes is that it goes from nothing to full-blown diabetes very quickly. It’s only when you’re pregnant, so there’s no warning beforehand. The symptoms I had were swollen hands and feet, bad circulation, pins and needles in the hands, and constant thirst – I was drinking a lot of water.
Does diabetes run in the family?
Yes – my late mother had Type 2 diabetes, and three of my sisters and my brother have diabetes (half of my eight siblings, in fact!) None of my family recognised my symptoms, but none of us were looking for them: you put your faith in the doctor, that’s what doctors are there for.
What did you do to manage your gestational diabetes?
During my pregnancy with the twins, I was put on Metformin and later insulin. I also had to have monthly HbA1c tests and test my blood sugar seven times a day: when I woke up, before each meal, after each meal and before I went to bed. My fingers had so many holes in them; I didn’t know where to prick myself! I went to a dietician, which was helpful, we discussed good eating habits and made a lot of changes – we started eating more steamed foods and not so much starch (like potatoes, bread and pasta). And I started exercising. My diabetes doctor, Dr Dave, told me I had to exercise every day, even when I was tired after working all day.
What advice would you offer to women with gestational diabetes?
Listen to your doctors, stick to your eating plan and exercise a little bit every day. Stay focused: this is for the health of your babies. It helps that you just have to stay focused for nine months, and then the reward at the end is breathtaking. My boys were big for twins (2.8kg/each at 35 weeks) and healthy. I’ll never forget how relieved I was to hear both babies crying in the delivery room. They were both crying at the same time, and the doctor said: “Wow, they sound like a choir!”
What makes your life sweet?
I could say sunsets and sunrises, I could say my religion or even cupcakes and chocolates. But my husband and three boys are the light of my life, and sharing everything with them makes my life so sweet.
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 chat to Ishay Govender, acclaimed foodie writer, about her love of cooking and how to make Indian food just as tasty – but a little healthier.
You have a family history of diabetes – have you been tested yourself?
I get my blood sugar and cholesterol tested once a year – every year. Because I’m aware that Type 2 diabetes is often a hereditary condition, I’m very conscious of my health and how food contributes to my wellbeing. In traditional homes there’s an emphasis on food and family as a way of expressing love, and I know I’ve inherited that from my mother and grandmother – sharing food with people is my way of expressing that love.
Have you made any changes to your diet because you know Type 2 diabetes runs in the family?
I’ve learnt to alter things slightly so that they’re healthier but still have lots of flavour. When we first found out that my mom was diabetic I did a lot of research, and made sure she went to a dietician and found out specifics of how to change her cooking style. That said, we grew up in a very healthy household so the changes weren’t too difficult.
What advice would you offer to people who are struggling to eat a healthy diet?
I think the most important thing is to accept and make peace with the fact that you have diabetes – it doesn’t make sense to fight it. Also, food should never be about restriction, it’s about enjoyment. Change the spotlight from focusing on what you can’t have to what you can enjoy. It’s a great time to explore flavours, textures and a sense of fun in the kitchen.
Have you learnt any ‘tricks’ to make traditional Indian food a little healthier?
A few! Here are the main ones:
- Cook with less oil – it is possible, especially if you use olive oil cooking spray.
- Don’t eat double starch (i.e. rice and potato curry, or curry and roti)
- Cook vegetables for a shorter period of time so that they keep some of their goodness – things like okra and butternut don’t have to be cooked to mush.
- Rethink vegetables – they don’t only have to be pickled or curried, they can be fresh with interesting dressings. I try to include half a salad in a meal, with a yoghurt dressing (plain low fat yoghurt with toasted cumin seeds, mint and lemon zest – delicious!)
- I only use baby potatoes with their skins on – they’re low GI and the skin has fibre.
- Brown rice is so much healthier than white rice – it’s full of fibre and has a lovely nutty flavour. You also need less rice because it fills you up more.
- Spices and herbs are a diabetic’s best friends! They add such flavour and zest, and you can experiment with different combinations to make a dish more interesting.
What makes your life sweet?
The pleasure of enjoying food and food travel with my husband. Cotton pyjamas and fresh linen. The knowledge that even someone with a ‘soft’ voice like mine, can make a difference using it.
Get in touch with Ishay: @IshayGovender on Twitter / Instagram / Vin