diabetes in South Africa

Fun and informative posts about diabetes in South Africa.

The secret to a happy life with diabetes?

From Facebook (Diabetic South Africans):

What’s the secret to a happy life with diabetes?

To not make it an issue. Treat it and forget it. Life is too short.
Louis

Most people suffer some type of illness, but we all have to just deal with it and get on with our lives.
Erika

Sorry to all those optimistic people out there… but there is no happy life with diabetes 🙁
Lisa

Finding the right balance… While diabetes is not a good thing to have, one certainly does still have a happy life. Be informed… and that goes for your spouse and family members too.
Lynnae

Support and understanding from the people closest to you makes it easier to live with.
Adele

Top tips for a pregnancy diet

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.

Yoga and diabetes

Yoga is not only a fantastic form of strengthening exercise, it’s also great for calming the mind – something most of us with diabetes need to do! Bridget McNulty finds out more.

As a diabetic, the one thing I hear over and over is that exercise is good for me. And it is! But sometimes exercise feels a bit too much like… well… hard work. Not so with yoga. I started doing yoga a few months ago and I’m totally hooked – it has just the right balance of strengthening, balancing and heart-racing poses, and I love that we get to meditate after each class. I asked yoga teacher Tasha Saha why she thinks yoga is particularly good for diabetics.

“As well as better fitness and cardiovascular health, yoga massages and stimulates the function of the internal organs, balances the endocrine system and has measurable effects on the release of stress hormones,” she says. “All of these are factors that affect blood sugar, so it’s no surprise that several major studies have shown that regularly doing yoga can significantly reduce blood sugar levels.” Another aspect of yoga that sets it apart from other exercise is that it increases body awareness, which makes it easier to maintain a healthy weight and to make wiser food choices.

But which yoga to choose? In general, hot yoga (Bikram) and flow yoga (Ashtanga) are more demanding, so it’s better to begin with a slower practice like Hatha or Iyengar. Some poses (especially those that are active in the abdominal area and lower back) are particularly good for diabetics because they target the pancreas, promoting better function and helping to lower blood sugar levels. “But a balanced yoga session will work holistically on every system in the body,” says Tasha, “as well as the mind and emotions too – lowering stress levels and helping the whole person towards balance.”

I can honestly say that my yoga practice has helped me feel not only stronger and fitter, but calmer and more able to take on the daily challenges of diabetes.

Want to give it a try? Many yoga studios offer free trial periods or classes to beginners. Most gyms also offer yoga classes at a fraction of the price of private classes.

Find a yoga teacher in your area
Or visit Tasha Saha

Taking diabetes education to schools

When Roxanne and Derick de Villiers wanted to enroll their son Noah in pre-school, they didn’t think diabetes would be an issue. When it turned out it was, they turned the situation around.

Can you tell us about Noah’s diagnosis?

It was just before his 3rd birthday. When Noah got really sick and then diagnosed with Type 1 diabetes, we were really emotional. Here was our little boy who had this huge change in his young life: nurses and needles – that’s a picture we will never forget. But we can promise you this: in the midst of those overwhelming emotions, your parental instinct to protect your child immediately kicks in and your mind opens up so much to take in all that you need to. There is an urgency to get on top of the changes and adapt as quickly as possible.

Has it become any easier with time?

It has, it really has. You know that old saying that time is a healer? We believe time is a teacher. Diabetes is now second nature and so much a part of life. Having other family members also educated about Type 1 diabetes has made it easier as well because they can also test and inject when necessary.

When did Noah start pre-school?

Noah actually started pre-school the January before he was diagnosed with Type 1. When the pre-school was informed about him being diagnosed, the principal and his class teacher were at the hospital and were really supportive about this change in his life. What really impacted our lives positively was that they were prepared to learn and take part in this process too.

Could you tell us about the school application process?

At Noah’s first pre-school in 2012, he was already enrolled ahead of being diagnosed. We then made a home move and Noah needed to move pre-schools too. The school we enquired at for enrolment was amazing. Applying for Grade R was a little bit different and more involved. They had never had an application that included full disclosure of the child having Type 1 diabetes. We had a few meetings with the Executive Head and we pressed on for the understanding that we (the school and parents) could put a fair process in place that would protect both the child and the school without discarding school laws.

We needed to be a voice for Noah, for other diabetic children to follow and especially for the parents of diabetic children who go through this worry and want to enroll their precious children at the schools of their choice. The Executive Head and Regional Head of Noah’s grade school were true blessings because they agreed to put the suggested process in place and were on board to becoming the forward thinking, proactive and progressive school that they are. A beautiful school/parent relationship exists now.

What advice would you offer to other parents about diabetes education in schools?

The education is ongoing. It is never a once-off. Urge the school to have more teacher / parent sessions to talk openly about Type 1 diabetes. Whether your medical support is private or public, involve the nurse, the pediatrician, or the professor looking after your child. There is a big need, a big want and a big drive for education in this area. Minds need to be changed about diabetes and its management within the school system.

What makes your life sweet?

For Noah, having control of the DSTV remote and the Smart Tab and for us, his parents, seeing him so confident and secure even though he lives with diabetes.

Photos taken at Noah’s current school, Curro Century City.

Exercise classes for diabetics

Are you looking for a fun way to get fit? Here are a few exercise classes specifically for people with diabetes – we’ll add to this list as we find more! Please email us with details of other fun fitness classes for diabetics.


Latha Singh: Chatsworth, Durban

I’ve been an exercise instructor for the past 28 years. I teach exercise classes for women and senior citizen groups in and around Chatsworth.

I would love to spread my knowledge and literally hold exercise classes at hospitals (like Chatsmed Garden Life Hospital) and other venues to make people aware of the importance of exercise, especially people with diabetes.

My classes are currently at:

  • Malvern Library (Queensburgh): Monday and Wednesday from 8am to 9am
  • Shallcross Heidi School Hall: Tuesday and Thursday mornings from 8am to 9am
  • Woodhurst Library, Chatsworth: Tuesday and Thursday from 6pm to 7pm
  • Mobeni Heights Temple Hall: Wednesdays from 10am to 11am
  • Woodhurst Library: Thursdays from 11am to 11.30am

Email Latha to find out more.

 

Kayla Murphy: Randburg, Johannesburg

We are a private biokinetics practice in Randburg, Johannesburg. We specialise in youth and adult diabetic exercise classes: Fit for Diabetes (see below PDF for more info).

We are happy to do any free classes or participate in educational talks to get more involved and contribute to the diabetic community of South Africa.

Email Kayla to find out more.

Download (PDF, 1.05MB)

10 Fast facts about diabetes as you get older

Keeping your diabetes in check as you get older is not only possible, but important. Here’s what you need to remember.

  1. Diet is vital: be sure to eat as balanced a diet as possible. Not eating the right kind of food or often enough can result in low blood sugar. Drinking plenty of water is also important.
  2. The average HbA1c in the elderly population in SA is within national guidelines at around 7.3. What’s yours?
  3. Be prepared and always have at least 3 days of supplies on hand for testing and treating your diabetes.
  4. Hypos (low blood sugar) are a risk, especially in Type 2 diabetics who are on SUs (sulphonylureas). Severe hypos can result in comas, so it’s important to know how to treat them.
  5. Always keep a glucagon pen on hand for hypo emergencies (and make sure you’ve told someone close to you how to use it).
  6. Controlling Type 2 diabetes with Glucophage or Galvus can have a life-changing effect.
  7. It’s important to have regular blood pressure and cholesterol tests, and annual kidney, eye, teeth and feet check-ups.
  8. It’s a good idea for any diabetics over 65 years old to have a pneumonia vaccine shot. An annual flu shot is also beneficial.
  9. Keep active as it helps with mobility, balance, strength, mental wellbeing and insulin sensitivity.
  10. Studies show that older diabetics are more compliant than teenagers, the newly diagnosed, and even pregnant diabetics.

Yoga may help reduce heart disease risk

The millenary practice of yoga is fast gaining ground on a worldwide scale; known as an efficient stress buster that brings practitioners greater vitality and a better mood, it also helps prevent heart disease, which is good news for people with diabetes.

Heart disease a risk for people with diabetes

Adults with diabetes have a higher likelihood of heart disease for various reasons. Those with Type 2 diabetes, in particular, may have conditions that can increase this risk, including high blood pressure, high cholesterol and triglyceride levels, and obesity. Leading a sedentary lifestyle is another modifiable major risk factor for both cardiovascular disease and insulin resistance, so one way to reduce the risk for heart attack or stroke is to keep physically active through aerobic activity and, new studies indicate, yoga.

Yoga as a means to reduce cardiovascular disease risk

In a review of 37 randomized controlled trials, researchers from the Netherlands and the USA found that yoga can provide the same benefits in risk factor reduction as commonly recommended activities such as cycling or fast walking. These two forms of exercise could have comparable working mechanisms; that is, yoga could have more physiological benefits, and exercise more relaxing effects than was originally thought.

As a deeply spiritual practice affecting physical and mental health positively, yoga is being embraced in a plethora of mental health settings, including rehabilitation centres for substance abuse. Science is more accepting than in the past of so-called ‘alternative therapies’ like yoga since numerous studies have shown that spirituality is linked to greater happiness and reduced anxiety and depression – key factors in managing diabetes from an integrated perspective.

In the studies, yoga practice was associated with significant improvement in Body Mass Index (BMI), blood pressure, and lipid levels, particularly when patients also took medication.

Yoga and aerobic activity a winning combination

Another, more recent study, presented at the American College of Cardiology in 2017, found that those who already have heart disease but practiced yoga in addition to aerobics, saw twice the reduction in BMI, blood pressure, and cholesterol levels, as those who practiced either of these activities exclusively. Combining these activities could also increase exercise capacity and improve heart function.

Of course, even if you only have time for yoga, you will still be doing yourself plenty of good, since heart rate variability (an indicator of optimal heart health) is higher in yoga practitioners. Yet another study showed that yoga can reduce atrial fibrillation (‘heart quivering’) while improving heart rate, blood pressure, and general quality of life.

If you have diabetes, it is important to lower your likelihood of heart disease by staying active, keeping to a healthy weight, and tapping into the potential of combining yoga and aerobic activities, making time for each throughout the week. By boosting physiological changes and lower stress levels, you can kill two birds with one stone, finding greater enjoyment and vitality as an added bonus.

Reflexology and diabetes

Bridget McNulty finds out what reflexology is all about, and if there’s any chance it can help those with diabetes.

Before I went for a reflexology session, I didn’t know much about it. I knew it was more than a foot massage, but didn’t really see how pressing a few points on my feet could affect my health and wellness.

Reflexology, it turns out, is a therapy that uses specific finger, thumb and hand pressure techniques on the different reflex areas, or zones of the feet, to correlate with different organs of the body. A reflexologist can tell you a lot about your body by feeling for congestion and imbalances in the feet, which show up as tightness, sensitivity or grainy areas. They can also ‘read’ the feet: the shape of the feet, the valleys and peaks, and how they respond to pressure.

The South African Reflexology Society has been recognized by the medical profession, and all reflexologists have to register with the Allied Health Professions Council. But what does a reflexology session actually feel like? Well, at first it is a little uncomfortable. The therapist looks for areas of tension or imbalance, and these are rubbed or pressed until they loosen. It’s like having a really firm massage: not painful, but not necessarily soothing. It is deeply relaxing, though, an hour of having your feet worked on feels like a few hours of sleep, and Lulu Beyers, the therapist I went to, says she has a lot of insomniacs as patients!

Reflexology, like most alternative therapies, has to be given on a regular basis to really see the results and changes in the body – the changes are slow but can be very positive, especially when it comes to treating complications of diabetes, like numbness in the feet. There have been a number of studies done on diabetes and reflexology (including self-reflexology, like the example below). The studies are mainly in Korea and China, as reflexology is an accepted form of healing in the East. (It began in 2330BC in Egypt, then spread to India, and from there to China and Japan.) Many of these studies show that reflexology is helpful in improving peripheral neuropathy, especially tingling sensation and pain, as well as slightly lowering blood sugar – perhaps due to a reduction in stress from the relaxing nature of the treatments – and an improvement in fatigue and mood.

Whether this is because of the nurturing nature of the treatments, an improvement in blood circulation from the massaging movements of reflexology or because of the endocrine system (especially the pancreas) being activated through pressure points is still to be discovered. But there is certainly no harm in having reflexology as part of your diabetes programme. Think of it as putting your feet up on the diabetic table, made up of the right medication, a healthy diet and regular exercise.

Try out this simple self-reflexology at home:

Press on each of these glands of the endocrine system (pictured below) with the base of a ball point pen for a few minutes at least once a week.

Ask the expert: Andy Blecher, podiatrist

“In my opinion, having time out to put your feet up and have them massaged can be good for your overall wellbeing – and if there’s some evidence that it helps with circulation and peripheral neuropathy in diabetics then patients should give it a try.”

Find a reflexologist in your area: www.sareflexology.org.za
Or visit Lulu Beyers in Cape Town: www.white-lotus.co.za

Lessons learnt from a diabetic pregnancy

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!

 

Get in touch with Bridget: @sweet_life_mag on Twitter or hello@sweetlifemag.co.za

Diabetes dietary tips

Ajita Ratanjee is a registered dietician on the Sweet Life Panel of Experts. She shares some of her diabetes dietary tips with us today.

Blood sugar control is of the utmost importance for a diabetic. To date, many diabetics have a challenge keeping their glucose levels controlled. A combination of the following 3 factors ensure good glucose control:

  1. Use of medication (oral meds or insulin injections)
  2. Diet
  3. Exercise

Foods to avoid

Most diabetics I meet are familiar with the “AVOID” list of foods. These are the obvious sugars e.g. Sugar, sweets and chocolates, sugary cooldrinks, cakes, pastries, biscuits, ice-cream, puddings etc. If you’re a diabetic and continue consuming the above list, then you are literally accelerating the chances of complications of diabetes: nerve damage, blurred vision, kidney failure, sores on feet etc.

However there are many who are compliant with the “AVOID” list yet may still find that their blood sugar levels remain elevated. Many years of clinical experience working with diabetics has allowed me to create a shortlist of other foods that are most likely spiking your blood sugar and you’re not even aware they are the cause. They are “healthy” food choices; however they tend to spike blood sugar and are not the best choice for a diabetic.

Other foods that spike blood sugar

These foods should also be avoided:

  • any 100% fruit juice,
  • dried fruit,
  • energy drinks,
  • flavoured bottle water,
  • energy bars,
  • muesli (containing nuts and dried fruit),
  • popcorn, and
  • rusks.

100% Juices and dried fruits are a concentrated source of natural sugar resulting in blood sugar elevation. Most energy drinks are loaded with sugar and are not suitable for diabetics. Energy bars tend to be marketed as low-fat, however that is not the same as sugar free (at all!)

The important thing to remember is that a diabetic should be aware of all foods that elevate bloods sugar levels. Grains, fruit and vegetables are all healthy but they need to be eaten in the correct portions to keep sugar controlled. Protein helps to stabilize sugar and thus an extra serving of meat / fish / chicken / egg etc. will not elevate glucose as much as an additional slice of bread / rice / potato.

The magic diabetes diet lies in the correct proportion of carb to protein at meals and snacks, and the correct portions at every meal and snack.

Choosing the right food

Fatty fish are high in omega 3 – tuna, sardine, salmon and mackerel are high in essential fatty acid. These are protective towards cardiovascular health and have anti-inflammatory properties. Diabetics are at high risk of heart disease thus omega 3 supplements are highly recommended. Make sure that you use good quality omega 3 that is heavy metal free.

Alcohol is metabolized as a sugar so plan in your glass of wine (preferable red and dry) or whiskey.

My key message in a nutshell would be it’s not just about “no sugar” but rather getting the carbohydrate and protein balance. Test your glucose regularly; at different times of the day. This enables you to monitor your control throughout the day. Test your sugar before a meal or 2 hours after a main meal. Keep a record of your blood sugar readings.

At Easy Health Wellness we assist our clients by teaching them how to exchange carbs and how to count carbs to ensure that they always are in balance at each meal and snack, and they can enjoy variety in their eating plans. We also stock a fabulous range of sugar-free products to support our diabetic’s client needs.

The diabetic way of eating is a very healthy way of eating. We can all do with avoiding the refined carbs and eating regularly.

Find out more at www.easyhealthwellness.com or call 012 997 2783.

Reiki and diabetes

Bridget McNulty goes for a reiki session to see what it can do for diabetics.

At first glance, reiki seems a little odd. How can it possibly help to have someone wave their hands over your body? What could this do for diabetes, really? But if you put your doubts aside for a minute, the effects of reiki can be quite profound.

To understand what reiki is, think back to the last time you stood in line at the bank, and someone came up behind you. Even though you couldn’t see the person, you could sense that they were in your space. This space is your energy field, and just like your body, the energy field becomes blocked from physical, emotional and mental experiences. These blockages can cause you to feel ill, or tired, or depressed – they literally block the flow of energy in your body. Reiki helps to unblock the energy field, which in turn unblocks the body.

So what does it feel like? Deeply relaxing. A reiki session generally begins with a conversation about whatever is bothering you, and then moves to the treatment, where you lie down and the healer moves their hands over your body. You’re fully clothed at all times, and while there may be some light pressing of the hands, it’s not a massage. Some people feel heat coming from the healer’s hands, others just feel relaxed and sometimes even sleepy. It is completely non-intrusive and actually very pleasant.

But what can it do for diabetes? That’s what I asked Debbie Caknis, the reiki healer I visited. “Reiki can help people with diabetes as historically it has been known to heal on the physical, emotional and mental levels of the personality,” she explained. “Therefore disease (or dis-ease, because the body is not at ease) is addressed on many different levels.” It’s not only a physical healing – emotionally you can begin healing stuck energy, and mentally you can learn how to cope with the management of the condition in a more positive way. “Reiki helps people to get to know their bodies and be able to respond to ailments in a conscious manner,” says Debbie.

What’s interesting here is the focus not just on the physical side of the condition, but also on the emotional and mental side. As all diabetics know, there’s a lot more to managing diabetes than just taking your medication, eating right and exercise. Reiki helped me to see my emotions around diabetes in a clearer way, and understand why I react the way I do to high and low blood sugar. It also took away a lot of stress, and we all know how badly stress affects blood sugar.

I left the session feeling calmer, more on top of my condition, and with a burst of fresh energy. In short, I was quite amazed what healing hands can do.

Want to give it a try? Go for a reiki session, or do a once-off course that enables you to do your own treatments at home.

Ask the expert: Ruth Scott, psychologist

“While it is easy to feel overwhelmed by all the treatment options out there claiming to ‘heal’ you, many forms of alternative therapy can really help to calm the mind and therefore relax the body. How you feel about your treatment is almost as important as the treatment itself.”

Find a Reiki healer in your area: www.reikihealing.co.za
Or visit Debbie Caknis in Cape Town: www.zeropointhealing.co.za

Climbing Kilimanjaro – with diabetes

It’s the highest mountain in Africa, but that didn’t stop Neil Rae – a Type 1 diabetic for 50 years – from wanting to climb it. We chat to Neil, 63, about his preparation, the climb itself, and life with diabetes.

How long have you been diabetic?

I was diagnosed on the 13th December 1964: over 50 years. I’ve seen a lot of changes for diabetics in my time – there’s a lot more we can eat, the technology to monitor blood sugar levels is a lot more advanced and the insulin pen sets are much more convenient. We’ve come a long way since the gas cylinder with a tin cup that I used to sterilise my glass syringes when I was at university!

What made you decide to climb Kilimanjaro?

I grew up in Lesotho and I’ve always had a love for mountains. I don’t know how many decades ago, I said to myself I wanted to set a goal for my diabetes: to climb Kilimanjaro when I’d lived with it for 50 years. About 18 months ago I contacted Novo Nordisk, the people who manufacture my insulin, to ask if they’d like to partner with me. They were very excited to join the challenge. As you can see it’s been a long-term goal of mine…

What did you do to prepare?

I’ve always been a relatively fit person, and I do a lot of walking with my wife Shaye, in and around the streets of Johannesburg and in the Drakensberg. I was walking between 30 and 40km a week and over weekends doing long walks in Westcliff – they have a flight of 222 stairs built into the rock face, and with a heavy rucksack on your back it’s good training! I did the climb with my doctor, Dr Bruce Ilsely and David Broomfield from Novo Nordisk so as a team we were well prepared.

How did you know what to eat and drink while climbing, and how to balance your blood sugar?

Balancing blood sugar was obviously going to be a challenge – spending between 7 and 8 hours a day climbing up and up and up all the time. It was tricky to balance that amount of exercise with the food supplied by the people who organised the walk – we didn’t take any food with us. Normally my sugar is very well controlled, so the plan was to do very regular checks of my blood sugar levels, see what we were going to be given to eat and then decide how much insulin to take. It turned out that I didn’t eat very much – I became nauseous quite early on, once we were over 3500m.

What was the hardest part of the climb?

The hardest part for me were the ascents and descents because you had to climb up mountains and then down into valleys, and there was a lot of very rocky pathways – walking from rock to rock. Some days we went up and down two or three times in a day. We left Moshi on the Monday and we summited on the Thursday night/Friday morning. Unfortunately I wasn’t able to make the summit – I got up to about 5000m and my altitude sickness was so bad that Dr Bruce said to me, “If you carry on, you’re going to die”. Once I got back down to the base camp at 4600m, then I was fine: it wasn’t diabetes related at all.

What advice would you offer to diabetics who are struggling?

In my opinion, every diabetic who’s struggling has got to develop a lifestyle routine: get up in the morning, check your blood sugar, decide how much insulin you need and what you’re going to eat for the day. You have to have a definite lifestyle routine, and stick to it every day. Discipline is so important to a diabetic. If you don’t have the routine and don’t have the discipline, you’re not going to live with it for 50 years!

What makes your life sweet?

I’m very fortunate: I’m married to a lovely lady and I have two daughters and four grandchildren now. My family, my life and everything in it makes my life very sweet.

How the diabetes diagnosis is changing

Type 1 diabetes used to be diagnosed in the young; Type 2, mostly in older people. But the picture is changing. Why? And what can we do about it? Carine Visagie asks the experts.

Since the 1980s, diabetes has rapidly increased – so much so that the global prevalence has nearly doubled since 1980, rising from 4.7% to 8.5% in adults. Over the past decade, Type 2 diabetes has become a massive problem in low- and middle-income countries and, for the first time in history, it’s a significant problem among the world’s children. What’s more, Type 1 diabetes is also on the increase.

It’s estimated that about 1.396 million of South Africans with diabetes remain undiagnosed, which makes it hard to judge the scale of the problem here. “But diabetes certainly is on the increase here, too,” says Johannesburg-based paediatric endocrinologist Prof. David Segal.

While the worldwide increase in Type 2 diabetes can be explained by unhealthy, modern lifestyles, rapid urbanisation (linked to inactivity and unhealthy eating patterns), a wider spread of the genes linked to the disease, and an ageing population, the reason for the increase in Type 1 diabetes is less clear.

To complicate matters, an increasing number of adults are presenting with latent autoimmune diabetes (LADA) – a form of Type 1 diabetes in which the progression of the disease is slow. As such, many adults with LADA are misdiagnosed as having Type 2 diabetes.

Type 1 diabetes in adults and the very young

 

At the start of the 20th century, diabetes was rare in children. By the end of the century, it increased substantially in many parts of the world and, right now, many countries are documenting higher numbers of Type 1 diabetes than ever before. Plus, the profile of patients is changing.

Across the world, this autoimmune disorder now often strikes at a younger age. And while similar research hasn’t been done locally, research shows that 50% of people newly diagnosed with Type 1 diabetes in the United Kingdom are over 30. This turns the long-held belief that Type 1 diabetes develops only in childhood on its head.

It’s long been known that both environmental and genetic factors contribute to Type 1 diabetes, but the exact triggers remain unknown. One of the theories, according to Johannesburg-based endocrinologist Dr Zaheer Bayat, is the hygiene hypothesis, which suggests that exposure to a variety of pathogens during early childhood might protect against Type 1 diabetes. A second theory suggests that certain viruses may initiate the autoimmune process involved. Another is that vitamin D deficiency plays a role. And a link between Type 1 diabetes and early exposure to cow’s milk is being explored.

According to Segal, being overweight or following the lifestyle of an obese person (being inactive and following an unhealthy diet) may also be a trigger. The “accelerator hypothesis” argues that Type 1 and Type 2 diabetes are in fact the same condition, distinguished only by the rate at which the beta cells in the pancreas are destroyed, and the triggers (or “accelerators”) responsible.

Type 2 diabetes still on the increase

In South Africa, Type 2 diabetes remains a massive health problem that accounts for more than 90% of diabetes cases. This condition, in which the pancreas either doesn’t produce enough insulin or the body doesn’t use it effectively, still predominantly occurs in adults. “But, for the first time, we’re also seeing young adults and adolescents with Type 2 diabetes,” says Bayat.

Ethnicity, family history and gestational diabetes combine with increased age, overweight/obesity and smoking to increase a person’s risk. In this country, the high incidence of Type 2 diabetes is also closely linked to the rapid cultural and social changes we’ve experienced over the last 20 to 30 years. With them came physical inactivity and unhealthy eating – both important risk factors.

According to Fiona Prins, diabetes specialist nurse practitioner, researchers are also currently investigating how, genetically, some of us store fat differently – a factor that could play a role in diabetes risk and management. “Some people may have ‘thrifty genes’, which would allow them to cope better on meals that are eight hours apart,” she says. “But this goes against all our messaging of eating three meals a day (or six, in the case of diabetics).”

Part of the problem, adds Segal, is that many of us don’t quite know what obesity is – we think we’re just overweight when, in fact, we’re obese. His advice is clear: “You have to lose weight to halt the progression to diabetes. It’s the only way.”

Jenny Russell, support group expert, adds: “Go and see a dietician who specialises in this field. They can do a thorough history and advise on an eating plan that suits you. Then simply get moving – every bit of exercise counts.”

Photo by chuttersnap on Unsplash

“Cheat” treats


Ask the dietician: Genevieve Jardine

From our community: “I know that as a diabetic I should always try and be good, but sometimes it’s hard… What can I snack on without feeling too guilty about it (but that will also be a treat)?” Charne Smith.

A treat is something that tastes great, is normally high in fat and refined carbohydrate, and is eaten to either celebrate or make you feel better… But how do you have your treat and prevent it from totally messing up your blood sugar levels for the day?

Treats are not forbidden, but they should not be too often or too big. It all comes down to self-control and portion control. The occasional block or two of chocolate should not mean disaster for your blood sugar: it’s when you eat the whole slab that things spiral out of control. Everything in moderation is the key.

If you battle with cravings, you need to understand that the last bite never tastes as good as the first bite. The feel good rush you get from the first bite of a treat starts to fade as you continue eating, but your blood sugar levels start to increase.

What does this mean? You only need a small amount to feel like you’ve had a treat. You don’t need the whole slab, packet, bowl or slice…

How to cheat:

  • Split a dessert with your partner. It might drive them nuts, but it will keep your blood sugar and weight down. Better yet, plan ahead and choose a light main course so that you can have a small dessert on those special evenings out.
  • Choose biscuits and cakes that don’t have icing, or remove the icing and jam from cakes. Icing has twice the amount of sugar as the cake or biscuit.
  • Choose a dessert like apple crumble (without the ice-cream or cream) or two small scoops of ice-cream. Just remember to keep portions small.
  • Spoil yourself with some good diabetic-friendly ice-cream (low fat/low sugar), lite custard and diabetic friendly puddings.
  • Opt for small “bite” sized chocolates or chocolates with wafer inside (e.g. Kit Kat Fingers).
  • Dark chocolate with a high percentage of cocoa is better for you as it is higher in antioxidants. Dark chocolate is also bitter so people tend to eat less of it: usually a block or two is enough.
  • Salt and vinegar popcorn instead of crisps will keep your fat content low and help with salt cravings. When going to the movies, choose a small popcorn and a diet drink.

Remember: Spoiling yourself on the odd occasion is allowed. Always test your blood sugar levels to see how they react and you will learn to better control these situations.

10 Fast facts about blood sugar testing

If you’re diabetic, you probably know all about testing your blood sugar… But are you doing it the right way? Here are some top tips.

  1. The goal is always to keep your blood sugar in a healthy range: not too high and not too low.
  2. Checking your blood sugar often makes it easier to understand the relationship between blood sugar levels and exercise, food, medication and things like travel, stress and illness.
  3. Blood sugar readings also give your doctor, diabetes nurse educator or clinic sister information to help you adjust medication and food, if your numbers are often too high or too low.
  4. Modern blood sugar meters only take 5 seconds and need just a tiny drop of blood.
  5. Pricking the tip of the finger is the easiest place to get the drop of blood.
  6. Before you test, it’s important to wash your hands with soap and water and dry them properly.
  7. Type 1 diabetics should test before every meal, to decide how much insulin to take.
  8. Before a meal, blood sugar readings should be 4 to 7mmol/l*.
  9. Two hours after a meal, blood sugar readings should be 5 to 10 mmol/l*.
  10. Keeping a blood sugar log is a very helpful tool for all diabetics. Write down your blood sugar test results, along with the date, time and what food you ate. This can make it easier to see if there are patterns in your blood sugar readings.