diabetes in South Africa
Fun and informative posts about diabetes in South Africa.
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!
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:
- Use of medication (oral meds or insulin injections)
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
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.
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.”
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.
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.”
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.
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.
- The goal is always to keep your blood sugar in a healthy range: not too high and not too low.
- 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.
- 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.
- Modern blood sugar meters only take 5 seconds and need just a tiny drop of blood.
- Pricking the tip of the finger is the easiest place to get the drop of blood.
- Before you test, it’s important to wash your hands with soap and water and dry them properly.
- Type 1 diabetics should test before every meal, to decide how much insulin to take.
- Before a meal, blood sugar readings should be 4 to 7mmol/l*.
- Two hours after a meal, blood sugar readings should be 5 to 10 mmol/l*.
- 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.
From Facebook (Diabetic South Africans):
Belinda wants to know if there are any parents of Type 1 diabetic kids out there… Want to share advice?
Some advice: the treatment of diabetes is not a perfect science. What works for one person may not work for the next. You need to make notes of what works for your child. This will take much of the guess work out of controlling your child’s blood sugar.
Allow your kids to have a say and let them see the effects. Never wrap them in cottonwool! Let them live, learn and experiment!
Hi. I’m also new to this. My little girl was diagnosed in May. She’s 2 and a half. Very scary and completely heart breaking often.
Hi Belinda – join Kids Powered by Insulin if you haven’t yet. You’ll get good advice and support there. My son is 15 – diagnosed when he was 13. A good endo and educator, healthy diet and an understanding of how much insulin is needed and how each insulin works has helped us a lot so far. Take care x
Hi there my daughter is 3 years old and Type 1 diabetic, she was diagnosed last year two weeks before her 2nd birthday.
Belinda there are LOTS of us – join the Facebook group Kids Powered by Insulin.
Never tell them they can’t do something because of diabetes. As a child, I was told that I can’t do many things because of my diabetes – I missed out on a lot.
My daughter is 9 years old now and was diagnosed when she was 4. I would love to help anyone who has had to endure diagnosis – it was 3 months of pure hell and would have loved a shoulder to cry on or some tips to help.
Thank you everybody for the reply. I am feeling much better that there are so many parents that are prepared to give me advice!
Neville Pillay is one of Durban’s favourite DJs and comedians… Who just happens to be a Type 2 diabetic. We speak to him about keeping up with the Morning Rush on Lotus FM, with diabetes.
How long have you been diabetic?
I was diagnosed well over 12 years ago, when I was 28 years old. But I remember my doctor telling me at 24 that I was at higher risk for diabetes because of my family history, and that I should change my diet… If only I had listened then!
Was your diagnosis a surprise?
To be perfectly honest, I knew all the symptoms – frequent urination, constant thirst, itchy skin, the sweats – but I chose to ignore them. By the time I was diagnosed I wasn’t surprised at all.
Are any of your family members diabetic?
My dad was and my mom is – she’s a Type 1 diabetic. You would think that would have made me more aware of diabetes, but the way we were brought up, we were ignorant about it – it was just something that my mom had. Type 2, or adult-onset diabetes, is also a very different condition to Type 1.
Do you ever talk about diabetes on air?
Absolutely: every chance I get to relate my story, I do. Many of my listeners on Lotus FM are affected by diabetes in one way or another, so it helps to be able to share our stories.
Do you ever tell jokes about diabetes in your comedy shows?
Oh yes, for sure. My comedy is based on my life, so of course I do! For example, I’ve got a lot of friends whose dads have passed away and left them things: cars and houses, even a Jaguar – all kinds of things. What did my dad leave me? Diabetes. I also like pointing out the irony of the fact that Indians came to South Africa as indentured labourers to cut sugar cane… And what disease do we all get? The sugars! Diabetes.
How do you balance a busy lifestyle with eating right and exercise?
It’s so difficult to do, so difficult. I’m not a pro at it and yes, I lapse every now and then. But for the most part I’m on point with eating well, staying away from sugary drinks and sweets and taking my medication. I’ve been a DJ since 1997 and I love it, but if you want any kind of stability or comfort zone, radio isn’t it. Every day is different and the landscape is constantly changing. So that’s an added challenge.
What do you think the biggest challenge of living with diabetes is?
To constantly monitor your blood sugar and make the right choices. The difficulty is in making those daily healthy choices, even when you’re around other people who can eat anything they like. That said, I know that there are terrible side effects, so it’s well worth making the effort. I was diabetic for a long time before I was diagnosed, and I know there have been some debilitating effects on my body, so I’m very careful to take good care now.
What advice would you offer to diabetics who are struggling?
Make one small change at a time and eventually you will have changed your lifestyle to effectively manage your condition.
What makes your life sweet
My girls, Jordan and Skylar, and my job. I love to entertain and it drives me daily.
If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.
Meet the expert
Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years
What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.
What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.
What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.
When should someone consider getting an insulin pump?
- If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
- If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
- If they have irregular eating, working and resting times.
Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.
A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.
FAQ about the insulin pump from our community:
What is an insulin pump?
- Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
- The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
- It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
- Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
Where do you buy an insulin pump and how much does it cost?
You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.
What are the advantages and disadvantages of using an insulin pump?
Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.
- Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
- You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
- You can participate in sports whenever you feel like it — without having to plan in advance
Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.
Will my blood sugar control be better if I use an insulin pump?
It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.
Will I still have to test my blood sugar as much?
A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.
Are there insulin pumps that have a Continuous Glucose Meter attached?
Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs
How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?
You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.
At what age can you put a child on the insulin pump and how easy is it for them to adapt?
I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.
What is the risk of infection?
If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.
How much is an insulin pump with and without medical aid?
That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.
Ask the expert: Dr Claudine Lee, GP
“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”
One of the most common complications of uncontrolled diabetes is diabetic neuropathy – but do you know what it is? Here are the basics of what it is, how to avoid it, and how to treat it if necessary.
- Diabetic neuropathy is the most common complication of diabetes.
- Neuropathy is short for “peripheral neuropathy” which means nerve damage in the peripheral nervous system.
- The peripheral nervous system includes all the nerves outside the brain and spinal cord, and connects the central nervous system to the hands, legs and organs.
- Diabetic neuropathy is caused from damage to the small blood vessels that supply the nerves.
- Blood vessels are damaged by high blood glucose levels, having diabetes for many years and abnormal blood fat levels.
- Smoking and excessive alcohol use can also cause diabetic neuropathy, as can mechanical injury to the nerves (like carpal tunnel syndrome).
- Symptoms can include numbness and tingling in the hands and feet, erectile dysfunction, dizziness, muscle weakness and changes in vision.
- Some common signs of peripheral neuropathy are sharp, jabbing pain that may get worse at night, and pain when walking.
- Diabetic neuropathy can’t be cured, but there are treatments to help the symptoms.
- The best treatment for neuropathy is good blood sugar control, which will prevent the condition from getting any worse.
From Facebook (Diabetic South Africans):
What advice would you give a newly diagnosed diabetic?
Get as much info as you can. Prepare to make lifestyle change. Respect the illness and it won’t control you
Don’t think you are any different from any other human. Carry on and enjoy yourself: everything in moderation. Exercise a lot and eat well – no problem!
Vat een dag op ‘n slag. eet gesond en doen oefeninge. en als wat ‘n nie-diabeet doen kan diabete ook doen!
Cut out anything white (sugar, flour, bread, chips, etc) and start an exercise program.
Don’t dwell on it too much. My Type 1 diabetic son of 8 understands his illness yet just gets on with life. He is a happy child and a true inspiration to the people around him.
Relax – it’s not the end of the world. It can be so overwhelming at first, but remember you have a manageable condition (note, not disease) God bless you!
We chatted to community inspiration Veronica Vember about how she changes lives, one step at a time.
What got you interested in diabetes at first?
It all started whilst working in the vascular unit at Kingsbury Hospital. I realised that most people are not informed about managing diabetes after being diagnosed. So I became passionate in the control of potential complications, and Kingsbury management identified my passion and allowed me to do the vascular course in London as it’s not offered here. On my return, I did two presentations at the doctors academic meetings. At the time my husband had a myocardial infarction and had been diagnosed with hypertension and diabetes. The entire experience stimulated me to get involved with my community. Now my husband is one of the volunteers. I then started doing motivational talks at schools, groups, on radio and at our nursing college.
How did you start your community group?
I joined the Strandfontein Health Forum and offered to do the diabetes awareness events as there was no project as such. With the awareness held at the Strandfontein Clinic I handed out questionnaires and a suggestion box. The community asked for a diabetic support group: that’s what started it.
What keeps you inspired?
The positive attitude and enthusiasm of the volunteers, and noticing the excitement of the attendees. When we take a break, people want to know when we’ll be starting again. The continuous support of ‘diabetes life’ (a diabetic clinic at Kingsbury hospital) under the management of endocrinologist Dr May, Dr Tracy van Rensburg and nurse educator Sr. Dee Ferguson (my mentor). Positive feedback from the doctors at the day hospitals where the clients attend also keeps me going.
You were voted one of the Western Cape’s Lead SA heroes – how did this make you feel?
Surprised, shocked, emotional, confused and thankful towards the responsible person for the recognition. I’m very proud of the team of dedicated volunteer attendees as I can’t do this alone. It’s a team effort – unity is strength.
What advice do you offer your support group members when they are struggling?
To persevere, not to give up, not to give in, to be compliant, to attend the support group regularly. We do individual counselling and have a communication box available for constructive comments and replies.
How do you make diabetes inspiring?
We create a harmonious atmosphere: a safe environment with easy accessibility, clean, functional equipment and competent staff. We vary programs, presentations, literature, topics and menus (soup in winter and tea and a snack in summer). We also combine our decision making with the volunteers.
What makes your life sweet?
Carrying out our mission, vision and outcome.
S – be sensitive towards all
W – warn people about the consequences of not being compliant
E – educate people regarding a healthy lifestyle and change of mindset
E – be empathetic and empower people with knowledge
T – to be trained, to train others
To ensure that all community members are well informed, and reach and maintain normal glucose levels.
Get in touch with Veronica: Strandfontein Diabetic Support Group on Facebook
We all know that more and more people are now living with Type 2 diabetes. It used to be seen as a condition for the wealthy, but today it’s increasingly common in every community – rich and poor. Nicole McCreedy takes a look.
Diabetes in South Africa is often associated with the Indian community among whom – compared with other cultures – it is more widespread. According to a study by the Human Sciences Research Council and Medical Research Council, 61% of South African Indians over the age of 45 have pre-diabetes, and are more likely, with age, to develop Type 2 diabetes.
But the Indian community is no longer the only group facing the diabetes challenge. It is now being reported as one of the leading causes of death in areas where diabetes was once unheard of.
The rapid rise in diabetes
There are a number of factors that put a person at risk for developing Type 2 diabetes. A family history of the condition, your lifestyle – what you eat, whether you smoke and how often you exercise – as well as your environment all play a role.
In the past, the Indian and white population in South Africa were more likely to be urbanised and wealthier, while Africans lived in the rural areas. Living in an urban environment often means longer hours at work, commuting and easy access to cheap fast foods. This type of lifestyle is linked to higher levels of overweight and obesity, and in turn diabetes. A study from 2005 found South African Indians ticked all the boxes: a diet low in fibre and high in unhealthy fats, physical inactivity, and insulin resistance.
However, in recent decades, South Africa has undergone both political and economic change. As a result, many people living in rural areas, especially Africans, have moved to cities for work and better opportunities. Being less physically active and eating a more Western diet (high in carbs and fats) is contributing to the growing diabetes burden in the African and coloured communities.
South Africans are fat
The relationship between overweight/obesity and Type 2 diabetes is critical. An unhealthy diet and not enough exercise can lead to being overweight or obese. Carrying extra weight, especially belly fat, is bad for your health, specifically leading to insulin resistance, high cholesterol and high blood pressure. All of which are damaging to long-term health.
What’s scary is that in South Africa, 7 out of 10 women and 4 out of 10 men have significantly more body fat than is healthy. The issue of overweight and obesity is emerging as a particular health concern among black women living in urban areas where there is a high rate of HIV. Weight gain, especially among black women, has always been seen as a sign of wealth, health and success in traditional African society, while being thin is associated with being HIV-infected. But overweight and obesity is also linked to diabetes. In a study on body perception among urban-dwelling black women, as many as 90% were overweight and obese, while almost three-quarters had diabetes.
The next generation
Your lifestyle not only affects your own health; it can also impact the health of your children. High blood sugar levels in pregnancy impact the unborn baby’s genes, making them more vulnerable to Type 2 diabetes later in life. Babies exposed to high blood sugar in the womb may have a higher birth weight and this can continue into adulthood with serious effects on their long-term health. Among South African Indians, where high blood sugar has been a problem for much longer, diabetes is now showing up at a much younger age than ten years ago – as early as between 25 to 45 years old.
Ignoring the problem
For many individuals, diabetes is a problem they don’t want to acknowledge. “A big concern is that people with diabetes are not taking their condition seriously enough,” says Jenny Russell from Diabetes South Africa’s Durban branch. “They want to swallow their tablets and carry on their unhealthy lifestyles.” According to Jenny, “in the Indian community, it is almost accepted as ‘normal’ that if you have diabetes, you will have diabetes-related complications: limb amputation, blindness or needing kidney dialysis.”
Others struggle with feelings of guilt. But whatever your culture, as Jeannie Berg, a pharmacist and diabetes educator in Mpumalanga, says:
“Diabetes is the same for everyone. Don’t let it define your life: it is not who you are, it is a part of your life you need to manage.”
Ask the dietician: Cheryl Meyer
From our community: “Can anyone tell me about madumbis for diabetics – good or bad for us, and how much can we eat?” Lynette Hitchcock.
Madumbis, amadumbe, African potato or taro – call them what you will, they are delicious! They have a rich, nutty, earthy flavour and a stickier texture than potatoes. Like potatoes, they fall into the carbohydrate group of foods and can be roasted, mashed or boiled.
The key to eating proudly South African carbohydrates like madumbis, roti, pap or samp in a healthy diabetic diet is portion control! Counting the carbs in your meals and being aware of the carbs you eat can help you match your medication or activity to the food you eat. This can lead to better blood sugar control.
Remember: Everyone needs a different amount of carbohydrate at each meal and/or snack – the amount that is best for you depends on your:
- physical activity
- current blood sugar
- blood sugar targets
Not sure how many carbs you should be eating? Ask your doctor or dietician for help.
|A general guide:|
|Carb limits for women||Carb limits for men|
|Meal||30 – 60g||45 – 75g|
|Snack||15 – 30g||15 – 30g|
What does this mean? A food that has 15g carbohydrate is called “one carb serving”. One slice of bread or a small piece of fruit each have around 15g carbohydrate, so they are equal to one carb serving.
One carb portions of Proudly South African foods:
|1 carb serving||50g madumbi|
|1 small roti (35g)|
|⅓ cup pap (60g)|
|⅓ cup samp (75g)|
|½ cup sweet potato (100g)|
|1 medium mielie (140g )|
|½ cup rice (50g)|
|1 x 15cm tortilla or wrap (35g)|
|½ cup pasta (100g)|
|1 slice bread (30g)|
|1 small apple (115g)|
As much as possible, try to stick to this portion size, with a serving of protein (meat, fish, chicken, eggs, beans) and half a plate of vegetables or salad.
How to cook amadumbe: Scrub them clean and steam or boil until soft. Drain and cool slightly before removing the skins. Serve dusted with black pepper, a dash of salt and a drizzle of olive oil. Yum!
Amadumbe in numbers:
100g portion boiled amadumbe has: *
- 600 kJ
- 5g plant protein
- 1g fat
- 5g of carbohydrate
- 1g fibre
* According to The SA Food Tables