type 1 diabetes

Information and questions about Type 1 diabetes.

Raising a diabetic child

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.

References:

Diabetes and children’s parties

My son was just diagnosed with Type 1 diabetes and I want to know what to do about children’s parties and play dates? I don’t want him to feel ‘different’ but I also want to make sure his blood sugar won’t get out of control.” Linda van der Merwe.

Dear Linda,

I’m not sure how old your son is, but diabetes at any age can be difficult. Rest assured, what seems overwhelming now will eventually become routine.

Diabetes affects a child’s emotions, and badly controlled blood sugar can make diabetics feel irritable. If your son forgets to take insulin for a piece of cake at a birthday party, for example, he could end up fighting with his friends. Talk to him about the kind of food that will be at the party and help him to make decisions about which foods to choose, and which to avoid. Make sure he has something sweet on him in case he goes low, and chat with him about what to do if he feels funny. Most importantly, let him know that you are only a phone call away.

Yes! The thought of your child going off to a party at someone else’s home may make you scared. Away from your control, over-excited by all the fun and surrounded by delicious high sugar and high carb treats. A parent’s worst diabetic nightmare. But just remember: a child with diabetes is still a child. And children LOVE birthday parties!

It’s a good idea to call the host parent and find out what sort of food and drinks are planned for the party. You can even offer to provide a platter of your child’s favourite (diabetic-friendly) snacks, so that he can share them with his friends. Let the host know that you will have your phone on you the whole time.

Lastly, try to relax. With careful planning, your son can safely enjoy birthday parties as part of his childhood.

– Jeannie Berg, Diabetes Educator

 

Grief and Diabetes

Gabi Richter is a diabetic counsellor on our Panel of Experts. Today, she speaks to us about grief and diabetes.

Stages of Diabetic Grief:

Dealing with life can be tough enough for emotionally strong people, but being diagnosed with diabetes changes the ball game completely, and sends you on a never-ending emotional rollercoaster ride.

Most people think that grief only applies to losing a person. But when you are diagnosed with diabetes, your world stops and the person you were before ‘dies’. The same stages of grief that apply to losing a person, mainly anger; denial; bargaining; depression and acceptance, apply to diabetic grief, but we have a few extra for good measure. The stages begin at the moment of diagnosis and never quite end, thus the diabetes loop begins and we continue to cycle through the stages on our new journey.

The first stage: Shock

First, there is denial and shock. You hear the doctor say that you have diabetes, and your mind stops.

‘It’s not possible. I don’t even eat that much sugar.’

That’s the shock part.

The second stage: Denial

Then you think, ‘Well, I will just inject for a bit till I feel better and it will be okay.’

This is denial. But unfortunately diabetes and the need for good control leave little room for denial to live.

The third stage: Anger

Anger quickly follows the denial, but this stage is hard to overcome, and you never fully let go of the anger. You get angry at yourself for not going to the doctor sooner and getting checked. You get angry when your blood sugar levels are high or low, and this leads to stress which will increase your levels. Of course in the anger phase, we all ask ‘why me?’ and ‘what did I do to deserve this?’ So we open the door to the bargaining and depression stages.

The fourth stage: Bargaining

As diabetics, we become expert bargainers, even though all our bargains are one sided. We bargain with our medical team that if we do things a little differently, our results will change, but mostly we bargain with ourselves. This is dangerous. We bargain that since our levels are good, we will eat now and skip a dose, and it will be fine. But each bargain we make can lead us closer to the depression stage. When our bargains fail, and they do, we get depressed and loop back to anger.

The fifth stage: Depression

Depression is something that most diabetics battle with. We get depressed when our blood sugar levels are bad, and we have not done anything wrong. Mostly, we get depressed when our routine and bargains fail us. For example, when we think we have everything under control and our levels are good, that bad day hits and we have to start all over again.

The sixth stage: Anxiety and fear

With the normal stages of grief, the next one would be acceptance. With diabetes, however, there are two extra stages. After depression come anxiety and fear. As diabetics, we tend to become very anxious and fearful people. Since diabetes is an unrelenting disease with constant management and a constant cycle of injecting, carb counting and weighing of food and reading of labels, it does not allow for any days off. It’s no wonder we have anxiety and fear! We never know what will happen from one day to the next, therefore it also makes it harder to move to the acceptance stage.

The seventh stage: Acceptance

Acceptance is something that even the most veteran diabetic struggles with. It’s the one thing we all want, and yet we rarely achieve. We all live in hope of a cure that will end our rollercoaster ride, and stop our management routine. There is a difference between acceptance and compliance. What can look like acceptance is in fact compliance. We need to acknowledge that compliance is good and normal, but we also need to acknowledge the fact that we will possibly never gain full acceptance of our condition. That is why we always live with a bit of hope.

The daily rollercoaster

Grief is something very common in everyday life, but in the diabetic life, it’s harder to overcome. We are on a constant rollercoaster ride that we have no control over, and never asked to get on. We are always wishing for a cure.

Even nine years after my diagnosis, I still find myself replaying these steps in no certain order. Unfortunately, there is no diabetic nirvana. It is a daily rollercoaster ride of emotions. The trick is to try not to get stuck in a specific stage, and realise that with diabetes, it is an ever-evolving process through the stages of grief.

We need to be ready for whatever comes our way. We need to keep in mind that the body reacts to emotional trauma and excitement by triggering a chemical reaction that will make the blood sugar rise, and also remember that with grief and life, it is normal to have bad days and we must try and enjoy the good days and not linger on the bad days.

Howza’s life with diabetes

Musician, actor and Type 1 diabetic – we find out how Howza fits it all in.

How long have you been diabetic?

Since 2003: I was 21 at the time. I was actually introduced to diabetes from a very young age because my father had Type 2 diabetes, but I was very ignorant – I didn’t know what it was until I got it. But I think the younger you are, the easier it is to adapt your life.

What was your diagnosis like?

You know, all the symptoms kicked in – loss of weight in a very short space of time, dehydration, constantly going to the toilet. I didn’t understand what was going on. When you lose weight like that you instantly associate it with HIV/AIDS, because there’s so much awareness of that. So obviously I panicked… But I did the responsible thing and went to the doctor – that’s when I found out I was diabetic. I wasn’t exactly relieved, the doctors put the fear of God in me by telling me all the things that could happen to me. It was hard to come to terms with…. But I was scared, and I was willing to turn my life around for the sake of living longer.

What’s the biggest challenge of living with diabetes?

Obviously diet and exercising. I was saying to my wife the other day, as much as I enjoy going to gym, it’s never easy. You need to find a way to motivate yourself to go to gym 3 or 4 times a week – self-motivation is important to live a healthy life. Nobody likes gym, in all honesty! But at the end of the day, when you put your mind to it, you’ll end up enjoying it.

I used to live a very unhealthy lifestyle – eating fast food and drinking every day. That had to change. I’m not saying be a health nut, but you need to find a way to do things moderately. If you’re going to drink, you need to drink responsibly and be aware of your sugar levels. I decided, instead, to stop drinking. But it was difficult for my friends to understand – you’re not drinking, so all of a sudden you’ve become a priest! It wasn’t easy, trust me, that was the most difficult part, especially as a youth. But at the end of the day I became selfish and told myself, “It’s not about them, it’s about me.” If I don’t take care of myself, they’ll still be cool – I won’t.

What advice would you offer to other diabetics?

I always say to people – look, I’m living with it, it’s not the end of the world. As cliché as that might sound, that’s the actual truth. I’m living a healthy, normal life with diabetes. Like I said, I don’t want to put myself on a pedestal and act like I’m perfect. I have my challenges. So when I speak to the youth I try to be as open and truthful as I can, so that they can relate. At the end of the day, the bottom line is that you have to be responsible for your own life.

What makes your life sweet?

My daughter, Tumelo.

Get in touch with Howza: @Howza_SA on Twitter

Mr South Africa contestant is a Type 1 diabetic

We just got an email from Derick Truter, who is a Type 1 diabetic and also a Mr South Africa contestant. Here’s his story – let’s all support him on his Mr SA journey!

Let me quickly introduce myself.
My name is Derick W Truter (Age: 21), and I am one of the Top 50 Finalist for the Mr South Africa Competition of 2017.

As challenge one of four (1/4), we had to raise a minimum amount of R10,000.00 for CANSA. We are being judged on our creativity and hard work during the contest. I held a “Potjie” Contest and family day to raise funds for this good cause; we have raised R13,000.00.

I was born in Carletonville, Gauteng (06/06/1996), and grew up living in Gauteng. I was diagnosed with Type 1 diabetes on 14/10/2010 in the Potchefstroom Medic Clinic hospital, after I was rushed to the medical department after my local doctor tested my sugar and found the meter saying “HI”. This was after my grandma noticed diabetic symptoms. At the time of hospitalisation, my blood reading showed 34.4mmol.

In 2011, I was also diagnosed with Pancreatitis (Inflammation of the Pancreas, causing abdominal pain). I went for several medical procedures, including CAT Scans and Endoscopy. With the time passing, I have already begun to experience diabetic complications, as my eyesight is getting poor, and I still experience occasional abdominal pain caused by the inflamed pancreas.

But today I am standing strong as one of the MR SA contestants.

As a diabetic, I fully understand the emotions we have to deal with daily: this is not an easy condition to live with, because it takes time to manage and a lot of patience…

Sometimes I also experience ups and downs and days I am not feeling well, and I know how hard it is to educate other people, who think diabetes is caused by eating too much sugar.

Insulin is not a cure: it is life support.
I want us to find a cure.
I will stand strong, and fight this condition every day.
I want to be a voice for every other diabetic!

A Fabulous Sugar Alternative

IMG_7025I don’t know about you, but sometimes I want something decadent to eat – despite being diabetic. I want a slice of cake with my cup of tea, especially if I’m celebrating with friends and family.

Of course, Sweet Life has always shared recipes for treats as well as ordinary food, because we believe that you can’t be on a diet your whole life, and diabetes is definitely sticking around for your whole life… But still, it made me feel guilty to use sugar in recipes when I know what sugar does to my blood sugar (bad, spiky things!)

That’s why I was so delighted to be given Natreen artificial sweetener to test out. I’ve always been a bit scared of artificial sweeteners because of aspartame, which has been linked to cancer, but Natreen doesn’t have any aspartame which makes me very happy! (Apparently the claims of aspartame being linked to cancer haven’t been proven, so it’s not something that they can shout about any more).

My next concern, though, was what replacing normal sugar with a sugar substitute would do – particularly while baking. I’m very happy to report that the result was exactly the same, and my non-diabetic friends didn’t even notice the difference! I made our special occasion Flourless Chocolate Tart and it was simply fabulous. Best of all, my blood sugar readings were heaps better than if there had been sugar in the cake. That’s because the sweeteners in Natreen (cyclamate and saccharin) don’t have any carbohydrate – as opposed to sugar, which is 100% carbohydrate. I actually asked for a breakdown so that you could see exactly what I was talking about – take a look below:

Calories:

  • 8 drops Natreen Liquid = 1 tsp sugar (4.2g)
  • 100ml Natreen Liquid = 0.96 calories
  • 1 tsp sugar (4.2g) = 16 calories
  • 100g sugar = 387 calories
  • 6.67ml Natreen Liquid = 100g sugar

Carbohydrates:

  • 100ml Natreen Liquid = 0g carbohydrates
  • 100g sugar = 100g carbohydrates

So for those special occasions when you really want something delicious and sweet, I would highly recommend using Natreen instead of sugar… Your blood sugar will thank you!

Specialist Physician in KZN?

Hi there,

We relocated a year ago from the good old Gauteng to Nottingham Road in the Midlands. I have Diabetes 1 and am looking for specialist physician, I have tried two one in Hilton and one in Pietermaritzburg. The one in Hilton sent me to be scanned for kidney failure, the radiologist found nothing and could not understand why I was sent there.

The second one in private hospital Pietermaritzburg, saw me the first time where I presented him with a letter of introduction from my previous specialist as well as a copy script of all my medication agreed to by the doctor and my medical aid. He then said on my next visit he want a complete set of blood test done so he can build up his own file on me. This was done and dusted and sent to him a week before my scheduled appointment, the day before my appointment they cancelled the appointment, when I asked why I was told he is an I house doctor with the hospital.

When I explained that I urgently needed a script because my repeats were finished I got nothing but attitude from this practice, even after explaining to them that I can’t stop my medication to suit them, after a few days of verbal battle I was given a new script with 6 repeats to date I am still waiting for a new appointment date, I won’t be going back there. And then the cherry on the cake the medical aid rejected all the blood test bar those that conforms to my treatment plan, which meant I had to pay a whopping R 1600.00 out of my pocket (I’m a pensioner so this type of spend really puts a strain on my finances). The medical aid insisted that these tests where not necessary.

I can’t believe the unprofessional attitude here in KZN, I only have two repeats left and am desperately trying to find a specialist physician, can you help me please.
– Don

Diabetes Turned My Life Around

Hi everyone…

It’s so heartening to read all of the posts on your website and learn from all of your experiences! It has inspired me to share my story on your website.

I am a 40 year old Indian male. Two years ago (18 December 2013) to be exact, I had admitted my self to the Umhlanga Netcare hospital. I was just too tired, too run down and did not know what was going on with my body. I had started feeling tired, restless, sleep deprived a few days before. I was also very stressed out and emotionally down due to a lengthy divorce battle and being separated from my children. The doctor attending to me admitted me to ICU. I was undergoing a Type 1 Diabetic Keto Acedosis attack. I lay in hospital for a week. When I was finally discharged, my weight had dropped from around 85 kg to 68kg! I was totally insulin dependent, and was diagnosed as a Type 1 Diabetic at the age of 38.

My world seemed to be collapsing around me. First, the divorce/separation from my wife and kids (who mean the world to me), and now finally my health just failing me completely. I just could not cope with anything at that point in time.

Eventually I pulled myself together. I started off my new life by following my Insulin dosage instructions carefully, and by doing relentless research on Diabetes Type 1 and read up on everyting about Diabetes and related topics/posts/blogs etc. I learnt about a balanced Diabetes nutrition and and how to shop, prepare and eat food Diabetes Smart. I eat a low fat, controlled Low GI Carb Diet, with no refined/processed foods. I have developed an exercise routine that I follow religiously. My eating pattern, portion controls and diet have become a daily way of life now. Its embedded in my lifestyle.

When I was going through the Type 1 DKA attack, my blood Glucose was 27 mmol/l, my HbA1C at that time was 18.5 percent and Cholesterol 4.67 mmol/l. Since Dec 2013, I do HbA1c’s every 6 months, together with Cholesterol checks etc. My last two HbA1C’s were 4.90 and 5.10 mmol/l, and Cholesterol 3.67 mmol/l.

I believe that I have my condition under control, and firmly believe that I can still have a meaningful, productive life of good quality, if I maintain my Diabetes Care Routine.

Type 1 Diabetes does not have to be a death sentence, you can turn it in your favour by living and eating healthily and staying positive about your life.

Cheers for now everyone and happy, healthy living!

– Dhiraj

All About the Continuous Glucose Monitor (CGM)

We recently got an email from a reader who loves the Continuous Glucose Monitor (CGM) and asked us to write an article about it in Sweet Life magazine next year – we will! Here’s what he has to say about it.
I’ve been a Type 1 Diabetic since 2006 (at age 27). I’m on MDI (multiple daily injections) and not on a pump. Apidra + Lantus.
Early this year, I started using a CGM, it made a massive difference in how I treat my glucose levels.
I don’t think everyone knows the power of a CGM such as:
* it gives me a reading every 5 minutes
* given above, it provides a graph which clearly show you that you are going high or low
* it provides alarms to alert you about lows and highs.
* useful statistics, you can calculate your average and time in target much better
* useful to see the dawn phenomenon in action when you wake up, i.e. easily correct your basal rate.
* useful when exercising, you don’t have to stop to take a BG check, just checkout your graph all the time.
* glucose values can be automatically uploaded online such that family members can monitor you remotely. This feature is very handy for keeping track of T1D children.
I experienced the FreeStyle Libre (not really a CGM, but almost) and I’m using the Dexcom G4 now. Yes, the sad part is that they are expensive, but some people might be able to afford them. The G4 sensor is suppose to be used for only 7 days, but many people get 3-4 weeks out of them. My first sensor lasted 30 days, which makes them more affordable.
My online real-time glucose values : http://jaco-cronje-cgm.herokuapp.com/
it is using nightscout (I hope you have heard about ;))
I have a blog where I post CGM related stuff once in a while: www.freestylelibre.co.za
It would be great if you can look into CGM’s in one of the magazine issues.
– Jaco
Jaco also sent a link to his Type 1 Diabetes Survival Kit, which is very helpful!

Looking for Diabetes Support

Hi there,
I think it is so great that you have managed to turn your diagnosis into a magazine!  I think it is really inspiring!
Im hoping you can help me.  I am looking for an online forum to support me and my diabetes.  I am 29 and was diagnosed at 5.
I want to get on to a pump because I think it is the next best thing for me, however, I am stuck between a finding a good clinic in Joburg, Medtronic and finding a Medical Insurance company that will cover me.
I just need someone I can speak to and help me clear my questions as I do not understand all this legal terminology.
In Zambia we have no support network (in fact I am the head of one but no one comes to it) – and I just need someone to talk to. The psychological aspect can have such a toll.
I look forward to hearing from you.
Kind regards,
Kaajal

Blood Sugar and Exercise

After 20 years of being a Type 1 diabetic the insulin has finally caught up with me and caused me massive weight gain over the last couple of years, a year of Banting did not help, it did nothing for my insulin or weight levels, so in my desperation I joined the gym at the beginning of the year.

I attend four hour long classes a week; namely Kick class, Zumba, and two spinning classes.

When I first started going to the gym I tested my sugar half an hour before class, it was spot on ranging between 4’s and 6’s, I always took a snack along with me as I expected my sugar to drop during or after exercise; as we are generally taught is the case.

To my absolute horror my sugar did not drop, the complete opposite happened, an hour after gym class I would retest my sugar levels and it would be between 15 and 22!

This is a little sample of how my sugar readings looked before and after exercise:

  • Before:  6.3  After:  16.4
  • Before:  4.7  After:  14.7
  • And the cherry on the cake, Before:  5.2.  After:  22.1.

This continued for about two months, I started to panic and was worried that I would have to stop the exercise because of this.  I thought that surely these high sugar levels after exercise were doing damage and the exercise was hurting my body more than helping it.

That was when Google became my new best friend, I googled “High Blood Sugar After Exercise” and found hundreds of articles explaining to me that the more intense the exercise is that you do, the greater the chance is that your sugar levels will spike and NOT DROP after exercise.

According to the articles I read this is due to the fact that during intense exercise your liver starts increasing the amount of glucose that it is producing, the glucose needs insulin in order for it to be used by your muscles, so if there is not enough insulin in your body at the time of exercise the glucose cannot get to your muscles and your sugar levels will spike.

I started experimenting by not snacking before class and giving a unit or two of Humalog 30 minutes before the class.  The results were epic.  Perfect levels before and perfect levels after exercise.

This is a little sample of how my sugar readings look now before and after exercise, after introducing a unit or two of Humalog before class:

  • Before:  7.1.  After:  6.6
  • Before:  6.7.  After:  7.2
  • Before:  7.4.  After 4.2.
  • Before:  7.3.  After 5.8.

Who knew!  After all these years of being taught to eat before you exercise because the exercise will probably cause a hypo.

5 months into the gyming and this regime continues, a unit or two of Humalog before class and perfect readings after exercise.

Alas, the gyming is not helping for the weight yet, but hopefully it will in time…

This is just my experience, I hope that maybe sharing my experience may help someone else suffering from the same issue.  I wish that we were taught this along with the “low blood sugar after exercise” theory.

By Frances Gates

The Diabetes Dawn Phenomenon

Hi,

I’ve been a Type 1 diabetic for 20 years now.  Lately I am suffering horribly from the dawn phenomenon.  My sugar readings are perfect before bed, perfect at 03:00 am when I wake up to test, but absolutely sky high when I wake up in the mornings.

Has anyone experienced this and if so how can it be prevented?

Thank you.

– Frances

Advice for Newly Diagnosed Sportswoman

Good evening.

Our daughter was diagnosed with Type 1 Diabetes two weeks ago. Up to then, this 11 year old spent up to 6 hours a day on the tennis court in her quest to become a pro.

We are already discussing with her doctor the possibility on a insulin pump.

Any views and comments from other sport active people out there?

Thanks,

– Louis