type 2 diabetes
Information and questions about Type 2 diabetes.
“My dad is a poorly controlled Type 2 diabetic, and he doesn’t seem to care. I keep telling him how serious his condition is and that he has to take care of himself, but he continues eating whatever he likes and says he’s too old to change. What can I do?” Celeste Damen.
It isn’t easy for people to hear that they have diabetes. Diabetes is a condition that cannot be cured: it has to be taken care of every day. People who have diabetes have to make some important changes in their lives, but if the change is forced on them, they may not want to do it.
This is what is probably happening with your dad. He most likely knows exactly how important it is to look after his diabetes, but might still be in denial or angry that this inconvenience has been brought into his life.
The fear you feel for your dad’s condition also projects to him, and he is probably trying to reassure you by giving you excuses that he is too old to change or that the situation is not that serious.
Instead of telling Dad what to do and being cross with him when he doesn’t do the right thing, you need to ask him what changes he is willing and able to make. Then encourage him to follow through on what the two of you have decided.
Diabetes has not only happened to him: it has happened to your whole family. This is something all of you have to accept. It’s a good idea to get the whole family to adopt healthy habits, so that there will be less temptation… Offer your dad help, but try not to be the Diabetes Police.
– Jeannie Berg, Diabetes Educator
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.”
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.
There are no two ways about it: insulin is a miracle drug. It was discovered in 1921 and has saved millions of lives in the last 95 years. Andrea Kirk explores the topic.
“In people with Type 1 diabetes, insulin is essential for maintaining good health, and many people died from Type 1 diabetes before insulin,” says endocrinologist Dr Joel Dave. “Insulin therapy is started as soon as the diagnosis is made, and although being diagnosed with Type 1 diabetes can be a traumatic experience, with the use of insulin, you can maintain good health and achieve anything in life that those without diabetes can.”
For people with Type 2 diabetes, however, there is often a reluctance to start taking insulin. Some people manage to control their blood sugar without it, by making changes to their diet, getting more exercise and going on oral medication. But for others, insulin is a necessity.
“There’s a huge stigma about this,” says Mark Smith, who was diagnosed with Type 2 diabetes a year ago. “I feel like starting insulin would mean that I’ve failed at controlling my blood sugar with lifestyle changes.”
Diabetes educator, Jeanne Berg, sees things differently. “Diabetes is a progressive condition and insulin therapy is inevitable. Some people take longer to get to the point of starting insulin than others, but every patient with diabetes gets there eventually. There shouldn’t be any shame or sense of failure in this.”
Jeanne says that in the past, doctors would try to intimidate people with Type 2 diabetes into changing their lifestyle. “They’d say: if you don’t change your diet and get more exercise, you’ll end up blind, or have your legs amputated, and eventually you’ll die.” This blame-filled approach may be part of the reason there is still such a stigma associated with Type 2 diabetes. “People would think ‘this is all my fault, I did this to myself’, but that is not the whole truth,” says Jeanne. “Diabetes has a genetic inheritance factor to it as well.”
Doctors and diabetes educators today steer away from using scare tactics and encourage people to accept insulin as a means of coping and having a more flexible life with diabetes.
Are there any benefits to starting insulin sooner?
“In people with Type 2 diabetes, there is a theory that glucose can cause damage to the beta-cells of the pancreas, which are the cells that make insulin,” says Dr Dave. “The longer the glucose remains high, the more damage occurs. Since insulin is the best way to lower blood glucose, some suggest that insulin should be taken sooner rather than later in order to preserve beta-cell function for longer.”
You would never guess that Trevor Davids, a business consultant, film and TV producer and biker filled with the joys of life, has Type 2 diabetes. That’s because he’s managed to take diabetes in his stride.
When did you find out you were diabetic?
Six years ago, in November 2010. I had all the usual symptoms – constantly thirsty, needing to urinate a lot – and I looked them up on the internet. Up came: diabetes. I read up on the condition before going to the doctor, and then announced, “I have diabetes.” We took the necessary tests and my blood sugar was really high (18mmol/l), so I was put onto insulin tablets immediately. Diabetes doesn’t run in my family, I’m not overweight and I do a lot of exercise, so I’m not a typical Type 2 case. I do have high blood pressure that runs in the family. When I was diagnosed with diabetes I had already given up alcohol ten years before, but I was smoking 40 cigarettes a day, so I had to give that up too. After 31 years of smoking, I quit on the first try. Once I make up my mind about something, there’s not much that can move me.
How has diabetes changed your daily life?
I’m a lot more conscious of my eating patterns now. I never used to eat breakfast – I’d grab something on the run, snack in the afternoon, and then eat a big plate of food in the evening. I had to learn to be less flexible about food. Eat a regimented breakfast, lunch and dinner, look at my intakes and learn about low GI. I couldn’t have done it without my family – my wife Norma and son Danté have been the most amazing support.
How do you manage to focus on the lighter side of living with a chronic condition?
I never focussed on the darker side of diabetes! I’m a very positive person, I like being focussed on doing something well. In challenging times, I just take it in my stride and deal with life’s knocks as they come.
Is there anything diabetes has stopped you from doing?
No. Only smoking! I’ve actually been able to take on more daily life challenges since being diagnosed, because I restructured and reorganised my life, so I now have more time.
What advice would you offer to other diabetics?
If you’ve just been diagnosed, don’t worry – it’s not as daunting as you think. It can become a lifestyle condition, you just need to adapt your lifestyle. Diabetes is part of who you are now, and denying it doesn’t make it go away.
What makes your life sweet?
Life itself! And my family, of course. And laughter: the ability to laugh and create a laugh. I believe that people can live a long time if they can learn to laugh in the face of adversity. I like to use laughter as part of my medication.
Every two years, the International Diabetes Federation (IDF) publishes a Diabetes Atlas, with estimates of diabetes facts and figures from around the world. The 8th Diabetes Atlas is now live – take a look! Here’s more information about it.
To mark World Diabetes Day, the International Diabetes Federation (IDF) released new estimates on the prevalence of diabetes around the world, indicating that 1 in 11 adults are currently living with diabetes, 10 million more than in 2015.
Data published in the 8th edition of the IDF Diabetes Atlas confirms that diabetes is one of the largest global health emergencies. More action is required at the national level to reduce the economic and social burden that it causes.
Type 2 diabetes
Diabetes, which is associated with a number of debilitating complications affecting the eyes, heart, kidneys, nerves and feet, is set to affect almost 700 million people by 2045. Over 350 million adults are currently at high risk of developing type 2 diabetes, the most prevalent form of the disease. One in two adults with diabetes remain undiagnosed, emphasizing the importance of screening and early diagnosis. Two-thirds of adults with diabetes are of working age and 8 million more adults living with diabetes are over 65 years old.
“Diabetes causes devastating personal suffering and drives families into poverty,” said Dr. Nam Cho, IDF President-Elect and Chair of the IDF Diabetes Atlas committee. “There is urgency for more collective, multi-sectoral action to improve diabetes outcomes and reduce the global burden of diabetes. If we do not act in time to prevent type 2 diabetes and improve management of all types of diabetes, we place the livelihood of future generations at risk.”
Diabetes and women
Diabetes has a disproportionate impact on women, the focus of IDF and its affiliated members in over 160 countries this World Diabetes Day. Over 200 million women are currently living with diabetes and many face multiple barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care, particularly in developing countries. Women with diabetes are more likely to be poor and have less resources, face discrimination and have to survive in hostile social environments. Diabetes is also a serious and neglected threat to the health of mother and child, affecting one in six births and linked to complications during and after delivery.
“Women and girls are key agents in the adoption of healthy lifestyles to prevent the further rise of diabetes and so it is important that they are given affordable and equitable access to the medicines, technologies, education and information they require to achieve optimal diabetes outcomes and strengthen their capacity to promote healthy behaviours,” said Dr. Shaukat Sadikot, IDF President.
Urgent action needed
IDF welcomes all the international commitments on diabetes that have been made over the last few years and acknowledges that some advances have taken place. However, it is clear that urgent action is still required to achieve the targets agreed by UN member states in 2013 and 2015. These include a 0% increase in diabetes and obesity prevalence; 80% access to essential medicines and devices by 2025; and a 30% reduction in premature mortality from NCDs by 2030. To this end, IDF has launched a call to action for the 2018 High Level Meeting on NCDs, calling on governments to renew their commitments and increase their efforts towards achieving the agreed targets.
“IDF is calling for all nations affected by the diabetes pandemic to work towards the full implementation of the commitments that have been made. We have both the knowledge and the expertise to create a brighter future for generations to come,” said Dr Sadikot.
Indigenous Afro-Soul artist Candy Tsamandebele talks to us about living with Type 2 diabetes.
When did you find out you had Type 2 diabetes?
After the death of my son through an accident. It was unexpected to say the least.
Was it a shock?
Yes it was.
How did you have to adapt your lifestyle?
I started with what I ate and drank. It was difficult at first, but with time I got used to it. Secondly, my lifestyle all together.
How do you balance a busy lifestyle with eating well and exercise?
Sticking to a strict diet. Also understanding the consequences of ignoring that diet.
What advice would you offer to those living with diabetes?
Just take it one step at a time. Take your medications on time and eat healthy.
What makes your life sweet?
Music. It really does.
Some background on Candy and her outreach work:
August 2, 2011 was one of Candy Tsamandebele’s most trying times in her life when she lost her son in a car accident. Six months later she was diagnosed with Type 2 diabetes. Not one to be kept down, two years after the trauma, Candy garnered strength to launch CANDY TSAMANDEBELE FOUNDATION. She uses the foundation to teach young women and the youth in general about values and it is her vehicle to drive and leave behind a legacy as she continues to grow in the music industry.
The main aim of the Candy Tsamandebele Foundation was to teach kids about music, the importance of culture, significance of language, youth development, medical assistance, helping with school uniforms to needy, and several other initiatives that are close to her heart.
Every year Candy Tsamandebele dedicates her time to carry out community building initiatives such as visiting schools and donating school uniforms, as well as motivating the youth both in and out of school. She encourages young people to use their natural abilities and talents to make it through life. During her motivations, she always talks about the importance of getting tested for diabetes and other chronic conditions and adhering to taking treatment once diagnosed.
Since she was diagnosed with diabetes, Candy Tsamandebele has made it her mission to be a national diabetes warrior. She is a force to be reckoned with and she will stop at nothing for as long as she is needed to make a difference.
Find out more at www.candytsamandebelesa.com
“My friend was just diagnosed with Type 2 diabetes and weirdly the thing that’s bothering him most is what people will think. He doesn’t want to tell anyone because he says they’ll blame him for becoming diabetic – because he didn’t eat healthy or exercise enough. How can I help?” Shan Moyo
First of all, I think your friend is lucky to have someone like who cares enough for him to help him work through the barriers of accepting his diabetes. Because of all the studies that have shown that diet and lifestyle have an influence on Type 2 diabetes, uninformed people forget that there are numerous other reasons for developing diabetes as well. And the Type 1 and Type 2 labels also make people more judgemental.
To some people, their personal health problems and issues are exactly that: personal. Frankly, your friend doesn’t have to share with everybody that he has diabetes, but it is a good idea to let someone close to him know, in case of an emergency. One of the hardest things that newly diagnosed people with diabetes experience and fear is that those who have known you for years start treating you like you’re different. They see your diabetes and not you. But help him look at it this way: no one today would accuse someone with AIDS of giving themselves the condition. So why allow anyone to do it with diabetes?
What can you do? Be an active reader and read your friend like an open book. Listen more and talk less. Help him come to terms with his diabetes and find confidence in managing it. Don’t let him assume that others are judging him: nobody has any power over what other people prefer to think.
Finally, if your friend is really struggling with a lot of mixed emotions, remind him that it’s perfectly normal to feel that way, and that it’s okay to need some help with the burden of managing a demanding condition. And lastly, one of my favourite quotes by Lao Tzu for him: “Care about what other people think and you will always be their prisoner.”
Help him to live free and happy.
– Jeannie Berg, Diabetes Educator
- Half of South African adults are overweight or obese. What that means is increased risk of heart disease, Type 2 diabetes, certain cancers and premature death.
- Our eating habits have changed so much that South Africans now spend more money on beer than on vegetables and fruit combined. What?!
- 45% of South African women are obese, as opposed to only 15% men. In 2013, South African women were the most obese in sub-Saharan Africa. So South African women are the most at risk for obesity.
I asked why that was and apparently there are three reasons:
- Women who were nutritionally deprived as children are more likely to be obese as adults (men who were deprived as children are not).
- Women of higher adult socioeconomic status (which is income, education and occupation) are more likely to be obese, which is not true for men.
- And possibly: in South Africa, women’s perceptions of an ‘ideal’ female body are larger than men’s perceptions of the ‘ideal’ male body – it’s seen as a status symbol to be a heavier woman.
Are you a South African woman? I am… Let’s make sure we’re informed and don’t let obesity happen to us and our sisters, mothers, daughters, friends.
Vitality gathered data from half a million Discovery members to give us these results:
- Their weight status (BMI and waist circumference)
Cape Town scores highest, with 53.5% of Capetonians in a normal weight range. Cape Town also topped the healthy purchasing score (which shows a positive relation between what you buy and whether your weight is in range or not.)
Fruit and vegetables
Cape Town purchased the most portions of fruit and vegetables compared to other cities – see the ranking above. In general, though, South Africans are only eating 3 servings of fruit and vegetables a day, as opposed to the 5 servings we should be eating.
Durban purchased the least amount of salt in SA, with Cape Town purchasing the most. We are eating twice as much salt as we should be in a day: it should only be 5g (1 teaspoon).
Durban came out top of this test too, with the lowest average number of teaspoons of sugar purchased – Bloemfontein purchased the most sugar. And again, we’re eating twice as much sugar as we should be – a staggering 100g a day! (That’s 24 teaspoons – in the food and drink we consume.)
There are a number of factors that play into this, of course. The way we buy our food – the impulse buys, the treats, emotional eating. Fast food is also a huge problem, because it’s loaded with salt, sugar and bad fats. Cooking at home with whole foods (not convenience foods or ready-made meals) has been proven to have an enormous impact on health and weight.
So what should we be eating? Here are some excellent guidelines.
What do you think? This information made me take a closer look at how I shop and what we eat… Not even because I’m diabetic, but just because I want my family to be as healthy as we possibly can.
We just heard about new studies at Duke University in the USA that may lead to an injection for Type 2 diabetes that could provide weeks of good blood glucose control… Doesn’t that sound wonderful, and hopeful?
Biomedical engineers at Duke University have created a technology that might provide weeks of glucose control for diabetes with a single injection, which would be a dramatic improvement over current therapies. In primates, the treatment has been shown to last for weeks, rather than days.
By creating a controlled-release mechanism for a drug and optimizing its circulation time in the body, this new biopolymer injection has the potential to replace daily or weekly insulin shots with a once-a-month or twice-a-month treatments for Type 2 diabetes.
The new therapy is described June 5 in Nature Biomedical Engineering.
Many current treatments for Type 2 diabetes use a signaling molecule called glucagon-like peptide-1 (GLP1) to cause the pancreas to release insulin to control blood sugar. However, this peptide has a short half-life and is cleared from the body quickly.
To make treatments last longer, researchers have previously fused GLP1 with synthetic microspheres and biomolecules like antibodies, making them active for two to three days in mice and up to a week in humans. Despite this improvement, many of these treatments don’t include a mechanism to control the rate of the peptide’s release, causing the treatment’s effectiveness to plateau after prolonged use.
Now researchers at Duke have created a technology that fuses GLP1 to a heat-sensitive elastin-like polypeptide (ELP) in a solution that can be injected into the skin through a standard needle. Once injected, the solution reacts with body heat to form a biodegradable gel-like “depot” that slowly releases the drug as it dissolves. In animal experiments, the resulting therapy provided glucose control up to three times longer than treatments currently on the market.
“Although we’ve pursued this method in the past, Kelli Luginbuhl, a grad student in my lab, systematically worked to vary the design of the delivery biopolymer at the molecular level and found a sweet spot that maximized the duration of the drug’s delivery from a single injection,” says Ashutosh Chilkoti, chair of the Department of Biomedical Engineering (BME) at Duke University and a senior author of the paper. “By doing so, we managed to triple the duration of this short-acting drug for Type 2 diabetes, outperforming other competing designs.”
Building upon their previous work with the drug and delivery system, researchers in the Chilkoti lab optimized their solution to regulate glucose levels in mice for 10 days after a single injection, up from the previous standard of 2-3 days.
In further tests, the team found that the optimized formulation improved glucose control in rhesus monkeys for more than 14 days after a single injection, while also releasing the drug at a constant rate for the duration of the trial.
“What’s exciting about this work was our ability to demonstrate that the drug could last over two weeks in non-human primates,” says Kelli Luginbuhl, a PhD student in the Chilkoti lab and co-author of the study. “Because our metabolism is slower than monkeys and mice, the treatment should theoretically last even longer in humans, so our hope is that this will be the first bi-weekly or once-a-month formulation for people with Type 2 diabetes.”
Currently, the longest-acting glucose control treatment on the market, dulaglutide, requires a once-weekly injection, while standard insulin therapies often have to be injected twice or more every day.
Despite a variety of treatment options, managing Type 2 diabetes still poses a problem. Patients don’t always reach their glycemic targets, and adherence to a treatment plan that relies on frequent, meal-specific dosing leaves room for human error. By limiting the number of injections a person will need to control their glucose levels, the researchers hope this new tool will improve treatment options for the disease.
The researchers now plan to study the immune response to repeated injections and test the material with other animal models. Chilkoti and Luginbuhl are also considering additional applications for the controlled-release system, such as delivering pain medication.
Chilkoti also said that because the drug is synthesized inside E. coli bacterial cultures instead of mammalian cells, it is cheaper and faster to produce, making it a potential target for use in developing countries once it’s commercialized.
The research was funded by the National Institutes of Health (R01-DK091789). Chilkoti is a scientific advisor for PhaseBio Pharmaceuticals, which has licensed this technology from Duke.
CITATION: “An Injectable Depot of Glucagon-Like Peptide-1 Fused to a Thermosensitive Polypeptide With Zero-Order Release Kinetics Provides One Week of Glucose Control,” Kelli M Luginbuhl, Jeffrey L Schaal, Bret Umstead, Eric Mastria, Xinghai Li, Samagya Banskota, Susan Arnold, Mark Feinglos, David D’Alessio, Ashutosh Chilkoti. Nature Biomedical Engineering, June 5, 2017. DOI: 10.1038/s41551-017-0078
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.
I’m so excited to introduce you to Gabi Richter, a Type 1 diabetic and counsellor, and a new member on our Panel of Experts who’s going to be dealing specifically with the emotional side of diabetes with a monthly column. Let us know if you have any specific questions for her! Today she’s talking about stress and diabetes.
It does not matter how long you have been diabetic, for whether it is years or if you are newly diagnosed, living with a chronic condition comes with a certain amount of stress. How you manage that stress will determine the effects it can have on your sugar levels. To much stress or mismanaged stress can affect control of your levels, however having diabetes with its constant control and management can cause stress. Therefore we need to find a workable and manageable balance between the two.
There are many definitions of stress but simply put: stress happens when pressure exceeds your perceived ability to cope. It is an emotional strain or tension that occurs when we feel that we can’t cope with pressure.
Research shows a physiological difference between pressure and stress,
People experiencing stress have higher levels of various stress hormones in their blood stream then those that merely feel challenged. When we are stressed, the body releases hormones that give cells access to stored energy known as fat and glucose to help you get away from perceived danger. This instinctive response is known as the Fight, Flight or Freeze response.
When we are confronted by a threat, a hormone called cortisol are released to help us get ready to either Fight, Flight or Freeze. This hormone allows for the increase in blood sugar for energy and an increase in blood pressure for fresh oxygen to flow to the working muscles and the release of adrenaline for heightened vigilance and alertness. However, in diabetics this instinctive response does not work well since insulin is needed to get the stored energy (glucose) to the cells and we either do not produce insulin or we produce too much of it. We are then left with an excess build-up of glucose in the blood, which results in higher levels and one more thing we need to manage and worry about.
In today’s world, it is impossible to fully avoid stress even in small doses and since the body is still programmed to release this hormone whenever it detects a threat, we as diabetics are at a bit of a disadvantage and therefore need to have a good stress management plan in place that we can fall back on when we feel stressed.
Stress can be brought on by a number of factors: a higher Hba1c or a new treatment plan or even being late and getting stuck in traffic. And then of course work and family expectations – all of these situations will lead to some level of stress. It is never a good idea to ignore stress and to think that emotions like anger and sadness don’t affect our levels, because unfortunately that is wrong and as we know everything can affect us. Ongoing stress can wear you down and lead to poor management of levels: this in turn can then lead to depression.
As diabetics we need to always look at the bigger picture and have many management programmes in place. The simplest one I have found for stress so far is to rate my stress on a scale of 1 to 10 when testing my levels and to make a note next to each reading. This will allow you to see if your high or low reading could possibly coincide with stress of any kind.
When dealing with everyday situations in life, we need to try and remember that stress of any kind is not good. Our bodies are wired to cope with a small amount of stress and for a short period, however if we continue to stress for a long period this will have negative effects on our heath. It will not only lead to depression but has also been known to lower the immune system which in turn will make us more prone to colds and illness. Therefore, we need to try and take many deep breaths when we feel overwhelmed, and to try and find ways that we can relax. Even if that means having coffee with a friend and simply talking about our problems.
– Gabi Richter
The latest diabetes-related research suggests that those who have Type 2 diabetes may reap more benefit from eating two large meals a day, rather than the traditional view of six smaller meals. Pippa Stephens from the BBC, reports that the new research from Prague was conducted using two samples sets of 27 people. One group was fed two meals a day – breakfast and lunch – and the other group was fed six smaller meals. The number of calories contained in both groups’ meals were equal. At the end of the study, the volunteers who had been eating two meals a day were found to have lost more weight and have lower blood sugar levels. Previous diabetic diet regimes were based on the assumption that eating small amounts of food regularly would be more beneficial in controlling levels of blood sugar. The Czech research calls this into question.
How the study quantifies the new claim
Kathleen Lees details the specific nature of the tests. The study was undertaken by researchers at the Diabetes Centre, at the Institute for Experimental and Clinical Medicine in Prague. Researchers selected “54 patients between the ages of 30 and 70. Participants were initially divided into two equal groups, and followed a diet that either consisted of six smaller meals or two larger ones, both containing around 1,700 calories, to include 50-55% of energy from carbohydrate and under 30% of energy from fat. Three months later, the groups switched their diet regimens.” Diabetes.co.uk noted that although all participants lost some weight, “the 2 meal diet was more effective, resulting in an average 3.7kg weight loss compared with a 2.3kg weight loss on the 6 meal diet.” Those on the two meal diet also experienced greater improvement in fasting plasma glucose levels. The study also noted that “reductions in HbA1c were modestly improved in both groups by around 0.25% (3 mmol/mol).”
In South Africa, this new research could be used to great effect following last year’s announcement that the canagliflozin drug would be made available to treat those suffering from Type 2 diabetes. Jo Willey reports that the drug, also known as Invokana, “cuts blood sugar levels in people for who diet and lifestyle measures or other blood sugar-lowering medicines do not work well enough” and “blocks the re-absorption of glucose in the kidneys, which is instead passed in the urine.” Whilst the drug’s availability in Africa, America and Asia was confirmed last year, it has only just recently been approved for use in the European Union, where it is being hailed as an important and welcome announcement for those with Type 2 diabetes. Center Watch reports that research is underway in multiple global locations, including several in South Africa, “assess the effectiveness of the co-administration of canagliflozin and metformin extended release (XR) compared with canagliflozin alone, and metformin XR alone in patients with Type 2 diabetes.” This study is sponsored by the drug’s manufacturer, Janssen, and aims to be completed in 11 months.
According to Diabetes.co.uk, “people who are diagnosed with a chronic physical health problem such as diabetes are 3 times more likely to be diagnosed with depression than people without it.” Prescribed anti-depressants are a common treatment for depression, but can have negative effects, including addiction. There is plenty of guidance available online to help friends and family find the right support and treatment for a loved one. Rehabilitation organisation, We Do Recover, run a number of rehabilitation centres across South Africa, including Johannesburg, Cape Town and Pretoria.
Whilst the new developments in the treatment of Type 2 diabetes is undoubtedly welcome news to those with the condition, as well as their friends and family. It should be borne in mind, however, that the research in Prague was undertaken with a relatively small sample set. A great deal of further study needs to be undertaken to refine what has been learned from that study. Likewise, although canagliflozin has been made available, research into its use, and its use as combined with other drugs is ongoing. Despite this, there is no doubt that treatment for Type 2 diatbetes is most definitely looking up.
– by Lily McCann
“2 larger meals beats 6 much smaller meals for type 2 diabetes.” Diabetes.co.uk. http://www.diabetes.co.uk/news/2014/may/2-larger-meals-beats-6-much-smaller-meals-for-type-2-diabetes-95702186.html (accessed May 17, 2014).
“Addiction, Durban.” Johannesburg Rehab Centre. http://wedorecover.com/sa-rehab-centres/johannesburg.html (accessed May 17, 2014).
“Clinical Trial Details.” A clinical trial to evaluate treatments using Canagliflozin 100 mg, Canagliflozin 300 mg and Metformin XR for patients with Diabetes Mellitus, Type 2. http://www.centerwatch.com/clinical-trials/listings (accessed May 17, 2014).
“Diabetes and Depression.” Diabetes.co.uk. http://www.diabetes.co.uk/diabetes-and-depression.html (accessed May 17, 2014).
Lees, Kathleen. “Could Two Large Meals Help Better Manage Type 2 Diabetes than Six Snacks?.” Science World Report. http://www.scienceworldreport.com/articles/14765/20140516/could-two-large-meals-help-better-manage-type-2-diabetes-than-six-snacks.htm (accessed May 17, 2014).
“News.” Latest Data for Type 2 Diabetes Treatment INVOKANA (canagliflozin) to be Presented at American Diabetes Association Annual Meeting. https://www.jnj.com/news/all/latest-data-for-type-2-diabetes-treatment-invokana-canagliflozin-to-be-presented-at-american-diabetes-association-annual-meeting (accessed May 17, 2014).
Stephens, Pippa. “Two meals a day ‘effective’ to treat type 2 diabetes.” BBC News. http://www.bbc.co.uk/news/health-27422547 (accessed May 17, 2014).
“Your Guide to Xanax Detox Centers and Programs” Detox.net. http://www.detox.net/articles/xanax-detox/ (accessed May 17, 2014).
I am using Lantus Solostar and due to medical aid restraints have to change. I have been given a Lilly Humapen Savvio and would like to use the Lilly equivalent cartridge to Lantus, but don’t know which one to use.
My Hba1C is 6.5 and I inject Lantus once a day in the morning and take Glucophage XR 500mg, 1 x morning and 1 x evening.
Your help will be appreciated. I know what you are going to say: “See your doctor!” but I need more answers as the doctor does not know too much about diabetes. He wants my Hba1C much lower and so doubled up on my glucophage a month ago to the present dosage, which I find a bit strange.
Thanks for your help,