type 2 diabetes
Information and questions about Type 2 diabetes.
The 12th to the 16th of February is Pregnancy Awareness Week, an excellent opportunity to discuss one of the most common forms of diabetes: gestational diabetes. It is estimated that between 3% and 20% of pregnant women develop gestational diabetes, depending on their risk factors. We asked Pick n Pay’s dietician Leanne Kiezer for some helpful tips on gestational diabetes.
All pregnant women should be screened for gestational diabetes between 24 to 28 weeks of pregnancy. Women who are at high risk for undiagnosed Type 2 diabetes should be screened earlier than 20 weeks of pregnancy. This information, compiled by Diabetes Canada, helps to clarify some of the common myths and misconceptions around gestational diabetes, as well as offering some tips for its management.
What is gestational diabetes?
Gestational diabetes is a type of diabetes that occurs during pregnancy. Your body cannot produce enough insulin to handle the effects of a growing baby and changing hormone levels. Insulin helps your body to control the level of glucose (sugar) in your blood. If your body cannot produce enough insulin, your blood sugar levels will rise.
The good news
- Your baby will not be born with diabetes.
- Gestational diabetes can be managed and you can expect to have a happy, healthy baby.
What does gestational diabetes mean for my baby?
If left undiagnosed or untreated, gestational diabetes can lead to high blood sugar levels. This increases the risk that your baby will weigh more than 4kg (9lbs) and will have a difficult delivery. Gestational diabetes can also increase the risk of your baby becoming overweight and developing Type 2 diabetes in the future. It is important to breastfeed immediately after delivery for at least four months, if you can, to help reduce the risk of obesity and diabetes for your baby.
What does gestational diabetes mean for me?
A diagnosis of gestational diabetes means you will be working closely with your health-care team to manage your blood sugar levels and keep them in the target range. This will help you avoid complications in labour and delivery. After your baby is born, blood sugar levels will usually return to normal. However, you are at greater risk for gestational diabetes in your next pregnancy and of developing Type 2 diabetes in the future. Achieving a healthy weight in the normal BMI range can help reduce this risk.
Risk factors for gestational diabetes
- 35 years of age or older
- From a high-risk group (African, Arab, Asian, Hispanic, Indigenous, or South Asian descent)
- Corticosteroid medication
- 35 years of age or older
- From a high-risk group (African, Arab, Asian, Hispanic, Indigenous, or South Asian descent)
- Corticosteroid medication
- Given birth to a baby that weighed more than 4kg
- Gestational diabetes in a previous pregnancy
- Obesity (BMI of 30kg/m2 or higher)
- A parent, brother or sister with Type 2 diabetes
- Polycystic ovary syndrome (PCOS) or acanthosis nigricans (darkened patches of skin)
How is gestational diabetes managed?
Choose a healthy diet
Ask your doctor to refer you to a registered dietitian to learn about healthy eating during pregnancy. Try eating low-glycemic index foods (e.g. whole grains, legumes), spread over three meals and two snacks to help manage your blood sugar.
Achieve a normal pregnancy weight gain
The amount of weight you gain will vary depending on your weight before your pregnancy. Weight loss is not recommended. Talk to your health-care provider about appropriate weight gain for you.
Be physically active
Regular physical activity can help control your blood sugar levels. It can also help you:
- Boost your energy
- Sleep better
- Reduce stress
- Reduce pregnancy discomfort
- Prepare for childbirth
- Get your body back faster after childbirth
Talk to your health-care provider about the right type and amount of activity for you.
Check your blood sugar at home
Checking and tracking your blood sugar with a blood glucose meter will help you and your health-care team manage your gestational diabetes.
Take medication, if needed
Sometimes healthy eating and physical activity are not enough to manage blood sugar levels and your health-care provider may recommend insulin injections or pills for the duration of your pregnancy. Medication will help keep your blood sugar level within your target range. This will help to keep you and your baby in good health.
Your health-care team can answer your questions and support you through this important time in your life. Your team may include your doctor, nurse and dietitian, but remember: the most important member of your health-care team is you!
Pick n Pay Health Hotline
Did you know that Pick n Pay employs a registered dietitian to provide free food and nutrition-related advice to the public? Contact Leanne via the Health Hotline on 0800 11 22 88 or email her directly on
email@example.com to start your nutrition conversation.
“Diabetes…. Uugh.” That feeling pretty much sums up what diabetes burnout is all about: the feeling that it’s too exhausting / frustrating / unpredictable / impossible to manage your diabetes, so why even try? Diabetes burnout is common in people with diabetes (both Type 1 and Type 2) and for good reason – it’s a chronic condition. Chronic as in forever, never giving you a break, never giving you a holiday, never giving you a moment’s rest. Add to that the fact that diabetes is an ever-changing condition, with blood sugar fluctuating depending on everything from your diet and exercise to hormones, weather, sickness and more, and it’s no surprise that people with diabetes sometimes feel exhausted by it all.
When you need to worry about diabetes burnout
“Diabetes burnout is a normal emotion for diabetics to feel at any given time,” explains Gabi Richter, a Type 1 diabetic and counsellor in Cape Town. “It occurs when you are fed up with the routine and lifestyle that being diabetic entails, and you just want to forget it all. This is fine to feel once in a while – and can even be healthy to some point. But it needs attention when the feeling stays for a long time and your routine diabetes care stops.”
This, of course, is the warning sign. If it feels like there’s no point taking care of your diabetes because you have no control any more, that’s when you stop paying attention to food and medication and self-care. And that’s when blood sugar levels can get wildly out of control. Extended periods of high blood sugar (hyperglycemia) lead to diabetes complications, and in Type 1 diabetics, low blood sugar (hypoglycemia) can be extremely dangerous.
So what do you do if you’re experiencing diabetes burnout? Reach out. Connect. Realise you’re not alone. “Diabetes burnout is a very real issue for all the people I am privileged to educate and spend time with,” explains Kate Bristow, a diabetes specialist nurse in Pietermaritzburg, KZN. It’s a combination of the frustration of things: Never having a day off from diabetes. The guilt of not sticking to the right eating plan or forgetting to take medication or check blood sugar. The relentlessness of never being able to take time off from managing diabetes. “Burnout is often accompanied by stress and anxiety and sometimes depression or guilt – all negative emotions,” says Kate.
5 tips for diabetes burnout
Here are 5 pieces of advice Kate Bristow offers her patients.
Share your frustrations with someone – a family member, or diabetes nurse or educator. See if there are ways to decrease your burden for a while.
Try new diabetic-friendly recipes – a change is as good as a holiday.
Try practicing mindfulness – a practice based on learning to become aware of how you are feeling emotionally in a non-judgemental way. It has been found to be effective in supporting diabetes management and the general stress of everyday life. Eating mindfully has been shown to improve diabetes control.
Life is busy – stress is a way of life – defined as a state of emotional tension elicited by the pressure of everyday life. Diabetes is probably only one of those stresses. Exercise has been shown to reduce stress levels and alleviate depression as much as some medications used for the same purpose. Exercise is also good for our physical health – blood pressure, weight, cholesterol, and diabetes. So perhaps another way of dealing with burnout is to get an accountability exercise partner and start getting physical at least 3 times a week (even if it’s only for 20 minutes at a go, or at work).
If you really feel like you are not coping – ask for help. This is why you have a health care team and a diabetes community. Ask your doctor, your diabetes educator, your diabetic community. You’re not alone in this.
Diabetes burnout is a reality for many of us with diabetes, but it doesn’t have to be a long-term reality. With the right help and care, it can be a phase we move through – just another part of living with this chronic condition. How do you cope with diabetes burnout? Do you have any tips to share?
Did you catch Sweet Life editor Bridget McNulty when she returned to the Expresso show on SABC3 to talk about Type 2 diabetes? Here’s an excerpt of the interview in case you didn’t… Watch Bridget try to remember everything she can about Type 2 diabetes, on air!
The interview covers the causes of Type 2 diabetes, who is most at risk and why, the symptoms of Type 2 diabetes to look out for, and what food to eat to help combat Type 2 diabetes. Check out the previous interview here.
Prefer reading? Here’s an excerpt of the interview:
1. What causes Type 2 Diabetes?
Although Type 2 diabetes is known as a lifestyle disease, which means that poor lifestyle choices cause it, there is also a strong genetic component. So if you have family with Type 2 diabetes, you’re more likely to get it – it can be hereditary. There’s not much you can do about that but there’s a lot you can do about your lifestyle.
Poor lifestyle choices like eating a lot of processed, sugary, fatty foods (junk food, essentially) and not exercising, smoking and drinking too much all elevate your risk of Type 2 diabetes developing. Being overweight is also a risk factor, especially fat around the middle. These all lead to insulin resistance, which means your body can’t process insulin properly. This is one of the main causes of Type 2 diabetes. The other cause is when your body doesn’t make enough insulin.
2. Who is most at risk and why?
People who lead a sedentary lifestyle – not exercising – and making bad food choices – too much sugary, processed food. White bread, white rice, pasta, chips, chocolates, pies, sweets, cooldrinks – all the delicious stuff that’s bad for you.
3. What are the symptoms to look out for?
There are 5 common symptoms of diabetes: extreme thirst, extreme hunger, needing to pee a lot (especially at night), exhaustion and blurry vision. If you have any of these symptoms you should get a fingerprick blood test – it takes less than 5 minutes at your local clinic or pharmacy and will tell you if you’re at risk of developing diabetes.
4. Nutrition-wise, which types of foods can help combat type 2 Diabetes?
All the healthy stuff! High fibre, whole foods. Fresh fruit in moderation, loads of vegetables, some good carbs that are low GI and high fibre, good quality protein. No junk food, no cooldrinks, no cakes, sweets, biscuits, chips. If you think of your plate as a circle, half of it should be filled with vegetables or salad, 1/4 with good quality protein (fish, chicken, meat, eggs) and 1/4 with high-fibre carbs, with some good quality fats (like olive oil or avocado). If you’re Banting, this will be a different proportion, but it’s the same idea: good quality, healthy, whole food.
Jane Sandwood, one of our regular contributors, tackles the issue of diabetes diagnosis in the elderly.
In a recent study of South Africans over the age of 50, 9% reported having diabetes and this percentage rose with age. With the proportion of elderly people over 60 growing fast in South Africa, having reached 4.6 million in 2017, this means that a chronic disease like Type 2 diabetes is on the rise too. As an older person, dealing with a new diagnosis can be challenging and as well as changes in diet and lifestyle, support from family and friends can be very helpful in managing the disease.
Changing habits to be diabetes-friendly
In a country where the demands of other health challenges take precedent, the needs of older people can be overlooked. Even with the best health care, a diagnosis of diabetes can be difficult for older patients. They need to change deep-rooted habits when they may already be facing symptoms and illnesses associated with the condition.
Nearly a third of people with diabetes have diabetic retinopathy which causes gradual deterioration to sight, and yet with early and regular treatment, the risk of blindness is reduced by 90%. This highlights how, by attending routine regular check-ups and creating new healthy habits, many of the symptoms of diabetes can be controlled.
Managing sugar levels
Older people are particularly vulnerable to hyperglycemia caused by very high blood sugar levels. Complications from a hyperglycemic crisis are dangerous. This is a very real risk in the elderly who may have trouble getting used to a new diagnosis and forget to follow health and diet guidelines strictly. Daily reminders about diet, keeping hydrated, careful monitoring of blood sugar levels and, in case of collapse, a system to ensure treatment is provided promptly can all help the patient feel more in control and less vulnerable.
Coping with stress – and diabetes
Adjusting to a new regime can be very demanding but it’s important to learn to relax (easier said than done!) Stress affects metabolic control and can lead to increased HbA1c, a term for glucose in the blood. HbA1c levels are almost double in diabetics experiencing extreme stress, increasing the risk of long-term complications. Tempting as it might be, it’s crucial not to rely on habits like smoking to relieve stress. One of the many consequences of smoking is hardening of the arteries, leading to an increase in cardiovascular complications. In a recent study of adult South Africans with diabetes, 73% were dealing with other cardiovascular illnesses such as angina or hypertension. In order to alleviate stress and improve circulation, an increase in exercise can be very helpful
A diagnosis of diabetes in later life can be a lot to cope with. However, small changes in lifestyle and regular check-ups and treatment can make a big difference.
Bridget McNulty, editor of Sweet Life diabetes community, was recently interviewed on the Expresso show on SABC3.
The segment was about what Type 2 diabetes is, how it is caused, what to do to prevent Type 2 diabetes and how to live a healthy, happy life with diabetes.
What is diabetes?
There are three types of diabetes: Type 1, Type 2 and gestational diabetes. They are all related to how insulin is used in the body. In people without diabetes, when you eat your pancreas releases the perfect amount of insulin to match the food you’ve eaten. In Type 1 diabetes, the pancreas releases very little (or no) insulin so insulin injections are necessary. In Type 2 diabetes, either not enough insulin is being produced or the insulin that is being produced isn’t being used properly – the body is insulin resistant.
Insulin is so important because it acts as a key that unlocks the cells. When you eat, food is broken down into glucose, which is absorbed into your bloodstream. Insulin transports the glucose from the blood to the cells of the body, where they are used as fuel – as energy. People with diabetes have impaired insulin function, which means that if they are not in good control. their blood glucose gets higher and higher – this can lead to complications like blindness, amputation and kidney failure. But only if you don’t look after yourself! It is possible to live a perfectly happy, healthy life with diabetes.
What causes Type 2 Diabetes?
There is a strong genetic component, but Type 2 is often called a lifestyle disease because it is strongly linked to a poor lifestyle – being overweight (particularly around the belly), eating the wrong kind of food (junk food, lots of refined carbohydrates, fizzy drinks etc) and not exercising. If caught early enough, Type 2 can be reversed with a healthy diet, weight loss (if necessary) and exercise. (Type 1 can never be reversed). If lifestyle modifications don’t help, the treatment is generally insulin pills and eventually insulin injections. But the earlier you are diagnosed the better it is, because your body has not been damaged – that’s why we always promote getting your blood sugar checked. It’s a simple, fingerprick blood test at your local clinic or pharmacy.
Is stress a contributing factor – and how?
We all know that stress is bad for us. When it comes to diabetes and how the hormones function in the body, stress releases stress hormones like cortisol which raise blood sugar to give you an energy boost in times of danger (I’m not a doctor, but I’ve experienced this a lot myself). There are a lot of studies being done at the moment about prolonged stress, anger, anxiety, depression, poor sleep and how they relate to diabetes, but nothing has been proven yet.
What diet and lifestyle changes need to be made to fight diabetes?
Funnily enough, the kind of diet and lifestyle changes we should all be making – whether or not we have diabetes. A balanced diet with lots of fresh food and no refined carbohydrates (white bread, white rice, cakes, biscuits, etc), no juice or fizzy drinks, no fast food. Plenty of water, little alcohol, no smoking. Regular exercise – the recommendation is 30 mins 5 times a week, and it doesn’t have to be anything hectic, it can just be walking around the block and getting faster as you get fitter. And losing weight if necessary. Also regular sleep and keeping your stress down. It’s a recipe for health for anyone!
Diabetes and diet is a hot topic at the moment because of Banting and the wonderful results many people with Type 2 diabetes have had on it. At Sweet Life we don’t recommend a particular diet, we give everyone the facts so that they can decide for themselves. What works for one person may not work for others.
It’s one of the questions we get asked at Sweet Life all the time. Do I have to change my lifestyle – and my diet – to manage Type 2 diabetes?
Well, that depends. Most of the time, Type 2 diabetes is caused directly or indirectly by issues of diet and lifestyle – it’s sometimes called a ‘lifestyle disease’. That said, there is a strong genetic component, so it’s not helpful to think that you ‘gave yourself diabetes’. That kind of attitude isn’t going to help you live a healthy, happy life with diabetes.
Take a close look at your lifestyle. Do you think it’s one of the reasons you were diagnosed with Type 2 diabetes? Do you eat a lot of fried, fatty food? Is there enough fresh fruit and vegetables in your diet? Do you eat a lot of processed food or refined carbohydrates? Do you eat large portions, even if you’re no longer hungry? If so, it might be time for a lifestyle revamp. Take a look at Sweet Life’s Ask the Dietician articles for advice on a healthy diabetes diet.
Family with diabetes
One of the hardest things for newly diagnosed diabetics is making the changes necessary for their health, while still being part of the family. For many people, family meals are an important part of the day, and having to either eat a different variety of a meal or eat at different times or in a different way (a plate of food instead of sharing from communal plates, for example) is a difficult adjustment. Some families are fantastic at supporting the newly diagnosed, others find it too much of a challenge. Sweet Life has written about the challenges of family life with diabetes in our Partner’s Corner articles – you can find out more about families with diabetes here.
Remember that it’s important to sit down and explain to your family why you need to make certain changes, and how they can benefit from them too. Those who have adopted a healthier lifestyle – one that’s rich in fresh food and regular exercise – not only see the effects in their blood sugar results, but in their overall wellbeing.
Have you had to change your lifestyle because of 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