Type 2

How to help a poorly controlled diabetic

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.

Dear Celeste,

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.

Good luck!

– Jeannie Berg, Diabetes Educator

 

A fit pregnancy

Staying active during pregnancy is the best thing for you – and your baby, Cindy Tilney tells us.

While exercise may not be what you feel like doing when you’re expecting, experts agree that it has a host of benefits – besides being a natural mood-lifter, there’s no denying how good it is for you. “In pregnancy, it’s always better to exercise than not – even with a chronic disease such as diabetes,” says personal trainer Shelley Lewin, who offers specialised pre- and postnatal exercises in Cape Town. “Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active. Unless you have a specific medical condition that puts you and your unborn child at high risk during pregnancy, it can only work to your advantage,” she says. “And in people with diabetes, it can help the body to process glucose more effectively.”

What can exercise do for pregnant diabetics?*

  • Lower blood sugar
  • Improve insulin sensitivity
  • Control blood pressure
  • Increase energy
  • Reduce after-meal blood sugar spikes
  • Encourage restful sleep
  • Lower gestational weight gain.

According to the American College of Obstetricians and Gynecologists (ACOG).

*Type 1, Type 2 and gestational diabetes

Remember: If you have diabetes, it is essential to get the all-clear from your doctor before starting an exercise programme, particularly if you are pregnant.

“Exercise in any form may require a reduced amount of insulin because exercise increases glucose uptake in the cells,” explains biokineticist Sarah Hall. “The intensity of the exercise you are doing will determine this: lower-intensity exercise can lead to a recommended insulin reduction of roughly 20%, as opposed to a possible 50% with higher intensity exercise.” This is further complicated by insulin needs often doubling during pregnancy, so consulting a doctor is a must.

Healthy exercise tips during pregnancy:

  • Check your blood sugar before and after exercise (Type 1 diabetics).
  • Always take a ‘quick-fix’ snack, such as a banana, along with you when you exercise, so that you have a sugar source on hand in case of hypoglycaemia (low blood sugar).
  • Stay away from forms of exercise that carry a high risk of falling, and avoid lying on your back with the head below the level of the heart, as this can restrict the blood flow to your baby.
  • Wear a heart rate monitor during cardiovascular exercise, and keep your heart rate to 140bpm or below. In the past, there was a widely held belief that pregnant women should stay away from all cardiovascular exercise – but modern research has shown that this does not hold true.

The good news? If you’ve been exercising regularly, you can carry on very much as normal, agree Hall and Lewin – provided the activities are not extremely high impact, do not involve fast or sharp changes in direction, or cause surges in blood pressure or adrenalin.

Ideal pregnancy exercise

Both experts recommend 30 minutes of moderate physical activity three times a week, such as walking, swimming, aqua aerobics and light weight lifting under the guidance of a certified ante-natal instructor. The ligaments tend to naturally relax during the second and third trimesters of pregnancy, so be careful not to overstretch during warm-ups – and if you are weight training, use machines rather than free weights to avoid any hyperextension injuries.

“Building up core strength is important in pregnancy,” says Lewin, “but as your tummy grows, you should stay away from certain intense core exercises, such as tummy crunches – instead opt for opposite leg and arm lifts, or practice stability work on a Pilates ball.” Kegel exercises are also important during pregnancy, as they strengthen the pelvic floor muscles.

Be gentle with yourself during pregnancy: stay away from contact sports and aggressive forms of exercise. And be aware of your body and how hard you are pushing yourself during workouts. “The ‘talk test’ is always a good marker of whether you are pushing yourself too hard,” says Lewin. “If you are exercising at the right level, you should be able to talk at the same time – but if you’re struggling to take in breath and unable to hold a conversation, it means you are pushing yourself too hard.”

Find out more about pregnancy exercise at www.homefit.co.za

“Staying active is not only important for the physical and emotional health of the expecting mother – research has shown that unborn babies thrive if their moms are active.”

Ask the expert: Sarah Hall, Biokineticist

Warning Signs

Don’t exercise if you have:

  • Pregnancy-induced hypertension
  • Ruptured membranes
  • Placenta praevia
  • Vaginal bleeding of any kind
  • Incompetent cervix (when the cervix is weak and opens too early)
  • Or if you are expecting twins or more

If you experience any of the following during exercise, stop immediately and seek medical help:

  • Sudden calf swelling
  • Headaches
  • Decreased foetal movement
  • Chest pains
  • Any amniotic leakage
  • Excessive overheating

A walk in the park

Do you want to know how to lose weight, feel better and control your blood glucose levels the easy way? Take a walk!

If your doctor keeps telling you to get active but you’re not sure what kind of exercise to do, why not take a walk? Walking is the one of the easiest ways to get fit because you need very little preparation – we all already know how to do it! Studies have shown that people with Type 2 diabetes who walk daily are able to store sugar and burn fat more effectively. The result: better glucose control and weight loss.

That’s not all. Because walking is relaxing it lowers your blood pressure. This decreases your risk of heart disease. At the same time fitness, lung capacity, stamina and mental alertness all improve.

Still not convinced? It can even make you happier―walking is an excellent way to naturally boost your mood.

Beginners

Because you don’t need special equipment, walking is ideal for beginners. A pair of well-fitting trainers will do the job. The International Diabetes Federation (IDF) recommends 30 minutes of brisk walking daily as part of a healthy lifestyle programme to manage diabetes. However, every journey begins with a single step. Start slowly with 5 or 10 minutes per day and try to add 5 to 10 minutes to your programme weekly.

What is the best technique? Watch your posture. Walk tall. Back straight. Look ahead and keep your chin parallel to the ground. Shoulders should be relaxed. Gently tighten your stomach muscles and tuck your pelvis in to bring it in line with your upper body. Feet must make contact with the ground heal first and then push off with the toes.

Need extra motivation? Use a pedometer, a small device that clips onto your waistband, to track the total steps you take during the day. With your pedometer at hand, find ways to activate your day as much as possible: walk the dog, window shop, use the stairs or walk to visit a neighbour. The end goal is 10,000 steps a day, but anything over 5,000 is a good start!

Advanced/Adventure

Want a challenge? Head off-road: go trail walking or hiking. Keep these points in mind when you’re going for an adventure walk:

Be wise. Hike in a group and choose your route according to the least fit person in your group’s abilities. Tell someone where you are going and when you will be back.

Be prepared. Hiking requires planning. Pack enough water for the trip to ensure that you are properly hydrated and take something sweet in case your blood sugar goes low. Avoid blisters and don’t hike wearing new shoes. Protect yourself from the sun: wear a hat and sunscreen.

Be aware of your surroundings. Check the weather forecast, be familiar with the route and carry a map.

Get moving

Walking is the most recommended and popular form of exercise. It is plain to see why. It can be fun, relaxing and a great way to spend time with people. You can do it practically anywhere and it is a good excuse to visit new places. Best of all anyone can do it and it is really good for your health. Start today― take a few steps in the right direction.

Ask the expert: Diabetic tips for walking
Dr. Zaheer Bayat, Endocrinologist

It is important to balance enthusiasm and common sense when beginning an exercise program.

  • Have a pre-exercise examination by your GP. This may include a stress test for patients over the age of 35 or have had diabetes for more than 10 years.
  • Discuss with your doctor whether or not your insulin dosage needs to be adjusted.
  • Choose an insulin injection site away from exercising muscles.
  • Eat a snack approximately 15 to 30 minutes before exercise, and again every 30 minutes during exercise. Choose a snack that’s a slowly absorbed carbohydrate.
  • Drink enough liquids before, during, and after exercise to prevent dehydration, which can upset blood sugar levels.
  • Test your blood sugar before, during, and after exercise to figure out your body’s typical response to exercise.
  • Be sure to keep some juice or sweets on hand in case your blood sugar goes low.

Ask the expert: foot care
Anette Thompson, Podiatrist

  • Go for a check-up with your podiatrist so that you know the status of your foot health.
  • Blisters, hot spots, breaks in the skin or blood flow problems to the feet may go undetected; foot numbness could also be present without your being aware of it. These need to be treated.
  • Wear well-fitting shoes that fit comfortably with at least 15mm length ahead of the longest toe and don’t rub at the heel. Try on new shoes, with socks, in the afternoon when your feet are at their biggest volume.
  • Invest in good socks. Diabetic socks are made so that they don’t cut off circulation around the ankle.
  • Check your feet after each walking session for cuts, blisters, hot red spots or abrasions.