what is diabetes?

Basic information about Type 1 and Type 2 diabetes.

Mr South Africa contestant is a Type 1 diabetic

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

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

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

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

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

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

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

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

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

Stress and diabetes

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

 

Need to know: what are PMBs?

Did you know that if you have diabetes and you’re a member of a medical aid, they have to – by law – give you certain benefits for free? Nicole McCreedy explains all you need to know about PMBs.

If you’re a Type 1 or a Type 2 diabetic and you belong to a medical aid, you have the right to certain health services, known as Prescribed Minimum Benefits (PMBs). There are about 300 medical conditions where PMBs apply, and 26 of those are chronic conditions like Type 1 and Type 2 diabetes.

Your health is important

PMBs were introduced to the Medical Schemes Act to protect members. It doesn’t matter how old you are, how healthy you are, or which medical aid option you are on (yes – even hospital plan counts!) Your medical aid has to provide minimum healthcare if you have a chronic condition – at no extra cost. You shouldn’t have to pay extra (over and above your monthly medical aid contribution) for certain medical services for diabetes. Because the government has made this law, it is also impossible for medical aids to charge you more or force you to lose your medical aid cover because you have a serious medical condition.

When you can (and can’t) use PMBs

What does this mean? A medical aid must pay in full, without any co-payment from you, for the diagnosis, treatment and care costs of the PMB condition (your diabetes). The medical aid cannot use your medical savings account or day-to-day benefit to pay for PMBs. Remember, though, that PMBs are subject to pre-authorisation (you have to register your PMB with the medical aid first), protocols (specific treatment and medication guidelines), and making use of designated service providers (hospitals, pharmacies and doctors that they have chosen). So you can’t expect your medical aid to cover the costs of your diabetes care unless you play by their rules, and you may not be able to get the same doctors and medicine as you had before.

Sometimes, members will not have cover for PMBs from their medical aid. This can happen if you join a medical aid for the first time (without switching from another medical aid) or if you join a new medical aid more than 90 days after leaving the previous one. If this is the case, there is a waiting period, during which you won’t have access to the PMBs for any pre-existing condition for 12 months.

Diabetes treatment and PMBs

The treatment of diabetes focuses on the control of blood sugar levels. Treatment involves all aspects of your lifestyle, especially nutrition and exercise, but most people with diabetes also use medicine (usually insulin) at some point. Treatment of other risk factors, like blood pressure and high cholesterol, is also very important.

Both Type 1 and Type 2 diabetes qualify as PMBs and must be treated according to PMB regulations for diagnosis, medical management and medication. You can ask your medical aid about the following treatments that should be covered:

  • Visits to your doctor (GP or specialist – if authorised).
  • Dietary and disease education.
  • Annual eye exam for retinopathy.
  • Annual comprehensive foot exam.
  • Blood tests every 3 to 6 months.
  • Disease identification card or disc.
  • Home blood sugar testing.

How to get your Prescribed Minimum Benefits:

Step 1: Register

Phone your medical aid and tell them you want pre-authorisation for diabetes PMBs. They will ask for a code that your doctor will be able to give you. It is very important that you have the right ICD-10 code – this gives the right information about your condition and helps the medical aid to know what benefits you are allowed. A PMB condition can only be identified by the correct ICD-10 codes. If you give the wrong ICD-10 code, your PMB services might be paid from the wrong benefit (like your medical savings account), or it might not be paid at all if your day-to-day or hospital benefit limits have run out.

Step 2: Your service will be pre-authorised

After you have registered your chronic condition for PMB, your benefits will be authorised and you can ask for your PMB schedule, which tells you exactly what you get for free.

 

The A to Z of PMBs

Chronic Diseases List (CDL)
A list of the 26 conditions (including diabetes) that qualify for PMBs.

Chronic Medicine
Medicine used for the long-term treatment (three months or longer) of a chronic condition. The chronic medicine must be used to prevent or treat a serious medical condition, to sustain life and to delay the progress of a disease. It must also be the accepted treatment according to treatment guidelines (protocols).

Co-payments
The difference between the cover provided by the medical aid and the cost of the medical service – payable directly to the service provider.

Designated Service Provider (DSP)
Doctors and other health care providers who have been chosen by the aid to “provide its members diagnosis, treatment and care” for PMB conditions.

Emergency Medical Condition
A medical condition that needs immediate medical or surgical treatment.

Formulary
An official list of the medication that can be prescribed for the treatment of the 26 conditions on the Chronic Diseases List (CDL).

ICD-10 Codes
An international clinical code that describes a disease diagnosis. If you want to qualify for PMBs, you must be sure your doctor puts the correct ICD-10 code on all your forms.

PMB Medicine
Medicine for the treatment of the 26 conditions on the Chronic Diseases List (CDL) qualifies for PMBs, as long as you provide all the necessary information. This can be anything from a diagnosis by a specialist to results of certain tests – your medical aid will tell you what you need.

Prescribed Minimum Benefits (PMBs)
The minimum benefits that must be provided to all medical aid members. These include diagnosis, treatment and care costs for a number of conditions, including diabetes.

Protocols (Treatment Guidelines)
There is a minimum standard treatment for each PMB condition. Medical aids use these guidelines to come up with protocols (treatment guidelines) and formularies (lists of approved medication) to manage PMBs.

This article was reviewed by:

  • Alain Peddle, Discovery Health
  • Herman van Zyl, Principal financial advisor, HVZ Financial Consultants
  • Rossouw van Zyl, Brokers, t/a Medinet, Authorised Financial Service Provider
  • Michael A.J. Brown, Accredited Diabetes Educator,
Centre for Diabetes and Endocrinology, Houghton

 

Gastric bypass surgery to “cure” diabetes

Recent research suggests that a certain kind of surgery may “cure” Type 2 diabetes. We find out more, and give you the facts.

One of the experts in the field of gastric bypass surgery is Professor Tess van der Merwe, the president of the South African Society for Obesity and Metabolism, who have been sharing information about the surgery. We found out what it could mean for Type 2 diabetes, then asked our experts to weigh in on the topic.

Is this surgery a cure for Type 2 diabetes?

Gastric bypass surgery has been used to help obese people lose weight since it was first performed 20 years ago. But now there is new research that this same surgery (specifically a type called “laparoscopic Roux–en–Y gastric bypass”) could cause Type 2 diabetes to go into long-term remission. What does this mean? Type 2 diabetes could be “paused” for a number of years. An international study shows that about 90% of obese patients with Type 2 diabetes who go for this surgery have normal blood sugar and no evidence of diabetes for three to fifteen years.

Is it a cure? No. But it is possibly a very long break from a chronic condition.

Some might say that any surgery that causes very overweight people to lose weight will have a good effect on blood sugar, but experts say the difference can be seen before the weight is lost. Professor Francesco Rubino (a leader in surgery for Type 2 diabetes) was in Johannesburg for the 3rd Centres for Metabolic Medicine and Surgery Workshop. He said that a few days after a gastric bypass, patients with Type 2 diabetes show normal blood sugar levels, even before any weight has been lost.

Ask the expert: Dr. Joel Dave, endocrinologist
“Bariatric surgery is becoming an important part of the treatment of diabetic patients with a BMI over 35. But although the results with this surgery are very good, it is still an invasive procedure with potential complications. It should not be considered a shortcut to weight loss and diabetes improvement, but a last resort after a low calorie diet and structured exercise programme has failed.”

 

What if the Type 2 diabetic ate badly and didn’t exercise, and returns to this same lifestyle – will the surgery still work?
The surgery doesn’t just help the patient by making their stomach smaller. It also triggers changes to the hormones, the appetite and the metabolism, so that long-term change is possible. But it is not a magical cure – the patient has to be ready to make changes to their diet and exercise. As Prof. van der Merwe points out, “There is not a single treatment in medicine that will be immune to an uncooperative patient.” In other words, if the patient goes back to a diet of fast food and no exercise, the same problems will return. One of the ways they guard against this in the Centres of Excellence (where they do the surgery) is by coaching the patient to start new, positive habits. They have a team of experts to help with this.

Ask the expert: Genevieve Jardine, dietician
“It is my opinion that gastric bypass surgery may be a good option for those who have a high BMI (above 35) and have tried for many years to lose weight. If they are managed well after surgery and take this opportunity to start over, it could mean a second chance at health. It is important to remember, though, that it still comes down to diet and exercise. Lifelong lifestyle changes are still the foundation of good diabetes management.”

How extreme is the surgery?

The surgery is minimally invasive. It is also known as laparoscopic surgery, keyhole surgery or bandaid surgery because the cuts made are so small – on average 0.5 to 1.5 cm. The doctor uses images on TV screens to magnify the surgery so they can see what they need to do.

Ask the expert: Dr. Joel Dave, endocrinologist
“Although the procedure is minimally invasive there are still some potentially serious complications. The patient’s decision to have this surgery must not be taken lightly.”

Is the surgery covered by medical aids?

That depends on how urgently you need it. In order to work that out, doctors look at your BMI (Body Mass Index), which outlines whether you are underweight, at a healthy weight, or overweight (see the box on this page). Diabetic patients with a BMI over 35 may be able to get the surgery covered if they have a motivation letter from a Metabolic Centre for Excellence, and if they are on the right medical aid option. There is usually a 20 to 30% co-payment that the patient would have to pay.

Have there been any local studies?

A South African study based at Netcare Waterfall City Hospital tracked 820 patients who had not been able to lose weight for up to 18 years before they had surgery. Three years later, 88.5% of the patients who had diabetes at the time of the surgery still had normal blood sugar levels.

Is there anyone it won’t work on?

This surgery is only an option for Type 2 diabetics who are very overweight – with a BMI greater than 35. They are doing research on lower BMI’s as well.

Want to find out more?
Visit www.sasomonline.co.za

How to work out your BMI

There are many websites (http://www.smartbmicalculator.com/) that calculate BMI for you, but if you want to do it yourself, here’s what you need:

  1. Your weight.
  2. Your height in metres.
  3. A piece of paper and a calculator!

First, find out the square of your height in metres (your height times your height, i.e. 1,5m x 1,5m).
Then do this sum: (Weight in kg) divided by (square of height in metres)
You should get a number between 18.5 and 40.

Results:

  • Less than 18.5 means you are underweight.
  • 18.5 to 25 means you are at a healthy weight.
  • 25 to 30 means you are slightly overweight.
  • More than 30 means you are very overweight (obese).

Humans of South Africa

Hi there,

I am a writer, copywriter and journalist; I have been running Humans of SA for 2 years – we also have a Facebook page. I wanted to create a space where I could share South African stories. My aim has always been to open windows into worlds we might know nothing about. I interviewed a lady recently who lost her father to diabetes.

Screen Shot 2016-06-21 at 12.18.07 PM

She speaks about a lack of understanding in terms of care and treatment. I feel it is important to bring attention and help create more awareness by telling stories of people who are diabetic, of professions who can advice and help.

If you have a story you are happy to share, please get in touch by emailing me.

Thank you!

Sandy

The sweet life at school

Here’s some advice from Novo Nordisk for teachers with diabetic children in their classroom…

One of the many challenges facing busy educators today is how to manage the situation if they have a child with special healthcare needs in their classroom. This is especially true of conditions that can be life-threatening, like diabetes. As up to 3.5 million South Africans are estimated to be living with diabetes, and as up to 45% of all new cases diagnosed are in children, the chances of having a child with diabetes in the classroom are quite high. So it’s important for teachers to know what to do if this is the case.

“Each school should have a formal process for obtaining information about special-needs children,” says Jacquie van Viegen, a diabetes educator at Novo Nordisk, “and all teachers should be notified if there are children with diabetes or other chronic conditions at the school. This enables them to be alert to any changes in the child’s behaviour or to any signs of distress. It also gives individual teachers the opportunity to educate classmates about the condition in general at the beginning of the school year.”

Written instructions and guidelines from parents can be especially helpful, and these can be pinned up in an accessible place in the classroom so that both teachers and fellow learners can refer to them if necessary. Educating classmates about their friend’s condition will also help to eliminate fear and empower them to act if necessary.

Screen Shot 2014-02-18 at 10.39.28 AM“It’s always helpful to include information and discussion on special-needs classmates during the welcoming process at the start of the year,” says van Viegan. “This is important in order to dispel myths about diabetes and other chronic conditions.”

Children may, for instance, need to be reassured that diabetes isn’t contagious, and be enabled with the necessary knowledge to help their friend out should the need arise. Knowing about diabetes will also help them to recognise that, when a classmate’s behaviour is unusual, this may be a sign that they need assistance.

On an everyday level, teachers of younger children in particular should keep a watchful eye over the situation without giving the impression that the child is receiving preferential treatment. They should, for instance, ensure that children with diabetes have a healthy snack before undertaking strenuous exercise, either in the gym or on the sports field. Exercise, like insulin, lowers blood glucose levels, and can lead to low blood sugar or hypoglycaemia.

Similarly, teachers should ensure that children with diabetes always have access to an emergency source of glucose in order to counteract a hypoglycaemic episode should this occur. A ready supply of glucose sweets is always advisable, and a small carton of fruit juice can be a life-saver in an emergency.

“It’s also important for teachers to understand that children with diabetes need to have regular snacks throughout the day,” says van Viegen, “and they should allow them to eat a small yoghurt or another suitable snack in class if necessary. Some children may also need to use the bathroom more frequently than others, and this should be taken into account too.”

And it’s essential for teachers to be able to identify the early warning signs of a hypoglycaemic episode. In general, these include irritability, sleepiness and erratic responses to questions. The child who appears not to be paying attention may, in fact, be getting low on all-important glucose.

“In terms of first-response treatment, glucose sweets or fruit juice usually does the trick,” says van Viegan, “but if the child doesn’t show signs of improvement almost immediately, it’s important to seek medical help.”

Informed and caring teachers can make all the difference to a child living with diabetes or any other chronic condition. They can help to teach them how to live normal, active lives outside the home, and can ensure that they’re well integrated with their peers.

“In fact,” says van Viegan, “the lessons they teach them about coping with the condition in everyday situations are likely to be of great value to them throughout their lives.”

Image credit

Diabetic dietary changes

Hello,

Just found out that my dad in-law has 7.2 count blood sugar.

I would like to find out more about how he should change his diet, e.g. – white rice now what should he eat – etc… fruits can and cannot eat, beverages, replacement for sweets biscuits   etc… he loves those.

In his morning cereals he usually uses sugar – what can he use now – Honey?

We also saw on Google – 5 foods one should not eat – but the sites do not open – so still not sure what one should and should not eat as far as that is concerned –

Your reply is much appreciated,

Antonella

Is joint pain related to diabetes?

Hi
I am a diabetic for the past 15 years.

Please could you give me some advice?

I have this burning sensation under my feet and my joints on my fingers burns and pains.

I am on medication which I take 2 x 500m metformin and 1 x glicozine in the morning and the same at night.

Please could you tell me if my sugar level is high or what it is I should do for the pain?

Kind Regards

– Strini