What is diabetes?

Basic information about Type 1 and Type 2 diabetes.

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.

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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

Interesting diabetic lunchbox options:

Hi there,

My husband is 44 years of age and he is a diabetic. I have endless problems with preparing his lunch boxes as I am not sure what to put in it for him so he ends up with the same things on his sandwiches every week.

Here is the list:
Cheese
Bacon
Chicken/ smoked chicken
Beef patty
And Cheese spread
Sometimes tuna but he dislikes it.

I need help please!

I would also like to know if I will need a script to buy Viagra for him because he won’t talk to his doctor  about it and he has seen the doctor already for this year and will only see the doctor next year again.

Regards
– Michelle

Breastfeeding on insulin

Hello,

I’m hoping somebody will be able to help me. I’m a breastfeeding mommy and I’ve been given Humalog – Insulin (starting today). I want to know if this will have any impact on my daughter or my milk-supply.

Also, if my sugar levels are high, does that have any impact on her?

Update: I’m doing okay. I crashed a couple of times over night and in the mornings between breakfast and snack-time! But other than that I’m finding my feet as a newly diagnosed diabetic. What really gets me is that it is so hard to find food that is safe to eat!

Any advice?

– Elrica

Injecting insulin in the workplace

Good day!

I am employed as a health and safety official in my workplace and a subject of diabetics injecting themselves at work came up… Is there a law that forces the workplace to have a dedicated place, space or room (for a company bigger than 150 people) for the diabetic to go and inject himself and have the facility to dispose of needles in the correct way? Is it excitable for a employee to test and inject himself or herself at their own desk?

“Needle disposal is one of the things that are being looked at.” Putting these disposal boxes up in a toilet and expecting people to go and inject and test themselves in an unhealthy environment like a toilet… need I say more!? If the employee chose to rather use the toilet than sitting at his desk or using a allocated “clean” space ‘if he or she has access to a space like this’ that surely is his or her own preference!

So the question would then be: is the employer obligated to allocate a space for employees to self medicate whatever it is that they require to medicate… from injecting for diabetes to self cleaning a surgical wound if an employee is back at work after having surgery and need to take care of themselves.

What do you think?

– Lourens Marx

Insulin pump Q&A

I think almost every diabetic on insulin is curious about the insulin pump… What exactly is it? Is it the miracle worker so many claim? Does it take all the hassle out of insulin injections?

With all these questions (of my own and from the community) in mind, I met with Michelle Massyn from Medtronic and tried to get some clarity on the whole pump situation. Here’s what she had to say:

Q1. So what exactly is the insulin pump?

A: It’s an infusion device that only infuses fast acting insulin. It’s basically an artificial pancreas – it covers basal and bolus needs, just with fast acting insulin (i.e. you never have to take long acting). Even if you never ate, you would still need insulin to cover hormones and stress, so for instance if you work out that you used to need 20 units of long-acting insulin (just under 1 unit per hour for 24 hours), with the pump you program it to give you 1 unit per hour instead of all of it in one dose. You can also give less than 1 unit an hour, and you might need less at night, more in the day – all of that can be programmed. Studies show that there’s a 68% variance with long-acting insulin, so it’s really not that precise*. Short-acting is much better absorbed into your system.

Q2: How do you get started with the pump? Can you do it yourself?

A: We have special pump doctors who are trained to get new users started on the process – you work out all your insulin needs and doses with your doctor, and then a Diabetes Nurse Educator or a pump specialist trains you how to use it. Any adjustments to insulin needs are done by doctors and DNEs, so you don’t ever have to do it alone.

Q3: Is it a miracle worker for those with diabetes?

A: Pumps are hard work in the beginning – they don’t just make all the daily work of diabetes go away. You have to vary your dose as you go, until you find the amount that works for you, and that can take 2 to 3 months. But if you put a lot of effort in, you get a lot out – you’ll notice a marked improvement in your blood sugar levels.

Q4: So is the pump better for diabetics than insulin injections?

A: Everyone is different, and each body metabolises differently. It also really depends on your lifestyle – some people do prefer insulin injections. But physiologically, the pump offers much better control. That said, it’s not a plug and play – if you put the work in, you’ll get good results. If you don’t put the work in, you won’t. It can help diabetics get better control because it’s more accurate, it more closely reflects what your pancreas would be doing if it still worked.

Q5: Is it painful?

A: Not at all. This is the biggest fear of a lot of diabetics, but as soon as people try it, it’s the least of their complaints. They just get used to it. And once they see the difference in their blood sugar, they don’t mind at all.

Q6: Is it uncomfortable and bulky?

A: No – the infusion set that is connected is the size of a R5 coin, and that’s connected via tubing to the pump which is the size of a cell phone (not a smart phone!) You can keep it on for 4 days (taking it off for an hour at a time to shower or swim – it can’t get wet) so it really just becomes a part of your body. If you don’t want to wear it on your stomach you can wear it on your chest (it fits neatly between the breasts even), or on your ankle, or your thigh, or keep it in your pocket.

Q7: Are there different types of pumps?

A: Medtronic has been in South Africa for 8 years, and currently has 4 different kinds of pumps – a range for different budgets and different medical aids.

Q8: What about the CGMS (Continuous Glucose Monitoring System)?

A: Some pumps come with a CGMS, some don’t. A CGMS gives the whole picture of what your blood sugar like – you can see a graph of exactly what’s been happening to your blood sugar, 24 hours a day. It doesn’t replace finger pricking, because you need to calibrate the machine, but it does give an overview – which finger pricking can’t do. It can also show you the trends – if your blood sugar is on the way up or on the way down – which can be really helpful.

Q9: And finally, the question on everyone’s lips – is it covered by medical aid?

A: The higher options of medical aids do cover the insulin pump, if it’s motivated for. Remember that there are monthly consumables to keep the pump going, as well as the insulin and testing strips you would be getting otherwise – so be sure to check if everything is covered.

Michelle’s final words on the subject? “With the pump you’re not just randomly guessing – you have all the information you need to make an informed decision. That’s tricky to do with injections if your long-acting insulin is not working the way it should. The pump is like a map to help you navigate your diabetes better.”

Find out more on www.insulinpumps.co.za or email Michelle and she’ll come and explain it to you in easy-to-understand English!

* Looking for that study? Here it is:
With an insulin pump the insulin reservoir is outside the body and tiny amounts of short acting insulin are injected every few minutes automatically, according to a programme set into the pump. This can be fluctuated every half an hour if necessary. The patient will carry the pump on a daily basis and the reservoir will have plenty of insulin for daily boluses when the patient is attending her daily demands, so no running out of insulin and running high.
In addition to this, pumps provide more predictable absorption: insulin pump therapy uses only short-acting analogue insulin for both the basal and bolus, which means less variation (faster-acting insulin delivers less than 3% absorption variability. Absorption of longer-acting insulins can vary up to 52% of the daily injected insulin dose, which explains as much as 80% of day-to-day blood glucose concentration variations (Lauritzen T, et al).

Sweet Life issue 2: your thoughts?

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Editor: Sweet Life magazine