what is diabetes?
Basic information about Type 1 and Type 2 diabetes.
When you think of your diet as it relates to your diabetes, you probably think mostly about the foods you consume. However, did you know that staying hydrated is also a big concern if you have diabetes? In fact, polydipsia is the term given to excessive thirst that is a symptom of diabetes. According to the Mayo Clinic, dehydration occurs when the kidneys have trouble filtering and absorbing excess sugar. Those who suffer with diabetes insipidus are also at an increased risk for dehydration.
To ensure that you stay hydrated and reduce the risk of dehydration caused by diabetes, follow these three top strategies.
Keep a water bottle with you at all times
One of the easiest ways to stay hydrated is to keep a full water bottle with you at all times. This removes the need to purchase water outside of the home, makes it simple to have a constant supply of water, and serves as a constant reminder to drink water throughout your day. Since many public places are equipped with filtered water, you can prevent the onset of dehydration caused by diabetes with little effort and no expense.
Set reminders to get enough water
The importance of staying hydrated while managing your diabetes symptoms should not be overlooked. Dehydration is a serious condition which shouldn’t be treated lightly. If you are having a tough time remembering to drink water during the day (even while carrying a water bottle with you), set daily reminders for yourself on your phone or computer to make it a habit. Treat regular water drinking as if it were as essential as taking a medication on schedule.
Replace other beverages with water
Do you tend to drink beverages other than water throughout the day? Skip beverages that don’t provide adequate hydration. Instead, replace some of your carbonated beverages, coffee, and other drinks with a glass of water. Aim to drink at least eight 250ml glasses of water every day. Consuming a sufficient amount of water (rather than beverages that simply contain water) will help combat the risk of dehydration.
Make it simple to stay hydrated
Making it a habit to stay hydrated doesn’t have to disrupt your life. Begin working these simple steps into your life to limit your chances of developing dehydration as a result of diabetes. While it may take a few weeks (or more) to be sure that you are consuming the proper amount of water, you’ll eventually see how simple it is to stay hydrated throughout the day.
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
Motherhood is a great adventure and (morning sickness aside!) being pregnant is magical. Inside of you, a perfect little baby is growing… Carine Visagie explains what you need to know to ensure everything goes smoothly.
If you have diabetes, or get diabetes during pregnancy, you’ll naturally want to know what you can do to stay healthy. We spoke to endocrinologist Dr Veronique Nicolaou, obstetricians Dr Veronique Eeckhout and Dr Manasri Naiker, and registered dietician Emily Innes to learn more about diabetes and pregnancy.
Get this right before pregnancy
Keen to start a family? Don’t ditch the contraceptives yet. To prevent miscarriage, stillbirth, birth defects and other complications, our experts say you first need to:
1. Tightly control your blood sugar levels. This means keeping your HbA1c below 6.1% for three months.
2. Lose excess weight. Being overweight ups your risk of complications during pregnancy.
3. Take a 5mg folic acid supplement (three months before pregnancy up until the 2nd trimester).
4. Stop smoking.
Stay healthy during pregnancy
If all goes according to plan, you’ll soon be pregnant. Congratulations! Now is the time to focus on your baby’s growth and development, which (still) means managing your blood sugar levels as well as you can.
Poorly controlled blood sugar spells trouble for pregnant moms. Apart from a higher risk of infections, hypoglycaemia (low blood sugar), pre-eclampsia (high blood pressure) and ketoacidosis, excess amniotic fluid is an increased risk, which could lead to premature delivery. Existing diabetes-related problems (like nephropathy) may also worsen during pregnancy. Additionally, your baby may grow too big, which increases the risk of stillbirth, birth trauma and respiratory distress. But this is all if your blood sugar is uncontrolled: stay in good control and you’re likely to have a perfectly normal, healthy pregnancy.
Five steps to stay in good control:
Step 1: Eat well.
- Choose high-quality, nutritious foods.
- Steer clear of refined carbohydrates.
- Include healthy fats and lean protein at each meal.
- Eat plenty of vegetables (and some fruit) every day.
- Don’t be tempted to eat for two!
Step 2: Exercise.
Talk to your medical team about physical activity. Exercise is a key part of diabetes management, but can sometimes be risky (for example, if you have high blood pressure). Keep your pulse rate below 140 beats per minute at all times.
Step 3: Get your treatment plan right.
If you have Type 1 diabetes, talk about your insulin dosage with an endocrinologist: the amount of insulin you need may double or possibly triple during pregnancy. Women with Type 2 diabetes who use only oral medication (like metformin) before pregnancy may require insulin at some point. The good news is that metformin is safe to take during pregnancy.
Step 4: Monitor your blood sugar frequently.
As many as six times a day (before meals and snacks, and one hour after). Find out from your medical team if you should be doing any other checks (like ketone testing).
Step 5: Visit your obstetrician regularly.
Your doctor will tell you how often to come: some recommend very two weeks until 32 weeks of pregnancy. After this, schedule a weekly visit until your baby is born.
Natural birth or C-section?
If all goes well, it’s possible to deliver your baby naturally. The timing is more important than the method of delivery. Your doctor will most probably induce to deliver naturally at 38 weeks, or do a C-section if there are other problems (for example, if you have a large baby). To control your blood sugar during labour, an insulin pump and a dextrose drip will be used, and your sugar and ketone levels will be checked every 2 to 4 hours.
Gestational diabetes explained
Gestational diabetes occurs for the first time during pregnancy and goes away again after birth. Uncontrolled blood sugar levels in gestational diabetes can be as dangerous as in Type 1 and Type 2 diabetes. It may be possible to control your blood sugar with diet and exercise, or medication may be necessary. The medication will most likely be stopped after pregnancy, but it’s important to get your blood sugar tested again six weeks after delivery to rule out Type 2 diabetes.
- Dr Veronique Nicolaou, specialist physician and consultant endocrinologist, Chris Hani Baragwanath Academic Hospital
- Dr Veronique Eeckhout, gynaecologist and obstetrician, Medi-Clinic: Cape Town
- Dr Manasri Naiker, gynaecologist and obstetrician, theWomanSpace: Cape Town
- Emily Innes , registered dietician: Cape Town
From the artificial pancreas to new ways of testing blood sugar and more, we take a look at the future for those with diabetes.
Diabetes is a rollercoaster ride of blood sugar ups and downs, and tight control can be hard work. But there’s good news: while some researchers are working on a cure, others are making life easier for those with diabetes right now, through technology.
Carine Visagie brings you a roundup of the top new technologies out there.
Continuous glucose monitoring (CGM) devices are soon going to take blood sugar control to another level.
With the help of tiny electrodes stuck beneath the skin, CGM devices allow for real-time glucose readings throughout the day. The results are sent wirelessly to a monitor you can clip onto your belt and access on the go, and some devices can even send results to your doctor. Normal finger prick testing is still required (for a double check and to calibrate the CGM sensor), but you can rest assured that a CGM device will alert you if your sugar spikes or drops below your limits.
Examples include the Flash Glucose Monitoring System (Abbott) and the Guardian REAL-Time Continuous Glucose Monitoring System (Medtronic).
Ask the expert: Dr Joel Dave, endocrinologist
“24-hour glucose monitoring is going to be very helpful in patients that have difficulty controlling their blood glucose levels, as it will provide a 24-hour 360-degree view of their diabetes control.”
Ask the expert: Dr Wayne May, endocrinologist
“I’m looking forward to the Abbotts Flash Monitor, as it will stay on for 14 days and doesn’t require calibrating with a second machine.”
Insulin pumps keep getting smarter: some of the latest ones sync with CGM devices, while others are incredibly accurate at giving just the right insulin dose at the right time.
One example is the touch-screen Tandem t:slim insulin pump, which shows the date, time, how much insulin is ‘on board’ (seeing this before you bolus can help you avoid stacking your insulin*), duration of insulin action, and the amount of insulin in the reservoir. It looks like a smartphone and data is easily transferrable via a USB port. Plus, it can deliver insulin in very small doses.
*Insulin stacking is injecting a second dose too soon after a first, without taking into account the insulin already in your system. This can result in low blood sugar.
Another insulin pump to watch is the MiniMed530G by Medtronic – the first pump to shut off when blood sugar goes below a predetermined level.
Ask the expert: Dr Joel Dave, endocrinologist
“Although an insulin pump isn’t the ideal way of administering insulin for everyone, many diabetics find a pump improves their diabetes control and quality of life. Since the addition of CGM, the use of this technology has improved even more, especially in children and patients with very erratic blood sugar.”
Bionic (artificial) pancreas systems are the next big thing in diabetes management. These systems, the first of which is still being tested, combine the latest CGM tech with the most advanced insulin pump tech and add a sophisticated computer programme to simulate the function of the pancreas.
The system constantly checks blood sugar levels by means of a CGM, and responds automatically by administering either insulin (to lower blood sugar) or glucagon (to raise blood sugar levels quickly) via two separate pumps. The system hooks up to a programme on your smartphone that makes decisions every few minutes, telling the pumps via Bluetooth how much hormone to deliver.
The bionic pancreas should be available in the next 5 years.
Ask the expert: Dr Joel Dave, endocrinologist
“The artificial pancreas has been the ‘holy grail’ for diabetes care for many years. The system has been vastly improved and early studies are showing great promise. Although not for routine clinical use at the moment, in the near future it will be a life-changing addition to the diabetes care of many patients.”
What about now? Smartphone apps for diabetes
If the future of diabetes tech seems too far away, keep an eye out for apps that can help you deal with diabetes right now, on your smartphone. We like:
Glucose Buddy: to track blood sugar readings, insulin doses, carb intake, exercise, blood pressure and weight, and
Diabetic Connect: helping you tap into trusted advice, friends, support and tips.
But be warned: many international apps use mg/dL, the US blood glucose standard, instead of mmol/l, the South African standard.
Celeste Smith is no stranger to gestational diabetes: she’s had it twice, including during her pregnancy with now-five-year-old twins Connor and Adam. We find out what she wishes she’d known before she fell pregnant.
Is there a reason you’re so happy to share this very personal story?
I want to educate, encourage and motivate women with gestational diabetes, and prevent other women from having to go through what I and many others had to endure.
How did you find out you had gestational diabetes?
My first pregnancy was stillborn: Noah was born at 38 weeks. I didn’t know I had gestational diabetes until after Noah was born. We suspected with my family having diabetes that I could get it, but my doctor at the time never picked it up. When I wanted to fall pregnant again, my new doctor Dr Jansen immediately tested for glucose tolerance before I fell pregnant, and then again after I fell pregnant. That’s how we found out I had gestational diabetes again.
What were your symptoms?
What’s tricky about gestational diabetes is that it goes from nothing to full-blown diabetes very quickly. It’s only when you’re pregnant, so there’s no warning beforehand. The symptoms I had were swollen hands and feet, bad circulation, pins and needles in the hands, and constant thirst – I was drinking a lot of water.
Does diabetes run in the family?
Yes – my late mother had Type 2 diabetes, and three of my sisters and my brother have diabetes (half of my eight siblings, in fact!) None of my family recognised my symptoms, but none of us were looking for them: you put your faith in the doctor, that’s what doctors are there for.
What did you do to manage your gestational diabetes?
During my pregnancy with the twins, I was put on Metformin and later insulin. I also had to have monthly HbA1c tests and test my blood sugar seven times a day: when I woke up, before each meal, after each meal and before I went to bed. My fingers had so many holes in them; I didn’t know where to prick myself! I went to a dietician, which was helpful, we discussed good eating habits and made a lot of changes – we started eating more steamed foods and not so much starch (like potatoes, bread and pasta). And I started exercising. My diabetes doctor, Dr Dave, told me I had to exercise every day, even when I was tired after working all day.
What advice would you offer to women with gestational diabetes?
Listen to your doctors, stick to your eating plan and exercise a little bit every day. Stay focused: this is for the health of your babies. It helps that you just have to stay focused for nine months, and then the reward at the end is breathtaking. My boys were big for twins (2.8kg/each at 35 weeks) and healthy. I’ll never forget how relieved I was to hear both babies crying in the delivery room. They were both crying at the same time, and the doctor said: “Wow, they sound like a choir!”
What makes your life sweet?
I could say sunsets and sunrises, I could say my religion or even cupcakes and chocolates. But my husband and three boys are the light of my life, and sharing everything with them makes my life so sweet.
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.
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).
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.
An official list of the medication that can be prescribed for the treatment of the 26 conditions on the Chronic Diseases List (CDL).
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.
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
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.
From Facebook (Diabetic South Africans):
What’s the best diabetic advice you’ve ever been given?
Lower your carbs.
Exercise and drink lots of water.
No diabetic is the same… Individuals react differently!
Daily cardio and eggs for breakfast!
Eat the same time everyday.
Take your insulin even if you are ill, and always eat regular small meals
Kid first, diabetes second.
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?
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:
- Your weight.
- Your height in metres.
- 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.
- 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).
For those of you who’ve been here for a while, you’ll know that we started this online community (both here on the blog and on Facebook – Diabetic South Africans) at the same time as we started Sweet Life magazine. It’s been over 5 years, and 20 issues of our free quarterly diabetes lifestyle magazine, and the response from you – our readers – has been amazing. We are constantly told what a relief it is to find a safe space to be able to talk about diabetes, and learn from each other and our amazing Panel of Experts.
We’ve been able to print and distribute Sweet Life for free for all these years because of the generous support of our advertisers – diabetes brands who saw the worth in the information we were sharing, and wanted to be part of it. But the times are changing, as we all know, and at the beginning of this year all our major advertisers told us that their marketing budget had been removed from print and so they wouldn’t be able to advertise in Sweet Life any more. The world has turned digital!
It’s taken us a few months to decide what to do next – we knew that without the print publication every 3 months you would still need a space to be able to get information and inspiration on how to live a happy, healthy life with diabetes, so we’ve been revamping our website and social media presence. You’ll notice that we have a lot of new sections on the site, and over the next few weeks we’ll keep adding more and more articles: we want this to be a database of helpful diabetes information, with all the features from the last 20 issues of Sweet Life right here in one place. And if you prefer the magazine format, you can also read all our past issues here.
So it’s a new start for Sweet Life: an online home that draws together all the best of the past magazines and lets us move forward in a way that everyone will be able to contribute to. We’re excited to have you on this journey with us!
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!
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
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.
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.
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.
“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.”