Category: 2019 Summer – Diabetes Focus

foot care

Preventative foot care for people living with diabetes

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Riaan Knight, a medical orthotist and prosthetist, explains why preventative foot care is so important for people living with diabetes.

Father’s loss of limb directs choice of career

As a medical orthotist and prosthetist, I frequently deal with the debilitating effects of foot ulcers and amputation caused by vascular disease. Sadly, in my practise, vascular disease is almost always directly linked to diabetes.

Speaking from personal experience, I can’t emphasise enough the importance of diabetic foot care. As a young man, I had to watch my dad, who was diabetic, deal with the devastating effects of a recurring foot ulcer.

At first, he lost his mobility, he had to walk with crutches. Later, he lost his ability to drive a vehicle and then eventually, as to stop infection from spreading, he had to undergo an amputation of his left lower limb.

Although the medical aspect was dealt with successfully, he now faced a new dilemma, he used up all available sick leave and had to deal with the loss of his income.

On the upside, his successful rehabilitation with a prosthetic limb left a huge impression on me. I immediately knew I wanted to study medical orthotics and prosthetics.

It was during my studies that I realised to my dismay that if only the medical team followed proper orthotic management protocols, he may have never had re-ulceration or limb amputation. Research proved the effectiveness of foot orthotic treatment to assist in recurring foot ulcers. (Alprazolam)

I have often asked myself could we have cured his foot ulcer? Could we have prevented the amputation of his limb? What I do know is that foot orthotic studies confirm positive results.

Study with astounding results

A well-known study, done on the effectiveness of orthotic treatment in patients with recurrent diabetic foot ulcers, by Fernandez ML, Et al, published in the American Journal of Podiatric Medicine showed astounding results:

  • “Before foot orthotic treatment, the re-ulceration rate in diabetic patients was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the re-ulceration rate was 15% and the amputation rate was 6%.
  • Orthotic therapy reduced peak plantar pressures in patients with re-ulcerations and in those without.
  • Sick leave was reduced from 100% to 26%.”

The results are staggering. Yet, sadly the incidence of pressure ulcers in the diabetic community remains high and may very well increase.

Diabetes on the rise

The World Health Organisation (WHO) has predicted that there will be 380 million diagnosed diabetic patients worldwide by 2025. They further determined that Africa will face the second highest increase in prevalence of the disease.

A research study by the Non-Communicable Diseases Research Unit, based at Tygerberg Hospital, confirmed this “increase” prediction for South Africa. Their research found an above normal increase in persons diagnosed with diabetes in SA.

In fact, they state that the prevalence of diabetes increased amongst the female population from 8 to 14% and amongst male population from 5 to 10% for the period between 1980 and 2014.

Risk for foot ulcers

WHO further state that the lifetime risk for foot ulcers in people with diabetes is estimated to be as high as between 15 and 25%. Research further showed that 85% of all amputations done in diabetics are preceded by ulceration.

The at-risk diabetic would need to take cognisance of the fact that due to insufficient vascularity and neural dysfunction associated with diabetic neuropathy, he/she will always be at risk of developing a plantar foot ulcer. Preventative action should be high priority.

Preventative plantar pressure screening is essential

Unfortunately, an aspect that can greatly assist with the early detection of possible ulcer prone areas of the diabetic neuropathic foot has been ignored to a fair extend. Preventative plantar pressure screening is essential. Stop the ulcer before such can develop.

I am obviously aware of all other avenues of diabetic screening and complication prevention protocols. But, I do feel that it’s of paramount importance that diabetic foot care screening via specialised medical plantar pressure devices are developed and implemented in addition to those throughout South Africa.

Although such medical devices are available in the private sector, only a small handful is available to state patients. The conundrum is to convince government to invest in such fairly-expensive systems.

However, the money saved in long-term (unnecessarily used to fund wound treatment and limb prosthetics) would be astronomical and will far outweigh the initial set up cost.

Studies prove effectiveness of these systems

The effectiveness of these systems has been proved in many a medical research study. A study, by Joslin Beth Israel, Et al, at the Deaconess Foot Centre, Harvard Medical School, concluded that both the rearfoot and forefoot pressures are increased in the diabetic neuropathic foot, indicating an imbalance in pressure distribution with increasing degrees of neuropathy. The later stages of peripheral neuropathy play an important role in the aetiology of diabetic foot ulceration.

Another study, by the Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, showed that claw/hammer toe deformity is associated with elevated plantar pressures at the metatarsal heads in neuropathic diabetic patients. This condition increases the risk for plantar ulceration.

The fact remains that even healthy tissue placed under abnormal pressure over a prolonged period will break down and ulcerate. Unfortunately, in the case of diabetic patients even more so.

How does a plantar pressure device work?

Planter pressure devices can predict areas of abnormal pressures by measuring pressure over time and relating such to normative values from healthy individuals.

Another plus point is the ability of specialised integrated software as to recommend areas and percentage of correction to be applied via a suitable foot orthotic.

I strongly advise all high-risk diabetics to seek referral from their diabetologist (or medical doctor) to undergo such preventative foot care (preventative plantar measurement) screening on an ongoing basis. Prevention is better than the cure.

MEET OUR EXPERT

Riaan Knight is a medical orthotist and prosthetist based in Port Elizabeth. He has been in private practise since 1994. He served as Chairperson to the South African Orthotic and Prosthetic Association for 10 years and is regarded as the forefather of plantar pressure measurement devices in SA. Riaan was the first person (2003) to import and train local orthotists on the use and advantages of plantar pressure measurement devices in SA.

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Diabetic Athletic – Nicholas Caracandas

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Nicholas Caracandas, a Type 1 diabetes patient, tells us how he is paying it forward with his Diabetic Athletic programme.

Nicholas Caracandas (32) lives in Pinelands, Cape Town with is partner, Deborah. They have one daughter.

My diagnosis

Back in the early 2000s, at the age of 12, I was diagnosed with Type 1 diabetes. I remember it like it was yesterday. I was at my aunt’s house for the weekend. She had just opened a Greek restaurant and we decided to go as a family to celebrate. I remember spending the weekend with an unquenchable thirst. I had a dry mouth and a thirst that just wouldn’t go away. Anything I could find, I would drink and just seconds later be as thirsty as ever before.

My vision started to blur and I was urinating every five minutes. I put the frequent urination down to the fact that I was drinking a lot of liquid. The fact that I was drinking sugary drinks to quench my thirst wasn’t helping me in any way.

Mom also a diabetic patient

My mother had been a Type 1 diabetic patient for five years prior to this day (my diagnosis). She wasn’t with me on that weekend so when I told her in the week, she took me for tests immediately.

Due to circumstances, I was taken to a government hospital and tested for diabetes. It was confirmed, I also had Type 1 diabetes, just like my mom.

I remember staring out of the hospital window which overlooked the highway and thinking to myself how life was going to change. I didn’t understand diabetes very well, if at all. As a 12-year-old boy, I had seen my mother try and deal with the exact thing, with much difficulty. I knew I had to try and tackle this for the rest of my life.

Even at that age, I knew that my choices from then on would determine every outcome that would come my way.

Good foundation set

I was fortunate enough to have a good professor help me manage my diabetes initially. The lessons he taught me have stayed with me until this day.

After talking to him, I knew I stood at a crossroads but I also knew where I wanted it to go. He said to me that I needed to make a choice as to whether I was going to allow the diabetes to control my life, or if I could be brave enough to step up and choose to control it. I chose to control it.

Helping each other

My mom helped me with the basic things like finger pricks, bedtime meals and insulin. She also shared her daily experiences with diabetes; this was of great help.

Unfortunately, my mother struggled with managing her diabetes. I saw her in multiple diabetic comas as a child. Though, somehow it taught me more about the importance of management. Plus, our situation worked because we helped each other.

Getting into fitness

Going through school with an endocrine disorder that affected energy levels, overall moods, muscle gain, and just being a kid in general, I knew that whatever I chose to become after school would have to revolve around my diabetes.

I knew that I had to choose a career that would put myself and my diabetes first. My fitness journey started when I was 17 and I became a personal trainer at age 18, and have gone on to owned three successful fitness facilities over the past 10 years, learning many important lessons through victories and failures.

Early on in my career, it was clear I had the natural ability to take the specific industry jargon and explain them in ways my clients could understand, remember, and apply. This is a skill most don’t see as being very important.

With the years of experience, I have been able to share my knowledge of how fat loss works and help those needing to achieve it.

Diabetic Athletic

I decided to merge my two worlds: fitness, strength and conditioning and living with diabetes. I knew that one day I would turn it into a programme that could help people living with diabetes in the same, if not better, manner as it did for my clients needing to lose fat successfully and sustainably.

Diabetic Athletic is over 10 years old. Today it is a fully interactive, educational video course that arms people living with diabetes with all the tools they need to achieve and manage diabetes through nutrition, exercise, education and support.

The Diabetic Athletic video modules are aimed for people wanting to reverse pre-diabetes and overcome their struggles with diabetic overwhelm, diabetic management, obesity and fat loss.

I noticed most programmes address very few of the much-needed facets of diabetic and fat loss success.

Fat loss, diabetic control, education, nutritional guidance, general guidance and 24/7 support are the foundational needs to your success. As diabetics we need them all, not just one or two. The Diabetic Athletic programme provides them all

Us, diabetics, are faced with hundreds of decisions each day, all the while still trying to lose fat and regain our health.

The support and guidance provided by Diabetic Athletic allows people to not only educate themselves as to how fat loss works, what diabetes is, and how to manage it, but also how to use the tools they are given.

The triangle of control

You will hear me speak about the triangle of control at my academy as well as in my video series. The triangle of control is all about managing your weight and diabetes through exercise and nutrition before medication.

Now, where diabetes is concerned this means eating foods that keep glucose levels constant. Being active, to keep glucose levels controlled and using whatever medication needed to make up for the rest.

If you get the triangle of control mixed up, you eat bad foods which results in less than optimal activity and you will need to administer far more insulin than a non-diabetic would need.

Keep in mind insulin is a hormone. Every action has a reaction. More insulin leads to a heap of processes that lead to weight gain, energy lows, and overall issues.

Pre-diabetes and obesity

For those dealing with pre-diabetes or obesity, the triangle of control is still my holy grail.

For these individuals, the medication aspect is not insulin but rather the marketing gimmicks and magic pills people are sold every day. They are made to believe that the fat burners, meal replacement shakes, and all the other crazy things (that do not work) are the answer.

These big corporations need to make money and do so by playing on our needs and, at times, desperation to lose weight and regain our health.

Pay it forward

I have dedicated my life and profession to doing for others what that professor did for me 22 years ago.

You can be in control and you can lose weight, properly, sustainably and for good. You can take charge of your health and live your best life.

There are many that are standing at that very crossroads I once stood at. Diabetic Athletic is a support system and the final stop to life-long fat loss, management and success.

Managing my diabetes

Since I was diagnosed, I have been using a glucometer to test my glucose levels up until 2018. I now use a Dexcom G6 and have been using it for just over a year now.

I currently use Toujeo long-acting insulin pens and Humalog as my short-acting insulin.

My exercise regime consists of walking each day. I am a 10 000 steps-kinda-guy throughout the day. This is an accumulative 10k steps per day. Not a-get-it-all-done between 6am – 7am.

I lift weight three times per week and play as much sports as I possibly can. Fitness needs to be fun. We cannot and will not sustain anything if we don’t enjoy it.

Having a supportive partner goes a long way. She supports and encourages me in every way possible and enjoys that she can monitor my glucose levels as well. She uses the Dexcom Sharing App to do so, and is very clued up about diabetes and helps maintain healthy habits in the home.

I am proud to say my mom follows my programme and content and says she has learnt about glycaemic index, fibre, salt and carbs.

For more info on Diabetic Athletic, visit www.diabeticathletic.com or www.facebook.com/diabeticathletic/

Click below to learn more about the Free 3-week training & nutrition program for diabetics!

MEET OUR EXPERT

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

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drink

Rethink your drink this summer

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Dietitian, Retha Harmse, educates us with facts so we can rethink our drink this summer.

With summer here, it’s not only imperative to keep sipping to prevent dehydration due to the heat, but it’s also such a good way of refreshing and cooling down.

But with so many drinks fighting for your attention and so many controversies regarding sugar-free drinks, and trying to keep your total energy and glucose levels down, it might be necessary to rethink your drink.

Looking at the facts

Studies found that among respondents 15 years and older, they consumed large amounts of sugary drinks daily, in the form of carbonated beverages and fruit juices.

However, is the sugar-free alternative better? It turns out it doesn’t matter if the soft drink you’re consuming is the normal or sugar-free alternative, scientists say both kinds are associated with an increased risk of early death.

JAMA Internal Medicine

This shocking fact is according to a recently published (September 2019) study in JAMA Internal Medicine. The study looked at more than 450 000 people from across 10 European countries, including the United Kingdom, Germany and France.

Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC), the research team looked at what participants ate and drank for an eight-year period.

They found one or more glasses of sugar-sweetened beverage a day were positively associated with deaths related to digestive diseases. While having two of more artificially sweetened drinks a day were positively associated with deaths related to circulatory diseases.

The findings are in line with previous studies that found a connection between sugary drinks and risks of early death. Another study has associated soft drinks to other health issues, such as having higher risks of having a stroke and dementia.

What are the options now?

Eat your water

Pile your plate high with vegetables and salad. Most vegetables are between 90 – 95% water. This additional to fibre, vitamins, minerals and antioxidants makes them the perfect accompaniment for every meal.

Try to ensure that at least half of your plate is vegetables and/or salad, and that they represent all colours of the rainbow, from purple eggplants, yellow peppers, red radishes, orange butternut to green spinach.

Be wary of fruit juices

These often confuse people living with diabetes, because they read “no sugar added” on the label. Although there is no added sugar, fruit juices are high in fructose sugar that can push up blood glucose levels.

Fruit juices are a concentrated form of natural sugar from the fruit. You get all the sugar, but none of the fibre that’s good for you. A small glass of fruit juice can have twice as much sugar as a piece of fruit! Rather eat fresh fruit or see the next point for new fresh ideas.

Infused waters

Fresh fruit, herbs, and some vegetables make great flavours for water. While any combination can be tasty, here are my go-to resources for flavour pairings:

  • Apple, lemon, carrot
  • Strawberry, lemon, mint
  • Apricot, raspberry, mint
  • Orange, lime
  • Strawberry, pineapple
  • Peach, plum, mint
  • Cucumber, lemon, celery
  • Apple, cinnamon stick, red pear
  • Lemon, mint, ginger, cucumber
  • Cucumber, thyme, lime

Infused water is best two to four hours after you’ve made it. Or, you can let it infuse overnight in the refrigerator. Some ingredients last better than others. With herbs, for example, fresh basil lasts two to three days but rosemary can last up to a week.

Normal water

Last but not the least, your normal straight-forward water. It’s always a winner and so refreshing! If you feel it looks a bit bland, remember that you can always freeze edible flowers into your ice-cubes and serve in a beautiful glass.

What are the benefits of water?

  • Metabolic and biochemical reactions
  • Breaking down food through hydrolysis
  • Internal creation of water
  • Prevents constipation
  • Transport nutrients
  • We have approximately five litres of blood in our body. Our two kidneys filter about 180 litres of blood volume a day (125 ml/minute), performing this filtration some 50 to 60 times a day.
  • Body temperature regulation

Therefore, please enjoy a wonderful refreshing drink of any of the healthier options to keep the blood glucose levels in check. Manage your weight and prevent unnecessary weight gain over the holiday season as well as keeping dehydration at bay.

Retha Harms

MEET OUR EXPERT

Retha Harmse (née Booyens) is a registered dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

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injury

How to recover from an injury if you have diabetes

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Saadia Jantjes shares advice to help you recover from an injury if you have diabetes.

Leading a healthy and active life is an essential aspect of managing diabetes. When a body injury occurs, it often presents challenges in maintaining fitness, preventing weight gain and could potentially have negative effects both physically and mentally. Recovering from an injury is tough, and even more so for someone living with diabetes.

When it comes to recovering from an injury while managing diabetes, you could be faced with thoughts and fears of gaining fat, losing muscle and how to adjust insulin doses now that you are relatively less active.

Being immobile increases the rate of muscle loss, thus making you more sensitive to insulin.

So, how do you manage an injury while still managing your diabetes?

Check your glucose levels

Often. Because most injuries require a period of rest and recovery, if you are injured and you were particularly active and fit, you will now face a period of relative inactivity.

You’ll need to check and test your glucose levels as often as you can to gain as much information as possible to understand how your body is reacting to a significant lack of exercise or movement.

Once you have collected this information, it’ll make it easier to see when and how you would need to adjust your insulin doses.

When you have recovered from your injury, the same strict management and regular testing will gradually get you back to your pre-injury fitness level without experiencing phases of hypoglycaemia.

Nutrition

Nutrition will become a key element in both diabetes and injury management. Now that your energy expenditure is relatively less due to being injured, you can’t expect to continue eating the same way without an effect on weight and blood glucose levels.

With a decreased energy expenditure, comes a decrease in caloric intake. Depending on the period of recovery and absolute rest, you will have to adjust your calorie intake.

A calorie and carb tracking app, like MyFitnessPal, will help you keep track of your daily consumption in relation to your activity levels.

Protein is a vital macronutrient when recovering from an injury, as are vitamins A, C and D, calcium and zinc.

Adopting a well-balanced diet of wholesome foods can meet your injury management needs as well as your diabetes needs.

Consult your dietitian if you are struggling to manage your blood glucose levels or start to experience weight gain after facing an injury.

Positive and optimistic

Staying positive and optimistic while recovering from an injury is challenging. Especially if it means forfeiting a race, competition or a goal which you had been working towards.

Keep motivated by putting as much effort into your rehabilitation and recovery as you would have if you were indeed training for that 10km race.

Have a solid support structure in your family, friends and those involved in your rehab, like your physiotherapist, biokineticist or trainer. Make sure these people are aware of your goals so that they are implemented into your recovery programme.

Alternate activities

Find alternate activities to keep your fitness levels up. Continuing to exercise while you have an injury ultimately depends on the severity of the injury as well as the location of the injury.

For example, if you have a broken wrist, you could still walk, do aqua aerobics or resistance training, or spinning. However, if you are recovering from a back operation, your activity options are significantly less and could be limited to only walking for a few minutes at a time.

Again, consult your healthcare professionals, like the operating surgeon or a physiotherapist, if you are worried that you’ll be causing more harm than good by doing some exercise.

Recovering from an injury is always a setback, both mentally and physically. Be patient. Allow your body to heal through rest and recovery, while still maintaining a positive outlook to your daily activities, and you’ll be back to your best in no time.

MEET OUR EXPERT

Saadia Kirsten Jantjes is a physiotherapist with a passion for health and wellness. With a second degree in Sport Science, exercise is one of her favourite rehabilitation tools, to not only rehab injuries but prevent injuries too. Saadia has her own private practice in Morningside, Johannesburg, while working at a Sub-Acute Clinic and furthering her studies in Pilates.

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Baqsimi

Baqsimi – a nasal glucagon

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Dr Louise Johnson explains why it’s good news that a nasal glucagon, sold under the name Baqsimi, was approved in July by the US FDA. The bad news is that it will be some time before it is available in South Africa. 

Baqsimi, manufactured by Eli Lilly, is the first nasal glucagon approved for the emergency treatment of severe hypoglycaemia that can be administered without an injection.

The risk of hypoglycaemia

Millions of people living with diabetes are on insulin to control their blood glucose levels and to prevent long-term complications of diabetes.

Insulin can cause hypoglycaemia (low blood glucose), potentially severe and even life-threatening complications that burdens insulin users each day1.

The risk is relevant to all Type 1 diabetes patients and 30% of Type 2 diabetes patients receiving insulin treatment.

Severe hypoglycaemia is defined as an episode of low blood glucose, wherein a person with diabetes requires assistance from a third party to treat the episode.

In the T1D Exchange Patient Registry, it was indicated that this occurs more frequently than previously thought2.

The fear of another hypoglycaemic episode often leads to reduced glucose control to allow glucose to remain higher than desired. This increases the risk of both microvascular and macrovascular complications3.

It’s acknowledged that, if it was not for the fear of hypoglycaemia, people with diabetes could have normal to near normal glucose levels and avoid the complications of hyperglycaemia (high blood glucose).

Challenges with management of severe hypoglycaemia

Glucagon hypo kit

Glucagon is the treatment of choice in severe hypoglycaemia. It is very unstable in the liquid form and is therefore available in a hypo kit.

This kit consists of a pre-filled liquid syringe and a vial of dry powder. It must be mixed by the third party who then administers the treatment during an episode of severe hypoglycaemia.

It can be very daunting for the third party, usually a non-medical person, to observe the person with diabetes having hypoglycaemic seizure or being in a hypoglycaemic coma.

Study

In a study, in which parents of children with Type 1 diabetes used a glucagon hypo kit in a simulated emergency hypoglycaemia, it showed that the parent took between two minutes and 12 minutes to get the solution ready and inject it into a piece of meat (to simulate a thigh muscle).

The study consisted of 136 parents who were all trained before the study. The data shows that despite the training, 69% of the parents had trouble with the hypo kit.

These were all handling difficulties, such as opening the pack, removing of the needle sheath, mixing the ingredients and bending needles4.

The great concern in this study was that 6% aborted the injection entirely and 4% injected only air or water from the prefilled syringe.

This data clearly indicates the need for a better, safer and easier way of giving glucagon in an emergency.

A unique and critical aspect of glucagon use is the intended user. Unlike insulin, a third party gives glucagon. This is the co-worker, teacher, friend, child, sport coach, etc. This is almost never a trained medical professional.

The previous study clearly shows that this leads to suboptimal use of otherwise effective medication, delays in treatment and costly use of emergency services and hospitalisation.

Nasal glucagon

In 1983, it was shown that glucagon administered with a carrier drug, such as sodium glycocholate, could raise blood glucose levels when administered as intranasal drops.

Despite promising data, research into nasal glucagon was minimal. Reasons are debatable. Some of the reasons given are the fact that the market is very small for this drug and new promising drugs, such as the SGLT2 inhibitors, came onto the market and many more.

In recent years though, there was renewed interest to address the unmet need for a glucagon delivery system that is easy for healthcare providers to teach and easy for caregivers and third parties to administer.

Introducing Baqsimi

Baqsimi is a dry powder glucagon formulation in a compact, highly portable, single-use nasal powder dosing device that allows for a single-step nasal administration.

The caregiver simple inserts the device into the nasal opening and fully depresses the plunger. This gently expels the powder into the nasal cavity.

The product has been designed that no breathing is necessary as it is absorbed from the nasal mucosa. The dosage is a fixed 3mg dosage for all people with diabetes from four years of age.

What are the side effects of Baqsimi?

  • Nasal irritation (runny nose, congestion, sneezing, cough, nasal bleed) – 12,4% people experienced these side effects. The nasal irritation in injectable glucagon was only 1,3%.
  • Nausea (26%), headache (18%), vomiting (15%). These last three side effects were also experienced in intramuscular injected glucagon preparations in 33,8%, 9,3%, and 13,9%.

Warnings and precautions

Intranasal glucagon should not be used in persons with hypoglycaemia of chronic nature due to starvation; low adrenal gland functioning (Addison’s disease); insulinoma (tumour of pancreas) or pheochromocytoma (tumour of adrenal gland tissue (which produces catecholamine and where glucagon can cause a dangerously high blood pressure)).

Previously allergic reaction to glucagon with injectable form should be avoided.

It also carries a warning that it should not be used in those that have been fasting for long periods. The reason for this is that it causes low levels of reusable glucose in the liver.

Drug interaction

Patients taking beta-blockers may have a transient increase in blood pressure and pulse rate when given nasal glucagon.

Patients taking indomethacin may have no response to nasal glucagon, or even lower glucose. In such situations, per mouth or IV or IM glucose should be given5.

In conclusion, we can at long last be excited about an easy-to-administer drug for people with diabetes on insulin that should need this in a hypoglycaemic emergency. It will, however, still take some time to arrive in South Africa.

References:

  1. Pontiroli A.E. “Intranasal glucagon: A promising approach for treatment of severe hypoglycaemia.”Journal of Diabetes Science and Technology,2015 :vol9(1) p38-43
  2. Beck R. et. al. ‘The T1D Exchange Clinic. Registry.’ J Clin endocrinol Metab ,2012;97 p4383-4389
  3. Cryer P. ‘Hypoglycemia in diabetes: Pathophysiology, Prevalence and Prevention. 2nd Alexandria V.A.: American Diabetes Association,2012
  4. Harris G et.al. ‘Glucagon administration –underevaluated and undertaught.’ Practical Diabetes Int 2001:18;22-25
  5. (GN HCP ISI 24Jul 2019 (Eli Lilly Baqsimi package insert)
Dr Louise Johnson

MEET OUR EXPERT

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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Cognitive behavioural therapy

Cognitive behavioural therapy and diabetes

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Clinical psychologist, Daniel Sher, explains how cognitive behavioural therapy, a psychological tool, can help people with diabetes to thrive.

What is cognitive behavioural therapy?

Cognitive behavioural therapy (CBT) is a form of psychological therapy that is widely used by mental health professionals because it is so effective in treating a wide range of psychological conditions.

How does CBT work?

CBT helps people recognise and replace unhelpful thinking patterns. Often, dysfunctional ‘automatic thoughts’ flit through our minds, below the level of conscious awareness. If these thoughts are distorted or problematic, they may lead us to feel emotional distress.

This, in turn, can lead to behaviours, such as sleeping all day, binge eating or neglecting our responsibilities, that tend to worsen our mental health.

How can CBT help people living with diabetes?

  • CBT can help people living with diabetes to address misconceptions about their self-management that tend to sabotage their efforts at looking after themselves.
  • People with diabetes are at an increased risk of experiencing psychological disorders, including depression, anxiety and eating disorders. CBT has been shown to help people with diabetes in particular to improve their mental health. This, in turn, makes it easier to manage diabetes.
  • Diabetes is a life-long condition. For this reason, ongoing support is needed: diabetes patients are at risk of relapse and burnout! CBT helps people to think about behavioural changes that are going to serve them in the long run.
  • In recent times, in-depth scientific studies have been conducted on people with diabetes who get help via CBT. The research suggests that CBT can help people with diabetes improve their glycaemic control, experience a better quality of life and reduce the risk of long-term complications.
  • CBT can reduce stress. When people are anxious or upset, cortisol (a stress hormone) is released into the bloodstream. Cortisol can negatively affect blood glucose levels. Furthermore, when we are stressed we are more likely to fall behind on our self-management and perhaps even engage binge eating or other unhealthy behaviours. By helping us to cope with stress and anxiety, CBT can help overall diabetes control.

What are the advantages of CBT?

  • CBT is evidence-based. Over the years, a large amount of scientific research has been conducted to show that CBT is a powerful way of improving a person’s mental health.
  • CBT is focussed on the present. While some forms of therapy involve looking at our past to understand our current difficulties, CBT is focussed on thoughts and feelings that affect one’s functioning in the here and now.
  • CBT aims to empower the client. Often, having diabetes can make a person feel powerless. CBT can help one to develop practical skills which can empower a person to take back control.
  • Compared to other forms of therapy, CBT is a relatively short-term intervention. For this reason, it is often considered to be one of the most efficient and affordable ways of getting help.

What are the disadvantages of CBT?

  • CBT involves a structured programme, which may not always be suitable for people with more complex mental health difficulties.
  • CBT requires motivation and commitment. It is only helpful for those who are willing to put in the time and effort. Ultimately, what you put in is what you get out.
  • CBT is present-focussed. The downside to this is that CBT does not always pay enough attention to how our past has shaped us; and to how our unconscious mind affects our current functioning.

Where to get help

If you have diabetes and would like to get a bit of extra support, speak to a psychologist or psychiatrist near you. Keep in mind that CBT is a specialised skill that needs to be provided by a board-certified professional. Ideally, try to find a clinical psychologist who is trained in CBT and has experience in working with diabetes.

Sources:

Seyed-Reza, A., Norzarina, M. Z., & Kimura, L. W. (2016). The Benefits of Cognitive Behavioral Therapy (CBT) on Diabetes Distress and Glycemic Control in Type 2 Diabetes. Malaysian Journal of Psychiatry, 24(2).

Li, C., Xu, D., Hu, M., Tan, Y., Zhang, P., Li, G., & Chen, L. (2017). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. Journal of Psychosomatic Research, 95, 44-54.

Uchendu, C., & Blake, H. (2017). Effectiveness of cognitive–behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes mellitus: a systematic review and meta‐analysis of randomized controlled trials. Diabetic Medicine, 34(3), 328-339.

Driessen, E., Smits, N., Dekker, J. J. M., Peen, J., Don, F. J., Kool, S., … & Van, H. L. (2016). Differential efficacy of cognitive behavioral therapy and psychodynamic therapy for major depression: a study of prescriptive factors. Psychological medicine, 46(4), 731-744.

MEET OUR EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes patients to help them thrive. Visit www.danielshertherapy.com

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dehydration

The dangers of dehydration

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Doug Potter shares the reason for his mom’s passing and goes on to educate us on the dangers of dehydration.

I am blessed with longevity on my dad’s side of the family, with his grandpa living to 104 and his mom two months shy of 101. I thought if I don’t get hit by a train or die in a car crash, I might break a new family record myself.

There were many family discussions around living and dying around our dinner table, with half of us in the medical field. We even signed up for Ancestry.com to see how far back we could chase this longevity gene and our string of good luck.

We never thought in a million years that one of us would die from something as simple as dehydration.

My mom

My mom, Nancy Potter, was a labour and delivery nurse. She worked from the time she was 21 till she retired at 70. When my parents retired, they travelled extensively from Europe to Africa and within the United States, where they lived.

On what would be her last vacation with my father, they went on a road trip along the New England states ending in Maine by the Canadian border. It was a typical trip by all accounts as they would stop about every three to four hours for fuel, a visit to a restroom, and a bite to eat and drink.

On this trip, she was more tired and thirsty and thought if she drank liquids every time, they would have to stop more so she didn’t and rather just slept.

By the time they had reached their destination, her kidneys were screaming in pain and she had to go to the hospital. She was admitted that night in Guthrie Robert Packer Hospital in Pennsylvania.

Kidney stones

One of the causes of kidney stones is constant low urine volume caused by not drinking enough fluids. Dehydration is a harmful reduction in the amount of water in the body.

In my mom’s case, the pain of the kidney stones caused a rise in her heart rate and blood pressure. She was being treated for kidney stones but within the next hour would go blind and become confused. When pressure is exerted in the brain, it causes swelling and dependent on what part of your brain swells shows a deficit in that area.

My mom’s brain swelled at the back and she was diagnosed with posterior reversible encephalopathy syndrome (PRES). Her symptoms got better and she could travel back with us to her home in Charleston, South Carolina.

There she was admitted to Roper St. Francis Hospital, in Charleston, and would remain there, off and on for the next few months.

Oddly enough, the hospital she was first admitted to and the one she eventually passed away in, were the hospital she trained at 57 years ago and the one she retired from.

When I look back on all this…it is something a bottle of water could have fixed. So, therefore, I am explaining the secrets of dehydration.

Dehydration

Mild dehydration – 5% fluid loss.

Moderate dehydration – 10% fluid loss.

Severe dehydration – 15% or more fluid loss.

  • If you feel thirsty, you’re about 300ml in low to mild dehydration.
  • You’re about 700ml in low to moderate dehydration, if you do a skin turgor test and pull the skin on the back of your hand and it releases slow.
  • If your heart is beating 20 beats higher than normal or you have palpitations, you could have severe dehydration.

So, some advice for this summer

How much you need to drink each day relies on your medical conditions, your activity level and your body weight.

The formula is for every kilogram of body weight you should drink 30ml of water. I currently weigh around 100kg. So, I should drink 3,3 litres a day, or more if I’m jogging, or when it’s hotter.

The day my mom passed on changed my life and created a hole which will probably never get filled. So, if I’m to take something positive out of this situation, it would be to tell others drink more water and take care of their health. Mom, I will see you in 50 more years when I break that family record.

MEET OUR EXPERT

Dr Doug Potter is a pre-eminent specialist in fatigue risk management, chronobiology, shift scheduling and nutritional evaluations in South Africa. He has developed fatigue and nutritional programmes for numerous companies in Brazil, UK, USA and South Africa. He was the primary consultant for the development of the Africa’s first fatigue centre. His passions are research in Alzheimer’s, wellness and fatigue management. His goal is to be the kind of person his dog thinks he is!

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How to stay healthy on a budget

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Ronel Jooste offers practical tips for potential savings and how to  stay healthy on a budget.

Medical care is expensive, not only in South Africa but worldwide. The costs are constantly on the rise. The lifestyles people are accustomed to in the modern era, as well as increased stress levels also contribute to more people having to spend more money on medical expenses at a progressively younger age.

Unfortunately, there is not always much that we can do about the costs of medical expenses and the rates medical aids are charging. So, we need to look for alternative ways to save money and make our budget work for us.

Your health is your biggest asset and most people will agree that we need to take care of our health, even if it is at the expense of other things.

Therefore, it’s important to adopt a healthy lifestyle. Taking precautionary measures is always the cheaper option over the long run. We also know that a healthy lifestyle is associated with expense.

Save money on your food bill

So, how can we stay healthy on a budget? Firstly, a healthy lifestyle starts with a balanced diet. Here are some tips to save money on your food bill:

  • Convenience food, restaurants and take away food are expensive and, in most instances, not very health conscious. Get in the habit of preparing your own food and cooking at home. Not everyone is a great chef but there are loads of healthy recipes available on the internet, and investing in a cooking course will also save money in the long run.
  • Buying produce that are in-season is more cost effective.
  • Plan your menu in advance and prepare a shopping list. This will assist in not wasting money on items that go off and going to the shops unnecessarily.
  • Keep to a shopping list when going to the shops to avoid buying items that you don’t need.
  • Buying food in bulk often seems cheaper but this might not always be true. It is important to know your prices. Use the price per unit that is indicated on the price label and compare different items, different volumes and different brands by using a consistent basis. Also shop around at other stores that might offer better prices on certain items. But, keep into account the time and petrol you spend when driving from shop to shop. Quite often the time and petrol spent on driving to another shop is not worth the saving on the food.
  • Growing your own produce is also a great cost-saving idea. Not only will you save money but you are guaranteed to eat fresh produce that are free from chemicals and other preservatives.
  • Smoking and excessive alcohol are also culprits impacting negatively on both your health and budget.

Exercise

Exercise is equally important in maintaining a healthy lifestyle. There are plenty of exercises you can do on a budget. Walk your dog around your neighbourhood, running, hiking or cycling.

If you are a gym member who hardly ever goes to gym, you might have to reconsider if it isn’t more cost effective to cancel your gym membership and use the money to buy a treadmill or stationary bike to exercise in the comfort of your own home, at a time that is convenient for you.

Tips to stay within your budget

These cost-saving tips can help you to pay less for medical expenses and stick within your budget:

  • Discuss with your doctor or pharmacist if there are other alternatives to your prescribed medication. Buying generic medicine can be a lot cheaper than buying the brand name medicine. But, get advice from an expert before making this decision.
  • In South Africa buying medicine online might not yet be as popular, freely available and well-regulated as in other countries. It’s, however, worthwhile to explore the option of buying medicine online. Many service providers in South Africa do already offer legitimate online shops with cheaper prices than buying in-store.
  • Negotiate with your pharmacist for cheaper prices on prescription medicine. There are pharmacists who will be happy to match lower prices if you discuss it with them.
  • Make use of pharmacies or stores that offer loyalty reward programmes and discounts. You can save a significant amount when making use of these rewards and discounts.

It is worthwhile to adopt a savings mind-set and constantly look out for potential savings. Even small savings will add up and can quickly put more money back into your pocket. Take proper care of your health and be money savvy.

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Ronel Jooste is a director at FinanciallyFiT Group (Pty) Ltd, a company specialising in financial consulting and training for businesses and individuals. She developed online financial courses and employee financial wellness programmes. She is a chartered accountant, speaker and the author of the award-wining book Financially Fit and Wealth, a guide to achieve financial success. www.roneljooste.com

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Ego-mind vs. true-self

Ego-mind vs. true-self – which one controls your life?

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Peter Shrimpton helps us understand how the ego-mind vs. the true-self and how this battle affects our health and life choices.

Be honest. Have you ever heard yourself say, “From tomorrow, I’m going to manage my diabetes better? I’m going to be more health conscious, or start a new diet, or begin an exercise programme, or quit drinking?”

In short, from tomorrow you plan on being a whole new, improved you. Right?

The funny thing is, you really mean it in the moment when you make those claims, don’t you? You’re full of conviction and determined to make it happen. In fact, if anyone who knows you challenged you by sarcastically saying, “Oh sure, I’d like to see you go for a run at 6.00am, or stop drinking wine, or cut out junk food.”, you might find yourself becoming quite defensive. You may even get a little angry and shout, “Just you wait and see, I’ll show you, from tomorrow!”

But what happens when tomorrow comes? 

At 6:00am when your alarm clock rings, you roll over and hit the snooze button. You don’t get up and go for that run like you said you would. A little while later, you eat that leftover piece of chocolate cake in the fridge.

During the day, as much as you try to ignore it, that half a bottle of Merlot glares at you every time you walk into the kitchen. It seems to call out to you, “Drink me, drink me.” Needless to say, by sundowners you find yourself with a glass of wine in one hand and a ciggie in the other, while you frantically flip through a take-out menu.

Let’s face it, you didn’t stick to your plan so you may as well start again. From Tomorrow. Can you relate to this? Does it strike a chord in you?

If so, don’t panic! You’re not alone. We all do it. Every single one of us. But why?

Ego-mind vs. your true-self 

Let’s crack this nut wide open, shall we? It’s not just that you say you’re going to do something and then you don’t do it. It’s more bizarre than that! You do the opposite of what you said you were going to do.

For example, you say you’re going to eat healthily but then you go on a sugar binge. So, what gives? Do you have a split personality? Are you delusional? What’s going on? Why do you lose the plot?

The answer is simple, yet life-changing! You see, you may think of yourself as being one person because you wake up each morning, put your clothes on, go about your day, and engage with the world around you. It’s just you being you, but this isn’t the case. It may appear you’re responsible for what you think, say and do but this is an illusion. There is a hidden truth.

In fact, there are two, completely different people inside of you. Oh yes, it’s true! You have two distinct sides to yourself. They are opposites: the one is good for you, and the other is bad for you.

The one will make you sick (or sicker) and the other will sustain health and wellness. They’re called your ego-mind and your true-self.

Ego-mind

Your ego-mind is the mask you show the world. It’s who you pretend to be, not who you actually are. It’s what you’ve become. It’s who you think you should be, and who you want other people to think you are.

It tells you how to think, feel and act, and it wants to be in control all the time. It is also the culprit behind all your negative characteristics, and is therefore often referred to as your lower-self.

Be aware. Your ego-mind loves instant gratification and sensory stimulation, and will happily allow you to harm yourself and compromise your health in the present moment, if your actions satisfy your immediate desires or comforts your woes.

True-self 

On the other hand, your true-self is who you really are. It’s often referred to it as the higher-self because to access it, you must rise above your lower-self, the ego-mind.

It’s the part of you that is spiritual, eternal and divine. It’s the essence of your being. The core of your inner goodness. It is ever-present and always accessible.

When you reconnect with your true-self, you transcend the self-destructiveness, pain, misery, lack, fear, doubt and negativity of your ego-mind and you feel energetic, creative, alive and full of possibility.

Healing journey: make sense of the battle of ego-mind vs. true-self

Understanding these two facets of yourself is essential on a healing journey. It’s critical for you to be able to identify which part of you is expressing itself at any given time.

When you can tell the difference between the thoughts and feelings of your ego-mind, and the thoughts and feelings of your true-self, then, and only then, can you make conscious choices about your behaviour.

Trust me, your soul purpose in life is to find your true-self. When you live from your true-self you discover your true nature. You always do what’s best for you (and your loved ones) in the long run. You live in harmony with Mother Nature, abide by the natural laws, cut out your vices, and promote health and healing in your body every day.

Think about it: each day you either promote health in your body or disease. What do you do?  Who is controlling your life – your ego-mind or your true-self?

MEET OUR EXPERT

Peter Stephen Shrimpton is the author of The Healing Chronicles of Henry Jones, and the originator of the Jumpstart Healing Program which enables people to apply what they learn from his book. He founded The Henry Jones Wellness Institute in Cape Town, South Africa and has embarked on a mission to help people heal themselves through his exclusive books, programs, classes, seminars and retreats. Visit www.henryjoneshealingsanctuary.co.za

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