Body image and sexual function

Posted on August 24, 2020 by Diabetes Focus eMag

Dr Larisse Badenhorst explains the correlation between body image and sexual function.

Body image is the confluence of your perception of your physical self and the thoughts and feelings that result from that perception. It involves how you see yourself compared to the standards that have been set by society.

It is evident that body image is highly subjective, whereas body mass index (BMI) is more objective. Your BMI is the measure of your weight compared to your height. Using this calculation, you are classified into categories (either underweight, healthy weight, overweight or obese).

Your perception of your physical self can be either positive or negative (body satisfaction versus dissatisfaction). This is not necessarily dependent on body habitus, but on how you perceive yourself.

How is body image formed?

The evaluation of your appearance is shaped and developed in a socio-cultural contact where cultural messages convey standards, valued physical characteristics, and gender-based expectations to certain physical attributes.

The media is often claimed to be the most influential source of presenting the ideal body. It is believed that body image is well-established by the age of 16. For both genders, an exercised and slender body symbolises values that are highly-regarded in our society, such as will power, control and success.

The difference between men and women

Body image as a construct is not gender-specific, but literature on it correlates overwhelmingly focus on women’s experiences. Many women’s self-worth is tied in with their perceptions of their attractiveness. Women are socialised to believe that if they fail to attain the cultural ideals of thinness and beauty, men will not see them as attractive.

Although there is pressure on men to fulfil the male body ideals, men are socialised to believe that other characteristics are also important when women evaluate their attractiveness.

Women’s bodies are regarded more as objects of observation. Particularly by men, in a way that is sexually satisfying for men. Thinness rather than health has been described as the most valued physical attribute in women.

Self-objectification, body dissatisfaction and the desire to change one’s body to more closely meet the ‘thin cultural ideals’ are normative among women in the western culture. Consequently, many young women may view their sexual desirability as synonymous with thinness.

Effects on sexual relations

Situations where body-related concerns are more prominent and the body is at focus is during sexual intercourse. Body dissatisfaction may result in avoidance of exposing the body in sexual encounters. This in turn may inhibit sexual desire, pleasure and performance.

Negative body image has been found to be a predictor for lower intercourse frequency or sexual avoidance; being distracted during sexual intercourse; and inhibited sexual arousal, pleasure and satisfaction, especially in women.

Given that messages around women’s bodies are fractured and contradictory, being dependent on intrapersonal and cultural-level ideas around fat and shape, may leave women at the whim of things out of their control.

Mental health factors, such as anxiety, depression or eating disturbances directly or indirectly through BMI and body image, may influence sexual satisfaction. People who experience body-related anxiety may also be experiencing sexuality-related concerns.

Accepting your body

Size acceptance has the goal of decreasing negative bodily regard and increasing acceptance of your body as it currently is. Rather than focusing on weight loss.

A woman resisting self-objectification may have a different perception of her appearance to others and a different reaction to a partner’s attraction to her and may experience a more integrated and satisfying sexually healthy self.

Sexual satisfaction, specifically in women, stems from the need to feel accepted and emotional closeness with their partner, as well as commitment and love in their relationships. This shows that a person’s perception of intimacy with his or her partner is important for sexual satisfaction.

However, negative body image is often associated with feeling sexually insecure and dissatisfied. This may in turn have consequences for the perception of intimacy with your partner. If the body becomes too much of an object and does not feel emotionally intimate with the partner, this is likely to result in reduced sexual satisfaction.

In studies done, the relationship between body image and sexual satisfaction disappeared when relationship satisfaction was introduced in the model. The most important predictors of high sexual satisfaction were perceived intimacy with a partner, followed by body image. Sexual satisfaction is likely to stem from feeling acceptance and emotional intimacy with the partner, in both men and women.

MEET THE EXPERT

Dr Larisse Badenhorst is a medical doctor. She joined the My Sexual Health team, in Bryanston, Gauteng, during May 2019 as general practitioner with a special interest in sexual health and HIV. www.drlarissebadenhorst.co.za

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Guidepost: diabetes telemedicine

Posted on August 24, 2020 by Diabetes Focus eMag

About Guidepost

Guidepost is a South African healthcare technology business that has been innovating in the telemedicine space since 2012. The company’s unique diabetes offering has grown into a national network, serving leading visionary health insurers, life insurers and pharmaceutical companies.

Guidepost’s technology platform enables diabetes coaching that is long-term, relationship-based and driven by trained diabetes coaches.

The Guidepost programme has served over 15 000 patients and has collected over one million clinical data points. On average, patients on the programme have seen a 2,5% point decline in their HbA_1C levels.

COVID-19 results in telemedicine services

The recent pandemic is a serious risk for the estimated 4,6 million people with diabetes in South Africa as high blood glucose levels increase the mortality risk posed by COVID-19.

“COVID-19 is far more serious for people with chronic conditions like diabetes and hypertension” says Professor David Segal, Chief Medical Officer and co-founder of Guidepost. “A recent study by the provincial Health Department in the Western Cape found that diabetes was a factor in more than half of the province’s 2 000 COVID-19 deaths of people older than 20. As the risks related to chronic conditions are now more ‘real’, people are more aware of the risks and are taking the management of their chronic conditions seriously. They are looking to digital healthcare services, such as telemedicine, as safe, effective and efficient ways of managing their conditions.”

Joint investment to scale up impact

AlphaCode, the fintech investment arm of Rand Merchant Investment Holdings (RMI), and the local investment fund of Endeavor, a global entrepreneur network, have recently concluded a joint investment in Guidepost.

“We believe in the work being done by Guidepost and continually invest in the technical tools that are enabling a technologically advanced future for our country. Guidepost has demonstrated its ability to reduce claim costs for clients and improve the lives of thousands of diabetes patients and we’re excited to support the growth and development of their services locally and internationally through this second-round investment. We also believe that the skilled leadership team could roll out this methodology for other diseases and chronic conditions,” says Dominique Collett, Senior Investment Executive at RMI and Head of AlphaCode.

Managing Director at Endeavor South Africa, Alison Collier, added, “Endeavor supports high-impact entrepreneurs that are scaling their business rapidly, and looking to grow to be the market leader in South Africa and expanding internationally. We’re delighted to be investors in Guidepost, helping a South African success story to scale their business globally leveraging Endeavor’s strong local and international mentor base. Guidepost’s service is particularly relevant given the COVID-19 crisis – offering diabetes patients improved healthcare while simultaneously reducing the total care cost for these patients as patients using Guidepost are healthier.”

The future of healthcare is digital

In April 2020, the Health Professions Council of South Africa updated their guidelines on telemedicine, ensuring telemedicine is easier to access.

“The COVID-19 pandemic and lockdown conditions have made digital healthcare services, such as telemedicine, the only option for many people, driving rapid adoption and use of the services. Many people who were initially sceptical of digital healthcare have found, through this ‘enforced use’, that the services are easy to use, convenient, lower cost and often just as effective as in-person healthcare services. We believe these factors will drive a permanent shift to increased use of – and often preference for digital engagement with healthcare providers even after lockdown lifts,” explains Professor Segal. “The recent investment will enable Guidepost to continue growing, serve its patients and support safe jobs for nurses and dietitians as diabetes coaches during these challenging times”.

Post-transplant diabetes mellitus

Posted on August 24, 2020 by Diabetes Focus eMag

Chronic kidney disease

Chronic kidney disease (CKD) is quite common. This is when kidneys are damaged and can’t filter blood the way they should. Renal (kidney) transplantation is one of the treatment modalities thereof. The leading cause of CKD, worldwide, is said to be diabetes mellitus.

Kidney transplants

In 1964, it was recognised that hyperglycaemia (high-blood glucose) developed in some of the renal transplanted patients.

In South Africa, the first kidney transplants took place on 25 August 1966. But because of the lack of well-designed immunosuppressants, these transplants succumbed due to organ rejection.

Post-transplant diabetes mellitus (PTDM) is associated with increase in hospitalisations and deaths and is also known to cause cardiovascular disease and infections. The latter two conditions are also the leading causes of death in the transplant population.

History

After a meeting in 2003, guidelines were published that changed Transplant-Related Hyperglyceamia to New-Onset Diabetes After Transplantation (NODAT).

In 2014, new and updated guidelines were published, which renamed the disease: post-transplant diabetes mellitus.

Post-transplant diabetes mellitus

This disease entity describes the presence of diabetes after transplantation, irrespective of the timing of diagnosis, or having had undetected elevated blood glucose levels prior to transplantation.

Some patients may develop elevated blood glucose levels immediately after the transplant, or soon thereafter. This group of patients would be referred to as having Transient Hyperglycaemia and is excluded from PTDM.

PTDM occurs in 4-25% of kidney recipients, and the variation is due to definition, duration of follow-up and the presence of risk factors for developing hyperglycaemia.

Risk factors for developing PTDM

The risk factors that predisposes to the development of PTDM has been grouped into two groups.

Traditional risk factors

Not forgetting that patients who are subjected to renal transplants may have the traditional risk factors that predisposes the general population to develop DM. These risk factors would include advanced age (>40yrs), obesity (BMI>30), Black race, a history of diabetes during pregnancy and a positive family history of DM.

Transplant-related risk factors

The second group of risk factors are referred to as transplant-related risk factors. They include immunosuppressive therapy, infections, impaired glucose tolerance and peri-operative hyperglycaemia and human leukocyte mismatching.

Immunosuppressive drugs

Not all immunosuppressive drugs are known to contribute to the development of PTDM. Only the diabetogenic drugs are discussed below:

Glucocorticoids/Steroids

These drugs have an effect on the production of glucose in the liver and it also reduces glucose uptake in fat cells. Higher doses of glucocorticoids in these patients has been associated with the development of PTDM.

Calcineurin Inhibitors (tacrolimus and cyclopsorine)

Patients on tacrolimus have a higher chance of developing PTDM. Patients with higher tacrolimus drug levels (>15ng/mL) have a higher chance to develop PTDM.

Both these drugs are toxic to the pancreatic cells (reduces insulin secretion and makes cells resistant to the effects of insulin), and thus causes PTDM to develop.

Sirolimus

This drug is also known to cause diabetes.

Infections

There are certain infections that predisposes the recipients to develop PTDM. These infections would be hepatitis C and Cytomegalovirus (CMV).

Hepatitis C is primarily a liver disease, which causes liver dysfunction and also causes pancreatic cell dysfunction. For these two latter reasons, this infection results in hyperglycaemia.
CMV infection is also known to cause PTDM.

Patients who have impaired glucose tolerance (glucose level is elevated, but not high enough to make a diagnosis of DM) before transplantation are also more prone to develop PTDM. Patients who develop hyperglycaemia around the time of the transplantation are also at risk of developing PTDM.

Clinical relevance

PTDM is associated with the development of cardiovascular disease, and thus an increase in mortality. Studies have also shown that patients who had diabetes before the transplant compared to those who develop PTDM have an even higher cardiovascular mortality rate.

Although newer immunosuppressive therapies have improved allograft survival, the development of PTDM decreases the long-term allograft survival.

It is postulated that the recipients who develop PTDM, may be due to diabetic nephropathy (diabetic kidney disease) or the early efforts to reduce the diabetogenic immunosuppressants, which then lead to rejection.

PTDM is also associated with more frequent infections; the infections that seem to occur more commonly is CMV, urinary tract infections and lower respiratory tract infections.

Diagnosing PTDM

Elevated blood glucose levels are commonly seen in the peri-operative time period, and is related to surgical stress and the use of high-doses of steroid therapy that forms part of the induction therapy.

This is referred to as transient post-transplant hyperglycaemia, and can last up to six weeks. Thus, a diagnosis of PTDM should not be made within the first six weeks, post-transplantation. This group of patient is also at an increased risk of developing PTDM at a later stage.

The blood glucose level should be monitored weekly for the first four-six weeks post-transplantation and then at three months and six months.

To diagnose a patient with PTDM, you would prefer to have a non-acutely ill patient, who is stable on immunosuppressants and whose transplanted kidney is having stable renal function.

Diagnosis requires the same symptoms that is seen in non-transplanted diabetic, in combination with a biochemically proven hyperglycaemia.

The symptoms usually include: excessive thirst, excessive hunger, unintentional weight loss and excessive urination. These symptoms usually occur in combination with a random blood glucose level of ≥11,1mmol/L. The diagnosis can also be made by having a fasting blood glucose of ≥7mmol/L.

The HbA1c can also be used as a marker of glucose control after the first three months post-transplantation.

Management

The current treatments available include oral hypoglycaemic agents and insulin therapy. Adjustment of the immunosuppressive therapy should also be considered, but it should be weighed against the possibility of the recipient suffering an acute rejection episode.

Conclusion

Post-transplant recipients have similar complications as the non-transplanted diabetics. Immunosuppressive therapy has become more sophisticated and has improved long-term graft survival, but some of them still has diabetogenic effect. Also, with the change in the field of diabetes management, the treatment of PTDM has become slightly easier.

Read Jordan Barber’s story of developing post-transplant diabetes mellitus after a kidney transplant.

MEET THE EXPERT

Dr Riaan Flooks is a practising nephrologist at Bloemfontein Mediclinic. His interests include ICU Nephrology, Diabetic Kidney Disease, Hypertension and Transplant Medicine. He forms part of the Transplant Team in the Free State Province, and is an active member of the Bloemfontein Mediclinic Medical Board.

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Play therapy in diabetes management

Posted on August 24, 2020 by Diabetes Focus eMag

Daniel Sher educates us on the basics of play therapy and how it can help a child to manage their diabetes.

Diabetes is, quite literally, a matter of life and death. The implications for a child diagnosed with this condition are huge! That’s a lot of seriousness for a little human to be taking on board, right? This is where play therapy can help.

Play provides kids with a wonderful medium through which to counteract and cope with all this tiresome seriousness. This sort of work is vital when it comes to helping your little one develop healthy beliefs, emotions and behaviours in relation to their diabetes.

What is play therapy?

Play therapy is an evidence-based counselling intervention. It is based upon scientific knowledge about how child development happens, with particular reference to the importance of play in the context of emotional and mental growth.

More specifically, it seeks to empower a child to express themselves non-verbally and in abstract, rather than concrete ways. In doing so, this type of therapy equips children with a new language with which to express their emotions and experiences.

What happens during a session?

There are many different models and approaches. The most common format for this sort of intervention involves the child meeting regularly with a trained psychotherapist and playing together during session times to build a therapeutic relationship and promote emotional healing.

The child will be encouraged to “play out” conflicts, feelings and experiences which they may not otherwise be ready to verbalise.

Some therapists bring specific games, such as a doll or snakes-and-ladders, that is directly focused on promoting healthy diabetes behaviour. Other therapists might use painting, word games or any number of toys and activities that they have at their disposal.

What does the research say?

Play therapy is a widely-used intervention that psychologists all over the world have used to help children cope with a range of psychological and emotional difficulties. For example, research has found that it can be effective in managing:

Depression
Anxiety
Post-traumatic stress disorder
Communication difficulties
Anger outbursts
Grief and bereavement
Conduct disorder

Studies^1,2 which systematically analyse the results from existing research (i.e. meta analyses) have consistently found that play therapy has a lot of potential in successfully treating these psychiatric symptoms.

How does play therapy help with diabetes?

To date, the research directly exploring play therapy applied to children with diabetes is sparse. Nonetheless, one study³ published in The International Journal of Play Therapy found that this approach can help young children with Type 1 diabetes to reduce emotional difficulties (including depression and anxiety) related to diabetes.

The researchers also advised that children with diabetes receive preventative play therapy to foster longer-term medical and psychological health.

Furthermore, given the positive impact that this approach can have on children’s cognition, emotional development, problem solving and communication skills generally, there are good reasons to believe that play therapy can significantly help kids with diabetes to cope.

Therapy goals

In my own practice, I use play therapy as a way of helping children with diabetes to:

Cope with difficult emotions related to a new diagnosis.
Process the “unfairness” of having this condition.
Develop healthy communication skills and thus better manage relationships with their family and treating team.
Increase responsibility and self-respect.
Regulate and express difficult emotions, such as frustration, grief and anxiety.
Feel heard and supported.
Recognise and address diabetes burnout.
Develop healthier dietary habits to prevent later eating disorders.

Improved self-efficacy

Another benefit is that play therapy can help a child develop their self-efficacy. This refers to a child’s belief in their own ability to successfully manage their condition. Self-efficacy is absolutely vital when it comes to diabetes self-management.

Research⁴has consistently shown that diabetes patients who have high self-efficacy are more likely to have better glycaemic control. In this way, it can help children with diabetes to feel more in control of their behaviours, habits and overall blood glucose management.

More than just fun and games

Ultimately, play therapy is a safe, enjoyable, empowering and affirming experience. Younger children struggle to express abstract concepts verbally, in the way that adults do. Play therapy is effective because it meets children on their level, drawing on the language of play to help them express their inner world. By providing children with a safe space in which to play therapeutically, we can help them develop healthier relationships toward themselves and their diabetes.

References:

1. Bratton, S., Ray, D., & Rhine, T. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Journal of Professional Psychology Research and Practice, 36(4), 376-390.
2. Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107-123.
3. Jones, E. M., & Landreth, G. (2002). The efficacy of intensive individual play therapy for chronically ill children. International Journal of Play Therapy, 11(1), 117.
4. Beckerle, C. M., & Lavin, M. A. (2013). Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum 26(3), 172-178.

MEET THE 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 to help them thrive. Visit danielshertherapy.com

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Shelly Schutte – Diabetes is my superpower, not my disability

Posted on August 24, 2020 by Diabetes Focus eMag

Shelly Schutte (29) lives in Fish Hoek, Cape Town. She has Type 1 diabetes.

I grew up in an outdoorsy family. My childhood was filled with running, hiking and playing sport. Even if I wasn’t the most gifted at it! I was a healthy, active child with a healthy, active family, and I still got diabetes.

Despite what well meaning textbooks or radio shows often describe, diabetes (especially Type 1) doesn’t only affect people who struggle with weight or health issues. It can affect anyone, and more importantly, you don’t sacrifice everything you were before when you became a ‘diabetic.’

Diagnosis

In early February 2001, I started feeling…off. My thoughts began wandering more often in school and weight started dropping off me. Fast forward a week or two and an intense thirst began to burn in me all day. No matter how much I drank, I could not seem to fill up the desert inside. What goes in must come out. So, I visited the bathroom multiple times an hour.

This period is foggy in my mind. But one of the most vivid memories I have is the night I slept over at my best friend’s house. I was thirsty. So, thirsty in fact, that I went to her fridge, grabbed a 2L bottle of apple juice, and just chugged it. I was exhausted and feeling ill but also not sleepy. So, I stayed up chatting to her dad (who was sitting trying to work) long after my friend went to bed. She still teases me about this to this day.

The next day my parents and I began to realise that the gradually increasing tiredness, nausea, thirst and weight loss couldn’t just be chalked up to a nagging flu anymore. There must be something more.

My mother took me to my GP, who took one look at me and did a blood glucose test. He later told me he smelled the fruity odour of ketoacidosis the minute I walked through the door.

My blood glucose level was 22,9. No doubt about that: T1 diabetes. He booked me into hospital and by the time I arrived that evening, my blood glucose level was 44. I was doubled over with pain and nausea. When ketoacidosis hits, it hits hard.

The start of acceptance

The next few days were a bit of a whirlwind of pulling me out of ketoacidosis, getting my glucose stabilised, working out insulin doses and meeting the amazing Sister Stark. She made me realise that there was a road of learning ahead, and she would be with me on that road.

I was so grateful to not feel sick at first that I was not actually upset about the diagnosis. However, I was determined to learn to inject myself . I overheard the nurse telling my mom that it was one of the conditions of my discharge from hospital. I really wanted to be out by the weekend so I could still go to church camp!

About three days into my hospital stay, I remember asking my mom how long I would have to inject myself for. She very kindly and gently gave it to me straight, until a cure was found. And that’s when it hit me. This was going to be something that would be a part of me for the rest of my life. I have cried many times about having diabetes over the years and that day was the first time I felt that pain. But it was also the start of acceptance.

I did go to the church camp that weekend, carrying a humorously enormous box of syringes, insulin, glucogel, glucagon injections and information packets. It was not the same as it had always been as people didn’t know how to treat me at first. But, gradually they began to see I was the same person. Just with a lot more needles in tow and a tendency to not be phased by blood anymore.

The many hates

Diabetes is not an easy condition to have as a child, teenager or adult. For a long time, I hated diabetes. It was blamed for me feeling tired and lethargic when my friends would have energy for days. I hated having inappropriately-timed lows that disrupted or delayed plans. I hated having to eat a certain way, or sometimes, having people question why I didn’t eat a certain way! But most of all, I hated the planning.

Even today, if I ever jump into spontaneous plans, I realise at some point that I need to leave early because I don’t have my overnight insulin on me. This is just one example of the many ways that Type 1 diabetic patients need to plan their daily lives.

A force for positiveness

It was only when I started realising that diabetes could be a force for positiveness in my life that I truly began to see it as a gift. And really, in many ways it has been.

It led me towards teaching and advocating for others as a career. It has allowed me to meet some of the most awesome people imaginable. And now, I belong to a global community of fascinating, intelligent, strong, powerful individuals who are doing great things to change the world’s perception of chronic conditions and invisible disability.

I belong in this community. I am one of these people because of the journey I am on and the 20-year path with diabetes I have walked.

Slightly out of tune but better for it

People with diabetes are not sick. We are not diseased. We are just slightly…out of tune. My brain, pancreas and immune system do not do what they should, in terms of opening my cells and letting the glucose flood in automatically when I eat. So, I must help.

I calculate the carbs and inject the insulin and along the way, become highly attuned to how my body feels in every variation of high, low, rising, falling, normal tired, low tired, high tired, low moody, high moody, high thirsty, low shaky and so on.

I make a hundred decisions every day to keep myself alive and to keep myself healthy. And because of that, I am stronger, calmer under pressure, more empathetic and more analytical than I ever would have been without diabetes.

I have travelled the world for work and play with diabetes and continue to look forward to the many opportunities my future holds. Diabetes is difficult but it can be your superpower, instead of your disability. I have been involved in diabetes advocacy for many years and so excited to now be a part of Diabetes South Africa: YT1, which aims to bring T1 diabetes youth together to learn from and support one another.