Category: 2022 Autumn – Diabetes Focus Online

carbohydrate counting

What is carbohydrate counting?

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Dietitian and diabetes educator,Tammy Jardine, explains what carbohydrate counting is and how it helps in managing diabetes.

Carbohydrate counting (carb counting) is a meal planning method that allows you to match your insulin doses to the different types and amounts of carbohydrates you eat.

The carbohydrate nutrient has the greatest impact on post meal blood glucose, with a smaller and slower contribution from protein. The effect of fat is negligible.

When you eat carbohydrates, they break down into glucose. You need insulin to transport the glucose out of the bloodstream and into the body’s cells. This means that the more carbohydrates you eat, the more insulin you need.

Therefore, if you could quantify (count) the carbs in the meal and take the appropriate amount of insulin to match it, the next blood glucose should neither have risen nor fallen excessively. In other words, you are now mimicking the way the pancreas works.

By combining insulin doses based upon carbohydrate content with corrective doses, you have the opportunity at every blood test and injection of insulin to maintain normal glucose levels, or to bring errant blood glucose back into range. This reduces the fluctuation in blood glucose levels and reduces the risk of hypoglycaemic reaction from taking too much insulin when blood glucose levels are normal, or when too little carbohydrate is eaten at a meal.

Carbohydrate counting is a technique that is easy to learn and apply and offers the ability to match insulin doses with food eaten, carb counting offers flexibility in food choices that is often much appreciated. Carb counting is effective in controlling blood glucose levels and giving you flexibility.

What foods contain carbohydrates?

Carbohydrates are a nutrient found in large amount in starches, like foods made from grains: rice, maize, barley, wheat, oats, and rye; or starchy root vegetables, including potato, sweet potato, beetroot, carrots, turnip and onion. Carbohydrates are also found in dairy, fruit, legumes (beans and lentils), sugar and honey.

In a healthy meal plan, most carbs should come from nutrient-dense foods like whole grains, legumes, fruit, and vegetables. Nutrient-dense foods are high in vitamins, minerals and fibre.

Some sugary foods (cakes, biscuits, pastries and chocolate) can be included in your meal plan but should be limited (just like in any healthy eating plan) as they usually contain very few necessary nutrients.

Use common sense and indulge in moderation. Carb counting will help you decide how to include these foods in your meal plan.

Initially carb counting is a challenge as you need to identify carbs in food and how they affect you as an individual. It takes practice, trial and error, but as you persist it will come easier.

Tools to help with carb counting 

  • Measure portion sizes

It’s easy to overestimate portion sizes so it’s recommended that you use measuring cups and scales at home. Get into the habit of checking portions so that you keep portions in check. Learning portions sizes at home will help you to judge portions more accurately when you eat at a restaurant or dinner party.

When eating at home, always use the same bowl, cup, plate or glass. That way if you always pour milk to a certain point on the glass, then you know that you are eating a consistent amount of food and can expect a consistent blood glucose reaction.

Create a spreadsheet or list of foods that you typically eat at home and then look up the carb values. Then if you’re a person of habit and like to eat a certain band of cereal, you’ll always know how many carbs you’re getting.

  • Use technology

Calorie counting apps are really helpful in identifying carbs in foods. Make a list of the most common meals you eat. Some examples are MyFitnessPal, Carbs & Cals, and FatSecret. Useful websites include www.nutritiondata.com and www.eatright.org

Things to remember

Other tools include food labels, measuring tools, and recipe books. If you’re using food labels, always make sure that you’re looking at the amount of carbs in the portion that you’re eating and not only in 100g.

Pre-portion snack foods by measuring out single servings and putting them into small plastic containers or sandwich bags. This can help control your portions since it’s way too easy to keep grabbing crackers or nuts directly from the package without realising how much you’ve eaten.

Also remember that because a food says that it’s sugar-free on the label doesn’t mean that it doesn’t have carbohydrates.

Some restaurant chains will have the nutritional content of the foods on the menu so look up online so that you can make a choice before ordering.

When eating out, avoid sauces and don’t be afraid to ask the waiter how a meal is prepared or what ingredients are in the food.

For special dinners, eat the foods that are special and avoid the other foods that you can get at any time. For example, if you really love apple pie, then skip the mashed potatoes and bread at the meal and make the dessert your carb portion at the meal. Just be sure to watch your portion size.

What would you have to do?

Keep a very detailed food diary of the carb amount eaten together with corresponding blood glucose levels.

You will need to measure your blood glucose at least morning, midday and evening. If there aren’t excessive increases or decreases in the readings, then you know you have matched the insulin to carbs well.

If they are rising too much (greater than 2-4) then you know that you ate too many carbs at the previous meal and that you need to adjust either the amount that you ate or the dose of insulin that you took.

Provided that they are going lower (by more than 2-4) then you know that you’re giving too much insulin for what you have eaten at the previous meal and you need to either eat more or lower the short-acting insulin dose.

Initially, be very consistent with the amount of carbs that you eat at each meal as this will help to identify how much insulin you need for a specific amount of carbs. Knowing this will help you to be flexible with your insulin doses and adjust according to what you feel like eating.

Carb counting only influences your short-acting insulin. Your long-acting insulin will most likely stay the same and you would not adjust this insulin based on blood glucose or meals eaten.

How many carbs should you eat?

How many carbs you need is dependent on age, height, weight, level of physical activity, current blood glucose levels, and blood glucose targets. Your diabetes educator and dietitian can help you to determine this sweet spot.

Other factors to consider in carb counting

Physical activity, high fat meals and alcohol can have an effect on carb counting.

Physical activity has a various effect on blood glucose so it’s vital to monitor blood glucose to see how exercise affects you as an individual. Most people would require less insulin with a meal post exercise as exercise usually reduces blood glucose as the muscles suck up any glucose post exercise. This is individual so work with your diabetes educator to perfect this for you.

Alcohol also usually reduces blood glucose if it hasn’t been taken with sugary mixer. Keep alcohol to moderate amount (two drinks for men and one drink for women). If this seems impossible then be sure to measure you blood glucose often as symptoms of a hypo can often be confused for drunkenness. Don’t count carbs in alcohol as part of your carbs to match with insulin.

Fat slows the digestion of food in the stomach. This delay means that you may have a blood glucose level that looks fine after eating but spikes before your next meal. Sometimes a high fat meal will require a little more insulin more insulin. Work with your diabetes educator to help you with this scenario.

Step-by-step starter guide to carb counting

  1. Identify foods in carbs using tools and calculate the total of all the carbs in the meal or snack.
  2. Try to keep carbs to similar totals at each meal while your dose of short-acting (mealtime) insulin remains at a standard dose at each meal.
  3. Record your reaction to different meals so that when you eat those meals again, you can make the necessary adjustment to portion or insulin dose to create less flexibility in your blood glucose readings.
  4. Consider factors like fat, alcohol, and physical activity when you’re deciding on your insulin dose.
  5. Consider your premeal blood glucose level. You may need a bit more insulin to bring down high blood glucose. This is called a correction dose. Speak to your diabetes educator to determine this dose for you.
  6. Calculate your insulin dose considering the above factors and give the insulin dose.
  7. Record the blood glucose 2-4 hours after the meal. If it’s too high or low, consider where your calculation could be perfected.

We get over 40 different nutrients a day from food. It’s perfectly okay to eat and enjoy food. It’s just as important to also learn how to balance food, medication, and activity, so that you’re meeting your goals in managing your diabetes. What works for someone else may not work for you so identify and record how your diabetes reacts to these factors.

MEET the EXPERT

Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com

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EPT

The 2021 EPT Winelands MTB Experience

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EPT Recovery took to the MTB trails of the Stellenbosch Winelands all in the name of youth living with Type 1 diabetes. We find out more.

In October 2021, leaders in the sports recovery arena, EPT Recovery, invited a group of mountain bike enthusiasts to the Stellenbosch Winelands for a weekend of exhilarating mountain biking, a charity auction and luxury spoils.

With a national footprint, EPT Recovery provides a comprehensive sports recovery solution to prominent sporting events throughout the country. EPT Recovery is co-founded and managed by two prominent Stellenbosch-based biokineticists, Francois Retief and Russell Looms.

EPT Recovery took to the MTB trails of the Stellenbosch Winelands all in the name of youth living with Type 1 Diabetes. It’s their belief that through awareness and the generous support of our community, life can be sweet for those living with diabetes.

Inspiration

Proceeds from the fundraising drive have been channelled to the fundraising efforts of the EPT initiative charity drive. The EPT initiative fundraising drive was inspired by EPT co-owner, Russell’s young daughter being newly diagnosed with Type 1 diabetes at the age of 7 years in April 2021.

Through EPT’s love for mountain biking, they embarked on an awareness campaign to touch the lives of children living with Type 1 diabetes.

Successful day

The 2021 EPT Winelands MTB Experience was EPT’s second annual fundraiser of its kind, bringing together a group of like-minded riding aficionados to the prestigious Lanzerac Wine Estate to ride the nearby trails and enjoy all the facilities this diverse Stellenbosch estate has to offer.

An exciting morning in the saddle culminated with a wonderful lunch at Lanzerac’s Manor Kitchen restaurant, where guests were able to enjoy the warm hospitality of this iconic property.

The afternoon was joined by the National Manager from DSA National Office, Margot McCumisky, who witnessed an exciting auction taking place where bidders gave generously towards the lot. The proceeds of which will be directed to DSA Youth with Type 1 diabetes Warriors Projects.

Sport is an incredible medium to bring us together for a good cause.

For more information on EPT Recovery, visit eptrecovery.com

Video of the 2021 EPT Winelands MTB Experience

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Bella Hawkins

Funding for CGM, a game changer for young Bella

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Ten-year-old Bella Hawkins was diagnosed with Type 1 diabetes at the tender age of two. Now, with medical scheme funding for a game-changing glucose sensor that attaches to Bella’s upper arm her diabetes management has gone to the next level.

Diagnosing Bella

“Bella Hawkins is one of the youngest patients I have diagnosed with Type 1 diabetes,” says Dr Neville Wellington, a Cape town-based GP with a diabetes speciality. “Bella’s parents had brought her in a few days before we diagnosed her. She had a nappy rash and was passing a lot of urine. At the time, I thought it was a case of thrush,” he explains.

Kerry, Bella’s mom, was seven months pregnant with Bella’s sister, Hayley, at the time. She adds, “We were also potty-training Bella at the time. We noticed that, not only was she going through a large number of nappies, she was also drinking over five litres of water a day from the dispenser attached to our fridge. We realised this as we kept having to refill it.”

Dr Wellington continues, “Two days later, on 30 April 2013, Bella was brought in again as she was really not herself. When I checked her blood glucose levels, they were very high. They should have been less than 7,8mmol/L, however, her blood glucose was at 53 mmol/L. Also, the goal in managing a patient with Type 1 diabetes is to get their HbA1c levels below 6%. When Bella was diagnosed, her HbA1c was at 12,5%.”

“Dr Wellington immediately diagnosed her with Type 1 diabetes. He guided us as to what to do next, putting Bella onto insulin replacement medicine in the form of injectable insulin contained in an easy-to-use pen,” Kerry explains.

Bribery in the form of stick-on tattoos

“For the first few weeks after Bella’s diagnosis, Lance, my husband, and I were both completely numb. We had a little one who was sick and were trying to wrap our heads around this as a lifelong illness. We had to prick her finger every two hours, draw drops of blood onto a test strip, insert this into a blood glucose monitor, wait for the reading, then inject Bella with insulin according to the blood glucose reading.”

“The only way to know what her blood glucose levels were doing was to prick, draw blood and test. We were causing her constant pain that she initially did not understand. We were also trying to understand the impact of everything she ate and drank on her blood glucose and learn to balance her levels with the right amount of insulin throughout the day.”

The first two months, Lance and Kerry injected Bella with insulin every two hours. This meant finger pricks (to extract drops of blood for analysis in a blood glucose monitor) every 40 minutes, before and after injecting with insulin.

“We would have to bribe her with sticker type, press-on tattoos. Eventually Bella was covered in them and looked like a gangster,” Kerry recalls. “Fortunately, Bella soon began to feel better, and this helped to get her buy-in to the process.”

Finding a healthy rhythm as a family

“Over time we were able to reduce the insulin we were giving Bella to five or so injections each day. This was due to lifestyle changes we made as a family, particularly towards healthier eating, with a focus on low-carbohydrate options, as we all followed the same plan. In fact, at seven months pregnant, I lost 7kg of weight. This was weight I needed to lose which I had gained by eating a high sugar and junk food diet. So, we all got healthier,” Kerry explains.

Bella got through pre-school with Kerry checking her insulin levels in the morning and at noon when she fetched her. By the time she went to primary school, Bella had learned to test her own blood glucose levels. She would send a WhatsApp message to her mom with the readings, and then inject the amount of insulin Kerry advised.

“Physical exercise really makes a difference to Bella’s glucose control,” Kerry adds. “On a Monday, she swims at school and its very clear that on Monday night her blood glucose levels are stable. This lasts through the night to the next morning when she wakes up fresh, energetic and hungry.”

“From a parent’s point of view, dealing with Type 1 diabetes in a child takes complete commitment. Children’s food preferences also change week-to-week at times, and we’re always trying to get the healthy food in, in ways that Bella and Hayley will enjoy.”

High-tech glucose monitoring trial

In 2020, a manufacturer of a continuous glucose monitoring (CGM) sensor device contacted Dr Wellington. He offered him an opportunity to give some of his patients access to the sensors for a month on a trial basis.

This sensor is around the size of a R5 coin. It attaches painlessly to the upper arm with a small needle inserted into the skin which detects blood glucose levels. This device takes a blood glucose reading every five minutes.

To access the reading, you only need to swipe a smartphone with the linked app over the sensor. This process is a giant leap from traditional finger-pricking techniques used by millions of people with diabetes all over the world. The sensors cost around R1 000 each, and each last for two weeks (so two are needed each month).

Dr Wellington was keen for Bella to use the device. It would allow for 24/7 monitoring of her blood glucose levels in the least invasive way possible.

“Before Bella had access to this sensor, it was unclear whether she was experiencing hypoglycaemic lows (very low blood glucose) at night when asleep. It was also very challenging to wake her and do finger prick-based blood glucose testing. When they did occur, Bella found the symptoms very frightening, like feeling weak, a high heart rate, confusion and blurred vision,” explains Dr Wellington.

Life changing experience

The chance to use a CGM device to get proper insight into her blood glucose levels proved life-changing for Bella. In children, these devices make a massive difference as they take away the need for finger pricks. They allow for an infinite number of readings at any time of day. They also allow older children to take their own readings in an instant while at school or elsewhere. The app gives others, like a treating doctor, access to the results. These devices offer an unprecedented opportunity to identify what is and isn’t working in the management of a child’s Type 1 diabetes, with minimal impact on the child’s life.

Discovery Health Medical Scheme funds sensors

Unfortunately, both Kerry and Lance faced changes to their employment at the end of 2020, which meant they could not afford the R2 000 a month for Bella’s sensors. “However, we knew the value of the device for Bella,” says Kerry. “And she told us that, for the first time in eight years, she could feel her fingertips as she stopped pricking them for a month.”

“We were absolutely thrilled when Discovery Health Medical Scheme (DHMS) announced that in 2021, they would fund the bulk of the cost of CGM devices for people who have Type 1 diabetes. We only pay R3 90 a month for two sensors. So, we only pay R195 towards each sensor and Discovery pays the rest, making them really affordable for us.”

“Now we can check Bella’s blood glucose levels as often as we like, simply by hovering my smartphone (using the linked app) over the sensor. This sensor has enhanced Bella’s understanding of her condition and its management, so much so that she has expressed an interest in studying medicine in future,” Kerry says.

Dr Wellington adds, “It’s a huge shock to any parent to have their child diagnosed with a lifelong illness like Type 1 diabetes. I want to commend her parents, Lance and Kerry, for their dedication to optimising Bella’s condition through the years. Bella has also been incredible in the way she has adapted to coping with the condition and testing her blood glucose regularly, and now to the use of CGM devices.”

Almost all of Dr Wellington’s patients have either Type 1 or Type 2 diabetes. His practice focuses heavily on managing and correcting these (Type 2 diabetes in particular) through a low carbohydrate nutrition approach.

All medical information in this article including content, graphics and images, is for educational and informational objectives only. Discovery Health publishes this content to help to empower diabetes patients and their families by promoting a better understanding of a diabetes retinopathy.

Header caption: Bella Hawkins holding her sister Hayley.

working from home

Staying active while working from home

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Do you find that since you have been working from home, your physical activity has decreased? BASA offers guidelines to keep you moving throughout the day.

We have all heard the saying, “The only constant these days is change.” This can specifically refer to the changes that have been happening in our lives due to the COVID-19 pandemic. We have constantly had to adapt and change our schedules and routines as we received guidelines from our national government.

One of these areas where all of us had to make changes was in our work environment. Our work environment moved from the offices to our homes; for some it was part-time and for others, it’s permanent.

This change has many implications on many aspects of our lives, some positive and some negative. It can influence our emotional, physical, social, phycological and economic status. It affects sleep and eating patterns, social patterns and even work patterns and, in general, a total change in lifestyle.

Work vs home

Being at home can result in an increased sitting time compared to when you would be in a work environment. Staying active in general does need strict and good discipline from a person. It’s easier to go to the gym or meet up with a friend for a walk after work, or to take frequent breaks while at the office. Yet, some people would argue that working from home allows them to be more active because it’s better to manage their time and slot in exercise.

However, research shows that there is a 28% increase in sitting time and a decrease in all levels of physical activity together with an unhealthy food consumption pattern.1 This was not only the result of working from home, but also due to the closure of fitness centres, open areas and public events like parkrun.

Recently too much sitting (sedentary behaviour) is seen as a separate risk factor for hypokinetic diseases (heart disease and Type 2 diabetes, etc) and not grouped with the lack of exercise. Too much sitting on its own increases risk factors for metabolic diseases and other co-morbidities.2 It’s associated with increased waist circumference, increased levels of fasting glucose and triglycerides, and lower levels of good HDL cholesterol. Research has shown a direct correlation between abdominal obesity (waist circumference) and sitting time.2

Working from home does show to increase sitting periods compared to a work environment.

Keep moving

Regular physical activity (PA) not only has health and physical benefits for our bodies but also helps them respond to the adverse effects of several diseases like diabetes, hypertension and other cardio, metabolic and pulmonary diseases.

According to The World Health Organisation, regular physical activity is seen as an accumulation of 150 min per week aerobic work or 30 min per day for five days at a moderate intensity.

Physical activity or exercise helps the support and functioning of the different systems in our bodies. Some of the benefits are:

  • An immediate benefit on brain function.
  • Helps with weight control and management of obesity.
  • Reduces health risks of cardiovascular disease, Type 2 diabetes, metabolic syndrome and certain cancers.
  • Strengthens bones and muscles and improves ability to do daily activities, and prevent falls, especially later in life.
  • Reduces the effects of old age and increase the chance of living longer.

Practical guidelines

Seeing that it’s to your benefit to be active on a regular basis, how can you become more active while working from home?

  • Establish a routine

It will help to set a specific time for your PA and to keep to that routine. Early mornings are still the best. If you’re just starting, or 30 min of exercise seems too long for you, it’s better to do two to three accumulated bouts of exercise of 10 min each.  Set this in your diary and treat it as an appointment. Learn to say to people you have an appointment.

  • Establish the exercises

Walking is still the cheapest and easiest exercise you can do. If you live in a neighbourhood where you can walk, a brisk walk is good. You can work in interval walking: two lampposts – walk fast, two lampposts  – walk slower and build it up to the longer periods for the quicker pace 3:2/4:2.

If you’re confined to flats or cluster accommodation or in an unfriendly neighbourhood, you need to get creative with exercises.

  1. Follow an aerobics/exercise class online – work out in front of the TV or use your phone. There are many platforms available or get an exercise programme from a biokineticist.
  2. If you pay for something you will tend to comply more regularly.
  3. If you live in a block of flats, climb the stairs. Stair climbing is beneficial for cardiovascular fitness and leg strength. Take frequent breaks and climb the stairs.
  4. Set out a circuit for yourself focusing on upper and lower body exercises. Here is an example: 

Example of a circuit routine

(this can be in a picture format on the page instead of writing)

  1. Walking on the spot – lift the knees/step-ups (1 min)
  2. Sit to stand from a chair (1 min)
  3. Push-ups (1 min)
  4. Side steps (1 min to left)
  5. Side steps (1 min to right)
  6. Crunches (1 min)
  7. Hip bridges (1 min)
  8. Standing calf raises (1 min)
  9. Repeat 2-3 times (30min)

These exercises can also be done in the breaks between sitting periods; you’ll only do 1-2 exercises for the 2-3 minute breaks.

  • Break up sitting periods

The one big secret is to break up your sitting periods with bouts of 1-3 min of physical activities throughout the day. Set your alarm for every hour and a half or two hours. Either then do step-ups for 1-3min, walking on the spot, or sit to stands from the chair, wall push-ups, wall squats or lunges and repeat this every hour and a half, or to two hours.

It will be of more value if you can add it on the 30 min a day, 4-5 breaks of 3 min activities throughout the day. At a certain point in our lives, the more we are active throughout a day is just as important as a continuous exercise session at a specific time of the day.

  • The higher the intensity for shorter bouts the better

You might have been doing the 30 min of exercise, but lately don’t feel or see the benefits. Increase either your duration (which with a busy schedule is difficult) or increase the intensity of your workout, plus add the extra 4-5 breaks with 3 min activities bouts throughout the day.

  • Start slow and build up

People get demotivated if they miss one session or if one day they don’t follow their routine. This is because they want to reach the optimal programme in a week. Rather start with activities two to three times a week or once a day and each week you build on that. Build with small increments.

  • Get an accountable partner

If you consult with a biokineticist, or regular personal trainer, they can easily check up on you. Otherwise, get a friend or colleague to participate with you at their home so that you can motivate each other. It takes up to six to eight weeks to establish a good habit. Schedule mini achievement celebrations with this partner and celebrate small victories.

  • Personalise your workout

There are many other exercises you can add if you’ve other equipment at home like balls and dumbbells. These are guidelines and it’s always better to ask a biokineticist to help with structuring exercises for you and to monitor the technique you use.

It would be best to say that exercise or physical activity prescription should ideally be individualised. If you want to know more or need more personal help, contact a biokineticist near you. Biokineticists are recognised health professionals who are concerned with exercise and the physical well-being of patients. They use scientific exercise programme prescription which is individualised as a treatment modality. In short, we prescribe exercises to increase or maintain your health.

To find out more about biokinetics and to find a biokineticist near you, visit biokineticssa.org.za

This article was written on behalf of the Biokinetics Association of South Africa.
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silent killers

Would you know if you have one of the three silent killers?

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Type 2 diabetes, high cholesterol and high blood pressure can be silent killers. How often do you get screened for these chronic conditions?

Many people are unaware that chronic health conditions, such as Type 2 diabetes, high cholesterol and high blood pressure (hypertension), can cause damage to the body, often without the person experiencing noticeable symptoms.Although these conditions can occur individually, these three are often interlinked and can significantly increase the chances of stroke, heart attack and premature death.

NB! Routine health screenings

At the beginning of a new year, many of us think about improving our health through taking up a fitness regimen or eating more healthily. A crucial but often overlooked aspect of taking care of our well-being is having routine health screenings.

Even if you feel healthy and well, be aware that you could be living with one or more of these underlying conditionswithout knowing it. With non-communicable diseases on the rise in SA, it really is advisable for adults to screen for these common health threats each year so that any risks can be detected and managed early to ward off more serious complications from developing in future.

Three silent killers 

Diabetes – chronic high blood glucose

Diabetes is a chronic long-term condition that affects how your body breaks down glucose from the food that you eat. While Type 1 diabetes is usually diagnosed in childhood, Type 2 diabetes develops over time and is more often diagnosed in adulthood.

Insulin is a hormone that helps control your body’s blood glucose levels. If your body doesn’t produce enough insulin or cells stop responding to insulin, too much glucose remains in your bloodstream and this can lead to serious health problems over time, including potentially irreversible damage to the eyes, kidneys and other organ systems. It’s therefore critical to be aware of your blood glucose levels and get tested regularly to know if you are at risk of developing Type 2 diabetes.

With the medicines available these days, along with regular exercise and a healthy diet as advised by your treating doctor, diabetes can be well-controlled with many new oral or injectable medicines to help keep blood glucose levels stable.

Hyperlipidaemia – high cholesterol

High cholesterol, or elevated levels of fat in the bloodstream, is another common non-communicable disease that is all too common in SA. Although people with high cholesterol usually don’t have any symptoms, if it remains undiagnosed and therefore untreated it significantly increases the risk of heart disease, heart attack and stroke.

A simple blood test reveals cholesterol levels, and if these are outside of the healthy range your treating doctor will prescribe the right kind of chronic medicine to help maintain cholesterol at healthier levels. A diet that is low in saturated fat and regular cardio exercise are generally recommended as part of the treatment plan.

Hypertension – high blood pressure

The World Health Organisation estimates that almost half of people living with high blood pressure globally remain undiagnosed and therefore untreated, and only one in five have their hypertension under control.

When hypertension isn’t well-controlled, it places additional pressure on the cardiovascular system, potentially leading to heart attack, heart failure and stroke, as well as kidney damage among other risks.

Unmanaged, these conditions are associated with significantly higher risk of hospitalisation and premature death, but these outcomes can be avoided with the right treatment. Once a person has been tested, they have the power to improve their long-term health and can often avoid complications with the necessary treatment and lifestyle adjustments.

When your doctor has prescribed the right medication specifically for you, this is only the first step to effective treatment, and it’s of critical importance that you continue to take your medicine exactly as prescribed, even when you feel better.

Supporting better health outcomes

Being diagnosed with a chronic condition and starting new medication can be daunting, and to help make it as easy as possible to adhere to prescribed treatment, Medipost Pharmacy offers telephonic assistance from the pharmacy team in all official languages, as well as free delivery of chronic medicines to any address in SA. If you have any questions or concerns about your treatment, reach out to your pharmacist who can give you advice, such as how to overcome potential side effects.

To be effective, chronic medicine must be taken at the right dosage continuously, even when you’re on holiday or out of your usual routine.

As part of its free delivery service for chronic medicines, with advanced notice those registered with the courier pharmacy can have their confidential medicine parcels delivered to another address while they are away from their usual delivery address.

As well as dispensing medicines to individuals privately, the service also includes assistance with registering PMB conditions, including diabetes, hypertension and hyperlipidaemia, to help conserve medical scheme members’ day-to-day benefits.

Medipost Pharmacy aims to improve access to quality and affordable medicines for all South Africans, making it simple and convenient to adhere to chronic treatment and improve your health and quality of life.

MEET THE EXPERT

Joy Steenkamp is pharmacist at Medipost Pharmacy. She completed her Doctor of Pharmacy, in 2005, at the University of Mississippi, USA before gaining experience working as a home-infusion clinical pharmacist. In 2010, she moved to SA where she completed her community service as a pharmacist in SA. Since joining Medipost, in 2015, Joy has been actively involved in training new pharmacists and as a clinical analyst promoting public health awareness initiatives.
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summer 2023

DSA News – Autumn 2022

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DSA welcomes new board members

We get to know the two new DSA National Board Members, Salih Hendricks and Wesley Mc Aslin,who were elected at the DSA National AGM held on 14 December 2021.

Salih HendricksSalih Hendricks

Salih Henricks (55) lives in Crawford, Cape Town. He is separated and has five children. He has had Type 1 diabetes for 40 years and been a diabetic amputee for two years.

How do you feel about this appointment?

I’m happy to be part of this organisation and hope to be of value for DSA and the diabetes community.

What do you aim to achieve?

What I want to get into action is raising awareness on the less costly medications that are given to diabetes patients in the public sector. These medications aren’t working for many patients. Treatment needs to be put together as a package deal with extra management and added components to make these meds work.

No matter what type of medication you take, a good mindset and exercise help the medication work better. I want to ensure all people with diabetes don’t give up.

What are your responsibilities?

The community

In your opinion, how does the care for diabetes need to change or improve in SA?

There is no need for improvement but more involvement from communities and sharing their experience. We learn from each other better than from any book.

What does balance mean to you?

Nothing is perfect in this world therefore giving, caring, supporting , mental health and many more positives could help us balance our lives better. Just by trying, we can balance everything.

Wesley Mc Aslin

Wesley Mc Aslin (43) lives in Kempton Park, Gauteng. He is married and has two children. He has Type 1 diabetes.

How do you feel about this appointment?

I’m excited in that I believe I can make a difference to someone’s life by hopefully inspiring people with diabetes to push themselves and their limits and not to let diabetes rule their lives.

What do you aim to achieve?

Enlighten people about diabetes and eliminate any misconceptions

What are your responsibilities?

My responsibilities have not been completely defined as yet but I want people living with diabetes to know that they need to look after their health and they shouldn’t cheat as in the end it only does harm.

In your opinion, how does the care for diabetes need to change or improve in SA?

Better understanding and better education in all sectors about living with diabetes and the emotional toll it takes on people living with diabetes and their immediate family members.

What does balance mean to you?

Healthy living and been able to manage your diabetes efficiently without it encumbering your ambitions and goals in life.

Western Cape Camp Diabetable

With the kind sponsorship of EPT recovery, DSA is holding Camp Diabeteable on 22 to 24 April 2022.

Benefits of diabetes camps

Diabetes South Africa has been holding camps for children with diabetes for well over 40 years. These camps are designed to facilitate a camp experience in a medically safe environment, while fostering opportunities for children to develop basic diabetes self-management skills.

These type of camps also provides opportunities for children with diabetes to forge sustainable relationships, overcome feelings of isolation, and gain self-confidence and a positive attitude to living with a lifelong chronic disease which has to be managed hour by hour.

IMPACT 

According to three years of pre and post surveys, diabetes camps positively impact a wide-range of camper outcomes, including knowledge of diabetes management, management behaviours, and emotional well-being.

Doctors have reported to us that the positive benefits of our camps for children with diabetes are seen in their young patients for many months post camp. Newly diagnosed campers appear to benefit the most from their camp experience.  The encouragement and support the children receive often leads to them giving themselves their first insulin injection on their own. Campers usually ask on leaving the camp when the next one will be.

Some our past campers have joined our DSA Camp Management Team as young adults to pay forward the positive experience they had when attending our camps as children.

The theme of the camp is: The elements – earth, wind, fire, water.

To join the camp email margot@diabetessa.org.za

– DSA Port Elizabeth News –

Springdale Diabetes Wellness Group

What an amazing caring group this is. The convenor of this group is Clive Burke who is a management board member of the DSA PE branch.

This group was previously called Gelvandale Diabetes Wellness group and was started in 2008 by Hester Isaacs, ably supported by her husband, Esau, and daughters, Sadie and Terry.

In April 2018, at the 100th meeting organised by Hester, she handed over the reins to Clive Burke who had been an active and supportive member for many years.

Clive with his wonderful caring and compassionate nature has led this group since then and through the tough lockdown years, has still cared for each member in his own quiet and sincere way. We see this in his written word below:

In 2018, I took over from the late Hester Isaacs, who ably led the group since its inception in 2008. We have members from a wide spectrum in our area. Quite a lot of Muslim support as well. Our aim is to educate and support people living with diabetes. We have become a close group and we encourage each other to introduce other people living with diabetes to our meeting. I have found that they are very caring towards each other.

One of our members lost her husband recently and the group felt we should just lift her spirit a little bit and we decided to give her with a bouquet of flowers. This was handed to her close friend at the February meeting to take to her. This was indeed a WOW moment for her and much appreciated.

We do treasure each other’s company and share our sorrows and joys. May our group make a great impact in our society where we live, as we support and care for each other. We are about 15 to 20 members in regular attendance.

Denim For Diabetes

Megan Soanes, DSA Port Elizabeth’s fundraising co-ordinator, has already organised two Denim for Diabetes days. One at St George’s Prep School and one at the Provincial Hospital Outpatients Pharmacy. Both were held on Valentine’s Day.

Wellness meetings

Our Diabetes Wellness Groups in Newton Park, Malabar and Springdale held their meetings in February. This was an exciting step forward for the Malabar and Springdale groups as this was the first time they met since the start of lockdown.

Each group presented a topic relating to COVID and diabetes. At the Newton Park meeting, Renique Verhoef, dietitian, spoke about Leaving the Weight of COVID Behind. Dr Jeff Govender presented an interesting talk on COVID vs diabete at the Malabar meeting. While Stories of COVID-19 were told and shared by the members at the Springdale meeting.

Join Camp Diabetable 18-20 March 2022!

– DSA Pretoria News –

Wellness Day

As we are well aware, last year (2021) was not the best time in most lives. It was also not a good time for DSA Pretoria. Due to lock down we were unable to meet together for most of the year. We were also unable to do what we need to do and that is to inform people about diabetes, by means of holding wellness days at companies and doing testing, as well as free testing ay shopping malls.

So, we are thrilled to have hosted our first Wellness Day at x on 26 February.

DSA members interviewed on TV show

In December, DSA Pretoria was approached by SABC 2 asking for people with Type 1 and Type 2  diabetes to be interviewed their TV program, Vital Signs.

Frans Steenkamp (Type 1) and Brian Midlane (Type 2) were the two representatives chosen from the Pretoria branch. They shared their experience of living with diabetes. Both men had very interesting stories to tell.

At the end of the broadcast, National Chairman, Martin Prinsloo, was able to publicise the purpose of Diabetes SA. All in all a good experience was had by all and we are hoping that the message went out loud and clear.

Luleka Mzuzu

Luleka Mzuzu – experience is a great teacher

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After a year of being diagnosed with Type 2 diabetes, Luleka Mzuzu managed to stop taking insulin and only takes oral tablets. She is now focused on educating and helping her community.

Luleka Mzuzu (39) lives in Kayamandi, Western Cape with her husband and three children.

Exhaustion leads to diagnosis

For two weeks Luleka felt exhausted and was forever thirsty. “I never thought to go to the doctor or check my glucose levels as I thought it was just work related and being tired from commuting to and from work. When the mother of three finally went to the doctor in September 2015, her blood glucose reading was 28 and she was immediately sent to ICU. She was diagnosed with Type 2 diabetes. “I was immediately put on insulin (insulin glulisine and insulin glargine).”

Luleka was determined to educate herself and take control of her health. She changed her diet and started exercising. “This was a very long and hard journey with many obstacles,” she says.

However, her dedication paid off; in early 2017 Luleka’s treatment changed drastically. She only had to take metformin (oral tablet) once a day.

Ikhaya Diabetes Support Group

When Luleka was diagnosed, she wanted and needed support and diabetes education and she says it was hard to get it. “I had to google and use a private doctor to get info. But most people in our community can’t access Google or make use of private doctors and dietitians due to affordability. So, I thought of starting a group to educate, support and help other community members to manage their diabetes.”

At this time, Luleka contacted DSA and started a relationship with Margot McCumisky, National Manager of DSA. “I signed up to become a DSA member and would ask advice from Margot on how to run my support group. She assisted with literature and guided me on all the steps,” Luleka explains.

The group started informally in 2017, but in 2019 Luleka registered it as a NGO. Due to the restrictions in 2019 the group couldn’t meet. However, they still supported each other via WhatsApp.

“Together with Stellenbosch Municipality Community Development Department, we had Wellness Days, where we had different themes: How to keep moving (exercise routines), How to be financial savvy and What is diabetes and how to manage it.

Luleka believes that more diabetes education is needed in the public sector and dedicated public facilities for people living with diabetes, such as footcare and wound care clinics are needed.

DSA helps Ikhaya Diabetes Support Group

During COVID many of the members of Ikhaya Diabetes Support Group didn’t receive food parcels from the government. So, Luleka called on Margot from DSA to assist.

Luleka explains, “The food parcels were for the members in the support group. Most of the members are pensioners and don’t have other sources of income. We assisted them as some of them at that time used their money to get medication at the pharmacies as the community clinic was full and high-risk for them to go sit there and wait on their meds.”

Margot managed to get assistance from various churches in Stellenbosch and then dropped them off at Luleka. She then delivered them door to door.

Margot is currently assisting to get a blood glucose testing machine for the group and they continue to work as partners.

Balance is easy

The mother of three says achieving balance is easy. “Everything has its own time. I’m a family orientated person so it’s easy to balance work, family and diabetes, as it is now part of my lifestyle. I deal with it every day.”

MEET OUR EDITOR

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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Accu-Chek Instant system

Accu-Chek Instant system – Simply clear diabetes management

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We learn how the Accu-Chek Instant system assists with simple clear diabetes management.

The Accu-Chek Instant system is a unique solution designed to meet diverse needs of people with diabetes and their healthcare professionals.

The system features, such as the intuitive target range indicator and the on-board logbook, provide simply clear solutions to assist with blood glucose checking and interpretation.

The strip ejector interface supports simple diabetes management, and Bluetooth® connectivity offers quick insights virtually anytime and anywhere.

 Target range indicator1

  • Provides instant reassurance and clarity of high and low blood glucose readings.
  • Assists you to understand and interpret your readings more easily.
  • It can be individualised to suit therapy goals, using the mySugr application.

 Bluetooth® connectivity to mySugr diabetes management app* 

  • With over three million users worldwide2, the mySugr app facilitates decision support at the palm of your hand.
  • It’s an instant logbook with automatic and seamless transfer of readings.
  • View a snapshot of your diabetes on a daily basis. See trends, events and information in context.
  • Share detailed PDF reports via email with your healthcare provider.

Strip ejector

  • Because hygiene matters, the strip ejector allows for easy and hygienic disposal of used strips3.

Advanced accuracy4

The Accu-Chek Instant system provides reliable and accurate results having exceeded the ISO 15197:2013/EN ISO 15197:2015 accuracy requirement and delivers 10/10* accuracy.

*95% of results are within ± 10mg/dl (0.56 mmol/L) of the laboratory reference at glucose levels <5.5 mmol/L or ± 10% of laboratory reference value at glucose levels ≥ 5.5 mmol/L.

To check if your mobile device is compatible with the mySugr app, please contact our customer support team. For more information, contact your healthcare professional.

References

  1. Parkin C, Schwenke S, Ossege A, Gruchmann T. Use of an Integrated Tool for Interpretation of Blood Glucose Data Improves Correctness of Glycemic Risk Assessment in Individuals with Type 1 and Type 2 Diabetes. J Diabetes Sci Technol. 2016;11(1): 74 82
  2. mySugr Internal Data on File: January 2021
  3. Harvey C, Koubek R, B gat V, Jacob S. Usability Evaluation of a Blood Glucose Monitoring System with a Spill Resistant Vial, Easier Strip Handling, and Connectivity to a Mobile App: Improvement of Patient Convenience and Satisfaction. J Diabetes Sci Technol. 2016;10(5):1136 1141
  4. Breitenbeck N, Brown A. Accuracy Assessment of a Blood Glucose Monitoring System for Self-Testing with Three Test Strip Lots Following ISO 15197:2013/EN ISO 15197:2015. J Diabetes Sci Technol. 2016;11(4):854-855.

Visit the Roche Diabetes Care website at www.rochediabetescaremea.com

Roche Diabetes Care South Africa (Pty) Ltd. Hertford Office Park, Building E, No. 90 Bekker Road, Midrand, 1686, South Africa. Call Toll Free: 080-34-22-38-37. Email: info@accu-chek.co.za

ACCU-CHEK INSTANT, MYSUGR and MAKE DIABETES SUCK LESS are trademarks of Roche. ©2022 Roche Diabetes Care
ZA-288

SALT

The role of salt in our food and body

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Dietitian, Annica Rust, helps us understand why the body needs salt as well as why too much is dangerous.

Salt (sodium chloride) is important for your body as it performs vital functions, but consuming more than your daily requirements can be harmful. Most people consume on average 9-12 grams of salt per day, which is double the recommended maximum intake.3 It’s therefore no surprise that 13% of deaths caused globally are by high blood pressure and that on average 225 South Africans are killed by heart disease every day.5

The role of salt in food

Salt is commonly used to enhance the flavour of food, in addition to its commonly known benefit of being a preservative, which inhibits bacteria growth and increases the freshness and shelf life. Salt is also used to improve the texture and appearance of food.1,2

The role of food in our body

The human body needs a small amount of salt to perform vital functions, such as conducting nerve impulses, contracting and relaxing muscles and to maintain the water and mineral balance in the body.1

How much salt is needed to maintain the vital functions?

We need a minimum intake of 500mg of sodium (1/4 teaspoon of salt) a day to perform vital functions2, however it’s recommended that adults don’t exceed 2000 mg of sodium which is equal to 5 grams/1 teaspoon of salt per day. This will prevent high blood pressure (hypertension) and the associate risks of cardiovascular disease, strokes and heart attacks.

Eating too much salt

With a high intake of sodium, your kidneys can’t keep up to excrete the excess sodium in the blood and sodium will accumulate in the bloodstream. To compensate for this, your body will retain additional water to dilute the sodium. However, this in turn will increase your blood volume.

An increase in your blood volume will put unnecessary strain on your heart as it needs to work harder, which over time contributes to high blood pressure. High blood pressure further increases the risk for a heart attack, stroke and cardiovascular conditions. This is especially a problem if you have diabetes, which already places you at an increased risk of a heart attack, stroke and cardiovascular disease. 1,2

High blood pressure also increases the risk for chronic kidney disease and osteoporosis. Osteoporosis occurs with a high intake of salt which can further increase the amount of calcium that is excreted via urination, causing low blood calcium levels. Low blood calcium levels will result in the breakdown of bone to release the necessary calcium in the bloodstream to maintain blood calcium levels.1

 Steps to reduce your salt intake

  1. Reduce processed and restaurant/fast food

Processed and restaurant foods accounts for more than 70% of the sodium intake of Americans. Cutting down on processed foods will therefore be beneficial to lower your salt intake.6

Processed foods
Meats & cheese Salami, bacon, sausages, viennas, polony, ham, biltong and smoked chicken, cheese
Carbohydrates Breakfast cereals, bread, crisps, pies, cakes, biscuits
Vegetables & fruits Tinned vegetables and fruits
Meals Ready-made meals and microwave meals

 

  1. Label reading & logo identification

It’s valuable to look at labels, especially the nutritional information table as well as the ingredients listed when deciding which product to buy.

When comparing products, look at the amount per 100g and not the amount per serving. When looking at the ingredient list look out for sodium, monosodium glutamate (MSG), baking soda or sodium bicarbonate or any words containing the term sodium, nitrites, nitrates and salt.

The order in which the ingredients are listed is important as it serves as a rough indication as to how much of that ingredient is in the product. Ingredients will always be listed in descending order of weight (largest to smallest weight). Usually, the first three ingredients that appear in the list make up the largest portion of the product. Make sure that salt is not one of top three ingredients.4

Nutritional Information Table
                 Description Sodium (salt) per 100g
HIGH                                               

Avoid or limit intake

 > 600mg
MODERATE                            

Eat seldom

 120 – 600mg
LOW                            

Healthier option – eat often

 < 120mg

Look out for food items with the Heart and Stroke Foundation South Africa logo, given that these food items will be lower in sodium when compared to similar products.

 

  1. Stop using the salt shaker on the table 

  1. Reduce the amount of salt when cooking, by using more herbs, unsalted spices and strong flavoured food components to flavour your food.

 

Herbs, unsalted spices and flavourings4
Lemon juice and vinegar

Mixed herbs, basil, bay leaves, parsley, thyme, sage, dill and rosemary

Curry powder, turmeric, nutmeg, paprika and pepper

Garlic, ginger, chives, spring onions and onions

 

  1. Be aware of hidden sodium

Many food items already have a high amount of sodium included, such as bread, breakfast cereals, processed meats and sausages, stock, soup and gravy powders as well as brick margarine.4

When in doubt contact a registered dietitian for assistance. For more information on sodium, please visit The Heart and Stroke Foundation of South Africa

References

  1. https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/ [10 February 2022]
  2. Centers for Disease Control and Prevention. 2022. https://www.cdc.gov/salt/role_of_sodium.htm [9 February 2022]
  3. World Health Organisation. 2020. https://www.who.int/news-room/fact-sheets/detail/salt-reduction [10 February 2022]
  4. Salt watch: https://www.heartfoundation.co.za/wp-content/uploads/2017/10/Salt-brochure.pdf [10 February 2022]
  5. Heart & Stroke Foundation. 2022. https://www.heartfoundation.co.za/
  6. American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/hold-the-salt-infographic[10 February 2022]

MEET THE EXPERT

Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston. She assists with medical nutritional therapy for cancer prevention, treatment, survivorship and palliation. She gives individualised nutritional care to prevent or reverse nutrient deficiencies, nutrition-related side effects and malnutrition to maximise quality of life.

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best questions

The best questions to ask after being diagnosed with diabetes

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Receiving the diagnosis of diabetes can be daunting. However, having the correct information and guidance will make the transition and acceptance less intimidating. Diabetes nurse educator, Christine Manga, suggests the best questions to ask to make it a smooth transition.

Asking your healthcare professional the following questions will assist in receiving clarity about what is necessary to manage your diabetes to the best of your ability.

  1. What type of diabetes do I have?

Knowing what type of diabetes you have will determine your treatment plan. There are three main types: Type 1, Type 2 and gestational diabetes.

Type 1 is an auto-immune condition. This is caused by the body destroying its own insulin producing beta cells. The reason isn’t clearly understood but is often preceded by a viral infection. Type 1 makes up 5-10% of people with diabetes.

Type 2 is a progressive condition with ongoing loss of beta cell function. It’s also characterised by insulin resistance which is where the body still has sufficient insulin, but the body is unable to utilise it. Type 2 accounts for 90-95% of diabetes cases.

Gestational diabetes presents and is diagnosed for the first time during pregnancy. It usually develops at about the 24th week of pregnancy. Hormones produced by the placenta cause insulin resistance and an increase in blood glucose levels. These elevated glucose levels pass through the placenta to the foetus. Gestational diabetes tends to resolve after the birth.

  1. What treatment will I have to take?

The type of diabetes you have will determine the treatment that you’re prescribed.

Type 1

Type 1 will be treated solely with insulin, initiated at the get-go. Treatment will be lifelong. This will be administered as multiple daily injections or through a continuous subcutaneous insulin infusion from an insulin pump.

Some patients with Type 1 will also receive metformin if they become insulin resistant. Unfortunately, Type 1 is currently irreversible.

Type 2

People who are diagnosed with Type 2 can go into remission with a drastic change in lifestyle including diet, weight loss and an increase in activity. It’s vital to continue testing your blood glucose levels to ascertain if you’re still in remission.

For most of the population, treatment initiation is usually metformin. As time and condition progress, increased doses of oral medication may be indicated. There is a full plethora of oral medication available to people with Type 2. These medications will be introduced and removed in response to your diabetes progression.

Eventually insulin may be required to manage your blood glucose levels. This is not due to failure on your part but rather the natural progression of Type 2. Adding insulin to your medication regimen doesn’t change your diagnosis. You would be known as having insulin-dependent Type 2 diabetes.

Gestational diabetes

Treatment consists of metformin and/or insulin. Gestational diabetes usually resolves after the birth and medication would be discontinued. Testing your blood glucose levels by means of an oral glucose tolerance test at six to 12 weeks post-delivery is recommended. You should continue to test one to three years thereafter. There is an increased risk of developing Type 2 after having gestational diabetes. 

  1. Will the medication cause side effects?

Enquiring about potential side effects of new medication is useful, as knowing what to expect makes adherence easier, gives you peace of mind as well as knowing when to report a side effect to your healthcare practitioner.

Certain medications have common side effects experienced by many people. Being prepared for these and knowing how to manage them and how long to expect them to persist for will instil confidence in your treatment.

  1. What are the symptoms of uncontrolled blood glucose levels?

People tend to experience similar symptoms to each other when their glucose is either high or low however it’s possible to experience different symptoms. It’s beneficial to learn to recognise these symptoms to afford yourself time to take appropriate corrective action.

Typical symptoms of high glucose readings:

  • Increased thirst
  • Increased urination
  • Blurry vision
  • Nausea and vomiting
  • Fatigue
  • Dry mouth
  • Over a longer time, weight loss and delayed wound healing are also symptoms.

Typical symptoms of low blood glucose levels:

  • Sweating
  • Hunger
  • Shaking
  • Anxiety
  • Palpitations
  • Irritability

  1. Will these symptoms go away?

Once you’re diagnosed, commence medication and improve your lifestyle, your symptoms will almost definitely improve. They may not subside fully until your glucose levels are in target range or much improved. An exacerbation in the control of your diabetes may cause symptoms to recur. This may be a sign that medication needs to be reviewed.

  1. How often should I see my doctor and who else should I see?

Once you’re diagnosed you should see your doctor at least every six months, more regularly if you’re struggling to manage your diabetes. At these visits you should discuss your glucose control as seen on your blood glucose meter, or continuous glucose monitoring (CGM) and Hba1c. Medication should be reviewed and blood pressure and weight checked. Any concerns could be brought to the table here.

Blood tests for cholesterol and kidney functions should be done annually unless more frequent testing is required. Over and above monitoring these parameters, an annual visit to a podiatrist and ophthalmologist are recommended even if you’re not aware of any problems currently.

These initial visits will allow for a baseline from which deviations can be assessed. Getting assistance from a dietitian will be invaluable. Diabetes nurse educators, like myself, make understanding your diabetes much simpler. We are fortunate to be able to spend more time with you than the average doctor can. All the above-mentioned services will complement each other, hopefully making your diabetes journey a smooth one.

  1. What are realistic goals and targets?

Glucose:

Fasting readings of between 4-7mmol/L.

Two hours after a meal the reading should be below 7,8mmol/L.

Time in range (TIR) is a relatively new concept. This focuses on having above 70% of glucose readings within the range of 4-10mmol/L instead of focusing on specific numbers. There is a strong correlation between TIR and HbA1c.

HbA1c:

The usual target is 7,0%. These targets may be individualised between you and your practitioner.

BMI:

Maintaining a healthy weight with a BMI of between 18,5-24,9 is advised.

Exercise:

The World Health Organisation recommends 150 minutes of moderate exercise per week. This will be broken down to shorter sessions spaced out over the week.

  1. How often should I test my blood glucose levels?

People with Type 1, 2 and gestational diabetes using insulin need to test more often than people using oral medication only. People with T1 should be testing at least four times a day, pre meals and at bedtime. Before and after exercise may also be necessary. A 2am test is useful to rule out overnight hypoglycaemia.

For people not on insulin, less testing is required. Testing a fasting reading twice a week would be sufficient. It’s also useful testing two hours after meals from time to time, to establish the effects of your meal on your blood glucose levels. Try to aim for no more than 2mmol/L increase after meals.

When medication is being altered, more regular testing may be required, up to seven tests a day for three days. CGM is a convenient way to track blood glucose levels 24 hours a day. Unfortunately, it’s an expensive tool.

  1. Why should I make all these changes?

Unfortunately, uncontrolled diabetes can result in many long-term complications including eye, feet and kidney damage. There is also an increased risk of cardiovascular disease.

Having good communication and support from your diabetes team will lighten your burden, and managing diabetes will hopefully not weigh you down.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

MEET THE EXPERT

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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