Category: 2022 Winter – Diabetes Focus Online

Hacks

Hacks for healthy winter living

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Dr Louise Johnson offers hacks for healthy winter living for people with diabetes.

Professor Elliot Joslin was the first doctor specialising in diabetes in the United States. He was involved in diabetes for seven decades (June 6, 1869 – January 28, 1962) and first recognised the management of diabetes as the management of diet, exercise and correct medication to prevent complications. He coined it the “three wild horses of diabetes running each in its own direction.” To live healthy, it’s important to get the balance between diet, exercise and the correct medication. Either too little or an excess of any of the three can throw the scales over and cause havoc.

Diet 

A well-balanced diabetes diet that has adequate portions of starch, lean protein, vegetable, fruit and fat in the form of nuts and avocado is important.

Note, it’s vital to take in all your vitamins, especially in winter or during stress and illness when the immune system is down. Oral supplementation may be necessary. In winter and during stress and illness there is a need for more vitamin C, zinc and vitamin D.

Diet hacks

  • Vitamin C in dosage of 500 to 1000 mg per day improve the immune system.
  • Zinc is a nutrient that is important in the body for a healthy immune system, good wound healing and prevention of age-related macular degeneration. It’s found in chicken, red meat and fortified breakfast cereals. It’s good to supplement in winter: a dosage of 8 mg for women and 11 mg for men.
  • Vitamin D is more important in winter since we get less sun exposure.
  • Adequate calcium (600mg/d) is also important for good bone health throughout life in both men and women. Osteoporosis is four times more prominent in people with diabetes and can be prevented by calcium supplementation, sunlight and exercise.
  • During winter or sometimes watching TV, snacking is a problem amongst many people. Try to minimise this or do healthy snacking with cucumber or popcorn.
  • Water is always important. The calculated amount of water is your weight without the naught. For example: 60 kg person will need six glasses of water per day. This can be divided between tea, juice and water. Remember that coffee doesn’t hydrate. To get access to healthy water, use a water filter or boiled and cooled down water.
  • Don’t forget your probiotics for a healthy gut. The best form is in the form of yoghurt. Should you not get enough yoghurt, a supplement can also help but natural is always better.

Exercise hacks

The importance of aerobic exercise can’t be overstated. This increases insulin sensitivity and helps you use less insulin more effectively, burn fat and prevent osteoporosis. Any form of aerobic exercise (walk, swim, run or cycle) for 30 minutes per day is recommended.

  • Exercise in the morning is better for glucose control since insulin resistance is at its highest value then. Be careful of hypoglycaemia after exercise, especially if you do it in the evening.
  • Anaerobic exercises (weightlifting) can push up glucose due to the stress response of the body. It’s wise to do a combination of aerobic and anaerobic exercises dependent on the glucose level to help with control. For example, if glucose is above 10 mmol before exercise start with aerobic training (walking or running) and end with squats and weights. The reverse works well too when glucose is between five and 10 mmol to start with weights and end with aerobic exercise.
  • Always have a sugar snack handy and remember to hydrate well. Drink enough water and stretch well before and after exercises.
  • Proper shoes are important for people with diabetes, especially if you already have nerve damage with loss of sensation and burning feet. Don’t forget proper socks are as just important as shoes.

Medication hacks

To control the three wild horses, the correct medication is important. Remember that medication changes continually and better medication become available as well as devices (insulin pumps and glucose sensors). Visit your diabetes specialist regularly for an evaluation.

Other general hacks

Sleep

It’s important for good control of glucose and a healthy immune system to sleep at least six hours per night uninterrupted. If you have trouble sleeping talk to your doctor. Avoid caffeine (coffee) before bedtime. Daytime sleepiness can be a sign of sleep apnoea and can be diagnosed with a sleep apnoea test and managed with sleeping with a special mask. This will also improve glucose control and weight issues.

Seasonal affective disorder

Many people suffer from seasonal affective disorder (SAD) when the weather changes to cold. Symptoms include feeling tired, depressed, down or lethargic. Care for your mental health. Depression is 50% more common in people with diabetes and if symptoms persist despite healthy living, seek professional help.

Reduce shower/bath time

There is nothing better than a long hot shower or bath especially during winter times. You shouldn’t exceed this time with 10 minutes since all the healthy oils of the skin can be washed away. This can increase weakness and peeling of nails.

Relax

When we are stressed out, our immune system is compromised, and this can give viruses and bacteria space to cause problems. To help prevent this, spent time meditating daily in whatever form relaxes you. Reading, listening to music, drawing, sitting and reflecting.

Stay warm

The more constant we keep our body temperature, the easier it will be to fight of infections. Remember a scarf. Cold viruses spread in the cold. Your nose is the highway to your lungs. Keep it warm.

Remember to wash your hands

This is now second nature to us in the COVID era but don’t forget when inside and touching your face, wash your hands regularly. Travel with wet wipes when touching all those surfaces that are unavoidable and full of germs.

Gargle

Gargle regularly with warm water and a teaspoon of salt. This is anti-inflammatory and good for teeth and throat health. Gargle and spit with warm water until the salty taste is gone.

Laugh

I can’t think of a better stress reducer than laughing. Watch your favourite movie and start laughing.

Garlic

In the Middle Ages, it was tied around the neck to ward off evil. It still helps with those evil viruses by boosting your immune system. Be sure to crush whole garlic to get all the goodness that comes from its health-giving compound: allicin. Add it to your soups and stews for a healthy winter.

Immunisation

It’s good practice for people older than 50 years of age and those living with diabetes to be up to date with vaccines. Don’t forget the annual flu vaccine that is very effective against flu.

Do everything in moderation from diet, exercise to taking supplements. Remember too much is just as harmful as too little.

Dr Louise Johnson

MEET THE EXPERT

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

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Changing medication

Changing medication: why it’s necessary to keep up-to-date

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Diabetologist, Dr Paula Diab, explains the four scenarios in which changing medication is needed when treating diabetes.

Very often we get stuck in a place where we’re comfortable. We tend to stick with the same toothpaste or washing powder and go to the same restaurant for dinner. It’s good to feel comfortable but sometimes change is also good. This doesn’t mean a new set of wheels every year or trying out every restaurant in town, but it’s good to re-evaluate things from time to time.

So, why should you change your medication?

  1. Firstly, diabetes changes

It’s a little-known fact that the underlying pathogenic metabolism of Type 2 diabetes is present prior to the actual diagnosis of diabetes. What this means is that the cells in your body that produce insulin are significantly damaged even at the very start of your journey with diabetes. It’s important to remain ahead of these changes and ensure that the medication that you’re taking is constantly providing maximum benefit both in terms of managing your day-to-day health and preventing further damage and complications.

Over time, further pathological changes occur in the body which often necessitates a change in medication. Kidneys or vessels may become damaged and may require additional support or protection. These changes may occur not only because of lifestyle or dietary choices but purely due to the development of diabetes through the years. In addition, it also doesn’t make sense to continue targeting your therapy at a damaged organ. For example, as the cells in your pancreas become damaged, stimulating those cells to produce more insulin is like flogging a dead horse. Rather target a different pathway or mechanism of action.

  1. Your lifestyle may change

The most obvious example here is to compare a busy thirty-year-old working mother to a retired old lady living in an old age home where meals are provided at set times and activity is limited, not only by choice but also by physical ability. The same medication isn’t going to work for both of these people.

Some people eat erratic meals; they may eat out often, have business lunches whilst others have little to no control over their choice of food. Activities change on a daily basis and over time. The day you run a half marathon will require a different strategy from the rainy weekend you spend watching movies at home.

Sometimes our financial position and priorities in life also change. Rather than struggling with the same status quo, we may need to consider a different perspective. As we get older, our metabolism changes, our lifestyles change, and our goals change. Medication may also need to change.

  1. New medications are developed all the time

In just over two decades of managing people with diabetes, the scope of medication has almost completely changed. Some of the original medications used, no longer exist and others have been completely replaced. In fact, there is probably not one single tablet or insulin that was popular then, that is still used frequently today.

In the last two years that we have all been staying home and avoiding public events, there have been about eight new drugs developed and launched on the South African market specifically targeted for diabetes. This includes one completely new combination of medication as well as new delivery devices. Continuous glucose monitoring systems and pump therapy has changed, and closed-loop pumps are now also on the market.

These new drugs often provide an easier dosing regime, upgraded technology or an improved side effect profile. Recently, pharmaceutical companies have also been working at combining different classes of drugs so that multiple pathways can be targeted at the same time. Drugs that work synergistically not only benefit your body in that they often have a complementary side effect profile and enhance the action of the other but are also much easier to administer and reduce the burden of a box full of medication every day.

Researchers are also working on looking at additional mechanisms of treating diabetes and managing high glucose levels. Is it possible to prevent complications or even enhance the functioning of certain organs at the same time as managing your daily glucose fluctuations? There are very few other chronic diseases where the medication aims to treat daily symptoms and prevent further damage. This is exactly what we are striving for in diabetes.

  1. Protocols also change

The new South African guidelines are due to be released towards the end of this year. These will cover a range of topics that are associated with diabetes and provide expert guidance in terms of best available evidence. Although these guidelines are updated every five years, financial implications often mean that they don’t make their way into routine care. However, evidence-based, cost-effective medicine is still the ultimate goal of every healthcare provider no matter where they work or who the patient is.

Your responsibility

It’s your responsibility as a person living with diabetes, to identify key lifestyle factors that may influence your diabetes management and discuss these with your doctor.

Your doctor’s responsibility is to keep up to date with latest guidelines, evidence and protocols and to understand how the medications work.

The art of medicine is then beautifully demonstrated in the conversation that follows where doctor and patient work together to negotiate and decide on the best possible plan for that individual. A plan that is cost-effective, simple, evidence-based and will ultimately reduce the burden of diabetes.

Regular follow-up and changes to your medication shouldn’t be seen as a failure or medical authorities trying to benefit financially from the situation, but rather an opportunity to achieve a healthier and more manageable outcome. Ask your healthcare provider to assess your individual risk and situation and discuss the various alternatives with you: how the medications work, why they’re preferable and what benefit they have, and then you can make an informed decision about your health and disease management.

References available on request  

Dr Paula Diab

MEET THE EXPERT

Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.
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Lynne Vorster

Lynne Vorster – Being an Oumie keeps me active

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Lynne Vorster - Being an Oumie keeps me activeLynne Vorster tells us how being an Oumie keeps her active and her role as the librarian for DSA Port Elizabeth.

Lynne Vorster (64) lives in Gqeberha, Eastern Cape with her husband of 38 years. They have three daughters, two granddaughters and a grandson on the way.

Family first

First and foremost, I’m a wife, mother and Oumie. My husband and I are extremely proud of our three daughters: Nicola (36), Eleanor (34) and Christine (32). We are very blessed to have all three living in Gqeberha and incredibly lucky to have my two granddaughters, aged 3 years and 10 months, with me most days. We have a grandson on the way and are looking forward to meeting him in August.

Besides spending time with my family, I’m happiest in the kitchen; where my passion lies in bottling a variety of garlic, chilli and rosemary-infused olives. I also enjoy pickling peppers, beets, onions and cherry tomatoes.

Diagnosis of Type 2 diabetes

I was diagnosed in 2015 after going through a traumatic time. My doctor sent me for a complete blood work up and, unfortunately, his suspicions were correct.

I was constantly lethargic, went to the toilet often and mostly during the night, suffered from insomnia, and my eye sight became blurry.

My doctor prescribed metformin, half an aspirin, hydrochlorothiazide (blood pressure), simvastatin (cholesterol) and dual-acting human insulin. I was already on levothyroxine for my hypothyroidism.

Some positive news this year is that my metformin and levothyroxine dosage were lowered. I have, however, been prescribed another blood pressure tablet at night.

Veggie lovers

Fortunately, my family are veggie and salad lovers. We mostly eat chicken and fish. We seldom eat red meat with the exception of winter, where we tend to cook hearty stews and soups with lots of veggies and of course some starch.

I try to follow a meal plan but find myself derailing when I’m busy. Meals then become an afterthought and take a back seat unfortunately.

Being an Oumie helped me lose weight

I lost a considerable amount of weight looking after my first granddaughter from her birth, until she went to playschool last year. She is a very active and busy little girl. Running and skipping replaced walking at all times.

My 10-month-old granddaughter comes to me daily and will soon be walking. I guess I’ll be running and skipping once more. Exercise at the moment is getting up and down onto the play mat.

I do my own housework, cooking and all other tasks that come with running a home. I also run an aftercare service from my home and I have five children that come to me after school, during the week, assisting them with their homework, as well as helping them prepare for assessments, projects and orals. Added to that, I also do extra lessons in Mathematics and Afrikaans.

DSA librarian

Being nominated as the Librarian for the DSA Port Elizabeth branch was both a shock and an immense privilege. My duties include: ensuring that the books are available for everyone to browse during our monthly meetings; filling out a card with all relevant particulars; and ensuring that the books are returned by their due date.

I also create pamphlets with a variety of facts and information, which is available for everyone to take home and read at their leisure. My hope is that this information is shared with family members and friends who may also have diabetes.

Support and education

My family have been fantastic in supporting me and ensuring that I stay on the right track with my eating, medication and exercise.

If I was in the position to bring greater awareness to this disease, I would recommend sending medical staff to Government clinics and schools with a fun theme, ensuring that sessions are relatable and memorable.

I believe that more can be done to highlight diabetes on all forms of media, ensuring that the public is educated on symptoms that a friend, family member or loved one may be displaying. Having grandchildren, myself, I believe in teaching children the importance of a healthy and balanced diet and feel strongly that this should be taught at school as part of a formal curriculum. In turn, children can teach parents by sharing what they have learned at school and having fun activities to do at home.

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GlucaGen hypo kit

The GlucaGen hypo kit

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Kate Bristow, a diabetes nurse educator, explains how to use a GlucaGen hypo kit and what to be aware of.

Hypoglycaemia or low blood glucose can be a diabetes emergency. Let’s talk more about how to manage this and when to use the GlucaGen kit.

Recognise a hypoglycaemic episode

The first thing that is important is to recognise a hypoglycaemic episode.

Early signs include:

  • Sweating
  • A feeling of tiredness
  • Dizziness
  • Hunger
  • Tingling around the lips
  • Shaking
  • A rapid heartbeat – palpitations
  • Irritability, anxious feelings
  • Pallor

Symptoms of an untreated low can result in:

  • Weakness
  • Blurred vision
  • Confusion and difficulty in concentration
  • Slurred speech, unusual behaviour, and clumsiness (like being drunk)
  • Sleepiness
  • Seizures
  • Collapsing or passing out

How to respond to a low

 

RESPONSIVE AND ABLE TO SWALLOW CONFUSED AND AGGRESSIVE BUT AWAKE AND ABLE TO SWALLOW UNRESPONSIVE – SEIZURE OR COMA
Give 15g oral quick-acting CHO

e.g. Super C or Coke

 Give 15g oral quick-acting CHO

e.g. Super C or Coke

Get someone to help if necessary

 This is when if you have a GlucaGen hypo kit, it is time to use it as per below instructions
Wait 15 mins and check blood glucose levels Check blood glucose in 15 minutes and assess responsiveness Call for medical attention if no improvement in blood glucose or readings
If blood glucose has improved resume normal regime
If still low – give a further 15g CHO
If blood glucose has improved resume normal regime
If still low – give a further 15g CHO

What is GlucaGen?

Your GlucaGen hypo kit contains an injection of GlucaGen, a generic drug called glucagon. Glucagon works by triggering the liver to release some of the sugar that it has stored to help increase blood glucose levels.

It’s injected into the outer thigh but it does have to be mixed before injecting it so teach your friends and family how to use it as you may not be able to do it yourself.

The kit comes in an orange box and there are instructions inside the lid to show you how to use it.

  1. Pull out the syringe, slip off the grey needle protector on the syringe.
  2. Clip off the orange cap on the powder-filled vial and push the liquid contents through the rubber stopper into the powder in the second vial. Do not use anything except the pre-filled syringe to reconstitute the powder in the vial.
  3. Keeping the needle inside the vial, turn it the other way over and draw back all the contents of the second vial into the syringe. Make sure you have mixed the contents well before you do this by gently shaking it. You should end up with a clear solution. Be careful not to pull back air into the syringe.
  4. Take the syringe and needle out of the vial and inject into the outer upper thigh. Gently pinch the skin at the injection site and with the other hand insert the needle into the skin and push the plunger downwards until the syringe is empty.
  5. Your doctor should have told you exactly how much to inject. A child may not need as much as an adult so have clear instructions with your kit. The dose is calculated on weight of a child. Generally, a child under 6 years/below 25kg would be given 0,5mg. Over 6 years to adult would be given 1mg/1ml.
  6. After administering the injection, turn the person on their side as a precaution against vomiting and choking.
  7. ALWAYS CALL EMERGENCY SERVICES IMMEDIATELY AFTER ADMINISTRATION.
  8. Be aware that even after using a GlucaGen injection a second hypoglycaemic is possible.

General rules

  • It’s good idea to have two GlucaGen kits prescribed; one for home and another for the office or school.
  • Teach family and close friends how to use the kit in case of emergency.
  • It doesn’t have to be stored in the fridge by do try to keep it in a cool place, easily accesible.
  • In the case of a severe hypoglycaemic event, GlucaGen should be used quickly and medical help should be summoned as soon as possible.
  • Once concious and able to swallow have something sweet by mouth too.
  • Advise your healthcare team every time you have to use the kit. Your diabetes medication may need to be adjusted to prevent hypos.

When not to use GlucaGen

  • In rare cases where there may be other health conditions or rare tumours, GlucaGen is contraindicated. Please check this with your doctor.
  • Severe allergic reactions include rash, difficulty in breathing or low blood pressure. If this happens do not use GlucaGen.

Common side effects

  • Reactions at the injection site, generally localised and will resolve
  • Nausea and/or vomiting
  • Headache and dizziness
  • A feeling of drowsiness
  • Pallor
  • Diarrhoea
  • Low energy levels
  • Low blood pressure

Side effects generally resolve when blood glucose normalises and the effect of the injection wears off.

Final thought

Prevention is better than cure and although it’s essential to have GlucaGen as part of your diabetes emergency kit, we would prefer that if it gets to expiry date that it shouldn’t be used.

If you are having regular hypoglycaemic events, please talk to your healthcare team about adjusting your insulin doses.

When your blood sugar has normalised, resume your normal diabetes regimen with guidance from your diabetes team.

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

MEET THE EXPERT

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.

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Cannabis

Cannabis for treatment of peripheral neuropathy

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Lynette Lacock explains how cannabis has been used as medication in the past and the use of it for treatment of peripheral neuropathy today.

Brief history of cannabis as a medication

As far back as I can remember, cannabis was something to avoid if you were a law abiding citizen. It was illegal for most of my lifetime and considered a gateway drug, leading to all sorts of problems for those that used it.

Now all you read about these days is how cannabis helps this and that. So, how did it go from zero to hero in what seems like a relatively short period of time? Believe it or not, throughout history cannabis was more often the hero. The first documented use of cannabis for medicinal purposes was in Asia in 2800 BC by Emperor Shen Nung, the patriarch of Chinese medicine.

From that period onward it was also used for medicinal purposes by the Greeks, Romans, Indians and the British, just to name a few.  The Khoisan people were using it long before Europeans landed on the shores of Africa. It was even rumoured to have been used by Queen Victoria for menstrual cramps.

Labelled a dangerous drug

Eventually in the early 1900s it was labelled a dangerous drug and became heavily taxed, regulated and eventually outlawed in some Western countries.

In 1921, it was outlawed in South Africa under the Customs and Excise Duty Act. Some of the many reasons for this were due to an increase in recreational use, its link to crime and pressure from political and religious groups to have it banned.

Continued research

After the introduction of stronger pain medication, such as aspirin and opioids, cannabis was deemed no longer useful as a medicine and it was removed from most pharmacopeia.

Scientists still continued their research into the possible uses for cannabis. They isolated the compound cannabidiol (CBD) in the 1940s and tetrahydrocannabinol (THC) in 1964. It wasn’t until the 1980s that they discovered receptors for both of these in the human body. Finally, they were able to start to determine some of the effects these two substances had on humans.

Various Acts passed

In 1996 the Compassionate Use Act was passed in California (US) permitting medicinal use of cannabis for epilepsy unresponsive to other medications. Since that time the list of conditions it can be used for has grown along with the number of States that conceded to the Act.

In 2016 the Adult Use of Marijuana Act was passed in California.  Again other States followed suite. Many other countries around the world have also decriminalised it or legalised the use of cannabis for medicinal purposes.

It wasn’t until 2018 that South Africa legalised the private cultivation, possession and personal use of cannabis under the Cannabis for Private Use bill. Parliament’s Justice and Constitutional Development committee are tasked with amending the act to legalise and regulate the cultivation of medicinal cannabis with consideration of legalising it for recreational use by the end of 2022. This is a potential R28 billion a year industry for the country, not to mention the much-needed jobs this could create.

Unfortunately, at this point in time you can only get a license to cultivate cannabis for medicinal purposes and require special permission to obtain it for medical use.

Research continues to shows that CBD and THC can have a therapeutic effect on many different ailments, such as how it can help reduce symptoms associated with peripheral neuropathies.

Peripheral neuropathy in people with diabetes

A neuropathy is a damaged nerve or group of nerves causing numbness, weakness and/or pain. Peripheral means something on the periphery, such as your feet, legs, hands and arms. Unfortunately, 60-70% of people with diabetes will develop some form of peripheral neuropathy.

Neuropathy symptoms can vary from a burning sensation, numbness, weakness, sensitivity to touch, decreased ability to feel temperature or shooting pain. Annoyingly, symptoms can become worse at night when you’re trying to sleep.

This nerve damage can happen after a prolonged period of time with high and uncontrolled blood glucose levels. The damage can be made worse if a person also has high cholesterol and high blood pressure because this can further compromise blood flow to the nerves.

The best way to avoid peripheral neuropathies is to monitor your chronic conditions and maintain a normal blood glucose level. Once a nerve is damaged it can’t be repaired and you’re only able to treat your present symptoms while trying to prevent them from getting worse.

Finding the right cannabis for your neuropathy pain

There have been multiple studies conducted that have shown cannabis can be effective in reducing the symptoms of peripheral neuropathies. Most studies were done with combination of prescription strength (Schedule 6) CBD and THC.

The general conclusions have been that it helps with pain relief and inflammation while the THC can decrease anxiety and alter the perception of pain. This is good news for those neuropathy sufferers that haven’t had relief with conventional medication.

At this time, over-the-counter products containing maximum 600 mg CBD with maximum 20 mg daily dose per pack and 10 parts per million or <0.001% of THC are available to the general public in South Africa.

You can find these products at pharmacies or health shops and you won’t need a prescription to buy them. They come in different forms such as creams, drops or sprays. You can approach your pharmacist for assistance in finding which one would work best for you. This is regulated by the South African Health Products Regulatory Authority (SAHPRA).

Obtaining prescription strength cannabis

However, if you find these products are not effective enough you can get your doctor to apply to SAHPRA requesting permission to obtain prescription strength cannabis.

With a Section 21 application, your doctor can request unregistered medication if you qualify. Medicinal cannabis approval is usually granted by SAHPRA for the following four diagnoses: HIV/AIDS, anxiety, cancer and chronic pain.

Once you receive approval under Section 21, you’re issued with a medical card and are able to fill your prescription.

Since all of these laws and regulations are fairly new, not all doctors are aware of how to go about this process. It was only in September 2021 that the first person in the country received approval for medicinal strength cannabis.

You can go into the following link to find a doctor near you that is aware of how to apply for a Section 21 application for you and then prescribe Schedule 6 cannabis once your application is approved.

If this seems like too much trouble, you may want to wait and see what happens later this year. Hopefully in the not-too-distant future, you will be able to go to your local GP for a prescription then have it filled at your local pharmacy.

References

Sr Lynette Lacock

MEET THE EXPERT

Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.

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Brooklyn Rabie

Brooklyn Rabie – my life isn’t perfect, but I’m blessed

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Teenager, Brooklyn Rabie, tells us how she remembers her diagnosis of Type 1 diabetes and how she has accepted it and listens to her body.

Brooklyn Rabie (13) lives in Port Elizabeth with her parents and younger brother.

Remembering the diagnosis

On the 31st July 2018, I was diagnosed with Type 1 diabetes. First thought, what is that? That means my pancreas doesn’t produce insulin.

We were at my friend’s party. Cupcakes, donuts and any other sweet things you could think of. I wasn’t feeling too well. I was sitting with my parents and not even playing with the other kids. This isn’t normal for a nine year old.

On Monday morning we all preparing for the day ahead. But dad seems to capture my every move. I went to school and just before break my name gets called over the intercom. Instantly, I thought I was in trouble. I see dad standing in the reception area. He says “Princess, let’s go to the doctor and make sure that you are okay”.

Off we went to the doctor. He asked some questions and then tested my blood glucose, it was 27,8. We were shocked at first. My parents knew what it was and all the things we would have to do but I didn’t know what it meant so I wasn’t scared.

When I finally went to hospital and they told me what all I need to do. I’ll have to start using needles, giving myself insulin and testing my blood glucose. I got really scared. My parents were with me the whole time so I guess that’s what gave me assurance.

Diabetic ketoacidosis

One night, earlier in the year, my body just started to reject everything that I consumed, my eyes were watering and I couldn’t lift my head from bed. I was exhausted. My mom and dad decided to take me to hospital. At this stage, I couldn’t even drink water as I would just bring it up.

One hour later in the consultation room, I had two drips on one arm with blood tests being done on my other arm. I just wanted to sleep and felt as if my body was shutting off. From a distance, I heard my dad speaking to the doctor, and the doctor telling my dad that the matter is serious, and I needed to be moved to high intensive care as I was in diabetic ketoacidosis (DKA). This is a complication of diabetes that results from increased levels of ketones in the blood.

Thankfully on the second day, I was moved out of the high care ward and I was able to consume liquids and solids. After five days in hospital, I was discharged provided that I go for check-ups on monthly bases.

Listen to my body

There were many times when I had low and high blood glucose levels. Since being diagnosed, I’ve acknowledged and excepted what diabetes is and listened to my body. I wake up at night knowing something isn’t right without testing. I can feel if my levels are low or high. Thank God for having me in the palm of His hand.

What I want people to know

Many people think that I have diabetes because I ate to much sugar but that’s not it. It’s because my body doesn’t produce enough insulin.

Since I have to inject insulin or prick my finger at school, many of the children ask me what I’m doing and why am I doing that. They are always asking questions about it and unfortunately I hate answering those type of questions.

I would honestly like to do more to make people aware of diabetes, especially at school. That way, we will have more support and still feel as part of everything around us and then I wouldn’t have to answer all of the questions.

Having diabetes has also made me want to become an endocrinologist when I’m older.

Life isn’t perfect, but I’m blessed

This year July, I will have been living with diabetes for five years. I’ve seen better days, but I’ve also seen worse. I don’t have everything that I want, but I do have all I need. I wake up with some aches and pains, but I wake up. My life may not be perfect, But I’m blessed.

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Jane Mapfungautsi

Jane Mapfungautsi: Living with diabetes for 42 years

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Single mother, Jane Mapfungautsi, tells us about her diabetes care in Zimbabwe and Botswana.

Zimbabwean Jane Mapfungautsi (52) lives in Kanye, Botswana. She is a single mother of three, Rungano (31), Rutendo (29) and Ashley (23).

In the family

Diabetes isn’t a shocking word in my family; my daughter, sister and late nieces, cousins, aunts, and my late paternal grandmother all lived with diabetes.

I was diagnosed with Type 1 diabetes when I was 10-years-old, in 1980, in my home town, Gweru, in Zimbabwe. I was doing Grade 4 and my young sister, Blessing, had been diagnosed two years earlier. My mother, who was a nurse, noticed that I was drinking a lot of water and urinating a lot, especially at night. Before even going to the doctor, she said that she knew I had diabetes.

I was immediately admitted at Gweru Provincial Hospital under Dr Taylor, the resident physician. I still remember him well. Just like I remember all the doctors who’ve looked after me and have done such a wonderful job.

Living testimony

Forty-two years of manging my diabetes with insulin hasn’t been easy, but I’m a living testimony that it’s possible to survive. I was first put on a long-acting insulin. While I was been stabilised in hospital, I was taught how to inject myself. I would be given an orange and syringe with water and told to imagine that the orange skin was my skin and to prick at an angle of not more than 45°. It was a fun way of learning.

Once home, my mum would talk to my sister and I about diabetes care: the do’s and don’ts, what to eat and not to eat. Till now I admire the way she would place a flask of warm milk and some bread on top of the bedside cabinet in our bedroom and would wake us up at 2am every day to eat this snack. She had noticed how difficult it was to deal with a hypo attack in the middle of the night.

As I have grown older, I’ve realised that eating a snack just before bedtime helps me get through the night. The body actually uses a lot of energy while sleeping.

School years

Primary and secondary school were not easy. I would envy other children eating all the candy, biscuits, chocolates, and ice cream and so on. My parents would try to get non-sweetened substitutes for us, though of course they were not readily available.

When I started high school, I refused to be in boarding school after just a term. I didn’t like the fuss that was made over my diet and the strict monitoring of all my movements as my teachers were so scared that I would fail to inject or would eat the wrong food.

My parents tried to make sure that I enjoyed my childhood while adhering to the regime set by my doctors. My sister and I often attended Diabetes Association meetings, which gave us a chance to meet other people who had the same condition as us and share experiences. I remember Dr Lutalo, my physician, saying I needed to have a life like other children. I played a bit of netball and basketball, taking note of my blood glucose levels.

Pregnancies

One of the biggest challenges I had was during my pregnancies. For all my three children, I had Dr Purazi as my physician and he always referred me to good gynaecologists. All my children were born prematurely. Of course, the doctors always knew the expected complications and always helped me to the best of their ability.

Keeping active

Exercising is quite important for people living with diabetes as it helps insulin to work better as well as keeping us strong and feeling good. I do my own household chores and enjoy attending to my vegetable garden. Listening to some music and dancing along helps me relax. I don’t overexert myself as there is a danger of having a hypoglycaemic attack. Being a teacher, when I’m hungry or tired, I quickly sit down and eat. I’ve to be careful about what I eat, how much I eat and when I eat.

Brittle diabetic

I’m what is called a brittle diabetic. This means I have subtle to severe swings in my blood glucose levels and have had frequent episodes of hypoglycaemia. Brittle diabetes is hard to control. The changes in my blood glucose levels are unpredictable and sharp, like going to sleep with blood glucose level over 20mmol/L and waking up with a reading ranging between 2mmol/L and 4,5mmol/l. Thus, I’ve had my fair share of hospitalisation. My doctors always need to work out a care plan, aimed at stable control of my blood glucose levels. I always have to make sure that I have enough test strips for my glucometer and of course I always have it with me in my handbag or on my bedside table.

Most people with diabetes complain that their glucose levels go high when they’re stressed; with me the opposite applies. Dietary control is essential; I eat a lot of different vegetables, fruits, more white meat than red meat and avoid fatty foods and try to replace excess salt with different spices (not too spicy so as to avoid gastric pain). Of course, eating regularly in recommended portions is needed.

Been on various insulin

I have been on six different types of insulin in a bid to stabilise my blood glucose levels. It has since been realised that since my blood glucose levels can go from one extreme to the other, the best regime is for me to take insulin (Humulin R) or insulin aspart (which are both short-acting) pre-breakfast, pre-lunch and pre-supper, and then take insulin glargine insulin (long-acting) as I go to sleep.

My doctors have a care plan for me which I try to adhere to and I always diarise and discuss with them any problems or adjustments I would have made. I have been taught how to titrate my short-acting insulin dosages. I’m given a certain range within which I adjust the insulin dosages according to my blood glucose levels. Hopefully, one day I’ll be able to afford an insulin pump, or a continuous glucose monitor and avoid the pricks.

I also try to always have my routine blood tests done for Hb1AC, kidney and liver function and have my eyes checked annually.

Finding out about DSA

One Saturday morning, I was watching TV as I always try to watch programmes which address health issues. On Mzansi Insider, Diabetes South Africa (DSA) was addressing diabetes and Covid-19. I listened and learnt from the discussions. I found it interesting, so I visited the website and made contact to get more information.

Diabetes care in Botswana

I moved to Botswana in early 2007 and the diabetes care is quite good. What I appreciate most are the two big diabetes clinics the government has set up since 2012, one in the capital city, Gaborone, and the other in Francistown. I attend the Gaborone clinic.

These are facilities specifically built to attend to diabetes patients only and manned by teams of doctors well-versed in diabetes care and control. The facilities also have rooms where you get to have your eyes checked, get to see a dietitian, foot-care specialist, diabetes educators and so on. They also have well-equipped laboratories and pharmacies. Other government hospitals and private facilities also run diabetes clinics. The Botswana Diabetes Association holds meetings monthly and one can easily follow them on Facebook.

Taking care in winter

In winter, my biggest challenge is peripheral neuropathy, which causes a burning, painful pain in my hands. For this, I constantly take Vitamin B complex and a strong painkiller. I have since learnt the trick of sleeping with my gloves on and socks on my feet, with a hot water bottle. I have to make sure that I keep very warm all the time.

Just before the cold season starts, I have the flu vaccine. I usually tend to get throat infections and always make sure that I seek medical attention speedily, as any infection in my body makes my blood glucose levels to rise.

Winter also means taking multi-vitamins, not forgetting my green or mint tea with lemon. A warm cup of water first thing in the morning helps me detox. Although we don’t have a winter break at school, I make sure I rest indoors a lot and keep very warm. I try to avoid crowded places, worse now with the current Covid-19 pandemic, as having diabetes and having other underlying conditions means I’m at high risk of catching infections.

Candida is a problem I often have to deal with, especially when my glucose levels are high. I always quickly seek medical attention and get an anti-fungal cream or appropriate, recommended treatment. Pap-smear is a recommended must do.

Diabetes care challenges

Diabetes care is expensive. We appreciate governments who subsidise diabetes care. Not been able to go for check-ups when needed or not having enough money to buy all the required medication and glucose monitoring equipment is a challenge in most African countries.

Outreach programmes are really needed to teach the population at large especially in rural areas. People usually end up having amputations or going blind, because either they didn’t know that they have diabetes or due to poor diabetes control, or lack of nearby health facilities.

Educate all the time

Though a teacher by profession, my family and I do charity work. We always try to be a blessing to others, especially those who spend time hospitalised. Together we initiate community ventures both at home, in Zimbabwe, and here in Botswana whenever we can. We appreciate the gift of life.

I’m not shy to teach others about diabetes. Whenever I get a new class at school, I tell my pupils about my condition and teach them how they can help me, e.g. when I’m acting funny. I always talk to students, workmates, and friends about diabetes and the need for constant check-ups especially if there is a history of diabetes in the family.

To other people living with diabetes, I always talk to them about the need to know our bodies and the symptoms of high or low glucose levels. At the Diabetic Clinic, I always make new friends as we discuss our conditions.

Proper management is essential

The hardest lesson I have learnt in the 42 years of having diabetes is that without proper management, one can lose their life to diabetes complications. I have lost relatives and friends to diabetes and it’s very sad and painful. Diabetes is life-threatening but manageable if the necessary resources are there.

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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
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