Dr Enslin Uys, an ophthalmologist, describes the process of diabetic eye screening step-by-step and goes on explaining why it is vital.

What is diabetic eye screening?

Diabetes can cause health problems in several ways and your eyes are one part of your body that can be affected. Diabetic eye screening is a test to check for eye problems caused by diabetes.

Diabetic retinopathy is caused by diabetes. This can lead to loss of vision (ultimately blindness) if it’s not found early.

The eye screening test can find problems before they affect your sight. Pictures are taken of the back of your eyes to check for any changes.

If you have diabetes and you are 12 years or over, you should have your eyes checked at least once a year.

Diabetic retinopathy

This condition occurs when uncontrolled blood glucose levels affects small blood vessels, damaging the part of the eye called the retina. It can cause the blood vessels in the retina to leak or become blocked. This can affect your sight.

Importance of screening

Eye screening is an important part of your diabetes care. Untreated diabetic retinopathy is one of the most common causes of sight loss. When the condition is caught early, treatment is effective at reducing or preventing damage to your sight.

Diabetic eye screening is not covered as part of your normal eye examination with your GP or even some opticians. Screening doesn’t look for other eye conditions and you should continue to visit your optician regularly for an eye examination as well.

How can I reduce the risks?

You can reduce your risk of developing retinopathy, or help to stop it from getting worse by:

• Controlling your blood glucose level.
• Tightly controlling your blood pressure.
• Controlling your cholesterol levels.
• Keeping fit and maintaining a healthy weight.
• Give up smoking. Nerve damage, kidney and cardiovascular disease are more likely in smokers with diabetes. Plus, smoking increases your blood pressure and raises your blood glucose level, which makes it harder to control your diabetes.
• Get regular retinal screening. The most effective thing you can do to prevent sight loss due to diabetic retinopathy is to go to your retinal screening appointments by an eye specialist, also called an ophthalmologist. Early detection and treatment can stop you from losing sight. If you’re pregnant and have gestational diabetes, you will require retinal screenings more often during your pregnancy and after your baby is born.

The process of the screening test

Eye drops being administered prior to screening test

1. Drops will be administered in your eyes to temporarily make your pupils larger. You may find the drops sting a bit and the eye drops may affect your vision for a few hours, so you shouldn’t drive after your appointment.

2. Photographs will be taken of the back of your eyes. The camera doesn’t come into contact with your eyes. If the screening test isn’t performed by an ophthalmologist, the photographs will be sent to one.
3. The appointment will last around 30 minutes.

4. A feedback letter will be sent to you and your GP within six weeks letting you know your screening results.

Possible results

An ophthalmologist will study the photographs of your eyes after you have been screened. If there are any problems or more questions, we may call you back for another assessment.

Screening can detect:

• Early signs of retinopathy.
• If you need a follow-up appointment to see whether you need treatment.
• If you need to have more frequent checks.

Practical tips for the screening day

• Bring your glasses and contact lenses you wear along with lens solution for contacts.
• Bring sunglasses as your eyes can feel sensitive after the eye drops.
• You may want to bring someone with you to the appointment.
• Eye drops may affect your vision for a few hours, so you shouldn’t drive after your appointment.

Remember, eye screening is part of managing your diabetes and diabetic retinopathy is treatable, especially if it’s caught early.

Header image by Adobe Stock
Images supplied by Dr Enslin Uys

Liesbet Delport and Marinda Venter unpack the cons of a high-protein diet for people living with diabetes and offers the Smart Health Diet as the alternative.

A healthy gut

There is a myth that a high-protein diet is the best way people living with diabetes need to eat to get their blood glucose under control and to improve their health.

High-protein diets are low in fibre and most people with diabetes don’t have a healthy gut, due to limited fibre intake. A type of fibre, called prebiotics, is found in wholegrains, fruit, vegetables and legumes (collectively called functional foods). There is ample evidence of good blood glucose control and improved insulin sensitivity on high-fibre diets based on wholegrains.

For a gut that is soft-stool friendly, you also need the right, good bacteria to be active and flourishing in your gut, creating a healthy microbiome for nutrient absorption and regular soft stools. This good bacteria, called probiotics, is common in fermented dairy like yoghurt, as well as other fermented foods and they live on fibre. Without fibre they wane and so your gut health will wane with it.

On average, the recommended fibre intake per day is 30-35g, chosen from a variety of fibres as they don’t have the same properties. Constipation is often a symptom of a fibre poor diet.

Colorectal cancer

Sixty percent of the body’s immunity is situated in the gut, but apart from protection against colds and flu, a healthy gut is of utmost importance for protection against various cancers, especially colorectal cancer.³ There is convincing evidence that a diet high in red meat and alcohol predisposes to colorectal cancer, whereas a diet high in fibre and rich in calcium protects from colorectal cancer.⁴

So, although your diet needs to include plenty of vegetables and fruit, the bare minimum is at least three servings of wholegrains per day. Calcium’s best source is low-fat dairy products and again you need at least three servings per day.⁴

The myth

A high-protein diet for good glycaemic control is a myth, because the benefits of going high on protein and low on carbs will only last for a couple of hours. Protein and fat take longer than carbs to digest and your blood glucose will start to show the effect after two to three hours when the carbs have come and gone.¹ This will happen after every high-protein (and/or high-fat) meal.

Many people who have diabetes develop kidney problems (±30%) as high blood glucose levels cause damage to the kidney’s cells, just like it can cause damage to the cells of the retina in the eyes (causing blindness) and/or the cells of your nervous system, referred to collectively as microvascular damage. High-protein meals put more strain on your kidneys, as more protein in the bloodstream forces them to work much harder to get rid of waste products.

Many people with diabetes are sent to a dietitian by their doctor to place them on a low-protein diet, as their kidneys can’t cope anymore. The high-protein approach could fast forward you to chronic kidney disease. Serious circulation problems, due to damage to nerve cells are also common amongst the diabetic community and often end badly with amputations.

Pancreatic function

Taking care of your pancreatic function is at the essence of diabetic self-care. Insulin, which controls blood glucose levels, is excreted by the pancreas. Too much glucose in your blood causes your pancreas to work overtime and after weeks, month or years it gets tired and can’t cope. But it’s not only sugar and high-GI or refined carbohydrates that taxes the pancreas, protein and fat does too.⁵ So, changing from too much refined carbs to too much protein and/or fatty foods and shakes is like exchanging one bad habit for another.

Type 1 diabetic patients have been found to need extra insulin when they eat high-protein and/or high-fat meals, instead of balanced meals.¹ Balanced meals would typically be what you would find in the Mediterranean diet⁴ or what is promoted in the South African equivalent, the Smart Health diet.

High-protein diets have also been shown to increase LDL cholesterol (bad cholesterol).⁶ With all the risks of microvascular damage that people with diabetes have to avoid, a high cholesterol level is an unwanted problem. High LDL cholesterol can lead to atherogenesis, which is the main cause of macrovascular damage, leading to heart attacks and stroke. In contrast, wholegrains, legumes, with the addition of fruit and vegetables, are providing soluble fibre which aids in lowering cholesterol.

The diet solution

The diet solution is to have a balanced meal plan (like the Smart Health Diet) that includes healthy functional foods and eliminates all unhealthy foods. As a person with diabetes, it’s best to consult a registered dietitian to explain the detail to you. In the meantime, have a look at www.smarthealthdiet.co.za and use the figure below as a guide to have a healthy meal.

References

1. Smart, C.E.M., Evans, M, O’Connell, S.M., Mcelduff, P. Lopez, P.E., Jones, T.W., Davis, E.A. and King, B.R. Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes and the effect Is additive. Diabetes Care 2017;36:3897–3902.
2. Küster-Boluda I., Vidal-Capilla I. Consumer attitudes in the election of functional foods. Spanish J. Mark. ESIC. 2017;21:65–79. doi: 10.1016/j.sjme.2017.05.002.
3. 3. Tayyem, R.F., Bawadi, H.A., Shehadah, I.N., Suhad, S.A., Agraib, L.M., Bani-Hani, K.E., Tareq, A., Al-Nusairr, M., and Heath, D.D. Macro- and micronutrient consumption and the risk for colorectal cancer among Jordanians. Nutrients2015;7(3):1769-1786.
4. 4. Sajesh K.V., Wong, T.Y., Loo Y.S., et al. Role of Diet in Colorectal Cancer Incidence. Umbrella Review of Meta-analyses of Prospective Observational Studies. JAMA Network Open. 2021;4(2):e2037341.
5. Bell, K.J., Gray, R., Munns, D., Petocz, P., Howard, G., Colagiuri, S., and Brand-Miller, J.C. Estimating insulin demand for protein-containing foods using the food insulin index. Eur Jnl Clin Nutr 2014;68:1055-1059.
6. McMillan-Price, J., Petocz, P., Atkinson, F., O’Neill, K., Samman, S., Steinbeck, K., Caterson, I. and Brand-Miller, JC. Comparison of 4 Diets of Varying Glycemic Load on Weight Loss and Cardiovascular Risk Reduction in Overweight and Obese Young Adults. Arch Intern Med. 2006;166:1466-1475.

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Did you know that your feet can show your emotions and the state you are in? Veronica Tift educates on the benefits of foot readings.

The heat of the sun is on my face and a gentle ocean breeze is blowing, the beauty of the Cape is all around me and I can hear the sounds of the Tsitsikamma forest from all directions. Visiting family here has filled my soul and the pink hue on the soles of my feet reflect this feeling.

The colour of my feet shows that I’m currently well-balanced and healthy. Since I’m on holiday, this makes perfect sense. My feet one week ago were much whiter reflecting my feelings of exhaustion with a yellow colour on the balls of my feet because I was feeling fed up and cheesed off. Maybe as you read this you notice your feet have a green tinge to them, that could be a hint of jealously.

How your emotions show up on your body

When something emotional happens, like trauma, it not only affects you mentally but physically as well. We talk about a gut feeling and knowing something in our bones. We can see when someone is stooping over with hunched-up shoulders that they are struggling with burden so heavy they physically reflect this.

When you experience the same emotion over and over again, it can start to create physical changes in your body. When you consider this, you can understand how the things you feel emotionally could manifest physically on the body and reflect on the feet.

Your feet have personality and as they carry you through life their physical shape and condition changes. How we walk through life leaves an imprint on the feet that a reflexologist and foot reader can interpret.

Image courtesy of Christine Stormer-Fryer.

The stories feet tell in foot readings

Let’s start with the colour on the feet; this can tell me a lot about your diet or lifestyle and from a Traditional Chinese Medicine point of view, it can reveal which meridian is congested or the element that is out of balance.

Now let’s look at the feet from a foot reading point of view which gives us insight into what’s happing emotionally in your body (the present and female influence on the left foot), or what has happened in the past (the right foot is related to the past and male influence), possibly even what you are worried about for the future.

When looking at the feet, a couple of specific markers are noted. Calluses are common on the feet and often found on people who walk barefoot and have shoes that don’t fit just right. These thickened portions of the epidermal layer of the skin tell me something about a client. I look at what area of the foot the calluses have formed and whether it’s the right or left foot; this can give me an indication of which area in your life has been a struggle or if you have been in a situation that requires extra protecting. People in these situations can become harder, and just like the hard and multi layers of skin that form a callus, they too have become stronger, toughened up and formed layers of protection.

Maybe you need to break free from a self-limiting idea or fears, either from your past or in current situations depending on the location of the callus.

The toes

Each toe has its own story to tell. Toes are incredible and in reflexology the points in the big toe connect to the head. With foot reading, the head and neck reflexes house the thoughts and opinions, these thinking toes are where beliefs, ideas and self-esteem can be found.

When observing the second toe leaning toward the pinkie toe, I might ask the client if they are impatient and often think of the future rather than living in the past. In many cultures, the second toe has great meaning and importance. In India, mother-in-laws have been known to check the second toe of a potential future daughter-in-law and if that toe is too long, they are deemed to not be a good match for their son and probably too bossy. Having a long second toe myself, I prefer the Native American tribes that believe it’s a sign of royal birth.

Cracked heels

Cracked heels are another marker that is often seen. The splitting skin can often be painful with many having tried everything to nourish the skin on the outside, but nothing has worked. Emotionally this person often has cracks in their emotional foundations. Not knowing how to take the next step or digging in their heels, the heels crack from being pulled in many directions, feeling divided and not knowing which way to turn or being torn apart by conflicting views.

How does reflexology help?

The power of touch can be an incredible emotional tool, reflexology can be a true body and mind healing modality if you are open to that healing and ready for change.

Check with your reflexologist if they are trained in this incredible art and science of identify the markers of the feet to reveal physical, mental and emotional stories your feet could tell.

How you feel about your feet can often tell how you feel about yourself. Do you skip merrily or just shuffle along? I invite you to take a minute now and ask yourself how you feel about your feet and what kind of footprint do you wish to leave behind?

References

1. Let’s Read out feet! The foot reading guide – Jane Sheehan
2. Get Started in Reflexology: A practical beginners guide to the ancient therapy – Chris Stormer
3. Advanced foot reading: A consultative approach to reflexology – Sam Belyea
4. Foot Reading: A reflexology primer on foot assessment – Sam Belyea
5. Take the next step – It’s all in the feet – Christine Lynne Stormer-Fryer
6. The Language of the feet – Chris Stormer

Header image by Adobe Stock

– DSA Western Cape News –

Camp Diabetable Western Cape video

The Diabetes SA YT1 Camp Diabetable Western Cape was held on 16^th to 18^th  September 2022 at Soetwater Environmental Centre in Kommetjie, Cape Town. Camp Diabetable Western Cape were generously sponsored by EPT recovery, they also sponsored colourful good bags and this great feedback video. This successful event would not have been possible without their kind support. DSA needs regular donations and sponsorships to hold our Annual Diabetes Camps for children with Type 1 diabetes.

– DSA Port Elizabeth News –

Jump for Diabetes

On 2 October, DSA Young Guns held a Jump for Diabetes at the Indoor Trampoline Park. This was organised by Paula Thom and Darren Badenhuizen.

Health Awareness Day at St Luke’s Anglican Church

On 29 October, Martin and Elizabeth Prinsloo were invited to attend a Health Awareness Day at St Luke’s Anglican Church. These photos were kindly taken by photographer George Chase and used with his permission.

Festive Diabetes Wellness Meeting

The last Diabetes Wellness Meeting was held in Newton Park on 9 November. Dietitian, Emma Slabbert, gave an interesting presentation Don’t let the festivities of the end of the year upset your sugar control. Focus on the Basics and Practical Ways of eating better for Diabetes.

This was followed by a surprise arrival of our Christmas dog, Jessica, and her cart who brought diabetes blue goody bags. These were delivered to all present by Jessica’s handler, Joshua. After that delicious savoury snacks, sugar-free cooldrinks and coffee/tea were enjoyed.

The Global Diabetes Walk

The Global Diabetes Walk, held in Port Elizabeth on 19 November, was organised by Michael Zoetmulder and his team from Zsports Events SA and Megan Soanes from the Port Elizabeth branch of Diabetes SA. The main sponsor was KliniCare Pharmacies.

This is the first Global Diabetes Walk that we have held for several years; it was well-supported and enjoyed by all. We are hoping to make this once again an annual event to raise awareness for diabetes.

The walk started and ended at the Broad Walk Sun Park in Summerstrand and took the walkers on a tour of a section of the suburb.

Joy Steenkamp from Medipost Pharmacy explains how pharmacy support can assist in good management for diabetes.

Patient story

At just three years old, Liezl was diagnosed with diabetes. “My mom noticed I was losing weight and drinking lots of water, and I wanted to eat a lot of tomato sauce because I was craving the sweetness. She also says my breath smelled sweet. Now we recognise these as symptoms of uncontrolled diabetes, and diabetic acidosis, a shortage of insulin in the body that prevents blood glucose from getting to the cells to be used as energy,” says Liezl, now 34.

“Diabetes is a 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,” says Joy Steenkamp, a pharmacist at Medipost Pharmacy, South Africa’s first national courier pharmacy.

Having diabetes is a full-time job

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 leading to serious health problems over time, including potentially irreversible damage to the eyes, kidneys and other organ systems.

Liezl had to learn to inject herself with insulin at only seven years old. “My mother made my teachers aware that I had diabetes and I did my injections in the offices at the school. I always had to have insulin with me, from such a young age. Having diabetes is a full-time job. It’s a responsibility that comes too soon and the consequences may come when it’s too late,” she says.

“Diabetes can be a great journey or a terrible one depending on how you see it and manage it. Emotionally, it can get really tough. I want to help people understand what it’s like to have diabetes and, if you do have it, how important it’s to look after your health and do everything possible to avoid complications,” Liezl says.

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

“If you have diabetes, it’s especially important to be aware of your blood glucose levels and be consistent with managing the condition. No one chooses to have diabetes, and it’s often emotionally difficult to come to terms with a diagnosis and to learn how to control your blood glucose.”

Poorly controlled diabetes has lifelong consequences

“As somebody who has walked this path, I take blood glucose control seriously now. When I was a teenager, there was a time when I felt isolated because of my condition and, like a teenager, I rebelled against my diabetes and didn’t take the care I knew I should with my diet and monitoring my blood glucose to stay within safe levels,” Liezl says.

“You think diabetes is just about glucose, but there is so much more to it than that and every organ in your body is affected when the condition is not properly controlled because it damages your blood vessels. In my case, as a result of the damage caused in my teens, by the age of 20 I had developed kidney failure and impaired vision. I wasn’t managing my diabetes well enough all those years ago, and now I can’t reverse the damage it caused,” Liezl shares. 

The sweet spot for blood glucose levels

“Persons living with diabetes should monitor their blood glucose levels closely. Sometimes patients learn to recognise the symptoms when their blood glucose is high (hyperglycaemia) or too low (hypoglycaemia). However, there are several ways to accurately test and this should become part of your daily life to manage diabetes,” Joy Steenkamp advises.

The treating healthcare practitioner will recommend specific target blood glucose levels for you, according to an individualised risk-benefit analysis. For most adult patients, it’s recommended that blood glucose levels should be between 4 mmol/L to 7 mmol/L if you haven’t eaten in several hours, and less than 10 mmol/L within one to two hours of a meal.

“A glucometer measures blood glucose levels in a tiny drop of blood, which you extract from your finger by pricking it with a clean lancet. Nowadays technology is providing helpful tools for people living with diabetes. Some glucometers automatically digitally record blood glucose readings. There are also insulin pumps, which continuously monitor blood glucose levels and administer the correct amount of insulin as needed, without you having to check your blood glucose and inject yourself.”

Glucometers, glucose testing strips, lancets and insulin pumps, are useful in tracking and controlling blood glucose. To help make it as easy as possible to adhere to prescribed treatment and manage diabetes Medipost Pharmacy offers these devices as well as free delivery of chronic medications, safely and confidentially, to any address in South Africa.

Pharmacy support

“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. 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 South Africa. 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,” Joy Steenkamp says.

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

“I used to feel alone in my life having diabetes, and I hope that sharing my personal experience can help someone else out there to persevere if they are struggling with a diabetes diagnosis. It can feel overwhelming but take each day as it comes and do everything you can to remain healthy,” Liezl adds.