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Back to school (with Type 1 diabetes)

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Going back to school can be a stressful time for anyone. For people with Type 1 diabetes (T1D) this can be even more so, especially returning to school after a new diagnosis. Itā€™s important that teachers are aware of T1D so they can ensure the wellbeing of their students.

Education

Itā€™s so important that your school teachers are aware of your T1D and know what to do when you need assistance. If they are educated, they will be better prepared to help you.

Itā€™s also advisable to keep a Glucagon kit at the school office, therefore it’s best to educate the school secretaries or the school nurse.

If you feel comfortable, itā€™s also great to make your friends aware. That way you can ask them for help too.

Educate your teachers on the symptoms of high and low blood glucose so that they can keep an eye out for you.

If you play sports, educate your coaches on how you may need to take breaks if your blood glucose drop and eat and rest until your blood glucose returns to a good level.

Know your rights

Itā€™s important to educate your teachers that you need to eat during class. No excused from your teachers, you are the exception. If you write exams, make sure the teachers are aware of your T1D!

Be as open about your T1D as possible

The more open you are about your diabetes, the better. People are often very inquisitive and unfortunately T1D carries a lot of misconceptions so try to be as patient as possible

If you wear a medical device, wear it with pride

NEVER be ashamed of a CGM or pump being visible. People are more likely to ask you questions but use it as an opportunity to educate people and create a positive conversation about T1D.

Be prepared

Make sure you ALWAYS have glucose sweets or a juice box with you. Lows can happen at the most unexpected times. Itā€™s also important if you leave the classroom to carry your ā€˜lowā€™ treatments with you.

Drink plenty of water at school too. Pack your bag the night before; that way you are less likely to forget important things at home. Be prepared for more than one low a day and pack enough supplies.

RememberĀ that your T1D doesnā€™t define you

Know that diabetes doesnā€™t make you different from everyone else šŸ™‚

Click on the image to make use of a printable PDF from the JDRF which is a great resource to give to your teachers.

T1D

MEET OUR YOUTH WARRIOR

Sarah Gomm (16) has been living with Type 1 diabetes for nearly 13 years; diagnosed at age four.

Sarahā€™s story

My family knew something was wrong with me due to my symptoms of thirst and weight loss, etc. They took me to the doctor and I was immediately sent to the hospital where I was diagnosed with T1D. I spent a few nights in hospital where my family and I learnt all the ins and outs of T1D.

For the next eight years, I did insulin injections and finger pricks. My mom would come to my school during break to do my injections until I was able to do them myself.

The past five years, Iā€™ve been fortunate enough to use a CGM and insulin pump, which Iā€™ve found to assist in lowering my HbA1c and improve my overall control.

As I get older, Iā€™m becoming a lot more responsible managing my diabetes and itā€™s made me a very independent person.

However challenging T1D can be, I still count it as a blessing. I have experienced so many amazing things I never would have, itā€™s made me mature and, most importantly, Iā€™ve met so many amazing people.

T1D does not define me, though, it has made me the person I am today, and for that I am grateful!

donate blood

Can people living with diabetes donate blood?

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National Blood Donor Month was in June; with that we chat to Dr Nolubabalo Makiwane, from the South African National Blood Services (SANBS) about whether people living with diabetes can donate blood.

  1. Can diabetes patients using insulin (injection or pump) donate blood?

Yes, we accept donors who are using insulin to control their diabetes. Both those using injections or pumps. The most important factor is that their diabetes must be controlled and they must be well on the day they present to donate.

Insulin users should also not have any skin complications associated with using injections/pumps. We won’t allow a donor to donate blood, if they have a skin infection at the injection site, for example.

  1. Can diabetes patients using oral diabetes medication donate blood?

Yes, persons using oral medications and diet to control their diabetes are welcome to donate. Again, their diabetes must be well-controlled and they must be well when presenting to donate blood.

Most medication used to treat diabetes are classed as category B drugs. Therefore, are considered safe if one should opt to become a blood donor.

  • Understanding the categories of medication

Medications are assigned to five letter categories based on their level of risk to foetal outcomes in pregnancy. It can give one a good idea on the level of safety of a drug at a glance. This is of importance in transfusion as a fair percentage of SANBS blood products are used by pregnant women, women in labour or who are post-partum, and, of course, we also supply blood products for use in babies and children.

So, category AĀ is the safest category of drugs to take.Ā Category B medications are medications that are used routinely and safely during pregnancy. The C and D category drugsĀ have shown positive evidence of human foetal risk but potential benefits of the drug may warrant use in pregnant women.Ā Category XĀ is never to be used in pregnancy. This is a classification based on the safety of a drug in pregnancy and lactation.

Pregnancy Category

Description
A No risk in controlled human studies:Ā Adequate and well-controlled human studies have failed to demonstrate a risk to the foetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
B No risk in other studies:Ā Animal reproduction studies have failed to demonstrate a risk to the foetus and there are no adequate and well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the foetus in any trimester.
C Risk not ruled out:Ā Animal reproduction studies have shown an adverse effect on the foetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
D Positive evidence of risk:Ā There is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
X Contraindicated in pregnancy:Ā Studies in animals or humans have demonstrated foetal abnormalities and/or there is positive evidence of human foetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
N FDA has not yet classified the drug into a specified pregnancy category.

  1. What are the medications that if taken, a person canā€™t donate blood?

Generally, SANBS doesnā€™t accept donors who are using medication that is classified as teratogenic. These drugs would fall into category X. These medications are known to cause malformations in unborn babies, or miscarriages. These include a lot of dermatological agents, like Roaccutane, Neotigason and etretinate.

Some anticonvulsant medication has been found to have teratogenic effects, such as valproic acid, phenytoin and phenobarbitone.

Some antibiotics and male hormonal medications are also classed as teratogenic. The list of teratogenics is, of course, much longer than this. However, what is of note is that there are no hypoglycaemic agents listed as teratogenic.

  1. Diabetes, unfortunately, has many side effects, such as heart problems, neuropathy, slow-healing, etc. Will any of these side effects stop people living with diabetes from donating blood?

Most definitely. If donors are people living with diabetes and they develop a complication due to their diabetes, we defer them until the complications are resolved, and until good control of the donorsā€™ blood glucose level is re-established.

Persons who suffer from a hypoglycaemic coma (due to low blood glucose levels) are deferred for four months from the time of the episode. This is to ensure that their glucose control is adequate.

SANBS also doesnā€™t accept donors who develop diabetes as a complication of another disease process. For example, a donor who develops diabetes as a complication of acromegaly (a disorder caused by excessive production of growth hormone by the pituitary gland and marked especially by progressive enlargement of hands, feet, and face) would not be accepted for the procedure.

  1. Does SANBS encourage people living with diabetes to donate blood?

We encourage people living with diabetes to donate blood only if they are well enough to tolerate the procedures. At SANBS, the health of our donors is of very high importance. We do not collect blood from a donor if it would be detrimental to the health of the donor at all. This applies to our diabetic donors, even more so as they are at a slightly increased risk of developing infections and other complications.

MEET OUR EXPERT

Dr Nolubabalo Makiwane is a registered medical practitioner working in the transfusion medicine field. She is part of the medical team at the SANBS where she works to ensure that donor care is at its best.

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Breastfeeding

Breastfeeding with diabetes

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As a mom to be, we all want what is best for our baby. There is a huge amount of research that shows breastfeeding is best for baby and for mom. But, is this true when it comes to a mommy who is living with diabetes? The good news is, absolutely!Ā 

Firstly, we know that breastfeeding can reduce the risk of the baby developing diabetes, as well as less likely to be overweight later in life.1It has been shown that breastfeeding protects against both Type 1 and Type 2 diabetes.2,3 Breastfeeding is also thought to play a role in reducing the risk of a mom developing Type 2 diabetes later in life.1

However, a mom already living with diabetes may be concerned that she may face different challenges when it comes to breastfeeding.

Mothers with gestational diabetes

When a mom develops diabetes during pregnancy (known as gestational diabetes mellitus), the impact can be a delay in her mature milk (growing milk baby needs until the day they wean) coming in.4 Under normal circumstances the mature milk comes in on day three. However, a mom who has developed gestational diabetes – her mature milk may only come in on day five to seven.

This means that baby gets colostrum (first stage of breast milk) for the extra few days, resulting in baby feeding often, or not settling after feeding. Although colostrum contains many nutrients, it isnā€™t really growing milk and some babies on colostrum will lose weight. Up to 10% weight loss is considered normal. Because of this, parents introduce formula top-up which can further delay the mature milkĀ coming in. Formula top-ups can also result in lower milk supply long-term.

  • Differences in colostrum and mature milk

Mature milk and colostrum differ in the nutrient content. Colostrum being higher in fat and certain minerals whereas mature milk has a higher carbohydrate percentage. Colostrum comes in very small volumes with baby needing only about 5ml a feed whereas mature milk is found in much greater volumes.

On day 3, when the mature milk comes in, baby needs about 30ml per feed. However, a baby getting colostrum at this stage wonā€™t be getting this volume from the breast. So, they donā€™t fill their tummy as easily. These babies need to eat more often to keep their tummy full on the smaller volume of colostrum.

Your body will provide what baby needs with slightly more frequent feeds and a mom who is aware of this will be happy to give baby the extra feeds needed. A mom not aware of this change may feel she is not making enough milk for her baby and may be tempted to give formula top-up. Working with a lactation consultant at this stage can help give mom peace of mind and a plan to ensure baby receives enough breast milk.

  • Caesarean section

Another challenge we see with moms who have gestational diabetes is that they are more likely to need a caesarean section birth. This can cause delays in initiating breastfeeding and contribute to a delay in the milk coming in. The good news is that this isnā€™t always the case, but it is important to be aware that it may happen.

To help with milk supply, mommy needs to feed baby often after birth, about every 2 – 3 hours. This will also help with the other challenge we find with baby after the birth if a mom has gestational diabetes: hypoglycaemia (low glucose levels).5

Feeding often will help to keep babyā€™s blood glucose levels up. When we look at a mom who had gestational diabetes, her post-birth glucose levels stabilise, and breastfeeding has an additional benefit in that it can help prevent the onset of Type 2 diabetes later in life. This is a known risk factor of gestational diabetes.6,7

Mothers with Type 2 diabetes

Studies have shown that mothers with Type 2 diabetes are more likely to experience low milk supply or at least a delay in increased milk volume.8 This is because insulin plays a role in milk metabolism.5,9

Breastfeeding, however, may help to stabilise a momā€™s blood glucose levels. Mothers with Type 2 diabetes may be able to reduce their hypoglycaemic medication while breastfeeding. Most medication required to treat Type 2 diabetes is safe to take while breastfeeding.8

To be certain though, discuss this with your healthcare providers before your baby is born. Moms do need to monitor their glucose levels closely to start with, as breastfeeding can reduce maternal glucose levels which may in turn lead to mom experiencing hypoglycaemia.5As with gestational diabetes, we do find a delay in the onset of mature milk in moms living with Type 2 and Type 1 diabetes.10

Mothers with Type 1 diabetes

Breastfeeding rates in moms with Type 1 diabetes have been shown to be lower. The reasons are usually related to caesarean birth; delay in initiation of breastfeeding; and babies being born earlier in the pregnancy.

Earlier birth dates are associated with challenges with sucking coordination and latching issues.10 However, breastfeeding can assist in stabilising glucose levels in moms with Type 1 diabetes. These moms can then reduce the amount of insulin they are using.11

Managing milk supply with galactagogues

When looking at managing milk supply, many moms want to take medication to increase their milk supply. This is especially common when the milk is delayed as with diabetes. This medication is known as a galactagogue and it may be medical or natural.

Moms living with diabetes need to be particularly careful about taking galactagogues, unless guided by a healthcare provider. Many of the natural forms are readily recommended and easily available. However, some of them can impact a momā€™s blood glucose levels.

Goatā€™s rue is an herbal medication used to increase milk supply, but it is also used to lower blood glucose levels. It may present as a benefit to moms living with Type 2 diabetes, but moms living with Type 1 diabetes should not use it. 12,13

Likewise, fenugreek, milk thistle and alfalfa to name a few have been used to increase milk supply and are also associated with reducing glucose levels. 14,15,16,17 It is strongly recommended that moms consult with their healthcare providers before taking any form of natural supplements to increase milk supply.

Lactation consultant

Working with a lactation consultant is important to rule out any other underlying issues that may cause low supply, such as a poor latch. Lactation consultants can also guide mothers with practical steps she can take to increase her milk supply, as well as assist in making sure baby is exclusively breastfed. Most importantly, moms living with diabetes can breastfeed and will reap the rewards of doing so.

References

  1. Erica P Gunderson. Breastfeeding and diabetes: Long-term impact on mothers and their infants. 2008 Aug: 8(4): 279-286 [NCBI]
  2. Gouveri E, Papanas N, Hatzitolios Al, Maltezos E. Breastfeeding and diabetes. Curr Diabetes Rev 2011 Mar; 7(2):135-42 [PubMed]
  3. Stage E, Hogardd H, Damm P, Mathiesen E. 2006. Long-term Breast-feeding in women with type 1 diabetes. Diabetes care 2006 Apr; 29(4): 771-774
  4. Wallenborn JT, Perera RA, Masho SW. Breastfeeding after gestational diabetes: Does perceived benefits mediate the relationship
  5. Diabetes and breastfeeding. https://www.laleche.org.uk/diabetes-and-breastfeeding/#gestational
  6. Diabetes and breastfeeding: what to know. https://www.webmd.com/diabetes/breastfeeding-and-diabetes#1
  7. Wein, H. Breastfeeding may help prevent type 2 diabetes after gestational diabetes. 2015. NIH research matters. National Institute of Health.
  8. Thursdayā€™s tip: Breastfeeding if you are Diabetic or Insulin resistant. 2015. https://www.lllc.ca/thursdays-tip-breastfeeding-if-you-are-diabetic-or-insulin-resistant
  9. Factors leading to diabetes may contribute to milk supply problems for new mothers. 2014. https://www.sciencedaily.com/releases/2014/05/140505211037.htm
  10. Sparud-Lundin C, Weenergren M, Elfvin A, Berg M. 2011. Breastfeeding in women with type 1 diabetes. Diabetes Care 2011 Feb; 34(20): 296-301
  11. Breastfeeding with type 1 Diabetes. https://beyondtype1.org/breastfeeding-type-1-diabetes/
  12. Using Goats rue to increase your milk supply. Very well family. https://www.verywellfamily.com/goats-rue-and-increasing-the-supply-of-breast-milk-431841
  13. Goatā€™s rue. Drugs.com. https://www.drugs.com/npp/goat-s-rue.html
  14. Fenugreek and Diabetes. https://www.diabetes.co.uk/natural-therapies/fenugreek.html
  15. Ranade M, Mudgalkar N. 2017. A simple dietary addition of fenugreek seed leads to the reduction in blood glucose levels: A parallel group, randomized single blind trial. Journal List Ayu v.38(1-2); Jan-Jun 2017 PMC5954247
  16. Kazazis CE, Evangelopoulos AA, Kollas A, The therapeutic potential of milk thistle in diabetes. 2014. Rev Diabet Stud. 2014 Summer; 11(2): 167ā€“174. Published online 2014 Aug 10. doi: 10.1900/RDS.2014.11.167
  17. Amraie E, Farsani MK, Sadeghi L, Khan TN, Babadi VY, Adavi Z. 2015. The effects of aqueous extract of alfalfa on blood glucose and lipids in alloxan-induced diabetic rats. Interv Med Appl Sci. 2015 Sep; 7(3): 124-128.
Laura Sayce

MEET OUR EXPERT

Laura Sayce is a certified lactation consultant (IBCLC) and doula in private practice. She is also the mom of two gorgeous girls. With both personal and professional experience, Laura has a passion to help moms meet their breastfeeding goals. She has been working in the birth and breastfeeding industry for 11 years.

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What are the best sweeteners for people living with diabetes?

What are the best sweeteners for people living with diabetes?

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There is a lot of controversy regardingĀ  sweeteners (sugar substitutes) and which is better for people living with diabetes. Retha Harmse simplifies the facts.

Sugar consumption

The dangers of excessive consumption of sugar is well-documented. Including how it negatively affects the health status of individuals but even more so for people living with diabetes.

The typical South African consumes 24 teaspoons of sugar daily. More than double of the World Health Organization guidelines for daily intake. Added to that, 7% of the South African population has diabetes (3,85 million people, aged between 21 – 79 years old).

In 1985, 30 million people had diabetes. Its prevalence has increased six-fold and todayĀ  425 million people worldwide are currently. If nothing is done now to prevent this, this number will continue to increase to 629 million people by 2045.

Sugars that increase blood glucose levels

Some foods will be labelled ā€œno added sugarā€ but will still be high in natural sugar (e.g. fruit sugars). These natural sugars also raise blood glucose levels and should be monitored for people with insulin resistance and diabetes.

Sugar Forms & uses Other things you should know
  • Brown sugar
  • Maltodextrins
  • Icing sugar
  • Agave syrup
  • Invert sugar
  • Brown rice syrup
  • White sugar
  • Corn syrup
  • Dextrose
  • High fructose corn syrup
  • Fructose
  • Maple syrup
  • Glucose
  • Fruit juice concentrates
  • Lactose
  • Honey
  • Ā Maltose
  • Molasses
  • Sucrose
  • Barley malt
  • Used to sweeten foods and beverages.
  • May be found in certain medications.
  • There is no advantage to those with diabetes in using one type of sugar over another (in other words, one teaspoon of sugar has the equal effect of one teaspoon of honey).
  • Sugars may be eaten in moderation. Up to 5% of the daily caloric requirement can come from added sugar.
  • High-sugar diets are not recommended, since such foods could replace more nutritious foods and lead to deficiencies.

Sugars that donā€™t affect blood glucose levels

Non-nutritive sweeteners, such as aspartame, sucralose, saccharine, stevia, xylitol, and neotame, are so popular due to it being approximately 300 to 13 000 times sweeter than sugar. Though, they donā€™t have any nutritional value (meaning no or low kilojoules).

Although artificial sweeteners may help to reduce total energy intake, the effectiveness in weight loss or diabetes management has not yet been established. We think fewer calories consumed equals less weight gained or more weight lost, right?

However, according to a recent review, regular consumption of non-nutritive sweeteners is related to an increase in BMI. This might be explained by sweeteners being associated with an amplifying of general cravings and appetite.

Despite this, and this is imperative: sweeteners are not all the same. They have different biochemical structures, with different routes of metabolisation and absorption. Certain sweeteners metabolise differently and are therefore better than others in maintaining blood glucose and weight management. Letā€™s look at a few different sweeteners and how they weigh up.

Sucralose

Sucralose (sold as Splenda) is 600 times sweeter than normal sugar. Itā€™s mostly secreted which means it does not get absorbed in the body.

Although this might sound great, donā€™t be so quick to jump on the bandwagon. Sucralose has been associated with inflammation, and there is still ongoing research on whether it increases blood glucose level. The data is leaning towards a ā€˜noā€™ for people living with diabetes, as long-term use can cause insulin resistance.

Itā€™s also worth mentioning that added table sugar, if consumed in excess, also causes inflammation and has also been associated with insulin resistance.

Conclusion: Consuming sucralose (or normal sugar) in excess over a long period of time has been linked to inflammation. Sucralose should rather be avoided if youā€™re diagnosed with any inflammatory diseases such, as rheumatoid arthritis or Crohnā€™s disease, as it can worsen the inflammatory state.

Aspartame

Aspartame is mostly used in sugar-free or low-sugar drinks and Iced Tea lite.

After the big media frenzy of aspartame causing cancer, recent human studies proved aspartame had no carcinogenic effect. However, itā€™s worthwhile to note that itā€™s still not beneficial for your health. More specifically gut health, as aspartame increases certain bacteria in your gut that are directly associated with weight gain.

Furthermore, the long-term (more than 10 years) use of aspartame has been negatively associated with cardiac health. Lastly, aspartame also leads to an increase in carbohydrate cravings, which can lead to increased appetite.

Conclusion:Ā Although aspartame was set-free from being cancer causing, it still increases carbohydrate cravings and the effect it has on gut- and cardiac health shouldnā€™t be neglected.

Remember that moderation is key. Try to replace diet drinks with infused water or homemade iced teas (rooibos is such a good option). But if you still plan to consume aspartame, be sure to include extra fibrous vegetables, or even a probiotic, to keep the microbiota in balance.

Stevia, erythritol and xylitol

These three sweeteners have been categorised as natural sweeteners. The benefits of these sweeteners are that they donā€™t need insulin to be metabolised. Therefore, improves glucose tolerance and reduces insulin levels.

Stevia does have an undesirable bitter aftertaste, and erythritol and xylitol are quite expensive (roughly R150-160p/kg). But it seems worth it, because when consuming these natural sweeteners, the rewards system is activated leaving you feeling satisfied. And, in contrast to the previous mentioned sweeteners, they do not increase cravings.

Conclusion: Stevia, erythritol, and xylitol are superior. They can improve glucose levels and aid in weight management, in comparison to the other artificial sweeteners.

Still, moderation remains a key factor in any healthy diet. Therefore, using it sparingly will benefit your health as well as your wallet.

Retha Harms

MEET OUR EXPERT

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

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Irene Aarons

Irene Aarons – accepting diabetes with words

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Poet and writer, Irene Aarons (nom de plume ā€“ Irene Emanuel), tells us how writing poetry about her medical conditions, including Type 2 diabetes, has helped her comes to term with them.

Irene Aarons (75) lives in Port Elizabeth, Eastern Cape. She has three children, four step children, three grand-children and nine step grand-children.

Irene not only has Type 2 diabetes. She has chronic allergic asthma; a hernia; high blood pressure; rhinitis; osteoarthritis, and she is on medication for all these conditions.

Though, she explains that the upside of all the above is that she has material to work with; many of her poems are about medical matters.

ā€œI live the best life that I can, by finding the funny side of any limitations that there are. The poetry process gives me the chance to make light of a serious condition. By writing it down, I understand that this illness (diabetes) is not the end of my life but the beginning of new experiences. Poetry gives me an understanding that there is life after all my ailments; and whatever else finds me.”

“I always know that there are people far worse off than me. At least I am able to laugh at myself and write poetry that might make someone else laugh. One of my greatest joys is presenting a poetry talk to adults and children; to having them come up to me afterwards and telling me that my words have helped them in some way,” Irene explains.

Family history of diabetes

Irene was diagnosed with Type 2 diabetes in December 2008, at the age of 64. ā€œI was vaguely expecting it as my mother, two uncles and an aunt all had diabetes. My oldest brother had Type 1 as well as his son. Since my diagnosis, another nephew has been diagnosed with Type 1. So, it definitely runs on the maternal side of my family.

After seventeen years of marriage to her second husband, Irene became a widow, in 2000, when he died of diabetic complications (Type 2). ā€œMy second husband was on dialysis for about three years, had lost the sight in one eye and was quite ill for a long time,” she explains. “He was diagnosed when he was in his twenties. But refused to take pills and carried on as if there was no problem at all. He lived life to the full and took no notice of his condition.”

“By the time I married him, he was still a heavy smoker and a fearless ā€œanything-goesā€ person. When he finally gave in (I pressured him), it was too late. From his mid-fifties, he suffered from peripheral neuropathy, lost the sight in one eye, had a heart attack and then a multiple bypass, which made him give up smoking. His kidneys were damaged and he had to go for dialysis three times a week.”

“He died in his sixties. An early death which could have been delayed had he taken better care of himself. I supported him by going to support group meetings and ensuring that he followed a healthy way of eating. I helped him wherever I could by supporting him in his business and looking after all the children.”

Diabetes management

Currently, Irene is on 1000mg Glucophage twice a day. ā€œHaving diabetes is not a problem but rather a challenge. But a challenge that I accept to overcome every day,ā€ she explains.

ā€œThe downside of diabetes is that I have to be cautious about what I am able to eat safely. I do cheat. But as I get older, I find thatĀ I eat less and very plain food. However, I admit that my downfall is a Steers hamburger, which I do treat myself to aboutĀ once a month.ā€

Irene certainly does see the humour in everything. The proof is in the train of thought regarding diabetic food items. ā€œI am curious as to why the cost of diabetic food is always so expensive, considering that half the ingredients are left out.ā€

She adds that she prefers Hermesetas sweeteners. But since they are imported from Switzerland, they seem to be harder to get. For this reason, she uses Equal sweetener instead.

Exercise doesnā€™t form part of Ireneā€™s daily regime. Though, she adds ā€œI do park far from mall entrances so that I can walk a fair amount. I do enjoy walking and sightseeing, especially if I am somewhere that I have not been before.ā€

Keeping busy is the way to go

The 76-year-old is officially retired. Though, sheĀ  keeps herself very busy. She is the bookkeeper for a family business, which involves at least two days a week. She also offers her time in two different charity shops, twice a week. Lastly, she always avails herself for talks, let it be on poetry or health.

ā€œI have always been willing to talk to people on subjects, ranging from poetry to books, health, or whatever is needed. I have given talks at schools, clubs and societies. My favourite being schools because I have written poetry on rape, babies, abuse and topics that children can relate to. I am adamant that reading is the pathway to becoming informed and a useful member of society.

Publications

Irene has published four poetry anthologies. The poet has also had poetry and short stories published in both local and overseas books, as well as newspaper articles published in South Africa. She has won poetry awards and an award for general success in the publishing world.

See two of her poems below.

CHRONICALLY CHALLENGED

By Irene Emanuel

Iā€™m working and walking

though chronically challenged;

Iā€™m thinking and talking

though chronically challenged;

Iā€™m laughing and crying

though chronically challenged;

Iā€™m sitting and lying

though chronically challenged;

My insides are messed

and chronically challenged;

My outsides are dressed

though chronically challenged.

The list of whatā€™s challenged

is endlessly long

is medical science

going to write me a song?

In medical books, Iā€™m living proof,

though chronically challenged

Iā€™m still waterproof.

Iā€™ve asthma, diabetes and rhinitis too,

hernia, depression and no-one to sue;

Though chronically challenged,

and living on pills;

I know that my life

is still full of thrills.

So hit me again, what else is in store?

though chronically challenged,

at least I donā€™t snore.

 

PILLORIED

By Irene Emanuel

I am a rainbow ghost, see-through in the light;

A conglomeration of multi-coloured pills

that prevent me from becoming a real ghost.

The pills play music tattoos on my skeleton

as they race down my gullet, looking for signage

direction to the weak spot.

I wonder what the outcome would be if the signs got scrambled?

Would my diabetes become asthmatic?

Would my high blood pressure run into the blood thinnerĀ and become watery?

Would that increase the water on my lungs and cause flooding?

What would happen if there was a traffic jam?

Would the various pills just give up, dissolve into a heapĀ and suffer a melt-down?

Would my body rebel, fight back, expel the pills,Ā lie down and fade out?

A bitter pill to swallow is the fact that I am chainedĀ forever, to staying alive with pills.

MEET OUR EXPERT

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

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ZonƩ Oberholzer

ZonĆ© Oberholzer – the beauty living with Type 1 diabetes

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Modelling, insulin pumps, make-up and studying. This is all in the life of ZonƩ Oberholzer, a Type 1 diabetes patient and a Miss Supranational SA 2019 finalist.

ZonƩ Oberholzer (21) lives in Pretoria, Gauteng. She is an Education (BEd) student at Aros University.

The young Pretoria beauty recently celebrated her 21stbirthday which came at an apt time as she just finished her first year June exams. We caught up with theĀ  model to find out how she has handled living with Type 1 diabetes for 17 years.

When were you diagnosed?

In September 2002. I was four years old. My nursery school teacher mentioned to my mom that I was no longer playing outside and that I was constantly thirsty. She suggested that we see a doctor, where upon I was diagnosed.

I spent a week in hospital where my blood glucose was stabilised, and my parents were educated about Type 1 diabetes. The doctor said the most likely cause was the chickenpox virus which I had contracted nine months earlier.

I started using a pump (Medtronic Minimed Paradigm) at age six. My mother decided it would be easier for me to be on pump therapy before I started school. This helped my parents to regulate my blood glucose levels.

They educated the teachers in using it. We, however, quickly learnt that it would be best for me to handle my own pump. This forced me from a very young age to know my pump and also calculate carbohydrates. Although, it was very difficult to start off with, it helped me to manage my condition from an early age and to take responsibility.

The insulin pump only operates on short-acting insulin (NovaRapid). I think it makes life easier to not have to use a long-acting insulin as well.

When did you start modelling?

As soon as I was diagnosed, my mother decided to boost my self-confidence by enrolling me to do a modelling course. Since then it has been an absolute passion. Not only has it motivated me to look after myself, but it has inspired me to use it as a platform to promote diabetes awareness.

Did modelling boost your confidence as your mom hoped?

Modelling definitely boosted my confidence. But, it was a learning process throughout all the years to eventually bear the fruit. It definitely takes the correct attitude to use the experiences I learned from modelling for a positive growth experience. It stays crucial to seek your identity in Christ and not in modelling.

Why did you enter Miss Supranational SA 2019?

I entered as I saw it as an opportunity and platform to make a difference. Especially, among the diabetic community.

Miss Supranational South Africa 2019 focuses primarily on social upliftment. It creates a platform for finalists and winners to achieve their goals within the pageant, entertainment and business industries.

I am so grateful to be a finalist and thankful for the opportunity. The winner will be announced on 27 July at the Arto Theatre.

Have you been in any other contests?

Yes. Besides some smaller contests, I am currently a title holder (Apprentesses Charity 1st Princess) for Apprentesses SA. I was also a finalist for Top Model South Africa.

Do you proudly wear your insulin pump during modelling competitions?

In the past I would hide my pump as I was ashamed. I saw diabetes as my identity. This led me to hide myself from the world, but I realised that diabetes is only a part of me. A part of me that I should embrace and be proud of. This only happened after school.Ā 

It is my goal to wear my insulin pump with pride at Miss Supranational SA. Itā€™s not always easy as pageant dresses donā€™t always cater for an insulin pump. But, I will definitely wear it if the costumes allows.

Has it been easy to manage your diabetes?

No. It hasnā€™t been easy. Nonetheless, Iā€™m grateful for the lessons learnt through my diabetes journey. Every day has its highs and lows. One just has to learn how to deal with it and not run away from it.

I would definitely not exchange living with diabetes for an easier life, because the lessons Iā€™ve learned and keep on learning are far too valuable. The hardships of this condition empower me to empower those around me with positivity.

What are the highs of having diabetes?

Thereā€™s a valuable lesson that diabetes teaches every day. From a lighter viewpoint, you will live a healthier life than the average person out there. This is because you must be sensitive to what you eat, what you do, how you do things, and where you do things.

What are the lows of having diabetes?

Personally, the low is that no matter how healthy and cautious you live, there is always the risk of unexpected blood glucose drops and highs.

Do you follow any any special diet?

Iā€™m not on a special diet, but I do follow a balanced healthy diet. I eat according to my blood glucose levels. I give my body what it needs. Not what it wants.

Do you make use of sweeteners?

My mother raised me to be a healthy child living with diabetes. She taught me from an early stage that sweeteners arenā€™t necessary to live a happy full life.

What helps you the most to manage your diabetes?

My support system, my family, boyfriend and, most importantly, God! If it wasnā€™t for Him, I wouldnā€™t have made it this far. He turned my misery into a ministry.

Tell us how puberty affected your blood glucose

Puberty took my blood glucose levels on a roller coaster. My menstruation also affected my blood glucose levels. I usually struggle with a higher blood glucose level during menstruation.

We wish ZonƩ all the best for the finals of Miss Supranational SA 2019.

 

Photos by Kayleigh Kruger

ZonƩ Oberholzer - the beauty of living with Type 1 diabetes

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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Slender Wonder

Losing 25kg with Slender Wonder

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Michael Green, a person living with Type 2 diabetes, tells us how he lost 25kg in six months by using Slender Wonder ā€“ a medical weight loss programme.

Michael Green (55) lives in Randburg, Gauteng. He is divorced and has two adult sons and one grandchild.

When were you diagnosed with Type 2 diabetes?

I was diagnosed during an insurance medical examination when I was 28 years old. I was put on Glucophage for many years. More recently, I was prescribed Galvus Met 50/1000 (two tablets daily).

What made you decide to lose weight?

I always knew that a large part of my Type 2 diabetes was due to bad eating habits and bad hydration. I have seen how my father has suffered and is suffering now (in his seventies) due to many years of undiagnosed and untreated Type 2 diabetes problems. So, I decided to do something about my health on my own.

How did you find out about Slender Wonder?

I bumped into a friend who I hadnā€™t seen for about twenty years. He looked great and I complimented him. Then he showed me before and after photos. I was blown away and decided to try Slender Wonder.

Tell us about the Slender Wonder programme you followed?

I started Slender Wonder on 7 April 2016, with Dr Gerda Scholtz, weighing 110,3kg with aĀ body mass fat of 30,3%

I done the Slender Wonder Simeon B Programme which consists of six weeks of injections and a very strict meal plan, followed by a two week ā€˜Go moderateā€™ rest period which has no injections and slightly more food. This repeats until the goal weight is achieved.

As the weight came off and I had increased energy, I stepped up my physical training, which was not necessary but just something that I wanted to do. I must say that I was super strict. I weighed every meal and never cheated once.

By 23 September 2016, my weight was down to 84,7kg and my body mass fat was 12,9%.

From a diabetic perspective, the more important thing was that my visceral fat level (fat around the organs) dropped from 15 to 5. I had lost 25kg in six months.

Was your diabetes medication stopped or the dosage lowered once you lost weight?

No, I stayed on my diabetes medication as it has just become habit over many years. My HbA1c level dropped from around 7,5% on medication to under 5%.Ā Slender Wonder is by far the best thing that I have ever done in my struggle against Type 2 diabetes.

How did you feel once you lost the weight?

I felt fantastic! Like I had a new lease on life. Full of energy and motivated. Though, I got tired of people asking me if I was sick as I was always a stocky guy and now I was quite skinny.Ā I went from 38-sized jeans to a 32.

You have gained weight recently. AreĀ you disappointed?

No, Slender Wonder is a change of lifestyle more than a diet. I went back to my old eating habits and if you eat what you ate before going on Slender Wonder then you will weigh the same as you did before. For some reasons, I needed to prove that to myself, and I still do.

I currently weigh 97kg again and though better than when I started, it is a continuous process.

Would you go back on Slender Wonder?

Yes, absolutely! I am back using Slender Wonder. My goal, at this point, is to weigh 90kg and be healthy. I am less hard on myself and I cheat a bit which shows on the scale.

Before

After

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

exercise

Fighting fit: exercising with diabetes

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Prof Martin Schwellnus gives us a rundown of how to form a safe exercise regime when living with diabetes.

Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. Before you start exercising, the first, and most important, step is having a full medical check-up.Ā The main reason for this is to make sure that the prescribed exercise ā€œdoseā€ is safe.

Types of diabetes

Diabetes mellitus is a group of chronic diseases classified into four broad clinical classes:

  • Type 1 diabetesĀ is characterised by the destruction of pancreatic Ī²-cells, leading to insulin deficiency.
  • Type 2 diabetesĀ is characterised by insulin resistance and a relative insulin deficiency.
  • Gestational diabetesĀ is diagnosed during pregnancy.
  • Other types of diabetesĀ may be caused by genetic defects, disease of the exocrine pancreas, and drug- or chemical-induced causes.

Preventing and treating diabetes requires a lifestyle approach, of which exercise is a vital component. But it also includes nutrition, psychosocial support, smoking cessation and education. So, donā€™t forget the other important elements of your strategy for managing diabetes.

Benefits of exercise in diabetes patients

Exercise improves many factors important in the prevention and management of diabetes. These include improved glucose control, muscle and liver insulin sensitivity and muscle glucose uptake; reductions in HbA1c; improved weight management, blood pressure, and overall cardiovascular health.

Before you start exercising, the first, and most important, step is having a full medical check-up. The main reason for this is to make sure that the prescribed exercise ā€œdoseā€ is safeĀ Any treatment plan should be patient-centred, not disease-centred, which means you should be assessed and treated holistically.

Identifying any other health concerns is important. Since these may influence how you manage your overall health, and your ability to exercise safely and effectively. Once you have the full picture, a plan can be created that suits your specific needs.

This lifestyle intervention programme is usually directed by a physician trained in sport and exercise medicine and a physician specialising in diabetes management, together with a multi-disciplinary team. This team includes dietitians, biokineticists, endocrinologists, physiotherapists and others.

Your exercise/activity plan

Structured exercise is an important part of your lifestyle, and the FIT principles below give you an idea of the type of exercise you could include in your regime.

Having said that, your activity/exercise plan needs to take various things into account, including type of diabetes, age, activity done, medication use and the presence of any complications.

As such, your plan needs to be tailored to your specific needs. So, speak to a sport and exercise physician about the strategies you will need to adopt. You may be advised to participate in an out-patient setting, or you may be able to train by yourself. In most instances training is initially conducted in small groups, where sessions (usually three per week) are supervised by members of the lifestyle intervention team.

In addition, try to increase the amount of unstructured activity you do. This is the activity you typically do during your day, such as shopping, errands, household tasks, walking your dog and gardening.

If you feel you are not ready for a structured exercise programme, start by increasing your daily activity, and then start including short bouts of structured exercise.Ā Since any activity will increase energy expenditure and improve glycaemic control, this is a great step in the right direction.

Recently, more attention has been paid to prolonged sitting as this has a negative effect on health, irrespective of how active you are. So, be aware of how long you sit during the day, and try to stand up and do some light activity for a few minutes every 30 minutes.

General exercise guidelines for adults with diabetes and pre-diabetes:Ā 

F

I

T
Type of exercise Frequency Intensity Time

Progression
Aerobic

(cardio ā€“ walking, swimming, cycling)

3-7 days per week, with no more than 2 days without exercise.

 Moderate (your breathing and heart rate is increased slightly) to vigorous (only do if already active, your breathing is heavy and heart rate increased). Build up to at least 150 minutes per week of moderate-intensity. For those already active, 75 minutes per week of vigorous intensity.

If you are starting an exercise regime, start with bouts of 10 minutes at moderate intensity. Increase intensity, frequency and durations slowly over time to at least 150 minutes per week of moderate intensity.
ResistanceĀ 

(body weight exercises, free weights, resistance machines or bands)

At least 2 (preferably 3) non-consecutive days per week.

 Moderate (using weights that allow you to do up to 15 repetitions) to vigorous (using heavier weights allowing you to do up to 6-8 repetitions). At least 8-10 different exercises, doing 1-3 sets of 10-15 reps, to near fatigue.

Start with weights that allow you to do 10-15 reps per set. Increase weight only once you can do 15 reps consistently.Ā When you increase the weight, reduce the reps to 8-10, then increase reps again over time.
Flexibility & balance

(stretching, yoga, tai chi, balance exercises)

2-3 days per week.

 Stretch to point of slight discomfort, not pain. Balance exercises of easy to moderate difficulty. Hold static stretch, or do dynamic stretch for 10-30 seconds, 2-4 reps per stretch.

Increase duration and/or frequency slowly over time

Exercise guidelines during pregnancy with gestational diabetes:

Ā 

Aerobic exercise:

Resistance Exercise:
During pregnancy with gestational diabetes: check with your doctor Up to 30min of moderate-intensity (if sedentary before pregnancy, start at a lower intensity). No more than 2 consecutive days without exercising.

 

 5-10 different exercises, 1-2 sets of 8 -15 reps, up to 60 minutes. At least 2 but ideally 3 times a week, at moderate-intensity.

Monitoring and follow-up

All patients participating in a lifestyle intervention should be assessed regularly during exercise training sessions by a member of the healthcare team. Before each exercise session symptoms of diabetes mellitus (polyuria, polydipsia), other symptoms (cardiac, infectious disease), resting heart rate, resting blood pressure and blood glucose concentrations should be taken.

During the training session, rating of perceived exertion, peak heart rate, and peak blood pressure should be monitored.

After exercise, a blood glucose measure may also be taken.

All the measurements that were recorded during the initial assessment, before starting the lifestyle programme, should be repeated two to three months later. These results should be discussed and a revised strategy created for the subsequent few months. All patients with diabetes should be re-assessed at least once a year.

Cautions to keep in mind when exercising

  • Blood glucose responses are influenced not only by the type, timing, intensity, and duration of exercise, but also by many other factors. This variation in the way blood glucose responds to exercise makes it difficult to give generalised recommendations for the management of food (carbohydrate) intake and insulin dosing during and after exercise. Speak to your sport and exercise physician, doctor and/or dietitian about the strategies you will need to adopt.
  • Adults with diabetes are frequently treated with multiple medications for other conditions. Some medications may have a negative interaction with exercise and therefore dosage may need to be adjusted.
  • Older adults or anyone with autonomic neuropathy, cardiovascular complications, or pulmonary diseaseĀ should avoid exercising outside on very hot and/or humid days to prevent heat-related illnesses.
  • Patients with autonomic neuropathyĀ should undergo cardiac screening before starting exercise, and be monitored for hypoglycaemia and abnormal thermoregulatory responses during training.
  • High-intensity endurance and resistance training, jumping, jarring, head-down activities and breath-holding are not recommended for patients with proliferative diabetic retinopathy or severe non-proliferative diabetic retinopathy, due to the increased risk of triggering vitreous haemorrhage or retinal detachment.
  • Patients with peripheral neuropathyĀ should practise proper foot care during activity. Non-weight bearing exercise is recommended, to decrease the risk of skin breakdown, infections and joint destruction.
  • During pregnancy, avoid sports with a risk of forceful contact or falling (basketball, rugby, horseback riding, gymnastics), exercising in a supine position after the first trimester, scuba diving, and prolonged intensity workouts that increase body temperature and perspiration. Stop exercising immediately if your experience vaginal bleeding, dizziness, headache, chest pain, muscle weakness, preterm labour, decreased foetal movement, amniotic fluid leakage, calf pain or swelling and dyspnea without exertion.

What does the Sport, Exercise Medicine and Lifestyle Institute (SEMLI) offer?

SEMLI at the University of Pretoria has a team of specialist sport and exercise physicians, qualified to assess your current health status and advise you on an activity programme that will suit you.

The multi-disciplinary approach of SEMLI means you have access to a variety of healthcare professionals, including biokineticists, physiotherapists, dietitians and psychologists, as well as sport scientists who can assist you along your journey to good health.

For more information contact us at:Ā  info@semli.co.zaor 012 484 1749.Ā  www.up.ac.za/sport-exercise-medicine-and-lifestyle-institute/

References:

  • Schwellnus MP, Patel DN, Nossel C et al. Healthy lifestyle interventions in general practice
  • Part 4: Lifestyle and diabetes mellitus.Ā SA Fam Pract 2009; 51(1): 19-25
  • Colberg SR, Sigal RJ, Yardley JE et al. Physical Activity/Exercise and Diabetes: A Position Statement ofĀ the American Diabetes Association. Diabetes Care 2016; 39: 2065ā€“2079
  • Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6(8): 1033-1044

MEET OUR EXPERT

Prof Martin Schwellnus is the director of SEMLI.Ā He is a specialist sport and exercise medicine physician who regularly consults with athletes of all levels. He is passionate about promotingĀ safeĀ physical activity for all, as part of a healthy lifestyle.

art of living with diabetes

My art of living with diabetes

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When you think of art, what comes to mind? Creative art, colourful art, abstract art, black and white art? Art is different to every person, therefore, the art of living with diabetes is different to every person living with diabetes.

There are many different arts (ways) of living with diabetes. My art of living with diabetes include lifestyle, foodstuff and sports. I ensure my sugar readings stay under control so that I can be healthy and live a long and happy life.

I keep my blood glucose levels under control by making sure that I eat the correct foods. I include a large amount of fresh vegetables and fruit and, of course, protein. My favourite proteins are chicken and pork.

By doing this, my sugar readings do not get too high. By eating correctly, I donā€™t need to inject myself with insulin too many times a day.

In our household, we only drink sugar-free cool drinks and water, which means less sugar and less insulin injections for me. We also eat mostly home-cooked meals, which is healthier and better for my blood glucose readings.

I play a lot of sport which keeps me active and keeps me healthy and in shape, both physically and mentally. Iā€™m a cricketer and a golfer. It takes at least four to six hours to complete a cricket game or a round of golf. So, I always keep healthy snacks and water with me to ensure my sugar level remains stable. However, I enjoy any sport as I enjoy being out in the fresh air.

My lifestyle also includes not watching too much TV, etc. and trying not to stress too much about school and exams. Stress can affect my sugar readings too.

I realise that different people have their own art of living with diabetes. It is your choice what art you use and how you use that art.

MEET OUR EXPERT

Aiden Nel lives in Port Elizabeth. He is 15 years old and has Type 1 diabetes.