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Mpho Netshitongwe

Mpho Netshitongwe – Proud moments

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Despite being diagnosed with Type 1 diabetes while studying, Mpho Netshitongwe completed his degree and isn’t giving up on the life he strives for.

Listen to this article below or wherever you get your podcasts or visit our playlist.

2Mpho Netshitongwe-Proud moments

“It’s really not easy to live with diabetes, especially if you come from a poor background as you struggle to access resources that can help, and healthy food is expensive.”

Mpho Netshitongwe (26) lives in Thohoyandou, Limpopo.

In 2020, while completing his Bachelor of Science in Agricultural Economics Degree, Mpho experienced loss of weight and was always thirsty, which led him to go to the bathroom more frequently.

“I was always weak especially after eating. The dizziness worried me, so I went to the university clinic and explained my symptoms and was referred to a hospital. After some tests, that’s where they confirmed I have Type 1 diabetes. At first, I was scared and didn’t know what to do. All the information was too much for me to process since I didn’t know anything about the condition,” Mpho recalls.

Insulin was prescribed and Mpho was taught how to inject himself every day. Since he didn’t know much about diabetes, he read up on it. “By educating myself, I found out how it affects people and the difference between Type 1 and Type 2,” he says.

Using bursary allowance for diabetes management

With the help of research, Mpho implemented changes in the food he ate and began exercising. Though, he adds, “Changing the food I ate was extremely challenging due to lack of funds. Since I come from a poor background I had to use my university bursary allowance to cover my diabetic expenses (testing machine, monthly test strip purchases, doctor appointments, and expensive healthy food). The allowance wasn’t enough, and most was spent on my diabetes care.”

Unfortunately, Mpho says he suffered with anxiety after his diagnosis. “I would experience anxiety attacks if I’m in packed places but thankfully through the past years, I have learnt how to control it.”

He goes on to say, “It’s really not easy to live with diabetes, especially if you come from a poor background as you struggle to access resources that can help, and healthy food is expensive. More awareness is needed for people in the rural areas, to reduce the stigma around diabetes and other chronic illnesses so that people living with these conditions aren’t treated differently but rather accepted.”

Learning new strategies

In the past four years, Mpho has learnt strategies that work for him and help him to manage his diabetes better. “A lot has changed since I was diagnosed. Now when I plan my day I always consider my diabetes, wherever I go I must figure out will I access food there, how long till I come back. It’s a bit stressful so I avoid unnecessary trips,” Mpho explains.

“There are certain foods which I avoid especially ones with higher sugar and carb content, and people who don’t know that I have diabetes always offer these types of food and I have to explain why I’m declining the food.”

Proud moments

Mpho acknowledges his growth as a young man. He says, “When I look back I’m proud of myself because despite all these challenges I managed to complete my Bachelor of Science in Agricultural Economics Degree. Even though I struggled to get a job I then registered for a teaching degree which I also completed. I’m still looking for a job, but I won’t give up.”

He has the same perseverance with managing his blood glucose levels. “I go for check-ups every three months or if I don’t feel well or if my glucose levels are out of control. I collect my medication at hospital every two months.”

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

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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Dino Baijnath

Dino Baijnath – The strongman

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Dino Baijnath, an avid gym goer, shares how a near-death experience caused by septicaemia led to a diagnosis of Type 2 diabetes, and how he defeated both.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Dino Baijnath (47) lives in Sandton.

For the past 26 years, Dino has been an avid gym goer. “It started out as fun and to maintain muscle and have a good physique, but it soon became a lifestyle. It helps me manage stress and keeps me healthy too. I train four times a week for 90 minutes, and train each muscle group at least twice a week,” Dino says.

So, when Dino was diagnosed with Type 2 diabetes in 2023, this was a major shock to the muscle man.

Septicaemia leads to diabetes diagnosis

Dino developed a fever, thinking it was a cold but adds that it was unbearable. His colleagues encouraged him to go see a doctor as he was visibly not well. The doctor called an ambulance to take him to hospital.

“After being admitted, blood tests were done, and my liver and kidney were in failure, with a blood count of 330, and my blood glucose level was over 30. The high blood glucose level caused a blood clot in my lung that turned into septicaemia (a life-threatening infection that occurs when bacteria enter the bloodstream).”

Dino was put on an IV antibiotic drip for five days while in ICU and was put on oxygen as he had pneumonia too (lung infection that can cause inflammation and fluid build-up in the air sacs of the lungs) and was struggling to breathe.

“Thankfully, within three days the doctor was happy to see my organs starting to heal and insulin was administered to bring my blood glucose level down.

A week later, Dino had escaped death but now had to navigate life as he was now diagnosed as living with Type 2 diabetes.

Treatment

The medical treatment included pregabalin to treat nerve damage, and two insulins (insulin glulisine and insulin glargine) as well as blood thinners.

Dino also implemented lifestyle changes in his diet while administering insulin three times a day. “I always pack a cooler daily to keep the insulin in; thankfully it gets easier and is becoming second nature. Injecting insulin became part of my lifestyle and doesn’t bother me at all. My friends and family made it easier for my adjustment and helped me through the process with constant reminders of what I eat and medication times,” Dino explains.

Second septicaemia scare

Eight months later Dino defied odds again when he once again had septicaemia. He underwent another round of antibiotics in hospital but thankfully this time there was no organ failure, so he wasn’t in ICU, and was discharged in a few days.

Gym routine and diabetes management

Through trial and error, Dino has found what works for his blood glucose management and his love for strength training. “I usually train at night so just before gym it’s time for my last injection, so I administer before the workout and I consume branched-chain amino acids and creatine after injecting. This has been very positive in my training as insulin helps absorb nutrients. I actually gained 12kg of lean muscle mass, so I turned something negative to a positive,” Dino says.

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

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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hearing loss

Can diabetes cause hearing loss?

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Kate Bristow, a diabetes nurse educator, explores the link between hearing loss and diabetes.

Listen to this article below or wherever you get your podcasts or visit our playlist.

World Hearing Day is on 3 March.

World Hearing Day

While the impact of diabetes on heart, kidney and eye health is well-documented, its association with hearing loss is gaining increased attention recently.

To understand how hearing loss may occur, we first need to understand the effects of diabetes in the body. Diabetes causes small blood vessel disease throughout the body where blood vessels weaken and blood flow through the body is slower.

This impacts function and results in diabetic neuropathy or nerve damage to all parts of the body, including the ear. So, diabetes can affect the nerve endings as well as the system of blood vessels in the ear. This will impact hearing and balance as well as increases susceptibility to infections.

Studies have demonstrated a higher prevalence of hearing loss among people with diabetes compared to those without the condition. According to a 2008 study, individuals with diabetes are twice as likely to experience hearing loss as those without diabetes.

The study analysed data from the National Health and Nutrition Examination Survey (NHANES) and it was found that the risk of hearing impairment was evident across all age groups, suggesting that diabetes may accelerate age-related hearing decline.

The study was a large cohort of nationally representative members of the US population between ages 20 – 69 years old. An association between diabetes and hearing impairment was shown as early as 30 – 40 years old.

Statistics from the Centre of Disease Control and Prevention (CDC) showed that:

  • Hearing loss is 30% higher in adults with prediabetes than in those that don’t have it.
  • Hearing loss is twice as common in those who have diabetes than in those that don’t.
  • Vestibular dysfunction is 70% more likely in people with diabetes. This is a disturbance of the balance system in the body due to problems in the brain or inner ear. Symptoms include vertigo, dizziness, and lack of balance.
  • Incidence of falls is 39% higher in people with diabetes. Remember that the ear is also the balance centre of the body.

According to the National Institute of Health (NIH), loss of hearing in adults with diabetes is about twice as common as those who don’t suffer from the condition, and that it may be an under recognised complication of diabetes.

The cause of increase risk

Hearing loss is a complicated condition, often resulting from a combination of genetic, environmental, and physiological factors. For those with diabetes, there are several mechanisms believed to contribute to the increased risk of hearing damage.

  1. Microvascular damage: Diabetes is known to cause damage to small blood vessels which can affect the blood supply to the cochlea, a critical structure in the inner ear. Insufficient blood flow can lead to less oxygen and damage to the delicate hair cells responsible for sound transmission.
  2. Neuropathy: Just as diabetes can cause peripheral neuropathy, it may also damage the main nerve to the ear, the auditory nerve, as well as other nerves in the auditory system.
  3. Chronic inflammation: Elevated blood glucose levels cause inflammation, which may contribute to tissue damage in the auditory system.

Signs of hearing loss

  • Asking people to repeat what they said.
  • Trouble following conversation in a group setting.
  • Thinking that others mumble.
  • Difficulty hearing in noisy places.
  • Trouble hearing those with quiet voices and small children.
  • Turning up the volume on the TV or radio.

Damage to ears may also include balance issues which can lead to falls and fractures, particularly in the elderly.

Hearing loss is common and other causes such as age, disease, noise, and heredity should also be excluded. In other words, diabetes can’t always be blamed.

Hearing loss occurs slowly and may be noticed by those close to the person affected before they notice it themselves.

Questions to be asked

Doctor and diabetes educators should be asking you (patients) the following questions:

  • Do you have concerns about you hearing?
  • Any hearing and balance screening done regularly – preferably annually? Advocating regular screening of the ears, as we do for the other risk areas of diabetes and referring patients to an audiologist for regular assessment.
  • Any recent falls, dizziness or fear of falling?
  • Prescribed medications should also be considered as some may be ototoxic.

Neuropathy that occur in diabetes, including hearing loss cannot be reversed. Prevention is better than cure.

Guidelines to protect your ears

  • Keeping blood glucose levels as close to target as possible and try to prevent large excursions in blood glucose levels (the highs and the lows or bouncing blood glucose levels). Keeping your blood glucose levels in range is important not only for your hearing. You’ll feel better and have more energy the more you take care of your levels.
  • Get your hearing checked every year by an audiologist.
  • Avoid other causes of hearing loss such as loud noises.
  • Be aware of other causes of hearing loss; there are medications that can cause hearing loss. Discuss this with your doctor.
  • Loss of hearing can be very frustrating for you and for those around you. It will negatively impact how you function and your social life.
  • Work with a trusted diabetes healthcare team to learn as much as possible about your condition so you’re confident to manage it to the best of your ability.

Final word

Research suggests that hearing loss by diabetes may be due to damage to the nerves and blood vessels in the inner ear and autopsy studies of such patients have shown evidence of this.

This could be due to high blood glucose levels or fluctuating levels over time, damaging small blood vessels and nerves in the inner ear.  Low blood sugar too, affects how nerve signals travel from the inner ear to the brain causing hearing loss, according to the CDC.  Poorly controlled blood glucose levels lead to nerve damage and hearing loss. But reference articles do say that further research is necessary to determine the exact effect of diabetes on hearing.

What is evident is that those who have diabetes shouldn’t neglect their annual hearing tests. Ask your diabetes nurse educator or doctor about a specialist audiologist visit.

References

  1. https://diabetes.org/about-diabetes/complications/hearing-loss/diabetes-and-hearing-loss
  2. https://www.nih.gov/news-events/news-releases/hearing-loss-common-people-diabetes
  3. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-hearing-loss.html

MEET THE EXPERT

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

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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How to help your child cope and understand their diabetes

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As a parent, your support is instrumental in helping your child cope emotionally while also ensuring effective diabetes management. Daniel Sher shares how to foster understanding and resilience in your child.

Listen to this article below or wherever you get your podcasts or visit our playlist.

A diabetes diagnosis can be overwhelming for both children and their parents. Learning to navigate the complexities of Type 1 or Type 2 diabetes can be challenging, but with the right approach, children can develop resilience, confidence, and a sense of control over their condition.

  1. Explain diabetes in an age-appropriate way

Your child’s understanding of diabetes will evolve as they develop. For younger children, simple explanations such as “your body needs extra help to use sugar for energy” may be sufficient.

Older children may benefit from more detailed discussions about insulin, blood glucose levels, and long-term management. Using visuals, stories, or even apps designed for children with diabetes can help them grasp complex concepts.

  1. Encourage open communication

Diabetes management is a life-long commitment, and your child will have good days and bad days. Encourage them to express their feelings, whether it’s frustration, sadness, or anxiety. Reassure them that it’s normal to feel this way and that they’re not alone: both of which are completely true. Try to avoid minimising their emotions, and instead, validate their experiences while offering constructive support.

  1. Create a supportive environment

Your child will look to you for cues on how to manage their diabetes. If you approach their condition with confidence and a problem-solving mindset, they are more likely to adopt a similar attitude. Avoid using punitive language around blood glucose fluctuations; instead, frame challenges as opportunities to learn what works best for their body.

  1. Make diabetes management routine

Consistency is key when it comes to diabetes management. Integrating blood glucose monitoring, insulin administration, and meal planning into daily routines can make these tasks feel less burdensome. Encourage your child to participate in their care by allowing them to take small steps toward independence, such as checking their own blood glucose levels when they feel ready.

  1. Help them navigate social situations

Children with diabetes may feel different from their peers, especially when they need to check their blood glucose levels or administer insulin at school or social events. Role-playing different scenarios can help them develop confidence in explaining their condition to friends and teachers. Encourage them to carry a diabetes kit with essential supplies so they always feel well equipped to cope with blood glucose changes.

  1. Address feelings of anxiety and frustration

Many children with diabetes experience stress about managing their condition, particularly when they feel it limits their activities. Helping them develop coping strategies, such as deep breathing, mindfulness, or talking to a trusted adult, can be beneficial. If persistent anxiety or distress interferes with their daily life, seeking professional support from a diabetes psychologist can be helpful.

  1. Foster independence gradually

As children grow, they will need to take on more responsibility for their diabetes care. This process should be gradual and developmentally appropriate. Start by letting them make small decisions, such as choosing a snack that fits their meal plan, and gradually involve them in more complex aspects of management as they gain confidence.

  1. Connect with other families

Meeting other children with diabetes can be incredibly reassuring. Support groups, diabetes camps, and community events provide opportunities for your child to connect with peers who share similar experiences. These interactions can help reduce feelings of isolation and promote a sense of belonging.

  1. Encourage a healthy relationship with food

It’s important that children with diabetes develop a balanced perspective on food. Rather than labelling foods as strictly good or bad, teach them how different foods impact their blood glucose levels and how they can enjoy a varied diet while maintaining stability. Involving them in meal planning and preparation can foster a sense of empowerment over their dietary choices.

  1. Be their biggest advocate

Whether it’s at school, sports activities, or social gatherings, your child will need support from those around them. Educate teachers, coaches, and caregivers about your child’s diabetes and emergency procedures. Encourage your child to speak up about their needs when they feel comfortable doing so.

Summing up

Helping your child understand and cope with diabetes is an ongoing journey that requires patience, education, and emotional support. By fostering resilience, encouraging independence, and providing a nurturing environment, you can empower your child to live confidently with their condition.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit www.danielshertherapy.com

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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Diabetes and cancer

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Dr Angela Murphy looks at the correlation between diabetes and cancer.

Listen to this article below or wherever you get your podcasts or visit our playlist.

A diagnosis of either diabetes or cancer causes significant stress. There is no doubt that if both conditions are present this causes true distress. Although cancer isn’t a typical complication of diabetes, there is an increase in the occurrence of cancer in people living with diabetes (PLWD).

In 2009, the American Diabetes Association and the American Cancer Society developed a consensus document to look at the following questions:

  1. Is there an association between diabetes and cancer?
  2. What risk factors are common to both diabetes and cancer?
  3. What are the biologic links between diabetes and cancer risk?
  4. Do diabetes treatments influence risk of cancer?

What is the association between diabetes and cancer?

We see an increasing incidence of both diabetes and cancer. It seems that the diagnosis of both conditions in the same person occurs more frequently than would be expected by chance.

Some cancers (liver, pancreatic, and endometrium) occur more commonly in the presence of diabetes and some cancers (prostate) are less common in the presence of diabetes. Other cancers (lung, kidney, non-Hodgkin lymphoma) haven’t been conclusively shown to have an association with diabetes. Currently the association of cancer and Type 1 diabetes is not confirmed.

In addition to seeing an increase in the incidence of cancer in PLWD, it seems that diabetes increases the risk of complications and mortality from cancer.

What biological association is there between diabetes and cancer?

  1. Hyperglycaemia

In the 1920s, scientist Otto Warburg observed that cancer cells consume large amounts of glucose as they rapidly divide and proliferate. This is now called the Warburg effect.

  1. Hyperinsulinemia and insulin resistance

Certain cancers possess insulin receptors and stimulation of these by high levels of circulating insulin can directly affect the metabolism of cancer cells, promoting their growth. Insulin also stimulates insulin like growth factor 1 (IGF-1) which promotes cancer cell growth and inhibits cancer cell death. Insulin increases the levels of oestrogen that the body is exposed to which in turn increases the risk of certain cancers, such as breast cancer.

  1. Inflammation

Many pro-inflammatory substances (interleukin-6; tumour necrosis factor alpha, etc.) can induce malignant changes in cells and cancer progression. Both hyperglycaemia and hyperinsulinemia cause oxidative stress which in turn causes inflammation. The most common cause of chronic low-grade inflammation is obesity.

What are common risk factors between diabetes and cancer?

  1. Obesity

Most people living with Type 2 diabetes are overweight or obese. As mentioned, obesity is a state of low-grade inflammation. The longer overweight or obesity is present, the greater the risk of developing cancer.

The Centre for Disease Control (CDC) in America lists 13 cancers more commonly seen in people living with obesity: oesophageal, breast in post-menopausal women, colon and rectum, uterus, liver, stomach, kidneys, gallbladder, ovaries, pancreatic, thyroid, multiple myeloma, and meningioma, a type of brain cancer.

  1. Age

The incidence of most cancers increases with age with an estimated 78% of all newly diagnosed cancer occurring in people over the age of 55 years.

  1. Gender

In general, men are slightly more at risk of developing cancer than women and in turn have a higher incidence of Type 2 diabetes.

  1. Ethnicity

Statistics show that in the USA, African Americans develop and die from cancer more than other racial groups. This may be due to a variety of factors, such as socioeconomic status as well as genetic factors.

  1. Smoking

Tobacco smoking causes over 70% of all respiratory cancers and is a strong risk factor in many other cancers. In addition, studies suggest that smoking is an independent risk factor for developing Type 2 diabetes and we know smoking will always worsen the complications of diabetes.

  1. Alcohol

Even if alcohol is consumed moderately, it’s associated with an increased risk of cancers such as mouth, throat, gastrointestinal and breast. Moderate alcohol consumption may be protective against the development of diabetes, but excess alcohol is a diabetes risk.

  1. Sedentary lifestyle

There is a definite link between lack of physical activity and the risk of Type 2 diabetes and cancer.

Do diabetes treatments influence the incidence of cancer and cancer prognosis?

Good glucose control lowers the risk of complications and possibly cancer too. The influence of the various drug treatments are as follows:

  1. Metformin

At diagnosis all people with Type 2 diabetes are prescribed metformin and this is continued lifelong unless it can’t be tolerated, or kidney function drops below a certain threshold.

Metformin reduces circulating levels of glucose and insulin by reducing the production of glucose in the liver. Studies have shown that metformin inhibits the growth and proliferation of cancer cell lines.

Other research has demonstrated that metformin can selectively kill certain cancer stem cells, improving the effectiveness of the anticancer regimen. This has been particularly described in breast cancer.

There is significant evidence to show that PLWD who are on metformin are less likely to get cancer than PLWD that don’t take metformin. Additional observational data also suggests that PLWD taking metformin who do develop cancer are more likely to go into remission.

Metformin is sometimes used as an adjuvant treatment in a cancer regimen even in people without diabetes, particularly with breast cancer therapy.

  1. Thiazolidinediones

These are medications that work in the liver to treat insulin resistance. Pioglitazone is the only one available in SA. Results of studies are conflicting whether these drugs decrease, increase or do not affect cancer risk.

  1. Sulfonylureas

There is very little data to suggest any benefit or risk in this group of medications.

  1. Incretins

These are the injectables liraglutide, semaglutide, and dulaglutide. They bind to the glucagon like peptide-1 (GLP1) receptor which results in lower glucose levels and weight loss.

Liraglutide showed an increased risk of medullary thyroid cancer in rats. The risk of this cancer remains a black box warning. A study published in the British Medical Journal in April 2024 calculated that there was very little increase in risk for thyroid cancer in patients using GLP1 receptor agonists. They report this would be 0.36 excess cancers per 10 000 person-years which compares favourably to a background incidence of cancer in diabetes of 1.46 per 10 000 person-years. However, if there is a history of thyroid cancer or a family history of thyroid cancer, the PLWD may still be advised not to use this therapy.

  1. Insulin

As mentioned above, we know that high levels of insulin can be implicated in causing cancer. Naturally, PLWD who must inject insulin to treat their diabetes will be concerned. To date, there is no definite proof that insulin as a therapy causes cancer. However, people living with Type 2 diabetes who are using insulin will often have other risks as well: longer duration of diabetes with insulin resistance, obesity, older age.

One study also indicated a greater risk of developing cancer with higher doses of insulin. It’s critical to acknowledge that cancer cells in a person living with Type 2 diabetes may have spent years being exposed to abnormally high endogenous insulin due to insulin resistance. Thus, it’s difficult to blame the newly injected exogenous insulin to be the cause of any cancer.

How to lower cancer risk if you have diabetes

The most common cancers associated with Type 2 diabetes are breast, colon and prostate. However, as noted previously, if the PLWD also has an increased body weight there are many more cancers associated with obesity. Two main strategies are important: prevention and screening.

Prevention

There is always benefit in trying to improve the modifiable factors of lifestyle

  • Weight

Keeping body weight to normal or near normal is protective. This will lower insulin resistance while improving glucose control. In addition, weight loss has been shown to decrease cancer risk.

  • Diet

Having a diet that supports weight management is essential. There is also value in choosing foods that lower inflammation and have less direct carcinogens. The World Health Organization recommends avoiding processed meat as much as possible. Processed meats are prepared by smoking, curing, salting or adding chemicals (ham, bacon, pastrami, hot dogs, sandwich meat). Red meat should be restricted to 500g weekly. In fact, a plant-based diet is less inflammatory and lowers cancer risk.

  • Physical activity

Recommended activity is 150 minutes weekly ideally spread out over five days. This can be aerobic and resistance exercise.

  • Stop smoking

The connection between smoking and cancer has been established since 1963! Stop smoking!

  • Reduce alcohol

A woman can have 1 – 2 units daily and a man 2 – 3 units daily. One unit of alcohol is 340ml beer/cider; 120ml wine; 25ml spirits.

Screening

These recommendations are for the general population but if you are at higher risk for a certain cancer (family history, radiation exposure, etc.), then please chat to your doctor about your screening schedule.

BREAST – Start age 40 years with mammograms and generally every two years thereafter unless at higher risk. Monthly self-examination is also important.

CERVICAL – Screening starts age 25 years. A Pap smear can be done every three years, but the newer human papillomavirus (HPV) screening can be done every five years.

PROSTATE – Age 40 is the recommended screening age in black men and 45 years in other races with an annual PSA blood test. Any abnormality or change in this would prompt further testing by a urologist.

COLON – Start age 50 years with a stool sample to test for occult blood. Every 10 years a colonoscopy can be done.

SKIN – Be aware of changes in your own skin. An annual check with your doctor or dermatologist is valuable.

LUNG – In smokers age 55 – 80 years (and this is even for ex-smokers), consider having a CT chest annually.

Closing remarks

There is a link between diabetes and cancer. However, scientists from Mount Sinai in the USA, who looked at diabetes and pancreatic cancer, are still not clear about what comes first – the cancer or the diabetes.

What we do know is that high blood glucose will increase cancer cell metabolism and growth so good glucose control is essential. We also know that certain medications are protective, especially metformin.

With a healthy lifestyle and avoidance of other risk factors, as well as regular cancer screenings, it should be possible for PLWD to lower the risk of a cancer diagnosis.

References

  1. Edward Giovannucci, David M. Harlan, Michael C. Archer, Richard M. Bergenstal, Susan M. Gapstur, Laurel A. Habel, Michael Pollak, Judith G. Regensteiner, Douglas Yee; Diabetes and Cancer: A consensus report. Diabetes Care 1 July 2010; 33 (7): 1674–1685.
  2. Wang L, Xu R, Kaelber DC, Berger NA. Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes. JAMA Netw Open. 2024;7(7):e2421305
  3. https://www.discovery.co.za/corporate/health-ovarian-cancer-screening-and-prevention
  4. https://www.cedars-sinai.org/blog/link-between-pancreatic-cancer-and-diabetes.html

MEET THE EXPERT

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 17 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 17 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.

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Semaglutide: warnings, risks, and managing high cost

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Retha Harmse highlights the warnings, risks and how to manage the high cost of semaglutide.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Semaglutide has gained considerable attention for its effectiveness in managing Type 2 diabetes and promoting weight loss. However, as its popularity has grown, so too have concerns regarding its use, particularly regarding compounded off-brand formulations and the potential risks and side effects of long-term use.

The U.S. Food and Drug Administration (FDA) has issued warnings against the use of compounded semaglutide formulations, emphasising that these versions may not meet the safety and efficacy standards of the original FDA-approved product.

Mechanism of action of semaglutide

Semaglutide belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. This class of medication mimics a hormone naturally produced in the intestines in response to food intake, playing a crucial role in regulating blood glucose levels and appetite. The drug mechanism works by:

  1. Stimulating insulin secretion: In response to meals, it enhances insulin release from the pancreas, which helps lower blood glucose by facilitating glucose uptake into cells, especially muscle and fat tissues. This action helps prevent hyperglycaemia (high blood glucose) after eating.
  2. Inhibiting glucagon release: Glucagon is a hormone that raises blood glucose by signalling the liver to release stored glucose. Semaglutide reduces glucagon secretion, helping to prevent the liver from producing excessive glucose, especially when blood glucose is already elevated.
  3. Slowing gastric emptying: Semaglutide slows the rate at which food leaves the stomach, promoting a feeling of fullness (satiety) and reducing appetite, which is beneficial for weight management in people with Type 2 diabetes.
  4. Improving beta cell function: Over time semaglutide improves the function of beta cells in the pancreas, responsible for insulin production, potentially enhancing long-term blood glucose control.

The risks

While semaglutide is effective for managing Type 2 diabetes and aiding weight loss, it does come with potential risks:

  1. Gastrointestinal side effects: Common side effects include nausea, vomiting, diarrhoea, and abdominal discomfort. These symptoms are most pronounced when starting the medication and may decrease over time, though some may experience persistent symptoms.
  2. Hypoglycaemia: While semaglutide itself doesn’t typically cause low blood glucose, it can increase the risk of hypoglycaemia when used with other diabetes medications, particularly insulin or sulfonylureas. Regular monitoring of blood glucose is important in these cases.
  3. Pancreatitis risk: There have been reports of pancreatitis (inflammation of the pancreas) in some users. If symptoms such as severe abdominal pain, nausea, or vomiting occur, immediate medical attention is needed.
  4. Thyroid cancer concerns: Animal studies have shown an increased risk of thyroid tumours with GLP-1 receptor agonists. However, human studies haven’t clearly confirmed this risk. Still, semaglutide carries a black box warning for potential thyroid C-cell tumours, and it should be avoided by anyone with a personal or family history of thyroid cancer.
  5. Kidney function: Reports have indicated that semaglutide may cause kidney injury, especially in people who experience dehydration due to gastrointestinal side effects. Kidney function should be monitored regularly, particularly in those with existing kidney issues.

Impact on lean mass

One concerning aspect is its effect on body composition. Research has shown that users on high-dose semaglutide or tirzepatide may lose a significant amount of lean mass (about 6,35kg of muscle) along with body fat. This loss of muscle mass represents about 40% of the total weight lost.

While these drugs promote fat loss, the loss of lean mass can have detrimental long-term effects, including decreased metabolism, lower strength, and higher risks of injury. Furthermore, if the drug is stopped, people may experience weight regain, and there’s concern that the muscle mass lost might not be regained, leading to an unfavourable lean-to-fat ratio.

The high cost

The cost is one of the biggest barriers to long-term use. With monthly expenses reaching exorbitant amounts, many users find it difficult to maintain the medication without medical aid or patient assistance. Here are strategies to manage the cost:

  1. Explore patient assistance programme: The manufacturer of semaglutide offers patient assistance programmes for those who qualify. It’s worth exploring whether you meet the eligibility criteria for such programmes.
  2. Insurance coverage and co -pay assistance: If you have medical aid, check with your medical aid to see if it covers this drug. Some medical aids provide co-pay cards or discounts that can significantly reduce out-of-pocket costs.
  3. Consider generic alternatives: While there is no generic version yet, it’s important to keep an eye on future developments. Newer, more affordable GLP-1 receptor agonists may emerge, and discussing these options with your healthcare provider can offer more cost-effective alternatives.
  4. Partner with your healthcare provider: If semaglutide becomes financially unfeasible, consult your healthcare provider. They may be able to adjust your treatment plan or recommend other, more affordable therapies that still provide effective diabetes management.

 Sustaining the usage regimen

Semaglutide is typically administered once a week via subcutaneous injection, which can be convenient. However, consistency is key to its effectiveness. To maintain your regimen:

  1. Set a routine: Choose a day each week to administer your injection and stick to that schedule.
  2. Track progress: Regularly monitor your blood glucose levels, any side effects, and changes in your body. This can help you and your healthcare provider assess your treatment’s effectiveness.
  3. Manage side effects: If you experience side effects, like nausea or stomach discomfort, talk to your healthcare provider.
  4. Stay engaged with your healthcare provider: Regular check-ins with your doctor are essential to adjust your treatment as necessary.

Alternative lifestyle options

If you find that the cost is unsustainable, or the side effects are too challenging, it may be time to consider alternative lifestyle options. Weight management through healthy eating, regular physical activity, and other non-drug-based interventions can be effective and more affordable ways to manage Type 2 diabetes and promote overall health.

Take away message

Semaglutide can be an effective tool for managing Type 2 diabetes and aiding weight loss, but it comes with potential risks, including the loss of lean mass and high costs.

For those struggling with the expense, exploring financial assistance options, considering alternative medications, and discussing lifestyle changes with a healthcare provider are essential steps to maintaining health without the financial burden.

If semaglutide isn’t sustainable for you, there are various other approaches to diabetes management that may offer long-term success.

MEET THE EXPERT

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the 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.

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the 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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GLP-1 drugs

Who deserves GLP-1 drugs?

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Dr Paula Diab gives an overview of GLP-1 drugs, their approved uses, and who might benefit the most. She also explores newer combinations, oral formulations, and clinical trials shaping the future.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Over the past decade, GLP-1 receptor agonists (GLP-1 RAs) have revolutionised the management of Type 2 diabetes and obesity. These medications, initially developed to improve blood glucose control, have since demonstrated profound benefits for weight loss, cardiovascular health, and even emerging possibilities in treating other metabolic conditions. With their widespread availability and increasing popularity, one key question remains: who should receive GLP-1 drugs?

What are GLP-1 drugs?

GLP-1 receptor agonists mimic the action of a natural hormone called glucagon-like peptide-1 (GLP-1), which is released in response to eating. They regulate blood glucose and appetite by:

  • Stimulating insulin secretion.
  • Slowing gastric emptying (keeping food in the stomach longer, which helps you feel full).
  • Suppressing glucagon, a hormone that raises blood glucose.
  • Reducing appetite through signals to the brain. 

GLP-1 drugs available today

There are several GLP-1 receptor agonists available currently (not all on the South African market). Each has its own unique formulations, dosing schedules, and benefits. Here’s a breakdown of the most commonly used medications:

  1. Exenatide (Byetta, Bydureon)

  • Indication: Type 2 diabetes.
  • Form: Byetta, a twice-daily injection, was previously available in SA. Bydureon, the weekly injection isn’t available in SA.
  • Highlights: One of the first GLP-1 drugs, effective for blood glucose control but less commonly used today due to newer options with greater weight-loss benefits.

  1. Liraglutide (Victoza, Saxenda)

  • Indication:
    • Victoza: Type 2 diabetes and cardiovascular risk reduction.
    • Saxenda: Obesity or overweight with comorbid conditions (e.g. hypertension, sleep apnoea).
  • Form: Daily injection.
  • Availability: Both available and licensed in SA.
  • Highlights: A proven option for weight loss and diabetes, though some patients find daily dosing inconvenient.

  1. Dulaglutide (Trulicity)

  • Indication: Type 2 diabetes and cardiovascular risk reduction.
  • Form: Weekly injection.
  • Availability: Available and licensed in SA.
  • Highlights: Convenient once-weekly dosing, widely used for both blood glucose and heart health benefits.

  1. Semaglutide (Ozempic, Wegovy, Rybelsus)

  • Indication:
    • Ozempic: Type 2 diabetes and cardiovascular risk reduction.
    • Wegovy: Obesity or overweight with comorbid conditions.
    • Rybelsus: Oral form for Type 2 diabetes.
  • Form: Weekly injection (Ozempic and Wegovy) or daily oral tablet (Rybelsus).
  • Availability: Only Ozempic is currently available in SA, others may become available later in the year.
  • Highlights: Semaglutide has set a new standard for weight loss, with Wegovy often leading to 15% or more body weight reduction in clinical trials.

  1. Tirzepatide (Mounjaro)

  • Indication: Type 2 diabetes (with anticipated obesity indication approval).
  • Form: Weekly injection.
  • Availability: Available in SA as of February 2025.
  • Highlights: A dual-action drug targeting both GLP-1 and GIP (another gut hormone), delivering remarkable weight loss and glucose control.

Who can benefit from GLP-1 drugs? 

  1. People with Type 2 diabetes

For individuals struggling with blood glucose control, GLP-1 drugs offer a highly-effective option. Beyond lowering HbA1c levels, these medications often reduce cardiovascular risks and may even slow the progression of kidney disease in people with diabetes.

  1. Individuals living with obesity

Obesity is now recognised as a chronic, multi-factorial disease, not simply a result of willpower. GLP-1 drugs like semaglutide brand 2 and liraglutide brand 2provide a powerful tool for weight loss by addressing the biological mechanisms driving appetite and energy balance.

Eligible patients typically have:

  • A body mass index (BMI) ≥ 30 (obesity), or
  • A BMI ≥ 27 (overweight) with weight-related health conditions like high blood pressure or Type 2 diabetes.
  1. People with cardiovascular risk

Several GLP-1 drugs, including liraglutide, semaglutide, and dulaglutide, have demonstrated benefits in reducing the risk of heart attack, stroke, and cardiovascular death in people with Type 2 diabetes and existing heart disease.

  1. Those with prediabetes

Emerging evidence suggests that GLP-1 drugs could help prevent or delay the onset of Type 2 diabetes in individuals with prediabetes by improving insulin sensitivity and promoting weight loss.

  1. Individuals facing plateaus with lifestyle changes

For those who have struggled with diet and exercise alone, GLP-1 drugs can offer an additional boost. These medications complement healthy lifestyle choices and provide sustainable weight-loss results.

New combinations and oral GLP-1 options

The field of GLP-1 therapies is rapidly evolving, with exciting developments that enhance convenience and efficacy.

Combination therapies

  • Tirzepatide: Combines GLP-1 and GIP receptor agonism for dual-action benefits.
  • Next-generation therapies: Ongoing trials are exploring triple-action drugs targeting GLP-1, GIP, and glucagon receptors, potentially amplifying weight-loss effects.

Oral formulations

  • Oral semaglutide: The first and only oral GLP-1 drug, offering an alternative for patients who prefer not to use injections.
  • Future options: Researchers are investigating improved oral formulations to increase bioavailability and effectiveness.

Current clinical trials and future directions

Several clinical trials are expanding the potential uses of GLP-1 drugs. Studies, such as STEP and SURMOUNT, are investigating the weight loss potential in non-diabetic populations. Other studies are looking into the use of GLP1 medications to reduce liver fat and treat liver disease associated with diabetes and obesity.

Certainly, there is also great interest in looking into the cardiovascular benefits of GLP1 medications not only in diabetic populations but also in people without diabetes who exhibit risk factors for cardiovascular disease.

Finally, early research suggests GLP-1 drugs might also have protective effects in diseases like Alzheimer’s and Parkinson’s, but further investigation is required.

Are GLP-1 drugs right for you?

 Not everyone is a candidate for GLP-1 drugs. These medications are generally reserved for people who:

  • Have Type 2 diabetes or obesity.
  • Are unable to achieve sufficient results with lifestyle changes alone.
  • Have no contraindications, such as a history of medullary thyroid cancer or pancreatitis.

It’s also important to consider cost. While some medical aid plans cover GLP-1 drugs, others may not, particularly for obesity treatment. Speak to your doctor to determine your eligibility and explore various options that may be available.

Overview

GLP-1 receptor agonists are reshaping how we approach Type 2 diabetes and obesity, offering hope to millions worldwide. From improved blood glucose control to life-changing weight loss, these medications address the biological underpinnings of chronic conditions that were once considered unsolvable.

If you are interested in knowing more or think that these drugs might be right for you, please consult your doctor. Together, you can explore your health goals, treatment options, and the exciting possibilities these ground-breaking medications provide.

Diabetes breakthroughs

This year Dr Paula Diab will present a series of articles that address various new breakthroughs in diabetes management. These will focus mainly on medications that are becoming available – different ways of using old medications, new formulations, and new drugs in the pipeline.

MEET THE EXPERT

Dr Paula Diab

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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Wound care

Wound care management

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Monique Marais and Marionette Roselt outline the importance of wound care management in the diabetes community.

Listen to this article below or wherever you get your podcasts or visit our playlist.

People living with diabetes are more prone to wounds and/or chronic wounds due to several factors that affect the body’s ability to heal.

Neuropathy (nerve damage) can cause a loss of sensation, especially in the feet and lower legs, making it difficult to detect injuries like cuts or blisters, which can worsen over time without treatment.

Poor circulation (peripheral artery disease (PAD)) caused by narrowed blood vessels, reduces blood flow to the extremities, slowing the delivery of oxygen and nutrients needed for healing.

High blood glucose levels (hyperglycaemia) can damage blood vessels, weaken the immune system, and interfere with collagen production, making it easier for infections to develop and harder for wounds to heal.

Additionally, a weakened immune response further increases the risk of infections, such as cellulitis or gangrene, as the body’s ability to fight bacteria is compromised.

People who have diabetes also have thicker, less elastic skin, which is more prone to cracking and injury, and they produce less collagen, which is crucial for tissue repair.

Furthermore, increased pressure and poor foot care habits, often due to neuropathy and improper footwear, can lead to pressure sores and ulcers. All these factors combined make wound prevention and proper skin care essential for people with diabetes.

As a result of people living with diabetes being more prone to wounds, it’s important to know the various types of wounds that can develop to prevent them from developing.

The most common types of wounds

1. Diabetic foot ulcers (DFUs)

  • Most common type of wound for people living with diabetes.
  • Occurs due to neuropathy, which leads to a lack of sensation in the feet, and peripheral artery disease (PAD), which reduces blood flow, slowing healing.
  • Common triggers: pressure from shoes, minor cuts, blisters, or unnoticed injuries.
  • Can lead to infection and in severe cases amputation.

2. Pressure ulcers (bedsores)

  • People living with diabetes who have limited mobility are at risk of pressure injuries, especially on bony areas like heels, ankles, hips, and the sacrum.
  • Caused by prolonged pressure, friction, moisture, or shear forces.

3. Venous stasis ulcers

  • Occurs when poor circulation leads to blood pooling in the legs, resulting in swelling and ulcer formation.
  • Typically found on the lower legs and ankles.

4. Arterial ulcers

  • Result from peripheral artery disease (PAD).
  • Appears as deep, painful wounds, often with a punched-out appearance, typically on the feet, toes, or lower legs.

5. Surgical wounds and poor healing

  • People with diabetes have delayed wound healing due to impaired blood flow and immune response.
  • Surgical incisions take longer to heal and are at higher risk of infection or non-union (not healing at all).

6. Traumatic wounds (cuts, burns, scrapes)

  • Minor injuries can escalate quickly due to poor healing capacity and susceptibility to infection.
  • Common causes: household accidents, shoe-related friction, or stepping on sharp objects.

7. Infections (abscesses, cellulitis, gangrene)

  • Even small wounds can become infected quickly, leading to serious conditions, such as cellulitis (skin infection) or gangrene (tissue death).

Prevention action tips

People living with diabetes can take several preventative actions to avoid wounds and manage them effectively if they occur.

  • Regular foot care is crucial — checking feet daily for cuts, blisters, redness, or swelling, and moisturising to prevent dry, cracked skin. Ensure you dry between your toes after washing or swimming.
  • Wearing proper footwear that fits well and provides support can help reduce pressure points and prevent injuries. Inspect shoes on the inside to ensure no foreign objects are in the shoe that can contribute to pressure injuries or lacerations.
  • Keeping blood glucose levels under control is essential to promote better circulation and faster healing.
  • Practising good hygiene by keeping the feet clean and dry helps prevent infections.
  • Regular medical check-ups with a healthcare provider or podiatrist can catch potential issues early.
  • Engaging in gentle exercise improves circulation, while avoiding smoking and excessive alcohol consumption can further support vascular health.

If a wound does occur, it should be treated promptly by cleaning it, applying appropriate dressings, and seeking medical attention if it doesn’t heal or shows signs of infection.

Basic wound care at home

It’s always best to consult with a GP or wound care practitioner that has professional opinions and guidelines before attempting to do the wound care yourself.

Basic principles to follow on minor cuts or wounds at home:

  • Wash your hands thoroughly before touching the wound.
  • Clean the wound immediately with warm water and a disinfectant.
  • If the wound is large or deep, consider using a sterile saline solution or clean water to flush out any debris or foreign objects. This helps create a clean environment for healing. Consult with a professional if there is excessive bleeding or pain.
  • Avoid ointments that can cause irritation or allergic reactions.
  • Cover the wound to keep it clean and dry.
  • Monitor for signs of infection (see below) and seek professional care if it becomes infected or the wound healing process is prolonged.
  • Manage your blood glucose levels to promote wound healing.
  • Maintain good circulation to promote wound healing

Recognising the signs of infection

  • Warmth around the wound: If the skin around the wound feels hot to the touch, it could mean the body’s immune system is fighting the infection.
  • Increased redness and swelling: If the area around the wound become more red, swollen, or warm, it could indicate an infection is developing.
  • Increased pain: Some pain is normal, but persistent or worsening pain around the wound could be a sign of infection.
  • Pus or drainage: The presence of thick, yellow, green, or foul-smelling discharge is a clear sign of infection. Clear fluid is usually normal, but anything cloudy or discoloured is concerning, as well as if there is an increase in exudate levels.
  • Bad odour from the wound: An unusual or foul smell coming from the wound is often a sign of bacterial infection.
  • Increased drainage or bleeding: A sudden increase in fluid coming from the wound, especially if it’s thick or bloody, can be a warning sign.
  • Fever or chills: A fever (over 38°C) or feeling generally unwell with chills can indicate the infection is spreading beyond the wound. Seek urgent medical attention if these symptoms appear.
  • Delayed healing: If the wound isn’t improving or appears to be getting worse after a few days, it may be infected and require medical attention.
  • Skin discolouration: If the skin around the wound turns dark, bluish, or black, it could indicate serious tissue damage or a spreading infection.
  • Swollen lymph nodes: Tender lumps under the arms, neck, or groin may signal that the body is fighting an infection.

Wound dressing and treatment options

It’s important to educate yourself on the types of wound dressing and treatment options available so that you can discuss it with your GP or wound care practitioner and decide on an appropriate treatment plan.

The below guidelines serve as options for wound care treatment. Keep in mind that this is a field of expertise that is constantly evolving and improving, and what works now might not be the best treatment plan in the future.

Wound care dressing types

When choosing the right dressings for diabetic wound care, several factors should be taken into consideration:

Considerations for choosing the right wound care treatment
Wound type The type and severity of the wound will dictate the appropriate dressing. Different dressings are designed to manage specific wound types, such as diabetic foot ulcers or pressure ulcers.
Exudate level Assessing the amount of wound exudate (drainage) is crucial in determining the appropriate dressing. Dressings that are highly absorbent are suitable for wounds with heavy exudate, while low exudate wounds may require dressings that provide a moist environment for healing.
Wound size and depth Consider the size and depth of the wound when selecting dressings. Some dressings can conform to irregular wound shapes or are available in various sizes to cover larger wounds.
Frequency of dressing changes The frequency of dressing changes should be considered, as some dressings require more frequent changes than others. This can impact the overall management of the wound and the patient’s comfort.
Patient comfort and allergies Consider any patient-specific factors such as allergies or sensitivities to certain dressing materials. It’s important to choose dressings that are comfortable for the patient and minimise the risk of adverse reactions.

Taking ownership of your health is crucial for anyone living with diabetes to achieve better outcomes and lead healthier lives. By actively managing your condition through regular monitoring, healthy lifestyle choices, and adherence to medical advice, you can prevent complications and improve your quality of life.

Equally important is the role of healthcare professionals in providing education, support, and personalised care to empower you in this journey. A collaborative effort between you and healthcare providers is essential to ensure effective diabetes management, early intervention, and overall well-being. Together, through awareness, commitment, and proactive care, better health outcomes this can be achieved for those living with diabetes.

References

  1. How wounds heal: MedlinePlus Medical Encyclopaedia
  2. Evaluation and Treatment of Diabetic Foot Ulcers | Clinical Diabetes | American Diabetes Association
  3. Diabetic Foot Ulcers: Causes and Treatments
  4. Diabetic Wound Care: Why These Wounds Take Longer to Heal and What You Should Know About Treatment – R3 Wound Care & Hyperbarics
  5. South Africa – International Diabetes Federation
  6. UP EXPERT OPINION: South Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment | University of Pretoria
  7. 2023-11 – Diabetes – SA’s second biggest killer – Wits University
  8. Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa | Journal of Health, Population and Nutrition | Full Text
  9. South Africa diabetes report 2000 — 2045
  10. A Complete Guide for Wound Care for Diabetics?
  11. Diabetes and Wound Care, Steps to Find Healing | Banner Health
  12. The Dos and Don’ts of Diabetic Wound Care: Midwest Institute for Non-Surgical Therapy: Vascular and Interventional Radiologists

MEET THE EXPERT

Monique Marias is a registered social worker at the ClaytonCare Group which provides in-patient care to medically complex patients on a sub-acute level. She has specialised in physical rehabilitation for in-patients for 13 years, and has a passion to assist people to understand and manage their diagnoses and the impact on their biopsychosocial well-being.

Monique Marias is a registered social worker at the ClaytonCare Group which provides in-patient care to medically complex patients on a sub-acute level. She has specialised in physical rehabilitation for in-patients for 13 years, and has a passion to assist people to understand and manage their diagnoses and the impact on their biopsychosocial well-being.

MEET THE EXPERT

Marionette Roselt is a wound care specialist. Specialising in the treatment of pressure ulcers and complicated wounds, she has been running a private practice since 2021, providing specialised wound care. With a strong clinical foundation and a keen eye for detail, she is known for her compassionate approach and practical solutions in managing even the most challenging cases.

Marionette Roselt is a wound care specialist. Specialising in the treatment of pressure ulcers and complicated wounds, she has been running a private practice since 2021, providing specialised wound care. With a strong clinical foundation and a keen eye for detail, she is known for her compassionate approach and practical solutions in managing even the most challenging cases.

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Venous disease

Venous disease and diabetes

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Lynette Lacock discusses how venous disease is linked to diabetes and how to prevent future complications.

Listen to this article below or wherever you get your podcasts or visit our playlist.

What is venous disease?

Venous disease is any condition that affects the veins in your body. Veins are flexible, hollow tubes that are part of the circulatory system that moves blood through your body. The different types include: blood clots, deep vein thrombosis (DVT), superficial thrombophlebitis, chronic venous insufficiency, varicose and spider veins, venous ulcers, and arteriovenous fistulas.

Unfortunately, these conditions are familiar complications to millions of people who have unmanaged diabetes. The vascular system is negatively impacted by diabetes when it’s uncontrolled. This can result in poor circulation, deep vein thrombosis or clots, venous stasis, and varicose veins particularly in legs.

Why are people with diabetes susceptible to varicose veins?

You may have seen someone with varicose veins. They appear as lumps near the surface of the skin with a darker or bluish colour. This is actually enlarged vein walls that have become weakened over time due to the inability to push the blood back up toward the heart. This is caused by poor circulation and malfunctioning valves in the veins. Besides its distinctive appearance, it can be very uncomfortable, resulting in heavy aching legs and possible ulceration.

In diabetes, the risk of developing varicose veins is heightened for several reasons:

  • Altered circulation: Over time, uncontrolled high blood glucose can damage the blood vessels. As the vessels become worse, the valves start to malfunction due to the increase venous pressure leading to stretching of the veins causing them to become varicose.
  • Overweight and inactive lifestyle: Did you know that when you walk, your leg muscles help the blood defy gravity and pump it back up toward your heart?

 Unfortunately, the reverse is also true, inactivity helps gravity keep the blood in your lower extremities. Excessive weight puts pressure on the venous system making it harder to circulate the blood which compounds the problem.

  • Altered sensation due to neuropathy: Due to the decrease in sensation when you have peripheral neuropathy, you may be unaware that your legs are tight and sore. Therefore, you may not realise you have a problem until you start seeing the varicose veins or other problems appear.

Venous insufficiency in those with diabetes

When the venous system continues to malfunction, it’s called venous insufficiency. When the valves in the veins are damaged the condition becomes chronic. Chronic venous insufficiency can cause complications, such as swelling of the lower extremities and venous ulcers. Once ulcers appear, there is an increased risk of infection.

  • Delayed wound healing: Due to compromised circulation in people with diabetes, injuries and wounds will take longer to heal and are more prone to infection because of the delay in healing.
  • Chronic increased venous pressure: Obesity and a sedentary lifestyle can make circulation worse. Venous stasis can lead to complications because it starts to damage tissue in the area.
  • Complications of diabetic neuropathy: Having peripheral neuropathies makes it difficult to feel when something isn’t right. This delay in addressing a problem early can lead to complications that require a longer treatment.
  • Immune system weaker: Spikes in blood glucose or uncontrolled blood glucose can have negative effects on your immune system making it harder for the body to fight off infections. Having varicose veins only makes it harder to fight off infections due to venous stagnation.

What is a deep vein thrombosis?

A deep vein thrombosis (DVT) is a clot deep in the vein that can become a life-threatening condition if the clot travels to the lungs causing a pulmonary embolism (PE). Therefore, it’s essential to be aware of the symptoms to seek early treatment.

The symptoms include a warm, red, swollen and painful extremity.  Should you develop any of these symptoms, you should see your healthcare provider immediately.

People living with diabetes have an increased risk of DVT due to the following reasons.

  1. Increase in thickness of blood: Higher blood glucose levels can make blood more viscous and increase clotting factors, leading to an increased risk of clot formation.
  2. Obesity and inactive lifestyle: Obesity and diabetes slow down the circulation in the lower extremities. This greatly increases the risk of developing a DVT.
  3. Chronic systemic inflammation: Chronic inflammation is often present in people with diabetes due to prolonged high blood glucose levels and insulin resistance. This inflammation can damage blood vessel walls and increase the risk of clot formation.
  4. Vascular cellular damage: When the blood glucose spikes or remains elevated the endothelial lining of the vessels gets damaged. This damage produces inflammation in the vessels making the chance of a clot formation higher.

How to prevent venous disease if you have diabetes?

There are measures you can take to prevent early onset or the severity of venous disease.

  1. Stable blood glucose: Unstable and fluctuating blood glucose can cause inflammation and damage to your vessels and decrease circulation. Therefore, you must maintain a stable blood glucose level by taking your medications, eating correctly, and checking your blood glucose regularly.
  2. Maintain a healthy weight: Exercise and follow a healthy diet to maintain an optimal weight and prevent inflammation and added pressure on leg veins.
  3. Compression stockings: Compression stockings can help prevent blood from pooling in the lower extremities which can prevent a DVT. Discuss using stockings with your healthcare provider. You may need to be fitted for these stockings or you may not be a candidate for stockings if you have peripheral neuropathy.
  4. Keep fit and active: Maintaining physical fitness can go a long way in preventing the development and progression of venous disease. Speak to your healthcare provider about which exercises are best for you. Keeping your leg muscles fit and strong will help push the blood back to your heart preventing venous stasis.
  5. Avoid inactivity: Don’t stand or sit for long periods at a time as this will cause swelling and pressure in the legs. Changing positions often, elevating your legs, and lower leg exercises can prevent venous stasis.
  6. Foot-, wound- and skin- care routine: Examine your skin for cracks or ulcers and signs of varicose veins regularly. See a podiatrist every six months to have your nails trimmed and feet examined. See your healthcare provider with any signs of infection or DVT as soon as possible to prevent complications.

References

  1. usaveinclinics.com
  2. veinspecialists.com
  3. pmc.ncbi.nlm.nih.gov
  4. https://veincenter.doctor/chronic-venous-insufficiency-diabetes-mellitus/

MEET THE EXPERT

Sr Lynette Lacock

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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Steroid-induced diabetes

Steroid-induced diabetes

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Christine Manga, a diabetes nurse educator, unpacks what steroid-induced diabetes is.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Can steroids cause diabetes? The short answer is yes. There are a few terms used to describe this: steroid-induced diabetes, glucocorticoid induced hyperglycaemia, and new-onset diabetes after transplant (NODAT).

What are steroids?

Let’s delve into what steroids are, what they are used for, how they work, how they increase glucose levels and more.

The two main types of steroids we are going to discuss are glucocorticoid steroids (GCs) and androgenic/anabolic steroids which are hormones. Our focus will be on glucocorticoid steroids. These hormones are produced naturally in the body.

Testosterone is the naturally occurring androgenic steroid produced mainly in the testes in men and in a very small amount in women in the ovaries. This stimulates the development of male characteristics, such as more bodily hair, especially on the face, chest and underarms, deep voice, larger and stronger muscles. Mood, energy and sexual drive are also partially regulated by testosterone.

Cortisol is produced in the adrenal glands. It’s stimulated in many responses. It regulates our stress response to both physical and psychological stimuli, assists in metabolism, blood pressure and blood glucose regulation, suppresses inflammation (the body’s immune response), and plays a role in the circadian (sleep–wake) cycle as well as many other bodily functions. Testosterone and cortisol are usually produced at optimal levels in the body.

These steroids are also produced synthetically to mimic the effects of those made by the body.

Why are synthetic steroids used and how do they work?

Personal use

Often used by bodybuilders, anabolic steroids, a testosterone-mimicking steroid is usually used by people wanting to bulk up muscle and become stronger in a short period of time. There are also medical reasons to use these.

Medical use

GCs are used to suppress the body’s natural immune response, act as anti-inflammatory and anti-allergic drugs. People using GCs are therefore immunosuppressed. Conditions that would require these medications are usually autoimmune (a disease where the body’s immune system attacks its own healthy cells causing damage to the body). Some examples include: lupus, rheumatoid arthritis, celiac disease, psoriatic eczema, ulcerative colitis, adrenal insufficiency (Addison’s), and multiple sclerosis. These conditions require life-long GCs.

There are other inflammatory conditions that require GCs that are not autoimmune, such as asthma, severe bronchitis, severe allergic reactions. The GCs would be prescribed for acute and not chronic use.

Some people with cancer use them to assist in reducing chemotherapy side effects. People who have undergone an organ transplant will be prescribed life-long GCs to prevent the body from rejecting the new organ by reducing the body’s immune response to the foreign body.

These recipients who do develop diabetes are known as having NODAT.

Steroid preparations

GCs are taken in different preparations: tablets, intravenously, intramuscular injection, inhaled, and applied as a topical (skin) treatment.

Most inhaled and topical applications don’t affect glucose regulation, but long-term use would require monitoring. GCs are divided into three types, short-, intermediate- and long-acting.

How do glucocorticoid steroids affect blood glucose levels?

These steroids are called glucocortico steroids because of their effect on blood glucose levels. GCs make the liver less sensitive to insulin and signals the liver to produce more glucose called gluconeogenesis, even though the pancreas is producing and secreting insulin, albeit less.

Insulin production would normally inhibit gluconeogenesis. Reduced insulin sensitivity means that although the insulin required to transport glucose into muscle and fat cells is there, it’s unable to do the job leaving the glucose in the bloodstream. CGs increase the effects of epinephrine and glucagon which in turn increase glucose levels. These drugs often increase appetite and carbohydrate intake.

Risk factors for developing or worsening diabetes

Individuals who are overweight/obese, have a family history of diabetes, or have a history themselves of elevated glucose levels or prediabetes, and over the age of 50 are at a greater risk of developing steroid-induced diabetes.

Taking high doses for prolonged periods will increase the risk. People who already have diabetes will experience higher than usual glucose levels. People taking GCs are immune suppressed and are therefore also prone to developing other infections.

Other GCs effects on the body

Increased intra-ocular pressure causing glaucoma; this is important to monitor as people with diabetes are already predisposed to developing glaucoma, a leading cause of blindness. Weight gain, skin thinning, muscle weakness, and bone loss can occur. Fat redistribution takes place with long-term GCs use, resulting in fat accumulation around the abdomen and face known as moon face. Mood may be affected too.

How to mitigate the effects of glucocorticoid steroid use

If you already have diabetes, you may need to augment your oral medication with insulin. If already on insulin, dose adjustments will be necessary.

People who did not have diabetes to start will commence on oral medication.

After discontinuation of the GCs, some people will revert to normal blood glucose levels and be able to stop the diabetes medication.

Good food choices, such as smaller portions of carbohydrates and more low GI foods, as well as physical exercise where possible will play a positive role.

Regular monitoring of glucose levels

It’s important to monitor blood glucose levels regularly whilst using GCs. This will assist in early diagnosis of diabetes and timely intervention. People with existing diabetes will need to increase testing frequency. Even after discontinuation of GCs, which must be tapered, three-monthly Hba1c screening is advised.

MEET THE EXPERT

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

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

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