Shape Diet Meal Replacement Shakes

Registered diabetes educator and dietitian, Tammy Jardine, tells us all we need to know about Shape Diet Meal Replacement Shakes.


Shape Diet Meal Replacement Shakes should be used as a meal replacement and not as a supplement (addition to a meal).

When meal planning in diabetes, the priority is the total carbohydrate content since this is the macro-nutrient that most affects blood glucose.

As a basic rule of thumb principle, it’s recommended to limit total carbohydrate in a meal to no more than 45g, and to no more than 10g in a snack for optimal blood glucose control.

Water vs milk

Shape shakes provide 21,8-24g per serving when made up with water. This means that a small fruit or a green salad could be eaten with the shake if you still feel hungry, without compromising the carbohydrate limits.

If it’s made with milk then the carbohydrate will increase to 32,8-35g per serving which will still fall within the carbohydrate limits.

Monitor your blood glucose

When substituting the shake for a meal, it’s good practice to monitor blood glucose to see what affect the shake has on your blood glucose.

Since the shake is relatively low in carbohydrates, it’s a good idea to have a healthy snack, like a small fruit, available in case your blood glucose level drops.

If you find that the shakes do decrease blood glucose then instead of having food to increase them, which would contradict your weight loss efforts, try mixing the shake with skim milk. Alternatively, speak to your healthcare provider about adjusting your diabetes medications.

Fibre content

The fibre content is a little low when considering that the requirements for fibre is 25g a day. One shake provides between 0,2g and 1,3g per serving. Therefore, it is not recommended that the shake provide the sole source of nutrition for a day. Include some fresh veg to boost your fibre intake.

Protein, fat and energy

Shape Diet Meal Replacement Shakes are high in protein which helps you feel satiated. It’s low in fat and not high in energy, at less than 845kJ per serving, which is why it will be beneficial for weight loss.

Any meal replacement shake should have added vitamins and mineral so that micro-nutrient requirements are met. No additional multivitamin supplements are necessary when replacing meals with fortified shakes.

Non-nutritive sweeteners

The non-nutritive sweeteners, sucralose (in the shakes), and sugar alcohols (xylitol) are safe to use for people living with diabetes. They don’t cause a rise in blood glucose levels.

There will always be controversy about sugar substitutes since they require processing to achieve final product. The debate is not whether it’s natural (since sucrose sugar is natural), but rather about the process and the chemicals required to process the product. In studies, there is no scientific reason to avoid sugar substitutes in diabetes.

Frequently asked questions

Can I replace all three meals and just have some fruit or salad to add fibre?

The shake can be used to replace one to all three meals a day. The reason for using a shake will determine how many meals are replaced and the length of time it will be used.

Some people may want to use the shake as a meal replacement to replace a meal that they don’t have time to prepare, like breakfast and/or lunch. Some will use it as an alternative to a meal for weight loss. The benefit being that it’s calorie controlled and fortified with added vitamins and minerals.

If three meals are replaced, it’s advised to add vegetables to the daily intake to ensure a better fibre intake. Replacing all meals would be considered a low-calorie diet. There is some evidence that a low-calorie diet for six-12 weeks can decrease weight and improve insulin resistance. These improvements have been shown to have a positive effect on diabetes since blood glucose levels improve. If this weight loss is maintained, it’s possible that the improvements in blood glucose can be more long-term and can even possibly ‘reverse’ diabetes. You should speak to a diabetes dietitian if this interests you. A low-calorie diet should be undertaken under the guidance of a dietitian.

Do I only use Shape until I have lost the required weight?

If the aim of using a meal replacement is for weight loss, then you can use the shake for the time that it takes to lose the weight. Then use the shake less frequently to transition to a normal diet and prevent weight regain.

Could you substitute two meals and still have one cooked meal a day? Or would that upset the plan?

There are various ways to use the shake. This is probably the most common way (as mentioned in the question) of using the shake. The cooked meal should still be well-balanced, high in vegetables with a portion of lean meat, high-fibre starch and a small amount of fat.

If I don’t need to lose weight, can I still use the shake for an easy convenient midday meal?

Yes, you can use the shake to replace a meal if you don’t have time to prepare a meal.


MEET THE EXPERT


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

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MiaoMiao2 Smart Reader for FreeStyle Libre now Available in South Africa

MiaoMiao2 is an independent bluetooth reader designed to work with your FreeStyle Libre sensor. It transmits continuous glucose reporting every 5 minutes to your smartphone. MiaoMiao2 is rechargable and waterproof. You can track your blood sugars levels in real time and set low or high alarms without scanning your Libre sensor. With MiaoMiao2+Libre, you now get a continuous glucose monitor (CGM) which can also interface with closed loop artificial pancreas insulin systems.

Watch the video for more info or visit miaomiao.co.za

The risk of falls in diabetes

Worldwide Fall Prevention Awareness Week is in September. We learn about falls with special consideration to the fall risk of people living with diabetes, and the inner ear in maintaining balance.


The stats of falls

Falls are one of the leading contributors to unintentional injuries, hospital admissions, and under severest circumstance, may result in death.

One in five of those who fall are injured. In the USA alone, an older adult falls every second; is admitted to hospital due to fall-related injury every 11 seconds; and every 19 minutes, an older person dies from these injuries.

Even if falls don’t cause a physical injury, fear of falling can reduce physical activity, and so can increase fall risk. Globally, at least one in three older adults (65 years and above) will fall every year.

No country is spared the problem of falls, with data from emerging regions suggesting falls are as much of a challenge as in developed countries.

Moreover, ageing is growing at a disproportionate rate in low-and-middle-income countries, who have had less time to prepare for the health needs of an older population.

Diabetes increases the odds for falls

While ageing is the biggest predictor for falls, chronic health conditions also increase the odds. One of these conditions is diabetes.

Diabetes is one of the most prevalent non-communicable diseases. In 2020, the International Diabetes Federations (IDF) reported that approximately 4 581 200 million adults in South Africa have diabetes. These numbers will increase considering the undiagnosed cases.

Recently, scientific evidence suggests that people living with diabetes are at increased risk of falls, including acquiring injuries resulting from falls.

The function of the ear

Our ears are not merely a structure that aid our physical appearance. The function goes beyond what we see externally. Medically, the ear is referred collectively as the auditory system and gives the sense of hearing and contributes to balance, the sixth vital sense.

Balance is controlled by the vestibular system. The vestibular organs are in the inner part of the ear, deep within the skull, next to the hearing portion of the inner ear, called the cochlea.

The vestibular system can’t be viewed by looking in to the ear canal, but the diagram below shows what it looks like. This figure illustrates its location relative to the external ear and the shape of the semi-circular canals bones.

The vestibular system uses intricate structures to sense movement of the head and body. It works in collaboration with our eyes, brain, muscles, and joints to keep our vision stable and our entire body balanced while in motion or performing daily activities.

Unlike our other senses (e.g. vision, hearing, smell, touch), we typically don’t notice our vestibular sense when it’s working normally. However, if the vestibular system is damaged, the effects can be devastating and include dizziness, imbalance, and falls.

A large population-based survey, in the USA, suggested that the vestibular sense starts to decline as early as the 40th year.

The question is, how is my diabetes putting me at risk from falling?

Link between diabetes and falls 

Risk factors for falls are issues that increase your chance of falling. Generally, these can be divided into what are called intrinsic risks and extrinsic risks.

Intrinsic risks are individual risk factors like age, sex and health conditions. Extrinsic risks are related to the environment. For example, poor lighting, potholes in the road, and uneven pavements.

Challenges faced by people living with diabetes include the following: 

  • Use of multiple medications. These include medications prescribed by your doctor as well as anything over the counter. Use of four or more medications increases your fall risk. Do not stop your medications. Rather discuss with your doctor and see if any can be adjusted or stopped. Medications like sleeping pills, tranquilisers and anticonvulsants are particularly associated with fall risk.
  • Possible loss of sensation due to vascular damage to the nervous system. For example, peripheral neuropathy.
  • Dizziness and imbalance.

The sense of balance is the result of processing and responding to incoming signals from three senses. These are vision, vestibular and somatosensory (awareness of where the body is in space) inputs.

Diabetes can affect all these senses negatively. For example, peripheral neuropathy, or nerve problems can result in not being able to sense where the feet are.

Retinopathy, or vision problems, reduces important visual inputs necessary to identify slip and trip hazards and respond quickly*.

To be able to balance, visual input plays a crucial role.

Alongside the retinopathy that may be related to diabetes, older adults often have as issues with poor low-contrast visual acuity and impaired depth perception. Activities, such as climbing steps or stepping off pavements in bright sunlight or dappled shade, will be risky for adults with such visual changes.

Multifocal, bifocal and transitional lenses are particularly difficult and increase fall risk. The image below shows the distortion of the lower visual field when viewed with multifocal lenses.

Distortion of the lower visual field due to wearing multifocal lenses.

How diabetes affects the cochlea

As with other sensory systems, diabetes can also result in damage to the cochlea (the hearing organ) and its neighbouring vestibular system.

Within the inner ear, the balance organs are highly dependent on the tiny blood vessels for blood and nutrients. Studies report that diabetes is known to affect small blood vessels first before reaching the large ones. Therefore, compromising the ear’s ability to function properly.

When diabetes has been present for a long period, both inflammation and vascular damage are more likely*. Negative effects of diabetes on the vestibular system have been noted in both animal studies and clinical studies in humans*.

The vestibular system is a major contributor to our overall balance, and vestibular damage and its associated dizziness is an independent risk factor for falling*.

Large-scale epidemiological studies have shown that people with diabetes are associated with significantly higher odds of vestibular damage and, even after adjusting for nerve loss and vision loss, patients with diabetes and vestibular loss have a two-fold higher odds of falling*.

Fortunately, audiologists can assess vestibular function and fall risk. There are physical therapies that can help improve balance, which may be offered either by a suitably qualified audiologist or physiotherapist.

How to prevent falls 

The National Institutes of Health, Department of Health and Human Services (newsinhealth.nih.gov) provides the following practical tips on how to prevent falls:

  • Talk openly with your healthcare provider about falls.
  • Find out about the side effects of any medicine you take and ask for a medication review.
  • Have your blood pressure tested lying down and standing. Blood pressure that drops when moving from lying to standing is an easily reversible risk factor for falls and imbalance.
  • Stay hydrated and ensure your iron levels are normal. Dehydration and anaemia are common in all older adults and can contribute to dizziness and falls.
  • Stay physically active to improve your balance and strength. Guidelines for physical activity for older adults recommend 150 minutes of moderately intense physical activity per week; or 75 minutes of vigorous physical activity per week, as well as balance and strengthening exercises.
  • Have your eyes and hearing checked regularly. Ensure your vision and hearing are both as good as they can possibly be. Don’t hesitate to try spectacles and hearing aids, if needed.
  • See your healthcare provider about any foot problems. Make sure to discuss proper footwear.
  • Make your home safer. Remove things you can trip over from stairs and walkways. Have grab bars and non-slip mats in bathrooms.
  • Hold on to handrails when using stairs.

Which health professionals to consult when experiencing falls 

Falls are predictable events and are therefore preventable. They are not ‘accidents’. Although prevention (through education and healthy lifestyle) is better than cure, in an event where prevention wasn’t possible, there are numerous health professionals involved in the identification and treating balance problems. Hence, it’s a team effort.

Within the context of diabetes, an audiologist may be able to assess your balance and risk for falls using a variety of testing modalities. Recommendations on how to perform your activities of daily living, considering the balance problem that you might be experiencing will be provided.

Also, audiologists will facilitate referrals to other professionals as illustrated in below, should the need arise.

Multi-disciplinary team approach in the management of people with balance and falls disorders.

To conclude, falls are common occurrences in all adults. The presence of factors, such as age, and chronic health conditions, such as diabetes, increase the risk of falls.

However, falls are predictable and thus preventable. Maintaining a healthy lifestyle, careful monitoring of health and medication, and management of environmental fall risk factors all contribute to reducing the risk of falls.

MEET THE EXPERT


Sakhile Nkosi is an audiologist in clinical practice at a district hospital, South Africa. He is co-chairing the South African state cohort at The Audiology Project (TAP), a project that aims to advocate for the inclusion of audiological services in the care of patients with chronic illnesses. Sakhile is currently pursuing his master’s degree in audiology. 

MEET THE EXPERT


Dr Christine Rogers lectures at the University of Cape Town, South Africa and is an audiologist whose special interest is vestibular disorders. Christine remains a committed clinician, leading a multi-disciplinary team at Groote Schuur Hospital in Cape Town as well as her private practice.

MEET THE EXPERT


Dr. Erin G. Piker is an Associate Professor and Director of the Vestibular Sciences Lab in the Department of Communication Sciences and Disorders at James Madison University. Her research interests are in the areas of vestibular physiology and clinical vestibular diagnostics.

References: 

  1. Agrawal, Y., Carey, J.P., Santina, C. D., Schubert, M.C., & Minor, L. B. (2010). Diabetes, Vestibular Dysfunction, and Falls: Analyses From the National Health and Nutrition Examination Survey. Otology & Neurotology, 31(9), 1445-1450. 
  2. Agrawal, Y., Carey, J. P., Santina, C. D., Schubert, M. C., & Minor, L. B. (2009). Disorders of Balance and Vestibular Function in US Adults: Data From the National Health and Nutrition Examination Survey, 2001-2004. Archives of Internal Medicine, 169(10), 938-944. 
  3. D’Silva, L. J., Lin, J., Staecker, H., Whitney, S. L., & Kluding, P. M. (2016). Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Physical Therapy, 96(3), 400-409. 
  4. Jacobson, G. P., McCaslin, D. L., Grantham, S. L., & Piker, E. G. (2008). Significant Vestibular System Impairment Is Common in a Cohort of Elderly Patients Referred for Assessment of Falls Risk. Journal of American Academy Audiology, 19, 799-807. doi:10.3766/jaaa.19.10.7 
  5. National Institutes of Health Department of Health and Human Services. September 2019. newsinhealth.nih.gov/2019/09/preventing falls 
  6. Rybak, L. P. (1995). Metabolic Disorders of the Vestibular System. Otolaryngology–Head and Neck Surgery, 112(1), 128-132. doi:https://doi.org/10.1016/S0194-59989570312-8 
Header image by FreePik

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Shiara Pillay – Diabetes community helps keep you accountable

Shiara Pillay tells us how her diabetes community, formed at DSA youth camps, has helped her be accountable for managing her diabetes.


Shiara Pillay (25) lives in Muizenberg, Cape Town. She has Type 1 diabetes.

About Shiara

Shiara has attended the Diabetes South Africa youth camps for many years. First as a child and then as a teenager and young adult. She progressed from being a camp attendee to becoming a camp leader.  Presently, she is a dedicated member of the YT1 team that helps to organise and manage the Diabetes SA YT1 Children’s and Youth Outreach.

She is currently working in the social development and capacity building industry, and studying towards completing her Honours in Development Studies.

Consistent focus and attention

Life with Type 1 diabetes seems like the most normal thing in my life right now. Especially during the COVID-19 pandemic! It hasn’t always been that way though. It has required consistent focus and attention since I was diagnosed 15 years ago.

The last decade and a half has seen me experience things not a lot of other people I know have. I have advocated for diabetes awareness in school and social environments. Experienced an unexpected DKA admission to hospital. Held the space for countless conversations with friends and family about diabetes management support. All the while I am studying and pursuing a career path.

Community holds you accountable

One of my favourite triumphs of this journey is being a part of the gathering of young diabetic children at the DSA educational camps. Experiencing the connection between the diabetes community (young, old, family and friends) through shared and individual struggles and triumphs is so rewarding.

Being able to accept, grow and take control of the role that diabetes plays in my life is an ongoing commitment that this community has helped me stick to.

I work constantly to maintain my glucose levels through diet, exercise and regular testing. Supplemented by as much information as possible and a healthy balance of finding pleasure in all these things.

Shiara in Amsterdam, the Netherlands.
Shiara in Visakhapatnam, India.
Shiara Pillay
Shiara with her group of campers dressed for their Saturday camp concert evening at Diabetes SA April 2017 Diabetes Childrens Camp in Kommetjie, Cape Town.

DSA News Spring 2020

DSA Port Elizabeth news

Although it is still lockdown and we are not allowed to have public Diabetes Wellness Meetings, we still receive many calls for advice and assistance. We may be contacted via the cell and social media.

The mother of a newly diagnosed young fellow contacted us from the hospital. As he is under twelve years old, she could stay with him for the duration of his time in hospital. But, she had to remain in the hospital. If she left she would not have been allowed to return to her son. So, we were her lifeline while they were both confined to the hospital. They live on a small holding just outside Port Elizabeth.

Once he was released from hospital we drove out to their home, all masked and keeping our social distance and donated a brand-new glucometer to him, his free pair of mohair socks and the handy Diabetes Focus A to Z info booklet. These are some of the benefits of becoming a member of DSA.

Diabetes dog

We recently had an unusual request from a friend, Vasti Barkhuizen. She needed advice as her seven-year-old spayed Great Dane, Debbie, had just been diagnosed with diabetes. Debbie started to drink excessive water which Vasti noticed as it was mid-winter. A urine sample showed high glucose, and a urinary tract infection which was treated with antibiotics.

Debbie the Diabetic Dane is relaxing in her garden.

Debbie’s first fasting blood glucose level, taken on 13 July, was 23,7. She was started on 16 units of Protaphane 100 IU/mm twice daily, which is taken after meals.

Diabetes in dogs is very similar to Type 1 diabetes in humans. Female dogs are more frequently affected and known triggers for diabetes include pregnancy, dioestrus, Cushing’s disease and hypothyroidism as well as drugs, like progestogens and cortisone.

Debbie is lying on her bed and thinking “Please help me to feel better soon.”

Vasti’s biggest challenge was to get samples of blood to test Debbie’s blood glucose readings. This is when Elizabeth Prinsloo, from DSA Port Elizabeth, donned her mask and went to Vasti’s home to assist with Debbie, a huge gentle giant. The blood samples are usually taken from the ears or the inner lips of dogs. As our Rottweiler also had diabetes, Elizabeth could assist Vasti and show her how to get a blood sample.

Debbie looking at a piece of her reward, a few slices of low-fat biltong, when she stands quietly to have her insulin injection.

Debbie’s blood glucose tests are still in the 20s and her insulin is being gradually increased to find the optimum dose. She now receives 26 units of insulin twice daily. She has lost much weight but should soon start regaining it once she reaches her correct dose.

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Management of diabetic ketoacidosis

Dr Louise Johnson informs on what diabetic ketoacidosis is, the signs and how to manage it.

What is diabetic ketoacidosis?

Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes. DKA happens when your blood glucose is very high and acidic substances, called ketones, build up to dangerous levels in your body. It’s characterised by high glucose and ketonuria (ketones on dipstick in urine) and ketoacidosis.

The cause is due to decreased amount of insulin and too much glucose. The metabolism shifts from the carbohydrate metabolism to a starvation state where the fat metabolism is used.

 Signs and symptoms

  • General weakness, tiredness
  • Polyuria (passing a large amount of urine) and polydipsia (excessive thirst)
  • Nausea and vomiting
  • Abdominal pain
  • Decreased appetite
  • Rapid weight loss in a new Type 1 diabetes patient
  • Altered consciousness, disorientation and confusion
  • Decreased sweating with dry skin
  • Dehydration
  • Laboured breathing, called Kussmaul breathing
  • Apple smell on the breath
  • Dizziness due to low blood pressure and palpitations
  • Glucose more than 20 mmol/L and ketones on some glucose machines (if possible) and in urine as detected by a urine dipstick

Causes of DKA

  • Infection, especially bladder infections, lung infection, feet, tooth or other
  • Inflammation i.e. arthritis
  • Heart attack characterised by chest pain
  • Not taking insulin or enough insulin
  • Insulin not delivered due to pump obstruction or insulin pump failure
  • Trauma that can be either physical or emotional. The death of a pet is enough emotional stress to cause this.

The incidence of DKA is mainly in Type 1 diabetes but can also be seen in Type 2 diabetes that are on insulin and develop a bad infection.

In Type 1 diabetes it’s more common in young children and adolescents due to growth hormone and sex hormones that increases. It’s also seen in adolescents with psychological stress where insulin is not taken correctly or omitted on purpose.

Management of DKA

The most important factor is to test blood glucose when any of the signs are present. Nausea and abdominal pain are early signs that can be used to prevent hospitalisation.

If you are showing any signs, you should check your blood glucose and give a short-acting insulin as a correction to bring the glucose down below 10 mmol/L.

Drink clear water in an amount of 100ml/kg. In a person weighing 60kg that would be six litres. Drink the water slowly and check glucose every hour. About 1 litre fluid per hour.

Should there be excessive nausea, an anti-emiticum can be used for nausea, such as Valoid suppository.

If there are no signs of infection and the glucose is responding to the treatment, you can stay at home. In the case where the glucose is not responding and vomiting or confusion appears, you will need to be admitted to a hospital for intravenous insulin.

Prognosis

The overall mortality rate for DKA is 0,2 to 2% with persons with coma having the worse prognosis.

In properly treated patients, the prognosis is excellent. Before the discovery of insulin, in 1922, the mortality was 100%. Over the last three decades, the mortality rates from DKA have markedly decreased from 7,96% to 0,67%1.

Dr Louise Loot

MEET THE EXPERT


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



References:

  1. Lin SF, LIN JD et. al. “ Diabetic ketoacidosis: comparison of patient characteristics, clinical presentations and outcomes today and 20 years ago.” Chaung Gung Med J 2005, Jan 28(1):24-30

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Jordan Barber – I developed diabetes after a kidney transplant

We hear how Jordan Barber developed post-transplant diabetes mellitus after having a kidney transplant.


Jordan Barber (26) lives in Bloemfontein, Free State.

 

Stage 5 renal failure

Jordan Barber was diagnosed with Stage 5 renal failure in September 2014. His glomerular filtration rate (test used to check how well the kidneys are working) was 4 mL/min. This meant he had End Stage Renal Disease (ESRD); his kidneys had lost almost all ability to function effectively.

Jordan explains, “I was placed on dialysis (where all the toxins are removed from your body by a machine) for four hours a session, three times a week. A transplant was always the only solution and goal my medical team and I worked towards, to get back to a normal life.”

For four years, before a matching donor was found, Jordan had to go for three sessions (four hours) of dialysis every week, while still studying to complete his degree.

“I clearly remember going to dialysis at 4:30 in the morning so that I could be the first one put on the machine. Sometimes I even had to do dialysis on a Friday night which was never pleasant, especially while you are a student,” Jordan says.

Thankfully, he completed his studies in 2019 a year after his transplant.

Transplant

Jordan explains that the process of the transplant was long. “It involves many blood tests, doctors’ consults and other tests to ensure that your body will be able to withstand the transplant, if it’s done. You are also constantly monitored to ensure that if an organ does become available, your body is in the best condition to allow for a successful transplantation.”

“All the complications were discussed and consent had to be given to go ahead with having the transplant and accepting the risks. I recall that one of the risks is even skin cancer.”

He adds, “Waiting just over four years is a long wait. But, well worth it, looking back now and knowing everything one has to go through to receive a transplant.”

On the 19th February 2018, Jordan received a life-changing phone call to say there was a match (from a recently deceased person) and he should come to the hospital immediately.

Life after the transplant

The transplant went well and Jordan started experiencing the benefits. “My life has changed a lot since the transplant. I have a lot more freedom and free time and not constantly planning my life around dialysis. There are no worries about restricting fluids and avoiding eating certain foods anymore. Having a transplant is the greatest blessing that can happen to you. It gave me a new lease of life and a second chance.”

Post-transplant diabetes mellitus

Two years after the transplant, in May 2020, Jordan was diagnosed with post-transplant diabetes mellitus due to complications and side effects of the transplant medication. “In 2019, I had to use insulin for other diabetic related issues that arose due to medication, which was later changed and I could stop taking the insulin.”

When asked if he was upset by the fact that he had developed diabetes due to the transplant, he responds, “I was more nervous that it would affect my kidney function. But, luckily it didn’t. After that I just took things day by day and slowly got used to having diabetes.”

Currently, Jordan uses Apidra, a rapid-acting insulin, before each meal. Then at 10pm every night, he use a long-acting insulin, Optisulin. “Injecting yourself is scary in the beginning but you get used to it very quickly,” Jordan says.

Current lifestyle

The 26-year-old exercises frequently.“I usually walk and play golf in my spare time and try to lead an active and healthy lifestyle. I was due to take part in the South African National Transplant Games in June. But, due to COVID-19, it had to be postponed. I was going to play Table Tennis with the hope of qualifying for the South African team that would go to the World Transplant Games.”

He adds, “I also try to limit carbs and sugar as much as possible and only eat at mealtimes. I don’t snack between meal unless I have a hypoglycaemic episode and I drink a lot of water as well. Adapting to living with diabetes is a challenge. But, once you have a daily routine, it becomes quite easy to manage your glucose levels and it becomes routine.”

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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Sikelewa Duba: The reality of uncontrolled diabetes

Eighteen-year-old, Sikelewa Duba, candidly shares the complications  she has endured with her struggle of controlling her diabetes.


Sikelewa Duba (18) lives in Port Elizabeth. She has Type 1 diabetes and is part of DSA Port Elizabeth Young Guns.

Diagnosis

Growing up I was a healthy child. Then, in February 2015, when I was 13, I lost weight. My mom was concerned as I was a chubby baby. I also started urinating a lot, especially during the night. My mother took me to the doctor. I still remember my first reading; it was 26,6. The doctor told us that I have diabetes and I was admitted to hospital.

I did not know what to expect at the time, but I just did not want to die. I remember not wanting anything to do with needles. Not knowing that they were going to be part of my daily routine, forever. The doctor explained everything about my condition to me thoroughly and a dietitian provided me with a meal plan to follow.

Not getting the most effective medication has been the biggest challenge as my medical aid only covers certain insulins and has limited doctors’ visits. Thus, being the reason why I am a patient at a public clinic. Ultimately, this means that I must work twice as hard to keep my glucose within range.

Diabetic ketoacidosis

For the first two years, it was all smooth sailing in terms of range (4-8). Later, I noticed that my injection site was swelling up. So, I thought that the solution was to inject only twice a day, not four times a day. I wasn’t aware that I should change my injection sites.

At first, I feared skipping a dose. But, as time passed by it was easier not to inject. Little did I know that this would take a huge toll on me later.

In March 2018, the aftermath of my actions began to unveil. I suddenly felt tired and one day on my way to school, I experienced breathing difficulties.

At school, they called an ambulance and I was rushed to hospital where they told me that I had diabetic ketoacidosis (DKA). This was due to me skipping injections which caused uncontrolled diabetes. This was an eye-opener; I could have ended up in a coma.

So, I started working towards who I was before. Someone who managed and took ownership of her diabetes. I stopped skipping injections and starting alternating my injection sites. I also learnt how to adjust my insulin dose, based on my readings. Whenever I felt something was wrong, I tested my glucose and adjusted my insulin dose.

Surgical removal of a boil

In May 2018, I developed a boil on my left buttock. One night the pain was so unbearable that the doctor saw it fit to be removed. This meant that I had to be operated on. I was really scared, but all went well. The doctor explained that the boil was also a result of uncontrolled diabetes.

Since then I have had another boil in my right buttock. Though, this one didn’t need to be surgically removed.

Cataracts

The most recent challenge I faced was not being able to see clearly after lockdown stage 3. I always wore glasses but noticed that my eye sight had become worse. I was referred to an eye specialist and after running a few tests, he concluded that I had cataracts.

As soon as I heard that, I knew it was because of my uncontrolled diabetes. The only solution was to have cataract removal surgery. I wanted to have the surgery as soon as possible because I could not see in class, especially the board. So, on 14th July, my left eye was operated on. Then on 28th July, my right eye was done. The results are amazing that I don’t even wearmy glasses anymore.

Search for a better insulin

My doctor is concerned about my glucose levels and all the complications I have experienced. He is currently researching the different types of insulin that my medical aid will cover and be picked up from a pharmacy. In the meantime, I am monitoring my glucose levels as best as I can.

My journey so far has been tiring but I have learnt a lot as well. The challenges I have faced so far are extremely worrying. They have made me realise that having uncontrolled glucose levels can, and will have, dire consequences in the long run.

I have endured much and there is still much to go through. So, to all Type1’s out there I would like to say: please aim for progress, not perfection. It is always better to start gradually and measure progress using small steps, and avoid taking on too much yourself. Reach out for help.

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