Author: Diabetes Focus eMag

Sebastian Machill

Sebastian Machill – Making her life as easy as possible

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Sebastian Machill shares why he chooses to be as supportive as he can be to his girlfriend who has diabetes, Chelsea Schippers.

Sebastian Machill (23) lives in Wynberg, Cape Town.

Meeting Chelsea

When I met Chelsea, she had just recently been diagnosed. I was really intrigued by her condition, I knew what Type 1 diabetes was biologically speaking. But, it fascinated me how it affected her and how she had to do certain things daily, but I also found it quite sad to hear how normal life is quite difficult for her. Seeing how she pushes on and carries on with life made me see how much of a warrior she actually is. We started dating in March 2022.

Support comes in all forms

I support her in any way that I can, from injecting insulin for her to running around the house or driving to a petrol station at 3am to get her something to combat her lows.

I try to be emotionally supportive too. Having Type 1 diabetes is hard, physically it’s painful but emotionally I think it’s even harder. So, I’m there for her when she needs me. I help her count carbs and help her work out how many units she needs. When her blood glucose has been constant and within the safe zone during the night, I congratulate her every time, or I help her figure out why it went low to prevent it from happening again. I do what I can to make her life as easy as possible.

In my opinion, I think the hardest part of having Type 1 diabetes is the constant reminder that this is your life and that you’ll never be the same. The highs, lows, finger pricks, CGMs, doctor’s appointments; it’s a lot and it’s hard, it truly is. That’s why I admire her so much because despite all of this, she still smiles through it all.

New diabetes knowledge gained

Since dating Chelsea I’ve learnt a lot. There is a massive need for awareness of Type 1 diabetes, and a push to improve the lives of those affected by it, kids especially, and even more so those in the poorer communities who suffer the most.

There is a massive difference between Type 1 and Type 2, and Type 1s more often than not get thrown into the same pool as Type 2s, but yet they are significantly different from each other. Therefore, they get neglected by the government and medical aid companies. I’ve seen an eight-year-old girl having to prick her fingers several times a day and inject her insulin using a big syringe and needle, because it works. It’s heart-breaking.

The best thing I’ve learnt is that despite hardships and difficulties in life, through the highs and lows, there is always a reason to smile. Chelsea taught me that.

Volunteering at DSA

I started volunteering at DSA shortly after I started dating Chelsea when I saw, through her, that they needed all the help that they could get, especially in terms of a film and photography aspect.

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

MEET THE 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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Chelsea Schippers

Chelsea Schippers – Expressing your feelings is essential

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Chelsea Schippers chats about being diagnosed with Type 1 diabetes in her twenties, diabetes burnout, having a supportive partner and volunteering at DSA.

Chelsea Schippers (27) lives in Stellenbosch, Western Cape.

Diagnosis

In September 2020, I was diagnosed with Type 1 diabetes. Since I’ve had diabetes for almost three years, my treatment hasn’t changed much. I started metformin six months after being diagnosed and have decreased my long-acting insulin (insulin glargine) from 30 units to 16 units since being diagnosed.

Currently I’m on metformin, a rapid-acting insulin (insulin aspart) and a long-acting insulin (insulin glargine). I inject 1 unit of insulin aspart for every 15g of carbs/sugar I eat, 16 units of insulin glargine and 1000mg of metformin every night.

Food, fitness and feelings

If had R1 for every time someone told me, “There are carbs in that, so you can’t eat that” I’d be rich. While my body doesn’t make insulin and I have to inject for all the carbs I do eat, that doesn’t mean I have to stay away from them completely. Carbs provide energy and incorporating them in daily meals is vital even as a person with diabetes. I don’t have to avoid bad foods, everything can be enjoyed in moderation. I don’t follow a specific diet and eat what I feel like eating that day but aim to eat 1800 calories a day and keep an eye on my daily carb intake.

Exercising is also important as a person with diabetes. Apart from maintaining a healthy fitness level, it helps to reduce my glucose level if it’s too high. Exercising also releases endorphins which helps with my mental health. I have a gym membership so I’ll either play squash with my boyfriend, Sebastian, or go to a class. We try to go at least once a week.

Expressing your feelings is essential. A year after being diagnosed I ended up in therapy as a result of diabetes burnout. Talking about it really helped me a lot. I encourage anyone who is struggling with diabetes management to speak to someone they trust about their struggles.

Volunteering at DSA

A friend of mine, who also has Type 1 diabetes, told me about Diabetes South Africa. As an adult whose life had completely changed in a matter of days and the difficulties that came with that, I can only imagine what that must be like to deal with as a child. So, I really wanted to get involved with the DSA camp for kids and find a way to help and give back to the children in the diabetes community.

On top of that, there is so much information on diabetes and the differences between Type 1 and Type 2 diabetes. However, this knowledge is not well known in South Africa. DSA does good work in helping people living with diabetes but that is extremely difficult to do when people don’t know of DSA’s existence. I chose to volunteer so that I can help increase diabetes awareness and the importance of medical care for people living with diabetes.

My volunteering began in early 2022. So far, I have helped plan and have assisted at a DSA YT1 camp as a leader which took place last year September. I’m in the process of working with the team on the next camp which will take place in October 2023.

Supportive partner

Sebastian and I met at church in 2021. He saw my continuous glucose monitor (CGM) on my arm one day and asked me about it before we started dating.

He is an amazing partner; he helps me carb count for meals, calculates how many units of insulin to inject and even injects for me sometimes. If my blood glucose is too low or too high, he will quickly get anything I need. He has even gone to the shop for me at 3am when my glucose went low and I had nothing to bring it up.

Sebastian supports me on days when my body is feeling weak and I take a mental health day. He was the photographer at the YT1 camp last year. He took the time to talk to psychologist, Daniel Sher, and his wife, Jess, to ask how he can be a good partner to someone with diabetes. His support has been overwhelming. It brings me so much joy to see the compassion he has for me and the people around him, I couldn’t have asked for a better partner.

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

MEET THE 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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bone health

Bone health for people living with diabetes

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It’s common to hear about the relationship between diabetes and the eyes, kidneys and feet. But, did you know that diabetes can also affect your bone health?

People living with diabetes face a multitude of challenges in managing their condition and bone health shouldn’t be overlooked. Understanding the impact of poor bone health to people living with diabetes is crucial in achieving overall well-being and quality of life.

Bones plays an important role in your overall health, from being a protective shield to delicate body parts to providing structure and support. Bones need to be strong yet light enough to keep you moving. You depend on your bones for many aspects of your life, from the visible (walking and dressing) to the invisible (serving as storehouses for essential nutrients and minerals that the body needs).

Bone modelling and remodelling

Like all of your body parts, bones are active tissue, which means they are actively changing throughout your lifetime. When a child is born, they have few bones that assist in giving them shape (structure) and support, and as they grow the new bones are formed from the cartilage. Every milestone a child achieves results in stronger bones and muscles that enable them to grow in height and become stronger.

There are two bone-making processes involved in the development, growth and shaping of bones  as well as the continuous renewal of bone tissue throughout life.

Bone modelling

During childhood and adolescence, new bone tissue is formed and broken down at different sites throughout the body, allowing bones to grow in size and shape. The process is called bone modelling and continues until age 25 – 30 when the child reaches adulthood.

In some cases the process can be interrupted by health conditions such as Type 1 diabetes, which means people living with Type 1 diabetes might not have full bone maturity .

Bone remodelling

During adulthood, bone remodelling involves the removal and replacement of bone at the same sites to:

  • Replace old bone that can become brittle.
  • Repair small cracks or deformation.
  • Release calcium and phosphorus into the circulation when need arises (dietary inadequacy, pregnancy, lactation).

Figure 1 bone growth[1]

Diabetes and bone health

For people living with Type 1 diabetes, the main concern is bone fragility (ability of bones to break easily at low impact). According of The Lancet Journal of Diabetes and Endocrinology, bone fragility is a recognised complication of Type 1 diabetes. People with Type 1 diabetes have lower bone mineral density (BMD) and greater fracture risk than individuals without diabetes (more than five times for hip fracture and two times for non-vertebral fractures).

Bone fragility becomes a complication because when a person living with diabetes experience a fracture, to repair that fracture isn’t a straightforward process, as such they experience a delay which impacts the proper repair and healing of that fracture.

The research also shows that people with Type 2 diabetes who have complications such as diabetic eye disease or kidney disease are also at increased risk of fragility fractures despite having higher bone mineral density compared to people living with Type 1 diabetes.

Another complication of diabetes is nerve damage which results in impaired movement, increasing the risk of falls. Low blood glucose reactions may also contribute to falls and fractures.

The duration of diabetes also plays a role as those living with the condition for more than five years tend to be at a higher risk for fractures and poor fracture healing.

Other factors of poor bone health

Other factors that can increase the risk of falls and poor bone health that lead to fractures are low levels of calcium and vitamin D. The body parts as well as other substances within the body such as minerals and nutrients don’t work in isolation but work together, which is the case with calcium and vitamin D. They work together to build your bones. People living with diabetes tend to have low vitamin D levels. Vitamin D helps the body to absorb calcium, which the body needs to maintain strong bones.

Hormone interference

There are also important hormones that affect the quality of your bones. As a person living with diabetes and having low levels of the following hormones increases your risks of bone fractures.

  • Low oestrogen is known for causing bone loss. If you’re a woman in menopause, had a hysterectomy with ovaries removed, or  a younger woman with irregular menstruation or menstruation that has stopped for many months even years, you’re at risk of osteoporosis.
  • Low testosterone can also affect bone health.
  • Vitamin D is a true hormone that is made on your skin when exposed to sunlight. Most spend times indoors and don’t receive enough sunlight to activate this essential element the body needs. As you get older, the amount of vitamin D that your skin produces gets diminished.
  • Thyroid balance is important not only for your weight and energy level, but also for your bones. An overactive thyroid or taking too much thyroid hormone to replace an underactive thyroid can make bones brittle within a few months.
  • Extra parathyroid hormone made by an enlarged parathyroid gland in your neck is a common cause of fragile bones and osteoporosis.
  • High cortisol, a stress hormone made in your adrenals, may present a risk of osteoporosis.

Osteoporosis

Osteoporosis (loss of bone mass) is a silent condition. This is why many people may not know they’re at risk or think about prevention until they have a fracture in an unexpected way.

Osteoporosis causes your bones to become weak and more prone to a fracture as you get older. The hip, spine and wrist are most susceptible, but a fracture may occur in any bone.

It’s normal for women to start experiencing a decrease in bone density when they enter menopause. This happens due to hormonal changes and is generally a slow process. Breaking a bone after falling while in a standing position could be a sign of osteoporosis. Any fracture should prompt a discussion of bone health with your doctor.

Osteoporosis is diagnosed with a bone density test, a quick and painless type of X-ray, that provides information about bone strength and the risk of a future fracture. Many people are surprised to learn they have osteoporosis because they have no symptoms.

Unfortunately, osteoporosis can have devastating consequences. Falling may lead to a life-altering fracture and permanent disability.

Earlier screening is recommended for women with certain risk factors, such as a family history of fractures or the use of certain medications (steroids). Those who consumed very little calcium in younger years, had an eating disorder, smoke or consume excessive amounts of alcohol may also be vulnerable to accelerated bone loss. Women who are underweight are also at increased risk.

Treatment for osteoporosis

Medications used to treat and prevent osteoporosis should be tailored for each individual patient.

Most people think of calcium and vitamin D when it comes to bones. However, there are so many more nutrients that are essential for bones, including vitamin B12, phosphorus, magnesium, and vitamin K, to name a few.

It’s preferable to get your calcium from food sources. Though, if supplements are taken, two forms are available: calcium carbonate is absorbed most efficiently when taken with food while calcium citrate is absorbed equally well with or without food.

It’s recommended that patients divide their dose for optimal absorption, taking no more 500mg at one time. A calcium supplement can interact with various prescription medications, so you should talk to your doctor about the best way to take it.

Diabetes and the risk for osteoporosis

People living with diabetes risk losing bone mass at a more rapid rate than average. This is due to complications such as muscle weakness, vision issues, low blood glucose, neuropathy in the feet, and certain diabetic medications that causes bone loss. The factor that increases the risk of osteoporosis the most is sedentary lifestyle.

Protecting bone health

  • Being physically active helps keep blood glucose levelled and is important for bone health. Weight-bearing exercises (walking, jogging and stair climbing) can prevent bone loss and build muscle strength to prevent falls. Maintaining a healthy weight can help preserve bone mass, even as you age and living with diabetes.
  • Eating well-balanced nutritious meals. Avoid refined carbohydrates (white bread and sweetened drinks) that cause blood glucose levels to spike. Limit caffeine (coffee and energy drinks) as they may affect calcium absorption.
  • Having good diabetes control to prevent complications associated with falling, such as nerve damage, vision loss, circulatory problems, and hypoglycaemia (low blood glucose).
  • Quitting all tobacco products. Smoking reduces blood supply to the bones and other organs, increasing the risk of diabetes complications.
  • Limiting, if not completely avoiding, alcohol. Alcohol affects all parts of the body, including the bones, and may cause changes in blood glucose levels.

People with diabetes should have a bone density test to monitor bone mineral density every two years. Routine bone density testing isn’t recommended for men younger than 70 unless they have other risk factors. Since women have a higher risk of osteoporosis, it’s recommended that all women above 50 years of age and post-menopausal women younger than 65 years of age with risk factors get a bone density test.  

Motselisi R Mosiana is a radiographer and the founder of Qsight which offers preventative and wellness care, corrective exercise, health coaching, clinical bone density and whole-body vibration screening.

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Motselisi R Mosiana is a radiographer and the founder of InsureSPR Health which offers preventative and wellness care, corrective exercise, health coaching, clinical bone density and whole-body vibration screening. 
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Thyroid disease

Thyroid disease

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Thyroid disease is common and treatment is highly effective. Dr Louise Johnson tells us more.

What is the thyroid?

The thyroid is a small gland, measuring about 5cm, that lies under the Adam’s apple in the neck. The two halves (lobes) of the gland are connected in the middle (called the isthmus), giving it the shape of a bow tie. Normally the thyroid gland can’t be seen and can barely be felt.

The thyroid gland secretes thyroid hormones, which control the speed at which the body’s chemical functions proceed (metabolic rate). The thyroid hormone influences the metabolic rate in two ways:

  • By stimulating almost every tissue in the body to produce proteins.
  • By increasing the amount of oxygen that cells use.

Thyroid hormones affect many vital body functions, such as the heart rate, the rate at which calories are burned, skin maintenance, growth, heat production, fertility and digestion.

Thyroid hormones

There are two thyroid hormones:

  • T4 (Thyroxine)
  • T3 (Triiodothyronine)

T4, the major hormone produced by the thyroid gland, has only a slight effect, if any, on speeding up the body’s metabolic rate. Instead T4 is converted into T3, the more active hormone.

The conversion of T4 to T3 occurs in the liver and other tissues. Most of T4 and T3 in the bloodstream is carried bound to a protein called thyroxine-binding globulin. Only a little of T4 and T3 is circulating in the blood. However, it’s the free hormone that is active.

To produce the thyroid hormones, the thyroid gland needs iodine, an element contained in food and water. The thyroid gland traps the iodine and processes it into thyroid hormones. As the thyroid hormones are used, some of the iodine contained in the hormones is released, returns to the thyroid gland, and is recycled to produce more thyroid hormones.

The body has a complex mechanism for adjusting the level of thyroid hormones. First the hypothalamus, located above the pituitary gland in the brain, secretes thyrotropin-releasing hormone, which causes the pituitary gland to produce thyroid-stimulating hormone (TSH).

TSH stimulates the thyroid to produce hormones. The pituitary gland slows or speeds the release of TSH, depending on whether the level of thyroid hormones circulating in the blood are too low or too high.

Diagnostic tests for thyroid disease

  1. The neck of a person is examined to feel whether the thyroid gland is palpable.
  2. Blood tests are done measuring T4, T3 and TSH. Usually, the level of TSH in the blood is the best predictor of thyroid function.
  • If the TSH levels are high, the thyroid is underactive. It’s called hypothyroidism.
  • If the TSH is very low, the thyroid is overactive. It’s called hyperthyroidism.

Hypothyroidism

Simply put, this is an underactive thyroid gland and leads to inadequate production of the thyroid hormones and a slowing of vital bodily functions.

Clinical picture

  • Facial expressions become dull
  • Voice is hoarse
  • Speech is slow
  • Eyelids droop
  • Eyes and face become puffy (myxoedema)
  • Hair becomes sparse, coarse and dry
  • Skin becomes coarse, dry, scaly and thick
  • Fatigue is common
  • Weight gain
  • Constipation
  • Muscle cramps
  • Unable to tolerate cold
  • Older people may become forgetful; can easily be mistaken for Alzheimer’s disease
  • People with hypothyroidism have high levels of cholesterol

Causes of hypothyroidism

Primary hypothyroidism is due to a disorder of the thyroid gland. The most common causes are:

  • Hashimoto thyroiditis is an autoimmune disease where antibodies are formed against the thyroid gland and eventually destroy it.
  • Thyroid inflammation (thyroiditis) is caused by a viral infection and is usually temporary.
  • Treatment of thyroid cancer or hyperthyroidism treatment.
  • Lack of iodine in the diet is common in many developing countries. South Africa’s iodine is added to salt to prevent this.
  • Radiation of the head and neck due to the treatment of cancers.

Diagnosis of hypothyroidism

Measurement of the TSH levels in blood. If this value is high, then a second test of T4 can be done to confirm that it is low.

Treatment

Replacement of the thyroid hormone using oral preparations. The preferred form of hormone replacement is synthetic T4 (levothyroxine).

Hyperthyroidism

Simply put, this is an overactive thyroid gland and leads to high levels of thyroid hormones and speeding up of vital body functions.

Clinical picture

  • Heart rate and blood pressure increases
  • Heart rhythm may be abnormal
  • Excessive sweating
  • Feeling of anxiousness
  • Difficulty in sleeping
  • Weight loss without trying
  • Increased bowel movements
  • Hand tremors
  • Increased activity level despite fatigue and weakness
  • Change in menstrual periods in women
  • Changing in the eyes with a look of one that is staring

Causes of hyperthyroidism

The most common causes are:

  • Graves’ disease is an autoimmune disorder. In this disorder the antibodies that are produced against the thyroid, stimulate it to produce more thyroid hormones. This leads to enlargement of the thyroid called a goitre. The eye symptoms are very pronounced with puffiness around the eyes, increased tear formation, irritation and sensitivity to light. This is sometimes called thyroid eye disease. Two distinctive signs are: bulging eyes (proptosis) and double vision (diplopia).
  • Toxic multinodular goitre is a disease where there are multiple nodules (small lumps) in the thyroid. One or more produce excessive thyroid hormones. This is more common with ageing.
  • Thyroiditis is inflammation of the thyroid that at first causes an overactive thyroid due to viral disease or auto antibodies (Hashimoto’s). The thyroid stores become depleted in time and this will lead to hypothyroidism.
  • Single toxic nodule.

 

Diagnosis of hyperthyroidism

Measurement of TSH level in the blood. TSH level will be suppressed and T4 will be very high.

Antibodies against the thyroid can also be done to establish a cause.

Treatment

  1. Treatment of the cause.
  2. Betablockers to block the effect of the thyroid hormone and relieve the symptoms of palpitations, sweating, tremors and anxiety.
  3. Sometimes medication (carbimazole) to block the production of the thyroid hormone.
  4. Radioactive iodine to destroy the thyroid gland. This is the most common treatment of hyperthyroidism since it’s easy to administer a radioactive dosage of iodine that will destroy only the thyroid in a three-to-six-month period without surgery.
  5. Surgery (thyroidectomy) to remove the thyroid or part of it. Sometimes eye surgery is needed in Graves’ disease.

Thyroid disease is a very common disease and should always be suspected. Treatment is highly effective, and any person can live a full life with the correct medical treatment.

Dr Louise Johnson

MEET THE EXPERT

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

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life transitions

Coping with life transitions

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We learn eight tips to help make life transitions more bearable and positive experiences.

There is no escaping change or life transitions and its potential to impact your life. Change can often be stressful and may require adjustment time. Various types of change can seem overwhelming but may also present valuable opportunities for personal growth.

Whether you have been actively seeking change or it has been imposed upon you, there are unique challenges that come with different forms of change.

Typical life changes may include pivotal transitions in work or studies, relationships, or family dynamics, moving home or relocating, loss of a loved one or significant health diagnoses. Change and the uncertainty it brings are part of life and resisting change will not make it any easier.

Change is normal and adjusting to it comes naturally to most people, however, major transitions may mean letting go of the life you are accustomed to and embracing a new one. If a transition is intensely challenging, it can destabilise your thoughts and emotions, leaving you feeling overwhelmed and distressed.

Knowing how to cope with the curveballs life throws at you, is therefore a crucial life skill. Embracing change in a positive way helps you to become stronger and more resilient. Managing change in life is key to personal growth and enables you to live a life where you are thriving, rather than just surviving.

8 tips to cope with life transitions

  1. Understand and accept the limits of what you can control and what is beyond your control. Focus your energy and efforts constructively rather than becoming stuck in anger and denial.
  2. Practise good self-care. Get plenty of sleep, eat a balanced diet, and feel the benefits of physical exercise.
  3. Embrace healthy coping skills. Fun activities such as listening to music, spending time in nature, reading a good book or playing with a pet are good for your well-being and can reduce your stress levels.
  4. Cut out unhealthy coping skills. If you have been turning to activities or habits that do more harm than good, make a conscious effort to cut back.
  5. Seek meaningful connections and support. Spend time with family and friends who are good for you.
  6. Let go of your regrets. Regrets can hold you back in life. Looking back at the past may cause you to miss the opportunities change presents for the future.
  7. Practise self-compassion. Treat yourself with the same kindness and compassion as you would a loved one going through a challenging time in their life.
  8. The gift of gratitude. With reflection you may discover a greater appreciation for what you do have and what remains constant in your life during a period of change.

A life worth living

To create a life that you do not feel you need to escape from, a life worth living, you need to be proactive about how you manage the changes you face in your life. However, sometimes, adjusting can be so daunting and overwhelming that it leads to an adjustment disorder.

This may happen when the stress associated with change exceeds your resources for coping, and your reaction becomes disproportionate to the event. Consider seeking professional mental health support if you are struggling to cope with change.

While the personal experience of adjustment to any change is unique, and may be expected to be uncomfortable initially, it may be cause for concern if you still feel overwhelmed three months later, or your suffering is disproportionate in response to the situation.

If you are not coping in your day-to-day life, social relationships, at home, work, or school, talking to a mental health professional can be helpful in providing emotional support and learning to identify healthy coping mechanisms and stress management strategies.

Seek proper treatment from a therapist or psychiatrist who can help you to manage the condition and learn the skills you need to cope with change and future life transitions.

If you are having a difficult time coming to terms with change or experiencing emotional distress, Netcare Akeso’s 24-hour crisis line is always here for you on 0861 435 787. Trained counsellors are available to listen and can guide you on the various options for assistance, whether for yourself or a loved one.

Belinda Campher is an occupational therapist and the general manager of Netcare Akeso George.

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Belinda Campher is an occupational therapist and the general manager of Netcare Akeso George.
feelings

Is there a link between food and feelings?

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Kate Bristow expands on food and feelings: what food improves mood and knowing the difference between emotional eating and real hunger.

Happiness is something that we are all looking for. Generally, things like exercise, meditation and therapy are top of the list of recommendations. But did you know that the food you eat can play a role in your feelings?

There have been studies done on food and mental well-being and certain foods can be linked to increased serotonin levels in the brain. Serotonin is a chemical, also known as the happy hormone, which plays a big role in regulating your mood. Serotonin levels which are low can cause low mood.

Which foods lift mood and how to manage in diabetes

  1. Dark chocolate – There are components in dark chocolate which have been shown to produce serotonin and have anti-depressant properties. Dark chocolate isn’t a complete no in diabetes; in moderation it can be used to take away that craving for something sweet, and now to bring on a better mood.
  2. Bananas – Although not recommended in large quantities in diabetes, bananas contain vitamin B6 and the body needs vitamin B6 to create serotonin.
  3. Coconut – More research is needed here, but animal studies have found that coconut milk can possibly reduce anxiety.
  4. Coffee – Research shows that coffee consumption has been significantly associated with a decreased risk of depression, including the decaffeinated version.
  5. Avocado – This fruit is packed with good stuff, including choline which the body uses to regulate the nervous system and mood. Studies have shown decreased anxiety in women when they eat avocados. Avos are also rich in vitamin B which is good to decrease stress levels.
  6. Berries – Higher fruit and vegetable intake has been linked to better mental health. Berries are rich in antioxidants, which may reduce symptoms of depression.
  7. Foods which are fermented – Sauerkraut, kimchi, kefir, kombucha and yoghurt help with a healthy gut and may improve your mood. Up to 90% of serotonin is made in the gut, so eating these products will promote the production of serotonin.
  8. Mushrooms – These are packed with vitamin D which has been linked to antidepressant properties and mood enhancement. It’s also easily absorbed in this form by the body. For the best benefit, expose your mushrooms to the sun for a couple of hours before you cook them.

The good news is that the above, eaten in the right proportions are healthy choices and can be included as part of an eating plan in diabetes.

Emotional and comfort eating

We all have a relationship with food, just as we have a relationship with family and friends. And without even thinking about it, you could be an emotional or mindless eater. Add diabetes into the mix with a whole lot of strangers, as in the healthcare team and your family and friends taking extra interest in what you are eating, and it can get complicated.

Food is not just fuel for the body; it can be soothing and nurturing as in a baby receiving breast milk to settle and sooth. It’s not surprising then that you reach for food to help you cope with feelings (stress, conflict, anxiety, relationship challenges), we all need comforting from time to time.

However, even though eating does make you feel better and help settle emotions of distress, it may be beneficial to recognise the cause of the emotion and manage this rather than dull everything with food.

Diabetes itself can be a cause of stress and depression. Having to pay close attention to what you eat and learning on the job can be tough and possibly a cause of emotional eating.

Express your emotions in a safe way

Here’s one example of a conversation with yourself, “I’m eating because I’m frustrated for not being as productive as I would have liked today.”

It’s important to recognise behaviours like this and figure out your triggers and ways to express your emotions in a safe way. For example:

  • Talk to a friend or family member
  • Allow yourself to show emotion e.g. cry
  • Journal
  • Exercise
  • Do something fun to distract yourself

What can you do differently next time?

Dr Jen Nash, a psychologist who is living with diabetes, says that food challenges are real. But she also says that food should be pleasurable and a diagnosis of diabetes shouldn’t mean the end of this. Hunger is only one of 30+ reasons why you eat.

She suggests setting goals which are achievable. Strive to do the right thing 90% of the time and don’t feel guilty when things don’t go according to plan. She suggests an Oh-well attitude and to use the experience as a learning tool – What can I do differently next time?

  • Try not to feel that you’re being watched by everyone and equip yourself to face the challenges that food may give you in the journey ahead.
  • Try practical ideas such as experimenting with new recipes but planning a weekly shopping list and menu is a good idea.
  • Phone a friend who is there to support you and that you can be accountable to. This isn’t stalking, but rather support for choices that you make. Keep in touch with family and friends and reach out if you’re struggling. You are not alone.
  • Look after your body – make healthy choices with regards to food, get enough sleep and exercise regularly.

Mindful eating and how it helps in your meal plan choices

As a person with diabetes, you’re required to pay attention to what you’re eating constantly. Feeling stressed or depressed can be a cause of emotional eating. If you find yourself eating as a form of comfort, substitute this behaviour with an alternative treat: have your nails done, go to a movie or visit a friend.

You should enjoy food but eating mindlessly for the sake of eating means that you’re not taking time out to really savour what you’re eating. Before reaching out for a tasty treat, ask yourself “Why am I eating, am I actually hungry?” This is a more mindful approach.

Mindful eating means that you use all your emotional and physical senses to enjoy the food you’re eating. It encourages better choices for food, which are satisfying and nourishing.

Mindless eating or distracted eating can be associated with anxiety and stress, overeating and the associated weight gain.

How unhealthy eating patterns cause mayhem

Unhealthy eating patterns have been known to lead to mood swings, fluctuations in blood glucose levels and nutritional imbalances. With this lack of stability, your mind and body doesn’t function well.

Examples include:

  • Skipping meals leads to low blood glucose levels which can leave you feeling weak and tired.
  • Cutting out food groups can lead to not getting all the essential nutrients in your diet, which can also lead to mood swings and decreased energy.
  • Too many refined carbohydrates can cause erratic blood glucose levels, low energy and irritability.

Health eating habits

Evidence suggests that a healthy eating plan is both physically and mentally protective. Some general guidelines include:

  • Eat at regular set intervals during the day.
  • Choose less refined sugars and eat more whole grains.
  • Make sure you have protein at every meal.
  • Keep a variety of food in your eating plan.
  • Try to reach and maintain a healthy weight.
  • Drink enough fluid, particularly water.
  • Exercise regularly.

Pause mindfully

Pause mindfully when you eat, intentionally create time between each bite.

P    Present – Stop multi-tasking when you eat, and just eat.

A   Awareness – Be aware of the feeling of hunger, how does it make you feel physically?

U   Understand – Your feelings and how they may influence the food choices you make.

S    Savour – Take a mindful bite – smell, taste, touch, listen.

E    Enjoy – How much are you enjoying this bite?

Mindful eating becomes a strategy to encourage meals with fewer distractions, as well as better eating habits. Taking the time to enjoy the flavour of your food, atmosphere and company has been shown to lead to better psychological well-being, increased pleasure when eating and satisfaction.

So, go out there and enjoy mindful meals with your loved ones and in doing so create better health for yourself and fewer emotional eating habits.

Physical hunger vs. emotional hunger

PHYSICAL

Stomach growling

Thinking/considering choices

Low energy levels

Hunger grows slowly

How much time since the last meal?

Is food satisfying?

EMOTIONAL

What am I feeling? (anger, bored, stress)

How strong were the emotions?

When did you start feeling like this?

How did you hope food may help? (soothe or help you escape feelings)

References

https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/food-psychology/the-eating-journey

https://www.cnet.com/health/mental/8-mood-foods-that-will-make-you-happy/

www.eatingmindfully.com

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

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

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fitness

Making fitness fun

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Monique Marais explains how you can make fitness fun and shares tips on where to start depending on your fitness personality profile.

Fitness means different things to different people. For some, it means taking the dog for a walk while others train for marathons and extreme challenges. Fitness programmes are followed for various reasons, ranging from health-related benefits to weight loss management.

Fitness is not a one-size-fits-all concept and you need to know what your personal goals are to achieve your desired fitness level, and you need to find the motivation to stick to the plan.

Finding that motivation can be difficult, especially when you’re trying to balance a busy work schedule and raising children. The main reason reported for irregular exercise regimes is the lack of time. When you enjoy what you’re doing, you are, however, more likely to stick to it in the long run. The key is to make exercise fun.

F – focused

U – unique 

N – new normal

Focused fitness

Have a clear goal of what you want to achieve. This will help you to stay motivated and identify exercises that will help you achieve these goals. Sometimes you may need some external motivation, so find a fitness buddy that has similar goals to you and motivate each other. Look for group classes or activities in your area that suits your time schedule, pocket, and goals.

Also make sure your goals are achievable. If you continuously miss the target, you’ll become demotivated with the process. Having someone to exercise with gives accountability, which reduces your chance of cancelling at the last minute.

Unique fitness

Find a form of exercise that is unique to your needs. Just because everyone jumps on the latest bandwagon, doesn’t mean it will be suitable for your needs, or enable you to meet your goals.

There is a wide variety of exercises available that cater for different levels of fitness. If you’re a beginner, identify a form of exercise that matches your level of experience and goals. If you’re more experienced, find a new challenge and commit to it. There are also various online fitness programmes and challenges which you can tailor to your needs and schedule.

If the conventional ways of exercising don’t motivate you to get moving, consider options such as trampoline fitness, pole fitness, rock climbing, trapeze, or aerial skills or even horse riding.

New-normal fitness

To achieve sustainability, you need to identify a form of exercise that can fit into your routine and that you will stick to. This might mean exploring different options before settling on something specific. For others, variety is the key, and they want to do different activities.

Know yourself and know your goals. A mind-shift is, however, required; this needs to become part of your routine, your new-normal, a lifestyle change. If you have children, remember that you’re modelling healthy lifestyle choices when you’re choosing to exercise regularly. Include your children when you do physical activities, this way you get to spend quality time with them while working out.

Exercises for all levels of fitness and ages

Benefits of physical activity

 What fitness personality profile are you?

Dr James Gavin (Ph.D.) formulated the following fitness personality profile to help you identify the best fit for you that will be fun and sustainable.

Remember to follow a healthy balanced diet when you exercise to further contribute to your health and weight loss goals. By eating healthy and regular physical activity, you’ll reduce your risk of heart attacks and strokes, and manage symptoms of hypertension and diabetes more effectively.

You need to provide your body with the necessary fuel to continue in this fitness journey to prevent injuries and complications. Also check with your healthcare provider if you have any chronic conditions before starting a rigorous exercise regime.

Go out, get fit, get healthy, and have some fun while doing it!

References

6 Ways to Put Fun Back in Your Workout | MyFitnessPal

Fun Ways to Exercise: 23 Unconventional Workout Ideas | Bulletproof

Starowicz, J., Pratt, K., McMorris, C. & Brunton, L. 2022. Mental health benefits of physical activity in youth with cerebral palsy: a scoping review. Physical & Occupational Therapy in Paediatrics, 42(4):434-450.

Ntwanano, A.K. & Pule, E. 2016. Psychosocial and psychical benefits of exercise among rural secondary school students. European Review of Applied Sociology, 8(11):14-18.

Hosseini, S.A., Salehi, O., Keikhosravi, F., Hassanpour, G., Ardakani, H.D., Farkhaie, F., Shadmehri, S. & Azarbayjani, M.A.  2021. Mental health benefits of exercise and genistein in elderly rats. Experimental Aging Research: An international journal devoted to the scientific study of the aging process, 48(1):42-57.

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.

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Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

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Polycystic ovarian syndrome

Polycystic ovarian syndrome

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Dr Louise Johnson expands on polycystic ovarian syndrome and the risk of it leading to Type 2 diabetes.

Polycystic ovarian syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. It was described in 1935 by Stein and Leventhal.

Systematic screening of women according to the National Institute of Health diagnostic criteria estimate that 4 to 10% of women of reproductive age suffer from PCOS.1

Understanding PCOS

PCOS is a hormonal imbalance when the ovaries create excess androgen hormones.

The diagnosis of PCOS can follow one of three guidelines:

National Institute of Health criteria:

  1. Hyperandrogenism (high male hormone)
  2. Menstrual irregularity

Androgen Excess PCOS Society criteria:

  1. Hyperandrogenism
  2. Menstrual irregularity or polycystic ovaries on ultrasound

Rotterdam criteria (2 of 3):

  1. Hyperandrogenism
  2. Menstrual irregularity
  3. Polycystic ovaries on ultrasound

In polycystic ovaries there are small follicle cysts (fluid filled sacs with immature eggs) visible on your ovaries on ultrasound due to lack of ovulation (anovulation). This is one of the most common causes of infertility in women.

Signs of PCOS

  • Irregular periods which include missing menstruation or heavy bleeding.
  • Abnormal hair growth on arms, chest and abdomen. This is called hirsutism and affects up to 70% of women with PCOS.
  • Acne especially on face, chest and back. This may continue past teenage years and is difficult to treat.
  • Obesity is common in 40 to 80% of women with PCOS and they have trouble maintaining a healthy weight.
  • Darkening of skin in the folds of the neck, armpits and groin and under breasts. This is called acanthosis nigricans.
  • Cysts on ovaries that appear larger or with many follicles (egg sac cysts) on ultrasound.
  • Skin tags in armpits or on the neck.
  • Thinning hair or patches of hair loss.
  • Infertility is caused by PCOS.

What are the main causes of PCOS?

The exact cause is unknown. Genetics may play a role. Several other factors, most importantly obesity, also play a role. Other factors that play a role are:

  1. Higher levels of androgens (male hormones)
  2. Insulin resistance
  3. Low grade inflammation

How is PCOS diagnosed?

Clinical history of abnormal menstrual cycle.

Signs and symptoms as discussed above.

High levels of testosterone and luteinizing hormone (LH).

On ultrasound more than 12 follicles in each ovary.

Follicle size between 2 and 9mm.

Morbidities associated with PCOS

Obesity

This is one of the most common features of PCOS and varies between 61 and 76%. Childhood obesity is a well-documented risk factor for PCOS.

Insulin resistance

This is considered the main pathogenic factor in the background of increased metabolic disturbances in women with PCOS which can explain high androgen levels, menstrual irregularity and abnormal blood lipid levels.3

Type 2 diabetes

PCOS confers a substantially increased risk for Type 2 diabetes and gestational diabetes from early ages. About 1 in 5 women with PCOS will develop Type 2 diabetes.

Cardiovascular disease

In 1992 Dalhgren et al2 identified a 7 times higher risk of heart attack in women with PCOS compared to healthy people. More recent data shows higher burden of atherosclerosis and early onset cardiovascular dysfunction and heart vessel calcifications.

Infertility

In a 2015 study it was shown that infertility is 10-times more common in women with PCOS than in healthy controls. Women who conceive with PCOS might suffer from pregnancy-related complications, such as gestational diabetes and pregnancy-induced hypertension. Concerning the effects of the foetus, women with PCOS are 2.5 times at a higher risk of giving birth to a small for gestational age child.

Cancer

Females suffering from PCOS are at risk for endometrial cancer. Studies show a three-fold increase risk to develop endometrial cancer.

Psychological well-being

Women with PCOS are more prone to suffer from depression, anxiety, disordered eating and psychosexual dysfunction. It’s worth noting that obesity, acne, hirsutism and irregular menstrual cycles, all associated with PCOS, are major contributors to the psychological stress that the patients experience due to the challenging of the female identity and her body image.

Treatment

The management of PCOS targets the symptomatology for which patients usually present: anovulation, infertility, hirsutism and acne.

Lifestyle

Lifestyle modifications, such as exercise and a calorie-restricted diet, are considered as a cost-effective first-line treatment. Excessive weight is associated with adverse metabolic and reproductive health outcome. For instance, female fertility significantly decreases with body mass index (BMI) more than 30.

Multiple studies show that weight decrease as little as 5% regulates menstrual cycle, improves fertility, reduces insulin and testosterone levels, decreases acne and hirsutism and benefits psychological well-being.

Medical treatment

  1. Oral contraceptive pills

Oral contraceptive pills are the most used medication for the long-term treatment of women with PCOS. It’s recommended for regulating of menstrual cycle and decrease of testosterone levels as first-line treatment. A minimum of six months on oral contraceptives is usually required to obtain satisfactory results against acne and hirsutism.

  1. Metformin

Metformin is an oral antidiabetic biguanide drug that acts on suppressing glucose production from the liver and increasing peripheral insulin sensitivity. The use of metformin in women with PCOS decreases insulin resistance, reduces testosterone levels and improves glucose managing in the body.4

Screening recommendations

Screening for Type 2 diabetes

Women with PCOS should be routinely screened for Type 2 diabetes. Studies have shown that measuring only fasting glucose in patients with PCOS miss up to 80% of prediabetics and 50% of diabetics.

Current guidelines suggest screening women with PCOS using an oral glucose tolerance test every three years. Risk factors that require screening more often are:

  • Family history of diabetes
  • Hypertension medication use
  • Smoking
  • Increased waist circumference more than 80cm in females
  • Physical inactivity

Screening for cardiovascular disease

Women with PCOS should be screened regularly for risk factors such as:

  • Increased waist circumference
  • Smoking
  • Blood pressure
  • Abnormal cholesterol profile (increase triglycerides and low HDL)

 Screening for psychological well-being

Screening women with PCOS for depression, anxiety, negative body image and eating disorders is important.

PCOS is a complex disease and should be managed by a team of medical practitioners from a dietitian, psychologist, gynaecologist, dermatologist and specialist physician. Team work can lead to a successful outcome.

References

  1. Azzizz R, Woods K et.al. (2004)’The prevalence and features of the polycystic ovary syndrome in an unselected population.’ J Clin Endocrinol Metab. 89,2745-2749
  2. Dahlgren E, Janson P et.al. (1992) ‘Polycystic ovary syndrome and risk for myocardial infarction.’ Acta Obstet Gynecol Scand. 71,599-604
  3. Diamanti -Kandarakis E, Dunaif A (2012) ‘Insulin resistance and the polycystic ovarian syndrome revisited: an update on mechanisms and implications.’ Endocr Rev, 33 981-1030
  4. Hayek S.E., Bitar L et. al. (2015) ‘Polycystic ovarian syndrome: an updated overview’ Physiol, 7:124
Dr Louise Johnson

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

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hypoglycaemic anxiety

Managing hypoglycaemic anxiety

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Dr Paula Diab discusses hypoglycaemic anxiety, its impact on diabetes management and provides practical strategies to help take control and reduce it.

Living with diabetes can present numerous challenges, including daily glucose monitoring; paying careful attention to what you eat and when you eat; and compensating for normal, everyday lifestyle challenges such as stress, exercise and hormonal changes. Added to these challenges is the ever-present danger of low blood glucose levels (hypoglycaemia). While hypoglycaemia can be concerning in itself, it can also trigger hypoglycaemic anxiety and stress which may even exacerbate glucose levels further.

Understanding hypoglycaemic anxiety

Hypoglycaemic anxiety refers to the fear or worry experienced by people living with diabetes regarding the possibility of experiencing low blood glucose levels. This anxiety can stem from concerns about the physical symptoms as well as potential complications associated with hypoglycaemia.

Symptoms associated with hypoglycaemia include dizziness, confusion, and even loss of consciousness. These may often be misinterpreted as an anxiety attack or exacerbated by associated anxiety.

A previous experience of hypoglycaemia will also have a significant impact on future decision-making. Additionally, the fear of not being able to manage or control these episodes can contribute to heightened anxiety levels.

This is particularly true for the elderly; people who live alone and those who have poor or unstable support systems. Even an adult living with a spouse at home may feel unsupported and anxious if the spouse’s work demands irregular working hours or shift work. Children who have unpredictable daily routines where one day involves a two-hour sport practise after school and the next day is more sedentary or when sports practise is suddenly cancelled, or the time moved, or some aspect of the exercise changed.

Even those who rely on served meals (old age homes, hospitals, boarding schools, work conferences, travel, etc.) may experience anxiety at not being in control of what food they have access to at any time.

Impact on diabetes management

Hypoglycaemic anxiety can have a significant impact on diabetes management. Anxiety and stress can lead to hormonal changes that affect blood glucose levels, potentially triggering a vicious cycle of unstable glucose control.

Fear of hypoglycaemia may also result in intentionally maintaining higher blood glucose levels to avoid low episodes, which can lead to long-term health complications. It’s crucial to address hypoglycaemic anxiety to maintain a balanced and healthy approach to diabetes management.

Strategies to prevent hypoglycaemia

As with most challenges in diabetes, awareness and education are key to gaining control. Understand the signs and symptoms of low glucose levels and discuss them with your healthcare team.

Learn to recognise your individual triggers and identify the steps to prevent and treat low blood glucose effectively. This may differ for each and every individual.

Insulin

The most common culprit is short-acting insulin as this is exactly what it’s designed to do. Long-acting basal insulins don’t generally have a high risk of hypoglycaemia. Particularly the newer basal analogue insulins are very stable and don’t have a high risk for hypoglycaemia.

Pre-mixed insulins may also cause hypoglycaemia as they have a short-acting component in them and if you haven’t eaten enough to compensate for the insulin, your glucose levels will drop. Try to opt for newer insulins that have a lower risk profile.

Delayed food intake

Skipping meals, delaying meals, or inadequate carbohydrate intake can cause a drop in blood glucose levels. It’s important to maintain a regular eating schedule and include balanced meals and snacks to provide a steady supply of glucose to your body. When planning and scheduling isn’t in your control (boarding schools, catered meetings, travel), make sure that you speak to your healthcare team and mitigate this risk as best you can.

Physical activity

Engaging in physical activity or exercise can lower blood glucose levels, particularly if you aren’t properly fuelling your body before and after exercise or if the activity level is more intense than usual.

Once again, a change in scheduling of exercise, may enhance your risk of hypoglycaemia so try to mitigate the risk as best you can and understand what changes can be made if necessary.

The combined anxiety of a change in routine added to the risk of hypoglycaemia with exercise may well be a perfect storm so try to plan your exercise and stick to the regime as best you can.

Alcohol

Alcohol can interfere with the liver’s ability to release stored glucose, leading to hypoglycaemia. It’s important to consume alcohol in moderation and with food to help prevent low blood glucose.

Again, an honest discussion with your healthcare team can prepare you for this risk and help you to make the necessary adjustments rather than being afraid of a potential glucose low and making incorrect decisions around your medication.

Illness

Factors such as illness, hormonal changes (during menstruation), and stress can affect insulin sensitivity. These changes can result in increased insulin activity, potentially leading to hypoglycaemia. Education and awareness are the key ways to understand how these events will impact you and what you need to do to avoid hypoglycaemia.

Mistakes

You are human. You make mistakes. Sometimes you may confuse your long and short-acting insulins or miscalculate a carbohydrate intake. Such errors often result in glucose lows. Know how to correct your mistakes and have emergency plans in place.

Insulin pump malfunctions

If you use an insulin pump for diabetes management, a malfunction or infusion site issue can lead to improper insulin delivery. This usually results in glucose levels to rise but the corrective action may be a bit too severe and you may end up with a rebound hypoglycaemia. Many of the newer pumps have cut-off alarms and suspend functions that can now predict hypoglycaemia and switch off insulin delivery to prevent the event occurring.

However, a past experience of hypoglycaemia may tempt the user to override the pump actions and this generates artificial machine learning. Disconnecting your pump and allowing it to deliver insulin outside of your body or manually overriding settings aren’t encouraged as this will result in incorrect decision-making in the future. Speak to your pump specialist about individualising these settings and ensuring they work best for you. Too many alarms and alerts can also result in alarm fatigue where users ignore warning signs and don’t act appropriately.

Medications

Certain medications, such as those used to treat other health conditions like beta-blockers or some antibiotics, can mask the symptoms of hypoglycaemia or affect blood glucose regulation, increasing the risk of low blood glucose. If you’re taking other medications, make sure that they aren’t compounding the problem and be aware of additional signs and symptoms to look out for.

Test, test and test again

Regular monitoring of blood glucose levels empowers you to detect and address potential fluctuations promptly. There is unfortunately no easy and cheap way around this. Regular finger-pricking and interpretation of the numbers can give you important information as to how various lifestyle events, medications and situations affect your blood glucose levels. The more often you test, the more you can predict future patterns.

As an example, if you test regularly before going to bed and know that you’re generally safe if your levels are around 7 – 8mmol/L, then you can be assured that your levels will remain at that level overnight and not drop low.

Not testing leads to too many unknowns and consequent anxiety that a potential hypo will occur which, in turn, leads to false decision-making. By keeping a close eye on your glucose levels, you can gain confidence in managing your diabetes and reduce anxiety associated with hypoglycaemia.

Managing anxiety

Once you’re aware of the nuances of diabetes management and have educated yourself on the effects of daily food intake, activity and hormonal changes, then you can start to plan and make the necessary adjustments that are required.

Try to build a strong support network which can provide a valuable source of encouragement and assistance. Identify one (maybe even two) person/s that you trust (and who you have educated on diabetes) who can call you out and alert you to signs of potential danger.

One of the many downsides of hypoglycaemia is that it affects your executive brain function and decision-making abilities. It can also make you irrational, irritable and angry. Very often, people who are experiencing a severe low glucose level will make decisions that they would not normally make simply due to the physiological changes in their body as a result of the low glucose. Have a trusted friend who can very directly comment on your behaviour and enforce correct decision-making.

Try to find your tribe. Connect with other people living with diabetes through support groups or online communities. Sharing experiences and seeking advice from peers who understand your challenges can help alleviate anxiety. Very often these community groups can provide sound advice and understanding when healthcare professionals are unable to. It’s difficult to empathise with the fear associated with a severe hypoglycaemic episode if you have never experienced it yourself.

Mitigate stress

We are all far too stressed. At this time of year, we’re usually mentally exhausted. Having navigated the cold winter months, the onslaught of public holidays in the first half of the year that wreak havoc with business practices and still just too many months left until the end of the year. Medical aid funds are often depleted at this time and people are unwilling to invest time and money into healthcare.

Although the end of the year may rehabilitate your medical aid benefits, it will do no more than that. There will be more breaks in business function, more stress, more curveballs. Try to incorporate stress management techniques into your daily routine, such as regular exercise, meditation, deep breathing exercises, or engaging in hobbies you enjoy.

Reducing overall stress levels can positively impact both your mental well-being and your blood glucose control and will go a long way to improved diabetes management in the long run.

If hypoglycaemic anxiety significantly impacts your quality of life and ability to manage diabetes, don’t hesitate to seek professional help. Mental health professionals with expertise in diabetes care can provide guidance and support to address anxiety-related challenges effectively.

Questions to ask yourself are:

  1. How confident are you that you can stay safe from hypoglycaemia when:
  • Exercising
  • Sleeping
  • Driving
  • Social situations
  • Alone

If you feel that you lack confidence in any of these situations, then seek professional assistance from your diabetes team before you encounter the problem. Ensure that you know how to avoid and respond to hypoglycaemia and this will greatly diminish your anxiety. Involve your family and friends and ensure that those close to you are also well-equipped to support you.

Conclusion

Hypoglycaemic anxiety is a common concern among people living with diabetes. However, by understanding the condition, implementing effective strategies, and seeking support when needed, you can regain control over your diabetes management and reduce anxiety surrounding hypoglycaemia. Remember, managing diabetes is a journey, and with time, patience, and support, you can overcome hypoglycaemic anxiety and live a fulfilling life while effectively managing your condition.

Dr Paula Diab

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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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