Author: Diabetes Focus eMag

kidney disease

The connection between kidney disease and diabetes

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Diabetic kidney disease remains the most common cause of end-stage kidney disease in the world. It’s important to follow the five point treatment plan to decrease developemnt.

The kidney is a vulnerable organ as well as the most important target of microvascular damage in both Type 1 and Type 2 diabetes.

The first description of the association between diabetes and kidney damage in humans was in 1552 BC.2 As the disease spectrum has changed around the world, diabetic kidney disease (DKD) has become the single most frequent cause of end-stage kidney disease.

Kidney involvement both directly and indirectly increase involvement of other organs especially the heart and eye, and increase morbidity and mortality in diabetic patients.

The overall incidence 20 years after the diagnosis of diabetes is approximately 4 to 17% and after 30 years is about 16%. According to some studies the incidence of kidney disease in Type 1 diabetes is decreasing. The main reason for that is early diagnosis of Type 1 diabetes and good control of hyperglycemia.1

In Type 2 diabetes. the kidney damage may be present at the time of diagnosis. This is why it’s so important to screen people susceptible to Type 2 diabetes regularly for abnormal glucose values.

Genetics

Many patients with long-term high glucose have no diabetic kidney disease while others with a short disease course have clinical diabetic kidney disease (nephropathy). This may be due to predisposing factors including genetics.

The risk of diabetic kidney disease increases in Type 1 and Type 2 diabetes if the patient has a history of diabetic kidney disease in one of their first-degree relatives.

Patients living with diabetes who have a family history of hypertension or heart disease are more likely to develop diabetic kidney disease.

Screening

The easiest screening method is to evaluate a urine sample. This can be done in a doctor’s office with a urine dipstick. If this is normal, the urine sample should be sent to a laboratory for a urine albumin-creatinine ratio test.

Natural course of diabetic kidney disease

First stage

The filtration through the kidney tubes, called glomeruli, increases and the kidney enlarge. The urine albumin-creatinine ratio is still normal and blood pressure is also normal.

Second stage: microalbuminuria

With the progression of kidney involvement, urine albumin-creatinine ratio will also increase. This stage is called hidden or subclinical kidney disease.

In this stage, the conventional urine test strip in the doctor’s rooms will be negative but the risk of heart disease starts to increase. With Type 1 diabetes, the prevalence of other microvascular (small vessel) diseases start to increase, such as the eye and the feet. With Type 2 diabetes, other factors, such as age, high cholesterol, high blood pressure and duration of disease, play a role to increase microalbuminuria (small proteins in urine).

Diagnosis at this stage is a very good opportunity to prevent progression to clinical kidney disease.

Third stage: macroalbuminuria

This stage is also called diabetic kidney disease or clinical nephropathy. It occurs about 10 to 20 years after onset of diabetes; about five to 10 years after the onset of microalbuminuria.

In this stage, heart disease and strokes also increases compared to the previous stage, and about 75% of patients have high blood pressure. Control of blood pressure in Type 2 diabetes with previous hypertension becomes more difficult.

The conventional dipstick test in the doctor’s rooms is positive for proteins. Due to the leaking of proteins in the urine, these patients can develop swelling of the legs. If the leaking of proteins increases more the swelling can also develop around the eyes.

Fourth stage: End stage kidney disease

The end stage of kidney disease is reached about 10 years after the onset of clinical kidney disease (stage 3). The risk of heart disease and stroke increases, and the incidence of foot ulcers are also increased.

The prevalence of Type 2 diabetes to develop end stage kidney disease is nine times higher than Type 1 diabetes.

Diagnosis

To prove the diagnosis of diabetic kidney disease, the following criteria is used:

  • Enough time. At least 10 years past the onset of diabetes but this may be shorter in Type 2 diabetes.
  • Persistent proteins in urine more than 300mg in 24 hours ( normal is less than 30mg per 24 hours).
  • Diabetic retinopathy (eye disease) at the same time.

There are other causes in diabetes that can also lead to kidney disease:

  • Uncontrolled blood pressure
  • Recurrent bladder infections
  • Increased cholesterol with renal artery stenosis (decreasing of blood flow to the kidney)

Five point treatment plan

Treatment is based on the following principles:

  • Tight control of glucose

Keep the HbA1c (3 month average blood glucose) below 7% and in patient with glucose sensors; keep the time in range (time between 4 and 10 mmol\L in 24 hours) more than 70%.

  • Control of blood pressure

Both high glucose and high blood pressure can progress to kidney disease. In the control of blood pressure, it’s important to use the correct drug that address the kidney function as well. The renin-angiotensin-aldosterone system inhibitors can reduce the progression of diabetic kidney disease. There are two groups in this class: ACE inhibitors (perindopril or enalapril) and ARB group. (valsartan or losartan).

  • Restriction of protein intake

High protein intake increases the filtration of blood through the kidney. Protein restriction can decrease the progression of kidney disease

  • Stop smoking

  • Manage cholesterol

The aggressive treatment of abnormal lipids reduce both microvascular (small vessel disease such as eye, kidney and feet) and macrovascular disease (heart attack and stroke). The therapeutic target for LDL cholesterol (bad cholesterol) is below 1,8 mmol/L.

New drugs

The use of the ACE and ARB drugs was up to 2016 the only drugs, except cholesterol lowering medications, that could slow diabetic kidney disease.

There are now two new drugs available in SA that decrease the progression of diabetic kidney disease by 30%. These drugs are from the class sodium glucose transporter 2 inhibitor (SGLT2i) and work in the upper part (proximal tubuli) of the kidney. The reabsorption of glucose and salt are blocked. This leads to glucose in the urine and due to this: weight loss, decrease of blood pressure and improvement of kidney function are seen. The two available drugs in RSA are dapagliflozin and empagliflozin.

Final thought

Diabetic kidney disease remains the most common cause of end-stage kidney disease in the world. It’s important to follow the five-point treatment plan to decrease the chance to develop the disease, and should it already be present to use the correct drugs to decrease the progression of the disease.

Reference:

  1. Bojestig M et.al. “ Declining incidence of nephropathy in insulin dependent diabetes mellitus.” N Engl J Med 1994;330: 15-18
  2. Cameron J.S. 2006 “The discovery of diabetic nephropathy: from small print to centre stage.” Journal of Nephrology 19 ( Suppl 10): S75-S87
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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Warren Epsey

Warren Epsey chooses determination over diagnosis

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A diabetes diagnosis couldn’t even disrupt Warren Epsey’s sporting lifestyle. With honest acceptance, immense planning and the support of his wife, he is set to take on Ironman.

Warren Espey (37) lives in Lakeside, Cape Town with his wife and twin daughters (8).

Avid sportsman

Ever since I was a child, I always enjoyed being active and playing all sorts of sports. I started surfing at a young age and then through school I enjoyed rugby, cricket, golf and tennis. After school found my passion for cycling and running, with golf as a social sport. Four years ago, I found a new passion in triathlons.

All in all, I have done three marathons, eight half marathons, three half ironman distance triathlons, and many small triathlons. I also did the Knysna Extreme Triathlon 0.5 (2km swim/100km bike and 30km trail run), 100miler MTB race and many road races.

Diagnosed as an adult

I took part in the 2019 Sanlam Cape Town Marathon and was feeling really good. Then at 30km I hit the wall as runners call it. For the last 12km I  struggled but managed to finish. I then headed off to China for business and whilst away I was extremely thirsty, drinking up to eight litres of water a day. I thought I may have been dehydrated from the marathon and then travelling.

Once I returned I contacted my GP as I was still extremely thirsty. He did tests and confirmed it was diabetes. He explained that the wall I hit was a sugar low and not knowing this was a great learning lesson for me going forward.

Treatment

I was initially put onto tablets and treated as a Type 2. That, however, was short-lived as my blood tests came back and I was put into contact with a specialist physician. He diagnosed me as a Type 1 and admitted me into hospital for a few nights to get my glucose under control and to get my insulin dosage correct.

Ever since then I’ve been on insulin (short-acting and long-acting) and only my dosages have changed. This constantly depends on many factors, such as sports and training to eating patterns, etc. Currently, I use insulin glulisine (short-acting) and insulin glargine (long-acting).

Managing diabetes while doing sports

Honestly, managing diabetes and endurance sports is very difficult and I’m still learning. Whilst the training is nothing short of hectic, it becomes challenging to manage my blood glucose.

Different run sessions, for example, will all effect my blood glucose differently. The weather also has an impact on blood glucose together with diet and what has been eaten in the past 12 hours.

As said, I’m still learning how to manage this. I’ve recently been using the FreeStyle Libre to help understand what happens to my blood glucose levels whilst being active and also to help understand what happens after meals.

It’s a constant learning curve and I feel having diabetes and enjoying endurance sports, this will continue as there is no exact science as to how the body will cope with the session, the heat, the intensity, etc.

Becoming a DSA member

Once I was diagnosed, I wanted to learn more about diabetes so signed up to become a DSA member. Once I’m educated enough I want to help others as there is not much info and support in SA. I believe we are very uneducated, and we need to help one another.

I would like to attend one of the DSA Support meetings that they host so I can meet and learn from other people living with diabetes.

Family adjusting to diagnosis

My wife and I decided to keep our girls involved in everything like shopping, why I can’t eat certain things, carb counting, how I take insulin. They are very knowledgeable about diabetes for their age.

With that said, for eight-year-olds, they understand as much as they can without striking fear into them. As parents we have taught them as much as we can without making them fear the diagnosis.

Eyes set on Ironman

A goal of mine has always been to test myself and see who the real Warren Espey is. It may sound clichĂ©, but I really find that sport and especially endurance sport isn’t so much about talent, but more to do with mental toughness and true reflection of an individual.

The commitment to the training over a year (three years thanks to COVID) will really uncover the cracks in an individual. The learning you get, and self-reflection will only bode well for what life can and will throw whether it’s work, family, friends, or the normal life pressure one deals with.

I believe Ironman will help in so many personal areas, not just the medal you get at the finish line.

Delayed, delayed and delayed

The plan was to do my first full Ironman in March 2020. However, with the pandemic this was delayed to November 2020 which then became March 2021 which became November 2021.

I had trained from February 2019 for this but, in August 2021, we found out our one daughter had to undergo some brain surgery in October with no secure timeline on hospital time to full recovery time. So, I stopped all my training and focused on my family.

Things have gone as best they could go all things considered. So, I’ve deferred my entry until March/April 2023. The date is still to be confirmed.

My new goal for this year now is to do The Comrades Marathon and three half Ironman distance races this year as this is more plausible with the timeframe of what has transpired recently.

Training 

A general week of training eight months before a competition is:

Monday – 50 min gym session; 3,8km swim

Tuesday – 1h40 indoor bike session; 12km run

Wednesday – 3km swim; 50 min gym session

Thursday – 2-hour indoor bike session; 12km run

Friday – Interval running: warm up 2km, 16x300m sprints with 100m jog in between, 2km cool down

Saturday – 4-hour ride onto 20 min run off the bike

Sunday – 21 km run

Achieving balance

Maintaining balance in work, family, diabetes management and everything else is the most important thing to achieve. I’m very lucky in that I have the most supportive family and friends around me. My wife is very special and not only supports me but encourages me.

Having the support, I do makes life a lot easier. She is so involved with my eating and diabetes and tries to help whenever she can.

Planning is vital, and sacrifices have to be made to achieve a goal. Early morning sessions. Work unfortunately is work and pays the bills. Evenings vary depending on the block of training I’m in, when its serious then it’s tough. I try train as much as I can at home on the indoor bike or treadmill, so my presence is still there, but it’s hard either way.

Diabetes is always there and managing that is a constant thing that needs to be accepted and made a part of your life. Acceptance of the disease is so important.

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Megan Soanes – Nurse, mother and wife

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DSA SA Port Elizabeth board member, Megan Soanes, shares what it is like to have both her husband and son have Type 1 diabetes.

Megan Soanes lives in Gqeberha (Port Elizabeth) with her husband, Scott and their two children, Gabriel (11) and Cheyanne (4).

My husband has Type 1 diabetes

My husband, Scott (45) was diagnosed with Type 1 diabetes at age 12; he is insulin-dependent. When we started dating, it was a challenge for me to learn about diabetes, but after 12 years of marriage, I now understand the auto-immune disease.

Admittedly, it took time to learn the nuances of the disease and accept that it was not in my power to cure but rather maintain. One weekend, in 2018, everything appeared to be normal, little did we know our lives would change forever.

Finding out our son also has diabetes

My husband noticed that our, then 7-year-old son, Gabriel, was constantly thirsty and always needed the bathroom. My husband told me to test Gabriel’s blood glucose. To my shock, it was sitting on 35,2 (the normal level being between 5-7). We rushed him to the doctor, only for him to confirm what we already suspected. My baby boy is a Type 1 diabetic just like his dad.

My son and I cried together as we already knew what his father goes through with his diabetes. I always knew, in the back of my mind, that this could happen when I fell pregnant, but every mother hopes for their kids to be healthy.

It’s not easier for my son

Many people assume that it’s easier for Gabriel to accept his diabetes and the responsibilities that come with it, seeing that his father has diabetes. This is not the case. A seven-year-old child doesn’t expect to have the responsibility of keeping their glucose levels ‘normal’ and they certainly don’t want to stick needles in their bodies three to four times a day.

In the beginning, and still four years down the line, Gabriel is constantly worried that his glucose will drop when he is sleeping over at a friend, or anywhere that he doesn’t have immediate access to his medication.

High fibre diet

Although we try maintain a healthy diet, we, as a family, don’t follow any strict diet rules but we do keep Gabriel on a high fibre diet and ensure he stays away from starch. Luckily that is easy as Gabriel doesn’t enjoy pasta, rice or potatoes. In contrast, Scott loves starch.

It does become a challenge to figure out what snacks are appropriate for maintaining a good glucose level; this comes with time and research. We have found that our go-to snacks for when Scott or Gabriel have low glucose levels would be a juice box and Super Cs. If their glucose level is high, they take some insulin (a correction dose) and drink a lot of water.

Thankfully, we, as a family, love the outdoors, especially hiking and are always looking for new adventures. Over December, we did a 10km hike; I was exceptionally proud of Gabriel and Scott.

Nurse, mother and wife

Honestly, it’s not easy living with two family members who have Type 1 diabetes. There are days when I want to throw myself under my blankets and scream, “Why me, why do I have to deal with this?”

However, at the end of the day I know that Scott and Gabriel didn’t ask to have diabetes and I shouldn’t complain. I have to put on my ‘mother doing her best’ crown and carry on.

The big thing that keeps me going is knowing the best support system for my husband and son, is me. For them, I’m on call 24/7, 365 days a year. No leave, no holidays. I’m a nurse, a mother and a wife.

I do have faults, just like everyone else, and I get those days where I’m impatient, due to being a full-time working mom. I also get tired and want to have someone wait on me when I’m not feeling well, or to be left alone when I’m irritated, but I take one step at a time and keep moving forward.

Advice to other mothers and wives

My advice to moms and wives living with people who have Type 1 diabetes is:

  • Don’t expect the person with diabetes to be perfect. You’ll be chasing a lost dream, there is no such thing as a perfect diabetic. Each case is unique and can influence your lives in different ways.
  • Live life and be the support pillar that they need and always know there is a support group you can reach out to.
  • It’s important to remember, diabetes can’t take a backseat just because you’re a mother. To the contrary, diabetes is a priority because you’re a mother. This is one of the reason that makes me understand the reality of being a mother and a support figure for the two people in my house afflicted by Type 1 diabetes can leave anyone feeling overwhelming some days.

I’m sure all mothers and wives would agree, even without Type 1 diabetes in the mix, it’s very hard for mothers and wives to make themselves a priority. Everybody wants a piece of your time, your energy, and your heart. However, it’s important to know and accept that your needs matter, too, Mama! Like they say, “If Mama isn’t happy, then nobody is happy!”

Strive for balance

As difficult as it may be, the key to living a happier life is balance. So, think about what you need to create more balance in your life as a mother and wife. Some things you could possible try are: 30 minutes of exercise in the morning or motivating your children to be more responsible for cleaning and making their own beds. This can be a learning opportunity to teach them responsibility so that they can learn to look after themselves, especially the responsibility of keeping tabs on their diabetes. Maybe it’s assigning each child clean-up duties after dinner every night, or signing up for a fitness class twice a week which means dad oversees dinner those nights.

Once again, to ensure the stability of your own mental health, you need to maintain a more balanced and peaceful lifestyle for your own health Your needs matter, too, Mama! Don’t forget it!

DSA – Denim For Diabetes

I’m extremely happy that I got involved with DSA Port Elizabeth as I wanted to learn more about diabetes as well as help other moms that are going through what I’m going through.

I reached out to DSA Port Elizabeth and since then I have become a board member. I’m in charge of all the fundraising for this non-profit organisation. My main project is Denim for Diabetes, where we encourage schools to educate staff members and pupils about diabetes. We also ask companies to join us in this project as well.

In 2021, with the help of my friend, Jay, we got our first company, CompRSA, to take part in Denim for Diabetes. This was an amazing leap forward, witnessing a company supporting such a good cause.

I want all kids living with diabetes to know that they aren’t alone and we are here for you. Reach out to your parents and ask for help, let them know if you need them to hold you and reassure you that you are okay. Don’t let diabetes control your life, you must control diabetes. You can do anything you set your mind too!

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Western Cape Camp Diabetable

Western Cape Camp Diabetable

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Dear campers,

We are so sorry to have had to postpone the Western Cape Camp Diabetable in April. We know how disappointed you must have been, especially those who had already booked.

Unfortunately, the Camp Director took ill and had to have a major operation and was put on six weeks sick leave. Obviously, this couldn’t have been foreseen. The good news is that we have booked a new date (16-18th September) at Soetwater in Kommetjie and are looking forward to seeing all our pro-campers and welcoming lots of new campers as well.

The new details are on the poster and we hope you are as excited as we are to see you all at camp in September.

Benefits of diabetes camps

Diabetes South Africa has been holding camps for children with diabetes for well over 40 years. These camps are designed to facilitate a camp experience in a medically safe environment, while fostering opportunities for children to develop basic diabetes self-management skills.

These type of camps also provides opportunities for children with diabetes to forge sustainable relationships, overcome feelings of isolation, and gain self-confidence and a positive attitude to living with a lifelong chronic disease which has to be managed hour by hour.

Impact

According to three years of pre and post surveys, diabetes camps positively impact a wide-range of camper outcomes, including knowledge of diabetes management, management behaviours, and emotional well-being.

Doctors have reported to us that the positive benefits of our camps for children with diabetes are seen in their young patients for many months post camp. Newly diagnosed campers appear to benefit the most from their camp experience.  The encouragement and support the children receive often leads to them giving themselves their first insulin injection on their own. Campers usually ask on leaving the camp when the next one will be.

Some our past campers have joined our DSA Camp Management Team as young adults to pay forward the positive experience they had when attending our camps as children.

The theme for this camp is The elements: earth, wind, fire, water.

To join the camp email margot@diabetessa.org.za

Denim For Diabetes

Denim for Diabetes

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Cara Verster

Cara Verster, a Grade 6 learner, is thrilled that the Denim for Diabetes Day she organised at her school, Leeuwenhof Akademie, was such a success.

On 14th October, Leeuwenhof Akademie scholars swopped their school uniform for denims. They raised R3858 and donated the proceeds to Diabetes South Africa.

Cara Verster, a young diabetic, decided in the beginning of the year she wanted to get her school involved with the DSA Denim for Diabetes initiative. Leeuwenhof Akademie has been super supportive during Cara’s six years at the school.

The teachers and headmaster are always willing to help and very understanding when it comes to Cara’s diabetes management. Cara’s parents have peace of mind every single day sending Cara to school.

There isn’t a school activity or sport that Cara doesn’t try at school. She is an avid public speaker at the school, she is in the theatre group, she runs long distance, plays hockey and the drums. She is in the Top 10 academically and always full of beans. If you ask anybody at the school they will tell you Cara has never let diabetes stop her in any way. She always finds the strength to persevere and endure in spite of overwhelming circumstances.

Cara is looking forward to the Grade 7 trip to Cape Town next year.

Hannes Labuschagne

Hannes Labuschagne, a young boy with Type 1 diabetes, held a Denim for Diabetes Day at his primary school, Laerskool Mariepskop (Hoedspruit, Limpopo) in November. He raised R1500 for Diabetes South Africa from the proceeds of the day. His success was published in the local newspaper.

summer 2023

DSA News – Summer 2021

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DSA Cape Town News

Timeless Care Team

Timeless Care Team hosted their monthly Soft Spot session in November 2021 at the Jolly Carp. To create awareness on World Diabetes Day, and with the kind assistance of Diabetes SA, they distributed reading material and Sister Kopolo of the Grassy Park Clinic delivered an informative talk on the ‘silent killer.’

It was a session filled with various activities from dry-haircuts to painting nails and health services provided various testing, such as glucose testing, blood pressure and Pap smears.

The chatter and laughter was evidence of a wonderful time had by all. The knitting club members proudly handed over their amazing love projects of baby beanies, booties, blankets to be distributed to those in need.

In the background the sounds of memorable music played and here and there a few sang along and some showed a dance move or two.

DeafSA

Margot McCumisky, National Manager of DSA, went to DeafSA on 26th November to do a talk on diabetes. An interpreter was present and the group had many questions and showed a great interest in diabetes. Two of the attendees had Type 2 diabetes and found the information very helpful.

DSA Port Elizabeth News

Diabetes Awareness in Kamvelihle, Motherwell

On 4 November 2021, Pamela Molefe, Martin and Elizabeth Prinsloo were privileged to be invited to address a group of elderly residents in Kamvelihle. They meet regularly in a large container and were so keen to learn more about diabetes. Pamela, our Xhosa speaking nursing advisor, spoke to them and answered their many questions. She also tested everyone’s blood glucose.

Pamela explaing about diabetes, while Martin and Elizabeth listen.
A few of the people present.
Lely Zweni (standing) is the co-ordinator of this group.

Diabetes Wellness meeting in Newton Park

The last meeting for this year was held on 10 November 2021. Our guest speaker was Felicity Black, a registered dietitian, who helped us all to understand more about how our bodies react to insulin and what we eat and drink. A time for questions and lively discussion followed her presentation.

Some of the people present.
Festive decor in Caritas Hall.
Felicity Black, registered dietitian.

DSA Young Guns World Diabetes Day – Boerie Braai

On World Diabetes Day, the DSA Young Guns held an event at The Willows, Three Pools. This was well-attended by not only the Young Guns but also by family members and friends who could chat while the youngsters had fun.

The day started at 10am and ended at 5pm. One of the DSA Young Gun leaders, Darren Badenhuizen, braai’d one hundred boeries in the pool lapa area. The kids enjoyed boeries with low-cal juice and a protein bar which was sponsored by Future Life.

Diabetes South Africa’s National Chairman Martin Prinsloo and his wife Elizabeth, who is the chairman of the Port Elizabeth Branch arrived with their grandson; Joshua, and his dog, Jessica. Joshua performed a lovely obedience show with Jessica and everyone was impressed with the dogs good behaviour and stylish outfit.

Martin did the raffle draw with the help of five Young Guns. Thereafter the kids took a break from swimming and did a potato and spoon race. The Young Guns played their own version of dodge ball which was most enjoyed by young and old. There was an exciting game of Tug of war where the rope snapped. This did not stop the kids as they tied a knot and carried on with the war in good spirits.

Families from Port Elizabeth and surrounding areas such as Jeffery’s Bay and Grahamstown joined the event. The youngest DSA Young Guns member in attendance was 4-years-old Type 1 diabetic.

Prizes were donated in the form of vouchers by The Valley Craig and Wacky Water World. These prizes were awarded to the winners of the many games played on the day.

DSA Pretoria News

A tribute to Rentia Kinchenton

The song is ended (but the melody lingers on). – Irving Berlin.

The Diabetes South Africa Pretoria Support Group members fondly remember Rentia who passed away in March 2021, especially on 27 September as she celebrates her birthday in heaven. She loved the Lord, had a compassionate heart, was a wonderful person, a born helper and a very courageous woman.

Rentia was a dedicated member of the DSA Pretoria Support Group. She volunteered her services on an ongoing basis with a heart-warming smile.

She was famously known as the sandwich lady as she was the maker of many tasty chicken, egg and mayo sandwiches for the Pretoria Diabetes Support Group meetings. Rentia was a loyal member always helping where she could. May her beautiful soul rest in eternal peace.

New Benoni support group

At the request of Nursing Sister Ferosa and in line with DSA’s objectives to empower all those affected by diabetes through support, education and information, the DSA Pretoria Branch encouraged and supported the establishment of a new support group in Benoni on 16 October 2021.

The meetings of this support group will be held monthly to provide support and information to the Benoni community and the surrounding areas.

It’s encouraging to note that as a build-up to World Diabetes Day on 14 November, an initiative pioneered by Sister Ferosa resulted in a number of people joining a Diabetes Support Group at the Northmead Clinic in Benoni.

The group benefitted from the awareness campaign which highlighted risk factors associated with diabetes as well as the promotion of a healthy lifestyle.

The turnout at this event is evidence that people are keen to know and understand what diabetes is all about. The more people know, the easier it will be for them to make better-informed choices and decisions. Furthermore, they will be able to manage diabetes effectively.

The more new support groups created, the better it’s for DSA to reach a wider audience. This has the capacity to increase DSA’s membership and to curb the scourge of diabetes which has a negative impact on health, families and society at large.

Benoni Lakes Lions Club Diabetes Awareness and Screening Day

Benoni Lakes Lions Club held a Diabetes Awareness and Screening Day at Elate Eatery in November. It was a great success despite some rainy weather which forced them to pack up early.

They managed to screen 47 people over a four hour period and are happy that all readings except two were within normal range. We had two men that had readings of 7,4 and 18,1 respectively. The gentleman with the 18,1 reading has already been diagnosed with diabetes.

DSA contributed literature which made a huge difference to the success of the day. Benoni Lakes Lions Club really appreciat the guidance and materials which DSA National Office provided. They are planning more Diabetes Awareness and Screening days in 2022 with the support and assistance from DSA.

Wound Care Wellness Workshop

The Diabetes South Africa Pretoria Support Group hosted a Wellness Workshop on wound care on 16 October 2021. We are thankful to Nursing Sisters Backeberg and van Zijl for an informative and detailed presentation on wound care. This insightful session was followed by a live demonstration on a willing volunteer on what to do when testing your feet at home. 

For a person living with diabetes, the reality is that short-term and long-term complications of the feet are potentially life-threatening. The diabetic foot in South Africa, as in all parts of the world is associated with a high risk of amputation. The daily individual foot checks and annual foot assessment by a professional are important consultations to mitigate against possible complications.

DSA Kwa-Zulu Natal News

Ulundi Diabetes and Hypertension Fighters

Ulundi Diabetes and Hypertension Fighters along with DSA planned a community outreach service to educate and do testing for free to disadvantaged people. Ulundi Diabetes and Hypertension Fighters works together with a multi-disciplinary team in conducting community services. They promote diabetes and hypertension awareness in different communities around Northern KZN.

We started this Diabetes and Hypertension Wellness Drives mid-year 2021. Our first drive was at Ulundi on 28th May. The day was all about educating the community about the signs, symptoms, treatment and management of hypertension and diabetes.

We also did screenings for all the attendees according to our specialisations and we have referred some of them for further investigations to their nearest doctors and clinics. We had the following practitioners on that day: biokineticist, dietitian, diabetes educator, optometrist, clinical nurse, coastal nephrology clinic, physiotherapist, and podiatrist.

Nongoma

On 18th June, we went to Nongoma to promote and install the same vision and goal of managing diabetes and hypertension. The community was so welcoming and they were eager to listen to the information we had to share with them. We managed to see 50% of patients of which was really good, hence it was the first thing to be done in the community.

Hlabisa

On 29th June, we visited Hlabisa community to promote diabetes and hypertension awareness with an aim of educating the community and getting access to the health care resources they need to manage these conditions.

Due to COVID-19 restrictions, we did not do the presentations but we were able to do one-on-one patient education. Based on the information we received, we discovered that they need more of education mainly about medication, management and the importance of testing. We also referred a few for further investigations to their nearest doctors and clinics since we all stay far from their community. We planning to re-visit them again next year and we are hoping for better results.

Melmoth

On 5th July, we visited Melmoth with the same drive and vision of spreading the word of diabetes and hypertension management and treatment. Patients did come but there were few and most of them were rushing to work, we assume they also did not get the information plus we also had tight COVID -19 restrictions. We did all the testing and the patient education through one on one.

Jozini

On 18th September, we visited Jozini (Sisizakele Special School), there was aerobics competition The Noah’s Ark presented by Intengu fitness centre.  We managed to conduct tests on few but most of them were focusing on the event. What we discovered with them is that yes they are into “fitness” but they lack guidance on proper exercise techniques and proper nutrition to avoid unnecessary complications.

Ulundi – WDD

On 14th November, we had a World Diabetes Day (100 years of insulin) in Ulundi. This was our end-year event. The purpose of the day was to mainly educate diabetic patients and the community of the disease and management. The plan is to make it an annual event.

On the day, we did testing (glucose, blood pressure, HbA1c and body composition), management exposure where they were oriented to different stations of different HCP. Participants had a Q&A session after the talk and prizes were given. All participants were given goodie bags for participating in the event.

We had a 30 minutes session of an exercise as part of the event. Exercise forms part of  diabetes management and treatment. It is highly recommended because it helps to lower HbA1c values by 0,7% (with medication and diet), lowers blood glucose, and boosts body sensitivity to insulin. It has been highlighted that people with diabetes who walked at least 2 hours/week were less likely to die of heart failure than sedentary individuals.

Angela Murphy- When diabetes became personal

Angela Murphy: When diabetes became personal

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Dr Angela Murphy tells us how she went from being a diabetes doctor to a mother of a child who has diabetes.

Angela Murphy (54) lives in Brakpan, Gauteng with her husband and three children.

I woke on the morning of 25 November 2005 to a new world. For the third morning in a row, my two-year-old daughter, Olivia, complained of being very thirsty at 5am. I had been trying to suppress a worry for the previous few days and decided to do a blood glucose test on her: 16, 6 – a number I will never forget.

By the end of the day, my husband, Olivia, and I were sitting in the offices of my medical school classmate and colleague, getting a prescription for insulin. In one day, I was unceremoniously pushed from being diabetic doctor to diabetic mother.

Our lives became consumed by numbers: fear of the low ones, annoyance with the high ones, relief if the numbers were good. Olivia had to learn that being injected several times a day with a sharp needle was her new normal. We were blessed to be able to put her on an insulin pump within six months of her diagnosis. It took the injection burden away but not the testing.

Support and special bonds

My first thought as I woke and my last at night was: What is her blood glucose? Handing her over to the care of her teachers was terrifying but we were so blessed that she was well looked after at St Dominic’s School, Boksburg. Special bonds were made with people that helped so much in those earlier years, especially the wonderful diabetes educator Jen Whittall. Through her we met other families and formed a support group on the East Rand that met once a month: Super Kids With Diabetes (SKWID). Our children always had friends with diabetes, so they never felt odd.

Coming to terms with the diagnosis

When Olivia was diagnosed with diabetes, I was almost eight months pregnant with her sister, Julia. Her brother, Lorenzo was just four years old. In that first year, I lived in a fog, battling an immense sense of loss. I clearly remember seeing billboards advertising fruit juice and being heartbroken that Olivia would not be able to just drink that without thinking and planning. I was angry that she would have restrictions and anxious to keep her safe.

Doctor vs mother

The comment I heard most often was how lucky Olivia was to have me as a mother. I understood what was meant, that all my knowledge about diabetes could be used to care for her. However, as a specialist physician my patients are adults; a toddler with diabetes was completely outside my clinical realm.

As a doctor I knew controlling the glucose levels to target was vital. As a mother, I was terrified of my child slipping into a hypoglycaemic coma. I was privileged to attend the International Society for Paediatric and Adolescent Diabetes conference in Durban 2008. I gained so much new knowledge and insight, not only medical but also on parenting a child with Type 1 diabetes. One statement was a light-bulb moment for me: “A child’s HbA1c is proportional to the mother’s fear of hypoglycaemia – the higher the fear, the higher the HbA1c”.

With the guidance of her endocrinologist, we adjusted insulin doses and gradually Olivia gained good control. I still woke to check her glucose every night for years to come but learnt not to accept higher glucose levels out of fear. This was a big step among many small steps in learning to manage the constant tight rope of highs and lows.

The realisation that there is no holiday or break from diabetes can be crippling in the days after diagnosis, something I have felt with my own patients. Having crossed the line from advising about diabetes to living with diabetes (a parent with a young child almost takes on the diagnosis), I do truly empathise with my patients. However, it’s still my job to guide, advise and help them aim to reach those diabetic goals. I never judge, as I know how tedious glucose testing, carb counting, and bolus timing can be. I have really had to try and practice what I preach. We all need to learn to ride the diabetes rollercoaster while we live our daily lives.

Proud mom

I would still wish Olivia’s diabetes away, but I know she can cope. However, I’m so grateful for the technological advances and the fact Oliva can use an insulin pump and glucose monitoring system. I remain hopeful that more breakthroughs will be made, and as radical a discovery as insulin was 100 years ago, something else may change the burden of diabetes in the future. In the meantime, I know Olivia will continue to live her best life.

MEET THE EXPERT

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She runs a busy diabetes practice incorporating the CDE Programme, Discovery Diabetes Care Programme and an accredited insulin pump centre.

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Type 1 diabetes

A closer look at Type 1 diabetes

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Dr Angela Murphy shares informative insight on Type 1 diabetes, how it is managed and what the future holds.

What’s in a name?

The word diabetes originates from Greek, meaning increased or excess urination, a symptom common in the initial presentation of diabetes. However, an imbalance of hormones controlling water balance can also cause increased urination, but the quality of the urine is very different. Hence the terms mellitus, meaning sweet, and insipid which means clear. Diabetes mellitus describes the group of conditions where blood glucose is too high. Diabetes insipidus is an abnormality of water balance, either in the kidney or from the hormones in the pituitary.

What’s in a type?

Diabetes seemed to present in two different ways: more slowly and in older patients or very suddenly in younger patients. Some patients required insulin to survive, others could be managed with dietary changes and later, when they became available, oral medications.

Classification of diabetes has changed over the years and continues to be debated as there is likely an overlap of the different types. The current classification is based on the cause of the diabetes, not patient age or whether insulin is used.

Type 1 diabetes – autoimmune diabetes which will be discussed further.

Type 2 diabetes – insulin resistance (usually due to excess body fat) and decreasing insulin secretion from the pancreas cause high blood glucose levels. This is the most common type of diabetes accounting for more than 90% of cases.

Gestational diabetes – is diabetes occurring in the second or third trimester of pregnancy without a prior diagnosis of diabetes

Diabetes due to other causes – this includes monogenic diabetes, such as Mature Onset Diabetes of the Young (MODY); diseases of the pancreas, such as pancreatitis and drug-induced diabetes.

What went wrong?

Type 1 diabetes is a genetic, sometimes hereditary, autoimmune disorder present from birth. Our immune systems should activate to attack external dangers such as infections and allergens which could cause harm.

In autoimmune disease, the immune system is activated by an external trigger but then proceeds to attack the body’s own cells. In Type 1 diabetes, the target is the insulin secreting beta-cells which lies in the islets of the pancreas. There may be more than one attack on the pancreas before evidence of diabetes is seen. Insulin secretion is usually at 50% of normal before blood glucose rises significantly causing symptoms.

How does Type 1 diabetes feel?

Glucose is the primary fuel for the body and required for all cellular function. Almost all food is ultimately digested to glucose which is then transported around the body in the blood vessels. For glucose to enter each cell, insulin needs to unlock the cell door. If insulin is absent, as in Type 1 diabetes, the glucose gets trapped in the blood vessels. This causes:

Hyperglycaemia

Blood glucose is now trapped in the blood vessels causing hyperglycaemia (high blood glucose). When this blood is filtered in the kidneys, excess glucose spills into the urine drawing fluid with it.   This is what causes the excess urination as well as the ‘sweet’ urine. The glucose in the urine can be a breeding ground for bacteria and a urinary infection can further worsen the symptoms. This excess loss of fluid stimulates the thirst centre and so the person will develop another common symptom: incredible thirst and increased consumption of fluids.

Ketone formation

While the high glucose is causing problems by remaining in the blood stream, the lack of glucose entering the cells leaves them starving.  The cells must look for other sources of nutrition for energy production. Protein and fat stores are broken down to provide this source and as these are used up the person with Type 1 diabetes starts to lose weight, another common presenting symptom.

The energy produced may not be as great and so tiredness and fatigue become a complaint as well. As more fat is broken down, it creates a by-product – ketones. Ketones are acids which alter the pH of the body as they accumulate and can cause the dangerous condition of diabetic ketoacidosis (DKA). Sadly, an all-too-common presenting feature of Type 1 diabetes. The only way to rid the body of ketones is to give insulin which will then move glucose into the cells and switch off the use of fat as a source of energy.

Long-term complications

The circulating high blood glucose causes damage to the blood vessels, both small blood vessels (microvascular) and later large blood vessels (macrovascular).

Large clinical trials have conclusively shown that good glucose control reduces the risk of long-term complications. The most important trial, the Diabetes Control and Complications Trial (DCCT) showed intensive glucose control reduced the risk of all complications.

The Epidemiology of Diabetes Interventions and Complications (EDIC) trial followed the DCCT patients for up for a further 12 years and saw that the original intensively controlled group of patients continued to have a significant reduction in complication rates compared to those who had standard control. This proved the concept of ‘metabolic memory’ which means good control from diagnosis is vital for long-term protection.

How is Type 1 diabetes diagnosed?

The diagnosis of diabetes is the same for all types and accepted internationally as follows: if  fasting blood glucose level is ≄ 7,0mmol/L, or a two-hour post glucose challenge is ≄ 11,1mmol/L, or a HbA1c value is >6,5%.

In most instances, people presenting with Type 1 diabetes will have symptoms as described above so one test will confirm the diagnosis.  If there are no symptoms, a second confirmatory test has to be done.

How is Type 1 diabetes treated?

This is truly a one-word answer: insulin. This year we celebrate 100 years since the discovery of insulin and the fact that people diagnosed with Type 1 diabetes can live a long life. I have had several patients in my practice who have had Type 1 diabetes for more than 40 years and one remarkable lady for more than 60 years.

A healthy, balanced diet is important for people living with Type 1 diabetes and will contribute to overall better diabetes control.  However, the most important aspect of treatment is to ensure that there is enough insulin, at the right time, to move glucose from the blood stream into the cells.

Insulin fast facts

  • Basal insulin gives the necessary background insulin and specifically controls glucose released by the liver when a person has not eaten. It is longer-acting and is usually given as a daily dose; in some patients the dose can be split and given twice daily.

  • Bolus (short-acting) insulin is needed to absorb glucose derived from food eaten at mealtimes. The timing of bolus insulin is one of the biggest challenges for people living with Type 1 diabetes. It is essential that glucose and insulin ‘meet’ and do not miss each other. This means that the bolus injection must be given before meals and often up to 30 minutes before the meal. This holds true even for the new analogue insulins. No insulin is fast enough that it can be injected at the time of eating or even after a meal. For people with diabetes wearing sensors, it’s even easier to spot bolus insulin timing issues as we see a typical ‘witch’s hat’ picture in the glucose tracing (Fig.1). The sharp increase in the glucose is pathognomonic of a late bolus dose.

  • Pre-mix insulin has a fixed ratio of short-acting insulin and intermediate or long-acting insulin (ones that are usually used as basal insulins) and must again be given before meals. They are usually given twice daily before breakfast and before supper. In some instances, they may be used for the breakfast dose and other insulins used for the rest of the day. This is particularly the case with children when trying to cover food eaten at school.

How is Type 1 diabetes monitored?

Trying to manage Type 1 diabetes without regular measuring of blood glucose levels is like trying to drive a car with a blindfold on.  There are excellent glucometers available which allows accurate testing with results in seconds.

The advent of continuous glucose monitoring devices has truly improved the burden of glucose testing.  Not only does it mean less, or no finger pricks, but so much more information can be seen on the continuous sensor. Everyone living with Type 1 diabetes knows that no two days are alike. Being able to ‘see’ the glucose and take immediate action gives much better overall control.

It is still valuable to look at averages, patterns and, of course, HbA1c (three-monthly test). Most people with Type 1 diabetes should be aiming for a HbA1c of <6,5%. Guidelines tell us that this means keeping fasting blood glucose between 4 mmol/L and 7 mmol/L and the two-hour mealtime glucose should be less than 8mmol/L.

For those people fortunate enough to use a continuous glucose sensor, we look at a new parameter called Time in Range. This measures all readings from 4mmol/L to 10 mmol/L.  A Time in Range above 70% is considered good control.

Can Type 1 diabetes be cured?

Although many advances have been made to manage Type 1 diabetes, we cannot claim yet to have a cure. Research has focused on a biological cure, but it is technology that is making the greatest strides.

The age of the ‘artificial pancreas’ is here in the form of insulin pumps that respond to glucose readings from continuous glucose monitoring systems. The most sophisticated of these have almost closed the loop in diabetes control with only the calculation of carbohydrate content of a meal and the timing of food boluses still needing to be done by the person with diabetes. There is no doubt that these systems help achieve better and consistent glucose levels.  Unfortunately, they are expensive and not available to most people living with diabetes.

This means that instead of just supplying the body with insulin, a biological cure would need to supply the body with the functioning islet cells needed to make insulin. However, these islets need to be protected from being attacked by the same autoimmune process that caused the diabetes in the first place. The race is on to create the ideal barrier to protect the transplanted islet cells. There is, in addition, a need to produce large volumes of islet cells that does not rely solely on organ donation. And there is debate about the ideal site to introduce the new islets cells to, ranging from the liver to subcutaneous fat.

Much to be grateful for

I’m grateful that insulin was discovered 100 years ago and has allowed people to continue living with Type 1 diabetes. I’m grateful that there is still so much dedication and research in this field. And I’m hopeful that a cure will be found. In the meantime, managing blood glucose levels with a healthy lifestyle and access to insulin and glucose measuring should be something all people with Type 1 diabetes have the chance to do.

MEET THE EXPERT

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She runs a busy diabetes practice incorporating the CDE Programme, Discovery Diabetes Care Programme and an accredited insulin pump centre.

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Daniel Sher

Daniel Sher – Happy, healthy and making a difference

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Daniel Sher tells us how he has managed his diabetes successfully and how his diagnosis influenced his career path.

Daniel Sher (32) is lives in Cape Town with his partner and two fur-babies.

At the age of 18 months, Daniel was hospitalised after lapsing into a coma from hyperglycaemia. He was diagnosed with Type 1 diabetes and was put on Actrapid insulin.

When asked if he struggled to accept his diagnosis, he responds, “Not that I can recall. Then again, I didn’t have much of a hippocampus at that time, so my memories for that period aren’t too well-formed. Having been diagnosed soon after birth, my parents played an integral role in keeping me healthy and supporting me to foster healthy attitudes towards my lifestyle.”

It seems that the support from his parents built a solid foundation and led Daniel to achieve good management of his diabetes. The 32-year-old attributes his well-managed diabetes to“reliance on support from my medical team, friends and family. I’ve also relied heavily on meditation, psychotherapy and exercise (martial arts and surfing).” Adding that he exercises religiously.

However this doesn’t mean that he doesn’t face obstacles. He explains one of the hardest parts of having diabetes is “when plans need to be re-formulated due to diabetes. For example, having to turn back mid-hike due to having insufficient low supplies.”

Though, he is thankful for all the medical advances, “Insulin has evolved wonderfully, as has blood glucose monitoring technology. He currently uses Humalog and Lantus insulin and a Freestyle Libre CGM.”

Career path

Daniel admits that diabetes diagnosis influenced his career path; he became a psychologist who counsels people with diabetes. “Having had this condition for 30 odd years, I’ve become keenly aware of how important it is to consider the psychological side of diabetes. I’ve also become aware of how difficult it is for people with diabetes to access the right sort of specialised psychological support.

Public healthcare for diabetes needs more focus

In Daniel opinion’s, he thinks that we are getting there in terms of diabetes awareness. However, like many, he feels the public sector where the majority of South Africans receive diabetes care needs to be amped up. “Advocacy efforts need to be focussed on making diabetes education, care, management and psychological input more accessible to those who rely on public healthcare.”

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

Olivia Smargiasso:

Olivia Smargiasso – Walking the road to success

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Olivia Smargiasso is the perfect example of living her best life with diabetes. This young lady has achieved so much already and her future is bright.

Olivia Smargiasso (18) lives in Brakpan with her parents and two younger siblings.

Diagnosis

I was diagnosed with Type 1 diabetes at the age of two and a half, in November 2005. My mom had noticed the classic symptoms of thirst and excessive urination. She tested my blood glucose at home, and it was 16,6. By the end of that day, I had seen an endocrinologist and started using insulin.

I think at about five years old, I understood that I had something extra I always had to think about. It was then that I realised I needed to test my glucose and bolus for food (I had gone on to an insulin pump six months after I was diagnosed). This was also the time I became aware that other people in the class did not tell the teacher they were feeling low. A low usually left me feeling sweaty, irritable and very emotional. These mood swings were definitely difficult to regulate.

Aim for a dart board rather than the bullseye

I think because I was diagnosed at such a young age, living with diabetes is all I’ve ever known. Whenever I feel that I don’t want to have to deal with my diabetes anymore, I remind myself that I don’t need to be perfect, only aim for perfection. Living with the challenge of diabetes is more about aiming for a dart board rather than the bullseye, and it’s more than okay to miss here and there.

I’m currently on a Medtronic 670 pump. Before this I used the Medtronic Veo and before that injections. I have used Novorapid short-acting insulin for the last 15 years. My treatment hasn’t changed much in that time, only the carb ratios and other settings on my pumps.

As a child, I saw an endocrinologist, and a diabetes nurse educator, who also has a son (now grown up) with diabetes. Thus, she could empathise with my family, especially my mom. In more recent years, however, my mom, Dr Angela Murphy, has become my doctor; she is a specialist physician

Olivia Smargiasso: Walking the road of success

Dr Mom

I always joke that I couldn’t get away with anything because my mom knew when I wasn’t telling the truth. It was definitely challenging at times, having a doctor as a mom, because I knew she expected me to manage my diabetes with accuracy and precision.

I have also been very fortunate, though. My mom will often tell me about the launch of a new diabetic drug, or an advancement in research. She also sees how well I manage the many challenges of diabetes compared to patients or colleagues’ patients. I feel encouraged that perhaps I do manage my diabetes reasonably well.

Achieving in abundance

I was always encouraged not to let diabetes hold me back. I have Protea colours for karate after competing in Zimbabwe, Botswana and at the Commonwealth Karate Games. I’m a keen runner and Running Captain at school. I used to be an avid waterpolo and netball player too.

When I went onto continuous glucose monitoring (CGM), I found that playing sport became much easier as I was always aware of any change in my glucose levels. Before sensors, however, I would aim for a glucose level of 7,5-9 before playing sport in the afternoon and below 6,5 when swimming in the morning. This way I avoided experiencing a high after morning training and a low during netball or waterpolo practices after school.

I also make sure I always have something sugary close by. Game or Powerade have worked best for me; small sips throughout the training or match to replace any energy I’ve used while exercising. I also eat something with slow-releasing energy, like a banana, before training sessions or matches.

I don’t find that my diabetes affects my academic performance too much. If I go low or high in class, my teachers are always happy to let me eat something or bolus to correct my glucose. I am currently 4th in my grade, I was recently awarded the Best All Round Matric trophy and I’m the top senior public speaker too.

Next year, I’m moving to Stellenbosch to study environmental sciences. I’m really looking forward to this.

Diabetes camps

I have attended three diabetes camps; one as a camper and two as a leader. I absolutely love these camps and encourage every child with diabetes I meet to attend at least one. These camps not only equip kids with the practical and medical skills they need to live a full life with diabetes, but also instil a sense of belonging, showing kids that they are not alone in this very difficult journey.

Children get the chance to meet others with similar and different experiences, exchange stories and come up with new ideas and different approaches to the most common obstacles. These camps also show children that they can have a normal life and enjoy normal activities, they do not have to stop eating sweets or give up their favourite sports because of diabetes. I hope post COVID, camps will be able to happen again.

Supportive teachers 

My teachers were always patient, caring, and compassionate when it came to handling my diabetes. My Grade 00 teacher was particularly loving in helping me add up the amount of carbs I was planning on eating at lunchtime. I was always allowed to have a quick snack or go fill up my water bottle. Some teachers went as far as giving me nuts or fruit instead of cupcakes and biscuits when it was a birthday.

My Grade 2 teacher also has a child with diabetes and was involved in the diabetes support group my mom helped establish when I was a child. At the start of every year until I reached Grade 9, my mom met with the new teachers and chatted about my diabetes management. This was never a burden for them and they were always supportive. There have been other girls in my school with diabetes over the years, currently there are four of us in different grades. I’m always happy to chat to them if I can help them in any way.

I have heard stories of children being treated badly at school, by teachers and peers, because of their diabetes. I think more awareness is needed so that phrases like “you can’t eat that” and stigmas of diabetes being a result of an unhealthy lifestyle, are abolished.

Understanding friends

Most of my friends have been with me since preschool and have grown up knowing I have diabetes. When I explain the condition to people I have just met, I often use an analogy: the good soldiers in my body (my immune system) got confused and attacked their own castle (my pancreas) and destroyed it. Now it doesn’t work so I have to get insulin from this pump.

I also explain that it’s a genetic disease and there is nothing I could have done to avoid getting it. Nobody did anything wrong, my parents did not give me too many sweets when I was little. The condition was always in my DNA, it was only a matter of time before it activated.

I also say that I can live a completely normal life and do everyday activities like any other person. All I have do is simply be careful that my insulin covers my carbs, the correct amount and given in time. I need to be aware of the different effects of food and activity on my life.

Love of fruit

I absolutely love fruit, watermelon, pears, and oranges in particular. Whenever I have a sweet craving, I try to go for a fruit rather than a sugary snack. While sticking to a healthy diet is important, treats like KitKats or ice lollies are my go-to when I need something slightly less nutritious.

Good advice

For anyone that has just been diagnosed with diabetes, I would say the most important thing to remember is that life with this condition is a balancing act. It’s impossible to be perfect all the time and constantly have a blood glucose reading of 5,6 but luckily CGM has taught us if most of our readings are in the range of 4 to 10, overall control will be good.

But it’s normal and perfectly okay to miss the target range sometimes. The important thing is that we focus on the positives more than the negatives because that way we will see how well we are doing. Something I live by is, “Today I will do what others won’t do that tomorrow I can do what others can’t”.