Dry eye associated with diabetes

Posted on August 22, 2017 by Diabetes Focus eMag

Eye Care Awareness Month runs from 21 September to 18 October. In light of this, Dr Chrissie Cockinos explains why dry eye is so common in people living with diabetes.

Diabetes has a number of associated eye conditions: ocular muscle palsies, blepharitis, dry eye, corneal ulceration, changes in refraction, early cataracts and retinal disease.

Sadly, diabetes is becoming more common than ever before. The World Health Organisation (WHO) predicts that there will be 370 million diabetes patients by the year 2030. This is double the number of people living with diabetes registered in 2000.

Why is dry eye common in diabetes patients?

Some studies report dry eye in more than 50% of diabetic patients. People with dry experience discomfort, grittiness, sensitivity to light, redness and a foreign body sensation of the eyes. Sometimes vision becomes blurry. One of the most common causes of dry eye disease is blepharitis (infection and/or inflammation of the eyelids). This is very common in diabetic patients.

Causes of dry eye in people living with diabetes

Hyperglycaemia and insulin resistance can result in neuropathy. The corneal nerves can be affected by long-term diabetes and this may, via the trigeminal nerve and facial nerves, affect the way the lacrimal gland produces tears. This may result in dry eye.

Neurotrophic (insensitive) corneas often result from diabetes. This nerve damage interrupts normal tear development pathways.

Insulin also has a role in tear production.

Inflammation releases certain chemicals, called cytokines, in the body. These chemicals can also damage tear producing cells in the conjunctiva and lacrimal gland.

Sequelae of dry eye

Apart from the frustration of suffering from dry eye, people living with diabetes have a higher incidence of corneal ulceration. This is due to the lack of protection to the eye by a normal tear film, increased blepharitis incidence (a source of bacteria) and insensitivity of the cornea.

Treating your dry eye

Topical treatment

Eyelid hygiene to clear blepharitis. A good eyelid cleanser, preferably with tea tree is advisable.
Topical lubricant eye drops and lubricant ointments at night.
Visit your eye doctor annually.
The inflammation of your eyes may require additional treatment and extra measures with cortisone eye drops or ointments.
You may even require lacrimal plugs to be inserted.

General

Check your HbA1c and blood pressure regularly via your doctor.
Follow a good diet consisting of protein, vegetables, especially leafy greens, and oily fish like salmon and mackerel.
Exercise regularly. Walk 20 minutes daily.
Take Omega 3 supplements.

MEET OUR EXPERT - Dr Chrissie Cockinos

Put your sole at ease: exercise feet

Posted on August 22, 2017 by Diabetes Focus eMag

Anette Thompson, a podiatrist, tells us how to exercise feet to improve blood circulation, especially if you have diabetes.

An immense amount of recent research has reinforced the fact that exercise is essential for those who live with diabetes – at whatever stage you are – pre-diabetic; diabetic on diet + exercise only; diabetic on diet + exercise + tablets; diabetic on diet + exercise + tablets +/or insulin. This makes sense because we know that exercise helps ‘switch on’ insulin receptors in those with Type 2 diabetes, therefore is useful in lowering blood sugar levels.

There are also benefits of regular exercise of the feet, such as improved blood circulation. Blood contains oxygen, nutrients and repair cells so it’s vital that increased blood supply reaches each cell in the body, especially nerves and other structures in the feet, which are furthest away from the heart.

SA research

As part of Louise Stirk (a South African podiatrist) master’s degree, she studied the effects of an eight-week endurance exercise programme on blood sugar control and peripheral sensory neuropathy in people with Type 2 diabetes.

Her study was conducted on eight previously inactive diabetic volunteers, aged 34 to 47 years. They completed an eight-week endurance exercise intervention of moderate intensity. They started the exercise programme at the same time as two control groups. The first control group, aged 45 and 46 years, continued with a sedentary (inactive) lifestyle and the second active control, aged 40 years, continued with a prior exercise programme.

All participants were requested to maintain their usual diet. The moderate exercise for the previously inactive group consisted of a 30-minute cycling regime, during which the heart rate fluctuated between 60-80% of age-predicted maximum, repeated three times per week.

She measured the effects of this endurance exercise programme on diabetic peripheral neuropathy (DPN) and possible associations between exercise-induced changes in resting heart rate, blood pressure, body mass index, waist circumference, % body fat, six objective neurological measures of diabetic peripheral neuropathy, and eight subjective ratings of symptoms of foot discomfort. She also measured changes in HbA1c, plasma brain neurotrophic factor and serum adiponectin concentrations in all 11 participants.

The only significant change (p>0.05) in the passive (non-exercising) controls was an increase in subjective ratings of foot discomfort, while no significant change (p>0.05) was observed in the active control.

The eight-week endurance exercise programme was not combined with dietary intervention so it did not improve HbA1c levels, but it did result in significant improvements (p<0.05) in the average resting heart rate, systolic blood pressure, and patellar and ankle reflexes in the group of eight people.

Common reasons for not exercising

The most common reasons as to why diabetic patients don’t exercise on a regular basis is: their feet or legs hurt, they don’t know what shoes to wear, they don’t know how to exercise, they feel it isn’t safe to walk outside or they can’t afford a gym membership.

1. Feet or legs hurt
You may have an imbalance of the feet due to the effects of diabetes on soft tissue, or because of incorrect footwear or other biomechanical reasons of which you may be unaware. Feet should never hurt – this is a sign that something is amiss.

A podiatrist will conduct a full clinical biomechanical examination or you may choose to go to a biokineticist for a full-body assessment if other parts of your body also hurt when you exercise. Take your exercise shoes as well as your usual shoes with you to be assessed.

If imbalances or bony protrusions are present in the feet or ankles, a podiatrist will then take an impression of your feet in plaster of Paris or orthopaedic foam to fabricate custom foot orthoses, which fit into your shoes.

These can re-align your feet to make muscles work in balance with each other, offload sore spots or high pressure areas, and make you comfortable in your shoes once more.

Custom inserts, made by a podiatrist, can be moved between pairs of shoes and, even sandals, with a piece of adhesive Velcro affixed underneath to prevent sliding.

Do custom shoe inserts really work?

In July 2005, James Wrobel, Adam Fleischer, Ryan Crews, et al., reported in the Journal of the American Podiatric Medical Association on examining the outcomes of custom foot orthoses on patients with plantar heel pain.

These researchers randomised 77 patients with plantar fasciitis to one of three groups in a double-blind fashion (custom foot orthoses, prefabricated orthoses, and a sham). Using objective and subjective outcome measures, they found a 5,6-fold increase in physical activity and improved outcome measures with the custom foot orthoses in comparison with the other methods at three months.

2. How to exercise feet

The second largest pump mechanism of blood in the body (after the heart) is that of the calf muscle ‘pump’. When the calf muscles contract, they push up against the big blood vessels deep in the leg.

exercise feet Any exercise that helps the calf muscles to contract is a good exercise for lower limb blood circulation. Walking is excellent – choose a flexible pair of shoes that grip the back of your heels, and grip over the top of your foot with adjustable fastening.

If you have never exercised, start with a 5-minute walk then turn around and go back and you’ll have completed 10 minutes. The next day, increase by 5 minutes. The day after, increase by 5 minutes, or stay at the same number of minutes for a few days until you feel you can add on more minutes.

Motivating tip: If you are new to exercising, do not measure distance when walking as it will only discourage you, only measure by time spent. As you become fitter, you’ll naturally increase your distances. Work up to 30 minutes of exercise every second day, then eventually 30 minutes every day.

3. What shoes to wear

You need flexible flat soled shoes/takkies that have a good grip on your feet, either in the form of: laces up the foot or sturdy Velcro straps up the foot. No open back shoes. If you want to walk in hiking sandals, wear a pair of socks together with the hiking sandals to prevent chafing or blisters. Other types of fashion sandals are not suitable.

Make sure the shoes are wide enough for your feet. The easy way to check this, is to remove the innersole from the takkie and stand on top of it as if your foot was in the shoe. If your foot width spills over the sides, the shoe is too narrow for you and should be avoided.

New Balance and Asics now have sports shoes available in wider fittings, called 2E and 4E.

Be aware that your foot volume naturally increases by 7% after four hours of standing or walking, so allow for foot expansion when fitting.

exercise feet Make sure the shoe is flexible – you should be able to bend it back from the ball of the foot with one finger. If it is not flexible enough, the calf muscles can’t work to their full capacity because the foot can’t bend easily at the ball of the foot.

4. Can’t afford gym or scared to walk outside?

Here are simple ways to exercise feet in your own home:

Sitting: Sit up on a chair with your feet flat on ground and knees bent to 90 degrees. Keeping your toes on the ground, lift the heels off the ground then put them down. Increase the number of repetitions until the calf muscles feel tired, then stop.

The next day, try to increase beyond the previous day’s number of repetitions by 1, the day after by 2, the day after that by 3. That way you will gradually build up to being able to do 300 repetitions while watching TV, or sitting in the office, or waiting at an appointment.

Standing: You can do calf raises holding onto the back of a chair, or the supermarket trolley, or while waiting for the kettle to boil or the photocopy machine to do its work.

On your bed: If the weather isn’t good, you can still lie on your bed and do exercises pointing your toes away from you and then pointing them towards you. Do at least 100 repetitions or until your calf muscles ache. If you persist with the exercise each day, it will become easier to do and the aches ease up as you improve your blood circulation.

MEET OUR EXPERT - Anette Thompson

A day in the life of a diabetes nurse educator

Posted on August 22, 2017 by Diabetes Focus eMag

Christine Manga, a diabetes nurse educator (DNE), explains what her job entails and shares some of the challenges faced as well as the pluses.

I am a diabetes nurse educator. I use this title without much thought. My mistake, not everyone knows what DNE stands for, let alone what we do. So, let me explain what a diabetes nurse educator is, why we are necessary, and what an average day routine consists of.

Part of a team

DNE is an acronym for diabetes nurse educator. A DNE is a healthcare professional who possesses comprehensive knowledge, skills and experience in diabetes management. We work as part of a diabetes management team, along with doctors, podiatrists, dietitians and ophthalmologists. Patients tend to spend more time with their diabetes nurse educator than any other of the team members.

Role

Our role, as DNEs, is to assist patients to effectively manage their own diabetes. We strive to do this through education, coaching and support. Being non-judgemental is of paramount importance.

Because diabetes is a chronic condition – patients have to live with it 24/7 365 – it’s not surprising that managing diabetes effectively requires a lot of time and effort. Patients are required to take various medications at multiple times in the day. These may be tablets or injectables. Regular structured glucose testing is recommended. Constantly being aware of what they’re eating is tiring. It is therefore imperative that DNEs equip these patients with the tools and coping mechanisms to master self-management. We know that each patient is unique, hence we tailor a management plan around this.

First consultation

During the first consultation, a DNE does a thorough history taking. From this information, we can assess diabetes duration, comorbidities, medication, diet, lifestyle, and patient motivation level.

Working within the South African guidelines for diabetes management and taking into account the patient’s preferences and habits, together we can formulate a management plan.

General information is given to all patients. This includes explaining what diabetes is. Many patients are not aware of what diabetes is and the serious complications that can occur without good control. A lot of time is spent correcting misconceptions. We explain the various targets that they should be aiming for.

Basic dietary information including meal planning, portion sizes and timing of meals are explored. Small changes to these choices can result in improved glucose control. Educating patients on blood glucose testing technique, injection technique, needle and site rotation is key to good management.

Explaining how the medication works in the body, what side effects to expect, and what medication may need to be used in the future seems to have improved medication compliance in my patients. Highlighting the importance of exercise and quitting smoking is vital to incorporate.

This generic information is given to all patients. Without the basics, one cannot easily progress.

SMART goals

In future consultations, DNEs coach patients on how to set a Specific, Measurable, Attainable, Realistic and Time-based (SMART) goals. Once the patient has set goals, we sit together and discuss how he/she can attain these goals. These goals are much more than just achieving a good blood glucose reading.

It’s the patient who needs to formulate a plan; a DNE will assist or give potential options that he/she may not have been aware of. By coming up with the solutions themselves, it empowers them and builds self-confidence. It encourages self-management, which is what we are aiming for.

Daily routine

A routine day consists of consultations, checking and responding to patient emails and, in most cases, managing an emergency hotline. Remember, diabetes doesn’t go away after office hours.

Though, saying a day is routine is not very accurate. No two patients ever present in the same way. So, although saying a consultation is routine is true, the content will never be routine. The patient may be in a bad space – unrelated to diabetes – resulting in 90% of the consultation being spent on that issue.

A DNE needs to be flexible. A consultation should have structure, but the content should be led by the patient. Our agenda may not meet the patient’s needs. We need to be attentive to where the patient is leading us.

Pros and cons

As with every profession, there are both rewarding and challenging moments. The most challenging issues being language differences, financial constraints, and a general resistance (from patients) to change.

These changes include lifestyle modification, increasing, changing or adding medication. Resistance is also common when initiating insulin. Financial constraints affect the choice of medication, the amount of testing strips that a patient can use as well as food that can be purchased. All of these have an effect on the way the patient responds to the recommendations.

On the up side, I love being the first person to interact with a newly diagnosed patient. Being able to allay the fear these patients feel is extremely rewarding. Many people are scared when they have been diagnosed with diabetes. They also fear being judged.

As time goes on and my patients come for follow-up appointments, it is wonderful to see how many of them have embraced the diagnosis, worked through and with it. Their self-esteem appears to blossom.

Sadly, this is unfortunately not the case with all patients. At the end of the day, we are all human. Helping one person might not change the world, but it could change the world for one person.

MEET OUR EXPERT - Christine Manga

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

Early to bed, early to rise: sleep timing and your health

Posted on August 22, 2017 by Diabetes Focus eMag

Paula Pienaar explains why sleep timing is important to your health, adding that the time you go to sleep and wake up plays a large role in whether you increase your risk of obesity and Type 2 diabetes.

Traditional lifestyle-related risk factors, such as overeating, poor nutritional choices and physical inactivity, have long been blamed for the alarming global increase in obesity, diabetes and cardiovascular disease. In recent years, it has become evident that sleep habits (sleep timing) also contribute significantly to one’s health risk status. In fact, did you know that the time you go to sleep and wake up plays a large role in whether you increase your risk of obesity and Type 2 diabetes?^1-3

Sleep timing is crucial

Studies on how sleep timing affect health have shown that late bedtimes, combined with sleep deprivation (often due to waking up early enough for work) results in increased caloric intake in the late evening hours, as well as increased appetite for foods that are calorie-dense. In addition, later bedtimes seem to have become more frequent in the general population and is associated with an increased prevalence of Type 2 diabetes as well as poorer glucose control in diabetic patients.^1,3

The circadian rhythm influences sleeping, eating, heart rate, blood pressure, body temperature, the levels of certain hormones, and the immune system.

Tick-tock our body clock: our circadian rhythms

The time you go to sleep and the time you wake up, or your sleep-wake cycle, is referred to as your circadian rhythm.

This internal body clock is a 24-hour internal timer that functions by cycling between sleepiness and alertness at regular intervals throughout the day.

The pattern of feeling energised and tired at usual times is an example of your circadian rhythm at play.

For most adults, the biggest energy dip occurs between 2:00 am and 4:00 am, when we are meant to be sleeping, and 1:00 pm and 3:00 pm, usually after lunch. These circadian dips are especially prominent in those who are sleep-deprived.

Did you know?

After midday, body temperature drops slightly which prompts the release of melatonin. Although this effect is at a smaller scale compared to nighttime, we often experience it as a ‘post-lunch’ energy dip occurring between 2pm and 4pm.

Social jet-lag

Today’s society has created an illuminated environment that alters the natural light-dark cycle needed to regulate the circadian rhythm. Big cities with 24-hour light exposure, workplaces with bright artificial lighting, and neon lights adorning places of entertainment are all examples of how we are constantly exposed to unnatural lighting during the time when our body needs to wind down.

Additionally, our lifestyle choices may also create a body clock that is out of sync with the environment. For example, our natural rhythm is affected by being awake when we are meant to be sleeping; sleeping for long periods during the day; and even having erratic meal times.

When we intend on ‘catching-up’ on sleep during weekends, or days off from work, we expose ourselves to the same health ramifications, as now we are trying to change our sleep timing once again. This mismatch in sleep time is called ‘social jet-lag’ and affects most of us at some stage in our lives, whether it is due to travel, social engagements or work demands.

Consequences of a disrupted body clock

The sleep disruption and deprivation resulting from irregular sleep times and increased night-time light exposure have shown to disrupt metabolic and hormonal processes.^2,4,5

The body responds by:

Increasing hunger hormones, which may lead to weight gain and obesity.
Suppressing the release of sleep-inducing hormones, making it more difficult to fall asleep.
Creates an immune response, which lowers your immune status.
Increases stress hormones, which have shown to lead to hypertension and cardiovascular disease.
Disrupts insulin action, which favours fat accumulation.

The good news is that by adjusting your sleep routine to follow the environments natural light-dark cycle, you can support your body clock in restoring your health.

Managing sleep timing

The following tips have shown to help improve circadian function and sleep disruption:

Ensure adequate exposure to daylight: exposure to sunlight during the day and darkness at night helps to maintain a healthy sleep-wake cycle. This is especially important for people who spend most of their time indoors.
Stick to a healthy sleep and wake time routine: try to consistently make your way to bed when it gets dark, and wake up to natural light instead of hitting the snooze button.
Ensure the bedroom is dark, quiet and comfortable: cosy temperature; no television, mobile phones and bright lamps (see next tip below); and pets that wake you up should be kept out of the bedroom. The mattress and pillows should also be comfortable. It may be helpful to use blackout curtains, ear plugs, and eye shades.
Refrain from screen time at least an hour before going to bed: the blue light from certain televisions, mobile phones and tablet devices suppress the release of sleep-inducing melatonin. It may be useful to use blue-blocking glasses and apps to filter short-wavelength emissions from electronic devices. You can download such an app from https://justgetflux.com/ .
Avoid napping during the day, but if the need is very high, limit it to before 03:00 pm and for no longer than 30 minutes. You do not want to end up with a late bedtime and sleep deprivation the following day.
Get regular physical activity: moderate activity, such as brisk walking, has shown to help improve sleep quality. If you are a morning-type person, use that to your advantage and get natural morning light during your outdoor sessions.
Go camping! A weekend dose of nature’s light-dark cycle has shown to restore a disrupted circadian rhythm.

Shift workers and individuals who travel regularly across time zones are most vulnerable to circadian rhythm disruption and would benefit greatly from sleep-timing support. If having tried these tips, but you still are out of sync, or struggle with excessive daytime sleepiness, it is best to seek help from a sleep health professional.

References:

Knutson, Kristen L., et al. “Association Between Sleep Timing, Obesity, Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Cohort Study.” Sleep 40.4 (2017).
Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring). 2011; 19(7): 1374–1381.
Merikanto, Ilona, et al. “Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes.” Chronobiology international 30.4 (2013): 470-477.
McHill, A. W., and K. P. Wright. “Role of sleep and circadian disruption on energy expenditure and in metabolic predisposition to human obesity and metabolic disease.” Obesity Reviews 18.S1 (2017): 15-24.
Sharma, Arpita, Shashank Tiwari, and Muniyandi Singaravel. “Circadian rhythm disruption: health consequences.” Biological rhythm research 47.2 (2016): 191-213.
Potter, Gregory DM, et al. “Circadian rhythm and sleep disruption: causes, metabolic consequences, and countermeasures.” Endocrine reviews 37.6 (2016): 584-608.

MEET OUR EXPERT - Paula Pienaar

Paula R. Pienaar (BSc (Med)(Hons) Exercise Science (Biokinetics)), MSc (Med) Exercise Science) is the scientific advisor to EOH Workplace Health and Wellness, and a PhD candidate at the University of Cape Town. Her scientific research relates to sleep health and managing daytime fatigue to improve workplace productivity and lower the risk of chronic disease. Her thesis will identify the link between sleep and cardiometabolic diseases (Type 2 diabetes and cardiovascular disease) in South African employees. She aims to design a tailored sleep and fatigue management workplace health intervention to improve employee health risk profiles and enhance work productivity. Contact her at paula.pienaar@eoh.co.za

An opportunity to develop resilience

Posted on August 22, 2017 by Diabetes Focus eMag

Rosemary Flynn enlightens us as to why having diabetes is an opportunity to develop resilience.

When you have a medical problem, you usually go to a doctor to have the problem solved. With diabetes, the doctor cannot ‘solve’ the problem. He/she can give you medication and advice on living with diabetes to keep you going, but because there is no cure, taking care of diabetes falls to you.

Good diabetes control depends on a healthy psychological environment. You have diabetes, but the family has diabetes too, whether it is a marriage or partnership, with or without children, grandparents or extended family. Research has shown that families play a key role in how well people with diabetes adjust to their condition, integrate it into their lives, and manage it well.

But as far as you are concerned, you need a good attitude towards your diabetes and you need to develop resilience. Resilience is an important part of the process of learning to adapt to life with a chronic condition.

What is resilience?

It is the courage to come back after a stressful situation has arisen. It is the capacity to respond positively to adverse situations. It is the ability to learn from your experiences and a capacity to be adaptable.

You can develop resilience when you have diabetes. If you already have some resilience because you have had to deal with many other stressful events, it will become even better as you deal with the daily management of diabetes and you will be stronger for it.

There are many opportunities for personal growth, higher emotional intelligence and maturity because you have diabetes.

Things you can learn from diabetes:

You can learn to think – when your blood glucose levels surprise you, you have to think about what gave you a higher or lower level than you expected.
You can learn to handle the unpredictability of those blood fluctuations.
You can learn perseverance through thick and thin.
You can develop more empathy and compassion for others who are going through stressful situations.
You can develop a greater sense of purpose and meaning.
You can develop a greater appreciation of life itself, as you work on controlling your diabetes to keep your body as healthy as possible for as long as possible.

There are negative things that you have to deal with when you have diabetes, but if you choose to tackle your diabetes with effort and energy and strive to succeed, you can live with a sense of purpose and commitment to life which will make you feel positive and fulfilled.

MEET OUR EXPERT - Rosemary Flynn

Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

CDE Club App launched

Posted on August 22, 2017 by Diabetes Focus eMag

The first free information and support app for people with diabetes has been launched by the Centre for Diabetes and Endocrinology (CDE). Hamish van Wyk, registered dietitian and diabetes educator from CDE, tells us more.

The most important person in the management of diabetes is the person living with diabetes. For this reason, the CDE launched its CDE Club App to assist people with diabetes by providing valuable information, a tool to track progress, and even earn rewards.

“The majority of diabetes care is self-administered. For example, people with diabetes have to decide when to take their medication, what goes onto their plate on a daily basis, and whether or not they will exercise. It has been suggested that a person with diabetes should know more about diabetes than the average general practitioner. This can be overwhelming. The aim of the CDE Club App is to step in and empower people with diabetes so they can meet their daily self-management demands,” Hamish explains.

Discover

Discover is the first section of the CDE Club App. Here people with diabetes can access educational articles, videos and recipes, all designed to help gain a better understanding of their health. The content is developed by some of the leading healthcare providers in diabetes in South Africa. Very importantly, the app asks the user clinically relevant questions in an attempt to better understand the user’s health status. Based on these questions, the app can suggest educational content specific to the user.

“Our experience tells us that the majority of people with diabetes have many questions about their condition and don’t have the answers. The intention of the app is not to take over the role of a diabetes nurse, educator or dietitian, it provides information to support the user’s education journey and it acts as a point of reference. It offers answers to questions, such as: Why do I have diabetes?, What is an HbA1c?, Will I ever need insulin in addition to my pills?, How many times a day should I check my blood glucose levels? and so on,” says Hamish.

Act

The second section of the app is Act. “Knowledge alone is often not enough to change behaviour. So, paired with each article is an achievable action to provide the user with the next step forward. Basically, it provides a way to put what they’ve learned into action,” he says.

Based on the questionnaires the user has answered and the articles that they read, the app provides suggested actions, which pop up as notifications. For example, the app can remind the user to drink more water, or to take lunch to work. Users can also track their workouts and steps, among other things. Users that register on the CDE Diabetes Management Programme can view their online health record with clinical feedback. “This is incredibly important, as ultimately, the suggested actions ideally need to translate into improved clinical outcomes, such as lower blood pressure.”

To assist in the maintenance of changed behaviour, the next section of the app, Share, encourages users to view and share their successes with friends and supporters. “It is so important that people living with diabetes are encouraged and supported on their journey. Lifestyle changes are hard to implement alone. The true beauty of changing one’s health comes through two-way support. I believe that if we had a community that encourages and supports healthy living, we would not be experiencing the current ‘global tsunami’ of cde app Type 2 diabetes,” says Hamish.

Rewards

The CDE Club App will have a list of rewards that are redeemable at no cost. As users read articles, complete actions, and achieve clinical targets, they will earn ‘badges’. By accumulating badges, users are rewarded with coupons for discounted prices on various brands.

“Short-term rewards keep people motivated, which will ultimately lead to lifestyle changes and improved health. This rewards section of the app aims to give users a sense of achievement and keep them motivated.” Best of all, these rewards are free!

Hamish says this app is a first of its kind and believes it will make a difference in the lives of people living with diabetes. “Diabetes can be managed and people with diabetes can live rich and fulfilling lives. The CDE Club App is a brilliant support tool,” he concludes.

How to download the app

To download the CDE Club App scan the QR code on the website http://www.cdediabetes.co.za/home/diabetes/join-cde-club/about-cde-club.html or search “CDE Club” App on either Google Play Store or the iTunes Store.

MEET OUR EXPERT - Hamish van Wyk

The first flash glucose monitoring system now in SA

Posted on August 22, 2017 by Diabetes Focus eMag

The world’s first flash glucose monitoring system, which requires only a scan rather than a traditional finger prick to test blood glucose, is now available in South Africa.

The ability to get a glucose reading with a quick, painless scan has ushered in a new era of bloodless, simple and calibration-free visualisation of glycemic control – the flash glucose monitoring system.

The unique technology replaces blood glucose meters, while giving patients many of the benefits of continuous glucose monitoring (CGM), including real-time glucose values, trend information and comprehensive reports.

The flash glucose monitoring system

This new system includes a flexible filament sensor, which is inserted 5 mm under the skin. The filament is connected to a small, round disc and held in place on the skin with medical adhesive. The sensor remains inserted for 14 days. One hour after application to the upper arm, it begins reading blood glucose levels and continues to do so for up to 14 days.

The hi-tech monitor, first introduced in Europe, has provided unparalleled levels of data so necessary in the management of diabetes and has revolutionised the way people with Type 1 diabetes can manage their glucose levels.

Controlling glucose levels is a prerequisite for treating diabetes. Traditional testing with blood from a fingertip is recommended 4 to 8 times a day.

What the expert says

Dr Larry Distiller, an endocrinologist, says when the technology was first introduced in Europe, a voluntary pilot project was initiated. More than 50 000 people participated in the pilot, between 2014 and 2016, yielding 409 million data points. The analysed data provided invaluable insights into glucose monitoring.

In comparison, the new flash glucose monitoring system allows users to scan and check their blood glucose at any time without any limit. Practically, pilot project participants scanned on average up to 16 times per day. Research found that those who scanned the most had the best control of their blood glucose.

In addition to always being available and providing immediate personal monitoring, the reader data can be downloaded and analysed using specific software. This produces detailed and informative visual outputs on daily glycaemic trends and variability and highlights statistical risks of hypoglycaemia and hyperglycaemia according to the time of day.

Looking into the future

In time, patients will also be able to scan the sensor using their cell phone. Distiller says this new technology is approved for dosing insulin, except in three cases when a finger stick is recommended: when hypoglycaemic, when glucose is changing rapidly, or when symptoms don’t match the system’s readings.

MEET OUR EXPERT - Prof Larry Disteller

Six steps to boost health and ban dread disease

Posted on August 22, 2017 by Diabetes Focus eMag

John Hamlett, a fitness expert, shares six steps to boost health and ban dread disease.

According to the most recent South African Demographic and Health Survey, almost 70% of South African women are either overweight or obese, as are 13% of our children. More than double the global average of 5%.

While heart disease and diabetes are directly linked to being overweight or obese. There is evidence that a causal link exists between excess weight and cancers of the oesophagus, colon, rectum, liver, gall bladder, pancreas, breast, ovary, kidneys, thyroid gland, and even leukaemia.

It’s clear that South Africans need to take stock of their health, and their approach to regaining control of their weight – and what’s more, they need to take more action than signing up for a gym membership in January, then never using it.

“The slide to being overweight or being obese does not happen overnight. It’s the culmination of months and years of unhealthy eating, inactivity, and avoiding the right food and exercise choices for a variety of reasons,” says John Hamlett, a fitness expert and TomTom Athletics Club founder. “Losing the weight won’t happen overnight either – but doing so is vital if you are to reduce your risk of contracting a life-threatening disease, such as cancer or heart failure.”

Six tips and tricks to boost health and ban dread disease:

Limit your calorie intake. This doesn’t mean you need to stop eating. It means you need to make healthier food choices. Consult with your doctor or dietitian to find out what your daily calorie intake should be, and base your food choices on achieving that with the help of this handy online calorie counter.
Get out and about. One of the best ways to feel better about yourself is to get active – and you don’t have to go from zero to cardio hero to see the benefits. Track your movement with a TomTom Touch Cardioentry-level fitness tracker, which helps you monitor your daily step count, number of calories burned, as well as sleep and active time. Set yourself daily or weekly challenges, and decide on rewards before you start each challenge, to give yourself time to plan something healthy.
Ditch the diet drinks and choose water instead. Water hydrates the body, giving you a healthy glow, reducing wrinkles, and boosting weight loss. Drinking coffee or tea doesn’t count towards your daily recommended intake of eight glasses – you want to choose pure, unflavoured water for the best results.
Love the food you eat. It’s true that you’ll have to give up some types of food, but if you balance your food choices within your targeted calorie range, you can still enjoy tasty, filling meals. Veggies are low-calorie and include fibre (which makes you feel full) – but you can do so much more than just boiling them as part of a healthy eating plan. Steam them, roast them, bake them, spice them up with chilli or other fragrant spices. Healthy food certainly doesn’t have to be boring.
Up your game. Getting active by taking a walk around the office park at lunchtime is a great start – but you’ll see better results in your weight loss and health programme if you push yourself a little more each week. Take a jog at lunchtime instead of a walk, or use your newfound fitness as a foundation to make that gym membership worthwhile. If you’ve been tracking your progress on your TomTom fitness device, you can set yourself new goals (and rewards) to boost your activity even further.
Be prepared. Plan your meals in advance. Make sure you have all the required ingredients to prepare lunches for work in advance and have a good breakfast. A good breakfast will help you avoid those mid-morning nibbles, and a packed healthy lunch will reduce the temptation to eat unhealthy convenience foods during the day.

MEET OUR EXPERT - John E. Hamlett

John_Hamlett — John E. Hamlett is the Founder and Designer of John's New Lifestyle and is the coach of the TomTom Athletics Club Elite Athletes. He has been a professional athlete, teacher, electronic engineer and intelligence colonel; qualified as a specialist in nutrition and fitness (studied in Russia and the USA); was a physical training instructor in the military, qualified aerobics and swimming coach instructor, tri-athlete coach, gym instructor.

Diabetes apps: helpful or technology fad?

Posted on August 22, 2017 by Diabetes Focus eMag

Jessica Pieterse, a dietitian, helps us understand diabetes apps. She explains how to use them and shares the top five.

Carbohydrate counting may provide more freedom to a person with diabetes. One can adjust a meal depending on the blood sugar levels measured before a meal or adjust the insulin dosage according to the amount of carbohydrates eaten. However, keeping track of all this information may be challenging. Diabetes apps are the new kids on the block. Technology can aid you to count carbohydrates, monitor your intake, and track information that is important to a person living with diabetes.

What is an app?

An app is a software application designed for smartphones or tablets. It is different to programmes that are used on a computer or laptop as it runs directly on the mobile device and not on an internet browser.

How can diabetes apps help you?

Diabetes apps can help you monitor your glucose levels, food intake, medication doses, symptoms, kilojoule intake, carbohydrate intake, weight and exercise as well as supply meal recipe ideas and interesting articles. Most people always carry phones or tablets with them, which makes diabetes apps an easy and convenient method to store info.

What diabetes apps should you download?

CDE Club App

Free – available on Android and iOS.

The Centre for Diabetes and Endocrinology (CDE) provides scientific-based articles, videos, recipes and health-risk assessments.
Promotes participation by setting Life Actions, which are daily goals. If you are a CDE Centre patient, then your weight, blood pressure, glucose and HbA1c values are also recorded.
Provides reputable info, however, tracking of carbohydrates is not provided.

Diabetes apps

Diabetes in Check

Free – available on iOS.

Allows you to track your glucose, medication, food intake, exercise and weight.
It is user-friendly with helpful settings to make the records individualised, such as choosing the brand of insulin.
Highlights carbohydrates eaten at meals, which can assist with carb counting. However, portions are not always clear when entering into the app.

diabetes apps

Diabetes Lite

Free – available on iOS.

Tracks blood glucose, medication, physical activity, weight, food and water intake.
An advantage is that its comprehensive and includes water intake, which not all diabetes apps do. However, it is less user-friendly than other diabetes apps.
The nutrition tracking is probably the most confusing section as it is challenging to search for and log food items.

diabetes apps

Carb Counter

Free – available on iOS.

Can be helpful for the experienced person with diabetes – a person who already understands food.
The carbohydrate content can simply add the grams of carbohydrates eaten and note what meal or snack it is.
Tallies up a total daily carbohydrate intake.
Requires knowledge of carbohydrate contents of foods as no database of food items are given.

diabetes apps

Diabetes:M

Free – available on Android and iOS.

It is useful for an experienced person with diabetes. You can develop a detailed logbook of medication, glucose levels, meal times and carbohydrate intake.
Knowledge of carbohydrate contents of foods is needed as no food database is given.

How do you download diabetes apps?

Mobile devices will have an app store, either Google Play (Android) or Apple iStore (iPhone), to download various apps. You can search for diabetes apps by typing in the direct name of the app, or search for a general function that you desire.

Some diabetes apps are free while others you’ll need to purchase. If you are interested in an app, click on the ‘Get’ button, and then ‘Install’ button. Once it is downloaded, you can click on the ‘Open’ button.

What must you look out for when searching for diabetes apps?

There are plenty of diabetes apps to choose from, although not all of them should be used. Choosing the right one is a matter of understanding what function you want the diabetes app to have and where the diabetes app can support the health professional guidance.

Be cautious of prescriptive diabetes apps. Some diabetes apps prescribe goals, such as blood glucose levels or total kilojoule intake. This should be personalised and prescribed by your team of healthcare professionals, who have completed a comprehensive medical assessment and understand your unique requirements.

Should people with diabetes use diabetes apps?

Diabetes apps can provide useful information as well as an easy and convenient method of tracking important health data. These diabetes apps should be used as a complementary tool to your regular appointments with your health professional and not replace them.

Your health professional can use your tracked data on your chosen diabetes app to increase their understanding of your progress or difficulties. These diabetes apps can be used together with education on carbohydrate counting from your registered dietitian.

MEET OUR EXPERT - Jessica Pieterse

Mind over body

Posted on August 21, 2017 by Diabetes Focus eMag

Ilze Alberts explains how her excellent management of Type 1 diabetes came about – through mind over body.

Ilze Alberts (58) lives in Johannesburg with her husband. She has two adult children.

Type 1 diabetes fell out of heaven and hit my body; unexpected, uninvited, and bringing only promises of devastation. It felt like the end, but in retrospect, it was really just the start of a new beginning. One that proved infinitely better than the original plan that I had in mind.

If you’re reading this, you might have Type 1, Type 2, or you might be pre-diabetic. I know how scary that can be. Our afflictions, though different, are much the same – especially in the way we need to handle them. Perhaps you’re feeling angry, confused, even depressed. Maybe you blame yourself. “Why has this happened to me? What now?” It is within this context that I share my story with you.

Unexpected change in direction

I was a blooming 21-year-old with big dreams ahead of me; healthy and filled with a zest for life. I was in my final year of studies at university, working towards becoming a teacher, but I had wanderlust. I decided to become a flight attendant, to explore the world.

When I went for the medical, they told me, “You have diabetes.” It was one of the most cataclysmic events of my life. I was terrified, but I knew the first step was education. This is what I learnt:

Type 1 diabetes is an autoimmune condition in which the immune system is activated to destroy the cells in the pancreas. The cause is unknown, and it cannot be cured or prevented.
It occurs when the pancreas does not produce insulin.
It is managed with insulin injections several times a day, or the use of an insulin pump.
It represents around 10% of all cases of diabetes and is one of the most common chronic childhood conditions.

Finding the terrific in the terrible

Our biggest defeats often turn into our biggest victories. I would like to encourage you to find the terrific in your terrible. This requires that you apply your mind. I am not saying that your mind alone can be a substitute for the medication that you might need to take, but with the power of your mind, you can change the emotional and health impact it has on you.

Once I had educated myself and got the hang of things like the injections, correct eating, and regular exercise, I turned my attention – and still do – to the power of the mind to overcome challenges. I became aware, with lots of help, that my insulin dependency might well respond to the healing powers of my own mind.

I was so inspired to see the power that my mind had over my body. I began realising that my diabetes was not solely genetic, but also resulted from my unconscious perception that the condition somehow gave me more benefits than drawbacks, more pleasure than pain, and more positives than negatives. I wanted to know, “What is my hidden strategy? Why have I pulled this into my life?”

Exceptional management

Over time, as I committed my mind to wisely take control of my diabetes, my body started to respond positively to my actions. It was a slow process; it didn’t happen overnight. But eventually, with sustained physical and mental commitments, conscious actions to take control of my diabetes, the impact of diabetes became less. My HB1Ac levels remained constantly under 6, and my body loved the healthy eating and regular physical exercise.

Even an integrative and healthy-ageing practitioner was impressed. He had this to say: “When I met Ilze as a patient four years ago, I was blown away. She mentioned she was a Type 1 diabetic. I stopped in disbelief and looked at the blood tests done prior to her consultation. There was no indication of any underlying diabetes. The level of glucose in the red blood cells over the last 90 days was normal. Even today, this remains the case. Her holistic approach to her being, her life and her health is astounding. It is a source of hope not only to others, but also motivates me as a medical doctor to focus more on all the preventative lifestyle factors, and not just the disease and the management of the symptoms, signs and complications.”

How diabetes saved my life

Ironically, diabetes is one of the best things that has happened to me, for the following reasons:

I had to let go of my flight attendant plan. Instead, I studied psychology to master’s degree level, and I have practiced for over 30 years now. Today, I am also a life strategist, helping other people to create beautiful lives of their own. It gives me joy as I fulfil my purpose and live a life of meaning in serving others.
I was blessed to have given birth to two wonderful children, Charne and Jacques, despite my illness. They are healthy and diabetes-free, with a lust for life. They watch what they eat and exercise regularly.
I was widowed in my forties, but then met an extraordinary man, who is younger than me. One of the reasons he was attracted to me is because I am focused on empowering my life in all areas. We are happily married.
I am healthy, and I am filled with energy and vitality.
My health issues forced me to deal with the onslaught of bad food that we are exposed to. I exercise daily, eat very well, and I have a good body (according to my hubby).
My friends and family have been inspired by my life and my example.

Mind over body

“Yes, but I have Type 2,” you might say. “So, what worked for you will not work for me.” Not so. Like me, what has happened is that your body has communicated to you, that you need to adjust your lifestyle to be healthier. Your body is doing all that it can to wake you up and show you how to live an inspired and magnificent life. That is actually a blessing:

Has your illness added years to your life because you are forced to eat better and exercise?
Has this saved you from a stroke or a heart attack?
Have you helped your family because you have inspired them to live healthier?
Do you find you want to make every moment count, because you see how precious and valuable your life is? If not, when will you start?
Have you empowered your life by taking control, educating yourself, and focusing more on your family and the people that love you?

What is your big why?

You see, you need to have a big WHY, like I do – why is it so important to manage diabetes? If we don’t have this big why, the how will not appear. That is the big motivation. I desire to live my life with fulfilment, to live my vision, to make an impact on the world, to serve my family, to serve my clients, and I can only do that if I have a body that’s filled with health and vitality.

It became ever more apparent that I really wanted to be there for my husband, my children, my clients. I still do, as much as I ever did. My body is the vehicle through which I take my unique gift to the world (we all have one). If I don’t look after my body and my mind, then I cannot do this. How will you use your body’s response of trying to become well (manifest in your diabetes), to serve the people that you love, and the world?

I hope, with all my heart, that you see your life through new eyes because of my story. Our biggest stresses can be our biggest blessings. This is so true for me, because of my empowering journey with diabetes. May you, too, be inspired and motivated to live a beautiful life, and to powerfully share that with the world.

Eye Care Awareness Month runs from 21 September to 18 October. In light of this, Dr Chrissie Cockinos explains why dry eye is so common in people living with diabetes.

Why is dry eye common in diabetes patients?

Causes of dry eye in people living with diabetes

Sequelae of dry eye

Treating your dry eye

MEET OUR EXPERT - Dr Chrissie Cockinos

Anette Thompson, a podiatrist, tells us how to exercise feet to improve blood circulation, especially if you have diabetes.

SA research

Common reasons for not exercising

Do custom shoe inserts really work?

2. How to exercise feet

3. What shoes to wear

4. Can’t afford gym or scared to walk outside?

MEET OUR EXPERT - Anette Thompson

Christine Manga, a diabetes nurse educator (DNE), explains what her job entails and shares some of the challenges faced as well as the pluses.

Part of a team

Role

First consultation

SMART goals

Daily routine

Pros and cons

MEET OUR EXPERT - Christine Manga

Paula Pienaar explains why sleep timing is important to your health, adding that the time you go to sleep and wake up plays a large role in whether you increase your risk of obesity and Type 2 diabetes.

Sleep timing is crucial

The circadian rhythm influences sleeping, eating, heart rate, blood pressure, body temperature, the levels of certain hormones, and the immune system.

Tick-tock our body clock: our circadian rhythms

Did you know?

After midday, body temperature drops slightly which prompts the release of melatonin. Although this effect is at a smaller scale compared to nighttime, we often experience it as a ‘post-lunch’ energy dip occurring between 2pm and 4pm.

Social jet-lag

Consequences of a disrupted body clock

Managing sleep timing

MEET OUR EXPERT - Paula Pienaar

Rosemary Flynn enlightens us as to why having diabetes is an opportunity to develop resilience.

Things you can learn from diabetes:

MEET OUR EXPERT - Rosemary Flynn

The first free information and support app for people with diabetes has been launched by the Centre for Diabetes and Endocrinology (CDE). Hamish van Wyk, registered dietitian and diabetes educator from CDE, tells us more.

Discover

Act

Share

Rewards

How to download the app

To download the CDE Club App scan the QR code on the website http://www.cdediabetes.co.za/home/diabetes/join-cde-club/about-cde-club.html or search “CDE Club” App on either Google Play Store or the iTunes Store.

MEET OUR EXPERT - Hamish van Wyk

The world’s first flash glucose monitoring system, which requires only a scan rather than a traditional finger prick to test blood glucose, is now available in South Africa.

MEET OUR EXPERT - Prof Larry Disteller

John Hamlett, a fitness expert, shares six steps to boost health and ban dread disease.

Six tips and tricks to boost health and ban dread disease:

MEET OUR EXPERT - John E. Hamlett

Jessica Pieterse, a dietitian, helps us understand diabetes apps. She explains how to use them and shares the top five.

What is an app?

How can diabetes apps help you?

What diabetes apps should you download?

How do you download diabetes apps?

What must you look out for when searching for diabetes apps?

Should people with diabetes use diabetes apps?

MEET OUR EXPERT - Jessica Pieterse

Ilze Alberts explains how her excellent management of Type 1 diabetes came about – through mind over body.

Unexpected change in direction

Finding the terrific in the terrible

Exceptional management

How diabetes saved my life

Mind over body

What is your big why?

For more info or to contact me please go to bellavida.co.za