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diabetes invisible disability

Is diabetes an invisible disability?

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Dr Louise Johnson explains why diabetes can be classified as an invisible disability, but stresses that the term disability should not be used to describe a person as weaker or lesser than anyone else as everyone has a purpose, special uniqueness and value.

Diabetes distress

Living with diabetes is complex and involves various self-care activities, e.g. taking medication, healthy eating, carbohydrate counting, physical activity, checking blood glucose and problem solving5. These self-care behaviours are required to keep HbA1c (the three-month predictive glucose value) in target range – usually between 6,5% and 7,5%, according to the individualised value your doctor has decided on, after discussion with you. The HbA1c should be on target to prevent or delay onset of devastating complications.

The burden of self-management, living with diabetes-related complications (or the risk of their development) and managing difficult social situations has the potential to cause considerable emotional distress. The concept of diabetes distress was recognised in the early 1990s. Data shows that about one quarter of UK adults with diabetes experience elevated or severe diabetes distress at any given time. Similar rates are reported in Europe, Australia, and the USA6. It is also documented that diabetes distress is present among partners of those with diabetes.

Diabetes distress is the emotional response of specific aspects of living with and managing diabetes. The data shows that the higher the diabetes distress, the poorer the HbA1c. Your doctor can use different diabetes distress scales to determine your amount of distress and help with the management of it. Remember that diabetes distress is not depression.

Why would diabetes be an invisible disability?

To answer the question, letā€™s first look at the definition. The Oxford dictionary defines disability as: ā€œthe condition of being unable to perform because of physical or mental unfitness.ā€

Invisible or hidden disability is defined as disabilities that are not immediately apparent. This is an umbrella term that captures a whole spectrum of hidden disabilities or challenges.

It is estimated that 10% of the population in the USA have a medical condition that could be considered a type of invisible disability. Nearly one in two people, in the USA, have a chronic medical condition of one kind or another, but most of these people are not considered to be disabled, as their conditions do not impair their normal everyday activities.

According to the American Disabilities Act (ADA) of 1990, an individual with a disability is a person who:

  • Has a physical or mental impairment that substantially limits one or more major life activities.
  • Has a record of such impairment.

Invisible disabilities can include chronic illnesses, such as kidney failure, diabetes and sleep disorders; if these diseases significantly impair normal activities of daily living. Epilepsy, ulcerative colitis, and Attention Deficit Hyperactivity Disorder (ADHD) can also be classified as invisible disabilities.

A growing number of organisations, governments and institutions are implementing policies and regulations to accommodate persons with invisible disabilities. Governments and school boards have implemented screening tests to identify students with learning disabilities, as well as other invisible disabilities.

Statistics of invisible disabilities

About 10% of Americans have a medical condition that could be considered an invisible disability. It is shown that 96% of people with chronic medical conditions live with a condition that is invisible. These people do not use a cane or any assistive device nor show that they have a medical condition. About 25% of them have some type of activity limitation, ranging from mid to severe; the remaining 75% are not disabled by their chronic conditions.

Although the disability creates a challenge for the person who has it, the reality of the disability can be difficult for others to recognise or acknowledge. Others may not understand the cause of the problem, if they cannot see evidence of it in a visible way.

South African data shows that people with disabilities generally experienced career advancement challenges and reach career plateau. This study indicated that there is prejudice against invisible disabilities, and as a result, employees are reluctant to declare their disability7.

Why define invisible disability?

In general, the term disability is often used to describe an ongoing physical challenge. This could be a bump in life that can be well-managed or a mountain that creates serious changes and loss. Either way, this should not be used to describe a person as weaker or lesser than anyone else. Everyone has a purpose, special uniqueness and value, no matter what hurdles they may face.

If we take this into consideration, then the answer to the question, ā€œIs diabetes an invisible disability?ā€ should be yes, but only occasionally. It is important to keep into consideration the fact that there will be times when youā€™re not able to perform certain tasks due to a hypoglycaemic event. It is important to let your colleague or supervisor know and to take time out and correct this event.

In the case of a light hypoglycaemic event, it would take 15 to 30 minutes before the person is able to continue their work. This is an average, and dependent on the fact whether there are other co-morbid conditions also present in this patient, such as kidney failure or a previous heart attack or stroke.

Other complications

Diabetic patients that are not aware of their hypoglycaemic event are in a high-risk group. It is suggested that they wear monitors that can alert them of the lowering of blood glucose to enable them to act timely. There are a few continuous glucose monitors (CGM) available in South Africa.

The hypoglycaemic unaware diabetes patient usually has long-standing diabetes (more than 20 years) and has a degree of kidney failure. It should be noted that this could occur in a diabetic patient with a shorter duration of disease, if they have frequent hypoglycaemic events. The consequence of this is the body becomes use to the lower blood glucose, and its warning system only switches on very late.

The diabetic patient with complications, such as progressive retinopathy (bleeding eye disease), chronic end-stage kidney failure on haemodialysis, and amputations need some special arrangement with their work. The person with progressive diabetic retinopathy may need special measures to help with reading while patients on dialysis need time off work two to three times a week to get dialysis. There are dialysis units that operate at night to accommodate working people. This prevents absence from work.

This invisible disability is transient in the beginning due to the low and high blood sugars but can become a permanent disability. The disability only becomes evident when there is eyesight impairment, amputations, and chronic kidney failure on dialysis.

All patients should realise they can be proactive by gaining knowledge and prevent the invisible disability from becoming an overt disability. Knowledge is power; use this power to manage your diabetes as well as you can with the help of your diabetes doctor. Remember that you are unique and have a special purpose in life. You can rise to the occasion with the help of your diabetes team.

References:

  1. Peeples M, Tomky D, Mulcahy K et. al. (2007) ā€˜Evolution of the American Association of diabetes Educatorsā€™ diabetes education outcomes project.ā€™ Diabetes Educ. 33 p794-817
  2. Dennick K, Sturt J, Hessler D et. al. (2016) ā€˜High rates of elevated diabetes distress in research populations: a systematic review and meta-analysis.ā€™ Int Diabetes Nurs. http://dx.doi.org/10.1080/20573316205720161202497.
  3. Potgieter IL, Coetzee M, Ximba T (2017) ā€˜Exploring career advancement challenges people with disabilities are facing in the South African work contextā€™ SA Journal of Human Resource Management ,15(0) p815 http://doi.org/10.4102/sajhrm.v1510.815

MEET OUR EXPERT - Dr Louise Johnson

Dr Louise Johnson
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.
jobs diabetes patients

What jobs canā€™t diabetes patients do?

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There are certain types of jobs that diabetes patients are not allowed to do, especially if they are on insulin. Dr Louise Johnson explains the jobs that fall in this category and further discusses other concerns that diabetes patients could have while in the workplace.

Pilot

A Type 1 diabetes patient canā€™t be a pilot, however, a Type 2 diabetes patient, only treated with metformin tablets, can. The reasoning behind this is other oral medications and especially insulin could cause a sudden drop in blood glucose. This is dangerous for not only the pilot but passengers and public on the ground.

Mining industry

As soon as diabetes patients who work in the mining industry go on insulin, it becomes dangerous to go underground due to the risk of hypoglycaemia.

Public transport drivers

Since the driver controls the vehicle (taxi, bus, train) that carries passengers from point A to point B, it can be risky if the driver experiences hypoglycaemia. It can also be dangerous, if the driver has high blood sugar as it may lead to drowsiness and possible accidents.

Other concerns

Safety shoes

Diabetes patients working in industries where safety shoes are a requirement, need to ask their doctor to write a motivation to wear special safety shoes, suitable for diabetic patients. This is of importance to prevent their feet from injuries, such as scratches, pressure points and ulcers. Since injuries on the foot of a diabetes patient can lead to deeper ulcers and infection.

If it is not treated correctly and the patient has impaired sensation (peripheral neuropathy), it can contribute to the development of an amputation should the wounds not heal. Diabetes patients with impaired sensation often complain of burning feet, especially at night. They are the high-risk group for feet problems.

Writing exams

Diabetes patients that are on the go with studies should discuss their condition with the lecturers or invigilators. They need to inform them that their blood glucose can go incredibly high due to stress, and can cause severe drowsiness and a diabetic ketoacidosis (high sugar coma).

Diabetic ketoacidosis is a condition where the sugar rises exceptionally high due to insufficient insulin in the body. The bodyā€™s metabolism changes from using glucose as substrate for energy to using muscle breakdown products, called free fatty acids. The result is difficulty breathing, abdominal pain, nausea, vomiting, and confusion. This is a medical emergency, and can lead to death if not treated urgently.

Hence, why the lecturer/invigilator should also allow the diabetic student to take a sugar snack, glucose test machine, and insulin into the examination room. This is necessary to correct low or high blood sugar immediately to prevent any acute complications. Additional time should also be allocated to the student during exams, should the student have a low blood sugar event as it takes up to 30 minutes for the brain function to return to normal.

Driving

For many South Africans, driving forms part of their work – either by driving long distances to get to work or driving being one of their duties. Diabetes can affect driving due to hypoglycaemia. The low blood sugar may result in transient cognitive dysfunction or even loss of consciousness.

In a simulator, it was shown that cognitive functions critical to driving, such as reaction times and hand-eye coordination are impaired during hypoglycaemia. People experiencing hypoglycaemia ignored road signs and did not keep to lanes3.

Diabetes can also affect driving due to chronic complications associated with diabetes. The bleeding diabetic eye with decreased vision and the patient with an amputated limb has more difficulty to drive. The same can be said of the diabetic patient that had a stroke.

Type 2 diabetes is often associated with sleep apnea (stop breathing intermittently). This is a condition where a person has excessive daytime sleepiness due to snoring and a severe interrupted sleep pattern at night, which can be dangerous if the person is driving. Sleep apnea can be associated with obesity. It is effectively managed with a continuous positive airway pressure (CPAP) machine that increases the pressures in the airways at night and prevents the sleep apnea.

Any diabetic that had a severe hypoglycaemic event should not drive for at least six weeks thereafter. A severe low blood sugar event is where a person needs the help of a third party or is hospitalised due to hypoglycaemia. They can start driving again after six weeks or only after their awareness of hypoglycaemia has returned4.

Type 2 diabetes

People with Type 2 diabetes can do most occupations, if they follow a rigorous healthy lifestyle and diet to prevent going onto insulin.

Insulin is currently still needed after about 10 years of Type 2 diabetes but there are a variety of new drugs on the horizon that may help stretch this period even longer. Always take your HbA1c (average blood glucose value) into consideration to prevent complications and stay on target.

Managing your diabetes and workday

In the normal course of a workday, diabetes should be taken into consideration. Midday meals should not be skipped. If a person works at a company with a canteen, it would be reasonable to expect the company to cater for people with diabetes. Scholars and students attending academic institutions have the same requirements for special low-glycaemic index (GI) meals. Ideally, these institutions should cater for these scholars and students and their special needs.

The 2015 International Diabetes Federation (IDF) stats show that one in eleven people have diabetes, while the number of people suffering from diabetes in Africa was 14,2 million. This means that there are many diabetes patients at any company or academic institution.

One should take into consideration that obesity has epidemic proportions and healthy food consumption can help curb the diabetes epidemic. The South African National Health and Nutrition Examination Survey (SAHANES) data show that one third of men and two thirds of women are currently obese in South Africa1.

The data shows accordingly in Type 2 diabetes – an unhealthy lifestyle plays a major role in developing Type 2 diabetes and 80-90% of Type 2 diabetes patients are overweight. Data also showed that if obese people loose 5% to 10% of their weight, diabetes could be prevented2.

Any company should screen employees for diabetes at least once a year, since early detection of Type 2 diabetes can be excellently managed with lifestyle management such as moderate exercise and weight loss.

References:

  1. Shisana O, Labadarios D, Rehle T et. al. (2014) ā€˜The South African National Health and Nutrition Examination Survey. ( SANHANES-1)
  2. Wing RR, Lang W, Wadden TA et. al. (2011) ā€˜ Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.ā€™ Diabetes Care, 34(7) p1481-1486
  3. Cox DJ, Gonder-Frederick L, Kovatchev B et. al. (1993) ā€˜Driving decrements in type 1 diabetes during moderate hypoglycaemia.ā€™ Diabetes, 42 p239-43
  4. SEMDSA Type 2 diabetes guideline expert committee. (2017) ā€˜The 2017 SEMDSA Guideline for the management of type 2 Diabetes.ā€™ JEMDSA,22 (1)Supplement 1 (S1-S196)

MEET OUR EXPERT - Dr Louise Johnson

Dr Louise Johnson
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.

Low-carbohydrate sugar-free strawberry cupcakes

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This recipe makes six large cup cakes.

Ingredients

  • 200 g ā€˜liteā€™ margarine
  • 120 g fat-free smooth cottage cheese
  • 65 ml (1/4 cup) SUGAlite
  • 5 eggs
  • 190 g almond flour
  • 5ml (1 tsp) baking powder
  • Pinch of salt
  • Grated zest of 1 lemon

Topping

  • 250 g fat-free cottage cheese
  • 65 ml (1/4) cup SUGAlite
  • 6 strawberries

METHOD

  1. Preheat the oven to 170Ā°C.
  2. Grease the muffin mould and add wax paper rounds in the bottom of the muffin moulds.
  3. Cream the margarine, cottage cheese and SUGAlite together till fluffy. Add the eggs one by one while mixing continuously.
  4. Add the remaining ingredients and mix.
  5. Pour the cake batter in the pan and bake for 45 minutes till golden brown and the testing knife comes out clean.
  6. Cool down on a wire rack.
  7. To prepare the topping, mix the cottage cheese and SUGAlite together. Spread on to the cup cakes
  8. Add one strawberry on top of cupcake to garnish.

Nutritional analysisĀ per cup cake:

EnergyĀ  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā 1654 kJ

CarbohydrateĀ  Ā  Ā  Ā  Ā  Ā 15 g

ProteinĀ  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā 17g

Total fat Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  Ā  33 g

Unsaturated fats Ā  Ā  Ā 20 g

Love lives here… Our Story

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Marriage can be tough at the best of times, but then throw in a chronic disease like diabetes and the road can only get bumpier. We hear the amazing story of Alan and Shirley Goosen and how love, support, patience and understanding in a relationship will always win the day.

Alan (84) and Shirley (81) live in Gerdview, Germiston, JHB. They have two children, seven grandchildren and four great grandchildren, and will be celebrating their 62nd wedding anniversary in June. Alan has been living with Type 2 diabetes for 18 years.

Our Story4 DFAut17Alan was diagnosed with Type 2 diabetes at the age of 66. He went to his local GP as he had a painful growth on the back of his leg that was making it hard to sit and lie down. The doctor reluctantly cut it out. Through routine tests, it was discovered that Alan had diabetes. His sugar level was sky-high ā€“ sitting on 27mmol/L.

Even though Alan was put on numerous medications, he thought the doctor was ā€œtalking nonsenseā€. It was only in early 2000, when he lost part of his sight due to diabetic retinopathy, that he finally accepted and acknowledged his disease. Shirley too admitted that she never thought of his condition as serious until he went partially blind. ā€œAt that time, I never knew much about diabetes,ā€ Shirley said.

With Alan losing part of his sight, change was imminent. Shirley had to be the designated driver and do all the tasks that Alan couldnā€™t. ā€œI just naturally took over,ā€ Shirley said. However, it was Alan who grappled with the adjustment. ā€œWhen I realised I was nowā€¦letā€™s say disabled, I knew I would be a load on Shirley so I told her to leave me and go because I didnā€™t want her to carry that load,ā€ Alan said. Shirley was upset by Alanā€™s response but refused to leave him. Shirleyā€™s reaction, made Alan feel loved and supported. ā€œIt made me feel pretty good that she wouldnā€™t leave me,ā€ Alan said.

Shirley got advice from a sister at the clinic (the medication was too expensive so they asked their doctor to refer them to a clinic), on the types of foods that a Type 2 diabetes patient should avoid (fatty foods, fizzy drinks, sugar) and should eat more of (salads). Shirley added that she then followed the same diet, and that it wasnā€™t difficult for them to change their way of eating, however, one of Alanā€™s pet hates is lettuce.

Not being able to see took a toll on Alan; to not be able to drive was a massive blow – with him becoming dependent on Shirley if he wanted to go to the shops. He also had to give up his much-loved hobby gardening as he couldnā€™t see what he was planting. But in the true Alan-Goosen-fashion, he found a new hobby ā€“ woodwork, much to Shirleyā€™s horror. He had collected woodwork machines throughout his younger days so set up a workshop. In the beginning, it was a ā€œpainful experienceā€ as when Alan tried to do woodturning, many a times he would land up cutting his face. ā€œI wanted to hit him,ā€ Shirley retorted. Alan responded, ā€œI still have all my fingers!ā€ Soon, Alan learned how to do woodwork through the sensitive touch of his fingers and not with his eyes. If things got too difficult, he would ask Shirley to come assist him. He added that he has done some of his best woodwork during that period. Shirley also underwent emotional suffering. ā€œIf we went shopping and he couldnā€™t feel me or sense me, he would get into a panicā€¦it would just break my heart seeing him like that,ā€ Shirley said.

Nevertheless, the semi-retired couple carried on with their life, doing mission work while living in Breyton, Mpumalanga and gradually adjusted to the changes, persevering through the normal ups and downs that occur in marriage. In 2006, they relocated back to Johannesburg as Alanā€™s hearing was deteriorating, and they thought it would be best to be closer to their children. However, 18 months after moving back, Alanā€™s explained that ā€œthe Lord restored my hearing.ā€

Now, every morning after breakfast they go for a walk (Alan uses a walker) – just to the end of their road, weather permitting. ā€œIt is not far, but at least weā€™re trying,ā€ they said. Shirley makes sure Alan takes the correct tablets every day at the right time, arranging them in a weekly pill box and gives them to him to take. She drives them everywhere, cooks all their meals and sometimes must assist him in getting up and walking as he also suffers from diabetic neuropathy (nerve damage caused by high blood sugar resulting in numbness of feet and legs). Alan vulnerably admits, ā€œIf it wasnā€™t for Shirley, I wouldnā€™t manage. I rely totally on her.ā€

However, in the same breath, Alan finds Shirleyā€™s constant need to help him do everything exasperating. ā€œMy hope is to help myself, whereas she demands to do it for me,ā€ Alan explained, joking ā€œshe likes to show who is the boss.ā€ In Shirleyā€™s defence, she does it out of love and concern. ā€œMy worry is that he is going to fall so I am inclined to do things for him,ā€ Shirley explained.

Alan has a knack for twisting Shirleyā€™s arm, which she said annoys her. ā€œHeā€™ll say he feels like chocolate when he knows he isnā€™t allowed it and then I feel bad as he doesnā€™t enjoy the diabetic chocolates, so I land up giving him someā€¦just a piece, I make sure he doesnā€™t go overboard!ā€ Shirley said. When they do go out to functions, such as their senior church meetings, Shirley will dish-up food for him, making sure he eats correctly, and in moderation. She always carries hard sweets in her handbag in case Alan has a low.

Alan is still pushing-on and has taken up painting as his new hobby. He also has a tablet that he uses a magnifying glass to see and use. ā€œCall it stubbornness but I will never give up,ā€ he said.

At times, Shirley feels like she is not doing what she should for her husband and is letting him down. ā€œI flare-up and say the wrong thing and upset him, and I donā€™t like that,ā€ she acknowledged.

Despite all the negative effects diabetes had on Alan and Shirleyā€™s relationship, there is a significant positive. ā€œIt made me realise how much I trust my wife and how much I need her not only from a practical point, but also emotionally,ā€ Alan said.

Alan and Shirleyā€™s daily meals

Breakfast (8am): Oats with a banana and yoghurt.

Morning tea (10am): Cup of tea (with Suganon) with a piece of cheese and polony and sometimes a fruit.

Lunch (12:30 noon): Homemade soup with a slice of bread (if it is cold) or a sandwich.

Afternoon tea (3pm): A cup full of popcorn or a biscuit.

Dinner (6pm): Fat-free mince/chicken/fish with rice and always vegetables with a cup of coffee.

After dinner: A fruit (whatever is available).

thumb_IMG_6873_1024Diabetic Retinopathy develops over long periods with high levels of blood glucose which cause damage to blood vessels in the retina, causing them to clog or leak. In turn, these vessels are unable to deliver an adequate supply of nutrients to light-sensitive cells in the retina, resulting in partial or complete vision loss1.

References:

  1. https://www.visionweb.com/content/consumers/dev_consumerarticles.jsp?RID=16

MEET OUR EDITOR - Laurelle Williams

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
dsa news

DSA News – Autumn 2017

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Diabetes SA ā€“ Port Elizabeth branch

Malabar celebration

On Valentineā€™s Day, Diabetes SAā€™s Malabar Diabetes Wellness Group celebrated the fact that, after a recess, this group was relaunched on Valentineā€™s Day five years ago.

Most of the people dressed in redĀ to add to this festive occasion. Everyone present was given a special Valentineā€™s Day gift.Ā The guest speaker was Manhar Makan, an optometrist, who spoke about ā€˜Simplifying the grading of retinal changes in a diabetic Patientā€™.

Manhaar Makan(centre) flanked by Surendra Daya and the Malabar committee ladies.

Manhaar Makan(centre) flanked by Surendra Daya and the Malabar committee ladies.

Diabetes SA ā€“ Pretoria branch

Diabetes SA Pretoria branch AGM

The Diabetes SA Pretoria branch AGM was held on Saturday 25 March 2017.Ā It was well attended.Ā Brian Midlane, the branch chairman, led the meeting and gave a report on all the branch activities for the past year.Ā A diabetes workshop was also held during the event.Ā 

Domestic worker event

In February 2017, Liz Midlane, the treasurer of DSA Pretoria branch, spoke to a group of domestic workers about diabetes. She explained the symptoms, the types of diabetes, the treatments, the medications as well as the consequences of a well-controlled or uncontrolled diet.

The women were grateful for the information, and the literature which was handed out. A lucky draw was held where the winners won goodie bags.

Diabetes blame and shame game

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The stigma attached to diabetes is one of the least known and discussed complications of diabetes. The ā€˜diabetes blame and shame gameā€™ is real, and it has a negative impact on self-care, mental health and social life.

To some without the disease, people with diabetes are presented as overweight, lazy and guilty of bringing the disease upon themselves – often illustrated by faceless overweight people in reports on network news. On social media, images of large amounts of sweets often accompany the word diabetes.

People with diabetes are those people who must prick their fingers, inject themselves with insulin or carry around an insulin pump or a bag of medications. If they just got off the couch and stopped eating too much sugar, they would never have gotten the disease to begin with, right? Wrong.

“Diabetes is a complex disease,” diabetes educator Janis Roszler told Drugwatch. “For example, not everyone who is overweight develops it, and many who have Type 2 are thin.”

While being overweight is a known risk factor for Type 2 diabetes, those who have a family history of the disease, or had it while pregnant, are also at risk, regardless of weight. And Type 1 is actually an autoimmune disorder that occurs when the body destroys its own insulin-producing cells.

These are just a few myths about the disease that people with diabetes face on a daily basis. According to Roszler, there are people with diabetes who “feel they are damaged in some way.”

Through developing support and coping mechanisms, and education, people with diabetes can feel more equipped to manage it. And, hopefully, other peopleā€™s non judgemental attitudes and understanding will also lead to more compassion and support for those coping with diabetes.

Diabetes stigma: the blame and shame game

Fat, obese, overweight, big fat pig, lazy, slothful, couch potato, over-eater and glutton – these were a few of the negative stereotypes associated with people with Type 2 diabetes, according to participants in a study conducted by Jessica L. Browne and colleagues published in 2013 in BMJ.

“Once again, these stereotypes reflected the idea that you brought it on yourself,” Browne and colleagues wrote. “Less frequently reported, were stereotypes of people with Type 2 diabetes being poor people, not terribly intelligent, as well as being a shocking person or bad person and injecting insulin.”

Few other diseases carry the social stigma of diabetes. For example, most people never blame breast cancer patients for getting cancer. There are a number of positive, empowering campaigns for cancer cures and awareness. Supporters wear pink and celebrate survivors. According to the American Cancer Society, the five-year survival rate for women with breast cancer that has not spread is nearly 100%.

“Many cancers are curable. There is no current cure for diabetes that is available to the general public,” said Roszler. “Those who have it must monitor what they eat, check their blood, take their medication (if needed) and stay physically active to stay healthy.”

But in contrast to other diseases, the public is less accepting or encouraging of people living with diabetes. In fact, studies show more than half of Americans with Type 1 and 2 diabetes feel others blame them for their disease. A staggering 83% of parents of children with Type 1 feel the public blames them for causing their child’s disease.

“I think the stigma is that it’s a lifestyle disease. That somehow you’ve been lazy, and you’veĀ allowed this to happen to yourself,” ā€“ 54-year-old woman with Type 2 diabetes, 2013 Browne et al. study in BMJ

A common practice among healthcare providers and people without diabetes is to call someone with the disease a ā€˜diabeticā€™. Karen Kemmis, a diabetes educator with SUNY Upstate Medical University in Syracuse, New York, said this labelling is a “huge pet peeve” of hers and many educators and people with diabetes. According to Kemmis, this depersonalisation contributes to the stigma. “We don’t call someone who has cancer a ā€˜cancericā€™ and shouldn’t call someone with COPD a COPDer,” Kemmis told Drugwatch. “But, somehow, it seems acceptable to many to call someone a diabetic. No, they have diabetes. We should use person-first language rather than label someone by a disease.”

The burden of diabetes on those affected can be considerable. Experts call it diabetes distress – a mixture of depression, anxiety and stress. Research conducted by Dr Lawrence Fisher, Professor at the Diabetes Centre of the University of California in San Francisco, found about half of people with diabetes will experience it.

Fisher found one of the contributing factors to the distress is ā€˜social burdenā€™. The stigma attached to the disease takes its toll, Fisher told Diabetes Forecast. Researchers found suffering from distress and stigma-induced shame leads to poor self-care and worse health outcomes.

“Elevations in depressive symptoms and/or diabetes-related distress should be recognised as a predictor of problems with medication adherence in adults with Type 2 diabetes,” Dr Jeffrey S. Gonzalez, Associate Professor of Psychology at the Ferkauf Graduate School of Psychology of Yeshiva University, New York, told Endocrine Today.

The more intense the therapy, the more intense the stigma, Alexandra E. Folias and colleagues of dQ&A Market Research found. For instance, 43% of those with higher A1C levels who injected insulin or used a pump felt stigmatised, versus 25% of those with lower A1C levels.

The damaging stigma surrounding diabetes comes from a handful of myths. “I find a lot of people, they like to think of you as being the culprit. In fact, I actually had one person say, ‘Well, you’ve dug your grave with your own teeth.'” ā€” 67-year-old man with Type 2 diabetes, 2013 Browne et al. study in BMJ

Myth: People with Type 2 diabetes caused their disease

One of the strongest and most hurtful myths is that people with Type 2 diabetes wished it upon themselves and willingly gave themselves the disease. Kemmis has seen first-hand how the blame negatively impacts people with diabetes.

“I guess it is similar to people that have a disease that is related to cigarette smoking. It is their fault,” Kemmis told Drugwatch. “It can increase guilt and shame and could contribute to challenges in self-management. It is so important that people understand that family history and many other factors are involved in the onset of diabetes.”

Did you know?

Over 20 genes contribute to Type 2 diabetes.

For instance, another factor that increases the risk of developing Type 2 is gestational diabetes. Gestational diabetes occurs when pregnancy hormones decrease insulin sensitivity.Ā 

After her Type 2 diagnosis, Sue Rericha ā€“ a 45-year-old school teacher ā€“ had a friend tell her, “Oh, it runs in our family too, but weā€™re watching our weight so we wonā€™t get it.” She told Diabetes Forecast that she felt her friend was calling her ā€˜fatā€™ even though she had a normal body mass index, and Type 2 ran in her family. She also had gestational diabetes during pregnancy, five times.

FACT:

While lifestyle factors such as physical activity and weight may increase the risk of developing Type 2 diabetes; age, race and genetics also play a large role. Mothers who have gestational diabetes caused by pregnancy hormones also have a bigger chance of developing the disease.

Myth: Eating too much sugar causes diabetes

Another popular misconception is that eating sugar or carbs causes diabetes. While doctors are still learning about Type 1 and 2 diabetes, according to the Joslin Diabetes Centre, “What is known is that eating too many sweets doesn’t cause diabetes!” This myth also leads to what Kemmis calls the ā€˜diabetes policeā€™. The police are usually family members and friends who watch everything a person with diabetes does, especially sugary food intake.

“Thereā€™s always someone who makes a comment, ‘Itā€™s just because youā€™re fat and lazy. You just need to stop eating so much.’ Itā€™s very frustrating, and usually I just have to step back.” ā€“ Kate Cornell, online blogger, interview with Diabetes Forecast

“You shouldnā€™t have that dessert or drink that fizzy drink or eat that pasta. You should exercise and stop eating carbs, [according to the diabetes police],” Kemmis told Drugwatch. “Another issue is people blaming parents for ‘giving’ their child Type 1 diabetes because they gave them too much sweets/sugar. This has nothing to do with it!”

There is no specific diabetes diet for people with Type 2. Experts say each person is different, and eating sweets is not necessarily off the menu after diagnosis. Each individual should work with a medical team that can create a meal plan that works for them.

Myth: Type 2 diabetes can be permanently cured

Because of misconceptions about how Type 2 diabetes develops, the myth spreads that an adjustment to diet and activity ā€“ just getting off the couch and eating less ā€“ can cure it. But, the truth is people with Type 2 have to live with it and manage it for the rest of their lives.

Type 2 diabetes is a progressive disease, and sometimes people might need more medications than they did at the time of diagnosis. This could mean progressing from oral medicines to injecting insulin. Some patients may feel like failures when this happens.

FACT:

While eating too many sweets may lead to weight gain and increase the risk of developing Type 2, eating too much sugar does not cause Type 1 or 2. In Type 1, the body’s own immune system attacks the insulin producing cells and destroys them, and the body is no longer able to make its own insulin. In Type 2, the body develops insulin resistance. “The good news for a Type 1 and Type 2 patients is that if insulin, medication, weight loss, physical activity and changes in eating result in normal blood glucose, that means their diabetes is well controlled, and their risk of developing diabetes complications is much lower. But it doesn’t mean that their diabetes has gone away.” ā€“ Joslin Diabetes Centre.

FACT:

People with Type 2 diabetes can manage their disease with diet, exercise and medication, but must always stay vigilant against the complications and relapses of the disease. Taking stronger medications or insulin is not a failure on the part of the person with Type 2.

Think about people managing their diabetes as having to manually replace the functions of an organ in your body which is not working properly any more. This can be very challenging as you cannot take a break or a holiday from your diabetes without negative consequences.

Sources of stigma

“Thatā€™s just the nature of diabetes. Sometimes you need medicine to reverse things that arenā€™t working metabolically in your body.” ā€“ Dr Floyd Russak, medical director of East-West Health Centres in Greenwood Village, Colorado.

There are several sources of diabetes stigma. These messages can affect people with and without diabetes, and many have a negative effect regardless of intent. Browne and colleagues identified the media, healthcare professionals and family and friends as the main sources.

Because of the stigma, newly diagnosed diabetes patients may even keep it a secret for fear of judgement. They fear discrimination at work and the sense of blame they may get from others. For example, one study participant said she felt the need to hide it because she had a high-ranking position at her company.

Stereotypes can even lead to discrimination and restricted opportunities i.e. negative perceptions of the disease, particularly if an individual is overweight. Discrimnation due to diabetes is very real and may affect job opportunities and relationships.

Media

Media is even more prevalent than ever, and people can watch TV or look online to see presentations of people with diabetes, particularly Type 2 diabetes. As our media shifts to digital content, the internet is a growing source of stigma. Mike Durbin is a 31-year-old health blogger diagnosed with Type 2 diabetes and congestive heart failure in 2008. In an interview with Diabetes Forecast, he spoke about reader comments on his 2011 USA Today profile. ā€œSome of the [online comments] were: ā€˜If this guy would just get off his [couch] and do something, try exercising, try eating better, [he wouldnā€™t have diabetes]ā€™ ā€” most of the typical comments that you hear toward people with Type 2,” he said. “Iā€™ve gotten to where I really donā€™t take much of that to heart. It would really just eat you alive if you did.”

Browne’s research points to two views expressed in the media: Type 2 is a lifestyle disease, and emphasis on being overweight and physically inactive reinforced blaming attitudes. People with Type 2 diabetes also felt media often used scare tactics and sensationalism to describe the ā€˜diabetes epidemicā€™. Few stories or features focus on people who successfully manage the disease, and many of the characters with diabetes in movies or series are sensationalised or portray diabetes inaccurately.

Healthcare professionals

Healthcare professionals are also a source of negative feelings and stigma. Participants in Browne’s study reported their doctors focused on what patients did ā€˜wrongā€™. An example of this could be when patients are marked non-compliant in their files without a doctor trying to find out what could be contributing to the high glucose levels. Patients wanted more encouraging behaviour and helpful tips on how to improve. Patients instead reported feeling discouraged and judged.

“The reason is clear: Type 2 diabetes sufferers tend to be obese, and we still think of obesity as a self-created illness, caused by too much eating and too little exercise,” Dr Sanjay Gupta wrote in Everyday Health. “Even some doctors will admit they are less sympathetic to their diabetic patients.”

In a story about stigma, Gupta interviewed Dr Peter Attia, a physician who judged his patients with Type 2 because they were overweight until he had his own run-in with prediabetes. “[My patient] was in the emergency room for a condition I considered completely preventable,” Attia told Gupta. “She did in fact sense this was a physician who was judging her.”

But, while he judged his patients, Attia was borderline obese despite daily exercise and healthy eating. Then he found out he had prediabetes. Now he speaks about shedding the stigma of obesity and diabetes.

Another misconception that may spread among healthcare practitioners is that people with Type 2 diabetes need to lose large numbers of weight to make a difference. The information may be discouraging to people with diabetes. “Many people think they need to lose 20 to 45 kilograms, when studies show that diabetes management can change with a modest 2 to 4kg weight loss and moderate exercise of 30 minutes, five days per week,” Karen Kemmis told Drugwatch.

“The dietician was awful… she asked me if I exercise, and I said, ‘I do the gym twice a week and I have consistently since November.’ ‘That’s not enough, you need to go five times a week.’ This makes me really angry.” ā€“ 35-year-old woman with Type 2 diabetes, 2013 Browne et al. study in BMJ

“Thereā€™s no good news stories about Type 2 diabetes. Perhaps there should be. Perhaps it should be ‘it isnā€™t necessarily a death sentence.ā€ ā€“ 54-year-old man with Type 2 diabetes, 2013 Browne et al. study in BMJ.

Friends, family and colleagues

“I’d love it if you offer me what [food] you’re handing around and I can say ‘yes’ or ‘no thanks,’ that would be nice really. That makes me feel excluded.” ā€“ 59-year-old-woman with Type 2 diabetes, 2013 Browne et al. study in BMJ.

Despite the best intentions, family and friends may be hurtful and judgmental. People with Type 2 described the behaviour as “unhelpful, annoying or discouraging” and found it “hurtful, judgmental and interfering.”

“We talk about the ‘diabetes police’ who might be friends or family that watch a person with diabetes and tell them what they should and shouldnā€™t do,” said Kemmis. “No one likes to be told what to do or eat. It’s the idea that it is the personā€™s own fault for getting themselves into this mess.”

Significant others and dating

Type 2 diabetes stigma also extends to social life, particularly in intimate situations with spouses or even dating. When it comes to intimacy with a spouse or partner, the fear can be crippling.

Diabetes educator Janis Roszler is also a marriage and family therapist, and she has seen the stigma affect marriages and relationships.” About half of all men and women with diabetes develop some form of sexual complication,” Roszler told Drugwatch. “Men who struggle with their diabetes management are at an increased risk of developing erectile dysfunction. Women may have vaginal dryness, pain during intercourse, arousal and orgasm challenges, and an increased incidence of urinary tract infections.” Sexual dysfunction of any kind already comes with a hefty dose of shame, and according to Roszler, diabetes-related dysfunction adds more shame to it.

“They worry that others may not want to date someone who lives with a chronic disease that requires so much daily attention,” she said. “I’ve interviewed many people with diabetes who struggled to find a positive way to tell people they date about their diabetes.”

While it can be difficult to overcome, Roszler offers some suggestions to lessen the anger and frustration that can come with diabetes-related complications.

“Give ‘diabetes’ a name, and treat it like a totally separate entity,” she said. “I know of a couple who named the husband’s diabetes ‘George.’ When the husband started to feel his blood sugar drop during sexual activity, they blamed ‘George’ for making trouble, not the husband.”

“When I first got diabetes, I wouldn’t tell anybody. I didn’t even tell my husband. I told nobody. I felt so ashamed to have it. I felt completely ashamed of myself.” ā€“ 56-year-old-woman with Type 2 diabetes, 2013 Browne et al. study in BMJ.

Demystifying diabetes and dispelling myths

“Many of my patients are frustrated because the general public doesn’t understand what they go through each day. Diabetes affects every area of a person’s life. It isn’t possible to take a vacation from it.” ā€“ Janis Roszler, author and diabetes educator.

Even though there are 415 million adults with diabetes worldwide, there are still misconceptions about the disease. Education is one of the ways to dispel these myths.

So, here are the diabetes basics:

  • People can get diabetes at any age.
  • Men and women can develop the disease, though men are more likely to develop it.
  • According Statistics South Africa, the second leading underlying natural causes of death among South Africans in 2015 was diabetes.
  • Currently, there is no cure for diabetes though people can manage it through lifestyle changes and medical treatment.
  • There is more than one type of diabetes, and each type has its own risk factors.

MEET OUR EXPERT – Michelle Llamas

Michelle Llamas is a writer and researcher for Drugwatch.com. She is also the host of Drugwatch Radio and has appeared as a guest on podcasts and radio shows. Michelle has a varied background as a researcher and writer for magazines and public relations companies. She has been published in research journals and peer-reviewed publications. She graduated from the University of Central Florida with a degree in English ā€“ Technical Communication.

How is your relationship with your heart?

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Our hearts serve us dutifully, sustaining us from our first to our very last breath. In view of this, the Heart and Stroke Foundation South Africa (HSFSA) have come up with six practical tips to treat your heart with the respect and care it deserves.

Get active!

A strong heart is a happy heart. Regular exercise provides profound long-term health benefits including benefits which protect your heartā€™s health, such as:

  • Improves ā€˜goodā€™ cholesterol levels
  • Helps lower high blood pressure
  • Helps reduce and control body weight
  • Helps control blood sugar levels and reduces the risk of developing diabetes
  • Helps to manage stress and releases tension
  • Reduces the risk of heart disease and stroke

Aim for a minimum of 150 minutes of moderate activity a week, such as 30 minutes 5 days a week, or 75 minutes of vigorous activity per week, such as 20 minutes 4 times a week.

healthy-heart

Know your numbers

All strong relationships are built on good communication. Blood pressure, cholesterol and blood glucose values shouldn’t be a secret than can ruin the relationship with your heart. If these hidden numbers are out in the open, a broken heart could be saved before it’s too late! So go for regular health checks to make sure you know what your numbers are.

heart-healthy-meal-plan

Eat well

How we eat and it’s impact on our daily blood glucose control has an accumulating effect on our heart health. Which means that our daily choices which stretch over months and years have a far larger impact on our heartā€™s health than the odd chocolate. So, care for your heart by nourishing your body daily with a balanced, healthy diet. Eat more healthy foods such as fruits, vegetables, beans, low-fat dairy, whole grains, and healthy fats like olive oil and avocados. Watch your portion sizes to avoid over-eating and eat less food with excess sugar, salt and bad fats such as take-aways, sugary drinks, cakes and pies. For individualised dietary advice and support, find a dietitian at www.adsa.org.za.

Build healthy relationships

Could love improve heart health? Satisfying relationships and social support donā€™t only make us feel happy and loved, but may also provide health benefits. One reason for this is that it may lower harmful levels of stress and stress hormones. Many behaviours, such as human touch or showing affection; affirming our love for one another; caring behaviours or offering help, could elicit this calming effect, sense of security and support. Loved-ones may also provide encouragement for us to take better care of ourselves by preparing andĀ enjoying healthy meals together and supporting us to go for regular health check-ups.

Avoid smoking

Even though most people associate smoking with lung health, more smokers will in fact suffer heart disease. Smoking almost triples the risk of heart disease and more than doubles the risk of having a stroke. Therefore, you can’t have a good relationship with your heart if you light up a cigarette daily. It’s like saying ‘I love you, but I don’t want to be with you’. Quitting however, is not easy, itā€™s like getting out of a bad relationship. So don’t do it alone, ask for help or get in touch with any of the following support programmes:

Mind your mental health

Stress and depression have both been linked to an increased risk of heart disease. While we canā€™t always escape day-to-day stress, we can manage it effectively. Instead of reaching for a cigarette or a donut, try to relieve your stress with something healthier like going for a brisk walk, speak to a friend or take time to do something you enjoy.

Depression is a common mental disorder characterized by lowered mood, negative thoughts, low energy levels and a change in appetite. It increases the risk of heart disease by 50% compared to someone without depression. If you think you may suffer from depression, then speak to someone you trust and seek professional help from a psychologist or psychiatrist. Depression can be effectively treated but the first step is recognising it.

Are there any benefits in following a detox diet?

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Weā€™re all familiar with the variety of detox diets available on the market. They vary from drinking fluids, such as water, fruit and vegetable juices, and herbal teas while some variations offer the option to enjoy selected fruit and vegetables. Ria Catsicas weighs up the pros and the cons.

Although most of us find the first few days of a detox difficult, the lightness and improved energy levels that follows gives us an encouraging feeling. However, the problem arises a week or two later when we find ourselves slowly returning to our old eating habits. The reason for this is that these detox regimes are not substantial enough to support and sustain healthy eating habits in the long term.

What does medical science say about detoxification?

How does it work?

Detoxification is a continuous process that the body performs naturally. Seventy five percent of the deactivation of toxins take place in the liver and the remainder in the intestine. When potentially harmful substances enter the body, the bodyā€™s detoxification systems ā€“ which consist of a series of metabolic reactions ā€“ start performing.

Toxins are environmental of origin, such as processed foods (sugar and white flour products), medication, smoking, alcohol, caffeine and environmental toxins (heavy metals and pesticides). Toxins can also be from body origin, for example, the unwanted end products of metabolism, hormones (stress) or bacterial by-products.

Detoxification takes place in three phases:

  1. Identification (modification): certain enzymes support the reactions that identify harmful substances through oxidative processes and create unstable toxic substances.
  2. Neutralisation (conversion): these substances need to be bounded by conjugators to make them harmless and soluble for excretion.
  3. Elimination: the end products are excreted by our skin, lungs, kidneys and the digestive tract.

Stress hormones, medication and tobacco compete for the detoxification enzymes. Without the supply of all the nutrients from a wide variety of foods, the liver becomes overwhelmed leading to inflammation and disease.

What types of foods should we consume?

We need a large variety of nutrients, such as vitamins, minerals and phytonutrients (carotenoids, flavonoids, terpenes, indoles, isothiocynates), that support the enzymes and metabolic processes involved in phase one to three to function optimally. We find them in the following foods:

Vegetables:Ā Allium family – onions, garlic, chives and leeks.

Brassica – broccoli, Brussel sprouts, Bok choy, cabbage, cauliflower, kale, mustard greens, radishes, horseradish, turnips, watercress and wasabi.

Other – beets, celery, cucumber and spinach.

Fruit: Avocado, cranberries, blueberries, apples, pears, grapefruit, lemons, oranges and citrus peel.

Legumes:Ā Lentils, beans, dry peas and chickpeas.

Fats:Ā Olive oil, canola oil, almonds, Brazil nuts, hazelnuts and pistachios.

Herbs and spices:Ā Rosemary, cumin, turmeric, caraway and dill seeds.

Seafood:Ā Wild-caught salmon and sardines.

Animal protein:Ā Organic chicken, turkey and wild game.

Eats_HealthyFoodForHeart_Featured

Key points to remember

In order, to support the continuous detoxification processes in the liver, we need to not be sipping juices for just a few days but rather adopt to a healthy eating pattern for life. This includes the following:

  • Consume a wide variety of fresh vegetables and fruit daily.
  • Select foods which are whole and unprocessed. These foods you buy from the fresh section in the supermarket, and normally donā€™t come out of a box or packet. For example, snack on a fresh fruit instead of a protein bar and enjoy a freshly-made vegetable soup instead of an instant cup a soup.
  • Consume a minimum of six glasses of water per day.
  • Ensure optimal gut function by consuming high fibre foods, such as whole grains (hi fibre breakfast cereal, barley, quinoa, corn, rolled oats and wild/brown rice).
  • Move on a regular basis ā€“ adequately ā€“ to build up a sweat.
  • Should you decide to do a detox diet anyway, it should be done with the assistance of your health professional. Your medication may have to be adjusted to prevent hypoglycaemic attacks.

Vegetable juices should be thus enjoyed as part of a daily healthy eating plan and are ideal to boost your intake of five to nine portions of fresh vegetables and fruit. To adopt a healthy eating plan, it is advisable to consult a registered dietitian. He/she can provide you with an individualised eating plan and menu (that include all the above foods mentioned) and delicious recipes to meet your lifestyle requirements preferences. He/she can also provide you with practical advice to implement the plan successfully. For a dietitian in your area, contactĀ www.adsa.org.za

MEET OUR EXPERT - Ria Catsicas

Ria Catsicas
Ria Catsicas is a dietitian in private practice and completed a masterā€™s degree in nutrition. She has a special interest in the nutritional management of chronic diseases of lifestyle and authored a book The Nutritional Solution to Diabetes.

Diabetes and fasting during Ramadan

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With Ramadan approaching (26 May- 24 June), Diabetes Nurse Educator Razana Allie explains how having diabetes and fasting during Ramadan can be manageable.

The 26th of May is the start of most important month of the 2017 Muslim calendar. This month signifies and reaffirms our commitment to Islam and the five pillars which we conform to as Muslims. Islam is a way of life, and fasting is bestowed upon us as soon as we enter puberty until the time of death. As a Muslim, not fasting is a violation of who we are.

Sin, guilt, dishonesty and embarrassment are but a few words to describe what most feel when not fasting. The threat of developing complications or even death when fasting with an acute/chronic condition is not sufficient to deter most from fasting. This may result inĀ complications which may have been prevented.

Diabetes is a chronic condition which, with education and support, can be managed to prevent complications and obtain a good quality of health.

During Ramadan, many factors influence the quality of our fasting day. Maintaining normal blood glucose while fasting is quite a challenge even to the person without diabetes.

Late nights with Taraweeh (Ramadan prayers) and early mornings with Suhur (pre-dawn meal) means less sleep. Waking early for Suhur to keep you nourished and satisfied until Iftar (breaking the fast) is a challenge.

Mild hypoglycaemia, dehydration, lethargy is the order of the day, to continue for 29 to 30 days of the month.

In South Africa, itā€™s business as usual. Very few companies acknowledge fasting and how difficult it is. Work life is the same as the other 11 months of the year. Expectations to perform continue, which is added pressure while fasting.

Possible complications while fasting may be:

Hypoglycaemia ā€“ While fasting there is no opportunity to correct the hypoglycaemia, which may lead to symptoms including confusion, irritability, coma or hospitalisation if witnessed. The liver provides glucose throughout the day until it becomes depleted of its stores.

Dehydration ā€“ may occur as fluid intake is only allowed at night and not during the day.

Thrombosis ā€“ the formation of blood clots. More prevalent with uncontrolled diabetes, cardiovascular disease, hypertension as well as dehydration.

Hyperglycaemia ā€“ may occur when medication is not taken to prevent hypoglycaemia while fasting.

Those who should not fast:

  • People with uncontrolled diabetes who use multiple doses of insulin, especially Type 1 diabetes.
  • Patients with long-term diabetes complications, such as kidney failure or heart disease.
  • Women with gestational diabetes.
  • Patients with a tendency of high blood glucose levels and those with high ketone levels.

ramadan_625x350_61465466111It is stated in the holy Quran, ā€œAllah desires for you ease, and does not desire for you hardship.ā€ ā€“ Ramadan Mubarak.

Can blood glucose levels be managed during Ramadan?

Diabetes can be manageable with education, guidance and support, provided you are low risk.

During pre-Ramadan, it is advisable to visit your doctor and diabetes educator to measure control and risk. This visit should also provide education on how to manage your blood glucose levels while fasting. Discussion on dosage reduction and target blood glucose for the month is important. (Xanax)

Management of hypoglycaemia as well as hyperglycaemia should be stressed and confirmed. Exercise is usually minimal during Ramadan, and most regard Salaah, during Taraweeh, as a form of exertion like exercise. However, parking far from the entrance at work or when shopping, and taking the stairs instead of the lift is manageableĀ and acceptable forms of exertion.

Correct meal choices are important to get through the month of Ramadan. Minimal fatsĀ and carbohydrates, especially at Iftar, and additional proteins at Suhur is recommended. Faloodah with a sweetener instead of sugar; air fried or baked samosas insteadĀ of deep fried; two dates instead of six when breaking fast; baked curry balls instead of deep fried. Cake, biscuits, donuts and koeksisters may be taken in moderation at Iftar, providedĀ youā€™re aware of the consequences of high blood glucose levels when consuming these foods.

In addition to the low GI carbohydrates, proteins are recommended at Suhur to provideĀ and maintain energy levels throughout the day.

An increase in the intake of fluids at night is important; this will minimise dehydration throughout the day. Monitoring blood glucose is essential, with additional testing two hours after Suhur and Iftar, and before Asr Salaah for possible hyperglycaemia after meals and hypoglycaemia late afternoon. Changing injection times and adjusting insulin and oral dosages discussed with your doctor and diabetes educator before Ramadan prevents untoward abnormal blood glucose levels during the month.

Revisit your doctor and diabetes educator post Ramadan to readjust your medication and plan a way forward.

”MEET