Category: 2017 Autumn – Diabetes Focus eMag

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DSA News – Autumn 2017

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Diabetes SA – Port Elizabeth branch

Malabar celebration

On Valentine’s Day, Diabetes SA’s Malabar Diabetes Wellness Group celebrated the fact that, after a recess, this group was relaunched on Valentine’s Day five years ago.

Most of the people dressed in red to add to this festive occasion. Everyone present was given a special Valentine’s Day gift. The guest speaker was Manhar Makan, an optometrist, who spoke about ‘Simplifying the grading of retinal changes in a diabetic Patient’.

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 – Pretoria branch

Diabetes SA Pretoria branch AGM

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

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 ‘diabetes blame and shame game’ 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 people’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’ve allowed this to happen to yourself,” – 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 ‘diabetic’. 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 ‘canceric’ 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 ‘social burden’. 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.'” — 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. 

After her Type 2 diagnosis, Sue Rericha – a 45-year-old school teacher – had a friend tell her, “Oh, it runs in our family too, but we’re watching our weight so we won’t get it.” She told Diabetes Forecast that she felt her friend was calling her ‘fat’ 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 ‘diabetes police’. The police are usually family members and friends who watch everything a person with diabetes does, especially sugary food intake.

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

“You shouldn’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 – just getting off the couch and eating less – 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.” – 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

“That’s just the nature of diabetes. Sometimes you need medicine to reverse things that aren’t working metabolically in your body.” – 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. “Some of the [online comments] were: ‘If this guy would just get off his [couch] and do something, try exercising, try eating better, [he wouldn’t have diabetes]’ — most of the typical comments that you hear toward people with Type 2,” he said. “I’ve gotten to where I really don’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 ‘diabetes epidemic’. 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 ‘wrong’. 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.” – 35-year-old woman with Type 2 diabetes, 2013 Browne et al. study in BMJ

“There’s no good news stories about Type 2 diabetes. Perhaps there should be. Perhaps it should be ‘it isn’t necessarily a death sentence.” – 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.” – 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 shouldn’t do,” said Kemmis. “No one likes to be told what to do or eat. It’s the idea that it is the person’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.” – 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.” – 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 – 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 heart’s health, such as:

  • Improves ‘good’ 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 heart’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 don’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 and 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, it’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 can’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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We’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 body’s detoxification systems – which consist of a series of metabolic reactions – 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: 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: Lentils, beans, dry peas and chickpeas.

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

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

Seafood: Wild-caught salmon and sardines.

Animal protein: 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 don’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 – adequately – 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, contact www.adsa.org.za

MEET OUR EXPERT - Ria Catsicas

Ria Catsicas
Ria Catsicas is a dietitian in private practice and completed a master’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 in 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, it’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 – 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 – may occur as fluid intake is only allowed at night and not during the day.

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

Hyperglycaemia – 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, “Allah desires for you ease, and does not desire for you hardship.” – 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 manageable and acceptable forms of exertion.

Correct meal choices are important to get through the month of Ramadan. Minimal fats and carbohydrates, especially at Iftar, and additional proteins at Suhur is recommended. Faloodah with a sweetener instead of sugar; air fried or baked samosas instead 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, provided you’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 provide 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

One-on-one with Dr Cliff Allwood

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Dr Cliff Allwood, specialist psychiatrist – Akeso Clinic Pietermaritzburg, explains how diabetes and depression are linked.

What comes first – depression or diabetes?

As far as we know, there is not a causative link between the two conditions and they may occur at different times. However both conditions may be linked to a significant physical, medical or emotional stressor. The onset may have occurred at a similar time.

Is there a link between the two? And how does this work?

There does not seem to be a direct link, however, we do know that clinically the two conditions do affect each other. Each makes the other worse. Both conditions need to be adequately treated.

How do you break this vicious cycle?

Both conditions have to be taken seriously. Diabetes and any other medical conditions must be treated. Ongoing monitoring and control is essential. Depression must be treated with whatever biological, psychological, social or spiritual interventions are appropriate and effective. Lifestyle changes may have to be made in both conditions, and exercise is essential for both conditions.

How does depression in a diabetic patient differ to any other form of depression?

In the diabetic patient, mood can be affected by blood sugar changes. The patient has to be aware of the effects of both ‘highs’ and ‘lows’. Sometimes the medications used for diabetic control may have an effect on mood. Diet and lifestyle changes may also affect mood. The patient is encouraged to be observant about the effects of changes. A partner or close friend can be helpful in observing changes. On the other hand, depression may affect the manner in which the patient is managing his/her diabetes. Depression may have a negative effect on motivation and compliance with treatment.

In advanced stages of diabetes sufferers may lose sight, limbs, or have other medical conditions. These profound disabilities will commonly result in depression. The depression requires full treatment. Untreated depression may have severely negative effects on later compliance and efforts towards treatment and rehabilitation.

Is there an increase in this?

There is a worldwide increase in the incidence of depression.

What are the signs of depression in the diabetic patient? Do these differ from other forms of depression?

Depression in a diabetic patient is no different from depression in people who don’t have diabetes, except as mentioned in question four. However, any signs of ‘confusion’ in the patient must be taken very seriously since this indicates that either the blood-sugar is out of control, or there is some reaction to the medication. This requires a full medical examination and appropriate treatment.

How is depression beaten?

Treatment for depression varies dependent on the specific history and symptoms of each sufferer. Research does however indicate that treatment with medication and psychotherapy is generally most effective. Substantial lifestyle changes may be required and the recruitment of social support is also necessary, as self-isolation makes depression worse. If the depression is severe the sufferer can be treated with the assistance of an inpatient treatment programme, such as the programmes offered by Akeso.

When should partners or family members worry?

When the depression is preventing the sufferer from functioning as they wish to.

Are there tips and tools to reducing your levels of depression if you have diabetes?

Self-care is an important practice as is increasing self-awareness. The establishment of good habits like journaling (a food and mood diary); moderate and consistent cardiovascular exercise (brisk walking etc.); dealing proactively with negative thoughts; sustaining healthy friendships; ensuring compliance with medication; supplementation with Omega 3s; getting 20 minutes of sunshine every day; developing resilience; practicing self-acceptance and being kind to oneself – are just a few ways to limit the destructive impact of depression.

Read more on depression

Let’s talk depression

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World Health Day is celebrated on the 7th of April to mark the anniversary of the founding of the World Health Organisation. This year’s theme is “Let’s Talk: Depression.”

One in three South Africans will or do suffer from a mental illness in their lifetime – and depression is the most common mental illness. About one in six South Africans suffer from depression – although only about a quarter of people living with a mental illness ever seek or receive treatment.

Depression is the leading cause of suicide and, in South Africa, there are 23 completed suicides every day – and a further 460 attempted suicides every 24 hours. “Men are more likely to commit suicide than women as they don’t seek help until it’s too late,” said the South African Depression and Anxiety Group’s (SADAG) Director, Cassey Chambers.

It may not always be easy to tell the difference between a run-of-the-mill bad mood and depression. If you have five or more of these symptoms for most of the day, nearly every day, for at least two weeks, and the symptoms are severe enough to interfere with your daily activities, you may have depression:

  • Depressed mood, sadness or an ‘empty’ feeling or appearing sad or tearful to others.
  • Loss of interest or pleasure in activities you once enjoyed.
  • Significant weight loss when not dieting, or significant weight gain.
  • Inability to sleep or excessive sleeping, always feeling exhausted.
  • Restlessness or irritation (irritable mood may be a symptom in children or adolescents   too), or feelings of ‘dragging’.
  • Fatigue or loss of energy.
  • Feelings of worthlessness, or excessive or inappropriate guilt.
  • Difficulty thinking or concentrating, or indecisiveness.
  • Recurrent thoughts of death or suicide.

Depression affects people of all ages, from all walks of life and negatively impacts a sufferer’s ability to carry out everyday tasks. Depression has consequences for families, friends, workplaces, communities, and healthcare systems. Untreated depression can lead to self-injury and suicide. SADAG, like the WHO, believes that educating people about depression can reduce the stigma that surrounds mental illnesses and encourage more people to seek help.

We all have days when we want to hide under the covers and wish the world would leave us alone; days when we feel precariously on the verge of tears or an angry outburst. Minor things can trigger a bad day: having a squabble with a friend or colleague, getting stuck in traffic, or just waking up on the wrong side of the bed. Off-days happen to everyone, but when a bad day turns into a bad month, it’s time to take a closer look at your mood. It’s time to talk depression.

This year, for World Health Day, SADAG aided the whole of South Africa to talk about depression, using the following tools:

  • New online videos from actress and celebrity Lillian Dube sharing her experience with depression; Dr Frans Korb discussing depression in men; Dr Chabalala sharing information on depression in the elderly; psychologist Zamo Mbele giving tips on coping with depression as well as support group leaders Sheila and Thuli talking about how you can benefit by joining a local support group. Visit www.sadag.org to watch these videos, which were launched on Friday 07 April.
  • SADAG hosted a FREE Online #FacebookFriday Q&A Chat on “Let’s Talk: Depression” with psychologist, Liane Lurie at 1-2pm and again at 7-8pm with psychologist, Linda Blokland. Participates asked questions regarding depression diagnosis, symptoms, treatment plans as well as how to get help and support. Visit our Facebook Page “The South African Depression and Anxiety Group”.

This year’s World Health Day theme gives us a unique opportunity as the global community to talk about a health topic that concerns us all. Depression can be treated and suicide can be prevented. The more we understand about depression and suicide, the better we can help our communities.

In a country where access and services for people suffering with mental health issues is scarce, SADAG provides an invaluable service through their counselling call centre offering free telephonic counselling, referrals, information and support, as well as through various projects including school talks, rural outreach programmes, corporate talks and training.

To speak to a SADAG counsellor, call 0800 21 22 23 or SMS 31393 if you or a loved one are going through depression and need help.

SADAG is a mental health advocacy group, running a call centre with 15 helplines offering free telephonic counselling seven days a week, 365 days a year, and runs the only Suicide Crisis Helpline (0800 567 567) in the country. SADAG gives referrals nationwide, as well as information and support for all mental health issues encouraging people to speak out and get help.

Important SADAG Numbers:

SADAG Helpline – 0800 21 22 23

Suicide Crisis Helpline – 0800 70 80 90

24 Hours Substance Abuse Helpline – 0800 567 567

SMS – 31393

facebook Website – www.sadag.org

Article written by SADAG

Retinal detachments and diabetes

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When discussing complications and risks that diabetes patients face when it comes to the health of their eyes, the most common warnings are usually retinopathy, cataracts, refractive errors and dry eyes. However, people with diabetes also have a risk of developing another serious condition, known as retinal detachment.

The retina is the light-sensitive layer in the back of the eye that is responsible for the conversion of light into signals that are sent to the brain via the optic nerve. A retinal detachment occurs when the retina separates from its supporting layers. This can lead to complete loss of vision if it is not treated immediately.

A common form of retinal detachment in diabetic patients is called diabetic tractional retinal detachment1. This advanced form of retinal disease usually occurs in cases of proliferative diabetic retinopathy, as a result of extensive abnormal vessel growth, which in turn leads to the forming of fibrous scar tissue within the vitreous (jelly-like substance within the eye)1. The retina has a risk of detaching when this scar tissue contracts and pulls, and could also lead to the formation of retinal tears or holes1.

Symptoms of retinal detachment

This is not a painful condition, but it is an ocular emergency and requires urgent assistance in order to prevent total visual loss. When you see any of the following symptoms, it is crucial to get to your ophthalmologist as soon as possible:

  • Flashing lights2
  • Sudden occurrence of floaters (dark floating spots that look like threads or flecks)2
  • Black curtain-like appearance over visual field1

Risk factors

Although diabetic patients have a risk of retinal detachment, there are also several other risk factors that could lead to retinal detachment even in people who don’t have diabetes. This includes the following:

  • Severe myopia (near sightedness)2
  • Injury to the eye2
  • Cataract surgery2
  • Family history of retinal detachments2
  • In the case of diabetic patients, uncontrolled blood sugar levels is a big risk factor1

Treatment

There are several different treatment options that can be used to repair a retinal detachment, depending on the severity of the tear. With a full retinal detachment, surgery is most definitely required. Surgery will ensure that the retina gets placed back in its proper position, in order to recover full function of the retina3. The surgery method to be used will depend on the nature and characteristics of the tear3. Different types of retinal detachment surgeries include:

Scleral buckling surgery

With this surgery, a flexible band (made from silicone or rubber2) gets placed around the eye, counteracting the force that is pulling the retina out of place3. This method of surgery flattens the retina by pushing or ‘buckling’ the sclera towards the middle of the eye2. This allows the tear to settle against the wall of the eye2. This procedure will most likely be done in conjunction with cryopexy (extreme cold) or diathermy (heat) or laser photocoagulation to seal the retina to the bottom layers2. This is a same day procedure that gets done in theatre under local or general anaesthesia, and proves to be successful in retaining vision, especially when the macula was not affected by the detachment2.

Vitrectomy

A vitrectomy entails the removal of the vitreous where the abnormal blood vessels are growing1. The scars left by the abnormal blood vessels will then be microscopically dissected and laser therapy will be performed to prevent further vessels from forming1. A gas or silicone oil is then placed in the eye to keep the retina in place. A vitrectomy involves serious risks, such as cataracts; bleeding into the vitreous; increased pressure inside the eye; and infection2. It does, however, restore some of the vision and prevent the detachment from getting worse2.

Pneumatic retinopexy

This procedure combines the insertion of a gas bubble into the eye with laser therapy or cryopexy to flatten out the retina2. The patient must then keep their head at a certain angle for one to three weeks after the procedure, to keep the gas bubble in place2. This procedure is generally considered when a single break or tear caused the detachment or when the detachment is located in the upper part of the retina2. This is an effective surgical method to repair a retinal detachment but has an extensive recovery period.

Your ophthalmologist will discuss the treatment options with you and choose the suitable treatment for your specific case.

Last thought

It is important to maintain a HBA1C (long-term measure of blood glucose control) level of 7,0 or less. Although diabetic retinopathy can’t be prevented, maintaining proper blood glucose levels together with yearly visits to your ophthalmologist will go a long way to maintain the severity and progression of the condition. Constant self-monitoring and quick response to any of the abovementioned symptoms plays a key role when it comes to retinal detachments, so keep your ophthalmologist on speed dial if you know you might be at risk.

References:

  1. http://retinavitreous.com/diseases/dm_trd.php
  2. http://www.webmd.com
  3. https://www.aao.org

MEET OUR EXPERT - Dr Marcel Niemandt

Marcel is an eye surgeon specialising in cataract and laser refractive surgery. He has qualifications through the Universities of Pretoria and KZN and is a member of the CMSA and OSSA. Refer to www.drmcniemandt.co.za for further info or call the rooms at 012 809 6027.

Staying healthy together

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When starting your fitness journey, it can be challenging at first. Sheana Abrahams suggests getting a training buddy – partner, family member or friend – to help make it less of a burden. Training with someone will make exercise fun and gives you the support you need, and allows both of you to hold each other accountable for every training session. Sheana shares the benefits of exercise and provides tips on how to support each other and how to stay on this fitness journey together.

What are the benefits of exercise?

Where to start? Before you start any exercise, make sure you have spoken to your doctor and that he/she has cleared you for exercise and set out clear guidelines. If there are any other complications, or certain limitations have been set by your doctor, you should consider obtaining a personalised exercise program prescribed by a health professional, e.g. a biokineticist, to make sure that you’re doing the right exercise for your type of diabetes and at the right intensity level.

Let’s look at what some of the benefits are:

  • Better control of your diabetes and blood glucose levels: when you exercise, your muscles use glucose for energy. That being said, it is important to constantly check your blood sugar levels when you exercise. Physical activity may affect your blood sugar levels both during and after exercise, so make sure you check it regularly.
  • It can help avoid long-term complications: by exercising, you are in turn controlling your blood glucose levels, which is important to help prevent long-term complications such as kidney disease, nerve pain and heart problems.

Other benefits of exercise are:

  • Helps lower blood pressure
  • Better control of weight
  • Stronger bones
  • Stronger and leaner muscles
  • Exercise gives you more energy
  • Helps improve your mood
  • Makes you sleep better
  • Helps with stress management
  • Helps prevent diabetes in family members by lowering their risk factors.

What exercise can you do?

There are three types of exercises that you should do: aerobic; strength/resistance training; and stretching. Your aim should be to have a good balance of all three1.

Examples of aerobic exercises are:

  • Walking
  • Jogging/running
  • Tennis
  • Swimming
  • Dancing
  • Cycling, etc.

The American College of Sports Medicine (ACSM) guidelines say that you should aim to get at least 30 minutes of aerobic exercise most days of the week. Remember, this does not have to be done in one go, you can split the 30 minutes up throughout the day, for example you can do 10 minutes in the morning, 10 minutes in the afternoon, and 10 minutes in the evening. As you get fitter, you can gradually build up to doing exercise for a continuous 30 minutes.

Be creative with your exercise; go for a walk in the park, or after dinner get the whole family to walk together, put the music on and dance, walk with a friend, take the dog for a walk, or go for a nice jog near the beach. The more fun exercise is, the more you’ll stick to it. Find activities that you really love and enjoy, and ask your friend, partner or family to do the exercises with you. This will help keep you motivated.

Strength training

Once you have started doing your aerobic training and you’re managing to fit in 30 minutes most days of the week, chat to your doctor about adding strength training to your exercise regime.

Simple strength training on at least two days of the week is important in Type 2 diabetes as it helps to control the blood sugar levels and improves the action of the body’s own insulin2. Strength training builds lean muscle, and it also helps to maintain strong healthy bones.

Strength training doesn’t mean that you need to lift weights, you can use your own body weight to build up strength. Using your own body weight, you can do exercises such as squats, push-ups, lunges, crunches or sit-ups.

When you’re starting a strength training program, make sure that it is prescribed specifically for you. Always seek advice from your doctor, biokineticist or personal trainer who has experience in working with people who have diabetes. It’s important for you to start with the right exercises and the right intensity as well as being taught how to do the exercise correctly. Doing strength training for 20-30 minutes two or three times a week is sufficient1.

Flexibility training

Flexibility training can help prevent pain, stiffness, and injury of muscles and joints1. Stretching before and after training reduces muscle tenderness and relaxes your muscles2. Yoga is a great activity to do to help increase your flexibility.

Exercise safety

  • Remember to start slowly, especially if you have not exercised before.
  • Check your blood sugar before and after exercise until you’re aware of how your body responds to exercise4.
  • Do a nice warm up before training and a cool down after training.
  • Remember to stay hydrated and drink plenty of water before, during and after exercise4.
  • Be prepared for any episodes of low blood sugar. Always have something sweet with you that can increase your blood sugar level4.
  • Always carry a cell phone with you when exercising in case of an emergency4.
  • Do not exercise in extremely hot or cold temperatures.
  • Wear proper shoes and socks to protect your feet when doing any physical activity4.

Remember to be conscious of your body, if you become short of breath, dizzy or light-headed, stop exercising. Seek advice from your doctor if you continue to have any of the above symptoms or feelings or experience any other unusual problems4.

What can you do as a partner, family member or friend?

  • Talk to your partner, family member or friend who has diabetes about seeing the doctor before starting an exercise program. This will allow him/her to know their exercise limits and from there you can both set realistic goals and choose the right exercises for the type of diabetes.
  • Suggest going for walks a few days in the evening after work.
  • Instead of going out and getting takeaways, take a nice walk together or do a fun activity and then make a healthy meal.
  • Sit down and work on your training plan together, set your goals, and decide on the exercises that both of you can do. Make it a team effort.
  • Encourage your friend, partner or family member who has diabetes to do his/her blood checks before, during and after exercise, and to keep an exercise journal and write down all training sessions and blood glucose readings.
  • Encourage each other to make exercise a daily habit, and choose fun activities to do together that you both enjoy.
  • Get educated about diabetes, know the signs and symptoms of low blood sugar and learn what to do in these situations.
  • Constantly acknowledge your partner, friend or family who has diabetes, and let them know how proud you are of them for keeping up with their exercise regime, and remind them how this is an important part of managing their diabetes3.

Any chronic illness can have a profound impact on the family member, partner or friend. Looking at ways to stay active and healthy can be a fun and rewarding journey that you can all take together.

References:

  1. https://www.endocrineweb.com/conditions/type-2-diabetes/type-2-diabetes-exercise
  2. http://prescription4exercise.com/patientpublic/health-enhancing-recommendations/condition-specific-recommendations/type-2-diabetes/type-2-diabetes-prescription/
  3. https://www.ghc.org/healthAndWellness/?item=/common/healthAndWellness/conditions/diabetes/familyAndSupport.html
  4. https://health.clevelandclinic.org/2014/06/5-best-exercises-for-people-with-diabetes/

MEET OUR EXPERT - Sheana Abrahams

Sheana Abrahams studied a BSc. Sport and Exercise Science and then completed a BSc. (Honours) Biokinetics. Based in Cape Town, she the Head of Health and Wellness at GetSmarter, and frequently presents the fitness segment on the Expresso Show on SABC 3.

Maintaining a healthy sex life

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Newly diagnosed diabetes patients may have many questions at first, but, “How will this chronic illness affect my sex life?” is probably not one of them. However, diabetes and the medications used to treat it can cause sexual challenges for men and women, but with some education and a little extra planning, there’s no reason for diabetes to be a downer in the bedroom.

It’s important to be aware of these possible sexual changes, and to discuss any sexual malfunctions with your doctor no matter how embarrassing you may find the topic.

Women’s sexual health

Most commonly, women who have diabetes will experience a lower sex drive compared to women without the condition.

This can be for several reasons:

  • Blood glucose level changes can cause irritability or a lack of energy.
  • Depression and anxiety associated with diabetes can lower a desire for sex.
  • Anti-depressive medications can lower sex drive.
  • Autonomic neuropathy can lead to vaginal dryness and painful sex.

In some cases, nerve damage in diabetic women can make it more difficult for a woman to experience an orgasm. Sex can also be uncomfortable and unpleasant when a woman has a yeast infection or experiences vaginal itching.

These sexual difficulties are not a normal part of aging and can be addressed if you broach the topic with your doctor. They may suggest the following options to maintain a healthy sexual appetite:

  • Monitor your blood glucose levels closely before having sex to increase energy and reduce irritability.
  • Seek medication for depression or anxiety.
  • If anti-depressive medicines are causing your low sex drive, speak to your doctor about trying a different medicine, or discontinuing the medication and seek counselling instead.
  • Use water-based lubricant to combat vaginal dryness and practice Kegel exercises to relax vaginal muscles.
  • Avoid drugs that may cause painful yeast infections.

Men’s sexual health

Diabetes can also cause sexual complications in men; most notably, erectile dysfunction and retrograde ejaculation. Those with erectile dysfunction cannot get or maintain an erection. In men with retrograde ejaculation, semen empties into the bladder, rather than out of the tip of the penis. In both cases, diabetes-related autonomic neuropathy is likely the cause. This type of nerve damage often occurs when a person maintains poor control over their glucose levels.

In the case of erectile dysfunction, when the autonomic nerves are damaged, they can no longer communicate arousal from the brain to the penis. Similarly, damaged autonomic nerves may stop a sphincter in the bladder from opening, stopping semen to exit the penis. Erectile dysfunction can be embarrassing and makes the act of sex physically impossible. Men with retrograde ejaculation will likely experience infertility.

Additionally, some uncircumcised men who take certain drugs may also notice a high frequency of genital bacterial infections. While neither condition is, painful or causes bodily harm, both can cause problems in the bedroom.

Fortunately, both erectile dysfunction and retrograde ejaculation have solutions. To treat erectile dysfunction, men may consider trying:

  • Oral prescriptions, such as Viagra.
  • Injections of prostaglandins into the penis.
  • Vacuum pumps to draw blood to the penis.
  • Surgical implants.
  • Counselling to reduce anxiety about sexual performance.

To treat retrograde ejaculation, men may consider trying:

  • Meeting with a urologist for a more specific diagnosis of the condition.
  • Medication that strengthens the bladder sphincter muscles.
  • Fertility treatments, such as extracting semen from the urine to use in artificial insemination.
References:
American Diabetes Association. (2013, June 7). Autonomic Neuropathy. Retrieved from http://www.diabetes.org/living-with diabetes/complications/neuropathy/autonomic-neuropathy.html.

American Diabetes Association. (2013, August 1). Sexual Health. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/women/sexual-health.html

Auteri, S. (2014, March). How Chronic Illness Can Affect Sexual Function. Retrieved from https://www.aasect.org/how-chronic-illness-can-affect-sexual-function

The National Institute of Diabetes and Digestive and Kidney Diseases. (2008, December). Diabetes & Sexual & Urologic Problems. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual-urologic-problems

Nyirjesy, P. (2013, May). Genital mycotic infections in patients with diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23748505

MEET OUR EXPERT – Taylor Griffith

Taylor Griffith2Taylor Griffith is an award-winning journalist with a background in newspaper, magazine and digital writing. She earned her degree from the University of Maryland’s Philip Merrill College of Journalism. She regularly contributes to drugwatch.com, along with other publications.