Category: 2019 Autumn – Diabetes Focus

Ramadan

Ramadan and diabetes: a collaborative approach to fasting

Posted on by
Share

Dr Salim Parker gives a collaborative approach to Ramadan fasting.

One of the five pillars of Islam

Fasting from dawn (the meal in the morning is called Suhoor) to dusk (Iftaar) during the Muslim month of Ramadan is one of the five pillars of Islam. The Quran specifically instructs all mature and healthy Muslims that: “Oh you who believe! Fasting is prescribed to you as it was prescribed to those before you so that you may attain self-restraint.”

Most Muslims start fasting from a very young age. Even though, it’s only obligatory when puberty is attained and it is a religious, social and community in most societies. The Islam religion follows the lunar calendar and Ramadan occurs 10 days earlier each successive year. This year (2019) it will be nearly the whole of May.

The sick are allowed to postpone the fast and may even be exempted from it, as stated in the Quran: “Whoever witnesses the month (of Ramadan) then he/she should fast. But, if any of you is ill or travelling – then he or she is exempted from fasting.”

Despite this concession many sick Muslims will fast despite learned religious scholars and medical professionals advising them not to. This applies equally to people living with diabetes and this article outlines some guidelines as to how to approach diabetics intending to fast.

Benefits of fasting

It’s known that there are several potential benefits of fasting during Ramadan. Feelings of compassion for the less fortunate and underprivileged are evoked in Muslims who fast. Though the hunger and thirst senses are heightened, the natural sense to eat or drink is controlled. This leads to a sense of having willpower and to be in control of the senses.

The long-term ideal is for Muslims to ultimately be able to resist daily unnecessary and potentially harmful forms of food as urged by the Quran to: “Eat of what is lawful and wholesome on the earth,’ and ‘And He (God) enforced the balance. That you exceed not the bounds; but observe the balance strictly and fall not short thereof.”

Fasting also offers a time to ‘cleanse’ the body and the soul. The person fasting is encouraged to develop a greater sense of humility, spirituality, and community involvement.

There are also indications of physiological benefits of fasting. Some studies indicate that intermittent fasting limits energy intake. This promotes weight loss in obese individuals, which could be cardio-protective. Insulin sensitivity is also increased.

A holistic approach needed

Currently, of the 366 million humans on earth living with diabetes, more than 50 million are Muslim. In 2015, diabetes was the leading cause of death amongst South African females, and the sixth most frequent one amongst males. Diabetes was the second leading cause of death overall in South Africa after tuberculosis that year.

Many South African Muslims living with diabetes will fast irrespective of their health status. It’s important that there should be synergy between the healthcare professionals, the Islamic scholars and the Muslims living with diabetes who want to fast. Several factors need to be considered:

  • Age of the person
  • Medications used
  • Insulin dependency or not
  • Co-morbidities
  • Recent complications
  • Whether living alone or not
  • Easy access to a glucometer
  • Social support

Lifestyle management

All Muslims living with diabetes should ideally have a pre-Ramadan consultation beforehand with their healthcare practitioner. Fasting and the management of lifestyle conditions go hand in hand and a holistic approach should be adopted.

Dietary intervention is essential and the inclusion of more fibre, complex carbohydrates, vegetables, legumes should be encouraged, as should sparing salt use.

There is increasing evidence that dates, a staple food type during Ramadan, may have beneficial effects on glucose and cholesterol levels during Ramadan and may lead to a decrease in cardiovascular risk factors. Dates, consumes in moderation, are rich in fibre and is high in fructose, which has a lower glycaemic index than sugar.

It’s known that not having breakfast, in the normal population, increases the possibility of being overweight by a factor of five, and increases the chance of developing diabetes. The consumption of the pre-dawn meal is hence paramount. Stopping smoking and optimising of medication and co-morbid conditions should be discussed as well.

Maintaining some form of exercise, such as the optional nightly Ramadan prayers (if possible and depending on level of fitness), is part of lifestyle maintenance.

Complications associated with fasting

Hypoglycaemia

Hypoglycaemia is the concern of most doctors and patients when fasting is contemplated by the Muslim living with diabetes. Several patients, especially the elderly, are not always aware when their glucose levels drop. In one study, 24 out of 29 subjects were not aware that their glucose levels were low.

Different patients will have different signs and symptoms at different levels, with a glucose level below 4 mm/L being dangerous in most instances. Signs are often subtle, such as slight inattentiveness, and may not be easily be picked up by household members. The easy availability of glucometers is paramount in all circumstances and it should be emphasised that checking the levels (finger prick test) does NOT invalidate the fast. If levels are low, the fast should be broken immediately with the religious edict that life and health are MORE important than obligations emphasised.

Hyperglycaemia

Ramadan, contrary to its intention, is associated with caloric excess. An abundance of savouries, pastries and desserts is the norm and people living with diabetes consume as much as others. Hyperglycaemia can thus occur and at times is difficult to distinguish from hypoglycaemia, based on signs and symptoms alone.

The availability of glucometers is thus again important. Patients often fear hypoglycaemia and reduce, or even stop, their medication on their own. Coupled with the dietary excess, the chances of hyperglycaemia are increased and in some countries, such as Pakistan, more cases of hyperglycaemia than hypoglycaemia are seen during Ramadan.

Dehydration

Dehydration, especially if the diabetes is poorly controlled, is a possible complication of fasting during Ramadan. Polyuria (production of abnormally large volumes of dilute urine) and a reluctance to consume too much fluids at night (to avoid urinating) increases the possibility and the development of pre-renal failure, and thrombosis may have to be considered.

Risk categories1 

Category 1: Very High Risk

This include patients with one or more of the following:

  • Severe hypoglycaemia within the three months prior to Ramadan.
  • Diabetic ketoacidosis (DKA) within the three months prior to Ramadan.
  • Hyperosmolar hyperglycaemic coma within the three months prior to Ramadan.
  • History of recurrent hypoglycaemia.
  • History of hypoglycaemia unawareness.
  • Poorly controlled Type1 diabetes mellitus (T1DM).
  • Acute illness.
  • Pregnancy in pre-existing diabetes, or gestational diabetes (GDM) treated with insulin or sulphonylureas.
  • Chronic dialysis or advanced kidney disease.
  • Advanced macrovascular complications.
  • Old age with ill health.

Patients in this category MUST NOT FAST. If they insist on fasting, close monitoring and counselling is essential, with specific instructions given on when they MUST break their fast if necessary. They must be informed that they are putting their health and life at risk.

Category 2: High Risk

In this category are patients with one or more of:

  • T2DM with sustained poor glycaemic control.
  • Well-controlled T1DM.
  • Well-controlled T2DM on MDI or mixed insulin.
  • Pregnant T2DM or GDM controlled by diet only or metformin.
  • Chronic kidney disease stage 3.
  • Stable macrovascular complications.
  • Patients with comorbid conditions that present additional factors.
  • People with diabetes performing intense physical labour.
  • Treatment with drugs that my affect cognitive function.

Patients in this category SHOULD NOT FAST. If they insist on fasting they should also be closely monitored.

Category 3: Moderate/low risk

The following fall in this category:

  • Lifestyle therapy
  • Metformin
  • Acarbose
  • Thiazolidinediones
  • Second-generation Sus
  • incretin-based therapy
  • SGLT2 inhibitors
  • Basal insulin

These patients should be able to fast with sound advice being given first.

Medication adjustment

Each person living with diabetes will have unique circumstances and should be counselled individually. Explaining the risks and symptoms of hypoglycaemia and what appropriate actions to take must be emphasised.

Patients on medication need to be advised to change their dosages to accommodate the daytime fast. Some general guidelines are given below. But, again it must be emphasised that each Muslim who intends fasting must have advice tailored to their unique situation.

Metformin

Metformin has a low-risk of causing hypoglycaemia and generally no dose adjustment is needed. Some authorities advise taking two thirds of the total daily dose with the evening meal, with one third taken with the morning meal. The once-a-day formulation should be taken at the usual dose in the evening.

Sulphonylureas (SU)

The first-generation SUs had a high propensity of causing hypoglycaemia and should be avoided. The second-generation SUs are much safer. The general rule for stable patients living with diabetes is to take half the morning dose and the normal evening dose.

The other option is to switch evening and morning doses and reduce the morning dose. The once-a-day formulation should be taken in the evening, instead of the morning with a halving of the dose for the first few days. The dose can then be adjusted as needed.

Insulin

The dose of basal insulin or once a day premix should initially be decreased by 20% and given in the evening. When basal insulin is given twice a day, the morning dose should be given in the evenings with half the evening dose given in the morning. The same applies to premixes given twice a day. Insulin that is used three times a day should have the midday dose omitted and the morning dose halved. The dosages can then be adjusted as needed.

Other diabetic medications

These generally do not need dose adjustments. Once daily doses should preferably be taken in the evening.

Conclusion

Ramadan is an ideal time for people living with diabetes to implement lifestyle changes that would be in accordance with their religion and improve their health as well as their diabetes control.

Each patient must be consulted well before the commencement of Ramadan and their risks stratified according to their unique circumstances.

Access to glucometers is an important aspect of fasting, as well as knowing who should and should not fast, how and when to test for glucose abnormalities and when to break the fast. A collaborative approach between patients living with diabetes, religious scholars and medical professionals is the ideal approach to ensure the safety of those who want to fast, and to assure those who should not fast that their religion most certainly permits that.

 

Reference:

  1. JEMDSA 2017 Volume 22 Number 1 (Supplement 1) Page 119-136

MEET OUR EXPERT

Dr Salim Parker is a general practitioner in Elsies River. He is an Honorary Research Associate: Department of Medicine, University of Cape Town and Immediate Past President: South African Society of Travel Medicine (SASTM).

diabetic alert dog

Is it worth getting a diabetic alert dog in South Africa?

Posted on by
Share

James Leech explains the pros and cons of a diabetic alert dog in the South African setting.

What is a diabetic alert dog?

A diabetic alert dog is a guide/service/assistance dog trained to detect high or low levels of blood sugar in humans with diabetes. These dogs then alert their owners to dangerous changes in blood glucose levels.

South African setting

A service dog is an amazing resource. Diabetic alert dogs, in many cases, perform better and are more advantageous than diabetic alert equipment. The idea and novelty is amazing. However, in South Africa, you really need to identify the pros and cons if it is really worth investing in one for the following reasons:

Training programme and suitable match

Having a dog qualify to become a service dog is the equivalent to applying to the South African Special Forces. From all the entrants, there is a very low conversion rate.

This is not because the dogs were not of amazing calibre but because one must first assess: the dog’s traits, training ability, environment they will be going into, and whether the dog will be a suitable match to the owner.

Watch this video. It gives a full account of potential issues including the trainer’s personal bias.

Enforcement and support of the law

The Promotion of Equality and Prevention of Unfair Discrimination Act, 2000 (PEPUDA or the Equality Act, Act No. 4 of 2000) is a comprehensive South African anti-discrimination law. It prohibits unfair discrimination by the government, private organisations and individuals and forbids hate speech and harassment. A powerful and supportive piece of legislation. I have used it several times in court applications in protecting the rights of my service dog usage.

The cultural rainbow of South Africa

In South Africa, there is a fairly large subset of the population with a fear of dogs. Adding to that, certain religious objections to dogs being within a home environment or public spaces.

  • Encountering resistance

In South Africa, typically, if you are not visibly blind, i.e. a cane, sunglasses and a guide dog in a full uniform and accessories, you are likely to encounter resistance.

This is a cultural and retail training issue. For example, a decade ago, when I was helping in difficult cases for the South African Guide-Dogs Association for the Blind, an incident occurred. A woman went to a government bank. She was 90% blind and had a guide dog. However, she didn’t look the typical biased view of a blind person.

The security personal stopped her, continually berated her, bringing her to tears on the floor. Her guide dog starts barking and causing a further scene. None of this ended happily in the end.

After hearing this story and many others I was the first in South Africa to develop a certificate, issued by the court, that can be carried by special service dog carriers, acting as a proxy medium of assistance.

This document greatly helps but one still encounters resistance in needing to approach the courts. I highly recommend you have money saved aside to hire an advocate (not attorney) in handling these matters on your behalf, as it can be great stress undertaking it on your own when you are not familiar with the system.

The blessing

If you are fortunate enough to have a guide/service/assistance dog, they can provide an amazing blessing. In the picture (above) is my non-nativeelectromagnetic fields (nnEMF) service dog, Pebble and one of my children.

I have electromagnetic field intolerance syndrome (EMFIS). She picks up when my tolerance to the radiation in the environment is low, and/or when causing a neurological and functional impairment she helps me navigate through the space.

From my personal point of view, if I didn’t have to have a service dog, I would prefer not to. The obstacles one faces in terms of unfair discrimination, unwanted attention, questions and hoops having to jump through can be taxing.

However, in my circumstances, I am blessed that she is able to do her job in aiding me in certain environments and helping provide added independence.

Getting her was a family choice based on our circumstances. It was deemed unfair to rely on my wife and three children in assisting me for the rest of my life. Plus, it is more reasonable to have Pebble as an assistive aid to improving the quality of life for all of us.

Conclusion

Do not get a diabetic alert dog because it sounds and looks cool. First, take all steps to treat the epigenetic disease of Type 1, 1,5, 2 or 3 diabetes.

Once it is well-managed and depending on your circumstances, and environmental exposures, if needed, then consider getting investing the time, money and patience into one.

List to my podcast [ jameslech.co.za/podcasts/] ep 31 – How SARS helps with my service dog – Disability Tax Incentives

MEET OUR EXPERT

James Lech is a consulting scientist to doctors, architects and attorneys. He is a doctoral candidate in sub-molecular medicine/ biophysics and a contracted agent of national government in novel research and solutions.

sugar

Are there links between sugar, cancer and diabetes?

Posted on by
Share

Dietitian, Berna Harmse, unpacks the evidence on the effects sugar has on our bodies and the direct and indirect links it has with cancer and diabetes.

Researchers are continuously investigating the connection between sugar and cancer. Unfortunately, the topic causes a lot of anxiety and misinformation in the media and on the internet. There is no strong evidence that directly links sugar to increased cancer risk, but there is an indirect link.

What is the indirect link?

All the cells in our body, including cancer cells, need sugar (glucose) from our bloodstream for fuel. We get this blood glucose from carbohydrate-containing foods, including fruit, vegetables, starch, wholegrains and dairy. Some glucose is also made in our bodies from protein.

Sugar doesn’t make cancer grow faster. As stated in a Mayo Clinic article, “All cells, including cancer cells, depend on glucose for energy. But giving more sugar to cancer cells doesn’t speed up their growth. Likewise, depriving cells of sugar doesn’t slow down their growth.”

Eating high-sugar foods increase our body weight and body fat, which is linked to some kinds of cancer. For that reason, the American Institute for Cancer Research recommends increased intake of wholegrains, vegetables, fruit and beans; and reducing intake of sugary beverages and sweets.

Influence on weight and metabolism

Let’s look at the influence on weight and metabolism. The Academy of Nutrition and Dietetics reinforces that much research shows that higher insulin (a hormone) levels and related growth factors may influence cancer cell growth the most, as well as increasing the risk for other chronic diseases.

Different types of cancer cells have high amounts of insulin receptors, making them respond more than normal cells to insulin’s ability to promote growth.

All the food we eat gets broken down to smaller bits, in the process we call digestion. Glucose sits in the veins, and insulin working like a key, unlocks the veins so the energy can get to the rest of the body to be used.

When insulin levels are high, it is a signal to the body that there is plenty of food available, and that these kilojoules should be used to grow and build reserves for future times of starvation.

Insulin levels rise quickly when we eat unrefined carbohydrates (white bread and sweets) and leads to a drop in blood glucose levels. Low blood glucose is the biggest appetite stimulant in the world. It makes you overeat, which again causes a release of more insulin and thus a cycle of eating more and gaining weight and body fat continues.

Inactivity and being overweight also increases insulin levels, and so insulin resistance is caused. If no intervention is launched at this stage, diabetes soon follows.

Is there a link between cancer and diabetes?

Research is being done to investigate the direct link between cancer and diabetes, with some researchers speculating that the underlying metabolic factors, like long-term stress and the inflammation that comes with it, underpins some of the patterns behind it.

So, what do I eat considering all this information?

If you can keep your food portions controlled and maintain your weight, you are on the right track.

Avoid refined carbohydrates, like take-aways, white bread products, and sweetened foods and beverages. Rather choose high-fibre carbohydrates, like wholegrains, fruit, vegetables and legumes. Higher fibre foods are the cornerstone of blood glucose management.

The five-a-day approach is still best – try to have at least two fruits and three vegetables per day, or vice versa. This ensures the adequate intake of antioxidants which plays a big role in terms of fighting and preventing chronic diseases.

Vegetables and salad should take up half of your dinner plate, and carbohydrate and proteins should be the side dishes of the meal.

Try to have breakfast every morning and do not skip meals

Aim to do some form of physical activity most days of the week.

MEET OUR EXPERT

Berna Harmse is a private practicing dietitian in Cape Town, she holds a MSc in Dietetics and has a special interest in oncology nutrition. She is also an external lecturer at Stellenbosch University Division of Human Nutrition.

whats in my food campaign

What’s in my food campaign

Posted on by
Share

The Healthy Living Alliance (HEALA) launched a campaign, #whatsinmyfood, that asserts the right of every South African to know what is in the processed food they are eating. HEALA have called on government to help them do this.

About the campaign

The overall message of the #whatsinmyfood campaign is that South Africans have the right to know what’s in their food. The campaign aims to raise awareness and encourage dialogue among ordinary South Africans about the harmful contents of unhealthy food sold by the food and beverage industry.

There is a direct link between obesity and related non-communicable diseases such as diabetes, and the excessive consumption of foods high in salt, sugar and saturated fat.

The objective of the campaign is to get people to realise that a lot of the everyday processed food they are eating is unhealthy, and that there is a correlation between eating unhealthy food and poor health. Everyone needs to scrutinise the contents of their food, and particularly to cut down on foods high in sugar, salt and saturated fat.

Obesity stats

According to a 2016 Lancet study, South Africa is the most obese nation in Sub-Saharan Africa. Almost 40% of women and 11% of men are obese and over two-thirds (69,3%) of women and 39% of men are overweight1.

Obesity is one of the top five risk factors for early death and disability in the country2. In addition, 1,6 million South African children are considered obese and the condition is growing at a much faster amongst kids than adults1.

The study further reveals that obesity is linked to the development of chronic non-communicable diseases, such as Type 2 diabetes, heart disease and strokes. These are among the top 10 causes of death in South Africa, accounting for 43% of deaths1.

Fighting obesity

The availability of unhealthy food combined with aggressive marketing, advertising and incomprehensible food labels, disempowers the consumer from making healthy food choices.

It is the responsibility of the food and beverage industry to clearly disclose the contents of the food they produce, market and supply to the public.

HEALA requires government to create policies and laws to ensure that the food and beverage industry provide South Africans with the clear and accurate information they need to make better food choices for themselves and their families.

Microsite

Linked to the campaign is a microsite (www.whatsinmyfood.org.za) that features simplified nutrition information on popular packaged foods and beverages. There is also a pledge for visitors urging government to put in place policies that call for clear food labels and hold industry accountable for the harmful ingredients in the food they supply.

People can support and benefit from the campaign by engaging in social media conversations using the #whatsinmyfood, visiting the microsite and taking the pledge at www.whatsinmyfood.org.za.

References:

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. The Lancet. 2016; 387(10026): 1377-96)
  2. Pillay-van Wyk V, Msemburi W, Laubscher R, Dorrington RE, Groenewald P, Glass T, et al. Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease.

 

Slender Wonder

Losing 25kg with Slender Wonder

Posted on by
Share

Michael Green, a person living with Type 2 diabetes, tells us how he lost 25kg in six months by using Slender Wonder – a medical weight loss programme.

Michael Green (55) lives in Randburg, Gauteng. He is divorced and has two adult sons and one grandchild.

When were you diagnosed with Type 2 diabetes?

I was diagnosed during an insurance medical examination when I was 28 years old. I was put on Glucophage for many years. More recently, I was prescribed Galvus Met 50/1000 (two tablets daily).

What made you decide to lose weight?

I always knew that a large part of my Type 2 diabetes was due to bad eating habits and bad hydration. I have seen how my father has suffered and is suffering now (in his seventies) due to many years of undiagnosed and untreated Type 2 diabetes problems. So, I decided to do something about my health on my own.

How did you find out about Slender Wonder?

I bumped into a friend who I hadn’t seen for about twenty years. He looked great and I complimented him. Then he showed me before and after photos. I was blown away and decided to try Slender Wonder.

Tell us about the Slender Wonder programme you followed?

I started Slender Wonder on 7 April 2016, with Dr Gerda Scholtz, weighing 110,3kg with a body mass fat of 30,3%

I done the Slender Wonder Simeon B Programme which consists of six weeks of injections and a very strict meal plan, followed by a two week ‘Go moderate’ rest period which has no injections and slightly more food. This repeats until the goal weight is achieved.

As the weight came off and I had increased energy, I stepped up my physical training, which was not necessary but just something that I wanted to do. I must say that I was super strict. I weighed every meal and never cheated once.

By 23 September 2016, my weight was down to 84,7kg and my body mass fat was 12,9%.

From a diabetic perspective, the more important thing was that my visceral fat level (fat around the organs) dropped from 15 to 5. I had lost 25kg in six months.

Was your diabetes medication stopped or the dosage lowered once you lost weight?

No, I stayed on my diabetes medication as it has just become habit over many years. My HbA1c level dropped from around 7,5% on medication to under 5%. Slender Wonder is by far the best thing that I have ever done in my struggle against Type 2 diabetes.

How did you feel once you lost the weight?

I felt fantastic! Like I had a new lease on life. Full of energy and motivated. Though, I got tired of people asking me if I was sick as I was always a stocky guy and now I was quite skinny. I went from 38-sized jeans to a 32.

You have gained weight recently. Are you disappointed?

No, Slender Wonder is a change of lifestyle more than a diet. I went back to my old eating habits and if you eat what you ate before going on Slender Wonder then you will weigh the same as you did before. For some reasons, I needed to prove that to myself, and I still do.

I currently weigh 97kg again and though better than when I started, it is a continuous process.

Would you go back on Slender Wonder?

Yes, absolutely! I am back using Slender Wonder. My goal, at this point, is to weigh 90kg and be healthy. I am less hard on myself and I cheat a bit which shows on the scale.

Before

After

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on [email protected]

Marius Schutte

The sky’s the limit for Marius Schutte

Posted on by
Share

Last year Marius Schutte placed third in Virgin Active’s The Grid Games national event. He then came first, out of 687 athletes, in the sprint event of the first-ever Spartan Race held in South Africa. Recently, he took part in the Warrior Race and placed 11thoverall and second in his category. His aim is to show people that if he can achieve this as a person living with diabetes, so can anyone else.

Marius Schutte (32) lives in Krugersdorp, Gauteng. He was diagnosed with Type 1 diabetes at the age of 25.

When were you diagnosed?

I had a roller coaster experience when I was initially diagnosed as was first treated as a Type 2 diabetes patient.  Symptoms were something I never experienced, or rather I never noticed symptoms as I always drank a lot of water (because it’s healthy) and in turn had to go to the toilet a lot.

I got flu just before a big competition and went to the doctor to see if I could get better before the competition. Being very thorough, the doctor did a urine test and picked up that there was glucose in my urine. He explained it should not be like this and did a random glucose test. It was at 11mmol/L which is way too high. He then sent me for tests and diagnosed me with Type 2 diabetes and prescribed oral treatment.

I did not understand my diagnosis so I went to different doctors to get a better understanding of why I got diabetes. I had so many questions but I did not get many answers. That was until I went to another doctor who said I was on the wrong treatment as I do not produce enough insulin and the tablets will not work. I did not have Type 2 diabetes but Type 1 diabetes. In her opinion, the only way I managed without insulin was because of my strict diet and gym programme.

I was then diagnosed with Type 1 diabetes in December 2012. Insulin was prescribed. I am currently using Lantus insulin and inject myself. I am also on Glucophage XR, Liaglucide MR and Adco Simvastatin. Though my doctor is currently reducing the doses of Glucophage XR and Liaglucide MR so soon I won’t be using them.

Tell us more about The Grid Games

The Grid Games started at my local gym, Virgin Active Little Falls. We had an in-house competition. The competition requires participants to perform eight exercises in four minutes in a 2m x 2m grid. The aim is to accumulate as many reps (calories in rowing) within 20 seconds, with only a 10 second rest in between exercises. The winners of the male and female category went on to represent the club at the regional competition.

I succeeded in winning the regional competition and was given the honour to represent Gauteng at the national event of The Grid Games. There were more than 14 000 athletes competing through all The Grid Games stages.

It was an extremely tough competition as we had to go through knock out stages. The winner of each round would progress to the next round. We had to go through three stages on the day. I found it very difficult to recover in the small time between the rounds.

My peers without diabetes could energise themselves with supplements and energy drinks whist I only had water to drink and ate chicken. I could not have any of the products on offer though I managed to finish in third position overall.

The organisers of The Grid Games insisted that I have a paramedic in my lane when I competed. This drew a lot of attention. The officials, competitors and the crowd could see that I was different. Many enquired afterwards as to the state of my health. This was a blessing in disguise and it gave me an opportunity to share my experience with diabetes and to make people aware of the condition. Most of all, I could show that diabetes is not a death sentence and you can still live life to the fullest.

How did you become involved in sports?

I’ve always had a love for the outdoors and being active. I never believed in sitting in front of the TV. I would rather go outside and do something in nature.

But after being diagnosed with diabetes, it became more of a lifestyle. I had to be active so I took it upon myself to set an example and help motivate other people to get off the couch and get active.

I want to show people living with diabetes that diabetes that you can still have a full active life. It takes a bit more planning, etc. but it is totally possible and totally worth it. We have to look after our bodies, we only have the one and there are no spares available.

What is your art of living with diabetes?

The first word that comes to mind is consistency. Dedication and commitment follow. You need to be committed to a healthy lifestyle and dedicated enough to carry you when motivation is low.

What does your exercise regime consist of?

I absolutely love sport and being active and this can be seen in my exercise routine. I train five days a week, twice a day. The morning sessions consist of cardio training and is mixed between running and cycling. The evening sessions consist of CrossFit and weight training. On weekends, I go for active rest. This will include swimming, rowing and hiking.

What does your diet consist of?

Like mentioned before consistency is key. I try not to be adventurous with food and rather stick to the basics.

I start my day with boiled eggs for breakfast. My morning snack will usually consist of berries or an apple and mixed tree nuts. I found that the fruit does not spike my sugar when eaten with a protein.

For lunch, I have a chicken salad in summer and in winter I prefer cooked chicken and veggies. My snack between lunch and dinner is biltong.

I have an avocado before I go to gym and eat dinner straight after gym. This consists of protein (chicken, fish or red meat) and veggies. I stay away from carbs as much as possible. The only carbs I have are the veggies. I don’t eat any pasta, rice, bread or potatoes.

Do you suffer with any other side effect related to diabetes?

Diabetes affects me immensely. I suffer from a range of side effects from both the condition itself as well as the medication. It affects my mental and physical well-being. Mental – because I suffer from severe insomnia. This alters my whole countenance when I am sleep deprived. Plus, I experience immense feelings of irritability when my blood glucose levels are high. Physical – because of the muscle spasms and the body aches I experience.

What helps motivate you?

I read all the time, anything and everything about diabetes. The more informed I am, the better I can manage my condition. I find reading stories of other people living with diabetes helps me. Sometimes it feels like you’re fighting alone but then reading about someone else struggles and how they got through them motivates and encourages me to keep on fighting.

What is the reality of diabetes?

Type 1 diabetes is a lifelong condition. It is the first thing I think of when I wake up in the morning and the last thing I think about when I go to bed. This is how it will be for the rest of my life. You don’t have any days-off. A day-off can mean a trade-off with my life. Thus, it is a condition that forces me to be extremely disciplined and strict.

People in general have a limited understanding of this condition and think that I can’t eat sweets or chocolates. That is not true. Diabetes is affected by everything, from the food I eat to the weather I experience and my emotional condition, etc. In short, it is a forced lifestyle change, that if not taken seriously can mean my life can be lost.

What is next?

I am a very adventures person and love living. I hope to inspire other people to do the same. Even people without diabetes. It is just so easy to say that something is difficult and to just give up. I want show that anything is possible. If I, with my diabetes, can do it, so can any other person.

I have two big dreams that I would like to achieve to bring more awareness to diabetes. Firstly, I would like to climb Mount Kilimanjaro and to complete an Ironman (I will start with Ironman 70.3).

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on [email protected]