Category: 2019 Spring – Diabetes Focus

Kyra Stevens with Coach Shafiek Murphy and Principal, Ruschda O'Shea

I saved my coach’s life – Kyra Stevens

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We chat to Kyra Stevens, a 15-year-old living with Type 1 diabetes, who saved her athletics coach, Shafiek Murphy’s (48) life, with quick-thinking and action when he went into a diabetic coma.

Kyra Stevens (15) lives in Kenilworth, Cape Town with her parents, Marco and Kim, and her brother. She is a Grade 9 pupil at Sans Souci Girls High School.

Kyra to the rescue

On 11 July 2019, Shafiek Murphy, a Type 1 diabetes patient, was found on the floor, in the community room, at the school. He had recently returned from the Winter Games, in Durban, where he coached the Western Cape girls U/15 rugby team. Unfortunately, he became ill while on tour.

The principal, Ruschda O’Shea, and two other teachers were called. Kyra sprang to their minds as she has diabetes as well, and had informed the school. When Kyra arrived, she tested Shafiek’s blood glucose level which was extremely high. She then administered insulin into his abdomen, before another teacher rushed him to hospital.

At the hospital, Shafiek’s blood glucose level was 36 which is near fatal. After X-rays, Shafiek was diagnosed with a chest infection and tonsillitis. The doctor explained that if Kyra had administered the insulin five or 10 minutes later, Shafiek would have died.

One-on-one with Kyra

Tell us in your own words what happened on that day when you saved your coach’s life.

I was in a class lesson. Then very randomly my maths teacher approached me in the class and asked for my glucometer. I asked him why. He responded by saying that someone went into a diabetic coma. I gave him my FreeStyle Optium Neo glucometer and told him that he has to warm the fingers before checking the glucose level.

No later than five minutes, I was called via the intercom to come to the community room. I ran there knowing that is was Coach Murphy as he was the only other person in the school who has diabetes. When I got there, they told me I must test his glucose levels. So, I got everything ready.

But when I pricked a finger on Coach Murphy’s left hand, no blood came out as his hands were already cold. I told one of the teachers to warm up his right hand warm so I could get blood.

Eventually I got blood and his glucose level was really was high. Immediately, I asked where his emergency kit and insulin were. I found his insulin in his bag and injected 25 units in his abdomen.

After that Coach Murphy was taken to the hospital. The very next day, he phoned me to say the doctor said if it wasn’t for me, he would have died. So, I saved his life.

Are you proud of yourself?

I am proud. But, at the moment, I have no words to explain how. Everybody is asking me how do you feel and how this, and how that and I’m like, “Ja!”

Do you and Coach Murphy have a good relationship?

Coach Murphy started working as the Head of Sports at our school at the beginning of the year. So, yes we have a relationship and we had spoken to each other about diabetes. But since this incident, we have become closer. I have been checking up on his every day, sending him messages asking if he is okay.

When were you diagnosed with diabetes?

Two years ago in July 2017. I am currently using an insulin pen and administrate Humalog, Protaphane and Actrapid.

Has it been easy to be open about your diabetes at school?

Yes it has. I have told most of my friends and all my teachers know. At  the beginning of the year, my parents had a meeting with all my teachers and the Grade Head. The first year I was diagnosed, my parents also held a meeting so all my teachers knew.

Have you ever experienced bad lows or highs?

Yes I have, but I have never gone into a diabetic coma.

Have you fully accepted your diabetes?

Yes and no. More a no, because I don’t have a grasp on it yet. It’s not easy for me because I have never had to checked my glucose before I ate. Now I do.

Normally, I was like, ‘Okay food is ready.’ But now, I see my brother eating and my mom and dad eating and I’m the only one who has to check my glucose levels before I can eat. Sometimes I’m really hungry so I don’t check and then don’t inject at all.

Has this incident showed that good management of glucose levels is important?

Absolutely! Now more than before it’s encouraged all of us (my family) to be more aware of what could happen if we don’t control my numbers.

One-on-one with Kim Stevens, Kyra’s mom

How proud are you of your daughter?

When Kyra came home and told us about the incident, she played it off as though it was not a big deal. It was only until I heard from Coach Murphy that I completely understood the gravity of what took place. It is a super proud moment, for myself and my husband, to know that Kyra was calm under pressure and she managed to do what she did. I don’t know if I would have been able to do it.

How does it make you feel to see your daughter go through the journey of accepting her diabetes?

I think Kyra going through puberty has a lot to do with being able to accept being diabetic. Plus, she was diagnosed with ADHD in Grade 3. That was hard for us to get through and work through.

Kyra attended Timour Hall Primary School and every single year of primary school was hard for Kyra. Hard to make friends, hard to keep friends, hard to get invited to parties, hard to please teachers. She was always in trouble.

But then she started Grade 7 and she absolutely enjoyed it and there was such a change. Once we got the ADHD under control, she was then diagnosed with diabetes. This news has thrown our whole family into a total spin and it has been hard for her to accept.

But due to the fact that she used her knowledge to save someone’s life is tremendous. This shows us that even though she acts like she’s not interested in the management of her diabetes, she has taken note of what to do. So, it gives us, as parents, a little more confidence to be able to trust her if something should go wrong.

Is Kyra’s medication covered by medical aid or public hospitals?

We started off at The Red Cross War Memorial Children’s Hospital at the Diabetic Clinic there. It is a fantastic hospital, with brilliant doctors. Everyone was super nice and the education we got there was top class.

Since the beginning of this year, we were transferred to the outpatients at the Groote Schuur Hospital as part of the adolescents diabetic clinic. She still gets to see the same doctors because the doctors work at both hospitals. We collect her medication from the public hospital, Groote Schuur Hospital.

What are the financial implications of having a child with diabetes?

I think I speak for everyone when it comes to eating healthy. It is just so expensive. So, we try to encourage Kyra to inject. I made a deal with her that she can eat what she feels like, but she must inject. There was a period, for about six months, where she wasn’t injecting at all. She wasn’t even checking her glucose levels. Because of this, we considered trying a continuous glucose monitor but it was just expensive. We cannot even think about getting her one.

I was thinking of doing fundraisers to raise funds but that money will only last so long. What happens after that? So, the financial implications are quite severe. My husband and I run a small business, and have to pay salaries and adding a diagnosis of diabetes to the mix has just thrown us in the deep end. We still just trying to swim. But, we will do what we have to to ensure Kyra’s health is good.

MEET OUR EDITOR

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

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(Cost) effective blood glucose monitoring

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Kevin Stead explains (cost) effective blood glucose monitoring.

With the rising cost of living in South Africa, it is imperative that we realise value in every rand spent. Especially when it comes to treatment and control of diabetes.

This becomes clear when reviewing the cost of healthy living and medication. It’s therefore important to understand why it is so essential to know and understand blood glucose control and why monitoring is so crucial to reduce cost, as well as prevent complications.

The situation in South Africa

Seven percent of South Africans, between the ages of 21 and 79, have diabetes. This means that 3,85 million South Africans in this age group may have diabetes.

The prevalence of diabetes in South Africa, in 2010, was estimated at 4,5% – a 155% increase in six years. The International Diabetes Federation (IDF) Diabetes Atlas indicates that the uncertainty range is between 3,6 and 14%. Data suggests that 630 000 to 2, 394 million people are undiagnosed in South Africa.

Financial implications

Cost per person per annum was approximately R5 000 in 2010 and R26 743,69 in 2015.

Sixty to 80% of people with diabetes in South Africa die before the age of 60 (loss of manpower).

The World Bank suggests that no more than 5% of a country’s gross domestic profit should be spent on health. In South Africa, 8,9% GDP is spent on health.

What is the solution?

What of glycaemic control? Complications? Education? Dr Shaukat Sadiko, IDF president, said, “Big talk and quoting statistics have little value if we do not do initiatives which improve the lives of all our people with diabetes.”

Testing in pairs

The average cost of a glucose strip is R3,76 (R188 medical aid reimbursement rate). So, testing can be expensive and seemingly worthless, especially in people living with diabetes who don’t understand how to use the information from their meter to control their glucose levels.

For example: A Type 2 diabetes patient will test their glucose level in the mornings only (fasting), only to discover six months later that their HbA1c levels are high (above 6,5%). So, where is the problem?

The blood glucose peaks are not being pinpointed, i.e. the after-meal glucose levels which only peak from 1,5 to 2 hours after meals.

If testing is performed in pairs, before and after meals, an accurate and immediate benefit is that the patient will see the effect that a meal has on their glucose levels. This in turn leads to an action to either reduce food intake, exercise, or increase medication to address the ‘spike’.

By alternating testing times (breakfast, lunch and supper), very soon a clear picture will emerge and a better understanding of the effect that testing with a purpose has on food and medication.

Yes, testing in the morning is important but testing in pairs on alternate days and alternate meals will provide a clear understandable picture of overall control.

A tin of 50 strips will be sufficient in most Type 2 diabetes patients to test 12 times a week. And, if utilised correctly, will result in the healthcare provider to easily access and manage diabetes patients effectively.

Education is the key. Many diabetes patients need to be educated on why monitoring is important as well as an understanding of the effects that food and medication has on blood glucose.

How does this make sense?

It seems nonsensical to cut down cost by testing in pairs. That means more glucose strips are used, right?

Yes, indeed. But, a random test means nothing to you, the patient, as well as your doctor. If random tests are done, they are a complete waste of money and strips.

Once your diabetes is controlled and you are on the correct dosage, etc. then and only then will testing protocol’s as per Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) apply.

However, usually diabetes patients that get one tin of strips per month, on medical aid, never uses them. So, by the year end, they end up with lots of unused, expired strips that are a complete waste of money.

On the other hand, if all 50 strips are used in a month, a comprehensive trend pattern is formed allowing the patient and doctor to intervene much sooner.

In effect, the question really is: Do I only test once a week in the mornings (complete waste of a strip) or do I use what the medical aid is paying for to get as much data per month on my “actual” glucose control?

Regardless, if patients test in pairs, even minimally (three times a week) then at least test with a purpose (before meals and after meals and a fasting).

What is the real issue?

The real issue is: do you, the diabetes patient, know what a Sunday lunch does to your glucose level? Do you know what effect the six beers you drank last night has on your glucose level? Or what the effect of exercising was? What happens to your glucose when you are sick?

Often than not, most don’t know and wonder why their HbA1c levels are so high, or suddenly get an abnormal high and don’t know why?

Another main issue is morbidity and the result of developing the complications. The cost of treatment is exorbitant so as the old adage goes, prevention is better than cure.

So, when we step back and look at the entire picture, isn’t it good sense to monitor effectively and prevent complications, or simply test at random, waste strips, be blissfully ignorant of glucose changes and hope for the best?

What it boils down to

It really boils down to the value you are spending on strips against the value of saving a few strips that would be better utilised. And, at the same time prevent a stroke, heart attack, kidney failure, blindness, amputations, etc.

SEMDSA guidelines

The diagnosis of diabetes is confirmed1

  1. In patients with symptoms of hyperglycaemia (excessive urination, rxcess thirst, blurred vision, weight loss) or metabolic decompensation (diabetic ketoacidosis or hyperosmolar non-ketotic state), when any one single test confirms that the:
  •  Random plasma glucose is ≥ 11,1 mmol/L
  •  Fasting plasma glucose is ≥ 7,0 mmol/L
  •  HbA1c is ≥ 6.5%
  • 2-hour post-load glucose is ≥ 11,1 mmol/L.

However, a glucose tolerance test is rarely needed in this category of patient.

  1. In an asymptomatic individual, when any one of the following tests, repeated on separate days within a two-week period confirms that the:
    •  Fasting plasma glucose is ≥ 7,0 mmol/L
    • 2 hr-post load glucose (OGTT) is ≥ 11, 1 mmol/L
    • HbA1c is ≥ 6,5%

If the diagnosis of diabetes is not confirmed with the repeated test, institute lifestyle modification and retest in three to six months.

References:

  1. SEMDSA guidelines 2018
  2. Centre for Diabetes and Endocrinology clinical guidelines 2018
  3. IDF IDF Diabetes Atlas. Seventh edition Brussels, IDF 2015, IDF Atlas Sixth edition, Brussels IDF. 2013
  4. Statistics South Africa. Midyear population estimates 2015 htpp://www.statssa.gov.za/publications/P0302/P03022015.pdf
  5. World Bank. Health expenditure, total (% GDP) 2016 htpp://data.worldbank.org/indicator/SH.XPD.TOTL.ZS 

MEET OUR EXPERT

Kevin Stead is a professional representative specialising in diabetes and diabetes management.

Header image credit by Freepik 

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Living positively with diabetes

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Hannie Williams, a dynamic diabetic nurse educator, shares tips on how to live positively with diabetes.

How do you do? What a pleasure to have an opportunity to ‘meet’ on the pages of Diabetes Focus.

This article is all about you – the person living with diabetes, or the spouse/significant other of a diabetic person. We, as healthcare professionals, learn so much from you, our patients. So, thank you for sharing your experiences gained from living with diabetes with us.

Let’s look at the individual words used in the topic of this article: living; positively; diabetes. I want to tackle the last word first.

Diabetes

This requires lifelong management, including the use of various medications (tablets, insulin injections, etc.), diet, exercise, testing your blood glucose, annual checks of your eyes and feet. And, the list goes on.

Add some other chronic diseases, such as high blood pressure and raised cholesterol (more tablets!), the fear of complications of diabetes and, of course, the cost of medical treatment. Wow! It is overwhelming! I am exhausted from listing all of this and you must deal with this daily.

I often notice how stressed patients are when attending their visit as they so want to please the doctor with good results and reduction of weight. If they don’t achieve this, they feel guilty for not doing what was expected, for example, more frequent blood glucose testing, adjustment of insulin dosages, etc. When asked how they are, some will respond, “I will be able to answer you once I have seen doctor.”

Stop. Take a deep breath. We must acknowledge that you are dealing with health issues and the treatment thereof, but let’s look at the other words.

Living

This does not mean to just exist. To exist is just doing what one must do while being alive i.e. paying tax, paying more for food, petrol and electricity.

Living is to be alive. It’s an active process asking us to be involved in life around us. You are a unique human being, with your own special talents. Acknowledge this and use it to make your world a better place.

Get involved – visit a care centre in your town and volunteer your help. You may be an excellent gardener and can help them creating their garden. You may like to read to those with bad eyesight, or just visiting the people in the centre.

Make sure to pass your life experiences, lessons learned and family traditions to the next generation. Write a letter(s) to your children and grandchildren and share your valuable unique life experiences. One of my most treasured items is a handwritten letter from my mother to me.

Sing Happy Birthday to family and friends. I can promise you that this will be a gift more special than anything you can buy. I always do this (to the annoyance of my husband and sons). But last year I was surprised when I was away from home on my birthday and I got a phone call from my oldest son, and guess what, he sang Happy Birthday to me. I felt such an accomplishment that my tradition is rubbing off on the next generation.

Do not let a day pass without doing or noticing something special in your surroundings.

Positively

“I can BE optimistic by showing a positive attitude.”

Abraham Lincoln said, “Most people are as happy as they decide to be.” How true this is?

Is the glass half full or half empty to you? The choice is yours.

Nobody wants to be around someone who is constantly criticising everything and moaning about what is wrong. We avoid people like this. Let us not be the person that others want to avoid.

Changing is difficult. But just start by being the person that will try to make an effort to change a negative conversation to something positive. It’s not that we do not acknowledge that things do go terrible wrong; that bad things happen to good people and that times are tough. Rather try to make everyone in the conversation realise what a privilege it is to be together as family or as friends, sharing a cup of coffee or glass of wine.

Take time to notice the everyday miracles happening around us. How day becomes night. Change of seasons – green leaves quietly changing to beautiful autumn colours. The same tree that provides us with shade against summer heat, shed its leaves in autumn to let warm sunshine through in the cold of winter.

So, if life handed you a lemon tree, what will you do with it? How about making the most wonderful lemonade or pickles from the fruit of the lemon tree? Forget the thorns and smell the heavenly scent of the lemon blossoms.

Do what you can with what life hands you. You will be amazed how much this is once you start embracing your own unique self.

Your legacy in life should not be the ‘Oompie or Auntie’ who had diabetes. You have much more to offer this world.

Active in decision making

I want to encourage you to be actively involved in the decision making about your treatment. Ask as many questions as needed for you to understand why you should take that medication.Don’t just exist. Live your life to fullest with your available resources.Attitude is everything!

MEET OUR EXPERT

Hannie Williams (B Nursing (Stell) 1987) has been working as diabetic nurse educator since 2004, alongside the specialist physician, Dr G Podgorski and his wife, Alice, in Port Elizabeth. She is married to Kobus.

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The 5 healthiest cooking oils

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Fats are an essential part of the human diet, helping synthesise hormones, promoting overall brain- and mental health, and keeps us full. But what are the healthiest cooking oils to cook with?

In addition to thinking about the overall nutrient profile of cooking oils and how they are processed, you must consider another factor: the smoke point (which is the temperature at which an oil begins to smoke).

Every type of cooking oil has a different smoke point, and heating an oil beyond its smoke point causes it to oxidise, resulting in the release of harmful free radicals and other compounds.

  1. Avocado oil

Surprisingly, avocado oil has a high smoke point, making it a smart cooking choice if you’re scaling back on saturated fats. Avocado is comprised mostly of the monounsaturated fatty acid, called oleic acid, which has potent anti-inflammatory properties and promotes heart health. It also contains lutein, a carotenoid, that can improve eye health. By virtue of it’s high smoking point, it’s suitable for all cooking. But because it’s pricey, it would not be wise to use it for deep- frying and may lose flavour due to prolonged exposure to heat.

  1. Ghee (clarified butter)

Many people love cooking with butter for obvious reasons: flavour! But it has a relatively low smoke point at 300°F. When you remove its milk solids to create ghee, however, that smoke point jumps to a safe level for most cooking applications while retaining its amazing flavour. Bonus: It’s lactose-free; contains vitamins A, E, and K2; and is rich in conjugated linoleic acid (CLA) and butyrate, which may help lower body fat and decrease inflammation.

  1. Algae oil

Algae oil is high in monounsaturated fats and low in saturated fats. It’s a great option to add to the rotation if you’re looking for a neutral-tasting high-heat oil, as it’s incredibly versatile and a great option for cooking, baking, and salad dressings. The one downside; it tends to be a bit expensive.

  1. Olive oil

Olive oil is high in the monounsaturated fat oleic acid, which is anti-inflammatory and promotes heart health. Extra virgin olive oil (EVOO), specifically, is packed with polyphenol antioxidants as well, which are thought to contribute a range of benefits.

However, EVOO is only suitable as a finishing oil and for low- to medium-heat cooking (sautéing vegetables), as it has a smoke point of 325 to 375°F.

Refined olive oil, on the other hand, has a smoke point of 425°F but does not contain nearly as many beneficial polyphenol compounds.

  1. Unrefined coconut oil

Coconut oil is mostly saturated fat, which makes it more stable, and it also contains medium-chain triglycerides, a fat source that converts to energy more quickly.

As an added benefit, coconut oil contains an antimicrobial compound, called lauric acid, which has also been shown to have beneficial effects on cholesterol. Refined coconut oil has an even higher smoke point, but it’s thought to lose many of its beneficial health effects.

Oils are a vital component of every meal, more so people with chronic disease, such as diabetes and heart disease.

Matsepo Manyokole

MEET OUR EXPERT

Matsepo Manyokole is a registered nurse with more than 20 years of international nursing experience. She has worked in a variety of settings, including maternity, infectious diseases, public health and medical units with special emphasis on chronic diseases, such as diabetes and heart disease.

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Diabetes and financial stress

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Daniel Sher educates us on how to deal with the psychological burden of financial stress when living with diabetes.

Case study of patient with financial stress

Doug (not his real name) is a 33-year-old Capetonian who visited me looking for a bit of extra support in meeting his diabetes-related goals.

What was Doug struggling with exactly? Well, it wasn’t entirely clear. It never is. When it comes to thriving with diabetes, there are always complex interacting factors that need to be considered. In Doug’s case, however, financial stress was one of the biggest factors leading him to neglect his health.

Doug most certainly isn’t alone in this regard. As a person living with diabetes, how frequently have financial concerns negatively affected your ability to cope? Research has backed up what so many of us know all too well: diabetes is expensive! This, in turn, can create a whole lot of stress and anxiety that makes it even harder for us to thrive.

A tale of two cities

In South Africa, historically-based economic inequality means that a large proportion of people rely on public health to manage their diabetes. Research has consistently shown that public clinics and hospitals are overburdened – and people with diabetes struggle as a result.

However, even for those who are lucky enough to have access to private medical aid, there are hidden costs that hold many back.

The hidden costs of diabetes

  1. Your endocrinologist is really good at what she/he does. She/he is now charging above medical aid rates, meaning that you must front a co-payment.
  2. Lantus insulin isn’t covered by medical aid, even though your doctor has motivated for it.
  3. Having diabetes means that you’re more susceptible to colds and bugs. You find that you’re spending a fortune on vitamins, cold remedies and doctor visits.
  4. You have maxed-out your sick leave at work and need to take unpaid leave.
  5. When your blood glucose levels are out, you struggle with fatigue and low motivation. This means that at work, you’re not meeting your targets.
  6. It’s not cheap to eat healthily.
  7. You would love to be able to test more frequently, but extra strips are very pricey. What about that shiny new Dexcom? That would cost the equivalent of three months of rent.
  8. You have developed an additional chronic condition, such as hypertension, kidney disease, psoriasis or coeliac disease. People with diabetes are at a higher risk of developing these sorts of conditions. This means more specialist visits and expensive medications.
  9. You’re depressed or anxious. As people with diabetes, you’re two to three times more likely to have a psychological disorder. This means extra fees for therapy or psychiatry visits, as well as reduced productivity at work.

What can you do about financial stress?

So, what can you do to cope with these sorts of feelings and barriers to healthcare?

  • Get healthy

If you want to manage the costs and financial stress of diabetes, your best bet is to become as healthy as possible.

You’ve heard all of this before. It’s important to think about diet, exercise, testing, medication adherence, mental health, self-care and so on. This is more than just behavioural change. This is a shift in mindset that is going to save you money and allow you to be the happiest and healthiest version of yourself.

Let’s address the elephant in the room: it’s not easy to simply ‘get healthy’. This is a process; and a challenging one at that. It can also be expensive to maintain healthy habits.

But it’s important to see this as investing in yourself. By adopting a healthy lifestyle now, you’re going to avoid developing complications that could cost you more in the future. You’re also going to increase your emotional and financial well-being in the present moment.

  • Shift your mindset

When Doug came to see me, he benefited from analysing and altering some of his thinking patterns. As mentioned, one of Doug’s biggest challenges was that he was not all that well-off, financially speaking. Of course, compared to many in our country, Doug was in a very privileged position. Nonetheless, he often made unhealthy choices based on his financial worries. These included:

  • Buying cheaper meals rather than opting for low-carb options.
  • Seeing his doctor once per year, rather than every six months.
  • Choosing not to test in the morning because he wanted to deny the fact that his glucose level was high, so that he could avoid having to up his Lantus dose.

In therapy, we worked on a skill, called cognitive restructuring. This forms a part of cognitive behavioural therapy (CBT), which is a powerful psychological approach that has been shown to help people with diabetes cope better.

In Doug’s case, cognitive restructuring helped him to catch subtle thoughts that lurked just below the level of conscious awareness. These thoughts reminded him of his financial stressors, triggering anxiety and leading him to make unhealthy choices.

Once Doug could identify these problematic thoughts, he was able to replace them with healthier thinking patterns. Often, this involved him reminding himself that it was worth spending that extra bit on his diabetes care so that he could reduce costs in the long run.

If you want to learn more about the basics of CBT and changing unhelpful thinking patterns, you can visit this page.

  • Talk to your doctor or therapist

If you’re struggling financially, this is nothing to be ashamed of. It is vital to speak to your treating team so that they can help you find creative solutions. At times, doctors and therapists may be willing to negotiate a reduced rate. Alternatively, they may be able to provide pointers for reducing expenses by, for example, taking full advantage of chronic cover possibilities.

What about counselling and psychotherapy?

Once I had met with Doug, it became clear that he was suffering from clinical depression. Just like many other people with diabetes. Together, we filled out an application form and his medical aid agreed to help cover treatment of depression as a chronic (Prescribed Minimum Benefit) condition.

If you know that you can improve your diabetes control by seeing a therapist, don’t let the costs involved hold you back. Chat to a therapist about applying for chronic cover. This applies to anyone who is on a medical aid, including hospital plans.

Invest in yourself

Diabetes is a complicated and challenging condition to manage. A big part of this challenge involves the hidden costs that we have discussed. Just another one of the many factors that we need to consider and address as a part of our everyday management plans.

Remember, though, that by addressing these concerns, we can learn to take our coping skills to the next level. At times, this may simply be a matter of shifting your mindset, adopting healthier lifestyle habits, or speaking to your treating professional to find creative solutions.

Reference:

  • Endocrine Society. (2014, June 23). High blood sugar causes brain changes that raise depression risk. ScienceDaily. Retrieved June 19, 2019 from sciencedaily.com/releases/2014/06/140623092011.htm
  • Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.
  • Pinchevsky, Y., Raal, F., Butkow, N., Chirwa, T., Distiller, L., & Rothberg, A. (2018). Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa. International journal of general medicine, 11, 383.

Additional Reading:

* Not his real name

MEET OUR EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital, in Cape Town, where he works with Type 1 and Type 2 diabetes patients to help them thrive. Visit danielshertherapy.com

Header image credit by Freepik 

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Justin Groenewald

Justin Groenewald – doing the unthinkable

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Type 1 diabetes patient, Justin Groenewald, tells us about his dream of doing the unthinkable – to be the first person with diabetes to complete Roof of Africa Enduro 2020.

Justin Groenewald (38) lives in Bellville, Cape Town. He is divorced and has a daughter.

Ever since Justin was young, he refused to sit on the sidelines. He is a go-getter that will do anything to achieve what he wants. Even when he was diagnosed with Type 1 diabetes at the age of 10, his attitude stayed the same. He continued competing in school sports and doing everything he wanted to do.

Though, he admits that he has not always been the best example when managing his blood glucose. “I didn’t follow diets ever. I smoked and managed my glucose via symptoms, not testing. If I felt terrible, only then would I test, inject or eat,” he explains.

This changed when he needed to get a motorsport license. “I needed a specialist to sign off a medical letter and that would only happen when my diabetes was under control,” he says. “Managing my diabetes well includes three steps: First – exercise is core, secondly – avoiding unnecessary food and snacks, and thirdly – laughing. There is no perfect diabetes patient, when things go wrong, just smile and fix it.

Six years ago a specialist signed off that Justin was medically fit to compete in endurance motorcycle racing. With that Justin has competed in many races, Roof of Africa bronze qualifier and Motorsport Cross Country events, to name a few. Though, further goals lie ahead.

He has had an on and off battle with smoking but is proud to say he has stopped smoking again this year. He adds, “It limits my performance. It stinks and I cannot live my dream whilst smoking. It had to go.”

So, what is his dream?

Justin tells us in his own words:

For 28 years, I have been a Type 1 diabetes patient. I have injected more than 31 000 times (now Apidra and Basaglar), tested my glucose level about 25 000 times (now Accu-Check instant), had approximately 3 400 hypoglycaemia events and 4 300 hyperglycaemia events.

Yet, my life has been filled to the brim with adventure and doing things that people said I could or should not do. There should be no reason for our condition to stop us from doing the unthinkable.

We, people living with diabetes, have lives filled with routine: testing glucose and injecting, limited diets and even getting into a habit of counting calories. Our bags are filled with glucometers, injections and low sugar meds. We freak out when we realise that we have lost or forgotten our diabetic paraphernalia on a trip to the shop, never mind a weekend away.

High expenses

We often incur unnecessary costs by purchasing emergency items and our daily expenses are slightly higher (additional vitamins), and due to higher likelihood of getting sick, we have additional medical costs. Medical aid (Discovery Coastal Saver) is essential for me but life insurance is just too expensive.

My medical aid covers most of the costs. The only issues I have encountered has been towards the end of the year when I need to pay for my glucometer strips. I test at least three times daily and this runs over their minimum prescribed benefit.

The other issue is that I used to receive disposable pens. However, the medical aid now only covers the cartridges and I have already broken two of the permanent pens. Luckily, a pharmacy replaced them without charge.

Constant worry

As people living with diabetes, we are uncertain how far or how long we can run, cycle, play hockey, rugby and surf before our glucose level drops.

We constantly live off the feedback from our lifestyles. We feel weak, angry, irritated, get the dreaded cold sweats, or pins and needles from hypos and hypers. Sometimes just getting up takes all our effort and sometimes we just don’t want to care anymore. We get tired of the constant worry of our diabetes being under control.

Stop and take a deep breath

It is at exactly this point that I say stop. Take a deep breath and understand that you are able. Understanding your body, looking after your glucose levels to the best of your ability means that you have very few limitations.

I have done many crazy things and didn’t manage my diabetes as best as I could. I have over a hundred scars on my body; broken both my wrists, one twice; broken my arm twice; ribs several times, at least three toes, fractured a vertebra and chopped part of my finger off.

I have spear dived and been with sharks, with blood in the water. At provincial hockey trials, I kept vomiting next to the field  after waking up in an ambulance from a hypo. I have taken on every challenge and I am still here in one piece. I admit this is not the wisest and safest way of doing the unthinkable.

Manage your diabetes properly

So, I realised that if I want to achieve all my dreams, I had to start with managing my glucose levels properly. I have changed my lifestyle as mentioned above. The next step in my journey cannot be taken lightly. I am about to do the unthinkable.

All the silly and crazy things I have done in the past was just me fighting against people saying I can’t. The next step will be done to prove to all my fellow people living with diabetes that I can and so can they.

What is doing the unthinkable?

A journey that will start with Roof of Africa Enduro 2020 (Silver Category). I will be the first person with diabetes to complete this race – a race considered one of the world’s hardest extreme motorcycle enduros.

The next steps will take place in 2021 and 2022. I aim to complete Red Bull Romaniacs and then the big one, The Dakar Rally. Each event will be used as an opportunity to drive diabetes awareness.

The question is why?

The answer is simple…It is for each parent of a child living with diabetes to realise that their children can. Their children can play rugby, hockey, run long distance, play chess, race mountain bikes and surf. Their children can compete in any event with their parents’ support.

It is for every diabetic child to realise that they can do the unthinkable. The only person to stop them or slow them down is themselves. Their future is not limited by their condition.

The future might require a bag with medicine. It might require them to pay attention to what they eat and managing their glucose levels. But there are diabetic athletes in SA that have ridden some of the hardest mountain bike races. There are diabetic runners, swimmers and none of them allowed their condition to slow them down.

Preparation

Competing in any endurance event takes months of training. I keep fit by doing Muay Thai three times a week and then at least one day, increasing up to three days’, seat time (on bike). Anything from three hours to nine hours on the seat per session.

The Roof of Africa consist of three days riding. So, your body needs to be used to the pain and going past its limits. I travel with a bag on my back; it contains three litres of water, two litres of Powerade/Energade, two sandwiches, hardboiled sweets and three to five protein bars, my glucometer and my insulin pen. My bag easily weighs an additional 3 kg’s more than the average riders.

Justin already has a sponsor: WaldCon. His agent will enter him into the race once entries open early next year. We wish Justin all the best and hope he achieves the unthinkable. Follow his journey on www.diabetics-do-it.com

MEET OUR EDITOR

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

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Retire

Retirement planning: why and how

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Did you know only 3% of South Africans will be able to retire comfortably? Ronel Jooste advocates why it is important to start saving from as early as possible.

Only 3% of South Africans retire comfortably

According to the National Treasury, less than 3% of South Africans can retire comfortably, without having to make drastic changes to their lifestyles.

These statistics are worrying. Do you want to work hard all your life, only to struggle financially when you are retired? Or rather work hard and putt away sufficient funds towards your retirement to ensure you can reap the full benefit of your rest period in future.

High cost of living in SA

Living costs in South Africa are high and constantly on the rise. A struggling economy results in several employers no longer being able to reward employees with decent salary increases.

Consequently, many households experience financial strain as their income can no longer keep up with the increase in living costs. If you add to an already trembling budget, a medical condition that requires constant healthcare and medical expenses, budgets are put under further strain.

When expecting this strained budget to also make provision for retirement planning, it becomes crystal clear why retirement planning quite often ends up last on the priority list.

Types of retirement products

Retirement products are designed to help individuals save money towards retirement, usually with tax benefits. The purpose is to provide individuals or their dependents, with an income upon retirement. This income can be paid out in the form of a lump sum and/or a monthly pension until death.

Most employers structure retirement benefits as part of their employees’ remuneration packages. Examples of retirement benefits offered by employers are as follows:

  • Pension fund – on retirement, a lump sum, in cash, equal to one third of the total retirement value, plus an annuity/monthly pension over the rest of the lifetime of the employee are paid out.
  • Provident fund – the full benefit is paid out as a lump sum upon retirement.
  • Preservation fund – when you change jobs, or become self-employed, and don’t cash in your pension, a preservation fund enables you to preserve your pension or provident fund savings in this fund until you retire. A once-off contribution is thus made into a preservation fund once you resign or are retrenched.

Retirement annuities are available for individuals who are self-employed, or who work for a company that doesn’t offer pension benefits, or for employees who want to save for their retirement in addition to their existing pension or provident fund contributions through their employer.

Making your budget work for you

Living with diabetes does have a serious impact on any budget due to expensive medical costs. Therefore, it is important to have a good medical aid or health insurance plan in place to cover most the costs.

Also look out for potential savings:

  • Live a healthy and active lifestyle.
  • Discuss options for generic medication or alternative healthcare options with your medical practitioner.
  • Consider buying medicine online which is often cheaper, and buy medicine from pharmacies who offer discounts and loyalty reward programmes.

Potential cost savings can be allocated to a retirement savings plan. Although diabetes is a serious illness that can have a negative impact on a person’s life expectancy, more and more studies are proving that when diabetes is properly managed through healthy lifestyle programmes there is a minimal impact on the life expectancy of a person living with diabetes compared to a person living without diabetes. This re-emphasises why retirement planning should not be neglected.

Why start saving as early as possible?

Consider a simple example to bring this into perspective. Previous generations generally started working after school at the age of 18. If they had to retire at age 65, they would have had 47 years to save for retirement.

In those days people died on average at a much younger age. If they lived on average to age 75, they had 10 years to live off their retirement savings. Thus, they had 47 years to save and their savings had to last 10 years.

These days many people go to university or college and only start working on average at age 23, which means they have already lost five years of their potential retirement savings period. Current generations tend to live much longer, and it is not uncommon for people to reach 95 years of age. The result is that we have about 42 years to save for retirement, and our retirement savings must last for 30 years should we reach age 95.

This simple example illustrates why it’s important to start saving as early as possible for retirement. If you haven’t started yet or you are not saving enough, don’t wait any longer. Start working towards creating a solid retirement plan today.

Tips to consider for your retirement planning:

  • Calculate how much you will need for retirement and review it annually. As your salary package grows and your standard of living improves, your expectation regarding retirement savings will increase as well.
  • Be realistic and make sure you save enough. If your monthly living costs are R40 000, for example, and you consider your second property providing you with R10 000 rental income monthly as your retirement plan. You must realise that R10 000 will not be enough to cover your living costs. Additional retirement savings will have to be added to your retirement plan.
  • Don’t be tempted to use your retirement savings to start a business or buy a bigger home. Once you have used your savings, it will be extremely difficult to catch up or recover.
  • You can get tax deductions for your monthly contributions towards your retirement savings. Make use of these tax savings to build a tax effective asset portfolio.
  • Younger people can be much more aggressive with the underlying asset allocation of retirement funds. As you get older, it is advisable to be more conservative. You don’t want to invest in high-risk assets a few years before retirement with a risk of losing the money that you worked hard for over many years.
  • Don’t be tempted to buy expensive cars or a holiday home on receiving a lump sum retirement pay-out. Invest your lump sum wisely as you need the money to maintain your required living standard throughout retirement.

This article includes extracts from Financially Fit and Wealthy. The book (hard copy or e-book) can be ordered on roneljooste.com

MEET OUR EXPERT

Ronel Jooste is a director at FinanciallyFiT Group (Pty) Ltd, a company specialising in financial consulting and training for businesses and individuals. She develops online financial courses and employee financial wellness programmes. Ronel is a chartered accountant, speaker and the author of the award-wining book Financially Fit and Wealthy, a guide to achieve financial success.

Header image credit by Freepik 

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Florence

Fabulous Flori – Florence Schrikker

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Florence Schrikker, aka Flori, tells us how living with Type 2 diabetes and an amputation never stopped her living her life to the fullest. She has since co-written two cookbooks, Kook sam Kaaps and Soettand, and co-hosted a cooking show, Flori en Koelsoem se Kosse.

Florence Schrikker (66), better known as Flori, lives in Bonteheuwel, Cape Town with her husband. They have four adult children and 10 grandchildren.

Diagnosed 36 years ago

Florence was diagnosed with Type 2 diabetes over 36 years ago. Though she learnt to live with her condition by keeping her faith and remaining positive no matter what, even when she was faced with the decision to amputate her left leg. She explains, “I try to stay positive with the help of God. His grace is sufficient for me; if it wasn’t for God, I don’t know where I would have been.”

She explains her symptoms, before she was diagnosed, included an uncomfortable dryness of the mouth as well as frequent visits to the restroom, and dry itchy eyes. “I was diagnosed by my family doctor, who put me on NovoMix (insulin) and Metformin tablets.”

Complications

On 2 February 2011, the grandmother had to have her leg amputated above the knee due to a diabetic ulcer not healing and gangrene setting in. Diabetic ulcers are caused from uncontrolled blood glucose levels.

“My doctor tried his best to avoid the amputation. He battled for two years to get the ulcer to heal. I wore various shoes and many gadgets in attempts to save my foot but eventually we had no other option but to amputate. But, thankfully, the ulcer on the right foot healed,” the 66-year-old explains.

As can be expected, the idea of losing half a leg was not only hard for her to handle psychologically, but it took a strain on her financially. “I needed to get around and somehow regain my independence. So, I eventually invested in getting myself a battery-operated bike. Although, I was on a medical aid, it didn’t cover all the costs. But, fortunately for me, I had received a pay-out due to being medically boarded from work (a bank) and I used that money to purchase my bike.”

“I chose the battery-operated bike because it was by far the most convenient option. It gave me a sense of being independent as it allowed me to move around by myself.”

It took Florence six months, after her amputation, to learn how to walk again. On the long and bumpy road to her new normal, she never gave up.

She regards her life as an exciting journey with many adventures, which includes her famous cookbooks, Kook sam Kaaps and Soettand, and the television programme, Flori en Koelsoem se Kosse.

Talking money and medical costs

Being financially prepared by such an event can prove to be so hard for many people, especially the elderly like Florence. She urges those who are still considered healthy to begin saving for rainy days. “Having savings for rainy days is vital because like myself I am living off the government pension. Luckily, my medical aid is covered by previous employer. At times, I have to ask for financial help from my family.”

Flori goes on to say, “Having medical aid has assisted me a lot, and although I have to contribute to some of my medical costs, it’s not the same as having to pay for everything. Being a pensioner, it’s not easy covering all the costs that come with being diabetic as well as an amputee, and having extra financial help is always something positive.”

For those who aren’t fortunate enough to afford medical aid, she gives the advice that prevention is better than cure. “I encourage everyone, whether you have diabetes or not, to equip yourselves with knowledge of the basics of healthy living, by watching your diet and eating as healthy as possible from the get go. If I had known what I know now, I would have been more careful.”

Try to live a healthy lifestyle

Although the self-proclaimed sweet lover admits that there is nothing wrong with  spoiling yourself with sweet treats every now and then, she encourage to balance everything out.

She also adds that due to healthy organic foods are not always cheap and affordable, making it nearly impossible to maintain a healthy diet, she advocates people to cultivate their own vegetable farms, and most of all, exercise every day.

She concludes, “I know some people don’t know how to go on after something like an amputation but I want them to see people like me living, to show them that they shouldn’t give up on life. Never let your condition determine your position.”

MEET OUR JOURNALIST

Londiwe Nkonyane is a second-year journalism student at Rosebank College. Her hobbies include reading and writing short stories and she wishes to own her own publication company in the near future.

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